Tales of the Terai, Day Two in Bhairawa Nepal


So they tell me it was 39 degrees here yesterday. Thank God the classroom was air conditioned, although it was being stressed by the work it was doing. I had to Google a temp converter. Yes folks, 102 and it could have been a lot hotter.

So close to the Indian border, there is an awful lot of Hindi being thrown around, I don’t feel so bad about my weak Nepali. The whole town has a deeply Indian feel to it. Very few of the oriental-looking Nepalis or Brahmins or Chhetris.
Lots of people who looked like Tharu; although I was told I’d need to go to Chitwan to be in the heartland of Tharu.

I took a rickshaw from the guest house to the hospital in the morning. 30 nrs.

My bedroom has A/C and I am sleeping under a blanket. To admit any thing less would be a lie. Go ahead, call me a wimp. From what I can tell I am the only Westerner in this town. Yesterday was market day, sort of an all purposes open-air event with a throng of people, as the sun went down. If there was one other Westerner I should have seen them there.

Despite water breaks all day I needed to drink about a gallon of fluid after the class was over. Teaching megacode involves a lot of agile movement for me.

There was a torrential rain storm for about two hours today as well. The dirt plaza outside the main gate became a sea of mud.

Twentysix in the group here. Class yesterday went well, I won’t bore you with too many of the details, the morning was a bit of a slog because the group was working through ECG. Totally new to them.
Some bright folks feeling their way in the dark.

The afternoon, though, when we do mega-code, took on a theatrical component that created a really good vibe. Simulation is very very new here.

There were a couple of really funny things in a workshoppy kind of way: we were joined by two interns (MBBS docs) and they became the “victims” for the bradycardia scenario. This was where the whole group learned that one nurse who works in ER customarily delivers a light face-slap as part of her assessment of consciousness. (Like, two or three at times and the third is always a bit harder). I admonished her after the first time, then she did two more scenarios, doing it again, and each time the grouped roared. (She did too).

People were having trouble remembering the xiphoid landmark, so naturally I asked the guys’ permission for all the ladies to palpate their xiphoid (shirt on of course). Twitters of laughter. For all the physical proximity that people have in South Asia, it’s not a “high touch” culture. But they did it….

There were four of my former students in the group, as well as a former Mission Hospital employee; so we took a photo (see FB). Monica and Aruna were two I met my first day of TNS teaching in 2007, now working in Operating Theatre and ICU. Sarita that same batch; Mina was a firstyear in 2008. And of course Manju BK, older than the others, was a staff nurse on Medical during the snakebite incident. As I have said before, when you are a teacher it’s great to meet your former students in this way.

At the end of the class, Karass my contact person, came to escort me to the office of the hospital CEO, and a couple of docs joined us there. We got a round of mango juice delivered on a tray. Then a meeting began. They had heard reports about Day One, and the CEO wanted to book me for a return visit in which they would pay the flight this time, in July. The CEO also asked me for a frank assessment of what they needed.

So that was an ego boost. I had to tell them that July is getting full for me. Maybe some future trip. I took the opportunity to talk about strengthening the role of nursing in patient advocacy, so that was good.

Dinner with friends in the town. It was still hot, water was everywhere, it’s essentially built on a former swamp. As we walked by the drug rehab place, new residents there squatted on the grassy sideyard, getting their heads shaved.

Today: more ECG; quick 12-lead lecture; lots more megacode; more cowbell.

About Joe Niemczura, RN, MS

Experienced nursing educator and problem-solver. I have fifteen years of USA nursing faculty background. Add it with fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. I travel outside of Kathmandu Valley as well. When the recent violence happened, I knew the cities - I had trained people in those locations. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011. Global Health Nursing is not all sweetness and light; not solely milk & honey and happy moms and babies.
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2 Responses to Tales of the Terai, Day Two in Bhairawa Nepal

  1. gaynor says:

    Interesting to read about the problems finding the xiphoid. The problem locating the xiphoid is a pretty universal one. It was found that one of the delays in commencing cardiac compressions was due to time wasted trying to find the xiphoid, using methods such as the caliper one, and an associated general lack of confidence about the right spot. The latest ACLS protocol here has ditched it in favour of “visualizing” the lower half of the sternum, so that compressions can start quickly, highlighting the increased focus on beginning compressions earlier in the process.
    Hope the weather is a little less humid for you today although I doubt it! Great to hear of the positive response from the hospital already

  2. here is a link to my YouTube channel that shows one o fmy rickshaw rides

    http://www.youtube.com/user/Joeniemczura?feature=mhee#p/u/8/1tDTlOEtDFU

    enjoy

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