Male Nurses in Nepal – The Topic of Which We Dare Not Speak.


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Caveat:

In this blog I am about to divulge something I generally refuse to discuss. Nowadays the youth of today have a term they call a “rant” – meaning, a diatribe against some thing that drives the speaker crazy. I like to think I am too old to unleash a diatribe. There is more than one side to any given issue. Let’s just blithely move along… But I am at last propelled to use my role as Oracle of Nursing, to address the qustion laid before me by the hardy pilgrims to the cave where I meditate. They are asking that I make yet another cryptic pronouncement of great virtue….

Gender Issues in Nursing

In other words, male nurses.

When some person tries to survey me as to Men In Nursing, I always throw the questionnaire away.

“But we’re doing a completely anonymous survey of male faculty attitudes toward their colleagues as part of a University-approved research project”

“Right. There are three of us male faculty members here, and you are saying nobody will guess what my opinion may be?”   That will be the day.  I‘ll get back to you on this.

 And Now for Something Completely Different:

There is a convoluted friend-of-a-friend-of-a-friend nature to the way I have been going about constructing my schedule this summer. At some level of the business world, there is a free enterprise what-can-you-do-for-me model that drives the world economy.  My project is somewhat amorphous inasmuch as I announce that “I am here, let’s do some training…..” and I am privileged to have some flexibility as to how to go about it. So bear with me for the following.

In Nepal in 2008, I visited a friend in Kathmandu who was taking IELTS English class, and got invited to speak to her class – for many of them I was the first bonafide native English Speaker they had ever had a personal conversation with, you would have thought I was the Panda from the National Zoo. One guy in the class later became a student in Boise Idaho, and I saw him again this May when I was there to speak with the BSU Nepal Students Association. At that time  he told me about a buddy of his that was an MBBS doc in Myagdi/Beni Nepal. ( look it up on a map, you will remember it longer…) At the same time, a nurse  from Myagdi found the FaceBook  through which I advertised my plans to the universe ( well, to the “Universe” of Nepali nurses on FaceBook anyway). So the idea at one point was to go to Myagdi and do a version of my course there. It’s a small fifteen-bed government hospital in the foothills, along the western leg of the Annapurna trekking route, just below timberline. They only have three docs, three staff nurses and five ANMs ( like an LPN).  Not very productive from the numbers viewpoint, but hey – when do you ever get the chance to go on this particular type of Busman’s Holiday? If somebody said, “come to _____ and you will get the completely inside view of how we do _____________,” wouldn’t you go?

Ultimately it didn’t work out, for various reasons. I would love to visit that part of Nepal though. Just to say I had been there. Any body can go to Everest Base Camp – I want to go to Myagdi.

“On the Internet Nobody Knows you’re a dog”

With email correspondence they seemed, well, so darned enthusiastic!  The chief nurse offered to take me on hikes  in the area if I would go there…. Not usually part of the package for me…..

It happens that the doc was coming to Kathmandu for a qualifying exam, and so we met for lunch, which was fun because he told me about the services of the hospital, and the challenges. They too have dealt with the issue of violence directed at health care workers, and he shared a hair-raising story which will make it into book number two if I ever write another. It is not easy to run a hospital anywhere, but in rural Nepal running this kind of outpost is daunting.  At that lunch I gave him a copy of my book. Why not? He’d heard about it from his friends in Boise, but of course, it’s not possible to obtain a copy here in Nepal. And I have suspended plans to get it published locally. He was grateful and he took it back to Beni to read. I brought a dozen copies with me and he got one…. I have three left……

So today I get a delightful email from the Chief Nurse ( the one who invited me hiking) :

+++++++++++++++++++++++++++++++++++++++==

first I want to tell u that I ve thought u must be a girl with light golden hair, when I got ur book through dr. k______ {the hospital at the end of the world} and saw ur pic, I laughed a lot at myself…….

I got the chance to read ur book , and I really loved that book, your presentation and explanation about each patient, incident, issue and ur feelings was heart touching……u must b a kind and energetic nurse,,, u ve done a brilliant job while working in tansen with the little resources,.  but  still there so rural places in nepal, from where people have to work 2, 3 days to reach the district hospital,,,,

++++++++++++++++++++++++++

She has a great sense of humor. We all need to laugh at ourselves every day. When I get there I suppose the hiking side-trip is off. Don’t make fun of her spelling. If you think it’s cute, you should see me trying to spell something in Devanagari…. Now that is comedy….

Naturally I replied:

“If I had to guess, I would definitely say you were a female;  most likely with long black hair and dark eyes.”

Back to the Men In Nursing topic.

Men are not allowed to be nurses in Nepal, which was most likely the source of her confusion as to gender.  There was a period of time when men were allowed to go to nursing school, but this is now officially illegal here. There are a few guys working here and there, grandfathered in, but you don’t see them in Kathmandu. When I heard of this I asked “ how did they decide this?” and the answer was, “the doctors of Nepal were not used to having nurses that spoke out and challenged them on things” – which was an acknowledgement that those men were not afraid of advocacy. Hmmm… this same argument is being presently made as to why docs and hospitals in Nepal are reluctant to hire the nurses with B Sc degrees as opposed to PCL or BN nurses…..  Here is a loaded question: are we expecting nurses to be passive or submissive? to what degree?

As part of my project in Nepal, I meet with anybody who wishes to meet with me, and we discuss wide-ranging perspectives – I enjoy a good old-fashioned bull session and I have had a few here. So – I suppose you want my opinion.  Do I think men should be nurses, here?

No, they should not. I actually think the present policy is the most appropriate policy at this time.  Oh, in an ideal world, sure.. but not here. What I have seen in Nepali culture is a nearly complete divide between the parallel universes of men and women. People here travel in packs. It’s rare to see a social group that is mixed, unless children or family are involved. The extended family is very tightly knit, but outside of that  you see women in groups, and men in  small packs.  In group work situations, women always defer to the males in the group, at least publicly.  Small inroads are being made, but….

Going through an Open Door

Here is something to chew on:  At TNS in 2008 for a two-week period I shared the supervision of a clinical group of nursing students with a female faculty member. Our little band of students were split, some in one area, some in an adjacent building thirty yards away. To check on both groups meant that she and I had to go in and out of two sets of doors, about a dozen times a day. This was awkward. Why? Because in Nepal, the man goes through the door first, and the woman follows. In USA, of course, the man always politely allows the woman through first. It became a running joke, Ranjita and I did a little stuttery dance every time, but it was still awkward every single day. Going through the door is emblematic of the way that things get deeply ingrained in a culture. It is like one of those sociology experiments where you decide to break an unwritten norm ( such as where you stand in an elevator or how to veer off and avoid an oncoming pedestrian, or which side of the road to drive on).  Surely you must be able to think of others. In Nepal another obvious one is not to use your left hand while handling food. Just the fact that I am here, breaks a barrier.

The original basis of nursing and medicine was a surrogate family role: the doctor is the “daddy” and the nurse is the “mommy”. Thre was a famous article in JAMA titled “The Doctor-Nurse Game” forty yeard ago in which this was put into print. Has the situation changed? Not hardly.

I do believe the daddy-and-mommy thing, and it’s a fall back whenever you are thinking of the next logical move during an interdisciplinary meeting. The role socialization of the two are still built on this idea. In a post-feminist society, we dare not speak it aloud. Somewhere out there is a large feline waiting to pounce……

Can Caring be Learned?

I met a nursing faculty member who had never taught at the beginner level before, who asked me what I meant by “role socialization,” which was a bit of a surprise to me. She seemed to think it meant encouraging the students to have fun with each other and bond as a group. Mais non.  People think of the beginner course I teach as a series of skills, but it is actually a sophisticated jump into modeling professional behavior and thinking, if the faculty have a grasp of what they are trying to achieve. Viz:

From http://medical-dictionary.thefreedictionary.com/Role+socialization

role socialization

Professionalism A process in which a person incorporates knowledge, skills, attitude and affective behavior associated with carrying out a particular role–eg, physician, nurse, technologist, etc. See Affective behaviors.

Role socialization

Step 1 Develop cognitive and psychomotor skills, and affective behaviors

Step 2 Internalize behavior and values of profession

Step 3 Individualize professional role

Step 4 Incorporate professional role into other life roles

Every nursing faculty member who wishes to teach beginners need to have a firm grasp of this process and to analyze the end-point of socialization that begins with their teaching style. There is a “butterfly effect” here.

Now, I believe that “caring behavior” can be learned. It’s not innate to women, I have met plenty of uncaring women who were nurses.  I also believe that caring behavior can be non-gender based, and that it’s okay for guys to develop a form of “caring” that reflects being a guy. You can be a male nurse and not be effeminate. This does not simply happen, and there does need to be a process of role socialization,  even in USA. Every now and again at the place where I teach for example, I detect that maybe a  guy is  enrolled in nursing school because he thinks that “nursing must be easy because mostly women do it.” Now, there is a guy who  is in for a big surprise. Likewise, “I’m only doing nursing because ultimately I am going to medical school” – all well and good but this is nursing school, right here,  and we teach nursing….

It’s not that I won’t do anything about role socialization. Far from it.  Here is a role I play in the undergraduate program. The students, male and female, know that I have an open door policy and they  know they can come to me for avuncular direction, even if they were not in my group in clinical during the second semester.

Having a woman boss?

Nursing occasionally attracts guys who have never actually had a woman for a supervisor before, and this can lead to problems. My colleagues who teach in the upper-level courses after me are not afraid to tell the students what they need to do to succeed. In other words, sometimes if it’s a guy, they come to me because they are  having trouble with a female faculty member, one who is trying to advance the student’s role socialization. If the student doesn’t “get it” they view themselves as being “harassed because I am a guy,” which is the point where they end up sitting in my office.  That’s when I pull out one of my copies of  “You Just Don’t Understand (Men and Women in Conversation)” by Deb Tannen. This is an oldie-but-goodie that was on the New York Times nonfiction Best seller list way back in the 1970s. This book is full of gems of insight into gender-based communication roles.

Back to the subject of men nurses in Nepal, the Himalayan country between India and China

And so all of these things inform my opinion. There needs to be tremendous attention and maintenance paid to gender roles before we will institutionalize a different role for nurses in Nepal. But I think that given the cultural dynamic here, Nepal has a long way to go to get there. Just one male in the group will leave all the women unwilling to speak, voiceless and powerless. For me, that is not the way to advance the cause of women’s roles in Nepal society.

Take Home lesson

Finally, this whole line of thought has direct impact for the ACLS content I am teaching, here and now. To respond to an emergency situation requires advocacy, assertiveness and confidence, all of which are braided into the cultural identity of every woman in nursing.  To reflect on my teaching leads me to believe that we still need to work on this with a mainly female group in order to develop leaders, because even just on guy on the team will trigger the role socialization behaviors from the past….

As they say on the internets, I will climb into the flame-retardant suit – and waiting the burning fervor of zealots from all segments of the spectrum. Let the feedback begin.

Did you ever hear the Buddhist legend about the King that dealt with a hungry tiger?

Joe

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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10 Responses to Male Nurses in Nepal – The Topic of Which We Dare Not Speak.

  1. Justin says:

    Good post and relevant for me; being of the hairy and testosteroned persuasion and in nursing school. No need for a flame suit that I saw in this blog post, and I’m quite certain Godwin’s law will not be invoked here at any point. I do appreciate your avuncular though often abstruse and eccentric open door guidance, and have availed myself of it a number of times. I look forward to introducing you to my lovely wife. I’ve told (warned) her about your often loquacious and incredibly interesting tales of Nepalese nursing, and assured her she would not be disappointed.

    • Okay, well, this is what I get for using the word “avuncular” – been awhile since I used it in a sentence. And the word “abtruse” – a fifty-cent word if there ever was one. I once served on the Board of Directors of my State Nurses Association, and six of the eleven Board members had their PhD. In a conversation, I described a certain volunteer as “abstruse” -a chaacterization I considered to be true. The person hearing me thought I had said “obtuse” – obviously almost a homonym but with very different meaning. zThat got me in to trouble and I needed to apologize and clarify. Go figure.

      and “locquacious???”

  2. gaynor says:

    hmmmm. Interesting stuff. Just some random thoughts….. Female Nepali doctors seem to be able to hold their own with male professional colleagues in Nepal as far as I can tell…….There a female Indian paediatrician at Patan who would not be someone to take a backward step and commands great respect….. I have witnessed older, motherly nurses in the West, treat male nurses like their own sons, while being absolute b…tc….es to female nurses in the same group…….Historically, as nursing has changed in the west – becoming more high tech, more academic and uni based – so it has been increasingly seen as suitable for men……Male nurses do seem to gravitate towards areas such as ICU, theatre, and ED generally, where everyone wears scrubs and they can play with lots of equipment with flashing lights and buzzy noises, and where patients aren’t always awake and wanting to connect in any emotional way…… Or am I being sexist?……Maybe the attitude towards men in nursing in Nepal will change as the hospitals become more sophisticated and high tech, and THIS will drive cultural change – with nursing being seen as more suitable for men with its complicated technical equipment………When I tried to introduce triage to Patan Hospital ED I eventually had to give up training nurses to work in triage, and medical assistants (all male) took the role on instead…..still trying to work out why the idea of a female nurse doing triage didn’t work so well

  3. M A says:

    Joe-maybe you are planting the seed for future male nurses in Nepal. I can’t fathom that being illegal. Cultural differences play a huge role in this. I smiled when I read about the man holding the door for the woman. When I studied in Germany, I learned that the man goes through the door first and holds it for the woman to go through. In Saudi Arabia, women are trying to get the right to drive a car. Imagine! Do the women in Nepal drive or is that forbidden? Take care, M A😉

    • jniemczu@hawaii.edu says:

      O yes, They drive!

      Most people here own motorcycles. When the person is in full regalia including helmet and a kerchief covering their mouth and nose, you can’t tell whether it’s a man or a woman. Some of these women are fearless like it’s moto-cross.

      The male nurse issue is considerably more complicated, here.
      From may until August 2nd I am in Nepal.

      email is the besy way to reach me – but my mobile is

      +9779802038060

  4. Shyam says:

    Joe, I think you need to learn more about Nepali nurses. I believe that you’ll contact me, if you wanna update your knowledge.

    Mr Shyam lamsal, RN, MS
    Associate professor
    B.P.Koirala Institute of Health Sciences
    (www.bpkihs.edu)
    dharan, Nepal
    E-mail: shyamlamsal001@yahoo.com

    • Dear Professor Iamsal:

      so pleased to make yor acquaintance. Til now I have mainly been in western Nepal or Kathmandu. I invite you to check out my FaceBook Fan Page and/or my YouTube Channel and/or my book, as we get to know each other. I have heard esxcellent things about BPKIHS in Dharan, as some of the former students from there were in a class with me in KTM.

      The purpose of a blog is partly to create dialogue among interested parties, and it is easier than say, writing a letter to the editor. So – please feel free to add specific commentary to this thread, so that all person who read it may benefit, not simply limited to the two of us in private email. Looking back, this particular entry has elicited many more hits than usual, and I am sure the back-and-forth will help a wide cross-section of people interested in this topic.

      thank you

      Joe

      • Yogendra Prasad Mehta says:

        Hello Sir
        I had gone throyough your articles about male in Nursing profession. You didnot write much about it or situation of gender in nursing profession. As we are the first batch of B. Sc Nursing in BPKIHS, Dharan where 11 male entered in nursing profession out of 20 students. Now they are working in various sector . Many of them are working in BPKIHS as a nursing faculty.
        I am also the person of that batch working in Nobel Medical College, Biratnagar.
        I hope you have done the good job that highlighting the male in nursing profession.
        Thank you so much
        Mr Yogendra Prasad Mehta
        Master in Medical Surgical Nursing
        Lecturer
        Nobel Medical College, Biratnagar

  5. Shyam says:

    Joe,
    As you seem interested to know about Nepali nurses, kindly go through this small study among the public health nurses.

    Abstract
    Authors:
    Shyam Lamsal, Associate Professor
    Shyamlamsal001@yahoo.com
    Angur badhu, Additional Professor
    Tara Shah, Additional Professor
    Department of Community Health Nursing
    B.P.Koirala Institute of Health Sciences (www.bpkihs.edu)
    Dharan, Nepal.
    Title of study:
    Training Needs Assessment of the Public Health Nurse (PHN) Competency on STD/HIV prevention at Health Post in Nepal.

    Aim of study:
    This study aimed to assess the training needs of public health nurse (PHN) and compare the job performed by them with job description.
    Materials and Methods:
    A descriptive study was conducted by utilizing triangulation research method. It was conducted in Eastern and Central regions of Nepal with 13 PHNs (of 13 districts among 75 districts of Nepal) and their supervisors were included as the samples. Data was collected by using standardized tools.
    Results:
    The mean age of the PHNs was 43.69 ± 9.4 years. Near about half (46%) were having 10 to 20 years job experience. Most of the respondents (85%) had undergone PCL Nursing. All most all (92%) subjects had undergone some in-service education. Most of them (57%) used to visit health posts. Majority of PHNs (85%) were assisted in planning and implementation of STD/HIV programme for health post. Majority of them (85%) were involved in educational activities. Most of them (85%) used to supervise the staffs involved in STD/HIV prevention and treatment activities at health post. Majority of PHNs (77%) were not involved in research activities. Most of them (85%) felt the needs of training on recent concepts of STD/HIV prevention to bridge the gap between traditional and recent concepts of public health.
    Conclusion:
    PHNs have broad areas and lots of opportunity to work, in case of sufficient manpower at district level. Most of them did PCL nursing long back; therefore they need training on recent advancement of STD/HIV prevention and need to recruit more PHNs to improve public health services in Nepal.

  6. Shyam says:

    Our institute is the largest health sciences university in Nepal. I’ll be happy to welcome you here during your next visit to Nepal.

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