not sleeping alone in Bharatpur

Let’s start a nursing school

Okay, so one missing piece of the economic puzzle is why there are so many B Sc nursing schools being started in Nepal. There is a rush of new programs on the books in Nepal.

One answer, the one a cynic might choose, is the profit motive. Tuition money. To get a nursing degree from one of the public universities here costs about 20 lakhs – 2,000,000 nrs. This is about $28,000. “TU” is Tribhuwan University. Students not scoring well enough to qualify for TU (of which LNC is part) can get into a private college by paying more.

The private colleges can charge 80 or 90 lakhs (8,000,000 to 9,000,000 rupees). That’s roughly $100,000 US which is a fortune by Nepali standards. From this viewpoint, the cost of college in Nepal is about the same as that in the USA or Oz.

This is a factor in propelling students to go “for further study” abroad. Cost out the alternatives and decide which is the better “value.”

For the school, there are startup costs – building a practice lab, getting books etc. These costs are all incurred in the first years. Once these are paid off, the further tuition that comes in has a high profit. The colleges are not obligated to provide a lot of clinical, so the cost of paying faculty ( a key indicator of quality) is low.

The Need for Ful Fledged Learning Laboratories, not just Demonstration rooms

At the hospitals, the people who interview the B Sc grads for jobs in Nepal after graduation say “they don’t have any skills or experience” which echoes the feedback about BSN nurses back in the day when USA was transitioning away from hospital-based schools of nursing. There is some truth to this. There needs to be a way to ensure that the school actually teaches the students to do psychomotor skills instead of only observing. This is a model with flaws.

A few years after graduation the nurse with a B Sc will be more equipped to apply critical thinking and problemsolving skills. More likely to be a leader. More adaptible. So it’s good that Nepal is trying to produce that kind of workforce. In the meantime, the policies such as tuition etc are the real drivers of student choice.

Livingston I presume?

This past spring I sponsored a “directed study” for a senior nursing student who is a committed Christian, on the subject of Global Health. Ashley McArdle had lived in rural Africa before, and approached me three semesters in a row expressing interest in Global Health Directed Study. I put her off and tried to get somebody else to sponsor her. (It’s too much work and you don’t get paid extra). Finally I signed the paperwork for three credits of self-directed work and we met occasionally over the spring.

The readings did *not* include Bible study, after all UH is a public University. We covered a lot of ground. Colonialism, the post-colonial legacy, and of course Paulo Freire and self-determination. I shared my books on specific medical diagnoses and hospital care ( she had already read my own book back along). Throw in some maternal-child health, epidemiology, malaria and TB and re-entry shock.

Ashley applied for the summer internship at Queens, for which UH students compete fiercely. These are paid internships and they serve as a springboard for future employment. After an interview, she got offered a slot in ICU, for which the competition is particularly intense.

And then…… She turned it down.

And decided to spend the summer at a Christian Mission Hospital in Africa. In “Congo-Brazzaville.” Only, it’s nowhere near the city of Brazzaville, it’s in the countryside.

When she told me, you’d think I’d be joyful, but I listened with mixed emotions. Many readers of this blog have also read my book about my first experience. What if that was my own daughter telling me she was going to do this?

“You realize you’re not likely to be the same person after this.”


I asked her what her folks thought, and told her “I just want to make sure nobody thinks I over-glamorize what this is about, to encourage you to do this…”.

She assured me it was her own idea.

Then I left on my trip. I wondered what happened, but there were no emails and nothing on her FB page except friends asking if she was okay. She seemed to have disappeared for a month or so.

Until today. She sent a link:

And so she is alive, we don’t have to hire Charles Marlow after all.

My sleeping companion

I am also alive, and the internet here is better than the Congo. In Bharatpur I recommend The Globe Hotel east of downtown a mile or so. I’m in room 207, sleeping next to an air conditioner that’s either full-on or full-off. It’s on, and the wind reminds me of an autumn night in Maine – I’m curled under a blanket. I haven’t been lonely either; I am sharing the room. The gekko in my room is bigger than the ones we had in Hawaii – about eight inches. In the middle of the night I awoke with a start. Yes, it was under the covers with me at one point, probably trying to get warm. Fortunately these things don’t bite, but still….. I’d prefer somebody warm blooded, even if they snore!

Day One in Bharatpur

Day One was grand. Took a rickshaw to the hospital and I noticed the small Tamil-style Hindu Temple on the grounds such as I’s seen in Singapore. Odd. I almost expected to hear a nagaswaram calling me. Later somebody told me that the administrator was from South India and opted for that style. I couldn’t remember how to get to the classroom, but finally found it after asking directions in ER.

In the classroom I met thirty nurses. Yes it was hot and there was NOT air conditioning. Going around the room, the whole nursing school faculty was there. They have some talent in the middle-management; more than the usual number of B Sc nurses (!).

We did my standard review of physiology and the conductive system, but by ten-thirty, due to the heat, started CPR and mega-code drills. This was the usual fun.

The Matron of nursing took me to lunch and told me they will buy a plane ticket for the return to KTM Tuesday.

The Honey-Hunters of Nepal

Looking out the window of the class during a break I noticed something unusual. Under the eaves of this tall building, are colonies of honeybees. Very large hives. Where are the honey-hunters of Nepal when they are needed in Bharatpur?

At the end of the day I came back to the hotel, played with wi-fi and drank three liters of cold water. Went for a short walk. The town is located on the main east-west highway and the hospital gets many RTAs (“Road Traffic Accidents”).



About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it 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. 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.
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