Joe is just as pretty as he always was, and wins a beauty contest to prove it

Time Travels back and forth

The dilemma is always whether to use this as a chronology or not.

Yesterday was a get-your-chores-done kind of day, picking up photocopying for my last cohort, meeting with people to plan events, grocery shopping, and the like. But I also got over to Tribhuwan University and spoke to a group of nursing students there. Originally it was going to be the twenty MN students but then the B Sc kids tiptoed in to the room, and the group was thirty eight all told. I did my usual collection of email IDs and now I have 38 more in the database – hooray!

It was the “Advanced Nursing” class – and I was told I could speak about anything within that topic.

 Functional Nursing redux

 Taking a show of hands, the students told me I was the first videshi nurse who had spoken to them during the duration of their various programs. The MN students here are from all over Nepal and will generally plan to return when they are finished. Also, I asked about videshi nurses at Tribhuwan University Teaching  Hospital (TUTH) next door – the 700-bed(?)  hospital that covers a city block. They told me that nurses from Japan or Canada or USA sometimes come there to teach CPR but that none ever work side-by-side on the wards with the Nepali nurses. Another source of confirmation that I am an oddball since I have spent time at Tansen doing that very thing.

Oh well. Somebody once told me “If Joe Niemczura is the answer, it’s got to be a strange question.” 

I decided to speak on somewhat of a scholarly or theoretical plane, and gave a talk on “models of nursing care delivery” in which I contrasted the good and bad points of Functional Nursing against Primary Nursing, and then spoke about Failure to Rescue, Rapid Response Teams, Leadership Development, that sort of thing. Takeaway message was that you work with the system you have, not the one you wished you had, and that to understand the limitations of the chosen system would help you to be more effective with patient outcomes.

That lasted seventy-five minutes and I did some of my usual interactive pyrotechnics, such as the ECG dance, etc.

I then conducted a nominal group process, the “Dear Abby” exercise…. In this, each person writes their question on a piece of paper and passes it forward to be answered by me as an ad lib. Always fun.

Afterwards, the B Sc students stuck around and had a photo session with me (sigh) and brought me to a computer where I used my thumb drive to upload the ECG teaching materials I got from Jason Waechter.

Telephone Manners and Om Mane Padme Hum

I have been getting phone calls related to the three day training event that starts Sunday, in Old Kathmandu. I have been calling it the Fifth Cohort. I hate to admit this but my patience was wearing thin. Help me oh Lord.

 I have only myself to blame because of the way the registration was set up. I have been determined to use the most open-ended registration process as possible for these events, a sort of all-comers first-come-first-served free market approach to this. Lots of reasons why this is good. What I noticed this time was that some people heard about it from friends but were trying to sign up without truly knowing what they were going to do. And also, (this is where the impatience comes in) several of the calls were from nurses who spoke no English whatsoever. Granted, this is Nepal and ideally this course should be taught in Nepali, but it’s simply not what I can deliver. So, the persons on the other end of the phone were literally speechless when they called. From the weekly Wednesday group, I know that much of my attrition was from the participants who were less fluent in English, and the same phenomenon is at play. I won’t lie and say that I am fluently able to teach this in Nepali. Now, for this course, I have invited some of the Wednesday group to come help and they say they will; maybe it won’t be so bad….  

Also, I had one guy call to register his wife and four of her friends. Okay, maybe she was working or something but why couldn’t she call herself? I told him each nurse must send a personal email to my address seeking to be added to the list and that holding a slot for somebody who didn’t call on their own behalf was not allowed.  Also, an ANM (sort of an LPN level) wanted to join, and I said no, it’s for Staff Nurses or above, no ANMs. And then the numbers filled up and the course is full – so all future emails will be added to a waiting list and they take their chances if they show up Sunday morning or not. I may end up with less than the fill-the-room  complement of sixty, but that’s actually okay – I don’t feel as driven to add to the sheer numbers as I did two months ago. This train is coasting into the station.

I am well aware that there is an easier way to do this – to go through somebody else for registrations – but I was determined to have an open process so I have to take a deep breath and simply be patient. Ommmmmmmmmmmmm……. Next time I will have clearer policies.

Then on the bus cross-town to get to Patan Hospital by 2 PM for a meeting with the ICU in-charge regarding next Friday’s ACLS training for nurses.

“You Have Been Declared the Winner in a Beauty Contest”

 When I first arrived I contacted Patan Hospital to see about working with them, but they took a long time to get back to me, and I didn’t pursue them because I had my hands full. In the last two weeks, that has changed, since I will be doing a training event for them Friday July 29^th. Patan Hospital is big and busy, all the tourist guidebooks say that if you are a sick foreigner, it’s the best place for medical care in KTM (those same guidebooks generally also say to go to Singapore if you possibly can….). When I go there I am Mister Popular now. Who knows why, but it’s as if I won a Beauty Contest. Sashay down the runway and wave to the audience…. The people at Patan Hospital have now been very solicitous in working with me, which is nice. In turn, I thank them for each collaborative gesture, it’s the way the wheels of the world are lubricated.

The plan for next Friday has changed, though. Originally it was going to be just nurses, two three-hour sessions (10 to 1 then 2 to 5) with thirty in each session, using a big room where they normally do childbirth classes. Now it has been moved to the air conditioned theater-style palatial digs reserved for the signature events, and all forty house staff (interns and resident doctors) will join us for the morning. In other words, there will be a total of one hundred people at Patan Hospital I will meet and do something with. The auditorium-style seating and the lack of manikins ( they have just one..) makes it a challenge.

Talking Heads?

I don’t do talking heads… I don’t do talking heads…I don’t do talking heads… I don’t do talking heads… I don’t do talking heads… I don’t do talking heads… I don’t do talking heads… I don’t do talking heads…I don’t do talking heads… I don’t do talking heads… I don’t do talking heads… I don’t do talking heads…

By that I mean, I am firmly committed to imparting this material by hands-on scenarios and critique as opposed to a lecture about how to do it. I will plan the presentation strategy accordingly. Also, when docs (male, mostly) are involved, the added element of testosterone makes it possible to contemplate an approach which makes use of the competitive angle of playing the protocol games. So, my plan for the 0900 to 1000 hour is to hand out the protocol sheet and go straight at it with scenarios.

Psycho Killer – Qu’est-ce Que C’est?

One wrinkle in the timing: the nursing folks asked me to do it from 10 am on, and the medical folks will start at 0900 – this wrinkle is not a bad thing – in Nepal, I tend not to mix the docs and nurses in this stuff, not until the nurses are a bit more confident.

 So the upcoming week, my last full week here, goes like this: Sunday-Monday-Tuesday is the fifth cohort, sixty students in a three-day event; Wednesday is the final exam for the LNC green ballroom cohort; and Friday is the event at Patan Hospital.

Revenge of the Crash Test Dummies

Finally, I will attach to this a link to a YouTube video I shot at a school of nursing. It was taken in their “demonstration room” which is used to practice beginner skills. In the USA, we now use “Sim-Man” and there is a craze sweeping nursing education in which teaching is focused on advanced simulation techniques. ACLS has always been taught with simulation, but regular nursing is still finding its way. With the projected change in nursing education in Nepal, there is enormous pressure to incorporate better lab time and better simulation into the educational plan. This video will show you the current state of the typical physical plant to be used for such activities. I have visited five schools of nursing and they are all about the same……