Joe puts on his matador’s hat and Suit of Lights

“A Man Without a Cross”

Each cohort of students this summer is a book on my shelf. A handsome cover beckons to us – nice words on the back – The first line of the first page draws us in to the story…. We continue eagerly, characters are defined, a series of adventures takes place and challenges rise then are met as we move on and grow. Finally, the hero rides out of town, promising to come back some day and settle down…..

Yes, I allow myself to have grandiose moments, despite the fact that what I do is simply to stand in a classroom and talk, not such a big deal….. we all know that the act of writing is grandiose becasue it means that  the writer assumes there is an audience that wants to read. O maybe you can simply dismiss this summer’s Blog  as  a wannabe Indiana Jones,  or even a series of Harlequin books ( without Fabio and without much bodice-ripping), but to me it’s always felt a bit more weighty, like James Fenimore Cooper’s “Leatherstocking” series or The Lord of the Rings.  Natty Bumppo was a hero for the ages….. So was Frodo. Not so sure that this blog will achieve that destiny. Even less sure that the tales of the Fifith Cohort will be so memorable. Sometimes this is a slog.

The bookshelf of the summer trip has grown each week, and the chronicle of this blog says I have more than fifty entries. Some of the “books” will be favorites and years from now, I will recall cherished chapters in the future when I sit by the wood stove on a cool evening drinking tea, leafing through  something to read before bedtime. Rummaging the attic of memory.

The Fifth Cohort of summer 2012

The Fifth Cohort, it seems, is the next to last volume before the right-sided bookend frames the collection. In my office at UH, one shelf right over the computer is so full I can’t add any book properly unless I take another out – consequently each added book gets heaped oddly on top like a salvaged brick at a construction site.

After my first day with this cohort, I wonder what kind of book this will be – post-modern surrealism comes to mind – Kafka On The Shore. I am the kind of guy who will read a book to the end even if I don’t understand the plot…. This may be one of those.

I’m getting ahead of myself here and the reader wonders what the story is…. so I will back up. Twenty seven nurses showed up from all over, mostly having heard about me from their friends in the Wednesday class who said nice things. Word of mouth is important in this country. Six from HAMS hospital, the rest are the usual mix including three teachers. No problem.

Twenty seven plus twenty two makes forty nine.

They were joined by twenty two more,  staff from the host hospital, most of whom worked the night before, arriving in a powder-blue clump as soon as they were out of report. These latter nurses sat together, did not speak, not even to each other, and did not answer questions when asked, even though I resorted to  standing directly in front of them to make eye contact. They held blank papers on their laps but did not take notes until I started going around.

This was just a bit – shall we say – different. I realize now that I had prodromal indications that there would be this issue when some of the phone inquiries were from people who spoke no English.

Diagnosis: severe language barrier issues between myself and this group.

Let’s be honest here: I can speak some Nepali but not at the level of vocabulary that would address the concepts I try to deliver. I rely on students in each class who are fluently bilingual. This material is not accessible to a Nepali-only  nurse unless taught in Nepali. See the problem? At the end of the day I am still a videshi.

Adapt and Overcome

The Sun Also Rises was Ernest Hemingway’s book about Spain. One character is a bullfighter and Hemingway threaded small stories about bullfighting throughout. Hemingway wrote about how a true matador adopts a different strategy for each bull that enters the ring. Not all those watching will recognize this, for example if a nearsighted bull does not even see the red cloth, it’s a boring bullfight. The uninitiated spectator may dismiss the matador as lacking in style.  These persons draw the wrong conclusion about the nature of the bullfight, since the matador is doing the best he can – it takes a person with aficion, a true fan, to appreciate the nuances.and so – –

My response to this challenging group was to make everyone stand up, mix the seats, ask the more bilingual ones to help, play “speed dating for nurses” and  break up the clique. Re-seating. Enlist other students’ help, again. I used every technique of classroom management to overcome this, that I could recall. The goal was to overcome passivity, and get people engaged.  We moved very slowly through the material and it was draining. So at  eleven I decided to start megacode. We took an hour for lunch. The location is near the “lighting Bajar” of Old Kathmandu and I could have explored for hours if I was looking for just the  right chandelier. I found a dal-bhaat place.

As we re-assembled after lunch somebody said this crew had mostly attended nursing school outside the KTM valley and many had never taken even one class from a foreigner. Wow.

A bit more about the neighborhood. Sundhara is on the fringe of Old Kathmandu, the signature landmark is a minaret about two hundred meters away. The street plan is similar to Boston’s Haymarket neighborhood – originally these were cowpaths and they still are. You step out of the door and you know you are No Where Else But…..

Three new lifetime friends come to the rescue 

At one PM, three of the stars from my Wednesday group, showed up. Chuckle to myself over being clever enough to arrange help in advance.  Indu, Smriti and Kripa salvaged the day for me. These are some of the students employed as fulltime teachers at nursing schools, and they were eager to practice out leading mega-code groups, since they will adopt this into their own teaching practice. I quickly re-assigned the students into four smaller groups, and we spread out the tables and equipment and chairs…. Each of the others got to work and ran their section in Nepali.  This salvaged the day. Whew!

I’m clear; You’re clear; we’re all clear!

Megacode practice proceeds on the basis of the Onliest Six Rhythms, and we introduce defibrillation safety on Day One in these short courses. One of the night crew nurses that was in my section, failed to “clear” FOUR TIMES IN A ROW despite stopping the scenario each time to give face to face explanation in English and twice in Nepali. I try very hard never to single anybody out, but I ended up  holding the nurses hand and asking the group leader to translate verbatim what the problem was.  Cowabunga.

So there were times when I was wondering what genre of book I happen to have picked up ….. Not exactly a linear plot, here. Maybe the Beetlejuice version of KTM Critical Care.

Tomorrow (Monday) is another day. Four cadre from the Wednesday group will again join me. (Smriti again and this time she will be joined by Bijaya and Rajani from Norvic, as well as Rita). I remain undaunted…. This is a plot twist I will deal with in some imaginative way; and when I ride off into the sunset the townspeople will still wave…..


At the end of the day, a class member who teaches at one of the schools, came over to tell me how she was delighted to watch me deal with the language issue and gained so many ideas about how to manage a classroom while teaching. Here was somebody in the stands that watched this matador deal with this bull in this way. An aficionado of teaching technique.

I relaxed. Look at this one more closely.  Squint. Laugh. She was giving me a new perspective, here.

“Are all the teachers in USA like you?” She asked.

(For those of you with whom I have shared a classroom: how would you answer this question?)

“Not exactly” is what I said.

That’s why they pay me so much money doing this!


PS got a pleasant call in the evening from one of the nursing school Campus Chiefs (one of the half-dozen  I have met…). She invited me to recruit for her a visiting faculty member from USA to teach nursing there for a whole semester.  Or go there myself.  Oh My.

And at night as I compose this, i realize that I would look truly ridiculous in a matador’s hat and especially if I tried to squeeze into the Traje de Luces (Suit of Lights….) let’s not take ourselves too seriously here……It’s the seventieth day of a seventy eight-day trip….. I will return to Sundhara tomorrow with a good frame of mind……


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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5 Responses to Joe puts on his matador’s hat and Suit of Lights

  1. gaynor says:

    Although I do understand the problems some of the nurses have with English, Joe – I encountered very similar problems to the ones you describe above when teaching in Tansen – I am puzzled as to how nurses get through any form of nurse training (apart from the most basic nursing aide level) without even a basic grasp of English? As far as I am aware, all nursing texts are in English. There are no Nepali words for virtually any of the medical and nursing terminology generally used. Granted it is preferable that Nepali is used to explain concepts and difficult physiology using plain first language, but otherwise I have to ask – how do they manage to get thus far? How could they have studied any of the nursing texts? I believe nursing exams are written in English. Do they understand more than they let on but lack confidence to speak English, particularly in front of a bideshi? I thought this of some of my students in Tansen. Although the final exam I set was translated into Nepali for them they certainly had understood the difficult ventilation concepts taught to them in English. So I’m baffled.

    • To be a nurse is to be an optimist, the old saying goes. Yes, this was a googli in the cricket game of life. In defense of this group, they arrived straight from night duty, maybe they had not been told what to expect, etc etc etc.

      No matter where you go it’s difficult to find people who will work nights, so some of these were also quite young and inexperienced. Today is another day and I will use my mix-it-up strategery from the start.

      The larger issue of nursing in Nepal –

      There is no NCLEX-style exam here for licensure, and I’ve heard it said that nobody ever is dismissed from nursing school due to poor academic work, no matter how many exams they fail.. The schools vary widely in quality of faculty, and also in quality of clinical work. You or I may use TNS or LNC as a benchmark, forgetting that these two schools are considered the best in the country.

      On ward


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      Ubi Caritas est vera, Deus Ibi est

  2. And I would add: due to the textbook situation, nurses who study don’t do it alone – they go to the library as a group and four or five will look at the textbook together. The best one, reads it in English and explains to the others,often in Nepali. This is the mode at every nursing school I have seen.

  3. gaynor says:

    Thanks Joe. Some good points. I am about to start a Masters unit on education in nursing and will be doing an assignment on something along the lines of teaching in Nepal/developing countries/rote learning/critical thinking/functional nursing/learning when English is a 2nd (or even 3rd!) language. Exploring the possibilities at present, but your blog has been very helpful in raising some of the issues and how to solve them. There seems to be something of a dearth of studies specifically done in Nepal, so may have to widen my scope unless my wonderful librarian can come up with more than I can! Thanks for your openness in sharing your experiences

    • I try very hard to be truthful and resist the urge to gloss over the problems. It’s easy to write about the successes, not so easy to write about the challenges.

      Today each person from the host hospital is paired with a person from the rest of the group – I am trying that out…

      More later


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