reading for Nepal volunteers Jan 9 2013


So yesterday I skyped with a nurse who will be joining us in Nepal, and she asked what to read to prepare.

I have previously recommended some of my own specific past blogs, of course, but she wanted more.

“The world is a book and he who does not travel reads only one page”

And so i was reminded that some time ago i composed a “listmania” on Amazon, of books that I had come across along the way. here is the link. The books tended to include ethnographies and descriptions of local culture, or else some of the popular books in which Nepal was featured. Looking back, this was a good place to start, because these books sharpened my observational skills as to the culture and practices to be found in that beautiful country.

Cultural Literacy

If you read up, you will learn, for example, that most people are cremated after death; that you use only the right hand when you eat, which is often with the fingers; the proper way to use a squat toilet, and so forth. these are external indicators. all well and good. we need those kind of factoids. But that is just the surface….

Taking a step into the Great Beyond…..

A Listmania list is limited to published books. I have previously recommended a website run by the International Exchange Program of the University of the Pacific  and to this day, I can’t recommend it highly enough. Somebody who gets involved in Global Health needs to develop a self-awareness of their own stress, and I’m not talking only about the stress of unusual diseases or lack of resources (though this is certainly stressful.) there is baseline stress associated with off-the-beaten-track travel, even if you were limiting yourself to the beautiful tourist experiences. To succeed with this, requires just as much planning as becoming culturally literate.

The U of P website is oft-quoted, and they devote a lot of energy to the subject of re-entry shock, a highly underrated and misunderstood phenonmenon. Here is a quote about returning from a a college international exchange program, used by Chapman University, that ought to inspire you:

Top 10 Study Abroad Reentry Challenges and Strategies

  1. Boredom – life isn’t as exciting as it was while you were abroad. Solution: Follow your new adventure spirit and interests – explore what your home has to offer.
  2. “No One Wants to Hear” about your experiences. Solution: Do not be upset if people seem indifferent to your experience abroad.  Understand that those who haven’t studied abroad will have a hard time relating.  Generally students who want to study abroad in the future will be very interested to hear your stories. Find out how you can connect with them! 
  3. It’s hard to explain your experiences and what you went through to people back home. Solution:Talk with others who have come back from abroad and share your experiences, frustration, and joys. You will likely find that these are the people who can help you through it. 
  4. Reverse “Homesickness” – Missing the place you studied abroad. Solution: Go to a World Market and get Nutella if you miss the UK, Japanese tea if you miss Japan.  There are many country-specific markets in Southern California. Everything is available on the Internet!
  5. Relationships have changed with friends, family, and significant others back home. Solution:Accept that you have changed and that things are not going to be the same as when you left and that’s a good thing.  You will need to build on relationships, not merely resume them. No one’s life went on hold just because you were gone, and his or her experiences are just as important to him or her.
  6. People see the “wrong” changes if your ideas and behavior have changed.Solution:Focus on how you are now better off from the experiences you have had.
  7. People misunderstand you if you use words or actions that you picked up while abroad. Solution: Try to apply what you learned abroad to your life here. What can be saved? What is useful?
  8. Feelings of Alienation/Critical Eyes – Feeling out of place in the U.S. and recognizing the faults of society.Solution:Don’t isolate yourself.  Use your cross-cultural study-abroad skills to observe and understand your own culture.
  9. Few opportunities to apply all the new social, language, or practical coping skills learned. Solution:What does Chapman offer that you can apply your new skills to? Join a language or cultural club on campus.
  10. Afraid of losing the experience back home.Solution:Keep your memories alive – do not store them away in a shoebox. It wasn’t a dream and it was important.

Remember: Like culture shock, re-entry shock passes in time.

(adapted What’s Up With Culture?, School of International Studies, University of the Pacific, Bruce La Brack, ed. (2003), funding by FIPSE, U.S. Department of Education. Available at www.pacific.edu/culture)

Finally, issues of development:

There are some oldies but goodies of which people need to be aware. When we are talking about exporting health technology, we start considering issues of High Income Countries vs Low Income Countries. and though Nepal was never officially colonized, it still gets lumped into the Low Income Country category.

the key: get rid of the idea that you are innately superior because you are from the USA or Canada or Uk or Aus. you only get the respect you earn. the way people do it in Nepal is often dictated by lack of resources, not lack of intelligence or work ethic. People hate being condescended to or patronized. do everything you can, to examine your own attitude about this. It is the single most important key to success.

the Ugly American was the Good Guy

“we don’t want to be the Ugly American” is a phrase you sometimes hear. “The Ugly American” was a book that came out in 1959 or so, and the characters showed various ways that Americans acted when they were in a Low Income Country. When I hear this term referenced by somebody, I cringe a bit, because in the actual book, The Ugly American was the good guy, working in a bicycle shop alongside his Vietnamese peers. The Beautiful Americans would never be caught dead staying somewhere that didn’t have a pool, or air conditioning, or which did not insulate them from the basic living conditions of the locals. The Ugly one was the role model.

Travel Style – with self-assessment quiz!

along these lines, think about your Travel Style. This is a concept that nurses don’t think of, but which the tourist industry spend time with. The link includes a self-assessment quiz  as to your “Travelling Personality.”

Colonialism and Development

This leads to issues of colonialism. I highly recommend The Wretched of the Earth by Frantz Fanon. It’s been around a long time, and he wrote from an African perspective. He described the frustrations and anger of being in a post-colonial country which faced challenges. Another oldy but goody, and more important for our purposes, is The Pedagogy of the Oppressed by Paulo Freire, who was from Brasil. I first read this in college, many years ago, and there will be those who say it’s outmoded, but I disagree. Freire was describing a way of relating to people in a classroom setting, that relies on mutual respect and sharing.  How does this relate to what we do? simple. when we bring volunteers from USA or Canada to teach critical care nursing, we can’t simpy teach people in Nepal about the American system, because they do not have the technology or the same set of basic assumptions. we have to examine how to adapt what we teach so that it matches what they need to know in their system, right now. The Pedagogy of the Oppressed is a book that will help you get in the right mindset.

any other ideas?

I am curious to know if any of the readers of this blog have favorite books they would like to suggest….. feel free to comment below…..

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.
This entry was posted in medical care in low income countries, medical volunteer in Nepal, The Hospital at the End of the World and tagged , , , , , , , , , , . Bookmark the permalink.

2 Responses to reading for Nepal volunteers Jan 9 2013

  1. GREAT Stuff, Joe… MUCH appreciated…. Cheers!

  2. Amanda Giles says:

    THanks Joe, and thanks for sending me that article, I am just about to read it!

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