First-hand eye-witness description of nursing needs in earthquake-ravaged area of Nepal by a Nepali-American nurse

A #Nepal -American nurse reports from #Sindupalchowk after #Nepalquake

Firsthand assessment

This was on the FaceBook page of a friend and I thought it was newsworthy. Generally, the people doing actual earthquake relief are too busy to send reports back, and there is limited teleconnectivity in the rural area.

Note; Unita Magar, RN, MS is a nurse from Nepal who went to school in USA and now is in graduate school in New York City. I met her when I was on book tour for The Hospital at the End of the World in 2009.  (she rode the train for two hours to hear me speak). She is active in NANA – the professional nurses association for Nepali nurses in North America. Click here for their FaceBook page. There you will also find pictures.

In November, I met with NANA members in Jackson Heights, Queens New York ( the epicenter of Nepali neighborhoods in USA!)  and Unita brought me “panipuri take-out” – a very hospitable gesture.

NANA could not stay in USA

When the earthquake hit, NANA members did not hesitate. They spent some time gathering equipment, and got on the plane. Normally, it is not a good idea for Americans to just jump on a plane and go to a disaster area. NANA knew they had specific skills to offer.  ( the current President, for example, got her PCL nursing education from Bir Hospital) As you might imagine, their language skills are flawless and they come to Nepal with perfect cultural understanding as well as nursing background.  Nepal is not an easy country for foreign nurses. They invited me to join them on their relief mission, but I decided to continue my teaching.

Here is what Unita Magar, RN,  wrote ( I did not edit it, but added some formatting):

Our team went to thulo bhotang, sindhupalchowk and kalleri, dhading. All the villages in sindhupalchowk have been very much damaged, most of them down to rubbles – sad. We were able to see many patients in both regions. My heart breaks to see so many people losing their loved ones – orphans, widows, mothers who have lost their child/children …

My assessment so far:

1. Eating utensils: One of the young girls from dalit community who lost her mom and sister mentioned not having utensils to eat food, as they are buried in rubbles. So while distributing rice bags and other foods that is one area to keep in mind.

2. Schools and health posts have been badly damaged in most of these villages. That is another area of need. With no proper health posts, patients are not able to f/u with the the medical professional re: their wounds, upper respiratory problems and other health issues – wounds can get infected if not followed up. Medical teams come and leave in 3-4 days that is not good enough for continuity of care.

3. Most people have been displaced from their homes – educating public re: what type of houses to build is important. People were asking me what type of houses to build. Educating public on this will be very helpful.

4. Houses: so far people are using tarps for temp housing. Monsoon season is coming soon. This means people especially in mountains will need more stronger houses – jasta pata type to keep them dry.

5. Many kids are orphaned – putting them in schools will be important. It is so sad frown emoticon I wanted to adopt them all. At one instance I was trying to counsel one baini (young girl) who lost her mom and lil sister in earthquake and I could not hold up my tears. Tears rolled down my cheeks. Instead of me comforting her, she was telling me “please don’t cry, things like this happen.” One of the dai (young Nepali guy) said he will educate those 3 kids. Bless his heart. There are many young needy kids displaced by earthquake like this baini and her siblings. Many might get dragged into bad direction if not guided, so kids, especially girls will be important to focus on.

5. Elderly people: who are living alone by themselves. More chances of being malnourished due to lack of proper help and resources due to current situation in Nepal.

6. Women and dalit community – important to distribute food/shelter to them first when distributing goods. As they may stand behind allowing others to get the goods first due to Nepal’s cultural practices. Sometimes, they may not get anything because of that.

7. Important to use the locals from the region when doing any projects or distributing foods.

8. Going from house to house may mean everyone will get the medical tx and supplies. Some ppl maybe too weak, busy or disabled to even walk 15 minutes to use the available services. Going door to door is beneficial if u want to be more effective in your effort. We were able to reach out to more people when we went from door to door from village to village.

8. Counseling and psychological services – will be very much needed in Nepal. We saw many patients with c/o headache. This may indicate post traumatic stress disorder. One baini said to me she felt relieved after talking to me. She was afraid of sharing her thoughts with her neighbors as she was afraid they may gossip. Some people may feel comfortable sharing their thoughts with an unknown face to known face.

Everyone in the city and villages continue to live with some lingering fear of earthquake recurring again. It will take a while to overcome this fear.

9. Men in Nepal may have difficulty sharing their concerns and thoughts with others, thus holding their worries and loss/losses locked inside their minds. They may instead resort to drinking to forget their worries. This is another area of concern.

10. Some patients are in hospitals with no family members visiting them. We saw some volunteer bhais acting as a companion and advocates for these patients. There are quite a few patients like these in hospitals.

11. Hard hand gloves in villages for villagers trying to take out their belongings from the rubbles.

There is lot to be done. However, everyone is doing their best here in Nepal and abroad in any way they are able from taxi driver brothers to students to professionals, army, police to the general people in Nepal despite the fact that their families are also suffering. Salute to all of these kind souls

for foreign response teams

It is critically important, for all foreign response teams, to have somebody like Ms Magar  with them. She understands the cultural nuances of Nepal and can guide decisions. For example, the truly vulnerable persons do not always appear in public, at the front of the line, demanding help – they suffer alone and in silence. In the above, she is an articulate link between the ongoing social issues of  human trafficking, the depopulation of rural Nepal’s young men, and the coming famine.

The reconstruction needs are extensive. I am sure that NANA will continue to send money.  go to their site.

Prior to the earthquake, it was difficult to get young doctors and nurses to serve in these areas, and the Nepal government was actively supporting various schemes to do so. Since the earthquake, I have read various USA editorials about “rebuilding Nepal’s health system” and frankly, some of these were by International NGOs that had only a minor presence in this country before the quake. I have worked with Nepali people since 2007 and in a future blog I will throw in my two cents. Briefly, Nepal has twentyeight million people with about twenty medical schools, hundreds of nursing schools, and a system of hospitals in the private sector, some of which are quite new and modern. Most of the hospitals in Kathmandu survived intact; click here for more info on hospital damage assessment. The health sector has a history of extensive collaboration, and any International NGO that comes here, needs to know this. Resist sloganeering.


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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2 Responses to First-hand eye-witness description of nursing needs in earthquake-ravaged area of Nepal by a Nepali-American nurse

  1. Mel Venn says:

    Great post Joe. I’ve been volunteering here (in Dharan, E Nepal) as an ED doc/mentor for the last 4 months and I wish I had read some of these before I came! Had the privilege of meeting and working with NurseTeachReach and agree they are doing amazing work helping Nepali nurses to up-skill and provide better care.

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