Hospitals in Nepal Terai and elsewhere need to keep their workers safe Sept 2 2015

update:  a short video about the incident in Rajbiraj Zonal Hospital

This will be brief.  And this blog entry does not take sides in the current Andolan. It is my prayer for Nepal that everyone will live long and prosper.

This scene is not pretty. For the nurses and doctors who read this blog, the only certain thing is - casualties will be headed to the emergency ward, and so will the adversaries!

This scene is not pretty. For the nurses and doctors who read this blog, the only certain thing is – casualties will be headed to the emergency ward, and so will the adversaries!

The above photo was taken in Terai. When I copied it, I forgot to note the source – I apologize for not citing it. The photographer was brave.

Be sure to click on the underlined words, or the blue words – they are hyperlinks. They make the reading more in-depth.

The Problem #1: In Terai, victims of thrashing, tear gas, shooting with bullets (“rubber” or lead), and other trauma are brought to the nearby hospital. (warning, link shows events in Birgunj, it’s graphic)

The Problem #2: Some cases have been reported that people from other groups have followed in to the hospital and looked for victims, then thrash them some more.

The Goal: maintain security of hospital, treat all patients regardless of political affiliation, keep staff safe.

September 5th update: I wrote a blog about the riot control squads and latest developments in Birgunj, in a separate website. click here.

The plan:

  1. review the physical construction of the building. Limit number of access points, install steel grates, lighting, etc so that it’s not so easy to get in. see the previous blog for a long list of ideas. It has a checklist from “Secure by Design” that is excellent. Put locks on internal doors such as the ones between wards, and develop internal escape routes.
  2. Develop a system to  alert people if a problem occurs, not just the other staff, but also the chowkidars, administrators, and police.
  3. If the Army is there, meet with the in-charge so they know who you are, before trouble starts.
  4. put phone numbers in your smartphone on speed dial.
  5. secure anything that might be grabbed and used as a weapon.
  6. discuss ways to de-escalate angry persons and run a practice drill.
  7. learn about treatment of tear gas exposure, the types, and decontamination. (it’s a powder and if it’s on the patient you may get exposed).
  8. develop a triage plan for mass casualties. There are some excellent videos on triage! Be advised, the system to process wounded people is not the usual. You can’t just start with first-come, first-served. You need an Incident Command System.

Safeguarding health

There are many places on the internet where you can get advice about personal safety. I recommend “Safeguarding Health.”  They work in countries where there is an actual war zone – let’s hope Nepal never gets that way!

On their website it gives the following statement:

During armed conflict or civil disturbances, assaults on health facilities, health workers, and the patients they serve are all too common. Aside from the human toll they take, these attacks compromise the ability to deliver care to populations in great need, impede efforts to reconstruct health systems after war, and lead to the flight of health workers whose presence in a time of great social stress is essential.

The risks of being a health worker on the frontline

During periods of armed conflict, health workers are at risk of:

  • Torture, abuse, kidnapping, and other human rights violations for treating patients on either side of the conflict
  • Poor mental health and well-being due to living in troubled locations with the constant threat of attack
  • Lack of supplies and vital equipment due to systematic raids
  • Forced displacement due to attacks and fear of continued violence.

These dangers contribute to critical shortages in human resources in areas where care is most needed, as well as decreased efficacy of health professionals, wastage of millions of dollars in aid, and loss of human capital through migration.

Obstructions to routine health care delivery

Assaults not only result in obstructed access to health services but pose a formidable challenge to health systems, limiting the effective operation of health systems during instability and impeding the development of health infrastructure and meeting human resources needs once stability returns.

The legal framework for protection (editor’s note: see the comments section. The current Terai events are “internal violence” – go to the Terai Human Rights Defender’s Alliance site and learn about THRDA )

The Geneva Conventions of 1949 and the Additional Protocols of 1977 mandate the protection of medical facilities, personnel, and patients; the humane treatment of civilians; the right of access to care; and the nondiscriminatory treatment of the ill and wounded in time of war. International Human Rights Law is the only international legal framework governing situations of internal violence and continues to apply during armed conflicts.

My book

My novel, The Sacrament of the Goddess, is set in Nepal during the Civil War. Yes, there is a love story, and the reviewers so far have focused on that aspect. But the setting is a hospital, and the book tells how the people there deal with being caught in the middle of conflict. One of the key questions is “If this is a Buddhist country, why and how can such violence take place?” When I wrote it, I was not thinking we’d have a flare-up in Nepal again, but those sections are now more timely than ever. It’s on Amazon.  There is a separate blog for The Sacrament of the Goddess.


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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4 Responses to Hospitals in Nepal Terai and elsewhere need to keep their workers safe Sept 2 2015

  1. “The legal framework for protection” is misguiding and is not accurate.

    • thank you. That passage is cut-and-pasted word-for-word from the Safeguarding Health website. I agree that since the andolan is not an “armed conflict” where both sides have firearms, or at war, it does not fit. I appreciate your point. I will edit and add a note.

  2. Pingback: What every nurse and doctor in Nepal needs to know about Triage of mass casualties Sept 7, 2015 | CCNEPal 2015

  3. Pingback: What nurses and doctors need to know about the patient in eastern Nepal pulled from Ambulance and murdered Sept 11th, 2015 | CCNEPal 2015

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