What nurses and doctors need to know about the patient in eastern Nepal pulled from Ambulance and murdered Sept 11th, 2015


Every nurses and doctor in Nepal has probably already heard about the patient that was thrashed and killed by a mob in eastern Terai Friday.

(Kathmandu) The Red Cross in Nepal expresses its deep concern at increased incidents of vandalization of ambulances in relation with ongoing demonstrations in Terai/Madhes in the past four weeks. The incident that happened on 11 September 2015 at Sonukhada of Mahottari district has astounded the Red Cross – an injured person in need of urgent medical care was taken out from the ambulance and killed; the ambulance was then torched.  https://www.icrc.org/en/document/nepal-injured-people-and-medical-transports-must-be-protected-all-circumstances

“Astounded” is not a word or phrase that the Red Cross uses lightly.

Yes, the man was a police member.  Yes, he was also a dalit  – a member of a caste that has suffered poor treatment; YES, he was a family man with two children; and a son. But most of all, he was a Nepali citizen from Nepalganj who was defenseless. He already had twelve stitches on his head.

Cadre

Here is a small thing that has bothered me. The young men and boys who participate in these demonstrations are often called “cadre” in the newspapers. This is not the right word. “cadre” implies that they are politically indoctrinated and trained –

:  a nucleus or core group especially of trained personnel able to assume control and to train others;

These guys are far from trained and disciplined. Can we find a better name? Maybe “follower” or something like that. “Cadre” elevates them higher than they really are.

Some questions about the police decisions

Why was there no police escort?  Why was the ambulance the only vehicle? How did the mob on the side road know he was coming? Will the police and army now take additional steps to make sure their vehicles are safe?

Click here to read a news account of the way that businesses and factories are being targeted in Biratnagar, the  industrial heart of Nepal.

The Asian Human Rights Commission issued a report Sept 11th that said (in part):

Moreover, the State needs to think about the scale and nature of the escalating protest. The situation is more dangerous than the State thinks. Most of the rural areas of Nawalparasi, Kapilvastu, Rupandehi, Parsa and Bara are extremely tense. Because of the excessive use of force by police, people are angry and more violence can erupt at anytime. So far, 31 people, including 10 police officers, have been killed due to the ongoing protests and resultant violence. And, violence only seems to be increasing in Nepal’s Terai. Click here to find the field report prepared by the Terai Human Rights Defenders (THRD) Alliance about the reality of violence in Terai in the last 2 weeks. http://www.humanrights.asia/news/ahrc-news/AHRC-STM-152-2015

There is a webpage called Madhesi Youth. They publish reports as well. Most of theirs are in Nepali.  http://www.madhesiyouth.com/human-rights/reports-on-human-rights-violations-in-Nepal/

What can Be Done?

Long before this happened, I was teaching about a skill known as “situational awareness.” After reading the statement from the Red Cross, I decided to Google the Red Cross  and see if they had any recommendations about ambulance safety.

About the Red Cross and Ambulances

The Red Cross works in Africa and the middle east, and the situation is different there.  Syria, Yemen, Somalia, and places where armies are using machine guns and artillery supplied by outside countries. Suicide bombers are active. These are active war zones, and military weapons are widely available. The bloodshed here in Nepal is shocking to people in Nepal because it goes against the image we all want to have, but on the scale of things Nepal  is not as out of control as these other parts of the world, where for example, fifty people per day may get blown up.

For nurses and doctors?

The psychological toll of being threatened by violence, such as when you are working in an ER, is tremendous. In the long run, nobody will want to work in affected areas. People will get out.

Health Care in Danger project

The Google search led me to the section of the ICRC site that deals with ambulances and hospitals that get caught in the middle.

Towards a solution : The Health Care in Danger project

Health Care in Danger is an ICRC-led project of the Red Cross and Red Crescent Movement scheduled to run from 2012 to 2017 and aimed at improving the efficiency and delivery of effective and impartial health care in armed conflict and other emergencies. This will be done by mobilizing experts to develop practical measures that can be implemented in the field by decision-makers, humanitarian organizations and health professionals. https://www.icrc.org/eng/what-we-do/safeguarding-health-care/solution/2013-04-26-hcid-health-care-in-danger-project.htm

Browse this link

On the ICRC site, are links to a dozen or so publications related to this.

https://www.icrc.org/eng/what-we-do/safeguarding-health-care/solution/2013-04-26-hcid-health-care-in-danger-project.htm

Videos

The Red Cross has some videos as well. These tend to focus on Africa.  The first is short  -just 3 minutes and 21 seconds. Health Care In Danger: Seeking solutions video https://youtu.be/tknwQDlZx2I

The socond is longer, about an hour. Health Care in Danger: the way forward https://youtu.be/EvLLMhBngZI

In this thought-provoking event, part of the ICRC-led Health Care in Danger project, the panel discusses a range of practical steps that can be taken to address the critical humanitarian challenge of violence against medical care, and save the lives of thousands of people around the world. Featuring speakers Dr Bruce Eshaya-Chauvin Medical Advisor, Health Care in Danger Project, ICRC Geneva, Paul McPhun Executive Director, Médecins Sans Frontières – Australia, Dr Sarah Miller Clinical and Forensic Psychologist & delegate with the International Red Cross Red Crescent Movement.

The recommendations are similar to things I already described in past blogs.  Not every preventative measure applies to Nepal, but it gives examples of how to plan.

Please everyone step back and stop and think of who you are hurting. Like everyone else who is following the news, I want the violence to end. From the beginning I have thought that all parties needed to talk and be open to dialog. I am holding my breath, hoping that things will calm down.  Further problems in Terai will impact every doctor and nurse, and certainly make it harder for every one who needs a doctor or nurse.

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.
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One Response to What nurses and doctors need to know about the patient in eastern Nepal pulled from Ambulance and murdered Sept 11th, 2015

  1. Pingback: A simple idea for the Nepal Government to seize the initiative in Terai and silence the opposition | The Sacrament of the Goddess – a Novel of Nepal

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