CCNEPal report of critical care training August 13th 2016


It was good.

More detail?

Original goal for summer 2016 was to teach as many sessions as possible, focus on areas of Nepal outside of Kathmandu Valley, while yet minimizing bus travel.

Each session is two or three days in length, and consists of a variety of short lectures and discussion punctuated by “megacode” – simulated critical situations requiring a team response and return demonstration of specific scenarios. Here is an example of how the group breaks into “megacode” activities:

(above video shows  how the class divides into five groups for practice of scenarios)

At each location, I was humbled by the hospitality, support and enthusiasm of my hosts and the students.


Dr Umid Shrestha of Pokhara is a faculty member of Manipal College of Medicine and a supporter of upgrading the nurses role in critical care in Nepal. He has supported CCNEPal from day one.


The means of deciding where to go was the same as in in past years. I announce my dates of availability on FaceBook and people contact me. I see what can fit the schedule. I email individual places that were on the waitlist of previous years to remind them I’m coming back. And it happens. It was amazing to see that based on word-of-mouth, I could refill the schedule at a moment’s notice when something changed.  Every session but one was full – (there was one session for just five MBBS students in Biratnagar that fell on Eid).

Please note: If I return in 2017 I will again use FaceBook to announce the dates.

The list of venues was:


Paschimanchal Community Hospital


Tina Byrnes of “Phect” joined me in Pokhara to see my ing methods. She is a nurse frm OZ now working at Nepal Burn Center and I returned the favor by collaborating on a session later in the summer.


Charak Community Hospital


College of Medical Sciences


The College of Medical Sciences Teaching Hospital in Bharatpur operates one of the busiest Emergency Rooms in Nepal. They first hosted me in 2011.

Pushpanjali Community Hospital


Janaki Medical College Teaching Hospital ((JMCTH)


Janaki Mandir is a major Hindu site in Nepal. the BBC documentary “Last Train in Nepal” was filmed here.

Janaki Health Care Center and Research Center (JHCRC)


Here is a BBC documentary from a few years back that portrays a fascinating view of life in this region of Nepal.

JHCRC was my host in Janakpur. They were at 100% occupancy while I was there.


Dr Raman Mishra (L) was my main contact in Janakpur. He was educated in Varanasi and practiced in Chandigarh India prior to returning home to Janakpur last year. In this photo, he is beginning the day with rounds accompanied by his entourage.


Nobel Medical College Teaching Hospital


Nobel Medical College is a major complex and they provide comprehensive services including a cath lab

Nobel has  committed to the use on education, investing in equipment and a training hall.


the main training hall at Nobel Medical College


Chitwan Medical College


Bir Hospital School of Nursing,

Norvic International Hospital, and

Nepal Burn and Cleft Palate Center in Kirtipur


The “HDU” at Kirtipur is the most active critical car unit for burn victims in Nepal.

Total number of certificates awarded:

715 – including nurses, MBBS, Medical Officers, Health Assistants, and Nursing students.

Number of sessions:

24.  Most weeks I worked six days per week.

Travel days

six. Instead of staying in Kathmandu and going out-and-back, out-and-back, I did a circuit.The longest was from Biratnagar to Bharatpur.

Cumulative totals:

from previous years, 2170 participants in 70 sessions.

2170 + 715 = 2,885 participants.

70 = 24 = 94 sessions


The fundamental challenge of acute care in Nepal right now is that the hospitals are installing critical care units but the nurses and junior doctors are not trained to conduct their activities at the skill level required.

Nurses do not read ecg. Nurses have a superficial knowledge of equipment such as bag-Valve-Mask devices or ventilators. The primary system of nursing education teaches “Functional Nursing” which is the antithesis of the critical thinking required to assess and evaluate nursing care to a critically ill person.

Junior doctors, likewise, are not given any kind of formal ecg class, nor do they do BLS or ACLS training. During the internship year they may be conducting the team response to a cardiac arrest but have never been trained as to the protocols in any practical way.

Overall cultural factors tend to work against interdisciplinary collaboration due to the perceived role of women.

This continues to be a gap in health professions education in Nepal. The overall education system is theory-based and there is no transition to the practical-based focus exemplified by BLS, ACLS and the like.

Future Directions

CCNEPal will continue to advocate for inclusion of BLS and ACLS-type training in undergraduate nursing schools, including PCL programs.

CCNEPal will endeavor when possible, to introduce these methods to faculty as well as critical practitioners.

CCNEPal will identify leaders who can teach this themselves.

CCNEPal will introduce the teaching methods and skills to as many medical colleges in Nepal as possible, and advocate for course placement in 4th year of MBBS or at start of Internship year after MBBS.


quite a bit of the class is devoted to elementary ecg and how to incorporate it into overall assessment. Any person who says ecg is not a cornerstone of critical care, does not know what they are talking about.

CCNEPal will continue to share information about Nepal with medical and nursing schools in the west as well as with individual persons wishing to collaborate with Nepali health care organizations.















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.
This entry was posted in medical volunteer in Nepal. Bookmark the permalink.

2 Responses to CCNEPal report of critical care training August 13th 2016

  1. gaihreshobha says:

    I m interested to be part of u training programme.I m nurse and have been working in national trauma center bir hospital..plz may i know the date n time

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s