Janakpur summer 2016 – part 3 – JHCRC


Two weeks in Janakpur Nepal, training nurses and doctors in critical care skills.

The first part of this series focused on Janakpur, the town in eastern Terai. It is the market town for the district, and the home of a major Hindi temple celebrating the enduring love of Sita and Rama. click here: https://joeniemczura.wordpress.com/2016/08/27/janakpur-visit-summer-2016-part-one-the-town/

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seen on a section of the wall of the Tundikhel. Health promotion info focusing on when you should bring your baby to the hospital.

The second part focused on CCNEPal’s training sessions at JMC Teaching Hospital ( “city” as opposed to “country” – JMC operates two teaching hospitals. Be advised, there are two other hospitals that are also referred to as “city”- a bit confusing!). click here: https://joeniemczura.wordpress.com/2016/08/30/janakpur-summer-2016-part-2-of-3-jmc-teaching-hospital/

And today? part three describes JHCRC – Janiki Health Care and Research Center.

Raman Mishra, MD

raman mishra

Dr. Raman Mishra was my main contact in Janakpur. He is an internist, trained in India though Janapur is his home town. He is working in an impoverished area of Nepal and his vision is to improve health outcomes. We generally met each day after work to chat about the best way to do ICU and how the training was going.  I love a “college bull session” when we discuss how to improve critical care and prevent excess deaths.

entourage

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I joined Dr. Mishra on rounds several times. He generally was accompanied by an entourage of MBBS students, Medical Officers, interns and hangers-on. Rounds start in ER, that’s where the critical patients go since the ICU is not presently opened.

Dr. Mishra seemed to be seeing several dozen inpatients each day as well as maintaining an outpatient schedule. In order to accomplish this feat, he heads a team of interns and Medical Officers. This is an important point: JHCRC is in a region that’s low on the development index ( even within the country of Nepal) but there is a system, a hierarchy, and daily followthrough.

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auscultation. Dr. Mishra always includes the family on every discussion, twice a day.

JHCRC does have it’s own web page:  http://janakihealthcare.com/

and a FaceBook page: https://www.facebook.com/jhcrc/?fref=ts

They have an active pediatric service and Neonatal ICU.

Administrative duties

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I was committed to exactly two weeks in Janakpur, and no more. Here Dr. Mishra is going over the list of attendees for JHCRC batch one. We were going to do an MBBS batch later in the week, but nurses felt “left out” from the first batch and complained bitterly, so we adjusted the schedule and poof! the second batch at JHCRC was for nurses and H.A.s

JHCRC – the complex of buildings

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The one-and-only gate to JHCRC. As readers of this blog know, focus of my work in Nepal is to mitigate violence against health care workers. Here is a built-in security feature.

the outside walls….

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the east side of JHCRC abuts one of the ponds. sort of a moat, actually…..

at night –

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inside the courtyard, at night, the ER is the door to the right.

and in the daytime

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all services at JHCRC are arranged around the inner courtyard.

my room –

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JHCRC has two guest rooms on site, in an out-of-the-way spot, for visiting doctors. I could have stayed in a hotel, but I preferred to be closer to where the activity was. The room had air con. I confess I needed it after each full day of teaching ( the classroom at JMC had fans but no air con and I was beat!)

The kitchen

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throughout the Terai, dinner is usually at 8 or 9 PM. I don’t like to wait that long, and I also like to putter around and make my own coffee early in the morning so they gave me my own key. There was also a refrigerator.

mosquito netting

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There weren’t many mosquitos and I also was taking prophylaxis, but – since it was there I slept under it. The bedroom also had air con… teaching during the day in the heat was exhausting, so I admit I used the air con every evening while I rehydrated.

dormitory for patients from distant areas

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every few weeks, an ophthalmic surgeon comes to do a flurry of cataract surgery. JHCRC has a small dorm to house the recipients for a few days – so they can be accessible to followup despite living a distance away. I thought this was a nice touch.

the New ICU under construction

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The new ICU at JHCRC. during the past few years, JHCRC has been the “go-to” with high occupancy rates. It was finally time to invest in ICU construction. They were adding the finishing touches while we were there.

the JHCRC courtyard

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participants in CCNEPal training

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the first session of JHCRC. this was a smaller batch than usual for me, due to space considerations. They worked hard and helped each other.

JHCRC leadership

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The CEO of JHCRC is Dr. Surendra Yadav, MD. He led the setup of the system of health posts that are part of JHCRC, funneling patients from the rural areas to the hospital when needed.

Dr Baghat

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Dr Sarban Kumar Bhagat of JHCRC was the on-site administrator. Here he’s talking with the class about the certificate.

another view of soon-to-be ICU

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a panoramic shot of the ICU space while it was set up for training purposes. piped in oxygen and suction; air con; and big fans overhead.

The second batch

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the second JHCRC batch, in the soon-to-be-opened ICU. In Nepal, men aren’t allowed to attend nursing school – they attend “Health Assistant” training instead.

time to move to next location, but not until a few formalities….

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at the end of two busy weeks, I got “felicited” – which of course, I love.

 Token of Love

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My”Token of Love” from Janakpur was a silk screen done in Maithili style (note the iconic eyes) depicting a wedding. I shall cherish this!

In Summary

Janakpur is the hub of a fascinating region of Nepal, not on the beaten track for western tourists.  There are other hospitals besides JMC TH and JHCRC, including a large and busy zonal hospital. But without JMC and JHCRC they would not be producing health manpower likely to stay in the region.  Janaki Medical College hosts many doctors from India; but very few from western countries  For teaching purposes they are interested to host more and to participate in international exchange.

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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2 Responses to Janakpur summer 2016 – part 3 – JHCRC

  1. raman mishra says:

    It was such strange thing for me that Janakpur didn’t have an ICU…..so many of preventable deaths in this region couldn’t be prevented …i just knew that I’ve to do it once I came back from India …its been just beyond a year with the help of people like you, I believe we can do it ……and my ICU is going to be much different from those corporate icus running only for profit motive…will keep u updated .

    • thank you for these. Please consider writing an entire blog entry. I will publish.

      There are many factors that contributed to Janakpur’s situation, not the least of which is the low development index and general level of poverty (defined by me as lack of access to cash money). I was honored to have gone there.

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