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/
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
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.
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.
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.
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
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….
the east side of JHCRC abuts one of the ponds. sort of a moat, actually…..
at night –
inside the courtyard, at night, the ER is the door to the right.
and in the daytime
all services at JHCRC are arranged around the inner courtyard.
my room –
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!)
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.
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
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
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
participants in CCNEPal training
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.
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 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
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
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….
at the end of two busy weeks, I got “felicited” – which of course, I love.
Token of Love
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!
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.