Biratnagar 2016 excursion part 2 – the sessions

In summer 2016 I spent two weeks teaching in Biratnagar, Nepal. Though it’s the second-largest city in the Himalayan country, it’s not on tourist path. In the first part of this series I described a few things about the town. Here is what the teaching was like…..


the suite of rooms included many tables with green drapes. Nobel has just purchased a set of simulation manikins and they are developing the simulation capability. For my own sessions, I only used the equipment I brought (plus borrowing a defib and a monitor and I was careful not to let the students play with the new tools). What was under the drapes, stayed under the drapes.

Nobel got their manikins from “General Doctor” a company based in Shanghai. here is their website:

The Classroom Space


panoramic view of classroom space. I asked them to bring the beds, for the small group work. the space was ideal for our training and I recommended to them to keep the beds there. in this pic, the groups are working on scenario practice, a key component of all such courses.

Lecture time


Nobel Medical College Teaching Hospital has a suite of classrooms including a very large and modern space for skills training. One end was supplied with chairs and a white board. we could jump from one configuration to another seamlessly.



from the outside, the suite of classrooms is nondescript, as a matter of fact, to get to it you needed to walk through an area under construction so it had a sort of abandoned feel. But it’s on the hospital end of the large building complex. Once you got inside it was nice. It is a fine setup for teaching

Simulation equipment, anatomically correct


okay, so when you invest money in a complete set of simulation manikins, you get the ones used to prepare nurses and doctors for Labor and Delivery. Post-partum hemorrhage is a leading cause of maternal mortality in Nepal, and a a good outcome requires a successful team response. In Nepal, a training certification effort known as “Skilled Birth Attendants” uses these. In this regard, using scenarios to drill on delivery will lead directly to better outcomes. Nobel Medical College is to be commended for their commitment to training that will benefit the region.

Simulation equipment

Effective use of the defibrillator is enhanced when you train on the device you will use in clinical practice.


on the first day of class, the MBBS students arrived in their clinical uniform which includes a necktie and a white lab coat. Here, they are reviewing use of a defibrillator. please note that the paddles are disconnected from the power source, for safety.

My contact person from the anesthesia department


my contact person was Dr. Bandana Paudel of the anesthesia department. She had trained at Nepal Medical College in Jorpati, and we both knew Dr. Gautam Bajracharya, one of my favorite docs in Nepal. For me, I love it when I meet a new person whose sense of humor matches mine. Dr Paudel is a champion of hands-on training in Nepal.

One of the defibrillators


Nihon-Kohden. Nobel has a cath lab and this is their “go-to” machine. in combination with my Pinnacle Technologies AT-35 rhythm generator, we gave students confidence in this machine.

second MBBS batch


after Day One, the Nobel College MBBS group got hip and arrived wearing the polo shirt (non-clinical) uniform, more comfortable in the heat. Al the Nobel groups shared one characteristic: they were incredibly focused. By that I mean, you could hear a pin drop when I was lecturing; they took good notes; they jumped to do the things I asked, and there was no horsing around. Some days were really hot, and they worked hard with no complaints even though everybody was sweaty. And I almost forgot: one of the MBBS batches included a subgroup of Maldivians. I gave them permission to act out the scenarios in the Maldivian language. Which they did. It was fun.



Dr Paudel maintained an anesthesia clinical schedule while the sessions took place, but I laughed when she came to help. She was the only colorful person in a sea of black-and-white. Please don’t misconstrue this comment – Dr Paudel uses the fuchsia outfit to command attention – in USA we would call this “power clothes.”

helping out my friends at Center for Medical Simulation


I gave out brochures for the classes offered by my friends at the Center for Medical Simulation in Kathmandu, Nepal’s only “Official” International Training Center for ACLS with the American Heart Association.

Lunch al fresco


on teaching days I preferred not to go all the way to Guest House to eat, so I shared meals at the canteen. This was quite pleasant. I always tell people “No, I’m not teaching under a grass-roofed hut somewhere!” but, I did eat a few meals under a thatched roof.

five assistants


for each session, I recruit leaders from among the group. Here are five who served as “my assistants” for one of the nursing sessions. And Shahruk?  ask me about him sometime when we meet again.

Nursing staff


Jamuna Bhatterai is Matron of Nobel Medical College Teaching Hospital and also campus chief of nursing college. she has a M Sc degree from BPKIHS and she participated in the role play. The puggri? it is not worn in this region of South Asia as a rule, but – it’s fun. And since she is “in-charge,” she also wears it as “power clothes.”

one of the group shots. I taught twentyfour sessions overall,  of which six were here. Two hundred trainees at Nobel – wow. On the FaceBook page, one album shows all groups. I always stay until everyone gets a photo with me if they like.


One of the nursing sessions. The first batch of nurses were really fired up about what they learned. This created a dilemna because the ones unable to go complained. So the administrators asked if we could add a session. Which we did. They approached the training with a wonderful attitude.

acting worthy of Bollywood


As always, we did the “family counseling scenario” on day three. I’ve written extensively on this in previous blogs. The nursing groups at Nobel Medical College included excellent acting, but – the amazing thing was that they met the challenge by applying some very specific things from their own customary practice. Probably the top two of the best executed responses in the whole time I have used this scenario. I was blown away.

Training with the work team


part of the cath lab crew. Biratnagar does caths and pacing; you would have to go all the Bharatpur to find the next place in Terai (BPKIHS in Dharan also does these procedures). Over the three days they did  about forty scenarios together. When they next have a critical situation in clinical, they will be a team.

Role Play scenarios


we don’t normally give the security guards much thought, until we need them. The “Gorkhali topi” is widely worn by chowkidars. Recently I read that this is considered a stereotype by members of the Gurung ethnic group. Okay. I’ll come up with better props for next year.



at the end of more than two weeks, we had a “felicitation” ceremony in which we acknowledged the work done by all the nurses and doctors. They gave me some nice “tokens of love.” Here I am with Mr. A.G. Singh, the Principal of Nobel Medical College. ( and Jamuna Bhatterai, the hospital Matron)

At the end of the time in Biratnagar,  we had a gathering in which we memorialized the effort. This is a expression of collegiality in Nepal, and I get boxes of these “tokens of love” by the end of the summer. Call me if you need some Nepali bric-a-bracs.  I hope to return to eastern Terai in future travels.

Part three of this series will show the critical care units and a bit more about the hospital itself.


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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