Biratnagar Part three – a few scenes of Nobel Medical College August 2016

This is the third of a series about the two-and-a-half weeks I spent teaching critical care skills at Nobel Medical College in Biratnagar Nepal. I taught 200 nurses and MBBS students and doctors, there.

When I posted the blog about the Nepal Burn Center, my friends from Nobel sent me a reminder that they also participate in the Nepal Burn Network and collaborate with ReSurge International. In fairness, Nobel has a wide range of services including cardiac catheterization lab, and they participate in many international initiatives. But I’ll keep this short and pictorial.

This one will describe a bit more about the ICU at Nobel.


Nobel Medical College in Biratnagar has a majestic driveway, and it is a nice touch that the designers left the chautara at the beginning intact.

Resource Nurses


the two nurses in dark green are “resource nurses” – in a role similar to “in charge.” The ICU at Nobel is about 30 beds, but the physical layout is somewhat unique compared to most ICUs in Nepal. ICU is a series of rooms, with about five beds in each. each of these pods is semi-self-contained, but the nurses in the resource role float from room to room. Srijana (on the right) had taken my course at Hotel Namaskar ew years back and I was delighted to see her again. she was one of my “assistants.”

The census


one of the census boards. This is publicly viewable, which would be a no-no in USA, but still okay in Nepal.



for the in-charge nurses, the day begins with report on the status of every patient

Medicine Preparation


bedside medication. they tried to stop me from taking this pic “it’s never this messy!” but I wanted to show how it’s set up. Meds are purchased by the family as ordered, using the pharmacy downstairs, and brought up to the patient’s bedside. There is also a stock medicine cart for emergency meds.

Room set up of ICU


the stock emergency med cart is against te back wall, left of center. nobody uses abbojects in Nepal, it’s all in ampules and vials. The patient on the right is being ventilated. The head of each bed is detachable. In this particular hospital, there was no distinguishing features of the room to remind you which of the six rooms you were in.

In the above, if you look closely you can see that one nurse is hanging an IV on the same pole that holds a syringe pump. Here, they have piped-in oxygen and compressed air and well as wall suction.

the inpatient pharmacy


when the doctor orders a medicine, the relative takes the scrip to the inpatient pharmacy where it is filled. always busy. these pharmacists did one quirky thing: hen they opened a carton or extra packaging, the trash went to the floor and stayed there – at times they were walking on accumulated trash six inches deep. they collected it during the slow times for disposal.

family waiting

Every patient is expected to have family available. I did not tour the ICU at night ( I realize I should have) but during the day the family waited outside ICU at the adjacent inner courtyard. it always reminds me of a bus station.


One of the families, waiting outside ICU. the sleeping pad is rolled up.

Emergency Room

panoramic shot:


Panoramic view of ER at Nobel.

I took a tour of the Emergency Room at Nobel, and made a short video. It’s a large open bay with about thirty beds, so I was interested to learn how they organized it. When a western person sees any such place, the first reaction is usually “OMG!”  but there is a system that goes with it. They use the “Australian Model” –

Time passes


at the end of the time in Biratnagar, the farmers planted the entire paddy behind the guest house, as well as others. during this period, it’s like the hospital is an island in a large lake that’s only six inches deep. I left one day before the torrential rains began for monsoon 2016.






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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