More #thrashing incidents in #Nepal Oct 8th, a registry and data collection system is sorely needed!

There was more news over the weekend, the bad kind of news nobody wants to read.

The Nepal Medical Association published a letter to the government:

NMA Oct 9thHere is the translation, roughly. My friend in Nepal used Google translate so there are some inexactitudes in the words, but you get the idea:

Press Release

The Nepal Medical Association Central Office has focused significantly on the incident that happened on October 8, 2017 at B.P. Koirala Health Sciences Institute Dharan. Despite the tremendous efforts by the doctors after informed consent during the treatment of a patient in CCU/ICU, a patient of acute MI expired and the relatives of the patients manhandled the medical team inside CCU. The Nepal Medical Association condemns the inconvenient activities, such as handling and use of abuses on the doctors and the staffs. This union asks the government to bring legal action to the people who are taking criminal mentality to get medical attention, abusive violence, and health accidents.

The recent Mahakali Zonal Hospital, V.P., due to the incident of repeatedly handling the health institution on the doctor at impulsion and excitement, can not meditate on the sensitivity of health care, can not meditate on the actual situation, impulse and excitement. Koirala has gone to the environment in health environment, including health science establishment.

Remaining the agreement between the Nepal Medical Association for the last 24 years, the Nepal Medical Association (MoU) in the presence of the Honorable Prime Minister, for the last 20 days of amendment regarding the security of the health worker and the health organization, was given by the Nepal Physician Association for the end of the hospital and according to the purpose of handling of the patients in the hospital not only for the treatment of the patient.

The alliance The task force proposed amendment is prepared in accordance with the normal passage of the corresponding legal action in the process of re-stir the Nepal Medical Association, stern action would be compelled to note also reads.

Dr. Lochan Karki

General secretary

I think we are now entering a period in which every incident of thrashing a doctor in Nepal will be publicized.

The Kathmandu Post published the following news from Kanchanpur:

Oct 9, 2017-Service except for emergency at Mahakali Zonal Hospital in Kanchanpur has been halted from Sunday morning over health worker’s protest against an attack on them.

mahakali emergency room

The entrance to the ER at Mahakali Zonal Hospital. Typical hospital construction for government hospitals in Terai.


The health workers including doctors have taken to the streets to protest an attack on them by the family of a woman, who was admitted to the hospital for delivery, and gave birth to a stillborn child on Saturday night.

The family of the mother blamed doctor’s negligence for the incident. In the attack, a police personnel deployed in the hospital was injured.

The enraged family assaulted in rage Dr Satya Prakash Koirala following the incident, said the Hospital Development Committee Chairman Ashok Pandey.

Meanwhile, the police arrested five protestors in connection with the incident. Investigations were on, said Deputy Superintendent of Police Gyan Bahadur Setti. RSS

Published: 09-10-2017 14:12

BPKIHS incident

In Nepali language:

Motorcycle helmets

This comes at a time when some doctors are still protesting the recent deal between NMA and the government. They do not feel adequately protected, and as a protest decided to wear motorcycle helmets during daily rounds:

Systematic data collection is needed

It is clear that a systematic registry is needed at this point. There need to be decisions made, based on the facts not sensationalized details poorly reported by the news media. The policymakers need to get more data than just what is being published. #Jailwithoutbail is a start and needs to be implemented immediately – the police role in preventing these incidents needs to be clearly spelled out. There are too many factors at play to make a clear one-size-fits-all policy.

Things that can be done right now:

Here is a link to a site titled “Preventing Workplace Violence: 10 Critical Components of a Security Plan”

They list:

  1. Identify tools you might use to secure your workplace. Include physical barriers such as fences and gates, access control systems, door locks, security guards, and video surveillance.

  2. Create a facility map that marks all doors, security cameras and stairwells. This will help law enforcement in the event of an emergency. It will also help you determine the best place to deploy security assets, such as cameras.

  3. Devise a plan for access control. Consider using keys that cannot be replicated or cipher locks that require a code. Electronic access cards are another good option. They allow you to disable a terminated employee’s card without having to issue new codes to everyone. This system also enables management to limit access to certain areas. However, they are expensive and can be stolen. A more expensive option is a biometric system, which uses physical characteristics, like fingerprints, palm prints and iris patterns. This system is ideal for a high-security facility.

  4. Ensure security cameras are positioned where you need them. A surveillance system can both deter criminal activity and provide valuable information about who enters and exits your facility.

  5. Consider hiring security guards. Many facilities contract with security companies to provide guards. These guards tend to focus on screening and assisting building visitors.

  6. Address how to secure particularly vulnerable areas. These include locations where visitors can enter freely or with little scrutiny. This might be the waiting area in a doctor’s office, the lobby of a law firm or the loading dock of a trucking company.

  7. Conduct a periodic review of security measures. The review should ensure that doors are closed or locked as needed, that locks are functional, and that guards are properly screening visitors. For example, sometimes doors designed to keep intruders out don’t close completely, rendering their locks useless. Employees may not report this because they appreciate the convenience of not having to use their keycards. A periodic review can identify these issues and determine how your security plan should be modified to address them.

  8. Devise a plan for communicating with employees in the event of a security emergency. If a visitor turns violent, or a fired employee returns to retaliate, what doors will you lock? How will you warn employees to seek cover? Where can they go to not only avoid harm but to escape?

  9. Create a system for tracking security issues. If an employee reports that her ex-husband is stalking her in or around the facility, do you have a process for communicating that information to your front desk so they can watch for him? If an employee finds a door open when it shouldn’t be, does she just close it? Or does she report it so that you can investigate whether this happens a lot and adjust your security measures? The system for recording security issues doesn’t have to be complex. Purchase a simple logbook from an office supply store or record your data in a spreadsheet. Your security plan should detail where this log will be kept and who will be responsible for updating and reviewing it.

  10. Designate a spokesperson to issue communications in the event of an incident. The spokesperson should be able to speak intelligently to the media, the public and employees’ relatives. Choose a person who would be able to impart the facts about an incident and convey concern for victims and their relatives. In more complicated situations, a public relations professional can help you craft a message for the media.

Similar advice has been reprinted here in the past. time to do it while we await action  by the government.

CCNEPal, the owners of this blog, has been teaching critical care skills to doctors and nurses in Nepal since 2011 and from the beginning we included practical information as to how to minimize the threat of thrashing. The book The Sacrament of the Goddess, explores the issues surrounding thrashing as well. Since 2011, progress has been made; at least now the problem is not being ignored or swept under the rug or simply blamed on the doctor.

But there is a long way to go…..


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 and tagged , , , , . Bookmark the permalink.

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