Please — no rock crushers and no pies.
I was thinking of titling this “I’m going away and I expect that you won’t screw things up while I am gone” sort of like the mom in The Cat in the Hat. And, I haven’t actually left yet. Not until May 8th.
And no, it’s not a GBCW.
Well now — DailyKOS is not the ones who got us into this mess — and I’m hoping you will keep the pressure on and help us get out of it.
As for where I am going and what I will be doing? In the past on DailyKOS, I wrote about the pre-Byzantine politics there, including a long series on the “Petrol Blockade” in 2015 which continued for four months and heightened the awareness of issues between Nepal and India, it’s southern neighbor. For now, get your shots; present your pass port; go through the Departure Gate; and read below the fold….
I am an RN here in USA but these days I also have a nursing license in the country of Nepal. I teach nursing in USA, and the job allows me to have the summers off. Oh, I could teach summer classes here (I love what I do), but my soul needs to do something different in order to renew after the two action-packed semesters of the school year. So since 2007 I voluntarily teach nurses and doctors in Nepal instead.
I probably work harder when I am there than I do when I am here.
I will spend the bulk of the time at the College of Medical Sciences in Bharatpur/Chitwan Nepal. This medical college operates a 700-bed teaching hospital along with outreach centers etc. When you say the name of the country, most people conjure up an image of doctors who go to some kind of Sherpa village in the Himalayas. Because after all, that’s where Everest is located.
Nepal has thirty million people, and only a few of them live in the Himalaya. So — no. For me to personally deliver health care,even in a scenic location with unique culture, is not the point (anymore). It’s to train the Nepalis to deliver the health care.
When you read about groups of Americans bringing their skills overseas, it’s exciting but it’s not the best way to expend resources except in some specialized areas.
The Terai
So, instead of the mountains I go to the Terai, the flat hot humid plain near the border with India. Half the population lives there, and the Terai is the place where the general health outcomes are the poorest. And like the rest of Asia, urbanization is a trend that isn’t going away. The Medical College I affiliate with tends to produce doctors who stay in that region, more so than other medical colleges.
The life expectancy of a person born in Nepal has improved, but in the Terai it is about twenty years less than in Kathmandu.
Heart Disease
The Nepal “health system” has been changing rapidly over the past fifteen years. Formerly, like most developing countries, the focus was on infectious disease and maternal-child health. These days the profile of illness approaches a similar appearance to that of the West. The biggest one is smoking-related heart disease, exploding in the country. In Nepal the youth have a high rate of smoking and it is easy to predict that this will lead to an explosion of heart disease. The focus needs to be on prevention of this addiction, but right now they also need to upgrade cardiology services. That is the first of the two main initiatives I am involved with. Though I teach in a basic nursing program leading to an Associate Degree, I still think of myself as a critical care nurse because that is what I did (and taught others to do) for fifteen years, and in Nepal I teach critical care skills to nurses and doctors.
Advanced Cardiac Life Support
I use the protocols of the American Heart Association, adapted to the current medical practices and availability of equipment in Nepal. the training consists of a three-day intensive course, repeated over and over. The course is more than the content — it also relies on the delivery method, designed to promote independent initiative and team problem-solving in a simulated emergency. This last is new; Nepal is a “collectivist society” where the group relies on consensus, as opposed to the cowboy mentality of USA. and successful emergency resuscitation requires breaking social norms. The idea is to impart a sense of “agency” to the boots-on-the-ground personnel to address unexpected situations as they arise. This is new to Nepal. I did not invent anything in particular but I have helped popularize the approach there, modeling a style of teaching that is considered to be revolutionary though in USA we have taught ACLS this way for forty years.
Thrashing
One component of what I teach is “situational awareness.” This is an unexpected focus of the training, one which I did not anticipate when I started this project. When I began going there I was perplexed by the degree to which local personnel avoided participating in emergency response. Turns out that there is a long and well-documented history of “thrashing.” In brief, a person is critically ill and brought to the Casualty Room ( what we would call the E.R.). If the resuscitation attempts are unsuccessful the relatives assault the doctor. Turns out hat this is a phenomenon throughout South Asia. It is a pervasive issue, causing young doctors to shy away from practice in rural areas. From the beginning, I teach people the strategies to protect themselves. This includes role-play of a thrashing incident and debriefing.
Never Ending Peace And Love?
When I write about this, I invariably get responses to the effect of “Nepal is a peaceful Buddhist country, what you are describing is not true!” and my reply is, “You may think so but that is because you probably stick to the touristy areas and have no idea of what goes on in places where the tourists don’t go.” Ask any Nepali nurse or doctor and they can describe their own personal experience of this problem. In India not long ago there was proposed legislation to allow doctors in the E.R.s to carry handguns for self-defense. In Australia a similar set of issues led to the passage of a #JailWithoutBail law.
Because of this focus on situational awareness, I have a sort of cult following and the word-of-mouth makes my training sessions popular ( which amuses me to no end, but also makes it rewarding) and a few E.R.s in Nepal have used the recommendations to re-organize the way they respond.
I’m not the only person working on these issues but I still think that what I teach is producing a good effect. Over the eight years of this project, the needle has moved and progress has been made.
update: I will be able to read DailyKOS. so — keep the language clean even though I am gone. Also, I generally write about the medical boots-on-the-ground in my own blog — follow me there at www.joeniemczura.wordpress.com or the FaceBook page for what I do (lots of pictures there).
So — I will see you on the flip side. And — would you please manage to fix our current national crisis before I get back?