What Joe the Nurse Saw in Nepal
"I spent 15 years of my career doing critical care," said Joe Niemczura, MSN, RN. "Sure, I can run hemodynamic monitoring ... But, if you have a high-tech background in nursing, just throw that out the window. In Nepal, they don't have hemodynamic monitoring, they don't have PIC lines. They don't do TPM. They're new at giving insulin because they have trouble with refrigeration. The amount of technology an American hospital has is roughly the same amount they don't have in Nepal. Amazing."
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A Magar woman stays with her child, a hospital patient. |
Spending three summers, most recently this past one, in Nepal has been an eye-opener for this nurse who spends most of his time as an instructor at the University of Hawaii-Manoa, on the island of Oahu. He takes that same teaching expertise to Nepal, with some revisions. "[In Nepal] I supervise students in the clinical area," explained Niemczura. "The nursing system there is built around very old-fashioned, functional nursing; it's task-oriented. I help to teach the tasks." He also tries to hone emergency response skills among the nursing students. "I want them to get beyond functional tasks, and learn to be responsive to changing conditions."
Burning Changes
Changing conditions are exactly what Joe encountered himself. Despite being heralded as a "snake bite expert," Niemczura found himself moved to the pediatric burn care unit. Ah, burn care. It comes up often in conversations with nurses working in challenging healthcare environments. You may recall a recent blog series about Haiti. One of the nurses there also told me pediatric burn care was a big issue. It's a common thread, stunningly similar when detailed by Niemczura on the other side of the world.
"There's no electricity in large areas of the country. People have wood stoves, and a lot of food has to be boiled," he began. And, they are closer to the equator than we are in the U.S., so that means they have long 12-hours nights, all year long. In summertime the days don't get longer like here. If they want light at night it's customary to take a soda can and fill it with kerosene and stick a cloth in it; it's used as a crude lantern. When that gets tipped over it's like a Molotov cocktail going off in your house."
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A steep street challenges Tansen pedestrians. |
There are cultural issues that come into play, too. Women get burned, men not so much. "Domestic violence is an issue in Nepal just as it is in America," said Niemczura, "and burn injuries are sometimes inflicted during the course of a domestic violence episode, which seems to account for a higher proportion of adult burn victims who are female."
LIfe Altering Experience
An American nurse in Nepal, who hasn't previously done pediatric burn care, is in for a big shock, said Niemczura. "I went from the incredible high of the snake bite thing to questioning the meaning of the universe with the pediatric burn care. In fact, that's what has changed my life.
"Here in the U.S. we're so far ahead in so many things. I've learned to appreciate more what we have. I stopped buying stuff years ago; I live a much simpler life now. When you start to understand how privileged we are in this country, it makes you a much more humble person. You really can't do this kind of work and not think about the metaphysical questions of why are we here, what are we doing, what are our obligations to each other? A lot of nurses are motivated by these altruistic things," said Niemczura reflectively. "You always have this fantasy of wanting to help. Nurses have to be in touch with that motivation to get up and do their nursing every day. Nepal has affirmed that for me."
A Big Thumbs Up
Joe Niemczura has captured his experiences in Nepal in a book, The Hospital at the End of the World. In it he details his impressions of the geographic area, its people, medical experiences and sometimes the meaning of life itself. Often, it's the smallest details that make the reading so fascinating (..."Nobody will get into bed between two white sheets, not for a million rupees. Sheets are blue or pink. White is the color of a shroud.") He also offers photographs that bring his fully engaging text to life. The book is available at Amazon.com (use a title search) or at http://www.plainviewpress.net/zencart/ .
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Cover from The Hospital at the End of the World, by Joe Niemczura. |
If you'd like to meet Joe personally, he'll be greeting the public during a brief book tour this fall. He'll be in Washington, DC, at Wesley United Methodist Church, in NW, On Oct. 18, 2:30 to 5 p.m., and at University of Maryland, Baltimore, on Oct. 19, 1 to 2 p.m. Dates will be announced for Philadelphia and New York City. And if you become a fan, he'd love to "see" you on his Facebook wall.
Next time: Anchors aweigh! Let's cruise with a nurse who found a career, and a marriage, on the high seas with Holland America Line.