In the past, it was difficult to find a good nurse in Nepal, even in the metropolis. But the field has been growing and producing proficient women who serve from Kathmandu to remote villages in the country. Nurses, however, face severe challenges in these villages, where poor infrastructure and equipment pose problems.
Two years ago, Pratima Subedi, who was working in a mobile camp, met a woman going through labour pains in Rolpa. Subedi and her colleagues were unable to perform a Caesarean delivery with the equipment they possessed, and so suggested that the woman be transported to Dang Hospital. The woman's family refused, not because of the expense, but because of the dangerous drive to Dang. With roads curving into the hillside and mudslides causing delays, the family argued for two whole days before finally deciding to go to Dang. When they arrived and conducted the C-section, it was too late for the baby.
Nurses like Pratima faced such moments where they had to intercede for the safety of the patient. But at the time, Nepal's traditional nursing education system hadn't been training its students on how to handle these situations. This is likely to change for the better, for newer methods of teaching have been brought into practice, specifically at the Lalitpur Nursing School (LNC) of the Tribhuwan University School of Medicine this summer.
Joe Niemzcura, an instructor and nurse at the University of Hawaii at Manoa School of Nursing and Dental Hygiene—also author of The Hospital at the End of the World, an autobiography on the day-to-day realities while teaching in rural hospitals far off the beaten track—is teaching critical care at LNC. During his eight-hour class, he goes through important decision-making techniques and improvising skills. “It is basically Nepal's version of the TV show ER, where students and teachers get to practice alongside each other and keep their decision skills fresh in their minds,” says Niemczura. He believes that the first step to changing the demographics of medical care in a country is to teach medical professionals a new set of skills.
The students and teachers of nursing at LNC have found their new lessons very useful indeed. “The first time I worked in an emergency room, I was so nervous,” shares Subedi, who has been feeling more comfortable ever since she's taken the classes.
Niemczura, who has been teaching in Nepal since 2007, has had an impact on many students thus far. Just last week he travelled outside of Kathmandu to teach nursing in Bhairawa in the Tarai region. While there, he bumped into one of his former students
working in a hospital with a capacity of 20 beds. The nurse was tending to 18 men in the facility that had tropical diseases such as typhoid, malaria, and diarrhea from drinking local water. As the nurse ventured from bed to bed, she brought life back to the patients. “I am so honoured that one of my students is treating people in poverty the same as if they were a King, and I think that because of her nursing education she is able to treat more patients in a crisis situation,” he says.
A sustained practice of critical care is sure to produce more nurses capable of handling the challenges of healthcare in rural Nepal. Niemczura will continue teaching critical care theory and practical education until September, and plans on returning every year to teach different techniques to enhance the health sector here. The teachers at LNC will continue the programme long after Niemczura returns home; only funding issues now stand in the way of these new methods becoming a permanent part of the curricula. Says the Campus Chief Radha Bangdel: “Over time our curriculum changes to fit in better with the society and its needs. We can assure that more classes like Niemczura's will continue to bloom, of course only if we can find outside funding to sustain us.”
(Source: The Kathmandu Post: Published on the Kathmandu Post on 25th June)