Our Final Week in Nepal

Our last week in Nepal was full of incredible experiences in Pokhara, a busy but beautiful city miles away from the noise and chaotic environment we experienced in Kathmandu. We were all pleased to reach this destination and enjoyed some free time around Lakeside and the surrounding area before visiting Green Pastures Hospital.

We were fortunate to enjoy the spectacular views of the Annapurna mountain range, including the remarkable Machhapuchhre Mountain, (one of the most photographed mountains in the world) also known as ‘Fish Tail’ and the ‘Holy Mountain’. It is considered sacred by the locals as it has never been climbed and climbing it has in fact been banned.

Marie, Brad and I (Jayne), took leaps of faith (literally) as we experienced paragliding from Sarangkot – the views, including that of Phewa Lake were spectacular.

This was followed by Marie and I taking a spur of the moment yet fun afternoon exploring by way of scooters while the rest of the gang soaked up the local culture. The following day Jodi, Tom, and I were fortunate to have the time to hike the Panchase trek. The views of the Annapurna mountain range were amazing, the hospitality at the tea house gracious, the Dahl baht (food) delicious and the tea house rooms quaint and quite perfect.

The 3.5 hour hike down the relentless steps was not so much fun on the knees but the dip in the cold river was appreciated and invigorating to say the least. The rest of the gang also enjoyed swimming in the lake, more adventures on motorbikes exploring the backcountry, views from the World Peace Stupa, exploring bat caves, local villages, shopping, and dining and hanging out with some great new friends.

For our final three days we all spent valuable time at the Green Pastures Hospital and Rehabilitation Centre. This facility, run by the International Nepal Fellowship is a Christian organization that started in 1957 and continues to provide specialist people oriented services in leprosy, disability and spinal cord injuries. The staff we interacted with included doctors and nurses, counselors, physiotherapists, orthopedic appliance technicians, nursing aids, and volunteers’ that all showed incredible dedication, commitment and compassion towards their clients and co-workers.

Green pastures provides in and out patient leprosy services, reconstructive surgery, nursing care, laboratory services, counseling and health education, patient rehabilitation that inclueds the Orthopaedic appliances, occupational and physiotherapy, and self care. There are 73 official beds but extra patients are often taken in and include those with leprosy, tuberculosis and other disabilities such as cerebral palsy, burns, and spinal cord injury. Green Pastures is a hospital for the poor; they provide schooling for the children of patients as well as education for the illiterate clients and when older people have been abandoned by their families, due to the stigma and discrimination attached to leprosy, they are allowed to stay at the hospital to live out their lives.

With a thirst for knowledge, working in pairs, we spent time in various areas around Green Pastures to further appreciate the work that people do with such limited resources. The staff surpassed our expectations with their graciousness, enthusiasm, and creativity. Nurses apply honey to wounds to assist healing because they can no longer get silver nitrate. Honey and sugar work very well to increase granulation tissue, extract water, and lower the pH which decreases bacterial growth. Medications for leprosy, tuberculosis, and HIV/AIDS are supplied by the Government, but other services are billed to the patient according to what they can afford. The Red Cross covers the cost of prosthetics for people who have lost a limb due to the war but patients cover the cost for leprosy amputations if they can afford it and if not the hospital supplies whatever they need. Occupational therapists work with individuals to increase their ability to adapt with the use of attachments and devices, provide self-care teaching/learning, facilitate empowerment and increase self-worth. The majority of the prosthetics are made on site with the feet attachments supplied by Red Cross. It was incredible to have this opportunity to be involved with spinal cord injured and leprosy infected patients and seeing prosthetics being hand made. Interacting with clients during wound dressing changes, and physiotherapy sessions was inspirational as we observed their strength, courage and determination. As our visit came to an end, it was difficult to say goodbye; certainly, some of us left with a strong desire to return one day.

We enjoyed a final night out in Lakeside and said farewell to Jodi and Tom as they remain behind to embark on their adventure of hiking in the Annapurna Conservation Area and a day later (back in Kathmandu) we also said farewell to Bronwen as she also stays behind before heading off for her travels in Thailand with her partner James (very envious!). We all look forward to hearing about all of their adventures on their return.

To end, visiting Nepal for our nursing practicum was an incredible experience and opportunity of a lifetime, and speaking on behalf of the group we would have to say that we all managed extremely well considering all the challenges faced. Our lives have been touched and changed by the diverse interactions with the many children and adults of Nepal, coping with the environment, immersing ourselves into the incredible culture, the daily chaos, and gaining a raised awareness of political upheaval. I (Jayne) feel honored to have been a part of this group and look forward to more adventures and the future planning that will come from of the continuing development and hard work of the Global Nursing Network and Faculty at North Island College. We would particularly like to thank Cathy, our instructor, for her dedication, enthusiasm, and commitment that helped to make this practicum become a reality. Namaste, Jayne & Brad

Farewells in Kathmandu

Hello from Jodi and Marie, from Pokhora, Nepal
Due to some computer compatability issues, we are sorry for any errors in the posting.

After an exciting and interesting experience in Thakre, we settled back intoa short week in Kathmandu that allowed just enough time for a couple morevisits to our practice placements and our goodbyes. Although each set ofpartners had a different week, for the two of us, we returned to the Old Age Management/ Society in Kalimati. It was our second visit. Our first visit a week before opened our eyes tosome of the resource shortages in Nepal, specifically water. The facility ishome to 27 women without a home or caregivers available to support them ontheir own. As well, it is now home to three abandoned, orphaned children that have been taken in by the women, and the main caregiver for the home.The home has a 500L water tank to last 5 days. We figured this out to be approximately 3L/person/day for all their needs; including, washing, drinking, food preparation, and cleaning. We gave small baths to about 6 women, whom had not bathed in about 2 months. They were very happy. Of course, when we were finished, we washed their laundry in the water, to avoid any waste. There is so much for us to learn on the necessity of resource sharing. We also provided foot/hand care and massaged their feet and hands with moisturizer, which left the women with smiles on their faces as well as ours. On the second visit, we went with some hygiene supplies and towels to assist with bathing. We were once again greeted with warm smiles and the unconditional Nepali hospitality that we seem to have met along our journey. Even with the communication barrier, we were able to provide some basic careto people that truly appreciated it. It was humbling and once again a wonderful and engaged experience. The women were absolutely lovely and hugged us and asked us to take their pictures each time we saw them. It was amazing to feel so appreciated and welcome in a place where all we can say to one another is "Namaste" (hello) and "danya-bhad" (thank-you). As a group, we all went and listened to a presentation by a Canadian Doctor,Penny Dawson, that has been working in Nepal over the course of 28 years. She spoke about some of the programs and organizations she had worked with. The progress and commitment to health was inspiring to hear.

On Wednesday, the farewells to our placements included Hospice Nepal and the two elder care facilities. We were not ready to leave and it was difficult to explain that we were leaving and likely not to return any time soon, ifat all. It was definitely a day full of bittersweet goodbyes, as the relationships that we have made here have been incredible.After a long night of packing, we traveled for about 6 hours via bus toPohkora. We are all enjoying the calm atmosphere that surrounds us here, specifically in Lakeside where we are staying. The hustle and bustle of Kathmandu might not be missed, but the people will not be forgotten. The views that we have seen are beautiful and we got our first, clear view of the Annapurna mountain range from the rooftop of our hotel. We have been trying to see all of the sights here and to take everything in during our last week of this amazing experience.

Although this is not the final posting, there is atleast one more to come, it is our last one, and we would like to give a special thanks to everyonethat helped make this possible, as it would not have happened without all of the support we have and are still receiving from both friends, family, and members of the community.

Sincerely,
Marie Ellis and Jodi Wright

Nutrition Outreach in Village of Thakre, Dhading District

Hello readers, this is Bronwen posting on behalf of the NIC nursing students in Nepal, reporting on a nutrition outreach clinic we participated in this last May 14th and 15th. In cooperation with the nutrition rehabilitation home (NRH) in Baluwater, Kathmandu, this two day outreach was organized and executed. Six nursing students, one nursing instructor, two physicians, one dietitian, four nutrition centre coordinators, two Nepali nurses, two cooks, a bus driver, bus driver assistant, and 450 children were in attendance. Children were first registered, then height measurements were taken, followed by weight. Then a calculation was made to determine each child's nutritional status as a standard deviation from the median norm. Children then were seen by a physician, who would advise on health matters and prescribe medicines for any existing ailments. The majority of pharmaceuticals prescribed were brought along with the clinic and provided free of charge and with administrative advice from the Nepali nurses. Parents and children then attended a nutrition education seminar, which is intended to include information that demonstrates how to include complete nutrition with the foods that are available and affordable to villagers. They were then fed a meal and supplied with super flour, a fortified product, one kilogram per participant.
We started with a 2.5 bus ride out to the village, via winding narrow roads over mountainsides, which was breath-taking and exhilarating. When we arrived there were several villagers awaiting our arrival, some had walked great distances up and down mountainsides to attend, carrying children to boot. We took a short time to set up and then began the clinic. It was crowded and hot, and at times there was a significant push on the entry doors from less than patient would-be participants. Nepalis are not much for queuing.
Many of the children were malnourished, ranging from mild to moderate to severe. A significant portion of the children were afflicted with either an acute respiratory infection, acute gastroenteritis, or both together. At times the children were terrified of us, and at others just curious. The villagers provided us with meals and tea, which we were told had never happened for an NRH nutrition outreach before. This is of note as the special service was attributed to the presence of foreigners; us. This leaves an unsettled feeling of enjoying the efforts and intentions of the villagers mixed with discomfort at the thought that they would not otherwise have shown such hospitality. The efforts of the NRH staff are obviously well deserved of the efforts without the foreign presence. Something to think about.
The days were long, and we were exhausted at each end, but incredibly satisfied. Overnight, we drove another hour and a half again over semi treacherous roads to our accommodation, which had been given away to a busload of people who had arrived earlier than we had. Forty minutes later, we had accommodation, yes, but it was less than comfortable. With four to a room, two to a small, rock hard bed, we slept (if you could call it that), to the fine smell of cooking fuel from the kitchen below mixed with smokey incense.
After a 4:30 am wake up, we then half walked, half drove up to a lookout from Daman in the morning, from which the haze blocked us from seeing much at all. Another long day at the clinic, and we headed for home, with eleven children and their caregivers in tow, to attend the rehabilitation home in Kathmandu. Several children and one mother vomited with motion sickness on the twisting, winding bus ride on the way to Kathmandu, attributed to the smell of spilled kerosene and limited bus ride experience. Kudos to Jodi and Marie who sustained vomit soiling and nursed sick children the whole of the bus ride home.
When we arrived at NRH, late in the evening (about 8:30), all the parents and staff came out to greet the new arrivals and assist in unloading the bus. It was such a welcome sight, for us tired travelers, and I am sure, for the parents and children arriving in the dark at the strange new place. I must admit that I was overwhelmed with the smiles and welcome that our greeters provided. As I am placed with NRH for my practicum, I was familiar with them all, and was touched by the joyous atmosphere at our arrival.
I believe I can safely say that we all gained a great deal of knowledge and experience from this clinical experience that will have a profound impact on how we choose to practice as we go forth in our nursing careers.
Namaste, and best wishes, having a fantastic experience, Bronwen.

Third Week in Kathmandu

Welcome from Jayne Fisher and Brad MacIver, also third year nursing students at NIC doing our practicum in Nepal. We are both really pleased to be here to expand both our knowledge, develop our cultural competence, and undoubtedly enhance our nursing practice through this incredible experience.

We are spending our time at the HIV/AIDS clinic run by the Friends of Needy Children; Manisha Singh Punarjeevean Niwash (MSPN) started the clinic in 2006 as part of a non government organization to provide care for children living with HIV/AIDS. MSPN is now a transitional home for 18 children and their caregivers that aims to provide treatment, care and support to enhance, prolong and fulfill lives. Their mission is to ‘add life to their days while adding days to their life’.

The centre provides care for children that are predominantly 10 yrs old and younger and are infected by HIV/AIDS. When clients come to the centre they are often malnourished and caregivers (parents/guardians) stay with them at the centre to assist in their care. The stay at the clinic can last up to six months. Emergency treatment, food and lodgings are provided to both children and their caregivers. Services include medical, nutritional, and educational support as well as extra activities such as teaching, crafts, and outings.

There is also a close connection with regular counseling sessions (in a near by centre) also run by Friends of Needy Children. Parents/guardians are provided with educational sessions on hygiene monitoring, family planning, nutrition, personal hygiene, tuberculosis, antiretroviral medications, childhood health hazards, malnutrition, pneumonia, chickenpox, sexually transmitted infections and opportunistic infections related to HIV/AIDS. Parents/guardians are also taught the importance of taking their children’s weights regularly and shown how to administer all antiretroviral and daily required medications in preparation for their transition back to their home community.

One of the main focuses of the centre, in addition to increasing health and wellbeing, is to facilitate empowerment to enable parents/guardians to increase their independence, enhance their resourcefulness, and strengthen their sense of identity and belonging.

The staff at MSPN includes four nurses who show dedication and empathy in providing unconditional support to both the children and parents/guardians. They provide care with a holistic approach and their work ethics are outstanding, covering back to back shifts without hesitation or complaints. We are amazed at their resourcefulness; for example, the nurses make their own cotton balls and gauze pads using an autoclave for sterilization, they re-use gloves out of necessity, and are very creative due to limited equipment and supplies. Their warmth, compassion, energy and love that they instinctively show to their clients touch us daily.

In addition to our rewarding experience at MSPN we have also had the opportunity to visit a famous Bouddhanath Stupa (the largest Buddhist temple), Pashupatinath Temples, and hike in the Shivapuri National Park.

Our last trip was to visit the village of Karvrepalanchowk (2.5 hrs East of Kathmandu) and stay in the home with a local family; it was interesting to experience such privilege as white foreigners but also overwhelming, challenging and somewhat uncomfortable to be the ‘minority’.

We were treated with utmost respect, the food was endless, and our evening was simply spent enjoying dressing up in Nepali clothing, hanging out with the locals, and falling asleep to the sound of crickets; a stark contrast to the consistent barking dogs in Kathmandu! The weekend ended with a fun top side bus ride enjoying incredible views over the cliffs, terraces, and farmland.

We are now looking forward to our next excursion with the Nutritional Rehabilitation Home (NRH) for children in Dhading, North West of Kathmandu. So please tune in for the next group members insights…until next time, Namaste from Jayne & Brad.

Second week in Kathmandu!

Hi from Jodi Wright and Marie Ellis, 3rd year North Island College nursing students. We came to Nepal to gain insight into different cultures in hopes that it will help us in our future as nurses.

The two of us are currently doing our practicum at Hospice Nepal in Lagankhel, Lalipur. The staff at this facility provides palliative care for patients with advanced cancer. http://www.hospicenepal.org.np/ . It is currently an 8 bed unit with round the clock nursing care. However, nursing care looks different than back home, as the family tends to almost all personal needs including washing, feeding, toileting, and emotional support. This organization provides nursing service and doctor consultations free of charge. It is expected that patients will pay for medications, lodging, and food, if they are unable to pay, then it is also free of charge. In Nepal, many health services are NGO funded, but Nepalese run. Hospice Nepal is one of them, and relies on donations to stay running. Hospice Nepal utilizes the information suggested and provided on the World Health Organization (WHO) website for palliative care and pain management.

The idea of Hospice in Nepal is a very new concept and is met with hesitation and resistance from health care workers as well as the Nepalese people. This is partially due to the cultural influences surrounding illness and death. For example, it is not an unusual occurrence for the patient to be unaware of their current disease and prognosis. It is the family’s decision on how much a patient is told. At the same time, they will talk about the illness around them, somehow presuming they do not understand.

So far, our experience at Hospice Nepal has been different than expected, as the workload and priorities are much different than in Canada. We have learned a lot from the nurse we have been following as he is full of experiences, insight, and cultural information. He seems to be taking on a lot within the organization as he is also the primary home care nurse.
We have been lucky to have him as our primary preceptor because of the vast experiences he is able to share with us, including the home care visits that we have been able to partake in. Although home care is relatively new, it is not that much different from back home, and focuses a lot on the relational practice aspects of care. The nurse listens to the patients and family’s needs and concerns, and then works with their resources to attain a more suitable and client focused care plan. Home care has taken us to areas of communities we may have never seen otherwise, and are rarely visited by tourists. It has opened our eyes, in the sense that we are able to put faces to the places we see. As it is one thing to see a picture of hardship, it is another to get to know the person behind the face, and begin to gain insight into how they manage to get to where they are in the world in which they live.

After an exciting and scary river rafting experience down the Bhote Kosi River that originates in the Himalayan Mountains of Tibet, we are back in the Kathmandu Valley and ready to start back into our school routine. The rafting showed us aspects of Nepal that you can only see from the river, the children swimming, garbage and sewage dumping in from the houses above, people fishing with homemade rods, elders resting, water buffalo bathing, farmers working their fields, farmers herding yaks or goats, monkeys climbing on the cliffs, bees nesting and building honey comb in the rock, and cremations on the river bank. It was an experience of a lifetime.

We have visited one elder care facility, where Cathy and the two of us gave out toothbrushes, toothpaste, bananas, watermelon, and candy to the 35 residents. While there we visited with residents, listened to a few people’s lungs, and looked around. Traditionally, elders are held with high regard and respected and cared for by family and communities. Old age is considered a time for relaxation, prayer, and meditation. Hopefully by the time we do our next posting, we will have had a little more of a chance to visit and learn about other elder care facilities in the Kathmandu Valley.

Even with the current political situation here in Nepal, that leaves the country without a government, we are all well, safe, happy, and having a great experience.

Till next time
~ Marie and Jodi

1st Week in Kathmandu

My name is Tom Thomas. I am a 3^rd year nursing student at North Island College in the Comox Valley. I have many reasons for wanting to come to Nepal. While most stem from a strong sense of social justice and wanting to make a difference, others have to do with my personal interests in learning how to be a more culturally aware, competent, and safe nurse. I also think that while I can offer something to the communities I visit, there is a lot to be learned here as well.

It is 5pm in Kathmandu, and is approximately 30 degrees Celsius. I and the five other nursing students have been here for five days thus far. We arrived late Tuesday night and hurried off to our house shortly after arriving. Kathmandu is one of those places that hit you in the senses the second you land. From the moment the doors open the humidity, smells, and noise flood the senses. It is almost like having a warm wet horse blanket thrown on you in the middle of an over populated rock concert. It is unrelenting.

Even though we were suffering from the 36 hours of travel, and 12 hours and 45 minute time difference, we were all up at the crack of dawn. From the roof top balcony of our three story guest house the astonishing beauty of our first Kathmandu sunrise hypnotized all who ventured up to the roof. The smells and noises seemed muted in comparison to the magnificence of the blood red globe rising from behind the distant mountain tops.




Kathmandu comes to life very early in the morning. There is little doubt the massive Himalaya and amazing morning view contributes to this phenomena.

The first few days have consisted of reconnoitering our local neighborhood, and traveling as a group to each of our nursing placements. Traveling the streets of Kathmandu is a much larger hazard than I ever anticipated. In many places in Kathmandu there is no sidewalk, and walking within a few inches of moving vehicles is the norm here. I think it is safe to say that all of us came close to being run over several times in the first few days. It is only due to the kindness of the Nepali drivers and the quick watchful eyes of our instructor that we still stand six strong. As a group we have adapted quickly and have graduated to crossing roads on our own and travelling with some sense of competence.

In our initial meetings with our practice placements it is an understatement to say that that each is amazing in its own way. I will personally be working with Friends of Needy Children at the Nutritional Rehabilitation Home (NRH), a malnutrition clinic for children and their caregivers. The kind, caring, and compassionate nature of the staff at NRH was evident from the second we arrived, and their acceptance of us as fellow healthcare professionals was inspiring. I look forward to the weeks ahead. The second placement we visited was the Friends of Needy Children Manisha Singh clinic for children with HIV/AIDS. What struck me most about the staff at was the amazing energy and passion they displayed in every aspect of their work. We also had the opportunity to meet some of the volunteers there. The highlight for me at this placement was playing soccer with a three year old patient. The joy he displayed while we played touched me deeply. I have no doubt that this placement will be the center of many cheers and tears over the next few weeks. The last placement we visited was Hospice Nepal. Visually Hospice Nepal is a stark contrast to palliative care in Canada, but at its heart it is concerned with the dignified death of its clients. As someone who has had a lot of experience in palliative care I was pleased to hear one of the physicians talk about assisting patients in achieving “the best death for them”. I should say that Hospice Nepal is an anomaly when it comes to end of life care in Nepal, yet it inspiring to see the values and beliefs I have developed as a caregiver in Canada can be found in the far reaches of the globe.

The weeks ahead hold many unknowns, but it is with great anticipation that we head into our practice placement. I have no doubt that we will learn a great deal about the peoples, traditions, and cultures that exist in this amazing country. That said, travel is also a journey of self discovery, and I am sure that we will all gain a greater understanding of ourselves and the culture we often take for granted back home.

Namaste

Tom Thomas NICBSN III

Introduction

This blog will document the thoughts and experiences of the six nursing students before, during, and after their experience in Nepal.

Over the last year and a half, the The Global Nursing Committee at North Island College has diligently worked towards creating a vision for nursing students within an international landscape.

Several relationships with international partners are already being developed. The goal of these partnerships is to create relationships according to the guiding principles of the Global Nursing Committee. Thus far the Global Nursing Committee has joined in partnership with great local organizations such as Word Community Development Education Society and Africa Community Technical Services (ACTS). For 2009, the NIC Global Nursing Committee has arranged for two global practice placements for local nursing students. The first will be in January, 2009 in collaboration with ACTS. In this placement two students will work in conjunction with ACTS in Uganda focusing on health promotion and community development. In April, 2009 NIC and the Global Nursing Committee have arranged for a further six students to travel to Kathmandu, Nepal, where they will be working in a variety of health care settings including a hospice center, an orphanage, and an opportunity to work with a leprosy clinic. Currently students are engaged in pre-departure workshops aimed at raising awareness and cultural sensitivity. Gains will be made on three fronts; individually, locally, and globally. Individually, global placements will provide students with insight into cultural diversity, global health, and cultural safety. On a local level students will return with new knowledge, resources, and insight that will be used and shared to serve the communities they are a part of. Globally, students will be better prepared to focus on the large scale concerns that global health presents. In short, the growth of the individual contributes to the growth of the communities that they are part of.

This blog will document the thoughts and experiences of the six nursing students before, during, and after their experience in Nepal.
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