Global Health Nursing & Midwifery

Hi Joe
This sounds like such an exciting opportunity! I'd love to learn more about this undertaking. What program this involves and how you got involved? I've always wanted to visit Kathmandu and this sounds like the perfect experience. I would consider something like this so any information you can provide would be much appreciated! Happy Travels! Christine

dear joe
seem you took marvellous assignment.critical care & emergency care are very
important and we find very few people are willing to impart training.
criyicsl care as concept and hands on skills is becoming rather essential in
this part of world particularly in my country Bhutan. if you think you can
spare time let me know..i can request relevant people in health.

Dear Joe,

My name is Rhonda Martin & I work at Brigham & Women's hospital in Boston. I
too have a program in Nepal. A team from the Brigham goes to Patan hospital each
year to teach critical care nursing to the ICU nurses. This year we are going
in October.

Our focus now will be to get on-line teaching modules set up for the nurses so
that they can study throughout the year and eventually get credentialed on-line.
We have donated laptops for the ICU. We are looking for ways to decrease the
brain drain and are hoping that more continuing education and career development
while remaining in Nepal may help. We are always looking for more
thoughts/ideas/suggestions on this topic. We will also be helping in some ways
to set up the new nursing school at Patan Academy of Health Sciences.

Teaching strong nursing & professional skills at the beginning of nurse's
foundation are the key for future development. I applaud your efforts and would
like to hear more specifics of what you will be teaching and if will be
classroom or clinical or both.

I look forward to further discussion!

Rhonda Martin, RN. BSN. MPH

Dear Joe and all,
Sounds like great opportunities to build in country expertise for nursing-- so critical for the provision of quality care. I would love to hear more about both you and Rhonda's programs-- through PIH we are ramping up critical care in some of our clinical sites and it would be wonderful to learn from your experience.
In solidarity,
Sheila

Dear All,

First of all, I would like to thank Joe and Rhonda for your supportive initiation and thoughts in improving quality of nursing education and care in Nepal.

My name is Laxmi Tamang from Nepal. I'm a nurse with public health background. I did my bachelor of nursing in Lalitpur Nursing Campus (where Jo is going) and clinical placement in Patan Hospital (where Rhonda is supporting). Just few weeks back I had communication with Patan Academy of Health Science (PAHS), Vice Chancellor, Dr. Arjun Karki and he told me that team of nurses from UK are helping to set up nursing school in PAHS. I told him that whether he is aware or not from the mushrooming private colleges every year around 5000 nurses graduate and are unemployed and country needs midwives as per the government of Nepal's policy in achieving millennium development goals 5 not the nurses. He replied me actually we are going to produce nurses for our hospital. Hearing this I was amazed because there are too many nurses unemployed and do not get sites even to do volunteer work. So, we group of nurses from Patan Hospital (Rashmi Rajopadhyaya, Ratna Maharjan and Rachana ...

Dear All,

First of all, I would like to thank Joe and Rhonda for your supportive initiation and thoughts in improving quality of nursing education and care in Nepal.

My name is Laxmi Tamang from Nepal. I'm a nurse with public health background. I did my bachelor of nursing in Lalitpur Nursing Campus (where Jo is going) and clinical placement in Patan Hospital (where Rhonda is supporting). Just few weeks back I had communication with Patan Academy of Health Science (PAHS), Vice Chancellor, Dr. Arjun Karki and he told me that team of nurses from UK are helping to set up nursing school in PAHS. I told him that whether he is aware or not from the mushrooming private colleges every year around 5000 nurses graduate and are unemployed and country needs midwives as per the government of Nepal's policy in achieving millennium development goals 5 not the nurses. He replied me actually we are going to produce nurses for our hospital. Hearing this I was amazed because there are too many nurses unemployed and do not get sites even to do volunteer work. So, we group of nurses from Patan Hospital (Rashmi Rajopadhyaya, Ratna Maharjan and Rachana Shrestha), nursing colleges and Maternity Hospital established the first and only nurses led birthing centre in Nepal in July 2007.

In Nepal, the root cause of brain drain is not the education. Education is only the way to get visa for going abroad. Actually they are going abroad because there is no or limited opportunities or paid very less.

I completely agree with Rhonda teaching strong nursing & professional skills at the beginning of nurse's foundation are the key for future development, which is lacking in other nursing colleges in Nepal. Relatively to other nursing colleges in Nepal Lalitpur Nursing Campus graduates are considered best in the country both in term so theory and practical. In Nepal, due to mushrooming private nursing colleges, colleges are struggling to find the place for the clinical placements of the students. So, students, who graduates from private nursing colleges have good theory but very very poor in skills.

Apart for private hospitals and medical colleges in Nepal nursing care is very poor and I believe unless and until Nepal Nursing Association or nursing leaders don't take action it is very difficult to improve quality of nursing care. Patan hospital nursing care is the best in the whole country.

Once again thank you all for your supportive thoughts and initiation in improving nursing education and care in Nepal.

Laxmi Tamang

Thank you so much Laxmi for responding.

You are the voices we need to hear. Your note certainly has changed by
perspective already. I was aware that private colleges were sprouting, but I
didn't realize how fast. Now, my thoughts are running toward exchange programs
where nurses and students could get the clinical skills they need.

Also, from a variety of conversations with a variety of people, I got the
impression that there were not enough nurses in Nepal for the rural areas. In
fact, one of my other projects this time may be to visit the western region of
Aachem to look at a hospital that has midwives but no nurses. (Sheila--this is
the Nyaya program loosely associated with PIH) Instead of looking toward better
education for CHW's, it may be more efficacious to try & organize to get nurses
out there. Do you believe that nurses would be willing to go to such rural areas
considering the conditions?

Also, with regards to the Nepal Nursing Association, what small steps would you
envision they could take over the next year to help the profession? This year I
have a larger group going with me and may be able ...

Thank you so much Laxmi for responding.

You are the voices we need to hear. Your note certainly has changed by
perspective already. I was aware that private colleges were sprouting, but I
didn't realize how fast. Now, my thoughts are running toward exchange programs
where nurses and students could get the clinical skills they need.

Also, from a variety of conversations with a variety of people, I got the
impression that there were not enough nurses in Nepal for the rural areas. In
fact, one of my other projects this time may be to visit the western region of
Aachem to look at a hospital that has midwives but no nurses. (Sheila--this is
the Nyaya program loosely associated with PIH) Instead of looking toward better
education for CHW's, it may be more efficacious to try & organize to get nurses
out there. Do you believe that nurses would be willing to go to such rural areas
considering the conditions?

Also, with regards to the Nepal Nursing Association, what small steps would you
envision they could take over the next year to help the profession? This year I
have a larger group going with me and may be able to find some time to visit the
association, or elsewhere. I know Rashmi and look forward to speaking with her,
and perhaps meeting you in October!

Rhonda Martin

Hi Joe,
Try to reach WHO for their Trauma checklist, which will be out soon. It will tremendously help if you can integrate that in your education program. Enjoy the beauty of volunteering!
Tess P. Panizales

Dear Rhonda,

Yes, whatever you have heard from people about scare of nurses in rural areas is true. But it is not due the shortage of nurses in the country. It is because government don't absorb them. In the public sector we've only 3000 nurses including Auxiliary Nurse-Midwives (ANM) with 18 months training after grade either 8 or 10 and Staff Nurses with 3 years nursing training after grade 10 and whenever people talk about there is no nurses they refer to nurse working in government sector only.

According to the recent Nepal Nursing Council record there are more than 30,000 nurses. In Nepal, ANM, staff nurses and Bsc. Nursing graduates are having problems in finding out jobs especially in clinical settings. Especially BSc, nursing graduates usually join nursing college as a instructor of staff nurse program.

Concerning Nepal Nursing Association, most of the nurses including almost all junior nurses do not have positive impression towards the association because they are not advocating in strengthen nursing care system in the country. Also, all executive members are affiliated with one after another political parties and indulge with political parties’ ideology i.e communist and Maoist. Our association was ...

Dear Rhonda,

Yes, whatever you have heard from people about scare of nurses in rural areas is true. But it is not due the shortage of nurses in the country. It is because government don't absorb them. In the public sector we've only 3000 nurses including Auxiliary Nurse-Midwives (ANM) with 18 months training after grade either 8 or 10 and Staff Nurses with 3 years nursing training after grade 10 and whenever people talk about there is no nurses they refer to nurse working in government sector only.

According to the recent Nepal Nursing Council record there are more than 30,000 nurses. In Nepal, ANM, staff nurses and Bsc. Nursing graduates are having problems in finding out jobs especially in clinical settings. Especially BSc, nursing graduates usually join nursing college as a instructor of staff nurse program.

Concerning Nepal Nursing Association, most of the nurses including almost all junior nurses do not have positive impression towards the association because they are not advocating in strengthen nursing care system in the country. Also, all executive members are affiliated with one after another political parties and indulge with political parties’ ideology i.e communist and Maoist. Our association was established 40 year before but still they have only around 3000 memberships. Last year when there was election out of total 2800 nurses in their voting list only 1800 nurses voted. So, this is a scenario of our nursing association. I would appreciate if you could help them to work and engage in strengthening nursing profession and improving quality of care in the respective hospital at least where executive members are working and be a role model.

If you are planning to go to Accham I suggest you to watch this video "Birth in Nepal" filmed by 5-months pregnant Nepalese woman who sets out to find out why so many mothers are dying in childbirth in Nepal. Here is it links http://english.aljazeera.net/programmes/witness/2010/05/20105372154435803.html.

Since last few years I've been actively involving in empowering nurses through APS Birthing Centre/Reproductive Health Care Centre and Midwifery Society of Nepal (www.midson.org ) established in 2007 and 2010 respectively. Both of these organisations have been established in my initiation and under my leadership in collaboration with other 11 nurses. APS has been established with the notion of social enterprise targeting to serve urban poor families, empowering nurses to become entrepreneurs, whereas MIDSON is a professional organization registered as a NGO to strengthen social model of maternity care (midwifery services) in the country, especially in rural Nepal. Former and present Nepal Nursing Association president has also supported our initiative so they are also the founding member of the Society.

Unfortunately, Nepal Nursing Association and Nepal Nursing Council do not work collaboratively and they are against each other because of political ideology clashes. This is infortune for our juniors and nurses in Nepal.

In Nepal, we don't have a midwife nor midwifery is a profession so I together with my colleagues in Nepal have been actively involving in advocating for this together with UNFPA to operationalise the plan as per the government of Nepal's National Policy on Skilled Birth Attendants 2006, where it has acknowledged the need to produce a separate cadre of professional midwife to provide leadership in safe motherhood program of the country. Though I'm currently not in Nepal because of my study still I'm actively involve virtually (email, facebook) in advocating for this in Nepal. To learn about me and my work you can visit http://www.ausaid.gov.au/hottopics/topic.cfm?ID=1914_7489_8187_2588_9517 and http://www.unfpa.org/public/site/global/pid/5859.

Currently UNFPA together with Ministry of Health and Population is on the process of developing Bachelor Midwifery Curriculum for 2 years midwifery program. It has been planned to train staff nurses to become a midwife. Though it is good initiation but still this is not practical because bachelor level midwife is not going to work in the rural settings of Nepal because they will not be employed by the government because they will be costly. Currently mainly ANM are the one who are working in the countryside health facilities. I've to say they are the backbone of the maternity care services of the national health care delivery system.

I like the idea of exchange program again rural district hospitals and zonal hospital nurses will not get chances I hope so. Actually they are the one to whom we've to empower. They do work and talk less. Our Nepal Nursing Association leaders they talk a lot but to work in ground. We want action oriented nurses in Nepal but unfortunately we hardly get such nurses in the association.

There is no doubt nurses are willing to go and work in rural Nepal if they get opportunities or jobs but to get this itself is difficult. In the context of Nepal when you said nurses you have to be clear to whom you are referring to i.e. ANM, Staff Nurses or Bsc. Nursing graduates.

It seems that in my writing I’m bit cynical but this is the fact.