Monthly Archives: September 2012

Sept 23 2012 writing a book about global health care

Okay, you may be wondering why I have not written much new in the blog lately. I only have so much writing time each day, and for the past month I am using it to write the long-thought-about second book on health care in Nepal. I am making progress, but I have to attend to work as well.

My first book

The first book was titled The Hospital at the End of the World,  and it told the story of my first trip to teach nursing in Nepal in 2007. It got published in 2009, and established some notoriety for me regarding the topic. The book never cracked the New York Times best seller list, but then again, I was writing for a very specialized audience – people who were considering whether to truly go deep in the field of global health nursing. Along with the book, I created a FaceBook fan page, a YouTube channel, and this set of blogs about nursing and Nepal.  The goal was a sort of “here’s what I learned when I did it so that you will do better even if it’s your first time” sort of program.

In the book publishing biz this is called “creating a platform” – nowadays they recognize that readers want to feel a connection to the writer, and the internet allows that to happen. I still get emails or phone calls on nearly a weekly basis from this or that person who has questions. I am humbled when this happens.


I never thought I would write any book, let alone a book on this topic. The first book is “narrative nonfiction” meaning that it portrayed events that took place using a storytelling format. I made a conscious choice not to write a scholarly paper or a text-book or a research article. To do this meant I would have needed to focus on just a small biopsy of the experience, not the entire organic whole. The immersion into a different culture is a key part of the journey.

I knew the limitations when I had the finished project. It was a chronology, it was too graphic for a non-medical audience, and a main part of it dealt with the death of children with no socially redeeming features. Now, in real life, the unfortunate death of children is senseless most of the time, so I make no apology for telling those stories. I also confess, i was not that good a writer, at that time. Oh, I took English 101 in college, because it was a core requirement. In grad school at UCSF I took a workshop on technical writing and for years I had a copy of Strunk and White ( my younger daughter appropriated my copy  for her own use in fifth grade). I can write a policy or procedure as well as legislative testimony on matters of health policy that affects nurses. I am really great at Behavioral Objectives, as befits any faculty who is “old School”  – No problem!

homage to Suzanne Gordon and Bernice Buresh

But the way that nurses write has nothing to do with what most people want to read. Any nurse reading this needs to find Suzanne Gordon’s book, From Silence to Voice, which explores this subject in much greater detail than i could ever muster.  When I set out to write the first book, I also found the book “The Making of a Story” which was very valuable.

and now, for something completely different……

Fiction. the second book will be fiction. I can still use a Nepal hospital as the setting, and still slip in details about health care in that country. I can create a better plot, and I can also invent characters for the book who will be more likely to capture the reader’s attention.

They say that people make their book-buying decisions by looking at the cover and reading the first paragraph. do you think it’s true?

Cover ArtWith that in mind, I started writing in earnest about a month ago. The final book will have about 110,000 words, and I have 60,000 words toward a first draft. I am sure that there will be considerable editing before the final product is sent off to a publisher. I have a plot outline.

I am relying on information gathered over the course of four trips to Nepal to describe the challenges. ( this one will NOT be set in Tansen).

And finally – cover art. For the first book, we used a photo I took myself ( I was proud of that picture, it showed Boudhanath mandir in an unusual angle).  For the second book, it will be more along the lines of the one at left.



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Nurse midwifery in Nepal


every nurse in Nepal knows how to use this, but I wonder if the younger nurses from USA even know what it does…….

This will be mercifully brief.

You may know that every RN  in Nepal is also a nurse-midwife. When I got my Nepali RN license I was surprised to see it in print. Men don’t attend  homebirth in Nepal.

Terrific link to a YouTube video about childbirth in rural Nepal.

go to my other blog to find it, plus the commentary from my book that deals with childbirth.


Filed under Nepal, nursing education

Never Doubt the power of nursing

If you want to read about a country where health care is not a right or a privilege, buy my book.  would you want to get health care there?

The key to this entry is the hyperlinks. when there is an underlined piece of text or it’s in a different color, it leads to a video. Click on those.

thought for the day

watch this video. It shows Gabby Giffords leading the Pledge of Allegiance. bring a tissue.

Congressperson Giffords was severely injured in a shooting. She received first aid at the scene and was rushed to a hospital where doctors and nurses stabilized her. She was on a ventilator in an ICU for weeks. I don’t know the details of her hospital stay, but she was on  a mechanical ventilator and received excellent care if you ask me. Her husband made a video journal of her progress.



It didn’t stop in ICU.  She got excellent physical therapy and speech therapy.  I would be remiss if I did not mention those disciplines. I can see it by looking at her gait in the video of the Pledge.

Here is the punchline

Every one deserves that level of excellent, compassionate care.

Never doubt that national trends affect you when you work as a nurse at the bedside. When Romney and Ryan say they are going to cut health care costs, and roll back Obamacare, they mean it. For me, I have seen the cause-and-effect every time we elect a Republican. The war on Women is not limited to control of reproductive rights. It extends to a lack of care about occupations that are traditionally thought of as “Women’s Jobs.” Yes folks, that includes nursing, whether you are a male or a female nurse.

Here is the opinion of the American Nurses Association

don’t think “My congressperson is okay it’s the other congresspeople who are the problem”

we need to do more to elect people to congress who are likeminded. In some cases, the local voters figure “yes, congress is bad and they aren’t getting anything done, but my guy is okay”

No. If your guy is voting against women, voting against nurses, voting against health care, and trivializes the effect of sexual assault on women, then he’s not okay. Your guy is not helping.

Every family in America has something at stake in this election.  Every nurse knows the need to fund health care.

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Filed under Nursing in Hawaii, Obamacare

Nurses, nursing and unions – Happy Labor Day!

from a site on FB called ” the other 98%” – I have this idea that the person who made this won’t mind, but I don’t know who that was.

For a nifty poster about team work, feminism, solidarity etc, go to Syracuse Cultural Workers and get their catalog.

How nurses get their groove back…..

In the Year of Our Lord 2000,  I was elected the President of the Maine State Nurses Association. My tenure there was rocky, which is a whole ‘nother story. At the time we had 1,800 members, the vast majority of whom were rank-and-file unionized nurses. Prior to being President of the organization I had never visited some of the unionized hospitals around the state, so I decided to do so ( I was a faculty member at a college at the time.)

“And how did you get the union, here at this place?”

I always asked this question. At one particular place, I got the answer below. Here is the  true story of the nurses union at a small Maine hospital. The names of the hospital and the name of the administrator and the name of the nurses, have been changed.

A small hospital (about sixty beds) in the state of Maine was having financial problems. The CEO of the hospital was concerned about the amount of money being spent on the payroll. To use the management euphemism “labor costs” were going up.  this particular CEO had no clinical background. He decided that he would show some “leadership” in controlling costs.

Fair enough; that’s what we expect administrators to do.

I suppose he thought he was “innovative.” He adopted a tactic of walking through the building every day between nine in the morning and noon. At each nursing station, he would look to see if nurses were sitting down. If they were, he would come up behind them, tap them on the shoulder, and tell them to sign out on their time sheet, because if they were able to sit down it must mean that they were done for the day. And send them home.

Nurses protested that they needed to “chart” – to document their care’ and to do such things as checking doctor’s orders, etc, but to no avail. Spending part of each day sitting down and doing book work is part of the job. The Director of Nursing was a pleasant older lady who was not willing or able to stand up for the nurses.  The medical staff of the hospital was supportive but they couldn’t do anything right away.

Within two weeks, there were enough union cards signed to force an election. Within two months, the CEO was gone.  So was the Director of Nursing.

The nurses didn’t get the union right away, but when they did, they thought of naming their local after the (now gone) CEO, because as one nurse put it “He did more to bring a union there than any fifty organizers could ever have done.”

Since then

Since then, the hospital has still struggled with finances, and yes, there was a round of layoffs along the way and a new emphasis on cost containment. The union was not able to prevent those mega-trends from affecting the nurses jobs.

But the union was able to establish that reductions-in-force would be conducted fairly. Along with  a lot of other things that stabilized the employment scene. and most importantly, things that contributed to better patient care.


which leads to the moral of the story. Within the realm of people who organize nurses into unions, there are proverbs. And this story illustrates a few general conclusions.

1) Nurses will not vote for a union so much as they will vote against their manager

2) nurses will not vote for a union because of promises of more money, but they will always vote for a union if they feel that patient care is threatened.

3) if the administration wishes to prevent a union from forming, the best step is often to fire the managers who are being unresponsive.

4) a union can not promise results such as better wages or working conditions or job stability; but the union can promise a framework within which the union members can bring their concerns to management so they can at least be heard.

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Filed under Nursing in Hawaii, Uncategorized