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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