Sept 1st back in USA

Hi –

I’m back in USA and still following the Nepal news.

I’ m keeping this blog “up” but not focusing on it right now. My main effort has been going to the blog that accompanies my second book, the novel about Nepal.

Nepal is presently in political turmoil (to say the least) and you can read my thoughts about it here.

sending the best karma to all my readers.

Nursing in Hawaii blog is still on Hiatus while I’m in #Nepal until May 30

Thank you for wandering into this blog site!

Though it’s titled Nursing in Hawaii, most of it is devoted to general advice about nursing. There are three blog entries that seem to get the most hits – look on the list at the right and you can see them in all their glory.

Work in Hawaii?

I do have specific advice for nurses from the mainland who want to work in Hawaii. In summary, if you enjoy the cultural stuff, you will love it here. You can maximize your fun by studying the different cultures of the patients and co-workers you will meet. Browse the blog entries to find the gems…. I love Hawaii!

Nepal

You may wondering why the blog is suspended. Well, the answer is, I have been following a lifelong dream and working in Nepal for a year. I am making a difference in health care in this country, and every day I thank God for designing my life so I can do this.

Read my Book?

My second book is a novel about Nepal health care. It’s titled The Sacrament of the Goddess, and there is a FaceBook page for it. Click here to get to the Amazon site.  Also I have another blog, just for the book.

The book is enjoying popularity here in Nepal, as crazy as that sounds. Want to read a review in Nepali language?

I will return to USA after May 30th.

Aloha!

This blog is not dead, it’s in suspended animation

Why no entries lately?

I keep my blogs separate ( or try to…) and since I’m in Kathmandu, Nepal, the action has moved to my Critical Care Nursing in Nepal blog. Click here and you will be transported to that other place.

The Sacrament of the Goddess

in case you are wondering, my second book, the novel about love in the time of the Nepal Civil War, has been published in USA. You can find it on Amazon. No, it’s not on the New York Times Best Seller list. Not yet anyway.

Nepal edition?

I’m working to get it published in Nepal. The people here are interested in this book – after all, it’s about their country!

what did you do for your summer vacation

school begins again soon.

if you really must know, here is what I was doing all summer….

http://joeniemczura.wordpress.com/2013/08/14/preliminary-report-of-ccnepal-2013/

It was fun but I will be happy to be back in a routine.

Please help me get funding for 2013 trip to teach critical care nursing in Nepal

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.

Limitations

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.

:-)

Description of an art object I own…. the “Bird’s Eye” Thangka of Nepal

Most of this blog is devoted to nursing issues, but I have also travelled to Nepal, the setting for my narrative nonfiction book. Want to subscribe to this blog? just go to the little box on the right that says sign me up.

About the Nepal “Bird’s Eye” Thangka

Okay, so the thangka I bought this past summer is 32 inches by 52 inches, and it’s too big to photograph. So – I decided to photograph parts of it. You can use your imagination as to what the entire grand piece looks like…… the nature of this particular thangka is to draw you in, and make you stand closer – there is simply too much detail when viewed from a distance, anyway.

It was purchased at the Thamel neighborhood of Kathmandu in July 2011. To paint a thangka is an ancient tradition. This one shows river rafting, bungee jumping, and the cable gondolas at Manakamana (center-left) so it is not older than 1998.  I had seen it on the wall of a shop, then came back after thinking about it for two weeks. I  was told that this Thangka became available due to the renovation of a hotel lobby in Kathmandu where it was displayed.

Most Thangkas depict a “mandala” – an abstract wheel.  Many Buddhists believe that the Kathmandu Valley itself is a giant mandala, and that the layout of temples and sacred places within the Valley will help the untrained mind to reflect on Buddhist teachings.

In this Thangka, you can see more than just Kathmandu, however, and in fact that’s what appealed to me  – landmarks in the left of the painting show Tansen, a Newari hill-town in the Palpa District; The Bus Park; “Elephant Gate;” and Tundhikel (parade ground). Tansen is the setting for My book, “The Hospital at the End of the World,” (available on Amazon dot com.) and the inclusion of these proved to be irresistible.

Guide to other famous localities depicted in this Thangka.

Bottom edge. Lower Left – Lumbini, the birthplace of Buddha.  Center of bottom edge – Chitwan, nature preserve where rhinoceros, tigers and elephants roam.  Janakpur, legendary birthplace of the Goddess, Sita. Jhapa, the easternmost district of the Terai, the plain at the border with India.

Left border: Tansen (see above); Jumla.The tower in the upper left corner is thought to be Mongolia, but may also represent the top-secret America C.I.A. monitoring post maintained during the cold war. The forest is Siberia.

Upper left – Phewa Tal Lake, near Pokhara, with the island temple. Devi Falls. Fort with gray steps is Gorkha. River rafting is depicted on the Trisuli River, as is the tourist gondola to the top of Manakamana.

The Himalaya (“snow-covered”) forms the spine of Nepal and is a focal point here, rightfully so!  Peaks depicted include Annapurna, Rum Doodle, Machhapuchre, Langtang, Everest, Makalu, and others.  Note the Yeti and salt traders with a caravan of yaks. A team of alpinists seeks their destiny on the slopes of one peak. Perhaps the ill-fated Mallory expedition of 1924.

Along the upper border: The Great Wall of China; the temple at Muktinath on the Annapurna Circuit; Mt Kailash “The Crystal Mountain;” and the Tibetan Plateau. Monasteries in Tibet include the Potala Palace in Lhasa; Tyenboche, and other pilgrimage sites.

Upper right: Bhutan (denoted by a different style of architecture); Namche Bajaar, in the Solu Khumbu region at the foot of Sagarmatha (Everest); and Taplejung.

Center right edge Ilam, the region of tea plantations. Throughout the painting, there are small scenes of village life, including herding of animals, weaving, and farming.  Women carry the ubiquitous dokha, or woven pack-basket. Terraced rice-paddies punctuate the steep landscape.

In the center is the Kathmandu Valley, capital of the country and main tourist gateway. Curiously, the modern airport is missing, along with the Prithvi Highway.  The location of Shangri-La seems to have been obscured intentionally, though I do have fond memories of my pilgrimage to that mystical place.  My time there will serve as the setting for my second book about Nepal.

Center: In the north Valley is Buddhanilkantha, where the “Sleeping Buddha” rests under a serene pool of water, and Shivapuri.

On the left of the valley cluster is Swayambunath, the “Monkey temple.”  In the city center is Kathmandu Durbar Square.  Narayanhiti Palace faces the “Rani Pokhari” pool. The two towers are the mosques – Sundhara and the “Clock Tower.” On the right of this cluster is a major temple complex which serves as the sacred and auspicious location for Hindu funerary rituals, Pashupattinath. The river here is a tributary of the Ganges, though it is not shown here.

Below that is Mangal Durbar in Patan, across the Bagmati River. A team of men uses ropes to pull the Mechhandranath juggernaut, in a ritual seven hundred years old. To the right of Pashupattinath is the Great Stupa at Boudhanath, largest such temple in the world, centerpiece of the Tibetan expatriate community. The ancient Malla kingdom of Bhaktapuris depicted to the south of Boudhanath, a collection of brick temples with multi-story pagoda-like roofs.

They say you can tell something about the traveller by examining the things he or she brings home. In fact as tourism is promoted, great study is made of the type of traveller likely to visit a place and what they are interested to buy. A certain type of person will bring a t-shirt with the name of the place; still another will bring trinkets. (And of course, a vagabond traveller will bring home some sort of intestinal infestation) The usual traveller to Nepal buys a khukri, or a singing bowl, or a pashmina shawl, or a Tibetan item. And yes, thangkas are on the list but usually these are more abstract. For me, I make a careful assessment of items likely to remind me of daily life – sometimes this is quirky, such as taking home  one of tiny  hand-fired clay pots used to send stool samples to the lab!  One of my best souvenirs is a shawl that was given as a gift from my hosts at the medical center in Bharatpur – it”s the type of men’s shawl worn by the close-to-the-land farmers of the Terai, hand-embroidered with the Kulsani plant ( hot peppers). I tend not to buy the “usual” touristy art objects, but this time I could not resist.

destination: Maine Nov 20th 2011

From the airport terminal in Philly, Sunday morning

Three months ago some former colleagues in Maine got a grant from the Libra Foundation to promote crosscultural awareness among nurses there ( it’s a homogenous state, homogenized like milk….) and they had this idea to feature my work in Nepal. Originally I could not get the time off to attend in person, and so we were going to do a teleconference link. But now through a strange set of circumstances, I am able to go to the Pine Tree State and be “live” … and I will throw in a visit with my daughters on the side.

Nov 21st from 0900 to 1100 in Augusta on ITV network

I will be appearing live and in person at the University of Maine at Augusta, the state Capital, Monday the 21st. The event will be broadcast to five locations around the state. Eighty people there have read my book as part of a course assignment – I have been in front of large audiences, but not when so many have actually read the book. I am told it’s created a stir over there!

My Life flashes before me?

I brought a copy with me on the plane – the first time I myself had opened it in awhile – and I was thinking, gee – I remember that event – fun to reread my own stuff from a new perspective. There are parts I would change, if I had it to write it all over again. On the other hand, I cried at the sad parts. I am still a softie. When you crank out a hundred thousand words, you don’t put the same effort into every single word – there were a bunch of places where the ratio of time to words was high – and where I can recall sitting for hours struggling to describe some of the events. Those persons who have read the book can guess the places I am talking about…..

Wintering over on an island

My younger daughter is spending the winter in Northeast Harbor Maine – and I will be the first overnight guest at her cabin there, quite an honor. This is a gem of a coastal Maine town – at the head of Somes Sound. In summer, Sweet Cottage rents for $2,000 per week. In winter, the tourist trade drops off considerably, so she has got a deal to keep it occupied until May. It’s beside the merriest babbling brook on Mount Desert Island, and a short walk to Asticou Terraces…

Maine Humor?

My daughter is prolly the best twentysomething Maine Humorist out there. A difficult legacy to assume – the pantheon includes E.B. White, Marshall Dodge, Tim Sample, Paul LePage ( by default; he thinks he is serious) – She has her own blog, titled mainethewaylifeturnedout, here in wordpress. Take a look at it.

Fried Clams?

She says I will get a bean supper while I am there – (“with red hot dogs?” i asked – “yes” she said!) complete with brown bread and ginger bread for dessert. An old friend of mine would say “that’s half of a Maine Saturday night!” and I laugh…. to get to her place I need to pass the Trenton Grange Hall – and other delights. I am a “Past Master” of P of H #550. Alas, I will not be there for a contra dance…..

But from the foodie end of things, I am salivating at the prospect of New England Seafood – forgot how much I missed it – I may very well be eating fried clams with bellies, every day….. not for breakfast though.

I wil be renting a car in Boston and driving north, later today. I am still wearing shorts and my red Heinz Ketchup t-shirt – I dug my polar fleece out of the closet and I did bring long trousers –

Deep Cultural References

I lived in Skowhegan for years, a dairy industry stronghold, and a dairy man once told me never eat red hot dogs “them’s BULL MEAT!” he would say…. I admit I can’t sday as how I have seen them in Honolulu….

…. and every bean supper blends together in memory…..

Movie review of “Contagion”

Contagion

Not much of a date movie. As we left the theater the military guys behind us were talking about where to get hand sanitizer.  

 Gwenyth Paltrow

Okay okay there’s more to life than trying to unwind from the work week. I wanted to see Contagion partly because it has Gwenyth Paltrow in it, and I now realize that she and the other stars (Matt Damon, Lawrence Fishburn, Kate Winslet, Sanjay Gupta) probably got signed on for the express purpose of luring their fans into the theater. It worked in my case. The movie was also recommended by Willie Marshall, a public health nursing faculty at UH. 

 Heroism is not always glamorous

Public health, the part that deals with epidemics, is heroic in it’s own quiet way, but not “sexy.” There is no glamor to be found, no countdown to a victory celebration at the end.  Every schoolchild grows up hearing about polio, small pox, plague (“the Black Death”), Spanish Flu, Malaria, yellow fever and the like, but western  society has insulated all of us from close contact with infectious diseases, and I greatly prefer to deal with illnesses that can be packaged and treated within the confines of a hospital building. I feel secure that way. We all do. Let’s keep the wild viruses in a zoo as if they were lions and tigers…..

 The Dark Ages

For those of us in health care, there is a certain medieval quality to the idea that these things are out there and can kill you, that they have literally been a plague since the dawn of time. And that humanity is also a “herd” governed by the same rules that apply to the cattle business.  Just because these diseases are old-fashioned does not mean they have gone out of style, and we get these jarring reminders now and again.  And these threats have  not gone away just because we now have pennicillin and DNA sequencing. 

 Memories of past adventures

Allow me to reminisce in an unsentimental way. Over my whole career, taken in it’s entirety, I have been in the presence of just about everything. AIDS was not named until 1981 or so, but I know that I took care of Intravenous narcotic abusers with broken-down immune systems at Boston City Hospital in 1977 in my very first RN job. (“Heroin does funny things to the immune system” we used to say in those days)  At UCSF the neuro-ICU  was the site of inpatient care for a study they were doing on infectious encephalitis while I was there, I remember calling for one particular specialist consult, then meeting UCSF’s  Fellow in Infectious Diseases (I.D.). It was a small department in those days, with a shining history dating back to the days of Pasteur.  The I.D. Fellow wore horn-rimmed glasses and was a bit tweedy. “Don’t run away. I may need you,the first rule is not to panic.” he said. This will be interesting, I thought. I.D. has always been a specialty for thoughtful nerdy doctors, with a sort of Clark Kent quality, and an air of the Mad Scientist about them.   Whenever a doctor prefaces his remarks by saying “don’t run away,’ I have learned that something really really interesting is about to happen. 

 Q Fever

While at UCSF,  the half-dozen or so Q fever victims of the now-infamous Q fever mini-epidemic were admitted to Neuro-ICU, my workplace. ( Infamous because it later became a poster child for the impetus to revise federal rules on use of laboratory animals in academic medical centers).

 ANA-Maine

While President of ANA-Maine, part of the American Nurses Association (ANA), I was editor of their statewide quarterly newspaper mailed to every RN in Maine. In that role I got to know people  from the public health infrastructure of Maine, and gained a new respect for the great care taken in efforts  to present accurate public health info.  Do you remember the anthrax threat after 9-11? Or that national debate about smallpox vaccination? I sure do. I remember coming back from an ANA national meeting in  DC with a box of the first smallpox brochures, hot off the press, wondering how to best share the info with people in my home state.  Maine State Public Health also sponsored an annual workshop on public health, a must-go-to event, and one year  the featured speakers were the  leaders of the Toronto SARS response.  All the key players in Maine  got a jaw-dropping inside look at the true story behind that the response to that event. Health workers died in Toronto. The speakers conveyed the gravity of the “oh shit” moments, times when  the Toronto Public Health authorities realized it was getting away from them.

 (First rule of public health – don’t alarm the public.)  

 And of course, Nepal. Read my book. :-)

 Somewhere previous, http://joeniemczura.wordpress.com/2011/05/03/reprint-of-2008-meningococcal-meningitis-episode/ I described the single most gut-wrenching inadvertent exposure I ever was involved in, and it unfolded on a hot afternoon in Tansen in 2008 (I survived to tell the tale, just the smell of peach soap is enough to remind me of that day). Nepal remains a  simmering stewpot  of infectious diseases I hope we never see here in the USA – kala-azar, leprosy, tetanus, malaria, Japanese encephalitis, TB, brucellosis, hepatitis, meningococcal meningitis. A long list – what I am I forgetting???? 

Oh – add cholera, typhoid, plain ol’ infectious diarrhea, helminths of all types, snakebites,  HIV,  pneumonia and meningitis…… 

Worms and snakes *do* belong on that list.

 I am happy to report that I have never caught anything major during that whole thirty two years. Oh, I got rotavirus (“cruise ship virus”) one time at a hospital, along with a dozen others, but I take comfort in the fact that I was the one who said “hey, something fishy here that we are all getting sick.” So, some good came of it.

 Handwashing

The secret? I always wash my hands, always. That is still the number one rule at work. On the home front,  I never got a tattoo, visited Haiti, drank unpasteurized milk, or had skanky sex. (TMI perhaps, but true). 

 Movie Review, here, finally

Back to the movie. The challenge for the moviemakers was to dramatize and personalize something that unfolds over time and which requires a bureaucratic response with hundreds of players. Also, quite frankly, to compete with fictional action-adventure movies. In a fictional outbreak, the disease can be exaggerated so that the audience is gripped by  an immediate horror, satisfying the thrillseeking entertainment value of the genre, and allowing the pace to be  faster. In real life, we are programmed so that an illness of this nature causes disgust and revulsion, not quite the kind of “thrill” that pulls people in to a movie theater.  There is a slow-motion aspect caused by the incubation period, a seeming randomness to the victims that is maddening to uncover, and an element of quiet suffering, as the victims go down, one by one, laying quietly in a heap for awhile before they pass away.

 These scenes were accurately depicted in Contagion. Whenever I see a movie in which a person dies, it’s ruined unless the details are plausible and realistic to the T.

Shakespeare in Love

(The autopsy scene was truthful but I prefer to remember Gwenyth as Viola De Lesseps, flowery incandescent youthful glory of her Oscar-winning role…..isn’t that how we all prefer to remember our loved ones?)

 Death by Committee

To convey the drama of a worldwide pandemic, the movie was forced  to include various committee meetings where the protagonists were educating elected officials or each other, a sneaky way to clue in the audience  as to the relevant science. They tried to keep the lectures short, but it still had the feel of being lectured or taught about the action.  The geography also played a role – switching from rural China to Atlanta, Minnesota, and San Francisco (and yes, I recognized all the San Francisco scenes since most were in the neighborhood of UCSF where I used to live,  Parnassus Heights and on the UCSF campus. My alma mater).

 Anyway, I think the movie did the best possible job to depict  the phenomenon, given these constraints. At times it had the feel of a documentary, since there was an obvious educational component to it (here is what the Red Cross does, here is the National Guard. A very poignant moment in which a Roman Catholic nun appears. Go get ’em, Sister!)  and of course, when we finally get the next pandemic I wonder if any body will be left around to tell the tale in a similar way.  For those persons who have not been involved in this line of work, I can tell you  it does mirror real life, people making decisions based on incomplete knowledge. 

 In summary – worth seeing, a thought-provoking effort to educate the general public about a little-known part of the medical establishment.

the ultimate video link to summer 2011 critical care nursing project

sorry if this is crossposted too much – but I wish to share this widely. Twenty three minute description of my Nepal summer project 2011, done by a professional photojournalist. partially edited.

http://youtu.be/FZjqfOdWRb8

Several things to point out.

First,I was grateful for the use of the classroom space at Lalitpur Nursing Campus in Sanepa. The school is located in a former Rana-era palace, and this was the ballroom -crystal chandelierand all.

Next, we did these drills every class day. There were three simultaneous stations; only mineis shown.

If you listen carefully to the background during theinterview at the end, some women in the neighborhoood were chanting a Buddhist hymn.

Enjoy!