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Page 6 • ANA\C The Nursing Voice

Practice Committee Invitation

March 2009 started the next term for the ANA\C Practice Committee. As the new ANA\C Practice Director, I would like to invite all interested nurses to participate. Currently, we have 12 members representing 10 nursing specialty areas. The areas of interest in our discussions so far include: health care reform; health IT; magnet status; and advance practice nursing. As the committee grows and gains focus, we intent to share ideas and to participate in advocacy and legislative issues. If you are interesting in participating in the ANA\C practice committee, please email me at donnadolinar@anacalifornia.org.

California Counties Rank Health Outcomes Factors

The Robert Wood Foundation and University of Wisconsin did a survey of all counties across the country and ranked them within each state as to the healthiness of the county. Factors that were included were health care access, healthy air, smoking per population, and many others. For a detailed report you can go to http://www. countyhealthrankings.org

Overall Rankings 1 Marin 2 San Benito 2 Placer 3 Colusa 3 Santa Clara 4 Santa Clara 4 San Mateo 5 San Mateo 5 Nevada 6 Placer 6 El Dorado 7 Orange 7 San Luis Obispo 8 Santa Cruz 8 Santa Cruz 9 Sonoma 9 Orange 10 El Dorado 10 Napa 11 San Luis Obispo 11 Sonoma 12 Yolo 12 San Francisco 13 Napa 13 Contra Costa 14 Nevada 14 Yolo 15 San Diego 15 Alameda 16 Monterey 16 Ventura 17 Ventura 17 Santa Barbara 18 Amador 18 Mono 19 Contra Costa 19 San Diego 20 Santa Barbara 20 Inyo 21 Sutter 21 San Benito 22 Calaveras 22 Amador 23 Alameda 23 Calaveras 24 San Francisco 24 Mariposa 25 Plumas 25 Mendocino 26 Los Angeles 26 Humboldt 27 Riverside 27 Lassen 28 Solano 28 Solano 29 Tuolumne 29 Monterey

30 Glenn 30 Siskiyou 31 Kings 31 Plumas 32 Sacramento 32 Tuolumne 33 Mendocino 33 Butte 34 Mariposa 34 Sacramento 35 Butte 35 Sutter 36 Mono 36 Modoc 37 Shasta 37 Shasta 38 San Joaquin 38 Del Norte 39 Imperial 39 Trinity 40 Merced 40 Riverside 41 Fresno 41 Glenn 42 Humboldt 42 Lake 43 Stanislaus 43 Stanislaus 44 Lassen 44 Los Angeles 45 San Bernardino 45 Kings 46 Tehama 46 Colusa 47 Modoc 47 Madera 48 Madera 48 Tehama 49 Tulare 49 Merced 50 Inyo 50 San Bernardino 51 Kern 51 San Joaquin 52 Yuba 52 Yuba 53 Trinity 53 Fresno 54 Lake 54 Imperial 55 Siskiyou 55 Kern 56 Del Norte 56 Tulare

Not Ranked: Alpine, Sierra

The Nursing Faculty at CSU Stanislaus invites applications for a full-time, tenure-track appointment at the rank of Assistant or Associate Professor depending on highest degree earned and experience. The person appointed to this position will be expected to teach in the graduate and undergraduate programs. A Master of Science degree with clinical area of concentration in M/S is required, with an earned doctorate preferred. This is an academic year appointment. For further information please contact

Dr. Peggy Hodge at PHodge@csustan.edu

April, May, June 2010

Nursing Practice


ANA-Maine member goes to Nepal to teach nursing, and becomes locally famous as an expert on snakebite treatment.

In the USA there exists more awareness about cross-cultural nursing than formerly, and I have always enjoyed the opportunity to meet people from other cultures if they needed health care. Until 2007, though, it was always on my own turf since the recipients of my care were here in the USA, and the elements of the society and health care system were ones I could take for granted.

I now teach at the University of Hawaii. In 2007, I got enough funding through our Office of International Health to pay for a round trip ticket to Asia. I had three months off, so I figured “why not?” and decided I would see what nursing in Asia was about, first hand. Nepal seemed appealing so I searched the Web and found the site of United Missions to Nepal (UMN), a Christian Non-Governmental Organization (NGO) which operates several hospitals and nursing schools. Nepal is best known as the home of Mount Everest. The name of the capital city is used in a Bob Seger rock ‘n roll song—“Kathmandu.” (I have the idea that Mr. Seger has never actually been there though.) In May I arrived in Tansen, a city in a rural area. Students of Tansen Nursing School on class day. They lived five-to-a-room in the TNS dorm. On class days, the uniform consisted of matching saris. In 2007, I gained local notoriety when I was widely credited with saving the life of a young man who had been bitten by a Banded Krait, a species of snake whose venom is highly poisonous. I became a local hero. Many people who go to serve in a low income country bring a fantasy of “rescuing” the natives, who will then be grateful. In reality, the local personnel are often just as intelligent as the foreigners. The best way to work is to get rid of the unnecessary baggage of thinking we are somehow superior. And yet, after the incident with the snakebite victim I found myself in this circumstance, a very singular experience. Life steps off into surrealism sometimes. Nepal’s health system has been in disarray because of the eleven-year civil war, which ended in 2006. UMN operates a hospital in Tansen, and the Nursing School is set up along the old “hospital school” model, with a three-year program, forty students in each “batch.” Because of the missionary history, the language of instruction is English. The hospital serves a catchment area of about 750,000 people. Now ask yourself this question: if there was just one hospital for a city this size, and it had 160 beds, what would it be like? I was about to learn the answer to this question and more. I spent much of that summer on the Pediatric ward. It was a psychological shock to care for pediatric victims of burn injury. Though I was not a Christian missionary per se, this burn care experience made me re-examine my faith. I think it helped me to strengthen my commitment to nursing as a necessary function of humanity.

In 2008 when I returned to Tansen, I was stationed on the adult Medical ward where we admitted most of our infectious disease victims. I learned more about TB and tropical diseases. I spent a good part of each day supervising students as they prepared IV and oral meds for administration. I also worked with the students and staff to improve their emergency response and overall assessment skills.

We had one of our snakebite victims on the mechanical ventilato , and there was an electrical malfunction of the machine and we needed to use an ambu bag for eight hours. His brother was there, and we enlisted his aid in bagging. He posed for a picture at 3 o’clock in the morning.

To describe the angles of cultural immersion is like opening one of those gag gifts that consists of a neatly wrapped package only to find another slightly smaller package inside which needs to be unwrapped, then another and so on. When the plane landed in Kathmandu, the initial experience of landing in a city of two million people in a lesser developed country was overwhelming—like being in a movie but not being able to turn it off, ever.

I have written a book about the experience, titled “The Hospital at the End of the World” which is now being edited and will be in print in late summer 2009. It is “narrative nonfiction”; it’s meant to be the book I wish was available before my own first trip. And finally, I am planning my third trip to Nepal for summer 2009. This time I will take other University of Hawaii faculty with me, and some students. Stay tuned for the next installment!

Joe Niemczura, RN, MS is a former President of ANA- Maine. His Nepal photos and videos can be found on Facebook. To access them, go to the Facebook search function and type in “The Hospital at the End of the World.” Add yourself as a “fan.” The book will be published by Plain View Press in Austin Texas in 2009. It will be available on Amazon.com and fine bookstores coast to coast. Email Joe at josephn@prexar.com.

Tansen is on the edge of the vast roadless area of Nepal, on a clear day we could see the Himalaya even though these mountains were seventy miles away. Hundreds of thousands of people live in areas with no paved road or electricity. People light the night with kerosene lanterns.

The hospital uses a “functional nursing” model, providing care in open wards with eleven patients to a room. When there was an overflow, they would admit patients to low-lying pallets in the corridors, and it was not unusual to have twenty or thirty patients sprinkled around the wards on these pallets. Everyone is accompanied by a relative, adding to the congestion. There was no air conditioning and the daytime temperature was around 95 degrees.

TB is widespread; there were always people being re- hydrated after a diarrhea episode; and we admitted many “rule-outs” with possible cholera or typhoid. Some of our patients were women who had been trafficked over the border to work as sex slaves in India. They returned to Nepal in the end stages of HIV disease.

One of our infant burn victims with her mothe . Burn wounds are much more common due to the use of kerosene for fuel. Also, the mother is wearing the nose jewelry typical of the Magar ethnic group.

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