​Lucy Rowe was in Kathmandu for a week in September to revive planning towards the development of emergency nurse training in Nepal. 
 
You may recall that Lucy and a team of emergency nurses were in Kathmandu in April for the 3rd Nepal Emergency Medicine International Conference (3rd NEMIC) and made great strides in consultations with senior nurses in the Nursing Association, Nursing Council and Ministry of Health.  However, a week later this development came to a standstill as the earth moved.  It has taken many months for Nepalis to begin to feel that the earth is not going to move again for now, and that life must go on.
 
Lucy organised her week with characteristic energy and enthusiasm.  The key business was a meeting at the headquarters of the Nursing Association of Nepal (NAN), in Lazimpat, Kathmandu.  This included key nurse leaders from the NAN, the Nepal Nursing Council, the Institute of Medicine of Tribhuvan University (IOM) and the Tribhuvan University Teaching Hospital (TUTH).  IOM and TUTH are the leading nurse training institutions in Nepal.

Nepal Nursing Council:  http://www.nnc.org.np/
Nursing Association of Nepal:  http://www.nursingassoc.org.np/
Institute of Medicine:  http://www.iom.edu.np/
Tribhuvan University Teaching Hospital:  http://www.teachinghospital.org.np/

This meeting produced an undertaking to organize programs of one month to introduce the main concepts and practices of emergency nursing.  Subsequent meetings conducted by Lucy developed some content from this initial outline.
 
There is now the potential for Australian emergency nurses to make a substantial contribution towards building capacity for the delivery of emergency care in Nepal.  Lucy is progressing this in the hope of making a start in mid 2016. ​ Please contact NTR if you are interested in joining their programs.

Chris Curry FACEM

Nurse Teach Reach would like celebrate International Emergency Nurse Day with all of the amazing and talented ED nurses across the world.  We have been working in Nepal to further the specialisation of Emergency Nursing and are excited to work closely with the Nursing Association of Nepal in 2016 to commence the first Emergency Nurse Training programs in Nepal!

The following article was posted by the Australasian College for Emergency Medicine today and it is a great insight into the development of Emergency Care as a speciality, especially in resource low settings.

If you want to support NTR in developing the Emergency Nursing course or in the delivery of the course, please get in touch! Email info@nurseteachreach.org for details!

It definitely had its frustrating times and we were intitially having to encourage (aka bribe) the nurses with goodies in the form of pen torches and educational flip cards! This level led us to create a nursing star of the day award that consisted of a Facebook photo and a chocolate

Along with our focus on education we met with a group of senior Nepali nurses froth Nursing Association and the Nursing Council to put forward an idea to establish a dedicated nurse education program. All parties agreed that education dedicated tot he emergency nursing setting would be valuable for the Nepali healthcare system. As a result of these meetings, NTR and the nursing parties are working to establish a curriculum aiming to be implemented in the coming year.

We found that having the backing from senior management and senior clinical nursing staff influenced the attitudes towards educating the emergency nurses and the importance of critical thinking skills.

After experiencing the earthquake on April 25th and seeing the devastation it was having in Kathmandu, we quickly realised the impact this would have on Tribhuvan University Teaching Hospital.  Ironically, the week before we attended the 3rd Nepal Emergency Medicine International Conference (NEMIC) in which we were given a lecture on disaster management by the head of the disaster management team! From this lecture, we had some idea of what was expected if a disaster was to occur. Having an idea of this plan, but also knowing the reality of the resources and staffing available made it a  no brainer that we were going back to Kathmandu to see where we could help.

The NTR team arrived in Kathmandu two days after the earthquake after a huge day of travelling. Our car was loaded with supplies for the hospital that we had picked up before we left. That night, we felt a significant aftershock and it made the situation all he more real to actually be right in the middle of the disaster zone, needless to say - not a lot of sleep was had that night.

Being Emergency Nurses, disaster management was a long term goal for both of us and so to find ourselves in this situation, although scary at times, was a great opportunity and experience.

The two of us were based in the "Red Zone" which was for the critically unwell. Not knowing what to expect was quite daunting when making the way to the hospital, but the best approach was to just put your had down and get on with it.  We became walking observation machines, with all the equipment we needed carried around on us at all times.  We got straight to work once we arrived in the department - because we already knew the staff and administration, we were able to start work immediately.  We assessed patients and intervened where necessary.  One thing became very clear to us - nurses still were extremely task orientated and were not utilising critical thinking skills that we had just taught them!  We decided we needed to highlight situations that should have been escalated at an earlier stage.

When a nurse would go and put an IV line in, take bloods or put an Nasogastric tube in, they nailed the task every time. But when we asked them why there were doing those things - the answer we mostly received was because the doctor told them to.  As we became more clinical after the earthquake our role as educators also changed.  When a patient was deteriorating, we could explain why we would be taking the vital signs more frequently, and what interventions could be done without having a doctors order.  We hoped that by seeing what our approach to patient care was would inspire them and give them an insight into what their role as emergency nurses could be.

The hospital was de-escalating the emergency protocol after our second day and NTR decided to organise disaster relief packs to assist local NGOs and Individuals going to affected districts.  The money we raised during our earthquake appeal gave us the chance to help villages who had not yet received any aid.  Our packs were given to local people through word of mouth and social media and we estimated that we gave out 15packs per day.

It was hard work and absolutely exhausting but extremely rewarding. Our NTR team was awesome and there was always a debrief buddy around if you needed it. Lucy, Anna, Alice and Laura are legends and it would have been a completely different experience without them.

Thank you to everyone who supported us and NTR during this time! 

Namaste! Mero Name Laura Ho...

This was probably the extent of my Nepali language after some embarrassing incidents where I was given honey instead of 'Pani' (water) with my dinner. 

Around a month ago I returned from an amazing, life changing experience.


A little bit about me.....

I have been nursing for 6 years in Haematology and Oncology. After training in the south of England I then dove straight in at the deep-end working within inpatient cancer care. During my 3 years in the UK I completed my chemotherapy training whilst gaining valuable experience of outpatient chemotherapy. Whilst all this study and work was very enjoyable, I felt an urge to go on a bit of an adventure.

 I landed in Melbourne and gained a position at a Cancer Specialist Hospital working in the chemotherapy day ward. During my time in Melbourne I've met many people who have inspired me and I've continued to grow as a nurse.


How did I hear about and get involved with NTR....

After some time travelling around Asia, Australia and NZ I decided I wanted to do something different and challenge myself in a new way. As most nurses can probably relate to, the experience of nursing opens your eyes to how fortunate we are and how different the lives of others can be. The combination of this and travelling around some developing countries sparked my interest in wanting to contribute to health care in the developing world. It took a  bit of investigation to find a suitable NGO that shared the same goals as myself. However, on my travels, a friend recommended the Nurse Teach Reach volunteering programs. I was very much attracted to the concept of developing nurses education in a longer term model. 

It wasn't long before I contacted Lucy, the founder of NTR and arranged to join the April general program working in a cancer hospital in the Chitwan region of Nepal. I found the work up to the trip very well organised and all the information I required to get a feel of the program very manageable. 

On arrival in Kathmandu, Lucy made us all feel very welcome and relaxed. I was so chuffed to be engaged in such a wonderful project. We spent our first night being welcomed to Nepal, with red scarfs and red powder on our foreheads, as a sign of well wishing. Getting to know the group and learning the story of how Lucy came to start NTR 3 years ago. My admiration of Lucy continued to grow throughout our trip.

The following day was spent having an orientation to the program with basic admin and planning the one month program and what our goals would be. 

Our plans at BPKMCH April 2015...

I enrolled in the 4 week general nursing program at BP Koirala Memorial Cancer Hospital.   The goal for the time Alice and I whilst at BPKMCH was to train a further 5-6 Preceptors and work along-side them to support their patient assessment and assuring these preceptors were competent in A-G assessments themselves. Additionally, we planned to continue pursuing some of the chemotherapy safety work that the incredible Ida Line had done so well with last year.

Our experience and progress at BPKMCH....

As I landed at Kathmandu I instantly fell in love with the snow-capped mountains. It felt great to be back in Kathmandu and surprisingly very familiar from my previous visit 2 years ago.  Alice and I had been in contact via social media prior to our arrival, so it was great to met in person after a long travel journey. 

Over the first couple of days we visited some tourist hotspots over the capital city including ancient temples with incredible views covered in prayer flags and monkeys bounding around, hectic roads and reacquainting myself with Daal Bhat. We then got to work on orientation and planning our NTR Program. 

Alice and I headed down to Bharatpur where we would be staying for our one month program in Nepal. We got the bus and got to know each other along the way before arriving and meeting our lovely family. We were very well looked after and made great friends with our nepali family. We ate a lot of delicious variations of daal bhatt and dumplings. 

During our first week in Bharatpur we were introduced to many senior nurses and doctors and had brief discussions regarding our plans for our time spent in Nepal. We drank a lot of chai tea! 

We were introduced to all of the sisters of the various wards in the hospital and spent some time on the medical oncology and day wards learning the daily routine of the wards there. Lucy came down to Chitwan for several days during this week and orientated us to the hospital and the local area. We made our plans for a preceptorship training day the following week. This was decided to be Monday of the following week as Tuesday was Nepali new year entering the year 2072! Which was rather baffling. 

The preceptor training day went very well following a few early surprises. We were prepared to train 6 new preceptors but it turned out to be 9, plus 8 guests. This included some of the previous preceptors who would help with assessment teaching, translations and discussions. 

We focused on the concept of preceptors, competence and assessment. Continuing professional development is a very new concept to introduce within Nepal and I felt at times the ongoing purpose of nursing development beyond NTR was being misunderstood. Overall I thought the day went well and we were able to educate nurses as to the importance of development and why starting with patient assessment and basic interventions was an essential grounding of clinical practice. It did seem that some senior members of staff were still yet to be convinced of the value of professional development (at times we take for this for granted in our regulated world of NMC and AHPRA), so this will be area for NTR to continue to push for in the future.

Previously, during Ida's trip, great progress had been made regarding chemotherapy safety at BPKMCH. The differences in practices in the medical oncology ward where Ida had focused her work in comparison to the day chemotherapy ward were very noticeable, it will be great to transfer these developments across, however time was very limited whilst we were there and it can be tricky to start introducing changes prior to building a rapport with the staff of a unit. 

We commenced further surveys to assess nurses chemotherapy exposure including staff in contact with and not with chemotherapy, to demonstrate a difference. This was a progression from the previous discovery of a high incidence of nurses at the hospital working with chemotherapy reporting side effects of cytotoxic exposure. Unfortunately I was unable to collect results of this survey due to the huge earthquake that hit Nepal during our program. It did not feel appropriate to pressure staff given the circumstances.

During the third week, great progress was being made building a relationship with the staff of the day oncology unit and plans to improve the nursing process. Unfortunately due to the earthquake our program was cut short by a week, as our team and the whole country dealt with the shock of this huge natural disaster and moved toward disaster relief priorities. 


Conclusion....

My time with Nurse Teach Reach was likely to be one of the biggest learning curves of my life, not only about life in the developing world, but the realisation and reality of my privileged lifestyle which I so often take for granted. I learnt a great deal about myself and the strength of others in disaster situations. I would love to return to Nepal to continue the ongoing support of nurses, limited time felt like one of the biggest barriers to our program alongside my slight lack of confidence. I felt like it took some time to find my direction. I would highly recommend  to any nurse to get involved with NTR as it is a wonderful organisation with fabulous ideas and goals for realistic future development across the world.

Nurse Teach Reach wants to say a huge thank you to one very special supporter - Milo! He is 10 years old from Sheffield South Yorkshire and is a family friend of volunteer Alice. 

Milo decided to help NTR so he baked cakes, designed a poser and promoted a table top sale - selling his own toys so that he could raise money for NTR! In total, he donated $183AUD to our Earthquake Disaster Relief Appeal! 

Thank you Milo from the entire Nurse Teach Reach team! Such an amazing act of kindness :)

Hi - Im Alice, and i volunteered with NTR in April of 2015.  Im from the UK, in Kingston upon Thames and I studied undergraduate nursing in Sheffield and recently studied Torpical Nursing at the Liverpool School of Tropical Medicine.  Beyonce is my spirit animal. 
With this blog I'm focussing on the earthquake itself and the role of NTR in the aftermath.

There was the earthquake on April 25th at 12.30pm and then the aftershocks started within minutes of the initial quake, and continued the whole time I was in Nepal. We were shaken, but we gathered ourselves up and got back to our hotel and I was glued to the Nepali Tv stations broadcasting images of the destruction in Kathmandu. 

The damage was catastrophic. The images of Kathmandu were awful. The scale of what had happened sank in with awful clarity. And as soon as I saw the news images on loop of Kathmandu, I knew I was going to abandon the educational work I was doing with NTR and was going to join the relief effort in any capacity to help. I discussed my intentions with Lucy, as I think a few of the other girls did and soon we had created a rogue little Nurse Teach Reach disaster relief team. 

And so we had a group of nurses, good intentions and a plan, to go to Kathmandu and work. However, we had little money, limited supplies and we were an 5 hour journey from the city and it wasn't exactly safe to travel. 

Fortunately we had an internet connection so we were able to spread the word to our friends and family who contributed to our relief fund and who enabled us to get into the field with the necessary supplies and equipment. So as soon as we were able to arrange a car to take us back to Kathmandu, we went back with a jeep stuffed full of medical essentials. 

The 5 hour journey took us an entire day, due to landslides and road closures, and we reached the city at night. I remember feeling increasingly anxious as we got closer to Kathmandu, as the damaged houses we drove past got worse and more frequent, worried about what we would find when we got into the Valley. In reality, the damage was hidden in the dark but it was painfully obvious that Kathmandu was now a ghost town, driving round the dark, empty streets. 

On our first morning in Kathmandu we got up early and headed to the Tribhuvan University Teaching hospital. It is one of Kathmandu's largest Hospitals and trauma canter. As NTR already run educational programs in the Emergency Department, NTR Founder Lucy was easily able to obtain permission for us to work clinically in the hospital. 

The amount of pepole needing medical attention had overwhelmed the hospitals capacity and the A&E had spilt out into three triaged wards and much of two car parks. I walked into a word outpatients eye clinic waiting room that had been overtaken by the yellow area. People with multiple, unset fractures and wounds, some of whom had been sat there for 3 days since the initial quake, were lying in beds or on the floor, with no analgesia, and little medical attention. There were only a few doctors and nurses, and several overseas medical volunteers.I didn't know where to start but Lucy took control of the situation and set us up, soon we were doing sets examinations,  wound dressings, giving medications and escalating issues to the doctors.

Although we had bought some supplies with us, they soon were snapped up and the reality of what was needed and huge quantities became obvious. Thankfully we had been able to raise a significant amounts of money. So I would do runs to the cash points, withdrawing the daily maximum from each, and then run across the street to the pharmacy to buy supplies of principally medications, but also basic equipment, blood pressure sphygmomanometers and stethoscopes, and infection control equipment like gloves and hand sanitiser. 

This was the best thing we were able to do. Within a few days we had got back to Kathmandu, and we were working as nurses to help in the immediate post earthquake relief. But we were only 5  nurses, and despite all of our experience and skills, there was a limit to how useful we could be. Furthermore, If the patient was in pain, there was no analgesia, If there was a wound to be dressed there was no dressings or antiseptic. However with the donations we had I was able to go out to buy all these supplies. Nothing fancy, no hydrocolloid dressings with silver or quick release analgesia, just basic, essential, supplies. 

This was the beauty of what we were able to do in Kathmandu in our NTR disaster relief effort. We were able to do an initial needs assessment, go buy the needed equipment and deliver it to those who needed it, within hours. We were working as nurses, purchasing supplies and delivering them to those in need all while other international NGO’s were still stuck in other countries trying to fly in their personnel and supplies. Even days into the disaster other organisations were still performing needs assessments while we were stuck in. 

And we were flexible and versatile, when the demand in the hospital stabilised and the reports of the devastation of the villages around the valley started to reach us, we focused our attention on purchasing supplies and creating first aid packs to distribute to these effect isolated communities, where help was not reaching. 

Nurse Teach Reach Is a small International NGO thats been running for a few years off Lucy’s unwavering determination and the work of a handful of nurses that donate their time. The purpose is to develop nurses in developing countries through education and professional development. And yet, we found ourselves at the centre of natural disaster. We gathered ourselves up and got on with it, did ourselves proud and we did great things with the overwhelming amount of support that our families and friends rustled up for us. 

We did great work and it is the most exceptional thing I've done, I’m incredibly proud to be part of Nurse Teach Reach. I know there is so much more to do though and NTR will continue to play its role in rebuilding Nepal through the work of its volunteers 

Namaste

Nurse Teach Reach is the focus of NURSE UNCUT - the NSW Nurses and Midwives Association online Blog.

Please click on THIS LINK to be taken to the page to read the story of NTR Founder and Director, Lucy Rowe.  She writes about why she started Nurse Teach Reach and the future directions for the organisation in the wake of the Nepal Earthquakes. 

Thank you to all of the friends, family and supporters of Nurse Teach Reach for coming to our incredible fundraising event at Mustang Nepalese Restaurant in Crowsnest. The night was incredible and we raised much needed funds to continue our programs in Nepal and to support our Earthquake relief efforts.

Thank you to the artists who donated to our raffle and to the amazing staff at the restaurant for all of your hard work. A special shout out to Aaron, Kaz and Chelsea for helping us organise the event!

THANK YOU!

Megan Wake and Dr Jennifer Rush attended the 3rd NEMIC conference in Nepal in April.  They both work at the Royal Adelaide Hospital in the Emergency Department and they have been featured in the "In Central" newsletter distributed by the local health network.  Have a read and see how they have been supporting Nurse Teach Reach by fundraising for our Earthquake Disaster Relief Efforts.  Thanks Megan, Jennifer and the team at the Royal Adelaide Hospital!