Following Joe to The Hospital at the End of the World

Nursing in Nepal is a cultural world away from the care we often take for granted in western health care facilities. Although it’s undoubtedly a beautiful country, Nepal’s unforgiving terrain and the high South Asian location are distinct challenges to medical missionaries who seek to care for people living on what some call the roof of the world.

“The Hospital at the End of the World” is Joe Niemczura’s interesting autobiographical story about teaching nursing in Nepal. It’s a thoroughly entertaining and educational documentary including personal photographs and a helpful glossary to assist with Nepalese vocabulary.

Niemczura is a brave nurse, and writer who twice made the extraordinary journey to a missionary hospital located off the muddy and beaten Nepalese roads in Tansen, Nepal. He arrived with cartons of his nursing texts during Nepal’s rainy season.

His purpose was to teach 20th century health care practices to nursing students in Tansen. But, he didn’t have the advantages of 20th century medical technology to do it. Instead, he relied on instinct, experience, positive communications and compassion to teach in a hospital where culture, western civilization and medical science can often be at odds.

His day to day experiences are cultural short stories. Frequently by his own wits, he quickly learned the customs and habitat of Nepal’s pristine land-locked heritage. All the while, he was often teaching out of text books he transported to the hospital from his home base in Hawaii.

He writes about the Tansen hospital, “There are no IV pumps; everything is dripped and the drop rate is controlled by a hand roller on the IV line….” Some of us nurses recall how to calculate a drip rate on a hand roller, but those days are ancient history for a modern trained nurse.

Every nurse or student of nursing should read this book. For some, it will be a literary experience in cultural immersion. Many nurses, like me, might connect the human stories with the values which drove us to choose nursing over other careers, like computer science or entomology.

Niemczura writes about the people who survive and some who, unfortunately, die, in a place where modern medicine is trying to improve outcomes for a litany of endemic diseases. We read about leprosy, hookworm, tuberculosis and venomous snake bites. Modern pharmacology clearly improves the outcomes of these medical conditions in western societies, but they cause widespread morbidity and mortality throughout poverty stricken Nepal.

We read how Niemczura teaches the art of healing to eager nursing students who grew up without the benefit of modern medicine at their fingertips. He writes about the compassion shared by the nurses and physicians who arrive at the Missionary Hospital to care for the Nepali.

Yet, teaching Tansen nursing students is, more or less, the easier part of Niemczura’s story. Learning how to negotiate within the Nepalese culture is as fascinating to read as are the numerous medical situations he describes.

Some stories are humorous while others are heart breaking. Niemczura’s literary description of trans-cultural health care puts faces on those who depict the biblical proverb “Whatsoever you do to the least of my people, that you do unto me.”

Most important, by his example and experience as a skilled medical professional, Niemczura teaches Nepali nursing students to become experts in providing quality care for their own people.

Nurses of all specialties will appreciate this well written book because, at its core, the stories are an aggregated tribute to the noble and holistic art of caring for others.

Check Amazon listing and reviews: http://www.amazon.com/Hospital-at-End-World/dp/1935514288/ref=sr_1_1?ie=UTF8&s=books&qid=1259454248&sr=1-1