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Functional Nursing Care
The nursing department of the hospital is organized using a "functional nursing" model. Nursing report is in a mix of English and Nepali. Each employee starts the day with an assigned list of repetitive tasks. One nurse gives all the medications, one nurse takes all the blood pressures, and one nurse changes all the dressings. The only nurse who has the "big picture" is the charge nurse, or didi.
If you asked a staff nurse how they know when they are doing a better job, they would probably reply, "Because I can get the medications delivered more efficiently." This is in contrast to other models of care delivery that might be more conducive to an outcomes-oriented approach, where the nurse might reply, "Because my patients are improving faster with fewer complications."
Nursing School
The nursing school is located just downhill from the hospital, connected by a long stone staircase. The school is brick, constructed like a military fort with classrooms, offices, and dorm space around a central plaza, guarded by its own Chowkidars. The students stay five to a room, and the dorm rooms are smaller than my faculty office at the university. A student once told me that most of her classmates kept the same roommates for the entire 3 years of school. Restrooms and showers are at the end of the hall. The school has its own canteen, and if a student is on night duty, she is allowed to appear in a tracksuit or something casual.
Nurses' Uniforms
Students wear a uniform and old-fashioned white cap when doing clinical rotations. On class days, they wear a bright purple sari with a white top, hair pulled back, and no skin showing at the midriff. When the students cross the courtyard in their saris, it is like a flock of blue-and-white penguins going by (Figure 19).
Figure 19. The school uniform worn for classroom and community health nursing experiences. Image courtesy of Joe Niemczura
There are no male nursing students. On Saturdays, students are allowed to go the bajar (downtown shopping district) in western-style clothes. Nursing students who live in the hostel are not allowed to have cell phones, a great hardship for teenage girls nowadays.
If You Read This Far
If you got this far, you deserve my thanks. You may be interested in my first book, The Hospital at the End of the World. My second book, The Sacrament of the Goddess focuses more on the cultures of Nepal, and how these influence the way that decisions are made. I also welcome readers to my blog or my YouTube channel.
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