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Comment: Lite wear to cover & pages. Tight binding. Good Read! Personal Favorite.
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The Hospital at the End of the World Paperback – May 13, 2009

4.4 out of 5 stars 38 customer reviews

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Editorial Reviews


Joe Niemczura brings to life the day-to-day realities of life in a rural teaching hospital, literally at the "end of the road." The harsh realities of a lack of modern medical equipment when mixed with the humanness of endurances demonstrates that above all, it is the individual who matters; both patient and caregiver. All else pales in comparison. The strength of this story is in relationships with students, physicians, other nurses, patients, families and most importantly with Nepal itself. There is a sense of community connectedness which the author brings alive as the reader becomes one with the story. The heartbreak and grief of death to the celebrations of life will elicit those same emotions. The thread through it all is the author's own journey as he discovers himself and renews his spirituality. The reader is immediately pulled into the drama and nakedness, and the beauty and mystery of this incredible part of the world.
Ellen L. Bridge, RN, BS, MTS, Public Health Nursing Consultant

"I generally don’t rush to read books put out by offbeat publishers, because theirs is usually a niche market. However, at the urging of my editor (to whom I will always be grateful) I picked up The Hospital at the End of the World and realized that author Joe Niemczura, RN, MS, wrote for my niche — nurses interested in improving smart nursing practice on a global scale. I couldn’t put the book down for several days and actually contacted the author as soon as I was done.

Niemczura teaches nursing at the University of Hawaii, and it’s probably safe to say that he’s a singular sort of guy. Through a large misunderstanding he agreed to give a lecture to nursing students visiting from Japan, but when he tried to collect his pay he found himself involved in international outreach efforts of the university. A leap of faith and some free time then took him to the Mission Hospital in Tansen, Nepal, where he became responsible for a semester of nursing education for students age 16–19 and encountered many situations far outside his comfort zone.

His goal had been to take himself beyond the tourist bubble, and he succeeded at nearly every level. Immersing himself in the life of the hospital, he joined with practitioner volunteers from many developed nations who united to make this 160-bed hospital function, providing health care to the neighboring community of nearly one million people.

It was largely through the efforts of nongovernmental organizations that this hospital was able to exist at all, and the author encountered pathology with which he had little real experience. On the medical unit he saw and heard pertussis, leishmaniasis, tuberculosis, intestinal worms and tetanus. He learned to piece together and use donated ventilators, and he became familiar with performing care without running water. In fact, the book contains photos of the rolling “hand-washing station” and he states that gloves were “washed and reused until they break.” Having 24-hour coffee availability now makes me a little uncomfortable.

The book takes us beyond the hospital to the intense relationships Niemczura formed with other volunteers, the music he played at church, shopping, food, clothes, etc. He shared all that he experienced, which is all fascinating.

When I was finished reading I almost felt like I knew him personally and wondered how he was doing. It seemed logical to send him an inquiring email, and he answered directly, telling me that he was back in Tansen waiting for the monsoons to begin.

I’d encourage anyone who has considered a medical mission to read this book first. The author has a direct style, describing the work, place and events exactly as they happened, and seems to give an accurate portrayal of the level of skill, emotional health and resolve necessary for this kind of commitment. For him, the benefits of his time in Nepal went both ways: He improved the clinical skills of the nurses he taught, and he found an inner peace he’d apparently been searching for."---Christine Contillo, RN, BSN at Working Nurse

From the Author

This book is not a "feel-good" story in the sense of "Three Cups of Tea" or "Mountains Beyond Mountains" - so don't buy it unless you want to learn about the real problems faced by real people. see comments on the author page about the four groups of readers.

I wrote it for others who might be thinking of doing what I did. When I got home from my first trip to Nepal, I dealt with cultural re-entry shock, and reflected on the experience. I realized I had no idea what I was getting into. 

If the reader is contemplating a similar adventure, my advice is to go. do. contact me - I will do whatever I can to help you prepare.
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Product Details

  • Paperback: 260 pages
  • Publisher: Plain View Press (May 13, 2009)
  • Language: English
  • ISBN-10: 1935514288
  • ISBN-13: 978-1935514282
  • Product Dimensions: 6.1 x 0.6 x 9.2 inches
  • Shipping Weight: 1 pounds (View shipping rates and policies)
  • Average Customer Review: 4.4 out of 5 stars  See all reviews (38 customer reviews)
  • Amazon Best Sellers Rank: #251,113 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

By Susan Henderson on July 17, 2009
Format: Paperback
I would like to review a book written by our former ANA-Maine President, Joe Niemczura. The book is entitled The Hospital at the End of the World (2009, Plain View Press). It is the story of transition and a personal, spiritual and professional journey. Joe left Maine to teach at the University of Hawaii. While there, he took the opportunity to spend a summer teaching nursing at a mission hospital in Tansen, Nepal. He wrote the book to describe that experience.

The book begins as Joe is met at the Katmandu airport by a cab driver who is to take him to the mission guest house. I felt like I was in the cab looking at the totally amazing sights of a very foreign land. The descriptive narrative is vibrant and one can feel excitement, awe and a degree of fear and trepidation in terms of what will happen over an entire summer in this distant and strange land. People and places come alive and one eagerly awaits finding out what the hospital will be like. Photos Joe has taken are excellent and aid one to visualize what is being described.

The hospital, patients and staff are presented very much from the perspective of an experienced nurse trying to orient himself to a new work setting. Things are very different, but Joe relates what he sees to what he knows from his experiences so that he has a basis from which to begin functioning. In bits and pieces, we learn that a great deal of time was spent in preparation for this trip. Months were spent studying the language and the culture. Used, but good textbooks were collected and carried to the hospital. After an orientation, Joe's role will be to teach nursing students at the hospital school.
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Joe writes, "The Hospital at the End of the Word," with brutal honesty, conviction, and compassion. I admired his willingness and desire to experience and live the culture and traditions of the Nepali people. He wears the traditional Topi to show his respect and even studied the Nepali language prior to his trip. Joe embraced life in Nepal, all of it...the good, the bad, the painful, the joy, and he pushed past his feelings of discomfort and accepted whatever crossed his path. As a fellow RN and person who has traveled to Nepal, I appreciate Joe's insight of Nepal, it's people, it's religion, it's political situation, and it's medical care. His voice comes through as passionate and authentic. He does a wonderful job in describing his experience as a nursing instructor in a third-world country. Additionally, the reader is engaged in Joe's own personal struggles & victories throughout his journey. This real-life story touched my heart, a great read for anyone interested in cultural nursing and/or a spiritual pilgrimage.
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I just enjoyed a journey with an unusually observant and perceptive visitor to Nepal. I was amazed at the depth and sensitivity of Joe's preparation for and immersion in the life and culture of a people so far removed from his own experience. Although I had spent 8 years teaching Nursing in Tansen, I learned a great deal revisiting Nepal, Tansen, Mission Hospital through his fresh eyes. It was a nostalgic journey for me as together we worked with the staff, guided the students, and prayed and worked to care for so many of the patients. I loved meeting my students and coworkers again with him. I found myself eagerly beginning each chapter and reliving the episodes he recounted.
Joe has a remarkable skill of storytelling, bringing the reader with him into each experience. His observations are accurate, respectful and delightfully descriptive. He touches real life and tragedy with sensitivity and compassion. He is honest in relating his own reactions and feelings in the face of the helplessness of the poor and their caregivers in these rural areas. It was a truly transformative experience for him professionally, psychologically and most of all, spiritually. I hope this book reaches many nurses and health professionals and inspires them to dedicate the richness of their education, experience and faith to those less fortunate. I know, meeting Joe, and reading his book was an unexpected blessing for me, as I know it will be for all who read it.
(Sr.) Patricia A. Conroy, M.M., Maryknoll Sisters, Monrovia, California
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Excellent descriptions of what it is like to volunteer for a Christian NGO in Nepal. Honest and to the point. Horrible editing. Misplaced quotation marks, sentences repeated almost verbatim in 4 chapters, and confuses decorticate and decerebrate posturing. A great book all around though. I'm a new grad but I highly recommend, especially for any nurse.
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I highly recommend this book for RN's, Nursing Students and anyone who would like to learn more about another country and their health care practices. If I were a lot younger (now 78), I would probably be on the next plane to Nepal to help. This book makes one so appreciative of the care that we can receive and especially care that is available to our children. Mr. Niemczura has written a thoughtful,insightful book. I could vividly picture his descriptions in my mind as I read it. Loved it.
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