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The Hospital at the End of the World Paperback – May 13, 2009
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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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Top Customer Reviews
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. During orientation, he memorizes how the rooms are organized and notes how extra patients are placed on pallets in the hall and how family members frequently sleep under the beds or in the hall with their sick relative. I feel a sense of anxiety trying to visualize myself taking report and organizing an assignment in this environment, yet Joe proceeds.
The mission hospital in Tansen serves people who live hard lives. Injuries occur that are related to poverty and primitive living conditions. Illnesses and diseases are related to issues of sanitation, lack of public health measures and geographical location. There are tropical diseases in addition to worms, cholera and poisonous snake bites.
Nepal has many varieties of extremely poisonous snakes, when the monsoons come, the snakes move closer to humans as dry land becomes scarce. In the ER, jars of dead snakes were kept on a shelf. When a person with a snake bite came in, they were shown the jars and asked to identify which type of snake bit them. Anti-venom is not always available. The hospital had one respirator that a physician acquired but it had never been used because staff did not know how to use it. Joe and the doctor had worked together on developing a learning packet for staff re how to use the respirator, so when a snake bite victim arrived whose respiratory muscles were paralyzed, the young man was cared for on the respirator with Joe taking the lead and teaching others. The man survived.
The medical and nursing staff of the hospital is described as caring, competent and knowledgeable. The reader becomes acutely aware of the scarcity of resources common to medical practice in more developed Western countries. Early in the book, Joe mentions that the hospital has no cardiac monitor or defibrillator yet the reader comes to realize that of all the items lacking, a monitor and defibrillator are not a priority. Joe demonstrates respect for the doctors and nurses who work skillfully within the context of the situation. One part of the readers mind is aware of what is missing, yet the other part is aware of people doing a beautiful job with what is present.
Joe takes us on trips around Tensen bringing us to the market with him, showing us the woman's clothing, letting us visualize a little of what life was like, the beauty of the land and the culture of Nepal. A bus trip to Katmandu on days off is described. The matter of fact description of the city and dinner in a hotel restaurant shows the reader that they are seeing a place very far from our usual paths.
After orientation, Joe began to teach the nursing students on pediatrics. This section of the book is particularly moving. At the hospital, when a burn exceeded a certain percent of a child's body surface area, no treatment was attempted- a heartbreaking but realistic type of triage in the situation. Of the burned children who are admitted, the lack of technological resources mean that only basic treatment can be administered. Joe profoundly struggles to come to terms with the pain and suffering of the little children with burns for whom little could be done. In our society with all our technology, we can often defeat death or pretend for a very long time that death has no power. In the mission hospital in Tansen, death is a part of daily life. Yet as Joe makes his rounds and teaches students to do all they can do to relieve their little patients' pain and to be skillful in their dressing changes to the burn wounds, caring comes through as the universal foundation for nursing. Death is not a stranger, yet one feels that love is stronger than death.
Additional information about the hospital and the country are given in the Appendixes. This allows the reader access to very interesting facts without having them slow down the narrative. My favorite Appendix is the one entitled "What would Florence Nightingale do....." In this section, it is identified that women have a disproportionately hard life in countries like Nepal. Women are often subject to varying levels of abuse and most often lack access to family planning information and adequate health care during pregnancy and child birth. Illnesses that ravage countries like Nepal are discussed in terms of clean water, sewage disposal, clean meat and adequate protein for children along with immunizations and follow up of infectious diseases. Nightingale's legacy to us is that we have a good idea what she would have said and we have a good idea about what she would have wanted us to do. Joes notes that "Nursing is an important solution to all these problems" (p234). Nursing is described as a gateway to a new way of life in Nepal and perhaps around the world. These powerful words by a male nurse evoke memories of nursing leaders through the years and into the present. Nursing is a voice for social justice, caring and a global vision of health.
I found this book to be very well written and totally engaging on a professional, personal and spiritual level. It was an added bonus that I know Joe, but the book would have been just as good if I had never met him. In the beginning of the book, Joe talks about having wanted to get out of his "bubble" of the secure and familiar. He indeed traveled far from his "bubble" and confronted amazing things. There is laughter and tears, sadness and hope in this story of a nurse who dared to travel and dared to care. I highly recommend that you read it.
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
Niemczura's book is both heart-breaking and inspirational. He's a very good writer, and the story of his service teaching young nursing students in a bare-bones hospital in the barely accessible mountains of Nepal introduces dedicated doctors and nurses stretching their skills to the utmost for people in a fascinating culture. Niemczura gets "out of the bubble," learning as much as he teaches in the course of his odyssey. This is a book that speaks to the idealist in all of us.