Nurses: Stepping up, Stepping
forward, Stepping beyond.
Treks to Nepal
Denise Cummins
Clinical Nurse Consultant
MPH, PhD Candidate
Sydney District Nursing Service
Sydney Local Health District, NSW, Australia
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Visiting Nepal since 2003
Varied agencies:
• Life Giving Life Saving
• Ausaid collaboration
• Peace Freedom Rehabilitation
• Nava Kiran Plus ( three workshops)
• Nepal Hospice
• APN Kendra
• Changes over the years…..
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Volunteering…
• Clinical skills, workshop, outreach,
mentoring
• Fund raising, The Polly’s
• Nurses have so many varied skills and are
willing to share and learn from others….
One person can make a difference
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Demographics
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Population: 30 million
75% agricultural labour workforce
25% live below poverty line
Life expectancy: 67 m, 69 f
Literacy 62% m, 34% f
GDP $700-$1500
Unicef country information
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Rural Community
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Buddhism and Hinduism
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General Health
• Vector borne disease: Japanese
encephalitis, malaria, and dengue fever
• Food or waterborne diseases: bacterial
diarrhoea, hepatitis A, and typhoid fever
• Infant mortality rate
• Heart disease and TB (11%)
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HIV Information
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First infection 1988
HIV prevalence 0.3% (39000-65000)
8% children <15 years
5000 deaths
• Concentrated epidemic: people who inject drugs,
MSM and transgender people, FSW and male
labour migrants
National Centre for AIDS and STD Control Nepal; Country Progress Report on HIV/AIDS Response,
Nepal, 2014
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YET
• HIV prevalence is declining after reaching the
peak during 2002 – 2003
• 4 of every 5 HIV infections are sexually
transmitted
• Survey of comprehensive knowledge of HIV
amongst adolescents 2008-2012:
25% F, 33% M
National Centre for AIDS and STD Control Nepal; Country Progress Report on HIV/AIDS
Response, Nepal, 2014
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HIV Services
• 200 testing sites in 75 districts
• 70+ Mother to Child sites
• 18 CD4 & 1 viral load sites
• 44 ART sites ( M: 4709, F: 4129, 30
transgender, 638 children)
National Centre for AIDS and STD Control Nepal; Country Progress Report on HIV/AIDS
Response, Nepal, 2014
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Nava Kiran Plus, 2003
• NKP - 25 districts and provides care to
300 people daily
• Core actions: provide treatment, care and
support related services and advocacy
• Orphanage
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2008- 50 bed centre
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2013 Field Trip
• 3 nurses from Sydney
• Palliative care, HIV specialist
• 4 sites: NKP, Nepal Hospice, APN
Kendra, Peace Freedom Project
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NKP 2 day workshop
• Collaboration via email for content
• Participants from NKP and Women’s
Refuge Service
• Badal
• 24 Participants (12 m, 12 f) and a few
children!
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Program
Day 1
Day 2
• Ice breaker activity
• Quiz
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Being HIV positive
HIV information
Medication adherence
Dealing with side effects
• Hand massage
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Recap
Mental health
Depression and anxiety
Cognitive impairment
Pain and pain
management
• Panel Q&A
• Celebration
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Evaluation- Positives
Increased knowledge on:
– HIV and HCV
– HIV and HCV medications (e.g. adherence, how drugs worked)
– Viral load and immune system
– Depression and cognitive impairment
– Interaction and activities good
– Ongoing commitment
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Evaluation- Negatives
– Wanted longer workshop
– Group discipline
– Medical terms difficult to understand
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Lessons learnt
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Expect unexpected
Language and literacy
Participants personalising information
Interpreters
• Nurses experience….
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The Kids
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Donated clothing
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So why do it….
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Challenge yourself
Cultural exchange
Share your skills
Make a difference
Make friends
Adventure
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Create Memories
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So take the first step
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