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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

• 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

• 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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ProgramDay 1

• Ice breaker activity• Quiz

• Being HIV positive • HIV information• Medication adherence• Dealing with side effects

• Hand massage

Day 2

• 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

• 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….

• 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