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

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…..

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

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

Rural Community

Buddhism and Hinduism

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%)

HIV Information First infection 1988 HIV prevalence 0.3% ( ) 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

YET HIV prevalence is declining after reaching the peak during 2002 – of every 5 HIV infections are sexually transmitted Survey of comprehensive knowledge of HIV amongst adolescents : 25% F, 33% M National Centre for AIDS and STD Control Nepal; Country Progress Report on HIV/AIDS Response, Nepal, 2014

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

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

bed centre

2013 Field Trip 3 nurses from Sydney Palliative care, HIV specialist 4 sites: NKP, Nepal Hospice, APN Kendra, Peace Freedom Project

NKP 2 day workshop Collaboration via for content Participants from NKP and Women’s Refuge Service Badal 24 Participants (12 m, 12 f) and a few children!

Program Day 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

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

Evaluation- Negatives –Wanted longer workshop –Group discipline –Medical terms difficult to understand

Lessons learnt Expect unexpected Language and literacy Participants personalising information Interpreters Nurses experience….

The Kids

Donated clothing

So why do it…. Challenge yourself Cultural exchange Share your skills Make a difference Make friends Adventure

Create Memories

So take the first step