Summer reading for #Globalsurgery

The Sacrament of the Goddess is a great “beach read” for persons who want to be transported to an exotic time ( in the recent past) and place (on the far side of the planet from Boston).

It’s a way to learn the boots-on-the-ground of #Globalhealth and #globalsurgery without wading through a textbook. The story of working in a remote hospital in the Himalaya is told through the eyes of an international crew of medical volunteers working with a team of Nepali and Indian doctors.

Doing surgery is hard enough and it is not the usual experience to be around sick people every day. Taking your skills and offering them to people of another country during a civil war will take the challenge to a new level. Soon you are thinking about commitment, courage and sacrifice in a different way.

This book is available on Amazon.




The Greatest Fear of Every #Nepal woman, part 2 – the answer! May 2nd 2015

Last week I posted a blog to say that I knew the greatest fear of any Nepali woman, and that I would reveal the answer in a week.

A lot has changed since then.

I don’t want to beat about the bush, so – I will give my answer.

The greatest fear of any Nepali woman is that her friends will not be there when she needs them.

Collective culture

In my seven trips to Nepal and my extensive dealings with Nepali people and culture including research of two books, I learned a lot. Nepal is a wonderful place because of the hospitality of the people. Tourists come here to experience it.  Because I work in hospitals and health care, I see a part of Nepal that is carefully hidden from tourists most of the time.  People having a health crisis.

It’s about culture.

When we talk a culture, we often start with the superficial things  – food, clothing,  religion and rituals, family relationships. Externalities.  Culture includes the indigenous use of objects that later become tourist souvenirs – in this case singing bowls, kukri knives, thangkas, statuary, prayer beads.

Culture is not just “stuff”

Any nurse needs to go to a deeper level of culture. How are health decisions made? What are the social practices that contribute to disease? What is the view of Western doctors and western medicine? how does a person decide to see a doctor, or not? how are children raised, and what is the attitude toward family planning and “Women’s Issue

These issues go beyond culture and into the field of “Medical Anthropology.”

In Nepal, when you go deeper, you learn one over-riding  “deep culture” concept that is taught to Nepalis from birth. You will never be alone. Rely on Buddha, Dharma and Sangha. Always seek the wisdom of those around you, especially the elders ( often called “your seniors” if they are only a year older than you).

Every Nepali woman has fifty sisters. When you try to get her to say exactly how they are related, she’ll say “Um, my cousin-sister,actually.”

Man or woman, every Nepali travels with a pack.

Teej celebration hosted in New York by NY/NY Nepali Women Group, 2015. These people draw on the strength of each other....

Teej celebration hosted in New York by NY/NY Nepali Women Group, 2015. These people draw on the strength of each other….

A Nepali man does not marry a Nepali woman. It’s the two families that get married.

Every ritual, every life event, is shared with the family group or the group of friends. Life decisions  are only taken when every member of the family has given their opinion.  If it’s a Nepali woman, they especially value their mother’s opinion. This is what we call “collectivism” or “collectivist culture“.

If you are trying to work within this culture, you need to grasp this.

I am not saying it’s good or bad – it just “is

And so, when a Nepali woman does not have her friends nearby, she is cast adrift.  In a small boat. Floating on an endless sea.

My book, The Sacrament of the Goddess, explores this idea of collectivism as an underlying theme. You can get it in USA via Amazon or in Nepal via Tibet Books on Tri Devi Marg.

The Sacrament of the Goddess is “required reading” for medical volunteers to #Nepal

note: a recent conversation with a medical person who read this book caused me to update the description on Amazon.

Updated April 27th, 2015.

There’s always been a small group of international medical aid workers who find their way to Nepal, and never quite find their way back. Matt is one such person, who came to Nepal as a trekker in college. Now he’s back, agfter completing a surgical residency in Boston.

On that fateful first trip he met Sushila. Matt did not know at the time she was the love of his life. Sushila was raised in Vajrayanic Buddhist culture, with customs and beliefs far from any that Matt ever knew. They shared the passion of young people with the world ahead of them.   By the time Matt returned, she disappeared, no trace other than a faded photo on a wall.  Sushila’s Buddhist faith was challenged when the civil war came to Beni and to her house. Matt throws himself into medical practice in rural Nepal, immersing himself in the reality of medical care in a low income country.

It is these sections that caused the book to develop a cult following among doctors and nurses who get off the beaten path into global medicine. The Sacrament of the Goddess has been described as “required reading for every foreign medical person that wants to volunteer in Nepal” due to it’s unfailing description of Nepali culture.


The back cover of the USA edition was a short synopsis. By the time we printed the Nepal edition, there were some reviews to quote and they were more colorful. In a bookstore, people make decisions to buy based on the first page and back cover, or so they say.

This book is also a rollicking adventure story and tale of love and heroism. A small group of international doctors deliver care at a missionary hospital where there is only one missionary left.

The Sacrament of the Goddess also reveals events of the Nepal civil war in layers, as we meet the medical team of Beni Nepal and see it through their eyes. Superficially, it is a classic story of star-crossed lovers, but the events unfold partly in real time and partly as flashbacks – memories that may or may not have happened, meanings that only reveal themselves through gazing at the stars on the darkest of nights.

At it’s core The Sacrament of the Goddess is about the choices people make in a civil war where the moral virtues of each side is ambiguous.  On a daily basis the doctors confront the clash between western-style individualistic culture and eastern-style collectivist culture. As we learn how they cope with difficult events we ponder how people’s actions express their conception of God and the infinite in a culture with plural religions.

And the meaning of love.

You can get this book on Amazon

teasing the reader in a novel of #Nepal?

Are you interested in the lives of the people in #Nepal?

Maybe – here to do serious medical work?

Want to read a book about the real #Nepal?

Or maybe – Are you a Nepali nurse or doctor  that wants to read something “real?”

The Sacrament of the Goddess Amazon page tells me there is a new review.

The title was:

An enjoyable fictional intro to real-life issues in modern Nepal

This is an impressive first novel which combines romance and Nepali culture and history in an easy-going, highly readable style. As an American physician who has visited Nepal numerous times doing teaching, public health research, and yes, toss in some trekking, I find the plot credible and the character development well done in the brief time allowed.

The history and cultural components are expert “teasers” enticing you to get a more in-depth exposure–ideally by going to Nepal! The religious discussions are very simplified, but again, will lead the reader to seek more data if interested. I

f you are planning to traveling to Nepal for the first time, this is good counterpoint to standard guides such as Lonely Planet. The medical discussions are appropriate and yet many Americans might find them difficult to believe, as they are harsh. Nepal is not a place fully appreciated by the naive, so take a little time to read this book before you go.When you get to Nepal, you can track down much denser historical, political, and religious tomes.Nepal continues to fascinate–and this book will give you some reasons why.

In Nepal, you can get this book at Vajra Books on Jyatha Marg in Thamel.

About doctors getting “thrashed” in Nepal March 14 2015

There are some “dirty little secrets” of Nepal healthcare – things that everybody knows but which nobody talks about. And my book, The Sacrament of the Goddess, deals with many of them, head-on. That’s why the novel has a cult following among doctors and nurses who have read it in Nepal.

Oh, the descriptions of the novel are a bit vague

“It’s a love story;” or

“It’s about the Civil War in Nepal and the missionaries caught in the middle;” or

“It’s about the way that medical decisions are made in a low income setting.”

Yeah, well, all the above are true, sort of. But the story is also about the way that people in Nepal deal with tragedy during those times when the doctors are unable to save somebody’s life.

“Thrashing” is a euphemism

And that’s where it gets interesting. The newspapers in Kathmandu always seem to publish stories about how this or that group of angry relatives “thrashed” a doctor, beating him (or her) senseless or creating a disturbance. When I first heard the term I thought it was “quaint.” Getting thrashed means that a mob beats you with bamboo sticks. If they are angry enough they can break every bone you have.

It’s not unique to Nepal, it happens a lot in India. On more than one occasion, doctors in Nepal have held a one-day strike to bring attention to the issue.

But there are even more stories that do not make the papers, and every doctor and every nurse is able to share the details of their own encounter with danger.

Young doctors dealing with fear

Young doctors in Nepal are trained at the larger hospitals, but after getting their MBBS degree, many of them spend a year posted in a rural health post, as a partial payment for student loans. If you ask them about this, their near-unanimous feeling is worry about trying to do the best they can, yet getting thrashed by angry family members if things don’t turn out perfectly.

Three actions to take

Every one concerned about this issue can do three things.

First, go to Vajra Books on Jyatha in Thamel, or Tibet Books on Tri Devi Marg, and buy The Sacrament of the Goddess. It’s a highly readable novel that gives a first-hand, truthful picture about hospitals in Nepal. Yes, folks, it’s the book I wrote.

Next, this issue is addressed in the 2- and 3-day courses in cardiac resuscitation taught by CCNEPal. CCNEPal has materials on strategies to minimize the risk of an escalating situation. Those persons who have taken the course can tell you about it. Sign up for a course.

UPDATE May 2nd 2016

If you don’t believe that this is a problem, read this report from Maharashtra State in India.

Finally, in the coming days, I will post a series of blog entries on the CCNEPal blog page, that will educate about strategies to deal with this problem. Click here to get to that blog, and when you do- click on the “subscribe” button. It will be a series you won’t want to miss. You will want to share it with your friends.


Book Review of The Sacrament of the Goddess in Nepali bhasa Jan 19

Note: this book is now available in Vajra Books or Tibet Books in Thamel. click here for the list!


द साक्रामेन्ट अफ गोड्डेस्,,अथवा नेपाली मा भन्नु पर्दा देबी को प्रसाद,,एउटा यस्तो नोवेल जसमा माया,जिबन्,त्याग्,आत्मियता जस्ता आध्यात्मिक कुरहरु को मिठो बयान गरिएको छ, यसका लेखक जो निम्जुरा एउटा अमेरिकि नागरिक र पेसामा उनि नेपाल र अमेरिका दुबैमा राजइस्टर्ड नर्स हुन्,,बिगत ७ बर्ष देखी उनि नेपालमा स्वास्थ्य को क्षेत्रमा उल्लेख्हनिय काम गर्दै आइरहेका छन्,.यो किताब उन्कै मिहिनेत को फल हो,,यसमा नेपालमा दस बर्स सम्म चलेको जनयुद्द को बेलाको.. एउटा अमेरिकन सर्जन र नेपाल को बेनी भन्ने ठाउँमा बस्ने साधाराण नेपाली केटी बिचको प्रेम सम्ब्न्ध को बारेमा बयान गरिएको छ,,,,,, एउटा यस्तो पबित्र प्रेम सम्ब्न्ध जुनसाधारण,,अपरिपक्व,,र सारीरिक तर इन्टेन्स लभ बाट सुरु भएर,,धेरै त्याग र प्रतिक्षा बाट गुजृदै एउटा आत्मिय र परिपक्व्य प्रेम भएर फुल्छ,,यै प्रेम कथा लाई प्रमुख सेरोफेरो बनाएर लेखकले, ,,जिबन का धेरै तिता मिठा सत्य,,जिबन मा गरिने त्याग्,,तपस्या आदी को बारेमा अत्यन्तै सरल तर सत्य,मार्मिक र चित्त बुझ्दो तरिकबाट बयान गरेका छन्,,, नोवेलमा लेखकले नेपाल को गाउँ र शहर दुबै को सुन्दर्ता जती स्वच्छता का साथ बयान गरेका छन्,,,,एउटा बिदेशी नागरिक भएर पनि नेपाल लाई यती नजिक बाट नियालेका छन लेखक ले,,,जती नजिक बाट हामी नेपाली ले पनि नियाल्दैनौ होला माया,,प्रेम्,,,,तपस्या,,त्याग्,, पर्‍खाइ,,धैर्यता,,,, चोखो माया.. जस्तै भगवान प्रती को जस्तै सध्भाव्,,र सङ्सङ्गै मेडिकल ज्ञान ….लेखक का भाबुक्,,पबित्र शब्द बाट सजिएका मार्मिक पल हरु ले धेरै पटक आँखा रसाइदिन्छन एस्तै कुरा हरु को मिश्रड भएको नोवेल हो द साक्रामेन्ट अफ गोड्डेस्,,,, यो किताब को बारेमा थप जानकारिको लागि यसको फेसबुक पेज मा हेर्न सकिन्छ

साथै २४ जनवारी को दिन यस नोबेल को रिलिज हुँदैछ नेपालमा…. ठेगाना:पाटन दरबार स्क्वर समय:दिउसो २ बजे (प्रसिद्ध ब्यान्ड एभरेष्ट ब्यान्ड बाजा का साथ सबै लाई रातो ड्रेस कोड को अनुरोध का साथै नोबेल किन्न इछुक ले नेपाली रुपैया ५०० मा लिन सकिने छ)

about rural hospitals in Nepal

The setting of the book is just as important a character as the people

Much of the book is set in a rural hospital in Nepal -specifically the one in Beni. The book is fiction, however, and license has been taken as to the exact specifics of the hospital there.  I chose Beni as the setting because of the historical fact that a major attack of the PLA took place there, and the battle provides a dramatic element that electrifies the plot. Having said that, I am very familiar with rural hospitals and tried to convey a composite of the challenges.

Here is a link to the hospital in Rukum, Nepal.  It will give you an idea of what I am trying to describe.

click here > Chaurjahari Hospital