The Hospital at the End of the World
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 atWorking Nurse