Leaving India

We are on the bus heading back to Delhi from Agra. We have been graced with such great weather for our whole trip. Everywhere we went people said how great it was to have us, as we brought good weather with us. Last night it started to rain. This morning it cleared up for exactly two hours so we could visit the Taj. Now we are on the bus to the airport and there is a downpour.

It is making the drive a bit bumper, much muddier and a lot longer. But I look at this as a positive omen. India wants us to stay.

We have met wonderful nurses and doctors and seen the amazing work they are doing. We have been able to learn from each other and are working to establish longer partnerships. We have done things I never thought I would, like riding an auto rickshaw, known locally as a Tuktuk.


So many of the customs in India may seem antiquated or just superstition. But there are not – they are rooted in truth and reason. Cows lay in middle of the road because the traffic keeps the flies away. One reason why some men wear turbans with a long tail down the back is because when they ride horses it can be used to cover their mouth. And I truly believe it is raining now because India wants us today.

Is it coincidence or destiny? As it was said on the first day of our trip – it was destiny, because nothing happens without a purpose.

Forever and for everyone

We all know the Taj Mahal as an amazing feat of architecture and one of the seven wonders of the world. But, in spite of its size, views of the Taj sneak up on you. Our first night in Agra, we visited the Red Fort of Agra. It was just before closing, but our guide took time to explain all of the ways the fort was protected. From a moat filled with alligators to (what I call) the Indiana Jones’ ball that can be rolled down main entrance, it is a spectacular. After we were lead us through the entrance, very causally he said, “And to your right, you can see the Taj Mahal.”

Wow.

The Taj is an amazing building, but the story is even more amazing. The Mughal emperor, Shah Jehan’s wife Mumtaz Mahal had a dream she was going to die in child birth. So, she made Shah Jehan promise three things:

1. To never marry again
2. To take care of her parents
3. To build her a special mausoleum.

He kept all three. His love for his wife lead him to spend the next 22 years building the Taj Mahal. Everything is perfectly symmetrical and painstakingly handmade. The designs on the walls are not just for decoration. They are meant to show that all are welcomed. Religious symbols from Hinduism, Islam, Christianity, and Judaism can be found. What is written across the entrance is the phrase, “Forever, for everyone.”

Shah Jehan wanted to build an exact copy of the Taj across the river as his mausoleum. But, his son imprisoned him in the Fort and only the foundation was laid. Shah Jehan was only able to view the Taj from his room at the Red Fort, the Jasmine Room.

The Taj Mahal is Forever and For everyone.

Visiting SMS Hospital - guest post

Carol Reineck contributes again -

A patient was brought in the front door of SMS Hospital on a steel stretcher. He was one of 4,000 patients seen that day in the government hospital in Jaipur. We were met by Dr Randawat, Deputy Superintendent and Chief of Surgery. We toured triage where patients were sorted by age. Most patients were high risk OB with anemia. The principal admitting diagnosis, though, was cardiac. We removed our shoes in the ICU where we saw high technology monitoring and ventilators. Most of the nurse managers were male, but opportunities and recognition for women are increasing.



The school of nursing was a few blocks away. The director, a Psych Clinical Nurse Specialist (CNS), met us in the classroom. She explained the various levels of program, including those of the maters and doctoral levels. She stated that tuition in the government school is all paid by the government. She mentioned their faculty shortage and that there are plenty of clinical experience in the hospital. Their students do not need to use labs for practice in the school.

The overwhelming volume of patients was accompanied by an equal abundance of patience, hope, and gratitude among those receiving compassionate care.

How Bazaar

What did you do last Friday night? Well, I got to breeze through the Tripoliya Bazaar and street vendors in the Pink City of Jaipur. When you are on the streets, all five senses are used. You see all of the vibrant colors in the sarees for sale. You hear the lyrical Hindi language being spoke. You smell the amazing and almost indefinable aroma of tea, flowers, and city live. You feel the age of the 200 year old brink and limestone buildings. You taste just a bit of the cinnamon and spices.

I only got to spend about half hour there Friday night, but I could spend days – maybe weeks weaving my way through the small streets and allies.

Lessons the Hindu King taught us

We can always learn from history and lessons in leadership come from many places. I learned a leadership lesson from a Hindu King yesterday at the Amber Fort in Jaipur

Shiv Partap, our tour guide, told us the story of Raja Man Singh and his bodyguard. Raga Man Singh slept outside each night and had a jug of water by him because it was so hot. He was accompanied only by his bodyguard. One morning he woke up and found that half of his water was gone. He knew only his bodyguard had been there, but said nothing.

He went to court in the morning as usual and asked if there was a party the night before. There had been one so he asked for the guest list to see if his guard was on the list. His guard was. Raja Man Sing then asked who the person was who threw the party. Raja Man Singh went to the host and asked what grocer he got the food from. Raja Man Singh then put the grocer in jail.

Raja Man Singh knew his guard was very loyal to him; nothing would cause the guard to leave his post in the middle of the night. The guard was so loyal Raja Man Singh knew only a great thirst would cause the guard to drink his water.

Raja Man Singh deduced the only thing that could make his guard so thirsty was if the ghee at the party had been mixed with animal fat. The grocer was put in jail because he sold impure ghee to the host of the party.

Raja Man Singh handled the issue with Root Cause Analysis. The problem was not with the loyalty of the guard, but the loyalty of the grocer who sold impure ghee. By investigating and finding the true cause of the issue – where the problem originated.

It is important to know the loyalties of your staff. But more importantly, you need to trust the loyalty of your staff. If Raja Man Singh did not trust that his guard would only drink his water for an important reason, the grocer would have gone unpunished and would have continued to sell impure ghee.

A super secret surprise at the Amber Fort

Shiv, our tour guide told us we had to get up early the other day, but he wouldn’t tell us why. The day before we had a great, but very long. We wanted to enjoy a late dinner and sleep in just a bit – maybe to 9:30? But no, Shiv was very stern – we would meet in the lobby at 8:15am – and there would be a surprise.

Okay, my interest was pique.

At 8:15ish we boarded the bus and finally Shiv told us where we were going – Amber Fort in the Pink City. Lovely! But why so early?

To Paraphrase Shiv:

Thank you all for your willingness to get us so early to see the wonderful Amber Fort. But, the reason why we had to get up so early is how we will be arriving at the fort – BY ELEPHANT!

Can you believe it? We all climbed up on the elephant ride for a 15 minute ride up to the fort. The view from atop of such a lovely animal was amazing. We could look down o the small village at the bottom of the fort; look across to the mountains and the wall that surrounds Jaipur; and see the beautiful paintings and decorations on the elephant up close. It was one of the best moments of the trip.

All of the elephants used are female and are limited in the number of trips they can make each day. The city of Jaipur regulates the care and usage of the elephants very closely. The entire experience is very human for the elephants.

I know, I know

I know - I know - I haven't posted in a few days. Well, that is what happens when you travel for about 20 hours and you don't really know what day it is. But - I was keeping notes along the way. I will add in some posts written through the trip with pictures!

A day at Fortis Escort, Jaipur

Today we spent the day at Fortis Escort. Located in Jaipur, it is a hospital in the larger Fortis system we met in Delhi on Tuesday.

The meeting began with a lovely lamp ceremony where Mr. Prateem Tamboli, Head of Administration, Pam Rudisill, and Pam Thompson each light a section of an oil lamp that burned throughout of meeting. This lamp ceremony is to bring good luck and successful outcomes – which it did.

Mr. Mohammed Mubeen Ahmed, Deputy Nursing Superintendent, lead us through some challenges the nursing profession is facing in India. The first is “brain drain.” Often, highly trained Indian nurses do not stay in India. After their education, many nurses leave and find employment in the US, Europe and countries in the Gulf. This leads to not only a shortage of nurses, but also a shortage of qualified nursing leaders.

They also face the challenge of nurses spending time on non-nursing related activates. As a system, Fortis is currently working to address this issue and reassign non-nursing tasks to other staff members. This will allow nurses to spend more quality time with the patient.

There were many other presentations covering issues related to patient care, the current improvements for continuing education to develop nurse leaders and community outreach programs Fortis has initiated. Again, these presentations will be available in a week or so.

An open discussion followed with both AONE delegates and Fortis nursing and medical professionals looking to exchange ideas. Fortis has a card at each bed that notes the Estimated Date of Discharge (EDOD). This simple red, yellow, green sign can be updated and helps manage the expectation of patients.

Fortis was interested in our CNML and CENP certifications and what domains of knowledge are covered. AONE plans on sharing aspects of our competency assessment tools. We finished the full-day meeting with a tour of the hospital. We were able to view wards, observe the nurse’s station and get a general feel for how a private hospital in India works. This will provide a great context for our public/government hospital visit tomorrow.

Just before dinner we popped into a handcrafted jewelry store. Jaipur is known throughout the world for its precious and semi-precious stones and jewelry settings. Yours truly made a small “investment” and will come back to the States with a small, sparkly reminder of my time in India.

dekhthe Hai! ("see you" in Hindi)

Alyse

Carol Reineck blogs from India

Greetings from the AONE nurse delegation trip to India!

Carol Reineck heard about my previous blog entries and wanted to share a few things. Here is a special post from Carol:

India is a land of contrasts. Today we rode in rickshaws through the wedding market in Old Delhi and saw tangles of electrical wire, a cacophony of sellers, and smelled the incense mixed with Indian food cooking. Later, in contrast, we visited a maker of Indian rugs who explained an intricate, orderly design system, painstaking exact processes of weaving and knotting, and the family-centered nature of this beautiful endeavor.

In India, chaos and order are weaved into a bustling, active and free market economy that works.

The health system application draws on these contrasts. Our visit with the government health system yesterday introduced us to the uneven mix of traditional medicine and Indian medicine. This mix provides for increased access to care. The order we observed was the fact that the Indian Nursing Council sets standards for a consistent syllabus in all government schools of nursing, similar perhaps to the AACN Essentials.

Thank you Carol!

Here delegate Verena Briley-Hudson enjoys a bumpy rickshaw ride through the streets of Old Delhi.

Tomorrow we will be meeting with a Jaipur-based hospital in the Fortis Health System. After having met their counterparts in New Delhi, we have high expectations of the dialogue for tomorrow.

Cheers!

Alyse Kittner
AONE membership manager

Maulana Azad Medical Center and Medanta Medicity

Morning - it is 7am here - I have no idea what time it is in the states...

We began yesterday at the Maulana Azad Medical Center and associated hospital complex, including the Maulana Azad Medical College - a publicly run hospital. Coordinated by Dr. Suneela Garg, AONE delegates were lead through presentations about the Health Workforce in India, the public health system and how it differs from private hospitals and systems, a comparison of health care issues in India and the United States, an overview of the health care finance system, and a review of the current nursing care scenarios and future prospects.

These were very detailed and informative presentations that will be posted on the website. There was one aspect of the presentation by Mr. T Dilip Kuman, Nursing Adviser to the Ministry of Health and Family Welfare and President of the Indian Nursing Council (INC) that the delegates found very interesting. There is the one syllabus used for each of the nursing education programs. This syllabus is created by INC and used in all public/governement nursing colleges in India. We hope to collect more information about the syllabus used.

From there we traveled about an hour to the brand new private hospital complex Medanta Medicity. Medicity opened just two months ago. Their vision is, "Excellence in patient care through education and clinical practice." - something we all strive for. We had the pleasure of touring the new facility with Mrs. Vijayakshmi Banerjee, Chief Nursing Officer. We were also able to meet the man who made Medanta Medicity possible, Dr. Naresh Trehan, Chairman and Managing Director. It was a great honor to dialog with both prestigious professionals.

Today we are going to tour the "heart" of Old Delhi. We will be going to Raj Ghat, the simple memorial to the legendary hero Mahatma Gandhi and taking a rickshaw ride to view the Red Form and the Mosque of Friday, the largest mosque in India. I am personally very excited to ride the rickshaw. I have been seeing them buzz around. Driving in Delhi has been an experience in Chaos Theory - I can't wait to get out of the bus and experience it first hand! I will be taking pictures, but they may be a bit blurry. The rickshaws weave in and out of traffic pretty quickly!

Cheers!
Alyse Kittner
AONE membership manager

An amazing first day

I want to catch you up on the first two days of our program. It has been so amazing to meeting with these nurse leaders and to discover there are so many similarities.

Yesterday we attended the Fortis Nursing Forum. Lead by Ms Thankam Gomez, BSN, Chief Nursing Officer Fortis Healthcare, each quarter the chief nursing officers of the Fortis Hospital System gather to share their experiences and create standardization throughout the system.

One of the first things asked was, “Is it destiny or is it coincidence?” Months ago our People-to-People dates were set. By chance, these dates corresponded with the Nursing Forum. And by chance that they were also opening their outpatient treatment center. It was a very auspicious day and it was decided that our meeting was destiny – as nothing happens without a purpose.

AONE president Pam Rudisill gave a presentation: “Where Nurses Spend their Time.” There are three challenges facing US nurses today: the future of care delivery, creating excellence in the work environment, and building leadership competences. AONE CEO Pam Thompson wrapped up the presentation with a few comments about the pending changes we will experience with health care reform in the United States and asked the question: “How do we make the major changes to health care while maintaining the high standard of care?” She paraphrased American Hospital Association CEO Rich Umbdenstock‘s description of health care reform. She said it is a beautiful map of where we need to go, but we haven’t built the road yet.

Ms. Gomez presented “Vibrant India”, which described the Fortis hospital system. Fortis is among the Asia’s largest private service providers. The system employs 5,420 nurses at almost 20 facilities. As it turns out, the challenges we face in the US are very very similar to the ones nurse leaders face in India. Workforce, specifically retention, and standardization of education are some of India’s pressing nursing issues. Copies of these presentations will be available on the AONE website in the next week or so.

The AONE delegation and members of the Forum had an open discussion on how we can recognize nurses and show our appreciation for them, with the hopes of improving nurse retention. At Fortis, they have developed a very interesting quarterly review called Nursing Quality Improvement Process. This is an individual review each quarter to evaluate the growth of the nurse, where they have improved from the prior quarter, where they still need improvement, and if any compensation changes need to be made based on the nurse’s progress. They also have Nurse of the Month, Nurse of the Unit, and a celebration of Nurses’ Week each year.

Both the AONE delegation and Fortis members agreed that the best recognition is most often not related to compensation. A personal thank you card or simply saying “nice job” can go very far. The most important thing is that the feedback happens immediately.

There were two more quotes from the day that have stuck with me and I think we can all relate to:

"Tell me and Iwill forget; show me and I will know ; involve me; and I will remember” – Chinese Proverb

• Does this sound strikingly familiar to “See one, do one, teach one”?

“If you want to get something done, give it to the busiest person you know.” – Pam Rudisill

• I know you can related to this – we are all busy!

We finished the afternoon with a visit to the India Gate and Humayun's tomb. Located in New Delhi, the India Gate is a memorial built by the British to honor the fallen India soldiers from World War One. This striking monument was based on the Arch de Triumph in Paris. The name of each of the fallen soldiers is carved into the stone.

Humayun's tomb is a great example of a Mughal garden tomb. It was build by the widow of Humayun and houses not only his remains, but the remains of 150 members of the royal court. As a footnote, there is also a tomb for Humayun ‘s barber. It is legend that Humayun said you must trust your barber with your life. He was so fond of his barber, a tomb was built for him just south of Humayun’s.

More pictures of our meeting with the Fortis Nursing Forum and our sightseeing will be posted shortly.

Best wishes from New Delhi!

Alyse Kittner
AONE membership manager

Greetings from New Delhi!

It is 7am in New Delhi and the delegation is gathering for breakfast. We got in late last night and went directly to our hotel. AONE CEO Pam Thompson greeted us - she arrived earlier in the day. After a quick glass of guava juice - which I highly recommend - we were off to bed.

The first bit of business today is our orientation. We will meet our guide for the week and learn about local customs to help us throughout the trip.

Then we will leave for Fortis Hospital-Shalimer Bagh in west Delhi for a half day workshop as part of the Fortis Nursing Forum. Fortis Hospital focuses on super specialties in cardiac, neuro and renal sciences as well as GI diseases and orthopedics. AONE will participate in presentations such as the Nurse Executive Role and Leadership and the Future Role of Nursing in Health Care.

Jet lag will probably be setting in soon, but I will try to keep up with the posts!

Cheers,

Alyse Kittner
AONE membership manager

Hitting the road!

On Sunday, 15 AONE members will hit the road (tarmac actually) and begin the AONE People-to-People ambassador program to India. From September 12-21, we will be meeting with nurse leaders in India to discuss common issues and challenges; share success stories and growth; and discuss how nurse leaders will shape the future of health care in India and the US.

I am Alyse Kittner, AONE membership manager. I have the pleasure of accompanying the fantastic delegation on this adventure and keeping you updated on our trip. Lead by Pam Rudisill and Pam Thompson, we will visit Delhi, Jaipur and Agra. Yes…we will get to see the Taj Mahal…

Every other year AONE partners with People-to-People for a citizen ambassador program. AONE went to South Africa in 2008 and China in 2006. People-to-People offers many ambassador programs – visit their website (http://www.peopletopeople.com) for other programs.

The 2010 delegates are:
Pamela Rudisill
Pamela Thompson
Verena Briley Hudson
Cynthia Carlson
Pamela De Back
Judy Husted
Pamela Jackson-Malik
Patricia Layton
Joyce Martin
Carol Reineck
Roxane Spitzer
Susan Spoelma
Cathleen Wheatley