The Stories

Photo Credit: Seed Global Health

Championing Nurses and Midwives in Uganda

Story By: Seed Global Health   |   July 20, 2020     |    Uganda,

Championing Nurses and Midwives in Uganda

Elizabeth Ekong

Please tell us a little bit about yourself

I am a nurse-midwife and a lecturer in the Department of Nursing, School of Medicine at Uganda Christian University (UCU). I am a wife, mother, and a leader in my church. My nursing career started in 1992 after obtaining a Diploma in Midwifery from Mulago School of Nursing and Midwifery. 

What inspired you to become a nurse?

I always desired to help the sick. Despite growing up and studying in a rural setting, nothing was going to come between me and that dream. When I was in primary five, my siblings and I went with our father to the county health facility for immunization. I recall seeing the nurses who immunized us dressed in pink. I liked the way they were smart and cared for people. From that moment, I knew I wanted to be like them when I grew up. 

I was not able to join the nursing school after senior four but I later got an opportunity to join Mulago School of Nursing and Midwifery after passing public service interviews. It’s been a wonderful journey since. I worked at Mulago National Referral and Teaching Hospital in different maternity unitsmajorly antenatal, labour, postnatal, and gynecology wards.

What has your most memorable moment as a nurse been?

In 1997, I was working in the casualty unit at Mulago Hospital. There was political instability in the country. I can never forget that experience of receiving casualties with lost limbs, shuttered skulls, and abdomens. My work involved arresting bleeding, putting up intravenous fluids, cleaning the patients, and wheeling them to X-ray units or to the theatre, and administering prescribed drugs. The wounded were many yet the rooms at the casualty ward were few. Some of the patients had to lie on the floor. The in charge had to mobilize beds from other wards. It was a difficult time but with teamwork, from the entire healthcare and support staff in the accident and emergency department, we went through it.

What are some of the challenges that nurses and midwives face in Uganda? 

The greatest challenge is limited resources ranging from human to space to equipment. The number of health workers in public health institutions has remained low despite the fact that a larger part of the population seeks treatment from these facilities. The International Council of Nurses and World Health Organization recommend a ratio of 1:3 patients in emergency units; 1:2 in intensive care units; and 1:8 in other wards. But according to statistics in Uganda, the current ratio of nurse to patient is about 1:1884. With so many patients and few nurses, the workload becomes overwhelming. This can lead to stress and burnout. As such, some nurses become irritable and their performance is affected. 

Many health facilities in the country lack even the basic resources like thermometers, gloves, drugs including fluids to resuscitate a patient, and blood pressure machines. In some health facilities where these tools exist, they may be non-functional. Many health facilities do not have the means to transfer a patient to another health facility. All this compromises the nurses’ work. It affects our patients especially those who seek care from public health facilities where services are expected to be free and instead, we ask them to dig into their pockets to buy medical supplies or pay for fuel to transport the patient. Unfortunately, nurses are always blamed because we are forced to explain these issues to patients who sometimes do not believe us. It is quite demoralizing and challenging.

How can we advance nurse and midwife leadership in the clinical setting as well as in policy making?

Clinical leadership is the process that one engages in to influence innovations and improvements at the point of care by using organizational procedures and individual care practices for quality and safe outcomes. As nurses, we ought to focus on this kind of leadership if we are to achieve the recognition that we desire. It is also important for nurses and midwives to be deliberate about advancing their careersto continuously obtain the required knowledge, skills, and abilities that will enable them to implement improvements at the point of care.

There is a need to adopt new approaches to higher education, such as “Work-Based Learning.” It is an effective model that promotes inter-professional learning, teamwork, and improved nursing and healthcare outcomes. 

Nurses and midwives ought to acquire management skills and use evidence-based practice for problem solving. The ones leading units and programs at all levels of the care continuum should get leadership training to enable them to coordinate and execute their roles more efficiently. Lastly, nurses and midwives in leadership positions must develop a succession plan. Each nurse and midwife leader should mentor a successor.

It is the International Year of the Nurse and the Midwife. How can we, as a global community, better support nurses and midwives?

By advocating for representation at all policy making levels. For example, the parliament of Uganda has a parliamentary health committee but no nurse sits on it to articulate nurses’ and midwives’ issues. 

We can collectively push for the approval and implementation of key statutory documents such as the Uganda Nurses and Midwives Council Act and the scope of practice that guide the advancement of the nursing and midwifery professions. 

Ugandan health professionals need to embrace the uptake and implementation of the scheme of service for nurses and midwives. The scheme was approved but it has not been effectively disseminated among nurses and midwives and their leaders at the different levels in order to be fully operationalized. 

Lastly, nurses and midwives must have continuous professional development to enable them to meet the demands of changing disease burdens and effectively incorporate technology in the provision of quality health care services. Eligible nurses and midwives should be given a chance to take up high level positions in nursing leadership without delay, if they fall vacant, to ensure continuity. 

*Photo Credit: Pius Gyagenda for Seed Global Health