Cliff Aliga
Please tell us a little bit about yourself
I am a senior lecturer at Aga Khan University School of Nursing and Midwifery and currently pursuing a PhD in Nursing at the University of South Africa. I am an emergency critical care nurse specialist and the team leader of the Critical Care Nursing Association of Uganda and president of African Federation for Critical Care Nurses. I also serve as an executive member of the Emergency Care Society of Uganda, an umbrella organization that promotes emergency medical services in the country.
What inspired you to become a nurse?
My mother was my inspiration. She was a nurse at Arua Regional Referral Hospital and I grew up watching how she cared for my ailing grandmother. I know that without my mother, my lovely grandmother would not have lived to be 67 years old. My mother ensured that my grandmother took her medicine on time and went for her checkups. She talked to her and bathed her without complaining all while raising nine children. I knew then that I wanted to follow in my mother’s footsteps and become a nurse. I admired my mother’s resilience and, like her, wanted to care for sick people so that they could live a longer life.
Surprisingly, I almost ended up as a secondary school teacher. After senior six, I joined Muni National Teachers College but dropped out after one year to study nursing. That is the best decision I ever made. I now have over 18 years of multicultural nursing experience in emergency and critical care in Uganda and Europe.
What has been your most memorable moment as a nurse?
In 2001, I was on night duty when a seven-year-old child experiencing difficulty in breathing was brought to the hospital. We put him on oxygen and kept monitoring him. None of the medication he was given seemed to improve his condition. At around 3 am, the oxygen got finished and I had to run around the hospital to find another cylinder. I eventually found one in the theatre and had to move the child there. That was a very long night.
Part of me was frustrated that the medicine he had been given was not working and I could not think of an alternative to improve his condition. Something was wrong with him and I could not figure it out. However, I was relieved and happy to see the sun rise in the morning and the child was still alive. It was a miracle and that experience has stuck with me. It was a moment of pride as a nurse knowing that I contributed to the child living longer. That incident drove me to further my studies, to specialize in child-related illnesses because I never wanted to be as helpless as I was that night.
What is the role of nurses in strengthening emergency and critical care in Uganda?
As nurses, we identify patients who need immediate and critical care right from the emergency department to the wards through the application of standard assessment tools for triage and emergency care. We also organize emergency departments ensuring that the environment is appropriately prepared to receive, assess, treat, transfer, and care for acutely ill patients. The ability to perform exceptionally well in such circumstances comes from a point of knowledge, quick thinking, and fast action.
Knowing that gaps in care delivery exist, nurses play a key role in challenging the health system to respond appropriately to the needs of the patients through advocating for resources and access to quality care.
How can the global community better support nurses so that they can deliver quality care and effectively respond to pandemics such as COVID-19?
The global community can advocate for and involve nurses in decision making, surveillance planning, and determining interventions to prevent the spread of pandemics such as COVID-19. As an example, Uganda’s national task force for COVID-19 mainly comprises medical doctors with nurses seemingly less involved. Nurses have a body knowledge that other professionals do not have. If they are not involved, they cannot utilize their skills and experience to help create protocols.
Over 70 percent of health workers are nurses yet they are few in health leadership positions. If nurses are involved in leadership, they can take part in everything ranging from recruitment of staff to purchase of appropriate equipment to developing guidelines that govern hospitals. Most hospital guidelines, for example, are developed by hired consultants who don’t work in these hospitals and lack the experience that comes with it. This usually hinders adaptation processes.
The regulatory arm of the nursing department at the national level needs to implement its role by ensuring that nurses and midwives are protected and that they practice within their scope. Unfortunately, the regulatory framework for nursing is outdated and doesn’t favor current nursing trends which puts nurses at risk of litigation as task shifting has become a norm. The current nurses act was enacted in 1996 at a time when very few nurses had advanced degrees. It limited the services they could provide in hospitals. However, today, nurses can do so much more and there is increased task shifting from doctors onto them. The context of the law doesn’t support the dynamics of healthcare and nurses’ education today.
There is also a need to transform nursing education to adapt to the changing times. For instance, in Uganda, over 75 percent of the nurses hold certificates in nursing. Nurses with certificates may not feel empowered to challenge the system. In low-income countries, training of nurses to diploma level education should be promoted as a minimum to practice in nursing.
Nurses should engage in community health education, local council meetings, and media opportunities. As the world grapples with coronavirus, there is a lot of misinformation. Nurses should be out there educating the public, demystifying myths, and countering misinformation with correct information.
Lastly, the global community can amplify nurses’ work through highlighting the strengths and key roles they play. This will inspire a young generation interested in nursing and midwifery as professions. Generally, the public has a negative perception of health workers, especially nurses, because they don’t understand what we do.
It is the International Year of the Nurse and the Midwife. What do you want people to know about nurses and midwives?
The International Year of the Nurse and Midwife is a welcome strategy to profile the work of nurses and midwives globally. However, it elicits mixed feelings among nurses because good initiatives, such as this one, have happened but their outcomes have not translated into reality.
In Uganda, we need a nursing scope of practice which is supposed to demarcate the levels of practice of nurses based on education and experience. This year gives us an opportunity to define the different nursing cadres with clear roles for each. It will also help us determine the quality of nursing expected in the country.
Nurses and midwives need to be properly equipped and protected. We know that many health workers have contracted COVID-19 from patients and vice versa. The only way to prevent this from happening is to develop a health care system that is robust and provides health workers with needed resources.
To improve service delivery and achieve Universal Health Coverage, we need more nurses and midwives. Less than half of the more than 70,000 nurses and midwives in Uganda work in the formal sector. Half of them remain unemployed and underutilized. Over 6,000 nurses of all cadres graduate from different institutions in the country each year. However, there is no clear plan to ensure that they can work and serve communities.
