Nurses—Making a Difference in Global Health
Nurse stories: Develop a global partnership for development
Building Partnerships: Connections and Commitments
After bouncing along on the rutted dirt roads, we arrived at Bududa Hospital in eastern Uganda. On our previous trip, we had visited this rural district hospital located near the Kenyan border. The nurses we met on our previous trip greeted us warmly and we were equally glad to see them. Differences in culture, socioeconomic status, and educational level faded away as we renewed our shared commitments to patients and the nursing profession. How did four Texas nurses come to be welcomed in rural Uganda? The answer can be summed up in two words- connections and commitments.
Our small team of nurses is part of the North Texas Africa Initiative (NTAHI), a network of health professionals committed to improving health of people living in Africa. Two non-nursing members of NTAHI have been instrumental in helping us lay the foundation in Uganda. One is Dr. Allusine Jalloh, a native Sierra Leonean and Founding Director of the Africa Program at the University of Texas at Arlington. The other is David Mureeba, a native-born Ugandan who was in the US during Idi Amin’s reign. After that tumultuous time, Mureeba’s contemporaries became leaders in the Ugandan government and educational system, while he became a successful US businessman, maintaining strong connections with his Ugandan colleagues. In 2007, Jalloh and Mureeba participated in our team’s first fact-finding trip to Uganda. Because of Mureeba’s relationships, we were even accompanied at some meetings by the Honorable Perezi K. Kamunanwire, Ambassador from Uganda to the United States. In addition to the guidance of these leaders, we had the good fortune to start working with the Uganda National Association of Nurses and Midwives. These nurses are well-organized and have a history of collaborating with international partners. With the support of UNANM, we met with key decision makers in government and non-governmental organizations and conducted a workshop on HIV/AIDS care in Kampala, the capital city.
The second year, we continued to develop connections with fellow nurses in Uganda. We worked closely with the faculty of the School of Nursing at Makerere University (MU), one of the oldest universities in Africa. We reviewed a sample graduate curriculum and conducted a workshop on curriculum design. UNANM had also indicated a need to develop the business and research skills of nurses. In collaboration with the MU College of Business, a workshop on entrepreneurship was conducted for 35 nurses who were midwives in private practice or nurses who had started small health-related businesses. To develop research skills, we conducted a research workshop and invited Mariam Walisimbi to be our keynote speaker. Walisimbi is the Chief Nurse of Mulago Referral Hopsital, Kampala, and a nurse researcher who has authored publications for peer-reviewed journals. She described the essential role of research in moving the nursing profession forward in Uganda. Our team provided an overview of the research process and principles of research critique. Then, the 65 attendees were divided into smaller groups to critique a study published by Walisimbi. The day concluded with reports from the group and identification of the strengths and weaknesses of the study. During this trip, we continued to gather information about health care by visiting Bududa District. In Bududa, we toured the hospital, went with the nurses in home visits, and met with community development groups being led by nurses. We worked with these nurses to document their commitment to their patients and their communities, now reflected in their new motto, “We, the nurses of Bududa, will serve each patient equally with compassion, integrity, and competence.”
Building on these relationships, we traveled to Bududa again this year where we conducted a two-day physical assessment workshop. Generous donors had provided stethoscopes and pen lights for each participant. The excitement of the nurses to have their own stethoscopes was humbling to experience. A piece of equipment so often taken for granted here in the US was cause for great celebration in Uganda. As the nurses learned and practiced their new skills, we shared jokes, meals, and hugs. The workshop concluded with the formal presentation of completion certificates by the medical director of the district. Back in Kampala, we worked with UNANM leaders as they crafted the mission and objectives for a national nursing research committee. We spent most of one day with nursing faculty, discussing the challenges involved in preparing additional baccalaureate nurses with too few faculty. We also conducted a two-day research workshop culminating in four research proposals. During the first day, the research process was described as a series of steps. Between steps, small groups of participants developed that component of a research proposal. At the end of the day, each of the four groups had an outline of a feasible, clinically relevant study. The second day, we reviewed the studies before describing how to establish journal clubs. Meeting coordinators, locations, and dates were scheduled for the first year of ‘train-the-trainer’ journal club to be held in Kampala. We ended our time with the nurses by recapping the trip accomplishments and deciding on goals for next year’s trip.
The approximately 30 million people who live in Uganda face serious threats to their health. The average life expectancy at birth is 48 years for men and 51 years for women. Maternal mortality is a reality, with 880 women dying for every 100,000 births. Infant mortality is also high, with 81 babies dying for every 1,000 births. The numbers of health care providers are inadequate to meet the needs of the country. UNANM leaders estimate that there are fewer than 6000 nurses in the country or approximately 1 nurse for every 5000 people. In comparison, in the United States, we have approximately 1 nurse for every 100 people.
In the face of these challenges, what impact can our NTAHI team have on the health of the people in Uganda? Realistically, our impact may be small, but we believe that we are working with nurses who have the potential to reshape the health care system. Whatever we do to encourage one nurse, improve the health of one person, or provide data to shape one health policy- each action has value.
We are only a few, but we are a few.
We cannot do everything, but we can do something.
What we can do, we ought to do,
And what we ought to do, by the grace of God, we shall do.
Jennifer Gray RN, PhD
Lori Spies RN, MS, NP-C
Jackline Opollo RN, MSN, MPH
Kristina Ibitayo, RN, MSN, PhD candidate
Jennifer Gray, RN, PhD
Associate Dean, PhD in Nursing program
George W. and Hazel M. Jay Professor
2008 Ann Zimmerman, RN/ANF Scholar
Distinguished Teaching Professor
University of Texas at Arlington
School of Nursing
Arlington, TX 76019-0407