It’s still dark outside our tiny pup tent, and the air feels humid after the sudden torrential downpour the evening before. The melodies of unusual songbirds welcome the morning to this remote village medical clinic in rural Uganda, where our U.S. team of volunteer healthcare professionals has come for the fourth year to partner with the local staff for provision of care to the needy.
As I emerge from the tent, I see that barefoot clients in colorful, but worn apparel are beginning to appear, walking down the muddy roadside to line up for treatments. The nurse, who has ridden her bicycle for an hour to get here, is now energetically unlocking medicine cabinets and laying out supplies. In spite of the impending 12-hour day that lies ahead, she smiles and hums contentedly as she works.
Although superficially this situation seems acutely different from nursing in the United States, there are some parallels, with the differences being a matter of degree. I now have established friendships with seven nurses from four separate rural clinics in Uganda. Conversations with them and observations reveal particular challenges faced the rural health care providers in Uganda. In spite of these obstacles, the nurses seem to retain a positive outlook. A look at the ways in which they seem to cope may have some implications for nurses in the United States.
Challenges in rural Uganda
The most notable challenge for nurses working in rural areas of Uganda is the harsh working conditions. The nurses make difficult home visits by walking to huts through cornfields, or even rowing across a lake to an isolated island. Some nurses live in a room at the clinic and are on call every hour and day of the week. Supplies, including medicines and equipment, are unavailable, insufficient, or in poor condition. A 2012 survey of nurses in eastern Uganda revealed similar perceptions of extremely poor working conditions.
There is a severe shortage of nurses in rural Uganda. My colleagues there believe this relates to the harsh conditions and low salaries. In most rural clinics, physicians are only rarely present. Typically, one nurse is responsible to make medical decisions, prescribe, and perform treatments, as well carry out any administrative details. One nurse with midwifery training, in addition to her usual duties, also delivers around 200 babies per year with only one assistant to help her.
Nurses treat a large number of patients who have serious diseases that can lead to death. More than two-thirds of the world’s population with human immunodeficiency infection (HIV) lives in Africa, and malaria is prevalent in that continent as well. Nurses tell me that because of inadequacy of supplies and the poor outcomes associated with these conditions, caring for these patients leads to feelings of helplessness.
Coping strategies of rural Uganda nurses
The seven nurses I know in Uganda seem able to cope exceedingly well with the harsh realities of their profession. They have endless patience with long lines of very ill clients and little assistance. They have bright smiles and are often seen holding hands or hugging one another. It is rare to hear a complaint. I took some time on this last trip to interview the nurses and ask about their coping methods. Analysis of the taped transcripts reveals three themes.
A desire to help
Nurses in rural Uganda persevere out of a desire to help others. Over and over they indicate that the best thing about nursing is having the ability to help others. According to one, “When one comes with some severe illness, you treat them, you welcome them, it comforts them.” In the words of another, “We work a lot. We are few in Uganda. You got a little salary, no motivation, but you just do it because it’s your call from God.” Keeping that focus on service seems to minimize the impact of the overwhelming challenges. This passionate commitment of Ugandan nurses for patient care also has been noted in previous research by Harrowing and Mill.
A respected profession
Another avenue that seems to help nurses in rural Uganda cope is that they perceive the nursing profession to be notable and respected. According to one, “The people respect us, because we are underpaid and we do some [difficult] work” Another remarks, “They respect nurses because they trust you a lot. It comes when you give tender, loving care. It means a lot. People have respect for you.” These nurses are able to de-emphasize the negative components of their jobs with the consideration that they do something important and valued by others.
A positive outlook
The final coping theme is the ability to maintain a positive outlook. The nurses build meaningful relationships and nurture hope. They often speak tenderly and fondly of their colleagues and co-workers. One nurse commented, “I have no day off, but when my colleague is around she [is my] help.” They work together to do any part of the clinic work, regardless of their roles. Even though they live in poverty, they speak of their personal hope, such as returning to school for further education, and about the hope of changing the lives of their patients for the better. One says, “I see many people suffering, and at home we are 12 children. I followed in nursing. People are helped.”
Like the nurses in rural Uganda, you, as nurses in the United States, also face staffing shortages, deal with serious illnesses, and work under conditions that you may perceive to be inadequate. You might be able to successfully apply some of the strategies of rural Ugandan nurses by focusing on the service you provide, remembering you’re a member of a profession that is well respected and important to society, and building meaningful relationships while maintaining hope.
Linda Johanson is an associate professor in nursing at Appalachian State University in Boone, North Carolina.
Van der Doef M, Bannink M, Verhoeven C. Job conditions, job satisfaction, somatic complaints and burnout among East African nurses. J Clin Nurs. 2012;21(11-12):1763-75.
Harrowing J, Mill J. Moral distress among Ugandan nurses providing HIV care: a critical ethnography. Int J Nurs Studies. 2010;47(6):723-31.