Dr. Ruby Dunlap’s Uganda Fulbright Blog
Kampala is a city of unknown millions who, from a distance and from a height, has a lush look to it with many red tiled roofs nestled among trees and rolling hills. Marabou storks are its biggest birds, tall, gaunt, bald-headed carnivorous birds that prefer their meat well-aged. When one sees many of them circling, a ballet of exquisite grace for one of the world’s ugliest birds, one can be sure of a butcher shop close by.

Getting into Kampala from Mukono is a laborious drive of around an hour if one is lucky, the vehicle lurching either to avoid or try to beat other occupants of the road to a coveted spot. Lurching, I might add, in a mix of oily black diesel fumes, red Ugandan dust, and the smell of garbage which litters the roadsides. I had to make this trip four times this week. I have decided the experience gives me sensory data with which the better to enter imaginatively into Dante’s Inferno.

The first trip was on Monday for groceries, a weekly hire of driver and vehicle which has become necessarily routine. The next two trips were for a two day meeting of a Duke University sponsored “partnership to improve the Ugandan health system.” Mike Smith, the chair of health sciences at UCU, had been invited and, in turn, invited Jean Chamberlain, a Canadian OB/GYN who has made it her personal life’s mission to reduce maternal mortality in Uganda, and Edward, the Ugandan physician who heads an undergraduate program in health administration which is funded by another Canadian organization. As it turned out, I was the only nurse invited to the group.

The meetings were convened in one of the buildings of the compound of the Uganda Catholic Medical Bureau. Each of Uganda’s three major religious groupings, Catholic, Protestant, and Muslim, has its own medical bureau which oversees its hospitals and practicing physicians. I was told they collaborate on a regular basis. Uganda was chosen by Duke’s Global Initiative for this project because it is a small country and because it does have some existing structure for quality improvement. The project was funded by the Robertson Family Foundation which has taken a special interest in projects which combine healthcare, business, and faith.

In addition to representatives from the medical bureaus, Duke University, and two of Uganda’s faith-based universities, there was considerable representation from Makerere School of Public Health. I found out that educated Ugandans do not lag in this world when it comes to making speeches sprinkled with terms like “paradigm shift,” “thinking outside the box,” “operational modalities” and “stakeholder interfaces.” I thought of a certain bingo game we nursing faculty make reference to now and then; it seemed like a lot of that was going on.

I did discover that a document I’ve used in community health at Belmont which describes the dire state of the “brain drain” in sub-Saharan Africa was describing the simple and brutal truth. The shortages exacerbate each other and sometimes a well-intended supply such as a funded HIV/AIDS clinic will cause a shortage of nurses elsewhere. Nursing assistants get paid about $14.00 a month—when they get paid. One of the issues was lack of regularity in one’s paycheck. That would be enough to discourage anyone from working, I would think.

Another issue everyone agreed upon was that there is plenty of money flowing into the Ugandan system, both public and private funds, but no one knows for sure where it goes. When the problem of corruption and diversion of funds was brought up, one of the public health folks dismissed this as a “name-blame-shame” ploy which apparently has begun to irritate at least some Africans who don’t think Africa should be singled out for corruption charges. And, of course, it shouldn’t be. There’s enough corruption to go around, the seven deadly sins hating a vacuum as much as nature does.

When it came my turn to speak, I advocated as strongly as I could for the nurses of Uganda “who carry this system on their backs as nurses do around the world.” “Nurses,” I said (and not in a meek, quiet, Ugandan woman voice, either), “know as much about the system problems as anyone and surely need to be part of any solution.” They forgave me because I had been introduced by Mike as UCU’s “Fulbright scholar” and therefore needed to be made allowances for. I noticed that the two Ugandan women present, one a physician and head of the Protestant bureau and the other the chair of Uganda Martyr’s business department, spoke with soft voices and downcast eyes. But Jean and I were loud, firm, and looked straight into faces as we spoke, two brash and uncouth North American women who each felt called upon to advocate for a vulnerable population. Jacinta, sitting beside me in the photo and the business chair, did have some trouble restraining her brows from arching and her eyes from rolling as the speeches went on. “I didn’t know doctors talked so much,” she said to me later. We both laughed in shared understanding.

Friday class went well although one student called in sick with “running of the stomach.” I introduced those who came to the history of categories of nursing leadership in the U.S. and Canada: clinical leaders, administrative leaders, educational leaders, and professional leaders. I showed them my RN and APN licenses as a way of demonstrating how these are differentiated as well as related to each other. They do have nurses who administer anesthesia and I overheard one of the physicians talking about setting standards for “task shifting in the theatre.” (“Theatre” is operating room. Jemimah refers to scrubs as “theatre clothes.”) Specially trained midwives in some places are already doing C-sections and from the overhead comment, non-surgeons doing some types of surgery may be in Uganda’s future. But the APN is otherwise non-existent in Uganda.

Saturday, my fourth trip into Kampala this week, was spent on the top floor of UCU’s Kampala “campus,” a building with six floors if you count American style, and five floors if you count Ugandan style. I will be spending many Saturdays there with students to facilitate their progress. It was located in the epicenter of last week’s riots. I looked over the city, its flashing mosques, its dark red cathedrals, the palace of the tribal king over which the riots had taken place last week, and sighed. It was all beautiful and terrible, too.

Kampala
Along the rise and dip of hill
The nesting trees secure
Rich red of tiled roof that will
The wandering eye allure.
No sight or sound of squalor there
Can reach to sense abused
Though wide of wing on drifts of air
Fly carrion birds bemused.