Dr. Ruby Dunlap’s Uganda Fulbright Blog
This past Friday night, I dreamed I was a pizza box. My consciousness resided in part of the box lid; I felt the air move as my cardboard face fell downwards. Mefloquine can do that. I had forgotten to take it in the morning and rather than skip another dose as I inadvertently had the week before, I took it just before bedtime with consequences among those the inserts predict: vividly bizarre dreams.
Many of the expatriates here take no malaria prophylaxis at all and few Ugandans do. But malaria is endemic and dangerous; I helped a wobbly student walk to the front gate, get on a boda, and on to home a few weeks ago with a 3+ malaria raging in her system. Being stricken with recurrent bouts of malaria is what all Ugandans deal with as a matter of routine. It only takes one bite from one infected mosquito. Many sleep under mosquito nets; many do not. Dad refuses his mosquito net since it hampers him getting in and out of bed. I do not fuss since a fall and a broken bone are at least as risky for him as malaria and he is taking his malaria prophylaxis weekly.

The classroom teaching part of this semester is done; my students have all gone home. It was four intensive weeks of morning to late afternoon teaching, Monday through Friday, trying to make sense of nursing theory (among other things) at some graduate level of understanding. Some nursing theories are intuitively easy even across cultures. The so called “human needs” theories of Henderson, Orem, and those like them had already been easily grasped by the students in their undergraduate courses; there was no need to further explain them. Their universality was also easily demonstrated by the students’ ability to produce numerous Ugandan examples of applicability. That these sorts of human needs theories drive modern nursing is clear from the latest iteration of quality upgrade in the QSEN movement in U.S. healthcare. Human needs seem to have remained fairly constant across the decades and around the globe. In this category also belong the various nursing taxonomies.

Some, like Martha Roger’s theory of “Unitary and Irreducible Human Beings” are particularly difficult to explain, even to myself. Scholars as dissimilar as CSLewis (in Miracles, 1947, and in Bluspells and Flalansferes, 1969) and Lakoff and Johnson (in Metaphors We Live By, 1980, and in Philosophy in the Flesh, 1999) tell us that metaphors are required for all abstract thought and that, for us as embodied beings, metaphors close to bodily experiences communicate more intelligibly than metaphors which themselves are close to abstractions. This is why the metaphoric language of Rogers and those like her, borrowed from mathematics and physics, (e.g., “unitary” and “energy field”) is less accessible to the imagination, the “organ of meaning” (Lewis), at best and nonsensical at worst. Theories like this are also difficult to justify on pragmatic grounds: how would understanding this theory move nursing in Uganda forward? How does one even identify what “forward movement” is within such a theory? Is “forward” a concept logically possible in theories which are “nonlinear,” “pandimensional,” and characterized by “energy fields” which are “infinite and in continuous motion” (McEwen & Wills, 2007, p.204)?

We did the best we could, the students and I, but questions like those we left largely unanswered and, perhaps, unanswerable. That Uganda nursing, as nursing around the world, needs to be able to justify its actions on the basis of tested and formalized relationships among concepts was very clear to the students. “What happens when nursing is not based on theory?” I asked them.

“It will be based on trial and error,” one of them immediately responded. “True,” I said, “or perhaps based on the whim of the moment. Or based on the whims of others. Nursing cannot be self-directed and self-governing if its activities are not guided by theory.” The move towards professionalizing nursing in Uganda is dependent on the selection, development and integration of solid theories into their nursing practice. And this requires some threshold of nursing leadership within Uganda, some catalyst or tipping point in the direction of insight, motivation, and executional capacity. As with nursing development in the North Atlantic societies, the process is likely to be slow and difficult.
The students arrived January 4. Daughter Amy and son-in-law Chris returned to Tennessee on January 2 after an intensive three week visit. I’ve already described the Murchison Falls safari, Uganda’s largest and possibly most popular game park. The last week of December, we enjoyed a variety of tourist activities. One of these was visiting Uganda’s island chimpanzee sanctuary, situated in the northwest corner of the massive Lake Victoria, second in size to Lake Superior among the planet’s lakes. These chimps were rescued from the illegal pet trade, the bush meat trade, or the animistic offering trade. All of them were juveniles when rescued. There were about 40 of them. (See photo) We crossed the equator going to and from the island.

Following the visit to Ngamba Island Chimpazee Sanctuary, we visited several tourist attractions between Mukono and Jinja. The ruggedly beautiful Ssezibwa Falls required some rocky climbing. (See photos) This is a sacred spot for what some call “traditional religion” and others call “witchcraft.” The guide said that participants in a traditional rite will throw a sheep down the falls. If the animal dies, it proves it is an unacceptable offering to the spirits. The participants have to go and get another sheep. If the animal survives, it is acceptable and then is slaughtered. The sheep is grilled over a charcoal fire; the spirits consume the smoke and the humans consume the meat. The participants then feel they have adequately placated the spirits to act in their favor. We took plenty of photos of the falls but all of us were strongly disinclined to photograph the shrines although photos of these and other such sites around Africa are readily available in books.

Mabira Forest is an ancient place of massive trees and long, winding trails, one of Uganda’s National Forests. Birds, monkeys and other small animals live here in abundance. We had a delightful hike through this forest. A mature strangling fig lives in its heart. Birds or monkeys drop the fig seeds in a cleft of a host tree and the fig sprouts. It sends multiple structures downwards which eventually completely envelope the host tree, strangling it to death. It does not actually live on the host but uses it for support until its own structures are in place. The size of a mature strangling fig is enormous. (See photo) The dead host tree is inside the tree you see here.

The Nile River has its southern origin at Jinja. A branch of the Nile (the Blue Nile) has an eastern origin in Ethiopia. It is marvelous to behold: in the placid waters of Lake Victoria, springs churn up creating a strong current. The lake looks like it is boiling at those spots. A boat will stand still on the lake water but move swiftly in the current; the change in motion is dramatic. That current is the beginning of the Nile which exits Lake Victoria at Jinja, pouring over a series of rapids which creates Bujagali Falls, another place of awe-inspiring beauty. Sadly, Bujagali Falls will disappear in the construction of a new dam in the next few years. (See photo)

Dad and Bob stayed at the apartment while Chris, Amy and I went to Entebbe for some last hours together before taking them to the airport. I had not anticipated the grief at seeing them leave and taking with them a sense of community and belongingness which are among the many things we are missing while here in Uganda. My chest hurt from the crying I had done the evening before. That part of the grieving was out of my system and a resolve to see the assignment through had taken its place. And so we were able to enjoy Entebbe’s excellent zoo and laugh at the antics of the dumpster-diving troop of monkeys which live outside the zoo’s gates. Here is a photo of a baby climbing the tail of a cooperative adult. And then Chris and Amy left for home. And last week, so did the students. In about three months, it will be our turn. For now, I have grading to do, lots of it.