NML-ISSUE 7

The Nurses and Midwives Letter Issue 7

THE NURSE & MIDWIVES LEADERS’ THINK TANK

Emotional PPE is a Survival Tool Kit for all

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Table of Contents Resilience and Renewal, by Dr. Rose Clarke 5 minutes with a Young Nurse – Lubega Martin Nanyonga ………………………………………………pg 13 ……………..………….………………….pg 3 100 Outstanding Women Nurse and Midwife Leaders, 2020 2020 in Review by Irene Atuhairwe & Tracy …………………..………………………....pg 16 Kobukindo Nurses and Midwives on Social Media Platforms ……………...…………………..……...….pg 7 During the Pandemic. By Elizabeth M. Pearson …………..…………………………………...pg 17 5 Minutes with a Nurse Leader: Sr. Vanice In Remembrance of You Katusiime Petwa …………………………………………….…pg 21 ……………...………………...…………...pg 10 NMLTT Holiday Greetings ……………………………………………….pg 22

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Resilience & Renewal

By Dr Rose Clarke Nanyonga All I want for Christmas is some Emotional PPE! No, not some. Loads of it. The Pastor of the Worship Harvest Church in Naalya, often says that Church begins on Monday and Sunday is garage time. It made me reflect on what this Christmas season ought to be about—getting fixed! I do not know a single friend, family member, colleague, or even a stranger who isn’t in desperate need of renewal. At the time of writing this article (December 23rd) nearly 77 million total cases of Covid-19 had been reported around the world., 43 million had recovered and 1.7 million deaths had been registered. Here at home, the tally is at 31+ thousand cases; 10+ thousand recovered, and 230+ deaths have been reported. Among the reported cases in Uganda, a little over 1000 are nurses and clinical officers (see Health in Africa Dec. 13, 2020). On October 28th, the International Council of Nursing (ICN) reported at least 1500 nurses from 44 countries had died of Covid-19. With the total health worker covid-19 fatalities estimated to be more than 20,000 (ICN, 2020).

But the major impact of Covid-19 is not seen or felt just in numbers, it is the degree to which our lives are inextricably affected. I recently asked people to describe the year 2020 for me in one word or a sentence. The answers were not surprising and represented a collective mix: from hope to despair. Grief to opportunity. Here are a few ways of how people described it: "It has been a twisted year” "A year of grief and despair, and of lockdowns and loneliness."

“I see no end in sight…its quite hopeless".

“It has been a year of weeping” “It has been physically, mentally and psychologically exhausting” “Catastrophic” “Apocalyptic” “Unprecedented” “It has been a very, very, dark year” “Simply depressing” “Traumatic” Other people described the year in more positive terms:

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“It has been hard, but there are opportunities as well”, one person said.

“I feel extremely clean” (referring to all the handwashing and sanitizing).

“We are discovering what we can achieve with technology. I think that is good” “It brought nurses and midwives together in a way that has never happened before” “I hope for a vaccine” “We need renewal; and you know, for once, it feels as though we are all the same—this disease does not discriminate” “We are resilient, we will overcome this” … et cetera.

So, I used some of these words to create a graphic (See Fig I: A Twisted Year) and in that creative process, I zeroed in on Resilience and Renewal. Over the last nine months, nurses and midwives and other healthcare providers have showed up to work every day. They have pushed back against fear, trauma, depression, exhaustion and lack of safety and resources. They have demonstrated an admirable collective strength and solidarity. They have mobilized communities towards preventive practices, kept hope alive for many families who couldn’t get to their Covid-19 isolated patients, cried with colleagues who were dying, delivered healthy babies, and sent home many other patients with positive health outcomes. If this isn’t the hallmark of resilience, I don’t know what else is.

Fig I: A Twisted Year Unpre ce

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“It has been a Twisted Year.”

Resilie n ce YONM

Opportunity

Faith Grief &Despair

t Trace Test Trea

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Emotional PPE is a Survival Toolkit for All Psychologists define resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress—such as family and relationship problems, serious health problems, or workplace and financial stressors…That's the role of resilience” (APA, 2020).

This is not to say the resilient individual will not experience extreme grief, pain and despair. But building resilience requires intentional practices or disciplines that renew, restore and rejuvenate our physical, psychosocial and mental health wellbeing. This may be a challenge for busy people and nurses, midwives and doctors are the worst culprits when it comes to prioritizing their own wellness. Most of their work is driven by "…nurses, purpose, passion and often a grand goal of saving the world one patient at a midwives and time. But let's be honest: you simply won't be able to save anyone if you doctors are the ignore the principal disciplines of rest and renewal. One thing is true for worst culprits sure, our mental reservoir of strength (and resilience) is not an endless when it comes to fountain from which we can dip again and again without the necessary prioritizing their refills. The pandemic has taken its toll and both our bodies and minds own wellness…" “keep the score” (I recommend Der Kolk’s, book (2015): The body Keeps the Score: Brain, Mind and Body in the Healing of trauma) of all the stress, trauma, anxieties, uncertainties and fatalities we encounter and therefore must endure. This holiday season do not just endure. Healthcare providers need more than medical supplies, they need “Emotional PPE” and taking active steps towards rebuilding and sustaining your resilience is one way to foster emotional wellness and ultimately a healthy workforce.

Look for Bucket Fillers Active steps require mindfulness and intentionality. The internet is full of advice of what healthcare providers need to do to sustain their mental health wellness. We have had more than our share of webinars on this. And yet, it is so easy for us to go through these emotions, attend every webinar, listen to podcasts, read every WhatsApp message, and “hang out” with people without really getting what we need from those encounters.

This means we need to intentionally connect with others who add value; or seek only those events that are lifegiving. And it wouldn’t hurt to pace our social media/WhatsApp encounters and instead identify persons or events that trigger joy, happiness, relaxation, and stress-relief.

The “Bucket Man” Merrill Lundgren popularised the idea that people carry invisible buckets (also referred to

by Covey as emotional bank accounts). According to Lundgren, a bucket filler is an individual who fills the buckets of others with kindness, empathy, love and consideration; while a bucket dipper is an individual or event that empties our bucket (dips and takes)—leaving us feeling empty and sad. A children’s book by McCloud and Messing (2016) illustrates this concept very well. Nurses and midwives fill and protect other people’s buckets every day. That’s the job. But who is filling your bucket? I encourage you to seek those persons out or engage in 5-minute daily disciplines or routines that restore your emotional reservoir.

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Renewal The NMLTT recognises that this has been a year of collective woundedness. We have all experienced waves and waves of emotions.

Despite these challenges, nurses and midwives have shined brightly. We hope that Christmas whether celebrated at work or home, would inspire renewal for each and every one of you. And as the staff of Masaka Regional Referral Hospital have encouraged us…get well soon.

(Photo by Masaka RRH).

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2020 In Review

By Irene Atuhairwe and Tracy Kobukindo APRIL 2020: Formation of the NMLTT The Nurses and Midwives Leaders Think Tank (NMLTT) initiative was formed as a response to the COVID-19 pandemic. It comprises of Nurse and Midwife Leaders from the following institutions: Ministry of Health, Department of Nursing, Ministry of Education and Sports, Uganda Nurses and Midwives Council, Uganda Nurses and Midwives Examination Board, Uganda Nurses and Midwives Union, Professional associations like Critical Care Nursing Association of Uganda, Association of Graduate Nurses and Midwives, Nurses and Midwives Society, Nurses and Midwives in the Private Sector, Leaders from Training Institutions and Academia, Nurse leaders from respective National and Regional Referral Hospitals among others.

Objectives of the Think Tank During this period, the Think Tank was tasked to address the following issues relating to COVID 19: i.Representation of nurses and midwives at the Ministry of health level as well as the interministerial task force. Leadership is critically important during the management of a pandemic. The magnitude of challenge nurses and midwives face amidst the pandemic underscores the urgency of nurses to be fully and deliberately involved in all strategic measures taken by any government. ii.Increase access to adequate PPE for nurses, midwives and other frontline health workers. Nurses and midwives are uniquely placed as they spend a significant amount of time with patients. This puts them at a higher risk of acquiring the infection. iii.Adequate training on: Management of COVID-19 suspected or confirmed Cases; Appropriate use of COVID19 specific PPEs; Mitigation, Preparedness and Response to a pandemic. iv.Logistics and Resources including: Transportation and Accommodation. v.Provision of psychosocial support to nurses, midwives and other frontline health workers. Studies indicate that there is a significant amount of mental health distress associated with pandemics. vi.Appropriate compensation and facilitation for healthcare workers involved in COVID-19 patient care as well as considerations for the Welfare of their families. vii.Increase testing for frontline health workers for COVID-19 viii.Appreciation for the nurses and midwives’ continuing contribution to health for all by the Government of Uganda.

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Advocacy The Leaders of the Think Tank met with the Permanent Secretary (PS), Ministry of Health, Dr. Diana Atwine. During this meeting, the above issues were presented to the PS and her response was positive on all of them. After this meeting, press statement highlighting key issues affecting Nurses and Midwives was issued.

Another concern that was raised to the Think Tank was that of Nurse Doris Okudunia who was being harassed by district officials. The Think Tank raised these concerns with the Uganda Nurses and Midwives Council who engaged their lawyer for support. The matter was resolved, and the nurse did not face any further threats.

Fundraising for PPE One of the critical challenges that is affecting nurses and midwives among as well as other health workers is the lack of adequate PPE. To address this concern, the Think Tank fundraised for PPE under the PPE for Musawo campaign, raising a total of UGX21,700,000 and has since procured PPE for 3 hospitals, namely: Mulago National Referral Hospital, Entebbe Grade B Hospital and Arua Regional Referral Hospital. The support to Arua Regional Referral Hospital was featured in the Daily Monitor of September 1st, 2020.

Celebration of International Midwives Day and International Nurses Day The Think Tank joined the rest of the world to commemorate these days. On international Day for Midwives, the Think Tank arranged for 2 midwives to be interviewed on National Television: Ms. Catherine Odeke, the National Coordinator for Nursing Now in Uganda, and Ms. Annet Kanyunyuzi on NTV during the 9pm News Bulletin. To Celebrate the International Nurses Day, Members of the Think Tank participated in a Live show on UBC to commemorate both Mother’s Day and International Nurses Day represented by Dr Rose Clarke Nanyonga and Ms Irene Atuhairwe. This show also included Young Nurses Ms Lillian Nuwabaine and Ms Mary Najjuma. International Day of the Nurse celebration at Union offices and at various RRHs.

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Communication through Newsletters: The Think Tank has engaged in several ways to communicate with nurses and midwives as well as other health workers. One of the ways this has been done is through the Think Tank Newsletter that has been released since April 2020. The Think Tank has so far published 6 editions which have featured articles from nurses and midwives all over the country, on topics ranging from Nursing Research to Nursing Education amidst the pandemic, leadership and the importance of nursing professional associations and unions. These editions also introduced s special section entitled: “Five mins with a Nurse Leader” where different leaders shared their opinions on how to advance the nursing and midwifery profession as well as their inspirational personal stories.

This section also featured updates from the national Nursing Now coordinator.

One of the high notes of the year was the New commissioner for Nursing and Midwifery services was appointed to MOH, Comm.

Beatrice Amuge.

Webinars and Dialogue with Nurses and Midwives Among activities undertaken by the Think Tank was organising and participating in webinars to encourage dialogue and professional development among nurses and midwives (full list below): 1. Effective Leadership and Advocacy, May 18th, 2020 – Facilitated Dr. Rose Clarke Nanyonga, Dr. Margaret Phiri, Nursing Advisor Seed Global Health Malawi. Featuring Dr. Richard Idro (Pediatric Neurologist & President, Uganda Medical Association) 2. Dialogue with the Uganda Nurses and Midwives Council, featuring Ms Angela Ilakut, Ms Mercy Mwema 3. Dialogue with the Ministry of Health on the National Covid 19 Response featuring Dr. Amone Jackson, Dr. Mugahi Richard, Commissioner Beatrice Amuge and moderated by Dr. Safinah Museene 4. Communication in Public Service and interpersonal skills facilitated by Dr Rose Chalo and moderated by Ms Angela Illakut 5. Mental Health and Psychosocial Support for Health workers facilitated by Dr. Keneth Kalani and Zam Nabukera, moderated by Cliff Aliga 6. Writing for nurses and midwives facilitated by Dr Rose Clarke Nanyonga, Dr. Rose Chalo, Tracy Kobukindo and Elizabeth Pearson 7. Clinical documentation facilitated by Dr Grace Nakate, Ms Emily Musimenta, Ms Rita Mugerwa and Mr. Edson Monday 8. The Future of the Nursing Profession amidst the Covid Pandemic with leaders from the Think tank Dr. Safinah Museene, Dr Rose Clarke Nanyonga, Ms Angela Illakut and Cliff Aliga and frontline health workers from Mbarara Regional Referral Hospital and Entebbe Grade B Hospital.

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5 Minutes with a Nurse Leader Sr. Vanice Katusiime Petwa Katusiime Vanice Petwa is a retired Senior Principal Nursing Officer and a Specialist in Public Health. She was inspired to join politics through a colleague that knew her passion about worker’s rights. She is now a successful politician serving as Movement flag bearer for District Lady Councilor for workers, Isingiro District - awaiting general Elections, at the same time, she is currently the National organising secretary for the Uganda Nurses and Midwives’ Union (UNMU)

Who is Vanice?

Vanice started her career in 1983, as a Nursing Officer (NO) Grade 11. She then studied midwifery in 1992 - 1994, and Public Health Nursing. Her credentials are DHA, BHA, MPH. Following that, she served as Senior Nursing Officer (SNO) /District Nursing Officer (DNO) and Health Visitor, in Mbarara District from 1995 - 2011. At that time, the district structure was so rigid that the highest post was the SNO and it remained stagnated for 16 years. From 2011 - 2016, she was a Principal Nursing Officer (PNO) at Cufh - Naguru. From 2009 - 2017, she was the National Chair for the Massuna faction during the wrangles. From 2016 - until her retirement this year, she was the SPN0 at Mbarara.

What Inspired you to Join Politics?

After my retirement, I qualified to participate in politics according to the local government Act which was revised in 2017, that catered for councilors for workers, among others. As a defender of nurses/midwives, my friends including Assumpta, reminded me that I should take up the post and speak for workers at the District council, advocate for better terms and conditions for workers (especially Nurses and Midwives), advocate for scholarships, and work to eliminate all forms of workplace violence.

Why the interest in politics - how did your journey into politics begin?

In 1998 when I joined the Uganda Nurses and Midwives Association (UNMA), I became the NEC Western Region Representative. The association registered the Union in 2002 August, and I registered as a member in the same year in October. I subscribed to the Union from 2006 till the date I retired. During my duties in the district, I appreciated the challenges nurses/midwives were facing right from grass root up to management level.

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The Trigger One day in 2005, a politician slapped a nurse in front of her clients over the weekend because he needed medicine and the SNO had no keys to the store. Of course, it was not her fault, it has always been that a nurse cannot head a unit, so it was the clinician’s fault. I made sure the politician faced the consequences of his actions. He was arrested, taken to the police cells and I ensured that he apologized in the presence of all the District Leaders. My experience in the local government showed me that nurses/ midwives are generally disregarded especially where there's anything beneficial.

This disregard for our profession was prominent; In the Union, we were tormented by the Medical workers Union because we had denied them the continued opportunity to earn from unsuspecting nurses.

We were harassed to such a point that nurses/midwives started to hate their union. One time we were awarded the privilege to have a Nurse given a Ministry responsible for workers - some Senior Nurses marched to the Ministry of Public Service in protest of a nurse Minister! “We don’t want Minister Bakojo, we don’t want the Nurses Union!”

In 2009 there was another split between those who wanted both the Association and Union, and those who only wanted the Union. This conflict gave birth to wrangles that lasted nine good years. But I stood for appreciating the different roles or benefits the two bring to a nurse/midwife.

“A politician slapped a nurse in front of her clients over the weekend because he needed medicine and the Senior Nursing Officer had no keys to the store.”

It was 2017 when I was approached to end the wrangles, I agreed. And now, we are one Union under one leadership; and for the first time ever, we managed to successfully lobby for salary increment and statehouse scholarships - the power of unity!

There are nurses or midwives out there who believe that politics isn't for them, why do you think it is important for them to join or participate?

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Unless Nurses join the politics where policies are made and approved, they will continue grumbling. We need representatives at that level. Norwegian Nurses became strong after dominating the legislature. At Least one of the Ministers of Health should be a nurse. It's very unfortunate for Uganda.

Currently Doctors are targeting to have 60 entrants in parliament but for us we have only one Nurse. Even the nurses don't see it as an issue. How I wish we woke up to this noble cause.

Do you think there are people out there who say that Nurses and midwives cannot be good politicians?

Some believe so but that's a wrong perception, I got overwhelming support when I contested, and the majority were not medics. When I contested everybody - health workers woke up to the cause because they knew me as a defender. But I had been asleep in the routines without knowing the Union technicalities.

I have a task to sensitize the nurses and midwives on these other issues that determine the conditions of their services.

What message would you like to send to nurses and midwives?

My message to nurses and midwives is to be part of the move or the voice that speaks for them. I request all nurses and midwives to be members of the unit irrespective of where they belong for collective bargaining. Good enough elections are not yet here .I encourage colleagues to go and register to be councilors in their respective Districts. Teachers are highly organized - they occupy all those positions yet nurses are equally many. And one doesn't need to first retire, they can represent while still in service.

May God bless you all. To love and Serve

"Unless Nurses join the politics where policies are made and approved, they will continue grumbling."

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5 minutes with a Young Nurse – Lubega Martin Please tell us a little bit about yourself Am Lubega Martin, a 25-year-old Ugandan male nurse. I hold a Bachelor of Science in Nursing from Makerere University. I am a young nurse leader, writer and Rotarian. I am passionate about maternal and child health, medical journalism and nursing education. I have a keen interest in patient and public health education because we are living in an era where patients and the general public are inquisitive and want to know more, about their health, ailment, treatment options among others. There’s an opportunity across all health professional cadres for us to improve information dissemination to patients and our clientele – In the future, this might be the difference between a good or bad Health Worker.

What drew you to the nursing profession?

To be honest, and like many of my fellow University classmates, nursing wasn’t my first choice. When I applied for government scholarship, it was my second choice after Medicine and Surgery. I was selected for the scholarship to pursue Nursing studies at Makerere University, and in August 2015, I started my Nursing journey. As a junior student nurse, I explored a lot about the profession, and this helped me to recognise the opportunities and unexplored areas in the profession. The department of nursing at Makerere University had a student mentorship program, through which I got access to one of the best mentors. With time I developed a lot of interest, getting involved in Nursing student leadership at the University as well as National Level. By third year, I had become one of the most vibrant nursing students in the college of health sciences and across the country.

What is your biggest achievement to date – personal or professional After 1 year of professional practice, I have been blessed, to be able to write and publish a book: “My Pregnancy” handbook, for which we received international and national recognition. It’s been an action packed 20 months: • February 2019: The My Pregnancy Handbook is published • November 2019: Awarded Student Innovation of the year by Makerere University Department of Nursing • January 2020: I graduate from Makerere University • March 2020: My pregnancy handbook is nominated for Students Project for Health awards by The Network – TUFH and FAIMER • July 2020: My pregnancy handbook is named among top 4 social innovations in health by the Social Innovations in Health Initiative and Makerere University School of Public Health.

• September 2020: My pregnancy handbook awarded among the best international Students Projects for Health awards by The Network – TUFH and FAIMER in Mexico 13

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November 2020: Finalist nominee for Innovations in Health in the HIHA (Heroes in Health Awards) by the Ministry of Health Uganda.

How do you prefer to receive recognition – publicly or privately and why?

Recognition is about appreciating someone but is also a way of motivating others. I would prefer public recognition. This is the only way you can motivate others. I personally get motivated when I see colleagues and those I look up to being recognized publicly.

“ My Pregnancy, a pregnancy guide for all women”

Why your book on ‘’My pregnancy” and not anything else and what inspired you to write it?

Health education is a core nursing role thus advise colleagues to appreciate it; I have previously written in various magazines on health topics and am a regular health columnist in one of the most selling newspapers in Uganda. Only that this was my first book and I have invested a lot in promoting it, but I have also authored another patient handbook: “Living with Diabetes, a health perspective” which will soon be published.

“My Pregnancy, a pregnancy guide for all women” is a simple handbook intended to deliver authentic basic health information concerning pregnancy to women, couples and the general public. It also serves as an antenatal class guide for the midwives. I was inspired to write the book during my third-year midwifery rotation at Kawempe National Referral hospital. While there, I discovered that the information midwives shared with mothers during the antenatal care talks was so insufficient. This was partly because of the overwhelming numbers of mothers turning up for antenatal care versus the staff shortages thus the contact time with every mother was less than 10 minutes. Amidst the fact that antenatal classes are held in a group, the midwives were ever rushing through the topics, there was limited time to respond to questions and interact with the mothers. On many occasions even the mothers were rushing for other activities and work outside the hospital. In such a situation, the aim of antenatal care classes, is never achieved. This was a challenging experience that inspired me to think of other better ways of delivering the same health information to mothers.

I carried out research online on what has been done in other countries to change the status quo. I found out a number of interventions including sending text messages on phones among others.

However, I wanted to innovate something that would create a sustainable impact; the initial idea was to create videos of various topics that are covered in antenatal care classes to that these are accessible to mothers, on demand online and also in the hospitals. Upon further analysis, I realised that this would be cumbersome and probably expensive, as it would require me to engage actors, videographers who all cost money that I did not have at that moment. I still went ahead and wrote the scripts for the videos and shared the final copy of the script with our course coordinator, requesting her to proofread it and advise accordingly. From our interaction, we realized we would publish the script as a handbook. The book was published in February 2019 and patented with the Uganda National Library. It was submitted to the Technical Working group at Ministry of Health for approval and now awaits adoption for Nation-wide use. Currently the books are sold in bookshops and clinics.

It has received endorsement from various gynaecologists, midwives and mothers who keep recommending it.

Since the reading culture of the general public is low, I still believe video clips would create notable impact and still hope that once finances and other resources are available, the book will be transcribed to video clips.

What would you tell someone who is thinking about getting into the nursing profession regarding emerging trends and changes in this profession?

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Nursing is a diverse profession, with emerging opportunities ranging from management, research, epidemiology, clinical nursing, education, advocacy etc. And with ever growing demand of nurses globally, one is certain they will get a job or even start up something from any of the emerging fields. My advice is that one should invest time and all efforts in discovering where their passion is earlier so that time is not wasted along the career path.

What's your personal philosophy on what should be done about (the Cause)?

I personally believe in prayer, hard work and dedication to anything am passionate about. For anything I wish to achieve, I believe it is worth sacrificing personal time, thoughts and resources.

What are your short, medium, and long-term career goals?

I want to get affiliated to a nursing training institution to help me shape my dream of becoming a high-level academician in the nursing fraternity. In the next five years, God willing, I should have a master’s degree aiming at having my PhD before 40years of age. In the long run, I would want to contribute and invest in improving nursing education and training in Uganda.

At The End Of The Year As this year draws to its end, We give thanks for the gifts it brought And how they became inlaid within Where neither time not tide can touch them.

The days when the veil lifted And the soul could see delight; When a quiver caressed the heart In the sheer exuberance of being here.

Surprises that came awake In forgotten comes old fields Where expectation seemed to have quenched.

The darkened days that stopped The confidence of the dawn.

Days when beloved faces shone brighter With light from beyond themselves; And from the granite of some secret sorrow A stream of buried tears loosened.

We bless this year for all we learned, For all we loved and lost And for the quiet way it brought us Nearer to our invisible destination

…John O’Donohue

The slow, brooding times When all was awkward And the wave in the mind Pierced every sore salt.

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100 Outstanding Women Nurse & Midwife Leaders

CONGRATULATIONS The NMLTT congratulates Dr. Rose Clarke Nanyonga (Vice Chancellor, Clarke International University and member of the NMLTT Secretariat); Christine Otai, (Senior Midwife, Kiwoko Hospital); Margret Seela (Midwife and Neonatal Nurse, Kiwoko Hospital); and Cornety Nakiganda, (Midwife, Adara Development’s Hospital) on being nominated to the 100 Outstanding Women Nurse and Midwife Leaders cohort 2020.

Learn more about them here

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Nurses and Midwives on Social Media Platforms During the Pandemic

By Elizabeth M. Pearson The COVID-19 outbreak has changed the way Nurses and Midwives interact with each other. While in person interaction has been restricted, virtual interaction has had an unprecedented surge. With many turning to social media platforms to connect with loved ones, friends and colleagues. Professionals in the Nursing and Midwifery profession are no different, we too have turned to WhatsApp for timely updates, connection and sharing with each other - it has been a coping mechanism in these extremely difficult times. WhatsApp has been utilised for continuing to embrace the call to serve positively, and to work together through this dark phase. The maximum number of participants for the first WhatsApp messenger group reached the maximum limit within a few hours and in a couple of days, nearly three groups were running concurrently. This steady increase has carried on with different Nurses and Midwives groups being formed, some are cadre based, most are hospital or institution based, while some are general - accepting all Nurses and Midwives from all corners of the country until a maximum limit is reached.

Some positive ways the groups are being used are briefly explained below: The groups have been great motivation and support.

Many colleagues have used the forums to share positive stories and motivate each other including prayers, humour stories, MOH messages, Council communication, job updates and offers as well as hilarious video clips - Afterall, laughter is medicine for the soul!

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Sharing updates on Covid 19 The Covid 19 updates have been shared and circulated via the groups to keep us all informed of the progress of this pandemic. Including official policies and guidelines published by MOH such as: COVID19 Case management guidelines, Community Engagement Strategy and Home-Based Care strategy for COVID management. The Uganda Nurses and Midwives Council has also shared official communication and updates for example on the WCEA courses, council appointments for collecting certificates and licenses. Various local and International articles on COVID19 have also been successfully shared.

Welfare Support - One group for instance the Uganda Nurses and Midwives Hub congratulated and supported the Nurse of the year Doris, by writing out in her support when her selfless act of wheeling a patient brought some negative criticism, they also contributed and bought her a smartphone. She's now connected with colleagues, able to use the internet and enjoy the online experience and can join the conversations.

They have been a platform where announcements have been made in a safe space like colleagues who have passed on and collecting funds in support for funeral arrangements has been done.

Networking with other colleagues. Nurses/Midwives have been able to meet online with colleagues all over the country from Apac to Kawempe to Mbale and the diaspora, to share their experiences and connect professionally. This has also progressed to international networking with counterparts, writing collaborations and support in career growth as many have received mentorship support for free from more experienced Nurses or Midwives in the various fields.

The groups have been a communication channel with the other Nursing bodies like the NMLTT, which used this as a major channel for sharing the Nurses and Midwives Newsletter, a list of useful contacts and various interviews and official communication from various highly respectable Nurse & Midwifery leaders in the country.

Sharing encouraging messages with each other. As quoted by Joan Mugabi in her message: Let's Love One Another.

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“As a nursing fraternity, let's learn to love each other, celebrate each other, accept each other, support each other and learn to appreciate our differences. My first job I got was in 2005 in compassion international, my project director was a female. She welcomed me and loved me the way I was a young girl fresh at the job, very green in the project. But she respected people no matter how you were. I learnt a lot from her. We need to even respect our colleagues even when they don't know anything. Let us nurture them in love, let's not show them we know better. Let’s not demand respect but teach each other in love and support each other. That's when we shall grow together as nurses and midwives. Some young nurses have hated the nursing profession because of how we handle each other at work in rage and stress. It's absurd.

Let's encourage young ones that the nursing profession is the best by being models, working together, communicating well at work, not despising, backbiting, not criticising everything we see, not even pretending to love and not sitting back wanting them to do the work. This year I wish you the best and merry Christmas!!! stay well stay safe!"

Webinar updates and highlights from webinars have also been shared on the forums and shared learning including interesting discussions have also been on the groups.

They have been used as a learning tool including diagnosis.

The members have been and continue to use the group messengers for shared learning including diagnosis and treatment. Colleagues share different conditions maintaining confidentiality of area and patients and seek peer support discussion with others.

5/June/2020 Colleagues posts: “What is really this nurse-patient relationship, majority of us nurses may know it but there's is a hidden component in it, which majority of us don't recognize; the hidden component is that once you fail to build and maintain a nurse-patient relationship, you are completely out of management. What really heals a patient? It may be drugs or other parts of management but your relationship and attitude contributes 60% of the healing process of this patient, don't materialise things, don't ask for money to help this patient, you rather be appreciated and blessed by a patient than receiving a silent curse from a patient, I am aware patients can embarrass and annoy but control your temper always, pray before going for work, ask for God's knowledge and guidance because he is our boss and be calm always because your reward is not from Man but from God, I am really humbled by you comrades serving in difficult situations but I know one day we shall make it through, God bless your souls."

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Of Course, there's a downside to anything and there have been some negative aspects.

These groups have no formalized channels to voice concerns.

When concerns that are pertinent are voiced, there seem to be no proper channels to relay the information.

Although a list of useful contacts was formulated, it requires reposting from time to time.

Deliberate leadership on the groups: Leadership in the groups is voluntary and due to commitments sometimes inappropriate messages are shared and not censored.

Limited to those with access Although it has had a positive impact on the fraternity, the WhatsApp messenger groups are limited to those who have internet access and smartphones, so others are missing out on learning opportunities like the webinars and any updated information from Nursing and Midwifery bodies.

As the forums are for social engagement and therefore not official but have been specifically titled for the Nurses and Midwives, the participants have not gone through any vetting procedure to gain admission to the groups.

In conclusion, the forums have been very engaging and have seen some Nurse and Midwifery leaders engage with colleagues who might not have had that opportunity to engage with previously.

The tax imposed on these platforms where health care professionals interact with purpose should be reviewed and perhaps internet connectivity in health care settings should be a priority.

As Eleanor Roosevelt is quoted as saying,

"You gain strength, courage, and confidence by every experience in which you stop to look fear in the face. You must do the things which you think you cannot do".

Let us continue to embrace these platforms and use them positively.

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In Remembrance of You To all the families, friends, and colleagues, who have lost their loved ones during this difficult time - we are with you and today we mourn with you all as one community united. May you be comforted, strengthened and have peace that surpasses all understanding.

And for every Fallen Colleague, may your Candles Keep Burning

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NMLTT Holiday Greetings

Ongoing NMLTT continues to work in collaboration with the National task force in the Management of Covid 19.

The Think Tank Newsletter editing team accepts articles on a rolling basis under the sub themes below: ● ● ● ● ●

Research and Innovation Continuing Professional development (CPD) Policy Leadership/Governance Clinical Practice Covid-19 Response.

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The Think Tank continues to meet regularly to check on progress and formulate strategies to support and advocate for Nurses and Midwives. We would like to thank Seed Global Health for the continued support for hosting our zoom meetings and webinars. We will resume meeting at the later part of January 2021.

Our faith in you is steadfast. May you continue to rise up to the challenge in this International year of the Nurse and Midwife - 2020. More than ever, this nation needs you. We thank you and May God bless you.

Please feel free to contact us with your concerns. If you find this Nurse & Midwife Letter useful, we would really like to hear from you. We continually evaluate and assess the progress of our communication channels with you.

Please email us at the address above.

Copy to: The Hon Minister for Health The Permanent Secretary, Ministry of Health The Chairperson, NATIONAL TASK FORCE COVID 19 The President of Uganda Medical Association Commissioner Nursing Services, Ministry of Health All Nurses and Midwives in Uganda

Compiled by the Think Tank Debrief Team on behalf of the Nurses and Midwives Think Tank: Dr. Rose Clarke Nanyonga, Elizabeth M. Pearson, Irene Atuhairwe, Tracy Kobukindo, Christine Alura and Judith Kiconco

References APA (2012). Building your resilience. Available at https://www.apa.org/topics/resilience Health in Africa (2020). Uganda confirms 1200 health workers tests for COVID19 , majority Nurses and Clinical Officers. Available at https://healthinafrica.world/2020/12/13/uganda-confirms-1200-health-workerstests-for-covid19-majority-nurses-and-clinical-officers/ ICN (2020). Press Release: October 28th, 2020: ICN confirms 1,500 nurses have died from COVID-19 in 44 countries and estimates that healthcare worker COVID-19 fatalities worldwide could be more than 20,000.

Available at: https://www.icn.ch/news/icn-confirms-1500-nurses-have-died-covid-19-44-countries-andestimates-healthcare-worker-covid McCloud, C. (2016). Have you filled a bucket today?: A guide to daily happiness for kids. Bucket Fillers.

Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma.

Penguin Books.

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