MINUTES WITH A LEADER: PSYCHOSOCIAL CHALLENGES FACED BY NURSES AND MIDWIVES DURING COVID

The Soroti A-Team

Photo credit: Dr, Claire Nakubulwa

3. What is your most significant achievement to date?

• Whenever I see my patients getting better, I feel a sense of satisfaction and joy. That is my most outstanding achievement; seeing my patients recover.

Sometimes we get patients to come to the brink of death, and as a nurse, you do all you can just to get them through the day. So, seeing a patient recover brings me joy and is an achievement. • This recent admission challenged me. I was the nurse on duty when they came into the hospital. We thought a referral might be the best option, but the mother was poor. She did not have money to go to

Mulago, so as hospital staff, we had to collect money to send them to Mulago until we were successful. • However, I was told that they had returned to Soroti, and I felt so bad. It was tough seeing the other baby struggling to breathe as the other twin was dead. Every time I would sleep, I saw the image of this baby struggling to breathe. I told my colleagues, including the surgeons, that we needed to operate on this baby. I discuss freely with the surgeons, and we have a good working relationship. I was thrilled when my colleagues agreed that we should operate on the twins. This, I can say, has been one of my most outstanding achievements. We decided to do something about it. • Another achievement I feel was working at Soroti Hospital during the War. I was working in theatre.

Operations were endless due to emergencies due to gunshots. We would work all day without lunch and not even realise that the day is gone.

• I was also among the first nurses to work on the Covid unit because others were shying away and feared getting sick. I decided to do this because if I did not offer myself, who would take care of these patients. I thank God that I worked there for a month and God protected me, I did not get sick, so I was pleased about this recognition. Overall, I can say that my most significant achievements are when I nurse patients to recovery.

The Team Being Recognized at Parliament

Photo credit: Dr. Claire Nakubulwa

4. How do you prefer to receive recognition? Publicly or private and why?

• Public recognition is good so that the public knows the good things that we do. For example, there is a lot said about health workers that we are rude and get money from patients. So, I want the public to know that it is good in the hospitals. Some people don’t want to come to the hospitals and instead go to clinics, then come to the hospital. So public recognition is good for the public to know that it is good in hospitals. • Another good thing about public recognition is that it encourages other colleagues as well to do better. I am grateful to the Nurse leaders Think Tank that has looked for me and recognized me. It’s good that we are recognising each other.

5. You were involved in the recent ground-breaking surgery in Soroti RRH conducted on conjoined twins, and one of the twins had died. How did that make you feel, and why?

As I mentioned earlier, we first referred the patient to Mulago. This was a young mother who was not stable financially. We had to collect money to send her to Mulago, but then they returned to Soroti. I convinced my

colleagues, including the surgeons, that we should try our best to help the baby. Even if the baby does not make it, we would have tried our best. When they all agreed to work on the baby, I was relieved.

I ensured that everything that was needed was ready, blood was available for the baby. Of course, we ensured we had two units of the baby’s blood type even if the baby required less, but we wanted to be sure that we were prepared in case of anything.

I was the instrument nurse for this surgery. The senior surgeon, Dr Joseph, worked with another surgeon, and I provided instruments to the surgeons as they carried on the surgery.

It took about 2 hours. We started at 11, and about 1:30, we were done. It was mainly the sternum and lower lobe of the liver that were affected. That is why it did not take so long.

We all felt delighted after the operation. We ensured that the baby recovers from General anaesthesia before taking them to the ward. When we took the patient back to the ward, everyone was happy, including the patients on the ward. They all clapped and were filled with Joy seeing the baby come back from the operation. As a team, we check on them every day, monitor them to ensure the baby is stable. We also counsel the mother and giving the necessary support with the social issues she has. We have had to buy some items like soap, clothes for the baby, among other things. As hospital staff, we had to make some contributions from our pockets. However, the hospital director has put aside some money to take care of the baby right now. A group of Teso doctors has made some contributions and is sending one of the surgeons to support the mother.

This has been one of my most outstanding achievements, given the condition the baby was in.

6. As a nurse who participated in this surgery, what was your role?

I was the instrument nurse; I ensured that we had all the supplies required, including the instruments and blood. I also ensured that the theatre was prepared; we had just had another surgery, so we had to prepare quickly for this one to take place. I also confirmed that the personnel were all available for this operation.

7. What is the role of nurses in the pre-and post-Operative care of surgical patients, especially with such complicated procedures?

Nurses ensure that patients are stable pre-op by monitoring vitals and ensuring that the patients are ready for the procedure. The nurse has to create rapport with the patient when they come into the theatre, ensure that it is the right patient for the proper technique. If there is any required treatment that may not have been given in the wards, we can also give it.

If we see that a patient is not stable, we can take them back to the wards to be counselled until they are ready. So, we keep monitoring their vitals.

Nurses play a significant role in ensuring that patients recover and are stable Post-Op, maintaining the airway and monitoring vitals until the patient is fully recovered. We then hand it over to the surgical unit nurses to continue care. We have to hand over patients who have fully recovered.

During the operation if patients are awake, e.g., when they receive spinal anesthesia, continue engaging until the operation. The instrument nurse is the one who ensures that the surgeon has the instruments; in case things are not available, there is the runner nurse to avail these.

We can also give a hand in the procedures, share best practices with the surgeons. I have done this in some cases, and some surgeons/doctors take my advice while others don’t. If I see that things are not going well, I can call one of the senior surgeons. The surgeons I work with are outstanding and they always respond to my calls and recommendations.

Some may not want to listen to me, thinking that “what can a nurse teach me?” So, I usually advise them which instruments to use on what tissue and so on.

Nurses Being Recognised at Parliament.

8. What is your message to nurses out there?

• My message to the nurses is that I urge my colleagues to be kind and have the heart of loving our profession. We should show people that when they get nursing care from us, they know they have been cared for by knowledgeable and kind nurses. • Nurses should adhere to our ethical code of conduct – avoid being rude to patients. • I always advise my colleagues who may complain that the salary is negligible, but we have to always have the heart for helping patients no matter the circumstances. • We always have to be available and approachable to our clients.

9. How can policymakers and government support you better deliver quality nursing care to the patients you serve.

• More nurses in Health Facilities are few on the ground, and this leads to nurses getting overwhelmed. if we are many, we divide the roles, and we work better. • Improve on Equipment and resources, including personnel at the hospitals. Soroti RRH operates about 200 patients per month. It serves the Teso region and beyond. However, the theatre is small, and some equipment is not available. There only two nurses in the theatre, and when one is on leave, you have one nurse working alone. • We are supposed to have 5 Anesthetic officers, but we have 3. This leads to having one Anesthetic Officer serving more than one patient at once. One can work for two weeks without leave. • Better pay for health workers and improve working conditions for personnel, such as providing lunch so that health workers don’t have to go out to look for lunch. When we go out, patients complain, and yet you can’t work on an empty stomach. • Politicians should leave health workers to do their work. Drug stock-outs, politicians, can make noise without understanding which drugs. • Improve on supplies, for example, gloves – we recently got only size 7. Some staff use 7.5, so this is a problem. They ask me to do something, but I cannot buy gloves all the time. So, government bodies should provide supplies as ordered. • Too many Attendants and in this time of covid its more dangerous– when you tell them to go away, it’s a problem – they go to media and politicians and complain. • Colleagues got covid, better policies for managing occupational hazards and staff who get sick while on duty.

10. Any last words of wisdom

• Appreciate the government of Uganda for the work done. We now have stability; we are not getting many gunshot wounds in the hospital as before. • Nurses Thinktank, it’s great that we recognise our work. When we realise ourselves, it’s a motivating factor for others too. • Let us be vigilant, update ourselves with knowledge and skills for the good of our patients, • Urge the government to treat all hospitals equally and equip Soroti regional referral hospitals to manage patients within the region. It’s a way of decongesting the national referral hospital. • Covid has highlighted the need to have well-equipped hospitals – the rich stayed with the poor since they could not leave the country.