Our Last Day in Uganda

From Sunday, November 29, 2009











(Picture sent via iPhone is from the plane on the way home….see the sunset and the coast of Greenland!)

Today is our last blog entry, and a short one.

We have spent the day packing and getting ready for the 29 hours of travel ahead of us. But since we didn’t leave until 11:00 pm, we made sure the day was productive and we met with UNANM for a few hours putting together the final pieces of our strategy and defining our goals and objectives. It was a particularly engaging meeting as now after all this time, we have some clear direction and aspirations.

I am very excited about our plans and I look forward to coming back in March to make the next crucial steps.

It has been a pleasure sharing this experience with you all and thank you for your interest in our work.

“Kwaheri” from Uganda!

From Saturday, November 28, 2009

One thing I didn’t mention yesterday was our wonderful dinner with our UNANM (Uganda’s national nursing association) friend, Patrick B. He joined us on our tour to Kabale and was very helpful in scheduling appointments during our trip.

He continues to be a wonderful help and a terrific mind. I really enjoy collaborating with him, sharing ideas, and of course learning all that he knows about nursing in Uganda which seem endless.

Because his wife Prissy is so patient to let us take him away so much we took them out to a fun part of Kampala called Centenary Park. It is a huge compound of restaurants and more restaurants. The park was alive on a Friday night and we sat under the stars eating Uganda’s version of BBQ while competing music from three different restaurants vied for our attention.

Today we went for a tour of the national museum. It is lovely, but small and had the feel of an old-school museum with dioramas and displays of baskets and tools used years long gone. It took less than an hour but it was a nice break before continuing to type up more notes and compiling additional information from the SONS.

We ended the day over dinner with our good friend Janet O. who is the President of UNANM. We gave her a recap of our trip and an update on our work. She too is a wealth of information and we continue to learn a great deal from her extensive experience. For our work to sustain itself it is so important that we actively engage UNANM in the development of our work. By working together, we can better ensure that future Gretta graduates have appropriate remuneration, safe working conditions, due professional status and the like.

Well today was our last full day in Uganda. Until tomorrow….

From Friday, November 27, 2009

Today was a national holiday but we still squeezed every bit of work out of this trip that we could. We toured the last school of nursing scheduled for this trip. Rubaga, a private faith-based SON and affiliate hospital had very warm and gracious faculty. We are grateful that some of the sisters came on the holiday to show us around.

There are many things on this trip that I have probably neglected to share but one thing I can't overlook is acknowledging Janet's nerve, tack and sensitivity in capturing our trip visually. Today was no different. Can you imagine coming into a hospital ward and asking to take pictures of patients in bed at the bedside of a loved one? Capturing these pictures so that we can come home to help share these important stories is so invaluable.

She instinctively seemed to know when to proceed and when to pull back. She greeted each person with an extended hand and asked kindly for permission. Today she seemed to be the much needed respite in the pediatric ward. All the kids, except for a confused one or two, along with their mothers posed for pictures. Janet went through the same process each time and when she was done taking the picture, would share the image with them. It brought many laughs and smiles. Well done Janet and a heartfelt thank!!

For the record, we have visited 12 schools of nursing and eight hospitals during our two weeks on the ground. And in between those SONs and hospitals were lots of road in between them. We have now visited almost every SON in Uganda that meets our program requirements and we are very proud of our extensive research all the support we've received along the way.

This afternoon was spent with an American nurse from a prominent SON in the US who is in Uganda for two years. We were discussing what we've learned and in addition to a new masters program that is in the works which we hope to support next year when it is launched. It is greatly needed.

Happy Thanksgiving from Uganda

Photo description: Student in her dorm room at PHNC

From Thursday, November 26, 2009

Today we were back in Kampala and spent the day touring more nursing schools; Mulago Tutors College and Public Health Nurses College to be specific. We did hear some encouraging news that the Minister of Health is interested in learning more about our program. Unfortunately our visit is coming to an end and we are unable to schedule a time during this visit.

However, in my talks with the national nursing association here in Uganda, UNANM, we are collaborating together on different front such as strengthening UNANM and strategizing an assembly of sorts where UNANM and TGF bring together the major players in health and discuss important ideas in addition to our goals and objectives for nursing education. At that point we will be able to share our programmatic strategy and model which will be the product of our extensive research. We are looking to come again in late March of next year. This will be a good time to meet the esteemed Minister.

Today is Thanksgiving and once again we are in Uganda and far from home and family. We had a lovely hotel dinner and gave our thanks. I am grateful for many things in my life including the enthusiastic reception our work continues to receive.

But thank you most of all to all the persons here in Uganda who support our work in a multitude of ways. I am immeasurably grateful.

Happy Thanksgiving from Uganda!

The Face of Critical Nursing Shortages

From Tuesday, November 24, 2009

We left early again and hit the road for another long bumpy drive to Kabale to visit the SON there. Kabale SON’s Principal is particularly warm. I must say the Ugandan people are incredibly friendly and welcoming. Each person we meet whether the SON head or the person cleaning the hall floors greets you with a friendly, “you’re welcome.”

After we toured the school, we were treated to delicious African Tea and simosa’s (deep fried dumplings stuffed with meat) which are very popular here. I must say that African Tea (made with hot milk and spices) is now my favorite thing on this planet….next to my family of course.

We were escorted to the affiliate hospital next door, Kabale Regional Referral Hospital. It is better than many we have seen but each ward tells a multitude of painful stories of suffering. The HIV ward is jammed to the walls with people and the pediatric ward is also working beyond capacity.

Next we headed back to Mbarara to continue our visit which we began yesterday afternoon. We learned of their programs and how TGF might work with them to facilitate increasing their educational capacity and sponsor scholarships. I was impressed with the school head’s enthusiasm and innovative spirit.

Our new friend toured us through the hospital at Mbarara. This is where I am at a loss for words. I choked back tears at every turn. The nurses were so incredibly overwhelmed. We just witnessed one unbearably horrific sight after another.

The pediatric ward that day had 89 patients according to one of only two nurses on hand this shift. You read that correct, 89 sick kids and only two staff nurses! Most of the children were babies and toddlers. We saw a bench packed with mother after mother helplessly holding her sick child, many critical. This bench is their triage area. I almost broke down when I saw one baby with visibly labored breathing and very thin. What her mother must be feeling!!

We traveled through the maternity, labor, antenatal, postnatal wards with all beds full and some women under beds lying on the floor. Then off to the surgical and burn wards. One woman was treating her elderly family member’s sever burn wounds because the nurse was not available; just too busy with all the others.

Scenes like these kept coming and coming and my mind just went numb. The smells and sounds and sights were unbearable. I only wish that I could make everyone on this planet not living this reality witness this pain and suffering for themselves. This is the face of critical nursing shortages in disease-burdened nations like beautiful Uganda.

Far West to Kabale

From Monday, November 23, 2009

We left early in the morning and headed out in an old Land Cruiser to go far west to Kabale. Kabale is just next to the Rwandan and Democratic Republic of Congo’s borders.
Drives like these are fascinating. You just see life play out here for many of Uganda’s population that live in these rural areas. There is no ignoring the extreme poverty everywhere. Except for those in school uniforms all kids, whether just beginning to walk or school age, are in nothing more than rags and rarely do they have shoes. Women prepare food over fires and wash their babies in small plastic tubs. Most seem to live off subsistence farming and will sell what they don’t eat along the roadside. Everyone smiles when you wave. The children seem particularly curious.

We reached Musaka SON today and had a thorough tour. We are very pleased with the Principal’s dedication. But once again, we learn that many can’t pay their school fees and the school is in desperate need for books, computers, and clinical skill lab equipment. Thankfully, each school we tour is very supportive of TGF’s mission and “praying” for our help.

We then traveled potholed roads to the town of Mbarara where we will tour the SON there and then stay the night.

A Meeting with Our Gretta Scholars

From Sunday, November 22, 2009

We met the scholars at their school today. First we interviewed them so that we can better introduce these wonderful ladies and their powerful stories to our friends back home in the US.

We were brought to tears at times while listening to them share their lives with us. Their past circumstances seemed insurmountable but they are testament to the fact that that word doesn’t exist unless we let it.

It was very clear to us that these young women are overwhelmed with gratitude. Some still struggle to believe that this is now their life and they are living it. Truthfully, I’m the one that is grateful. Providing this opportunity to them gives me a feeling of immeasurable satisfaction which surpasses most any other feeling I’ve ever known.

Next we toured the room they shared together along the back of a woman’s house and I’m happy to see that they live in a safe, comfortable and clean place. While we walked along the roadside to a restaurant to treat them to dinner, I looked back and enjoyed watching them interact. They seemed liked sisters. I hope it stays that way.

I learn from our friends at the school that they are working hard and taking their studies seriously. And later that evening, we got a call from the father of one of the scholars. He called from his village and we had to call him back. Speaking on behalf of him and his wife, he expressed their happiness and gratitude and promised that his daughter would succeed. I don’t doubt it.

Well it is hard to exceed this day but I will treasure the memory of it and keep it as a remembrance of why TGF does what it does.

The Source of the Nile

For Saturday, November 21, 2009

We woke up to a beautiful morning. The hotel rooms were not more than quaint huts along a stretch of water called the Source of the Nile. We paid a small fee to travel on a man’s tin-hulled boat.

We traveled up one river’s edge and then along the other. Children were swimming and women cleaning clothes not far from our boat. The trees that cradled the river sides were alive with exotic birds and monkey’s doing what you would imagine; swinging from tree branch to tree branch putting on a hysterical show for us. This is certainly not something that you see every day at home.

The water had a strange movement to it like life deep under the earth’s surface was bubbling under it trying to escape. Drums would sound off from time to time. Not as romantic as it sounds though. At a vista overlooking the river, a group of musicians would play on cue every time a bus of tourists would stop. Well they sounded nice anyway.

Next we went to eat along the Bujagli Falls. These falls aren’t waterfalls as I expected but rapids and they are something to see and experience. This place is just you’d dream Africa would be; glorious, beautiful, untamed and vast.

We are excited about tomorrow. This is when we meet with the Gretta Scholars. Now we leave paradise and go back to Kampala.

Continued Nursing School Tour in Uganda

Our delayed post from Friday, November 20, 2009. We finally have an internet connection again.

Today was a day for touring more nursing schools. We started early a.m. and headed East.

Our first stop was the Uganda Christian University. They have two programs of interest to TGF; a BSN conversion and a masters program (MSN). This school has only one of two MSN programs in nursing in all of Uganda. These programs are particularly important because MSN level nurses are critical to teaching baccalaureate nurses. Here, nurse educators, or tutors as they are called, must be one cadre higher than those they instruct.

The lack of tutors is the biggest constraint in increasing the intake of nursing programs here so supporting these programs will be instrumental in our work to provide nursing scholarships and quality of nursing education. Often we will visit a school and the tutor to student ratio is an abysmal 1:100. During our tour we walked into a leadership class for the MSN program. In order for the nursing profession to advance it is very important that nursing students gain an empowered mindset and learn the skills to be future nurse leaders.

Next we headed further east to a town called Jinja and toured the Jinja School of Nursing and Midwifery. The faculty was partially friendly and we enjoyed our visit. A summary of our agenda when visiting each school is to meet the principal and faculty, get their input on nursing education and nursing practice, learn about the school’s infrastructure and recourse and teaching capacity, details on the programs offered, scholarship costs and the like.

We stayed the night in Jinja and enjoyed an evening of R&R at a hotel near the Source of the Nile.

Our TGF Founder, Meg Styles, is continuing her travel through Uganda this week. Her internet access is non-existent at the moment, but we will be posting all journal updates asap.

Thanks for staying tuned. Your support is very appreciated.



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Days Like this Make Me Particularly Proud of Our Mission

I have experienced a few particularly poignant moments which powerfully embody the critical nursing shortage in countries like Uganda and why TGF is here to do what we do. For example, the moment when I turned the corner in the maternity ward, or, "the factory" at Mulago hospital where I saw over a dozen women in active labor lying on the floor with no medical assistance. 60-80 births a day happen here with only a few nurses on hand. Watching these women, powerless, much like the overworked nurses, continues to be haunting memory. Today, left another indelible mark.

Daily at Butibika there are over 750 patients with each day bringing more. No one is turned away. All patients suffer from some form of mental illness with 15% being treated for medical conditions as well. Of the approximate 300 nurses needed to cover all shifts, there are only 90. At night they have to close the children's ward and bring them to sleep in one of the adult wards. One women's ward has an average of 70 patients but only 2-3 nurses a shift. These are just a couple of examples of the struggles this hospital faces every day. But the acute ward is where we were struck the hardest.

This ward holds the hospital's most ill. Many stay here until they are stabilized and until they are transferred to other wards. For obvious reasons, we didn't take pictures but I'll try to recreate the image that is searing in my mind.

We first walked through a heavily locked gate surrounding the ward and then up the walkway to what must have been a reception area. To the right was a large ward with dozens of empty beds. There were only a couple of patients in the room; one sitting in the far corner alone on the floor, and the other, heavily sedated. To the left, was one nurse standing next to a large tray of pharmaceuticals. Directly past her was a locked gate door leading to another room where there were a multitude of patients; clearly the ones meant for the vacant ward to the right. All were what clearly to me seemed to be severely mentally ill. Where there was an inch to spare, the patients clung to the gate bars, while the rest gathered closely behind. It was the time of day to dispense medications. To complete this task this sole nurse was left to her own resourceful devises. She had rounded up all the acute patients into one room and locked them in behind the gate door. Then she would let out each one, one by one, give them their medications, and then direct them to the other room. Amazingly, she seemed undaunted, even speaking warmly to one patient who was still standing by her side. As the hospital director pointed out to us, "She must be creative."

Now I don't want to mis-characterize Butibika. Her director and all the nurses and other staff are very dedicated to providing the best care. Each ward and the entire facility and grounds were clean, in order and the overall atmosphere, surprisingly calm. I can't tell you how or why. Somehow this place manages to pull off a miracle each day, and the nurses are key in this.

Days like this make me particularly proud of our mission...and nurses always, of course.

Visit to the Uganda Nurses and Midwives Council

Traffic and getting around continues to be an exciting experience. Just walking around means taking your life into the hands of boda bodas (motorcyclists masquerading as mass transit) and cars which along with the boda bodas don’t always respect the notion of a pedestrian and their place on sidewalks, such as they are.

While dodging near-death experiences, I saw a truck jam-packed with cows and people. The truck was so full that there wasn’t enough room for all the bovine limbs. We learned that the cows had traveled from far away, Mbarara, and were on their way to slaughter just a few blocks from the hotel. Well that did it for me. I’m going vegan!

We found a reliable cab driver who goes by the name Captain Bravo. Somehow his name seems appropriate.

We visited nursing’s regulatory body, the Uganda Nurses and Midwives Council (UNMC). The appointed Registrar, Mr. Wakida, was extremely informative and helpful. We met with him during our last trip in 2008. It is very critical that we keep him apprised of our work and collaborate with the council as we progress. His office is the vessel of all information nursing practice/nursing education and he gives us updates on what is happening in the profession. For example, we learned that the council has put together a consortium comprised of university representatives that will act as a think tank to discuss key issues in nursing education. It is not hard to see why we must stay plugged-in.

We had a wonderful lunch at a place called Ekitoobero which serves traditional Ugandan food. On lovely tropical grounds under massive trees we sat at a bench and ate yams, pumpkin, cassava, matooke (fried plantains,) beans, rice and a sauce made of ground peanuts and mushrooms which kind of looked like purple paste, but gave the matooke a much need boost.

We visited a school of nursing on Rubaga Hill but will report further when we tour fully next week. Tomorrow we will be touring more nursing schools and tweeting and providing further updates.

Bye for now.

Lack of Nursing Educators in Uganda

Well today was a day for ministry meetings…and would-be ministry meetings.

I had a very exciting meeting with Dr. J. Okou of the Ministry of Education and Sports. Ugandan Universities are under the umbrella of this ministry so they are very important to our work. We discussed in great detail government sponsored scholarships (not full scholarships) and how we can work together. There is particular excitement over partnering together to support the tutor (nursing educators in this case) program in Uganda. There is only one such program in Uganda and they have an average annual enrollment of only 20-30 students. This is a real problem.

The lack of nursing educators is the biggest bottleneck in nursing education here….and globally I might add. For example, the largest nursing school in Uganda has over 800 students but only 9 tutors!! I will be touring this school later next week. It is agreed that supporting this program is a priority for TGF.

Unfortunately my date with the Ministry of Health did not materialize. I can’t say that this is a huge surprise. It is not uncommon to run into challenges (more common than not) scheduling commitments here. I have plans to visit for another day.

Signing off for now...

Day One in Kampala

Today was a first of many busy days.

At 9:00 sharp, we toured a new hospital called CoRSU which is 20km outside Kampala. It specializes in orthopedic and plastic surgery. We met a great crew of dedicated workers from the admin Irene to chief nurse Joy, to Michael, potentially our next new Gretta Scholar. They toured us throughout the facility and I must say that it surpasses anything that we have seen touring any hospital in Uganda to date.

We met many babies that suffer from birth defects such as cleft palates to club feet to injuries such as burns. It is heart breaking to see a baby malnourished because it can’t feed adequately from its mother’s breast or see a small child wrapped in bandages with missing fingers due to severe burns. Wounds are sometimes slow to heal and bone infections are everywhere. Some wards are dedicated to septic patients alone.

I was particularly touched when meeting a 17 year old girl named Barbara. She has cerebral palsy. She has been neglected most of her life because her mother is weak from AIDS. Her father died of AIDS so the mother is taking care of the family alone and she is overwhelmed. It was Barbara’s little sister, only 15, who sat by her side at the hospital. Barbara is there because she developed bed sores and no one at home is able to attend to her adequately. The nurses at CoRSU are not only providing loving care to Barbara, but teaching her sister how to care for her as well. Although Barbara can’t speak, her lovely spirit spoke volumes to me. We spent a few minutes passing a piece of red plastic back and forth. This random object was precious to her and she seemed to want to interact and play with me. No one knows what her chances are, but at CoRSU, they are doing their best.

They also showed us the morgue and were proud to inform us that it was empty and they were determined to keep it that way. I left feeling intense pride in the personal care the nurses and doctors gave there. They introduced me to each and every patient by name. What a testament to their commitment.

The afternoon was spent with our friends taking care of business at the International Health Science University (IHSU). Dee (Vice Chancellor), Dorothy (Finance), Evelyn (Registrar), and Gerald (Head of SON) are key to the success of our work in Uganda. IHSU is the home of our 5 Gretta Scholars. We will have more to report on the scholars and the crew‘s work on Sunday when we meet again. But I continue to marvel at the personal investment that they make with the scholars. They attend to their needs like they are their own children.

It is evening again and time to get ready for tomorrow.

Good night from Kampala.

Day One in Uganda

Well we finally made it safely. It was late at night when we arrived and we had the thrill of another harrowing drive from Entebbe(airport) to Kampala. This kind of driving is for adrenalin junkies only. Thank goodness we weren’t driving.

If you can imagine, there are virtually no street lights except in the city centre so all headlights are blinding. That wouldn’t be so bad if it weren’t for the hundreds of people who walk along the roadsides only inches from the cars. And then there is the head-on traffic which are the impatient many who pass from the other lane, blinding you further so that missing the persons walking seems more like a game of Frogger. It is a real E-ticket ride. Approximately 50% of all hospitalizations at the injury clinics are from traffic related incidents. I can believe it.

The streets are really something to see. They bustle with people coming and going and hanging out at the multitude of small businesses which aren’t much bigger than shacks. Most are only lit by a single candle. Businesses range from meat shops, cellular minute stores, barber shops to bars (“bottle shops”). Who would think that there would be so much need for a haircut so late at night. The bottle shops are very busy too; large or small, candle lit or electrified; they are filled with people.

We have a busy day tomorrow, so off for much needed rest.

Goodnight from Kampala!

Off to Uganda - Stopover in Amsterdam

Our founder, Meg Styles, left on her journey to Uganda yesterday. Here's day 1's journal entry...

Janet Pinto, a faithful TGF friend and supporter, and I left SFO yesterday afternoon. After a long but easy flight, we have arrived safely in Amsterdam for an overnight layover. I took the opportunity to do one of my favorite things; walk for miles exploring a new city. Amsterdam is beautiful and exciting and I look forward to coming back one day and giving it the time it deserves. The streets are packed and Amsterdam's many cafés spill out onto every sidewalk. Evidence of the holiday season is everywhere. As you can see from the picture, the streets are littered with lights.

I made sure that this day included a visit to Anne Frank's home. It was a somber visit and a very powerful experience. No one should visit Amsterdam without visiting this place. Anne was a brave and beautiful girl. It is right that her memory lives on in this way.

We leave tomorrow for Uganda. Until then, good-bye!

Meg Styles

Our Mission

The Gretta Foundation’s mission is to provide in-country nursing education to impoverished persons living in disease-burdened nations while bolstering depleted healthcare workforces and improving patient care and outcomes.

About The Global Health-Care Worker Shortage

Healthcare shortages affect everyone, everywhere with critical shortages equivalent to a global deficit of over 4.3 million doctors, nurses, and other health-care professionals.

Nowhere are these conditions more evident than in Africa. According to the WHO World Health Report 2006, sub-Saharan Africa has 24% of the global disease burden but only 3% of the health care workforce worldwide and 1% of the global health expenditure. Where the need is most dire, the health-care resources are nearly nonexistent.

Exacerbating the health-care crisis is a problematic trend of the nursing “brain drain.” Due to higher pay and better workplace conditions, many skilled nurses are migrating from disease-burdened countries to more industrialized countries in the north. As a result, the loss of this essential human capital gravely affects health-care availability and patient’s quality of care.

Always more information on our website too...
http://grettafoundation.org

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