Our Side of the Story - Ugandan health workers speak up - VSO

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Our Side of the Story: Ugandan health workers speak up Reasons for becoming a health worker: the “right heart” and the “wrong heart” Participants explained what prompted them to become healthcare professionals. The urge to help, prevent suffering and save lives stood out. The overriding impression emerged of a heartfelt desire to ‘make a difference’ as a nurse, midwife, clinical officer or medical doctor, rather than merely to earn a living. It is a mark of their professional commitment that almost all participants said they would still choose to become a health worker. Participants observed that some people joined the health professions, notably nursing, for the “wrong” reasons. This, in their view, was one explanation for poor attitudes and unethical behaviour, and they put forward suggestions for improving the calibre of recruits. The recommendations also include other stakeholders’ views. A passion for the patients For many health workers, the strong need to give to others was born of childhood experience. It had been common in rural areas to see close family and members of the local community suffer and die in pain, with no proper medical care. Participants recounted how siblings and parents had died of mysterious illnesses that, they later realised, were due to preventable epidemics or treatable with modern medicine. Training as a nurse, clinician or medical doctor would bring to the community essential knowledge to help prevent illnesses, discourage harmful traditional healing practices and save lives: “They were really suffering, people were dying, there were no doctors, no nurses, nobody to give them an idea about their health. I wanted to help my people.” Others spoke of atrocities in conflict areas and the need for medical skills to rebuild communities. Health workers spoke warmly of positive experiences undergone when they or family members were in hospital. The gentle and caring touch and the healing words of nursing staff left a lasting impression. They wanted to be that person, to give in that caring way, to stop others’ pain. Growing up, they learnt how the skills of the medical staff had saved the life of someone close to them, or even their own life, and they wanted to give something in return. Some were encouraged by a parent who, gratefully remembering a midwife, urged that their child become a midwife too. Not all impressions were good. Negative experiences of healthcare services fuelled a desire to raise the standard of medicine in Uganda. Young men and women said they felt compelled to join their professions because they believed that professional neglect had contributed to the deaths of a parent, siblings or a newborn baby, or because they perceived the limitations of Ugandan medical expertise in the face of a life-threatening condition. Unsympathetic handling prompted a wish to improve the quality of nursing, and the shouts of women abandoned in labour evoked a desire to help. Women spoke of only ever wanting to be a nurse from as early as primary school stage. They saw themselves as naturally kind, a helping sort of person, with an urge to relieve suffering: “I just had it in me,” or “I had that heart.” Some women found they “developed the heart” as young adults when they had to nurse a family member. Not-for-profit sector participants especially cited a desire “to love and serve the patients” or “to care for the needy”, spoke of coming “closer to God” or explained they had “a call” or were “chosen by God”. Health workers emphasised giving, and spoke less about what they had expected to gain from their profession, though the prospect of knowledge to care for and treat one’s family and oneself was important, especially among lesser-qualified women in rural areas. Nurses’ happiness when a patient recovered was mentioned, as was the respect people gave to a local nurse. The nurse had status as a life saver, a person of importance to call on in an emergency. Young girls who went on to be nurses had been greatly attracted by the dress and deportment of nurses, their smart, clean uniforms, shoes and gloves and the way they walked, which set them apart from other people. Among would-be medical doctors there was some admiration of smart white coats and acknowledgement of the prestige attached to being a doctor. Financial gain was not a driving force, though earning in a steady job was certainly a better option than ‘digging’ in vegetable gardens and relying on uncertain harvests. In the most remote rural area, the health facility was the only source of training and employment locally, and so a magnet for school-leavers. 10
Our Side of the Story: Ugandan health workers speak up For most participants, the decision to become a health professional was positive and informed. Time spent at hospitals or health centres – as a patient, relative of a patient or just as a curious child allowed to sit with nurses – had shown how nurses worked with patients, and helped stimulate an interest. Empathy for patients sometimes developed when ‘touched’ by their condition. Having a father, mother, sister, brother or aunt in a nursing or medical field gave some insight into the work, through visiting their place of work, living in staff quarters or listening to their accounts of day-to-day happenings. A close relative’s positive attitude, humility or empathy for patients attracted young women to nursing. For many of these participants, the example of their relative was the main reason for entering a nursing or medical profession. With little career guidance at school, it was natural to do what members of the family were doing. Others were expected by their family to take up a profession and saw health work as a more appealing option than teaching, secretarial or business occupations, even rebelling against fathers who insisted on a teaching course. Some older participants had been encouraged by adults at school or family friends, such as priests and nuns, to apply for a medical or nursing course. Others from that generation had been recruited to nursing by agents of the Ministry of Health, or had followed family wishes or suggestions in complete ignorance of what nursing involved. Clinical officers and medical doctors told of expectations on them as the brightest school students to enter one of the prestigious professions. Engineering and medicine were the prime alternatives if they excelled in science subjects. So the path towards medicine could be set in early years when top students were pushed towards sciences. Faced with a choice of career direction, financial security was something younger men had taken into account, in the context of many qualified professionals chasing too few jobs: “At least you can always find a job.” But nobody said they joined the nursing or medical profession purely for that reason. Among doctors, the choice of medical training over another sciencebased profession was in some cases influenced by the prospect of professional advancement and mobility, self-employment and private practice. Not all those who had decided on a career in the medical field entered via the course of their choice. Lacking financial backing from their families, uncertain about getting the grades, or failing to gain entry, would-be medical doctors had to settle for clinical officer training or a nursing course, and aspiring clinical officers became nurses. It was sometimes hard at first to accept a substitute course, especially when other people said nursing is for “failures”. “They join for the wrong reasons” There were widespread beliefs among nursing and midwifery professionals that poor attitudes and unethical behaviours are linked to joining nursing for “the wrong reasons”. It was thought that more recent recruits joined because they had no other option, because nursing was a last resort when they failed to qualify for more prestigious professions or because parents pushed them into it. Pursuing pay, looking only at the job market and even aspiring to leave the country were other presumed reasons for joining nursing. Older nurse managers had noted “very few nurses come with a sense of vocation now.” There was a widespread view that people enter nursing with “the wrong heart”. It was believed that as a result, unhappy, disinterested and self-serving recruits resort to bad habits, become rude and forget their ethics and accountability to patients. There were also some comments by managers about medical doctors’ questionable attitudes to work when they seemed to lack that “inner drive”. Yet more than one nurse, and also a medical doctor, said they came to love their profession only when in practice. A story was told of how a lecturer inspired an enthusiasm for nursing in a student whose sole ambition had been to train as a doctor. Indeed, some of those most critical of motives for joining were staff who had developed an interest in their profession after they started work. Participants’ recommendations include: • career guidance for school students and arrangements between schools and health facilities for work experience • tighter admission procedures for nurse training, to probe reasons for applying • improvements to standards of nurse training schools, including more and better-quality tutors, smaller class sizes and more attention to the practical application of professional ethics • integration of health and human rights training into the curricula • improvements to the community-based education component of pre-qualification training • the establishment of more training schools in rural areas, to produce health workers adapted to rural lifestyles and bind health workers to the community • a review of the value of the Nurses and Midwives Council registration interviews. 11
Page 1 and 2: Coalition for Health Promotion and
Page 3 and 4: Our Side of the Story: Ugandan heal
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Page 36: ISBN 978-1-903697-13-9 9 781903 697

Our Side of the Story - Ugandan health workers speak up - VSO

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