By Patty Huston-Holm
Four plastic cups of passion juice. Several crumbling, miniature queen cakes. Bananas. Two melting strawberry and vanilla ice cream cones – a relatively new treat on the Uganda Christian University (UCU) Mukono campus. Laughter.
For 15 of the university’s year-four nursing students, that’s how the ride in a burgundy and white bus in central Uganda’s scorching heat started.
Loosely called a “community visit,” this weekly trek supplements learning that takes place in classrooms and laboratories on the campus. The trips into remote villages enable students to see the practical side of health care in their final months before graduation. In years one, two and three, the book, lecture and Internet knowledge have been complemented with real-world experiences in hospitals and health centers.
Previous real-world experiences have included conversations with traditional healers and professionals dealing with mental illness and observing circumcision and critical care of accident and HIV/AIDS victims.
On this sunny, February 2020 pre-COVID-lockdown day, the student nurses and Elizabeth Nagudi Situma, UCU head of nursing in the School of Medicine, travel on bumpy, dirt-rutted roads 45 minutes away from the main campus. They serve and learn in village of Nakoba – an area too remote to be found on a map. With guidance by Situma, students listen, observe, record and advise two residences each at various locations within an approximate one-mile radius.
“I think it was more than worms,” student Nankya Brenda Diana said about one child’s protruding abdominal area. “When you push on the stomach, it feels like an organ or something out of place.”
Normally, she said, a child’s extended belly means intestinal worms. They contract them from uncooked food, walking barefooted among cattle feces or eating dirty mangoes. In her kit, she has mebendazole, a drug that she can provide to eliminate worms. The better resolution is prevention through proper sanitary practices. This time, however, Brenda is not so sure that the stomachs of a two-year-old and her four-year-old brother are filled with worms. She puts her suspicions in her report.
The mother, Helen, has six children, including two sets of twins. Giving birth to more than one child at a time is a much-esteemed blessing in Ugandan culture. In addition to discussion of hygiene related to chickens that roam freely in the family’s cooking and sleeping areas, a rudely constructed rain water pipe and lack of dedicated space for the household’s bathroom habits, Brenda is ready today to discuss family planning. Steven, the husband and father, is there to get advice, too.
Brenda, wearing a backpack and holding a clipboard, talks to the family in their Luganda mother tongue. Helen sits on a single stool, nursing the baby, as Steven and their other children, barefooted in torn and dirty clothes, lean against trees near their humble home. Across an unpaved, dirt road are more than 20 gravesites, signified by a few stones but mostly by rounded mounds of dirt.
Roughly a half mile away, John Damasen Ntwari has his second weekly meeting with Niyonsaba, a mother of seven who, along with her husband, escaped here from Burundi ethnic disputes in 2015. They are Tutsi who fear death still today from the richer, more powerful Hutu. In broken English, she explains that they want to go back someday. But the time is not yet right.
“I am very happy to see John,” she says. She shares that her family is better off than most with two children enrolled in school. While her young daughter smiles broadly, Niyonsaba says her problems with allergies and a weak heart seem less than John’s last visit and the daughter has healed nicely from a vaginal repair.
John, who is president of the nursing class, scribbles notes as walking to his second site. There, 15-year-old Nabaweesi Zakiah emerges. As when John previously visited, she’s alone. Again, in clear English, she says her mother is away “just one day to visit a friend.” When she returns with school fees, Zakiah can return to school.
Situma emerges and deepens the questioning about what the girl eats, if she is alone, if she is afraid at night, and if anyone hurts her. She praises the surroundings that include a vanilla plant and trees plentiful with bananas and jackfruit. Zakiah carries a large knife to a tree, cuts down some matooke and carries it back to her small living quarters. A dog, kitten and chicken with babies scatter.
“It’s hard to know,” John said. “I’ve asked that her mom be here today, but she still isn’t. Maybe next time.”
For most of the UCU student nurses, including Brenda and John, the desire to work in health care stems from a young age when encountering a void in medical attention for a family member. In addition to this motivation, there is a government promise of a paid job for at least one year after graduation. They are placed around the country with a 750,000 UGX ($200) a month salary for 12 months.
Seat backs filled with ready-to-eat avocados. Fingers dipped into large, freshly opened shells of sweet jackfruit. Some laughter, but mostly vocalized thoughts about the conditions, causes and remedies for health maladies. That’s how a February six-hour day – but not professional careers – concluded.
“Ultimately, I want to work in cancer care,” John said. “But I’m prepared for anything.”
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