Four UMECS Nursing Students:
Determined to Change Community Health Conditions
When they were in primary school, Jenifer Rose Idilet, Kevin Aujo, Annet Adie and Vivian Agik dreamed of going to nursing school to become nurses. When they were in secondary school sponsored by UMECS in the Northern Uganda Education Programme, they set academic goals to qualify for admission to nursing school. Earlier this year, they reached their goals, having qualified for and been admitted to nursing school. On Wednesday 20th November 2013, their dreams came true. Continuing their educational journeys under UMECS sponsorship, Jenifer, Kevin, Annet and Vivian registered at Gulu School of Nursing and Midwifery, a fully accredited residential nursing programme.
I Want to Heal and Help in My Community
Jenifer details the need for more nurses in her community and sub-region. “There are many diseases in my home community that require more nursing professionals. There are few nurses in some hospitals yet the patients are many.”
Expounding on why she wants to devote her life to the sick and to improving health conditions, Jenifer explains: “The helping heart. I want to help the people who are sick. I want to heal and help in my community. Nursing has huge impacts. I want to go into general nursing for community health transformation. I want to be ready to serve at all times.”
If Women Are Not To Die
Kevin is particularly concerned about maternal health: “There is a gross need for nurses and midwives. When you go to the hospitals, the ratio between patients and nurses and midwives does not meet the needs of patients leading to many maternal deaths. There is a great need for more nurses and midwives in my community and throughout Uganda if women are not to die in hospital simply because they are delivering a child.”
His Death Motivated Me to Become a Nurse
Annet is equally clear about her mission in life: “My life-long dream of becoming a nurse started a long time ago. I was driven by one goal, one vision of helping others and saving lives which started when my uncle died of a simple, treatable disease. There was nobody to treat or nurse him. His death motivated me to become a nurse so I can save lives and prevent people like my uncle from dying needlessly.”
“In addition to nursing, I want to train as a midwife because I have witnessed many pregnant women in Katakwi (her home district) dying during labour due to lack of experience in the field. Women are getting pregnant every day, people are falling sick, and accidents are occurring yet there are not enough nurses and midwives to care for the pregnant, the sick and injured.”
The Multiple Roles of a Nurse
Vivian sees the role of the nurse as multifaceted. “The nurse must be able to offer counseling to patients and community members. Nurses must be caring, loving and kind. We must be able to diagnose, advise and treat patients. We must know how to make referrals and consultations. We must know how to educate and sensitize our communities. We must encourage people to use condoms or practice abstinence to prevent sexually transmitted diseases. Nurses have significant impact in contributing to the health and welfare of the community.”
Health Conditions in Uganda
Uganda, a landlocked country of 33 million people is bordered by Kenya, Tanzania, Rwanda, Democratic Republic of Congo and South Sudan. 87% of the people live in rural areas, the majority of whom depend upon subsistence agriculture for their livelihood. The risk of infectious, water borne and vector borne diseases is high. The rate of malaria is one of the highest in the world and is a major factor in the high infant mortality rate. With a low contraceptive prevalence rate and high fertility rates, Uganda’s maternal health is among the worst in the world.
Despite the need for more healthcare infrastructure and improved efficiency and performance delivery, Uganda’s healthcare system has demonstrated strengths. Uganda is one of the rare HIV/AIDS success stories in the world. More than 30% of Ugandans were HIV positive in the 1980’s as HIV/AIDS spread silently throughout East Africa. The Government of Uganda took on the challenge and through a series of smart policies and effective implementation, reduced one of the highest double digit HIV/AIDS rates in the world to an approximate 6% national average by 2008, considered the most effective response to the AIDS pandemic among all African countries. People have faith that with this track record, Uganda can vastly improve its healthcare system at every level.
Government expenditures on health have increased steadily, almost tripling since 1995 and overall, the government has adopted a pro-poor approach to health care performance delivery including the elimination of user fees. However, there is considerable inequity in health care outcomes across regions, sub-regions, rural and urban divides, districts and socioeconomic classes in terms of life expectancy rates, infant, child and maternal mortality rates, and access to quality health care.
Most people, especially those who are poor, who use health care services, clinics and hospitals in Uganda generally experience highly committed, hardworking health care professionals usually working in the most difficult conditions of high patient ratios, overcrowded facilities, inadequate diagnostic equipment, and shortage of medicines and medical supplies.
In the conflict-affected Katakwi communities of Teso sub-region where Jenifer, Kevin and Annet are from, and war-affected Amuru district communities in Acholi sub-region where Vivian is from, healthcare conditions and services are on the low end of the scale.
There are shortages of doctors, nurses, midwives, technicians and medical specialists. Diagnostic equipment is limited. Many life-saving medicines are unavailable through the health services and have to be purchased privately by community members living in extreme poverty.
The twenty year Lord’s Resistance Army (LRA) war in Northern Uganda that ended in 2006 damaged much of the health care infrastructure in Vivian’s communities. In addition, the war and displacement of two million people to overcrowded, disease-ridden camps deteriorated the overall health of Northern Ugandan communities, increased alcoholism (in a country with one of the world’s highest alcoholism rates) and spread HIV/AIDS to approximately 12% in many Northern Uganda communities.
Likewise, the spillover from the LRA war into Teso sub-region combined with generations of violence and displacement from neighboring sub-region cattle rustling damaged public health conditions of Jenifer’s, Kevin’s and Annet’s communities through increased alcoholism, poverty and violence and spread infectious diseases including HIV/AIDS.
As rising nursing students determined to change healthcare conditions in their communities and serve in a healing, helping profession, Jenifer, Kevin, Annet and Vivian have their work cut out for them. Over the next three years, until their graduations in May 2016, we will keep you updated on their progress in nursing school and thereafter, on the impact they will have as nurses in their communities.
Jenifer Rose Idilet
Born on the 6th of May in 1992, Jenifer, who is from Ooloin village, Achanga Parish, Katakwi district in Teso sub-region in Northeast Uganda was the first-born of eight siblings. “I grew up with my aunties and uncles. My childhood was difficult in terms of feeding, accommodations and education.”
Her childhood was filled with violence borne of generations of cattle rustling and raids from neighbouring Karamoja sub-region. Karamajong warriors have been raiding into Teso sub-region to the west and across the Kenya border to the east for generations, raids that historically grew from colonial policies that stripped the Karamojong of their most fertile lands. Over the years, climate change contributed to degrading the environment, turning once arable grazing land into semi-arid areas. In contrast to the pastoral economies and lifestyles of the Karamojong, iTeso people are mostly subsistence farmers, agriculturalists, and grow crops such as sorghum, millets and cassava with cattle supplementing crop production. Colonial policies led to conflict between these two sub-regions. Unreconciled grievances and insufficiently addressed environmental and economic issues following Independence in 1962 continued the conflict between the iTeso people of Jenifer’s communities and the Karamojong. Women and children in both sub-regions suffered the most. Jennifer’s childhood was filled with anxiety, fear and violence. “My childhood was filled with cattle raids, even killings. We lost lives and animals to the rustlers.”
Environmental degradation in Tesoland led to flood and drought – and famine. Jenifer experienced hunger and malnutrition as a child, along with many other children and community members. She also suffered from sickness, including typhoid and kidney infections.
When she finished primary school, she wanted to continue with her education in secondary school. Despite the fact that in her community, many girls are forced by their families into early marriage – an aspect of community culture she would like to see changed – her family was supportive of her going on to secondary school but there were no family resources to support her goals. To her amazement, shortly after she received the disappointing news, “UMECS came to my community in January 2007 and I was selected to be sponsored in the Northern Uganda Education Programme.”
UMECS sponsored Jenifer and a cohort of eleven girls from Katakwi in St. Mary’s Girls Secondary School, Madera, Soroti in her four year O-level secondary school programme, then at Soroti Community Secondary School for her A-level programme.
“I am thankful to UMECS for sponsoring me in secondary school and now nursing school. I have been blessed. I will do my part when I have completed the programme. There are great healthcare needs and diseases in my community such as malaria, HIV/AIDS, maternal and child mortality, nutritional deficiencies and malnutrition. As a nurse, I will be trained and prepared to treat disease and prevent disease.”
“In addition to my nursing duties, I will be prepared to effect change by advising girls to avoid early pregnancies and early marriage and advise parents to practice family planning. Every population segment in my community needs healthcare information. I will be a role model as UMECS staff are role models to me. As a role model, I will try to make change in my community.”
Kevin was born on 3rd March 1992 in Mayuge district in Busoga sub-region. Her parents and ancestral roots are in Apeleun village, Kelim parish, Ocwiin sub-country in Katakwi district. She is the third-born of ten siblings. Her parents are subsistence farmers.
In 2004, when she was 12, her family returned to Katakwi, to their ancestral village, Apeleum which due to cattle rustling and raids from Karamoja, had become an Internally Displaced Persons (IDP) camp. Life was challenging – inadequate housing, food and clothing – but her grandmother, “my first heroine,” encouraged her to stay focused on performing well in school. “Study and luck may come to our village,” she would tell Kevin.
“Luck” came to her village when UMECS came to her community in January 2007. Charles Onencan, then UMECS Outreach Coordinator, now Executive Director, led UMECS team that selected Kevin, Jenifer, Annet and eight other girls from Katakwi to enroll in St. Mary’s Girls Secondary School in Soroti. Their lives have all transformed through education.
Kevin completed both her O-level and A-level secondary school programmes at St. Mary’s Madera, completing her Senior 6 in 2012. On November 20, 2013, having qualified for admission, Kevin registered for her nursing programme at Gulu School of Nursing. She graduates in 2016.
Kevin is a strong advocate for the education of girls: “I see the challenge of early motherhood and I see women being battered and beaten and I feel if they were educated, they could have avoided these situations.”
She first started thinking of nursing when she was a child. “My mum became sick and was taken to hospital for a blood transfusion. I was there with her. The nurse was very harsh to her and the other patients. I felt if I was a nurse, I would be kind to patients.”
Later, Kevin became conscious of the overall condition of girls and women in her community: held back from being educated; forced into early marriage; victims of violence, poverty and maternal mortality. She became convinced that girls must stay in school and become educated (her mother completed Primary School Grade Four).
She also realized her community needed nurses, midwives and advocates for girls and women.
“UMECS is an organization that made me who I am today. If it was not for UMECS, I would be rotting in the village. Mum told me to stay in school, my aunt told me to stay in school, my grandmother told me to stay in school but they had no means for me to do so. They kept me focused until UMECS came along. They are my role models. UMECS is my ‘way-paver.’ “
Says Anthony Ojok, UMECS Education Field Coordinator, a former classroom teacher and head teacher: “It makes us proud that we can support the educational journey of Kevin and young women like Kevin who will change their community’s health and improve the condition of women. I am proud to serve as Kevin’s mentor, advisor and educational coordinator. It is the Kevin’s who change the world.”
Annet, whose ancestral village of Ameritele is in Askum parish, Usuk sub-country in Katakwi district, Teso sub-region was born on 28th October 1991. She was born in nearby Akobai village where her peasant farmer parents took refuge due to the frequent Karamojong cattle raids in her ancestral village.
“Life in my village was not okay because the Karamojong would come to raid cattle. Sometimes they would kill, loot property, rape women and young girls, making the village very insecure, hostile and so vulnerable.”
“We grew up learning a lot of cultural stories, norms, values and the culture of our community. My mother was a good example for me because she was a very decent woman in our community. I take my parents as role models because of the cultural and traditional education they instilled in us. I will also continue the tradition and teach my children the same cultural values my parents taught me.”
As one of 16 siblings, Annet wants to raise only 3 children. “My mother has already produced enough. If God does not give me children, then I will keep other children, especially my sister’s and I will also adopt other children even though they are not my relatives, to keep and take care of them the same way UMECS did for us.”
Like her colleagues, Annet is a strong believer in education as a means to cut off syndromes that deter human dignity and gender equality: “The community I come from discourages the girl child from education. Some of them look at girl child education as a waste of time. Many such people have told me to stop wasting my time studying. Instead, they say I should get married. Sometimes the men ask for my hand in marriage. I simply refer them to my Dad and they do not disturb me again.”
“I joined UMECS on 26th January 2007 and went for my ordinary (“O”) level at St. Mary’s Girls Secondary School Madera in Soroti and Soroti Community Secondary School for my Advanced (“A”) level respectively. I am excited about my nursing programme because I will be saving lives and helping people. I am expecting to finish my programme and graduate in May 2016.”
“UMECS staff became my role models because they mentored, advised, encouraged and counseled me to work hard, providing scholastic materials, transport and paying my school fees from S.1 all the way to my nursing programme which they are now sponsoring. I received mentoring, counseling and career guidance from UMECS staff whenever they came to visit us at Madera (Soroti) during our “O” Level and Soroti Community Secondary School during our “A” level. UMECS made me what I am today.”
“Education has transformed me in many ways. I can now write, read, speak English. I can communicate nationally and internationally and in this part of the country I can never get stranded because I am an informed person. I made so many friends from my primary, “O” level, “A” level. I became UMECS family member and I know so many brothers and sisters in Acholiland. I have visited many districts like Gulu, Lira, Oyam, Soroti and Kumi.”
“Education has opened my eyes to see the past, present and envision the future. I strongly believe that I will be able to own a decent home, get married at my will to the person I love and be able to help others.”
“In my village, I am the secretary for finance in the Village Savings Association because of my education. I also used to translate English into Ateso in the community church services. Education has also improved my confidence level, my comprehension skills and vocabulary. It has given me hope and courage to speak with anyone in my community, something which I used to fear.”
“I aspire to be a nurse who makes a difference with patients and my community. For me, a good nurse has certain traits. A good nurse should be a person with a caring heart. A good nurse does not segregate anyone. A good nurse is disciplined. She should have good communication skills. A good nurse is willing to work at any time. She should be a person who has positive feelings for others. A good nurse should be a person who looks at work as a service but not in terms of what he/she is going to earn in terms of compensation. A good nurse is a person with a yearning to help others.”
“I see the impact of a nurse in the community as a person who can save lives, provide services to people, help women who are pregnant to stay well until they deliver a baby, provide counseling services to people, prevent the spread of diseases and above all, give hope for people who have lost hope.”
“Nursing is a lifelong career and my family and community feel good about me doing a nursing program.”
“UMECS organization has contributed diligently to our educations and given us hope and a future. I come from one of the poorest backgrounds (Katakwi district) of which most of the community is illiterate and was displaced to the IDP camp due to violent raiding of livestock of the Karamojong for more than 40 years.”
UMECS staff has taught us peace aspects of forgiveness, reconciliation, dialogue and caring for others. From these lessons, I learned to respect everybody from my village. Even if somebody is harsh with me, I will not reply in the same violent tone because my mission is to help create a peaceful environment.”
“UMECS keeps their word and promises to the end. We talk face to face like equals. UMECS is a genuine organization which can be depended upon.”
Born on 14th August 1993 in Langeta village, Pawel parish, Attiak sub-country in Amuru district, Northern Uganda, Vivian Agik is the 4th born of 8 siblings. She grew up with her parents and her aunt, Anena Christine.
“My community where I grew up in Pawel was kind and hospitable and believes all children who are school age should be educated including the girl child. In primary school, explanations are conducted in Luo language because of the composition of the people in that area. My community was engulfed by war which made my childhood more difficult”
As a child growing up in Pawel, she was plagued by problems with her legs which made it difficult to walk. A cousin investigated her condition, found a recommended medication and brought it back to her village. The medicine helped but her condition persisted. Eventually, her legs healed and she could walk long distances. This started her thinking about the role of health care in her community.
Vivian joined UMECS as a sponsored student from Amuru district in 2008 and was enrolled with a cohort of students at Gulu Senior Secondary School for her “O” level programme. She completed her “O” levels at Gulu Central High School.
On 20th November 2013, UMECS continued her sponsorship in Gulu School of Nursing and Midwifery, together with her UMECS colleagues Jenifer Rose Idilet, Kevin Aujo and Annet Adie. She is eager to excel in nursing school and embark upon a career as a health care professional in her community.
According to Vivian, the health care needs in Pawel are extreme, and broad-based:
“The spread of diseases is increasing resulting in higher death rates. Treating sickness needs concerted efforts and skilled health care professionals and they are not there in sufficient numbers. Many health care personnel are inadequately trained. There is a lack of medicines and a lack of ambulance transport for emergencies.”
“There is a need for more trained nurses, more midwives, more medical supplies and equipment in the health centers.”
“There is especially the need to sensitize the community around health issues and to provide counseling including in the remote rural areas.”
“The youth are the most vulnerable as they are in danger of contracting HIV/AIDS. There should be provision for counseling in the community and community meetings and community radio to sensitize and educate. Many people in the community do not bother to go to health service centers.”
How does Vivian see her role after she graduates from nursing school in 2016?
“I see nursing as my lifelong career. As a trained nurse, I will be posted to a health care center in my community or in some other relevant capacity. As a nurse, I will be helping to heal the sick and helping community members prevent diseases. I will counsel and advise patients and also community members.”
“I hope to encourage more girls to consider nursing as a career. Part of my role as a nurse in my community is to serve as a role model, especially to the girls and help them see it is possible to become a nurse.”
“I will also encourage traditional birth attendants in my community to provide basic care to pregnant women and help during labour until the nurses take over. This will help reduce maternal mortality.”
“I see the characteristics of a nurse as someone who keeps confidentiality of patient information, has the trust of her patients and is caring. She makes regular check-ups of her patients because she is part of the patients’ community.”
“I also want to conduct research on diseases in my community. Many people become sick and sometimes the cause of the diseases are not known. Uganda needs nurses to help overcome the prevalence of disease and also to conduct research to prevent disease. I plan to be that kind of nurse.”
“UMECS started sponsoring me in 2008. UMECS staff are supportive and committed to their work. I am grateful for their support because my parents were unable to pay for my school. Because of UMECS, I became educated and confident. Now I am becoming a nurse. Without UMECS. I would have by now been married.