Today, May 3 was the second of a two day workshop put on for the Kibaale Community Clinic staff…..

I really do not know where to start but at the beginning….. the second day of my work in the clinic, I was shanghaied into a meeting with 6 of the 11 clinic staff…. they informed me that there were two problems which needed to be resolved immediately. The first was the fact, the nursing staff were not being paid the same salary as the nurses in the nearest hospital, Rakai. The second issue was that the PHC fund was not suppose to go through the accountant but go directly to them and avoiding the money being double taxed. Well, only one of the 6 was a nurse.

Over the next few weeks, I had one nurse do all the research…. he was given money and time to find out the truth. He was able to obtain a copy of a Rakai employed nurse’s pay stub. He thought it showed the fact the staff were not being paid the correct amount BUT Master Peter, Kibaale Community Centre director and Madame Samalie, the clinic administrator corrected the miss information and showed them that they were paid the appropriate amount. What a surprise!!!!!!!

During that same time….. I learned that PHC fund, Primary Health Care fund is a set amount of money given to the clinic by the Government of Uganda for outreach…. vaccinations and immunizations. For some reason… the past few cheques have been given to our accountant, Mark, who deposits them and then hands out the money accordingly along with removing the required taxes. But after much discussion and lots of confusing information…. I traveled to Rakai along with a nurse and Madame Samalie to discover the truth…. we were told what the money can be used for, how much each person is to be paid and that when the money runs out… it is up to the clinic as to where the employees get paid for any additional work. Somehow, the nurses expected to be paid the amount required through the PHC fund for all out research. So, 4, 5 and 6 people would go out expecting to be paid the PCH fund requirement. The fund now comes through me as of the first of April and there is a limit to how many can go out.

Theses were the issues most urgent to the staff…. money.

The second Friday, I was in Kibaale…. at 3:30, I was given a two page list of medications and told I must go immediately to Kampala and buy these medications. It was a demand, I was confronted by the three nurses and told that these medications were needed urgently. I was told I had to go right then and there to Kampala….as they were pushing me out the door. I was confused…. a list that long was required immediately. Nothing in me said I needed to go…. but what was going on. I took a big step into the Pharmacy to discover the room was a mess… boxes atop boxes, there was no order and with that I was convinced that I needed to clean up the room and put it into some order before we could possibly know what medications were needed…… as I was walking slowly out the door…. I remember the receptionist opening the store room door for some cannulas (IV catheters). So, I asked for the key… and waited and waited. Finally, I opened the door to discover the room was filled to the ceiling with unopened boxes of medications.

The only help I received was from Madame Samalie who kindly offered a few of the senior students to help me take apart the Pharmacy and Store room…. open up more than 150 boxes of medications and put them in alphabetical order. All the medications were counted and recorded….. I now count or do an inventory of each medication weekly. I would love to give this job to one of the nurses but….. the four days I was gone to Queen Elizabeth Park…. I returned to discover a large number of the IV antibiotics missing…I put someone in charge but she got very busy and passed the keys off to the other nurses…. I was told the clinic was extremely busy BUT the records do not support that fact.

I discovered the receptionist (with no medical experience) was giving the vaccinations during one of the outings while the two nurses sat and did the paper work. I also discovered the same receptionist taking blood in the lab while the techs watched. No one thought any of her actions were wrong….. she was fired.

IV catheters or cannulas are put in by nurses without cleaning the skin nor washing their hands…. in fact patients are discharged into the community with cannulas still in place…. taped over to keep them closed. Everyone tells me that this is wrong but it continues…. why? I do not know. WE DISCUSS, IN FACT THEY TELL ME ALL THE REASONS IT IS WRONG…. BUT THERE IS NO CHANGE.

Nurses tell me one thing and do the opposite. I stop them and ask them why and I can a variety of answers…. but mostly it is easier to do the same… it will be very upsetting to the patients.

There is so much more than can be said…. but each time I think about them my blood boils…… I get so upset that these nurses who are trained refuse to follow the guidelines and principles of nursing practice. They say one thing and go on doing what they want.

So…. back to the two day workshop….. May 2 and 3. The first day was for Master Peter, the director, who spoke about the mission statement for Kibaale Community Centre and clinic….. it is to do excellence….that each of us must be a Christian first and do what is right before God and man…. to show love, and caring and compassion.

The second morning was for Pastor Eric, the chaplain, who spoke about vocation (God’s calling on your life) versus a career (self directed work)…. and teamwork. It was powerful. The afternoon was for Medical Officer,Ronald…. he is a graduate of Kibaale Community Centre and he is working his way through medical school. He had a month off from school so came and worked in the clinic 3 or 4 days a week. He is known to all the clinic staff so was a good person to discuss medical ethics…… what are the rights of the patient, the expectation of the patient and what we as nurses are expected to do.

Right now…. the students, employees and community are not getting quality care…. I would question if they are even getting any care at all. I am sad….. my heart hurts… why do these nurses do what they know is wrong.

I and many of you…. have prayed for this workshop to have some affect on the hearts and minds of each and everyone of clinic staff….