Sylvia Nyangoma was raised in a peasant family in Kisansya, Kibwera Sub-County in Buliisa District. Her childhood dream was midwifery because she desired to help women after hearing her mother’s ordeal while giving birth to her.
“My mother said she was about to die while delivering me. She suffered a haemorrhage and was saved by only two tablets that nurses administered. After seeing the difference midwives make, she encouraged me to join the profession,” Nyangoma recounts.
Not even her peers could convince Nyangoma to give up her dream of becoming a midwife for the teaching profession.
“In Senior Four vacation, my friends tried to persuade me to join the teaching profession, but my sister was against it and advised me to go for nursing even if we did not have enough money because it was my childhood dream,” Nyangoma explains.
In 2014, Nyangoma enrolled for a two-and-half-year certificate in midwifery at Hoima School of Nursing and Midwifery. Four years later, she got a job at Hakki Medical Centre in Kigorobya.
“I thank Godfrey Bwambale, my clinical officer who mentored me at Hakki Clinic, I developed the confidence to work by myself,” she says, adding “Also the discipline they instilled in me at St Martin Vocational Institute Munteme shaped my work ethic,” she says.
In 2019, she was recruited and posted to Buliisa District General Hospital. There, she became so passionate about her work that she could not take the mandatory days off.
“I wondered what I was going to do at home on such days. I got used to this routine until 2020 when I was transferred to Bugoigo Health Centre II,” she explains.
Her workplace is 25 kilometres from Buliisa District local government headquarters in a little known area.
Her name did not ring a bell to many people until last year when she single-handedly helped to deliver mothers of more than 100 babies, attended to 17 referral cases, and registered zero death under difficult working conditions during the lockdown.
“Mid last year I was alone on duty because my colleague took sick leave and later maternity leave which ended on February 9. God helped me to handle 126 deliveries without any deaths recorded,” the soft-spoken midwife and mother of three shares.
She commends the community of Bugoigo including staff at the facility for being hospitable and understanding while she struggled to serve them. “I have a lot of work here compared to her previous workplace. Here, I have to do almost everything as opposed to my former placement,” she says.
Nyangoma is not new to challenges; a Health Centre II has basic equipment for delivering mothers which does not help with the complicated cases. She recalls a woman who rejected a referral to Hoima yet she was over bleeding. On examining her, she discovered the woman was pregnant after which she miscarried. “I faced many challenges to arrest the bleeding since all tests had turned out negative,” she relates.
She also recalls a mother of six who suddenly started bleeding and Nyangoma called for an ambulance from Hoima Regional Referral Hospital because she was worried the woman would bleed to death while she watched.
Refusing to give in, she consulted medical officers at Buliisa General Hospital who instructed her to give the bleeding woman first aid which arrested the bleeding and kept her alive until the ambulance arrived.
Bugoigo Health Centre II has two midwives, it receives 20 to 40 women per day for antenatal services but in January, the number shot up because Butiaba Health Center III was overwhelmed raising the number of women attending antenatal to almost 200 per month.
The community especially expectant mothers are kind and understanding to her. They know she works alone.
“When I spend about two days without visiting the community people come to check on me at the facilty,” she adds.
The only big fear Nyangoma has is the state of the clinic.
“Our working condition in the maternity section is not good, our walls are cracked making it unfavourable. I fear that it might collapse any time. I pray that the government considers building a bigger maternity ward for us,” she says.
According to Nursing Now Uganda (which partners with many organisations including the Ministry of Health), nurses and midwives form the backbone of health care delivery in Uganda, making up 72 per cent of the public health care workforce.
They are usually the first point of contact for most patients.
Achieving universal health coverage in Uganda, among other national and global targets, depends on empowering nurses and midwives to build on and expand their knowledge and skills.
Investing in more nurses, nurse education and training, regulation, enhanced working conditions and developing practice in Uganda will strengthen their ability to contribute to the provision of better health care, promote gender equity, and ultimately strengthen the economy of the country.
There are, for example, only 61,813 nurses and midwives in Uganda (Uganda Nurses and Midwives Council, 2017) with a nurse/patient ratio of 1:11,000 against the recommended 1: 1,000 ratio.
A stressful schedule
“Whether it is day or night someone can get into labour and you have to come out and assist,” Nyangoma explains. She is therefore always on standby for any emergencies even when she is at her home.
She says she has managed to come to terms with this punishing schedule because she has learnt to manage her own emotions and instead put the expectant mother’s needs first.
“When you are overwhelmed, you can get agitated but you need to keep calm because sometimes mothers in labour lose control of their emotions and become angry, rude and argumentative, remember they are experiencing extreme pain and empathise. As a mother I have been there and I can easily imagine what they are going through,” explains the midwife.