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Standing in Solidarity With Rosemary
Letters to the Editor
Standing in Solidarity With Rosemary Editor’s Note: Rosemary Namubiru was released from a Ugandan prison on November 28, 2014 and her 3-year prison sentence was commuted to time served. The intent of this letter to the editor was to influence Ms. Namubiru’s release, which has clearly already happened. Despite that, we decided to print the letter as a cautionary message about the continuing fear, stigma, and potential for discrimination against HIV-infected health care providers around the globe. To the Editor,
R
osemary Namubiru, currently in prison in Uganda, is a professional nurse who made a terrible mistake. As she attempted to start an intravenous (IV) drip on an ill 2-year-old child, she accidentally scratched her finger. She paused, placed a dressing, and continued with what she considered to be an urgent task. After the IV was placed, the mother of the child asked if Rosemary had used the same cannula that had scratched her finger. Namubiru was not certain and admitted the possibility that she had erred. Prophylactic exposure protocols were implemented. It was a most unfortunate occurrence, but it was initially addressed appropriately. Then the scenario changed and a series of surreal and tragic events ensued. The world watched as a respected, experienced nurse was brutalized in the press and treated like a malevolent criminal. The headlines read ‘‘Woman arrested for injecting a baby with HIV infected blood’’ (Anguyo, 2014) and ‘‘How a nurse injected baby with HIV blood’’ (Ssekika, 2014). Preposterously fictitious accounts were written describing how she drew blood from her finger while the mother sat idly watching (Ssekika, 2014). She was referred to in the media as the ‘‘killer nurse’’ (Muhumuza, 2014). She was initially charged with attempted murder, and denied bail (Segawa, 2014). The murder charge was later changed to criminal negligence, but
her HIV status had already been made public and she had become an exemplar of what is wrong with health care in Uganda (AIDS-Free World, 2014). Examples of her mistreatment are beyond the scope of this letter, but accusations were recanted and truthful stories appeared in the press. Still, Rosemary Namubiru is in prison. Rosemary Namubiru was a nurse doing her job. There is an expectation that it be done perfectly, but as humans, nurses sometimes make mistakes. There are challenges everywhere nurses work. Nurses expect them, prepare for them, and cope. Difficult tasks, difficult patients, and demanding jobs are the norm. Nurses who work with HIVinfected patients are, without question, electing to work in some of the most challenging environments of all. In the United States, nurses are valued. In a 2013 Gallup poll, consistent with annual findings since 1999, it was revealed that 82% of people in the United States rated nurses’ honesty and ethical standards as high or very high (Gallup, 2013). Nurses in high-income countries can expect to have personal protective equipment available to help them take reasonable precautions to stay safe while they work in difficult environments. Nurses in high-income countries can expect protection under policy and regulatory guidelines. The Namubiru case illustrates that, in some countries, nurses have a different reality. The nurse who works in East Africa, given the prevalence of HIV, is far more likely to provide care for a significant number of people with HIV. Nurses have a particularly high rate of occupational HIV exposure (Mill, Nderitu, & Richter, 2014). Government health centers and hospitals in Uganda frequently operate far below designated staffing levels, with only 58% of staffing targets reached (The Parliament of Uganda, 2012). At the Mulago Hospital, the country’s national referral hospital in Kampala, the ratio can be greater than 1:50 (Natukunda, 2012). It is not uncommon for hospitals and health centers to run out of basic supplies, such as gloves, while providing care (The
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 26, No. 3, May/June 2015, 222-226 Copyright Ó 2015 Association of Nurses in AIDS Care.
Spies, Gray / Letters to the Editor
Parliament of Uganda, 2012). Given that nurses in Uganda and across East Africa continue to do their jobs even with the risk of exposures to blood-borne pathogens, and the grueling workload, one might reasonably expect the profession to be well regarded. The treatment of Rosemary Namubiru by the press and courts is an extreme exemplar of nurses’ struggles for safety, dignity, and respect. Rosemary has said that her greatest prayer would be for her name to be cleared (Personal communication, July 2014). Rosemary’s treatment perpetuates barriers to meeting health-related goals. Janet Obuni, president of the Uganda Nurse and Midwives Union, issued a press statement related to Rosemary Namubiru. The statement emphasized not only the harm to Namubiru but to the reputation of nurses everywhere. Obuni made note that the child has had five negative HIV test results and yet Namubiru has been in prison for more than 7 months, now with a guilty verdict. Support for Rosemary from the international nursing community should continue. Let us not forget the work that countless other nurses are doing – the vulnerable situations they are in, and that they literally put their lives in danger without the support of the public in order to tend to the needs of that public. Nurses should stand in solidarity with Rosemary; demand that her name be cleared and that she be released from prison. Rosemary is an example, albeit an extreme one, of the consequences nurses can face each day. Rosemary Namubiru is a clarion call that we need to uplift and support our nursing colleagues everywhere.
Disclosures The authors report no real or perceived vested interests that relate to this article that could be construed as a conflict of interest.
Acknowledgments We extend a special thanks to Janet Obuni, the president of the Ugandan Nurse and Midwives Union. We are indebted to our nursing colleagues in Uganda and around the world.
223
Lori A. Spies, PhD, RN, NP-C Assistant Professor Baylor University Louise Herrington School of Nursing Dallas Texas, USA Jennifer Gray, PhD, RN Associate Dean University of Texas at Arlington College of Nursing Arlington Texas, USA
References AIDS-free World. (2014, February 11). HIV-positive nurse tried by media. Retrieved from http://www.aidsfreeworld.org/ Newsroom/Press-Releases/2014/HIV-Positive-Nurse-Tried-byMedia.aspx Anguyo, I. (2014, January 12). Woman arrested for injecting baby with HIV infected blood. Retrieved from http://www. newvision.co.ug/news/651356-woman-arrested-for-injectingbaby-with-hiv-infected-blood.html Gallup. (2013). Honesty/ethics in professions. Retrieved from http://www.gallup.com/poll/1654/honesty-ethics-professions. aspx#1 Mill, J., Nderitu, E., & Richter, S. (2014). Post-exposure prophylaxis among Ugandan nurses: ‘‘Accidents do happen.’’ International Journal of Africa Nursing Sciences, 1, 11-17. http:// dx.doi.org/10.1016/j.ijans.2014.05.003 Muhumuza, R. (2014, April 14). ‘‘Killer nurse’’ faces charges in Uganda. Retrieved from http://www.rep-am.com/articles/ 2014/04/15/news/national/797538.txt Natukunda, A. (2012). Nursing Mulago’s staff shortage. Retrieved from http://www.independent.co.ug/news/newsanalysis/5302-nursing-mulagos-staff-shortage The Parliament of Uganda. (2012). Report of the parliamentary committee on health on the ministerial policy statement for the health sector for the financial year 2012/2012. Retrieved from http://www.parliament.go.ug/new/index.php/documents-andreports/committee-reports/category/45-committee-on-health Segawa, N. (2014, February 7). Nurse facing murder charge, denied bail. Retrieved from http://chimpreports.com/index. php/special-reports/crime-investigation/16823-nurse-facingmurder-charge-denied-bail.html Ssekika, E. (2014, January 13). How a nurse injected baby with HIV blood. Retrieved from http://www.observer.ug/index. php?option5com_content&view5article&id529592:how-anurse-injected-baby-with-hiv-bloodhttp://dx.doi.org/10.1016/j.jana.2014.09.005
Standing in Solidarity With Rosemary Editor’s Note: Rosemary Namubiru was released from a Ugandan prison on November 28, 2014 and her 3-year prison sentence was commuted to time served. The intent of this letter to the editor was to influence Ms. Namubiru’s release, which has clearly already happened. Despite that, we decided to print the letter as a cautionary message about the continuing fear, stigma, and potential for discrimination against HIV-infected health care providers around the globe. To the Editor,
R
osemary Namubiru, currently in prison in Uganda, is a professional nurse who made a terrible mistake. As she attempted to start an intravenous (IV) drip on an ill 2-year-old child, she accidentally scratched her finger. She paused, placed a dressing, and continued with what she considered to be an urgent task. After the IV was placed, the mother of the child asked if Rosemary had used the same cannula that had scratched her finger. Namubiru was not certain and admitted the possibility that she had erred. Prophylactic exposure protocols were implemented. It was a most unfortunate occurrence, but it was initially addressed appropriately. Then the scenario changed and a series of surreal and tragic events ensued. The world watched as a respected, experienced nurse was brutalized in the press and treated like a malevolent criminal. The headlines read ‘‘Woman arrested for injecting a baby with HIV infected blood’’ (Anguyo, 2014) and ‘‘How a nurse injected baby with HIV blood’’ (Ssekika, 2014). Preposterously fictitious accounts were written describing how she drew blood from her finger while the mother sat idly watching (Ssekika, 2014). She was referred to in the media as the ‘‘killer nurse’’ (Muhumuza, 2014). She was initially charged with attempted murder, and denied bail (Segawa, 2014). The murder charge was later changed to criminal negligence, but
her HIV status had already been made public and she had become an exemplar of what is wrong with health care in Uganda (AIDS-Free World, 2014). Examples of her mistreatment are beyond the scope of this letter, but accusations were recanted and truthful stories appeared in the press. Still, Rosemary Namubiru is in prison. Rosemary Namubiru was a nurse doing her job. There is an expectation that it be done perfectly, but as humans, nurses sometimes make mistakes. There are challenges everywhere nurses work. Nurses expect them, prepare for them, and cope. Difficult tasks, difficult patients, and demanding jobs are the norm. Nurses who work with HIVinfected patients are, without question, electing to work in some of the most challenging environments of all. In the United States, nurses are valued. In a 2013 Gallup poll, consistent with annual findings since 1999, it was revealed that 82% of people in the United States rated nurses’ honesty and ethical standards as high or very high (Gallup, 2013). Nurses in high-income countries can expect to have personal protective equipment available to help them take reasonable precautions to stay safe while they work in difficult environments. Nurses in high-income countries can expect protection under policy and regulatory guidelines. The Namubiru case illustrates that, in some countries, nurses have a different reality. The nurse who works in East Africa, given the prevalence of HIV, is far more likely to provide care for a significant number of people with HIV. Nurses have a particularly high rate of occupational HIV exposure (Mill, Nderitu, & Richter, 2014). Government health centers and hospitals in Uganda frequently operate far below designated staffing levels, with only 58% of staffing targets reached (The Parliament of Uganda, 2012). At the Mulago Hospital, the country’s national referral hospital in Kampala, the ratio can be greater than 1:50 (Natukunda, 2012). It is not uncommon for hospitals and health centers to run out of basic supplies, such as gloves, while providing care (The
JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE, Vol. 26, No. 3, May/June 2015, 222-226 Copyright Ó 2015 Association of Nurses in AIDS Care.
Spies, Gray / Letters to the Editor
Parliament of Uganda, 2012). Given that nurses in Uganda and across East Africa continue to do their jobs even with the risk of exposures to blood-borne pathogens, and the grueling workload, one might reasonably expect the profession to be well regarded. The treatment of Rosemary Namubiru by the press and courts is an extreme exemplar of nurses’ struggles for safety, dignity, and respect. Rosemary has said that her greatest prayer would be for her name to be cleared (Personal communication, July 2014). Rosemary’s treatment perpetuates barriers to meeting health-related goals. Janet Obuni, president of the Uganda Nurse and Midwives Union, issued a press statement related to Rosemary Namubiru. The statement emphasized not only the harm to Namubiru but to the reputation of nurses everywhere. Obuni made note that the child has had five negative HIV test results and yet Namubiru has been in prison for more than 7 months, now with a guilty verdict. Support for Rosemary from the international nursing community should continue. Let us not forget the work that countless other nurses are doing – the vulnerable situations they are in, and that they literally put their lives in danger without the support of the public in order to tend to the needs of that public. Nurses should stand in solidarity with Rosemary; demand that her name be cleared and that she be released from prison. Rosemary is an example, albeit an extreme one, of the consequences nurses can face each day. Rosemary Namubiru is a clarion call that we need to uplift and support our nursing colleagues everywhere.
Disclosures The authors report no real or perceived vested interests that relate to this article that could be construed as a conflict of interest.
Acknowledgments We extend a special thanks to Janet Obuni, the president of the Ugandan Nurse and Midwives Union. We are indebted to our nursing colleagues in Uganda and around the world.
223
Lori A. Spies, PhD, RN, NP-C Assistant Professor Baylor University Louise Herrington School of Nursing Dallas Texas, USA Jennifer Gray, PhD, RN Associate Dean University of Texas at Arlington College of Nursing Arlington Texas, USA
References AIDS-free World. (2014, February 11). HIV-positive nurse tried by media. Retrieved from http://www.aidsfreeworld.org/ Newsroom/Press-Releases/2014/HIV-Positive-Nurse-Tried-byMedia.aspx Anguyo, I. (2014, January 12). Woman arrested for injecting baby with HIV infected blood. Retrieved from http://www. newvision.co.ug/news/651356-woman-arrested-for-injectingbaby-with-hiv-infected-blood.html Gallup. (2013). Honesty/ethics in professions. Retrieved from http://www.gallup.com/poll/1654/honesty-ethics-professions. aspx#1 Mill, J., Nderitu, E., & Richter, S. (2014). Post-exposure prophylaxis among Ugandan nurses: ‘‘Accidents do happen.’’ International Journal of Africa Nursing Sciences, 1, 11-17. http:// dx.doi.org/10.1016/j.ijans.2014.05.003 Muhumuza, R. (2014, April 14). ‘‘Killer nurse’’ faces charges in Uganda. Retrieved from http://www.rep-am.com/articles/ 2014/04/15/news/national/797538.txt Natukunda, A. (2012). Nursing Mulago’s staff shortage. Retrieved from http://www.independent.co.ug/news/newsanalysis/5302-nursing-mulagos-staff-shortage The Parliament of Uganda. (2012). Report of the parliamentary committee on health on the ministerial policy statement for the health sector for the financial year 2012/2012. Retrieved from http://www.parliament.go.ug/new/index.php/documents-andreports/committee-reports/category/45-committee-on-health Segawa, N. (2014, February 7). Nurse facing murder charge, denied bail. Retrieved from http://chimpreports.com/index. php/special-reports/crime-investigation/16823-nurse-facingmurder-charge-denied-bail.html Ssekika, E. (2014, January 13). How a nurse injected baby with HIV blood. Retrieved from http://www.observer.ug/index. php?option5com_content&view5article&id529592:how-anurse-injected-baby-with-hiv-bloodhttp://dx.doi.org/10.1016/j.jana.2014.09.005