According to Winifred Mbabazi, Assistant Commissioner of Nursing at Mulago, the most distressing aspect of the job is not death itself, but the inability to save lives due to limited resources.
Long after their shifts end, many health workers at Mulago National Referral Hospital carry the hospital with them—reliving critical moments, battling lingering stress, and, in some cases, waking up from disturbing nightmares.
Behind the life-saving efforts in the hospital’s wards lies a quieter struggle: the psychological toll of working in an overstretched health system where resources are limited and the stakes are always high.
For Martha Alupo, the nurse in charge of the Intensive Care Unit (ICU), nearly a decade of service has required not just clinical expertise but emotional resilience.
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“It’s a tiring unit, and it even traumatizes you,” she says. “If you don’t have passion for critically ill patients, you cannot work in the ICU.”
In a setting where patients often hover between life and death, nurses must constantly manage both medical emergencies and their own emotional responses. Alupo says one of the hardest aspects of the job is losing patients unexpectedly, especially those who show signs of recovery.
To cope, she has adopted a routine of mental preparation, beginning each day with prayer to help her separate personal stress from professional duty.
“I ask God to guide me and help me not carry my problems from home to my patients,” she explains.
However, some experiences are difficult to leave behind.
Alupo recalls the COVID-19 pandemic as the most traumatic period of her career. During one incident, a power outage struck the ICU, the backup generator failed, and oxygen supply was interrupted.
“We had four patients on life support,” she says. “We tried to keep them alive using manual resuscitators, but we lost all of them.”
The memory continues to haunt her, forcing her to seek spiritual support to cope with recurring visions of the event.
In such high-pressure environments, nurses often become more than caregivers—serving as advocates, companions, and emotional anchors for patients who cannot speak for themselves.
Elsewhere in the hospital, similar struggles unfold.
On Medical Ward 4B, Nursing Officer Faith Nassali describes a system stretched to its limits. While a shift ideally requires eight to ten nurses, the reality is far different, with each nurse sometimes attending to as many as 60 patients.
“We are few, so we support each other,” she says. “If someone is overwhelmed, we encourage them to step away and regain strength.”
During the pandemic, Nassali endured long hours in protective gear, often working to the point of exhaustion. Today, the pressure continues, driven largely by staffing shortages.
The demands of the job also spill into personal lives. Irregular schedules and extended night shifts have strained relationships, with some health workers experiencing marital breakdowns.
“You leave home for days, and it’s not easy for families,” Nassali says.
According to Winifred Mbabazi, Assistant Commissioner of Nursing at Mulago, the most distressing aspect of the job is not death itself, but the inability to save lives due to limited resources.
“It is painful when you know you could have helped a patient, but you didn’t have the necessary equipment,” she says. “That stays with you.”
She adds that grief is often shared across entire units, with health workers carrying emotional scars long after a patient’s death.
The situation is compounded by a significant staffing gap. Of the 2,344 approved positions at Mulago, only 1,327 are filled, leaving the hospital operating with a 43 percent shortfall while attending to over 1,500 patients daily.
Despite these challenges, the dedication of health workers remains unwavering.
For Alupo, it is the rare moments of success—when a critically ill patient recovers and walks out of the ICU—that provide hope and purpose.
“Those moments remind you why you continue,” she says.
