在乌干达，80% 的人口生活在农村地区，尽管需求很大，但大多数护士无法到达或不准备居住。
Many of us are painfully aware of the extent of the global nursing shortage. The problem is particularly acute in Africa, Southeast Asia and some parts of Latin America. In Uganda, 80% of the population lives in rural areas (World Population Review, 2022) that most nurses cannot reach or are not prepared to live in despite great need. Most nurses want to live in the city area because of higher standards of living including better roads, easy access to social services, availability of electricity, clean water, internet and recreational facilities (Uganda Bureau of Statistics, 2020). In Uganda better schools, well-equipped hospitals, and transportation methods are all found in urban or city areas. However, with most (63%) Ugandans living on less than a dollar a day (Development Initiative, 2020; World Bank, 2016), cost of living in city areas is an issue, so many people still live in the more affordable rural areas.
In this editorial, I will describe the development of a hospital and nursing school in the southwestern part of the country. This school and hospital have contributed to reducing the critical shortage of nurses in the local rural area.
In 2003 Dr. Scott Kellermann founded a hospital in the Bwindi area in the Kanungu district of southwestern Uganda (Bwindi Community Hospital, 2020). In 2010, international entrepreneur James D. Jameson and his close friend Stephen M. Wolf, an ex-Chairman and CEO of United Airlines, were hiking into the mountain rain forests of southern Uganda to track mountain gorillas. The pair encountered Jenny Farrer, a British nurse who was volunteering at the hospital. Jenny invited the two to tour the hospital and meet Dr. Kellermann. When that hospital tour took place, I was the head of nursing and midwifery at the hospital, and I described the shortage of nurses and midwives, the challenges we were facing in staffing the hospital, and the need for more nurses and midwives. At that time, the 112-bed hospital served 40,000 patients a year and we were faced with a critical shortage of nurses. Our long-range planning for the hospital included a nursing school that would prepare registered nurses to respond to the critical shortage (Bwindi Community Hospital, 2015).
The encounter with James and Stephen generated profound changes to the village, the community, the country's approach to health care and education for nurses, and to me as an individual nurse because it was not long after this encounter that James and Stephen decided to support and fund the creation of a premier Uganda Nursing School Bwindi (2015). Uganda Nursing School Bwindi (UNSB) is now well established and located in Bwindi area in the Kanungu district of southwestern Uganda. The location is remote, rural and hard to reach with very poor, often impassible road networks. The area is comprised of very low-income and low-educated communities with poor access to health care services. This underserved community is also a home to the marginalized Batwa Pygmy people who were evicted from the Bwindi impenetrable forests in the early 90s to make way for the Gorilla National Park (Kellermann Foundation, 2014).
With support of James, Stephen, Reno Rotary International, international university partners, the Kellermann Foundation and Abercrombie and Kent Philanthropy, the first students commenced the first day of coursework in November of 2013. The Kellermann Foundation has financially support the development of UNSB and nursing scholarships for the Batwa Pygmie People (Kellermann Foundation, 2014).
Three years after that first day, student numbers increased from the original 13 (comprising 11 males and two females) to 90, which was the original capacity of the school, and then to 215. Our action plan for this increase was based on our concerns with recruiting female students. Few (2) female students were able to join the nursing school because most you women would drop out of school early. After community research we realized that the drop off rate was due to culture that did not support education for girls. We agreed to recruit more girls, support them and have them study for more years and still obtain their diploma degree. When this plan happened, many girls joined the school and we increased the capacity of the school from our original plan of 90 students. For women, cultural barriers appeared to be a factor hindering them from reaching the necessary level of secondary school education for admission to the school. Abercrombie and Kent Philanthropy through Keith Sproule as the executive director supported 90 female students with tuition in 2014–2015 and this boosted the education for female students in this community (Abercrombie and Kent Philanthropy, 2016).
So far, 392 female students have graduated from the school. The school's graduates have achieved great results as compared with many nursing schools in Uganda (UNSB, 2019). Through its desire to support the health care needs of the community, the school has also proudly supported the Batwa community through the programme and we are the first institution in Uganda to support the marginalized Batwa people in this way.
To date, the school has graduated 507 nurses and midwives including one person of the Batwa community, and there are 425 students currently enrolled. UNSB has been established as one of the model nursing and midwives' educational institution in southwestern Uganda, and there are plans to have the school achieve university status by 2025.
The school provides preparatory education to nurses and midwives using a modified ministry of education curriculum. There is collaboration with Uganda Christian University (UCU), which monitors the teaching and evaluation every 6 months. The school also uses state of art technology, unique to East Africa, including smartboards, Kindles and iPads. UNSB has been able to attract top-quality students from across Uganda and the neighbouring countries of Kenya and Rwanda. The students that graduate are well prepared to meet the needs of local communities and are able to use minimum resources to provide quality care.
The school also provides practical skills to students at the associated Bwindi Community Hospital. The hospital is rooted in rural southwestern Uganda through strong relationships with other regional health facilities including lower health facilities such Kambuga hospital, Kihihi Health Centre and the national referral hospitals of Mulago and Butabika for clinical practise.
The school's leadership and management have also focused on exploring new approaches of teaching, management and operation coupled with collaborations with other universities (University of Scranton, University of San Francisco, Dominican University, University of Nevada, Orvis school of Nursing, University of Vermont and local universities such as UCU, Makerere university, Mbarara universities and other nursing schools in the country). These relationships are crucial to the continued development of the school.
Key outcomes and successes of UNSB include the following.
Reducing the critical shortage of health care providers in a rural area. Since its inception, 507 nurse and midwives have graduated with 81% of graduates working in rural settings in Uganda.
There are now 392 new female nurses in Uganda who have graduated from UNSB.
52 graduates are in nursing and midwifery leadership positions in various health facilities with two taking top leadership positions in the Ministry of Health Uganda.
32 graduates are working as sonography and radiography services providers alongside their nursing and midwifery skills. The multi-skilled nurses and midwives providing radiography and sonography are able to identify complications in pregnancy early before they cause complications requiring hospitalization, or death.
15 graduates have become nurse and midwifery entrepreneurs and have opened pharmaceutical shops/clinics.
12 graduates are working as nurse tutors.
11 graduates are in research-based organizations.
Eight graduates are now employed at the school as clinical instructors and role models.
Eight graduates are working outside Uganda in rural areas.
Six graduates have upgraded to degreed nurses.
Three graduates are continuing their studies to become nurse educators.
Students have conducted over 60 primary research projects all that have generated new knowledge in the field of care and education in the Bwindi area. Papers from four of these projects have been published in international journals and others presented at national conferences.
The UNSB's educational approach differed from that of Uganda's other programmes in a variety of ways:
Uganda Nursing School Bwindi was founded with a full complement of iPads and electronic whiteboards for instructional use. The high-tech approach was envisioned as a smart use of resources that would allow for remote learning and collaboration while also luring potential students to study and work in rural Uganda with 21st century technology.
The UNSB's rural location acclimatizes the school's students to living and working in remote areas over the course of the 3-year programme. Throughout their education, they are also encouraged to consider practising in rural areas after graduation with a major emphasis of the curriculum focusing on community health.
The nursing curriculum includes research training, and students are encouraged to take part in research. Original research has touched on a diverse range of health care topics, and generated knowledge leading to improved care including the uptake of antiretroviral drugs for HIV treatment, factors contributing to sepsis after caesarean sections, the relative success of various prescription drugs and dosages prescribed by nurses in rural clinics, addressing multiple aspects of domestic violence in rural communities, infection control, preventable diseases and emerging chronic diseases in rural Uganda.
The predominantly male enrolment of the first class at the nursing school surprised school leaders. In Ugandan culture, as in other countries, women are traditionally expected to be caregivers. A male worker in a hospital is often assumed to be a doctor, while a female would typically be addressed as a nurse because the females are viewed as caretakers in communities.
Hoping to educate a diverse group of nurses that would be effective under these cultural expectations, the school founders determined that the undervaluing of female education had led to fewer females having the secondary school background that was a prerequisite for the school's diploma programme. A grant from Abercrombie and Kent Philanthropy in the 2014–2015 school year allowed 90 females to begin their education at a more remedial level that compensated for their lack of secondary school credits.
From its founding until the onset of the COVID-19 pandemic that has impacted global economies, UNSB evolved from an institution primarily funded by foreign philanthropy for both startup and operating costs to a school in which 83% of students are able to pay their own tuition. Where we took advantages of economies of scale from the large numbers.
Students from UNSB are hired by many health providers a semester before they graduate. The school's demonstrated ability to prepare graduates for the job market has been key to attract a clientele willing to invest in a UNSB education. It remains to be seen if the economic impact of the pandemic will reverse these trends.
The UNSB benefited from a fortunate confluence of circumstances, especially the proximity of the Bwindi Impenetrable National Park which brought Western tourists in contact with the poverty and underdevelopment in the region.
Not all rural areas of the developing world are so fortunate to have a local tourism industry, but those that are, could be considered for comparable projects. Similarly, rural areas that attract mining and exploitation of other natural resources could offer the same combination of extreme need and encounters with corporations or individuals that have the potential to make meaningful investments in those communities.
Perhaps ways to attract foreign support to areas that do not have industries like tourism or mining can also be developed. Absent existing opportunities for encounters between the rural poor and monied elite, the effort to improve rural nurse staffing could be enhanced by initiatives such as government outreach, lobbying to have more foreign investment in rural areas and local collaborative efforts by nurse leaders.
As the voice of academic nursing in rural southwestern Uganda, the school has continued to provide excellence and innovation in nursing education, research and practise. The graduates are successful and engaged in important work to promote health and further develop the nursing workforce. The school has received an award as best institution in educating nurses and midwives in Uganda.
Self-sustainability is possible through tuition if the nurses are marketable through quality education.
Committed leadership and a flexible team to adapt to the changing health care needs, critical shortage of nurses and work environment are key in the development of an institution such as UNSB.
Despite the challenge of the COVID 19 pandemic, UNSB continues to evolve, with plans to become a university granting nursing and midwifery degrees equivalent to a U.S. bachelor's degree by 2025. To that end, I am studying for my PhD and two additional buildings are planned for the Bwindi campus. The university's mission will be to ensure that its graduates provide a globally acceptable standard of care, whether they are working in the cities of the developed world, with their own nursing shortages, or in rural Bwindi.
I would like to acknowledge and honour James D. Jameson for inspiring me to write about the UNSB story. Thank you for instilling in me the confidence that I could do anything I put my mind to and that the story of UNSB could be shared with the entire world. In a special way, I would like to thank Stephen M. Wolf; I cannot mention James D. Jameson without you. Your friendship extended to me through it all. Your patience, understanding, insights and support have not gone unnoticed, here is a story. I could not write and be part of this story without you. Together you have created a legacy that will live on. You are the social entrepreneurs of this century. My sincere gratitude to Vickie Thaw and Debra Jackson for all the efforts in writing this document. Thank you for joining our efforts and making sure this story reaches the entire world. To Christina Murray, thank for contributing to the writing of this paper. Thank you for following critically the evidence and willing to help write it out. To Dr. Scott Kellerman, thank you for sowing the mustard seed and leading the way for big contributions to come to the underserved rural Uganda. I must also thank Keith Sproule, for supporting UNSB. We can sustain the training and particularly the disadvantaged girls in rural Uganda. You have made me feel that everyone can have a chance to study, achieve and make a change. I would also like to thank Jerry Hall and Rotary International, thank you for supporting the establishment of the story. I will also extend my gratitude to Bwindi Community hospital staff. Thank you for furthering this major cause. I must also specifically thank all staff of UNSB. You have endured it all and maintained her at high standards. Lastly, I must thank the students at UNSB and alumni from 2013 to date, we have the evidence of what we do in you. Thank you for being part of UNSB.
全文翻译（仅供参考）
我们中的许多人都痛苦地意识到全球护理短缺的程度。这个问题在非洲、东南亚和拉丁美洲的一些地区尤为严重。在乌干达，80% 的人口生活在农村地区（《世界人口评论》， 2022 年），尽管需求很大，但大多数护士无法到达或不准备居住。大多数护士希望住在城市地区，因为生活水平更高，包括更好的道路、便捷的社会服务、电力、清洁水、互联网和娱乐设施（乌干达统计局， 2020）。在乌干达，更好的学校、设备齐全的医院和交通方式都在城市或城市地区。然而，由于大多数 (63%) 乌干达人每天的生活费不足一美元（发展倡议， 2020 年；世界银行， 2016 年），城市地区的生活成本是一个问题，因此许多人仍然生活在负担得起的农村地区.
在这篇社论中，我将描述该国西南部一所医院和护士学校的发展。这所学校和医院为缓解当地农村护士严重短缺的情况做出了贡献。
2003 年，Scott Kellermann 博士在乌干达西南部卡农古区的 Bwindi 地区创办了一家医院（Bwindi Community Hospital， 2020）。2010 年，国际企业家 James D. Jameson 和他的密友、联合航空公司前董事长兼首席执行官 Stephen M. Wolf 徒步进入乌干达南部的山地雨林，以追踪山地大猩猩。两人遇到了在医院做志愿者的英国护士珍妮·法雷尔（Jenny Farrer）。珍妮邀请两人参观医院并会见凯勒曼医生。参观医院时，我是医院护理和助产士的负责人，我描述了护士和助产士的短缺、我们在医院人员配备方面面临的挑战，以及对更多护士和助产士的需求。当时，这家拥有 112 个床位的医院每年服务 40,000 名患者，我们面临着护士严重短缺的问题。 2015 年）。
与詹姆斯和斯蒂芬的相遇给村庄、社区、国家对护士的医疗保健和教育以及作为一名护士的我带来了深刻的变化，因为在这次相遇后不久，詹姆斯和斯蒂芬决定支持和支持资助创建首屈一指的乌干达护理学校 Bwindi ( 2015）。乌干达布温迪护理学校（UNSB）现已建立，位于乌干达西南部卡农古区的布温迪地区。该地点偏远、乡村，道路网络非常差，通常无法通行，因此难以到达。该地区由极低收入和受教育程度低的社区组成，难以获得医疗保健服务。这个服务不足的社区也是被边缘化的巴特瓦俾格米人的家园，他们在 90 年代初被赶出布温迪人无法穿越的森林，为大猩猩国家公园让路（凯勒曼基金会， 2014 年）。
在詹姆斯、斯蒂芬、雷诺国际扶轮社、国际大学合作伙伴、凯勒曼基金会和 Abercrombie and Kent Philanthropy 的支持下，第一批学生于 2013 年 11 月开始了第一天的课程。凯勒曼基金会为 UNSB 和护理的发展提供了财政支持巴特瓦俾格米人奖学金（凯勒曼基金会， 2014 年）。
第一天之后的三年，学生人数从最初的 13 名（包括 11 名男性和 2 名女性）增加到 90 名，这是学校的原始容量，然后再到 215 名。我们的行动计划是基于我们的担忧与招收女学生。很少 (2) 名女学生能够进入护理学校，因为大多数女性会提前辍学。经过社区研究，我们意识到辍学率是由于不支持女孩教育的文化造成的。我们同意招募更多的女孩，支持她们，让她们学习更多年，仍然获得文凭。当这个计划发生时，许多女孩加入了学校，我们从最初的 90 名学生计划中增加了学校的容量。女用，文化障碍似乎是阻碍他们达到入学所需的中学教育水平的一个因素。Abercrombie and Kent Philanthropy 通过 Keith Sproule 作为执行董事，在 2014-2015 年支持了 90 名女学生的学费，这促进了该社区女学生的教育（Abercrombie and Kent Philanthropy， 2016 年）。
迄今为止，已有392名女学生从学校毕业。与乌干达的许多护士学校相比，学校的毕业生取得了很好的成绩（UNSB， 2019）。通过支持社区的医疗保健需求，学校还自豪地通过该计划支持巴特瓦社区，我们是乌干达第一家以这种方式支持边缘化巴特瓦人的机构。
迄今为止，学校已毕业507名护士和助产士，其中包括一名巴特瓦社区的人，目前在校学生425人。UNSB 已成为乌干达西南部护理和助产士教育的典范之一，并计划在 2025 年之前使学校达到大学地位。
学校使用修改后的教育部课程为护士和助产士提供预备教育。与乌干达基督教大学 (UCU) 合作，每 6 个月监测一次教学和评估。学校还使用东非独有的最先进技术，包括智能板、Kindle 和 iPad。UNSB 已经能够吸引来自乌干达各地以及邻国肯尼亚和卢旺达的高素质学生。毕业的学生为满足当地社区的需求做好了充分的准备，并且能够使用最少的资源来提供优质的护理。
学校还为相关 Bwindi 社区医院的学生提供实用技能。该医院扎根于乌干达西南部农村，与其他地区卫生机构建立了牢固的关系，包括 Kambuga 医院、Kihihi 卫生中心等低级卫生机构以及用于临床实践的 Mulago 和 Butabika 国家转诊医院。
学校的领导和管理层还专注于探索教学、管理和运营的新方法，并与其他大学（斯克兰顿大学、旧金山大学、多米尼加大学、内华达大学、奥维斯护理学院、佛蒙特大学和当地大学，如 UCU、马克雷雷大学、姆巴拉拉大学和该国的其他护士学校）。这些关系对于学校的持续发展至关重要。
UNSB 的主要成果和成功包括以下内容。
减少农村地区医疗保健提供者的严重短缺。自成立以来，已有 507 名护士和助产士毕业，其中 81% 的毕业生在乌干达农村地区工作。
乌干达现在有 392 名新的女护士从 UNSB 毕业。
52 名毕业生在各种卫生机构担任护理和助产领导职务，其中两名在乌干达卫生部担任高级领导职务。
32 名毕业生除了具有护理和助产技能外，还担任超声检查和放射检查服务提供者。提供放射照相和超声检查的多技能护士和助产士能够在妊娠并发症引起需要住院或死亡的并发症之前及早发现它们。
15名毕业生成为护士和助产士企业家，并开设了药店/诊所。
12名毕业生担任护士导师。
11 名毕业生在研究型组织工作。
八名毕业生现在被学校聘为临床指导员和榜样。
八名毕业生在乌干达以外的农村地区工作。
六名毕业生已升级为学位护士。
三名毕业生正在继续学习，成为护士教育者。
学生们开展了 60 多个初级研究项目，所有这些项目都在 Bwindi 地区的护理和教育领域产生了新的知识。其中四个项目的论文已在国际期刊上发表，其他论文已在国家会议上发表。
UNSB 的教育方法与乌干达其他项目的不同之处在于：
乌干达护士学校 Bwindi 成立时配备了全套 iPad 和电子白板，供教学使用。这种高科技方法被设想为对资源的巧妙利用，可以进行远程学习和协作，同时还可以利用 21 世纪的技术吸引潜在的学生在乌干达农村学习和工作。
UNSB 的农村位置使学校的学生在为期 3 年的课程中适应了在偏远地区的生活和工作。在整个教育过程中，还鼓励他们考虑毕业后在农村地区执业，课程的重点是社区健康。
护理课程包括研究培训，鼓励学生参与研究。原创研究涉及广泛的医疗保健主题，并产生了有助于改善护理的知识，包括用于 HIV 治疗的抗逆转录病毒药物的摄取、剖宫产后败血症的因素、各种处方药的相对成功率和护士规定的剂量在农村诊所，解决农村社区家庭暴力、感染控制、可预防疾病和乌干达农村新出现的慢性病的多个方面。
护士学校一等班主要是男性入学，这让学校领导感到惊讶。在乌干达文化中，与其他国家一样，传统上期望女性成为照顾者。医院的男性工作人员通常被认为是医生，而女性通常被称为护士，因为女性在社区中被视为看护人。
学校创始人希望能够在这些文化期望下对多样化的护士进行有效的教育，他们认为，对女性教育的低估导致具有中学背景的女性人数减少，而中学背景是学校文凭课程的先决条件。Abercrombie 和 Kent Philanthropy 在 2014-2015 学年提供了一笔赠款，让 90 名女性能够以更补习的方式开始她们的教育，以弥补她们缺乏中学学分的情况。
从成立到影响全球经济的 COVID-19 大流行爆发，UNSB 从一个主要由外国慈善机构资助的启动和运营成本的机构发展成为一所 83% 的学生能够自己支付学费的学校. 我们利用大量的规模经济优势。
UNSB 的学生在毕业前一个学期就被许多医疗机构聘用。学校展示的为毕业生准备就业市场的能力是吸引愿意投资 UNSB 教育的客户的关键。大流行的经济影响是否会扭转这些趋势还有待观察。
UNSB 得益于一个幸运的环境融合，特别是靠近 Bwindi 难以穿越的国家公园，这让西方游客接触到了该地区的贫困和不发达状况。
并非发展中世界的所有农村地区都如此幸运地拥有当地旅游业，但可以考虑开展类似项目。同样，吸引采矿和开采其他自然资源的农村地区可以提供相同的极端需求组合，并与有潜力在这些社区进行有意义投资的公司或个人相遇。
也许还可以开发一些方法来吸引外国对没有旅游业或采矿等行业的地区的支持。由于缺乏农村贫困人口和有钱精英之间接触的现有机会，改善农村护士人员配置的努力可以通过政府外展、游说在农村地区增加外国投资以及护士领导的当地合作等举措得到加强。
作为乌干达西南部农村学术护理的代言人，学校在护理教育、研究和实践方面不断提供卓越和创新。毕业生成功并从事促进健康和进一步发展护理人员的重要工作。学校曾获得乌干达护士和助产士教育最佳机构奖。
如果护士通过优质教育有市场，则可以通过学费实现自我维持。
坚定的领导和灵活的团队，以适应不断变化的医疗保健需求、护士的严重短缺和工作环境，是 UNSB 等机构发展的关键。
尽管面临 COVID 19 大流行的挑战，UNSB 仍在继续发展，计划到 2025 年成为一所授予与美国学士学位相当的护理和助产学位的大学。为此，我正在攻读博士学位，并计划增加两座建筑为 Bwindi 校园。该大学的使命是确保其毕业生提供全球可接受的护理标准，无论他们是在发达国家的城市工作，他们自己的护理短缺，还是在 Bwindi 农村。
我要感谢并尊重 James D. Jameson，因为他激励我写下 UNSB 的故事。谢谢你让我相信我可以做任何我想做的事情，并且 UNSB 的故事可以与全世界分享。我要特别感谢 Stephen M. Wolf；没有你，我无法提及 James D. Jameson。你的友谊通过这一切延伸到我身上。您的耐心、理解、见解和支持并没有被忽视，这里有一个故事。没有你，我无法写作并成为这个故事的一部分。你们一起创造了将继续存在的遗产。你们是本世纪的社会企业家。我衷心感谢 Vickie Thaw 和 Debra Jackson 为编写本文档所做的所有努力。感谢您加入我们的努力，并确保这个故事传遍全世界。感谢 Christina Murray，感谢您为本文的写作做出了贡献。感谢您批判性地关注证据并愿意帮助将其写出来。致斯科特·凯勒曼博士，感谢您播下芥菜种子，并带头为服务不足的乌干达农村地区做出重大贡献。我还必须感谢 Keith Sproule 对 UNSB 的支持。我们可以维持培训，特别是乌干达农村的弱势女孩。你让我觉得每个人都可以有机会学习、成就和做出改变。还要感谢 Jerry Hall 和国际扶轮社，感谢你们支持故事的建立。我还要感谢 Bwindi 社区医院的工作人员。感谢您推动这一重大事业。我还必须特别感谢 UNSB 的所有工作人员。你已经忍受了这一切，并保持着她的高标准。最后，我必须感谢 UNSB 的学生和 2013 年至今的校友，我们有证据证明我们在你们身上做了什么。感谢您成为 UNSB 的一员。
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