In the high-pressure environment of the Intensive Care Unit (ICU) at Mulago Specialized Hospital, the line between professional duty and personal trauma is razor-thin.
For Martha Alupo, the unit’s in-charge, nine years in the ICU have demanded constant resilience. Chronic staffing shortages only deepen the strain—one that rarely ends at the hospital doors. “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.”
For nurses, the role requires not just clinical skill but psychological endurance. Alupo describes the anguish of losing patients unexpectedly, even those who seemed to be improving. “It can feel like torture,” she admits.
To cope, she relies on strict mental boundaries. Each day begins with a quiet ritual. “If you are stressed at home, you have to compose yourself,” she explains. “I tell God: lead me… let me not carry what I have encountered at home to the team and to my patients.”
The most harrowing chapter of Alupo’s career remains the COVID-19 pandemic, a period that laid bare the catastrophic stakes of equipment failure and understaffing. She recalls a “worst-case scenario” when the power failed, the backup generator stalled, and the oxygen supply vanished.
“We had four patients here on life support,” she says, pausing to adjust her spects and hide welling tears. “The desperate team used Ambu bags -those are manual resuscitators- to keep patients breathing, but the delay in oxygen cylinder supply proved fatal. We the patients, go one after another, dying. All four.”
The trauma was so profound that Alupo eventually sought religious intervention from a priest to manage recurring visions of her helpless patients. In the ICU, where patients often cannot speak, nurses become more than clinicians; they become “advocates, parents, and sisters.”
The experience is mirrored on Medical Ward 4B. Nursing Officer Faith Nassali echoes the exhaustion of the pandemic, recalling days spent in suffocating coveralls where she nearly collapsed from the heat. Today, however, the challenge is the “daily math” of staffing gaps.
While a morning shift ideally requires eight to ten nurses to handle the patient volume, the reality often falls short. This deficit forces nurses to rely on a “buddy system” to prevent total burnout. In this ward, a nurse handles upto 60 patients during her shift.
“We are few so we cater for one another,” Nassali says. “You tell your colleague: ‘If I see you are no longer doing your best, I say, stop… go refresh yourself.”
The toll isn’t just clinical; it is domestic. A demanding schedule sometimes involving five consecutive night shifts places immense strain on marriages. Nassali warns that without high emotional intelligence and a supportive partner, the profession can lead to broken homes. “You left your husband at home… some of my colleagues have had spouses who separated or ran away,” she says.
Winifred Mbabazi, the Assistant Commissioner of Nursing at Mulago with nearly forty years of experience, notes that the greatest stressor for health workers isn’t death itself, but the feeling of inadequacy caused by a lack of resources.
“People feel more comfortable if they have everything they need to manage a condition,” Mbabazi explains. “It is more stressful if you feel like ‘I could have helped, but because of shortages I was unable.’ You keep blaming yourself.”
Mbabazi has seen entire units falling into a collective lamentation when a patient dies unexpectedly, a grief that follows them home in the form of night visions.
The systemic pressure is backed by stark data. Mulago currently has 1,327 staff positions filled out of 2,344 approved structures, leaving a 43% staffing gap. Despite this, the hospital serves over 1,500 patients per day across its outpatient and inpatient services.
Despite the trauma and the systemic hurdles, these frontline workers remain the backbone of Uganda’s national referral hospital. For Alupo, the motivation remains simple: the rare, beautiful moment when a critically ill patient defies the odds and walks out of the unit smiling.
