chairman of a Tanzanian church who had a plan and vision to build and run a nursing school at a mission hospital and church compound in his ecclesiastical province. Now, 9 years later, it is time to reflect and tell the story of the evolution of a nursing school in Tanzania describing the issues we confronted and how, in the future, they might be best overcome. The aim of this study was to reflect on the issues experienced whilst establishing and implementing a FBO nursing school and make recommendations for other similar initiatives.

Methods {#S0002}
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Study design {#S0002-S20001}
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I have used an auto-ethnographic approach to describe how the nursing school project evolved through different phases. Auto-ethnography is one of the newer developments in ethnographic inquiry, 'in which the researchers' own thoughtswas leading the global health agenda and influenced the debates that led to the Alma-Ata declaration ([@CIT0007]). It also set the pace in the World Health Organization\'s (WHO\'s) new commitment to Alma-Ata revisited ([@CIT0019]).

The district in which the nursing school project described in this paper is located is one of several in the region, comprising about 1,000 km^2^ and is on the border of a neighbouring country. Half a million people live in the district, and most of them are farmers, 21% of the population living below poverty line. The infant mortality rate in the district is 165 (compared to the Tanzanian mean of 109).

At the time of the project inception, there were two hospitals in the district: the district hospital and a mission hospital, an FBO. There