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Gibson Mhaka, Zimpapers Politics Hub

INTERVIEW

IMPROVING preparedness for emergencies and aligning with international commitments to strengthen the country’s healthcare systems has always been a noble pursuit for the country’s health sector. In line with ensuring adequate care of patients involved in accidents, Mpilo Central Hospital in Bulawayo recently made history by launching Zimbabwe’s inaugural post-basic nursing diploma in accident and emergency management.

Notably, Mr Nicholas Chidowore (47), Zimbabwe’s sole trauma and emergency nurse, is the programme’s focal person and is instrumental in this effort.

Mr Chidowore (NC) spoke with Zimpapers Politics Hub’s Gibson Mhaka (GM) on this ground-breaking initiative. 

GM: What is your background and experience in trauma and emergency nursing?

NC: I am a registered general nurse with a Postgraduate Advanced Diploma in Emergency Nursing from the University of Witwatersrand, South Africa, obtained in 2015. With over nine years of extensive experience in emergency care, I have worked across diverse healthcare settings, including Level one trauma centres in high-resource environments in South Africa, six years at a central hospital, and two years at a district hospital in Zimbabwe. This exposure has given me a comprehensive and well-balanced understanding of emergency care at all levels.

My expertise is continuously updated through active membership in various professional bodies, including the African Federation for Emergency Medicine (Afem). Additionally, I have complemented my knowledge with specialised training, including Immediate Life Support (ILS) and Advanced Trauma Life Support (ATLS).

GM: What does it mean to you to be the focal person for this ground-breaking diploma?

NC: Being the focal person for this ground-breaking diploma means everything to me. When I first embarked on this journey, it was an uncharted path — one that few, if any, recognised. I leaped into an unknown field, driven by a belief in its importance. 

Now, nine years later, seeing the impact of my work not only within the hospital but also at a national level, where it is now acknowledged as a critical part of the healthcare system, is incredibly fulfilling.

GM: What inspired you to specialise in this field and what keeps you motivated?

NC: It’s hard to pinpoint a single inspiration; perhaps trauma and emergency nursing chose me. In 2010, I had my heart set on midwifery and passed the interviews, but was denied admission due to insufficient experience. This setback pushed me to explore other specialties, including anaesthesia. Despite multiple applications over two years, I faced repeated rejections. 

Frustrated, I turned to trauma and emergency nursing, initially as a fall back, after my attempts to pursue a diploma in anaesthesia were unsuccessful.

Ironically, this detour became a blessing. When I began, I had no background in emergency or pre-hospital care. However, I quickly discovered a profound passion for the field. The dynamic, fast-paced nature of trauma and emergency nursing constantly challenges and motivates me.

However, my path wasn’t straightforward. Even after choosing this specialty, I faced resistance from my superiors, who denied me their recommendation for the programme. 

It was only through the intervention of the Health Service Board (HSB), specifically their manpower development department, that I was finally granted permission to pursue this career. I am forever grateful for the fairness displayed by the HSB. Their support, amidst significant obstacles, is a primary source of my inspiration and motivation.

GM: As the only trauma and emergency nurse in Zimbabwe, what challenges have you faced and how have you overcome them?

NC: My journey has been fraught with significant challenges, all of which I have overcome through persistence and a steadfast commitment to improving our healthcare system. 

The most formidable challenge was systemic resistance to education and specialisation. Initially, superiors dismissed emergency care as “non-essential,” denying my application for study leave. I overcame this by personally lobbying the HSB until I received temporary permission. 

Even after gaining admission, I faced prolonged uncertainty, spending nearly three-quarters of my first year awaiting formal approval from the HSB. I persevered despite the risk of having to abandon my training or continue without income. 

Additionally, the recognition of my qualification by the Nurses Council of Zimbabwe (NCZ) took two years due to the novelty of the specialty in the country, involving extensive lobbying. Implementation and resource allocation presented further obstacles.

Upon completing my training, I was initially assigned to a department outside my specialty, requiring the intervention of the clinical director to secure a position in the emergency department. Securing adequate resources and equipment for the emergency department has also been a constant struggle, requiring persistent advocacy to hospital administration. 

Establishing formal training and recognition also met resistance. Introducing formal emergency nursing training was met with attempts to side-line me and take credit for my work. I bypassed this by directly presenting a proposal to the Ministry of Health and Child Care, which permitted me to lead the initiative. 

Lack of financial resources also inhibited the ability to attend important medical symposiums, leading me to personally fund my attendance at the African Conference on Emergency Medicine (Afcem) to network with global experts. 

Finally, bureaucratic delays surrounding the recognition of my qualifications and the implementation of new training programmes were a constant obstacle, which I overcame with perseverance and direct engagement with relevant authorities. 

These challenges, though significant, have ultimately paved the way for the establishment of formal emergency nursing training in Zimbabwe and have strengthened the nation’s emergency care system.

GM: How do you plan to share your expertise and knowledge with the nurses enrolled in the programme?

NC: With over nine years of emergency care experience, gained both internationally in South Africa and locally at central and district hospitals, I have developed a comprehensive understanding of our emergency care system. I plan to share this knowledge with the nurses enrolled in the programme through clinical mentorship, structured lessons and hands-on training. 

To further support their learning, we have also engaged experts from various specialties, both locally, regionally and internationally. However, currently, I am the sole individual with this specific knowledge and expertise, which presents challenges, particularly regarding 24/7 availability.

GM: What are your thoughts on the current state of emergency care in Zimbabwe, and how can it be improved?

NC: Zimbabwe’s emergency care faces critical challenges. The most pressing issue is the severe lack of specialised training for healthcare workers, directly impacting the quality of care. Critical shortages of essential drugs and equipment in under-resourced, emergency departments further hinder effective patient management.

Dysfunctional pre-hospital care, marked by poor co-ordination and inadequate ambulance services, all lead to life-threatening delays. 

Brain drain exacerbates these problems by depleting the skilled workforce. To improve, Zimbabwe must prioritise specialised training programmes, increase funding for resources, strengthen pre-hospital care through better co-ordination and equipment and secure Government commitment and international collaboration.

GM: What are the most pressing needs in emergency care in Zimbabwe that you hope this diploma will address?

NC: Strengthening emergency and critical care systems by developing highly skilled emergency nurses, and improving trauma and accident response. This will enhance the management of medical emergencies, disaster preparedness and mass casualty response, all while reducing patient mortality and morbidity.

A key focus is bridging the gap in pre-hospital care, particularly in rural areas, by integrating emergency care from pre-hospital to definitive care. This integration will lead to standardised emergency care, improved pre-hospital response at district and provincial levels, and the implementation of protocols and standards in emergency care. 

Ultimately, these efforts will help reduce pre-hospital times, enhance public healthcare infrastructure, lower medical costs and contribute to achieving the Ministry of Health’s Vision 2030.

GM: What were the biggest challenges in establishing this programme and how were they overcome?

NC: Establishing this programme faced immense challenges, primarily due to Zimbabwe’s severe brain drain, which has left critical gaps in emergency care expertise. Despite the vital role of emergency nursing, meaningful institutional support has been minimal. 

As the country’s sole qualified emergency nurse, I encountered resistance and a lack of resources, often funding my own efforts. This reflects a broader issue where personal biases undermine national healthcare initiatives, depriving communities of essential advancements.

This challenge is widespread among Zimbabwean healthcare professionals. 

GM: How will the programme address the specific challenges of emergency care in Zimbabwe, such as resource limitations or access in rural areas?

NC: The solution is enhancing responder efficiency and effectiveness. 

It combats prolonged hospital stays, delayed interventions and resource overuse caused by limited healthcare provider training. 

By equipping cadres with skills to optimise limited resources, the programme ensures every available tool is maximally utilised.

Early pre-hospital intervention prevents disease progression and improves recovery. Training reduces prolonged hospital stays by addressing emergency care gaps and mitigates delayed rural responses through enhanced pre-hospital care, improving survival rates. 

Standardised training curbs drug overuse and unnecessary investigations, conserving resources and reducing costs.

The programme standardises emergency care practices, promoting resource efficiency and extending equipment durability. Ultimately, it transforms Zimbabwe’s emergency medical care, making it more efficient, cost-effective and accessible, particularly in rural communities where trained responders are crucial.

GM: What is the long-term plan for the programme’s sustainability and expansion?

NC: The plan should envision extending to other schools, offering valuable training to a wider student base. For sustained success, a mentorship model could be implemented, integrating high-performing graduates to guide junior students. However, several challenges must be addressed.

Currently, clinical supervision relies heavily on a single individual, demanding 24/7 availability, which is unsustainable. Furthermore, brain drain has severely depleted experienced nurses in critical departments, straining healthcare resources. 

Retaining skilled professionals is essential; policies and initiatives are urgently needed to keep healthcare workers with specialised expertise within the system. The Government should prioritise strategies to retain these highly trained professionals, as their contributions are vital for the nation’s healthcare development.

GM: What message do you have for the public about the importance of supporting and investing in emergency care services?

NC: Supporting and investing in emergency care services is vital for ensuring swift, life-saving interventions during medical crises, accidents and disasters. A well-funded system reduces mortality, improves patient outcomes, and strengthens public health resilience. It guarantees that trained professionals, modern equipment and efficient infrastructure are readily available when time is critical. 

Furthermore, robust emergency services contribute to economic stability by lowering long-term healthcare costs and preventing productivity losses from untreated or delayed medical conditions. 

Public support, through advocacy, funding, and the responsible use of emergency resources, builds a strong system capable of effectively responding to both routine emergencies and large-scale crises, ultimately protecting the well-being of individuals and communities.

GM: What advice would you give to nurses who are interested in pursuing a career in emergency care?

NC: I would advice gaining strong clinical experience, developing critical thinking skills and continuing learning. 

Emergency medicine evolves rapidly, staying updated with new protocols, technology and best practices. 

Emergency nursing opens doors to leadership roles, specialised trauma care, flight nursing, disaster response teams and more. The experience gained can also lead to opportunities in education and research.