Efficiency in Emergency Medicine: ZIMALERT in Zimbabwe
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Development. Copyright © 1999 The Society for International Development. SAGE Publications (London, Thousand Oaks, CA and New Delhi), 1011-6370 (199912) 42:4; 150–152; 010947.
Local/Global Encounters
Efficiency in Emergency Medicine: ZIMALERT in Zimbabwe A N T O N VA N D E L L E N AND RICHARD JOHN LANE
ABSTRACT Anton van Dellen and Richard John Lane report on a sustainable programme of emergency medical education in Zimbabwe where the level of emergency care varies tremendously. They address some of the logistic and organizational difficulties encountered and suggest some important principles for successful cooperation in the field of emergency medical education.
Introduction Zimbabwe is a developing country with very limited resources for medical care. The state health care system, which is responsible for the bulk of medical care for the country’s citizens, is therefore constantly under severe pressure. There is a very under-developed system of pre-hospital care and a severe shortage of intensive care beds that are available only in urban areas. The private sector is unaffordable for most of the citizens of the country, although it does provide a fairly high standard of care – once again, overwhelmingly based in urban areas. Geographically, Zimbabwe is a sparsely populated country with long distances between centres of any advanced medical care. However, there are a number of existing factors that assist in the transportation of and co-ordination of care for critically injured patients. There are, for example, a large number of airstrips developed during the war for independence to serve as infrastructure for mobile fire force elements of the then Rhodesian Air Force. These airstrips presently allow rapid access to aero-medical teams based in Harare and Bulawayo. The army and airforce have traditionally also played a role in provision of critical care, particularly in disaster situations, as have non-governmental organizations such as the Red Cross and St John’s. Finally, municipal services also provide emergency medical care, but ambulance provision only extends a certain distance beyond their local boundaries, though paradoxically they have responsibility for disaster planning within their region.
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Van Dellen and Lane: Emergency Medicine in Zimbabwe ZIMALERT ’98 It was decided at the outset that the maximal benefit would be achieved by educating and upgrading the skill levels of the existing personnel delivering emergency care in Zimbabwe. Alternatives mooted were soon shelved. Major restructuring of the actual system of delivering critical care was not considered attainable in the time available for the project, especially considering the inevitable political repercussions. The intervention planned was in the form of a series of training programmes that were used to upgrade predominantly the practical skills of both pre- and in-hospital health care providers. Programmes could constitute a sustainable resource that would continue to deliver results after the depart
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