BY PHYLLIS MBANJE
Nurse aides in Zimbabwe continue to play a critical role in plugging the gaps in the healthcare system created by a massive brain drain of professionals.
The advent of the COVID-19 pandemic exposed the scarce human resources in the health sector, which was also highlighted by a nationwide exodus of nurses and doctors to high-income countries.
Nurse aides play an important role in supporting nurses and doctors in human resource-limited settings.
According to Doctors Without Borders (MSF), the subsequent human resources gap in government hospitals saw the few remaining nurses and doctors overwhelmed and the month of July 2021 remains the worst so far in terms of COVID-19 deaths and infections in Zimbabwe, as there was a rapid spike in hospital admissions and deaths.
Hospitals like Parirenyatwa and St Anne’s were overwhelmed, with an overload of admitted patients, forcing the already limited and exhausted nurses and doctors to prioritise technical tasks with minimum time available for basic patient care.
Under such a scenario, important elements essential for patients’ survival can be easily missed in a busy ward.
The role of nurse aides and their presence is key in the management of COVID-19 patients who require constant care, monitoring and management.
They deliver oxygen therapy and reposition oxygen masks that fall off, among their many duties. But often their role is not recognised and their challenges are sidelined.
“We are the first port of call for patients seeking healthcare, but our contribution is trivialised. The members face a lot of challenges and I want them to speak out on their own so you can understand our plight better,” said Sekai Ticky Watungira, the president of the Nurse Aides Association of Zimbabwe.
He added that while nurse aides were playing a major role in the delivery of health services, they were not even recognised by the employers.
“Our grievances are not even solved,” Watungira said.
Various interviews with some nurse aides working for both private and government facilities across the country, revealed that their common grievances were lack of recognition and poor remuneration.
“In the healthcare system ladder, we occupy the bottom rung and yet we work just as hard as the other cadres,” said a nurse aide at a private facility in the Avenues area in Harare. The 26-year-old bemoaned long working hours as well as risk of exposure to infection.
“We do the dirty work that no one wants to do. We mop up bodily secretions and for COVID-19 patients, we are the most exposed because we are hands-on,” she said.
Those working at public facilities said qualified nurses rarely recognised their role and dismissed them as labourers who clean up the mess.
“I work in casualty (department) and that is where all emergency cases come. Some patients are bed-ridden and we are the ones to lift them to the stretcher bed. Others present with festering wounds that I have to clean up and dress,” another nurse aide said.
The nurse aides said they were most at risk to contracting COVID-19 infection.
“We do screening at the gate before a patient is directed to the tent. We are the ones who take temperature and do initial documentation,” they concurred.
“But the salaries that we get are not commensurate with the amount of work we carry out. We feed, bathe patients and carry out all errands, but hatinyatso kosheshwa (we are not given the respect we deserve).”
Watungira said another challenge that had been raised was that of shortage of staff.
“There is an acute shortage of registered general nurses (RGNs) and this has worsened our plight because nurse aides are few and there has not been any move to recruit more. The workload is killing us and it has been too long since we last received uniforms,” he said.
Another nurse aide had this to say: “As a nurse aide, I work in the wards, carry out errands and I am also supposed to escort patients for their X-ray sessions or when they are discharged. It is overwhelming.”
Day’s work in the wards
“We start off by doing what is called damp dusting. This involves cleaning all surfaces and disinfecting the working area. We are supposed to do this with the RGNs, but they are not willing, so as juniors, we do this on our own,” said a male nurse aide. He said after cleaning up, they joined the nurses for wound dressing and throughout the day they will be doing observations of patients and attending to their concerns.
A nurse aide, who works in the theatre, also revealed shocking details of operations at the health facility (name withheld).
“There are no qualified nurses in the theatre and as nurse aides, we do everything. The doctors tell us to draw the drugs and we follow instructions and specifications. But that is the role of a qualified nurse,” the nurse aide said.
A nurse aide from Mt Selinda said they were the backbone of the health delivery system.
“We carry out a lot of duties and are the general hands at the hospitals. But no one bothers to look into our plight. Those who work in the maternity (wards) are hands on. They prep the mothers before, during and after birth. They change the soiled and bloodied linen in preparation for the next patient. Throughout the night, they do observations at 6pm, 10pm, 2am and 6am. It means if there are 15 patients in a ward, you have to check all of them. That is overwhelming,” she said.
Meanwhile, to address some of the training gaps, MSF recently trained nurse aides on providing quality COVID-19 patient care to fill the gap in the provision of basic tasks at Wilkins Infectious Disease Hospital and Beitbridge District Hospital (BDH) using its COVID-19 Enrolled Nurse Aide (CENA) programme model.
The MSF CENA programme equipped nurse aides with basic technical knowledge to support the daily care of COVID-19 patients in hospitals.
Nurse aides were also provided with the tools for good patient communication, waste management and how to react in an emergency. MSF has also implemented similar CENA programmes in Lesotho and South Africa.
“The main aim of employing the CENA concept was to relieve the overwhelmed nurses of some COVID-19 specific duties, which were shifted to nurse aides after the training,” said Shingairai Mawarire, MSF nurse mentor.
“While the role of nurse aides exist in most hospitals around the country, their inclusion in COVID-19 wards focusing on patient care was new and essential. Increasing the number of nurse aides enabled nurses to focus on more technical nursing duties.”
In Beitbridge, MSF responded by setting up the screening and referral unit (SRU) at the hospital entrance to screen and test for COVID-19.
The organisation also supported the establishment of a 24-bed dedicated COVID-19 ward at BDH to ensure adherence to infection prevention control (IPC) measures. The organisation worked within the Health and Child Care ministry facilities, providing human resources to address staff shortages and services needed in ensuring implementation of IPC measures.
“My main motivation was to play a significant role in patient management and IPC as this helps in reducing transmission and increases the number of discharged patients. I got most of the satisfaction from patients who were discharged and to be part of the team which helped to save humanity in this pandemic,” said one Mary an MSF trained nurse aide at BDH’s SRU.
“The upskilling of nurse aides improved morale and job satisfaction among nursing assistants leading to better patient care and timeliness of care,” confirmed Doctor Munya, an MSF medical doctor.
As recommendations to the Health ministry, MSF said hospitals should be equipped with human resources, including nurse aides, in anticipation and preparation for future spikes in COVID-19 cases and the adoption of the CENA concept in order to improve the provision of basic but essential patient care in COVID-19 wards.