Elective placements enable nursing students to engage in an area of interest outside the essential standards required for pre-registration nursing (Nursing and Midwifery Council (NMC), 2010). Elective placements in developing countries are increasingly being used to help enrich cultural sensitivity and develop awareness of global nursing (Jacob, 2019).
I opted to spend my 4-week elective placement at the University Teaching Hospital (UTH) in the capital city of Lusaka, Zambia. While there, I split my time between the admission ward, intensive care, malnutrition and haematology in the paediatric hospital. UTH is divided into five different hospitals, which are all located on the same site, making for a large area to explore. Many patients and families travel long distances from villages across Zambia for the expertise of the UTH specialist healthcare teams.
Early on at UTH, I learned the importance of making the most of any experiences offered. On the admissions ward, I was provided with the opportunity to observe several post-mortem examinations. This allowed me to greatly improve my anatomy knowledge.
During my placement, I explored many of the professional and ethical issues in healthcare in Zambia. As Zambia is a developing country, its hospitals often only have access to limited resources such as medication, electronic monitors, personal protective equipment and sterile items. Zambian nurses are taught cost-effective methods for nursing practice. Used equipment such as intravenous lines, oxygen masks and catheters are routinely recycled for the next patient. The protocols and procedures of infection control are possibly one of the biggest differences between home and Zambian practice. Zambian nurses reuse patient-care equipment and avoid infection by decontaminating equipment using large containers of chlorine solution on the wards. In the UK, we often use disposable one-use equipment, which helps prevent the spread of disease and infection. However, in the future, with ever more pressure being placed on the NHS, I believe we can draw on Zambian practice to cut down on several wasteful practices. Moreover, at UTH I witnessed the shortage of opioid medication, this meant that patients could not be given morphine analgesia for more than 3 months. I was shocked by this and found it very upsetting that children who needed effective pain relief could not receive it due to a lack of resources and funding.
‘As Zambia is a developing country, its hospitals often only have access to limited resources … Zambian nurses are taught cost-effective methods for nursing practice’
Good nursing practice delivers individual compassionate care to patients by encouraging and empowering them to take an active role in their own care (Sinclair et al, 2016). Webb and Dening (2016) argued that a nurse's knowledge should be used and shared to increase control for patients and empower them as individuals. During my time on the haematology ward I was able to take part in the haemophilia clinic for the patients receiving their clotting factor treatment. The children in the clinic were encouraged, under supervision, to cannulate themselves and push their own medication through the line. This was an example of nurses working in effective partnership with patients to help promote individualistic care. This clinic helped to increase the children's confidence, independence and control of their own condition.
Many of the conditions I witnessed at UTH are not routinely seen in the UK. They included malaria, hydrocephalus, sickle cell disease and malnutrition. A lack of healthcare education and remote services in Zambia causes many families to present their children at hospital in a late stage with very severe symptoms. Often treatable conditions reach crisis points and children deteriorate extremely fast. I found that the Zambian interprofessional healthcare team shared an in-depth knowledge on conditions and worked collaboratively together to help treat their patients and improve families' education on health.
In summary, my elective experience taught me the importance of reflective practice. As a student, I have rarely paused to think about the cost implications of care and the waste generated. I believe that our effect on the environment and on resources is something we should all be conscious of and try to improve. I was amazed how resourceful the multi-professional team were with their restricted resources and how they dealt with the health concerns of their nation.
I feel privileged that I was able to experience the differences and similarities between UK and Zambian culture and healthcare. I understand how incredible the NHS is, and I am very proud to be part of it. I would strongly encourage any nursing student to step out of their comfort zone with their choice of placement for their elective. It will increase confidence, knowledge, critical thinking and enhance passion for global nursing. I found travelling overseas to be a life-changing opportunity for both personal and professional growth.