Clinical placements

Never underestimate the importance of engaging with patients

During an elective placement in the Philippines, nursing student Cara Sturgess witnessed some great examples of compassionate care, delivered by dedicated nursing staff, despite high levels of poverty and deprivation. 

During an elective placement in the Philippines, nursing student Cara Sturgess witnessed some great examples of compassionate care, delivered by dedicated nursing staff despite high levels of poverty and deprivation 

Cara Sturgess worked in the department of psychiatry in the Philippines.

For my elective placement at the end of my second year of training, I chose to visit the Philippines. I worked in the department of psychiatry in a small government hospital in a deprived city.

The ward had 20 beds that were shared by a patient and a family member, who was required to stay with their relative throughout their admission. 

Consultant psychiatrists have no holding powers in the Philippines, it is for the family to decide when a patient is admitted and discharged. 

Shocking poverty

I researched the hospital before I arrived, and spoke with the organising team about what to expect. I thought I had prepared myself well, but I soon discovered that nothing could have prepared me for the poverty and deprivation I would witness. 

Admission to the ward was government funded, but food, water and medication had to be purchased. Often, relatives of patients would only be able to afford 2-3 tablets a time from the onsite pharmacy, so there was a high rate of relapse and readmissions. 

The beds had no mattresses, and unwell or distressed patients were tied to the bed using holes in the frame, which goes against everything we learn and practice in the UK. 

Care and dedication

The most interesting aspect of this for me was that the theory underpinning the care was current and evidence-based, but the lack of money, staff and resources made it impossible to deliver care safely and effectively.

The team worked tirelessly to nurse their patients to the best standard they could, but their frustration at being so limited by their surroundings was palpable. 

Beds on the ward had no mattresses. 

Despite the limitations experienced by the nursing team, it was clear from their interactions with their patients how much they cared for them, and from the way they communicated with other professionals. 

It also became clear that although the patients were often hungry, dehydrated and distressed, it was the dedication of the staff that meant the most to them. There were no psychological therapies available but the staff ran a constant stream of activities for patients and their families, which they were always grateful for. 

Supporting patients 

Although it seemed strange to me that the relatives of patients make the decision to admit or discharge a loved one, the handful of families I met during this time held so much hope, perhaps because they felt they had more control over their relatives’ care than in the UK. 

This, combined with the hope nurses held for their patients, created an overwhelming sense of optimism within the patients themselves. There appeared to be little doubt that recovery was a possibility, despite the potential barriers.

This experience taught me to never underestimate the importance of engaging with patients face-to-face. No matter what resources we have available, or what paperwork needs completing, the fundamental aspect of nursing for me is building relationships, and caring for and supporting our patients.

Cara Sturgess is a third-year mental health nursing student at the University of Southampton 

This article is for subscribers only