Career advice

My elective in Malawi highlighted the true values of nursing

Final year nursing student Sarah S Ball reflects on her trip to a remote village in Malawi, and how the duty of care is still at the heart of good practice.

Good care matters. If I learned one thing from my nursing elective in Malawi, East Africa, it was this: whatever the environment or situation, good care should be at the heart of our practice. It was an incredible contrast to come from a London hospital to a remote one-room clinic on the shores of Lake Malawi – no running water, road access, phone reception, market or electricity.

Sarah Ball (right) doing a malaria test and mentor Philippa Mander, health coordinator of the
charity Phunzira, dispensing medication at the clinic

Navigating such a low-resource environment as a nursing student was challenging and exciting. Not only were we working in a different cultural context to our own, but also a different culture in terms of healthcare. It was fascinating to explore what joined us across continents as healthcare workers and our duty to those in our care.

We spent the four weeks of our placement in the small fishing village of Ruarwe, situated on a sandy beach nestled on the north-western lakeshore. It took us a little over 12 hours to reach the village by a local motorboat, which set off from the nearest town once a week – making Ruarwe one of the most isolated settlements in the country. We were lucky enough to have a fantastic mentor – Philippa Mander, health coordinator with the charity Phunzira.

Phunzira was founded in 2009 to provide education and healthcare to the villagers of Ruarwe, where the lack of infrastructure and remote location makes accessing services extremely difficult. The clinic was a half an hour’s walk each day along the shore, and served a population of 8,000 people from the surrounding area, many walked far further than us.

'We are brought together in our duty to relieve suffering and to care for our patients, to the best of our abilities and with the resources available. My international elective was invaluable to me as a nursing student'

Watching staff at work in the clinic and participating in care was humbling. It led me to reflect on my own practice and the type of nurse that I would like to become. I have often thought that becoming a nurse is as much a process of socialisation as it is of learning practical skills. In Malawi, I was lucky enough to have the opportunity to build and reflect on these aspects of nursing training.

Reflective learning

During my time at the clinic, I gained confidence in giving injections, taking manual blood pressures, dressing wounds and dispensing medication. I learned about the pathology of malaria, sickle cell, the availability of certain medications, and managing the human immunodeficiency virus in Malawi. But perhaps, most importantly, I was reminded of the importance of looking at the patient, before any reliance on electronic measurements and numbers on screens. This last lesson was a reminder not to let dependence on technology or abundantly available resources distract from providing care that has a focus on humanity and dignity at its heart.

One morning, I watched the incision and drainage of a breast abscess in a young girl without anaesthesia. Removed from high-tech systems, the principles of care remained the same: non-maleficence, beneficence, and respect for autonomy.

'Universal hallmark'

Compassionate and courageous care such as that I witnessed in Malawi should be a universal hallmark of our practice as healthcare professionals – a dedication to do the right thing for the people we look after, and an effort to build relationships based on kindness and respect.

We are brought together in our duty to relieve suffering and to care for our patients, to the best of our abilities and with the resources available. My international elective was invaluable to me as a nursing student. Not only did it broaden the scope of my education and understanding in a culture and environment different to my own; but emphasised the values that should be at the heart of our practice and inspired me to reflect on the type of nurse I want to become.

For more details on the charity visit

About the author

Sarah S Ball is a final-year children’s nursing student at King’s College London

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