For the past three years, I have worked as a 5th grade bilingual Math/Science teacher in the southwest side of Chicago. I became a teacher through the program Teach for America, whose mission is, “enlist, develop, and mobilize as many as possible of our nation’s most promising future leaders to grow and strengthen the movement for educational equity excellence.” Although the United States of America is a developed nation, it is a country where racism still persists and is one of the main roots of a major challenge: educational inequity. Unfortunately, many children are still lacking the proper education and opportunities that can help them grow economically and academically, which then perpetuates their family’s low- income household. I have seen the ways that mismanagement of a nation’s economy can benefit some whilst hurting others. Something that I see lacking a lot in the low-income communities and their public schools, is a massive under resourcing of mental health professionals.
My experience as a teacher, paired with my undergraduate degree in psychology, has made me want to pursue a career in the mental health field. Which is why, a year ago, I was researching mental health programs, especially those that would give me more experience working in underserved communities. I am specifically interested in being a school psychologist and working with students who have experienced trauma. The four weeks I lived in Mombasa, Kenya impacted me in ways I did not anticipate or expect. I went in with no expectation and had no idea what my experience was going to be include.
Before my internship experience with International Medical Aid (IMA), I had very little experience actually shadowing or observing counselors, besides my psychology courses when I was still attending university. My first day at the Gender Based Violence Recovery Center (GBVRC) at the Coast General Provincial Hospital (CGPH) I met a couple people who either volunteered or worked at GBVRC. I was given a packet to read that contained the procedures that were to be followed whenever any survivors, patients, came to the center. Survivors would go through reception first and they had to come with a referral. Many times, it was just a paper they obtained from within the hospital, although some referrals came from the police station, depending on what the case entailed. Then, they would wait to be called into the Counseling/Triage room, where I was, along with whomever was in charge of counseling that day. After counseling, survivors are taken to the doctors’ room, where they are given a comprehensive head to toe examination, as well as taking specimen for investigation.
From my experience the week I was in the GBVRC, I learned the importance of building rapport and about the opinions and ideas that still surrounds the topic of sexual violence. We never knew how much information the survivors were going to share or felt comfortable sharing; or any certainty of how quick they would explain what happened to them. I was able to observe and learn from the counselors how important it is to make the survivor’s feel safe and comfortable. Most cases were about rape or statutory rape, which are not easy things to share with someone you’ve just met. However, as the counselor it is important to get as much information as possible to determine what next medical steps need to take place, and to properly provide counseling specific to how the survivor was feeling. At times, the counselors would help the survivors make goals and talk about their achievements. This built their rapport further, and it helped survivors realize and/or recognize the good that has been in their life before. By doing so, survivors can start to move forward and understand that what happened was not their fault.
I also learned that a lot of stigmas still surround sexual harassment and sexual violence, which can make survivors feel like they should not share their experience. There were survivors that came within 24 hours of their rape, and for some, months had passed. Reasons for waiting to report, were rooted in fear, and in thoughts that it was their own fault for what had happened. I was able to witness counselors ask, “Why did you wait to report?” multiple times, not something I would feel is my place to question, but that I learned is a great way to keep the survivors participating in the session. Some survivors put off reporting because they feared they were going to be punished or consequence by their parent/guardians.
After my week in the GBVRC, I moved to the Psychiatric Clinic, also referred to as “Psychiatry”. Here, I saw a myriad of diagnoses and types of patients too. The clinic was open every day, but had different foci depending on the day. Mondays and Thursdays were open clinic days, and these tend to be the busiest days where anyone with a referral or has checked in at the hospital can attend. Tuesdays and Fridays were substance abuse days, and these days there were few people who came, but was a day that they invited patients to come for a longer counseling session. Wednesdays was the “Forensics” day, where prisoners were brought to be assessed on whether they were fit for trial or not.
Within my first day at Psychiatry, I noticed many differences between counseling in the U.S and Mombasa. For starters, I was going to be observing the psychiatric nurse, not a psychiatrist, because there is only one psychiatrist in all of Mombasa, and they only came to the clinic on Wednesdays. Also, there was very little privacy. All counseling sessions were conducted with the door open and people would frequently drop in during the middle of a session, or interrupt to ask questions, or even to have a conversation. Also, most patients came with other people, mainly family members. The great majority of patients came with family, and the psychiatric nurse would ask everyone present questions.
I was in psychiatry for two weeks and in that short time I was able to see the significance and importance of having family members present and involved. No matter the diagnosis, a support system is vital. The psychiatric nurse was able to ask family members to provide history and observations of symptoms and or recognize any improvements while on medication. Having the support system can also ensure compliance of medication and accountability for follow-up appointments. Occasionally, they are also their financial support and live with the patient, so their involvement is imperative. There were instances when the patient was unable to communicate properly, or at all. If no family members were present in these cases, a proper diagnosis and prescription would be impossible.
Before this internship, I was unsure and unclear on whether or not I wanted to pursue a career in mental health. I have enjoyed my time as a teacher, but this experience invigorated my love for mental health. Moving forward, I know that I am passionate about providing those in need with mental health services. The lives we all lead come with trials and tribulations, but for the members of under-served, low-income, minority, less educated communities, their lives come with extra obstacles. The likelihood of early intervention is a lot less in these communities. At CPGH, I saw how finances can have someone avoid coming in because they know they cannot afford services, which in effect can make symptoms get worse, both with physical and mental health. Although there is a way the government can help with insurance, for many, they do not have the means to afford another monthly bill.
This has taught me that there is a huge disparity between the healthcare conditions provided to those who are wealthy, middle-class, or low-income. It is not fair that priority is given to appeasing those who are wealthy, only because they are better able to advocate for themselves. The government should understand that there is a much greater priority, helping those in need. They think that due to a lack of education they are able to abuse their own power and continue to disserve those who are in need the most. I see the same with my school in Chicago, where our school is under-resources only because it’s in a low-income community. My drive moving forward will be to continue finding ways to provide services to these communities.
Not only do I want to pursue a career in the healthcare system, specifically providing mental health services. I want to advocate for communities that continue to be underfunded and under sourced. I saw how under resourced CPGH was and it effects the ability to proper care for patients. I want to be trained and educated and be able to serve communities with limited resources and supplies. Also, through my experience, I know that I want to be more informed on how to provide counseling to patients that are taking medications, have experience trauma, and/or sexual assault.
I was blessed with this opportunity and all its teachings were not just about healthcare. Despite its newness as a country, I see people who are hard workers and work for a better future. As curious as I am, I was asked questions by the counselors and other staff members about my experiences and what my thoughts were on Kenya. I talked to people with varying opinions and different religions, and different education levels. Most of my time was in the hospital, but I also was able to go to different communities, an orphanage, a primary school, and explore places that are integral to who Kenyans are, and why Kenya is who it is. I want to bottle up all the feelings and teachings that came from this summer, so that I will never forget what this summer was. I want to communicate to people I meet all that Kenya was for me. Many assume it is somewhere dirty, poor, and not up their living standards. Although there are stark differences between Kenya and the United States, it does not lack beauty. Despite its religious diversity, I saw unity as a country and acceptance of each other, no matter the differences.