My clinical internship in Mombasa, Kenya was the best experience of my life thus far. It has been a month since I have been home in the states, and not a day has passed that I have not dreamed of the people, culture, hospital wards, and the incredibly vibrant spirit that is Kenya. My whole family did not want me to come; they were afraid for my wellbeing. After fundraising the cost of my trip, they couldn’t have been happier when I assured them of my safety at the residence in Kenya. The entire staff went above and beyond to make us feel comfortable and at home during our stay. The hospitality and cooking were unlike any I’d ever had – we were so welcomed and loved. I learned more than I ever thought I would during my internship and rotations in the hospital. I spent every day with my jaw to the floor, in complete awe of my surroundings. This experience awoken my soul and changed what direction I want to go in healthcare. I would recommend this program to absolutely anyone. I greatly hope to go back.
When I arrived in Kenya, I was wide-eyed, restless, and eager to breathe in every single aspect of Kenyan culture, tradition, and healthcare. I came into the program as a pre-nursing student and a Certified Nursing Assistant for the last year and a half, working back home in a nursing and rehabilitation home for the elderly. My only hospital experience was the 40 hours of clinicals that my program required for training. Needless to say, I had no idea what to expect. All I knew going into this experience was that it was going to change me. I severely underestimated how deeply it would.
My first rotation in the hospital was in obstetrics. I saw a twin C-section in theatre on my very first day in the hospital and it was the most fascinating experience of my lifetime thus far. Throughout the week I had the pleasure of witnessing 15 babies come into this world. It was the most beautiful, raw, and touching experience I’ve ever been a part of and I felt as if I could stay there forever. Of all of the differences between Western and Kenyan hospitals and healthcare systems, I was most taken back by the procedures in the labor and delivery ward.
One of the first things I witnessed was the extreme shortage of supplies. You had to hunt hard for a pair of gloves, there was no soap, and no hand sanitizer. I later found it to be odd when I worked in the ICU and ER and found that they had plenty of these products, which seemed just as essential during labor and delivery. They seemed to always be very busy, with a shortage of beds, thus explaining the reasoning behind their protocols. They did not come out and say it, but it seemed as if their goal was to get patients in and out as efficiently as possible, with good outcomes of course. Expecting mothers were instructed to come to the hospital at the first sign of labor pains, at which point the nurses began the process of artificially (manually) rupturing their membranes (breaking their water), if their water had not spontaneously broken yet. At the first sign of labor, your water in most cases has not broken yet. When the amniotic sac ruptures, the cushioning between the fetus and uterus is decreased, both of which are processes that increase the frequency and intensity of contractions. In other words, stripping the membrane is a way to induce labor and speed the process along. Spontaneous rupture of membranes is the most common practice in the U.S., unless there are complications and inducing labor is absolutely necessary. If they need to rupture the membrane in the U.S., they use a sterile plastic hook instead of a needle, and it usually is not painful. Watching the women in Kenya being poked and prodded with a needle inside their cervix until a gush of fluid and blood rushed out while they yelled and screamed in pain was horrifying, and my heart hurt for them every second of the way.
Following the rupturing, it was then a waiting game as they continued to measure the cervix until the women were fully dilated. The birthing process was also much different than that of in the United States. It was much less personal and intimate for the mother and baby, and much less of a celebration that it is in America. The mothers never seemed to show much emotion after giving birth or towards what sex the child was, or perhaps they were too exhausted to show it. During birth they were often hit by the nurses to spread their legs open or push harder, and they took the pain with such endurance and strength. After cutting the umbilical cord, the protocol is to quickly show the sex of the baby to the mom, wrap the baby on her chest, and whisk the baby away for measurements. The mother is then given a shot of oxytocin immediately, and the nurses force the delivery of the placenta by pulling the umbilical cord tightly until it spills out. In the U.S., the placenta is only delivered naturally, unless there are complications, or it is during C-section. Afterwards, the mother is cleaned up and within minutes she is standing and walking to retrieve her baby. They are then moved to the Post-Natal ward where they are allowed to stay for 24 hours, where they must share a bed with another new mom due to overcrowding. In America, women cry for hours during and after birth. Their whole family gets to be there, especially their spouse or partner. They have a private room, or at least their own bed. They are pampered. These women were happy with just their baby being alive and healthy. They did not care about anything else. I compared them to warriors. The women of Kenya will forever be warriors in my mind and in my heart.
To end on my experience in labor and delivery, as it was by far the most moving for me, I was very surprised by the cultural differences in birth control. On the first day I noticed a nurse wearing a uniform that said, “Ask me about…,” with a picture of an intrauterine device. I asked her for additional informational and then asked several other doctors and nurses in the ward. They offer the copper (non-hormonal) IUD free of cost for any women post-delivery, and many government funded organizations will provide contraceptives at little or no cost. An IUD at a private hospital in Kenya costs between 7,000-15,000 shillings. I asked if a lot of women take them up on this offer of a free IUD post-partum, and they said no. I learned that in Kenya, and in the Muslim culture, men don’t believe in family planning. They believe that pregnancy is part of God’s plan and it is wrong to tamper with his narrative. They prefer if their wives do not take birth control. The women I spoke to say that many take it behind their back and that the Depo-Provera birth control shot is popular for this reason because it can remain a secret. Some partners can notice the IUD, the pill is obvious since you take it every day, and the Nexplanon arm implant is big enough to feel. However, according to my research, the most common form of birth control in Kenya is the pill. It hurts my heart that women have to hide this from their partners in order to be in control of their own bodies. Here in the U.S., as women we are constantly having to stand up to our Republican government and argue for the rights to our own body that were given to us at the beginning of time when it comes to abortion laws. I cannot imagine it going any further than that, but in Kenya it is worse for women in every way.
As I drove away from our residence in Kenya, I had never felt more lost or alive all at the same time. And the most beautiful, profound part of the entire journey, was how much it changed me fundamentally. It awakened my soul to find a deeper purpose to my existence and helped me find what I need to do in order to feel fulfilled in life. My internship with International Medical Aid and my experience in Kenya has drastically changed the course of my future healthcare plans. Instead of staying sedentary after completing my degree in two years, I plan on traveling with Nurses Without Boarders to different developing countries each year for a month and volunteering my services. Kenya has created a passion for service within me that I never knew existed so boldly. The thoughts and memories of the Kenyan people and their culture is all-consuming. I have never missed a place so badly. I yearn for the day I can return and gaze in awe again over the people, the sights, and the healthcare system. I now know that I was put on this earth to help others, to nurture spirits, and bring care to parts of the world that need it. My ultimate goal would be to move to Africa for several years. It takes time to truly make a difference, and four weeks just wasn’t enough. I’ll be back.