My experience in Mombasa what life changing. The people I met and all that I learned while working at CPGH was irreplaceable. I worked in the nutrition department at CPGH and saw so many different types of conditions and learned so much about the health care system in Kenya. The support from the International Medical Aid’s staff was amazing. Bella and Husna were always there when I needed something and I felt like they truly cared about my well-being and experience. The food at the house was AMAZING to say the least. I am a pescatarian and don’t eat poultry or red meat and they were so accommodating! Their fish was so delicious and tasted so fresh. All of the cooks were so sweet as well and they even let me use the kitchen one night to bake chocolate chip cookies! International Medical Aid and my trip to Kenya was truly amazing and I can’t wait till I get to go back one day. The impact this experience had on me will last a life time and I hope the knowledge I gained will help me with my future career to change the lives of those around me.

Growing up, I never knew what I wanted to do. I looked at my friends who were so sure of their passions and their future, but when I looked at myself, I was stumped. The one thing I was always sure of was that I wanted to help people. “But how can I do that?” I would ask myself constantly. Then, in 10th grade, I was diagnosed with the autoimmune disease, Type 1 Diabetes. This changed everything. One thing I learned quickly after being diagnosed was that there were a lot of different medical professionals involved in the management of this disease. Every three months I would visit an Endocrinologist, Dietitian (RD), Therapist, and a Certified Diabetes Educator. During these appointments, I was always intrigued by the Dietitian and found it so fascinating how foods and the nutrients can affect our body on a molecular level. This was when I knew how I was going to help people, as a Dietitian.

When I arrived in Mombasa in June of 2019, I had no idea what to expect. I have taught nutrition classes to low income families in the area where I live, and I figured this might be similar to what I might see in Kenya. When I went into Coast Provincial General Hospital (CPGH) on that first Monday, I had no idea that what I would see there would forever change my life and my perspective on health care.

During my time at CPGH, I was working in the Nutrition department. I shadowed Dietitians and Nutrition interns in almost every department of the hospital, because nutritional support is needed everywhere. The differences between nutritional support in the United States and Kenya varies greatly, as well as the conditions seen in the different hospitals. During my first week at CPGH, I spent most of my time in the pediatrics department. I was shocked to see over a dozen cases of PEM, aka. Protein Energy Malnutrition, which is not common in developed nations because malnutrition is a poverty associated condition, which is very common in Kenya. (The Current State of Healthcare in Kenya, pg.33) I was able to learn, hands on, about the different types of malnutrition, which was an invaluable experience and something I would have never been able to see in the United States. I remember one patient in particular that really stuck with me. It was a young boy around the age of 3 years who had Kwashiorkor. I had seen pictures in textbooks of this condition, but it is so rare to see cases like this back home. The child had edema and his whole abdomen was so swollen and distended that he couldn’t even sit up straight. The Nutritionist, Hussein, working in this department looked at me and said, “what can we do for this patient?” I remember having no idea how to approach a case of PEM this severe. I had no idea what was in store for me. Hussein was very knowledgeable and informed me on the two main types of PEM, Kwashiorkor and Marasmus. Over the next week, I was able to learn how to diagnose and differentiate between the two, as well as learning about the different treatment methods for both of these conditions and how to measure the level of malnutrition a patient has. In the pediatrics department, I also saw many cases of iron deficiency Anemia, meningitis, and tuberculosis.

Although I saw many conditions which are uncommon in the United States, I also saw many conditions that I was familiar with. One of these conditions that I got to see a lot of was Diabetes Mellitus, both Type 1 and Type 2. Non-communicable diseases (NCDs), such as Diabetes, are one of the top three areas that contribute to the disease burden in Kenya. “Non-communicable diseases account for 27% of the total deaths and over 50% of total hospital admissions in Kenya.” (Disease Burden in Kenya, pg.20) Because NCDs like Diabetes are so common in Kenya, I saw many cases of Diabetic patients at CPGH. While working in the Diabetes Clinic, I was able to learn how these conditions are treated and managed, which was very different from the management for Diabetes in the United States. The first thing I was taught while working with Diabetic patients at CPGH is that both Type 1 and Type 2 patients are immediately put on the “diabetic diet” when they are diagnosed. This is different from the treatment in the United States in that only Type 2 Diabetics are prescribed a “diabetic diet,” while Type 1 Diabetics are immediately put on insulin therapy. Type 1 Diabetics work with a Dietitian to maintain a healthy diet, but their carb intake is not limited like the Type 2 patients on the diabetic diet. At CPGH I learned that the Type 1 Diabetic patients are typically put on a long acting, mixed insulin and are advised to take two injections daily. In the United States, Type 1 patients are typically on two types of insulin, long acting, and short acting. They will take anywhere from 5-10 injections per day, or they will use an insulin pump, which is not an option for Diabetics in Kenya. In Kenya, there are also many misconceptions about Diabetes. I learned that it is not uncommon for families to think that the Diabetic patient is cursed, or that their disease is a result of witchcraft. This leads to families of patients not wanting to give the proper care to the patient, but instead trying to use prayer and other natural remedies to “cure” them. Working at the Diabetes clinic was an eye-opening experience for me because of how different the management for the disease is. This gave me a new perspective into the health care in developing nations that I would have never known about otherwise, as well as broadening my horizons to learn about how other cultures perceive different diseases.

The ICU at CPGH was one of the most rewarding, but also most taxing departments, that I was able to work in. Before I came to Kenya, I knew I wanted to be a clinical Dietitian and work in a hospital, but I wasn’t sure which departments I had interest in. After spending a week in the ICU at CPGH, I fell in love. The ICU was so challenging because you are treating patients with life threatening conditions, and most of them aren’t using oral feeds, but instead are on TPN (Total Parenteral Nutrition) or NG tube (Nasogastric intubation). This means that your role as the Dietitian is to come up with the feeds that will be given to these patients. I learned the most working in the ICU, because there is so much for the Dietitian to do. I learned how to assess a patients nutritional and physical status to decide what type of feed (oral, TPN, NG) they should be put on. Derrick, the Nutrition Intern working in the ICU, was so engaging and showed me the different types of TPN feeds they use at CPGH and how to calculate the amount of feed the patient should be receiving per hour, as well as how to administer the feeds. He taught me how to prepare diets, meal plans, and mixed feeds for patients that are on an NG tube. 36.1% of Kenyan’s are living below the international poverty line. (The History of Pre and Post-Colonial Kenya, pg.20) This means the Dietitians have to consider whether or not the family can afford something when planning feeds for patients in the ICU at CPGH. At CPGH, all patients are given porridge, along with options of milk, mala (fermented milk) or juice. If the patient requires NG feeding, they would initially be given porridge through the NG tube. Typically, the patients require more nutrients than just what the porridge can provide so it is up to the families of the patients to provide the funds for a speicialized feed. “About 50% of Kenyan households are food insecure due to poverty and inadequate food production.” (The Current State of Healthcare in Kenya, pg.20) This means that providing the proper diets for patients at the hospital can be impossible for some families. When coming up with feeds, this was something that had to be prioritized. I think the reason why I loved working in the ICU so much was because of all of these challenges. With all of the obstacles thrown at you, it makes you think critically and become a better Dietitian. But it is so rewarding because you get to see patients heal and see an actual difference in whether or not what diets you are prescribing are helping them or not. Because of my time at the ICU at CPGH, I have found a passion in my future career that I never would have known about. I cannot wait to see how this will affect my career as a Dietitian.

The experience I had at CPGH was truly life changing and has given me so much clinical knowledge that I will be able to take with me into my career as a Dietitian. I think above all the knowledge I’ve gained, most importantly, I was exposed to a new culture and community. Spending six weeks in Mombasa, working at CPGH, I have grown an interest in public health and helping lower income communities right here at home. I come from the San Francisco Bay Area, which has a large homeless community, as well as many people who are classified as low income, living paycheck to paycheck. My experience in Kenya has shown me how important it I s that everyone have access to health care. I am beyond excited and eager to start my career. International Medical Aid and all the Nutritionists and Dietitians at CPGH have given me an irreplaceable experience that will stick with me throughout my future in the health care field and will always hold a special place in my heart.