“More than any information learnt (which can be forgotten)… it’s better the experience impacts your thoughts, whether it’s [learning to be] more careful of the resources you do have or just being able to empathize better – that, I think is more difficult for people to learn”. This statement was written to me from Dr. Jhuthi, a medical officer I had the privilege of shadowing in Coast Provincial General Hospital’s New Born Unit, and it beautifully captures how I feel my internship with Internal Medical Aid has impacted me. To elaborate, although I had anticipated learning medical terminology or procedural guidelines during my time in Kenya, I actually gained insight into my character and who I am more than anything else during the trip. More specifically, my experience with IMA has taught me how to be more open – open to new career avenues, open to learning the context of situations before judging, and open to listening to perspectives that are different from my own. Being a person who is not used to stepping outside her comfort zone, this lesson was incredibly valuable for me because it helped me to truly understand what it means to work in healthcare.
I have never really considered becoming a therapist, counsellor, or psychiatrist. Before my internship with International Medical Aid, I did not even have a desire to set foot in a psychiatric ward. Yet, during my final few weeks in Mombasa, I found myself requesting to shadow at Port Reitz mental hospital, engaging in exciting conversations with my psychiatric resident roommate, and enrolling myself in a psychopharmacology class for when I returned back to school in Canada. Needless to say, I became fascinated with the fields of psychology and psychiatry during this internship.
There were many experiences in and out of the hospital that helped me to realize this fascination, one patient encounter in particular being very impactful: a man came into emergency who had just tried to commit suicide. He had done so by trying to slice his throat with a knife. As he was rolled in on his stretcher, I saw some other interns around stare in awe at his trachea sticking out of his opened throat that contracted and relaxed with every strangled breath he took. What I was concerned about, though, was his face; tears were streaming down the side of his cheek, of course because of the injury, but as I looked at his eyes, all I could think of was what kind of emotional pain he must have been in. This was his second suicide attempt that week – he had tried to hang himself just a few days earlier – and it made me so upset to imagine not only what kind of state his mental health was in, but also the reason why he was not taken to a facility after the first attempt or monitored. In other words, although the immediate, main concern of doctors in the ward was to fix his throat, I realized I was more concerned about how his mental health was going to be treated.
I brought this up during lunch at the program residence and one of my housemates, a recent medical school graduate, found my concern so interesting because she admitted that she wasn’t really thinking about the patient’s mental health when I told her about his situation; just like the other doctors in the ward, she was wired to think about the cut on his throat. This difference in the way we framed the situation made me realize that, in addition to my interest in human biology and the physical aspect of medicine, I am also very concerned with understanding what a patient is going through emotionally. My desire to have this kind of interpersonal interaction with patients was confirmed continually as I got to have different kinds of patient encounters. Much more so than the countless surgeries and suturing procedures I watched, I clearly remember situations like: getting to hold the hand of a mother who was getting her second degree peritoneal tears sutured, giving an HIV-positive mother her newborn baby, whom she had not been able to visit in weeks due to her illness, and having conversations with inpatients at Port Reitz who usually do not have anything to do all day. This insight into what I am passionate aboutmental health and learning patients’ stories – has really been helpful to me because I had thought that something more spontaneous and exciting like emergency medicine would be an area of healthcare I would be interested in pursuing. I am now much more open to changing direction and developing my interests by taking more psychology classes and looking more into different kinds of mental health careers in healthcare that will lead me to help people in a way that is true to what I love and value.
Interacting with so many patients face to face for the first time in my life not only helped me to understand what I enjoy, but also helped me to understand what kind of person I need to be in order to be the most caring healthcare provider possible. Being in a position where you establish intimate relationships with people almost instantaneously requires so much empathy and practice in learning to recognize your own biases. I believe being immersed in a completely new country and culture during this internship was especially helpful in developing these traits within me because I had to learn to accept certain aspects of Kenyan healthcare that I was not used to seeing back home in Canada. Being at CPGH in particular was a lesson in empathy for me since it was such a busy, over-crowded and under-resourced hospital. The first few weeks I interned there, truthfully, I was bothered by many issues like uncleanliness, disorganization, and an overall lack of a sense of urgency in the attitudes of the staff. I recall other interns being frustrated by the fact that there most patients pay by pocket and so, if they did not have money, they did not get treated. One intern was so upset by this that she basically accused the doctors by saying, “so you just let them die?” I remember being upset as well, especially being from a country with universal healthcare, but in that moment, I learned to take a step back and learn the context of the situation. I knew that CPGH was the second-largest hospital in Kenya and that it was part of the public sector, funded by a mere 6% of the government budget (Njeru, 2018).
The fact that patients have to be turned away from the hospital is an ugly issue, but once you face reality, you see that if the hospital were to take every patient that could not afford treatment in and treat them, evidently, resources would be drained. After discovering how much money the government allocates for healthcare during one of the IMA lectures, it is not difficult to comprehend how helpless the staff at CPGH are when it comes to receiving patients that cannot afford treatment. It is easy to blame who you see right in front of you, but learning to recognize the underlying issue was incredibly valuable for me; not only did it make me a much more empathetic towards patient and healthcare staff alike, but it also made me learn to approach the healthcare system in a holistic way by appreciating how much the immediate care provided by the doctors, nurses, paramedics etc. is affected and essentially controlled by the politicians and policy makers in a whole different, political side of medicine.
As a first year undergraduate student who is just starting to explore what it means to be in medicine, the experience I have gained from this internship will be incredibly helpful as I decide what I want my future in healthcare to look like. In the long term, I know that the insight I have gained into different systems of healthcare has made me into a person who strives to be empathetic and I hope that will translate onto any patients that I encounter. In the short term, the internship has also been so helpful in terms of my university life: I now have further insight into what I would be interested in studying and as a member of a Medicins Sans Frontières chapter at my university, I can now use my experience to have a better understanding of how crucial initiatives like raising awareness about having the right to healthcare and World Aids Day actually impact real people. Truthfully, I was concerned that my inexperience and age would prevent me from being able to gain a lot from this internship. In reality though, I believe having such an immersive experience at such an early stage in my academic career has helped me to have a much more focused outlook on what I want to study and more importantly, what kind of person I want to become.