Before my internship with International Medical Aid, I was conflicted with my future career path. Since eighth grade I had my heart set on being a pediatrician or a family practitioner, but as I grew older I developed a new interest of public health and health equity. Recently, I have been struggling with combining my two passions. As I did more research, I discovered disaster relief medicine, international medicine, or work with communities who have inequitable access to health care are possibilities. In these career paths, I can practice medicine while creating more equitable and sustainable access to quality health care. But this past summer, I started to doubt my ability to take on the challenges of medical school – as its no easy task – and I was unsure if I was cut out for long hours, intense workload, and honestly, blood.

Within a couple hours of my first day in the Labor Ward, I knew I could handle blood. I remember it clearly. By 10am Monday morning there had been four births and everyone was running around to deliver a baby, or placenta, suture up a woman’s tear, or taking care of a newborn. As I watched the blood drip onto the floor, I thought nothing of it except for excitement because I realized I could handle blood. My entire experience with this internship was discovering new abilities I had and how eager I was to use them in the future.

Each day in the hospital brought on new surprises and challenges, but as I surpassed each one, I became more and more confident in myself and my future. My first surgery, a C-section, taught me that I crave to scrub in and suture up. As each minute went by, I slowly inched closer and closer wanting to get a better view of the surgery. I was ready to scrub in and learn as much as possible about the anatomy and steps of the C-section.

My second week, I was placed in internal medicine and by the end I knew this what I want to do. I loved the variety of symptoms, diseases, and treatment in internal medicine and the ability to work with inpatients and outpatients. Doctors were always thinking and trying to figure out the puzzle of the patient’s symptoms. One of the most memorable moments for me was working in outpatient in the cardiac clinic. I loved asking patients questions and learning about their symptoms.

On my second day in internal medicine, I was with an intern M.O. and she was going through a woman’s medical history and writing up her chart. The woman had posterior lumbar pain. Her abdomen CT scan showed that her right kidney was inflamed and she recently had a miscarriage and had pain in her lower abdomen. The intern M.O. stepped out to get a consultation about her CT scan and the patient turned to me and asked me if I thought her inflamed kidney was what caused her miscarriage. I didn’t know the answer to her questions. I despised the feeling of not knowing and not being able to help her. I didn’t know what was causing the issue with her kidney or her miscarriage, but I couldn’t help her. I wanted to figure out what was wrong with her so she would not worry or fear what was wrong with her.

After the hospital, I felt unsettled and researched everything I could think of related to kidneys and miscarriages and uteruses. I still wasn’t sure which infuriated me. I wanted help, but I couldn’t. In that moment, I turned my frustration and anger to motivation. This interaction is what I now use as motivation to get through stressful times preparing for – and hopefully, will stick with me during – medical school.

In ever interaction with a patient, whether it was watching, asking the patient a question, helping dress wounds, or using my stethoscope, I had a surge of exhilaration running through my body. I felt like I was at the start of making my dreams come true.

To be honest, at the beginning of my internship I didn’t have the urge to suture or put an IV in. I was scared and didn’t want to harm any patient, but by the end it took everything in me not to step up and ask to draw blood myself. After watching M.O.s, C.O.s and nurses’ practice, and Dr. Arif’s seminars on intubation, IVs, and suturing, I wanted to do them myself, but I knew I was not qualified and couldn’t risk harming patients. Instead, I used this as motivation. By the end of my internship I was ready to go home in order to look at medical schools, prep for the MCATs, finish up my last two years of undergrad to get back in a hospital and be allowed to practice medicine on my own.

Not only have I learned a tremendous amount about medical diagnosing, treatment, and care, but I also learned a lot about the impact of health care on communities. I learned about the basics from my time in triage in IMA’s pop-up medical clinics to learning about an orthopedic surgical femur repair. Furthermore, the impact of communicable diseases and non-communicable diseases on communities in developing countries is something I was never exposed to in the US. Diseases such as AIDs, tuberculosis, malaria and dengue fever are out of control in developing countries (Boutayeb 2006). First hand, I saw how these diseases affected the patients at Coast. Not a single patient had just one thing wrong with them, and sometimes patients contracted communicable diseases – like TB – while in the hospital. Furthermore, Non-communicable diseases account for 27% of total deaths and over 50% of total hospital admissions in Kenya (Boutayeb 2006). Non-communicable diseases such as, cardiovascular conditions, cancer, diabetes, violence, epilepsy and mental disorders are just a few examples. Patients suffering from these diseases come to the hospital as last resort. Sometimes, public hospitals are too expensive for citizens of Mombasa. Patients leave with the best care they can afford, but often times it’s not a sustainable treatment.

While in Kenya, I learned a lot about myself. Not only my future and ambitions, but also more about what I am capable of doing. I was pushed – in and out of the hospital – to be more confident in my decisions and to do things I never thought I would do. In the hospital, there were countless occasions where I was asked to put in IV’s or suture, but with zero previous experience in the medical field, I was not comfortable to perform either. My first week I was told I was going to deliver a baby. Don’t get me wrong, I wanted to do it and be more hands on, but I wasn’t comfortable to do so with the minimal training and experience I had. I respectfully refused, but on some occasions, I had to do it repeatedly and stand my ground. On the other side of it, I was pushed to be in highly sensitive situations I wasn’t sure I could handle. For instance, on my first day in the surgery ward, I was pulled into a tiny room with a nurse dressing a woman’s burn wounds. This was the first time I have seen burn wounds and this woman was covered with burns. The patient had an epileptic episode and fell into a fire pit with no one around to help her. She was burnt on both of her legs, stomach, breasts, and her arms. One arm was fully burnt with negligible movement in her fingers, but the other arm was amputated above the elbow because of how severely burnt it was. After two months of recovery, most of her body was exposed flesh. What stuck out to me were the smell of burnt flesh and the flies landing in her open wounds. During the three hours I helped the nurse dress wounds, I felt like my instincts took over me. I mainly swatted the flies away, handed the nurse cream and the dressings, but I didn’t realize until later that afternoon how intense that situation was. I felt awful for what pain that woman had to endure and I still do, but I also try to take the positives out of this situation. First, this woman is incredibly strong – she represents true bravery and determination. Second, this situation showed me the power and influence doctors, nurses, and other medical practitioners have. When patients seek medical care they are in the most vulnerable and exposed situations.

Medical professionals are entrusted with the lives of people. Finally, this situation taught me a lot about myself. I realized I can handle high pressure situations and can prioritize the care patients over emotions.

In the future, the knowledge I have acquired will be helpful for my volunteering with the Blood Center at St. Jude, as well as, when I am in DO school and learning about patient care, diseases and illnesses, and treatment. Furthermore, my experience in Kenya has helped me gain a new perspective of what I want/have in life and what I need. In Kenyan culture, I notice there is a different prioritization of values. Even in the simple phrase, “hakuna matata” or “no worries” people seem to not fret the small stuff. Kenya has helped me check myself and focus on what is important and good for me. To continue, my time in Kenya taught me that I value the health and happiness of myself, my family, and my friends over all else. What I want is to keep challenging myself and making sure I’m happy while doing it. For me, that’s going to medical school, focusing on public health and giving the best care I can to patients.

Another aspect of health care I learned about was the public health care’s role was in the access to quality care. In the Coast Providence, citizens are from predominately minority tribes. Past and present Presidents and Prime Minister have only been from two majority ethnic tribes, which has resulted in some bias and uneven distribution of money towards providences with minority tribes. CPGH is a regional hospital funded by the regional government that is distributed from the national level. Since the Coast Providence is not represented very well at the national level, the hospital is underfunded and understaffed. Gloves and hand sanitizer are difficult to find at times, but more importantly, doctors split their time at Coast and their own private practices, patients don’t have privacy, and there are not enough monitors, suture kits, beds, etc. Speaking of private practices, once doctors are done with their fellowships, many go to private practice because that is where the money is. The Kenya private sector is one of the most developed and dynamic in Sub Saharan Africa (Barnes et. al. 2010). For those that can afford private health care, it is fantastic care, but for those seeking public health care it leaves them with doctors at the hospital for only a couple hours a day. Many doctors that work at CPGH only come in for a 3-4 hours a day and they consider it volunteering because the hospital can’t afford to pay them a competitive salary.

Furthermore, the culture around health care affects how people view going to see a doctor. It’s important to note, that cultures are created around the lifestyles of people; it comes from people’s jobs, income, food security, access to transportation, and access to quality education which affects the culture around health care. For instance, food security is a public health issue that effects the overall health of patients seeking care. In Kenya, people with low incomes cannot purchase adequate food, such as fruit and meats, to reach recommended levels of food and nutrition (Olielo 2013). Food insecurity leaves people in various forms of malnutrition and makes it more difficult for patients to recover from diseases and illnesses. Additionally, Because forty-two percent of a population of 44 million in Kenya live below the poverty line (“UNICEF” 2018) going to the hospital when a child has a small rash or an adult finding a lump, or getting annual checkups is not the most important thing. Food on the table, clean water, and a home for their family is where money goes first. This isn’t just a Kenyan problem, it is international problem. Every family in the world deal with this situation, but especially those below the poverty line.

Moreover, the Kenyan population is religious, about 70% are Christian (38% Protestant, 28% Catholic), about 25% are adherent of indigenous religions and 6% are Muslim (“East” 2018). Religion and ethnic tribes influence patient’s decisions of when and where to get access to health care. There are many religious healing practices, as well as, praying and having faith in God and his plan. Some communities will partially or wholly rely on religion for answers concerning their health and wellbeing. This affects how people view western medicine practices and if they go to hospitals or clinics for health care.

My time with IMA and CPGH felt too short. In some ways, I was ready to leave to kick start my career, as this internship has motivated me beyond belief. But, I miss being in the hospital; asking questions and building friendships with the M.O.s, C.O.s and nurses at Coast. They taught me about medicine, yes, but they also taught me about people’s decision making, their cultures and beliefs, what it means to be a strong and empathetic doctor and about what I want in my life and future. Thank you, Kenya, IMA, and Coast for giving me the opportunity to participate in a life changing medical internship.