This internship has been the most challenging yet rewarding experience I have ever done. Due to the lack of some resources, it made it difficult for me to observe some patient cases. I have learned and seen more at CPGH than I would have ever thought was possible. Both Bella and Phares did everything in their power to make accommodations for me whether it was at the hospital or in Mombasa. In Kenya I never really felt unsafe. I was always in a group of people and never ventured out late at night. These three weeks have made me both mentally and emotionally stronger and will definitely guide me to be a better physician in the future.

In my opinion the most valuable aspect of this program were the people at the hospital whether it was interns, residents, or even nurses; all of them wanted you to learn. Obviously, there was a language barrier so while they were doing rounds once they were done conversing with the patient they would explain what was going on in English. Or in surgery the lead surgeon would explain the anatomy, the precise steps he/she was doing, and why it was important. When looking at CT scans interns would explain the disease and show us where it was located on the x-ray. The little things that the staff at CPGH did to accommodate me made me have a better understanding of the medical field.

Coming to Kenya to work at Coast General I knew there was going to be a lack of resources compared to what I had been used to seeing in the United States. Because of this the doctors had to rely on their clinical experience to diagnose their patients. During the hospital orientation, Dr. Aarif, who was in internal medicine at the time, had suspected that one of his patients had a multiple myeloma. The only problem was that he couldn’t obtain a bone marrow sample from his patient since he couldn’t afford the procedure. Therefore Dr. Aarif had to find another way to confirm that the patient had a multiple myeloma. I realized that if this exact case had occurred in the United States the doctor would perform multiple tests and use various forms of technology to diagnose the patient. I’ve realized throughout my time at CPGH that the doctors rely more on their medical knowledge compared to doctors from more well developed countries.

While I was in the surgical ward I witnessed a specific case that confirmed my desire to become a physician’s assistant. The patient was a fifteen-year-old boy with neurofibromatosis. He had neurofibromas growing between his C1 and C4 vertebrae. Because of these tumors, the patient was basically a quadriplegic, he barely had any movement in his arms or legs. Neurofibromatosis is a genetic disease but neither of the patient’s parents had it. Because of this, the disease was caused by a mutant gene. Luckily, a neurosurgeon from California was at CPGH that week and decided to perform the operation pro bono. In the United States, this genetic disease would have been diagnosed in the very early stages but unfortunately the patient had been presenting symptoms for three months before he came to CPGH. The surgeon informed me that the purpose of this operation was to try and relieve some pressure off the cervical spine so he could try and regain some type of movement in his limbs. While the interns were presenting the patient to the neurosurgeon along with the two residents I broke down emotionally. I excused myself from the pre-operation room and immediately went into the bathroom. I was confused as to why I couldn’t hold back my tears, I had seen so much heartbreak over the past two weeks and I was completely fine. I looked at myself in the mirror and thought to myself, this is something that you may have to see often as a physician’s assistant. Unfortunately, not everyone is as lucky as you are to be able to walk on their own two feet and lift their arms above their head. I went back to the pre-operation room and one of the nurses informed me that the patient had been taken to theatre three. I decided to wait outside the operating room until the patient was under anesthesia and covered to prevent myself from breaking down again. The surgery began and the residents made an incision on the back of his neck and cauterized the tissue until they reached the spinal cord. All of the surgeons in that operating room were absolutely astounding, they let all me and the two other interns stand right behind the patient’s head so we were able to see his C2, C3, and C4 vertebrae. About two hours into the surgery we had to leave to go back to the residence.

I was in a somber mood all day, I think I was just trying to process everything that I had encountered. Luckily, I was doing a night shift that night so when I arrived at CPGH the first thing I did was head up to the ICU where the patient was placed after his surgery. He was asleep at the time so I decided to look at his chart to see how the rest of the operation had went. The doctor’s notes had stated that the rest of the surgery went very smoothly and that he was able to regain some movement in his legs. I will never forget that moment when I read those written words. Tears started to swell up in my eyes when all the sudden I felt someone grab my hand. I looked down at my side to see his hand in mine and to him smiling up at me. Out of all the things that I have experienced in my twenty-one years on this earth, that moment was by far the most moving. I know by some grace of God I was meant to meet that little boy and watch him regain something that most people take for granted. I think this specific experience has taught me that I’m a very emotional person and that as a physician I am going to want to build an emotional connection with my patients. I don’t think that I would be able to handle only seeing a patient once and then never seeing them again or forcing myself to be distant with a patient because he or she is terminally ill. This experience has ruled out a lot of specialties for me like oncology, forensic pathology, etc.

Most importantly, I think that this internship has just reconfirmed my want and need to work with children. Throughout the entirety of these three weeks, I encountered some of the most resilient children. They have taught me some of the of the most important life lessons like to smile and laugh even when you may be going through some of the darkest times and to be grateful for everything that you have. I will never be able to thank IMA enough for accepting me into this program and placing me at Coast General. Everything that I have learned during my time in Mombasa and the lifelong friends that I have made will shape who I am and the physician that I will become.