Every aspect of the program can only be spoken highly of. The trip exceeded my expectations and there was no part of it I would change. Being an intern at IMA was a very amazing experience and it is something I will definitely recommend to others. The ability to shadow in such a different atmosphere from what you are used to is very rewarding. Not only were the experiences inside the hospital enjoyable, but outside of it as well. Getting to bond with the other interns was also an awesome aspect of the trip. Overall the IMA internship was a very unforgettable experience and if I can do it again in the future I will in a heartbeat.

My time in Kenya was incredibly eye-opening and worthwhile. The staff was excellent and very helpful. The residence was safe and comfortable. The food provided offered a nice variety and was always plentiful and fresh. Transportation to the hospital and cultural sites was efficient and safe. There is a whole team of people that cared about your well-being and your experience. They always checked-in to make sure that you were doing well and that your internship was living up to expectations. They were always willing to discuss life and culture in Kenya. Benson was particularly kind and compassionate–he really cares about what he does and about the experience the interns have. Husna was also extremely helpful and informative and Bella was always there when you needed something or had a question. An experience like this changes how you view the world and also makes you think about your role in it. I wish I could have stayed twice as long–there was so much more to do and see. Back at home, I think about my experience every day and can’t wait to go back.

This experience was honestly better than I had hoped or imagined that it could be. The Program mentors and IMA staff were absolutely incredible, super accommodating, and worked super hard to make sure that I got the absolute most out of my experience. I came into this program not entirely sure about my desire to go into medicine and I have most definitely come out of this program more inspired and motivated to pursue a job in medicine.

I came to Kenya on June 13th, 2018, hauling the hazy childhood dream of becoming a field doctor. The doubts and insecurities that arose from my freshman year of college had bombarded that once luminous vision. Thus, my International Medical Aid internship would ultimately serve to either crumble or invigorate those lingering ambitions. The priceless knowledge I have gained from medical staff, peers, and Kenyan natives has spurred my desire to grasp onto my dream of becoming a field doctor with new clarity. Although, I observed many fascinating clinical cases, I found that the most powerful lessons came through the questions I asked from my observations.

At Coast General Hospital, I had the incredible opportunity to learn from the medical staff and observe cases I would not be able to see in US hospitals. Some of the most notable clinical cases I observed included Cholera, Malaria, Hydrocephalus, Organophosphate Poisoning, and Gastroschisis. I learned how to take and read vitals and how to set the oxygen levels for oxygen masks and nasal cannulas. However, the most impactful lesson came from the woman with Herpes Zoster in Surgical Ward 7. She left a burn untreated which was sadly a common occurrence. Eventually, the burn became septic, she contracted shingles, and the entirety of her midsection became one festering wound. As I watched the nurse carefully peel away the dead skin from her oozing breast tissue, I could not comprehend the amount of physical and emotional pain she must have been experiencing. There were no psychologists around to talk her through the body dysmorphia she must have been feeling. And yet, she barely showed any signs of physical or emotional pain except for a wince or two. It was baffling to me. I later learned the cultural norm in Kenya is not to visibly show pain in response to physical pain but it’s customary to openly display emotional pain in response to death, which is the opposite of the cultural norms of the United States. That newfound information caused me to speculate whether pain catastrophizing, which is the tendency to describe a pain experience in more exaggerated terms than the average person, is caused more by genetic or cultural factors. When I get back to school, I hope to do more research in this area and propose a cross cultural psychological study about the factors that contribute to pain.

My Invaluable Experiences both Inside and Outside the Hospital Reinvigorated my Fantasy to Become a Field Doctor

Additionally, something of interest I noted was the lack of cancer patients during my rotations in different departments. It could have been that most of them were relocated to the cancer center or that cancer patients either could not afford a consultation or that cancer is not as common in Kenya as in the US. After inquiring, I was told that breast, prostate, and cervical cancer are the leading cancers in Kenya. I found it significant that skin cancers were not mentioned since it is quite prevalent in the US. I later asked an ER doctor if sunscreen was a common practice. He informed me that it is not due to the high amount of Melanin in African skin compared to Caucasian skin. However, I felt that since Kenya has a thinner ozone layer because it is located near the equator, that might counteract the effects of having more Melanin. Perhaps skin cancers are not reported as much because it is often diagnosed in later stages whether that is because it is harder to discern the symptoms with darker skin or perhaps because there is a false belief in the commonality of it so it is not common practice to check for skin cancer. I will definitely continue to research and mull over that variation. Despite the engrossing information I took in during my internship, the most invaluable thing I have taken with me are the questions that I hope to be able to independently research in the future.

There were many differences in clinical practices that I observed at the Hospital. For the first two weeks, I was troubled by how nonchalant the staff reacted to medical emergencies; in fact, they did not seem to regard any situation as an emergency. Nevertheless, as I took on my second night shift, I started to empathize with the attitudes of the hospital staff. By 3 am, I found myself mentally conflicted. How could I strive to become a sympathetic field doctor if I accept the suffering around me as normal? The pained moans and terrified eyes that greeted me in every Ward had morphed into an accepted backdrop by my third week. Does one even bother trying their best for patients who look like they are about to die? Once you see enough cases, you will probably be able to predict the life expectancy of most patients that come in. Should you only be prioritizing the people that have the best chance? Is it naive to think I can give every patient 110% of my effort and somehow not grow too emotionally attached? Many times during my internship, I heard about patients who took off their oxygen masks and later died because the nurses did not manage to put the masks back on. I was told that that happens because they know that the patients who seek help at Coast General are not wealthy by any means. Thus, there is no fear of repercussions. I found that frightening. Even if the patient has given up, should their physicians as well? Shouldn’t compassion for others be the driving motivation for doctors rather than money? The next morning, I found myself more motivated than ever to pursue medicine and become a doctor who would care for every patient equally, no matter their background or economic status.

Many of the ethical issues I observed at Coast General can be contributed to a lack of resources. As I was taken on a tour of the Accident & Emergency Department, I was not prepared to be greeted by a cadmium yellow door with vertical bars across the window. It was labelled the “Strong Room” and its appearance was contradictory. To the rest of the world, it appeared to be a cheerful yellow door but the dark, musty interior divulged its purpose as a solitary holding cell with minimal light and no food or water. I was perplexed by the existence of such a room. After continuous inquiries, I learned that patients who are violent or suicidal are locked in the room for days until a nearby psychiatric facility is able to take them. However, during Bella’s presentation, I learned that there were only 14 hospitals in the area equipped to deal with only about 10-20 psychiatric patients. These lack of resources necessitated the creation of this inhumane room of sensory deprivation. The hospital had no physical department to transfer any psychiatric patient to and no straps to tie down any patient that was suicidal or violent. Additionally, the lack of resources at the hospital clearly made it hard to keep sanitary conditions for the safety of both the patients and the staff. Many times, there was no running water for doctors and nurses to wash their hands. The transportation of patients from the OR to a Surgery Ward often involved having the patient physically move themselves from one stretcher to another. There were flies buzzing everywhere because of the building’s open air design. The hot and humid climate mixed with the inability to create a pristine and clean sanitary environment is a breeding ground for infection. Ultimately, I found it incredibly courageous that the staff at Coast General were able to run a functioning healthcare facility with the limited resources they had.

In the US, I acknowledge the existence of the less fortunate but I never truly reflect on the depth of their suffering. But at Coast General, when timeworn beds are lined up centimeters apart, there is nowhere to avert my eyes. I spent weeks at the hospital marveling at the strength of every patient and healthcare professional I came across and heartbroken over the implication that some could not pay the mere $3 USD for a day’s stay at the hospital. This remarkable experience has cleared the hazy doubts in my mind and replaced it with thought provoking questions. I’ve walked away with a newly found motivation to pursue my childhood dream in hopes that one day I’ll be able to shine hope into hopelessness and help patients conquer their illnesses as courageously as the woman in Surgical Ward 7.

My experience of Kenya through this program was amazing, not only because of amazing people I was able to meet, but quality of the program and enriching opportunities I was able to participate in. Food from the house was amazing, safety was not a concern for me (because it’s safe around the house!), people are amazingly welcoming, and unforgettable experiences!

I was able to further enrich myself in the field of medicine, especially plastic surgery. By jumping into the scene, I was able to first-hand experience what the physicians may handle daily.

This program provided me with many unique opportunities and an incredible experience overall. The people in Kenya were extremely kind and accepting, and the children absolutely stole my heart. Every day was filled with beautiful scenery and Kenyan cuisine that I still daydream about–including chipati. Visiting the local communities during the medical or hygiene clinics was a blessing to me even more than it was to them. Seeing the different living situations for the lives of all these joyous people showed me just how unimportant and unnecessary that material things are! I hope that I can bring this new perspective to the many future teams/schools/jobs that I will be a part of in the years to come. I certainly can’t wait to go back to Kenya when I am certified and skilled enough to make a medical impact at their hospitals and in the community! The Masai Mara safari was a once in a lifetime experience. It was incredible to see these majestic animals in their domain! Our driver that we were placed with was humorous, kind, and got us some incredible shots. I will never forget this adventure!

My internship with International Medical Aid allowed me to be a part of unique cultural situations that can only be experienced in Africa, exposed me to medical conditions that are rare in the Unites States, and taught me more about myself in one month than I thought possible. I now see the world through a different perspective in various situations and am better off for it. My experience, combined with my newfound knowledge, will also enhance my ability to inspire teams I am a part of in the future, and allow me to convey ideas or concerns sparked by this experience abroad.

Healthcare delivery in Kenya is different from the United States’ hospitals in countless ways. The most pronounced differences that I noticed is the lack of technology, materials, and medicine/anesthesia. Due to this reality, I witnessed many doctors and nurses forced to improvise. In one case located in a minor theatre, the nurse could not find a scalpel with a handle, so the doctor had to use a clamp to hold onto the blade for the entire procedure. Also, due to the lack of available drugs, all mothers in the Labor and Delivery ward had zero access to pain killers of any kind. Another difference that took me a while to get used to is the Kenyan staff’s sense of urgency. For instance, a woman began seizing in the ER, and I watched as nurses stood by, looking unconcerned, until one nurse finally took some action several minutes later. In the states, the patient would have been monitored with multiple machines, alarms would have been going off, and a team of providers would have probably responded immediately. But I really admired the physicians and the staff I was fortunate enough to observe, and I hope someday I will be able to come back as a physician and help at Coast Provincial General Hospital physically and financially.

Along with the many differences in healthcare, Kenya’s culture and religious status made an impact on me as well. The first things I noticed when I entered the city of Mombasa were the people—with their heavy accents, fluent Swahili, and the many hijabs being worn by citizens. My first week in the hospital proved to be quite a difficult learning environment strictly because I could not understand what the doctors were explaining to me or the other interns. Even though they were speaking English, the accent took some getting use to. However, once I adjusted to the native peoples’ accents, I learned that the nurses and doctors were extremely willing to teach! Before my visit to Kenya, I had not been exposed to many religions, and I did not know much about Muslims. While in the beautiful country of Kenya, my eyes were opened to this religion; my roommate was even Muslim! What I learned is that they are just normal people with all different personalities, they just have some different beliefs than I do. I think I subconsciously stereotyped them before this trip just because I have not been around many Muslims and I was slightly ignorant of their faith. This is just one more way that my experience in Kenya opened my eyes to the fact there is so much unique and beautiful in this world.

All of the exposure and close up observation inside the Kenya healthcare system really confirmed I want to pursue a career in medicine. I witnessed new lives being brought into the world in the Labor and Delivery ward, and also observed a man pass away right before my eyes in the Casualty ward due to impact injuries. In these moments, I realized that I wanted to be a part of the process, whether it be life or death. I understand that I will encounter many gruesome and heartbreaking things by joining the medical world, but it’s going to be the smiles and the joy of patients and their families that I am able to truly help that will make everything worth the struggles and effort. It would be my privilege to be a part of something that deeply affects so many peoples’ lives, and I sincerely hope I can have such a positive impact.

Growing up there, my parents allowed me to live a life of great privilege that included going to an international school to learn English, moving abroad as an exchange student for a year and lots of travelling throughout Europe, Africa, and America. Especially, the family trips throughout Africa had a great affect on my personality and upbringing and thus I decided to apply to International Medical Aid in Kenya after working in hospitals in Germany for a year now and attaining my EMT license.

Getting accepted into the IMA pre-med program was a great honor and throughout my 6 weeks in the program I learned more than I could have ever asked for. At Coast Provincial General Hospital (CPGH), I started out in the New Born Unit (NBU) with Dr. Juthy. She took me under her wing and I felt sorry for bothering her with my million questions about the different clinical pictures: which diseases were very common, which were rarer, how they tested for the diseases and the treatment plans. I also asked many questions about the Kenyan healthcare system and Dr. Juthy always took her time in answering my questions thoroughly. She also helped me draw comparisons to Germany as she has worked in Germany as a Doctor for some time doing an internship and so we could draw parallels between the two healthcare systems together. One day for example, there was a highly septic new born, that had been transferred to CPGH from a different clinic, which needed to be ventilated as it could not breathe on its own. So, for my whole shift I ventilated the new born by hand as there was no ventilator available, this is the first time I encountered the magnitude of the lack of resources.

Following the NBU, I rotated in the Emergency Room (ER). I didn’t really have a mentor there, as doctors always dropped in and out of this department but I did manage to make this an everlasting learning experience that strongly assured me that starting medical school in March 2019 is the right decision for me. In Emergency I had many learning by doing experiences and I could draw from my EMT knowledge to assist the doctors and nurses. As an EMT at home you must think on your feet and always be ready for the unexpected, this helped me in a lot of ways at CPGH as the emergencies rolling could be anything from minor issues to actual life-threatening problems and the shortage of resources and staff made it hard to keep up with all the cases. Here I learned about the lack of insurance coverage within the population and the struggle the patients face when having to come up with the money for a CT scan for example. Coming from a country where everyone is insured by the government at no cost, I learned to appreciate what I had been given by just being born in Germany. While I surely shouldn’t apologize for this privilege I, by all means, have grown more aware of it and as a future doctor I hope I will be able to give back. Working in the ER, I got to witness and assist many interesting cases that did not only better my understanding of the Kenyan healthcare system but also the culture. Especially, the different way of viewing death in Kenya vs. Germany was a unique experience for me. One day I witnessed a 4-year-old arriving at CPGH’s Emergency room after a tuktuk accident. The patient was on her way home from school, when she was hit by a tuktuk, so the tuktuk driver brought her to a local hospital as the child was badly injured. Unfortunately, the hospital was ill equipped for such severe traumas, so they sent the injured child away without stabilizing her first and suggested the tuktuk driver to take her to CPGH. When they arrived, the child was already dead, and I ended up just cleaning up the blood as far as I could so the parents didn’t have to see all the gory. When the mother arrived, she was miserable but also accepting of her daughters passing and said that if this was God’s wish she must let go and comply. One of the nurses their explained to me later that the high child mortality makes death a much more present thing throughout the country, so it is almost expected that one may lose a child. This struck a nerve in me, as my adopted parents had lost child doing pregnancy before they adopted me, and they still struggle with accepting this loss.

Subsequently I rotated in the Operating Room. There I worked especially close with Dr. Peter, the plastic surgeon at CPGH. This was probably one of my favorite learning experiences, as I have been very interested in pursuing a career in reconstructive plastic surgery and I could draw from my experiences in Germany working in multiple plastic surgery departments in various hospitals, including Germany’s biggest burn unit. Dr. Peter showed me how to be innovative and creative when in lack of resources. I learned how one can amputate a leg without a tourniquet and how to do a make-shift tourniquet from bandages. He explained and showed me how to do skin grafts when you don’t have a meshing device, how to harvest skin without an automated skin shaver, how to make vacuum wound dressing without the actual vacuum machine and many more things. As he is the only plastic surgeon in all of hospital, seeing him work without a team of plastic surgeons assisting him, without surgical nurses that have been trained to assist in plastic surgery was also very impressive. As Dr. Peter and I worked well together and as he mentored me far beyond what I ever expected we have now decided to create an exchange program for doctors with a plastic surgery department in Germany that we are now working on together. I hope that this project will help the plastic surgery departments in both countries to learn from and with each other and to improve patient care in the long run.

Besides the work at CPGH, I also learned a lot thru the outreach events that IMA organized, and I was happy to also organize a few community outreach projects. I especially liked working with the Gender Based Violence and Recovery Centre (GBVRC), because this opened my mind to the issue of defilement in Kenya and the resulting unwanted pregnancies and sexually transmitted diseases. Through this Centre I also met the paralegal Mary, who helped me organize an outreach in the Mikindani Area to educate the youth about gender-based violence in this at-risk area. As I have returned to Germany now, I’m continuing communicating with the GBVRC to fund their projects to raise awareness and build safe shelters for children that have experienced defilement by a family member.

All in all, IMA in Kenya was a program with unlimited options. Phares and Bella, the program coordinators, were more than willing in helping me realize all my plans and dreams for this experience. My time at CPGH taught me many things some of them being: how to connect with patients when you don’t share the same language or culture, how to be more proactive and take initiate, how to work around a lack of resources with creativity and how to cope with drastic situations. The outreach programs like the mobile medical clinics or hygiene clinics installed a sense of confidence in me and my medical knowledge and taught me to take on more responsibility. I learned that you can not only see the human as a biological structure, but you must see the person as whole with mind, body and spirit in unity. I feel more certain than ever that a profession in health care is the right choice for me as I don’t only like working with patients and assisting them in difficult times, but I also learned that taking initiative and taking on responsibility doesn’t scare me it empowers me. Seeing doctors that work well in a team and some that don’t, I also understood more and more what it means to work in a team where sometime a life is at stake, and that to obtain the best patient care everyone needs to take a step back from their own personal wishes and focus on what is best for the patient. Thus, I hope to be a doctor someday that is reflective, balanced, open-minded, determined, creative and always ready to learn more.

Participating in the IMA pre-medical internship has been a life changing experience for me. The program mentors, resident chef, and local support staff were always helpful and accommodated any need that I had. Working in the hospital definitely tested me in ways that I never imagined. I saw a lot, and I experienced a lot. Most of all, I learned a lot. Every doctor that I came in contact with was more than willing to teach me and allow me to interact with patients.

Riding to Coast Provincial for my first day of rotations, I did not know what to expect. I was filled with feelings of anxiety and joy; I was about to embark on a once in a lifetime experience. As I made my way to the gynecology ward, many thoughts rushed through my head. What would I see? What would my mentor doctor think of me? I was greeted by the warm embrace of Dr. Rehema, and I knew that everything was going to be alright. My time spent at Coast General taught me so much. Not only did I learn about medicine, but I learned about myself. With each patient I saw in the hospital, I gleaned medical knowledge and learned about not only my humanity, but the humanity of the people around me.

During my internship, I spent a large portion of my time in the wards dealing with women and children. In each of those wards, despite seeing women laboring, children in agony, and innocent newborns fighting for their lives, there was so much beauty and strength to be found. One of the first things you notice going being in the wards is the immense strength of the women; not just the strength of women in labor, or the mothers watching their children fight off illness, but of the female nurses and doctors. The female doctors displayed a level of confidence that I had never seen before. They were always sure of their work and what they knew; they were never afraid to speak up concerning a patient’s diagnosis and why their diagnosis was correct. Despite being fierce and knowledgeable of their field, every female doctor I came in contact with was kind and gentle with me as well as their patients. I could not always understand what they would say to their patients, but each doctor took their patient’s hand and gave them caring, reassuring looks. Where I was concerned, each doctor took their time to explain cases to me and ensure that I was learning something along the way. Being around these women taught me how I should be as a future physician: sure of my knowledge, yet humble enough to care for my patients and those around me.

I learned an immense amount about myself during the four weeks I spent in Mombasa. The first thing I learned was that obstetrics and gynecology was my calling. I absolutely loved being in the labor ward and realized that I could see myself being there everyday. The next thing I learned was that my passion for helping people was greater than I thought. I absolutely loved doing hygiene clinics. I gained a sense of fulfillment that I had never experienced before every time I saw the smiling face of a child that I had just received a new toothbrush.

My internship with IMA was by far one of the greatest experiences of my life. I learned a lot about medicine; more importantly, I learned about myself. Medicine is not just about taking care of someone’s health: it’s about recognizing the patient’s humanity as well.

The experience I had with IMA was entirely different than any health care or outreach experience I have had previously. Outside of hospital placements, it was wonderful getting to know the other participants on the program while learning about the culture of Mombasa, Kenya. The program mentors were phenomenal- extremely supportive and accommodated to my exact interests. They went out of their way to ensure I was having a good experience and had the opportunity to do everything I wanted to. The accommodations were very nice and in a very safe neighborhood and we had incredible meals prepared by the resident chef. Regarding hospital placements, the experience is what you make of it. You need to be ready to dive in, be proactive, and build relationships. I underestimated how challenging the hospital placement would be, in terms of how mentally and emotionally draining it was. There are things I saw and experienced in the hospital that have made a permanent mark in my mind. I gained valuable insight into how cultural differences impact health care, being aware of the way things are done differently due to either cultural differences or systemic differences. In many ways my mind grew, my heart expanded, and my heart broke. I am incredibly grateful to have had this experience, and I know it will stay with me. I am confident that this experience will forever change the person that I am and the nurse that I am.

I went on the Masai Mara Safari and it was incredible. It was definitely worth the cost to do it. If you are going to Africa, it is something you need to do while you are there. My group had an amazing driver who educated us on all the animals we saw. We got right up close to so many different animals. The accommodations we stayed in were also extremely nice!

This program is the best decision I ever made. The program mentors in Kenya helped me from the minute I got accepted to the moment I left. They were very approachable and friendly. I always felt safe during my stay in Kenya. The mentors go out of their way to ensure the safety of the interns. They provided us with tips that would further ensure out safety while they were not around. The accommodations were much better than I had anticipated. Our rooms were cleaned every day and we stayed in a very nice neighborhood. The food never disappointed. All of the interns looked forwards to meals as it was always something yummy. This program had a huge impact on me. I have learned so much about Kenyan culture and was able to see and learn a lot. I was able strongly notice the differences between Kenya and North America. With the help of hygiene and medical clinics as well as other outreach activities, I hope I made some impact on the communities we visited, they certainly made an impact on me.

I believe the most valuable aspect was the interactions we had with the children at schools and within the communities. performing the hygiene clinics and medical clinics really opened up my eyes to what some of these kids are exposed to. Despite the exposure I faced at the hospital, being involved within a community was slightly more valuable for me.

The safari was a huge highlight on my trip. It was worth every penny that was spent. The lodge we stayed in was beautiful. The food was great and our safari driver was hilarious. No improvements here.

Going into this pre-dental internship with International Medical Aid, I didn’t know what to expect. Traveling to a foreign country alone and being completely submerged into their culture, I was very nervous. But, once it was all said and done, I am so happy I took on the challenges that this internship had to offer and I really did learn a lot. Everything that I learned over the month has further encouraged my interest in the dental field as well as opened my eyes to different cultures and newfound knowledge.

The dental field within Canada is very different than that of Kenya. I have shadowed multiple dentists within my hometown and have never experienced such things as I have within just one short month as Coast General Provincial Hospital. The Canadian dental field generally focuses on cosmetic issues. Many procedures that are done are not completely necessary. What I originally liked about the dental field, over the medical field, is that slight changes in your oral health can make a world of a difference for one’s self esteem. The dental field does not typically consist of life or death situations and immediate emergencies. I went into the internship thinking I would see the absolute worst things. I was pleasantly surprised to realize that even though the systems are very different, they do have more similarities than I expected. For some reason, I was expecting the largest difference to come with the equipment used. I thought that they would not have access to general anesthetic, which was wrong. They use anesthetic and are happy to administer more if the patient complains of pain. They have all of the same dental tools used in a general dentists office in Canada. They perform every single procedure, most times, the exact same. This all came as a shock to me. But, from conversations with my fellow interns in different sections of the hospital, I believe the dental unit within CGPH was blessed to have such amenities.Tools and equipment were not so plentiful in other areas of the hospital. Obviously, the system was more similar than I thought, but it was also very different than what I am typically used to. Having a dental unit within a hospital is almost unheard of in Canada. Most dentists own private practices. It may have been interesting to visit a private dental office within Kenya, just to have more of a comparison to what I am typically use to. The dental unit being within a provincial hospital meant that most patients could only afford minimum treatments, if any at all. This was a major difference, as most patients that came in waited until the very last minute they could to see a dentist. This made what I seen a lot more extreme than if it was at a privately owned practice. If patients are waiting until the very last minute, most of them will end up getting an extraction. The dental unit was equipped with four extraction chairs. This can be compared to only three chairs where fillings, root canals, and cleanings were performed. While shadowing dentists here in Canada, I’ve only witnessed two extractions take place. While in Kenya, I could watch two extractions within 20 minutes. It seemed that the dentists in Canada, spend most of their days doing fillings and root canals, while the dentists in Kenya within that section, had empty chairs for the majority of the day. Another difference I noticed between the two healthcare systems is how broadly trained the dentists are. I spent a lot of time in the minor oral surgery room where I was introduced to things I’ve never witnessed before, and that I probably never will witness in Canada. Often things they were required to treat would have been sent to a specialist or even a medical doctor in my country. But, this is what they’re dealing with and all dentists must be trained very broadly for whatever may be thrown at them. This was fascinating to me and what I loved most about my shadowing time. I was also able to scrub in twice on a couple different procedures within the main theatre. This was very intriguing to me as I would probably not witness most cases in Canada. It was awesome to see the equipment used, methods of scrubbing in and the actual surgery. The specialist that performed these surgeries was very willing to teach me anything and everything he could. It made me eager to learn and I hope to return when I am in dental school so I can actually help the dentists out and practice.

This internship made me realize that dentistry is so much more than cosmetic. Although, I do love the confidence booster dental work can cause, this experience made me fall in love with the emergency side of the dental field. It taught me that the dental field is just as important as the medical field. In Canada, although oral health is encouraged, a lot of the work done by dentists is deemed unnecessary. This experienced showed me exactly what will happen if oral health is not taken seriously and said “unnecessary” procedures are not performed. One of the dentists I shadowed during my time at CGPH emphasized the importance of even small procedures and the difference it can make to one’s health in the future. Oral infections and other complications can eventually lead to more serious illnesses. This is not something that is often seen in Canada, as oral infections and cavities are generally taken care of immediately.

Not only did this experience accelerate my interest for the dental field, it also came with some eye opening experiences. These experiences have intrigued me in the area of global health and educated me on the issues that Kenyans face. The clinics that we conducted and the community outreach that we were exposed to was the absolute best part of the entire internship for me. These activities are life-changing opportunities that I will take with me for the rest of my life. The hospital was an obvious shock for me, but seeing the communities and living condition these people come from topped any exposure I would have received from the hospital. Being submerged into these kids schools and seeing what they do day-to-day is surreal. I was imagining very similar things before I had attended the internship, but being there is crazy. These experiences definitely changed my entire perspective on life. I will never take my life here in Canada for granted, along with the basic amenities we are blessed to have.

I have learned more than I can even imagine during my time in Kenya. I was able to gain knowledge within the hospital in the area of dental medicine. Since the dentists are so broadly trained, I learned a lot of medical techniques and was exposed to a lot more than you think a dentist would see. The amount I learned from conducting both hygiene and medical clinics was amazing. I have gained so much knowledge throughout this entire experience. I am so fortunate to have met such amazing people during my stay in Kenya, who all played a role in ensuring my internship was great and I learned everything I can in the short month I was there.

My experience with IMA was both very positive and memorable in the entire four months I interned as a practitioner. I found the support of both Bella and Phares to be on point in that they were always available to address any questions and/or concerns I had – as well as proactively followed-up each and every time. Bella and Phares are very approachable and friendly individuals. 



My placement at the GBVRC at CPGH was definitely a highlight of my time in Mombasa, Kenya. As a Counsellor early in my vocation, I was able to both learn and practice even more so about trauma counselling, and how it applies to survivors of defilement and rape. I was provided with thorough shadowing and training for some weeks before I commenced counselling independently. In this placement, I was able to help fill a void, as the centre was understaffed. By taking on primarily counselling work, in the time that I was at Gender, it allowed the clinic’s Nurse (in-charge) to focus on medical exams, as she used to do both counselling and medical exams. I found the staff, Saida and Mary, very welcoming, accommodating, caring, and helpful at all times. 



Throughout my time with IMA, I always felt safe, whether at the residence, on the road, in the hospital, or elsewhere. I felt that IMA made safety a priority and we were briefed at the start of our internships about local safety and so on. By having Javan always drop us off and pick us up from the hospital was especially helpful. Javan was always very careful when driving us from place to place and his friendly persona was always appreciated. The guards at the residence too were always very helpful and caring towards us too. 



The residence was very accommodating and provided us with luxuries such as hot water, air-conditioning, and even wifi. I appreciate that the rooms were simple and shared as it allowed us interns to get to know others more. By sharing rooms, we also had to learn and practice balancing everyone’s needs, and adjusting/being flexible. We were fortunate to have housekeepers who worked hard in ensuring that our rooms, bathrooms, and laundry were up-to-date. Rehema, Naomie, and Victoria were very easy to approach and always very helpful. 



Chefs Wilson and Osman were wonderful chefs. They were both cooking for us a variety of local and international dishes for lunches and dinners. The chefs provided me with filling packed lunches too when I was at the hospital for longer shifts. The chefs would always take on board our dietary requirements as well as cook on request any meals that we might be craving from home e.g. pizza or a favorite local dish from Mombasa. 



The impact on me, that interning with IMA has left on me, can only be described as overwhelming (in a positive way). In the months that I was in Mombasa, I learnt so much about Kenya and its culture, Kenyans, trauma counselling, sexual violence, and about challenging myself. I am so grateful for everything that I was exposed to as I acquired many learning opportunities and life experiences. I always desired practicing counselling in East Africa, and having the opportunity to do so via IMA, and with such an at-risk population group, was most definitely fulfilling and something I will be eternally grateful for.



I would like to hope that I offered both the residence community and the GBVRC community my entire self when I was on placement. I feel that within the residence, I offered a helping hand and caring heart, as I truly do enjoy supporting others. Whenever I was referred to as the “house captain” or “mum of the house” – it was always something I took seriously. In the residence, I tried my best to help others, help the staff, and of course to be responsible. 

Within the GBVRC community, I hope that I was able to help comfort my clients in knowing that such violent acts do not determine who a person is. Rather, it is what the survivors choose to do next in moving forward, and knowing that myself and Gender will always be there to support them with counselling and medical support. I believe the counselling that I provided my clients with was the start of the healing process. For quite a few clients, we explored several sessions, and the healing process was further advanced, whereby clients were adjusting to leaving the violent act behind them, and that they were carrying on with their lives, and with a different perspective on life.

Gender-Based Violence is an area of counselling unique to East Africa and especially Kenya. Yes, in Australia we have counselling services for victims of rape and sexual assault, but, it is almost unheard of that a child has been defiled. As a Children’s Counsellor interested in trauma counselling, I was able to apply and practice my own counselling skills, as well as learn more about trauma counselling skills specific for survivors of defilement and rape.

Through the GBVRC, I was able to participate in an outreach program called 160 Girls’ Justice Clubs. I had the opportunity to work with three local primary schools in educating students about defilement; how to identify it, how to ask for help, and what to do if someone has been defiled. This program is primarily based in Kenya and again another unique experience of my time with both GBVRC and IMA.

I went on the Watamu Beach Safari and I absolutely loved it. I was very happy with everything and wouldn’t change anything. If a change had to be made, maybe add an extra free day, just to explore or wander around.

Many months ago, before arriving in Mombasa, Kenya, I made both the best and hardest decision of my entire life. The internship through International Medical Aid was the perfect fit and one of the first steps along my journey of becoming a surgeon. I made the choice to independently coordinate, plan and pay for this experience myself. I clocked in extra hours at my work and acquired various side jobs to save enough money to be comfortable with each amount. Not only was I still in Massachusetts, but the internship was already teaching me responsibility and a sense of maturity that I will forever be grateful for.

Once I arrived in Mombasa, the reception and the atmosphere of the program was something I have never experienced before. Right from the first minutes of arriving in Africa, Javan, who I became quite close with, had one of the best personalities I have ever seen; and from that moment on, I knew that I was meant to be there. As for the program directors, Phares and Bella, not enough great things can be said for both individuals. Their warm welcome and tireless work to accommodate all interns both in the hospital and outside the hospital was absolutely amazing.

With my time in the hospital I was able to shadow and learn from many amazing doctors that work at Coast General Provincial Hospital. It was amazing to see the environment in which these professionals were able to work and the attitudes they carried to work; knowing very well that the environment was less than standard. The amazing part in which I learned the most can be categorized into one word: Innovation. To me, memorizing information is the easy part. Anyone is able to memorize a ton of words and definitions, whether it be medicine, music, or even a language. However, where I was able to learn the most is from how innovative each doctor was. The resources were quite limited in the hospital, so each case and each procedure had to be done in a way that was the most effective with what they had. The image that sticks in my mind the most is how the doctors established an IV line. In the United States, there are special rubber bands to help express a vein. However, from the innovation of the doctors in Kenya, a simple rubber glove wrapped around the arm did just as well. Little snapshots and moments like this is where I learned the most throughout my time in Kenya. Yes, the knowledge I gathered through research on each case was amazing, but being able to see how these doctors worked, and what they were able to utilize for each case and scenario is something I will be able to take with me through life. To learn the ability to scan what you have and think of more than one way to use an item is something that will not only help me in medicine, whether surgery or an urgent case, but will also help me in everyday life.

The experiences I have learned from outside of the hospital are also once in a lifetime. Through the various orphanages the program visited and also the many medical clinics that were performed, the importance of life was very much, re-learned. In the United States, many things are taken for granted and often overlooked. Simple items such as a toothbrush and toothpaste that were given out, are almost a hassle to many Americans. However, in Mombasa, these two items are so appreciated and could definitely change the lives of many. That is why I believe that the most important things in life were truly re-learned during this internship. The aspects of family and togetherness, and to be grateful for what we have stretches beyond just Africa, but can be applied to our everyday lives as well. Also outside of the hospital, it was amazing to see the attitudes of all the children. Each child has been thrown into a life that may seem less fortunate to many, but for them it is their everyday reality. They make the most of their situation and truly go through life with amazing attitudes. It was amazing to learn through these children, that life really is what we make it. Not only did the children help me learn more about life but it also strengthened my urge to pursue medicine. Being interested in pediatrics, it was gratifying to be able to help even if it was by the smallest gestures. Working with the children and seeing their attitudes has most definitely pushed me into a field where I can continue to help children.

Throughout my whole time in Kenya, it was truly a life changing experience. From the directors, to the doctors, to the everyday locals I saw on the street, I cannot say enough great things. This experience has taught me more about myself and my path towards my career in medicine. I will be able to use both this innovation and new aspects on life to my advantage as medical school become very competitive. Furthermore, in my years, I will be able to utilize these techniques and experiences in my practice. I have always had a passion for medicine, however, the International Medical Aid only strengthened my decision to pursue medicine. I will be forever grateful for the experience.

Having recently graduated from a Master’s degree in Biology, I felt disenchanted by the experience of working in a research lab. To this end, I looked toward the more dynamic, high-pressure working environment of the hospital. I am fortunate enough to have been born in the UK, where I currently live, which means the National Health Service (NHS) is available to care for me if I fall ill. No questions asked and no bills to pay. The public-funded NHS will provide healthcare to all British citizens without discrimination. I applied for an internship with International Medical Aid (IMA) for two reasons; one, to further my understanding of healthcare in a system which is not paid for by the government; and two, to develop my skills working in complex, high pressure environments. This essay will explore the extent to which these objectives were met during my internship.

Upon arrival in at Mombasa, Kenya, I was warmly greeted by Bella and Javan and instantly put at ease. They then took me to the villa I was to stay in, where Chef Wilson prepared a delicious breakfast for me. Rehema, the housekeeper, had a very comfortable room prepared for me. The welcoming nature of Kenyan culture was heart-warming and provided stark contrast to the lukewarm personalities found in British society. I was allowed the opportunity to rest for the first day before beginning my rotations at Coast General Provincial Hospital (CPGH).

When Phares escorted me through the hospital for my first day on placement in the Internal Medicine ward, my first impressions of the hospital were mixed. It threw me to see patients left exposed on balconies or kept in close proximity to other patients with contagious diseases, especially if they had open wounds susceptible to infection, without barriers to inhibit contamination. Further to this, the long queues for examination and treatment were a new concept to me – in the UK, queues are avoided by employing more staff to ensure faster patient turnaround times and following strict procedures when it comes to organising appointments. Neither of these methods appeared to be employed at CPGH (presumably due to a lack of financial resources), resulting in consistently full waiting rooms. However, despite these differences, the similarity shared between Kenyan and British healthcare remained in how diligent and thorough the staff remained in treating patients. No corners appeared to have been cut in order to minimise expenditure, which surprised and reassured me.

Before my arrival in Kenya, I erroneously believed that healthcare might be hindered by improper education of medical staff due to a lack of funding and investment in education, research and development. I found it impressive that despite the formidable difference in funding, the expertise of the doctors and nurses was not limited by this. The level of knowledge shown by the doctors, nurses and even students exceeded all expectations. In this respect, there was no compromise on patient care.

As an intern, the working conditions in the hospital were trying. It was emotionally difficult to meet patients who were unable to pay for the treatment they needed and to see priority given to patients who could pay. It was also difficult to adapt to a system that lends freedom to students to practise their skills on real-life patients as I am used to the western style that does not allow students to practice certain skills until after graduation. Although I was never pressured into performing any task or procedure that I was not comfortable with, I did feel spurred to keep up at times. I am all the more grateful for experiencing this style of learning (a sort of “learning by doing” practice) as I would never have seen this in my home country and feel this experience has made me more adaptable in pressurised environments. Moreover, as distressing as it was to see patients turned away for lack of funds, it was interesting to see how healthcare is provided when it is not accounted for by a single-payer system (like the NHS).

Following my first week shadowing staff in the Internal Medicine ward, I was to observe in the Casualty and Surgical wards. The surgeons in the operating theatre had no qualms at all answering questions and actually prompted and invited questions. Similarly, the doctors and nurses in the Casualty ward pushed me to learn as much as I could from each individual case, providing me with hands-on experience. I found my time in these departments to be particularly enjoyable and feel I learned the most during my time spent there, owing to the willingness of the doctors and nurses to educate and involve me. Looking to the future, I would like to think that, having experienced first-hand the value of enthusiastic teaching, I would endeavour to emulate this quality during my time as a professional.

Prior to my experience with IMA, I was hesitant in belief that medicine was the right career for me, primarily because I felt that I would not be good enough to contribute to the field, or even if I were good enough, that I would not have the resources to pursue this career. However, working with the staff at CPGH, who have become so excellent in their profession in spite of the plethora of hardships they have had to overcome in order to gain their education, has imbued a sense of duty in me. It would be narrow-minded to say that it would be impossible for me to become a doctor in the UK when these doctors have achieved so much in the face of obstacles greater than those that I face.

Despite the myriad of systemic differences in healthcare between Kenya and western society, the ultimate objective of curing the sick remains universal. With this, I can say with some certainty that my experience with International Medical Aid has solidified my resolve to pursue a career in medicine. The question now remains, where would my efforts be best placed? In the sterile comfort of the NHS in my home nation, or the visceral grit of healthcare in the developing world?

IMA has provided me with an experience that will stay with me for a lifetime. In the last three weeks, I have met physicians and hospital staff that have taken their time to teach me and my peers. In the US, it is incredibly difficult to obtain clinical exposure and experience, but the doctors and staff at CPGH welcome you with open arms and truly want you learn from their lessons. Although Kenya is a third world country and lacking proper medical resources, there is so much modern medicine in the states and abroad can learn from their practices. Apart from the hospital, the living conditions and IMA staff were wonderful. They care about each intern and strive to make their experience as perfect as possible. The food cooked by Wilson and Paul was amazing. The chefs introduced me to authentic Swahili cuisine, and I was never disappointed. The house keeping staff was kind, always keeping the IMA villas clean and tidy. The drivers and security were always so nice and managed to make me feel safe, whether we were at the villas or exploring the sites around Mombasa.

Bella and Phares were my right hand me, as they were always there for me and the other interns, making our stay the best it could possibly be. Some of my favorite memories that I will take back with me were the community outreach clinics. Being able to interact with Kenya’s youth has a major impact on me, and I hope the feelings are reciprocated. Educating children on proper hygiene is so important, and I’m glad IMA encouraged us to get involved in the community outside the hospital. This program has introduced me to a myriad of people and taught me so much. I am beyond grateful for the experience this program has given me, and I encourage anyone seeking valuable medical experience to consider IMA.

I believe the most valuable aspect of this program was learning how comprehensive medical care can be provided with Kenya’s lack of resources. In Westernized cultures, medicine has increasingly been dominated by technology. We rely on a plethora of tests in order to obtain a diagnosis and then continue to implement technology during the treatment of patients. This results in astronomical hospital bills that burden families for years after treatment. Kenyan physicians do things quite differently. Because CPGH serves such a poor population, the doctors refrain from expensive tests in diagnosing patients. Rather, physicians rely on their extensive knowledge to determine and care for the conditions patients present. While working with doctors in the obstetrics/gynecology ward and pediatrics ward, I was able to learn how diagnose and treat many conditions with the least amount of resources possible. If anything, I have truly realized that sometimes less is more. Despite the huge amount of money spent on healthcare in the United States, the Kenyan healthcare system still manages to do as much as, if not more in some cases, the United States in treating patients

My mental health placement with International Medical Aid taught me so much about not just mental health and the mental health system in Kenya, but also about myself. I completed my placement at Port Reitz Mental Health and Substance Abuse Unit and I only wish I would have had longer. Port Reitz taught me strength by surviving and adapting to minimal standards of working conditions due to lack of funding. The undying support by the staff was above impressive considering the limited resources they have. Additionally, the stigmatization around mental health in Kenya was at the forefront of challenges experienced by staff and patients alike. It is very confronting to accept that for so many families they are related to ‘crazy people who have lost their mind’ to quote many family members directly.

I have a deepened interest in creating awareness of mental health and mental illness in Kenya and other African or third world countries who deserve to be educated on the need for mental health facilities but also in order for them to understand their own family and community members who have been struck with mental illness. This is how I would like to shape my career, working in these respective countries to help combat the stigmatization surrounding mental illness, and Port Reitz has definitely helped me understand the need for this and the way that the families need to be educated.

My first day was difficult and heavily confronting, especially seeing men in blue and white striped clothing in the isolation unit. The prison like structure at Port Reitz is a very difficult environment for staff to confidently and efficiently assist in the patient’s recovery. My second day created a change in me, when a young patient was walking beside me saying ‘don’t be scared.’ It was in that moment that I realised that perhaps my body language had shown I was reserved, and that was the last thing that I wanted the patients to feel. We had arrived at Port Reitz being debriefed that the patients could be violent, and that was the understanding that I had in the beginning. I wasn’t scared of the illness, but I was scared of the ideas about the patients that had been pushed onto me. The heavy sedation of the patients meant that I never actually saw them act out or be violent, and with me they were grateful, interested and always showed a smile. Their happiness was contagious because it was a little bit of hope that I needed to see in what could be such a difficult place to seek such an emotion.

The staff at Port Reitz were so committed to ensuring I had a fulfilling experience, and I could not thank them enough for the time and effort they put into ensuring that I was gaining everything possible from my time there. But amongst my gratefulness, they were so thankful that I had been there, a feeling I could not comprehend as I could never have done as much for Port Reitz as it did for me. I learnt so much about counselling in my time with the clinical psychologist. It was interesting because many outpatient cases will only ever visit for counselling once, which meant that much different counselling approaches needed to be taken compared to Western cultures in which clients will often come back multiple times.
During my time at Port Reitz there was a visit from the local MP who made numerous promises to the hospital, ones that I knew he was not necessarily obliged to follow through with. I wrote him an email myself, hopefully making him a little bit more accountable for what he had said, but also as a desperate plea to do something for a place that had shared so much love, generosity and compassion with me. The political system severely underfunds and does not recognise mental illness and the needs of these hospitals to continue functioning adequately. However, it is only recently that my own country, Australia, has been able to combat these fears and misunderstandings surrounding mental illness. I only wish that I could bring our politicians together and let the Kenyan government be more educated on these issues. The government body should be the first people to promote mental health awareness, but without this structure in Kenya the mental health facilities and those suffering with mental illness will continue to suffer because the stigmatisation is at the forefront of the challenges for both staff and clients.

Whilst I cannot discuss specific counselling cases, I can guarantee that each one gave me a unique cultural perspective on the differences between Western and Kenyan approaches to dealing with relative issues, and the challenges that cultural and religious views can have on dealing with specific cases. It is not possible to throw Western ideologies and ways of counselling into Kenya because that would neglect the cultural differences that are so apparent and necessary when dealing with individuals.

Overall, I would not change my experience with IMA for the world. I am so privileged to be invited into Port Reitz and be immersed in the environment of both the staff and the patients. A piece of me will stay with this hospital forever.

My time here in Kenya was incredible. The residence allowed for us to truly get to know the other interns and spend time together. The location of the residence was great in terms of activities for us to engage in outside of the hospital. Safety was no question, and if there were ever any red flags we know that we could reach out to Bella or Phares. The food is fantastic and I cannot wait to make chapati when I return to the US! My placement in CPGH was so impactful on my education and future role in medicine. The mentors were so willing to teach and not only about medicine, but also about life in Kenya as a physician. The outreach events for the community is something that will never leave me, from the welcoming songs to simply filling up containers with medicine to disperse – it all made such an impact on me and bettering my understanding of global health care. Kenya truly is a beautiful place with even more beautiful people, that thankfully I got to know well!

The most valuable experience to me would be to understand what it is like to work with minimal supplies. In the US, we tend to overuse supplies and make healthcare expensive do to all the resources we use. Here in Kenya, the lack of supplies has really taught me to think on my feet and be able to truly assess the patient and understand what is needed rather than what it done to prevent litigation in the US.

America is viewed, as I came to understand from my time in Kenya, as the land of milk and honey. Unfortunately, that is not the case. Westernized medicine is costly and there tends to be more discussion of litigation than holistic treatment. There is an unhealthy, fast paced practice where patients feel neglected and doctors feel pressed to meet a quota. Kenya was full of knowledge and I gained experiences that I never would have elsewhere. I saw cases such as leprosy that I would rarely ever come across in the United States. It was incredible to see the physicians treat with such little access to supplies and recognize how easily as Americans we take for granted the access to resources such as electronic fetal heart monitors and electronic patient records. My time in Kenya truly opened my eyes to how misinformed I and many other Americans are of developing countries. We are taught to believe that areas are desolate and if individuals would donate money to the cause, life would become better. My time in Kenya grew me in my love for medicine, cultural awareness, and mostly a better understanding of what it truly looks like to help another.

The practice of medicine in the United States has always been considered a noble career in which young children aspire to become a doctor from a seemingly simple idea of being able to help people. My time in Kenya truly exposed me to what it means to help another human. Dr. Matonda is a dermatologist at Coast Provincial General Hospital in the Comprehensive Care Clinic (CCC). The CCC treats cases of chronic illness such as Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Disease (AIDS), and tuberculosis. Dr. Matonda’s role was to address and treat the secondary skin illness these patients would face. The first day I was with Dr. Matonda, a elderly gentleman walked in the door, not for an appointment but to see Dr. Matonda. His skin was covered with lesions like I had never seen, and Dr. Matonda began to ask him how he was and if he had found time to have lunch. After realizing he had not eaten, Dr. Matonda began to probe him about what he would want for lunch, then giving him two fold of what he asked, sent him to the canteen with a doctor’s note from him. Without explanation, he brought in the next patient. Dr. Matonda then explained how he knew the previous man. He had come to the doctor with a severe case of leprosy a year ago and Dr. Matonda realized that he was homeless and was struggling with substance addiction. Dr. Matonda acknowledged the simplest, yet profound piece of information – that an addict rarely has money to spend on food, and if he does not eat the medicine for the leprosy will not take effect. I sat there in awe of the story of their relationship and how Dr. Matonda was so humble about who he was to this man. In those days with Dr. Matonda he embodied how being a doctor comes second, and being kind to fellow man first. Measuring success in medicine is tricky when life and death is a consequence of your practice but Dr. Matonda taught me one line that I will take with me through my career to judge daily how I am as a provider – “see how they are happy, that means I am happy too.”

In reality, as individuals raised in western culture, it is rare to think that money cannot fix a problem and in a sense, money cannot fix anything to do with the medical system in Kenya. If money is donated, it is quite easy for the money to seemingly vanish due to government corruption. Understanding how to aid a developing country long term is difficult if there is no research done or experience had. The exposure I had made it apparent how frequently my train of thought, even if meaning well, is focused on short term rather than long term. To truly aid a country, to prosper in medicine, to make a difference at all our actions must be directed toward a long term goal. Focusing on the long term is the only way to create sustainable change. Due to my newfound knowledge, I can make more educated decisions in the future on how to be of true sustaining change within healthcare.

All the lessons I learned over this internship will continue to mold me as a person and future clinician. Gaining a deeper understanding of global healthcare has been a privilege, but also necessary for me to develop into a physician that will treat and think holistically in medicine. I will be forever grateful for my time and experiences in Kenya and would be overjoyed to return to Coast Provincial General Hospital and Mombasa in the future.

I loved my experience in Kenya so much. I never once felt unsafe from the moment I was picked up at airport. The food and overall accommodations exceeded my expectations greatly and I had no problems with the accommodations or food. My experience in Kenya had such a profound impact on me because I was able to learn so much about another health care system and I was able to get hands on experience with cases that aren’t common in the US. I kept a notebook with me every day in the hospital and everyday it would be filled with notes from the doctors I was shadowing. The doctors in Kenya are so intelligent and the language barrier isn’t difficult to overcome. I am so grateful for all the things I learned from my doctors both about medicine and about health care in developing countries.

The most valuable aspect of this program is that you are able to do everything that the doctor does with the patients. You are able to go through the whole diagnostic process with the doctors and they will explain to you their thinking and ask you questions along the way. The doctors in the hospital are so creative and smart, and it is amazing to be able to get close to so many different doctors in all different departments. You are able to see cases that you would never see in the US and people often come into the hospital with multiple things wrong, which makes the diagnostic process more difficult. Being in the hospital really tests you and can really help you grow as a person and a professional in the medical field.

The safari was amazing overall. I really liked the accommodations in Nairobi and the Mara Sopa Hotel. I don’t have any ideas on what to improve because I had such a great time on the safari that I wouldn’t change a thing!

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.

This trip to Kenya was truly incredible, and has definitely both solidified, and encouraged my interest in medicine! I made some really meaningful relationships with doctors, nurses, and technicians at the hospital who took the time to teach me and engage me in their work. The mentorship I received at CPGH allowed me to not only learn how to do technical and hands-on tasks, but also how to be a confident and compassionate person in healthcare. As each day passed, I learned how to take advantage of my time here more and more, and play an active role in helping the staff as well as the patients! It took time before I was able to fully immerse myself in the hands-on experience, but when I did, I felt like I really found what I want to dedicate the rest of my life to! I learned so much in such a short amount of time, and got to see a lot of different perspectives and ways of thinking that I think other countries could really learn from! After working in the hospital, we would always come home to a lovely house, a very supportive staff, and amazing food! IMA really made sure we were well taken care of, and kept safe! IMA also gave us many opportunities to explore Mombasa, and see a way of life that is rich in spirits. Kenya has left a big mark on my heart and mind, and I am already thinking of when I can come back!

The most valuable aspect of this program is the relationships you can and will make, both with fellow interns and the hospital staff. I have never formed such close bonds with fellow humans in such a short amount of time! In this program, you meet very like-minded people, who value the foundation of medicine, which is to simply help another human. We all understand the value of a life, and share a passion for coming together to help one another. Spending time with these kinds of people in both a working and non-working environment allows for close relationships to form! Moreover, relationships made with the administration, doctors, nurses, and technicians at the hospital have really made this program impactful. These are people who believe in you and your effort to come to Kenya and learn. With their busy schedules, they still make time to bring you places with them, explain concepts, and teach you how to be a great doctor. I will definitely keep in touch with the staff at CPGH, for they played a critical role in encouraging my eagerness and excitement to pursue a career in medicine!

My trek experiences were nothing short of amazing! I went to Watamu and Diani Beach, and during both Treks, IMA did a great job of keeping us safe as well as giving us time to explore and have fun on our own. IMA offered many different activities, some of which were pre-planned, and they were some of my friends and I’s favorite moments of the trip! From feeding giraffes, to holding snakes, to visiting schools, to touring Old Town, IMA definitely made sure we had the opportunity to see and enjoy Mombasa!

My Medical Officer (MO) and good friend Abdalla shared his philosophy with me after witnessing my heart twinge with pain alongside the 14-year-old girl sprawled across the ER table. His ideal has ingrained inside me and transcends all injustices I see— at CPGH, in child detainment alongside our southern border, in racial and gender inequity in the workplace, in the homeless shelter across the street from the Starbucks I frequent. But in that dusty corner of the CPGH ER, I understood the difference between witnessing injustice as a passive bystander and taking control of said injustice to learn from and better the debilitated victims. For most of my IMA peers, this call of responsibility transcended into a pursuit towards medical school. Me, I diverged.

I entered IMA with an open soul and an undecided scholarship beneath the healthcare inequity umbrella. With an inclination to study infectious disease and global health inequity, I requested to learn in the CCC (comprehensive care unit) unit for the entirety of my stay, all while taking afternoon shifts in the ER, maternity ward, and NBU to enrich my studies. I soon came to the unsettling realization that hands-on patient care would not be my field of pursuit—I wanted something more, to upscale my actions, to treat populations rather than individuals, to be bigger, to do better.

My call to action stemmed from observations of systematic injustice entrenched upon CPGH and accepted by the masses. A lack of a ventilator in the NBU ended the life of a newborn baby. Unwashed materials between patient rotations in the ER left many susceptible to infection. A lack of nutritional supplements in the CCC denied an HIV patient from increasing her BMI to a healthy level. These small pieces of the CPGH puzzle not only identify the many broken links in the chain of action, but also how widespread the issues are. Each fault can ideally be eradicated via simple intervention, more donations, or even more attentiveness. While all true, each imperfection relates back to the large injustices done onto the facility by lack of governmental upkeep, monetary corruption, and a disadvantageous starting place. Trained and qualified healthcare workers cannot care for their patients to the best of their abilities given the state of hospital resources. I visualized this injustice firsthand in the maternity ward. A woman in labor had no access to a Cesarean section due to a lack of available theaters; as such, she succumbed to a natural birth for forty hours. In another example, a cancer patient in need of radiation was referred to a hospital in Nairobi, which was the only facility in Kenya to offer such services. This patient could not afford a ticket to Nairobi nor the time to wait months for the next available appointment; as such, this patient’s health was sacrificed due to a lack of resources not only in CPGH, but also in all of Kenya.

Besides health crises that stemmed from within the hospital, I also recognized the population denied access to CPGH facilities as a whole. One consultation meeting is 200 Ksh. Over half of the Kenyan population amasses 180 Ksh per day; to ask a majority of the population to give over a day’s amount of work (and maybe more to cover transportation fees) over to a consultation that lacks the resources to properly treat serious inhibitions is preposterous. That money could instead be used for food, drink, shelter, and any other daily life accommodations. The public health system is broken if it cannot serve who it is meant to serve.

Hyperaware of all the issues observed around me, I decided to educate myself on the topic as well as I could. Bridging my two passions of infectious disease and healing public health disparities, I circulated my self-education around the CCC.
I spent my hours at the CCC conducting personal research regarding the current state of the public health system in Kenya, the general sentiment towards NGO donors and public aid, the meager state of sustaining supplies, and what needs to be done to improve patient outcomes as a whole. I conducted 21 interviews amongst the MO’s, nurses, and interns stationed around the CCC to try and understand the state of public health from all health worker perspectives. Each interviewee spoke upon the lack of governmental support for the CCC, the lack of resources and staff for day-to-day life, and the overall belief that the CCC can run smoother, faster, and more carefully. Alongside these sentiments, every interviewee relayed their belief that the CCC has improved in resources and daily mechanics throughout the years and will continue to improve given the dynamic nature of the facility.

The CCC serves one of the most vulnerable patient populations in the world (patients living with HIV), and requires up-to-date facilities and resources in order to do so well. It is largely unaffected by governmental influence due to NGOs that cover the majority of the funding. However, the funding covers just enough to keep the center afloat on a day-to-day basis.

I also discovered improvements made to the CCC throughout the past ten years; the center digitalized its patient database, relocated its pharmacy inside the center to reduce stigmatization, and hosts daily health talks as a form of social intervention and education. These interventions have improved patient outcomes and adherence records, thus reflecting the benefits of constantly updating the center and innovative thought.

Compared to a western facility, the CCC is in need of more technology, more MO’s, and more mental health resources. However, because this list of demands is considered superfluous to donors, patients are then denied access to a more updated system, a more competent staff, and mental health services to guide them through a life of HIV.
My interpersonal relations within the CCC were the most impactful CPGH moments outside of my research. I woke up each morning excited to see my friends and learn from them why they decided to pursue a career in infectious disease. Nurse Rosie’s eyes glimmered whenever she talked about the gratification that came to serving those who truly needed it. Nurse Rebecca treats each patient with the same love and care that my family graces me with. Dr. Matonda treats a man living with leprosy to lunch every week because he sees him not only as his patient, but also as his brother. This well-rounded treatment gives patients the physical and emotional support required to maintain a high compliance percentage. I am honored to have witnessed and integrated myself into the CCC’s culture of respect, dignity, and grace.

I hold the hope instilled within the CCC, the compassion in Nurse Rebecca’s will, and the pursuit of justice within every healthcare worker in the CPGH with me every day. I will not let these sentiments fade away after my physical time in Mombasa. Rather, I will use my efforts and attained knowledge to be proactive about some issues noticed at CPGH. I am working with two other CPGH interns and professors from my school to create an online platform that connects Western doctors to doctors in Mombasa. The platform will offer a source of support and mentorship, and will be an optimal resource for those at CPGH to convey the resources they need to a power that may be able to help them acquire it.

From my time with IMA, I learned that I am meant to participate in the healthcare sector on a larger magnitude than everyday patient care. I want be the change for unjust policy, and I want to be the link between Western and LMIC communication. Through these implementations, I hope to positively influence a larger magnitude of vulnerable populations suffering from unjust healthcare systems.
IMA taught me that change comes slow, but change is necessary. And while change has been happening throughout the decades, it is not happening at a fast-enough rate. I want to be the catalyst in this reaction, and, thanks to IMA, I believe that I can.

This year, I decided to challenge myself and push my clinical knowledge to its boundaries by working in an unfamiliar country with a different health-care experience than my country Qatar. I wanted to go somewhere that possessed little technological resources. Although some people may aim for more well-developed locations, I believe that learning starts from the patient’s bedside, by seeing, feeling, and listening. In my opinion, the lack of resources, tools, or laboratory and radiological tests challenge the doctors to use and rely on their own brains and to think in creative ways—something I do not often see in my country due to its wide availability of advanced technology, which can quickly give a definitive diagnosis. Because the future is difficult to predict, I decided to pursue this experience to prepare myself for all difficult circumstances. Fortunately, I found this program offered by the International Medical Aid at the Coast Provincial General Hospital.

On the first of July, I arrived in Nairobi, the capital of Kenya. It was a difficult day. At the airport, I struggled to get my bags to another building, where I had to go check in my bags for my next flight to Mombasa. My bags weighed a total of 60 kg, and they fell from the trolley twice. At that time, I was already sweating heavily from the pressure of making it to my other flight on time. During those moments, I remembered my father’s advice to exercise in preparation for this trip, as things here are not as developed and comfortable as in Qatar. This was my first lesson from this trip; I needed to get stronger and healthier to be able to serve people as a health-care provider.

When I first arrived at the CPGH, I noticed that the building looked old and that the roads were full of mud and unclean water. This was the total opposite to the hospitals back home, which are actually much cleaner and newer than five-star hotels. Nevertheless, I told myself not to judge the hospital from the outer appearance of its building but rather the people serving in it, as well as the availability of essential clinical tools. When I entered the hospital, I noticed that many departments had a sign on their doors stating the foundation or persons who have donated for the development of the department. I felt happy when I saw the names of countries, presidents, spiritual leaders, and others.

During my time there, I saw many clinical signs I have read and studied about but never seen anywhere outside of our clinical books. Having this opportunity allowed me to see and examine things I have never seen in my country; it gave me an alternative way of learning that I never would have received in my country. I learned by touching, smelling, hearing, seeing and, most importantly, feeling. This way of learning is a more effective way of encoding these lessons into my memories because they are not pictures in a book. These were real people in front of me, and I could clearly see their suffering and pain. They say that feelings and emotions make our memories stronger. Back home, our population is made up of only 2,000,000 people, making it difficult to observe the clinical signs I encountered here. For example, I have studied ascites (fluid accumulation in the abdominal cavity) considerably, including how to confirm it; however, I never had the chance to see a case with my own eyes. I was able to see one here and even do the clinical exam to confirm it. As another example, prior to this experience, I never saw a woman in labor. Here, not only did I see many, but I was also able to apply my knowledge of the Apgar score, which assesses the need of the newborn for resuscitation and needs to be done as soon as the baby is born. Another case I will never forget is a woman with crepitus (crackling) in her chest. This woman had CPR 2 days prior and, due to the fracture of her rib, had air escaping under the skin of her chest, making it feel like crackles. All these cases I have so far mentioned were witnessed within 1 week. I saw many more that I will never forget.

One encounter I will never forget happened to me and another medical student at the hospital. Back home, our university offered all students a subscription to a well-known, trusted medical resource called Up-to-date. I remember how professors urged students to use and take advantage of its benefits. I also remember students complaining about how annoying and pushy the professors were in regard to this resource. Here in Kenya, I saw people dreaming of getting access to this resource. Many were jealous of my access, particularly because I am only a third- year medical student whereas they were already medical doctors. As an act of goodwill, I decided to offer a last-year medical student a subscription. She was surprised and even cried for a couple of minutes. This reminded me to be thankful. It is important to use our resources as much as possible, as many in the world wish for it.

I have been obsessed with basic life support for a long time. Back home, however, I was unable to obtain any experience related to it. I only practiced and had several courses on models. I never thought I would be able to resuscitate a real person until a very late stage of my life. I always wondered how I would act and whether I was strong enough. Would I be well prepared for such situations? In an unexpected situation, one of the doctors in the women’s ward asked me to perform CPR on a dying woman. I was shocked but immediately shook it off because there was no time to waste. So, I started performing CPR exactly the way I was taught. I did not think that it would be so similar to the model I had practiced on, but surprisingly, it was. After 3 minutes, I felt exhausted and could not do it anymore. I felt guilty because, while anyone would feel exhausted after a while, I felt I could have done better if I was more fit and if I regularly performed physical exercise. I asked one of the nurses to come and take my place. As soon as she came to replace me, the doctor asked us to stop the resuscitation process. At this moment, I felt very upset and confused. I talked to myself, saying, “Where is the AED? This isn’t the way it’s supposed to be! Only 3 minutes?! Seriously? Giving up this soon?!” I then talked to the doctors to express my frustration, but I felt that they were used to it. I felt very distraught at the idea that I might one day feel just like them, used to seeing people die in front of me and able to give up so easily. Thankfully, it is not the same case at home; doctors try for a much longer time and use as many available resources as possible to bring the patient back.

In summary, I learned many lessons from this trip that I would never have learned from the health-care system back home. I became more thankful of what I have, and I saw many clinical cases that made me apply my clinical knowledge to determine patients’ diagnoses. I talked to many nice, kind patients and learned their sides of the story. Finally, I learned that I should work more on myself and never underestimate a patient’s life. They say that people change over time, but I believe that there are certain values that should never change.

During my summer in Kenya, I worked through challenging cases with incredibly resourceful and intelligent providers at Port Reitz Psychiatric Hospital and The Gender Based Violence Recovery Centre. The standard of care was often unavailable due to financial constraints, but it took just as much mastery of medicine to provide valuable alternative therapeutic plans. The clinics were short staffed, compelling me to work to the limit of my medical knowledge in order to contribute meaningfully to the team. Working with these dedicated providers helped me appreciate the integral roles that creativity and critical thinking play in medicine. This was particularly evident in the case of a patient who was having a psychotic episode.

This patient was exhibiting violent and bizarre behavior; he was completely non- functional and required 24-hour supervision. He was strong and lunging at providers during his entire exam. His four friends who brought him in had to hold him down the whole time.

Socioeconomic factors complicated his care. It was very clear that he needed to be admitted, but he could not afford it. I had to figure out how to do inpatient management as an outpatient on someone who was very unstable. I prescribed him every injectable antipsychotic and benzodiazepine we had, but knew this would only be a short term solution. What would happen when he was home and they wore off? I also prescribed oral antipsychotics, mood stabilizers, and benzodiazepines and instructed his friends to give him this medicine while he was still calm from the injectable medications but not fully sedated in order to prevent aspiration. I may have treated him less aggressively if he was inpatient and being monitored, but keeping him calm while out in the community was a priority. I also had to think about the safety of the patient and others while he was at home. I instructed his friends to find his wife and two young
children somewhere else to stay until he was stabilized. The patient was also a danger to himself, so I told them that he would need 24-hour supervision by enough men strong enough to hold him down, if necessary. I asked them to bring the patient back for close follow up.

There were many other experiences that made me realize the difficult decisions practitioners in Kenya make daily. While working at the GBVRC, I found it important to learn both the guidelines made by the Ministry of Health in Kenya and understand why those guidelines were implemented. This too proved challenging. For example, as standard of care, metronidazole is recommended for coverage for Trichomonas as first line therapy for STI prophylaxis when Ceftriaxone and Azithromycin are given. However, in the recommendations made by the Ministry of Health, when switching to second line treatment with a fluoroquinolone and doxycycline, it is not recommended that you add metronidazole. I was never able to find any medical justification for this recommendation. I could only hypothesize that it has something to do with the cost-benefit analysis and use of available resources.
As a provider, this choice creates a conflict: do I make a decision based on medical knowledge or based on public health recommendations that take overall health resources into consideration? I often operate on the principle when making decisions with my patients: “What would I want done for a loved one?” If someone I cared for was sexually assaulted, would I want to give them prophylaxis for Trichomonas? Would I want them to avoid potentially getting PID and losing their fertility in the future? Of course I would. But in the bigger picture, how much would this metronidazole cost over the years? Where else would that money have gone? Who else’s life could have been saved with that money? How many people would have actually gotten Trichomonas or PID or had serious consequences like loss of fertility?

Being able to operate on the principle of “What would I want done for a loved one?” is huge privilege of working in the United States. Providers in Kenya have the difficult task, in any medical decision, to think about both what is best for the patient in front of them and what is best for all patients. Experiencing having to make these kinds of difficult decisions myself while I was there gave me so much respect for the providers in Kenya and the unique challenges they face working in a resource poor country.
I learned so much from the providers I worked with, but I also learned lessons from the culture in Kenya. A common theme during my time in Kenya was seeing communities come together to take care of one another. One patient who came to Port Reitz was severely agitated. At first I thought the crowd that brought him to our care were his family, but it turns out they were just members of his community. While one of the friends was filling the patient’s prescriptions, the other held him in his arms and sang to the patient until he was calm. I was so deeply moved by the depth of their love and caring. It’s something I will hold on to for a very long time. This sense of community is big part of the culture in Kenya, but it is something we do not regularly see in the United States. I hope to incorporate it more in my life and how I practice medicine.

This strong sense of community was not just apparent with patients but also with my colleagues. My coworkers made an effort from day one to make me feel welcome. That friendship became such an important part of how well we worked together. There was no ego on the team. Every opinion was equally valued and we would always discuss challenging cases together. We were quick to ask each other for help and learn from one another. The goal was always for everyone to do their best and to bring out the best in each other. This feeling of being a team not only helped us provide the best care for our patients, it made working together a pleasure. Practicing medicine is always a team effort, and I hope moving forward to always bring this kind of spirit to any team I am on.

One of the most unexpected and treasured parts of my time in Kenya was making friends in the earlier stages of their medical careers. From tentative pre-meds, to post-bachelors, to just fledgling med students, I became close with colleagues at different steps of the path to becoming a doctor, and I saw myself in all of them. It reminded me of some of that initial passion I had for medicine, some of which I had lost along way. Or rather, I realized it was not really as lost as I thought it was. It was important for me to reconnect to that earlier me and to feel hopeful and excited about this profession again.

I went to Kenya with an open mind. I didn’t know exactly what I was looking for, but I knew something was missing from my career. I had just left my family medicine residency program and I knew I wanted to continue in medicine, but I was still trying to figure out the path I wanted to carve out for myself moving forward. I didn’t expect to find the answers to these difficult questions while I was in Kenya, but I am grateful that I did.

I hoped that my work in Kenya would help me learn more about psychiatry while having a unique experience abroad, but it ended up being so much more. Before medical school, I worked as a nurse assistant at Christ House, a homeless shelter clinic in Washington D.C. It was a very meaningful part of my career in medicine and was the reason I decided to become a doctor. While I was working there, I remember looking forward to going back to work on Mondays. I distinctly remember this feeling because, to some extent, I have been chasing it ever since. Working in mental health this summer was the first time since my job at Christ House that
I looked forward to Mondays again. During my time in Kenya, I really felt like I had found in Psychiatry the joy in my work that I was searching for. I feel like my life was set back upon the right path- I’m excited about medicine again and excited to move forward with a career in psychiatry.

My month in Mombasa, getting to work alongside so many other brilliant and encouraging inters, was truly an experience of a lifetime and was only made possible through the incredible love and support of the staff. The way they cared so deeply about every intern who walked through the front door, ensuring safety, proper hospital placements that matched each interns desires and needs, and being of major help in situations big and small, truly reflects their outstanding desire to make this a unique and memorable trip for all. From the food to the hospital, and the medical clinics to the beach and everything in between, allowed for one of the greatest months of my life. Leaving more full of growth in both my knowledge of medicine and culture, I wouldn’t trade my time here for anything.

The most valuable aspect of this program was having the opportunity to rotate through multiple wards in the hospital. Before arriving, I never thought I’d even have an interest in orthopedics or in A&E. Yet after my week in each of those departments, I gained a new appreciation, love, and respect for both specialties, giving me the desire to keep all my options opened as I move on to the next stages in my desire to become a physician.

My safari experience was out of this world. I never thought I’d be able to say that I had completed an African safari. Truly a once in a lifetime experience that I will cherish forever. Masai Mara was beyond beautiful and our driver was very engaging, allowing for the best possible time.

During my time in Mombasa, Kenya, I’ve lived more life, gained more knowledge and experienced more medicine than I ever thought possible when initially embarking on this adventure. Through my month at Coast Provincial General Hospital along with my time at the International Medical Aid residence, I’ve learned what it looks like to care for people deeply; not only those that are sick, but those that express different beliefs, religions, lifestyles and cultures. I think the most valuable thing I’ve gained since arriving, has been the understanding that sickness is the universal connector, a lot like O- is the universal blood donor. The hospital is a place where everyone congregates, seeking care for a wound or disease that they most definitely don’t want. With that being said, I can attest that no patient at CPGH chooses to be there. That was made very clear during my weeklong rotation in the Accident and Emergency Ward. I saw patients with tumors the size of baseballs walk through the front doors. After a quick history, it was made clear that this patient’s mass had been growing for over 3+ years. Due to skewed beliefs of medicine, lack of money, and ignorance, led to case after case of patients arriving to CPGH with diagnoses far worse than they would have been if they had just shown up to the hospital when initially symptomatic. Yet, even in the midst of the frustration, knowing that what was actually being treated could have been alleviated by simply showing up, the doctors I got to shadow showed them grace, understanding the patient more than I may ever understand. It was a beautiful picture of community, people working together to offer the best care they could. One of the doctors in A&E once said, while treating a man who came in after theft and assault, “It’s not up to us to judge a patient, only God can do that. We are here to treat.” This quote, simple yet so profound, completely shaped the way that I view medicine and shaped the future physician I hope to one day become.

I learned that as a physician, your job is to care and to treat. It sounds obvious, even as I write it down, but an art that I’ve seen been lost in the US. My initial desire to be a physician, for as long as I can remember has always been rooted in my desire to interact with people and love them in the midst of suffering. Giving them hope when hope can be received, and to provide a plan when everything else seems to be spinning out of control. My time in Mombasa has shown me that to be a doctor is the most rewarding profession. It’s by no means the most glamorous job, and far from a job with “good hours.” Yet it somehow continues to draw me in. Intrigues me to my core. I’m convinced that has to do with the fact that the good ones, the doctors who have made an impact on me, are the doctors who act out of love. The doctors who see patients as people who are hurting, yet are also people who can heal. From that, stemming the desire to treat, even in situations far less than ideal. During my time at Coast General Provincial Hospital, I saw a lack of resources that left doctors helpless to use techniques far from ideal. Yet they were beyond brilliant. The doctors at CPGH had the most incredible critical thinking skills, having to constantly think on the go. Most doctors in the departments I got to observe, would even stop to tell me what they “should be doing at this time” given the proper equipment and resources. For example, a patient with abdominal pain from a stab wound on his left side, needed to have the FAST method performed on him, to indicate the location of fluid they knew was in the cavity of the body. Yet, due to lack of equipment, it took 4 hours before this patient could be x-rayed and have ultrasound performed, leaving the patient at larger risk for infection and even fatality. The resident in charge showed his frustrations, yet worked when possible, and didn’t complain once. I’m more grateful for the resources the US has to perform medicine, yet am shocked at some physicians who have lost the necessary skill to critically think in situations where the brain is required to create a proper diagnosis, apart from technological tests that at times are wrong. I will be leaving Mombasa with the desire to increase my critical thinking skills, knowing that medicine is a never-ending classroom, with new knowledge and techniques to learn every day. I owe such a desire to my experience with the doctors at CPGH and the IMA program, as without it, ignorance would still ring in the ears of an American boy, thinking western medicine could fix any problem.

It would be a shame if I didn’t reflect on the culture I had the opportunity of being immersed in. Culture that not only changed the way I view medicine and treating patients, but culture that changed the way I view people and life and freedom and community. I had the privilege of going to a local market at what locals call “Old Town”. I was with a smaller group, so we had more opportunity to embrace what it may be like to shop and buy as a local Kenyan, without the large stigmatization of being the “mazungu”. I watched as people bartered and ran from shop to shop helping mothers find the right size dress for their children and walked past mosques were Muslims get the call to prayer 5 times a day. I was overwhelmed by the sights and the smells. It was raw and it was beyond beautiful. It’s so easy to get caught up in the monotony of western culture. The day in and the day out of what I’ve come to call comfortable. The second I stepped outside of “comfortable” into what I once saw as “unknown”, I was overcome by joy that exceeded any and all tiny expectations I may have held a month prior. I think there’s value in traveling and immersing oneself into the daily lives of people who may seem so different, only to find that maybe we all aren’t so different after all. From patients and doctors at CPGH, to beach goers at Nyali beach, to the meat butchers in Old Town who think it’s funny to make a severed goat head look like it’s talking, to the school kids who’s community I got to interrupt and intercede in even for only a few hours; I learned more than I ever thought I could, simply by listening and watching. Movements and phrases, handshakes and smiles, they all seem to speak this universal language that brings me back to the reality that we are all human. We’re all in need of being the patient, and other times get the opportunity to be the hero. I’ve come to learn that nothing is as grand and nothing as beautiful as the little moments in life where we get to say “yes” to the once in a lifetime opportunities that end up changing our lives in ways we didn’t think possible. In ways we didn’t expect. To be a physician, to be an advocate for the sick and needy, to possess the power to heal. I’m convinced it’s the most powerful yet humbling profession in the world.

As a pre-Physical Therapy intern, I was one of the first interns to ever come to work in the Therapy Department; therefore, it was a new experience both for me, and the therapists that I worked with. Everyone was very open and excited to teach me everything from their treatment methods to their favorite foods. The amount I learned from each therapist in the department, whether I personally shadowed them or not, is immeasurable. On top of the success I had in my department, the relationships that I made with the other IMA interns was something that made my experience even more amazing. Sharing stories from our days in the hospital, having tough conversations concerning things that we saw, and exploring Kenya together is something that I will always cherish. Altogether, my experience with IMA was rewarding, impactful and life changing in many ways.

Upon my arrival in Mombasa, Kenya, I was completely unaware of the impact that the International Medical Aid internship program would have on me as an individual, and further, an aspiring Physical Therapist. The culture in Kenya was overwhelming, in the best sense. It completely engulfed me and allowed me to explore the ins and outs of a foreign culture and healthcare system. My experience through this internship program provided me the opportunity to break down various barriers, allowing my perspectives and attitudes towards everyday situations to be transformed.
Mombasa, being one of the two cities in Kenya that has major hospitals, has a public teaching hospital called Coast General Provincial Hospital. It is here where my internship began, and where I was able to learn from multiple different therapists to broaden my knowledge on Physical Therapy and foreign healthcare systems. My experience at Coast General, located in an area of extreme impoverishment, provided me with an environment that required me to understand and break down socioeconomic, racial, cultural and language barriers. The way in which Kenyans welcomed me into their country, and made sure I was learning everything that I possibly could, made me have a whole new respect for the way in which they live their day to day lives. Although I was from a different continent, and looked so different than the native population, I never felt as if I was a minority. I have always believed that people should be treated as human beings and not any differently based on their characteristics, and this experience allowed me to gain more perspective on this idea than I ever thought possible. I learned that being open and eager to learn about all groups of people enables individuals to gain insight and understanding of the world as a whole, expanding the capabilities and assets that such people have. I believe that having this desire and drive is important for Physical Therapists working in all settings, and I trust that it will benefit me greatly in the future. Through this perspective, I also learned the impact that a simple smile and wave has when there is a strong language barrier, being calm in situations that are outside one’s comfort zone, and asking tough questions when one does not understand a cultural practice of another group.

In addition to these barriers that I learned to overcome through gaining perspective, the atmosphere of the hospital also presented itself with barriers concerning the resources and population of Coast General. The hospital is extremely under resourced and overcrowded, which gives ample opportunity for high stress situations. This atmosphere creates a barrier in itself, which often requires health professionals to make difficult decisions regarding the number of patients they will see in a given amount of time and the amount of resources they will use. From this, I learned from Kenyan Therapists the importance of patience, and giving their undivided attention to each patient in order to see the best results. There would be many times where the therapists would be called to other wards to see other patients, but they were always sure to stay with their current patients until the very end of their care. From the first moments I knew I wanted to become a Physical Therapist, I always admired the relationships that therapists had with patients based on the level of interaction that they had, and how they genuinely cared about their quality of life. By being able to form relationships in Kenya myself, I was able to practice this characteristic of Therapists that I thought so highly of at a whole new level. Through this experience, I learned how to better understand and adapt to stressful situations by remaining patient, but efficient, in order to give each individual that I form relationships with the proper care that they deserve.

Altogether, my experience in Mombasa, Kenya allowed me to acquire skills and perspectives that I hope to use in order to become the best Physical Therapist I could be. My experiences with this program not only reaffirmed my interest to become a Physical Therapist, but greatly expanded it due to the characteristics of the therapists and hands on work that I was able to observe. I desire to continue to give and learn from each community that I am able to work with, in order to continue expanding my knowledge on various groups and characteristics of people. The perspectives that I gained from this experience will stick with me throughout the course of my future career, where I will continue to learn and build upon them.

“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.

This program provided me with many unique opportunities and an incredible experience overall. The people in Kenya were extremely kind and accepting, and the children absolutely stole my heart. Every day was filled with beautiful scenery and Kenyan cuisine that I still daydream about–including chipati. Visiting the local communities during the medical or hygiene clinics was a blessing to me even more than it was to them. Seeing the different living situations for the lives of all these joyous people showed me just how unimportant and unnecessary that material things are! I hope that I can bring this new perspective to the many future teams/schools/jobs that I will be a part of in the years to come. I certainly can’t wait to go back to Kenya when I am certified and skilled enough to make a medical impact at their hospitals and in the community!

My internship with International Medical Aid allowed me to be a part of unique cultural situations that can only be experienced in Africa, exposed me to medical conditions that are rare in the Unites States, and taught me more about myself in one month than I thought possible. I now see the world through a different perspective in various situations and am better off for it. My experience, combined with my newfound knowledge, will also enhance my ability to inspire teams I am a part of in the future, and allow me to convey ideas or concerns sparked by this experience abroad.

Healthcare delivery in Kenya is different from the United States’ hospitals in countless ways. The most pronounced differences that I noticed is the lack of technology, materials, and medicine/anesthesia. Due to this reality, I witnessed many doctors and nurses forced to improvise. In one case located in a minor theatre, the nurse could not find a scalpel with a handle, so the doctor had to use a clamp to hold onto the blade for the entire procedure. Also, due to the lack of available drugs, all mothers in the Labor and Delivery ward had zero access to pain killers of any kind. Another difference that took me a while to get used to is the Kenyan staff’s sense of urgency. For instance, a woman began seizing in the ER, and I watched as nurses stood by, looking unconcerned, until one nurse finally took some action several minutes later. In the states, the patient would have been monitored with multiple machines, alarms would have been going off, and a team of providers would have probably responded immediately. But I really admired the physicians and the staff I was fortunate enough to observe, and I hope someday I will be able to come back as a physician and help at Coast Provincial General Hospital physically and financially.

Along with the many differences in healthcare, Kenya’s culture and religious status made an impact on me as well. The first things I noticed when I entered the city of Mombasa were the people—with their heavy accents, fluent Swahili, and the many hijabs being worn by citizens. My first week in the hospital proved to be quite a difficult learning environment strictly because I could not understand what the doctors were explaining to me or the other interns. Even though they were speaking English, the accent took some getting use to. However, once I adjusted to the native peoples’ accents, I learned that the nurses and doctors were extremely willing to teach! Before my visit to Kenya, I had not been exposed to many religions, and I did not know much about Muslims. While in the beautiful country of Kenya, my eyes were opened to this religion; my roommate was even Muslim! What I learned is that they are just normal people with all different personalities, they just have some different beliefs than I do. I think I subconsciously stereotyped them before this trip just because I have not been around many Muslims and I was slightly ignorant of their faith. This is just one more way that my experience in Kenya opened my eyes to the fact there is so much unique and beautiful in this world.

All of the exposure and close up observation inside the Kenya healthcare system really confirmed I want to pursue a career in medicine. I witnessed new lives being brought into the world in the Labor and Delivery ward, and also observed a man pass away right before my eyes in the Casualty ward due to impact injuries. In these moments, I realized that I wanted to be a part of the process, whether it be life or death. I understand that I will encounter many gruesome and heartbreaking things by joining the medical world, but it’s going to be the smiles and the joy of patients and their families that I am able to truly help that will make everything worth the struggles and effort. It would be my privilege to be a part of something that deeply affects so many peoples’ lives, and I sincerely hope I can have such a positive impact.

About 20 years ago I was born “Nameless” in a Hospital in Berlin. My mother vanished one day after my birth and left me at the hospital for adoption. As good luck seemed to be part of my life from the beginning, I was soon adopted and called Anna Minkwitz. With my newfound parents I moved to the suburbs of Berlin, close to my new grandparents and extended family. Growing up there, my parents allowed me to live a life of great privilege that included going to an international school to learn English, moving abroad as an exchange student for a year and lots of travelling throughout Europe, Africa, and America. Especially, the family trips throughout Africa had a great affect on my personality and upbringing and thus I decided to apply to International Medical Aid in Kenya after working in hospitals in Germany for a year now and attaining my EMT license.

Getting accepted into the IMA pre-med program was a great honor and throughout my 6 weeks in the program I learned more than I could have ever asked for. At Coast Provincial General Hospital (CPGH), I started out in the New Born Unit (NBU) with Dr. Juthy. She took me under her wing and I felt sorry for bothering her with my million questions about the different clinical pictures: which diseases were very common, which were rarer, how they tested for the diseases and the treatment plans. I also asked many questions about the Kenyan healthcare system and Dr. Juthy always took her time in answering my questions thoroughly. She also helped me draw comparisons to Germany as she has worked in Germany as a Doctor for some time doing an internship and so we could draw parallels between the two healthcare systems together. One day for example, there was a highly septic new born, that had been transferred to CPGH from a different clinic, which needed to be ventilated as it could not breathe on its own. So, for my whole shift I ventilated the new born by hand as there was no ventilator available, this is the first time I encountered the magnitude of the lack of resources.

Following the NBU, I rotated in the Emergency Room (ER). I didn’t really have a mentor there, as doctors always dropped in and out of this department but I did manage to make this an everlasting learning experience that strongly assured me that starting medical school in March 2019 is the right decision for me. In Emergency I had many learning by doing experiences and I could draw from my EMT knowledge to assist the doctors and nurses. As an EMT at home you must think on your feet and always be ready for the unexpected, this helped me in a lot of ways at CPGH as the emergencies rolling could be anything from minor issues to actual life-threatening problems and the shortage of resources and staff made it hard to keep up with all the cases. Here I learned about the lack of insurance coverage within the population and the struggle the patients face when having to come up with the money for a CT scan for example. Coming from a country where everyone is insured by the government at no cost, I learned to appreciate what I had been given by just being born in Germany. While I surely shouldn’t apologize for this privilege I, by all means, have grown more aware of it and as a future doctor I hope I will be able to give back.

Working in the ER, I got to witness and assist many interesting cases that did not only better my understanding of the Kenyan healthcare system but also the culture. Especially, the different way of viewing death in Kenya vs. Germany was a unique experience for me. One day I witnessed a 4-year-old arriving at CPGH’s Emergency room after a tuktuk accident. The patient was on her way home from school, when she was hit by a tuktuk, so the tuktuk driver brought her to a local hospital as the child was badly injured. Unfortunately, the hospital was ill equipped for such severe traumas, so they sent the injured child away without stabilizing her first and suggested the tuktuk driver to take her to CPGH. When they arrived, the child was already dead, and I ended up just cleaning up the blood as far as I could so the parents didn’t have to see all the gory. When the mother arrived, she was miserable but also accepting of her daughters passing and said that if this was God’s wish she must let go and comply. One of the nurses their explained to me later that the high child mortality makes death a much more present thing throughout the country, so it is almost expected that one may lose a child. This struck a nerve in me, as my adopted parents had lost child doing pregnancy before they adopted me, and they still struggle with accepting this loss.

Subsequently I rotated in the Operating Room. There I worked especially close with Dr. Peter, the plastic surgeon at CPGH. This was probably one of my favorite learning experiences, as I have been very interested in pursuing a career in reconstructive plastic surgery and I could draw from my experiences in Germany working in multiple plastic surgery departments in various hospitals, including Germany’s biggest burn unit. Dr. Peter showed me how to be innovative and creative when in lack of resources. I learned how one can amputate a leg without a tourniquet and how to do a make-shift tourniquet from bandages. He explained and showed me how to do skin grafts when you don’t have a meshing device, how to harvest skin without an automated skin shaver, how to make vacuum wound dressing without the actual vacuum machine and many more things. As he is the only plastic surgeon in all of hospital, seeing him work without a team of plastic surgeons assisting him, without surgical nurses that have been trained to assist in plastic surgery was also very impressive. As Dr. Peter and I worked well together and as he mentored me far beyond what I ever expected we have now decided to create an exchange program for doctors with a plastic surgery department in Germany that we are now working on together. I hope that this project will help the plastic surgery departments in both countries to learn from and with each other and to improve patient care in the long run.

Besides the work at CPGH, I also learned a lot thru the outreach events that IMA organized, and I was happy to also organize a few community outreach projects. I especially liked working with the Gender Based Violence and Recovery Centre (GBVRC), because this opened my mind to the issue of defilement in Kenya and the resulting unwanted pregnancies and sexually transmitted diseases. Through this Centre I also met the paralegal Mary, who helped me organize an outreach in the Mikindani Area to educate the youth about gender-based violence in this at-risk area. As I have returned to Germany now, I’m continuing communicating with the GBVRC to fund their projects to raise awareness and build safe shelters for children that have experienced defilement by a family member.

All in all, IMA in Kenya was a program with unlimited options. Phares and Bella, the program coordinators, were more than willing in helping me realize all my plans and dreams for this experience. My time at CPGH taught me many things some of them being: how to connect with patients when you don’t share the same language or culture, how to be more proactive and take initiate, how to work around a lack of resources with creativity and how to cope with drastic situations. The outreach programs like the mobile medical clinics or hygiene clinics installed a sense of confidence in me and my medical knowledge and taught me to take on more responsibility. I learned that you can not only see the human as a biological structure, but you must see the person as whole with mind, body and spirit in unity. I feel more certain than ever that a profession in health care is the right choice for me as I don’t only like working with patients and assisting them in difficult times, but I also learned that taking initiative and taking on responsibility doesn’t scare me it empowers me. Seeing doctors that work well in a team and some that don’t, I also understood more and more what it means to work in a team where sometime a life is at stake, and that to obtain the best patient care everyone needs to take a step back from their own personal wishes and focus on what is best for the patient. Thus, I hope to be a doctor someday that is reflective, balanced, open-minded, determined, creative and always ready to learn more.

Participating in the IMA pre-medical internship has been a life changing experience for me. The program mentors, resident chef, and local support staff were always helpful and accommodated any need that I had. Working in the hospital definitely tested me in ways that I never imagined. I saw a lot, and I experienced a lot. Most of all, I learned a lot. Every doctor that I came in contact with was more than willing to teach me and allow me to interact with patients.

Riding to Coast Provincial for my first day of rotations, I did not know what to expect. I was filled with feelings of anxiety and joy; I was about to embark on a once in a lifetime experience. As I made my way to the gynecology ward, many thoughts rushed through my head. What would I see? What would my mentor doctor think of me? I was greeted by the warm embrace of Dr. Rehema, and I knew that everything was going to be alright. My time spent at Coast General taught me so much. Not only did I learn about medicine, but I learned about myself. With each patient I saw in the hospital, I gleaned medical knowledge and learned about not only my humanity, but the humanity of the people around me.

During my internship, I spent a large portion of my time in the wards dealing with women and children. In each of those wards, despite seeing women laboring, children in agony, and innocent newborns fighting for their lives, there was so much beauty and strength to be found. One of the first things you notice going being in the wards is the immense strength of the women; not just the strength of women in labor, or the mothers watching their children fight off illness, but of the female nurses and doctors. The female doctors displayed a level of confidence that I had never seen before. They were always sure of their work and what they knew; they were never afraid to speak up concerning a patient’s diagnosis and why their diagnosis was correct. Despite being fierce and knowledgeable of their field, every female doctor I came in contact with was kind and gentle with me as well as their patients. I could not always understand what they would say to their patients, but each doctor took their patient’s hand and gave them caring, reassuring looks. Where I was concerned, each doctor took their time to explain cases to me and should be as a future physician: sure of my knowledge, yet humble enough to care for my patients and those around me.

I learned an immense amount about myself during the four weeks I spent in Mombasa. The first thing I learned was that obstetrics and gynecology was my calling. I absolutely loved being in the labor ward and realized that I could see myself being there everyday. The next thing I learned was that my passion for helping people was greater than I thought. I absolutely loved doing hygiene clinics. I gained a sense of fulfillment that I had never experienced before every time I saw the smiling face of a child that I had just received a new toothbrush.

My internship with IMA was by far one of the greatest experiences of my life. I learned a lot about medicine; more importantly, I learned about myself. Medicine is not just about taking care of someone’s health: it’s about recognizing the patient’s humanity as well.

This program is the best decision I ever made. The program mentors in Kenya helped me from the minute I got accepted to the moment I left. They were very approachable and friendly. I always felt safe during my stay in Kenya. The mentors go out of their way to ensure the safety of the interns. They provided us with tips that would further ensure out safety while they were not around. The accommodations were much better than I had anticipated. Our rooms were cleaned every day and we stayed in a very nice neighbourhood. The food never disappointed. All of the interns looked forwards to meals as it was always something yummy. This program had a huge impact on me. I have learned so much about Kenyan culture and was able to see and learn a lot. I was able strongly notice the differences between Kenya and North America. With the help of hygiene and medical clinics as well as other outreach activities, I hope I made some impact on the communities we visited, they certainly made an impact on me.

I believe the most valuable aspect was the interactions we had with the children at schools and within the communities. performing the hygiene clinics and medical clinics really opened up my eyes to what some of these kids are exposed to. Despite the exposure I faced at the hospital, being involved within a community was slightly more valuable for me.

The safari was a huge highlight on my trip. It was worth every penny that was spent. The lodge we stayed in was beautiful. The food was great and our safari driver was hilarious. No improvements here.

Going into this pre-dental internship with International Medical Aid, I didn’t know what to expect. Travelling to a foreign country alone and being completely submerged into their culture, I was very nervous. But, once it was all said and done, I am so happy I took on the challenges that this internship had to offer and I really did learn a lot. Everything that I learned over the month has further encouraged my interest in the dental field as well as opened my eyes to different cultures and newfound knowledge.

The dental field within Canada is very different than that of Kenya. I have shadowed multiple dentists within my hometown and have never experienced such things as I have within just one short month as Coast General Provincial Hospital. The Canadian dental field generally focuses on cosmetic issues. Many procedures that are done are not completely necessary. What I originally liked about the dental field, over the medical field, is that slight changes in your oral health can make a world of a difference for one’s self esteem. The dental field does not typically consist of life or death situations and immediate emergencies. I went into the internship thinking I would see the absolute worst things. I was pleasantly surprised to realize that even though the systems are very different, they do have more similarities than I expected. For some reason, I was expecting the largest difference to come with the equipment used. I thought that they would not have access to general anesthetic, which was wrong. They use anesthetic and are happy to administer more if the patient complains of pain. They have all of the same dental tools used in a general dentists office in Canada. They perform every single procedure, most times, the exact same. This all came as a shock to me. But, from conversations with my fellow interns in different sections of the hospital, I believe the dental unit within CGPH was blessed to have such amenities. Tools and equipment were not so plentiful in other areas of the hospital.

Obviously, the system was more similar than I thought, but it was also very different than what I am typically used to. Having a dental unit within a hospital is almost unheard of in Canada. Most dentists own private practices. It may have been interesting to visit a private dental office within Kenya, just to have more of a comparison to what I am typically use to. The dental unit being within a provincial hospital meant that most patients could only afford minimum treatments, if any at all. This was a major difference, as most patients that came in waited until the very last minute they could to see a dentist. This made what I seen a lot more extreme than if it was at a privately owned practice. If patients are waiting until the very last minute, most of them will end up getting an extraction. The dental unit was equipped with four extraction chairs. This can be compared to only three chairs where fillings, root canals, and cleanings were performed. While shadowing dentists here in Canada, I’ve only witnessed two extractions take place. While in Kenya, I could watch two extractions within 20 minutes. It seemed that the dentists in Canada, spend most of their days doing fillings and root canals, while the dentists in Kenya within that section, had empty chairs for the majority of the day.

Another difference I noticed between the two healthcare systems is how broadly trained the dentists are. I spent a lot of time in the minor oral surgery room where I was introduced to things I’ve never witnessed before, and that I probably never will witness in Canada. Often things they were required to treat would have been sent to a specialist or even a medical doctor in my country. But, this is what they’re dealing with and all dentists must be trained very broadly for whatever may be thrown at them. This was fascinating to me and what I loved most about my shadowing time. I was also able to scrub in twice on a couple different procedures within the main theatre. This was very intriguing to me as I would probably not witness most cases in Canada. It was awesome to see the equipment used, methods of scrubbing in and the actual surgery. The specialist that performed these surgeries was very willing to teach me anything and everything he could. It made me eager to learn and I hope to return when I am in dental school so I can actually help the dentists out and practice.

This internship made me realize that dentistry is so much more than cosmetic. Although, I do love the confidence booster dental work can cause, this experience made me fall in love with the emergency side of the dental field. It taught me that the dental field is just as important as the medical field. In Canada, although oral health is encouraged, a lot of the work done by dentists is deemed unnecessary. This experienced showed me exactly what will happen if oral health is not taken seriously and said “unnecessary” procedures are not performed. One of the dentists I shadowed during my time at CGPH emphasized the importance of even small procedures and the difference it can make to one’s health in the future. Oral infections and other complications can eventually lead to more serious illnesses. This is not something that is often seen in Canada, as oral infections and cavities are generally taken care of immediately.

Not only did this experience accelerate my interest for the dental field, it also came with some eye-opening experiences. These experiences have intrigued me in the area of global health and educated me on the issues that Kenyans face. The clinics that we conducted and the community outreach that we were exposed to was the absolute best part of the entire internship for me. These activities are life-changing opportunities that I will take with me for the rest of my life. The hospital was an obvious shock for me, but seeing the communities and living condition these people come from topped any exposure I would have received from the hospital. Being submerged into these kids schools and seeing what they do day-to-day is surreal. I was imagining very similar things before I had attended the internship, but being there is crazy. These experiences definitely changed my entire perspective on life. I will never take my life here in Canada for granted, along with the basic amenities we are blessed to have.

I have learned more than I can even imagine during my time in Kenya. I was able to gain knowledge within the hospital in the area of dental medicine. Since the dentists are so broadly trained, I learned a lot of medical techniques and was exposed to a lot more than you think a dentist would see. The amount I learned from conducting both hygiene and medical clinics was amazing. I have gained so much knowledge throughout this entire experience. I am so fortunate to have met such amazing people during my stay in Kenya, who all played a role in ensuring my internship was great and I learned everything I can in the short month I was there.

As this was my first trip alone, I was a little scared of what I might encounter in Kenya. However upon landing, Benson and Brian were very sweet and I felt already secure. When I approached the resident I felt safe to know that there was a security guard at all time and there were also cameras outside the door. The resident was clean and comfortable. Naomi and Joshua were amazing. They were super sweet and accommodating to whatever I needed. They’re energy and continuous smile was pleasant to see in the morning. Benson was very accommodating when it came to seeing the city and always asking for feedback, which I really liked! The program was very organized. The time table helped to know what and where I should be at all times. There were a lot of rotations and so I was able to get my first pick. The mentors at the hospital were very helpful and asked a lot of questions. I found this experience to be very educational.

All in all, my time in Kenya was eye opening. This experience was a validation for me that I want to be in the medical field and I want to be helping people in every way I can. I want to use my knowledge on how they treat patients and expand it to other countries that are way less developed. I have learned balance and not dependency. To further elaborate, I want to be able to talk with patients and understand their symptoms as well as looking at labs and testing to decide on a conclusive diagnosis. It takes a lot of practice to be able to spot diagnosis a patient as there are many diseases and similar symptoms. This trip has made me realize that I am eager to learn. I didn’t know the answers to many questions asked by the interns and medical officers due to the fact that I simply didn’t learn. But when the medical officers were asking questions I was motivated to think outside the box. I was able to adapt to their style of thinking to figure out how to diagnosis a patient. This is a skill that I learned via this internship and I plan on expanding my knowledge even further. Not only do I want to become a PA and be able to provide care for those needed, I also want to teach and educate patients. As mentioned before education is key for prevention. I strongly believe that educated youngsters can play a huge effect in promoting good health. A story to tie with how a simple education can go a long way is the Red Cross. This name is a commonly known world-wide and it all started by a simple businessman, Jean-Henri Dunant who organized local relief assistants to partake in basic wound care for hit soldiers. This act of selflessness has saved many lives and now currently Red Cross has over 97 million volunteers saving lives on a daily basis. I want the knowledge I have to be spread and passed and that is why I want to become a Physician Assistant.

 

 

 

The experience I had with IMA was entirely different than any health care or outreach experience I have had previously. Outside of hospital placements, it was wonderful getting to know the other participants on the program while learning about the culture of Mombasa, Kenya. The program mentors were phenomenal- extremely supportive and accommodated to my exact interests. They went out of their way to ensure I was having a good experience and had the opportunity to do everything I wanted to. The accommodations were very nice and in a very safe neighbourhood and we had incredible meals prepared by the resident chef. Regarding hospital placements, the experience is what you make of it. You need to be ready to dive in, be proactive, and build relationships. I underestimated how challenging the hospital placement would be, in terms of how mentally and emotionally draining it was. There are things I saw and experienced in the hospital that have made a permanent mark in my mind. I gained valuable insight into how cultural differences impact health care, being aware of the way things are done differently due to either cultural differences or systemic differences. In many ways my mind grew, my heart expanded, and my heart broke. I am incredibly grateful to have had this experience, and I know it will stay with me. I am confident that this experience will forever change the person that I am and the nurse that I am.

I valued having a combination of time in the hospital with time in the community. My favorite days were when we would visit schools and have hygiene clinics and medical clinics.

I went on the Masai Mara Safari and it was incredible. It was definitely worth the cost to do it. If you are going to Africa, it is something you need to do while you are there. My group had an amazing driver who educated us on all the animals we saw. We got right up close to so many different animals. The accommodations we stayed in were also extremely nice!

Prior to beginning my internship in Mombasa at Coast General Provincial Hospital, I had completed approximately 200 hours of medical volunteering in hospitals around Los Angeles, California. I had never been exposed to serious illnesses or diseases with pneumonia arguably being the most serious condition I have ever encountered. Most of the patients I had seen and interacted with simply had some sort of upper respiratory tract infection or were simply stricken with diabetes or obesity. Looking back, I could not have imagined all that I would be able to view and learn while rotating through the different departments at CPGH. During the internship, I was happily placed into the Pre-PA Program where I hoped to gather knowledge and shadowing experience from Clinical Officers which are the equivalents of PAs in Kenya.

As for the unique and remarkably memorable cases I had the privilege of viewing firsthand, there was certainly no shortage of them. My very first case was of a two-year-old boy who was suffering from Ricketts. I had only heard of the condition from textbooks and learned from my attending pediatrician that this was common among young children in Kenya. Dr. Siminyu passionately questioned, “I bet you’ve never seen that in America and I highly doubt you’ll ever see it even after you become a PA.” To be frank, he is probably correct. As my first case this was especially memorable simply since the condition is just so common in Africa and learning that just easily made it unbelievable to me.

However, the case of Rickets is certainly not a case that will stick with me for the rest of my life as the one I am about to describe. My experience in being in areas of intense odors and smells is certainly above average in my opinion for a young college student. I have taken a class with cadavers and have grown accustomed to the smell of formaldehyde. In addition, I also visited the morgue on a few occasions at CPGH and witnessed some autopsies right behind the medical examiner. Nevertheless, none of this experience could have prepared me for the sight or smell I would experience with this patient. The patient was a middle-aged man who was suffering from a rare form of Tuberculosis called Pott’s Disease. This form of Tb usually affects the lower area of the spine and can easily spread to other areas of the body. In this patient, Dr. Hassan had to forcefully remove pus and other fluid from the patient’s inner right thigh. A rather significant and potent iliopsoas abscess had been festering for a period of three days now. The disease had unfortunately spread to this area of the body and had caused significant infection of the muscle and tissues associated in that region. The procedure itself was simple; squeeze out all the fluid. I have never smelled a worse stench in my life than the pus that was streaming from that man’s inner thigh. Dr. Hassan simply made a small incision and just pushed on the area surrounding the hole and an endless faucet of rather odorful fluid came out. Most memorably, I have never seen a doctor or attending nurses gag from a smell before. The odor was so strong people in the waiting area of the Emergency Ward were complaining of the smell. Importantly, Dr. Hassan stopped the procedure because the man was thriving and screaming in too much pain. He mentioned to me however that he truly stopped the procedure because there was simply too much fluid coming out; that this simple procedure had transformed into a surgical one that would have to be continued in the Main Theatre. This by far was the most unique and memorable case I ever encountered during my time at CPGH.

In addition, I should mention that I had the most interactable and personal relationship I have ever had with a patient before throughout all my clinical volunteering hours. I had the pleasure of caring for and getting to know a middle-aged man for two weeks during my departmental rotations. The first week I met him was in the Radiology department where I was shadowing radiographers, radiologists, and sonographers through various procedures. My radiologist happened to be on her lunch break at the time and I thought this would be a great and humbling opportunity for me to meet and just talk to some of the patient s waiting. This man happened to speak English perfectly to the point where he was understanding my American slang and jokes. He happened to also be born in California as I was and moved to Kenya when he got married as his wife was from Nairobi. I can not express how much we had in common throughout our initial conversations; we were simply compatible. He told me how he graduated from the U.S. and met his wife on an internship and how life just took him to Nairobi and Mombasa. We shared several hearty laughs and heated discussions about our favorite American sport teams and even had heated arguments on what Steven Spielberg movie was the best. In the moment, I could not believe how someone on the other side of the world and twice my age could be so relative and share so much in common with me. As he was a fantastically friendly and intelligent person, he was unfortunately in a hospital.

I asked him what images or tests he was getting done at Radiology and even at the lab as he had several referrals for blood and platelet tests as well. He explained to me that physicians were not certain as to what was causing his symptoms of exhaustion and severe headaches. I responded that hopefully none of his symptoms meant anything too serious and happily helped him into the X-Ray room and told the radiographer just how incredible of a person he was. His tests commenced and I happily wished him a great afternoon. However, later that evening, as I was viewing several chest X-Rays and angiograms along with Dr. Valerie, we happened to come upon his chest X-Ray, spinal X-Ray, and angiogram. Dr. Valerie quickly turned upset as she viewed his angiogram and even me with little experience in reading radiological tests noticed there was certainly some sort of mass located in his brain.

I honestly hoped I would not see the man again as I could not face him and let on to him that he was fine. Incredibly, he found himself again back in Radiology with more tests being conducted on his lower extremities. I made little contact with him, but on his way out he called to me and told me he had a question. He asked, “Just because I have cancer doesn’t mean we can’t still be friends, right?” I awkwardly smiled and let him know that we were absolutely still friends. He continued onto me that it was an operable mass and that his outlook on the surgery would be positive. The doctors noted to him that he may experience some weakness in his limbs on his right side after the surgery due to the mass being located on the left side of his brain. Altogether, he should make it out alive and continue living his life with his daughter and wife. He also mentioned to me that the tests being conducted today were just as a precaution and to assure that there were no abnormalities located around his body. Most importantly, he stated his surgery would be taking place next week and I happened to be rotating into surgery the following week. I made it clear to him that I would be there for his surgery and to talk about how the Dodgers were going to lose in the World Series again this upcoming season. He laughed at my comment and graciously invited me over to dinner later that week so I could meet his family.

The dinner was easily the best dinner I had in Kenya. His wife made an assortment of Kenyan foods and we basically just talked about life and all that comes with it for 5 hours. However, the most memorable thought from that night I can recall was his wife reassuring me that he would be fine throughout the surgery and that all would be well. Friday morning came around and the surgery was a few hours prior to commencing. I was with him for about an hour during pre-operation in the surgical ward and we talked about a plethora of things. However, approximately 20 minutes before we carted him into the theatre, he sharply motioned to me to come over as he had something to tell me. “Okay, I need to get a little serious before I head in.

You are the only person among this hospital staff that I truly trust, and I know we’ve known each other for a few weeks, but I have a task for you. If I go on the table, I need you to tell my family how it happened as best as you can. My wife also trusts you and I think my daughter trusts you, but she does think you’re weird since you’re not African. And lastly, make sure they put everything back where it should be will ya’?” I laughed at his explanation but as he got carted in and went under, I could not help thinking that what he told me was outright frightening in my mind. He had to make it through this.

The surgery went perfectly through the first three hours with all the now removed glioblastoma resting on the nurse’s equipment tray. However, just as Dr. Okonga removed the last bits of tumor and told his assistant surgeon to begin the suturing process, the unthinkable began occurring. His heart rate and respiration plummeted and Dr. Okonga ran right back into the theatre and from there chaos ensued. I could not understand what the staff were communicating to one another as everything was now being said in Swahili; all I could make out was that this perfect surgery was heading in the wrong direction. Additional oxygen and compressions began 30 minutes after his decline in respiration and heart rate, and in a span of an additional 10 more minutes he lay cold on the metal table. My friend was no longer with me. I let the surgeons and nurses break down what just happened for some time and patiently waited outside the theatre for Dr. Okonga. He came out about 20 minutes later and all he could explain to me that there was a complication as he removed the last bit of tumor from his brain. His body utterly and completely went into shock as it occurred and they made several attempts of trying to raise his heart and respiration rate back to normal, but to no avail. Dr. Okonga relayed, “These things happen in medicine unfortunately and there was nothing else we could have done.” And just like that, he walked away back to the surgical ward to report and file my friend’s untimely death. Now I had to prepare for a guilty walk to a home that seemed strange to me now and an explanation for which I had none.

I left that home feeling disheartened and outright helpless, but also hopeful. I relayed the explanation to his wife just as Dr. Okonga told me. She was in tears, but she also wanted to assure to me that it was all a part of God’s plan. We happened to all be Catholic which may have been a huge reason in all of us gelling together so well. I cannot even remember how many apologies I gave her that evening and she kept repeating that none of it was my fault. My lasting memories of the conversation I had with her that night was her sternly telling me to keep following my path in becoming a PA and to do my best and to try and make sure something like this never occurs again within another family. I left that sanctuary of a home with my friend’s Dodgers jersey as his wife mentioned to me that he would have wanted me to have it. I have that Steve Garvey jersey already framed in my bedroom as a reminder of him and how he impacted my life. I highly doubt I will ever have a personal interaction with a patient in the same way I had a relationship with this man throughout my life or medical career. I simply hope that I can devote my life’s effort to making peoples’ health better and more friendly just as my friend and his family wished. If there was any doubt in becoming a PA or other health professional, the thought was eradicated the moment I met this person.

My experience from working at CPGH was certainly memorable, but the second I stepped into the hospital I already noticed the significant differences in the delivery of healthcare compared to the United States. As discussed in one of our lectures, “Among the Public Health Services Sector, most facilities tend to be under-resourced in terms of equipment and clinical staff as well as share lower standards of care when compared to the private sector” (IMA 2019). There were numerous differences I noticed as I began my internship at CPGH compared to hospitals in the United States. For example, every note, record, chart, or evidence of a patient was in paper with no information digitized at all. The use of physical copies of information and data caused notorious confusion among health care practitioners at moments since some data would often go missing or be misplaced. Arguably the greatest misfortune without a computerized central system was how archived patient information would be deleted or otherwise misplaced, meaning if a returning patient came into CPGH, they would have to be processed all over again.

Other differences I readily viewed firsthand was the lack of sanitation, cleanliness, and otherwise disorder of CPGH. Each of the physicians and nurses are fully capable of handling and caring for patients but with the environment they work in, the job becomes challenging and, in many cases, quite difficult. With upmost resources challenging to acquire, “The health insurance scheme does not contribute a significant amount of funding to public hospitals in Kenya and is largely unaffordable for a majority of Kenyan citizens especially in the informal or poor sector” (IMA 2019). Without out delving too much into the steps Kenya needs to become a more advanced and industrialized country, the country needs to solve the poverty issue. Most lifestyles and other ways of life will fall into order once poverty is mostly eradicated in Kenya. The overall wellbeing and security of the healthcare system will improve greatly if poverty were cut down to improve the lives of most Kenyans.

If the overall welfare and status of Kenya improves some of the direct issues regarding Kenya’s healthcare can be readily improved. For example, “Many of the current challenges facing healthcare in Kenya include inconsistent resource allocations, ethnic discrimination, long and frequent medical personnel strikes, resignation, and poor working conditions” (IMA 2019). I happened to work during one of the many healthcare strikes they hold at CPGH every year during my internship. The period was unsettling especially for interns since we had no doctor or nurse to whom we could shadow. More importantly, there were hundreds of people who had no option to seek and acquire the care they needed. The strike apparently was due to the medical professionals going unpaid for months at a time. Their response was completely understandable, but obviously a problem exists between the government and its medical practitioners. The issues regarding the stability of healthcare in Kenya all begin at the top of the Kenyan government and unless there is a significant change of view in determining what is best for the country, the healthcare system will continue to suffer dearly.

This internship with International Medical Aid has been a productive, engaging, and humble experience. Any and all my expectations and goals I had prior to travelling to Kenya were satisfied in the first week in Mombasa. I do not believe I could ever share an experience as fulfilling and knowledgeable in the United States nor would I see 90% of the associated diseases and conditions I met while interning at CPGH. All the physicians, nurses, and clinical officers at CPGH provided me with invaluable knowledge that I will go on and use as I train to become a PA. They taught me techniques and ways of looking at medical problems that I do not believe I would be able to find in a medical textbook. They were simply lessoning I could not learn in a traditional classroom setting. Through this experience with IMA, I have learned how to readily listen to a patient and to complete challenging tasks with limited and otherwise underwhelming resources. I believe that my passion for wanting to help and care for people increased insurmountably through this internship and my motivation for becoming a PA is more confirmed in my mind. Every health care professional I met at CPGH did their job and did not complain about being out of examination gloves or faulty MRI’s or chest X-Rays. They all contained a passion for providing people with care that I have not seen personally in the United States.

Perhaps it was the conditions in which they worked in or just how much harder they had to work to be in the positions they are now in, but they all seemed to have this “fire” to solve the problem. I hope I can adapt and acquire this “fire” and integrate it into my own medical training and career. Nonetheless, I believe I will never have an experience as fulfilling and enriching as this internship that I had the pleasure of working through with International Medical Aid.

My experience in Kenya was incredible. In terms of interning at CPGH, I was exposed to so many cases and learning opportunities, it was truly a once in a lifetime experience. The doctors and nurses were for the most part very helpful and instructive. The tours and treks I was a part of, shaped my stay in Kenya in so many ways. I was taught so much on the culture, food, traditions, current setbacks, etc. The knowledge enriched my outlook on the country I was staying in for over a month. Being able to go on the safari and experience the Lion King in real life was indescribable. The food, attentiveness, and care that I received while staying in the residency was truly was made the trip feel like home. Every person I interacted with made sure I was happy, fed, and had clean scrubs every day. I was able to help cook a few meals for the interns and I, Joshua was incredible. I am still in awe that I was a part of such an amazing program. 

My safari experience was truly phenomenal. Our tour guide Enok was the smartest and most well rounded person. He is the reason why I was able to see the Big Five on my weekend, which is not common. The hotels I stayed in were amazing, it truly felt like I was on vacation instead of an internship. I loved that the hotels had buffet like food services, it accommodated perfectly to my no meat diet.

As I reflect on my experiences with International Medical Aid (IMA) at Coast General Hospital, I am reminded of an ancient African proverb, “seeing is different than being told”. This priceless Internship placement with IMA has shed more light onto this age-old saying. I am still in disbelief, as I reflect on my encounters with patients, healthcare members, and health systems. Some experiences were as if they were drawn straight from Global Health textbooks, while other clinical presentations were so uncommon, it baffled even the most senior of nursing staff. In the States, I have been a practicing Nurse in the perioperative environment for over six years. However, my desire to help others globally is what initially propelled me into the nursing field since Iwas a young girl. This ambition, lead me to complete my Master of Global Health in 2018. However, a deeper curiosity remained, to hopefully yet experience and expand my theoretical knowledge of Global Health and Nursing. This calling eventually lead me to Mombasa, Kenya with International Medical Aid.

This was such an incredible experience. I learned so much about myself and what I am capable of doing. I grew in my self-beliefand determination to practice personal excellence. My experience in emergencies in the A&E, ICU, and Labor Ward has given me the confidence that I can act well under pressure and in fact, I enjoy it. I am a strong patient advocate. This experience has taught me that I am ready to change from practicing in the operating room to another specialty. This experience has also reinforced my passion and desire to work in Global Health. Additionally, I learned that qualitative research is valuable in understanding the social networks among people and environments, and I wish to deepen my research skills. I learned so much about myself, however, my path is still unclear. Wherever my path may lead, I know that it was guided by the experiences shared with International Medical Aid at Coast General Hospital, and for this I am grateful.

An unforgettable experience where I learned more than I have ever expected and grew to appreciate the Kenyan culture and history. Staff went above and beyond to make everyone feel at home and when accommodating requests. Residence was very clean and the food was amazing (both prepared by Chef Joshua and the restaurants we visited such as Mubins Cafe). The internship impacted me in ways I never expected. It taught me many lessons such as humbleness and appreciation and I left the country a different person for the better.

I went on the Watamu Beach Safari and it was a great experience filled with adventure and education. I loved how we were able to have fun, try new foods (ex. local seafood) and learn something new such as the history behind the Portuguese Church and the Gedi Ruins. Some portions of the trip could have been longer such as when we went snorkeling and when we were able to get off the boat and into the water, but overall an amazing experience that I would definitely recommend to everyone.

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.

The administration was amazing and very accommodating and I made life-long friends among them. There was never a moment that I was in there company that I felt unsafe or frightened. The residence was great and despite the lack of infrastructure of the nation everything worked to the extent that I could feel sanitary and relaxed. The food and the kitchen staff were great. The way to really make it an amazing experience though was to put yourself out there and make as many friends as you possibly could. I am glad to know that I now have friends from all over the world. I loved the experience and found a new love for Kenya and its people that I never thought I would have.

During my time in Kenya, I learned so much about how politics and cultural differences affect healthcare delivery and quality. Growing up in America, I don’t often consider the cost or availability of healthcare. Resources such as technology, equipment and supplies seem readily available to everyone. I trust that my healthcare providers possess the knowledge, skill and experience to preform medical miracles. In Kenya, I learned that my high healthcare expectations might be idealistic and non-universal.

The Kenyan perspective on wellness, hygiene, cleanliness, disease transmission and triage differ greatly from what I see in the United States. The healthcare workers I encountered in Kenya are every bit as smart, compassionate and hardworking as those in America, but they work shorthanded and ill equipped. Nevertheless, the Kenyan people receiving medical care are less entitled than the American patient is. The faith, trust and gratitude Kenyan patients show inspires me.

People in the U.S. often die from non-communicable, preventable diseases such as cardiovascular disease, diabetes and cancer due to our sedentary and abundant lifestyles. In Kenya, preventable diseases are also a serious issue. However, overeating and lack of physical activity isn’t what’s killing most Kenyans. Poor sanitation and lack of affordable medications contribute to the prevalence of communicable, preventable diseases such as malaria and HIV in a country already up against daunting challenges to delivering basic healthcare.

Although the American healthcare system suffers from healthcare disparities, African healthcare appears even more imbalanced. As in the U.S., the African population’s health needs and access to care vary across different parts of the country. Socioeconomic status greatly affects the quality and accessibility of healthcare. The government is Kenya’s largest provider of healthcare. However, the public healthcare system is plagued by staffing and supply shortages.

These shortages directly and indirectly impact patient outcomes. The average African citizen can’t afford to go to a private facility where qualified providers and adequate equipment are more available. Attaining equitable health services requires run-down public health care infrastructures to be revamped, management practices to be improved, priorities to be set for accountable and transparent use of resources and more skilled healthcare workers to be trained and retained (Benatar, 2013).

When I entered the Coast Province General Hospital on my first day in Mombasa, I was surprised by the shortage of healthcare professionals and the condition of the facility. This hospital is the second largest government hospital in Kenya and serves the entire coast region. The harbor view from the hospital is splendid, but the facility is sadly unkempt. The garbage receptacles outside the hospital are overflowing. The water supply inside the hospital is unpredictable. The equipment is worn and in poor repair. Healthcare workers are trying to keep up with the demand for care, but the supply of workers and resources keeps them continually behind.

Some of my experiences in Kenya changed my perspective on global healthcare. In America, the labor and delivery and postpartum areas of the hospital are happy and flourishing. Mothers are comfortable and babies are thriving and secure. However, when I entered labor and delivery in Kenya, the scene was distressing. One small room holds several delivery suites separated only by curtains. Patients aren’t able to labor or birth with dignity and privacy. They hear each other’s painful cries. Anesthesia isn’t common, so the area is loud and chaotic. Cleanliness isn’t a priority either.

Along with the grim situation in labor and delivery, Kenyan hospital nurseries host a number of abandoned babies. Mothers leave babies for various reasons in African countries, but regardless of the situation the babies’ health and development is at risk. These destitute babies also burden an already depleted healthcare system. Seeing babies without families and homes and mothers without hope tugged at my heartstrings and changed my perspective on life and priorities.

I witnessed a new mother lose her life as a healthy baby boy started his life without a family. To me, this situation seemed preventable. The mom with Placenta Previa lost a lot of blood during a long, difficult labor. Late in the process, the doctor opted for a caesarian section. We desperately performed CPR to save the young women, but blood loss and fatigue won in the end and the mother died leaving a baby (and probably more children at home) with no one to nurture and love them.

Rivaling the despair in the birthing area, the intensive care section of the hospital dismayed me. In the middle of the night, this area hosted people who were losing a hard-fought futile battle. Quality care end of life care isn’t a priority. Comfort and dignity are lacking too. The residents seemed to have surrendered to an overburdened system. I felt heartsick seeing the desperation in this place.

As previously mentioned, too few doctors and other professionals manage Kenya’s healthcare. According to Naicker, Plange-Rhule, Tutt, & Eastwood (2009), the World Health Organization (WHO) recommends at least two physicians for every ten thousand people (p. 62). In Kenya, one doctor per ten thousand people serves the community (p. 60). In many African countries, doctors, nurses, and other health professionals leave for countries better provided with health workers, technology and medical supplies. Also, two-thirds of African countries have one or less medical schools (Hagopian, Thompson, Fordyce, Johnson, & Hart, 2004).

To help with the medical worker shortage in Africa, quality in-country training or incentives to return home after foreign training might increase the supply of professionals. Also, recruiting medical students unlikely to leave the country may help. Africans are smart and motivated enough to take care of their own healthcare needs. Establishing quality medical and nursing schools in Africa would boost the morale of healthcare workers and decrease the chances qualified personnel would migrate to other more developed countries (Naicker, Plange-Rhule, Tutt, & Eastwood, 2009).

Although most of the doctors I encountered in Africa, are smart, educated and experienced, according to Chatterjee, Datta, & Sriganesh, (2012) lack of healthcare information and poor infrastructure contribute to healthcare disparity and poor outcomes in the country. Increasing the number of healthcare workers is not a permanent solution to this problem. Funding and resources to initiate and sustain the training of medical personnel in Africa would offer a more long-term solution (Chatterjee, Datta, & Sriganesh, 2012).

Nevertheless, despite these discouraging scenes, hope prevails in Kenya. People are helping. A caring medical community is working hard to improve the system. Africans are grateful for their lives and health. The optimism and faith of the African people is motivating. The Kenyans exhibit incredible strength and courage. My experience in Kenya strengthened my resolve to pursue a career in healthcare. The perspective I gained in Kenya encouraged me to gain the knowledge and skills necessary to improve healthcare both at home and abroad. With my privileges and opportunities, I know I can help.

As I look back at my stay in Kenya this summer, I am struck by the incredible knowledge and experience I was able to obtain from my peers and mentors in the hospital. From seeing a natural birth for the first time to seeing neurosurgery on a 7-year-old boy, I realize the wealth of information I was exposed to. I am so grateful for the opportunities I was given to learn more about healthcare in such a different environment. During my internship, I learned how to be empathetic, sure of myself, and how to remain calm in high-stress situations. When comparing what I saw at Coast General Hospital versus what I have experienced in hospitals here in the United States, the biggest differences that jumped out were the state of medical issues presented, and the resources available to treat said issues.

The easiest way to sum up the difference between the care I saw in Kenya and the United States is that in Kenya, the majority of treatment is reactive while in the U.S. the majority of care is preventative. In other words, illnesses were very advanced by the time a patient decided to seek help limiting doctors to do damage control for these people. An example of this is a middle-aged man who came into the emergency room for “foot pain”. When Dr. Ahmed removed his sock, it revealed a big toe that was almost completely black necrotic tissue. Looking at his patient booklet, I saw that the man was a diabetic and Dr. Ahmed explained to me that he clearly had not been taking his medication, causing this breakdown of tissue. There was little that could be done except for cutting away as much dead tissue as possible. Had this been any other toe, the entire toe would have been removed completely but since the big toe is essential for walking, Dr. Ahmed explained that it had to be preserved as well as possible. This case demonstrates the state of care I observed at Coast General because had this man came into the hospital a few weeks earlier, a doctor could have seen the beginnings of tissue breakdown and implored him to take his medication before the damage progressed. I believe this problem of patients waiting too long to get care can be attributed to two main factors: Accessibility and Urgency.

Healthcare is simply not easily accessed by a large percentage of the population due to the proximity of hospitals, the cost of care, and the ability to leave home and family. There was a patient who came to the hospital with a cist the size of an apple protruding from his mandible. The doctor estimated that this had been growing for at least 10 years. When asked why he had never come for treatment before, the patient replied that he lives a whole day of travel away from the hospital and had nowhere to stay in Mombasa until now. The low concentration of good hospitals in rural areas is clearly a factor in the delay of patient care and this is an issue that is rarely seen in the United States. Here, every major city has multiple hospitals, and most smaller towns also have an assortment of healthcare options. Another patient I saw was a single mother who was having trouble breathing due to a large supra- clavicle abscess that was slowly closing her airway. With three young children, she was unable to receive earlier treatment because she had to wait for a family member to come take care of her kids. It is sobering to recognize that with such a serious ailment, factors like this causing a few days of delay can be the difference between life and death. In the U.S. most patients are fortunate enough to have easy access to reliable healthcare which allows disease to be caught early and remain treatable.

Urgency is the other factor I identified as a root cause of the disparity in healthcare between Kenya and the United States. It became clear to me that most patients at Coast General didn’t realize that their injuries and illnesses could very quickly become life threatening when left untreated and were caught by surprise and forced to rush to the hospital. This speaks to a general lack of knowledge regarding medical issues throughout the population that causes many to believe they are not in danger or in need of help. In addition, going to the hospital is not a priority until it is a pressing matter due to finances because basic necessities such as food will always trump that. By the time a medical issue has reached the point where going to the hospital is the patient’s greatest need, it is often too late. When looking at a patient in the United States, choosing between their food for the day or going to the hospital is not often a decision that has to be made. Because of this, an American can go to the hospital at will as soon as they realize something is wrong. Having this luxury makes the difference in catching medical emergencies before they happen.

In addition to having reactive care versus preventative care, the availability of resources was also a very evident difference between Kenyan and U.S. healthcare. I watched in the minor theater as one of the Nurses struggled to suture and dress a wound because the surgical gloves were only available in one size and were too big for her hands. This is exceptionally hazardous for both her and the patient as she could have easily punctured a glove while handling the needle, or misguided the needle due to reduced dexterity. Looking back on my time spent in hospitals in the U.S., I had never seen a limit in resources, especially one that was detrimental to a care provider. This lack of resources was also apparent in the newborn unit (NBU) where two or three infants would be sharing a bed designed for one baby. It is very easy to imagine American parents outraged at the sight of their newborn sharing a bed because such lack of resources is unheard of in U.S. hospitals.

When I signed up for this program, I thought I had my entire career planned out and was ready to start checking boxes along the road ahead. I wanted to go to dental school and was considering orthodontics or oral surgery as possible specialties. It was only through spending consecutive weeks in the dental unit at Coast General that I began to realize I could use my skills in a much better way in a different setting. This realization first dawned on me during morning rounds with the oral surgeon as he visited a patient in the emergency ward. As we walked into the triage room, I noticed commotion at one of the beds and saw a nurse beginning CPR on a patient. My heart jumped as I realized this was real, I had been trained and re-certified multiple times in in CPR but had never seen it happening in real life. Without thinking, I threw on a pair of gloves and began to rotate in doing chest compressions. Dr. Aarif kept encouraging us to continue as we desperately hoped for any activity from the heart. Finally, it was called off and I stood there in shock realizing what had just happened, my instincts threw me right into the heat of it, and I was totally confident in my own abilities. That experience in the Emergency Room made me want to go back, and I did so with frequent night shifts because I had discovered a love for high-pressure situations and knowing you were the first person to make an impact. I now see that my abilities to stay calm under pressure and have thick skin make me very well-suited for a career in Emergency Medicine and am genuinely excited for what lies ahead.

This trip to Kenya taught me so much about healthcare delivery and how I can fit into such a system. I learned so much about what it means to care for patients, and how important the relationship is between a healthcare provider and a patient. I also was able to see the devastating effect that a lack of resources has on a hospital, and how a general lack of urgency regarding wellness can magnify illness. Spending time back home has helped outline the stark differences between Kenya and the U.S. and it has given me a new-found appreciation for all that I have.

For the past three years, I have worked as a 5th grade bilingual Math/Science teacher in the southwest side of Chicago. I became a teacher through the program Teach for America, whose mission is, “enlist, develop, and mobilize as many as possible of our nation’s most promising future leaders to grow and strengthen the movement for educational equity excellence.” Although the United States of America is a developed nation, it is a country where racism still persists and is one of the main roots of a major challenge: educational inequity. Unfortunately, many children are still lacking the proper education and opportunities that can help them grow economically and academically, which then perpetuates their family’s low- income household. I have seen the ways that mismanagement of a nation’s economy can benefit some whilst hurting others. Something that I see lacking a lot in the low-income communities and their public schools, is a massive under resourcing of mental health professionals.

My experience as a teacher, paired with my undergraduate degree in psychology, has made me want to pursue a career in the mental health field. Which is why, a year ago, I was researching mental health programs, especially those that would give me more experience working in underserved communities. I am specifically interested in being a school psychologist and working with students who have experienced trauma. The four weeks I lived in Mombasa, Kenya impacted me in ways I did not anticipate or expect. I went in with no expectation and had no idea what my experience was going to be include.

Before my internship experience with International Medical Aid (IMA), I had very little experience actually shadowing or observing counselors, besides my psychology courses when I was still attending university. My first day at the Gender Based Violence Recovery Center (GBVRC) at the Coast General Provincial Hospital (CGPH) I met a couple people who either volunteered or worked at GBVRC. I was given a packet to read that contained the procedures that were to be followed whenever any survivors, patients, came to the center. Survivors would go through reception first and they had to come with a referral. Many times, it was just a paper they obtained from within the hospital, although some referrals came from the police station, depending on what the case entailed. Then, they would wait to be called into the Counseling/Triage room, where I was, along with whomever was in charge of counseling that day. After counseling, survivors are taken to the doctors’ room, where they are given a comprehensive head to toe examination, as well as taking specimen for investigation.

From my experience the week I was in the GBVRC, I learned the importance of building rapport and about the opinions and ideas that still surrounds the topic of sexual violence. We never knew how much information the survivors were going to share or felt comfortable sharing; or any certainty of how quick they would explain what happened to them. I was able to observe and learn from the counselors how important it is to make the survivor’s feel safe and comfortable. Most cases were about rape or statutory rape, which are not easy things to share with someone you’ve just met. However, as the counselor it is important to get as much information as possible to determine what next medical steps need to take place, and to properly provide counseling specific to how the survivor was feeling. At times, the counselors would help the survivors make goals and talk about their achievements. This built their rapport further, and it helped survivors realize and/or recognize the good that has been in their life before. By doing so, survivors can start to move forward and understand that what happened was not their fault.

I also learned that a lot of stigmas still surround sexual harassment and sexual violence, which can make survivors feel like they should not share their experience. There were survivors that came within 24 hours of their rape, and for some, months had passed. Reasons for waiting to report, were rooted in fear, and in thoughts that it was their own fault for what had happened. I was able to witness counselors ask, “Why did you wait to report?” multiple times, not something I would feel is my place to question, but that I learned is a great way to keep the survivors participating in the session. Some survivors put off reporting because they feared they were going to be punished or consequence by their parent/guardians.
After my week in the GBVRC, I moved to the Psychiatric Clinic, also referred to as “Psychiatry”. Here, I saw a myriad of diagnoses and types of patients too. The clinic was open every day, but had different foci depending on the day. Mondays and Thursdays were open clinic days, and these tend to be the busiest days where anyone with a referral or has checked in at the hospital can attend. Tuesdays and Fridays were substance abuse days, and these days there were few people who came, but was a day that they invited patients to come for a longer counseling session. Wednesdays was the “Forensics” day, where prisoners were brought to be assessed on whether they were fit for trial or not.

Within my first day at Psychiatry, I noticed many differences between counseling in the U.S and Mombasa. For starters, I was going to be observing the psychiatric nurse, not a psychiatrist, because there is only one psychiatrist in all of Mombasa, and they only came to the clinic on Wednesdays. Also, there was very little privacy. All counseling sessions were conducted with the door open and people would frequently drop in during the middle of a session, or interrupt to ask questions, or even to have a conversation. Also, most patients came with other people, mainly family members. The great majority of patients came with family, and the psychiatric nurse would ask everyone present questions.

I was in psychiatry for two weeks and in that short time I was able to see the significance and importance of having family members present and involved. No matter the diagnosis, a support system is vital. The psychiatric nurse was able to ask family members to provide history and observations of symptoms and or recognize any improvements while on medication. Having the support system can also ensure compliance of medication and accountability for follow-up appointments. Occasionally, they are also their financial support and live with the patient, so their involvement is imperative. There were instances when the patient was unable to communicate properly, or at all. If no family members were present in these cases, a proper diagnosis and prescription would be impossible.

Before this internship, I was unsure and unclear on whether or not I wanted to pursue a career in mental health. I have enjoyed my time as a teacher, but this experience invigorated my love for mental health. Moving forward, I know that I am passionate about providing those in need with mental health services. The lives we all lead come with trials and tribulations, but for the members of under-served, low-income, minority, less educated communities, their lives come with extra obstacles. The likelihood of early intervention is a lot less in these communities. At CPGH, I saw how finances can have someone avoid coming in because they know they cannot afford services, which in effect can make symptoms get worse, both with physical and mental health. Although there is a way the government can help with insurance, for many, they do not have the means to afford another monthly bill.

This has taught me that there is a huge disparity between the healthcare conditions provided to those who are wealthy, middle-class, or low-income. It is not fair that priority is given to appeasing those who are wealthy, only because they are better able to advocate for themselves. The government should understand that there is a much greater priority, helping those in need. They think that due to a lack of education they are able to abuse their own power and continue to disserve those who are in need the most. I see the same with my school in Chicago, where our school is under-resources only because it’s in a low-income community. My drive moving forward will be to continue finding ways to provide services to these communities.

Not only do I want to pursue a career in the healthcare system, specifically providing mental health services. I want to advocate for communities that continue to be underfunded and under sourced. I saw how under resourced CPGH was and it effects the ability to proper care for patients. I want to be trained and educated and be able to serve communities with limited resources and supplies. Also, through my experience, I know that I want to be more informed on how to provide counseling to patients that are taking medications, have experience trauma, and/or sexual assault.

I was blessed with this opportunity and all its teachings were not just about healthcare. Despite its newness as a country, I see people who are hard workers and work for a better future. As curious as I am, I was asked questions by the counselors and other staff members about my experiences and what my thoughts were on Kenya. I talked to people with varying opinions and different religions, and different education levels. Most of my time was in the hospital, but I also was able to go to different communities, an orphanage, a primary school, and explore places that are integral to who Kenyans are, and why Kenya is who it is. I want to bottle up all the feelings and teachings that came from this summer, so that I will never forget what this summer was. I want to communicate to people I meet all that Kenya was for me. Many assume it is somewhere dirty, poor, and not up their living standards. Although there are stark differences between Kenya and the United States, it does not lack beauty. Despite its religious diversity, I saw unity as a country and acceptance of each other, no matter the differences.

From an early age, I dreamt of traveling to an African region, out of my comfort zone andinto a world of contrast. I’m not entirely sure why—perhaps I was transfixed by images from commercials or something that would show up on my TV—but it had been a very conscious goal of mine. I wanted to know why others were different than me. I wanted to see how they lived. I wanted to see if they actually receive Americans with smiles, just as the United States mediaportrays when describing our effect on Africa’s poverty. Admittedly, this image of Africa is what I expected. And to a certain extent, this is actually what I saw. Thousands of kids would overwhelm me with love and joy at hygiene clinics. Orphans would cling and wail as I said goodbye after just a short visit. People would see my scrubs and would actually thank me for coming to their under-resourced, under-staffed hospital (even though I didn’t benefit them in any way). While I stood amongst poverty, I still saw the joy and richness of Africa’s culture and Kenya’s particular beauty.

However, American media could never portray exactly the experience that International Medical Aid gave me. Upon arriving in Mombasa, I was shocked by the beauty of the palm trees which shadowed the tin huts that impoverished Africans called home. Their middle class lives relatively similarly to the American middle class. However, simple cultural differences revealed how much harder those with power need to work to provide each demographic the life that they deserve. I remember not being able to look away from the streets of Mombasa on my first fewmorning commutes to the hospital. Each block featured something I wouldn’t see very often inAmerica. People driving toward each other on the wrong side of the road. Blind men being guided through traffic to tap on windows for spare change. Women carrying bags of maize ontheir heads while busting children on both the front and back. I couldn’t even begin to imagine what I would see in the Coast Provincial General Hospital, where so many of these people took refuge.

During my six weeks in Mombasa, I sought to understand the root causes of various illnesses, disorders, and deaths in third world countries. I wanted to know why certain populations suffer from certain disparities, and why those disparities remain among certain populations for so long. How do areas within a progressive sphere still fail to meet the standards of equality that we claim to value for each member of society? This is a question that I had been tackling in America. Though our system claims to value a good life for each individual, not every member of society has equal access to quality healthcare. It seemed that we didn’t have allthe answers and that in order to find them, I would have to look at more extreme cases of poverty and inequality. This idea drove what would become a world-shaping experience for me.

In my first few hospital rotations, I saw more differences than I could count. Each new patient that we saw demonstrated the complex of complications between socioeconomic class and political power. From the pediatric to the psychiatric ward, I could see how a lack of effective policies impacts people of every age, race, gender, and illness. In the labor ward, not only were women rushed through the birthing process, but the babies they carried had higher risks for complications due to the lack of care leading up to their birth. In Kenya, 4% of mortality is caused by preterm birth complications and another 4% occurs due to birth asphyxia and trauma (WHO and UN partners, 2015). Though relatively short compared to a lifetime, the prenatal and birthing periods have long-term effects on a child’s development and overall well- being for the rest of their life. For example, one study found that co-exposure of various nutrition-related factors “were together responsible for about 35% of child deaths and 11% of the total global disease burden” (Black et al., 2008). In the U.S., women choose specific OB/GYNs, pregnancy diets, and birthing conditions to ease the painful process and ensure smooth and safe deliveries. In Kenya, women do not even receive local anesthetic before their vaginas are cut diagonally in an episiotomy. Due to a lack of both time and money, the doctors and nurses at Coast General must perform dangerous procedures to decrease the likelihood of further complications. While these professionals usually perform procedures in the safest way possible, the fact remains that patients cannot access the safest and least painful healthcare possible.

My third week began with one of the most difficult days of my life. As soon as another intern and I walked into the surgical ward, a bubbly male nurse asked us to assist him in changing the bandages of a burn patient. Putting on a brave attitude, we stepped into a small room reserved in the very back of the ward, immediately humbled by the odor of rotting, burnt flesh. There in front of me lay a boney, miserable, rigid woman ready for another two hours of unimaginable pain. We learned from the nurse that she had been injured a few months ago when one diagnosis had spiraled into another. During an epileptic episode, she had fallen into a fire with no one to save her and lost part of both arms as well as most of the skin on the front half of her body. Having been rushed to the hospital, the accident and emergency staff diagnosed her with burns on 30-35% of her flesh. Now, even months later, she shook violently as the bandages peeled off with her newly dead skin. Flies swarmed every inch of smelly, open wound. We attempted to fan away both the flies and the heat that the tropical air brought, but there was very little we could do to ease the difficulty of her situation.

At the time, I couldn’t help but wonder how she could live through the pain. It’s hard toimagine how she had dealt with the agony not only in those two hours but in the two months that had led up to my interaction with her. Supposedly, the state I saw of her was one of healing and progress. Soon she would be healthy enough for a skin graft and she could return to her “normal” life. But what would prevent the same situation from unfolding again? She still had a psychiatric disability. She still lost function of both arms. She still had the traumatic memory of helplessly burning alive. What was to prevent a similar incident from happening again, not only to her but also to others in similar situations? It seemed that no matter what she survived, she would never lead a fully-abled life with the care and safety that she deserved.

I realized that a doctor or nurse could only do so much to fix the problem at hand. In the world of medicine, the physical problem reveals the product of the accident itself. When lookingat the bigger picture, however, the accident itself reveals how one’s standard of living andchronic health issues can drastically damage the quality of the rest of their life. These healthcare facilities not only need more human and material resources, but the world also requires better healthcare policies if each person is to receive the quality of life they deserve. As ProfessorKokwaro of Strathmore Business School puts it, “the problem in Kenya is not [necessarily] lack of money…. [It] is actually efficient use of the resources we have” (2017). Money must bemanaged better in order to provide people the healthcare they need and to support the work of their healthcare providers. Thus, it is the management of healthcare within the society that needs to change, not necessarily the healthcare or the society itself.

In addition to the global health awareness I gained, I also learned more about who I want to be in relation to it. My whole life up to this point has been anchored by healthcare. For the thirteen years that I did gymnastics, I had to listen to both my body and to the doctors and therapists that took care of it. After my career came to a sudden stop, I lacked a part of me that I had always known. I still had to go to the doctor and see my therapists to manage chronicinjuries. But without the sport, I didn’t have any techniques to work on or a strict schedule to stick to or a team that depended on me. I felt lost. I felt useless. I didn’t know what to do with the skills I enjoyed practicing. But then I began observing surgeries. On my very first day in the theater, I observed three neurosurgery procedures. Surgery combined the skills I sought to practice and perfect: using knowledge of how the human body functions to problem-solve a leaky dura tear, working as a team to place a VP shunt within the thin skin of hydrocephalus patient, and even perfecting the fine motor skill techniques needed to cleanly suture a messy wound. Though neurosurgeries can be much more complicated, I felt a sort of adrenaline rush from the technical variety and creativity of these procedures. It was as if I was once again flipping through the air.

For the first time in a long time, I have a clear sense of direction in my studies. A career in healthcare and surgery have interested me for a while now. But it was only in understanding the medical tragedies and the poverty in Kenya that I was able to gain insight into the future that, at one point, I could only imagine. I can see more clearly now why poorer people have poorer health outcomes. Though some problems seem to have obvious answers, my time in Kenya showed me how deep-rooted their sufferings are. At the core of every surface-level issue, we face complex, systemic challenges that affect each and every person in each and every society. Unfortunately, it is how the world is and became to be. However, because we run the system, we also hold a certain responsibility to deal with and learn from its consequences.

All in all, my trip to Kenya held more lessons than I could comprehend in a mere month and a half. I immediately saw many differences between the ways that Kenyans and Americans live. However, it took time, bravery, and heartache to completely understand the culture of the country and the types of changes it needs. From culture-shock to gory surgeries, I gained experiences that will leave a mark on my heart and fascinations in my mind for the career to come. I love the people that I happened upon, and I am so unworthy of the love I received. I want more than anything to go back and drastically change the lives of those suffering. But I am forever grateful for the short opportunity to see into the lives of so many people and learn from the most beautiful of countries.

Boarding my flight for Kenya, I didn’t know what to expect. I knew I would be in a hospital rotating through different specialties and volunteering during the week. I chose to observe a variety of specialties in order to expose myself to a variety of cases within the hospital. I also knew that I would get out of my experience what I put in. I went into this trip with an open mind and willingness to learn. I wanted to take this as an opportunity to motivate me in my academic career moving forward. I knew that I wanted to go to school to become a physician assistant, but I wanted to begin my exposure to medicine in an environment that is completely different from the United States. In doing this, I would allow myself to step out of my comfort zone in order to learn the most about not only medicine in Kenya, but also the way of life there. I could then also realize how fortunate we are in the United States to have access to so many medical supplies and to see how Kenyans adapt to supply and staff shortages.

According to a lecture series that was presented during my orientation day in Kenya, the national poverty line for Kenyans is making less than 2 USD a day and about 40% of Kenyans are below this number. This means that 40% of people living in Kenya can’t afford basic necessities, let alone healthcare. This was a very tough concept to grasp but was very evident in my time at Coast Provincial General Hospital on many different occasions.

I remember one of my first days at the hospital I saw a sign on each ward that showed the services offered to patients and the price. Most services were free, but not all. One of the interns I was with was baffled by the idea that a major surgery only costed the equivalent of 100 USD. To us, that seemed affordable and was surprising. However, the reality of the situation is that many people cannot afford that because it is 50 times more than the poverty line. This leads to patients not receiving surgeries or medications because of the cost.

Another difference in the healthcare systems between Kenya and the United States is the method of payment for services. In the United States, if a surgery is needed or lifesaving medication is required for a patient, they receive the treatment and are billed later. Of course, this leads to a huge burden of debt from medical bills. According to a medical officer that I was observing in Mombasa, if the patient does not have the money up front, they do not receive care at CPGH. This was heartbreaking to witness as patients who had options for continuing care were trapped in a corner due to the price. However, this is the case for so many people who live in this country.

The highlight of my trip was being able to do a few night shifts in the labor ward. My mother is a labor and delivery nurse in the United States, so I had a rough idea of what giving birth involved. However, watching my first delivery on night shift was shocking. Having the ability to watch different moms bring new life into this world every hour or so was an incredibly humbling and invaluable experience. Each time I watched a new birth I was reminded that there is no pain medication offered to the moms here, but the exhaustion of delivery was quickly washed away by the joy of a newborn baby.

During one of my night shifts I talked to a midwife about her career and what she has seen in her years at CPGH. I couldn’t help but mention how many children people have at such young ages in Kenya, especially since there is high population of those in poverty. She told me that Kenyans do their best to not worry about money. They know that they will be able to make ends meet one way or another, but correlating having kids with lack of money never crosses their mind. I found that to be inspirational that they leave material wealth up to a higher power and appreciate everything that they do have.

All of these experiences and many more allowed me to develop a deeper appreciation for medicine and a desire to be able to do more. After doing my rotations, I am elated to continue my education and upon completion of school I want to come back to Kenya. I want to return when I am qualified to do more at the hospitals and when I can make more of an impact on the people who cannot afford medical care.

I would not have been able to experience any of this without International Medical Aid. The program had an amazing staff that was more than willing to help out with any problems that arose, or questions that came up. They also made sure that the interns knew what was expected of them throughout their stay. I learned so much about not only healthcare in Kenya, but also about daily life on that side of the world. I would not trade my experience for anything, and I hope to someday return the favor.

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.

My experience through IMA will forever be held in my heart. The impact this has made on not only my nursing career but also on a personal level is truly indescribable. My perspective on life has totally changed and I’ve learned to view things with in broader perspective and with an open heart to all people of all cultures. Nursing requires me to be competent in many things besides just skills. Patients rely on me as their advocate, their hand to hold when no one else is there for them and someone they can trust. My time in Kenya gave me a new perspective on how to do those things and be a better nurse to my patients. The clinical experience was almost better than my experiences at home. To be able to watch how nurses and doctors improvise to deliver the same care to patients at the standard level with limited resources was interesting but most importantly their desire to want to help people and to learn new conditions and treatments was very influential on me. It didn’t matter that they didn’t have many books to read about medical conditions or what level each professional was at they all worked together to formulate a plan of treatment which I think impacted me the most during my observations. The staffing at IMA was also above satisfactory. All of my mentors were so accommodating and always made sure we received the best of the best in our conditions and were very responsive to anything we asked or needed during our stay. The cultural treks I had the privilege to go on were AMAZINGGGGG!!!

If you take this opportunity to travel to Kenya you simply must go on them, it is worth every cent you spend. I still sit back and reflect on my safari experience and I can still feel the “wow” feeling I had when I was in the jeep staring off into what felt like an endless world of animals and natural beauty! It is hands down the most incredible feeling to be out there in the natural environment of these beautiful animals and watch how they function without being held captive in a cage. An experience I truly never could forget. My time in Kenya is something I will always hold near and dear to my heart and continue to let influence my future career decisions. I hope to someday return and provide more care to those in need and expand my cultural competence even further as a Nurse Practitioner.

Programme was very well run, with the local staff ensuring we were all coordinated in our placements and maximising learning opportunities. They were very helpful with arranging extra learning opportunities too, and I always felt comfortable to bring up any issues or requests. Really appreciated the extra local experiences and tours, I feel it was incredibly enriching to learn about the social and historical context of Kenya. The house was very comfortable and we were incredibly well looked after, from the room cleans to the large variety of delicious food cooked for us daily. The clinics and outreach gave variety to our experience, loved going to new places, meeting new people and learning new skills. Safari was well planned. The guides we had were excellent, the accommodation much more luxurious than what I was used to/expecting!

A fascination with transcultural psychiatry was what initially set me on the path to want to become a psychiatrist, and an unforgettable six weeks in Kenya.

All through medical school I was determined to work in infectious diseases. This abruptly changed in my final year thanks to an elective placement abroad. I chose to study malaria with Shoklo Malaria Research Unit in a remote area of Thailand helping the Karen refugee population. Soon after arrival I found that the organisation was so good at its job, there was barely any malaria left. Looking for additional work, I undertook antenatal clinics where to my initial confusion, nearly every woman was reporting ‘chest pain’, ‘breathlessness’ but with no underlying cardiac or respiratory causes I could determine. Probing further, it became apparent that many women were suffering from prolonged severe stress, having survived a civil war with ongoing uncertainty regarding their futures. Many could have met the criteria for depression, anxiety, post traumatic stress disorder (PTSD). Their presentations however were completely different from that in my native UK, mainly favoring physical somatic symptoms. I wondered if they would be picked up on a standard diagnostic questionnaire, which invariably were created based on Western, Caucasian patients. This fascinated me. How could the same diagnosis present differently across different cultures and peoples? Is this the same for all mental illnesses? I learned that day a new phrase – transcultural psychiatry – the study of how social and cultural factors can create, determine or influence mental illness. I wanted to discover more about this nuanced and multifaceted specialty, to experience more countries and cultures.

After graduation and two relentless foundation years in multiple busy specialties, I was exhausted. I decided to take a year out before applying to specialty training and return to what made me first enjoy with psychiatry initially. IMA’s Kenya internship in mental health seemed the perfect fit. I wasn’t sure what to expect, but these last six weeks have both exceeded and challenged my expectations.

CPGH – GENDER BASED VIOLENCE RECOVERY CENTRE (GBVRC)

I had prepared for GBVRC by reading up on post sexual assault/rape guidelines beforehand, mostly geared towards adult victims. What shocked me on the first day was that 75% of the attendees are under 18. I was seeing children both male and female who were as young as 1 year old brought in post sexual assault and rape. Attendees had to undergo further rounds of an intimate examination, pregnancy test if necessary and a long course of HIV prophylaxis, coming back for counselling and support. I learned how to carry out an intimate examination with the help of the sister in charge, how to fill out a post rape care form, handle the evidence collected and prescribe prophylaxis according to guidelines. A lot of the survivors were unaware that they shouldn’t change their clothes, wash, etc after an assault, so in many cases there was no evidence to collect. A situation analysis of post rape services in Kenya found overall a limited awareness of what to do, where to go in the event of rape, with it generally not reported. (Kilonzo, 2003)

Gender based violence also includes domestic violence and its consequences. There was a young boy around 5 years old in the clinic and he wouldn’t stop crying. When I tried to engage with him, he suddenly started shouting at, punching and kicking me. His mother said that the father routinely beats her and the children; the day before when the boy was crying the father beat him until he stopped, then burned him with a cigarette. His face and torso were covered in bruises and there were circular burns on his shoulder blade. How could I blame him for his attack on me, when violence was what he knew? We tried to get the father arrested ASAP, and continue working with the boy in therapy, praying that this could break the cycle. These experiences with children have led me to consider seriously the subspecialty of child and adolescent mental health, where the patients are amongst the most vulnerable, and you hope that an early intervention can change the path of their lives.

Seeing how sensitively and calmly the counsellors dealt with the survivors and relatives, treating each person’s stories seriously and with compassion was a bright beam of humanity in what were often deeply upsetting accounts. Feeling some difficult emotions, I would try to verbalise and make sense of them after the survivor had left, and I appreciated then how important it was to have supportive colleagues to debrief with, for the sake of one’s own mental health.

An interesting aspect of being at the clinic was how I learned through the survivors about some of the wider social issues. Poverty meant many patients could not continue to attend counselling, that young poor girls were exploited by older men giving them money or a meal in exchange for sexual contact. The nurse in charge Saida would give all the girls counselling on the importance of staying in education, but when young girls became pregnant (and there is a high rate of teen pregnancy in Kenya with a national average of 18% according to the Kenya Demographic and Health Survey 2014), they mostly dropped out of school due to lack of resources to support them. There was also the tension seen between the generation of young Kenyans who wanted to have casual relationships, go out drinking alcohol and party, and the older generation of the clinic staff who still taught celibacy before marriage. Some of these issues were universal to other countries such as substandard sex education, but knowing about others more specific to Kenya, such as the tradition for early marriages, helped explain why so many teenagers were seen.

PORT REITZ

Port Reitz was yet another learning curve! I saw patients mainly in outpatient clinics, clerking them for admission as necessary then reviewing them on the ward. There was also an opportunity to sit in on counselling sessions with the psychologists and take part in occupational therapy. Highlights of the occupational therapy included being taught by a patient how to use a hoe to garden and taking the patients for a therapeutic seaside walk.

The very concept of a mental illness was very different in Kenya compared to what I was used to. Patients and relatives would often have spent years trying prayers or traditional healers before attending the hospital. It is more considered a spiritual disorder e.g. due to possession or witchcraft rather than a medical condition and a hospital attendance was often the last resort. There are innovations being trialed for delivering community based mental health care in Africa such as collaborating with traditional healers, establishing relationships with Muslim leaders to facilitate identifications, which I will follow with interest.

The presentations were also different. There was high prevalence of psychoactive substance use such as khat/mugoka, bhang/cannabis which lead to psychotic symptoms. Psychotic patients would present with symptoms ‘talking too much’, ‘wandering’ – these presenting statements I have never heard uttered in the UK.

The psychotic patients tended to present more with visual and auditory hallucinations rather than thought disorders, which was also found in a worldwide study of schizophrenia in different cultures (Sartorius et al., 1986). Interestingly, they seemed less concerned by auditory hallucinations than patients I saw in the UK were. An anthropological study by (Luhrmann, Padmavati, Tharoor, & Osei, 2015) has found that voice hearing experiences of people with serious psychotic disorders were shaped by local culture. The African and Asian participants were more likely to report rich relationships with their voices compared to American participants who tended to describe the voices as a sign of a violated mind. A possible explanation posited is that Europeans and Americans tend to see themselves as more individualistic, whereas outside the West people see themselves as more interwoven with others. I learned to be more flexible in seeing how different mental illnesses present, and not make assumptions about the person’s own interpretations of their symptoms.

Comparing the scarcity of the resources available here compared to the UK was sobering. Staffing levels were low, with so few psychiatric nurses, clinical officers, and only one psychiatrist for the whole county who was retired. I could choose between only about four antipsychotics due to limits of cost. The patients were mostly poor so I found myself grappling with wanting to help my patients but they were unable to afford medications, admission, therapy, or even follow up attendances. At home in the NHS, I was used to working within the limits set by a nationally funded healthcare system. However, at the point of contact with patients all services were free. Here I found it difficult deciding which of the three medications the patient needed was the most important when she could only afford one, how to best manage a patient as an outpatient who would otherwise have been admitted but the family could not afford it. Instead of ‘best practice’, it became ‘good enough practice in these circumstances’. This can sap morale at times, so I suppose that is why when one of the patients I first clerked got discharged completely well, I was extraordinarily happy.

There were many instances which were cause for admiration. I was surprised at how many people attended with the patients. It was common to have a brother/sister, father/uncle, neighbor/friend all present, and patients are often living with an extended family. The care shown was humbling; an elderly father who travels 4 hours from home and back every day to visit their child in hospital; family members washing and helping toilet a young man who had been too psychotic for a month to self care. In the UK, it seems like a greater proportion of the psychiatric patients I’ve seen are living alone and have little to no family support. The role of the family and community support cannot be underestimated and has long been seen as a positive and protective feature in mental illness. There is a hypothesis to suggest that schizophrenia has a better outcome in developing countries, however the WHO studies with this conclusion have many limitations and there have been studies questioning the findings since (Cohen, Patel, Thara, & Gureje, 2008). What is clear to me is that the level of family and community interconnectedness is higher in Kenya and can be a significant resource in a patient’s improvement.

As beautiful as the landscapes of Kenya are, I will leave with the greatest impression of its people. The extraordinary resilience of the psychiatric patients, clinic survivors and the clinical staff living and working in circumstances that are often limiting are an inspiration. I am encouraged to continue down the path I have chosen and will hopefully be able to help more sexual violence survivors and psychiatric patients in the years to come, as a better doctor than before I started six weeks ago.

In July of 2019, I went to my first health-related experience abroad as a medical student. I spent four weeks in Mombasa, Kenya, shadowing physicians from the country’s second-largest public hospital, and learning about the Kenyan culture and healthcare system. My goal through this experience was to learn and understand how a country, different than my own, manages public healthcare, to perceive how culture plays a part in healthcare, and precisely what role I can assume, as a future doctor, to better global health care. I firmly believe that a great doctor cannot be limited to their home surroundings to treat a patient holistically. They must be knowledgeable about different cultures and beliefs and the way that disease manifests in different ethnicities and backgrounds. My trip to Kenya had the sole objective of putting me on the path to becoming, what I regard as a great doctor.

Similarl to Brazil’s public healthcare sector, Kenya has four levels of public healthcare services: primary, secondary, tertiary, and urgent. During my time in Mombasa, I got to experience the functioning of the tertiary healthcare level, being that I was shadowing physicians at Coast Provincial General Hospital (CPGH). The first thing I grasped about public healthcare in developing nations such as Kenya is that underfunding is generalized in the healthcare system. This, likewise, happens with public healthcare facilities in Brazil; however, the tertiary level is usually better funded if the city is large enough or if the hospital attends to a large number of individuals, but still underfunded nonetheless. Whereas, here we had the second-largest public hospital in Kenya and there were only three nurses per shift working in an ICU with over ten beds (usually in ICUs it is necessary to have one nurse per bed) and that was the only public ICU in the whole county district, portraying that even though this hospital clearly attends to a vast group of people, it still did not receive the funds to hire more hospital staff. This understaffing issue depicts something that I took for granted for a long time about Brazil’s public system: in Kenya, there are two doctors for every 10,000 Kenyans, whereas solely in the state of Bahia (my state in Brazil) there are 13.5 doctors per 10,000 citizens. I always thought that my state was considerably medically understaffed, but after realizing that my state had almost seven times as many doctors for 10,000 people than an entire country, that put things in perspective for me.

One thing that I learned once I immersed myself in the Kenyan healthcare system that surprised me was that public healthcare is not free. This took me by surprise because I come from a country in which everything in the public health sector, ranging from surgeries to hypertension medication, is free. And I assumed that it would be the same in Kenya because 37% of its population is living below the poverty line. During my time at CPGH, I witnessed people that could not afford to pay 5 USD for a cast, that could not pay 2 USD for prenatal care, I saw people that weren’t able to be treated because they did not have the money to buy the medication needed for it. The country’s public healthcare policies do not always favor the people to which they are attending. With only 4.6% of the population having health insurance and public insurance not always being able to afford what they propose, the Kenyan people end up at a dead-end street, where the policies that should be for them, sometimes are against them. However, even with all of these hardships, I got to witness doctors, among other health professionals, do whatever they could to try and help these patients with the few resources that they had. Even though they were clearly not paid enough, they were there for the patient and would try to help in the best way that they could, because they lived and understood the disadvantages that the patients went through within the public sector.

The most compelling aspect of my whole experience was being able to understand the Kenyan labor culture as it is remarkably distinct from the Brazilian one. Brazil is the world’s second lead in c-section as many women choose to undergo this procedure rather than natural birth. Whereas in Kenya, c-sections are reserved for emergencies or high-risk pregnancies only. After experiencing the natural labor procedure, it was clear that it is a more accessible, humanized, and holistic approach to the labor process, as it praises the natural course of birth, and allows a better connection between mother and child. In my medical career, I will most certainly advocate for natural labor and its benefits.  Also different from Brazil; women go through labor alone, with no family member present. This was something I considered extremely important to learn about, as I believe that, particularly because the women are undergoing the labor process alone, the health professional must form an even stronger connection with them to make them feel comfortable during the process. This is something I will take into my medical career as I work abroad.

As I lay out my commentary based on my experience, it is important to note that it is easy to be a spectator, a passenger that will not have to live through these hardships that Kenyan medical professionals and its population face daily within the healthcare system. And it is easy to assimilate everything that is wrong with the system, but not provide solutions, or care enough to empathize because it does not directly affect you. However natural that may be, it is essential to try and understand what these difficulties mean socially, economically, and culturally to a country, how it affects the growth, the education, and try to find ways, even if small ones, that a spectator can help out. Kenya is a country that has only had four presidents and not even 60 years of independence yet, it has an abundant amount of growth in its future, and it is important to magnify this growth. Kenya taught me the importance of giving back to the community. It taught me that healthcare is inherently a human right, and it should not be taken for granted. The experiences I’ve had through this program helped me understand that I want to be involved in global health and that I want to help create policies that make public healthcare systems beneficial for the people that it is designed for. The good things do not convey the potential that something has, as growth is found in hardship.

Medicine has always been my passion, however the road to get into medical school is a tough and competitive one. My purpose for volunteering abroad was to learn, encourage, and remind myself the reason why I decided to take this road. Being a pre- med student in Canada can sometimes get discouraging since we get absolutely no clinical experience or courses related to medicine, besides basic science. Even volunteering opportunities at hospitals are narrow and not really hands-on. Having said so, I will be forever grateful for the opportunities that International Medical Aid offered me and the inspiration and courage they seeded in me to pursue my dream with more determination than ever. The reason why I have chosen medicine is to help others to the best of my abilities. I was born and raised in Honduras, also a developing country, and ever since I participated in brigades there, I was motivated to dedicate my life to serving those in need. World Health has always been an interest of mine, so I was thrilled to get to know Kenya and have the opportunity to immerse in a healthcare setting that I was not accustomed to. This internship not only challenged me but also gave me significant insight and preparation to work under difficult circumstances and scarce resources.

I was fortunate to work with incredibly knowledgeable doctors who were patient enough to answer all my questions. There were several scenarios that I will carry with me throughout my career. During my week in Radiology, we saw numerous relatively young patients (20-45 years old) with traumas and diseases that were never treated properly and had only grown worse over time, up to a point were a full recovery was nearly impossible. For instance, a 3 year old boy was referred to Coast General Provincial Hospital. He had lupus, but he was not treated properly nor diagnosed with lupus on time. He had recurrent fevers and was only treated with ibuprofen for the fever specifically. Unfortunately, when a patient has lupus, they are more vulnerable to get infections since the disease weakens the immune system. As a consequence, the patient developed cerebritis (bacteria entered the brain through his sinuses) and this caused hydrocephalus. Dr. Valerie explained that the CT scan already showed irreversible brain damage that would most likely result in dementia. The only plan of treatment was now a shunt to release the pressure caused by the excess fluid.

This case was a quintessential example on the importance of having the equipment necessary to properly diagnose a patient and giving adequate treatment as early as possible. In Canada, cases like this would rarely happen since detailed lab examinations are made to rule out any other diseases, patient follow-up is reachable, and treatment technologies are exceedingly advanced. In this situation, the patient’s mother did not have the healthcare knowledge nor the economic freedom to visit a doctor as often as desired. The National Insurance Hospital Fund offers two types of memberships, the one more accessible to the majority of the population costs $5 per month. Taking into consideration that most Kenyans live by making $1-2 per day, insurance is helpful but still unaffordable for those living below the poverty line, which is a vast majority. I was able to see this as we visited the Maasai village and its surrounding areas. As we drove from Maasai Mara back to Nairobi, the closest health centre from the villages was in Narok, which was 2 hours away driving.

During my week in Internal Medicine wards, I was able to have a better understanding of the hospital’s dynamic. Usually consultants, interns, and some nurses gather and discuss the cases after they finish their morning rotations. The discussions gave me a better understanding of the weakness that exists in Kenya’s health infrastructure. Nurses expressed their frustration when they received patients from the Emergency department with no X-rays or lab examinations done prior to admitting them to the wards. Consultants also talked about how hard it is to get specialists to visit patients. For example, there was a patient with a skin condition and consultants in Internal Medicine were unsure if it was scleroderma or other disease. They had been waiting for the dermatologist for 5 days to tell them what treatment would be best to follow. Dr. Bebora, a medical officer, also addressed the lack of blood supply available for patients. During my rotation, there were three patients with severe anemia that had been waiting to get a blood transfusion for days. She explained there were several more patients who needed blood, but not enough donors. I decided to donate myself, so she took me to the blood blank. The clinic was “hidden” behind the hospital and there were no signs that would help me get to it if I was not accompanied by Dr. Bebora. I was surprised that the only test done was to make sure my hemoglobin and my blood pressure were fine. The form I filled was not too detailed and asked about medical history. I then handed in my form and the clinician told me my hemoglobin was fine and that I was all set to donate. Personally, I am aware about my medical history, vaccinations, medications, etc. but I can see how this can be a setback for those who want to donate but have no file or knowledge of theirs. Additionally, if information is hidden or the donor is not aware of a condition, complications during the transfusion increase. With the Canadian Blood Bank, the procedure is more detailed. After the form is filled, the clinic staff makes sure you understood every question and goes through the questionnaire with you. A brochure is also provided so that the patient understands the procedure and an aftercare guide is also given. This provides a pleasant and reliable experience, which encourages donors to keep donating and create awareness.

Another problem Dr. Bebora addressed was the strikes by the personnel. Staff from the diabetic clinic and nutritionists were on strike, demanding a better pay for their work. As a result, interns and officers from Internal Medicine were asked to rotate throughout the week to cover for them at the clinics. According to the World Health Organization, the doctor to patient ratio in Kenya is 1:5000. This is an incredible amount of work and pressure on doctors and nurses who are not making enough money for their work. Inevitably, they go on strikes, resign, or move to the private sector.

There were several cases that stuck with me during this week. I saw a girl my age who at first glance I believed was around 6-7 months pregnant. Dr. Fatma explained it was a progressive abdominal extension and that the patient had AIDS. Patients with AIDS are more likely to form masses, and they were waiting to do an ultrasound to confirm it was a tumor. There was another case were I first believed the patient was a psychiatric patient due to the signs he presented. He was screaming incoherencies, had urinary incontinence, and an altered level of consciousness. I was astounded to learn this was a case of severe malaria and could not believe a 12-year-old child was going through such a complicated case. Dr. Varvani went through all the symptoms that severe malaria presents, its causes, and its treatments. I even had the chance to look at the parasite from the patient’s blood sample and the lab technician guided me through the life cycle of one of the most common parasites that causes malaria.

These two cases are an example of what I’m calling “eye opening”, I felt ignorant with the assumptions that I made and how little I knew about the extent of these diseases, but at the same time these cases ignited my passion for medicine and how much I want to help especially in countries that are carrying heavier burdens than others. During this week, I also saw two cases of attempted suicide through poisoning. I find it appalling how a corrupt government turns a blind eye on a major health issue. Apparently, there is no funding towards mental health in Kenya from the government. According to WHO, over 2 million Kenyans are living with mental health problems, and those are only the reported cases. I believe health should always be seen in a holistic perspective, always including mental health.

My week in surgery was mesmerizing. As I mentioned before, during Pre-med there is no chance at all to see surgeries, so I felt very fortunate to be present in those procedures. I even did a night shift in Surgery. However, it did not go as expected. I was only able to see one surgery since there was no water available the whole night. This inconvenience heavily affected the one surgery that I got to see. It was a 22-year-old man whose surgery was delayed from 3:00pm to 10:00pm. He was induced for acute testicular torsion but the delayed caused necrosis of the testicle, it now had to be removed and the patient was now infertile. It was tragic to see how a very simple procedure grew in complexity due to not having water and I cannot imagine how the other scheduled patients were affected too. I spent the rest of the night talking to one of the anesthesiologists, who kindly showed me all the medications they used, the machines in the operating rooms, and how they clean everything. It was nice to see that the Surgical department actually had good equipment, a better sterile environment than the rest of the departments, and according to the anesthesiologist, medications were always available.

This internship gave me much more than I could have ever asked for. It not only reminded me of why I wanted to study Medicine, but it inspired me tremendously to pursue my career in Global Health. I learned how important it is to educate and create better awareness in order to avoid or mitigate harms. It can help people start practicing preventive health behaviors that would reduce the risk of developing diseases. It can also help detect an illness when it is easier to treat with fewer complications. I believe education is also the key out of poverty and corrupt systems, and what I aspire is to be able to invest in a country that has given me so much. I cannot fully express in words how Kenya has inspired me. Its people and its amazing culture have motivated me to become the best I can be with the hope of being able to give back once I become a doctor.

IMA made this experience very pleasant. I felt secure all the time and very well informed by my mentors on what to do and also what to avoid doing. The environment at the residence was more than I could ask for, everybody was very welcoming and making sure I was enjoying this experience. I also loved how Naomi, Benson, Joshua, and Brian were always helping get my Swahili words right! The food was delicious and accommodations were comfortable. My mentors at the hospital were incredibly helpful and patient. Even though it was very hectic, there was always someone who could guide me or help me understand everything that was going on. The only thing I would have changed is that I didn’t get to attend clinics since there were not enough interns during my time there. It was a little bit sad to see that a clinic was done just a week after I left. Overall, I will be forever grateful with IMA for making this experience as productive and comfortable as it could be.

I stumbled up International Medical Aid’s website while looking for an opportunity to gain experience in the healthcare field. This program stood out to me because the internship was unique in providing insight to specific health care roles. As a Pre-PA student, my experience up to this point was limited to working as a nursing assistant in a brain injury rehab and in an emergency room. Although these experiences were valuable in forming the foundation for my career goals, there was a whole other side of healthcare that I had yet to see. I was curious to learn more about how healthcare in other countries differed from that of the USA. Out of curiosity, I decided to apply for International Medical Aid’s pre-pa internship. After a few months, I received the news that I was accepted. I was terrified, but excited at the same time. I had never traveled alone, but I needed to push past my comfort zone and learn more about the world outside of my two-story suburban home. Without hesitation, I booked my ticket and flew to Mombasa, Kenya.

To my surprise, Mombasa was very similar to my motherland, India. I felt at home as we passed by colorful buildings and street vendors. When I was given a tour of Coast Provincial General Hospital for the first time, I was shocked at how different the hospital was from a typical American hospital. One of the first places we visited was the NICU. The incubators were filled with up to four babies, and the staff was extremely limited. There were two to three nurses in charge of over fifty babies! I learned that the nurses depended on the mothers to tend to their children because there is not enough staff to watch over all of the infants. I could only imagine what I would see next. I was placed in surgery the first week and shadowed Dr. Hasan. We went patient to patient, and I saw cases that I had never seen in America. During our disease burden lecture, we learned that the most common cases that you will see in a Kenyan Hospital are “malaria, respiratory diseases, skin diseases, diarrhea, and accidents” (Disease Burden Lecture, n.d). Patients are at a higher risk of acquiring these illnesses because of their environment and living conditions. Dr. Hasan emphasized how important it was to touch the patient instead of solely relying on scans and verbal complaints. I admired how the team of surgeons worked tirelessly to assess and treat each patient in an overcrowded ward with no air conditioning. When I asked Dr. Hasan why he chose to work in a public hospital instead of a private hospital, he explained that these patients were in dire need of medical attention, and it was important for him to serve the needs of the public community, especially those with low-incomes. “Public hospitals have the most accessible and affordable care for populations, but they are also the most under-resourced and have higher rates of poor patient outcomes” (International Medical Aid, n.d).

While in the OR, I noticed there was no proper protocol to enforce scrubbing in and scrubbing out, and staff walked freely from room to room. When radiation was involved, I was told to stand behind staff with protective garments on because there were not enough gowns for everyone. I met a kind nurse who was able to take the time to explain each surgery to me. I learned that a common issue that they have in the OR was lack of equipment. If a surgeon needed a specific tool and it was not available, they would have to make do with what they had on the table. One surgery that stuck out to me was an anterior cervical discectomy and fusion performed by a group of surgeons from Spain. They treated a patient’s spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine. Then, they performed an inter-vertebral fusion to stabilize the corresponding vertebrae. Their team and the medical staff at Coast General had to work together to overcome the language barrier in order to execute the surgery. Overall, I was extremely grateful to have my first rotation in surgery. I learned that there was a vast difference in protocol between our two countries, and this is largely due to differences in access to equipment and proper staffing.

My second rotation was in the emergency room. The first thing I noticed in the ER was that the doctors were in charge of inserting IVs, and that it consumes a lot of their time. In America, nurses are trained to place IVs so that the doctors can focus their time on meeting the patient’s medical needs. One doctor that I shadowed had trouble inserting an IV in an infant who came in in critical condition. The infant eventually passed because she was not able to get the medication and fluids that she needed fast enough. This was not the first death I had seen from a patient seeking medical attention at late stages. I learned that many low-income patients in Kenya hesitate to make their health a priority because they have to weigh the cost of travel, missing work, and health care expenses. Additionally, health literacy continues to be a massive issue in under-served populations. Patients fail to assume an active role in preserving their health because they are simply unaware of their options.

One thing I discovered in the ER is that the billing and administration process is extremely frustrating. Doctors completely rely on the patients to maintain their medical history in a small booklet. To administer medication, a doctor will issue a prescription. The patient’s family will then have to visit the pharmacy and billing and then show proof of payment before the doctor can even administer the medication. There was one instance with a patient’s family that I will always remember. A pediatric patient had passed, and his family was taken out of the ER. The grandfather came back and wandered aimlessly trying to find someone to assist him. This poor man had just lost his only grandchild, and he was desperately trying to pay the bill so he could leave and be with his family.

Also, the lack of equipment, staff, and space is glaringly apparent. “The doctor to patient ratio per 1,000 people is 1:5000” (International Medical Aid, n.d). Most health care workers in Kenya choose to work in private sectors, or work in public sectors temporarily and then move to private as a result of burn-out. Public hospitals are under-resourced, under-staffed, and have higher rates of stress while confronting the obstacles they face. I remember standing between a Masai warrior with a neck injury and an HIV patient that was going to die because they did not have enough ICU beds. I assisted the doctor in creating a makeshift c-spine collar for the neck injury patient out of a cardboard box and cloth. We wrapped it around the patient’s neck and used tape to hold it together. I could not believe the ER doctors had to go to this length to make up for the conditions that they worked in. I admired their ability to assess a situation quickly and get creative in finding a solution.

After interning at Coast Provincial General Hospital, I have developed a deeper understanding of my desired role as a future health care provider. I knew that I wanted to be a Physician Assistant, but I didn’t put much thought into where I would work and what I would do after I achieved this goal. Through International Medical Aid, I realized that my education would have a meaningful impact on communities that cannot access the care they need. I was able to gain so much knowledge and perspective on the accessibility of healthcare. I have decided to work as a primary care provider in underserved communities. My dream is to provide care for those who need it the most, but do not have the means to attain it. As a future Physician Assistant, I will do all I can to increase access to health care services in medically under-served populations.

I am so glad that I took the leap and applied for International Medical Aid. I was able to immerse myself in Kenyan culture and gain perspective on what health care is like there. The staff went above and beyond to make sure we felt comfortable and safe. They were extremely flexible and worked with us to adjust any last-minute changes. After interning with International Medical Aid, I have developed a deeper understanding of my desired role as a future health care provider.

My experience in Mombasa was 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.

When I decided to apply to medical school, I was super nervous and intimidated by what I read online (SDN, Reddit, etc). From undergrad, I knew that medical school admissions was competitive and honestly I didn’t know where to apply or what experiences I should focus on my AMCAS. I worked with my pre-med advisor at school but she basically told me that I was not going to get in with my current stats. Well, I decided to apply anyway and worked with IMA throughout the whole process. My consultant (Dr. G) was upfront and honest but also kind. He listened to my story, and took a genuine interest in my experiences and what led me to medicine. I worked with him from beginning to end in the process (from the primary application to interviews). I applied to 20 schools, was rejected from 18, waitlisted at one but was ultimately admitted to University of Cincinnati College of Medicine.

 

UCSF was always my dream school and I wanted to do all could to get in. The biggest issue I had was filling out the primary application and personal statement. I knew that writing in general was not one of my strong suits, so I wanted to make sure I did everything right. I worked with IMA on my primary application and all of my secondary essays. I really struggled with some of the secondary questions and the character limits. My consultant’s experience really helped me to express my thoughts in coherent ways without being too wordy. I’m also thankful that they were available whenever I needed them and they answered every question I had. Without them, I don’t know how my applications would have gone or if I would’ve even gotten an interview, let alone actual acceptance letters.

With a family full of doctors and medical professionals, I grew up always wanting to be a doctor but it was hard for to put in to words the “why”. I struggled with my personal statement and didn’t really know how to tell my story in a unique or memorable way. I worked with IMA to brainstorm ideas for my personal statement and to approach from a unique angle. It took a few months and several revisions to get a final version that I was proud of. I didn’t use IMA for any other aspect of my application but in multiple interviews I was told that my personal statement was one of the best they had read. I’m extremely happy and thankful for all the help and guidance IMA provided me!!

I applied to 6 medical schools. I ended up getting a rejection letter from 4 of them, and interview requests from 2.  I was rejected from one school post interview and placed on the waitlist for the other school I interviewed at. Ultimately I received a rejection from that school as well. I was pretty discouraged and didn’t know if I could handle another cycle. I reached out to IMA for help and was really amazed by the experience. While the actual consulting was great, I was most impressed by the my consultant’s compassion and understanding. He helped keep me motivated through another stressful cycle and was honest and realistic about my chances. I reapplied more broadly to about 15 schools with improved essays and ultimately was accepted to my top choice.

Once it was time to start applying for medical school, I had some people in mind that I wanted to ask to write a recommendation letter. I decided to ask 5 different people if they would write one for me. These included 2 professors and 3 personal letters. My professors and 2 of the personals were able to write them, but the last person wasn’t really sure where to go. I decided to try and see if IMA Consulting could help them. They worked with my recommender to outline and edit my letter of recommendation.

I read the letter before sending it with my applications and I was surprised at how amazing it was! I’m so thankful that I was able to used IMA Consulting’s services and get the help needed. I received my decision from the last medical school last week I was waiting on and I can happily say I’ve decided to go with Duke University. I had other acceptances, but this is the school I’m most excited about and ready for.

While it was my own fault, I ended up applying for medical school late in the game. I wasn’t sure exactly what I wanted to do or which colleges I wanted to apply to, so I waited longer than I should have. Once I decided these things, I had a very close deadline to meet. I jumped onto IMA Consulting and started getting help the same day. Once I explained my situation to my consultant, Bryan jumped right on it. I used a few different services in order to make sure I had my bases covered. The 3 main ones I used were for essay writing (for secondaries), resume building and the interview process.

I ended up getting a few interview requests late in the cycle and one acceptance letter! So thankful I don’t have to apply again!

While I was accepted to a few different colleges, my top choice ended up putting me on the wait list, which was Boston University School of Medicine. I know this means i’m not rejected, but I also wasn’t accepted. I wanted to find a way to move from the wait list to the accepted pile since I’ve been dreaming of attending this college. I decided to try out IMA Consulting to see if they could help me. In addition to reviewing my application, they went over the wait list letter and helped me revise everything, so I could send it back.

I did all that and it was a few weeks before I got any kind of mail from them. I ended up getting an interview request that ultimately resulted in them accepting me. I was so surprised and I’m very thankful with this company. They are extremely professional and knowledgeable on everything to do with the process. I don’t think I would’ve been able to move off of the wait list without them and I want to say thank you so much! You were the ones that helped me get a little closer to my goals.

While I knew that I wanted to apply for medical school, I had no idea where I wanted to apply or which schools were the best. I especially wasn’t sure about what the requirements were for the application process. I decided to go ahead and use IMA Consulting to help me out. Once I made my payment, I was paired with a consultant. I decided to get the 10 hour package to ensure that I could get as much information as I could. Not only did my consultant help me narrow down my choices, but she also helped me figure out what my chances were for each school. She did this by looking at my strengths and weaknesses and compared them to the requirements of the school.

We talked a lot about my future plans and what I should expect for the application process. I decided my top choice was Albany and we decided I would also apply to 8 other colleges as a backup plan. While I would’ve been happy getting accepted into any of them, I’m super excited that I got into my top school. This company helped me so much and I’m so very thankful.

In addition to needing help with the interview process and personal statement, I also wanted to see if I could get help with scholarships. Medical school is very expensive, so I wanted to try and get as many as possible. My consultant helped me with all of these things. The first thing we did was work on my primary application and secondary essays. Once I was confident with that, I went ahead and sent my applications in.

I was invited to participate in 9 different interviews, 5 of which I was accepted into. One of these was my first choice and I couldn’t be happier! At the end of the process, I ended up submitting several scholarship applications. It took some time to hear back, but I was able to win some and get a decent amount of tuition assistance. Thanks again!

While I do well with actually writing the essays, I tend to lack the ability of writing more personal and vulnerable information. As a result, I’ve gotten a few rejections and I knew if I continued this way, I would end up being rejected for all the applications I sent in. Before I applied for anymore, I decided to try out Accepted Consultants to try and improve my skills. My consultant looked at my essays and was able to give feedback and point out areas that were probably the cause of my rejections. In addition to coaching me about my writing style, they also let me know that I would have better luck if I made the essay more personal and vulnerable instead of cold and professional.

For every application after that, I took this into account. I applied for another 10 colleges and was invited to interview for 8 of them. Out of those 8, I was accepted to 6. While I didn’t get into my top choice, I did get accepted to my second choice. Without Accepted Consultants, I would’ve probably just continued receiving rejection letters. I’m so thankful for their help.

I’ve always wanted to get into medical school, but I was one of those students that just didn’t do great in some of the pre-reqs. As a result, I had some lower grades and stats. I didn’t think I’d get any acceptance letters because of this. When I decided to work with IMA Consulting, I was hoping they would be able to help me. I can happily say that the consultant I was matched with was ready to help. In addition to letting me know (realistically) how well my chances were with my past stats and experiences, she also looked over my applications and essays, then provided feedback. We also worked together to make sure my application was completed thoroughly and my essays came out fantastic.

I applied to 35 different schools and was very surprised when the acceptance letters started coming in. I didn’t get accepted to every one of the schools I applied to, but I did get into some of my top choices. I just want to say thank you to IMA Consulting for helping me and making my dreams come true.

I worked with IMA throughout my entire application process. I sent around 14 different applications in order to try and get into as many as I could. Not only did my consultant help me with the primary application, but he also helped me with my secondary essays and resume. He assured me that I was highlighting the correct strengths and wording my weaknesses in a way that didn’t make me look bad. He also helped me with the interview process, which was very needed and helpful. Since Dr. G has so many years of experience, he was able to help me know what questions to expect and get an idea of what answers the interviewers were looking for. He also helped me answer the way I needed in terms of how I worded answers and how quickly I responded.

All-in-all, I’m extremely happy with my experience with IMA Consulting and I believe that they are the biggest reason why I was able to actually get into medical school. I’m ready to continue my education and continue moving forward to be in the career I’ve always dreamed of.

The process of applying to medical school has been long and stressful. I did fine with my primary application, but kept running into issues while I was trying to write my secondary essays. My consultant and I sat down and talked about how to write a effective yet concise essay  and how to make it stand out among the others. I brought one of the essays I wrote and we went over it to see where my weaknesses and strengths were. My consultant recommended that I bring more personal and vulnerable writing instead of being more “professional”.

I was able to use the same essays (with slight variation) for most of my secondaries, but I did have to write different ones for others. I was rejected from a few schools pre-interview, but the majority wanted interviews and ended up accepting me. I now have plenty to chose from and I can choose the school that’s best for me. Thank you so much!

I’m really not great at creating resumes and doing interviews, so I knew I needed as much helps as I could get. This is where IMA Consulting saved the day. I was quickly matched with a consultant. Not only did she help me create an essay that highlighted all of my strengths and past experience, but she also helped me prepare for interviews. Through Zoom calls, we had a few mock interviews where she gave me feedback at the end. She asked me a lot of questions that are common with these types of interviews and let me answer to see how I would do. My consultant let me know where my weaknesses were during the process and coached me on what kind of answers the interviewers were looking for and how to word them in a way that was acceptable.

It took some time, but I was extremely confident by the end. I didn’t get accepted into every school I applied for, but I was invited for quite a few interviews. I was even invited to interview with my top choice, which was the Washington University School of Medicine. I ended up getting accepted into all but 2, so I’m extremely happy with and thankful!