Internships in Ambato, Ecuador

My time studying abroad in Peru was truly unforgettable. Surrounded by the soothing mountain air and immersed in the captivating local culture, I found myself at a loss for words, overwhelmed by the sheer beauty of it all. During my clinical rotations, I had the privilege of learning from compassionate and highly skilled doctors dedicated to enhancing the healthcare system while navigating the challenges of limited resources. These dedicated doctors demonstrate an unwavering commitment to advocating for their patients' well-being every single day—a trait that I deeply admire. None of this would have been possible without the guidance of my exceptional mentors. Thanks to their support, I felt at ease in this beautiful country while exploring its wonders. I'm also deeply grateful to our tour guides for their expertise in bringing history alive and for adding an extra dose of enchantment to our memorable 8-mile Inca Trail hike to Machu Picchu.

My internship in Mombasa, Kenya, was one of the most incredible experiences of my life. From the moment I began preparing for the trip, I received an immense amount of support that continued throughout my time there. Having the opportunity to give back to a community in need was deeply meaningful, and I am truly grateful to have been part of this program. During my stay, I loved exploring Mombasa through cultural treks, participating in outreach programs and clinics, and, of course, experiencing the amazing food. The warmth and hospitality of everyone I met made my time there unforgettable, and I cannot wait for the chance to return. For as long as I can remember, I have loved to travel. One of my greatest inspirations is family travel journalist Garrett Gee, co-founder of the award-winning travel-lifestyle brand The Bucket List Family. A Utah-born entrepreneur and content creator, Gee and his wife sold all their belongings after selling a mobile scanning app to Snapchat for $54 million, embarking on a world tour that has now spanned more than 65 countries over the past decade. What drew me most to The Bucket List Family was their philosophy of travel, rooted in adventure, culture, and service. This approach transforms each trip into more than a destination; it becomes a journey of personal growth, global connection, and lasting impact. Africa has been on my bucket list for as long as I can remember. From its extraordinary wildlife to its rich and diverse cultures, the continent offers unparalleled experiences. As the world’s second-largest continent, Africa holds vast reserves of fossil fuels, precious gems, and valuable metals. Home to nearly 1.4 billion people, most of them young, it remains economically developing, with a significant portion of the population living in poverty. Yet, according to the World Economic Forum, Africa is prioritizing economic growth by providing “financial support to innovative and dynamic startups, spurring job creation and technological advancements across the continent” (Masiga, 2025). The wildlife alone is captivating, lions, elephants, leopards, and countless other species roam free. I feel incredibly fortunate to have had the opportunity to experience this remarkable setting during my internship in Mombasa, Kenya. The past four weeks in Kenya have been transformative. Through my internship with International Medical Aid, I rotated through multiple departments at Coast General Teaching and Referral Hospital, including Accident and Emergency, Obstetrics and Gynecology, the Newborn Unit, and Radiology. I also sought out extra opportunities, such as afternoon shifts in the Intensive Care Unit and overnight shifts in both Accident and Emergency and Obstetrics and Gynecology. Alongside these rotations, I participated in community clinics and led educational sessions where I provided vital health information. These experiences were both professionally enriching and personally humbling, lessons I will carry with me throughout my career. Coming from the United States, I am accustomed to a healthcare system that is primarily privatized, supplemented by public hospitals and nonprofit organizations. While U.S. healthcare is among the most expensive in the world, spending rose 7.5% in 2023 to $4.9 trillion, or $14,570 per capita (AMA, 2025), it is often characterized by advanced technology and high-quality care. By contrast, Kenya’s healthcare system is divided into three sectors: public health, commercial private health, and faith-based organizations. Public facilities, though the most accessible and affordable, often face shortages of staff, equipment, and supplies, which can impact patient outcomes and increase the risk of hospital-acquired infections. The private sector offers higher-quality care and stronger doctor–patient relationships but comes with prohibitive costs. Faith-based organizations, such as the Christian Health Association of Kenya (CHAK) and the Kenya Conference of Catholic Bishops, provide approximately 30% of the nation’s healthcare (IMA, 2025). Despite the presence of diverse providers, Kenya’s system faces significant challenges, including high burnout rates among healthcare workers, inadequate compensation, limited resources, and gaps in public health education. Poverty compounds these issues, contributing to malnutrition, poor working conditions, and the spread of preventable diseases. Communicable diseases, noncommunicable diseases, and trauma-related injuries remain major public health burdens. HIV remains the leading cause of mortality, responsible for 15% of deaths nationwide (IMA, 2025), with rates disproportionately high in certain regions due to poverty, limited prevention strategies, and resource constraints (NIH, 2024). This experience has reshaped my understanding of healthcare. Working in an environment with limited resources strengthened my adaptability and problem-solving skills while deepening my commitment to equitable access to care. I now feel an even stronger calling to work in underserved communities, both locally and globally, delivering clinical care while promoting education and preventive measures to reduce health disparities. My time in East Africa reinforced my belief that healthcare is about far more than treating illness; it is about prevention, advocacy, and compassion. Observing Kenyan healthcare workers provide exceptional care despite resource limitations inspired me to carry forward the values of resilience, creativity, and teamwork in my nursing career. This internship not only confirmed my desire to be a nurse but also gave me a greater purpose: to advocate for health equity, serve with empathy, and deliver high-quality care to those who need it most.

My experience with International Medical Aid (IMA) was truly incredible. I gained so much during my time in Mombasa, both professionally and personally. Throughout my four weeks, I felt consistently supported, safe, and inspired. My placement at Coast General Teaching and Referral Hospital allowed me to expand my clinical skills as a nursing student, broaden my perspective on global healthcare, and bring home new knowledge that I am now applying in my practice in Canada. For this, I am deeply grateful. The community clinics were a highlight of my experience. Each visit left me feeling humbled and fulfilled. We were able to make a real difference by meeting people where they were and providing education in a safe, inclusive environment. The residence where we stayed holds some of my fondest memories. The entire staff was incredibly kind and welcoming from the moment I arrived. Our mentors were consistently supportive—checking in on us daily and sometimes joining us for meals to talk about our experiences. Their presence and encouragement made all the difference. There is nothing I would change about my time as an intern with IMA. The professional and personal growth I experienced would not have been possible without the unwavering support, guidance, and warmth of every staff member involved. I sincerely hope, and fully intend, to return one day. This past summer, I had the incredible opportunity to complete a four-week nursing internship with International Medical Aid in Mombasa, Kenya. As I reflect on that transformative month, I recognize how profoundly the experience shaped me—both professionally and personally. The sheer volume of knowledge I gained, the experiences I had, and the moments I witnessed exceeded anything I thought possible in just four weeks. Now, as I sit down and write, my mind and heart overflow with vivid memories: clinical observations, impactful patient interactions, and invaluable learning moments—each one worthy of its own chapter in a book. From all that I experienced, I return to Canada with a renewed perspective and a deeper sense of self—more intuitive, insightful, and, I dare say, wiser. While I cannot recount every story or experience from my time in Mombasa in this piece of writing, I will use this opportunity to highlight the most meaningful moments and lessons—those that have most profoundly shaped my perspective and influenced how I intend to practice and serve as a healthcare professional. My time in Kenya not only deepened my commitment to nursing but also instilled in me a clearer vision of the kind of compassionate, culturally competent, and purposeful medical practitioner I am determined to become. Kenya’s healthcare system is a tiered system, unevenly built. It is structured into four main levels: community health services, primary care facilities, county referral hospitals, and national referral hospitals (International Medical Aid, 2022, slide 4). While this tiered system is well-designed in theory, significant disparities in funding and resource allocation undermine its effectiveness in practice (Kairu et al., 2021). The most critical gaps exist at the foundational level—community and primary care—where underfunding results in inadequate services and a lack of essential preventative care (Oleribe et al., 2019). These upstream failures cascade into more serious and complex issues at higher levels of care, as patients often present with advanced, preventable conditions that could have been addressed much earlier (Vedanthan et al., 2015). One of the most striking examples I observed was the lack of accessible and effective prenatal care. Without adequate prenatal services, many congenital conditions go undetected or unmanaged (Baschat, 2023). During my pediatric rotation, I encountered a multitude of congenital heart defect cases—conditions that, in many instances, could have been prevented or treated accordingly through routine prenatal screenings and maternal care (Baschat, 2023). Among these patients was a six-year-old girl whose story had a profound impact on me. She had advanced-stage complications of a congenital heart defect, including lung damage, and required both a heart and lung transplant. This type of surgery was not available at Coast General Teaching and Referral Hospital (CGTRH), and her family could not afford to pursue treatment elsewhere. As a result, she was placed on comfort care. I spent several days with her and her father during my rotation, building a bond. Her father spoke about their struggles—financial and logistical—and how he just wanted his daughter to be pain-free. Despite everything, the little girl remained remarkably quiet, never once crying or openly displaying the pain that she must have been enduring. On the day of her discharge, her father told me that she had shared a dream with him: she wanted to become a healthcare provider. She had told her father that she would go home and begin studying so she could help people, just as she had seen me and other CGTRH staff do. Holding back tears, I knelt beside her and asked if I could make her a “daktari” right then and there. When she nodded, I placed my stethoscope around her neck. Her eyes widened, and a look of awe spread across her face. Her father’s eyes grew glassy, and in a moment of sorrow, we found a bit of joy. That experience is something I will carry with me forever. This little girl’s story is one of many that speak to the structural issues within Kenya’s healthcare system—where preventable conditions are allowed to progress due to gaps in early intervention, and where economic barriers determine the course of a child’s life. Yet, amidst these challenges, moments of connection and humanity shine through. They remind me that fair access to healthcare is not just a professional requirement—it should be our moral obligation. I also came to understand the human cost of understaffing. At CGTRH, the ratio of doctors to patients stands at an alarming 1 to 17,000 (NTV Kenya, 2025). This stark imbalance is not just a statistic—it is a daily reality that shapes the way care is delivered, or, more often, not possible. Due to government corruption, limited public funding, and deep financial disparities across the country, Kenya cannot afford to train or retain enough healthcare professionals to meet its population’s needs (Zhao et al., 2023). The result is a healthcare system that is critically overburdened, where the high volume of patients makes it difficult to provide compassionate and individualized care (Babaei & Taleghani, 2019). I witnessed the impact of this crisis firsthand during a day in surgical consults. A young boy came in with complications following a urethroplasty. Scar tissue had formed excessively, closing off his urethra and putting him at risk of acute urinary retention. The doctor assessed the situation and determined that an immediate catheter insertion was necessary. There were no pain medications administered, no attempts at comfort or distraction—just urgency. She asked that I hold him down during the procedure, explaining she had many more patients waiting and no time to delay. I now understand the pressure these doctors face and the difficult choices they must make. I did as she asked. But as the boy screamed—cries of pain and fear—I had to look away. It was one of the most traumatic moments I’ve ever experienced. After the catheter was inserted and began draining, the doctor left the room. The boy lay there, exposed and in visible pain. I helped his mother dress him, watching him wince with each movement. He was expected to walk himself back to the waiting area. I couldn’t let that happen. Instead, I lifted him gently off the table and walked hand in hand to a chair in the waiting room. He sat on my lap, leaned against my chest, and we waited together while his mother went to retrieve pain medication. I let him watch a children’s show on my phone, and slowly, other young patients—some of whom had also undergone a procedure or were awaiting their turn—gathered around us. One leaned on my arm as another rested his head nearby, all quietly watching. For that hour, I wasn’t delivering clinical care, but I was offering something that, in a severely understaffed system, was unfortunately rare: presence, comfort, and empathy. That afternoon stayed with me and taught me something I will carry into my practice as a healthcare provider: patient care is more than procedures and diagnoses—it’s also about dignity, connection, and compassion. I saw firsthand that when a system is too overwhelmed to allow for those practices, it is the patients—especially the most vulnerable—who suffer. Moving forward, I will hold onto this newfound knowledge and strive to create a space for empathy at all times. I will advocate not only for clinical excellence but for compassionate care that sees and honours the person behind the patient. Integrating into Kenya’s healthcare system also came with challenges. The clinical practices and resources were markedly different from what I was used to in Canada. Many of the regulations and routines I had been taught were, and are, simply not feasible at CGTRH due to a lack of materials, equipment, and staffing. Yet, what struck me most was not what was missing—but what was present: impressive skill, resilience, and adaptability. Despite the resource limitations, the Kenyan healthcare providers were knowledgeable and innovative. Where I might have stopped and thought, “There’s nothing we can do,” they found ways. Their ability to improvise—often under pressure—was inspiring and, in some situations, lifesaving. This difference in approach fostered meaningful collaboration between my Canadian training and their resourceful, hands-on approach to problem-solving. One such moment occurred during a shift in the Intensive Care Unit (ICU). A young man was admitted with some of the most severe pressure sores I had ever witnessed—so deep that muscle tissue was exposed. The pain he must have been enduring was unimaginable. I shared with the nurse I was working alongside that in Canada, we often use donut pillows to offload pressure from such wounds. She agreed that we needed to try something similar. Although CGTRH had no such medical devices, we rolled blankets into circles to create makeshift cushions together. We carefully placed them beneath the affected areas, and when I asked the patient if it felt any better, he said, “Yes.” While we didn’t have high-end tools, by combining our experience, ideas, and compassion, we were able to enhance someone’s comfort level. Another pivotal moment of teamwork came again in the ICU, when a three-month-old infant coded. Within a short period, three nurses, a clinical officer, and I were working in unison. One administered medications, one gave breaths, another completed suction, and I performed chest compressions. My mind focused only on doing what had to be done. About twenty minutes into the resuscitation, a medical officer entered the room. I was in the midst of compressions when he asked if I was okay or needed a break. I responded, “No,” and kept going. A few minutes later, he listened to the baby’s chest and assessed, then looked at me and nodded: “The heartbeat is back in the 100s—and it is strong. Well done.” Relief swept over me as my mind caught up to the moment. One of the nurses pulled me aside, checked in on me, and said, “Be proud of yourself. You did something good.” She also reminded me that the child was critically ill, and even with all our efforts, he still might not survive. It wasn’t a burden that could be carried alone. Her kindness, support, and presence in that moment meant the world to me. From this experience, I learned how essential support from fellow healthcare providers is, not only for delivering effective care but for sustaining the emotional strength to continue this line of work. Although we came from different countries, backgrounds, and paths, we were united by a shared purpose. Together, we saved a life. That moment taught me that medicine isn’t just about knowledge or resources—it’s about people. It’s about trust, shared purpose, and the powerful moments when compassion reaches beyond borders. Moving forward, I will hold onto this perspective, recognizing that collaboration and human connection are essential to patient care and to the well-being of healthcare workers. Education is key. According to the World Bank Group, millions of females globally, including those in Kenya, lack the resources and support necessary for proper menstrual hygiene management. This issue stems from limited access to menstrual products, lack of education on the topic, and social stigma. Therefore, millions of females live in ignorance and fear, which directly impacts their health, confidence, and life opportunities (World Bank, 2018). During my time in Mombasa, I was able to witness just how real and pressing this issue is. As part of our community clinic work, we visited numerous schools to conduct Women’s Health Education Sessions, focusing on menstrual hygiene management practices. Before these sessions, I was uncertain about how the girls would respond. Reflecting on my own experience at their age, where I had a solid understanding of menstruation, I wondered if they were already quite informed and thus might see our lessons as unnecessary. I was deeply mistaken. The gaps in knowledge and widespread misconceptions were staggering. It was heartbreaking to learn that many of these young women had never been taught how to manage their periods or understand the physical changes they were experiencing. Many did not know that blood clots and heavy bleeding were often normal, nor were they aware that pregnancy remains a risk during menstruation or before the first period. The silence and stigma around women’s health had left them confused and vulnerable. Despite this, the sessions were filled with curiosity and eagerness. The girls were engaged, asking questions that reflected their desire to learn and understand. We were able to create a safe space where talking openly about the female body was not only accepted but encouraged. During each session, we gradually replaced shame and silence with knowledge and empowerment. To help foster that comfort, I even shared my own experiences with menstruation, showing them that their questions were valid and that they were not alone. Participating in community clinics, such as the menstrual health sessions, taught me the importance and power of education and knowledge sharing. Empowering young women with information is a vital step toward reducing stigma and improving health outcomes. The perspective I gained through these experiences is one that I will consistently apply to my future practice as a healthcare provider: create safe, inclusive spaces that foster learning, encourage open dialogue, and prioritize education, as it is a powerful tool and integral to improving both health and quality of life. My time as an intern with International Medical Aid was more than a clinical rotation; it was one of the most transformative experiences of my life and has profoundly shaped my path as a healthcare provider. Experiencing the healthcare system in Mombasa, Kenya, redefined my understanding of care itself and the people involved, including both providers and patients. I learned that providing adequate healthcare extends beyond diagnostics and procedures. It involves listening, empathy, and the ability to adapt. I witnessed how healthcare systems function under extreme strain, how disparities affect outcomes, and how creativity and collaboration can become the most powerful tools clinicians have. From bringing light to moments that felt impossibly heavy, to holding and comforting a young boy after a painful procedure, to performing a resuscitation alongside an international team, and helping young women understand their own bodies—I now know the kind of healthcare provider I strive to be. I strive to be someone who leads with cultural sensitivity, humility, and compassion. Someone who sees every patient not just as a case, but as a whole person, deserving of empathy, connection, and dignity. The lessons, newfound knowledge, and perspectives I’ve gained from this internship will guide me as I continue down my healthcare journey. Back in Canada, and wherever my career may take me, I will continue to advocate for equity, create safe and inclusive spaces, and never forget what a privilege it is to educate and care for others. Kenya not only helped shape my goals as a healthcare provider and as a person, but it also solidified them in a way that nothing else ever has. I return to Canada with greater knowledge and a commitment to lead with compassion, guided by my new insight and grounded in humility.

International Medical Aid did a fantastic job of making sure all of the interns were well taken care of. There was never a time when I needed something and IMA was not immediately working to fix the issue. The IMA team in East Africa was so accommodating, welcoming, and overall kind to all of the interns. They genuinely wanted to get to know each and every intern in order to make your experience the best it could possibly be. Personally, I became really close with the transportation team and the kitchen staff whilst in Mombasa. These individuals made my day every time I got the opportunity to talk to them and get to know them. The kitchen staff made amazing food from all different cultures to accommodate everyone's different tastes. I was able to taste classic Kenyan dishes as well as my favorites from home, like pancakes in the morning at breakfast. If you have an allergy or dietary restriction, the kitchen staff will not rest until your dietary needs are not only met but exceeded. They would go above and beyond at every meal, making the whole experience better for everyone as we were all well-fed. As for the transportation team, my favorite thing to do was sit in the passenger seat of the bus on the way to/from the hospital or community outreach and chat with the drivers. I was able to get to know the transportation team on a more personal level, making the drives more fun when you had someone you considered a friend driving rather than just an employee. As for the in-country support, the staff of IMA did a great job of communicating with us quickly when we had a question. They were also clear with us on what was going on around Mombasa that we as interns should be aware of (politically, socially, and culturally) as we made our way throughout the city. As for the living accommodations, the residence was nicer than I could have ever imagined. From the pool the interns would frequently hang out in at night, to the spacious living quarters, the residence gave us more than enough room to play games at night, live amongst 50+ other people comfortably, and rest and relax after a long day. The residence was sparkling clean with comfortable accommodations and, again, the best staff taking care of the living spaces and grounds. Given that the residence was located in a gated community in one of the nicest neighborhoods in Mombasa, I always felt safe and at home. Whenever we would leave the residence, I still felt extremely safe and cared for by the staff members and my fellow interns. However, Mombasa as a whole is made up of some of the nicest, most welcoming people who almost never make you feel as though you are in an unsafe situation. All in all, I would rate this experience a 10/10. I was on the phone with my dad the night before I left, begging to push back my flight just a few more hours to spend more time with all of the amazing interns and staff I met during my six weeks in Mombasa. I did not want to go home, and I still miss it every day. In my opinion, Mombasa changed me for the better, not only as a healthcare professional but also as a person. As a nursing intern going into my senior year of nursing school, I was able to help out the nurses and doctors in the hospitals. Whether I was providing the patient with a hand to hold during a procedure, or doing head-to-toe assessments and giving authorized medications to help relieve the nurses of their heavy workload, I was able to see the impact on not only myself but also the community through the things I did. Mombasa changed me as a future nurse, teaching me how to problem solve in situations where resources and staffing are at the absolute minimum. In the future, I will be able to think quicker on my feet and problem solve in my workplace thanks to my time in Kenya. I was also able to see my impact on the community of Kenya through community outreach set up by IMA and through my patients getting better in the hospital. Whether I was watching a malnourished patient get better over my weeks in the hospital or teaching a child at the local school how to brush their teeth, I was seeing the impact not only myself, but the entire organization of IMA had on the community around us. This program is very special, and anyone who has the opportunity to participate should consider themselves very lucky. Thank you, International Medical Aid. Kwaheri, Kenya! It has been about a year exactly since I called my parents to tell them my wishes of spending my summer in Africa as a nursing intern. Although they were on board with me going abroad to experience other healthcare systems and help those in need, they were not sold on the idea of me flying by myself for the first time to a continent so far away from home. With my fantastic marketing skills, I was able to convince them that I would, in fact, be killing three birds with one stone by going on this adventure. I would gain vital clinical hours to set me apart for nursing job interviews coming up sooner than I would like to admit; I would get the opportunity to study abroad in a sense which I would not have otherwise been able to do due to the constraints of the nursing school timeline; I would get to go to the continent I had always dreamed of traveling to, Africa. Fast forward about ten months later, and I was on a plane en route to Mombasa, Kenya, where I did not have a single clue what I was about to experience over the course of the next six weeks of my life. Upon my arrival to Mombasa, I had an instant culture shock. For starters, Kenyans drive like crazy in comparison to Texas drivers—and that is saying something—and all of the people are very friendly and welcoming, which is uncommon in the United States, even in the South. Thankfully, International Medical Aid did a wonderful job of properly introducing not only Mombasa, but also the country of Kenya to all of the interns within less than 24 hours of their arrival. We learned about the political, social, and religious cultures of both Kenya and Mombasa specifically. We were also given a “Swahili survival guide” of sorts to jumpstart the interns’ typically rocky journey of learning the language. These first few lectures and tours of the city helped put into perspective where our planes had touched down just the day prior, immersing us into the culture and welcoming us into a place like no other. Upon applying to IMA, I expected to learn and grow as a nurse and as an individual. What I did not expect was how much I really would learn during my six weeks with IMA. Throughout my time at Coast General Teaching and Referral Hospital in Mombasa, Kenya, I was able to experience nursing in a multitude of different specialties. Naturally, each specialty came with its own challenges and learning curves. Through encountering these obstacles head-on in each unit, I was able to come back to the United States as a much more well-rounded nurse. My rotations made me think quickly on my feet and problem solve as I went, namely my rotations in the OB-GYN, Pediatrics, and A&E units. During my OB-GYN rotation, I encountered mistreatment of patients. Throughout my rotation, I saw healthcare professionals slapping patients and pinching their lips shut if they made noise while in labor. I saw patients ignored when they voiced their pains and fears as they progressed through labor. I saw a lack of patient consent for procedures such as episiotomies. Witnessing these events taught me how, as a nurse, I must step up to enforce patient-centered care and advocate for my patients to receive the best possible treatment, even when the unit is short-staffed and running low on resources. I did this by taking initiative in the care of the patients—providing them with non-pharmacological pain management methods I had learned and used during my OB-GYN rotation in the United States. These measures included massage, changing the patient’s position, and lending a hand to hold in order to calm their nerves. While on the OB-GYN unit, I learned not only how to take initiative in uncomfortable situations for the good of my patients, but I was also able to show staff members how comfort measures can help enhance a patient’s entire birthing experience. Pediatrics taught me the importance of time management as a nurse. During this rotation, I had the pleasure of shadowing and assisting Nurse Wafa in the pediatric inpatient ward. During my time there, the ward was full, and we had approximately forty patients needing medication administration. Given that there was only me, Wafa, and a nursing student available to help all forty patients, it was very difficult to make sure all medications were given to every patient on time. Therefore, we created a system where the nursing student would chart, Wafa would draw up the medications, and I would administer all medications I was approved to administer as a student nurse. In working with Wafa and the other student nurse from Kenya, I was able to learn about time management while still providing my patients with safe, timely medication administration. Arguably, my rotation in the Accident and Emergency Department at CGTRH taught me the most out of all my rotations. Whilst in the A&E, I learned how to think quickly on my feet to help solve unforeseeable problems as they arose with the ever-changing patient conditions present in this unit. I learned how to jump in where needed to assist doctors and nurses in doing assessments and vitals, as well as IV insertions, as I had previously been trained and approved to do such things. This was a huge help to the staff, as there were also things I could not do, such as comforting family members who had just lost a loved one, administering blood, or giving high-risk medications, to name a few. That being said, I was able to learn so much with the guidance of the staff in the Accident and Emergency Department as they gave me opportunities to learn new things, practice my skills, and ask questions when appropriate. For example, the physicians would point me toward a patient to assess and ask me to guess their presenting diagnosis. By doing this and reporting back with my notes, I was able to receive instant feedback and advice on my assessments. My learning did not end in the hospital. Much of it took place outside the clinical setting in the form of cultural and global health discussions. Through IMA-led lectures and conversations with fellow interns, I was able to better understand how different healthcare systems operate based on each country’s laws, cultural beliefs, and available resources. With interns from around the world, I learned how the U.S. healthcare system differs from those in Australia, Dubai, the UK, Kenya, and more. Thanks to International Medical Aid, I have begun to pay closer attention to healthcare differences worldwide so I can become a more globally aware nurse for my patients. By understanding how a healthcare system works, it becomes easier to recognize inequities in hospital infrastructure and patient care across countries. One of the major differences I noticed between Kenya and the United States was how few patients were insured in Kenya. Even at what U.S. citizens would consider the low price of five dollars a month for insurance, “the insurance scheme is still unaffordable to a majority of Kenyans” (IMA, 2024). This means that many Kenyans are paying out of pocket for healthcare services, making care less accessible and affordable for a vast portion of the working population. Throughout my time in CGTRH, I saw hardships and challenges in every unit I encountered. Many of these issues stem from socioeconomic disparities among different populations across Kenya. In 2020, BMC Health Services Research conducted a quantitative study on the “cost-related unmet need for healthcare services in Kenya” (Arsenijevic et al., 2020). The study found that multiple factors drive unmet healthcare needs due to cost, requiring a multifaceted approach to address inequities, especially among the most vulnerable and marginalized populations. In short, lack of health insurance, limited access to services, and socioeconomic disparities all contribute to patients’ challenges in acquiring necessary healthcare. Throughout my rotations at Coast General, I saw the effects of these factors firsthand. One patient in particular came in with extreme malnutrition during my night shift in the Pediatric A&E during my third week in Mombasa. A couple of weeks later, during my Pediatric rotation, I saw the same child looking much healthier and in better spirits, ready for discharge. When I came back in my last week with IMA to say goodbye to my favorite nurse in Pediatrics, I saw that my patient had been moved to a “waiting” area where children and their mothers stay until they can pay off their medical bills. Their bill continued to increase each day they remained in the hospital, as they were still using bed space and resources. When I asked the mother what was happening, she said they were 30,000 Kenyan shillings short. This mother and son were still there when my internship ended, and I will never know if they were able to go home. This is a real-life example of cost-related barriers affecting real patients. Each day during my rotations presented different challenges and complications. I learned that many of these issues were linked to the political approach taken toward healthcare in Kenya. I witnessed the effects of government shortcomings firsthand, particularly regarding healthcare worker pay and support. During my time in Mombasa, I observed the country struggle under growing tension over how citizens and healthcare workers were being treated. The Kenya Medical Practitioners, Pharmacists, and Dentists Union (KMPDU) “has accused county governments of failing to prioritize healthcare workers’ welfare, with some counties owing salaries for up to five months” (Aura, 2024). Due to strikes by healthcare professionals, staffing became even more limited, making it harder for hospitals to meet patient needs. This even affected interns in the IMA program, as there was a week when no surgeries were available to observe in the Surgical Ward. These issues between the Kenyan government and the healthcare system are deep-rooted and affect many more people than those whose voices are heard. Unfortunately, it is primarily the patients who are put in danger by not receiving proper or timely treatment due to these systemic inequalities. Throughout my time at CGTRH, I learned how these political and structural challenges shape patient care. I learned so much from my six-week adventure in Kenya. Whether I was in the hospital, doing community outreach, or just sitting in the living room with my fellow interns, I was constantly learning—professionally and personally. Professionally, I worked alongside some of the smartest people I have ever met from all over the world, collaborated across specialties, and witnessed a completely different way of practicing medicine due to limited resources and staffing. I also saw stark inequalities and recognized many things we take for granted in the U.S. Personally, I met some of the kindest individuals I have ever known, was welcomed into one of the most vibrant cultures I’ve encountered, and reignited my love for adventure. Thanks to International Medical Aid, I experienced the greatest period of personal and professional growth of my life so far, and for that, I will forever be grateful.

During my internship with International Medical Aid in Kenya, I received exceptional in-country support that significantly enhanced my experience. From arrival, I was warmly welcomed and received through orientations on Coast General Hospital, Kenyan culture, and safety protocols. Throughout my stay, the IMA team was accessible and responsive, ensuring a smooth and enriching experience. They provided unwavering support in every aspect, from safety and accommodations to delicious meals, fostering a supportive environment that facilitated both my clinical growth and cultural immersion. My journey into healthcare began in kindergarten, though I can’t pinpoint exactly why I was drawn to it at such a young age. My enjoyment of doctor visits might have been an early sign, but with no family background in healthcare to spark it, my interest seemed almost instinctive. I found anatomical charts interesting and I didn’t even mind the shots. As I progressed through school, my passion for working in a hospital solidified, but I found myself torn between nursing and medical school. Eventually, I chose nursing school, though uncertainty lingered because I wasn't entirely sure what it entailed. Being the first in my family to pursue college added to my uncertainty; I had to figure this out on my own. Entering nursing school, I fell in love with everything about it. I was certain I had made the right choice. Yet, whenever asked, 'Why nursing and not medicine?' I struggled to give a confident answer. I lacked familial influence in healthcare and had limited hospital experience at that point. Over time, I gained significant clinical exposure, but doubts persisted. Then, I discovered International Medical Aid. Having longed to travel and previously planned to study abroad before COVID disrupted those plans, I saw this as the perfect opportunity to gain clinical experience while exploring the world. Participating in this program was a transformative experience that reaffirmed my decision to pursue nursing. I am immensely grateful for the opportunity it provided. During my first week of internship, I had the opportunity to rotate between the pediatric outpatient clinic and the inpatient wards, providing me with valuable insights into different hospital settings and healthcare professions. The outpatient clinic, primarily managed by clinical and medical officers, and the inpatient wards, overseen by nurses, offered contrasting but equally enriching experiences. I was particularly thrilled to begin in pediatrics, a potential specialty of interest to me. In the outpatient clinic, I was warmly welcomed by Dr. Ken, who delivered extensive and captivating lectures on common pediatric diseases in Kenya. I shadowed him as he treated a continuous stream of anxious mothers and their children, learning assessment techniques firsthand during patient examinations. Transitioning to the inpatient setting, I had the privilege of working alongside Sister Wafaa. She graciously guided me through the daily responsibilities of a pediatric nurse at Coast General Hospital. I assisted with basic treatments, obtained vital signs, and helped gather essential supplies. It was here that I quickly learned to think creatively and adapt to various challenges. I observed firsthand the striking differences in resource availability in Kenya compared to healthcare facilities in the U.S., underscoring the challenges and ingenuity required to deliver quality care in a resource-limited environment. Each day, I was struck by the nurses' resourcefulness—they devised solutions to problems that I, coming from a more privileged background in the U.S., would never have had to solve. In my spare moments, I cherished conversations with mothers about their children and offered them comfort by giving them a support person. I noticed that Kenyan women exhibited remarkable strength, often adhering to cultural norms that discouraged overt displays of emotion such as fear. Although initially reserved, they gradually opened up during our conversations, revealing their resilience and the deep emotional fear they faced for their children. I frequently visited Sister Wafaa as well as the mothers and children we treated; there will never be anything as refreshing as the feelings that overcame me when returning to the unit to see children who were once battling for their lives now nearly unrecognizable jumping and playing in their cribs. These interactions are among the fondest memories I will carry from this experience as they reaffirmed to me what being a nurse was all about. During my second week of internship, I immersed myself in the challenging environment of the surgical intensive care unit (ICU). With limited prior experience in such a fast-paced setting, I was grateful for the opportunity to shadow nurses, clinical officers, and medical officers. Under the guidance of Dr. Mohammed, I delved into the intricacies of disease pathology and treatment plans. His interactive teaching style extended beyond clinical practice; he assigned us homework on researching electrolyte imbalances and hormonal conditions, which served as a valuable refresher from my nursing school pathophysiology courses. Beyond academic challenges, Dr. Mohammed posed thought-provoking questions that pushed me to reflect deeply on my internship experience. One particular inquiry resonated with me: What makes nursing different from any other profession where one can also help people? This question challenged me to articulate a meaningful response, one that went beyond clichés about helping others. Through this interaction, I came to the realization that nursing is truly a unique profession. Each and every healthcare provider has a common goal of helping their patient, but how they do it is what makes each profession unique. This reflection helped me articulate a more profound personal mission within the field, driving me to make the most of my internship experience. My third week was spent rotating between the pediatric and adult accident and emergency units. Similar to ICU, these were faster paced units as one second you could be sitting at the desk reviewing charts and only moments later you could be performing CPR on a child. I spent the majority of my time in the pediatric A&E practicing assessment skills and assisting with treatments. In my spare time, I spent the time conversing with mothers. I felt heartbroken for these mothers, who were alone aside the beds of their sick children. You could see the looks of desperation and hopelessness in their eyes as they begged for us to help their children. These moments give you purpose and fuel for your passion as there is nothing more rewarding than being able to be the best part of the worst day of someone’s life. During the final week of my internship, I had the privilege of working in the labor ward, where I had a profound experience that answered the question that I had been pondering for years. I had the honor of holding the hands of twelve incredibly brave new mothers. These moments became the most meaningful of my internship. Whether they know it or not, I cried tears of joy alongside these women as each beautiful baby entered the world, and I shed tears of sadness with those who were grieving. Witnessing their journeys was a deeply emotional experience for me. Each mother arrived on a stretcher, filled with fear. When their babies were born, their expressions weren't joyous; they were simply filled with relief at having survived the delivery. Maternal mortality rates have risen in Kenya, ranging between “...500 and 999 deaths per 100,000 live births…”, making many women fearful for their lives (World Health Organization, 2023). Many of these women were alone—either because their partners weren't allowed in the room or because they were young and had been abandoned by their families out of shame. It was particularly difficult as unlike the United States, birthing women do not routinely receive anesthetics or pain medication in Kenya. So, throughout their labor, I stayed by their sides, offering reassurance and advocacy. I promised them that I would do everything in my power to support them and make the process as comfortable as possible. In their most vulnerable moments, many cried in my arms, expressing gratitude for my presence on what was undoubtedly the hardest and scariest day of their lives. I will never forget these moments as they are what helped solidify my passion for nursing. My four-week internship at Coast General Hospital not only reaffirmed my passion for nursing but also provided profound insights into the healthcare challenges in Kenya. I witnessed firsthand how limited healthcare literacy and overall accessibility due to financial constraints often prevent individuals from accessing essential care (Ilinca et al., 2019). The shocking contrast between healthcare systems was highlighted further when I learned that in 2021, healthcare expenditure per capita in Kenya was approximately $95 USD, compared to $12,470 USD in the United States (World Bank Group, 2024). This significant disparity in resources, coupled with the resilience and ingenuity of Kenyan healthcare workers, has inspired me to be an educated advocate for providing equitable healthcare. I plan to incorporate this newfound knowledge into my practice by actively engaging in policy advocacy to support healthcare reforms that address disparities. I am dedicated to remaining educated and open to learning about healthcare policy worldwide. I will use this passion and my clinical experience to promote culturally competent care and advocate for access to resources for underserved populations. By staying informed about global health issues and working to implement evidence-based practices, I am committed to bridging gaps in healthcare access and improving patient outcomes. This experience has ignited a passion and I am dedicated to applying these insights to make a meaningful impact in the field of nursing. In conclusion, my internship with International Medical Aid has been transformative, deepening my global healthcare experience and reaffirming my passion for nursing. This journey has clarified that my interest in healthcare lies in the patient-centered approach of nursing, rather than the broader focus of medicine. Each rotation, from pediatrics to obstetrics, has enhanced my clinical skills and broadened my understanding of healthcare disparities, strengthening my role as a patient advocate. I’ve developed a greater sense of compassion and a strong commitment to supporting vulnerable populations. This experience has solidified my determination to pursue a nursing career where I can make a meaningful impact. I am excited to apply the knowledge and perspectives gained to provide compassionate, culturally competent care and am grateful for the lessons and relationships that will guide me through my final year of school and into my professional career.

Interning at IMA was a life-changing experience for me. It completely transformed my daily life, bringing me immense joy. The welcoming atmosphere from my fellow interns and the entire staff—mentors, doctors, security, and even the cleaning and kitchen teams—made me feel like I was part of a family. I had the opportunity to witness wonders of the world that I never thought I'd see, and now that I've left, I deeply miss those moments. I hope to return as soon as possible. The food was always fresh and delicious, and the kitchen staff were open to any suggestions or special requests. The accommodations were lovely, and the location was convenient, with easy access to essentials like grocery stores, malls, and even the beach. Our drivers became more than just drivers; they were our friends, joining us on many memorable trips. When I came to Africa, I expected a strictly professional and clinical experience, but I received so much more. I now cherish countless memories and have made lifelong friends.

My experience with IMA in Kenya was amazing and unforgettable. The program exceeded my expectations. From the moment I arrived, the local team was there to guide me through every step of the journey. They were friendly, knowledgeable, and always available to answer questions or address concerns. The organizers took every precaution to ensure we were always in secure environments. They were well-prepared for any potential issues, making me feel safe. The accommodations were comfortable and provided a good mix of local and modern. Each place was also very clean and well-maintained. The program also had a positive impact on the local communities we visited. By engaging with local guides, artisans, and families, we helped support their livelihoods.

Overall this internship with IMA was amazing in several aspects. In country support, accommodations and day to day communication made me feel safe and at home. The staff was very friendly and catered to any need we had day or night. The hospital was welcoming and so many doctors and nurses were eager to help me learn. The community outreach was one of my favorite aspects of the program. Being able to teach children in remote area about sensitive health topics and them fully embracing the information and asking a million questions made every bit of our hard work pay off. I have a new found respect for this country and healthcare system and will take back so much new knowledge about procedures, protocols and the nursing role within CGTRH. During my International Medical Aid Internship in Mombasa Kenya at Coast General Teaching and Referral Hospital (CGTRH) I was placed in the pediatric ward, accident and emergency and labor and delivery. My experience in these three wards were very different and provided a lot of insight into the differences of healthcare in this region compared to the United States. Having gone through three years of nursing school already and only one more year before graduation, it was very eye opening to see not only the nursing role and procedures but also how nurses are taught and the weight they carry within the hospital. I have gained an immense amount of respect and appreciation for not only the doctors and nurses of these under resourced facilities but also how knowledgeable everyone is despite the difference in healthcare delivery. One of the biggest factors I have taken from my hospital experience is that you cannot save everyone, and the limited resources cannot be allocated to everyone. Financially, many patients and families in these public sectors do not get the care or treatment they need because there is no money to pay. Others may be neglected if not with a support system or not treated in a timely manner. Medication is limited and medical supplies are sometimes made from innovative ideas like making splints from bending metal. I have not only seen a lot but learned and practiced skills alongside the nurses and providers. My perspective of how this area of the world functions has certainly shaped my idea of healthcare in different countries. I am coming back from this experience with a more open mind and appreciation for life. I have one more year left of nursing school and my experience here has only made me want to perform me in school and in my career to the best of my abilities. After seeing the disparities and lack of resources in this hospital and country it makes me realize how fortunate I am to be going into a workforce that can truly impact almost every life in a positive way. I want to take with me the care and compassion of some of the nurses and doctors I have encountered. I’m also invigorated to provide a calm and friendly bedside manner than not many of the nurses and doctors have in Kenya. I am also influenced to maybe even go back to school after some experience and earn a higher degree to perform more tasks and skills. Outside of the hospital I was very excited about each of the hygiene, reproductive and mental health clinics and seeing how much of an impact we had on the children. I think that might be taken for granted in the US as from from a young age children are taught about health and hygiene and their bodies. As a nurse one of my roles will be education of every different age and population. It excites me to know that children appreciate and take this information to heart. I want to be able to talk young girls through puberty and menstruation or be able to destigmatize and help someone going through a mental health crisis. I want to be that person that someone knows they can go to for information, in hard times or just needing a hand to hold. I felt that in the community and in CGTRH and It makes me so excited to carry that back into my career here in the US. The biggest aspect of this whole experience was seeing the differences in healthcare delivery and use of resources compared to the United States. Starting with the private vs public health care sectors. The public sector is more accessible and affordable but also contributes to poorer patient outcomes, lower standards of care and limited resources. On the other hand, the private sector is slightly more common in use (International Medical Aid, 2024) and provides a higher quality of care for patients. Upon arrival to the hospital patients must pay for their records booklet and then are given a bill that must be paid before leaving the hospital at the end of their stay. Those who do not have the money to pay their bill are detained at the hospital until it can be covered and some even change clothes and run away. I was shocked by this fact as well as the matter that no one goes after the escapee and police do not intervene. In addition to the financial side of the healthcare system I found it very shocking how common medical neglect was. A patients must come in with a support system or person to advocate for their health, especially in accident and emergency, otherwise doctors may not see them right away or at all. Patients or their family must also purchase their own medical equipment as needed for their condition. Whether it be sutures, ng tube, catheter, medication, etc.… The family or person accompanying the patient must follow what the doctor says to go buy it at the entrance of the hospital and then come back with the supplies. Each unit of the hospital has its differences and different procedures for care, but I found that labor and deliver was one of the most different from the US. First, the nurses and even student nurses are the providers for vaginally delivers while only the PA’s and Doctors perform the c-sections. Mothers are to birth alone in their bay, no one else is allowed to be with them including the father figure. Fathers and family must wait outside of the unit but can buy and bring in medication or supplies if instructed to. Most women birth naked and are left to scream in pain for hours without anyone checking in \. Epidurals are only used for c-sections and even then, are only an injection into the spinal column rather than a catheter that is left in place until after the procedure. At CGTRH babies are brough straight to warmers after delivery and remain there for 2-3 hours. On the other hand, in the US babies are delivered straight to skin-to-skin contact with the mother called the “golden hour” and breastfed with in that time. I found it interesting that there are signs all over the unit saying babies must be fed within 30 minutes to an hour, but I never saw that happen. After asking a nurse about this they said that the baby must remain in the warmer while the mother cleans herself up and after three hours the baby must be breastfed to prevent hypoglycemia. In addition to the procedures, I observed that no stethoscopes or dopplers were used when assessing fetal heart rate, only fetoscopes. There is also only one maybe two for the whole unit and they are just passed from patient to patient as needed. Doctors and nurses are very skilled at using this device and can almost immediately determine what condition the mom and baby are in without any other test or device. The pediatrics department also surprised me, where critically ill babies are placed in wooden bins next to each other and older children are still in cribs or beds with their parent next to them 24/7. Patients do not have their own bay or room and everyone is in one area together. All children and babies have an IV placed upon admission to the unit and many have ng tubes for feeding. Children are here for a number of reasons, but the most common illnesses are tuberculosis, severe acute malnutrition, HIV and pneumonia. Aside from the public and private sectors to healthcare only around 35% of the population has health insurance. This leads to patients not seeking care when needed, increasing transmission of diseases like HIV and Aids and therefore putting even more strain on the system. I also find it interesting that faith-based organizations are a large contributor to the healthcare system. In the United States doctors and other providers are of the highest paid professions with some making over $500,000 per year. Nurses make an average annual salary of around $94,000 (US Bureau of Labor and Statistics, 2024) with that coming out to around $45 per hour. At CGTRH I asked a labor and delivery doctor about his income which was only around $1,200 USD per month or $14,400 per year. This encompasses a full 40-hour work week, 50-60 c-sections per month, being on call, assisting with vaginally delivers, caring for complications and leading the unit. He said at the end of the month he still must scrounge from money to pay rent and provide for his family. I was also able to talk to nurse about their salary and it comes out to around $3 USD per hour which is practically nothing. Culturally disease, death and dying is all too common in this part of the country and happens quite often. Many people do not see a doctor when they are sick and only show up to a hospital if they are extremely ill. Everyone is very strong. From a young age boy are taught that crying is a sign of weakness and can even be punished for it. Death and burial are also a very religious process. Families of a deceased body follow the body to the morgue and stay with it until they can have it for ceremony. People are very protective of the body and have specific rituals when it comes to death and the afterlife. During my time in the hospital, I saw many unique cases that are not common or even exist in the US. The pediatrics department saw many cases of malnutrition which is common in the country but quite the opposite in the US. Marasmus, also called severe acute malnutrition, is a condition that I have only read heard and learned about in textbooks where the patient’s body is not absorbing nutrients and therefore the stomach becomes very large while the limbs are very tiny. This was my first time seeing a patient living with it and I was shocked by how someone could live with this. In labor and delivery there was such a high volume of patients, some came in so fast and providers had no idea how many weeks they were, the condition of the baby or specifically how many babies there were. I was working a night shift when a momma came from around the corner of her room and asked for a cervical check. As we laid her on the bed and pulled the gown back, the tiniest foot was coming out. Nurses scrambled to find her chart and it wasn’t until both babies were coming out that they realized she was only around thirty weeks. Each weighing less than two pounds they were just set in a warmer until being brought to the newborn unit and eventually both passed away. In the United States there are so many technologies and medications used to detect multiple fetuses, abnormalities and solutions for be able to carry the babies closer to term. It’s just another eye opener to the disparities of this area but also the strength and resilience of the mothers who give birth under these circumstances. I the pediatric ward also learned that there are no organ transplants within the whole country and those who are in need must make arrangements to travel to a different country. Specifically, there were two children in the POW ward that needed liver transplants to survive. One child’s family was fortunate enough to have the funds to travel and he was being prepared to leave for India where he would receive the new liver. Unfortunately, the other child did not have much family and traveling for the surgery was not an option, so providers were just making him comfortable with the time he had remaining. I had never heard of the term mob justice until coming to CGTRH. I learned about this when in accident and emergency after seeing patients come in who had just been brutally attacked. This is the result of letting the public handle discrepancies rather than the police getting involved. From stealing to fighting, looting and assault, the “mob” will get back at the person who was involved in the event by throwing rocks called stoning with the intent of killing the person. In extreme measures tires are put around the suspect so they cannot move or run and then lit on fire are stoned until death. If they are lucky at any point during these events, bystanders may try to help and pull them from eventual death, but this is just how some problems are taken care of. In the US there are also many injuries and death due to gunshot wounds, but in this part of the world there are more manchette attacks and stoning than anything else. This all was a little scary to see at first but just gives me a deeper look into the difference of a less developed and structured country. In accident and emergency, I was observing the intake side with some other interns while a patient to the left fully seizing. Not a single doctor or nurse came over, so we ran over, turned her on her side and protected her head. She was foaming at the mouth, barely breathing and seizing uncontrollably every minute or so. It took almost 45 minutes for a nurse to push meds, which the grandmother could not pay for, so another person did. This did not work, and she was given more an hour later. After about 2 hours a doctor came over and yelled at us to let go of her. It was extremely hard to see that she didn’t get the care she needed because money was a factor and the fact that doctors and nurses did not seem to care, they just stood around and did nothing. We all thought she was going to pass away, but two days later came back to find her in the ICU in a coma. I don’t know what while happen or if she will live but she was only 20 years old, and I pictured that being me. In labor and delivery, a mama had just delivered a baby girl. She was so excited and all she wanted was to hold and feed the baby. After talking to her for a little while this was her third child but the other two were both still births. It was so rewarding to see her happiness with this child, knowing it was most likely going to survive but also a eye opener learning that still births and complications during labor and delivery are a very common occurrence in the hospital. In addition to patient interactions, I enjoyed getting to know some of the doctors and nurses very well and hear about not only their role in the hospital but their background and details of the job. Schooling is somewhat like the United States as doctors are in school for 6 years, PA’s and Nurses have 4 years along with clinical rotations and shadowing hours. The main difference though is that students are taught the best way to learn is to do. The interns and students do much of the work and care while they are supervised by the higher ups. It’s taught during any skill or procedure that you observe one, do one and teach one. Once those three have been covered you do them on a regular basis, even without having full credentials. In conclusion to my internship and looking back at my experience as a whole I have expanded my knowledge and skills greatly and taken with me a newfound respect for the lives of everyone who lives here. Life may be hard, and healthcare may be scarce, but I fell in love this the fact the citizens of this country are so proud to call Kenya their home. Everyone was so warm and welcoming, and I never once felt scared or in danger. The experience and memories I have taken with me from this internship will last a lifetime and hopefully inspire others to follow in my footsteps.

IMA has provided me with an experience I can never forget. The staff went above and beyond to ensure my stay was perfect. They continuously provided me with comfort, support, encouragement, educational mentorship, and safety. The accommodation was consistently a welcoming environment and never failed to provide me with anything I needed. The IMA chefs were incredible and were always supplying me with incredible and nutritious meals. 12,029 Kilometres and 40 memorable days in the most welcoming country of Kenya. Never in my wildest dreams did I picture my future including a nursing internship in Africa and now I can’t imagine my life without this incredible experience. Nursing is my passion but my time with the International Medical Aid proved that my passion extends to underprivileged countries and communities. I have worked within the healthcare system in Australia for 3 years now and for the first time I have felt truly valued as a medic and saw first-hand the impact my profession can have on my wider community. My time in Kenya was extraordinary, I created connections from across the globe and became companions with many of the locals. I was provided with an incredibly opportunity to enhance my clinical skills, learn from exceptional practitioners and explore the impacts of diseases not seen in Australia. I completed rotations in departments I wouldn’t have been able to access at home including Accident and Emergency, obstetrics, paediatrics, radiology, laboratory sciences, internal medicine, surgery, and neonatal care. Interning with International Medical Aid has been a dream come true and I am beyond thankful for everyone who helped make this opportunity a realty. Kenya is immersed with so many cultures and during my internship, International Medical Aid provided me with numerous opportunities to learn and engross myself in the community. My time in Kenya solidified that I have never met a society as pure and genuine as that of Mombasa. Despite, its severe poverty, and disadvantages within political systems the people of Kenya never fail to smile. In addition to the classes on Kenya’s culture, I learnt the most about Kenya’s culture through my interactions with the locals. I will have long term memories of all these encounters, including my time in the Masai Mara community, Bombolulu, Mackinnon Markets, Shauri Yako Slum, and the Mombasa Cultural Centre. The opportunity I was given to explore these incredible communities allowed me to ask questions and understand how they ended up in the conditions they are in. It allowed me to see first-hand the impact of poverty on communities, the economy, and especially healthcare. It was refreshing to see many values within the Kenyan culture which I value as an individual, but are not fully appreciated in Australian culture, still being prioritised. Some of the values that were evident to me in Kenyan communities was their commitment to marriage and family, their respect for privacy and maintenance of religious traditions (Wandibba, S., 2004). As a vastly multi-cultural and multi-ethnic country it was very impressive to see that individuals within the Kenyan community were still able to practice their own religions with very little resistance. One of the key elements in my internship that really helped immerse me in Kenya’s culture was the amazing food. I was able to try many of Kenya’s well known Swahili foods such as Ugali and Chapti. I was extremely appreciative of IMA’s staff for providing us with the opportunity to try some of their favourite local dishes. Furthermore, participating in the IMA Swahili classes was incredibly enjoyable and allowed me not only ability to communicate but gave me orientation to my locations. I was able to read basic signs and notices that ensured my safety and provided me with relief. I thoroughly enjoyed learning this language and using it to play with kids in the communities and local schools. I have learnt an incredible amount about the healthcare system within Kenya and how it compares to Australia. I studied how the health clinicians have been trained to cope and adjust to circumstances beyond my imagine. Working at Coast General I was exposed to numerous amounts of diseases, conditions, and therapeutic treatments that were foreign to me living in Australia. The impact of HIV and Malaria was one that I severely underestimated going into this internship. I was not aware of the severity in which Malaria impacts Kenya, with three quarters of its population infected in 2022 (Githure, J., et.al., 2022). Malaria exacerbations were a highly common patient presentation at Coast General and it’s evident that despite Kenya’s increasing awareness of this disease without more sufficient interventions this disease will continue to progress (Githure, J., et.al., 2022). It became very clear to me early in placement at Coast General that my time there was going to be confronting and overwhelming, but an incredible opportunity to enhance my clinical scope to a completely new patient presentation. As a paediatric nurse I was expecting my rotation in the paediatric unit to be my most memorable week, but I was surprised when my time in main laboratory quickly became my preferred place. The Laboratory allowed me to learn brand new skills in the areas of Haematology, Chemistry, Microbiology, and my personal favourite, Histology. This rotation provided me with a incredibly unique view on healthcare. As a clinical practitioner I am used to seeing the patient and treating the symptoms of disease. However, in the laboratory there is no patient contact, which meant I got to see diseases and conditions from an investigations view which included the dissection and mounting of tissue samples. This has given me a new perspective on the way I treat and understand patients’ presentations and I am so very grateful for this newfound knowledge. It's no secret that Coast General is functioning on a very low resource income and it was evident that the staff working there are functioning hard to keep their patients safe. It was beyond impressive to observe the work that the healthcare practitioners were able to provide their community despite the circumstances they are working in. Learning from the nurses allowed me to understand how little we need to provide high quality care and they taught me how to utilise my resources to treat the greatest number of patients. 5 weeks working at Coast General no doubt resulted in many notable patient interactions, however I do believe that for me it was the relationships I formed with hospital staff that made my experience beyond incredible. Going into my final year of university there are many lessons from my internship that I endeavour to incorporate into my ongoing clinical practice. Communication and cultural acceptance are a significant aspect of health care that challenged me while working in Kenya. Due to the language barrier and cultural differences between me and my patients, communicating with these families was difficult. I struggled to provide adequate care to these patients as I was unable to gain consent from majority of them. After seeking assistance, I was taught keyways to approach patients of certain cultures, key words, and sayings to use to communicate effectively. Most importantly I was taught what values of patient care must be prioritised for certain cultures, religions, and genders. I was surprised at the difference in health seeking behaviours of women in Kenya compared to Australia. Women of Kenya were typically more resistant or hesitant to come to Coast General for support, compared to their male counterparts (Mochache, V., et.al., 2020). Whereas, in Australia that is reversed. Kenya is heavily impacted by socio-cultural norms and gender stereotyping which has had an ongoing effect on the vulnerability, behaviours, and attitudes towards women seeking healthcare particularly around reproductive health (Mochache, V., et.al., 2020). I am extremely grateful for the new insight I have into cultural and religious practice as it’s something that is not commonly taught in Australia, and I have in turn had very limited experience with these patients. As an aspiring travel nurse these newfound skills in communication are something that will be vital in my ability to travel the world and provide quality healthcare. The 5 weeks I spent in Kenya gave me so much more than just a holiday, I have learnt clinical and life skills that will be with me forever. The incredible hospitality of the country and IMA staff will never be forgotten. I am beyond grateful for the opportunity and cannot wait to use my newfound skills to make a genuine impact on my community and hopefully disadvantaged communities globally.

The last month in Kenya changed me. I can't describe the impact Kenya has had on my heart, and I will forever be grateful for the memories I have made that will shape the rest of my life and nursing career. I’m beyond devastated to leave because the staff, interns, and locals in Kenya welcomed me with open arms and fully immersed me into their culture, but I know for certain I will be back to rekindle my forever friendships! There are no words to sum up how incredibly thankful I am to have experienced the full beauty of Kenya and its incredible people. Thank you for bringing me perspective and shifting my mindset to encourage a better version of myself. ASANTE SANA KENYA and IMA for a once-in-a-lifetime experience. P.S. I'm gonna miss the food so much! A portion of my heart is in Mombasa, Kenya and it will travel with me for the rest of my life. Through the experience with International Medical Aid, I learned how to step out of my comfort zone and always strive to do and be my best no matter the environment or people around you. Not only did I learn more within the field of nursing and medicine, but I learned how to prioritize, think quickly, and adapt to any measures given. The biggest gift International Medical Aid gave me was the opportunity to meet lifelong friends. Not only did I bond with my fellow interns from IMA, but I also bonded with nurses and medical officers who work in Kenya. I sat for hours learning about the ins and outs of nursing and life in Kenya. To be able to compare our lives and acknowledge the differences and similarities between each other, taught me to be cognizant of others, what they have been through and how we are different, while connecting on what brings us together. I feel beyond grateful for the people I met in Kenya. From their welcoming attitude, laughing at nursing school teachers, going to dinner, talking about relationship issues, fun gossip and serious issues, we built forever friendships. From worlds apart that are completely different, we always connected on the same things. Our differences made our relationship beautiful. Through my nursing career, I promise to acknowledge the difference between me and others, and celebrate them, instead of allowing that to create distance. I now understand the value of immersing myself in someone else's culture and learning from the people and experiences. It allows you to learn so much more than any textbook can teach you. My experience in the hospital from a medical perspective was beyond eye opening. I loved seeing how patient’s family members took the role of the nursing assistants, that we have in the United States. It showed how they value family and the Kenyan culture of love and hospitality. I learned from my fellow colleagues the importance of resourcefulness, as in using gloves for tourniquets, saving gauze and open sterile gloves if unused, hanging IV’s off of windows, and sharing beds for infants if need be. Healthcare for everyone stems from the same place, no matter where you are, with whatever resources are around, the end goal is always the same. Watching Coast General nurses and doctors eventually get to the same desired goal encourages me to be less wasteful and to realize how much extra resources we have in the United States. I found the hospital experience to be so inspiring. It drives me to root my career in serving under-sourced countries. I hope to use my education and ability to provide care communities that have little to no resources. Shadowing and working alongside the most knowledgeable people, gave me so much valuable information on global health, specifically in Kenya. Their dedication to Kenya while working in unbelievably challenging work environments, is both motivating and inspiring. These working conditions were elaborated on during one of the lectures so I was able to start to understand the depth of their overall healthcare issue. Due to these conditions, I took note of the lack of empathy given to the patients, sometimes I noticed Coast General staff be very apathetic towards patients. For example, working in labor and delivery, I reached out to one of the mothers and touched her shoulder and said good job mama after all the nurses has been screaming at her, and she squeezed my hand and started to cry. I took so much away from that interaction, the simple act of kindness made such an impact on her. Allowing her to be vulnerable during a very difficult time. It motivates me to continue to lead with empathy and kindness toward all my future patients. Being able to see the epidemic of infectious diseases in comparison to the United States, where we have an epidemic of chronic diseases, allowed me to take a step back and realize all the things I can improve in my own community, as far as illness and community outreach. It seems that the reason Kenya has less of an issue with chronic disease is because most people are not living sedentary lifestyles and/or eating a westernized diet. Dr. Shazim lead a lecture of “Disease Burden in Kenya” which taught us why we were seeing the communicable disease we were seeing at Coast General but also about the uprising epidemics of poor mental health and chronic issues like “cardiovascular and metabolic disease including hypertension, diabetes mellitus, congestive heart failure, and chronic kidney disease” (Shazim, slide 4). Mental health being a scary issue Kenya faces with only fewer than 500 mental health specialists to serve over 50 million people (2021, Marangu, E). One of the most mind blowing aspects of my internship in Kenya is the lack of health literacy of the common citizen. For example, if anyone in the United States saw someone giving CPR they would know that the victim is in a very unstable condition and all measures are being practiced to resuscitate that person back to life. Yet, in Kenya when CPR was given to a very young infant, I watched the mother have almost no reaction. I was so confused and I Sniderman had to step back and realize she didn't even know what the doctors were doing, she just assumed the healthcare providers were helping her young son. Soon later they turned to her and pronounced him dead and then she had a surprised and devastated reaction, as she had no clue that CPR was a procedure used when someone is close to death. This was shocking, in fact it really made me reflect on the importance of patient teaching. The reason I was able to identify the issue of health literacy with this woman was due to one of the lectures during my first week. In the lecture “ The Current State of Health Care in Kenya” given by one of the amazing IMA staff members, they had mentioned one of the biggest systemic issues in Kenya on why people are not getting the healthcare they need was due to health literacy (slide 40). In nursing school they harped on how you must teach everything to your patient and watching the lack of patient education and general health literacy made me incredibly aware of incorporating that heavily into my career. Not only was the hospital a valuable place to grow my education, but I found the lectures and treks added a lot to my overall experience with all of the community outreach opportunities. I was able to fully understand the differences between our countries. One of the many highlights of my stay in Kenya was outreach to the schools. One in particular, where we helped to educate children on hygiene and women's health, was a highlight. They were so warm, welcoming and excited to learn everything we were explaining to them. I have never felt so much love and gratitude from people in my life. They were eager to learn and they valued the time we spent with them as much as I did. I truly have never smiled so much in my life. I learned so much about healthcare throughout my time in Mombasa, but more than that I learned the value of a smile, a hug, a compliment, patience, and understanding. Asante Sana Mombasa and International Medical Aid. I’m going to continue to work hard so I can come back to Mombasa and rekindle my friendships as well as give deserving healthcare to the beautiful people of Kenya.

International Medical Aid has completely changed my life. I wish I could put into words just how impactful this experience has had on my life because I want everyone to know what an incredible journey this past month has been. I've never felt more welcomed, safe, and accommodated in a foreign country so far away from home. The staff were absolutely incredible, and I can't thank the kitchen and housekeeping staff enough for their services (I have a new love and appreciation for African cuisine!). The program was very organized and there was always something to do and explore. The mentors did a phenomenal job with getting to know each and every intern on a personal level, and encouraging us to participate in all the planned activities. At the hospital, I learned more than I have in my entire time at school, and I have never been more solidified in my passion for nursing. I also appreciated how involved IMA is in the communities around Kenya, and I realized how big of an impact we had when participating in clinics, donating to orphanages, and supporting local attractions. I could go on forever about how phenomenal this program is and I will look back on this experience for the rest of my life! What have I learned from my internship with International Medical Aid in Mombasa, Kenya? That’s a question I love being asked, because there is no end to my answer. I have learned more in this short month than I ever have in my entire nursing education. But before I acknowledge the question, I would like to give some context of my life before embarking on this once-in-a-lifetime experience. It was early January and I had no idea that I would be spending a month of my summer in Mombasa, Kenya. I was stuck in my comfortable routine of going to clinical at the same time every day, at the same hospital, treating the same kind of patients. I always knew that I had such a strong passion for nursing, but I often found myself asking, was this it? Am I able to become the best nurse I can be if I solely stick to what is familiar? By February, I was itching to get out. I had an overwhelming desire to push myself so far outside my boundaries and experience something, anything, different from my life in Omaha. I did some long and hard searching, and when I heard about International Medical Aid, I immediately started gearing up for the journey of a lifetime. Now back to the question, what have I learned from my internship with International Medical Aid in Mombasa, Kenya? The very first thing I learned was how to adapt to unfamiliar places. This was a continuous lesson over the past month, as I entered new places and situations that required me to adapt my attitude, beliefs, and way of thinking. When I stepped foot into Coast General Teaching and Referral Hospital for my first shift in the emergency room, my stomach dropped. Seeing the people line the hallway to the entrance and sheetless beds overflowing with multiple patients, I knew that this was far from my familiar hospital in Omaha. I was overcome by a mixture of sadness, fear, excitement, and anxiety, and questions piled in my head. Immediately upon entering, I teamed with a nurse and two Kenyan nursing students and began to help with what I could. I remember standing at the nurses station getting report from a doctor, when I turned around and saw a child getting CPR by a single nurse. I searched all around me in a panic to see if anyone else was going to help, if materials were being fetched or if parents were being consoled. But it was just the singular nurse, quietly trying to rescue this child’s life while other patients, doctors, nurses, and families went about their days. I was horrified, and rushed over to help. Tears pooled in my eyes and my hands quivered as I held my flashlight over the child’s face. I looked around again to see if anyone was coming, and heard the nurse mumble that we needed adrenaline. No one heard. I yelled, “we need adrenaline over here!”. No one came. I was distressed at this point, confused and frustrated by the lack of urgency and wondering why on earth this situation was not considered a medical emergency. After about 10 minutes, the nurse called over the doctor to pronounce the time of death. I was frozen. Everyone had already moved onto the next patient or next task, and I stood there unable to move. The nurse I teamed up with grabbed me and brought me into a back room, where I hysterically let out tears of anger, confusion, frustration, and sadness. After comforting me and giving me time to grief, I remember her saying, “Caroline, this is the harsh reality of working in this kind of environment, so how are you going to adapt? You can either learn from this experience or it will eat you alive”. I’ve never needed to hear those words so badly in my life. In that crisis, I was expecting a team of healthcare workers to come to the rescue, with a crash cart filled to the brim with every medication and tool you need to save someone’s life. I assumed that the norm in which patients are treated back in Omaha is the same as in Kenya. From that point on, I adapted both my mindset, beliefs, and thinking to my present environment. I recognized how different our healthcare systems were, and used that knowledge to create new solutions to the problems I faced. I learned how to not disregard, ignore, or depress the rollercoaster of feelings I felt along the way, but rather feel them to the full extent so that I can move on to the next patient without carrying the weight of others. This experience has shocked me into the reality that there is no place that will be exactly the same as Omaha. Throughout my nursing career, I will encounter a variety of different work environments, situations, and patients that all require and depend on my ability to adapt. In nursing school, we are repeatedly taught the importance of cultural competency. We have numerous simulations and case studies that test us on our ability to care for patients of different races, religions, and backgrounds. But, despite how much stress my school puts on this aspect of nursing care, I have never actually had any experience treating a real patient that is not caucasian and catholic. Interning in Kenya was my opportunity to expand my knowledge and learn how to adjust my care for the well being of every patient. I not only learned how to perform skills on darker skin, such as finding veins or identifying discoloration, but I learned about the Kenyan culture and the beliefs, values, and practices that are seen in the health care setting. I was in the labor and delivery ward, when I really learned about the different Kenyan tribes and how their individual practices are respected within the hospital. It was shocking to me when I saw young women giving birth to their third or fourth child. Such women were often found to be in polygamous marriages, where their husbands stayed at home with the other wives. The Muslim religion was also very common, and I learned about why some of the women requested private prayer time throughout the day. The most surprising thing that I noticed was that childbirth in general is not typically experienced and celebrated as a joyous or exciting event in one's life, unlike in the United States. It was very difficult at first to set aside my own beliefs that I had about childbirth and I had so many questions about why and how it could be so different from back home. I was tested to self reflect on a much deeper level so that I could provide the best level of care and respect to each woman. This experience has allowed me to broaden not only my perspective of other cultures and religions, but also my competency and ability to care for such patients. I’ve learned that cultural competency is an ongoing practice of health care with no limit of improvement and something I will continue to work on in my nursing career. At the beginning of every day at the hospital, all the IMA interns would scatter to the wards they were assigned to and shadow the head doctor, surgeon, or clinical officer. In my cohort, I was only one of three nursing students, so it was up to me to scout the nearest nurse that was willing to let me tag along for the week. I not only had the privilege to get to know all the wonderful nurses who worked vigorously to care for each patient, but I also became friends with many of the Kenyan nursing students. A new group of them would circulate throughout the ward I was assigned to, and we would quickly become friends after bonding over the hardships that come with nursing school. I felt so drawn to these students, not only because we were the same age or that we were all still in school, but because their perspectives on health care and being in the hospital were so different from mine when I first began clinical. I remember being hungry for opportunities to practice my skills, would give anything to see the most interesting cases, and focused much of my time on finishing my paperwork rather than speaking with the actual patients. On the other hand, the Kenyan nursing students were some of the most composed, smart, kind, and respectful people I’ve ever met. They preferred to respect privacy and tend to other patients than to sit and watch family break down during a medical crisis. They often were cleaning, taking vitals, fetching supplies, or comforting a patient rather than fighting over who got to insert the next catheter. I truly looked up to these students. I not only learned about the kind of nursing student I want to be in my last year of school, but I learned about the kind of nurse and person I want to be overall. While there was not much they could do to assist medically, they showed me just how far compassion and respect can go in such a high demand and high stress environment. They showed me that simply taking the time to change the sheets and make the bed of a patient who had been there for weeks can actually make their entire day. They showed me how just sitting down and listening to a patient can make them feel safer, more relaxed, and a little less lonely. They showed me that by being kind and loving to everyone they encounter can make the hospital a more hopeful environment. I will always value how influential these students and nurses at Coast General were to me and how they helped shape the kind of nurse I want to be in the future. International Medical Aid has changed my life forever. Five months ago I felt like something was missing in my life and forced myself to do something completely different and outside of my comfort zone. Now, I look back and think why I hadn’t done something like this sooner. I will take all that I’ve learned and apply it in every aspect of my life, because Kenya has changed me in more ways than I ever thought. The friends I’ve met along the way, all the IMA staff, and the patients I’ve cared for will stay in my heart forever and remind me of exactly why I want to be a nurse in the first place. This is who I am meant to be; someone who loves, cares, and serves others that are in need. Thanks to this incredible experience and International Medical Aid, my passion for nursing has never been stronger, and I have felt called to declare my specialty in pediatric oncology!

I enjoyed my time in Barcelona very much. I was ecstatic to get there and start. When I first started it wasn't exactly what I was expecting. Nonetheless, I enjoyed every minute of it. I have made some dear friends. I can say I will be back in Barcelona. I would recommend Adelante. Without them, none of this would have been possible. Spain in general is beautiful, but Barcelona has to be my favorite. It has everything. From mountains, oceans, beaches, forests, etc. They have the cold, breezy weather and the hot, humid weather.

This was an experience of a lifetime. The treks were amazing and I learned so much about Kenyan culture and history. The hygiene clinics left me smiling. The kids were so happy to see us and they were so fun to teach and play with. I felt like I was helping these kids by reinforcing their knowledge and answering any questions they had. It left me feeling warm and fuzzy inside. Being in the hospital can get difficult emotionally and mentally. Observing taught me a lot and motivated me to work harder to get my nursing degree. When things got hard, in the hospital or outside, I had so much support from the mentors. I absolutely loved the mentors as well as the staff. They were so sweet and could always put a smile on my face. The food never disappointed either. They were very accommodating to those with restrictions and every Friday night the staff did big and amazing BBQs. I loved every moment of this trip.

From the moment I stepped off the plane, I received a warm welcome from Javan and the other program staff. I always felt at home and created friendships with the drivers, kitchen staff, housekeepers, maintenance, guards, and administration. I was comfortable asking for support when needed, but I rarely had to do so. My living situation was great and every single meal was incredible. I never felt unsafe because Sofie and Austen were at the gate at all times, and the drivers always made sure we got to different locations safely. I am still reflecting on my experiences at the hospital. It was very challenging. I saw many things that I felt were unfair and not right. At the same time, it was rewarding, and I am grateful to have been exposed to the Kenyan healthcare. I've learnt that it's very political, the disease burden plays a large part, and hospital staff have to be resourceful. I am also glad to have had the opportunity to participate in community outreach. Although we interact with patients in the hospital daily, it is nice to see and interact with children and adults on the outside. This internship as a whole has increased my desire to be a part of healthcare and work in underserved and low-resource areas. I hope one day I'm able to return.

My time in Kenya gifted me with some of the most heartwarming memories and valuable experiences of my life. Under the guidance of my fellow interns and mentors, I learned important skills and lessons that I will carry forward into my nursing career. I am so grateful to all of the doctors, nurses, and midwives at Coast General who allowed me to learn alongside them. Many of the lessons they taught me went beyond the hospital, instead focusing on how to truly impact patients' lives. Beside hospital hours, my time spent at local clinics and schools taught me the importance of humility and patience. It showed me how a simple act of kindness can have lasting affects on someone's life. The staff at IMA worked diligently day in and day out to make Kenya a second home for the other interns and I. Every aspect, from cooking to safety, was planned out to ensure we had a good experience. Their kindness and support made for a better experience than I could have ever dreamed of.

My time in Ecuador with Adelante Abroad was an unforgettable experience that fulfilled all of my hopes and expectations. Despite being much more affordable than other programs, the services provided 2 meals a day, personalized internship placement in the field of my choice, accommodating housing in a safe and accessible neighborhood of the Ecuadorian capital, one on one Spanish classes at the beginning of my stay and multiple personal resources in Quito that I could reach out to with any concern or in case of emergency. In addition to exploring the city, the affordability and flexibility of the program allowed me to visit some of Ecuador’s most popular destinations including Cotopaxi, Mitad del Mundo, and Baños. I was also able to easily plan a trip to the Galapagos to add on to the end of my program which was truly an incredible experience. For my internship I was able to communicate professionally in Spanish while working directly with locals to address issues negatively impacting vulnerable communities. As someone who was unable to study abroad due to COVID, I am immensely grateful for this internship that allowed me to augment my Spanish communication, work experience, and confidence and to visit so many amazing places.

This experience opened my eyes and my heart to the world around me. Even though there was so much loss to be seen, it was accompanied with determination, grace, and fearlessness.These qualities could be seen through the eyes of the several healthcare providers around me and it only made me inspired to dance in the face of my fears and not let circumstances limit me. Most importantly, I learned to make the best out of everything and to be discouraged from any hardship I face, but rather embrace it and move on. As long as I keep knocking, a door is bound to open. I know now that if I look closely through the rain, I’ll see sun glow. " “Live life simply” is the first phrase that stuck with me while on my first flight to Kenya. Although I have heard this phrase a multitude of times prior, it carried a little more weight to it this time around. Whenever I travel, I always like to converse with individuals who have the same nag to talk as I do. The man who said this to me was a man on his way to Rome, newly retired, and immensely excited. Beginning from that engagement forward, I made sure to journal everything that caught my eye and ear. The journey began in the airports—before the destination—through conversations with people who came from all over. Specifically, an older gentleman Daniel I met in Frankfurt, Germany. I started talking to Daniel due to baggage issues and discovered that he was flying back to Nigeria to return to his wife and the two orphanages they own together; after informing him that I was adopted myself from Russia and was headed to Kenya, he immediately exclaimed “God bless you, for you are doing amazing things” to which was proceeded by the exchange of emails and departing to our separate ways. A year ago, if someone told me that I would spend my next summer in Kenya, I would have a tough time believing them. I have always wanted to travel to Africa and Asia, primarily because of the drastic cultural differences and the abundance there is to learn from in both places. No matter how much I read on the places I have never been, I knew it to be true that I would never utterly understand it unless I experienced it for myself, once and for all. Landing in Kenya immediately put my imagination of this country to rest and allowed me instead to simply be and embrace where I was. The first thing I noticed was the beautiful palm trees that surrounded the airport and how I was welcomed with open arms by the customs staff as I was getting checked through security. I wondered if everyone was this welcoming at the time, for I was honestly unsure of what to expect; but looking back now, no matter where I was in Kenya, I always felt welcome. On the numerous drives taken during my time in heart of Mombasa, I was cognizant of everything—paying special attention from the buildings to the various personalities strolling across the streets and how the town was separated between the old and the new. Every hospital ride, I saw something new: a walker strolling in between two moving trucks with no hesitation, an older gentleman working hard under a tin hut carving wooden statues, four children riding a single motorbike on their way to school, and three men pushing a wheelbarrow on the side of the road—one in the front, two in the back. Taking in not only the interactions I had personally but also the physical place where I was in that second allowed me to constantly feel present and take notice of all the radiance in Kenya, including the individuals who I did not have the privilege to talk to. Along with the radiance of course came the burden of poverty displayed in the city. One of the first things I learned when I arrived was that 40% of Kenyans live below the poverty line; “below the poverty line” equates to less than two dollars a day (Odhiambo, 2019). In the city, individuals can be seen with no shoes on and torn clothing while surrounded by buildings that are just not upkept. No literature or videos could have prepared me for the first-hand experience of no traffic lights and extraordinarily little signs or markings on the streets. Every day, I was in awe at how the walkers, bikers, cyclists, and motor vehicles all shared the same roads in some areas, with no distinction for sidewalks. Given the fact that a massive chunk of Kenya’s population is indubitably tight on income, it reinforces my mind to remember that going to the hospital is expensive, even if the consultation at Coast General Hospital is much lower in price compared to a private hospital and arguably more than reasonable to someone who is used to the United States’ cost of healthcare. Throughout my days at the hospital, I often begged the question, “why do people wait so long and let their condition get severe rather than going in sooner?” to finally one day have it hit me that the reason a family may not eat that night is the very consequence of that two-dollar consultation. Putting this in perspective lead my brain down a path of questions, each one leading to the next. Eventually with time, a bigger question grasped my thoughts over all others—taking precedence in my mind. That question was this: if there are this many people suffering in front of me due to limited income and resources, can my imagination even grasp how many people pass away without even stepping foot in a hospital due to income restraints? Spending the vast majority of my life in the States with a financially stable household granted me the privilege of not having to worry about necessities and although I argue that I am an open-minded individual, I also recognize my shortcomings; specifically, my lack of awareness on the ways of life for varying populations around the world. I never had to worry about Malaria nor Cholera back at home, meanwhile those two diseases are seen often in the hospital. Additionally, I never had to worry about drinking contaminated water or going to a hospital that may not have the staff at the time to treat me. It never would cross my mind that a hospital would be anything less than sterile and well kept, forgetting that funding for public hospitals can be minuscule depending on the place. These things were overlooked by me back in the states and as I reflect now, I notice how much privilege I possess that I was not even aware of. Observing daily rounds in Coast General Province Hospital in various units in addition to hearing fellow interns’ stories from their shifts enabled me to learn a substantial amount in the three weeks that I spent there. My first week was spent in the neonatal unit (NBU) of the hospital and I was able to work closely with the doctor as well as two medical interns who were also shadowing him around the unit. Several incredible cases came out of that week, and I am immensely grateful to him; he always made sure we knew what was going on, each baby’s case was discussed for at least fifteen minutes. He took time after rounds were complete to allow us to share what we had learned in addition to asking him questions or asking him to elaborate on a case further. Two of the cases that stuck out the most to me were a baby with a neural tube defect and another baby born with gastroschisis. These two complications as well as other common complications that babies were born with like jaundice are most often preventable with proper nutrition for the mother. Because pre-natal care is not a commonality in Kenya, a decent number of babies born that I observed were malnourished, resulting in some type of complication causing the need for admission into the hospital. Around 26% of children under the age of 5 in Kenya are stunted and around 11% of children are underweight (UNICEF, 2017). A lot of defects seen in babies admitted to the NBU would be considered avoidable with proper pre-natal care. Although this does not affect me personally at my age, it bothers me deeply for the simple fact that malnourishment should not be an issue globally this day in age; malnourishment is something that could be fixed, it is not a disease that scientists do not have the answer to, so why aren’t we doing more? This is a major point I took away and ask myself “why does it have to be this way?” frequently. Food inequality needs to be addressed and should not be treated as another unanswerable burden that people need to suffer with. One day I had arrived at the NBU earlier than the doctor and decided to see if any of the nurses could use an extra hand. In this time, I became close to the head nurse or “boss” as the doctor would call her. She was incredibly kind-hearted. She opened up about herself which then got a few other nurses talking and eventually the conversation led to the question of if I had ever washed a baby before and if I would like to. Of course, I jumped at this opportunity. As I was gathering materials, I sped past the doctor and happily exclaimed “I get to wash the baby!” The head nurse supervised me through the full process of carrying, washing, and drying the baby; afterwards, I was able to introduce myself to the mom and found out that the baby was admitted due to the possibility of infection from birth. I got the great news that the baby was set to be discharged in the next day, and after seeing so much death in the unit over the past couple of days, I was over the moon. Although this experience is nothing groundbreaking to some, it was nothing short of everything to me. International Medical Aid offered many opportunities in the weeks I was there, and I made sure to take all of them. Similarly, each unit of the hospital I rotated through offered numerous lessons, I just had to listen. The emergency room was no exception, and I am happy to have taken all the afternoon and night shifts possible in this unit. Being able to get this much time in the emergency room was amazing since emergency medicine is what I have a primary interest in, along with medicine practice abroad. There is one case specifically that circulates my mind frequently, and this case was on my second night shift. In the emergency room, there is never a dull moment; I got to shadow doctors taking care of inmates with diabetic ketoacidosis, patients expelling bodily fluids, screaming individuals, plus several other types of cases. There are limited resources in combination with limited staff and these factors both contribute to the challenge medical staff face of trying to provide the best quality of care possible; but from what I saw, they truly tried making the best of what they had around the clock. As I walked in the front trauma section of the emergency room, I saw a patient bleeding from the ears, a patient with a blood pressure reading of two-hundred twenty-two over one-hundred eleven getting treated, a man with a belly as enlarged as a nine-month pregnant woman, and an old lady who looked severely malnourished. I walked around taking it all in while helping where I could. After taking a few vitals and grabbing supplies for the nurses, I listened to what the doctor had to say about a few cases and read over some charts. After some time, I made my way over to the minor theatre, where surgeries that do not require anesthesia are performed. In the minor theatre is where I met a little girl. She was currently getting examined by the doctors at her leg and was crying. As I approached her bed, I saw her whole Achilles tendon and gastrocnemius muscle exposed. Seeing such a thing is shocking and intimidating to say the least; after reviewing her chart, I quickly noticed that she was on no pain medication. Pain medication is too expensive and not often given in the hospital but for a case like this, I was not prepared. Not to mention that she did not scream, she just cried like many other cases where I would expect people to be screaming their hearts out. I stood there just watching the nurses wrap her foot up while I myself could not move, for my soles were firmly planted to the ground. It was at that time I had decided I would not leave her side. After she was relocated to the main room of the unit, I got to sit down and talk to her mom for a bit, and she explained that the cause was a motorbike hit-and-run and we discussed this in addition to her daughter’s hobbies and school friends for a while. After they fell asleep, I continued rounds until it was late into the night when I circled back around to them. The little girl heard me and put out her hand, leaving me to stand by her bedside where I held her hand until it was time to go that early morning. I learned early on that you cannot get caught up on every upsetting case you see. Just because I am aware of this does not mean it was easy. From the first time I saw a dead baby in the NBU to now, it never became easier; I just was able to temporarily move on a little less hesitantly by this point. I remember the doctor in the NBU stating casually “that baby seems to be dead for a while now, but we can still attempt compressions” and after attempting CPR for a couple of minutes, he quickly continued with rounds. This experience paralleled what occurred in the emergency room. Patients often passed away and it was not made into anything bigger than what it was: reality. As I previously mentioned, the hospital had limited resources and the emergency room displayed this everywhere you turned. Since all wall monitors were broken, nurses were stuck with wheeling around a single portable defibrillator to take vitals. Let me be clear: all doctors and staff work tirelessly to provide the best care they can, but death was often indirectly affected by the limited resources available. One night, I witnessed this first-hand: an older woman passed away because her vitals were not being monitored continuously; when a sudden drop in her blood pressure occurred, no monitor was in place to alert the staff and therefore she passed away. Seeing death so frequently was difficult to get used to, and I often grieved for the mothers of the babies that passed and older patients themselves who did not make it. Even though doctors seemed hardly affected, I understand that this is just their everyday reality, and I know they are consistently putting their best into every patient. The only way to continue giving their all is to move on during that time. The doctor on one of my night shifts was an amazing person who I was able to learn so much from while I worked with him. He helped me understand the trauma and violence he sees the most. He expressed his concern for safety on the street due to the number of assault cases that come through the doors over the span of a single night in addition to motor vehicle accidents. He progressed the conversation into the topics of the GCS scale, how to assess trauma, one patient who had a stoma ruptured colon, a possibility as to what was causing a young boy to have uncontrollable seizures, and another patient who came in with a breast lesion. Knowing that he sees plenty more than I could fathom and is still positive and graceful made me feel all the more grounded and content. There was not one person who I walked away from after a conversation and was unable to gain a new perspective from. Everyone gave me insight, whether that be a doctor, a nurse, or a child that I talked to when visiting their primary school. Not only did this internship enrich my knowledge entirely on the different practices of medicine in a new country but it also enriched my knowledge on life lessons. A lot of life lessons and philosophies I carry with me originated from books that I read or word of mouth before traveling here. My two main philosophies are to expand my knowledge and therefore increase my contact with the unknown (what I do not understand) and to lessen the suffering of others. Although I was unable to provide pain relief to the little girl in the ER through medication, I tried my best to keep her distracted and entertained while awaiting surgery; between drawing on paper, playing SpongeBob on my phone for her, and talking to both her and her mom, I put all my effort in that moment of keeping her smiling. Treating each patient as a unique case rather than letting your mind be swayed by assumption is one of the most important takeaways that was stressed rigorously here in practice. The most prominent example of this was during my time in the ER, distinguishing patients who displayed symptoms that were found in both diabetic ketoacidoses. There are ways to distinguish between the two but the easiest way to determine which one a patient has is by testing the blood ketones and following protocol from there. Treating each patient as an individual was also stressed away from the patients during staff board meetings. Whenever a hospital board meeting took place, I always tried to sit in. The one that I recall vividly was on the topic of mortality in the NBU. I clearly can recall the doctors and the cases discussed because it triggered an enormous uproar. The first problem was the staff was just listing numbers rather than providing the statistics—the main picture—of what was going on. When one wants to make an analogy—a conclusion of one aspect based off points of commonality between two or more similar things— you need trendlines to base a claim on, not raw data. The head supervisor was furious due to zero critical analysis of the data being performed; some cases discussed also got him upset due to mistakes made that were avoidable, the wavering quality of treatment, and excuses being made on the spot for it. After several workers were flustered over the words that were spoken, the supervisor asked the question “was this death avoidable or unavoidable?” after every case and many times, although hard to admit, the death was avoidable. An example of this was a case of a patient with hypoglycemia, chronic liver disease, among many other diagnoses. The cause of death, the doctor proclaimed, was hypoglycemia, which is what initially set off the head supervisor, as hypoglycemia is not a reasonable cause for death when the patient was admitted for over a week already. Coast General Hospital is a referral hospital, causing the mortality rate to be elevated in comparison to neighboring hospitals because Coast General Hospital takes on more complicated cases which directly corresponds to the increased mortality rate. From this board meeting, I took so much out of it and reflected that night on everything that I heard. I hope to build from their experiences and mistakes, so I do not repeat what I know does not work. Once again, let me be precise in my words when I say that Coast General Hospital is a great hospital with impressive patient stats such as the average annual outpatient visits of 240,000 people (Coast General Teaching and Referral Hospital, 2019). Of course, I will make mistakes, and of course medical professionals everywhere make mistakes, for we are all human; but this will remind me to be more precautious and precise in the future rather than unsure. I will be sure to keep the lessons in my head so that I learn from them and have the capability to catch my mistakes early, should I ever slip. Another place I found myself reminiscing about when I asked myself what experiences had shaped me during my time in Kenya was certainly the hygiene clinics. My first one was at a primary school nearby. It was downpouring that day and we got to discuss menstrual periods with the girls who attended that school. After a couple minutes of discussion, the students began to open up and we got to answer all their questions. It was an amazing experience where the kids just clung to you wanting pictures or to talk further. I was touched at how welcoming all of them were and how happy they were to have us visit; it was truly a once-in-a-lifetime experience. I found beauty in the town of Mombasa and the culture in which I was fortunate enough to be engulfed in. The hospitality from everyone was overwhelming and left me reminiscent of all I had seen and experienced. It is not the easiest of lives living in Mombasa for most and yet from what I had experienced, that did not deter anyone from being the most friendly and outgoing individuals. I was fortunate enough to be invited to a patient’s house with a friend since she was thankful to us for keeping her company in the maturity unit as she was giving labor. The extraordinary experience of going to her home, meeting her family, having a feast of ugali and vegetables as well as getting to hold the newborn was nothing less than an honor. Exploring old town and new town, walking through the parks and shops where people hand made all types of art, attending morning prayer at a local temple, and strolling around all the natural scenery on the outskirts of Mombasa offered me a perspective which in turn revealed a new dimension of beauty. People with varying beliefs all living in one city, hearing prayer broadcasted over all the buildings, and the persistent feeling of welcoming was unlike anything back at home and utterly left me with a feeling of melting tenderness. This country is referred to as the Cradle of Mankind which I was not aware of until I learned it during my visit (Odhiambo, 2019). After spending three weeks there, I believe the name fits like a glove on the hand that is Kenya. Learning about all the history of pre- and post-colonial Kenya as well as the burdens that plague the country up to this day, it displays how strong the wills of Kenya’s people are and have always been. I was always inspired from what I saw daily whether it was the strength of someone pushing a massive cart down the road or the quick decision a doctor would have to make on the spot; this kept me aiming to be a better, more open-minded, individual myself. Whenever I had free time, I tried to practice Swahili just so I could connect with the patients some more and it was a beautiful moment when a patient looked at you and understood that you were trying your best to connect with them. I always had a feeling that I wanted to practice medicine abroad as I began college, but this experience has confirmed it. I get great pleasure out of learning new languages, and I clearly remember a conversation I had with one doctor during my emergency night shift. It was on the topic of reading and how he and I are both avid readers. I told him about all the books I have read and how I am on a mission to learn as much as possible in every way, not just in medicine. He informed me that I should learn Arabic, as many terrific books are written in that language. We built off of each other on how certain things just do not have a direct translation and being able to absorb these things in their mother tongue provides more insight than the most effective translation could give you; after all, a translation is someone else's interpretation of the words. Later that shift, there were a few quiet moments in the emergency room, so I decided to pull out a book. He looked over and asked, “What are you doing?” to which I replied, “I am understanding.”

I know- it's cliché- but Adelante Abroad was truly a life-changing experience. Leading up to, and throughout the entirety of my trip, Adelante's staff was exceptionally supportive and well organized. Every step of the way, I knew exactly what I was getting into. I always felt completely prepared. As far as Ecuador and my actual internship goes, all I can say is WOW. Don't get me wrong- I had my challenges, but my internship, albeit short, provided me with newfound education and skills I could have never gained in the states. I had the opportunity to learn from highly-knowledgeable, highly-skilled individuals every single day. When I wasn't working, I was fully immersed in the Ecuadorian culture. Somedays that was simply cooking with my host family and other days it was hiking Rucu Pichincha. All in all, come time to leave, I just... didn't want to go home. At the moment, I'm getting back into my daily routine. While it's strange not to wake up in this beautiful country I called home for 2 months, I feel that I've grown into an individual who my younger self would be proud to know. I thank Adelante Abroad for that.

I have had a great experience interning abroad with a civil engineering and architecture company. My hours are flexible, allowing me to take time off to show my parents, who visited me, around the city, and enjoy a long weekend at one of the many beautiful places in Ecuador. My host family has been incredible! My host mom has helped me drastically improve my Spanish speaking skills, cooks delicious traditional food, and provides insight into life in Ecuador and where to visit. I have spent every weekend visiting somewhere different and exploring the rich culture of Ecuador. This experience has been life changing and I cannot wait to return to Latin America.

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 I was 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.