Biology Internships in Ecuador

My experience in the Galápagos was definitely one of the best of my life for several reasons. I lived with a family, which allowed me to share in their daily life and learn about their eating habits. By working on farms, I was able to understand the challenges the archipelago faces with its agriculture (especially the lack of fresh water) and see how they are addressing them! I also spent a lot of time exploring Santa Cruz and other islands with their magnificent landscapes and unique wildlife. it was incredible for me to move around the island and randomly encounter a giant tortoise or groups of marine iguanas. I am grateful to everyone I met there for being so welcoming; it’s an experience I highly recommend!

I lived in the community Nueve de Junio, Sacha Waysa, for one month. It was such an amazing experience, I got to really connect with the people in my community, learn a lot from their experiences, travel around Napo and meet others, and make a lasting connection with everyone I met. I hope to go back at least one more time in the next year (maybe during the fruit season) because of how close I got with my host family. I learned a lot about the land and Ecuador in general which was great, and Im glad Im still in contact with my hosts because I miss them already.

Beyond Travels allowed me to feel comfortable and confident while taking part in a fun, exciting, and powerful cultural immersion experience. I spent my days in the Amazon living and working with farmers tending to their sustainable agroforestry systems. I learned about the ecology of the region, their successful regenerative practices, and also their struggles. I made lasting connections with my host family, as well as other community members and interns I met during my time in Ecuador. Beyond Travels connected me with other communities working on similar projects in regenerative agriculture and tourism, giving me a broader view of what it's like to be a farmer in the Amazon. I also got to take part in unforgettable activities like rafting, hiking, and swimming in my free time, while also exploring the local shops and restaurants along the way. Beyond Travels allowed me to have an unforgettable experience while keeping me in constant connection with multiple guides and mentors so I always felt safe and comfortable. Thanks to them I made so many great connections with the community and I feel like I have a second home in the Amazon!

I cannot recommend this internship highly enough. The host family I stayed with was so welcoming and really made me feel part of the family. Everyone in the community was so knowledgeable and open to teach me as much as possible, from local wildlife to the workings of their Chakras (permacultures). It really opened my eyes to new possibilities for sustainable agriculture, ethical tourism and safeguarding of biodiversity and local culture/knowledge. All the planned days were a lot of fun, from white water rafting to seeing an apiary with stingless bees and vanilla production. Tena is also one of the most special places I have been to, with great food, a fun nightlife, all while being in the Amazon rainforest, with Cafe Tortuga an amazing hub to get to know a vast array of amazing people. Really, this is an experience which is eye-opening, rewarding, and filled with unforgettable experiences.

The program I was enrolled in was unavailable to review on this platform, but I was more focused on learning amazonian arts from the Ecuadorian people. I learned a lot about how to derive materials from plants and the earth, including how to harvest and purify clay, how to make fibers from the pita leaf, and which plants or minerals could be used as natural pigments for dyeing or painting fabric, a painting surface, or skin. I also learned how to make many artesanias with the natural fibers, how to make glasses and bowls from various woods and fruits from the trees, and traditional pottery techniques. I also learned about the natural medicinal properties of many plants, and about more environmental topics. I painted a mural for my community's business and learned about the gastronomy of the area and how the farming influences it as well.

I honestly wouldn't know what to improve — I had the best time and would 100% recommend it to others. During my internship, it started with the Ministry of the Environment, which began great. However, at a certain moment I realized that it didn't work out for me personally. Luckily, I was able to shift my focus to the chakra systems and Guayusa! Andy and Mirka were both lovely and super helpful. What I'm most proud of is deepening my understanding of nature and its global, border-transcending impact. The most impactful part was my host family. It was hard to hear of and see so much environmental destruction and social inequalities — it is one thing to learn about it at University, but to witness it can be very hard to process and deal with. So I'd say I learned how to cope with that and channel it into something useful. I think I could have tried to learn Kichwa better, but speaking Spanish for most days was already challenging. Looking back, I improved my Spanish and learned a ton about the complex realities that people face in the region — it also got me to think about ways to alleviate some of the issues, and I was able to practically use the skills I learned at University. If it works out, this program might have given me the inspiration to start my own business! Beyond that, it changed my life and made me affirm the life choices that I have made and the ones that I am about to make. I am immensely grateful for my host family's hospitality and kindness — they took me in and made me feel welcome and happy. I would recommend this to anyone, outside or inside of a university program, who is open to getting to know a culture and themselves on a deeper level.

This program allowed me to grow as an ethical leader in my community, a leader who leads by example. My experiences at Coast General will forever shape my perspective on health care and scarce resources in healthcare settings. While in Kenya, I received constant support from the IMA staff. One specific example that stands out to me was when I was left in the lab by one of the CCC doctors. I called Hilda for support, and even though she was not working that day, she immediately sent Dr. Shaziim to support me. In the residences, the mentors would always be looking out for me, making sure I was healthy and happy as I completed the program. One specific moment in Internal Medicine that stood out to me was when I did rounds in the women's ward with Dr. Shaziim and the gastroenterologist. Dr. Shaziim incorporated my previous knowledge of HIV from the CCC into explanations to help me learn and build upon my knowledge. Thanks to their efforts to involve me in their diagnosis process, I now want to pursue gastroenterology.

During my internship, my main project was teaching English in 5 de Octubre — three hour-long classes twice a week for about six weeks. In my community, I spent a lot of time taking care of the big vegetable garden, and I also helped out with the tourism business in my community, whether that was cooking, translating, or helping them with money stuff. I really liked the 1:1s I had with Mika — I always left our conversations feeling good about what I had done and inspired for the future. Once we started, I could see a change in the way I approached my internship — with more focus, purpose, and confidence! I loved every single minute I spent in 9 de Junio and would not have changed anything about my time there. The people are so kind and friendly and welcoming. What I'm most proud of is the relationships that I built with everyone in my community — it was one of my goals to get to know everyone in 9 de Junio and I feel like I both met and exceeded that goal. I was proud of how openly I trusted and shared about myself in order to build trust, and then how people reciprocated that by telling me about their lives, inviting me to come live with them or go visit their family. When I left, I truly felt like I was leaving a second family. The most impactful part was my host family. While living with a host family, I found the lack of personal space challenging at times — I learned to keep my things very tidy and to take intentional time out of my day or week to be by myself to recharge and then return home at my best energy. I was really proud of how my Spanish improved, and I also think I practiced and learned a lot about self-accountability and taking initiative. From my experience in my Kichwa community, I learned a lot of spiritual practices about the earth, the jungle and our world that I want to take with me into my personal life. I am most grateful for having gotten to know my community — I am so grateful for the way they opened their homes and their arms to me, and for all the laughter and fun times we shared, but also for the way they opened up to me about their lives and their challenges. I had a lot of personal transformations about the way I view the world and my place and responsibility in it. I think this is a super program, especially for gap year students — it was the perfect combination between support and freedom, and I think the freedom also pushed me to grow more than I would have in a structured program, all while knowing that if I ever needed anything, you both were right there to help me.

This internship was an amazing once-in-a-lifetime experience that I am very grateful for. I have met so many wonderful people, including all of the program staff, interns, and hospital staff. Safety was a major concern for my family and me before my internship, but the program mentors and staff were very informative and cautious, so I felt very safe throughout my stay. The accommodations and food were also beyond what I expected. I have learned so much not only clinically, but culturally as well, and I would love to go back once more in the future. My internship this past winter with International Medical Aid in Mombasa, Kenya has opened my eyes to different perspectives and has given me a glimpse of what life is like in a place that is more than 10,000 miles away from my home. I have learned so much in not only medicine but in culture as well. Through the cultural treks and language classes provided by this program, I was able to learn about the history of the Swahili people, how the Kiswahili language came about, along with the traditions and practices of the culture of the people of Kenya. This opportunity has allowed me to gain meaningful experiences and relationships that I will forever cherish. I spent my internship at Coast General Teaching & Referral Hospital, where I had the opportunity to shadow both medical and clinical officers who play a large role in healthcare in three major departments: Emergency Medicine, Pediatrics, and General Surgery. Alongside these healthcare providers were nurses who play a critical role in patient-centered care and whom I came to befriend. Every day of my three weeks of this internship contained precious moments and learning points that have only furthered my passion for the medical field. Even through a slight language barrier, sincerity shines through, which is something that I will always carry into my practice as a future healthcare provider in the United States. If there is anything that has had a profound impact on my view of life, it is the realization that there is a limit to what I am able to control. From my experiences so far, whether in a medical setting or daily life, there is only so much I am capable of doing for people. This realization crossed my mind countless times as I thought about ways in which I could do more because in my current position, I have no say or control in a life-or-death situation, regardless of how dear someone may be to me. Especially as an intern and student, I was limited to speaking words of encouragement as I watched patients suffer, or simply waiting and hoping for good news. The desire to be able to do more than that has sparked my passion to pursue a career as a medical professional. The healthcare system I experienced in Kenya is notably different from the United States in terms of access to care, disease burden, and health coverage for patients. From the medical officers, clinical officers, nurses, and patients that I spoke to, I found that many patients do not seek care due to long distances and lack of transportation. Although hospitals are scattered throughout the country, they may not be evenly distributed throughout each region or neighborhood. Furthermore, some patients live closer to private hospitals but cannot afford them because they charge much more than public hospitals, which many patients are also unable to afford. This relates to Kenya’s poverty rates, with about one-third of the population living below the national poverty line in 2019 (World Bank, 2023). Additionally, the disease burden in Kenya is very high, with human immunodeficiency virus (HIV), which can develop into acquired immunodeficiency syndrome (AIDS), being one of the major communicable diseases. As for non-communicable diseases, major ones include cardiovascular disease (CVD) and metabolic diseases such as chronic kidney disease, diabetes, and hypertension, all of which contribute to the high disease burden in Kenya. The need for non-communicable disease services to be expanded has been recognized, with guidelines supporting these provisions in patients with HIV, but coverage still remains low (Smit et al., 2019). Additionally, during the Global Health Lecture Series presented by Dr. Shazim during our internship, we learned that the high burden of HIV and AIDS in Kenya accounts for about 29% of annual adult mortality, 20% maternal mortality, and 15% mortality in children under the age of five, which are much higher than mortality rates in the United States. Similarly, non-communicable diseases contribute to more than 50% of inpatient admissions and 40% of hospital mortality, which is also linked to a financial burden for these patients that is further connected to nationwide poverty. With a high disease burden in Kenya also comes a high financial burden, with a major issue being health coverage. Informal sector workers, a population that drives a significant portion of employment in Kenya, have a low rate of national healthcare insurance (NHI) enrollment. This may be due to existing socioeconomic inequalities and barriers they face, including limited access and having to pay NHI premiums out-of-pocket (Wamalwa et al., 2025). This contributes to increased morbidity and mortality due to inequitable access to care, as high out-of-pocket costs prevent patients in this population from seeking care. Studies suggest strategies such as using a tax-based system or expanding subsidies to support NHI enrollment among populations like this, though more research may be needed. Diving deeper into the healthcare system in Kenya showed me the existing gaps that prevent patients from receiving the care they need and ultimately contribute to mortality. My first thought when I learned about the healthcare system in Kenya was that these gaps seemed almost impossible to close. However, it made me think about how these gaps could be reduced, even slightly—whether by addressing health disparities through a health equity lens, focusing on advocacy, or working as a healthcare provider in a hospital setting. This led me to ask further questions, which eventually instilled in me a desire to contribute to making a difference. Although my role as an intern may have seemed insignificant in terms of what I was able to practice, I built many meaningful relationships with various people there and I would like to believe that I made a difference in at least one person’s life. Even though I cannot change the world, brightening one person’s day may feel to them as if something meaningful has changed. This could be the drop that turns into a ripple and has a lasting effect. If one drop can turn into a ripple, I can only imagine what numerous drops can do. I believe International Medical Aid is a wonderful example of how gaps in Kenya’s healthcare system can begin to close. Each intern interacts with numerous patients and healthcare providers and brings back a piece of their journey home to share their stories. Each intern may have also offered words of consolation, encouragement, and hope to the patients they encountered, giving them strength during what may have been the lowest points of their lives. I learned that the smallest acts can accumulate and become something deeply meaningful that touches people’s lives. Each person’s life holds immense value, and I want to be part of something that gives people the opportunity to value their own lives—whether by providing treatment options or simply being there to reassure and brighten their days. I want to be someone who brings joy into people’s lives, a shoulder to cry on when they are hurt, and a source of peace for those in their final moments of life, because that is what I would want if I were in such a position. I want to bring good news to families of patients who have recovered, console them when unexpected things occur, reassure them when they express concerns, and be someone not only patients can trust and rely on, but someone their families can rely on as well. My perspective on life has changed, and for that I am eternally grateful.

During my internship, I worked with the Ministry of Environment to write a story about the history of Santa Rita, and I accompanied my supervisor for her daily activities, including tour guide. They were incredible — 10000/10. Stephanie was awesome! She helped me with any struggles I faced and was there with a tremendous amount of support and guidance, and I felt very comfortable speaking to her and expressing my feelings. What I'm most proud of is the friendships and relationships that I fostered. The most impactful part was my host family. I struggled with my lower level of Spanish, but I learned to practice it and learn from others. I could have reached out to more actors to help jumpstart the trash program in my community. Looking back, I became more selfless, resilient, and learned to be more curious rather than judgmental. I believe I gained a multitude of skills from working at MAE which will benefit my career in the environmental studies realm, and I would want to focus my work in Latin America, where practicing Spanish will serve as a huge benefit. I really loved Ecuador and I would hope to live here one day. I am super grateful for this experience, but I am most grateful for living in Santa Rita.

My experience with International Medical Aid in Kenya was truly exceptional and profoundly impactful, both personally and professionally. From the moment I arrived, it was clear that the program was thoughtfully designed with intern safety, learning, and well-being at its core. The structure and support provided allowed me to fully immerse myself in the experience while feeling consistently supported and valued. The in-country support team was outstanding. Orientation sessions were thorough and reassuring, covering safety, cultural expectations, and hospital dynamics in a way that made the transition into a new healthcare system feel manageable and exciting rather than overwhelming. Throughout the program, staff members were consistently available, responsive, and genuinely invested in our experience. Whether addressing logistical questions, health concerns, or simply checking in on how we were adjusting, their presence made a meaningful difference and created a strong sense of trust and community. Safety was clearly prioritized at every level. Transportation to and from clinical sites was reliable and well coordinated, housing was secure and comfortable, and clear guidance was provided on navigating the local environment responsibly. This allowed me to focus fully on learning and engagement rather than worry. Accommodations were welcoming and well maintained, offering a restorative space after long hospital days, and the food provided was both nourishing and culturally enriching, giving us the opportunity to experience local cuisine while meeting dietary needs. Clinically, the experience was transformative. Exposure to high-acuity cases and diverse patient populations in a resource-limited setting deepened my understanding of medicine, adaptability, and health equity. Despite demanding clinical environments, clinicians and mentors made time for teaching, discussion, and reflection. Case debriefs and guided conversations helped contextualize what we observed and strengthened my clinical reasoning. I gained invaluable insight into patient-centered care, interdisciplinary teamwork, and ethical decision-making in global health contexts. Importantly, the program emphasized respectful engagement with the community. Interns were encouraged to learn with humility, prioritize patient dignity, and understand the broader systemic challenges facing the healthcare system. The presence of the program supported busy clinical teams while fostering meaningful cross-cultural exchange. Overall, this internship reinforced my commitment to medicine and global health. It strengthened my cultural competence, resilience, and sense of purpose, and it was made exceptional by the dedication, compassion, and professionalism of the International Medical Aid staff and local clinicians. This experience will continue to shape my approach to healthcare, service, and learning moving forward. When I arrived in Mombasa, Kenya, to begin my clinical internship with International Medical Aid (IMA), I expected to gain experience in medicine, but I did not expect to feel so immediately immersed. On my first morning at Coast General Teaching and Referral Hospital, voices in the corridor found me before I found the ward: “Daktari, daktari!” The word—Swahili for “doctor”—warmed and unsettled me in equal measure. I wasn’t wearing a white coat, only IMA-branded scrubs, and I was not yet a doctor. But in that moment, the title wasn’t about qualifications; it was about need. “Daktari” carried a weight of expectation that followed me through every ward, every patient encounter, and every conversation. I rotated through the intensive care unit (ICU), emergency department, cardiology, and surgery, with overnight shifts in maternity when the ward was stretched thin. Over weeks, the hospital’s sounds and textures became my syllabus: the oxygen concentrator’s steady sigh, the antiseptic mingled with ocean air, the clink of enamel mugs as tired clinicians shared tea. I learned to say habari (how are you?), asante sana (thank you very much), pole and pole sana (I’m sorry/so sorry), tafadhali (please), samahani (excuse me), ndiyo (yes), hapana (no), kidogo (a little), and polepole (slowly). People smiled at my first crooked attempts and coached me kindly—“Sawa, daktari, polepole.” It mattered to them that I tried. It mattered to me that they let me. A question became inseparable from my days in the hospital: What have I learned—and how will I use it? My answer lives in stories: of scarce resources and stubborn hope, of ethical lines that felt like cliffs, of laughter shared over tea and cake during a ten-minute truce in an endless day, of a husband in a plastic chair at 3 a.m. asking me if everything would be okay and knowing I could not promise it would. These experiences clarified not only the kind of physician I want to be—clinically excellent and radical in empathy—but also the kind of advocate I must become for equity in global health (Afulani et al., 2021; Kinuthia et al., 2022; WHO, 2023). Being called daktari by patients was an honor, but it was also one of the most sobering experiences of my internship. In Canada, I am “Nia, the student.” In Mombasa, I was “Doctor,” simply because I wore a pair of scrubs and stood beside physicians. Patients would look at me expectantly, asking questions, sometimes holding out prescriptions for me to explain. Their trust was profound, but it also reminded me of the immense responsibility medicine carries. The most challenging moments came when Kenyan doctors asked me to do things far beyond my training. In the emergency department, a physician once handed me a syringe and said: “You give the injection — I will show you this one, and you will do the next patient.” I froze. I had never given an injection in my life. I explained that I wasn’t trained, and he smiled, a little surprised, but then proceeded to demonstrate. When he turned back to me, I shook my head. I had to refuse. He looked puzzled at first, but eventually nodded and moved on. That moment taught me two things. First, the scarcity of staff often pushes students into roles they are not prepared for, out of necessity rather than negligence. Second, I realized the importance of knowing my limits. Patient safety must always come before pride or the desire to fit in. The moment branded a lesson I will carry for a lifetime: in settings where task sharing is a pragmatic response to workforce shortages, clarity about scope and competence is an ethical anchor (Kinuthia et al., 2022; Okoroafor et al., 2023). Even without doing procedures, there was plenty I could do. I learned to read the room quickly, to fetch, translate, listen, soothe, count breaths, find a blood pressure cuff that almost fit, and—most of all—to communicate honestly. Briefly as I remember it, a senior physician offered an unforgettable lesson on empathy versus sympathy: “Sympathy stands beside the cliff and waves,” he said. “Empathy climbs down, sits on the ledge, and helps someone look up.” The next day he put me to the test: a family’s matriarch was failing, and we knew she was unlikely to survive the night. He asked me to speak with them first. I used the SPIKES framework—Setting, Perception, Invitation, Knowledge, Emotions, Strategy—pulling chairs into a circle, asking what they understood, inviting permission to share more, delivering information in short sentences, then letting silence do the rest before outlining next steps (Baile et al., 2000; Buckman, 2005). I did not tell them it would be okay. I told them we would not let her suffer and that we would stay. They wept; I listened. When we stood, the physician squeezed my shoulder and said, “Asante, daktari.” It was especially then that I realized how deeply I want to be a doctor who does not only prescribe but also accompanies (Jeffrey, 2016; Byrne et al., 2024). The ICU taught me the arithmetic of scarcity. Beds were almost always full; positions, too. Kenya has grown critical care capacity since 2020, but the distribution remains uneven, and functionality is a persistent challenge—by one national survey, more than a quarter of ICU beds were nonfunctional on the day of assessment (Barasa et al., 2020; Mwangi et al., 2023). On rounds I juggled vitals and vocabulary: pumua polepole—breathe slowly—repeated to a hypoxic patient as we watched an oxygen cylinder’s needle drift toward red. Families seldom entered the ICU; most waited outside or at home, a difference from many North American units where bedside family presence is standard. This wasn’t indifference; it was infrastructure and policy. And still, even behind glass, love found a way—caregivers pressing palms to doors, whispering their person’s name, and trusting us to be their hands for now. One night, we faced a quiet ethical storm. Four patients needed dialysis by dawn: an elderly man with septic AKI, a young teacher with rapidly rising potassium, a diabetic woman in pulmonary edema, and a middle-aged patient with chronic kidney disease who looked relatively stable. We had one machine available. By clinical urgency, the choice seemed clear. Yet the machine went to the one with the lowest immediate risk. A doctor muttered why: “She’s connected… a politician’s prostitute.” I felt my stomach turn. I had been reading about how procurement, politics, and favoritism can distort resource allocation in Kenyan health systems; now the literature had a face (EACC, 2023; Musiega et al., 2023; Munywoki et al., 2023). We stabilized who we could, improvised where we must, and documented everything. That night hardened my resolve to fight corruption and inequity as fiercely as I fight disease. It also pushed me deeper toward policy: devolution has created possibility and variation across Kenya’s 47 counties, but budget execution, cash flow, and procurement bottlenecks still undercut efficiency (Barasa et al., 2021; Musiega et al., 2023). Scarcity is not an abstraction in nephrology. In Kenya, chronic kidney disease affects millions, dialysis is expanding but remains unreachable for many, and transplant capacity meets only a fraction of need (Maritim, 2022; Japiong et al., 2023; Hathaway et al., 2023; Sawhney et al., 2024). That night, the human cost of those percentages sat at the edge of one bed, wrapped in a paper gown, waiting her turn that didn’t come. I want to be the kind of physician who refuses to accept a world where political proximity sets triage. I also want to be the kind of advocate who helps build systems where such choices never arise. The emergency department compressed hours into heartbeats. One evening a boy arrived listless, skin tented over his knuckles, his mother murmuring tafadhali as we lifted him. The chart said suspected cholera. I had read WHO updates about multi-country cholera surges and Kenya’s intermittent outbreaks; suddenly the textbook was on the gurney (WHO, 2024a; WHO, 2024b). We warmed fluids between our palms, counted capillary refill, measured stool in a basin the color of the sea—only thinner, crueler. When he finally sat up and sipped, his mother clasped my hands and said, “Asante sana.” I shook my head: hapana, pamoja—no, together. It was true. The nurse who found an elusive vein, the clinical officer who triaged quickly, the cleaner who changed the soiled sheets in seconds—medicine is choreography, and everyone had a step. In that same department, the cleavage between can and should appeared again in small ways. Could I interpret an ECG? Yes. Should I be the one to adjust a drip? No. Kenya’s Emergency Medical Care Policy and Strategy envision a coherent, universal emergency system; the WHO Basic Emergency Care curriculum is training first-contact providers to act fast and act right (Republic of Kenya, 2020; Lee et al., 2022; WHO, 2024c; Michaeli et al., 2023). I saw the promise—and the gap between policy and practice when volume surged. Strengthening emergency care is not a luxury; it is a multiplier for survival in trauma, sepsis, obstetrics, and cardiac crises. Cardiology days stitched physiology to story. I will never forget a gentle woman in her forties with poorly controlled hypertension and shortness of breath. She had missed clinic visits—money for transport had gone to school fees. Her ECG muttered strain, her ankles told the rest. I sat beside her and tried my Swahili: Tutapanga pamoja—we’ll plan together. The doctor drew a medicine grid with the colors of her cooking spices: red pill with lunch (chapati day), small white at bedtime (lala salama, sleep well). She laughed, promised to try, and pressed a warm orange into my hand from her bag when we were done. Across Kenya and globally, noncommunicable diseases are rising fast while specialist numbers remain thin; in settings like this, patient education is not a bonus but a therapy (World Heart Federation, 2023; Smit et al., 2020; Oguta et al., 2024). Another morning, I helped a young man with suspected rheumatic heart disease understand why stairs stole his breath. With the team’s okay, I only echoed what the physicians had already explained—nothing more—turning their guidance into quick sketches of valves in my IMA notebook while his friend filmed on a cracked phone. We spoke, strictly within those instructions, about prophylaxis and when to seek help if the chest began to thud like a drum; I made clear I wasn’t adding my own opinions, just passing along accurate information from his clinicians. He shook my hand with both of his and whispered, “Asante sana.” Teaching—faithful to the team’s advice—is a clinical intervention; in low-resource settings, it is sometimes the only one you can leave behind. Surgical days carried a ritual clarity—checklists, cleansing, exactness. After shadowing several operations and taking pages of notes, I followed the team to a break room with practically destroyed leather couches. Someone produced a dented tin and a flask. “You must try our tea and cake,” the doctor insisted, breaking the slice into generous pieces though everything was rationed—time, sutures, sanity. We joked about my Swahili and the way I said ndiyo like a question. We also spoke plainly about weight. One surgeon rubbed his eyes and said, “Sometimes I just want to get out of this place.” He didn’t mean Kenya; he meant the machinery of exhaustion: blocked procurement, too few hands, too many late-stage presentations. He was not cruel, only human. Studies from Kenya echo what I saw—burnout is real among providers, especially in high-acuity, under-resourced settings (Afulani et al., 2021; Lusambili et al., 2022). I could not blame him; I could only admire the way he scrubbed again ten minutes later and went back in. Those same surgeons modeled another kind of abundance. They let me stand a little closer, ask one more question, listen a little longer to a patient’s fear before anesthesia. When I thanked them, they shrugged. “We were also students,” they said. Then they handed me another piece of cake. It tasted like saffron and solidarity. On a night shift that still wakes me, a man found me outside the maternity ward. “Daktari, where is my wife?” His hands trembled. I had observed the birth and learned quickly: his wife had delivered a stillborn baby and was now hemorrhaging. She had lost roughly two litres. The team had rushed her to theatre for uterotonics and transfusion. He asked if she would be okay. I wanted to say yes. I could not. I remembered the lesson: empathy sits on the edge of the cliff. I sat with him in plastic chairs for an hour that felt like a day, using the best therapeutic communication I had—short sentences, honest pauses, simple words, pole sana—and I did not make promises. He told me this wasn’t the first time they had tried, how badly he wanted to become a father, how brave his wife was. He held his head and sobbed. I handed him tissues and spoke to the theatre when I could. When the nurse finally waved us closer and said the bleeding was controlled, he broke again—this time with relief, not joy. We had saved a life; we had also witnessed a loss that would live in the room for a long time. Postpartum hemorrhage is the leading cause of maternal mortality in Kenya, responsible for a staggering share of preventable deaths (Clarke-Deelder et al., 2023; WHO, 2023; Miller et al., 2024). Policy and innovation—from calibrated drapes to E-MOTIVE care bundles—are making a dent, but systems strain at three a.m. (Forbes et al., 2023; WHO, 2023). That night honed my understanding of what “advocacy” must mean for me: not speeches, but the slow, procedural work of ensuring blood is in the fridge, oxytocin is not expired, and referral roads are passable. I learned to see difference not as deficit but as context. Kenya’s health system is decentralized; counties hold power over budgets and hiring, yielding both innovation and inequity (Barasa et al., 2021). Emergency care policy is advancing but remains a patchwork in implementation; critical care capacity has expanded yet is uneven and sometimes nonfunctional; task sharing is both policy and necessity (Republic of Kenya, 2020; Mwangi et al., 2023; Kinuthia et al., 2022). These structural variances mattered in daily decisions—who got a bed; which lab test we could run; whether a consultant could be reached. Politics walked the corridors, too. I saw the best of it—county investments that opened new ICU wings—and the worst of it—procurement shortcuts that warped triage, whispers of favoritism, and morale that bent under both (EACC, 2023; Musiega et al., 2023). Culture threaded everything: family structures, faith, the communal cadence of waiting rooms, the hospitality of tea that no one could afford and everyone insisted you take. I also learned that language is a clinical tool. Saying pole at the right time with the right tone mattered as much as any manual skill I had. People corrected me gently—hapana, not hapoana—and then used my effort as a bridge to trust. Competence before confidence. In resource-limited settings, the temptation to “just do it” is real. I learned to hold the line, graciously and firmly. My future self will keep that boundary for patients’ sake and my own (International Medical Aid, 2025; Kinuthia et al., 2022; Okoroafor et al., 2023). Communication is care. Breaking bad news with the SPIKES framework, listening more than I spoke, and choosing empathy over sympathy are not soft skills; they are lifesaving ones. I will keep training this muscle, because it determines how patients endure what medicine cannot yet cure (Baile et al., 2000; Jeffrey, 2016; Byrne et al., 2024). Systems shape outcomes. Clinical excellence cannot outrun broken procurement, underfunded emergency systems, or nonfunctional ICU beds. My internship turned my interest into commitment: I will pair practice with policy, advocating for anti-corruption safeguards, budget transparency, and county-by-county strengthening (Barasa et al., 2021; EACC, 2023; Musiega et al., 2023). Equity is a clinical competency. Dialysis for the connected instead of the sickest is not only unjust; it is deadly. I want to help build guardrails—triage protocols, ethics support, and public accountability—that make fairness the default, not the miracle (Munywoki et al., 2023; Japiong et al., 2023; Maritim, 2022). Joy sustains the work. Tea and cake in a cramped break room were not trivial; they were resistance. Laughter over my rookie Swahili reminded me that hope is a renewable resource. I will carry that with me—and reciprocate it—for my teams and my patients. These lessons have already recharted my academic path. I am minoring in Global Peace and Social Justice to deepen my understanding of health equity, ethics, and policy. I seek coursework in health systems, anti-corruption in public procurement, emergency care strengthening, and community-centered research. Clinically, I envision a life as a traveling physician-scholar who rotates through hospitals like Coast General, supports county health teams, mentors trainees, and returns regularly—not as a parachute, but as a partner (International Medical Aid, 2025; Kinuthia et al., 2022; WHO, 2024c; Siegel et al., 2024). On my last week, a nurse in surgery pressed my hand and said, “When you come back, will you be a real doctor?” I swallowed. Ndiyo. Nitarudi. Yes. I will come back. I want to be the physician who hears “daktari, daktari” in a crowded corridor and knows both the science and the story behind the plea; who can titrate a drip and also sit in the dark with a husband while the theatre doors stay closed; who insists on ethical triage even when the room grows quiet; who fights for emergency systems that answer in minutes, not hours; who teaches in simple metaphors and shaky Swahili until a patient laughs and understands; who accepts cake and offers it; who returns. One day I hope to wear that word without hesitation—daktari—and to bring it back to the very wards that taught me what it means. Until then, I will study hard, listen harder, and carry Kenya with me into every exam room. Asante sana. All patient stories are de-identified and composite to protect privacy. Details altered or composited for confidentiality include: the exact sequence of the four dialysis candidates; the names, ages, and non-essential demographics of patients in emergency, cardiology, and maternity; and the particular phrasing of clinicians’ quotes (the sentiments are faithful to actual conversations). Specifics about procurement favoritism were reported to me verbally during a night shift and are presented here as a firsthand account consistent with published reports on health-sector corruption in Kenya (EACC, 2023; Munywoki et al., 2023). The scenes of tea and cake with surgeons, the SPIKES conversation with a family, turning down an injection at the bedside, being called “daktari” while in IMA scrubs, learning and using basic Swahili with patient interactions, and sitting with a husband during his wife’s postpartum hemorrhage are drawn directly from my internship experience.

During my internship, I worked at Kallari Association, helping their cacao business in any capacity that I could. I learned how the cacao is planted, grown, harvested in my family's chakra, and then collected, processed, packaged, and marketed at Kallari. I also was given the opportunity to explore and learn from nearby cacao organizations and chakras. Carla and her family were absolutely wonderful — super friendly, helped me out a lot, and made delicious food. Mirka was an excellent mentor! She helped me understand what to expect during my time in Tena and provided excellent support. What I'm most proud of is being able to build relationships with the members of my host family — my Spanish is not anywhere close to perfect, but my host family was very supportive and patient. One challenge was trying to fit in everything I wanted to do and learn during my short stay in Tena — I learned how to be efficient and concise with the things I did. I think I could have put more effort into speaking Spanish during the entirety of my stay instead of speaking English when I had the opportunity to do so. Looking back, I was pushed out of my comfort zone and became much more flexible and able to adapt to situations — my Spanish skills most definitely improved, as did my agriculture skills, since I only knew of American farming techniques. This experience has helped me determine that I want to go into sustainable agriculture or food security in the United States. I am applying to graduate school now, and hopefully will start my own entrepreneurial venture relating to this one day. I will be much more aware of how my actions impact my community and the planet, and I will be doing things I'm passionate about instead of purely monetarily. I am grateful for the wonderful family that so generously opened up and shared their lives with me. I think exposing as many people to this program would be wonderful — it helps people explore their interests in a new perspective and makes a positive impact on the community in Tena.

During my internship, I worked with GIZ helping with climate change workshops and inputting information into Excel spreadsheets, worked at Tamia Yura getting a tour of the botanical gardens, and taught English classes two evenings a week at Cavernas Jumandy. I also conducted independent research on Buen Vivir for school. I really loved Tamia Yura — the people there and the forest, the gardens, everything. It was so beautiful and I hope it can work out in the future. The 1:1s were fantastic, very helpful and thorough. I loved my host family — they did a great job making me feel included in the family and welcome in the home. They all made efforts to get to know me and ask questions, and taught me about their culture. What I'm most proud of is conducting interviews for my research project, starting teaching English classes at the Cavernas Jumandy, and developing strong relationships with my host family. The most impactful part was all of the above. At the beginning it was hard for me to be so visibly different, so conspicuous as a gringa — I didn't like walking on the street because I felt like everyone was looking at me all the time. After a while I realized that I couldn't change the way I looked and was just going to have to brush it off. I learned to care less about what other people were thinking about me — it's not something I can really change from a distance. I wish I would have started more conversations with family members instead of waiting for them to start conversations. Looking back, I got better at Spanish, learned to take more initiative, and became more confident in myself through being visibly different. This experience made me more interested in environmental education and made me want to work in South America. I really want to come back in the future to see the people I developed relationships with, and going to Ecuador made me realize how important traveling can be and how much I want to keep traveling, and possibly live abroad at some point. I am so grateful for my host family and their support, friendship, and for including me in their lives. I had a wonderful experience — I'm having a hard time explaining it to others. You just have to go yourself.

During my internship, I organised various viveros in different communities, collecting seeds and plants from the rainforest and planting them. I felt like I could always get in touch if I needed to, as both Andy and Stephanie were friendly and approachable — I appreciated the check-ins to ensure everything was going well and I felt comfortable. The most impactful part was my host family. What I'm most proud of is the ability to communicate effectively with members of the community and gaining respect from them and my colleagues. Getting off the wrong stop on the bus and ending up in a different community was a challenge — I learnt to have confidence to ask questions and ask for help, as people are generally willing to give it. Looking back, I developed Spanish and physical manual labour skills. This experience gives me something interesting to talk about in job interviews, as it shows that I understand other cultures and biodiversity. Beyond that, it made me more humble and more conscious about my consumption and trying to be more sustainable. I am grateful for the opportunity to live with a local family and understand everyday life as a local. I feel it is a good way to understand the Amazonian region deeply rather than just focusing on its attractiveness.

During my internship, I was working on a reforestation project with chunchos and corn. My Ecuafamily was perfect — I really enjoyed working and living at Mushullacta with Jose and Maira's family. The 1:1 was very useful at the beginning because I was a little bit lost in this new country, and my English and Spanish were very bad at the time. For the first time I think I have realized and accomplished something professionally. What I'm most proud of is accomplishing my personal and professional project. The most impactful part was all of the above. Improving my language skills was a real challenge — I learned that to learn a new language perfectly it's important to take classes, because people could not understand me but my English and Spanish are not very academic. Looking back, I wish I had been myself earlier. I developed skills in how to manage a reforestation project in a developing country, and it confirms me in the idea that it is what I want to do in my future professional life. All of my experience there was a personal transformation, and I discovered a new culture I am grateful for. It was one of my best experiences — I would recommend it extremely likely.

During my internship, I inventoried chakras with a professor at Ikiam University — he plans to experiment growing different species on Ikiam property and help the local communities retain more value from their crops. Great family, plan to stay in touch with them after just three weeks! My 1:1 happened on my last day, so it was nice to recap and touch base before re-entering the US. What I'm most proud of is analyzing tree species data to understand best growth conditions and value potential. The most impactful part was all of the above. Parsing out when a local was telling me species names in Kichwa versus Spanish was a challenge, and I could have connected more with Amazon Learning and the other interns. Looking back, I developed plant species identification, strengthened my Spanish, and gained some international experience. This experience helped me understand a foreign culture through the eyes of local people and become more sympathetic to their way of living. It gave me more perspective and made me realize how many things I take for granted. It is a very unique and formative experience — the combination of receiving some formal training through Amazon Learning and then getting an immersive experience is very powerful and rewarding. Thank you for everything!

My experience with International Medical Aid in Peru was transformative, and the staff were at the heart of it. Their guidance, care, and example shaped not only my learning but also the way I now see medicine. Dr. Fabrizio was one of the most down-to-earth and knowledgeable teachers I have ever had the privilege of learning from. He led many of our lectures and constantly reminded us that health is never just physical; it is also mental. He taught us how to approach patients holistically and how to rely on our clinical skills and hands as tools when technology was limited. His way of teaching made complex concepts accessible and grounded, and his example will stay with me throughout my career. Dr. Miriam was equally impactful. She not only lectured with clarity and compassion but also worked alongside us in the community clinic in Andahuaylillas. I had the privilege of being with her when we saw a 78-year-old farmer who had not sought medical care in years. Watching her balance empathy with clinical skill as she cared for him was deeply moving, and it showed me what it means to treat a patient as a whole person, not just a list of symptoms. Our program coordinator, Manuela, created an environment where we always felt supported and welcomed. She was consistently kind, approachable, and attentive to our needs, which allowed us to feel at home even when we were far away. Surabhi and Juda also played an invaluable role in ensuring our safety and comfort throughout the program. They were present and attentive, often behind the scenes, and their commitment gave us the confidence to immerse ourselves fully in the experience without worry. What stood out most to me was that each staff member went beyond their formal roles. The physicians modeled the kind of care that sees patients as individuals with stories, while the program staff ensured that we had the structure and security to learn and grow. This combination made my time in Peru not only eye-opening but also profoundly fulfilling. The program has given me lessons about privilege, resilience, and holistic care that I will carry into my future in medicine, and for that I am deeply grateful to every member of the team. “Un día.” One day. This is what a nine-year-old girl said to me when I showed her pictures of my life back home. That simple phrase has stayed with me as it revealed both her dreams and my privilege. We don’t realize the opportunities we hold until we’re met with the reality of others. This was the greatest lesson I learned throughout my internship with International Medical Aid in Peru. Over several weeks in Cusco and the surrounding mountains, I saw the ways limited health education, scarce resources, and cultural barriers shape how people experience health. I listened to children who had limited education about hygiene or menstruation, to patients who had not seen a physician in years, and to elders who still relied solely on traditional remedies. I also saw resilience—in girls who proudly signed their names on pottery they sold to support themselves, in communities who welcomed us into their schools, and in physicians who made the most of every tool available. These experiences challenged me to rethink what it means to be a healthcare provider. They taught me that medicine is not just about treating disease; it is about building trust, offering education, and meeting people where they are. My time in Peru deepened my commitment to a career in healthcare, one rooted in empathy, humility, and advocacy. In every school and orphanage we visited, I realized how much of healthcare begins long before a patient steps into a clinic. Many of the children we met had never been taught how to wash their hands properly, why brushing teeth matters, or what to expect when their bodies begin to change. At the girls’ orphanage, we gave talks on dental care, handwashing, and menstruation, and their questions reminded me just how powerful basic education can be. Some of the girls believed that menstruation meant they were sick, while others were shy to even say the word. Watching their faces light up as myths were debunked was a reminder that information can be as healing as medicine. Back home, I had always taken school health classes for granted; in Peru, I saw what it meant when those lessons were missing. It struck me that the first prescription a physician can give is not always a pill—it is knowledge, dignity, and understanding. As a future physician, this lesson reminds me that I cannot assume patients come with the same baseline of health literacy I had growing up. If I want to truly serve my patients, I will need to carry this humility forward, taking the time to listen, explain, and leave them with more than a prescription—with the confidence and knowledge to care for themselves. That same lesson came into sharper focus during my rotation in Tópicos, where nearly every patient who walked in had varicose venous ulcers. We cleaned and re-dressed wound after wound, with many returning with infections and deterioration. One woman had scratched at her ulcer, not realizing the bacteria under her nails could worsen it beyond recognition. It wasn’t neglect; it was lack of guidance. The nurse explained that these ulcers were so common in Peru due to long-standing labor in agriculture and markets, high rates of obesity, and almost no access to early preventive care. She enlightened me that chronic venous disease thrives where occupational risks, delayed treatment, and poverty converge, and I could see that truth in every leg we bandaged. What I had glimpsed in orphanages—the cost of missing basic education—I now saw magnified in adults whose wounds had spiraled because no one had ever taught them how to care for themselves. In Canada, I grew up with hygiene lessons, clean water, and health literacy woven into everyday life; in Peru, those privileges were often absent, and the consequences were written directly on people’s skin. These structural inequities became even more visible during our community clinic in Andahuaylillas, where many of the patients we saw had not accessed medical care in years. One man I encountered, a 78-year-old farmer, had bilateral vision loss, severe back pain, and a chronic cough that had persisted for more than five years. Decades of agricultural labor, exposure to wood smoke from cooking fires, and his deep mistrust of physicians reflected patterns I later recognized were not unique to him, but part of a larger reality in Peru. He told us that nearly thirty years ago, doctors had advised amputating his leg due to a severe problem, but he refused and “treated it at home,” now claiming it was fine. That experience convinced him that doctors could not be trusted, reinforcing a reliance on home and traditional remedies—an approach I saw echoed in many rural patients. Chronic obstructive pulmonary disease (COPD) in Peru is often driven not by smoking, as in wealthier countries, but by biomass fuel exposure in rural areas and past tuberculosis infection in urban centers (Miranda et al., 2015). His case was a striking reminder of how structural and environmental conditions dictate disease pathways. I saw similar themes in patients who were either visibly malnourished or living with obesity—two extremes often rooted in the same absence of nutritional education and preventive care. Nearly 30% of Peruvian children suffer from anemia, with prevalence reaching 38% in rural areas, largely explained by socioeconomic and educational disparities (Al-Kassab-Córdova et al., 2022). These same inequities perpetuate adult conditions like venous ulcers, which worsen without early nutrition and wound care. At the other end of the spectrum, I also met patients struggling with obesity and hypertension, consistent with data from Lima showing that more than half of patients with type 2 diabetes live with additional chronic diseases such as obesity, hypertension, and dyslipidemia (Bernabé-Ortiz et al., 2015). My patient in Andahuaylillas was not just an individual with COPD or TB; he was the embodiment of Peru’s double burden of disease, where poverty, environment, and education converge to shape health outcomes. His story made me realize how much of my own access to clean cooking, preventive care, and trusted physicians has been a form of privilege I had never questioned before. This showed me that medicine is as much about context as it is about cure, and that healing begins with seeing the whole person along with the conditions that shape their daily lives. Another significant lesson I carried home was the manner in which Peruvian physicians approached mental health. Although I learned in lectures that Cusco has only about fifteen psychiatrists for the entire region, the doctors and nurses I observed never disregarded psychological well-being. They recognized that health cannot be separated into physical and mental dimensions, consistently seeking to make patients feel heard and understood. This was especially evident in the orphanages, where many of the girls had endured poverty, trauma, or domestic violence. Their questions to me revealed how deeply their environment shaped their sense of identity and purpose; some, not even two years younger than myself, asked whether I had a husband or children, as if a woman’s life were confined within these boundaries. At eighteen, I was struck by how different our realities were, and how limited social and educational opportunities had already narrowed their vision of what was possible for themselves. These conversations underscored that health is not only about physical well-being, but also about how people understand their worth, their opportunities, and their place in the world. I saw this perspective carried into practice at the community clinic in Andahuaylillas, where the physicians made it a priority to establish a station for a psychologist so that patients could receive mental health support after their medical evaluations. Their example reminded me that being a doctor requires seeing patients not only as clinical cases, but as whole individuals whose stories and experiences profoundly shape their health. They showed me that holistic care does not always depend on advanced technology or specialist services; it begins with empathy, attentive listening, and presence. While in Canada I have often taken for granted the growing recognition of mental health and the availability of counseling, in Peru I witnessed how deeply impactful it can be when physicians themselves integrate mental well-being into every encounter. This approach is one I intend to carry forward in my own career, ensuring that my patients feel acknowledged not only in their symptoms but also in their humanity. My time in Peru taught me what it truly means to be privileged. I had never realized how far my liberty extended or how much I had taken for granted. The ability to imagine a successful future for myself, to believe I could pursue it, and to access clean water, preventive health, and nutritional education are privileges that often pass unnoticed. In Peru, I saw the reality behind what happens when those pieces are missing: children growing up without health education, adults unable to manage preventable conditions, and elders relying on traditional remedies after losing trust in the medical system. Yet I also witnessed resilience—in young girls who inscribed their names into pottery to claim a sense of identity, in communities that welcomed us into their schools, and in physicians who, even with few resources, practiced medicine with empathy and intentional care. These experiences taught me that medicine is never only about treating disease, but about restoring dignity, sharing knowledge, and meeting people where they are. The physicians I shadowed modeled what it means to care for the whole person, listening to stories, acknowledging mental as well as physical well-being, and ensuring that every patient left feeling seen. Their example reshaped the vision I hold for myself as a future physician. I want to carry forward what Peru gave me: the discipline to look beyond symptoms, the humility to learn from every patient, and the responsibility to use my own privilege to bridge gaps in care. One day, I hope to stand fully in that role, offering my patients the same compassion and hope I once witnessed in Peru. Un día.

Overall, I really enjoyed my time with IMA in Peru. I thought the program was very well organized and thought out. Our mentors/coordinators were great and easy to contact when needed. As the fluorescent light of the operating room shone on my face, I looked over to my father in awe of his work after performing an Ablation on a patient. From a very young age, I was exposed to the medical field and the U.S. health system, as my father is a cardiologist and my mother was a nurse. After my first visit to the hospital with my father to shadow him, I knew the medical field was where I wanted to be in terms of a career. Fast forward to my sophomore year of college, and I knew it was time to get serious and find unique ways to gain medical experience. That’s when I stumbled upon International Medical Aid online. I had no prior knowledge of this program except that a friend of a friend had completed it in the past, and I had seen a few photos from her time in Peru. Almost completely unsure of what was yet to come, I later embarked on my journey to Cusco, Peru. The feelings of excitement, curiosity, and eagerness were overwhelming, but I was excited to see what was yet to come. I had set many goals for myself before leaving for this trip, the main one of which was to explore different careers in medicine. During my time shadowing in the U.S., I spent time with only a Cardiologist, Pharmacist, and Anesthesiologist. After spending many days with an Anesthesiologist and Anesthesia Assistants, I was set on attending anesthesia assistant school rather than medical school. Now that I have spent time at Hospital Nacional Adolfo Guevara Velasco – EsSalud with General Medicine physicians, Pediatricians, Gynecologists, Obstetricians, and Ultrasound Specialists in Peru, I have decided to keep an open mind about attending medical school since I need to take the MCAT before anesthesia assistant school anyway. My favorite department that I spent time in was Ultrasounds, shockingly. I was not expecting to enjoy this specialty as much as I did, but being able to actually perform ultrasounds on patients and learning how to read them really sparked my interest. I also thoroughly enjoyed being with the Obstetricians, seeing the joy on the mothers’ faces, and hearing their babies’ heartbeats was so rewarding. One thing that stood out to me was that, regardless of the department, a large number of patients were seen within a short period of time. For example, one morning when I was in General Medicine, the doctor saw eighteen patients in the span of 3 ½ hours. That being said, I noticed many differences between the way medical professionals and patients interact with each other in Peru versus the United States. There were many times when other patients would walk into an examination room while the physician was meeting with another patient. This caught me off guard because in the U.S., this would not be tolerated, as it is seen as an invasion of the patient's privacy. I also remember Dr. Pedro (General Medicine physician) telling me, “Patients come to doctors with symptoms and expect a remedy; if the doctor doesn’t provide a fix, they are considered to be bad at their job.” I’m unsure why, but this stuck with me because it made me think about the cultural viewpoint that patients in Peru have on healthcare and doctors. Both of these instances made it seem as though patients in Peru feel they are superior to other patients and that the doctors don’t receive as much respect as they deserve. Oftentimes, patients would speak openly about their concerns or disregard for their physician, which can be a good thing, but also is something you don’t see often in the United States. The overall relationship between patients and doctors was something that stood out to me as I was observing. As a student also pursuing a certificate in Public Health, being immersed in the Peruvian health system was eye-opening and put my learnings into perspective. I had recently taken a class called “The U.S. Health System in a Global Context,” where we learned about foreign healthcare systems, the role insurance plays worldwide, and different cultural views on healthcare. Although I wasn’t specifically taught about the Peruvian system, after learning about it through IMA, I was able to quickly compare it to the Canadian or German system. Much like the German and Canadian systems, Peru launched Universal Healthcare Insurance in 2009 (International Medical Aid, 2024). While the country as a whole is still working to achieve this, it’s in the process of expanding public and private sectors. Peru is made up of two different public sectors. MINSA, the Ministry of Health, provides healthcare for low-income informal workers. EsSalud (one of the hospitals we were in) is a type of social health insurance that covers formal workers and their families (International Medical Aid, 2024). I found learning about this interesting because I have spent a long time learning about U.S. insurance plans, such as Medicaid and Medicare. In terms of quality of care, the U.S. has high-quality care available. Outcomes on certain health measures, like long-term health and certain treatment results, can be worse than in other wealthy countries. In Peru, quality varies, with private providers generally offering better services but higher costs. The public system struggles with strained resources, fragmented communication, and long waiting times for appointments and procedures. Aspects of public health vary between the U.S. and Peru; having first-hand exposure to a foreign system will be beneficial in my studies moving forward. One challenge I faced while being in South America was the language barrier. In high school, I had taken German classes; therefore, I knew little to no Spanish when I entered the internship. This was my biggest worry before leaving for Peru; I was concerned about how I would communicate with/understand patients and the medical professionals I would be working with. Oftentimes, I was paired with someone in my cohort who spoke or understood Spanish proficiently, but there were a few days I was alone in the clinic. Being in this position allowed me to push myself and become creative in my communication methods. I always had a translator app pulled up on my phone to help me understand what was being discussed between the medical professional and the patient. Although sometimes inaccurate, having a translator gave me a general idea of what was going on and allowed me to engage in the consultation versus just observing. I also learned that hand gestures were a fun way to communicate, especially in pediatrics. After taking the provided Spanish classes and being surrounded by so much Spanish, I am more confident in my Spanish understanding skills. Language barriers are something I am likely to face again while working in the medical field. The skills I gained from this experience will allow me to navigate those situations better and communicate smoothly in the future. My favorite part of the internship was the day we visited the rural town of Casacunca and set up a Community Medical Clinic for the town's residents. This was when I applied my learnings from our Clinical Simulation Sessions at the Hospital Nacional Adolfo Guevara Velasco – EsSalud. After being taught how to perform an initial patient workup, being able to apply it hands-on with real patients made it a full circle. During the clinic, we saw many families with young children, the majority of whom presented symptoms of anemia. Poor appetite, fatigue, and slowed development were all prevalent when doing initial work-ups. Anemia is an indicator of poor health and nutrition (International Medical Aid, 2024), therefore coinciding with the fact that these patients live in a rural area with a lack of resources. My most memorable patient interaction was with a 60-year-old male who came to us with upper left leg/hip pain. He presented with an X-ray of his hip from 2019 that showed a clear fracture in his right hip. Without updated scans, we couldn’t determine the state the fracture was in, so we diagnosed him with atrophy. All we could do was suggest that he go to Cusco for new scans, a hip replacement consultation, and prescribe Meloxicam to help manage the pain. While conducting a physical exam, we noticed worrisome symptoms such as severe hand tremors and a fixation of the eyes. These symptoms suggest that the patient likely has Parkinson's disease, but without an official neuro exam, this could not be confirmed. The reason this patient stood out to me was that it put into perspective how many people struggle with underlying symptoms but never receive the opportunity to be treated due to location and resources. Although it was sad to see struggling patients, this was such a rewarding and fulfilling day. Being able to treat those who needed help confirmed my love for working within healthcare and pushed my drive to continue down this path. Overall, my time spent with International Medical Aid in Cusco will be something I always remember. Whether I was attending Spanish class, exploring local markets, shadowing in the hospital, or giving health presentations to children, I was always learning and exploring. I not only achieved the goals I had set for myself, but I exceeded them. In just three short weeks, I watched myself grow as a person and became even more passionate about pursuing a career in medicine. Being in Cusco changed my outlook on not just the medical field, but life in general. Every chance I had to immerse myself in the Peruvian culture, I took it, and I am grateful I was given opportunities to do so. In addition, having first-hand experience in another healthcare system has helped me make connections between things I am learning in school (public health classes) and real life. All in all, this internship has taught me many things, and I can’t wait to take those learnings into my future endeavors, whether that be school or a career. It truly was a once-in-a-lifetime experience, and I forever have IMA to thank for that.

I had a truly memorable experience in Peru. Every single aspect of the program was meticulously planned, and everything ran smoothly. All of the mentors were very helpful, concerned for our well-being, and in constant communication with us. They also interacted with us in a way that showed they were our friends rather than our superiors, which is something I greatly appreciated. The accommodations made me feel right at home and safe, and we had a variety of food that was always very well prepared. With regard to the clinical aspect of the program, all of the physicians were more than happy to answer any questions and ensured that we understood what each patient was dealing with by giving us a short debrief after every consult. From teaching kids about oral hygiene to setting up a clinic in a rural community, I felt we had a tangible impact on the community, which was a very fulfilling part of the program. All of the students we presented information to were excited to learn, participated in answering questions, and were grateful. The clinic we set up in the rural town was an eye-opening experience where we saw differences in resources between the city and rural communities firsthand. Overall, I am grateful to have been given the opportunity to spend three weeks in Peru, where I learned so much about the culture, people, and healthcare system and met some amazing people. Thank you, IMA! The touch of the textured ice cream cone, taste of vanilla, aromatic scent of waffle cones, sound of laughter, and sight of good company are what my senses were occupied with on my last night at home before embarking on my journey to Peru. My friends and I went to Graeter's Ice Cream, a local chain, after our weekly Friday night dinner at Buffalo Wild Wings. After enjoying our time together and finishing off the last of our sweet treats, we began to say our goodbyes, at which point one of my friends asked me, “So Arya, what exactly are you going to be doing in Peru?” I responded, “I am honestly not sure.” That was the truth. Although I had a high-level idea about the program, I did not know what to expect. It only occurred to me when my friend questioned me that the familiarity of home was about to disappear. So much, if not every aspect, of the trip was unknown to me at the time. Where was I going to be living for three weeks? How were the other members of my cohort going to be? Were the hospital staff going to be friendly? Was it even going to be worth it? As I continued to ponder these questions while driving home, I quickly realized I had adopted the wrong mindset. I knew that the best course of action would be to embrace the uncertainty rather than be so worried. Instead of going to sleep nervous that night, I went to sleep excited in anticipation of what was to come. The next day, I went on a last-minute shopping spree before I gathered my belongings and headed to the airport with my parents. The process at the check-in counter felt familiar, as my family and I travel to India every year to visit our extended family, but my dad always takes care of our passports and ensures our bags arrive with us. This time around, I was responsible for everything, which was a bit daunting, especially considering the number of times my parents reminded me not to lose my passport. After checking in my bags, my family and I approached the security line where we exchanged hugs and bid farewell to one another. The journey to Peru itself had a couple of challenges, as a flight delay and long immigration line caused me to miss my connecting flight from Lima to my final destination of Cusco. However, nothing could have taken away from the beauty of Cusco after seeing the vibrant city tucked in between the vast mountainous terrain upon exiting the airport. Immediately, I felt a sense of comfort after being greeted by our mentor Cynthia and meeting some of the other interns. Following our arrival at the accommodations, becoming acquainted with the other interns and mentors, and listening to a presentation about the structure of the program, I went to sleep that night knowing I would not regret coming on this trip. The very next day, we were given a very informative tour of the city by our guide Hans Ramirez. In addition to seeing Sacsayhuamán and preparations for Inti Raymi, one notable attraction that we visited was the San Pedro Market. Here, Hans invited us to try various local delicacies including pan chuta and cherimoya. Hans also stated that the use of naturally derived medicine, such as herbs and fruit, to treat various ailments is very common in Peru and originated from Incan practices. For instance, all of the interns were recommended by our mentors to drink coca tea, made using coca leaves, to help with altitude sickness. I greatly resonated with this aspect of Peruvian culture, as being of Indian descent has given me the opportunity to experience such natural methods of healing firsthand. For example, my mother would always combine ginger juice and honey to cure congestion or a sore throat throughout my childhood. In fact, there is a natural system of medicine that originated in India thousands of years ago known as Ayurveda. Generally though, many Western communities heavily rely on the use of synthetic products instead of natural remedies due to what seems like the widespread belief of most Americans that only medications made in a lab by professionals have the ability to produce tangible results. After a very thorough acclimation to the city and its rich history, I was excited to begin shadowing physicians at Hospital Nacional Adolfo Guevara Velasco–EsSalud. The following day was my first day rotating in EsSalud, where I would spend the next three weeks learning a plethora about healthcare in Peru through my time in the gynecology, nutrition, general medicine, geriatrics, obstetrics, and nursing departments. My first realizations were the stark contrast in the structure and organization of EsSalud compared to similar facilities in the United States, as well as the widespread use of paper over electronics for many processes. At EsSalud, patients would come to practitioners who were situated in their own rooms, which was a foreign concept to me considering it is the other way around in the United States where patients are ushered into their own rooms by nurses and assessed by providers who come to those rooms. As a matter of fact, it is a common practice for nurses in the United States to make initial contact with a patient to obtain various pieces of information related to the patient’s health including weight, a baseline set of vitals, relevant history, and the patient’s reason for visiting depending on the type of doctor the patient has come to see. At EsSalud, on the other hand, the doctors had to assume the role and responsibilities of a typical nurse in the United States by discerning the patient’s motivation for seeking a consultation through analyzing signs and symptoms, as well as taking vitals including blood pressure and blood glucose if necessary, which we, the interns, would often assist with. I was also surprised to witness the lack of supporting personnel for physicians at the O2 Traveler’s Clinic, a private medical center that I had to visit after experiencing throat pain and general malaise. The practitioner who examined me took care of everything from asking me about the onset of my symptoms and the quality of my pain, to writing down everything I was saying, conducting a physical exam, and prescribing medication. On a related note, patients receive prescriptions and referrals to other doctors on paper. This was interesting since everything that occurs after visiting a doctor in the United States is done electronically and essentially taken care of automatically. Patients simply have to pick up prescriptions from the pharmacy and attend any follow-up appointments if necessary. Patients in Peru, on the other hand, have more responsibilities when it comes to keeping track of their medical records, which can make organization especially important. On the topic of comparing EsSalud and the O2 Traveler’s Clinic, it is important to understand the composition of the healthcare system in Peru and the United States, both of which are separated into public and private sectors, to put differences into context. In Peru, the public sector includes the Ministry of Health (MINSA), EsSalud, Armed Forces, and National Police. MINSA is responsible for providing health services to around 60% of the population, especially individuals who are uninsured, while EsSalud covers those who are formally employed. The Armed Forces and National Police provide their own services to members. The private sector is comprised of for-profit and nonprofit organizations that provide services to people who can afford them (Borgen Project, n.d.). Similarly, in the United States, federal programs including Medicare, which supports the elderly and those with disabilities, and Medicaid, which covers low-income individuals as well as people with disabilities, make up the public sector. The private sector consists of private health insurance companies which are subsidized in many cases by employer-sponsored group plans (Commonwealth Fund, 2022). While it may seem like both countries have their bases covered, that could not be farther from the truth. A report published by The Commonwealth Fund in 2014 states that the United States struggles with disparities in health outcomes, service quality, and access to care despite the country’s healthcare system being one of the most expensive in the world. This report highlights the need for systemic reform, as well as improving access, efficiency, and equity due to high out-of-pocket expenses and insurance costs limiting access to care (Commonwealth Fund, 2014). Similarly, a study done by the World Bank describes how the fragmentation of Peru’s healthcare system, due to the number of entities providing services and challenges associated with administering care across an often remote landscape, has resulted in uneven access to healthcare as well as disparate health outcomes. This study also discusses the importance of providing access to healthcare to remote communities where infrastructure is subpar, as well as the lasting out-of-pocket payments for certain portions of the population despite the implementation of the Comprehensive Health Insurance (Seguro Integral de Salud, or SIS), a publicly funded insurance program that aims to help the poor. Some solutions the study offers include improving the quality of care through reforming each health sector in addition to addressing coverage, access, quality, and financial protection to achieve health equity for all (World Bank, n.d.). Various practitioners that I shadowed at EsSalud emphasized the prevalence of such issues. For example, Dr. Fabricio Wiesse explained to us during lecture that Peru lacks sufficient laboratory resources, resulting in doctors having to rely heavily on interviewing patients and conducting physical examinations to arrive at a diagnosis. Another provider stated that there are not a lot of specialized doctors in Peru and that the country does not have the resources to produce medications that many patients need. The same doctor went on to say that the only way to obtain such medications is by leaving Peru, and the pension that people get paid is not very high, which can make access more difficult. Another physician told us that emergency rooms in Peru are very busy, and people who have conditions that can be treated during a consult at a hospital such as a headache sometimes go to the ER, which can make it harder for people with life-threatening emergencies to be seen quickly. The same practitioner also talked about how patients with chronic conditions like diabetes are prescribed medicines for three to four months but have regular checkups to ensure their condition is being controlled since some patients sell their medication. Despite being faced with a lack of resources and strenuous circumstances on a daily basis, the providers at EsSalud are truly admirable for upholding their promise to provide the highest quality care to their patients. They showed me the importance of being adaptable in an ever-changing environment as a doctor regardless of the location, resources, and facilities. As I continue to pursue my career in healthcare, my experience in Peru has further motivated me to focus on acquiring knowledge and skills that could be applied in different parts of the world. This would enable me to benefit a larger section of the global population when opportunities arise for me to work outside the United States. In addition to learning about the use of natural resources to treat ailments, other aspects of Peruvian culture became apparent while shadowing at EsSalud. One such characteristic is the unique relationship between physicians and their patients. At EsSalud, practitioners and patients would treat one another in a manner similar to that of family members or loved ones, which was heartwarming. During a rotation in the adult infirmary, we learned that it is common for people in Peru to be hypertensive due to the excessive consumption of salt. However, such dietary habits are hard to break since they are passed down from generation to generation and influenced by tradition. Seeing the uniqueness of Peruvian culture and even its impact on the health of the population reinforced how vital it is to have excellent bedside manner as a provider in order to make sure the patient knows they are being heard. In addition, being empathetic will allow me to make my patients feel like they are in a safe and comfortable environment to express their concerns. It is also equally as important to be culturally sensitive and take certain lifestyle choices into account when developing a treatment plan for patients. For example, it is common practice for people in Peru to consume their prescribed medication after breakfast and lunch since dinner is not often eaten. Being culturally competent will help me develop trusting relationships and optimize the experience for my patients. One of the most memorable parts of the trip was the clinic we set up in Mollepata, a mountain town around two hours away from the city of Cusco. Here, we were able to see firsthand the healthcare inequities between urban and rural communities. One such disparity is the severe lack of certain medications in rural areas of Peru. There was one instance where a patient needed a specific medication that the physician was not able to prescribe because that medication was neither one that we had brought with us nor was it one available in Mollepata. In addition, patients who were told to get imaging taken or received references to see specialized practitioners needed to drive two hours into the city due to the lack of such resources in the town. One unique case that I observed was that of an older gentleman who came into the clinic with fungus on his hands and a respiratory condition. It was sobering to see his condition, especially when considering the amount of time and energy it would take for him to receive the proper treatment. In spite of such challenges, it was fulfilling to have a tangible impact on addressing the issues affecting rural communities, no matter how small, as it is important to remember that change is enacted by taking small strides. My experience in Mollepata helped me understand how crucial it is to consider how I can have a positive impact on communities that are in need. One way of doing this is by not focusing only on jobs in urban locations, but also seeking out employment opportunities in areas of the country where there is a dearth of medical professionals. It goes without a doubt that cities generally have more resources to provide high-quality care compared to rural communities. Therefore, working in these areas would provide me with the opportunity to administer the same quality of care found in cities to individuals dealing with critical issues, as well as a greater sense of fulfillment. Mollepata also highlighted the necessity of community-based health education in order to provide people who do not have access to the same resources as their counterparts in the city with relevant information on how to protect themselves. The idea that caring for the well-being of patients as a practitioner does not end when they exit the room has motivated me to find opportunities that will allow me to act now and educate disadvantaged groups. Overall, I am very grateful for the time I spent in Peru, as it has opened my eyes to the similarities and differences in healthcare between the United States and other parts of the world, as well as how each country can learn from one another’s systems. My experiences have certainly altered my perception of what characterizes a good provider and have provided me with a clear-cut example of the type of doctor I want to become: one that is culturally aware, adaptable in the face of adversity, and focused on having the largest impact, taking after the meritorious professionals at EsSalud. I hope to live up to the words of Dr. Wiesse, who on our last day affirmed, “I might not be the best doctor in the world, but my patients know that I care for them.”

Participating in a three-week medical internship in Cusco, Peru, was truly a once-in-a-lifetime experience. The in-country support provided by International Medical Aid (IMA) was exceptional, ensuring a safe and supportive environment for all interns. The accommodations were comfortable and well-maintained, with staff who were attentive to our needs and safety. The food was delicious and prepared with care, providing a consistently safe and enjoyable dining experience. This opportunity allowed me to immerse myself in a different healthcare environment and significantly strengthen my medical Spanish skills. IMA offers more than just medical internships—they create narratives of hope, health, and humanity. Through this program, I gained a unique perspective on patient care and the importance of health equity. Working in the EsSalud clinic, I observed how diverse medical disciplines come together to serve the community. Each patient we treated, each smile of relief, and each word of thanks reaffirmed my commitment to compassionate care. I am deeply grateful for the chance to be part of this incredible experience and for the profound impact it has had on my personal and professional growth.