Internships in Guayaquil, Ecuador

What I enjoyed most about my Dental internship in Zanzibar was meeting new people and learning about a new culture. I gained a lot of knowledge about Zanzibar and made very meaningful friendships with those I met.

I felt safe and supported in all areas during the program. Staff and fellow interns made me feel welcome and comfortable during my stay. The whole experience has helped me to realize that I am pursuing what I would like to do as a career - clinical psychology. The staff in the psychology department at Coast General were open, friendly, and knowledgable. I had the opportunity to see diverse mental health cases and learn how different cultures address mental health issues. The most influential part of the program was the outreach we participated in at schools and community clinics. Speaking with the kids and community members was moving because I encountered both kindness and resilience. “Although the world is full of suffering, it is also full of the overcoming of it,” Helen Keller. My time with IMA and at Coast General Teaching and Referral Hospital in Kenya was utterly life-changing and exemplified that quote. The role of psychologists at Coast General Teaching and Referral Hospital is multifaceted. They are counselors for patients, their families, and doctors; they are the support system for those patients without family or friends; they are educators, explaining the health implications to patients for their individual physical ailments; and they are called in to convince patients to get crucial surgeries. Every day there are cases of schizophrenia, bipolar disorder, major depressive disorder, anxiety, postpartum depression, postpartum psychosis, post-traumatic stress disorder (PTSD), autism, cerebral palsy, and learning disabilities. Cases of deteriorating mental health continue to increase, particularly anxiety and depression, as a large portion of the population deals with poverty and fear from political instability. According to the IMA lecture on the disease burden in Kenya, “one in four Kenyans is likely to suffer from a mental disorder at some point in their lives” (IMA, 2025). The psychologists have an added barrier to their work because of widespread stigma against mental health care. Mental health professionals have a battle to fight against stigma in every country and society, but people’s preconceptions differ from culture to culture. I arrived in Kenya with an understanding that there was pervasive skepticism and distrust towards mental health, but I did not expect to encounter a widespread belief in witchcraft. Almost every day, at least one patient would blame witchcraft or karma as the reason for their suffering or the suffering of a loved one. Someone experiencing psychosis, addiction, depression, or the loss of a child in childbirth might explain it away as the result of being cursed by a witch, or a consequence of wrongdoing by them or a relative. Thus, patients refused psychological care, disbelieving that anything other than praying to God or seeing a traditional healer could free them from their suffering. When the psychology department was called to the wards for specific patients, many of them would ask, “Are you talking to me because you think I’m crazy?” They feared this label and made it clear that we could talk to them if we wanted, but they were nothing like the “crazy people” we usually speak to. Mental health stigmas come from more than fear of the supernatural. In the United States, people also fear seeking treatment because of potential discrimination. This discrimination is a product of centuries of misunderstanding the brain and mental illness, and viewing negative representations of those with mental health disorders in the media. According to the American Psychiatric Association, even when people understand the medical and biological aspects, mental disorders still have a bad connotation and people will go out of their way to avoid those who suffer from these conditions (Singhal, 2024). The better my understanding of these social and cultural stigmas, the better clinician I will be in the future. Treatment of patients who believe their disease is a spiritual or metaphysical problem will be different from treatment of those who see it as biological or emotional. It is not helpful to deny the patient’s belief and attempt to psychoeducate them because such beliefs are often deep-rooted. The delivery of mental health care at Coast General is largely the same as treatment in the West, though provider strategies differ slightly. A combination of counseling and prescription medications are used for psychological disorders, but care at Coast General goes far beyond mental disorders. As the medical doctors have limited time to spend with their patients, psychologists fill in the gaps and take on the responsibility of explaining patient conditions and treatments. Low levels of health literacy among patients complicate communication between the patient and health care provider. I witnessed multiple difficult moments with patients’ family members and real moral dilemmas in terms of approaches used to communicate the need for certain treatments. At least once a week we visited the mother of a three-year-old boy who was being cared for in the ICU. I sat with her for the first time as the psychologist explained that her son was initially misdiagnosed. The doctor understated the severity of the boy’s heart condition and missed the gangrene consuming his left foot, up to his ankle. We informed her that her son needed heart surgery as soon as possible, required his leg amputated, and still only had a 50% chance of surviving. The mother held an immense sadness behind her eyes but sat stone-faced and strong as she expressed gratitude for the psychologist’s honesty. The doctors avoided her and she was in the dark before we saw her. She said she understood the limited resources of the hospital and would be satisfied with the doctors’ best efforts. We visited her multiple times to update her on her son’s condition, finally giving her the date of his upcoming surgery after three weeks of waiting. She was grateful and I was hopeful for the boy until my final day at Coast General, when the psychologist informed me she had to tell his mother her son could no longer get surgery. He was too malnourished and his vitals were too low to survive the procedure. He would die in a few days. Patients often expressed distrust of the medical providers at Coast General. Some, such as the three-year-old boy’s mother, understood that few other choices exist, despite a lack of resources at this hospital. However, others preferred to take their chances without treatment. In these cases, the psychologists applied any strategy they could to change the patient’s mind, even if it required strong persuasion. One mother refused to let her five-year-old son receive heart surgery that would increase his chance of living by 20% because she did not trust the capabilities of the doctors. The psychologist sent to speak with the mother told her that she was in luck: a specialist from Nairobi was coming to the hospital. He visited only once a year and received a limited list of patients to perform surgery on, and her boy made it onto the list. At this news, the mother agreed for her son to receive the surgery. However, this specialist from Nairobi did not exist and the surgery would be performed by a Coast General surgeon. The psychologist explained her choice as the only option because the mother was risking her son’s life based on fear and this was unfair to the child. Another patient, a sixteen-year-old girl who had just given birth, had a tear from her vagina to her anus and needed to get stitches, but refused. She was afraid of experiencing more pain after the agony of childbirth. The psychologist began the conversation explaining the risk of infection and other health problems that could result without suturing the tear. However, as the girl did not seem convinced, the psychologist switched tactics and told her that without stitches, her husband would leave her because she would no longer have a tight vagina. This, the psychologist explained, was a greater fear than the risk of infection and death. I continue to wrestle with whether these decisions to scare patients outweigh the problems that might result from declined procedures. A population of people the psychologists treat with regularity are those who have experienced gender-based violence (GBV). GBV has been a long-time problem in Kenya, and similar to mental illness, it is a taboo topic. The GBV patients I encountered were often soft-spoken and reluctant to talk about their specific experiences with violence, while able to converse on other topics. This is particularly the case for male victims. The GBV clinic psychologists explained that male victims do not often come forward because of shame and the feeling of weakness. However, the psychologists also said that any victim who does not speak about their experiences has a higher likelihood of becoming a perpetrator to others. It is also common for families to try and handle the situation among themselves, making it difficult to pursue justice. The fear of stigmatization by others outweighs the desire to report the incident to police. The GBV clinic at Coast General is one of very few in the country and was partly funded by the United States Agency for International Development (USAID) before it was disbanded by the Trump administration. USAID targeted GBV in Kenya by funding “shelters, medical care, counseling, legal aid, and educational initiatives” (Burkybil, 2025). A plaque in the psychology office read, “The Medically Assisted Therapy (MAT) Clinic at Coast General Hospital was officially handed over to the Governor of Mombasa County H.E. Ali Hassan Joho on the 11th September 2015. The facility was refurbished and equipped by UNODC [United Nations Office on Drugs and Crime] with financial support from USAID”. I saw similar signs and brandings of USAID around the hospital, on trash cans and equipment, with the words “From the American People”. My breath caught in my throat the first time I saw this as I had never seen firsthand evidence of the work done by USAID abroad. It made me reflect on how much these programs matter, and how real their impact is on everyday care. Based on these experiences, I feel inspired to write my college senior thesis on gender-based violence and the effects that ending USAID has internationally. My time with IMA in Kenya confirmed my desire to pursue clinical psychology and work for a humanitarian organization, like Doctors Without Borders. Trauma psychology, advocating for better mental health care, and education on mental health are my primary interests. Since returning to my home in the United States and sharing my stories with others, I realize that simply sharing makes an impact on those around me. Describing my experiences and recounting interactions with patients and children, and the examples of USAID’s impact in the country, are transformative to others I’m told. My participation in the East Africa IMA program is a lifetime gift resulting in an increased understanding of cultural differences, helping me be a better global citizen, and impacting my future career.

Overall, I truly can’t say anything but great things about this program. The bonds I made with my fellow interns turned into strong friendships, and it was incredible to experience the entire internship surrounded by such supportive, inspiring people. Our accommodations and food in Peru were top-notch, which made the whole experience even more enjoyable. I genuinely believe the professional growth I experienced during this internship was invaluable. I gained practical skills that will benefit me throughout my future career. I left feeling deeply inspired to keep working toward my goals, but also extremely grateful for an experience that will stay with me forever. Working in such a supportive environment allowed me to thrive, and I couldn’t have done it without the guidance of the doctors I interacted with and my Program Mentors.

During my time in Mombasa, from the moment I exited the airport doors, I felt safe, heard, and cared for. The housekeeping and kitchen staff were all amazing at both their work of keeping our area clean and making delicious meals for us, and at bringing a positive energy into the residence. We would always be reminded of how we need to stay positive and have an amazing day, and those little reminders would be an instant mood booster. Grace was amazing. She would do some morning affirmations with us: I am kind, I am positive, I am worthy. I will never forget her, and I still practice these affirmations in my day to day. The kitchen staff looked after us so incredibly well, accommodated my alimentary preferences, and would always start small talk. I also want to highlight our amazing security guards and how precise they were. I truly felt safe at all times both inside and outside the residence. Overall, I have nothing but kind words to say about my time in Mombasa; the mentors and all the staff made this experience that much better. During my time in the dental unit at Coast General Teaching and Referral Hospital, I learned that dentistry is not only about treating the symptoms patients present with but also about paying attention to the small details. I realized I naturally look for these details, even outside the hospital. One day, while riding to the beach with friends in an Uber, I offered gum I had brought from Madrid to everyone in the car. The Uber driver then asked me about all the gums I've tried. I went on to explain why and describe all the gums I've tried from different parts of the world. He looked at me and said, “You really have an eye not everyone has.” That is true. I am curious as they come, and my curiosity was sparked during my time in the dental department as I sought to understand not just the “what” but the “why” behind each step of care. Every morning, I greeted patients with a cheerful “Habari!” and was rewarded with a smile and curiosity about how I had learned Swahili. Bryan, the staff member responsible for keeping the clinic clean, made sure I practiced by greeting me in Swahili each day. These small cultural exchanges helped me connect with patients before they even sat in the dental chair. Regarding our different backgrounds, life experience, and language barriers, there was a deep level of understanding of the patient in a holistic manner. In Kenya, preventative dental care isn't as common as it is in the US or Europe. The cost of a healthcare premium is $5, although only around 26% of Kenyans have some form of healthcare insurance (IMA, 2025) due to this price being a financial burden for many. Keeping in mind that half of the population are unaware of measures that can be taken to prevent dental disease (Barber S, 2010). This puts into perspective why the condition of the patients' oral health is so poor; the lack of awareness and tools to prevent, combined with the financial burden that it is to get the issue under control. Most of the oral health treatment expenses are out of pocket and with low insurance coverage (Kenya National Oral Health Policy, 2022). Under Dr. Rajeev, “Dr. Raj” to us, I assisted in several procedures and discovered how dentistry adapts to different realities depending on the resources at hand. The first procedure I observed was a root canal. I noticed the absence of tools I was familiar with, such as rubber dams, loupes, different rotary systems, or even a microscope. Despite these limitations, Dr. Raj displayed mesmerizing skills in performing such a complex procedure without magnification or specialized tools for the root canal. He would, some days, bring his own equipment such as mirrors or hand files due to the low quality of the ones provided by the hospital. With the x-ray machine broken in the department, he placed a temporary filling and referred the patient to a private hospital for radiographs. I quickly saw how resource limitations meant root canals often took 3–4 visits to complete, creating financial burdens for patients already from low-income backgrounds. I rotated through periodontics, oral surgery, prosthetics, and orthodontics. The specialties that fascinated me most were endodontics and pediatrics. With Dr. Maria, another intern in the pediatric department, I assisted in procedures such as pulpotomies, pulpectomies, and extractions. One memorable case was a 4-year-old child with autism. Though numb, she became overstimulated by the lights, drilling, and people around her, leading to a meltdown. My initial role was to help restrain her, but I also engaged her with toys I had in my pocket and calming words, which helped her refocus. Dr. Maria worked calmly under pressure, and after the procedure, she congratulated me and asked me to assist again. Another case involved a 3-year-old with advanced cavities in his front incisors. While Dr. Maria stepped out for supplies, I used the time to build trust with him, showing him the suction, water spray, and materials to reduce his fear. Once the procedure began, I distracted him as Dr. Maria administered anesthesia. These experiences taught me that pediatric dentistry requires not only technical skill but also patience, empathy, and creativity in creating a safe environment for children when the resources are limited. In Spain or in the US, pediatric clinics are designed to create a comforting and welcoming environment with toys, etc. Here, I tried to create that with my presence and words. Pediatrics became my favorite specialty because each child reminded me of my dual mission: to relieve pain and to create a safe, welcoming space for them. During our outreach clinics, during my breaks from assisting Dr. Ian in cleanings, I would take the opportunity to interact with the curious kids that were waiting right outside the dental area. I took a dental teeth model from the consult table and would pop quiz them on oral health. I asked them to show me how they would brush the model's teeth, and they were eager to get to do it, and I was eager to answer any questions they had. In addition, I spent two days in the prosthetics laboratory. Mansoor, a technician, showed me their creative but improvised methods of working. For example, they made their own Bunsen burners by filling a container with spirit, inserting a cotton wick, and lighting it to heat tools when working with wax. The lab environment, though functional, was crowded, disorganized, and limited in resources. Mansoor asked me about practices in Spain, and when I explained digital impressions, he and the other technicians were fascinated and eager to learn. They were explaining how their work would be quicker and more efficient with modern technology. In the emergency room, where Dr. Raj was on call, I saw patients with maxillofacial fractures, often from motorcycle or tuk-tuk accidents. Many never returned for definitive treatment because of the high cost of plates required for fixation. These systemic challenges opened my eyes to the intersection between dentistry, medicine, and socioeconomic barriers to care. Low prioritization to implement preventive and promote oral health programs has led to a demand for curative and rehabilitative services outstripping the facilities and human resources available (Kenya National Oral Health Policy, 2022). I also observed the use of products such as chloroform and formocresol without proper isolation. These were used to resolve gutta-percha in root canals and formocresol as intracanal medication. These medications came with negative side effects such as tissue necrosis due to negligent use as an anesthetic or as a dissolver without proper isolation preventing it from coming into contact with tissue in the oral cavity (Taghavi Zenouz, 2022). When I found this out, I asked one of the dentists if these risks were highlighted to the patient, and the short answer was “no”. I realized that whether it was due to the low literacy level of the patients or the lack of patient protection, patients weren’t educated the way they should be with all the risks that the procedure could have. I also noticed this during my night shift in maternity; the lack of provider-patient communication shocked me compared to what I had seen in the US. During one of the labors, the doctors were injecting medications in the mom with no prior warning or explanation as to what it was. As well as with pelvic checks, they just did what they had to do, without reporting the dilatation to the mother or indicating the stage of labor to the mother. This would leave patients disoriented and lost in their procedure, although the ratio of doctors/nurses to patients was so disproportionate that they didn’t have the time to fully educate their patient, because they had 20 other patients waiting for them due to the low amount of doctors and the high number of patients (Okoroafor et al., 2022). My weeks in Mombasa also exposed me to broader realities of the Kenyan healthcare system. Patients or their families were often responsible for transporting blood samples, buying plates, sutures, or even medications themselves. This was at times the nurses' task, although a doctor in the maternity ward was explaining that as a form of strike, due to the high number of patients per nurse and the low pay, nurses wouldn’t do these things at the speed that would be expected. This doctor went on to explain how he would at times go get CT scans, medications, or lab tests for patients to avoid them missing a dose of their medication or waiting all night for results. He seemed burned out due to this situation. He went on to exclaim, “I am tired too, but these people need us no matter how we feel.” As the internship went on, I realized that every x-ray, every case of fluorosis, and every fractured tooth represented more than a medical condition, it represented a person's battle with comfort, confidence, and dignity. This internship not only strengthened my technical understanding of dentistry but also deepened my appreciation for resilience, creativity, and compassion in healthcare, no matter where you are. Mombasa taught me lessons that will stay with me as I continue my journey in dentistry, appreciating the tools I have within my reach, and the team I will work with. I was able to fully grasp the similarities and differences dentistry has across the world. I was aware of the difficulties other developing countries faced, but it is not until you are facing those difficulties that you truly understand what they entail. I aspire to come back one day and be able to give back all the knowledge that I was given during my time in Mombasa. As someone who has called “home” multiple parts of the world, I was eager to see if Mombasa would fit into that category. It did. The people I met, the opportunities I encountered, and the lessons I will carry with me for the rest of my life all made Mombasa feel like home.

From the moment I arrived at the airport to the last moment at the residence, I received excellent mentorship and had an amazing experience. All of the mentors were attentive, friendly, and always had everything prepared for us. I was very satisfied with the meals, hospitality, and living arrangements, and I never felt unsafe at any point during my stay. The cultural treks were a wonderful addition to the clinical experience and helped me better understand the local community. Overall, everything exceeded my expectations, and my time in Kenya was truly unforgettable. Spending several weeks in Mombasa, Kenya, interning through International Medical Aid’s Pre-Dental Internship Program was one of the most eye-opening experiences of my life. As an undergraduate student who plans to attend dental school, I knew I wanted more than just classroom knowledge—I wanted to see what healthcare looked like in different parts of the world, especially in places where people don’t always have easy access to care. I hoped the internship would give me a better understanding of dentistry, but what I didn’t expect was how much it would impact the way I see people, healthcare, and my own future. I was placed in the dental unit at Coast General Teaching and Referral Hospital, one of the largest public hospitals in the coastal region of Kenya. From the first day, I was amazed by how busy the clinic was and how many patients arrived seeking care. Many had waited a long time to be seen, often because they couldn’t afford treatment at private clinics or because there simply were not enough dentists in the region. In the oral surgery department, I observed many extractions and abscess drainages. These procedures were often performed under challenging conditions—limited tools, time constraints, and a high volume of patients. Most of the people we saw were in serious pain and had delayed care until their symptoms became unbearable. We also treated patients with jaw fractures, tumors, and cysts—cases that would typically be addressed much earlier in more developed countries. Here, patients often came in only when the pain was no longer tolerable or when the condition visibly affected their daily lives. Beyond oral surgery, I spent time in other areas of the dental unit, including general dentistry, pediatric care, and cosmetic procedures. In the cosmetic area, I developed close friendships with several dental technicians who took the time to show me how they crafted and molded patient impressions. Watching them create these molds by hand, with such attention to detail, helped me see the artistic and technical sides of dentistry coming together. It showed me how much of dentistry is hands-on craftsmanship—and how rewarding that part of the field can be. One thing I noticed early on—and something I will never forget—was how deeply grateful patients were, even for what might seem like basic procedures. In many cases, the dental treatment they received was the first real care they had received in years, or even in their lifetime. Many patients left the clinic smiling, even after a difficult extraction or painful procedure, simply because their pain had been eased. One patient in particular stands out in my memory: a woman who came in with a serious dental abscess. She had been living with swelling and pain for weeks but delayed care because she couldn’t afford treatment or take time off work. When the team finally drained the abscess and relieved her pain, she was overwhelmed with emotion. She held my hand, looked me in the eyes, and thanked the entire team for helping her. That interaction taught me more about the human side of healthcare than any textbook ever could. It reminded me why empathy is so important—not just in medicine, but in life. These moments of connection were everywhere. Whether I was helping a child feel calm before a check-up or observing a young man’s reaction after getting his teeth cleaned for the first time in years, I felt more and more certain that I was on the right path. Dentistry isn’t just about treating teeth—it’s about restoring confidence, easing pain, and helping people live their lives more fully. Before going to Kenya, I had read about healthcare disparities and access issues in developing countries, but it is one thing to read about them and another to witness them firsthand. I quickly saw how the lack of resources, infrastructure, and funding affected both patients and healthcare workers. Coast General is a teaching and referral hospital, yet they often didn’t have enough basic dental supplies. There were days when the team had to get creative or work with whatever was available to treat patients. I also noticed that many of the conditions we saw could have been prevented with earlier treatment or better education. Dental hygiene tools like toothbrushes, floss, or even clean water were not always available to patients. Preventive care—something I had always taken for granted—was not common in many parts of the community. People simply didn’t have access to the resources or information needed to maintain good oral health, which led to more serious and costly issues over time. According to an IMA lecture on healthcare systems in low-resource settings, one of the biggest challenges is the “delayed care model,” where people only seek treatment when their condition becomes critical (IMA, 2023). I saw this everywhere. Patients weren’t neglectful—they were doing the best they could with what little they had. This made me realize how important community-based health education is and how much of an impact even basic awareness can have. Living and working in Mombasa also gave me the chance to engage with a culture very different from my own. From local food and music to traditions and social customs, I learned so much simply by listening, observing, and asking questions. I was especially touched by how welcoming the staff and patients were. Even in moments when I felt out of place or unsure, people took the time to teach me and include me. The dental technicians I grew close to didn’t just show me their work—they welcomed me like a younger sibling. We talked about our different upbringings, laughed about the differences in slang and language, and even arm wrestled. I learned a few phrases in Swahili, and they teased me kindly when I mispronounced words. Through these moments of cultural exchange, I began to appreciate the power of kindness, curiosity, and humility in building trust—not just with coworkers, but also with patients. Working in this environment made me think deeply about my future and how I want to practice dentistry. I realized that I don’t want to be a dentist who only works in a comfortable clinic treating patients who can easily afford care. I want to be someone who actively looks for ways to give back—whether that means volunteering my time, serving underserved communities in my own country, or returning to places like Mombasa to provide care. I also became more aware of how public policy, infrastructure, and government systems shape access to healthcare. Kenya’s national healthcare system has made progress in expanding coverage, but underfunding, political instability, and uneven distribution of services continue to pose challenges (World Health Organization, 2021). This experience showed me that being a healthcare provider isn’t just about what happens in the clinic—it’s also about advocating for systems that support equity and access. The IMA global health curriculum emphasized this as well. One lecture noted that “healthcare providers must understand the sociopolitical structures that influence patient care, particularly in low-income settings” (IMA, 2023). That point stayed with me because it reinforced the idea that medicine doesn’t exist in a vacuum. As a future dentist, I want to use my voice not only for individual patients, but also to support policies and programs that improve health on a larger scale. Looking back, I feel incredibly fortunate to have had this experience. It pushed me out of my comfort zone, helped me grow both personally and professionally, and confirmed that dentistry is the right path for me. More importantly, it showed me the kind of provider I want to become—empathetic, hands-on, and committed to serving those who are often overlooked. I want to use what I’ve learned to help people with their dental needs while also advocating for better access, more education, and more compassion in healthcare. Whether I am treating a child in a high-tech clinic or helping someone in a mobile dental unit, I will carry the lessons from Mombasa with me. I’ll remember the people, their stories, and the moments of gratitude that made every day in that dental unit meaningful. In the future, I hope to work with organizations that serve low-income communities, both at home and abroad. I would love to participate in dental missions and work in community health centers to provide care and education to those who need it most. My goal is to take the privilege of my education and pay it forward—to use my skills to improve lives, one patient at a time. My internship with International Medical Aid didn’t just teach me about dental procedures or hospital systems; it taught me about people. It reminded me that behind every tooth is a story, a struggle, and a human being who deserves care and dignity. It showed me that healthcare is about more than tools and techniques—it’s about listening, learning, and doing the best you can with what you have. This experience will stay with me for the rest of my life. It has shaped not only how I see the world, but also how I see myself. I am more motivated than ever to become a dentist—not just to practice a profession, but to make a real difference in people’s lives.

My experience with IMA was truly one of the most meaningful and unforgettable journeys I’ve ever had. Not only did I have the chance to explore the rich culture, heritage, and cuisine of Mombasa, but I also gained invaluable insight into the local healthcare system. I had the unique opportunity to support dental professionals in a clinical setting, which deepened my appreciation for global dental care and patient-centered treatment. The hospitality throughout my stay was exceptional; the staff and medical professionals were incredibly welcoming, supportive, and kind. IMA created the perfect balance between cultural immersion and clinical exposure. I wholeheartedly recommend this internship to anyone looking to grow both personally and professionally in the healthcare field. As a Health Sciences student born and raised in Canada, I was always aware of the structural advantages of our healthcare system. Universal healthcare, preventive care, and routine dental visits were all part of the fabric of my life growing up. However, I never truly appreciated the scale of global health disparities until I participated in the International Medical Aid (IMA) internship in Mombasa, Kenya. During my two-week placement in the dental unit at the Coast General Teaching and Referral Hospital (CGTRH), along with outreach education at local schools, I witnessed first-hand the resilience of providers, the creativity demanded by resource scarcity, and the tragic consequences of systemic inequities. This experience deeply altered my understanding of healthcare and solidified my long-term commitment to becoming a dentist who not only treats patients, but advocates for access, education, and equity. My placement at CGTRH’s dental unit was an intense immersion into a high-demand, low-resource clinical setting. Under the supervision of local dental professionals, I observed procedures that I had previously only read about, and in some cases, never imagined performing without the basic tools I had always taken for granted. The dental unit was constantly overwhelmed with patients, most of whom came in with severe, irreversible oral conditions due to lack of early treatment. One of the most eye-opening aspects was the frequency of extractions. Unlike in Canada, where cavities are treated with fillings and root canals are routinely performed to preserve natural teeth, extractions were the default intervention in Kenya. The concept of restorative dentistry was, in many cases, financially and practically out of reach for the average patient (IMA, 2025a). I witnessed multiple cases of impacted wisdom teeth removal, with patients often enduring prolonged discomfort and swelling before seeking care. One case involved horizontally impacted molars causing nerve compression and jaw swelling. Due to space constraints and tissue overgrowth, the extractions were highly invasive, and the patient left with instructions for limited follow-up, partly due to the understaffed unit and partly because many patients lacked the means to return. A particularly memorable case involved a man who fell from a roof, suffering a complex craniofacial injury. The diagnosis revealed bilateral Le Fort III fractures, mandibular fractures, orbital wall injuries, and a fractured nasal septum. In Canada, he would have immediately been managed by a trauma team including maxillofacial surgeons, radiologists, and anesthesiologists. In Mombasa, the patient had to wait for a CT scan due to limited access and cost and ultimately underwent mandibular-maxillary fixation (MMF), a technique that wires the jaws shut to heal fractures. While effective, the treatment posed challenges to feeding, breathing, and hygiene, and highlighted the difficult choices faced by both patients and clinicians (IMA, 2025a). I also observed alveoloplasties, surgical procedures where the alveolar bone is reshaped in preparation for dentures. Most patients had lost all or most of their teeth, not due to age, but because they couldn’t access care early on. Many had never been educated on proper brushing or flossing, and their diets, often high in starch and low in calcium, exacerbated the problem. The more time I spent with patients, the more I realized how dentistry intersects with nutrition, education, and economic policy (IMA, 2025c). Alongside clinical work, one of the most transformative parts of the internship was participating in hygiene education sessions at Shimo La Tewa Primary School and Makande Girls' Secondary School. At the primary school, we led informal sessions using demonstration props to show children how to brush their teeth and the importance of oral hygiene. The children were excited, curious, and surprisingly unaware. Many had never owned their own toothbrush or used toothpaste. Some were visibly shy about their dental conditions, stained teeth, loose teeth, or visible decay (IMA, 2025c). At the girls’ school, we led a comprehensive health session focused on women's menstruation. The environment was more structured, and the questions we received were thoughtful and candid. It was clear that there was a hunger for health information, but a lack of structured avenues to receive it. These sessions highlighted the urgent need for early preventive education (IMA, 2025c). By the time many of these children become adults, the damage to their teeth is often beyond repair, leading to infections, poor self-esteem, and preventable complications. What struck me was how much of the problem could be prevented with minimal intervention: education, access to toothbrushes, fluoridated toothpaste, and routine screenings. It inspired me to consider incorporating school-based education and outreach into my future dental practice. Prevention must begin in childhood, and we must meet people where they are. The disparities between Kenyan and Canadian healthcare systems were stark. In Canada, we benefit from a publicly funded model where essential medical and hospital services are covered. In contrast, Kenya’s system is fragmented, with a mix of public and private services. While the public sector is more affordable, it is also severely underfunded (IMA, 2025a). As IMA’s orientation materials explained, over 50% of hospital admissions in Kenya are due to non-communicable diseases (NCDs), yet funding disproportionately favors emergency and tertiary care (IMA, 2025b). In rural or low-income areas, even basic medical supplies may be missing. The National Health Insurance Fund (NHIF) in Kenya is theoretically universal but practically limited. A large portion of the population works in the informal sector and cannot afford the monthly premiums (IMA, 2025a), even though they are only a few U.S. dollars. As a result, many Kenyans rely on out-of-pocket spending, delaying care until absolutely necessary. The result is a population that often only seeks care at crisis points, rather than through preventive visits. This structure is reflected in comparative global data as well. According to the World Health Organization (2012), Kenya’s per capita health expenditure is less than 1% of that in high-income countries. With limited insurance coverage and overwhelmed public facilities, patients are often forced to choose between financial hardship and timely care. Living and working in Mombasa taught me lessons that extended far beyond clinical knowledge. As outlined in IMA’s cultural framework, Kenya is a highly community-oriented society with strong tribal and religious identities. Mombasa, in particular, has a predominantly Muslim population, and gender sensitivity in healthcare is essential (IMA, 2025c). In some cases, women preferred female clinicians; in others, family members were required to be present. Understanding these dynamics was essential to gaining patients' trust and being respectful in clinical settings. Language was another key factor. While English is an official language, many patients, especially in rural or older populations, felt more comfortable speaking Swahili. I made an effort to learn basic phrases like “Asante” (thank you), “Karibu” (welcome), and “Habari” (how are you), and patients often responded warmly to these attempts. It reminded me that cultural humility and effort go a long way in building rapport (IMA, 2025c). I now see language learning as a professional obligation, especially if I hope to serve multicultural populations in Canada or abroad. Another deeply moving aspect of the culture was the sense of community. Patients did not come alone; they were accompanied by neighbors, friends, or fellow church members. I saw community members sharing food with one another in the waiting room, praying together, and offering comfort during procedures. In one instance, a man who had no family was cared for by strangers from his village who brought him to the hospital and stayed by his side. This collective spirit was something I hope to emulate both in my future practice and personal life (IMA, 2025d). A recurring theme throughout the internship was the ethical complexity of working in a low-resource setting. Providers often had to choose between what was medically ideal and what was realistically possible. In Canada, we are taught to aim for gold-standard care. In Kenya, gold-standard care is rarely feasible. Instead, clinicians must weigh the cost of each procedure, medication, or diagnostic test against the patient’s ability to pay and the broader hospital demand (IMA, 2025a). For instance, there were times when CT scans were postponed because the machines were shared between departments or operating at limited hours. In the dental unit, anesthesia supplies were carefully rationed. I learned to appreciate the ingenuity of local providers who, despite these limitations, delivered care with precision, compassion, and creativity. They were not only clinicians but problem-solvers, advocates, and negotiators (IMA, 2025a). While the orientation emphasized the importance of patient consent and dignity, in practice I sometimes observed procedures being conducted with minimal explanation due to time constraints or understaffing. This highlighted the gap between intention and reality in overburdened public healthcare settings and made me appreciate how systemic limitations can affect patient-centered care (IMA, 2025c). This experience has fundamentally changed my outlook on healthcare and my role as a future provider. I no longer view dentistry as a narrow specialty focused only on teeth; I see it as a field that intersects with education, policy, community development, and global health. I now have three clear goals moving forward. First, to incorporate global service into my career. Whether through short-term dental missions or long-term public health initiatives, I want to continue serving in under-resourced communities both locally and abroad. Second, to focus on preventive oral health education. Inspired by our school outreach in Kenya, I hope to create community partnerships to bring oral hygiene education to youth, newcomers, and marginalized groups in Ottawa. Third, to advocate for healthcare equity. I want to use my voice to address disparities in oral healthcare access, whether it’s through policy change or research. In conclusion, this internship experience with International Medical Aid in Kenya profoundly shaped my personal and professional development. It challenged me intellectually, emotionally, and ethically. It reminded me of why I chose this path in the first place—not just to learn how to fix teeth, but to understand people, to advocate for justice, and to make healthcare more compassionate and accessible for everyone. Through clinical exposure, cultural immersion, and community outreach, I gained a deeper sense of purpose. I left Kenya with greater clinical insight, a new lens for viewing global health, a stronger commitment to advocacy, and a deep gratitude for the resilience of both the providers and patients I encountered. I now know that wherever I go in the future, I will carry the lessons of Kenya with me and let them guide the kind of dentist and person I strive to become.

Every aspect of my International Medical Aid internship exceeded my expectations. From the moment I arrived at the Mombasa airport, the incredible IMA staff helped me feel at home. Throughout my five-week internship, they made sure I was safe, comfortable, and supported through every high and low. The program mentors—Michelle, Hildah, and Margaret—checked in daily about my experiences at the hospital and generously shared their knowledge of both Kenyan healthcare and culture. The drivers navigated the often chaotic roads safely while keeping us entertained with conversation and music, and I always felt well cared for. The residence was comfortable, clean, and a genuinely enjoyable place to spend time. The housekeeping team went above and beyond to make sure we had everything we needed and even did our laundry every day. The food—a mix of Kenyan dishes, international options, and familiar comfort foods—was consistently delicious. The kitchen staff took our requests seriously, accommodated our busy schedules, and even surprised us with a cake on Valentine’s Day. I also appreciated the cultural treks, which provided balance to the emotional intensity of hospital work and helped us better understand the communities we were serving so we could connect with them more meaningfully. I cannot say enough positive things about the kind, professional, and supportive staff I interacted with throughout the program. My time with the Psychology team at Coast General Teaching and Referral Hospital was truly transformative. As a mental health intern, I had the opportunity to shadow outpatient counseling sessions, observe psychiatric evaluations, and join ward rounds in maternity, pediatrics, internal medicine, oncology, emergency, and post-operative wards. I expected to learn primarily about conditions like anxiety, depression, autism spectrum disorder, and how they are diagnosed and treated. I did see these cases, but I also saw far more intense situations that revealed the deep intersections between mental health, trauma, poverty, grief, and limited access to care. Over the course of a single week, I witnessed moments that will stay with me: a woman attempting suicide after being unable to leave the hospital because she could not pay her bill; a mother grieving a stillbirth linked to lack of prenatal care; a 15-year-old boy facing amputation after a school bus accident; a family in oncology learning that their child had very little time left without fully understanding what cancer is; and a community mourning two college students who drowned. These experiences, among many others, showed me how deeply human suffering is intensified when health systems are overburdened and resources are scarce. They motivated me not only to support individuals in their mental health in the future, but also to think critically about systemic change. A central theme of my experience was the role of education in patient outcomes. Many patients—especially those from rural or lower-income communities—arrived at the hospital with very limited understanding of their conditions or when to seek medical attention. Because many cannot afford preventive care, they often present late in the disease process, when treatment options are more limited. Gaps in health education, cultural and religious beliefs, and reliance on traditional healing can create communication barriers between patients and hospital staff. At the same time, healthcare workers are understaffed and overextended, leaving little time to thoroughly explain diagnoses or provide emotional support. In this environment, the psychology team often became the bridge: helping patients process difficult news, understand their situation, and feel seen. The demand for mental health support was overwhelming. The psychology team I shadowed could only see a small number of patients each day, yet we were frequently approached by nearby patients and families who asked to be added to the list. Nearly everyone in a hospital like Coast General is in crisis in some form—physically, emotionally, or both—yet mental health services remain limited and, for many, unfamiliar or stigmatized. Through this internship, I came to appreciate the importance of meeting patients where they are, rather than expecting them to navigate unfamiliar systems alone. I was grateful to contribute in a small but meaningful way through IMA’s community outreach efforts. I helped lead clinics on hygiene, menstruation, and mental health at local schools, where we aimed to empower students with knowledge and practical tools, such as sanitary pads and toothbrushes. These sessions reinforced for me how interactive, engaging education—songs, demonstrations, questions, and open dialogue—can help young people retain information and feel more in control of their health. Seeing students connect with these lessons showed me how early education can reshape health outcomes, whether that means recognizing pregnancy, understanding consent, or knowing when to seek care. This internship also brought my academic studies in psychology, community and global health, and epidemiology to life. I observed diagnoses such as schizophrenia, bipolar disorder, anxiety, and depression in real clinical settings. I watched psychiatrists conduct evaluations, form treatment plans, and collaborate with counselors, and I had the opportunity to debrief with them afterward, which added depth and context to everything I witnessed. I also saw, firsthand, the burden of HIV, tuberculosis, and other infectious diseases and how policy decisions—such as cuts to external funding—directly affect access to medications and staffing. The experience tied together theory and practice in a way no classroom ever could. Throughout my time at Coast General, I noticed small but powerful examples of systemic tension: suggestion boxes that no one used, overflowing containers of condoms alongside persistently high rates of HIV and unplanned pregnancy, and brand-new computers sitting unopened while essential supplies like gloves and needles remained limited. These details highlighted the complexity of building effective health systems and the importance of thoughtful implementation, not just resources. Ultimately, this experience deepened my understanding of how culture, stigma, education, and economics shape access to mental healthcare, and it solidified my commitment to being part of positive change. It reinforced my desire to work in the mental health field, to advocate for health education, and to support communities facing structural barriers to care. My internship with International Medical Aid in Mombasa was challenging, eye-opening, and profoundly meaningful, and I will be recommending this program to everyone I know in the pre-health world.

Staff members were kind, welcoming, and extremely helpful day to day. Hospital placements and community outreach were better than I expected, allowing interns to immerse themselves in hospital and community culture. I was able to make lasting connections with the people I worked with and experience so much more than I anticipated, while still adhering to ethical standards. This is a very difficult line to walk and IMA did it very well. Overall, this was an incredible experience and exceeded my initial expectations. Interning at Coast General Teaching and Referral Hospital (CGTRH) provided the opportunity to observe the psychology department directly, as well as the entire hospital through a psychological lens. Psychologists have a unique role in the healthcare setting because they see patients in every section of the hospital. As a psychologist, with academic focuses in neurology and education, learning about the educational models and cultural beliefs that guide clinician practices provided insight into the systemic workings of the hospital as well as the different types of relationships between patients and providers. This experience yielded a better understanding of the psychological education system, knowledge of the daily workings of a hospital, and an increased perception of the mental healthcare system in Kenya. One thing that stood out is how new psychology is as a field of study. The University of Nairobi offered the first psychology degree beginning in 1999 (Department of Psychology, n.d.). Prior to that, the first psychology classes were offered to healthcare professionals beginning in 1989. Today, psychology is recognized as a degree at 30 institutions across the country, with four different tracks; general psychology, counseling psychology, medical psychology, and psychology with an IT (technology) focus (KUCCPS, n.d.). The formal psychology department at CGTRH was created in 2020. The department is still so new that it is not discoverable on the hospital website (Coast General Teaching & Referral Hospital, n.d.), so the remainder of the given information was provided verbally by psychologists working in the hospital (CGTRH Psychology Staff, personal communication, June 2024). Prior to the pandemic, there was one psychiatrist in the hospital, and a majority of his case load had to do with secondary conditions, such as addiction, insomnia, and anger management. This is a result of a combination of understaffing in the hospital; i.e. a psychiatrist was only called for the most outwardly disruptive cases, and that mental health was, and still is, largely stigmatized. It wasn't until the pandemic hit, and a majority of the neurotypical population was faced with social isolation, that the general public began to accept that mental health conditions, such as depression and anxiety, can arise in otherwise healthy individuals. It was at this time that the previous psychiatrist was reaching retirement age, but realized that there was nobody else in the greater Mombasa area who was certified to replace him. As a result, the hospital paid two students to become certified psychiatrists in order to replace him, but the previous psychiatrist had to work an additional four years past when he wanted to retire, until these two students were able to complete their degrees. In addition to hiring two new psychiatrists, the hospital hired three full-time psychologists, to assist with the growing case load. In addition, there is one visiting psychologist, who works for the government, and a number of students, interning at the hospital, who are still among some of the first psychologists in the country. Currently, the hospital has a large outpatient clinic, several specialized clinics; such as the Gender-Based Violence Clinic (GBV) and the Comprehensive Care Center (CCC), and conducts daily rotations in the wards. Speaking with the Kenyan psychology students about their educational experiences has allowed the ability to learn more about the psychological education model in Kenya. From talking with students, it appears that the lessons taught in the classroom model those taught in the U.S. pretty similarly. The main difference is that because this is still such a new field, there is not a whole lot of guidance in the clinical applications; i.e. students complete a two month clinical rotation during their fourth year of schooling, where students are working alongside certified psychologists in the workforce. Many of the students expressed stress during these rotations because they did not feel they had the guidance needed to effectively handle the given cases. Since there is a language barrier, all IMA interns were paired with a Kenyan student or provider during our rotations. We were also given two comprehensive tours of all departments in the hospital, with both general healthcare and psychology specific focuses. The Kenyan interns, however, were expected to go off on their own from day one and handle cases independently. The interns were not explicitly trained on how to make people feel comfortable while asking questions. Consequently, many of the students struggled to get patients to open up to them; i.e. if someone was not immediately forthcoming with information, students would move on to the next patient without really asking a lot of follow-up questions. From an outsider's perspective, as reported by many of the patients, it appeared that these students didn't care to learn more about the patients. It, however, became quickly apparent that this was not the case at all, but rather students were not properly trained in asking questions in a way that makes people feel comfortable to share. For example, there was one young man who had been in the hospital for several months due to a machete accident, who previously was an orphan living on the streets. This particular gentleman had experienced a lot of betrayal; his adopted family physically abused him and he had to run away from home, some of the friends who he met on the streets robbed him of all his belongings in the middle of the night, and even his current friends never bothered to visit him in the hospital, which is something that he expressed really hurt him. Initially, he did not want to talk to anyone, and it took one psychology student sitting with him every day for weeks before he opened up about his situation. He told her that he felt as though many of the students were simply trying to check a box during rounds, but did not actually care to really get to know him. Although this was definitely not the intent of the other students, this was the impact of their actions. As such, it is so important when working with vulnerable populations to understand how our actions are perceived by others. It is not a fault of the students, because they are all still learning, but rather a gap in the education system. Another thing that was really interesting about the teaching practices, is that there is a wealth of knowledge with regard to mood disorders, such as depression and anxiety, PTSD, and other related trauma response conditions, but there is still a lot of unknown with regard to conditions such as bipolar or schizophrenia, i.e. mental health conditions that don’t have concrete triggers. In the past, mental health conditions were considered to be a result of witchcraft, in that there was an external reason why someone was acting in a particular manner, rather than a biological imbalance. While today this is not a widely accepted belief in the medical community, mental health treatment plans are often still focused on treating external factors. For example, there was a middle aged woman who was admitted to the ER after being hit by a tuk-tuk, but was referred to psychology due to disjointed thoughts and erratic decisions. This woman had late stage HIV, which she believed to be caused by bewitching by her husband’s second wife. While this on its own is not necessarily cause for concern, her actions that followed the onset of this belief are indicative of an underlying mental health condition. When this woman started experiencing these symptoms she ran away from home, leaving behind her three children, and moving to Mombasa to live on the streets and work as a sex worker. She claimed that this was a much needed vacation for her, and that she came to Mombasa to relax, but that she was still worried about her children. Her disjointed thoughts were likely attributed to her HIV, as it is quite common to experience mental disturbances if it is left untreated (National Institute of Mental Health, 2023), but her impulsive actions and observed mood disparities were characteristic of another underlying condition. Unfortunately, there are not enough beds in the hospital to admit psychiatric patients long term, so the treatment plan was centered around relieving HIV symptoms, and hoping that she would realize that her physical symptoms were a result of her condition rather than bewitching. The thing that was most interesting about this is that the mental health treatment practices are focused on treating physiological conditions and assuming that mental health will improve on a parallel basis. While this logically makes sense, someone with a true chemical imbalance is not able to think rationally in this way. The treatment for mental health conditions is still very neurotypical centered and there is still not a lot of knowledge about invisible disorders. A lot of this too comes down to limited resources, so there's not necessarily an easy fix, nor are physicians at fault, but it does illuminate a systemic pattern about how mental health conditions are treated. One aspect of the Kenyan mental health system that could be implemented in the American system, is that care is very patient centered. Despite there being limited staff members, once psychologists get over the initial hurdle of learning how to ask good questions, staff prioritize quality of care over quantity of patients seen. Most psychologists have regular patients that they see daily or weekly (depending on if they are in or out patients) and psychologists never rush conversations or go in with set expectations about appointment times. In the U.S. there are very clearly defined timelines for which a provider will spend with a patient, and once that time is done, the psychologist will leave, even if they are in the middle of a conversation. This, however, is not the case here, as there are no set appointment times and psychologists will stay with the patient until the conversation runs its course. This often means that practitioners don't end up getting to everyone, i.e. they are assigned more cases than they can ever get to in a day, and thus patients often have to wait to speak with someone, but with the knowledge that when it is their turn, they will have the undivided attention of staff members. For example, there was a young girl who came into the outpatient clinic due to anxiety induced muscular pain. Whenever the daughter experienced a lot of anxiety, typically centered around academic performance and exams, she would develop debilitating pain in her legs, which prevented her from walking or performing other necessary tasks of living. The girl was accompanied by her father, who was also experiencing a lot of anxiety around the situation. The father was the only person supporting the daughter, as everyone in the family had dismissed her pain as psychosomatic, and essentially her just being dramatic. Typically an outpatient session runs about thirty minutes, give or take, but this particular session lasted over two hours. Although the session was for the daughter, we spent a large amount of time speaking with the father, as he expressed a lot of guilt and wanted help in deciding how to handle the situation moving forward. We were able to speak with both family members individually, and then bring them back together to have a facilitated conversation in which they could share their respective grievances and come up with a plan of action for moving forward. This personalized care model, in which providers really take the time to get to know patients, is so incredibly important because it builds trust between patient and provider, and helps to make patients more likely to follow through with treatment plans. Providers take the time to explain why they are doing what they are doing, and really break down each step of the process, which is a critical step in building genuine therapeutic relationships. Something that was really emphasized at the hospital, that is also emphasized a lot in my psychology classes at home, is the interconnectedness between mental and physical health. At home we talk a lot about spheres of wellness; physical, mental, social, intellectual, environmental, spiritual, vocational, and financial (Northwestern University, n.d.). These factors all work parallel to one another in order to make a complete and well person. When one factor becomes depleted, imagine the cup metaphor, in which each sphere is represented by a cup of water. When one cup of water (sphere) becomes depleted, all of the other cups must give some of their water to the empty cup, meaning that all other spheres become a little bit depleted as well. This is especially important in the hospital because if someone is in the hospital, by definition, their physical wellness cup is depleted. As such, it is crucial for people to take care of their mental health and fall back on their support systems in order to have the strength and energy to recover physically. It is so incredibly important to speak with patients and allow them to know that there is someone out there who cares about them and wants to see them get better. This is especially true for patients who don't have family members and/or are struggling financially, because multiple of their spheres are depleted at once, which means that there is even less water (energy) to be distributed. Many people who are in the hospital give up mentally long before they give up physically, and as such psychologists play a critical role in patient outcomes. For example, there was an older woman in the oncology department, who was undergoing radiation treatment. The first day we met her she was very withdrawn, talking about how she thought she was going to die, and how she didn’t see a point to traveling to the hospital everyday anymore. We spoke with her and her husband at length, allowing her to talk through her fears, and validating that it was worth it to continue treatment. Over the next several days she slowly came out of her shell and began to appear brighter. By the third day she was walking around the center, instead of sitting in the corner, and was even laughing at jokes. She confirmed that she wanted to continue treatment and that she was feeling much better after our conversations. The main reason being that she previously did not feel like she had an outlet to express her concerns, since she didn't want to further burden her family, and was bottling it all up inside. As a result, the psychology team was able to help her and many other patients realize the importance of their life, and remember that they are not alone in their fight, which can often be the make or break moment in a person’s recovery journey. Interning at CGTRH provided the opportunity for immersion in daily hospital routines, allowing the ability to forge genuine connections with patients, observe noticeable improvement in patient outcomes, and learn about the educational and clinical psychological practices in Kenya. This placement allowed the possession of a deeper understanding of healthcare as a whole, an increased conception of the interconnectedness between the body and mind, and a greater appreciation of the importance of patient centered care in psychology. Additionally, working as a team with providers has fostered the ability to form compassionate therapeutic and professional relationships, as well as a deeper understanding of the factors that inform clinical practices. The knowledge obtained from this experience will guide any and all future work in the field.

The program was more than I could have ever expected. When I first arrived in Mombasa, I did not know what to expect. I was not even sure there was going to be a sign from IMA waiting outside of the airport for me. But when I stepped out from the airport I was greeted by an IMA staff member with kindness and hospitality. The staff at the residence was more than helpful by doing laundry daily, providing excellent meals, and willing to help with anything us interns may have needed help with. The program mentors were always very easy to approach and some I have become close with after my time in Kenya. I appreciate everyone's kindness and help during my time in Kenya. At the hospital, I learned more about healthcare than I expected. The doctors were kind, and willing to spend the time to teach us how they were treating the patients. Many of the medical staff also provided us insight on the healthcare system in Kenya. The community in Mombasa was welcoming and everyone I met was nice. When doing the Women's Health clinics, I could immediately see the impact we had on the young women we talked with. I distinctly remember meeting a young girl at one of the school we went to for a clinic and she was asking me if I was a doctor. I explained that I was in school to become one and she looked at me with such excitement and explained that she dreams of becoming a doctor one day. Seeing the girls hope in her eyes to become a doctor makes me realize how much of an impact we have on the schools we attended. I made sure to tell her she could do anything she set her mind to, because I truly believe that. That exchange I had with the young girl is the best example of how much I see we have made an impact on the community, not only by teaching about Women's hygiene but also showing that these girls can pursue the careers they choose to. The experience I had with International Medical Aid was one that more than exceeded my expectations. When I first discovered IMA, I was unsure of how much I may learn or experience, but after reaching Mombasa, I discovered a program that taught me far more about healthcare than I could have imagined. Not only did I learn about the overall experience as a healthcare provider, but also what healthcare looks like in Kenya and some of the differences in the healthcare system between East Africa and America. I have gathered a new appreciation for healthcare providers, especially those in the Coast General hospital. Coming to Coast General, I was not sure what to expect especially on the Physical Therapy side because many of the other interns there were pursuing Pre-Med or Pre-PA. But I met many Physical Therapists that welcomed me with such kindness and taught me a great deal about what it means to be a Physical Therapist. During my days in Coast General I rotated between six different in-patient Physical Therapy areas of the hospital. Each rotation I worked with a different Physical Therapist and learned something new that I will continue to value through my time as I pursue a career in healthcare. I began my first three days in the medical ward of the hospital with Omar. Omar was kind and welcoming, and a wonderful teacher. He showed me to every patient that he had in the ward and discussed with me the details of their prognosis and how a Physical Therapist would treat the patients. Many of the patients we saw in the medical ward were stroke patients. Omar spent time with me and the other Kenyan Physical Therapy students discussing the physiology of a stroke. He taught me many details on stroke patients such as the etiology, risk factors, the two types of strokes, the clinical presentation, and how a physical therapist may help a patient’s condition when presented with a stoke patient. After this discussion, we went to see some of the stroke patients and Omar continued to ask me questions about how I think we should proceed when presented with a stroke patient that had developed hemiplegia. His openness to my own learning experience while I shadowed him in the hospital is something I more than appreciate. Some of the things that PT would do with a stroke patient would be passive physiological exercises. The goal of this exercise would be to maintain joint range of motion, blood circulation, muscle tone and more. The only reason I am able to list these details is because of Omar and his openness in sharing with me his own knowledge. I have shadowed Physical Therapists in America, but I had never been met with such eagerness to teach than the therapists I met in Mombasa such as Omar. After my first three days in the hospital, I had already gathered a new respect for not only Physical Therapists overall, but also the ones I had met at Coast General. The next rotation I had in the hospital was in the surgical ward with the Physical Therapist Joanne. In this ward I saw neurological and general surgery patients who suffered from things like cervical spine fractures, traumatic brain injuries, and severe burns. The PTs would often ask me questions to understand more of my own knowledge on the different cases that we saw. Most of the questions I was unsure of, and the PT would send me home with homework to do some research on the condition of the patients we would see. Even for the Physical Therapist to have me do research outside of the hospital is something I appreciate because it shows even though they have just me they still care for me to learn. One of the more memorable patients we saw in the surgical ward was Nickson. Nickson was a burn patient who suffered from severe burns on both of his legs. I had learned that he had been in the hospital for five months and is still far from fully healing. One of the main tasks of the Physical Therapist when helping Nickson was to apply pressure on his knees to help him fully extend his legs as that what something he was unable to do after being burned. Watching the patient-therapist interaction is something that I have appreciated. I learned though my shadowing the importance of a Physical Therapists encouragement and support especially with a patient that is undergoing severe pain in the process of physical therapy. In addition, there were time it seemed to me that the therapist should have stopped the pressure on the knees to help Nickson fully extend them, but what I have learned is that there would be no progress in his injuries if he was met with insufficient exertion. The experience I had seeing the work Joanne was doing with Nickson made me appreciate the mental strength of a PT. It is hard to see someone suffering in any form, but to be able to have the ability to encourage someone to continue to help themselves and get better takes much strength. Each day I would return to see Nickson I could see the progress being made and it filled me with optimism and hope. Although I could see his pain, I could also see how the work of a Physical therapist can truly help someone’s recovery process. The other rotations I was able to do were in orthopedics, Peds, NBU, and the surgical and medical ICU. These rotations each taught me something new about the importance and purpose of Physical therapists. Each therapist I shadowed showed me something new about how important a physical therapist is when it comes to someone’s recovery or stability. The ability to shadow in several different specialties of physical therapy allowed me to see what I may be more interested in as I continue to pursue a career in physical therapy. The area that I enjoyed the most was orthopedics. During my time in the orthopedic ward the physical therapist was more than willing to teach me about the duties of a physical therapist when it comes to orthopedics. The most memorable aspect of ortho was seeing difference in physical therapy management between pre-surgery versus post-surgery. In addition, seeing the x-rays of the bone fractures before and after surgery seeing the check x-ray. There is so much that the physical therapist taught me one the protocol of therapy when it comes to a patient with a fracture. On the third day in orthopedics there was a new patient with a femur fracture and the therapist asked me how I would begin to help the patient. From what I learned in the past days in orthopedics I was able to share with her what I thought would be important for a physical therapist to have the patient do. To be able to shadow a PT who was willing and able to teach me about the responsibilities of a physical therapist is one that I greatly value. My time at Coast General, shadowing each of these therapists has allowed me to learn far more about physical therapy than I could have imagined. With IMA I was able to attend weekly Women’s health or hygiene clinics that allowed us interns to connect with the community and provide knowledge of various topics. I was able to attend two Women’s health clinics where we attended secondary schools in the community and discussed the female reproductive system as well as educated the students menstrual hygiene. The clinics gave me an opportunity to have a better understanding of the limitations girls face not only in Kenya but globally when it comes to menstrual hygiene. During the clinic we made sure to keep the girls engaged by asking questions to have a better understanding of their knowledge on menstrual hygiene. Most of the girls had a basic understanding, but I could immediately see the impact we had being there and giving the girls more insight on this important topic. Each one of them had many questions to further their knowledge on Women’s health and continued to show their excitement at our presence at their school. After the clinic was over, we were able to hand out pads to the girls. As an American who has grown up privileged to have access to something like pads, I truly gathered a new appreciation for the opportunity to be able to supply these young women with something that can truly help them feel more comfortable with their natural cycles. Not only did I see how educating the girls on Women’s health and supplying them with pads impact them, But I also saw how our presence as students ourselves made an impact. At the second Women’s Health clinic there was a young girl who asked me many questions after the lecture was over and one of them was if I was a doctor. I explained to her I was currently in school to be a doctor, and she looked at me with so much excitement in her eyes and said she dreams of being a doctor one day. This exchanged showed me how much influence we may have on these young girls we can have just by coming to their school. Through reaching out to the community in Mombasa, we had a significant impact on the girl’s lives. The opportunity that IMA gave us to be able to have such an impact on the community is one that has allowed me to have a new appreciation for my own experiences in life and even more being able to share this knowledge with these young women. During my time in Mombasa, IMA presented us interns with several different global health lectures where we learned about the history of pre- and post-colonial Kenya, disease burden in Kenya, and the Kenyan healthcare system. Through attending the lecture on pre- and post-colonial Kenya I was able to grasp a better understanding of the culture and history of Kenya. The lecture taught me of some cultural differences between America and Kenya. One of these differences is the number of ethnic groups in Kenya compared to America. Kenya is a diverse country with 44 ethnic groups and almost all speaking at least two languages. This to me represents the rich culture of Kenya and during my time in Kenya it is important to think about how diverse the country is. Another difference is the economy and poverty in Kenya. While Kenya is continuing to develop as a nation, it was clear to me not only from the lecture, but also during my time at the hospital that there is a great deal of poverty. Many patients at the hospital were unable to financially support themselves to receive treatment they needed from the hospital. This challenge is something I saw the healthcare providers have to navigate as they are trying to care for their patients, but without financial support sometimes they are unable to. In addition to the differences in economy, I also learned of the history of Kenya. Learning about the history of Kenya is something that was important to me during my time with IMA. In order to fully immerse myself into the culture of Kenya, learning of the history is an important step. Through this lecture I was able to better understand the experience of Kenya through history and how it came to be the way it is today. The lecture is one I value and remember during my entire time in Mombasa and still even after I have left that has given me an appreciation for the culture of Kenya. An additional lecture topic that I found to be important to understand during my time with IMA is the Disease Burden in Kenya lecture. During this lecture I was able to grasp more knowledge on the main diseases that are seen in Kenya. I found this lecture to be the most important to use as a resource when in the hospital so I could understand more of what the healthcare providers are mainly treating, one of these diseases being HIV/AIDS. HIV/AIDS is a disease that many patients in the hospital have and as I learned in the lecture has one of the highest mortality rates in Kenya. The lecture also mentions that over 50% of males in Kenya have HIV. This statistic alone exemplifies how prevalent HIV is in Kenya. Learning about these facts made me have a better understanding of what healthcare providers may have to deal with in the hospital and even in the community in HIV prevention education in order to slow the rates of infection in Kenya. In addition, diseases such as malaria, TB, of the respiratory system, skin diseases, and more are extremely prevalent in Kenya. Many of the patients in the Coast General hospital had these diseases and the doctors in the hospital are the ones that have to diagnose and treat these illnesses. It is important to understand how prevalent these diseases are in Kenya in order to understand how the doctors may try to manage these various illnesses. Of course, these are not the only illnesses of the disease burden in Kenya, but they are some of the ones I most frequently saw patients within the hospital. The lecture on Disease Burden in Kenya allowed me to understand the challenges that healthcare providers in Kenya often face and how they may manage the spread of these diseases. The last lecture I was able to attend was on the current state of healthcare in Kenya. This lecture was particularly insightful because I was able to grasp a better knowledge on the working of Kenya’s healthcare system. In Kenya there are three different categories of healthcare which when comparing to America is similar. Where I found more differences between America and Kenya is with the funding, accessibility, and outcomes. American spend much more on healthcare than the citizens of Kenya, but in Kenya many more citizens are paying out of pocket which can become difficult for the patients who cannot afford their needed healthcare services. In the Coast General hospital, this issue of being unable to pay medical bills was prevalent as many of these patients were not allowed to leave the hospital or did not get the service they needed until the bill was paid. It is important to consider the challenges that many healthcare providers must face when working in a hospital such as Coast General where they may be unable to care for a patient due to their economic status. Through this lecture I was able to understand more of the differences between Kenya’s healthcare system and America’s. My experience with International Medical Aid was one that I will never forget or take for granted. To be able to have the opportunity to immerse myself in a new culture is one that has allowed me to grow as a person. Being in the Coast General hospital for the three weeks I had there taught me to be more grateful for the life I have been gifted with. In addition, it has pushed me to want to give back to communities as well as be open minded to new experiences. The list of lessons I have learned during the internship could be endless, but mostly it has taught me what it means to be a physical therapist. The Therapists I worked with were kind, generous, and careful to be sure they gave the patients all the help and support they needed. There is not enough gratitude I can express to be given this opportunity to learn and grow during my time with Internation Medical Aid.

IMA has built an incredibly tight-knit family and makes you feel like one of their own. There is nothing more refreshing or reassuring than having a smile greet you at every moment of the day, telling you that you belong here and your hands are helping change lives. You can only begin to understand the gravity of what you are accomplishing once you step out of your comfort zone and into the world of service and education. There is not one thing I would change about my experience and I am glad to be coming home with a wealth of knowledge, strong friendships, and an even stronger initiative for helping others. There are no words to describe how incredible of a country you are. Even though I was more than 8,000 miles from home, you made the distance feel not as far. Your people, the culture, and everything you stand for have opened my eyes to the immeasurable amounts of your compassion and the pride you hold. When I first arrived on your soil, there was this beautiful collision between nerves and excitement I had never felt before. Even though I had researched and read about all that you had to offer, I was still shocked to see the bustling streets of people that were shoulder to shoulder, the nonexistent streetlights or road signs, and the endless sidewalks lined with vendors. I got to experience the sunrise over the horizon of the Indian Ocean and watch the colors of the night sky fade away from the residency balconies. I saw Fort Jesus, MacKinnon Market, and other prominent landmarks that show the deep roots of your history. On the Maasai Mara Safari I learned about local customs and saw exotic animals, including the Big Five. Even learning simple phrases from your language made me feel more connected to others and allowed me the chance to show my respect towards everyone. My favorite days were those when we hosted our outreach clinics in your local communities. We helped the men, women, and children of these places by providing them with necessary medical resources and instructions on how to stay safe and healthy during their lives. My favorite clinic was when we visited Coast Girls’ High School and presented an educational lecture on Women’s Health and Hygiene. According to the World Bank Group, five hundred million women across the world have inadequate care when it comes to menstrual hygiene. Lack of supplies and education on how to effectively manage these health concerns have many adverse implications. It can cause disease, and lack of confidence, and make it easy for other complications to arise. Our goal was to create an environment where the girls at this school felt safe and comfortable asking questions regarding menstruation, the women’s reproductive system, and other related topics. The girls were attentive, asked great questions, and enjoyed our presence. We were even able to give them menstrual products as our way of saying thank you and further pushing the importance of management. There were still times when I wished I could do more for you and your people. You made it difficult to leave a place where I consciously knew that people were in poverty, struggling, and suffering. Yet, you gave me hope from the impactful experiences that I witnessed and most importantly, a love that goes far beyond the walls of any hospital. I know I will visit you again someday and find more ways to make a difference in people’s lives. Until then, I will use all that I have learned to continue towards my goal of becoming the most compassionate, competent, and confident dentist I can be. Asante sana, Kenya. It was my greatest pleasure and highest honor to get the opportunity to know you and learn your stories. I was welcomed not as a guest, but as an integral member of the IMA group. I feel that I have truly made lifelong friends and strong relationships that span across states and continents thanks to the efforts of International Medical Aid. Everyone continues to be supportive and caring as we move on to our new chapters in healthcare professions. It has been one month since my departure and my days have been filled with warm wishes to all as we continue adjusting to our lives without one another. It was with you all that I learned of the Healthcare systems, financial and resource constraints, and other challenges people face daily. There is a severe lack of human capital, varying standards of quality and sanitation, a prevalence of preventive diseases, ethnic discrimination, and deteriorating working conditions in which the sectors of healthcare struggle most. Witnessing these barriers every day not only makes one fortunate for what they have but begs the question of what else can be done. I know many of my fellow interns became proactive and started donating supplies, holding GoFundMe’s, and holding themselves responsible for checking in on specific patients. My personal goal is to one day return with the sole mission of giving people the best quality of dental care possible for their issues and donating equipment that allows hospital staff to better treat future people. From getting us safely to our destinations to providing us with fabulous meals, and accommodating the needs of everyone, IMA gave me the peace of mind to focus on what mattered most during my time in Kenya: learning, educating, and helping. It was this experience that opened my eyes to the possibility of pediatric dentistry, made me start putting my goals into perspective, and gave me the desire to return with more knowledge on how to assist those in need. I cannot wait to see where these upcoming years take us, and I am looking forward to watching everyone’s story unfold. Asante sana, International Medical Aid family. Learning about the types of diseases patients often deal with, the lack of mental health treatment, and the common issues that Kenyans face daily was staggering. 1HIV, malaria, tuberculosis, diabetes, and respiratory infections are just a few causes of mortality that we see across Kenya. While all of these are treatable and often preventable, there is a lack of medicine, protection, or education on them that results in higher prevalences. While I did not interact with patients who had these as their main concerns, there are different procedures to take in the dental unit when understanding the patient’s history. I connected with your dental specialists who gave me valuable insights on the procedures they follow. I got to see how resourceful these doctors are and how treatment varies globally. Every member of the hospital was educated and ready to share their own experiences and how they approached different cases. What came to me as a shock was how patient history is taken and filed. Everything is still done by hand, and the patients are the ones responsible for keeping their X-rays, files, and other important documents of reference. It is incredible to see the different spectrums of dentistry and how care can be given. I broadened my horizons in the field of dentistry, but I was also fortunate enough to participate in the overnight shifts that other departments offered. It is not every day that you get to witness three C-sections and three live births on the same day as your birthday. There is so much still to learn from you, your doctors, and your patients, but for now, we will have to wait until I see you again. Asante sana, CGTRH. I do not know how to say thank you. A thank you does not begin to touch the surface of how grateful I am for you all. There has been nothing more reassuring than having you all in my corner rooting me on in my every endeavor. The support, generosity, and sacrifices each of you have made are invaluable and have left me forever changed. This trip meant more to me than I could ever imagine, and I am so glad that you were able to live vicariously through me during this time. Getting the chance to update everyone or talk about my time in the hospital was always my favorite way to finish off my nights. I hope each of you enjoy all the pictures I sent back and the stories that are yet to be told. A special thank you to my parents, grandparents, brother, and girlfriend is much deserved. You understand the effort I have put into my future and all that I aspire to be. You are all the cornerstones of my life, and I could not imagine taking on my feats without any of you. Asante sana, family, and friends. You did it. You traveled overseas, made new connections, and made your shadow time worthwhile. I am deeply proud of all the people you met and helped during this journey. You spread smiles to children, opened conversations with your fellow interns, and talked to doctors about their paths and reasons for being where they are now. Thank you for having the courage and the passion for dentistry that you do. You are going to be a rockstar throughout graduate school, during your years of associate work, and into your practice one day. You may think that this trip was only a once-in-a-lifetime opportunity, but you are just getting started. Asante sana, Nathan.

I am SO glad that I made the decision to join IMA in Kenya. After endless vetting for the seemingly most legitimate, meaningful, and impactful internship abroad, I decided to go with IMA. As my parents were initially hesitant, I am glad to report that neither of us are disappointed. There were so many positive experiences, that whatever else paled in comparison. The staff were THE BEST and helped make the trip that much more organized, fun, educating, and memorable! They were always open and receptive with communication and addressed any questions or concerns. I felt truly supported by them. Working in a hospital setting for the first time was extremely eye-opening, and oftentimes heartbreaking. I was admittedly afraid of being thrust into conducting psychiatric sessions and offering helpful advice to patients - but was instantly moved by the abundance of faith and positivity. The impact made me feel as though I had contributed meaningfully and learned so much. Gratefully, IMA planned lots of interesting tours, clinics, and lessons to adequately add to the experience and education. Planned activities were immersive, and enjoyable, and also provided unique cultural perspectives. The treks were incredible and well organized, with great guides and activities. It is quite the luxury, but it is definitely worth having the experience while you're there! When asked to reflect on what I have learned from my internship with International Medical Aid in Mombasa Kenya, my mind floods with an amalgamation of faces, stories, smiles, and painful struggles. It is no easy feat to concisely put into words all of the experiences shared, and lessons gathered. Though cliché, I truly felt as if I was acquiring knowledge in each interaction had – whether it be medical, historical, cultural, or personal, there was always a new perspective to be learned. Made clearer than ever, was the opportunity for growth and connection when one opens their mind, heart, and ears to those around them. By voicing our concerns and deepest struggles to somebody we trust, the grounds for support and healing become fertile. Though community is a powerful agent of health, it is inevitable that individuals will fall through the cracks in the foundation of governmental institutions. When housing, food, and education are a large financial burden for many, accessing quality healthcare becomes a luxury (Odhaimbo & Njeru, 2023). Additionally, there are social constraints such as religion, stigmas and taboos, and gender norms that further dictate health quality and seeking behaviours (Bakibinga et al., 2022; Coast General Teaching and Referral Hospital, October 2023). Throughout this paper, I aim to highlight the disparities and their origins in the Kenyan healthcare system, via resource scarcity, financial instability, lack of health education, social stigmatization, and violence against women and children. Lastly, I seek to draw comparisons from North America to illustrate that these inequities are ubiquitous and cross-cultural in nature. Firstly, I would like to preface that this discussion is from the perspective of a Canadian student, who has never known the struggle of financially supporting my family members, falling short of tuition fees, or only affording one meal a day. I do not know what it is to live in a country that largely pathologizes homosexual relationships, or what it may feel like to be ostracized from my community for engaging in premarital intercourse. While I was aware of these differences before I began my journey, my fear of immersing myself in this culture lay in transitioning to a label that was now “other”. The worry was not aimed internally, but rather at, “how would I adequately understand, support, and respect a culture so different from my own?”. Ingrained deeply in my values and often uncensored personality is a duty to speak up in the face of injustice and inequality. And so navigating a terrain rife with these imbalances was a daunting feat. Without proper experience, training, and cultural knowledge, how was I going to effectively and ethically address the concerns of patients in need of dire help? Sadly, yet thankfully, I quickly learned that any participation would be of enough value. An unfortunate truth made apparent swiftly, was that skill and ethics are cast aside when labourers and resources are scarce. With a meager 8.5% expenditure allocation from the government, considerable mortality rates from treatable ailments, and approximately 1 psychiatrist per 1 million Kenyans, one would be illogical to assume the level of standard practiced in the West (Odhaimbo & Njeru, 2023). In spite of the barriers, I observed many determined doctors and interns. They are passionate about their patients and offer healing in the best ways they know how. As always, there are those who exploit a flawed system. Sadly, this reality is inevitable cross-culturally, where financial gain often remains a top priority. Many practitioners and organizations will cut corners across care and ethics standards to reduce costs and effort output (Odhaimbo & Njeru, 2023). Alternatively, skilled professionals often flock to the private sphere or other nations in search of higher-paying wages (Odhaimbo & Njeru, 2023). Perpetuating a cycle of inaccessible care, those most vulnerable often bear the direst consequences. Whilst the government invests heavily in infrastructure to boost private capital growth and the production of goods, the needs of the population are severely ignored (The World Bank, 2017). Coupled with the fact that mental health is heavily stigmatized and not overtly apparent, seeking help for it is even harder. Alike North America, a historical lack of education, cultural gender norms, and the fear of being labeled ‘crazy’, seem to perpetuate the stigmatization and lack of access to mental health care. Though doctors recognize that targeting prevention is a more effective means of remedying physical and social ailments, the current system and resources in place often inhibit it (Odhaimbo & Mohammed, 2023; Coast General Teaching and Referral Hospital, October 2023). Too frequently, a problem remains untreated until its manifestation becomes critical. Rather than the loss of human lives, this turning point wrongfully often lies in the loss of capital and productivity. To provide a small-scale example, I was pleasantly surprised when one of the head psychologists, Anne, was invited to spend the day at a local shipping company to discuss mental health with their employees. The following day, seemingly exhausted, she shared the alarming degree to which these individuals were suffering at. Until eight o’clock in the evening, she was flocked with pleas for private discussion, where similar tales were divulged of severe stressors, an inability to cope at or prioritize their work, and a deeply rooted shame in the expression of their emotions and struggles (A. Nzioka, personal communication, October 12, 2023). To take time away from work to focus on our health and our dependents is a luxury that many cannot afford. When I praised Anne and the company for their efforts, she non-chalantly remarked that the company had suffered several suicides and a drop in workplace productivity (Coast General Teaching and Referral Hospital, October 2023). Presumably, the company sought to improve their financial returns and efficiency, rather than the health of their staff that allowed it to function. Likely, the most common concern from patients was how they would manage to pay their bills. Though private healthcare providers exist, and are the dominant choice, they are unaffordable and inaccessible to many (Odhaimbo & Njeru, 2023). Additionally, only 26% of Kenyans have insurance, and 36% live below the poverty line (Odhaimbo & Njeru, 2023). In the United States the rate of poverty is estimated at 11.5%, and in Canada 8% (Shrider & Creamer, 2023; Government of Canada, 2023). To risk their family’s being pulled from school or starving, people are unable to afford the time and cost of seeking medical attention. Due to a shift toward decentralized control and a lack of resources, public sectors remain grossly unequipped (Odhaimbo & Njeru, 2023). Statistically, patient outcomes are poorer and the rate of infection from the hospital is larger (Odhaimbo & Njeru, 2023). As a result, having less financial means leads to inequitable access and quality of healthcare. For those with a poorer socioeconomic background, a lack of education and health literacy results in worse health-seeking behaviours (Odhaimbo & Njeru, 2023). These individuals are more likely to delay diagnosis and treatment, or simply do not have the knowledge and tools to create and maintain health promoting habits (Odhaimbo & Njeru, 2023). A reality for some patients is spending weeks in the hospital, unsure of their diagnosis, and unsure of how to ask their doctors about it. From a lack of time or urgency, the role of many doctors and nurses remains to examine patient status, administer medication, and move on to the next. Patients may refrain from demanding explanation or treatment for fear of being labeled difficult, and further ignored by faculty (Coast General Teaching and Referral Hospital, October 2023). Oftentimes, the burden of disclosing the most sensitive and heartbreaking news is delegated to the psychological staff. To highlight the extent of broken communication, Margaret was a young woman teeming with discomfort and pain. She was noticeably underweight, tears leaked from her eyes, and her stomach was distended to the degree that assumed pregnancy. Following a discussion conducted in Swahili by a psychiatrist in training, Dr. Sood, we consulted her medical file. Since 2018, extensive detail had been recorded on Margaret’s treatment and recurrence of cystic ovarian mets (Personal communication, October 15, 2023). Though receiving blood and chemotherapy in the past, it was clear - without medical training, that her condition had catastrophically worsened. Dr. Sood and I were shocked to see that a recent entry had stated the patient was briefed on her condition, yet she and her husband were asking about the course of treatment and surgery that would follow. The file read that Margaret would be transferred to the palliative care unit, as there was no further treatment (Coast General Teaching and Referral Hospital, October 2023). Lastly, a major disparity that I witnessed was in the way that women are treated both inside and outside of the hospital. Touring the labour wards, I was appalled to see each expectant mother alone - a protocol that is enforced by the hospital. In the maternity and other female wards, a male companion was a rare sight. Gender roles seemed much more solidified, where daughters, sisters, and mothers were often relegated to caretaking, and men presumably remained at home and in the workplace. Though many had several family members that were capable, it was the school age girls, elderly matriarchs, and working mothers that assumed the role of personal nurse. In the male wards, a wife was the most common bedside assistant, followed by a son or brother (Coast General Teaching and Referral Hospital, October 2023). Confined in the bleak hospital environment, women frequently risked their physical and mental health, education, income, and free time in order to provide care for their loved ones. Remarkably, Kenya has abolished user fees for labouring mothers in the hospital, a luxury that does not exist in the United States (Odhaimbo & Njeru, 2023). However, several breaches of Western healthcare practice and standards were detailed by my medical peers against birthing women. Though anesthesia is rarely administered to the degree it is in the West, it is seldom used in the process of labour. Additionally, though it is classified as a high-risk procedure, the lack of resources and standard of care employed reflects a greater ignorance of female health. One intern detailed how more than once, after closing a c-section only then did medical personnel count the sponges and realize they were short. The response was that of, “well, she is already closed”. Another intern described the sheer agony a delivering mother was in when her baby was not crowning, devoid of familial support and epidural or pain medication. Mistakenly taking the doctors open hand as an attempt to soothe, he smacked it away. Afterward, they proceeded to inefficiently cut her perineum with a dull pair of scissors. Many Kenyan women avoid delivery in public facilities for these reasons. While other labs at the hospital have received state of the art technology and adhere to proper sanitary protocol, the condition of maternal care reflects the greater inequality and acceptance of violence toward female bodies. Similarly, we were met daily with the harsh realities of violence and abandonment perpetuated by male figures in domestic and public spheres. During my time in the gender violence department, not one survivour was over the age of 25, and the majority were children below the age of 10. Among my consultations, there was only one boy, yet he was brought in by his mother for assaulting their house staff. Rather than fearing his harmful behaviour and seeking psychological treatment, her main concern was that he had been engaging in intercourse and wanted him to be “checked”. With slight gestures to her behind, it was evident that she feared her son was engaging in homosexual intercourse, thus leading him to assault their cleaning lady (Coast General Teaching and Referral Hospital, October 2023). Countless other horror stories were divulged, including one where a man living at the perimeter of a school was coercing female students on a scheduled basis to engage in sex for the exchange of money. Having close connections with the village elder and a relatively corrupt justice system, the process to detain and charge the perpetrator was hampered. Another incident was where a teacher physically reprimanded a 3 1/2-year-old student which resulted in her broken arm (Coast General Teaching and Referral Hospital, October 2023). An image I doubt will fade from mind, is when we visited the Kadzandani primary school for a hygiene information session, and a teacher smacked a child in the head for misbehaving. Such force of power from an authority figure toward a child - or any being for that matter, was completely foreign to me. Instinctively, I audibly gasped and froze in place, though no one around me acted like anything had happened. Admittedly horrified and unable to shake the occurrence, I afterward asked a program mentor if physical punishment is common in Kenya, aware that there are cultural differences in the practice. After a genuine bout of laughter, she replied that it is considered weird if a parent does not do that. Apparently, it is only against the law if you leave a mark or sustained injury. How does one learn that corporal violence is psychologically harmful and has long lasting negative effects, when caregivers freely enact it on children? In all instances, there was some form of institutional authority that minimized or largely perpetuated the acceptability and prevalence of physical and gendered violence. Lastly, a large player dominating the intersection of gender, health, and sexuality is devout religious ideals. Stemming from the amalgamation of colonizing powers in the country, Christianity and Islamic faith are widespread (Odhaimbo & Njeru, 2023). With 94% of Kenyans identifying as religious (Odhaimbo & Njeru, 2023), sex outside the context of marriage and childrearing is taboo and strongly discouraged. Coupled with a lack of health literacy and birth control access, many young individuals do not have the knowledge, tools, and acceptance to engage in healthy sex practices. Unfortunately, this leaves many with sexually transmitted infections, unwanted pregnancies, and ostracism from family and community. The implications of sexual harm are worse for women, where they must unequally bear the outcomes of pregnancy and childrearing, assault, and victim blaming. This effect is even larger for LGBTQ+ individuals, who face immense shame, disapproval, and a lack of community or supportive systems. It was shocking to hear the contempt, perceived ill-nature, and need for cure of “gayism” espoused by psychological professionals. Likewise, in order to “safely” access resources, intimacy, and a family life, many young women are sold the dream of marriage before their minds and bodies have had the chance to fully develop. It is estimated that about one in every five of Kenyan girls aged 15-19 are expecting, or already have a child (African Institute for Development Policy, 2016). At one point, the head psychologist Anne led a small group of interns to speak with an 18 year-old girl who had just lost her baby and her uterus. In many traditional Swahili cultures, men are permitted to have multiple wives (Odhaimbo & Njeru, 2023). In reality, this often allows men to neglect their family once they have grown tired of them, as their attention and income is redirected to alternative dependents. As heard many times by a variety of female patients in the hospital, when a man decides to spend his time and resources elsewhere, it becomes the responsibility of the mother to pay bills, feed their families, and raise their children. Additionally, where abortion is only offered in life-threatening emergencies, similar to some of the United States, women are once again disproportionately restricted to the choices they can make for their own bodies and life. Many women are forced to choose between raising a child they may not want or have the means to support or risking their lives in an underground abortion procedure. It became no wonder why the top cause for admission to the gynecological ward was incomplete abortion (Coast General Teaching and Referral Hospital, October 2023). “But it is not like that where you are from”, or some version of this was a statement I heard often. My immediate and truthful response was to reply that - in fact it is in some ways the same. Despite Kenya having higher poverty and a host of inequitable challenges, many of these same health and social concerns exist in North America and for a large number of people. In Kenya, the poverty and disparity in healthcare is simply more widespread and easier to see. My aim in this statement is not to neglect the health crises and larger gaps that exist in Kenya, but rather to highlight the ubiquitous nature of inequitable global health. Whether in North America or Africa, the resources available to a nation and individual will heavily impact ones’ quality of safety and health. During my time in the hospital, the primary lesson I learned was that positivity and support truly go a long way. Connection and belonging are essential for wellbeing, which was observed in each interaction. Daily, I found myself glowing from the unyielding spirit and hopeful souls of so many people. Though I have never worked in a hospital, I doubt that this radiance exists everywhere. It seems as though it is much easier to appreciate what you have, when one is not constantly striving to gain more. My journey in Kenya magnified the level of privilege that exists in my own life - where travel, education, health, safety, and clean water come relatively easily. Pertinently, my life has allowed me the luxury to question the environment around me and freely decide the paths that I venture. For those in a cycle of poverty or struggling to make ends meet, the same freedoms, safeties, and choices are far less tangible. More than ever, Kenya has shown me that humanity fares much better when we are united in community, rather polarized and interested in our own good. I realize that while stigmas are alive and well to demonize those that stray from the norm, the global community heals when we accept those that are different and learn from new perspectives. While the world of economics and power politics fills us with fear, hatred, and superiority, it distracts us from what it means to be most human - to relate to and care for one another. In summary, the key teaching from my internship abroad in Kenya is that we must critically challenge systems of inequality, and actively work to promote health and safety for the welfare of all global citizens. Though health is a human right, it is far too often treated as a commodified privilege. Unsure of exactly which career path I will end up on, my internship experience has assured me with confidence that I will continue to assist others in achieving safety and support. Gaining this firsthand knowledge, I am eager to continue counselling gender violence survivours, and promoting education on sexual and mental health. Being abroad in a completely new environment ignited my passion to work with the global community and explore other cultures. Overall, my internship with International Medical Aid has provided me with lessons and experiences I would not expect to gain elsewhere. I am forever thankful for the perspective and connections it has opened me toward as I seek to find myself and my career journey.

I really enjoyed being a participant in the program. From the moment I was picked up to the moment I was dropped off from the train station I felt very safe and the IMA staff was there every step of the way to support and guide me. The accommodations were excellent, I was not expecting the hospitality that I received and I have no complaints! The kitchen staff and the food were all amazing. The chefs were very friendly and made very yummy food. My experience at the hospital was also good. The dentists in the dental unit were all very friendly and were very open to having interns there. I always left the hospital having learned something new. The community outreach was nice because it felt like I was able to make an impact in the community whether it was through the women’s hygiene education session or the mental health education session. I especially enjoyed the free medical clinic. I was with the dentists and I was able to assist them by setting up the tools needed for extractions and cleaning up after an extraction was completed. During my childhood, my career aspirations varied from wanting to become an astronaut to a wanted to pursue a career in education. However, all those aspirations quickly changed after I got my wisdom teeth removed at the age of 12. I thought it was cool that the oral surgeon was able to remove all four of my wisdom teeth in just 45 minutes. I started to think about possibly pursuing a career in dentistry. I had always enjoyed going to the dentist as a child. I loved everything about the dentist’s office; from the smell, to getting my teeth cleaned, to the sound of the instruments as they did procedures. I quickly fell in love with the idea of becoming a dentist, and it stuck. As a college student, I have actively pursued my interest in dentistry by joining various pre-professional clubs for students wanting to pursue careers in healthcare. While looking for something to do over the summer that would add to my professional development, I stumbled upon International Medical Aid. Initially skeptical since I stumbled upon it through a random Google search, something urged me to complete an application. When I received an email for an interview, the opportunity became real, and I excitedly informed my parents. Upon acceptance into the program, I knew with certainty that I wanted to participate during the upcoming summer. Although I have family in Kenya and I had visited them a few times in the past, I wasn’t quite sure of what to expect at the hospital, especially in the dental unit. However, over the course of four weeks, I witnessed the extraordinary dedication of doctors and dentists who provided exceptional care to numerous patients despite the limited resources available to them. On my first day we were introduced to the dental unit and one of the dental interns showed us around before cutting us loose to choose where we wanted to observe. I began by observing in the oral diagnosis department where I watched as Dr. Mulei attentively listened to patients’ complaints and examined their mouths. Throughout his diagnosis process, he was sure to thoroughly explain what he was doing and why he was doing it. By the end of my shift, Dr. Mulei had already started quizzing me on the different issues that ailed the patients. Upon my return to the residence, I was already in awe of all that Dr. Mulei had done with the patients he saw in the few minutes that he interacted with each patient. The set up in the oral diagnosis department consisted of two plastic chairs that were facing each other and a box of tongue depressors. Despite all the resources that were lacking in that environment, Dr. Mulei was still able to provide the best care he could to his patients and help them find the best course of action for them. Observing the dentists in the Dental Unit at Coast General further solidified my decision in wanting to pursue a career in dentistry. Two distinct moments were particularly impactful. The first occurred when I accompanied Dr. Khadija Athman as she went to see a patient who was staying in a ward to clean his tumor. The patient had been hospitalized for about a month and the only unit that was really seeing him and making sure he was getting the care he needed was the dental unit. The patient had an oral squamous cell carcinoma, and the tumor was so big that it was protruding from the patient’s eye and had taken over the entire right side of the patient’s face. The dentists had put in a request to have the patient reviewed by oncology 3 weeks prior to the day that we had come in to clean his tumor. The tumor was very infected and had started to bleed which is why the patient needed to have someone come every day to clean it. After reviewing the patient, it was noted that oncology still had not come to review the patient and over those three weeks that the patient was waiting, the patient’s condition continued to deteriorate. The dentists called the oncology unit and were told that if they wanted an oncologist to review this patient that they would need to physically come to the oncology unit and request the review. Once the dentists had arrived at the oncology unit and asked why they didn’t review the patient after the first request was sent, they told the dentists that they never received such a request. So, because of miscommunication, this patient was left untreated by the unit that he needed the most and at the time the oncology unit was finally able to see the patient, there was nothing more that could be done for him. The patient ended up passing away that very afternoon and it left me thinking about how much the dental unit did for the patient even though to a certain degree it was outside of their scope of practice. But because the patient was not receiving the treatment he needed from the oncology unit, the dental unit continued to care for the patient, check up on him, and advocate for him. The second instance that reinforced my dedication to dentistry involved a patient who I saw improve over the four weeks that I was at coast general. This patient was in the hospital because they had a decayed tooth that caused a case of Ludwig’s Angina, which was left untreated and then became necrotizing fasciitis. I was told by the dentist who saw the patient when she first came in that the necrotic tissue went from just under her chin all the way to her chest. When the patient first arrived, she had a very poor prognosis and they did not think that she would make it, but the patient was able to recover and come out even stronger. Every time I saw the patient no matter how much pain she was in, she always found a way to smile. By the time I left, she had been cleared to leave the hospital and was crying tears of joy at her dressing changing visits. Something that the dentists at Coast General often discussed was how people in Kenya view dentistry more as a cosmetic matter, and they don't really visit the dental unit unless it is their last resort. Growing up, I regularly went to the dentist every six months for check-ups and cleanings. I had never once thought that these appointments were vain or solely for maintaining the appearance of my teeth. It saddened me to know that a large part of the population believed that dental visits were necessary only if they were experiencing significant issues. Consequently, most of the visits I observed at the dental unit were for curative care rather than preventive care. This trend was also evident throughout the hospital. In "The Current State of Healthcare in Kenya" presentation, one of the covered topics addressed the division of the healthcare system. During this lecture, I learned that the prevalence of curative care over preventive care at the hospital was partly due to the greater funding allocated to curative care. Another contributing factor was the expense of receiving treatment at the hospital, even with subsidized prices, making it unaffordable for the average Kenyan. People are reluctant to spend extra money that could be used to support themselves or their families solely for ensuring their health. They only want to invest in healthcare when it becomes a dire situation. This brings me to a conversation I had with my uncle and cousin after they picked me up from the train station in Nairobi. Based on what I had witnessed during my time at Coast General, I stressed the importance of taking oral health seriously and considering it a priority for overall well-being. While my uncle agreed with me, he also reminded me of the significant costs and time involved in visiting the dentist. These are resources that could be used for necessities such as food or paying bills. He even expressed his reluctance to find out if there was a serious health issue, as he wouldn't want to burden his family with the financial strain of medical bills and treatment, potentially jeopardizing their well-being. When he shared this with me, I experienced a range of emotions. The environment I grew up in had shaped my perspective on priorities. I had placed great emphasis on oral health based on my own experiences, but my uncle's upbringing and current circumstances differed significantly from mine. He never visited the dentist solely for teeth cleaning or an x-ray. His life is filled with struggles, and ultimately, having a roof over his head and food on the table takes precedence over going to the hospital for a check-up. The knowledge I have gained from my time with International medical aid is invaluable. Witnessing the dedication and resourcefulness of the healthcare professionals in Kenya, despite the challenges they face, has inspired me to become more of an advocate for improved access to preventative care and to address the systemic issues that inhibit proper healthcare delivery to those who need it. I am committed to using the knowledge I have accrued from this experience throughout my career in healthcare and to continue to build upon it. I hope to return to Kenya as a licensed practitioner and continue to learn and grow as a medical professional. Most importantly, I plan to share my experience and inspire others to come to Kenya and learn about healthcare and the beautiful culture that surrounds Coast General. My experience through IMA has shaped me into a more aware and perceptive person. It has changed my worldview and my view on healthcare. Although I have only experienced healthcare in the United States and Kenya so far, it is a starting point for me. It has helped me understand how healthcare works, how healthcare systems can impact a population, and the importance of never losing sight of the primary goal of healthcare: improving the lives of patients!

From the moment I stepped off the plane in Mombasa, the program mentors were there to assist me in any way I needed. The security on site made me feel incredibly safe during my stay. My experiences in the hospital were some of the most shaping of my entire life and I could never be more grateful for the experience I had there. Our program chefs were incredible and made delicious food, including cultural foods for us to try. I know this sounds like rambling, but I just have too many good things to say about my time with IMA. I have what I would consider to be a special and deep passion for mental health care. As someone who has struggled with mental health for a majority of my life, I have seen first hand how detrimental and isolating mental illnesses can be. As a child, I lived what can only be described as a double life. At school, I was a poster child for the perfect student. I excelled in all my studies, testing years above the grade I was in at school. All throughout elementary school, my teacher’s took special interest in me and my intelligence, giving me advanced worksheets and books to read to keep me entertained and challenged. However, once I went home, a switch flipped and I became a completely different version of myself. Nearly every day when I would come home from school, I would scream and cry for hours, throwing tantrums that left my parents helpless with no clue what to do. They took me to specialist after specialist, and no one could figure out what was wrong with me. Hearing that there was something wrong with me at such a young age definitely impacted the way I viewed myself and mental health growing up. It was not until I was about thirteen years old that I was diagnosed with anxiety. This anxiety that I masked at school, when paired with the boredom I experienced due to work I found too easy, fostered tension that was released once I stepped foot inside the safety of my home. For a short period of time following this diagnosis, I wanted to be a child psychologist. Frankly, I just thought it would be a cool career. It was not until I turned twenty that I realized my passion for mental health care and how deeply I cared about the issue. It sounds cliche and dramatic to state that I had an epiphany, but that is the only way I can think to describe how I came to my decision to be a psychologist. Yes, I was a psychology major in my last year of college, but I had no idea what I wanted to do after graduation. This fall, I went through what can only be described as the hardest time I have experienced. I spent days unable to get out of bed, trapped inside my own head and paralyzed by my anxiety. At night, I would be taken by horrifying panic attacks that seemed to come out of nowhere, leaving me shaking and unable to catch my breath between sobs. At this point, I genuinely no longer wanted to be alive. The single hardest thing I have had to do in my entire life was tell my parents I needed help. Once I got my medicine adjusted, my anxiety started to decrease, and it was at this point that it became clear to me that I wanted to work in mental health, helping people who struggle like I have. Once I was accepted into International Medical Aid’s Mental Health program in Kenya, I was beyond excited. I had never worked in a clinical setting, and the only exposure I had previously had to mental health facilities was the child counseling center I went to when I was younger. I thought that I could not be more prepared, as I would have a unique first-hand understanding of what the patients I would deal with experienced. However, I could not have imagined the dire state of mental health care in Kenya. My first day in the hospital was nothing short of eye opening and shocking. While I had known that the hospital would be nothing like the healthcare facilities in the United States, I could not have imagined the setting I stepped foot in. The first thing I noticed was the sanitation, or lack thereof. Nearly every room in the hospital held rusty equipment, with few monitors or other devices one would expect to see in a large hospital. There were flies everywhere, and it was drastically clear that there was not only a lack of staff, but an abundant lack of resources. The moment I stepped foot into the psychology unit, my confidence that I knew what to expect immediately dissipated. The unit was incredibly small, with a medical officer and two psychologists. There is also a psychiatrist, but during my three weeks in Kenya, I did not ever meet or see them. Considering the population that Coast General Teaching and Referral Hospital serves, two psychologists was nowhere near enough to combat the mental health problems that Kenyans faced. Statistics supported my observations, as it is estimated that 1 in 4 Kenyans is likely to suffer from some sort of mental illness at some point in their life. Furthermore, there are only 62 psychiatrists in the entire country of Kenya (International Medical Aid, 2019). Learning about these facts only further solidified that the state of mental health care in Kenya was much worse than I had previously thought. Each day in the psychology department brought new cases and challenges. I was able to sit in on counseling sessions with a variety of different patients, allowing me a clinical experience that I would never be able to have in the United States. One of the first cases I sat in on was with a first-time mother who had lost her baby during childbirth. While Anne, the psychologist who handled the case, counseled the mother with nothing short of compassion and inspiration, it was immediately clear the vast differences between psychological counseling in Kenya as opposed to the United States. Essentially, all the psychologists were able to do in this case was to provide support and guidance for staying busy to keep the mother’s mind off the loss. It was also emphasized to her that she would likely conceive again, and that situations like these are out of our human control. Though, the most shocking part of the session was that we sent the mother back to the maternity ward to wait for discharge, where she was surrounded by all the other new mothers holding their newborns. While there was nowhere else for her to go, as there wasn’t a psychiatric ward or anything of the like in the hospital, sending her back to an environment that would only remind her of her loss seemed cruel. Perhaps the most heartwrenching case I experienced over the span of my three weeks in Kenya was with a fourteen year old girl. She came into the Gender-Based Violence Center, and the first thing I noticed about her was how small she was. She looked sickly, and during her counseling session, she kept coughing and appeared short of breath. It was during this session I learned that she had been raped by a neighbor. She actually had blocked the rape out of her conscious due to trauma until she realized she was pregnant, at which time the horrific event came back to her. When I heard this story, I was overcome with anger and felt physically sick. Hearing this small fourteen year old child tell us that she was pregnant with her rapist's baby brought bile up my throat. The worst part of it was that he was not in prison. She had to go home and live in fear everyday because he was not in custody. After the session ended and the girl left the room, I asked why he wasn’t in custody. I was told that it was a legal issue and there was nothing we could do pertaining to the rapist other than offer the girl support. This infuriated me and truly showed me how vastly different Kenyan medical care and politics were from those in the United States. If something like this happened in America, there are systems in place, teams that work together to ensure that the patient is taken care of medically, psychologically, and legally. But there was no legal team for us to work with to ensure justice. Rather, it was a completely different structure in society that needed to be dealt with separately, only causing additional stress to the client. Rape was actually something that I heard a lot about during my time working alongside the psychology team. This sparked a desire inside of me for working with those who have experienced sexual assault and abuse. While I have not personally experienced rape, I know far too many people who have, and hearing these stories lit a fire within me for advocating and helping these victims. While I had previously known that I wanted to work with adolescents and young adults, this clarification allowed to me realize that I would like to work specifically with depression, anxiety, and sexual abuse cases. Depsite the challenges I know will come with this field of practice, these victims deserve to have someone listen to them and support them through these dehumanizing experiences. A study on mental health and gender-based violence in Kenya found “...that experiencing rape within the last two years was a strong predictor of scoring poorly on all PTSD, depression, and anxiety scales” (Friedburg et al., 2023, p. 10). In a country that already is facing a multitude of mental health problems, with no public funding to combat them, the co-occurence of rape and poverty only further worsen these issues (International Medical Aid, 2019). Despite the difficult and sickening stories I heard during my time at Coast General, my experience is one that I will cherish and remember for the rest of my life. I learned more than I could have ever imagined about mental health care and what a career as a psychologist looks like. While there were vast differences between psychological care in Kenya and the United States, there were still countless lessons I learned during my internship. For starters, I learned how to deal with cases using empathy and kindness, fostering a comforting environment that allowed clients to feel safe opening up and sharing their experiences. I also learned how to support clients through these extremely difficult times, providing them with hope and support. It was nothing short of fulfilling knowing that despite the difficult circumstances these clients were facing, I was someone that they knew supported them and believed in them. It became clear that providing support is no small gesture, as mental health in Kenya is extremely stigmatized. According to the Forum on Neuroscience and Nervous System Disorders et al. (2016), “Stigma toward people with mental illness exists on every level, from the community to health care workers.” This stigma further deters people from seeking help, exacerbating the mental health problem. My time in Kenya with International Medical Aid was nothing short of a dream come true. During my time working at Coast General Teaching and Referral Hospital, I gained an immense amount of knowledge and experience that I would never have the opportunity for in the United States. Working alongside the psychology team allowed me to sit in on counseling sessions with patients and to see how the psychologists handled difficult issues. Each day I spent at the hospital further solidified my passion for mental health care and provided me with clarity that this is the career I was called to. I am confident that this experience will help shape my counseling outlook during my career, as I now have a unique perspective on cultural aspects of mental health. This experience has also opened my eyes as to how desperately mental health needs a global platform. Even in the United States, mental health still has a lot of stigma attached to it. I will never stop advocating that mental health matters. After all, how can we expect people to live a full life, contributing to society, if we do not address the illnesses and challenges they face concerning their mental well-being?

The programme was extremely safe and welcoming. The food was excellent and so were the ALL of the staff. The mentors were very helpful and kind. Safety and accommodation was also excellent. I found it extremely difficult, especially the first few days, to hear the stories and get to know the patients myself and the psychologists spoke to. I found it of course very upsetting, however I did not expect there to be such amazing facilities or organisation regarding mental health because of the stigma in Kenya. So, this was a nice surprise and helped when I found it upsetting, because it was good to know that they have somewhere, and that they have people to help them. The psychologists and psychology interns I worked with were truly outstanding at their jobs, I am surprised about the difference between psychologists in Kenya vs at home. I prefer the more hands on/passionate techniques and demeaners that the psychologists in Kenya had. I knew I wanted to work in psychology before and most likely with victims of abuse, and after this experience, it has tripled my goal of pursuing this career. Seeing the effects that talking to the patients had alone was so inspiring and confirmed the need to work in this field. I was also extremely taken aback by the resilience of the patients, I believe that a part of this is because most of them do not have the 'luxury' to dwell on their feelings, as they have families to run, jobs to go to (without excuse) and fewer resources to help them with their troubles over a long period of time. The GBVC clinic and the people dedicating their lives to helping patients was so inspiring; going to court for them, carrying out gruelling medical exams for abuse survivors, and supplying victims with resources, despite them having little to give themselves. I could not have had this kind of experience in my home country.....it was more than valuable. I hope to keep in contact with the staff I worked with and hopefully return to the hospital when I return to Kenya. My experience in Mombasa with IMA has motivated me further to pursue a career in Clinical Forensic Psychology and if possible, return to Mombasa to conduct research for my future dissertations. I found the cultural/social differences to be extremely interesting and enriching, including the greater resilience that I observed in the people in CGRTH compared to people in the UK (a generalisation). Additionally, it was priceless for me to be able to shadow doctors in surgery and OB, as I would not be able to gain this kind of experience in the UK (without being a medical student). I found it extremely interesting, however I am still set on pursuing a career in psychology. Since the very start of my high school years, I was fascinated by how people think and what makes people act as they do. I realised I fell in love with Psychology after completing my final 2 years of high school studying higher level Psychology. This was my first formal introduction to the subject, but I did not have any hands-on experience with the clinical aspects of psychology until my first years of university, where I volunteered at a suicide prevention phone line. I learnt so much during the training for this experience and during the night shifts on the phone talking to the hotline users. Talking to them about their suicidal thoughts, severe depression, anxiety and experiences with abuse, I was able to fully understand the extremes that poor mental health support can bring people to. I knew that I would do whatever I could to help people with this delicate area of wellbeing and I would take great pride in doing so. I had been to Kenya on multiple occasions prior to this internship as I have family living all around the area, however I had never been to Mombasa or to a hospital in East Africa. I arrived in Mombasa only knowing that I want to pursue a career in psychology and that I would have novel experiences that I would not be able to get in my home country, England, or most other places in the world. I experienced this within my first day in the hospital. I walked into the Gender Based Violence Clinic and was shocked by the number of patients waiting to be seen and the small size of the facility. However, having had some experience with East African culture and society, I was also pleasantly surprised that there even was such a facility or that there were a good number of psychologists and psychology interns who were making such a large difference at the hospital. During my first day in the hospital, after introducing myself to the psychologists and psychology interns that I would be shadowing for the next 2 weeks, we started our rounds in the post-natal department to look for new mothers who needed counselling. The first thing that stood out to me was that new mothers had to share beds with their babies and other women due to capacity limitations, this was seen all around the hospital, including in units where patients may have been contagious. During the rounds on the first day at the post-natal unit, the majority of the counselling was for mothers who had lost their babies. I was taken aback by the psychologists and their interns’ counselling techniques because I immediately noticed differences between them and psychologists that I have seen and worked with in England. For example, in England a psychologist would not suggest what the clients next steps should be at all or if they did it would be after trying many other techniques first; there are strict regulations on ‘advice-giving’. In England psychologists would not often give patients any options until the patient suggested them themselves. For example, we spoke to a woman in the GBVC whose daughter had been defiled, and the perpetrator was said to be released from prison and back into their village, where her children live. The mother was quite inconsolable at first, very emotional and understandable, not thinking rationally. The psychologists seemed to deem that the best way to help her was to lay out ideas and steps that she can take, to help make it clearer for her and it seemed to calm her down a lot. After reading psychology guidelines, I found that very few people recommend this technique for psychologists as it is seen as unethical and to cause very harmful, ultimately unhelpful, outcomes. However, I personally saw that it truly helped the patients to be told their options and to let them decide the outcome. I believe that this observation is due to the severity of their living conditions, which means that they do not have the ability to draw counselling out over multiple sessions, they cannot afford to take time from work, their family or make the journey to their sessions. If they were to be treated by a psychologist as though they had expendable time and money, they could maybe slow down the end goal of viewing options and instead focus on emotions and recovery. However, they do not, therefore, I really believe that in scenarios such as the ones I witnessed over my internship, this is the best technique to use. Additionally, I believe that the success of this method may also be due to a lack of education in some cases. For example, the case with the mother that I mentioned above, the direct advice seemed to help a lot not only due to the short amount of time and money she could spend in counselling, but also because she simply did not know what some of the options and legal consequences for the perpetrator entailed. The first week, when we were asked to sum up our week in five words, I thought of ‘the luxury of staying sad’. It seemed as though the patients we saw did not have the “luxury” to remain crippled by their emotions for long at all after an incident. For example, there was a mother we saw in the post-natal unit who had lost her 3rd child only moments ago, and within 10 minutes of speaking to the psychologist she stopped crying, her mood seemed to lift and she came to the conclusion that she must be fine in order to go home quickly and feed her other children, take care of her family and go to work. I found this difference to be extremely interesting between what I saw here and what I see in the western world. Family and friends that I know have gone through a stillbirth, a miscarriage or any kind of physical assault would have not been able to carry on, compartmentalise, push through, however you would like to describe this resilience. I believe this is because their lifestyle does not force them to. By no means am I suggesting that the patients I saw in Kenya feel less about the traumatic incidents that they face, but that they are more resilient because they must be. This is interesting because it shows what the human is truly able to withstand. In the UK (and USA) we are overly coddled to a point where it seems as though it is having negative effects on the population, which most psychologists are trying to fight back on. For example, in the USA and in the UK, people have been trying to censor what others say, write and read if they deem it “offensive” or “triggering/traumatic”. Countless psychologists have deemed this practice to be increasingly harmful for our youth’s mental health, anxiety, depression, and victimization. I will be writing a dissertation for my master’s programme this year and for my masters next year. This observation has piqued my interest in studying resilience in the face of trauma across the globe, perhaps even looking into people’s emotional resilience in war zones or advocating for the damage that censoring does to our resilience and mental health. Another idea I would like possibly to explore is the relationship between happiness and resilience, then compare this in Kenya to the UK. I spoke to IMA alumni Caitlin Moroney and saved her contact details as she completed her research project based in Mombasa, which is something I would like to do either on some of the subjects above or this related to sexual violence victims. My first 2 days especially, I found it very hard to not be too emotional in front of the patients in response to seeing them in dismay or after hearing their stories. I spoke to the psychologists and interns (Anne, Saida, Joy, Grace and Hashwin) to learn how they do not allow themselves to be too emotional in front of the patients. They advised me that I am not the patient’s friend or family, so I do not need to be so closely emotionally involved in their stories. The patients need someone to talk to who will be professional and who won’t get emotional, that is how we would help them. This advice really helped; I carried it with me for the next 2 weeks and putting this advice into practice in Mombasa. We are only there to help them and be able to listen and provide comfort that they may not get elsewhere. Something interesting that I observed when the patients could only speak Swahili was that I was trying so hard to decipher what they were saying through their body language and facial expressions that it felt harder to not get too emotional. I tried to find studies supporting this however I found that although body language provides us with 90% of our information about people, body language is not universal and differs across cultures (Academy & Sharmin Chonda, 2022). I am unsure why I felt like it was harder for me to witness sadness of the patient through their body language compared to their words (when they spoke English), perhaps it is because of my prior experience with the Kenyan culture, or perhaps it was due to the timing of the observation being at the beginning of my trip before I became able to control my emotional reactions to patients. The psychologists and interns always debriefed me after the session with the patient if they only spoke Swahili, and if appropriate, they would translate a bit of the conversation during the session. Those were my observations from just the first few days, and already I confirmed that I had chosen the right career path to follow. I was very lucky to have another intern from IMA who was working in the Gender Based Violence Clinic (GBVC) at the same time as me for the first week of my stay. She already knew about how the days worked and what our roles could be in the GBVC, so she helped fast track my learning process and ensured I was integrated quickly. During the first week we saw a case of a 2-year-old sexual abuse survivor. While the mother and the psychologists spoke in Swahili, the other intern and I kept the little girl company and brought toys from the children’s area for her to play. Despite her sad backstory she had, she was extremely playful and very affectionate which was surprising but inspiring to see. We were with her for quite a long time, playing with the toys and learning some words in Swahili from her and her mother, however we noticed that the toys were not clean, a lot were broken, and it was a safety concern. The young girl we saw that day was putting the toys in her mouth (as expected from a 2-year-old) even though the toys were very unsanitary. The other intern, who was also working in the GBVC, and I went to the mall to buy new toys for the children’s play area in the clinic and cleaning supplies so we could clean the existing toys and tidy up the area. We saw many more children that week and hope that it helped make the area more comfortable during stressful times and appointments. The women working at the GBVC were exceptional. There are the psychologists who work at the GBVC when needed to counsel, there are the doctors and nurses who work a the GBVC to perform medical tests, and then there is Mary who organises so much and works with the victims regarding the legal aspect of their cases. I never shadowed Saida in the medical examination room, but I know that they performed forensic sexual violence examinations that mimic the ones you would see where I am from in the UK. This includes tests for STD’s such as HIV, and oral, vaginal or rectal injury examinations. During the second half of my second week, I went with the psychologists and interns to do rounds at the oncology, radiology, newborn and burn unit. The oncology unit where patients were receiving chemotherapy was extremely cramped, but the majority of the patients seem to be uplifted after speaking with us. This was interesting to see how a little conversation seemed to improve their demeanour so much. On one of our rounds to ward 1, we spoke to a girl who was born with HIV (transmitted from her mother) who had been in hospital for 8 weeks with tuberculosis. She was extremely upset in all of our visits over the 2 weeks because she wanted to leave the hospital and return home, although she could not because her mother could not pay, and her father refused to. The social services were in the process of helping her return home when I left, and after following up with one of the interns a few days ago I found out that she has been waivered and thankfully sent home! I was stationed with the psychology department and the GBVC for the duration of my internship, and I never wavered that that is where I wanted to stay. I was however interested to see the real life versions of the stories that my peers who were all pre-med were describing. I was especially interested in experiencing OB, and surgery, so I signed up to an afternoon shift in surgery and a night shift in OB. My afternoon in surgery was certainly intriguing, I had never seen anything like it, unlike my other peers who had been in pre-med school for the last 3 years. The first surgery I saw was a diabetic man who’s sole of his foot had begun to rot away, I found out that this surgery is called a debridement. It seemed like standard procedure except for the comfort offered to the patient, in that I did not observe the surgeons provide any comfort to the man. His heart rate was rising quickly, so I tried to search for the word in Swahili to tell him not to worry and confirmed it with the main surgeon. The patient laughed and politely corrected my pronunciation of ‘usijali’, which seemed to lessen his nerves. Whether it was from the entertainment and distraction he found in correcting my Swahili or from the phrase itself, or both, I am unsure, but I was relieved to see him relax during the spinal anaesthetic. I was also lucky enough to see a twin c-section. I have never seen a natural birth (until my nightshift in OB) let alone a c-section. One of the babies was in breach and one had the umbilical cord wrapped around his neck. I was able to watch the c-section with another intern who had been in OB all week and who had OB-GYN work experience back home, which was very interesting and helpful to be able to ask her questions. I was beyond shocked when I saw the surgeon reach into the small incision with both hands and pull apart the muscles to get into the uterus. I was even more surprised to find out that this was a normal worldwide procedure for c-sections. I was able to view my IB biology knowledge in real time during the c-section When the babies were out and stable, and the mother was safely stitched back up, the wave of relief was unexpectedly strong. The last surgery I saw was for an open tib-fib fracture, where a man had an accident on his ‘boda-boda’. Here I watched the surgeons cut open the wound further to expose the broken bone, then drill metal rods into 4 precise places in his tibia, stretch it apart and forcefully push the bones back into place. It was totally novel and fascinating. In all these surgeries, the patients were only on local anaesthesia and were therefore awake. This was especially shocking in the tib-fib fracture due to the noise of the drills that the patient was able to hear. The patient was severely shaking and was complaining of being cold, we turned off the AC and covered him up where we could, however it did not seem to help. I thought it may also have been from the cold IV drips he was receiving or most likely from some shock because of the noise and commotion surrounding his injury. I realised that the lack of general anaesthesia and the fact that the patients were awake during their surgeries is different to the USA and England after asking my friends who study medicine. After asking the surgeons, I found out that this was due to a lack of supply, which reminded me of the luxuries in western countries or private hospitals in Kenya compared to Coast General Teaching and Referral Hospital (CGTRH). Since the doctors and psychologists, I shadowed were highly trained and knowledgeable, sometimes it was easy to forget that CGTRH was in a third world country facing the limited access to basic resources and medicines. One of the most interesting, and less emotional cases was of a young boy who was referred by his aunt who was worried about him after finding out about a sexual experience he had with an older man. I waited with him for a while before the psychologists were ready to come back in and speak to him. During this time, he lied about where he lived, why he was there and that he had a full-time job as well as a successful rapping career. He was obsessed with a rapper from the US and had become violent when people didn’t share a mutual love for the rapper. He also explained that when he is violent, it is a female alter-ego of his and not his male personality, which I found out is not what I thought-split personality disorder, but rather a dissociative disorder, possibly because of his upbringing by an extremely unstable mother. I have never met anyone like this patient in my life and it sparked such a great interest in dissociative and split personality disorder in relation to violence. I completed my undergraduate dissertation on sexual violence, so I have previously had great interest in why people commit such violence, this experience gave me an ulterior angle to research it from. This leads me to a cultural difference that I found intriguing. I had heard of the stigma surrounding mental health in Kenya; however, I had never seen it in person properly until my trip to Mombasa. Although I have read many studies about the inadequate access to mental health in Kenya (Short, 2023). I noticed that after we would introduce ourselves to patients and psychologists and psychology interns, they would seem confused and sometimes did not understand what our role was or how it differed to a doctor. Despite this observation, it was found by the World Health Organisation that over 2 million people in Kenya have a reported mental illness (International Medical Aid, 2019). This statistic is likely much higher, as are other statistics of many physical illnesses, although this is often due to the reliance on religious beliefs to cure their illnesses over doctors at the hospital to. Another cultural difference was the difference in expectations for men from Kenyan women and expectations for men from western women. For example, I was asking the psychologists and interns why men are rarely present for the birth of their child. I was old that it is not the man’s role to be there for the women, it is a women’s time. This is very different to England and the USA which I explained to the interns. In response to me explaining how unacceptable it would be for the husband to not be there for his wife during birth (unless there was a very valid excuse), the interns were confused and quite amused. Additionally, from the women who came into the GBVC for domestic abuse, it seemed as though men had a disregard for the women in their communities. This may be a factor in the high prevalence of sexual abuse crimes that is recorded by the women working at the GBVC. This has been seen as a factor that increases the probability of sexual violence towards women in other cultures (Kalra & Dinesh Bhugra, 2013). Another cultural difference was the alternate views about sexuality and masculinity, compared to what we have in the UK. We saw quite a few patients being referred to the psychology unit from the GBVC for being homosexual. These counselling sessions were extremely interesting to observe because I heard of the true opinions that the psychologists and interns had about homosexuality, yet during the patients’ sessions, they made the patient feel comfortable and gave little to no indication that they were acting particularly taboo. This was extremely professional and useful for me to observe, because knowing their true feelings about the subject made the techniques and phrases, they used to make the patient more comfortable were easier for me to pick out (after observing them with other patients prior to the homosexual patients). Near the end of my internship, I introduced 3 of the other interns who were placed in other units of the hospital, to the psychology staff so that they could maybe spend some time with psychology and the GBVC to raise awareness for the units. We also bought newborn baby diapers to give to new mothers who were referred to us by Mary at the GBVC. Most of the mothers impregnated as a result of rape or underage sexual activity did not have the support to afford such a basic necessity for their babies. I would like to say how appreciative I am of this internship experience, meeting the IMA staff, the friends I made, and having the experience of visiting the historical and cultural sites of Mombasa. My experience with International Medical Aid has been beyond valuable. I hope to be able to return and visit CGRTH/GBVC and possibly conduct some research for my master’s and PhD dissertation. I have touched on some gruelling stories, and of the cultural differences in perceptions of mental health. However, it is important to note that the UK is also troubled with such cases. I am even more motivated to pursue a career in clinical forensic psychology now, and I will benefit greatly from the experiences I have collected from IMA and Mombasa.

My time in Kenya was truly unforgettable. I met incredible people, made new friends, and learned more than I could have ever imagined. To be able to say I traveled to Kenya is awesome, but to be able to add that I interned in a public hospital and got to observe patient care up close is really the cherry on top. The dentists that I observed were some of the nicest people I have ever met. The IMA team/mentors were always ready to answer questions, and they taught me so much about Kenya. The food was delicious! I usually went back for seconds, and it was such a treat to be looked after by the housekeeping team. Snorkeling in the Indian Ocean and experiencing Malindi/Watamu was definitely a highlight, but I also loved the day-to-day routine of going on the bus, driving to the hospital and people watching out the window, saying hello to and fist-bumping the guards, and walking all around the dental unit. Going out to local spots with my fellow interns was also so much fun. I really do hope I have a chance to return to Kenya one day. As a child, I was terrified at the thought of sitting in a dental chair. Sitting in the chair itself was a whole other obstacle. There I was sitting in a bizarre-looking chair with a direct view to a tray of dental tools that had 6-year-old me thinking would bring me nothing but pain and discomfort. Needles and drills moving towards my face with no explanation of what was about to happen. It was a complete nightmare…until I met the person that would end up being my pediatric dentist. Her office was warm and inviting. The chairs had TV screens attached to them so that patients could be entertained and distracted from all of the drilling and prodding. Her assistants always let me hold their hands while they administered the anesthesia, because even though squeezing their hands did not actually help much with the pain, it was nice to know that they simply cared to ease my pain. My dentist talked me through every little thing she did, and she got me cavity-free. Being her patient–a scared child desperately wanting someone to validate her fear–inspired me to want to become a pediatric dentist. I wanted the chance to help other children be calm and maybe even excited to sit in the dental chair. When I tell people I want to be a dentist, I usually get asked, “why teeth?” I do not think it has much to do with teeth as it does with patient interaction. I am fascinated by teeth and take dental hygiene quite seriously, but I am most excited about the thought of telling a young patient that I will leave the numbing gel on just a tad longer before administering the anesthesia if it means easing their anxiety. Or demonstrating proper dental care on stuffed animals just like we did during the hygiene clinics at the primary schools. The little things. In preparation for dental school, I have spent hours shadowing at local dental offices, but in 2022, I became interested in observing dental work on an international level. After some research, I stumbled upon International Medical Aid. I took a leap of faith and applied, and I landed in Mombasa, Kenya in the Summer of 2023. Being able to say I have traveled to Kenya has given me a lot of pride, but also being able to say I interned at Coast General Teaching and Referral Hospital just does not seem real... During my time with IMA, interning at CGTRH in the dental unit, I learned more than I could have ever imagined. I felt incredibly privileged being in a position to observe dental care in a country that has significant healthcare differences to the United States. Much of the healthcare challenges in Kenya are poverty related; for example HIV/AIDs is so prevalent that all patients are assumed to have it until proven otherwise (Current State of Healthcare in Kenya, 2022) . I observed that sanitation was at its best after procedures that resulted in some blood loss. HIV prevalence in Mombasa is actually 1.2 times higher than the national level at 7.5% (Disease Burden In Kenya, 2022). Additionally, I observed low health literacy–many patients did not fully understand their conditions or treatment plans, but they followed all of the doctors’ orders, trusting that the doctors knew best and accepting that they themselves did not know better ( Health Literacy, 2022). Notably, Dr. Khadijah did an excellent job helping patients try to understand the need for tests, treatments, and medications. She was compassionate and patient, and always encouraged her patients, particularly during painful procedures. I also noticed that many patients were coming in for issues caused by self-neglecting behavior. Most did not have the luxury of coming in for annual cleanings or routine treatment. If they noticed a cavity or a slight ache, this would go untreated for months or maybe years until the pain became so unbearable they had no choice but to come in. The dentists extracted many teeth that had complete decay of the crown. There were multiple instances in which they extracted teeth from abscessed sites, but due to the infection, the anesthesia was not fully effective, resulting in pain and discomfort. After root canals, most patients did not return for the crown. I was informed that they actually just keep the temporary filling in until that starts to cause issues. There was one particular patient who had cavitation on a tooth on her lower jaw, and it went untreated for so long that the infection spread to her roots and then to her neck, which resulted in necrotizing fasciitis. During my time in the unit, I saw her return for a check-up after prior treatment, and the infected site was healing well. The degree of infection was disheartening to consistently see, because it seems so normal to have these issues addressed promptly in the United States, and most of the time, the issue will be caught during regular cleanings before it can even progress to infection. Early detection and treatment seem like such little things. In Mombasa, they were not so little things, since early detection and treatment were not affordable for many. In the United States, there is a routine to most treatment plans. The patient sits in the chair, a bib is placed around their neck, the dentist applies numbing gel to the treatment site in preparation for the lidocaine, and then lidocaine is administered. I was incredibly shocked to see that numbing gel was not being used in the dental unit. There was lidocaine spray, but it was only used occasionally on pediatric patients. It was certainly not part of routine treatments. Even when the lidocaine spray was used on pediatric patients, they reacted poorly to the subsequent lidocaine administration. Some began crying while the lidocaine spray was getting applied, and those who made it through that stage screamed and squirmed at the sight of the needle. There were times doctors would jump in to hold a patient’s arms and legs down, and others would steady the head and neck so that the lidocaine could be given, but the patient would fight even more. This young boy reluctantly made it past the lidocaine, but the moment the dentist began extraction, the boy had had enough. He flipped over in the dental chair and slid off, refusing to get back on. He screamed, “Jesus” over and over again, and he was completely inconsolable. I felt awful, because I know how terrifying the dentist can be, yet I have all these little things that help ease my fear, like numbing gel. Maybe these “little things” were actually not so little. I also witnessed adults experience intense anxiety in the dental chair. They would grimace at the sight of the needle and even reach for the dentist’s hand while the anesthesia was getting administered. Something as not so little as numbing gel could make patients’ and dentists’ lives easier. I actually was able to sit-in on a meeting during which the dentists discussed pediatric treatment and how to manage patient and parent behavior better. They noted the importance of using simple terms, for example, referring to lidocaine as “sleeping juice.” They also mentioned how the presence of parents can change a child’s behavior. The previously mentioned combative young patient originally came in with his mother, and he left without having completed his treatment. However, he returned a few days later with his father and was fully cooperative. One dentist suggested using colorful composite for fillings to incentivize children to fix their cavities, and it just makes it more fun for them. The fillings would be on their primary teeth, so as they lose their teeth, they will lose the colorful fillings, but it could be something for children to look forward to. She also suggested limiting the number of people in the room during pediatric treatments because having more dentists present may make the patient feel uneasy and concerned about the need for so many people. I believe these changes can truly improve children’s experience in the dental chair. I was someone who hated going to the dentist, and now, I look forward to every visit. I want to help people take pride in their teeth and smile. I hope one day I am given the chance to heal any traumatic experiences a person has ever had in the dental chair.

Travelling to Kenya for merely two weeks was not nearly enough to experience such an amazing culture and amazing people full of joy in their hearts. This trip opened my eyes to the challenges countries in Africa face when compared to other countries and what a blessing it is that a program is going above and beyond to give to those deserving yet underrserved. Even though I was there for a short time, I gained so much knowledge from compassionate an selfless doctors and hopefully have impacted the lives of those during educational sessions. This experience marks a pivotal turning point in my life and will always be grateful for the chance to educate the people of Kenya while also learning from them as well. I will remember this moment in my life and hope to continue the characteristics IMA has instilled in me, teaching what I have learned and carrying the tradition of providing to those less fortunate - changing their lives!

This experience was completely different than anything I've done in my life, but I am so happy that I leaped out of my comfort zone and came to Kenya! Everyone at IMA was very welcoming. They made sure we were safe in and out of the residence and were always available to address concerns. Before coming to Mombasa, I had never shadowed in a hospital before. Seeing the passion of the doctors and medical interns at Coast General taught me a lot about the hard work, dedication, and kindness it took to be a physician. It was interesting to see the differences in healthcare delivery, sanitation, and treatments offered in Kenya compared to the United States. One of the best parts of the trip was getting to interact with the locals. The weekly hygiene and menstrual health education sessions gave me a deeper look into the community of Mombasa. It was so cool to experience a new culture!

One of the things that stuck out to me the most during my time in Kenya was that no matter the circumstances, the people of Kenya always manage to find a reason to smile. On top of that, they showed a side of strength that I have never seen before. During my 3 weeks of shadowing the doctors in the dental unit at CGRTH, I was able to obtain a different perspective on dental care. They gave me tools that I will forever cherish as I continue my career in dentistry such as the way they approach extractions, how to handle kids, and operate minor and major oral surgeries. I am grateful to have been able to see how they work to ensure that the patient is getting the care they deserve. They showed me how teamwork is essential to problem-solving when performing a procedure and assessing a patient. I cannot express how thankful I am for how welcoming everyone has been to me and the rest of the interns. Being able to visit schools and educate the students about hygiene and women’s menstrual hygiene was so rewarding. Everyone expressed the most welcoming and kindest smile. Lastly, I’m blessed to say that I made lifelong friends with the people I met. I was enlightened by the city of Mombasa and all it has to give. These experiences have been life-changing and given me a different perspective on healthcare, life choices, and friendships. In 2019, I was a senior in high school. A senior that is just beginning to think about what career to pursue for the rest of my life. Finding a career that I find rewarding and helpful to others. A job that could fulfil my goal in assisting people. With many dentist and orthodontist appointments, I soon realized that teeth were very fascinating to me. Teeth are very interesting because you might think that they are all the same, but in reality, they are all different. I soon began to realize this as I interned with the dental unit in CGTRH. The dentist would observe the panoramic of the teeth and roots when preforming a procedure on the patient to make sure they approach it the correct way. They would show us that some teeth have very short roots, or some have very long ones which would take a longer time to get out when extracting because they don’t want the roots to break off. It was very interesting to see how each individual dentist approached a patient and what they did to preform the procedure. During my three weeks in Kenya, I have gained knowledge, resources, and friendships. Before coming to Kenya, I had my mind set on being a pedodontist. I really enjoyed being around kids, so I thought being a dentist and working with kids would be the perfect job for me. I shadowed one of the Dentist, Dr. Ian, to see how he approached the procedures when dealing with kids. He did a beautiful job of calming the kids down and explaining what he would be doing, but I soon realized after watching a couple procedures be done, that pedodontist isn’t for me. That is one thing that I am grateful for as I shadowed the dentist at CGRTH, I got to see what interest me and what didn’t. All the Dentist in the unit were very knowledgeable and help explain the procedures to us as we were watching. They made sure that every patient was getting the care that they need even when they had limited resources. Right from the start of shadowing the dental and facial unit in CGRTH, I was immediately shocked. With the cases the doctors observed and how they handle and went about them was incredibly amazing to experience. They explained that they had a lack of resources, and they would only use some instruments on a patient if they really needed it. They mentioned that they could use an elevator on a patient’s tooth when extracting it, but only if the tooth really needs it because they might need it more for the next patient that comes in to get an extraction. This was one of the big differences between Kenya and the States. In the United States, we tend to take advantage of the resources we have. For example, the private dentist I work with explained to me that they would rather use more resources on a tooth, like cement for a crown, so they know that it is going to stick and be easier for them to work with, rather than use a smaller amount to where they might run into more issues when preforming on the tooth or in the future. Whereas in Kenya they used only what they needed and never used more because they couldn’t afford to waste material and instruments. The first day at CGRTH was one of the most intense days I have ever experienced. The pace of the hospital and what they saw daily was a complete culture shock. I saw more intense cases then what I am used too with my internship with the private dentist in Michigan. Dr. Grutter, a dentist I work with back in the States, explained to me that the “bread and butter” -what they see and work on every day- are crown and bridges. Whereas for the dentist in Kenya, their “bread and butter” is extractions and root canals. There is a big difference in the dentist in the States and in Kenya. For example, the dentist in Kenya went straight to dental school after high school whereas the dentist in the states must go to undergrad before attending dental school. Also, the dentist is Kenya did everything from oral diagnosis, exodontia, periodontics, paedonotics, conservative dentistry and endodontics, prosthetics, orthodontist, and minor oral surgery and the dentist in the States usually specialize in one thing. This was so fascinating to me because it showed how diverse they were in dentistry. They can do any of those procedures and do a great job at it. One of the cases that stuck to me the most was this 5-year-old girl with a sarcoma. It was my first day at the hospital when she came in. She was held by her mother who looked worried and anxious for her daughter, but still made sure to comfort her daughter during the whole procedure. Dr. Solomon, a maxillofacial surgeon, attended the patient with great care and observation as he examined her face. She had what they thought was a sarcoma on her right cheek. As they were done examining her face, they started to clean it out to try to get rid of the infection that was causing this. She was in so much pain as they did this, but she was able to sit there and not make it hard on the Doctors. She was one of the strongest girls I have ever met. Every day she would come back for daily cleans knowing what was going to happen, and still willing to get it done. She never gave the Doctors a hard time when they were cleaning her infection. After this case, I soon realized that the people of Kenya are a different bread of toughness. The people of Kenya gave me a new prospective of what toughness and kindness is. No matter the circumstance they were always grateful and happy. They always had a smile on their face and made sure we felt welcomed. Something that can be uncommon in the States. The dentist that we worked with took us out and gave us a once in a lifetime experience. They gave us a tour of the city of Mombasa and made us try food that they enjoy and that are common in Mombasa. This just showed that even though we are all from different parts of the world we are still human beings. This experience not only gave me great knowledge and tools to use towards my journey towards dentistry, but it also gave me lifelong friendships and memories. Being able to visit schools and educate the students about hygiene and women’s menstrual cycle was so rewarding. Everyone expressed the most welcoming and kindest smile. I’m blessed to say that I made lifelong friends with the people I met. I was enlightened by the city of Mombasa and all it has to give. This experience taught me so much and made me realize that once I become a dentist that this is the type of work I want to do. I want to travel the world while helping as much as I can with dentistry to keep the world smiling. This experience has been the most rewarding and challenging thing I have ever done. I am grateful that I was given the opportunity to push myself to go out of my comfort zone because I’ve gained so much from everyone I met in Kenya. This was a life changing opportunity which will shape my future as I continue my journey in dentistry, forever advocating for equality in the healthcare systems around the world.

My time spent in Kenya was a life-changing experience, to say the least. I set out on this experience promising myself to step out of my comfort zone. I’m not very good at learning languages, but learning Kiswahili made locals so excited when I would use the few words I learned. I’m a picky eater, but I got to try and enjoy so many new, traditional Kenyan meals. I have never liked talking in front of groups, but I decided to assert myself in clinics and debriefings. With the help of mentors, guides, locals, and the other interns I got to meet, I got to learn so much about mental health and how other communities live.

My internship in Kenya truly helped me understand what it means to be culturally competent, and the skills it requires and offered me the chance to appreciate the differences between individual cultures. It challenged me and allowed me to assess whether I was truly culturally competent beyond working with my community. I could practice adapting to cultures different than my own by subtly changing psychological techniques or advice I’d usually offer as I had to decide whether they were suitable and effective. During my time at Coast General Teaching and Referral Hospital, I discovered a new interest in Sexual Health Psychology through interning in the Youth Zone and HIV Clinic (within the CCC). I’ve always known I wanted to work in Psychology and this trip only confirmed this. Within this essay, I will share what I’ve learned, explain some of the differences in mental healthcare delivery between Kenya and the UK, as well as some of the patient interactions that stood out to me. Mental Healthcare at Coast General: Throughout my three weeks in Mombasa, I spent time in multiple areas of Coast General Hospital. Starting in the Gender-Based Violence and Recovery Centre (GBVRC), then getting permission to shadow clinicians in the Psychiatric ward, Psychological Ward Rounds, Youth Zone, HIV clinic in the CCC, and a nightshift in Maternity. Each area taught me different things and I had a chance to meet and learn from a variety of different conditions. The prevalence of mental illness is very high in Kenya, with 1 in 4 citizens likely to experience a mental health problem at some point in their life (Ministry of Health, 2015). Despite this, funding for mental healthcare in Kenya does not have a separate budget. This is different from the UK where although the mental healthcare system is thought to be underfunded, the budget is still separate. With the mental healthcare funding coming from the national healthcare budget, there is little government funding going towards it. This ultimately leads to less staff in hospitals, less money to invest in staff training, and fewer public patient facilities. In the Coast General Psychology department, the majority of staff were interns themselves, undergraduates still studying their degrees and who were only there for a short amount of time. This seemed to be a common theme across all departments; a lot of student nurses and doctors, working long hours and taking on difficult clinical cases. Whilst this is an amazing first-hand experience, I can imagine it can sometimes be incredibly daunting being thrown into the deep end so early on in one’s career. However, the support system from the lead psychologists was amazing as at the end of each day, they offered a space for reflection and where the interns could share difficult cases. Being an intern in an underfunded system will always be difficult as you are affected by staff pressures and limited resources, and this could lead to burnout. This may explain why there is such a shortage of mid-senior level clinicians, as they may be burnt out and want to move to a different healthcare system (Strathmore Business School, 2017). Professor Kokwaro mentions the importance of investing in current healthcare staff, so they feel valued and have a better working environment & this better working environment is what I feel makes the Psychology team so great. I met 2 psychiatrists at Coast General, both of which worked in different hospitals throughout the week. One of the psychiatrists only came in on Wednesdays for the forensic cases. This is due to the low number of psychiatrists working in Kenya, with the majority of psychiatrists being based within Nairobi. When the psychiatrists weren’t there, the psychiatric nurses were prescribing medication and offering counselling sessions. One thing that was common across all departments was that nurses seem to be the backbone of the hospital system. I saw them leading and managing different departments; this concept is similar to the UK with a lot of Service leads coming from a nursing background. We also have leadership pathways specifically for nurses to progress, it is refreshing to see nurses in management positions rather than the stereotypical idea of only trusting doctors. Gender Based Violence and Recovery Centre: My first few days within the GBVRC were quite intense. On my first day, 4 young boys came in who had all been abused by the same man; some of them were penetrated. This was followed by 4 more boys the day after. The first major difference I noticed was the different ways people expressed trauma. Some of the survivors were very open with the psychologist, Saida, this may be linked to Kenyan culture, where people are open to discussing topics that may otherwise be considered sensitive or personal (International Medical Aid, 2022a, p. 31) The current understanding of trauma is very Eurocentric, focusing on how trauma is understood in the Western world. However, this differs across cultures and even more so across sub-cultures. Instantly I saw that Western understandings of trauma cannot be so easily applied here. It is important to provide mental health care that is culturally responsive to the area it is being used, particularly when using a specific therapeutic model (Woods-Jaeger et al., 2017). I loved how the Kenyan psychologists I worked with used their understanding of their communities combined with their psychological knowledge to provide the best possible service. Saida created a safe space for both the survivors and their families, it can sometimes be difficult to contain both a client and their family at the same time, especially within the same space. This was an example of systemic therapy used, in conjunction with narrative therapy as there was a key focus on the survivor being given a narration platform. The GBVRC had a multi-disciplinary team made up of a nurse, a general psychologist, a child psychologist, and a paralegal. The staff worked across departments, specifically with the Youth Zone and Maternity; as there were often abuse or statutory rape cases. The team was incredibly welcoming and coved what they did, they acknowledge the job was difficult but they continued to provide amazing care for people who may have just gone through the most traumatic thing in their life. Mary, the paralegal, was a particular stand-out character. She took us around the hospital, telling us how the GBVRC is involved in different departments and what they do. Rates of domestic abuse are high in Kenya (BBC DOC REFERENCE) and the litigation process can take up to years. However Mary shared with us how she follows up with the police to ensure survivors receive justice, she’s received threats and bribed but she has remained true to her morals. I saw how truly important it is to love what you do and care about the people you’re helping, in a system that often seems against you. In the GBVRC, people are offered either short or long counselling sessions if needed; a stark contrast to the UK where people are typically offered 6 sessions maximum and are subject to up to yearlong waiting times compared to the 2 weeks offered at Coast General. This may be due to the difference in mental health literacy, with fewer people accessing services and continuing to attend sessions after the first one offered to them. Psychology Department: The Psychology department within Coast General is still relatively new, opening in 2019 as a response to Covid-19 patients being isolated and unable to speak with their families. Despite only being a recent addition to the hospital they are still heavily relied upon, being called to different areas when they’re needed and doing ward rounds across the hospital. While I was at Coast General, there were 5 psychologists, with 3 of them being interns. As they have to work across hospital wards with a limited number of staff, there’s little room for specialisation. I mainly shadowed Ann, the Clinical Psychologist, and the interns. I observed the 8-step psychological assessment they follow when doing the ward rounds: 1) Check medical report 2) Observation 3) Cognitive assessment 4) Psychological review 5) Insight 6) Thought Process 7) Narration 8) Offer Psychosocial support What I liked about this assessment style is its focus on understanding the patient, their understanding, and their background. All of these things have to be taken into account when offering psychological care. A key similarity I noticed was that both this assessment and the GBVRC use narration platforms for their clients. I saw the positive impact of people being given a chance to share their stories. During our ward rounds, there was a woman who was terrified of eating as she was in too much pain. She began shouting when we went near her as she thought we were going to force her to eat. The psychologist reacted calmly, showing her that there wasn’t any food in our hands so she would feel at ease. She sat down at her level and spent time with her, calling her “Mama” as a sign of respect. Despite the Psychology team being pressed for time, they always ensured they spent time with each patient so they felt seen and understood. When we followed up the next day the woman began eating again. The psychologist mentioned that the woman was Swahili and her understanding of Swahili culture was that Swahili women enjoyed being treated gently and looked after. It was because of this cultural understanding she adapted her disposition and tone to best suit the patient. This was a defining moment for me as it was my first true understanding of what culturally competent practice means. The key difference between Kenya and the UK public mental health care is that therapeutic models aren’t as heavily relied upon in Kenya. I discussed this with Ann who explained that since the understanding of mental health is still new in Kenya, the general public doesn’t understand different models and theories. She also stated that CBT models are often used in private hospital settings. At Coast General I saw theory being used in practice, there wasn’t a huge focus on overexplaining people who may not be familiar with theory as the psychologists knew what would work best. Psychologists seemed to be used as an intervention technique for grief, fear, anxiety, and more. In the UK there is a huge focus on theory and models in our NHS service before a client signs up for sessions. Different service websites explain the theories or techniques that will be used in the session. It was refreshing to take a break from learning and applying theory and instead see it in practice, as it seemed equally as effective for patient care. Another difference was the use of prayer to instil hope into the patients and this was very well received. The Kenyan demographic is very different from the UK where there is more of a separation between church and state. 94% of Kenyan people would say they are religious (International Medical Aid, 2022a), I imagine this is why using faith as a support tool is very beneficial. Youth Zone and HIV Clinic (CCC): HIV is a large part of Kenya’s disease burden (International Medical Aid, 2022b, p. 4) as it is one of the biggest killers. Mombasa rates are higher than the national prevalence in the rest of the country (National AIDS Control Council, 2015) though rates do differ between local areas. Before coming to Kenya I had a general understanding of HIV and the negative stigma surrounding it, what surprised me the most was the joy of working in this area and promoting a healthy, happy, and positive lifestyle. I worked with Cynthia, the Youth Zone adherence counsellor. The Youth Zone is the equivalent to the UK’s Child and Adolescent Mental Healthcare services but specifically for those living with HIV up to the age of 25. Cynthia led health talks throughout the week. The main aim was to create a stigma/judgement-free environment for the young people, so they could discuss tackling stigma, their struggles, relationships, or anything else that was bothering them. I learned a lot more about what HIV is, how it is spread, how it attacks the body, and the positive lifestyle changes that can help maintain a low viral load (LVL). The daily routine at the Youth Zone consisted of a health talk followed by consultations. Here they checked height, weight, medication adherence, further referrals, and the use of condoms. If necessary, the client was then referred to counselling with Cynthia. Within these sessions Cynthia delved deeper into medication adherence, trying to understand the root causes. Psychosocial support was also offered and advice for being in a relationship as someone who is living with HIV. The young people knew they were in good hands as they slowly warmed up to sharing their struggles with the group, knowing that this was a safe space. After this visit appointments were made 3 months in advance unless the person has a high viral load that needs to be monitored in which case they come back in 1 month. The volunteers are also people living with HIV, which gives a solid sense of community and role modelling. The aim for each person is to work towards a Differentiated Care Model (DCM) which offers 6-month appointments rather than 3 however the patient needs to have an LVL and no opportunistic infections. This model of care both fosters independence as and reduces hospital burden, whilst still ensuring the patient has access to the care they need. My experience in the HIV Clinic was similar to the Youth Zone, though I only spent one day here. I noticed that this clinic was larger and there seemed to be more staff; which I narrowed down to differences in funding. The clinician talked me through what good adherence looked like and the content was similar to what was shared at the Youth Zone health talks. • Taking drugs at the right time each day • Consistent use of condoms to prevent the spread of HIV or other STIs/STDs • Good nutrition and exercise to improve immune systems and keep them as strong as possible • Stress management • Appointment keeping to help monitor one’s health Psychiatric Clinic: Visiting the psychiatric clinic, I saw a mixture of general and forensic cases. There were some issues with the forensic cases accessing treatment/assessments as those under the care of the prison were no longer entitled to free psychiatric care. There seemed to be some miscommunication between the hospital and the prison as they now had to pay, this meant for the first half of the clinic no prisoners could be seen. It is my understanding that bureaucratic processes often take a while in Kenya and this may have been an example. Once the forensic cases began, the psychiatrist went through them very quickly. Perhaps because he had quite a few cases to see, he had already started late and was only based at Coast General for a few hours before having to leave for another hospital. One major difference I noticed is psychometric tests were not being used for psychiatric evaluations, learning disability assessments, or mental health conditions. Instead, the psychiatrist used his understanding of these conditions to assess each individual. Considering that these tests were developed in the West and for Western populations, much like the theories they’re often used with, this may be a good thing. They may not be as accurate of an assessment or need to be adjusted culturally. Furthermore, some psychometric tests are very time-consuming and expensive, especially with so many becoming computerised (French, 1986). This may be the most cost-effective and efficient way of working for Kenyan mental health professionals. As well as not using psychometric tests, there were differences in how learning disabilities were treated or assessed. One of the forensic cases involved assessing an individual who had been raped for a learning disability; it wasn’t made clear whether this was to assess their credibility, his ability to give consent or to ensure the punishment for the perpetrator was more severe. I worked in a learning disability setting for 6 months and often conducted assessments and these were very thorough, taking up to 3-4 hours whereas this lasted 20 minutes. Rather than a learning disability, the psychiatrists called it a “mental retardation”. I was rather shocked by the term as using the term “retarded” is heavily frowned upon in the UK, but that may be due to the recent reframing of language surrounding disability. I learned more about Kenyan attitudes to both physical and learning disabilities during our cultural treks, which I will expand on in my next paragraph. Outreach and Cultural Treks: Interning at Coast General was an amazing experience but I also loved our weekly afternoon excursions with IMA. We volunteered in schools, leading hygiene workshops and helping out in free medical clinics for the community. My favourite was the women’s health presentations, we were fortunate enough to have a qualified midwife with us who gave a brilliant explanation of the menstrual cycle. We did our best to create a safe space for the girls to ask us any questions they had, ensuring they were met with zero judgement. These clinics are important has some of the girls may not have had a space to ask questions without stigma before, it was fun to laugh and joke whilst also normalising feminine hygiene and making it accessible. We had the advantage of visiting the Bombalulu Workshops, a community organisation that provides work, housing, schooling, and more for people who are physically disabled and their families. They foster independence, improve general life skills, and self-esteem and instill a sense of self-worth. It was inspiring to see the space they have created and the art that comes from their hard work. The workshop runs as a project by the Association for the Physically Disabled of Kenya and doesn’t seem to be reliant on government funding. This made me think about how much public funding goes towards the needs of those with disabilities. A report from Development Initiatives illustrates that whilst there is government funding available to those with disabilities, there doesn’t seem to be an allocated budget for “vocational and technical training” (Owino, 2020). This is a key focus area at the Bombalulu workshops. The report also highlights the difficulties of not being able to adequately evaluate outcomes, since the data isn’t available. It is difficult to know where the money is going or if the current budget allocation is truly effective and making a difference. Conclusion: My time in Kenya was the most influential time of my life, it took 2 years due to Covid but I’m so glad I had the opportunity to learn and meet so many people. It determined my passion for working in public healthcare and it reminded me that whilst I can make a difference at home, there is the rest of the world to experience and learn from. Mombasa will be seeing me again, thank you to IMA for making my first internship experience so amazing and to the Coast General clinicians for taking me under their wing.