Internships in Ecuador

My internship at El Terreno lasted 1 month. This month I was part of the Water a d Reforestation project. It was great to help the community and immerse myself in this life completely different from the one I usually do in Italy. Joshua is an example of dedication to work and community and it was an inspiration to see him work for this project. During my internship I met fantastic people from all over the world, I left alone a little fearful but it only took me a few hours to feel at home. I think it's an experience that everyone should have at least once.

My experience with International Medical Aid in Kenya is one that I will never forget. The memories I made during this program will be cherished forever. During this internship as a high school student, everything I saw was new to me. My time at Coast General Teaching and Referral Hospital was transformative. The experience of rotating through different departments was eye-opening and profoundly educational. In the pediatric department, I witnessed the severe effects of poverty and disease. The sight of malnourished children and the struggle of their families was heart-wrenching. One of the most impactful moments was observing a lumbar puncture procedure on a child suspected of having meningitis. Despite the distressing nature of the procedure, it was a significant learning opportunity that deepened my understanding of medical practices. Beyond the hospital, engaging with local communities was an enriching aspect of the program. Participating in health clinics at local schools allowed me to interact with children and learn about their lives. Despite initial nervousness about public speaking, I grew more confident as I engaged with the children, providing advice and support on various health topics. The mental health clinics, in particular, were both challenging and rewarding. Addressing issues such as domestic abuse and food insecurity, although difficult, provided valuable insights into the socio-economic challenges faced by the local population. My outlook on life will forever be altered because of this program. This program was able to convert me into a very social person that I wasn't before. I will always remember the people that I met in Kenya and the memories I made with them. My safety in Kenya was never a concern for me because the mentors told us what to avoid and recommended better and safer options. The mentors were extremely supportive and helpful if I had any questions or concerns and made sure all the interns were having a great time. The food was great and it was always a highlight to come back from the hospital and sit down for a fulfilling meal with your friends. I will forever grateful for this experience, Kenya and IMA will always have a special place in my heart. As a young girl growing up in Afghanistan, I always knew I wanted to become a doctor. I watched my father save countless patients, whether they were strangers or family members, and his calm demeanor during crises inspired me deeply. One moment that stands out is when he saved my grandfather's life, maintaining his composure even as his own father coded right in front of him. My father's dedication and resilience fueled my desire to become a doctor, to be in the midst of action, and to make a tangible difference. Being born and raised in Afghanistan, I was familiar with the challenges of the healthcare system in a developing country. However, it was not until I went to Kenya that I truly understood the depth of these challenges. As a child, I watched from the sidelines, but as an adult, I became physically involved and saw firsthand how limited resources and understaffing profoundly impact healthcare delivery. My exposure to healthcare in the United States further highlighted these disparities, making it evident how financial struggles and a lack of resources hinder the ability to provide adequate care. My experience in Kenya has been bittersweet. I am deeply grateful for the opportunity to gain exposure to medicine, surgeries, and diagnostics. However, it has also exposed me to the harsh realities of healthcare in developing countries. In America, there is greater access to healthcare, and most patients receive treatment at the early onset of disease because they visit the hospital as soon as symptoms appear. In contrast, many people in Kenya cannot afford their medication or delay treatment due to cost, which worsens their condition by the time they seek medical help. Witnessing patients die due to lack of treatment, resources, or financial means is incredibly difficult. Many of these patients would have survived if they had access to care in a more developed country. For instance, during my time in the Accident and Emergency department, we had a patient suffering from an intervertebral hemorrhage who also presented with aspiration. The patient was given oxygen and medication. The next day, when I had my shift, the patient was still in the ER, oxygen saturation was low, and 30 minutes later, the patient passed away. The patient was in the emergency room for over 24 hours, but his surgery and treatment were delayed. Many patients with intervertebral hemorrhages required surgeries such as External Ventricular Drain (EVD), but due to the unavailability of ICU beds or lack of finance, these surgeries are often delayed. This is a frequent occurrence, with surgeries being postponed due to the lack of available surgeons, operating room, ICU beds, or because the patient cannot afford the procedure. In the coastal region, there is only one neurosurgeon and one psychiatrist, and the ratio of doctors to patients is a staggering 19 practitioners per 100,000 people, which is far off the 1:1000 ratio recommended by the World Health Organization (Mwaura, 2024). Seeing patients pass away due to these systemic issues was the hardest thing to watch and it was a reminder of the disparities in healthcare access. Additionally, financial constraints prevent patients from seeking timely medical help, exacerbating their conditions. Many cannot afford insurance, medical fees, or medications. Kenya’s medical insurance, NHIF, covers hospital stay, consultation, procedure, treatment, and medication (NHIF, 2023). The medical insurance cost in Kenya is approximately 500 Kshs per month, equivalent to three dollars, yet many families cannot afford this for each member. Also, Patients residing in rural areas often face limited access to healthcare services. For those in remote locations, traveling to urban centers for medical care not only delays treatment (Bakibinga et al., 2022) but it may also cause lack of awareness about available health insurance options among these communities, further complicating their access to timely and effective healthcare. These factors combined lead to worsening health conditions, and ultimately, preventable deaths. Being in the hospital also exposed me to issues related to malpractice and personal protective equipment (PPE). I observed practices such as nurses reusing needles by sticking them back into saline solutions and staff using their phones while wearing gloves before intubating patients. Such lapses in hygiene and protocol contributed to the risk of post-operative infections in the hospital. Understanding these issues has deeply informed my perspective on healthcare in developing countries. This experience has instilled in me a profound awareness of the realities of healthcare in developing countries and strengthened my determination to make a difference. Proper equipment, medications, resources, and adequate staffing are crucial in transforming healthcare delivery. Increasing the number of ICU beds and ventilators, ensuring proper sterilization, improving facilities, and updating equipment can not only reduce infection rates but also save countless lives. I had the privilege of working with some of the most talented doctors. Despite their skills, it was heartbreaking to see how many more lives could have been saved with proper equipment and resources. One crucial lesson I learned was from Dr. Rashid during my surgical rotations. He advised us to "promise less, but deliver more" to patients. Doctors are not infallible; mistakes can happen, and complications can arise even in seemingly routine surgeries. His words emphasized the importance of managing expectations while striving to exceed them through dedicated effort and skill. During my time here, I also realized that unlike in the U.S., where a doctor's visit is typically only 15 minutes, doctors in Kenya do the majority of the work themselves. They are thorough in their examinations, meticulously collecting past medical histories and conducting diagnostics. They spend significant time with patients, ensuring they are well cared for and quickly assessing their needs. The doctors were great mentors who truly cared for their patients, reflected in the quality of care they provided. There are misconceptions about doctors in third-world countries, but I quickly learned that the doctors in Kenya are exceptionally talented. They constantly adapt to provide patient care based on a wide variety of diseases and conditions, often dealing with advanced stages of illness due to delayed visits. Despite limited resources, they swiftly treat patients with worsened conditions. The resourcefulness of Kenyan doctors in the face of adversity left a lasting impression on me. They often had to think outside the box to overcome challenges, adapting to the limitations they faced. For example, I witnessed a patient presenting with cervical spondylotic myelopathy, a herniated disk in the cervical spine, which put the patient at risk of paraplegic paralysis. This patient required emergency spine surgery but could not afford the procedure, as they did not have insurance and the cost was significantly beyond their means. Dr. Rashid, demonstrating remarkable adaptability, opted to use an artificial bone graft from the iliac bone instead of the more expensive artificial intervertebral disk. He also made every effort to lower the cost of the procedure to ensure the patient could afford it and have a better quality of life. I respect the determination of these doctors to treat patients and save their lives, despite financial constraints. They consistently found innovative solutions to provide the best possible care with the resources available. My experiences in each department were distinct and unique, offering valuable learning opportunities, and some were more surprising than others. For instance, the first time I entered a maternity ward in Kenya, I was utterly shocked. While I had an idea of what to expect, the reality was far different. Having been familiar with how OB/GYN and maternity wards operate in the United States, I was aware that third-world countries faced limitations, but I was unprepared for the extent of these limitations. The small concrete walls, metal beds, and only two cribs for newborns were truly startling. And the labor and delivery ward of vaginal births were primarily managed by nurses, who serve as qualified midwives. Witnessing how childbirth was practiced and how babies were delivered was equally shocking. I was a nervous wreck observing deliveries, from nurses holding the baby upside down and slapping it to delayed suctioning of the airway. Pregnant women did not receive epidural for vaginal births or local anesthesia for episiotomy when their vagina is cut diagonally to have a controlled vaginal tear. In the United States, mothers have their own bed and room, and babies have their own cribs. Epidurals are available, and immediate suctioning of the airway is standard. Babies are not held upside down but supported carefully, and gentle slaps are administered on the back if necessary. At the start of one of my maternity shifts, I observed an emergency C-section. I watched silently as the surgeons began the procedure. When the baby was delivered, there was no cry. I quickly learned that the cry of a newborn is the sweetest sound, a symphony of life that fills the air with hope. As a healthcare provider, one yearn for that cry more than anything else. Each cry signifies a new beginning, a promise of life. There are moments when that anticipated cry never comes. The baby does not breathe, does not move, and has no heartbeat. In those heart-wrenching moments, you feel utterly powerless. Despite all your knowledge, skills, and drive, you cannot bring life back to the tiny, lifeless body before you. The weight of helplessness is crushing as you realize there is nothing more you can do. Unfortunately, I witnessed many stillborn babies during both C-sections and vaginal deliveries. One of the hardest tasks is breaking the news to the family. I saw hope drain from their eyes, replaced by unfathomable sorrow as they came to see their baby, lying still and silent amidst the cries of healthy newborns. One mother spent the night in the maternity ward with all the other mothers, surrounded by those nurturing their living, breathing babies. She watched them feed, cuddle, and care for their little ones, each cry a painful reminder of what she had lost. This scenario would be different in the United States, where a mother with a stillborn child would have privacy in her own room, away from the other mothers with their newborns. This difference highlights another issue: the mental health impact on mothers who lose their newborns. Being surrounded by what they have lost immediately after giving birth is unimaginably excruciating. During my clinical rotations, I also observed the significant impact of religion and culture on medical treatment in Kenya. Women who become pregnant before marriage are often abandoned by their families, which worsens their financial struggles. One patient, a young woman in her early 20s, had a stillbirth after a vaginal delivery. Alone and grieving, she asked me for water. When I approached the nurse, I was told the patient either needed a family member to bring her water or she had to buy it herself. I bought the water for her, but the harsh reality of the situation struck me. It made me reflect on the many mothers who give birth without any support. This patient received no assistance from the hospital due to limited resources and no support from her family due to cultural and religious reasons. Amidst these moments of deep sorrow and reflection, I also experienced the incredible highs of the medical profession. While I witnessed the hardest parts of death, I also experienced the profound joy of saving a life or seeing a newborn take its first breath and hearing its first heartbeat. One case involved a mother delivering twins, with one twin in a breech position. The staff proceeded with a vaginal birth for one twin and an emergency C-section for the other. When the second baby was delivered, it was lifeless. I held my breath, waiting for the cry that never came. The nurse began suctioning the airway and asked if anyone could perform CPR. As an EMT trained in the United States, I had only performed CPR on adults. My first thought was fear of hurting the baby, but I quickly realized we were the baby's only hope. Everything felt like a blur as I donned gloves and began CPR. The only thought running through my mind was “please live” over and over again. I do not remember how long I performed CPR, but when I finally felt a heartbeat, a profound sense of relief washed over me. The joy I felt at that moment was indescribable. It felt like I could breathe again. That experience reaffirmed my decision to pursue a career in healthcare, solidifying my commitment to making a difference in people's lives. I knew I had chosen the right path because the joy of saving a life is something I want to experience repeatedly. While I understand that being a healthcare provider has its ups and downs and that losing patients is inevitable, saving lives is what I strive for. I may not be able to save everyone, but doing my best to the fullest of my ability is what truly matters. My shifts in the surgical rotation were truly captivating. Standing in the operating room, watching surgeries, and observing the various techniques employed by surgeons were invaluable experiences. The surgeons were exceptional mentors, providing thorough explanations of different procedures and potential complications associated with each surgery. I had the privilege of observing a range of specialties, including neurosurgery, spine surgery, general surgery, ENT, orthopedics, and ocular surgery. These experiences solidified my passion for medicine and surgery. The excitement of learning something new and witnessing different surgical techniques after each procedure was profoundly inspiring. The dedication and expertise of the doctors not only motivated me to pursue a career in this field but also deepened my understanding of the risks and knowledge required to become a skilled surgeon. The intricate nature of the work underscored the importance of minimizing mistakes and meticulously assessing and performing each procedure to deliver the best patient care. This experience also taught me the critical importance of early recognition, treatment, and diagnostics. The doctors were prompt with lab work, treatment, and patient diagnosis to ensure timely care. In Internal Medicine, I learned to appreciate the significance of patient family history, medical background, and living conditions when diagnosing illnesses. In Kenya, where patients are more susceptible to infectious diseases, such as malaria, TB, HIV, cholera, dengue fever and typhoid fever, understanding these factors is crucial. The doctors utilized information about patients' locations to diagnose various bacterial infections, recognizing that some communities are more vulnerable to specific diseases due to environmental factors. Furthermore, during my ward rounds in Internal Medicine, I had the privilege of learning extensively from the doctors. They conducted thorough assessments of patients and engaged in detailed discussions with residents about potential diagnoses based on patient history and lab results, as well as treatment plans and their rationale. This approach provided me with valuable insights into recognizing symptoms of a range of conditions, including malaria, hypertension, diabetes, chronic kidney disease, urinary tract infections, tuberculosis, stroke, and other diseases. During my clinical outreach and women's health volunteering event, I gained deeper insight into Kenya’s culture and people. It was heartwarming to be surrounded by enthusiastic young children who were thrilled to see "Americans" in blue scrubs. They were incredibly welcoming and kind, making it easy to form connections despite our brief visit. However, The women’s health events highlighted a range of issues, especially when young girls inquired about topics such as menstruation, medicine, and pregnancy. A recurring concern was infections following female genital mutilation (FGM). In Kenya, the prevalence of FGM is 15%, and Kenyan Somalis practice FGM with a prevalence of above 90% (Sheikh et al., 2023). FGM is often carried out at home in non-sterile conditions, which increases the risk of infection. Faced with these concerns, I had to find respectful and culturally sensitive ways to address their questions. Common queries included whether undergoing the procedure was advisable, how to prevent infections, and what steps to take if an infection occurred. Additionally, we encountered individuals in need of financial assistance for treatment, who might not be able to afford it. Balancing respectful dialogue with practical advice and addressing financial constraints presented a significant challenge during these interactions. During my hospital rotations, I encountered a wide range of illnesses and treatments. While gaining knowledge about these conditions was exciting, I was soon confronted with the harsh reality of inadequate resources. Many patients faced severe challenges in receiving or affording proper care, highlighting a stark contrast with healthcare accessibility in the United States. The disparity was evident, with financial constraints often preventing patients from accessing essential services such as procedures and medications. This exposure made it clear that while doctors and nurses are dedicated and provide quality care to the best of their abilities, they face limitations beyond their control. I observed that despite their best efforts, the broader socio-economic issues often impede effective healthcare delivery. This realization emphasized the need for systemic changes to ensure that quality healthcare is available to all. Before going to Kenya, I was determined to volunteer outside of the United States. This experience not only deepened my motivation to pursue a career in medicine but also gave me invaluable insights into volunteering abroad. My goal was to better understand the culture, people, and healthcare systems in third-world countries and how these factors impact healthcare delivery. I believe that healthcare should be accessible to everyone, and this experience clarified the type of doctor I aspire to be: compassionate and committed to the principle that every life matters and everyone deserves equitable treatment and healthcare. My goal is to return as a qualified doctor and contribute to improving healthcare delivery in third-world countries. The disparities in healthcare access and resources greatly impact patient outcomes. Witnessing these challenges has fueled my determination to be part of the solution, to drive change, and to help as many people as possible in underprivileged areas.