Internships in France

My experience with International Medical Aid was life-changing. All of the staff members were incredibly nice, accommodating, and helpful if problems arose. They were easy to reach and made me feel very safe both at the residence and on our trips. The residence was clean and our laundry being done for us was a perk I never would have expected. All of our meals were fresh and the cooking staff was open to suggestions for any foods that we wanted more/less of. That being said, one of my favorite parts was how dedicated IMA was to teaching us about the culture of Kenya. We went on multiple excursions/tours of Mombasa and other parts of Kenya and the tour guides were incredibly knowledgeable. There were also scheduled lectures regarding health care in Kenya, cultural ideas, and history of Kenya and it's political system where I got to ask questions and learn more about the innerworkings of the country. The other aspect of this internship that I thoroughly enjoyed was the community outreach activities that we were able to participate in. I loved going to the local schools and talking and interacting with the kids during both the handwashing clinics and the menstrual hygiene clinics. Overall, I am forever grateful to IMA and the people of Kenya for allowing me to live out this amazing opportunity. I knew coming into this internship that I would have an opportunity to see healthcare in a setting that many never have or will see. However, I did not expect to emerge from this internship with so many new friends found in the hospital, community, and the IMA program itself. From the moment I drove through the IMA residence gates, I was greeted by a community of staff and interns who welcomed me like one of their own. The hospitality and generosity continued as I began to engage with the Coast General Staff. Even through chaos and exhaustion, the medical professionals I worked with were willing and eager to teach me about procedures and illnesses they encountered, local healthcare struggles, and even inform me about Kenyan life outside of the hospital setting. The IMA staff worked extensively to ensure that the interns were exposed to all of the things that Kenya has to offer. I especially cherish the kitchen staff for introducing me to traditional African dishes and even their takes on American classics, all of which were phenomenal. I enjoyed the cultural treks and classes that further helped me to immerse myself in this new culture. My favorite activities outside of the hospital setting were the community outreach events, or more specifically, getting to visit the Tumaini Children's Home. Being able to connect with the youth of Mombasa is something that I will never forget, and it is something I wish for everyone to get to experience. Following the end of my internship, I wish I could stay for many more weeks, and I am eager to find more opportunities like this in the future. From my two weeks in Mombasa, Kenya, I vividly remember three words from the Swahili Language: “jambo”, “pole pole”, and “rafiki”. Even if they are few in number, the sentiment behind these words is a true testament to the hospitality, serenity, and amiability of this country and the people who inhabit it. My time with International Medical Aid has been an experience that has taught me amounts of medical knowledge beyond measure, but it is these three specific attributes that I will carry with me through my future medical journey and beyond. “Jambo”, meaning “hello”, perfectly encapsulates the welcoming nature of the people I met in Keyna. At the IMA residence, the staff’s openness was remarkable. I was greeted by a team of individuals who were eager to provide me with abundant opportunities to explore Kenya, even beyond the medical scene. My favorite trek included visiting the spice markets, Fort Jesus, and, most notably, the Pembe Za Ndovu. “One has not truly been in Mombasa without seeing the giant tusks,” our guide said. Known by many as the Mombasa Tusks, this attraction site historically commemorates Queen Elizabeth's visit during the time of British colonization and was later refurbished before Princess Margaret’s visit in 1956 (Gacherl, 2022). This large structure symbolizes the culture's hospitality as it welcomes thousands of individuals a year, from royalty to travelers like myself. Similarly, the Coast General Teaching and Referral Hospital staff welcomed me with open arms. The medical professionals enthusiastically participated in discussions regarding typical cases and their management, the influence of local culture on medical procedures, and their creative use of resources to assist patients. Several Medical Officers, in particular, were especially skilled at informing interns about specific cases, explaining them in precise but easily understood detail. For instance, Dr. Sarat extensively explained meningitis, a condition where the meninges become infected, causing fever, a stiff neck, and potentially seizures or death. While this disease annually affects around 3,000 individuals in the United States, it ranks among the top five pediatric cases at Coast General Teaching and Referral Hospital (Boston Children’s Hospital). Cerebrospinal fluid retrieved from lumbar puncture procedures is commonly used to diagnose meningitis. I had the opportunity to witness two lumbar punctures during my pediatric rotation in addition to a variety of other minimally invasive, palliative, and diagnostic procedures. The willingness of the busy staff to share their knowledge and genuine interest in my learning made my experience invaluable. Mombasa’s medical community, much like its general population, has characteristics of generosity and openness, making it a truly welcoming place for anyone fortunate enough to visit. “Pole Pole”, meaning “slowly” or “little by little”, captures the laid-back and contented attitude prevalent in many aspects of Kenyan life. This philosophy promotes slowing down to appreciate the hear and now and life’s journey, as opposed to rushing toward the future. Based on my experiences, the most significant difference between American and Kenyan communities is the level of urgency and perception of time. In the United States, a fast-paced, career-driven lifestyle is the norm. Although Kenyans place a high value on their work, they also tend to live considerably slower and more deliberately. The emphasis on connections and experiences over strict adherence to time is evident in the fact that it is culturally acceptable to arrive thirty minutes later than planned (Healthcare Internship Orientation: Cross-Cultural Considerations). They are efficient, yet they savor and appreciate the journey that leads to their final destination. During the hospital orientation, Dr.Shazim stated that each ward floor has a patient capacity of 75, yet there is usually only one Medical Officer on each floor. This information shocked our entire group, as such a disproportionate ratio is relatively uncommon in the United States. I anticipated my first day shadowing in these wards to be chaotic, with little opportunity to build rapport with and inquire information from the Medical Officers. To my surprise, this was not the case. Despite being severely outnumbered, the Medical Officers took their time assessing and explaining each patient and their treatment plan, often engaging in lighthearted interactions with both patients and fellow staff members. The surgery department shared a similar sense of serenity. During my night rotation in this department, there were multiple gunshot casualties, creating a serious, urgent atmosphere. However, amidst all the x-rays and sutures, the anesthesiologist was singing along to “Tennessee Whiskey” by Chris Stapleton. The ability of the medical staff to stay composed through daily tasks and challenges highlights the common sense of calmness and relaxation towards life shared by Medical Officers, other medical staff, and Kenyan citizens in general. “Rafiki”, meaning “friend”, indicates the importance of friendship and teamwork that I observed through my experience. Aligning with their welcoming charisma, the African people are thoughtful, supporting the community and individuals alike. During my second week at this internship, I got to visit the Tumaini Children’s Home. From the moment we walked through the gate, the children asked us to talk, laugh, dance, and play. Their eagerness to befriend every one of the interns models that, even in this culture's youth, they are committed to serving and supporting everyone. This sense of friendship and care extends far beyond the youth of Kenya, as exemplified in their Vision 2030 political agenda. In 2008, the president at the time, Mwai Kibaki, initiated a campaign that planned to create a more industrialized society by 2030. One of the three pillars of this plan was to increase the social prosperity of the Kenyan people. From recruiting more teachers and building more educational centers to supplying additional tuition funding to lower-income families, this pillar strives to facilitate educational opportunities for citizens to become more involved in society through jobs, vocation, and recreation (Kenya Vision 2030). The Kenya government replicates its cultural values of promoting the well-being and happiness of others by continuously focusing on providing opportunities for growth and support to all of its citizens. In the hospital, the camaraderie among the staff was palpable. Whether professional or personal, the medical staff at Coast General were always communicating with each other. During a thoracic gunshot wound procedure, I witnessed their remarkable teamwork firsthand. Nearly 15 medical professionals were coming in and out of the operating room, retrieving supplies, providing the newest MRI scans, offering their expertise, etc. The bullet ended up being more difficult to retrieve than expected, and they were unsure if they would actually be able to do so without causing too much trauma. I specifically remember a group of Medical Officers huddled together going back and forward discussing this matter. They ultimately came to the general consensus that they would send the stable patient to the ICU, allowing a more specialized professional to assess the patient and provide his medical advice. Much like healthcare within the United States, it is essential that the medical staff discover and communicate patient care plans with one another. The staff at Coast General surpassed my expectations of what communication in the hospital setting should be, as they effectively communicated through difficult cases and maintained a positive, friendly relationship. My time in this internship exposed me to an abundance of medical diagnoses and procedures, some of which I had never even heard of. I enjoyed the ability to feel so involved in each case, affirming my ambition to go into this field, particularly in the high-pressure environment of the operating room. While I gained significant medical knowledge and techniques, the most valuable lessons I learned were those that medical school might not necessarily teach, such as the concepts of “jambo”, “pole pole”, and “rafiki”. Experiencing the warm and welcoming nature of the Kenyan culture has made me realize how essential this trait is in the healthcare setting. Having these welcoming characteristics helps foster trust, comfort, and honest communication between the medical staff and patients. In the role of a healthcare professional, I have found the importance of replicating the Kenyan's relationship with time. Moving forward, I understand the necessity of slowing down and invoking professional and personal life balance. Doing so ensures that I can provide a calm and supportive environment for patients. Along with this, having supportive friendships and collaborative teams is an important aspect of my career and life in general. Being able to effectively communicate with staff members is important, but obtaining supportive relationships is equally as important in this high-stress career. This experience has prepared me to embrace these three values as I pursue my future in healthcare. After completing this internship, I am extremely grateful for the chance to travel to Mombasa, Kenya, for two weeks and be a part of the International Medical Aid program. In addition to explaining my knowledge of medicine, this experience has taught me priceless life lessons. The warmth of the Kenyan people, their emphasis on cooperation, and their balanced outlook on life have taught me the value of building trust, upholding individual well-being, and working well with others. I am applying these traits in medical school and future career endeavors to continue to provide kind, patient-centered care.

My experience with International Medical Aid in Mombasa, Kenya, has been transformative on multiple levels, encompassing a comprehensive view of healthcare delivery, cultural immersion, and personal growth. The support provided by International Medical Aid was crucial in navigating the complexities of working in a foreign healthcare environment. From the initial orientation to daily guidance and mentorship from local medical professionals, I felt well-supported throughout my internship. The program coordinators were responsive to our needs and ensured that we had the resources and assistance necessary to make a meaningful impact in our placements. Safety was a priority throughout the program, and I appreciated the proactive measures taken by the organization to ensure our well-being. We received thorough safety briefings upon arrival, including guidance on cultural norms and potential risks. The accommodations were comfortable and provided a safe haven after long shifts, and the communal living fostered camaraderie among participants, creating a supportive network. Professionally, the experience enriched my clinical skills and broadened my understanding of global healthcare disparities. I gained firsthand experience in diverse medical specialties, from obstetrics to infectious diseases. Personally, the exposure to Kenyan culture and daily interactions with patients deepened my empathy and reinforced the importance of patient-centered care in all healthcare settings. Our contributions through free clinics, hygiene initiatives, and educational sessions had a tangible impact on the local community. We provided essential healthcare services to underserved populations, addressing immediate medical needs and promoting long-term health through education. My passion for healthcare—particularly in underserved communities—began in high school. My journey began freshman year of college volunteering in the Dominican Republic; I witnessed firsthand the impact of compassionate care on those with limited access to medical services. However, growing up in a supportive environment, I was initially shielded from the struggles many face accessing healthcare. My time in Mombasa opened my eyes to significant disparities in healthcare delivery. It further inspired me to pursue a career as a physician assistant dedicated to bridging these gaps. Arriving in Kenya with International Medical Aid, I was prepared to learn about healthcare delivery in a resource-limited setting; however, despite that preparation, the differences were striking. From the moment I stepped off the plane the bustling streets of Mombasa, the vibrant markets, and the warm greetings from locals set the stage for an immersive experience. Over the next four weeks, I moved through various clinical rotations, from the Newborn Unit to Radiology. I taught at various schools and had the opportunity to help with community medical clinics. The hands-on involvement and the cultural exchange were profound. Observing and participating in the care of premature infants, learning from seasoned professionals, and connecting with patients deepened my understanding of the human side of medicine. These experiences enriched my clinical knowledge and reinforced my commitment to providing compassionate and equitable healthcare. On my first day of internship orientation at Coast General Teaching and Referral Hospital (CGTRH), I walked through bustling corridors, observed daily operations, and absorbed common rules and practices. I soon learned that patients had to pay out of pocket for basic medical supplies, including sutures, medications, and catheters. If and when they were unable to afford these essentials, they were subjected to detention within the hospital until they could settle their bills. This practice was starkly different from anything I had encountered in the United States, where such necessities are routinely provided. Proceeding through orientation and a tour of the hospital, it seemed the aforementioned healthcare disparities only continued to grow. While healthcare inequality is an unfortunate reality throughout the world (to include back home), my work in Mombasa set into stark relief just how extreme those inequities can be. It was disheartening to see patients without rooms—separated only by thin curtains—waiting for an indeterminate amount of time to receive care due to significant staff shortages. The overburdened healthcare providers struggled to meet the overwhelming demand, resulting in long waits and insufficient attention to individual patients. The immediate exposure to these harsh realities was a poignant reminder of the impact of systemic inequity in healthcare. My first week in the OB labor ward at CGTRH was eye opening, and it afforded me the opportunity to engage with deeply moving work. I was inspired by the strength and resilience of the women I encountered. Despite the intense pain and fear they must have been feeling, these women endured labor and related procedures without epidurals or any form of pain relief, including episiotomies. Witnessing their courage firsthand was humbling and enlightening, and highlighted the incredible fortitude of mothers in this environment. Parallelling and necessitating this inspirational courage, the care provided in the labor ward was markedly rushed due to chronic understaffing. The limited number of healthcare professionals available required tasks to be performed quickly, often without adequately communicating with patients. I was shocked to observe that staff did not explain procedures to women, instead performing actions (e.g., bursting the amniotic sac or making incisions) without any warning or explanation. The urgency of the situation was often conveyed through yelling at the mothers to push and (at times) even physically pressing on their stomachs to expedite the process. This sometimes-necessary approach was decidedly different from the patient-centric work I was more familiar with. Nested with the staff challenges discussed above, much of the delivery work was carried out by student nurses. One particularly memorable moment was watching a 20-year-old student nurse perform her first solo delivery. She managed the situation with competence and confidence, a testament to her training and ability to remain adaptable in such a high-pressure environment. This reliance on student nurses was a direct consequence of the severe shortage of medical staff. Dr. Mohammed—the one doctor in the ward—was frequently needed in the operating room to handle emergency C-sections, leaving the ward under the care of these young trainees. One night shift brought an emotional and heart-wrenching experience that I will never forget. A mother, clearly in distress, tapped me on the shoulder to get her cervix checked. Her desperation and the immediacy of her need were palpable. When she opened her legs and revealed her cervix, I saw a foot—a clear sign of breech birth for the premature 30-week-old twins. I immediately alerted the doctor, and the twins were delivered promptly. The delivery was complicated by both babies being in a breech position, requiring extraordinary efforts from the medical team to ensure a safe birth. Tragically, despite all efforts, one of the twins passed away the next day. This event made clear that in neonatal care, there is an ever-present, fragile line between life and death; this practice can take a profound emotional toll on families and healthcare providers. Access to skilled healthcare providers and adequately stocked facilities is critical. Notwithstanding global disparities, the divide between rural and urban areas (e.g., Mombasa) domestically is similarly stark. Resources remain limited in urban centers but are relatively better than in the westernmost provinces of Kenya. By way of example, the maternal mortality ratio in Kenya “stands at 355 deaths per 100,000 live births, translating to nearly 5,000 women and girls dying annually due to pregnancy and childbirth complications. While access to skilled birth attendance has improved . . . over 80% of maternal deaths are attributed to poor quality of care” (UNFPA Kenya, 2016). Without routine care, including regular antenatal visits, ultrasounds, and blood tests, women are more likely to die from complications during pregnancy and childbirth. In the U.S., maternal and prenatal care is generally more accessible, with regular standard care practices. Most women have access to skilled healthcare providers, advanced medical facilities, and pain relief options during labor. By contrast, Kenya faces substantial challenges, including a shortage of healthcare professionals, limited medical supplies, and under-resourced facilities. As with the previously-identified high rates of maternal mortality, the disease burden in Kenya was an ever-present reality during my time in the labor ward. HIV remains a significant health challenge in Kenya, where stigma and misinformation about the disease continue to affect many, particularly expecting mothers and newborns. According to the 2015 Kenya HIV Estimates, “women in Kenya are more vulnerable to HIV infections compared to Kenyan men, with the national HIV prevalence at 7.0 percent for women and 4.7 percent for men.” This heightened vulnerability translates into considerable impacts on maternal and child health. For example, “HIV and AIDS in Kenya accounts for 20 percent of maternal mortality and 15 percent of deaths of children under the age of five” (International Medical Aid, 2024). During my time in Mombasa, I observed that healthcare staff often avoided discussing the HIV status of mothers directly, referring to it as "RVD" (retroviral disease) instead of HIV. This semantic avoidance perpetuates the stigma and prevents open conversations that are crucial for effective disease management and support. In the maternity ward, HIV-positive mothers were subject to different delivery protocols to minimize the risk of mother-to-child transmission. For instance, staff would take extra precautions such as delaying the rupture of the amniotic sac until the baby was fully delivered, reducing the baby’s exposure to HIV in the birth canal. Despite these careful measures, the lack of open communication about their condition left many mothers feeling confused and isolated, unable to fully understand or engage with the necessary steps to protect their health and that of their newborns. These anecdotal experiences underscore the immense challenges faced by the Kenyan healthcare system and the pressing need for improvements in maternal care. The courage and endurance of the mothers, coupled with the dedication of the healthcare providers working under such constraints, left a lasting impression on me. It reinforced my commitment to advocating for better healthcare resources and practices, both locally and globally, to ensure that all women have access to the quality care they deserve. I found one of the most important parts of my 4-week internship was engaging with the local community through hygiene clinics at children's schools, women's healthcare sessions, and free Saturday clinics. These opportunities offered me a deeper understanding of the cultural context in which healthcare is delivered. Teaching dental and hand hygiene to children, for example, emphasized the importance of preventive care and health education in improving public health outcomes. We introduced basic concepts of cleanliness and disease prevention through interactive demonstrations and activities, which were met with enthusiasm and curiosity from the children. This hands-on approach not only equipped them with essential skills, it highlighted the critical role of early education in fostering long-term healthy habits. Witnessing the children's eagerness to learn and their immediate application of these practices was a powerful reminder of the impact that simple, preventive measures can have on a community's overall health. The cultural variations I encountered during these sessions, such as different beliefs about healthcare and varying levels of health literacy, reinforced the need for culturally sensitive and patient-centered care. For instance, in women's healthcare sessions, we discussed female anatomy, family planning, and hygiene. These discussions often revealed deeply ingrained cultural beliefs and practices that influenced women's health choices. Understanding these cultural nuances was crucial in providing relevant and respectful healthcare advice. It was evident that a one-size-fits-all approach would not be effective; instead, healthcare providers needed to tailor their communication and interventions to align with the community's values and beliefs. With improved communication comes better community outreach, a key component to improved healthcare outcomes made evident during my work in the Saturday community medical clinic at Likoni Primary School. Many patients who attended these clinics had limited access to healthcare due to financial constraints, geographic barriers, or lack of awareness about available services. In Kenya, the current health expenditure per capita is only $88.39, compared to $10,623.85 in the United States, reflecting the vast difference in economic resources and the extent of healthcare services available. By bringing healthcare directly to these underserved communities, we were able to reach individuals who might otherwise go without necessary medical attention. This initiative emphasized the importance of accessibility and equity in healthcare delivery, particularly in a country like Kenya, where healthcare spending stands at just 5.167% of its GDP compared to 16.885% in the U.S. (International Medical Aid, 2024). This divide in health expenditure reflects the challenges faced by Kenyan communities in accessing comprehensive services. Outreach programs are critical in bridging the gap and ensuring that more people receive the medical care they need. Through these community engagements, I also learned about the challenges faced by healthcare providers in educating and empowering patients. Many individuals struggle with literacy, making it difficult for them to understand medical advice and adhere to treatment plans. For example, one of the last patients we consulted was a 13-year-old girl with sickle cell disease; she was experiencing severe pain in her upper left abdomen, likely due to a sickle cell crisis. This condition, exacerbated by limited access to medications and healthcare resources, can lead to complications such as splenic sequestration or splenomegaly. The girl’s condition showed me the unfortunate impact of inadequate healthcare infrastructure and education. Her family lacked knowledge about the importance of regular medical check-ups and the management of sickle cell disease. They were unaware of the necessity for routine blood tests, vaccinations, and the avoidance of dehydration and infections; all critical components in managing her condition. This meant that the girl often went without the necessary medications and preventive care, leading to frequent and severe pain crises. During the consultation, it was clear that her condition had been neglected not out of indifference, but due to financial constraints and a lack of awareness. This anecdote is representative of a broader trend; most patients we consulted at community clinics were young teenagers. This demographic presented unique challenges as they were at a critical stage of development and faced various health issues, including malnutrition, infectious diseases, and reproductive health concerns. Many had limited knowledge about their health and the importance of seeking timely medical care. The doctor explained that they relied on these clinics to get the medication and care that they needed. Most obviously, healthcare providers play an important role in treating illnesses; however, that importance is matched by the need to educate and empower patients. Effective communication and education can bridge the gap between limited resources and better health outcomes. By providing clear, simple, and culturally appropriate information, healthcare providers can help patients understand their conditions, adhere to treatment plans, and make informed decisions about their health. These experiences have deepened my appreciation for the complexities of delivering healthcare in diverse cultural settings, teaching me the importance of adaptability, empathy, and cultural awareness in my practice. Moving forward, I will integrate these lessons into my career as a physician assistant, striving to provide compassionate, culturally sensitive, and patient-centered care to all individuals, regardless of their background or circumstances. My time in Mombasa has solidified my interest in pursuing a career focused on global health and working in underserved communities. The resilience, dedication, and resourcefulness of the healthcare professionals I worked with have inspired me to strive for excellence in my own practice. I have developed a specific interest in neonatal care and maternal health, recognizing the need for specialized care in these areas, especially in low-resource settings. To this point in my professional development, my internship experience in East Africa is the cornerstone of my journey toward becoming a physician assistant. I am beyond grateful for the clinical exposure, cultural immersion, and unique challenges faced. Looking back, this time has not only enriched my knowledge and skills, it has deepened my passion for making a meaningful impact in the field of healthcare.