Internships in Haiti

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

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

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

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.

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

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

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

My experience in Cusco, Peru, as a Midwifery Intern at EsSalud Centro Médico Metropolitano de Cusco was extraordinary, and one that I will be forever grateful for. My accommodations were in the heart of Cusco, where the other interns and I felt comfortable walking to dinner, exploring, and experiencing the culture of the city. Our in-country support from our mentors and staff was so welcoming, and everyone was genuinely happy to share a conversation. Our driver each morning, who always let us play music on the way to the hospital, and the amazing program chefs who made sure we were happy and cared for, truly made me feel at home. Our mentors went above and beyond to ensure we were able to get the most out of our experience, and to them I am forever grateful. As a Midwifery Intern, I was able to spend all of my days in the same two rooms with the same three practitioners, allowing me to form real relationships and gain firsthand experience. The obstetricians and I often, in between patients, asked each other fascinating questions comparing maternal and reproductive care in the States to the Peruvian system, and we also exchanged our knowledge on holistic care. During my time in Peru, I had the honor of seeing 122 patients ranging from contraceptive care, to pap smears, to pre- and post-partum appointments. These stories and experiences are irreplaceable, and I hope to one day be as caring, attentive, and awe-inspiring as the obstetricians I shadowed at EsSalud Centro Médico Metropolitano de Cusco. Thank you to International Medical Aid for this incredible opportunity, and I hope to return to Cusco in my future. During my two weeks in Cusco with International Medical Aid, I had the extraordinary opportunity to shadow obstetricians at EsSalud Centro Médico Metropolitano de Cusco. This experience gave me the opportunity to learn about Peruvian birthing customs and holistic medicine in a way that cannot be replicated in a classroom or textbooks. The knowledge I gained from this experience is invaluable and unforgettable, and I am honored and privileged to have received it. I selected International Medical Aid for my midwifery internship because of their integrity and mission. As a Latin American with the privilege of living in the United States, I wanted a program grounded in ethical, community-centered engagement, and IMA stood out for their clear message that the program exists as a symbiotic relationship. Students benefit from meaningful clinical learning while IMA provides free community clinics to give back to those who do not have adequate primary care. IMA’s approach is centered on creating and executing programs that align closely with the needs of the communities they serve, and these initiatives are designed to have a lasting impact that reflects sustainable development principles (@internationalmedicalaid, 2024). This long-lasting care is what solidified my decision to do my midwifery internship with International Medical Aid in South America. It aligned beautifully with my educational and career goals, where I believe representation and multiculturalism are essential steps toward addressing negative social determinants of health. The pregnancy and birthing experience from pre- to postpartum should be filled with joy and cultural customs, and I am inspired to support futures where mothers and babies can thrive. Education, advocacy, and awareness are the foundations for that brighter future. I can’t even begin to express my gratitude to the obstetrics staff of EsSalud Centro Médico Metropolitano de Cusco. As a midwifery intern, I was able to spend all of my days in the same two rooms with the same three practitioners, allowing me to form real relationships and get some firsthand experience. I quickly learned the routine of initial appointments, from questions to ask to paperwork and tests required. I was able to sit back and listen to the consultations and questions of each mother. In between patients, the obstetricians were beyond enthusiastic to answer any of my questions or ask questions themselves, and we could honestly converse for ages about differences between American and Peruvian healthcare systems and birthing customs. We could spend forever talking about holistic medicine alone. For instance, here in the States, birthing customs often come in waves, generally stemming from indigenous cultures or dating back to Black Granny Midwives of the South, and sometimes they become more widely recognized through articles or social media. Meanwhile, in Peru, it seems these traditions have been passed down through generations and remain deeply woven into care. It was remarkable how practitioners in Peru weave indigenous practices into modern medicine, while in the States this balance can feel more difficult to achieve. Practitioners would frequently offer holistic solutions before pharmaceutical ones, or give honest advice such as when mothers asked, “what is the best position to give birth?” and the doctor would respond with squatting instead of the stereotypical position of lying on the back, which has dubious origins anyway (DiFranco, 2014). In the States, I feel that patients, especially patients of color, often benefit from a certain level of health literacy and self-advocacy to have the most empowering birth experience, both of which are privileges. Pregnancy in the United States is often extremely medicalized and has been for years (Johanson, 2002), while in many other countries, including Peru, it is seen as a time filled with cultural customs and joy. At EsSalud, comprehensive and educational care is provided with nutritionist appointments, child-rearing classes, full lab work, psychologist appointments, vaccinations, and pap smears all in one location. In the States, each of these services is often fragmented, and each comes with its own bill, many of them not covered by insurance. Both countries have their flaws and triumphs, and it was enlightening to compare and contrast the two. There is a sense of autonomy at EsSalud that was refreshing to see compared to the systemic issues the United States continues to work through. Right now, I work as a Research Assistant at the Maternal Outcomes for Translational Health Equity and Research (MOTHER) Lab at Tufts School of Medicine in Boston, Massachusetts. There, I serve on the Marketing and Communications committee, where I dissect scientific papers and condense them into infographical posts about maternal-child health equity. This background knowledge fueled my curiosity in Peru, leading me to ask the obstetricians thoughtful questions about differences in their country. The knowledge I gained in Peru will continue to shape my work at the MOTHER Lab and, I hope, my future work as a practitioner. There were many interesting differences, such as the age women get their first pap smear, the ages of first-time mothers, the percentage of geriatric pregnancies, paid parental and maternal leave, and more. In the States, everything is state-by-state, while in Peru the obstetricians noted differences mainly between MINSA and EsSalud. These differences are fascinating and often culturally and socially determined, so it was meaningful to learn how and why they developed. One standout aspect was a document given to each new mother called “Esperando Mi Parto,” or “Awaiting My Birth.” This form allows each new mom to preemptively plan her birth while also giving her provider key information. Some details include questions like who will be in the room, what position she wants to give birth in, and whether she would want to give birth in the hospital at all. In contrast, American hospitals often require patients to independently develop birth plans, and many times those plans are not fully honored. Of course, birth plans and home births are generally supported for low-risk pregnancies, but this form encourages autonomy and helps reduce fear and anxiousness going into this chapter of life. This connects to health literacy again. In the United States, there is often an individualized mindset in medicine where patients feel the need to educate themselves deeply before childbirth because so much information is inaccessible, overwhelming, or anxiety-inducing (Khajeei, 2022). I believe that this one sheet of paper is crucial in giving mothers peace of mind, rather than requiring them to do extensive independent research and negotiation for their needs. Contraceptive care also differed in important ways. In Peru, girls as young as 13 can obtain contraceptives without parental consent, whereas in the States it is state-by-state. Discussing these differences and their origins with the obstetricians was remarkable. Both countries share the same four main methods of contraception for women (besides abstinence): injectables, oral pills, arm implants, and intrauterine devices (Díaz-Alvites, 2022). This was the order of popularity shared by the obstetricians at EsSalud, while in my community in the States I have more often seen intrauterine devices, oral pills, arm implants, and then injections. By the end of my internship, I felt we both benefited from each other’s knowledge and conversations. The community clinic was one of my favorite experiences with IMA. Set up in Poroy, interns had the opportunity to shadow general medicine physicians consulting with the people of Poroy. This was especially exciting for me since I had spent most of my time with obstetricians. I loved sitting in on consultations with a broader range of patients across sexes, ages, and conditions beyond reproductive health. It was beautiful to see entire families come together to receive basic care that is otherwise difficult to access. The community center where we hosted the clinic was also beautiful, and it was inspiring to witness the communal aspect of healthcare, an art that can sometimes feel less emphasized in the United States. Another highlight of my time in Peru was the educational workshops and lectures given by Dr. Fabricio and Manuela. I learned about differences in healthcare systems and insurance models, the funding structures of each country’s health system (International Medical Aid, 2024), and also their similarities. Dr. Fabricio taught us CPR, suturing, how to take vitals, and many other valuable skills I had not had the chance to learn before. Manuela taught us about Peru’s rich history, from Pre-Incan times through modern-day events, including the upcoming election. With these lectures combined, we were able to connect Peru’s social determinants of health to real-life clinical experiences. The lectures were truly eye-opening and answered so many of the questions I had written in my journal during rotations before I even had the chance to ask them. Seeing how socioeconomic aspects of a patient’s life directly impact their health was profoundly meaningful to learn in real time. Along with these remarkable experiences, I also lived my lifelong dream of hiking Machu Picchu. A beautiful end to the trip, a few interns and I hiked the six-hour Inca Trail to the Sun Gate and down to Machu Picchu. It was no easy feat, but one I am extremely proud to have completed. Not only were the views and flora astonishing, but learning about Incan culture and history reignited a sense of wonder I felt as a child reading picture books about Machu Picchu. Learning about Pachamama, Mother Earth, and relating it back to Peruvian birthing customs I had learned throughout my experience was especially meaningful, including that “women in Inca society typically gave birth at home in a squatting position (toward Pachamama) with the assistance of a midwife or female family members” (Pacino, 2015). Truly a once-in-a-lifetime experience that I will always cherish. In true Latin American fashion, I must express my deepest gratitude to the people—the amazing IMA staff including Manuela, Eder, Grezia, Dr. Fabricio, Dra. Miriam, Señor Victor, Hans, and Piero of DolciDolci—along with the wonderful obstetricians of EsSalud, and the land of Cusco for hosting me. I am the first person in my family to be born in the States, to go to college, and I will be the first to go to medical school, where I hope to one day give back to my community as an obstetrician. During my time in Peru, I had the honor of seeing 122 patients ranging from contraceptive care, to pap smears, to pre- and post-partum appointments. These stories and experiences are irreplaceable, and I hope to one day be as caring, listening, and awe-inspiring as the obstetricians I shadowed at EsSalud Centro Médico Metropolitano de Cusco. Thank you to International Medical Aid for this incredible opportunity, and I hope to return to Cusco in my future!

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

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.

I felt very safe with the Program Mentors, and they were extremely helpful in guiding us throughout the internship. The food was consistently very good, though it was sometimes a bit repetitive. Shadowing was highly educational and beneficial, but I think the experience could be even stronger with a little more variety during the two weeks. The treks were both fun and informative, although they were more physically demanding than I expected based on the description when we signed up. Overall, this was a great experience with only a few areas that could be improved. I thoroughly enjoyed this internship and am very grateful to IMA for the opportunity. I especially loved being able to go on the Machu Picchu trek and am glad that I signed up for it. Our tour guide was very kind and helpful, which only added to the experience. One suggestion for improvement would be allowing interns to drop off items at the hotel before heading out on the trek, since it was difficult to carry all of our belongings with us the entire time.

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

International Medical Aid's internship in South America is an experience I am immensely grateful for and recommend to others interested in the medical field, especially rural and global medicine. I am a pre-medical student and primarily shadowed doctors during my time with International Medical Aid (IMA) in Cusco, Peru. I observed general practitioners and specialists at Hospital Nacional Adolfo Guevara Velasco's outpatient center. Each of the talented doctors I had the opportunity to learn from was engaging, open, and kind. They were excited to teach and answer questions about medicine, as well as about the unique medical needs of their hospital and community. I had so many great conversations with these doctors, and they taught me a great deal about overcoming challenges as a physician (such as not having enough resources). Aside from shadowing, I also had the opportunity to participate in community outreach through rural clinics and teach-ins at orphanages. I believe that volunteer work committed to the unique medical needs of underserved populations is essential for healthcare workers, and it was wonderful to be a part of an organization like IMA that clearly also valued this commitment. IMA was also clearly committed to the safety and well-being of its interns. I am especially grateful to have had Manuela and Surabhi as my IMA mentors during my internship. They went above and beyond in providing their support and guidance. Lastly, I am also very thankful for our chef, Piero! During my stay in Cusco, I was sick for a couple of days, and he provided me with food and chamomile tea that calmed my stomach and helped me recover quickly. He also asked the interns each day what they would prefer to eat for dinner, and always invited feedback to help make all of the interns feel more comfortable during their stay.

My internship with International Medical Aid (IMA) in East Africa was a transformative experience that deepened my commitment to pursuing a career in healthcare. Shadowing healthcare professionals in a resource-limited setting provided me with a profound understanding of global health disparities, cultural influences on medical practice, and the resilience of both patients and providers. This experience not only solidified my passion for medicine but also equipped me with perspectives and skills I will carry forward in my future career. While shadowing doctors, nurses, and community health workers in Kenya, I observed the ingenuity required to deliver care in an under-resourced environment. Unlike the technology-driven healthcare systems I was accustomed to in my home country, many facilities in Kenya relied on basic diagnostic tools and clinical expertise. For example, I saw physicians diagnose complex conditions like malaria or tuberculosis using physical exams and patient histories due to limited access to advanced imaging or laboratory tests.

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.

I truly felt that this internship was very well organized, from the contact I had with my mentor before arriving in Kenya to the pick-up at the airport. The transport was very good, and I really think that the orientation day was extremely useful. Everyone at the residence was always happy to explain things and give tips—whether it was what to do in our free time or information about the hospital and the community outreach programs. I remember the food and hospitality always being great. My friends and I helped Erastus bake some delicious desserts, and the kitchen staff was always super friendly and helped us whenever we needed something, like hot water. Before my internship, I had been super excited about all of the community outreach programs, and I was not one bit disappointed. All of them were truly so fun to be a part of, and I really liked that there is one community outreach program each week plus a medical clinic. This was especially meaningful for someone who was only able to stay for two weeks. My mentor Christabel, along with Margaret and Hilda, were all super nice, and I really enjoyed having them there. Bright, sterile lights shone over my eyes as voices moved with calm urgency through the Emergency and Casualty department. I could hear the faint beeping of monitors, the rustle of gloves, and the muffled groans of patients. Patients flowed in, some walking, others carried, yet the medical staff moved smoothly through the chaos. It was my first week at Coast General Teaching and Referral Hospital (CGTRH), and despite attending orientation just a day earlier, I was overwhelmed. This wasn’t just a hospital; it was a high-pressure system driven by resilience, improvisation, and determination. The other interns already looked like they belonged, trailing behind doctors, scribbling notes, asking questions. As this was my first real exposure to a hospital and my first internship of this kind, I stood quietly in the middle with the other interns, observing and absorbing everything, unsure of what to say or do next. My heart raced, not because of what was happening around me, but because I didn’t want to miss anything. Even in the uncertainty of how my time in Mombasa would go, there was one thing I knew with complete clarity: I wanted to learn. I wanted to earn my place in this environment, to contribute, to ask questions of my own, and to slowly become someone who could walk into this space with both confidence and care. CGTRH is the largest public hospital in Kenya’s coastal region and the second largest in the country. As a level 5 facility, it serves as the main referral center for more than four million people across various Kenyan counties. Despite CGTRH’s vital role, the hospital faces several systemic challenges, ranging from staff shortages to limited equipment and overcrowded wards. My internship at Coast General Teaching and Referral Hospital has exposed me to the extraordinary resilience of healthcare workers in resource-limited settings. This experience has not only influenced my understanding of global healthcare inequality but has also reshaped my goals and values as a future healthcare professional. The difference between resource-limited and resource-rich healthcare systems lies mainly in the availability of funding, equipment, infrastructure, and personnel, which directly affect the quality, accessibility, and outcomes of care. Examples of resource-rich healthcare systems include Sweden, Germany, Japan, some areas of the USA, and the UAE. These systems are characterized by advanced medical technology; sufficient funding from the government or private insurance; well-trained and specialized staff with lower patient-to-doctor ratios; comprehensive infrastructure such as clean facilities, laboratories, emergency transport, and reliable electricity and water; widespread access to preventive care and screening programs; efficient digital systems for health records; and strong regulatory systems to ensure safety and ethical standards. The benefits of resource-rich healthcare systems include early diagnosis and treatment, lower infant and maternal mortality rates, longer life expectancy, and a greater capacity for medical research. Examples of resource-limited healthcare systems include Kenya, Bangladesh, and Haiti. These systems are often characterized by limited medical equipment, underfunded public hospitals, high patient-to-doctor ratios (understaffing), weak infrastructure, minimal preventive care or public health education, and continued reliance on paper-based systems that make patient tracking difficult. Other barriers to access such as cost, distance, and cultural factors further complicate care. The consequences can include delayed or missed diagnoses, higher rates of preventable deaths, burnout and stress among healthcare workers, and inequity in healthcare access, particularly between rural and urban areas. Kenya’s healthcare system is complex, shaped by both progress and persistent challenges. It is divided into three main sectors: the public health care sector, which includes facilities like Coast General Teaching and Referral Hospital; the commercial private sector; and faith-based organizations, often funded by religious groups. While the public sector provides specialized care and is officially backed by the government, it suffers from underfunding, resource shortages, and workforce strain. As a result, the private sector has grown to account for nearly 47% of all healthcare facilities in the country, even serving patients from the poorest income quartile, especially when children are sick. This trend is often driven by accessibility, as private clinics are typically located in more urban areas, making them easier to reach than some public hospitals. Many senior doctors split their time between public hospitals and private practices due to overwhelming demand. This situation is partly the result of systemic issues in medical education: attending medical school is expensive, and many who train abroad do not return to practice in Kenya. In addition, Kenya invests more in curative services than in preventive healthcare, leading to delayed diagnoses and higher patient loads in emergency departments like the one I interned in. This experience made it clear to me that improving healthcare in Kenya is about strengthening human resources, supporting primary care systems, and investing in prevention and public health literacy. Despite the structural challenges faced by Kenya’s healthcare system, my time at CGTRH also revealed significant improvements within the public sector that often go unrecognized by the general public. One example is the National Health Insurance Fund (NHIF), which has expanded coverage for millions of Kenyans, including access to essential treatments for cancer, diabetes, hypertension, maternity care, and kidney failure. Coast General itself is an example of how public hospitals are evolving. It is currently the only public hospital in the region with an interventional catheterization lab, a modern 15-bed ICU, and advanced radiology services, which enable it to manage complex cases that smaller private clinics cannot. During an IMA lecture, we even discussed instances of misdiagnosis in some low-tier private practices—a reminder that private care does not always guarantee better outcomes. It is a privilege to be able to see this change happening in front of me and to witness more accessible, system-level improvements in healthcare delivery. Kenya’s healthcare system is heavily impacted by three major domains of disease burden: communicable diseases, non-communicable diseases (NCDs), and injuries and violence. These health issues affect both public health institutions and the overall economy. Communicable diseases remain a leading cause of illness and death in Kenya. According to national outpatient morbidity data, the five most common conditions seen in outpatient visits are malaria, respiratory infections, skin diseases, diarrheal diseases, and accidents. Additionally, HIV/AIDS, referred to as retroviral disease in Kenya, continues to be one of the country’s deadliest health concerns. According to the WHO Country Health Profile (2012), HIV accounts for approximately 15% of all deaths in Kenya. It is responsible for 29% of annual adult deaths, 20% of maternal mortality, and 15% of child mortality under the age of five. The socio-economic consequences of this epidemic are significant, leading to a 4.1% reduction in per capita output. In Mombasa County, where I completed my internship, HIV remains a critical issue, contributing to 3.6% of the national HIV burden and ranking seventh among all counties. Surprisingly, women in Mombasa are disproportionately affected, with a prevalence rate of 10.7%, compared to 4.6% in men. This gender disparity highlights deeper issues related to access to care and awareness, especially among underserved communities. At the same time, non-communicable diseases (NCDs) are becoming an increasingly alarming concern. NCDs now account for over 50% of total hospital admissions in Kenya. Common NCDs include cardiovascular diseases, cancers, diabetes, obesity, and chronic obstructive pulmonary disease (COPD). This rise reflects an epidemiological transition, where lifestyle-related illnesses are increasing in parallel with persistent communicable diseases. The burden of NCDs is worsened by limited resources for early detection and long-term management, especially in rural or economically challenged regions. Injuries and violence also contribute significantly to hospital admissions and deaths. Based on the IMA slides, assault-related injuries account for 42% of trauma-related hospital cases, while road traffic accidents represent another 28%. These statistics reflect broader health concerns related to safety, infrastructure, and social stability. One often overlooked aspect of Kenya’s disease burden is the rising prevalence of mental health disorders. During one of the lectures I attended, I learned that one in four Kenyans is likely to suffer from a mental disorder at some point in their life. However, tragically, five out of six of those individuals will not receive any form of treatment. This treatment gap is due to a combination of factors, including stigma, the limited availability of affordable mental health services, and social taboos that prevent people from seeking help. During my internship at CGTRH, I rotated through Emergency and Casualty (ER) and Internal Medicine. I also had the opportunity to shadow during night shifts, which exposed me to a wide variety of urgent cases. Rather than one defining moment, what I learned came in the form of many small but powerful experiences, like pieces of a puzzle that slowly revealed a bigger picture. In the ER, I learned how to interpret patient vitals on monitors and understand what deviations might indicate, with the support of doctors and nurses who took the time to explain their thinking. Alongside other interns, I asked questions at appropriate times about patient histories, diagnoses, and treatment plans. While I sometimes did not fully understand the information they shared, I scribbled it down in my journal with the goal of researching it later. One case that stood out was a patient in septic shock caused by severe infections in both legs. Through this case, I learned about the different types of shock—cardiogenic, hypovolemic, and distributive—and how septic shock falls under the distributive category. Another meaningful case was observing a nasogastric tube insertion for a heart failure patient, who was later transferred to the ICU (by me). This case not only taught me the procedure of the insertion but also how it feels to become emotionally attached to patients. This particular patient didn’t want to wear his oxygen mask, and it often had to be readjusted or put back on (often by me with the doctor’s consent). I must have adjusted it at least five different times, each time gently asking if he was in pain or uncomfortable, trying to find a way to ease his distress. Yet every time we had found a solution, he would still take it off. Maybe it was out of stubbornness, or perhaps fear, confusion, or fatigue. It was a small yet intimate exchange that repeated throughout the day, and in those moments, I started to feel a deep sense of responsibility. I wasn’t just observing anymore—I was caring. Later that day, I asked the doctor about his treatment plan, and he responded that the patient was close to cardiac arrest, as he was presenting with agonal breathing. I tried to mentally prepare myself for what could happen. I had seen pain and chaos during my time in the ER, but this felt different—more personal. And yet, cardiac arrest never came, and we moved him to the ICU. As I was about to walk away from the ICU, I remember looking at him one last time and quietly hoping that he would make it. That day, I learned not just how to care for a patient, but how to care about one. And that, I think, is one of the most difficult and beautiful lessons in medicine. The emergency department was often at full capacity, and I saw patients suffering from severe head injuries, road traffic accidents, and trauma-related bleeding. One particularly eye-opening adaptation was seeing staff use a medical glove as a tourniquet—a reminder of how healthcare professionals creatively adapt to limited resources. In the Internal Medicine rotation, I had the privilege of following Dr. Faruk to the outpatient clinic, where we encountered a case of hypothyroidism. The patient had painful, swollen lymph nodes, and Dr. Faruk generously walked us through the symptoms and causes of hypo- and hyperthyroidism and diabetes, helping us make connections between physical symptoms and internal cellular processes. I asked whether he found it difficult to diagnose and treat patients without the same resources available in other countries. He explained that in such settings, the lack of advanced technology sharpens one’s observational skills and encourages greater care in physical examination. His teaching allowed me to analyze patients more holistically and strengthened my clinical reasoning skills. That day, our group discussed diabetes management, including different types of insulin (rapid-acting, short-acting, intermediate-acting, etc.). When I mentioned insulin pumps, a common treatment where I come from, I was told that such technology would be considered a luxury in Mombasa. In that moment, I truly understood the disparities between healthcare systems. It struck me deeply that many lives could be improved or saved, yet access and affordability remain major barriers in places like Kenya. Another deeply meaningful aspect of this internship was participating in the community outreach programs, which will forever hold a special place in my heart. I was fortunate enough to take part in four different initiatives: a hand and dental hygiene clinic, a women’s health hygiene clinic, a mobile medical clinic, and a visit to a school for children with mental disabilities. Each outreach experience taught me something unique, but they all left me with the same outcome: a genuine, lasting smile. It was impossible not to feel joy in the presence of the children we met. Their infectious laughter, radiant smiles, and warm, welcoming energy made every interaction unforgettable. At first, I believed we were going there to teach the kids something. But in the end, it was they who taught me. They reminded me of something so simple yet so often forgotten in our busy lives: to smile more. Not just for others, but for myself and for the people I care about. To celebrate life, no matter how small an act or accomplishment may seem. It was a powerful reminder of the emotional connection between joy, kindness, and health, and how much impact a moment of shared humanity can truly have. At the end of this journey, I feel a renewed sense of purpose—a deep, clear reminder of why I want to become a doctor. Before this experience, my mind was often clouded by thoughts of status, prestige, and financial stability. But through my time at Coast General Teaching and Referral Hospital and International Medical Aid, I’ve come to realize that the true core of medicine lies in the desire to help others. I had lost sight of this essential and important desire, and this internship reignited that motivation in me. I couldn’t have asked for a better outcome, as this is a drive I know I will carry with me through the hard times ahead and that will remind me of my “why” when I finally reach the milestone of becoming a doctor. But who says I have to wait until then to start making a difference? I’ve learned that helping others doesn’t always mean performing surgeries or diagnosing illnesses. Until I earn that title, I can still show up with kindness, humility, and gratitude—whether it’s picking up someone’s jacket, smiling at a stranger, or simply listening to someone who needs to be heard. These small acts matter, and they reflect the kind of doctor and, more importantly, the kind of person I aspire to be. In the future, I want to apply what I have learned and witnessed in Kenya. Seeing doctors improvise with limited equipment has taught me that it is important to use sharp observation and creativity to serve patients with what is available. This type of adaptability and mindset is something that I want to carry forward, whether I am in a well-equipped hospital or a resource-limited setting. The outreach programs reminded me of the power of prevention, education, and community engagement. Moving forward, I want to integrate public health into my career, advocating for preventive care and empowering patients to take ownership of their well-being. Kenya showed me that real change starts with you—not necessarily in the hospital, but in schools, neighborhoods, and communities. Additionally, this experience has sharpened my cultural awareness, something that will help me connect with patients from diverse backgrounds. Healthcare is universal, but barriers such as culture and language can greatly impact the care people receive. My goal moving forward is to deepen my understanding of how cultural perspectives shape health behaviors so that I can build stronger trust and provide more effective care for my patients, wherever I practice in the world. I didn’t know what to expect on my first day at the hospital, just as I don’t know exactly what lies ahead in my future. But I now walk into each day with the same excitement and drive I felt back then—ready to learn, ready to grow, and ready to help. No matter how small the action, my time in Mombasa taught me that compassion and presence are some of the greatest tools a person can carry, in medicine and in life. This experience has also shaped my understanding of what makes a truly great doctor, Yes, clinical skills and medical knowledge are important, but just as essential are empathy, courage, independence, resilience, and the ability to collaborate and connect with others. I learned the value of teamwork, the importance of cultural understanding in healthcare, and the critical role of preventive care, especially in the context of under-resourced settings. What truly made this journey unforgettable were the people—the healthcare workers at CGTRH, the IMA staff, and my fellow interns, who inspired me daily with their dedication, curiosity, and shared passion for medicine. I walk away from this experience with lifelong memories, new friendships, and a stronger belief in myself and the path I’ve chosen. Ultimately, this internship didn’t just expose me to the realities of healthcare; it confirmed my passion for it. Every moment, whether observing a nasogastric tube insertion, adjusting a patient’s oxygen mask, or educating children on hygiene, helped me see that medicine is more than a science—it’s about service, resilience, and connection. I now understand more deeply what it means to care for someone physically and emotionally, and it excites me to think that one day I’ll have the skills to make an even greater impact. This experience didn’t just shape my understanding of healthcare; it became the journey of finding my “why.” And now that I have found it, I will carry it with me through every challenge, every opportunity, and every step toward becoming the doctor I aspire to be. “The best way to find yourself is to lose yourself in the service of others.” – Mahatma Gandhi

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

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.

This program was truly one of the most amazing experiences of my life. My time spent at the hospital, the residence, and out in the community was incredible and shaped my experience in such a positive way. I felt very supported and knew that the mentors, especially Bella, were there for me. I also felt extremely safe at the residence, and the program mentors always made sure we knew our schedule in advance so they could address any questions we might have. Everything was very well communicated to us as interns. I truly felt at home in Mombasa. The food was amazing and the chefs were so kind and accommodating. One example of truly feeling at home was when Dorcas, one of the housekeeping staff, noticed that I put my blanket under my sheet and began doing that for me whenever she made my bed. I know that it was extra work for her, and the fact that she noticed and took the time to do that made me feel so special. As mentioned, Bella was an extremely important part of my experience as well. I am so happy she accompanied us on our safari trek and that I was able to properly meet her. She always went out of her way to talk to us and was just all-around amazing. IMA generates a culture in which you are encouraged to befriend the mentors, and I am so beyond grateful because this experience not only gave me incredible clinical exposure but also friends for life. When I reflect on my time as an intern in Mombasa, Kenya, I think about how excited I was to have my first experience shadowing in a hospital setting. I could not wait to learn more about what working in a hospital looked like, especially one in East Africa. Upon arriving in Mombasa, I found that my expectations would be far surpassed. I had unique clinical experiences, shadowing amazing nurses and doctors, but I also gained insights that extended beyond medicine, including a deeper understanding and appreciation for healthcare systems and cultures different from my own. Every single aspect of my time in Mombasa—whether a presentation, debrief, or public health outreach event (both clinical and mental health)—has altered how I see my future in healthcare. What surprised me most during my internship was not how the doctors and nurses practiced medicine, nor the technology or resources, which were often similar to what I would expect in more developed countries, but rather the level of health literacy among patients. Of course, International Medical Aid prepared us during orientation and taught us throughout the internship that this was an issue in lower-income sections of Mombasa and Kenya as a whole. However, I did not comprehend the full magnitude of the situation until seeing it firsthand. Watching a middle-aged man come into the cardiology outpatient clinic with continued trouble breathing, only to find out he had never learned how to use his inhaler properly, was one of those moments. I realized that the problem wasn’t necessarily a lack of resources—he had access to an inhaler with the proper medication—but that he did not understand how to use it. In Kenya, many people rely on “traditional healers and religious leaders” to “treat and prevent illnesses” (Robbertz et al., 2022), and such practices are often passed down from generation to generation. As modern medicine evolves, this can make health illiteracy a major problem. As defined by the NIH, health literacy is “the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions” (“Qualitative Analysis of Health Literacy,” 2022). I saw firsthand at Coast General Teaching and Referral Hospital (CGTRH), and through our presentations, that health literacy is particularly a challenge in low-income areas, making it harder to deliver care at the level that is possible given the available resources. Additionally, the challenge of health literacy is more prominent in underprivileged groups, such as women (Gatimu, 2018). In Kenya, educational practices often favor boys over girls, meaning girls might lack or struggle more with basic skills such as reading and writing, which subsequently “contribute[s] greatly to how they access health information” (Gatimu, 2018). This is an issue we saw while doing feminine hygiene clinics. Many girls had basic knowledge of the menstrual cycle, but there were often gaps in their understanding. For example, we would often get questions such as whether tampons break virginity, or encounter minimal knowledge of the female anatomy and its role in the menstrual cycle. Such questions and lack of knowledge were not a reflection of their intelligence but rather of their lack of access to accurate information. Health literacy is key to an individual’s ability to advocate for themselves and receive appropriate healthcare—something I had taken for granted in the United States but now understand in much greater depth. While working as an intern, I not only learned about medical practices but also about broader aspects of healthcare, such as insurance and how it can shape patient outcomes. Currently, Kenya has a national health insurance policy in place known as SHA, or Social Health Authority, which operates through contributions from Kenyan citizens. The idea is that “every resident in Kenya can access a comprehensive range of quality health services they need without the burden of financial hardship” (“Social Health Authority”), but I saw that this is not necessarily the case for some patients. During a night shift in the pediatric A&E, a woman brought her infant in with a snake bite. The doctor followed protocol and took blood for testing to determine the type of antivenom needed, as the mother was unsure which kind of snake had bitten her child. However, she had not been paying the monthly contributions to SHA and would need to pay those arrears before being able to receive the antidote under insurance. She ultimately decided against treatment for her child, as she could not afford to pay back the months she had missed or cover the cost of the antivenom out of pocket. She had to sign a form stating she was taking her baby home against medical advice and risk her child suffering a potentially fatal bite simply because she was not covered by SHA. For some lower-income Kenyans, I found that they would often skip paying for SHA. While there are government subsidies available for low-income individuals, many still could not afford SHA and were therefore unable to receive needed treatment. I also observed a few patients, particularly in the internal medicine wards, who were medically ready for discharge but had to wait until they settled their SHA balances or paid out of pocket. Despite this not being legal—“imprisoning patients is not one of the acceptable avenues [for hospitals] to recover debt”—it still happens (“AP Probe Finds Hospitals Detaining Patients Who Can’t Pay,” 2018). This means that beds are being occupied by patients who do not need to be there, rather than incoming patients who require immediate care. This style of insurance, especially for low-income populations, impacts how hospitals utilize resources and the level of access patients have to healthcare. During my five weeks in Kenya, I was able to participate in five different rotations—cardiology, surgery, internal medicine, the comprehensive care center (CCC), and emergency—as well as a night shift in the maternity ward. Each of these rotations provided me with a unique learning experience that has collectively shaped how I see healthcare as a whole. My first week in cardiology was extremely surprising. During the orientation tour, much of the technology I saw in the hospital was outdated, but the cath lab (cardiac catheterization lab) was new and state-of-the-art. Observing procedures in the cath lab helped me realize that there is no major difference in how procedures are performed or how doctors, clinical officers, and nurses are trained compared to more developed countries. The main difference is access to such technology, which is rarer and therefore makes it harder for hospitals to operate at similar levels. Coast General was actually the second public hospital in Kenya to have a cath lab, highlighting how monumental and important this facility is for the public health sector. Despite never having had the opportunity to observe surgery in the United States, I assumed that surgery would be a more universal aspect of healthcare and somewhat standardized across different countries. For the most part, it was. The procedures I observed were similar to those seen in the U.S., such as exploratory laparotomies, central venous catheter insertions, and even skull elevation procedures. Speaking with the surgeons and nurses about these operations was extremely interesting and helpful. It was incredible to have a surgeon talk through each step as he performed it right in front of us. I watched burr holes being drilled into a skull to relieve pressure, saw a patient’s large intestine brought outside of her body in order to remove a dead segment of small intestine, and observed intramedullary nailing to repair a tibial fracture. Internal medicine was my third week, and this was when I started connecting everything into a broader understanding of healthcare. I often saw patients with diagnoses that might eventually require procedures I had observed in surgery. The internal medicine wards were a shock after coming from the cardiology unit and surgical theatres: they were not air-conditioned, had fewer supplies, and had less advanced technology. I was able to learn more about diseases and conditions I was less familiar with, such as tuberculosis, malaria, chikungunya, and sickle cell anemia. I really enjoyed the internal medicine rotations because of how kind and patient the doctors and nurses were. They explained each case and walked us through how they arrived at their diagnoses. One doctor even gave us homework, asking us to come up with differentials for given symptom sets. The CCC, or Comprehensive Care Clinic, offers a wide range of services and resources for members of the community. Within the CCC, there were many different professionals and services available, including dermatology, phlebotomy, and a pharmacy. I expected that the CCC would mainly serve patients living with HIV, but was surprised to see that many patients simply came in on their scheduled dates to pick up medication—quick in-and-out visits. In fact, I spent the majority of my time in the CCC in the dermatology section, where I learned about conditions such as tinea and molluscum. The CCC is a very efficient and important part of Coast General Hospital, and I am so happy that I had the opportunity to observe an outpatient system like this. To me, the CCC is vital in slowing HIV-related stigma in Kenya. From day one of orientation, we learned that there is a significant stigma surrounding HIV in Kenya, which can result in “many people with HIV suffering in silence” and feeling deep “embarrassment” about their diagnosis (Onyegbu, 2022). Many people living with HIV are unaware of their status, “posing a major barrier to HIV prevention, care and treatment efforts” (Cherutich et al., 2012). In an effort to combat stigma and promote better health practices, education is essential. This is why the CCC is so important: it offers resources not only for testing and treatment, but also for providing accurate information and support for those living with HIV. Although this rotation was not as hands-on as some of the others, it taught me so much about another side of healthcare and reinforced how lack of education remains a major barrier to care in Kenya. My last week in Mombasa and at Coast General was spent in the Accident and Emergency (A&E) department. This department was absolutely eye-opening and has permanently changed how I view healthcare and the respect I have for healthcare workers. It was also one of the most emotionally challenging rotations of my internship, as I witnessed a patient unexpectedly die—something I knew was possible in this department but had never seen or truly understood before. It was difficult to watch patients in severe pain having to wait because there were no beds available, even to the point of patients staying in the DOA (dead on arrival) room while waiting for a bed in the main bay. Not only were there limited beds, but during night shifts there were fewer doctors and nurses available, making it harder for patients to receive timely care. In the pediatric emergency room, what stood out most was the lack of adequate resources, such as lines small enough for some of the babies. One baby was poked more than ten times—in his hands, feet, arms, and even head—with no success because there were not enough appropriately sized IV lines available in the pediatric section of A&E, especially considering his severe malnourishment. There were parts of the emergency department that seemed new and modern, such as some of the equipment in the infant section of the pediatric emergency area, but it was still clear that a lack of resources inhibited the care that could be provided. Despite all of these challenges, it was obvious how hard the doctors, clinical officers, nurses, and even medical students worked to provide the highest level of care possible. I saw countless interesting cases, and even in such a stressful environment, the staff did their best to explain what they were doing and why—something I greatly appreciated. In addition to my main rotations, I also completed a night shift in the maternity ward. I wasn’t quite sure what to expect, but I really enjoyed my time there. I observed natural births and C-sections, as well as a miscarriage case. One encounter I remember most involved a woman who had undergone tubal ligation after a previous C-section but had still become pregnant. She could not understand that there is still a small chance of pregnancy after tubal ligation and initially refused to believe she was in labor—again emphasizing how important education is in healthcare. I also found it striking that no pain management was provided to women who were not undergoing C-sections. Epidurals were reserved only for C-section births, and even then, I observed one woman being poked four times before the anesthetic was successfully administered. When we were not in the hospital, I loved visiting schools and working with young women in menstrual health clinics. We answered questions about the menstrual cycle and female reproductive health, and we also visited schools with younger children, making up songs to teach about general hygiene, such as handwashing and toothbrushing. Not only did I enjoy teaching about hygiene, but I also valued talking to some of the girls about what they enjoy outside of school, what they want to be when they grow up, and even their recommendations for things to do in Kenya. These interactions enriched my experience and gave me a better understanding of both healthcare education in schools and local culture. I also appreciated our Friday meetings, where I could hear about rotations I might not experience myself and learn important clinical skills like CPR, intubation, and suturing. It was fun to practice hands-on skills and try to apply some of what we were observing in the hospital. Our public health clinics were probably one of my favorite parts of the program. I enjoyed meeting and speaking with people from local communities and ensuring they had access to healthcare. It was sometimes hard and emotionally taxing to watch children come in alone, single mothers who did not know how to help their child, or older individuals who had been struggling for a long time without time or money to seek treatment. I especially liked working in the consultation room, where we partnered with a doctor to review symptoms and decide whether patients needed referrals or could receive medication at the clinic. Every doctor was so kind and accommodating and was happy to explain how they were making clinical decisions and proceeding with diagnoses. Of course, no healthcare system is perfect, and there are certainly different problems impacting healthcare in more developed countries such as the United States. Because of my time in Kenya—shadowing in the hospital, speaking with doctors, nurses, and patients, and learning through presentations at both the residence and hospital—I now have more insight into the challenges within the Kenyan healthcare system. It would be interesting to dive deeper into how healthcare systems around the world compare to Kenya’s and whether they have had—or currently have—similar problems, as well as how they have addressed or are working to address them. There is no overnight solution, and many of the problems I observed in Kenya are systemic in nature, such as health literacy patterns passed from parent to child or unequal educational opportunities between boys and girls. My time in Mombasa, Kenya, and at Coast General Teaching and Referral Hospital has changed me not only as a hopeful healthcare provider, but also as a person. I feel inspired to continue working hard in my pursuit of a career in healthcare to better serve those who are not yet receiving the care they deserve. Prior to traveling to Kenya for this internship, I had some interest in working in healthcare outside of the United States, but this experience cemented that passion for me. It also made me realize how multifaceted medicine is—that it is not just about a provider’s training, but also about the patient, the culture, the country, and many other factors. It is important not only to learn clinical skills, but to understand the background of the healthcare system and how to use that knowledge to become a better provider and meet patients’ needs. I am so grateful for the friends I made and the experiences I had during my five weeks in Kenya, and I am hopeful that one day I will return to work even more hands-on in the communities that taught me so much.