Internships in Jacmel, Haiti

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

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

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

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.

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.

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.

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

My experience with International Medical Aid (IMA) was truly incredible. I gained so much during my time in Mombasa, both professionally and personally. Throughout my four weeks, I felt consistently supported, safe, and inspired. My placement at Coast General Teaching and Referral Hospital allowed me to expand my clinical skills as a nursing student, broaden my perspective on global healthcare, and bring home new knowledge that I am now applying in my practice in Canada. For this, I am deeply grateful. The community clinics were a highlight of my experience. Each visit left me feeling humbled and fulfilled. We were able to make a real difference by meeting people where they were and providing education in a safe, inclusive environment. The residence where we stayed holds some of my fondest memories. The entire staff was incredibly kind and welcoming from the moment I arrived. Our mentors were consistently supportive—checking in on us daily and sometimes joining us for meals to talk about our experiences. Their presence and encouragement made all the difference. There is nothing I would change about my time as an intern with IMA. The professional and personal growth I experienced would not have been possible without the unwavering support, guidance, and warmth of every staff member involved. I sincerely hope, and fully intend, to return one day. This past summer, I had the incredible opportunity to complete a four-week nursing internship with International Medical Aid in Mombasa, Kenya. As I reflect on that transformative month, I recognize how profoundly the experience shaped me—both professionally and personally. The sheer volume of knowledge I gained, the experiences I had, and the moments I witnessed exceeded anything I thought possible in just four weeks. Now, as I sit down and write, my mind and heart overflow with vivid memories: clinical observations, impactful patient interactions, and invaluable learning moments—each one worthy of its own chapter in a book. From all that I experienced, I return to Canada with a renewed perspective and a deeper sense of self—more intuitive, insightful, and, I dare say, wiser. While I cannot recount every story or experience from my time in Mombasa in this piece of writing, I will use this opportunity to highlight the most meaningful moments and lessons—those that have most profoundly shaped my perspective and influenced how I intend to practice and serve as a healthcare professional. My time in Kenya not only deepened my commitment to nursing but also instilled in me a clearer vision of the kind of compassionate, culturally competent, and purposeful medical practitioner I am determined to become. Kenya’s healthcare system is a tiered system, unevenly built. It is structured into four main levels: community health services, primary care facilities, county referral hospitals, and national referral hospitals (International Medical Aid, 2022, slide 4). While this tiered system is well-designed in theory, significant disparities in funding and resource allocation undermine its effectiveness in practice (Kairu et al., 2021). The most critical gaps exist at the foundational level—community and primary care—where underfunding results in inadequate services and a lack of essential preventative care (Oleribe et al., 2019). These upstream failures cascade into more serious and complex issues at higher levels of care, as patients often present with advanced, preventable conditions that could have been addressed much earlier (Vedanthan et al., 2015). One of the most striking examples I observed was the lack of accessible and effective prenatal care. Without adequate prenatal services, many congenital conditions go undetected or unmanaged (Baschat, 2023). During my pediatric rotation, I encountered a multitude of congenital heart defect cases—conditions that, in many instances, could have been prevented or treated accordingly through routine prenatal screenings and maternal care (Baschat, 2023). Among these patients was a six-year-old girl whose story had a profound impact on me. She had advanced-stage complications of a congenital heart defect, including lung damage, and required both a heart and lung transplant. This type of surgery was not available at Coast General Teaching and Referral Hospital (CGTRH), and her family could not afford to pursue treatment elsewhere. As a result, she was placed on comfort care. I spent several days with her and her father during my rotation, building a bond. Her father spoke about their struggles—financial and logistical—and how he just wanted his daughter to be pain-free. Despite everything, the little girl remained remarkably quiet, never once crying or openly displaying the pain that she must have been enduring. On the day of her discharge, her father told me that she had shared a dream with him: she wanted to become a healthcare provider. She had told her father that she would go home and begin studying so she could help people, just as she had seen me and other CGTRH staff do. Holding back tears, I knelt beside her and asked if I could make her a “daktari” right then and there. When she nodded, I placed my stethoscope around her neck. Her eyes widened, and a look of awe spread across her face. Her father’s eyes grew glassy, and in a moment of sorrow, we found a bit of joy. That experience is something I will carry with me forever. This little girl’s story is one of many that speak to the structural issues within Kenya’s healthcare system—where preventable conditions are allowed to progress due to gaps in early intervention, and where economic barriers determine the course of a child’s life. Yet, amidst these challenges, moments of connection and humanity shine through. They remind me that fair access to healthcare is not just a professional requirement—it should be our moral obligation. I also came to understand the human cost of understaffing. At CGTRH, the ratio of doctors to patients stands at an alarming 1 to 17,000 (NTV Kenya, 2025). This stark imbalance is not just a statistic—it is a daily reality that shapes the way care is delivered, or, more often, not possible. Due to government corruption, limited public funding, and deep financial disparities across the country, Kenya cannot afford to train or retain enough healthcare professionals to meet its population’s needs (Zhao et al., 2023). The result is a healthcare system that is critically overburdened, where the high volume of patients makes it difficult to provide compassionate and individualized care (Babaei & Taleghani, 2019). I witnessed the impact of this crisis firsthand during a day in surgical consults. A young boy came in with complications following a urethroplasty. Scar tissue had formed excessively, closing off his urethra and putting him at risk of acute urinary retention. The doctor assessed the situation and determined that an immediate catheter insertion was necessary. There were no pain medications administered, no attempts at comfort or distraction—just urgency. She asked that I hold him down during the procedure, explaining she had many more patients waiting and no time to delay. I now understand the pressure these doctors face and the difficult choices they must make. I did as she asked. But as the boy screamed—cries of pain and fear—I had to look away. It was one of the most traumatic moments I’ve ever experienced. After the catheter was inserted and began draining, the doctor left the room. The boy lay there, exposed and in visible pain. I helped his mother dress him, watching him wince with each movement. He was expected to walk himself back to the waiting area. I couldn’t let that happen. Instead, I lifted him gently off the table and walked hand in hand to a chair in the waiting room. He sat on my lap, leaned against my chest, and we waited together while his mother went to retrieve pain medication. I let him watch a children’s show on my phone, and slowly, other young patients—some of whom had also undergone a procedure or were awaiting their turn—gathered around us. One leaned on my arm as another rested his head nearby, all quietly watching. For that hour, I wasn’t delivering clinical care, but I was offering something that, in a severely understaffed system, was unfortunately rare: presence, comfort, and empathy. That afternoon stayed with me and taught me something I will carry into my practice as a healthcare provider: patient care is more than procedures and diagnoses—it’s also about dignity, connection, and compassion. I saw firsthand that when a system is too overwhelmed to allow for those practices, it is the patients—especially the most vulnerable—who suffer. Moving forward, I will hold onto this newfound knowledge and strive to create a space for empathy at all times. I will advocate not only for clinical excellence but for compassionate care that sees and honours the person behind the patient. Integrating into Kenya’s healthcare system also came with challenges. The clinical practices and resources were markedly different from what I was used to in Canada. Many of the regulations and routines I had been taught were, and are, simply not feasible at CGTRH due to a lack of materials, equipment, and staffing. Yet, what struck me most was not what was missing—but what was present: impressive skill, resilience, and adaptability. Despite the resource limitations, the Kenyan healthcare providers were knowledgeable and innovative. Where I might have stopped and thought, “There’s nothing we can do,” they found ways. Their ability to improvise—often under pressure—was inspiring and, in some situations, lifesaving. This difference in approach fostered meaningful collaboration between my Canadian training and their resourceful, hands-on approach to problem-solving. One such moment occurred during a shift in the Intensive Care Unit (ICU). A young man was admitted with some of the most severe pressure sores I had ever witnessed—so deep that muscle tissue was exposed. The pain he must have been enduring was unimaginable. I shared with the nurse I was working alongside that in Canada, we often use donut pillows to offload pressure from such wounds. She agreed that we needed to try something similar. Although CGTRH had no such medical devices, we rolled blankets into circles to create makeshift cushions together. We carefully placed them beneath the affected areas, and when I asked the patient if it felt any better, he said, “Yes.” While we didn’t have high-end tools, by combining our experience, ideas, and compassion, we were able to enhance someone’s comfort level. Another pivotal moment of teamwork came again in the ICU, when a three-month-old infant coded. Within a short period, three nurses, a clinical officer, and I were working in unison. One administered medications, one gave breaths, another completed suction, and I performed chest compressions. My mind focused only on doing what had to be done. About twenty minutes into the resuscitation, a medical officer entered the room. I was in the midst of compressions when he asked if I was okay or needed a break. I responded, “No,” and kept going. A few minutes later, he listened to the baby’s chest and assessed, then looked at me and nodded: “The heartbeat is back in the 100s—and it is strong. Well done.” Relief swept over me as my mind caught up to the moment. One of the nurses pulled me aside, checked in on me, and said, “Be proud of yourself. You did something good.” She also reminded me that the child was critically ill, and even with all our efforts, he still might not survive. It wasn’t a burden that could be carried alone. Her kindness, support, and presence in that moment meant the world to me. From this experience, I learned how essential support from fellow healthcare providers is, not only for delivering effective care but for sustaining the emotional strength to continue this line of work. Although we came from different countries, backgrounds, and paths, we were united by a shared purpose. Together, we saved a life. That moment taught me that medicine isn’t just about knowledge or resources—it’s about people. It’s about trust, shared purpose, and the powerful moments when compassion reaches beyond borders. Moving forward, I will hold onto this perspective, recognizing that collaboration and human connection are essential to patient care and to the well-being of healthcare workers. Education is key. According to the World Bank Group, millions of females globally, including those in Kenya, lack the resources and support necessary for proper menstrual hygiene management. This issue stems from limited access to menstrual products, lack of education on the topic, and social stigma. Therefore, millions of females live in ignorance and fear, which directly impacts their health, confidence, and life opportunities (World Bank, 2018). During my time in Mombasa, I was able to witness just how real and pressing this issue is. As part of our community clinic work, we visited numerous schools to conduct Women’s Health Education Sessions, focusing on menstrual hygiene management practices. Before these sessions, I was uncertain about how the girls would respond. Reflecting on my own experience at their age, where I had a solid understanding of menstruation, I wondered if they were already quite informed and thus might see our lessons as unnecessary. I was deeply mistaken. The gaps in knowledge and widespread misconceptions were staggering. It was heartbreaking to learn that many of these young women had never been taught how to manage their periods or understand the physical changes they were experiencing. Many did not know that blood clots and heavy bleeding were often normal, nor were they aware that pregnancy remains a risk during menstruation or before the first period. The silence and stigma around women’s health had left them confused and vulnerable. Despite this, the sessions were filled with curiosity and eagerness. The girls were engaged, asking questions that reflected their desire to learn and understand. We were able to create a safe space where talking openly about the female body was not only accepted but encouraged. During each session, we gradually replaced shame and silence with knowledge and empowerment. To help foster that comfort, I even shared my own experiences with menstruation, showing them that their questions were valid and that they were not alone. Participating in community clinics, such as the menstrual health sessions, taught me the importance and power of education and knowledge sharing. Empowering young women with information is a vital step toward reducing stigma and improving health outcomes. The perspective I gained through these experiences is one that I will consistently apply to my future practice as a healthcare provider: create safe, inclusive spaces that foster learning, encourage open dialogue, and prioritize education, as it is a powerful tool and integral to improving both health and quality of life. My time as an intern with International Medical Aid was more than a clinical rotation; it was one of the most transformative experiences of my life and has profoundly shaped my path as a healthcare provider. Experiencing the healthcare system in Mombasa, Kenya, redefined my understanding of care itself and the people involved, including both providers and patients. I learned that providing adequate healthcare extends beyond diagnostics and procedures. It involves listening, empathy, and the ability to adapt. I witnessed how healthcare systems function under extreme strain, how disparities affect outcomes, and how creativity and collaboration can become the most powerful tools clinicians have. From bringing light to moments that felt impossibly heavy, to holding and comforting a young boy after a painful procedure, to performing a resuscitation alongside an international team, and helping young women understand their own bodies—I now know the kind of healthcare provider I strive to be. I strive to be someone who leads with cultural sensitivity, humility, and compassion. Someone who sees every patient not just as a case, but as a whole person, deserving of empathy, connection, and dignity. The lessons, newfound knowledge, and perspectives I’ve gained from this internship will guide me as I continue down my healthcare journey. Back in Canada, and wherever my career may take me, I will continue to advocate for equity, create safe and inclusive spaces, and never forget what a privilege it is to educate and care for others. Kenya not only helped shape my goals as a healthcare provider and as a person, but it also solidified them in a way that nothing else ever has. I return to Canada with greater knowledge and a commitment to lead with compassion, guided by my new insight and grounded in humility.

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

International Medical Aid did a fantastic job of making sure all of the interns were well taken care of. There was never a time when I needed something and IMA was not immediately working to fix the issue. The IMA team in East Africa was so accommodating, welcoming, and overall kind to all of the interns. They genuinely wanted to get to know each and every intern in order to make your experience the best it could possibly be. Personally, I became really close with the transportation team and the kitchen staff whilst in Mombasa. These individuals made my day every time I got the opportunity to talk to them and get to know them. The kitchen staff made amazing food from all different cultures to accommodate everyone's different tastes. I was able to taste classic Kenyan dishes as well as my favorites from home, like pancakes in the morning at breakfast. If you have an allergy or dietary restriction, the kitchen staff will not rest until your dietary needs are not only met but exceeded. They would go above and beyond at every meal, making the whole experience better for everyone as we were all well-fed. As for the transportation team, my favorite thing to do was sit in the passenger seat of the bus on the way to/from the hospital or community outreach and chat with the drivers. I was able to get to know the transportation team on a more personal level, making the drives more fun when you had someone you considered a friend driving rather than just an employee. As for the in-country support, the staff of IMA did a great job of communicating with us quickly when we had a question. They were also clear with us on what was going on around Mombasa that we as interns should be aware of (politically, socially, and culturally) as we made our way throughout the city. As for the living accommodations, the residence was nicer than I could have ever imagined. From the pool the interns would frequently hang out in at night, to the spacious living quarters, the residence gave us more than enough room to play games at night, live amongst 50+ other people comfortably, and rest and relax after a long day. The residence was sparkling clean with comfortable accommodations and, again, the best staff taking care of the living spaces and grounds. Given that the residence was located in a gated community in one of the nicest neighborhoods in Mombasa, I always felt safe and at home. Whenever we would leave the residence, I still felt extremely safe and cared for by the staff members and my fellow interns. However, Mombasa as a whole is made up of some of the nicest, most welcoming people who almost never make you feel as though you are in an unsafe situation. All in all, I would rate this experience a 10/10. I was on the phone with my dad the night before I left, begging to push back my flight just a few more hours to spend more time with all of the amazing interns and staff I met during my six weeks in Mombasa. I did not want to go home, and I still miss it every day. In my opinion, Mombasa changed me for the better, not only as a healthcare professional but also as a person. As a nursing intern going into my senior year of nursing school, I was able to help out the nurses and doctors in the hospitals. Whether I was providing the patient with a hand to hold during a procedure, or doing head-to-toe assessments and giving authorized medications to help relieve the nurses of their heavy workload, I was able to see the impact on not only myself but also the community through the things I did. Mombasa changed me as a future nurse, teaching me how to problem solve in situations where resources and staffing are at the absolute minimum. In the future, I will be able to think quicker on my feet and problem solve in my workplace thanks to my time in Kenya. I was also able to see my impact on the community of Kenya through community outreach set up by IMA and through my patients getting better in the hospital. Whether I was watching a malnourished patient get better over my weeks in the hospital or teaching a child at the local school how to brush their teeth, I was seeing the impact not only myself, but the entire organization of IMA had on the community around us. This program is very special, and anyone who has the opportunity to participate should consider themselves very lucky. Thank you, International Medical Aid. Kwaheri, Kenya! It has been about a year exactly since I called my parents to tell them my wishes of spending my summer in Africa as a nursing intern. Although they were on board with me going abroad to experience other healthcare systems and help those in need, they were not sold on the idea of me flying by myself for the first time to a continent so far away from home. With my fantastic marketing skills, I was able to convince them that I would, in fact, be killing three birds with one stone by going on this adventure. I would gain vital clinical hours to set me apart for nursing job interviews coming up sooner than I would like to admit; I would get the opportunity to study abroad in a sense which I would not have otherwise been able to do due to the constraints of the nursing school timeline; I would get to go to the continent I had always dreamed of traveling to, Africa. Fast forward about ten months later, and I was on a plane en route to Mombasa, Kenya, where I did not have a single clue what I was about to experience over the course of the next six weeks of my life. Upon my arrival to Mombasa, I had an instant culture shock. For starters, Kenyans drive like crazy in comparison to Texas drivers—and that is saying something—and all of the people are very friendly and welcoming, which is uncommon in the United States, even in the South. Thankfully, International Medical Aid did a wonderful job of properly introducing not only Mombasa, but also the country of Kenya to all of the interns within less than 24 hours of their arrival. We learned about the political, social, and religious cultures of both Kenya and Mombasa specifically. We were also given a “Swahili survival guide” of sorts to jumpstart the interns’ typically rocky journey of learning the language. These first few lectures and tours of the city helped put into perspective where our planes had touched down just the day prior, immersing us into the culture and welcoming us into a place like no other. Upon applying to IMA, I expected to learn and grow as a nurse and as an individual. What I did not expect was how much I really would learn during my six weeks with IMA. Throughout my time at Coast General Teaching and Referral Hospital in Mombasa, Kenya, I was able to experience nursing in a multitude of different specialties. Naturally, each specialty came with its own challenges and learning curves. Through encountering these obstacles head-on in each unit, I was able to come back to the United States as a much more well-rounded nurse. My rotations made me think quickly on my feet and problem solve as I went, namely my rotations in the OB-GYN, Pediatrics, and A&E units. During my OB-GYN rotation, I encountered mistreatment of patients. Throughout my rotation, I saw healthcare professionals slapping patients and pinching their lips shut if they made noise while in labor. I saw patients ignored when they voiced their pains and fears as they progressed through labor. I saw a lack of patient consent for procedures such as episiotomies. Witnessing these events taught me how, as a nurse, I must step up to enforce patient-centered care and advocate for my patients to receive the best possible treatment, even when the unit is short-staffed and running low on resources. I did this by taking initiative in the care of the patients—providing them with non-pharmacological pain management methods I had learned and used during my OB-GYN rotation in the United States. These measures included massage, changing the patient’s position, and lending a hand to hold in order to calm their nerves. While on the OB-GYN unit, I learned not only how to take initiative in uncomfortable situations for the good of my patients, but I was also able to show staff members how comfort measures can help enhance a patient’s entire birthing experience. Pediatrics taught me the importance of time management as a nurse. During this rotation, I had the pleasure of shadowing and assisting Nurse Wafa in the pediatric inpatient ward. During my time there, the ward was full, and we had approximately forty patients needing medication administration. Given that there was only me, Wafa, and a nursing student available to help all forty patients, it was very difficult to make sure all medications were given to every patient on time. Therefore, we created a system where the nursing student would chart, Wafa would draw up the medications, and I would administer all medications I was approved to administer as a student nurse. In working with Wafa and the other student nurse from Kenya, I was able to learn about time management while still providing my patients with safe, timely medication administration. Arguably, my rotation in the Accident and Emergency Department at CGTRH taught me the most out of all my rotations. Whilst in the A&E, I learned how to think quickly on my feet to help solve unforeseeable problems as they arose with the ever-changing patient conditions present in this unit. I learned how to jump in where needed to assist doctors and nurses in doing assessments and vitals, as well as IV insertions, as I had previously been trained and approved to do such things. This was a huge help to the staff, as there were also things I could not do, such as comforting family members who had just lost a loved one, administering blood, or giving high-risk medications, to name a few. That being said, I was able to learn so much with the guidance of the staff in the Accident and Emergency Department as they gave me opportunities to learn new things, practice my skills, and ask questions when appropriate. For example, the physicians would point me toward a patient to assess and ask me to guess their presenting diagnosis. By doing this and reporting back with my notes, I was able to receive instant feedback and advice on my assessments. My learning did not end in the hospital. Much of it took place outside the clinical setting in the form of cultural and global health discussions. Through IMA-led lectures and conversations with fellow interns, I was able to better understand how different healthcare systems operate based on each country’s laws, cultural beliefs, and available resources. With interns from around the world, I learned how the U.S. healthcare system differs from those in Australia, Dubai, the UK, Kenya, and more. Thanks to International Medical Aid, I have begun to pay closer attention to healthcare differences worldwide so I can become a more globally aware nurse for my patients. By understanding how a healthcare system works, it becomes easier to recognize inequities in hospital infrastructure and patient care across countries. One of the major differences I noticed between Kenya and the United States was how few patients were insured in Kenya. Even at what U.S. citizens would consider the low price of five dollars a month for insurance, “the insurance scheme is still unaffordable to a majority of Kenyans” (IMA, 2024). This means that many Kenyans are paying out of pocket for healthcare services, making care less accessible and affordable for a vast portion of the working population. Throughout my time in CGTRH, I saw hardships and challenges in every unit I encountered. Many of these issues stem from socioeconomic disparities among different populations across Kenya. In 2020, BMC Health Services Research conducted a quantitative study on the “cost-related unmet need for healthcare services in Kenya” (Arsenijevic et al., 2020). The study found that multiple factors drive unmet healthcare needs due to cost, requiring a multifaceted approach to address inequities, especially among the most vulnerable and marginalized populations. In short, lack of health insurance, limited access to services, and socioeconomic disparities all contribute to patients’ challenges in acquiring necessary healthcare. Throughout my rotations at Coast General, I saw the effects of these factors firsthand. One patient in particular came in with extreme malnutrition during my night shift in the Pediatric A&E during my third week in Mombasa. A couple of weeks later, during my Pediatric rotation, I saw the same child looking much healthier and in better spirits, ready for discharge. When I came back in my last week with IMA to say goodbye to my favorite nurse in Pediatrics, I saw that my patient had been moved to a “waiting” area where children and their mothers stay until they can pay off their medical bills. Their bill continued to increase each day they remained in the hospital, as they were still using bed space and resources. When I asked the mother what was happening, she said they were 30,000 Kenyan shillings short. This mother and son were still there when my internship ended, and I will never know if they were able to go home. This is a real-life example of cost-related barriers affecting real patients. Each day during my rotations presented different challenges and complications. I learned that many of these issues were linked to the political approach taken toward healthcare in Kenya. I witnessed the effects of government shortcomings firsthand, particularly regarding healthcare worker pay and support. During my time in Mombasa, I observed the country struggle under growing tension over how citizens and healthcare workers were being treated. The Kenya Medical Practitioners, Pharmacists, and Dentists Union (KMPDU) “has accused county governments of failing to prioritize healthcare workers’ welfare, with some counties owing salaries for up to five months” (Aura, 2024). Due to strikes by healthcare professionals, staffing became even more limited, making it harder for hospitals to meet patient needs. This even affected interns in the IMA program, as there was a week when no surgeries were available to observe in the Surgical Ward. These issues between the Kenyan government and the healthcare system are deep-rooted and affect many more people than those whose voices are heard. Unfortunately, it is primarily the patients who are put in danger by not receiving proper or timely treatment due to these systemic inequalities. Throughout my time at CGTRH, I learned how these political and structural challenges shape patient care. I learned so much from my six-week adventure in Kenya. Whether I was in the hospital, doing community outreach, or just sitting in the living room with my fellow interns, I was constantly learning—professionally and personally. Professionally, I worked alongside some of the smartest people I have ever met from all over the world, collaborated across specialties, and witnessed a completely different way of practicing medicine due to limited resources and staffing. I also saw stark inequalities and recognized many things we take for granted in the U.S. Personally, I met some of the kindest individuals I have ever known, was welcomed into one of the most vibrant cultures I’ve encountered, and reignited my love for adventure. Thanks to International Medical Aid, I experienced the greatest period of personal and professional growth of my life so far, and for that, I will forever be grateful.

During my internship with International Medical Aid in Kenya, I received exceptional in-country support that significantly enhanced my experience. From arrival, I was warmly welcomed and received through orientations on Coast General Hospital, Kenyan culture, and safety protocols. Throughout my stay, the IMA team was accessible and responsive, ensuring a smooth and enriching experience. They provided unwavering support in every aspect, from safety and accommodations to delicious meals, fostering a supportive environment that facilitated both my clinical growth and cultural immersion. My journey into healthcare began in kindergarten, though I can’t pinpoint exactly why I was drawn to it at such a young age. My enjoyment of doctor visits might have been an early sign, but with no family background in healthcare to spark it, my interest seemed almost instinctive. I found anatomical charts interesting and I didn’t even mind the shots. As I progressed through school, my passion for working in a hospital solidified, but I found myself torn between nursing and medical school. Eventually, I chose nursing school, though uncertainty lingered because I wasn't entirely sure what it entailed. Being the first in my family to pursue college added to my uncertainty; I had to figure this out on my own. Entering nursing school, I fell in love with everything about it. I was certain I had made the right choice. Yet, whenever asked, 'Why nursing and not medicine?' I struggled to give a confident answer. I lacked familial influence in healthcare and had limited hospital experience at that point. Over time, I gained significant clinical exposure, but doubts persisted. Then, I discovered International Medical Aid. Having longed to travel and previously planned to study abroad before COVID disrupted those plans, I saw this as the perfect opportunity to gain clinical experience while exploring the world. Participating in this program was a transformative experience that reaffirmed my decision to pursue nursing. I am immensely grateful for the opportunity it provided. During my first week of internship, I had the opportunity to rotate between the pediatric outpatient clinic and the inpatient wards, providing me with valuable insights into different hospital settings and healthcare professions. The outpatient clinic, primarily managed by clinical and medical officers, and the inpatient wards, overseen by nurses, offered contrasting but equally enriching experiences. I was particularly thrilled to begin in pediatrics, a potential specialty of interest to me. In the outpatient clinic, I was warmly welcomed by Dr. Ken, who delivered extensive and captivating lectures on common pediatric diseases in Kenya. I shadowed him as he treated a continuous stream of anxious mothers and their children, learning assessment techniques firsthand during patient examinations. Transitioning to the inpatient setting, I had the privilege of working alongside Sister Wafaa. She graciously guided me through the daily responsibilities of a pediatric nurse at Coast General Hospital. I assisted with basic treatments, obtained vital signs, and helped gather essential supplies. It was here that I quickly learned to think creatively and adapt to various challenges. I observed firsthand the striking differences in resource availability in Kenya compared to healthcare facilities in the U.S., underscoring the challenges and ingenuity required to deliver quality care in a resource-limited environment. Each day, I was struck by the nurses' resourcefulness—they devised solutions to problems that I, coming from a more privileged background in the U.S., would never have had to solve. In my spare moments, I cherished conversations with mothers about their children and offered them comfort by giving them a support person. I noticed that Kenyan women exhibited remarkable strength, often adhering to cultural norms that discouraged overt displays of emotion such as fear. Although initially reserved, they gradually opened up during our conversations, revealing their resilience and the deep emotional fear they faced for their children. I frequently visited Sister Wafaa as well as the mothers and children we treated; there will never be anything as refreshing as the feelings that overcame me when returning to the unit to see children who were once battling for their lives now nearly unrecognizable jumping and playing in their cribs. These interactions are among the fondest memories I will carry from this experience as they reaffirmed to me what being a nurse was all about. During my second week of internship, I immersed myself in the challenging environment of the surgical intensive care unit (ICU). With limited prior experience in such a fast-paced setting, I was grateful for the opportunity to shadow nurses, clinical officers, and medical officers. Under the guidance of Dr. Mohammed, I delved into the intricacies of disease pathology and treatment plans. His interactive teaching style extended beyond clinical practice; he assigned us homework on researching electrolyte imbalances and hormonal conditions, which served as a valuable refresher from my nursing school pathophysiology courses. Beyond academic challenges, Dr. Mohammed posed thought-provoking questions that pushed me to reflect deeply on my internship experience. One particular inquiry resonated with me: What makes nursing different from any other profession where one can also help people? This question challenged me to articulate a meaningful response, one that went beyond clichés about helping others. Through this interaction, I came to the realization that nursing is truly a unique profession. Each and every healthcare provider has a common goal of helping their patient, but how they do it is what makes each profession unique. This reflection helped me articulate a more profound personal mission within the field, driving me to make the most of my internship experience. My third week was spent rotating between the pediatric and adult accident and emergency units. Similar to ICU, these were faster paced units as one second you could be sitting at the desk reviewing charts and only moments later you could be performing CPR on a child. I spent the majority of my time in the pediatric A&E practicing assessment skills and assisting with treatments. In my spare time, I spent the time conversing with mothers. I felt heartbroken for these mothers, who were alone aside the beds of their sick children. You could see the looks of desperation and hopelessness in their eyes as they begged for us to help their children. These moments give you purpose and fuel for your passion as there is nothing more rewarding than being able to be the best part of the worst day of someone’s life. During the final week of my internship, I had the privilege of working in the labor ward, where I had a profound experience that answered the question that I had been pondering for years. I had the honor of holding the hands of twelve incredibly brave new mothers. These moments became the most meaningful of my internship. Whether they know it or not, I cried tears of joy alongside these women as each beautiful baby entered the world, and I shed tears of sadness with those who were grieving. Witnessing their journeys was a deeply emotional experience for me. Each mother arrived on a stretcher, filled with fear. When their babies were born, their expressions weren't joyous; they were simply filled with relief at having survived the delivery. Maternal mortality rates have risen in Kenya, ranging between “...500 and 999 deaths per 100,000 live births…”, making many women fearful for their lives (World Health Organization, 2023). Many of these women were alone—either because their partners weren't allowed in the room or because they were young and had been abandoned by their families out of shame. It was particularly difficult as unlike the United States, birthing women do not routinely receive anesthetics or pain medication in Kenya. So, throughout their labor, I stayed by their sides, offering reassurance and advocacy. I promised them that I would do everything in my power to support them and make the process as comfortable as possible. In their most vulnerable moments, many cried in my arms, expressing gratitude for my presence on what was undoubtedly the hardest and scariest day of their lives. I will never forget these moments as they are what helped solidify my passion for nursing. My four-week internship at Coast General Hospital not only reaffirmed my passion for nursing but also provided profound insights into the healthcare challenges in Kenya. I witnessed firsthand how limited healthcare literacy and overall accessibility due to financial constraints often prevent individuals from accessing essential care (Ilinca et al., 2019). The shocking contrast between healthcare systems was highlighted further when I learned that in 2021, healthcare expenditure per capita in Kenya was approximately $95 USD, compared to $12,470 USD in the United States (World Bank Group, 2024). This significant disparity in resources, coupled with the resilience and ingenuity of Kenyan healthcare workers, has inspired me to be an educated advocate for providing equitable healthcare. I plan to incorporate this newfound knowledge into my practice by actively engaging in policy advocacy to support healthcare reforms that address disparities. I am dedicated to remaining educated and open to learning about healthcare policy worldwide. I will use this passion and my clinical experience to promote culturally competent care and advocate for access to resources for underserved populations. By staying informed about global health issues and working to implement evidence-based practices, I am committed to bridging gaps in healthcare access and improving patient outcomes. This experience has ignited a passion and I am dedicated to applying these insights to make a meaningful impact in the field of nursing. In conclusion, my internship with International Medical Aid has been transformative, deepening my global healthcare experience and reaffirming my passion for nursing. This journey has clarified that my interest in healthcare lies in the patient-centered approach of nursing, rather than the broader focus of medicine. Each rotation, from pediatrics to obstetrics, has enhanced my clinical skills and broadened my understanding of healthcare disparities, strengthening my role as a patient advocate. I’ve developed a greater sense of compassion and a strong commitment to supporting vulnerable populations. This experience has solidified my determination to pursue a nursing career where I can make a meaningful impact. I am excited to apply the knowledge and perspectives gained to provide compassionate, culturally competent care and am grateful for the lessons and relationships that will guide me through my final year of school and into my professional career.

Interning at IMA was a life-changing experience for me. It completely transformed my daily life, bringing me immense joy. The welcoming atmosphere from my fellow interns and the entire staff—mentors, doctors, security, and even the cleaning and kitchen teams—made me feel like I was part of a family. I had the opportunity to witness wonders of the world that I never thought I'd see, and now that I've left, I deeply miss those moments. I hope to return as soon as possible. The food was always fresh and delicious, and the kitchen staff were open to any suggestions or special requests. The accommodations were lovely, and the location was convenient, with easy access to essentials like grocery stores, malls, and even the beach. Our drivers became more than just drivers; they were our friends, joining us on many memorable trips. When I came to Africa, I expected a strictly professional and clinical experience, but I received so much more. I now cherish countless memories and have made lifelong friends.

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

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

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

My experience with IMA in Kenya was amazing and unforgettable. The program exceeded my expectations. From the moment I arrived, the local team was there to guide me through every step of the journey. They were friendly, knowledgeable, and always available to answer questions or address concerns. The organizers took every precaution to ensure we were always in secure environments. They were well-prepared for any potential issues, making me feel safe. The accommodations were comfortable and provided a good mix of local and modern. Each place was also very clean and well-maintained. The program also had a positive impact on the local communities we visited. By engaging with local guides, artisans, and families, we helped support their livelihoods.

Overall this internship with IMA was amazing in several aspects. In country support, accommodations and day to day communication made me feel safe and at home. The staff was very friendly and catered to any need we had day or night. The hospital was welcoming and so many doctors and nurses were eager to help me learn. The community outreach was one of my favorite aspects of the program. Being able to teach children in remote area about sensitive health topics and them fully embracing the information and asking a million questions made every bit of our hard work pay off. I have a new found respect for this country and healthcare system and will take back so much new knowledge about procedures, protocols and the nursing role within CGTRH. During my International Medical Aid Internship in Mombasa Kenya at Coast General Teaching and Referral Hospital (CGTRH) I was placed in the pediatric ward, accident and emergency and labor and delivery. My experience in these three wards were very different and provided a lot of insight into the differences of healthcare in this region compared to the United States. Having gone through three years of nursing school already and only one more year before graduation, it was very eye opening to see not only the nursing role and procedures but also how nurses are taught and the weight they carry within the hospital. I have gained an immense amount of respect and appreciation for not only the doctors and nurses of these under resourced facilities but also how knowledgeable everyone is despite the difference in healthcare delivery. One of the biggest factors I have taken from my hospital experience is that you cannot save everyone, and the limited resources cannot be allocated to everyone. Financially, many patients and families in these public sectors do not get the care or treatment they need because there is no money to pay. Others may be neglected if not with a support system or not treated in a timely manner. Medication is limited and medical supplies are sometimes made from innovative ideas like making splints from bending metal. I have not only seen a lot but learned and practiced skills alongside the nurses and providers. My perspective of how this area of the world functions has certainly shaped my idea of healthcare in different countries. I am coming back from this experience with a more open mind and appreciation for life. I have one more year left of nursing school and my experience here has only made me want to perform me in school and in my career to the best of my abilities. After seeing the disparities and lack of resources in this hospital and country it makes me realize how fortunate I am to be going into a workforce that can truly impact almost every life in a positive way. I want to take with me the care and compassion of some of the nurses and doctors I have encountered. I’m also invigorated to provide a calm and friendly bedside manner than not many of the nurses and doctors have in Kenya. I am also influenced to maybe even go back to school after some experience and earn a higher degree to perform more tasks and skills. Outside of the hospital I was very excited about each of the hygiene, reproductive and mental health clinics and seeing how much of an impact we had on the children. I think that might be taken for granted in the US as from from a young age children are taught about health and hygiene and their bodies. As a nurse one of my roles will be education of every different age and population. It excites me to know that children appreciate and take this information to heart. I want to be able to talk young girls through puberty and menstruation or be able to destigmatize and help someone going through a mental health crisis. I want to be that person that someone knows they can go to for information, in hard times or just needing a hand to hold. I felt that in the community and in CGTRH and It makes me so excited to carry that back into my career here in the US. The biggest aspect of this whole experience was seeing the differences in healthcare delivery and use of resources compared to the United States. Starting with the private vs public health care sectors. The public sector is more accessible and affordable but also contributes to poorer patient outcomes, lower standards of care and limited resources. On the other hand, the private sector is slightly more common in use (International Medical Aid, 2024) and provides a higher quality of care for patients. Upon arrival to the hospital patients must pay for their records booklet and then are given a bill that must be paid before leaving the hospital at the end of their stay. Those who do not have the money to pay their bill are detained at the hospital until it can be covered and some even change clothes and run away. I was shocked by this fact as well as the matter that no one goes after the escapee and police do not intervene. In addition to the financial side of the healthcare system I found it very shocking how common medical neglect was. A patients must come in with a support system or person to advocate for their health, especially in accident and emergency, otherwise doctors may not see them right away or at all. Patients or their family must also purchase their own medical equipment as needed for their condition. Whether it be sutures, ng tube, catheter, medication, etc.… The family or person accompanying the patient must follow what the doctor says to go buy it at the entrance of the hospital and then come back with the supplies. Each unit of the hospital has its differences and different procedures for care, but I found that labor and deliver was one of the most different from the US. First, the nurses and even student nurses are the providers for vaginally delivers while only the PA’s and Doctors perform the c-sections. Mothers are to birth alone in their bay, no one else is allowed to be with them including the father figure. Fathers and family must wait outside of the unit but can buy and bring in medication or supplies if instructed to. Most women birth naked and are left to scream in pain for hours without anyone checking in \. Epidurals are only used for c-sections and even then, are only an injection into the spinal column rather than a catheter that is left in place until after the procedure. At CGTRH babies are brough straight to warmers after delivery and remain there for 2-3 hours. On the other hand, in the US babies are delivered straight to skin-to-skin contact with the mother called the “golden hour” and breastfed with in that time. I found it interesting that there are signs all over the unit saying babies must be fed within 30 minutes to an hour, but I never saw that happen. After asking a nurse about this they said that the baby must remain in the warmer while the mother cleans herself up and after three hours the baby must be breastfed to prevent hypoglycemia. In addition to the procedures, I observed that no stethoscopes or dopplers were used when assessing fetal heart rate, only fetoscopes. There is also only one maybe two for the whole unit and they are just passed from patient to patient as needed. Doctors and nurses are very skilled at using this device and can almost immediately determine what condition the mom and baby are in without any other test or device. The pediatrics department also surprised me, where critically ill babies are placed in wooden bins next to each other and older children are still in cribs or beds with their parent next to them 24/7. Patients do not have their own bay or room and everyone is in one area together. All children and babies have an IV placed upon admission to the unit and many have ng tubes for feeding. Children are here for a number of reasons, but the most common illnesses are tuberculosis, severe acute malnutrition, HIV and pneumonia. Aside from the public and private sectors to healthcare only around 35% of the population has health insurance. This leads to patients not seeking care when needed, increasing transmission of diseases like HIV and Aids and therefore putting even more strain on the system. I also find it interesting that faith-based organizations are a large contributor to the healthcare system. In the United States doctors and other providers are of the highest paid professions with some making over $500,000 per year. Nurses make an average annual salary of around $94,000 (US Bureau of Labor and Statistics, 2024) with that coming out to around $45 per hour. At CGTRH I asked a labor and delivery doctor about his income which was only around $1,200 USD per month or $14,400 per year. This encompasses a full 40-hour work week, 50-60 c-sections per month, being on call, assisting with vaginally delivers, caring for complications and leading the unit. He said at the end of the month he still must scrounge from money to pay rent and provide for his family. I was also able to talk to nurse about their salary and it comes out to around $3 USD per hour which is practically nothing. Culturally disease, death and dying is all too common in this part of the country and happens quite often. Many people do not see a doctor when they are sick and only show up to a hospital if they are extremely ill. Everyone is very strong. From a young age boy are taught that crying is a sign of weakness and can even be punished for it. Death and burial are also a very religious process. Families of a deceased body follow the body to the morgue and stay with it until they can have it for ceremony. People are very protective of the body and have specific rituals when it comes to death and the afterlife. During my time in the hospital, I saw many unique cases that are not common or even exist in the US. The pediatrics department saw many cases of malnutrition which is common in the country but quite the opposite in the US. Marasmus, also called severe acute malnutrition, is a condition that I have only read heard and learned about in textbooks where the patient’s body is not absorbing nutrients and therefore the stomach becomes very large while the limbs are very tiny. This was my first time seeing a patient living with it and I was shocked by how someone could live with this. In labor and delivery there was such a high volume of patients, some came in so fast and providers had no idea how many weeks they were, the condition of the baby or specifically how many babies there were. I was working a night shift when a momma came from around the corner of her room and asked for a cervical check. As we laid her on the bed and pulled the gown back, the tiniest foot was coming out. Nurses scrambled to find her chart and it wasn’t until both babies were coming out that they realized she was only around thirty weeks. Each weighing less than two pounds they were just set in a warmer until being brought to the newborn unit and eventually both passed away. In the United States there are so many technologies and medications used to detect multiple fetuses, abnormalities and solutions for be able to carry the babies closer to term. It’s just another eye opener to the disparities of this area but also the strength and resilience of the mothers who give birth under these circumstances. I the pediatric ward also learned that there are no organ transplants within the whole country and those who are in need must make arrangements to travel to a different country. Specifically, there were two children in the POW ward that needed liver transplants to survive. One child’s family was fortunate enough to have the funds to travel and he was being prepared to leave for India where he would receive the new liver. Unfortunately, the other child did not have much family and traveling for the surgery was not an option, so providers were just making him comfortable with the time he had remaining. I had never heard of the term mob justice until coming to CGTRH. I learned about this when in accident and emergency after seeing patients come in who had just been brutally attacked. This is the result of letting the public handle discrepancies rather than the police getting involved. From stealing to fighting, looting and assault, the “mob” will get back at the person who was involved in the event by throwing rocks called stoning with the intent of killing the person. In extreme measures tires are put around the suspect so they cannot move or run and then lit on fire are stoned until death. If they are lucky at any point during these events, bystanders may try to help and pull them from eventual death, but this is just how some problems are taken care of. In the US there are also many injuries and death due to gunshot wounds, but in this part of the world there are more manchette attacks and stoning than anything else. This all was a little scary to see at first but just gives me a deeper look into the difference of a less developed and structured country. In accident and emergency, I was observing the intake side with some other interns while a patient to the left fully seizing. Not a single doctor or nurse came over, so we ran over, turned her on her side and protected her head. She was foaming at the mouth, barely breathing and seizing uncontrollably every minute or so. It took almost 45 minutes for a nurse to push meds, which the grandmother could not pay for, so another person did. This did not work, and she was given more an hour later. After about 2 hours a doctor came over and yelled at us to let go of her. It was extremely hard to see that she didn’t get the care she needed because money was a factor and the fact that doctors and nurses did not seem to care, they just stood around and did nothing. We all thought she was going to pass away, but two days later came back to find her in the ICU in a coma. I don’t know what while happen or if she will live but she was only 20 years old, and I pictured that being me. In labor and delivery, a mama had just delivered a baby girl. She was so excited and all she wanted was to hold and feed the baby. After talking to her for a little while this was her third child but the other two were both still births. It was so rewarding to see her happiness with this child, knowing it was most likely going to survive but also a eye opener learning that still births and complications during labor and delivery are a very common occurrence in the hospital. In addition to patient interactions, I enjoyed getting to know some of the doctors and nurses very well and hear about not only their role in the hospital but their background and details of the job. Schooling is somewhat like the United States as doctors are in school for 6 years, PA’s and Nurses have 4 years along with clinical rotations and shadowing hours. The main difference though is that students are taught the best way to learn is to do. The interns and students do much of the work and care while they are supervised by the higher ups. It’s taught during any skill or procedure that you observe one, do one and teach one. Once those three have been covered you do them on a regular basis, even without having full credentials. In conclusion to my internship and looking back at my experience as a whole I have expanded my knowledge and skills greatly and taken with me a newfound respect for the lives of everyone who lives here. Life may be hard, and healthcare may be scarce, but I fell in love this the fact the citizens of this country are so proud to call Kenya their home. Everyone was so warm and welcoming, and I never once felt scared or in danger. The experience and memories I have taken with me from this internship will last a lifetime and hopefully inspire others to follow in my footsteps.

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

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