Internships in Mombasa, Kenya

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

When I boarded the plane to Kenya to begin my internship with International Medical Aid, I was filled with excitement, curiosity, and a desire to serve. I have long aspired to become a physician assistant, but I also wanted to ensure that this goal was driven by genuine passion rather than simple interest. I had always hoped to participate in global health efforts and provide care to populations with limited access to healthcare. I wanted to understand patient care outside the modern diagnostic tools, fast-paced hospital systems, and technological resources that shape much of medicine in the United States. During my time at Coast General Teaching and Referral Hospital in Mombasa, I discovered far more than I anticipated: a deeper understanding of healthcare disparities, a profound respect for resilience and community, and a renewed commitment to pursue my career with purpose. When I landed in Mombasa, I felt a mix of familiarity and astonishment. Palm trees swayed over busy streets, and the air carried a warmth that extended beyond the weather. Cars moved in a chaotic harmony, with drivers honking and weaving through traffic while somehow avoiding collisions. Tuk-tuks sped between cars and motorcycles, while pedestrians crossed roads amid the flow of traffic. Vendors lined the roadside selling everything from fresh fruit to clothing, their voices full of energy and persistence. As a Somali born and raised in the United States, these sights felt both foreign and strangely comforting. They reminded me of the stories my family shared about home, full of movement, community, and constant hustle. For the first time, I felt connected to a place I had never lived, yet somehow carried within me. The warmth I received from the IMA staff, doctors, nurses, and local community helped me transition from feeling like an outsider to feeling accepted. Coming from the United States, I have grown up in a healthcare system that, despite its high cost, is equipped with advanced technology and support systems for many patients through insurance programs and government assistance. In the United States, individuals facing financial barriers often still have access to emergency care, routine screenings, and early diagnosis. In Kenya, I learned that healthcare accessibility is shaped not only by cost, but also by location, transportation, and the uneven distribution of medical resources. Many patients travel long distances to reach facilities like Coast General Teaching and Referral Hospital, a public hospital that serves a large population with limited supplies and staffing. Unlike private hospitals, public hospitals operate with restricted funding, yet they remain the primary option for most families. Witnessing doctors and nurses provide care despite shortages in equipment, staff, and funding reshaped my understanding of healthcare. I realized that medical systems are defined not only by their resources, but also by the resilience of the people working within them and the accessibility they provide to those who need care most. My first week was spent shadowing in the pediatric ward at Coast General. There, I learned that caring for a child involves far more than treatment and diagnosis. A child’s well-being is also deeply influenced by the social, political, and economic circumstances surrounding them. The ward was filled with young patients, each with conditions shaped by a different combination of medical and social determinants. Many children were battling illnesses such as malaria, pneumonia, and tuberculosis, conditions that are often preventable or treatable when identified early. However, because of delayed diagnosis and limited access to healthcare, relatively manageable illnesses often developed into serious complications. It became clear that a child’s health in Kenya is influenced not only by biology, but also by access, opportunity, and affordability. One of the most valuable lessons I took away was observing how healthcare providers approached diagnosis through close observation, critical thinking, and thorough physical examination. Dr. Ken, whom I shadowed throughout the week, emphasized that medicine begins with asking the right questions, listening carefully to caregivers, and using physical examination as a primary diagnostic tool rather than relying immediately on testing. For example, a nine-month-old baby who was struggling to breathe needed to be evaluated for either pneumonia or asthma. The physician assistant used chest auscultation, history-taking, and observation to guide treatment. This demonstrated a high level of clinical judgment and confidence. It showed me that good medicine does not always require advanced technology, but it always requires close attention. Another case that deepened my understanding of pediatric care involved a twelve-year-old child suspected of having leukemia with a critically low platelet count of 7. A normal platelet count ranges from 150,000 to 450,000 per microliter. The providers were not yet certain whether the child had cancer, and additional testing was needed before a definitive treatment plan could be made. In the meantime, the child was closely monitored and treated as necessary, highlighting how medical teams must make critical decisions even when full information is not immediately available. Witnessing this balance of caution, urgency, and hope was both shocking and eye-opening. I realized how fragile a child’s health can be, and how every clinical decision carries immense weight. The patient who affected me most was a child admitted with aspiration pneumonia, a bacterial lung infection caused by inhaling substances other than air, such as vomit, saliva, or liquids. His bones were fragile, his legs were extremely thin, and swallowing placed him at constant risk of aspiration. The recommended treatment was a PEG tube to provide nutrition, but the procedure had been delayed because of his mother’s financial hardship. It was heartbreaking to watch her sit beside him each day waiting for a solution. Another intern and I spoke with her, and with her permission, we organized a GoFundMe fundraiser. Within a few days, we raised enough money to cover the PEG tube and his hospital bills. For the first time, I truly understood the role of advocacy in patient care. This experience taught me that healing can depend not only on medical expertise, but also on community action and compassion. By the end of the week, I saw pediatrics differently. It was not just a place where children received treatment, but a setting that reflected larger public health challenges such as malnutrition, sanitation, infectious disease, and socioeconomic inequality. I learned that healthcare professionals in Kenya practice medicine with deep dedication, knowledge, and resourcefulness. Their work reinforced my belief that becoming a physician assistant means not only treating illness, but also understanding the realities that shape health. Pediatric care reminded me that every child is more than a diagnosis; each is a life shaped by family, environment, and access to opportunity. My second week was spent in the maternity ward, where I witnessed joy, strength, and hardship. Unlike pediatrics, where children often arrived after days or weeks of illness, maternity care centered on the very beginning of life. Most of the births I observed were cesarean sections, and seeing the surgery in person was very different from reading about it in a textbook. I was struck by how quickly and confidently the surgical team delivered each baby. What impressed me even more was the precision required afterward. While the actual delivery took only a few minutes, closing the uterus and carefully suturing the abdominal wall required patience, skill, and focus. Observing a C-section up close felt surreal. Witnessing a stillbirth was one of the most emotionally difficult experiences I had during my time at Coast General. I had read about fetal mortality rates and the impact of inadequate prenatal care and delayed access to hospitals, but no statistic could capture the silence in the room or the quiet empathy of the nurses, who understood exactly how to offer comfort without words. In that moment, I realized that healthcare providers must possess not only medical knowledge, but also emotional strength. The ability to support patients and families in their worst moments is just as important as providing skilled care during successful ones. As a future physician assistant, I will need to approach moments of loss with the same clarity, compassion, and devotion I bring to moments of healing. This experience taught me that clinical success does not always mean a positive outcome, but compassion is always part of the responsibility. My time in maternity showed me that medicine is not only about welcoming new life, but also about honoring lives that do not begin as hoped. One of the clearest takeaways from my internship was the contrast between healthcare delivery in Kenya and in the United States. In Kenya, medical care is often provided with limited resources and equipment that would be considered standard elsewhere. Yet the system compensates for these limitations through resilience, teamwork, and creativity. Doctors and nurses consistently made the most of what they had. For example, I observed nurses using part of a surgical glove as a tourniquet when drawing blood. These realities reflect a broader systemic difference in healthcare spending and infrastructure. Recognizing that disparity helped me understand why the two systems function under such different conditions. My internship with International Medical Aid changed how I see healthcare, the world, and myself. I learned that medicine involves far more than treatment plans and clinical skills. It also requires advocacy, cultural humility, emotional intelligence, and adaptability. I encountered illnesses that are uncommon in the United States but prevalent in Kenya. More importantly, Kenya will remain part of my story, not simply as a place I visited, but as the place that reshaped my understanding of medicine, taught me the power of empathy and resilience, and showed me what it truly means to care for others.

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

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

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

My experience in Kenya with International Medical Aid was incredible. The in-country support was excellent, and I always felt safe thanks to clear guidance and protocols. Accommodations were comfortable, and the food was a wonderful introduction to Kenyan cuisine. The clinical experience was invaluable. I got to shadow PAs and physicians, learning how they provide compassionate care even with limited resources. My mentors Mitchel, Margaret, Benson, and Hilda were especially amazing; they guided me, answered questions, and made the experience meaningful and inspiring. Overall, this program deepened my understanding of healthcare, strengthened my communication and cultural awareness, and reinforced my commitment to becoming a healthcare provider. It was a truly memorable and transformative experience. I came to Mombasa, Kenya, with a curiosity about global healthcare. What I left with was far more than observation—I left with a deeper understanding of resilience, compassion, and the creativity required of healthcare providers in resource-limited settings. My two weeks at Coast General Teaching and Referral Hospital through International Medical Aid shaped not only my perspective on medicine, but also the kind of provider I aspire to become. The resource-limited setting of a Kenyan referral hospital highlighted the importance of adaptability, clinical judgment, and teamwork in medicine. It also deepened my appreciation for cultural competence and reinforced my desire to pursue a career that bridges patient care with compassion, equity, and access. I reflected throughout my internship on how these lessons shaped my personal and professional goals, and how I plan to apply this knowledge to my future career in healthcare. My first week at the hospital was spent in pediatrics, including the High Dependency Unit, the inpatient ward, and the outpatient clinic. Each area exposed me to different aspects of pediatric medicine and highlighted the challenges of providing care in a resource-limited setting. In the High Dependency Unit, I saw children critically ill with conditions such as malaria, pneumonia, and severe dehydration. With limited monitoring equipment, providers relied heavily on careful physical exams and clinical judgment. Watching physicians and nurses act with such precision reminded me that medicine depends as much on knowledge and presence as it does on technology. I also noticed how central families were to care—mothers and caregivers often stayed at the bedside, feeding and comforting their children. It underscored for me that treating a child means supporting the entire family. The inpatient ward was crowded but full of resilience. Children admitted for longer-term care still found ways to laugh, play, and smile, even while battling illness. This reminded me that pediatrics requires not only medical skill but also creativity, optimism, and patience. The outpatient clinic emphasized communication and trust. I shadowed physicians and medical students as they diagnosed fevers and infections, counseled parents, and provided follow-up care. One memorable encounter was a mother worried about her child’s persistent cough. The physician took time not only to examine the child but to reassure her and explain how to monitor symptoms. That interaction showed me how powerful reassurance and education can be. That week in pediatrics taught me that medicine is not only about addressing immediate illness but also about building trust, supporting families, and adapting to circumstances. The lack of abundant resources revealed how powerful strong clinical reasoning, communication, and compassion can be. As an aspiring PA, I want to carry these lessons forward by becoming a provider who combines medical expertise with cultural sensitivity and emotional intelligence. In the United States, I may not always encounter the same level of resource scarcity, but disparities still exist. This experience showed me that effective providers don’t just treat patients; they meet them where they are, partner with their families, and offer care that is both competent and compassionate. During the second week of my internship, I rotated through the emergency department, including both adult and pediatric units. The emergency department was fast-paced, unpredictable, and often chaotic—a contrast to the structured environment of the outpatient clinic. I witnessed cases ranging from acute infections to trauma. One case that stayed with me was a toddler with severe malaria whose rapid deterioration required immediate intervention. Observing how the team coordinated care under pressure highlighted the importance of quick decision-making and clear communication. Another case involved a man who was involved in a street traffic accident and sustained a significant injury to his face, including a compound fracture and mandible dislocation. The attending physician quickly assessed the situation, coordinated imaging, and explained the care plan to the anxious patient. Observing this interaction, I realized how crucial clear communication is—not just with the patient but also with the family. Every word mattered in building trust and helping the family feel involved in care decisions, and it made me feel content with how everything was handled. The adult ED presented different challenges. Patients often arrived with complex conditions, and resources were limited compared to what I have seen in U.S. hospitals. I saw providers rely on careful observation, prioritization, and creative problem-solving to stabilize patients efficiently. Overcrowding was common, and staff had to make rapid decisions about who required immediate intervention versus who could wait. I had the opportunity to observe the triage process firsthand, watching nurses and physicians quickly assess vital signs, symptoms, and overall condition to determine urgency. This experience emphasized the importance of staying calm under pressure, making swift decisions, and trusting one’s clinical judgment—skills I hope to carry forward as a future physician assistant. Beyond clinical skills, the ED also highlighted the human side of medicine. Many patients were in distress not only from illness or injury but also from fear, uncertainty, or socioeconomic stressors. I observed how providers offered reassurance, listened attentively, and made patients feel heard even in brief interactions. This reinforced a lesson I had learned in pediatrics: effective care is not just about diagnosis and treatment, but about empathy, communication, and emotional support. Experiencing this firsthand strengthened my desire to pursue a career where I can provide competent and compassionate care, especially in moments when patients are most vulnerable. During my overnight shift in the Labor and Delivery ward, I witnessed the intensity, urgency, and profound humanity of bringing new life into the world. Even though my time there was brief, I observed the critical teamwork between medical officers, nurses, and midwives, and how every decision carried weight for both mother and child. I was shocked to learn that epidurals were generally not offered unless the mother was undergoing a C-section, and I felt for the women laboring without this form of pain relief. Seeing their strength and resilience firsthand was both humbling and inspiring. I also had the opportunity to view a C-section, which was an eye-opening experience. Observing the surgical team’s coordination and focus, as well as the immediate transition of the newborn to care, highlighted the precision and teamwork required in critical situations. This experience reinforced lessons I had already begun to understand in pediatrics and the emergency department: medicine is not just about technical skill, but also about empathy, communication, and presence. Providers balanced clinical urgency with compassion, comforting patients and offering reassurance even in high-stress moments. Being in the ward overnight gave me a deep appreciation for the emotional and human side of healthcare and reminded me that being a provider is as much about supporting people through life’s most vulnerable moments as it is about treating disease. These lessons strengthened my aspiration to become a physician assistant who can deliver competent care while also connecting with patients on a human level. Mombasa County has a higher HIV prevalence than the national average, and that statistic became profoundly real during my time at the hospital. I encountered numerous patients—both adults and children—whose lives were directly affected by HIV. The emotional weight of these encounters was palpable, especially when discussing treatment plans and the challenges of medication adherence. One particularly memorable interaction involved a mother in the pediatric ward, deeply concerned about her child’s health. The physician took extra time to explain the child’s condition, the importance of antiretroviral therapy, and the need for consistent follow-up care. Witnessing this compassionate communication underscored the significance of not only medical treatment but also emotional support and education in managing chronic conditions like HIV. My two weeks in Mombasa were transformative, offering lessons that extended far beyond clinical knowledge. From pediatrics, I learned the power of observation, clinical reasoning, and compassion. The emergency department taught me adaptability, rapid decision-making, and the importance of clear communication under pressure. Labor and Delivery showed me the courage and resilience of patients and the teamwork required in critical moments. Encountering patients affected by HIV deepened my appreciation for the intersection of medical care, patient education, and emotional support. I realized that effective healthcare requires not only knowledge and skill but also cultural sensitivity and the ability to support patients through their most vulnerable moments. Together, these rotations solidified my desire to become a physician assistant who can provide competent, compassionate care in a variety of settings. I am inspired to carry forward the lessons I learned in Kenya—the importance of empathy, communication, adaptability, and partnership with patients and families. This internship has not only reinforced my commitment to healthcare but has also shaped my vision for the kind of PA I aspire to be.

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

My time in Kenya was one of the best experiences of my life. Interning in the hospital taught me so much about myself, nutrition, and the world. The clinical mentor Nashon in the ICU was one of the more helpful nutritionists I worked with—and while he challenged me, he also taught me so much. Each individual, from the mentors to the chefs to the interns, was so kind and made the experience so fun. The Masai Mara safari was definitely a highlight as well. The tour guide, Shadi, was so kind and really made the experience. I did feel that the program was geared a lot more toward pre-med fields, with mandatory sessions about suturing and clinical skills like that. As a nutrition intern, I sometimes felt out of place and that my time was not as well organized—but I still got so much out of the experience and would not trade it for the world! My recent nutrition internship with International Medical Aid in Mombasa, Kenya, was nothing short of transformative. Throughout my three week internship, I had the opportunity to experience hospital rotations in the pediatrics, oncology, and ICU units, participate in community health clinics about hygiene and women's health, and participate in cultural treks that gave me an expansive view of Kenya and its healthcare system. This experience opened my eyes to new aspects of healthcare delivery, nutrition practice, and political and cultural dynamics that will forever impact my career in nutrition and my approach to healthcare equity and global health overall. During my rotations at Coast Provincial General Teaching & Referral Hospital, I encountered a variety of nutrition-related conditions during my rotations in pediatrics, oncology, and the medical and surgical ICUs. The healthcare professionals I shadowed were working in an environment constrained by limited supplies and strained infrastructure despite having patients plagued by advanced malnutrition, dehydration, and complications resulting from infectious disease and poverty. However, I was most stricken by the lack of basic nutrition information from patients, especially during my rotation in the pediatric department. Formula feeding is very stigmatized in Kenya because breast milk is considered a safe feeding option for mothers battling with HIV/AIDS. Due to the stigmatization of formula feeding, mothers face excessive stress to ensure that their child is being fed properly, especially within the first six months of life. I saw many cases of children who were malnourished from the start of their life with symptoms such as muscle wasting, edema, weakened immune systems, and cognitive defects. On top of the stigmatization of breast feeding, mothers often failed to have adequate knowledge of breastfeeding despite it being the predominant form of feeding for their infants. The other nutrition interns and I performed breast feeding information sessions to large groups of mothers in the pediatrics unit to inform them on the proper way to hold their child when breastfeeding, how to get the child to suckle, and more. Being able to educate patients is the first step in making a change so being able to do this felt very impactful. Another example of limited access to nutrition education was during my rotation in the oncology department. Nutrition interns were given a pamphlet that outlined how to take care of yourself with cancer through methods like food, exercise, and sleep. While working in the oncology clinic taking the height, weight, and BMI of patients I left the pamphlet on the desk. An older man came in and shared that he had prostate cancer and had about six months left to live. He picked up the pamphlet and was immediately taken by the information inside. I told him he could keep it and he was incredibly grateful. I wondered why he was not given a care guide like this alongside his diagnosis and if he had, would his outcome have been different? Coming from America where the predominant nutrition related issues are obesity and chronic disease, I was shocked by the amount of kids facing food insecurity. According to the article Preventing and Treating Maternal, Adolescent, and Child Malnutrition written by UNICEF, “11 per cent of children are underweight, with four per cent wasted. Wasting and severe wasting are linked to increased and preventable deaths among young children,” (UNICEF). This was very prevalent in the pediatrics ward at Coast General Hospital and with just one nutritionist for the whole ward, this posed a challenge. Treatment options for these cases included vitamin supplements such as F-75, F-100, AminoGuard, and more in addition to counseling patients on how to increase their caloric intake. I found it challenging to see that even though a patient may have the proper nutrition information, a lack of monetary stability didn’t always make it possible for patients to have access to the food or supplements that they needed. This was new for me because in America, it is more common to have access and money to ensure that the changes a healthcare professional is providing can be implemented. Despite this, the problem solving techniques and resilience demonstrated by the medical professionals in these scenarios taught me that nutrition interventions can be creative and require deep contextual understanding. Kenya’s healthcare system operates under complex political dynamics. Areas such as Mombasa are historically underrepresented and underfunded. I saw firsthand how malnutrition in marginalized communities are deeply tied to such structural inequalities. For example, during my rotation in the surgical ICU, we saw a patient that needed liquid feed during his recovery from an Ileostomy because he was not able to properly break down micro and macro nutrients. These feeds were too expensive for him to purchase, however, so the nutrition team had to come up with a creative solution to this problem: Mala. Mala, fermented milk, naturally breaks itself down into glucose and galactose due to its enzymes. Therefore, Mala is very easy to digest and a cheap option for individuals who cannot afford the medication they need. This experience taught me that as a future nutritionist, it isn’t enough to focus solely on nutrient science. I must understand, and whenever possible help improve, the political, administrative, and infrastructural systems that determine supply chains, health education, and equitable program implementation. One unique experience that I had during my time in Mombasa was that I was present during a medical personnel strike. According to Daily Nation, “Doctors were promised salary adjustments and payment of arrears spread across different financial years, to be implemented in phases. However, the implementation has been plagued by delays, with healthcare workers pointing to bureaucratic inefficiencies and a lack of political will to honour the agreements,” (Daily Nation, 2025). This leads to healthcare workers' payment being delayed and them not getting the money they need in time. Many student nutritionists that I spoke with during my time at Coast General explained how even though you can be educated, it is extremely hard to get a job in Kenya. This is because it is necessary to have a connection to the place in which you are trying to get a job through family or status. This corrupt system leaves educated people working under-paying jobs and a shortage of healthcare workers overall. Political and structural issues directly impact a patient's access to care and this became evident during my time at Coast General. I found myself in a hospital lacking attending nutritionists, while hundreds of patients still needed basic care. This experience revealed the relationship between labor relations, government, and healthcare access and highlighted that effective nutrition care depends not only on clinical skills but also on policy stability and the rights of workers. My experience at IMA was more than just clinical exposure. It provided me with the opportunity to participate in community outreach. Being a part of the Women's Health Clinic and Hygiene Clinic were some of the highlights of my time in Kenya. Co-leading information sessions to educate kids about their bodies and how to take control of their health was such a unique experience. We were able to tell how genuinely interested they were about what we had to teach them and how much this information meant to them. Although it was hard to see the lack of basic knowledge when it comes to hygiene and health, we were really able to make a difference in the lives of these individuals. A particular moment when I felt really affected was during my first Women's Health Information Session. While we were handing out menstrual pads, girls were taking multiple and hiding them under their chairs or in their desks in order to get more. Although this could be seen as a practical joke done by the kids, I took it as an indicator of just how limited resources are in this area and what a need there is for help. Cultural norms, oral tradition, and location all affect access to accurate health information and resources so being able to set the facts straight with these populations can make a great impact. One thing that I was not anticipating to be such a challenge during the internship was the language barrier. While English is an official language in Kenya, many patients and community members are more comfortable speaking in Swahili. Communication required patience, empathy, and occasional translation support. I learned a greater message in this struggle, however. I learned that the basis of healthcare is always built on trust, mutual respect, and cultural humility. It is so important for nutrition professionals to be culturally competent and understand how to interact with those different from us because nutrition is such a personal topic. Things like religion, socioeconomic status, and environmental factors have a large impact on nutrition care and it is necessary to have a grasp on a patient's history before providing care. One thing that I found interesting was that on the front of each patient file was the patient's religion. Religion greatly affects how patients will respond to care in Kenya. For example, Muslim patients do not eat pork which is something that you would not want to overlook when having a conversation with a patient or creating their food regime. Even though I did not fully understand each religion or tribe in Kenya, I learned that moving forward in my career it is necessary that I stay curious and aware of the differences in patients. Before Kenya, public speaking was not one of my strengths. Although it is still not my favorite thing, my time in Kenya taught me to be a lot more confident in myself. From traveling halfway across the world on my own, to leading women's health information sessions, teaching about hygiene in schools, and having group discussions with nutrition professionals and interns my confidence improved exponentially. Teaching during health education sessions made me feel more confident in the field of nutrition as it combined nutrition science and food hygiene with community engagement. I learned to enjoy sharing health information with large groups of individuals which is something that I can definitely pursue in America especially as I get further along in my nutrition career. Healthcare environments at Coast General Hospital showed me the power of resourcefulness and problem solving. I learned new techniques and ways of looking at nutrition issues that I would never be able to find in a textbook. I learned how to listen to patients and complete urgent and challenging tasks with limited and underwhelming resources. One example of this is how all medical records are hand written. Charting took much longer than it would in America because everything was done on pen and paper. There was also a plethora of missing information on many charts because they were not available to Coast General or they were just never updated. Additionally, I saw nutrition professionals pivot when supplements ran out. In the pediatrics ward, one of the main supplements for malnourished children ran out, F-75. The nutritionist swiftly found another supplement, F-100, that could be used instead with a few modifications. This taught me how to deal with contingencies that are bound to happen in the medical field and emphasized the importance of problem solving that I will carry into my future career. My experience in Mombasa cemented my desire to become a nutritionist who also understands the social, political, and infrastructural drivers of nutrition. I envision a career that designs culturally adapted nutrition education for all individuals. It is important to recognize how factors such as funding inequities determine nutrition and healthcare access. In Kenya, there is a large difference between the public and private sectors of care. Public healthcare is government funded leading them to be understaffed, poorly equipped, and lacking supplies. Private hospitals have much better funding and facilities and they can handle more rare and serious cases of illness. According to The Center for Human Rights and Global Justice, “The wealthy may be able to access high-quality private care, for many, particularly in lower-income areas, the private sector offers low-quality services that may be inadequate or unsafe,” (The Center for Human Rights and Global Justice). It is unfair that individuals have to be wealthy in order to receive quality care. If I had to sum up my nutrition internship with two words it would be life changing. I learned that science and medicine are only powerful when paired alongside cultural empathy, political awareness, and peer collaboration. I saw that structural inequities greatly affect lives, that clinical skills must be flexible, and that meaningful change often begins with listening, adapting, and teaching. Going forward, I will build a career that incorporates both nutrition science and health equity. I am committed to respecting culture, navigating resource limitations, and advocating for policies that ensure every community has access to the nourishment they need to not only survive, but to thrive. While Kenya is very different from America, these are messages that can transcend continents, languages, and lives.

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

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

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

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

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

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

Overall, my experience in Peru was unreal. I truly learned so much, and it helped me see myself working in healthcare and doing what I love. Eder, Grecia, and Manuela were incredibly supportive and helped us with anything we needed during our time in Peru. They stayed in close communication with us and made sure our experience was the best it could be. I felt safe everywhere I went—including at the hospital, while walking around the city, and especially at the hotel. There truly wasn’t a moment when I felt unsafe. The accommodations were better than expected, and although there were a couple of minor bathroom issues, the staff were responsive and willing to help right away. The food was amazing, and the cooks at the restaurant welcomed our feedback and prepared some truly incredible meals. There were a couple of treks we went on during our time in Cusco. Starting on the second day we were there, we had Hans as our tour guide, and he showed us around Cusco as well as Saqsewaman. He shared so much information with us and answered any questions we had. We then went on another trek (I don’t remember the name), and Hans was also our guide—he showed us more ancient Incan ruins, which was really insightful. Lastly, I went on the Inca Trail and Machu Picchu trek, which was honestly my favorite. Even though the hike was long and rough at moments—especially with the heat and all the uphill stairs—Johanns, our tour guide, was understanding, stopped whenever we needed to, and went above and beyond to make sure the other interns and I were taken care of and had the best experience possible. The overall impact this program had on me was inspiring and eye-opening. I loved every part of my time there—from exploring the city and going on treks, to working in the hospital, visiting rural communities, and participating in hygiene sessions. Everything left a lasting impact on me as I move forward with applying for grad school and pursuing my future in healthcare.

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

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

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

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

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