Medicine Internships in Mombasa

After my time with IMA, I will be quick to recommend this Internship with anyone who is interested! This internship taught me numerous lessons that will stick with me for a lifetime. Among many things, I learned how medicine has the power to remind people of the value and dignity of their life. This opportunity has made me even more excited to pursue a future in Medicine. Outside of the hospital, the accommodation that the program offers are exceptional. The IMA staff is so kind and work incredibly hard to give every intern the best experience. Typically when someone is asked why they want to work in the medical field, they might respond by saying it is because they want to help people in a tangible and hands-on manner. Growing up with no family members in the healthcare field, I never really thought about working in medicine until I was a junior in high school. What drew me to the medical field was, in fact, the opportunity to help others. However, as time goes on, my perspective and understanding of medicine has exponentially grown and developed beyond “helping others”. Yes, medicine without a doubt gives someone the ability to help a hurting person, but it goes much deeper. My time in Kenya exposed me to that deeper motivation and helped further develop my reason for why I want to pursue a career helping others. Everyone in life needs a ‘why’, a reason for why you want to do what you want to do. Knowing your ‘why’ brings perspective, clarity and direction to life and the way you choose to live it. Having a why grounds you and makes you a steady, thoughtful person even in the midst of adversity. My time in Kenya has given me a different ‘why’ for practicing medicine, a ‘why’ that I am eager to explain. During my internship I spent time in three different rotations with extra shifts in other departments. My view of medicine grew in different and unexpected ways during each of the rotations. My first week was spent in the Accident & Emergency Department, getting to see both pediatric and adult patients. Patients who came into the A&E often had wounds that smelled foul, defects that made them look different, and injuries that were grotesque. Additionally, there were patients who were brought in dead (BID) and placed in a small exposed hallway until their family arrived. I also encountered many younger patients who had been abandoned by friends and family. As the week went on, I began to understand the power that those who work in the medical field have: the power to rehumanize the dehumanized. The word re-humanize implies the process of restoring human dignity, value, and respect where dignity has been diminished or deprived. Circumstances or illnesses that bring patients to the hospital leave many of them in a dehumanized condition. However, medicine gives physicians and nurses the means to pursue and draw close to those patients, to restore human dignity, value and respect. Those who practice medicine are able to engage with these same patients, look them in the eye, help bind up their wounds and give them excellent care. This concept of re-humanization was something that I had never associated with medicine before my rotation in the A&E, and it continued to grow throughout my other rotations. I spent the second week in the Obstetrics Department, and I feel that this rotation was the one that surprised me the most and, at times, was the hardest to observe. I learned that all patient care in OB is free for mothers and babies (Brian Barasa Masaba & Mmusi-Phetoe, 2020). The majority of nurses and physicians were exceptional and treated their patients with great care, while there was a small minority who struggled with the idea of free health care. As I observed, my new perspective of medicine as a means of restoring dignity and value continued to grow. I began to grasp that just because medicine has the power to rehumanize people, does not mean that a doctor or nurse will exercise its power. The kind of medical professional you are is not only related to the foundational knowledge and experience gained in school. It is also just as related to who you are as a person and who you desire to be for your patients. A health care worker’s moral and ethical qualities, who they are when no one is looking, what they believe about the dignity of human life, and how they demonstrate these qualities to their patients is vital. If your patient needs to be gently cared for, you gently care for them. If your patient needs to be reassured and met with peace, you reassure them and meet them with peace. If they need a truthful explanation of a procedure, you patiently deliver information honestly. A good physician meets medical needs, while an exceptional physician considers who they need to be for their patient, and becomes that, while also meeting their medical needs. In the OB Department I understood this difference and realized that all the nurses and doctors were good, and some were truly exceptional. To be exceptional, you realize the power that you have to give excellent medical care and you strive to exercise that power by showing each patient dignity, honor and respect. I hope and desire that this knowledge gained from Kenya will help me not just be a good Physician's Assistant, but an exceptional one. My last week was spent in the surgical department. I thoroughly enjoyed this rotation and I was able to learn so much because of all the different cases I was exposed to. I watched everything from brain and spine surgeries to amputations and hydrocephalus surgeries. Anesthesia is not as commonly used in Kenya as it is in the US, due to lack of access to it and lack of safety resources when using it (Epiu et al., 2017). So, patients are either fully under anesthesia or they are awake but covered so they do not panic during surgery. Surgery at times can feel exposing and dehumanizing. You are laying on a cold table only covered with a sheet while many eyes stare at you. As I watched the surgeons I realized that their patients really did not know what was going on due to them either being asleep, or awake, but covered. Because of this, the surgeons and nurses hold a lot of power. This made me think about what I will do when my patients cannot speak, feel, see or move for themselves. How will I seek to protect their humanity and dignity in a time where they cannot do it for themselves? How will I choose to treat them in the moments when they will never have any idea how I actually treated them? Medicine has the power to re-humanize, but will this still be executed even when no one is looking? I hope that I strive to protect the humanity, dignity and value instilled in every patient, even when they are not watching. While I learned so much about medicine inside the hospital walls, I also grew in my understanding of a different culture during my time talking to the nurses and spending time outside of the hospital. I learned a lot about Kenyan culture and the way Kenyans think. One of the big things I learned is that if you leave Kenya without having learned any Swahili, it is considered rude because you have not invested in their culture (Odhiambo, P., & Njeru, C). I realized that if you want to show someone you care about them, it is crucial to invest in the things they invest in, to care about the things they care about. This can be true when you are halfway across the world with strangers or when you are in the comfort of your own home town with friends and family. Showing interest in someone’s life and caring for them is rooted in investing in their life and the things that matter to them. The ability to invest in others I believe also reminds people of their value, worth, and dignity. I was amazed at how much Kenyans know about Americans, our politics, even our stereotypes, and how much they wanted to talk about them. I was challenged by how little I knew about Kenya, so I sought to spend my time in Kenya, growing in my understanding of their worldview, their perspective, and their culture so that I could show my investment in them as individual people. I am incredibly grateful for the willingness of the staff at CGTRH to allow students from all over the world to come and learn. The kindness and eagerness from doctors and nurses to teach me was remarkable and forever impactful. My time in Kenya helped further shape the way I view medicine in light of the world around me and it fueled my desire for how I want to use medicine for the good of the world around me. This opportunity in Kenya gave me my new “why” for choosing medicine, stretching beyond the purpose of helping people. So, why medicine? Because of the opportunity and privilege medicine grants for helping rehumanize those who have been dehumanized in a way that other professions are unable to. I can now see that medicine provides a powerful way to restore dignity, value and humanity to the dehumanized. It is up to me in how I choose to exercise that power for my patients, even and especially when no one is watching. In Kenya, I saw a new side of medicine I had never seen before, a potential for medicine I had never understood before and a power of medicine I had never experienced before. My passion for medicine was ignited into a passion that cannot be contained. It is opportunities like this one in Mombasa, Kenya that make me desire to choose medicine again and again.

My three-week internship with IMA was the most incredible experience I have ever had. Working in Coast General Teaching and Referral Hospital gave me a new outlook on life and such a sense of gratitude for the access that I have and a newfound drive to be the best healthcare professional I can be. The IMA staff, from the house staff to the program mentors, were the nicest and most helpful people I have ever met. I f ever there were any challenges we were facing, they worked very diligently to make us feel comfortable and supported.This trip had such an impact on me. I met the most amazing people - friends I feel like I've known forever. Working in the clinics with the kids were always my favourite. Getting to meet them, talk with them and answer their questions was such an amazing feeling. Seeing the impact we made on the communities we visited was such a monumental feeling that will last a lifetime. I have nothing but gratefulness for the opportunity to participate in such an amazing experience. Thank you, IMA, for having me! My whole life I’ve known exactly what I wanted to do with my life. I’ve spent my entire educational career working towards becoming a cardiothoracic surgeon, whether it be studying my dad’s old anatomy textbooks at 14, researching the results of my latest blood test, or doing Co-op placements at a hospital in high school. I have been building up my clinical experience in the Canadian Healthcare system for the past 4 years, and I can honestly say that nothing came remotely close to the profoundly impactful experience I had at Coast General Teaching and Referring Hospital. The sheer amount of opportunities to observe so many different arenas of the healthcare system in Kenya could not compare to what I could have gotten back in Canada. I arrived in Mombasa at 4 in the morning after 30 hours of travel and a treacherous experience in the Jomo Kenyatta International Airport. Immediately, I was greeted by Benson and Javan who packed me in my “brain-fogged” state into a van and brought me to the residence. The only thing I remember from the drive was staring out the window and seeing the giant elephant statues and Javan asking me if I knew any Swahili. I arrived at the house, to find it completely empty; I was the first person to arrive for the summer cohort. I fell fast asleep and was awoken by a knock on my door a couple hours later by Naomi, who had called me down for breakfast. I met with Joshua, Grace, and the rest of the amazing kitchen staff who had prepared me a beautiful meal. I ate and proceeded to go right back to sleep, which was interrupted by the arrival of my newest roommate. Hilda introduced me to my roommate Lily, and we then proceeded to complete our first bonding moment: sleeping the entire day. We met the rest of the mentors: Margret, Christabel, and Michelle later that day and our driver Teddy and next housemates Terry, Devi, Sarah, and Lakshanna. It may seem strange that I dedicated an entire paragraph to talking about a day that I spent mostly sleeping. However, to me, this day was when I met some of the greatest people. Every single staff member I mention had such a deep impact on my experience in Kenya. These were the nicest people I have ever met, and they went above and beyond just doing their jobs to make each and every one of us interns feel safe and welcome in that home. The experience was only enhanced by having the other interns around. The opportunity to not only learn from my experiences, but learn from their experiences as well was profound. As one of the younger and less experienced students in the house, my newfound friends offered me much advice on how to pursue my future career when I return home. This experience has given me lifelong friends who made my trip even more insightful than I could have imagined. The three weeks that I was in Kenya was an interesting time to travel in terms of healthcare politics. I arrived in Kenya during the doctor strike. Kenya doctors' strike of 2024 was a major statewide demonstration by physicians working in public hospitals that started on March 13 and went on for 56 days. The Kenya Medical Practitioners, Pharmacists, and Dentists Union (KMPDU) called for the walkout in response to unresolved concerns about low pay, unfavourable working conditions, and the failure to execute a previously agreed-upon Collective Bargaining Agreement (CBA) from 2017. The physicians requested increased pay, the immediate posting of medical interns at KSh 206,000 per month, and improved working conditions in all public institutions. Millions of patients countrywide were negatively impacted by the strike's substantial interruption of medical services, which made it difficult for many public hospitals to provide even emergency care. I spent my first week ( May 6 - May 10) in the Accident and Emergency Department, where I saw first hand the effects of this strike on patient flow. The halls of CGTRH were empty, the beds in the acute injury area were at ¼ capacity. The emergency area of the A&E was filled with patients that were picked up on the street by the police or brought in by ambulance. I walked in and was introduced to the charge nurse Antoine, who showed me around. We went to see each patient and he explained to me what was going on with them. We saw a patient with deep head lacerations from a drug induced motor incident, a woman with a blocked urethra causing her filled bladder to protrude out of her stomach, a teen boy with a fractured ulna and a blood infection, and most notably, a patient who overdosed on drugs trying kill himself. Antoine explained to me that unfortunately, cases of attempted suicide is something that is seen quite often in the emergency department. This notion was solidified during our global health lecture series where it was explained that mental health disorders are a significant cause of morbidity and contribute to the burden of non-communicable diseases in Kenya. These disorders not only affect but are also affected by other non-communicable diseases. They can serve as a precursor or consequence of a non-communicable disease or result from interactive effects between the two1. During this strike period when I was in the A&E, I saw the physical manifestation of the consequences of the strike. I had read articles that the bodies in the morgue were piling up because people were not going into the hospitals to get treated because they knew the strike was happening2. I saw this first hand based on the sheer amount of bodies brought in dead, either by family, or by police who found them on the streets. Many people were brought in alive, but it was too late to help them and they were made comfortable so that they could pass away painlessly. Although the patient influx was slower than it normally would have been, I was able to learn quite a lot during my time in the A&E. I followed around new nurses as they were trained on hospital procedure and they taught me the ins and outs of their jobs. I shadowed the doctors and asked questions about their patients to which they explained in detail their conditions and their course of treatments. I was able to observe minor procedures and assist in small ways. I saw an incredible amount of patients flow in and out of the hospital in such a small amount of time, allowing me to experience so many different avenues of healthcare. My most notable patient interaction occurred when I was in A&E, which solidified my already heightened interest in healthcare and will probably have a great impact on the way I will treat all my future patients. A woman was brought into the hospital by her daughter and granddaughter. This woman had an underlying heart condition and came in with a systemic infection. She was short of breath and frothing at the mouth. This woman was in a state of extreme discomfort. I was the only IMA intern in the A&E this week, however, there were other interns from other companies who were already in medical school from across the world and the interns and medical students from the local medical school who had joined me in the A&E that day. When the doctor rounded on this patient, we all joined her. The medical students were allowed to take vitals and speak with the patient and family about the condition. Once the doctor had left, the students remained, curious as to what this patient's conditions were. Throughout the day, the students went back and forth, playing with the equipment surrounding the patient, taking her vitals, and blatantly talking about her conditions in front of her face. This woman was working her harvest to stay alive, she was in extreme discomfort, her family was surrounding her, and these students, who were so eager to learn, had forgotten that this wasn’t a dummy they are given in school to guess what the disease is. They seemed to have forgotten that there was an actual human being laying on that bed and not a textbook for them to study. This made me quite uncomfortable watching, but I tried not to think anything of it, as they were just eager students wanting to learn more. I went to the trauma theater sometime later to observe a hip realignment, and when I returned, I was met with a code blue. This patient had coded and was brought to the resuscitation room. I stood back, blocking the view of passing spectators. That’s when a flood of students from across the hospital rushed into the already crowded room. The doctor and nurse were performing CPR on the patient, as the 25 students stood back, whispering and snickering in the corner of the room as the daughter and granddaughter cried and paced the floor behind them. The resuscitation went on for 25 minutes. Not a single person in that room was helping apart from 3. They were all talking in the background while this woman was vomiting the contents of her stomach. Unfortunately, the patient passed away. I will never forget the screams of her distraught daughter, they still ring in my ear. All I could think about for the rest of the day was this woman and her family. She spent the last remaining moments of her life treated like a lab experiment and died with no semblance of privacy. She was poked and prodded, not even for the benefit of her health, but for the education of others. Her family couldn’t enjoy their final moments with their mother and grandmother. This experience will change the course of my education. When I do my rotations in hospitals, this experience will follow me. I will do everything in my power to never make a patient feel the way this woman must have felt in her dying moments. Although the story is sad, and most other interns will probably have more inspirational stories that inspired their future careers, this is the most significant one for me. This experience will forever serve to remind me that I am treating a human being, and not a disease; It will remind me to not get too wrapped up in my love of medicine and remember the reason I wanted to go into healthcare in the first place, to help human lives. After the KMPDU and the Kenyan government reached a return-to-work deal, the strike came to an end on May 8, 2024. The government promised to comply with the physicians' requests in this agreement, but other matters remained unsolved and were postponed for future discussion, especially those pertaining to the posting of medical interns. During this time, I was in my 2nd week of my internship, working in the surgical department. This week was the transition week where the hospital was starting to return back to normal. This rotation was one that I was most excited for as this is what I wanted to do in my future. I spent time in the Surgical Outpatient Clinic Department, where I shadowed a group of neurosurgery residents and cardiothoracic surgery residents. When speaking with the neurosurgery residents I learned 2 interesting facts. 1) that there is only one active neurosurgeon in the entire Mombasa county and 2) the most common type of cases they see is pediatric head traumas. The leading causes of injury in Kenya include assault (42%), road traffic crashes (RTC) (28%), unspecified soft tissue injury (STI) (11%), cut-wounds and dog-bites, falls, burns and poisoning (each <10%)3. This was made prevalent when I was in the surgical department. Most of the procedures I encountered were performed on children ranging from ages 2 months to 14 years of age. During my time in the surgical department, my love of surgery was amplified exponentially. The procedures I observed include: jugular dialysis catheter implantation, craniotomy and hematoma removal, VP Shunt for hydrocephalus, Acute Left Thalamic Hemorrhagic CVA, 2 Fistulas, Suprapubic Catheter Implantation, Anterior Corpectomy, Umbilical Hernia Removal, 5 C-Sections, Tubal Ligation, and an Emergency Hysterectomy. I spent my last week in the Labor and Delivery Ward, where I quickly realized that maternity care was not the right fit for me. Despite observing around 25 live births and several C-sections, this experience confirmed my preference for the surgical field. Although it wasn't my favorite rotation, I still gained valuable insights and skills, which only heightened my excitement for a career in surgery. Reflecting on my time at Coast General Teaching and Referral Hospital, I can see how profoundly this experience has shaped my professional aspirations. The opportunity to observe and participate in a wide range of medical procedures and patient interactions has provided me with a holistic understanding of the healthcare system, particularly in a resource-limited setting. This exposure has taught me the importance of adaptability, empathy, and cultural sensitivity—qualities that are essential for any healthcare professional. Witnessing the impact of the doctors' strike firsthand underscored the critical need for effective healthcare policies and the challenges that medical professionals face. It reinforced my commitment to advocating for better working conditions and patient care standards in my future career. Furthermore, the relationships I built with my mentors, colleagues, and patients in Kenya have left a lasting impression. Their dedication and resilience have inspired me to strive for excellence in all aspects of my practice. I am more determined than ever to pursue a career in cardiothoracic surgery, armed with the knowledge, skills, and compassion gained from this transformative experience. This journey has not only confirmed my passion for medicine but also deepened my resolve to make a meaningful difference in the lives of my future patients. My internship experience with International Medical Aid in East Africa has been profoundly transformative, offering me invaluable insights and shaping my future career aspirations in healthcare. Throughout my time at Coast General Teaching and Referral Hospital, I have gained a comprehensive understanding of healthcare delivery in a resource-limited setting, experienced the impact of political dynamics on medical practice, and encountered cultural variations that have enriched my perspective as a future healthcare professional. One of the most significant lessons I learned is the importance of adaptability and resourcefulness in healthcare. Working in a setting with limited medical supplies and personnel, I witnessed firsthand how healthcare professionals in Kenya make the most of available resources to provide patient care. This experience has taught me to be innovative and flexible, qualities that will undoubtedly enhance my ability to respond to various challenges in my future career. The doctors' strike during my internship period highlighted the critical need for effective healthcare policies and the challenges faced by medical professionals in advocating for better working conditions. This experience has underscored my commitment to not only practicing medicine but also being an advocate for systemic improvements in healthcare delivery and professional working conditions. Understanding the intricacies of healthcare politics has made me more aware of the broader context within which healthcare is provided and the importance of being an informed and engaged healthcare professional. Culturally, working in Kenya exposed me to diverse patient populations and varying health beliefs and practices. This cultural immersion has enhanced my cultural competence, an essential skill for providing empathetic and effective care to patients from different backgrounds. The patient interactions I had, particularly with those who faced significant health challenges, reinforced my dedication to treating each patient as a unique individual, respecting their cultural context and personal experiences. Observing unique clinical cases, such as severe trauma cases and the management of non-communicable diseases in a different healthcare environment, has broadened my clinical knowledge and skills. These experiences have solidified my interest in pursuing a career in cardiothoracic surgery, as I have seen the critical need for specialized surgical care in diverse settings. In conclusion, my internship in East Africa has profoundly influenced my interest in pursuing a career in healthcare. It has equipped me with a deeper understanding of the complexities of healthcare delivery, the importance of cultural sensitivity, and the need for advocacy in healthcare. I am committed to using this newfound knowledge and perspective to make a meaningful difference in the lives of my future patients, advocating for improved healthcare systems, and providing compassionate, culturally competent care. This transformative experience has not only confirmed my passion for medicine but also strengthened my resolve to be a dedicated and empathetic healthcare professional.