Internships in Rwanda

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

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