Dentistry/Pre-Dentistry Shadowing & Clinical 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.

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.

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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.

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From the moment I arrived at the airport to the last moment at the residence, I received excellent mentorship and had an amazing experience. All of the mentors were attentive, friendly, and always had everything prepared for us. I was very satisfied with the meals, hospitality, and living arrangements, and I never felt unsafe at any point during my stay. The cultural treks were a wonderful addition to the clinical experience and helped me better understand the local community. Overall, everything exceeded my expectations, and my time in Kenya was truly unforgettable. Spending several weeks in Mombasa, Kenya, interning through International Medical Aid’s Pre-Dental Internship Program was one of the most eye-opening experiences of my life. As an undergraduate student who plans to attend dental school, I knew I wanted more than just classroom knowledge—I wanted to see what healthcare looked like in different parts of the world, especially in places where people don’t always have easy access to care. I hoped the internship would give me a better understanding of dentistry, but what I didn’t expect was how much it would impact the way I see people, healthcare, and my own future. I was placed in the dental unit at Coast General Teaching and Referral Hospital, one of the largest public hospitals in the coastal region of Kenya. From the first day, I was amazed by how busy the clinic was and how many patients arrived seeking care. Many had waited a long time to be seen, often because they couldn’t afford treatment at private clinics or because there simply were not enough dentists in the region. In the oral surgery department, I observed many extractions and abscess drainages. These procedures were often performed under challenging conditions—limited tools, time constraints, and a high volume of patients. Most of the people we saw were in serious pain and had delayed care until their symptoms became unbearable. We also treated patients with jaw fractures, tumors, and cysts—cases that would typically be addressed much earlier in more developed countries. Here, patients often came in only when the pain was no longer tolerable or when the condition visibly affected their daily lives. Beyond oral surgery, I spent time in other areas of the dental unit, including general dentistry, pediatric care, and cosmetic procedures. In the cosmetic area, I developed close friendships with several dental technicians who took the time to show me how they crafted and molded patient impressions. Watching them create these molds by hand, with such attention to detail, helped me see the artistic and technical sides of dentistry coming together. It showed me how much of dentistry is hands-on craftsmanship—and how rewarding that part of the field can be. One thing I noticed early on—and something I will never forget—was how deeply grateful patients were, even for what might seem like basic procedures. In many cases, the dental treatment they received was the first real care they had received in years, or even in their lifetime. Many patients left the clinic smiling, even after a difficult extraction or painful procedure, simply because their pain had been eased. One patient in particular stands out in my memory: a woman who came in with a serious dental abscess. She had been living with swelling and pain for weeks but delayed care because she couldn’t afford treatment or take time off work. When the team finally drained the abscess and relieved her pain, she was overwhelmed with emotion. She held my hand, looked me in the eyes, and thanked the entire team for helping her. That interaction taught me more about the human side of healthcare than any textbook ever could. It reminded me why empathy is so important—not just in medicine, but in life. These moments of connection were everywhere. Whether I was helping a child feel calm before a check-up or observing a young man’s reaction after getting his teeth cleaned for the first time in years, I felt more and more certain that I was on the right path. Dentistry isn’t just about treating teeth—it’s about restoring confidence, easing pain, and helping people live their lives more fully. Before going to Kenya, I had read about healthcare disparities and access issues in developing countries, but it is one thing to read about them and another to witness them firsthand. I quickly saw how the lack of resources, infrastructure, and funding affected both patients and healthcare workers. Coast General is a teaching and referral hospital, yet they often didn’t have enough basic dental supplies. There were days when the team had to get creative or work with whatever was available to treat patients. I also noticed that many of the conditions we saw could have been prevented with earlier treatment or better education. Dental hygiene tools like toothbrushes, floss, or even clean water were not always available to patients. Preventive care—something I had always taken for granted—was not common in many parts of the community. People simply didn’t have access to the resources or information needed to maintain good oral health, which led to more serious and costly issues over time. According to an IMA lecture on healthcare systems in low-resource settings, one of the biggest challenges is the “delayed care model,” where people only seek treatment when their condition becomes critical (IMA, 2023). I saw this everywhere. Patients weren’t neglectful—they were doing the best they could with what little they had. This made me realize how important community-based health education is and how much of an impact even basic awareness can have. Living and working in Mombasa also gave me the chance to engage with a culture very different from my own. From local food and music to traditions and social customs, I learned so much simply by listening, observing, and asking questions. I was especially touched by how welcoming the staff and patients were. Even in moments when I felt out of place or unsure, people took the time to teach me and include me. The dental technicians I grew close to didn’t just show me their work—they welcomed me like a younger sibling. We talked about our different upbringings, laughed about the differences in slang and language, and even arm wrestled. I learned a few phrases in Swahili, and they teased me kindly when I mispronounced words. Through these moments of cultural exchange, I began to appreciate the power of kindness, curiosity, and humility in building trust—not just with coworkers, but also with patients. Working in this environment made me think deeply about my future and how I want to practice dentistry. I realized that I don’t want to be a dentist who only works in a comfortable clinic treating patients who can easily afford care. I want to be someone who actively looks for ways to give back—whether that means volunteering my time, serving underserved communities in my own country, or returning to places like Mombasa to provide care. I also became more aware of how public policy, infrastructure, and government systems shape access to healthcare. Kenya’s national healthcare system has made progress in expanding coverage, but underfunding, political instability, and uneven distribution of services continue to pose challenges (World Health Organization, 2021). This experience showed me that being a healthcare provider isn’t just about what happens in the clinic—it’s also about advocating for systems that support equity and access. The IMA global health curriculum emphasized this as well. One lecture noted that “healthcare providers must understand the sociopolitical structures that influence patient care, particularly in low-income settings” (IMA, 2023). That point stayed with me because it reinforced the idea that medicine doesn’t exist in a vacuum. As a future dentist, I want to use my voice not only for individual patients, but also to support policies and programs that improve health on a larger scale. Looking back, I feel incredibly fortunate to have had this experience. It pushed me out of my comfort zone, helped me grow both personally and professionally, and confirmed that dentistry is the right path for me. More importantly, it showed me the kind of provider I want to become—empathetic, hands-on, and committed to serving those who are often overlooked. I want to use what I’ve learned to help people with their dental needs while also advocating for better access, more education, and more compassion in healthcare. Whether I am treating a child in a high-tech clinic or helping someone in a mobile dental unit, I will carry the lessons from Mombasa with me. I’ll remember the people, their stories, and the moments of gratitude that made every day in that dental unit meaningful. In the future, I hope to work with organizations that serve low-income communities, both at home and abroad. I would love to participate in dental missions and work in community health centers to provide care and education to those who need it most. My goal is to take the privilege of my education and pay it forward—to use my skills to improve lives, one patient at a time. My internship with International Medical Aid didn’t just teach me about dental procedures or hospital systems; it taught me about people. It reminded me that behind every tooth is a story, a struggle, and a human being who deserves care and dignity. It showed me that healthcare is about more than tools and techniques—it’s about listening, learning, and doing the best you can with what you have. This experience will stay with me for the rest of my life. It has shaped not only how I see the world, but also how I see myself. I am more motivated than ever to become a dentist—not just to practice a profession, but to make a real difference in people’s lives.

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My experience with IMA in Kenya was nothing short of memorable and deeply reflective. It reaffirmed my purpose for wanting to attend dental school. From the moment I arrived, I was warmly welcomed by Michelle and Teddy, whose kindness immediately put me at ease. The kitchen staff, especially Joshua and Maria, went above and beyond- helping me open my charger adapter and telling me, “We are here for you.” That simple gesture made me feel truly at home. Whether it was baking donuts with Erastus or building meaningful friendships with the other interns, every moment contributed to an unforgettable experience. I’m also incredibly grateful to Naiomi for coordinating everything so seamlessly and always being available to answer any questions. One of the highlights of my time was the community clinic- an opportunity I almost missed due to a flight change. I’m so glad I made it. There, I was able to contribute by recording teeth numbers during oral diagnoses and cleaning instruments for extractions. It was in this clinic that I truly saw the heart of IMA’s mission in action. This experience was especially meaningful to me, as I hope to one day practice dentistry in a charitable manner.

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

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

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

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My time in Kenya was truly unforgettable. I met incredible people, made new friends, and learned more than I could have ever imagined. To be able to say I traveled to Kenya is awesome, but to be able to add that I interned in a public hospital and got to observe patient care up close is really the cherry on top. The dentists that I observed were some of the nicest people I have ever met. The IMA team/mentors were always ready to answer questions, and they taught me so much about Kenya. The food was delicious! I usually went back for seconds, and it was such a treat to be looked after by the housekeeping team. Snorkeling in the Indian Ocean and experiencing Malindi/Watamu was definitely a highlight, but I also loved the day-to-day routine of going on the bus, driving to the hospital and people watching out the window, saying hello to and fist-bumping the guards, and walking all around the dental unit. Going out to local spots with my fellow interns was also so much fun. I really do hope I have a chance to return to Kenya one day. As a child, I was terrified at the thought of sitting in a dental chair. Sitting in the chair itself was a whole other obstacle. There I was sitting in a bizarre-looking chair with a direct view to a tray of dental tools that had 6-year-old me thinking would bring me nothing but pain and discomfort. Needles and drills moving towards my face with no explanation of what was about to happen. It was a complete nightmare…until I met the person that would end up being my pediatric dentist. Her office was warm and inviting. The chairs had TV screens attached to them so that patients could be entertained and distracted from all of the drilling and prodding. Her assistants always let me hold their hands while they administered the anesthesia, because even though squeezing their hands did not actually help much with the pain, it was nice to know that they simply cared to ease my pain. My dentist talked me through every little thing she did, and she got me cavity-free. Being her patient–a scared child desperately wanting someone to validate her fear–inspired me to want to become a pediatric dentist. I wanted the chance to help other children be calm and maybe even excited to sit in the dental chair. When I tell people I want to be a dentist, I usually get asked, “why teeth?” I do not think it has much to do with teeth as it does with patient interaction. I am fascinated by teeth and take dental hygiene quite seriously, but I am most excited about the thought of telling a young patient that I will leave the numbing gel on just a tad longer before administering the anesthesia if it means easing their anxiety. Or demonstrating proper dental care on stuffed animals just like we did during the hygiene clinics at the primary schools. The little things. In preparation for dental school, I have spent hours shadowing at local dental offices, but in 2022, I became interested in observing dental work on an international level. After some research, I stumbled upon International Medical Aid. I took a leap of faith and applied, and I landed in Mombasa, Kenya in the Summer of 2023. Being able to say I have traveled to Kenya has given me a lot of pride, but also being able to say I interned at Coast General Teaching and Referral Hospital just does not seem real... During my time with IMA, interning at CGTRH in the dental unit, I learned more than I could have ever imagined. I felt incredibly privileged being in a position to observe dental care in a country that has significant healthcare differences to the United States. Much of the healthcare challenges in Kenya are poverty related; for example HIV/AIDs is so prevalent that all patients are assumed to have it until proven otherwise (Current State of Healthcare in Kenya, 2022) . I observed that sanitation was at its best after procedures that resulted in some blood loss. HIV prevalence in Mombasa is actually 1.2 times higher than the national level at 7.5% (Disease Burden In Kenya, 2022). Additionally, I observed low health literacy–many patients did not fully understand their conditions or treatment plans, but they followed all of the doctors’ orders, trusting that the doctors knew best and accepting that they themselves did not know better ( Health Literacy, 2022). Notably, Dr. Khadijah did an excellent job helping patients try to understand the need for tests, treatments, and medications. She was compassionate and patient, and always encouraged her patients, particularly during painful procedures. I also noticed that many patients were coming in for issues caused by self-neglecting behavior. Most did not have the luxury of coming in for annual cleanings or routine treatment. If they noticed a cavity or a slight ache, this would go untreated for months or maybe years until the pain became so unbearable they had no choice but to come in. The dentists extracted many teeth that had complete decay of the crown. There were multiple instances in which they extracted teeth from abscessed sites, but due to the infection, the anesthesia was not fully effective, resulting in pain and discomfort. After root canals, most patients did not return for the crown. I was informed that they actually just keep the temporary filling in until that starts to cause issues. There was one particular patient who had cavitation on a tooth on her lower jaw, and it went untreated for so long that the infection spread to her roots and then to her neck, which resulted in necrotizing fasciitis. During my time in the unit, I saw her return for a check-up after prior treatment, and the infected site was healing well. The degree of infection was disheartening to consistently see, because it seems so normal to have these issues addressed promptly in the United States, and most of the time, the issue will be caught during regular cleanings before it can even progress to infection. Early detection and treatment seem like such little things. In Mombasa, they were not so little things, since early detection and treatment were not affordable for many. In the United States, there is a routine to most treatment plans. The patient sits in the chair, a bib is placed around their neck, the dentist applies numbing gel to the treatment site in preparation for the lidocaine, and then lidocaine is administered. I was incredibly shocked to see that numbing gel was not being used in the dental unit. There was lidocaine spray, but it was only used occasionally on pediatric patients. It was certainly not part of routine treatments. Even when the lidocaine spray was used on pediatric patients, they reacted poorly to the subsequent lidocaine administration. Some began crying while the lidocaine spray was getting applied, and those who made it through that stage screamed and squirmed at the sight of the needle. There were times doctors would jump in to hold a patient’s arms and legs down, and others would steady the head and neck so that the lidocaine could be given, but the patient would fight even more. This young boy reluctantly made it past the lidocaine, but the moment the dentist began extraction, the boy had had enough. He flipped over in the dental chair and slid off, refusing to get back on. He screamed, “Jesus” over and over again, and he was completely inconsolable. I felt awful, because I know how terrifying the dentist can be, yet I have all these little things that help ease my fear, like numbing gel. Maybe these “little things” were actually not so little. I also witnessed adults experience intense anxiety in the dental chair. They would grimace at the sight of the needle and even reach for the dentist’s hand while the anesthesia was getting administered. Something as not so little as numbing gel could make patients’ and dentists’ lives easier. I actually was able to sit-in on a meeting during which the dentists discussed pediatric treatment and how to manage patient and parent behavior better. They noted the importance of using simple terms, for example, referring to lidocaine as “sleeping juice.” They also mentioned how the presence of parents can change a child’s behavior. The previously mentioned combative young patient originally came in with his mother, and he left without having completed his treatment. However, he returned a few days later with his father and was fully cooperative. One dentist suggested using colorful composite for fillings to incentivize children to fix their cavities, and it just makes it more fun for them. The fillings would be on their primary teeth, so as they lose their teeth, they will lose the colorful fillings, but it could be something for children to look forward to. She also suggested limiting the number of people in the room during pediatric treatments because having more dentists present may make the patient feel uneasy and concerned about the need for so many people. I believe these changes can truly improve children’s experience in the dental chair. I was someone who hated going to the dentist, and now, I look forward to every visit. I want to help people take pride in their teeth and smile. I hope one day I am given the chance to heal any traumatic experiences a person has ever had in the dental chair.

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Travelling to Kenya for merely two weeks was not nearly enough to experience such an amazing culture and amazing people full of joy in their hearts. This trip opened my eyes to the challenges countries in Africa face when compared to other countries and what a blessing it is that a program is going above and beyond to give to those deserving yet underrserved. Even though I was there for a short time, I gained so much knowledge from compassionate an selfless doctors and hopefully have impacted the lives of those during educational sessions. This experience marks a pivotal turning point in my life and will always be grateful for the chance to educate the people of Kenya while also learning from them as well. I will remember this moment in my life and hope to continue the characteristics IMA has instilled in me, teaching what I have learned and carrying the tradition of providing to those less fortunate - changing their lives!

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One of the things that stuck out to me the most during my time in Kenya was that no matter the circumstances, the people of Kenya always manage to find a reason to smile. On top of that, they showed a side of strength that I have never seen before. During my 3 weeks of shadowing the doctors in the dental unit at CGRTH, I was able to obtain a different perspective on dental care. They gave me tools that I will forever cherish as I continue my career in dentistry such as the way they approach extractions, how to handle kids, and operate minor and major oral surgeries. I am grateful to have been able to see how they work to ensure that the patient is getting the care they deserve. They showed me how teamwork is essential to problem-solving when performing a procedure and assessing a patient. I cannot express how thankful I am for how welcoming everyone has been to me and the rest of the interns. Being able to visit schools and educate the students about hygiene and women’s menstrual hygiene was so rewarding. Everyone expressed the most welcoming and kindest smile. Lastly, I’m blessed to say that I made lifelong friends with the people I met. I was enlightened by the city of Mombasa and all it has to give. These experiences have been life-changing and given me a different perspective on healthcare, life choices, and friendships. In 2019, I was a senior in high school. A senior that is just beginning to think about what career to pursue for the rest of my life. Finding a career that I find rewarding and helpful to others. A job that could fulfil my goal in assisting people. With many dentist and orthodontist appointments, I soon realized that teeth were very fascinating to me. Teeth are very interesting because you might think that they are all the same, but in reality, they are all different. I soon began to realize this as I interned with the dental unit in CGTRH. The dentist would observe the panoramic of the teeth and roots when preforming a procedure on the patient to make sure they approach it the correct way. They would show us that some teeth have very short roots, or some have very long ones which would take a longer time to get out when extracting because they don’t want the roots to break off. It was very interesting to see how each individual dentist approached a patient and what they did to preform the procedure. During my three weeks in Kenya, I have gained knowledge, resources, and friendships. Before coming to Kenya, I had my mind set on being a pedodontist. I really enjoyed being around kids, so I thought being a dentist and working with kids would be the perfect job for me. I shadowed one of the Dentist, Dr. Ian, to see how he approached the procedures when dealing with kids. He did a beautiful job of calming the kids down and explaining what he would be doing, but I soon realized after watching a couple procedures be done, that pedodontist isn’t for me. That is one thing that I am grateful for as I shadowed the dentist at CGRTH, I got to see what interest me and what didn’t. All the Dentist in the unit were very knowledgeable and help explain the procedures to us as we were watching. They made sure that every patient was getting the care that they need even when they had limited resources. Right from the start of shadowing the dental and facial unit in CGRTH, I was immediately shocked. With the cases the doctors observed and how they handle and went about them was incredibly amazing to experience. They explained that they had a lack of resources, and they would only use some instruments on a patient if they really needed it. They mentioned that they could use an elevator on a patient’s tooth when extracting it, but only if the tooth really needs it because they might need it more for the next patient that comes in to get an extraction. This was one of the big differences between Kenya and the States. In the United States, we tend to take advantage of the resources we have. For example, the private dentist I work with explained to me that they would rather use more resources on a tooth, like cement for a crown, so they know that it is going to stick and be easier for them to work with, rather than use a smaller amount to where they might run into more issues when preforming on the tooth or in the future. Whereas in Kenya they used only what they needed and never used more because they couldn’t afford to waste material and instruments. The first day at CGRTH was one of the most intense days I have ever experienced. The pace of the hospital and what they saw daily was a complete culture shock. I saw more intense cases then what I am used too with my internship with the private dentist in Michigan. Dr. Grutter, a dentist I work with back in the States, explained to me that the “bread and butter” -what they see and work on every day- are crown and bridges. Whereas for the dentist in Kenya, their “bread and butter” is extractions and root canals. There is a big difference in the dentist in the States and in Kenya. For example, the dentist in Kenya went straight to dental school after high school whereas the dentist in the states must go to undergrad before attending dental school. Also, the dentist is Kenya did everything from oral diagnosis, exodontia, periodontics, paedonotics, conservative dentistry and endodontics, prosthetics, orthodontist, and minor oral surgery and the dentist in the States usually specialize in one thing. This was so fascinating to me because it showed how diverse they were in dentistry. They can do any of those procedures and do a great job at it. One of the cases that stuck to me the most was this 5-year-old girl with a sarcoma. It was my first day at the hospital when she came in. She was held by her mother who looked worried and anxious for her daughter, but still made sure to comfort her daughter during the whole procedure. Dr. Solomon, a maxillofacial surgeon, attended the patient with great care and observation as he examined her face. She had what they thought was a sarcoma on her right cheek. As they were done examining her face, they started to clean it out to try to get rid of the infection that was causing this. She was in so much pain as they did this, but she was able to sit there and not make it hard on the Doctors. She was one of the strongest girls I have ever met. Every day she would come back for daily cleans knowing what was going to happen, and still willing to get it done. She never gave the Doctors a hard time when they were cleaning her infection. After this case, I soon realized that the people of Kenya are a different bread of toughness. The people of Kenya gave me a new prospective of what toughness and kindness is. No matter the circumstance they were always grateful and happy. They always had a smile on their face and made sure we felt welcomed. Something that can be uncommon in the States. The dentist that we worked with took us out and gave us a once in a lifetime experience. They gave us a tour of the city of Mombasa and made us try food that they enjoy and that are common in Mombasa. This just showed that even though we are all from different parts of the world we are still human beings. This experience not only gave me great knowledge and tools to use towards my journey towards dentistry, but it also gave me lifelong friendships and memories. Being able to visit schools and educate the students about hygiene and women’s menstrual cycle was so rewarding. Everyone expressed the most welcoming and kindest smile. I’m blessed to say that I made lifelong friends with the people I met. I was enlightened by the city of Mombasa and all it has to give. This experience taught me so much and made me realize that once I become a dentist that this is the type of work I want to do. I want to travel the world while helping as much as I can with dentistry to keep the world smiling. This experience has been the most rewarding and challenging thing I have ever done. I am grateful that I was given the opportunity to push myself to go out of my comfort zone because I’ve gained so much from everyone I met in Kenya. This was a life changing opportunity which will shape my future as I continue my journey in dentistry, forever advocating for equality in the healthcare systems around the world.

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I loved my time in Mombasa with International Medical Aid. From the moment I met the team at the airport, everyone was extremely welcoming and very accommodating. I learned so much during my time at the hospital in the dental clinic and am so grateful I got to shadow such knowledgeable and accomplished dentists and oral surgeons. Some of my favorite parts of this experience included when we got to go to the schools and teach the health and hygiene lessons - I loved all the community outreach we did! The IMA program was undoubtedly a life-changing experience for me and I would 100% recommend it to any pre-health students who want to witness healthcare in a different country. When I received my acceptance email into a pre-dental internship with International Medical Aid, I was overjoyed. I recall immediately phoning my mom to inform her of the great news, and she mimicked my elation. After a few days of discussion about the logistics of the feasibility of this sort of large scale trip, it had been decided - in 2 months time, I would be headed to Mombasa, Kenya for 3 weeks. I had rather straightforward goals for what to gain out of my time in Africa: to learn as much as I could about dentistry and oral healthcare, to help wherever and however I could, and to immerse myself fully in a completely new culture and continent. In the weeks leading up to the trip, I remember feeling extremely excited for the adventure I was about to embark on but also nervous about the cultural and medical differences I would be experiencing. I have had ample clinical experience in the past, with 100+ hours spent shadowing in both hospitals and dental offices, but despite this, I knew that none of that would prepare me for what healthcare would be and seem like in Africa. Flying into Mombasa, I knew I was in for the experience of a lifetime. The sheer amount of information I learned from my internship experience with International Medical Aid was staggering. Spending 5 hours a day, 5 days a week, for 3 weeks, in a clinical setting, particularly one that is characterized by being a fast-paced, high-energy environment, provided me the unique opportunity to see a variety of new procedures each week and gave me exposure to many cases that I would likely never have the opportunity to see firsthand in the US, some of which will be discussed later. As for procedures that I observed and learned about, I was able to witness many that were both common and uncommon in US dental clinics. I observed many extractions, scalings, and root canals (which I learned are actually 3 different procedures: extirpation, biomechanical preparation, and obturation), which I had a certain level of familiarity with from my time spent shadowing in America. While the methodology employed to conduct said procedures were quite similar, the materials used were oftentimes very different. When I inquired about what some of these different materials were (such as using silver fillings instead of composite) and why they were being used, I was oftentimes responded to with the same answer: finances. Seeing the lack of resources available, and even the quality of materials being used, made me acutely aware of the sheer disadvantage that many of the dentists and practitioners had due to the materials they were working with. It was not uncommon for me to hear about how, when moving to work at Coast General, the dentists had to learn new ways and tricks to use the materials they had on hand and improvise in order to provide the patient with the best quality of care possible. One of the most advantageous aspects of my time spent at Coast General Teaching and Referral Hospital was the fact that the dental clinic had almost every aspect of not only general dental work but also specialties in-house, in the dental unit. In the US, when you go to visit a general dentist for a routine check up or cleaning, you would usually go to a clinic, or a stand-alone office. Then, if you need specialized care, such as to see an endodontist or periodontist, you would be referred to one of these care providers who has their own clinic, most times located far away from the original general dentist’s office. If you are visiting a prosthodontist, and need to get fitted for dentures or other similar mouth gear, while you may be fitted for such at the prosthodontists office, the molds taken from the patient will then be sent out to a specialized oral prosthetics lab where the new denture will be made. In Coast General, all of these aforementioned specialties in dentistry are located just a few rooms down from each other. This gave me the unique opportunity to be able to experience so many specialties, with such a wide range of procedures included in each one, each and every day. It was not uncommon for me to go from observing a patient getting braces put on in the orthodontics room to shadowing in the minor oral surgery theater where a different patient was getting sutures on their lip and mouth after being injured in a road traffic accident. I think that this set up could be advantageous to be used in America. Oftentimes, referring patients to further clinics requires extra time and planning, and can lead the patient to be untreated for a lengthy period of time than could be necessary. If dental clinics were set up similar to Coast General, with multiple specialties grouping together and having their own in-house or nearby prosthodontic lab, I think that the quality and efficiency of care could be increased significantly. One of my most poignant learning experiences was becoming aware of how different healthcare delivery is in Africa, particularly when contrasted with the healthcare delivery I am most accustomed to in the United States. Patient interaction and bedside manner is focused on much more heavily in the US (Reference 1). At Coast General, I became more accustomed to seeing limited patient-provider interaction, as reading from patient charts seemed to be the more common form of becoming acquainted with what the purpose of the visit to the hospital was. Then, the dentists would often do an oral examination, without much more direction for the patient other than instructions to open their mouth. Following this, the dentists, if multiple were present in the room, would briefly discuss amongst themselves a possible diagnosis and then determine the course of action following. To contrast this with the US, dental care providers would often initiate conversation with the patient about their medical history and what was ailing them, and there would be much more verbal communication between both parties. Some potential reasons for this could be cultural and social differences in dynamics between healthcare professionals and patients, perceived time allotment per patient, and level of healthcare literacy among the general population. That last reason is also something worth mentioning about differences in patient care. After a visit to the dentist, and especially after a procedure is conducted, either the dentists themself or a hygienist or assistant will give the patient specific instructions about how to care for the wound, any lifestyle or dietary changes that need to be made immediately follow, and any other things to look out for or change. This instruction sequence was not at all present at Coast General. It was rather shocking for me to learn that, other than occasionally telling patients to chew their food on the opposite side of wherever they had the procedure done, there was no instruction given on how to clean or care for the recently operated on site. I believe that a lot of the differences I was made aware of can be attributed to differences in the political systems and structures in place in Kenya as well as some of the many cultural variations interwoven in society that I encountered. One thing I noticed was, because Coast General is a government hospital, many government workers came in for procedures. There would be times when many members of what I assumed to be the Kenyan military would line up inside the dental clinic to get extractions or other such procedures done. This was somewhat surprising to me because I had assumed that those who were a little more financially well off, such as those with jobs in the government, may choose to get their dental and medical work done at a private or other such hospital; however, because of the way the government works in conjunction with the hospitals their, government workers and officials often had their medical care done in hospitals just like Coast General because of their verys subsidized or sometimes even free costs (Reference 2). There were also numerous cases of cultural differences I noted. One was the level of patient and family interaction, especially when dealing with pediatric patients. It was not uncommon for an 8 to 10 year old patient to walk by themselves into the clinic room to be seen by a dentist. In the US, parents are almost always accompanying the children, and it is rare, if ever, to see any patient under the age of 16 without a parental figure with them. The independence and bravery of these elementary and middle school aged children was very impressive (Reference 3). Throughout each day at the hospital, I would take notes on different patients, cases, and procedures, as well as notes on any of the equipment, skills, and techniques being used. Over the course of my time there, I amassed dozens of pages of notes and saw hundreds of cases. Out of these huge quantities of procedures seen and people talked to, a few specific clinical cases did stand out to me. One of which was a 12 year old boy who had been diagnosed with epilepsy. He had been on medication to treat his epileptic episodes for a few months at that point, but had presented at the hospital with extensive oral tumors covering the entire roof and most of the walls of his mouth. When visiting him on rounds through the wards each morning, the dental team began to predict that the cause of these tumors was one of the specific anti-epileptics he was on, called phenobarbital. Dr. Solomon, who led the rounds, instructed some of the attending interns to do research and see if there was any scientific literature or previously published cases where this specific medication had resulted in manifestations of oral tumors. The dental and inpatient team was then put in the difficult position of choosing whether to keep him on the phenobarbital and work to remove the tumors individually or risk taking him off the anti-epileptic medication and see if the tumors reduce from that. Another case that stuck with me was with that of a 25 year old man who initially came in with zygomatic bone fracture and fibrous dysplasia, but who also had fibrosis. I was rather familiar with fibrosis because I have worked in some underserved communities in the US where fluorosis is also a rather common issue. Being able to juxtapose the specific treatment given for this diagnosis in the US versus Mombasa was very advantageous for me to see. A third case that I believe will stick with me far into the future was one of a young girl who was about to turn 6. When she initially came in, I thought she could be no older than 3 based on her small stature. She had a bony tumor on her left cheek that the dentists presumed was cancerous, so they decided to do a biopsy of that sarcoma. She had a huge ulcer on the side of the tumorous mass, and I watched as the doctors carefully cut a small chunk of her cheek out for a biopsy. When cleaning the wound, they found that not only did she have necrotizing fasciitis of the cheek and oral tissue but also of the bone, and one of her molars even fell out while they were treating the ulcerous area. This girl, before she even entered elementary school, would have to undergo a partial jaw resection. The severity of this case was quite shocking to me, but I found the work the doctors did with ehr, and were planning on doing with her into the future, very valiant. The quantity of notable patient interactions is not to be understated, either. One of the particularly poignant interactions for me was seeing an older man who was visiting the dental clinic after having had his jaw fracture treated with a maxillomandibular fixation. After 4 weeks of having his top and bottom jaw wired together, one of the dentists in the clinic assessed him and decided his jaw was stabilized to remove the wiring. This meant he was able to fully open his mouth and eat non-liquid food for the first time in over a month. After the wires were removed, as he was on his way out of the clinic, he approached each of the dentists and interns in the room, including myself, and grasped their hands saying “asante sana” over and over again. He had visible tears in his eyes, and the earnestness with which he was expressing gratitude for the team was very touching to witness. Another meritorious patient interaction I saw was when one pediatric patient, a boy around 5 or 6 years of age, was very hesitant to sit still enough to allow the dentist to inject him with the local anesthetic. He was obviously very scared about the lengthy needle that was about to be stuck in his gums, but instead of just brushing aside his nerves, the dentist took time to speak to him in Swahili and explain where and how the anesthetic would be put in, and how he would feel much better after it was injected. The dentist then repeated what he said to me in English, and it became apparent that the boy was much more relaxed after he knew what was happening. Despite his young age, the boy seemed to just be seeking some words of affirmation from the dentist who was operating on him, and it was very heartwarming to see how the practitioner took just a few extra moments to make the pediatric patient’s dental experience much calmer. This sort of care is something I hope to carry with me when I become a healthcare professional. I will undoubtedly use this newfound knowledge and the perspectives I gained throughout my healthcare career. Throughout my college career, I have always enjoyed community outreach and worked towards connecting volunteers and students from my school to the greater community and city that I live in. I have chaired multiple outreach committees in various clubs I am in on campus and am a frequent volunteer at shelters and mobile health clinics. I was able to pursue this passion on a much larger and a much more diverse scale while in Mombasa. My experiences in East Africa have influenced your interest in pursuing a career in healthcare because I now know I want to incorporate global outreach and service to become an integral component of my career. During my time observing, I was able to see a program known as Smile Train perform dozens of cleft palate surgeries on children, completely free of charge. This is a program I would love to become part of so I would be able to visit hospitals like Coast General and put my knowledge and skills to beneficial use to the community, especially at a low, if not free, cost. I am extremely grateful for all the learning experiences I had in Mombasa, and am sure they will stick with me for not only the rest of my academic and medical career but also for the rest of my life.

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My three weeks in Mombasa, Kenya, were easily the best three weeks of my life. The idea of traveling to a foreign country with little to no knowledge of its people, culture, language, and the healthcare system can be presumably scary. However, after just my first day in Mombasa, it became obvious to me that I had nothing to worry about. Foremost, I would like to thank IMA Program Staff for the role they had in making me feel welcome and safe during my stay. I am extremely thankful for the opportunity I had this summer to learn from my peers, the patients, CGTRH dentists, and IMA staff while in Kenya. I leave knowing that I have made a group of lifelong friends as well as an everlasting support system from the IMA staff. I look forward to coming back soon. For now, Asante IMA.

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My trip to East Africa was an absolute success thanks to all the IMA staff who protected us and worked hard on our behalf during our stay. From our daily drivers: Javan, Teddy, and Benson to our housekeepers and chefs, we were able to have every one of our needs met due to their efforts. Our safety was a top priority during our trip and we never had to sacrifice the feeling of comfort. I am grateful to have experienced the way of life and the Kenyan culture during my two-week stay abroad. I was able to grasp the true meaning of a developing nation as I was faced with the reality of Kenyan's way of life. Whether it was through the constant bus rides and the observations I was making of the roads, the houses, and the civilians. Or whether it was face to face on a daily basis at the public hospital where I interned in the dental unit, it was under these circumstances that I was exposed to a lifestyle that will forever linger in my memory. This mission trip will serve as a personal reminder for my long-term aspirations in the health care field. I would like to return as a dentist in the future and aid these people with my time, effort, and resources. I would like to extend my gratitude towards the International Medical Aid organization for allowing me to participate in this educational experience so early in my dental career.

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I’ve never shadowed dentists before, but after just a week of shadowing at Coast Provincial General Hospital, I witnessed procedures that I never would have imagined seeing. I spent a lot of time in the minor oral surgery room because I’m interested in specializing in oral surgery after dental school. During the first hour of every shift, all the interns and dentists gathered in the minor oral surgery room and did dental rounds on cases of patients. This was my favorite time of the day because it was a great opportunity to be in a discussion setting. I listened to the dentists talk about unique cases including facial and oral tumors, and a lot of the times, the cases would be truly uncommon in a dental setting back in Canada. Reflecting on my journey today, I couldn’t be more grateful for the incredible individuals I’ve met along the way. Although public healthcare in Kenya is completely different than a setting that I hope to work in the future, I’ve realized that what makes a great dentist is all the same, no matter where in the world. A great dentist should be someone who is not afraid to make sacrifices for the ultimate greater good of health, and that is to do the best you can for as many people as possible. My memories with IMA are definitely ones that I will carry with me for the rest of my life. Before I arrived, I had a full schedule planned for me so I knew exactly what I had to do. I had three meals a day planned out for me, but also had the flexibility to go out to eat. My cultural trek to the Masai Mara was also very organized. I enjoyed being a guest of IMA my entire trip and definitely would say that IMA made me feel comfortable during my trip to Kenya.

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This program is the best decision I ever made. The program mentors in Kenya helped me from the minute I got accepted to the moment I left. They were very approachable and friendly. I always felt safe during my stay in Kenya. The mentors go out of their way to ensure the safety of the interns. They provided us with tips that would further ensure out safety while they were not around. The accommodations were much better than I had anticipated. Our rooms were cleaned every day and we stayed in a very nice neighbourhood. The food never disappointed. All of the interns looked forwards to meals as it was always something yummy. This program had a huge impact on me. I have learned so much about Kenyan culture and was able to see and learn a lot. I was able strongly notice the differences between Kenya and North America. With the help of hygiene and medical clinics as well as other outreach activities, I hope I made some impact on the communities we visited, they certainly made an impact on me. I believe the most valuable aspect was the interactions we had with the children at schools and within the communities. performing the hygiene clinics and medical clinics really opened up my eyes to what some of these kids are exposed to. Despite the exposure I faced at the hospital, being involved within a community was slightly more valuable for me. The safari was a huge highlight on my trip. It was worth every penny that was spent. The lodge we stayed in was beautiful. The food was great and our safari driver was hilarious. No improvements here.

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International Medical Aid provided stellar in-country support, safety, and accommodations. The food was prepared by a top chef and is hands down, some of the best food I've ever had! Our oral hygiene clinics that we held in the slums were beneficial to the local community as we were able to educate the locals on hygiene habits, something that isn't commonly available. The hygiene clinics were some of my favorite aspects of this program. This program also was very safe and necessary precautions were taken in this program to ensure our safety.

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If you are you looking for a radically different yet incredible experience next summer, stop looking. This is it. Granted that this was my first time in Africa. And the first time I volunteered as a dentist. So the experience would have probably been a memorable one either way. That said, it was not just memorable, it was simply life-changing. IMA gave me a unique opportunity to both work as a doctor, and learn as a student. There was obviously some ramping-up to do, but it was just a matter of days until I started getting hands-on experience, working with dedicated mentors, and really wonderful colleagues. The organization was also great in helping me to explore, learn and live the city and culture of Mombasa. Locals are incredibly welcoming, and while you might think safety is an issue, the in-country support was just exceptional at making sure we did not take any unnecessary risks. And don't get me wrong. I did take risks. But they involved holding snakes with my own hands, driving by lions at Maasai Mara, and skydiving over the Mombasa valleys. And I can tell you those risks were totally worth taking. The worst part is that all of this happened while staying and living at genuinely one of the most wonderful dorms in the city, with great people taking care of you, and delicious food waiting on the table. Hope this does not sound too good to be true, but I really could not speak any better of my time in Kenya, with IMA. It has been an incredibly enriching experience, and one I will never forget.

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