IMA Cross-Cultural Care Mental Health Internships Abroad

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

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

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