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.

I am SO glad that I made the decision to join IMA in Kenya. After endless vetting for the seemingly most legitimate, meaningful, and impactful internship abroad, I decided to go with IMA. As my parents were initially hesitant, I am glad to report that neither of us are disappointed. There were so many positive experiences, that whatever else paled in comparison. The staff were THE BEST and helped make the trip that much more organized, fun, educating, and memorable! They were always open and receptive with communication and addressed any questions or concerns. I felt truly supported by them. Working in a hospital setting for the first time was extremely eye-opening, and oftentimes heartbreaking. I was admittedly afraid of being thrust into conducting psychiatric sessions and offering helpful advice to patients - but was instantly moved by the abundance of faith and positivity. The impact made me feel as though I had contributed meaningfully and learned so much. Gratefully, IMA planned lots of interesting tours, clinics, and lessons to adequately add to the experience and education. Planned activities were immersive, and enjoyable, and also provided unique cultural perspectives. The treks were incredible and well organized, with great guides and activities. It is quite the luxury, but it is definitely worth having the experience while you're there! When asked to reflect on what I have learned from my internship with International Medical Aid in Mombasa Kenya, my mind floods with an amalgamation of faces, stories, smiles, and painful struggles. It is no easy feat to concisely put into words all of the experiences shared, and lessons gathered. Though cliché, I truly felt as if I was acquiring knowledge in each interaction had – whether it be medical, historical, cultural, or personal, there was always a new perspective to be learned. Made clearer than ever, was the opportunity for growth and connection when one opens their mind, heart, and ears to those around them. By voicing our concerns and deepest struggles to somebody we trust, the grounds for support and healing become fertile. Though community is a powerful agent of health, it is inevitable that individuals will fall through the cracks in the foundation of governmental institutions. When housing, food, and education are a large financial burden for many, accessing quality healthcare becomes a luxury (Odhaimbo & Njeru, 2023). Additionally, there are social constraints such as religion, stigmas and taboos, and gender norms that further dictate health quality and seeking behaviours (Bakibinga et al., 2022; Coast General Teaching and Referral Hospital, October 2023). Throughout this paper, I aim to highlight the disparities and their origins in the Kenyan healthcare system, via resource scarcity, financial instability, lack of health education, social stigmatization, and violence against women and children. Lastly, I seek to draw comparisons from North America to illustrate that these inequities are ubiquitous and cross-cultural in nature. Firstly, I would like to preface that this discussion is from the perspective of a Canadian student, who has never known the struggle of financially supporting my family members, falling short of tuition fees, or only affording one meal a day. I do not know what it is to live in a country that largely pathologizes homosexual relationships, or what it may feel like to be ostracized from my community for engaging in premarital intercourse. While I was aware of these differences before I began my journey, my fear of immersing myself in this culture lay in transitioning to a label that was now “other”. The worry was not aimed internally, but rather at, “how would I adequately understand, support, and respect a culture so different from my own?”. Ingrained deeply in my values and often uncensored personality is a duty to speak up in the face of injustice and inequality. And so navigating a terrain rife with these imbalances was a daunting feat. Without proper experience, training, and cultural knowledge, how was I going to effectively and ethically address the concerns of patients in need of dire help? Sadly, yet thankfully, I quickly learned that any participation would be of enough value. An unfortunate truth made apparent swiftly, was that skill and ethics are cast aside when labourers and resources are scarce. With a meager 8.5% expenditure allocation from the government, considerable mortality rates from treatable ailments, and approximately 1 psychiatrist per 1 million Kenyans, one would be illogical to assume the level of standard practiced in the West (Odhaimbo & Njeru, 2023). In spite of the barriers, I observed many determined doctors and interns. They are passionate about their patients and offer healing in the best ways they know how. As always, there are those who exploit a flawed system. Sadly, this reality is inevitable cross-culturally, where financial gain often remains a top priority. Many practitioners and organizations will cut corners across care and ethics standards to reduce costs and effort output (Odhaimbo & Njeru, 2023). Alternatively, skilled professionals often flock to the private sphere or other nations in search of higher-paying wages (Odhaimbo & Njeru, 2023). Perpetuating a cycle of inaccessible care, those most vulnerable often bear the direst consequences. Whilst the government invests heavily in infrastructure to boost private capital growth and the production of goods, the needs of the population are severely ignored (The World Bank, 2017). Coupled with the fact that mental health is heavily stigmatized and not overtly apparent, seeking help for it is even harder. Alike North America, a historical lack of education, cultural gender norms, and the fear of being labeled ‘crazy’, seem to perpetuate the stigmatization and lack of access to mental health care. Though doctors recognize that targeting prevention is a more effective means of remedying physical and social ailments, the current system and resources in place often inhibit it (Odhaimbo & Mohammed, 2023; Coast General Teaching and Referral Hospital, October 2023). Too frequently, a problem remains untreated until its manifestation becomes critical. Rather than the loss of human lives, this turning point wrongfully often lies in the loss of capital and productivity. To provide a small-scale example, I was pleasantly surprised when one of the head psychologists, Anne, was invited to spend the day at a local shipping company to discuss mental health with their employees. The following day, seemingly exhausted, she shared the alarming degree to which these individuals were suffering at. Until eight o’clock in the evening, she was flocked with pleas for private discussion, where similar tales were divulged of severe stressors, an inability to cope at or prioritize their work, and a deeply rooted shame in the expression of their emotions and struggles (A. Nzioka, personal communication, October 12, 2023). To take time away from work to focus on our health and our dependents is a luxury that many cannot afford. When I praised Anne and the company for their efforts, she non-chalantly remarked that the company had suffered several suicides and a drop in workplace productivity (Coast General Teaching and Referral Hospital, October 2023). Presumably, the company sought to improve their financial returns and efficiency, rather than the health of their staff that allowed it to function. Likely, the most common concern from patients was how they would manage to pay their bills. Though private healthcare providers exist, and are the dominant choice, they are unaffordable and inaccessible to many (Odhaimbo & Njeru, 2023). Additionally, only 26% of Kenyans have insurance, and 36% live below the poverty line (Odhaimbo & Njeru, 2023). In the United States the rate of poverty is estimated at 11.5%, and in Canada 8% (Shrider & Creamer, 2023; Government of Canada, 2023). To risk their family’s being pulled from school or starving, people are unable to afford the time and cost of seeking medical attention. Due to a shift toward decentralized control and a lack of resources, public sectors remain grossly unequipped (Odhaimbo & Njeru, 2023). Statistically, patient outcomes are poorer and the rate of infection from the hospital is larger (Odhaimbo & Njeru, 2023). As a result, having less financial means leads to inequitable access and quality of healthcare. For those with a poorer socioeconomic background, a lack of education and health literacy results in worse health-seeking behaviours (Odhaimbo & Njeru, 2023). These individuals are more likely to delay diagnosis and treatment, or simply do not have the knowledge and tools to create and maintain health promoting habits (Odhaimbo & Njeru, 2023). A reality for some patients is spending weeks in the hospital, unsure of their diagnosis, and unsure of how to ask their doctors about it. From a lack of time or urgency, the role of many doctors and nurses remains to examine patient status, administer medication, and move on to the next. Patients may refrain from demanding explanation or treatment for fear of being labeled difficult, and further ignored by faculty (Coast General Teaching and Referral Hospital, October 2023). Oftentimes, the burden of disclosing the most sensitive and heartbreaking news is delegated to the psychological staff. To highlight the extent of broken communication, Margaret was a young woman teeming with discomfort and pain. She was noticeably underweight, tears leaked from her eyes, and her stomach was distended to the degree that assumed pregnancy. Following a discussion conducted in Swahili by a psychiatrist in training, Dr. Sood, we consulted her medical file. Since 2018, extensive detail had been recorded on Margaret’s treatment and recurrence of cystic ovarian mets (Personal communication, October 15, 2023). Though receiving blood and chemotherapy in the past, it was clear - without medical training, that her condition had catastrophically worsened. Dr. Sood and I were shocked to see that a recent entry had stated the patient was briefed on her condition, yet she and her husband were asking about the course of treatment and surgery that would follow. The file read that Margaret would be transferred to the palliative care unit, as there was no further treatment (Coast General Teaching and Referral Hospital, October 2023). Lastly, a major disparity that I witnessed was in the way that women are treated both inside and outside of the hospital. Touring the labour wards, I was appalled to see each expectant mother alone - a protocol that is enforced by the hospital. In the maternity and other female wards, a male companion was a rare sight. Gender roles seemed much more solidified, where daughters, sisters, and mothers were often relegated to caretaking, and men presumably remained at home and in the workplace. Though many had several family members that were capable, it was the school age girls, elderly matriarchs, and working mothers that assumed the role of personal nurse. In the male wards, a wife was the most common bedside assistant, followed by a son or brother (Coast General Teaching and Referral Hospital, October 2023). Confined in the bleak hospital environment, women frequently risked their physical and mental health, education, income, and free time in order to provide care for their loved ones. Remarkably, Kenya has abolished user fees for labouring mothers in the hospital, a luxury that does not exist in the United States (Odhaimbo & Njeru, 2023). However, several breaches of Western healthcare practice and standards were detailed by my medical peers against birthing women. Though anesthesia is rarely administered to the degree it is in the West, it is seldom used in the process of labour. Additionally, though it is classified as a high-risk procedure, the lack of resources and standard of care employed reflects a greater ignorance of female health. One intern detailed how more than once, after closing a c-section only then did medical personnel count the sponges and realize they were short. The response was that of, “well, she is already closed”. Another intern described the sheer agony a delivering mother was in when her baby was not crowning, devoid of familial support and epidural or pain medication. Mistakenly taking the doctors open hand as an attempt to soothe, he smacked it away. Afterward, they proceeded to inefficiently cut her perineum with a dull pair of scissors. Many Kenyan women avoid delivery in public facilities for these reasons. While other labs at the hospital have received state of the art technology and adhere to proper sanitary protocol, the condition of maternal care reflects the greater inequality and acceptance of violence toward female bodies. Similarly, we were met daily with the harsh realities of violence and abandonment perpetuated by male figures in domestic and public spheres. During my time in the gender violence department, not one survivour was over the age of 25, and the majority were children below the age of 10. Among my consultations, there was only one boy, yet he was brought in by his mother for assaulting their house staff. Rather than fearing his harmful behaviour and seeking psychological treatment, her main concern was that he had been engaging in intercourse and wanted him to be “checked”. With slight gestures to her behind, it was evident that she feared her son was engaging in homosexual intercourse, thus leading him to assault their cleaning lady (Coast General Teaching and Referral Hospital, October 2023). Countless other horror stories were divulged, including one where a man living at the perimeter of a school was coercing female students on a scheduled basis to engage in sex for the exchange of money. Having close connections with the village elder and a relatively corrupt justice system, the process to detain and charge the perpetrator was hampered. Another incident was where a teacher physically reprimanded a 3 1/2-year-old student which resulted in her broken arm (Coast General Teaching and Referral Hospital, October 2023). An image I doubt will fade from mind, is when we visited the Kadzandani primary school for a hygiene information session, and a teacher smacked a child in the head for misbehaving. Such force of power from an authority figure toward a child - or any being for that matter, was completely foreign to me. Instinctively, I audibly gasped and froze in place, though no one around me acted like anything had happened. Admittedly horrified and unable to shake the occurrence, I afterward asked a program mentor if physical punishment is common in Kenya, aware that there are cultural differences in the practice. After a genuine bout of laughter, she replied that it is considered weird if a parent does not do that. Apparently, it is only against the law if you leave a mark or sustained injury. How does one learn that corporal violence is psychologically harmful and has long lasting negative effects, when caregivers freely enact it on children? In all instances, there was some form of institutional authority that minimized or largely perpetuated the acceptability and prevalence of physical and gendered violence. Lastly, a large player dominating the intersection of gender, health, and sexuality is devout religious ideals. Stemming from the amalgamation of colonizing powers in the country, Christianity and Islamic faith are widespread (Odhaimbo & Njeru, 2023). With 94% of Kenyans identifying as religious (Odhaimbo & Njeru, 2023), sex outside the context of marriage and childrearing is taboo and strongly discouraged. Coupled with a lack of health literacy and birth control access, many young individuals do not have the knowledge, tools, and acceptance to engage in healthy sex practices. Unfortunately, this leaves many with sexually transmitted infections, unwanted pregnancies, and ostracism from family and community. The implications of sexual harm are worse for women, where they must unequally bear the outcomes of pregnancy and childrearing, assault, and victim blaming. This effect is even larger for LGBTQ+ individuals, who face immense shame, disapproval, and a lack of community or supportive systems. It was shocking to hear the contempt, perceived ill-nature, and need for cure of “gayism” espoused by psychological professionals. Likewise, in order to “safely” access resources, intimacy, and a family life, many young women are sold the dream of marriage before their minds and bodies have had the chance to fully develop. It is estimated that about one in every five of Kenyan girls aged 15-19 are expecting, or already have a child (African Institute for Development Policy, 2016). At one point, the head psychologist Anne led a small group of interns to speak with an 18 year-old girl who had just lost her baby and her uterus. In many traditional Swahili cultures, men are permitted to have multiple wives (Odhaimbo & Njeru, 2023). In reality, this often allows men to neglect their family once they have grown tired of them, as their attention and income is redirected to alternative dependents. As heard many times by a variety of female patients in the hospital, when a man decides to spend his time and resources elsewhere, it becomes the responsibility of the mother to pay bills, feed their families, and raise their children. Additionally, where abortion is only offered in life-threatening emergencies, similar to some of the United States, women are once again disproportionately restricted to the choices they can make for their own bodies and life. Many women are forced to choose between raising a child they may not want or have the means to support or risking their lives in an underground abortion procedure. It became no wonder why the top cause for admission to the gynecological ward was incomplete abortion (Coast General Teaching and Referral Hospital, October 2023). “But it is not like that where you are from”, or some version of this was a statement I heard often. My immediate and truthful response was to reply that - in fact it is in some ways the same. Despite Kenya having higher poverty and a host of inequitable challenges, many of these same health and social concerns exist in North America and for a large number of people. In Kenya, the poverty and disparity in healthcare is simply more widespread and easier to see. My aim in this statement is not to neglect the health crises and larger gaps that exist in Kenya, but rather to highlight the ubiquitous nature of inequitable global health. Whether in North America or Africa, the resources available to a nation and individual will heavily impact ones’ quality of safety and health. During my time in the hospital, the primary lesson I learned was that positivity and support truly go a long way. Connection and belonging are essential for wellbeing, which was observed in each interaction. Daily, I found myself glowing from the unyielding spirit and hopeful souls of so many people. Though I have never worked in a hospital, I doubt that this radiance exists everywhere. It seems as though it is much easier to appreciate what you have, when one is not constantly striving to gain more. My journey in Kenya magnified the level of privilege that exists in my own life - where travel, education, health, safety, and clean water come relatively easily. Pertinently, my life has allowed me the luxury to question the environment around me and freely decide the paths that I venture. For those in a cycle of poverty or struggling to make ends meet, the same freedoms, safeties, and choices are far less tangible. More than ever, Kenya has shown me that humanity fares much better when we are united in community, rather polarized and interested in our own good. I realize that while stigmas are alive and well to demonize those that stray from the norm, the global community heals when we accept those that are different and learn from new perspectives. While the world of economics and power politics fills us with fear, hatred, and superiority, it distracts us from what it means to be most human - to relate to and care for one another. In summary, the key teaching from my internship abroad in Kenya is that we must critically challenge systems of inequality, and actively work to promote health and safety for the welfare of all global citizens. Though health is a human right, it is far too often treated as a commodified privilege. Unsure of exactly which career path I will end up on, my internship experience has assured me with confidence that I will continue to assist others in achieving safety and support. Gaining this firsthand knowledge, I am eager to continue counselling gender violence survivours, and promoting education on sexual and mental health. Being abroad in a completely new environment ignited my passion to work with the global community and explore other cultures. Overall, my internship with International Medical Aid has provided me with lessons and experiences I would not expect to gain elsewhere. I am forever thankful for the perspective and connections it has opened me toward as I seek to find myself and my career journey.

From the moment I stepped off the plane in Mombasa, the program mentors were there to assist me in any way I needed. The security on site made me feel incredibly safe during my stay. My experiences in the hospital were some of the most shaping of my entire life and I could never be more grateful for the experience I had there. Our program chefs were incredible and made delicious food, including cultural foods for us to try. I know this sounds like rambling, but I just have too many good things to say about my time with IMA. I have what I would consider to be a special and deep passion for mental health care. As someone who has struggled with mental health for a majority of my life, I have seen first hand how detrimental and isolating mental illnesses can be. As a child, I lived what can only be described as a double life. At school, I was a poster child for the perfect student. I excelled in all my studies, testing years above the grade I was in at school. All throughout elementary school, my teacher’s took special interest in me and my intelligence, giving me advanced worksheets and books to read to keep me entertained and challenged. However, once I went home, a switch flipped and I became a completely different version of myself. Nearly every day when I would come home from school, I would scream and cry for hours, throwing tantrums that left my parents helpless with no clue what to do. They took me to specialist after specialist, and no one could figure out what was wrong with me. Hearing that there was something wrong with me at such a young age definitely impacted the way I viewed myself and mental health growing up. It was not until I was about thirteen years old that I was diagnosed with anxiety. This anxiety that I masked at school, when paired with the boredom I experienced due to work I found too easy, fostered tension that was released once I stepped foot inside the safety of my home. For a short period of time following this diagnosis, I wanted to be a child psychologist. Frankly, I just thought it would be a cool career. It was not until I turned twenty that I realized my passion for mental health care and how deeply I cared about the issue. It sounds cliche and dramatic to state that I had an epiphany, but that is the only way I can think to describe how I came to my decision to be a psychologist. Yes, I was a psychology major in my last year of college, but I had no idea what I wanted to do after graduation. This fall, I went through what can only be described as the hardest time I have experienced. I spent days unable to get out of bed, trapped inside my own head and paralyzed by my anxiety. At night, I would be taken by horrifying panic attacks that seemed to come out of nowhere, leaving me shaking and unable to catch my breath between sobs. At this point, I genuinely no longer wanted to be alive. The single hardest thing I have had to do in my entire life was tell my parents I needed help. Once I got my medicine adjusted, my anxiety started to decrease, and it was at this point that it became clear to me that I wanted to work in mental health, helping people who struggle like I have. Once I was accepted into International Medical Aid’s Mental Health program in Kenya, I was beyond excited. I had never worked in a clinical setting, and the only exposure I had previously had to mental health facilities was the child counseling center I went to when I was younger. I thought that I could not be more prepared, as I would have a unique first-hand understanding of what the patients I would deal with experienced. However, I could not have imagined the dire state of mental health care in Kenya. My first day in the hospital was nothing short of eye opening and shocking. While I had known that the hospital would be nothing like the healthcare facilities in the United States, I could not have imagined the setting I stepped foot in. The first thing I noticed was the sanitation, or lack thereof. Nearly every room in the hospital held rusty equipment, with few monitors or other devices one would expect to see in a large hospital. There were flies everywhere, and it was drastically clear that there was not only a lack of staff, but an abundant lack of resources. The moment I stepped foot into the psychology unit, my confidence that I knew what to expect immediately dissipated. The unit was incredibly small, with a medical officer and two psychologists. There is also a psychiatrist, but during my three weeks in Kenya, I did not ever meet or see them. Considering the population that Coast General Teaching and Referral Hospital serves, two psychologists was nowhere near enough to combat the mental health problems that Kenyans faced. Statistics supported my observations, as it is estimated that 1 in 4 Kenyans is likely to suffer from some sort of mental illness at some point in their life. Furthermore, there are only 62 psychiatrists in the entire country of Kenya (International Medical Aid, 2019). Learning about these facts only further solidified that the state of mental health care in Kenya was much worse than I had previously thought. Each day in the psychology department brought new cases and challenges. I was able to sit in on counseling sessions with a variety of different patients, allowing me a clinical experience that I would never be able to have in the United States. One of the first cases I sat in on was with a first-time mother who had lost her baby during childbirth. While Anne, the psychologist who handled the case, counseled the mother with nothing short of compassion and inspiration, it was immediately clear the vast differences between psychological counseling in Kenya as opposed to the United States. Essentially, all the psychologists were able to do in this case was to provide support and guidance for staying busy to keep the mother’s mind off the loss. It was also emphasized to her that she would likely conceive again, and that situations like these are out of our human control. Though, the most shocking part of the session was that we sent the mother back to the maternity ward to wait for discharge, where she was surrounded by all the other new mothers holding their newborns. While there was nowhere else for her to go, as there wasn’t a psychiatric ward or anything of the like in the hospital, sending her back to an environment that would only remind her of her loss seemed cruel. Perhaps the most heartwrenching case I experienced over the span of my three weeks in Kenya was with a fourteen year old girl. She came into the Gender-Based Violence Center, and the first thing I noticed about her was how small she was. She looked sickly, and during her counseling session, she kept coughing and appeared short of breath. It was during this session I learned that she had been raped by a neighbor. She actually had blocked the rape out of her conscious due to trauma until she realized she was pregnant, at which time the horrific event came back to her. When I heard this story, I was overcome with anger and felt physically sick. Hearing this small fourteen year old child tell us that she was pregnant with her rapist's baby brought bile up my throat. The worst part of it was that he was not in prison. She had to go home and live in fear everyday because he was not in custody. After the session ended and the girl left the room, I asked why he wasn’t in custody. I was told that it was a legal issue and there was nothing we could do pertaining to the rapist other than offer the girl support. This infuriated me and truly showed me how vastly different Kenyan medical care and politics were from those in the United States. If something like this happened in America, there are systems in place, teams that work together to ensure that the patient is taken care of medically, psychologically, and legally. But there was no legal team for us to work with to ensure justice. Rather, it was a completely different structure in society that needed to be dealt with separately, only causing additional stress to the client. Rape was actually something that I heard a lot about during my time working alongside the psychology team. This sparked a desire inside of me for working with those who have experienced sexual assault and abuse. While I have not personally experienced rape, I know far too many people who have, and hearing these stories lit a fire within me for advocating and helping these victims. While I had previously known that I wanted to work with adolescents and young adults, this clarification allowed to me realize that I would like to work specifically with depression, anxiety, and sexual abuse cases. Depsite the challenges I know will come with this field of practice, these victims deserve to have someone listen to them and support them through these dehumanizing experiences. A study on mental health and gender-based violence in Kenya found “...that experiencing rape within the last two years was a strong predictor of scoring poorly on all PTSD, depression, and anxiety scales” (Friedburg et al., 2023, p. 10). In a country that already is facing a multitude of mental health problems, with no public funding to combat them, the co-occurence of rape and poverty only further worsen these issues (International Medical Aid, 2019). Despite the difficult and sickening stories I heard during my time at Coast General, my experience is one that I will cherish and remember for the rest of my life. I learned more than I could have ever imagined about mental health care and what a career as a psychologist looks like. While there were vast differences between psychological care in Kenya and the United States, there were still countless lessons I learned during my internship. For starters, I learned how to deal with cases using empathy and kindness, fostering a comforting environment that allowed clients to feel safe opening up and sharing their experiences. I also learned how to support clients through these extremely difficult times, providing them with hope and support. It was nothing short of fulfilling knowing that despite the difficult circumstances these clients were facing, I was someone that they knew supported them and believed in them. It became clear that providing support is no small gesture, as mental health in Kenya is extremely stigmatized. According to the Forum on Neuroscience and Nervous System Disorders et al. (2016), “Stigma toward people with mental illness exists on every level, from the community to health care workers.” This stigma further deters people from seeking help, exacerbating the mental health problem. My time in Kenya with International Medical Aid was nothing short of a dream come true. During my time working at Coast General Teaching and Referral Hospital, I gained an immense amount of knowledge and experience that I would never have the opportunity for in the United States. Working alongside the psychology team allowed me to sit in on counseling sessions with patients and to see how the psychologists handled difficult issues. Each day I spent at the hospital further solidified my passion for mental health care and provided me with clarity that this is the career I was called to. I am confident that this experience will help shape my counseling outlook during my career, as I now have a unique perspective on cultural aspects of mental health. This experience has also opened my eyes as to how desperately mental health needs a global platform. Even in the United States, mental health still has a lot of stigma attached to it. I will never stop advocating that mental health matters. After all, how can we expect people to live a full life, contributing to society, if we do not address the illnesses and challenges they face concerning their mental well-being? 

The programme was extremely safe and welcoming. The food was excellent and so were the ALL of the staff. The mentors were very helpful and kind. Safety and accommodation was also excellent. I found it extremely difficult, especially the first few days, to hear the stories and get to know the patients myself and the psychologists spoke to. I found it of course very upsetting, however I did not expect there to be such amazing facilities or organisation regarding mental health because of the stigma in Kenya. So, this was a nice surprise and helped when I found it upsetting, because it was good to know that they have somewhere, and that they have people to help them. The psychologists and psychology interns I worked with were truly outstanding at their jobs, I am surprised about the difference between psychologists in Kenya vs at home. I prefer the more hands on/passionate techniques and demeaners that the psychologists in Kenya had. I knew I wanted to work in psychology before and most likely with victims of abuse, and after this experience, it has tripled my goal of pursuing this career. Seeing the effects that talking to the patients had alone was so inspiring and confirmed the need to work in this field. I was also extremely taken aback by the resilience of the patients, I believe that a part of this is because most of them do not have the 'luxury' to dwell on their feelings, as they have families to run, jobs to go to (without excuse) and fewer resources to help them with their troubles over a long period of time. The GBVC clinic and the people dedicating their lives to helping patients was so inspiring; going to court for them, carrying out gruelling medical exams for abuse survivors, and supplying victims with resources, despite them having little to give themselves. I could not have had this kind of experience in my home country.....it was more than valuable. I hope to keep in contact with the staff I worked with and hopefully return to the hospital when I return to Kenya. My experience in Mombasa with IMA has motivated me further to pursue a career in Clinical Forensic Psychology and if possible, return to Mombasa to conduct research for my future dissertations. I found the cultural/social differences to be extremely interesting and enriching, including the greater resilience that I observed in the people in CGRTH compared to people in the UK (a generalisation). Additionally, it was priceless for me to be able to shadow doctors in surgery and OB, as I would not be able to gain this kind of experience in the UK (without being a medical student). I found it extremely interesting, however I am still set on pursuing a career in psychology. Since the very start of my high school years, I was fascinated by how people think and what makes people act as they do. I realised I fell in love with Psychology after completing my final 2 years of high school studying higher level Psychology. This was my first formal introduction to the subject, but I did not have any hands-on experience with the clinical aspects of psychology until my first years of university, where I volunteered at a suicide prevention phone line. I learnt so much during the training for this experience and during the night shifts on the phone talking to the hotline users. Talking to them about their suicidal thoughts, severe depression, anxiety and experiences with abuse, I was able to fully understand the extremes that poor mental health support can bring people to. I knew that I would do whatever I could to help people with this delicate area of wellbeing and I would take great pride in doing so. I had been to Kenya on multiple occasions prior to this internship as I have family living all around the area, however I had never been to Mombasa or to a hospital in East Africa. I arrived in Mombasa only knowing that I want to pursue a career in psychology and that I would have novel experiences that I would not be able to get in my home country, England, or most other places in the world. I experienced this within my first day in the hospital. I walked into the Gender Based Violence Clinic and was shocked by the number of patients waiting to be seen and the small size of the facility. However, having had some experience with East African culture and society, I was also pleasantly surprised that there even was such a facility or that there were a good number of psychologists and psychology interns who were making such a large difference at the hospital. During my first day in the hospital, after introducing myself to the psychologists and psychology interns that I would be shadowing for the next 2 weeks, we started our rounds in the post-natal department to look for new mothers who needed counselling. The first thing that stood out to me was that new mothers had to share beds with their babies and other women due to capacity limitations, this was seen all around the hospital, including in units where patients may have been contagious. During the rounds on the first day at the post-natal unit, the majority of the counselling was for mothers who had lost their babies. I was taken aback by the psychologists and their interns’ counselling techniques because I immediately noticed differences between them and psychologists that I have seen and worked with in England. For example, in England a psychologist would not suggest what the clients next steps should be at all or if they did it would be after trying many other techniques first; there are strict regulations on ‘advice-giving’. In England psychologists would not often give patients any options until the patient suggested them themselves. For example, we spoke to a woman in the GBVC whose daughter had been defiled, and the perpetrator was said to be released from prison and back into their village, where her children live. The mother was quite inconsolable at first, very emotional and understandable, not thinking rationally. The psychologists seemed to deem that the best way to help her was to lay out ideas and steps that she can take, to help make it clearer for her and it seemed to calm her down a lot. After reading psychology guidelines, I found that very few people recommend this technique for psychologists as it is seen as unethical and to cause very harmful, ultimately unhelpful, outcomes. However, I personally saw that it truly helped the patients to be told their options and to let them decide the outcome. I believe that this observation is due to the severity of their living conditions, which means that they do not have the ability to draw counselling out over multiple sessions, they cannot afford to take time from work, their family or make the journey to their sessions. If they were to be treated by a psychologist as though they had expendable time and money, they could maybe slow down the end goal of viewing options and instead focus on emotions and recovery. However, they do not, therefore, I really believe that in scenarios such as the ones I witnessed over my internship, this is the best technique to use. Additionally, I believe that the success of this method may also be due to a lack of education in some cases. For example, the case with the mother that I mentioned above, the direct advice seemed to help a lot not only due to the short amount of time and money she could spend in counselling, but also because she simply did not know what some of the options and legal consequences for the perpetrator entailed. The first week, when we were asked to sum up our week in five words, I thought of ‘the luxury of staying sad’. It seemed as though the patients we saw did not have the “luxury” to remain crippled by their emotions for long at all after an incident. For example, there was a mother we saw in the post-natal unit who had lost her 3rd child only moments ago, and within 10 minutes of speaking to the psychologist she stopped crying, her mood seemed to lift and she came to the conclusion that she must be fine in order to go home quickly and feed her other children, take care of her family and go to work. I found this difference to be extremely interesting between what I saw here and what I see in the western world. Family and friends that I know have gone through a stillbirth, a miscarriage or any kind of physical assault would have not been able to carry on, compartmentalise, push through, however you would like to describe this resilience. I believe this is because their lifestyle does not force them to. By no means am I suggesting that the patients I saw in Kenya feel less about the traumatic incidents that they face, but that they are more resilient because they must be. This is interesting because it shows what the human is truly able to withstand. In the UK (and USA) we are overly coddled to a point where it seems as though it is having negative effects on the population, which most psychologists are trying to fight back on. For example, in the USA and in the UK, people have been trying to censor what others say, write and read if they deem it “offensive” or “triggering/traumatic”. Countless psychologists have deemed this practice to be increasingly harmful for our youth’s mental health, anxiety, depression, and victimization. I will be writing a dissertation for my master’s programme this year and for my masters next year. This observation has piqued my interest in studying resilience in the face of trauma across the globe, perhaps even looking into people’s emotional resilience in war zones or advocating for the damage that censoring does to our resilience and mental health. Another idea I would like possibly to explore is the relationship between happiness and resilience, then compare this in Kenya to the UK. I spoke to IMA alumni Caitlin Moroney and saved her contact details as she completed her research project based in Mombasa, which is something I would like to do either on some of the subjects above or this related to sexual violence victims. My first 2 days especially, I found it very hard to not be too emotional in front of the patients in response to seeing them in dismay or after hearing their stories. I spoke to the psychologists and interns (Anne, Saida, Joy, Grace and Hashwin) to learn how they do not allow themselves to be too emotional in front of the patients. They advised me that I am not the patient’s friend or family, so I do not need to be so closely emotionally involved in their stories. The patients need someone to talk to who will be professional and who won’t get emotional, that is how we would help them. This advice really helped; I carried it with me for the next 2 weeks and putting this advice into practice in Mombasa. We are only there to help them and be able to listen and provide comfort that they may not get elsewhere. Something interesting that I observed when the patients could only speak Swahili was that I was trying so hard to decipher what they were saying through their body language and facial expressions that it felt harder to not get too emotional. I tried to find studies supporting this however I found that although body language provides us with 90% of our information about people, body language is not universal and differs across cultures (Academy & Sharmin Chonda, 2022). I am unsure why I felt like it was harder for me to witness sadness of the patient through their body language compared to their words (when they spoke English), perhaps it is because of my prior experience with the Kenyan culture, or perhaps it was due to the timing of the observation being at the beginning of my trip before I became able to control my emotional reactions to patients. The psychologists and interns always debriefed me after the session with the patient if they only spoke Swahili, and if appropriate, they would translate a bit of the conversation during the session. Those were my observations from just the first few days, and already I confirmed that I had chosen the right career path to follow. I was very lucky to have another intern from IMA who was working in the Gender Based Violence Clinic (GBVC) at the same time as me for the first week of my stay. She already knew about how the days worked and what our roles could be in the GBVC, so she helped fast track my learning process and ensured I was integrated quickly. During the first week we saw a case of a 2-year-old sexual abuse survivor. While the mother and the psychologists spoke in Swahili, the other intern and I kept the little girl company and brought toys from the children’s area for her to play. Despite her sad backstory she had, she was extremely playful and very affectionate which was surprising but inspiring to see. We were with her for quite a long time, playing with the toys and learning some words in Swahili from her and her mother, however we noticed that the toys were not clean, a lot were broken, and it was a safety concern. The young girl we saw that day was putting the toys in her mouth (as expected from a 2-year-old) even though the toys were very unsanitary. The other intern, who was also working in the GBVC, and I went to the mall to buy new toys for the children’s play area in the clinic and cleaning supplies so we could clean the existing toys and tidy up the area. We saw many more children that week and hope that it helped make the area more comfortable during stressful times and appointments. The women working at the GBVC were exceptional. There are the psychologists who work at the GBVC when needed to counsel, there are the doctors and nurses who work a the GBVC to perform medical tests, and then there is Mary who organises so much and works with the victims regarding the legal aspect of their cases. I never shadowed Saida in the medical examination room, but I know that they performed forensic sexual violence examinations that mimic the ones you would see where I am from in the UK. This includes tests for STD’s such as HIV, and oral, vaginal or rectal injury examinations. During the second half of my second week, I went with the psychologists and interns to do rounds at the oncology, radiology, newborn and burn unit. The oncology unit where patients were receiving chemotherapy was extremely cramped, but the majority of the patients seem to be uplifted after speaking with us. This was interesting to see how a little conversation seemed to improve their demeanour so much. On one of our rounds to ward 1, we spoke to a girl who was born with HIV (transmitted from her mother) who had been in hospital for 8 weeks with tuberculosis. She was extremely upset in all of our visits over the 2 weeks because she wanted to leave the hospital and return home, although she could not because her mother could not pay, and her father refused to. The social services were in the process of helping her return home when I left, and after following up with one of the interns a few days ago I found out that she has been waivered and thankfully sent home! I was stationed with the psychology department and the GBVC for the duration of my internship, and I never wavered that that is where I wanted to stay. I was however interested to see the real life versions of the stories that my peers who were all pre-med were describing. I was especially interested in experiencing OB, and surgery, so I signed up to an afternoon shift in surgery and a night shift in OB. My afternoon in surgery was certainly intriguing, I had never seen anything like it, unlike my other peers who had been in pre-med school for the last 3 years. The first surgery I saw was a diabetic man who’s sole of his foot had begun to rot away, I found out that this surgery is called a debridement. It seemed like standard procedure except for the comfort offered to the patient, in that I did not observe the surgeons provide any comfort to the man. His heart rate was rising quickly, so I tried to search for the word in Swahili to tell him not to worry and confirmed it with the main surgeon. The patient laughed and politely corrected my pronunciation of ‘usijali’, which seemed to lessen his nerves. Whether it was from the entertainment and distraction he found in correcting my Swahili or from the phrase itself, or both, I am unsure, but I was relieved to see him relax during the spinal anaesthetic. I was also lucky enough to see a twin c-section. I have never seen a natural birth (until my nightshift in OB) let alone a c-section. One of the babies was in breach and one had the umbilical cord wrapped around his neck. I was able to watch the c-section with another intern who had been in OB all week and who had OB-GYN work experience back home, which was very interesting and helpful to be able to ask her questions. I was beyond shocked when I saw the surgeon reach into the small incision with both hands and pull apart the muscles to get into the uterus. I was even more surprised to find out that this was a normal worldwide procedure for c-sections. I was able to view my IB biology knowledge in real time during the c-section When the babies were out and stable, and the mother was safely stitched back up, the wave of relief was unexpectedly strong. The last surgery I saw was for an open tib-fib fracture, where a man had an accident on his ‘boda-boda’. Here I watched the surgeons cut open the wound further to expose the broken bone, then drill metal rods into 4 precise places in his tibia, stretch it apart and forcefully push the bones back into place. It was totally novel and fascinating. In all these surgeries, the patients were only on local anaesthesia and were therefore awake. This was especially shocking in the tib-fib fracture due to the noise of the drills that the patient was able to hear. The patient was severely shaking and was complaining of being cold, we turned off the AC and covered him up where we could, however it did not seem to help. I thought it may also have been from the cold IV drips he was receiving or most likely from some shock because of the noise and commotion surrounding his injury. I realised that the lack of general anaesthesia and the fact that the patients were awake during their surgeries is different to the USA and England after asking my friends who study medicine. After asking the surgeons, I found out that this was due to a lack of supply, which reminded me of the luxuries in western countries or private hospitals in Kenya compared to Coast General Teaching and Referral Hospital (CGTRH). Since the doctors and psychologists, I shadowed were highly trained and knowledgeable, sometimes it was easy to forget that CGTRH was in a third world country facing the limited access to basic resources and medicines. One of the most interesting, and less emotional cases was of a young boy who was referred by his aunt who was worried about him after finding out about a sexual experience he had with an older man. I waited with him for a while before the psychologists were ready to come back in and speak to him. During this time, he lied about where he lived, why he was there and that he had a full-time job as well as a successful rapping career. He was obsessed with a rapper from the US and had become violent when people didn’t share a mutual love for the rapper. He also explained that when he is violent, it is a female alter-ego of his and not his male personality, which I found out is not what I thought-split personality disorder, but rather a dissociative disorder, possibly because of his upbringing by an extremely unstable mother. I have never met anyone like this patient in my life and it sparked such a great interest in dissociative and split personality disorder in relation to violence. I completed my undergraduate dissertation on sexual violence, so I have previously had great interest in why people commit such violence, this experience gave me an ulterior angle to research it from. This leads me to a cultural difference that I found intriguing. I had heard of the stigma surrounding mental health in Kenya; however, I had never seen it in person properly until my trip to Mombasa. Although I have read many studies about the inadequate access to mental health in Kenya (Short, 2023). I noticed that after we would introduce ourselves to patients and psychologists and psychology interns, they would seem confused and sometimes did not understand what our role was or how it differed to a doctor. Despite this observation, it was found by the World Health Organisation that over 2 million people in Kenya have a reported mental illness (International Medical Aid, 2019). This statistic is likely much higher, as are other statistics of many physical illnesses, although this is often due to the reliance on religious beliefs to cure their illnesses over doctors at the hospital to. Another cultural difference was the difference in expectations for men from Kenyan women and expectations for men from western women. For example, I was asking the psychologists and interns why men are rarely present for the birth of their child. I was old that it is not the man’s role to be there for the women, it is a women’s time. This is very different to England and the USA which I explained to the interns. In response to me explaining how unacceptable it would be for the husband to not be there for his wife during birth (unless there was a very valid excuse), the interns were confused and quite amused. Additionally, from the women who came into the GBVC for domestic abuse, it seemed as though men had a disregard for the women in their communities. This may be a factor in the high prevalence of sexual abuse crimes that is recorded by the women working at the GBVC. This has been seen as a factor that increases the probability of sexual violence towards women in other cultures (Kalra & Dinesh Bhugra, 2013). Another cultural difference was the alternate views about sexuality and masculinity, compared to what we have in the UK. We saw quite a few patients being referred to the psychology unit from the GBVC for being homosexual. These counselling sessions were extremely interesting to observe because I heard of the true opinions that the psychologists and interns had about homosexuality, yet during the patients’ sessions, they made the patient feel comfortable and gave little to no indication that they were acting particularly taboo. This was extremely professional and useful for me to observe, because knowing their true feelings about the subject made the techniques and phrases, they used to make the patient more comfortable were easier for me to pick out (after observing them with other patients prior to the homosexual patients). Near the end of my internship, I introduced 3 of the other interns who were placed in other units of the hospital, to the psychology staff so that they could maybe spend some time with psychology and the GBVC to raise awareness for the units. We also bought newborn baby diapers to give to new mothers who were referred to us by Mary at the GBVC. Most of the mothers impregnated as a result of rape or underage sexual activity did not have the support to afford such a basic necessity for their babies. I would like to say how appreciative I am of this internship experience, meeting the IMA staff, the friends I made, and having the experience of visiting the historical and cultural sites of Mombasa. My experience with International Medical Aid has been beyond valuable. I hope to be able to return and visit CGRTH/GBVC and possibly conduct some research for my master’s and PhD dissertation. I have touched on some gruelling stories, and of the cultural differences in perceptions of mental health. However, it is important to note that the UK is also troubled with such cases. I am even more motivated to pursue a career in clinical forensic psychology now, and I will benefit greatly from the experiences I have collected from IMA and Mombasa.

My time spent in Kenya was a life-changing experience, to say the least. I set out on this experience promising myself to step out of my comfort zone. I’m not very good at learning languages, but learning Kiswahili made locals so excited when I would use the few words I learned. I’m a picky eater, but I got to try and enjoy so many new, traditional Kenyan meals. I have never liked talking in front of groups, but I decided to assert myself in clinics and debriefings. With the help of mentors, guides, locals, and the other interns I got to meet, I got to learn so much about mental health and how other communities live.

My internship in Kenya truly helped me understand what it means to be culturally competent, and the skills it requires and offered me the chance to appreciate the differences between individual cultures. It challenged me and allowed me to assess whether I was truly culturally competent beyond working with my community. I could practice adapting to cultures different than my own by subtly changing psychological techniques or advice I’d usually offer as I had to decide whether they were suitable and effective. During my time at Coast General Teaching and Referral Hospital, I discovered a new interest in Sexual Health Psychology through interning in the Youth Zone and HIV Clinic (within the CCC). I’ve always known I wanted to work in Psychology and this trip only confirmed this. Within this essay, I will share what I’ve learned, explain some of the differences in mental healthcare delivery between Kenya and the UK, as well as some of the patient interactions that stood out to me. Mental Healthcare at Coast General: Throughout my three weeks in Mombasa, I spent time in multiple areas of Coast General Hospital. Starting in the Gender-Based Violence and Recovery Centre (GBVRC), then getting permission to shadow clinicians in the Psychiatric ward, Psychological Ward Rounds, Youth Zone, HIV clinic in the CCC, and a nightshift in Maternity. Each area taught me different things and I had a chance to meet and learn from a variety of different conditions. The prevalence of mental illness is very high in Kenya, with 1 in 4 citizens likely to experience a mental health problem at some point in their life (Ministry of Health, 2015). Despite this, funding for mental healthcare in Kenya does not have a separate budget. This is different from the UK where although the mental healthcare system is thought to be underfunded, the budget is still separate. With the mental healthcare funding coming from the national healthcare budget, there is little government funding going towards it. This ultimately leads to less staff in hospitals, less money to invest in staff training, and fewer public patient facilities. In the Coast General Psychology department, the majority of staff were interns themselves, undergraduates still studying their degrees and who were only there for a short amount of time. This seemed to be a common theme across all departments; a lot of student nurses and doctors, working long hours and taking on difficult clinical cases. Whilst this is an amazing first-hand experience, I can imagine it can sometimes be incredibly daunting being thrown into the deep end so early on in one’s career. However, the support system from the lead psychologists was amazing as at the end of each day, they offered a space for reflection and where the interns could share difficult cases. Being an intern in an underfunded system will always be difficult as you are affected by staff pressures and limited resources, and this could lead to burnout. This may explain why there is such a shortage of mid-senior level clinicians, as they may be burnt out and want to move to a different healthcare system (Strathmore Business School, 2017). Professor Kokwaro mentions the importance of investing in current healthcare staff, so they feel valued and have a better working environment & this better working environment is what I feel makes the Psychology team so great. I met 2 psychiatrists at Coast General, both of which worked in different hospitals throughout the week. One of the psychiatrists only came in on Wednesdays for the forensic cases. This is due to the low number of psychiatrists working in Kenya, with the majority of psychiatrists being based within Nairobi. When the psychiatrists weren’t there, the psychiatric nurses were prescribing medication and offering counselling sessions. One thing that was common across all departments was that nurses seem to be the backbone of the hospital system. I saw them leading and managing different departments; this concept is similar to the UK with a lot of Service leads coming from a nursing background. We also have leadership pathways specifically for nurses to progress, it is refreshing to see nurses in management positions rather than the stereotypical idea of only trusting doctors. Gender Based Violence and Recovery Centre: My first few days within the GBVRC were quite intense. On my first day, 4 young boys came in who had all been abused by the same man; some of them were penetrated. This was followed by 4 more boys the day after. The first major difference I noticed was the different ways people expressed trauma. Some of the survivors were very open with the psychologist, Saida, this may be linked to Kenyan culture, where people are open to discussing topics that may otherwise be considered sensitive or personal (International Medical Aid, 2022a, p. 31) The current understanding of trauma is very Eurocentric, focusing on how trauma is understood in the Western world. However, this differs across cultures and even more so across sub-cultures. Instantly I saw that Western understandings of trauma cannot be so easily applied here. It is important to provide mental health care that is culturally responsive to the area it is being used, particularly when using a specific therapeutic model (Woods-Jaeger et al., 2017). I loved how the Kenyan psychologists I worked with used their understanding of their communities combined with their psychological knowledge to provide the best possible service. Saida created a safe space for both the survivors and their families, it can sometimes be difficult to contain both a client and their family at the same time, especially within the same space. This was an example of systemic therapy used, in conjunction with narrative therapy as there was a key focus on the survivor being given a narration platform. The GBVRC had a multi-disciplinary team made up of a nurse, a general psychologist, a child psychologist, and a paralegal. The staff worked across departments, specifically with the Youth Zone and Maternity; as there were often abuse or statutory rape cases. The team was incredibly welcoming and coved what they did, they acknowledge the job was difficult but they continued to provide amazing care for people who may have just gone through the most traumatic thing in their life. Mary, the paralegal, was a particular stand-out character. She took us around the hospital, telling us how the GBVRC is involved in different departments and what they do. Rates of domestic abuse are high in Kenya (BBC DOC REFERENCE) and the litigation process can take up to years. However Mary shared with us how she follows up with the police to ensure survivors receive justice, she’s received threats and bribed but she has remained true to her morals. I saw how truly important it is to love what you do and care about the people you’re helping, in a system that often seems against you. In the GBVRC, people are offered either short or long counselling sessions if needed; a stark contrast to the UK where people are typically offered 6 sessions maximum and are subject to up to yearlong waiting times compared to the 2 weeks offered at Coast General. This may be due to the difference in mental health literacy, with fewer people accessing services and continuing to attend sessions after the first one offered to them. Psychology Department: The Psychology department within Coast General is still relatively new, opening in 2019 as a response to Covid-19 patients being isolated and unable to speak with their families. Despite only being a recent addition to the hospital they are still heavily relied upon, being called to different areas when they’re needed and doing ward rounds across the hospital. While I was at Coast General, there were 5 psychologists, with 3 of them being interns. As they have to work across hospital wards with a limited number of staff, there’s little room for specialisation. I mainly shadowed Ann, the Clinical Psychologist, and the interns. I observed the 8-step psychological assessment they follow when doing the ward rounds: 1) Check medical report 2) Observation 3) Cognitive assessment 4) Psychological review 5) Insight 6) Thought Process 7) Narration 8) Offer Psychosocial support What I liked about this assessment style is its focus on understanding the patient, their understanding, and their background. All of these things have to be taken into account when offering psychological care. A key similarity I noticed was that both this assessment and the GBVRC use narration platforms for their clients. I saw the positive impact of people being given a chance to share their stories. During our ward rounds, there was a woman who was terrified of eating as she was in too much pain. She began shouting when we went near her as she thought we were going to force her to eat. The psychologist reacted calmly, showing her that there wasn’t any food in our hands so she would feel at ease. She sat down at her level and spent time with her, calling her “Mama” as a sign of respect. Despite the Psychology team being pressed for time, they always ensured they spent time with each patient so they felt seen and understood. When we followed up the next day the woman began eating again. The psychologist mentioned that the woman was Swahili and her understanding of Swahili culture was that Swahili women enjoyed being treated gently and looked after. It was because of this cultural understanding she adapted her disposition and tone to best suit the patient. This was a defining moment for me as it was my first true understanding of what culturally competent practice means. The key difference between Kenya and the UK public mental health care is that therapeutic models aren’t as heavily relied upon in Kenya. I discussed this with Ann who explained that since the understanding of mental health is still new in Kenya, the general public doesn’t understand different models and theories. She also stated that CBT models are often used in private hospital settings. At Coast General I saw theory being used in practice, there wasn’t a huge focus on overexplaining people who may not be familiar with theory as the psychologists knew what would work best. Psychologists seemed to be used as an intervention technique for grief, fear, anxiety, and more. In the UK there is a huge focus on theory and models in our NHS service before a client signs up for sessions. Different service websites explain the theories or techniques that will be used in the session. It was refreshing to take a break from learning and applying theory and instead see it in practice, as it seemed equally as effective for patient care. Another difference was the use of prayer to instil hope into the patients and this was very well received. The Kenyan demographic is very different from the UK where there is more of a separation between church and state. 94% of Kenyan people would say they are religious (International Medical Aid, 2022a), I imagine this is why using faith as a support tool is very beneficial. Youth Zone and HIV Clinic (CCC): HIV is a large part of Kenya’s disease burden (International Medical Aid, 2022b, p. 4) as it is one of the biggest killers. Mombasa rates are higher than the national prevalence in the rest of the country (National AIDS Control Council, 2015) though rates do differ between local areas. Before coming to Kenya I had a general understanding of HIV and the negative stigma surrounding it, what surprised me the most was the joy of working in this area and promoting a healthy, happy, and positive lifestyle. I worked with Cynthia, the Youth Zone adherence counsellor. The Youth Zone is the equivalent to the UK’s Child and Adolescent Mental Healthcare services but specifically for those living with HIV up to the age of 25. Cynthia led health talks throughout the week. The main aim was to create a stigma/judgement-free environment for the young people, so they could discuss tackling stigma, their struggles, relationships, or anything else that was bothering them. I learned a lot more about what HIV is, how it is spread, how it attacks the body, and the positive lifestyle changes that can help maintain a low viral load (LVL). The daily routine at the Youth Zone consisted of a health talk followed by consultations. Here they checked height, weight, medication adherence, further referrals, and the use of condoms. If necessary, the client was then referred to counselling with Cynthia. Within these sessions Cynthia delved deeper into medication adherence, trying to understand the root causes. Psychosocial support was also offered and advice for being in a relationship as someone who is living with HIV. The young people knew they were in good hands as they slowly warmed up to sharing their struggles with the group, knowing that this was a safe space. After this visit appointments were made 3 months in advance unless the person has a high viral load that needs to be monitored in which case they come back in 1 month. The volunteers are also people living with HIV, which gives a solid sense of community and role modelling. The aim for each person is to work towards a Differentiated Care Model (DCM) which offers 6-month appointments rather than 3 however the patient needs to have an LVL and no opportunistic infections. This model of care both fosters independence as and reduces hospital burden, whilst still ensuring the patient has access to the care they need. My experience in the HIV Clinic was similar to the Youth Zone, though I only spent one day here. I noticed that this clinic was larger and there seemed to be more staff; which I narrowed down to differences in funding. The clinician talked me through what good adherence looked like and the content was similar to what was shared at the Youth Zone health talks. • Taking drugs at the right time each day • Consistent use of condoms to prevent the spread of HIV or other STIs/STDs • Good nutrition and exercise to improve immune systems and keep them as strong as possible • Stress management • Appointment keeping to help monitor one’s health Psychiatric Clinic: Visiting the psychiatric clinic, I saw a mixture of general and forensic cases. There were some issues with the forensic cases accessing treatment/assessments as those under the care of the prison were no longer entitled to free psychiatric care. There seemed to be some miscommunication between the hospital and the prison as they now had to pay, this meant for the first half of the clinic no prisoners could be seen. It is my understanding that bureaucratic processes often take a while in Kenya and this may have been an example. Once the forensic cases began, the psychiatrist went through them very quickly. Perhaps because he had quite a few cases to see, he had already started late and was only based at Coast General for a few hours before having to leave for another hospital. One major difference I noticed is psychometric tests were not being used for psychiatric evaluations, learning disability assessments, or mental health conditions. Instead, the psychiatrist used his understanding of these conditions to assess each individual. Considering that these tests were developed in the West and for Western populations, much like the theories they’re often used with, this may be a good thing. They may not be as accurate of an assessment or need to be adjusted culturally. Furthermore, some psychometric tests are very time-consuming and expensive, especially with so many becoming computerised (French, 1986). This may be the most cost-effective and efficient way of working for Kenyan mental health professionals. As well as not using psychometric tests, there were differences in how learning disabilities were treated or assessed. One of the forensic cases involved assessing an individual who had been raped for a learning disability; it wasn’t made clear whether this was to assess their credibility, his ability to give consent or to ensure the punishment for the perpetrator was more severe. I worked in a learning disability setting for 6 months and often conducted assessments and these were very thorough, taking up to 3-4 hours whereas this lasted 20 minutes. Rather than a learning disability, the psychiatrists called it a “mental retardation”. I was rather shocked by the term as using the term “retarded” is heavily frowned upon in the UK, but that may be due to the recent reframing of language surrounding disability. I learned more about Kenyan attitudes to both physical and learning disabilities during our cultural treks, which I will expand on in my next paragraph. Outreach and Cultural Treks: Interning at Coast General was an amazing experience but I also loved our weekly afternoon excursions with IMA. We volunteered in schools, leading hygiene workshops and helping out in free medical clinics for the community. My favourite was the women’s health presentations, we were fortunate enough to have a qualified midwife with us who gave a brilliant explanation of the menstrual cycle. We did our best to create a safe space for the girls to ask us any questions they had, ensuring they were met with zero judgement. These clinics are important has some of the girls may not have had a space to ask questions without stigma before, it was fun to laugh and joke whilst also normalising feminine hygiene and making it accessible. We had the advantage of visiting the Bombalulu Workshops, a community organisation that provides work, housing, schooling, and more for people who are physically disabled and their families. They foster independence, improve general life skills, and self-esteem and instill a sense of self-worth. It was inspiring to see the space they have created and the art that comes from their hard work. The workshop runs as a project by the Association for the Physically Disabled of Kenya and doesn’t seem to be reliant on government funding. This made me think about how much public funding goes towards the needs of those with disabilities. A report from Development Initiatives illustrates that whilst there is government funding available to those with disabilities, there doesn’t seem to be an allocated budget for “vocational and technical training” (Owino, 2020). This is a key focus area at the Bombalulu workshops. The report also highlights the difficulties of not being able to adequately evaluate outcomes, since the data isn’t available. It is difficult to know where the money is going or if the current budget allocation is truly effective and making a difference. Conclusion: My time in Kenya was the most influential time of my life, it took 2 years due to Covid but I’m so glad I had the opportunity to learn and meet so many people. It determined my passion for working in public healthcare and it reminded me that whilst I can make a difference at home, there is the rest of the world to experience and learn from. Mombasa will be seeing me again, thank you to IMA for making my first internship experience so amazing and to the Coast General clinicians for taking me under their wing.

My time in Kenya was incredibly transformative in so many ways. My cultural understanding, medical knowledge, and awareness of disease burden, politics, and healthcare quality all upgraded more than I could have ever imagined in 4 short weeks. From the moment I was greeted by the IMA staff at the Mombasa airport to my very last day, I was always comforted by the immense kindness and hospitality of the IMA staff and Kenyan people. I never had a moment where I felt unsafe, in fact, I would always feel a sense of love from every local I had encountered. When I arrived at the residence, I was astonished by how clean and spacious the residence was. The staff was incredibly accommodating and never failed to brighten the room. Linnet, Catherine, and Naomi constantly made sure the residence was in tip-top shape with the most amazing attitude. Linnet specifically treated me as if I was her own son, which made me feel like I never left home. I always looked forward to meals, because Joshua, the chef, did an amazing job of introducing Kenyan cuisine in new and delicious ways every single day. One of my favorite parts of my time in Kenya was with the driver, Francis, who became a lifelong friend and was always enthused to drive us anywhere in the Nyali area and provide amazing insight into what it is like to be a born and raised Kenyan. The food and culture I experienced were like no other. Our mentoring doctor, Dr. Shazim, who lead suturing, intubation, and resuscitation workshops, also took time to tour us on the best restaurants and street food Kenya has to offer. He also took us to a go-karting spot and a kayaking site where I made some life-long memories. Benson also did an amazing job showing us the must-see spots of Mombasa on the city tours. I was stationed at the Mental Unit of Port Reitz Hospital. My rotations sectioned my time between the Outpatient department, Occupational Therapy department, and clinical psychology. However, Psychiatry is an interdisciplinary field, so it was encouraging to see all the departments work cohesively as one unit despite the stark lack of resources compared to the western world. The lacking of sufficient resources was a constant theme throughout my experience at Port Reitz, but it was awe-inspiring to witness the creative lengths the staff managed to perform to deliver the best care they could despite the cards being stacked against them. On top of all the routine obstacles to the delivery of proper mental healthcare, during my time there, devastating nurses and physicians strike was in full swing. While this caused most public hospitals to be virtually non-functional, the few immensely altruistic nurses and interning physicians who still called to duty allowed Port Reitz Mental Health hospital to not only fully functional but adapted and evolved to make their healthcare delivery more efficient prior to the strike. It was thanks to these heroic few that I even still had the opportunity to shadow abroad, but more importantly, they kept from depriving the Kenyan people access to the second-largest Mental Health Institution in Kenya. Overall, my experience in Kenya is one that I will never forget. I recommend this program to everyone and the lifelong friendships I made in 4 weeks will have me back in Mombasa in no time.

My experience with IMA was both very positive and memorable in the entire four months I interned as a practitioner. I found the support of both Bella and Phares to be on point in that they were always available to address any questions and/or concerns I had - as well as proactively followed-up each and every time. Bella and Phares are very approachable and friendly individuals. My placement at the GBVRC at CPGH was definitely a highlight of my time in Mombasa, Kenya. As a Counsellor early in my vocation, I was able to both learn and practice even more so about trauma counselling, and how it applies to survivors of defilement and rape. I was provided with thorough shadowing and training for some weeks before I commenced counselling independently. In this placement, I was able to help fill a void, as the centre was understaffed. By taking on primarily counselling work, in the time that I was at Gender, it allowed the clinic's Nurse (in-charge) to focus on medical exams, as she used to do both counselling and medical exams. I found the staff, Saida and Mary, very welcoming, accommodating, caring, and helpful at all times. Throughout my time with IMA, I always felt safe, whether at the residence, on the road, in the hospital, or elsewhere. I felt that IMA made safety a priority and we were briefed at the start of our internships about local safety and so on. By having Javan always drop us off and pick us up from the hospital was especially helpful. Javan was always very careful when driving us from place to place and his friendly persona was always appreciated. The guards at the residence too were always very helpful and caring towards us too. The residence was very accommodating and provided us with luxuries such as hot water, air-conditioning, and even wifi. I appreciate that the rooms were simple and shared as it allowed us interns to get to know others more. By sharing rooms, we also had to learn and practice balancing everyone's needs, and adjusting/being flexible. We were fortunate to have housekeepers who worked hard in ensuring that our rooms, bathrooms, and laundry were up-to-date. Rehema, Naomie, and Victoria were very easy to approach and always very helpful. Chefs Wilson and Osman were wonderful chefs. They were both cooking for us a variety of local and international dishes for lunches and dinners. The chefs provided me with filling packed lunches too when I was at the hospital for longer shifts. The chefs would always take on board our dietary requirements as well as cook on request any meals that we might be craving from home e.g. pizza or a favorite local dish from Mombasa. The impact on me, that interning with IMA has left on me, can only be described as overwhelming (in a positive way). In the months that I was in Mombasa, I learnt so much about Kenya and its culture, Kenyans, trauma counselling, sexual violence, and about challenging myself. I am so grateful for everything that I was exposed to as I acquired many learning opportunities and life experiences. I always desired practicing counselling in East Africa, and having the opportunity to do so via IMA, and with such an at-risk population group, was most definitely fulfilling and something I will be eternally grateful for. I would like to hope that I offered both the residence community and the GBVRC community my entire self when I was on placement. I feel that within the residence, I offered a helping hand and caring heart, as I truly do enjoy supporting others. Whenever I was referred to as the "house captain" or "mum of the house" - it was always something I took seriously. In the residence, I tried my best to help others, help the staff, and of course to be responsible. Within the GBVRC community, I hope that I was able to help comfort my clients in knowing that such violent acts do not determine who a person is. Rather, it is what the survivors choose to do next in moving forward, and knowing that myself and Gender will always be there to support them with counselling and medical support. I believe the counselling that I provided my clients with was the start of the healing process. For quite a few clients, we explored several sessions, and the healing process was further advanced, whereby clients were adjusting to leaving the violent act behind them, and that they were carrying on with their lives, and with a different perspective on life. Gender-Based Violence is an area of counselling unique to East Africa and especially Kenya. Yes, in Australia we have counselling services for victims of rape and sexual assault, but, it is almost unheard of that a child has been defiled. As a Children's Counsellor interested in trauma counselling, I was able to apply and practice my own counselling skills, as well as learn more about trauma counselling skills specific for survivors of defilement and rape. Through the GBVRC, I was able to participate in an outreach program called 160 Girls' Justice Clubs. I had the opportunity to work with three local primary schools in educating students about defilement; how to identify it, how to ask for help, and what to do if someone has been defiled. This program is primarily based in Kenya and again another unique experience of my time with both GBVRC and IMA. I went on the Watamu Beach Safari and I absolutely loved it. I was very happy with everything and wouldn't change anything. If a change had to be made, maybe add an extra free day, just to explore or wander around.

My mental health placement with International Medical Aid taught me so much about not just mental health and the mental health system in Kenya, but also about myself. I completed my placement at Port Reitz Mental Health and Substance Abuse Unit and I only wish I would have had longer. Port Reitz taught me strength by surviving and adapting to minimal standards of working conditions due to lack of funding. The undying support by the staff was above impressive considering the limited resources they have. Additionally, the stigmatization around mental health in Kenya was at the forefront of challenges experienced by staff and patients alike. It is very confronting to accept that for so many families they are related to ‘crazy people who have lost their mind’ to quote many family members directly. I have a deepened interest in creating awareness of mental health and mental illness in Kenya and other African or third world countries who deserve to be educated on the need for mental health facilities but also in order for them to understand their own family and community members who have been struck with mental illness. This is how I would like to shape my career, working in these respective countries to help combat the stigmatization surrounding mental illness, and Port Reitz has definitely helped me understand the need for this and the way that the families need to be educated. My first day was difficult and heavily confronting, especially seeing men in blue and white striped clothing in the isolation unit. The prison like structure at Port Reitz is a very difficult environment for staff to confidently and efficiently assist in the patient’s recovery. My second day created a change in me, when a young patient was walking beside me saying ‘don’t be scared.’ It was in that moment that I realised that perhaps my body language had shown I was reserved, and that was the last thing that I wanted the patients to feel. We had arrived at Port Reitz being debriefed that the patients could be violent, and that was the understanding that I had in the beginning. I wasn’t scared of the illness, but I was scared of the ideas about the patients that had been pushed onto me. The heavy sedation of the patients meant that I never actually saw them act out or be violent, and with me they were grateful, interested and always showed a smile. Their happiness was contagious because it was a little bit of hope that I needed to see in what could be such a difficult place to seek such an emotion. The staff at Port Reitz were so committed to ensuring I had a fulfilling experience, and I could not thank them enough for the time and effort they put into ensuring that I was gaining everything possible from my time there. But amongst my gratefulness, they were so thankful that I had been there, a feeling I could not comprehend as I could never have done as much for Port Reitz as it did for me. I learnt so much about counselling in my time with the clinical psychologist. It was interesting because many outpatient cases will only ever visit for counselling once, which meant that much different counselling approaches needed to be taken compared to Western cultures in which clients will often come back multiple times. During my time at Port Reitz there was a visit from the local MP who made numerous promises to the hospital, ones that I knew he was not necessarily obliged to follow through with. I wrote him an email myself, hopefully making him a little bit more accountable for what he had said, but also as a desperate plea to do something for a place that had shared so much love, generosity and compassion with me. The political system severely underfunds and does not recognise mental illness and the needs of these hospitals to continue functioning adequately. However, it is only recently that my own country, Australia, has been able to combat these fears and misunderstandings surrounding mental illness. I only wish that I could bring our politicians together and let the Kenyan government be more educated on these issues. The government body should be the first people to promote mental health awareness, but without this structure in Kenya the mental health facilities and those suffering with mental illness will continue to suffer because the stigmatisation is at the forefront of the challenges for both staff and clients. Whilst I cannot discuss specific counselling cases, I can guarantee that each one gave me a unique cultural perspective on the differences between Western and Kenyan approaches to dealing with relative issues, and the challenges that cultural and religious views can have on dealing with specific cases. It is not possible to throw Western ideologies and ways of counselling into Kenya because that would neglect the cultural differences that are so apparent and necessary when dealing with individuals. Overall, I would not change my experience with IMA for the world. I am so privileged to be invited into Port Reitz and be immersed in the environment of both the staff and the patients. A piece of me will stay with this hospital forever.