Physician Assistant/Pre-PA Internships Abroad | IMA

When I boarded the plane to Kenya to begin my internship with International Medical Aid, I was filled with excitement, curiosity, and a desire to serve. I have long aspired to become a physician assistant, but I also wanted to ensure that this goal was driven by genuine passion rather than simple interest. I had always hoped to participate in global health efforts and provide care to populations with limited access to healthcare. I wanted to understand patient care outside the modern diagnostic tools, fast-paced hospital systems, and technological resources that shape much of medicine in the United States. During my time at Coast General Teaching and Referral Hospital in Mombasa, I discovered far more than I anticipated: a deeper understanding of healthcare disparities, a profound respect for resilience and community, and a renewed commitment to pursue my career with purpose. When I landed in Mombasa, I felt a mix of familiarity and astonishment. Palm trees swayed over busy streets, and the air carried a warmth that extended beyond the weather. Cars moved in a chaotic harmony, with drivers honking and weaving through traffic while somehow avoiding collisions. Tuk-tuks sped between cars and motorcycles, while pedestrians crossed roads amid the flow of traffic. Vendors lined the roadside selling everything from fresh fruit to clothing, their voices full of energy and persistence. As a Somali born and raised in the United States, these sights felt both foreign and strangely comforting. They reminded me of the stories my family shared about home, full of movement, community, and constant hustle. For the first time, I felt connected to a place I had never lived, yet somehow carried within me. The warmth I received from the IMA staff, doctors, nurses, and local community helped me transition from feeling like an outsider to feeling accepted. Coming from the United States, I have grown up in a healthcare system that, despite its high cost, is equipped with advanced technology and support systems for many patients through insurance programs and government assistance. In the United States, individuals facing financial barriers often still have access to emergency care, routine screenings, and early diagnosis. In Kenya, I learned that healthcare accessibility is shaped not only by cost, but also by location, transportation, and the uneven distribution of medical resources. Many patients travel long distances to reach facilities like Coast General Teaching and Referral Hospital, a public hospital that serves a large population with limited supplies and staffing. Unlike private hospitals, public hospitals operate with restricted funding, yet they remain the primary option for most families. Witnessing doctors and nurses provide care despite shortages in equipment, staff, and funding reshaped my understanding of healthcare. I realized that medical systems are defined not only by their resources, but also by the resilience of the people working within them and the accessibility they provide to those who need care most. My first week was spent shadowing in the pediatric ward at Coast General. There, I learned that caring for a child involves far more than treatment and diagnosis. A child’s well-being is also deeply influenced by the social, political, and economic circumstances surrounding them. The ward was filled with young patients, each with conditions shaped by a different combination of medical and social determinants. Many children were battling illnesses such as malaria, pneumonia, and tuberculosis, conditions that are often preventable or treatable when identified early. However, because of delayed diagnosis and limited access to healthcare, relatively manageable illnesses often developed into serious complications. It became clear that a child’s health in Kenya is influenced not only by biology, but also by access, opportunity, and affordability. One of the most valuable lessons I took away was observing how healthcare providers approached diagnosis through close observation, critical thinking, and thorough physical examination. Dr. Ken, whom I shadowed throughout the week, emphasized that medicine begins with asking the right questions, listening carefully to caregivers, and using physical examination as a primary diagnostic tool rather than relying immediately on testing. For example, a nine-month-old baby who was struggling to breathe needed to be evaluated for either pneumonia or asthma. The physician assistant used chest auscultation, history-taking, and observation to guide treatment. This demonstrated a high level of clinical judgment and confidence. It showed me that good medicine does not always require advanced technology, but it always requires close attention. Another case that deepened my understanding of pediatric care involved a twelve-year-old child suspected of having leukemia with a critically low platelet count of 7. A normal platelet count ranges from 150,000 to 450,000 per microliter. The providers were not yet certain whether the child had cancer, and additional testing was needed before a definitive treatment plan could be made. In the meantime, the child was closely monitored and treated as necessary, highlighting how medical teams must make critical decisions even when full information is not immediately available. Witnessing this balance of caution, urgency, and hope was both shocking and eye-opening. I realized how fragile a child’s health can be, and how every clinical decision carries immense weight. The patient who affected me most was a child admitted with aspiration pneumonia, a bacterial lung infection caused by inhaling substances other than air, such as vomit, saliva, or liquids. His bones were fragile, his legs were extremely thin, and swallowing placed him at constant risk of aspiration. The recommended treatment was a PEG tube to provide nutrition, but the procedure had been delayed because of his mother’s financial hardship. It was heartbreaking to watch her sit beside him each day waiting for a solution. Another intern and I spoke with her, and with her permission, we organized a GoFundMe fundraiser. Within a few days, we raised enough money to cover the PEG tube and his hospital bills. For the first time, I truly understood the role of advocacy in patient care. This experience taught me that healing can depend not only on medical expertise, but also on community action and compassion. By the end of the week, I saw pediatrics differently. It was not just a place where children received treatment, but a setting that reflected larger public health challenges such as malnutrition, sanitation, infectious disease, and socioeconomic inequality. I learned that healthcare professionals in Kenya practice medicine with deep dedication, knowledge, and resourcefulness. Their work reinforced my belief that becoming a physician assistant means not only treating illness, but also understanding the realities that shape health. Pediatric care reminded me that every child is more than a diagnosis; each is a life shaped by family, environment, and access to opportunity. My second week was spent in the maternity ward, where I witnessed joy, strength, and hardship. Unlike pediatrics, where children often arrived after days or weeks of illness, maternity care centered on the very beginning of life. Most of the births I observed were cesarean sections, and seeing the surgery in person was very different from reading about it in a textbook. I was struck by how quickly and confidently the surgical team delivered each baby. What impressed me even more was the precision required afterward. While the actual delivery took only a few minutes, closing the uterus and carefully suturing the abdominal wall required patience, skill, and focus. Observing a C-section up close felt surreal. Witnessing a stillbirth was one of the most emotionally difficult experiences I had during my time at Coast General. I had read about fetal mortality rates and the impact of inadequate prenatal care and delayed access to hospitals, but no statistic could capture the silence in the room or the quiet empathy of the nurses, who understood exactly how to offer comfort without words. In that moment, I realized that healthcare providers must possess not only medical knowledge, but also emotional strength. The ability to support patients and families in their worst moments is just as important as providing skilled care during successful ones. As a future physician assistant, I will need to approach moments of loss with the same clarity, compassion, and devotion I bring to moments of healing. This experience taught me that clinical success does not always mean a positive outcome, but compassion is always part of the responsibility. My time in maternity showed me that medicine is not only about welcoming new life, but also about honoring lives that do not begin as hoped. One of the clearest takeaways from my internship was the contrast between healthcare delivery in Kenya and in the United States. In Kenya, medical care is often provided with limited resources and equipment that would be considered standard elsewhere. Yet the system compensates for these limitations through resilience, teamwork, and creativity. Doctors and nurses consistently made the most of what they had. For example, I observed nurses using part of a surgical glove as a tourniquet when drawing blood. These realities reflect a broader systemic difference in healthcare spending and infrastructure. Recognizing that disparity helped me understand why the two systems function under such different conditions. My internship with International Medical Aid changed how I see healthcare, the world, and myself. I learned that medicine involves far more than treatment plans and clinical skills. It also requires advocacy, cultural humility, emotional intelligence, and adaptability. I encountered illnesses that are uncommon in the United States but prevalent in Kenya. More importantly, Kenya will remain part of my story, not simply as a place I visited, but as the place that reshaped my understanding of medicine, taught me the power of empathy and resilience, and showed me what it truly means to care for others.

This program was a great experience in exploring global health differences and disparities, gaining shadowing experience, and immersing myself in a different culture. The mentors were very welcoming and supportive, even checking in on us when we seemed down or quiet. Hilda in particular checked in on us frequently. The food was 10/10, and the kitchen staff was very hospitable. I enjoyed Dr. Shazim's collaboration with the program, where I learned a great deal from his knowledge and experiences. He was always witnessing to discuss clinical experiences and took it upon himself to give us new facts or wisdom. Additionally, I enjoyed the effort put into the cultural treks, and the mentors always encouraged us to explore while giving us tips on staying safe in the area. I appreciated the gated location of the residence with a guard and locked doors in keeping us safe at night. I gained a lot out of observing the public health system and the impact that access, socioeconomic status, health literacy, local diseases, etc. has on a population's health outcomes. I tend to be a shy person as well, and so this opportunity helped me grow out of my comfort zone a bit in getting to know the other interns and the staff at CGTRH, as well as exploring the city. Lastly, I appreciate that IMA enforces the ethical standards of students participating within their scope of practice. Because the vast majority of interns are students with minimal to no experience, it did feel as though not much of an impact was made from us to the hospital, at least for my duration (except for the medical clinic, where I felt useful). Everyone comes into this world with nothing. Most people spend their whole lives working to have something—then leave this world with nothing again. So, your soul must gain more than your hands. That sentiment has come to define the way I view my daily life after my internship in Mombasa, Kenya. I've always struggled to find my passion and purpose. Yes, I have things I enjoy doing, but nothing defines who I am as an individual. It's something I’ve prayed about for as long as I can remember but never quite felt to come to fruition. That changed during my time in Mombasa. I found the importance of being a part of a community greater than myself and the impacts small actions can have on others for an eternity. I can truly say it set me on the path to becoming a better version of myself—a better future physician and a better friend. I witnessed the beginning of life, formed lifelong friendships, and saw the end of life. The full cycle. And through it all, I was challenged to value every part of my life more deeply. Birth. As Dr. Shazim would say in every debrief, “Let’s start at the beginning of life. Maternity.” Before arriving at Coast General Teaching and Referral Hospital, I was pretty determined to become a pediatrician. I have always been somewhat apprehensive about going into a specialty where death was on the line, and admittedly I had never stepped into a surgery prior to theater 2 at Coast General. Thus, I have spent most of my shadowing hours in a pediatric clinic. However, surprisingly, the maternity ward quickly became my favorite rotation. I could directly see my feelings about Kenya correspond to labor. Mothers spend months preparing to deliver their babies. They feel everything—excitement, fear, anxiety. There’s always an adrenaline rush. No one knows exactly what will happen, but the mothers, nurses, and physicians prepare for the moment a baby finally comes into this world expectantly. That’s exactly how I felt arriving in Kenya—a rush of emotions and so much uncertainty. A dream I’d held since high school was finally coming true, but I had no idea what to expect. The culture shock, the unknown, the lack of healthcare resources—it was all very real. But the maternity ward shaped me into the kind of physician I want to become. Witnessing a woman’s intense pain during labor to then peacefully hold her newborn is a moment I will carry with me. Despite the challenges of pursuing a career in medicine, like labor, being a part of some of the most shaping and important aspects of someone’s lives will make it worth it. In Mombasa I thought I’d be most influenced by the physicians, but it was the strength of the women that inspired me. They made me want to be the best physician I can be—for them. From C-sections to natural births, witnessing the beginning of life reminded me that nothing is guaranteed. I walked away with a new calling: to pursue a career in obstetrics and gynecology. I looked back on my journal entries for my rotation in the maternity ward, and I couldn't help but smile. The women I directly got to help, either by stretching with them during labor or holding their hands, I will always remember, and that empathy I learned while in Kenya will shape me into the best physician I can become. Friendship. Throughout my life, many people have influenced me. I’m a firm believer in “friends for different seasons”—some friendships fade, and some stand the test of time. Friendship is an impactful aspect of a person’s life and shapes who they are and become. In Mombasa, I saw the true value of friendship: in patients, mentors, fellow interns, and strangers. Growing up, I attended the same private school from kindergarten to senior year. I graduated with seven people, and I was not challenged to step outside my comfort zone and interact with different types of individuals. However, during my time in Kenya, I was able to reflect on different friendships I had encountered and truly what I had learned from other individuals in my daily life. There were friends who rallied together after tough shifts at the hospital. Friends like Hilda and Michelle, who made Mombasa feel like home. Patients who opened up to me—confided in me—as if we had known each other for years. Strangers asking me what I was doing in Mombasa and fully welcoming me into their city and culture. There were friends who became like family. I watched physicians rally around one another to care for a community in need. That kind of camaraderie—rooted in compassion—deepened my belief in the importance of human connection in medicine. According to Harvard Medical School, medicine has somewhat lost its human connection due to technology: “At its best, being a doctor is an extraordinary and intimate privilege. We build relationships with our patients and see them through times of both joy and suffering; our relationships with each other help us through the same. It's hard to do that in a way that's truly satisfying when we spend most of the day at the computer screen” (Harvard Health, 2016). At Coast General, resources and technology are very limited, and these physicians and nurses must communicate with the patients and peers, which depends on human connection and in turn often creates a more positive experience for the patient. I specifically saw this at the medical clinics, as physicians had limited resources but collaborated and did their best to help every individual, which is something I deeply admire. Death. I wasn’t prepared to see someone take their last breath. I expected panic, sadness, maybe fear. Whenever I have had a loved one die in the past, I usually view it in a negative way. But the death I witnessed was peaceful—like the patient was ready. In a strange way, that’s how I felt leaving Mombasa. I expected to be in tears, not ready to leave the place I had called home for the past month. But instead, I felt peace. Peace that I had experienced something life-changing. Peace that I had grown spiritually, emotionally, and personally. Peace that I had found friendships that would last a lifetime. In a way, this feeling of “death” will stick with me as I start my career to become a physician. The feeling of peace is advice I can pass onto others who are losing a loved one. Death is inevitable, but while in Kenya I learned it can also be peaceful. Death does not have to have a negative connotation, but the narrative of death can be changed for the better. “If you think about it, life is nothing but thoughts, and our thoughts come from the mind. Our thoughts are an internal path leading us somewhere. To the next thought, the next idea, the next life. Everything is created with thought—emotions, designs, and theories. Where thoughts lead us is the most important thing; it’s our inner path leading to freedom or suffering” (At Peace With Death | Bennington College, n.d.). The people in Kenya were steadfast in their faith, and this helped me realize that in some way we are all just walking each other home. I feel like this is an important lesson to take with me in my journey to become a physician, as I have to come to peace with death and help loved ones keep moving forward in their lives. Souls. Souls tie people together. A soul is what makes someone who they are—and it’s shaped by every experience, every relationship. Kenya changed my soul for the better. I poured into others. I learned patience. I experienced a completely different culture and let it shape me. In the pediatric outpatient ward, I met a young girl named Nora who became obsessed with a balloon glove I made for her. That small gesture—something so simple—brought her joy, and in turn, filled me with joy. It made me more aware of how even the smallest acts can have a big impact on someone else’s soul. Yes, Kenya was culturally different from my small town in Georgia. But what struck me most was the people—their outpouring of love and gratitude. They valued what they had. They didn’t take life for granted. In the Western world, we often measure worth by material things—by how much we have, not by how full our lives are. But in Kenya, I saw the meaning of the phrase “Make sure your soul gains more than your hands.” Even amidst poverty and corruption, people remained faithful, grounded, and fulfilled. That lesson is one I’ll carry for life. Before Kenya, I struggled to articulate my "why" for medicine. My answer was something generic—“I enjoy helping others.” But now, I understand it's deeper than that. Medicine isn’t just about helping others—it’s about having a soul-level impact. What I saw, experienced, and endured in Kenya wasn’t easy. The children begging for food outside our Ubers, the lack of basic life-saving devices in the hospital, and people dying due to lack of ICU beds. None of this was glorious, but the community of people that rallied around each other was. Despite differences in ethnic and religious backgrounds, I saw new mothers look out for each other and their newborns, which is a testament to the people in Kenya and the type of person I want to be for others in my life and when I become a physician. Following my arrival home from Kenya, I was asked to speak at church about my experience. I gave my presentation about my time in Kenya and the ways Mombasa and Coast General impacted my life. I will still struggle to put into words the impact the experience had on me. However, unbeknownst to me, the sermon directly following my speech was about souls. About how people have started to value what they materially have in this life over friendships and the impact they have on others. But whenever one dies, none of those materialistic things goes with them, but their soul does. The experiences and impacts that others have on their soul go with them to their next life. Thus, I realized that the impact Kenya had on my life will stay with my soul forever, and consequently the impact I had on others will stay with their souls. Those who connect medicine with the soul are the difference between a good physician and a great physician. The main physician I saw this connection in was Dr. Faruk. Spending the day with him in the diabetes and thyroid clinic, he taught me the importance of finding my voice and passion in medicine that subsequently has an impact on others' lives. He is starting his own nonprofit to help children with type 1 diabetes get access to insulin. This is something he is passionate about and will have an amazing impact when accomplished. Dr. Faruk is an inspiration for me, as he is the physician I want to become. A physician who is not in it for the money or for the fame but is in it for the direct impact that they have on others' souls and daily lives. As Sir William Osler said, “The good physician treats the disease; the great physician treats the patient who has the disease” (Centor, 2007) International Medical Aid has shaped me into the physician I want to become. My time in Mombasa taught me the importance of understanding each patient’s story and beliefs, and the responsibility I have now to leave a lasting impact on everyone I meet. These challenges and lessons will stick with me forever and my growth as an individual is all accredited to my experience in Mombasa, Kenya.

This trip was truly life-changing and inspiring, and I am very thankful for all of the staff for their amazing support through the process. I loved everything—the food and culture were beyond amazing. I want to give a shout out to my bestie Janet; she accompanied me through my weekend treks. I had a blast with her, and I’m so glad she’s the one that went with me. I never felt unsafe during my time in Kenya, and for that I am so appreciative. I think one of the most positive experiences I made on this trip were the friendships I made, but also the community outreach events we had. There was nothing more eye-opening than going to underprivileged communities and providing the extra support that they desperately needed, which is proper healthcare. I am so blessed to have been able to experience something like this with such a well rounded program. Thank you!! The first time I heard about IMA, I was immediately intrigued. I remember seeing the program, and it fueled my curiosity that had been growing ever since I thought about doing an internship. The idea of actually getting accepted into such a program felt almost far-fetched. I have never taken the time to apply to anything like this before, so the idea of stepping into this opportunity was so thrilling yet nerve wracking. I was lucky enough to have a supportive circle around me—people that encouraged and reminded me that I was capable of doing anything I set my mind to. With enough convincing, I applied. In my mind, I thought, “What’s the worst that could happen? I don’t get accepted—or I could end up having the craziest experience in Kenya.” Fast forward a couple months, and I find myself at the Royal Suites residence, staring in awe at what the next three weeks of my life would hold. I was greeted by a wonderful group of peers and staff, and from that moment, I knew I would be in good hands. Walking into this program, I had some experience as a medical assistant in a neurology office. However, that was completely different from what I encountered at Coast General Teaching and Referral Hospital. I vividly recollect the first day I arrived at the hospital, knowing I would encounter far more striking cases than those back home. During my time there, I rotated through the Emergency, Pediatrics, and Surgery departments, and I also participated in night rotations at least once a week in other departments. Before beginning, I received an orientation that included discussions on what to expect in terms of medical cases, as well as the local culture and customs. I was told that healthcare in Kenya was severely understaffed and poorly supplied due to location and financial reasons (Cultural Approaches to Pediatric Palliative Care in Central Massachusetts: Kenyan, n.d.). I was also informed that many patients present with advanced stages of illness, often as a result of financial constraints or religious beliefs. During my time in the Emergency Room, I saw many patients that would arrive with advanced cancers, severe infections, and untreated wounds. When asked about the situation, the most common response was that they simply did not have the money for treatment. Others would say the nearest medical facility was too far from their homes, requiring them to strategically plan when they could make the trip. One response in particular really struck me: a patient’s family explained that they were relying on prayer to heal their loved one, believing it was best to let God provide the cure. As a believer myself, I was impacted and inspired by that statement. However, it was hard to reconcile because many of the situations I saw needed urgent attention. In those moments, it felt challenging to accept that faith alone was being relied upon in circumstances where timely medical care was critical. There are many traditions of healing and medicine that Kenyans use. Various natural remedies are commonly used such as African potatoes, rooibos, and the hoodia cactus. Additionally, there are rituals that are performed for spiritual healing. For example, shells, bones, and stones are used to communicate with ancestors or spirits to learn more about the patient’s health condition (Brooke, 2023). When I was in the hospital I never encountered someone that firmly believed in these practices, but I heard from the nurses around that it was used by many patients. In terms of patient care, I witnessed a wide range of cases. Being in a public hospital, I observed severe understaffing as well as lack of essential tools equipment. There were many moments when I would instinctively look for an instrument we would normally have back home, only to find it unavailable. In those situations, we often had to improvise and make do with what was already on hand. I vividly recall one night during a shift a patient began coding. One of the nurses was desperately searching for a BVM (bag valve mask), going drawer by drawer in an attempt to find one. The search took four or five minutes, and by the time the mask was finally located, the patient had already been declared deceased. I don’t know if the patient would have survived had the mask been found and used sooner; regardless, the situation highlighted the critical lack of necessary resources. Another example of improvisation was when gloves were used as tourniquets, which led to supplies running out more quickly. I remember one shift in the PICU, I was reminded that one of the mothers that gave birth to two beautiful boys was in intensive care due to birthing complications. One of the nurses approached me and one of my peers, asking if we were interested in feeding the babies. Without hesitation, we both agreed. I have never fed a premature baby before, so I was incredibly nervous and assumed there would be a machine of some sort. I was wrong. We had to use a syringe, carefully letting the milk independently go through the tube. This process was time-consuming, as we had to hold the syringe up in the air to allow the milk to flow, which took roughly ten to fifteen minutes. At times, the milk would get stuck in the tubes or even harden, creating additional challenges. I remember hearing that these methods were used back in the day, so it wasn’t uncommon—just time-consuming and requiring extra attention. Typically, Nairobi and the Central Province are considered to offer the best public healthcare, while the North Eastern Provinces are generally more underdeveloped in terms of medical infrastructure and resources. There are private hospitals in Nairobi that are very respected and known to be top tier (Healthcare in Kenya, n.d.). After all that I have learned during this trip, I returned home with a deep sense of appreciation for the healthcare providers I had worked alongside, as well as a strong desire to continue learning more about global healthcare practices and the challenges faced in resource-limited settings. Witnessing the dedication of the healthcare providers who worked tirelessly despite limited supplies and overwhelming patient needs gave me a deep sense of respect and admiration for their commitment to their patients. I recall all of the conversations I had with the providers and students—one thing was clear: they all shared a deep love for the field. They acknowledged that their work could be challenging and frustrating at times, yet none could imagine doing anything else. There was genuine passion and grit behind every single provider, evident in the care they provided and the dedication they showed to their patients. I witnessed what it was like to think quickly on my feet and rely on the limited skills I had. These experiences taught me that healthcare isn’t just about medicine—it’s about human connection, understanding, and trust. I will be sure to bring these lessons into my career by prioritizing empathy, effective communication, and cultural sensitivity. I’ve always had a deep passion for healthcare, shaped both by my childhood interests and personal experiences. This trip has only intensified my passion, leaving me with a strong desire to learn and do even more in the field. I fully plan to return to Kenya and work at Coast General once I am a certified Physician Assistant, so that I can gain more practical experience while contributing to the healthcare system and properly helping patients in need. My time in Kenya was transformative. It exposed me to the realities of healthcare in resource limiting settings, challenged me to develop critical thinking skills and adaptability, reignited my passion for healthcare, and strengthened my commitment to pursuing a career as a Physician Assistant. I am determined to apply all that I have learned in every aspect of my future practice—fully dedicated to serving patients with compassion and cultural competency while continuing to seek opportunities to learn and grow as a healthcare professional. Beyond the clinical skills, this experience taught me the importance of patience and resiliency. This applies to myself and the patients. I learned how small gestures like listening, showing empathy, and providing reassurance can have a profound impact on the patient’s wellbeing and steps to recovery. Allowing myself to see how other providers navigate such a challenging system inspired me to think of more solutions and think proactively about improving healthcare, even in similar situations where resources are limited. I have gained an appreciation for proper teamwork and collaboration. It was refreshing to see how providers rely on one another to manage heavy workloads and ensure the patients’ comfortability—some demonstrated it better than others. This experience has diligently motivated me to approach my future career with a humbled mindset of service, humility, and continuous growth. Every patient encounter is an opportunity to make a meaningful difference. I am now more committed than ever to properly advocating for patients, embracing diverse perspectives, and integrating proper cultural competency in all aspects of my future practice.

My experience in Kenya with International Medical Aid was incredible. The in-country support was excellent, and I always felt safe thanks to clear guidance and protocols. Accommodations were comfortable, and the food was a wonderful introduction to Kenyan cuisine. The clinical experience was invaluable. I got to shadow PAs and physicians, learning how they provide compassionate care even with limited resources. My mentors Mitchel, Margaret, Benson, and Hilda were especially amazing; they guided me, answered questions, and made the experience meaningful and inspiring. Overall, this program deepened my understanding of healthcare, strengthened my communication and cultural awareness, and reinforced my commitment to becoming a healthcare provider. It was a truly memorable and transformative experience. I came to Mombasa, Kenya, with a curiosity about global healthcare. What I left with was far more than observation—I left with a deeper understanding of resilience, compassion, and the creativity required of healthcare providers in resource-limited settings. My two weeks at Coast General Teaching and Referral Hospital through International Medical Aid shaped not only my perspective on medicine, but also the kind of provider I aspire to become. The resource-limited setting of a Kenyan referral hospital highlighted the importance of adaptability, clinical judgment, and teamwork in medicine. It also deepened my appreciation for cultural competence and reinforced my desire to pursue a career that bridges patient care with compassion, equity, and access. I reflected throughout my internship on how these lessons shaped my personal and professional goals, and how I plan to apply this knowledge to my future career in healthcare. My first week at the hospital was spent in pediatrics, including the High Dependency Unit, the inpatient ward, and the outpatient clinic. Each area exposed me to different aspects of pediatric medicine and highlighted the challenges of providing care in a resource-limited setting. In the High Dependency Unit, I saw children critically ill with conditions such as malaria, pneumonia, and severe dehydration. With limited monitoring equipment, providers relied heavily on careful physical exams and clinical judgment. Watching physicians and nurses act with such precision reminded me that medicine depends as much on knowledge and presence as it does on technology. I also noticed how central families were to care—mothers and caregivers often stayed at the bedside, feeding and comforting their children. It underscored for me that treating a child means supporting the entire family. The inpatient ward was crowded but full of resilience. Children admitted for longer-term care still found ways to laugh, play, and smile, even while battling illness. This reminded me that pediatrics requires not only medical skill but also creativity, optimism, and patience. The outpatient clinic emphasized communication and trust. I shadowed physicians and medical students as they diagnosed fevers and infections, counseled parents, and provided follow-up care. One memorable encounter was a mother worried about her child’s persistent cough. The physician took time not only to examine the child but to reassure her and explain how to monitor symptoms. That interaction showed me how powerful reassurance and education can be. That week in pediatrics taught me that medicine is not only about addressing immediate illness but also about building trust, supporting families, and adapting to circumstances. The lack of abundant resources revealed how powerful strong clinical reasoning, communication, and compassion can be. As an aspiring PA, I want to carry these lessons forward by becoming a provider who combines medical expertise with cultural sensitivity and emotional intelligence. In the United States, I may not always encounter the same level of resource scarcity, but disparities still exist. This experience showed me that effective providers don’t just treat patients; they meet them where they are, partner with their families, and offer care that is both competent and compassionate. During the second week of my internship, I rotated through the emergency department, including both adult and pediatric units. The emergency department was fast-paced, unpredictable, and often chaotic—a contrast to the structured environment of the outpatient clinic. I witnessed cases ranging from acute infections to trauma. One case that stayed with me was a toddler with severe malaria whose rapid deterioration required immediate intervention. Observing how the team coordinated care under pressure highlighted the importance of quick decision-making and clear communication. Another case involved a man who was involved in a street traffic accident and sustained a significant injury to his face, including a compound fracture and mandible dislocation. The attending physician quickly assessed the situation, coordinated imaging, and explained the care plan to the anxious patient. Observing this interaction, I realized how crucial clear communication is—not just with the patient but also with the family. Every word mattered in building trust and helping the family feel involved in care decisions, and it made me feel content with how everything was handled. The adult ED presented different challenges. Patients often arrived with complex conditions, and resources were limited compared to what I have seen in U.S. hospitals. I saw providers rely on careful observation, prioritization, and creative problem-solving to stabilize patients efficiently. Overcrowding was common, and staff had to make rapid decisions about who required immediate intervention versus who could wait. I had the opportunity to observe the triage process firsthand, watching nurses and physicians quickly assess vital signs, symptoms, and overall condition to determine urgency. This experience emphasized the importance of staying calm under pressure, making swift decisions, and trusting one’s clinical judgment—skills I hope to carry forward as a future physician assistant. Beyond clinical skills, the ED also highlighted the human side of medicine. Many patients were in distress not only from illness or injury but also from fear, uncertainty, or socioeconomic stressors. I observed how providers offered reassurance, listened attentively, and made patients feel heard even in brief interactions. This reinforced a lesson I had learned in pediatrics: effective care is not just about diagnosis and treatment, but about empathy, communication, and emotional support. Experiencing this firsthand strengthened my desire to pursue a career where I can provide competent and compassionate care, especially in moments when patients are most vulnerable. During my overnight shift in the Labor and Delivery ward, I witnessed the intensity, urgency, and profound humanity of bringing new life into the world. Even though my time there was brief, I observed the critical teamwork between medical officers, nurses, and midwives, and how every decision carried weight for both mother and child. I was shocked to learn that epidurals were generally not offered unless the mother was undergoing a C-section, and I felt for the women laboring without this form of pain relief. Seeing their strength and resilience firsthand was both humbling and inspiring. I also had the opportunity to view a C-section, which was an eye-opening experience. Observing the surgical team’s coordination and focus, as well as the immediate transition of the newborn to care, highlighted the precision and teamwork required in critical situations. This experience reinforced lessons I had already begun to understand in pediatrics and the emergency department: medicine is not just about technical skill, but also about empathy, communication, and presence. Providers balanced clinical urgency with compassion, comforting patients and offering reassurance even in high-stress moments. Being in the ward overnight gave me a deep appreciation for the emotional and human side of healthcare and reminded me that being a provider is as much about supporting people through life’s most vulnerable moments as it is about treating disease. These lessons strengthened my aspiration to become a physician assistant who can deliver competent care while also connecting with patients on a human level. Mombasa County has a higher HIV prevalence than the national average, and that statistic became profoundly real during my time at the hospital. I encountered numerous patients—both adults and children—whose lives were directly affected by HIV. The emotional weight of these encounters was palpable, especially when discussing treatment plans and the challenges of medication adherence. One particularly memorable interaction involved a mother in the pediatric ward, deeply concerned about her child’s health. The physician took extra time to explain the child’s condition, the importance of antiretroviral therapy, and the need for consistent follow-up care. Witnessing this compassionate communication underscored the significance of not only medical treatment but also emotional support and education in managing chronic conditions like HIV. My two weeks in Mombasa were transformative, offering lessons that extended far beyond clinical knowledge. From pediatrics, I learned the power of observation, clinical reasoning, and compassion. The emergency department taught me adaptability, rapid decision-making, and the importance of clear communication under pressure. Labor and Delivery showed me the courage and resilience of patients and the teamwork required in critical moments. Encountering patients affected by HIV deepened my appreciation for the intersection of medical care, patient education, and emotional support. I realized that effective healthcare requires not only knowledge and skill but also cultural sensitivity and the ability to support patients through their most vulnerable moments. Together, these rotations solidified my desire to become a physician assistant who can provide competent, compassionate care in a variety of settings. I am inspired to carry forward the lessons I learned in Kenya—the importance of empathy, communication, adaptability, and partnership with patients and families. This internship has not only reinforced my commitment to healthcare but has also shaped my vision for the kind of PA I aspire to be.

My time in Cusco was amazing, and I really appreciated everything and all the staff who took care of us. Juda, Manuela, and Surabhi were all very helpful when it came to asking them questions about the program, and they were equally helpful when we asked questions about Cusco, such as restaurant or shop recommendations and how to navigate around the city. I have no complaints with any of the doctors; all of them were super nice and answered any of our questions. Particularly, Dr. Silva and Dra. Yadhira stood out to me, and I really liked their approach to medicine. Lastly, I participated in the Machu Picchu trek, and I want to shout out Hans and Raul, who were our guides. They were amazing and very accommodating. I am a slow hiker, so Raul stayed back with me and my friend so that we wouldn't get lost or be unsafe. They were also very fun and did karaoke with a few of us after the trek, which is forever going to be memorable for me. Overall, I have no complaints with any staff. I also want to shout out Victor for being the best driver, and all of the staff in the hotel for all their hard work. My experience being a pre-Physician Assistant intern through International Medical Aid (IMA) in Cusco, Peru is an experience I will be eternally grateful for—not only because it was a determining factor in why I want to pursue medicine, but also because I learned so much from the social and medical culture in Peru. A reason I applied specifically to the Peru location is because I never hear much about South America as a whole in U.S. media, and if I do hear about it, they only mention the “dangers.” However, the three weeks I have spent here gave me so much growth and knowledge about Peru. I was able to connect deeply with the mentors and other locals in the city of Cusco, and getting to talk to the doctors about their experience in the medical field was eye-opening. Coming to Peru was like finally understanding the expression, “Don’t knock it till you try it,” because all my preconceptions were erased and replaced with true knowledge of the culture and the socioeconomic structure. Ever since I was younger, I was always interested in the medical field, and as I grew up, I started to become more and more aware of how medicine is run in the U.S. I am lucky to have grown up in a household where we are able to afford sufficient insurance, so personally, I have never dealt with the hardship of large medical bills, but through personal research, I have learned how difficult it is for people of low socioeconomic status to get proper insurance and medical care. In the United States, healthcare is not free, but as I learned in Peru through our cultural presentation sessions, all Peruvians have the right to universal healthcare. Though I did not know this before coming to Peru, I was not shocked. It is rarer to see countries that do not provide free healthcare, such as the United States. One of the largest ongoing debates is whether the U.S. should pivot to a universal healthcare plan; some of the disadvantages include “significant upfront costs and logistical challenges,” while the advantages could create “a healthier populace and thus, in the long-term, help to mitigate the economic costs of an unhealthy nation” (Zieff et al., 2020). Due to the U.S. having an extremely advanced healthcare system that can offer some of the best care and procedures for extremely unique cases, many people disagree with the idea of offering a universal plan because it will create more complications in how healthcare should be divided. However, the latter perspective suggests that having an option of universal healthcare will create a healthier America and illness in our population will decrease. Furthermore, in Peru, the way healthcare works is that everyone has access to universal healthcare, but if they are employed, they can opt in to affordable insurance that gives them access to more advanced hospitals such as EsSalud, which is a division 3-1 center. The level of care there is not entirely comparable to the advanced care in the U.S.; however, these hospitals provide general and some specialized care, which is considered high level. The highest level of care in Peru is division 3-2. These centers contain sub-specialized fields and are only found in the capital, Lima, because it is the most populated city (International Medical Aid, 2025). This is unfortunate because if someone were to have a unique medical emergency, they would have to be rushed to Lima to get quality care, while in the U.S., it is common to live closer to hospitals with specialized care. During our time with IMA in Cusco, we also made a short trip to a nearby rural city called Casacunca, where we held a community clinic to help and provide medical attention to the citizens of the city. As we learned in our clinical debriefing sessions, most of Peru’s population is in the large cities such as Lima and Cusco, but there are a vast number of rural cities that, unfortunately, rarely get medical attention, so it was amazing that we were able to assist those who deal with this misfortune. Through my American perspective, I initially thought it was so unfair that people who live far from major cities hardly ever seek medical attention from doctors, and I believed it was almost diabolical that the government hasn’t expanded and created more large hospitals in these regions. However, as I learned by being in the rural cities in Peru, a lot of the citizens do not go to physicians and/or do not believe in Western science and instead prefer herbal medicines and advice from shamans/healers. This is because they strongly believe in the powers of traditional medicine, and access to it is more proximal (van Soeren & Aragon, 2016). In contrast, in Cusco, more people tend to turn to Western medicine because they have access to it, and the EsSalud hospital and many clinics we shadowed at are examples. In an even larger contrast, in the United States, we are the pinnacle of Western medicine—so much so that we try to cure anything and everything with medicine or medical treatment. The U.S. also spends the most out of all wealthy countries on healthcare, which allows us to have many advanced hospitals and medical technology throughout the country. However, we still see a lot of problems with the health of our citizens (PFPG, 2022). Even with this level of spending, we see high infant mortality rates, unmanaged diabetes, and more (PFPG, 2022). This shows that maybe Western medicine is not always the cure for medical problems, and instead there should be a balance between traditional and Western medicine. In one of my classes in college, I learned how if someone is pre-diabetic, instead of instantly starting insulin doses, they should invest in caring for their diet by cutting out artificial sugars and eating more protein. Ultimately, from my knowledge of Western and traditional medicine, I believe that they are both valuable and people should research both when they are looking for a “cure” to what they have. Additionally, through the IMA program, we had weekly presentation sessions, and in one session we specifically discussed the disease burden in Peru. One large takeaway I had from this presentation was that many people die from disease annually in Peru, and some of the main diseases that are killers in Peru are completely managed here in the United States. From the lecture, we learned about the most common communicable and non-communicable diseases found in Peru. Communicable diseases are transmitted between people or other organisms, and the common ones in Peru are malaria, dengue, tuberculosis, and acute respiratory infections (International Medical Aid, 2025). Non-communicable diseases are not spread from person to person, yet they arise due to the individual’s behavior, and the most widespread ones in Peru are hypertension, diabetes, and COPD in adults and anemia and malnutrition in infants/children (International Medical Aid, 2025). Two diseases that stood out to me from being in the lecture and staying in Peru for three weeks were tuberculosis and anemia. According to the lecture, there are about 27,000 cases of tuberculosis (TB) annually in Peru. In the U.S., we have less than half that rate annually, at around 10,347 cases reported by the CDC in 2024 (CDC, 2025). One possible reason that could explain why the U.S. does not experience as many TB cases compared to other countries like Peru is because of our widespread healthcare system. Again, as I have mentioned earlier, U.S. healthcare is considered to be one of the most technologically advanced and is well known for having extremely specialized care. This is most likely the reason why we do not see as many cases of TB, and if we do see them, there is less chance of it leading to mortality. In Peru, healthcare is not as widespread, and what I mean by this is that large hospitals with specialized or sub-specialized care are only seen in the most populated cities. If people are diagnosed with TB in a rural city, they will have to travel long distances to get specialized care in a hospital, and if they can’t afford the travel or do not have access to travel, they have to treat themselves the best they can. This is why TB is extremely prevalent in Peru specifically, and the reason why TB is one of the most deadly diseases in Peru, causing an estimated couple thousand deaths annually (International Medical Aid, 2025). This is why Peruvian healthcare should be more accessible, and this can start with the government allocating more funds to build more division 3 hospitals throughout the country, not just in major cities. Anemia was another disease that I became more familiar with through this internship. Working alongside the doctors and nurses in the EsSalud hospital, I learned that anemia has a different detection threshold in Cusco, Peru in comparison to the U.S. and even other cities in Peru, such as Lima, due to the high altitude. In Cusco, Peru, a detection of 11 mg/dL or below in the hemoglobin is considered anemic, but in the U.S. it is 13.5 mg/dL for men and 12 mg/dL for women (International Medical Aid, 2025; American Society of Hematology, 2025). The high altitude causes there to naturally be less oxygen in your blood because there is less oxygen in the atmosphere, and that is why anemia has a lower threshold in Cusco than in other cities/countries—because Cusco stands at about 12,000 ft, being one of the tallest cities in the world. Anemia is also highly prevalent in infants and children in Cusco, and this is due to malnutrition. Children in Cusco do not eat enough red meat and, in general, have poor nutrition, and I was able to actually see this while shadowing in the pediatric and nutrition departments. Fortunately, most of the doctors I worked with explained that anemia usually goes away after about 3–4 years of age, so it is able to be managed, but they did explain that malnutrition is something that is very common in infants throughout all of Peru, and this is the larger problem. Malnutrition comes with a lot more problems than anemia such as irregular bowel movements, thermal issues, dehydration, and even mortality. Chronic malnutrition in infants in Peru is at levels of 11.5%, and in the U.S. it is about 1%, which shows that our government has more control over infant malnutrition. However, according to the USDA, 1 out of 5 children in the U.S. lack food security, so the statistics on chronic malnutrition could be fluctuating regularly depending on the state of the economy (International Medical Aid, 2025; USDA, 2025). Ultimately, infant malnutrition should not be something prevalent in any country, and it should always be a priority that children have access to sufficient nutrition and meals. To conclude, my pre-Physician Assistant internship with International Medical Aid was life changing and taught me more about medicine and myself. I learned exactly how passionate I am about medicine, and I am grateful that I was able to learn in a new environment where I experienced medicine in ways that I have never seen or heard of before. Now, as I pursue my future career, my perspective on medicine and patient care has broadened, and this is for the better because I can approach medicine with the structured U.S. mindset and also the more interactive Peruvian mindset. I will always remember my time in Cusco, and I cherish it. Thank you for giving me this outstanding opportunity.

Overall, I loved the program. I loved how all the doctors were inclusive. On off-clinic days, the program mentors always had an event planned, which was so nice. Being able to learn about the city and tour around was great, and I loved all the food they offered. I want to thank the mentors for being flexible with the interns. They would ask daily who was going out to eat and who was eating at the accommodations. The mentors were always concerned about our health if we did not feel well. I remember the day I got sick—Juda and Manuela kept checking up on me to make sure I was okay. I really appreciated their concern and willingness to help us. Manuela did a great job letting me know who was going to pick me up for my trek, and all the drivers were on time. Big shoutout to my trek guide, Hans. We got to know each other very well and really enjoyed the lunch spot he picked out for us. During my three-week internship with International Medical Aid (IMA), I gained a vast variety of knowledge and experience that has permanently impacted my medical journey. One of the most memorable moments of my internship happened at the community medical clinic. We traveled to Casacunca, a small village in the highlands of Anta, where I gained knowledge on how doctors diagnose patients based on their symptoms and physical examination. I also observed how doctors provided exceptional patient care with limited resources. Having the ability to apply my acquired knowledge of physical examination under the supervision of a physician and contribute to essential healthcare access was my favorite part. Furthermore, this experience is one I will carry with me throughout my medical journey to becoming a physician assistant. It helped me understand the importance of patient care, cultural sensitivity, and the value of healthcare access. At the beginning of the internship, I was excited and curious to see how the clinical rotations were going to be organized. I was looking forward to being hands-on and eager to learn from all the medical personnel at the hospitals and clinics. I have a healthcare background—my mother is a medical assistant, and I work at Stanford Health Care—but my patient care experience is limited. Moreover, I was indecisive about my career path in medicine at the beginning of this program. I have a bachelor's degree in Economics, and starting a career path in medicine would mean I would have to go back to school and start over. My plan is to become a nurse to gain patient care hours and then become a physician assistant. By the end of the internship, I was confident and certain my plan was the right one for me. One of the most important lessons I learned during this program was that patients are not just data or markers you read from an exam. They are human, just like us, so we must take the time to get to know them. This made me realize that becoming a nurse before I become a physician assistant is the right path for me. While shadowing the doctors in the IMA program, I learned something new in each rotation and gained an immense amount of experience in general medicine, urgent care, ultrasound, wound care, and pediatrics. Starting with urgent care, working with Dr. Pedro was great. The environment was fast-paced, as he only had about seven minutes to see every patient, but he always took the time to explain the key points to the interns after seeing each patient. During my time with him, we had a patient who came in with complaints of fever, dry cough, and throat pain that had lasted four days. The patient's oxygen saturation was at 88%, which is normal in Cusco. Dr. Pedro explained that the elevation causes physiological changes to the body. We see these changes not because there is less oxygen at higher altitudes, but because of the change in pressure. With the decline in barometric pressure and the ambient partial pressure of oxygen during ascent, the partial pressure of arterial oxygen and the oxygen saturation are reduced (Luks & Hackett, 2022). I was able to observe this change as soon as I started to walk around Cusco. I was out of breath and felt my body working harder to breathe. As we continued to examine the patient, Dr. Pedro auscultated the patient's lungs to check for any abnormal sounds. Dr. Pedro allowed the interns to participate, and we all heard a crackle in the patient's breathing. This moment stood out to me because I was able to put a sound and label on what abnormal sounds could be during a lung auscultation. When the patient was asked if they were taking any medicines for the cough, the patient said yes, they were taking antibiotics. However, the antibiotic the patient mentioned was indicated for someone who had a cough with phlegm, not the dry cough the patient reported. Dr. Pedro then highlighted the pharmaceutical problem they face in Peru. A pharmacist in Peru can prescribe antibiotics based on someone's symptoms. This causes an issue for doctors, as many patients don't need antibiotics for their illness. From this rotation, I learned that the environment and background of a patient become as important as the symptoms you see present. In addition, although Dr. Pedro had limited time with each patient, he made sure to answer all of the questions the patient had. “It's important to get to know the patient and understand them so they trust you and feel comfortable sharing their history with you,” Dr. Pedro would say. The more information you have, the better evaluation you can assemble, which is especially valuable in a setting where healthcare access has its barriers. These barriers can differ from country to country. Some are systemic differences, and others are economic differences. Having the opportunity to shadow at EsSalud helped me understand these differences. I have the privilege of working at Stanford’s Emergency Department, where resources are abundantly available compared to other hospitals. When shadowing at EsSalud, doctors highlighted the limited amount of resources they have to work with. They don't have every specialty at their disposal, so they work with what's available. One of the systemic problems they face consistently is the use of antibiotics. In Peru, pharmacists are allowed to provide antibiotics to patients without a prescription. Doctors are not supportive of this practice, as the patient could be taking medication that does not treat the illness they have. Many infections are caused by viruses, and antibiotics will have no effect on them because antibiotics are prescribed for bacterial infections (What Happens If You Take an Antibiotic You Don’t Need? | UNC Health Talk, 2024). I recall Dr. Fabrizio teaching us the Centor criteria to determine if an infection is viral or bacterial. The Centor criteria had different components in which you awarded a 0 or a 1. If the total came out to be greater than or equal to 4, then the doctors would consider the infection bacterial. This is when the use of antibiotics becomes most practical. Having this understanding of antibiotics has helped me educate my family members. My father is from Mexico, and they have the same type of pharmacy system. Throughout my childhood, I would visit my family in Mexico, and having the ability to discuss my complaints with a pharmacist and then obtain medicine in the same moment was something I always viewed as beneficial. However, after interning in Peru, my perspective has changed. I now remind my family to be cautious about going to the pharmacy right away when we visit Mexico. I advise them to see a doctor first so they can be evaluated and prescribed the right medication. As patients have easy access to antibiotics and are exposed to consuming so many, it's concerning that patients can become antibiotic-resistant. A study was carried out analyzing 10 hospitals across Peru to see the effects of antibiotics given to patients in a hospital setting. About 900 patients were given antibiotics, and around 70 percent of those patients were prescribed antibiotics as empirical treatment, with only about 4 percent of those prescriptions being effective (Rondon et al., 2023). Although this study does not address the specific reason why so many Peruvians are antibiotic-resistant, when I asked the doctors at EsSalud, they all attributed it to the easy access to antibiotics. Patients can simply walk over and obtain medication based on their symptoms from someone who is not licensed to prescribe. Over time, patients have taken so many unnecessary antibiotics that they have become antibiotic-resistant. Comparing this system to the United States, back in 1951, the US government passed the Durham-Humphrey Amendment. This amendment categorized prescription drugs and over-the-counter drugs, with the intention of preventing harm to patients. Prescription drugs would be monitored by licensed medical professionals, and over-the-counter drugs would be available to patients at any local pharmacy (Harrington & Jarrell, 2024). This amendment laid crucial groundwork in controlling access to antibiotics and many other drugs within the United States. Furthermore, another factor that has contributed to the control of antibiotics is antibiotic stewardship programs. These programs aim to optimize the use of antibiotics and minimize the harm caused by unnecessary use (Centers for Disease Control and Prevention, 2024). With programs like these in place and with political influence, the United States is able to control a problem other countries are still facing. The pharmaceutical industry is not the only systemic difference between the United States and Peru. The next topic of discussion looks at the economic differences between the two. During our lecture series with Dr. Fabrizio, he educated us on the economic differences between the healthcare systems of the United States and Peru. In the US, hospitals rely on private funding and public funding. Private funding comes in the form of private insurance companies and patient out-of-pocket payments. Public funding usually comes from government programs like Medicare and state-to-state insurance programs like Medi-Cal. My eyes lit up during this part of the presentation, as I deal with insurance as part of my job at Stanford, and I understand the struggles with funding. Most patients do not understand how insurance works. They think that by paying their monthly premium, they have nothing else to pay. Unfortunately, that is not the case. Some insurances have deductibles, and insurance companies want you to pay out-of-pocket to meet that full amount. However, there is another part of your insurance that many do not know exists, which is your out-of-pocket maximum. This number is the amount of money your insurance company wants you to pay out-of-pocket before they start covering all your medical expenses. So, in addition to paying your deductible, you must also meet your out-of-pocket maximum. When patients receive their estimate for their emergency visit, they are astonished by the high amount. The reason the bill is so high is because of the out-of-pocket maximum that patients are not aware they have. Consequently, patients have shared with me that the high bill is a reason they do not seek medical attention at times. Not everyone can cover the thousands of dollars it costs to be seen in the emergency department. It's always a tough conversation to have with a patient when they are dealing with an illness, accident, or injury, and my job requires me to collect payments from patients. Now, looking at public funding programs like Medi-Cal, which is insurance for low-income individuals and families in California, there are both benefits and setbacks. Patients with Medi-Cal insurance will have their emergency visits covered, but when they want to see a primary care provider or specialist, that becomes difficult. Patients insured by Medi-Cal have to see a primary care provider within the network before they see other doctors. These in-network doctors are usually based in small clinics around the communities and don't typically work at these clinics for very long. Patients have a hard time building a relationship with their primary care provider because they will see them a couple of times in the year, and by the following year, they have a new doctor. Patients have shared with me that they prefer Stanford's doctors, but their insurance makes it difficult to see them. There are even times when patients obtain an appointment, but at check-in, we have to inform them that their insurance has denied the visit. If they want to pay out-of-pocket to see the doctor, we have to advise the patient that they might lose their insurance coverage if they proceed. This can be a very frustrating process for the patient and is a reason why patients don't continue with their medical care. In comparison, the economic problems Peru faces are a bit different. When it comes to funding, they rely on public funding and insurance to cover the costs. Public funding comes directly from the government. In 2009, the government created universal healthcare for all Peruvians to address the health inequities and disparities in its most vulnerable population (International Medical Aid, 2023). Peru's healthcare system is divided into different sections. The Ministry of Health (MINSA) provides services to patients under universal healthcare. Social health insurance, or EsSalud, is a medical service that is paid for by patients' employers. Lastly, there are private clinics that typically receive their funding from patients paying out-of-pocket for their services. Many would think that having universal healthcare would solve healthcare access problems, especially for the most vulnerable and poor populations, but this is not the case. Although these services are built to help, access to these locations is still the biggest problem. Another complication is the distribution of funds from the government. When I asked our mentors in the program what they thought of the government, no one was in support. Some of the things they mentioned were the inconsistency of presidents and the misuse of funds. A study was completed in 2020 about the use of funds, and they found that 3.4 billion soles (1 billion US dollars) was not used (Rolf Erik Hönger & Montag, 2024). These funds could be very useful in many different areas, from healthcare supplies to healthcare infrastructure. No one’s healthcare system is perfect, and both systems could use improvements in different ways. Learning about each country's economic differences was interesting. There was always new information I learned throughout my internship. During my rotation at the private clinics, I observed how to perform an arterial blood draw and how doctors use it to obtain a more accurate read on a patient's oxygen level. Being able to see this in person was fascinating, and the lab technician explained all the new information in a simple manner. However, the patient interaction that stuck with me the most was with the community medical clinic patients we saw at Casacunca. Seeing doctors travel hours to provide care to people in rural communities, all while doing it with a smile, has shaped my perspective on being a healthcare provider. Being a provider is not only about giving care to those who can access it or afford it, but also about providing care to anyone, because everyone should be cared for regardless of their social or economic background. At the community medical clinic, I worked in general medicine with the doctors and attended to a mother and her son. The mother came in for a headache, and her son came in for throat pain. I was able to improve my communication with patients as I completed the lung exam and checked if the patient had any tonsillitis with the supervision of the doctor. Having this opportunity helped me better understand the importance of communication in the medical field. You want to make sure the patient understands how to take care of themselves once they go home, and being able to communicate that with your patient is essential in medicine. Being a part of the community medical clinic was my favorite part of my internship with IMA. Not only do I feel I made an impact in this community, but likewise, this community has made an impression on my future goal to become a physician assistant. In closing, this internship has shaped the way I will approach my medical journey. All of the rotations helped me understand the importance of patient care. The lecture series from the doctors improved my cultural sensitivity, and the community medical clinic helped me recognize the value of healthcare access. My career goal is to become a physician assistant. Before, this idea was up in the air. I was thinking of becoming a nurse first and then seeing if I still wanted to go back to school. After being around providers for three weeks, I have never been more certain that being someone who can diagnose and care for patients is my ultimate goal. I want to have the knowledge and autonomy to care for patients and help them understand what is going on with their bodies so they can care for themselves as much as I will. My next steps are to complete my last couple of prerequisites and apply to nursing school. If I don't get accepted in my first round, I will transition into working as an EMT, CNA, or MA to gain patient care experience and then become a physician assistant. Additionally, working in a rural community has sparked my interest in rural medicine, as it resonates with my family background. When we were in the Casacunca community, I felt at home. My father grew up in a village where you would have to drive for hours to seek medical care. I aim to study rural medicine or conduct research and be able to go back to my father's town or Peru as a physician assistant to provide care. I have already talked about applying to IMA again as an official provider with some of my IMA classmates. Not only do I want to provide care in a hospital or clinical setting, but I also want to travel to provide care to those with limited access. Healthcare should have no barriers and should be accessible to all. I intend to contribute to this belief by sharing my knowledge and being part of medical humanitarian programs throughout my medical career. This program will have a lasting impact on my medical journey, and I cannot be more thankful to IMA for allowing me to have this life-changing experience.

This experience in Peru has changed my view of not only healthcare but also life. The things I have learned are valuable not only to my future working in healthcare but also as life lessons. The doctors I worked hands-on with were all incredibly helpful and understanding. The culture I experienced will stick with me for a lifetime. My internship with International Medical Aid in Peru deepened my knowledge of healthcare and strengthened my resolve to work in the field. Being exposed to a healthcare system that is very different from the one in the United States has influenced who I am and the kind of healthcare professional I want to become. I was able to fully immerse myself in a different culture during this two-week trip, analyze the differences between healthcare systems, and observe a wide range of patient relationships. I will use the important experiences and knowledge I gained as I work toward becoming a physician assistant and developing into the best healthcare provider I can be, committed to combating healthcare inequities. The healthcare systems in Peru and the United States differ greatly. Infrastructure, equipment, and resources are some of the primary distinctions. The healthcare system in the U.S. benefits from significant funding, modern infrastructure, advanced technology, and a wide range of services. Despite having a highly developed healthcare system, access in the U.S. is often limited by insurance status and socioeconomic class. In contrast, Peru’s healthcare system faces major challenges, including older infrastructure, limited funding, and inadequate equipment—particularly in low-income communities and rural areas. Some Peruvian hospitals lack the specialized physicians that many patients may require due to these financial constraints. With limited resources, many hospitals do not have access to modern medical equipment, advanced technology, or even some basic supplies needed to evaluate and treat patients. The United States is said to have 95.58% access to modern technology, which is 27% more than Peru’s 75% (National Master, 2025). However, Peru is said to have 62.5% healthcare cost, which is 36% more than the United States at 45.81% (National Master, 2025). These percentages highlight just a few of the disparities between the healthcare systems in Peru and the U.S. During my internship, I was able to witness some of these differences firsthand. Compared to the United States, Peru has a higher prevalence of natural medicine. Instead of relying solely on pharmaceuticals, as is more typical in the U.S., many people in Peru advocate using natural methods to treat illnesses or wounds. Coca leaves, for instance, are strongly recommended as a treatment for altitude sickness, whereas in the U.S. a prescription medication is usually required to alleviate the condition. Another example is maca, which is said to help prevent or manage anemia due to its high iron, protein, and vitamin content (Peruvian Medicinal Plants, 2022). In contrast, prescribed medication or supplements are typically used to treat anemia in the U.S. Before traveling to Peru, I had never seriously considered using natural remedies to heal a variety of illnesses; I always assumed it was more of a placebo effect. This experience showed me how Peruvian and American approaches to treatment differ. During my time in Peru, I witnessed how medical professionals respected their culture and customs by treating patients with more conventional methods while also accepting and incorporating natural or traditional therapies. I learned to respect a patient’s culture and traditions while still offering a professional medical opinion, which can help the patient receive the best care possible. Traditional medicine was widely used when providing care in the Maras community. Although conventional medicine may often be more reliable or offer faster relief, allowing patients to continue using their traditional medicines helps them maintain their beliefs and gives them a sense of identity—both of which are essential for a patient’s overall well-being. I was also able to observe the distinctions between Peruvian rural and urban areas when delivering care in the rural town of Maras. I went to and helped at a day clinic run by IMA in Maras, which was about an hour and a half away from Cusco. My doctor and I saw about fifteen people and provided them with basic medical care. The patients in the rural and urban communities differed significantly. Due to the lack of resources in remote areas, many people had to endure illness for weeks, months, or even years before getting assistance. Delays in seeking treatment can lead to delayed diagnosis, which can mean that a patient’s condition is advanced and treatment is more difficult or sometimes impossible. This can result in increased rates of illness and mortality, contributing to Peru’s high burden of disease. The United States and Peru also differ in the diseases that are most prevalent in each country. In Peru, anemia is very common in children. About 7.3% of children ranging from ages 6 to 35 months have anemia (Alfonso Accinelli, Alfonso Leon-Abarca, 2020). In the United States, anemia prevalence is lower at 3% (Iron Deficiency in the United States, 2022). This is a major difference between Peru and the U.S. The leading cause of death in the United States is heart disease, with 680,981 deaths attributed to it (CDC, 2025). In Peru, noncommunicable diseases are the leading cause of death, accounting for 102,145 mortalities (World Health Organization, 2022). These differences show distinct challenges within each country’s healthcare system. My internship with IMA has transformed the way I look at healthcare. It has taught me to advocate for better care and preventative measures for all communities. It has opened my eyes to worldwide disparities within healthcare systems. By witnessing these disparities firsthand, I feel even more encouraged to continue my commitment to becoming a healthcare provider. With this new understanding of patient interaction, preventative care, and advocacy for a better healthcare system, I am committed and excited to use my newfound knowledge to provide the best care possible to all patients. This experience has deeply impacted the type of provider I plan to be. It has taught me the importance of compassionate, patient-centered care, and it has strengthened my determination to help reduce healthcare inequities wherever I work in the future.

With hotel accommodations located just a 15-minute walk from the Plaza de Armas, I was right in the center of the city. The location was also close to so many delicious restaurants and cafés where I could enjoy local cuisine. Safety never felt like a concern, as transportation was provided everywhere we went. The hotel was comfortable, and if we had any trouble, our mentors were always available. Am I on the right path? Is healthcare the best place for me? These were questions I asked myself constantly before my time with IMA in Cusco, Peru. Here, I was exposed to various specialties, shadowing doctors, engaging with patients, improving my medical Spanish, watching a surgery, and being a part of a rural health clinic. All of this instilled confidence and trust in myself. I know more than ever that healthcare is the path for me. That’s all thanks to IMA. Before I boarded my plane to Peru, my path still looked blurry. I had only experienced alternative medicine, worked with physical therapists and chiropractors, and went to school with the original plan of becoming a dietitian. When I decided that dietetics was not for me and I began my pursuit of becoming a Physician Assistant, I was nervous, a little unsure, and quite overwhelmed with all the prerequisites just to apply to schools. Alongside that initial fear, I knew I would have to forge my own path and make my own connections, as I am the first person in my family to enter the medical field. Most people I know going into the medical field have some idea about what specialties they’re drawn to, but I was filled with uncertainties. The purpose of my first international trip alone to Peru was to determine if medicine was for me or if I needed to find something else. Originally, I was hesitant about leaving home and going to a country where I knew I would have to use a language I had barely used since college graduation. I kept reminding myself how I always wanted to use Spanish in my future career. What better way to get comfortable with it than an immersive experience abroad? At least that’s what I thought. Upon my arrival, I quickly realized how rusty my Spanish had gotten, though with some rest, rehydration, and food, I felt ready for my first day Monday morning. My first day started in General Medicine with Dr. Pedro. In general medicine, I saw a variety of cases and had the opportunity to listen to heart and lung sounds to determine abnormalities and get to the root of the patient’s complaint. While performing these tasks, I realized how broad general medicine truly is. Many patients came in with a variety of problems—some for monitoring their medication, others for back pain, and some needing referrals to doctors with further specializations. I was shocked by the extensive knowledge that general medicine doctors need to have to provide care to their patients with such a wide range of issues. The following day, I was in geriatrics. Geriatrics surprised me. From my time working in an assisted living facility, I knew that older patients tend to have multiple medical conditions requiring multiple medications. I found it very impressive how the doctor quickly evaluated labs and made changes to medication lists and instructions on when to take them. It was second nature for her and seemed to require little thought to ensure that the medications were administered at the correct times. Although impressive, it was a little overwhelming to see the speed at which she worked and to imagine how a future in healthcare would require the same confidence from me. She did take the time to explain everything she was doing and allowed me to help with taking vitals and listening to lung and heart sounds. This calmed my nerves. It was interesting to hear the differences in these sounds between an older and a younger person. One thing that stood out to me here was how everyone’s blood oxygen saturation was below 90%. In the U.S., this requires immediate attention, but she explained that in Cusco, these values were normal and healthy. This is due to the low atmospheric pressure at higher elevations, decreasing the binding between hemoglobin and oxygen in the blood (Matthew, 2023). Geriatrics was also where I was introduced to traditional Peruvian attire. Many older women came into the exam rooms with more than five skirts, called polleras, tied around their waists, aprons with a big pocket draped in front of them, and bright, colorful blankets called mantas hanging behind them, holding their belongings and sometimes even children (Merotto, 2021). Topico was by far one of my favorite rotations, where we worked with the nurses. It was a fast-paced environment with multiple things happening all the time. We hardly had a second to sit down, but it was packed full of learning and patient interaction. The nurses here were very kind, and the one I shadowed was a fantastic teacher. She taught me how to draw up injections. Using one hand to hold the syringe while simultaneously drawing the liquid proved to be a difficult challenge. She explained every step in performing the injection—from disinfecting the injection site, stretching the skin, injecting at the cross-section of the iliac crest and top of the hip, aspirating the needle to ensure that you were not in a blood vessel, and finally injecting slowly to reduce the discomfort the patient might feel. She also described the uses of different medications that were administered there every day. Here, I developed a thorough understanding of the common pains, wounds, and problems that the community of Cusco dealt with and got to see it all firsthand. Although I loved my time in topico, obstetrics was my number one. We discussed the growth and development of fetuses, evaluated growth through measurements of the mothers’ uteruses, and listened to fetal heartbeats. Becoming a part of the patient’s journey into parenthood was magical. I didn’t expect to enjoy this specialty so much. I began to see my future in healthcare more clearly and found myself fully engaged in each visit, trying to soak up all that I could. My favorite memory in this unit was with a patient who was about 28 weeks pregnant. During the visit, the obstetrician needed to palpate the mother’s stomach to feel the position of the baby. After doing so, she turned to me, grabbed my hands, and guided me to locate two little feet and the baby’s head. It felt amazing to be able to feel the little invisible human, and in that moment, I realized I might want to do that in the future. The last mentionable rotation was surgery. Maybe because of my love of Grey's Anatomy, I always saw myself working in an OR. Although I’ve tried to find opportunities in the U.S., observing surgeries is difficult to arrange, and being able to see one after wanting to for so long filled me with excitement. We were fortunate enough to watch a patella fracture repair. It began by administering an epidural to numb the lower half of the patient’s body, leaving him awake. Before this, I had only heard of brain surgeries where patients were kept awake, so I was shocked when I realized that this patient was going to remain awake the entire time. What surprised me most about my first surgery experience was how poorly I was able to handle it physically. I thought that I would have no problem watching a surgery, but I quickly found that I was wrong. It might have been a combination of nerves, excitement, and discomfort, but I felt nauseous and lightheaded through just about the entire process. Even so, it was an important learning moment. I realized that becoming a healthcare provider also means understanding your limits, working through them, and giving yourself grace as you grow. Another component IMA included in my time in Peru was being able to provide care to the rural town of Poroy. In Poroy, I saw firsthand the lack of medical knowledge and access to adequate care that affected the lives of the people living there and that of their children. Early on in the clinic day, there was a little girl and a father who came up to the doctor I was with for a consult. The father was concerned about his daughter’s teeth, which caused her pain when she ate. She was just four years old. When she opened her mouth, it was full of cavities. We later learned that she had never been taught how to properly brush her teeth. This broke my heart. What made it worse was that there were many other children just like her that day. A study conducted to compare adolescent oral hygiene in Cusco, Lake Titicaca, and Lima found that 97.65% of their participants in Cusco had dental caries of varying degrees, and 20.81% were severe (Llano-Pérula, 2020). They indicated that these values were likely due to little oral hygiene knowledge. In Poroy, I witnessed the importance of rural healthcare and the need for health education, and I want to be a part of more health clinics in the future. Outside of the clinical experiences I had with patients and providers, I was also able to develop my skills and techniques. I had a refresher on CPR, learned how to perform abdominal, heart, and lung exams, learned how to intubate a patient, and learned three common types of sutures and how to do them. Since then, I have purchased a suture kit to master the knots I learned. My time shadowing the doctors was amazing. In the U.S., this is a very difficult opportunity to find, but with IMA, I was able to be with the doctor, assisting them while caring for people in the community. I was exposed to a variety of specialties and found what areas excite me the most, giving me a better idea of where I want to end up. There are so many options out there, and it’s easy to get lost and stressed about which one is the right choice. My time with IMA allowed me exposure to those options and solidified that I am on the right path. Because of this experience, I am more confident than ever that I will make a great healthcare provider.

Overall, my experience in Peru was unreal. I truly learned so much, and it helped me see myself working in healthcare and doing what I love. Eder, Grecia, and Manuela were incredibly supportive and helped us with anything we needed during our time in Peru. They stayed in close communication with us and made sure our experience was the best it could be. I felt safe everywhere I went—including at the hospital, while walking around the city, and especially at the hotel. There truly wasn’t a moment when I felt unsafe. The accommodations were better than expected, and although there were a couple of minor bathroom issues, the staff were responsive and willing to help right away. The food was amazing, and the cooks at the restaurant welcomed our feedback and prepared some truly incredible meals. There were a couple of treks we went on during our time in Cusco. Starting on the second day we were there, we had Hans as our tour guide, and he showed us around Cusco as well as Saqsewaman. He shared so much information with us and answered any questions we had. We then went on another trek (I don’t remember the name), and Hans was also our guide—he showed us more ancient Incan ruins, which was really insightful. Lastly, I went on the Inca Trail and Machu Picchu trek, which was honestly my favorite. Even though the hike was long and rough at moments—especially with the heat and all the uphill stairs—Johanns, our tour guide, was understanding, stopped whenever we needed to, and went above and beyond to make sure the other interns and I were taken care of and had the best experience possible. The overall impact this program had on me was inspiring and eye-opening. I loved every part of my time there—from exploring the city and going on treks, to working in the hospital, visiting rural communities, and participating in hygiene sessions. Everything left a lasting impact on me as I move forward with applying for grad school and pursuing my future in healthcare.

My time as a Pre-Physician Assistant intern with International Medical Aid (IMA) changed me from the inside out. I went in with very few expectations, eager to embrace whatever was in store for me. I was so happily surprised with the overall program and felt so individually cared for throughout it all. The residence was such a safe, comfortable place where I felt cared for. One of the chefs, Grace, went out of her way to introduce herself to me on the very first day and make sure that I had eaten and enjoyed the food. She always greeted each intern with a smiling face and so much intentionality. My room was such a great space, and it exceeded all expectations. I always felt seen by the mentors, and they accommodated every need throughout the entire journey. I really appreciated the balance that we were given between learning and rest; while we had deeply meaningful experiences at Coast General, in clinical simulation sessions, through lectures, and at community outreach events, these were often a lot to take in, so I was grateful for ample personal time to reflect, unwind, explore Mombasa, and bond with fellow interns. Janet and Hildah were also so welcoming and personal, and they both were so great at organizing the two weekend trips I went on. Thank you so much to IMA for everything; you made this experience so life-changing and comfortable! Two words describe my overall experience as an intern for four weeks at Coast General Teaching and Referral Hospital (CGTRH) in Mombasa, Kenya: adaptability and humility. When the ENT doctor I was shadowing had her otoscope stolen and there were no funds to buy another, we used a headlamp. When a patient tested positive for cholera but there was no room in an isolation ward, we created a makeshift room for her outside. When a patient had never been seen for his heart condition and had arrived at the Emergency Department with end-stage heart failure, and there was nothing the providers could do to help, we made him as comfortable as possible and comforted his family members. As a volunteer, I worked with the local physicians to understand the best ways to provide care in a place where resources, sanitation, and health literacy are minimal. I learned that medicine is more than diagnoses; it is compassion for the person at large and resilience through obstructions. No medical education, shadowing experience, or laboratory curriculum can prepare you for the moment that a mother is lying in your lap on a cold hospital floor, hysterically crying after losing her two-year-old daughter to cholera. In that moment, explaining the physiology of the disease and treatment methods could not offer any support; I could only provide pure, compassionate human connection. This scenario occurred during my recent medical internship in Mombasa, Kenya, where resources, sanitation, and provider attention were minimal, causing the daughter to pass away from an illness that would have been preventable in the United States. As we watched her child die, I held on to the mother as she collapsed and continued to hold her through her grief. As I cried alongside her, periodically wiping her tears with my scrub top and answering her phone calls that came through from family members, I felt utterly heartbroken and helpless. More than anything, I was forced to reflect on the stark differences between healthcare in Kenya and the US, and how the diseases people face are vastly different from what I am used to. While I have worked in clinical settings at home, where many of the patient presentations are elective, noncritical forms of preventative medicine, many of the cases I interacted with at Coast General Teaching and Referral Hospital (CGTRH) were end-stage disease or emergency cases. I witnessed necrotizing fasciitis, malaria, chronic kidney disease, heart failure, enlarged malignant tumors, an electrocution injury, and Meig syndrome. Each of these was a captivating occurrence that not only taught me an extensive amount, but also opened my eyes to a new side of medicine I had never before encountered. In our “Disease Burden in Kenya” lecture, Dr. Shazim explained to us that a large majority of diseases historically present within the country are tropical illnesses (IMA, 2025). During the clinical debrief on this same day, we also learned about the intersection between healthcare and climate change that plays a drastic role in the distinct disease qualities between the US and Kenya. Cholera, specifically, is preferential to specific water temperatures, salinity, and humidity, making the bacteria more likely to live and survive in conditions like those in Kenya as opposed to the US (Lipp, 2002). While human immunodeficiency virus (HIV) is not necessarily a product of the climate, it is considered a tropical illness due to its prominent dispersion within countries of the tropics (American Society of Tropical Medicine and Hygiene). I had no prior knowledge of this virus aside from the minor details covered in my Microbiology course. During our tour, the stigma and tension behind this diagnosis were strongly apparent to me when Dr. Shazim highlighted the fact that we could not refer to HIV by its name, but rather as retroviral disease (RVD). Furthermore, patients were treated specially in the CCC, a special ward for HIV treatment where, even within its walls, the words could not be spoken. On my first day in the hospital, a clinical director told me to “assume each patient is HIV positive until proven differently” (IMA, 2025). Even with such a widespread presence, this disease is heavily looked down upon, and patients refuse to accept it as a diagnosis. Thus, it leads to a multitude of greater complications, as it destroys essential immune CD4 cells and makes individuals more susceptible to other illnesses, namely tuberculosis or chronic cardiovascular disease (HIV Gov, 2024). Because of this, HIV was consistently in attendance in each unit of Coast General throughout my internship. It was constantly lingering as a possibility in each provider’s mind, as well as my own. I quickly learned how to take this disease into account and factor it into corresponding diagnoses in order to attain a full picture of the patient and provide the best care possible. This came into great display during my last week of my internship, when I was in the maternity unit. Each mother was classified by her relation to HIV, as the virus is automatically transmitted in the birth canal to the fetus. By no fault of their own, the baby is then automatically a carrier of this illness, leading to a greater spread of it throughout the country. It was saddening, yet powerful, to witness the existence and effects of this virus in real life, as it is something that is commonly cited in medicine but not commonly seen throughout the United States. I was surprised and grateful to learn that there is antiretroviral therapy that people can begin to reverse the effects of this devastating disease, yet cost and limited healthcare literacy continue to be major barriers that inhibit people from receiving the care they need, as is the case for nearly every individual I interacted with in Coast General. A lack of health literacy, resources, and funding towards medicine leads to widespread impacts that bleed into every facet of the healthcare system in Kenya. One of the hardest moments I endured in Mombasa was on my very first day as an intern. I had been placed in the Accident & Emergency unit, where there was a surge of patients following a rainstorm the day prior. Right at the end of the shift, when the three of us interns were already drained and overwhelmed from the morning, a case came in who quickly coded in front of us. The clinical directors and clinical officers were all attending to other patients in the back, and the student nurses in charge did not know how to administer CPR. As we interns jumped in to help, we were frustrated when we found out that the oxygen mask had a tear and the only AED in the unit hadn’t worked in months. We were all left helpless, watching as this 18-year-old boy passed away traumatically. As someone who had never witnessed death with my own two eyes, I was frozen in place. It felt like life was moving around me, but I was at a standstill, brokenhearted and powerless in the moment. The three of us with IMA left, unable to verbalize to one another or the rest of the interns what had happened. Initially, I was angry—angry at the lack of provider attention; angry at the fact that they had an AED that didn’t even work; angry that the nurses had not been trained in CPR; and angry that this boy would never get to live the life he deserved. I will be the first to admit that it was incredibly difficult to go back to the hospital the following days and try to be present within my rotation. I found my mind silently criticizing everything and trying to find fault with the Kenyan healthcare system. Fortunately, I had the two other interns who had witnessed this scene, as well as supportive mentors and other clinical directors, to help me get through this barrier. The “Current State of Healthcare in Kenya” lecture opened my eyes with the fact that 5% of the total national profit of the country goes into healthcare. This was followed up by the statement: “Most healthcare funding goes to top hospitals rather than primary care or community health centers, so there isn’t much focus on preventative care” (IMA, 2025). Furthermore, we learned that Coast General cares for a primary population of 700,000 people and also a secondary population of 2 million. I remember being shocked by these truths, and immediately my perspectives were shifted. Rather than frustration towards the system at large, I felt newfound empathy for both the patients and the providers. I was able to realize that it is not the fault of the hospital workers themselves that resources, time, and skills are sparse; rather, there is a nationwide systematic malfunction that is cost-ineffective and inhibits the capacity of the caregivers. With such limited funding, there is no way that the hospitals can have updated equipment, consistent training sessions, or adequate attention from all of the providers. Moreover, the public hospitals are overpopulated in general, but especially with patients who are being seen for the very first time with chronic diseases that have progressed beyond management levels. A qualitative research study led through Health Promotion International identified several key factors as causes of low health literacy throughout Kenya: traditional cultural practices, religious beliefs, inadequate sources for medical advice, inaccessibility to caregivers, cost barriers, and personal responses to illness (Robbertz, Kim, et al., 2022). Without preventative care or basic understanding, citizens allow their maladies to develop past a point of return, and there is often nothing that can be done. While this, in itself, was still incredibly frustrating to me, I was able to enter into my clinical experience with a newfound lens. I saw that the providers were doing all they could, and they were even more defeated by the lack of consideration by the federal government. Coming full circle, this stuck out on my very last shift in the hospital, when I was engaging in a night shift in the Emergency Department. A patient came in with heart failure and COPD, having never seen a healthcare professional for either of these illnesses. I was working closely with the Clinical Director assigned to this case, and I directly witnessed the toll that this situation took on him personally. When asking him what he would do for the patient, he told me that, due to the lack of space in the ICU and end-stage progression of this disease, there was nothing that could be done. He explained that resuscitation “would be a legal formality rather than a helpful procedure” and “all that can be done is to watch his vitals and attempt resuscitation at the last minute” (IMA, 2025). I could visibly see the pain in his face as he explained the emotional and personal hardship of under-resourcing on the providers. He told me that he often feels helpless and takes failure personally, when it is really a result of systematic faults and inadequate healthcare access. Amidst all of their efforts, a single medical professional cannot take on the weight of these issues themselves, and there is clearly a federal transformation that needs to occur for every Kenyan citizen to receive the care they deserve. After hearing this analysis, many family members and friends questioned if and why I still wanted to go into medicine, a career that is quick to repeatedly break one’s heart and challenge one’s faith. Few other careers allow for such depth of connection with others; through immense vulnerability, suffering, celebrating, and intimacy, healthcare providers are able to share in people’s most significant moments. They are consistently called to consider it joy in all things, knowing that each trial brings a new level of depth that lasts far beyond the fleeting moments of this world. It is apparent to me that being a provider is my vocation; my intellectual passion for medicine as well as a love for caring for people align in perfect harmony in this profession. I realize that as a PA, I will not be immune to the many challenges that come with healthcare. My title may read PA-C, but ultimately I am a servant, and I am committed to use my gift of a medical education to serve in all capacities. Through my four weeks as an intern in the Pre-Physician Assistant Internship Program with International Medical Aid, I learned more about medicine, humanity, and myself than I ever thought possible. As I returned to life in the United States, I found it challenging to fit into my previous patterns, as I had changed in such drastic ways. While I initially went to Kenya to serve the people there, everyone I encountered instead helped me in forms that I can’t quite articulate. Seeing first-hand the disease burden, hardship of life, and difficult conditions completely rewired my perspectives. What stood out most was each person’s endurance amidst trials, and their overwhelming joy that filled even the darkest moments. The ways in which I live and practice medicine have been forever altered, and I have a profound gratitude for all that is accessible to me in the US. Still, I greatly miss the vibrant life in Mombasa and yearn for the day that I can return to this beautiful country. I will forever cherish the four weeks that I was lucky enough to spend as a student at Coast General Teaching & Referral Hospital, and I credit International Medical Aid with so much of who I am today.

My five-week experience in Kenya with International Medical Aid was life-changing, both personally and professionally. From the moment I arrived, the in-country support team ensured I felt safe, prepared, and cared for. Our accommodations were clean, comfortable, and well-maintained, and the meals provided were amazing. I had the privilege of shadowing local doctors in hospitals, assisting in medical clinics, and teaching children about hygiene, often working with patients who had limited or no access to healthcare. Witnessing cases of TB, HIV, and extreme poverty deepened my understanding of global health disparities, while moments of joy—like interacting with children in schools—reminded me of the resilience of the human spirit. The staff offered invaluable guidance and encouragement throughout the program. This experience strengthened my skills, broadened my cultural awareness, and affirmed my passion for pursuing a career in healthcare, while also making a tangible difference in the communities we served. For as long as I can remember, I have felt a deep desire to serve in Africa and contribute to healthcare in a place where the need is great and the impact can be life-changing. However, for many years, I was unsure how to turn that goal into a reality. I didn’t know where to begin or what that path would look like. My internship with International Medical Aid (IMA) in Kenya provided me with that long-awaited opportunity. Over the course of five weeks, I was immersed in a healthcare system vastly different from what I had previously known. I transitioned from working in urgent care in America—with abundant resources and typically seeing illnesses like influenza, pneumonia, and streptococcal infections—to Coast General Hospital, where resources were sparse and I encountered diseases I had never seen before, such as malaria, cholera, dengue, and tuberculosis. I anticipated I would encounter malaria, as we interns were required to take anti-malarial prophylaxis during our stay. Malaria in Kenya is caused by Plasmodium parasites, most commonly Plasmodium falciparum, which are transmitted through the bite of infected female Anopheles mosquitoes. After a bite, the parasites first travel to the liver, where they mature and multiply, then enter the bloodstream and infect red blood cells, leading to the onset of symptoms. The disease often begins with flu-like signs such as high fever, intense chills and shivering, headaches, sweating, fatigue, muscle or joint aches, and sometimes nausea, vomiting, or diarrhea. If untreated, malaria can progress to more severe forms, particularly in young children and pregnant women. Severe symptoms can include anemia, difficulty breathing, jaundice, seizures, confusion, coma due to cerebral malaria, and, in some cases, multiple organ failure, which can be fatal without medical attention. Malaria is widespread in Kenya, with transmission peaking during the rainy seasons when mosquito breeding increases, and it remains a major health concern across much of the country (World Health Organization, 2023). This experience challenged me academically and emotionally, exposed me to both the beauty and hardship of global health, and ultimately helped me discover clarity in my professional and personal journey. This reflection explores the clinical knowledge I gained, the emotional toll of working in an under-resourced environment, the individual healing I experienced, and how it all solidified my commitment to becoming a compassionate and globally minded Physician Assistant. One of the most complex and unforgettable experiences of my life happened during this internship: performing CPR on an infant for the first time. Despite our efforts, the baby could not be saved. I was the one who had to tell the mother that her newborn had passed. Moments later, I was handed the lifeless body and told to “place it on the shelf” for the morgue to retrieve later. The nurse tried to reassure me that the baby had endured asphyxia during birth and would not have had a good quality of life due to brain damage and the likelihood of developing cerebral palsy. That moment shattered something in me. It was cold and deeply unfair, and yet it was a reality for far too many families here. No words can truly capture how it felt to hold that lifeless baby in my arms, or how helpless I felt knowing that in another country, with better access to care, that child might have lived. Cerebral palsy that develops after birth as a result of asphyxia is caused by a lack of oxygen and blood flow to the baby’s brain during delivery. This oxygen deprivation, also known as birth asphyxia or hypoxic-ischemic encephalopathy, damages brain tissue, particularly in areas that control movement, posture, and coordination. The injury is permanent and does not worsen over time, but the effects can vary depending on the severity of oxygen loss and which parts of the brain were most affected. The symptoms of cerebral palsy following asphyxia often appear within the first few months or years of life. Common signs include delayed developmental milestones, such as difficulty holding up the head, sitting, or walking. Children may show muscle stiffness or spasticity, making their movements appear rigid, or the opposite—low muscle tone, where their body feels floppy. Other symptoms can include poor coordination, involuntary movements, and difficulties with balance and posture. In more severe cases, children may also experience problems with speech, swallowing, vision, or hearing. Seizures and intellectual disabilities can also occur depending on the extent of the brain injury. Overall, cerebral palsy after birth asphyxia results from permanent brain damage due to oxygen deprivation, and the symptoms typically center on motor difficulties and developmental delays that vary in severity from child to child (Seattle Children’s Hospital, 2025). Yet even in the heaviness, there was light. When we visited schools to teach hygiene and promote health, the joy in the children’s faces was overwhelming. The young girls looked up to us with wide eyes, fascinated and ecstatic to touch my long blonde hair for the very first time. They danced, laughed, and hugged us as if we had known each other for years. In their embrace, there was no barrier of culture or circumstance—only shared humanity. They clung to us with a sense of trust, finding safety in our presence. For a moment, the weight of poverty, disease, and hardship disappeared, replaced with laughter. It was in those moments that I remembered why I chose this path: not just to heal the body, but to connect, to educate, and to serve with compassion. Their joy reminded me that even in the most challenging environments, hope persists. These children had so little by material standards—their uniforms were often ripped or dirty—yet their capacity for happiness was abundant. They taught me that healing isn’t always about medicine or procedures; it is just as much about kindness, presence, and human connection. Walking away from those schools, I carried with me the realization that healthcare is not only about addressing illness, but also about empowering communities, instilling knowledge, and creating bonds of trust. I also learned many different things and observed complex procedures, such as surgery to treat hydrocephalus. Hydrocephalus is a condition caused by an abnormal buildup of cerebrospinal fluid (CSF) within the ventricles of the brain, leading to increased pressure inside the skull. This occurs when the normal flow or absorption of CSF is disrupted. Common causes include obstructions that block the flow of fluid, such as congenital malformations, tumors, or scarring from injury or infection. In some cases, hydrocephalus develops because the body cannot properly absorb CSF, often due to conditions like meningitis, hemorrhage, or inflammation. More rarely, it results from the overproduction of CSF. The condition may be present at birth due to genetic abnormalities or neural tube defects, but it can also be acquired later in life from brain injuries, strokes, or infections. The symptoms of hydrocephalus vary depending on age, but they all relate to increased pressure on the brain. Infants may show signs such as an unusually rapid increase in head size, a bulging soft spot, irritability, poor feeding, seizures, or delayed development (Mayo Foundation for Medical Education and Research, 2023). This internship has not only solidified my goal of becoming a Physician Assistant; it has reshaped the kind of provider I want to be. I want to be someone who leads with empathy, who is prepared for the weight of difficult moments, and who can navigate both the beauty and the brutality of healthcare. I now understand that medicine is not always about saving lives—it is also about standing with people in their most vulnerable moments and being present, even when there is nothing more to be done. Kenya taught me how to think critically in low-resource environments, how to deliver care with compassion, and how to see patients as whole people, not just cases. It also taught me the importance of humility, resilience, and cultural understanding in clinical practice. This experience was not easy. It was raw, emotional, and at times overwhelming—but I wouldn’t trade it for anything. I am walking away more grounded, more focused, and more committed than ever to becoming the kind of provider who doesn’t flinch in the face of hard moments, but instead honors them. Kenya didn’t just teach me how to care for others—it taught me how to carry their stories with grace and never forget why this work matters. On a personal level, Kenya also helped me heal. Before this journey, I carried the weight of depression and struggled to find light in my own life. But in the middle of such profound hardship and suffering, I found strength, purpose, and hope. The joy of the children, the resilience of the patients, and the bonds I built with others reminded me that life is worth fighting for. I left Kenya not only with new clinical skills and perspective, but with a renewed sense of self—one that is healthier, steadier, and more hopeful than the version of me who arrived.

This program challenged me, inspired me, and changed me in ways I never expected. I learned more than I could have imagined, not only about medicine, but also about resilience, compassion, humility, and human connection. The doctors at CGTRH work with limited resources, yet they are among the most resourceful and dedicated physicians I have ever encountered. Their ability to balance urgency with empathy is truly inspiring. They were always eager to teach, creating an environment that was both supportive and motivating. The mentors were equally incredible. From guiding us through the day-to-day at the hospital to ensuring I felt comfortable at the program residence, they provided unwavering support. Margaret, Hilda, Bella, Janet, and Michelle were always approachable, offering guidance, encouragement, or simply a listening ear whenever I needed it. I also want to recognize the rest of the IMA staff—the housekeepers, cooks, and drivers—who played an essential role in making the residence feel like home. From the moment I arrived, they welcomed me with open arms. Whether it was returning to a perfectly made bed after a long day or sharing laughter and good energy around meals, their efforts brought a sense of comfort, joy, and community that greatly enriched my experience. Above all, what made this experience truly unforgettable was the incredible sense of community. From the hospital to the residence, I was surrounded by people whose kindness, generosity, and dedication left a lasting impact on me. Being welcomed into this community has been a privilege, and this program has truly been the opportunity of a lifetime. “Someone needs to switch with him,” said the nurse managing the airway. I stood there in awe. It was May 27, 2025, around 11 p.m., my second week at Coast General Teaching and Referral Hospital (CGTRH) and my very first night shift. I had just entered the pediatrics accident and emergency room (A&E), and in front of me was another, more experienced intern performing CPR on a 2-year-old boy. My heart dropped. I am CPR-certified, but I had never seen it being used, nor needed to use it myself, especially not on a child. The pediatric emergency room that night was short-staffed, and every set of hands mattered. When the call came for someone to take over, another intern stepped forward. Before he could move closer, I asked him, “Are you CPR-certified? Do you know what you’re doing?” He hesitated and admitted he would just try to copy what he saw, believing this is how he could help. At that moment, I made a choice. As a young woman heading not just into medicine, but existing in the world around us, I’ve been taught to always question myself; but this was not the time for self-doubt. I knew I had the training and ability, and I wasn’t going to let hesitation compromise that child’s care. With confidence, I said no, stepped forward, and took responsibility. I quickly pulled on gloves, steadied myself, and took over the airway from the nurse. I focused on the rhythm of counting breaths, grounding myself in the task and pushing away the crushing reality: that this small, innocent boy’s life was partially in my hands. After multiple rounds of CPR, the time of death was called. My adrenaline still surged, but the room was silent, heavy with grief. I locked eyes with the intern who had been doing compressions, and together we stepped back. Then came a sound that will stay with me forever—the anguished scream of the boy’s mother. She rushed to her son’s lifeless body, then turned her grief into rage, lunging toward the doctors, the nurses, towards us. Her pain was uncontainable, raw, and devastating. Nothing more could be done. That night was a turning point for me. I learned that even in the most harrowing circumstances, I could step up, not timidly but with the confidence and clarity needed to help. Yet, even as I carry that lesson forward, I also carry the weight of lingering guilt. I know, rationally, that everything possible was done, but part of me still replays those moments, wondering if anything could have changed the outcome. That tension between confidence and guilt is what continued to drive me throughout my two months at CGTRH. It reminded me of the gravity of this work and of the responsibility I hold each time I step into the hospital. Every patient interaction reinforces that responsibility, but it also fuels my drive to be a source of light in what can sometimes feel like an unbearably dark space. That night in the pediatric emergency room, during only my second week, put everything I was doing at CGTRH into perspective. It was a stark reminder that this was not just observation; this was the reality of medicine. Grateful doesn’t even begin to capture how I feel when reflecting on my eight weeks in Mombasa, Kenya. From the moment I landed on May 16, 2025, I could not have anticipated how profoundly my outlook on medicine, life, and humanity would change. Throughout my time at CGTRH, I was able to rotate through a wide range of departments, from Accident and Emergency (A&E) and Cardiology to Surgery, Pediatrics, the Comprehensive Care Clinic (CCC), Oncology, and Obstetrics and Gynecology (OB-GYN). I also gained exposure to Radiology, the Newborn Unit, the Casting Unit, and even the Morgue. Each placement revealed a different side of patient care—whether it was the urgency of A&E, the vulnerability of the newborn ward, or the complex emotions surrounding end-of-life care. Beyond the hospital walls, I joined community health initiatives, helping in our IMA-sponsored community clinics with triage, pharmacy support, and nutrition counseling. Yet what left the deepest impression were the school-based health education sessions we led with primary and secondary students. Teaching hand hygiene, dental care, and personal and feminine hygiene practices, I saw how simple education could spark lasting change. Those classroom moments brought joy and hope in weeks that were otherwise some of the most emotionally demanding. I also took part in a youth mental health seminar, contributing to efforts to destigmatize a critical global issue. While these experiences gave me invaluable clinical exposure, they also pushed me to think beyond individual patient encounters. Living and working in Mombasa meant witnessing first-hand how healthcare delivery is shaped by political systems, cultural values, and resource availability. Each department, each clinic, and each classroom not only deepened my medical knowledge, but also highlighted the broader forces that define patient care in this context. To truly capture what my eight weeks taught me, it is important to reflect on these systemic differences, unique clinical cases, and powerful patient interactions that left a lasting impact. While at CGTRH, I was able to observe how healthcare delivery, structure, and human resources are deeply influenced by both healthcare literacy and the broader political system—factors which shape patient outcomes in Kenya in ways that stand in sharp contrast to my experiences in Canada. To better understand the challenges many healthcare workers face in Kenya, I first had to grasp the different levels of integration within the healthcare system and the route that many patients must take to finally end up at the hospital. Kenya’s health sector is divided into three main categories: commercial, private, public, and faith-based. CGTRH falls into the public sector, primarily government-funded and used by those less financially fortunate. While this makes it more affordable, it is also severely under-resourced and understaffed. This correlates with higher incidences of hospital-acquired infections and generally poorer patient outcomes (International Medical Aid [IMA], 2025). Limited accessibility to public healthcare compared to private care drives patient numbers at CGTRH even higher, pushing the patient-to-healthcare worker ratio to staggering levels of nearly 21 doctors and 100 nurses per 100,000 people (IMA, 2025). Despite being a publicly funded hospital, CGTRH does not provide universal healthcare. Patients are still required to pay out-of-pocket fees, and for some, even the cost of opening a patient file can be unfeasible. While private medical insurance exists, it largely serves individuals in the formal employment sector. This creates systemic inequity, as approximately 80% of Kenyans are employed in the informal sector (IMA, 2025). Though the National Health Insurance Fund (NHIF) offers subsidized coverage for as little as $5 USD a month, many families cannot afford to opt in, as food, shelter, and school fees often take precedence (IMA, 2025). This makes healthcare bills instantly unaffordable, forcing families to pursue cheaper, short-term "quick fixes" rather than sustainable, long-term solutions. One patient story that has stayed with me was that of a seven-year-old girl in the pediatric outpatient ward (POW), who was born with biliary atresia and, after an unsuccessful Kasai procedure, now also has a chronic form of cholangitis. Her family had traveled to India when she was only two months old for the Kasai procedure, knowing this could be a potential permanent solution but also risky. For this family, it was more financially feasible than the alternative—a liver transplant. Sadly, the cost of HLA testing for family compatibility and the transplant itself made it unattainable. For years, she has been in and out of the hospital whenever her symptoms flared up. Despite these challenges, the POW staff knew her and her mother by name, and together with other mothers on the ward, they built a supportive community. I was welcomed into this circle, often sitting with her, taking her vitals, and giving her mother moments of respite. On my last day, her tearful embrace reminded me of the resilience and humanity that emerge even in resource-strained settings. Her story emphasizes how both hospitals and families must navigate systemic shortages with creativity, sacrifices, and solidarity. Her story also reminds me of my own family. My younger brother also has a chronic form of cholangitis, but in Canada his condition has been far more manageable since diagnosis because of the medications and consistent monitoring available to him. Thanks to this access, his liver has even begun to regenerate, reducing his need for a transplant. The stark contrast between his journey and that of the little girl in Kenya highlights the reality of how geography and resources can determine health outcomes. There is almost a dependence on outside support, especially in CGTRH’s reliance on international aid and donations. Free surgical camps from Canadian open-heart specialists or American pediatric teams temporarily filled gaps that the local system could not. Yet this reliance also revealed its fragility. Recently, cuts to U.S. international medical funding have already impacted departments like oncology, contributing to shortages in HPV vaccines and further increasing the future rate of cervical cancer, which is the most prevalent cancer within East Africa (Shah, 2025). The ripple effects of global politics are felt most acutely by the patients who can least afford it. The contrast with Canada became strikingly clear after I returned home this past summer. While working as a lifeguard, I was involved in a major first aid response where an overdose required CPR. Within seconds, we were able to hook the patron up to an AED. The device not only analyzed the rhythm but gave us real-time feedback, telling us if compressions were too shallow or too slow. Having access to such resources fundamentally changes the effectiveness of care and outcomes. In Kenya, even basic resources like functional monitors or gloves were sometimes scarce. Within my eight weeks at CGTRH, I never saw a working AED being used during a code. In Canada, by contrast, advanced life-saving technology is publicly available in gyms, schools, airports, and pools. To put Kenya’s healthcare spending into perspective, the country invests approximately $88 USD per person annually, or 5% of its GDP, in healthcare (IMA, 2025). This contrasts sharply with the United States, which spends nearly $11,000 USD per person—17% of its GDP—yet still struggles with equitable access. Canada falls between these two extremes, with healthcare expenditure around $4,600 USD, representing about 11–12% of GDP (Canadian Institute for Health Information [CIHI], 2024). Delivered through a publicly funded, single-payer model, Canada’s system ensures that patients do not pay directly for most physician or hospital services at the point of care, unlike in Kenya, where out-of-pocket costs are the norm and often prohibitive. While Canada faces its own systemic challenges, such as longer wait times and healthcare worker shortages, it does not experience the severe supply and resource gaps I witnessed at CGTRH. This comparison sharpened my understanding of how political systems and financial priorities shape access to healthcare. In Kenya, limited government investment and a reliance on out-of-pocket costs mean families are forced into difficult choices between medical care and basic necessities. In Canada, taxation and collective funding help ensure universal access, even if delivery is not always timely. And in the U.S., despite extraordinarily high investment, unequal access persists. These contrasts revealed to me that medicine is not only about clinical skill, but also about the systems that enable or limit its delivery. These systemic differences in healthcare delivery became even more apparent when considering the disease burden in Kenya, where patients face a dual challenge of communicable illnesses, rising rates of non-communicable conditions, and the often-overlooked crisis of mental health—each of which I witnessed firsthand through patient interactions. One of the most striking realities in Kenya is how heavily communicable diseases continue to shape patient care. Malaria, tuberculosis, and HIV remain widespread, but what I learned is that these illnesses are often compounded by malnutrition. This was very prevalent within the pediatric ward and the pediatrics A&E; children admitted for infectious diseases were frequently also struggling with severe undernutrition, which not only weakened their immune systems but also prolonged recovery. This dual burden was something I had not fully appreciated until I witnessed it firsthand. Mosquito-borne viruses were especially prevalent, with many patients only seeking care once symptoms became unmanageable without urgent medical intervention. Numerous malaria cases progressed to cerebral malaria, severe anemia, or other hematologic complications and even liver issues. This vector-borne communicable disease represents 3% of mortalities and one of the top outpatient morbidities in Kenya (IMA, 2025). When speaking about vector-borne viruses, I think it’s also important to highlight chikungunya. Within the hospital, I had many encounters with all severities of this virus—from cerebral chikungunya to cases where it presented as a co-infection with another illness. During my time at CGTRH there was even a chikungunya outbreak within the pediatric ward. This is due to limited resources such as insecticide-treated bed nets, reliable diagnostic testing, and vector control programs. Alongside malaria and other mosquito-borne illnesses, HIV remains one of the more pressing communicable diseases in Kenya, and my time in the Comprehensive Care Clinic (CCC) gave me firsthand insight into the challenges patients face in living with and managing this condition. Beyond the medical realities of antiretroviral therapy, I witnessed the weight of stigma, the barriers to consistent medication adherence, and the extraordinary resilience of patients who showed up day after day for their care. These experiences highlighted how HIV is not only a clinical diagnosis but also a social and emotional journey, one that deeply shapes both patients and their families. Within the CCC, I spent most of my time in the consulting rooms and the pharmacy. In consulting, I was able to learn and educate myself more on the stigma around HIV, and why, when working within the hospital, it was referred to as RVD (retroviral disease). I found that many patients feared being recognized by other community members they might know, and most were willing to travel to this CCC from other surrounding regions to avoid this. Mombasa County contributes 3.6% of the total people living with HIV in Kenya (IMA, 2025). Many would come in disguises, some women wearing full burkas even though they weren’t Muslim. After speaking with one of the consulting physicians, I learned that around 10% of patients wear a disguise so they can remain anonymous to the public. Many, if not all, would transfer their antiretroviral treatment (ART) medication to different pill bottles or stuff them deep into bags so others around them could not hear the shake of the pill bottle. These practices are created by—and further feed into—the negative stigma surrounding HIV, which in turn delays treatment and contributes to a negative self-image. Many CCC physicians found that newly diagnosed patients experienced a decline in their mental health; that is why they offer free counseling for people with a positive status. They found that most patients who accepted their status were very good at keeping up with their ART and informed me that 98% of CCC regular patients had low viral loads. Thanks to this, childhood cases have had an 18% decline. It was also encouraging to learn that they are starting to educate and destigmatize HIV within public schools, helping to increase health literacy among the youth of Kenya. At the same time, I observed the growing burden of non-communicable diseases such as cancer, hypertension, and diabetes. Unlike in Canada, where chronic conditions are supported by long-term management programs, in Kenya many families face fragmented care, limited access to medications, and the overwhelming financial toll of repeat hospital visits. These systemic gaps make non-communicable diseases especially devastating, as families often must choose between temporary fixes and the hope of a definitive treatment. During my time at CGTRH, I spent many hours observing the oncology team. This is where I came to understand how deeply non-communicable disease, especially cancer, can impact patient care in Kenya. Cervical cancer stood out as the most prominent cancer—a trend driven largely by limited access to HPV vaccination and lack of healthcare literacy about cancer signs and symptoms (Ferlay et al., 2024). This often caused women to present in advanced stages of disease. While early detection ensures a favorable outcome and prognosis for most cancers, about 80% of reported cases in Kenya are detected at an advanced stage when very little can be achieved in terms of treatment (IMA, 2024). In these late stages, treatment is not only medically complex but also financially devastating. Even patients with health insurance frequently find that their coverage does not meet the full cost of treatment, forcing families to make impossible choices. I witnessed one particularly heartbreaking case of a woman diagnosed with both breast and cervical cancer who was financially constrained to treat only one condition. Stories like hers were not uncommon, as many patients are forced to pause or abandon life-saving treatment due to lack of funds. These encounters made clear how structural and financial barriers can dictate survival, and how different this reality is from Canada, where universal healthcare ensures that cancer treatment is covered and patients do not have to choose between their health and financial stability. At the same time, I also saw glimpses of hope and innovation. The hospital was running a free drug trial for patients with a specific type of red blood cell cancer, where those enrolled not only received their medication but also had the entirety of their care costs covered. For these patients, research provided an opportunity that healthcare systems alone could not afford them. One oncology consultant I worked with was deeply committed to expanding knowledge beyond hospital walls. He was engaged in outside research and organized medical camps that focused on the hidden burden of undiagnosed cancers within refugee camps. Unlike viral illnesses such as HIV or malaria, cancer often goes overlooked in these contexts, yet the suffering it causes is no less profound. Together, these experiences highlighted how non-communicable diseases are shaping Kenya’s healthcare landscape in profound and complex ways. They expose systemic inequities in access to screening, treatment, and financial protection, but they also underscore the resilience and dedication of healthcare providers who are working to bridge these gaps. My time in oncology left me with a deep appreciation for the urgent need to prioritize non-communicable diseases within global health, as their impact continues to grow in places where resources remain scarce. Equally important, yet often hidden in the shadows, is the burden of mental health. Mental health in Kenya remains deeply stigmatized, with many people taught to simply put their heads down and endure their struggles in silence. The Kenya Mental Health Policy states that 1 in every 4 people is likely to suffer from a mental health illness at some point in their lifetime. This statistic translates to around 12 million Kenyans (IMA, 2025). This mindset, while born from resilience, often eats away at individuals who feel isolated in their pain. Too often, people are left unaware that it is not only acceptable, but necessary, to reach out for help and that they are not alone. This silence surrounding mental health extends into other sensitive issues—most painfully, sexual assault. Nationally in Kenya, approximately 1 in 3 women have experienced sexual violence before the age of 18, and 38% of married women have faced physical violence (Yusuf, 2024). One of the most haunting cases I witnessed was that of a woman who had been assaulted and left at the front of the A&E department with no identification. It ended up taking days for her family to arrive, leaving her alone—a victim of both violence and abandonment. Even more devastating was the case of a three-year-old girl I met on one of my night shifts who had been sexually assaulted. What struck me most was that she did not even realize that what had been done to her was profoundly wrong. I was fortunate enough to gain her trust, and once I did, I was able to help distract her from the harsh reality she was in, trying to offer her some type of comfort in a world that had already failed her. Her innocence—her willingness to laugh and play despite such trauma—was heartbreaking. Having a personal connection to the topic of sexual assault, this experience hit me in an especially raw way. It was both painful and humbling to witness the resilience of someone so young while knowing the lifelong shadow such violence can leave behind. These moments revealed how sexual violence has, in many ways, become normalized, with little discussion of consent or accountability. In Mombasa County, data from CGTRH’s Gender-Based Violence Recovery Centre indicates that between 2017 and 2023, over 3,100 sexual violence survivors sought care, with the median age of female survivors being 15 years old (Olum et al., 2025). This silence echoed in the youth mental health sessions we conducted, where many adolescents asked difficult questions about safety, consent, and how to protect themselves. One female student confided through an anonymous note that a boy continued to force sex on her despite her saying no. Her fear was not only about the violation itself, but also about how it could impact her future. She worried that an unwanted pregnancy might strip her of her chance at an education. Hearing this raw and desperate call for help was devastating. It revealed how deeply these issues are tied to cycles of poverty, gender inequality, and systemic neglect. Yet alongside these experiences, I also witnessed providers who deeply understood the psychological weight of illness and injury. In the casting unit especially, physicians often spoke with me about how traumatic it can be for patients—not just children—to come to the hospital. They made it a priority not only to treat physical injury, but also to ensure patients were leaving in a good headspace. They reassured them that it was okay to feel scared, but that by coming to the hospital, they had done the right thing. Watching this intentional care, acknowledging the patient’s emotional well-being as inseparable from their physical recovery, stood in sharp contrast to the cultural stigma that often surrounded mental health outside the hospital walls. This demonstrated how essential it is to create spaces where young people feel safe to share, to learn about their rights, and to begin breaking the silence surrounding both mental health and sexual violence. It was July 8, my eighth and final week interning at CGTRH, and I found myself once again on the night shift in the accident and emergency department. It felt like a full-circle moment. My first night shift had been here, and now my last would end in the same place. Over these weeks, I had grown tremendously: I had stepped into leadership, learned when to take control, and found confidence in the unpredictability of the night. At 3 a.m., the usual chaos of the ER had quieted, and a few of us sat at the charge station updating notes when the PA system broke the silence: “Code blue, Obstetrics and Gynecology High Dependency Unit. Code blue. Any available A&E staff please report.” I jumped to my feet. This time, I was the experienced intern, turning to the ones beside me who were on their very first night shifts. For me, these codes had become part of the rhythm of nights at CGTRH, each one sharpening my skills and deepening my confidence. A nearby nurse caught my eye and simply said, “Let’s go.” We ran through the back lot toward the OB-HDU, where we found a woman lying unconscious on the bed. She had recently undergone a C-section, but her abdomen remained extremely swollen. The diagnosis: a severe post-surgical infection—sepsis. Gloves on, I stepped forward while another intern checked for a pulse: “I have no pulse, I’m starting CPR.” Immediately, I knew the drill. I directed another intern to find a bag-valve mask, quickly grabbed an oropharyngeal airway, and took charge of the airway. Around me, the doctors and nurses rushed to assess and attend to medications and equipment, much of it outdated or nonfunctional. There was no AED, and the unit was desperately under-resourced. The first bag-valve mask didn’t work, so I sent an intern running to another department’s crash cart for a replacement. Once we had a functional one, I stopped alternating with compressions and remained in charge of the airway. The woman began vomiting bile and blood mid-code. My instincts took over: removing the airway, turning her head, clearing the airway with my gloved hands while the nurse suctioned, then replacing the airway, becoming covered in splashes of vomit in the process. We repeated this cycle again and again until every measure was exhausted; the time of death was called. When I looked up, the newer interns stood frozen, witnessing their first death. This time, though, I did not feel the same guilt I had during my first code. Instead, I felt deep remorse, knowing that this woman’s death was not from a lack of effort, but from a lack of resources. She was a daughter, a friend, a mother—and now she was gone. The fragility of life in that moment forced me to pause. Am I doing something that brings light into my life, into other lives? Am I doing something that makes the world better? I knew the answer was yes. Despite the heartbreak, I knew there was nowhere else I needed to be but here—helping, learning, and stepping forward. This experience, though one of my most testing, affirmed my path. I may not be the most religious person, but in these past few months a verse from Romans 8:18 has kept finding its way into my life: “The pain that you have been feeling can’t compare to the joy that is coming.” That night crystallized for me that medicine, through all the pain and suffering you may have to deal with, is not just a profession but a calling. It inspires me every day to do good, to help others, and to keep driving toward the future I know I am meant for in medicine. These experiences deepened my medical knowledge but also reshaped my perspective. I was able to see firsthand how systemic inequities in healthcare delivery, political priorities, and resource allocation determine patient outcomes. Yet I also witnessed resilience: mothers forming support systems, physicians creating research initiatives, and hospitals leveraging partnerships to meet overwhelming needs. In contrasting Kenya and Canada, I am left with a sharper awareness of privilege, responsibility, and the urgent need for systems that do not force families to choose between health and survival. This journey illuminated not only disparities, but also the universal values of compassion, resilience, and hope that underpin patient care. It highlighted the profound privilege it is to be able to live, to learn, and to love. Life is a gift, and thanks to this incredible opportunity from International Medical Aid, I want to use part of my gift to continue to give back.

Overall, my experience with IMA was life changing and more meaningful than I could ever hope to put into words. The meaning I derived from both the clinical and extracurricular activities cannot be overstated. All the staff members were very nice, and even helped when I forgot to put out my scrubs, which I appreciate immensely. I cannot remember her name (it’s a miracle I can remember my own sometimes), but whoever cleaned Karibu did an amazing job and was very kind. I felt as though the residence was very safe, as was Nyali at large. Mentors had a smaller part than I anticipated, but were nonetheless helpful with questions I had throughout the experience. Accommodations were nice as well—not over the top, which was good. Hot water would’ve been nice, but I understand why it isn’t always possible. Food was excellent, and I really appreciated the lengths the culinary staff went to accommodate my vegetarian diet. I never felt as though the food was boring or repetitive, and I’m still Googling some of the recipes they used. Overall, impact-wise, I feel as though I’m forever changed by the experience. I never would’ve imagined I could achieve such a level of personal fulfillment coupled with seeing the impact of my actions. Outside of just the patients I helped, the community outreaches on alternating Saturdays were my favorite part. To deliver healthcare directly to communities was genuinely one of the most positive things I’ve ever been a part of. These people would have access to the same MOs/COs that they’d get at the major regional hospitals, and at little or no cost. It made all the program fees and expenses seem justified. It’s clear IMA is a force for good in the Mombasa area, not just for the hospital, but for public health writ large. Also, Erastus, the dessert chef, needs a raise. He was a kind person to all of the interns and an excellent chef. The official national languages of the Republic of Kenya, as per the Kenyan Constitution, are Swahili and English. However, I believe there is a third language commonly spoken within the Republic that supersedes national borders or regional dialects: the language of medicine. In a country where healthcare literacy is increasingly essential but tragically uncommon, this language connects every human at the most basic level, as medicine is inherently objective. This point was solidified for me on one of my first days, while rotating in the Comprehensive Care Centre (CCC). I remarked, noticeably surprised, that lavender-topped tubes have the same anticoagulant at Coast General Teaching and Referral Hospital (CGTRH) as they do in U.S. hospitals. A Kenyan clinician replied immediately, very matter-of-factly, that of course that is the case. To paraphrase, he stated that in order for delivery of healthcare to be optimal, providers must have an understanding of equipment and associated physiology regardless of location. While astoundingly simple to grasp, hearing this early on in my internship allowed me to confidently merge my existing clinical knowledge with the invaluable lessons I’d be taught over the next four weeks. While the language of medicine is universal, interpretations and effectuations certainly change between states, nations, and continents. My first day of shadowing with a primary care physician in the CCC would be the first and last time I saw the electronic medical record (EMR) software used at CGTRH. Perhaps naively, I was initially relieved when I saw the EMR wasn’t very different from others I’ve grown accustomed to in my own career. Each patient is attached to a ten-digit number indicating the hospital code and a unique medical reference number. However, this relief would turn to confusion the next day. While shadowing the phlebotomist, Peter, I watched patients file into his office and hand him booklets that looked like they were hit by several vehicles on Links Road, Mombasa. On the front cover, their names, unique identity numbers, and presenting conditions were handwritten in the respective sections. Peter explained that patients were responsible for keeping track of their own health records. I asked what happens if patients lose these books and he shrugged, stating that loss of records is a problem that can, and does, impact continuity of care. While, in the coming weeks, I’d become more skilled at reading these books to understand patient cases, it nonetheless is still something that bothers me on a deep level. The paper system places an unfair burden on a population that already struggles with healthcare literacy, as the paper records—which they must keep track of—become their only means of communicating what plagues them. The differences in delivery between Western and Kenyan public hospitals are not only disadvantageous to the latter, however. Given that resources are more scarce, on both the provider and the patient level, it has forced providers to develop more effective patient care and education strategies than even in many clinics stateside. For example, when explaining complex disease processes such as hypertension to their patients, doctors pull up images on their computers or phones of, say, the vascular anatomy of the brain, and show how hypertension can cause ischemic or hemorrhagic strokes, with pictures for reference. Further, in the outpatient surgical clinic, I witnessed a doctor take a history for a known patient, listen to her symptoms, and calmly write the title of a YouTube video on a prescription pad detailing how to stretch out a muscle that was bothering her. At first, I thought this was a bit dismissive, but upon further reflection, the pseudo-prescription became more ingenious than I had initially thought. In the U.S., a presentation like this would likely involve costly physical therapy or surgery; this solution was far more cost-effective, conserving time and resources. A large majority of patients have access to the internet, and as any student can attest, the internet is full of free, readily available information. Nonetheless, he knew she would return if her condition worsened, and he had an understanding of her as a returning patient. In Mombasa, it is common for workers to be paid at the end of each workday. Compounded with low wages generally, this means failure to show up to work on a given day means that, for that day, the family will not have any money. This paycheck-to-paycheck lifestyle is not specific to Mombasa, as even in the U.S., where wages are much higher proportionally, as many as 57% of people live paycheck-to-paycheck (MarketWatch, n.d.). Unfortunately, though, this day-by-day model means workers will ignore medical ailments until absolutely necessary, because unlike in the U.S., sick days are not readily available. As a consequence, patients won’t seek out medical treatment until symptoms are unbearable, if at all. On my second day in the ER, a patient presented with a history of crushing chest pain for five days. Upon reading the ECG, it was the most profound ST-segment elevation that I had ever seen outside of a textbook. This patient had likely been having a STEMI (ST-Segment Elevated Myocardial Infarction) for five straight days and only came when it became intolerable. This is in stark contrast to my experience in the U.S. as a pre-hospital firefighter/EMT, where people will call emergency services the second they feel slightly abnormal. On the topic of EMS, the pre-hospital medical services of Mombasa’s public healthcare system leave a lot to be desired, but still have the echoes of providers doing their best under suboptimal circumstances. I had the opportunity to enter an ambulance during a lull in one of my night shifts in Emergency & Casualty, and what I found in the patient compartment was a single stretcher, a few rolls of gauze, a loose oxygen tank, and some BLS vital-taking equipment. Even so, what the ambulance workers lacked in equipment, they made up for in compassion. Multiple times throughout the several transfer-of-care reports I garnered from the ambulance teams on patient intake, the EMT was holding back tears, shed for his patient. While every ambulance I’ve worked on in the U.S. is better equipped than entire departments at Coast General, I’ve never shed a tear during patient care, as patient death or decompensation occurs after several interventions, and the general sentiment is that we, as providers, gave the patient the best chance of survival. These handoff reports alone elicited a strong emotional response from me, as I could not imagine being put in his position, where he may or may not know what the patient needs, and certainly lacks the equipment. These shortcomings in the hospital systems are not isolated incidents, but rather a reflection of deeper, systemic issues interwoven in the fabric of Kenyan politics. Since its liberation from British colonial rule in 1963, Kenya has been self-governed via a constitutional republic system of government (Embassy of the Republic of Kenya in Japan, n.d.). While this system of government necessitates frequent elections, there is still a fair amount of civil unrest and political corruption. Just during my brief stay in Mombasa, an afternoon shift was canceled due to riots in the country over an unjust police shooting. This sense of political unrest is not only observed at the macroscopic level, but also weighs heavily on the minds of almost everyone I spoke to about the matter. It was fascinating to talk to patients, providers, and laymen alike and get their input on politics, as even in a country without protected freedom of expression, politics remains in the realm of casual conversation. Specifically pertaining to healthcare, it is essential to first understand how the industry is managed in Kenya. Kenyan healthcare is designed as a mixed system, with both public and privately funded healthcare facilities available to everyone. There are three primary media of healthcare delivery within the nation. Public, which is what I was exposed to primarily, relies on taxpayer funding via the Ministry of Health (MOH) to provide lower-cost health services (Africa House Business, 2021). Private healthcare facilities make up the largest percentage of overall facilities available but are more expensive, with the benefit of better patient outcomes. Faith-based organizations (FBOs) are the third type of healthcare delivery system in Kenya. While I had minimal exposure to these during my time in Mombasa, these FBOs provide 30% of healthcare services in Kenya. Interestingly, while they’re funded and run by religious organizations, the patient’s religious affiliation is not considered by these facilities. While ideally, all three of these systems would provide an equal quality of care, this sentiment is tragically naïve. The exact reasons as to why public healthcare systems continue to lag behind the more progressive private commercial sector are up for debate, but common themes are insufficient funding, political corruption, and exceedingly low provider-to-patient ratios. Whether the funding is insufficient due to low allocation or governmental embezzlement is also up in the air. The way Peter in the CCC explained the healthcare system funding is that SHA, or Social Health Authority, established a framework for managing health insurance. SHA primarily manages the primary and emergency health funds, as well as SHIF, which is the newest administration’s healthcare insurance initiative. While SHA is relatively new to Kenya, every patient chart has their SHA status on the front cover page. The funding of Kenya’s public healthcare system isn’t entirely internal, as an estimated 19% of the capital comes from external funding sources such as UNAIDS, USAID, and the World Bank (Moon & Omole, 2021). On every door of the CCC, for example, the various agencies responsible for funding are listed on a placard, along with the room’s function. Even with all of this funding, both endogenous and exogenous, many providers still feel that the funding each department receives isn’t aligned with their patient load, causing routine supply shortages. When things as simple as disposable tourniquets aren’t even readily available for phlebotomy, it requires the whole system to be examined. The dissolution of USAID was an issue not only heavy on the minds of the clinicians. Patients in the CCC would often pose questions to the doctors about how their treatment plan would change in the coming months and years. These questions were impossible to answer, as not a single concrete answer was available to anyone. These patients could’ve asked the U.S. government directly the same question and been met with the same uncertainty, albeit a more apathetic response. HIV is not an illness that can be put on the back burner while politicians figure out how many people they’re comfortable with killing to save a few dollars. One night shift in Emergency & Casualty, there were two patients that exemplified the shortcomings and corruption of the public healthcare system. The first patient was a bariatric diabetic who was escorted by two bodyguards. After about a ten-minute stay at the patient intake in the ER, this patient was immediately transferred up to ICU without proper indications because she had known the right people to make her stay superior to the common man. We transported her up in the elevator, and as I tried to assist her to the intensive care bed, she was able to move herself over. This wouldn’t have been so shocking if the patient in the bed next to her didn’t have an SpO₂ in the 70s, with a GCS of 3. A couple of hours after the first patient was transferred, a second patient arrived via ambulance. The patient presented as a pleasant 20s male with a unilateral radial fracture. His other arm had been amputated in another hospital about three days before contact, which, according to his history, was indicated due to an RTA (road-traffic accident). Despite this, all his vitals were within normal ranges, and I walked him to a bed shortly after finishing his triage. He was transferred into the bed, after which the man the patient had arrived with, his father, handed me a folder full of scans and a box. He was speaking Swahili, but when I asked the ambulance worker who was with us to translate, he stated that inside the box was the patient’s amputated arm, marked for disposal at the hospital. I placed the box underneath the patient’s bed and reported to the MO with the scans. Upon observing the scans, which were plentiful, there were no obvious abnormalities aside from the arm. Despite this, the patient had a full battery of tests, which was completely unheard of for any patient I had encountered in the hospital, much less a subacute patient such as this one. After further investigation, it became apparent that the reason for the transfer from a private sector hospital to CGTRH was to allow the patient to be closer to home. The father of the patient continued to follow the Medical Officers around, even while they were checking on other patients. Even when I would go to cycle the patient’s NiBP or pulse oximetry, he’d approach me and ask questions, with a rather authoritarian undertone, about what we were going to do with the patient. At approximately 04:00 that morning, the interns were invited to accompany the doctors to the street just outside the hospital for some bananas and coffee. While we were all delighted to experience a wholesome outing amidst a chaotic night shift, we still had questions pertaining to what those two patients meant about the system as a whole. Upon returning to the ER, the doctor sat us down and explained what had happened. The first patient, the diabetic, had been transferred because she was a politician’s mistress, and therefore an order from the top mandated the transfer. He elaborated that it wasn’t a clinical transfer indicated by presenting conditions authorized by Medical Officers on the floor, but rather came from an unknown overseer. The second patient, the man with his arm in a box, was the son of a military power and was afforded higher quality testing and personalized care than typically offered because of his father’s standing. He continued to vocalize his discontent with the system and voiced frustrations that would be too specific to put into writing, due to privacy concerns. In the middle of this passionate political conversation, however, another patient arrived and we had to divert attention to the next patient. One day in internal medicine, after rounds, a Medical Officer asked me if there were any more cases I’d like to see that I wouldn’t at home. At this point, I’d seen more tuberculosis, meningitis, malaria, and dengue fever cases than I thought I’d see my entire career, but after some thought, I replied with “Kwashiorkor.” The MO paused for a moment, then replied that Kwashiorkor is “a thing of the past” for Africa, and that cardiovascular disease is now a much more pressing issue for Kenya. While stating hypoproteinemia cases are a thing of the past is a bit hyperbolic, his comment still reflects the actual disease burden felt by the clinicians and the Mombasa community as a whole. According to the WHO, a third of the Kenyan population has hypertension, a serious risk factor for developing cardiovascular abnormalities such as atherosclerosis, ischemic/hemorrhagic strokes, and even myocardial infarction (World Health Organization [WHO], n.d.). With that, 12.4% of the Kenyan population qualifies as clinically obese. However, according to the CDC, this number trends much higher in the urban regions of Kenya, with some models showing obesity in these regions as high as 60% (CDC, 2018). A 2021 NIH study found this percentage to be closer to 40% in Mombasa specifically (Mkuu et al., 2021). Even without the concrete data, any hospitalist will attest to the fact that hypertension, diabetes, and obesity are a major public health concern at CGTRH. While the high prevalence of nutrition-mediated cardiovascular issues could be manageable on its own, these pre-existing conditions are more likely to become comorbidities in the Kenyan population, worsening the patient outcomes for communicable and infectious diseases, namely dengue and tuberculosis (Onyango et al., 2015). Furthermore, the three leading causes of mortality in Kenya are tuberculosis, HIV/AIDS, and respiratory infections (WHO, n.d.). The high mortality rates for these three diagnoses are not solely attributable to the pathogenicity and immune processes specific to each disease; ultimately, cultural and socioeconomic factors play an unfortunate role in solidifying these diseases as death sentences (Barua et al., 2018). Tuberculosis was a disease I sadly grew all too familiar with by the end of my internship. From visiting the microbiology lab to discuss diagnoses and epidemiology with the lab lead, to writing a rounds-style patient report on a 28-year-old male with recurrent tuberculosis, to assisting with a full physical exam on TB patients, I was privileged to learn as much as I could about all forms of tuberculosis. Mycobacterium tuberculosis, the causative agent of tuberculosis, is an aerobic, non-motile bacterium that originates in the alveoli of the lungs causing PTB (pulmonary tuberculosis). If left untreated, PTB can result in systemic tuberculosis if access to the bloodstream is obtained (Chakraborty & Rhee, 2018). While TB has been mostly eradicated in the Western world, it remains the most fatal disease in Kenya due to poor healthcare literacy and access, economic factors, and a 35% rate of patient noncompliance in the antibiotic regimen (Muture et al., 2011). Kenya utilizes the live-attenuated BCG vaccine as a part of its routine immunization schedule for tuberculosis (Lönnroth et al., 2015). While it’s a positive that there is a cost-effective and widespread vaccine in place, this limits the assays available for diagnosis. Immunologically, a weakened form of tuberculosis is acquired via the live-attenuated vaccine, the pathogen is then phagocytosed, and IgG antibodies memorize the pathogen for future destruction. An unintended side effect of the BCG vaccine is the PPD, or purified protein derivative, being falsely positive, as the IgG antibodies mentioned are still present. Treatment of tuberculosis also remains an issue due to the socioeconomic and cultural variations of Kenya (Abebe et al., 2011). Not only is a three- to twelve-month antibiotic regimen expensive and difficult to adhere to, it also may seem pointless after a few weeks. As any microbiologist will attest, while the patient may feel better when the bacterial load drops below a threshold, the antibiotic course must be continued until a predetermined date, as bacteria are able to reproduce, even in dwindling numbers (American Lung Association, n.d.). This initial “feeling better” may cause patients to discontinue the medication before indicated, causing recurrent infection (Barua et al., 2018). Further, due to the highly infectious nature of tuberculosis, the patient may begin sharing their medication with family and friends suffering from the same—or similar—diseases (Kipruto et al., 2024). This trend of medication sharing is tragically not unique to tuberculosis regimens. In the CCC, providers recount stories of HIV/AIDS patients sharing their antiretrovirals with family and friends. This act of sharing, while reflective of an impoverished and medically illiterate patient population, also represents the cultural stigma around the treatment and prevention of HIV/AIDS. This disease, referred to as RVD (retroviral disease) by those within the CCC to avoid alarming patients, presents with flu-like symptoms, dermatological abnormalities, and, if left untreated, neurological impairments. It is transmitted by transfusion, which often means sexual contact, which is why many Kenyans see it as a consequence of poor morals. Mechanistically, HIV binds to CD4+ receptors and co-receptors (CCR5 or CXCR4) on T-helper cells, allowing viral entry and destruction of these cells, thereby impairing cell-mediated immunity (CMI). Once CD4+ T-cell counts fall below 200 cells/µL, HIV is classified as full-blown AIDS. Due to the high death rate of this disease (WHO, n.d.), compounded by the dominant social stigma of this being a disease of morality, patients may travel hundreds of kilometers from home to get treatment, so as not to face social repercussions from being seen at the HIV treatment center. Because of this large diagnosis and treatment barrier, every patient who arrives at the Emergency & Casualty department is tested for RVD despite symptomatology. Unfortunately, until cultural stigma moves in a more progressive direction, HIV/AIDS will continue to worsen. Even for existing patients in the CCC, treatment isn’t guaranteed; as a part of the Trump administration’s budget cuts, USAID funding has been halted altogether with no meaningful prospective replacements (Baker & Crowley, 2025). Respiratory tract infections account for 37.6 per 100,000 deaths in Kenya (WHO, n.d.), solidifying them as the third leading cause of death in the country. Because of this, throughout the course of my four rotations, specifically in emergency and internal medicine, I saw many lung X-rays positive for pneumonia. Often, if the lung X-ray was ordered and showed no abnormalities, it meant the patient likely had another disease process in the lower respiratory tract, only prolonging his or her stay in the hospital. While on their own, respiratory infections, particularly those of the lower respiratory tract, are difficult to manage, it’s often not the only patient illness. COPD is a pervasive, chronic burden to public health in Mombasa. While the disease is mostly attributed to smoking in the Western world—as well as in Mombasa, with smoking rates of up to 20%—it is also worsened by the use of in-house firepits to keep warm and cook food (Statistics Kenya, n.d.). Many houses lack appropriate ventilation, and therefore it’s not uncommon for the entire home to be filled with smoke. I experienced this firsthand while on an International Medical Aid safari to the Masai Mara. A tribesman invited me into his home to see the living arrangement. Immediately upon entry, my first instinct, as a trained firefighter, was to crouch down. Nevertheless, I followed him into the main room, where I saw the origin of the smoke: a small fire pit maintained by the burning of biomass such as grass and wood. He’d periodically stoke it, only worsening the air quality. Next to the pit was a makeshift kitchen and a bed. While this was a rural community, doctors assured me these living conditions are just as pervasive in the urban areas of Mombasa. It goes without saying that prolonged exposure to smoke predisposes someone to chronic obstructive pulmonary disease, but this chronic exposure also means the immune system is not as capable of fighting infections, specifically pertaining to the respiratory tract. While disease statistics can certainly help form a picture of the types of healthcare challenges in Mombasa, one patient I encountered embodied the consequences of systemic shortcomings and their humanitarian consequences. While awaiting the next patient in Emergency & Casualty, I saw a man wheel an empty stretcher rather hastily towards the ambulance bay. Having a background in emergency medical services, I knew this meant a patient had arrived who was, at the very least, unable to ambulate. I helped him steer the stretcher and walked outside to find that there was not an ambulance in sight, but rather a single red tuktuk with a man standing by the rear trying to pull someone out of the back seat. I walked over and looked inside to assess the patient’s condition, finding a 40s male, unconscious. I checked his carotid artery for a pulse, which thankfully was present. With the help of the man he arrived with, I lifted him from the car and placed him on the stretcher to wheel him into the emergency department. There were not any open beds or available Medical Officers, so I placed the stretcher he was already in against the wall and began a primary assessment. The patient was placed on his side in the recovery position due to the presence of secretions and vomit. His Glasgow Coma Scale (GCS) I evaluated as 5, due to unresponsive, dilated pupils, no vocalizations, and decorticate posturing. Pulse and oxygen saturation were within normal ranges, but his blood pressure exceeded the machine’s capability of approximately 240 mmHg systolic. While gathering vitals, I was talking to the man the patient came in with to obtain a semblance of a history. The man spoke very little English, as did I Swahili, but after acting it out I came to the understanding that the man had fallen straight backwards spontaneously from a standing position, striking his head on the ground. No seizure activity or convulsions were reported prior to or after the fall. Upon physical examination, a soft spot was noted on his rear cranium, proximal to his scalp, suspected to be a contusion. Abdominal examination was unremarkable, as was the musculoskeletal system. Upon auscultation of his lungs, they were observed to be clear and equal bilaterally, with equal chest rise and fall. Upon completion of the primary and secondary assessment, I reported my findings to the closest available Medical Officer. He nodded his head and asked what actions I thought should be taken next, to which I replied a head CT and intubation. He agreed with the indications for a head CT, but stated that due to the patient’s stable SpO₂, procurement of an intensive care unit spot would be difficult. I remained with the patient until the end of my shift, and there he remained for an indeterminate amount of time, as his insurance had to be confirmed before he could be moved to a bed and further evaluated. I arrived back at the hospital at 20:30 that night for night shift, and immediately upon entering, a doctor I had talked to earlier in the week came up to me and asked if I wanted to see an EVD (external ventricular drain). I enthusiastically followed him, pulled back the curtain to enter the bedside, and found my patient still unconscious with a surgeon actively drilling a hole into his head. I referenced the chart, and this anonymous unconscious patient finally had a name: Mohammed. Upon reading the notes and looking at the head CT, it became apparent the reason for the bedside EVD was a massive intracranial hemorrhage, which likely resulted from a hemorrhagic stroke. The EVD was completed without issue, but Mohammed remained vitally unstable and profoundly hypertensive. Mohammed remained in that ER bed for the remainder of my shift, as an ICU bed was unable to be allocated. On the morning two days after the night shift, I spoke to a doctor I had been shadowing, where he revealed Mohammed had expired. While I have had patients die before in the U.S., and also understood this was inevitable given his history and presenting condition, Mohammed’s death still affected me more than any other patient I’ve ever had. The hospital system failed him. He needed an advanced airway and a bed in the ICU, and that was unable to be obtained. I visited Mohammed one last time in the mortuary that afternoon. He was still wearing the same clothes he had arrived in, and had the same expression on his face, with the exception of his mouth being secured closed post-mortem. Mohammed had become just another corpse in the morgue, but he will be with me for my entire career in medicine. Ultimately, aside from the shortcomings and injustices I witnessed during my internship, the lesson that reigns true—regardless of how many confounding variables there may be—is that to be a good clinician, one applies his or her breadth of knowledge to individual patients as effectively as possible. At the end of the day, patient outcome is the only metric that truly matters. If the hospital administrator fails his or her task, money may be lost, but if the hospitalist fails his or her task, people can and will die. On my final day at CGTRH, after visiting and saying my farewell to all the providers I had the privilege of calling teacher and/or friend for that month, I walked past the morgue. The hauntingly familiar smell of formaldehyde and decaying flesh grazed my nostrils and I decided to do one last walkthrough. While I did not recognize any of the people laying to rest, I still spent a few minutes in the building, taking it in one last time. Although I’d be leaving Kenya in the coming days, I had to remind myself that this reality is universal. Whether it be from action, inaction, or unfortunate luck, these people had died in the hospital, and that is something that will always happen, even through no fault of my own. I will always remind myself, before every primary assessment or pharmacological intervention, of the consequences of failure, and I think that’s a lesson every student entering the industry should take to heart. Nonetheless, it’s still important to understand that, even under ideal conditions, patients will still die. At CGTRH, as well as many other under-resourced healthcare facilities, often clinicians are limited in what they can do because of factors outside their control. Even confronted with these realities, I was inspired to see MOs, COs, nurses, and general staff alike always provide the best care possible with afforded circumstances. No task was beneath anyone, as Medical Officers would routinely adjust the angle of patients’ beds for their comfort. There was something about working in an under-funded hospital that inherently increased the empathy required. Unlike U.S. hospitals, there were not many machines with complex algorithms determining dosages or displaying every vital sign and waveform one could ever need. Because of that, patient care wasn’t shrouded with the same superiority complex as in the U.S. Patients often recognized providers were doing the best they could, and providers would see patients as people rather than room numbers and conditions. Ultimately, a good clinician isn’t defined by the resources at their disposal, but rather by how their fluency in medicine translates to maintaining the patient’s humanity and improving their condition.

Participating in International Medical Aid’s program in Kenya was a truly transformative experience, both professionally and personally. I had the opportunity to shadow physicians and healthcare professionals at Coast General Hospital in Mombasa, gaining firsthand exposure to global healthcare challenges and delivery in a resource-limited setting. From the moment I arrived, the in-country support team made me feel safe, welcomed, and well-oriented. IMA’s staff were consistently responsive and approachable. They ensured that all volunteers understood local customs, safety protocols, and expectations in clinical settings. We had weekly check-ins, and the team was always available to address any concerns. Despite being in a new country, I felt incredibly safe throughout my stay, thanks to the reliable transportation, secure housing, and clear communication from the local coordinators. IMA did a great job preparing us with pre-departure materials and continued that level of support on the ground. The accommodations exceeded my expectations. The volunteer housing was clean, secure, and comfortable, with amenities like running water, Wi-Fi, and mosquito nets. Meals were delicious and diverse, offering a great introduction to Kenyan cuisine. The kitchen staff also accommodated dietary preferences and restrictions without hesitation. The clinical shadowing was eye-opening. I rotated through various departments such as maternity and pediatrics. I observed cases I would likely never encounter in my home country and learned to appreciate how medical professionals innovate and adapt under constrained conditions. One particularly memorable moment was observing a C-section where the team maintained high standards of care despite limited resources. I also appreciated the cultural immersion opportunities provided, including excursions to historical sites, safaris, and time spent in local communities. These moments added depth to my understanding of healthcare in Kenya by allowing me to witness the social and economic factors influencing health outcomes. The program strengthened my desire to pursue a career in global health and gave me a more nuanced perspective on the importance of healthcare equity. I became more adaptable, empathetic, and aware of the cultural dimensions of medicine. I also believe that, through volunteer outreach initiatives like health education days, we made a small but meaningful impact on the community. From a young age, I felt an unshakable pull toward the medical field. My white coat was never far from my shoulders, and the plastic stethoscope that draped around my neck felt like a symbol of something bigger, something I couldn’t yet fully explain. I would transform my dolls and stuffed animals into patients, performing makeshift surgeries on them as if I were already a seasoned doctor. Even my dog, who was far too old to escape my ministrations, became my loyal patient. My family played along, offering their arms for bandages, pretending they had broken bones or caught the flu, while I took it all in with a fierce sense of responsibility. It was in seventh grade when my sister asked the question that everyone asks: “What do you want to be when you grow up?” Without hesitation, I said, “I want to be a doctor so kids like me can feel safe and healthy.” I know many kids make fleeting promises to become doctors, only to let those dreams fade. But for me, even then, it was never just a passing thought. It was a passion that felt destined, something I’ve carried with me ever since. When I first considered a career in medicine, I never imagined that a Physician Assistant (PA) was an option or even that the profession existed. It wasn’t until I found myself in the hospital one day, expecting to see a doctor, that I was instead greeted by a PA. At first, I didn’t realize the extent of responsibility and autonomy this role carried. But the more I learned, the more I discovered how much PAs actually do, from assisting in surgeries to diagnosing patients, ordering tests, prescribing medications, and performing physical exams. This role offers the perfect balance: the opportunity to be deeply involved in patient care, but still working collaboratively with doctors. The ability to specialize in different fields, combined with the flexibility to work in diverse settings such as hospitals, clinics, private practices, and urgent care centers, made me realize that this is exactly what I’ve been searching for. Suddenly, my path became clear. I knew this was the profession I wanted to pursue, one that would allow me to contribute meaningfully, grow continuously, and make a real difference in healthcare. I knew I was destined for healthcare the moment I didn’t hesitate to save a life. It was Halloween weekend in 2022. My friends and I were standing outside the bar, waiting for a ride home, when suddenly, the sharp crack of a crash split the air. I turned around and froze. A man lay unconscious in the street, blood spilling from his body, while a motorcycle lay in pieces just a few feet away. Without thinking, I ran straight to him. Later, I learned he’d been hit by a motorcyclist, but in that moment, it was clear only one thing mattered: getting to him. I dropped to my knees beside him. He wasn’t breathing. Blood was pooling around him. I grabbed his wrist, searching for a pulse. Nothing. A rush of adrenaline surged through me, and without hesitation, I started chest compressions. Another person appeared beside me, panic in their eyes. “What do I do?” they asked. “Two breaths every thirty compressions,” I instructed, barely looking up. I could hear the sickening sound of his ribs cracking under the pressure, but I didn’t stop. I couldn’t. We kept switching, exhaustion creeping in, but we pushed through, each compression a desperate plea for life. Time seemed to stretch and warp as we kept going, our breaths shallow, our hands working in sync. Finally, we heard the distant wail of sirens. The ambulance screeched to a halt, and the paramedics rushed in to take over. I stood up, my hands slick with blood, and looked down at them, bright red and trembling. A police officer approached me, his gaze steady as he placed a hand on my shoulder. “You did great,” he said, his voice firm but filled with something more. “You may have just saved that kid’s life.” In that moment, everything shifted. I felt a sense of certainty wash over me; this was no longer just an instinct. It was my purpose. From that moment on, I knew this was meant to be. There was a moment, not long ago, when I truly questioned whether I was cut out for this profession. About six months ago, I was helping a nurse with a blood transfusion. She casually asked, “Do you get squeamish around blood?” Without hesitation, I said, “No.” I figured, having donated blood countless times and seen my fair share of bloody injuries, I’d be fine. But then, as the nurse started the procedure, she pulled out this long, 12-inch needle. With a swift, almost aggressive motion, she drove it into the patient’s arm. The pain was immediate and intense. The patient screamed in agony, but because he was on a ventilator, no sound came out. In that moment, I froze. My body went ice cold, and I knew exactly what was happening. I’d fainted before, and I could feel all the signs: my limbs tingled, my legs started to give way, and my vision blurred, fading into stars. Desperately, I turned my head away, trying to block it out, taking deep breaths to keep myself steady. I knew I had to leave before I collapsed, so I whispered to the nurse, “I need to get out of here or I’m going to pass out.” But she quickly responded, “You can’t, or he’ll bleed out.” I fought with everything I had to stay focused. But suddenly, the room went black. My legs buckled, and I crashed to the floor, hitting my head hard. When I came to, I was surrounded by a crowd of nurses, all staring at me. Embarrassed and shaken, I made my way to the break room and broke down, overwhelmed with doubt. “How can I be a PA if I can’t even handle a simple procedure like this?” I thought. Then, a nurse walked in and asked what had happened. I explained, feeling humiliated. She smiled and told me a story. “When my brother broke his nose,” she said, “there was so much blood pouring out that I passed out. My mom told me, ‘How can you be a nurse if you can’t handle blood?’ But here I am, 10 years in.” Something about what she said stayed with me. “Don’t let one moment define your future,” she told me. “Keep going.” From that day on, I’ve carried her advice with me. Every time doubt creeps in, I remember her story. It became my motivation, proof that even the toughest moments can become stepping stones toward achieving something greater. I never imagined that choosing the path of becoming a Physician Assistant would lead me to this internship, an experience that completely reshaped the way I see medicine, privilege, and the reality of global healthcare. Before this, my understanding of healthcare was largely rooted in what I saw in the U.S., a system full of flaws, yes, but still one with access, options, and a certain level of expectation. But nothing prepared me for what I would witness during my time abroad. One of the first things that hit me was the line outside the hospital—dozens of people, some waiting for hours just to see a doctor for a single minute. That kind of patience, that desperation, shook me. And it wasn’t just the wait times. It was the staggering lack of resources and staff that made me stop in my tracks. When I learned that there was only one neurosurgeon and one cardiologist in the entire country, I was stunned. Then came the numbers: a nurse-to-patient ratio of 1 to 70, and a doctor-to-patient ratio of 1 to 13,000. For comparison, in the U.S., it’s about 1 to 5 for nurses and 1 to 400 for doctors. I was speechless. In the maternity ward, a nurse explained to me how their scope of work stretched far beyond what we’d expect in the States. They did everything: suturing, delivering babies, examining placentas, because there simply weren’t enough midwives or doctors to do it. The only thing they couldn’t legally do was diagnose or prescribe a treatment plan. They had no choice but to stretch themselves thin. In some cases, heartbreakingly thin. One nurse told me how, during critical shifts, they’d sometimes have to make impossible decisions, choosing who had the better chance of surviving, because they didn’t have the time or resources to save everyone. They had to let go of patients who were fading, simply because they didn’t have the luxury to sit beside them in their final moments. I remember watching a woman undergo a labial laceration repair after giving birth. Lidocaine was scarce, so it was diluted to conserve every drop. I’ll never forget the sounds: sharp inhalations, low groans turning into cries, the way her fingers gripped the edge of the bed as her body trembled. The pain was visible in every part of her. It was like the anesthetic barely worked, and yet it was all they had. Back home, I work in a hospital where nurses often talk about being overwhelmed with five patients instead of three or four. I’ve heard the frustration, the burnout, and the complaints about skipped breaks and long hours, and I don’t dismiss any of that. But after seeing what I saw, I can’t help but think: some of us need a reality check. We forget how much we do have. We forget that access to clean instruments, consistent medication, and specialized staff is a privilege, not a given. We take so much for granted. This experience didn’t just show me the cracks in the global healthcare system. It lit a fire in me. It made me realize that being a PA isn’t just about diagnosing or prescribing. It’s about being adaptable, compassionate, and resourceful even in the most limited of settings. It’s about seeing the patient in front of you, not the chart. And sometimes, it’s about bearing witness to pain—real pain—with the humility to learn from it. This was more than an internship. It was a wake-up call. And I’ll carry that with me into every patient room, every diagnosis, every decision I make in the future. I spent my first week in the maternity ward, a deliberate choice driven by a deep curiosity about the female body and the intricate process of childbirth. On my very first day, we were led upstairs to the operating room. The moment I stepped in, a wave of cold air hit me, sterile, sharp, and unforgiving. The room was tense, thick with anticipation. A woman lay on the table, visibly trembling, not from the temperature alone, but from the shock and fear coursing through her. Then the surgeon walked in. She carried herself with unshakable confidence, as though she had done this a thousand times, and maybe she had. The sudden blast of upbeat music filled the room, lifting the heavy silence. It was unexpected but oddly comforting, a tactic, I realized, to keep the energy high, the mood steady. The procedure began. What felt like 15 minutes stretched into an hour; time warps in places like this. The surgeon moved with precision, almost like she was dancing through the motions, each action flowing from muscle memory. But nothing about the procedure was gentle. I watched as she made the first incision, then began pulling and tugging with force to open the abdomen. It was raw, intense, and real. That’s when the nausea crept in. The room started to spin ever so slightly. My arms and legs tingled. Lightheaded, I fought to stay upright. I didn’t want to miss this. I didn’t want to be that person who had to step out. But my body gave me no choice. I slipped out quietly. By some miracle, I returned just in time. The room was still. And then a sharp, powerful cry filled the air. A newborn. Her lungs were strong, her presence undeniable. It was one of the most profound moments I’ve ever witnessed. From cold steel and silence to life and sound, all within a single breath. It was nothing short of extraordinary. After experiencing that, the next two C-sections were amazing to watch from start to finish. I felt like I could handle seeing anything. My second week was spent in the Pediatrics ward, a world entirely different from Maternity. In Maternity, we celebrated new life, the joy of arrival. But here, we faced the fragile thread between hope and heartbreak. It wasn’t about welcoming a child into the world anymore; it was about fighting to keep them in it. The first thing you notice when you walk in is the sound—not soft coos or lullabies, but the piercing screams and cries of children in pain. Then you see the mothers, weary, worried, clutching their sick little ones with tired eyes that have known too many sleepless nights. It was hard to approach the children without fear reflecting on me. To them, we weren’t helpers; we were strangers in white coats who brought needles, pain, and confusion. I could feel their distrust, and it made me feel helpless. I wanted to reach out and let them know I was there to help, not hurt. I wanted them to feel safe, even in the scariest place. That feeling, that longing to be a comfort in the chaos, is exactly why I chose this department. Because in pediatrics, medicine isn’t just about charts and treatments; it’s about connection. It’s about kindness, magic, and making space for laughter even in the midst of fear. Someone once said, “Children may forget what you say, but they’ll never forget how you made them feel.” That’s the truth of pediatrics. Sometimes, the most powerful medicine is simply making them smile. A silly face, a warm hand, a few minutes of pretending the hospital bed is a rocket ship—it changes everything. Children fight hard. They recover fast. They believe in magic. And in pediatrics, you start to believe, too, that maybe, just maybe, anything is possible. It was 8:40 AM when we stepped through the doors of the pediatric emergency room. Almost immediately, I sensed something was wrong. A commotion behind a curtain in the corner of my eye pulled me in. I moved quickly toward the noise. Behind the curtain was a little boy, or so I thought. He looked no older than six or seven. I later learned he was thirteen. His body told a different story. He had pneumonia and was dangerously susceptible to secondary illnesses like meningitis and anemia. His frame was skeletal, every rib visible beneath pale, stretched skin. His abdomen was distended, a stark contrast to the rest of his frail body. Malnutrition had taken a cruel toll. Two nurses were performing CPR—fast, hard compressions—and I could hear the crack of ribs with each push. They were tiring. Without hesitation, I stepped in. Thirty compressions, pause, glance at the monitor. Flatline. Silence. A breath held. Then nothing. Again. And again. Twenty minutes passed, but it felt like an eternity. I pressed a stethoscope to his chest, hoping the monitor had missed something. Still nothing. No heartbeat. No murmur. Just silence. We checked his pupils. Black, fully dilated. No response. No reflex. His brain was gone. There was no life left in that fragile body. We called the time of death: 8:59 AM. That number is etched into my memory. I will never forget it. And then came the part no one can prepare you for: the mother. She entered through the curtain, her face shifting instantly from anxious hope to unspeakable grief. Her knees buckled. She collapsed to the floor, sobbing uncontrollably. Her cries filled the room and pierced through every layer of calm we tried to keep. We stepped out, giving her space. But the sound stayed with me. He had so much life ahead of him. And yet it was taken not by something rare or untreatable, but by something entirely preventable. If he had been in the United States, his outcome would likely have been very different. Routine vaccinations could have protected him from the infections that weakened his immune system. Early medical care could have treated his pneumonia before it became severe. Nutritional programs, regular checkups, and access to antibiotics, oxygen, and intensive care could have given him a fighting chance. Even his severe malnutrition, so apparent in his fragile body, would likely have been addressed long before reaching this point. In the U.S., a child like him wouldn’t just be seen; he’d be saved. This experience gave me more hands-on exposure than I ever expected. But more than that, it exposed me to the brutal reality of healthcare inequity and the devastating cost when basic needs go unmet. Medicine is more than procedures and protocols. Sometimes, it’s about witnessing a loss that never should have happened and carrying it with you so it never happens again. After my week in the Pediatrics ward, something clicked. For the first time, I felt a real sense of direction, a clear understanding of not only what I wanted to do, but why becoming a Physician Assistant is the right path for me. That week, I rotated through three different pediatric settings: two days in outpatient, two in inpatient, and one unforgettable day in the pediatric ER. Each offered its own lessons, but it was those first two days in outpatient that lit something up in me. It wasn’t just interesting; it was fun. Surprisingly fun. I’ve always had a thing for puzzles. I find myself doing mini puzzle games all the time—during car rides, in waiting rooms, even while half-watching TV. There’s something so satisfying about taking scattered pieces and fitting them together to reveal the bigger picture. Outpatient care felt exactly like that. A child walks in with a list of symptoms, sometimes vague, sometimes oddly specific. You ask the right questions, listen closely, and examine carefully. You take all those disconnected pieces—the fatigue, the rash, the cough that won’t go away—and slowly, you build a picture. You work backward from the clues, solve the case, and figure out how to help them feel better. It’s medicine, yes, but it’s also a puzzle. And I loved it. Working alongside the Physician Assistants during those outpatient days was eye-opening. There was an ease to the way they moved—calm, confident, efficient. They listened to their patients, made swift yet thoughtful decisions, and always stayed one step ahead. Sometimes they’d already guessed the diagnosis before even starting the physical exam. It wasn’t rushed; it was refined, like muscle memory earned through years of practice. Watching them, I could see a glimpse of my own future. I imagined myself in their shoes: solving puzzles, guiding patients, making a real difference. It didn’t feel out of reach; it felt like the right fit. That week didn’t just reaffirm my career path. It gave me something more powerful: clarity. And for the first time, I could truly see the future I’ve been working toward. On my last day, we held a mental health awareness clinic at a local high school. One of the activities we did was simple on the surface: a piece of paper divided into four prompts—“I feel…,” “Because…,” “I wish…,” “I will….” The students filled them out anonymously and handed them in. Most were what you’d expect: stress about exams, pressure from home, friendships, the usual teenage chaos. But then I read one that stopped me cold: “I feel sad and scared because I like boys (I’m gay). I wish my friends and family would accept me. I will try to figure it out.” That was it. Just a few words. But behind them was a storm of fear, isolation, and incredible vulnerability. I sat there, holding the paper, unsure of how to even process what I had just read. This wasn’t a cry for attention; it was a silent scream from someone hiding in plain sight. What hit me hardest was realizing just how dangerous that confession was, even anonymously. I hadn’t fully grasped how severe the consequences of being gay could be in this country. Homosexuality isn’t just stigmatized; it’s criminalized. A person can be expelled from school, fired from their job, refused medical care, violently attacked, evicted from their home, or sentenced to up to 14 years in prison. And that’s not even counting the emotional trauma of being rejected by your own family. That student, whoever he is, is living a life of secrecy, fear, and constant self-monitoring. Just being seen could ruin everything. And he’s only a teenager. I wish I could have helped him. I wish I could have told him that he’s not alone, that his identity isn’t something to fear. It wasn’t long ago that being gay was illegal in the United States, too, and was only decriminalized in 2003. And same-sex marriage didn’t become legal until 2015. It’s easy to forget how recent that progress is. For millions around the world, it still feels impossibly out of reach. In Kenya, public pride parades are rare and dangerous. LGBTQ+ activism is heavily restricted. There are no laws that protect queer individuals from hate crimes or discrimination. The fear is not just cultural; it’s legal, physical, and endless. Reading that note reminded me why mental health advocacy matters. It reminded me that healing isn’t always about medicine; sometimes it’s about being seen, being heard, and being safe. And it reminded me that change takes more than time; it takes courage, protection, and people willing to listen to anonymous cries for help and say, “I hear you.” This journey has deepened my understanding of medicine beyond clinical skills and textbooks. It’s shown me that being a Physician Assistant is about more than just treating illness; it’s about listening when someone is afraid to speak, acting when others hesitate, and showing up fully, even in the hardest moments. I’ve witnessed the power of empathy in a crowded ER, the strength of resilience in underserved communities, and the urgent need for equity in global healthcare. I’ve seen how a single act, whether it’s saving a life on the street, holding a child’s hand, or reading a note from a student too afraid to be themselves, can ripple out and change lives. I am no longer the little girl with a plastic stethoscope and big dreams. I am someone who has seen the beauty and the brutality of medicine and who is ready to step into this role not just with knowledge, but with compassion, purpose, and unwavering commitment. Becoming a PA is no longer just my dream; it’s my calling.

Participating in the International Medical Aid (IMA) internship program in Mombasa, Kenya, was one of the most formative experiences of my academic and professional life. My time interning at Coast General Teaching and Referral Hospital not only solidified my passion for OB/GYN but also deepened my understanding of global health disparities and the importance of compassionate, culturally competent care. In-Country Support and Staff: The in-country support provided by IMA was exceptional. From the moment I arrived in Mombasa, I felt cared for and supported by the entire team. All of the mentors were approachable, knowledgeable, and always willing to answer questions or provide guidance, both in the hospital and outside of it. I especially appreciated their attentiveness when I was feeling under the weather; Mitchel always checked in on me and made sure I was okay, which meant a lot being far from home. I want to give a special shout-out to Hilda, who was absolutely awesome to be around. Her energy and warmth made the experience even more memorable. I especially enjoyed hanging out with her during the safari; she was fun, supportive, and made the trip memorable. Safety: Safety was a major concern of mine before arriving, but IMA did an excellent job maintaining a secure environment. Our housing was guarded 24/7, and we were advised on areas to avoid, appropriate dress codes, and how to navigate the city respectfully and safely. I never felt unsafe, and knowing that IMA was always reachable in case of emergencies gave me peace of mind. Accommodations and Food: The accommodations were clean, comfortable, and conducive to rest after long days at the hospital. Rooms were shared with other interns, which fostered strong friendships and a sense of community. The meals provided were consistent, nutritious, and offered a mix of local and international flavors. Having home-cooked meals prepared daily made a huge difference in helping us stay energized and healthy throughout the program. One of my favorite memories was getting to help the pastry chef bake cinnamon rolls and a cake for the other residents. Even though most of us didn’t have strong baking skills, he was incredibly welcoming and made the experience fun and relaxed. It was a small but memorable moment of connection and hospitality that made our temporary home feel even more like a community. Clinical Experience and Impact: The clinical rotations were diverse and eye-opening. I was exposed to several departments, including pediatrics, internal medicine, surgery, and maternity. I found myself deeply drawn to the labor and delivery ward, where I observed numerous births and even had the chance to assist in some non-invasive ways under supervision. This was where I discovered my true passion for OB/GYN. However, this area also exposed one of the most challenging parts of my experience: witnessing the lack of empathy in some clinical interactions. While technically proficient, many staff lacked bedside manner, rarely acknowledging mothers post-delivery. While this was difficult to witness, it also shaped my own understanding of the kind of provider I want to be: one who prioritizes both clinical excellence and compassionate care. Additionally, the resources in the hospital were lacking. From reusing supplies to patients having to bring their own bedsheets, the lack of basic necessities was an ongoing challenge. These experiences gave me perspective on the privileges of the healthcare system in the U.S. Community Impact and Cultural Insights: The program’s connection to the community was one of its strongest features. We weren’t just observers in a hospital; we were invited to engage with a broader conversation about healthcare access, economic disparity, and public health education. Many of the patients we encountered lived in poverty and were unaware of the healthcare services available to them. This highlighted the need for more than just clinical care; it underscored the importance of community outreach and education. IMA’s local partnerships and involvement in community projects show their commitment to making a sustained impact, not just hosting interns. This part of the program helped me understand that healthcare must be holistic, starting long before a patient enters a hospital and continuing long after they leave. Personal Growth and Long-Term Impact: This experience transformed not only my academic path but my worldview. I entered the program as a Pre-PA student, still exploring specialties. I left with a clear vision of becoming an OB/GYN and pursuing medical school instead of the PA route. The emotional and ethical insights I gained from this experience, especially the importance of empathy and equity, are lessons I carry into every patient interaction as a CNA and will continue to prioritize throughout my career. Since returning, I’ve shadowed OB/GYNs in the U.S. and found the same aspects of the field that inspired me in Kenya; emotional connection, variety, and challenge are just as alive here. That consistency across cultures affirmed my decision to pursue this path. Final Thoughts: I am incredibly grateful to International Medical Aid for facilitating such a meaningful, safe, and eye-opening experience. The combination of clinical exposure, cultural immersion, and ethical reflection has had a lasting impact on me as a future healthcare provider. While there were challenging moments, especially in observing disparities and resource shortages, these were necessary for growth and reflection. To anyone considering this program, I would strongly encourage them to go with an open heart, a respectful attitude, and a willingness to learn, not just about medicine, but about humanity. The impact this experience had on me was profound, and I know it will shape the kind of physician I become.

The time I spent in Kenya was life-changing. I did not want to leave. The residence and the staff make you feel like you're at home and are very accommodating with special needs you may have. The hospital and the medical staff are welcoming and genuinely want to help you learn and experience new things. Outside of the hospital, I participated in all of the cultural treks and learned so much about Mombasa and surrounding areas. I'm happy I went on two safaris because I was able to see regions in Kenya. My favorite part was visiting the orphanages and giving one-on-one attention to kids. The smile on their face when receiving a sticker made the entire trip worth it. I can't wait to go back to volunteer at the orphanages and hopefully as a physician assistant as well. I came to Kenya with a general idea about what the healthcare system would entail, visually expecting small huts, minimal electronics, limited transportation, and overall a severely impoverished area, as well as anticipating interactions with local people to be limited or insignificant. I mistakenly created an implicit bias for this country and its people. “Welcome to Kenya.” “You are one of us.” “We welcome you, our home is your home.” All of these phrases comforted me as I acclimated to a foreign country. Culture shock is defined as “the feeling of disorientation experienced by someone who is suddenly subjected to an unfamiliar culture, way of life, or set of attitudes” (Oxford Languages). I never felt this unwavering feeling; instead, my comfort level was at an all-time high. I became so infatuated with the people around me and their way of living that it made it hard for me to picture myself going back to America. The simplicity of the basic needs and the resources available made it impossible to always want more. In America, consumers are constantly wanting more, leading to sellers producing even more. Yet, in Kenya I felt comfortable with the only few things I had. I never had the desire to buy more things to fit in with society or to make my life easier during the time I was there. I simply was living and enjoying the few things I had. I felt a similar way when I spent time at Coast General Teaching & Referral Hospital (CGTRH) in regard to how medical care was being provided. The medical providers focused on the basic needs of a patient and further escalated the plan of care within the hospital. The United States requires many different hoops you must jump through to receive proper or even basic-level care. Many times, you see a primary care doctor one day and then they may refer you to a specialist but can be booked out for months, leading to a waiting period of not receiving any sort of treatment. Once a patient sees a specialist, they may even refer you to a different specialist or recommend you for surgery, which is another waiting period in itself because it probably wouldn’t be considered urgent. Receiving medical care in America is not simple; it comes with many different complex factors in regard to what the doctor is willing to put orders or labs in for. Pediatric rotation is when I noticed this huge difference between the healthcare systems. The providers listened to the patients’ parents’ concerns and ordered lab work immediately. Once results were given, the treatment option was clear. Unlike America, diagnoses aren't assumed simply based on symptoms and recommended further referrals given. It made me question why it is so difficult to get U.S. doctors to write orders, labs, or referrals. With the complexity and time it takes to receive an official diagnosis in America, it can lead to a very large, extensive medical bill even with insurance. The costs of healthcare differ drastically between the U.S. and Kenya. According to World Bank Data (2018), the current healthcare expenditure per capita for the United States was $10,623.85. In comparison, Kenya’s healthcare expenditure per capita was $88.39. Significantly less, but it reflects the limited resources Kenya has in regards to newer medical technology, drugs given, and overall cost of the length of stay at a hospital. However, it's important to consider the ratios of staff to patients within the public hospitals and the overall healthcare system. “Kenya has 11,000 doctors, 76,000 nurses and 19,085 clinical officers, of whom only 4,000 doctors, 47,000 nurses and 6,659 clinical officers were active in the public health sector as at June 2018. This translates to an average of 21 doctors and 100 nurses per 100,000 people compared with the WHO-recommended minimum staffing levels of 36 doctors and 356 nurses per 100,000 people” (IMA Lecture: The Current State of Healthcare in Kenya). Not only is there a lack of resources but also a lack of medical professionals to provide care. During the fourth week of my internship, I was able to shadow in the cardiac cath lab at CGTRH in Mombasa. It is the only cath lab at a public hospital in the entire country of Kenya. Visually, it looked very similar to cath labs I have seen in America. I was able to see many different procedures including angiograms and stent placements. One day in particular made me realize how short-staffed the hospital was. A 60-year-old male patient was admitted to get a stent placed because of the blockage in his left anterior descending artery, which is the largest coronary artery in the heart. For most cath lab procedures at CGTRH, anesthesia is not given because it's a bigger risk to put someone under general anesthesia, especially with a cardiac condition. As the procedure began, the surgeon realized it was much more complex than they had thought. He further requested another surgeon to assist and requested anesthesia to be on standby in case the patient needed to be intubated. However, no extra anesthesia staff were available; all were actively in other procedures. The surgeons decided to proceed knowing that his vitals had been stable the entire time and if it wasn't fixed that day they wouldn't know how much longer he would have to live. Something to note is that these cath lab procedures are paid out of pocket in advance, meaning there was less hesitation to proceed since the family had paid for the procedure. Furthermore, they proceeded with the procedure and were successful enough to put the stent in. The procedure was complete, but soon the patient's vitals became irregular, leading to a cardiac arrest. A code blue was called and CPR was performed. The only anesthesia member available had just finished a procedure and came down to intubate the patient. The vital signs were not improving even with the fluids, drugs, and chest compressions. After 45 minutes, they pronounced the patient dead. Questions began to flood my head: “Why did the surgeons proceed?”, “How did they not know the complexity of it before?”, “Would it have been different if anesthesia was there from the beginning?”, and “Why isn’t there an extra anesthesia staff at all times in case of these emergency situations?”. Simply put, there just weren't the right resources or people at that specific time. This became a common theme throughout the time I was there. Other interns described their experiences where lack of resources, people, or time led to an unfortunate death. In the emergency department, a patient arrived with a severe head injury that required a craniotomy. His vitals were beginning to decrease and there was no brain activity. The neurosurgeon said he would have a slight chance if they went to surgery right away, but there were no operating rooms available. The patient ended up passing within the hour. In the maternity department, a mother had a C-section that soon led to a postpartum hemorrhage so severe that she required a blood transfusion, but there was simply no blood to give her. The mother passed the next day due to several complications stemming from the large amount of blood loss. All of these situations have a common factor of not having enough resources to provide life-saving or adequate care to patients. “Was it really a culture shock?” is the question that I continue to ask myself being back in the United States. In all honesty, it wasn't a culture shock. Instead, it was an experience that led me to feel more comfortable and happier than ever being in America. I experienced culture shock returning home to a place that wastes resources daily, patients complaining about the size of their private room, and families arguing with doctors and nurses instead of saying thank you. I am forever thankful to have spent time in Kenya and look forward to returning as a physician assistant. The internship has pushed me further to not only pursue a healthcare career but return to Mombasa, Kenya. I want to provide care to people in Kenya who are beyond grateful to receive medical care.

The program has not only deepened my passion for healthcare, but also opened my eyes to global healthcare disparities, the beauty of community outreach, and the vital role that systemic infrastructure plays in delivering healthcare. In the hospital, I shadowed a range of specialties, giving me the opportunity to watch live births and learn pathology alongside medical students. Our outreach clinics had lasting effects on the community, and we were able to see this in real time. Even after educating and answering questions on menstruation and women’s health for 1.5 hours, girls continued to come up to me with questions on the way to the bus. You could see the relief on children’s faces when they learned about issues involving menstruation or mental health and realized they weren’t alone. Children who had previously attended the hygiene clinic remembered the information and were able to assist in educating their peers. One of the issues Kenya suffers from is poor health literacy. Through these clinics, we were not only able to provide supplies for immediate care but also make a lasting impact through health education. As demonstrated in the hygiene clinic, even educating just one group of students can make a difference as they continue to educate each other. From the second I arrived in Kenya, the IMA staff made it feel like home. I felt safe at all times, and if I ever needed anything, our program mentors were easily accessible. The accommodations were more than comfortable—the food was amazing, and the house and kitchen staff always went out of their way to ensure we were taken care of. I often took naps after a long shift at the hospital, causing me to miss the planned dinner time. However, Joshua always made sure there was a meal left for me to wake up to. Being the only new person to the program during my time in Kenya, I was nervous to go on the safari alone. Thankfully, Vivian was there to accompany me the whole time, and there was no one better I could have asked for. She immediately put me at ease and became a lasting friend in the process. I did not expect to love Kenya as much as I did, and I truly believe the IMA staff played a significant role in that. I will always be grateful for my experience there and hope to come back soon.

No words can fully capture how much this experience meant to me. From shadowing at the hospital to going on safaris and even simply spending time at the residence, every moment of my trip to Mombasa was invaluable. In just three weeks, I advanced my medical and cultural knowledge and built lifelong relationships. At Coast General Teaching and Referral Hospital (CGTRH), I shadowed in three departments: Accident & Emergency, Pediatrics, and Surgery. In each, the medical staff were welcoming and eager to teach, taking time to explain their roles on the care team and how they work to provide the best patient care. In Pediatrics, Dr. Ken and Dr. Nancy were excellent mentors, guiding me through how they evaluate, diagnose, and treat each patient. I expanded my familiarity with common pediatric conditions and treatment plans, and—perhaps most importantly—learned by watching how they communicated with families and patients. The school clinics might have been the highlight of the trip. Visiting classrooms and seeing how excited the children were is something I will never forget. Many were studying in challenging conditions, yet they were among the happiest people I’ve ever met. I loved teaching basic hygiene and personal health. Their pure joy left a lasting impression and made the school clinics an experience I will always cherish. I’m deeply grateful for the memories I made in Mombasa, and I owe so much to the wonderful IMA staff. From the moment I arrived at the residence, I was greeted warmly and always treated kindly by program mentors. Their support and hospitality helped our cohort collaborate and form a strong community. From the chefs to housekeeping, everyone worked hard to make our three-week stay feel like home. This journey was truly transformative. Even after three years of rigorous university classes and guidance from great professors, I gained insights in Mombasa that went far beyond the classroom. I’ve wanted a career in healthcare since high school—partly influenced by my parents, who both work in the field, and partly by my desire to build a meaningful life by serving others. I set my sights on becoming a physician assistant (PA). To gain experience, I started volunteering at my local hospital a couple of years ago, mostly answering phone calls and tidying nursing stations. I became comfortable in a hospital setting but wanted a more immersive, hands-on learning environment. I chose Kenya because I believed the shadowing opportunities would be intensive and eye-opening—and they were. What I didn’t expect was how deeply I would connect with the local community. From my first day, I was struck by the warmth, kindness, and generosity of both patients and providers. Week 1: Accident & Emergency The emergency department forced me to adjust quickly to a fast-paced environment. Without a formal orientation to the local systems on day one, I learned by observing workflows and team communication. The variety of cases was extraordinary; each shift brought a completely different set of presentations, which expanded my understanding of conditions and corresponding treatment plans. One notable case involved an open femur fracture from a tuk-tuk accident—an injury that clearly required urgent surgical care. I observed the team stabilize the patient, and I also saw how resource constraints and staffing pressures can lead to delays. Having volunteered in a U.S. emergency department, I hadn’t seen patients with comparable injuries wait as long; witnessing this underscored the reality of working in high-volume public hospitals. Throughout the week, I asked nurses how I could help to support flow. They gave me simple but meaningful tasks: attaching monitors for new patients, taking vitals, and transporting trauma patients for X-rays. These responsibilities helped me develop my communication skills and learn how to comfort patients in stressful moments. One case that stays with me involved a toddler who appeared to have been abused. He arrived frightened and silent. I sat beside him, introduced myself, and offered a few high-fives until he managed a small smile. In that moment, I realized how much emotional support matters. Health care isn’t only about physical healing—it’s also about presence and humanity. I’ll carry that lesson into my PA career. Week 2: Pediatrics I spent most of the week in the outpatient unit with Dr. Nancy, observing her examine children with a wide range of conditions. She narrated her reasoning—from exam to diagnosis to treatment planning—which made each encounter a teaching moment. We saw several cases of hydrocephalus (excess cerebrospinal fluid in the brain), and I learned how limited access to neonatal care can increase risk. I also visited maternity during a night shift and became aware of how water and sanitation constraints can complicate sterile technique. These observations broadened my understanding of how resource limitations affect patient safety and outcomes. I also noticed cultural differences in patient-provider dynamics. Families in Mombasa were consistently trusting and collaborative with the care team and respectful with student observers. Compared to my experiences in the U.S., where families may more actively challenge recommendations, this highlighted the importance of cultural sensitivity. As a future PA, I want to adapt my communication style to each family’s needs while supporting shared decision-making. Week 3: Surgery Surgery was exhilarating and humbling. At my local hospital in California, I’m not permitted inside the operating theater; at CGTRH, I stood just feet from the field (while maintaining sterile boundaries), asking questions and learning from surgeons and nurses who welcomed teaching. Watching complex procedures up close revealed just how intricate and coordinated surgical care is. One case—an open-heart operation on a young boy—involved a large, highly skilled team. Even with constant movement in and out of the theater, the team’s focus never wavered. Seeing everyone operate as a single unit reinforced the importance of preparation, communication, and mutual trust. It’s a model I hope to emulate in my own practice. Beyond the Hospital While my clinical knowledge grew tremendously, the most profound impact was the people. Driving from the airport, I saw neighborhoods where families lived with limited resources—often without running water or reliable electricity. Yet the everyday joy I encountered, especially among children, was unforgettable. Each week, our cohort visited K–12 schools to teach basic hygiene. I have never been around more enthusiastic kids—dancing, singing, asking questions, and making us laugh. They reminded me that happiness doesn’t come from what you have, but from connection with others. The Kenyan emphasis on community and caring for one another offered a perspective I’ll carry with me. Looking Ahead My three weeks with International Medical Aid changed my life. I came to Kenya to gain clinical exposure, and I left with so much more: stronger patient-care skills, a deeper understanding of global health disparities, and a clearer sense of the kind of clinician I want to be. As I prepare for PA school, I’ll keep prioritizing kindness, cultural awareness, teamwork, and communication. This journey is one I won’t forget—and it has solidified my commitment to provide excellent care while building relationships rooted in empathy and respect.

From the moment I arrived at the airport to the moment I departed, I felt thoroughly supported and guided by the IMA staff. Their attentiveness made me feel safe and ensured a smooth transition throughout my stay. The accommodations exceeded my expectations—exceptional hospitality that made my time comfortable and enjoyable. I have no complaints about the housing. The kitchen staff and the food were outstanding; the chefs prepared delicious meals, greeted us warmly, and accommodated dietary needs. My experience at the hospital was equally positive. The nurses in OB/GYN were incredibly friendly and welcoming to interns. They were open to teaching and involving us in procedures, and I left each day with new knowledge and skills. One highlight was the community outreach initiatives. Whether participating in women’s health and hygiene clinics or mental health education sessions, I felt privileged to contribute to community well-being. The free medical clinic was particularly impactful. As a first-generation college student, I have often felt unsure about which career path to pursue. During a meeting with my advisor, I discovered the physician assistant role and was immediately captivated. When I told my parents, they laughed—reminding me of my fear of needles and anything to do with blood. Despite that, I was determined to explore the field. With no prior healthcare experience, I knew I needed firsthand exposure. I spent hours researching internships that explored different specialties in a hospital setting. When I received my acceptance to International Medical Aid in Kenya, I couldn’t contain my excitement. I had also heard warnings about challenging conditions, crime, and health risks, and as the departure date approached, I felt a mix of nerves and anticipation. The temptation to cancel crossed my mind, but I was committed to facing my fears. Those three weeks turned out to be an eye-opening journey beyond anything I had imagined. On my first day at Coast General Teaching and Referral Hospital, I was assigned to the accident and emergency department with Dr. Anton, who greeted us with genuine warmth and enthusiasm and gave a comprehensive tour. I noticed differences from what I’d seen in the U.S.—from attire to documentation systems and room layouts that offered limited privacy. I also saw the structured ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) used to triage critically ill or injured patients, which underscored how clinical officers prioritize care. While initial assessments were quick, there were often delays before tests or imaging—something I’ve also observed in U.S. emergency departments. Several cases stood out. One involved a young man injured after a mob incident; another, a patient attacked with a machete who required suturing. As days went by, patterns of trauma were common, which prompted me to learn more about local safety dynamics. Clinical officers—who complete several years of training and gain seniority through experience—performed much of the frontline care. Observing this system deepened my appreciation for the range of professionals who keep high-volume public hospitals running. In the pediatric emergency department, I assisted with gentle immobilization for IV placement, sometimes via jugular or scalp veins when needed. I observed variations in technique and equipment usage, which reinforced for me the importance of adhering to evidence-based protocols to minimize infection risk and ensure patient safety. As a future physician assistant, I’m committed to following best practices to provide safe, compassionate care. During my surgery rotation, I worried about fainting at the sight of blood. I walked into the middle of a knee replacement and, despite initial nerves, became absorbed in the teamwork and precision. Later, I observed a hysterectomy and a salpingectomy. Seeing how surgery could restore mobility and health was inspiring and sparked a deeper interest in operative care. In my second week in OB/GYN, I explored the labor ward, High Dependency Unit (HDU), gynecology ward, antenatal ward, postnatal ward, and the theater. On day one, I joined the oncology team. Many patients had advanced cervical cancer in a setting where HPV vaccination was introduced relatively recently. Treatment planning often occurred alongside other health challenges such as acute kidney injury and anemia. One case that stayed with me was a 12-year-old with a newly diagnosed malignancy who underwent surgery. Despite her age and diagnosis, she showed remarkable strength, even comforting her mother. The experience deepened my understanding of the complexities families face and strengthened my commitment to women’s health in resource-limited settings. I spent time in the labor ward and witnessed both a vaginal birth and a C-section for the first time—an almost surreal experience. The ward is divided into first- and second-stage areas; women are placed based on their presentation at admission. Space constraints limited family presence, and immediate newborn assessments sometimes left little room for early skin-to-skin contact. Learning more about the benefits of skin-to-skin reinforced for me how small changes in practice can have meaningful impact for mothers and babies. In the HDU, I joined nurses on rounds and witnessed their gentle, compassionate care. They shared detailed patient histories and kept me updated on ongoing treatments, creating a supportive, non-toxic learning environment. When a new patient arrived, the team quickly focused on her comfort. Another patient developed severe bleeding; I helped by handing gauze while the team stabilized her. A third patient with eclampsia deteriorated and entered a coma. The nurses continued talking to her and offering reassurance, acting as surrogate family when loved ones couldn’t be present. I brought adult diapers as a small contribution—it reminded me of my grandmother’s struggle with an incurable illness and the importance of simple comforts. As my time wound down, I visited the gynecology unit, where I encountered a range of conditions—ectopic pregnancies, incomplete miscarriages, pelvic inflammatory disease, molar pregnancy, and gynecologic cancers. Throughout this rotation, Dr. Rehma was an invaluable mentor. She broke down complex concepts—from disease mechanisms to treatment protocols—and invited me to intern meetings on labor progress. I learned to graph labor curves and present cases, which fueled my passion for OB/GYN and showed the power of great mentorship. This program shaped my future profoundly. Beyond hospital learning, the people I met made a lasting impact. As a first-generation student, I found peers who also hoped to become physician assistants and generously shared practical advice on preparing strong applications—from clinical volunteering to relevant coursework. I returned home determined to gain more experience, pursue additional learning, and build toward PA school with an OB/GYN focus. With each step, I feel more equipped and more passionate about my goals. Overall, I am deeply grateful for the opportunity to be part of this program. It enhanced my professional skills and allowed me to contribute meaningfully to the community. The support, safety, accommodations, and enriching clinical experiences have left a lasting impression and clarified the kind of clinician I aspire to be.

My experience in Kenya was better than I could have ever imagined. I truly think it was the best experience I have ever had. From the day I arrived, the IMA staff was always friendly and immediately made me feel at home. The residence was always well kept, with staff cleaning our rooms. Additionally, the food was amazing, and the kitchen staff always welcomed our meal requests and would get them to us right away. Our program mentors were amazing and would always happily talk to us. They gave excellent advice and were always willing to help. The program staff was the main reason that my experience was so amazing. We also received a lot of knowledge about the culture of Kenya from them, which helped me to understand the situations of patients I saw at the hospital. I learned so much about different types of health conditions, especially from Dr. Ken in pediatrics, who would give mini-lectures to us between patients so that we gained the most amount of knowledge that we could. Along with shadowing at the hospital, all the community outreach clinics taught me so much about the community in Kenya. The clinics were my favourite part of the internship, as the kids were always so happy to see us, and I felt like I was making a difference to them. Overall, my experience was amazing, and I felt it went so quickly. I never once had any worry about feeling unsafe or alone, as I was surrounded by amazing staff. I will definitely be coming back. Five years ago, I would have never imagined that I would be spending 3 weeks interning as a pre-physician assistant student at the second-largest public hospital in Kenya. From a very young age, the idea of attending medical school was implanted into my head by grandparents, teachers, and even friends’ parents. However, healthcare workers were plenty in my family, and I did not want to do what everybody else wanted of me. It was not until the end of my high school career during the COVID-19 pandemic that I found a real love for the medical field. Throughout the past 3 years of university, I started working towards the goal of attending medical school and working in the healthcare field, yet I was still confused about whether becoming a physician was my calling or whether there was another healthcare profession that I would be interested in. When I learned about physician assistants, it seemed to be a perfect match for what I wanted, yet it also added to my confusion about what healthcare career I should pursue. Coming to Kenya, I had plenty of questions and was unsure of where I stood in my career but came with an open mind. Before my internship in Kenya, the only clinical experience I had was volunteering at the Grace Hospital emergency department in Manitoba, Canada. I had expected that the Kenyan hospital would look much different from the Canadian hospitals and would be severely under-resourced. Additionally, being born in a third-world country myself and having visited back home to Sri Lanka on multiple occasions, I have seen what an underfunded public hospital can look like and thought I had a decent idea of what the Coast General Hospital would look like. However, from the first orientation day in the hospital, I realized how much I truly had to learn about the state of healthcare in Kenya. Much like I imagined, there were outdoor portions of the hospital and cracks were present in the walls and ceilings; what I had not thought about previously was the lack of sanitation at the hospital. I was shocked to see doctors treating patients without gloves and sometimes without masks as well. Blood spills in the emergency department were wiped with a dirty, wet mop that was then used to wipe another spill in a different room. The only time I saw a counter being wiped was in the pediatrics department, but I was saddened to see that there were no actual cleaning products used, and it was only hand sanitizer being wiped down. In Canada, I would have never thought of cleaning products as a privilege, but from that first day, I realized just how much I have taken for granted. My first week was spent in the pediatrics department, where I switched between the outpatient clinic and the in-patient ward. There were two medical students at the in-patient ward who explained to me what the morning would look like, which included changing patient bed sheets, taking vitals of all patients, and then doing rounds with the doctor once she arrived. Right away, I noticed how involved mothers were in the care of their children in the ward. In Canada, it is normal for the nurses and healthcare aides to change bed sheets and clean the baby, yet in this ward it was the mothers changing the bed sheets and getting the baby ready for when the doctor came around. The sense of community between the mothers in the ward was evident, as everyone was helping each other. Even though many things from Western healthcare may be an improvement compared to the healthcare found in Kenya, I think having the mother involved more in their babies’ care is something that Western healthcare should adopt as well. The mothers all seemed so happy to aid in their babies’ care, which is not something you see in Canada, as nurses and healthcare aides do most of the caring. Furthermore, during rounds, I was able to learn about rickets disease and feel a baby’s abdomen for a common swelling symptom of rickets. The doctor explained that vitamin D deficiency is very common in babies who take formula because the formula in Kenya lacks vitamin D, leading to plenty of deficient children. Additionally, a natural source of vitamin D is sunlight; however, it is “imperative for mothers to seek employment very early in the postnatal period [meaning] that infants are often looked after in indoor informal daycare facilities” (Jones, 2017). As much as I would like to think that if we get formula with vitamin D into Kenya the cases of deficiency would decrease, I could see that the problem was much bigger, and therefore the solution would also take years of change. This first case of rickets opened my mind a lot, as I would have never thought that something as simple as access to enough sunlight would be an issue for these children; but with families facing poverty and mothers having to work right away, most of the children are not raised the way we are in North America. Finally, in the outpatient clinic, I learned a lot from Dr. Ken. With every patient that came in, he explained all the symptoms and possible treatments for the child. Between patients, he would also take the extra time to teach us about pneumonia, tuberculosis, and different blood disorders. I will forever be grateful for all the knowledge I received from Dr. Ken and will make sure to keep the notes with me for when I continue into physician assistant school. The biggest lesson that I learned from Coast General that I will be keeping with me throughout my career is how important patient bedside manner is. I was heartbroken to see how some of the nurses and doctors treated the patients. One case in particular that struck me was a boy in his 20s who came in after an accident in a tuk-tuk that resulted in him rolling on the pavement and having multiple large wounds all over his body, as well as a shattered wrist and broken ribs. When taking him for an X-ray, the medical students were pulling his body left and right to get him into position and trying to force the board under him while berating him for screaming in pain. The sounds of his screams were very difficult for me and the other intern to hear and are something I still remember. I could see how much pain he was in when he arrived, and to see him treated so rough at a place that should be caring for him was very difficult to watch and understand. I saw situations similar to this multiple times during my internship where just a little bit of compassion may have helped these patients tremendously. At the labour ward, I saw doctors telling the mothers to stop screaming during labour and saw them get annoyed when mothers tried to hold their hands. I could see that most of the healthcare workers at Coast General were very overworked and exhausted with the conditions they had to work in, causing them to show less compassion. In addition to a lack of resources, the hospital was severely understaffed, with an average of 21 doctors and 100 nurses per 100,000 people compared with the WHO-recommended minimum staffing levels of 36 doctors and 356 nurses per 100,000 people (IMA, 2024). This was especially evident to me in the newborn unit, where I spent one night shift. There was one premature baby whose oxygen saturation level had dropped to 40% because his oxygen tube was not in his nose properly; however, even though the monitor was beeping, no nurses were rushing to fix this. I notified the nurse, who then came to fix it, but when I came back half an hour later, I could see the oxygen saturation at a dangerously low level once again. This time, when I notified the nurses, they did not come to fix it, and I had to tell three nurses before one finally came to help the baby. Even then, this nurse showed no sense of urgency and came only after a few minutes. This was extremely frustrating for me, as all I could do was notify them, but I could not force them to have more urgency. I realized quickly that in the newborn unit, some nurses had the mindset that the premature babies would probably die anyway, which may be the reason for their lack of urgency, as at least 5 babies passed away there every day. An article from the UCLA School of Medicine says that “how physicians, [and] nurses… approach patients and their families can directly affect the overall experience for patients and their willingness to learn… good bedside manner ultimately improves communications and reduces errors” (Geffen, 2016). If there were more staff present, I am sure bedside manner would be much better and would no doubt lead to a decrease in patients’ distress and hopefully even a decrease in this mortality rate. Apart from all I learned at Coast General, I learned a lot from the culture and people of Kenya. I was amazed at how welcoming everyone was and was especially touched by how happy the kids were at the schools we visited. I have truly never felt as happy as I was when I walked into a classroom and had all the young kids come up to hug me and touch my hair, and it only confirmed for me how much I want to work with children during my career. One school we visited for a mental health clinic especially touched me because I got an insight into how hard their lives must be. The classroom was filled with teenagers, and when we asked them to write down their feelings and any questions on paper, I received multiple comments talking about friends who had committed suicide. Within that classroom of about 30 to 40 students, there were six stories of friends who had committed suicide because of physical and/or sexual abuse from family members. It was heartbreaking to hear these stories but was also heartwarming to see how much joy these teenagers portrayed throughout all their struggles. After we had a good conversation on journaling and how to express our feelings, we had a small dance party outside on the field, and it was truly amazing to see how much fun they were all having. They were so welcoming to us and even brought me into the dance circle with them. I will never forget that moment, as they brought me so much joy, and I only hope that we brought them as much joy as well. Every day that I experienced more of the culture, I became more aware that I was extremely lucky to be there. I went to Kenya with an open mind, ready for new experiences and to learn as much as I could. I got so much more out of this internship than I could have ever imagined. My boyfriend has always said he has wanted to come to Africa to live in a village and help the people as much as he can, and this trip led me to start planning this trip for our future, as I honestly fell in love with the culture and people. I also believe that my experience at Coast General helped me to fall in love with medicine just as I had at the beginning of my university career. I no longer have any doubts about what I want to pursue as my career and have decided to apply to a physician assistant program. None of these plans and excitements for myself were present before my experience in Kenya. I will forever be grateful for my life-changing experience and promise to come back to Coast General once I have started my career to help as much as I can.