Physician Assistant/Pre-PA Internships Abroad | IMA

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.

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.