Global Health & Pre-Medicine Internships Abroad | IMA

This program allowed me to grow as an ethical leader in my community, a leader who leads by example. My experiences at Coast General will forever shape my perspective on health care and scarce resources in healthcare settings. While in Kenya, I received constant support from the IMA staff. One specific example that stands out to me was when I was left in the lab by one of the CCC doctors. I called Hilda for support, and even though she was not working that day, she immediately sent Dr. Shaziim to support me. In the residences, the mentors would always be looking out for me, making sure I was healthy and happy as I completed the program. One specific moment in Internal Medicine that stood out to me was when I did rounds in the women's ward with Dr. Shaziim and the gastroenterologist. Dr. Shaziim incorporated my previous knowledge of HIV from the CCC into explanations to help me learn and build upon my knowledge. Thanks to their efforts to involve me in their diagnosis process, I now want to pursue gastroenterology.

This internship was an amazing once-in-a-lifetime experience that I am very grateful for. I have met so many wonderful people, including all of the program staff, interns, and hospital staff. Safety was a major concern for my family and me before my internship, but the program mentors and staff were very informative and cautious, so I felt very safe throughout my stay. The accommodations and food were also beyond what I expected. I have learned so much not only clinically, but culturally as well, and I would love to go back once more in the future. My internship this past winter with International Medical Aid in Mombasa, Kenya has opened my eyes to different perspectives and has given me a glimpse of what life is like in a place that is more than 10,000 miles away from my home. I have learned so much in not only medicine but in culture as well. Through the cultural treks and language classes provided by this program, I was able to learn about the history of the Swahili people, how the Kiswahili language came about, along with the traditions and practices of the culture of the people of Kenya. This opportunity has allowed me to gain meaningful experiences and relationships that I will forever cherish. I spent my internship at Coast General Teaching & Referral Hospital, where I had the opportunity to shadow both medical and clinical officers who play a large role in healthcare in three major departments: Emergency Medicine, Pediatrics, and General Surgery. Alongside these healthcare providers were nurses who play a critical role in patient-centered care and whom I came to befriend. Every day of my three weeks of this internship contained precious moments and learning points that have only furthered my passion for the medical field. Even through a slight language barrier, sincerity shines through, which is something that I will always carry into my practice as a future healthcare provider in the United States. If there is anything that has had a profound impact on my view of life, it is the realization that there is a limit to what I am able to control. From my experiences so far, whether in a medical setting or daily life, there is only so much I am capable of doing for people. This realization crossed my mind countless times as I thought about ways in which I could do more because in my current position, I have no say or control in a life-or-death situation, regardless of how dear someone may be to me. Especially as an intern and student, I was limited to speaking words of encouragement as I watched patients suffer, or simply waiting and hoping for good news. The desire to be able to do more than that has sparked my passion to pursue a career as a medical professional. The healthcare system I experienced in Kenya is notably different from the United States in terms of access to care, disease burden, and health coverage for patients. From the medical officers, clinical officers, nurses, and patients that I spoke to, I found that many patients do not seek care due to long distances and lack of transportation. Although hospitals are scattered throughout the country, they may not be evenly distributed throughout each region or neighborhood. Furthermore, some patients live closer to private hospitals but cannot afford them because they charge much more than public hospitals, which many patients are also unable to afford. This relates to Kenya’s poverty rates, with about one-third of the population living below the national poverty line in 2019 (World Bank, 2023). Additionally, the disease burden in Kenya is very high, with human immunodeficiency virus (HIV), which can develop into acquired immunodeficiency syndrome (AIDS), being one of the major communicable diseases. As for non-communicable diseases, major ones include cardiovascular disease (CVD) and metabolic diseases such as chronic kidney disease, diabetes, and hypertension, all of which contribute to the high disease burden in Kenya. The need for non-communicable disease services to be expanded has been recognized, with guidelines supporting these provisions in patients with HIV, but coverage still remains low (Smit et al., 2019). Additionally, during the Global Health Lecture Series presented by Dr. Shazim during our internship, we learned that the high burden of HIV and AIDS in Kenya accounts for about 29% of annual adult mortality, 20% maternal mortality, and 15% mortality in children under the age of five, which are much higher than mortality rates in the United States. Similarly, non-communicable diseases contribute to more than 50% of inpatient admissions and 40% of hospital mortality, which is also linked to a financial burden for these patients that is further connected to nationwide poverty. With a high disease burden in Kenya also comes a high financial burden, with a major issue being health coverage. Informal sector workers, a population that drives a significant portion of employment in Kenya, have a low rate of national healthcare insurance (NHI) enrollment. This may be due to existing socioeconomic inequalities and barriers they face, including limited access and having to pay NHI premiums out-of-pocket (Wamalwa et al., 2025). This contributes to increased morbidity and mortality due to inequitable access to care, as high out-of-pocket costs prevent patients in this population from seeking care. Studies suggest strategies such as using a tax-based system or expanding subsidies to support NHI enrollment among populations like this, though more research may be needed. Diving deeper into the healthcare system in Kenya showed me the existing gaps that prevent patients from receiving the care they need and ultimately contribute to mortality. My first thought when I learned about the healthcare system in Kenya was that these gaps seemed almost impossible to close. However, it made me think about how these gaps could be reduced, even slightly—whether by addressing health disparities through a health equity lens, focusing on advocacy, or working as a healthcare provider in a hospital setting. This led me to ask further questions, which eventually instilled in me a desire to contribute to making a difference. Although my role as an intern may have seemed insignificant in terms of what I was able to practice, I built many meaningful relationships with various people there and I would like to believe that I made a difference in at least one person’s life. Even though I cannot change the world, brightening one person’s day may feel to them as if something meaningful has changed. This could be the drop that turns into a ripple and has a lasting effect. If one drop can turn into a ripple, I can only imagine what numerous drops can do. I believe International Medical Aid is a wonderful example of how gaps in Kenya’s healthcare system can begin to close. Each intern interacts with numerous patients and healthcare providers and brings back a piece of their journey home to share their stories. Each intern may have also offered words of consolation, encouragement, and hope to the patients they encountered, giving them strength during what may have been the lowest points of their lives. I learned that the smallest acts can accumulate and become something deeply meaningful that touches people’s lives. Each person’s life holds immense value, and I want to be part of something that gives people the opportunity to value their own lives—whether by providing treatment options or simply being there to reassure and brighten their days. I want to be someone who brings joy into people’s lives, a shoulder to cry on when they are hurt, and a source of peace for those in their final moments of life, because that is what I would want if I were in such a position. I want to bring good news to families of patients who have recovered, console them when unexpected things occur, reassure them when they express concerns, and be someone not only patients can trust and rely on, but someone their families can rely on as well. My perspective on life has changed, and for that I am eternally grateful.

My experience with International Medical Aid in Kenya was truly exceptional and profoundly impactful, both personally and professionally. From the moment I arrived, it was clear that the program was thoughtfully designed with intern safety, learning, and well-being at its core. The structure and support provided allowed me to fully immerse myself in the experience while feeling consistently supported and valued. The in-country support team was outstanding. Orientation sessions were thorough and reassuring, covering safety, cultural expectations, and hospital dynamics in a way that made the transition into a new healthcare system feel manageable and exciting rather than overwhelming. Throughout the program, staff members were consistently available, responsive, and genuinely invested in our experience. Whether addressing logistical questions, health concerns, or simply checking in on how we were adjusting, their presence made a meaningful difference and created a strong sense of trust and community. Safety was clearly prioritized at every level. Transportation to and from clinical sites was reliable and well coordinated, housing was secure and comfortable, and clear guidance was provided on navigating the local environment responsibly. This allowed me to focus fully on learning and engagement rather than worry. Accommodations were welcoming and well maintained, offering a restorative space after long hospital days, and the food provided was both nourishing and culturally enriching, giving us the opportunity to experience local cuisine while meeting dietary needs. Clinically, the experience was transformative. Exposure to high-acuity cases and diverse patient populations in a resource-limited setting deepened my understanding of medicine, adaptability, and health equity. Despite demanding clinical environments, clinicians and mentors made time for teaching, discussion, and reflection. Case debriefs and guided conversations helped contextualize what we observed and strengthened my clinical reasoning. I gained invaluable insight into patient-centered care, interdisciplinary teamwork, and ethical decision-making in global health contexts. Importantly, the program emphasized respectful engagement with the community. Interns were encouraged to learn with humility, prioritize patient dignity, and understand the broader systemic challenges facing the healthcare system. The presence of the program supported busy clinical teams while fostering meaningful cross-cultural exchange. Overall, this internship reinforced my commitment to medicine and global health. It strengthened my cultural competence, resilience, and sense of purpose, and it was made exceptional by the dedication, compassion, and professionalism of the International Medical Aid staff and local clinicians. This experience will continue to shape my approach to healthcare, service, and learning moving forward. When I arrived in Mombasa, Kenya, to begin my clinical internship with International Medical Aid (IMA), I expected to gain experience in medicine, but I did not expect to feel so immediately immersed. On my first morning at Coast General Teaching and Referral Hospital, voices in the corridor found me before I found the ward: “Daktari, daktari!” The word—Swahili for “doctor”—warmed and unsettled me in equal measure. I wasn’t wearing a white coat, only IMA-branded scrubs, and I was not yet a doctor. But in that moment, the title wasn’t about qualifications; it was about need. “Daktari” carried a weight of expectation that followed me through every ward, every patient encounter, and every conversation. I rotated through the intensive care unit (ICU), emergency department, cardiology, and surgery, with overnight shifts in maternity when the ward was stretched thin. Over weeks, the hospital’s sounds and textures became my syllabus: the oxygen concentrator’s steady sigh, the antiseptic mingled with ocean air, the clink of enamel mugs as tired clinicians shared tea. I learned to say habari (how are you?), asante sana (thank you very much), pole and pole sana (I’m sorry/so sorry), tafadhali (please), samahani (excuse me), ndiyo (yes), hapana (no), kidogo (a little), and polepole (slowly). People smiled at my first crooked attempts and coached me kindly—“Sawa, daktari, polepole.” It mattered to them that I tried. It mattered to me that they let me. A question became inseparable from my days in the hospital: What have I learned—and how will I use it? My answer lives in stories: of scarce resources and stubborn hope, of ethical lines that felt like cliffs, of laughter shared over tea and cake during a ten-minute truce in an endless day, of a husband in a plastic chair at 3 a.m. asking me if everything would be okay and knowing I could not promise it would. These experiences clarified not only the kind of physician I want to be—clinically excellent and radical in empathy—but also the kind of advocate I must become for equity in global health (Afulani et al., 2021; Kinuthia et al., 2022; WHO, 2023). Being called daktari by patients was an honor, but it was also one of the most sobering experiences of my internship. In Canada, I am “Nia, the student.” In Mombasa, I was “Doctor,” simply because I wore a pair of scrubs and stood beside physicians. Patients would look at me expectantly, asking questions, sometimes holding out prescriptions for me to explain. Their trust was profound, but it also reminded me of the immense responsibility medicine carries. The most challenging moments came when Kenyan doctors asked me to do things far beyond my training. In the emergency department, a physician once handed me a syringe and said: “You give the injection — I will show you this one, and you will do the next patient.” I froze. I had never given an injection in my life. I explained that I wasn’t trained, and he smiled, a little surprised, but then proceeded to demonstrate. When he turned back to me, I shook my head. I had to refuse. He looked puzzled at first, but eventually nodded and moved on. That moment taught me two things. First, the scarcity of staff often pushes students into roles they are not prepared for, out of necessity rather than negligence. Second, I realized the importance of knowing my limits. Patient safety must always come before pride or the desire to fit in. The moment branded a lesson I will carry for a lifetime: in settings where task sharing is a pragmatic response to workforce shortages, clarity about scope and competence is an ethical anchor (Kinuthia et al., 2022; Okoroafor et al., 2023). Even without doing procedures, there was plenty I could do. I learned to read the room quickly, to fetch, translate, listen, soothe, count breaths, find a blood pressure cuff that almost fit, and—most of all—to communicate honestly. Briefly as I remember it, a senior physician offered an unforgettable lesson on empathy versus sympathy: “Sympathy stands beside the cliff and waves,” he said. “Empathy climbs down, sits on the ledge, and helps someone look up.” The next day he put me to the test: a family’s matriarch was failing, and we knew she was unlikely to survive the night. He asked me to speak with them first. I used the SPIKES framework—Setting, Perception, Invitation, Knowledge, Emotions, Strategy—pulling chairs into a circle, asking what they understood, inviting permission to share more, delivering information in short sentences, then letting silence do the rest before outlining next steps (Baile et al., 2000; Buckman, 2005). I did not tell them it would be okay. I told them we would not let her suffer and that we would stay. They wept; I listened. When we stood, the physician squeezed my shoulder and said, “Asante, daktari.” It was especially then that I realized how deeply I want to be a doctor who does not only prescribe but also accompanies (Jeffrey, 2016; Byrne et al., 2024). The ICU taught me the arithmetic of scarcity. Beds were almost always full; positions, too. Kenya has grown critical care capacity since 2020, but the distribution remains uneven, and functionality is a persistent challenge—by one national survey, more than a quarter of ICU beds were nonfunctional on the day of assessment (Barasa et al., 2020; Mwangi et al., 2023). On rounds I juggled vitals and vocabulary: pumua polepole—breathe slowly—repeated to a hypoxic patient as we watched an oxygen cylinder’s needle drift toward red. Families seldom entered the ICU; most waited outside or at home, a difference from many North American units where bedside family presence is standard. This wasn’t indifference; it was infrastructure and policy. And still, even behind glass, love found a way—caregivers pressing palms to doors, whispering their person’s name, and trusting us to be their hands for now. One night, we faced a quiet ethical storm. Four patients needed dialysis by dawn: an elderly man with septic AKI, a young teacher with rapidly rising potassium, a diabetic woman in pulmonary edema, and a middle-aged patient with chronic kidney disease who looked relatively stable. We had one machine available. By clinical urgency, the choice seemed clear. Yet the machine went to the one with the lowest immediate risk. A doctor muttered why: “She’s connected… a politician’s prostitute.” I felt my stomach turn. I had been reading about how procurement, politics, and favoritism can distort resource allocation in Kenyan health systems; now the literature had a face (EACC, 2023; Musiega et al., 2023; Munywoki et al., 2023). We stabilized who we could, improvised where we must, and documented everything. That night hardened my resolve to fight corruption and inequity as fiercely as I fight disease. It also pushed me deeper toward policy: devolution has created possibility and variation across Kenya’s 47 counties, but budget execution, cash flow, and procurement bottlenecks still undercut efficiency (Barasa et al., 2021; Musiega et al., 2023). Scarcity is not an abstraction in nephrology. In Kenya, chronic kidney disease affects millions, dialysis is expanding but remains unreachable for many, and transplant capacity meets only a fraction of need (Maritim, 2022; Japiong et al., 2023; Hathaway et al., 2023; Sawhney et al., 2024). That night, the human cost of those percentages sat at the edge of one bed, wrapped in a paper gown, waiting her turn that didn’t come. I want to be the kind of physician who refuses to accept a world where political proximity sets triage. I also want to be the kind of advocate who helps build systems where such choices never arise. The emergency department compressed hours into heartbeats. One evening a boy arrived listless, skin tented over his knuckles, his mother murmuring tafadhali as we lifted him. The chart said suspected cholera. I had read WHO updates about multi-country cholera surges and Kenya’s intermittent outbreaks; suddenly the textbook was on the gurney (WHO, 2024a; WHO, 2024b). We warmed fluids between our palms, counted capillary refill, measured stool in a basin the color of the sea—only thinner, crueler. When he finally sat up and sipped, his mother clasped my hands and said, “Asante sana.” I shook my head: hapana, pamoja—no, together. It was true. The nurse who found an elusive vein, the clinical officer who triaged quickly, the cleaner who changed the soiled sheets in seconds—medicine is choreography, and everyone had a step. In that same department, the cleavage between can and should appeared again in small ways. Could I interpret an ECG? Yes. Should I be the one to adjust a drip? No. Kenya’s Emergency Medical Care Policy and Strategy envision a coherent, universal emergency system; the WHO Basic Emergency Care curriculum is training first-contact providers to act fast and act right (Republic of Kenya, 2020; Lee et al., 2022; WHO, 2024c; Michaeli et al., 2023). I saw the promise—and the gap between policy and practice when volume surged. Strengthening emergency care is not a luxury; it is a multiplier for survival in trauma, sepsis, obstetrics, and cardiac crises. Cardiology days stitched physiology to story. I will never forget a gentle woman in her forties with poorly controlled hypertension and shortness of breath. She had missed clinic visits—money for transport had gone to school fees. Her ECG muttered strain, her ankles told the rest. I sat beside her and tried my Swahili: Tutapanga pamoja—we’ll plan together. The doctor drew a medicine grid with the colors of her cooking spices: red pill with lunch (chapati day), small white at bedtime (lala salama, sleep well). She laughed, promised to try, and pressed a warm orange into my hand from her bag when we were done. Across Kenya and globally, noncommunicable diseases are rising fast while specialist numbers remain thin; in settings like this, patient education is not a bonus but a therapy (World Heart Federation, 2023; Smit et al., 2020; Oguta et al., 2024). Another morning, I helped a young man with suspected rheumatic heart disease understand why stairs stole his breath. With the team’s okay, I only echoed what the physicians had already explained—nothing more—turning their guidance into quick sketches of valves in my IMA notebook while his friend filmed on a cracked phone. We spoke, strictly within those instructions, about prophylaxis and when to seek help if the chest began to thud like a drum; I made clear I wasn’t adding my own opinions, just passing along accurate information from his clinicians. He shook my hand with both of his and whispered, “Asante sana.” Teaching—faithful to the team’s advice—is a clinical intervention; in low-resource settings, it is sometimes the only one you can leave behind. Surgical days carried a ritual clarity—checklists, cleansing, exactness. After shadowing several operations and taking pages of notes, I followed the team to a break room with practically destroyed leather couches. Someone produced a dented tin and a flask. “You must try our tea and cake,” the doctor insisted, breaking the slice into generous pieces though everything was rationed—time, sutures, sanity. We joked about my Swahili and the way I said ndiyo like a question. We also spoke plainly about weight. One surgeon rubbed his eyes and said, “Sometimes I just want to get out of this place.” He didn’t mean Kenya; he meant the machinery of exhaustion: blocked procurement, too few hands, too many late-stage presentations. He was not cruel, only human. Studies from Kenya echo what I saw—burnout is real among providers, especially in high-acuity, under-resourced settings (Afulani et al., 2021; Lusambili et al., 2022). I could not blame him; I could only admire the way he scrubbed again ten minutes later and went back in. Those same surgeons modeled another kind of abundance. They let me stand a little closer, ask one more question, listen a little longer to a patient’s fear before anesthesia. When I thanked them, they shrugged. “We were also students,” they said. Then they handed me another piece of cake. It tasted like saffron and solidarity. On a night shift that still wakes me, a man found me outside the maternity ward. “Daktari, where is my wife?” His hands trembled. I had observed the birth and learned quickly: his wife had delivered a stillborn baby and was now hemorrhaging. She had lost roughly two litres. The team had rushed her to theatre for uterotonics and transfusion. He asked if she would be okay. I wanted to say yes. I could not. I remembered the lesson: empathy sits on the edge of the cliff. I sat with him in plastic chairs for an hour that felt like a day, using the best therapeutic communication I had—short sentences, honest pauses, simple words, pole sana—and I did not make promises. He told me this wasn’t the first time they had tried, how badly he wanted to become a father, how brave his wife was. He held his head and sobbed. I handed him tissues and spoke to the theatre when I could. When the nurse finally waved us closer and said the bleeding was controlled, he broke again—this time with relief, not joy. We had saved a life; we had also witnessed a loss that would live in the room for a long time. Postpartum hemorrhage is the leading cause of maternal mortality in Kenya, responsible for a staggering share of preventable deaths (Clarke-Deelder et al., 2023; WHO, 2023; Miller et al., 2024). Policy and innovation—from calibrated drapes to E-MOTIVE care bundles—are making a dent, but systems strain at three a.m. (Forbes et al., 2023; WHO, 2023). That night honed my understanding of what “advocacy” must mean for me: not speeches, but the slow, procedural work of ensuring blood is in the fridge, oxytocin is not expired, and referral roads are passable. I learned to see difference not as deficit but as context. Kenya’s health system is decentralized; counties hold power over budgets and hiring, yielding both innovation and inequity (Barasa et al., 2021). Emergency care policy is advancing but remains a patchwork in implementation; critical care capacity has expanded yet is uneven and sometimes nonfunctional; task sharing is both policy and necessity (Republic of Kenya, 2020; Mwangi et al., 2023; Kinuthia et al., 2022). These structural variances mattered in daily decisions—who got a bed; which lab test we could run; whether a consultant could be reached. Politics walked the corridors, too. I saw the best of it—county investments that opened new ICU wings—and the worst of it—procurement shortcuts that warped triage, whispers of favoritism, and morale that bent under both (EACC, 2023; Musiega et al., 2023). Culture threaded everything: family structures, faith, the communal cadence of waiting rooms, the hospitality of tea that no one could afford and everyone insisted you take. I also learned that language is a clinical tool. Saying pole at the right time with the right tone mattered as much as any manual skill I had. People corrected me gently—hapana, not hapoana—and then used my effort as a bridge to trust. Competence before confidence. In resource-limited settings, the temptation to “just do it” is real. I learned to hold the line, graciously and firmly. My future self will keep that boundary for patients’ sake and my own (International Medical Aid, 2025; Kinuthia et al., 2022; Okoroafor et al., 2023). Communication is care. Breaking bad news with the SPIKES framework, listening more than I spoke, and choosing empathy over sympathy are not soft skills; they are lifesaving ones. I will keep training this muscle, because it determines how patients endure what medicine cannot yet cure (Baile et al., 2000; Jeffrey, 2016; Byrne et al., 2024). Systems shape outcomes. Clinical excellence cannot outrun broken procurement, underfunded emergency systems, or nonfunctional ICU beds. My internship turned my interest into commitment: I will pair practice with policy, advocating for anti-corruption safeguards, budget transparency, and county-by-county strengthening (Barasa et al., 2021; EACC, 2023; Musiega et al., 2023). Equity is a clinical competency. Dialysis for the connected instead of the sickest is not only unjust; it is deadly. I want to help build guardrails—triage protocols, ethics support, and public accountability—that make fairness the default, not the miracle (Munywoki et al., 2023; Japiong et al., 2023; Maritim, 2022). Joy sustains the work. Tea and cake in a cramped break room were not trivial; they were resistance. Laughter over my rookie Swahili reminded me that hope is a renewable resource. I will carry that with me—and reciprocate it—for my teams and my patients. These lessons have already recharted my academic path. I am minoring in Global Peace and Social Justice to deepen my understanding of health equity, ethics, and policy. I seek coursework in health systems, anti-corruption in public procurement, emergency care strengthening, and community-centered research. Clinically, I envision a life as a traveling physician-scholar who rotates through hospitals like Coast General, supports county health teams, mentors trainees, and returns regularly—not as a parachute, but as a partner (International Medical Aid, 2025; Kinuthia et al., 2022; WHO, 2024c; Siegel et al., 2024). On my last week, a nurse in surgery pressed my hand and said, “When you come back, will you be a real doctor?” I swallowed. Ndiyo. Nitarudi. Yes. I will come back. I want to be the physician who hears “daktari, daktari” in a crowded corridor and knows both the science and the story behind the plea; who can titrate a drip and also sit in the dark with a husband while the theatre doors stay closed; who insists on ethical triage even when the room grows quiet; who fights for emergency systems that answer in minutes, not hours; who teaches in simple metaphors and shaky Swahili until a patient laughs and understands; who accepts cake and offers it; who returns. One day I hope to wear that word without hesitation—daktari—and to bring it back to the very wards that taught me what it means. Until then, I will study hard, listen harder, and carry Kenya with me into every exam room. Asante sana. All patient stories are de-identified and composite to protect privacy. Details altered or composited for confidentiality include: the exact sequence of the four dialysis candidates; the names, ages, and non-essential demographics of patients in emergency, cardiology, and maternity; and the particular phrasing of clinicians’ quotes (the sentiments are faithful to actual conversations). Specifics about procurement favoritism were reported to me verbally during a night shift and are presented here as a firsthand account consistent with published reports on health-sector corruption in Kenya (EACC, 2023; Munywoki et al., 2023). The scenes of tea and cake with surgeons, the SPIKES conversation with a family, turning down an injection at the bedside, being called “daktari” while in IMA scrubs, learning and using basic Swahili with patient interactions, and sitting with a husband during his wife’s postpartum hemorrhage are drawn directly from my internship experience.

My experience with International Medical Aid in Kenya was transformative, not only because of the extensive clinical exposure but also due to the rich cultural immersion. From the moment I arrived, the program mentor ensured that I felt safe and welcomed. Accommodations were comfortable and secure, and cultural treks and team-bonding activities fostered a strong sense of community with fellow interns and mentors while deepening my appreciation of Kenyan culture. By engaging with patients in the hospital, participating in clinic outreach to underserved communities, and interacting with young students during educational sessions, I witnessed the generosity and compassion of the community despite the significant hardships they faced. Shadowing in the hospital was invaluable, as doctors guided me through clinical presentations, diagnoses, and treatments while linking them to underlying pathophysiology, allowing me to bridge my academic knowledge with the real-world challenges of healthcare delivery in Kenya. One of the most striking cases I witnessed involved a pregnant woman with severe mitral stenosis who required an emergency cesarean section—the first surgery ever performed inside the ICU at Coast General Teaching and Referral Hospital. Systemic challenges common in resource-limited settings, including non-functional equipment and a shortage of trained staff, had delayed intubation overnight, leaving the baby without a heartbeat and placing the mother at risk of hypoxic brain injury by the time I arrived. These limitations ultimately forced clinicians to perform the c-section within the ICU, a decision that highlighted both the difficult trade-offs in patient safety and the resilience and ingenuity of providers working under immense pressure. During community outreach to rural areas, I met a teenage boy with osteosarcoma who presented with a large knee mass he initially believed was from a soccer injury. The doctors explained that amputation was the only available option, as both the financial burden and the lack of chemotherapy resources and training made limb-salvage treatment impossible in Kenya. Watching his tears and the worried faces of his family was deeply difficult, yet it became a profound lesson in empathy and the realities of delivering care in resource-limited settings. I also had the opportunity to observe the neurosurgery camp, where neurosurgeons from Germany traveled to Kenya to perform procedures and follow up on patients from previous years. During outpatient clinics, a neurosurgeon explained that their work has two sides: the heartbreak when patients arrive too late for treatment, and the hope and fulfillment of witnessing patients improve from the condition they initially presented with. The gratitude of families who previously had no access to specialized care is what motivates them to continue returning. Their work highlighted the power of global collaboration in medicine and showed me how compassion and cultural humility truly transcend borders. Overall, the strong support I received from mentors, the meaningful clinical immersion, and the kindness of the local community made this program an experience I will carry with me into my medical career. It not only strengthened my commitment to global health but also underscored the importance of adaptability and empathy in delivering care across diverse cultural and resource settings. but show the full text Thought for 1m 8s My experience with International Medical Aid in Kenya was transformative, not only because of the extensive clinical exposure but also due to the rich cultural immersion. From the moment I arrived, the program mentor ensured that I felt safe and welcomed. Accommodations were comfortable and secure, and cultural treks and team-bonding activities fostered a strong sense of community with fellow interns and mentors while deepening my appreciation of Kenyan culture. By engaging with patients in the hospital, participating in clinic outreach to underserved communities, and interacting with young students during educational sessions, I witnessed the generosity and compassion of the community despite the significant hardships they faced. Shadowing in the hospital was invaluable, as doctors guided me through clinical presentations, diagnoses, and treatments while linking them to underlying pathophysiology, allowing me to bridge my academic knowledge with the real-world challenges of healthcare delivery in Kenya. One of the most striking cases I witnessed involved a pregnant woman with severe mitral stenosis who required an emergency cesarean section—the first surgery ever performed inside the ICU at Coast General Teaching and Referral Hospital. Systemic challenges common in resource-limited settings, including non-functional equipment and a shortage of trained staff, had delayed intubation overnight, leaving the baby without a heartbeat and placing the mother at risk of hypoxic brain injury by the time I arrived. These limitations ultimately forced clinicians to perform the c-section within the ICU, a decision that highlighted both the difficult trade-offs in patient safety and the resilience and ingenuity of providers working under immense pressure. During community outreach to rural areas, I met a teenage boy with osteosarcoma who presented with a large knee mass he initially believed was from a soccer injury. The doctors explained that amputation was the only available option, as both the financial burden and the lack of chemotherapy resources and training made limb-salvage treatment impossible in Kenya. Watching his tears and the worried faces of his family was deeply difficult, yet it became a profound lesson in empathy and the realities of delivering care in resource-limited settings. I also had the opportunity to observe the neurosurgery camp, where neurosurgeons from Germany traveled to Kenya to perform procedures and follow up on patients from previous years. During outpatient clinics, a neurosurgeon explained that their work has two sides: the heartbreak when patients arrive too late for treatment, and the hope and fulfillment of witnessing patients improve from the condition they initially presented with. The gratitude of families who previously had no access to specialized care is what motivates them to continue returning. Their work highlighted the power of global collaboration in medicine and showed me how compassion and cultural humility truly transcend borders. Overall, the strong support I received from mentors, the meaningful clinical immersion, and the kindness of the local community made this program an experience I will carry with me into my medical career. It not only strengthened my commitment to global health but also underscored the importance of adaptability and empathy in delivering care across diverse cultural and resource settings. To provide additional context for why this Pre-Medicine Internship meant so much to me, I want to share the personal experiences and reflections that shaped how I approached this opportunity and what I learned through it. From a young age, I became acutely aware of the challenges of living with illness. As a child, I struggled with severe atopic eczema, which affected me physically and also introduced me to the emotional weight of managing a chronic condition. At sixteen, I was diagnosed with keratoconus—a progressive eye condition where the cornea thins and changes shape, leading to blurred vision. The exact cause of keratoconus remains uncertain, with both genetic and environmental factors implicated; in my case, it was suspected that repetitive eye rubbing due to chronic eczema contributed to the disease. Undergoing treatment to halt its progression was a formative experience and one of the first moments that truly drew my curiosity toward medicine. I became deeply interested in how diseases can arise from different etiologies yet converge in their pathophysiology, and I wanted to understand the mechanisms behind those connections. During middle and high school, I dedicated much of my energy to lifesaving sport. The hours of training instilled discipline, initiative, and a readiness to step into leadership roles—especially when preparing for basic life support scenarios. These experiences taught me teamwork, responsibility, and the ability to stay calm in moments of urgency. Together, my medical history and my training offered a glimpse into what a career in healthcare might involve. Still, at that time, those influences felt more like inspiration than conviction; while they sparked my admiration for medicine, I had not yet fully envisioned myself carrying the immense responsibility of caring for patients in a clinical setting. That perspective changed profoundly through my Pre-Medicine internship experience with International Medical Aid (IMA) in East Africa—one of the most transformative opportunities of my life. Immersing myself in a healthcare system so different from the one I knew in Canada not only deepened my understanding of medicine, but also reshaped how I think about what it means to serve as a healthcare provider. I witnessed the resilience of patients facing significant barriers to care, the ingenuity of clinicians working resourcefully with limited supplies, and the strength of community that was woven into daily life. These experiences challenged me to think critically about global health disparities, the importance of cultural humility, and the role of empathy and gratitude in clinical practice. More importantly, they gave me a clear and undeniable sense of direction: I want to dedicate myself to medicine—not only to treat patients, but also to contribute to bridging systemic inequities in healthcare. I invite you to follow along with my journey as I reflect on the knowledge and perspective I gained through this internship, and how these lessons will guide my path toward a career in healthcare. During my first week, I rotated through the intensive care unit (ICU), a critical care environment dedicated to managing patients with acute, life-threatening organ dysfunction. In Canada, where I am from, the closed model of care—intensivist-led management—is the standard. At Coast General Teaching and Referral Hospital (CGTRH), however, I experienced a more open model. Although medical officers were designated in ICU, patient management was largely directed by surgeons and primary physicians in the absence of intensivists. In conversations with staff, I was struck to learn that only one nurse in the unit had specialized in critical care. Beyond human resource challenges, equipment limitations also played a major role. For example, the blood gas analyzer—essential for monitoring critical respiratory conditions—was non-functional, and these systemic constraints were not abstract; they had direct and visible consequences for patients. One case left a lasting impression on me because it had never happened in the hospital before. A 31-week pregnant woman with severe mitral stenosis, complicated by heart failure and pulmonary edema, was admitted to the medical ICU following cardiology consultation. On the night prior to my observation, her oxygen saturation had dropped below 65%, and fetal distress was documented. At that time, the medical ICU lacked access to non-invasive oxygen delivery devices, and the blood gas analyzer was non-functional. Despite multiple indications for airway intervention, limited equipment and a shortage of trained personnel led to intubation being deferred overnight. When I arrived the following morning, the unit was in a state of urgency, with ongoing debate about whether to transfer the patient to the operating theatre. Given her critical status, disconnecting her from mechanical support for transfer was not feasible. She had already endured prolonged hypoxemia overnight, raising grave concern for hypoxic brain injury. As a result, an emergency cesarean section was performed in the ICU—the first surgical operation in the hospital’s history to be conducted in that setting, without standard infection-control infrastructure. That morning, no heart rate was detected on fetal assessment. Neonatal resuscitation with CPR was attempted but unsuccessful. After delivery, the mother experienced a period of profound hypotension, with persistently low perfusion pressures despite intensive resuscitative measures, before eventually stabilizing and surviving. This case illustrated both the complexity of critical care in resource-limited settings and the devastating consequences of systemic constraints. Beyond observing these systemic challenges, I also gained direct exposure to critical care procedures, including placement of a central line. A patient presented with hepatic encephalopathy in the setting of hepatic, hypovolemic, and septic shock—likely secondary to chronic alcohol use and underlying liver cirrhosis. The patient suffered cardiac arrest but was successfully resuscitated with CPR. A central venous catheter (CVC) was then inserted to provide rapid access to a major central vein for administration of medications and fluids. Vasopressors such as adrenaline (epinephrine), dopamine, or norepinephrine were administered to restore adequate blood pressure and perfusion to vital organs by constricting blood vessels, as the patient remained in a state of shock. Inotropes were also considered when low cardiac output was present. The catheter was primed with heparinized saline to prevent clot formation. I learned that a triple lumen central line has three ports, and that the distal (blue) port provides the closest access to the right atrium—one reason it is used for vasoactive medication and central venous pressure monitoring. In this patient, the CVC was inserted via the subclavian vein for palliative care, as this site offers longer-term access due to thicker surrounding soft tissue and carries a lower infection risk compared to femoral and internal jugular sites. Aside from clinical learning, I also witnessed a case involving mob justice—where community members collectively punish a suspected offender outside the formal legal system. The patient I encountered in the ICU had sustained extensive burns as a result. Cases like this underscore deep societal distrust in law enforcement and the judiciary, often fueled by perceptions of corruption and impunity. Immersed in the intensity of the ICU, I came to appreciate that empathizing—rather than simply sympathizing—with patients’ families is crucial for effective care. Sympathy can cloud clinical judgment and decision-making, especially in sensitive discussions like signing a do-not-resuscitate (DNR) order or explaining a poor prognosis. I observed this challenge in cases ranging from a patient dying of a pulmonary embolism to a cerebral malaria patient in a coma for several days. These experiences showed me how empathy allows physicians to acknowledge emotions while maintaining clarity, objectivity, and professionalism. Similarly, during a community medical outreach clinic to underserved populations, I witnessed the importance of strong collaboration with local communities in providing accessible and compassionate care. One patient remains vivid in my memory: a teenage boy who presented with a progressively enlarging, painful lump around his knee. He initially thought the swelling was from a minor soccer injury, but Dr. Katana, whom I shadowed, had to explain that it was osteosarcoma. While limb-salvage surgery has become the standard of care worldwide, amputation remains the predominant surgical practice in much of Africa. Watching tears well up in this young boy’s eyes as he processed the reality of amputation was heartbreaking. The moment brought to mind my visit to Bombolulu Workshop, where I learned how cultural stigma around disability can intensify psychosocial burden. This experience underscored the importance of building emotional resilience while staying grounded in empathy. During my second week in the surgery department, I learned extensively about medical terminology and surgical procedures. This week coincided with a neurosurgery camp, where neurosurgeons from the SAWUBONA Foundation (Germany) visited to perform procedures and follow up on patients from previous years. With less than 1% of the world’s neurosurgeons serving the African continent, neurosurgical cases are an emerging public health concern. I was struck by how critical it is to exchange knowledge globally and build local capacity to advance neurosurgical care across Africa. My week in surgery began in the outpatient clinic, where I engaged directly with patients, observed clinical assessments in practice, and listened to patients describe their experiences confronting disease. I observed a patient with cervical myelopathy undergoing reflex testing, where hyperreflexia (an exaggerated knee-jerk response) served as a key clinical sign. In contrast, I was taught about the relevance of myelomalacia—an MRI finding reflecting spinal cord softening due to compression. Importantly, patients can present clinically with cervical myelopathy even without visible myelomalacia on MRI, and conversely, myelomalacia can appear when clinical signs are subtle or absent. This reinforced that understanding disease requires actively capturing the clinical picture and integrating—rather than confusing—signs and imaging findings. While shadowing Dr. Degiannis from Germany, I encountered a patient who had undergone resection of a pilocytic astrocytoma a year prior and now presented with a new lesion at the original tumor site. The patient remained seizure-free post-surgery, and histological analysis again showed no atypia or mitotic activity—consistent with a low-grade pilocytic astrocytoma—suggesting residual or recurrent disease rather than a new glioma. Unlike diffuse low-grade gliomas that can transform aggressively, pilocytic astrocytomas rarely progress to higher grades. Even with this relatively reassuring pathology, I observed the difficult decisions the surgeon had to make, especially in a setting where chemotherapy and radiotherapy are nonexistent and remain financially out of reach for many patients despite the oncology department at CGTRH. As Dr. Degiannis explained, outcomes often fall at two extremes: some patients arrive too late for treatment and face a poor prognosis, while others experience remarkable recoveries after surgery. I witnessed this spectrum firsthand—from an elderly patient who underwent lumbar decompression and fusion and later regained the ability to stand independently, to a child with an encephalocele who overcame ataxia and was able to walk with stability. Dr. Degiannis described these moments as joyful and fulfilling, and emphasized that they are why he continues providing care in settings where neurosurgeons are scarce. In the operating theatre, I observed craniotomy and tumor resection for various intracranial tumors. One particularly challenging case involved a giant pituitary macroadenoma with suprasellar extension. Unlike typical pituitary adenomas that are removed via a transsphenoidal approach, this surgery required a craniotomy and entry into the ventricle for safe aspiration. The tumor was soft and easily aspiratable, consistent with a benign adenoma, but its superior boundary was unclear. The surgeons encountered a thin layer over the tumor and could not immediately determine whether it was the tumor’s pseudocapsule or the diaphragma sellae—the dural layer forming the roof of the sella. Removing the diaphragma forcefully could cause a cerebrospinal fluid (CSF) leak or damage critical structures such as the optic apparatus or hypothalamus. Although intraoperative assessment (visual inspection, tactile evaluation, gentle suction, and observation of CSF pulsations) was used to distinguish capsule from diaphragm, it was unlikely that the entire tumor was resected. This case highlighted the importance of meticulous surgical technique and real-time intraoperative judgment, and it inspired me to deepen my understanding of neuroanatomy. I also cannot conclude my surgery week without emphasizing pediatric hydrocephalus. Hydrocephalus is highly prevalent in Kenya, partly due to limited prenatal screening and folic acid supplementation, which increases the risk of neural tube defects. Children often present with complications such as meningitis, and because Kenya is a high TB-burden country, infectious diseases must also be considered as contributing factors. To manage these cases, an external ventricular drain (EVD) was placed to temporarily drain CSF, relieve intracranial pressure, and obtain CSF for diagnostic infection testing. The procedure involved creating a small burr hole, opening the dura, and advancing a catheter 1–2 cm into the lateral ventricle. CSF can appear clear if normal or cloudy if infection is present. This step stabilizes the patient before a definitive procedure, such as ventriculoperitoneal (VP) shunt placement. EVD also allows CSF sampling for culture or PCR to ensure no acute infection is present before proceeding with a VP shunt. During VP shunt placement, CSF is diverted from the ventricle to the peritoneal cavity, where it can be safely absorbed. One case stood out in particular: isolated dilation of the left temporal horn, which required two shunts. Hydrocephalus can be classified as noncommunicating (obstruction within the ventricular system) or communicating (impaired CSF absorption). The case I observed represented an extreme localized form of noncommunicating hydrocephalus, where the affected ventricular compartment becomes sealed off from the rest of the CSF system. This rare presentation often occurs due to post-infectious scarring or post-hemorrhagic fibrosis. By the end of this extensive neurosurgery exposure, my curiosity about neuroanatomy had grown more than ever—along with an even deeper understanding of why global collaboration matters. During the third week, I rotated in internal medicine after requesting a change from pediatrics. I had met Dr. Faruk during a clinical outreach, and his passion for teaching and thorough explanations inspired me to learn from him. In internal medicine, morning rounds were conducted with Dr. Faruk, where a group of interns followed him while medical officers presented their patients. Although crowded rounds are not common in North America, in Kenya this approach was necessary given the level of medical training. I appreciated being part of the intense atmosphere as Dr. Faruk rigorously tested medical officers on diagnosis, management plans, and broader medical knowledge. His questions spanned multiple specialties and consistently emphasized pathophysiology and how drugs act to alleviate disease. He often reminded us that as doctors we are constantly reading, forgetting, and relearning—and that even brief daily study is essential to keep clinical knowledge alive, a habit I intend to maintain. Possibly influenced by neurosurgery camp, I will share one in-depth diagnostic challenge discussed repeatedly by Dr. Faruk that week: a suspected tuberculoma. The patient was admitted with neurological symptoms including progressive leg weakness, episodes of unconsciousness, recurrent vomiting, and convulsions. MRI revealed extensive vasogenic cerebral edema, obliteration of the ventricular system, and a significant midline shift—raising concern that untreated intracranial pressure could progress to brainstem herniation. The initial suspicion was tuberculoma, a granulomatous CNS lesion due to an immune response to Mycobacterium tuberculosis, based on two ring-enhancing lesions on MRI and the patient’s TB history. From there, I was drawn into the essence of internal medicine: evidence-based evaluation and differential diagnosis, acknowledging multiple possible diseases with similar presentations and working to distinguish them by underlying pathology. PCR for TB was inconclusive, HIV serology was negative (despite HIV being a major risk factor for TB), and the white blood cell pattern—elevated neutrophils and reduced lymphocytes—did not strongly support tuberculoma. With limited evidence, attention turned to distinguishing the lesion from metastases and primary brain tumors. Metastasis was considered given the patient’s age, though there was no known malignancy history. A primary brain tumor such as glioblastoma was also considered, though two separate lesions would be unusual. Dr. Faruk suggested a brain biopsy, but it was not recommended due to high intracranial pressure and the risk of spreading infection if the lesion were an abscess. Later that week, a colonoscopy revealed something suspicious, but before confirmation could be reached, the patient passed away—leaving the underlying cause unknown. Kenya is undergoing an epidemiological transition, where infectious diseases remain prominent while non-communicable conditions continue to rise. At the bedside, this reality is complex. The patient above had battled TB yet also carried epilepsy and what may have been an untreated malignancy. This double burden places families under major financial strain and stretches an already overburdened healthcare system, where layered illness complicates both diagnosis and management. In the internal medicine ward, this shift was reflected in the range of commonly encountered cases: acute decompensated heart failure, hypertensive emergencies, acute decompensated liver disease, and multiple myeloma. This trend became even more evident during my final-week rotation in the emergency department. While pediatric emergencies were dominated by communicable conditions such as pneumonia, sepsis, meningitis, and gastroenteritis with dehydration, I was surprised by how often adult emergencies were driven by non-communicable disease—more frequently than trauma, which I initially expected to predominate. One emergency department case remains with me. CPR was attempted on a patient for over ten minutes. As resuscitation continued and no circulation was detected in his foot, I realized he had passed away. His wife collapsed beside him in grief. He had a long history of uncontrolled hypertension, which damaged renal vasculature over time, leading to chronic kidney disease and eventually end-stage renal disease. He required hemodialysis, but financial constraints prevented consistent treatment. Severe electrolyte disturbances, including hyperkalemia and metabolic acidosis, likely triggered arrhythmias that progressed from ventricular tachycardia to ventricular fibrillation, prompting resuscitation. This case highlighted the consequences of limited health literacy around non-communicable disease, poor medication adherence, and the financial barriers that prevent access to essential therapies and follow-up care. Finally, seeing an unconscious patient brought into emergency following a suicide attempt with paracetamol poisoning reinforced that mental health cannot be ignored. Being involved in mental health education for secondary school students reinforced for me how important education is for improving community health literacy. It also reminded me of the value of offering support, sharing perspective, and being someone who listens—qualities I intend to carry forward as I take on greater leadership roles in my community. Experiencing international healthcare collaboration in Kenya was deeply inspiring. From the neurosurgery camp organized by the SAWUBONA Foundation in Germany to the establishment of the medical ICU at CGTRH through support from JICA, I witnessed dedication and expertise that truly transcend borders. Every time I introduced myself, doctors noticed my Japanese background and eagerly shared their experiences, expressing appreciation for doctors from Japan who worked with them during the challenging COVID-19 period. It made me proud of my background and inspired me to one day serve underserved communities similarly—collaborating with cultural sensitivity, sharing expertise that is valued and empowering, and contributing to lasting development of local healthcare systems. Beyond shaping my ambitions, my time in Kenya profoundly reshaped me as a person. One of the most powerful lessons I gained was a deeper recognition of gratitude. Being in a setting where resources were scarce yet generosity flowed freely gave me perspective on privileges I often take for granted. Whether it was patients sharing their stories or students welcoming me openly, I was struck by compassion and kindness that persisted despite hardship. Their resilience redefined what I believe is most essential in life: meaningful human connections, bonds of community, and the ability to appreciate what we already have. Reflecting on these experiences, I see how closely they connect to the personal health challenges and curiosity about medicine that first shaped my journey. Just as navigating my own illnesses ignited a desire to understand disease and provide meaningful care, my time in Kenya deepened my appreciation for empathy, cultural insight, and the responsibility of serving others with humility. These lessons strengthened my resolve to pursue medicine not merely as a profession, but as a lifelong commitment to addressing healthcare disparities, supporting communities, and continually learning from diverse perspectives. I am deeply grateful to the friends and colleagues I met from around the world through this program, as well as the doctors, medical officers, nurses at Coast General Teaching and Referral Hospital, and the program mentors who taught me and offered new perspectives. The medical knowledge I gained, along with the opportunity to immerse myself in healthcare in Kenya, is an experience I will carry with me throughout my continued studies in medicine.

“Pole! Pangusa,” I said gently as I poked a woman’s finger to check her blood sugar at a remote community clinic. Her daughter clung tightly to her leg, scared. The woman paused for a moment—then her face lit up. “You know Swahili!” she said, smiling. My Swahili is far from fluent, but I never expected a simple phrase to bring someone that much joy. As patients continued rotating through the vitals station, I realized how easily a small gesture can build connection. It also felt like a meaningful way to give back, even in a small way, for the immense hospitality I had already received in Kenya. That hospitality began the moment I stepped out of Mombasa International Airport. I was greeted with warmth and kindness that exceeded my expectations. The mentors and staff at International Medical Aid made me feel instantly at home, and even small moments early on reassured me that I had made the right decision. Before I had even set foot in the hospital, I met Kate—an intern from a previous cohort who was packing to leave after two months. As she tearfully described how moving and powerful the experience had been, something in me settled. I had arrived worried about travel complications, communication barriers, and whether I’d feel supported. That conversation affirmed that I was exactly where I was meant to be. My relationship with medicine started long before I arrived in Mombasa. In third grade, my dad experienced pituitary apoplexy—a rare hemorrhaging brain tumor. I still remember paramedics rushing into my parents’ room, asking rapid-fire questions, attaching electrodes, and moving with urgency. My mom’s advocacy ultimately helped get him transferred to a facility with the specialized resources he needed. After two brain surgeries, he made a near-full recovery, but as a kid I was confused and scared, desperate to understand what was happening. For years I followed his journey through appointments and specialists, and those early experiences planted the questions that eventually became my motivation. A few years later, I found myself in that same ambulance again—this time as an EMT. Serving predominantly low-income communities taught me how deeply social determinants of health shape outcomes. I learned to meet people with the same empathy and patience I would want for my own family: an elderly patient nearing the end of life, a scared immigrant mother relying on her child to translate, a veteran coping with PTSD. Over time, I stopped seeing “patients” as categories and started seeing whole individuals with layered histories—and loved ones waiting anxiously nearby. That work strengthened my commitment to medicine and to the idea that equitable healthcare must extend beyond treating symptoms: it must restore dignity and hope, especially for people society often overlooks. Kenya expanded that understanding further. During my weeks at Coast General Teaching and Referral Hospital (CGTRH), my view of medicine and humanity deepened in ways no textbook could teach. In Adult and Children’s Accident & Emergency, the pace and volume were unrelenting. Sometimes it truly felt like trying to steady a sinking ship. On my first day, I hated the helplessness of watching people suffer—patients pleading for relief while staff balanced constant urgency with limited resources. But as the days passed, I began to find my role. Some days that meant small, practical acts: comforting families, collecting supplies, helping with vitals and charting, and doing whatever I could to keep the workflow moving. Other days required stepping into high-stakes moments—joining resuscitation efforts, doing CPR, assisting with ventilations, and witnessing how teams function under extreme pressure. Those experiences reminded me why emergency medicine draws me in: the demand for critical thinking, adaptability, and calm decision-making when you don’t know what you’re walking into. In A&E, I saw clinicians and trainees constantly adjusting—using skill, teamwork, and creativity to provide care despite resource gaps. It challenged my assumptions about what “good medicine” looks like. I realized that great care isn’t defined only by pristine facilities or the newest equipment. It is defined by empathy, clinical judgment, creativity, and cultural understanding—especially when the margin for error is small. In the New Born Unit (NBU), I found a different kind of purpose. Caring for fragile new lives brought both joy and heartbreak, sometimes in the same shift. My rotations in NBU and Labor & Delivery exposed me to the raw intensity of birth, loss, and resilience. I was struck by the way staff leaned on each other, on faith, and on community to keep moving forward through grief and exhaustion. Their approach to death and dying also differed from what I had been used to at home. Rather than framing every loss as a “medical failure,” there was often a sense of acceptance grounded in spirituality and shared strength—without diminishing the seriousness of what had happened. Over and over, I witnessed life-saving adaptations in resource-limited settings—workarounds that were clever, effective, and grounded in experience. It made me rethink the “extras” I took for granted in the U.S. I saw how much can be accomplished when teams are resourceful and determined, and how survival does not always depend on the most advanced technology. That discomfort I initially felt—like the absence of certain monitoring or supplies—became a lesson in humility and perspective. I also gained deep respect for healthcare professionals who carry extraordinary responsibility while navigating systemic strain. Conversations with clinicians revealed challenges that extended beyond the bedside—financial uncertainty, heavy workloads, and the ongoing pressure to meet unrealistic standards. Those reflections naturally connected back to what I have witnessed in the U.S. as well: barriers created by insurance, delayed care until problems become critical, and the ways cost and access shape outcomes for marginalized communities. In both contexts, I saw how often the root causes of suffering exist outside hospital walls—embedded in systems that fail to provide consistent, accessible, and equitable care. That theme came into sharper focus as I reflected on rural health and “medical deserts,” where geography, poverty, transportation, and historical injustice can fuel mistrust and limit access. In Kenya, I noticed similar patterns—gaps in health literacy, financial burden, infectious disease concerns, and barriers that weaken trust between patients and the healthcare system. After speaking with people working in emergency settings, I also recognized how different infrastructure can be: when formal EMS systems are limited, communities often rely on family networks, friends, and local support systems to respond. In many places, community becomes both the first line of care and the long-term safety net. One of the greatest takeaways from my time in Mombasa is that kindness and optimism are not byproducts of circumstance—they are conscious choices people make every day. Despite limited resources and immense need, I witnessed gratitude, humor, generosity, and perseverance. The kindness I received—from program mentors to hospital staff to strangers on the streets—left a lasting imprint on me and reinforced a truth I want to carry forward: compassion doesn’t require abundance; it requires intention. I returned home with more than clinical exposure. I returned with a deeper commitment to advocacy—the kind my mother showed for my father—along with a renewed dedication to listening closely, seeing patients as whole people, and challenging the systems that repeatedly fail them. Kenya opened my eyes to a new world, a new culture, a new healthcare system, and a new reality many patients navigate daily. I am forever grateful for the experiences, lessons, and people who shaped me there, and I will carry what I learned in Mombasa into every step of my journey toward medicine.

My experience with International Medical Aid in Mombasa, Kenya, was deeply meaningful and transformative. From the moment I arrived, the in-country support team made me feel grounded and safe. Margaret, my program mentor, was incredibly supportive, always checking in on my well-being and helping me process the emotional weight of clinical work. Janet was equally encouraging, offering guidance, reassurance, and genuine care throughout my placement. Their leadership made the experience both structured and personally empowering. At Coast General Teaching and Referral Hospital, the nursing staff, physicians, and medical students were welcoming and eager to teach. They explained cases in detail, demonstrated procedures, and trusted me to participate in ways that helped me grow. I felt respected as a learner, and I appreciated how open everyone was to sharing their knowledge despite the fast-paced and resource-limited environment. The local community also showed tremendous kindness. Whether in the hospital, at outreach sites, or in everyday interactions, people were supportive, patient, and willing to help us understand cultural norms and the realities that shape healthcare access. This experience strengthened my passion for maternal and child health and further inspired my interest in child neurology, especially after witnessing how delays in early care can affect long-term outcomes. Living and working in Kenya taught me that compassion, cultural understanding, and preventative care are just as essential as clinical knowledge. Overall, this program was a powerful step in my journey toward becoming a physician who serves vulnerable populations with empathy, humility, and a global perspective.

My experience in Kenya was amazing. I loved fully embracing the culture and meeting so many new people. The people who worked at IMA and in the hospital were wonderful. From the moment Michelle picked me up from the airport, she made IMA feel like home. She was so welcoming, and we quickly became very good friends. I also grew very close with Hilda, who always went above and beyond to make me feel at home and let me know I had a friend in her. The kitchen and housekeeping staff made my time at IMA even more enjoyable. The housekeeping team once even washed my scrubs when I forgot to put them out—something I truly appreciated. I loved the food at the residence, especially the cake! It was really fun when a few of my friends and I got to help make a cake and cinnamon rolls. The residence quickly became my home, and I’m so grateful for that. I feel that I grew as a person both in the hospital and in everyday life, as I was constantly challenged to step out of my comfort zone. The special relationships I formed and every moment I spent in Kenya will stick with me forever. I truly cannot wait to return someday. 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.

I spent three weeks in Mombasa, Kenya completing a medical internship that combined hospital rotations with community outreach. I shadowed doctors in surgery, the labor ward, and pediatrics, gaining valuable insight into patient care and healthcare delivery in a new environment. The hands-on learning and exposure to different medical challenges broadened my perspective and strengthened my passion for medicine. Outside the hospital, our community outreach work showed me how education can make a lasting impact in the lives of others. The accommodations were comfortable, and I especially enjoyed the local food—like the chicken dishes and chapati quickly became my favorites. When I was young, the doctor’s office was one of my least favorite places to be. I hated the smell of antiseptic wipes, the crinkle of the exam table paper, and especially the sharp sting of shots. If someone had told my childhood self that eight years later I would spend my summer in an East African hospital, shadowing doctors, observing surgeries, and rushing from ward to ward, I would have laughed and run in the opposite direction. But my fear of healthcare did not last forever. As I grew older, the very things that once scared me began to fascinate me: how the body works, how diseases disrupt it, and how doctors step in to restore balance. That curiosity is what caused me to apply for an internship with International Medical Aid and board a plane alone to a very unfamiliar location: Mombasa, Kenya. After interning in a hospital in San Ramon, California for a year, I thought I knew what to expect from my experience with International Medical Aid. I would be rotating through obstetrics, surgery and pediatrics. Also, because I have traveled in a handful of developing counties, I thought I knew what to expect from the environment around me. However, nothing could have prepared me for the totality of the experience in Mombasa. The city was chaotic, with crowded streets, blaring horns, and a humid air with the lingering smell of cooking fires and burning trash. A constant reminder that life here moved quickly and under challenging conditions. I was initially overwhelmed. Looking back, this experience has profoundly changed me. It enabled me to make a real difference in another human being’s life. Beyond a single patient’s case, the experience ignited my interest in global public health because I witnessed firsthand the disparities in healthcare delivery in such a resource-limited setting. I will never forget the day I observed an emergency C-section. Although Kenya is not among the top 10 African countries with the highest maternal mortality rates, it continues to experience a high maternal mortality (OD AWE 2023). In 2015, Kenya’s maternal mortality rate was 510 maternal deaths per 100,000 live births (Muthee R 2025). This is an exceedingly high number when compared, for instance, to the US maternal mortality rate of 17 per 100,000 live births in 2023 (WHO 2025). That day at Coast General, the mom was in distress, lying on her side in pain because she had been in labor for hours, and everyone in the room was tense. When the doctor finally delivered the baby, I felt such relief when I heard the first cry. But then, everything changed as the baby stopped crying and became limp, not showing any of the normal reflexes babies usually have. I kept waiting for someone to do something fast to address the situation, but the nurse did not seem worried at all. The seconds seem to drag on like minutes. The nurse moved slowly, cleaning the instruments like nothing was wrong. My heart raced. I knew the baby was not breathing, and I could not just stand there, so Dani and I gently but urgently tried to stimulate the baby’s body, which did not open the baby's airway. I spoke up and asked if they could suction the baby’s airway, and the nurse finally grabbed the bulb and cleared the mucus, and after what felt like forever, the baby gasped and started to cry again. I could finally breathe, too. That moment shook me. In a hospital back home, a whole team would have rushed in right away. But here, with fewer resources and a calmer attitude toward emergencies, things moved more slowly. The nurse was operating in an environment that was under-staffed and to her the baby’s status was not an emergency. In that moment, I felt I witnessed a situation that teetered on the edge of life and death. Responding to my perception of an emergency, I also learned that even as a student, I have a voice, and using it can make a difference. I believe it is crucial to act quickly when someone’s life is at risk, regardless of where the emergency takes place. As I reflect back on this moment, however, I can see that “less” does not necessarily mean “worse.” It means using the tools around you to the best of your abilities. In this case, for the busy nurse, that included relying on the two interns to try to revive the newborn. After that moment in the operating room, I started paying closer attention not only to individual cases, but to the entire healthcare system around me. Working at Coast General gave me an unfiltered view of what it means to practice medicine in a public hospital in Kenya. The wards were crowded, sometimes with 70 patients in one large room, and just a couple of nurses caring for everyone. Each morning, before even entering the wards, lines of patients waited in areas overflowing with people, and many of them had been waiting since dawn. It looked very different from hospitals at home, where there is privacy, access to technology, and a sufficient number of staff. Even though the doctors were working with so little, they were incredible. They cared about their patients and took time to explain things to us students. They were patient teachers, despite being clearly exhausted. When the doctor could not do well, it was not because they did not care, but rather because they lacked sufficient resources, staff, or equipment. Or the patient came in too late in the evolution of a disease process. Sometimes doctors had to make hard choices about which patients to treat first because there simply was not enough time or supplies for everyone. My experience in Kenya taught me that healthcare outcomes are not purely just about medicine and physician expertise, but also about systems, access, and resources. I saw how strong clinical skills mattered more without advanced technology to rely on. And I learned how important it is to speak up when something feels wrong, even as a student. My internship with International Medical Aid was more than just a learning experience, it was a life-changing journey. I came to Kenya eager to observe medicine in action and care for people, but I left with so much more: a deeper understanding of health inequities, a stronger sense of compassion and independence, and a clearer vision for my future career. In the developing world, healthcare, I learned, is not just about curing disease; the human being, who has come into the clinic for help, has a particular life story and background that is relevant to their reason for being there. Their treatment is embedded within a complex health care delivery system with its own limitations. In a developing country, what I witnessed is that delivering healthcare means working to create the best outcome possible for that patient. I will continue to carry the lessons of Mombasa with me into every classroom I sit in, every patient I meet, and every decision I will make as a future healthcare professional. Through this experience, I learned that fear can evolve into passion, challenges can lead to growth, and even the smallest acts of care can change or even save another person’s life. Most importantly, this journey showed me that medicine is not just a career, it is a calling to help people who need it most in the worst or hardest moments of their lives. And it has shown me how great the need is in other parts of the world.

My internship with International Medical Aid in Peru was life-changing and gave me deep insight into global health disparities and the cultural complexities of healthcare delivery. As I immersed myself in the tapestry of Peruvian life, I was consistently struck by the resilience of the health providers and the people they served. From learning about Incan history to seeing firsthand how healthcare can look very different between the United States and Peru, the experience was full of meaningful revelations. These moments expanded my worldview and helped cement my desire to pursue a career in healthcare with a focus on underserved populations. One of the most impactful aspects of my time in Peru was seeing how healthcare delivery contrasted with what I was used to in the United States. In many rural areas, the infrastructure for health care is still developing. Some clinics and hospitals lacked basic medical supplies and advanced diagnostic equipment that are often taken for granted in more developed settings. For instance, at Clinic Metropolitano, we frequently took blood pressure by hand because there were few automatic machines. In these circumstances, healthcare professionals demonstrated tremendous resourcefulness and creativity. Specialized care was often limited, especially in rural regions, and many patients had to travel long distances to receive basic healthcare, let alone see a specialist. During mental health clinics in a rural town, I saw how limited access to psychiatric care affected patients. Some women struggled to find support if they experienced sexual or physical violence, and young children did not always have the opportunity to speak openly with a psychologist about issues at home or school. At the same time, I was able to observe a public healthcare system that aimed to provide care to all who worked and contributed. For example, those eligible for EsSalud clinics could receive treatment, but they sometimes faced long waits for appointments, procedures, and medications that were occasionally out of stock. When I visited a hospital to observe an Achilles tendon repair, I learned the patient had waited a year for surgery—an experience that highlighted the realities of limited resources. I also noticed that patient privacy was handled differently in a busy public teaching hospital. Interns were often allowed to observe and sometimes participate in procedures in ways that would be approached more cautiously in the United States. These experiences helped me better understand the trade-offs, pressures, and ethical considerations that come with delivering care in resource-limited, high-demand settings. Navigating cultural differences was part of everyday life in Peru. The country’s rich cultural heritage—rooted in Indigenous, Spanish, and African histories—shapes both healthcare practices and health beliefs. One of the most important lessons I learned was the value of cultural competence in healthcare. When cultural differences are understood and respected, they can significantly improve patient outcomes and satisfaction. Traditional medicine and healers remain highly relevant in many Peruvian communities, especially in rural areas. During my internship, I often saw patients using leaves and other herbal remedies that had been passed down through generations. I observed healthcare providers who respectfully acknowledged these practices while also introducing modern medical interventions when needed, carefully balancing both approaches. I also saw patients who self-medicated with antibiotics and pain medications purchased from street vendors. Although this practice can be risky, physicians approached these conversations with patience and education, encouraging safer behaviors. This experience reinforced for me how essential it is to build trust and collaborate with local communities to provide holistic, culturally sensitive, and effective care. Language barriers were another meaningful part of the learning process. Even though I was conversational in Spanish, many patients spoke only Quechua, an Indigenous language common in the Andean region. This sometimes made verbal communication challenging, but it also underscored the universal nature of empathy in healthcare. One powerful moment occurred when I interacted with a 91-year-old woman who came to the clinic alone. Despite the language gap, we communicated through gestures and with the help of the physician’s limited Quechua. That encounter showed me how deeply kindness, patience, and compassionate presence can impact someone who rarely receives medical attention. I also encountered patients with chronic conditions whose health had been affected by a combination of access issues, lifestyle factors, and healthcare hesitancy. For example, one man in his fifties had uncontrolled diabetes that was leading to neuropathy and vision problems because he did not consistently renew his insulin. Due in part to diet and social norms, many patients lived with chronic hypertension. One patient, who had been taking his medications for three months, still presented with a blood pressure of 176/101. The doctor immediately referred him to the emergency room, knowing that such levels could lead to a stroke or heart attack. These cases were powerful reminders of the importance of preventive care, education, and easily accessible services in managing chronic disease. Another highlight of my internship was learning about Peru’s rich Incan history and how it continues to influence health beliefs and practices today. The Incas were known for their sophisticated knowledge of medicine and their holistic approach to healthcare. They used a wide variety of medicinal plants, many of which remain central to traditional Andean medicine. The Incan emphasis on the mind–body–spirit connection is still reflected in the beliefs of many Indigenous communities. As part of my internship, I visited several archaeological sites where we discussed the Incan approach to health and medicine. I learned about trepanation, the surgical removal of a piece of the skull to treat head injuries—a practice that revealed advanced knowledge of anatomy and surgical technique. These visits gave me a deep appreciation for Peru’s cultural heritage and the ways historical knowledge continues to shape modern health practices. During a tour of the city and surrounding ruins, we also learned about the arrival of the Spanish and the impact of colonization on the Incan people. We heard stories of the encomienda system and the attempted rebellion led by Tupac Amaru, the last Incan leader, whose tragic fate is still remembered. The Plaza de Armas—also called the Plaza de Lágrimas—was the site of many of these events and remains a powerful symbol of resilience and history. Seeing Spanish-built cathedrals constructed with repurposed Incan stone was a vivid reminder of the layers of history present in modern-day Peru. Overall, the tour was an unforgettable experience that deepened my understanding of Incan and Spanish history and its lasting influence on the region. Comparing the healthcare systems of the United States and Peru was eye-opening and thought-provoking. In the United States, healthcare is often characterized by advanced technology, ready access to specialized care, and a strong emphasis on patient autonomy—though these benefits are intertwined with high costs and complex insurance systems. In Peru, particularly in rural areas, healthcare is shaped by limited resources, the continued relevance of traditional medicine, and strong family and community involvement in health decisions. I noticed that patients in the United States are often highly informed about their conditions and actively involved in decision-making. In Peru’s rural communities, there tended to be more deference to healthcare professionals and traditional healers. This difference seemed linked to varying levels of education, cultural beliefs, and access to medical information. I saw many instances where patients trusted and followed the advice of their providers wholeheartedly. Preventive care was another area of contrast. In the United States, routine screenings and vaccinations are widely promoted. In Peru, preventive services can be harder to access, and patients may seek care later in the course of their illness, when conditions are more advanced. This experience sharpened my awareness of the importance of public health initiatives and the need to improve access to preventive care worldwide. Ultimately, this internship was not just an academic experience—it was a journey of personal growth. Living and working within another cultural and healthcare system pushed me beyond my comfort zone and taught me to adapt quickly. I learned to navigate communication barriers, build rapport with patients from diverse backgrounds, and develop a deep respect for cultural practices that differ from my own. These experiences have made me more flexible, empathetic, and culturally sensitive. Some of the most rewarding moments came from bonding with local healthcare providers and community members. Their dedication, perseverance, and compassion were incredibly inspiring. Despite the challenges and resource limitations they faced, they were unwavering in their commitment to providing the best possible care. Their example strengthened my own resolve to pursue a health-related career focused on service and equity. Now, more than ever, I am committed to working in healthcare—particularly in global health and healthcare equity. After completing my undergraduate studies and medical school, I envision myself serving underserved populations in international settings, working to increase access to and improve the quality of care. I am also deeply interested in public health initiatives that address social determinants of health and emphasize preventive care. My time in Peru sparked a fascination with medical anthropology and the ways cultural beliefs and practices influence health behaviors. I believe that understanding these factors on a deeper level will help create more effective interventions and better health outcomes. My internship with International Medical Aid in Peru changed my life and provided invaluable insight into global healthcare disparities and cultural competence. From the ingenuity of healthcare providers working in resource-limited settings to the richness of cultural heritage preserved since the Incan civilization, every day offered something meaningful to learn. The differences between the healthcare systems of the United States and Peru were both surprising and illuminating, reinforcing the need to work toward more equitable global systems. This experience solidified my commitment to a career in medicine, with a focus on global health and healthcare equity. It taught me the importance of empathy, adaptability, and cultural sensitivity in delivering compassionate, effective care. As I continue on my path toward becoming a physician, I am motivated to apply what I learned in Peru to advocate for improved access to quality healthcare for all, regardless of socioeconomic background.

I had an excellent experience with IMA. The staff all went above and beyond to ensure my comfort and safety. The experience was so incredibly meaningful, and IMA’s accommodations helped me feel less overwhelmed and more prepared to take in the experience. Hilda in particular went above and beyond, especially on the Malindi adventure. She was very approachable, fun, and organized. I remember sitting in my high school biology class, flipping through a textbook when I stumbled upon a section on diseases prevalent in the developing world. It described, in vivid and unsettling detail, the symptoms of illnesses like Ebola and malaria—two diseases I had never heard of at the time. The page depicted Ebola’s internal hemorrhaging and malaria’s destruction of red blood cells as they burst and release parasites into the bloodstream. The section ended with a sobering note: Ebola and malaria might be curable, but little progress was being made due to a severe lack of research funding. The textbook also estimated the total cost to eradicate malaria. According to the Gates Foundation, the estimated cost to eliminate malaria by 2040 is between $90 and $120 billion—a sum less than the net worth of many of the world’s wealthiest individuals (Renwick). That statistic stuck in my mind and has remained with me ever since: global health inequality is a solvable problem—so why aren’t we doing more to solve it? Over the following years, my interest in global health deepened, particularly as the COVID-19 pandemic exposed glaring inequities in vaccine access. I found myself inspired by frontline healthcare workers—many of whom were my own neighbors—and by the efforts to democratize vaccine availability worldwide. I trained to become an EMT, responding to medical emergencies on my college campus, and became involved in vaccine delivery research focused on developing pulsatile-release vaccines aimed at improving vaccination rates in low-resource settings. I joined a global health club on campus and worked to raise awareness of global health issues among my peers. Still, something felt missing. I didn’t fully understand who I was helping. Who were these vaccines for? Who truly bore the brunt of these inequities? Why was it urgent to act now? I wanted to understand who was behind the numbers—the lives, the faces, the families. Landing in Mombasa marked my first time outside the developed world. I remember the drive from the airport vividly. It felt chaotic, alive, and strained all at once—tuk-tuks, motorcycles, cars, and pedestrians weaving through the streets with no apparent regard for traffic rules. At every stop, people approached our windows offering fruit, nuts, or handcrafted goods, desperate to make a sale. The struggle for daily survival was tangible. I watched silently from the backseat, feeling a complex mix of awe, guilt, and anticipation for what lay ahead in the hospital. During my first week, I was placed in the internal medicine ward, where we were introduced to Dr. Suhail, who guided us through patient rounds. One of the first patients we met was Margaret, a woman who had clearly suffered a stroke. I had been trained to recognize strokes as an EMT, but this was the first time I saw the reality firsthand: facial drooping, right-sided weakness, and expressive aphasia. Dr. Suhail explained that Margaret had been in the ward for about a week and was showing slow signs of improvement. Margaret could understand us but couldn’t speak. She lay motionless on a rusty bed, covered by a colorful blanket, with flies buzzing across her face. Her daughter, strong and vigilant, stayed at her bedside, advocating fiercely for her care—swatting flies, changing Margaret’s clothes, and reading aloud to her. When I asked Dr. Suhail how long it had taken for Margaret to reach the hospital after her stroke, he explained that many patients arrive well past the “golden hour,” when intervention might still reverse the damage. In neighboring Somalia, the average time to arrival for stroke patients is 16 hours (Sheikh Hassan). Many delay care due to lack of healthcare literacy or a belief that divine intervention will heal them (Kimani). As we continued our rounds, I began to notice the silence that filled the ward. Patients sat quietly, not using phones or engaging in conversation. It wasn’t peaceful—it was haunting. It felt like a collective understanding that not much could be done for them. Limited resources meant that Dr. Suhail had to prioritize only the most urgent conditions. Retroviral diseases, for instance, were often left untreated. Despite taking thorough histories and analyzing labs and imaging, there was often little he could offer by way of treatment. One moment that struck me deeply was meeting a 20-year-old woman with stage 4 cervical cancer. She was my age. No treatment was scheduled; she was only receiving palliative care and was expected to spend her final days on a deteriorating hospital bed under the beating sun. That image stayed with me—how unjust it felt that someone my age, with a potentially preventable and treatable disease, was forced to endure such a fate. Had the cancer been caught earlier, this woman might have a better prognosis. However, like many of the other patients we saw that day, she presented with an advanced-stage illness, and the opportunity for curative treatment had already passed. The internal medicine ward revealed a grim reality, yet within it, I also witnessed resilience and community. The patients, though suffering, created a comforting environment within the ward. They wore vibrant fabrics and their beds were covered in intricately patterned blankets. Family members looked after not only their loved ones but checked in on others in the ward as well. In the midst of helplessness, the community thrived. My second week was spent in the surgical department. I observed an array of procedures—from the placement of a ventriculoperitoneal (VP) shunt to a coronary artery bypass graft. On my first day, I watched a double valve replacement. Dr. Iqbal, a visiting surgeon, generously spent two hours walking us through the procedure. He explained that such surgeries are often the result of untreated rheumatic fever—something nearly eradicated in the U.S. due to access to antibiotics like penicillin (Cleveland Clinic). It was jarring to see complex, high-risk surgeries being performed for diseases that could have been prevented with basic, affordable interventions. This theme of treating symptoms instead of root causes recurred throughout the week. VP shunts, for example, are used to treat hydrocephalus, which can arise from neonatal infections like Streptococcus pneumoniae (Sakurai et al.). In many African countries, these infections go untreated due to limited access to antibiotics (World Health Organization). Similarly, I observed a spina bifida surgery—another condition preventable through folic acid supplementation, a standard and inexpensive part of prenatal care in high-income countries (Mayo Foundation). The reality is stark: in Africa, families face costly, high-risk surgeries for conditions that are preventable with the right public health measures. In a country where the health expenditure per capita is just $88.39 compared to over $10,000 in the U.S., bearing the cost of expensive, preventable procedures is unconscionable (International Medical Aid). It was a painful reminder that without robust public health infrastructure, expensive hospital interventions become the last resort for preventable tragedies. Even the operating rooms reflected the resource gap. During one open-heart surgery, a fly buzzed around the room. The presence of a fly during open-heart surgery wasn’t just a nuisance—it was a symbol of how drastically under-resourced the system had become. At one point, Dr. Iqbal requested an alpha blocker only to be met with silence—it wasn’t available. Instead, he instructed the anesthesiologist to improvise using a mix of saline and nitroglycerin. I later learned that Dr. Iqbal was a visiting cardiothoracic surgeon and had only been at Coast General Hospital for three days. Many doctors at the hospital split their time between public and private hospitals to make ends meet. Coast General, the largest public hospital in the region, has only one full-time cardiothoracic surgeon. As my time in Mombasa came to an end, I was left with a deepened sense of purpose, humility, and urgency. I witnessed physicians delivering care under unimaginable constraints, doing everything they could with the limited resources they had. I was struck by their willingness to teach and share knowledge despite the demands of their work. I returned home with renewed gratitude for the healthcare systems I had always taken for granted. Yet, I also returned with frustration. Why are essential resources being cut from USAID-supported programs in this region? I heard stories of emergency rooms without working defibrillators, CT machines being down, patients undergoing procedures without anesthesia, and common medications being out of stock. These are all solvable problems. Programs like PEPFAR (President’s Emergency Plan for AIDS Relief) are being significantly disrupted. PEPFAR has saved over 26 million lives since its inception and cuts to the program could put millions of additional lives at risk (UNAIDS). Additionally, PEPFAR alone employs 41,500 healthcare workers in Kenya, many of whom are now facing layoffs (Kenya News Agency). When international aid programs are cut abruptly, the burden falls on local communities who are ill-equipped to fill the gap, exacerbating health inequities and endangering the lives of many additional people. The future of healthcare in Kenya is unstable and it has me worried. The world has the tools, resources, and knowledge to fix this, but the will to help is eroding. This experience affirmed my commitment to global health—not just in theory, but in action. I now understand that to be a good healthcare professional is to care deeply about people and systems alike. It means advocating for equity, addressing root causes, and seeing the patient within their full human, social, and economic context. My hope is to one day contribute to the transformation of healthcare systems like Kenya’s—through better infrastructure, expanded access to care, and increased healthcare literacy. I am more determined than ever to be part of the solution.

My experience with International Medical Aid in Peru was transformative, and the staff were at the heart of it. Their guidance, care, and example shaped not only my learning but also the way I now see medicine. Dr. Fabrizio was one of the most down-to-earth and knowledgeable teachers I have ever had the privilege of learning from. He led many of our lectures and constantly reminded us that health is never just physical; it is also mental. He taught us how to approach patients holistically and how to rely on our clinical skills and hands as tools when technology was limited. His way of teaching made complex concepts accessible and grounded, and his example will stay with me throughout my career. Dr. Miriam was equally impactful. She not only lectured with clarity and compassion but also worked alongside us in the community clinic in Andahuaylillas. I had the privilege of being with her when we saw a 78-year-old farmer who had not sought medical care in years. Watching her balance empathy with clinical skill as she cared for him was deeply moving, and it showed me what it means to treat a patient as a whole person, not just a list of symptoms. Our program coordinator, Manuela, created an environment where we always felt supported and welcomed. She was consistently kind, approachable, and attentive to our needs, which allowed us to feel at home even when we were far away. Surabhi and Juda also played an invaluable role in ensuring our safety and comfort throughout the program. They were present and attentive, often behind the scenes, and their commitment gave us the confidence to immerse ourselves fully in the experience without worry. What stood out most to me was that each staff member went beyond their formal roles. The physicians modeled the kind of care that sees patients as individuals with stories, while the program staff ensured that we had the structure and security to learn and grow. This combination made my time in Peru not only eye-opening but also profoundly fulfilling. The program has given me lessons about privilege, resilience, and holistic care that I will carry into my future in medicine, and for that I am deeply grateful to every member of the team. “Un día.” One day. This is what a nine-year-old girl said to me when I showed her pictures of my life back home. That simple phrase has stayed with me as it revealed both her dreams and my privilege. We don’t realize the opportunities we hold until we’re met with the reality of others. This was the greatest lesson I learned throughout my internship with International Medical Aid in Peru. Over several weeks in Cusco and the surrounding mountains, I saw the ways limited health education, scarce resources, and cultural barriers shape how people experience health. I listened to children who had limited education about hygiene or menstruation, to patients who had not seen a physician in years, and to elders who still relied solely on traditional remedies. I also saw resilience—in girls who proudly signed their names on pottery they sold to support themselves, in communities who welcomed us into their schools, and in physicians who made the most of every tool available. These experiences challenged me to rethink what it means to be a healthcare provider. They taught me that medicine is not just about treating disease; it is about building trust, offering education, and meeting people where they are. My time in Peru deepened my commitment to a career in healthcare, one rooted in empathy, humility, and advocacy. In every school and orphanage we visited, I realized how much of healthcare begins long before a patient steps into a clinic. Many of the children we met had never been taught how to wash their hands properly, why brushing teeth matters, or what to expect when their bodies begin to change. At the girls’ orphanage, we gave talks on dental care, handwashing, and menstruation, and their questions reminded me just how powerful basic education can be. Some of the girls believed that menstruation meant they were sick, while others were shy to even say the word. Watching their faces light up as myths were debunked was a reminder that information can be as healing as medicine. Back home, I had always taken school health classes for granted; in Peru, I saw what it meant when those lessons were missing. It struck me that the first prescription a physician can give is not always a pill—it is knowledge, dignity, and understanding. As a future physician, this lesson reminds me that I cannot assume patients come with the same baseline of health literacy I had growing up. If I want to truly serve my patients, I will need to carry this humility forward, taking the time to listen, explain, and leave them with more than a prescription—with the confidence and knowledge to care for themselves. That same lesson came into sharper focus during my rotation in Tópicos, where nearly every patient who walked in had varicose venous ulcers. We cleaned and re-dressed wound after wound, with many returning with infections and deterioration. One woman had scratched at her ulcer, not realizing the bacteria under her nails could worsen it beyond recognition. It wasn’t neglect; it was lack of guidance. The nurse explained that these ulcers were so common in Peru due to long-standing labor in agriculture and markets, high rates of obesity, and almost no access to early preventive care. She enlightened me that chronic venous disease thrives where occupational risks, delayed treatment, and poverty converge, and I could see that truth in every leg we bandaged. What I had glimpsed in orphanages—the cost of missing basic education—I now saw magnified in adults whose wounds had spiraled because no one had ever taught them how to care for themselves. In Canada, I grew up with hygiene lessons, clean water, and health literacy woven into everyday life; in Peru, those privileges were often absent, and the consequences were written directly on people’s skin. These structural inequities became even more visible during our community clinic in Andahuaylillas, where many of the patients we saw had not accessed medical care in years. One man I encountered, a 78-year-old farmer, had bilateral vision loss, severe back pain, and a chronic cough that had persisted for more than five years. Decades of agricultural labor, exposure to wood smoke from cooking fires, and his deep mistrust of physicians reflected patterns I later recognized were not unique to him, but part of a larger reality in Peru. He told us that nearly thirty years ago, doctors had advised amputating his leg due to a severe problem, but he refused and “treated it at home,” now claiming it was fine. That experience convinced him that doctors could not be trusted, reinforcing a reliance on home and traditional remedies—an approach I saw echoed in many rural patients. Chronic obstructive pulmonary disease (COPD) in Peru is often driven not by smoking, as in wealthier countries, but by biomass fuel exposure in rural areas and past tuberculosis infection in urban centers (Miranda et al., 2015). His case was a striking reminder of how structural and environmental conditions dictate disease pathways. I saw similar themes in patients who were either visibly malnourished or living with obesity—two extremes often rooted in the same absence of nutritional education and preventive care. Nearly 30% of Peruvian children suffer from anemia, with prevalence reaching 38% in rural areas, largely explained by socioeconomic and educational disparities (Al-Kassab-Córdova et al., 2022). These same inequities perpetuate adult conditions like venous ulcers, which worsen without early nutrition and wound care. At the other end of the spectrum, I also met patients struggling with obesity and hypertension, consistent with data from Lima showing that more than half of patients with type 2 diabetes live with additional chronic diseases such as obesity, hypertension, and dyslipidemia (Bernabé-Ortiz et al., 2015). My patient in Andahuaylillas was not just an individual with COPD or TB; he was the embodiment of Peru’s double burden of disease, where poverty, environment, and education converge to shape health outcomes. His story made me realize how much of my own access to clean cooking, preventive care, and trusted physicians has been a form of privilege I had never questioned before. This showed me that medicine is as much about context as it is about cure, and that healing begins with seeing the whole person along with the conditions that shape their daily lives. Another significant lesson I carried home was the manner in which Peruvian physicians approached mental health. Although I learned in lectures that Cusco has only about fifteen psychiatrists for the entire region, the doctors and nurses I observed never disregarded psychological well-being. They recognized that health cannot be separated into physical and mental dimensions, consistently seeking to make patients feel heard and understood. This was especially evident in the orphanages, where many of the girls had endured poverty, trauma, or domestic violence. Their questions to me revealed how deeply their environment shaped their sense of identity and purpose; some, not even two years younger than myself, asked whether I had a husband or children, as if a woman’s life were confined within these boundaries. At eighteen, I was struck by how different our realities were, and how limited social and educational opportunities had already narrowed their vision of what was possible for themselves. These conversations underscored that health is not only about physical well-being, but also about how people understand their worth, their opportunities, and their place in the world. I saw this perspective carried into practice at the community clinic in Andahuaylillas, where the physicians made it a priority to establish a station for a psychologist so that patients could receive mental health support after their medical evaluations. Their example reminded me that being a doctor requires seeing patients not only as clinical cases, but as whole individuals whose stories and experiences profoundly shape their health. They showed me that holistic care does not always depend on advanced technology or specialist services; it begins with empathy, attentive listening, and presence. While in Canada I have often taken for granted the growing recognition of mental health and the availability of counseling, in Peru I witnessed how deeply impactful it can be when physicians themselves integrate mental well-being into every encounter. This approach is one I intend to carry forward in my own career, ensuring that my patients feel acknowledged not only in their symptoms but also in their humanity. My time in Peru taught me what it truly means to be privileged. I had never realized how far my liberty extended or how much I had taken for granted. The ability to imagine a successful future for myself, to believe I could pursue it, and to access clean water, preventive health, and nutritional education are privileges that often pass unnoticed. In Peru, I saw the reality behind what happens when those pieces are missing: children growing up without health education, adults unable to manage preventable conditions, and elders relying on traditional remedies after losing trust in the medical system. Yet I also witnessed resilience—in young girls who inscribed their names into pottery to claim a sense of identity, in communities that welcomed us into their schools, and in physicians who, even with few resources, practiced medicine with empathy and intentional care. These experiences taught me that medicine is never only about treating disease, but about restoring dignity, sharing knowledge, and meeting people where they are. The physicians I shadowed modeled what it means to care for the whole person, listening to stories, acknowledging mental as well as physical well-being, and ensuring that every patient left feeling seen. Their example reshaped the vision I hold for myself as a future physician. I want to carry forward what Peru gave me: the discipline to look beyond symptoms, the humility to learn from every patient, and the responsibility to use my own privilege to bridge gaps in care. One day, I hope to stand fully in that role, offering my patients the same compassion and hope I once witnessed in Peru. Un día.

My internship in Cusco, Peru, through International Medical Aid was an incredibly rewarding and transformative experience. From the moment I arrived at one in the morning, the in-country team went out of their way to ensure that we felt comfortable, safe, and welcomed. They checked in regularly, offered tips such as where we should get food or exchange money, and made sure we always had someone to turn to if we needed help. Safety was clearly a priority. Whether we were in the clinic, traveling to our placements, or exploring the city, I felt well-supported and informed about precautions. Accommodations were comfortable and clean, with a friendly and welcoming atmosphere that made it easy to connect with fellow interns. The food provided was both delicious and varied—meals reflected the local culture, which was a wonderful part of the immersion experience. Professionally, I learned so much through shadowing and observation in the local hospital and clinics. I gained a deeper understanding of how healthcare is delivered in resource-limited settings and saw firsthand the adaptability and creativity of medical professionals working with fewer resources. I especially appreciated the chance to engage with patients, practice my Spanish, and observe procedures that broadened my clinical perspective. On a personal level, this experience deepened my cultural awareness and reaffirmed my passion for medicine. I left Peru with a stronger appreciation for community-based care, a greater respect for global health work, and lasting friendships with fellow interns. The combination of meaningful clinical exposure, cultural immersion, and outstanding in-country support made this one of the most impactful experiences of my life. I am truly grateful for everyone who made it possible and would highly recommend this program to anyone considering a healthcare career. As an aspiring future healthcare worker, I believe that the opportunity to travel and experience other cultures and healthcare systems is extremely integral to a comprehensive education in medicine. Global health experiences provide valuable insight into how socioeconomic, cultural, and systemic factors can shape patient health and, as a result, their experience with healthcare. In July 2025, I participated in a three-week internship in Cusco, Peru, through International Medical Aid (IMA). The program placed me in local hospitals and clinics, where I observed patient care in a variety of specialties such as general medicine, obstetrics, pediatrics, among others. My goal was to gain a deeper understanding of how healthcare is delivered in a country different from the United States, particularly in rural and underserved communities, and to compare these observations to my experiences volunteering in rural Pennsylvania. Peru presents a unique healthcare landscape. While the Ministry of Health (Ministerio de Salud, MINSA) provides public services for citizens, geographic and economic disparities persist. Rural communities, particularly those in the highlands, face limited access to physicians, inadequate infrastructure, and significant travel times to reach care. Language and cultural differences, such as the use of Quechua rather than Spanish in some regions, can further complicate patient–provider communication. According to the Pan American Health Organization, these barriers contribute to higher rates of preventable disease and delayed treatment in rural populations (PAHO, 2024). During my internship, I witnessed the consequences of these barriers firsthand: patients who had waited weeks for care, difficulty explaining treatment plans across language divides, and the creative problem-solving of healthcare workers operating with limited resources. These experiences not only enhanced my understanding of global health disparities but also reinforced the importance of culturally competent, patient-centered care—principles I plan to integrate into my future career as a physician. As part of our education and lecture series with International Medical Aid, I learned that Peru’s geography creates significant challenges for healthcare delivery and patient care. The Andean highlands and Amazon basin contain remote communities where the nearest health facility may be several hours or even days away by road. Public healthcare is available through the Ministry of Health (MINSA), but resources are concentrated in urban centers such as Lima and Cusco—especially with the highest-level clinics only being found in the capital city of Lima. According to the World Health Organization, rural areas in Peru have significantly fewer physicians per capita than urban regions, and residents face longer wait times for both primary and specialty care (World Health Organization, 2017). One of my first encounters illustrating this issue occurred in an emergency clinic in Cusco, where two Quechua-speaking sisters arrived to visit their critically ill mother. Their distress was compounded by the language barrier—Quechua is Peru’s most widely spoken Indigenous language—and luckily, the nurse I was shadowing knew enough to help quell the sisters’ frustration and uncertainty. In another instance, while shadowing in general medicine, I met an older man suffering from a severe case of bronchitis. He had been ill for over a month before reaching the clinic, unable to access a physician sooner due to the distance from his rural home and limited transportation options. These experiences reflect a broader pattern in rural Peruvian healthcare: geographic isolation, limited infrastructure, and language barriers not only delay treatment but also erode trust in the medical system. Studies have shown that such barriers contribute to poorer health outcomes, particularly for preventable or manageable conditions (Houghton et al., 2020). Addressing these challenges requires a multifaceted approach, including expanding rural healthcare infrastructure, improving transportation networks, and increasing the availability of trained medical interpreters. Rural communities worldwide often face significant barriers to accessing timely and quality healthcare due to geographic isolation, limited infrastructure, and workforce shortages (Strasser et al., 2016). My experience in the rural area of Casacunca in the Anta province of Peru exemplifies these challenges. Located several hours from the regional hospital in Cusco, Casacunca is a community where many residents must navigate difficult terrain and scarce transportation options just to reach basic medical services. During my internship with International Medical Aid, I participated in a rural outreach clinic in Casacunca, which provided critical primary care services at a primary school directly within the community. This model addresses some of the obstacles residents face by bringing healthcare closer to patients, reducing travel time and associated costs. At the clinic, I observed patients presenting with a range of conditions, from chronic diseases such as hypertension and diabetes to acute respiratory infections—many of which had worsened due to delays in care. During one memorable case, I could only watch as a doctor diagnosed an eleven-year-old child with malnourishment after finding him 10 kilograms underweight and very small for his age. It was hard to watch, knowing I could not even offer verbal comfort as I was unable to speak the mother’s language as she walked away with her son looking utterly defeated. This experience in a remote rural community highlighted the importance of preventive care and consistent management in rural settings, which are often under-resourced. During this time, I also learned about Peru’s SERUMS program, where medical students are required to complete a mandatory one year of service in a rural or low-resource urban area. This year of service is a prerequisite for medical graduates who want to work in the Peruvian public health system or pursue a specialization. As someone interested in rural medicine, I found this program very compelling and found myself wondering why we do not have similar programs in the United States. My experience in Casacunca deepened my understanding of how rural outreach programs can mitigate healthcare disparities by improving accessibility and fostering trust within communities. It also echoed themes I had seen earlier in my volunteering with patients in rural Pennsylvania, where similar barriers (geographic, economic, and cultural) affect health outcomes. These parallels reinforced my commitment to practicing medicine that not only treats disease but also proactively addresses social determinants of health. My clinical experiences in both Peru and rural Pennsylvania have profoundly shaped my understanding of the multifaceted challenges that affect health outcomes in underserved populations. Witnessing firsthand the geographic, cultural, and systemic barriers in Casacunca, Anta, alongside my work at a rural hospital in Pennsylvania (Evangelical Hospital) and local outreach programs, emphasized the critical need for adaptable, patient-centered care that considers the whole person. These experiences have reinforced the importance of cultural humility and effective communication in building trust with patients. In Peru, I observed how language differences and cultural beliefs could complicate healthcare delivery, highlighting the necessity for physicians to engage respectfully with diverse worldviews. Similarly, in rural Pennsylvania, I see how religious and cultural norms influence patients’ healthcare decisions, reminding me that medical knowledge must be paired with empathy and contextual awareness. As an aspiring future physician, I am especially drawn to the holistic approach central to osteopathic medicine, which emphasizes the interconnectedness of body, mind, and community. This philosophy aligns with the lessons I learned abroad and at home—treating patients not merely as clinical cases but as individuals shaped by their environments and experiences. By integrating osteopathic manipulative treatment with culturally competent communication and community engagement, I aim to address both the physical and social determinants of health. Furthermore, my time with International Medical Aid has inspired a commitment to serving underserved and rural populations. I recognize that improving healthcare access requires not only clinical expertise but also advocacy for systemic change, including expanding rural healthcare infrastructure, enhancing interpreter services, and supporting community-based health initiatives. These goals will guide my future medical practice, ensuring that I contribute to reducing disparities and promoting equitable care. My internship with International Medical Aid in Peru offered far more than a glimpse into another healthcare system; it fundamentally reshaped how I view the practice of medicine. From the bustling clinics in Cusco to the rural outreach program in Casacunca, Anta, I witnessed the resilience of patients and providers working within the constraints and stress of limited resources. These experiences highlighted both the universality of health disparities and the shared human need for trust, respect, and access to care. When compared with my work in rural Pennsylvania, the parallels became strikingly clear: geography, culture, and systemic inequities create barriers to care regardless of national borders. Yet in both settings, I also saw the profound impact of providers who listened, explained, and treated patients with dignity. This reinforced my belief that the most meaningful medicine is practiced at the intersection of clinical skill and human connection. As I move forward in my medical career, I will carry with me the lessons of cultural humility, the importance of preventive and community-based care, and the value of addressing the broader determinants of health. I aim to practice medicine within a framework that aligns seamlessly with these insights, emphasizing the treatment of the whole person rather than just the disease. My goal is to apply this perspective in rural, underserved, and global contexts—wherever the need is greatest—helping to narrow the gaps in healthcare access and equity. The internship not only deepened my passion for medicine but also clarified my purpose within it: to serve as a physician who advocates for patients, bridges divides, and delivers care that is both clinically effective and profoundly human.

Hans was an amazing tour guide both times we had him. I learned so much about Incan culture because he was so knowledgeable and passionate about the subject. I felt incredibly safe the entire time I was there—at no point did I feel like I was in a shady area or surrounded by questionable people. The accommodations were good. As expected, there was no central heating system, so I was perpetually cold, but still comfortable. Our mentor staff, Surabhi and Juda, were incredible—supportive, kind, and always there when we needed them. I never got the name of our chef, but she was amazing as well and very receptive whenever we requested specific foods.

This experience has truly been one of the best of my life. The entire staff was incredibly kind, supportive, and understanding in every circumstance. They were always willing to help us, and I felt cared for throughout the program. The food was also amazing—I still miss it! My favorite part of the internship, however, was being able to learn how another country runs its healthcare system and what the people there need, while also doing our best to help with the guidance of local physicians who showed us how to examine patients and think through cases. As a young girl, I had always aspired to become a doctor. This pre-medicine internship in Peru was my first real experience in a hospital setting and my first time shadowing physicians. Before arriving, I was extremely nervous and unsure of what to expect. However, from the moment I met the staff at International Medical Aid (IMA), I felt welcomed. Their warmth and professionalism immediately eased my anxiety. We were given an overview of our schedule and provided with scrubs, which made everything feel exciting and real. The next day, I was assigned to a physician in the general medicine department. I was struck by the types of cases we saw and the way care was delivered. The doctors conducted consultations, prescribed medications, and referred patients to other specialties when needed. Being a Spanish speaker gave me a meaningful advantage, as it allowed me to fully understand patients’ concerns and connect with them more deeply. One case that stood out to me involved a woman with paralysis on the right side of her face. The doctor explained that it was likely caused by stress, and the patient shared that family issues were affecting her well-being. This experience highlighted the powerful connection between mental and physical health. Throughout my time in the hospital, I noticed many cases of diabetes and high blood pressure, often related to poor diet and limited use of preventive care. Many patients delayed seeking medical attention and relied on home remedies instead. I also learned about the referral system, where patients needed a formal reference to be seen in another department. One patient had been waiting over three months for a follow-up X-ray and still did not have an appointment. I was surprised to learn that waits of up to six months were not unusual. This was very different from what I had seen in the United States, where imaging is typically completed within days. One of the most impactful days of the internship was a community outreach initiative in a small rural town with very limited access to healthcare and diagnostic equipment. Many patients had poorly managed chronic conditions, such as diabetes and joint problems, and had gone a long time without proper care. We saw clear signs of unmet health needs, even in small details like the condition of people’s nails, which reflected years of limited access to services compared with the urban population. Many individuals depended on the medications and supplies we brought with us, even though we knew that long-term solutions were still needed. During this outreach, I met physicians who travel from the city to this rural area once or twice a week to support the local community. Their dedication inspired me and gave me a clearer picture of the kind of physician I hope to become. Witnessing these healthcare disparities firsthand strengthened my commitment to serving vulnerable populations and pursuing a medical career grounded in compassion, service, and global health equity. I now understand that being a physician is not just about diagnosing and treating illnesses. It is also about recognizing the social, cultural, and systemic factors that shape people’s health. Moving forward, I plan to continue working in underserved communities, participate in global health initiatives, and advocate for more equal access to medical resources. Most importantly, I will carry with me the empathy, responsibility, and perspective I gained through my pre-medicine internship with International Medical Aid in Peru—lessons that will guide how I care for patients and contribute to the healthcare system in the future.

Overall, I really enjoyed my time with IMA in Peru. I thought the program was very well organized and thought out. Our mentors/coordinators were great and easy to contact when needed. As the fluorescent light of the operating room shone on my face, I looked over to my father in awe of his work after performing an Ablation on a patient. From a very young age, I was exposed to the medical field and the U.S. health system, as my father is a cardiologist and my mother was a nurse. After my first visit to the hospital with my father to shadow him, I knew the medical field was where I wanted to be in terms of a career. Fast forward to my sophomore year of college, and I knew it was time to get serious and find unique ways to gain medical experience. That’s when I stumbled upon International Medical Aid online. I had no prior knowledge of this program except that a friend of a friend had completed it in the past, and I had seen a few photos from her time in Peru. Almost completely unsure of what was yet to come, I later embarked on my journey to Cusco, Peru. The feelings of excitement, curiosity, and eagerness were overwhelming, but I was excited to see what was yet to come. I had set many goals for myself before leaving for this trip, the main one of which was to explore different careers in medicine. During my time shadowing in the U.S., I spent time with only a Cardiologist, Pharmacist, and Anesthesiologist. After spending many days with an Anesthesiologist and Anesthesia Assistants, I was set on attending anesthesia assistant school rather than medical school. Now that I have spent time at Hospital Nacional Adolfo Guevara Velasco – EsSalud with General Medicine physicians, Pediatricians, Gynecologists, Obstetricians, and Ultrasound Specialists in Peru, I have decided to keep an open mind about attending medical school since I need to take the MCAT before anesthesia assistant school anyway. My favorite department that I spent time in was Ultrasounds, shockingly. I was not expecting to enjoy this specialty as much as I did, but being able to actually perform ultrasounds on patients and learning how to read them really sparked my interest. I also thoroughly enjoyed being with the Obstetricians, seeing the joy on the mothers’ faces, and hearing their babies’ heartbeats was so rewarding. One thing that stood out to me was that, regardless of the department, a large number of patients were seen within a short period of time. For example, one morning when I was in General Medicine, the doctor saw eighteen patients in the span of 3 ½ hours. That being said, I noticed many differences between the way medical professionals and patients interact with each other in Peru versus the United States. There were many times when other patients would walk into an examination room while the physician was meeting with another patient. This caught me off guard because in the U.S., this would not be tolerated, as it is seen as an invasion of the patient's privacy. I also remember Dr. Pedro (General Medicine physician) telling me, “Patients come to doctors with symptoms and expect a remedy; if the doctor doesn’t provide a fix, they are considered to be bad at their job.” I’m unsure why, but this stuck with me because it made me think about the cultural viewpoint that patients in Peru have on healthcare and doctors. Both of these instances made it seem as though patients in Peru feel they are superior to other patients and that the doctors don’t receive as much respect as they deserve. Oftentimes, patients would speak openly about their concerns or disregard for their physician, which can be a good thing, but also is something you don’t see often in the United States. The overall relationship between patients and doctors was something that stood out to me as I was observing. As a student also pursuing a certificate in Public Health, being immersed in the Peruvian health system was eye-opening and put my learnings into perspective. I had recently taken a class called “The U.S. Health System in a Global Context,” where we learned about foreign healthcare systems, the role insurance plays worldwide, and different cultural views on healthcare. Although I wasn’t specifically taught about the Peruvian system, after learning about it through IMA, I was able to quickly compare it to the Canadian or German system. Much like the German and Canadian systems, Peru launched Universal Healthcare Insurance in 2009 (International Medical Aid, 2024). While the country as a whole is still working to achieve this, it’s in the process of expanding public and private sectors. Peru is made up of two different public sectors. MINSA, the Ministry of Health, provides healthcare for low-income informal workers. EsSalud (one of the hospitals we were in) is a type of social health insurance that covers formal workers and their families (International Medical Aid, 2024). I found learning about this interesting because I have spent a long time learning about U.S. insurance plans, such as Medicaid and Medicare. In terms of quality of care, the U.S. has high-quality care available. Outcomes on certain health measures, like long-term health and certain treatment results, can be worse than in other wealthy countries. In Peru, quality varies, with private providers generally offering better services but higher costs. The public system struggles with strained resources, fragmented communication, and long waiting times for appointments and procedures. Aspects of public health vary between the U.S. and Peru; having first-hand exposure to a foreign system will be beneficial in my studies moving forward. One challenge I faced while being in South America was the language barrier. In high school, I had taken German classes; therefore, I knew little to no Spanish when I entered the internship. This was my biggest worry before leaving for Peru; I was concerned about how I would communicate with/understand patients and the medical professionals I would be working with. Oftentimes, I was paired with someone in my cohort who spoke or understood Spanish proficiently, but there were a few days I was alone in the clinic. Being in this position allowed me to push myself and become creative in my communication methods. I always had a translator app pulled up on my phone to help me understand what was being discussed between the medical professional and the patient. Although sometimes inaccurate, having a translator gave me a general idea of what was going on and allowed me to engage in the consultation versus just observing. I also learned that hand gestures were a fun way to communicate, especially in pediatrics. After taking the provided Spanish classes and being surrounded by so much Spanish, I am more confident in my Spanish understanding skills. Language barriers are something I am likely to face again while working in the medical field. The skills I gained from this experience will allow me to navigate those situations better and communicate smoothly in the future. My favorite part of the internship was the day we visited the rural town of Casacunca and set up a Community Medical Clinic for the town's residents. This was when I applied my learnings from our Clinical Simulation Sessions at the Hospital Nacional Adolfo Guevara Velasco – EsSalud. After being taught how to perform an initial patient workup, being able to apply it hands-on with real patients made it a full circle. During the clinic, we saw many families with young children, the majority of whom presented symptoms of anemia. Poor appetite, fatigue, and slowed development were all prevalent when doing initial work-ups. Anemia is an indicator of poor health and nutrition (International Medical Aid, 2024), therefore coinciding with the fact that these patients live in a rural area with a lack of resources. My most memorable patient interaction was with a 60-year-old male who came to us with upper left leg/hip pain. He presented with an X-ray of his hip from 2019 that showed a clear fracture in his right hip. Without updated scans, we couldn’t determine the state the fracture was in, so we diagnosed him with atrophy. All we could do was suggest that he go to Cusco for new scans, a hip replacement consultation, and prescribe Meloxicam to help manage the pain. While conducting a physical exam, we noticed worrisome symptoms such as severe hand tremors and a fixation of the eyes. These symptoms suggest that the patient likely has Parkinson's disease, but without an official neuro exam, this could not be confirmed. The reason this patient stood out to me was that it put into perspective how many people struggle with underlying symptoms but never receive the opportunity to be treated due to location and resources. Although it was sad to see struggling patients, this was such a rewarding and fulfilling day. Being able to treat those who needed help confirmed my love for working within healthcare and pushed my drive to continue down this path. Overall, my time spent with International Medical Aid in Cusco will be something I always remember. Whether I was attending Spanish class, exploring local markets, shadowing in the hospital, or giving health presentations to children, I was always learning and exploring. I not only achieved the goals I had set for myself, but I exceeded them. In just three short weeks, I watched myself grow as a person and became even more passionate about pursuing a career in medicine. Being in Cusco changed my outlook on not just the medical field, but life in general. Every chance I had to immerse myself in the Peruvian culture, I took it, and I am grateful I was given opportunities to do so. In addition, having first-hand experience in another healthcare system has helped me make connections between things I am learning in school (public health classes) and real life. All in all, this internship has taught me many things, and I can’t wait to take those learnings into my future endeavors, whether that be school or a career. It truly was a once-in-a-lifetime experience, and I forever have IMA to thank for that.

I honestly loved it there. If I could, I’d do it often. The food was delicious, the people were very welcoming, the hospitality was outstanding, and the team of mentors we had were super great (I don’t think we could’ve asked for better ones). I learned so much; everyone was so insightful, and the doctors and even patients were super nice and open to letting us learn everything. The treks and tours we took were so good and educational (the tour guide we had was amazing, I loved the guy). Overall, a 10/10 experience—if it wasn’t as expensive, I’d do it all the time. I did the city tour and the museum walk and honestly it was so good. The tour guide we had explained everything in so much detail; we could tell he enjoyed doing what he was doing. What we saw was beautiful, and the amount of culture we saw was incredible. “Lub dub, lub dub, lub dub” were the sounds echoing in my ears as the people around me walked up to their gate waiting to board their plane. “Lub dub, lub dub, lub dub” were the sounds I was so sure everyone around me in the JFK airport could hear as I stared at that text message wishing me a safe flight. Beads of sweat started to form on my forehead as I sat there deaf to my surroundings but painfully aware of the sounds my heart was making. Being anxious was usual for me; however, traveling to a new country where I knew absolutely nobody was out of the ordinary. New levels of anxiety were reached that night, and the pounding of my heart was the only thing that brought me comfort. I was sure all the anxiety would dissipate the moment I landed back in New York after the two weeks of interning; however, I was proven wrong. From the moment I heard the first “lub dub, lub dub, lub dub” coming from the stethoscope and not my own chest, I knew I was exactly where I was supposed to be, and this realization excited me and calmed me down. Interning in Peru was an eye-opening experience where I learned what it would've been like to grow up in South America (I’m from Ecuador) and receive medical care. I learned a lot about the people in general and how a different environment (altitude, vegetation, climate, etc.) can have different effects on their bodies and lifestyles. I learned how medicine is practiced and, most importantly, the sanitary precautions doctors take on a day-to-day basis. I learned the difficult choices that are made when there is a lack of resources. And last but not least, I learned the difference between having money and not when it comes to getting better healthcare. Cusco is at 3,400 meters above sea level, it has a dry season and a wet season (while I was there it was dry season), and some of the common food items are potatoes, pasta, corn, and rice. These aspects of Cusco shape the lifestyles of the people and that influences their health. When I was doing hospital rounds my first week in Peru, I noticed a peculiar pattern; most of the people going to see the doctor had hypertension (high blood pressure) or diabetes. As I was taking their blood pressure, one after the other I would see blood pressures like 148/90, 160/95, and even one that reached 177/89 (this one was due to not taking medication). Curiosity got the best of me, and when I was with the nutritionist we discussed some of the causes for hypertension. She explained to me that most people have hypertension and/or diabetes because of their diet. Since Cusco is so rich in grains like potatoes, rice, and corn, and their gastronomy includes a lot of pastas, most of the people eat that and don’t watch the amounts they eat. Poor diet quality alongside the low intake of healthy food groups eventually leads them to develop conditions like hypertension and/or diabetes (Tarazona-Meza et al., 2025). As well as this, the people were not very trusting and/or educated about the medication for these conditions and were stuck in their old ways, so many of them did not take them as directed by their doctor. Additionally, with Cusco being at such high elevations, the UV rays coming from the sun are hitting the people more directly and intensely. With this said, when we did the mobile clinic in Maras, I made another peculiar observation. Many of the younger women that came to see the doctors did not appear their age. Most of the population in Maras did outside field jobs, so they spent most of the time under the sun. When they came in to get checked, women in their 20s looked like women in their 30s or 40s. Being under the sun and the lack of sunscreen affected their skin and made them appear older than they were. Following this, I also learned the differences between the sanitary precautions they take in Peru versus the ones in the United States. My first observation was made in the ESSALUD hospital in Cusco while doing rounds in the general medicine area; I noticed that all doctors wear masks during consults. From the nutritionist to the general medicine doctors, there was not one nurse, doctor, patient, receptionist, security guard, etc. that wasn’t wearing a mask. On the contrary, in the U.S.A., when you go to any doctor’s office, after COVID it is recommended to wear masks but not everyone does it. I’ve had my gynecologist not wear a mask during my consults. In Peru, masks were enforced. Another key difference was the sanitary precautions taken—or the lack of sanitary precautions taken—in between patients. In Peru, I noticed that in between patients there was no attempt to clean and sanitize the bed where the previous patient was seen. They would have a blanket-type cover on the mattress but it would not get changed in between patients. There was one instance where a patient (female) walked in with a cold; she was coughing all over the place and she sat on the bed and coughed on it. After her, we had a patient come in to discuss his lab results and sit on the same bed. The lack of sanitation could have resulted in the patient coming in for the results to get sick just by sitting on the contaminated blanket. On the other hand, in the U.S.A., after every patient, I see the medical assistants or nurses or PAs sanitize the space. When I go to my primary doctor, they have the paper lining on the beds and after every patient, they change it and sanitize the bed. Furthermore, I noticed that in Peru they don’t wear gloves when working with needles. For example, I was doing rounds in the Geriatrics department when I was taught to take the glucose level of the older patients. When the nurse was showing me, she took the needle with no gloves and took a tiny blood sample to check the glucose levels. It was a culture shock to me because I had never seen anyone take blood samples of any kind without gloves. In the U.S.A., when taking blood samples, every doctor, nurse, PA wears gloves. Furthermore, during my internship I learned that the lack of resources has a great impact on the quality of care patients get in Peru. From my observations, I noticed that the hospital lacked newer equipment, they ran out of instruments such as lancets at times, and/or they didn’t have the facilities to take care of some patients’ needs. For example, while working in the Geriatrics department, I noticed that we ran out of lancets often. We would have to ask the nurses to get them for us, and there was one time we were told there were none left, that the delivery wasn’t in yet. This caused a lot of time to be wasted and the patient care decreased (seeing how some of them had to wait for longer periods of time). Additionally, when I did rounds in the ultrasounds section, the machine stopped working for a while. It was a really old machine and definitely not up to date (the doctor even explained that it wasn’t the first time it had happened). This also decreased patient care because time is not cheap for people. They take off from their jobs to get examined, and when the hospital is not up to par, time is wasted and so is money. Alongside this, when we went to Maras, we didn’t have a lot of the medication people needed. The people would get prescribed medication to treat their illnesses; however, we couldn't provide that at our makeshift pharmacy, so they had to walk out of the consult with no medication. Because we couldn't provide these basic medications, patients had to buy it from private sellers at unaffordable prices (Herrera-Añazco et al., 2021). Having money in Peru also had a huge impact on whether you got better healthcare than others. With having money comes great benefits, such as being able to afford private clinics where the equipment is up to date, medication is available, and being able to travel further distances for better care is not a big issue. However, that is not the case for most people in Peru. Most people have access to some type of healthcare; however, it is not what it should be. The waiting times for people to be seen are ridiculous (one patient had to wait more than 6 months to get an appointment to be seen), the equipment in the public hospitals and clinics is not well equipped, and people can’t travel far to be seen because of their jobs. When we went to Maras, most of the people we saw had not been seen by a healthcare professional in years. Maras is a couple of hours away from the main city and it doesn't have a main hospital facility like ESSALUD, so going to one was expensive. The lack of money, long waiting times, main hospitals being too far away, and being uninsured prevents the people from having access to better healthcare (Aguirre Martens, 2023). With everything that I observed and learned in those two weeks, the drive towards my future goals only got strengthened. When I’m older, I hope to join a non-profit organization (like Doctors Without Borders) and/or create my own to help countries that lack the resources that prevent their people from good healthcare. My perspective on how the world is has definitely changed because I am no longer trapped in a bubble that keeps me from seeing how not every country is like the U.S.A. I plan on using what I learned to be more sympathetic towards others and understand that not everyone has it like me. I know that with this newfound knowledge I will become a great surgeon, one that isn’t about the money but is all about the people. “Lub dub, lub dub, lub dub” are the sounds that I hear in my ears at the moment, but it’s not anxiety-driven; it’s from the excitement of knowing that soon I will be out there in the world applying what I learned and educating others for a better future in healthcare worldwide.

I truly had such a great experience. All the staff were incredibly kind and willing to help us 24/7. The food was amazing, and I still miss it. Overall, my favorite part of the three weeks was the community we built together. We all became so close in such a short time, and everyone was truly inspiring. I am so grateful to International Medical Aid for giving me this experience and introducing me to people who I know will continue to be a part of my life.

I truly enjoyed my time in Peru. It was fulfilling and humbling being able to experience all the amazing people there. Their kindness does not go unnoticed. Being able to practice my Spanish was also a highlight of my time. The staff was so amazing. I did become ill but they were my home away from home. Being able to experience the culture was great. I felt safe throughout the entirety of my stay. My roommate was great, and while it was a bit challenging going to sleep with someone who had different sleeping habits, it helped me become more flexible and understanding. Being able to serve was my favorite part and the hospital staff was amazing. I truly learned so much intellectually and hands on. I would do it again if I could and it is my wish to return again. I can’t wait to see all those kind people and smiling faces. Volunteering at EsSalud Hospital in Cusco, Peru, was an eye-opening and humbling experience that deeply impacted me as a pre-medical student. I learned the importance of patient-centered care, especially in a setting where resources were often scarce and the system faced numerous challenges. Greeting patients with warmth and empathy was crucial, as many came in distressed and vulnerable, some crying due to their diagnoses, such as cancer. I was struck by how patients, despite their struggles, greeted me with gratitude and trust. I had the opportunity to wash feet and clean wounds, which was humbling, as I had never experienced such intimate and personal care before. Seeing the everyday resilience of people enduring conditions like osteoporosis, respiratory problems, and parasitic infections opened my eyes to the vast difference in healthcare challenges between the U.S. and Peru. I realized that though my contributions were small, they meant so much to these patients, who were often at their lowest. This experience fueled my passion to serve others and deepened my desire to become a doctor. It was both challenging and inspiring to witness the limitations of the healthcare system in Cusco, especially when many patients came in with conditions that could have been easily prevented or treated with more resources. However, I left with a renewed sense of optimism, believing that change is possible, both in the U.S. and abroad. The cultural richness of Cusco, the kindness of the people, and the everyday struggles they faced shaped my perspective on medicine. It reinforced that being a doctor is not just about treating physical ailments, but about providing comfort, support, and hope to people in their most vulnerable moments. This experience made me more excited about pursuing a career in medicine, committed to making a difference not just through medical knowledge, but also through compassion and service to those who need it most. Healthcare systems vary significantly across the world, influenced by economic resources, government policies, and cultural factors. Comparing the healthcare system in Cusco, Peru, to that of the United States highlights important differences in accessibility, quality of care, and cost. While both systems strive to provide essential medical services, they differ in their infrastructure, affordability, and overall effectiveness in addressing public health needs. One of the most notable differences between healthcare in Cusco and the United States is the level of infrastructure and accessibility. In the U.S., healthcare facilities are generally well-equipped, with advanced medical technology, specialized hospitals, and a wide network of healthcare professionals. However, access to this care depends on factors such as health insurance and socioeconomic status, and many Americans struggle to afford medical treatment due to the high costs associated with private healthcare. In Cusco, healthcare infrastructure is more limited, particularly in rural areas. The city has public hospitals, private clinics, and smaller community health centers, but many lack advanced medical equipment and specialized services. Rural communities surrounding Cusco often experience difficulties accessing healthcare due to geographic barriers and a shortage of medical professionals. The Peruvian government provides public healthcare services through the Seguro Integral de Salud (SIS), a program designed to offer free or low-cost medical care to low-income individuals. However, overcrowding in public hospitals and long wait times are common challenges. Quality of healthcare in the United States is among the highest in the world, particularly in specialized treatments and medical research. Patients have access to cutting-edge treatments, highly trained medical professionals, and state-of-the-art facilities. However, the quality of care often varies depending on factors such as location, insurance coverage, and financial means. Wealthier individuals have access to top-tier medical institutions, while lower-income populations may struggle with limited options and high costs. In Cusco, the quality of healthcare varies significantly between public and private facilities. Private clinics often provide excellent services, shorter wait times, and more modern equipment, but they are expensive and inaccessible to many residents. Public hospitals, while affordable, often face challenges such as understaffing, outdated equipment, and shortages of medication. Traditional Andean medicine also plays a role in healthcare in Cusco, with some individuals relying on herbal remedies and indigenous healing practices alongside modern medicine. One of the most significant contrasts between healthcare in Cusco and the United States is cost. The U.S. has one of the most expensive healthcare systems globally, with high insurance premiums, medical bills, and prescription drug costs. Many Americans rely on employer-sponsored insurance or government programs such as Medicare and Medicaid, but uninsured individuals face significant financial burdens when seeking medical care. Medical debt is a common issue, even among those with insurance. In Cusco, healthcare is generally more affordable, especially within the public system. The SIS program provides free or low-cost medical care to those in need, and out-of-pocket costs for medical services and prescription drugs are significantly lower than in the United States. However, the trade-off is that public healthcare services are often underfunded, leading to resource shortages and long wait times. Private healthcare in Cusco offers higher-quality services but is costly, making it inaccessible to many lower-income residents. The healthcare systems in Cusco, Peru, and the United States reflect the broader economic and social structures of their respective countries. While the U.S. offers high-quality medical services, its system is expensive and can be inaccessible to those without adequate insurance. Cusco, on the other hand, provides more affordable healthcare options, but with limitations in infrastructure and quality of care. Both systems have strengths and weaknesses, highlighting the ongoing global challenge of balancing accessibility, affordability, and quality in healthcare. Overall, there is no better feeling than holding the future of the world. I always envisioned my life as an anesthesiologist, but holding those babies truly warmed my heart. The idea of watching these little humans grow into adults sounds so fulfilling. If the opportunity ever arises, my only goal will always be to serve, be an advocate for my patients, and spread endless amounts of love with every patient I meet, no matter what specialty I go into. I know that is my purpose here. I know now that there is no language barrier to love and care. I know that cultural differences can bring people together. Leaving my little island and traveling was the best decision I could make. Seeing how a “buenos días” and a smile can light up a whole room was my awakening. Leaving with so many hugs from patients and hospital staff warmed my heart more than anything else. Until I return to Peru again, chao! Be sure to look out for the traveling doctor.

I had a great experience during my Pre-Medicine Internship with IMA in Peru. It was wonderful getting to learn the history of Peru, Cusco, and the healthcare system. I enjoyed trying new foods and drinks that are not common or available in the U.S. My mentorship was spectacular—every doctor took the time to answer my questions and explain everything in detail. The directors and other staff were amazing. They always put our safety and health first, while also ensuring we had a truly wonderful experience. Our days in the clinics were informative, and our leisure time exploring Cusco was exquisite. I was greatly impacted by learning about the state of Peru and the people living there, and I will carry these lessons with me for the rest of my life. I truly consider the directors of the program friends in another part of the world.

I had a truly memorable experience in Peru. Every single aspect of the program was meticulously planned, and everything ran smoothly. All of the mentors were very helpful, concerned for our well-being, and in constant communication with us. They also interacted with us in a way that showed they were our friends rather than our superiors, which is something I greatly appreciated. The accommodations made me feel right at home and safe, and we had a variety of food that was always very well prepared. With regard to the clinical aspect of the program, all of the physicians were more than happy to answer any questions and ensured that we understood what each patient was dealing with by giving us a short debrief after every consult. From teaching kids about oral hygiene to setting up a clinic in a rural community, I felt we had a tangible impact on the community, which was a very fulfilling part of the program. All of the students we presented information to were excited to learn, participated in answering questions, and were grateful. The clinic we set up in the rural town was an eye-opening experience where we saw differences in resources between the city and rural communities firsthand. Overall, I am grateful to have been given the opportunity to spend three weeks in Peru, where I learned so much about the culture, people, and healthcare system and met some amazing people. Thank you, IMA! The touch of the textured ice cream cone, taste of vanilla, aromatic scent of waffle cones, sound of laughter, and sight of good company are what my senses were occupied with on my last night at home before embarking on my journey to Peru. My friends and I went to Graeter's Ice Cream, a local chain, after our weekly Friday night dinner at Buffalo Wild Wings. After enjoying our time together and finishing off the last of our sweet treats, we began to say our goodbyes, at which point one of my friends asked me, “So Arya, what exactly are you going to be doing in Peru?” I responded, “I am honestly not sure.” That was the truth. Although I had a high-level idea about the program, I did not know what to expect. It only occurred to me when my friend questioned me that the familiarity of home was about to disappear. So much, if not every aspect, of the trip was unknown to me at the time. Where was I going to be living for three weeks? How were the other members of my cohort going to be? Were the hospital staff going to be friendly? Was it even going to be worth it? As I continued to ponder these questions while driving home, I quickly realized I had adopted the wrong mindset. I knew that the best course of action would be to embrace the uncertainty rather than be so worried. Instead of going to sleep nervous that night, I went to sleep excited in anticipation of what was to come. The next day, I went on a last-minute shopping spree before I gathered my belongings and headed to the airport with my parents. The process at the check-in counter felt familiar, as my family and I travel to India every year to visit our extended family, but my dad always takes care of our passports and ensures our bags arrive with us. This time around, I was responsible for everything, which was a bit daunting, especially considering the number of times my parents reminded me not to lose my passport. After checking in my bags, my family and I approached the security line where we exchanged hugs and bid farewell to one another. The journey to Peru itself had a couple of challenges, as a flight delay and long immigration line caused me to miss my connecting flight from Lima to my final destination of Cusco. However, nothing could have taken away from the beauty of Cusco after seeing the vibrant city tucked in between the vast mountainous terrain upon exiting the airport. Immediately, I felt a sense of comfort after being greeted by our mentor Cynthia and meeting some of the other interns. Following our arrival at the accommodations, becoming acquainted with the other interns and mentors, and listening to a presentation about the structure of the program, I went to sleep that night knowing I would not regret coming on this trip. The very next day, we were given a very informative tour of the city by our guide Hans Ramirez. In addition to seeing Sacsayhuamán and preparations for Inti Raymi, one notable attraction that we visited was the San Pedro Market. Here, Hans invited us to try various local delicacies including pan chuta and cherimoya. Hans also stated that the use of naturally derived medicine, such as herbs and fruit, to treat various ailments is very common in Peru and originated from Incan practices. For instance, all of the interns were recommended by our mentors to drink coca tea, made using coca leaves, to help with altitude sickness. I greatly resonated with this aspect of Peruvian culture, as being of Indian descent has given me the opportunity to experience such natural methods of healing firsthand. For example, my mother would always combine ginger juice and honey to cure congestion or a sore throat throughout my childhood. In fact, there is a natural system of medicine that originated in India thousands of years ago known as Ayurveda. Generally though, many Western communities heavily rely on the use of synthetic products instead of natural remedies due to what seems like the widespread belief of most Americans that only medications made in a lab by professionals have the ability to produce tangible results. After a very thorough acclimation to the city and its rich history, I was excited to begin shadowing physicians at Hospital Nacional Adolfo Guevara Velasco–EsSalud. The following day was my first day rotating in EsSalud, where I would spend the next three weeks learning a plethora about healthcare in Peru through my time in the gynecology, nutrition, general medicine, geriatrics, obstetrics, and nursing departments. My first realizations were the stark contrast in the structure and organization of EsSalud compared to similar facilities in the United States, as well as the widespread use of paper over electronics for many processes. At EsSalud, patients would come to practitioners who were situated in their own rooms, which was a foreign concept to me considering it is the other way around in the United States where patients are ushered into their own rooms by nurses and assessed by providers who come to those rooms. As a matter of fact, it is a common practice for nurses in the United States to make initial contact with a patient to obtain various pieces of information related to the patient’s health including weight, a baseline set of vitals, relevant history, and the patient’s reason for visiting depending on the type of doctor the patient has come to see. At EsSalud, on the other hand, the doctors had to assume the role and responsibilities of a typical nurse in the United States by discerning the patient’s motivation for seeking a consultation through analyzing signs and symptoms, as well as taking vitals including blood pressure and blood glucose if necessary, which we, the interns, would often assist with. I was also surprised to witness the lack of supporting personnel for physicians at the O2 Traveler’s Clinic, a private medical center that I had to visit after experiencing throat pain and general malaise. The practitioner who examined me took care of everything from asking me about the onset of my symptoms and the quality of my pain, to writing down everything I was saying, conducting a physical exam, and prescribing medication. On a related note, patients receive prescriptions and referrals to other doctors on paper. This was interesting since everything that occurs after visiting a doctor in the United States is done electronically and essentially taken care of automatically. Patients simply have to pick up prescriptions from the pharmacy and attend any follow-up appointments if necessary. Patients in Peru, on the other hand, have more responsibilities when it comes to keeping track of their medical records, which can make organization especially important. On the topic of comparing EsSalud and the O2 Traveler’s Clinic, it is important to understand the composition of the healthcare system in Peru and the United States, both of which are separated into public and private sectors, to put differences into context. In Peru, the public sector includes the Ministry of Health (MINSA), EsSalud, Armed Forces, and National Police. MINSA is responsible for providing health services to around 60% of the population, especially individuals who are uninsured, while EsSalud covers those who are formally employed. The Armed Forces and National Police provide their own services to members. The private sector is comprised of for-profit and nonprofit organizations that provide services to people who can afford them (Borgen Project, n.d.). Similarly, in the United States, federal programs including Medicare, which supports the elderly and those with disabilities, and Medicaid, which covers low-income individuals as well as people with disabilities, make up the public sector. The private sector consists of private health insurance companies which are subsidized in many cases by employer-sponsored group plans (Commonwealth Fund, 2022). While it may seem like both countries have their bases covered, that could not be farther from the truth. A report published by The Commonwealth Fund in 2014 states that the United States struggles with disparities in health outcomes, service quality, and access to care despite the country’s healthcare system being one of the most expensive in the world. This report highlights the need for systemic reform, as well as improving access, efficiency, and equity due to high out-of-pocket expenses and insurance costs limiting access to care (Commonwealth Fund, 2014). Similarly, a study done by the World Bank describes how the fragmentation of Peru’s healthcare system, due to the number of entities providing services and challenges associated with administering care across an often remote landscape, has resulted in uneven access to healthcare as well as disparate health outcomes. This study also discusses the importance of providing access to healthcare to remote communities where infrastructure is subpar, as well as the lasting out-of-pocket payments for certain portions of the population despite the implementation of the Comprehensive Health Insurance (Seguro Integral de Salud, or SIS), a publicly funded insurance program that aims to help the poor. Some solutions the study offers include improving the quality of care through reforming each health sector in addition to addressing coverage, access, quality, and financial protection to achieve health equity for all (World Bank, n.d.). Various practitioners that I shadowed at EsSalud emphasized the prevalence of such issues. For example, Dr. Fabricio Wiesse explained to us during lecture that Peru lacks sufficient laboratory resources, resulting in doctors having to rely heavily on interviewing patients and conducting physical examinations to arrive at a diagnosis. Another provider stated that there are not a lot of specialized doctors in Peru and that the country does not have the resources to produce medications that many patients need. The same doctor went on to say that the only way to obtain such medications is by leaving Peru, and the pension that people get paid is not very high, which can make access more difficult. Another physician told us that emergency rooms in Peru are very busy, and people who have conditions that can be treated during a consult at a hospital such as a headache sometimes go to the ER, which can make it harder for people with life-threatening emergencies to be seen quickly. The same practitioner also talked about how patients with chronic conditions like diabetes are prescribed medicines for three to four months but have regular checkups to ensure their condition is being controlled since some patients sell their medication. Despite being faced with a lack of resources and strenuous circumstances on a daily basis, the providers at EsSalud are truly admirable for upholding their promise to provide the highest quality care to their patients. They showed me the importance of being adaptable in an ever-changing environment as a doctor regardless of the location, resources, and facilities. As I continue to pursue my career in healthcare, my experience in Peru has further motivated me to focus on acquiring knowledge and skills that could be applied in different parts of the world. This would enable me to benefit a larger section of the global population when opportunities arise for me to work outside the United States. In addition to learning about the use of natural resources to treat ailments, other aspects of Peruvian culture became apparent while shadowing at EsSalud. One such characteristic is the unique relationship between physicians and their patients. At EsSalud, practitioners and patients would treat one another in a manner similar to that of family members or loved ones, which was heartwarming. During a rotation in the adult infirmary, we learned that it is common for people in Peru to be hypertensive due to the excessive consumption of salt. However, such dietary habits are hard to break since they are passed down from generation to generation and influenced by tradition. Seeing the uniqueness of Peruvian culture and even its impact on the health of the population reinforced how vital it is to have excellent bedside manner as a provider in order to make sure the patient knows they are being heard. In addition, being empathetic will allow me to make my patients feel like they are in a safe and comfortable environment to express their concerns. It is also equally as important to be culturally sensitive and take certain lifestyle choices into account when developing a treatment plan for patients. For example, it is common practice for people in Peru to consume their prescribed medication after breakfast and lunch since dinner is not often eaten. Being culturally competent will help me develop trusting relationships and optimize the experience for my patients. One of the most memorable parts of the trip was the clinic we set up in Mollepata, a mountain town around two hours away from the city of Cusco. Here, we were able to see firsthand the healthcare inequities between urban and rural communities. One such disparity is the severe lack of certain medications in rural areas of Peru. There was one instance where a patient needed a specific medication that the physician was not able to prescribe because that medication was neither one that we had brought with us nor was it one available in Mollepata. In addition, patients who were told to get imaging taken or received references to see specialized practitioners needed to drive two hours into the city due to the lack of such resources in the town. One unique case that I observed was that of an older gentleman who came into the clinic with fungus on his hands and a respiratory condition. It was sobering to see his condition, especially when considering the amount of time and energy it would take for him to receive the proper treatment. In spite of such challenges, it was fulfilling to have a tangible impact on addressing the issues affecting rural communities, no matter how small, as it is important to remember that change is enacted by taking small strides. My experience in Mollepata helped me understand how crucial it is to consider how I can have a positive impact on communities that are in need. One way of doing this is by not focusing only on jobs in urban locations, but also seeking out employment opportunities in areas of the country where there is a dearth of medical professionals. It goes without a doubt that cities generally have more resources to provide high-quality care compared to rural communities. Therefore, working in these areas would provide me with the opportunity to administer the same quality of care found in cities to individuals dealing with critical issues, as well as a greater sense of fulfillment. Mollepata also highlighted the necessity of community-based health education in order to provide people who do not have access to the same resources as their counterparts in the city with relevant information on how to protect themselves. The idea that caring for the well-being of patients as a practitioner does not end when they exit the room has motivated me to find opportunities that will allow me to act now and educate disadvantaged groups. Overall, I am very grateful for the time I spent in Peru, as it has opened my eyes to the similarities and differences in healthcare between the United States and other parts of the world, as well as how each country can learn from one another’s systems. My experiences have certainly altered my perception of what characterizes a good provider and have provided me with a clear-cut example of the type of doctor I want to become: one that is culturally aware, adaptable in the face of adversity, and focused on having the largest impact, taking after the meritorious professionals at EsSalud. I hope to live up to the words of Dr. Wiesse, who on our last day affirmed, “I might not be the best doctor in the world, but my patients know that I care for them.”