International Medical Aid (IMA)

This program blew my expectations out of the water. I was prepared to be challenged physically and mentally since I was visiting a new country. Still, the only mental and emotional challenge was at the hospital which was to be expected. However, for the rest of the program, I felt relaxed and eager to participate in any activities. I felt extremely safe, probably because I remained in a large group. I also expected the accommodations to be less lovely. The house itself was spotless and secluded, and I was blown away by the efficiency and attentiveness of the house staff, who cleaned our rooms and did our laundry. I expected to lose weight since I am a picky eater, but I didn't. The chefs and the kitchen staff cooked some incredible meals, and the food was delicious (breakfast could be improved a little). I loved that the program always had something planned and scheduled. I was never bored and felt like I could make an impact on the community, which was a big goal of mine on this trip. There was good variety between each outreach trip and trek, and this program did a great job of acclimating each new group to Kenya. I genuinely could not have asked for a better experience. I wish I knew how amazing the trip was going to be so that I could have stayed longer. It is hard to perfectly articulate exactly what it felt like to experience and encounter Kenya. Words fall short when trying to capture the feelings I felt. I was aware that I had lived and grown up in a safe little bubble, but I was not prepared for what it would be like to take off the filter. This trip stretched me in every way possible and in the best ways possible. I met and interacted with people of varying religions, backgrounds, cultures, and ethnicities; some of which, I had never been exposed to before. All of whom, were the most welcoming and most kind individuals I had ever met. Everyone laughs and smiles so easily, something that is not as commonly seen in the United States. Some of the kindest individuals had the poorest backgrounds and lived very challenging lives. However, I noticed that the Kenyans chose not to focus on what they were lacking but remained grateful for what they did have. Kenyan culture does not promotes a “more is better” mentality like the United States because the majority of the population do not have the luxury of obtaining anything more than the necessities. Therefore, I noticed many people found contentment in the little things, like spending time with friends or family, being physically healthy, and freedom in their religion. This trip put into perspective how much I take for granted, and shadowing at Coast General Teaching and Referral Hospital bolstered that sentiment. As a public hospital, it saw and cared for some very ill and poor individuals. This hospital has absolutely no comparison to any I have ever experienced in the United States. Despite the meager resources, each clinical officer, medical officer, intern, and nurse put their heart into caring for each and every patient. The hospital is federally funded; however, few national funds are allotted for public healthcare which means that many times the health care professionals were either being underpaid or not paid at all. Even though this may seem counterintuitive, many of the hospital staff continued to work overtime or with minimal pay. I learned that many of the staff were driven to work due to their heart to serve and not for the monetary gains of the job. One specific nurse working in the Comprehensive Care Clinic confided that she cared for others because of her strong faith in God. She wanted to live as Jesus would and believed that the reward she would receive from God would be greater than any purchase that money could buy. She taught me how important it is to be grateful and to remain grounded in life. I also learned a lot from shadowing in the pediatrics unit. Not only are the children fighters, but the mothers have such strength and composure. The mothers are there every hour of the day taking care of their children and giving them comfort. Most of the children, even the ones with chronic diseases remain in high spirits. I loved interacting with the children and playing with them. Despite having IVs strapped to their hands, they loved to laugh. One girl in particular had been staying at the hospital for seven months. She was diagnosed with a cancer that affected one of her eyes and had started to move into her brain. After months of radiation and chemotherapy treatment, the cancer had been contained to her eye. However, she was the most joyous of all the children in pediatrics. I would see her every day running around with a smile on her face. Hearing her laugh was medicine for the soul. The good natured and carefree spirits of the children taught me so much about how I want to approach situations in the future. Despite the challenges and rejections I expect to face in the future, there is always something to smile about and be thankful for. The ability to persevere through life with a smile on my face depends on my perspective. It’s easy to become discouraged or focus on the negative, but at the same time, there is also always something to be learned and gained from every situation. As I said, it’s all about perspective, and I have learned so much from the positive perspective that the children and mothers maintain throughout their hospital stay. I also became much more knowledgeable about the healthcare system in Kenya after shadowing multiple different medical officers and medical interns. Especially in the pediatrics unit, I was working with a medical officer who had just graduated from medical school, so she and I both were learning as we saw patients. I learned how to determine if a patient has cardiomegaly from an x-ray. I read the difference between Hodgkin’s and non-Hodgkin’s lymphoma and how each is classified. I learned that malnutrition is a leading cause of skin diseases in children. I also learned the normal respiratory rate for children at different ages, and these are just a few of the many topics where I was able to expand my medical knowledge. As I continued to observe in the hospital, at times, I realized that the lack of resources makes it difficult to perform the necessary tests and implement the best treatment. This seems to be common for public hospitals. For example, there are limited sizes of needles, so I watched as a nurse attempted to insert an IV catheter in an infant with a needle that was much too big for the baby’s veins. At another point, I observed another nurse trying to take the blood pressure of a child with the same size cuff that would be used for an adult. Because there is a lack of necessary resources or a variety of instruments, the hospital practices are much more tedious and difficult to perform. However, each medical professional gives their best with the equipment they are afforded. I learned in one of the lectures that the Kenyan government allots a smaller percentage of the general government expenditure on healthcare than the United States. While the United States allocates 22.502% of the general government expenditure on health, Kenya only allocates 8.549% indicating that the financial resources for public hospitals is much more limited. The Kenyan budget is much more focused on infrastructure. Also, much of the funding is funneled into interventional care instead of into primary healthcare services, and most of the health care workers are in the private sector due to better pay and environment leading to low retention and lack of physicians at public hospitals. Unfortunately, the number of healthcare workers in the public and private sector only totals 78,7111 people for a population of 47.8 million citizens. This means there is a ratio of 16.5 health care workers per 10,000 people which is much lower than the recommended ratio of 23 per 10,000 by the World Health Organization. Therefore, there is not enough staff in order to properly treat each individual leading to poor patient outcomes and more incidences of negligence. There is especially a lack of psychiatrists even though 1 in every 4 Kenyans suffer from a mental illness during their lifetime which means that about 12 million Kenyans are affected. In Kenya, there is a total of about 92 consultant psychiatrists and 327 nurses with most based in urban cities. There is even a limited number of psychiatric hospitals and bed space for treatment with only 19 mental health hospitals in Kenya. Meaning that many people suffering from mental health illnesses will go untreated. Despite the lack of funding and resources, there have been some recent improvements to the healthcare system. Kenya’s Vision 2030 plan that launched in 2008 seeks to “deliver sustainable healthcare development that assures equitable, accessible, affordable, and quality health for all populations despite their location in the country”. Another project called the Healthcare Transformation Program was launched in 2015 which aims to decentralize healthcare services so that local counties are able to make health care decisions for their area instead of the federal government. This allows the citizens to have a louder voice in healthcare decision making locally. Also, preventative screenings have become more popular in order to diagnose and treat diseases at an earlier stage which reduces hospital costs later down the line and decreases patient mortality rates. Coast General has seen some of these program goals materialize in the past few years. They have a modern cardiac center, radiology facility, intensive care unit, and improved operating room technology that allows for high risk surgeries; however, there are still many parts of the hospital that have yet to be improved. However, progress is progress, and any small improvement is welcome. Despite some improvements in the healthcare system, Kenya still has a high disease burden meaning that thousands die each year from diseases that can be prevented or treated. The disease burden is the amount of life that is lost due to a disease compared to an individual’s life expectancy. Some of the most common preventable diseases is HIV/AIDs, diarrhea, and respiratory infections. HIV/AIDS is the leading cause of death in Kenya with about 1.5 million people living with HIV. HIV, human immunodeficiency virus, is caused by a retrovirus that attacks and kills the CD4 white blood cells that work to fight infections and disease. Because HIV decreases the amount of effective white blood cells, the individual is much more prone to contracting other diseases that could be deadly since the individual is unable to mount a proper immune response. HIV is mainly spread through blood and unprotected sex; therefore, educating the general public about ways to prevent spreading HIV could prove very effective. HIV is especially prevalent in Mombasa, contributing to about 3.6% of the total Kenyan population with HIV. However, there have been improvements in HIV treatment and spread prevention. Antiretroviral treatment is now free in public hospitals and the majority of the medicine is donated by the USAID. While I was shadowing in the Comprehensive Care Clinic, all of the patients coming in with HIV had such a low viral load that it was undetectable by the system, meaning that the patients were all receiving medicine and taking it as prescribed. If an individual with HIV maintains a low or undetectable viral load, this greatly reduces the risk of HIV transmission. Malaria also has a high prevalence in Kenya. An individual can contract malaria via a female mosquito infected with a Plasmodium parasite. One day, when shadowing in the pediatric outpatient clinic, I learned that if a fever is detected in a child, malaria is the first suspected cause. Non-communicable diseases also play a large role in the high disease burden. These include cardiovascular disease, diabetes mellitus, cancer, hypertension, mental disorders, and injuries, for example. Non-communicable diseases are responsible for 27% of total deaths in Kenya and seems to be on the rise. Cardiovascular disease and cancer have the highest mortality rates. An individual with untreated HIV is more likely to contract cancer, non-Hodgkin’s lymphoma, Kaposi sarcoma, and cervical cancer. I also learned that there are a lot of unnecessary deaths due to the lack of health care literacy in Kenya, meaning that the general public is not properly educated about the system. There are many stigmas and rumors about hospitals that are not true. For example, some people falsely believe that ultrasounds are dangerous when in reality they are a necessary part of the pregnancy pre-screening process. This prevents many mothers from coming into the hospital for their check-ups. Many people also do not realize the importance of preventative medicine. A lot of Kenyans do not begin to take care of themselves until they begin to feel sick or their body starts to hurt. Even if a person does start to feel sick, most will not come to the hospital unless it starts to affect their ability to work or provide for their family. Which many times, when they come in, it is too late. Spreading knowledge about preventative medicine and visiting the hospital when the concern is minimal could prevent future deaths and lead to a longer life expectancy. For example, I was in dermatology when a man entered with a left foot that was four times the size of the right. He was diagnosed with elephantiasis which is when a limb becomes significantly enlarged due to a blockage of the lymphatic vessels in that area. However, his condition was so severe that when he visited the hospital the damage was permanent and no treatment would be effective, so this man would have to live with an enlarged leg for the rest of his life. Unfortunately, due to high poverty rates, many ill individuals avoid the hospital until absolutely necessary in order to continue making money for their family. Taking a day off from work or closing their business in order to go to the hospital could be the difference between their family having food for dinner that night or not. So not only is a lack of healthcare literacy preventing people from visiting the hospital when necessary but also high poverty rates. It is also common to see people seeking natural remedies from a witch doctor since it is less expensive than the hospital. The hospital is not only more expensive, but if an individual is unable to pay their bill, the patient is detained at the hospital until it is paid. However, the price increases daily with interest which prevents most people from being able to leave. There is a program in place by the federal government that allows for hospital bill forgiveness if a family is unable to pay. However, most people do not know that this relief exists which prevents many from going to the hospital in the first place or trying to run away. There were a few people in the IMA program that paid for the release of a patient. I wish I had the opportunity to pay a patient’s medical bill, but the opportunity did not arise in the departments where I was shadowing. One day, when I am financially secure, I plan to help cover some of the hospital bills at Coast General. Some of the payments are considered chump change in America but may bankrupt a family in Kenya. It is the absolute least I can do. Even though I am unable to change the hospital structure in Kenya, I plan to advocate for and teach about preventative medicine. It is so important for people all over the world to understand how it increases infant survival rates and increases life expectancy overall. The disease burden and the lack of proper health care infrastructure is a systemic problem that cannot be solved overnight. It is the role of the Kenyan government to prioritize the health of its citizen and create a system that aids those who are impoverished. I thoroughly enjoyed the lectures on Kenya’s health care system. I am much more educated on the topic and how drastically it differs from the healthcare system in the United States. Not only am I much more educated about Kenya’s healthcare system, but I am also so grateful for the United States’ healthcare system. Even though the system in the United States is not perfect by any means, there is at least a better standard of care with structured rules and safety precautions. Sanitary and safe hospital practices are lacking in Kenya which lead to a higher number of infections and hospital accidents. For example, I saw a nurse use an open needle to pick up gauze and deliver it to a physician. I learned so much from shadowing at the hospital, but I would not feel comfortable being treated at Coast General. Despite the heartbreaking work environment and deteriorating condition of some of the patients, I am so fortunate that I am able to learn and expand my current knowledge about the healthcare system in Kenya. It is so important to remain educated about different cultures and how each country has varying systems. I not only broadened by medical knowledge, but I became much more educated on the culture and customs of Kenya as a whole. Observing and participating in specific Kenyan practices was one of my favorite parts of my experience. I absolutely love learning about different cultures with practices that vary from my own. Not only is it fascinating, but it is so important to understand and respect other cultures. As a future physician, I will be treating patients of all different backgrounds, races, religions, and ethnicities, each of which have their own unique practices and beliefs. Learning how to communicate and best treat people of different backgrounds is a necessary skill in order to succeed in the medical field. In order to gain the respect of the patient, you must be knowledgeable about their values and cultural practices. I learned that Kenya has 44 different tribes, each with their own dialect. The largest ethnic groups are the Kikuyu, Luhya, and Luo. Because they are the largest ethnic groups they tend to control the political sphere which can lead to discrimination and marginalization if the government is corrupt. The ethnic group that holds the majority of positions in the government tend to distribute more resources to their own people leaving smaller tribes without a voice and without the proper amount of resources. This type of discrimination in Kenya can be equated to the racial discrimination that still unfortunately occurs in the United States. Despite learning about that tragic fact, I loved learning about the dynamic way that the tribes all interact and affect one another. I enjoyed even more being able to visit a traditional tribe community. I visited two separate cultural centers, one in Mombasa and the other one in Nairobi where I watched as traditional ethnic dances were performed. I loved watching the dances and being pulled up on stage to dance with them. The dances were so lively, and the dancers were so passionate. We were also able to tour about 10 out of the 44 traditional tribe homes and learn about their customs. Many of the tribes had homes built from mud and straw some with separation of rooms and others without. Most of the men lived in separate homes from their wife or wives. If a tribe practiced polygamy, all the wives would live separately with the first wife living in the largest home. I think my favorite experience from the trip was visiting a Maasai village and learning about their traditions. Immediately, we were greeted by the men in the tribe where they performed a traditional dance for us. I loved being able to join in and share the experience with them. Next, we watched at the men showed us how they make fire. I found it fascinating that they chose not to buy matches since they are nomadic and may require a fire without modern resources. They made it look so easy, but once we tried their technique, it proved to be much harder than we anticipated. Next, we watched as the women welcomed us with song. However, my favorite part of the visit was being invited into one of the homes. I loved being able to sit and talk with Daniel and his family, learning about their family dynamic and what life looks like for them. The home is humble compared to American standards, but it was so fascinating to understand and truly experience what life is like as part of a traditional Maasai community. And of course, I bought a painting and some jewelry in order to remember and commemorate my experience there. At first, I felt like I was intruding into their space and community, but then I realized that they truly enjoyed having us there. In American, many times people welcome me into their city or home, but few times do I actually feel welcome. However, in Kenya, I could sense the genuine warmth and kindness from each person that welcomed me. I have learned so much from this trip, not just about Kenya, but also about myself. Not only do I have an ever growing interest in the medical profession, but I have a strengthened desire to connect with others that are different than me in one or many ways. I have found a true joy in interacting with and learning about different cultures and people, hearing stories that are different than mine, but also finding similarities between people who live a life very different than mine. This trip was so fulfilling in many ways. Within the two short weeks that I was in Kenya, there was so much personal growth. I have grown academically, emotionally, and socially. Now, I just count down the days until I can visit Kenya again.

Overall, my experience was wonderful. I enjoyed the food, meeting new people, learning the culture, exploring the country, and understanding the healthcare system of Kenya. I felt very safe with security being at our residence and also knowing that there is security in the majority of the places we visited. The staff was lovely and made sure we had everything we needed. The chefs also made sure that we enjoyed what we were eating and provided alternatives if needed. This trip made a huge impact on my life because I came home with a different mindset. I became motivated and started to see the good in all aspects of my life. I truly appreciate everything I have and everything I learned from being in Kenya. This is an experience I would recommend to everyone and I would do it again!

Travelling to Kenya for merely two weeks was not nearly enough to experience such an amazing culture and amazing people full of joy in their hearts. This trip opened my eyes to the challenges countries in Africa face when compared to other countries and what a blessing it is that a program is going above and beyond to give to those deserving yet underrserved. Even though I was there for a short time, I gained so much knowledge from compassionate an selfless doctors and hopefully have impacted the lives of those during educational sessions. This experience marks a pivotal turning point in my life and will always be grateful for the chance to educate the people of Kenya while also learning from them as well. I will remember this moment in my life and hope to continue the characteristics IMA has instilled in me, teaching what I have learned and carrying the tradition of providing to those less fortunate - changing their lives!