Public Health Study Abroad Programs in Tanzania

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.

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

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.

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

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 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.

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

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

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.

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.

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

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

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 loved each of the Mentors (Manuela, Cinthia, and Wilo). They were all very helpful and kind. Also, the highlights of the program include watching surgeries, the rural community clinic, and the at-school presentations. Thank you so much, International Medical Aid, for an incredible experience. I loved teaching about feminine hygiene, oral health, and more, and learning about the differences in healthcare systems and their outcomes. In addition, all the people in this group and country are incredible. Until next time, Peru! My internship with International Medical Aid (IMA) in Peru has profoundly influenced my understanding of healthcare and strengthened my commitment to pursuing a career in this field. Immersed in a healthcare system vastly different from what I had known, I gained invaluable insights during my three-week experience that will forever shape my future endeavors. This opportunity allowed me to analyze differences in healthcare delivery systems, cultures, and patient-doctor interactions. As I work towards my goal of becoming a physician, I will utilize these experiences and insights to address disparities in medical care and become a resourceful healthcare provider. The healthcare systems of the United States and Peru differ significantly in terms of infrastructure, accessibility, and resources. In the U.S., healthcare is generally well-funded, with advanced medical technology and a wide array of specialized services. However, access to this care is greatly unequal, largely influenced by factors such as insurance coverage and socioeconomic status. In contrast, Peru's healthcare system, while making strides in recent years, still faces challenges due to limited resources, especially in rural and underserved areas. Healthcare in Peru is often more reliant on primary care and community-based interventions, with less access to specialized care and modern medical equipment. Additionally, there are statistically significant differences in health outcomes between the United States and Peru, which I observed firsthand. For instance, the likelihood of a child in Peru dying before the age of five is 1.4%, compared to just 0.1% in the United States (The Borgen Project, 2020). In 2022, the US spent approximately 16.57% of its GDP on healthcare, whereas Peru spent approximately 6.15% of its GDP (World Bank, 2024). These disparities in both morbidity and mortality rates, as well as healthcare spending, highlight the profound inequalities between the two countries. During my time in Peru, I was able to personally witness the impact of social determinants and the resulting disparities in health. Traditional medicine is far more prevalent and accepted in Peru compared to the US. Upon arriving, I immediately noticed this difference: local Peruvians, including doctors, advised me to drink coca tea as a remedy for altitude sickness. Before this experience, I had never been recommended tea, or any other herbal remedy, as a treatment for an illness; typically, I would be prescribed medication or advised to take over-the-counter medicine. In general, traditional medicine tends to be less regulated and scientifically validated than modern medicine. For instance, there is no proof of the effectiveness of coca leaves for a cure for altitude sickness (Bauer, 2019). This contrast highlights the differing approaches to healthcare, where traditional remedies may be based on centuries of cultural practices rather than rigorous clinical testing. Although the effectiveness of coca leaves remains unproven, research has shown that traditional medicine can offer notable benefits. In some cases, it has demonstrated greater “clinical efficacy, user satisfaction, and future risk reduction”—all while being more cost-effective than conventional treatments (Bussmann, 2006). This suggests that traditional practices may complement modern medicine, providing holistic care that resonates with cultural values and individual preferences. During my time in Peru, I observed how local healthcare providers often integrated traditional remedies with conventional treatments, offering patients a more holistic approach to their care. This exposure allowed me to appreciate how these practices can work together to address the physical, emotional, and cultural needs of patients. I also engaged with the local community, listening to their experiences and understanding the deep cultural significance of traditional medicine, which further enriched my perspective on how these practices resonate with individual values and beliefs. Seeing firsthand how traditional medicine is deeply woven into the fabric of daily life, I realized that while modern medicine offers precision and reliability, traditional practices provide a sense of continuity, identity, and holistic care that can be just as vital to overall well-being. Additionally, through my experience with International Medical Aid, I observed significant disparities between rural and urban areas in Peru, as well as notable differences in the trends of prevalent diseases when compared to the United States. With IMA, I had the opportunity to assist in running a day clinic in Pisac, Peru, a rural town about an hour and a half from Cusco. At the clinic, we assisted approximately 85 patients in receiving baseline medical care. There were stark differences between the level of medical attention these people receive compared to residents of Cusco. In Pisac, medical care and appropriate treatments are not a high priority for many individuals due to the community's limited resources and the significant effort required to travel to hospitals in Cusco. As a result, many locals rely on traditional medical practices and often delay seeking medical treatment until their symptoms become severe. These norms have many implications, including 1) delayed diagnosis and treatment, 2) increased rates of morbidity and mortality, and 3) an overburdened healthcare system. Moreover, the delayed diagnoses are problematic as waiting until symptoms become severe often means that conditions are diagnosed at a more advanced stage, making them more difficult and costly to treat. This ultimately corresponds to the higher rates of morbidity and mortality in Peru. Additionally, when patients finally seek medical care, they may require more intensive treatment, which can strain the already limited healthcare resources in nearby urban centers like Cusco. Beyond the rural and urban disparities, the most prevalent diseases also differed between Peru and the United States. While shadowing at Hospital Nacional Adolfo Guevara Velasco EsSalud in Cusco, I noticed that hypertension and diabetes were highly prevalent among adults, while anemia was common in children. For instance, approximately 32.9% of children aged less than 5 years are diagnosed with anemia in Peru (Al-Kassab-Córdova, 2023) whereas in the United States the prevalence is 3.2% (Gupta, P. M., 2016). Additionally, in 2019, the top 10 causes of death in the U.S. were all due to non-communicable diseases, with ischemic heart disease as the leading cause. In contrast, in Peru, the leading causes of death that year included a mix of injury-related, non-communicable, and communicable diseases, with lower respiratory infections being the most common cause (WHO, 2019). The differences in leading causes of death between the U.S. and Peru highlights the distinct public health challenges faced by each country. In the U.S., the dominance of non-communicable diseases reflects the impact of lifestyle factors, aging populations, and chronic health conditions. In Peru, the mixture of leading causes of death indicates the broader spectrum of health challenges. The prominence of lower respiratory infections as a leading cause of death indicates gaps in access to basic healthcare, sanitation, and public health interventions, while reflecting the ongoing burden of infectious diseases in less-resourced settings. Through my experience and newfound understanding, I have enhanced my cultural competence, allowing me to provide more sensitive and tailored care to patients from diverse backgrounds. It has also deepened a passion of mine to improve healthcare, ultimately inspiring me to advocate for preventive measures and community health initiatives. Overall, I will be better equipped to inform my patients on managing chronic conditions, adopting healthier lifestyles, and the importance of early treatment for infectious diseases. Furthermore, my internship with International Medical Aid in Peru was a transformative experience and profoundly enriched my understanding of global healthcare disparities and deepened my commitment to becoming a physician. By witnessing firsthand the contrasting healthcare systems, traditional practices, and regional challenges between Peru and the United States, I have gained invaluable knowledge into the complexities of delivering equitable care. The stark differences in healthcare access, disease prevalence, and treatment approaches between these two countries have highlighted the need for a more integrated and culturally sensitive approach to medicine. As I continue my journey towards becoming a physician, these experiences will guide me in delivering compassionate, patient-centered care. This internship has not only broadened my perspective but also strengthened my desire to contribute meaningfully to the field of medicine.

I enjoyed the experience in Peru. In the future, I look forward to seeing more medical procedures and surgeries as I gain additional necessary experience. I learned so much from my experience in Cusco, Peru with the International Medical Aid organization that will greatly influence how I approach healthcare in my future. The Spanish immersion aspect of my trip was a bit challenging at first, but I learned quickly so that I could understand people in the facility better. I am a person who thrives in new environments, and I learn best from overcoming difficulties. I was able to see how crucial the nursing department is to any healthcare facility, and I found it very interesting to learn about proper procedures for cleaning wounds and administering injections. Of particular interest to me was when I was able to observe an appendectomy with tubes and cameras because I did not previously know this surgery was completed in this way. I believe that I would like to study more about surgery in medical school, so anytime I can observe these procedures is of great value to me and my future. A doctor also taught me how to do CPR, and I also found it interesting to learn how to correctly complete suturing as well. I was also surprised that it was very common for the Cusco population to suffer from respiratory illnesses and infections. Healthcare is the backbone to the well-being of any society, and I will explore some of the ways that Peru and the United States are similar and different in their approaches. I was able to see how difficult it was for those who live in rural areas to obtain necessary healthcare because of challenges with transportation, which highlights a similarity between Peru and the United States. Individuals in the U.S. who live in rural areas often have reduced access to healthcare as well because of transportation, but other factors such as affordability, quality of care, insurance coverage, and race play a major role as well (Commonwealth Fund, 2022). In Peru, during the early part of the 20th century, healthcare was provided mainly as charity or from the state, but this idea has been met with changes to provide Universal Health Insurance to Peruvian citizens in 2009 (Borgen Project, n.d.). Both Peru and the United States are striving for universal healthcare coverage, but in the U.S., limitations arise which deal primarily with high costs for coverage. Employers sponsor healthcare plans for employees, but individuals pay for their deductibles, coinsurance, and copayments. These costs can be quite costly and can deter people from obtaining healthcare which they need (Commonwealth Fund, 2022). Even though the United States is known for being a global leader in medical technology and innovation, there are too many variations in the care that its citizens receive (Commonwealth Fund, 2014). In Peru, urban areas often have a better quality of care, and rural areas suffer because of the lack of insurance coverage and economics (Country Reports, n.d.). In the public sector, MINSA and EsSalud are funded through taxes, but costs are still prohibitive for some Peruvians (Pacific Prime, n.d.). I look forward to my future in healthcare, and I will always cherish my experience in Peru as a starting point to this important journey. I am currently in my last year of college at the University of California at San Diego (UCSD), preparing to take the MCAT exam and apply to medical schools within the next year. My experience in South America has opened my eyes to other cultures and healthcare systems to see that the world can and should be seen from a wider lens. As I become a doctor, I would like to also assist impoverished people in the world to obtain high-quality healthcare that they deserve. Some ways I might like to do this are to do more work for International Medical Aid or help on the Mercy Ship as a surgeon to provide vital surgeries for those who would otherwise not be able to receive these procedures. I would like to be a part of helping others receive life-changing treatments to improve their quality of life, and I would like to thank International Medical Aid for providing me with such a valuable starting point on my life journey.

In-country support was great, and all the mentors were super helpful and caring from start to finish. Any time someone wasn’t feeling well, the staff were incredibly sweet and checked in often to make sure we were comfortable, had what we needed, and knew we were supported. That level of attentiveness really helped me feel safe and taken care of, especially in a new country and a new healthcare setting. My favorite part of the program was going out to local schools and educating the kids on how to wash their hands and brush their teeth. It was such a simple but meaningful form of outreach, and seeing how engaged and curious the students were made the experience even more rewarding. Moments like that reminded me why public health education matters and how much of a difference small interventions can make at the community level. Clinically, I learned so much about the differences in healthcare systems between the U.S. and Peru. Being in hospitals and clinics there gave me a new perspective on how resource availability, patient needs, and cultural context shape medical care. Honestly, I also ended up learning things about the U.S. healthcare system that I didn’t even realize before—this internship pushed me to think more critically about access, prevention, and what quality care really looks like in different environments. On top of everything, I feel like we all grew really close with our program mentors while we were on the trip. They weren’t just there to guide us in the hospital—they helped create a supportive community, answered every question we had, and made the whole experience feel personal and meaningful. Overall, this program was such a positive, eye-opening experience, and I’m leaving Peru feeling more inspired, more informed, and even more excited about my path in medicine.