Volunteer Programs in Armenia, Colombia

I did not know what to expect when I originally applied for this program. However, it ended up being everything I could have ever wanted and more! I felt safe and well taken care of during the entirety of my time in Kenya. I learned so much at the hospital and was able to enjoy numerous cultural treks in my free time. I would thoroughly recommend this program to anyone. I have always had an interest in global health but throughout my undergraduate career, I could never find the time to travel abroad. So during my first gap year, post-graduation, I was excited to finally have time to pursue this dream. I spent several weeks researching medical programs in Africa before coming across International Medical Aid. Between the glowing reviews on the website and all the beautiful Instagram photos from past interns, I decided IMA was the program for me. I was ecstatic when I received my acceptance but also incredibly anxious because what was once just an idea was now becoming a reality. I spent the next few months prepping, and then COVID hit, and I had to delay my trip to the following summer. During that year span, I changed jobs and was accepted into medical school. It felt like a lifetime since I had applied for IMA and what was once a fully planned experience, felt more like a dream again. But somehow on June 4th, 2021 I sat down on a plane in the JFK airport and departed for Kenya. When I arrived in Mombasa, a mere 17 hours later, I had no idea what to expect. The first car ride to the residence was a culture shock in itself. Beyond the initial surprise of the road system, traffic patterns, and tuk-tuks, I took immediate notice of the poverty level and the clear economic stratification. According to the World Bank, “ Kenya is East Africa’s largest economy…” and yet “36.1% of Kenyans [are] still living below the international poverty line” (The history of pre-and post-colonial Kenya lecture). This inequality is evident on the street as you see families living in huts only a few minutes away from mansions with tall gates, topped with glass shards so no one can enter. It is also evident in the healthcare systems. Private hospitals, such as Premier, offer superior facilities to those who can pay the cost, while the lower class has access to public-funded hospitals such as Coast General Teaching and Referal Hospital (CGTRH). The public facilities are “under-resourced in terms of equipment and clinical staff” and have “overall, poorer patient outcomes and higher incidences of hospital-acquired infections” (The current state of healthcare in Kenya). Equipt with this information, I was eager to start my hospital rotations and get a better idea of the true healthcare experience in Kenya. My first week in CGTRH was spent in the Obstetrics department. Within my first day, I saw six vaginal births, including a set of twins, and learned all about the different stages of labor, medications given to mom and baby, use of the fetoscope, procedures for cord-cutting and sex determination, and so much more. I felt immediately welcomed into the hospital. Everyone was eager and willing to teach and let us see everything. This was a welcome change from shadowing in the United States where pre-medical students are often treated as more of an inconvenience than anything else. This was definitely not the only notable difference from the hospital settings I was used to. The biggest difference, by far, was in the use of pain medications. In the United States, a woman laboring in the hospital readily has access to multiple forms of pain medication including the well-known and commonly used epidural. In Kenya, however, moms are not given any pain medications unless they have to undergo a cesarean section. This means that women go through the entire labor, sometimes including an episiotomy and later suturing, unassisted by analgesics. This type of strength and personal fortitude is unimaginable in the United States. The other major difference is in prenatal care. Although prenatal care is offered for free in Kenya, most people do not go to the doctor before they are in labor. This is due to a large number of factors, including lower health literacy. Due to this, most mothers go into labor without any knowledge of the sex of the baby or even the number of babies they are having. In the United States, most women receive consistent prenatal care, including “every 4 weeks until 28 weeks of gestation, every 2 weeks from 28 to 36 weeks, and then weekly until delivery” (Lockwood, 2021). This creates much more opportunity to monitor the health of both mom and baby, increasing the likelihood that any complications would be detected early and taken care of. The following week I was in the pediatrics ward. I was able to learn a lot here from the nurses and resident doctors. It was particularly interesting to learn about their top ten most common conditions -gastroenteritis, pneumonia, several acute malnutrition, neonatal sepsis, neonatal jaundice, meningitis, malaria, anemia, bronchitis, and tetanus- because they are so much less commonly seen in the US. I was also shown how to insert a nasogastric tube into a newborn which was very interesting. My third week was spent in the Accident and Emergency Department. Here I was able to see a lot of interesting and varied cases from bandage and catheter changes in the minor theater, to epilepsy and pneumothorax in the beds. But what I really enjoyed about this department was getting to talk with so many of the staff members when there was downtime. Doctors spoke openly with us about the corruption in their government and police force, the lack of resources and staffing at the hospital, the pay delay that they were currently experiencing, and the poverty that surrounds them. Here, I gained a new sense of appreciation for the level of dedication that these people were putting towards their patients. I was told that the staff is paid monthly and that although it was almost the end of June, they still had not received payment from May. They had apparently tried to strike in the past but were unsuccessful. Despite all of this, when I asked the residents if they would continue to work at Coast after their training was completed, most of them said they would because they loved the work they were doing. That is one of the biggest things I will take with me into my future practice of medicine. Always put the patients first and remember why you came into the profession. My last week was spent in the surgery department. This rotation was particularly fascinating as I have had very minimal OR time in the US. During my first day in the theater, I was able to observe a bilateral inguinal hernia repair on a five-month-old baby, a biopsy and excision of a mediastinal mass, and a bullet removal from near the spine performed under local anesthesia. On my second day, I was able to watch a broken femur repair. Then, I was even fortunate enough to get a third day in the OR after another intern had a night shift. During that shift, I was able to observe another inguinal hernia repair with a circumcision, and a skin graft from a woman’s leg onto the right side of her face after they had previously removed a neurofibromatosis. The skin graft was by far the most interesting and intricate procedure that I have witnessed. The surgeon was absolutely amazing and really took the time to teach us and show us what he was doing. I was able to learn so much from this. I was also able to learn a tremendous amount outside of the hospital. Between the clinics, the cultural treks, and the Masai Mara safari, I was able to gain a deeper knowledge and appreciation of the history and culture of Kenya. What stood out to me the most was the warmth we received everywhere we went. In the United States, especially in New York, where I am from, people aren’t very openly friendly to one another. This was not the case in Kenya. At the hygiene clinics, the children would run up to us with open arms for hugs and high fives. At the beach, people would strike up conversations about where we came from and what we thought about Kenya so far. At the grocery store, we had people thanking us for coming to the country and working in the hospital even though we got much more than we were able to give. Time and time again the people of Kenya inspired me to be a kinder, warmer person. When I sat down on my June 4th flight, a year and a half after applying to IMA, I could not have known the impact this experience would have on me. I am so grateful to the IMA staff, the hospital staff, the Kenyan people, and the other interns for making my experience everything that it was. As I start my journey through medical school, I will take with me all the knowledge I gained and the lessons I learned. I will be kinder, warmer, more dedicated, more resourceful, and above all, more appreciative for all the things that I had previously taken for granted. And once I complete my training, I would love to return and give back to the patients everything that was given to me.

Every intern and physician I had the pleasure of interacting with was incredibly welcoming and emanated such perseverance, passion, and enthusiasm. I’m forever thankful for the opportunity to absorb the culture of the Kenyan people alongside my fellow colleagues. My involvement in the hospital was a once-in-a-lifetime experience, but being able to have such intellectual and zealous interactions with my fellow colleagues and physicians was incomparable. My fellow colleagues really showed me the true meaning of how to be welcoming of others who may hold foreign ideals or passions that may not necessarily align with my own. They showed me the meaning of gratitude and optimism despite unfortunate circumstances. I will be forever grateful for my experience in Kenya and to International Medical Aid for allowing me this opportunity. My trip to Africa has broken countless boundaries and shown me what it takes to be a successful physician. As I arrived June 18th in Mombasa, I soon realized my experience in Kenya was going to be simply life-changing. On our way to the residence, I stared out the window as we drove through unfinished roads and passed what looked like destitute infrastructure. With this being my first time out of the US, the sentiment towards my journey was filled with times of uncertainty and indications of acculturation. In preparation for my trip, I often found myself looking at pictures on Google of what I could potentially expect in Mombasa; however, pictures could never truly encapsulate the extent to what I felt and experienced during my time. This experience altered my perspective on the healthcare industry while simultaneously promoting a greater understanding of myself. The knowledge I gained while in Kenya has filled me with a greater sense of gratitude and humility beyond what I could have ever found or experienced in the US. My first weekend in Kenya consisted of a tour of Coast Provincial General Hospital, which kickstarted an already eye-opening experience. Our program mentor, Dr. Shazim, began our tour in the Emergency Room where I saw a patient who had just passed being draped with a bedsheet. I had heard stories from other interns about the possibility of seeing patients pass during my time here, but this wasn’t something I could’ve expected to see on my very first day visiting the hospital. As we continued with the tour, despite the prominence of a shortage in both the accessibility of resources as well as clinical staff in the public sector hospitals such as Coast (Nejru, C.), the doctors continuously persevered and were seemingly unaffected by the dire circumstances. They only incessantly provided exceptional care for all of their patients to the best of their ability. There was an understanding amongst the interns, staff, as well as myself that we were in fact walking into a hospital that is incredibly underfunded and built by a system that was completely foreign to our traditional western medical practices. Nevertheless, I could not have anticipated to what extent this was the case until I saw it first hand. The tour was just the starting point, but I was already in amazement at the sense of gratitude for not only the healthcare workers working at Coast Provincial General Hospital, but also for the healthcare we are provided with back at home. As the weekend came to an end, I could only wait in anticipation about getting started in my first rotation, the Ear, Nose, and Throat Department. Given the often up-to-date and medically advanced technology I am used to in the US, I was baffled by the usage of ancient and considerably outdated instruments. An outdated instrument such as a head mirror and light for ear, nose, and throat examinations were being used by the physicians at Coast whereas most physicians in the states use an otoscope, which can be more efficient, reliable, and more effective than the traditional head mirror. However, the concept of reliable and advanced technology coincides with an acknowledgment of the privilege needed in obtaining those “updated” instruments. His knowledge, however, spanned beyond the beneficial aspects the otoscope might have provided through obtaining a proper diagnosis for each patient. This accounts for only one of the many instances where Coast providers amazed me with their ability in providing such admirable and impressive care given the insufficient resources allotted to them. Between each patient, he would take time to explain the different diagnoses as well as their indicators. During this week, I gained extensive knowledge on not only the different parts of the ear but also infections that could occur, which could potentially develop into more serious health issues, such as meningitis. Additionally, I was also able to learn how to conduct hearing loss tests with the tuning fork and how to read audiograms. Due to the continuous technological advancements being adopted in the US, there is often a misconception that the adoption of newer technology will enhance the work of the physician, but in my experience, ENT proved to be more about knowledge and the true understanding of the basics. Oftentimes technological advancements act as shortcuts for a lot of physicians in the US and ultimately inhibit the proper care needed in a place that lacks those same advantages. Moreover, a key component to the proper deliverance of medicare is through proper bedside manner, which was demonstrated so proficiently by the MO’s, CO’s, and nurses at Coast. I can only hope that one day I can adopt their same principle in providing the best care for my patients through extensive knowledge and patient etiquette. In my second week, I was able to conduct a rotation in the Emergency ward. Inherent in its reputation, I found my time in this department to be by far the most hectic yet interesting experience of all my time at Coast. The underlying theme throughout the hospital of being under-resourced was more prevalent in this department than ever, given its chaotic and frantic environment. They had a singular working vitals cart circulating both the triage and outpatient units. Given its inevitable mayhem, a singular working vitals cart isn’t sufficient enough to support a whole department, especially one as tumultuous as this one. Most patients that come into the ER need to be continuously monitored in the prevention of coding. A 70-year-old patient came in complaining of pain on her left side and was evidently severely malnourished, which was, unfortunately, a consistent theme amongst patients I saw during this rotation. Watching this woman pass before any treatment was administered to treat her hypertension left me with a feeling that was incredibly disheartening. I had a million thoughts going through my head and all I could do was just stand there in shock watching her daughter drop to the floor in agony. All I could think was how curable her diagnosis was and how she could have been treated if the scarcity of resources wasn’t such a pervasive issue. The unfortunate reality of the apparent low socioeconomic status amongst the population of Kenya has left a disparaging mark on their health status. Most Kenyans earn only about one US dollar per day, which cannot even cover the dollar fifty(one hundred fifty shillings) baseline pay for a visit to the hospital. Consequently, many patients entering the ER are those with severe injuries or illnesses that require immediate attention, yet the rates are still incredibly unaffordable given the general population’s socioeconomic status, leaving many worse off. My week proceeded to include learning about suturing and other infections taking place in the minor theatre as well as many wounds being re-dressed and sutured. One case, in particular, struck me; a man came in with a severe cut on his hand, which required suturing. Much to my dismay, the Clinical Officer made the patient go to the pharmacy to purchase his own sutures in order for them to proceed with the proper course of treatment. This put an emphasis on my comprehension that Coast General was not acquiring the proper amount of resources to accommodate all their patients. This brought about a state of incertitude and left me with the troubled feeling that had me pondering the luxuries granted to us in the states of never having to be responsible or obliged to bring our own medical supplies. My last day in the ER consisted of a patient who was a known HIV patient. While attempting to place an IV into her arm, blood had dripped onto the floor. As I continued to watch the course of her treatment being carried out, no staff member had attended to the blood laying on the floor. Given that HIV is the highest cause of mortality in Kenya at a rate of about 15%, I was personally taken back by the potential risks that are associated with the lack of urgency in the cleaning and disposal of the infected blood (Njeru, C.). Even so, this common communicable disease is seen by physicians on the daily. The Emergency ward gave me an immense amount of knowledge through not only an observational lens, but also through a more hands-on approach. This consisted of taking vitals and assisting the nurses and Clinical Officers during their suturing and wound dressings. The doctors and Clinical Officers were incredibly knowledgeable in educating us on the understanding of all aspects surrounding their diagnosis. Given that the interns are predominantly made up of pre-medical students, the feeling of being treated as if we were equivalent to the medical interns or residents was incredibly refreshing. The substantial amount of unique cases and knowledge that I gained during my time in this unit is incredibly valuable as I embark on my future endeavors. Once again, I was confronted with a new outlook on the healthcare field and seasoned my determination towards the pursuit of my future profession. My following two weeks consisted of my placement in two new departments: Radiology and the CCC. Personally, I could not have foreseen the possibility of either of these two units becoming of interest, but astoundingly I found that some of my favorite experiences lied in both of these departments. It was less so about the subject matter and more about the excellence exhibited by both the physicians and radiographers. Beginning in Radiology, the radiographer on staff during my week, Kelvin, provided us with the most engaging and thoughtful teachings. I imagined my time in Radiology to consist of simply viewing scans all day; however, this was not the case. As soon as we walked into the room, Kelvin immediately stood up, offered his seat and spewed his knowledge on all the doctrines associated with the operations behind understanding the usage of the CT machine. His astounding yet personable character, demonstrated through as simple of an act as giving up his seat, was striking as many radiographers in the US would have never evinced that same tutelage. Kelvin made us feel as if we were wanted and meant to be in that control chair. He started explaining the capabilities the machine could carry out, what each one was for, and how the contrast works after being injected into the patient. His esse exemplified through his eager and willful nature in trying to teach me made me feel at home given my real home being 9,000 miles away. Throughout the whole week in radiology, Kelvin took us under his wing and taught us more than I could have ever imagined. This corresponding theme was carried over into the commencement of my next department: Dermatology in the CCC. My original discernment regarding this department was once again refuted. The physician on staff during my week in dermatology within the CCC, Dr. Matunda, was by far one of the most charismatic and knowledgeable doctors that I had the pleasure of meeting while at Coast. Dr. Matunda took the time to make us feel as if we belonged in this department, similar to that of my previous mentor, Kelvin. Dr. Matunda’s effervescent self was displayed by his salutations towards every patient in the introduction of us interns as “his friends from the United States.” Shadowing Dr. Matunda was a pleasure due to his solicitude for both his patients and us interns. One instance that I remember so fondly was when he took forty-five minutes to simply explain to us everything he knew on leprosy. I found this to be one of the most intriguing parts of dermatology because of how HIV and leprosy go hand in hand. Dr. Matunda was in no way inclined to spend time outside of seeing his patients to go into such depth about leprosy given how busy he already was, but he wanted us to understand every detail of the disease because of its prevalence. Another aspect that amazed me about Dr. Matunda was the considerate and thoughtful nature he exuded on a daily basis. One patient came in with a very severe bacterial infection, but due to the socioeconomic status of the patient, he did not have the means to acquire the antibiotics necessary in treating his infection. Dr. Matunda’s following actions spoke true to his character and will be a moment that will stick with me forever. He told them to meet him outside around one o’clock, so Dr. Matunda himself could purchase the antibiotics needed for the patient to treat his infection. This was not the only time I witnessed what I believed to be a heroic doing by Dr. Matunda. He continuously upholds his values in being a good person before being a doctor. In a country that is so socially and economically challenged, oftentimes there are limitations to the value of human life. Dr. Matunda was the perfect example of what it means to uphold the value of every human life no matter the circumstance. His upstanding efforts went beyond the scope of just medicine alone, in which, on multiple occasions, patients would ask for money in order to buy food because they could not afford any. His willingness to always lend a helping hand to his patients not only clinically but in other hardships as well showed just how compassionate he really was. These two departments not only taught me a lot of the necessary medical knowledge, but also how to treat those who may be learning from me in the future. Kelvin taught me to always be welcoming to those who are new and how to make others feel as if they are equals in the healthcare field. Dr. Matunda taught me how to put being a good human being before being a doctor and how to take the time to teach others who are learning from you. These two experiences will forever stick with me through my journey into the healthcare field. I can only hope that one day I will be able to make future doctors, nurses, physician assistants, etc. feel the way they made me feel. Coast alone could never make up the entirety of the extensive knowledge I gained; infact, the cultural treks and clinics that were held outside of the hospital were some of the most memorable parts about my experience. The hygiene and menstrual clinics were incredibly educational, nevertheless, my interactions with the students at the schools was where I believe I gained the most. Upon arriving at every school, we were invariably greeted with lots of smiles, hugs, high fives, and a multitude of additional friendly gestures. All of the students emanated such enthusiasm with their ecstatic greetings and interactions. It was like nothing I have experienced before. I was ambivalent about how the interactions between us and the rest of the Mombassan community would manifest, but I could not have asked for a more inviting and heartfelt welcoming from the community. I was fortunate enough to be given the opportunity to learn more about the Kenyan culture on different treks throughout my four weeks in Kenya. The two that really stand out to me are the treks to Bombolulu and the Maasai Mara. Bombolulu was incredible in that their mission made the entirety of my experience there that much more meaningful and heartfelt. At Bombolulu they give disabled adults the chance to learn different skills in order to help provide for their families as well as themselves. My interactions with the people in Bombolulu really showed me the amazing capabilities people can possess. One of the other cultural experiences we had there was having the opportunity to watch tribal dances and walk through re-creations of the different tribal housing. The ability to see how different tribes lived and how they were able to maximize the resources offered to them given their geographical location was indelible. The tribal dances in particular were very intriguing to me because the tribal dances I have seen on the internet were nothing in comparison to witnessing one in person. Their expression through every little movement and the meaning behind each of the individual dances was captivating. Additionally, my participation in some of their dances was marvelous. It really made me feel like they wanted me to immerse myself in a part of their culture. The other experience of being able to visit the Maasai Tribe in the Masa Marai was one of the highlights of my trip. I was delighted by the welcoming presence from the members of the tribe and was grateful for a sneak peek into their lifestyle. I met some of the happiest people I have ever met during my time at the Maasai village. This really put things into perspective for me, especially when comparing it to the western world’s adoption of what I believe now to be a materialistic outlook on happiness. They were all so willing to answer the many questions we posed and even welcomed us into their homes, which was mesmerizing. We were able to watch and perform a dance with many members of the tribe. It was an amazing experience being able to meet these people and learn more about the Maasai tribe and its history. These experiences outside of the hospital will help me in my future endeavors in the healthcare field, but also have changed my outlook on my life back here in the states. These opportunities allowed me to get out of my comfort zone and really showed me that when you break the boundaries you’re used to then that's where you learn the most. Every intern and physician I had the pleasure of interacting with was incredibly welcoming and emanated such perseverance, passion, and enthusiasm. I’m forever thankful for the opportunity to absorb the culture of the Kenyan people alongside my fellow colleagues. My involvement in the hospital was a once-in-a-lifetime experience, but being able to have such intellectual and zealous interactions with my fellow colleagues and physicians was incomparable. My fellow colleagues really showed me the true meaning of how to be welcoming of others who may hold foreign ideals or passions that may not necessarily align with my own. They showed me the meaning of gratitude and optimism despite unfortunate circumstances. I will be forever grateful for my experience in Kenya and to International Medical Aid for allowing me this opportunity. My trip to Africa has broken countless boundaries and shown me what it takes to be a successful physician.