Health Education Volunteering in France

I enjoyed some of the activites , but not others. The rivre walk and the walk to the koppies was 10/10. No intrenet was challenging , so 7/10. Jane , Precious , Patrick and Lucas were 10/10. I woul recommend this project to anyone who needs a detox from Social media.

New culture, new people, New Life. When we exchange our perspectives, ideas and plans to make a world better place for everyone. It's good to go different places it helps me view life in many directions

Hice 5 años en haiti, me se su idioma, se toda su cultura, me gustaría volver y apoyarlos en todas las dificultades que tienen, ya que ameritan mucha ayuda de todos nosotros, para ellos poder sobrevivir

I would really like to volunteer. I am passionate about charity and showing kindness to the world. Please, give me a chance. Kindly provide Certificate of sponsorship too since I'm not able to provide for myself at the moment. Kindly put my request into consideration.

This an increasingly popular way for individuals to make a meaningful impact in communities around the world. With numerous organizations offering volunteer programs, it's essential to review and research these opportunities to ensure a safe and rewarding experience. *Pros:* 1. *Cultural Immersion*: Living and working with local communities provides an immersive cultural experience. 2. *Skill Development*: Volunteers can develop new skills and gain experience in areas such as teaching, conservation, and community development. 3. *Networking Opportunities*: Volunteers can connect with like-minded individuals from around the world. 4. *Personal Growth*: Volunteering abroad can be a transformative experience, fostering personal growth and self-awareness. *Cons:* 1. *Cost*: Many volunteer programs come with a hefty price tag, which can be a barrier for some. 2. *Safety Concerns*: Volunteers may face safety risks, such as health concerns or political instability, depending on the destination. 3. *Cultural Differences*: Adapting to local customs and way of life can be challenging for some volunteers. 4. *Quality of Programs*: Some volunteer programs may lack structure, support, or meaningful work, leading to a disappointing experience. *Recommendations:* 1. *Research Thoroughly*: Investigate the organization, program, and destination to ensure a safe and rewarding experience. 2. *Read Reviews*: Look for reviews from past volunteers to gain insight into the program's quality and challenges. 3. *Choose a Reputable Organization*: Select an organization with a proven track record, transparent policies, and adequate support for volunteers. 4. *Prepare Yourself*: Culturally, emotionally, and physically prepare yourself for the experience to ensure a smooth transition. By being aware of the pros and cons, doing thorough research, and choosing a reputable organization, volunteers can have a safe, rewarding, and life-changing experience abroad.

As a Social worker i often meet with clients to assess their needs, provide counseling, and develop individualized plans to address their challenges. This could involve sessions with individuals, families, or groups.

I truly enjoyed my experience with International Medical Aid. From the very first day the staff made me feel right at home, from getting picked up from the airport to my final exit. During my free time, I immersed myself in the Kenyan culture by going to local restaurants and trying the local cuisine, as I wanted to really get the most out of my experience. When I became slightly ill, I informed the Program Staff and was quickly taken to the private hospital five minutes away from the residence; my problem was handled in the quickest manner which made me feel very safe. I felt we made the biggest impact on the community during our bi-weekly free medical clinics, as we were able to do something hands-on to really help so many different communities. International Medical Aid was truly one of the best experiences I've ever had, and I will cherish it forever." Upon arriving in Kenya, I had no clue what the outcome would be after completing my internship at Coast General Teaching and Referral Hospital, but I couldn’t be more thankful for what I’ve learned about healthcare, as well as myself. Although I had done research on International Medical Aid in the past, there was no amount of internet research that could prepare me for the experience I was going to have. It has taken me thirty days to be able to summarize my experience and what I learned from it, as it has completely changed my perspective on life as well as what I want to do as a career. For the past thirty days, I have been researching and digging through the internet to find a career that could encompass everything that I felt while I was in Kenya, and that has led me to Nursing. Before arriving in Kenya, I was set on becoming a Physician Assistant, which has recently been changed to Physician Associate in The United States. I was even a part of a club in college called The Association of Pre-Physician Assistant Students, or better known as APPAS. Given this information, I signed up for the Pre-Physician Assistant internship through International Medical Aid. In Kenya, the “equivalent” to a Physician Assistant is a Clinical Officer (CO). It was extremely interesting to me to learn the multitude of different names for their health care providers such as Medical Officer (MO), Clinical Officer Intern (COI), and so many more. In the beginning, it was a little confusing, as I was referring to CO’s as MO’s, and CO’s as COI’s, and I had to be corrected a few times by interns who were there weeks before me. The one thing that was perfectly similar to the name in the US, was a nurse. I may not have always known who the CO or the MO was, but I always knew who the nurse was in the room, as I came to learn they are extremely autonomous in Kenya, and often are running the wards. My time in the different wards is what truly shaped my experience in Kenya. My first week, I was in the Internal Medicine Ward. Before going into the week, a few of the interns who had already been there asked me which wards I would be in during my time at Coast General. When I mentioned Internal Medicine, I would constantly hear that people found it to be boring, but as it was my first week, I still went into it with high hopes. Upon my arrival in the ward, I was introduced to the MO, a few medical students, and a few nurses. The other interns and I were then taken around the ward and we went patient to patient, doing major work rounds, which is done on Monday and Thursday of the week. I found the major work rounds to be extremely enriching as I was able to see how the MO figures out what is wrong with the patient, and then determines the plan of treatment. After the MO determines the plan of treatment, it is the medical students and the nurses/nursing students who actually handle the treatment. The students welcomed us with open arms and allowed us to follow behind them closely to every patient and watch every single thing they did. Not only did they welcome us, they also perfectly explained what they were doing, as they wanted us to be as engaged as possible. I personally found my time in Internal Medicine to be very rewarding, and I feel this ward is where I learned the most medicine during my entire time in Kenya. My favorite part of Internal Medicine was being able to draw connections between the diagnosis and plan of treatment to my knowledge of microbiology. Being able to understand a lot of what the healthcare providers and the students were talking about allowed me to be engaged, and even give my input when asked. Starting off in Internal Medicine was the perfect start to my internship. My second week in Kenya, I was in the labor ward. Prior to going into the ward, I was expecting it to be like an OBGYN office. To my surprise, the entire room was labor and delivery. One side of the room is called first stage, which is for women who are thought to not have any complications giving birth. The other side of the room is second stage, for women who are more likely to have complications and/or possibly need emergency caesarean sections. I split a lot of my time between both stages, but the most interesting births were in the second stage. The labor ward was where I discovered my love for the Nursing profession, as the nurses and nursing students ran this entire ward from triage to the actual birth. I loved seeing how autonomous the nurses were. The week that I was in the labor ward happened to be the last week for the nursing students in that ward, as they had been there for three months. Due to this, a majority of the births that week were “final assessments” for the students, and we were unable to watch the assessment births. Luckily, there was one assessment birth that the lecturers allowed me to watch, and it was the most interesting thing I had ever seen, as I’ve never seen a live birth. The nursing students were extremely welcoming; as soon as I told them I had never seen a live birth, they came to find me in the ward when someone was close to giving birth, just to allow me to see. The nursing students in the labor ward were some of the smartest and nicest people I have ever met, and I fell in love with their love for health care, as it was truly inspiring. The most interesting thing was the differences between a labor ward in Kenya, in comparison to the US. There are no family members in the ward with the women while they’re giving birth, and this was a shock to me, as birth is such a special time in a woman’s life. Aside from it being special, it is also painful, as they do not use epidurals in this labor ward. Learning this, I was able to see how the nurses try to keep the women as comfortable as possible, given the resources. They have to be more than nurses; they have to exude such a warm energy for these women going through an uncomfortable experience, and I loved every second of my experience in the labor ward. At the conclusion of this week, I was so inspired to the point that I wanted to also pursue nursing. My third week in Kenya, I was in the Emergency Room. The Emergency Room physicians were some of my favorite physicians that I met during my internship, as they wanted to engage the interns as much as possible. I spent a lot of my time in the Emergency Room split between “Minor Theater” and triage. Minor Theater was for patients that needed things such as wound dressing, debridement, stitches, and many other small things. The Minor Theater was ran by some of the most amazing nurses, who also wanted the interns to be as engaged as possible, and allowed us to watch every single thing that they were doing. They were open to any question we had, and never once did they seem annoyed at the amount of questions I had, as there were a ton. Triage had many different types of patients every day, such as patients with broken ribs. I learned a lot of medicine in Triage from the physician and medical students, as they explained everything from the patient coming in to them either being discharged or admitted to the Emergency Room ward. During this week I also did an overnight shift in the Emergency Room, which was very enriching. This was the first time I had ever done an overnight shift in a hospital, and I had no clue what to expect. Due to Kenya having a curfew, there are less people coming into the Emergency Room for things such as car accidents, as people are in their homes. Patients were coming into the Emergency Room mostly from at home accidents. Because there were less people in the hospital at night, the interns were able to be engaged in the plan of treatment, and even more engaged with the physician, as there were no medical students at night. We also spent a lot of our overnight shift in the Emergency Room ward, following the physician around patient to patient, checking on things such as catheters, and making sure they were comfortable. I found the Emergency Room to be very exciting, as you never knew what the next patient was going to come in with. My favorite case was a one year old baby coming in that had a disease called Hydrocephalus, which is the buildup of fluid around the brain. As soon as I saw the baby, I knew exactly what they had, which made me so excited to be able to know what was going on. An interesting part of my internship, I actually contracted food poisoning, after going out to a Japanese restaurant and eating raw sushi. Although this was a painful and excruciatingly uncomfortable experience for me, I was able to experience another hospital known as Premiere Hospital. The differences between Coast General Hospital and Premiere are drastic, as Premiere Hospital is in the Commercial Private Sector while Coast General is in the Public Health Sector. As we learned in our lecture series, hospitals in the Public Health Sector is considered more accessible and affordable for citizens in Kenya. Public hospitals are also under-resourced when compared to the private sector. On the other hand, hospitals in the private sector offer much higher quality healthcare when compared to the public sector. One of the interesting differences I noticed in the under sourcing of hospitals in the public sector, is that at Coast General, to take blood they tie gloves together to be used as a tourniquet, while at Premiere, they use actual tourniquet. I even noticed simple things such as automatic doors, and automatic hand sanitizer dispensers at Premiere Hospital. It was very evident that the private sector is well funded in comparison. Although I was sick, I was grateful to be able to experience the difference as a patient hands on. My last week was in Surgery, which to my surprise, was my favorite. When doing surgery, you split your time between the surgical theater and the surgical ward. My first day was in the surgical theater, which started my week off on the highest note. The other interns and I were able to see an adenoidectomy on a baby, a broken femur repair, and the beginning of a skin graft surgery. I stood as close as possible without being in the way of the surgeons, as I was extremely interested in everything they were doing. One of the more surprising things that I found interesting was the nurse anesthetist. During the broken femur repair, there was something about the surgeons inserting multiple rods into the patients leg, and the patient feeling absolutely nothing due to anesthesia. I was very intrigued by all of the different machines used for the anesthesia and to make sure that the patient stays asleep during the surgery. It was after this surgery that I found an interest in being a Nurse Anesthetist, as I loved the surgery atmosphere and all that goes into having a successful surgery. When I mentioned this new found revelation, many of the interns asked me why I don’t want to pursue surgery, but this is when I mentioned that in the previous weeks I found a love for the patient care experience, and Nurse Anesthetists get the best of both worlds, by handling pre and post-operative patient care, and also getting the full surgery experience. Finishing my internship with surgery and figuring out what I want to do in life, was the perfect conclusion. As mentioned in the beginning, this internship really put my life into perspective, because even though I figured out what I want to do career wise, something still seemed to be missing. This is when I came across the area of Global Health. After spending a month in Kenya, I felt that I wanted to be a part of tropical medicine, and have a hand in some of the neglected tropical diseases such as malaria, dengue fever, rabies, and many other diseases. I had hands on experience with dengue fever, as of my roommates contracted it while we were in Kenya. This caused me to do a lot of research on how to not only keep myself protected, but what I could do to help her feel better, as she was miserable. As I’ve been home for a month doing research, I found that it is possible to be a nurse and also take part in global health in the US and also in other countries through organizations such as the World Health Organization. Completing a healthcare internship abroad allowed for me to understand the importance of cultural competency, especially if I’m going to be working in a country like the US, as it is a melting pot, full of people with many different beliefs and cultures. It is important to be able to place yourself in your patients shoes to treat them to the best of your ability. To conclude my reflection on my internship, I am beyond appreciative for the experience. I feel if I didn’t participate in this internship, I would be pursuing a career that isn’t my dream. I truly feel that being a nurse anesthetist and also incorporating global health is the perfect career for me. I am extremely thankful for International Medical Aid allowing me to understand the importance of cultural competency, as I will carry that lesson with me for the rest of my life, for my future patients. I have left Kenya as a completely different person, but a much better person.

My time in Mombasa, Kenya with International Medical Aid was the most fulfilling, educational, and enjoyable months of my life. All of the staff was helpful, caring, knowledgeable, gracious, and so much more. I could (and did) write an entire essay over the staff and how grateful I am for each and every one of them. The accommodations, transportation, and food could not have been more ideal. The lodging surpassed all of my expectations and I was constantly outside to enjoy the beauty of the residence we were in. The food was always delicious and more than I could have asked for. In-country support ties hand in hand with the staff of IMA and how I could not have been more thankful for them. This summer they had more interns than ever before, which I was one of the many that was considered lucky and blessed to be accepted again post COVID, and the staff handled it with grace and ease. Even though it may not have seemed like that behind the scenes, there was not a moment where I thought the staff did not have everything under control and was on top of everything. The attention to detail and each aspect of every intern still blows my mind to this day. On day 1, the entire staff had memorized my name and knew everything about me. I could go on and on, but overall the experience was an 11/10. I would, and will, recommend this program to everyone that I can.

I couldn't have asked for a better experience in Mombasa. Everything was thoughtful and planned for our sake - the food, the lectures, the tours. I follow a vegan diet and the kitchen staff was extremely accommodating and always made sure I had enough to eat, so that was amazing. The residence is beautiful and wonderfully maintained, and the cleaning/laundry staff are all so friendly. I fell in love with Mombasa through the local tours and, mostly, through the hospital. The doctors, nurses, clinical officers, interns, students, and everyone were so welcoming and willing to teach us. I learned so much every single day and completely filled up a notebook with all of my notes from the hospital. So many of the doctors and consultants wanted to make sure we (IMA interns) were being actively included in the team, and would give us readings to study when we got home as well as some responsibility for the patients at the hospital. I really felt like a useful member of whatever department I was in at the time, but particularly in my radiology and OB/GYN rotations. The opportunity to do night shifts allowed me to familiarize myself with the Maternity department, which, coming into the internship, I believed would be my preferred department. I could not have been more right. I felt completely at home in OB/GYN and my rotation and night shifts there truly solidified my love for women's health and I am now certain of my career path. IMA gave me the chance to explore different parts of the hospital and immerse myself enough to get an idea of what my future will look like. I always thought I was scared of babies. A strange thing to be scared of, maybe, but their seemingly fragile bodies and sharp cries have always put me on edge and made me feel like if I even touch them, I’ll hurt them. Although I had always been interested in women’s health, I assumed that childbearing wasn’t too important of a component. I had always said “Sure, I’ll deliver a baby, but afterwards I don’t want anything to do with it – only with the mother.” You might imagine, then, how terrified I was to have my first rotation in the Newborn Unit (NBU) at Coast General Teaching and Referral Hospital. I was never supposed to have this extra rotation, and never would have chosen it for myself, but due to a last minute change in flights which had me arriving a week earlier than expected I was put into NBU. I felt unprepared and out of place amongst the sick babies and the team of healthcare professionals who seemed to know exactly what to do for them. For the majority of my first day, I hung back during rounds and mostly just tried not to pass out from the heat. With no prior clinical experience in the US, I had nothing to which I could compare the Neonatal High Dependency Unit (HDU). I knew, though, that there would at least be air conditioning in a US hospital. I focused less on the babies and more on myself, how uncomfortable and disoriented I felt. Had I made a huge mistake? Was I even prepared to be spending nine weeks in Kenya? If I couldn’t do my internship here, how was I going to be a medical professional in the States? Questions ran through my mind later that night as I fought against the time difference to fall asleep. The next morning I woke up with conviction in my heart – there was no way I was going to come seven thousand miles to a country I’d never been to, a country that everyone back home told me wasn’t even worth coming to despite never having been there, to just pout and give up. The least I could do was start researching conditions I had seen the previous day. I was going to do everything I could to learn about these babies and their conditions, even if it wasn’t my preferred department. I spent the morning cramming on respiratory distress syndrome, sepsis, and jaundice, some of the most common ailments found in the babies in the Neonatal HDU. With my change of heart and nightly studying, I quickly figured out that I would only get out of this internship whatever I put into it. I also started to realize that neonatal care is not too different from adult care and can sometimes be more complex because the patients can’t tell you what they’re feeling. I got into my groove in NBU and started to really enjoy looking at each case as a sort of puzzle; what symptoms can I physically observe? How does the baby appear? What sort of investigations can we perform to find out more about the baby’s condition? Dr. Yamani was an enormous help, always explaining cases to me, telling me what to study for the next day’s discussion, and making me feel like a real part of the NBU team. Once I got over my fear of these fragile babies, though, I started to notice stark differences between the healthcare practiced at a public Kenyan hospital like Coast General and a hospital back home. The only US hospital experience I had to compare was when I was a volunteer for patient transport, as well as the secondhand hospital stories from my mother who has been a respiratory therapist for 37 years. Whatever little I knew of healthcare and the hospital environment in the US was wildly different from what I was seeing here in Mombasa. I immediately noticed the lack of resources – both equipment and staff – the hospital had. Instead of the disposable rubber tourniquets used to draw blood that I remembered from home, the staff used the fingers of latex gloves. The doctors were being pulled in a million directions, and even with the help of the Medical Officer Interns (MOIs) they seemed overworked. The lack of resources, however, sparked ingenuity and resourcefulness in the doctors at Coast General, as I saw in some rather extreme cases. Gastroschisis is a condition in which a neonate is born with a defect in the abdominal wall which results in the abdominal organs coming out of the body. Cases can range from minor, with a small portion of the intestines outside of the body, or severe, with the stomach, liver, and larger portions of the intestines found outside the body. Gastroschisis is extremely rare, occurring in approximately 1 in every 2,000 babies worldwide (Opitz, J. M., Feldkamp, M. L., & Botto, L. D., 2019). This means that a large public hospital like Coast General would only see around two cases of gastroschisis a year. During my time in NBU, there were two cases of gastroschisis within days of each other. Needless to say, I was shocked and confused, and at a loss for what could even be done for these babies. As always, though, the doctors in NBU and OB/GYN worked together with their cool heads and quick thinking, using their expertise and the resourcefulness they’d grown accustomed to needing. In the first gastroschisis case, the mother came into the Labor and Delivery in active phase of labor without ever having had an ultrasound done. Her chart was sparse, and the nurses and doctors only had the information she’d given in triage to build her case. Without an ultrasound, the doctors just had to pray that the baby would be healthy. No such luck. Hours passed and the woman wasn’t progressing in her labor well – the normal range of progress for cervical dilation is approximately 0.5-1.0 cm per hour. When a woman is dilating normally and stops for an hour or two, or if she is dilating too slowly, this is considered poor progress of labor, or prolonged labor (Arthur H. R., 1972). This is one of the most common reasons a woman would need to have an emergency caesarean section delivery: a surgical delivery of the newborn. The doctors in Maternity explained to the patient the importance of delivering via C-Section as well as the risks that come with it and had her sign an informed consent form. Prepped and ready for surgery off the patient went to the operating theater. Expecting a normal delivery, the doctors hadn’t specially prepared for an unhealthy newborn – definitely not a newborn that would need the level of care that this particular baby would need. Needless to say the surgeons were surprised to deliver a baby with its intestines outside its abdomen. Working quickly, they wrapped the abdomen in saline-soaked gauze to protect the intestines and keep them moist and flexible, then sent the neonate to NBU for further care. Usually, before surgery can be performed on the neonate to close the abdominal defect and return the organs in place, a silo needs to be put in place. Because the fetus’s organs are exposed to the amniotic fluid, they get irritated and inflamed which makes it even more difficult for them to fit back into the abdominal cavity. A silo is a clear sheath of silicone which contains the intestines above the newborn’s body and allows gravity to shrink and pull the intestines back into the cavity over the course of hours or days. Typically the silo is tightened using a rubber tourniquet to encourage the intestines to shrink, but in the case of the babies at Coast, we had to get a bit creative. With the silo being held up using string, the doctors needed a way to tighten the silo without the typical disposable tourniquet. Something durable, yet easy to adjust. The answer? Two popsicle sticks, one on either side of the silo, held together horizontally by string at both ends. The solution was perfect – the more the intestines shrunk, the further down the popsicle sticks could slide. No need for multiple rubber tourniquets, i.e. no need for excess or waste or unnecessary materials. Over the next few days the department waited and held its breath while we watched the intestines shrink back into the body where they belonged. The newborn was able to be taken to the operating theater after about a week where the life-saving surgery was performed successfully. The gastroschisis cases made me question whether most American doctors would be able to think on their feet in this way. As a product of the privilege of working in the US’s stocked, staffed, and comfortable hospitals, it seemed to me that doctors in the US had forgotten what it was to think critically and creatively. Although I had heard stories of doctors in the US thinking outside the box out of necessity in extraordinary situations, I wondered whether they would be able to find everyday solutions to everyday problems, sans all the fancy equipment. I thought back to the gastroschisis case; most doctors in developed nations have never had to deal with lack of resources like the doctors at Coast General had to in this case. From the mother not having an ultrasound done to the baby’s makeshift silo-contraption, it was clear that if there had been more resources available this case would have been easier to deal with. In the United States, no woman would dream of passing up a chance to see an ultrasound of their unborn baby, and yet many women don’t even realize that it is a huge privilege for them to be able to get ultrasounds. Although there is no upfront medical care cost associated with maternal health in Kenya, it is still difficult for women to take full advantage of the care available to them and their young children. Consider not only the monetary cost of transportation but also the time cost. Time spent away from a job, time that children at home would have to be looked after by someone else. It is not always realistic for women to make regular or even semi-regular visits to the clinic or hospital, especially if they live far away and need to take some sort of transportation. This explains why the woman from the first neonatal gastroschisis case, and many other women I encountered in my time in OB/GYN, didn’t have any ultrasounds or previous visits to the doctor pertaining to the pregnancy. And so, just one more thing that American doctors never have to consider or worry about; almost every single American mother will get an ultrasound during her pregnancy. I was amazed at the speed and calm with which the gastroschisis case was handled. From the surgeons who delivered the baby to the doctors who took over in NBU, the entire team seemed to keep their cool in a way that I’m sure is learned with many years of practice. I loved seeing the babies come into NBU and be taken care of, but I was ready to see the other side of things – the labor and delivery side. I wanted to see the mothers, get to evaluate them, learn how to listen to the fetal heartbeat. I wanted not only to meet the mothers in antenatal and postnatal, but I wanted to meet the women in the gynecology ward. Women’s health had been my passion since I had first become interested in pursuing medicine. I’ve always seen the stark gap in research for a group that makes up half the population in any given country, at any given period in time. It has always been astonishing to me how often women are cast aside or not taken seriously when they bring up medical complaints. Over and over we’re told “it’s normal, nothing to worry about” or “it’s just hormones acting up, nothing to worry about.” It’s always “nothing to worry about” and women all over the world learn to keep quiet until they can’t anymore, and oftentimes it’s too late. I wanted to get into women’s health to be better, to start creating a culture of believing women when they say something is wrong. I wanted to be a healthcare professional that women would feel comfortable with, someone they knew wouldn’t dismiss their pain and ailments as “nothing to worry about.” And so, when my Obstetrics and Gynecology rotation rolled around, I was more than ready to learn about the clinical side of women’s health. My first day in OB/GYN was not really my first day – I had chosen to work several night shifts in the department throughout my seven weeks prior to my actual rotation, so I was familiar with the department and the people there. During the morning meeting, I got to meet Dr. Farhiya, one of the consultants for OB/GYN, for the first time. Instantly I was in awe of her assertive nature and no-nonsense attitude towards the MOIs and Clinical Officer Interns (COIs) – if someone had made a mistake, she had no problem calling them out clearly in front of everyone. It made me at the same time terrified and delighted by her, and this feeling would only intensify the longer I knew her. I decided to spend my rotation in the antenatal and gynecology ward since I had already had some experience in labor and delivery, and would have more, from night shifts. This was my moment – for years I had told everyone in my life about my passion for women’s health. I was so set on doing OB/GYN as a career path, but I had never actually gotten any clinical experience in the area. This rotation would make or break my visions of my future career, and I started to get nervous that I wouldn’t like Gynecology as much as I had thought I would. I walked into Ward 9 with the medical students, nervous as ever, but soon realized my fears were for naught. From the beginning I was made to feel that I was part of the team – when the medical students were given cases to present, I was also given cases to present. When Dr. Farhiya assigned reading to the medical students, she made sure I was also reading. I never felt like I was in the way or that I was cast aside during my time in the Gynecology ward. Aside from feeling like I was part of the team, I found the cases in gynecology absolutely fascinating. Enough so that when we were asked to read on risk factors of cervical cancer, ovarian cancer, molar pregnancy, and ectopic pregnancy to present the next day, I studied all through my night shift and still came in the next day. Something about the cases in the Gynecology ward were so interesting to me that staying up for 36+ hours multiple times a week seemed to have no effect on my energy levels. It felt like I could have read and studied those patients for hours on end without getting bored, and oftentimes that’s what I did. My passion for women’s health only increased when I was given direction and guidance for my studies as well as free reign to read charts and ask questions to patients. This is something that Coast General could offer me as an intern that I knew no American hospital would – free reign. American hospitals tend to be extremely strict when it comes to interns and volunteers reading patient charts, and especially when it comes to interacting with patients. As an intern, there’s not much you would be allowed to do without a doctor breathing down your neck. Reading charts is a HIPPA violation, and doctors just assume that students haven’t learned bedside manner well enough to speak to patients, so interns end up being stuck behind a doctor and missing a lot of context for the patients’ cases. In my experience at Coast General, we were not only allowed but encouraged to learn about the individual patients, collect histories, and ask questions in order to piece together why this particular patient may be suffering with this ailment. My studies came to life as I wasn’t just reading a textbook anymore but was seeing real women with real diseases and cancers and disorders right before my eyes. One particular case that illuminated my textbook studying was a woman in her late thirties with a massive ovarian cyst which was scheduled to be surgically removed. Only having briefly read the woman’s chart, I got to meet her right before she went into surgery. All I could think was how she almost looked pregnant, and I had to make sure I had read the right chart, and this wasn’t actually a C-Section being performed. Never had I seen an ovarian cyst as large as the one I saw that day. Typically the ovaries are about the size of an almond, and the ovarian cyst I saw extracted from the patient could be described as beach ball sized and looked to be about 7 kilograms. I was incredulous as the surgeons worked painstakingly to detach the cyst from the abdominal cavity without rupturing it. It looked heavy and fragile, and my admiration for the doctors grew rapidly in the operating theater that day. The way they worked together, one holding the cyst above the body as the other used a scalpel and a cauterizer to bring the cyst away from the body. The cyst, the ovary to which the cyst was attached, and several other cysts and masses were removed from the woman’s body in the theater that day. Astonishingly, the surgeons were able to keep the entire uterus and the other ovary intact and did not have to remove them, as they would play an important role continuing to produce hormones so the patient would be able to live a normal life and not reach menopause early. As the woman’s abdomen was sutured, I could only stand in awe of what I had just seen. I knew in that moment that women’s health – both Gynecology and Obstetrics – is my calling. Never in my life had I been so sure of anything. This is the biggest gift that International Medical Aid and Coast General have granted me: certainty in my career path. If possible, I was even more amazed the next day to see the patient, not looking pregnant anymore and looking more like a burden had been lifted from her. I couldn’t help but smile at the way she was sitting up in bed, talking, laughing, and just having lighthearted banter with the MOIs. I understood all at once that this is why we do medicine – not for the money, not for the clout, but for the simple “thank you” from a patient. For the experience of seeing a woman who could barely walk the day before transform into a woman who is able to live a normal life because of a surgery you performed. I learned that the woman had been screened a year earlier and they had found the cyst – at that point no larger than a pencil’s eraser. It had taken a year for this woman to come in for surgery, due in part to the issues mentioned earlier such as transportation, taking time off of work, taking time away from her mother for whom she was the caregiver, as well as the money it would cost to get to the hospital and for the surgery. The patient had almost no choice but to let the cyst grow for more than a year to prepare herself financially, physically, and mentally for the tough surgery and recovery process she knew she would have to go through. Yet here she was – through with the surgery and just beginning the recovery, but happy all the same that she would be able to live normally from now on. The case invigorated me and made me imagine being someone who could give this same peace of mind to my own patients someday. My path became clear, and I just needed to use my experience in CGTRH now to remind myself of my “why.” So where does this all leave me now? My “why?” How has my experience changed my prospective career path? There are so many different answers to this question because my experience has changed and shaped me in ways that I never would have expected. First and foremost, my “why.” I’ve always condemned people who get into the medical field just for the money. “It’s not worth it” I would say, “it’s too much work and time and heartache to just be doing it for the money” – and I think I truly believed that. It wasn’t until I finished my internship that I realized that I was doing it for the money. Of course, I had other stronger motives to get into medicine, but whenever someone would ask me why I wanted to be a Physician Assistant, part of my answer always included “they make good money.” It took me going to Kenya for two and a half months to realize that money is not what will keep me interested and grounded in my career. Watching your patients heal, saving a life, changing a life for the better – those are the things that will be my “why.” Those are things that are irreplaceable, priceless. When I saw a baby born for the first time, I had to leave the room because I was crying – how amazing was it that I could be the medical professional that helps to bring a new life into this world! I could be lucky enough to behold a miraculous creation and be a tiny part of this newborn’s life. My “why” changed from “because they make good money” to wanting to make a difference, however small, in someone’s life. I always thought I was scared of babies. I was never really scared of them – just scared that I wouldn’t be a good enough medical professional to take care of them. I was scared that I wouldn’t be able to put together the puzzle pieces of their care and save lives like I had seen so many doctors do throughout my life, and especially here at Coast General. Being in the newborn unit, however, brought me closer to what that level of care actually looks like on the doctor’s side. There’s a lot of trial and error, guessing at symptoms because the patient can’t tell you what’s wrong, and consoling worried mothers. Mothers who have just given birth, who still need medial care for themselves. Seeing these mothers care for their babies bridged the mental gap I had made between Obstetrics and Neonatology and made me realize that to take care of a mother postpartum, I must also be able to take care of the newborn. I must be able to understand the newborn’s condition and the treatment going into their care to be able to explain it clearly to the worried mother. More and more I’ve come to understand that being a good medical professional not only has to do with diagnosing and treating patients, but also with consoling families, explaining a diagnosis, and working with patients towards the most sustainable treatment plan for them. I’m so fortunate to have been an intern at CGTRH where the staff saw me and met me where I was, while at the same time working to expand my knowledge and expectations for myself. They reminded me every day that the field of medicine is never static, but moving and breathing and constantly changing, and I will be blessed enough that it will be my job to keep up with it for the sake of my patients, my team, and myself.

The experiences I encountered during my 6 weeks in Mombasa were truly transformative. It not only built on my foundation of medicine, but increased my awareness of disease burden, cultural competency, politics, quality of healthcare, and so much more. The staff at CGTH including the consultants, medical officers, clinical officers, nurses, etc. were so open and willing to teach you. They were enthusiastic to answer all of my questions. I learned so much that is already overlapping in my life back in the states. I appreciated that it is run by staff who are born and raised in the area to not only provide local support but to talk about their own perspective of healthcare in Kenya. The entire IMA staff welcomed all the interns with open arms and truly made me feel like family. I am forever thankful for the time spent playing soccer with Benson and Teddy, good conversation with Phares, cooking with Catherine and Joshua, driving adventures with Javan teaching me Swahili, and everything in between. My time with International Medical Aid (IMA) allowed me to be more cognizant of biases, increase my cultural competency, increase my awareness of disease burden, and build on my foundation of medicine. I was introduced to aspects of medicine I had never seen before, such as various systemic factors and how the role of politics influences or hinders care. Even beyond the hospital, I learned about healthcare in a whole new light. I truly believe my outlook on medicine is dynamic, ever-changing, and never static. Perspectives can change in an instant after one experience, one second, or one moment in time. Beyond that, perspectives on medicine and healthcare can be molded by social situations that don’t necessarily relate to medicine. These moments can shape you by providing insight to the type of healthcare worker you want to become someday. The experiences I encountered here during my six weeks in Mombasa were so transformative that I have a new career plan, cultural awareness, and outlook on life. The distance between America and Africa is significantly great not only by miles, but by social and cultural ignorance. When I would tell people in the United States I was going to be an intern in Mombasa, Kenya, I was bombarded with many questions. People would ask me, “Is that in Africa?” “Are you going to help starving kids?” “Are you going to be staying in a hut?” “Will you see a giraffe outside your window?”. The heavy implication of ignorance that was loaded with these questions was truly disheartening. The lack of cultural competency when I returned was about the same. When I got back to the United States, I received a single question and it was always the same question, “How was Africa?”. While it’s true I was in Africa, they were generalizing my time spent in the beautiful country of Kenya to the entire continent. By not specifying as well, they were further supporting the idea that the continent of Africa is an undifferentiated entity. This idea couldn’t be farther from the truth and is not a new issue. In fact, in 1988, Gerald J. Bender described it as “a ‘know nothing’ approach to Africa which has dominated American thinking about the African continent” (Bender, 1988). Many Americans believe that all the people located in Africa are poor and, yes, some people are faced with poverty and disease, but this isn’t the sum total of everyone. In Kenya, I was able to see the diversity, compassion, and richness of its culture, specifically the beauty of Mombasa. In fact, some of my favorite memories there were talking with the local residents in town, learning about the culture from the IMA staff, and having conversations with various staff at Coast General Teaching and Referral Hospital (CGTH). I loved walking the streets of Marikiti market attempting to utilize the little Swahili I was learning. I saw a beauty to Kenya that isn’t portrayed properly in today’s social media. This idea of cultural competency is one of the several layers to healthcare that go far beyond medicine. At the core of every surface-level issue, there are challenging systemic factors that either help or hinder the patient. I saw this firsthand at CGTH. Some of the experiences that stuck out to me specifically were in the Comprehensive Care Clinic (CCC) and the Gender-Based Violence Recovery Centre (GBVRC). The CCC and its staff are funded completely through USAID and all services in this department are free to patients. This differs from the rest of the hospital because patients don’t have to worry about the cost of their treatment. It does, however, pose different challenges. Because it is funded through an outside source, the CCC relies heavily on the dependability of USAID. For example, when the US government imposed a new tax into their donations a few years back, that led to a snowball affect where the medications at Coast General were extremely limited. Instead of writing prescriptions for 3-6 months, the CCC was giving them for only a few weeks at a time, limiting patients to get only the immediate medicine they needed. This created serious complications as adherence to the medicine will be lower due to limited accessibility (Associated Press, 2021). In 2015, there were about 1.5 million people living with HIV in Kenya, accounting for 29% of annual adult deaths (IMA, 2021). These statistics show the severity of HIV in Kenya and prove the issue of limited accessibility is life-threatening. This is not a limitation or fault of the hospital, but a lack of resources available to them as a direct result of the supplier. This example directly showed me how important it is to look past the medicine and to the many other changing systemic factors. It is vital to keep in mind accessibility and availability to healthcare to maximize patient outcomes. Other times I saw systemic factors affect the way I see healthcare was during my time in the GBVRC. Services provided in this department are also free to patients, similar to the CCC. It is a small department, with only one nurse named Saida. Because there was less concern about cost, Saida was able to focus on giving the survivors the compassion and counseling they need. She was able to give them rapid HIV testing, STI treatment, pregnancy prevention, and paperwork to take to the police to give the survivors justice. She spent almost an hour with every patient to ensure they understood their options, time being a privilege here that is not an option in the United States. Because nurse Saida is the only one in the entire department, I was able to help her with basic paperwork and counseling, all within my scope of practice. I saw strength in this department like I have never seen before. Strong women came in brave enough to talk about how they were raped or involved in domestic violence. Young boys talked about how they were defiled in a men’s bathroom. A young girl cried as she described in detail how she was sexually assaulted by her uncle and wanted justice. Saida showed patience as we listened to survivors tell their stories. I could not begin to fathom experiencing first-hand the events they discussed. It made me wonder how many others in the area had something happen to them and were not yet willing to come forward. It made me want to examine the culture of healthcare in a bigger picture, looking beyond a single patient interaction. Coming to Kenya, I initially had my heart set on medical school. I wanted to be a doctor practicing medicine internationally and thought that was the best way for me to help patients. However, it was these experiences at Coast General that influenced my decision to explore a new career plan and push for a desire to go beyond single patient interactions. Currently, I have a Bachelor’s degree in physiology and will receive my Master’s in Health Education in May 2022. When I graduate, I am also completing a certification in non-profit management with an emphasis in International Non-governmental Organizations (INGO). After graduation next year, I’d like to utilize my certification and work for an INGO or non-profit in the healthcare industry. With a new career path in mind, I hope to incorporate what the staff of IMA has taught me into this new career choice. Benson showed me kindness in a way I’ve never seen before. Teddy taught me compassion. Christabel is a strong woman and showed me it is okay to be a female in a place of authority. Joshua and Catherine, in teaching me how to cook new foods, showed me patience. Conversations with Phares opened me up to being more cognizant of my surroundings and help shed light onto difficult topics. I can’t thank the entire IMA staff enough for opening up their beautiful city and allowing me to change my perspective. IMA and Coast General let me explore systemic factors and shine light on various biases in a way I never could have done in the United States. This new perspective and increased cultural awareness is what I hope to be able to build on within my own life and professional career.

Before leaving for Kenya, I was lost. A year prior to my acceptance, my dad passed away unexpectedly from carbon monoxide poisoning. My dad was, and always will be my best friend. With that being said, after the incident happened I was totally disoriented. I did not know how to go on with my life without someone so special to me. For a whole year, I was miserably unhappy. I felt lonely and I was on the wrong path in life. I needed a way out. Fast forward to Christmas break of my sophomore year of college, I was researching international shadowing opportunities. Luckily, International Medical Aid was the first to pop up. I took a chance and applied. After about a month, I received a letter of acceptance and I was thrilled. Never did I know this could turn my life around for the better. Going into college, I majored in biology as a safety major but never knew I was going to have a passion for it. Before Kenya, I really was not totally interested in the medical field, I needed this internship to help me make my final decision. There were alot of experiences that really pointed into the direction to continue my education within the medical field but there was one that really stood out to me. It was my third week in Kenya, I had been trying to get a night shift but because everyone wanted one, it was hard to get. Moreover, one of the slots for the Emergency Department opened and I immediately took it. I was most definitely frightened as I have never been in that fast paced environment. About 20 minutes into the shift, we noticed a little girl that had been in the minor theatre for quite some time. Never did I think this little girl would for one, show me my passion for medicine, and for two, change my life. As we read her chart, we were in disbelief that she was not crying. The ten-year-old girl, Louise, was so strong. Louise and her mom did not have any means of transportation other than by tuktuk, motorcycles, or buses. So, they both hopped on a motorcycle. On the way home, her right leg accidentally hit the spinning wheel, rupturing her achilles tendon. In the states, a grown man would be crying if that happened to him. Furthermore, as they were assessing her injury, pulling on her skin revealing the ruptured tendon and heel bone, a doctor asked her, “How are you?” She replies, “Fine…” The moment she said that, my heart dropped. I knew she was in excruciating pain but she was so brave. As I entered the room, her eyes lit up. I had no idea why. She whispers to her mom, “Is that Grace?” For context, Grace is her friend from the states that comes to visit when her family travels to spread Christianity. She immediately felt safe with me. I immediately felt like I was there to not only care for her medically, but be a friend to her. She clinged to me all night. She never left my side and I never left hers. When the doctors did not have a sense of urgency to care for her pain, I made sure to push them. As she fell asleep, she held my hand so tight. With tears in her eyes, her mom starts talking to me. She was talking about her faith in Jesus and how He was going to get them through it. That was when she looked me in the eye and said something I will never forget. She said, “Thank you so much for not leaving us tonight. We were so scared, I did not know what to do. You really are our saving grace.” Those words meant more to me than anyone would ever know. I remember I had to step away for a little bit because I was so emotional. Coming home, I knew that I was starting to become passionate about medicine being a human right for everyone. I started doing research and found myself watching hours upon hours of those that grew up in Kenya, studied other places, then practiced back in Kenya. A man named Joseph Lekuton experienced this first hand. In his lecture, he states, “ I represent Northern Kenya: the most nomadic, remote areas you can even find. And that man told me, ‘So, here you are. You've got a good education from America, you have a good life in America; what are you going to do for us?’” Due to the lack of education in Kenya, he has started multiple organizations to help fund schools that will concentrate in medicine. Moreover, the biggest problem is that the majority of the population is below the poverty line. Meaning, they are not able to pay their hospital bills. Many will not be able to afford a check-up in a hospital, so many of their serious health problems go untreated which is very harmful. To help this, there have been multiple attempts to bring the cost down. The SimIns Basic Model has uncovered various strategies to assist those that need it the most. In the article, “The cost of free health care for all Kenyans: assessing the financial sustainability of contributory and non-contributory financing mechanisms,” it explains the potential outcomes of the different frameworks. It states, “Expected future changes in disease burden from communicable to non-communicable diseases (NCDs) as well as management of revenue and expenditure were beyond this model. These, however, are expected to have some influence on health-seeking behavior and health care costs…” Not only are they creating plans to help the population, but they are also taking notice that things may go wrong. Healthcare is not the only problem in Kenya, infrastructure is a major problem. The biggest challenge of creating that is the people. Most of the population can not find jobs because there is no open work. The article, “Infrastructure for Economic Growth and Shared Prosperity in Kenya: Addressing Infrastructure Constraints, Promoting Economic Growth, and Reducing Inequality,” explains it very well. The article states, “Due to the stagnation, agriculture and manufacturing have not been able to create enough jobs for Kenya’s growing working population. Most of the jobs are created by the informal economy and are concentrated in the low productivity segments of hospitality, trade, etc. Improving the ease of doing business is one way toward job creation and higher productivity in the manufacturing sector.” Creating more jobs for more people can help a lot of characteristics about Kenya. All in all, this trip has helped me realize that medicine is right for me. I knew it in my mind but I needed confirmation in my heart. I will never forget everything Kenya brought me. It has truly changed my life forever. Kenya has taught me so much, and I can not wait for the day that I can bring something back.

No words can describe how amazing my month in Mombasa, Kenya was. From shadowing the amazing staff at Coast General Hospital to going on an African safari and everything in between. Mombasa has brought me forever friends and memories I will always cherish! The entire IMA staff was extremely welcoming and helpful with any questions/concerns I had. The accommodations were clean and in great condition. The cooking staff did a great job making sure the food was prepared well and on time. I enjoyed all the food that was made and was always excited to try new Kenyan dishes both at the residence and at local restaurants. I felt very safe every day at the residence and in the surrounding community of Nyali/Mombasa. I enjoyed all of the community outreach programs such as the hygiene clinics and medical clinics on the weekends. It was a great experience to work directly with the surrounding communities. Thank you International Medical Aid for this once-in-a-lifetime experience!

So grateful to have been able to spend two weeks in Mombasa, Kenya as an intern for International Medical Aid. During my time here I shadowed at Coast General Teaching and Referral Hospital where I had the opportunity to learn about international medicine and Kenya’s health care system from incredible doctors, nurses, and medical interns. These short two weeks have taught me so many life lessons that I will hold on to tightly as I work towards becoming a physician assistant. I want to thank the IMA staff for making my time in Mombasa unforgettable and providing me with such a great learning environment! And lastly, I am thankful for the bonds that I created with the other interns who shared the same goals and interests as me.

I have a fantastic experience with International Medical Aid in Mombasa, Kenya. From all of the staff at the residence to the transportation and mentorship staff, every individual was helpful and incredibly kind to us. I felt very safe traveling with the IMA staff and at Coast General Hospital. The accommodations at the residence exceeded my expectations and the staff was very kind. The kitchen staff was incredible and constantly provided us with local Kenyan dishes and delicious homemade juice, fruit and desserts. I appreciate the staff very much and think they are all fantastic. The opportunity provided by IMA that made the biggest impact on me was the community clinics held on the weekends. Meeting and speaking to local residents of Mombasa at the clinics who otherwise would not be able to afford healthcare made me feel truly lucky to be a part of this program. The power of IMA as a force for good in their community really shown in these experiences. I feel humbled and fortunate to have been able to play a role in the care for these individuals and learn from the physicians treating them. Coast General Teaching and Referral Hospital afforded many learning opportunities as well. A mentor who stood out during my time there was Dr. Matonda through the Comprehensive Care Clinic. During my last day of my Internal Medicine rotation, I passed by the CCC where my fellow intern Erica was shadowing for the week. She introduced me to Dr. Matonda, who instantly showed so much interest in teaching interns that I knew I had to switch my final week rotation to the CCC. While shadowing Dr. Matonda in the Dermatology clinic, he constantly challenged us to learn and remember diagnostic features of common diseases and skin conditions. By Wednesday of my rotation, I was able to give correct diagnoses to Dr. Matonda when listening and looking at how his patients were presenting in clinic. With how busy the providers and staff are at Coast General due to understaffing and lack of resources, it truly meant so much to me that Dr. Matonda cared and gave us so much of his attention during his clinics. When leaving at the end of the week, Dr. Matonda shared his contact information with me after a long day of learning and observing. This mentorship is what I am most taking away from my experience at Coast General. I feel very lucky to have met the Medical and Clinical Officers who work at Coast General and to know their adaptability and drive to give the best medical care available.

IMA Kenya was absolutely amazing! Very well accommodated and felt safe at all times. The food was great and I am so thankful I got to have this learning experience and make lifelong friends that I plan to see again. I am always thinking about Kenya now that I am back in my own country and plan on going back to contribute to a positive change in healthcare. I have learned many things such as ways of treatment that will be useful once I’m a certified Physician Assistant but of course, learning never stops and you can never know “too much”. I 100% recommend to everyone especially those pursuing healthcare to go abroad. Ever since I was a young girl, I have always dreamt of being in the medical field. Growing up, I was fortunate enough to have been exposed to some of the ins and outs of healthcare as my mother was an RN, now NP (nurse practioner). A few months prior to graduating with my Bachelor of Science degree in Exercise Science and Health promotion in 2020, I thought interning abroad would be an excellent way to close out that chapter of my life before starting the next. I plan to become a certified Physician Assistant (PA) while I have an interest in different specialties such as, pediatrics, dermatology, and emergency medicine. I went to Africa with an open mind knowing that there would be challenges that I have never seen or faced before such as having to be careful with drinking water, but I was eager to learn about the culture and how healthcare is delivered in a country apart from my own. I was placed at Bomu Hospital. As I completed rotations in the Maternity (Ob-Gyn) and Outpatient department, I noticed that in the United States, if one needs to be seen by a doctor, we will go to our primary care and then referred to a specialist. Our primary care doctors are typically in offices away from hospitals but at Bomu Hospital, everything is in one building. A difference in the healthcare delivery that stuck out to me apart from having different providers in one building was how patients in Africa must pay first to be seen and treated, as mentioned by the MO’s and CO’s I met and in our lecture meetings. In America, hospitals will see you and take payment after treatment. That is extremely unfortunate when many civilians make less than $2 a day while healthcare is expensive. One case that I followed where I saw this happen was in the maternity ward. There was a baby that was about 4kg and had sepsis, oxygen levels went down to 42% and she needed to be transferred but the family did not have enough money to pay. Thankfully after almost 6 days in the NICU, she was able to go home. This has made me want to contribute to a change in healthcare even more because, I strongly believe that everyone should get the medical help they need to live a long and healthy life. I spent majority of my time in the outpatient department at Bomu and was able to shadow clinical officer (PA), Jacob Mutai. Due to language barriers, Jacob thoroughly explained the patients concerns and possible course of treatment to me and followed up with questions to allow me to think critically. Throughout my days shadowing him, we saw a numerous number of patients dealing with scabies which is common in crowded areas. I learned how scabies is treated in Africa. Scabies is treated in Kenya by placing mattresses outside for 3 days along with dipping sheets into boiling water to destroy the mites and applying a topical cream to the infected body without bathing for a few days. Seeing how the same illnesses that can affect everyone in the world were treated, allowed me to learn a few different alternatives that I can use throughout my future career as I will see a variety of patients with different living circumstances. Outside of the hospital setting, we did hygiene clinics in the communities which I truly enjoyed. I have learned that many people including kids do not know how to properly wash their hands, brush their teeth or how to protect themselves during sexual intercourse. This stems from not having the proper resources to be educated and actively practice these safety measures and that is also something in the near future that I would like to help change, which is, the delivery of medical education. It is so important for people to be able to wash their hands properly and in clean water to prevent the spread of germs especially in crowded spaces as seen in Kenya. It is also important to have good oral hygiene and reduce the spread of sexually transmitted diseases such as HIV, which is extremely prevalent in Africa. During my 2-week internship in Kenya, I was able to shadow a PA to learn more about medicine. I made incredible friends and I was educated on the culture in Kenya due to the community outreach activities and I am so grateful to have gotten this unique experience to remember for a lifetime. I will use my abroad experience and newfound knowledge to educate others on the life and healthcare in Kenya and remind others to be mindful and grateful at all times. I will also use my abroad experience to encourage others to step out of their comfort zone and see more of the world to broaden their perspective on various things such as cultural differences. In the future, once I am a practicing Physician Assistant, I would like to return to Kenya as well as visit other countries and help where I can through programs like Doctors Without Borders.

I probably had one of the best experiences of my life in Natuwa for a month, feeding the many animals that live there, taking care of them, discovering a different way of life than mine, more minimalist and peaceful. Rodolfo is an extremely understanding man who cares about the well-being of his voluntarios. We had the chance to do several extra activities outside the centre, such as snorkeling near to Isla Tortuga, or swimming at night with bioluminescent planktons, which were dazzling. The workteam is really friendly and allows you to feel integrated quickly and easily. However, you have to expect to work hard sometimes, for example planting trees, doing work to maintain the infrastructure, but this is only a part of the day. outside the centre

My accommodations were better than when I go on a personal vacation: always got the best food, having a chef allowed us to get to taste so many different food from the country, beautiful home, so comfortable, absolutely felt like a home away from home! There is so much support from the IMA crew, always someone there for you, they even provide you with a SIM card to make sure you have a way to communicate with them and others at anytime. Our mentor was always available through e-mail and replies so fast. No matter what was the request, they found a way to answer to it and made it safe for all the interns. Only positive comments really! I went on the Safari in Nairobi: loved the fact that the IMA team had everything set for you once you had paid the required fee like the plane tickets, the rides from the airport to hotels, rides all over the city, some of the meals, etc. You had one job after that: ENJOY THE TRIP! The presence of a guide throughout the entire trip is also a plus since we had someone to help us go from place to place, communicate and teach us on so many aspects of the city and animals. Finally, the visit to the Masai Community was a great idea: I love getting to know real life stories so this was a safe and amazing opportunity. Just recently, I graduated from my undergrade program in Health Sciences, at Ottawa University. Afterwards, I had the opportunity of working in different fields as a physical therapy assistant at a private clinic, a care giver’s assistant in a home and a substitute teacher in elementary and high school; all which led to my final career choice, Physician Assistant in Pediatric. Next fall, I will hopefully be attending a PA program in which I will use a combination of my previous healthcare experience with the new ones acquired through my International Medical Aid internship in obstetrics and gynecology, in pediatric and in intensive care units, to excel in my future courses. Through this essay, I will present various perspectives of my placement in Kenya using different aspects based on the healthcare delivery, the political system and the cultural variations encountered at Coast General Hospital. My learning adventure began on week one, at the Labour Ward of the hospital. The first element that caught my attention was the lack of privacy, a major concept in Canada that was not enforced at Coast. For instance, during their visits, pregnant women were required to make their first stop at the examination room.Every “room'” was separated from one another by a simple curtain, in most cases not entirely closed; thus, private conversation subjects between doctor/nurse/intern and patient would become a conference with everyone in the perimeter. In addition, mother’s hospital books were located at the welcome counter, giving accessibility to anyone at anytime. At Coast General, the notion of giving birth is comparable to a transaction: for example, some show up at thehospital for the first time only when the moment comes to give birth. Nurses also expect each patient, when dilated enough to allow the baby’s exit (at seven to ten centimetres), to push quickly and efficiently; as a matter of face, it was rare for a birth to occur without an episiotomy. The most rapid delivery I have seen at Coast General Hospitalwas of a mother, who made her first hospital visit when having short contractions and all in around fifteen minutes,she had given birth to a premature baby, taken a shower and was ready to go. Aside preterm births, stillbirths andfetal deaths are very common in Kenya – hence many mothers barely flinch when announced the baby’s death. For Canadian women, the entire pregnancy process is an experience with several steps: prenatal visits many weeks before the child’s arrival, pregnancy photoshoots, gender reveals, pregnancy workouts, etc. Some even get to choose the type of delivery they desire such as vaginal births, natural births, scheduled cesarians, scheduled inductions, etc. On the big day, in contrary to Kenyan women, Canadians enter the delivery room with their companion by their side and their families eager to meet the family’s new addition. Unlike the American postpartum rooms, where each mother gets a clean bed, a spacious room, and fair nutritious meals portions, at Coast, rooms are overcrowded, sometimes obliging two mothers and their babies to share abed. In addition, the food provided by the hospital consists of a slice of bread and milked tea. During my time at the Coast General, I noticed a big lack of sterile instrument use. For each birth, a nurse-midwife is entitled to a sterilized pack of equipment allowing her to proceed to the delivery with safety. Unfortunately, therewas a lot of contact between clean and sterilized surfaces: in certain cases, after wearing sterile gloves, midwives would handle various objects before inserting their hands into the mother’s vagina. For the second and third week of my internship, I got to work alongside Doctor Siminy in pediatrics: myfavourite department. There was a lot of opportunities for learning in such short amount of time due to the diversity of the cases. Just like in Canada, each doctor has an office where patients are received: in every room there are two chairs, a table, and an examination bed. However, they are aesthetically different from our “kids friendly” rooms: walls did not have paintings of children playing at the park and room corners did not have toys and drawings for entertainment and distraction purposes. The benefit of an outpatient department like pediatrics at Coast General Hospital is the increased probability offinding treatment in one location. Let us use a scenario to illustrate this statement: a child, born to a mother with HIV, comes in with a high fever, diarrhea, and a pulmonary infection. After the diagnostic, the physician requires the patient to consult the Comprehensive care clinic for AIDS, the Laboratory and the Radiology Department forthe fever, diarrhea, and lung infection and the pharmacy for the medicines. For many families, “going to the hospital” involves taking a day off work, paying transportation fees, traveling forty-five minutes to two hours, etc. Thereby, having the possibility of making one stop to get all the help they need is a major upside. From my observations, I noticed that many of the severe cases in pediatrics were direct consequences of parent’sbeliefs. For example, we had a young patient who came in one year following the incident responsible for distorting his elbow. “Why would they wait this long to bring him to a hospital?” I wondered the exact same thing. As Dr. Siminy explained, after an incident requiring medical help, many parents will first turn to religion. If that doesnot work, they will try traditional medicine through consumption of mixtures of ginger, lemon and medicinal plants,witchcraft, etc. As a last resort, they will lean to modern medical care, and when they do, more damage would have already been done. On my second week at the pediatric ward, we had an interesting case of a mother who brought in anunconscious baby for a late vaccination. She had carried that newborn, all the way from home, covered with a traditional sheet. Once in the vaccination quarter, mothers were required to sit in a row, allowing nurses to work effectively. Nurses would ask mothers to make the child’s arm available for the shot, going from one baby to the other. As the nurse was about to vaccinate our patient’s baby, unlike her usual habits, she first asked for the blanket to be lifted, revealing a lifeless child. From my standpoint, the most chocking part of this case was not the baby’s condition but the healthcare professional’s reaction to the nurse’s implication: many congratulated her for checking the infant’s status before the procedure, an initiative that seemed crucial to me. Later, I was explained that mothers have tried prosecutinghospitals for administering medications potentially responsible for a deceased infant, hoping to get a compensation from the organization. Finally, I spent my last week at Coast at the Intensive Care Unit (ICU). The recently renovated department ofthe institution exuded features of Canadians ICU’s. However, as observed in the whole hospital, there was a lack of resources in this unit as well: it accommodated only nine beds for adults and kids, two beds for babies, one electrocardiogram, and one defibrillator. In addition, the availability of some materials, such as bed nets, were at the families’ discretion, therefore, not provided by the hospital. As it was my first time working in an intensive treatment unit, I had few expectations, especially given that this was the unit sheltering patients with the most critical cases. Coast’s ICU’s death rate was surprisingly high: onlytwo out of nine patients had a chance of survival. In my opinion, I found that Coast General’s ICU mostly contributed in slowing patient’s deaths. Also, on many occasions, working in the ICU was emotionally challenging: one day the patient could be doing great and stable and the next day, his health could be worse than when he arrived. While I had great hope for patients with an improving condition, seeing them die before my eyes was difficult. The common factor of in these deaths seemed to be poverty and lack of resources (provision of health professionals). Here is an example to support my affirmation: Early in the week, we had a patient who suffered from a postpartum bleeding causing a bilateral acute subdural hemorrhage. As she underwent her first burr holesurgery for the right side, she had a cardiopulmonary arrest. That is when they implied a myocardial infraction (M.I.). For several days, doctors studied her case, suspecting that the anesthesia, trauma, and her personal history of myocardial infraction made her code. Due to the shortage of surgical nurses and the seriousness of the situation, physicians concluded that it would be best for the patient to get her left side burr hole surgery in a private facility. Healthcare workers of Mombasa public hospitals are currently, on and off, on an ongoing strike: several have not had their salaries for months. According to the World Bank Data, in Kenya, the doctor to patient ratio per 1000 people is 1:5000 in comparison to 1:385 for the same population in the United States.1 The patient’s family refused to send their relative to a private facility due to the lack of funds and the high cost of treatment in a non-public establishment. Public health service sector provides the most accessible and affordable care for populations in Kenya. […] These facilities are mostly under-resourced in terms of equipment and clinicalstaff.2 Unlike hospitals in Quebec, Kenyan relatives had to purchase the medications prescribed by the physicianin order for it to be administered to the patient during the intensive care, pay for the patient’s daily cost of bed use and pay for the anesthetic needed during surgery. Ultimately, as the medical team took the decision of performing the surgery at Coast General Hospital, with employees and residents available at the time, the patient died before she could go to the operating room. In Quebec, these types of situation are unlikely to happen due to the common use of health insurance, covering most of our health expenses. In opposition, building a market for health insurance in Kenya has been an uphill task. Only 25% of Kenyans are covered under a private, public, and community-based insurance schemes. […] Both consumers and health care providers have poor knowledge and perceptions of health insurance. […] Low cost, innovative insurance products are uncommon in Kenya.3 If I had to use one sentence to describe what I have learned from my internship with IMA, I would say that I have learned that: “It’s not how much you have that counts, it’s how much you can do with what you have.” Coast General Hospital partakes in the improvement of many lives with just a few resources. Could we imagine how much more they could do if they had as many resources as Canadians do? They would do miracles. And this quote could be applied in many aspects of life: Kenyans are one of the most loving and welcoming people I have ever met, and, truly, they are the proof that you do not need to be a billionaire to be happy. Working at Coast General Hospital officialized my decision of wanting to become a Physician Assistant. Once I graduate, I plan on doing humanitarian work at hospitals in my home country, Ethiopia, and hopefully make a difference in many lives. Moreover, inspired by our Wednesday’s IMA community outreach, I will also use my background in teaching to raise awareness on many subjects that are currently taboo in the African communities such as periods, sex, rape, mental health, etc. And on this note, I will add “Assante” Kenya and “Assante” IMA for all you have thought me.

I loved every moment and every aspect of working with International Medical Aid! The staff of program mentors and interns was incredible. They were extremely efficient and made everything run smoothly, ensuring the success and well-being of each volunteer. They were so kind and I always felt welcomed and encouraged! The living accommodations and food were also great! Joshua and the support staff were the best, and I always looked forward to coming down in the morning to chat with them. The safety could not have been better. I never once felt unsafe or worried. Driving accommodations were always provided and we were introduced to our surrounding areas on foot, which provided a sense of familiarity and comfort. IMA proved to be extremely thorough in making me feel safe. The days were split nicely. In the morning, we would work in the hospital and usually do a cultural trek or community outreach in the afternoon/on the weekends. Going out into the community and meeting the individuals in their neighborhoods was amazing. We volunteered at feeding centers and brought supplies to orphanages. We set up clinics on the weekends and did health/hygiene clinics for children in local schools. These memories are some of my fondest and were some of my favorite parts of IMA. I would definitely recommend this program. The staff could not have been more professional and the experiences I had there I would not trade for the world. I am so grateful that this program exists. The lessons learned and experiences had are truly once in a lifetime and are ones that will be with me forever. I look back on my time in Kenya as one of the most important times in my life and in my journey as a healthcare professional.

My time in Kenya was incredibly eye-opening and worthwhile. The staff was excellent and very helpful. The residence was safe and comfortable. The food provided offered a nice variety and was always plentiful and fresh. Transportation to the hospital and cultural sites was efficient and safe. There is a whole team of people that cared about your well-being and your experience. They always checked-in to make sure that you were doing well and that your internship was living up to expectations. They were always willing to discuss life and culture in Kenya. Benson was particularly kind and compassionate--he really cares about what he does and about the experience the interns have. Husna was also extremely helpful and informative and Bella was always there when you needed something or had a question. An experience like this change how you view the world and also makes you think about your role in it. I wish I could have stayed twice as long--there was so much more to do and see. Back at home, I think about my experience every day and can't wait to go back.

The time I spent in Dubai, Oman and Abdul Dhabi, I have a wonderful and experiential Joy with the people and I was able to showcased my skills and the people explore my knowledge to their satisfaction Little details of my experience Dubai Falcon Ballroom Hotel which was so great. Even more perfect was the fact that they had thought of everything in advance, I didn’t need to remind them I needed a fresh bed shread in the room (which I did have to do twice at the local hotel I stayed in my country, more on this later) as they had already taken care of that prior to our arrival. The bed, oh the bed! It was dreamy in every way, the most comfortable place I’ve ever laid in, and the most restful sleep I had had in years, and sometimes teary nighttime awakenings. some things can’t be helped…oh, the joys of travelling with flight Emirate is spectacular. A night between those bed-sheets really restores and rebalances you. I had excellent views directly facing the Mall of the Emirate and part of the pool below (if you stretched your neck). Everything in the room was spotlessly clean and looked brand new. The desk was comfortable for planning my daily routes on our my map.