Human Rights Internships in Haiti

I am SO glad that I made the decision to join IMA in Kenya. After endless vetting for the seemingly most legitimate, meaningful, and impactful internship abroad, I decided to go with IMA. As my parents were initially hesitant, I am glad to report that neither of us are disappointed. There were so many positive experiences, that whatever else paled in comparison. The staff were THE BEST and helped make the trip that much more organized, fun, educating, and memorable! They were always open and receptive with communication and addressed any questions or concerns. I felt truly supported by them. Working in a hospital setting for the first time was extremely eye-opening, and oftentimes heartbreaking. I was admittedly afraid of being thrust into conducting psychiatric sessions and offering helpful advice to patients - but was instantly moved by the abundance of faith and positivity. The impact made me feel as though I had contributed meaningfully and learned so much. Gratefully, IMA planned lots of interesting tours, clinics, and lessons to adequately add to the experience and education. Planned activities were immersive, and enjoyable, and also provided unique cultural perspectives. The treks were incredible and well organized, with great guides and activities. It is quite the luxury, but it is definitely worth having the experience while you're there! When asked to reflect on what I have learned from my internship with International Medical Aid in Mombasa Kenya, my mind floods with an amalgamation of faces, stories, smiles, and painful struggles. It is no easy feat to concisely put into words all of the experiences shared, and lessons gathered. Though cliché, I truly felt as if I was acquiring knowledge in each interaction had – whether it be medical, historical, cultural, or personal, there was always a new perspective to be learned. Made clearer than ever, was the opportunity for growth and connection when one opens their mind, heart, and ears to those around them. By voicing our concerns and deepest struggles to somebody we trust, the grounds for support and healing become fertile. Though community is a powerful agent of health, it is inevitable that individuals will fall through the cracks in the foundation of governmental institutions. When housing, food, and education are a large financial burden for many, accessing quality healthcare becomes a luxury (Odhaimbo & Njeru, 2023). Additionally, there are social constraints such as religion, stigmas and taboos, and gender norms that further dictate health quality and seeking behaviours (Bakibinga et al., 2022; Coast General Teaching and Referral Hospital, October 2023). Throughout this paper, I aim to highlight the disparities and their origins in the Kenyan healthcare system, via resource scarcity, financial instability, lack of health education, social stigmatization, and violence against women and children. Lastly, I seek to draw comparisons from North America to illustrate that these inequities are ubiquitous and cross-cultural in nature. Firstly, I would like to preface that this discussion is from the perspective of a Canadian student, who has never known the struggle of financially supporting my family members, falling short of tuition fees, or only affording one meal a day. I do not know what it is to live in a country that largely pathologizes homosexual relationships, or what it may feel like to be ostracized from my community for engaging in premarital intercourse. While I was aware of these differences before I began my journey, my fear of immersing myself in this culture lay in transitioning to a label that was now “other”. The worry was not aimed internally, but rather at, “how would I adequately understand, support, and respect a culture so different from my own?”. Ingrained deeply in my values and often uncensored personality is a duty to speak up in the face of injustice and inequality. And so navigating a terrain rife with these imbalances was a daunting feat. Without proper experience, training, and cultural knowledge, how was I going to effectively and ethically address the concerns of patients in need of dire help? Sadly, yet thankfully, I quickly learned that any participation would be of enough value. An unfortunate truth made apparent swiftly, was that skill and ethics are cast aside when labourers and resources are scarce. With a meager 8.5% expenditure allocation from the government, considerable mortality rates from treatable ailments, and approximately 1 psychiatrist per 1 million Kenyans, one would be illogical to assume the level of standard practiced in the West (Odhaimbo & Njeru, 2023). In spite of the barriers, I observed many determined doctors and interns. They are passionate about their patients and offer healing in the best ways they know how. As always, there are those who exploit a flawed system. Sadly, this reality is inevitable cross-culturally, where financial gain often remains a top priority. Many practitioners and organizations will cut corners across care and ethics standards to reduce costs and effort output (Odhaimbo & Njeru, 2023). Alternatively, skilled professionals often flock to the private sphere or other nations in search of higher-paying wages (Odhaimbo & Njeru, 2023). Perpetuating a cycle of inaccessible care, those most vulnerable often bear the direst consequences. Whilst the government invests heavily in infrastructure to boost private capital growth and the production of goods, the needs of the population are severely ignored (The World Bank, 2017). Coupled with the fact that mental health is heavily stigmatized and not overtly apparent, seeking help for it is even harder. Alike North America, a historical lack of education, cultural gender norms, and the fear of being labeled ‘crazy’, seem to perpetuate the stigmatization and lack of access to mental health care. Though doctors recognize that targeting prevention is a more effective means of remedying physical and social ailments, the current system and resources in place often inhibit it (Odhaimbo & Mohammed, 2023; Coast General Teaching and Referral Hospital, October 2023). Too frequently, a problem remains untreated until its manifestation becomes critical. Rather than the loss of human lives, this turning point wrongfully often lies in the loss of capital and productivity. To provide a small-scale example, I was pleasantly surprised when one of the head psychologists, Anne, was invited to spend the day at a local shipping company to discuss mental health with their employees. The following day, seemingly exhausted, she shared the alarming degree to which these individuals were suffering at. Until eight o’clock in the evening, she was flocked with pleas for private discussion, where similar tales were divulged of severe stressors, an inability to cope at or prioritize their work, and a deeply rooted shame in the expression of their emotions and struggles (A. Nzioka, personal communication, October 12, 2023). To take time away from work to focus on our health and our dependents is a luxury that many cannot afford. When I praised Anne and the company for their efforts, she non-chalantly remarked that the company had suffered several suicides and a drop in workplace productivity (Coast General Teaching and Referral Hospital, October 2023). Presumably, the company sought to improve their financial returns and efficiency, rather than the health of their staff that allowed it to function. Likely, the most common concern from patients was how they would manage to pay their bills. Though private healthcare providers exist, and are the dominant choice, they are unaffordable and inaccessible to many (Odhaimbo & Njeru, 2023). Additionally, only 26% of Kenyans have insurance, and 36% live below the poverty line (Odhaimbo & Njeru, 2023). In the United States the rate of poverty is estimated at 11.5%, and in Canada 8% (Shrider & Creamer, 2023; Government of Canada, 2023). To risk their family’s being pulled from school or starving, people are unable to afford the time and cost of seeking medical attention. Due to a shift toward decentralized control and a lack of resources, public sectors remain grossly unequipped (Odhaimbo & Njeru, 2023). Statistically, patient outcomes are poorer and the rate of infection from the hospital is larger (Odhaimbo & Njeru, 2023). As a result, having less financial means leads to inequitable access and quality of healthcare. For those with a poorer socioeconomic background, a lack of education and health literacy results in worse health-seeking behaviours (Odhaimbo & Njeru, 2023). These individuals are more likely to delay diagnosis and treatment, or simply do not have the knowledge and tools to create and maintain health promoting habits (Odhaimbo & Njeru, 2023). A reality for some patients is spending weeks in the hospital, unsure of their diagnosis, and unsure of how to ask their doctors about it. From a lack of time or urgency, the role of many doctors and nurses remains to examine patient status, administer medication, and move on to the next. Patients may refrain from demanding explanation or treatment for fear of being labeled difficult, and further ignored by faculty (Coast General Teaching and Referral Hospital, October 2023). Oftentimes, the burden of disclosing the most sensitive and heartbreaking news is delegated to the psychological staff. To highlight the extent of broken communication, Margaret was a young woman teeming with discomfort and pain. She was noticeably underweight, tears leaked from her eyes, and her stomach was distended to the degree that assumed pregnancy. Following a discussion conducted in Swahili by a psychiatrist in training, Dr. Sood, we consulted her medical file. Since 2018, extensive detail had been recorded on Margaret’s treatment and recurrence of cystic ovarian mets (Personal communication, October 15, 2023). Though receiving blood and chemotherapy in the past, it was clear - without medical training, that her condition had catastrophically worsened. Dr. Sood and I were shocked to see that a recent entry had stated the patient was briefed on her condition, yet she and her husband were asking about the course of treatment and surgery that would follow. The file read that Margaret would be transferred to the palliative care unit, as there was no further treatment (Coast General Teaching and Referral Hospital, October 2023). Lastly, a major disparity that I witnessed was in the way that women are treated both inside and outside of the hospital. Touring the labour wards, I was appalled to see each expectant mother alone - a protocol that is enforced by the hospital. In the maternity and other female wards, a male companion was a rare sight. Gender roles seemed much more solidified, where daughters, sisters, and mothers were often relegated to caretaking, and men presumably remained at home and in the workplace. Though many had several family members that were capable, it was the school age girls, elderly matriarchs, and working mothers that assumed the role of personal nurse. In the male wards, a wife was the most common bedside assistant, followed by a son or brother (Coast General Teaching and Referral Hospital, October 2023). Confined in the bleak hospital environment, women frequently risked their physical and mental health, education, income, and free time in order to provide care for their loved ones. Remarkably, Kenya has abolished user fees for labouring mothers in the hospital, a luxury that does not exist in the United States (Odhaimbo & Njeru, 2023). However, several breaches of Western healthcare practice and standards were detailed by my medical peers against birthing women. Though anesthesia is rarely administered to the degree it is in the West, it is seldom used in the process of labour. Additionally, though it is classified as a high-risk procedure, the lack of resources and standard of care employed reflects a greater ignorance of female health. One intern detailed how more than once, after closing a c-section only then did medical personnel count the sponges and realize they were short. The response was that of, “well, she is already closed”. Another intern described the sheer agony a delivering mother was in when her baby was not crowning, devoid of familial support and epidural or pain medication. Mistakenly taking the doctors open hand as an attempt to soothe, he smacked it away. Afterward, they proceeded to inefficiently cut her perineum with a dull pair of scissors. Many Kenyan women avoid delivery in public facilities for these reasons. While other labs at the hospital have received state of the art technology and adhere to proper sanitary protocol, the condition of maternal care reflects the greater inequality and acceptance of violence toward female bodies. Similarly, we were met daily with the harsh realities of violence and abandonment perpetuated by male figures in domestic and public spheres. During my time in the gender violence department, not one survivour was over the age of 25, and the majority were children below the age of 10. Among my consultations, there was only one boy, yet he was brought in by his mother for assaulting their house staff. Rather than fearing his harmful behaviour and seeking psychological treatment, her main concern was that he had been engaging in intercourse and wanted him to be “checked”. With slight gestures to her behind, it was evident that she feared her son was engaging in homosexual intercourse, thus leading him to assault their cleaning lady (Coast General Teaching and Referral Hospital, October 2023). Countless other horror stories were divulged, including one where a man living at the perimeter of a school was coercing female students on a scheduled basis to engage in sex for the exchange of money. Having close connections with the village elder and a relatively corrupt justice system, the process to detain and charge the perpetrator was hampered. Another incident was where a teacher physically reprimanded a 3 1/2-year-old student which resulted in her broken arm (Coast General Teaching and Referral Hospital, October 2023). An image I doubt will fade from mind, is when we visited the Kadzandani primary school for a hygiene information session, and a teacher smacked a child in the head for misbehaving. Such force of power from an authority figure toward a child - or any being for that matter, was completely foreign to me. Instinctively, I audibly gasped and froze in place, though no one around me acted like anything had happened. Admittedly horrified and unable to shake the occurrence, I afterward asked a program mentor if physical punishment is common in Kenya, aware that there are cultural differences in the practice. After a genuine bout of laughter, she replied that it is considered weird if a parent does not do that. Apparently, it is only against the law if you leave a mark or sustained injury. How does one learn that corporal violence is psychologically harmful and has long lasting negative effects, when caregivers freely enact it on children? In all instances, there was some form of institutional authority that minimized or largely perpetuated the acceptability and prevalence of physical and gendered violence. Lastly, a large player dominating the intersection of gender, health, and sexuality is devout religious ideals. Stemming from the amalgamation of colonizing powers in the country, Christianity and Islamic faith are widespread (Odhaimbo & Njeru, 2023). With 94% of Kenyans identifying as religious (Odhaimbo & Njeru, 2023), sex outside the context of marriage and childrearing is taboo and strongly discouraged. Coupled with a lack of health literacy and birth control access, many young individuals do not have the knowledge, tools, and acceptance to engage in healthy sex practices. Unfortunately, this leaves many with sexually transmitted infections, unwanted pregnancies, and ostracism from family and community. The implications of sexual harm are worse for women, where they must unequally bear the outcomes of pregnancy and childrearing, assault, and victim blaming. This effect is even larger for LGBTQ+ individuals, who face immense shame, disapproval, and a lack of community or supportive systems. It was shocking to hear the contempt, perceived ill-nature, and need for cure of “gayism” espoused by psychological professionals. Likewise, in order to “safely” access resources, intimacy, and a family life, many young women are sold the dream of marriage before their minds and bodies have had the chance to fully develop. It is estimated that about one in every five of Kenyan girls aged 15-19 are expecting, or already have a child (African Institute for Development Policy, 2016). At one point, the head psychologist Anne led a small group of interns to speak with an 18 year-old girl who had just lost her baby and her uterus. In many traditional Swahili cultures, men are permitted to have multiple wives (Odhaimbo & Njeru, 2023). In reality, this often allows men to neglect their family once they have grown tired of them, as their attention and income is redirected to alternative dependents. As heard many times by a variety of female patients in the hospital, when a man decides to spend his time and resources elsewhere, it becomes the responsibility of the mother to pay bills, feed their families, and raise their children. Additionally, where abortion is only offered in life-threatening emergencies, similar to some of the United States, women are once again disproportionately restricted to the choices they can make for their own bodies and life. Many women are forced to choose between raising a child they may not want or have the means to support or risking their lives in an underground abortion procedure. It became no wonder why the top cause for admission to the gynecological ward was incomplete abortion (Coast General Teaching and Referral Hospital, October 2023). “But it is not like that where you are from”, or some version of this was a statement I heard often. My immediate and truthful response was to reply that - in fact it is in some ways the same. Despite Kenya having higher poverty and a host of inequitable challenges, many of these same health and social concerns exist in North America and for a large number of people. In Kenya, the poverty and disparity in healthcare is simply more widespread and easier to see. My aim in this statement is not to neglect the health crises and larger gaps that exist in Kenya, but rather to highlight the ubiquitous nature of inequitable global health. Whether in North America or Africa, the resources available to a nation and individual will heavily impact ones’ quality of safety and health. During my time in the hospital, the primary lesson I learned was that positivity and support truly go a long way. Connection and belonging are essential for wellbeing, which was observed in each interaction. Daily, I found myself glowing from the unyielding spirit and hopeful souls of so many people. Though I have never worked in a hospital, I doubt that this radiance exists everywhere. It seems as though it is much easier to appreciate what you have, when one is not constantly striving to gain more. My journey in Kenya magnified the level of privilege that exists in my own life - where travel, education, health, safety, and clean water come relatively easily. Pertinently, my life has allowed me the luxury to question the environment around me and freely decide the paths that I venture. For those in a cycle of poverty or struggling to make ends meet, the same freedoms, safeties, and choices are far less tangible. More than ever, Kenya has shown me that humanity fares much better when we are united in community, rather polarized and interested in our own good. I realize that while stigmas are alive and well to demonize those that stray from the norm, the global community heals when we accept those that are different and learn from new perspectives. While the world of economics and power politics fills us with fear, hatred, and superiority, it distracts us from what it means to be most human - to relate to and care for one another. In summary, the key teaching from my internship abroad in Kenya is that we must critically challenge systems of inequality, and actively work to promote health and safety for the welfare of all global citizens. Though health is a human right, it is far too often treated as a commodified privilege. Unsure of exactly which career path I will end up on, my internship experience has assured me with confidence that I will continue to assist others in achieving safety and support. Gaining this firsthand knowledge, I am eager to continue counselling gender violence survivours, and promoting education on sexual and mental health. Being abroad in a completely new environment ignited my passion to work with the global community and explore other cultures. Overall, my internship with International Medical Aid has provided me with lessons and experiences I would not expect to gain elsewhere. I am forever thankful for the perspective and connections it has opened me toward as I seek to find myself and my career journey.

From the moment I stepped off the plane in Mombasa, the program mentors were there to assist me in any way I needed. The security on site made me feel incredibly safe during my stay. My experiences in the hospital were some of the most shaping of my entire life and I could never be more grateful for the experience I had there. Our program chefs were incredible and made delicious food, including cultural foods for us to try. I know this sounds like rambling, but I just have too many good things to say about my time with IMA. I have what I would consider to be a special and deep passion for mental health care. As someone who has struggled with mental health for a majority of my life, I have seen first hand how detrimental and isolating mental illnesses can be. As a child, I lived what can only be described as a double life. At school, I was a poster child for the perfect student. I excelled in all my studies, testing years above the grade I was in at school. All throughout elementary school, my teacher’s took special interest in me and my intelligence, giving me advanced worksheets and books to read to keep me entertained and challenged. However, once I went home, a switch flipped and I became a completely different version of myself. Nearly every day when I would come home from school, I would scream and cry for hours, throwing tantrums that left my parents helpless with no clue what to do. They took me to specialist after specialist, and no one could figure out what was wrong with me. Hearing that there was something wrong with me at such a young age definitely impacted the way I viewed myself and mental health growing up. It was not until I was about thirteen years old that I was diagnosed with anxiety. This anxiety that I masked at school, when paired with the boredom I experienced due to work I found too easy, fostered tension that was released once I stepped foot inside the safety of my home. For a short period of time following this diagnosis, I wanted to be a child psychologist. Frankly, I just thought it would be a cool career. It was not until I turned twenty that I realized my passion for mental health care and how deeply I cared about the issue. It sounds cliche and dramatic to state that I had an epiphany, but that is the only way I can think to describe how I came to my decision to be a psychologist. Yes, I was a psychology major in my last year of college, but I had no idea what I wanted to do after graduation. This fall, I went through what can only be described as the hardest time I have experienced. I spent days unable to get out of bed, trapped inside my own head and paralyzed by my anxiety. At night, I would be taken by horrifying panic attacks that seemed to come out of nowhere, leaving me shaking and unable to catch my breath between sobs. At this point, I genuinely no longer wanted to be alive. The single hardest thing I have had to do in my entire life was tell my parents I needed help. Once I got my medicine adjusted, my anxiety started to decrease, and it was at this point that it became clear to me that I wanted to work in mental health, helping people who struggle like I have. Once I was accepted into International Medical Aid’s Mental Health program in Kenya, I was beyond excited. I had never worked in a clinical setting, and the only exposure I had previously had to mental health facilities was the child counseling center I went to when I was younger. I thought that I could not be more prepared, as I would have a unique first-hand understanding of what the patients I would deal with experienced. However, I could not have imagined the dire state of mental health care in Kenya. My first day in the hospital was nothing short of eye opening and shocking. While I had known that the hospital would be nothing like the healthcare facilities in the United States, I could not have imagined the setting I stepped foot in. The first thing I noticed was the sanitation, or lack thereof. Nearly every room in the hospital held rusty equipment, with few monitors or other devices one would expect to see in a large hospital. There were flies everywhere, and it was drastically clear that there was not only a lack of staff, but an abundant lack of resources. The moment I stepped foot into the psychology unit, my confidence that I knew what to expect immediately dissipated. The unit was incredibly small, with a medical officer and two psychologists. There is also a psychiatrist, but during my three weeks in Kenya, I did not ever meet or see them. Considering the population that Coast General Teaching and Referral Hospital serves, two psychologists was nowhere near enough to combat the mental health problems that Kenyans faced. Statistics supported my observations, as it is estimated that 1 in 4 Kenyans is likely to suffer from some sort of mental illness at some point in their life. Furthermore, there are only 62 psychiatrists in the entire country of Kenya (International Medical Aid, 2019). Learning about these facts only further solidified that the state of mental health care in Kenya was much worse than I had previously thought. Each day in the psychology department brought new cases and challenges. I was able to sit in on counseling sessions with a variety of different patients, allowing me a clinical experience that I would never be able to have in the United States. One of the first cases I sat in on was with a first-time mother who had lost her baby during childbirth. While Anne, the psychologist who handled the case, counseled the mother with nothing short of compassion and inspiration, it was immediately clear the vast differences between psychological counseling in Kenya as opposed to the United States. Essentially, all the psychologists were able to do in this case was to provide support and guidance for staying busy to keep the mother’s mind off the loss. It was also emphasized to her that she would likely conceive again, and that situations like these are out of our human control. Though, the most shocking part of the session was that we sent the mother back to the maternity ward to wait for discharge, where she was surrounded by all the other new mothers holding their newborns. While there was nowhere else for her to go, as there wasn’t a psychiatric ward or anything of the like in the hospital, sending her back to an environment that would only remind her of her loss seemed cruel. Perhaps the most heartwrenching case I experienced over the span of my three weeks in Kenya was with a fourteen year old girl. She came into the Gender-Based Violence Center, and the first thing I noticed about her was how small she was. She looked sickly, and during her counseling session, she kept coughing and appeared short of breath. It was during this session I learned that she had been raped by a neighbor. She actually had blocked the rape out of her conscious due to trauma until she realized she was pregnant, at which time the horrific event came back to her. When I heard this story, I was overcome with anger and felt physically sick. Hearing this small fourteen year old child tell us that she was pregnant with her rapist's baby brought bile up my throat. The worst part of it was that he was not in prison. She had to go home and live in fear everyday because he was not in custody. After the session ended and the girl left the room, I asked why he wasn’t in custody. I was told that it was a legal issue and there was nothing we could do pertaining to the rapist other than offer the girl support. This infuriated me and truly showed me how vastly different Kenyan medical care and politics were from those in the United States. If something like this happened in America, there are systems in place, teams that work together to ensure that the patient is taken care of medically, psychologically, and legally. But there was no legal team for us to work with to ensure justice. Rather, it was a completely different structure in society that needed to be dealt with separately, only causing additional stress to the client. Rape was actually something that I heard a lot about during my time working alongside the psychology team. This sparked a desire inside of me for working with those who have experienced sexual assault and abuse. While I have not personally experienced rape, I know far too many people who have, and hearing these stories lit a fire within me for advocating and helping these victims. While I had previously known that I wanted to work with adolescents and young adults, this clarification allowed to me realize that I would like to work specifically with depression, anxiety, and sexual abuse cases. Depsite the challenges I know will come with this field of practice, these victims deserve to have someone listen to them and support them through these dehumanizing experiences. A study on mental health and gender-based violence in Kenya found “...that experiencing rape within the last two years was a strong predictor of scoring poorly on all PTSD, depression, and anxiety scales” (Friedburg et al., 2023, p. 10). In a country that already is facing a multitude of mental health problems, with no public funding to combat them, the co-occurence of rape and poverty only further worsen these issues (International Medical Aid, 2019). Despite the difficult and sickening stories I heard during my time at Coast General, my experience is one that I will cherish and remember for the rest of my life. I learned more than I could have ever imagined about mental health care and what a career as a psychologist looks like. While there were vast differences between psychological care in Kenya and the United States, there were still countless lessons I learned during my internship. For starters, I learned how to deal with cases using empathy and kindness, fostering a comforting environment that allowed clients to feel safe opening up and sharing their experiences. I also learned how to support clients through these extremely difficult times, providing them with hope and support. It was nothing short of fulfilling knowing that despite the difficult circumstances these clients were facing, I was someone that they knew supported them and believed in them. It became clear that providing support is no small gesture, as mental health in Kenya is extremely stigmatized. According to the Forum on Neuroscience and Nervous System Disorders et al. (2016), “Stigma toward people with mental illness exists on every level, from the community to health care workers.” This stigma further deters people from seeking help, exacerbating the mental health problem. My time in Kenya with International Medical Aid was nothing short of a dream come true. During my time working at Coast General Teaching and Referral Hospital, I gained an immense amount of knowledge and experience that I would never have the opportunity for in the United States. Working alongside the psychology team allowed me to sit in on counseling sessions with patients and to see how the psychologists handled difficult issues. Each day I spent at the hospital further solidified my passion for mental health care and provided me with clarity that this is the career I was called to. I am confident that this experience will help shape my counseling outlook during my career, as I now have a unique perspective on cultural aspects of mental health. This experience has also opened my eyes as to how desperately mental health needs a global platform. Even in the United States, mental health still has a lot of stigma attached to it. I will never stop advocating that mental health matters. After all, how can we expect people to live a full life, contributing to society, if we do not address the illnesses and challenges they face concerning their mental well-being?