Internships Abroad in Multiple Countries

I really enjoyed being a participant in the program. From the moment I was picked up to the moment I was dropped off from the train station I felt very safe and the IMA staff was there every step of the way to support and guide me. The accommodations were excellent, I was not expecting the hospitality that I received and I have no complaints! The kitchen staff and the food were all amazing. The chefs were very friendly and made very yummy food. My experience at the hospital was also good. The dentists in the dental unit were all very friendly and were very open to having interns there. I always left the hospital having learned something new. The community outreach was nice because it felt like I was able to make an impact in the community whether it was through the women’s hygiene education session or the mental health education session. I especially enjoyed the free medical clinic. I was with the dentists and I was able to assist them by setting up the tools needed for extractions and cleaning up after an extraction was completed. During my childhood, my career aspirations varied from wanting to become an astronaut to a wanted to pursue a career in education. However, all those aspirations quickly changed after I got my wisdom teeth removed at the age of 12. I thought it was cool that the oral surgeon was able to remove all four of my wisdom teeth in just 45 minutes. I started to think about possibly pursuing a career in dentistry. I had always enjoyed going to the dentist as a child. I loved everything about the dentist’s office; from the smell, to getting my teeth cleaned, to the sound of the instruments as they did procedures. I quickly fell in love with the idea of becoming a dentist, and it stuck. As a college student, I have actively pursued my interest in dentistry by joining various pre-professional clubs for students wanting to pursue careers in healthcare. While looking for something to do over the summer that would add to my professional development, I stumbled upon International Medical Aid. Initially skeptical since I stumbled upon it through a random Google search, something urged me to complete an application. When I received an email for an interview, the opportunity became real, and I excitedly informed my parents. Upon acceptance into the program, I knew with certainty that I wanted to participate during the upcoming summer. Although I have family in Kenya and I had visited them a few times in the past, I wasn’t quite sure of what to expect at the hospital, especially in the dental unit. However, over the course of four weeks, I witnessed the extraordinary dedication of doctors and dentists who provided exceptional care to numerous patients despite the limited resources available to them. On my first day we were introduced to the dental unit and one of the dental interns showed us around before cutting us loose to choose where we wanted to observe. I began by observing in the oral diagnosis department where I watched as Dr. Mulei attentively listened to patients’ complaints and examined their mouths. Throughout his diagnosis process, he was sure to thoroughly explain what he was doing and why he was doing it. By the end of my shift, Dr. Mulei had already started quizzing me on the different issues that ailed the patients. Upon my return to the residence, I was already in awe of all that Dr. Mulei had done with the patients he saw in the few minutes that he interacted with each patient. The set up in the oral diagnosis department consisted of two plastic chairs that were facing each other and a box of tongue depressors. Despite all the resources that were lacking in that environment, Dr. Mulei was still able to provide the best care he could to his patients and help them find the best course of action for them. Observing the dentists in the Dental Unit at Coast General further solidified my decision in wanting to pursue a career in dentistry. Two distinct moments were particularly impactful. The first occurred when I accompanied Dr. Khadija Athman as she went to see a patient who was staying in a ward to clean his tumor. The patient had been hospitalized for about a month and the only unit that was really seeing him and making sure he was getting the care he needed was the dental unit. The patient had an oral squamous cell carcinoma, and the tumor was so big that it was protruding from the patient’s eye and had taken over the entire right side of the patient’s face. The dentists had put in a request to have the patient reviewed by oncology 3 weeks prior to the day that we had come in to clean his tumor. The tumor was very infected and had started to bleed which is why the patient needed to have someone come every day to clean it. After reviewing the patient, it was noted that oncology still had not come to review the patient and over those three weeks that the patient was waiting, the patient’s condition continued to deteriorate. The dentists called the oncology unit and were told that if they wanted an oncologist to review this patient that they would need to physically come to the oncology unit and request the review. Once the dentists had arrived at the oncology unit and asked why they didn’t review the patient after the first request was sent, they told the dentists that they never received such a request. So, because of miscommunication, this patient was left untreated by the unit that he needed the most and at the time the oncology unit was finally able to see the patient, there was nothing more that could be done for him. The patient ended up passing away that very afternoon and it left me thinking about how much the dental unit did for the patient even though to a certain degree it was outside of their scope of practice. But because the patient was not receiving the treatment he needed from the oncology unit, the dental unit continued to care for the patient, check up on him, and advocate for him. The second instance that reinforced my dedication to dentistry involved a patient who I saw improve over the four weeks that I was at coast general. This patient was in the hospital because they had a decayed tooth that caused a case of Ludwig’s Angina, which was left untreated and then became necrotizing fasciitis. I was told by the dentist who saw the patient when she first came in that the necrotic tissue went from just under her chin all the way to her chest. When the patient first arrived, she had a very poor prognosis and they did not think that she would make it, but the patient was able to recover and come out even stronger. Every time I saw the patient no matter how much pain she was in, she always found a way to smile. By the time I left, she had been cleared to leave the hospital and was crying tears of joy at her dressing changing visits. Something that the dentists at Coast General often discussed was how people in Kenya view dentistry more as a cosmetic matter, and they don't really visit the dental unit unless it is their last resort. Growing up, I regularly went to the dentist every six months for check-ups and cleanings. I had never once thought that these appointments were vain or solely for maintaining the appearance of my teeth. It saddened me to know that a large part of the population believed that dental visits were necessary only if they were experiencing significant issues. Consequently, most of the visits I observed at the dental unit were for curative care rather than preventive care. This trend was also evident throughout the hospital. In "The Current State of Healthcare in Kenya" presentation, one of the covered topics addressed the division of the healthcare system. During this lecture, I learned that the prevalence of curative care over preventive care at the hospital was partly due to the greater funding allocated to curative care. Another contributing factor was the expense of receiving treatment at the hospital, even with subsidized prices, making it unaffordable for the average Kenyan. People are reluctant to spend extra money that could be used to support themselves or their families solely for ensuring their health. They only want to invest in healthcare when it becomes a dire situation. This brings me to a conversation I had with my uncle and cousin after they picked me up from the train station in Nairobi. Based on what I had witnessed during my time at Coast General, I stressed the importance of taking oral health seriously and considering it a priority for overall well-being. While my uncle agreed with me, he also reminded me of the significant costs and time involved in visiting the dentist. These are resources that could be used for necessities such as food or paying bills. He even expressed his reluctance to find out if there was a serious health issue, as he wouldn't want to burden his family with the financial strain of medical bills and treatment, potentially jeopardizing their well-being. When he shared this with me, I experienced a range of emotions. The environment I grew up in had shaped my perspective on priorities. I had placed great emphasis on oral health based on my own experiences, but my uncle's upbringing and current circumstances differed significantly from mine. He never visited the dentist solely for teeth cleaning or an x-ray. His life is filled with struggles, and ultimately, having a roof over his head and food on the table takes precedence over going to the hospital for a check-up. The knowledge I have gained from my time with International medical aid is invaluable. Witnessing the dedication and resourcefulness of the healthcare professionals in Kenya, despite the challenges they face, has inspired me to become more of an advocate for improved access to preventative care and to address the systemic issues that inhibit proper healthcare delivery to those who need it. I am committed to using the knowledge I have accrued from this experience throughout my career in healthcare and to continue to build upon it. I hope to return to Kenya as a licensed practitioner and continue to learn and grow as a medical professional. Most importantly, I plan to share my experience and inspire others to come to Kenya and learn about healthcare and the beautiful culture that surrounds Coast General. My experience through IMA has shaped me into a more aware and perceptive person. It has changed my worldview and my view on healthcare. Although I have only experienced healthcare in the United States and Kenya so far, it is a starting point for me. It has helped me understand how healthcare works, how healthcare systems can impact a population, and the importance of never losing sight of the primary goal of healthcare: improving the lives of patients!

My overall experience with IMA was terrific. The house was spotless, with helpful staff. Interning in the hospital was a great learning experience. I thoroughly enjoyed every community outreach opportunity. Coming to this internship experience, I hoped to gain the hours needed to become a strong applicant for PA school. However, my internship experience in Mombasa instilled a new outlook on the medical field and invigorated my pursuit of a healthcare career. While in Kenya, I discovered my strengths and built the confidence needed to thrive as a provider. I plan to incorporate the same passion and dedication Coast General Teaching and Referral Hospital's medical staff displays into my career. I wish to educate my American colleagues about our privileges compared to others worldwide to create change. Kenya will forever have a place in my heart, and I aim to continue to support the people of Mombasa by building a non-profit while working for my medical license. "Bahati haibish mara mbili" is Swahili for "luck doesn't knock twice" and reminds people to take advantage of the opportunities that present themselves in life. I took full advantage of the opportunity to discover Mombasa; my lessons will live with me forever. Studies show that our brain is continuously changing through the process of neuroplasticity. Triggered by new stimuli, neuroplasticity is the ability of neural networks in the brain to change through growth, and reorganization. Neurologists suggest that traveling to a new location has been found to stimulate the brain, allowing neurons to form new connections with other neurons, generating more dendrites, and thus increasing neuroplasticity. That being so, the month spent in Kenya not only opened my eyes, it rewired my brain. Adapting to a new environment, learning the Kenyan culture, conducting a weekly community outreach, and assisting at Coast General Teaching and Referral Hospital (CGTRH) reframed my view of the global healthcare system and the world. Understanding the infrastructure of the Kenyan healthcare system was crucial to adjusting to the medical environment at CGTRH. The Kenya healthcare system is divided into three divisions: public health sector, commercial private sector, and faith based organizations. CGTRH is a part of the public health sector and provides the most affordable and accessible care to the majority of the Kenyan population. Unfortunately, these public facilities are often short staffed , low on medical resources, and provide a lower quality of patient care. During my time at CGTRH I was able to experience these disparities first hand as I shadowed in various departments around the hospital. For example, instances when a tourniquet was needed, a glove was used instead, lack of sterile technique contributed to high incidences of hospital acquired infections, and many wards were short staffed and run by residency doctors. However, aside from the lack of resources, all medical staff were knowledgeable , precise, well versed, and spoke multiple languages. I observed, as medical officers maneuvered through crammed wards with no central air conditioning, to monitor the health status of each patient and create a specialized plan of care. It was during these times that I was able to understand the true meaning of what it takes to be an exceptional healthcare provider. Even in the least desirable circumstances, all medical staff remained on the same mission; to listen, treat, and heal in the most efficient way possible. This was the case for an infant girl with hydrocephalus. Hydrocephalus is a neurological disorder caused by a buildup of cerebrospinal fluid deep within the brain. The excess fluid causes the ventricles to widen, putting pressure on the brain, potentially causing brain damage or early death if left untreated. A prominent indicator of hydrocephalus in infants is an enlarged head and swollen veins on the scalp. Due to lack of prenatal care in Kenya, hydrocephalus is commonly caused by deficiencies in folic acid and vitamin B12 during pregnancy , as well as neonatal infections like neonatal meningitis and ventriculitis. I observed as neurosurgeons skillfully performed a Ventriculoperitoneal shunting, or VP shunt, procedure on the small infant.The procedure consisted of drilling a small hole in the skull, making a surgical cut in the stomach, and passing a catheter through a ventricle of the brain down to the abdomen to drain the excess cerebrospinal fluid. Almost immediately after the shunt was placed into the ventricle, the excess fluid began to drain, indicating a successful procedure. Witnessing this operation awakened a new interest and enthusiasm for surgery , and the surgery department soon became my favorite rotation. I took full advantage of my time there, and observed over 10 major surgeries including an appendectomy, a skull elevation, a coccygectomy, and a foot amputation. During each operation, I had the opportunity to ask questions, take notes, and get an adjacent view of procedures I had only read about in books. This up close perspective helped me recognize that I am not a squeamish person, and am able to stay calm in paramount procedures. I continued to learn more about myself as I rotated throughout CGTRH, and my confidence grew as I shadowed and learned from medical and clinical officers in internal medicine, pediatrics, maternity, and the newborn unit. Outside of the hospital, I had the chance to display that confidence while hosting community outreach clinics. Every week, the IMA interns and I traveled to local primary and secondary schools to teach lectures on hygiene education, and women’s health. During these lectures I sharpened my public speaking skills, while engaging in important conversations. I enjoyed volunteering as a team leader and collaborating with the other interns to create fun and memorable lectures. However, the most rewarding part was being able to distribute items like toothbrushes, toothpaste, and menstrual pads. It was humbling to see how something as trivial as a toothbrush could bring so much joy to a child. Days like this put into perspective how privileged life in America was, and every week I became eager for the next clinic. Aside from hygiene and women’s health, the IMA interns and I also collaborated with psychologist and medical officers from CGTRH to host a mental health clinic, and a free community medical clinic servicing hundreds of civilians.The mental health clinic gave the interns and I a chance to speak with high schoolers and gain an insight on the day to day pressures they face. It was refreshing to learn that they deal with the same problems and insecurities as teens in America, and being able to relate to them made it easier to teach them positive mental health practices. The community medical clinic required a more hands on approach, as we provided essential healthcare services to those in need. Here I had the opportunity to work alongside pharmacists and learn how to fill free prescriptions for the community. Experiencing this level of philanthropy was profound, and made a lasting impression on me. Coming into this experience I hoped to gain the hours needed to become a strong applicant for PA school. However, my internship experience in Mombasa instilled a new outlook of the medical field and invigorated my pursuit for a career in healthcare. While in Kenya I discovered my own personal strengths, and built the confidence needed to thrive as a provider. I plan to incorporate the same passion and dedication displayed by the medical staff at Coast General Teaching and Referral Hospital into my own career. I wish to educate my American colleagues of the privileges we have compared to others around the world in hopes to create change. Kenya will forever have a place in my heart, and I aim to continue to support the people of Mombasa by building a non-profit while working for my medical license. “Bahati haibish mara mbili” is swahili for “luck doesn’t knock twice”, and reminds people to take advantage of the opportunities that present themselves in life. I believe I took full advantage of the opportunity to discover Mombasa and the lessons I learned will live with me forever.