International Medical Aid (IMA)

Whenever I’m asked, “How was your trip?” I find it hard to form a response that does justice to the experience. Whether I say “amazing” or describe it as “eye opening and incredible,” those words never capture the overwhelming impact of the journey—a journey I’m still processing. I chose IMA because of its highly rated safety and focus on cultural immersion, but I was met with far more. From the moment I applied, the staff was responsive and helpful in providing information. When I stepped off the plane in Mombasa, I had prepared myself for a very minimalistic lifestyle. Growing up, you hear stories about poverty in Africa. I had even visited other countries like Costa Rica, where I witnessed second-world conditions firsthand, so I thought my experience might be even more austere. However, when we arrived at the residence, I was surprised by the grandness of the home. There was a pool, indoor toileting, running water, and electricity. In addition, I enjoyed 24-hour security in a safe neighborhood, reliable transportation, hot meals prepared for me, air conditioning at night, a made bed, and daily laundry. I even sent pictures of my delicious meals to my parents, who were relieved to see I was well cared for. The staff’s attentiveness made me feel at home and ensured I had everything needed to succeed. There were moments when we interns felt it was more of an educational vacation than a rigorous internship. Yet, when considering my hospital experiences, it’s easy to recount the shocking differences between a third-world country and the United States. Life in Kenya is simpler and slower—people are kinder and more tolerant, and there’s far less judgment, which makes learning and connection more enjoyable. Even back home, I found the overstimulation of American life jarring—I once sat through an entire rotation of a stoplight in my first week back. My journey extended beyond lifestyle contrasts into the realm of healthcare—a sector where I encountered challenges that reshaped my perspective. Within the often frustrating limitations of Kenyan healthcare, I discovered a new regard for human life that has reignited my passion for becoming an empathetic provider. Healthcare delivery varies greatly around the world; each system has unique challenges that are impossible to fully appreciate without firsthand experience. As an emergency department clinical technician, I’m no stranger to staffing shortages or burnout, but the term “under-resourced” hardly conveys what I witnessed at Coast General Teaching and Referral Hospital. Many of these limitations stemmed from Kenya’s transition from centralized to decentralized operations. From 1964 to 2010, primary and secondary health services were run by the national government. Since 2010, these services have shifted to county governments for operation and financing—even though large public hospitals like Coast General still rely on national support. This hybrid system has led to challenges in financial distribution, resource access, and accountability. For example, in the Newborn Unit, a Pediatric Morbidity and Mortality CME session revealed a shocking 25% mortality rate in September. The head consultant demanded answers, and two critical issues emerged: there were only three CPAP machines available for the many infants who needed them, and most of the babies who died were not born at CGTRH but had suffered delayed care after being referred from underfunded county hospitals. Resource dilemmas were evident in nearly every department. In the maternity section, nearly no patients received prenatal care, resulting in many children being born with conditions like hydrocephalus—despite the known benefits of proper folic acid intake. At the medical clinic, high blood pressure was rampant, a situation likely exacerbated by the naturally high salt content in many African foods. While such issues might be addressed easily with sufficient funding and education, both county and national budgets in Kenya prioritize infrastructure and education over healthcare. (Current State of Healthcare in Kenya, 2022, p.31) The United States spends about 16.885% of its GDP on healthcare compared to Kenya’s roughly 5.167%, a disparity that affects everything from medical supplies to the quality of patient care. In the Casualty Unit, I witnessed gloves, needles, and sutures used with extreme frugality—often reused in ways that would be unthinkable in a more resource-rich environment. This culture of conservation is passed down through every level of the system. In Minor Theatre, I observed a resident chastising an intern for not conserving sutures—a practice critical in Kenya yet less emphasized in the United States. Staffing shortages compounded the issue, forcing interns into roles with minimal supervision. In Casualty, interns hurriedly collected patient histories, wrote orders, and interpreted scans with little oversight, sometimes leading to critical oversights. Cultural factors also heavily influence care. Kenya is home to forty‐four tribes, each with its own traditions and beliefs about medicine. In one instance at the skin clinic, a patient—initially hesitant to discuss his urinary issues because the room was filled with female staff—revealed he had been self-treating recurring UTIs for a year. When the consultant recommended circumcision as a preventive measure, the patient, a member of the Luo tribe which traditionally does not practice circumcision, refused the suggestion despite the explanation. This encounter underscored how deeply entrenched cultural values and stigmas, even among healthcare professionals, affect treatment decisions. The persistent stigmatization of HIV, which in 2015 was linked to 29% of annual adult deaths (with women being more vulnerable), further complicates efforts to educate youth and prevent transmission. (Disease Burden in Kenya, 2021, p.11) I also witnessed how financial constraints ripple through the system. Patients often remain in hospitals well past their discharge dates because they cannot pay their bills, leading to overcrowded wards and an increased risk of further illness. In remote areas, limited transportation and resources force many to rely on traditional remedies—exemplified by a twelve-year-old girl in Ward 10 who succumbed to Rheumatic Heart Disease after her family’s delayed decision to seek medical aid. Through all of these challenges, I learned that at the center of healthcare is the human life we serve. Whether it’s sutures, medication, surgery, or simply an empathetic ear, every patient deserves care. My time in Africa has reshaped my understanding of medicine and reinforced my commitment to compassionate, patient-centered care. It’s a reminder that even in resource-limited settings, the human spirit can inspire profound change.

My time in Kenya with International Medical Aid, while short, was the most inspiring, heart-wrenching, informative, and eye-opening experience. It surpassed any expectations I had previously set in my mind and deeply invigorated my passion for medicine. As soon as I stepped off the plane, I was met by the immense warmth and hospitality of the Kenyan people. I was able to develop strong bonds with the other interns and the incredible IMA staff during my two week stay while the mentors made all of the interns feel instantly at home. The kindness and happiness that the people of Mombasa exuded was extremely contagious and I will never forget all of the extraordinary people I met. At the hospital, the doctors went above and beyond to make the IMA interns feel included and be able to learn as much as possible. During my rotations in Pediatrics and Surgery as well as our Community Outreach lessons in orphanages and children’s homes, I witnessed great global health disparities stemming from a lack of healthcare literacy and a great lack of resources. The doctors, however, took on each challenge with great resilience and creativity and continuously demonstrated their passion and love for helping their patients. Moving forward, the lessons and experiences I have learned from my time in Mombasa will significantly guide and shape my future in healthcare. Asante Sana Mombasa! The sweltering heat and thick humidity slammed into my senses the second I de-boarded my plane in Mombasa. The climate was just one of the many things I was unprepared to experience during my time with International Medical Aid in Kenya. As I met Robert at the airport and was escorted through the city to the residence, the cultural shock began to settle in. I couldn’t stop staring out the window, noticing the cattle roaming in the road, the lack of driving lanes, wooden huts on the side of the road selling fruit or housing people, and the substantial poverty evident through the lack of infrastructure. But, I was also noticing the smiles that people adorned on their faces, the strong sense of community enveloping around me, the little kids waving at me and saying “Jambo!” as we drove past, and the overall great beauty of Kenya. I am not completely sure why, but I have always been drawn to Africa. For as long as I wanted to pursue medicine, I have had the desire to experience the healthcare system there whether it was through an internship or a volunteering program. Perhaps it was partly due to the countless stories I’ve heard of the kindness and generosity that the people of Africa exude or because of the experiences and knowledge I believed I could gain about global health disparities from this trip, but this urge to complete an internship in Africa finally came to fruition when I applied to International Medical Aid this past spring. While I expected great challenges and unique experiences, nothing could have prepared me for all the lessons I would learn and inspiration I would gain from this trip. The next round of shock came for me on our tour of Coast General Teaching and Referral Hospital (CGTRH) on our first day. When we first jumped out of that van, the first thing I noticed was the overwhelming number of people spilling out of every hallway, clearly in dire need of medical attention. As we walked throughout the entirety of the hospital, my sense were heighted and the weight of what I was going to be doing began to sink in. I started to feel quite anxious about these upcoming two weeks and all that I would witness. What I saw on this initial day was a severely understaffed and under-resourced hospital that looks drastically different from healthcare facilities in the United States. The smells were strong, the humidity made our scrubs drenched within seconds, there were wards full of hospital bed frames pushed next to each other with dirty cots resting on top, flies were landing on nearly every patient, mothers were sleeping on the same cot as their sick child, buckets of throw up were laying on the floor next to the beds, wails of injured patients poured through the walls, and not a sanitary surface in sight. While these first observations showed me a healthcare system in more severe distress than I had initially predicted, my previous assumptions about the doctors I would encounter during my internship were repeatedly proven wrong. Especially after seeing how few resources the hospital had to work with, I assumed that the quality of knowledge and experience the doctors possessed would be inadequate. However, throughout my two weeks in CGTRH, I met many doctors who were some of the most hardworking, intelligent, and caring people I have ever encountered. They approached each problem with such grace, creativity, and resilience. It was through these interactions that I came to fully understand that the disparities in healthcare between the United States and developing countries such as Kenya does not come from a lack of ability or passion in the healthcare field, but rather from intricate and complex root issues in the healthcare system and an overall lack of healthcare literacy throughout the greater population. I began my first week with my pediatrics rotation. As I stepped into the ward to join the doctors and other interns on rotations, my breath was immediately taken away. The first child that the doctors were revisiting this morning was extremely emaciated from malnutrition and his mother was laying on the tiny cot next to him, sobbing. As I glanced through his chart, I saw that the child also had cerebral palsy, congenital heart disease, respiratory distress, pneumonia, and dehydration in addition to his malnutrition. My heart sank at the ongoing list of medical complications and diseases that this poor 6 year-old had to endure. The doctor doing the rounds told me that since many mothers in Kenya do not have access to prenatal care, many babies are born with complications such as congenital heart disease. She also informed me that many of her patients have multiple underlying diseases and conditions which only further exacerbate one another. The high disease burden in Kenya comes from both communicable and non-communicable diseases which results in a double burden of disease (Disease Burden in Kenya Lecture, 2023). In addition, there is a high prevalence of diseases such as malaria, malnutrition, and HIV/AIDS which can open up the door and make the patient vulnerable to many other diseases. In fact, “50% of Kenyan households are food insecure due to poverty and inadequate food production” (Current State of Healthcare in Kenya Lecture, 2023). When many patients come into the hospital with baseline conditions such as malnutrition, it makes the other diseases more difficult to treat since the patient’s immune system is already on the decline. I learned that one of the major root causes of such high morbidity rates in Kenya is due to the healthcare budget allocation. Most of the budget tends to be skewed towards the secondary and tertiary care facilities which have a heavier focus on interventional care, leaving preventative care largely under-funded. Therefore, many diseases that could have been prevented with proper healthcare remain unsolved until they progress to a more serious stage. Throughout my rotation that week, I observed many difficulties that the pediatrics department faced daily. The wards were tightly-packed with hospital beds a mere foot or two apart from each other, no privacy existed between patients, mothers attempted to fit on the cot with their child, diligently taking care of them and watching over them after the doctors had done their morning visits, and the majority of the children appeared severely malnourished. Aside from these devastating conditions, I also witnessed the power of a mother’s love and the cheerfulness many of the patients still possessed despite their circumstances. Although I was merely there to learn, many of the mothers would profusely thank me for helping their children. Their love and strength was evident as they stayed by their children’s side day and night, feeding them and taking care of them when the doctors couldn’t. I often saw the mothers comforting each other or standing by each other’s side as the doctor delivered the notes for the day. The love and support they had for each other was palpable. Despite working in an under-resourced ward, the doctors were hardworking and passionate. On one of the rounds I observed, the doctor gave a lecture to the other doctors-in-training on how to be a good doctor. The doctor told them that there were only good doctors and bad doctors in this world, and in order to be a good doctor, you must understand your patient’s history thoroughly and have a detailed reason for every action in their course of treatment. She was harsh, but instructive, with her tone and the lecture resonated with me more than I realized. I saw how much this doctor cared about helping her students be the best they could. During my first week in Mombasa, I decided to complete a night shift in the casualty department. I knew the shift would be challenging and I wanted to embrace that challenge to see how I could potentially grow from it. I spent the night under Dr. Fatma, who so graciously spent a lot of her time that night teaching me and explaining her patients’ cases. Throughout the night shift, the creativity of the doctors and their ability to adapt to difficult situations strongly impacted me. One of the first patients brought in that night had been in a terrible traffic accident and his left tibia and fibula were fractured and sticking through his shin. At this time, all of the theaters were full and they were not able to rush him into the surgery he so desperately needed. The hospital also lacked proper equipment to brace and sterilize his leg. Dr. Fatma quickly adapted to the situation and found a long piece of cardboard and had me help her wrap the man’s legs with the cardboard and gauze in an effort to stabilize the fracture while he awaited surgery. I was in awe of how Dr. Fatma calmly responded to this dire situation and immediately found an alternative solution to help ease the patient’s comfort and heal his wound. The overnight shift also revealed to me what can go wrong when the hospital is severely understaffed. During the whole ten hours I was there, there were only two doctors on call for the entire hospital, including the casualty department and all of the wards. At one point, Dr. Fatma and I had to go to one of the wards to see a patient of hers. When we got there, the nurses said that he had suffered from a dislodged embolism after his surgery and had quickly died while we were on our way to the ward. When walked up to his bed, Dr. Fatma announced his time of death and closed his eyes. It was alarming how quickly the doctors could no longer be of help to this patient as life left his body. The doctor hadn’t even been able to be there when the emergency occurred. I couldn’t help but wonder if there had only been more doctors on call, or more equipment to keep him alive, maybe he wouldn’t have passed. While we walked back into the casualty department, stricken with sadness at what had just occurred, we immediately came upon the other doctor starting chest compressions on a woman who had just come in. After a few minutes of performing the compressions, the doctor shook his head and her family began wailing. In mere seconds, two lives had been taken away, leaving crushed families behind, and I was left deeply saddened, understanding that a lack of resources had been the cause. I was also very impressed with the doctors working that night. I saw how much they cared for their patients and the effort they put in to save them with what they had available. I also witnessed how they were able to feel that sadness, and keep it tucked away as they started to work on the next patients that needed saving. One aspect of CGTRH that I noticed was significantly obstructing the flow of healthcare was the delivery of medications. I first learned of this shortcoming on my overnight shift in casualty, but as the next two weeks progressed, I began to see how this process could be a significant turning point in the health of a patient. When a patient is brought into the casualty department, and the patient requires medications, such as pain medication, the family of that patient must go to the pharmacy in the hospital to purchase the drugs before the doctor can administer anything. This can severely reduce the quality of care the patient receives as the time for any helpful medications to be delivered is significantly delayed. This can have a further negative impact if the patient has not arrived with any family members and they must wait even longer for the family to arrive at the hospital. Finding a solution to this issue, I believe, could greatly improve the patient’s healthcare experience. Another facet of CGTRH that shocked me was that all patient records and medical notes are on paper. They do not have an electronic system to record any hospital activity or to copy their patients’ records. This worried me because if there were to be any sort of natural disaster at the hospital, all the medical records would be lost. According to the Current State of Healthcare in Kenya lecture, CGTRH has been working to improve their records system by converting their records to an electronic version. However, it is clear that it is taking a long time for these changes to come into effect within the hospital because none of the doctors I worked with used any sort of technology to track their patients. My second week marked the beginning of my surgery rotation. Throughout this rotation, I learned so much information from the doctors and I was deeply intrigued by the procedures they were performing. I was equally amazed by the amount of surgical equipment they had. They had far more than I had originally predicted and the theaters were well-staffed and resourced. I was again taken aback at the depth and quality of knowledge the surgeons had. They were more than willing to bring me close to the surgical table and explain the entire procedure to me. I saw more procedures than I can count including a shunt placement, craniectomy, orthopedic surgical repairs, laminectomy, adenoidectomy, and many more, each more enthralling than the last. I was fully prepared to sit back and observe, but whenever I asked the surgeons questions, they brought me in closer and taught me the entire time they performed the surgery. I had such a positive experience working with the doctors in surgery and wish I could have had the opportunity to stay longer. This rotation opened my eyes to the possibility of pursuing surgery which I had never really considered before. I was also able to complete two afternoon shifts during my second week at CGTRH in maternity. During my time in the maternity ward, I was overcome with deep appreciation for the strength of the women there. I was able to watch one vaginal birth and two cesarean sections, and each time I was in awe of the women and doctors. However, I did see many disparities in maternal healthcare when comparing the system to the United States. Some of the discrepancies stemmed from a lack of resources and some of them stemmed from a difference in bedside manner. The women were not allowed to have any other family members in the room with them, so they were often giving birth alone. During the first cesarean section I watched, I stood by the mother and attempted to comfort her in Swahili because I wished she was able to have a warm presence during the scary procedure. The doctors were working extremely diligently to deliver her baby, but none of them were comforting the mother or speaking to her throughout the procedure as they worked. During the vaginal birth, I felt significantly more defeated at the conditions in which these women had to give birth. Her room was tiny, extremely hot, dirty, had no privacy, the cot was slanted at a weird angle with just a singular sheet, and the bed had no stirrups for her to place her legs. The mother was laying on the cot with no one to hold her or comfort her as she gave birth. She was given no pain meds and the nurse delivering the baby barely spoke to her. Giving birth is such a vulnerable experience which was only exacerbated by these conditions. As soon as the baby was delivered, the baby was taken away to another room, so the mother couldn’t even hold the baby at first. She was lying in her waste for ten or fifteen more minutes while the nurse in training delivered the placenta incorrectly. The nurse in charge then had to put the mother through immense pain as she plunged her hand up her birth canal to check that the placenta removal hadn’t caused any more bleeding. I was so disgusted that this poor young woman had to endure one of the most painful experiences without anyone to comfort her, and in unsanitary conditions. I was so horrified by these events that I knew I had to learn more about what root issues had created such horrible birthing conditions for these women. In a conversation I had with Caroline, she informed me that delivering a child in a hospital in Kenya is free – a good thing for the progression of healthcare, but a detriment to the quality of maternal healthcare (personal communication, December, 2023). According to the World Health Organization, “In Kenya, between 2017 and 2020, maternal mortality increased by 55%” and it is one of the many African countries with a “very high rate of maternal mortality, ranging between 500 and 999 deaths per 100 000 live births” (WHO, 2023). Without regular prenatal doctor visits, women are far more likely to die from unforeseen complications during the pregnancy or childbirth. One of the maternity doctors at CGTRH explained to me that they have many cases of pre-eclampsia because women come in to give birth but haven’t received the proper prenatal care to understand how their blood pressure will affect their delivery. Many times, the doctor explained, this ends in them hemorrhaging during labor and can lead to death. During my two weeks in Mombasa, I was also able to participate in the community outreaches at both a children’s home and an orphanage. At the children’s home, we taught the girls the importance of female reproductive hygiene as well as handed out personal hygiene products. I absolutely loved teaching this lesson because I feel it is so important for girls to understand their bodies and care for themselves the best they can. On the way to the children’s home, I spoke to Caroline and was saddened at the state of women’s healthcare in Kenya. She told me that tampons and pads are difficult for young girls to purchase as they are too expensive (personal communication, December, 2023). According to the FSG organization, “65% of women and girls in Kenya cannot afford any brand of sanitary pads on a monthly basis” (Menstrual Health in Kenya, 2016). Additionally, it is illegal to buy any contraceptives before the age of 18 as well as get an abortion. The Center for Reproductive Rights recorded that “low uptake of contraceptives, increased rates of unintended pregnancies, unsafe abortions, sexually transmitted infections including HIV, sexual and, are attributable to lack of access to information by women and girls, the report found, which also leads to higher rates of gender-based violence such as rape and sexual exploitation” (Center for Reproductive Rights, 2021). I was exceptionally proud to be a part of a program that sees this disparity and actively works to educate and help young girls understand their bodies and their health more. I wish there was more that I could do to change the system that allows for such healthcare illiteracy and consequent healthcare ramifications to exist. However, I understand that the matter in question is far more complex than meets the eye and includes many interconnected issues such as cultural practices, biases and stigmas, and religious perspectives. I am at least very grateful to have been able to go to the children’s home and orphanage and know that those girls will go forth with a better understanding of their bodies and their health. One of the main concerns is the lack of healthcare literacy. Many young girls don’t know how to properly care for their bodies, understand their reproductive system and cycle, and are very misinformed on contraception. Caroline informed me that many girls will attempt to make a concoction of chemicals at home in an effort to perform an abortion which can cause sepsis and death (personal communication, December, 2023). Something that really struck me during our presentation was that many of the girls thought using a tampon would “take their virginity.” My heart sank at this because I’ve taken my access to healthcare information for granted. Every young female I know has been using a tampon since we first got our period. I realize now this is in part due to the education we receive on tampon use and personal hygiene. Conversely, the girls in Kenya didn’t grow up with that same access and therefore don’t have basic information about their own bodies. The Center for Reproductive Rights reports that only “12% of girls aged 12-19 and 38% of women ages 21-30, are knowledgeable about menstruation” (Center for Reproductive Rights, 2021). Giving young girls more education about their hygiene and menstruation can empower them to take control of their healthcare and make informed decisions. This could also lead to fewer health complications. Throughout my time with IMA, I experienced moments of heartbreak, despair, and frustration as well as moments of passion, love, and inspiration. I strongly desired to be able to help the hardships people face within the Kenyan healthcare system and oftentimes felt helpless as I observed disparities that, if alleviated, could greatly improve the quality of medicine. I also felt immensely motivated during my time in Mombasa and my passion for medicine was profoundly reinvigorated. Not only did I learn useful medical information, but I left with the knowledge of what kind of doctor it is that I want to be. I saw what I did not want to bring into my career in medicine. I do not want to be a doctor who does not have the patience to talk to the patients and make them feel comforted and informed because I believe that bedside manner is just as important as the medicine. Nor do I want to be a doctor who does not give their patients everything they possibly can with what is available. From observing and interacting with the doctors and watching them work under such difficult conditions, I realized I don’t just want to be a doctor. I want to be a doctor that is resourceful, creative, selfless, innovative, and most importantly, a doctor that comes to work everyday knowing why I go to work and why I dedicate my life to medicine. I will be a doctor because of my desire to help in an area of expertise I understand and my desire to guide patients to understand their health better; my internship in Mombasa has immeasurably helped illuminate this to me.

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.