Internships in France

The program has not only deepened my passion for healthcare, but also opened my eyes to global healthcare disparities, the beauty of community outreach, and the vital role that systemic infrastructure plays in delivering healthcare. In the hospital, I shadowed a range of specialties, giving me the opportunity to watch live births and learn pathology alongside medical students. Our outreach clinics had lasting effects on the community, and we were able to see this in real time. Even after educating and answering questions on menstruation and women’s health for 1.5 hours, girls continued to come up to me with questions on the way to the bus. You could see the relief on children’s faces when they learned about issues involving menstruation or mental health and realized they weren’t alone. Children who had previously attended the hygiene clinic remembered the information and were able to assist in educating their peers. One of the issues Kenya suffers from is poor health literacy. Through these clinics, we were not only able to provide supplies for immediate care but also make a lasting impact through health education. As demonstrated in the hygiene clinic, even educating just one group of students can make a difference as they continue to educate each other. From the second I arrived in Kenya, the IMA staff made it feel like home. I felt safe at all times, and if I ever needed anything, our program mentors were easily accessible. The accommodations were more than comfortable—the food was amazing, and the house and kitchen staff always went out of their way to ensure we were taken care of. I often took naps after a long shift at the hospital, causing me to miss the planned dinner time. However, Joshua always made sure there was a meal left for me to wake up to. Being the only new person to the program during my time in Kenya, I was nervous to go on the safari alone. Thankfully, Vivian was there to accompany me the whole time, and there was no one better I could have asked for. She immediately put me at ease and became a lasting friend in the process. I did not expect to love Kenya as much as I did, and I truly believe the IMA staff played a significant role in that. I will always be grateful for my experience there and hope to come back soon.

My experience in Kenya was better than I could have ever imagined. I truly think it was the best experience I have ever had. From the day I arrived, the IMA staff was always friendly and immediately made me feel at home. The residence was always well kept, with staff cleaning our rooms. Additionally, the food was amazing, and the kitchen staff always welcomed our meal requests and would get them to us right away. Our program mentors were amazing and would always happily talk to us. They gave excellent advice and were always willing to help. The program staff was the main reason that my experience was so amazing. We also received a lot of knowledge about the culture of Kenya from them, which helped me to understand the situations of patients I saw at the hospital. I learned so much about different types of health conditions, especially from Dr. Ken in pediatrics, who would give mini-lectures to us between patients so that we gained the most amount of knowledge that we could. Along with shadowing at the hospital, all the community outreach clinics taught me so much about the community in Kenya. The clinics were my favourite part of the internship, as the kids were always so happy to see us, and I felt like I was making a difference to them. Overall, my experience was amazing, and I felt it went so quickly. I never once had any worry about feeling unsafe or alone, as I was surrounded by amazing staff. I will definitely be coming back. Five years ago, I would have never imagined that I would be spending 3 weeks interning as a pre-physician assistant student at the second-largest public hospital in Kenya. From a very young age, the idea of attending medical school was implanted into my head by grandparents, teachers, and even friends’ parents. However, healthcare workers were plenty in my family, and I did not want to do what everybody else wanted of me. It was not until the end of my high school career during the COVID-19 pandemic that I found a real love for the medical field. Throughout the past 3 years of university, I started working towards the goal of attending medical school and working in the healthcare field, yet I was still confused about whether becoming a physician was my calling or whether there was another healthcare profession that I would be interested in. When I learned about physician assistants, it seemed to be a perfect match for what I wanted, yet it also added to my confusion about what healthcare career I should pursue. Coming to Kenya, I had plenty of questions and was unsure of where I stood in my career but came with an open mind. Before my internship in Kenya, the only clinical experience I had was volunteering at the Grace Hospital emergency department in Manitoba, Canada. I had expected that the Kenyan hospital would look much different from the Canadian hospitals and would be severely under-resourced. Additionally, being born in a third-world country myself and having visited back home to Sri Lanka on multiple occasions, I have seen what an underfunded public hospital can look like and thought I had a decent idea of what the Coast General Hospital would look like. However, from the first orientation day in the hospital, I realized how much I truly had to learn about the state of healthcare in Kenya. Much like I imagined, there were outdoor portions of the hospital and cracks were present in the walls and ceilings; what I had not thought about previously was the lack of sanitation at the hospital. I was shocked to see doctors treating patients without gloves and sometimes without masks as well. Blood spills in the emergency department were wiped with a dirty, wet mop that was then used to wipe another spill in a different room. The only time I saw a counter being wiped was in the pediatrics department, but I was saddened to see that there were no actual cleaning products used, and it was only hand sanitizer being wiped down. In Canada, I would have never thought of cleaning products as a privilege, but from that first day, I realized just how much I have taken for granted. My first week was spent in the pediatrics department, where I switched between the outpatient clinic and the in-patient ward. There were two medical students at the in-patient ward who explained to me what the morning would look like, which included changing patient bed sheets, taking vitals of all patients, and then doing rounds with the doctor once she arrived. Right away, I noticed how involved mothers were in the care of their children in the ward. In Canada, it is normal for the nurses and healthcare aides to change bed sheets and clean the baby, yet in this ward it was the mothers changing the bed sheets and getting the baby ready for when the doctor came around. The sense of community between the mothers in the ward was evident, as everyone was helping each other. Even though many things from Western healthcare may be an improvement compared to the healthcare found in Kenya, I think having the mother involved more in their babies’ care is something that Western healthcare should adopt as well. The mothers all seemed so happy to aid in their babies’ care, which is not something you see in Canada, as nurses and healthcare aides do most of the caring. Furthermore, during rounds, I was able to learn about rickets disease and feel a baby’s abdomen for a common swelling symptom of rickets. The doctor explained that vitamin D deficiency is very common in babies who take formula because the formula in Kenya lacks vitamin D, leading to plenty of deficient children. Additionally, a natural source of vitamin D is sunlight; however, it is “imperative for mothers to seek employment very early in the postnatal period [meaning] that infants are often looked after in indoor informal daycare facilities” (Jones, 2017). As much as I would like to think that if we get formula with vitamin D into Kenya the cases of deficiency would decrease, I could see that the problem was much bigger, and therefore the solution would also take years of change. This first case of rickets opened my mind a lot, as I would have never thought that something as simple as access to enough sunlight would be an issue for these children; but with families facing poverty and mothers having to work right away, most of the children are not raised the way we are in North America. Finally, in the outpatient clinic, I learned a lot from Dr. Ken. With every patient that came in, he explained all the symptoms and possible treatments for the child. Between patients, he would also take the extra time to teach us about pneumonia, tuberculosis, and different blood disorders. I will forever be grateful for all the knowledge I received from Dr. Ken and will make sure to keep the notes with me for when I continue into physician assistant school. The biggest lesson that I learned from Coast General that I will be keeping with me throughout my career is how important patient bedside manner is. I was heartbroken to see how some of the nurses and doctors treated the patients. One case in particular that struck me was a boy in his 20s who came in after an accident in a tuk-tuk that resulted in him rolling on the pavement and having multiple large wounds all over his body, as well as a shattered wrist and broken ribs. When taking him for an X-ray, the medical students were pulling his body left and right to get him into position and trying to force the board under him while berating him for screaming in pain. The sounds of his screams were very difficult for me and the other intern to hear and are something I still remember. I could see how much pain he was in when he arrived, and to see him treated so rough at a place that should be caring for him was very difficult to watch and understand. I saw situations similar to this multiple times during my internship where just a little bit of compassion may have helped these patients tremendously. At the labour ward, I saw doctors telling the mothers to stop screaming during labour and saw them get annoyed when mothers tried to hold their hands. I could see that most of the healthcare workers at Coast General were very overworked and exhausted with the conditions they had to work in, causing them to show less compassion. In addition to a lack of resources, the hospital was severely understaffed, with an average of 21 doctors and 100 nurses per 100,000 people compared with the WHO-recommended minimum staffing levels of 36 doctors and 356 nurses per 100,000 people (IMA, 2024). This was especially evident to me in the newborn unit, where I spent one night shift. There was one premature baby whose oxygen saturation level had dropped to 40% because his oxygen tube was not in his nose properly; however, even though the monitor was beeping, no nurses were rushing to fix this. I notified the nurse, who then came to fix it, but when I came back half an hour later, I could see the oxygen saturation at a dangerously low level once again. This time, when I notified the nurses, they did not come to fix it, and I had to tell three nurses before one finally came to help the baby. Even then, this nurse showed no sense of urgency and came only after a few minutes. This was extremely frustrating for me, as all I could do was notify them, but I could not force them to have more urgency. I realized quickly that in the newborn unit, some nurses had the mindset that the premature babies would probably die anyway, which may be the reason for their lack of urgency, as at least 5 babies passed away there every day. An article from the UCLA School of Medicine says that “how physicians, [and] nurses… approach patients and their families can directly affect the overall experience for patients and their willingness to learn… good bedside manner ultimately improves communications and reduces errors” (Geffen, 2016). If there were more staff present, I am sure bedside manner would be much better and would no doubt lead to a decrease in patients’ distress and hopefully even a decrease in this mortality rate. Apart from all I learned at Coast General, I learned a lot from the culture and people of Kenya. I was amazed at how welcoming everyone was and was especially touched by how happy the kids were at the schools we visited. I have truly never felt as happy as I was when I walked into a classroom and had all the young kids come up to hug me and touch my hair, and it only confirmed for me how much I want to work with children during my career. One school we visited for a mental health clinic especially touched me because I got an insight into how hard their lives must be. The classroom was filled with teenagers, and when we asked them to write down their feelings and any questions on paper, I received multiple comments talking about friends who had committed suicide. Within that classroom of about 30 to 40 students, there were six stories of friends who had committed suicide because of physical and/or sexual abuse from family members. It was heartbreaking to hear these stories but was also heartwarming to see how much joy these teenagers portrayed throughout all their struggles. After we had a good conversation on journaling and how to express our feelings, we had a small dance party outside on the field, and it was truly amazing to see how much fun they were all having. They were so welcoming to us and even brought me into the dance circle with them. I will never forget that moment, as they brought me so much joy, and I only hope that we brought them as much joy as well. Every day that I experienced more of the culture, I became more aware that I was extremely lucky to be there. I went to Kenya with an open mind, ready for new experiences and to learn as much as I could. I got so much more out of this internship than I could have ever imagined. My boyfriend has always said he has wanted to come to Africa to live in a village and help the people as much as he can, and this trip led me to start planning this trip for our future, as I honestly fell in love with the culture and people. I also believe that my experience at Coast General helped me to fall in love with medicine just as I had at the beginning of my university career. I no longer have any doubts about what I want to pursue as my career and have decided to apply to a physician assistant program. None of these plans and excitements for myself were present before my experience in Kenya. I will forever be grateful for my life-changing experience and promise to come back to Coast General once I have started my career to help as much as I can.