Before beginning our third year of medical school at Barts and The London, we embarked on a medical volunteering experience in Nairobi, Kenya. Our journey allowed us to develop our clinical skills, alongside witnessing healthcare in a new context. Unexpectedly, this experience deeply shifted our psychological perspective, not only on medicine, but also in the context of empathy, identity, and resilience.
We spent two weeks in a private community hospital in Nairobi, rotating through different departments, most of which were related to maternity care. Observing caesarean sections, assisting with antenatal assessments, and transporting newborn children between resuscitation and postnatal care emotionally charged us in this fast-paced, hands-on environment. A distressing experience that deeply moved us was seeing a newborn with low oxygen levels, turn blue in real time; the clinical intervention and oxygen given at accurate time intervals gave the child a second chance.
Learning about dignity
Moving away from the operating theatre, we sat in on consultations, dressed wounds, and provided analgesic massage techniques to relieve pain. A small yet humbling task such as moving a patient carefully between beds; a simple human gesture, reinforced the importance of dignity in a healthcare environment, reminding us of how clinical skill works alongside emotional labour.
Our experiences in the maternity unit set the tone for what would become a profound exploration of both medical and emotional resilience. In a low-resource area, the psychological dimension of our volunteering placement became increasingly evident. In the UK, there is often media coverage of our healthcare system not having enough resources. However, in Nairobi, healthcare staff operate under intense pressure, facing unreliable electricity, incomplete stocks of medication, and no constant access to water. When available, these resources are deeply valued and appreciated, reminding us how easy it can be to take the NHS for granted.
Learning about resilience
We were amazed by the implicit psychological skills that the staff in community hospitals relied upon. Whilst managing their own emotional burdens and trying to make a living for their families, their time was spent de-escalating distress – motivating hesitant patients and comforting grieving families. Compassion, but, also burnout, was evident. In the UK, employees are encouraged to seek mental health support through employers and colleagues. The absence of such support in the hospital made us question: how do healthcare workers overcome witnessed trauma, and what silent emotional toll is it taking on them?
As medical students, it made us think differently about our curriculum and clinical learning. According to Lazarus and Folkman’s theory of stress and coping, resilience is an ongoing process, that we develop. It’s not an innate trait. The clinical team in Nairobi illustrated this exceptionally well; when resources were scarce, they problem-solved collectively with a shared purpose. We were left wondering – emotional grit is essential, but should individuals have to be this resilient? Yes, there is endurance, and this is admired, however this should never distract from the changes needed to support healthcare teams globally.
Learning about connection
Outside of the hospital, we spent time volunteering in a local school and orphanage. Playing games with children, cooking, and teaching them evoked nothing but joy. The individuals ranged from four to sixteen years old, yet their optimism and the warmth of their community stunned us. Even though material support was scarce, what stood out was their sense of routine and identity, and how emotional connection and safety were prioritised over material needs. Many of these children had experienced loss in some form, and despite this, expressed happiness in the smallest of things. Their psychological wellbeing was determined by belonging, rather than possessions; and gratitude was a psychological buffer against hardship. This illustrated Maslow’s hierarchy of needs in a real-world context; while their physiological needs are uncertain, emotional safety provided hope. This allowed us to reflect, how often do we appreciate stability, education of a sense of community?
We also had the fortunate opportunity of visiting Mama Lucy Kibaki Hospital – one of the major public hospitals in Nairobi. The contrast to the private facility we had previously experienced was remarkable, this hospital was crowded and fast-paced. Touring departments ranging from internal medicine to the Gender-Based Violence Unit highlighted the emotional pressure triage nurses faced daily. In the gender-based violence unit, the quiet burden carried by staff was immediately apparent.
Learning about emotional support
In the hospital’s laboratories, we witnessed strain in a different form. Blood and urine samples were processed manually, with limited automation, yet efficiency prevailed. Risk factors for cognitive overload such as repetition, heat, and noise were present. The mental strain described by cognitive load theory was reaffirmed for us: although the mental bandwidth of laboratory staff was constantly stretched, their precision and professionalism were second to none. The team worked at the upper limit of working memory capacity, balancing their complex tasks with the chaos surrounding them. Despite this, their collaborative habits meant cognitive effort was distributed amongst the team, allowing for high performance to be sustained.
The shock we felt when walking into a government hospital in Kenya was something we could have never prepared for. We saw patients standing while waiting for the operating theatre due to a lack of beds; fresh blood from the previous delivery remained uncleaned, yet patients kept arriving. Yet, among the hardships were also smiles, happiness, and laughter. At first, we felt pity walking into the hospital, yet standing in the middle of the ward, we realised that no one needed our misplaced pity. We saw families standing strong amid hardship, relatives surrounding loved ones, people crying or laughing together. Despite the challenging conditions, they found a way to support each other. For the first time, it felt like a veil had lifted. This persuaded us to reflect on our experiences in Kenya through the lens of psychological healthcare.
During medical school interviews and throughout our education, we are often told to observe patients ‘holistically’ and recognise both the physical and the psychological aspects of illness. There are countless psychological determinants of health: fear, fatigue, hope, and resilience, just to name a few. However, what we have learned is that treating a wound is one matter and addressing the mental trauma arising from it is another. How do we achieve this good practice? Witnessing a nurse gently reassuring a distressed mother showed us that psychological skills are just as vital as clinical care, the difference being bedside manners cannot be learned from a textbook.
Learning to engage meaningfully
We are firm believers that at all stages of treatment, a good doctor must address the mental anguish of every patient they treat. We have come to learn that the true art of medicine lies in emotional attunement. However, as ordinary citizens, how much of this do we truly see? In Kenya, we saw family members bringing smiles to patients’ faces, strangers sharing laughter over a cup of tea, and doctors joking around with patients. This is a sharp contrast to the UK, where we have observed doctors moving quickly through wards, often unable to engage meaningfully with patients, not out of disinterest, but due to the immense systemic pressure.
If global healthcare systems reflect their societies, then Kenyan people’s way of ‘connecting with patients’ could be described as an informal form of therapy, complementing medical care alongside alleviating the patient’s psychological burden. A professor once described doctors as ‘healers’. If so, does our system truly allow doctors to heal? Even outside the hospital, a smile is rare on the streets of London, and conversations with strangers happen only occasionally. It made us wonder whether our society would be happier if we adopted the values of the Kenyan people. Could this, in turn, reduce the pressure on mental health services in the UK?
However, we also observed significant emotional burdens within the Kenyan healthcare system. Shadowing doctors in both private and public hospitals made us realise the importance of finance in healthcare, and how many patients were denied or delayed treatment due to an inability to pay. Not only were they physically unwell, but the anxiety on their faces when refusing life-saving treatment was unforgettable. One case that stood out was a patient who refused post-exposure prophylaxis for HIV due to financial constraints. HIV is still stigmatised. Coupled with limited access to medication, her diagnosis will likely remain secret and potentially passed to others
Learning the value of psychology
The conditions observed in Nairobi highlighted the abundance of psychological problems alongside physical impairments. For many medical conditions, there can be an accompanying psychological problem like anxiety, depression and PTSD. This is a global problem. In the UK, mental health services are facing record admissions and patients. The result is a self-perpetuating cycle where the influx of patients, and limited resources, amplify distress.
As mentioned previously, getting diagnosed with a life-long condition like HIV can profoundly affect a person’s self-esteem, both due to societal pressure and the demands of continued treatment. Addressing this requires more than medication. Psychologists can advocate for the rights of these patients to prevent unfair discrimination both within the workplace and in society. This includes advocating to end the stigma associated with contraceptive use. Healthcare professionals can be mindful of the language that’s used in consultations, and this may go a long way in alleviating the emotional distress of patients. Finally, encouraging strong family and friend connections to foster, as shown in Nairobi, can help provide support, and a vital source of strength, throughout difficult treatment journeys.
In contrast, the UK seems to be heading further away from connectivity between groups of people. Loneliness has become one of the biggest drivers of rising mental health rates particularly amongst the older population in hospitals as well as in wider society. In hospitals, many patients feel health conditions as individual battles, rather than a collective journey. Due to the structural pressure and time restraints for both patients and healthcare professionals, hospital environments can feel more robotic than human. One message we carried from Kenya was the importance of a structural support system, a framework which could be implemented within hospitals.
Psychologists can play a vital role in building such systems by partnering with local councils to tackle loneliness for those that are most vulnerable, alongside implementing better ways of identifying loneliness and providing support within the community. Equally, all healthcare professionals can advocate for hospital policies that prioritise human connection. With systemic integration, the goal is to treat patients both physically as well as psychologically, due to both being crucial for effective rehabilitation.
Our experience in Nairobi shaped the kind of doctor we hope to be. Despite hearing about junior doctor strikes, an under resourced NHS, Nairobi deepened our commitment to patient-centred care and illustrated how much of medicine is truly psychological. Amongst treating physical illnesses, it is vital to understand people. For psychologists reading this, we hope that our reflection encourages three things. Firstly, models of wellbeing differ between different cultures. Secondly, we should advocate locally and promote community interventions that promote connection and resilience. Finally, there should be more collaborations from multiple disciplines. Medicine and Psychology share a common focus; to allow humans to flourish. Psychology seeks to understand the human mind, and medicine seeks to treat the human body. Our time in Nairobi reinforced that both disciplines ultimately serve the same heart. The greatest healing often begins not in a procedure, but in understanding, listening, and connection.
link