Detroit Mercy PA student makes school history with rotation in Kenya

August 22, 2018

Mary Beth Couretas stands in front of the hospital she worked at in Kenya.University of Detroit Mercy Physician Assistant (PA) student Mary Beth Couretas knew she wanted to do something special for her elective clinical rotation. Couretas accomplished that by becoming the first Detroit Mercy PA student to do an international clinical rotation, completing a rotation in Mombasa, Kenya.

“As long as I can remember, I have always been drawn to help those less fortunate than me,” said Couretas, who is a seven-year Army veteran and served a tour in Iraq. “It was that same feeling that drove me to pursue a placement abroad for my elective rotation.”

Couretas spent four weeks in Kenya and describes the rotation as grueling, rewarding, eye-opening, heart-breaking and “one of the best experiences of my life.”

She saved lives, did what she could for those they couldn’t save, made a long-lasting difference by tapping into the generosity of others and became a stronger PA in the process.

“It’s hard to put into words exactly how it has changed me, but it definitely has,” Couretas said. “I hope to carry my current appreciation for my education, our healthcare access in the U.S., and for life in general throughout my career.”

A different world

When she arrived to work in Kenya, she was shocked by the hospital’s lack of resources.

“I noticed immediately there was no crash cart, no intubation equipment and no monitors of any kind in the department,” Couretas said. “The supplies available were on the counter and consisted of three bottles of normal saline, one box of gloves and about 10 IV needles in various sizes.”

Due to the lack of resources, treating ailments that might be just minor for patients in the U.S. could become deadly in Kenya.

The lack of resources wasn’t limited to just equipment — the hospital also had staffing issues. Patients had to have someone come with them and that person was responsible for taking them to a lab or to get an x-ray. If the patient needed a prescription, Couretas would have to write them a paper prescription and then the patient or the person they brought with them would have to take the prescription to the hospital pharmacy, pay to get it filled and bring it back.

“The process for prescriptions was the same even for emergency situations and conditions,” Couretas said. “As you can imagine, the process took a long time. Many patients died in the ER and often from things that could have been managed in the United States. That was very difficult to swallow.

“It was especially difficult when babies would come in with such severe dehydration that organ failure was already under way,” Couretas added. “I struggled in the beginning with seeing the traumas come in because there was no resuscitation equipment. As soon as you saw the patient, you knew they would likely not survive, simply because the only thing we could do in the immediate timeframe was give IV fluids, apply pressure and suture.”

As hopeless as the situation felt at times, Couretas was still moved by the resiliency of the patients and the hospital staff, who were doing the best they could with the limited resources at their disposal.

“As depressing as all of that sounds, there was still good medicine being practiced,” Couretas said. “The staff knew what should be done and what the patient needed, the barrier was the availability and the patient’s ability to pay. I have never seen stronger, more resilient people in my life. Patients would wait all day to be seen, spend the night outside the hospital and wait to be seen the next day. I never heard a single person complain.”

The city of Mombasa has several hospitals, but Couretas was working at the only government-funded hospital there.

“There are private hospitals that have more resources, but the general population can’t afford to go there,” Couretas said. “Sometimes I wondered, ‘Why is there an emergency room? You can’t treat an emergency here.’ And that was basically true, you couldn’t treat an emergency there. It was hard for me to see that, knowing we could have saved them if we had the equipment and resources available. Your hands are tied. That was the hardest part. It was the same in the emergency room and the labor and delivery room. It’s always heartbreaking to see a bad outcome from childbirth, but you can tell by the reactions of the staff that it happens so much more often than what I’m used to.”

Making a difference

Mary Beth Couretas (center) and her co-workers hold up a fetal dopplers.Still, Couretas knew she could make a difference and even came up with a way to help that will last much longer than her rotation in Kenya.

During her time in the labor and delivery ward, she noticed that the hospital was making decisions about who was going to deliver next without the help of fetal dopplers, which are used to detect the fetal heartbeat.

“In the United States, there are fetal dopplers in doctor’s offices, they are everywhere,” Couretas said. “They didn’t have one. They were determining who was going next for a C-section by listening for a heart rate without a monitor.”

Couretas decided to do something about it and set up a GoFundMe that raised $1,500. Her original goal was $1,300 which she believed would be the amount needed to have  a fetal doppler shipped from the United States, but due to the generosity of donors and some help finding a local dealer in Kenya, she was able to buy five fetal dopplers.

“I feel like it made such a huge difference for them, even going forward,” Couretas said. “That’s something that will last. I was really happy to do that. People were very generous.”

Couretas’ time in Kenya wasn’t limited to just the hospital. She went on a safari, visited her co-workers home and visited different parts of the city.

“I would love to do something like that again,” Couretas said. “When I first booked it I thought ‘Wow, four weeks is a long time, maybe I shouldn’t do four weeks?’ Then, when I was getting ready to leave Kenya, I wanted to stay three more months. Because after a month, you’re just learning. I picked up a lot of Swahili, at least enough to interact with the patients a little bit, ask them where they’re hurt, things like that.

“I started to make some friends and do some fun things around the city, rather than go to work and come home. I felt like I could have stayed a few more months. I definitely want to go back. I would even go back to that same place especially because I’m more familiar now. And I would recommend it to others.”

Moving forward

Mary Beth Couretas poses for a photo with a camel.Couretas left Kenya feeling more prepared for life as PA after graduation. In Kenya, Couretas was put in a sink-or-swim environment and rose to the occasion.

“It helped my confidence level as a PA,” Couretas said. “I was in a position where maybe I’ve never done that procedure before, but there they need me to do it and there is no one else. It’s like, ‘I’m going to do it, I’m going to learn how,’ and that’s something I probably wouldn’t have the opportunity to do here because there are always so many students and so many residents. It’s never just you doing something. So in Kenya when you’re put in a position of do something or it’s not going to get done, well then you’re going to do it. And it really raises your confidence level for what you’re able to do.”

In Kenya, Couretas didn’t have access to the technology most PAs use to help them determine a diagnosis. She had to refine her skills and adapt to what she had at her disposal in Kenya.

“I learned a lot about treating a patient when you don’t have access to imaging and the lab tests that we have there, especially in the emergency room,” Couretas said. “In the U.S., you can tell if someone’s sick but you’re also going to get all of these labs and tests and things like that. When the tests aren’t available, you really learn how to look at a patient.”

Couretas graduated Aug. 15 with a Master of Physician Assistant Studies and was awarded the Dr. William Montgomery Community Service Award, which is given to a PA who goes above and beyond for service.

“She won for not just her trip to Africa, but her whole tenure here as a student,” said Amy Dereczyk, associate professor and program chair of the Physician Assistant program. “Going to Africa, coordinating the fundraiser and having that big of an impact really put her above any other student in our program. All of our students, faculty and staff perform a great deal of service. She just blew everybody out of the water.”

Couretas was the first Detroit Mercy PA student to do a rotation abroad, but Dereczyk, is hopeful she won’t be the last.

“The next class is now getting ready to go out into their clinical rotations and there have been some students that really want to do something like this,” Dereczyk said. “It aligns well with the University of Detroit Mercy’s mission and identity. Some people might think it’s very romantic to think about going to Africa and working with an underserved area. But the reality is it’s not a vacation, it’s hard work. It’s 110 degrees at night, every day and there’s no air conditioning, so it’s not comfortable. You really have to have a good willingness and understanding to know what you’re getting yourself into.”

Couretas is hopeful other Detroit Mercy PA students will follow her lead and do an international rotation. She is thankful that the staff at Detroit Mercy was able to work with her so she could pave the way for others.

“I know it wasn’t easy to set up, there were a lot of logistical steps we had to go through for them to let me go out of the country and have it count for one of my rotations,” Couretas said. “I know it took a lot of work on everyone’s part and Detroit Mercy’s mission played a huge role in the University being willing to do all that work.  I’m so happy I got a chance to go and I would recommend it to others.”

To learn more about Detroit Mercy’s Physician Assistant program, please visit

— By Dave Pemberton. Follow Detroit Mercy on FacebookTwitter and Instagram. Have a story idea? Let us know by submitting your idea.