Health care providers, particularly English-speaking professionals participating in the delivery of short-term medical care in developing countries, face the challenge of delivering crucial information in a culturally competent way to people who may rarely or never have encountered the complex and important details of written medication instructions. Taking into account language, education, and literacy barriers, this study tested the effectiveness of a picture-based medication instruction sheet with bilingual labels during the operation of a temporary clinic in rural western Kenya. The goal was that medical treatment would be more effective and dangerous errors avoided if the patients could demonstrate effective patient recall of medication instructions immediately after they were given. In the sample of 248 patients, the pictograph was able to decrease the proportion of patients with multiple errors (p = 0.019). However, 35.8% of the sample still had one or more error. There was an unexpected lack of overlap in this sample among literacy, level of education, and ability to speak English. The pictograph was most successful in decreasing errors among uneducated patients (p=0.026), and the intervention had more of an impact among females (p=0.002) than among males. Future research will build on these findings to develop other interventions that can address these potentially lifethreatening mistakes that occur even among educated, literate, and English-speaking patients. Future work will also further explore the social context that would cause males to do worse than females.