Local generally tops international. A longer term commitment than most trips offer and involvement with healthcare delivery (the medical-related work. Not, say, teaching kids at the camps or stocking supplies.)
As Pakistan is your family heritage, yes, this makes sense (and I applaud you.) But a lot of kids go to visit family and do something short term. Then little back in the US. What do you do at the hospital? Is the Alzheimers work mostly social? Put the Pakistan work on your Common App Activities, but defineitely consider dropping the letter writing.
I can’t tell if you meet the range of hs courses colleges recommend. A number of your APs are easy ones- psych, stats, APES. Do you have the other rigorous cores? And subscores will matter.
Bottom line is, if CC keeps saying tippy tops are a reach for all, bsmd programs tend to be even more uber-reach. So have a happy Plan B.