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Equipping healthcare professionals to serve the forgotten

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INMED News, May 2013

  MISSIONARY OR MERCENARY?  
Nicholas Comninellis, MD, MPH

High in the mountains of Pakistan, Fatima's chest heaved as she gasped for air. Was the cause pneumonia? Pulmonary embolism? Heart failure? James Fyffe, an American RN, scrambled to clarify her diagnosis. Simple labs and a chest X-ray provided little clarity. No CAT scan or blood gas analysis available out there. James provided her basic oxygen and an antibiotic, but no option of prolonged ventilator support. On hearing James account I questioned him, "Why would you choose to volunteer under such austere conditions in remote, frigid Pakistan?" His response: "For me, it comes down to this, would I rather be a missionary or a mercenary?"



At the INMED Exploring Medical Missions Conference James met John Condie, a general surgeon, and his wife, Angela, a pediatrician, both on staff at Pakistan's Bach Christian Hospital. James became intrigued at their invitation. "Mercenaries," explains James, "are those who travel primarily for the benefit it brings them. Healthcare people often act like mercenaries, primarily looking for adventure, procedure opportunities, 'great cases,' and enhancement of their reputation. Missionaries in the best sense, by contrast, are motivated by compassion and focused on the mission to benefit those whom they serve."

Why Pakistan?

"For two years I lived and served in El Salvador. But I was only one among thousands of volunteers to Central America. The needs in Pakistan are infinitely greater, and so very few are willing to serve there. Christ has called me to be a light to the nations. Why would I choose to shine where thousands of lamps are already glowing?"

Isn't Pakistan dangerous?

"I never felt threatened. There were no terrorist events in Pakistan during my stay, and Pakistan's last school shooting was 10 years ago. Meanwhile, while I was away in Pakistan, America witnessed the Boston Marathon bombing, and repeated school shootings."

What's the greatest challenge?

"Some Pakistanis look at life through lenses I found hard to understand. Fatima, the woman with respiratory distress, died that night. Rather than be distraught over the loss, her family was resigned that her death was inevitable. I have much to learn about their culture. And yet I also know that like us they desire peace and compassion."

Can you really make any difference?

"A little compassion goes a long way - like a light illuminating a dark hill. It's not just about the people whom you touch directly, but also those who become inspired by your example."

Do you aspire to be a missionary or mercenary? Please join James Fyffe for his plenary exploration of this question at the INMED Exploring Medical Missions Conference on May 31 and June 1.






INMED News, April 2013

  TEST YOUR SKILLS: THREE CASE STUDY QUESTIONS  
Nicholas Comninellis, MD, MPH

The INMED Exploring Medical Missions Conference on May 31-June 1, will present you the chance to test your skills to the extreme. This event will include Tropical Medicine Rounds: A simulation of patient care in a resource-poor hospital with scenarios like the following three case study questions. Would you be able to pass an examination on these cases?



You are volunteering at a safety net clinic in Oklahoma City and seeing Erasto - a sixteen-year old refugee newly arrived from Somalia. He has cough, weight loss, poor appetite and vague but increasing abdominal pain. On questioning you learn that in his Somali home safe drinking water is a luxury and sanitation is in disarray. On exam Erasto has an oral temperature of 38.8, respirations of 30, and capillary refill time of 5 seconds. His abdomen is tense and diffusely tender. You are considering the possibility of typhoid fever. Which ONE of the following statements about typhoid fever is TRUE?

A Salmonella typhi is transmitted by ingestion of contaminated food or water.
B Typhoid fever almost always causes diarrhea.
C Typhoid fever commonly presents as an acute illness.
D Typhoid vaccination is quite effective.
E Typhoid fever can be readily differentiated on clinical examination from other infectious diseases, such as mononucleosis and infectious hepatitis.

You are in Jordan caring for Anas, a 2-year-old child whose family just escaped the blood shed in Syria. Anas is alert, temperature is 38 degrees C, respirations are 30 per minute, pulse is 90 bpm, and blood pressure is unobtainable. He has extreme muscle wasting throughout, reddish hair discoloration, and loss of adipose tissue with no peripheral edema.

Your first priority in managing this child with acute protein-energy malnutrition (PEM) is which ONE of the following:

A Treatment of coexisting medical illnesses
B Provision of high-concentration protein supplement
C Administration of micronutrient supplements
D Immediate refeeding
E Correction of hydration and acid-base alterations

You are in Cambodia seeing Solyna, a twentyone-year old lady, who suddenly developed fever, vomiting, severe headache, and pain on moving her eyes. On physical examination you note that Solyna is lethargic, has generalized lymph node enlargement and a slow heart rate relative to her fever of 39 degrees. Your initial differential diagnosis is broad: influenza, dengue, typhoid fever, mononucleosis, malaria. You Giemsa stain her blood smears but you do not identify any ring-like Plasmodium parasites that would suggest malaria. You initiate intravenous fluids and antipyretics. Over the next hours Solyna develops hypothermia, severe abdominal pain, decreased mental status, and bleeding from her gums and nose. You now suspect dengue - an arbovirus infection.

Which ONE of the following is a characteristic of severe dengue fever?

A Leukocytosis with increased band forms
B Increased urinary output
C Abnormal vascular permeability with spontaneous bleeding
D Predictable improvement in response to gamma globulin infusion
E Decreasing hematocrit



The INMED Exploring Medical Missions Conference on May 31-June 1, will both test and polish your skills through a simulation of tropical medicine rounds and crisis response, and workshops on basic suturing, wound care, management of obstetrical complication, newborn resuscitation, and strategies for malnutrition recovery. To provide quality medical care with few resources in communities disabled by poverty is the most extreme test of clinical skills. How would you rate in such a situation?






INMED News, March 2013

  ARGO, INMED AND THE ACADEMY AWARDS  
Nicholas Comninellis, MD, MPH

Iran is "an island of stability in one of the more troubled areas of the world," said President Jimmy Carter in 1977. Yet in 1979 Iran broiled over into a bitter revolution that killed over a million citizens. It also provoked the capture of 52 American hostages held at the United States embassy for 444 days. Given the courage, chaos, and conviction surrounding that bitter spectacle, is it any wonder that the film ARGO was selected as this year's Academy Awards Best Picture?



Iranians revolutionary agents also arrested, imprisoned, and executed more moderate Muslims in their midst. The six Americans portrayed in ARGO were not the only ones to escape this blood bath. Among them was the sophisticated, educated, David Nasser, whose family fearing for their safety determined to flee the nation.

Young David Nasser lived a year in exile before entering life as a foreigner in a vastly different culture - the American South. Mercilessly taunted, this terrified teen experienced both the destructive power of religion and the trauma of extraordinary prejudice. Inspired by a compelling search for security, David Nasser discovered that enduring peace and self-worth are only to be found in a personal relationship with the Messiah.

His first book, A Call To Die, is a bestseller that focuses on being honest with God, denying our desires, and serving the Creator through serving one another. Today, David Nasser addresses audiences of 700,000 people each year, presenting a call to faith and an appeal for genuine action across cultures on behalf of our world's most distressed people.

Would you like to hear David Nasser's personal account? INMED is honored to invite you to the Exploring Medical Missions Conference on May 31-June 1, where he will give the keynote address. You may discover, as David Nasser did, a far more compelling "island of stability in one of the more troubled areas of the world."






INMED News, February 2013

  SHOULD YOU VOLUNTEER IN HAITI?  
Nicholas Comninellis, MD, MPH

Haiti is the poorest nation in the Western World despite being just a one-hour flight away from Florida. Thousands of American healthcare personnel venture to volunteer in Haiti each year. Should YOU be one of them? Let's explore your questions with Jim and Sandy Wilkins of Haiti Health Ministries...



Can I give any substantial help in just a few days or weeks?

"Yes. Short-term volunteers relieve some of the load off of we who work here year-round. You may also discover a calling toward heart-felt commitment. We first came to the island as volunteers for a few days in 1995. A vision was cast on that trip, and now we've been living in Haiti fourteen years."

Can I assist even though I have no healthcare skills?

"Yes, we need both healthcare and non-healthcare volunteers. The latter can help us through rebuilding our clinic destroyed in the earthquake, and through such services as sewing and painting. Healthcare people do well to realize that there is much to learn about how to provide care in the particular context of Haiti, especially amid limited pharmaceutical and laboratory support, as well as vastly different cultural ideas of health and disease."

Do I need to speak Creole or French?

"No. We arrange interpreters for our volunteers. Haitians speak their native Creole language in daily conversation. Few speak French, and rarely English or Spanish. Volunteers soon discover that translation is slow and often cumbersome. They often say, 'I wish I could speak Creole,' and then endeavor to learn."

What's the risk I will be threatened?

"Robberies, rapes, and kidnappings do take place and are a statistical risk, just as they are in the US. However this risk can be minimized by cooperating with reputable organizations in Haiti, traveling in groups during daylight hours in safe areas, and by heeding the advice of local persons. Medical liability is also a theoretical risk, but in reality we've never heard of a lawsuit except Americans in Haiti suing other Americans. Most people, by contrast, will be extremely grateful for your service."

Must I have a specific faith to volunteer?

"No, we welcome people of all faiths as volunteers. We have a code of conduct that we require everyone to follow. We will also encourage you to attend a Haitian church service with us on Sunday morning and a weekday evening Bible group. These are important Haitian cultural as well as spiritual experiences. We respect those with other beliefs and would never demean them, but we are not ashamed of the good news that Jesus came to save us from our sins. It's natural for us to share this with Haitians and Americans alike."

Would you like to volunteer in Haiti or in another low-resource nation? INMED cooperates with Haiti Health Ministries as well as Medical and Public Health sites in forty locations around the globe. We will assist you with the logistics and particular skills you will need to acquire. And like Jim and Sandy Wilkins, you may also discover not simply a remarkable experience but a calling toward heart-felt commitment.






INMED News, January 2013

  WILL THESE LIVES BE SAVED?  
Nicholas Comninellis, MD, MPH

Zhangyi suffers from atherosclerosis blocking blood flow to her legs. Just taking a few steps brings on excruciating pain signaling near death of her toes and feet. But being retired and in residential care, transportation issues limit Zhangyi access to medical consultation.



Wanghui is a six-month old orphan, body critically thin, and with a chronic rash covering her cheeks. Taken in to custodial care, the facility would like to transfer Wanghui to a foster family, where her nutrition would likely thrive. But her rash dissuades potential parents.

Liuhong has weeping, green mucus running from both eyes, progressively losing his sight. But as a factory worker in the countryside, skilled eye care is only a distant possibility.

Should these lives be saved? Certainly. But will these lives be saved? Here enters the volitional element. In a world of limited resources the only unlimited one is our capacity for compassion and innovation. The LIGHT health team of Shenyang, China is exemplary for moving principle into practice. On location, I marvel at LIGHT in action: Zhangyi received her medical consultation right at the retirement center. Wanghui's rash was successfully treated inside custodial care, clearing the way for a foster family. Liuhong's vision was restored far out in the countryside clinic.

Ultimately, it is individuals and small organizations that provide actual care to people on the margins. Wouldn't you like to complement their mission? INMED can organize a service-learning opportunity with LIGHT or at another of our Training Sites in twenty-five nations.

Will people's lives be saved? Your personal actions of compassion and innovation will make it so.