Nicholas Comninellis’ Presentations
Nicholas Comninellis, President and Professor at the Institute for International Medicine, offers presentations for healthcare professionals, healthcare profession students, and undergraduates. Please Contact INMED to explore potential opportunities.
Dr. Comninellis’ most popular presentations include:
M3 Conference presentation of From Disaster to Durability
From Disaster to Durability
- Identify the limitations of the rescue paradigm
- Advocate for community-wide development
- Equip local health leaders to better care for their own
Abstract: Disasters, epidemics, and public health crises continue: Puerto Rico’s Hurricane Maria, Yemen’s cholera epidemic, Flint Michigan’s lead poisoning. The heartening response from many is to devote personal time, talent, and treasures to disaster relief, assisting those in crisis. Virtuous indeed, but even well-intentioned efforts have limitations. We must move beyond a rescue mentality and also pursue those interventions that build more durable communities. These interventions often include economic development, improved basic education, and highly efficient health initiatives. Throughout, we must equip and encourage local leaders with vision and skills to continue building strength from within their own communities.
TEDx Presentation of International Refugee Care
International Refugee Care – Displaced But Not Forgotten
- Appreciate the scope of the worldwide refugee crisis
- Identify the basic issues involved in meeting the needs of refugees
- Design comprehensive refugee care interventions for specific populations
Abstract: International refugee care is a pressing global issue. Today’s world has more refugees seeking asylum than at any time since the end of WWII. 86% of refugees are hosted in developing countries, severely straining existing social infrastructures. This presentation will introduce the principles of international refugee care, including the four recognized phases: Pre-Emergency/Mitigation Phase, Emergency Phase, Post-Emergency/Maintenance Phase, and Repatriation Phase. Throughout these phases, refugee leaders must attend to concern over security, location of settlements, mental stress, dependency, and host-guest relations.
TEDx presentation of Controversies in Short-Term Medical Missions
Controversies In Short-Term Medical Missions
- Recognize the questions of ethics and effectiveness surrounding of such missions
- Develop reliable partnerships with national healthcare leaders
- Embrace the virtue of continuity & long-term investment
Abstract: Short-term medical missions are a popular phenomena among North American healthcare professionals. Beyond a gesture of compassion, however, serious questions may surround the professional ethics and actual effectiveness of this practice. Short-term medical missions are often further complicated by concerns connected with limited time commitment, inadequate resources, unfamiliar cultural context, and lack of continuity following departure. A key element in assuring that such missions are ethical, effective, and culturally relevant is national partnerships: cooperation with healthcare professionals, healthcare institutions and/or educational institutions in the host nation. Such partnership may involve provision of materials, instruction, and/or special services – always in collaboration with, and ideally, under the direction of national leaders. Another key element is continuity of commitment over a period of years, especially when such periods of service are of short duration.
M3 Conference presentation of Serving the Forgotten
Serving The Forgotten
- Measure the health of communities by recognized standards
- Advocate for physical health, literacy, & economic growth
- Take personal action on behalf of a forgotten people
Abstract: Leaders in government, ethics, and healthcare agree on the imperative of health for all people. But while enormous gains have been made towards this end, today there exist multitudes of forgotten people who suffer preventable diseases and receive no healthcare. These forgotten people often include immigrants, refugees, minorities, elderly, disabled, non-English speakers, urban and rural poor, and victims of disaster and war. In their defense, health leaders must become effective advocates – rallying resources on their behalf. Health leaders must also prioritize prevention and treatment of forgotten diseases like measles, leprosy, vitamin A deficiency, polio and tetanus.
INMED Humanitarian Health Conference presentation of
Launching Your International Healthcare Career
Launching Your International Healthcare Career
- Apply principles of wisdom toward career decisions for service to forgotten people
- Prepare one’s self with the appropriate professional skills
- Prepare one’s personal life for the unique challenges of such service
Abstract: Healthcare professionals enjoy a strong record of service to forgotten people. However, this career track is associate with high turnover, especially in international and cross-cultural settings. Unique professional skills are required, for the diseases may be different, medical resources minimal, cultural context challenging, and leadership skills insufficient. This presentation first addresses the principles of wise decision making. Next, professional decisions are addressed, including the selection of a professional specialty, a community to serve, a sending organization, and language learning needs. Finally, personal decisions are explored, including money management, personal health, spiritual health, family relationships, and legal guidance.
INMED Humanitarian Health Conference presentation of Emergency Pandemic Control
Emergency Pandemic Control
Abstract: Rapidly increasing international trade and travel predictably increases the likelihood of rapid transmission of infectious diseases. The devastation caused by the 1918 Spanish influenza epidemic, and the worldwide alarm prompted by the 2004 SARS epidemic provide important insights into today’s concerns surrounding COVID-19. Epidemic investigation is based upon finding evidence-based answers to critical questions, including identifying the infectious agent, the mode of transmission, incubation period, and effective modalities for prevention, diagnosis, and treatment. Emergency pandemic control also often requires deliberate intervention to address special ethical challenges: disease-associated racism, resistance to local and international cooperation, and extreme stress placed upon low-resource health systems.
INMED Humanitarian Health Conference presentation of Universal Donors
Abstract: What is your blood type? Type O Negative is the “universal donor” – the rarest and also the most useful of all blood types. Healthcare professionals possess skills to protect and restore health. But like people contemplating blood donation, they often hold back from service to those in greatest distress. Concerns often expressed are fear over personal safety, finances, children’s education, and family life, unfamiliar disease, cultural barriers, and inadequate medical resources. The presentation addresses these fears with the aim of aiding healthcare professionals themselves to become “universal donors” on behalf of the world’s most poor.
Video excerpt from the presentation The Power of Applied Learning
The Power of Applied Learning
Abstract: INMED President Nicholas Comninellis describes his early failure on location in southern Africa to apply what he learned at the Walter Reed tropical medicine school to actual patient care. This failure to launch from didactic learning to performance is pervasive throughout education. The key element to successful transition is often practical, real-life experience, ideally in the presence of a dedicated mentor. INMED, the Institute for International Medicine, makes full use of this model, combining online and in-classroom education with on-the-field service-learning experiences with INMED facility residing in twenty-five developing nations.
M3 Conference presentation of The Power of Exemplary Role Models
Excerpt from the video presentation The Power of Exemplary Role Models
The Power of Exemplary Role Models
Abstract: Personal role models can profoundly impact our values and aspirations, resulting in exceptional inspiration or devastating iniquity. Nicholas Comninellis explores the power of role models and how these impact development of social movements, citing illustrations from his personal life and the genesis of INMED. Deliberate selection and rejection of persons to emulate and with whom to partner is a vital life skill. Dr. Comninellis concludes with a challenge for personal integrity and action on behalf of the world’s most forgotten people.
INMED Virtual Humanitarian Health Conference presentation of High-Risk, Low-Resource Maternal Care
Low-Resource High-Risk Maternal Care
- Identify major causes of maternal death and strategies for improvement
- Promote effective family planning & contraception
- Manage common complications of delivery
- Empower others to provide these essential services
Abstract: Surviving motherhood is a genuine concern. Maternal and newborn deaths make up the 6th and 7th leading causes of Disability Adjusted Life Years (DALYs) lost in the world’s poorest nations. Post-partum hemorrhage (PPH), eclampsia-preeclampsia, abortion complications and failure to progress are the leading maternal causes of death. Major modes of decreasing maternal morbidity and mortality are to reduce family size and to provide quality obstetric care at time of delivery. Breastfeeding is the most natural, available contraceptive, with multiple additional benefits. Management of PPH requires immediate evaluation and intervention, particularly against atony. Basic newborn resuscitation should be universally available. Healthcare professionals must advocate for the provision of these essential services to safeguard mothers and newborns.
INMED Virtual Humanitarian Health Conference presentation of
Fighting the Diseases of Poverty
Fighting The Diseases Of Poverty
- Advocate economic development as it relates to health
- Advocate for ending military conflict
- Advocate for effective disease interventions
Abstract: Poverty and health are intimately associated. The nations of poverty are also home to the lowest life expectancy, greatest child mortality, and highest number of preventable deaths. Three interventions are especially effective. First, we must promote economic development, for history demonstrates that as overall income increases so does health status. Second, we must stand against military conflict, for in nations so embattled over 90 percent of deaths are from hunger and infectious diseases. Third, we must advocate those specific interventions that have proven most effective against the leading diseases of poverty, such as the provision of safe drinking water and mosquito nets to prevent malaria, though these priorities may be inconsistent with the standard medical paradigm.
From Inspiration To Mobilization
- Select among the multiple modalities of service toward forgotten people.
- Manage the common rationales for not serving marginalized people.
- Mobilize yourself and your colleagues.
Abstract: It is human nature to defend. Whom will you defend? It is human nature to step up to a challenge. What challenge will you choose? Today we witness marvelous progress in healthcare: robotic surgery, miracle cancer drugs, vision correction procedures. Yet on the perimeter of our communities both in North America and abroad live multitudes of people who are barred from these innovations because of poverty, illiteracy, culture, and distance. Healthcare professionals often possess a virtuous desire to serve the poorest of the poor. But how do we move from feelings of inspiration to deliberate steps of action? This presentation takes makes us of popular movie clips demonstrating individuals who advance from inspiration to mobilization.
Health Of You The Traveler
- Identify the main hazards for those traveling to low-resource communities
- Protect oneself from such illness & injury
- Seek appropriate medical assistance
Abstract: Contrary to most perceptions, the leading causes of death among Americans who travel abroad are injuries and chronic diseases that they were suffering at the time of travel. Advanced preparation includes attention to injury prevention, adequate control of chronic disease, and measures to prevent infectious diseases. The latter include routine vaccinations, special vaccinations, emergency medications, and measures to prevent insect-borne diseases like malaria and dengue. Travel insurance and identification of reputable local medical care providers should be arranged prior to departure. Travelers are wise to also consider their own mental health in advance.
Appropriate Technology For Global Health
- Identify the controversies connected with use of technology
- Establish guiding principles for application of technologies
- Apply these principles to select technology most appropriate for given settings
Abstract: Healthcare is chronically in crisis – especially in low-resource settings. Improved health and healthcare demand skilled leadership, with attention to health systems. One ethical principle for developing successful health systems is the effective use of limited resources. This includes the appropriate application of technology. What principles can be used to determine whether a technology is appropriate or not? Reliability, sustainability, and acceptability. Some appropriate uses of technology in low-resource health systems often include rapid diagnostic tests, mobile health information systems, ultrasound imaging, and adherence to the use of WHO & National Essential Drugs. Collaboration with local partners and hosts is also essential. Their guidance greatly increases the likelihood that technology will be used appropriately. This presentation includes interactive use of role-playing to enhance the learning experience.
Chronic Disease Amid Chronic Poverty
- Describe the burden of the chronic diseases in developing countries
- Innumerate the challenges of managing these illnesses in low-resource settings
- Describe effective strategies to combat the most pervasive chronic diseases
Abstract:The most dramatic recent change in developing world health is the shift in burden of disease away from major infections towards chronic, non-contagious diseases. Malaria, TB, and HIV continue to cause tremendous suffering, but gains are being realized. Simultaneously, increasing longevity and adoption of “modern” lifestyle has produced expanding morbidity and mortality from COPD, cancers, coronary artery cerebrovascular disease. These are not simply disorders of abundance. Rather, they disproportionally impact people who are most poor, and the illnesses drive them into greater poverty. Intervention begins with reduction in familiar risk factors (smoking, obesity, fatty diet, sedentary lifestyle) and management of associated diseases, especially hypertension and diabetes mellitus.
Health Is Wealth
Abstract: Health is an ongoing crisis throughout the world. Cost is high and growing. Access is limited for those separated by distance or insufficient finances. And, quality care is difficult to assure. This is an age for heroes in healthcare who realize that the outcome aim is not simply more healthcare services. Rather, it is a system of care that results in healthier lives. A useful strategy is to revisit how care in incentivized: to pay for healthcare based on value of care, rather than on volume of care alone – so called Value Based Reimbursement. Practically speaking, how can we measure quality? By compliance with practice guidelines: evidence-based best practices, clinical markers (Hgb A1c), patient case management, preventive care, and use of health information systems. The latter make possible the tracking of compliance. Professionals providing primary care are well suited for quality-based care reimbursement because their patients already receive continuous and comprehensive care. Primary care is research-proven to improve quality and length of life, and to reduce overall costs. From multiple perspectives, indeed, Health is Wealth, and we do well to incentivize this fact.
Health Leadership for Low-Resource Communities
Abstract: The Health field is in crisis for lack of wise leadership, yet leadership skills are rarely taught. Health leaders in limited-resource communities must design and implement health systems that are both effective and efficient. A “health system” is a design for effective interventions based on health needs and on available resources. A variety of interventions may promote health but are either inappropriate or inefficient. To design a health system, first assess needs and resources. Second, plan appropriate interventions. Third, assure these are carried out. This three-step process is cyclical and continuous. Four levels of Interventions are commonly considered: population-oriented, disease oriented, primary care, and hospital care.
Health Through The Eyes Of Culture
- Avoid health interventions that are ineffective due to cultural irrelevancy
- Employ a process of observing, understanding, and adjusting to local cultures
- Design health interventions that are culturally appropriate and ultimately successful
Abstract: Many culturally influenced behaviors have important health consequences. As we better understand culture, we can become more effective health promoters. “Culture” itself is an integrated system of learned behavior patterns. Most cultures contain a broad mixture of both “scientific” and “traditional” viewpoints. Cultures can be effectively understood in terms of their perspectives on human nature, the relationship of humans to nature, their sense of time, their perspective on activity, and influence of social relationships. To effectively promote health in a new cultural context, one must apply the most basic principles of cultural adaptation: Observe, Understand and Adjust. Frequently say to your national colleagues, “Help me to understand why…” Asking questions maintains self-respect and creates ownership. Improvement in health behavior is a process built on trust and relationship. This presentation includes case studies and interactive use of role-playing to enhance the learning experience.
International Health Education – Multiplying Skill Capacity
Abstract: This session addresses the palpable issues of global health education, both to enhance the skill of North American personnel being sent and the skill of local hosts whose capacity needs to grow. Competency-based learning is emphasized throughout, with a focus on effective teaching and learning that is participatory, interactive, and case-based. Realistic outcome measurements will be suggested, with the adoption of locally-relevant criteria. Reference is made to the experience of INMED, with 600+ graduates over 12 years. During this presentation, participants will create their own framework by which to assess and/or design their own unique global health education programs.
Post-Covid Global Health
- Explain Covid-19’s impact on global health.
- Describe the influence of poverty on health.
- Specify the developing world’s highest priority disease interventions.
Abstract: The Covid-19 Pandemic has collapsed economies, devastated healthcare systems, overwhelmed hospitals, and killed millions of people. In the wake of the Pandemic, what is the way forward towards global health? This presentation, made via Zoom mid-Pandemic, unveils a roadmap for removing the risk factors that obstruct global health and promoting the interventions that protect populations. This presentation also explores the roles of education and economic development in achieving health for all, and concludes that No one is safe until everyone is safe.
Abdominal Pain Emergency Management
- Describe the leading causes of acute abdominal pain.
- List the clinical signs associated with leading causes of acute abdominal pain.
- Describe the special assessment of acute abdominal pain in children and females.
Abstract: Acute abdominal pain represents 15 percent of visits of emergency departments. 35 percent of primary care physicians report uncertainty with management. Correct diagnosis is paramount to correct management of acute abdominal pain. Evaluation begins with careful history with special attention to precipitating factors. Patient age and sex also highly influence the differential diagnosis. Physical exam with location of pain is extremely useful. Pain in particular abdominal regions is associated with likely diagnoses, often confirmed through evidence gathered from selective laboratory and imaging.
Chest Pain Emergency Management
- Describe the leading causes of acute chest pain.
- List a differential diagnosis, including associated signs, for acute chest pain.
- Describe emergency management of acute myocardial infarction.
Abstract: Acute chest pain is the most common serious condition prompting patients to seek emergency care. Primary care physicians are often those to first manage such patients. Correct diagnosis is paramount to correct treatment of acute chest pain. Evaluation begins with careful history with special attention to coronary artery disease risk factors. Patient age also highly influences the differential diagnosis. Causes of acute chest pain can often be divided into five categories: psychological causes, chest wall causes, gastrointestinal causes, pulmonary causes, and cardiovascular causes. EKG interpretation skill is essential, as is medical management of acute coronary syndrome.
Abstract: Primary care healthcare providers often enjoy influential opportunities to prevent disease and promote health. Risk factor identification and reduction/prevention is paramount. Prevention in the primary care or clinical setting can be classified into four categories: counseling, disease screening, immunization, and chemoprophylaxis. Counseling should be on topics that both significantly impact health and on which counseling has proven to improve behavior. Criteria for effective screening are strict, and few diseases qualify. Hypertension is an excellent qualifying example. Immunization includes recommended vaccines throughout life. Chemoprophylaxis means administering medication to prevent disease or maintain health, such as aspirin to prevent coronary artery disease.
Helping Babies Breathe Newborn Resuscitation
- Identify delivery risks for mothers and newborns
- Mitigate delivery risks for mothers and newborns
- Provide for the healthcare needs of newborns at delivery, include ventilatory support when appropriate
- Transfer newborn healthcare skills to other providers
Abstract: Some one million newborns die each year from inability to breathe at birth. This presentation introduces Helping Babies Breathe (HBB), an evidence-based educational program to prepare learners to teach basic neonatal resuscitation techniques in low-resource locations to benefit midwives, mid-level providers, and traditional birth attendants. Presentation highlights include the concept of the Golden Minute, basic bag and mask ventilation techniques, and continued newborn care during the first hours of life.
HIV Care for Low-Resource Communities
Abstract: HIV remains the leading cause of Years Of Life Lost in the world’s poorest nations. Effective means are available to both prevent HIV infection and to effectively treat HIV and AIDS. However, bias and lack of dedicated leadership often obstruct these life-saving interventions from reaching the most marginalized communities. We healthcare leaders must redouble our efforts to overcome these barriers. The ABCs of HIV prevention continue to be an effective message. HIV screening is now more accessible than ever. Prevention of Mother-To-Child HIV transmission is particularly effective if adequate detection and appropriate management are provided. Treatment of HIV and AIDS is facilitated by simpler protocols and more widely available trained personnel.
Malaria: A Disease of Poverty
- Express the magnitude of the malaria challenge
- Provide care for suspected cases of malaria
- Advocate for prevention of malaria
Abstract: Malaria is the sixth leading cause of DALYs lost in the world’s lowest-income nations and has killed more people than all other plagues and all wars in the entire history of the world combined. It is most lethal toward children and pregnant women in Arica. A number of other common disease cause similar symptoms, so the diagnosis should be confirmed with laboratory testing. Rapid diagnostic testing is particularly useful if the pros and cons are understood. Malaria treatment should take into account malaria species, medication availability, local medication resistance patterns, and the clinical status of the patient, including pregnancy and oral tolerance. Treatment requires monitoring for high-risk complications. Vector control is the chief intervention for reducing malaria, and hope remains guarded for an effective malaria vaccine.
Obstetrical Skills for Emergencies
Abstract: 98 percent of maternal deaths worldwide occur in low-resource communities, and are almost entirely preventable. System-wide improvements in contraception, prenatal care, and obstetrics hold promise to improve such outcomes. Equipping of midwives and community health workers is an important component. Everyone who delivers babies must recognize the most common obstetrical emergencies, and be able to manage appropriately. This session includes the use of manikins and hands—on skills to increase competency in treating postpartum hemorrhage, shoulder dystocia, and breech presentation.
Tropical Medicine Case Studies – Nonsurgical
- Identify a correct differential diagnosis of among common disease states
- Manage the disease appropriately in a low-resource setting
- Engage in effective disease prevention
Abstract: Effective management of disease in low-resource settings is particularly challenging for practitioners accustomed to both diseases of excess and abundant healthcare resources. Clinicians do well to begin by first understanding the epidemiology of the particular community. What, for example, are the most common causes of fever or diarrhea? Armed with a general understanding of probabilities, clinicians then must apply astute attention to history and physical examination, with minimal reliance upon laboratory or radiological evidence. Treatment options must also be modified to conform to local and often extremely limited resources. Finally, clinicians must be keen to use each patient care opportunity to both hone their skills and to transmit those skills to others. This presentation includes use of interactive case studies to enhance the learning experience.
Tropical Medicine Case Studies – Surgical
Abstract: Effective management of disease in low-resource settings is particularly challenging for practitioners accustomed to both diseases of excess and abundant healthcare resources. Clinicians do well to begin by first understanding the epidemiology of the particular community. What, for example, are the most common causes of infection or abdominal pain? Armed with a general understanding of probabilities, clinicians then must apply astute attention to history and physical examination, with minimal reliance upon laboratory or radiological evidence. Treatment options must also be modified to conform to local and often extremely limited resources. Finally, clinicians must be keen to use each patient care opportunity to both hone their skills and to transmit those skills to others. This presentation includes use of interactive case studies to enhance the learning experience.
Tropical Fever Evaluation
- Identify the unique challenges to evaluating tropical fever
- Employ an effective rationale in differential diagnosis
- Rely upon only limited diagnostic aids
Abstract: Evaluation of fever among patients in a tropical setting is one of the most daunting clinical challenges, stemming from unfamiliar causes, unusual causes, limited laboratory and imaging, cultural misunderstanding, time pressure, and out of practice clinical skills. A rational approach to febrile tropical-locale patients begins with knowledge of local epidemiology to assess particular risks. Next, clues can be gleaned from the history, such as freshwater exposure (schistosomiasis) and painful eye movement (dengue). Physical exam may reveal pathognomonic signs like conjunctival injection (leptospirosis) and Koplick’s spots (measles). Laboratory and imaging are usually very limited, but access to the proliferation of rapid tests holds much promise. Most importantly, results of basic malaria tests and neutrophil count can readily rule in or out numerous causes of tropical fever. This presentation includes case studies and interactive use of role-playing to enhance the learning experience.
Tuberculosis & Leprosy: Diseases of Poverty
- Identify cases of suspected TB & leprosy
- Provide care for confirmed cases of TB & leprosy
- Implement DOTS for preventing treatment failures
- Promote strategies for TB & leprosy prevention
Abstract: One-third of the world’s citizens are infected with TB, and 5-10% will sometime develop clinical disease. 95% of cases occur in the poorest nations, and are exacerbated by HIV, malnutrition, and lack of medical care. 80% of TB is pulmonary, and extra-pulmonary TB can occur in any organ. Diagnosis is by identification of acid-fast bacilli, and ideally by TB culture with sensitivity testing. TB and HIV frequent coexist, so vigilance must be maintained. Most countries have well-designed national guidelines for TB management that should be followed. Failure to complete the prescribed course often leads to resistant TB infection. Direct Observed Therapy Short-course (DOTS) is effective in preventing treatment failures. TB prevention focuses on early diagnosis and screening contacts. Progress is active towards more effective TB vaccines. ~ Leprosy continues to be a concern, with some 200,000 new cases each year. Leprosy presents with a spectrum of extremes between tuberculoid leprosy (paucibacillary) and lepromatous leprosy (multibacillary). Diagnosis is by identification of acid-fast bacilli. Leprosy medications are effective, and treatment requires a multidisciplinary approach. Prevention is largely based upon early case-finding and the greatest obstacle to elimination of leprosy continues to be the stigma that those infected are “unclean.”
Please contact INMED to explore any of these presentation options.
View Dr. Comninellis’ biography.