Positive News: Population Growing And Poverty Shrinking

January 6th, 2017 by INMED
Posted in International Public Health|


Positive News: Amid our world’s growing population, the portion of people living in extreme poverty has diminished nonetheless. Reliable data gathered from the World Bank, among other sources, indicates that over the last two hundred years the world population grew from about one billion to seven billion. Yet in 1820 the portion of people living hand-to-mouth (defined as spending less than $1.25 in today’s dollars) has fallen from greater than 90 percent to about 20 percent. More recently, the number of extremely poor people in the world is three times lower than in 1970. Remarkable!


To what can be attributed this remarkable progress? While such an answer is complex, some important factors include:

  • Industrialization, leading to mass production of life-sustaining products
  • Agricultural advancement, prompting greatly increased yields
  • Improved physical health, promoting economic productivity and decreased birth rates


While we continue to promote the welfare of all humankind, we can also be encouraged by the assurance of very real progress. Read more at https://ourworldindata.org/world-poverty/


From Germany To INMED And Papua New Guinea

December 30th, 2016 by INMED
Posted in INMED Grads In Action|


Let me introduce you to Rebekah Rose, a medical student in Germany. Above is an except from her personal newsletter, chronicling Rebekah’s growing interest in international healthcare, her participation in the INMED 2016 Pittsburgh PA International Medicine & Public Health Hybrid Course, and direct flight to Papua New Guinea to apply all she learned through a supervised service-learning experience at Kudjip Nazarene Hospital, an INMED Training Site.


Says Rebekah, “My grandparents served as missionaries in Papua New Guinea and that my dad lived there for the first 17 years of his life… This history was however not the primary reason for my choosing this place—I chose it because the hospital and work there appealed to me… I don‘t know what God has planned, but I do find this amazing (that Kidjip is just 20 miles from where my father lived) and feel truly blessed to be able to be right there and live in the culture and with the people that meant so much to my grandparents and among whom my dad was raised.” Please enjoy reading Rebekah Rose’s complete newsletter account.


What Moves You?

December 23rd, 2016 by INMED
Posted in Global Health News & Inspiration|


What are the experiences that make you feel choked up, that suddenly captivate your attention, cultivate passion within you, that ignite your soul with power – experiences invigorate you with energy and vision? I ask because at this interval most of us all are reflecting on the previous year and preparing for the next, so identifying what moves you is especially relevant.


Some individuals, being more analytical in their approach to existential motivation, asking questions like How can I attain my financial goals? and What’s required to succeed at work/school? But the reality of human nature is that such single mindedness can be rather easily thwarted by a sale on a product they want to purchase or by the seduction of an extra appealing vacation day.


What truly moves you, regardless of whether a more analytical or more emotion person, has the power to focus and magnify both the energy and satisfaction of your life. Myself, I’m most powerfully moved by actions of bravery and compassion, like those captured in this recent photo of a refugee fleeing brutality passing his baby under a barbed wire fence on the Serbo-Hungarian border, highlighting Europe’s worst migrant crisis since World War II.



The powerful passions symbolized by similar actions lie at the foundation of my own service at INMED, in China and in Angola. What moves you? Identify this – refine it and steer it as necessary – and I believe that you too will realize greater energy and satisfaction in 2017.


Aleppo Evacuation Ends With Thousands Ensnared

December 17th, 2016 by INMED
Posted in International Public Health|


The situation within the Syrian city of Aleppo, in a word, complicated. This major Syrian city has been a flash point in the heath political/military conflict that has incinerated this nation since 2011. In recent weeks, government forces have made gains against opposition forces within Aleppo. Amid increasing carnage, world leaders successfully pressured both side to allow a ceasefire wherein both civilians and combatants could escape the certain death awaiting them in Aleppo’s dilapidated quarters.


This historic ceasefire and civil mobilization began yesterday with the arrival in Aleppo of ambulances and buses designated to transport tens of thousands of children, families, mothers, fathers, daughters and son away from the bulls-eye of military strategists. Yet just hours later the exodus was halted. A government communiqué stated, “All women and children in areas controlled by rebel fighters have been taken out,” and “all those who wished to had left the eastern neighborhoods of Aleppo.” Simultaneously, journalists and political observes decried the fact that thousands of non-combatants remained stranded within Aleppo.


Tomorrow, December 17, the United States will be observing arguably the busiest shopping day of the year. Let us all pause at least a moment to observe and intercede on behalf of these multitudes ensnared and lying within the cross hairs of death.


Storms Are Life Giving – Angola Day 20

December 11th, 2016 by INMED
Posted in INMED Training Sites In Action|


Each afternoon we who live on the highlands of Angola are deluged by downpours and plummeted by thunderstorms. Just as rapidly at these storms appear they also pass, leaving behind a refreshing atmosphere and saturated earth. Everywhere in the countryside people are taking advantage of the showers to cultivate their corn and cabbage.


Metaphorically, Angola over the last century has endured many storms, and in the wave of these squalls, life springs anew. As I conclude my 2016 journey through Angola I’m impressed with the truth that it is through trials that we most respect victory, though hardship that character is forged, through sorrow that joy can become most full. Many thanks to my friends in southern Africa, who are living examples of these compelling truths in action.


Recovery From Severe Malaria – Angola 18

December 9th, 2016 by INMED
Posted in INMED Training Sites In Action|


Domingos’ father arrived yesterday at CEML Hospital with his ten-year old son. The father himself underwent cataract surgery at CEML three months earlier. After recovery, he ventured back home in the isolated eastern interior of Angola, where the father found Domingos febrile, vomiting, and with a large, painful abdomen. At first the father invited traditional healing – typically the first step in these cultures. But weeks later Domingos continued to decline such that he could hardly walk.


On exam, I was alarmed to find Domingos’ heart rate to be 180, his extremities swollen, and his liver and spleen enlarged, occupying almost his entire abdomen. Quick lab analysis revealed a hemoglobin of 5 and positive falciparum malaria. Hospitalization is expensive in Angola, but timely counsel convinced me to pursue inpatient care for advanced malaria nonetheless.


Within hours of initiating IV quinine, dextrose and clindamycin Domingos’ status was already improving. In this heartening photo, with father and brother looking on, Sari Simonich is reassuring Domingo he’s regaining health.


Lost In Translation – Angola Day 16

December 7th, 2016 by INMED
Posted in INMED Training Sites In Action|



The baby held in this photo is suffering from pneumonia. I’m in the process of explaining the disease and treatment to her parents, seated, using Portuguese. However, the parents are rural people and don’t understand Angola’s official language. Instead, the pastor to the left is translating into the language of their own Cunene people. Just how much important information is lost in converting to a tongue that has few words for concepts of microorganisms, drug adherence, or respiratory distress?


What’s more, observe closely the body language. The parents are looking at the floor; certainly not at the interpreter nor the physician. Are they being aloof? Disrespectful? Uninterested? Actually, within the culture of Cunene people deliberately avoiding eye contact is a sign of upmost respect. Understandably, assuring comprehension can be difficult to ascertain. Asking questions to test the parent’s understanding is also cumbersome, for respect requires that the parents assure that they understand perfectly and have no questions.


So very much can be lost in communication – whether verbal or nonverbal – between diverse people. A trusted sole who can interpreter both language and culture is an invaluable asset. Patience and healthy curiosity are also precious traits among healthcare professionals who are committed to little being lost in translation.


State-of-the-Art Mobile Medical Care – Angola Day 14

December 5th, 2016 by INMED
Posted in INMED Training Sites In Action|



Access to objective clinical information is one great obstacle to mobile medical care for underserved people. For two years in the 1990s, myself and a team of Angolans served five locations near the city of Huambo with weekly clinics. Our equipment mainly consisted of vaccinations, twenty-drugs, and a child weight scale. Objective data was mainly obtained from a blood pressure cuff, thermometer, and keen eyes and ears for clues from patient’s history and physical examination.


This week we’ve held clinic at Tchincombe Ranch. Normally a once-a-month service offered by Dr. Tim Kubacki, I took advantage of this opportunity to reenter the world of mobile medical care in Angola. Gathering patient information from vital signs, history and physical exam remains pivotal. What has improved dramatically is additional data from portable ultrasound and rapid diagnostic tests for malaria, syphilis, typhoid, hepatitis B, and HIV. The speedy advancement in rapid diagnostic tests means that reliable facts about the presence of diseases – especially infectious ones – can be available virtually anywhere in the world without needing a full laboratory.


Malaria is an illustrative example. This disease is frequent in Angola, and its most common presenting sign is fever. Understandably, the tendency is to start malaria treatment for every febrile Angolan. But, of course, many other diseases cause fever, too. The photo above captures Megan Foster and Sari Simonich at Tchincombe Ranch performing a rapid malaria test by pricking a woman’s finger for a drop of blood. In all, yesterday we performed eight malaria tests. Only one was positive. This translates into both more accurate diagnosis and into seven persons not being unnecessarily treated for malaria. Indeed, today’s mobile medical care is benefiting from a wealth of sorely needed objective clinical information.


Comprehensive Child Health – Angola Day 12

December 3rd, 2016 by INMED
Posted in INMED Training Sites In Action|



These children live at Tchincombe – a 200,000-acre ranch in southern Angola. Launched twenty years ago, this vast project of the Angola Union churches has multiple interventions including agriculture, primary school education, provision of drinkable water, and intermittent clinics. Tchincombe is also home to Stirling and Donna Foster, sweet friends whom I met during language school in Lisbon.


We were arranging clinic when I was approached by Tchincombe leaders. “Dr. Nicholas, please don’t simply treat our diseases,” they implored using the most graceful Portuguese language. “Share with us some insight from the words of Christ. Then, instruct our parents how to keep their children healthy, and encourage our elders how to recognize their grandchildren’s illnesses. Only then give yourself to examining our sick.” I marvel at their insight into the complex but essential relationships between mind, body, community, and spirit. But then, between these the African mindset rarely draws distinctions.

Psychosomatic Symptoms And Solace – Angola Day 10

December 1st, 2016 by INMED
Posted in INMED Training Sites In Action|



“I have headaches, terrible fevers, nausea, weakness, muscle aches and worsening vision.” Dona Maria was animated as she described her symptoms at CEML Hospital. “I also have pain on urination, back pain, dizziness, ringing in my ears, and tingling in my toes.” I proceeded with a physical exam which reveal no anomaly.


I was perplexed. “What in your life could be causing you stress?” I inquired. Dona Maria paused, and then began to weep. “I have seven children and live on a small farm. Last year my husband suddenly died. I could not possibly care for the young kids and farm the land. With no money and little food, I came quite close to losing our home.”


“What saved your situation?” I inquired. Dona Maria sat upright, slightly more composed. “Church leaders heard of my plight. Some of their young men came and repaired our leaking roof, and they are planting corn in my fields today. The women of the church gave me a bag of corn meal to hold us until harvest season.”


I explained how her symptoms didn’t match any particular illness, and then asked, “What do you suppose would help relieve your symptoms?” Dona Maria replied, “There’s a verse of scripture that’s especially meaningful to me: ‘Be anxious for nothing, but in everything by prayer and supplication with thanksgiving make your requests know to God. And the peace of God that surpasses all understanding will guard your heart and mind in Christ Jesus.'”