Can You Solve This Case Of Malnutrition?

May 15th, 2015 by INMED | Comments Off on Can You Solve This Case Of Malnutrition?



The two-year old child in this photo presents to your health center in the Democratic Republic of the Congo. Family members explain that eight months ago their farm was attacked by bandits. No one in the family, including this child named Aamir, has eaten regularly since then. What’s more, Aamir in recent days has developed fever, diarrhea and lethargy.


On initial physical examination you note that Aamir is poorly responsive to stimulation. His temperature is thirty-eight degrees C, respirations are thirty per minute, pulse is ninety, and blood pressure is unobtainable. He has extreme muscle wasting throughout and loss of adipose tissue but no peripheral edema. Aamir’s measurement of mid-arm circumference and skin fold thickness are well below the norms. Your diagnosis is marasmus.


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


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


Explanation: The correct answer is E. The management of acute PEM can be separated into two stages. The first stage is stabilization, to immediately correct hydration and acid-base alterations. The second stage is refeeding. This can begin as soon as medical problems are reasonably stable and rehydration is complete. It may be necessary to begin initial refeeding slowly in persons who have advanced PEM or kwashiorkor because of damage to the intestinal mucosa. During the period of renutrition, micronutrient supplements and attention to any coexisting medical illnesses may also be indicated.


Ten days later, Aamir, is alert and being fed F-100 – a 100 kcal/100 ml formula made from concentrated milk powder, food oil, and dextrin. During the coming weeks your care of this malnourished child will include which ONE of the following:


A Vitamin A supplementation
B Nutrition education to avoid legumes
C Removal of hookworms from feet
D Avoidance of vitamin C
E Provision locally mined salt


Explanation: The correct answer is A. The mainstay of therapy is continued administration of high energy, high protein food. Children of this age should also receive Vitamin A supplementation from prevention of xerophthalmia. Legumes are an important source of energy, though they may be deficient in iron. Hookworm initially penetrate the feet but reside in the intestines, requiring oral treatment. Vitamin C is important to aid in iron absorption. Non-commercially produced salt is unlikely to contain iodine supplement, contributing to iodine deficiency.


Would you like to take action on behalf of children like Aamir? Begin by arming yourself with the necessary knowledge and skills and experience though one of INMED numerous opportunities, including a supervised learning experience with one of our mentors in twenty-five developing nations. Be prepared when you care for a child like Aamir.

Who Are Our Neighbors?

May 8th, 2015 by INMED | Comments Off on Who Are Our Neighbors?



This week’s post-earthquake turmoil in Nepal is provoking some soul searching among the Nepali living in the United States, asking What is our responsibility to assist? Many of us who are well-resourced but not ethnically Nepali are nonetheless asking similar questions.


This image of the Good Samaritan is one I photo in the lobby of the Lubango Evangelical Medical Center, INMED’s Training Site in Angola, southern Africa. That morning the staff of our small medical center met together as Pastor Moses opened his Bible to Luke chapter 10 and read, “On one occasion an expert in the law stood up to test Jesus. ‘Teacher,’ he asked, ‘what must I do to inherit eternal life?’ ‘What is written in the Law?’ replied Jesus. ‘How do you read it?’ The expert answered, ‘”Love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind” and, “Love your neighbor as yourself.’” ‘You have answered correctly,’ Jesus replied. ‘Do this and you will live.’ But he wanted to justify himself, so he asked Jesus, ‘And who is my neighbor?'”


Pastor Moses motioned just outside the door, where some 100 people awaited their medical consultations. He then pointed to the hospital ward and maternity, where 50 more were already receiving life-sustaining attention. “Today,” declared Pastor Moses, “we enjoy the privilege of compassionate care for these, our neighbors.” I’ve no doubt that were he speaking of the Nepali Pastor Moses’ message would be unchanged.

Changing Course From Kansas To Brazil

May 1st, 2015 by INMED | Comments Off on Changing Course From Kansas To Brazil

whitton-dale-originalDale Whittom and his wife Lisa participated in the 2014 Exploring Medical Missions Conference (EMMC) and ended up moving to Brazil. They didn’t see it coming, either. “My wife’s a nurse practitioner and I’m an EMT. We have served on a number of short-term medical trips to Central America,” says Dale, “but never considered any large investment of our careers. That is until we met Oscar Paulo – the Brazilian/Angola physician who spoke at the Conference. Oscar prompted us to step up our commitment, and now I’m convinced that God can use almost anyone of any age as long as they are willing.”


Soon after the 2014 Conference Dale and Lisa followed with Baptist Medical and Dental Mission International, a sending organization who exhibited at the event. “BMDMI connected us with a clinic is the Brazilian city of Forteleza, which will be our new home. Right now we’re deep into learning the national language of Portuguese, and updating some of the skills we learned at the Conference, like how to manage birth complications and care for open wounds.” Dale concludes, “We’ve become some of those Sticks In A Bundle; Unbreakable and doing what God’s laid on our hearts.”

Whatever I Have To Offer In Congo

April 24th, 2015 by INMED | Comments Off on Whatever I Have To Offer In Congo



Marta Klein is a physician assistant from Salina, Kansas, who in the fall of 2013 joined INMED for the International Medicine & Public Health Intensive Course. Since 2010 she is a volunteer with the Evangelical Covenant Church in the Democratic Republic of the Congo. Marta writes, “I have training that is supposed to help, but sometimes there is little physically that can be done. For me, that is really a tough one. For example, my HIV positive patient has horrible pain from metastatic breast cancer, another man who for six months has had an open leg fracture and will need amputation, and a thirteen-year old boy only now coming for care with such profound malnutrition that he weighs just 12 kg.”


I think the negativity, despair, and suffering could become too overpowering for me,” writes Marta Klein. “So there are many moments when I internally raise my hands to God and ask for mercy and wisdom. I also offer to pray with my patients. And I try to find moments to savor, like enjoying the sweet perfume as I pass by the Plumeria tree by my apartment. I also especially enjoy teaching the nursing student here in Congo. If you are a healthcare professional – doctor, nurse, mid-level, dentist, physical therapist – please contact Paul Carlson Partnership for ways you can be involved. If you have any inkling to teach what you have gained through your career I especially encourage you to reach out and share what you know!

Test And Treat – The Future Of HIV Control?

April 17th, 2015 by INMED | Comments Off on Test And Treat – The Future Of HIV Control?



While HIV disease is relatively controlled in wealthier nations, the threat and suffering from HIV continues to be devastating throughout much of our world. One intriguing potential intervention for eliminating HIV from high endemic regions is know as “Test And Treat.” In short, this approach is to provide wide access to voluntary testing and then to initiate ART/ARV therapy to everyone who is HIV positive, regardless of their state of immunocompetency. Such therapy so reduces viral loads among infected person that they are almost entirely incapable of transmitting the disease to others.


Clearly such an approach is accompanied by a host of possible advantages and disadvantages. Unraveling these questions are researchers who include those at Macha Mission Hospital – an INMED Training Site in Zambia. John Spurrier career physician in Zambia with Brethren in Christ Church, is a leader in the endeavor. Dr. Spurries is optimistic, pointing out that when taken properly, 95 percent of the time, ART reduces the virus so effectively that within months it is undetectable in body fluids. “You haven’t cured them. You’ve just so totally suppressed the virus they gain weight and live a normal life,” he observes.


The unanswered questions in global health are numerous and pressing. For those with a research interest INMED offers hearty encouragement, and well as precious service-learning experiences with active researchers like John Spurrier.

PharmD From INMED To Indian Health

April 10th, 2015 by INMED | Comments Off on PharmD From INMED To Indian Health



“One thing’s for sure, my courses and experiences with INMED played a huge role in selecting me over other candidates that were interviewed for this highly competitive position. I’m forever grateful for that.” Joseph Muroka was a pharmacy student at the University of Missouri-Kansas City when he applied for the Diploma in International Medicine & Public Health. Joseph’s training included at stent at Kijabe Hospital in Kenya. “I had the opportunity to make a follow-up visit to a newborn of HIV infected parents. This was perhaps the climax of my clinical experience throughout that month. I had read studies of such fortunate children, however this was my first such real life experience. The mother was gracious to allow me to share their story.”


What is this new position for which Joseph Muroka is so qualified? Moreover, how can an American pharmacist apply the principles of global health to a career? Dr Muroka is now on staff with the United States Indian Health Service, serving one of the most disenfranchised subset of American citizens. “The position allows me to work as a public health ambulatory care pharmacist where a huge part of my duties will be to see patients with chronic conditions such as diabetes, HTN, asthma, and those requiring anticoagulation, among others. I’m excited and thankful to God for this new opportunity to God for this opportunity to serve and give back!”

What Is The Difference Between Mother Teresa And You?

April 3rd, 2015 by INMED | Comments Off on What Is The Difference Between Mother Teresa And You?



On March 13 I described the New York Times article by editor Nicholas Kristof about Steve Foster, tirelessly serving Angolans in that nation for the last thirty-seven years. What’s the difference between Mother Teresa, you, Foster, or any number of others? Thousands of dedicated individuals are persevering, often at great personal cost, in effective service towards humanity. Chances are good that you know such a person. Chances are also good that outside of that person’s immediate community few others are aware of his or her exemplary deeds.


So why are Mother Teresa and her Sisters of Charity recognized throughout the world? Part of the answer is consistency. In 1952, Mother Teresa opened the first Home for the Dying in Calcutta. By 1996, forty-four years later, she was operating 517 missions in more than 100 countries. But her fame as an international celebrity took root in large part from the 1969 book and film documentary Something Beautiful for God, produced by Malcolm Muggeridge.


To the benefit of the world Muggeridge discovered Mother Teresa, just like news reporter Henry Stanley uncovered David Livingstone in Tanzania, and New York Times editor Nicholas Kristof recognized Steve Foster. As a person who aspires to aid humanity should such publicity be pursued? Not necessarily. Many resonate with the statement in Matthew 6:3-4, “But when you give to the needy, do not let your left hand know what your right hand is doing, so that your giving may be in secret. Then your Father, who sees what is done in secret, will reward you.” But neither should such exposure be shunned. Few personal motivators are as powerful as an outstanding role model. I myself am a prodigy of Steve Fosters’ example.

Defending People Most Vulnerable

March 27th, 2015 by INMED | Comments Off on Defending People Most Vulnerable



“We in healthcare experience the unique opportunity of meeting, even defending, people when they are most ill, most distressed, most vulnerable.” Chris Deuel is a resident physician and currently a student in the INMED International Medicine & Public Health Hybrid Course, photoed here on the left. He appealed to his twenty-five classmates, “If we do not make ourselves available for these patients, we are missing a great opportunity to genuinely care for them when they may need care the very most.” Chris Deuel’s perspective is heartening, particularly in an era when clinicians feel suffocating pressure to shorten patient visits and thus bill more patient encounters.


“The time spent talking with patients and building trust,” Chris Deuel continued, “not only can allay their fears. If our patient genuinely trust us they will be more likely to be following with the treatment plan and to be motivated to take personal steps to improve their health.” Observing Chris’  sincerity reaffirms for me the conviction that INMED students are some of the world’s most compelling, skilled, and inspired individuals.

Nurse Anesthetist From INMED To Angola

March 20th, 2015 by INMED | Comments Off on Nurse Anesthetist From INMED To Angola



“God is always doing 10,000 things in your life, and you may be aware of just three of them.” April Hall, a graduate of Raleigh School of Nurse Anesthesia, quotes this statement by John Piper to illustrate the phenomena of her journey toward life in Angola. I first met April five years ago when she joined forty-three classmates for the 2010 Kansas City INMED International Medicine & Public Health Intensive Course. She anticipated I would be the only Angola connection. April was both surprised and encouraged to find three other students with commitment to this southern African nation.




Skilled surgical care requires more than a skilled surgeon. At least one other proficient professional must watch over the wellbeing of the patient. Steve Foster, Angola’s most renowned surgeon, is now complemented by April Hall, newest among Angola’s tiny cadre of anesthetists. She and her family anticipated that life in Angola might be isolated and melancholy, but through growing friendships and preserving lives they’ve discovered just the opposite. Says April, “I find such comfort in these words: ‘I have come into the world as light, so that whoever believes in me may not remain in darkness.’ Christ indeed shines in the darkness. He provides comfort for the shattered. He gives peace to the hopeless.” Indeed, God may be doing 10,000 things in your own life. What a joy to occasionally be aware of them.

A Little Respect For Doctor Foster

March 13th, 2015 by INMED | Comments Off on A Little Respect For Doctor Foster



“The next time you hear someone at a cocktail party mock evangelicals, think of Dr. Foster and those like him. These are folks who don’t so much proclaim the gospel as live it. They deserve better.” New York Times op-ed columnist Nicholas Kristof posted his findings this month in an article titled  A Little Respect for Doctor Foster. On a visit to Angola, the nation home to the world’s highest child death rate, Kristof interviewed INMED faculty Steve Foster at the Lubango Evangelical Medical Center. Foster, who moved to Angola in 1978, was my primary mentor when I lived there in the 1990s.


Nicholas Kristof continues, “Yet the liberal caricature of evangelicals is incomplete and unfair. I have little in common, politically or theologically, with evangelicals or, while I’m at it, conservative Roman Catholics. But I’ve been truly awed by those I’ve seen in so many remote places, combating illiteracy and warlords, famine and disease, humbly struggling to do the Lord’s work as they see it, and it is offensive to see good people derided.” We are INMED are privileged to match our student with mentors of such stature in Africa and throughout the world.