“Baby Gender Selection – Safe And Natural”

February 10th, 2015 by INMED | Comments Off

gender-biased-sex-selection

 

This promotional line from The Birth Planning Centre is representative of an entire industry built around the desire to birth children of a particular sex, usually male, and a particular genetic makeup, usually flawless. Gender biased sex selection is pursued on the premise that any deviation from the desire will result in killing that particular baby. This practice  is especially common in Asia, where it is also absolutely illegal. But the desire for profit making causes powers at multiple level to look aside.

 

In a heartening and unprecedented social transformation – one in contradistinction to Choose The Sex Of Your Baby – Chinese are increasingly fostering formerly abandoned children. The state orphanages which were once filled primarily with girls, babies with birth defects, and genetic disorders like Down’s, are progressively less populated today, as Chinese citizens take advantage of these new opportunities to provide a loving home – especially for babies who are female and less than flawless.

What Is Causing My Fever Here In China?

January 30th, 2015 by INMED | Comments Off

light-residents-2011

 

Yesterday I was mentoring these Chinese family medicine resident physicians. During my presentation I suddenly sensed a shaking chill. The weather is extremely cold here in Shenyang, far NE China – about -10 degrees. So I attributed my chill to the walk outside. But then I was struck once more by that bone-rattling sensation, followed by extreme fatigue. Not wanting to miss this teachable moment before I departed, I quizzed the residents about causes of acute fever in China. These are similar to the US: upper respiratory viral infection, strep throat, influenza. But China also has some unique causes: dengue, Japanese encephalitis, epidemic meningitis – uncommon but everyone here is vaccinated, except me.

 

malaria-rate-world-map

 

What would you teach these healthcare people about evaluation of people with acute fever? I emphasized to them, as I do to all INMED International Medicine & Public Health students, the prime importance of first considering the local fever etiologies wherever you may be serving. I related how last July I suffered a similar febrile illness with identical chills and fatigue. But at that time I was working in Angola, southern Africa. Observe the map above. Malaria is rare in China, and very common in central and southern Africa. My malaria test was indeed positive. I was treated and recovered quickly. Tonight in Shenyang I’m nurturing my fever, confident that at the very least my residents benefited from a very teachable moment.

LIGHT Shenyang: Sustainable Healthcare For The Poor

January 16th, 2015 by INMED | Comments Off

international_clinic_light_shenyang_china

 

This daunting challenge is at the forefront of most every healthcare forum, and as it should be. Essential healthcare services, like influenza vaccination and hypertension management, clearly improve life and longevity for relatively low cost. But over the long term, even these costs must be reimbursed. What are the alternatives? One is funding though taxation; well-proven but burdened with bureaucracy and inefficiencies. Another is charitable donation; also well-proven but fluctuates with societal sentiments. A third more innovative alternative is parallel profit-making ventures by health service organizations that in turn supports care for those who cannot pay full price. And finally, perhaps the most ingenious and complex of all: equipping the poor to rise themselves out of their poverty.

 

In my role with INMED leadership I’m privileged to witness such funding alternatives in action. Here in Shenyang, northeastern China, from where I’m writing today, the LIGHT Family Medicine Residency Program is fully engaged in providing charitable healthcare for retirees, orphans, students, and disabled persons. How to they fund such exemplary kindness? Largely through quality, full-cost care provided to those who can pay – most often employees of larger corporations.

 

Does there exist an ideal business model for sustainable health services for those who are poor? I think not. Each of the above is accompanied by numerous pros and cons. But we must applaud and encourage innovative approaches that promised to shed light on this foreboding but worthy challenge.

Global Health Career Decisions: First Select The Ball Park Or The Ball Team?

January 9th, 2015 by INMED | Comments Off

kansas-city-royals

 

In other words, as a person launching your international healthcare career is it better to first choose a particular community to serve, and then select from the available partnering organizations? Or vice versa?

 

I’ve personally taken both approaches. In the 1980s my main objective was a patient care position in China (the ball park). I next approached some universities and development NGOs in that nation (the ball teams), and in the end partnered with the Shanghai Charity Hospital where I served for a year. In the 1990s I formed a close partnership with the IMB (a ball team), who was active in fifty countries, and from their open positions I selected the nation of Angola (a ball park) where I was on site for two years.

 

Which approach is superior? Each has distinct pros and cons. First selecting your ball park may be best if you possess a strong attraction to a special community or nation – usually based on prior friendships, language skills, or travel experience. First selecting your ball team may be superior if you’re already attachment to that organization or if they have an appealing record of success. Ultimately, either approach is reasonable and prepares you for what’s most important: actually playing the game.

From KU to Hainan – INMED Grads In Action

January 2nd, 2015 by INMED | Comments Off

tim-stephens-first-inmed-student-to-light

 

His was an intriguing proposal. Tim Stephens, a medical student at Kansas University, approached me about a unique learning opportunity in the city of Shenyang, northeastern China. He selected the right mentor, for years earlier I too studied at the Shanghai Charity Hospital. Through the INMED Diploma in International Medicine & Public Health program Tim proceeded to study at the LIGHT Family Medicine Residency in Shenyang. This innovative site provides medical education for Chinese physicians while also serving that city’s most marginalized peoples.

 

The example ignited Tim’s vision. Subsequently he completed family medicine training in Boston and two years of dedicated Mandarin language school. Today Tim Stephens is a Faculty Physician with the Haikou Municipal Hospital on the island of Hainan, southern China. With a keen vision to multiply his skills, Tim and his Chinese colleagues are forging primary care training for young Chinese. The quality of their endeavor is of such high caliber that the World Bank is drawing upon their expertise. And this all began in 2004 with a student and a dream.

Head Injury And No CT Imaging

December 26th, 2014 by INMED | Comments Off

foster-hand-on-shoulder

 

“Yet another 9-year old with a coin stuck in the esophagus,” explains Steve Foster, INMED faculty physician in Angola, southern Africa. “I grabbed it with the biopsy forceps, and up came the coin worth maybe 6-7 cents… Then a laconic comment from an ER nurse, ‘Oh, there’s a guy here who can’t talk.’ That led to a story of head trauma in a 32-year old who was clubbed while thieves tried to take his motorbike. The man slipped into coma and his family drove 200 kms where I diagnosed him with a depressed skull fracture… No CT scan available within 500 km radius,” describes Foster. “But there was an obvious depression over middle meningeal artery on the Lt skull. So we operated, drained a diffuse hematoma… Post op the man was moving arms and legs. So will see if he survives.”

 

What are the values at play in this drama-in-real-life? For one, worth of human life cannot be adequately measured by the value of a coin ingested or a motor vehicle possessed. Another, listen carefully, for subtle culturally appropriate comments maybe extremely important. This scenario also highlights how an attentive history and physical exam may compensate for lack of very useful technologies. Finally, for those people gloomy over their professional routines, opportunities abound for compassion in action, exemplified by outstanding individuals like Steve Foster.

What Is INMED All About?

December 19th, 2014 by INMED | Comments Off

graphic-of-mission

 

INMED, in short, is all about equipping healthcare personnel with the skills essential to caring for the world’s most marginalized people. This graphic illustration, created by INMED Chief Programs Officer Elizabeth Burgos, condenses a thousand words into the essential ones. GREAT NEED: In spite of today’s communication and transportation marvels, women commonly perish during childbirth and families often have no safe drinking water. DESIRE TO SERVE: Most health professionals are passionate about caring, especially for people who are disadvantaged. EQUIPPING: the Institute for International Medicine offers innovative global health curriculum plus supervised learning experience with our faculty in twenty-five nations. OUTCOMES: Since 2004 INMED grads are continuing to serve the worlds most forgotten, both in their own nations and in the most isolated locales. It’s what we are all about.

Ebola Fighters Stride Out In Front

December 12th, 2014 by INMED | Comments Off

time-ebola-cover-person-of-the-year-2014

 

Fierce was the competition leading up to selection of this year’s Time Person of the Year. Runners up included Chinese business entrepreneurs, Russian politicians, Kurdish leaders, and even St Louis street protesters. But striding out front – on par with Pope Francis, 2013 Time Person of the Year – is this year’s winner “The Ebola Fighters: Doctors, nurses and others fighting Ebola through tireless acts of courage and mercy.”

 

What does Time’s choice of The Ebola Fighters as 2014 Person of the Year say about the temperature of American society? It could illustrate our fascination with minutiae: The risk in West Africa of dying from malaria is some 35,000 times higher than dying of Ebola. Time’s selection could also highlight our irrational obsession over pandemics: no American has yet to die of Ebola, while one hundred die every day from ordinary motor vehicle trauma.

 

I would prefer to look beyond these perspectives to some strikingly positive outcomes. Time’s choice of The Ebola Fighters is an endorsement of the virtues of bravery and self-sacrifice in defense of humankind. Time’s recognition also brings to West African nations and West African people previously unparalleled visibility. The future potential of this exposure for West African culture and commerce should be heartening, particularly in contrast with the struggles these nations face today.

 

Finally, recognition of The Ebola Fighters must be viewed as an outlier. Very few acts of true heroism are ever publicly acknowledged. Nevertheless everyday, in every corner of the planet, people go to great lengths to accomplish great good.

Finding Supplies For Charitable Healthcare

December 5th, 2014 by INMED | Comments Off

medical-supplies

 

Greg Shay is a mid-career pediatric pulmonologist embarking on a life-long dream: to promote the health of a marginalized community. He completed the INMED International Medicine & Public Health Hybrid Course this fall, and is now heading to the African nation of Cameroon with the organization Mission Doctors to serve at St Martin de Porres Hospital. Writes Greg, “They asked me to bring some intra-osseous needles but they are a whooping $100 each. Does anyone know a place to buy cheaper medical equipment? What is your best source of buying generic bulk meds for medical trips?” The Greg observes, “It is a bit depressing that even when you are volunteering to help people, you need to deal with exorbitant medical costs for supplies for the most disadvantaged.”

 

I resonate with Greg Shay’s sentiments. Fortunately a number of highly motivated organizations are addressing this problem. Just as INMED provides healthcare personnel learning opportunities, a number of reputable corporation provide healthcare supplies at reduced cost:

 

  • Blessing International “heals the hurting globally and locally by providing life-saving pharmaceuticals, vitamins and medical supplies to medical mission teams, clinics and hospitals.”
  • AfriMedShare “dedicated to improving public healthcare around the world by redistributing surplus medical supplies and equipment.”
  • Heart To Heart “exponentially expands access to healthcare by providing medicine and equipment to clinics in the US and by outfitting international medical teams with the supplies they need.”
  • IDA Foundation “for larger quantities of supplies destined for developing nations,” I have had excellent personal experience with IDA based in The Netherlands.

 

Promotion of health and healthcare in disadvantaged communities requires a remarkable network of visionaries, community leaders, trained healthcare personnel, financial supporters, and administrators. Provision of equipment and supplies for charitable healthcare rounds out these essential resources.

Febrile Illness? Begin Here…

November 30th, 2014 by INMED | Comments Off

typhoid-fever-global-distributionOne of the most daunting challenges in clinical medicine is finding the cause of an acute febrile illness. The implications are significant. Some acute febrile infections are life-threatening, like meningitis or cerebral malaria, causing death within hours. Some are highly contagious; putting loved ones – family and friends – at greatest risk. And some can be treated quite successfully, especially if a prompt, correct diagnosis made. Managing an acute febrile illness is difficult by nature, and the challenges are multiplied many-fold in settings without up-to-date laboratory, imaging, or therapeutic resources.

 

A useful first step in diagnosing an acute febrile illness is to understand the local epidemiology. The image above illustrates the distribution of typhoid fever. In the particular geographic region, time of year, age and sex of the patient in question, what infectious diseases most commonly cause febrile illness? If the setting is the United States, in January, in a young and unvaccinated person, then influenza may be a likely culprit. In China, in the rainy season (roughly May-September), Japanese encephalitis is a frequent threat. In Central America, also May-September and particularly among people with previous similar illness, dengue fever must be considered.

 

An understanding the local epidemiology gives astute clinicians the ability to assign probabilities to the etiologies being considered: to add some and to eliminate others. This forms the basis of a rationale that will lead to the next steps in the search for clues to the precise cause of fever.