Finally some exploration

July 25th, 2016 by Carlye Marszalek
Posted in Uncategorized|

Wow! Only one week left of the rotation! I don’t know how time has gone so fast. Week three was a bit different that the past two weeks. Monday I worked with Dr. Stockley and it was a normal day, full of tropical diseases and general practice. Then Tuesday and Wednesday Ashley and I actually took off and went to Jinja to spend two days outside of Kampala. Don’t worry I made up the work days this weekend.
But Jinja was a ton of fun. Tuesday morning we were picked up in Kampala by the Nile River Explorers bus and taken about 2 hours to Jinja. We spent Tuesday white water rafting on the Nile River which was absolutely amazing. Tuesday started off with a general introduction and safety briefing and then we got fitted with life jackets and helmets. Then we were given a Rolex and a bowl of fruit and put on a bus for another 45 minutes and taken to the starting point for rafting. We had an amazing guide, and he let us practice everything we needed to in the calm waters before the first rapid. Then the white water rafting began! As we approached the first of 8 Rapids, we watched another raft go down the first one. They went over this huge wave and then just disappeared and we all panicked because we had no idea how big the drop off was. Then it was our turn. We followed the guides instructions to paddle hard, get down and lean right, paddle some more, and then get down and hold on. We made it through the rapids without losing anyone and once we were passed it, we turned and looked back. Turns out we had pretty much just rafted down a 12 foot rock wall and survived!
The rest of the day was a mix of adrenaline pumping Rapids with lots of calm water in between. There were even areas in which we could jump out and swim around. I just couldn’t believe I was swimming in the NIle. And yes, I do plan to get tested for Schistosomiasis in a couple weeks and to take the treatment as recommended, because the Nile definitely has Bilharziasis! We did a total of 8 Rapids and only flipped the raft over 3 times, which I thought was fairly decent since all of the Rapids were between a grade 3 and grade 5.
After a full day of rafting we had a buffet barbecue with drinks and then got on the bus to go back to the lodge. Ashley and I opted to spend the night on the NIle River Explorers river view camp which was this amazing camp site compound right on a bluff over looking the Nile. We stayed in a river view safari tent, and I actually was able to go to a yoga class on a platform over looking the river for sunset. Everything was just beautiful and amazing.
Wednesday we just spent the day in town in Jinja getting some good food and visiting some of the craft and souvenir shops before we caught the bus home. In true African style the 80 km bus ride ended up taking 4.5 hours. Needless to say we were exhausted after a great two days and did NOT want to go back to work Thursday. But we did manage to finish up the week at the Surgery.
Thursday we used Ketamine and set a woman’s leg that she had fractured. I had never experienced ketamine use like that so it was nerve wracking but really cool. Then Friday was just another day with Stockley learning about tropical diseases. Friday we got off a bit early and went to the craft market in Makindye and I loaded up on gifts for everyone back home.
Then I worked this weekend and also prepared the presentation that I am going to give for the CME this coming Thursday. It was nice to work on the weekend because the patient load was less and I got to talk about the cases more with the doctors that I was working with. It is going to make for a long week though because I will be working 8 full days in a row. The worst part of being on the equator is that the sun goes down at 7 every day no matter what. So working till 6 or 7 and then the ride home, means that I am always home after dark so the day consists of pretty much only work and nothing else. It’s hard to get any work done or a workout in. But if that is one of my only complaints, I’m doing pretty dang awesome! So far I have loved it here, and I am so glad I am staying in Claire’ house. There is a great social aspect of the house and we all look out for one another and it really has been on of the best parts of my trip so far.
One of the other things that I have really enjoyed is learned about all the different countries processes in which they train doctors. The US system is about 3 years longer than any other country I have talked about and that is really frustrating to me. It is also by far the most expensive education. In the UK, it is only 5 years after graduation, and only 9,000 pounds a year for those 5 years. That is almost the same price as 1 year of medical school for me. It has been really enlightening to learn about all the different countries processes.

Babies. Vaccines. Soccer. Rolex.

July 20th, 2016 by Scott Biggerstaff
Posted in Uncategorized|

Halfway through week 2!  Today I watched a C-Section, sat in on the GYN clinic, and then there was another C-Section after lunch.  I have been on the maternity ward this week with a Dutch OBGYN who has been working here for 4 years and a Ugandan medical student named Fred.  Today, we were joined by a Ugandan physician – she was the one that performed today’s sections.  All the Ugandan students are expected to be competent at C-Sections when they graduate, so I saw Fred do a good chunk of two sections earlier in the week.  The maternity ward is pretty steady – plenty of business.  The hospital has a midwifery program and the midwives handle most of the vaginal deliveries, while the physicians round on patients and handle the surgeries.  They also oversee deliveries from time to time.  For the most part OBGYN is the same over here as back home with some caveats, namely less prenatal care, HIV prophylaxis is something to consider more frequently, there is no cautery for surgeries so they can be quite bloody, and the women have more children.  Like way more children.
Over the weekend I went with Dr. James, a surgeon and my ‘supervisor’, to vaccinate a bunch of chickens.  I mean a BUNCH.  I originally thought they were owned by the hospital, or that it was a public health measure (they were flu vaccines, bird flu, I dunno), but turns out they are just Dr. James’s chickens.  He raises them and sells them for meat to supplement his his income and help a young man who also tends to the chickens.  It was kind of surreal and hilarious.  He would say, “Come here, chick-un, do not be afraid, it is just your vac-see-nay-shuuunn.”
I finally made it down to the soccer ‘pitch’ outside the hospital compound.  Men that work at the hospital and men from the community come play soccer in the evening, and I had heard about it but didn’t venture down that way till yesterday.  I showed up in the pants I wore around the hospital, a T-shirt, and my Vans feeling like Woody Harrelson from White Men Can’t Jump, minus that sweet mid-range jumper.  Honestly, I had no idea what was going on for a while.  The ‘pitch’, first of all, is a scene from the D-Day beach storming in Saving Private Ryan.  It is sloping in more than one direction with paths running through it, rocks, and dirt mounds ready to rob you of your feet at any time.  On top of that, we were just playing on one half and the goals were bricks that had been set up, one on either end of the half.  So the object, I assumed, was to hit the brick with the ball.  Literally no one was going for goal.  The other team would get the ball 10 feet from our brick and just play the ball back, switch it, dink around with it, and I was defending a brick no one was attacking.  I finally figured out they basically just play keep-away.  They play really good soccer (football).  There are a couple of guys that can ball, for sure, and it’s all one and two touch – very impressive.  I think they’re warming to me, too – yesterday I was mzungu (pronounced mih-zoon-goo, means white guy), and today a few of them were calling me Scott.  I have even been invited to play with some of the staff from the operating room this weekend in a hospital tournament.
I got some company in the guest house after a week of solitude.  Two Portuguese nurses who were serving at a hospital north of here came to see the NICU, and two nursing students here to rotate – one German and one Brit.  We all wandered outside the compound last night to sample the local fare – ‘Rolex’.  That’s what it sounds like to me, anyway.  I think it was ‘rolled eggs’ at one point, but it all just runs together now.  It’s like a mini omelette with tomato inside a tortilla type wrap.  Worth the shillings.
Otherwise, just grinding on the daily.  reading, asking people to repeat things several times, and trying to learn from the experience.  It has been quite humbling in a number of ways – not being familiar with the language spoken by the majority of the patients and struggling to understand the English spoken by the hospital staff has made everything harder.  It’s tough to rotate in a new place because the way they do everything takes a little acclimatization, but here that is compounded by the differences in the culture, the demographics, served, and the limitations of the facilities and equipment available.  It has made me think a lot about what serving in a place like this would be like as a physician (read ‘grown up’).  Hungry for greater perspective and more Rolex.

United States Trailing In Global Humanitarian Responsiveness

July 15th, 2016 by INMED
Posted in Disaster Management|



International humanitarian response to recent large-scale disasters is widely regarded as unnecessarily inadequate, especially in light of advancements in disaster management understanding and available response resources. This unnecessary inadequacy is manifested in several forms: 1. Insufficient rapid assessment of disaster status and immediate relief needs prior to emergency response, resulting in frequent interventions that are inappropriate, 2. Poor communication and coordination between disaster responders, resulting in both duplication and omission of critical response elements, 3. Insufficient basic skills among disaster responders, resulting in under par acute injury and disease management, sanitation and preventive health measure, and provision of essential human needs (shelter, water, food, reunification), 4. Host government’s failure to recognize the skill, preparation, and capacity of EMTs (Emergency Medical Teams), resulting in denial of entry and participation of these EMTs that have potential to provide significant aid, 5. Insufficient attention to post-disaster on-going healthcare needs, infrastructure rebuilding, and disaster prevention, resulting in post-disaster epidemics, hunger, and recurrent disaster.


In response to these enumerated inadequacies, the WHO at the May 2016 World Health Assembly announced the process of developing and launching internationally-recognized EMTs as a critical component of rectification. At the time of this writing, over 64 nations have either launched or are developing accredited teams to provide surge support to nations by delivering emergency clinical care to sudden-onset disasters and outbreak-affected populations. Neither the United States government nor large-capacity US based NGOs have yet committed to adopting the EMT concept, leaving our nation of altruism on the sidelines of this critical international humanitarian development.


Reasons for this lack of progress stem from issues of funding and of leadership. The US Government continue to struggle to find funding for high-profile Zika concerns, let alone equipping EMTs. Similarly, funding of NGOs is crisis centered, rather than anticipatory such as is required for EMTs. Parallel to these funding concerns, organizational leadership, however well intended, is largely driven by funding and urgently felt needs – rather than by the future-oriented prospect of EMTs role.


What will be the United State’s response to trailing other nations in global humanitarian responsiveness?


Honesty And Truth Telling Within Chinese Healthcare

July 8th, 2016 by INMED
Posted in Cross-Cultural Healthcare Pearls|



Astute observations from Eva Holsinger, my pediatrician colleague here in northeastern China: “Do you want your doctor to tell you everything, right away, as soon as she knows something bad is coming at you? Take it another step: who do you want the doctor to tell first: you, or your family? In the US and other places like northern Europe, the answer to the former is umm maybe now but for sure eventually, and the second one is not even a question with HIPAA laws and all the other ways we strive to protect our privacy.


“My experience here in China has been vastly different. From our early days in 2009 we quickly heard about how often serious diagnoses are not disclosed to the patient, but to the other relatives, and they decide when and if to tell the patient. Of course I was aghast and fumed about patient autonomy, rights, lying to the patient, and more. There are many questions surrounding this that I can’t begin to answer, beginning with how..and why…and what on earth…and strong adjectives that I might quickly jump to using like insufferable and paternalistic.


“However… A friend was telling me about her father’s recent diagnosis with advanced lung cancer, and how she and her sister want to tell him but their mother does not. The mother has declined chemotherapy for him and they are telling him that his illness cannot be cured but he should eat healthy foods and take good care of his health. Every weekend the three adult kids come home with their families and have a good family time together. The dad says he didn’t have it so good until he got sick. She is pretty sure he suspects.


“My friend says they will go along with their mother because she will be around a lot longer and they don’t want to upset her too much since they have to deal with her. As we talked and she described their family’s situation I had a sudden a-ha moment. In the Chinese culture parents take care of children when they are young, and the expectation is that the children will take care of the parents when they are old and/or sick. In addition, major decisions about a young person’s life-college, career, spouse-are often all made by the senior decision makers in the family. When they age, the roles are flipped to some degree.


“In the US a big deal is made about living wills, health care power of attorneys, DNR statuses. We entrust our decision making to our designated loved ones only at the very end of the journey when we can’t make the decision ourselves. I wonder if the same choice is made but much earlier in the process here-at the beginning of the diagnosis, not at the end of life.


“There is an element of trust that seems very deep-trusting that your spouse and children will do their utmost to decide what is best but not only for you but for the family as a whole. I may not necessarily agree with that method in every regard, but that doesn’t mean it is less valid than my western perspective. Can family members be loving, honest and truthful without the element of naked and complete disclosure that we value so much in the west? Can doctors work within this system and still make sure that the needs of the actual patient are met appropriately?


“These are some of the bigger cross-cultural issues we are grappling with as we, a group of western-trained doctors, attempt to teach and mentor a group of young Chinese physicians.”


Join the INMED Course At Massachusetts General Hospital!

June 30th, 2016 by INMED
Posted in INMED Action Steps For You|



We must do better at doing good was the overwhelming evaluation of organizations responding to Haiti’s earthquake. Massachusetts General Hospital (MGH) Global Health, Harvard Humanitarian Initiative, Heart to Heart International, among others, are working in partnership with INMED to substantially improve the quality of both disaster response and sustainable community health improvement.


An essential element of doing better at doing good is you – the person who steps forward into such laudable service. Right now INMED is offering several opportunities to enhance your effectiveness via the INMED International Medicine and International Public Health Hybrid Courses. The 2016 Boston MA Courses are hosted by MGH and begin online Monday July 4, with in-classroom on Sep 16-18. Also starting very soon are identical INMED Courses in Glendale CA, Pittsburgh PA and Long Island NY. Please join in!

Lana Borden Teaching Nursing in Zambia

June 23rd, 2016 by INMED
Posted in Healthcare Education, INMED Grads In Action|



In 2013 Lana Borden, an RN from Kansas City’s Children’s Mercy Hospital, we recognized with the INMED Diploma in International Public Health, which included her formative service-learning experience at Mushili Health Center in Zambia, southern Africa.


“In January I was in the Copperbelt area of Zambia again,” says Lana “to visit nursing colleges and interview for professorship. A private college called Nkana wants me to return for an internship as a sort of working interview and orientation process with the dean of nurses. I would be working alongside 6 other nursing ‘tutors’ to train about 350 students through their three year nursing program. This was just the sort of thing I was hoping to do, as I believe the impact of training the next generation of nurses from the beginning of their studies will have an exponential effect on healthcare in Zambia. Doctors are scarce, especially in rural areas, and nurses are often the primary healthcare providers in their communities. INMED’s public health program was instrumental in getting me started on this journey.


“As a Christian and missions-minded nurse, I am excited at the opportunity to earn a living in the country I’ll be serving, although some may think it unusual. It is similar to the way the apostle Paul was able to generate income with his tent making trade as he traveled abroad and shared the gospel. It will be a challenging endeavor, but I am excited for what may be to come.”


Transformation In Healthcare Education

June 10th, 2016 by INMED
Posted in Healthcare Education|



Paul Larson, INMED Faculty and family medicine instructor at the University of Pittsburgh, notes how in 1956 Benjamin Bloom and collaborators developed a framework for classifying educational objectives. This image describes categories of behavioral learning of increasing cognitive complexity. In its most primitive form, learning is confined to recitation. With increasing maturity, learning expands toward application of what is learned, analysis of the validity of that information, and even to creation of new information.


This model of understanding has lead to tremendous shifts in healthcare education; moving the field from knowledge-orientation toward competency-accomplishment. Associated with this transformation has been the role of the teacher. She or he is no longer simply a source of information, but rather one who facilitates learning through creation of effective learning opportunities. Hence, the Bloom’s Taxonomy impacts both the Learner and the Teacher.


Why Construct A Ship Underway At Sea?

June 3rd, 2016 by INMED
Posted in INMED Action Steps For You|



Sounds like nonsense. Why construct a ship while plowing oceans waves? Wouldn’t it be more efficient to pull into a dry dock for a few months of focused building? The fact is, however, that once the hull is complete and engine installed the ship can technically start hauling passengers. 2003 was the year of INMED’s basic construction. Since then, the demand for ‘passenger service’ has been so steady that the we have not enjoyed the luxury of making people wait for our services. After all, equipping well-meaning healthcare personnel to serve the world most marginalized is one of the very most compelling payloads to bear.


During the coming year watch for several new additions presently being built onto INMED’s ship:


  • Establishment of a scholarship fund to facilitating healthcare students earning an INMED Diploma.
  • Expansion of the INMED Conference to address a broader audience of healthcare professionals and students.
  • Concentrated analysis of the impact of INMED training on the careers of our graduates.
  • Provision of augmented assistance for schools and programs to obtain global health accreditation
  • Introduction of healthcare education training to the core INMED curriculum.


Constructing a ship at sea has particular challenges: rough waves, extreme temperatures, exposed pilot house. But this also carries special benefits: the enthusiasm of the travelers and the joy of those in the harbors who great them.


2017 INMED Humanitarian Health Conference

May 27th, 2016 by INMED
Posted in Global Health News & Inspiration, INMED Action Steps For You|

2017 HHC Image


At this moment 400+ individuals and 28 exhibiting organizations are taking part in the 11th annual INMED Exploring Medical Missions Conference. When first conceived in 2006, this event was primarily intended to bring together well-meaning volunteers with sending organizations, most often for shorter-term commitments. Since that time, the developments within INMED and the healthcare professions have shifted focus toward longer-term personal investments and toward those health interventions that are more comprehensive and potentially sustainable in nature.


In step with these developments, we at INMED are pleased to announce the new identity of this event: the INMED Humanitarian Health Conference. Look for the 2017 event to be inclusive of all healthcare professions, interactive and personal in nature, and populated by both inspired individuals and inspirational organizations. Given the previous frequent overlap with graduation events, the INMED Humanitarian Health Conference will also be earlier in the year: Friday and Saturday morning, March 24-25, 2017. Please save the dates and join us!


Tomorrows International Health Volunteers

May 20th, 2016 by INMED
Posted in Global Health News & Inspiration|



What do you want to do with your life? Let me introduce you to some who already know: The 200 graduate and undergrad students, photographed here at the event, who received scholarships to participate in this year’s INMED Exploring Medical Missions Conference.


One is Jordan Crawford, whom I originally met through Joe White of Kanakuk Kamps. “As Joe and I talked about medicine, missions, purpose,” says Jordan, “Joe was convinced that he needed to connect us. He briefly told me about INMED I was more than intrigued to learn more.”


My extreme gratitude goes out to the fifty-two individuals who provided funding – and the associated vision-casting – for these students. I hope you’ll save the dates of March 24-25 to join INMED again for our 2017 event: the INMED Humanitarian Health Conference.