Why Is An International Healthcare Career Uniquely Challenging?

October 19th, 2014 by Nicholas Comninellis | Comments Off



This week I hosted the in-classroom section of the 2014 Fall, Glendale CA, INMED Intensive Course. Our ten participants came armed with extensive of experience in Cuba, Zimbabwe, Cambodia, Pakistan, Ghana, and Papua New Guinea. Nevertheless, most who serve on behalf of forgotten people, discovered that their prior education poorly prepared them for effective work.


Why is an international healthcare career so uniquely challenging? Primarily because:


• Health is largely determined by factors beyond mainstream healthcare that must also be addressed, like education, housing, and economic development.

• Diseases and injuries may be unfamiliar. Malnutrition, orthopedic trauma, and certain infectious diseases are common in low-resource communities, but rare in wealthier ones.

• Resources to manage these diseases and injuries are usually minimal, whether laboratory, imaging, medications, supplies, or consultants.

• Cultural context is frequently challenging, while success in promoting health and combating disease requires an intimate understanding of language and social behavior.

• Leadership skills are underdeveloped. But effective health intervention requires attention to community-wide needs and resources, team building, and strategic planning – concepts infrequently addressed in the education of healthcare professionals.

• Living and working in low-resource communities demands unique personal adeptness. Attention to physical health, emotional well being, financial strength, and family relationships is essential for long-term success.


Over the weeks we one-by-one addressed these challenges and sharpened our skills in each critical area. On the closing day Greg Shay, a pediatric pulmonologist serving in Cambodia, raised his hand and announced, “I have one other quality of such a career that I’d like to add.” Everyone turned attention to Greg. “Our opportunity to make a meaningful impact and to show remarkable compassion is also uniquely great!”

What Was The Ebola Of The 1970s?

October 8th, 2014 by Nicholas Comninellis | Comments Off

jenner-small-pox-vaccine-posterThe progress of today’s Ebola epidemic is largely being tracked through the commentary of one fortunate Ebola survivor: the physician Kent Brantly, stricken as he himself cared for Ebola sufferers. This disease, which to date has sickened about 7,500 person and killed 3,400 of them, bears some resemblance to another terrifying, contagious, viral disease: smallpox. Pictured here, Edward Jenner in 1770, the English physician and scientist who pioneered the world’s first smallpox vaccine.


During the 1900s, and as recent as the 1970s, smallpox caused some 300–500 million deaths. Unfathomable. Twice the population of the United States rapidly died from pneumonia, respiratory failure, and brain infection. With a mortality rate similar to Ebola, of all those infected 20–60 percent – and over 80 percent of infected children – died from the disease within ten days.


And like Ebola, the progress of controlling the world wide smallpox epidemic in personified through the life of one remarkable man: the physician William Foege. Clearly controlling smallpox was a global effort. But at the helm, Dr. Foege is credited with “devising the global strategy that led to the eradication of small in the late 1970s”.  His book, House on Fire: The Fight to Eradicate Smallpox, documents to the progress of science and public health intervention over a disease responsible indescribable loss for all of human history.


On my upper left I carry a small dark scar. It’s the remnant of my original smallpox vaccination. The dwindling number of people today who even received such a vaccination is testimony to the hope transmitted to us through people like William Foege. Such a vaccine scar is also a message of reassurance that amid today’s epidemics there continues to be well-founded hope.


Reference: Paulson T (March 9, 2006). “Carter hails UW’s shy hero Foege. New building named for health leader is dedicated”. Seattle Post-Intelligencer. Retrieved September 26, 2009.

Surviving Life’s Most Dangerous Day

October 1st, 2014 by Nicholas Comninellis | Comments Off

daily-risk-of-deathWhat is the most dangerous day in a person’s entire life? Perhaps the one when a teenager receives his or her driver’s license, the first big college party event, a rock climbing or back woods vacation? Worldwide data actually demonstrate that the highest risk of death – life’s most dangerous day – is the first 24 hours after birth. Why is this so? Newborns are particularly vulnerable. The transition from mother’s protective environment to the outside world involves drastic changes. One of the most extreme is the necessity to immediately begin breathing air for the very first time. Failure of babies to successfully clear the natural fluid from their lungs and fill them with oxygen within one minute will likely mean death, and for this reason some one million babies die each year.


The bright piece of this challenge is that assisting babies with simply, immediate resuscitation is usually lifesaving. Keeping a baby warm and dry, suctioning away the oral fluids, and providing ventilation when necessary is often all that is needed to see a newborn through the critical transition. In my personal role providing maternal-newborn care in Angola I’ve witnessed first hand how quickly babies in respiratory distress improve with such care, and how rapidly and enthusiastically health care personnel can acquire these skills.


Helping Babies Breathe (HBB)  is an evidence-based educational program to teach basic newborn resuscitation techniques to healthcare leaders who can in turn teach them to birth attendants and midwives in the world’s resource-restricted communities. As part of the global newborn health movement, INMED provides HBB Training though one-day events that can prepare you yourself to help a baby survive life’s most dangerous day.

What Shall Your Conquests Be?

September 26th, 2014 by Nicholas Comninellis | Comments Off

arab-horsemen.jgp“I am Shutruk Nahunte, King of Anshand and Sussa, Sovereign of the land of Elam. I destroyed Sippar, took the sword of Niran-Sin, and brought it back to Elam, where I erected it as an offering to my god.” ~ Shutruk Nahunte, 1158 BC. Regarding this inscription above his classroom door Professor William Hundert in The Emperor’s Club (2002 Movie) comments: “It’s a quote from a virtually unknown king, who speaks of his list of conquests, but speaks nothing about the benefits. This king is unknown in history, because ‘Great ambition and conquest without contribution is without significance.’ What will your contribution be? How will history remember you?”


In popular culture today we honor, reward, and often envy people who succeed in difficult conquests. The nature of their conquests often appears to be of lesser importance than the fact that a great obstacle was confronted and subdued: a battle was won, an elusive discovery was made, a peace was secured. I would offer, however, that conquests differ greatly in their nature and their value. As Professor Hundert affirms, “Conquest without contribution is without significance.”


And so it is imperative that we each singularly consider the enduring value of the challenges were choose to confront. Three questions may help to clarify such value: Would your mother applaud? Would this make your children proud? Would this cause God to smile? In such light, what shall your conquests be?

What Healthcare Field Or Specialty Should You Enter?

September 22nd, 2014 by Nicholas Comninellis | Comments Off

choices-signThis decision is often bewildering. As a young person proceeding through healthcare education you face increasingly complex choices that touch on academic ability, financial debt and earning potential, social pressures, prestige and reputation, non-career interests and responsibilities, and personal passions. You likely have considerable freedom of choice, and with that freedom can come marked anxiety.


My short answer is, choose the field or specialty that most interests you. What do you dream about, think of in your off hours, or imagine yourself doing with pleasure and pride? This may well be your very best selection.


Those of you interested in the world’s most low-resource communities may be under the misconception that only primary care specialties are appropriate in such settings. While it is indeed true that the greatest needs in developing nations are in public health and primary care, there is also an important role for specialists. Physical therapists, ophthalmologists, midwives, orthopedists, pharmacists, plastic surgeons, and researchers, for example, all have unique talents to offer.


Teaching opportunities – generally better suited for more narrow specialists – are constantly expanding and offer influential positions from which to multiply your skills and impact. There also is a real possibility that at some point in your career you will practice among more affluent people. For all these reasons, I believe you will do best in pursuing a field or specialty in which you are genuinely interested.

Should People Of Faith Be Allowed In Global Health?

September 20th, 2014 by Nicholas Comninellis | Comments Off

india-faithShould people of faith be allowed to participate in global health discussions or initiatives? Does not their spiritual orientation create ulterior motives and cause them to take advantage of people in need? How can those that may believe in a supernatural Being or an afterlife be considered respectable, professional colleagues in undertakings of such great importance? Such questions I encounter regularly in my interactions through the Institute for International Medicine, where it is my constant pleasure to interface with people from the entire spectrum of world views.


How many of today’s universities and health care facilities bear names like Jewish, Catholic, Baptist, or Presbyterian? By what sort of citizens were such institutions founded? Who is familiar with the predecessors of global health – individuals like Albert Schweitzer, David Livingston, and Mother Theresa? What was the spiritual orientation of such people? Today, what role does faith play among those who dedicate not just a few days, but year after year of their lives in devotion to the world’s most poor – people like those on staff at INMED Training Sites throughout Asia, Africa, and the Americas?


What do you think? Should people of faith be allowed to participate in global health?

Babies In Dumpsters And A Moral Imperative

September 15th, 2014 by Nicholas Comninellis | Comments Off

children-lookingA disturbing thought, indeed. Marek Banas, a medical student at Lincoln Memorial University, completed his INMED service-learning experience at The Surgery, a general practice clinic in Kampala, capital of Uganda. I find his account to be one of the most compelling of all our students have written…


“The Surgery is potentially the best clinic in Uganda,” she affirms. “People who did not have a conclusive diagnosis came from all over southern the country, as well as neighboring southern African nations to be helped by The Surgery doctors and other staff.” Marek continues, “Patients include wealthy Ugandans, tourists, expatriates… and abandoned infants – who are occasionally brought into The Surgery after being found on the street or in dumpsters.”


Many healthcare professionals are enamored with the possibility of international service. Yet relatively few ultimately sample such an experience or go on to make this a part of their continuing career. In reply to what motivates his, Marek says, “My desire to help the marginalized people springs from a moral imperative I found in myself years ago. I feel I have been lucky in life and it is my responsibility to share my fortune with the forgotten ones.”

Criticism Against Good Samaritans

September 10th, 2014 by Nicholas Comninellis | Comments Off

good-samaritan-modernThe debate surrounding Kent Brantly, the American physician serving in Liberia who became infected with Eboli, is representative of the dilemmas faced by many of us who are lead by good intentions. “Why wasn’t he taking care of his own people back home?” “It’s irresponsible to put himself and his family in such a dangerous place.” “All those resources spent on rescuing him could have been used to assist other people who are not so privileged.” And perhaps the most painful of all, “He really wasn’t doing much good over there anyway.”


You may be personally engaged in any number of virtuous ministries or missions. How do you respond when you receive parallel criticism? First, find comfort in the fact that “No good deed goes unpunished.” It’s a known occupational hazard that those who do good will be regularly criticized. Second, remember that ours is an enormously large world filled with infinite needs. In selecting which ones to particularly intervene we must assess our personal passions and resources. No one else can do this for us, and everyone one else must respect our decisions. And finally, you may be especially heartened as I am by this promise from Matthew 25 beginning in verse 31, “I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me…”


Our Response To Great Evil

September 4th, 2014 by Nicholas Comninellis | Comments Off

Syruan Refugeesnorthern iraqThe horrific recent videos of murders allegedly committed by the Islamic State In Iraq and Syria (ISIS) are deeply disturbing and provocative. They remind me of how very great is the potential for humans to willingly instigate and participate in great evil. As youngsters, the neighbors of these assailants surely could not have imagined them plunging into such reprobate behavior. Similar impressions are recorded by the contemporaries of Hitler, Mao, Stalin, and Ho Chi Minh. We do well to remain vigilant about humankind’s inherent potential for cruelty.


But where evil abounds so does opportunity for great compassion and acts of extraordinary kindness. My treasured friend, Lawand, a US-educated Kurdish attorney living in northern Iraqi, just departed his esteemed position to provide full-time aid to the thousand of refugees fleeing ISIS. Lawand is embodying the assurance documented in 1 Peter 1:4, “Jesus’ divine power has given us everything we need for a godly life through our knowledge of Him who called us by His own glory and goodness. Through these Jesus has given us His very great and precious promises, so that through them you may participate in the divine nature, having escaped the corruption in the world caused by evil desires.” As we witness great evil, both near our homes and abroad, we do well to remain steadfast to overcome great evil with compelling goodness.

Which EMMC Cluster Is Best For You?

September 2nd, 2014 by Nicholas Comninellis | Comments Off

2015-emmc-themeOn behalf of the world’s most disadvantage people, what can you do in ten minutes? What about ten days? What can you do to effectively promote global health in ten months, or even over a period of ten years? The 10th annual, 2015 INMED Exploring Medical Missions Conference (EMMC) theme question is What Can You Do In Ten? This year’s conference will also feature Clusters: sessions that combine brief introduction, hands-on skill development, and practical applications opportunities. You can select from clusters on Pediatric Care, Organizational Action, Mother/Baby Care, Crossing Cultures, Faith with a Mission, Displaced But Not Forgotten, Development Beyond a Band-Aid, Trauma: Life in the Mission Hospital, and My Global Community. Myself, I’ll be leading the International Medicine Cluster. Here we will quickly review leading tropical diseases, practice the logic of differential diagnosis with one another, and then try out our skill with patient actors in simulated settings around the world.


Which EMMC Cluster is best for you? Select those that match your particular skills, whether in nursing, administration, therapy, dentistry, pharmacy, public health or medicine. Or, you can test out new fields beyond your current expertise or experience. Six Cluster opportunities will be available during the event. But please remember that space available for each Cluster is limited, so register very soon, and I will look forward to meeting you on Friday and Saturday, May 29-30, 2015!