Psychosomatic Symptoms And Solace – Angola Day 10

December 1st, 2016 by Nicholas Comninellis
Posted in 2016 Angola|

dona-maria

 

“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.'”

 

“Something’s Eating At Me” – Angola Day 8

November 29th, 2016 by Nicholas Comninellis
Posted in 2016 Angola|

liver-abscess

 

He started to laugh as he uttered these words to me, but then suddenly cringed with pain. Solomon, a young man, winced and grabbed at his right side. Three days earlier Solomon developed fever, some abdominal cramping, and just a little dysentery. Such illnesses are quite common here in Angola. Solomon drake some traditional tea made by his grandmother and expected to feel better quite soon.

 

Instead, the next day his abdominal discomfort became quite severe. Then came profound weakness and vomiting. Solomon’s family began the 210-mile journey to our city of Lubango, where I first met him in outpatient clinic. Physical examination was rather unremarkable aside from temperature of 38.5 and right upper quadrant pain with hepatomegally. Here at CEML Hospital we keep a portable Sonosite ultrasound unit on standby. The size of a laptop computer, it’s remarkably convenient.

 

The above image shows Solomon’s liver containing an ill-defined, hypodense (black color) lesion. Among all those who provide healthcare in low-resources setting it’s well known that amebic liver abscess is one of the most frequent complications of Entamoeba histolytica infection. Indeed, Solomon’s stool analysis was positive for cysts of the Entamoeba histolytica organism.

 

What’s next in management of this man’s illness? Rather than immediately proceeding to surgical drainage we’ve opted for treatment with metronidazol and monitoring. Tomorrow he’ll undergo another assessment, including ultrasound imaging of the abscess. Hopefully next time he can chuckle and say “Something’s eating at me” without wincing in pain.

 

Higher Level Of Care – Angola Day 6

November 27th, 2016 by Nicholas Comninellis
Posted in 2016 Angola|

ankle

 

Senhor Alfanzo was riding his tiny motor bike in the city of Benguela when he was struck broadside by a truck. His right leg, hit full on, lay fractured with broken femur and tibia bones both protruding through the skin of his thigh and lower leg. A local healthcare facility applied a full leg cast, which nicely stabilized the fractures but also resulted in swelling within that threatened to entirely cut off circulation to his foot. After ten days and still no plan for repairing his fractures, Senhor Alfanzo insisted on transfer to CEML Hospital, where I first met him on Saturday morning.

 

fracture

 

Step one for us was to strategically cut open the cast, which Sari Simonich skillfully accomplished, immediately restoring arterial blood flow to his extremity. Today our surgeons, Annelise Oleson and Ken Foster, evaluated Senhor Alfanzo for surgical repair of these horrendous injuries, and tomorrow he’ll proceed to the operating room.

 

Perspective is especially important. In the days before CEML, people with injuries like these would regularly die from bone infection leading to sepsis. Or, their broken extremities would simply be amputated. Senhor Alfanzo will fare much better.

 

Shattered Leg Made Whole – Angola Day 4

November 25th, 2016 by Nicholas Comninellis
Posted in 2016 Angola|

pedrito

 

Twelve-year old Pedrito was riding on a motorcycle when the driver lost control and sent the boy flying. His leg was found bent at a right angle, and the child was immediately transported to CEML Hospital. Traumatic injuries – especially those of vehicular origin – are among the top causes of both years-of-life lost in developing nations and hospital admissions at CEML. Another frequent CEML Hospital phenomena is patients coming for care whose fractures occurred month or even years before, were never adequately treated, and now require extensive surgical repair and rehabilitation.

 

But Pedrito is particularly blessed by swift action. Annelise Olsen, CEML general surgeon, inserted a rod into his fractured femur, stabilizing the bone. This photo, captured the next day, documents the boy taking his first steps on that leg which just hours before lay shattered.

 

Ultra-Appropriate Technology – Angola Day 2

November 23rd, 2016 by Nicholas Comninellis
Posted in 2016 Angola, Low-Resource Healthcare Pearls, Uncategorized|

sari-ultrasound

 

Senhor Miguel has suffered increasing shortness of breath for one year. When he arrived here at CEML Hospital last week his heart exam revealed a loud systolic murmur, along with swollen legs and signs of fluid in his lungs. The potential causes are myriad, and important to distinguish in order to select the most appropriate treatment for Senhor Miguel.

 

We at CEML Hospital – along with all those committed to providing healthcare in low-resource settings – constantly struggle to find a balance between the need for useful medical information and the ability to access it over the long-term.

 

Today Sari Simonich, ER nurse from Hawaii, is making ready use of ultrasound to examine Senhor Miguel’s heart, confirming the cause of heart failure, and guiding us toward more effective treatment. Fast, inexpensive, reliable, and rather easily interpreted, ultrasound is one of the most exemplary appropriate technologies for low-income health centers. INMED is offering three Ultrasound for Primary Care Courses during the upcoming four months to better equip professionals like Sari to provide a breath of fresh air to those in need like Senhor Miguel.

 

Africa Again? Why? – Angola Day 1

November 22nd, 2016 by Nicholas Comninellis
Posted in 2016 Angola|

entrance

 

“Why do you keep going back to Angola? The visa is almost unobtainable, the journey brutal and expensive, and working conditions backwards at best. What’s more, they don’t pay you. In fact, you pay for the privilege of sweating it out!” After two year living in Angola and thirteen annual visits, such questions and protests are regular.

 

In response I could cite facts: Angola is among the world’s ten poorest nations. Life expectancy is only about 44, making grandparent-grandchild relations the exception. Angola is also just emerging from a full 42 years of war. But such facts rarely impress.

 

What does both motive my soul and convince my detractors is the accounts of my relationships with Angolan people: the military officer’s reassurance that his men were protecting me; the patient who lost his leg and was nevertheless grateful for his life; the blind woman who’s cataract surgery failed but who’s spirit remained buoyant. These are the most compelling reasons I’m in Africa again.

 

Haiti Launches World’s Largest-Ever Emergency Cholera Vaccination

November 18th, 2016 by Nicholas Comninellis
Posted in Disaster Management|

haiti-hurricane

 

We all recall the devastating cholera epidemic that swept through Port-au-Prince following Haiti’s 2011 earthquake. Whenever urban centers are disrupted the risk of cholera, causing rapid death via dehydration, is predictably high. So, it is laudable that now, just one month following Hurricane Matthew, history’s largest-ever emergency cholera vaccination is underway with the goal of protecting about one-million Haitians displaced by the storm.

 

“Vaccination is complementary to other preventive measures,” says Jean Luc Poncelet of the Pan American Health Organization (PAHO), quite appropriately adding that, “Each person must be a leader of change: daily chlorination of water in the house, drinking potable water, rehydration if there is diarrhea, and seeking treatment.”

 

All of us concerned with health in developing communities realize the importance of both water provision and of water-borne infections. What is taking place in Haiti at this moment is a case study of immense implications for future prevention and response to future catastrophes. All eyes on Haiti, please.

 

INMED’s 27th International Medicine And Public Health Course: 2016 Kirksville MO

November 11th, 2016 by Nicholas Comninellis
Posted in Healthcare Education|

2016-kirksville-mo-imph-hybrid-course-graduates-560

 

I just enjoyed a terrific weekend with these 21 medical students at AT Still University/Kirksville College of Osteopathic Medicine. Ten weeks ago they began a structured, aggressive study of paramount global health issues, including the impact of military conflict, today’s mushrooming refugee crisis, and the perils and privileges of launching their own international healthcare careers.

 

Following this heavy diet of cognitive information consumption and issues digestion, we meet in person for two days of intensive exercise: medicine and public health exams, a poverty meal, skills workshops in wound care, complicated obstetrics, newborn resuscitation, and disaster management and community health survey simulations.

 

What’s next for these remarkably bright and motivated healthcare learners? Such an intense learning experience is best soon followed by real-life experience. INMED makes this available through our Diploma offerings in International Medicine (DIMPH) & International Public Health (DIPH), which includes an international service-learning experience at an INMED Training Site in one of 25 nations. Watch out for inspiring individuals like these INMED grads, sharing hope and skill among our world’s most humble people.

 

Two INMED Faculty Nominated For L’Chaim Prize

November 4th, 2016 by Nicholas Comninellis
Posted in INMED Training Sites In Action|

lchaim-prize

 

“Christian medical missionaries are the unsung and unheralded heroes of humanity —so we had the idea to create the Rabbi Erica and Mark Gerson L’Chaim Prize. L’Chaim means “to life” — and it is this gift that the Christian medical missionaries serving in Africa provide to so many… To learn about the work of Christian medical missionaries is to enlarge the understanding of what a single human being can accomplish.” In so saying, the African Mission Healthcare Foundation announces the $500,000 prize, an annual award for Outstanding Christian Medical Missionary Service–the largest-ever in clinical patient care. This historic prize, was inspired by the response to a New York Times column illuminating Christian medical missionary service in Kenya.

 

The four L’Chaim Prize finalists include Steve Foster, top right photo, and John Spurrier, bottom right. Steve Foster, a Canadian general surgeon, has lived in Angola since 1975 and supervised seven INMED learners at CEML Hospital. One of his earlier mentees was INMED’s founder and CEO, Nicholas Comninellis. John Spurrier has served with Brethren in Christ in rural Zambia at Macha Mission Hospital, also since 1975. Fifteen INMED graduates to date have been blessed by his direct influence.

 

Theirs is career path predictably marked by overwhelming demands, meager resources, constant stress and fatigue, austere living, and remarkable family and personal health challenges. Whom do you know of a character similar to Foster and Spurrier? Please join me in offering a thoughtful word of encouragement to all individuals who are similarly engaged.

 

Happening Now: The World’s Largest Ever Refugee Exodus

October 28th, 2016 by Nicholas Comninellis
Posted in Disaster Management, Global Health News & Inspiration, International Public Health|

mosul-refugees

 

Seven-year old Ariya, photographed here with her mother and siblings, fled the outskirts of Mosul last week as Kurdish and Iraqi military forces advanced to retake that city from ISIS. Ariya joins the over 3.3 million Iraqis displaced by the conflict – not counting the innumerable Syrians. Where will Ariya find refuge? Anticipating mass exodus from Mosul, UNHCR pre-positioned new 5 camps to provide care for 60,000 IDPs – Internally Displaced Persons. UN personnel close to INMED report, “We are ensuring that people reaching camps are accommodated with sufficient shelter, water, sanitation, health and protection.”

 

But the compelling question is capacity. Desperate families daily arrive at Iraqi UNHCR camps by the hundreds, and Mosul has still yet to be penetrated by fighters. Once that occurs, aid workers expect the exodus to mushroom to thousands of families each day – as many a one million in a matter of weeks.

 

Please join in the INMED Humanitarian Health Conference on March 24-25, when Lawand Talal of UNHCR gives the opening address. In the meantime, Samaritans Purse is one of several quality relief organizations providing care for Mosul refugees just like Ariya. Your gift will be graciously received, as we all remember the ancient imperative of Leviticus 19:33-34 made to the once-enslaved Hebrews: “When a foreigner resides among you in your land, do not mistreat them. The foreigner residing among you must be treated as your native-born. Love them as yourself, for you were foreigners in Egypt. I am the Lord your God.”