Nicholas Comninellis

“Global Health” or “International Medicine”?

Well-meaning people continually inquire about the terminology associated with global health. Their inquiry is not just hair-splitting. Terminology may be subtlety different, and yet the meanings conveyed be profoundly divergent. And so consider these terms:  global health, international health, international public health, and international medicine.

In common usage,  global health and international health best refer to the overall health status of the people being considered. These people may be wealthy or advantages, or impoverished. Leaders in this field usually focus on the needs of people who are most disadvantaged, for enormous wealth and knowledge benefit the world’s affluent people, while some three billion persons subsist on less than US $2.50 per day. Global health and international health tend to focus on the factors of economics, literacy, education and public policy, in addition to more traditional ‘health’ factors.

International public health and international medicine, by contrast, are fields that focus more on the roles of the disciplines of public health and medicine, and on how these disciplines interface for the benefit of disadvantaged people.

The caution I constantly urge for people in the fields of  international public health and international medicine is that they do not allow their disciple itself to limited the actions or innovations that may be necessary to succeed in the overall goal of health improvement. Hence,  global health or international health should remain the goal of us all, regardless of training or discipline.

From Inspiration To Mobilization

Rapid-fire rifle shots grew closer, echoing from each direction. The cadence of explosions increased, accompanied by shouting just outside in the streets. Inside Dr. Steve Foster, keynote speaker at the 2012 INMED Exploring Medical Missions Conference, and his colleague Darrel Hockersmith barred the metal door and grappled in the darkness for protection from flying shrapnel. Sheltered in a corner they breathed a joint sigh of relief. But this was short lived.

Hammering emanated from the front door, along by the demand “Abra a porta ou vamos matar todo lá dentro!” Foster edged toward entry just as the door burst open. Soldiers shoved inside, very young men carrying weapons as large as themselves. They forced Foster and Hockersmith to the floor. Hovering over their faces with his pistol, the muscular captain pronounced sentence, “You are a Russian spy. The penalty for spying is instant execution!” He pressed his gun closer. “Tell me, Dr. Foster, why are you really in Angola?”

Steve Foster inched upward, made contact with every eye in the room, and addressed them all. “I am actually a surgery resident in Canada at the University of Toronto. But while enjoying every comfort of modern life, I can not but attune my ears to the bloodshed accompanying your civil war here in Africa.”

The stone-faced captain gazed at Dr. Foster in disbelief and demanded, “Tell me who is paying you?”

“No one,” replied Foster, “in fact, it’s my friends and personal savings that finance the medical care I’m providing your people. Earlier today I repaired the landmine injury suffered by a young man,” explained Foster inquisitively. “Perhaps he was your own cousin?”

“This is unbelievable,” replied the captain in a more consolatory tone. He lowered his gun slightly. “Many people have good intentions or contribute a little to a good cause. But what would motivate a person of your stature to take mortal risks to serve in a country of such chaos as Angola?”

Dr. Foster looked on the captain sincerely, “I envision the day when I’ll stand before God and account for my life. How can I say that I chose self-indulgence while other people, no matter how far removed, are struggling to survive?”

Disarmed, the captain motioned to his cadets to exit the house. “I mobilize my men for combat. But you are mobilized for virtue. I shall not trouble you again.”

On June 1st Dr. Steve Foster will address “From Inspiration To Mobilization” at the INMED Exploring Medical Missions Conference. Who is inspiring your life? Which virtue is your theme? For what mission are you mobilizing?

Babies In Dumpsters & A Moral Imperative

Marek Banas, a medical student at Lincoln Memorial University, just returned from her INMED service-learning experience at The Surgery, a general practice clinic in Kampala, capital of Uganda. I find her account one of the most compelling I have ever read.

“The Surgery is potentially the best clinic in Uganda,” she writes. “People who did not have a conclusive diagnosis came from all over Uganda as well as neighboring countries to be helped by The Surgery doctors.”

Marek continues, “Patients included wealthy Ugandans, tourists, expatriates… and abandoned infants - who were on occasion 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 make this a part of their career. In reply to what motivates her, 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.”

INMED Crisis Response Training

The Joplin Tornado of May, 2011 on caught many of us well-intentioned but unprepared to respond effectively. I, for one, felt a deep sense of pain over the catastrophe unfolding just 100 miles a way. But I also realized frustration that at such late notice there was little I could do to assist.

This scenario is becoming more commonplace. In fact, disaster occurrences are on the rise. But so are the number of non-profit organizations, church groups, and civic volunteers who are interested in, even passionate about responding to the needs of disaster victims. For all these reasons Micah Flint, INMED’s Chief Programs Officer, envisioned a series of events to prepare non-government organizations.

First up is INMED Crisis Response Training on March 16. This interdenominational, nondenominational event will equip individuals and volunteer organizations (both medical and non-medical) to apply best practices as they build resilience in their communities and to respond to disaster events. This hands-on training program is designed for participates to learn and then to do.

I am encouraged over the heart-felt anticipation expressed by Crisis Response Training participants. And next time such a disaster strikes close to home, my own sense of frustration should be supplanted by the anticipation of our well planned reaction.

Introducing ACIHE

Today’s citizenry and healthcare profession students are more keenly aware of the needs of marginalized people. I’ve noticed how educational institutions are rapidly developing curriculum and field experiences to match community and student expectations. As a result of such demand, however, health educators are grappling with how to best provide effective, relevant international healthcare training. Frequently cited challenges include:

• Identification of core curriculum and competencies across diverse institutions, accessible resources, and individual expectations
• Development of suitable partnerships with healthcare leaders in low-resource communities for the purposes of learning, service, and research
• Identification of qualified faculty for mentorship roles

For the last months INMED and I have been diligently developing the new Accreditation Council for International Healthcare Education (ACIHE). The intent is both to applaud the value of service to marginalized people and to provide useful guidelines and accountability to institutions developing educational programs for the benefit of such people.

Look in the very near future for ACIHE publications. I want to welcome healthcare educators from across the academic spectrum to join with INMED and I in this worthy endeavor.

You Must Help My Baby Now!

JOPLIN, MO — The warning “Execute Condition Gray!” blared through the halls of St. John’s Regional Medical Center. Personnel per protocol began rolling patients’ beds into the hallways. However, this was no drill. Near the ER’s glass doors Kevin Kikta, an emergency physician on duty, looked up to see a stunned security guard tearing down the corridor shouting, “Take cover! We’re gonna get hit!” Seconds later, on May 23, 2011 the entire nine-story building was pummeled by the tornado. Glass shards exploded from every window, doors blew of hinges, and patients’ IV-lines were ripped from their arms.

“You must help my baby now!” cried Amanda German. Moments after the strike she screeched to a stop at the stricken ER. Dr Kikta examined the child and found a deep chunk of his neck muscle torn away exposing bones in the boy’s spine. “You’re going to be OK, buddy,” Kikta told the boy, applying pressure to his bleeding wound. Then the doctor looked around himself, doubtfully. Rain was pouring in, the lights were out, natural gas sickened the air. Kikta realized a spark could cause the hospital to blow.

The next hours witnessed a massive response that alleviated Dr. Kikta’s worst fears. Missouri Governor Jay Nixon: “The response from Kansas City (the closest metro area) to help the people of Joplin is tremendous. Along side public safety agencies, several faith-based organizations are putting their faith into action.”

The Joplin catastrophe caused more deaths than any tornado in United States history. With disasters due to fire, flood, hurricane, heat, blizzard, and explosion predictably common, public disaster managers increasingly recognize the critical role played by non-government bodies. Regarding Joplin, Richard Serino, the Deputy Administrator of FEMA, noted “84 different volunteer groups served 134,000 meals and gave 275,000 hours of service with 41,000 volunteers. Who organized them? “Not FEMA,” Serino said. “Other volunteer organizations.”

Is your faith-based community or civic organization prepared for the next local disaster? Have you appointed leaders, organized teams, trained your personnel, and pre-arranged necessary equipment and supplies? What steps have you taken to become recognized and welcomed to participate in crisis response?

Anticipatory action is essential. For this reason, INMED is offering a Crisis Response Training event on Friday, March 16 to addresses emergency sheltering, feeding, emotional services, volunteer safety, and more. This opportunity will help your team leap into action when calamity strikes and another mother cries “You have to help my baby now!”

Wisdom and Valor: John Testrake

In 1989 I arrived in Luanda, the capital city of Angola, to begin making good on my commitment to assist the churches in interior city of Huambo as they launched a healthcare project. Those were wild days of civil war: roads littered with landmines, random military attacks on nationals and foreigners alike, wide-spread hunger, and epidemics of cholera and typhoid. Travel to the interior was especially risky. Mission Aviation Fellowship had just stationed a plane in Angola, upon whom so much of our initiative depended. The pilot, an older man, was very warm, competent, and engaging in character. Over several days I discovered that this was John Testrake - the hero of TWA Flight 847, hijacked in 1985 from Athens to Beirut and Algiers.

I was reminded of John recently when I discovered that his grandson is one of the students in my public health class at the University of Missouri-Kansas City School of Medicine.  What is so very striking to me about John Testrake is that he was a man of faith, fulfilling his ‘routine’ duties, when suddenly called upon to lead with wisdom and valor. Whether negotiating with terrorists, traversing the African outback, or confronting any of a myriad of challenges, may you and I do so with wisdom and valor.

Integrity Under Fire

The highlight of my INMED adventure is the exemplary people whom I meet in the course of “equipping healthcare professionals to serve the forgotten.” These include individuals living sacrificial lives in distant nations, students in the US whose enthusiasm for under-served people is truly inspiring, and the exceptional leaders in the INMED office: Micah Flint, Skylar Rolf, and Elizabeth Mowry - people of profound vision and integrity. All these people draw out the very best from within me and make me endeavor to a better man.

But people of vision and integrity are constantly under fire, tempted to compromise or become distracted. From where will we draw courage and conviction? I personally find the account of Daniel’s life to be particularly inspiring, and I trust you will as well:

“Now Daniel so distinguished himself among the administrators and the satraps by his exceptional qualities that the king planned to set him over the whole kingdom. At this, the administrators and the satraps tried to find grounds for charges against Daniel in his conduct of government affairs, but they were unable to do so. They could find no corruption in him, because he was trustworthy and neither corrupt nor negligent.” Daniel 6:3-4

In 2012 may you and I be people of integrity like Daniel!

A Window Into Our Souls

A sobering scene of heaven is described by Jesus in the book of Matthew chapter 25: “All the nations will be gathered before him, and he will separate the people one from another as a shepherd separates the sheep from the goats. He will put the sheep on his right and the goats on his left.

“Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 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.’

“Then the righteous will answer him, ‘Lord, when did we see you hungry, thirsty, stranger, sick, or in prison?’

“The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’

“Then he will say to those on his left, ‘Depart from me… For I was hungry, thirsty, stranger, sick, in prison… and you did not look after me.’

What is Jesus saying about the role of compassion, the spiritual significance of good works, and the window into our souls that is opened through evaluation of our personal actions?

What People Group Is Most Distressed?

In our era of natural disasters, social unrest, and economic turmoil, this question is more than academic. We want our personal lives and our organized efforts to be significant, even virtuous. A first step is to identify with whom to invest our good will, and so the question: What people group is most distressed?

A people group, or ethnic group, is a cluster of individuals whose members identify with each other through a common heritage, language, culture, and/or ideology. Why address people groups and not simply nations? For one, nations contain a broad mix of both advantaged people and disadvantaged ones. Effectively addressing the plight of the latter requires an understanding of their particular culture.

Who is taking advantage of this insight on behalf the worlds’ most poor? Let me introduce you to Doug Blackall. A former professor of pathology at the University of Arkansas for Medical Sciences, I met Doug when he participated in an INMED International Medicine Intensive Course – one that’s now offered each spring, summer, and fall. Doug explained following that training experience, “Because I now better understood the diseases of poverty my naturally hard heart softened a bit, and I was in a much better place to effectively serve those in need.”

Shortly thereafter, Doug and his family moved to the United Arab Emirates, where he today serves at Oasis Hospital. The UAE is known outwardly as a relatively wealthy nation. But like all well-to-do countries, including China from where I’m writing now, the UAE also hosts many foreign workers and people groups of lesser economic status like Iranians, Palestinians, and Jordanians. Such people receive quality care from Doug and his colleagues.

What people group is most distressed? Many are in peril: the Berbers of northern Africa, Kurdish of western Asia, and Miskito of Central America. Observing the lifestyle of Doug Blackall, we may do better to ask ourselves, “What will I do on behalf of people in distress?” and “How can I equip myself for this challenge?” How would you respond to such questions? I invite you to correspond with me on this subject. Please contact me via email to nicholas@inmed.us or via Facebook.