Ebola Fighters Stride Out In Front

December 12th, 2014 by Nicholas Comninellis | Comments Off



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 Nicholas Comninellis | Comments Off



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 Nicholas Comninellis | Comments Off



One 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.

Publicity And Perspectives

November 22nd, 2014 by Nicholas Comninellis | Comments Off



Publicity is a powerful molder of perspectives. This compelling image by André Carrilho – intended to illustrate the racial nature of concern surrounding Ebola – communicates both negative and positive messages. From a negative perspective, some diseases causing profound suffering do not receive worldwide media attention until those in wealthy nations are infected. HIV, polio, and now Ebola are examples. While this fact can be used as evidence of racism or nationalism, it is also true that wealthier nations in response have mobilized massive resources to combat these diseases, both on their own soil and in remote corners of the globe. No matter how well intended, such mobilization could never be realized by the low-resource nations themselves who first felt the painful stings of HIV, polio, and Ebola.


From a positive perspective, publicity over the plight of economically depressed people has repeatedly tugged at the hearts of thousands of well-resourced individuals. They respond by giving, by going, by generously offering themselves – often with little heed to potential adverse consequences. Richard Randolph, INMED Intensive Course Graduate and US military physician, provided healthcare among Syrians fleeing the conflict in their motherland. Last month he also announced, “I am going to Liberia – Yes, I know that is one of the countries that is effected by Ebola. That is why I am going.” How did Dr. Randolph know? The power of publicity, molded by his own very healthy perspective.

From Training To Tanzania

November 15th, 2014 by Nicholas Comninellis | Comments Off



“I had a vision for medical ministry in Tanzania,” says emergency medicine physician Danny Smelser. “Years ago, my ideas were bold and my heart filled with excitement and compassion. What was lacking was a road map to mature development of Tanzania Christian Clinic – TCC. That’s why I sought out INMED.” I first met in 2010 when he participated in the INMED International Medicine & Public Health Intensive Course, and then again in Louisville last week. During those course weeks Dr. Smelser and his classmates tacked the entire spectrum of low-resource, cross-cultural healthcare, from managing tropical fever to massaging relationships with national staff and civic leaders.


Today TCC, under Dr. Smelser’s guidance, offers expanding care for people of Monduli district, many of whom suffer from malaria, typhoid, schistosomiasis, tuberculosis, and severe dysentery. HIV-AIDS is prevalent, as are eye maladies. Danny Smelser describes the heart of the matter: “Like the Great Physician, TCC aims to minister to heart, soul, mind, and body. The typical history and physical at TCC includes a spiritual health component, and health care is administered to all patients without regard to their particular religious beliefs. Spiritual counseling and chaplain services are offered to all who express interest.” All this started with a vision, and we at INMED were privileged to help sharpen that focus.



Ebola For All Time

November 8th, 2014 by Nicholas Comninellis | Comments Off



Forecasts for potential deaths from Ebola are disturbing. But equally heartening are today’s expanded interventions. Very likely in the coming months this present epidemic will subside. But what should we retain from this Ebola experience to endure for all ages?


• Health and poverty are intimately connected. Ebola is just one of many deadly diseases that afflict people living under economic deprivation. Jobs, literacy, and community development are essential for limiting the risk of disease.
• Low-resource healthcare systems can quickly become overwhelmed. Whether from epidemic measles, dysentery, malaria, or one hundred other illnesses, health centers with marginal staff, diagnostic capability, or therapeutics are easily stretched beyond capacity.
• Disease prodrom are often indistinguishable. Initial fever, fatigue, and body aches may herald dozens of diseases. Only advanced technology can provide diagnostic testing to differential one from another in the early stages.
• Crisis breeds innovation. Development of such diagnostic tests and new treatment modalities that normally demand years can be fast tracked when calamity threatens.
• Response to epidemics requires expertise, manpower, and organizational leadership. Provision of field hospitals and medical supplies are useless without skilled people to apply the appropriate knowledge and resources. This is where the INMED, with our educational mission, is particularly relevant.


Finally, what is the most significant, enduring lesson we can reap from Ebola 2014? Consider this: Humans have potential to exercise great kindness, even at great risk to themselves. Working in the heart of today’s epidemic, thousands of healthy, deeply motivated people are at this moment demonstrating compelling compassion in action.

Are You Thankful? Are You Giving?

October 31st, 2014 by Nicholas Comninellis | Comments Off



Thanks and giving. The union is a powerful combination. Do you have thanks for the advantages you receive? Perhaps education, good health, encouraging friendships, a little financial margin. Recently have you told those in your circle of your gratefulness? Expressing appreciation is excellent for the health of any relationship. And whether earned or undeserved, it is also extremely good for your own emotion and physical well-being. Taking a further step, are you thankful for the challenges before you? Opposition and trials have potential to bring out and to solidify your most virtuous qualities.


Are you giving from out of your resources, no matter how humble? Virtually everyone has a some capital, whether time, talents, or treasure. Effectively sharing with others can alleviate suffering, prolong lives, cultivate trust, and restore hope on their behalf. But giving, especially in secret, also profoundly benefits the giver, cultivating humility, gratitude, and kindness. It is a powerful means of personal development; a cure for vanity, pride, and selfishness.


At INMED I daily enjoy the privilege of witnessing thanks and giving in action. Hannah Bolar is an undergraduate nursing student at Kentucky Christian University. This summer she earned the INMED Diploma in International Public Health, training at Mushili Health Center in Zambia. Of thanks and giving, Hannah writes, “I am personally motivated to promote health with these people through the realization that I have been blessed to receive an education. With this knowledge also comes my sense of responsibility and motivation to use it to help others, especially those who are disadvantaged. So in Zambia, whether screening children for malaria, or dispensing medications, or helping out young mothers with their newborn, it was all amid a deep appreciation.”


Do you have thanks? Are you giving? Sometimes thanks, and especially giving, requires a little outside assist. INMED Diploma programs like the one of which Hannah took advantage, are designed to pair you with excellent role models in settings of compassion, learning, and humanitarian service – ideal for growing heartfelt and deeply meaningful thanksgiving.


Polio vs Ebola

October 24th, 2014 by Nicholas Comninellis | Comments Off



Yesterday was Rotary’s World Polio Day, and the temptation to draw a comparison with Ebola is compelling. Both diseases at times sparked intensive public fear: polio in the 1950s and 1960s; Ebola only recently. Both diseases are killers; polio about 250 so far in 2014 (some 10,000 in 1960); Ebola about 4,000. Both diseases are linked to extreme poverty: polio currently resides in Afghanistan, Nigeria and Pakistan; Ebola in the West Africa nations of Guinea, Liberia and Sierra Leone. Both are deadly: polio killing about 15 percent of victims and Ebola some 40-50 percent. Both diseases have mobilized enormous international resources and cost the lives on people giving front-lines care. In March 2014, thirty-five health workers providing polio vaccination were tragically murdered in Pakistan by militants objecting to their efforts.


Polio and Ebola are also divergent in important ways. Polio is easily transmitted from person to person by contact with human waste and oral ingestion. Victims are often quite removed from the person carrying infection. Ebola, by contrast, requires intimate contact with bodily fluid and only those in very close proximity are at risk. Polio prevention is well-studied and vaccination effectiveness well-documented. Ebola prevention, by comparison, is in its infancy.


In the Polio vs Ebola analysis the most glaring contrast of all is that today it is well within our capability to eliminate polio, as decades of Rotary and WHO efforts demonstrate. An effective Ebola vaccine, or alternative prophylactic, will be years in development. In Polio vs Ebola the most relevant question is Will we take advantage of the technology we already possess to obliterate a disease we already know very well?

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



The 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.