Defending People Most Vulnerable

March 27th, 2015 by Nicholas Comninellis | Comments Off



“We in healthcare experience the unique opportunity of meeting, even defending, people when they are most ill, most distressed, most vulnerable.” Chris Deuel is a resident physician and currently a student in the INMED International Medicine & Public Health Hybrid Course, photoed here on the left. He appealed to his twenty-five classmates, “If we do not make ourselves available for these patients, we are missing a great opportunity to genuinely care for them when they may need care the very most.” Chris Deuel’s perspective is heartening, particularly in an era when clinicians feel suffocating pressure to shorten patient visits and thus bill more patient encounters.


“The time spent talking with patients and building trust,” Chris Deuel continued, “not only can allay their fears. If our patient genuinely trust us they will be more likely to be following with the treatment plan and to be motivated to take personal steps to improve their health.” Observing Chris’ sincerity reaffirms for me the conviction that INMED students are some of the world’s most compelling, skilled, and inspired individuals.

Nurse Anesthetist From INMED To Angola

March 20th, 2015 by Nicholas Comninellis | Comments Off



“God is always doing 10,000 things in your life, and you may be aware of just three of them.” April Hall, a graduate of Raleigh School of Nurse Anesthesia, quotes this statement by John Piper to illustrate the phenomena of her journey toward life in Angola. I first met April five years ago when she joined forty-three classmates for the 2010 Kansas City INMED International Medicine & Public Health Intensive Course. She anticipated I would be the only Angola connection. April was both surprised and encouraged to find three other students with commitment to this southern African nation.




Skilled surgical care requires more than a skilled surgeon. At least one other proficient professional must watch over the wellbeing of the patient. Steve Foster, Angola’s most renowned surgeon, is now complemented by April Hall, newest among Angola’s tiny cadre of anesthetists. She and her family anticipated that life in Angola might be isolated and melancholy, but through growing friendships and preserving lives they’ve discovered just the opposite. Says April, “I find such comfort in these words: ‘I have come into the world as light, so that whoever believes in me may not remain in darkness.’ Christ indeed shines in the darkness. He provides comfort for the shattered. He gives peace to the hopeless.” Indeed, God may be doing 10,000 things in your own life. What a joy to occasionally be aware of them.

A Little Respect for Doctor Foster

March 13th, 2015 by Nicholas Comninellis | Comments Off



“The next time you hear someone at a cocktail party mock evangelicals, think of Dr. Foster and those like him. These are folks who don’t so much proclaim the gospel as live it. They deserve better.” New York Times op-ed columnist Nicholas Kristof posted his findings this month in an article titled  A Little Respect for Doctor Foster. On a visit to Angola, the nation home to the world’s highest child death rate, Kristof interviewed INMED faculty Steve Foster at the Lubango Evangelical Medical Center. Foster, who moved to Angola in 1978, was my primary mentor when I lived there in the 1990s.


Nicholas Kristof continues, “Yet the liberal caricature of evangelicals is incomplete and unfair. I have little in common, politically or theologically, with evangelicals or, while I’m at it, conservative Roman Catholics. But I’ve been truly awed by those I’ve seen in so many remote places, combating illiteracy and warlords, famine and disease, humbly struggling to do the Lord’s work as they see it, and it is offensive to see good people derided.” We are INMED are privileged to match our student with mentors of such stature in Africa and throughout the world.

Women’s Birth-Related Disabilities

March 6th, 2015 by Nicholas Comninellis | Comments Off



Child birth is both beautiful and dangerous. Well known and still tragically common are the direct causes of maternal deaths: hemorrhage, infections, obstructed labor, and hypertensive disorders in pregnancy. But there also exist birth-related disabilities; ones not causing death near the time of delivery, but leading to extended incapacity and suffering not only for women themselves but also their children and families.


What are these disabilities? HIV/AIDS, for one, disproportionately impacts women of childbearing age. The 2013 UNAIDS Report documents that worldwide for women in their reproductive years (15–49), HIV/AIDS is the leading cause of death. Another is obstetrical fistula, leaving women incontinent of urine or feces or both, results from prolonged, obstructed labor. Some 1 million women live with obstetrical fistula, with fewer than two out of one hundred ever being treated. The most horrific birth-related disabilities is female genital mutilation/cutting; gruesome procedures sometimes referred to as female circumcision that result in infertility, recurrent urinary tract infections, and increased risk for childbirth complications.


What can we do prevent such women’s birth-related disabilities? Inclusion of this theme in women’s health forums is an important step, since these remain largely unrecognized. Support for targeted women’s health organizations, like Fistula Foundation and 28 Too Many, can link us with global movements. And supervised service-learning experiences, like those offered through the INMED Diploma programs, provide real-life application opportunities to intervene on behalf of women at risk.

EMMC Then Onward To Asia

February 27th, 2015 by Nicholas Comninellis | Comments Off



“Three years ago I participated in the Exploring Medical Missions Conference (EMMC)” says James Fyffe, an Emergency Department nurse at North Kansas City Hospital. “There I met influential staff from Bach Christian Hospital in Asia. They invited me to come visit, and soon I was on location with them in the mountains.” Last week James, with his wife Rosie and their boys, took the next step, boldly moving their home to the mountains of Asia. Theirs is a career devotion to serve at Bach Christian Hospital, with James taking a lead teaching at the school for national nurses.


James’ experience at the Exploring Medical Missions Conference is increasingly common. People come with curiosity, meet stimulating individuals, develop a vision, and climb upward through inspiring commitments. This cycle can even begin to repeat itself. “A little compassion goes a long way,” says James, “like a light illuminating a dark hill. It’s not just about the people whom you touch directly, but also those who become inspired by your example.”

Helping Babies Breathe In Zambia

February 20th, 2015 by Nicholas Comninellis | Comments Off



“Experiencing Zambia really changed my life!” Betsy Rogers is animated on her return after three weeks teaching Helping Babies Breathe (HBB) in southern Africa in association with Tiny People Matter. “We taught HBB in several settings. My favorite experience was teaching outside under trees with a slight breeze blowing, to village birth attendants for whom translation was needed. We also had opportunities to facilitate the course to a number of healthcare professionals and support staff at hospitals, clinics and orphanages.”


Betsy Rogers took advantage of the Helping Babies Breathe course offered by Cindy Obenhaus at INMED in 2014. “Next up, we are going to Central Vietnam, Quang Tri Province. Our group of four nurses partners with Global Community Service Foundation who has organized the logistics of the Vietnam HBB classes, including transporting birth attendants from faraway rural areas, translators, etc. We will be providing the booklets and flipcharts in Vietnamese, as well as the baby manikins for teaching. It is great that the learners will be practicing birth attendants who really can benefit from this education and equipment. So we are applying our HBB knowledge gained from INMED. I am so glad that you offer this class.”

Mid-Career & Where Do I Go From Here?

February 13th, 2015 by Nicholas Comninellis | Comments Off



You overcame the odds against you. For years you focused on education and service, and have excelled in your profession. And now you may be enjoying the blessings of mid-career: financial reserve, respect among your peers, children who are thriving and departing the nest. You are mid-career and pondering where to go from here. It’s an uncertainty frequently voiced to us at INMED.


Simply continuing to expand your income is an option, though one that’s not often satisfying. In 2010, Kahneman and Deaton documented that higher income earners usually report higher life satisfaction. However, that satisfaction only rose with earnings up to a threshold annual income of $75,000.1 What correlates with happiness beyond that point? They found the answer lies in personal freedom, meaningful work, and deepening relationships.


Oscar Paulo is one remarkable example of such satisfaction in action. Recipient of the 2014 INMED National Healthcare Service Award, he initially served as medical officer for the United States Embassy in Angola, southern Africa. Now in his fifties and enjoying relative mid-career flexibility, Dr. Paulo founded a medical clinic caring for the disadvantaged in the suburbs of Angola’s capital city. But his vision is greater than what he alone can accomplish. Recognizing the shortage of trained healthcare personnel, Dr. Paulo recently established a scholarship program to select and train Angolan medical students, personally mentoring them in professional, spiritual, and personal life skills required for this nation’s unique challenges. Says Oscar Paulo, “My model for prosperity is expressed in 1 Timothy chapter 6, ‘Godliness with contentment is great gain… But if we have food and clothing, we will be content with that…But you, pursue righteousness, godliness, faith, love, and endurance.’”


Personal freedom, meaningful work, and deepening relationships have many potential expressions. For those committed to healthcare advocacy for marginalized people, INMED offers a strategic launch: ACIHE accredited Diploma programs in both International Public Health and International Medicine & Public Health. These combine core knowledge with a supervised service learning experience with faculty like Dr. Paulo at INMED Training Sites available in twenty-five nations. Do you already have significant experience? INMED offers an Equivalency process to recognize your skills.


Mid-career and pondering where to go from here? Take advantage of your flexibility and resources by making an investment of your time in an underserved community.


1. Holmes, Bob (7 September 2010). “Money can buy you happiness – up to a point.” New Scientist. Retrieved 04 June 2014.

“Baby Gender Selection – Safe And Natural”

February 6th, 2015 by Nicholas Comninellis | Comments Off



This promotional line from The Birth Planning Centre is representative of an entire industry built around the desire to birth children of a particular sex, usually male, and a particular genetic makeup, usually flawless. Gender biased sex selection is pursued on the premise that any deviation from the desire will result in killing that particular baby. This practice  is especially common in Asia, where it is also absolutely illegal. But the desire for profit making causes powers at multiple level to look aside.


In a heartening and unprecedented social transformation – one in contradistinction to Choose The Sex Of Your Baby – Chinese are increasingly fostering formerly abandoned children. The state orphanages which were once filled primarily with girls, babies with birth defects, and genetic disorders like Down’s, are progressively less populated today, as Chinese citizens take advantage of these new opportunities to provide a loving home – especially for babies who are female and less than flawless.

What Is Causing My Fever Here In China?

January 30th, 2015 by Nicholas Comninellis | Comments Off



Yesterday I was mentoring these Chinese family medicine resident physicians. During my presentation I suddenly sensed a shaking chill. The weather is extremely cold here in Shenyang, far NE China – about -10 degrees. So I attributed my chill to the walk outside. But then I was struck once more by that bone-rattling sensation, followed by extreme fatigue. Not wanting to miss this teachable moment before I departed, I quizzed the residents about causes of acute fever in China. These are similar to the US: upper respiratory viral infection, strep throat, influenza. But China also has some unique causes: dengue, Japanese encephalitis, epidemic meningitis – uncommon but everyone here is vaccinated, except me.




What would you teach these healthcare people about evaluation of people with acute fever? I emphasized to them, as I do to all INMED International Medicine & Public Health students, the prime importance of first considering the local fever etiologies wherever you may be serving. I related how last July I suffered a similar febrile illness with identical chills and fatigue. But at that time I was working in Angola, southern Africa. Observe the map above. Malaria is rare in China, and very common in central and southern Africa. My malaria test was indeed positive. I was treated and recovered quickly. Tonight in Shenyang I’m nurturing my fever, confident that at the very least my residents benefited from a very teachable moment.

China: Sustainable Healthcare For The Poor

January 16th, 2015 by Nicholas Comninellis | Comments Off



This daunting challenge is at the forefront of most every healthcare forum, and as it should be. Essential healthcare services, like influenza vaccination and hypertension management, clearly improve life and longevity for relatively low cost. But over the long term, even these costs must be reimbursed. What are the alternatives? One is funding though taxation; well-proven but burdened with bureaucracy and inefficiencies. Another is charitable donation; also well-proven but fluctuates with societal sentiments. A third more innovative alternative is parallel profit-making ventures by health service organizations that in turn supports care for those who cannot pay full price. And finally, perhaps the most ingenious and complex of all: equipping the poor to rise themselves out of their poverty.


In my role with INMED leadership I’m privileged to witness such funding alternatives in action. Here in Shenyang, northeastern China, from where I’m writing today, the LIGHT Family Medicine Residency Program is fully engaged in providing charitable healthcare for retirees, orphans, students, and disabled persons. How to they fund such exemplary kindness? Largely through quality, full-cost care provided to those who can pay – most often employees of larger corporations.


Does there exist an ideal business model for sustainable health services for those who are poor? I think not. Each of the above is accompanied by numerous pros and cons. But we must applaud and encourage innovative approaches that promised to shed light on this foreboding but worthy challenge.