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.”

“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.

Global Health Career Decisions: First Select The Ball Park Or The Ball Team?

January 9th, 2015 by Nicholas Comninellis | Comments Off



In other words, as a person launching your international healthcare career is it better to first choose a particular community to serve, and then select from the available partnering organizations? Or vice versa?


I’ve personally taken both approaches. In the 1980s my main objective was a patient care position in China (the ball park). I next approached some universities and development NGOs in that nation (the ball teams), and in the end partnered with the Shanghai Charity Hospital where I served for a year. In the 1990s I formed a close partnership with the IMB (a ball team), who was active in fifty countries, and from their open positions I selected the nation of Angola (a ball park) where I was on site for two years.


Which approach is superior? Each has distinct pros and cons. First selecting your ball park may be best if you possess a strong attraction to a special community or nation – usually based on prior friendships, language skills, or travel experience. First selecting your ball team may be superior if you’re already attachment to that organization or if they have an appealing record of success. Ultimately, either approach is reasonable and prepares you for what’s most important: actually playing the game.

From KU to Hainan – INMED Grads In Action

January 2nd, 2015 by Nicholas Comninellis | Comments Off



His was an intriguing proposal. His was an intriguing proposal. Tim Stephens, a medical student at Kansas University, approached me about a unique learning opportunity in the city of Shenyang, northeastern China. He selected the right mentor, for years earlier I too studied at the Shanghai Charity Hospital. Through the INMED Diploma in International Medicine & Public Health program Tim proceeded to study at the LIGHT Family Medicine Residency in Shenyang. This innovative site provides medical education for Chinese physicians while also serving that city’s most marginalized peoples.


The example ignited Tim’s vision. Subsequently he completed family medicine training in Boston and two years of dedicated Mandarin language school. Today Tim Stephens is a Faculty Physician with the Haikou Municipal Hospital on the island of Hainan, southern China. With a keen vision to multiply his skills, Tim and his Chinese colleagues are forging primary care training for young Chinese. The quality of their endeavor is of such high caliber that the World Bank is drawing upon their expertise. And this all began in 2004 with a student and a dream.

Head Injury And No CT Imaging

December 26th, 2014 by Nicholas Comninellis | Comments Off



“Yet another 9-year old with a coin stuck in the esophagus,” explains Steve Foster, INMED faculty physician in Angola, southern Africa. “I grabbed it with the biopsy forceps, and up came the coin worth maybe 6-7 cents… Then a laconic comment from an ER nurse, ‘Oh, there’s a guy here who can’t talk.’ That led to a story of head trauma in a 32-year old who was clubbed while thieves tried to take his motorbike. The man slipped into coma and his family drove 200 kms where I diagnosed him with a depressed skull fracture… No CT scan available within 500 km radius,” describes Foster. “But there was an obvious depression over middle meningeal artery on the Lt skull. So we operated, drained a diffuse hematoma… Post op the man was moving arms and legs. So will see if he survives.”


What are the values at play in this drama-in-real-life? For one, worth of human life cannot be adequately measured by the value of a coin ingested or a motor vehicle possessed. Another, listen carefully, for subtle culturally appropriate comments maybe extremely important. This scenario also highlights how an attentive history and physical exam may compensate for lack of very useful technologies. Finally, for those people gloomy over their professional routines, opportunities abound for compassion in action, exemplified by outstanding individuals like Steve Foster.

What Is INMED All About?

December 19th, 2014 by Nicholas Comninellis | Comments Off



INMED, in short, is all about equipping healthcare personnel with the skills essential to caring for the world’s most marginalized people. This graphic illustration, created by INMED Chief Programs Officer Elizabeth Burgos, condenses a thousand words into the essential ones. GREAT NEED: In spite of today’s communication and transportation marvels, women commonly perish during childbirth and families often have no safe drinking water. DESIRE TO SERVE: Most health professionals are passionate about caring, especially for people who are disadvantaged. EQUIPPING: the Institute for International Medicine offers innovative global health curriculum plus supervised learning experience with our faculty in twenty-five nations. OUTCOMES: Since 2004 INMED grads are continuing to serve the worlds most forgotten, both in their own nations and in the most isolated locales. It’s what we are all about.

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.