Children Of The Atomic Bomb

August 11th, 2017 by Nicholas Comninellis
Posted in International Public Health|


“An explosion so terrible, a flash so blindingly bright, I thought the world had ended,” expressed Shin’s father. “Then, just a quickly, everything went black.” 3-year-old Shin was missing. Father frantically searched for him among the wreckage and found Shin pinned under a house beam, badly hurt. “His face was bleeding and swollen… Everyone was burned, and they were crying moaning and screaming for water… All around, people were dying when they drank water,” Shin’s father said. “So, I didn’t dare give him any.” Shin did not survive the night. ~ except from “Shin’s Tricycle.


How many little Shins died in Hiroshima? Research indicates that 70,000–126,000 civilians died along with 20,000 soldiers. In other words, 4 to 7 non-combatants like 3-year-old Shin died for every Japanese soldier lost. Such has been the tragedy ever since, with children, mothers, and the elderly bearing most of the indescribable pain of modern warfare.


Today the United States nuclear capability is some 2,400  megatons – equaling Hiroshima x 159,000 – and along with eight other countries the world now possess 14,900 nuclear weapons. What does this say about today’s threat towards children like Shin, towards the one-year old playing right now on my lap?


INMED Helping Babies Breathe Saves a Life In Uganda

August 4th, 2017 by Nicholas Comninellis
Posted in INMED Grads In Action|


“A laboring mother had pre-eclampsia and the midwives called saying that the fetal strip didn’t look good.” INMED Diploma candidate Isaac Billings pulled on his shoes, and ran to the maternity ward where his attending, recognizing the emergency, rapidly performed a C-section.


Isaac continues, “It was quickly obvious that the baby was in need of resuscitation. He was limp, with no respiratory effort, and had cyanosis. I quickly clamped and cut the umbilical cord, and handed the baby to the Nurse with the towel. The nurse, however, was new and did not have experience with newborn resuscitation. She and her assistant were struggling.


“Remembering my recent training in the INMED Helping Babies Breathe Course, began by quickly and vigorously drying and stimulate him with a towel. There was still no respiratory effort. Setting the wet towel aside, I began to ventilate with the bag-valve-mask. The nurse anesthetist came over and soon confirmed that the baby’s pulse was greater than 100. After about 90 more seconds total of ventilating, the baby began a weak cry and started to breath on his own. Five minutes later, he was pink with an APGAR score of 8 out of 10. The baby went on to two days in the NICU, but was ultimately discharged healthy to a smiling mother.”


You Too Can Join Us – Angola Day 30

July 30th, 2017 by Nicholas Comninellis
Posted in 2017 Angola|


Departing Angola today I’m mostly impressed with the opportunities. CEML Hospital, and its affiliate Kalukembe Hospital, have years of solid experience providing care to the least of these. One bold step forward is to multiply the number of Angolans with similar vision and skills. Here’s where you can be a blessing.


Seriously consider coming to join us. Come with a spirit of flexibility, of learning, of serving, and of very tactfully sharing your own insights and expertise. Angola is a difficult environment, but not the most difficult. Many internationals before you have successfully adapted.


INMED has a tract for service-learning in Angola via our Diploma in International Medicine & Public Health. Alternatively, and especially if you are not a healthcare professional, volunteering directly through CEML Hospital is also encouraged. Come sample Angola for two weeks. If you travel in July 2018 I’ll enjoy the experience with you!


Breaking Disease Stereotypes – Angola Day 28

July 28th, 2017 by Nicholas Comninellis
Posted in 2017 Angola|


Little Avelino arrived today with his father, who explained how this four-year old has coughed constantly for 2 weeks. They visited a health post and were prescribed a cocktail of antibiotics. But when no improvement resulted, the family took a minivan taxi some eight hours to CEML Hospital. On my exam, Avelino had retraction of his chest muscles indicating difficulty breathing, and breath sound indicative of rather straightforward asthma. We don’t have the luxury of inhalers here in Angola, except at exorbitant cost, so I recommended 1960s-style medications. These have more adverse effects, but are still effective. Within a couple of hours Avelino was breathing fine.


Asthma – an exotic tropical disease? No quite. Actually, more of the health problems encountered in southern Africa are not exotic, perhaps not even infectious. Hypertension, stroke, heart disease, emphysema, hepatitis, and a host of injuries are found throughout the world. We with concern about limited-resource, cross-cultural healthcare do well to focus on developing mainstream health service which provide care for asthma, for example. And next we must address those unique, albeit often less frequent, diseases of poverty found in our communities. Both of these objectives are addressed in the INMED International Medicine & Public Health Course that I’m privileged to oversee. Let’s assist many more children like Avelino to breathe more easily.


From One To One Hundred – Angola Day 26

July 26th, 2017 by Nicholas Comninellis
Posted in 2017 Angola|


Photoed here are some of the thirty-five nurse practitioners who staff the rural health centers surrounding Kalukembe Hospital. Twice each year they converge for two days of continuing education. I enjoyed the opportunity to lead eight hours of workshops on how to promote economic development and literacy, since these are so very essential to physical health. I also lead them through management of simulated cases of tropical fever, acute abdomen, orthopedic trauma, and postpartum bleeding.


When I first came to Angola in the 1990s my approach was to care for as many people myself as I reasonably could. That emphasis lasted about six months, when I finally realized in my heart that progress in this nation required hundreds of people like myself. So I changed my approach to multiplying skill capacity, to sharing my vision and skills with talented Angolans who themselves would carry on the mission. Now, this vision is not valued by myself alone. Insightful Angolans, like Antonio Salamão whom I described in my most recent post, also  embrace this vision. What a joy to be part of this multiplication from one to one hundred.


Innovators Of Africa – Angola Day 24

July 24th, 2017 by Nicholas Comninellis
Posted in 2017 Angola|


Innovative and vulnerable – these are the children of Africa. Walking from home to clinic today, I met these boys touting their homemade airplanes. One is a King Air, followed by a Cessna Caravan – fine replicas of the aircraft that land on our dirt runway. The models include even spinning propellers and wheels. Innovative indeed! Toys created by children with no tools other than keen minds and observant skills are a testimony to the inner character of these youth.


But vulnerable they are, as well. Angolan children have among the highest mortality in the world. About one quarter will die before starting primary school. Malaria, pneumonia, diarrhea, TB and measles are the killers in this nation that spends on average $70 per person each year on healthcare, vs $10,345 per person in the United States. What can be done to protect these Innovators of Africa?


Choosing A Career In The Bush – Angola Day 22

July 22nd, 2017 by Nicholas Comninellis
Posted in 2017 Angola|


By Angolan standards, he was blessed indeed. While still a young man, Antonio mastered English and graduated from the Liverpool School of Tropical Medicine & Hygiene. But rather than succumb to the allure of privilege, Antonio Salamão chose to serve out his career at Kalukembe Hospital. This rural medical center provides care for some half-million extremely low-income people – mostly subsistence framers. Kalukembe has 130 inpatient beds, delivers 100 babies each month – and has no running water or functioning telephones.


I first met Antonio Salamão three decades ago when I arrived at Kalukembe for a six-month orientation to Angolan medical care. He walked me through the paces of African community health, of managing pediatric diseases amid very limited resources, and how to apply ultrasound technology to unique tropical syndromes. This week I enjoyed two days together with Antonio at Kalukembe, marveling at his continued bright spirit and virtuous persistence to serve out his career in the bush.


Surgeon With ‘Style’ – Angola Day 20

July 20th, 2017 by Nicholas Comninellis
Posted in 2017 Angola|


Annelise Olsen, CEML‘s youngest general surgeon, expresses an inspiring persona. She embraces style, whether in clothing, cooking or lively conversation. Annelise embodies medical excellence, devoting her judgment and procedures to our patient’s best welfare. And she advocates for the global health virtue of sustainability: giving our willing learners ample opportunity to develop their own skills under her keen supervision. I speak from experience. It was she who taught me the procedure for suprapublic prostatectomy.


I first met Annelise a few years back when she came to CEML as a resident physician. Like many considering a career serving disadvantaged people, this early experience was formative. Annelise’s skill in Portuguese and eager learning orientation were clear. Later, she returned as a Post-Residency Fellow with Samaritan’s Purse. And today, Annelise is an essential part of our career staff. I enjoy being on call, knowing I can summon her for assistance. As Dr. Olson likes to say, “I’m on back up for hell.”



Compassion In Action – Angola Day 18

July 18th, 2017 by Nicholas Comninellis
Posted in 2017 Angola|


“Our child became ill 6 months ago. So, we visited the traditional healer. We lost our money and our child was no better, so we went to the closest clinic. They did tests and gave medicine, but he didn’t recover.” Thus, begins an account we hear frequently. It continues like this: “Next we went to the hospital, but were told they would do nothing more. Finally, we traveled several hours or days to reach CEML Hospital. Can you help us?”


Photographed above are the kind of patients and families who most frequently recount such stories of health lost, assurance languishing, and hope of healing. CEML Hospital is often their last reasonable hope of assistance, especially for those suffering from eye disorders, orthopedic injuries, maternal fistula complications, and more recently, cancers too. Who is CEML? In short: a ministry of the Angola Association of Evangelicals – a collation of hundreds of churches pooling their influence to create care that none could provide alone. It’s an active expression of compassion on behalf of humble country men and women like these.


Life After Life – Angola Day 16

July 16th, 2017 by Nicholas Comninellis
Posted in 2017 Angola|


Life span in Angola averages only thirty-eight – a fact painfully experienced by our patients and families. We at CEML Hospital are diligent to help people better these odds. But all life has limits. As I pondered this truth, Pastor Moses phoned again, asking me to prepare a mediation for chapel today. Pictured above are patients and family members gathered outside their cabins, with the hospital in the background, singing in harmony with leaders from Moses’ church, below.



For my message of hope, I selected Philippians 3:20-21, “Our citizenship is in heaven. And we eagerly await a Savior from there, the Lord Jesus Christ, who, by the power that enables him to bring everything under his control, will transform our lowly bodies so that they will be like his glorious body.” What a wonderful promise! Whether we succumb to malaria in Angola at age eight, or malignancy in American at age eighty, Christ – the only person in history to return from death to life – assures His followers of life after life.