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.

Do You Express Thanks? 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.

Surviving Life’s Most Dangerous Day

October 1st, 2014 by Nicholas Comninellis | Comments Off

daily-risk-of-deathWhat is the most dangerous day in a person’s entire life? Perhaps the one when a teenager receives his or her driver’s license, the first big college party event, a rock climbing or back woods vacation? Worldwide data actually demonstrate that the highest risk of death – life’s most dangerous day – is the first 24 hours after birth. Why is this so? Newborns are particularly vulnerable. The transition from mother’s protective environment to the outside world involves drastic changes. One of the most extreme is the necessity to immediately begin breathing air for the very first time. Failure of babies to successfully clear the natural fluid from their lungs and fill them with oxygen within one minute will likely mean death, and for this reason some one million babies die each year.


The bright piece of this challenge is that assisting babies with simply, immediate resuscitation is usually lifesaving. Keeping a baby warm and dry, suctioning away the oral fluids, and providing ventilation when necessary is often all that is needed to see a newborn through the critical transition. In my personal role providing maternal-newborn care in Angola I’ve witnessed first hand how quickly babies in respiratory distress improve with such care, and how rapidly and enthusiastically health care personnel can acquire these skills.


Helping Babies Breathe (HBB)  is an evidence-based educational program to teach basic newborn resuscitation techniques to healthcare leaders who can in turn teach them to birth attendants and midwives in the world’s resource-restricted communities. As part of the global newborn health movement, INMED provides HBB Training though one-day events that can prepare you yourself to help a baby survive life’s most dangerous day.

What Shall Your Conquests Be?

September 26th, 2014 by Nicholas Comninellis | Comments Off



“I am Shutruk Nahunte, King of Anshand and Sussa, Sovereign of the land of Elam. I destroyed Sippar, took the sword of Niran-Sin, and brought it back to Elam, where I erected it as an offering to my god.” ~ Shutruk Nahunte, 1158 BC. Regarding this inscription above his classroom door Professor William Hundert in The Emperor’s Club (2002 Movie) comments: “It’s a quote from a virtually unknown king, who speaks of his list of conquests, but speaks nothing about the benefits. This king is unknown in history, because ‘Great ambition and conquest without contribution is without significance.’ What will your contribution be? How will history remember you?”


In popular culture today we honor, reward, and often envy people who succeed in difficult conquests. The nature of their conquests often appears to be of lesser importance than the fact that a great obstacle was confronted and subdued: a battle was won, an elusive discovery was made, a peace was secured. I would offer, however, that conquests differ greatly in their nature and their value. As Professor Hundert affirms, “Conquest without contribution is without significance.”


And so it is imperative that we each singularly consider the enduring value of the challenges were choose to confront. Three questions may help to clarify such value: Would your mother applaud? Would this make your children proud? Would this cause God to smile? In such light, what shall your conquests be?

What Healthcare Field Or Specialty Should You Enter?

September 22nd, 2014 by Nicholas Comninellis | Comments Off

choices-signThis decision is often bewildering. As a young person proceeding through healthcare education you face increasingly complex choices that touch on academic ability, financial debt and earning potential, social pressures, prestige and reputation, non-career interests and responsibilities, and personal passions. You likely have considerable freedom of choice, and with that freedom can come marked anxiety.


My short answer is, choose the field or specialty that most interests you. What do you dream about, think of in your off hours, or imagine yourself doing with pleasure and pride? This may well be your very best selection.


Those of you interested in the world’s most low-resource communities may be under the misconception that only primary care specialties are appropriate in such settings. While it is indeed true that the greatest needs in developing nations are in public health and primary care, there is also an important role for specialists. Physical therapists, ophthalmologists, midwives, orthopedists, pharmacists, plastic surgeons, and researchers, for example, all have unique talents to offer.


Teaching opportunities – generally better suited for more narrow specialists – are constantly expanding and offer influential positions from which to multiply your skills and impact. There also is a real possibility that at some point in your career you will practice among more affluent people. For all these reasons, I believe you will do best in pursuing a field or specialty in which you are genuinely interested.

Should People Of Faith Be Allowed In Global Health?

September 20th, 2014 by Nicholas Comninellis | Comments Off

india-faithShould people of faith be allowed to participate in global health discussions or initiatives? Does not their spiritual orientation create ulterior motives and cause them to take advantage of people in need? How can those that may believe in a supernatural Being or an afterlife be considered respectable, professional colleagues in undertakings of such great importance? Such questions I encounter regularly in my interactions through the Institute for International Medicine, where it is my constant pleasure to interface with people from the entire spectrum of world views.


How many of today’s universities and health care facilities bear names like Jewish, Catholic, Baptist, or Presbyterian? By what sort of citizens were such institutions founded? Who is familiar with the predecessors of global health – individuals like Albert Schweitzer, David Livingston, and Mother Theresa? What was the spiritual orientation of such people? Today, what role does faith play among those who dedicate not just a few days, but year after year of their lives in devotion to the world’s most poor – people like those on staff at INMED Training Sites throughout Asia, Africa, and the Americas?


What do you think? Should people of faith be allowed to participate in global health?