Ebola Vs The World

August 27th, 2014 by Nicholas Comninellis | Comments Off

leading-cause-of-death-africaWhy is Ebola such a concerning crisis? The fact that this is an unusual disease sparks intrigue. That it is contagious from person to person engenders particular alarm. But while I empathize with those who are ill, we also do well to consider the broader picture of health on the African continent. My colleague Tim Kubaki, veteran physician in Brazil and Angola aptly observes, “Ebola has killed 1300 people so far. Eight times this number die from malnutrition every DAY… Malaria kills this number every DAY… 4000 die from HIV every DAY… 3000 kids die from pneumonia every DAY… 2000 kids die from diarrhea every DAY… all preventable, all treatable… Where’s the outrage and concern for these?” Dr. Kubaki’s viewpoint is critical. For a pectoral representation, please study the above cause of death for Africa as a whole.


I personally hope that such a “global perspective” will motivate concerned people like you and I to not simply react with emotion over today’s crisis in West Africa.  Rather, let us respond in a manner that demonstrates sincere compassion for these people acutely afflicted and that activates effective strategies to build healthier communities in partnership with West Africans. Without such an approach, we will continue to find ourselves simply reacting with intrigue and alarm to each future crisis.

How Would You Handle This Fracture?

August 21st, 2014 by Nicholas Comninellis | Comments Off

femur-fracture-displacedI’m holding up to the window a plain X-ray (remember those?) from a young man in acute pain that fell from a moving bus in Angola, southern Africa. As you can see, the femur fracture is displaced and shortened. As you cannot see, this is also an open fracture. Bony fragments have pierced the skin of his thigh. Beyond pain control and initial debridement, how would you manage this man’s orthopedic injury?


Since the 1970s surgical fixation of such fractures with an intramedullary nail inserted into the femur has the standard of care. Fracture healing from this procedure is rapid and effective, with union rates of between 95% and 99%. However, in the face of an open fracture such procedures in the immediate setting must be delayed until infection risk has suitable declined. And, in this particular African locale no orthopedic or anesthesia specialist is available.


femur-tractionThe general approach to such management is monitored traction. A Steinmann pin is inserted just below the tibial tubercle  at the time of admission or after initial debridement of the open fracture wounds. Traction beginning with 7 to 8 kg is applied, with the foot of the bed elevated to prevent the patient from sliding forward. Follow up evaluation of the fracture every few days is necessary to assess bony reduction and adequacy of alignment.


Over the ensuing weeks traction should be intermittently lifted to allow the still non-weight bearing patient to mobilize the knee and lessen the risk of joint contracture. After 8-12 weeks of bed rest, and assurance of new bone formation at the fracture site, traction can be suspended and the patient encouraged to begin progressive weight bearing and rehabilitation from the muscle atrophy associated with prolonged immobilization.


Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2266653/


People To Watch: INMED Intensive Course Grads

August 18th, 2014 by Nicholas Comninellis | Comments Off

2014-08-intensive-classOn Saturday we completed the 2014 Late Summer INMED International Medicine & Public Health Intensive Courses – events that consistently attracted some of the world’s most remarkable participants. Please let me introduce you to just a few: Joseph Muroka, a native Kenyan with a passion for his own people, who just graduated from the University of Missouri-Kansas City School of Pharmacy. Robert Schneider, a Spanish-speaking academic family physician from AT Still University, who consistently serves in Central America. Ann Nichols, a nurse from California intent on better serving her immigrant and refugee community. Elise Wouters, an undergraduate from Alberta, Canada, pursing a career in international law and justice. Jared Wilmoth, a medical student from the University of Kansas already with extensive service experience in the Middle East. And Katy Kettler, pursuing her graduate degree in international public health. Observe the careers of these remarkable people, and be inspired!

Ebola, Ann Coutler, and Virtue Ethics

August 11th, 2014 by Nicholas Comninellis | Comments Off

coulter-cross-brantlyKent Brantly’s gradual recovery from Ebola infection is heartening news, for many people across North America are quite inspired by the example of his courageous medical care on behalf of the thousands in West Africa who suffer from this disease – one that carries an eighty percent risk of death. Clearly Dr. Brantly’s sudden notoriety came as a total surprise. He would not have begun his two-year commitment to the people of Liberia with any expectation of personal gain other than an occasional ‘thank you’ and a sense of internal satisfaction. Columnist Ann Coutler, by contrast, is outspokenly critical of Dr. Brantly professional focus on Africa instead of the United States, “If he had practiced at Cedars-Sinai hospital in Los Angeles and turned one single Hollywood power-broker to Christ, he would have done more good for the entire world than anything he could accomplish in a century spent in Liberia.”


This confrontation brings us to an intriguing analysis of ethics. Virtue Ethics stresses the importance of one’s personal character. Motives and individual dedication are paramount, and measurable outcomes are less significant than faithfulness to one’s vision. Dr. Brantly represents Virtue Ethics in action. Consequentialism, by contrast, is the ethical perspective that outcomes – or consequences – are paramount; that good intentions or personal commitment are less important than are the actual results. Ann Coutler’s position is Consequentialism in motion.


Which ethical orientation is correct or most appropriate? Please share your opinion with my by writing to nicholas@inmed.us


INMED Grads: Eyes And Your Own Vision

August 6th, 2014 by Nicholas Comninellis | Comments Off

clements-eye-patientJohn Clements, pictured here at the Boa Vista Eye Center in southern Africa, approached me four years ago about serving via the INMED International Medicine Fellowship. At that time I was also comforting the leaders of Boa Vista over the tremendous challenge of locating a qualified eye specialist. What an encouragement to facilitate Dr. Clements connection with Boa Vista, where over the next 3.5 years he restored sight for thousands, trained Angolan physicians themselves with essential eye surgery skills, and promoted via his extraordinary lifestyle the virtual of giving quality care for people who can least afford to pay for it.


Today INMED continues to assist the Boa Vista Eye Center is locating eye specialist physicians with similar attributes who are animated over the possibility of serving at their location on the coastal city of Benguela in Angola. Will this be a difficulty assignment? Undoubtedly. Will these long-term volunteers be well compensated? In monetary terms, no. But will they be enriched beyond description with professional satisfaction and lifetime friendships. Whom among your colleagues would be interested in exploring this opportunity?


Beyond Ebola: Other INMED Grads In Action

August 1st, 2014 by Nicholas Comninellis | Comments Off

uganda-hbb-mary-smithWe continue to follow the progress of INMED Graduate Kent Brantly in his personal battle against Ebola infection. His courage and devotion is hearteningly common among INMED Graduates. Susan Fockler, pharmacist, and Jennifer Wilson, family physician, are two additional INMED Grads who, like Brantly, have also invested heavily on behalf of the citizens of West Africa. Susan and Jennifer earner the INMED Diploma in International Medicine & Public Health, and reinforced their skills with training in Helping Babies Breathe – a newborn resuscitation program designed for very low resource communities. They next networked with 49 marginalized villages in north Kintampo and south Bole districts of Ghana to establish prenatal and neonatal home visit system for pregnant women and infants, and to equip birth attendants in the project area to provide low-resource antenatal care and infant resuscitation. Be encouraged by their recent Training Report, and watch for more news of INMED Grads in action.


Ebola, Kent Brantly & INMED Grads In Action

July 30th, 2014 by Nicholas Comninellis | Comments Off

2013-winter-intensive-hybrid-course-graduatesToday the world is following the status of Kent Brantly, American physician who contracted Ebola virus infection while serving at a mission hospital the nation of Liberia, West Africa. Brantly, photoed above in back row second from the right, participated in the 2013 INMED International Medicine & Public Health Intensive Hybrid Course held in Fort Worth, TX. Brantly impressed me as enthusiastic, intelligent, and devoted to providing care for the world’s most impoverished people – a passion in his heart since undergraduate years. In October 2013, Brantly began a two-year commitment in Liberia with Samaritan’s Purse, along with his wife Amber and their children, ages 3 and 5. At the time the he himself became infected, Brantly was directing the hospital’s care for Ebola victims.


Perhaps you would like to share an encouraging word to Kent Brantly? One effective way to do so is to send a thank you to someone you know who, like him, is in imperil on behalf of others, as every day thousands of those in healthcare place themselves at predicable risk.


Your Own Future In Africa – Angola Day 29

July 27th, 2014 by Nicholas Comninellis | Comments Off

angola-flagToday I’m thinking of all you back home as I pack for return to Kansas City. I am an extremely fortunate man be colleagues with the Angolans and to play a small part in their concerns. But I’m not the only one who is blessed. Many of you have interests and resources you too would like to share. This month I’ve received a number of messages inquiring about how people like you can become involved in challenging situations like Angola, using your gifts in public health, nursing, administration, medicine, and rehabilitation. This the reason why we created INMED. We exist to assist well-intended people in the health care fields with the skills, experience, and relationships to thrive in serving our world’s most disadvantaged. Please invest a moment to look over how INMED can facilitate your dreams, and just maybe you will join me in Angola again July 2015.

Prison Is Such A Joy – Angola Day 27

July 25th, 2014 by Nicholas Comninellis | Comments Off

angola-prison“I tried to visit the prisoners, but the guards would never let me in.” Pastor Cassicula was panting with excitement an Steve Foster evaluated his malnutrition and dysentery. “But then I was arrested for leading a church and imprisoned at the jail where I was trying so hard to go!” The year was 1984 and the communist-oriented leaders in Angola were bent on eliminating any vestiges of faith. “The guards put me into cells with ten other prisoners. The joy of Jesus overcame me as I explained to them the power of redemption. One by one, each of my cell mates trusted Jesus. The guards were so upset. They put me in a different cell, and soon all those fellow prisoners put their faith in Jesus as well.” Pastor Cassicula concluded, “My walk with Jesus and my impact on the world was never more rich than when I was imprisoned.” I can think of no better illustration of James 1:2-4 than that of Pastor Cassicula: “Consider it pure joy, my brothers and sisters, whenever you face trials of many kinds, because you know that the testing of your faith produces perseverance. Let perseverance finish its work so that you may be mature and complete, not lacking anything.”


A Daniel For Today – Angola Day 25

July 23rd, 2014 by Nicholas Comninellis | Comments Off

cesario-sapaloIn the 1990s I moved to the war besieged city of Huambo, in central Angola, to assist churches in starting up a health ministry. My Angolan counterpart was Cesário Sapolo, pictured here in front of the house where I lived. Cesário distinguished himself as a model human: intelligent, social, and devoted to his family and to his Lord. After only two years I had to evacuate just days before the city was overrun by the opposing military force. But Cesário continued to medical service we began together, even amid the hunger and death accompanying the occupation.


This week took the rugged road to Huambo, where I discovered that Cesário has risen to the position of Vice-Director of Health for the entire province. Remember the account described in the biblical book of Daniel, Chapter 6? This is real history from the Babylonian Empire of 538 B.C. “Now Daniel so distinguished himself among the administrators and the satraps by his exceptional qualities that the king planned to set him over the whole kingdom. At this, the administrators and the satraps tried to find grounds for charges against Daniel in his conduct of government affairs, but they were unable to do so.” Indeed, people of such quality still live among us, including Cesário Sapolo.