Criticism Against Good Samaritans

September 10th, 2014 by Nicholas Comninellis | Comments Off

good-samaritan-modernThe debate surrounding Kent Brantly, the American physician serving in Liberia who became infected with Eboli, is representative of the dilemmas faced by many of us who are lead by good intentions. “Why wasn’t he taking care of his own people back home?” “It’s irresponsible to put himself and his family in such a dangerous place.” “All those resources spent on rescuing him could have been used to assist other people who are not so privileged.” And perhaps the most painful of all, “He really wasn’t doing much good over there anyway.”


You may be personally engaged in any number of virtuous ministries or missions. How do you respond when you receive parallel criticism? First, find comfort in the fact that “No good deed goes unpunished.” It’s a known occupational hazard that those who do good will be regularly criticized. Second, remember that ours is an enormously large world filled with infinite needs. In selecting which ones to particularly intervene we must assess our personal passions and resources. No one else can do this for us, and everyone one else must respect our decisions. And finally, you may be especially heartened as I am by this promise from Matthew 25 beginning in verse 31, “I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me…”


Our Response To Great Evil

September 4th, 2014 by Nicholas Comninellis | Comments Off

Syruan Refugeesnorthern iraqThe horrific recent videos of murders allegedly committed by the Islamic State In Iraq and Syria (ISIS) are deeply disturbing and provocative. They remind me of how very great is the potential for humans to willingly instigate and participate in great evil. As youngsters, the neighbors of these assailants surely could not have imagined them plunging into such reprobate behavior. Similar impressions are recorded by the contemporaries of Hitler, Mao, Stalin, and Ho Chi Minh. We do well to remain vigilant about humankind’s inherent potential for cruelty.


But where evil abounds so does opportunity for great compassion and acts of extraordinary kindness. My treasured friend, Lawand, a US-educated Kurdish attorney living in northern Iraqi, just departed his esteemed position to provide full-time aid to the thousand of refugees fleeing ISIS. Lawand is embodying the assurance documented in 1 Peter 1:4, “Jesus’ divine power has given us everything we need for a godly life through our knowledge of Him who called us by His own glory and goodness. Through these Jesus has given us His very great and precious promises, so that through them you may participate in the divine nature, having escaped the corruption in the world caused by evil desires.” As we witness great evil, both near our homes and abroad, we do well to remain steadfast to overcome great evil with compelling goodness.

Which EMMC Cluster Is Best For You?

September 2nd, 2014 by Nicholas Comninellis | Comments Off

2015-emmc-themeOn behalf of the world’s most disadvantage people, what can you do in ten minutes? What about ten days? What can you do to effectively promote global health in ten months, or even over a period of ten years? The 10th annual, 2015 INMED Exploring Medical Missions Conference (EMMC) theme question is What Can You Do In Ten? This year’s conference will also feature Clusters: sessions that combine brief introduction, hands-on skill development, and practical applications opportunities. You can select from clusters on Pediatric Care, Organizational Action, Mother/Baby Care, Crossing Cultures, Faith with a Mission, Displaced But Not Forgotten, Development Beyond a Band-Aid, Trauma: Life in the Mission Hospital, and My Global Community. Myself, I’ll be leading the International Medicine Cluster. Here we will quickly review leading tropical diseases, practice the logic of differential diagnosis with one another, and then try out our skill with patient actors in simulated settings around the world.


Which EMMC Cluster is best for you? Select those that match your particular skills, whether in nursing, administration, therapy, dentistry, pharmacy, public health or medicine. Or, you can test out new fields beyond your current expertise or experience. Six Cluster opportunities will be available during the event. But please remember that space available for each Cluster is limited, so register very soon, and I will look forward to meeting you on Friday and Saturday, May 29-30, 2015!


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.




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


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.