INMED Welcomes New Faculty: Paul Larson

October 2nd, 2015 by Nicholas Comninellis | Comments Off on INMED Welcomes New Faculty: Paul Larson



Students in the 2015 Pittsburgh PA INMED International Medicine & Public Health Course – which begins on Monday – will enjoy the privilege of being mentored by INMED’s newest faculty: Paul Larson. Qualifications for this position are rigorous, and Dr. Larson’s credits are equally laudable. Following family medicine residency and a diploma earned from the Liverpool School of Tropical Medicine, Paul and Alysia Larson move to Kenya’s Kapsowar Hospital at the invitation of the Africa Inland Church. For two years they integrated themselves into rural Kenyan society, caring for their sick, partnering in community development, and raising their own five children.


Much like myself, Paul Larson possesses a special passion for enabling healthcare personnel to pursue their dreams of service. Upon returning to the USA, he completed graduate studies in medical education and a fellowship in faculty development. Today Dr. Larson is director of Global Health Education at the University of Pittsburgh Medical Center’s St. Margaret Family Medicine Residency. He also continues to rigorously apply his teaching skills by supervising INMED Diploma students at the Baptist Medical Center in northern Ghana, and more recently, by mentoring INMED International Medicine & Public Health Course students.


Whether by personal example or by instruction and supervision, Paul Larson casts an enticing vision for globally minded healthcare leaders. We are overjoyed and honored he has joined the INMED Team!

Mark And Angie Byler – Proving That Lives Matter

September 25th, 2015 by Nicholas Comninellis | Comments Off on Mark And Angie Byler – Proving That Lives Matter



To where could a short-term international healthcare experience ultimately take you? Please consider the inspiring lives of Mark & Angie Byler. As a medical student, Mark studied hospital medicine for a few weeks in Kenya. Later, Mark and I were on faculty together at the University of Missouri-Kansas City, where he met Angie and volunteered periodically in Zimbabwe, Southern Africa. Mark told me, “Those people are important. And I’m going to prove it.”


In 2004 Mark and Angie did just that by moving their home, along with son Luke, to Sanyati Baptist Hospital in southern Africa. Zimbabwe, once the most prosperous nation in Africa, today is rated as having the worst quality of life of any nation on our planet. Twenty percent of the Zimbabwe’s people are HIV positive, and half of all patients admitted to Sanyati Baptist Hospital are HIV infected. In spite of these odds, Dr. Byler for the next ELEVEN YEARS served as a leader in providing HIV therapy and managing the complications of opportunistic infections associated with HIV, including profound malnutrition, tuberculosis, and PCP pneumonia.


Today Mark Byler is a faculty physician with INMED, instructing students in the International Medicine & Public Health Course. Take advantage any opportunity to become acquainted with Dr. Byler and those of his caliber for whom the world is no barrier to affirm that, indeed, all lives matter.

Beauty From Ashes – An INMED Inspiration

September 18th, 2015 by Nicholas Comninellis | Comments Off on Beauty From Ashes – An INMED Inspiration



Oh the power of parents! Once when I was about eight years old I went  grocery shopping with my parents. It was a Friday afternoon, the time when we usually stocked up for our weekend trip to the Lake of the Ozarks. But unlike normal shopping trips, my parents were purchasing very unusual items: towels, silverware, bed sheets, lots of canned goods, and even a toaster. I protested, “But Dad, we’ve already got this stuff!” Dad just smiled and commented, “You’ll see, son.”


From the store, instead of driving to the lake we drove directly to the town dump located on the edge of the Missouri River. Now I really felt bewildered! Dad pulled the car to a stop in front of a burned-out trailer home. It still smelt of fresh soot, and whips of smoke rose from where the bedroom used to be.


From a tent pitched next to the trailer emerged an elderly couple, looking exhausted and anxious. I recognized them. They were the people who ran the dump! I remembered the story, too, that my dad told me just that morning. These were the ruins of the couple’s home where my dad, a volunteer firefighter, had battled a blaze just the night before. Mom and Dad opened the car trunk and started unloading our gifts of food and other essentials. With tears in their eyes, the surprised couple eagerly received our gifts.


Herein was a beautiful gift for me, as well: a real life demonstration of commitment love. As I remember my father’s passing just three weeks ago I’m touched over how such formative moments during my childhood contributed to the concepts that grew into INMED today.

Danny Estévão Bring Vision To Life – Angola 2015

September 11th, 2015 by Nicholas Comninellis | Comments Off on Danny Estévão Bring Vision To Life – Angola 2015



Lubango Evangelical Medical Center was for decades only a dream in the hearts of Pastor José Abias, Dr. Stephen Foster, and leaders of the Angolan Association of Evangelicals. The vision was substantial: within Africa’s poorest nation to create a center of healthcare and compassion. In 2006, with significant backing from Franklin Graham and Samaritan’s Purse, the center was founded. CEML – as it is know in Portuguese – offers daily outpatient clinic, emergency care, maternity, surgical center, inpatient care, and even housing for out-of-town patients and families. CEML is also an INMED Training Site.


These are all highly visible elements of CEML. What is less apparent is the man who maintains CEML’s daily operation. Please let me introduce Danny Estévão. “I was a businessman with no experience in medicine,” Danny told me just last week. “But in 2004 I learned of this vision for CEML and was convinced to apply whatever skill I posses to bringing this vision to life.” And this Danny has pursued with excellence and endurance.


Managing an organization like CEML is of necessity extraordinarily complex. Human resources, budgeting, accounting, facility maintenance, government relations, donor associations, supplies acquisition, marketing, patient satisfaction, even my visa processing – all rely upon Danny’s expertise. “I am recipient of the care and compassion of Jesus,” says Danny. ”How could I do anything less but facilitate these mercies towards my fellow Angolan people?”


I’m Coughing Blood Again – Angola 2015

September 4th, 2015 by Nicholas Comninellis | Comments Off on I’m Coughing Blood Again – Angola 2015



“I’m coughing blood again.” Moses gasped for breath, his chest muscles visibly contracting with each respiration. The starved figure of this man of twenty-six bespoke of profound malnutrition, infirmity, or both. His chest examination revealed distant, wet sounds divulging deep infection and his chest X-ray… Lacking an adequate view box, I’m here holding the film up to the sky. The white circle, where the clouds appear, is a density caused by pneumonia, abscess or cancer.


As our conversation continued I discovered the Moses was diagnosed with tuberculosis a year earlier. He began taking the appropriate treatment and within four weeks felt fine. Then like so frequently occurs Moses stopped his intended six-month treatment course. Now his infection was back, likely resistant to the original medications, and much more difficult to treat.


TB is the most common infection afflicting humans. One-third of all people on earth are infected. If we focus outside of Europe and North America, fully one-half of the world’s population is TB-positive. What can possibly be done on behalf of people like Moses? Current medications usually work. But they often require coaching to assure that people finish the treatment course. Healthcare professional need to assure such coaching. There exists a TB vaccine. But it is only marginally effective. Do you have a research interest? Pioneering develop of a superior TB vaccine holds promise to protect people like Moses in every nation.

Mother And Newborn In Peril – Angola 2015

August 28th, 2015 by Nicholas Comninellis | Comments Off on Mother And Newborn In Peril – Angola 2015



“I’m in labor, and the umbilical cord just fell out.” Utterly frightened, the mother Gilhermina approached the home of Donna Foster on a ranch here in rural Angola. Within moments, Donna and teenage daughter Meghan, loaded Gilhermina in their truck and began the 110 mile drive to us at the Evangelical Medical Center of Lubango. Once in range, I received her slightly distraught phone call. “Put your hand on the baby’s head and push upwards, “I advised. “This can relieve compression on the cord and increase blood flow to baby.”


Pregnant women like Gilhermina and their newborns are particularly vulnerable . The hours of labor, delivery, first breaths, and transition to exterior life hold a minefield of potential complications. Provision of at least a basic level of skilled care is lifesaving. With this objective in focus, INMED just added new Maternal-Newborn Health content to our International Medicine & Public Health Hybrid Course.


Despite Donna and Meghan’s heroic actions, Gilhermina’s child suffocated before arrival. And around the globe such save-able birth complications occur thousands of times each day. My dear hope is that armed with essential mother-newborn skills, even the most humble healthcare personnel will be more immediately available to preserve these vulnerable lives.

Diagnosis Under Stress – Angola 2015

August 21st, 2015 by Nicholas Comninellis | Comments Off on Diagnosis Under Stress – Angola 2015



“My chest hurts severely and the pounding of my heart is relentless,” exclaimed  a woman of forty whom I met in the emergency department. She proceeded to describe how she also felt fever and burning throughout her body, along with weakness of her legs and sensations of her head spinning. On exam, I indeed heard extraordinarily loud heart sounds, but I also found her ribs painful on palpation and her thyroid gland to be large and tender.


Can I make a reasonable diagnosis from this information? First let me analyze the factors confounding such a proposition, factors that ubiquitously challenge healthcare professionals working in low-resource, cross-cultural settings:

  • Language barrier – We both speak Portuguese quite well. But I have not been immersed in the language for a year, and some of her words cause me to pause and contemplate her meaning.
  • Cultural barrier – My understanding of illness is pathophysiological, cause and effect. Traditional Angola like this woman view illness as a result of spirit, curses, humors, failure to appease ancestors.
  • Unfamiliar diseases – In this region cardiac problems a frequently due to rheumatic fever, tuberculosis, and obscure viral infections; diseases uncommon in my United States experience.
  • Divergent health literacy – Angolan describe most all illnesses by using the words burning, irritating, weakness, and head spinning; words which have very different health meanings in North American English.
  • Travel fatigue – I’m hardly over jet lag. How could I possibly think clearly?
  • Few resources at best – In this locale, access to laboratory, imagine, consultants, and basic patient monitoring is severely limited. But we do have a portable ultrasound unit. In 30 seconds I identified normal cardiac valves, muscle, and pericardium. Finally, some objective data!


So in spite of the common limitations what was my diagnosis under stress? Hyperthyroidism, based mainly on her tachycardia, normal cardiac ultrasound, and tender, enlarged thyroid gland.


Shock And Distress – Angola 2015

August 14th, 2015 by Nicholas Comninellis | Comments Off on Shock And Distress – Angola 2015



Shock. Arriving in Angola inevitably distresses my soul. Though I lived here for two year and have return annually for fourteen more, reentry into this place of paucity continues to unmask any temptation towards complacency over the world’s affairs. Were I a normal Angolan, one of my own children would have died before reaching first grade and I myself would have passed years ago.


It’s good this I feel this way. Distress over unjust suffering indicates to me that the temporal pleasures of life have not quite entirely seduced my heart, as the God of Isaiah continues to counsel me to “Learn to do right; seek justice. Defend the oppressed. Take up the cause of the fatherless; plead the case of the widow” (1:17). This counsel is universal, advocating care for human life throughout world – in Anaheim, Angola, and Armenia. This counsel is also compelling, even to the degree that its execution is at times shocking to my soul.

Competencies In International Medicine And Public Health

August 7th, 2015 by Nicholas Comninellis | Comments Off on Competencies In International Medicine And Public Health



Remember being a student on the first day of class? We usually received a course syllabus, and a generation ago that syllabus began with a list of subjects studied; lists like:


  • Epidemiology of childhood illness
  • Physiology of fever
  • Metabolism of acetaminophen


Astute educators soon realized that the objective of education is not simply to study. Rather it is to learn. So the syllabi of fifteen years ago morphed into learning objectives, with contents like:


  • Describe the epidemiology of childhood illness
  • Explain the physiology of fever
  • List the steps in metabolism of acetaminophen


But preparation for actual practice of healthcare is inadequate with learning alone. So today education has moved on toward competency objectives. In other words, learner are ultimately measured their ability to apply newly acquired information and skills to real life situations, with competencies such as:


  • Capability of assessing a febrile child and reaching a correct diagnosis
  • Ability to evaluate the impact of fever and treat accordingly
  • Capacity to prescribe a correct antipyretic and evaluate its effectiveness and potential adverse impacts


Since 2003 INMED has developed and tested a variety of competencies relevant to equipping international medicine and public health personnel. Today we expect at the completion of the INMED Diploma is International Medicine & Public Health graduates in the context of a low-resource community will be able to:


  • Prevent, diagnose and treat the leading diseases of poverty
  • Prevent, diagnose and treat HIV infection
  • Provide for the health of pregnant women and newborns
  • Demonstrate proficiency in relevant clinical skills
  • Advance community-wide health promotion and death/disability prevention
  • Assure that healthcare interventions are culturally appropriate
  • Mitigate disaster risk and respond to disaster events
  • Design and implement effective healthcare as part of a leadership team


Studying. Learning. Competency to practice. The progress is wonderful, particular on behalf of a febrile child.



Apartheid And Poverty

July 31st, 2015 by Nicholas Comninellis | Comments Off on Apartheid And Poverty

An apartheid notice on a beach near Capetown, denoting the area for whites only. (Photo by Keystone/Getty Images)


Apartheid is an Afrikaans word meaning “the state of being apart,”, or rather “apart-hood.” It was a system of racial segregation in South Africa enforced through legislation by the dominant governing party from 1948 to 1994. But apartheid in various forms continues to exist throughout the world, most often based upon language, culture, race, and/or religious affiliation.


Ideally nations are secular and multi-ethnic, welcoming and accommodating to all people within their boarders. Sadly, recent history is replete with examples of just the opposite: Israeli suppression of Palestinians within Israel, Iraqi domination over Iraqi Kurds, Caucasian American subjugation of native Americans and blacks. Creating “homelands” for various such peoples has repeatedly only served to deepen the divides.


This week both Pakistan and India marked their independence days – independence from Great Britain that is. What followed was an ugly conflict between Indians whose culture and religion was distinct. Tens of thousands were killed, India was subdivided into Pakistan, India, and Bangladesh, and the conflicts between them continue today.


As nations consider policies characterized by apartheid, we do well to remember the wisdom of Mahatma Gandhi: “Recall the face of the poorest and weakest man you have seen, and ask yourself if this step you contemplate is going to be any use to him.”