Nicholas Comninellis

Make A Lasting Contribution: Teach Your Skills

How can you and I contribute to lasting care and progress in the world’s most impoverished communities – like sites in northern Ghana, urban India, or rural Papua New Guinea? Clearly our efforts to support basic literacy and economic development are foundational. Equipping local citizens is one of the most effective ways to make a lasting improvement on communities in distress. Several reputable programs are doing just this: Helping Babies Breath of the American Academy of Pediatrics teaches newborn resuscitation for midwives and birth attendants in low-resource settings. Heifer International provides training in livestock and agricultural management to boost economic development in low resource communities. International Literacy Institute  is a headquarters for worldwide movements to promote reading skills in developing nations.

Let’s join organizations like these in moving beyond simply providing care and towards building resiliency in local health care providers. Someday one of them may benefit a life because you taught your skills!

Rescue Has Limitations

Disasters and epidemic disease continue to mark this new century: Haiti’s earthquake, Pakistan’s flood, measles’ blight, and Zimbabwe’s cholera. The title waves in Japan last week are the most recent reminder of life’s vulnerability. The heartening response from many is to donate personal time, talent, and treasures to provide rescue and assistance to those in distress. But rescue alone has significant shortcomings: Most crises are far easier to prevent, rescue is costly, repeated & predictable rescue is shortsighted.

We must move beyond the rescue mentality and pursue those interventions that actually build more resilient communities. In the case of the world poorest communities, these interventions often include economic development, improvements in basic literacy, and proven effective health interventions like adequate nutrition, safe drinking water, reproductive health, vaccination, injury prevention, and well child care. We must also invest into equipping local healthcare personnel to provide for their own.

Image Worms Living Under Your Skin!

As a resident physician I spent a summer in Burkina Faso - an impoverished nation in West Africa. For years a group of nurses with SIM (Serving In Mission) had been living on site, providing community health and clinic care in this remote, hot, and culturally distinct community. As I attended to ill patients, I noticed many with unusual nodules just under the surface of their skin - like the boy’s scalp in the photo above. A novice to such finds, I anesthetized the boy, incised his nodule, and out fell a white worm two feet long!!

This was a ghastly introduction to onchocerciasis - a parasitic infection appropriately known as night blindness. The adult worm produce tiny worms (microfilariae) that migrate throughout the body causing inflammation, particularly in the eyes. A prototypical disease of poverty, we have the means to both effectively prevent and treat onchocerciasis. All that’s lacking is the leadership to carry out this worthy pursuit.

Pneumonia Get’s Personal!

One very early morning I heard a quite thump at the door. Opening it, I gazed out on to the little courtyard of my home in Huambo, Angola. Edwardo, a young pastor, stood clutching his four-year old son. The child was gasping and drooling, his little black body darker from cyanosis - insufficient oxygen. A quick listen to his lungs confirmed the obvious. The boy was dying of pneumonia. Oxygen was the first remedy, but none would be found in Huambo. I administered an antibiotic, but it was all too late. Only a few moments later, the boy breathed his last.

Pneumonia remains a ubiquitous killer in poorer nations. Check out the green portion representing pneumonia for each region of the world on the map above. What are effective interventions? Beyond general progress is nutrition, housing, and education, the most important is early recognition and treatment. Had this boy arrived for care even a day earlier he might well be writing blog posts today, just like me.

Polio - An Unnecessary Threat

As a kid, I noticed that my cousin Roger walked with a significant limp. He began wearing an elevated shoe to stabilize his gait. This was a result of polio he suffered in the 1950s - a time when the disease was rampant in the United States. Effective vaccines all but eliminated US polio in the 1960s, but it’s still epidemic in 4-5 countries today. The polio-crippled children in this photo at a physical rehabilitation center in Sierra Leone, West Africa.

Since humans are the only living being infected by polio, eradication is indeed possible. Ongoing polio eradication efforts include routine immunization of infants and children, and disease surveillance with vaccination for those missed by other approaches. Assuming that worldwide polio eradication is successful, an important unanswered question is how long wild-type poliovirus can persist in the environment and continue to be a threat, requiring sustained vaccine coverage.

Prevent This Child’s Blindness!

This child is going blind as a result of scaring to his cornea. Some 250,000 to 500,000 children in low-resource communities throughout Africa and the Indian subcontinent go blind each year from dietary deficiency of vitamin A. Severe deficiency causes irreversible corneal damage, leading to partial or total visual impairment. Startlingly, about half of these children die within a year of becoming blind - often due to associated protein-energy malnutrition and increased susceptibility to respiratory and diarrheal infections. Vitamin A deficiency also puts children especially increased risk for measles.

What can we do on behalf of children like this? Prevention of vitamin A deficiency includes breast feeding, promotion of vitamin A rich diets, food fortification with vitamin A, and vitamin A supplementation. In communities with vitamin A deficiency children age 6–59 months should receive two doses each year. Vitamin A supplementation is very inexpensive and effective. In 1997 alone, some 300,000 child deaths were prevented by vitamin A supplementation in developing countries. In the case of this child, unfortunately, corneal transplantation is likely the only option to prevent blindness.

Will You Bring ‘Good News’?

When Bill Gates or Bill Clinton have an important announcement, whom do they call? CNN, FOX, and MSNBC - of course. But when God announced the birth of our Messiah, he chose the lowest people in society - the equivalent of our landscapers and waste collectors - to receive and disseminate the news. Luke 2:8 describes the scene, “And there were shepherds living out in the fields nearby, keeping watch over their flocks at night. An angel of the Lord appeared to them, and the glory of the Lord shone around them, and they were terrified. But the angel said to them, “Do not be afraid. I bring you good news that will cause great joy for all the people. Today in the town of David a Savior has been born to you; he is the Messiah, the Lord.”

Why would God take such a counterintuitive approach to news announcement? Clearly it was to draw attention to God’s concern for those who are poor, sick, abused, downtrodden - forgotten by the mainstream. Would you join me today in asking ourselves, what are we doing on their behalf? What serious, intentional commitment can we make in the coming months to lift up the poor? In what way will we join the chorus of the angels is saying, ‘I bring you good news…?’

Literacy Development Case Study: Central Asia Institute

I continue to be impressed with the close association between physical health and grown in literacy and general education. One of the most celebrated successes in literacy development surrounds the Central Asia Institute (CAI) whose mission is to promote and support community-based education in remote regions of Afghanistan and Pakistan. As of 2010, CAI had successfully established 145 schools in Pakistan and Afghanistan, providing primary school to over 64,000 students, with an emphasis on girls’ education. Built on the philosophy of empowering local people through their own initiative, CAI also makes investments into teacher training, and more recently has expanded their projects to include vocational skills training and school health promotion. CAI began as the dream of one man, Greg Mortenson, who with perseverance and integrity cast an inspiring vision that thousand of others are now pursuing. Development of CAI is documented in the book Three Cups Of Tea.

War, Health, And Whatever Is Necessary

Contemplate for a moment the impact of war upon health… During World War I, roughly 5 percent of causalities were among civilians. In World War II, this figure rose to 50 percent. In the wars since 1980, fully 80 percent of deaths have been inflicted upon CIVILIANS. The British Medical Journal reported in 2002: “In many war zones, violent deaths are often only a tiny proportion of overall deaths. Populations face a deterioration of their already poor health status, and excess deaths from infectious diseases will usually outnumber deaths due to direct violence.” Highlighting a recent survey from eastern Congo, “Of an excess mortality of 2.5 million, only 350,000 were because of direct violence; most died from malnutrition and disease.” Clearly those of us in health leadership must make mitigation and resolution of military conflicts one of our highest priorities. For most, this is not our background by training. But our role demands that we undertake whatever is necessary to fulfill the worthy defense of life.

Essay 12: Gifted Obsession To Counter Depression

It’s February. Christmas festivities are long past. Those New Year’s resolutions that briefly infused inspiration are already becoming forgotten. The short, often gray days of winter layer a sense of gloom, even cynicism, over our moods. Valentine’s day is approaching, whose reminder that we ought all to be “in love” often makes it the holiday people love to hate. Then come the bills in the mail. Those credit cards from Christmas, property taxes, and, oh yes, it’s time to start preparing year-end income tax returns, too.

No wonder people become depressed in February! Suicide attempts climb. Mental health facilities fill up. Counselors start overbooking their schedules. And, oh, observe the soaring number of prescriptions filled Prozac, Ativan and Elavil! Justifiably, people want a cure from for the wintertime blues. But counselors start at $75 per hour. Medications take weeks to begin working. And when we’re honest about it, who really wants to be in therapy?

Let’s consider a “new” solution: selfless giving.

Selfless giving is a cure for melancholy and depression that is rooted in generosity towards others. But its therapeutic results don’t stop there. In his landmark book, Give To Live, Douglas M. Lawson, PhD, reveals the findings of extensive research on the health effects of giving. It didn’t matter much what people gave away. Gifts of time, money, or material possessions all had a similar affects. The factor that mattered most was the frequency and the attitude with which people gave. Those who made giving a regular part of their lives experienced a longer life expectancy, increased immunity, improved blood circulation, better sleep, and significantly less depression.

One of the most visible examples of therapeutic giving’s results can be seen in the life of Andrew Carnegie. This impoverished Scottish immigrant worked his way up to establishing the Pennsylvania steel industry in 1865, and by 1900 sold it for $480 million. But Carnegie hit a snag along the way. He became plagued by despair and paralyzed by physical illnesses linked to depression. His solution? Give away his wealth!

In 1889 Carnegie wrote The Gospel of Wealth, in which he stated that all personal wealth beyond what was required by one’s family should be regarded as a trust fund to benefit the community. Carnegie added, “The man who dies thus rich dies disgraced.” Carnegie established educational organizations that, among other objectives, founded 2,509 libraries around the world. Carnegie also became known as one of the most exemplary and joyous philanthropists of his day.

Few of us have access to the material wealth of Carnegie, but the power of giving is no less inspirational. For me personally, the example of Albert Schweitzer is most compelling. Schweitzer was not particularly blessed with financial resources. But he was a very wise man. By age thirty, Schweitzer had completed three PhD degrees in philosophy, music and theology. He had also become a popular author, whose books were widely read in Europe and America. But still, Schweitzer found his life incomplete.

In his autobiography, Out Of My Life And Thought, Albert Schweitzer wrote, “It struck me as inconceivable that I should be allowed to lead such a happy life while I saw so many people around me struggling with sorrow and suffering… I had already tried many times to find the meaning that lay hidden in the saying of Jesus: ‘Whosoever would save his life shall lose it, and whosoever shall lose his life for My sake and the Gospel shall save it.’ Now I had found the answer.”

Schweitzer resolved to leave the university where he taught, and to instead become a ‘jungle doctor’ and establish a hospital in equatorial Africa. His friends and relatives reproached him over the folly of such an idea. Why waste such a glorious, gifted career to serve faceless Africans on another continent? Schweitzer prevailed over their protests and entered medical school in Germany. Next, using the funds earned from his own book royalties and personal appearances, Schweitzer moved to Gabon in 1913 where he began caring for ill Africans and constructing a hospital. Most of the rest of his life was devoted to the health care of the people in the region.

Far away but not forgotten, Schweitzer welcomed journalists to Gabon, whose reporting on his ministry inspired an entire new generation of medical missionaries. In 1952 Schweitzer received the Nobel Peace Prize, and used the money to further expand the hospital and leprosy center. In 1955 Queen Elizabeth II awarded Schweitzer the Order of Merit, Britain’s highest civilian honor. And of the personal, emotional impact of his ministry, Schweitzer wrote, “It amazed me to experience how serving the love preached by Jesus sweep me into a wonderful new course of life!”

As we ourselves pass through life’s valleys and turmoil, where shall we turn for relief? Indeed, some people benefit enormously from counseling or medication. But we also do well to consider adding the “natural,” timeless remedy of therapeutic giving. This does not necessarily mean a radical move to Africa. Rather, begin with simple steps towards becoming more generous. Give to a charity. Sponsor a child. Coach a team. Volunteer at a hospital. Offer your skills to a non-profit organization. Give for the sheer sake of giving, and without expectation of any external reward. I trust that you will eventually resonate with Schweitzer’s observation: “I don’t know what your destiny will be, but one thing I do know: the only ones among you who will be really happy are those who have sought and found how to serve.”