March 2nd, 2023 by Nicholas Comninellis
Posted in Disaster Management|

The earth would occasionally rumble under my feet as a child living with my grandmother in Greece. We ran outside of her brick home; fearful it would collapse and kill us. One month ago, just 400 miles away in Turkey and Syria, earthquakes did indeed collapse thousands of homes, instantly killing 50,000 people – the same number of US soldiers who perished in the Vietnam War. The extent of this tragedy is almost unimaginable, and 1 million people are now homeless.

How shall we – people who enjoy relative affluence – respond to this catastrophe? In the coming weeks and months, survivors will be afflicted with hunger, cold exposure, unsafe drinking water, contagious diseases, and marked depression and anxiety. In the short term. your immediate donation of time or treasure to a reputable relief organization is especially strategic. INMED highly recommends Heart-to-Heart International (HHI), headquartered in greater Kansas City. At this moment, HHI is distributing trauma emergency surgery kits, deploying stand-alone portable medical trauma clinics, and sending the most-needed medicines and supplies, including analgesic medications, bandages, and crutches. You can also meet HHI staff in-person at the Humanitarian Health Conference on June 9-10.

In the long-term, how can we support sustainable infrastructures that will both prevent and more effectively respond to upcoming cataclysmic disasters? This broad question requires answers from multiple disciplines, including construction, governance, law-enforcement, and public safety. Within the discipline of healthcare education, professionals must be better equipped with critical disaster response and prevention skills – INMED’s particular forte. Each major INMED education program includes Disaster Management coaching.

Next time the ground rumbles, waters rise, tempest blows, or fires encroach may we all be well equipped for immediate and long-term response.

February 17th, 2023 by Nicholas Comninellis
Posted in International Public Health|

Last week, Jimmy Carter – 39th US President 1977-1981 – entered hospice care at age 98. Post-presidency, Carter focused his energies on distinguished humanitarian pursuits: launching Habitat for Humanity, negotiating cessation of international conflicts, instructing biblical truths, and leading the march to eradicate a human infection.

Dracunculiasis, or Guinea worm infection, is a parasitic disease acquired by humans who drink water contaminated with its eggs. Within the human intestine, these eggs develop into adult worms about 1 m (3 feet!) long that penetrate the intestine and begin migrating through the body until they reach the skin. Once the parasite detects water nearby, it begins to emerge through the skin inflicting unrelenting, debilitating pain upon the sufferer.

No successful medication, vaccine, or other treatment has been discovered. Management of this disease remains the same as it has for millennia: raping the emerging worm on a stick and slowly extracted over a period of weeks.

In the 1980s, about 3.5 million new cases were reported in eastern, central, and western Africa – primarily in the countries of Ethiopia, South Sudan, Angola, Mali, Chad, and Cameron. It occurs mainly within very low-income communities where water and sanitation infrastructure are undeveloped.

In 1986, a coalition of international partners, including the World Health Organization and the Carter Center, began a systematic program to both track the occurrences of the disease and educate communities regarding prevention. Effective prevention efforts include provision of safe drinking water, application of approved chemical agents to kill the parasite in contaminated water, and educating Community members to properly dispose of fish guts which breaks transmission of the parasite eggs.

So successful has been these efforts worldwide trust 25 cases were reported in 2016 and only 10 cases in 2021. Successful eradication of Guinea worm would be only the second time in history – following smallpox eradication – that a human infection has been entirely eliminated. A distinguished pursuit indeed!

February 3rd, 2023 by Nicholas Comninellis
Posted in INMED Grads In Action|

“Over the last year and one-half I have set foot in four continents, been a part of five conferences, lost a few team mates, welcomed others, and spoken languages I haven’t used in years. Captured below is a summary of the last few months in pictures. May you be blessed to see what the Lord is doing around the world!” – The words of Caren Abraham, DDS. In 2015, Caren began studying at INMED, and in 2019 earned the INMED Professional Diploma in International Medicine and Public Health (DIMPH) which included her supervised dental care service-learning experience in East Africa.

Caren continues, “Thank you to each one of you for upholding me in your constant prayers. Behind these highlights have been many challenges, but God has watched over me through them all. I pray that these photos give you a glimpse into the work that is happening on our side of the globe and help you know that your prayers and financial investment are not in vain.”

Caren is preparing to move back to Kenya to continue providing long-term dental care. Contact Caren Abraham at [email protected].

January 20th, 2023 by Nicholas Comninellis
Posted in International Public Health|

What great advances in international health have resulted from research? Measles vaccine, HIV drugs, malaria bed nets, tobacco controls, basic newborn resuscitation, to name a few. But profound international health challenges remain that can only be vanquished through continued scientific investigation. Some of these challenges include the quests for more effective tuberculosis vaccines, successful cardiovascular polypill, low-cost cancer treatments, and road trauma prevention.

The Humanitarian Health Conference, June 9-10 in Kansas City, is an opportunity for students and researchers of all experience levels to share their insights to an altruistic audience. We invite Poster Presentation subjects in three categories: global health education, research or innovation, and case study. For examples, please view the 2022 Poster Presentation Participants and Award Recipients. That’s right, awards and cash prizes for the premier poster presentations! More importantly, poster presentations can expand your professional network and advance your career qualifications. Please view the Poster Presentation Information and submit by May 25, 2023.

What great advances in international health are just over the horizon? Participating in the Humanitarian Health Conference is an ideal opportunity to contribute to the science, increase your healthcare skills, connect with volunteer organizations, and ultimately to advance the welfare of all humankind.

January 6th, 2023 by Nicholas Comninellis
Posted in International Public Health|

This provocative question evokes sentiments of national pride, social justice, and personal experiences. It’s also a pivotal question, influencing the design and resources for healthcare. A compelling follow up to “Who has the very best healthcare?” is to clarify, “By what criteria shall we judge quality of healthcare?” Consider the following benchmarks:

• Cost. Health expenditures per capita loosely correlates with quality of healthcare. United States: $11,800 per person, Canada: $5,800, Chile: $2,400, Turkey: $1,300, Ghana $221
• Health Outcomes. Commonly used measures include life expectancy, child mortality, and years of potential life lost. Life expectancy in the US: 79, Canada: 83, Chile: 80, Turkey: 78, Ghana: 63.
• Compassion. Authorities broadly agree on the essential nature of compassion in healthcare. Yet scholarly research has yet to identify an acceptable objective measure.

Compassion is a virtue better observed or experienced than quantified. Muhammad is a 13-year-old in the nation of Ghana, west Africa. For months he has suffered from severe scabies, an infestation of the skin causing relentless itching, weight loss, cellulitis and sepsis. See the above left photo. The volunteer physician caring for him in Ghana, Burton Adrian, is a graduate of the INMED Master’s Degree in International Health. Dr. Adrian made the diagnosis, and upon discovering that the needed medication was not available, he searched the country to locate it. Muhammad’s photo on the right was taken two months after treatment.

“Who has the very best healthcare?” Those who receive it with compassion! On Fri-Sat, June 9-10, INMED is hosting hundreds of professionals like Burton Adrian at the 2023 Humanitarian Health Conference. This gathering will increase knowledge and skill surrounding diseases connected with poverty, community health and development, and career decision making. Moreover, the 2023 Humanitarian Health Conference could be your very best opportunity to talk together with inspiring colleagues, whose priority is health care infused with compassion.

December 23rd, 2022 by Nicholas Comninellis
Posted in Low-Resource Healthcare Pearls|

Maria, the seven-year-old girl in this photo, presents to you at the Clinical Evangelica Morava on the remote western coast of Honduras. Her parents explain that five days ago she suddenly developed fever, vomiting, severe headache, and pain on moving her eyes. Several other children in the neighborhood have been similarly ill since the onset of the rainy season with its customary heat and mosquitoes.

On physical examination you note that Maria is lethargic, has generalized lymph node enlargement with clear lungs and a slow heart rate relative to her fever of 39 degrees. She has a fine rash on her extremities. You quickly perform thick and thin blood smears with Giemsa stain, but you do not identify any ring-like Plasmodium parasites within red blood cells that would suggest malaria.

Your initial differential diagnosis is broad: influenza, dengue, typhoid fever, mononucleosis, malaria with negative blood smear. You initiate intravenous fluids and antipyretics. Over the next hours Maria develops hypothermia, severe abdominal pain, persistent vomiting, decreased mental status, and bleeding from her gums and nose. You now suspect the Maria is suffering from dengue – an arbovirus infection.

Which ONE of the following is a characteristic of severe dengue fever?

A. Leukocytosis with increased band forms
B. Increased urinary output
C. Abnormal vascular permeability with spontaneous bleeding
D. Predictable improvement in response to gamma globulin infusion
E. Decreasing hematocrit

Explanation: Abnormal vascular permeability with spontaneous bleeding, fever, and low platelet count are key criteria for diagnosis of severe dengue fever. Leukopenia (low white blood cell count), increasing hematocrit, and decreased urinary output commonly accompany severe dengue fever. Gamma globulin is of no therapeutic benefit. The correct answer is C.

You continue to treat Maria’s hypotension and shock, taking care to not administer aspirin or nonsteriodal anti-inflammatory drugs (NSAIDs) as they may increase bleeding tendency. Vitamin K supplementation may be useful given her coagulopathy, but the Clinica has none in stock. Meanwhile, Maria’s parents politely but persistently press you for information about her illness.

Of the following statements about dengue fever which ONE is NOT true?

A. Dengue vaccine is indicated for administration to people living in regions with high mosquito density.

B. The vector for dengue is the Aedes aegypti mosquito.

C. Dengue most commonly occurs in Southeast Asia and Latin America.

D. Treatment is essentially supportive with particular attention to hemodynamic status.

E. Infection may progress to complications that include hemorrhage and shock.

Explanation: WHO recommends the dengue vaccine CYD-TDV for people ages 9 to 45—only in geographic settings with a high burden of dengue disease and only be given to persons with confirmed prior dengue virus infection. The vector for dengue virus is the Aedes aegypti mosquito, which feeds during the early morning and late afternoon. The mosquito is adapted to the human habitat, often bites indoors, and breeds in small quantities of water. Dengue is distributed throughout the tropics, causing sporadic cases or large epidemics, especially in Southeast Asia and Latin America. Commonly recognized complications include thrombocytopenia, bleeding, and hypovolemia. Treatment is supportive, with particular attention to hematocrit, blood pressure and urine output, and adequate hydration. The correct answer is A.

Reference

World Health Organization. Dengue and severe dengue. http://www.who.int/mediacentre/factsheets/fs117/en/. Accessed January 1, 2023.

Dengue fever is a classic disease of poverty – one associated with insects and poor housing, and one that calls for broad social development as well as medical interventions. The heartening response of many to Maria’s illness is to offer their personal time and talent to protect those like her. Together let’s continue to emphasize interventions that empower marginalized communities to combat poverty and to care for their own.

December 9th, 2022 by Nicholas Comninellis
Posted in International Health News & Inspiration|

At Christmas time we focus most on the details of Jesus Christ’s birth: the prophecies, star, virgin mother, impoverished setting, jubilant angels, and frightened shepherds. These indeed are intriguing and worthy of celebration. But let’s look deeper beyond the details of how Jesus came and inquire why Jesus came.

Jesus’ contemporaries largely hoped and anticipated that he would be their liberator from the oppression of harsh Roman rule. They expected Jesus and his followers would win political power and rule by decree. Similar sentiments exist even into today. But look carefully into the public statements of Jesus, recorded by the four independent authors of the Gospels, and the purpose of coming described by Jesus himself appears markedly different:

Rather than rule by way of might, Jesus advocated humble service to one another. Mark 10:42-45 declares, “Whosoever wishes to be great among you shall be your servant, and whoever wishes to be first among you shall be slave of all.” What an extraordinary contrast to the hierarchical and dictatorial structures that characterize most human societies. Jesus advocates a polar opposite definition of power (leading by example) and greatness (humility in service to one another). Many INMED grads continue to prioritize this modality of service towards humanity.

Jesus closes this short discourse with another profound statement: “For even the Son of Man (his title) did not come to be served but to serve, and to give his life a ransom for many.” What compelled Christ to come and give his life was not simply to model a lifestyle, but also to redeem the sin of humankind. For deep dive into this greater purpose, read Jesus’ explanation documented in John chapter 3.

November 25th, 2022 by Nicholas Comninellis
Posted in Low-Resource Healthcare Pearls|

What 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, 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 of birth will likely mean death, and for this reason some one million babies die each year.

The bright side of this situation is that assisting babies with simply, immediate resuscitation is usually lifesaving. Stimulating a baby, keeping he or she warm and dry, and providing ventilation when necessary is often all that is needed to guide a newborn through the critical transition to life outside mother’s womb. Through my personal experience 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 basic newborn resuscitation skills.

Helping Babies Breathe (HBB)  is an evidence-based 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. HBB has a companion course, Essential Care for Every Baby and Small Babies, that provides additional important newborn health skill, INMED provides Helping Babies Breathe and Essential Care for Every Baby and Small Babies at least twice each year, and next in Kansas City on June 7-8, 2023. Equip yourself to help one million babies each year survive life’s most dangerous day.

November 11th, 2022 by Nicholas Comninellis
Posted in Low-Resource Healthcare Pearls|

Malnutrition especially impacts pregnant women around the globe. The challenges of food security, poverty, anemia, malnutrition, low birth weight, and failure to thrive are all inextricably interwoven. Worldwide, the effect of protein-calorie malnutrition is correlated with low-birth-weight infants, maternal anemia, preterm labor, immune suppression, and loss of work productivity.

Maternal causes of newborn low birth weight include all EXCEPT which ONE of the following?

A. Protein malnutrition

B. Intestinal malabsorption

C. Iron deficiency anemia

D. B vitamin deficiency anemia

E. Eggs and beans as primary source of dietary protein

Explanation: Malnutrition and anemia are challenging for any person, but the added complication during pregnancy is that all forms of malnutrition and anemia can reduce fetal growth. Treating malnutrition and anemia with supplementation of calories, protein, iron, and vitamin B improves fetal growth and birth outcomes. Soybeans, black beans, pinto beans, lentils, white beans, and black-eyed peas are among the variety of superb bean protein sources. The correct answer is E: Eggs and beans as primary source of dietary protein.

October 28th, 2022 by Nicholas Comninellis
Posted in INMED Grads In Action|

“Ebola and HIV/AIDS were the reasons for me coming to Africa. I’ve been through 4 Ebola outbreaks so far,” says Luc Victor, United Nations physician in east Africa. “In the last 36 days we’ve had 109 confirmed cases of Ebola and 51 deaths.” Sadly, 15 of these deaths were among healthcare personnel. But Dr. Victor is undeterred. “I have been living and working in the African continent since 2006. I always wanted a career in healthcare. I also wanted a job that involved the international humanitarian relief and the international diplomatic spheres.” In pursuit of these opportunities, Dr. Victor earned the  INMED Professional Certificate in International Medicine and Public Health, and is now about to complete the Master’s Degree in International Health.

“Studying international public health definitely gave me further depth and breadth in my current career path,” observes Dr. Victor. “It’s really heartbreaking when it comes to protection of civilians.  The innocent indeed are the first and sometimes the only ones that suffer. Although healthcare should not necessarily involve politics and diplomacy, in peacekeeping the politics and diplomacy are needed to make sure everyone is safe from the most exigent harm – the scourge of war, unrest, and diseases like Ebola that kill two-thirds of people infected.”