INMED Blogs

What’s The Best International Healthcare Training?

As a medical student I dreamed of sharpening my skills on behalf of the world’s most poor. I dreamed of attending the esteemed John’s Hopkins School of Public Health, taking the diploma course at the London or Liverpool School of Tropical Medicine and Hygiene. What escaped my notice at the time was that I could spend years in such institutions and never actually care for a person suffering from measles or malaria. The most valuable learning experience actually proved to be none of the above. One afternoon shortly after arriving in at the Kalukembe Hospital in Angola a mother brought her five-year old child to me urinating blood. I supposed that, just like similar patients back in the United States, he was suffering from a urinary tract infection. I mentioned my diagnosis to my supervisor, Andreas Rohner, the Swiss physician to the left in the above photo. Andreas chucked, “No Nicholas,” he mused, “the boy has urinary schistosomiasis.” Sure enough, his urine analysis demonstrated the schistosome eggs.

Now clearly some individuals learn best via reading or seeing. But most of us, myself included, experience learning most powerfully through real-life experiences. I’d read about schistosomiasis before. But the experience of actually caring for such a patient proved far more beneficial. It’s this line of reasoning that is the foundation of INMED’s Certificate, Diploma, and Fellowship programs. Little else matches the high learning value of supervised, mentored service-learning experiences.

Pregnancy Can Be Dangerous!

Some 600,000 women die worldwide each year from pregnancy-related causes, and 98 percent of these deaths occur in developing countries. The major causes of maternal deaths in developing nations, in numerical order of importance, are hemorrhage, peripartum sepsis, abortion, eclampsia and obstructed labor/ruptured uterus. Regarding the latter, obstructed and prolonged labor alone leads to about 40,000 maternal deaths annually. Newborns who survive often suffer long-term complications related to birth anoxia. Mothers who survive frequently develop rectovaginal fistula or vesicovaginal fistula. The consequences of such fistulas are especially severe for young primiparas for whom social ostracism and divorce often follow.

What can we do about this travesty? Beyond contraception and family planning, the greatest opportunity to improve maternal outcomes lies in improving the quality of obstetrical care. Research demonstrates that communities that provide essential obstetric services can obtain remarkable improvement in obstetrical outcomes. Encouraging experience in Sri Lanka, for example, shows that even providing only some of these essential services can result in major maternal health improvements.

What We Never Talked About In Medical School

How would you work to improve the health of an entire community, rather than just one person at a time? We NEVER talked about this when I was in medical school, not even during our tiny public health course. I could wax poetic concerning all the reasons for focusing on health needs of individuals rather than on groups. I could cite, for example, financial reimbursement systems that recognizes only health services for individuals, or how our society tends to place a higher value on personal well being as opposed to corporate success. But ultimately, I find that our attraction to individual health is a matter of modeling. Our professors instruct us with this disposition, so we in turn practice in this way, and further instruct our own protégé to follow in our ways.

I later experienced first hand in urban China and rural Angola how such a approach is both inefficient and ineffective in addressing widespread health issues. Passionate about sharing my discoveries, INMED just published the International Health Leadership Self-Paced Course. This course requires only about three hours to complete, and embodies what I learned the hard way through years of experience.

What’s Your Global Health Curriculum?

What curriculum do you use to complement global health classes, international electives, study abroad, or even cross-cultural competency? Unfortunately, most universities and residency programs have little to offer beyond thick textbooks. For the last year,  Micah Flint and I have been creating for INMED a new series of online, self-paced courses covering the major global health topics: International Public Health, Diseases Of Poverty, International HIV Medicine, Cross-Cultural Competency, International Health Leadership, and Disaster Medicine Management. Each course peer-reviewed, interactive and also Continuing Medical Education accredited. We would like to invite you to browse the courses and work through the sample questions. Click here to view the courses.

Who Will Care For The Manuels and Gabriels Of Tomorrow?

Yesterday the medical team of Lubango Evangelical Medical Center returned from their spiritual life conference. My timing to volunteer each July is primarily to provide the vacation coverage they need. Tonight as I walked the wards tonight of our little hospital my thoughts turned to Manuel with the infection that ate away his entire jaw and chest, and Gabriel who nearly suffocated on a fish bone.

The medical staff of our center is mainly made up of volunteer expatriates, in spite of enormous effort to change this fact. We benefit from two part-time Angolan physicians. But the truth remains that the future of this healthcare ministry is in the hands of the Angolan people themselves. Canadians, Brazilians and Americans are not long-range solution. I ponder to myself, who will care for the Manuel and Gabriel of tomorrow? It will certainly not be a foreigner like myself, but Angolans standing up and caring for their own.

Sadly, We Can’t Help Everyone

Today in the midst of “normal” cases of malaria, amebas, schistosomiasis, I was summoned to see Feliciano. This boy of 6 was accompanied by his dad, who explained how over the last 4 months his kid has lost the use of his left arm, walks with an increasing limp, and now his mouth deviates to the right side. All these signs point toward a mass in Feliciano brain. His father gathered 4 months wages and paid the Chinese in Lubango for a CT scan, pictured. As I described the brain tumor, Feliciano’s father burst into tears. I immediately emailed the CT scan images to the Children’s Mercy Hospital in Kansas City, but I also felt a growing lump in my throat, for we really have no means at all out here to treat such a cancer. After a few moments the father said to me, “My son is in God’s hands. Can we pray together?” and he launched into the most beautiful adoration, thanking Jesus for the privilege of these years with his son and for courage in the coming trials. As he closed the prayer, I found that I was the one in tears.

Just What Is The Gospel?

At the Angolan medical center I’m presently being accompanied by four Canadian medical students. They are very sharp and eager to learn. The faith-basis of this facility is new to some. One student asked, “Just what is the Gospel?” That question caused me to ponder Jesus quoting Isaiah in Luke 4:17-18, “The Spirit of the Lord is on me, because he has anointed me to preach good news to the poor. He has sent me to proclaim freedom for the prisoners and recovery of sight for the blind, to release the oppressed, to proclaim the year of the Lord’s favor.” This freedom that Jesus describes is usually interpreted in a spiritual sense to mean release from the guilt and renewal of our relationship with God. But I can also also see a strong call for actions of compassion. Our deep desire here is that our words and our work of compassion both point toward Jesus.

It’s Not All Work

Early this Sunday morning I visited the church that meets in the community just outside of town. The singing and message were both in Portuguese and Umbundo, the local language. I adore how the people clap and beat the drums and books and dishes to the rhythm of each song. Then, often we’re off for a hike into the gorgeous landscape of cliffs, ridges, ravines, waterfalls, and escarpments where the highlands fall off abruptly to low elevations that precede the extensive beaches. Yes, the local say there are snakes, but thank goodness I’ve never seen one. This weekend I also explored the city market. Imagine thousands of native Africans with hundreds of little shelters pack back to back, and throngs of people pressing around, bartering for clothing, food, jewelry, cement, Coca-Cola, cell phones, pillows. And while all of you ago home are suffering in 100 degree weather, here is just 70!

Convulsions In Africa

This afternoon a mother was at home alone with her boy, whose temperature was 105. Suddenly his eyes rolled back and he had a seizure, flailing his arm and legs. Minutes later I received a distressing call from the emergency ward. This 18-month old was still convulsing and barely breathing. Convulsions here in Angola almost always mean malaria of the brain or meningitis - not the benign ‘febrile seizures’ like we see among children in the United States. When I examined the boy I discovered pneumonia, but with little in the way of tests to diagnose him more specifically, I simply treated him for all three infection - just in case. We also prayed of the little boy. Perhaps you’d join me?

Is There Hope For This Child?

This morning a father arrived at the hospital in Angola with his son, Josifas, whose photo I took with his permission. This boy of eleven was leaning over a cooking fire, when his shirt erupted into flames. Living in the bush, his family simply covered the wound with strips of cloth, linen that became stuck to the wound such that it could not be removed. The results of these tight contractions of skin are that he cannot close his mouth and is speech is indiscernible.

Is there hope for Josifas? Indeed. We will give him an anesthetic, release the contacted skin with multiple incisions, and place skin grafts over the newly exposed tissue. After the skin grafts are well attached, he’ll begin physical therapy to increase the motion of his neck and mouth. Three or four months from now Josifas, with lots of courage and coaxing, will be speaking and swallowing and even looking more like a healthy child.