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| WHAT'S YOUR FORMULA FOR HEALTH? |
What is the best formula for physical health? Actually, it depends upon whom you ask. People of some Asian cultures think that to be healthy they must eat snake, do Tai Chi, worship their ancestors, and never, ever give blood. Those from particular African cultures believe to be healthy they must eat a special plant root, avoid exercise, offer sacrifices to the local gods, and be bled periodically. Many who are nurtured in North America hold that to be healthy they must drink red wine daily, do yoga, have nothing to do with gods, and regularly give blood to be tested in a laboratory.
Can you imagine the disagreements if you bring such diverse people together into a healthcare setting? Truth is, these conflicts are a daily fact of modern medicine. People seeking healthcare in North America are increasingly global in their make up. Some 50 million are from distinct cultures and operate with understandings of physical wellbeing that are unfamiliar to most healthcare professionals. Nevertheless, we must effectively interact with these individuals and families to be successful in assisting them. For this very reason, we are offering the 2010 INMED Cross-Cultural Competency in Healthcare Symposium on October 1, 2010. What steps can be taken to cross the gulf that divides patients and providers of dissimilar backgrounds? The first is to understand their perspectives. Paul F. Basch, Professor of International Health at Stanford University observes, "Many culturally influenced behaviors have important health consequence. It may be our intention to try to modify the behaviors of other people in ways that we consider beneficial - that is, to immunize their children, to maintain sanitary conditions during childbirth, or to plan their families. Such efforts are unlikely to result in the desired changes if we do not understand why behaviors are as they are." Just how can we go about gaining such understanding? Here in the Kansas City area, the home of INMED, we have many residents of Bhutanese, Croatian, Turkish and Ukrainian roots. We must begin by assuming we know little at all about such people, and by asking them to enlighten us through questions such as "Among your people, what causes children to have fever? ...what is the ideal family size? ...what roles do spirits have upon health? ...when is it acceptable to seek medical care?" and so on. Time spent simply chatting like this will reveal significant insights that improve our care. These conversations also create another invaluable benefit: trust. In many cultures, a relationship is better established through more informal interaction than through professional consultation. Today's proficient healthcare professional must be skilled at building effective relationships with people of diverse backgrounds. Increase your own skills by taking advantage of events like the 2010 INMED Cross-Cultural Competency in Healthcare Symposium, and then apply your skills to help patients discover their most appropriate formula for physical health. |
| SUSTAINABLE HEALTHCARE FOR THOSE MOST POOR |
"Doctor, come quickly!" The nurse's voice carried a tone of urgency that matched his message. I rose rapidly and entered the chilly night air. Moments later, in the children's ward at Angola's Kalukembe Hospital, I met a distraught father carrying Maria, his five-year old daughter. "She's coughed for days," he explained with distress. Still in his arms, I unwrapped the blanket surrounding his girl. But too late. She took her final gasps and fell limp.
Early death is an inconsolable fact of life. In the world's poorest nations, like Angola from where I'm writing now, a quarter of children like Maria die before reaching school age, and adults can hardly expect to live much beyond age forty. Such disturbing truths motivate many healthcare professionals to do something bold on behalf of the world's most disadvantaged people, whether in the safety net clinics of North America's urban centers, or in the humblest healthcare posts dispersed throughout the developing world. Despite enormous efforts, such healthcare initiatives are in danger of being swept away, threatening both the good intentions of providers and the last hopes of those like Maria's father - swept away for lack of resources, chiefly the anchors of personnel and money necessary to support these upstanding efforts. A disturbing number of facilities serving the most poor have closed over the last decade, primarily in communities where they are most essential. A growing number of us ponder the vexing question, How can we assure sustainable healthcare for those who are most poor? Some suggestions, like focused prevention efforts, are thoughtful and constructive, yet fail to address the most fundamental issue: poverty itself. If healthcare is so difficult to sustain for those who are most poor, why not direct our effort toward alleviating poverty? In his provocative book The End Of Poverty, Columbia University professor Jeffrey D. Sachs brilliantly illustrates how economic growth in the poorest nations - those where people live on less than one dollar per day - has brought with it unprecedented progress in physical health. In Bangladesh, for instance, per capita income has doubled since 1971, while life expectancy has increased from forty-four to sixty-two and infant mortality has fallen from fourteen percent to five percent. How does economic growth foster physical health? Through improvements in housing, nutrition, vector control, water and sanitation, general education, industrial safety, medical care, and incentives to reduce fertility. Healthcare professionals must illuminate the importance of economic development, encouraging and collaborating whenever possible. As Dr. Sachs points out, increasing international trade, currency stabilization, debt forgiveness, and progress towards the Millennium Development Goals are imperative for the poorest nations to climb from their insufficiency. On a smaller scale, Heifer International is providing sustainable food and income for marginalized communities through animal husbandry. And here in distant Angola, innovative projects are underway to provide low-cost roofing materials to families who would otherwise have only thatch for protection from the heavy rains. The INMED International Public Health Intensive Course provides a rich opportunity to gain skill in such broad-based initiatives. Professionals like you and I must be on duty when a father brings his sick daughter for our attention. But we must also be eager to champion those economic development efforts that would ultimately mitigate the chance of little Maria ever becoming ill: improvements in her nutrition, her education, her house, her water supply, and even the speed of transport that night she arrived just minutes too late. |
| CHRONIC DISEASE AMID CHRONIC POVERTY |
Quick, what is the leading acute cause of death in world's poorest nations? How about the second most common acute cause of death? The truth may startle you. Pneumonia as the leading acute cause of death is no surprise. But number two is coronary artery disease. No, not HIV, not diarrhea, not even malaria. It is simply arterial athersclerosis. And least you believe this an outlier, consider the fact that stroke - another manifestation of athersclerosis - is the fifth leading acute cause of death in the poorest nations.
Such straightforward epidemiology challenges one of the most popular misconceptions in the field of global health: the notion that infectious diseases - particularly the Big Three: tuberculosis, malaria and HIV - are the greatest plagues afflicting the world's most vulnerable peoples. The fact of the matter, conversely, is that non-infectious, chronic maladies severely burden those living in extreme poverty, and that such maladies worsen their poverty through both health care costs and lost wages connected with lost work. Healthcare leaders of bear the responsibility of translating these truths into effective interventions. Such interventions begin with recalling the role of risk factors. Whether coronary artery or cerebrovascular disease, whether in North America or southern Asia, the antecedents are hypertension, diabetes mellitus, tobaccoism, hyperlipidemia, and unhealthy diet. And, regardless of one's nation or latitude, the chief therapeutic aim is reducing the Big Five Risk Factors. But how can we facilitate control of hypertension, diabetes mellitus, tobaccoism, hyperlipidemia, and unhealthy diet in communities with meager healthcare resources? Management of episodic infections can be difficult enough, while the logistics of providing continuity care for chronic diseases can seem unattainable. For me, the issue was epitomized in the case of an African pastor, Valencio. At the time, I was living at the Kalukembe Hospital in Angola. Valencio presented with frontal headache and a blood pressure of 220/140. I supplied him with a thiazide diuretic and asked him to return in two weeks. When he presented again the clinic staff tried to send Pastor Valencio away because he stated that he felt no discomfort. When I succeeded in speaking with Valencio he was incredulous at the thought of continuing to take medication. "Malaria treatment is only 5 days, so why should I take blood pressure pills week after week?" We can help control chronic diseases in low-resource settings by developing straightforward management protocols and through assuring an adequate supply of basic medications. INMED invites you to explore these strategies further at the International Medicine and International Public Health Intensive Courses. But most important is often simply assuring that both staff and patients understand the nature and importance of these conditions. 'Chronic disease requires chronic treatment,' I often explain, and, 'Patients without symptoms may need continued treatment to prevent symptoms from appearing,' I urge. We must educate people at all levels to appreciate that arterial atherosclerosis is a greater threat than the Big Three Infections, and urge them to direct efforts toward reducing the Big Five Risk Factors. |
| PARTNERING WITH NATIONALS TO SERVE THE FORGOTTEN |
The doctor's intentions were entirely good. Why else would an esteemed and skilled professor venture beyond the security of a North American medical center? He was brave and confident. What other mindset could compel him to enter the fray of Angola, Africa? His expectations were very high. Was it any surprise that he was anticipating the expertise he would bring? His day of arrival was greeted with festivities. Why wouldn't the nationals celebrate the arrival of this physician who promised a year in service?
Quickly, problems arose. The Angolan nationals were polite, but they didn't follow the doctor's orders. But how else were his patients going to get their needed care? The doctor announced lectures and no one came. But hadn't the nationals urged him to teach them? They invited their guest to the upcoming holiday events, but the doctor declined. Hadn't God called him here to work, not to play? Just two weeks after arrival, the doctor packed up and returned home in utter frustration. He is not alone. Many well meaning healthcare professionals become quickly disillusioned as they realize that providing care around the world requires more than good intentions, skill and courage. It also requires effectively partnering with nations to serve their own forgotten people. Particularly astute in this field is Dr. Mani who on May 21-22 will share his insights at the Exploring Medical Missions Conference. A graduate of Vellore Christian Medical College in southern India, Dr. Mani trained in plastic surgery at the University of Kansas. From 1974-1995 he served as Medical Director of the Gene and Barbara Burnett Burn Center and as a consultant to burn care programs in Malaysia, Kyrgyzstan, Australia, and India. Dr. Mani urges that we take on the perspective of nationals themselves: "How can you walk into my home country and tell me how to solve my problems, how to raise my children, what to eat, how to dress and what to believe - however poor or forgotten I may be?" He cautions, "We must be very careful not to judge people by what we have and what they don't have. What is the 'last best word' in cooperating with someone in a different culture, country and faith tradition?" asks Dr. Mani. "I believe indeed the most essential word, is RESPECT...If you hope to make a difference, you need to understand the language, culture, traditions, religion and why they do what they do. Respect is the key to opening relationship doors." How could the new doctor in Angola have shown deep respect for his hosts and established the basis for an effective partnership? Were 'orders' appropriate from the outsider? Were 'lectures' interpreted as teaching in that culture? Was observing their holiday really only meaningless diversion? Dr. Mani urges an entirely refreshing approach to effectively partnering with nations to serve their own forgotten people:
Please take advantage of Dr. Mani's additional insights by joining us all at the Exploring Medical Missions Conference! |
| SERVING THE FORGOTTEN AMONG US |
Is it necessary to board an airplane in order to serve forgotten people? Need you learn a new language, acquire a passport or special vaccinations to aid those who are most neglected? Actually no. While you may feel compelled to go to such lengths, this fact remains: there exist untold forgotten people, the least of these, right here among us.
Often, those on the margins in North America are unemployed, under-educated, immigrants, and/or non-English speakers. Consider the plight of people living in Appalachia. Forty percent are in poverty, only ten percent of men graduate from high school, and overall life expectancy of these individuals is startlingly on the decline! North America has also received an influx of some 22,000 refugees from the Himalayan nation of Bhutan. These arrive with virtually no possessions and continue struggling to find housing, employment and healthcare. Hidden in our midst are also a multitude of sex slaves, domestics, garment, and agricultural slaves. The Central Intelligence Agency estimates that 50,000 are trafficked into or transited through the USA each year. Who is taking action on behalf of the forgotten? Standing tall among many is Rick Donlon, keynote speaker at this year's Exploring Medical Missions Conference. A family physician, Rick witnessed the crime, disease and poverty of those in inner city Memphis. So moved was Rick that in 1995 he mortgaged his own home to raise the capital necessary to open Christ Community Health Services - a medical care facility that has since grown to five locations, providing over 95,000 patient visits and delivering 800 babies annually among the poor of Memphis. Rick shares about one of these patients: "Fred is in his 30s and has been HIV positive for 10 years. He suffered serious opportunistic infections and had no appetite. Daily diarrhea reduced him to skin and bones. Fred was dying. Over a series of visits to our health center, we established a degree of trust with Fred and then initiated life-saving anti-HIV medications. By God's grace, the medications worked quickly and powerfully. Over just a few months, Fred's appetite returned, his diarrhea left, and he gained back more than 60 pounds. Though it once seemed impossible, Fred has returned to work!" What would you like to do on behalf of forgotten people? Start by considering those in need who are already in your midst: the truly poor, illiterate, homeless, abandoned, addicted, invalid, or hopeless. Then, connect with potential partners - individuals or organizations who share your vision and passion. Many of such character will be participating in the Exploring Medical Missions Conference and have overcome great obstacles in their service to the forgotten. And though following their footsteps will inevitably require similar struggle, be encouraged by the truly eternal significance of your efforts. Remember the scene described by Jesus in Matthew 25:37-40? "'Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?' The King will reply, 'I tell you the truth, whatever you did for one of the least of these, you did for me.'" |
| ACTION IN THE NAME OF LOVE |
Have you considered helping out in Chile or Haiti? Clearly, these acute crises in health will be palpable for months to come as the nations rebuild. There exist an abundance of opportunities for you who dream of serving people in critical need, who have polished your skills, and who are now ready for action "in the name of love" - as U2 sings.
What's holding you back? Some healthcare persons are concerned because they will be professionally challenged. Yes, indeed-and just like athletes training for the Winter Olympics, success necessitates such stretching and vigorous training. Physical safety worries others. But be reassured, by far the greatest hazard for international travels is motor vehicle accidents, not HIV nor malaria. Financial ramifications cause apprehension for some. Yet greater giving of our time and talent often leads to greater personal joy. Others doubt whether they can make any significant contribution. But the grateful expression of just one child can extinguish such reservations. Individuals who overcome these sorts of doubts inspire me as they take action on behalf of people struggling to survive under the most desperate conditions. One of these is Myrna McLaughlin. We met in June, 2009, when Myrna participated in the INMED International Medicine Intensive Course. Soon after graduation Myrna returned to Zimbabwe--a nation in southern Africa rocked by political turmoil, hyperinflation, drought, hunger, and staggering health consequences. In the midst of this mayhem Myrna is leading extraordinary efforts to train community health workers, provide mosquito nets for children, cover school fees for vulnerable children, supply seeds and tools for gardening, and provide primary health care to those in need. Are you waiting for a call to action? Perhaps the only cue needed is an illumination on the name of love. Myrna McLaughlin explains, "Love is a powerful verb. Love changes lives. Love cannot be contained or stopped. It must be expressed, for true love is creative, redeeming and giving. People recognize it and then may never be the same. Authentic love is demonstrative." Authentic, loving, demonstrative people: Myrna McLaughlin is one of them. Several hundred more like her will be gathering for the Exploring Medical Missions Conference. You too can be a woman or man of such character. It only requires decisive action in the name of love. What action will you take? |
| RENEW YOUR SKILLS |
The day following Haiti's earthquake I received this message from Dr. Jim and Sandy Wilkins, who have served at Haiti's Christianville Medical Clinic since 1999: "Our house fell down while we were in it. Our clinic building is half down. We worked for 24 hours straight, suturing and bracing fractures. 5 died here, 2 arrived paralyzed, many huge lacerations, limbs cut off. We are out of supplies and medicines. We are working on survival for the injured over the next few days. Keep praying!"
What if you were the Wilkins? Would you know what to do? The crisis in Haiti is a sharp reminder of both the precarious nature of human life and the enormous compassion of humankind. This crisis reminds us forcefully of the importance of skills. The most effective teams serving in Haiti today readied themselves well in advance for such catastrophes. The same fact holds true for healthcare professionals who serve people living in crisis everyday, whether in North America or nations like Haiti. Maggie Higgins, daughter of INMED's Board Member Ted Higgins, is quite intentional about learning such skills. She was studying under Dr Wilkins in Haiti when the earthquake struck. "Last night, a flood of people were showing up," Maggie wrote. "I've been doing a lot of nasty wound irrigations and debris removal. I basically took out a cement block from a young girl's head today. Luckily we have generators that are functioning and access to water. Even with all the pain and death that is going on - bodies have been piled up outside our clinics - I helped birth three babies in the midst of it all. I'm exhausted." But in spite of her exhaustion, days later Maggie Higgins gave up her seat on a Coast Guard evacuation helicopter to let on a severely injured Haitian. 
Now is the time to renew your skills on behalf of people in greatest need - to bear up and carry your dreams by acquiring the necessary competencies. These include competencies like managing malnutrition, unique injuries, and unusual infections; like acquiring cross-cultural skills, learning to train health volunteers, and to lead health initiatives. You may also come to realize that renewing your skills demands a change of heart as well - a personal journey from being self-centered toward becoming more softhearted.
This Spring INMED is offering remarkable opportunities to renew your skills. Our Certificate programs in International Medicine, International Public Health, and International HIV Medicine pair you up with a mentor like Dr. Wilkins who is providing healthcare in a developing nation. No training is more effective than working side-by-side with such role models! INMED's International Public Health and International Medicine Intensive Courses also provide the conceptual and academic background in these compelling fields. The future is certain to contain both acute crises like Haiti's and ongoing depravation in a multitude of poorer communities. Maggie Higgins continues taking steps so that, like the Wilkins, she will be best able to provide meaningful care. What steps will you take to express compassion and renew your skills on behalf of people in greatest need? |
| RENEW YOUR DREAMS |
Remember when you dreamed big? Peace Corps worker, concert pianist, research scientist, international medical volunteer. Remember when thoughts of grand accomplishments inspired your mind and energized your efforts? Weren't those exciting, life-giving days!
What's happened to your big dreams since then? In all likelihood, life happened. Your dreams moved to second, even third place, as you came face to face with financial limitations, family conflicts, career setbacks or even your own physical illness. Disillusionment set in as you were forced to compromise, and your dreams became fading memories. “Aspirations may indeed become distant, but they are difficult to lose entirely. Albert Einstein predicted while he was still in college that he would someday win a Nobel Prize. His next years were plagued by indebtedness, a broken marriage and estrangement from his sons, one of whom suffered from schizophrenia. Yet twenty-six years later, in 1921, Einstein prevailed, winning the Nobel Prize for physics, revolutionizing scientific thought and making possible many of today's technologies including photoelectric cells, lasers, nuclear power, fiber optics, and space travel. Marcy Lynn Coonce also dreamed big while she was still a physical therapy student at Ohio State University. But she hit some obstacles. Marcy comments, "I felt God was calling me to become involved with medical missions, but my university did not have many resources and I didn't know where to start." Marcy then connected with INMED, and with our assistance, Marcy went on to study and serve for three months at Vellore Christian Medical College & Hospital in southern India. Marcy reflects, "This experience made an enormous impact on my life. I grew more confident in my ability to handle difficult and challenging situations across the divides of culture and language. I grew more assured in my conviction to provide treatment for people who are in greatest need of health care." Dreams are never far removed from interruptions nor distractions, whether you're an Einstein or a student. I believe a key to keeping your dreams in focus is to surround yourself with others who share your aspirations, who fuel your goals. Indeed, "As iron sharpens iron, so one man sharpens another" (Proverbs 27:17). We at the Institute for International Medicine are all about assisting healthcare professionals to keep alive their dreams of serving the least served. Opportunities to connect with like hearted individuals abound, like the Exploring Medical Missions Conferences and the International Public Health and International Medicine Intensive Courses. Regardless of your profession or place in life, I implore you to reconsider your dreams, hold fast to the ones most worthy, to surround yourself with those who share your aspirations and to make 2010 a year in which your dreams take on life. What dream will you renew? |