Misconceptions About Medical Missions

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Misconceptions About Medical Missions

• Nicholas Comninellis, MD, MPH
• President, INMED
• - Institute for International Medicine -

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Presentation Objectives

• At the completion of this presentation,
  participants will be able to more effectively
• Recognize todays world health issues
• Identify barriers that deter health care
  professionals from international service
• Take actions to engage in medical missions

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Ours Is A Very Needy World

• Sudan 1993

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Island of Phuket,Indonesia, December 26, 2004

• 400,000 Dead

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Pakistan Earthquake2005

• 73,000 Dead
• 3 Million Homeless

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At A Glance Health in the Two-Thirds World

• 4 out of 10 go to bed hungry
• Life expectancy as low as 40 years
• Infant mortality as high as 30
• Medical services almost nonexistent except for
  the wealthy
• Most deaths are preventable
• TB, measles, malaria, diarrhea, HIV, trauma

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At A Glance Health in the Two-Thirds World

• 13 million persons die annually from preventable
  or easily treatable infectious diseases.
• In particular, greater than 10 million children
  under age 5 die each year from preventable
  diseases chiefly pneumonia, diarrhea, malaria,
  measles, and malnutrition.

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Prevalence of Poverty

• Todays poorest nations are near the equator
  southern hemisphere.

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Malnutrition

• Red and brown indicate those countries with most
  malnutrition.

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Malnutrition especially places children at risk
for death from common diseases like pneumonia or
diarrhea. Malnutrition is a contributing factor
is 56 of childhood deaths.
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World Population Growth
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Reproductive Health Fast Facts

• Pregnancy is a major health risk for women in
  developing countries.
• 600,000 women die worldwide each year due to
  pregnancy-related causes, 98 percent are in
  developing countries.
• Obstructed and prolonged labor leads to 40,000
  maternal deaths annually.
• Survivors frequently develop vaginal fistulas
  newborns often suffering from complications
  related to birth anoxia.

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Infectious Diseases

• Childhood vaccine preventable diseases
• Acute respiratory infections
• Enteritic infections
• TB
• HIV/AIDS
• Hepatitis
• Malaria

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Poverty Infectious Diseases

• Unsafe drinking water and improper disposal of
  human waste contribute to ecoli, typhoid,
  cholera, hepatitis, and helmithic disease.
• Crowded living conditions promote infectious
  respiratory diseases, including influenza and TB.
• Lack of medical care for ID is a greater
  problem in impoverished communities.
• Control of insect vectors, for example
  mosquitoes and flies, is often lacking in poorer
  communities.
• Programs that provide vaccination are also
  often lacking.

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World health priorities TB

• TB is most common in
• nations of poverty.

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Tuberculosis Current Crisis

• Tuberculosis kills at least 2 million people each
  year world-wide.
• Overall, one-third of the world's population is
  currently infected with the TB bacillus.
• 5-10 of people who are infected with TB
  eventually become clinically ill or infectious.
• Second leading cause of death from infection in
  the world - second only to malaria.

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TB - A Disease of Poverty

• Epidemic worsened by breakdown in health
  services, the spread of HIV/AIDS, and the
  emergence of multidrug-resistant TB.
• Poverty, malnutrition contribute to spread of TB.
• Global trade and travel enhance exposure.
• In industrialized countries, one-half of TB cases
  are among immigrants.
• Refuges and displaced people also increase TB
  transmission.

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World Health Priorities HIV/AIDS

• At the global level, the number of people living
  with HIV continues to grow - from 35 million in
  2001 to 38 million in 2003.
• An estimated 5 million people acquired HIV
  infection in 2003, the greatest number in any one
  year since the beginning of the epidemic.
• In 2003, almost three million were killed by
  AIDS over 20 million have died since the first
  cases of AIDS were identified in 1981.

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World Health Priorities Malaria

• A Global Pandemic. Leading cause of death in the
  developing world.

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Trauma Injuries

• 70 percent of the worlds motor-vehicle injuries,
  and 83 percent of the worlds violence-related
  injuries occur in developing nations.

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Solutions To These Problems Demand Coordinated
Efforts

• National Governments
• Local Health Leaders
• Intl Health Agencies
• Medical Professionals

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Disparities Among Medical Professionals

• Disparities in numbers of medical care
  providers 500 physicians per 100,000 in US. 14
  physician per 100,000 in developing nations.
• Disparities in training. Postgraduate level in
  US vs. undergrad level in developing nations.

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Disparities In Specialty Location

• Disparities in specialty skills of providers.
  Traditional emphasis maternal and child health in
  the face of growing numbers of older adults with
  chronic diseases (Birn, 1999).
• Disparity in location of providers. Urban
  center with greatest concentration of providers,
  while few in rural areas.

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What Can We Do?

• Most health professionals have at some time
  considered international service

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Albert Schweitzer

• Already a world renowned philosopher, theologian,
  musician, at age 30 Schweitzer dedicated the rest
  of his life to medical care in Africa.

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Schweitzers 1952 Nobel Peace Prize lead to
world-wide recognition of medical missions.

• Schweitzer spent 50 years in Gabon, West Africa,
  continuing to write and raise awareness of the
  plight of those in developing nations.

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Honduras, Central America
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Clinica Evangelica Morava
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Villagers Waiting At Clinic
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Cerebral Malaria
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Emergency Obstetrics
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Commuting In The Jungle
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Happy Birthdays!
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Total Satisfaction
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Little Friends
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Angola, Africa
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Leprosy Village
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Fatherless
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Husbandless
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Kalukembe Hospital
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Nurses See The Outpatients
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Nurses Are The Attendings
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Doctors Are The Consultants
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Training For Future
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Measles, Malaria, Malnutrition
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Mobile Clinics
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Health Education
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Happy Vaccinations
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Frequent Guests
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Feeding 500 - 20 At A Time
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On The Lighter Side
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But Potential Obstacles/Concerns - Mostly
Misconceptions -Hold Us Back
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Leading Misconceptions

• I dont know those diseases
• What about malpractice?
• Isnt it dangerous?
• I dont speak another language
• I dont understand their culture
• Financially I cant afford the time away
• I dont have enough free time
• Im not a spiritual person
• My parents wont approve
• My children cant come
• I cant make any difference
• I dont know where to begin

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I Dont Know Those Diseases

• Leading diseases in developing countries are ones
  you studied in training diarrhea, pneumonia, TB,
  malnutrition.
• Malaria parasitic diseases are usually
  straightforward to diagnose and treat.
• Working along side an experienced colleague will
  speed the learning process.
• The most important skill is willing spirit.
• Opportunities exist to not just provide medical
  care, but to also teaching your unique skill.

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What About Malpractice?

• American physicians have rarely ever even been
  threatened with litigation.
• Communities of poverty rarely have litigation
  services.
• Many people have never been seen by a doctor, and
  they are almost universally grateful.

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Isnt It Dangerous?

• The main hazard to Americans traveling in
  developing countries is traffic-related injuries.
• Very few suffer complications from exotic
  diseases.
• Modern evacuation medical services provide
  excellent care in event of a health emergency.

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I Dont Speak Another Language

• English is truly the universal language.
• Specify that you wish to work in a nation where
  English is spoken.
• If English is not the dominate language of your
  destination country, translation certainly will
  be available.
• This also presents an opportunity to learn a new
  language. High school language experience is a
  poor predictor of actual language learning
  ability.

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I Dont Understand Their Culture

• Culture is highly connected with health, and
  understanding a local culture is important.
• Entering and learning about another culture can
  be one of lifes most enlightening experiences.
• Nationals are usually eager to explain their
  culture to an interested American.

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Financially, I Cant Afford The Time Away

• Most physicians are salaried employees and are
  not loosing money by being away.
• Some employers will negotiate for increased
  vacation time, such as a 90 contract.
• Those in private practice may be able to arrange
  a locum tenems - so at least it does not cost
  to be away.
• Few worthy endeavors have no financial drawbacks.

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I Dont Have Enough Free Time

• How do physicians spend their vacations? Skiing?
  Touring? Boating?
• How well do you remember these vacations?
• A period of providing free medical care to people
  who have no where else to turn will provide a
  memorable experience like none other.
• How many retiring physicians wish they had spent
  more time devoted to their normal practice?

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More Benefits Of A Medical Missions

• Emotional benefits from adventure and a change
  of pace

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Im Not A Spiritual Person

• Its true that most medical projects in
  developing countries were started by people who
  we would generally consider to be spiritual.
• But offering compassionate medical care does not
  first require a person to be spiritual. Rather,
  it is a privilege of any humane person.

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Im Not A Spiritual Person
The Good Samaritan A foreigner coming to the
aid of a person in grave need.
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My Parents Wont Approve

• But they will be proud you did, and will boast
  about you to their friends.
• They may worry, but remember as parents, its
  their responsibility to worry!

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My Children Cant Come

• Or, are too young, too old, will miss too much
  school, or sports, or music lessons, or
• An opportunity to explore another culture is one
  of the most educational experiences imaginable.
• A shared family experience in another culture is
  one of the strongest potential bonding
  experiences a family can enjoy.

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I Cant Make Any Difference

• It is true that during a short visit you probably
  will not be able to make any major impact in
  health.
• But you may be able to save a child who would
  otherwise die from pneumonia or dehydration. How
  often can you say this about a normal day of
  medical practice in the US?
• You can also train a national or other American
  who will stay on in service - better equipped
  because of your presence.

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I Cant Make Any Difference

• Eric Horton, KCMUB student serving at Nilerigu
  Baptist Medical Center in Ghana I saw so many
  children die from malaria, pneumonia and
  dehydration often 5 or 6 a day. We worked
  extremely hard to try and save them, giving IV
  fluids and medications. And often I saw a child
  whom I was first convinced would surely die look
  up at me the next day with a smile. What could
  possibly be more rewarding?

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I Dont Know Where To Begin

• Where would I serve?
• How would I get there?
• What would I need to bring?
• How can I become familiar with those diseases?
• How can I get ready to get along in a different
  culture?

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Institute for International Medicine

• Equipping health professionals to serve in
  medical missions

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On-Line International Medicine Course

• Covering topics of
• International health issues
• Diseases of poverty
• Cross-cultural skills
• Health leadership
• 15 hours of CME credit
• On-line at www.inmed.us

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International Medicine Conferences

• Covering
• International health issues
• Diseases of poverty
• Cross-cultural skills
• Health leadership
• Opportunities to meet with sending organizations
• 13 Hours of CME
• On-Line Registration www.inmed.us

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Explore Medical Missions With The Experts!
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Students Prefer the Exploring Medical Missions
Conferences

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INMED Diploma Training Sites

• Honduras
• Ghana
• Angola
• Zambia
• Jordan
• China
• Romania
• Macau
• South Africa
• Malawi
• Cameroon
• United Arab Emerates
• Papua New Guinea

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INMED Diploma Payson JenThompson, MDs, in
Honduras
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INMED/Childrens Mercy Hospital
ResidentsMichelle Johnson HondurasMeredith
Clayton Congo
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Medical Students to CameroonJana Allison, Janel
Bacheder, Michelle Pannell, Lisa Mohrman
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Inspiring Concept Medicine As A Mission, A
Ministry

• Tom Dooley in Indo China
• David Livingston in Africa

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Medicine Is Tough

• Grueling training
• Long hours in practice
• Thankless patients
• Malpractice threat
• Financial pressures
• Medical records
• Overbearing insurance companies

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It can cause us to become self-centered, bitter,
unhappy, vain even to regret entering medicine
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Humanity Transformed

• Service and giving are powerful means of
  self-development
• Service and giving help to cultivate humility,
  gratitude, and kindness
• A cure for vanity, pride, self-centeredness,
  exclusiveness, and unthankfulness

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For more info about training serving in
medical missions, please contactInstitute for
International Medicine Nicholas Comninellis, MD,
MPH, President 6700 Troost, Suite 224Kansas
City MO 64131-4410816-520-6900nicholas_at_inmed.us