Content Resources

Similar articles can be found on my blog Medical Missions 101 Understanding Global Access to Health Care as a Social Justice Issue I believe global lack of access to health care for the poor is one of the most pressing social injustices of our world today.  In reviewing the global health inequities it is very hard not to see this as a social justice issue. One study that appeared in the Lancet tells us that at least 4·8 billion people in the world do not have access to surgery. This equates to greater than 95% of the population in south Asia and central, eastern, and sub-Saharan Africa not having access to surgical care. Whereas less than 5% of the population in Australia, high-income North America, and western Europe lack access (Alkire, et al., 2015). A Global Health Care Workforce in Crisis The global health care workforce is in crisis, so the need for global health engagement has never been greater. The World Health Organization (WHO) tells us there is a need for another 7.2 million health workers in the developing world and this shortage is expected to grow to 12.9 million by 2035 (World Health Organization, 2013). The WHO also warns that if this crisis is not addressed now to slow or stop the growth of this shortage, it will have serious implications for the health of billions of people across all regions of the developing world. Global Health Inequities The World Health Organization (WHO) also tells is that 5.9 million children under age five died in 2016, about 16,000 every day. The risk of a child dying before the age of five is still highest in the Sub-Saharan Africa at 81 per 1000 live births, which is an incredible seven times higher than in developed nations. Compare that with the WHO European Region where that number is 11 per 1000 live births. The under-five mortality in low-income countries remains unacceptably high averaging 76 deaths per 1000 live births. This is about 11 times the average in developed countries, which is 7 deaths per 1000 live births (World Health Organization, 2017) (United Nations inter-agency group for child mortality estimates, 2015). Maternal mortality is also a enormous problem. 830 young women loose their lives each day ( about 330,000 annually) due to complications and 99% of those deaths are in developing countries; a direct result of lack of functional functional healthcare systems with surgical capabilities (World Health Organization, 2018).  A True Social Justice Issue One way to spot a true social justice issue is look where the Christians are working on behalf of the poor. Out of all the players in global health care, Christians have been by far the most actively  engaged in this problem. However, I fear this high level of engagement is now changing. There have been hundreds if not thousands of mission hospitals founded by many Christian denominations, these mission hospitals are often the only access to lifesaving healthcare for vulnerable populations. Motivated by faith and passion to share the compassion, love and mercy of Christ nearly every Christian denomination created hospitals and health programs to care for the poor globally. The Role of the Church in Global Health Care Christian Mission hospitals and health programs account for about 50% of all healthcare delivered in Sub-Saharan Africa (Olivier, et al., 2015). That figure is probably closer to 70% of the truly functional healthcare services delivered.  Sadly however, many of these Christian facilities are closing, those that remain are fighting for survival. This is not isolated to African countries, a recent report  tells us there have been approximately 200 Christian hospital closings in India alone in the last two decades. These facilities are often in remote rural locations making it difficult to attract and keep national health professionals and the only access to lifesaving healthcare for vulnerable populations. Christian missionary physicians and nurses started these facilities and have staffed them since their inception, however there are no longer enough medical missionaries to staff them. Our best estimates are that there are only about 1300 missionary healthcare providers  still serving full-time around the world. This is not nearly enough to cover even a small percentage of the need. This has left many poor communities without any access to functional healthcare, or the Christian witness these facilities once provided. As a global Church we cannot disengage from health care,  it is part of our identity as a faith community. It is no accident that out of the nearly 4,000 verses in the 4 gospels, 727 of them have to do with healing. The Churches role in health care for the poor globally is, and should continue to be, our tangible expression of Christ to the nations that we cannot abandon. Alkire, B., Raykar, N., Shrime , M., Weiser, T., Rose , J., Nutt, C., . . . Farmer, P. (2015, June). Global access to surgical care: a modelling study. The Lancet, 3, 316-323. United Nations inter-agency group for child mortality estimates. (2015, September). Inter-agency Group for Child Mortality Estimates. New York: UNICEF. Retrieved from https://www.unicef.org/publications/files/Child_Mortality_Report_2015_Web_9_Sept_15.pdf  World Health Organization. (2013, November 11). WHO Media Center . Retrieved from World Health Organization : http://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/ World Health Organization. (2018, February). Fact Sheet on Maternal Mortality. Retrieved from World Health Organization Newsroom Fact Sheets: http://www.who.int/news-room/fact-sheets/detail/maternal-mortality  

Intended for Physical Therapist and Occupational Therapist s to learn how to prepare for and then serve in a therapy clinic on a short term ( 1-2 weeks) medical missions trip. This session will teach needed preparations and expectations of a short term physical therapy medical mission trip.

This is a practical application of principles for the treatment of one of the most common problems that univerally is found in all cultures. That is mechanical spinal pain. This workshop is directed toward the Non-PT with application for all medical professionals that are seeing patients with back or neck pain. The method is designed to enable the patient to learn how treat and prevent recurrence of their symtoms.

Since substance abuse affects the physical, the mental, and the social well-being of an individual, several healthcare professionals, namely the physicians, the psychiatrists, the therapists, and the emergency-medicine professionals, are on the frontline of diagnosing and managing drug abuse disorders. With the increasing incidence and changing nature of substance abuse, it is crucial that these professionals keep themselves updated about all that's happening in this field. All healthcare professionals must be aware of the following four points related to substance abuse, enabling them to help patients overcome their addiction. 1. Healthcare Professionals Have a Collaborative Role to Play in Substance Abuse Disorder Management A thorough diagnosis and management of drug abuse patients require assessment by multiple addiction experts, namely the physician, the psychiatrist, the psychologist, and the therapist. This is because individuals undergoing treatment for drug abuse are also affected by other health conditions and mental disorders. The physician assesses the general health and performs drug tests to establish the levels of illicit substances within the patient's' body, whereas the other three professionals specialize in mental health. All these healthcare professionals must work together and use their skills and experience to prevent, screen, intervene, and treat patients with substance use and addiction disorders. 2. Cross Addiction Is Fairly Uncommon More often than not, physicians defer or avoid prescribing medications that are absolutely necessary but have the potential for abuse in patients with substance abuse disorders. For instance, patients recovering from alcohol abuse and suffering from anxiety or panic disorders are denied or taken off benzodiazepines for the fear that they may be addicted to these drugs. Similarly, patients requiring opioid-based pain management strategies are denied the treatment, often leaving them in agony. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that nearly nine million American adults (aged 12 and older) suffer from both a substance use disorder (SUD) and a physical and psychological health disorder of some type. Moreover, several studies have shown that cross-addiction, where a patient stops abusing a drug and gets habituated to another seldom occurs. Thus, a medical professional is expected to listen to his/her patients' complaints with respect to their health and avoid assuming that these grievances are signs of a drug-seeking behavior. Furthermore, when managing allied health issues, the practitioner can choose a drug with less risk for abuse. For instance, drug abuse patients with anxiety disorders can be prescribed clonazepam instead of other benzodiazepines as it is less habit forming. 3. Healthcare Practitioners Must Be Ready With a Relapse Management Strategy Though drug rehabilitation is effective in the management of addiction, it cannot completely cure this disorder. Research shared by the National Institute of Drug Abuse has shown that substance abuse relapse rates can be as high as 60 percent. Recovery from drug abuse is a lifelong process that demands several lifestyle changes and management of the associated health issues and situational factors that can lead to the relapse. Healthcare practitioners play a critical role in creating a relapse management strategy. They must address substance abuse by offering the necessary interventions, referring patients to substance abuse treatment, conducting ongoing drug testing and follow-up, and working with the therapist to manage critical cases in order to help the patients recover and prevent the chances of relapse. For instance, medical professionals conduct drug screening programs using instant drug test kits during the monthly and annual routine checkups. These tests help them assess the severity of the illicit drug use and prescribe a possible treatment regimen. Most addiction centers are aware of these medications, yet do not prescribe them. Medical practitioners can easily fill this gap by being aware of and prescribing the anti-relapse medications to overcome alcohol and drug abuse. For instance, naltrexone and disulfiram can be prescribed for the treatment of alcohol abuse. Similarly, buprenorphine, an opioid partial agonist, is extremely effective in treating opioid abuse and addiction. 4. Confrontation Strategies Do Not Work in Drug Abuse Management Originally practiced within peer-based communities, confrontational strategies and lecturing soon extended to authority-based medical set-ups and rehabilitation centers. Confrontational approaches are designed to make drug abuse patients feel scared, ashamed, or humiliated, with the assumption that such experiences are curative. However, research has shown little evidence for a therapeutic benefit of such approaches in substance abuse patients. In fact, they are potentially harmful and professionally inappropriate. Medical professionals must work in collaboration with counselors to motivate the patient in order to find new ways to manage their mental state of mind, control the triggers, and work towards a drug-free future. They must approach patients with sensitivity, understanding, and honesty and pay careful attention to their body language and tone of voice. This empathic and patient-centric approach respects the patients' capacity and the natural desire to grow in a positive direction. Healthcare professionals have a significant part to play in the management of substance abuse disorders. Consequently, they must be aware of the above-mentioned facts about substance abuse, enabling them to screen and manage such cases and reduce the risk of relapse.

6 Lifesaving Interventions for Children in Low-income Countries See this article with clinical pictures at http://www.healthservicecorps.org/6-interventions/ Saving the lives of children is one of the greatest joys of medical mission work. What if you could save the lives of not a few but of many children? This blog shares six very basic interventions that can help you achieve that aim. According to the World Health Organization (WHO) estimates on child mortality, 5.9 million children under age five died in 2015, about 16,000 every day. The risk of a child dying before the age of five is still highest in the WHO African Region at 81 per 1000 live births, which is a dramatic seven times higher than in developed countries. For comparison, in the WHO European Region that number is about 11 per 1000 live births. The under-five mortality in low-income countries remains unacceptably high averaging 76 deaths per 1000 live births. This is about 11 times the average in developed countries, which is 7 deaths per 1000 live births. We believe short-term and long-term medical missions have an important role to play in reducing these inequities across the world. However, the extent of the effectiveness of our medical missions on child mortality will be directly correlated to the level at which we learn and engage with international standards for the care of children in low-income countries. These six interventions, if used and promoted widely, can at help engage medical missions in this important fight. The doses listed in this blog post represent current recommendations published by the WHO although this blog post is meant only as an overview of information. It is not a comprehensive study of dosing or treatment modalities. We recommend downloading the reference from which these dosing recommendations were obtained. To download the IMCI chart booklet for dosing and process information IMCI Chart Booklet and Dosing Reference Guide. The complete computer-based IMCI training programs can be downloaded from the Christian Health Service Corps website at CHSC Clinical Resources. Please use and share these six child lifesaving interventions for children living in resource-poor communities: 1. Promotion of exclusive breast feeding for infants younger than six months This is probably the simplest of all interventions and yet it is the most effective. Communities should be educated on the importance of breast feeding. Improving exclusive breastfeeding practices of infants under six months of age has the greatest potential impact on child survival, higher than all other preventive interventions. According to Vesel et al (2009) improved breastfeeding practices could prevent over 800,000 deaths in children under age five every year. Simply counselling all mothers of young infants about the need for exclusive breast feeding can save the lives of many infants. 2. Immunizations About 10% of the diseases affecting children under five years of age are preventable with vaccines. A review of 12 studies found that measles immunization was associated with reductions in total mortality that ranged from 30–86%. Additionally, providing vitamin A supplements as part of measles case management can reduce the case fatality rate by more than 50%. Collaborating with local health departments and ministries of health to deliver vaccinations in rural unreached areas remains an underutilized strategy by medical missions and global health programs. There are many barriers to vaccination delivery in rural villages for local governments. Limited personnel and maintaining cold chain are but a couple. This medical mission strategy could help close this gap for some regional health authorities and improve vaccination coverage. Few medical mission or service learning programs engage in this type of collaborative efforts, but these projects can have lasting impact on child survival in rural areas. 3. Parasite prophylaxis Remember, many children in low income countries receive less than 50-75% of the daily-required caloric intake for growing children. Parasites further compromise the nutritional status of children. The WHO standard for parasite prophylaxis is to give all children one year or older mebendazole if they have not had a dose in the previous six months. • Give 500mg mebendazole as a single dose in clinic if 1) hookworm/whipworm is a problem in the area in which you will be working, 2) the child is one year of age or older, or 3) the child has not had a dose in the previous six months. 4. Vitamin A treatment In malnourished, micronutrient-deficient children, Vitamin A supplementation can reduce mortality by up to 23%. Vitamin A is important in interrupting the cycle of malnutrition that makes even mildly malnourished children susceptible to death in the event of a viral or bacterial illness. The vicious cycle of malnutrition and the way in which it claims the lives of even mildly malnourished children is illustrated below. It is an important topic to consider before seeing pediatric patients in developing countries. Malnutrition underlies more than 50% of the deaths of children under age five in the developing world. Diarrhea, acute respiratory illness, malaria, and vaccine-preventable diseases are the primary killers of children under five, but malnutrition is often the underlying factor that precipitates the child’s death. Children in developing countries who exhibit any signs of malnutrition should receive Vitamin A in much higher doses than practitioners trained in developed countries are familiar with prescribing. It should be noted that active collaboration with local health authorities and record-keeping is a fundamental requirement. • Give the first dose of Vitamin A any time after six months of age to ALL CHILDREN; thereafter, give Vitamin A every six months to ALL CHILDREN. • Give an extra dose of Vitamin A (the same dose as for supplementation) as part of treatment if the child has measles or PERSISTENT DIARRHEA. • If the child has had a dose of Vitamin A within the past month, DO NOT GIVE VITAMIN A. • Always record the dose of Vitamin A given on the child’s chart (i.e., AGE, VITAMIN A DOSE). • Dosage: Six months up to twelve months – 100,000 IU; one year and older – 200,000 IU 5. Zinc supplementation Zinc supplementation has been shown to reduce diarrhea incidence by 18% and pneumonia incidence by 41%. All children age two months up to five years presenting with diarrhea should receive the following: Instruct the mother on how much zinc to give (20-mg tab): • Two months up to six months – half a tablet daily for 14 days; six months or older – one tablet daily for 14 days. Demonstrate to the mother how to give zinc supplements; have her verbalize and (ideally) demonstrate how to mix and give the first dose. • Infants – dissolve tablet in a small amount of expressed breast milk, ORS, or clean water in a cup. • Older children – tablets can be chewed or dissolved in a small amount of clean water in a cup. 6. Iron supplementation for Childhood Anemia In developing countries, childhood anemia is a manifestation of micronutrient malnutrition and is often worsened by recurrent bouts of malaria. It is an extremely common symptom of mild to severe forms of malnutrition. According to the IMCI child health standards, all children who exhibit signs of anemia should receive the following: . TALC has hemoglobin color strips to use with finger-stick blood tests available at low cost for short-term global health initiatives. Palmar Pallor is the WHO standard for assessment of anemia in children in resource limited settings where there is blood hemoglobin measure available. Iron supplementation has also been shown to improve child development in children over age two and can have a significant affect on micronutrient-deficient children. Give iron daily for 14 days in the presence of childhood anemia. Give an oral antimalarial co-artemether in the presence of anemia in high malaria-risk areas as follows. Give the first dose of co-artemether in the clinic, and observe for one hour. If the child vomits within an hour, repeat the dose. The second dose is given at home after eight hours, then twice daily for a further two days as shown below; co-artemether should be taken with food. World Health Organization, 2017) Vesel, et al., 2009 Hill, Kirkwood, & Edmond, 2004 WHO/UNICEF, 2014 Hill, Kirkwood, & Edmond, 2004 WHO/UNICEF, 2014 Hill, Kirkwood, & Edmond, 2004 Hill, Kirkwood, & Edmond, 2004) WHO/UNICEF, 2014

God's Kingdom is one of paradox. He is famous for His heart for the poor and for His heart for the nations. However, most don't realize how intimately these two passions of His are intertwined. This has massive and unexpected implications for any disciple of Jesus. Paradoxically, global poverty will never end until every nation is reached with the Gospel.

The clear benefit to having multiple agencies work together to manage a disaster is that communities can manage hazards and cope with disasters more quickly. Emergency management professionals provide the framework for a society's survival after disasters occur. Given how consistently disasters occur and the need to limit the damage from emergencies and disasters, there is now a need more than ever for emergency management professionals.  In addition to natural disasters, there are a variety of different scenarios and industries an emergency management professional might find themselves in, including: local and state government, hospitals, scientific and technical services, and higher education. Figures from the Bureau of Labor Statistics indicates that jobs in this field will grow steadily well into 2024.  The below infographic, created by Arizona State University's Online Emergency Management and Homeland Security (EMHS) degree program, explores the field of emergency management and the various professions one might find in the field.

Many nurses put in 12-14 hour shifts, while a great deal of others work night shifts. Although these types of schedules are expected as a requirement of their job, many nurses expose themselves to different types of health risks that often are associated with prolonged work hours and disruptions to a normal circadian rhythm. To avoid health issues, it is critical to understand the nature of the problem and provide nurses and other workers with ways to reduce risks and manage late-shift schedules. This academic resource highlights health and wellbeing risks associated with 12-hour nursing schedules while providing tips and tricks to help hospital staff balance their circadian rhythm and reduce fatigue. This aims to create awareness around health problems and workplace errors that arise from lack of sleep and work-life balance, while providing materials that help create a better quality work environment for nursing staff.   With night shifts remaining popular among hospital staff, there is no sign of these lengthy shifts slowing down. It is important for nurses to take the necessary steps and health precautions for their own wellbeing so they can better take care of their patients.  To learn more, check out this infographic designed by Bradley University’s online Doctor of Nursing Practice program.

This is the handout for Session Three of the Human Trafficking Intensive, Developing a Response Protocol.

Key slides from intensive GMHC 2017

I saw a movie recently about two struggling families. The husbands had lost their jobs, and one of the wives could not keep up with the swelling bills, and of course lost her job as well. Things got so bad, the two families had to live in their cars on the streets. Luckily, one of the families got a hotel voucher and left the streets. Nothing was heard about them again. But the other family kept struggling, such that feeding became so impossible, their young son had to steal lunch at school. In fact, they got attacked by mobsters at night, and would have lost their lives. Now that scene made me wonder why anyone would steal from someone living on the streets. I mean, if they had any treasures, apart from their lives, they wouldn’t be on the streets. Then I concluded that if the blind could lead the blind, then the poor could steal from the poor. It’s the case of one person having a little advantage over the other. Such is life! For days this family didn’t take a bath. They only cleaned up at pubic restrooms.  They did everything they could to keep their condition from anyone, lest the authorities be informed, and they lose their children. As I watched, I could not help but come to terms with the fact that in the midst of plenty, there are some who starved, even unto death. Even though this family lived on the street, they were not entirely invisible. Someone should have noticed them, and reached out to help. But I guess everyone was busy with their own problems and activities, missions inclusive, that they did not notice this family. If someone had taken time to look within, they would have noticed this family. Compassion has eye that sees beyond the ordinary. The story of the Good Samaritan is one with many facets of truth, but you have to dig in to know this. A young Jewish man who was an expert in the law asked Jesus what he had to do to have eternal life. Jesus asked him what the law said. Of all the laws, he chose that which he believed was the simplest, “love the Lord with all thy heart and mind. And love thy neighbour as thyself”. “Wonderful”, Jesus said, “you are really smart. Well then, go and do what it says, and you shall have eternal life”. But his conscience was pricked, because he knew down in his heart, something was not right. To justify his foolishness, he asked, “Who is my neighbour?” I believe he was expecting Jesus to say, ‘your brothers and sisters”. But as usual, Jesus disappointed him by telling a thought provoking parable. Jesus told the story of a man who was robbed and left for dead on the street. Two people passed by and did nothing. Note Jesus’ choice of characters; a Priest, a Levite, and a Samaritan. He could have used a shepherd, a carpenter and a businessman as His characters. But He did not. He chose characters that represented the highest offices in the Jewish community, and one that depicted a class system. What was He trying to say? Well, the Priest was the intercessor between God and the people. He knew exactly what God wanted, and how God wanted it. God communicated His desire and instructions to the people through him. So he very well knew God and the law. The Levite was the next in line. He served in the temple, and carried out rituals nobody else in all of Israel could do. The Levite was strictly under God’s “employment”. So, he too had a good knowledge of God and the law. The Samaritan was a nobody who didn’t share the same heritage and affluence of a Jew, as it was believed. The Jews didn’t think the Samaritans were good enough to relate with, so they had nothing to do with the Samaritans. The traveller’s identity was not revealed. He could have been a Jew or a Gentile. Regardless of who he was, he was half dead and could not identify the people who passed him by. At this point conscience and compassion are put to play. Let me try and figure out what was going on in the minds of the Priest and the Levite.  May be, as Priest and Levite of the Holy temple of God Almighty, they were hurrying up to the Temple for worship or to meet the needs of the people. They had to get to their holy duties on time! Give me a break! Well then, the Samaritan was a common man who had no privileged duty, and had all the time in the world, so he had compassion on the man and helped him to an inn, where he spent the night with this broken man as he had him taken care of.  Well, Jesus asked who amongst the three men qualified as a neighbour, and the young man answered, “the Samaritan.”  Trust me, that answer, simple as it was, was very heavy in the mouth of the Jewish man, for obvious reasons. “Well then,” Jesus said, “go and do likewise”. Ouch! The man must have gasped. I love the way Jesus humbles certain people who feel they know it all. Jesus’ answer to this young man was a blow below the belt. If you have missed the point of this story, like many do, let me help you here. The point about the story was not necessarily about who helped the injured man. The parable was not referring to the “love your neighbour as yourself’ statement that Jesus made. But it was rather referring to the “who is my neighbour”, that the young man mischievously asked. The story was an indictment on the Jews, who believed they knew the law, but fell short of its expectation. In this article, the parable about the Good Samaritan is not referenced with regards to the class system. No, as Christians, I believe we know better. The point of reference here is how we can easily forget the work around us, because of the “big deal” in front of us, like the Priest and the Levite. Jesus is thorough, and everywhere He went, He took care of the people in that place before heading out to His next assignment. As Christians, God expects more from us. We should know better than the unsaved morally inclined man or woman. Our love for humanity should go deeper, and our search engines from the inside out. Think about heaven, and walking into a lovely garden, and a man calls out to you and says you look familiar. By the time you start a conversation with the person, you found out that he lived on the street three blocks from you, and you saw him but never noticed them. And then you find out how he died: it was on a certain day you remember. You had your beautiful unique bags packed for a trip to Cambodia, and headed for the bus stop. You were so excited you were going on a mission’s trip to do the Lord’s bid.  And then the picture flashes back to you. That day as you waited at the bus stop in excitement, you did see a man on the floor, a few yards from you, writhing in pain. But you didn’t notice him, because you were headed for a very important trip.  And then in conclusion he says, “thirty minutes after your bus left, I saw myself in heaven and knew I had died”. Sad, isn’t it? We actually need the help of the Holy Spirit not to be oblivious of the lonely and destitute around us, because I believe it is sometimes an innocent error. So as we go about our missionary activities, let us pray that our eyes be opened to see “them’ that are amongst us and do the needful, being the Jesus that they need.