Fifty years from now, the summer of 2003 may be known as the time when Americans rediscovered Africa. HIV/AIDS in Botswana, bloody internal warfare in Liberia, and yellowcake uranium from Niger have all appeared on television newscasts and the front pages of newspapers. The overall impression of many Americans is that Africa is a continent of coups and contagion. But in the midst of such tragedy (by no means new to that continent) stands hope—in the form of Christian medical missions.
The modern-day marriage of health-care and Christian evangelism has a relatively unknown history of success. It has saved the lives of individuals, families, and villages, and introduced traditional societies to the transforming power of the gospel and Christian community. It is one reason why an estimated 380 million Christians dwell in Africa's 56 nations.
A historical—and living—example of this marriage is Harold Paul Adolph, a retired missionary surgeon and the son of a missionary surgeon. During his career, Adolph performed 25,000 operations, mostly overseas, beginning after he completed his m.d. in 1958 at the University of Pennsylvania. Adolph practiced in Ethiopia, Niger, and Panama's Canal Zone, as well as suburban Chicago. In 1997, the Christian Medical and Dental Society named Adolph as its Missionary of the Year.
But Adolph and his wife Bonnie Jo have not been content to spend their retirement years resting on their laurels at their home in Wisconsin. This year, they have been traveling the United States, raising $1 million to build a new 200-bed missionary hospital in rural south central Ethiopia, a remote region subject to drought, famine, and disease. although the Adolphs don't have all the funding in place (they're about $300,000 short), they will be heading back to Ethiopia in a few weeks to help oversee the initial stages of construction.
Adolph's passion is not just for the missionary hospital. He's also committed to recruiting a new corps of missionary doctors from the ranks of students at American medical schools. In 1997, Adolph wrote an arresting first-person narrative, "Surgery on the Edge of the Desert" for the Bulletin of the American College of Surgeons. The article described in graphic detail 24 hours in the life of a missionary surgeon in Galni, Niger. After publication, dozens of medical schools invited Adolph to speak with students about overseas medical missions. "We see the sad disappearance of the career medical missionary," Adolph said recently to journalist James Adair. Adolph works closely with Project MedSend, a Christian agency that helps new doctors in debt get into the mission field.
A proud history In all of the discussion about Africa's problems, missions-based health care stands out as one of the evangelical movement's best examples of holistic ministry. The history of the medical missionary is rich, varied, and touches on all major branches of Christianity. It encompasses such legendary figures as David Livingstone, known more for his famous explorations of South Africa and discovery of Victoria Falls than his bedside manner, and Albert Schweitzer, the son of a Lutheran pastor, author of Quest for the Historical Jesus, founder of a missions hospital in Gabon, and winner of the Nobel Peace Prize in 1952.
There are many more contemporary heroes—to mention just two, Helen Roseveare and Paul Brand, who died on July 8 following several weeks in a coma after a fall.
Roseveare, born in the U.K., was profiled in the 1994 book Ambassadors for Christ. She arrived in the Congo in 1953 with Worldwide Evangelistic Crusade and spent much of her working life caring for the sick, administering a hospital, and training Africans to be doctors and health care personnel.
Roseveare shared a commitment common among missionary doctors that the cause of the gospel is paramount. She said, according to writer Lin Johnson, "I want people to be passionately in love with Jesus, so that nothing else counts."
"I'm a fanatic, if you like, but only because I believe so strongly that nothing counts except knowing your sins have been forgiven by the blood of Jesus.
"We've only got this short life to get others to know the same truth."
although Paul Brand's clinical work was mostly in India, his impact reaches into Africa and around the world because of his important research on leprosy, which remains a serious health problem in many parts of Africa.
One of Brand's most powerful contributions to the Christian community arose from his theological reflections on human experience. As a Christian physician, he discovered that the "most problematic aspect of creation [is] the existence of pain." He was later to write: "God designed the human body so that it is able to survive because of pain."
The origins of Christian medical missions The Bible and early church history link the spread of the gospel to care for the sick and healing. The miraculous healings of lepers, the blind, and the lame in gospel accounts and Peter's healings in Acts are intimately connected to God's work of salvation through Jesus Christ.
During a fourth century famine in Turkey, Basil the Great of Cappadocia built a complex of buildings, including a church, a hospice for travelers, and a hospital for the sick. The hospital at Cappadocia is one of the earliest examples in Christian history of a church community dedicating itself to the urgent physical needs as well as the spiritual needs of people.
Sixteen centuries later, this model of ministry still works. "A doctor's vocation is his medicine, but his real calling is still to win people for Christ," Harold Adolph said in a 1981 interview for the Billy Graham Center missionary archive.
"When the love of Christ can be demonstrated by fulfillment of a tangible need, you get farther. They're coming to us with their recognized need; we're taking care of that and pointing out other needs."
Timothy C. Morgan is deputy managing editor for Christianity Today.
Copyright © 2003 Christianity Today. Click for reprint information.
Pediatric Nephrology is located within the UAB Department of Pediatrics at Children's of Alabama. The nephrology team, which includes specialized nurses, nutritionist, social workers, family counselors and faculty, evaluate and treat children with kidney disease from infancy to adolescence. They care for those with urinary tract infections, hypertension, hematuria, proteinuria, glomerulonephritis, and nephrotic syndrome, vasculitis, and systemic lupus erythematosis and chronic kidney disease, including those who require chronic dialysis or transplantation.
The renal care center is one of the largest comprehensive pediatric dialysis units in the United States offering acute and chronic dialysis therapies. The specialized staff offers peritoneal dialysis, hemodialysis, continuous renal replacement therapies, kidney biopsies, and plasmapheresis for infants, children and adolescents. In order to maximize health and quality of life, the renal care center is one of three pediatric programs who train qualifying pediatric patients to perform hemodialysis at home using NXSTAGE Portable Dialysis Machine.
In conjunction with the Division of Transplantation Surgery at UAB, the Division of Nephrology is one of the largest pediatric kidney transplant programs in the country. Multi-center studies determine the optimal immunosuppression therapy to maximize long-term outcomes for children with kidney transplantation.
The research and clinical interest of the division are broad. The division participates in multi-center studies on drug discovery/ pharmacokinetics, assessment, progression and treatment of chronic kidney disease in children. Dr. Daniel Feig is division director and is an internationally recognized expert in hypertension in children who has research interests in the mechanisms of early onset and obesity related hypertension as well as mechanisms of hypertensive target organ damage. Dr. Sahar Fathallah, is the medical director of the Pediatric Dialysis Program works in concert with maternal / fetal medicine, neonatology, and pediatric urology to care for children with congenital abnormalities of the kidney and urologic tract. Dr. David Askenazi studies the impact, outcomes and non-invasive biomarkers in premature and asphyxiated critically ill infants who develop acute kidney injury.
Daniel Feig, M.D., Ph.D., M.S.
Nursing Staff
Gwen Gardner, RN; Administrative Director of Transplant Services
Veronica Starks, RN; Renal Clinic Coordinator
Jennifer Wilson, RN; Inpatient Case Manager
Leslie Ann Hallmark, RN; Inpatient Case Manager
Linda Lancaster, RN; Renal Biopsy Coordinator
Mary Jane Gillum, CRNP; Renal Clinic
Jessica Edmondson, CRNP; Renal Clinic
Christy Taylor, Nurse Clinician; Renal Clinic
Jan McGriff, Nurse Clinician; Renal Clinic
Amanda O'Hara, Nurse Clinician; Renal Clinic
Cindy Richards, RN; Renal Transplant Coordinator
Paige Perry, RN, BSN
Kari (Karlene) Pietsch, RN; Renal Transplant Coordinator
Kara Short, CRNP; Renal Clinic
General Renal/Dialysis Social Worker: Emily Wells, MSW, LICSW
Renal Transplant Social Worker: Wanda Hawkins, MSW
Outpatient General Renal Dietician: Michelle Jeffcoat, RD
Inpatient General Renal and Renal Transplant Dietician: Janelle Schirmer, RD
Dialysis Dietician: Perrin Bickert, RD
Transplant Child Life: Crawford Daniel, CCLS
Dialysis and Inpatient Child Life: Chelsea Brown, CCLS
Clinical Research Nurse: Lynn Dill, RN, BSN
Clinical Research Nurse: Susan Keeling, RN
Renal Care Center
Suzanne White, RN, BSN, CPN – Manager
Wendy Shirley, RN, BSN, RNC-NIC
Jessica Stephenson, RN, BSN
Amanda O’Hara, RN, BSN
Jessica Simmons, RN,
Angela Locklar, RN, MSN, NNP
Andrea Darnell, RN, BSN
Allison York, RN, BSN
Jennifer Cornelius, RN
Rebekah Sims, RN, BSN, CPN
Brittany Funchess-Wilson, RN
Daryl Ingram, RN, BSN, CDN
Catherine Gurosky, RN
Cynthia Rogers, RN, BSN, CDN
Stacia Patrick, RN, MSN
Dorothy Dorsey – Administrative Assistant
Those who choose to go on medical mission trips should be prepared physically, mentally, and spiritually for the challenges they will face while serving in the field. During the six months preceding the mission trip, team members should meet as a group monthly to participate in team-building exercises and to learn about the cultural, economic, and health care challenges of the country of destination. To aid in preparing for the trip, an online collaborative site such as sites available through Wikispaces or Google Docs can be set up to store and facilitate the dissemination of documents related to the trip.
Mission participants typically must sign a liability waiver form to release the institution from liability. Health requirements (e.g., immunizations, travelers' diarrhea or malaria prophylaxis) should be discussed and addressed in accordance with the recommendations of the Centers for Disease Control and Prevention.[13]
The trip leaders, usually faculty and alumni, should take responsibility for the general logistics of the trip, but some responsibilities, such as fundraising, packing, and presentations about the hosting country, can be delegated to students. Trip logistics include working with a travel agent to book airline flights, ground transportation, and accommodations (if not already provided by the hosting country or mission organization). From experience, we know that acquiring travel insurance is very important to protect against medical emergencies, flight cancellations, and baggage problems. Logistical concerns also include issues related to the immigration and customs regulations of the hosting country. Declaring the value of medications according to the WHO guidelines for drug donations[14] is important (as the Belize team learned when it experienced the unexpected taxation of donations by that country). Visa and passport requirements must be determined and addressed well in advance, as many consulates require a significant amount of time to process requests for those documents. Telephone cards can be purchased in the hosting country.
FORT DETRICK, Md. -- When working on highly complex medical devices, the repair bills for new parts can rack up quickly.
Parts for computed tomography or portable X-ray machines, for example, can soar past $25,000, which U.S. Army regulations state require additional oversight at the command level for purchasing.
It’s a common occurrence for the U.S. Army Medical Materiel Agency’s medical maintenance teams across the country, including at the agency’s Medical Maintenance Operations Division at Tracy, California, or MMOD-Tracy.
“For us specifically at Tracy, we often saw that problem with the $25,000 threshold because of a lot of the parts for imaging machines that we specialize in put us over that limit,” MMOD-Tracy Chief of Operations Ian McNesby said. “It was definitely a problem for us.”
To simplify and streamline the process, leaders at USAMMA’s Medical Maintenance Management Directorate, or M3D, created the Maintenance Procurement Office, or MPO, in 2016.
The MPO, made up of 13 civilian and contractor personnel, centralizes the ordering practices for repair parts and services that support all three of USAMMA’s MMODs across the U.S., as well as different medical materiel supplies located at Army Prepositioned Stocks sites around the globe.
The team functions largely behind the scenes and maintains constant contact with leaders at each of the MMODs as they work together to provide valuable sustainment-level maintenance support to operational Army units.
“We are one of those teams in the background,” said Newt Oliphant, one of the MPO team leads. “But we do matter and the warfighter is better able to perform their duties and survive because of what we do.”
M3D Director Jorge Magana likened the MPO’s role to one leg of a three-legged stool, providing resources in the form of medical materiel, Class VIII repair parts and supplies to execute the directorate’s mission.
“The MPO’s work is important as it consolidates, tracks and manages efforts for the entire directorate,” Magana said. “They support the entire maintenance program, which includes the three MMODs, the Medical Materiel Readiness Program and all three APS sites.
“That is a global presence in supporting medical device readiness.”
USAMMA is a direct reporting unit to Army Medical Logistics Command, the Army’s Life Cycle Management Command for medical materiel.
The MPO, functioning under M3D, supports the agency’s overall mission to deliver medical materiel readiness, synchronizing and integrating strategic sustainment, supply support and maintenance capabilities to enable global health care operations.
Comprised of supply management officers and specialists, equipment certified and contract administrative support specialists, the team executes purchase orders, bulk purchasing agreements and other procurements through prime vendors and various contracts.
“Without the MPO executing their function, both its assigned tasks and those as needed without additional resources, AMLC, USAMMA and M3D would cease to operate as a whole, and thus, the entire operational force would suffer,” said Jesus Tulud, a retired chief warrant officer five and current M3D contract employee.
Since its creation, the MPO has continued to evolve to better meet the medical maintenance needs of the operating force.
Prior to 2016, MPO functions were essentially split between the MMODs and USAMMA’s contract management section, which “was not medical maintenance-friendly,” Oliphant explained, often resulting in longer wait times.
Among several other responsibilities, the contract office would step in to handle larger purchases, with the smaller procurement operations happening at the MMOD level directly.
“The ability to purchase the vast array of repair parts needed was restrictive and difficult to execute,” Oliphant said.
“We could buy stuff that we needed, but only if it didn’t exceed $25,000,” McNesby said of past operations. “Now, each of the MMODs typically have the attention of at least one of the purchasing agents at headquarters who are there to support our needs. They’ve done a great job.”
Oliphant said M3D saw tremendous improvements in efficiency and turnaround times following the creation of the MPO. Revisions to regulations also made it easier to purchase repair parts to keep the MMODs stocked as needed to meet operational schedules and lessen wait times, promoting high levels of readiness for medical units that rely on their services.
Additionally, the MPO works to Boost and maintain vendor relationships, as well as perform a host of administrative tasks, including processing security requirements for contractors, database management, training tracking and customer support.
In short, the office is dedicated to and promotes the medical materiel readiness mission.
“They’re definitely important for not just our operation, but for the warfighter as well,” McNesby said. “They are an integral part of M3D.”
Ramakrishna Mission Vivekananda Educational and Research Institute, West Bengal is a Deemed university in West Bengal. It is located in PO Belur Math, Dist Howrah 711202, West Bengal, India. Given below are the DM in Nephrology colleges affiliated to Ramakrishna Mission Vivekananda Educational and Research Institute, West Bengal.
The goal of medical mission trips is to reach out to people who are less fortunate than most Americans and help them by providing culturally competent patient care. As pharmacists, we are trained to provide clinical pharmacy services within our areas of expertise, taking into consideration the needs of the local population and the available resources. Thus, researching and understanding local health needs and preparing to address a wide array of health problems—acute and chronic, rare and common—are important steps in the planning process, as the needs of the population served will vary from mission to mission.
For example, on the previously mentioned mission to Belle Glade, Florida, the most pronounced needs related to the management of chronic conditions such as hypertension, type 2 diabetes mellitus, dyslipidemia, heart failure, asthma, chronic obstructive pulmonary disease, HIV disease, and AIDS. On another mission, in the Juan Dolio area of the Dominican Republic, the greatest needs related to acute infections such as dermatophytosis, vulvovaginal candidiasis, urinary tract infections, respiratory tract infections, gastroenteritis, and parasitic infections. In Zambia, the areas of greatest need involved HIV disease, AIDS, opportunistic infections, tuberculosis, malaria and other parasitic infections, gastroenteritis, and superficial fungal infections. Pharmacists are well trained to work with other health care professionals to manage all of these conditions and ensure the judicious and appropriate use of medications.
During the mission trips organized by our school, pharmacists were available to support and coordinate the efforts of local physicians, physician assistants, and nurses. The pharmacists played an important role by reminding the team to avoid the use of certain medications without first assessing a patient's renal function (e.g., metformin), ensuring the availability of laboratory monitoring (e.g., warfarin), or ensuring the continuous availability of a given drug or drug class (e.g., β-blockers). The mission team recommended treatment options based on the limited medication formulary, checked and dispensed prescriptions, counseled patients, and supervised students.
Delegating responsibilities to students and local staff facilitates the workflow. With supervision provided as appropriate, students can assist in triaging patients, influencing prescribing behaviors, filling prescriptions, compounding, and counseling patients about their medications. Local staff can assist in advertising, spreading the word about mission-coordinated clinic days, organizing the workspace before opening the clinic, and serving as interpreters. They can also provide transportation and food services.
A typical clinic day usually starts with an early breakfast at which a faculty member or a student shares inspirational thoughts to energize the team. Both faculty and students then gather the supplies needed for the day. Categorizing the medications according to classes (e.g., antimicrobials, gastrointestinal products, analgesics and antipyretics, antihistamines and cough products, topical preparations, multivitamins) may facilitate the prescribing and dispensing process.
On clinic days, transportation is provided from the lodging site to the clinic site. On arrival at the designated town or other clinic site, the workspace is prepared by dividing it into four sections: a patient waiting area, a triage area, a diagnosing and prescribing area, and a pharmacy area. Mission teams usually see 50–100 patients per day, including pediatric patients and adults with various medical conditions, giving the students ample opportunity to apply what they have learned in pharmacy school.
At the end of the day, the team typically gathers in the evening around the dinner table for fellowship and a de-briefing session. Since clinic days can be exhausting, scheduling some free days to explore the hosting country and the culture of its people is good for bonding among team members and creating memorable experiences.
