Dan, Heather, Jeremiah, Emma, Claire, Levi, and baby Josie

Dan, Heather, Jeremiah, Emma, Claire, Levi, and baby Josie

Saturday, July 5, 2014

The Gold-digger, a Groin Flap and the DJ



The groin flap, still attached to the pedicle of skin which contains the artery and vein to keep the flap alive while the new blood supply from the hand develops.



Three weeks later, after division of the pedicle.  The new blood supply comes from the surrounding healthy tissues in the hand. 




 Jack, on the day he believed.  



Jack, with his surgeon, new Swahili bible (and "Kick-A" T-shirt)


One of the phrases we use regularly on the orthopaedic service at Tenwek, which seems to perfectly encapsulate the peculiarity of the day-to-day cases we see here, is “You just can’t make this stuff up.”   Last month, a 40 something year old man (who I’ll call George) presented to casualty with half his hand blown off by a stick of dynamite.   Apparently, Jeremiah was correct when he insisted that there is gold in the hills around Western Kenya (at one point when he was younger, he wanted to ship a large sluice so he could pan gold from the Tenwek river).   The patient had lit a fuse (yes, a fuse) on a stick of dynamite and when it didn’t ignite, he went to inspect, and just as he reached out his hand to grab the stick, it exploded and completely blew off his thumb and index finger. 

Covering large hand wounds such as this can be challenging.  But one of the described methods in plastic surgery literature is with a “groin flap” in which a full-thickness paddle of skin in the groin region is elevated with its blood supply within a pedicle and then draped over the defect to supply new skin to the region of loss.  The hand needs to remain still for three weeks while a new blood supply “takes” and so to accomplish this, the hand is literally sutured to the groin.  Then, after three weeks, the pedicle is divided and the hand “freed.”

During George’s three week waiting period, a young man named Jack was admitted to the bed next to him with a neglected open, segmental distal tibia fracture from a motorcycle crash.  He was first admitted to another hospital where he literally sat without care for 5 days, until his sponsor (who I providentially met at an Indian wedding last February) insisted that he be taken to Tenwek.   After several operations, including the placement of an external fixator (pins, clamps and bars), Jack was on his way to recovery.  

While on morning rounds one day, I asked Jack and George if they were Christians, and Jack very honestly answered ‘no’ but was interested in hearing more.  So, we made plans to meet later that day.  But as the work typically goes, I was completely slammed, and had no time to meet with Jack.  Unfortunately this scenario happened for the next three days, each day on morning rounds telling him I would find him later, and each day, loosing the opportunity because of work.  Finally, one evening I had time to have a cup of chai with Jack in the hospital canteen.  Jack explained to me that he was orphaned at age three when his parents were both killed in a car accident, and he literally lived on the streets from age 3 to age 15.    Then, he was “rescued” by his sponsor, a Hindu woman who helped him through school, and on to his current employment as a DJ.  I explained to Jack that Jesus came for all people, regardless of race, religion, color, background, etc., because we all desperately need a Savior and that through the forgiveness of sin that He offers through His death for us on the cross, we can now have hope.  Right then and there, Jack said he believed, and prayed one of the most honest, cool prayers that I have heard in a long time.

Through the randomness and oddities of the cases we see here, mixed with the busyness of work and life, we see glimmers of God’s grace (which continues to amaze).  Please keep Jack and George (and all our patients) in prayer that God would heal and restore physically and spiritually.  Thanks for all your support and prayers for our family!

Monday, April 28, 2014

Galat Family Update April 2014

Retreat to the Coast!

It seems that since returning to Kenya last fall, we have been going non-stop with family (Josie), visitors, ministry and work.  Thus, we were so thankful for a time of REST on the beaches of the Indian Ocean, where we spent time together as a family and attended our annual WGM Kenya retreat with friends and co-workers.  One of the definite highlights was Emma’s baptism in the Indian Ocean, which I helped perform!


The water was like a bath...about 90 degrees...perfect!


Emma has such a sweet heart for the Lord as she (like all of us) continues to learn faith and trust. 


New Lead and C-ARM for Tenwek Orthopaedics

Thanks to the generous donations from two friends of Tenwek orthopaedics, we were able to purchase sorely needed lead aprons and a newly refurbished C-ARM.   These items will be a huge blessing for the entire team, God-willing, for many years to come.  Our volume continues to grow exponentially, mainly due to the increase in road traffic accidents in Kenya.  Please pray for our department that we would continue to provide compassionate care in the name of Jesus Christ. 


The inaugural use of the new C-ARM and lead aprons. 


Alphine, one of our ortho surgery RNs, sporting the new lead and surgical caps (thanks to Jessica Nugent for making the caps).


Thanks to Dylan Nugent and his sister for helping to design the new Tenwek Ortho logo and incorporate it into our lead aprons!


Resident Training at Tenwek

Our first two orthopaedic residents, Dr. Victor Sowayi and Dr. Fasto Lado have settled into life and work at Tenwek.  We are thankful for the privilege of training orthopaedic surgeons for service in Africa!  Dr. Russ White and I recently met with the architect and surveyor of the new resident and trainee housing project to finalize plans and the budget for phase one.  We hope to break ground in June so that we can finish and have space for more residents by next January 2015!  The budget for phase one is $480,000 and we have raised approximately 75% of this amount.  We so appreciate those who have partnered with us in this project, and also the new residency, both of which would not be possible without our ministry partners.



Schematic of the Side Elevation of the new Resident and Trainee Housing Project.  This building will provide housing for about 25 residents, interns and medical students.  



Left to right: Drs. Dan, Fasto Lado, Victor Sowayi, Kiprono Koech and Will Moore at the white-coat ceremony.


Visiting a patient with the ortho team and Claire.  


The orthopedic consultant team at Tenwek.  


A time to build…

Housing is tight throughout Tenwek, both for visitors and trainees.  Thus, we recently began a new ministry/guest house just adjacent to our home.  In addition, our house itself is undergoing a major renovation with replacement of the old roof and trusses (which were completely rotten) and building of a front porch.   Needless to say, our “compound” is quite busy and chaotic with upwards of 25 workers at a given time.    We are looking forward to having a place for our many guests and medical visitors as well as an “upper room” for ministry, meals and bible studies.



The front view of the new guest/ministry house going up in our back yard.  The building will have two guest apartments, a storage and laundry room, and an "upper room" (ministry porch).  This project is providing steady work for 25+ local Kenyans!


Tearing off the old rusted iron sheets and replacing with new!




Our outstanding and very talented general contractor, Kimay.  He is employed by Tenwek to do most of the construction projects around the hospital. 


Family

We were so thankful to have Jeremiah home on break from RVA for the month of April, which was also busy with 4 Galat family birthdays!  Jeremiah is in his junior year at Rift Valley Academy, busy with rugby, friends, and studying for college entrance exams.  Emma is a joy to have at home as she is a great help in the kitchen and with Josie.  We will miss her come August, when she plans to start high school at RVA.  Claire loves school and her Tenwek friends tremendously, and is also a great help at home.  Levi is busy daily with friends and Legos and brings us much laughter.  Josie is such a joy (and a stinker) and helps to keep Heather and I “young” (and dependent on the Lord).  We both have biceps tendonitis of the right arm from carrying her around so much!


Together for Levi's 10th birthday (one of four in the month of April).


My standard answer is that they get their good looks from their mother.


Levi at a recent overnight father/son camping trip to Mount Suswa. 


Balancing act...gymnast in the making. 

Asante sana! 

Our family could not work and serve in Africa without our team of ministry partners who support us financially and in prayer.  Thank you!  We also invite others who would like to join the work at Tenwek through support of our family, sponsorship of the orthopaedic residency and/or the construction of the new resident and trainee housing.  Following are easy links to secure donation pages below:

www.wgm.org/galat  (Galat family)
www.wgm.org/orthofund (Orthopaedic residency)
www.wgm.org/tenwek-hospital-housing (Resident and trainee housing)

Again, thank you and may the grace of Christ be magnified in your life!





Saturday, March 8, 2014

Brilliant



Last month, a precious two-year-old girl was admitted to Tenwek with a severe, open right femur fracture, the result of a terrible, yet all-too-common motorcycle accident.  The fracture was easily fixed with multiple washouts and an external fixator (i.e. pins and rod holding the broken bone together).  The fact that Brilliant’s parent are dead as a result of the same accident, and that she is now an orphan is not so easy.  Sometimes it’s not just the injury, but the story behind the injury that causes us to shake our heads in shock and disbelief, and fills us with a longing to see more of God’s kingdom here on earth. 

Brilliant and her parents were on their way to Tenwek to visit Brilliant’s aunt, who was admitted after an attempted abortion with a coat-hanger in a back-alley “practitioner’s” office.  The dirty tool had pierced the uterus, and now she was septic with a raging infection in the ICU, hanging by a thread.  It was then that their motorcycle was struck by a speeding SUV, instantly killing Brilliant’s parents and causing the severe injuries to her right leg.  Brilliant’s aunt died a few days later. 

Brilliant’s story is one of the clearest recent examples for me of why Jesus had to die for us on the cross.  Mankind desperately needs saving, as the effects of sin are far-reaching, deep, and tragic.  And, in faith, we must believe that nothing is beyond God’s redeeming ability.  My prayer is that Brilliant may one day live her name, and shine as an example of God’s healing, grace, and hope in the darkest of histories.  Please join me in lifting up this little girl, asking God to bless and encourage and heal.   

“Our father, who art in heaven, hallowed be Thy name.  Thy kingdom come, Thy will be done, on earth as it is in heaven.”

Thursday, January 30, 2014

“The Maiming (and Healing) of a Generation”

Patient and her husband at first follow-up appointment after discharge from the hospital. 
 
X-ray showing wired pelvis with ex-fix pins in iliac crest.
 
Dr. Fasto Lado, the orthopaedic resident from South Sudan and his wife and daughter, all dressed up for the welcome pig roast. 
 
 Dr. Victor Sowayi, strong and dependable. 

 
Dr. Seno (general surgery resident in red shirt) donated his annual pig (gift from his father) for the roast.  With Seno and I at the helm, meat will always bring a smile. 
 


Dueling Weber grills - pork in one, chicken in the other.  Why not?
 
During an especially busy call weekend in December (exacerbated by a two-and-a-half-week doctors' and nurses' strike in Kenya, in which Tenwek was one of the only open hospitals in our heavily populated rural area), my resident called to say that there was a young female in casualty who was hit by a lorry (truck) while walking on the side of the road.  “She has bone protruding from her pelvic region,” a statement which perked my interest, knowing that an “open” pelvic fracture can be a life threatening condition.   As I walked into the bustling casualty overflowing with massive numbers of patients, I was surprised to see her tucked quietly into one of the corner beds away from the main activity .  I lifted the bloody sheet covering the lower half of her body, and was amazed at what I saw (one of many “firsts” I see at Tenwek on a regular basis, or as Will, my partner, frequently says, “you just can’t make this stuff up”).  Apparently, when she was hit by the lorry, her legs completely split apart, and the entire left half of her hemi-pelvis was protruding about 5 inches though her skin, and the surrounding area damaged by multiple lacerations.   The patient was very calm as I explained that we would need to take her to surgery to try to fix her, but in my heart, I fully expected her to die, given the complete severity of her injuries. 

We resuscitated her in theatre with several liters of fluids, and then began the arduous process of trying to put her back together.  After thoroughly washing the protruding bone, which was dirty with soil and grass, I wired the two halves of the pelvis together using sternal wire (probably brought by my brother John for open heart surgery).  Then, while Dr. Russ White and the surgical resident worked on reconstructing her soft tissue injuries, I supplemented the internal pelvic fixation with an external fixator, using 5mm diameter pins drilled deep into the iliac crests which were then connected by graphite rods.   Not once during the entire procedure did she show any signs of crashing, and, in the end, we were all pleased with the reconstruction.   

At first, during our post-op morning rounds, she would lay stoically while we examined her, likely traumatized by the horrific events in her life.  But over time, as we explained how God was healing her, and had even spared her life, she began to come alive with the most beautiful smile, and we saw her true person: a beautiful woman loved by God!   Amazingly, her postoperative course was entirely uncomplicated, and after about two weeks in the hospital, she was discharged. Just yesterday, I saw her in clinic, accompanied by her husband, actually standing (see pic), with completely healed wounds.  I was overwhelmed with a sense of God’s grace and presence as we prayed, thanking Him for His healing in her life.

The World Health Organization has recognized that road traffic accidents are becoming a public health crisis, on par with HIV and tuberculosis, and has declared this “the decade of road safety.”  As roads improve, and access to transportation increases (especially in our area via motorcycle taxis), the increase in injuries related to road traffic accidents is staggering.  The orthopaedic service has grown exponentially, and is now one of the busiest at Tenwek, with currently more than 55 inpatients.   And these patients' injuries are not simple, but complex, often with multiple open fractures, and challenging wounds that require multiple trips to the operating room.  I have come to call this epidemic “the maiming of a generation.”  But God has put Tenwek in this small part of the world (which also feels like the epicenter of this crisis) to stand as a testimony that Jesus loves His people, and that He has come to heal that which is broken, both body and soul.
Part of this holistic vision at Tenwek is the training of African surgeons.  The new orthopaedic residents are here and integrating well into our community (see pics of the annual pig roast) and plans for our sorely needed trainee housing complex are progressing.  About $340,000 of the needed $800,000 has been raised, and we are still trusting God to complete this project in time for the next class of residents (January 2015).  Would you consider partnering with us in what God is accomplishing here at Tenwek?  You can click the following links for secure on-line giving: Tenwek Orthopaedic Residency Fund and/or the Tenwek Trainee Housing Project. 
Thanks for all your continued support of our family and the work at Tenwek! 

Wednesday, December 11, 2013

Orthopaedic Residency Training at Tenwek: It’s a Full Go!


My partner, Dr. Kiprono and I just returned last week from Zimbabwe, where we traveled to take the second half of our fellowship examinations in orthopaedic surgery for the College of Surgeons of East, Central and Southern Africa (COSECSA).  The first half (the written portion), we took in Kenya this past September and both passed.  Hence, we were invited to the COSECSA annual meeting in Zimbabwe for the oral exams, which consisted of eight, 20-30 minute stations in which we examined live patients and were asked a myriad of questions to test our knowledge. 

In short, Kiprono and I both passed and are now Fellows in the College of Surgeons of East, Central and Southern Africa.  Additionally, during the COSECSA general council meeting, Tenwek was fully approved and accredited for higher fellowship training in orthopaedic surgery.  So along with approval by PAACS, the Medical Education Committee and the Board of Governors at Tenwek, and now COSECSA  (with accreditation and fellowship), what this all means is that our residency is officially a FULL GO!!  Tenwek will have the first ever PAACS affiliated-COSECSA accredited orthopaedic residency program in Africa!  Glory to God!

Now all we need are residents (trainees) to fill the first two positions!  As such, this Friday, we will be holding interviews for our first class of residents, and we are praying for God to provide a strong pair (academically, emotionally, spiritually and physically).  The program will be five years in length and so when fully-filled, we will have 10 residents in orthopaedic surgery.  Without outside funding or corporate sponsorship, we will need to raise the funds to sponsor these residents-in-training.  Because of our affiliation with PAACS, residents who are sponsored for training at Tenwek will "give back," year for year, at the end of training, working in areas of most significant orthopaedic need in Africa.  If you would like to become a part of training African Orthopaedic Surgeons for Africa, please join our team and help sponsor a resident (www.wgm.org/orthofund).  Training each resident costs about $20,000 per year. 

When I returned home last week, I told Levi and Claire that my prize for passing my fellowship exam in orthopaedics was 6 billion dollars.  Wide-eyed, Levi shouted something about being a billionaire and buying an airplane.  I then pulled out my wallet and extracted two crisp bills, one for 5 billion dollars and the other for 1 billion dollars, and gave one to each child.  Confused that these bills didn’t look like typical American cash, I explained that these were Zimbabwean dollars, and not worth much (I purchased both bills as a souvenir for 1USD).  Cruel, perhaps…but also a good lesson in the value of money, inflation, and things eternal which all the money in the world could never buy. 

Thanks for your ongoing prayers and support of our family!  We are privileged to serve with you at Tenwek Hospital in Kenya.


Sunday, November 17, 2013

Tenwek Orthopaedic Symposium 2013


The symposium attendees from all over Kenya...love the i-Phone pano function!



 The Tenwek Surgery Building auditorium...perfect venue for our symposium. 



Sawbones workshop...Dr. Cabanela demonstrating how to do a total hip replacement using model bones.


Coolest part of the symposium...the live surgery demonstration where video and audio feed was piped live from the operating room to the auditorium.  Here, Dr. Joe Cass is asking Dr. Ray Kim questions while Kim performed a total knee replacement.


Sawbones workshop...Dr. Kim demonstrating a total knee replacement on model bones.


During the days leading up to the symposium, the team operated on some patients with challenging problems!


28 year old young lady with a badly dysplastic hip, now with a brand new hip replacement.


At the close of the symposium, the team was thanked in typical Kenyan fashion, including the rungu, symbol of (orthopaedic) strength and power!


Each attendee was presented with an official "Certificate of Participation" and CME credit was given to attending physicians.


Left to right: Dr. Joe Cass, myself, Dr. Ray Kim and Dr. Mike Cabanela.  Thanks team!



This past week, the Tenwek Department of Orthopaedic Surgery hosted our first-ever, 3-day teaching symposium on hip and knee replacement surgery for surgeons and medical personnel from all over Kenya.  More than 50 people attended to hear teaching, participate in workshops, and see live surgical demonstrations (via closed circuit TV from the operating room to the auditorium) on adult reconstructive orthopaedic surgery.    Two of our three guest speakers, Dr. Mike Cabanela and Dr. Joe Cass, were consultants I had the privilege of working with while I was a resident at the Mayo Clinic in Rochester, MN and the third, Dr. Ray Kim, was my chief resident when I was a junior on the orthopaedic trauma service.  Their teaching was outstanding, and many of the attendees told me personally that this was the best symposium they had ever attended!  We thank God for this special opportunity and that, overall, the symposium was a smashing success!

Saturday, October 26, 2013

Emmanuel – God with us



Emmanuel, a 19 years young man, with a painful mass on the back of his leg.


X-ray showing this large osteochondroma growing off the top of his fibula, essentially filling the back 1/2 of his calf.


Removal success!!


Emmanuel was shocked (as were we) at the size of this mass which he lived with, in pain, for several years.


Other evidences of "God with us."  Dr. Dylan Nugent (left), who will join the ortho team (God-willing) in 2015 after he finishes residency, and Dr. Will Moore (right) who joined us 2 months ago, a stellar surgeon, team-member and friend.  (Dr. Kiprono - absent as he was on well-deserved leave after several months of faithful service - often alone - while I was away.)


Will showing "the love" during a femoral nailing.  He loves the big and bloody ortho procedures!


"God with us," as we continue to teach and train orthopaedic and surgical residents.


"God with us," as we continue to care for the myriad of patients who come to Tenwek for orthopaedic care - last week in Wednesday clinic, 137 patients...a new record.


"God with us," as our inventory grows.  The inaugural use of our new Biomet distal femoral locking plates. Huge...

 
Dr. Will, choosing the right plate for the job. 
 

"God with us," as we continue to share the good news of Jesus Christ with our patients.
 
Two days ago, I met (for the first time) a young man named Emmanuel who had a huge, firm mass growing in the back of his leg.  A previous biopsy had confirmed the mass was benign, a large tumor called an osteochondroma, which was growing off the top of his fibula bone.  All that needed to be done now was to “simply” remove this mass, which had grown to the size of a grapefruit (was now enveloping all the major nerves and vessels of his leg), and he would be “cured” of the years of pain associated with it.   

Assisted by Dr. Dylan Nugent, a visiting 4th year resident from the U.S. with a particular interest in orthopedic oncology, we proceeded, first isolating and protecting the peroneal nerve, then trying to shell out the tumor from the surrounding normal tissue, which proved to be anything but “simple,” as the tumor had grown to the opposite side of the leg, directly behind the tibia, where it was pressing directly into the large vessels that feed the leg and foot.  Our fear was that, in removing the tumor, damage would be done to these delicate structures. 

After removing the tumor and releasing the tourniquet (which allows a relatively blood-less surgical field), we encountered significant bleeding, although not pulsatile (i.e. from an artery), but rather a dark, steady flow (i.e. from a vein).   A small hemostat was used to (somewhat) blindly clamp the torn, bleeding vessel.  After tying off this small vessel with suture, the bleeding stopped, but we noticed the tissue surrounding was thumping at the same cadence of his heartbeat.  The vein we had clamped and tied (a branch of the major vein of the leg) was only a few millimeters from the tibial artery, which was completely intact, without any sign of injury, our hands sovereignly guided by a God who cares deeply for our patients at Tenwek.

After showing Emmanuel the mass (he was completely awake, anesthetized by a spinal), and enjoying his wide-eyed shock at the size of his tumor, I asked him, “Emmanuel, do you know what your name means?”  He responded with an eager smile which belied a deep inner faith.   “Yes,” he said, “it means ‘God with us.’”   Sensing God’s presence throughout the entire procedure, and amazed and humbled by the fact that we serve a God who shows up in times of our desperate need, I said “God was with us today, Emmanuel…He was with us today.”

Since returning to Kenya almost a month ago, life at the Galat house, and in the hospital, has been absolutely crazy.  Between unpacking, settling, changing diapers, organizing the orthopedic storeroom, entertaining guests, preaching, operating, homeschooling, cooking, etc. our lives could probably be described as chaotic, at best, out of control, at worst.   Our days are such a paradoxical mixture of highs and lows, struggle and victory, and good and bad feelings at all the difficulties and challenges we face (“normal” for missionary families, according to Mission Training International).  Yet God’s grace and faithfulness continues to overwhelm us on multiple levels, and more than ever, we are comforted by the fact that we serve a Savior whose name is Emmanuel – God with us.

Thanks for all your love and support of our family!