When I am Weak…

Most of the time, I have a lingering sense of my own weakness in this task of orthopedic surgery at Tenwek hospital. The relentless patient load with complex orthopedic problems, coupled with the responsibility of resident training, staff management, and equipment organization combine to often make me wonder, “What on earth am I doing here?” Sometimes, I feel this sense of weakness more acutely.

After a particularly difficult week, I made my way up for Sunday after-church rounds, which are intentionally more leisurely, taking a little extra time to minister to our patients’ spiritual needs, especially by praying with them. This Sunday, however, as I was feeling a little more self-focused and spent than usual, I was determined to do “lightning rounds,” i.e. to get home as fast as I could, so I could do my own thing. Of course, God, in His sovereignty, often has less selfish plans in store for us.

A man was admitted the night before with a femur fracture. As I looked at the x-rays, the multiple lesions peppered throughout his bones belied the cause of the fracture: multiple myeloma in very advanced stages. I knew his days were severely numbered, and as I explained his condition, I sensed God urging me to go further, although this was beginning to cut into my own plans. “Do you know Jesus,” I asked, a valid question in this part of Kenya, because of the candidly honest answers usually obtained. “No,” he said quietly in Kipsigis. “Would you like to?” I returned. “Please.”

There, in the ward, on an early Sunday afternoon, in front of several other patients, this man, for the first time in 70+ years of life, admitted his need for a Savior and gave his remaining days to his Creator. What happened next humbled me greatly, and reminded me that this is God’s business. Several of the young men with tibia and femur fractures called out, “Please pray with me too!” One man named Peter, about the same age as me, also married with four children, asked for a bible in the Luo language. Peter had been admitted the previous week for complications of a femur fracture fixed at another hospital. Being HIV+ (with a weakened immune system) does not mix well with fractures fixed nominally at ill-equipped, and often very unsanitary, hospitals. After lying in that hospital for three months, he begged to be transferred elsewhere, and he was finally released. He traveled directly to Tenwek, and was admitted with pus pouring out of his thigh. We did what we could, removing the infected hardware and dead bone, and stabilizing the fracture with an external fixator. I promised Peter that I would ask one of the chaplains for a Luo bible for him on Monday.

Of course, Monday came and went, the busyness of the surgical schedule causing me to forget about the bible. On Tuesday, Peter kindly reminded me with his big smile that he had not received his promised bible yet. This time I would not forget, I told myself. I did. Thankfully, God’s sovereignty is greater than my male compartmentalism, and on my way to the choo (bathroom), on a normally untraveled route, I ran into Helen, one of the head chaplains. I told her about Peter, and she then promised she would get the bible for him.

On Wednesday, our busy clinic day, I walked to the wards to check an x-ray, and heard a voice from one of the benches outside where our patients “bask” in the sun, soaking up vitamin D, an essential vitamin for healing bone. “Daktari,” Peter called excitedly, “I got my bible!” I was in a hurry and didn’t feel like talking much. “That’s great…are you reading it!?” I called back. “Yes, and I want to know Jesus!” I stopped there, again humbled by my own inadequacies and God’s far greater and perfectly sovereign plan. I slowly walked over, sat down next to him, and there prayed with him to receive Christ as his Savior.

While orthopedic surgery is my primary “function” at Tenwek, my ultimate purpose for being here is to share that Jesus is the greatest treasure our hearts could desire. What is paradoxical and sometimes incomprehensible, however, is the fact that God chooses to do this work through people who are weak, broken, and selfish, ourselves sinners in need of God’s grace. The reason for this is summed up perfectly by the apostle Paul, who referred to himself as “the chief of all sinners,” when he said to the Corinthians that “we have this treasure (Jesus) in jars of clay (broken vessels) to show that this all-surpassing power is from God and not from us.” In the end, the glory goes where it must.

Not to us, O LORD, not to us but to your name be the glory, because of your love and faithfulness. Psalm 115:1

But he said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me…For when I am weak, then I am strong. 2 Cor. 12:9-10

Images from Tenwek

"The Mystery of History" at Tenwek. All the children dressed up as their favorite character in history and went from house to house, each set up as a different time period in history, and to get a "treat". Jeremiah was a Spartan Soldier, Emma a gypsy, Claire a Grecian princess, and Levi, Cupid.

Emma is growing up!

Cupid getting ready to shoot his "love arrows."

Justice vs. Mercy

Stolen cell phone in the underpants igniting an extreme case of "mob justice."


The end result of an argument gone very bad.

This morning, on rounds, I was handed a crisp, new “orthopedic service list” by one of the Kenyan medical students, an invaluable tool for tracking our many patients scattered throughout the hospital. The List, kept by our hard-working interns and medical students, includes patient names, injuries and treatment plans. As I quickly scanned the list for any new overnight admissions, one patient distinctly caught my eye: Peter Kipkirui, mob justice victim. The patient had multiple injuries inflicted by blows and pangas (machetes) as a result of vigilante justice, meted out by a group of angry Kenyans. “He must have done something pretty bad,” I thought to myself. I asked the two medical students, Mercy and Justus (no joke), what he had done and they showed me a pelvic x-ray demonstrating what they thought was the reason for this swift punishment. A cell phone that the patient had stolen, and stuffed into his underpants, on x-ray, appeared as a rectangular, outlined skeleton of wires and chips. Later, I was called to the operating room to see a patient who was the victim of another kind of “justice” that unfortunately results from the simple equation: liquor + argument + sharp instrument = severe injuries. The man had the most impressive hand panga cut I have ever seen.

To be honest, as a surgeon dealing daily with injuries caused, in some way, by foolishness, carelessness, jealousy, anger, neglect, greed, etc. (essentially sin), I am tempted to lose compassion, and think, in my heart, “they get what they deserve.” Then, I am quickly disciplined by God as he reminds me of the incredible Grace that was given me, i.e. my sins paid for by the blood of his own Son. It’s a good thing I don’t get what I deserve. All of us receive one of two perfect options: justice or mercy. Either we receive just punishment for our sins…or mercy, embodied in the person of Jesus Christ as we come to Him in faith. The Newsboys sing a song with simple, yet profound lyrics: “When we don’t get what we deserve; it’s a real good thing…when we get what we don’t deserve; it’s a real good thing.”

Eph. 2:4-5 But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions--it is by grace you have been saved.

Behind the Scenes

Meshack, our outstanding orthopedic charge nurse, was notably happy at the amount of implants donated, in total, two pallets of equipment weighing 800 lbs. The man in the red jacket is a hospital chaplain who kept asking, shocked, "You put those big metal pieces inside someone's body?"


Meshack spent two days organizing and inventorying the donation in the orthopedic storeroom.

Brand new Zimmer ITST (Inter-Troch, Sub-Troch) femoral nailing instrument set.

First patient to receive the ITST nail for a proximal femur fracture. The nail is inserted through two incisions each measuring about 2 cm in length.

Post-op x-ray of ITST nail.

Recently, the Tenwek Orthopedic Department received a huge donation of orthopedic implants, sent by a group called Hope Force International. Several folks from different areas of the country rendezvoused in Memphis, Tennessee to pack two pallets of a board assortment of supplies: nails, screws, plates (in total 800 lbs of equipment!), to be used for the orthopedic care of the people in this poor region of Kenya. Amazingly, Fed-Ex air freighted the pallets free of charge (even upgraded to “express service”), thus the total time from leaving the US to arriving at Tenwek was only 8 days…and there were no issues with customs. Just yesterday, we used one of the nails, the Zimmer ITST (Inter-Troch, Sub-Troch), for an elderly woman with a fracture of her femur caused by an erosive metastasis of cancer. Although this will not cure her disease, now that the fracture is stabilized, she will be able to move without pain.

As I reflect on the incredible generosity of not just Hope Force, but the many other companies and individuals who have donated time, resources, and personal finances to supply Tenwek with implants, so essential to the practice of orthopedic surgery, and the care of our patients, I am humbled and thankful. I think of the SIGN nail company, whose sole mission is to manufacture low cost implants for the poor in developing countries…I think of an individual who bought a set of plates for Tenwek with his own finances…I think of a sales representative from an implant company who gathered and shipped screws and plates on his own time and dime…I think of a group of students from Cedarville College and their mentors who are designing a new nail to be used at Tenwek …and there are many, many others.

Together, these people and groups are serving faithfully in the way God has called, all of great significance to the work here in Kenya. It is a challenge for me to be a good steward of God’s provisions for Tenwek, and for all of us to ask, “God, what would you have me do today?” The majority of times, the work God calls us to goes “unnoticed” by the world, and the results of which may never be realized to the fullest extent in this lifetime (much like the Heroes of the Faith from Hebrews 11). But, faith in this matter is key, believing that God has a grand, sovereign plan for the redemption of mankind, yet somehow, paradoxically, God uses our small acts of obedience to His call, behind the scenes, to bring glory to his Name, and advance His kingdom.

Hebrews 11:1 Now faith is being sure of what we hope for and certain of what we do not see.

The Simple Life

Jeremiah, Jamie and Peter hanging out at the newly erected campsite.

Drinking coffee by the mud brick fire pit.

Jeremiah pouring a freshly brewed, and very stout, cup of cowboy coffee, a skill he learned from Grandpa Kinkel.

Remnants of a night of big fun...

Over the past week, Jeremiah has been uncharacteristically efficient with finishing his homeschooling assignments. As soon as Latin, literature, Algebra, and history are finished, he is gone…for several hours. “What is he up to?” I asked myself, and, knowing Jeremiah, I figured it involved something related to digging, chopping, cutting and fire. He would show up for dinner covered with sweat and dirt, smelling like a 12 year old + boy, but with a very contented look on his face.

Yesterday, the mystery was revealed, as Jeremiah invited me to see the campsite that he, Jamie and Peter had been diligently working on for days, tucked in a secluded area, what appeared to be a remnant of the high altitude rain forest that used to cover this area. Entering through the back, and going down dirt steps meticulously fashioned, was the fort, a small clearing created by pangas, with a lush canopy, a mud brick fire pit, and a leveled dirt area for sleeping.

When Jeremiah asked if they could sleep in the fort that night, the answer was easy. “Just be careful,” I said as he was gathering supplies: a bucket of Cokes, two onions for roasting in the fire, a package of marshmallows, a bag of Farmer’s Choice sausages (advertized proudly to be at least 62% meat), a panga, OFF!, and materials for making torches (the OFF! was not for repelling insects). I told Heather that the combination of pre-adolescent angst plus indigestion would guarantee about two hours of sleep for the boys.

This morning, I carried fixings for “cowboy coffee” to the fort for the boys…I figured they would need it. Jeremiah had already fried eggs over the fire, and the site was strewn with the remnants of last night’s events. Jamie was finishing off the last of the hideous sausages, and they all smelled like the open pit fire.

As I walked back home, I recalled the worry I had when we first arrived in Kenya, that our children would, in some way, suffer as a result of being here, not having the same opportunities available to kids in the States. And, there are missed opportunities for our children…piano lessons for Claire, violin lessons for Emma, football for Jeremiah, and, more importantly, missed family events with cousins, aunts, uncles, grandparents. But, we have seen God provide for our children in ways far beyond what we think they need, or what we could even provide. Now, we see the incredible blessing of raising kids in a simpler environment such as this. Without TV, soccer practice, McDonalds, school events, (and, for the first three months even, a vehicle), the kids finally have time to be kids, to use their minds, to create, to explore, and just have fun. Sometimes the things we think we so desperately need actually hinder that which our hearts truly desire. The simple life at Tenwek…not so bad after all.

God’s Timing: Lessons in Answered Prayer

"Spine week" at Tenwek. This patient had bilateral jumped facets at C5-6 and was treated with a posterior spinal fusion. Needless to say, a significant amount of reading (and prayer) went into this case.

"Spine week" continued...This man had a compression fracture at L1, treated with a posterior spinal instrumented fusion T12- L2.

Saturday morning relaxation in mom and dad's bed...

Solomon, our outstanding physiotherapist, with a spine patient sporting a newly applied halo.

The Monacle Man...this patient used a 1/2 pair of glasses, turned upside down, as his monacle to see. Stephen's parents glady provided the 250 shillings (3 bucks) to buy him a brand new pair of Ray Bans.



As a male with a certain amount of pride, it is hard to admit when I need help. About three weeks ago, overloaded with cases, and just plain physically exhausted, I finally admitted to Heather that I cannot continue at this pace alone. She came up with a rather simple solution. “Why don’t we ask God to provide another orthopedic visitor,” she asked. Admittedly skeptical that God would answer as quickly as I needed, we, as a family, began to pray.

About five days later, Russ White, the medical superintendent at Tenwek, approached me in theater. The previous weekend, he had been at the Rift Valley Academy, a boarding school located on the grounds of Kijabe mission hospital, just outside of Nairobi. While there, he had a “chance meeting” with an orthopedic surgeon who had been visiting at Kijabe hospital for about a month. When Russ asked how it was going, the surgeon said, “Fine, but I don’t feel very needed here…there are already 12 orthopedic surgeons at Kijabe!” Russ, as the quintessential recruiter, challenged him to come to Tenwek, where there would be no question about needed-ness. In short, in less than two weeks after we began to pray for another orthopod, Dr. Bob Greene arrived at Tenwek, and he will be here for the next 6 months!!

God’s timing is perfect. Many times, however, unwilling to wait on God to work or provide, I have formed my own plan, gone my own way, and, as a result, missed God’s best, or sometimes suffered undesirable consequences. Thankfully, this time, resisting the temptation to quit, although feeling spent, God gave us the patience to wait, and he provided miraculously, and far more quickly than I believed he was willing or able. Walking home from the hospital today at an early 5pm, I noticed a lighter step…I wasn’t feeling exhausted or angry or overwhelmed.

I am reminded of the verse from Jeremiah 2:13: "My people have committed two sins: They have forsaken me, the spring of living water, and have dug their own cisterns, broken cisterns that cannot hold water.” When we “dig our own cisterns,” they crack, leak, and never maintain the level that we need. We wonder why we feel unfulfilled, stressed, burdened, etc. Why do we feel compelled to forsake our God, who is able to provide in ways far more perfect and complete, fulfilling that which our souls really desire? The simple answer is pride…fear…anxiety…_______. However, when we wait on “the spring of living water,” the result is far beyond anything we are able to provide for ourselves.

Motorcycle Taxi for Hire

Waiting for customers...

Rigtht leg of 14 year old boy struck by a motorcycle taxi with open femur and tibia fractures.

Over the past few months, we have noticed a huge increase in the orthopedic trauma volume at Tenwek hospital, and now our current census has over 35 patients scattered throughout the hospital (even on the eye ward), making morning rounds a bit of a challenge. I find myself asking questions like, “Where did the patient with the bilateral open tibia fractures go?” and wondering when we will ever catch up. Daily surgery is just an attempt to keep up with the load of cases that continue to pile in, praying that God helps us do our best with each patient that He sovereignly brings to Tenwek. Currently there are 14 patients in the queue needing surgery.

All around Tenwek and the nearby village of Bomet, are what seems like hundreds of new motorcycles, all the same brand, all the same maroon color. To help distinguish one from another, drivers cover the gas tanks with decals that vary from “the mother Mary,” to a “skull and crossbones” (very apropos). Cost of a brand new Bajaj Boxer 5 motorcycle (hot off the production line in India) is a cool 85,000 Kenyan shillings (about 1,100 USD). “How can so many people afford a brand new motorcycle (more than two years average salary in this part of Kenya), and where are they all coming from?” I wondered to myself. What was clear, however, was the fact that the increase in trauma is most definitely related to an increase in motorcycle accidents.

A patient arrived in the early evening last week with an open tibia fracture, wound full of dirt and other debris, the result of…a motorcycle accident. While performing the initial “washout” surgery to clean the open wound, I decided to get to the bottom of this mystery. We use spinal anesthesia almost exclusively for lower extremity surgery, thus our patients are awake during surgery, and often very chatty. I asked him how the accident occurred, and he explained that he is a motorcycle taxi driver, and while carrying a passenger, after passing a large truck, looked over his shoulder at an interesting scene, and…(the stories are all too similar). Getting more personal, I decided to ask where he got his brand new motorcycle, and how much it cost. “About 500 shillings,” he said (i.e. $7). Puzzled, I probed further, “500 Shillings?” “Yes,” he answered, “for 500 shillings per day I can rent a brand new motorcycle, and whatever I make over that I keep for myself.”

A flurry of questions went through my head, as well as a sense of anger and injustice for all the passengers who have gotten injured or killed as a result of untrained, uneducated, and often irresponsible, motorcycle taxi drivers who can rent a motorcycle for almost nothing and, in a millisecond, change their lives or their passenger’s lives forever. “Who then is the real entrepreneurial kingpin behind this phenomenon?” “Where are the regulations?” “Is this really true or is this just one person’s story?” Just today, we cared for a 14 year old boy who was struck from behind by a motorcycle while walking down the road, with open femur and tibia fractures. His life will never be the same.

As we were pulling out of Tenwek to pick up Stephen’s parents in Nairobi, we noticed all the motorcycle taxis coming and going, all Bajaj and all maroon. One man came flying around the corner (faster speeds = more money) with three, young school aged girls on the back (more passengers = more money). After almost running into our van, he stopped directly next to me, and I noticed one girl handing him 100 shillings. I looked directly at him, and with more frustration than I would have liked, I said firmly, “you need to SLOW DOWN!!”

Trauma in developing countries is becoming a worldwide healthcare crisis, on par, or now, even more important than AIDS or tuberculosis. When a young man or women trying to earn a living for their families gets a life-altering injury, the entire family can be thrown into poverty and chaos. We see it every day at Tenwek. Please pray that God would intervene to bring this important issue to the forefront of our leaders, that the subject it would get due attention, and that real change would be implemented.

Proverbs 13:23 “A poor man's field may produce abundant food, but injustice sweeps it away.”