Grandparents, Uncle John and the Cardiac Team

Uncle John Galat and the "Cardiac Team" recently spent two weeks at Tenwek doing heart surgery. They were such a help to many needy patients!

Uncle John found some time to take his nephews fishing above the dam. Jeremiah caught some sort of bottom dwelling catfish and cooked it up for dinner.

Grandma Galat celebrated her 71st birthday with us in Kenya.

The kids LOVE their Grandma!!

Grandpa Galat could not resist buying chicken feet at the butcher in Nairobi.

Joshua’s Battle

Joshua and mom before surgery, where several people surrounded him with prayer.

Large mass on Joshua's right wrist.

Post removal...

Joshua the day after surgery. All smiles...

Certain patients leave more of an impact on the life of a physician, some because of their unique personalities, and others because of their amazing pathology. When the two combine in the same patient, that impression becomes indelible. Joshua is a sweet, little 18 month old boy, the son of a single and very poor mother from a border town near Tanzania. She noticed a “growth” on his hand, which had consistently grown larger over the past year. Through the friend of a missionary couple here at Tenwek, Joshua was referred for evaluation, and after the funds were scrounged, the journey was made.

The growth on Joshua’s right hand was fairly massive, and about to fungate through the skin on the undersurface of his wrist. While examining him, he managed to smile often, but I could tell the tumor was painful. While my strongest hopes where that this was some more aggressive type of benign tumor, I was also concerned that this could be a rare type of cancer found in children: rhabdomyosarcoma.

During surgery, we used loupe magnifying glasses to make sure no obvious tumor was left behind. Thank the Lord that the tumor did not involve the median nerve, one of the main nerves supplying the hand with vital function and sensation. Tenwek is blessed to have a newly trained Kenyan cytopathologist who received his training at the Mayo Clinic in Rochester (he said he did not know what cold was until he experienced true “cold” during his year in Rochester). Together we looked at a smear of cells from the tumor under the microscope, and found what looked like small “blue cells” mixed with more oddly shaped “spindle cells”…features that are more suggestive of what I feared. Final confirmation will come from the pathologists at Kijabe, a nearby mission hospital.

When viewed from a purely humanistic standpoint, if Joshua’s growth is confirmed to be cancer, the situation appears hopeless with the only option being an amputation of the arm, and with statistical chances of either recurrence or metastasis. However, a missionary colleague reminded me that this isn’t Joshua’s battle to fight, but rather the Lord’s. God is more than able to do a miracle, and we are praying that Joshua receives complete healing. This truth is applicable to our own lives. How often do we feel discouraged, and alone in our weakness, not realizing the truth that God is with us, and waiting with supreme strength to fight our battles? If we would only just submit to the One who knows us, created us, and loves us, I am convinced we would see the miraculous.

2 Chronicles 20:15 This is what the LORD says to you: 'Do not be afraid or discouraged because of this vast army. For the battle is not yours, but God's.

Deut. 31:6 Be strong and courageous. Do not be afraid or terrified because of them, for the LORD your God goes with you; he will never leave you nor forsake you."

Finding Forgiveness…

David's multiple injuries included an open knee fracture, femur fracture, and hip fracture on the right side, and a hip fracture-dislocation on the left side....the perfect example of the multiple injuries that occur with high-speeds.

In all honesty, the continual barrage of road trauma that presents at Tenwek, often patients with multiple open fractures whose care is extremely challenging and labor intensive, stressing our already taxed resources, causes me, as a flesh and blood human, at times to feel some degree of animosity towards certain patients, especially those who cause the accidents, careless drivers, who by their lack of experience, judgment or scruples, put of the lives of many people in danger. Not uncommonly, I see drivers of boda bodas (motorcycle taxis), often 18 year old boys, carrying three passengers while talking on their cell phones, simultaneously looking over their shoulders at interesting roadside phenomenon. Just last week, two patients were admitted to the orthopedic ward with multiple complex fractures, the result of a boda boda accident in which the driver was trying to pass a matatu (van taxi) around a bend in the road. On my own, without renewal of strength from the LORD, physically, emotionally, and spiritually, events such as these can threaten to make the fleshly heart hardened.

Last month, I mentioned a patient “David,” the driver who stuffed 14 passengers into his mini-matatu (seats 5), which, not surprisingly, lost its brakes while going down a hill, causing a massive pre-Christmas Eve crash, resulting in multiple injuries, including the death of two people. David himself was badly injured, including an open knee fracture, femur fracture and hip fracture all on the right side, and a hip fracture-dislocation on the left side. At any other hospital, he would likely have been left in traction for several months…and likely have remained a cripple, unable to walk for the rest of his life. But, at Tenwek, because God has blessed us with the resources to help patients such as David, after several surgeries, he is now able to stand without pain, and soon will be able to walk again. His physical recovery has been nothing short of a miracle. But God’s purposes in David’s life were well beyond the physical.

While rounding on David, I could sense a certain amount of guilt associated with his accident, although mixed with a denial that, at times, caused me to want to shake him and shout, “Do you realize what you have done!?!” Currently, we have a “super-chaplain” on our service, Helen Tangus, who faithfully and daily “rounds” on our orthopedic patients. I pulled her aside one day and asked her to “work” especially on David, and she said “Of course, Daktari, I have been reading scripture and praying with him daily.” Over the next several days, David’s countenance was notably different, a change which could only be the result of a person who had found forgiveness with his Savior, and perhaps with himself as well, a fact Helen later confirmed.

What amazes me is that God is always at work at Tenwek, and in all our lives, even in circumstances which, to us, seem purposeless or random. And His ultimate purpose is to work forgiveness into our lives, made possible only through the death of His Son on the cross…forgiveness which reconciles us to God, and us to one another…forgiveness which frees our conscience from guilt…and forgiveness that allows this simple orthopedic surgeon to see his own need for a Savior, and continue with our family’s calling to alleviate a little suffering in this small part of the world. Thank you for your ongoing support and prayers for our family, and for our patients that we care for in Kenya. We appreciate you!!

Eph. 1:7-8 In him we have redemption through his blood, the forgiveness of sins, in accordance with the riches of God's grace that he lavished on us with all wisdom and understanding.

Col. 3:13 Bear with each other and forgive whatever grievances you may have against one another. Forgive as the Lord forgave you.

Graduation Day 2010

Dan with Mr. Fred Ochieng and Dr. Gerald Angira, both of whom caught a passion for orthopedics while rotating on the service, and will be pursuing further training in orthopedic surgery.

Graduating intern class 2010 with consultants!!

The future of medicine in Kenya, 5 guys very happy to be finished with internship.

Today, we celebrated the graduation of another class of interns, sixteen Kenyan men and women who have been intensively training at Tenwek for the past year. The minor explosion at the lunch catering table, caused by an attempt to add butane fuel directly to an already lit burner used to keep the food warm, resulting in singed arm hair, flaming chapattis on the floor, and a dress that caught on fire, made the event even more memorable. Thankfully no one was seriously hurt, and after this minor disaster was cleaned up, the festivities continued. During the ceremony, each graduating intern received a diploma, a copy of the book “The Purpose Driven Life” and new white lab coat.

Undoubtedly, the most satisfying aspect of the work at Tenwek, and the unifying purpose of all us “western missionaries” who are serving here in rural Africa, is the opportunity to impact the lives of young African physicians. As a consultant in orthopedics, I am privileged to play a role in teaching these physicians who are the brightest and best in Kenya, and of course, to influence them that orthopedic surgery is the ultimate pursuit! And God is doing an incredible work in orthopedic surgery at Tenwek. In addition to Dr. Kiprono, who is currently in his orthopedic residency at Moi University and will be coming on staff at Tenwek as a full-time orthopedic consultant in 2011, two other young men have joined the Tenwek orthopedic bandwagon. Fred Ochieng is a very bright, and godly, young clinical officer, who aced orthopedics during his rotation. He plans to begin an 18 month diploma program in orthopedic surgery, then return to Tenwek to join the team. Additionally, Dr. Gerald Angira, a general surgery resident at Tenwek, rotated with me for 4 months last summer, and recently decided to pursue residency training in orthopedics, also with the plan to return to Tenwek. This greatly excites me to be involved in the “grassroots” development of orthopedic surgeons and clinical officers in a country of 38 million that has, at best, only fifty, less than the city of Rochester, Minnesota!

I have always viewed the work we are doing here as a team effort, all of us joining together in God’s kingdom to accomplish His plans. While I am here on the “front lines,” you could have as much impact in the future of medicine in Kenya, in the training of the next generation of godly physicians. We currently have two major needs, one being the funding for the training of Drs. Kiprono and Angira, and Mr. Fred Ochieng. Unlike in the U.S. where residents get a salary (albeit meager) for their training, residents in Kenya must pay for their own training and living expenses, which costs, on average, $20,000 per year. Thus, most residents have to find “sponsors” before they can even begin, and lack of funds often delays matriculation into programs. By sponsoring one of these fellows, not only would you be helping the future of Kenya, but also Tenwek, as sponsorship also guarantees a commitment to serves at the sponsoring institution upon completion of their training. The second need is for housing of the new interns. As the numbers of interns and trainees increases here at Tenwek, the housing situation tightens. Currently, there are plans for two new intern housing projects, and construction is set to begin on the first shortly. However, the second building is only partly funded, and each missionary consultant has been asked to raise $25,000 towards the completion of this project. If you feel led to join the awesome work that God is doing here at Tenwek in the training of Kenyan health care professionals, let me know and I can provide you with more information! Together we can work to better medical care in this needy area of the world. Thanks for all the encouragement and support you have provided to our family!

Christmas at Tenwek

The Galat Family Christmas Eve meal.

The result of deprivation: over-exuberance for mundane, hard to obtain items.

Yearly tradition in our house: Christmas books for the kids. This year, they each got a Masai blanket to keep warm while opening presents.

Ruth Melelei and Beatrice Rop gave kongas (aprons) to the orthopedic wives, Mrs. Gaw, Mrs. Greene, and Heather, a very kind and generous gift.

Meshack and Ruth enjoying something new on Boxing Day.



The Wednesday before Christmas was a clinic day, but because of the huge number of admissions, and patients in the queue awaiting surgery, we, being orthopedically blessed with greater numbers at the moment, exercised the divide-and-conquer strategy, thinking that we could win the battle and catch up in time for a quiet Christmas day at Tenwek. Dr. Gaw, and the Kenyan surgical resident and intern hit the battle front head-on in clinic and saw about 80 patients, while Drs. Greene, Kiprono and I flanked the enemy in theater, getting 7 surgical cases done. As Dr. Kiprono and I were leaving around 6pm, satisfied with the day’s work (although with a sore ring finger), a nurse from Casualty ran into theater asking rather excitedly, “Are there any C-collars here?” Kiprono and I looked at each other thinking, “This cannot be good.”

We walked over to Casualty to find it flooded with patients, and the courtyard crowded with a myriad of anxious relatives and onlookers. “What happened?” I asked one of the Kenyan residents. “A mini-matatu (small van holding a maximum of 5 people) was carrying 14 passengers, and while going down a hill, the brakes went out,” he said. I looked over at one older man struggling to breathe, with his chest wall visibly moving out of sync with his breathing, a flail chest. The lady next to him had a deformed forearm and an obviously dislocated left hip, which Kiprono and I quickly reduced. Across the room was an elderly woman with a swollen distal thigh and a small wound over her knee with visible bone peering through. Her breathing was labored. As we went from patient to patient, I felt my anger at this seemingly senseless situation flaring. “Where are the police?” I said out loud, as if I was the only one original enough to pose this grand question that everyone was already wondering. “Here is the driver,” someone said. My first emotion was anger at this man for illegally stuffing so many people into the van, and then his transfer of guilt to the simple mechanical failure of brakes. But after seeing his obviously dislocated hip, femur fracture and open knee wound, the frustration subsided. “They were all on their way to a wedding,” someone said. After hearing that, I just felt tired. After finishing in theater around 10pm, as I walked out into the fresh air of the courtyard, I was met with wailing. My suspicion was confirmed as I was told the man with the flail chest had passed away.

The next day, Christmas Eve, was a new day. The theater staff was super-charged and motivated to clear the board so we could all go home early. By 1pm, starting with 4 rooms, we had cleared another 7 cases. As I arrived home, the kids were gearing up for a serious Christmas Eve Galat family celebration, the main course decided weeks earlier, a rarity at our house in Kenya: cold cut meat sandwiches (salami can run as high as 3200 shillings per kilo, or about 20 bucks per pound!). However, a phone call at 5:30pm threatened to spoil the festivities. “There is a mass casualty going on up in the ER,” the person said on the other line, “and all available doctors are needed now.” As I was putting on my shoes, Emma was obviously upset. “It’s not fair!” she said, “It’s Christmas Eve and we have plans!!” Any “wise” explanation at that moment wouldn’t have mattered, so I just smiled and said, “I’ll be home as soon as I can,” and walked outside into the rain.

A bus carrying many passengers had rolled off the slick road about 10 km from Bomet, and patients were beginning to arrive in Casualty, most of them with minor injuries, but one serious case already in theater. There, the general surgeons had a young man, about 18, on the table with a severely mangled right upper extremity, and a huge laceration of the face and scalp, both ears having been shaved off, the horrible result of being caught between moving bus and road. The only option was an amputation at the level of the shoulder. “He must have been going home for Christmas,” I thought to myself.

After finishing this case, I went back to Casualty, fully expecting to be met with several other orthopedic disasters. However, by some miracle, all the other injuries that arrived were minor, and unbelievably, no fractures! As I walked through the door of my home, just in time for the planned celebrations, Emma burst out with excitement saying, “Dad, God answered my prayers!!” As a family, we attended the Christmas Eve services at Tenwek, then went home and feasted on salami sandwiches, Doritos, Mountain Dew (a rarity in Kenya), and other delicacies, followed by the sharing of our gifts with one another. Emma “splurged” and got me three travel size bars of my favorite soap, Imperial Leather.

Christmas day was much quieter, and we greatly enjoyed having our Christmas meal, meatballs and lasagna, ham and scalloped potatoes, with the Crognales, a missionary family famed for making the best Italian food on the compound. The following day was “Boxing Day” in Kenya, a holiday I am still trying, in vain, to understand. Nonetheless, still a reason to get together and celebrate, so we had a mini orthopedic Kipegange (meaning “party” in Kipsigis), with Meshack, Solomon, and their families, and the Greenes and the Gaws. We wanted to introduce our Kenyan guests to ice cream cones, and Solomon and Beatrice could not understand why Dr. Gaw would be eating what they all thought was the “plastic holder” of the ice cream (i.e. the cone). We all laughed hard, and celebrated together the great things that God has done in and through the orthopedic department at Tenwek…all a result of the advent of Christ as a babe, and through His eventual sacrifice on the cross. The paradoxical mix of sorrow and joy, tragedy and triumph…Merry Christmas and Happy New Year from Tenwek.

Lessons from the Fatherless

Thanks to the newly-arrived group of Samaritan’s Purse post-residents who just so happen to have as much exuberance for Ultimate Frisbee as I do, and the “slightly” broken left ring finger that resulted from a highly-competitive mid-Sunday afternoon game, I have been forced to take some leave from surgery. This is now my third “major” injury (including a self-diagnosed cracked skull, and a severely rolled ankle) resulting from this innocent-appearing, yet potentially dangerous game (I know what some of you are thinking). True, it is not rugby, or American football, but nonetheless, can be considered a contact sport in the right circles. Thankfully, our orthopedic department is currently expertly covered with Drs. Greene, Gaw and Kiprono, and being Christmas week, although realizing that my aging body is not 25 anymore, the timing was at least ideal. All things work together for good...

As a result, I was able to travel with our family and a group from Tenwek to Mosop Orphanage, one of the facilities supported by WGM, for the annual Christmas “party” with the children who live there (an event I missed last year). After playing many games, we heard the kids sing and recite bible verses, shared some ndazis (fried donuts) and just loved on them a while. When I spend time with these children, who have so little in terms of earthly possessions and relationships, yet seem so content and happy, I am struck by my own discontent. And I am reminded, especially at this Advent Season, that through Christ, we are “adopted” into God’s family, through faith in the work of His Son on the cross. Please keep these children in your prayers, that they would experience God as their true father, and that they would be blessed this Christmas season. Thank you for all your prayers and support!!

But you, O God, do see trouble and grief; you consider it to take it in hand…. you are the helper of the fatherless. Psalm 10:14

Seek justice, encourage the oppressed. Defend the cause of the fatherless, plead the case of the widow. Isaiah 1:17

The Future of Tenwek

Dr. Kiprono, a hard working orthopedic machine...


Stephen and our favorite patient on the female surgical ward. In Kipsipis, she calls Stephen her grandson, and me, her son-in-law?!

Laughter makes long days shorter...

"Thumbs down" for this unfortunate patient with a massive open knee fracture, another victim of the barrage of Bajaj motorcycle taxi accidents.

This past week, the Galat family celebrated our first year anniversary at Tenwek hospital, and as we went around the table thanking God for the incredible ways he has worked in the past year, my mind wandered back to those tumultuous first few weeks in Kenya, getting settled in a new culture, the new sights, smells…and challenges. I still have the original hand written list of 30+ orthopedic patients handed off to me within 5 minutes of arrival at Tenwek (I thank God I will never have to repeat that initiation!).

When I started in orthopedic surgery at Tenwek last year, it was me and one Kenyan female intern, who obviously was extremely disinterested in orthopedics, having rather been with the little babies in the NICU. Solomon, our chief physiotherapist, and Meshack, our head orthopedic nurse (both critical to our work at Tenwek) were inconveniently on annual leave when I arrived. After a few weeks of pounding (December is the “high season” for orthopedic injuries…Christmas bonuses + time to burn + alcohol - Jesus = Trauma), I found myself thinking, well beyond my comfort zone, “There is NO way I will survive here.” Thankfully, God promises never to give more than we can handle…Solomon and Meshack eventually returned from leave, and various orthopedic surgeon visitors began to arrive (at just the right time) to help with the workload. Then, in April 2009, more quickly than I had envisioned, Tenwek began as a training site for Kenyan orthopedic residents from Moi University in Eldoret.

Dr. Geoffry Kiprono, our most recent visiting resident from Moi, arrived in early November. Kiprono is one of 16 children of his still-living 90+ year-old father (who incidentally practiced polygamy, Kiprono’s mother being the “less favored wife”), and grew up with nothing. However, determined to succeed, he worked hard, and was eventually accepted to medical school. Kiprono first arrived at Tenwek in 2003 as an intern, and being Kipsigis (the most populous tribe in this area), was happily posted to Tenwek as a Medical Officer (MO), in which capacity he worked for 4 additional years. While working as an MO, he was exposed to orthopedics working with Dr. Mike Chupp and other visitors from the U.S., and knew this was his calling. Thus, in the fall of 2008, he began his 4 year orthopedic training residency at Moi, and being sponsored by Tenwek (residents actually have to pay for their training, unlike in the US), will eventually return as a full-time consultant once fully trained. Kiprono is the future of Tenwek…

God has provided exceedingly and abundantly more than I could have imagined over this past year: a highly organized, hard-working, and committed orthopedic surgical team with solid implant selection, a dedicated physiotherapy department, Stephen as our full-time orthopedic RN, various and multiple orthopedic visitors who commit time and energy to Tenwek, a strong teaching program including visiting medical students from Kenya and the U.S., Kenyan interns, residents, and the external rotation for Kenyan orthopedic residents from Moi, all working together as a team to provide our patients with (1) the best possible orthopedic care and (2) the good news of Jesus Christ, Hope for this world. God has done ALL this, and He deserves the praise and glory!

I will make rivers flow on barren heights, and springs within the valleys. I will turn the desert into pools of water, and the parched ground into springs.
I will put in the desert the cedar and the acacia, the myrtle and the olive. I will set pines in the wasteland, the fir and the cypress together,
so that people may see and know, may consider and understand, that the hand of the LORD has done this, that the Holy One of Israel has created it.
Isaiah 41:18-20