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

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

Friday, November 4, 2016

Divine Surgery



My second week at Kijabe, a clinical officer came for advice on a perplexing case of a young, 12-year-old boy with multiple joint pains and fevers.  “I think it’s a case of juvenile rheumatoid arthritis,” he said, “but it could also be infection.”  “Let’s go take a took,” I said curiously, as his lab work showed a markedly elevated white count and ESR, findings more consistent with a diagnosis of septic arthritis.  However, this condition is rarely seen in multiple joints simultaneously, unless the patient also had some hidden source of infection, showering the bloodstream with bacteria. 

When we came to Adan’s bedside, his body was burning with fever, and he looked rather ill.  Everywhere I touched hurt, but the slightest movement of his right shoulder, right elbow and left ankle caused excruciating pain.   A quick aspiration of his shoulder joint with a large-bore needle confirmed what we suspected: pus.  Thus, plans were made to take him to the operating room for urgent washout of these multiple joints. 

In theatre, Dr. John Deng (general surgery resident) and I started with the shoulder as Dr. John Weston (a visiting resident from Mayo) worked on the ankle.  As the capsule of the shoulder joint was pierced, pus under pressure oozed copiously and continued as we "milked" the arm upwards.  After opening the elbow joint, we found the same.  The entire fibrous covering (periosteum) of the humerus was elevated off the bone and a large pocket of pus communicated with both joints above and below.  Dr. Weston also found pus in the ankle, less than the shoulder and elbow, but still present.  Cultures were taken, and antibiotics were started.  Although we weren’t certain why multiple joints were infected, after these thorough washouts, we expected the pain and fevers to quickly diminish.

However, this was not the case.  Over the next 48 hours, this fevers climbed even higher, and his white count was not dropping, despite being on strong antibiotics.  Cultures eventually grew staphylococcus aureus, a common bug for musculoskeletal infections, which was sensitive to the antibiotics he was receiving.  Daily, on morning rounds, I kept hoping to find him better.  However, he continued to spike fevers, and still looked quite ill.  “What are we missing?” I asked the team, as we examined him daily.  Finally, after about a week, one of the nurses noticed a small amount of pus oozing from a wound on the lateral side of his leg, opposite the original incision made to wash the ankle.  “Let’s just take him back to theatre and wash all these joints again” I said, still not convinced we were on to the true source of his ongoing fevers.

In the operating room, after Adan received general anesthesia, I was able to do a more thorough exam.  I noticed that the left thigh was slightly larger than the right…subtle, but notable.  To confirm my suspicion, I stuck a needle in his distal thigh and pus rolled into the syringe.  “This must be the problem,” I thought as I prepared to again wash out the joints and make new incisions to wash the lateral leg and thigh.  As I opened the thigh, I was shocked to find about a liter of pus that tracked in a pocket up to the level of his hip.   “How can so much hidden pus escape the examining eye of so many providers?”  I thought to myself, now fully convinced I had found the culprit of the ongoing fevers.  As expected, over the next few days, Adan’s temperature and white count finally normalized, and he slowly gained strength as he was transferred out of the ICU onto the general peds ward.  We never found the exact cause for his polyarticular septic arthritis and osteomyelitis, but we are thankful that he is on the mend.

The spiritual parallels to Adan’s story are salient.  Hidden sins of the heart, when left un-confessed and un-addressed, continue to fester and cause soul-sickness.   Perhaps even more deadly than the “spectacular” sins, the “small” sins of jealousy, greed, pride, anger, selfish ambition, and unbelief are more easily hidden and, as such, are commonly left untreated.  As a result, they can grow into an ugly abscess, jeopardizing our very life and faith.  Let’s be honest with each other.  We are all sinners and that is why we so desperately need a Savior – Jesus, the great physician.  Only He can perform divine surgery to open the hidden areas and place us on the path to healing.

Thanks for all your prayers and support!

Mark 2:17  “On hearing this, Jesus said to them, ‘It is not the healthy who need a doctor, but the sick.  I have not come to call the righteous, but sinners.’”

Friday, September 30, 2016

Miracle at Kijabe

Samuel, now all smiles!


Original CT scan of the fracture of T7 vertebra. Bone fragments are pressing into the spinal canal, compressing the spinal cord.


Dr. Muchiri did excellent work stabilizing his spine. 



On my first day of work at Kijabe Hospital, I met a 20-year-old patient named Samuel, who had been involved in a terrible motorcycle accident resulting in a burst fracture of his T7 thoracic vertebra.  When he first presented to Kijabe (one week after the accident), Samuel was completely paralyzed from the abdomen down, without any motor and minimal sensory function in his lower extremities.  One of my new partners, Dr. Muchiri, had performed a decompression with posterior instrumented fusion from T4-T10 so that the patient could at least mobilize to a wheelchair.  Now, when I first met him, more than two weeks from his initial injury, Samuel was recovering from his surgery, and physiotherapy was beginning to work with him, teaching him how to live as a person with a new, permanent spinal cord injury.

Samuel’s affect was quite flat when I first met him, no doubt secondary to the realization that he would never walk again.  Spinal cord injuries in Kenya are at best, significantly challenging (as there are no disability provisions or laws in Kenya) and at worst, a “death sentence” (as patients, neglected by family and friends, often succumb to pneumonia, infected bedsores, or urinary tract infections).  My heart went out to Samuel as I was examined his legs, confirming that he was indeed paralyzed.  After my examination, I offered to pray for him, and he readily accepted.  I prayed simply that God would meet him in a meaningful way, and that he would be able to function well with his new condition.

Upon returning from a 3-day trip to Singapore for an orthopaedic training course, while rounding on patients in the morning, the team came to Samuel’s beside, and he was beaming.  “Anything new with Samuel,” I asked, hoping that he had gotten his wheelchair, and was progressing on schedule with therapy.  “Yes,” said Dr. Otido, rather dispassionately.  “He started walking about three days ago."  “What?” I said, looking searchingly at the team, entirely puzzled, as I had never seen, nor heard of a patient who made a complete recovery more than two weeks after such a spinal cord injury.   “Come again…you said he’s walking?!” I asked with emphasis.  “Yes,” said Dr. Okello, the orthopaedic resident.  “He’s been walking with crutches.”  Bewildered, I went to Samuel’s bedside to examine him myself.  I couldn’t believe what I was seeing… he had full sensation in both extremities, and was moving his legs, feet and toes as if he had never been injured (all the while smiling broadly).  I looked back at the team, and said, “This is a complete miracle!  There is no other way to explain this medically!”  Now Dr. Okello was the one looking puzzled.  “Daktari, you know…these things happen at mission hospitals,” he replied.   “Indeed,” I said, still amazed that I had witnessed a modern day miracle.  Later, I came to Samuel, and encouraged him with the truth that Jesus had heard our prayers and healed him.  He fully agreed and affirmed that he was a believer, a member of the Presbyterian Church in Kenya.   

As I have processed Samuel’s case (myself and with other physicians), I am convinced that we have been privileged to witness a true miracle.  There is absolutely no way to explain it medically.  While recovery after such spinal cord injuries can occur, it is usually minimal (e.g. slight improvement in sensation by a level or two), especially in those who have demonstrated almost complete neurologic deficit for an extended period of time after initial injury.  But should I be so surprised?  Is anything too difficult for the One who in perfect wisdom created something as complex as the spinal cord?  Surely, “Who is like you, Lord God Almighty? You Lord, are mighty, and your faithfulness surrounds you.” Psalm 89:8. 

Thanks for all your prayers and support which has sustained us over the years, and enables us to continue partnering with you in Kenya!  

Sunday, September 4, 2016

Home Bittersweet Home


With dear friends and orthopaedic colleagues, Dr. Kiprono and Dr. Dylan..."welcome home/return again" cakes in Kiswahili. 


Saying goodbye to good friends.


Our home at Tenwek which we newly remodeled.   We are thankful that our friends, Will and Alisa Copeland (neurosurgery) will be living in it for the next two years. 


The heaviest item - an old piano which was given to us when we packed our container in 2013.


The core crew gathering strength for the move...sausages, chapati, samosas and chai...breakfast of champions. 
  

Moving in Africa was quite the experience...despite the potholes and last 8 km of bumpy dirt roads, only one item broke during the process...a single coffee mug! Check out the video Dean Cowles made of the move!



Kijabe means "place of the wind."  


Not only is it windy, but cold here as well.  Josie and Jane both wear double sleepers at night. 


Kingfisher, the apartment at Kijabe. We now know why God placed us here originally...so we would have a place of stability for our little girls during the chaos of packing and unpacking.  


We also placed Claire and Levi temporarily in the dorms at RVA while we made this transition. 


Sand Grouse, our new house at Kijabe.  6 bedrooms and fully adequate for our family (and visitors!).



The view of the Great Rift Valley from our living room. 


The quad which we imported in our container in 2013 has been HUGELY useful here at Kijabe. 

Last week, our family moved from Tenwek to Kijabe, (our 21st move since Heather and I were married in 1995).  By far, this was our most challenging, not just because of the logistics of planning and executing a household move in Africa, but because we said goodbye to the place we poured our hearts and lives into the past 7+ years since first arriving in 2008.  And the tears flowed freely last week, as God allowed us to feel deeply the grief of loss as we said goodbye to our dear fellow missionary and Kenyan friends, and the place our kids called “home.” 

At the same time, we sensed God’s mighty hand of sovereign direction, despite moments of severe doubt, wondering if we had made the right decision for our family.   When we first arrived at Kijabe, the apartment to which we were assigned (called Kingfisher) had black mold growing on the ceiling tiles, and within a few minutes of being inside, Claire, Levi and I all experienced significant allergic reactions.  We knew that we were not going to be able stay long term in this house, so we asked Kijabe if anything else was available.  As housing is in short demand at both Tenwek and Kijabe, they confirmed that Kingfisher was it. 

The following day, while visiting the Smith family (with whom Claire lived while she was at RVA for her 8th grade year), we met the Smith kids’ grandparents, Mike and Rose Matlak who were visiting from the states.  Dr. Mike is a pediatric surgeon who has worked at Kijabe several times over the years, and was instrumental in starting the peds surgery program here.  Ironically (sovereignly), 20 years ago, while Heather and I were living at Trinity Evangelical Divinity School, when Jeremiah was just a baby, we had Mike and Rose over for dinner (long story), and Mike was very instrumental in convincing me to pursue a career in medicine.

After sharing with Rose about our situation with housing, she mentioned that she knew of a house at the nearby Moffat Bible College that might be available to rent.  “It’s very near the Smith’s house, and has 6 bedrooms,” she said.  “It would be just perfect for your family.”  Excitedly, I contacted the housing administrator from Moffat, but she informed me that it would not likely be available, as another missionary family (also friends of ours) were currently renting the house (called Sand Grouse) for a few weeks while getting their three children in boarding school at RVA.  Steve and Sharon were preparing to return to their place of ministry in Central African Republic and were debating whether to continue renting the house into the future, as a ‘home base’ for their family and for other team members with them in CAR.

About a week later, while attending new student/parent orientation at RVA, we saw the Steve and Sharon, and they informed Heather and I that they had decided not to rent the house, and later that day, the Moffat housing administrator called to let us know that the house was ours until July, 2017.  However, because the house was completely unfurnished, we would need to move our entire household from Tenwek, a task that seemed completely impossible to us, especially with two little girls at home who require full-time attention.   But with the help of faithful Kenyan friends and missionary colleagues who sacrificed time and effort to help in the process, it couldn’t have gone more smoothly. 


So now, Heather and I are in the process of setting up our 21st home.  While we are excited to see what God has in store for us as a family here at Kijabe, we also carry with us a feeling of sorrow, and more deeply, a longing for our unchangeable, eternal home, which awaits us in heaven.  We are convinced that this paradoxical bitter-sweetness is part of following Christ.  God never promised any of us that a life of faith would be without pain.  But, there is a reward that awaits us now, and in the end, as we continue in faith - that reward being Jesus Christ himself, our Greatest Treasure, our constant Companion and Friend, our Savior and God, our only Hope.

Thursday, July 7, 2016

Returning to Kenya: An Important Update from the Galats

God has faithfully carried us through this challenging past year of home ministry assignment (HMA) in the states, and we are now immersed in our preparations to return to Kenya on August 15th!  We are excited about our return and wanted to update you on some new directions in which God is leading our family.   The past few years, we have become increasingly aware that our children have some critical educational needs that have been challenging for us to meet in this life of missions.  As you know, since first arriving in Africa in 2008, our family has been serving at Tenwek Hospital (on the west side of the Great Rift Valley).   When our kids were young, homeschooling (supplemented by the Tenwek co-op) was the best (although not always easy) option.  But as they grew, and entered middle school and high school, we saw a growing complexity in terms of their educational, social, spiritual and relational needs.  The only real option for a secondary classroom education while serving at Tenwek is to send our kids to the Rift Valley Academy, a boarding school about 3-1/2 hours drive from Tenwek (on the east side of the Great Rift Valley).  Jeremiah graduated from RVA in 2015, and Claire and Emma have both sent time there as well.  While most families at Tenwek have done well with sending their kids to RVA, it is becoming evident that this boarding school environment is no longer a viable option for our family.  In addition, we have been counseled (and we agree), that our family, at least for this season in life, needs to remain together.   

As such, after much prayer, and seeking wise counsel from others with much more experience and knowledge than us, we have made the difficult, yet confident, decision to relocate our base of ministry to Kijabe Mission Hospital, which is on the same campus as the Rift Valley Academy.  In this way, our kids will be able to continue their education at RVA, but now as day students rather than as boarding students - which also means that we will be able to keep our family together during these important years.  In addition, I will be able to continue my calling to serve “the least of these” through orthopaedic medical missions and resident education/discipleship. 

Kijabe and Tenwek are similar (almost sister) hospitals - Christian mission in focus, and dedicated to the surgical education of African nationals.  Kijabe’s orthopaedic residents have rotated at Tenwek as part of their education for years, and we have recently started sending our Tenwek orthopaedic residents to CURE Hospital (located at Kijabe) for paediatric orthopaedic training.  Because of this already established Tenwek/Kijabe connection, even though our Galat “base of operations” will be at a different location (at least for the time-being), we very much view this as an opportunity to expand our current ministry in new and exciting ways. 

Nevertheless, as is so often the case in this life of international missions, our emotional response to this decision has been quite paradoxical.  While we are thankful for this opportunity to be together as a family, we are sad to leave our family at Tenwek, and our home, which we just recently rehabbed (our house at Kijabe will be quite small in comparison– three bed and one bath!).  However, we are thankful that another large family will have the opportunity to live in our house while we are away.  And while we are excited at the opportunity to broaden the scope of orthopaedic training at Kijabe, I will miss the day-to-day interaction with the consultants and residents at Tenwek whom I love deeply and view as family.  Thankfully, God has ordained two very qualified, talented and skilled orthopaedic surgeon consultants - Drs. Kiprono Koech and Dylan Nugent - to continue the work at Tenwek (as they have done even this past year while I have been stateside).  As I mentioned, I will remain closely tied to Tenwek, even while stationed at Kijabe, on multiple levels.

Some have wondered how this move will impact giving and support of the Galat Family Ministry going forward.  Although our ministry base of operations will change to Kijabe, we will continue with World Gospel Mission as career missionaries, so no change in giving is necessary.  Funds given to the Galat Ministry Account(125-03814) will continue to support our family, the orthopaedic work at Tenwek AND now the orthopaedic work at Kijabe as well.  Funds earmarked for the Orthopaedic Residency Fund (125-25240) will continue to support resident education at Tenwek, and now also at Kijabe going forward.  Thank you for being a part of our Galat Family Ministry in Kenya with WGM over the years.  Your partnership has enabled us to continue strongly in our calling to serve people in the most needy areas of the world through compassionate healthcare, and though the education, training and Christian discipleship of African orthopaedic surgeons.  Your support and giving is making a tremendous difference in the lives of countless people (directly, through surgical care, and indirectly through training of national surgeons)!

Please keep us in prayer over the next several weeks as we make this transition back to Kenya, and to our new home at Kijabe.   Pray for joy and peace as we pack (yet again!), say our goodbyes in Phoenix, and then enter a season of traveling with two little girls in tow!  Pray for Jeremiah, as he remains behind to continue college at ASU, and for Emma, as she continues for another 3-6 months at a wonderful program in Nashville, TN called Mercy Multiplied before joining us in Kenya.  Finally, pray for provision of all the orthopaedic needs (consultants, implants, residents, etc.) at Tenwek and Kijabe…the work is massive at both places – and in the entire developing world – and resources are so few.  This is a work that only God can sustain.  Thankfully, He is able to do immeasurably more than any of us could ever ask or imagine!   Thanks for all your prayers and support!!