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

Saturday, June 16, 2018

The Final Countdown (Ten Years in Waiting)


This week, I finalized the twelve surgical cases which were selected for my American Board of Orthopaedic Surgery (ABOS) part-2 oral certification exam, scheduled for July 24, 2018 at 6:30am at the Palmer House in downtown Chicago.  It all felt rather anti-climatic as I clicked the “submit” button around midnight on Thursday, after literally a 10 year process of waiting, trusting, and praying for the board to change it’s decades-old policy to allow me (and others) to “collect” cases while working overseas in missions settings (see When God’s Voice Thunders inMiraculous Ways).  Now, it all comes down to a three hour, grueling oral examination in which I will describe and defend these 12 cases, which were selected from a list of 120 that I did during a six-month period from April to September 2017.  In many ways, those six months were the most difficult of my career as an orthopaedic surgeon, as I felt continually pushed to the edge of my limitations, and had to manage complications which might not have occurred otherwise in a location without resource limitations.  The “strange and bizarre” cases at Kijabe, which differ so greatly from the “bread and butter” cases in the states, I’m sure, will raise a few eyebrows during my exam. 

After 10 years practicing in rural Kenya, it almost feels as if the “strange and bizarre” has become my new “bread and butter.”  Just last week, I did a hemipelvectomy (amputation of the entire hindquarter, including part of the pelvis) on a sweet, 45-year-old lady with dediffentiated chrondrosarcoma of the hip, a case way out of my comfort zone (sorry, no pics on this one).  Working late into the night, tying off large pulsing arteries deep in the pelvis in this HIV+ patient, her blood soaked through my cloth gown down to my skin.  I fearfully wondered if I would now have to take the one-month course of PEP (post-exposure prophylaxis) required after exposure to HIV+ blood.  Thankfully, after consultation with the PEP specialist at Kijabe, that answer was “no,” as these medications are known (by personal experience from another exposure in which a general surgery resident decided to stick my finger with a needle) to cause you to feel as if you’ve gotten the flu after being thoroughly beaten with a lead pipe.   

While I don’t have a hemipelvectomy on my list of 12, I still have some other challenging cases to defend, such as the patient who required an above knee amputation after her total knee replacement became infected with e. Coli, likely obtained at the local hospital she went to for “therapy” after discharge.   Her daughters later explained the conditions at this local hospital were entirely “unsanitary” and her wound left uncovered for days on end.  By the time she returned to Kijabe, her knee was draining copious pus, and she had developed a necrotizing-type fasciitis, which could not be controlled despite strong antibiotics and multiple trips to theatre.  Because I work in a resource-poor setting, other non-conventional techniques will need to be gingerly explained to the examiners, for instance, why I used a shorter plate here, or why I used a SIGN nail there.    Thankfully, though, all patients, whether complicated or not, did remarkably, even miraculously, well.

In the end, it is clear that God is sovereignly orchestrating all these events, from beginning to end, including the exact cases that were selected.  I’m praying this examination will be a testimony to many that God is at work around the world to bring glory to His name through orthopaedic medical missions.  Your fervent prayers are also appreciated during the final prep all the way up to the time of the actual exam.  Pray not only that I pass, but also that God would be glorified through the process, and that He would raise up others to follow a similar path so that PAACS orthopaedics can continue to expand (more on that later!).

Thanks for your ongoing prayers and support!



Tuesday, January 23, 2018

Imagine!


Beatrice hard at work doing PT after SIGN nailing of all 4 long bones of the lower extremities.



Beatrice standing with new, first-year orthopaedic resident Nobert Langat (left) and chief orthopaedic resident Isaac Kingori (right).


Right femur SIGN FIN nail.


Right tibia SIGN nail.


Left knee x-ray showing both femur and tibia SIGN nails. 


 The result of one of the multiple crashes which took the lives of more than 200 Kenyans in December 2017

Story told with patient's permission.

Kenyans use the word “imagine” frequently after listening to a story that has an unfortunate or unbelievable outcome, but that which might be ironically typical for normal, daily life in this developing nation.  For example…Me: “I just waited in line at the Immigration Office in Nairobi for more than 3 hours!” Kenyan friend: “Imagine!” Or…Me: “The policeman who pulled me over for ‘speeding’ actually suggested I pay him a bribe.” Kenyan colleague: “Imagine!”  Or…me eating lunch at the hospital: “My beef stew is missing the beef.”  Response?  You guessed it.  The word, used in these contexts, carries with it a negative sense of “if only.”  If only things could be different.  If only there was hope for real and lasting change.

Now, imagine yourself traveling cross-country as the front passenger in a matatu (14-seat van used for the majority of public transportation in Kenya), over-stuffed with more than 22 people (a common illegal problem in Kenya), and over-speeding on the main highway in Kenya (two-lane road with on coming traffic).   Imagine your matutu driver operating recklessly, crazily passing large trucks in order to save time, all the while with passenger shouting at him to “slow down” and “take care!”  Now imagine that, while overtaking another vehicle, a large semi comes barreling directly towards you, and with nowhere to turn to the left or right.

This is all Beatrice remembers prior to waking up one week later in Kenyatta National Hospital, with all four large bones of both legs shattered, the only survivor in this horrific December 2017 road traffic accident, only one among many in which more than 200 Kenyans lost their lives during this normally festive, family-oriented, but travel-heavy and now infamous month.   She had been given minimal care at KNH, and still had fragments of bone protruding through the skin in her right thigh.  Desperate, without money to pay for her care, family members requested transfer to Kijabe, where Watsi, (an on-line crowd funding platform), and four donated SIGN nails fixed her broken legs.  Now, she is on the mend, beginning to walk not even a month after her injuries.  When telling Beatrice how fortunate she was to be alive and how amazing, unbelievable and God-ordained the events were which brought her to Kijabe for care, her response was “Imagine!”

So the word “imagine” can also be used positively to respond to a story in which the impossible breaks through in the midst of tragedy, and in the end, all is not lost, futile, hopeless, or ruined.  Here, the positive use of the word carries the sense of “Can you believe it!?”  This is the essence of the gospel.  Imagine!...when we were dead in sin, God made us alive in Christ (Eph. 2:1-10).  Imagine!...every tear will be wiped away, and there will be no more pain or death (Rev. 21:4).  Imagine!...Christ is preparing a place for us in heaven (John14:2-3).  God can do exceedingly, abundantly more than we can ask or imagine (Eph. 3:20)!  Real, lasting change is possible (1 Cor. 6:9)!  Because of Christ, the “if only” becomes the “can you believe it?"  Imagine!


Thanks for all your prayers and support!

Sunday, December 24, 2017

Merry Christmas 2017 from the Galats!

As we finish another highly eventful year, we wish to acknowledge the grace of God that has carried us, the prayers of many which have sustained us, and the friendships which have enriched us.  This Christmas, may we all "have power, together with all the saints, to grasp how wide and long and high and deep is the love of Christ." (Eph. 3:18).  This is the essence of Christmas: the love of God expressed in the gift of His Son, Jesus.  Nothing else with change us like this Truth!  Merry Christmas from our crazy, chaotic, colorful household to yours!  

Here's a brief update on each one of us:


The newest addition to our home, Ethan Benjamin Galat, born October 11, 2017. This is his serious, "old-man" face.  Certainly a blessing to our family!


Jane Kathryn Galat, age 2. 
She brings constant laughter to our home with everything she is!  


Josie Grace Galat, age 4.
On the extrovert scale, she ranks an 11! 


Levi Stephen Galat, age 13.
Currently in 8th grade, and becoming quite accomplished on the tenor sax. 


  Claire Elizabeth Galat, age 16. 
In her junior year at RVA and enjoying school, friends, sports, music!


Emma Rose Galat, age 18. 
In her senior year at RVA, accepted to all five colleges to which she's applied!  Praying for wisdom for the next step. 


Jeremiah Daniel Galat, age 20. 
Currently a sophomore at Arizona State University, studying Biophysics for premed. 


Dan and Heather, married 22 years, and feeling too old to be parents of 7 kids spanning 20 years, but thankful for the family which God chose to bless us with.  


We continue to serve in missions at Kijabe Hospital in Kenya, where Dan works as the head of orthopaedic surgery, and as an educator for the orthopaedic residency training program here.  Heather has become increasingly involved with a growing prayer movement that God is raising up on our hospital and school campuses.  We continue to trust God for our next steps as well, as we plan (God willing) to stay in Kenya until our next furlough scheduled for 2019-2020. Thanks for all your prayers and support over the years!!

Monday, October 16, 2017

Strong, Firm, Enduring



The Kijabe Dream Team (minus Elector who hadn't arrived yet), pre-birth.  Everyone happy, except Heather.

How can someone look so good just a few minutes after delivery!

Getting to know baby Ethan. 

Claire and Ethan.

Emma and Ethan. 

Levi and Ethan. 

J&J love him too!

Almost smiling?


On October 11, 2017 at 2:51pm, Heather gave birth our seventh child, a son, whom we named Ethan Benjamin Galat.  Surrounded by what I call the “Kijabe Dream Team” (Dr. Catherine – OB/GYN, Allyson – Family Nurse Practitioner, Elector – Kenyan Nurse Midwife, and Joan – Doula extraordinaire), Heather amazed us all with her determination, courage, and grit, delivering a healthy baby boy in a newly remodeled private birthing room at Kijabe Hospital.  It was a surreal experience on multiple levels that we couldn’t have duplicated anywhere in the world, except for the fact that God was orchestrating it all.  And right as the baby’s head started to crown, and Heather began the final push, it started to pour long-awaited rains on the overly dry land in which we live.  We all had the sense that God was present, giving his blessing and affirmation to His sovereign plans.  

In truth, the past few years for our family have felt more fragile, shaky, and transient, than strong, firm and enduring.  We never imagined that we would leave our home at Tenwek and settle in a new place of ministry, nor in the midst of it all, add another child to our family (yes, by now, we should know what causes that), nor collect cases for board certification.  But God has faithfully done all this, and much more than we could have imaged (or knew we needed).  Hence, we gave our son the name Ethan, which in Hebrew means “Strong, Firm, Enduring” to honor our God who has remained our Fortress, our Strong Tower, our Ever-present Help in times of trouble.  We remain continually humbled by the fact that our weakness is His strength; our uncertainty is His opportunity to shine!  Oh, and the name Benjamin? It means “son of my right hand” or perhaps more appropriately “son born in my old age.”  Come on now…I’m not THAT old!

Thanks for all your prayers, love and support of our family over the years! 

Friday, February 10, 2017

A SIGN for a New Generation

 Orthopaedic residents and consultants from Tenwek and Kijabe.  Dr. John is on the far left.  We are demonstrating the "squat and smile" photo, which Dr. Lew Zirkle, the founder of SIGN, likes to see SIGN patients perform to show they are healed!
Dr. John and I.

AP view of Dr. John's tibial SIGN nail.  The nail goes in through the knee, and travels down the intramedullary canal of the bone, across the fracture to just shy of the ankle joint.  The two screws go through holes in the nail to stabilize and hold the fracture.   
Lateral view.

Teaching ex-fix principles using PCV pipes simulating bones.
The entire group at the PAACS Basic Science Course, Brackenhurst Conference Center, Limuru Kenya.

During one call night in December, two weeks into the national doctors’ strike in Kenya, and with cases stacking up for surgery, I received a phone call from one of the 3rd year orthopaedic residents.   “Dr. Galat,” he said, “you won’t believe this, but your resident, Dr. John Mandela, just injured his leg playing soccer.” “Really,” I said, somewhat concerned, as Dr. John was the only resident on my service at the time.   “He’s in casualty,” he said, “and it looks like he has an open (compound) tibia fracture.”  While heading to the hospital to see Dr. John, I chucked, musing at the irony of personally operating on my only resident.  “You just can’t make this stuff up,” I thought to myself, at the same time thankful for the opportunity to help.

I found John in casualty with a bloody splint on his leg, and, trying to lighten the mood, promptly informed him he was going to have to write all patient notes from his hospital bed.  Thankfully, we were able to take him to the operating room that same night to wash the open wound, and stabilize the fracture using a SIGN nail.  SIGN Fracture Care International is a not-for-profit company with a vision of “creating equality of fracture care throughout the world.”  They do this by providing nails to a network of SIGN surgeons in more than 300 SIGN programs in 53 developing nations.  To date, more than 180,000 patients have been healed using the SIGN intramedullary nail, and between Tenwek and Kijabe hospitals, we have treated more than 3,000 patients using this innovative nail.  Now, one of our own trainees has received the very nail he is learning to use to heal others. 

Recently, I saw Dr. John at the PAACS (Pan-African Academy of Christian Surgeons) Basic Science Conference, a two-week intensive course for 1st and 2nd year surgical residents from all over Africa.   I was amazed to see him walking without a limp, just 6 weeks from his date of surgery.   Without the SIGN nail, he would have still been in a heavy plaster cast, walking with crutches, and struggling to get around.  As I watched him interacting and learning with the other 50 residents, I thanked God for this new generation of surgical trainees who are dedicating their lives to helping others in need.  And the PAACS orthopaedic family is growing, as the Kijabe/CURE program will soon join Tenwek to make a total of 16 PAACS orthopaedic residents-in-training.  It is a privilege to be involved in the education of these young, bright, committed African trainees who will be part of the solution to the lack of surgical care in some of the most needy parts of the world. 

Dr. John will return to his training post at Kijabe next week, just two months from his injury.  I told him he failed his rotation on the Galat service, and will have to remediate!   Just kidding…we’ll all be glad to have him back.


Thanks for all your love and support over the years!