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

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

Monday, June 1, 2015

Word and Deed

In the operating room, the right shoulder with bone-destroying mass which fungated through the skin and became a large, pus-draining wound. 

The incision for a forequarter amputation.

The day after surgery still sick, but feeling better. 

The second day after surgery, Andrew felt significantly better, as the source of pain and blood infection had been removed.  We are praying that the cancer margins are clear and that it will not recur.  

Last weekend, while enjoying some time off with my family, I received an unexpected page from a visiting surgeon.  “I have an odd case I want to run by you,” he said apologetically, knowing I was not on call that night.  “An 18 year old boy presented to the emergency room tonight with a huge mass and an open wound on his right shoulder,” he said.  “He appeared very sick, with a white count of more than 20,000, so I took him to the operating room for a debridement, thinking this mass was secondary to an untreated infection…but we encountered significant bleeding which was very hard to control,” he continued.  Hearing this history, my mind went immediately to a condition we see frequently here, but only very rarely in the US: a highly aggressive bone cancer called osteosarcoma.   After explaining my opinion to the surgeon, he admitted that not once in his 25+ years of practice in the U.S. had he even seen an osteosarcoma, let alone one so advanced that it had fungated through the skin.

The following morning on rounds, I met Andrew and was surprised to find a young and handsome (yet sick appearing) man with excellent English.  He relayed that he was a college student studying computer science.  However, this mass has grown so aggressively painful that he found it difficult to attend classes.  Finally, when the cancer broke through the skin and became foul-smelling, the instructors asked him to leave and seek treatment.  I explained to Andrew that his x-rays showed the entire shoulder joint had been destroyed and that with the superimposed infection, with increased white blood count and high fevers, (really to save his life) the only solution was to remove the entire arm, including the shoulder blade, to the level of the chest wall, a surgery I had never desired to perform.  

After obtaining consent, we took Andrew to theatre and gave him general anesthesia.  Upon removing the packing, which had been placed in his shoulder to control the bleeding, a bolus of bloody, and very foul-smelling pus gushed from the wound, filling the operating room with a sickening smell.  The arm was prepped and draped, and with the help of Dr. Heath Many (who isolated the large vessels to the right arm), we performed the first forequarter amputation at Tenwek.  While we did not see any tumor during surgery, we did find pus which had tracked all the way to his chest wall.  After washing well with a mixture of bleach and normal saline, I closed the wound loosely over a drain. 

The following day, Andrew looked markedly better and no longer septic, the source of pain and massive infection having been removed.  I sat and talked with him, and he relayed a deep faith in God and a desire to trust Him no matter how his future would unfold.  I prayed for Andrew, and that his heart would be encouraged and that God would completely heal him of this cancer.  The results of the biopsy will be available in approximately two weeks, and if our suspicion is confirmed, he will still need chemotherapy, as a tumor of this size most certainly has metastasized to other areas of his body (although not immediately evident on our workup). 

Even after seven years at Tenwek, I am still routinely amazed at the level of orthopaedic pathology we encounter here.  In the past two weeks, we have seen not one, but four cases of the same type of massive osteosarcoma.  Patients come daily with multi-trauma and open fractures that would rival the busiest centers in the U.S.  And just last week, we recorded our 1500th patient having received a SIGN nail.  But what amazes me more so, is the opportunity this busy service provides to share the love of Christ with our patients.  Yesterday on rounds, after seeing the young men in our open 10-bed ortho ward, I took a few minutes to encourage these men to follow Christ.  While turning to leave, one man said out loud, “If we want to follow Jesus, can we raise our hands while you pray for us?”  Before I knew it, 8 men had their hands high in the air as I prayed for spiritual and physical healing.  Later in the day, I saw 4 of these men outside, basking in the sun, and they pulled me over to enquire about bibles.  The opportunities of both word and deed at Tenwek are unending.   

Thanks for your ongoing prayers and support for this ministry here at Tenwek.  We love and appreciate you all!

Sunday, May 3, 2015

Wanted: Orthopaedic Surgeons

Motorcycle taxis are taking over!  These guys are the major source of orthopedic trauma at Tenwek.

Current surgical trainees at Tenwek...adding to the numbers of qualified (and Christian) surgeons in Africa. 

Random pic of what I call "scary baby" with very happy orthopaedic pediatric patient.  

One of the many cases mistreated at another facility, and tragically ending in an above knee amputation. 

Adding to the lure of attraction of orthopaedic practice in Kenya.  Work hard during the week, golf outings with son on the weekends (notice zebra in the background). 

Not only did this young lady have this painful basketball sized mass on her knee, but an ultrasound of her abdomen checking for evidence of metastasis revealed that she was 12 weeks pregnant.  You just can't make this stuff up.

A recent 60-page, 30+ author article in the prestigious medical journal The Lancet reported data corraborating the purpose of our existence here at Tenwek mission hospital in rural Kenya.  The study reported that 5 billion people around the world are without access to safe surgical procedures, and that 93% of all people in sub-Saharan Africa cannot obtain basic surgical care.  The reason is simple: there aren’t enough qualified surgeons (nor facilities within reasonable distance) to provide life-saving surgery in low and middle income countries.  In Kenya, for example, which has a population of 43 million people, there are an estimated 50 orthopaedic surgeons, less than the number of residents at the Mayo Clinic alone.  The study also reports that 1/3 of all deaths in 2010 were from conditions which were treatable with surgery (including open fractures)…more than HIV, tuberculosis and malaria combined.  The problem is compounded by the fact that the number of injuries from road traffic accidents is exponentially on the rise.   This "perfect storm" of increasing need coupled with inadequate supply is creating a global healthcare crisis of massive proportions.  The authors call for an investment of 420 billion USD to increase access to safe surgical care.  Although a huge amount, they estimate that turning a blind eye to the problem could cost the global economy more than 12 trillion USD by 2030.  But the core issue is more than just financial...it is a mandate to care for those who are in greatest need or as Jesus put it, “the least of these.”

This article underscores the heartbeat of our mission statement at Tenwek: Compassionate healthcare, spiritual ministry and training for service.  Through the PAACS/COSECSA orthopaedic training program at Tenwek, we are trying to be a part of the solution to this global crisis: to provide more qualified national surgeons.  However, our training program is unique in that we are seeking to provide more than just surgeons, but Christian surgeons who are discipled to serve in a way that demonstrates the love of Christ to a hurting world.

The problem is that we cannot do this work of training national surgeons alone.  It is too great a job without the combined efforts of a team, whose members all have a common goal, the ultimate glory of the Lord Jesus Christ:
(1) We need those who will commit to long-term missions to join the orthopaedic team at Tenwek.  (2) We need those who will volunteer their time for short-term coverage to step in and provide relief and fresh teaching for the residents. Our need is especially acute now as we are looking for coverage July through December of this year during our scheduled furlough in the U.S.
(3) We need those who will “silently support” behind the scenes, praying and giving financially.   

Every month I receive orthopaedic journals in the mail with large classified sections in the back containing eloquently written "want ads" for orthopaedic surgeons.  Each ad enticingly describes the ideal location, work environment and compensation package.  I have often wondered what a "want ad" for an orthopaedic surgeon at Tenwek would look like:

Wanted: Orthopaedic Surgeon for Obscure Mission Hospital in Africa

Uniquely situated mission hospital in the highlands of western Kenya seeking qualified long-term and short-term orthopaedic surgeons.  Enjoy the best of equatorial highland living including lush, rolling hills, 12-hour 70-80 degree days year round and not one, but TWO rainy seasons.  Sip Kenyan coffee while working in the ideal environment: long hours, a plethora of complex cases well beyond your comfort (and skill) level, a constant sense of being overwhelmed, and with little recognition among your peers. However, the opportunity to impact the lives of patients and trainees in one of the most needy places on earth will provide you with significance and purpose beyond your wildest expectations.   Amazing benefits package including minimal earthly compensation, but with significant potential for long-term eternal rewards.  Do something different off the beaten path!  For more information, contact Dan Galat at daniel.galat@wgm.org or Dayna Wright with World Medical Mission dwright@samaritan.org.

Saturday, March 7, 2015

A Cord of Many Strands

Eric, with Kiprono (my partner) and I, his surgeons.   

Pre-op CT scan showing Eric's bent-over spine, the injury being right at the level where the spinal cord ends.  

X-ray, post-surgery, showing the straightened spine. 

Eric, a young 20-year-old patient recently admitted to Tenwek, was working as a mason at a local construction site, laying block.  He bent over to temper his mortar and when he stood upright, he became dizzy and disoriented and fell three stories onto a hard object.  The fall caused a flexion-distraction injury to the L1 vertebrae of his spine.  Fortunately, he was not paralyzed by the injury, but his spine was bent over with a significant kyphotic deformity.

Thanks to a generous donation from the NuVasive Spine Foundation (NSF), we had the tools to help, and a few days later, he underwent a posterior instrumented fusion of his T12-L2 vertebra using screws and rods, straightening his crooked spine.  Normally, these screws cost approximately $200 a piece, and had we not the donation, Eric would not have been able to afford such a life-changing surgery.  The days following surgery, Eric was out of bed, and walking almost normally with a big smile, realizing what God had done for him through the ministry at Tenwek.

Eric wrote a letter to NuVasive after the surgery: “I thought I was going to be bedridden, but to my surprise, NuVasive rescued me.  The donation has come as a blessing to me.  This is quite an innovative medical device that has come at the right time. Without it, we would not have afforded the price.” 

We are blessed at Tenwek to have multiple partners (NuVasive, Biomet, Hope International, Project Cure, and many others), who have joined us in our mission to care for the most needy patients here in our small part of Africa.  Without our partners, and you who pray for and support our family, we would not be able to offer such specialized orthopaedic services here in Kenya, and hence, such an effective means of sharing the practical love of Christ to our patients.  Together, we are a cord of many strands.  All I can say is that we can’t do this alone!  Thank you for your ongoing prayers and support! 

Ecclesiastes 4:12: "And though a man might prevail against one who is alone, two will withstand him—a threefold cord is not quickly broken."

Tuesday, January 27, 2015

Galat Family Update January 2015

2014 was one of the craziest years we have experienced since first arriving in Kenya six years ago.  The underlying theme of every event however, has been God’s continual sovereign love and faithfulness in our lives, through your prayers and support!  Following are some of the major highlights:

Rift Valley Academy
We now have three kids (Jeremiah, Emma, and Claire) at boarding school at the Rift Valley Academy in Kijabe.  Our family actually moved on campus for three months for one term (by God’s providence a house was available) to help our girls acclimate to their new environment.  The concentrated times spent together in our little, temporary home were so rich.   I continued working at Tenwek and made the three-hour commute on the weekends to visit (when not on call).   A little more than half of the Galat’s (more on this later) are now back at Tenwek while Jeremiah, Emma and Claire continue at school.  While we miss them tremendously, we also know that this is where God has ordained them to be and we treasure every moment we have together (last weekend we were all together back at Tenwek for the first time since August 2014).

Jeremiah, Emma and Claire on the first day of school.

Jeremiah has full-blown senioritis and has applied to 6 colleges in the states.  Among his top choices are Vanderbilt, Bowdoin and my alma maters, Ohio State University and Miami of Ohio.  I recently had the pleasure of disclosing volumes of financial data on the FAFSA and College Board applications!  Our prayer for him is that God would lead him to the school where he will grow as a young man of faith.   His newest passion is “crossfit,” an intense exercise regimen combining Olympic weight lifting with heavy aerobic activity. 

Jeremiah sporting his "epic apron."  Yes, he is a fantastic cook and heads the senior store grill at RVA.

Music in the Air
Emma is freshman in the dorms at RVA and continues to practice voice every day.  We miss her singing around the house!  She is growing in her faith, spurred on by the challenge of “independent” living at RVA.  Her goal is to attend Juilliard (dream big, right?) and will continue voice lessons in the states during our next scheduled furlough the second half of 2015.

Mother and daughter or twins?

God’s Provision for Claire
Claire started eight grade at RVA during our stint on campus last term, and loved it so much she decided she wanted to stay (friends, band…trumpet!, no homeschooling, etc.)  However, there was no space for her in the 8th grade girls’ dorm.  However, a wonderful family who lives at Kijabe invited her to stay with them for the remainder of the school year, and she is so well cared for and happy.   Claire’s interest remains math and science and she hope to be a pediatrician or orthopaedic surgeon some day!

 Claire learning how to apply contact lenses!

The Man of the House
During my frequent travels (currently at a conference for PAACS residents near Kijabe), Levi functions as the man of the house, and is a great help to Heather.  Although he misses his siblings, he keeps busy with his Tenwek friends, Josie and Legos.  Did I mention Legos? 

Levi and his handmade pinewood derby car.

Another on the Way!
Yes, God has surprised us again with another child on the way!  Heather is ending her first trimester and looking forward to the cessation of the endless nausea (I keep telling her it must be twins).  Heather is due in August and will deliver again in the states.  Because she will be so far along, she will need to travel back to the states in June (with Levi and Josie), and thus miss Jeremiah’s graduation from RVA.  I will remain in Kenya with Jeremiah, Emma and Claire and after graduation in July, we’ll all join them.  Our plan is to get Jeremiah in college, have a baby, and then remain in the states until the end of 2015. Whew!!

 "I'm going to be a big sister!"

Developing Scholars
Between bouts of nausea, Heather is also doing a fantastic job teaching the 4th and 5th graders at Tenwek literature and writing.  Currently, they are reading Robin Hood and doing writing lessons based on medieval history.  All the women at Tenwek work very hard teaching the 32 children who are based on our compound.

Major House Repairs
Our house at Tenwek was built in the 1940s and was literally falling apart, and desperately in need of major repairs (roof, ceiling, wood siding, etc).  God’s timing was perfect because the majority of the repairs were done while Heather and the kids lived at RVA last fall.  However, just last week, my office chair almost went through our wood floor and several other boards acutely became very loose.  An inspection under the floor in the crawl space revealed the culprit: termites!  I guess the repairs aren’t quite over…however this one will wait until furlough.

Major remodel/repairs in process.

Floor joists: Termites love wood from the 1940s. 

Galat Guest/Ministry House
The whole of 2014 was also consumed with building a guest/ministry house in our side yard and completion is drawing nigh (thanks be to God).   It includes two apartments for volunteer medical visitors and guests.  In addition, the large “upper room” will be used for meetings, meals (replete with wood fired pizza oven), and other ministry events.  We are looking forward to the first scheduled event, which will be the “white coat ceremony” for our new residents.

Some of the construction crew.  Hard working guys.  We were thankful to provide income for local workers and their families. 

PAACS/ORTHO Residency Training Program
The ortho program is now in the second year and we added Dr. Ian Orwa to our other two, Dr. Fasto and Dr. Sowayi.  The training and discipling of national residents, interns and medical students continues to be our primary ministry objective at Tenwek.  It is a privilege to impact the lives of future leaders in medicine and ministry in Kenya! 

 Graduation day for PAACS residents at Tenwek.  Dan and Kiprono with the ortho residents. 

So much more has happened, but these are the major highlights.  God has been teaching Heather and I to remain dependent on him in our weakness and brokenness, and to dwell on his promises in scripture.  Thanks again for your prayers and support!

 On the road from Kijabe to Tenwek.  Need we ever doubt God's faithfulness?!