When our family left for Kenya the first time in 2008, we felt the strong conviction to go in faith, despite many uncertainties and potential challenges that this calling might afford. As a newly graduated orthopaedic resident, leaving directly after training meant laying aside the possibility of board certification, a two step examination process for final validation of competency and knowledge as an orthopaedic surgeon. Part one of this process of board certification involves taking, and passing, a rigorous written examination (which I did in July 2008). After passing part one, a candidate becomes “board-eligible” (a period lasting up to five years). Part two involves working at least 20 consecutive months in the same location, “collecting” all cases done during a 6-month portion of that time period, and then orally defending these surgical cases before a board of examiners. However, the decades-old bylaws of the American Board of Orthopaedic Surgery (ABOS) includes a “practice location” requirement for part two, in which a candidate orthopaedic surgeon can only collect cases while working in the U.S. or its territories.
As such, the thousands of cases I have done in Kenya over the years can not count towards fulfillment of the requirements for taking part two. Orthopaedic surgery is the only surgical subspecialty that has this requirement (to my knowledge). As a result, this location requirement is a major hindrance for newly-graduated residents to go directly into missions. For us, however, several factors compelled us to go directly to Tenwek, rather than first working in the States to become certified prior to making the missions leap. First, our children were at an age where waiting would make it more difficult to leave after a few years of U.S. based practice (education, sports, comforts, etc.). Second, Heather and I know our own hearts, and realized our propensity to be the seed that falls among the thorns and is choked by the “worries of this world, and the deceitfulness of wealth” (Matt. 13:22). So we went, and set ourselves to prayer (and recruiting hundred of others to pray with us), asking God to move the “hearts of the kings” and make a way for me to get board certified while working at Tenwek.
In 2011, after many solid, board-certified, U.S.-based Christian orthopaedic surgeons began questioning the ABOS of the fairness of this practice location requirement, I was asked (by the Board), to write a “proposal” for getting certified overseas. The answer then, however, was “no,” the response letter to me saying “the exam was too high-stakes to make such a change in policy which would affect so few people.” As such, with my eligibility expiring in 2013, I had to retake part one in order to remain “board-eligible” (an exam which, trust me, you only want to take once!). Many times, Heather and I pondered whether we made the right decision, forsaking the possibility of board certification by going so quickly to Tenwek after graduation, and wondered if we should just leave the mission field and return to the states to complete the process (at least a three year commitment for us). However, with the amazing things God was doing at Tenwek with the growth of the orthopaedic department, and the start of the new PAACS orthopaedic training program, we never felt the release or peace from God to leave, when His calling was so clear to go in the first place. So we kept asking and praying, sometimes more fervently and sometimes less.
As the years wore on, the possibility of certification overseas seemed to fade. At times, we lost heart, believing that perhaps I would never become certified, in Kenya or the U.S. (a process which becomes more difficult the longer it’s delayed). Not being board certified has broad implications on many levels, both in the U.S. and abroad, including legitimacy with the African Colleges, and even on finding work in the States while on furlough. But last year, things began to change and God was starting to move. He began adding people to (and removing people from) the board according to His sovereign will in a drama akin to the story of Esther. Several board-certified orthopaedic surgeons who had been to Tenwek wrote letters to the ABOS asking them to reconsider their original decision. Then, in November, I was told that a sub-committee had been formed to explore the feasibility of changing this decades-old policy. Our hope was rekindled, although I was still expecting it to take years of step-wise, incremental change, rather than one instantaneous, complete paradigm shift. However, today, at a time when I least expected it, I learned that the ABOS has voted to eliminate the U.S. practice location requirement for part two, not just on a one-person basis (i.e. me), but for all orthopaedic surgeons who choose to work in humanitarian (missions) settings directly after finishing residency!!
The implications for this massive answer to prayer are enormous. I have corresponded with multiple orthopaedic residents over the years who have said the one hindrance to taking the leap into full-time missions is this issue of board certification. Now, with this hindrance removed, we are praying for God to open the floodgates for an entire generation of new, young, orthopaedic surgeons who will say “yes” to full-time missions without the fear of the negative implications surrounding certification. God did this according to his timetable, and to Him, belongs all the glory! In short, God answers prayer and still does miracles today! Thank you for all your prayers and support over the years. Please continue, as we plan our return to Kenya, God willing, this summer, and as I begin to collect my cases for the part two oral exam which I will take in July 2018. It's not over yet!
God’s voice thunders in marvelous ways; he does great things beyond our understanding. Job 37:5