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

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

Saturday, March 8, 2014

Brilliant



Last month, a precious two-year-old girl was admitted to Tenwek with a severe, open right femur fracture, the result of a terrible, yet all-too-common motorcycle accident.  The fracture was easily fixed with multiple washouts and an external fixator (i.e. pins and rod holding the broken bone together).  The fact that Brilliant’s parent are dead as a result of the same accident, and that she is now an orphan is not so easy.  Sometimes it’s not just the injury, but the story behind the injury that causes us to shake our heads in shock and disbelief, and fills us with a longing to see more of God’s kingdom here on earth. 

Brilliant and her parents were on their way to Tenwek to visit Brilliant’s aunt, who was admitted after an attempted abortion with a coat-hanger in a back-alley “practitioner’s” office.  The dirty tool had pierced the uterus, and now she was septic with a raging infection in the ICU, hanging by a thread.  It was then that their motorcycle was struck by a speeding SUV, instantly killing Brilliant’s parents and causing the severe injuries to her right leg.  Brilliant’s aunt died a few days later. 

Brilliant’s story is one of the clearest recent examples for me of why Jesus had to die for us on the cross.  Mankind desperately needs saving, as the effects of sin are far-reaching, deep, and tragic.  And, in faith, we must believe that nothing is beyond God’s redeeming ability.  My prayer is that Brilliant may one day live her name, and shine as an example of God’s healing, grace, and hope in the darkest of histories.  Please join me in lifting up this little girl, asking God to bless and encourage and heal.   

“Our father, who art in heaven, hallowed be Thy name.  Thy kingdom come, Thy will be done, on earth as it is in heaven.”

Thursday, January 30, 2014

“The Maiming (and Healing) of a Generation”

Patient and her husband at first follow-up appointment after discharge from the hospital. 
 
X-ray showing wired pelvis with ex-fix pins in iliac crest.
 
Dr. Fasto Lado, the orthopaedic resident from South Sudan and his wife and daughter, all dressed up for the welcome pig roast. 
 
 Dr. Victor Sowayi, strong and dependable. 

 
Dr. Seno (general surgery resident in red shirt) donated his annual pig (gift from his father) for the roast.  With Seno and I at the helm, meat will always bring a smile. 
 


Dueling Weber grills - pork in one, chicken in the other.  Why not?
 
During an especially busy call weekend in December (exacerbated by a two-and-a-half-week doctors' and nurses' strike in Kenya, in which Tenwek was one of the only open hospitals in our heavily populated rural area), my resident called to say that there was a young female in casualty who was hit by a lorry (truck) while walking on the side of the road.  “She has bone protruding from her pelvic region,” a statement which perked my interest, knowing that an “open” pelvic fracture can be a life threatening condition.   As I walked into the bustling casualty overflowing with massive numbers of patients, I was surprised to see her tucked quietly into one of the corner beds away from the main activity .  I lifted the bloody sheet covering the lower half of her body, and was amazed at what I saw (one of many “firsts” I see at Tenwek on a regular basis, or as Will, my partner, frequently says, “you just can’t make this stuff up”).  Apparently, when she was hit by the lorry, her legs completely split apart, and the entire left half of her hemi-pelvis was protruding about 5 inches though her skin, and the surrounding area damaged by multiple lacerations.   The patient was very calm as I explained that we would need to take her to surgery to try to fix her, but in my heart, I fully expected her to die, given the complete severity of her injuries. 

We resuscitated her in theatre with several liters of fluids, and then began the arduous process of trying to put her back together.  After thoroughly washing the protruding bone, which was dirty with soil and grass, I wired the two halves of the pelvis together using sternal wire (probably brought by my brother John for open heart surgery).  Then, while Dr. Russ White and the surgical resident worked on reconstructing her soft tissue injuries, I supplemented the internal pelvic fixation with an external fixator, using 5mm diameter pins drilled deep into the iliac crests which were then connected by graphite rods.   Not once during the entire procedure did she show any signs of crashing, and, in the end, we were all pleased with the reconstruction.   

At first, during our post-op morning rounds, she would lay stoically while we examined her, likely traumatized by the horrific events in her life.  But over time, as we explained how God was healing her, and had even spared her life, she began to come alive with the most beautiful smile, and we saw her true person: a beautiful woman loved by God!   Amazingly, her postoperative course was entirely uncomplicated, and after about two weeks in the hospital, she was discharged. Just yesterday, I saw her in clinic, accompanied by her husband, actually standing (see pic), with completely healed wounds.  I was overwhelmed with a sense of God’s grace and presence as we prayed, thanking Him for His healing in her life.

The World Health Organization has recognized that road traffic accidents are becoming a public health crisis, on par with HIV and tuberculosis, and has declared this “the decade of road safety.”  As roads improve, and access to transportation increases (especially in our area via motorcycle taxis), the increase in injuries related to road traffic accidents is staggering.  The orthopaedic service has grown exponentially, and is now one of the busiest at Tenwek, with currently more than 55 inpatients.   And these patients' injuries are not simple, but complex, often with multiple open fractures, and challenging wounds that require multiple trips to the operating room.  I have come to call this epidemic “the maiming of a generation.”  But God has put Tenwek in this small part of the world (which also feels like the epicenter of this crisis) to stand as a testimony that Jesus loves His people, and that He has come to heal that which is broken, both body and soul.
Part of this holistic vision at Tenwek is the training of African surgeons.  The new orthopaedic residents are here and integrating well into our community (see pics of the annual pig roast) and plans for our sorely needed trainee housing complex are progressing.  About $340,000 of the needed $800,000 has been raised, and we are still trusting God to complete this project in time for the next class of residents (January 2015).  Would you consider partnering with us in what God is accomplishing here at Tenwek?  You can click the following links for secure on-line giving: Tenwek Orthopaedic Residency Fund and/or the Tenwek Trainee Housing Project. 
Thanks for all your continued support of our family and the work at Tenwek! 

Wednesday, December 11, 2013

Orthopaedic Residency Training at Tenwek: It’s a Full Go!


My partner, Dr. Kiprono and I just returned last week from Zimbabwe, where we traveled to take the second half of our fellowship examinations in orthopaedic surgery for the College of Surgeons of East, Central and Southern Africa (COSECSA).  The first half (the written portion), we took in Kenya this past September and both passed.  Hence, we were invited to the COSECSA annual meeting in Zimbabwe for the oral exams, which consisted of eight, 20-30 minute stations in which we examined live patients and were asked a myriad of questions to test our knowledge. 

In short, Kiprono and I both passed and are now Fellows in the College of Surgeons of East, Central and Southern Africa.  Additionally, during the COSECSA general council meeting, Tenwek was fully approved and accredited for higher fellowship training in orthopaedic surgery.  So along with approval by PAACS, the Medical Education Committee and the Board of Governors at Tenwek, and now COSECSA  (with accreditation and fellowship), what this all means is that our residency is officially a FULL GO!!  Tenwek will have the first ever PAACS affiliated-COSECSA accredited orthopaedic residency program in Africa!  Glory to God!

Now all we need are residents (trainees) to fill the first two positions!  As such, this Friday, we will be holding interviews for our first class of residents, and we are praying for God to provide a strong pair (academically, emotionally, spiritually and physically).  The program will be five years in length and so when fully-filled, we will have 10 residents in orthopaedic surgery.  Without outside funding or corporate sponsorship, we will need to raise the funds to sponsor these residents-in-training.  Because of our affiliation with PAACS, residents who are sponsored for training at Tenwek will "give back," year for year, at the end of training, working in areas of most significant orthopaedic need in Africa.  If you would like to become a part of training African Orthopaedic Surgeons for Africa, please join our team and help sponsor a resident (www.wgm.org/orthofund).  Training each resident costs about $20,000 per year. 

When I returned home last week, I told Levi and Claire that my prize for passing my fellowship exam in orthopaedics was 6 billion dollars.  Wide-eyed, Levi shouted something about being a billionaire and buying an airplane.  I then pulled out my wallet and extracted two crisp bills, one for 5 billion dollars and the other for 1 billion dollars, and gave one to each child.  Confused that these bills didn’t look like typical American cash, I explained that these were Zimbabwean dollars, and not worth much (I purchased both bills as a souvenir for 1USD).  Cruel, perhaps…but also a good lesson in the value of money, inflation, and things eternal which all the money in the world could never buy. 

Thanks for your ongoing prayers and support of our family!  We are privileged to serve with you at Tenwek Hospital in Kenya.


Sunday, November 17, 2013

Tenwek Orthopaedic Symposium 2013


The symposium attendees from all over Kenya...love the i-Phone pano function!



 The Tenwek Surgery Building auditorium...perfect venue for our symposium. 



Sawbones workshop...Dr. Cabanela demonstrating how to do a total hip replacement using model bones.


Coolest part of the symposium...the live surgery demonstration where video and audio feed was piped live from the operating room to the auditorium.  Here, Dr. Joe Cass is asking Dr. Ray Kim questions while Kim performed a total knee replacement.


Sawbones workshop...Dr. Kim demonstrating a total knee replacement on model bones.


During the days leading up to the symposium, the team operated on some patients with challenging problems!


28 year old young lady with a badly dysplastic hip, now with a brand new hip replacement.


At the close of the symposium, the team was thanked in typical Kenyan fashion, including the rungu, symbol of (orthopaedic) strength and power!


Each attendee was presented with an official "Certificate of Participation" and CME credit was given to attending physicians.


Left to right: Dr. Joe Cass, myself, Dr. Ray Kim and Dr. Mike Cabanela.  Thanks team!



This past week, the Tenwek Department of Orthopaedic Surgery hosted our first-ever, 3-day teaching symposium on hip and knee replacement surgery for surgeons and medical personnel from all over Kenya.  More than 50 people attended to hear teaching, participate in workshops, and see live surgical demonstrations (via closed circuit TV from the operating room to the auditorium) on adult reconstructive orthopaedic surgery.    Two of our three guest speakers, Dr. Mike Cabanela and Dr. Joe Cass, were consultants I had the privilege of working with while I was a resident at the Mayo Clinic in Rochester, MN and the third, Dr. Ray Kim, was my chief resident when I was a junior on the orthopaedic trauma service.  Their teaching was outstanding, and many of the attendees told me personally that this was the best symposium they had ever attended!  We thank God for this special opportunity and that, overall, the symposium was a smashing success!

Saturday, October 26, 2013

Emmanuel – God with us



Emmanuel, a 19 years young man, with a painful mass on the back of his leg.


X-ray showing this large osteochondroma growing off the top of his fibula, essentially filling the back 1/2 of his calf.


Removal success!!


Emmanuel was shocked (as were we) at the size of this mass which he lived with, in pain, for several years.


Other evidences of "God with us."  Dr. Dylan Nugent (left), who will join the ortho team (God-willing) in 2015 after he finishes residency, and Dr. Will Moore (right) who joined us 2 months ago, a stellar surgeon, team-member and friend.  (Dr. Kiprono - absent as he was on well-deserved leave after several months of faithful service - often alone - while I was away.)


Will showing "the love" during a femoral nailing.  He loves the big and bloody ortho procedures!


"God with us," as we continue to teach and train orthopaedic and surgical residents.


"God with us," as we continue to care for the myriad of patients who come to Tenwek for orthopaedic care - last week in Wednesday clinic, 137 patients...a new record.


"God with us," as our inventory grows.  The inaugural use of our new Biomet distal femoral locking plates. Huge...

 
Dr. Will, choosing the right plate for the job. 
 

"God with us," as we continue to share the good news of Jesus Christ with our patients.
 
Two days ago, I met (for the first time) a young man named Emmanuel who had a huge, firm mass growing in the back of his leg.  A previous biopsy had confirmed the mass was benign, a large tumor called an osteochondroma, which was growing off the top of his fibula bone.  All that needed to be done now was to “simply” remove this mass, which had grown to the size of a grapefruit (was now enveloping all the major nerves and vessels of his leg), and he would be “cured” of the years of pain associated with it.   

Assisted by Dr. Dylan Nugent, a visiting 4th year resident from the U.S. with a particular interest in orthopedic oncology, we proceeded, first isolating and protecting the peroneal nerve, then trying to shell out the tumor from the surrounding normal tissue, which proved to be anything but “simple,” as the tumor had grown to the opposite side of the leg, directly behind the tibia, where it was pressing directly into the large vessels that feed the leg and foot.  Our fear was that, in removing the tumor, damage would be done to these delicate structures. 

After removing the tumor and releasing the tourniquet (which allows a relatively blood-less surgical field), we encountered significant bleeding, although not pulsatile (i.e. from an artery), but rather a dark, steady flow (i.e. from a vein).   A small hemostat was used to (somewhat) blindly clamp the torn, bleeding vessel.  After tying off this small vessel with suture, the bleeding stopped, but we noticed the tissue surrounding was thumping at the same cadence of his heartbeat.  The vein we had clamped and tied (a branch of the major vein of the leg) was only a few millimeters from the tibial artery, which was completely intact, without any sign of injury, our hands sovereignly guided by a God who cares deeply for our patients at Tenwek.

After showing Emmanuel the mass (he was completely awake, anesthetized by a spinal), and enjoying his wide-eyed shock at the size of his tumor, I asked him, “Emmanuel, do you know what your name means?”  He responded with an eager smile which belied a deep inner faith.   “Yes,” he said, “it means ‘God with us.’”   Sensing God’s presence throughout the entire procedure, and amazed and humbled by the fact that we serve a God who shows up in times of our desperate need, I said “God was with us today, Emmanuel…He was with us today.”

Since returning to Kenya almost a month ago, life at the Galat house, and in the hospital, has been absolutely crazy.  Between unpacking, settling, changing diapers, organizing the orthopedic storeroom, entertaining guests, preaching, operating, homeschooling, cooking, etc. our lives could probably be described as chaotic, at best, out of control, at worst.   Our days are such a paradoxical mixture of highs and lows, struggle and victory, and good and bad feelings at all the difficulties and challenges we face (“normal” for missionary families, according to Mission Training International).  Yet God’s grace and faithfulness continues to overwhelm us on multiple levels, and more than ever, we are comforted by the fact that we serve a Savior whose name is Emmanuel – God with us.

Thanks for all your love and support of our family!

Monday, September 16, 2013

Karibu Tena Tenwek!

During my whirlwind two week trip to Kenya (having just returned to the U.S. a few days ago), I must have heard the words “Karibu tena Dakari” (meaning “welcome back Doctor!” in Kiswahili) more than 100 times.  It really felt good to be greeted by so many people who (at least) appeared to have significantly missed me while I was away these past six months of furlough, and to experience again the sights and smells of the place that our family has now come to call “home.”   

Two days after arrival, I dropped Jeremiah off for his junior year (!) at the Rift Valley Academy, said goodbye (yet again) and then headed to Tenwek with Dr. Will Moore, newly graduated orthopedic resident (who traveled with us to Kenya) and our new partner at Tenwek for at least the next two years (joining Dr. Kiprono and I, who, I am convinced, had a tear in his eye when he saw the two of us on early morning rounds the following day).
Jeremiah in his new dorm room, with his Vitamix...for making protein shakes, and perhaps a few smoothies for the ladies...

 
Dr. Will Moore with one of his first patients at Tenwek.  I can't tell you how glad I am to have him with us!  Karibu sana Will!!
 
Not operating much over the past months, it also felt good to “be back in the saddle.”   After a long day of surgery, I was greeted with another hearty “Karibu sana” after which I was told about a young man in Casualty who was walking along the side of the road, just a few kilometers from Tenwek, when we was struck by a lori (semi-truck).  I ran into emergency room, and saw a large group of clinicians around this poor man, who was truly a horrific mess.  The impact had caused an “open book” pelvic fracture, accompanied by a large open wound in his groin, a left anterior hip dislocation, a mangled right leg, an open right knee dislocation, a humerus fracture, and a large avulsion of the entire right side of his face.  After several hours of surgery well into the evening (including an emergency amputation and external fixator to hold his pelvis closed), unfortunately, the man succumbed to his injuries.  I couldn’t help but think this man was someone’s son, brother, father, husband.  I certainly don’t miss the senseless myriad of road trauma at Tenwek. 
Pelvic x-ray showing "open book" pelvic fracture, with left anterior hip dislocation.

The following day, Dr. Kiprono and I traveled to Nairobi (with a team of PAACS general surgery residents) to take our written exams for Fellowship in the College of Surgeons of East, Central and South Africa (COSECSA), in preparation for the start of our new COSECSA-accredited, PAACS-affiliated (pan-African Academy of Christians Surgeons) orthopedic residency program.   The morning of this exam, ironically, I received, via email, my results from the American Board of Orthopedic Surgery exam (passed…again!), which gave me a boost to take this African exam (in some ways more difficult with a large essay section, and interestingly worded multiple choice questions).  On the way back to Tenwek, Kiprono and I stopped to view the wreckage of a bus crash which made international headlines just a few days before our arrival in Kenya.  The bus, sorely overloaded with people and cargo, traveling after midnight to avoid the law, lost control on a steep curve, careened over a “guardrail” and rolled several times, ripping off the entire top half of the bus.  42 people lost their lives. Again, hard to process the senselessness…
 
The other Tenwek-PAACS General Surgery residents who traveled with us to take their separate COSECSA exams.  Fun times all stuffed into the Landrover!
Dr. Kiprono and I just after our COSECSA fellowship exam in orthopedics. Glad it's done!
 
42 souls lost their lives...only 26 survivors. 

 
Hair-pin turn on steep slope where bus lost control and rolled several times.
 
Another few busy days at Tenwek were met with multiple meetings with various persons and staff.  Plans for a new Galat guest apartment/ministry area were drawn after midnight, and entered into the approval pipeline for hopeful soon commencement.  Most significantly, the day before I left to return to the states, the Tenwek Medical Education Committee met and officially approved the start of our new orthopedic residency, the culmination of years of vision and planning.

“Karibu sana” became “kwa heri” (goodbye) as my two week trip came to a close, and I traveled back to the U.S., greatly excited to see my family again, especially baby Josie (who, by the way, put on a significant amount of “chub” while I was away).  The greetings will return again, however, as exactly two weeks from today, we all return home, as a family, for our third term at Tenwek Hospital. 
"Chuma" our dog, well cared for by the Roberts family, eagerly awaits the arrival of our full family in a few weeks!!
Baby Josie at one month.

Overall, I am amazed at the sheer volume of incredible things God has accomplished over the past several years since heading to Tenwek in 2008, and these things stand as a testimony of His goodness and grace in the lives people who are so far from deserving.  And per God’s design of “partnership,” all this has been possible only through the prayers, financial support, and encouragement of many people who have joined us in this work to serve the underserved in Kenya.  Thank you! 
If you would like information on how to partner with us in this next term, as there are many areas of opportunity (i.e. sponsorship of new Tenwek PAACS/COSECSA orthopedic residents, the Orthopedic Compassionate Care Fund for financially needy patients, a new housing complex for Kenyan interns and medical students, and/or support of our family) shoot me an email at dgalat@gmail.com! Thanks for all your love and support! 
 

Friday, August 23, 2013

Joy through Suffering



After personally witnessing what Heather describes as “the most difficult labor of the five,” I have been reflecting on a subject that has honestly perplexed me over the years: pain and suffering.   In the weeks leading up to the birth of our new baby girl, Josie Grace, our two main prayers were for (1) a healthy baby and (2) a quick and relatively easy labor and delivery.   With the myriad of potential problems that could possibly occur during pregnancy and delivery, we were so thankful for the answer to prayer #1.  But prayer #2 was a different story, as in the end, the labor was certainly not quick, nor easy.  Heather pre-decided that this birth would be completely “natural” (or un-medicated as it is described in 2013), not because Heather has some amazing pain tolerance (her words) but because of a previous complication from an epidural when Emma was born.  In her mind, the pain experienced during child birth was nothing compared to a week-long spinal headache from a botched epidural.  Levi was also born “naturally” but his labor and delivery were within a few hours of arrival at the hospital.  So we were figuring little Josie Grace would come in the same way.

Heather was admitted to the hospital the afternoon of the 13th with fairly regular, but light contractions.  After several hours, we decided with the midwife that it would be best to “break her water” to hasten the process.  Shortly thereafter, hard labor began, and Heather spent almost the entire night laboring in the shower, with contractions coming fast and hard.  At 6am, exhausted, the midwife suggested that Heather get in bed so that she might check her progress, and we were distraught to discover that after all that work, she was only 3cm dilated.  “I can’t do this any longer,” Heather whispered, clearly discouraged at the slow progress.  “God help her,” I thought as I had her roll onto her side to continue this trial of labor.  What happened next was quite amazing.  Hooked to the monitor, I was able to see the baby’s heart rate and the onset, strength and duration of each contraction.  Lying on her side, the contractions became widely spaced (approx. 8-10 minutes apart) which allowed Heather to sleep soundly during each interim.  When each contraction came, however, Heather would abruptly awaken and work, with difficulty, through each extremely long and hard episode while I rubbed her back and helped her breathe.  This continued for the next 5 long hours, and what I thought was a slowing of the process with widely spaced contractions, was actually God allowing Heather to rest and prepare for the last “final push.”

When the time for pushing began, we discovered that the reason the labor had been so long (aside from the fact that she was the biggest baby Heather had delivered), was because Josie’s head was turned 180 degrees.  As such, pushing was no easy task either, and after what seemed like an eternity, Josie finally arrived, almost 24 hours after admission, with a massive cone-shaped head from being squeezed through a disproportionately small space.  As the midwife placed Josie on Heather’s chest, her face radiated sheer relief and joy.  “You did it!” I exclaimed, personally trying to hold back my own tears of joy and relief. 

As I reflect on this incredible and almost surreal experience, what impresses me is the fact that God did not answer prayer #2 in the way I thought He should have.  He did NOT deliver Heather from suffering, but delivered her through it.  He did not lessen the pain, make it go away, or even shorten it.  It was all there in its full, visceral, unbelievable “glory.”  But God did provide the help she needed, when she needed it, so that she might persevere until the task was complete.  And the relief and joy that resulted was indescribable.  The analogy to our spiritual lives is striking.  God never promised to shelter us from trials, suffering or pain (contrary to the teaching of many well-meaning, but incorrect Christians).  In fact, Jesus communicated clearly and with absolute certainty that pain would come, and that when it did, it would not be easy.  So where then is our hope in the center of our pain?  Only one place...Jesus.  After all, he had his body scourged, his beard plucked, a crown of sharp thorns crushed on his head, and his hand and feet nailed through to a cross, not to mention being betrayed, ridiculed and abandoned.  And somehow, I don’t think that He was shielded from any bit of that unimaginable pain.  But He persevered through it, overcame, and arose to utter and complete joy.  Jesus, God in the flesh, overcame, and as we put our hope and trust in Him, so will we, and thus, experience that same intense joy that can only come through suffering.  We may not understand it, but we can have the faith to believe God at his Word, that He will cause us to persevere, that (somehow) there is purpose in the pain, and that the end result will be joy unspeakable.