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

Thursday, July 4, 2019

Endings and New Beginnings

Happy 4th of July from Kenya!
It seems fitting on this cloudy and cold 4thof July in Kenya to reflect on what God has done in the past three years since we made the challenging transition from Tenwek to Kijabe Hospital. So, I’ve built a blazing fire, and I’m sipping a cup of hot chai as I write, all the while wishing we could be in the U.S. for a blazing hot Independence day cookout with burgers, beans and sweet corn followed by fireworks as the sun sets.  

Change is inevitable, and endings and new beginnings are a common part of this walk with Christ as strangers in this world.  We often don’t take the time to grieve the multiple “deaths” that we experience regularly, and as a result, can get stuck in confusion, disillusionment, and stunted growth.  But if we take the time to be honest with ourselves, and God, we can begin to see the new life that springs forth from the ashes (“Unless a grain of wheat falls to the ground and dies, it remains alone; but if it dies, it bears much fruit. John 12:24)

If we would have been told 4 years ago that we would leave Tenwek (endings) and start again at Kijabe (new beginnings), we would have thought that would be impossible.  We had worked too hard, invested too much, and planned to spend years, if not decades there.  And I admit, we did not grieve well the loses we experienced and spent many months in a fog after first moving to Kijabe. 

But God, in His mercy, began to reveal the bigger picture of his sovereign plan, and one by one, new beginnings unfolded. In December 2016, Emma graduated from Mercy Multiplied in Nashville and returned to Kenya to complete her junior and senior year at RVA. In February 2017, we discovered we were expecting another child, and Ethan Benjamin was born at Kijabe Hospital on October 11, 2017.  Now he is a little toddler, running around the house and trying to compete with his two, very doting older sisters.  


In March 2017, our oldest, Jeremiah, eloped, and although this was a complete surprise to us, we see God’s hand in this new beginning for him and Tory!

Jeremiah and Tory visited us in December 2017 when we found out the news!


In July 2018, I became the first orthopaedic surgeon to complete the American Board of Orthopaedic Surgery certification process overseas in a mission/humanitarian setting.  In January 2019, PAACS Orthopaedics added two new programs (Kijabe and Soddo/CURE) to join Tenwek (which graduated their first two residents) bringing to total number of ortho residents to more than 20 (of which I have the privilege of overseeing as the PAACS Orthopaedics Regional Director). 

Fasto and Victor as the first two graduates from the PAACS Tenwek program.  Victor is working part-time at Tenwek and Fasto is a fellow in paediatric orthopaedics at CURE Kijabe. 

Francis Mbugua and James Kinyua, the program directors at Kijabe. 

PAACS site visit to Soddo Christian Hospital in Ethiopia.
John Weston, recent graduate from the Mayo ortho residency program, visited us twice at Kijabe and had decided to join the team here. However, when Tenwek lost Dr. Kiprono and Dr. Nugent, he and his family changed gears and decided to make Tenwek their place of service.  They plan to arrive in September 2019!

And as of this month, we will have graduated two of our daughters from high school to send off to college (yes more endings/new beginnings).  

Emma is now a Voice Performance Major at Biola in La Mirada, CA
Claire plans to start at Princeton in the fall. 

The orthopaedic work at Kijabe Hospital thrived over the past three years, and I grew tremendously as I was pushed to more challenging cases such as revision total hip arthroplasty and bone transport for huge bony defects. 

22 year old young lady with gaucher's disease.  She required bilateral total hip replacements. 
Pelvic X-ray of above patient. 

14 year old boy with large femoral bone defect requiring "bone transport."
Pins and rail used to "transport" bone over a distance at 1mm per day to fill the defect. 

And as the Head of Orthopaedics, I was challenged to lead in deeper ways, including a book study for the consultants entitled “Emotionally Healthy Leadership” By Pete Scazzero (in which the last chapter is entitled “Endings and new beginnings.”  Yes, you could say this book has had a profound impact on me!) 


Heather and I also experienced a rebirth of regular prayer and a new conviction for sabbath rest.  We, for the first time in our missions career, began to experience the joy of intentionally leading together, in ministry, from our marriage (yep, another chapter in EHL).  Heather was involved with multiple prayer ministry groups around the Kijabe campus, and we met weekly with a group of peers (couples with young kids, most of whom were 10+ years younger than Heather and I!).  

And we were able to really connect with our older kids during this critical time of development in their high school years.  Many painful endings led us to beautiful new beginnings.  

Over the past three years, we have made more pizzas than we can count. 


Each Friday night, we have between 5-12 students with  large appetites!
Levi was baptized in the Indian Ocean in April 2019. 

And now, in two weeks, we will experience yet another ending as we leave this season at Kijabe, and head back to the States to begin a year of Home Ministry Assignment (HMA).  During this time, I will be doing a year-long fellowship at Mayo Arizona in shoulder, hip and knee arthroplasty.  At this point, we are planning to return to Kenya after the fellowship ends in July 2020, but we have learned to hold plans very loosely and are continuing to ask God for discernment of his will (Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect. Rom. 12:2).

We will miss sunsets (daily endings) like this at Kijabe!


We continue to be thankful for each one of you, who have supported us prayerfully and financially over the past 10+ years we have spent in Kenya.  Without your faithful work in our lives, we would not be here!   

Saturday, March 23, 2019

A Beloved Flower


Aimé's case of Blount's Disease or Tibia Vara was quite severe.


X-rays showing that the inside portions of both proximal tibia are severely sloped downward causing the bow-legged deformity. 


Ted (Samaritan's Purse Post Resident in General Surgery) drilling a K-wire to help fix the cut bones. 



After shot of both legs now straight and with good rotation (God was present!)


Aimé Fleury, the Beloved Flower

This past week, I’ve been at Hope Kibuye Hospital in rural Burundi, East Africa participating in World Medical Mission’s first sub-specialty orthopaedic outreach.  The fact that I am even here is a miracle, because in my busyness of life and work at Kijabe, I didn’t even think to confirm that I needed a visa to enter the country (unlike all other African countries I’ve visited where my American passport allows me to buy a visa at the airport).  And so, on Sunday morning, as Dr. Jomo (my 4thyear resident at Kijabe and accomplice to Kibuye) were about to board our flight, I was denied. “Go on ahead without me,” I encouraged Jomo as he looked at me wide-eyed.  “You get started on cases tomorrow, and I’ll catch up with you as soon as I can,” I said, knowing that to get a visa to join the outreach that week would take an absolute miracle.   

Little did I know, however, that there was a boy in Burundi named Aimé Fleury whose father and mother, along with their entire church had been praying and fasting for Aimés needed surgery to correct his severely crooked legs.  And little did I know that after Jomo and I parted ways, he called his Burundian friend Gad, whose father has serious connections in the Burundi Department of Immigrations.  Long story short, by Monday afternoon I had a visa stamped in my passport and by Tuesday morning, I was scrubbing cases with a grateful Jomo and the team here in Kibuye. The repeated response from everyone was, “How are you even here?” as the normal time to get a visa for Burundi is more than 10 days.  

I met Aimé the following afternoon as he was being prepared for surgery; an active, muscular 9-year-old boy with the worst case of Blount’s disease I’ve ever seen.  As an orthopod who does very little pediatric orthopaedics, I prayed to myself, “God, unless you help me with this one, it won't be pretty.”  As the patient was being wheeled to theatre, I met Aimé’s father, who explained that the meaning of his son’s name was “A Beloved Flower” and that his entire church had been praying and fasting for the success of his surgery since Sunday.  It was clear that this son was truly loved, and that God brought him to this small hospital for a purpose.  I relaxed a little as I realized I had no choice but to somehow let God work through our feeble hands to be an answer to the faithful prayers of so many.  

There are times in the operating room when we can sense the presence of God with us, and this was one of those times.  Fixing Amié's crooked legs required multiple cuts in multiple planes to realign, and then stabilize the bones with wires through the skin – all without the benefit of any intraoperative imaging (no C-ARM available at Kibuye).  But after finishing the case, I was pleasantly surprised at how normal the legs looked.  Ted (World Medical Mission post-resident general surgeon at Kibuye) and I bumped fists as all in the room felt like we were on sacred ground.  We said a prayer of healing and protection for Aimé and wheeled him back to his father.  David (Samaritan’s Purse photographer who snapped all photos) showed him the before and after pictures, and his father said in amazement, “Those are his legs?!”

So many deep and humbling lessons from this story: the power of faithful prayers of a small congregation in rural Africa, the love of a father, God’s help and strength in our absolute weakness.  In the end, I was reminded that there is much going on behind the scenes that is so far beyond us (it’s not about us), but as we make ourselves available to God in our weakness, we see His miracles unfold firsthand, as we become the hands and feet of Christ to one another. Not for our glory, but for His alone!  Please pray for Aimé, that he would heal without complications or infections, that he would walk with perfectly straight legs someday, and realize that he is a Beloved Flower of his Father in Heaven.  

Thanks for all your prayers and support!

Sunday, November 11, 2018

The Next Generation


Expansion of PAACS

Last weekend, I attended the annual Pan-African Academy of Christian Surgeons (PAACS) annual meeting in Chicago in my role as the Regional Director for PAACS Orthopaedics. Biggest news is that two additional programs will be joining the PAACS ortho family: (1) Kijabe/CURE (where we currently serve) and (2) Soddo/CURE in Ethiopia. In January 2019, the total number of residents will increase to over 20!

The PAACS Orthopaedic Council sub-meeting...13 US-based surgeons committed to the training and discipleship of national orthopaedic residents in Africa. 

The main PAACS commission meeting had more than 100 people in attendance. 

Tenwek

Tenwek will graduate our first two residents, Dr. Victor Sowayi, and Dr. Fasto Yugusuk in January 2019.  After graduation, Victor will be serving at Litein Hospital, joining three other PAACS General Surgery graduates at this mission hospital about 50 kilometers from Tenwek.  Fasto, who is from South Sudan, will God-willing return to his home after a few years of work or additional training.  Dr. Amada McCoy, who recently completed a pediatric orthopaedic fellowship at Baylor, joined the consultant team at Tenwek last month.

Dr. Amanda McCoy recently joined Tenwek as a long-term, orthopaedic consultant.

Kijabe 

The Kijabe/CURE program was approved to come under the umbrella of PAACS.  Although the residency was started in 2008, the consultants all agreed that PAACS would add tremendous value in terms of spiritual ministry, discipleship and training.  We recently held our residency interviews and have accepted three quality trainees into the program bringing our total number of residents to 10.  Dr. John Weston and his wife Ali, along with their two children, Gabe and Grace, will join Kijabe in late 2019. John is currently a chief resident at Mayo Clinic and has been accepted into Samaritan’s Purse Post-Residency Program.  


Dr. John and Ali Weston, Gabe and Grace will join the Kijabe team in 2019.  


John and I operated on this young man who received a total hip replacement for severe hip dysplasia. 

Kijabe CURE residents at our weekly PAACS spiritual curriculum bible study. 


Ethiopia

The new PAACS orthopaedic training program beginning in Ethiopia in January 2019 will involve two sites: (1) CURE Ethiopia in Addis Ababa and (2) Soddo Christian Hospital in Southern Ethiopia.  Recently, in my role as Regional Director, I visited both hospitals in Ethiopia, and was struck by the complexity of cases, and incredible talent of the surgeons at both sites.

The extreme work of the surgeons at CURE Ethiopia to correct neglected clubfoot.


The drive to Soddo was beautiful, roads flanked by red fields of teff, the grain used to make the Ethiopian staple food injera.


Dr. Duane Anderson (middle), a very gifted orthopaedic surgeon, has been at Soddo since 2005.  Dr. Brian Hodges (back row right) joined Soddo two years ago.  The three guys in the front are orthopaedic residents from Ethiopia and Kenya.


Global Missions Health Conference 2018

On the tail end of my quick trip back to the states, I attended the annual Global Missions Health Conference in Louisville, KY, where I taught a workshop on casting and splinting, and gave a presentation on PAACS orthopaedics to an enthusiastic crowd.  The conference was attended by more than 2500 medical professionals and students and was a impactful time of networking, and encouraging this next generation of young men and women called to serve in medical missions.

Instructing on the application of an RJ splint.


Great hands-on workshop.


Demonstrating how to reduce and splint an ankle fracture with Dr. Dylan Nugent as the "test subject."


A+ splints.

Psalms 71:14-16
As for me, I will always have hope;
I will praise you more and more. 
My mouth will tell of your righteous deeds, 
of your saving acts all day long - 
though I know not how to relate them all. 
I will come and proclaim your mighty acts, Sovereign Lord;
I will proclaim your righteous deeds, yours alone. 

Saturday, October 20, 2018

Brief Galat Family Update - October 2018



The past several months have been incredibly eventful, not surprising for a family of 10! We were in the states for 6 weeks over the summer, and had a fantastic time together. 



One of the reasons for our trip to the states was so that I could take my oral certification exams, defending cases that I "collected" overseas at Kijabe.  I found out I passed the day we returned to Kenya (late August 2018)!  Now, I can officially be called a "Diplomate of the American Board of Orthopaedic Surgeons."  I am so grateful to God for this miracle and for all who prayed me through this process!  



Emma graduated from the Rift Valley Academy in Kenya on July 12, 2018, the day we left for the States.



We transitioned Emma into college at Biola University in California, where she is a freshman studying in the Torrey Honors Program, and majoring in Voice Performance.  The week school started, she went to the music department to inquire about private voice lessons and they asked her to audition.  Long story short, the head professor of voice encouraged her to change her major, offering scholarships, and now she is pursuing her dream!  



Claire is now in her senior year at RVA, busy with multiple activities, and in the midst of applying to colleges. 



What? Josie is now 5 years old and started Kindergarten this year at RVA at the Titchie Swot (which is the British term for primary school).  We've not seen a girl more devoted to learning as Josie!



Jane is now 3, and primarily loves Ethan. 



Last week, we celebrated Ethan's 1st birthday!



While we were in the states, we were thankful to say goodbye to Heather's grandma Stuber before she passed away this month.  Heather is going to travel back to Phoenix for the funeral next week while I remain behind as Mr. Mom.  



This November will mark our 10th year anniversary of life and work in Kenya and our third year serving at Kijabe Hospital, where I continue to work teaching and training the orthopaedic residents.  The Kijabe program was recently approved to become the 2nd PAACS program and a 3rd program will begin January 2019 in Ethiopia.  God is doing amazing things to grow PAACS orthopaedics, which started at Tenwek just 5 years ago!



My hip and knee replacement practice has grown exponentially at Kijabe and now about 40% of what   I do.  The residents love learning about adult reconstruction, but our cases are far from straight-forward.  As such, during our next scheduled home assignment (July 2019-August 2020) I "matched" at Mayo Clinic Arizona for a year long fellowship to bring my skills to the next level.  We are so thankful to be near family during this time!

Overall, God has been incredibly faithful, providing for every need on multiple levels.  
Thank you for your continued love and support of our family!


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!