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

Sunday, December 28, 2008

The Essence of Christmas: Visit to Mosop Orphanage












(Photography by Jeremiah Galat, 24 December 2008)
On Christmas Eve, Heather and the kids went to visit the children at one of three orphanages supported by the ministry of Tenwek Hospital. Jeremiah, at first, was not excited to go, thinking that staying at home and playing with friends would be much more enjoyable. However, the experience had quite an impact on all our kids, mostly because of the way they were treated as visitors to the orphanage: being greeted with a program, songs, bananas, oranges, mangos, hard-boiled eggs, chai, and unlimited soda. Heather mentioned how humbling it was to be given so much by those who had so little. Later that evening, our family watched “The Nativity Story” on our surround sound home theater system (our laptop, with Sam’s Club Bose speakers), celebrating the birth of Christ. Amazing how the King of the Universe humbled himself to be born as a helpless baby in a stable. And the baby’s visitors, the wisest of the wise (Magi) and the lowliest of the low (the shepherds) demonstrate the fact that Christ is for all people who realize that on their own, if left to ourselves, and by our own means, all is hopeless. More paradox…

1 Cor 1:27-31 But God chose the foolish things of the world to shame the wise; God chose the weak things of the world to shame the strong. He chose the lowly things of this world and the despised things--and the things that are not--to nullify the things that are, so that no one may boast before him. It is because of him that you are in Christ Jesus, who has become for us wisdom from God--that is, our righteousness, holiness and redemption.

Monday, December 22, 2008

Images from Tenwek


As an astute orthopod, and by the look of his eyewear, I could tell my patient needed a stat ophthalmology consult. He saw Dr. Ben Roberts and had a cataract removed the next day. I thank God for these little bright spots in a long clinic day!

Beautiful Emma decorating Christmas cookies! Our yearly family tradition.



Jeremiah found this baby chameleon at the hospital and feeds it a daily ration of flies.



Becoming Less…

The young woman with “jumped facets” was placed in a “halo” with hopes that her cervical spine would be stable enough to allow healing over the next few months. However, as I read from my orthopedic textbooks, the recurrence of dislocation is approximately 50% even with a halo in place; and should that happen, the proper treatment is a spinal fusion. As a young, inexperienced surgeon with NO plans for spine surgery anywhere in the near future, my worst fears were confirmed on follow-up x-rays of her cervical spine. “Well, I’ve done all I can by putting her in a halo,” I thought to myself. “I’ll just have to refer her to a spine surgeon in Nairobi.” Thinking that I had devised a good, safe “out” (for myself), I ran my plan by Dr. Russ White, chief of surgery. “That’s fine,” he said, “but without money, no surgeon from Nairobi would ever agree to see her…you’ll just have to do the surgery yourself.” Easy words coming from a seasoned missionary general surgeon known to do everything (even some orthopedic spine surgery). “What are you doing tomorrow?” I asked calmly (on the outside) but with a certain amount of desperation (on the inside). Thankfully Russ was available in the afternoon.

In the US, prior to a surgical fusion for jumped facets, an MRI would be obtained (to evaluate for a herniated disc, which if present, could paralyze the patient). Additionally, spinal cord monitoring would be used during surgery to alert the surgeon of an impending spinal cord injury. Of course, neither are available in a rural Kenyan hospital. Surgery on patients with a spinal cord injury is usually less stressful (strangely comforting to a surgeon with the knowledge that neurologically, you cannot make the patient worse). However, our patient never had any neurological injury, and without a prior MRI or spinal cord monitoring, I kept praying during surgery, “God, let her remain that way.” Thankfully, the surgery went well, and despite our lack of technology, and my lack of experience, the patient awoke from anesthesia moving all four limbs and feeling every touch.

It is amazing how God desires to push us all beyond the edge of our abilities. When we get to the end of what we have to offer, to the end of our experience, our education, our means, our talents and gifts, to the very end of ourselves, the only thing that remains is God. Oddly, according to scripture, this is God’s design, so that Jesus Christ is glorified and His Kingdom is advanced. As John the Baptist replied to those taunting him that Jesus was drawing greater crowds and baptizing more people: "A man can receive only what is given him from heaven….He must become greater; I must become less.” And as Jesus replied to his disciples who were arguing amongst themselves as to who was the greatest: "If anyone wants to be first, he must be the very last, and the servant of all." Dependence on God, serving rather than being served, becoming nothing so that He can become everything, this is the paradoxical design for all our lives. May our eyes be opened this Christmas season to the inexpressible treasure of Jesus Christ and the true joy that can only be found when He is more, and we are less.

Saturday, December 13, 2008

A Day in the Life…



Wednesdays are “clinic day” for the orthopedic department, the one day of the week where surgeries are not routinely scheduled and patients arrive from all over this small part of the world to have their orthopedic issues evaluated. I liken clinic day to Forrest Gump’s proverbial “box of chocolates”…you never know what you’re gonna get. Could it be a draining fistula?...A two month old fracture-dislocation?...An open fracture that’s been festering for the past five days?”

Last Wednesday was extra-special. The “box of chocolates” motif also applies to orthopedic admissions from Casualty (the Emergency Department) from the night before. As of yet, there is no set protocol for the residents to follow regarding orthopedic trauma patients (which I remedied today), specifically regarding when Dr. Galat should be paged. I had hoped, in vain, to do a surgery or two before clinic in order to catch up on the back-log of cases, but when I arrived in the orthopedic ward at 6:30am, I was greeted by three new patients with the most incredible montage of trauma: (1) a female with a cervical spine fracture, a “unilateral jumped facet,” and lumbar spine fractures, (2) a 17 year old boy with a midshaft femur fracture, and (3) a poor young lady with bilateral tibia fractures, one side open (where the bone breaks through the skin), and an open elbow fracture (that thankfully at least had been washed in the operating room the night before). For those without ortho training, let’s just say these are all bad things.

I took a deep breath, cancelled our pre-clinic surgeries, and excused myself to run home for a quick refresher course on the proper treatment of “jumped facets.” This involved screwing tongs into the patient’s skull and using 20 pounds of traction to realign the spine the way God intended. Speaking of which, I (again) was praying the entire time, as I have never seen or done this myself. Thankfully, God intervened yet again, and x-rays after the patient was in traction for 30 minutes revealed perfect alignment of the spine.

Plans were made to operate on the young lady with the open fractures after clinic (I estimated at least 5 hours for the case). But it became apparent that this would not happen after I saw the massive crowds of people already lining up to be seen in the ortho clinic. Solomon (a Kenyan superstar physical therapist/functioning non-operative orthopedist) and I saw close to 90 patients and wrapped up our day at 8pm. By this time, the operating theater day staff was long-gone, having to walk home (sometimes miles) before it gets dark. The “on-call” staff is only available for “true emergencies,” such as perforated colons, not open fractures that have already been washed out. Truthfully, I was somewhat relieved because I was exhausted. I went home and collapsed into bed. The following day, I fixed all her fractures (and another one I found while she was in surgery), fixed the boys femur fracture, and did a few other cases.

Please continue to pray for our family and for our patients here. Because of the sheer volume of trauma cases, the back-log continues to grow. So far, I have 8 cases scheduled for Monday, and the weekend is still young. And, if you are an orthopedic surgeon with an interest in trauma and desire for some excitement, you are welcome to visit! Thank you for all your prayers and support.

Saturday, December 6, 2008

More images from Tenwek

Levi playing "Lion" scaring the Kenyan children.

Jeremiah finds another prize catch!

Heather getting to know some Kenyan children.

Jeremiah is becoming quite the photographer!



Unless the Lord Builds the House: Homeschooling, Flaps and Cut Tendons


As part of Tenwek Christmas tradition, the kids all gather together to make gingerbread houses in one huge event. Fueled by excess sugar and unbridled creativity, Emma, Claire and their new friend Mercy created a masterpiece that unfortunately crumbled into a pile of rubble by the time I arrived home from the hospital. “That gingerbread house symbolizes how we feel right now!” said Heather.

Heather and I were both struck square in the face by the words of Psalm 127 last week: “Unless the LORD builds the house, its builders labor in vain. Unless the LORD watches over the city, the watchmen stand guard in vain.” We realize that unless our sovereign LORD intervenes in the work we are called to here at Tenwek, that our labor will be in useless. Moreover, unless all we do is infused with love for other people, all our efforts and good intentions are meaningless. “If I give all I possess to the poor and surrender my body to the flames, but have not love, I gain nothing. (1Cor. 13:3)”

Heather’s work here is primarily homeschooling, and she is doing an outstanding job, trusting the LORD to build, provide, and enlighten….all a direct result of your prayers, so please continue! There are a myriad of other opportunities for ministry, especially to orphans, that she is also beginning to explore.

For me, I am reminded daily of my dependence on the LORD in every way for every case. In two weeks time, I have done 32 cases, many complex, that I would never have attempted without God’s direction and wisdom. But since I am the only orthopedic surgeon here, who else will do it?! During my training at Mayo, whenever a patient had a soft tissue defect in the leg after an open tibia fracture that needed to be covered, we would call the plastic surgeons to isolate and swing a piece of muscle tissue (called a “flap”) over the defect. Just last week, I thought to myself, “It would be so valuable to have a plastic surgeon visit Tenwek and show me how to do a flap…I will likely need to know how to do that some day.” Well, that day came last Friday, perhaps a little earlier than I had hoped, aided not by a visiting plastic surgeon, but by prayer and a few good textbooks…so far so good.

Another patient had a small laceration over the undersurface of her thumb and was unable to flex the distal joint, signifying a tendon laceration. I knew that the hardest part of repairing the tendon is first finding the cut ends. This sometimes requires a large dissection, and I am not a fellowship-trained hand surgeon! I took her to the operating room and enlarged the laceration a bit to get a better view. I found the distal end easily, but the proximal end was nowhere to be found, retracted far proximal into the palm of the hand. At this point, a tendon grasper would have been helpful, but Tenwek unfortunately does not have one. So for several frustrating minutes, I blindly (but gently) tried to “fish” it out with forceps and hemostats (not ideal instruments)…no luck. I was dreading the next step. Just then, a visiting minister from Alabama who enjoys watching surgery entered the room. “What are you doing?” he asked. “Trying in vain to find this cut tendon,” I said. “Well then, let’s pray!” said Earl. He offered a simple prayer that God would allow me to find this tendon. Right after he finished, I (again) blindly stuck the forceps about 2 inches down the sheath. But this time, I felt something, and no kidding, I pulled out the tendon! After this, the repair was easy.

Again, unless the LORD builds the house, unless he provides wisdom, and unity in the orthopedic department, and love for our patients, and all the necessary equipment and supplies, our work at Tenwek will be in vain. After all, this is His work. But dependence on God, no matter who we are, where we live, or what we do, is such a good place to be. God is the master builder, and although the process can be painful, and will require faith that seems impossible, the end result will be perfect. Let the LORD build your house. Thank you for all your prayers and support!

Monday, December 1, 2008

Images from Tenwek

20 year old with leg mass...a malignancy know as adamantinoma.




Pediatric wards at Tenwek.

Our temporary house, where we will stay until next summer (when the family that normally lives here comes back from furlough).

Playing with friends and the turtles in the back yard.