Christmas at Tenwek

The Galat Family Christmas Eve meal.

The result of deprivation: over-exuberance for mundane, hard to obtain items.

Yearly tradition in our house: Christmas books for the kids. This year, they each got a Masai blanket to keep warm while opening presents.

Ruth Melelei and Beatrice Rop gave kongas (aprons) to the orthopedic wives, Mrs. Gaw, Mrs. Greene, and Heather, a very kind and generous gift.

Meshack and Ruth enjoying something new on Boxing Day.



The Wednesday before Christmas was a clinic day, but because of the huge number of admissions, and patients in the queue awaiting surgery, we, being orthopedically blessed with greater numbers at the moment, exercised the divide-and-conquer strategy, thinking that we could win the battle and catch up in time for a quiet Christmas day at Tenwek. Dr. Gaw, and the Kenyan surgical resident and intern hit the battle front head-on in clinic and saw about 80 patients, while Drs. Greene, Kiprono and I flanked the enemy in theater, getting 7 surgical cases done. As Dr. Kiprono and I were leaving around 6pm, satisfied with the day’s work (although with a sore ring finger), a nurse from Casualty ran into theater asking rather excitedly, “Are there any C-collars here?” Kiprono and I looked at each other thinking, “This cannot be good.”

We walked over to Casualty to find it flooded with patients, and the courtyard crowded with a myriad of anxious relatives and onlookers. “What happened?” I asked one of the Kenyan residents. “A mini-matatu (small van holding a maximum of 5 people) was carrying 14 passengers, and while going down a hill, the brakes went out,” he said. I looked over at one older man struggling to breathe, with his chest wall visibly moving out of sync with his breathing, a flail chest. The lady next to him had a deformed forearm and an obviously dislocated left hip, which Kiprono and I quickly reduced. Across the room was an elderly woman with a swollen distal thigh and a small wound over her knee with visible bone peering through. Her breathing was labored. As we went from patient to patient, I felt my anger at this seemingly senseless situation flaring. “Where are the police?” I said out loud, as if I was the only one original enough to pose this grand question that everyone was already wondering. “Here is the driver,” someone said. My first emotion was anger at this man for illegally stuffing so many people into the van, and then his transfer of guilt to the simple mechanical failure of brakes. But after seeing his obviously dislocated hip, femur fracture and open knee wound, the frustration subsided. “They were all on their way to a wedding,” someone said. After hearing that, I just felt tired. After finishing in theater around 10pm, as I walked out into the fresh air of the courtyard, I was met with wailing. My suspicion was confirmed as I was told the man with the flail chest had passed away.

The next day, Christmas Eve, was a new day. The theater staff was super-charged and motivated to clear the board so we could all go home early. By 1pm, starting with 4 rooms, we had cleared another 7 cases. As I arrived home, the kids were gearing up for a serious Christmas Eve Galat family celebration, the main course decided weeks earlier, a rarity at our house in Kenya: cold cut meat sandwiches (salami can run as high as 3200 shillings per kilo, or about 20 bucks per pound!). However, a phone call at 5:30pm threatened to spoil the festivities. “There is a mass casualty going on up in the ER,” the person said on the other line, “and all available doctors are needed now.” As I was putting on my shoes, Emma was obviously upset. “It’s not fair!” she said, “It’s Christmas Eve and we have plans!!” Any “wise” explanation at that moment wouldn’t have mattered, so I just smiled and said, “I’ll be home as soon as I can,” and walked outside into the rain.

A bus carrying many passengers had rolled off the slick road about 10 km from Bomet, and patients were beginning to arrive in Casualty, most of them with minor injuries, but one serious case already in theater. There, the general surgeons had a young man, about 18, on the table with a severely mangled right upper extremity, and a huge laceration of the face and scalp, both ears having been shaved off, the horrible result of being caught between moving bus and road. The only option was an amputation at the level of the shoulder. “He must have been going home for Christmas,” I thought to myself.

After finishing this case, I went back to Casualty, fully expecting to be met with several other orthopedic disasters. However, by some miracle, all the other injuries that arrived were minor, and unbelievably, no fractures! As I walked through the door of my home, just in time for the planned celebrations, Emma burst out with excitement saying, “Dad, God answered my prayers!!” As a family, we attended the Christmas Eve services at Tenwek, then went home and feasted on salami sandwiches, Doritos, Mountain Dew (a rarity in Kenya), and other delicacies, followed by the sharing of our gifts with one another. Emma “splurged” and got me three travel size bars of my favorite soap, Imperial Leather.

Christmas day was much quieter, and we greatly enjoyed having our Christmas meal, meatballs and lasagna, ham and scalloped potatoes, with the Crognales, a missionary family famed for making the best Italian food on the compound. The following day was “Boxing Day” in Kenya, a holiday I am still trying, in vain, to understand. Nonetheless, still a reason to get together and celebrate, so we had a mini orthopedic Kipegange (meaning “party” in Kipsigis), with Meshack, Solomon, and their families, and the Greenes and the Gaws. We wanted to introduce our Kenyan guests to ice cream cones, and Solomon and Beatrice could not understand why Dr. Gaw would be eating what they all thought was the “plastic holder” of the ice cream (i.e. the cone). We all laughed hard, and celebrated together the great things that God has done in and through the orthopedic department at Tenwek…all a result of the advent of Christ as a babe, and through His eventual sacrifice on the cross. The paradoxical mix of sorrow and joy, tragedy and triumph…Merry Christmas and Happy New Year from Tenwek.

Lessons from the Fatherless

Thanks to the newly-arrived group of Samaritan’s Purse post-residents who just so happen to have as much exuberance for Ultimate Frisbee as I do, and the “slightly” broken left ring finger that resulted from a highly-competitive mid-Sunday afternoon game, I have been forced to take some leave from surgery. This is now my third “major” injury (including a self-diagnosed cracked skull, and a severely rolled ankle) resulting from this innocent-appearing, yet potentially dangerous game (I know what some of you are thinking). True, it is not rugby, or American football, but nonetheless, can be considered a contact sport in the right circles. Thankfully, our orthopedic department is currently expertly covered with Drs. Greene, Gaw and Kiprono, and being Christmas week, although realizing that my aging body is not 25 anymore, the timing was at least ideal. All things work together for good...

As a result, I was able to travel with our family and a group from Tenwek to Mosop Orphanage, one of the facilities supported by WGM, for the annual Christmas “party” with the children who live there (an event I missed last year). After playing many games, we heard the kids sing and recite bible verses, shared some ndazis (fried donuts) and just loved on them a while. When I spend time with these children, who have so little in terms of earthly possessions and relationships, yet seem so content and happy, I am struck by my own discontent. And I am reminded, especially at this Advent Season, that through Christ, we are “adopted” into God’s family, through faith in the work of His Son on the cross. Please keep these children in your prayers, that they would experience God as their true father, and that they would be blessed this Christmas season. Thank you for all your prayers and support!!

But you, O God, do see trouble and grief; you consider it to take it in hand…. you are the helper of the fatherless. Psalm 10:14

Seek justice, encourage the oppressed. Defend the cause of the fatherless, plead the case of the widow. Isaiah 1:17

The Future of Tenwek

Dr. Kiprono, a hard working orthopedic machine...


Stephen and our favorite patient on the female surgical ward. In Kipsipis, she calls Stephen her grandson, and me, her son-in-law?!

Laughter makes long days shorter...

"Thumbs down" for this unfortunate patient with a massive open knee fracture, another victim of the barrage of Bajaj motorcycle taxi accidents.

This past week, the Galat family celebrated our first year anniversary at Tenwek hospital, and as we went around the table thanking God for the incredible ways he has worked in the past year, my mind wandered back to those tumultuous first few weeks in Kenya, getting settled in a new culture, the new sights, smells…and challenges. I still have the original hand written list of 30+ orthopedic patients handed off to me within 5 minutes of arrival at Tenwek (I thank God I will never have to repeat that initiation!).

When I started in orthopedic surgery at Tenwek last year, it was me and one Kenyan female intern, who obviously was extremely disinterested in orthopedics, having rather been with the little babies in the NICU. Solomon, our chief physiotherapist, and Meshack, our head orthopedic nurse (both critical to our work at Tenwek) were inconveniently on annual leave when I arrived. After a few weeks of pounding (December is the “high season” for orthopedic injuries…Christmas bonuses + time to burn + alcohol - Jesus = Trauma), I found myself thinking, well beyond my comfort zone, “There is NO way I will survive here.” Thankfully, God promises never to give more than we can handle…Solomon and Meshack eventually returned from leave, and various orthopedic surgeon visitors began to arrive (at just the right time) to help with the workload. Then, in April 2009, more quickly than I had envisioned, Tenwek began as a training site for Kenyan orthopedic residents from Moi University in Eldoret.

Dr. Geoffry Kiprono, our most recent visiting resident from Moi, arrived in early November. Kiprono is one of 16 children of his still-living 90+ year-old father (who incidentally practiced polygamy, Kiprono’s mother being the “less favored wife”), and grew up with nothing. However, determined to succeed, he worked hard, and was eventually accepted to medical school. Kiprono first arrived at Tenwek in 2003 as an intern, and being Kipsigis (the most populous tribe in this area), was happily posted to Tenwek as a Medical Officer (MO), in which capacity he worked for 4 additional years. While working as an MO, he was exposed to orthopedics working with Dr. Mike Chupp and other visitors from the U.S., and knew this was his calling. Thus, in the fall of 2008, he began his 4 year orthopedic training residency at Moi, and being sponsored by Tenwek (residents actually have to pay for their training, unlike in the US), will eventually return as a full-time consultant once fully trained. Kiprono is the future of Tenwek…

God has provided exceedingly and abundantly more than I could have imagined over this past year: a highly organized, hard-working, and committed orthopedic surgical team with solid implant selection, a dedicated physiotherapy department, Stephen as our full-time orthopedic RN, various and multiple orthopedic visitors who commit time and energy to Tenwek, a strong teaching program including visiting medical students from Kenya and the U.S., Kenyan interns, residents, and the external rotation for Kenyan orthopedic residents from Moi, all working together as a team to provide our patients with (1) the best possible orthopedic care and (2) the good news of Jesus Christ, Hope for this world. God has done ALL this, and He deserves the praise and glory!

I will make rivers flow on barren heights, and springs within the valleys. I will turn the desert into pools of water, and the parched ground into springs.
I will put in the desert the cedar and the acacia, the myrtle and the olive. I will set pines in the wasteland, the fir and the cypress together,
so that people may see and know, may consider and understand, that the hand of the LORD has done this, that the Holy One of Israel has created it.
Isaiah 41:18-20

When I am Weak…

Most of the time, I have a lingering sense of my own weakness in this task of orthopedic surgery at Tenwek hospital. The relentless patient load with complex orthopedic problems, coupled with the responsibility of resident training, staff management, and equipment organization combine to often make me wonder, “What on earth am I doing here?” Sometimes, I feel this sense of weakness more acutely.

After a particularly difficult week, I made my way up for Sunday after-church rounds, which are intentionally more leisurely, taking a little extra time to minister to our patients’ spiritual needs, especially by praying with them. This Sunday, however, as I was feeling a little more self-focused and spent than usual, I was determined to do “lightning rounds,” i.e. to get home as fast as I could, so I could do my own thing. Of course, God, in His sovereignty, often has less selfish plans in store for us.

A man was admitted the night before with a femur fracture. As I looked at the x-rays, the multiple lesions peppered throughout his bones belied the cause of the fracture: multiple myeloma in very advanced stages. I knew his days were severely numbered, and as I explained his condition, I sensed God urging me to go further, although this was beginning to cut into my own plans. “Do you know Jesus,” I asked, a valid question in this part of Kenya, because of the candidly honest answers usually obtained. “No,” he said quietly in Kipsigis. “Would you like to?” I returned. “Please.”

There, in the ward, on an early Sunday afternoon, in front of several other patients, this man, for the first time in 70+ years of life, admitted his need for a Savior and gave his remaining days to his Creator. What happened next humbled me greatly, and reminded me that this is God’s business. Several of the young men with tibia and femur fractures called out, “Please pray with me too!” One man named Peter, about the same age as me, also married with four children, asked for a bible in the Luo language. Peter had been admitted the previous week for complications of a femur fracture fixed at another hospital. Being HIV+ (with a weakened immune system) does not mix well with fractures fixed nominally at ill-equipped, and often very unsanitary, hospitals. After lying in that hospital for three months, he begged to be transferred elsewhere, and he was finally released. He traveled directly to Tenwek, and was admitted with pus pouring out of his thigh. We did what we could, removing the infected hardware and dead bone, and stabilizing the fracture with an external fixator. I promised Peter that I would ask one of the chaplains for a Luo bible for him on Monday.

Of course, Monday came and went, the busyness of the surgical schedule causing me to forget about the bible. On Tuesday, Peter kindly reminded me with his big smile that he had not received his promised bible yet. This time I would not forget, I told myself. I did. Thankfully, God’s sovereignty is greater than my male compartmentalism, and on my way to the choo (bathroom), on a normally untraveled route, I ran into Helen, one of the head chaplains. I told her about Peter, and she then promised she would get the bible for him.

On Wednesday, our busy clinic day, I walked to the wards to check an x-ray, and heard a voice from one of the benches outside where our patients “bask” in the sun, soaking up vitamin D, an essential vitamin for healing bone. “Daktari,” Peter called excitedly, “I got my bible!” I was in a hurry and didn’t feel like talking much. “That’s great…are you reading it!?” I called back. “Yes, and I want to know Jesus!” I stopped there, again humbled by my own inadequacies and God’s far greater and perfectly sovereign plan. I slowly walked over, sat down next to him, and there prayed with him to receive Christ as his Savior.

While orthopedic surgery is my primary “function” at Tenwek, my ultimate purpose for being here is to share that Jesus is the greatest treasure our hearts could desire. What is paradoxical and sometimes incomprehensible, however, is the fact that God chooses to do this work through people who are weak, broken, and selfish, ourselves sinners in need of God’s grace. The reason for this is summed up perfectly by the apostle Paul, who referred to himself as “the chief of all sinners,” when he said to the Corinthians that “we have this treasure (Jesus) in jars of clay (broken vessels) to show that this all-surpassing power is from God and not from us.” In the end, the glory goes where it must.

Not to us, O LORD, not to us but to your name be the glory, because of your love and faithfulness. Psalm 115:1

But he said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me…For when I am weak, then I am strong. 2 Cor. 12:9-10

Images from Tenwek

"The Mystery of History" at Tenwek. All the children dressed up as their favorite character in history and went from house to house, each set up as a different time period in history, and to get a "treat". Jeremiah was a Spartan Soldier, Emma a gypsy, Claire a Grecian princess, and Levi, Cupid.

Emma is growing up!

Cupid getting ready to shoot his "love arrows."

Justice vs. Mercy

Stolen cell phone in the underpants igniting an extreme case of "mob justice."


The end result of an argument gone very bad.

This morning, on rounds, I was handed a crisp, new “orthopedic service list” by one of the Kenyan medical students, an invaluable tool for tracking our many patients scattered throughout the hospital. The List, kept by our hard-working interns and medical students, includes patient names, injuries and treatment plans. As I quickly scanned the list for any new overnight admissions, one patient distinctly caught my eye: Peter Kipkirui, mob justice victim. The patient had multiple injuries inflicted by blows and pangas (machetes) as a result of vigilante justice, meted out by a group of angry Kenyans. “He must have done something pretty bad,” I thought to myself. I asked the two medical students, Mercy and Justus (no joke), what he had done and they showed me a pelvic x-ray demonstrating what they thought was the reason for this swift punishment. A cell phone that the patient had stolen, and stuffed into his underpants, on x-ray, appeared as a rectangular, outlined skeleton of wires and chips. Later, I was called to the operating room to see a patient who was the victim of another kind of “justice” that unfortunately results from the simple equation: liquor + argument + sharp instrument = severe injuries. The man had the most impressive hand panga cut I have ever seen.

To be honest, as a surgeon dealing daily with injuries caused, in some way, by foolishness, carelessness, jealousy, anger, neglect, greed, etc. (essentially sin), I am tempted to lose compassion, and think, in my heart, “they get what they deserve.” Then, I am quickly disciplined by God as he reminds me of the incredible Grace that was given me, i.e. my sins paid for by the blood of his own Son. It’s a good thing I don’t get what I deserve. All of us receive one of two perfect options: justice or mercy. Either we receive just punishment for our sins…or mercy, embodied in the person of Jesus Christ as we come to Him in faith. The Newsboys sing a song with simple, yet profound lyrics: “When we don’t get what we deserve; it’s a real good thing…when we get what we don’t deserve; it’s a real good thing.”

Eph. 2:4-5 But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions--it is by grace you have been saved.

Behind the Scenes

Meshack, our outstanding orthopedic charge nurse, was notably happy at the amount of implants donated, in total, two pallets of equipment weighing 800 lbs. The man in the red jacket is a hospital chaplain who kept asking, shocked, "You put those big metal pieces inside someone's body?"


Meshack spent two days organizing and inventorying the donation in the orthopedic storeroom.

Brand new Zimmer ITST (Inter-Troch, Sub-Troch) femoral nailing instrument set.

First patient to receive the ITST nail for a proximal femur fracture. The nail is inserted through two incisions each measuring about 2 cm in length.

Post-op x-ray of ITST nail.

Recently, the Tenwek Orthopedic Department received a huge donation of orthopedic implants, sent by a group called Hope Force International. Several folks from different areas of the country rendezvoused in Memphis, Tennessee to pack two pallets of a board assortment of supplies: nails, screws, plates (in total 800 lbs of equipment!), to be used for the orthopedic care of the people in this poor region of Kenya. Amazingly, Fed-Ex air freighted the pallets free of charge (even upgraded to “express service”), thus the total time from leaving the US to arriving at Tenwek was only 8 days…and there were no issues with customs. Just yesterday, we used one of the nails, the Zimmer ITST (Inter-Troch, Sub-Troch), for an elderly woman with a fracture of her femur caused by an erosive metastasis of cancer. Although this will not cure her disease, now that the fracture is stabilized, she will be able to move without pain.

As I reflect on the incredible generosity of not just Hope Force, but the many other companies and individuals who have donated time, resources, and personal finances to supply Tenwek with implants, so essential to the practice of orthopedic surgery, and the care of our patients, I am humbled and thankful. I think of the SIGN nail company, whose sole mission is to manufacture low cost implants for the poor in developing countries…I think of an individual who bought a set of plates for Tenwek with his own finances…I think of a sales representative from an implant company who gathered and shipped screws and plates on his own time and dime…I think of a group of students from Cedarville College and their mentors who are designing a new nail to be used at Tenwek …and there are many, many others.

Together, these people and groups are serving faithfully in the way God has called, all of great significance to the work here in Kenya. It is a challenge for me to be a good steward of God’s provisions for Tenwek, and for all of us to ask, “God, what would you have me do today?” The majority of times, the work God calls us to goes “unnoticed” by the world, and the results of which may never be realized to the fullest extent in this lifetime (much like the Heroes of the Faith from Hebrews 11). But, faith in this matter is key, believing that God has a grand, sovereign plan for the redemption of mankind, yet somehow, paradoxically, God uses our small acts of obedience to His call, behind the scenes, to bring glory to his Name, and advance His kingdom.

Hebrews 11:1 Now faith is being sure of what we hope for and certain of what we do not see.

The Simple Life

Jeremiah, Jamie and Peter hanging out at the newly erected campsite.

Drinking coffee by the mud brick fire pit.

Jeremiah pouring a freshly brewed, and very stout, cup of cowboy coffee, a skill he learned from Grandpa Kinkel.

Remnants of a night of big fun...

Over the past week, Jeremiah has been uncharacteristically efficient with finishing his homeschooling assignments. As soon as Latin, literature, Algebra, and history are finished, he is gone…for several hours. “What is he up to?” I asked myself, and, knowing Jeremiah, I figured it involved something related to digging, chopping, cutting and fire. He would show up for dinner covered with sweat and dirt, smelling like a 12 year old + boy, but with a very contented look on his face.

Yesterday, the mystery was revealed, as Jeremiah invited me to see the campsite that he, Jamie and Peter had been diligently working on for days, tucked in a secluded area, what appeared to be a remnant of the high altitude rain forest that used to cover this area. Entering through the back, and going down dirt steps meticulously fashioned, was the fort, a small clearing created by pangas, with a lush canopy, a mud brick fire pit, and a leveled dirt area for sleeping.

When Jeremiah asked if they could sleep in the fort that night, the answer was easy. “Just be careful,” I said as he was gathering supplies: a bucket of Cokes, two onions for roasting in the fire, a package of marshmallows, a bag of Farmer’s Choice sausages (advertized proudly to be at least 62% meat), a panga, OFF!, and materials for making torches (the OFF! was not for repelling insects). I told Heather that the combination of pre-adolescent angst plus indigestion would guarantee about two hours of sleep for the boys.

This morning, I carried fixings for “cowboy coffee” to the fort for the boys…I figured they would need it. Jeremiah had already fried eggs over the fire, and the site was strewn with the remnants of last night’s events. Jamie was finishing off the last of the hideous sausages, and they all smelled like the open pit fire.

As I walked back home, I recalled the worry I had when we first arrived in Kenya, that our children would, in some way, suffer as a result of being here, not having the same opportunities available to kids in the States. And, there are missed opportunities for our children…piano lessons for Claire, violin lessons for Emma, football for Jeremiah, and, more importantly, missed family events with cousins, aunts, uncles, grandparents. But, we have seen God provide for our children in ways far beyond what we think they need, or what we could even provide. Now, we see the incredible blessing of raising kids in a simpler environment such as this. Without TV, soccer practice, McDonalds, school events, (and, for the first three months even, a vehicle), the kids finally have time to be kids, to use their minds, to create, to explore, and just have fun. Sometimes the things we think we so desperately need actually hinder that which our hearts truly desire. The simple life at Tenwek…not so bad after all.

God’s Timing: Lessons in Answered Prayer

"Spine week" at Tenwek. This patient had bilateral jumped facets at C5-6 and was treated with a posterior spinal fusion. Needless to say, a significant amount of reading (and prayer) went into this case.

"Spine week" continued...This man had a compression fracture at L1, treated with a posterior spinal instrumented fusion T12- L2.

Saturday morning relaxation in mom and dad's bed...

Solomon, our outstanding physiotherapist, with a spine patient sporting a newly applied halo.

The Monacle Man...this patient used a 1/2 pair of glasses, turned upside down, as his monacle to see. Stephen's parents glady provided the 250 shillings (3 bucks) to buy him a brand new pair of Ray Bans.



As a male with a certain amount of pride, it is hard to admit when I need help. About three weeks ago, overloaded with cases, and just plain physically exhausted, I finally admitted to Heather that I cannot continue at this pace alone. She came up with a rather simple solution. “Why don’t we ask God to provide another orthopedic visitor,” she asked. Admittedly skeptical that God would answer as quickly as I needed, we, as a family, began to pray.

About five days later, Russ White, the medical superintendent at Tenwek, approached me in theater. The previous weekend, he had been at the Rift Valley Academy, a boarding school located on the grounds of Kijabe mission hospital, just outside of Nairobi. While there, he had a “chance meeting” with an orthopedic surgeon who had been visiting at Kijabe hospital for about a month. When Russ asked how it was going, the surgeon said, “Fine, but I don’t feel very needed here…there are already 12 orthopedic surgeons at Kijabe!” Russ, as the quintessential recruiter, challenged him to come to Tenwek, where there would be no question about needed-ness. In short, in less than two weeks after we began to pray for another orthopod, Dr. Bob Greene arrived at Tenwek, and he will be here for the next 6 months!!

God’s timing is perfect. Many times, however, unwilling to wait on God to work or provide, I have formed my own plan, gone my own way, and, as a result, missed God’s best, or sometimes suffered undesirable consequences. Thankfully, this time, resisting the temptation to quit, although feeling spent, God gave us the patience to wait, and he provided miraculously, and far more quickly than I believed he was willing or able. Walking home from the hospital today at an early 5pm, I noticed a lighter step…I wasn’t feeling exhausted or angry or overwhelmed.

I am reminded of the verse from Jeremiah 2:13: "My people have committed two sins: They have forsaken me, the spring of living water, and have dug their own cisterns, broken cisterns that cannot hold water.” When we “dig our own cisterns,” they crack, leak, and never maintain the level that we need. We wonder why we feel unfulfilled, stressed, burdened, etc. Why do we feel compelled to forsake our God, who is able to provide in ways far more perfect and complete, fulfilling that which our souls really desire? The simple answer is pride…fear…anxiety…_______. However, when we wait on “the spring of living water,” the result is far beyond anything we are able to provide for ourselves.

Motorcycle Taxi for Hire

Waiting for customers...

Rigtht leg of 14 year old boy struck by a motorcycle taxi with open femur and tibia fractures.

Over the past few months, we have noticed a huge increase in the orthopedic trauma volume at Tenwek hospital, and now our current census has over 35 patients scattered throughout the hospital (even on the eye ward), making morning rounds a bit of a challenge. I find myself asking questions like, “Where did the patient with the bilateral open tibia fractures go?” and wondering when we will ever catch up. Daily surgery is just an attempt to keep up with the load of cases that continue to pile in, praying that God helps us do our best with each patient that He sovereignly brings to Tenwek. Currently there are 14 patients in the queue needing surgery.

All around Tenwek and the nearby village of Bomet, are what seems like hundreds of new motorcycles, all the same brand, all the same maroon color. To help distinguish one from another, drivers cover the gas tanks with decals that vary from “the mother Mary,” to a “skull and crossbones” (very apropos). Cost of a brand new Bajaj Boxer 5 motorcycle (hot off the production line in India) is a cool 85,000 Kenyan shillings (about 1,100 USD). “How can so many people afford a brand new motorcycle (more than two years average salary in this part of Kenya), and where are they all coming from?” I wondered to myself. What was clear, however, was the fact that the increase in trauma is most definitely related to an increase in motorcycle accidents.

A patient arrived in the early evening last week with an open tibia fracture, wound full of dirt and other debris, the result of…a motorcycle accident. While performing the initial “washout” surgery to clean the open wound, I decided to get to the bottom of this mystery. We use spinal anesthesia almost exclusively for lower extremity surgery, thus our patients are awake during surgery, and often very chatty. I asked him how the accident occurred, and he explained that he is a motorcycle taxi driver, and while carrying a passenger, after passing a large truck, looked over his shoulder at an interesting scene, and…(the stories are all too similar). Getting more personal, I decided to ask where he got his brand new motorcycle, and how much it cost. “About 500 shillings,” he said (i.e. $7). Puzzled, I probed further, “500 Shillings?” “Yes,” he answered, “for 500 shillings per day I can rent a brand new motorcycle, and whatever I make over that I keep for myself.”

A flurry of questions went through my head, as well as a sense of anger and injustice for all the passengers who have gotten injured or killed as a result of untrained, uneducated, and often irresponsible, motorcycle taxi drivers who can rent a motorcycle for almost nothing and, in a millisecond, change their lives or their passenger’s lives forever. “Who then is the real entrepreneurial kingpin behind this phenomenon?” “Where are the regulations?” “Is this really true or is this just one person’s story?” Just today, we cared for a 14 year old boy who was struck from behind by a motorcycle while walking down the road, with open femur and tibia fractures. His life will never be the same.

As we were pulling out of Tenwek to pick up Stephen’s parents in Nairobi, we noticed all the motorcycle taxis coming and going, all Bajaj and all maroon. One man came flying around the corner (faster speeds = more money) with three, young school aged girls on the back (more passengers = more money). After almost running into our van, he stopped directly next to me, and I noticed one girl handing him 100 shillings. I looked directly at him, and with more frustration than I would have liked, I said firmly, “you need to SLOW DOWN!!”

Trauma in developing countries is becoming a worldwide healthcare crisis, on par, or now, even more important than AIDS or tuberculosis. When a young man or women trying to earn a living for their families gets a life-altering injury, the entire family can be thrown into poverty and chaos. We see it every day at Tenwek. Please pray that God would intervene to bring this important issue to the forefront of our leaders, that the subject it would get due attention, and that real change would be implemented.

Proverbs 13:23 “A poor man's field may produce abundant food, but injustice sweeps it away.”

Something More to Offer

17 year old girl with gun shot wound to right elbow.

Trying to close my bag after a random inspection...I warned them (by experience).

Samson, Emma, and Ema, chillin' on the front porch.

After having flown over 18,000 miles (and six flight segments) to attend the four day SIGN conference in Richland, WA, I finally arrived home at Tenwek last night. The highlights of this long journey (but quick trip) were interacting with the hundreds of international SIGN surgeons, presenting the orthopedic work at Tenwek at the conference, spending time with my Galat cousins and the Pavkov’s (who happen to live in Richland), watching two agents try (in vain) to re-zip one of my bags after inspecting it…and, of course, coming home to my family. The low points were the flight from Amsterdam to Seattle…I sat next to a young girl who I think had swine flu…the flight from Seattle to Amsterdam (déjà vu), and laying awake all last night, trying to solve the world’s problems, still on West Coast time, awaiting a new and exciting day in clinic.

Thankfully, today was a “light” day in clinic…only 60 patients, but again with the “box of chocolate” motif in full throttle. One patient, in particular, was exceptionally challenging, the last patient of the day, a 17 year old girl with a completely deformed elbow from a random gun shot during Kenya’s post-election violence last year. As I examined this young girl’s hand, muscles wasted from the ulnar nerve which had been blown away by the bullet, I thought to myself, “there is nothing I can offer her.” Then, as clearly as day, as if to usurp the lie that just traversed my thoughts (and likely influenced by the fact that I was sleep deprived at that moment), I heard another inaudible voice that said, “How untrue…you have something more to offer.” God’s simple rebuke was loud and clear, and I felt ashamed of my humanism and plain lack of faith, but paradoxically, simultaneously strengthened, at that moment, to give what was needed.

After explaining the grim prognosis, I offered to pray with the girl and her family and they eagerly accepted. I thanked God that the bullet was not one foot to the right (potentially hitting her chest), and for the fact that she miraculously had limited, but pain-free and functional range of motion. Then, I asked God simply to heal her for His sake, and Christ’s glory, and after saying “amen,” I noticed the tears in her eyes. That “something more” was, at that moment, exactly what she needed.

As I walked home, I thanked God for taking me to the “woodshed,” and the reminder of my real reason for being at Tenwek…not just to operate, but to be an agent of healing, both physical and spiritual. What is the “something more” that you can offer those God sovereignly brings into your life? Where can you step out in faith, beyond yourself, to be what God has called you to be, for the sake of others, and for His glory? Let us encourage each other in this and consider the words of the apostle Paul as he wrote about his trials to the Corinthians:

All this is for your benefit, so that the grace that is reaching more and more people may cause thanksgiving to overflow to the glory of God. Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal.

Veterinary Surgery, Corn Rows and Other Miscellaneous News

Sarah, Claire and Emma, after having their hair braided into corn rows, a process which took literally 5 hours.

Samson, post-neutering, drugged up with valium and ketamine (a medication similar to "angel dust"). He never knew what hit him!

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Last month, we have had our new niece-in-law, Sarah, and her mom, Cindy visiting at Tenwek, and it was such a great time. Cindy is a CRNA (nurse anesthetist) in Ohio, and when we met at Sarah and Alex’s wedding last November, and she heard about the needs at Tenwek, she committed to come. And with Alex being on tour in Afghanistan for 6 weeks, the timing was perfect.

Cindy’s flight home coincided perfectly with a trip into Nairobi to continue our ordeal trying to finalize our work permits. We always hope that going to Nairobi will offer a few days of needed R&R, but it usually turns out to be almost as busy as our days at Tenwek. Thursday was spent at the Immigration Department (appropriately called by WGM staff the “house of pain and suffering”) in the morning, and then shopping for two months of groceries in the afternoon. The whole day Friday was spent at a non-profit organization in Nairobi which had medical supplies to donate to Tenwek, including 50 walkers, 20 brand new wheelchairs, and two huge boxes of men’s thong underwear??? (which I graciously turned down for some more “needy” organization). Saturday, we made the dusty trek back to Tenwek, and found 12 new patients admitted for surgery.

Last weekend was filled with diversion and excitement as our new dog Samson had “surgery,” as per Claire, “to turn him into a girl” (i.e. neutering). The surgery was a success even though it was done by a bone doctor (guided by a visiting veterinarian)! Sammy continues to grow as he devours everything we feed him.

Next week, I leave for a quick, one week trip back to the states for the SIGN conference in Richland, WA (thanks to the Coventry Award which I received from the Mayo Clinic when I graduated last year). I was asked to give a presentation on the SIGN nail experience at Tenwek hospital, which will also indirectly raise awareness of the work God is doing here. Please pray for “divine appointments” with the many people who will be at the conference, for the kind Dr. Glen Rowe who will be covering the ortho department while I am gone, and for Heather and the kids. Thanks for all the support and prayers you provide for our family here at Tenwek. We appreciate you all so much!

Little Black Book

The Little Black Book, a log of all orthopedic surgical cases at Tenwek.

A two year old boy with rhabdomyosarcoma of the hand: one of the sad cases in the book.

An example of "MacGyver orthopedics." A periprosthetic femur fracture fixed with a long plate, screws hand-cut to length and cerclage wires.

The book also contains more conventional cases such as this ulnar shortening for ulnar impaction syndrome.



For those who are familiar with John Piper, one of his books succinctly entitled “Don’t Waste Your Life” is a personal favorite. When we left for Kenya eight months ago, Heather’s parents gave us several items they purchased from John Piper’s Desiring God Conference, including the “Don’t Waste Your Life Field Journal,” a little black book intended for…journaling. I use mine to catalogue all the surgical cases I do here at Tenwek, and the daily reminder to “not waste my life” helps keep the daily challenges in perspective. So far I have filled one book and am now on my second. I lost count at 300 about halfway through the first book.

Most other medical specialties allow for board certification of physicians while doing full-time missions: OB-Gyn, General Surgery, Family Practice, etc. However, this is not the case with orthopedic surgery. The American Board of Orthopedic Surgery bylaws currently state that it is a requirement for prospective fellows to work in the United States for two years before allowing them to sit for the oral boards. Thus, although I passed the written boards last summer, as it currently stands, I cannot be fully board certified working as a busy orthopedic medical missionary in Africa.

However, I also believe God is able to do a miracle, and that is the reason I am keeping my “little black book” of Tenwek cases, in the hopes that some day, the policy may change, and I may be able to sit for my oral boards with cases that I have done while following the call of God here in Kenya. The book is not perfect, including a “few” cases treated in ways non-conventional, what I like to call “MacGyver orthopedics” (the show from the late 80s/early 90 in which MacGyver could create anything out of the most elementary supplies). We do what we can with what we have. On the other hand, we are very blessed at Tenwek to have, what I have been told, the best orthopedic inventory in Kenya, thanks to our friends in the US who are so faithful, behind the scenes, working to secure supplies for Tenwek.

How our culture defines a successful life (i.e. wealth, power, status, education ) may actually be a wasted life. On the other hand, what is viewed as a “wasted life” may actually be the most fulfilling, meaningful, and eternal. Paradoxically, in God’s economy, the path to a life not wasted is by the very act of losing it. The challenge is for me, you, all of us. Thankfully, I have a daily reminder of this every time I write a case in my little black book. Let us encourage each other to not waste our lives.

Matt. 16:25-28 Then Jesus said to his disciples, "If anyone would come after me, he must deny himself and take up his cross and follow me. For whoever wants to save his life will lose it, but whoever loses his life for me will find it. What good will it be for a man if he gains the whole world, yet forfeits his soul? Or what can a man give in exchange for his soul? For the Son of Man is going to come in his Father's glory with his angels, and then he will reward each person according to what he has done.

Harvest Time

Kenya, being a climate which I would classify as “perpetual springtime in Ohio,” enjoys a year round growing season. And although July is the peak of summer fun in the Midwest, in Kenya, it is actually the “coldest” month, with highs in the upper 60s and lows in the upper 40s. Thus, this is the time of year for harvesting maize. And, after a busy week of moving into our new “temporary” housing, and a caseload of almost thirty surgeries, what better way to relax and spend a free Saturday than harvesting maize?

Maize is a critical crop for Kenya, because it supplies the brunt of the caloric energy for daily living in rural Africa in the form of a pasty, tasteless starch called “ugali.” Maize (or corn) is planted, harvested, dried, and ground into a fine meal, then boiled in water, without salt, until it becomes a firm, starchy mass of pure carbohydrates, and the perfect accompaniment for every Kenyan meal. After tasting ugali and out of curiosity, I have asked many Kenyans what, in their opinion, is so special about ugali. Answers vary, but the common underlying thread is that “ugali fills the belly.”

So when Peter Ronoh, our outstanding maintenance man, invited us to his “chamba” (farm) to harvest maize, we were honored. Sarah Galat (our new niece-in-law) and her mother Cindy (a nurse anesthetist), who are currently visiting from Ohio, came as well, and we all had a ball, hand picking and shucking corn and tossing the ears into large piles. It was actually therapeutic, and downright fun. Afterwards, we all enjoyed a cup of hot chai with a large scoop of sugar.

Two thoughts went through my head as I was working in the field. First is the scripture from Matthew 9:37-8: "The harvest is plentiful but the workers are few. Ask the Lord of the harvest, therefore, to send out workers into his harvest field." In addition to our family, about 20 or so of Peter’s neighbors came to help harvest his maize, out of their own free will, without even being asked, or expecting anything in return. They just showed up. With all the help, in less than three hours, almost an entire acre of corn had been handpicked, the job complete. The spiritual harvest is not so, however. According to Jesus, the harvest is plentiful but the laborers are few. If more were willing to just “show up,” would the spiritual work be done?

Second, I asked Peter what he was going to do with all this harvested maize (incidentally a “bumper crop”). “Are you going to sell it?” I asked, in my mind, thinking what the income could buy: schooling for his kids, an addition onto his miniscule two room house, maybe a new dress for his wife, or a few other luxury items. “I would,” Peter answered, “but I get afraid of my kids going hungry if I don’t save enough.” How many of us actually worry that we won’t have enough to eat, even with the downturn of the economy? Incredibly humbling words as we drove back to Tenwek, and prepared a supper of BBQ beef sandwiches for a visiting work team. No room for plain old, bland ugali in our house...

Thanks for your recent prayers and email encouragements. We really depend on your support of the work here at Tenwek. Please let us know how we can be praying for you as well. And please keep Alex (our nephew, and Sarah’s husband) in your prayers, as he is on tour with the Air National Guard in Afghanistan for the next six weeks.