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

Friday, May 22, 2009

Holistic Ministry: Long term at Tenwek


Gently used lead aprons recently donated to the orthopedic department.

Chronically dislocated ankle...a challenge to reduce.


Dr. Kisorio and Josh Carter, performing a tibial SIGN nail.


Jeremiah's favorite Jackson's Chameleon appropriately named Feisty.


Prior to medical school, Heather and I spent two years in the Chicago suburb of Deerfield, where I attended Trinity Evangelical Divinity School. While I started with the idea that I would pursue a degree which would prepare me to be a pastor, the end result was far from expected. Through a series of sovereign events, including Heather landing a sweet job in the Missions Department, God resurrected a past dream I thought was long dead (medicine) and combined it with a present calling (missions) to provide a new hybrid vision: Medical Missions. As a culmination of the education at Trinity, I was required to write a final integration paper which I entitled “Holistic Ministry and Medical Missions.” The main premise was that ministry which was most effective was not only “incarnational” but also “holistic” in nature, that is, meeting the needs of the whole person: physical, emotional, cultural, and especially spiritual. Medicine provides a unique opportunity to minister to the physical needs of people, especially the poor, as Jesus has great compassion on, and healed, the sick and needy. But his message never stopped there, the healing serving as a segue to the true need of all people: spiritual healing.

The patients who come to Tenwek for orthopedic care are varied: male, female, young, old…some with acute injuries, others with chronic…some with injuries secondary to foolish decisions, others injured by no fault of their own. The common denominator however, regardless of the etiology, is a need for physical help, which Tenwek is thankfully equipped orthopedically to provide. Thus, our days are spent fixing what is physically broken, using plates, screws, rods, pins, saws, cement, etc. I would not say, however, that this is our primary reason for existence at Tenwek. Although the fixing of broken bodies is of inherent value, if the spiritual needs of the patients are not being addressed, then all we do is merely humanitarian in nature. Rather, we have the opportunity, and responsibility, and privilege to ask patients if they know Jesus, if we can pray for them, or meet their spiritual needs in some other way.

Being at Tenwek provides the opportunity for wide variety of ministry opportunities, and allows us as a family to fulfill the calling of holistic, incarnational ministry. While our work is primarily medical, we are also able to communicate the gospel, teach, preach, lead worship, disciple, and minister to the needs of the poor. I had mentioned a few blogs back that we were praying about God’s plan for our family long term at Tenwek. While the last six months have been full of many challenges, both Heather and I feel that we are to remain and continue at Tenwek beyond the two-year commitment with Samaritan’s Purse. Committing to stay long term presents us with many other new challenges (transitioning to a new mission agency, building a house, etc.) for which we would greatly appreciate your prayers. But, we feel that God has sovereignly and very clearly opened the door for us to be here at this point and time, and we have the responsibility to stay until it is just as clear that we are to be elsewhere. At Trinity, we made the commitment to pursue medical missions full-time as long as God directs, and as he continues, so we will remain. Thank you for all your encouragement and support over the last several months. We appreciate you so much!!

Friday, May 15, 2009

Six months at Tenwek: Highs and Lows


The sole cause of chronic neck pain in Africa.

Heather, Anna and Bryan.

Dr. Kisorio and Stephen with studious patient who daily reads the newspaper.



"Positive Kisii sign."


A daily reminder that without God there is no way....

Humor is often a healthy means of dealing with daily stress and this is certainly the case for me here at Tenwek. Sometimes you just have to laugh, and as a missionary, this is most often at yourself. One thing I find amusing are the various signs I see erected around Tenwek hospital. Our newest sign, which is posted just beyond the back entrance to the hospital, greets me every morning. It simply reads “No way.” I understand the intended meaning which is “please do not walk on the grass…stay on the sidewalk.” But instead it taunts me daily, simple writing on a wooden placard, reminding me that there is no way I can continue to serve the relentless onslaught of orthopedic patients at the hospital…no way except by the certain grace of God, who continues to provide strength, wisdom, and refreshment at just the right time. I can do everything through him who gives me strength. Phil. 4:13. Another sign was recently posted adjacent to a broken floor drain directly outside my operating room, in order to protect people from stepping into the small opening. It read “Warning. A hole ahead.” I chuckled to myself, wondering if they where referring to me, or to the actual drain hole.

We have now been here six months at Tenwek, and what has amazed me is variability of emotion which has been experienced, by both Heather and me. The spectrum is wide, with the highs high and the lows low. Certainly the biggest joy has been the fulfillment of the calling that God gave us over 17 years ago. Although there were rough patches along the way that threatened to derail the plan, God, by his sovereignty, remained faithful, and brought us here, despite ourselves. This calling encourages us to persevere and continue, even when we feel completely depleted. The orthopedic department is such that when you think the workload is managed, another four highly complex patients from Kisii District Hospital are admitted. Our most recent patient from Kisii was a 19 year old boy with a “floating knee” (both femur and tibia fractures on the same leg). Normally this is not difficult to treat, one incision in the knee with rods in both the femur and tibia. However, the “positive Kisii sign” (as Josh Carter, a medical student/soon to be orthopedic resident visiting from the states coined) was the fact that the tibia fracture was open, two months old, with a 10 cm segment of exposed, dead, infected, putrid bone. Another man recently admitted at Tenwek suffered bilateral femur fractures over a month ago. After lying in skin traction at Kisii hospital for more than a month, he discharged himself, and headed straight for Tenwek. The irony is that the medical officer made him sign a form that he was being discharged “AMA” which stands for “against medical advice.”
God provides continually. In April, Dr. Kisorio, our first visiting Kenyan orthopedic resident from Moi University arrived, and he has been a great partner and helpful colleague with skills well beyond his years of training. Additionally, Stephen Leimgruber, Heather’s cousin and recently graduated RN, arrived at Tenwek for a minimum one year stint with plans for two, and will be working directly in orthopedics. Stephen and Dr. Kisorio (and future visiting residents from Moi) are sharing a two bedroom apartment furnished by funds donated into our project account. As Paul McCartney and Stevie Wonder sang in the 80s: “Ebony and ivory, living together in perfect harmony.”

Heather would testify that homeschooling and the continual, unremitting needs of the community around us provide her greatest source of highs and lows. Although Heather often questions her ability and effectiveness as a teacher, the kids are learning amazingly. Our curriculum focuses on literature, reading, logic and writing…even Claire, in second grade, writes papers full of rich language. The needs around us are massive, and we have often thought that we could give all we have and still not make any effect. I wrote earlier about Anna, whose house we purchased with funds from our project account. When my brother John was at Tenwek, we visited Anna, who although thankful for the gift from you in the states, still feels the daily pressure to feed her children, and provide for their future as a single mother. We are currently “cow shopping” for Anna, who, with this asset, will have both a source of nourishment and income for her family. Thank you for donating into our Samaritan’s Purse account for needs such as these. There are countless other stories of people who have been blessed, in this way, by your generosity.

What we are reminded of daily is simply this: we need Jesus. In truth, we all do, whether or not we know it consciously, or choose to acknowledge it. We just have the luxury of living in a place where we feel it acutely every day. At times, we feel so inadequate, broken, unworthy, unequipped, and ineffective. But I have the sense this is exactly where we are supposed to be. In this way, paradoxically, the power of God is shown through the cracks, so that God, and not us, is glorified.

But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us. II Cor. 4:7



Thursday, May 7, 2009

A Willingness to Serve…


John and Dan getting ready to head to the hospital after a large cup of coffee in the morning.


John and Anna's boys (the lady whose house was purchased from funds you donated to our SP account). They were completely entralled with the SUV we borrowed from another missionary to make the muddy visit to her home (4-wheel drive is very useful in rainy season).


For the past two weeks, we have had a visiting heart surgeon exploring the possibilities of a future partnership for a heart valve replacement program at Tenwek. He also happens to be my oldest brother, John. Because of the nature of this initial “vision” trip, his work at the hospital consisted mostly of general surgery cases, which he has not done since residency, over 20 years ago. Although slightly anxious at first, toward the end, like riding a bike, he was whipping through typhoid small bowel resections, sigmoid volvulus, ruptured appendices, and even an orthopedic case or two (although he did mention that he was reminded why he chose to specialize in heart surgery). His willing to serve in simple ways, at times beyond what was comfortable and easy (could heart surgery be easy??), and in ways not so glorious, was a blessing and example to many here at Tenwek. Perhaps his greatest ministry, however, has been directly to our family. Our kids, loving their Uncle John, no doubt smothered him. We enjoyed our daily meals, and evenings reminiscing, laughing, watching “Planet Earth” and “Blue Planet” DVDs that he brought for us, looking at family pictures, and dreaming of the future. We will miss him when he returns to the States tomorrow, and look forward to what God may have in store for the future. Following is an excerpt from a letter he wrote telling of a young boy he met at Tenwek:

Dear Church Family and Friends- May 1, 2009
Two days ago I met a boy, twelve years old, who I will call “Edward”. Edward’s father had heard that there was a “mzungu,” a white doctor from America, who does surgery on the heart, visiting Tenwek Hospital. He told me that Edward was unable to run and play with the other kids and always seemed short of breath. Edward appeared small for twelve and as he lifted his dirty oversized shirt, which I was told was likely his best, I could see why. Edward’s small chest had been deformed to accommodate his enlarging heart. When I placed my hand over his chest, I could feel his pounding heart and the turbulent blood flow through a narrowed and badly leaking mitral valve. At some point in his childhood, Edward had gotten strep throat that progressed to rheumatic fever, damaging the connective tissue in the valves of his heart, causing them to thicken and contract. Without replacement of this valve, Edward’s heart failure will certainly progress and he will die a miserable and premature death. Simply treating Edward’s strep throat with Penicillin could have prevented this all. Rheumatic fever has largely been eradicated in the United States because of prompt evaluation and treatment of a sore throat. In poor and under-developed countries like Kenya, this is not possible. The damaged valves can be replaced but surgery has been likened to “attempting to mop up the water on the floor while leaving the faucet open.” As I watched Edward walk away, I felt very tired, sad, and overwhelmed by the enormity of the problem and the lack of immediate solutions…


Please keep John in your prayers that God would clearly direct his future, and open doors for heart valve replacement surgery, perhaps as early as next January. We appreciate you so much!

Whatever you do, work at it with all your heart, as working for the Lord, not for men, since you know that you will receive an inheritance from the Lord as a reward. It is the Lord Christ you are serving. Col. 3:23-4.