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

Thursday, June 25, 2009

New Family Addition and Other News





New Family Addition

Poor Emma has been begging for a dog since she was 4 years old. Her persistent requests have always been met with my standard, deflecting answer: “Keep praying and asking God for the right dog.” Well, it seems as if God heard Emma’s prayers, and at the same time, desired to teach me a lesson in giving pat answers. On Sunday, we brought home “Samson,” an extremely malnourished, flea-infested, and likely mistreated puppy, from one of the local orphanages. After three baths and several flea-dips he is finally cleaned up, and becoming more animated every day (from much love and attention). He is actually pretty smart, and as an outside dog, already knows to do his business in one area of the grass! Things with the other Emma (the White’s boxer dog who officially rules the Tenwek compound) are not so hot, however. Just today, dog Emma went directly to this “area” and overrode his business with her own. She’s the boss.

Total Hip Replacement at Tenwek

Last Monday, the first total hip arthroplasty with Kenyan obtained components was performed at Tenwek. Thanks again to Keith Braun who was here to offer moral support, and sweat with me as I cemented in the acetabular component (the plastic socket). The patient has done very well and now is up and about with minimal pain in her hip. We thank God for his incredible faithfulness and favor in allowing us to offer this service for patients at Tenwek.

Prosthetic Limbs at Tenwek

God continues to bring the right people at the right time. Allen Dolberry, a prosthetist (person specializing in the manufacture and fitting of artificial limbs) and his wife Kim, have been at Tenwek for the past month using their skills to serve the poor. Amputations are viewed as a death sentence in Kenya because of the lack of ability to fit prosthetic legs. During the last four weeks, Allen has custom-manufactured and expertly fitted 22 legs so that people without hope can walk again. It is amazing to see people take steps for the first time in years!!

Friday, June 19, 2009

Joint Replacement Surgery in Rural Africa?









The vast majority of orthopedic surgery at Tenwek is related to trauma: motorcycles, Masai swords, pangas (machetes) and similar instruments of pain and suffering. Often, the patients that present with these injuries are very poor and unable to pay their hospital bills. Since coming to Tenwek, Heather and I have been praying for ideas to provide a means to subsidize the care for the poor and help the hospital financially. Joint replacement surgery has been at the top of the list, although this seemed like an incredibly far off possibility in rural Kenya. As in the US, many people suffer from knee and hip arthritis here. But joint replacements, while common in the US, are performed by only a handful of surgeons in Kenya, typically only in big cities like Nairobi, and fetch a high price.

Knee and hip replacements have been done at Tenwek by visiting joint replacement surgeons in the past, with components donated from the United States, thankfully, most recently just last month. However, with the new stringent rules set forth by the US Department of Justice for implant companies and surgeons, donated implants and supplies are becoming more and more difficult of obtain. So, since coming to Kenya, I have been looking for a local supply of implants for purchase (both trauma and joint replacement), in order to reduce our dependence on donated supplies from the US. Sovereignly, while at the Kenya Orthopedic Society Meeting in Eldoret last March, I was introduced to Rose, a Kenyan lady representing DePuy (a division of Johnson and Johnson), who distributes orthopedic implants in Kenya.

In short, last Monday, we performed the first total knee replacement at Tenwek with components obtained locally in Kenya! Our first patient, “John,” is a very enthusiastic and animated former English teacher who, aside from a little pain with urinating from a Foley attempt gone bad, did very well. I was thankful to have Keith Braun (a visiting orthopod from Mesa, AZ) here to share the moment, and he, at one point, said “Ernie Steury (the first physician at Tenwek) could never have imagined this.” And, next Monday, we have our first total HIP replacement scheduled with local components! We are amazed at the speed at which God has answered our prayers for the start of an ongoing total joint replacement program here at Tenwek as a mean to help subsidize care for the poor! And selfishly, I am excited because joint replacement surgery is what turned me on to orthopedics in the first place.

Please pray that God would continue to bless the orthopedic department at Tenwek, and that the joint replacement program would assist with the overall care of the poor, and viability of the hospital. Pray that our patients would have good outcomes and that God would be glorified through this new work, and that many would hear the good news as a result. Thank you for all your support!

Psalm 113:5-8 Who is like the LORD our God, the One who sits enthroned on high, who stoops down to look on the heavens and the earth? He raises the poor from the dust and lifts the needy from the ash heap; he seats them with princes, with the princes of their people.

Psalm 140:12 I know that the LORD secures justice for the poor and upholds the cause of the needy.

Sunday, June 14, 2009

Road Trip to Eldoret: One Body, Many Parts


Photo op with Dr. Lew Zirkle, founder of SIGN (second from left), and Dr. Lelei, the chairman of the Moi Orthopedic Department (right).

On the road to Eldoret...


Stephen demonstrating his surgical prowess (and lack of restraint) with Dr. Zirkle and I in the background.

I think every man enjoys a good road trip, so when I was invited to attend the demo of the new SIGN hip construct device in Eldoret, it was difficult to turn down. Stephen, Mwangi (the most current visiting orthopedic resident from Moi University), Keith Braun (a visiting surgeon from Arizona) and I piled into the van and, fueled by beef jerky, Costco trail mix (luxuries from the US) and diesel, we made the 4 hour dusty, jarring journey through the famed tea fields of the Kenyan highlands. After chai (tea) and mdazis (little fried doughnuts) at Mwangi’s apartment we checked into the “4 star” Grand Prix Hotel (from the name, you have to know it is fancy).

Eldoret, north and slightly west of Tenwek, is home to Moi University, which has a large teaching hospital, medical school and brand new orthopedic residency program. Tenwek began hosting Moi orthopedic residents in April, which has been mutually beneficial: we provide qualitative (and of course quantitative) training in orthopedic trauma, and the residents provide a much needed helping hand. By God’s grace, this relationship with Moi is growing and strong. Dr. Lew Zirkle, the founder of the SIGN company, which designs and manufactures implants for use in developing countries, was at Moi demonstrating a new implant he developed for hip fracture patients, hence our invitation to attend. Much like the intramedullary nails developed for femur and tibia fractures, the SIGN hip construct is designed to be placed without the use of fluoroscopy, but it has a steep learning curve. Dr. Zirkle would like Tenwek be one of a few institutions to trial the new implant. It was an honor to meet a man dedicated to serving the world’s medically underserved in the unique way for which he was designed by God.
Because RTAs (road traffic accidents) are in no short supply around Tenwek, mainly due to dirt cheap motorcycles from India, no licensure requirements, and improving roads that allow excessively high speeds (it is difficult to go fast when the road is full of pot holes), our trip to Eldoret was cut short to two days…otherwise the cases would just continue to pile up. Thus, after returning late Friday afternoon, the whole of Saturday (12+ hours – only a “half day” as my dad used to say) was spent in the operating room catching up, and treating new admissions. The work load continues to increase, and even with help from visiting residents and surgeons from the US, we are overworked and, at times, overwhelmed.

In what way have you been uniquely designed for God’s purposes, for the service and glory of His Kingdom? If we want to finish well, and live a life of true meaning with eternity in mind, I think this is an important question to ask. It may seem small, the part we are called to play, but like a thread, it is woven into the tapestry of divine history. Find that calling, and by God’s grace, excel in it for Christ’s glory.
The body is a unit, though it is made up of many parts; and though all its parts are many, they form one body. So it is with Christ...But in fact God has arranged the parts in the body, every one of them, just as he wanted them to be...Now you are the body of Christ, and each one of you is a part of it. (1 Cor. 12:12, 18, 27)

Please continue to keep our family in your prayers. We need prayer for strength to persevere, wisdom for the complex cases that present, emotional health to minister to the people that God brings into our lives, and for unity as a family, for Heather as she continues homeschooling, and as we move into new temporary housing next month. Also pray that God would continue to bring short (and longer) term orthopedic visitors to Tenwek to participate in the work, educationally and spiritually, that God is doing here. Thanks so much!