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

Thursday, September 17, 2009

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.

Monday, September 7, 2009

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.”