Keeping the Right Perspective

I recently received this email from a patient at Tenwek:

“Hallo Doctor Galat – It’s Caroline from Kisii (the patient on whom you did bonegrafting at Tenwek Hospital of the right leg). I just wanted to inform you that I was able to heal completely. I can now walk freely without pain. Thanks a lot and may God bless you.”

Caroline first came to Tenwek in 2009 with severe pain, and unable to walk on her right leg. Several months prior, she had fractured her tibia, and a Kenyan surgeon at another hospital fixed the broken bone with surgery – using plates and screws – a practice that is not currently the preferred treatment for this type of injury. Now, her x-rays showed the plate had bent, the screws were backing out, and the bone around the fracture had a hazy look, evidence pointing to the high probability that she had a non-union of her tibia (i.e. the fracture was failing to heal). Worse, having surgery in an (often) unsanitary hospital meant the non-union was also probably infected. As I explained to Caroline the difficulty in treating this problem, requiring multiple staged surgeries, first to remove the plate and screws, debride the infected bone, and place an antibiotic cement spacer in the void, a month or more of antibiotics, followed by more surgery to remove the spacer and place bone graft from her pelvis in the void, I had my doubts that it would ever heal. “God is able to heal me,” said Caroline, causing me to realize that my perspective was somewhat tainted by my training. “True,” I responded back, “but even after all this time and effort, you may still need an amputation.” Together we decided to proceed and prayed multiple times that God would do what seemed impossible. Caroline had a total of three surgeries at Tenwek over a period of about one year, and spent many days in the hospital.

To be honest, I often have difficulty keeping the right perspective, especially being on furlough, away from the meaning and purpose I derive from serving as an orthopedic surgeon at Tenwek. Moreover, our culture has a distinct way of reminding me of what we could potentially have daily. But then, at just the right time, I receive an email such as this from Caroline. I am reminded of a simple, yet powerful promise from Galatians 6:9: “Let us not become weary in doing good, for at the proper time, we will reap a harvest if we do not give up.” This requires us all to have a perspective that is not based upon daily circumstances, but one that is rooted in God’s word, one that is eternal. Paul seemed to understand this better than anyone. In 2 Corinthians chapter 4, Paul, after explaining that he carries around in his body the death of Jesus (i.e. he suffers for the sake of the gospel), later says, "even so 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." Let us encourage one another to keep this eternal perspective as we fight to persevere in God’s calling for our lives.

Thank you for your partnership with us at Tenwek hospital for the gospel of Christ. One way to join our team is to support our family financially. If you are interested in serving in this way, please visit www.wgm.org/galat. Thanks, and God bless you this Christmas season.

P.S. Jeremiah’s surgery was denied initially by our insurance company, but is now approved for this coming Friday. Please keep him in prayer!

Knock-Knees and the Navicular Bone

C-ARM to Arrive in Kenya October 27th!

Thanks to your overwhelming response and generosity last summer when our precious C-ARM at Tenwek went down, we were able to raise the funds to purchase a second, refurbished C-ARM for the hospital. After many logistical delays (as you can imagine with air-freighting a 1700lb piece of equipment to Africa) the C-ARM is scheduled to arrive via KLM on Wednesday, October 27th. Having two C-ARMs at Tenwek will be a huge benefit with the large number of orthopedic cases and with other services increasingly using intraoperative fluoroscopy (such as ERCPs for gastroenterology). Thank you for this partnership!

Packed and crated C-ARM ready for delivery: total weight about 1700 lbs!


Intern Housing Project Building #1 Complete

In addition to the C-ARM project, again, thanks to your generosity, we were able to raise an additional $25,000 towards the intern housing project, two buildings designed to meet the increasing need for housing for the 16 Kenyan interns trained yearly at Tenwek, in addition to multiple residents from many specialties, including orthopedic surgery. The first building is complete, dedicated and occupied! God willing, the construction of the second building will begin shortly. Again, thank you.

Intern Housing Building #1 complete and occupied.

Dedication of building with Rev. Kilel.

Knock-knees and the Navicular Bone

Jeremiah, our oldest, is scheduled for orthopedic surgery next Wednesday, October 27th to help correct malalignment of his legs. Unfortunately, the “knock-knee” gene runs strongly in Heather’s side of the family, and Jeremiah was the lucky recipient. He has recently been complaining of pain in his ankles, and with his growth plates still open, the timing is optimal to stop the growth on the sides that are growing more quickly (which causes the malalignment). The hope is that, with his natural remaining growth, his legs will straighten over time.

Jeremiah's long-leg standing x-rays. Note the inwardly curved knees and ankles.

Adding to the intrigue, Emma rolled her ankle in gym class yesterday and hurt her foot. Unfortunately, I am in Minnesota for a two-week locum tenens job and was not able to examine her. Today, she had x-rays and by her report (I spoke with her on the phone after her appointment), she broke a bone in her foot, "a hard word to say,” she said, "that starts with the letter 'N' and has the letter 'k' in it." So, without seeing her x-rays, I am surmising it is the Navicular, an uncommonly fractured bone that sometimes requires surgery. Please pray for Jeremiah and Emma...and Heather, who will have two kids on crutches next week!


Support Update

We are well on our way to our monthly support goals (about 60%) and thanking God for his provision for our soon return to Kenya. We are still looking for monthly supporters to partner with us in this work at Tenwek in Kenya, so if you feel led to give in this way, please let us know, or visit http://www.wgm.org/galat. Thank you all for your ongoing love, prayers and support of our family!

“We’re Supposed to be Strong”

Camelback Mountain viewed from the north

(Sorry told with permission from the kids!)

One of the many benefits of living in Phoenix for this year of furlough is climbing the mountains which arise from "the Valley of the Sun." Squaw Peak is a favorite, especially since I proposed to Heather at the pinnacle (way back in 1994). A few weeks ago, our entire family attempted to climb another favorite, Camelback Mountain, not a smart idea in the Phoenix summer heat (which, I can tell you, is not always dry), especially on that particular day, because by 8am, when we started, the temps were already a balmy 100 degrees.

Literally about 50 yards into the hike, not unexpectedly, our youngest son Levi asked me to carry him (yes, he is six, but still a good size to handle). Thinking that he could use the help, and that I would have a better workout, I quickly obliged and swung him on my back, much to his delight. Jeremiah and Emma, being the sweet older siblings that they are, immediately protested, recalling an earlier 7 mile hike we had done in the Smokey Mountains about 3 years ago in which I carried Levi the entire way while he was sleeping soundly in my arms. “He’s big enough to walk!” they said. Levi didn’t care about their taunts…he just gave them a big, satisfied smile which irritated them further, leading to additional stinging comments. Curious, I asked, “Why does it bother you that I am carrying Levi?” Jeremiah thought for a second, and said passionately “Because our family is supposed to be strong!”

As we continued up the mountain, I was struck with the multivariate and deep content of this statement. I thought to myself, “Are we teaching our kids that it is important for our family to appear strong to others looking in, or that they cannot display weakness?” Likely not directly (I hope), but we are raising our children in a world that shuns weakness, and esteems the strong, the rich, the successful, the popular, the privileged, and the independent, and this has consciously or subconsciously had an impact on ALL our worldviews. Consider Paul’s incredible, culture-counterintuitive comments in 2 Corinthians: “If I must boast, I will boast of the things that show my weakness.” Why would anyone boast in his or her weaknesses? Statements such as these just do not make sense in our cultural paradigm. But he gives the reason in the next chapter. After pleading with Christ to remove some unknown, yet tormenting “thorn in his flesh” (some have speculated he had a physical ailment, but perhaps it was something more common to us all…emotional distress, haunting thoughts, fierce temptations, false accusations, etc.), Jesus answered him by saying, “My grace is sufficient for you, for my power is made perfect in weakness.” Paul accepts His answer and wraps it up by saying, “Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me. That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong.”

A good friend, Fred Haring, recently wrote, “Have you ever felt that God was calling you to do something that you're too weak for? Have you ever felt inadequate to represent a perfect God? The good news is that you don't have to pretend--you are inadequate.” The concept is simple, yet paradoxical, and may require a paradigm shift in our thinking: In a world that values strength, it is our very weakness that brings glory to God by the display of His strength. So yes, our family IS supposed to be strong…not in and of ourselves, so that we get any glory. But God’s strength displayed in our weakness.

The Obscure Missionaries of Tenwek

Solomon placing a cast on a young boy during a busy clinic day.

When I arrived in Kenya in November 2008, I was introduced to a Kenyan man named Solomon Rop, the head physiotherapist of the orthopedic department at Tenwek hospital. I quickly came to understand that he was much more than a physiotherapist, according to my western definition. In America, physical therapists help people recover from various musculoskeletal injuries through exercise, gait training and other modalities. But in Kenya, a physical therapist is more like a non-operative orthopedic surgeon, doing everything from conventional physical therapy, to correcting club feet, reducing and casting closed fractures, fitting prosthesis for patients with leg amputations, and even placing traction pins and halos (i.e. barbaric orthopedic devices).

The first day I spent in clinic, I pulled Solomon close to my side, and said “you ain’t going nowhere!” I needed him to help me navigate the myriad of patients with conditions that I had never seen before in my training. In one room was an 8 year old boy with pus draining from several sinuses in his leg from a chronic bone infection. Trying to be cool, I leaned toward Solomon, and said quietly, “What do I do with this one?” In another room was a 50 year old man with a femur fracture that was 5 inches short, and 8 months old. “How about this guy?” I said, losing more pride and confidence with every new patient seen. Very patiently, and never condescendingly, he would guide me through decision making processes that were completely foreign to me. Soon Solomon became more than a colleague, but a partner and close friend.

But beyond Solomon’s orthopedic knowledge and skills, and what became blaringly evident, was his commitment to tell patients about Christ (not just Solomon, but Meshack, Daniel, Joel, David, Vincent, Malel, Mailu and many others). In this way, we became true partners and brothers, missionaries working together to not only raise the standard of orthopedic care in this small part of the world, but to tell people of the only Hope that is true Hope. Underscoring this concept is the fact that all the Kenyan men and women who work at Tenwek (over 500) could be making two, sometimes three times what they earn at our small mission hospital, by working at one of the big government hospitals, while working less hours. And some are leaving for higher paying jobs. But for those who remain, when questioned about this, the common answer is, “God called me here, and this is where I belong.” Their example humbles and challenges me.

The work at Tenwek can only be done via partnership…all of us working together to bring glory to God. Where has God called you? Please keep these Kenyan missionaries in your prayers as you think of them. And as always, thank you for your prayers and support for our family!

Radical Service: Life Lessons from the Howell Boys

Our family just returned from a three week trip back to the Midwest, visiting family and going to a church camp at Huntington College in Indiana, the theme this year being Crazy Love taken from the book by Francis Chan. We had an incredible time with family, and reconnected with many old friends from this same church camp where, years ago, before we were married, Heather and I kindled our relationship. As missionaries, we had many opportunities to tell of the work God is doing in Kenya at Tenwek Hospital, and I preached a sermon on the Holiness of God.

Early in the week of camp, I noticed two young boys working hard carrying trays in the cafeteria at lunchtime. “Who are those boys and what are they doing?” I asked a friend. “They are the Howell boys from Ontario Christian Fellowship, and they are carrying food trays for tips, to earn money for world missions,” she said...“They do this every year.” I thought to myself, “How cool that these boys are doing this work,” as I handed Jeffrey two bucks to carry my tray.

The next day at breakfast, I noticed Jeffrey and his brother Jace still hard at work. Later, at the morning general assembly, the camp director announced that the money the Howell boys were earning was going toward the Mission at Tenwek Hospital, a decision made by the boys themselves, and that an anonymous donor was going to match whatever was given by 20%! I was incredibly humbled by these boys, and excited to see what God was going to do for Tenwek.

As the week wore on, the Howell boys continued their relentless service. I could tell they were getting tired and the trays were heavy. Moreover, there were many other fun activities around the camp for young boys to occupy themselves besides carrying people’s dirty trays with melted ice cream, half eaten sandwiches, and stray dollops of mayonnaise greasing fingers and staining clothes. But they persevered in a way that puts me to shame, and reminded me of the truth that our walk with Christ is sometimes hard, sometimes discouraging, in a word, paradoxical, but the joyful treasure that is gained (that is, Christ himself) is so worth it in the end.

At the last service on Sunday morning, the results were in…the Howell boys had collected, after an entire week of carrying trays at every meal, over $1,000. Additionally, five other anonymous donors also agreed to match the amount given by 20% (for a total of 120%) making the grand total raised for Tenwek Hospital over $2,300! More than the funds (although the generosity of all the camp attendees was incredible, and we are thankful for the money to help the poor at Tenwek), was the lessons that I (and others) learned from two boys, ages 11 and 8, about perseverance, radical service, finishing well, and ultimately loving Christ and others. I look forward to what God does through these boys in the future!

2 Cor. 9:13 Because of the service by which you have proved yourselves, men will praise God for the obedience that accompanies your confession of the gospel of Christ, and for your generosity in sharing with them and with everyone else.

Col. 3:17 And whatever you do, whether in word or deed, do it all in the name of the Lord Jesus, giving thanks to God the Father through him.

It's Official!

Heather and I just returned from World Gospel Mission headquarters in Marion, Indiana and have great news… we have been officially accepted as missionaries to Tenwek Hospital with WGM! We are thankful to be a part of the WGM team in Kenya, and our prayer is that we will be able to return to Tenwek as soon as possible, God willing as early as June 2011. God provided a small gift for us on the flights to and from Indiana in that we were upgraded to first class on 3 of the 4 flights (one of the few benefits of all the international travel as missionaries). I stepped into the coach section to use the restroom and was stopped by a flight attendant on my way back, telling me “I wasn’t allowed up in first class.” I looked at my non-first class attire, and coolly said, “I am just returning to my seat, thank you.” It will be hard going back to coach!

Intern Housing Update

I just received word from Russ White that the fund raising for the new intern housing project is going well, and with the $25,000 that is being donated from our ministry account (through your generosity), about half the amount for the second building has been raised. However, $140,000 is still needed to complete this second building. Please pray with us that the full amount would be raised soon in order that the construction can continue.

A Change of Plans

After returning to Phoenix in early June, and settling in, we began to question the wisdom of relocating to another place in such a short period of time in terms of the overall practicality, stress, and family life. So, although we were really looking forward to returning to Rochester, sending our kids to the school they attended during my residency, and being with our great friends and church family for the year, we have had to admit our limitations, and make the bittersweet decision to stay in Phoenix for this year. The paradox of conflicting emotions in missionary service continues in our lives. However, we are confident that this is where God has us and He is already providing. Our kids will start school at Christ Lutheran on August 12th, and we will be able to live in Heather’s parents’ guest house for the year, having their help with the kids, and their support and encouragement; plus we have a great fellowship at Whitton Ave Bible Church. Our goal for this year of furlough is rest and strengthening (ie. to return to Tenwek maximally healthy and ready for another term of service).

Proverbs 16:9 In his heart a man plans his course, but the LORD determines his steps.


Our schedule at a glance:

July 13th – Leave as a family for Ohio to visit the Galats, and our church family at Ontario Christian Fellowship.

July 26th - August 1st – Attend family church camp in Huntington, Indiana.

August 12th – Jeremiah, Emma, Claire and Levi start school.

August 9-23rd – Locum tenens job for Dan in Fairmont, MN. I hope to visit our friends in Rochester during this time.

Thank you for your support for our family. Your prayers and encouragement are appreciated!

How a C-ARM Can Bring Glory to God: Ann's Story

Mr. Rugut and the team after installing the new boards. Note the smile on Rugut's face.

A VERY welcome screen..."System Ready for Image Processing."

Test patient: A Leatherman tool.

Ann is one of many patients who benefitted by the use of C-ARM during her surgery (which occurred prior to our C-ARM malfunction saga). She is now back home with friends and family, and able to stand and walk after more than 5 months of laying in bed with two broken legs.

TENWEK C-ARM FIXED!

The two circuit boards made their way from Chicago to Phoenix to North Carolina to Amsterdam to Nairobi and finally to Tenwek, but not without significant effort and ordeal (yet all infused with the grace and sovereignty of God) by the family who carried them, our friends, the Camerons. For the amazing story of the events of their journey, check out their blog, and please keep Scott in your prayers as he has surgery at Tenwek on Monday.

Mr. Rugut and his qualified team of Kenyan technicians received the boards just yesterday, and after installing them found that the problem has been fixed! Thanks to God, our C-ARM is now fully functional again…and I received report that within 20 minutes of the repair’s completion, the C-ARM was used to help fix the multiple fractures of a young girl who fell out of a tree. Dr. Daniel Matthews, the visiting orthopedic surgeon currently covering at Tenwek, emailed saying how thankful he is to have the C-ARM up and running…he also asked for prayers in managing the thirteen patients in the queue awaiting surgery!

NEW C-ARM COMING SOON

When we ask and trust God for something that seems impossible, He often goes way beyond, far above what “we can even ask or imagine” so that all we can do is simply say, “God did that.” A mere week after sending out a plea for funds for a second C-ARM, and for the intern/resident housing project, the full amount for both projects has been pledged! The company in Chicago that provided the replacement circuit boards (incidentally, also as a donation) will also be providing us with a newly refurbished replacement C-ARM, identical to our current unit, so that, God willing, in the future, we will not be without fluoroscopy for an extended period of time again. The new unit should be ready for shipment in about 3 weeks.

THE STORY OF ANN

“Ann,” a 40 something year old lady who was tragically involved in a car accident in December of 2009, and fractured BOTH femurs (thigh bones), the right side in the middle, and the left side near the hip. Because (a) she is HIV positive, a widow to a husband who died from the same disease, and (b) utterly destitute as a result, thus unable to afford the implants needed to fix both fractures, she laid in a government hospital for 5 months, no treatment, wasting away, losing strength and all hope.

Resigning to the fact that she would never be able to walk again, she was discharged to her small home near Lake Victoria. A missionary in the area learned of her plight, and brought her, like the Good Samaritan, to Tenwek, agreeing to pay all medical bills associated with her care. When I first met Ann, I felt a mixture of sorrow, compassion, anger (because of her blatant medical mismanagement) and dismay. Had her fractures been “fresh,” (i.e. not more than a few weeks old), fixing them would have been relatively easy. But instead, with two non-healed and chronic fractures, both legs shortened more than 5cm, and with knees that were frozen because of non-use, the surgeries would be much more difficult. Before starting every case at Tenwek, a prayer is said for the patient…the day of Ann’s surgery, our prayers were charged with an extra sense of dependence on God to provide wisdom, grace, strength and healing. Aided by a “then-functioning” C-ARM (her surgery thankfully occured right before our C-ARM broke), we placed a rod in the right femur, a plate on the left, and manipulated both knees to break up the scar tissue that had formed from months of inactivity. After three weeks of intense physiotherapy (the patient being very unhappy with her doctor who insisted she continue to bend her knees daily), she WALKED out of the hospital (with the help of a walker), praising God!

Ann is just one of hundreds of patients who have been blessed by the generosity of the hundreds of people like you, who serve “behind the scenes” by giving, praying, as well as advocating and championing. Without our donated (current, and soon-arriving) C-ARMs, surgeries like hers would be, in the least, far more difficult, if not impossible. Without the donated implants, patients like her would still be laying in bed, unable to walk, or worse. And without housing for the interns and residents (i.e. extra manpower) there would be no way to take on “elective” patients like Ann. All these blessings work together for our patients so that they can glorify God, by saying, “Jesus healed me!” Thank you again for your continuing prayers and support!

Urgent Needs at Tenwek: C-ARM and Intern Housing Updates

The core of what we do at Tenwek is educating national doctors-in-training. Left to right, Dr. Jeff (general surgery resident), Dr. Shadrack (intern) and Dr. Kilonzo (orthopedic resident from Moi), all of which were on the orthopedic service when I left Kenya.

The progress of the first intern/resident building, with completion set for August.

Three days after returning to the US, I was (again) on a plane, this time to Chicago, wedged in a window seat on a crowded flight (yet thankful for the free ticket, compliments of my in-law’s frequent flier miles), on a mission to troubleshoot the two boards that I brought with me from our C-ARM at Tenwek. In Chicago, I met with the “guru” of OEC technology, who was able to test both boards on another machine, and unbelievably, both motherboards, in addition to the hard drive…ALL THREE were blown (as someone said, “when it rains, it pours!). But, thanks to God, they had replacement boards in stock, and after testing to make sure they were working properly, I promptly shipped them to the next visitor who will be leaving for Kenya next week. So God willing, by the end of next week, with these two new boards, and with the hard drive that was previously brought to Tenwek, our current C-ARM will be up and running. Thank you for your prayers for Tenwek, and for our current orthopedic visitors throughout this ordeal. Dr. Tim and Jennifer Oswald just left Tenwek, and here is an excerpt from their latest newsletter: “Tim had a great last week of surgery at Tenwek, doing a huge volume of cases. Despite adjustments due to the broken c-arm, his surgeries were successful and he was able to do a lot of teaching.” God is always faithful!

Now that goal #1 is on the way to being accomplished (fixing our current C-ARM), I have been concentrating on goal #2: obtaining a second C-ARM for Tenwek so that this problem does not happen again. After much thought and consultation with others involved in this project, we decided that it would be most advantageous and cost effective to obtain a unit identical to our current model OEC 9000 (making maintenance, parts, etc. streamlined). The estimated cost will be about $25,000 with shipping and I am currently obtaining quotes from different companies (less than the original estimated amount of $40,000). Please continue to pray that God would direct us to the right unit for our needs at Tenwek.

Another urgent need at Tenwek is the “Intern/Resident Housing Project” that I mentioned in previous updates. Tenwek, as an educational institution, is committed to teaching national doctors-in-training, many of which rotate on orthopedics. However, there is sub-adequate housing for many of these trainees. The first of two buildings is already paid for and construction well underway, and should be finished by August. However, as our medical superintendent wrote in his recent update, “we desperately need to begin the second building (which will house 12 additional doctors in training) before final completion of the first. This will save us a great deal of effort and money in reducing replication of services by the same building company, which needs to know by the end of June whether or not we will be able to start further construction.” As such, there is an urgent need to raise $250,000 by the end of June to start construction on this second building. Since orthopedic surgery is heavily involved in training these physicians, I have been asked to raise $25,000 toward this intern/resident housing project (and which I feel is very justified, and so important for what we do at Tenwek).

God is easily able to provide $50,000 for these two very important and urgent projects, through His people. Many of you have faithfully given toward the work at Tenwek over the past two years. But, if God has lain on your heart to give towards these special projects, please step out in faith and do so. The easiest way to donate would be to give directly into our project account at Samaritan’s Purse (account #003333), which you can do by calling Mary Elizabeth Jameson directly at 828-278-1508 or 828-278-1355, or by mailing a check to: Samaritan’s Purse PO Box 3000 Boone, NC 28607 (for account #003333). Please note that no administrative fees are taken out of this account…100% goes towards the ministry.

I look forward to seeing how God provides! If you decide to donate, please send me a quick email so that I can keep track of your donation and of the total amounts. Thanks again for your prayers and support. May God richly bless you!

We Have Arrived!

Saying goodbye to our family at Tenwek. We will miss everyone while we are away~

Levi saying goodye to his good friend Will Manchester.

On the day we left, we spent a few hours at the Giraffe Center. That's right...I think she liked me.

The girls loved feeding the giraffe.

A typical scene during our 24 hour journey back to the U.S. The last leg from Detroit to Phoenix.

Back in the U.S.

After one and a half years of service at Tenwek, over 1000 orthopedic surgical cases, a solid two school years of homeschooling, and many full joys and experiences, we have arrived safely back in the U.S., in Phoenix, staying with Heather’s parents. The kids were ecstatic to see grandparents, and go swimming (yes it is HOT here…I miss the 75 degree perfect weather of Tenwek), but they already say how much they miss their other “home” at Tenwek. Although a year and a half is not long according to adult standards, it is quite a length of time for kids. Levi was wondering why eggs are “white” in America, and Emma could not get over the fact that there was an automatic soap dispenser in the bathroom at the Detroit airport. Jeremiah is already hunting rabbits in the backyard here is suburban Phoenix, and Claire can’t wait to go to McDonalds. We feel so privileged to serve at Tenwek, and look forward to returning, God willing, in about a year.

Update on Maggie

Prior to leaving Kenya on Wednesday, we visited Maggie, the young lady who had a revision total hip arthroplasty in April. She is doing incredibly well, and the limp that she had preoperatively is almost gone, and will continue to improve as she strengthens the muscles around her hip joint (click here to see video of Maggie walking). Her pain is completely gone, and she wanted to express her thankfulness to all those who helped make this miracle possible.

Update on Tenwek C-ARM: Good News and Bad News

Bad news first: A week and a half prior to our departure from Tenwek, the only functional C-Arm at Tenwek stopped working. Our initial assessment was that the hard drive had failed; however, after installing the emergency parts that arrived with our most recent visitor, the same error message occurred. Apparently, one of two CPU motherboards that communicate with the hard drive also malfunctioned (a much more difficult problem to diagnose)…the bottom line issue is that our C-ARM is still not working, making the practice of quality orthopedics much more challenging for our current visitors. Here is an excerpt from the most recent update from the Oswalds: “Please pray for Tim. Without the c-arm he has had to treat some patients without surgery, which means longer hospital stays and possibly less excellent outcomes. While we are only here a couple weeks, this will be an ongoing problem for these patients. As Tim explained, if a c-arm is broken in the states, they just do NOT do the surgery until a working c-arm is accessible. Here, there is no choice.”

The good news: I brought both motherboards with me from Tenwek, and due to the great urgency of this problem, I will fly to Chicago on Sunday, where I will meet with the “guru” of OEC technology, and representatives from the company I have been in contact with from Cleveland, who can hopefully, collectively, diagnose the problem, and fix these motherboards so that our current C-Arm can be made functional again (they have all been incredibly helpful, even calling our tech in Kenya for information). Additionally, this company also has newly refurbished units that are immediately available for purchase, and I will be looking over the options on Monday. Please PRAY that this trip to Chicago would bear fruit, that our current C-Arm will soon be functioning again, and that God provides another C-Arm for use at Tenwek. As such, we need to urgently raise about $40,000 for the purchase and air freight of another unit. If you feel God leading you to give toward this immediate need, please let me know, and I can direct how you can help. Alternatively, you can call Samaritan’s Purse directly at 828-278-1508 (Mary Elizabeth Jamison) or 828-278-1355 (Scott Reichenbach). We are trusting God to provide abundantly for the people He cares for in Kenya. Thank you for all the prayers and support you have offered our family, and for your partnership in this ministry at Tenwek!

Urgent Prayer Request: Broken C-ARM

Examining the machine.

Discussing the options...

One the items that is essential for our broad practice of orthopedic surgery at Tenwek is a 20 year old C-ARM (or fluoroscopy), an old workhorse that provides “real-time” x-rays in the operating room, and critical for certain cases such as hip fractures, and many pediatric fractures. Although heavy and cumbersome (being several generations old) and likely producing significantly more radiation than newer units, it has provided years of faithful service.

About every two months, the image becomes blurry, or the software will not boot properly, an indication of growing age, yet problems always correctable with a quick call to Mr. Ragut, our contracted technician, who, in a few hours, has the machine up and running perfectly again. This past week (about the 2 month mark since the last “event”), while in the middle of a tibial plateau fracture, the image froze on the computer screen. After trying our usual intra-operative troubling shooting methods (like restarting the machine) failed to correct the problem, we finished the case without fluoroscopy, and took the C-ARM out for a better look. Two visiting bio-med technologists examined it, and delivered news I did not expect nor welcome: the hard drive had failed, a permanent and fatal error, which, for a 20+ year old C-ARM, is bad news. The only solution to fix the problem (according to the technologists) is to find an identical hard drive on an identical unit somewhere in the world, a task akin to finding a needle is a haystack.

Thinking that perhaps the shorter term solution is to purchase a new unit in Nairobi (while trying to find this potentially elusive replacement hard drive for the old unit), I solicited quotes which, for me in our mission hospital context, redefined the term “sticker shock.” So I ask for your prayers that: (1) God would do a miracle and allow us to find a replacement hard drive for our current unit (OEC Diagnostics Model 9000 S/N 99-1290), and get it to Tenwek Hospital quickly, (2) God would provide a second C-ARM (either by purchase or via donation) for Tenwek to have as a backup or primary unit, and (3) God, in the meantime, would give wisdom in cases that normally require C-arm. God always seems to push us to the edge of our limits, so our trust in His provision increases. Accordingly, last night, a 12 year old boy was admitted with a femoral neck fracture (perhaps of all the cases that could benefit from having C-ARM, the ultimate).

We hold to God’s promises in scripture and greatly appreciate your prayers…and if you have any leads on a hard drive for a 20 year old OEC model C-arm, or a new or used C-arm, let me know! Thanks for all your prayers and support.

Farewell to Samson

The classic saying goes “it is better to have loved and lost, than never to have loved at all.” With our departure to the states coming up in less than three weeks, we, as a family, have been praying for a good home for Samson, Emma’s “rescue” puppy from the local Umoja orphanage. Emma first met Samson a year and a half ago, when we visited the orphanage with my brother John. He was a subdued, mangy, flea-bitten, scrawny, half-starved, ugly puppy, tied to a three foot length of chain. But from the first time Emma saw him, despite his hideousness, she loved him, and begged to take him home. After a few other visits to the orphanage, and continual requests from Emma (and from the orphanage director) to take him home, I finally relented and on June 14th, 2009, Samson was officially adopted into the Galat family, much to Emma’s delight, and Heather’s chagrin.

With “proper” diet (including Emma’s frequent “breakfasts in bed” for Samson) and smothering love (and several flea baths, immunizations, Frontline, etc.), Samson grew into a large, healthy, and beautiful dog, with bright eyes and laidback personality. As my brother John said, “Samson is the quintessential doggie version of a ‘rags to riches’ story.” Samson had the reputation of being somewhat fat and lazy, which I attributed to living the deserved “good life” after so many initial months of hardship. Several weeks ago, however, we noticed that Samson was becoming more lazy than usual, and slowly, he started to lose his excess poundage. After a round of antibiotics for what was thought to be a bladder infection, he seemed to perk up. However, last weekend, he dramatically worsened, stopped eating and drinking, and by midweek, his gums and eye sclera turned vividly yellow, indicating that his liver was failing, likely secondary to a massive infection that was unresponsive to several antibiotics.

With all the hats that a missionary surgeon wears, the last role I ever thought I would play is that of veterinarian. But on Thursday, after long and tearful goodbyes from the kids, Samson was put to sleep with the most pleasant concoction of drugs I could muster from the Tenwek formulary. A grave was dug next to Sandy, the Chupp’s dog who also passed about 18 months ago (so they could “keep each other company”), a small service was held with several missionary children and Kenyans, and Samson was laid to rest. Emma managed to cram 15 years of dog love into one very full and very intense year. Through her tears, Emma told me she doesn’t think she has any dog love left because she spent it all on Samson… and if you were here to witness it, you would fully agree.

That intense kind of love, the kind that looks through ugliness and sees the potential for what could be, reminds me of the kind of love the Father has for us, who despite our sinfulness, our hideousness, loves us because He loves his Son, who redeemed us , and cleansed us by His blood. Thank you Emma for this lesson, and farewell Samson…you were loved.

Job 1:21 “The LORD gave and the LORD has taken away; blessed be the name of the LORD.”

A New Hip for Maggie

Maggie the second day after surgery.

The day after surgery, Maggie was already walking!

Maggie's preop films demonstrate a black line around all the parts, indicating that they are loose.

Maggie's new hip.

Last fall, while spending a few days in Nairobi resting and restocking supplies, our family (and Stephen Leimgruber, Heather’s cousin/RN who has been working with me in orthopedics for the past year) visited Amani Ya Juu, a ministry for marginalized women in Africa. At Amani, women needing a second chance are trained to create and sew a myriad of items from quilts to aprons, which are then sold at the Amani store, proceeds benefiting the women who live and work at the mission. While Heather and the girls love to visit the store and browse through the beautiful crafts, let’s just say that it wouldn’t be the first-choice hangout spot for the guys (there is even an “Amani Café” on the premises, which serves up non-masculine items such as tomato soup and blue cheese and pecan salad).

Earlier that particular day, feeling quite good about myself, and noting all the needy people in and around Nairobi, I was giving the kids one of my “fatherly lectures” on intentional ministry to strangers, saying that “we need to be willing to sacrifice our own agenda when an obvious need comes to our attention,” rather than turning a blind eye. While at Amani, Stephen decided to test me, to see if I “practiced what I preached,” by introducing me to Maggie, who works in the store at Amani, greeting every customer with a big smile and a hug. Stephen noted that she had a terrible limp, and thought perhaps there was something we could do for her. The desire to protect “my time” while on “R&R” in Nairobi, coupled with my desire to be doing some other activity during our precious few days away from the daily pressures of orthopedics at Tenwek other than shopping, mixed with a general dislike for random “curb-side” consults, made my initial greeting less enthusiastic. However, Maggie’s warm personality, and obvious pain with every step, quickly endeared me to her, and as she shared her story, I began to feel that this meeting was not random.

Maggie, now 35 years old, had been in an automobile accident at age 16, and injured her right hip. After 8 surgeries (the last being a repeat hip replacement in 2001), she now felt daily pain, with the sensation that the components in her hip where moving with every step, and she resigned herself to the fact that she would never be able to walk well again. However, amazingly, her joy and obvious love for others and for God were completely untouched by her grim circumstances. I told Maggie she should get some x-rays, and I would return the following day to look at them to determine if there was anything remotely possible that we, at Tenwek, could do to help. My skepticism was strengthened when I viewed her x-rays, which showed an obviously loose cemented hip replacement with significant bone loss, problems which were most likely the result of a chronic infection induced during one of her previous 8 surgeries. In my mind, I knew there was absolutely no way we could tackle her huge problem at Tenwek, and the only solution would be to try to get her to the U.S. for her needed surgery (which also seemed impossible with the huge expense). I told Maggie I would do what I could with my connections in the States, and left her with instructions to lose weight, and to see a physiotherapist to help strengthen the muscles around her hip. After two meetings, I felt like I had known her for years.

After several initially hopeful, but ultimately unfruitful leads for Maggie to come to the U.S. for surgery, I too resigned myself to the fact that she was beyond help. But, as is so often the case in these seemingly hopeless situations, when people are praying and when God is sovereignly directing, what we think is impossible becomes unstoppable. In February, when I emailed Dr. Wes Mesko (the joint replacement surgeon from Michigan who comes yearly to Tenwek for the annual Total Joint Replacement week) about Maggie, he felt that if we had the right components, and assuming the current hip was not infected, we could do her surgery right here at Tenwek. When I emailed Rose (the Johnson and Johnson rep in Nairobi who supplies our hip and knee components), to see if her company had these special revision parts in stock, amazingly, they did. During a return trip to Nairobi later that month, I called Maggie to tell her the news and she excitedly insisted I come to Amani immediately to see her. She looked like a different person, having lost over 30 lbs; and her limp (and pain), after months of physiotherapy, had dramatically improved. However, with loose components, surgery was still necessary, and Maggie was given a surgery date.

Maggie’s surgery, which happened just this past week, was one of those cases in which we felt like God was directing every step. With so many variables needing to occur simultaneously for a big surgery like this to even occur, let alone be successful, and with so many things that could have potentially gone wrong in this environment, miraculously, everything went perfectly. I am convinced that we witnessed a modern day “Miracle at Tenwek.” And just today, I checked all of the bacterial cultures we took during surgery, and every single one was negative! Maggie is so thankful because her surgery was possible through donations to our project account at Samaritan’s Purse. In addition to Maggie, eleven other patients had joint replacements, and thankfully, everyone did great, and most are already discharged. God sovereignly blessed the week, and I personally enjoyed taking a break from trauma to do these surgeries with Dr. Mesko (who, as a joint replacement specialist, taught me many of his valuable “tricks”).

I am humbled (yet again), and reminded of our smallness and God’s greatness, yet His desire to break in and miraculously touch the lives of people such as Maggie. This is God’s work, not ours, at Tenwek, and he is using it to glorify his son, Jesus Christ, in whose name patients are helped. Thank you for your ongoing prayers and support of the orthopedic ministry at Tenwek…without this partnership, this work would not be possible. Please continue to pray for Maggie and all the patients at Tenwek that God would be glorified in their lives.

Matt. 20:30-34 Two blind men were sitting by the roadside, and when they heard that Jesus was going by, they shouted, "Lord, Son of David, have mercy on us!" The crowd rebuked them and told them to be quiet, but they shouted all the louder, "Lord, Son of David, have mercy on us!" Jesus stopped and called them. "What do you want me to do for you?" he asked. "Lord," they answered, "we want our sight." Jesus had compassion on them and touched their eyes. Immediately they received their sight and followed him.

Trip to Malindi: Refreshment on the Coast

Ready for a day in the sun.

Jeremiah displaying one of two Wahoo that he caught.

Dr. Ben Roberts, ophthalmologist at Tenwek, and great friend, conquered the barracuda.

Our collective Tenwek families recently spent 5 days at the WGM Kenya Spiritual Retreat in Malindi, on the Kenyan coastline of the Indian Ocean. Sessions of solid biblical teaching from Stan Key, mixed with a few extra days of family fun in the pool, body surfing during high tide, prayer walks on the beach, exploring the tide pools, Kayaking, two birthday celebrations (Levi and Dan) and a day of deep sea fishing made for some serious spiritual, physical, mental and emotional refreshment, and one of our best family vacations ever. We see so clearly how God provides for us at the right time as we wait upon him.

The next several weeks are going to be extremely busy for our family and in the department of orthopedics. April 26-30th is the 4th annual “total joint camp,” and this year will be different in that all the implants will be provided by the local Johnson and Johnson Company in Nairobi (rather than as donations from the US). This is important as we seek to have an ongoing, independent, viable joint replacement program at Tenwek, which will, Lord willing, help subsidize orthopedic care for the poor. We have at least 10 patients in the queue for surgery, including a very sweet 37 year old lady named Maggie who injured her hip as a teenager in a car accident, and since then has had three hip replacements (the current component are loose, and she can feel them moving with every step). Please keep our patients in prayer, that all would go smoothly, that there would be no complications, and especially that God would be glorified through this work.

As a quick update on our family, our tickets to return to the states have been written! Apart from any natural disaster such as a volcanic eruption in Iceland, we will return to the states on June2nd for a year of furlough. We continue to pray and wait for God’s direction, and Lord willing, we will return to Tenwek in the summer of 2011. Please continue to pray with us, as there are many details still to work out. We are so privileged to be serving with you at Tenwek, and continue to view all that the LORD does as a partnership, working together to serve patients with (literally) broken bodies, train nationals in the field of orthopedic surgery, disciple young African physicians, and spread the “light of the knowledge of the glory of God in the face of Christ (2 Cor. 4:6).” Thank you for all your prayer and support!

Sunsets in Kisumu: New Lessons in Trust

After over 16,000 miles of air travel, and countless miles on the road, Heather and I finally made it back to our African home after a six day visit to the U.S. It was good to see the kids again, and they seemed happy we were home, although I suspect they also had a good time staying at friends’ houses, and of course, taking a break from homeschooling. The trip, overall, was tiring, but fruitful.


The day after I returned to Tenwek, I (Dan) was on the road again, this time headed to Kisumu, where I attended the Kenya Orthopedic Society’s 4th Annual Meeting, the theme “The Road Carnage Continues,” a very apropos title highlighting the significant increase in road trauma over the past few years, which, according to a few of the papers presented, is directly correlated to the onslaught of duty-free motorcycles imported into the country for use as taxis (called boda-bodas). One presenter, an official with the World Health Organization (WHO), remarked that Kenya, being one of the top 10 countries in the WORLD for road trauma, has the dubious honor of being selected for a new decade-long initiative exploring ways to decrease the tremendous burden of injuries and death that result from road traffic accidents. I gave a presentation on “Open Fractures of the Tibia,” and thankfully discovered that the American style of power-point presentations (including creative slides and mild humor), was well received.


Kisumu, on the Kenyan shores of Lake Victoria, is a beautiful city, famous for tilapia and Nile Perch, and now more famous as the home of Obama’s father. In fact, a new airport was just built to accommodate the increased number of tourists, and a new 5-star hotel is being erected. After striking out at several “lesser” hotels, John Tanksley and I thankfully found two rooms at one of the “3-star” hotels in town, “The Sunset Hotel.” Although “3-star,” I discovered, was a truly meaningless designation, (I was stung on the toe by some unknown African life-form at night, and the A/C leaked a huge puddle on the floor of my room), the hotel DID live up to its name…the view west over Lake Victoria, at sunset, was absolutely incredible.


While sitting out on the porch the final evening watching the sunset, as the colors changed every minute, from yellow, to orange, to red, to purple, I was overwhelmed with a sense of God’s goodness, of His delight in His own creation, His steadfast faithfulness, and His concern for humanity. Amazing how God uses his creation to point us to Him, to remind us how glorious He is…and how small we are; to show us His dependability…and remind us of our volatility; to demonstrate His power…and our weakness; and to show us His grace…and our need for it. Pondering all this placed, in my heart, a deeper trust in the God who pursues us because he loves us, and desires to meet with us, and to show us that He is the culmination of everything, the sum of all we strive so hard to find.


Psalm 8:3-4 “When I consider your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is man that you are mindful of him, the son of man that you care for him?”

The Tree Fortress, Update on Joshua, and Trip to the US

Grandpa Galat, Peter White and Jeremiah nailing the floorboards, which were very green and hard as a rock causing many nails to "ping" off the hammer. One stray nail eventually ended in Jeremiah's foot, requiring an "extraction" in the orthopedic clinic, a tetanus shot, and a week of antibiotics.

One of the members of the heart team told me, "You know, I saw the strangest thing today as I was looking out my bedroom window...a motorcycle carrying ten foot lengths of board, long-ways!" I chuckled to myself, knowing exactly where the driver was taking the wood.

The finished product...

The Tree Fortress

Jeremiah has been asking for months for me to help him build a tree house, and I had been able to successfully deflect his advances with a variety of good excuses. However, when Grandpa Galat arrived, he changed his recruiting efforts, and very soon the project was underway. What I thought was going to be a small wooden platform in a nearby tree became, with the influence of Grandpa, a 7x10 foot veritable fortress, which was big enough to raise some eyebrows and eventually require a permit from the Tenwek Building Committee (we have discovered that Jeremiah continues to be good at getting Heather and I in trouble). After many long hours, numerous motorcycle taxis carrying loads of fresh-cut lumber, two day-trips into the bush to harvest bamboo for the roof, and a trip to Casualty for a rusty nail in Jeremiah’s foot, the project is now complete. Jeremiah and Peter got a small taste of responsibility… and the joys of working with Grandpa Galat (they each only got yelled at twice)!

Update on Joshua

After removing the large mass on Joshua’s wrist, the initial pathology looked like a type of serious childhood cancer. However, after the long three-week wait for the final report from Kijabe hospital, amazingly, the mass was deemed to be a benign fibroma! With the mass removed, hopefully it will never be a problem again, and the latest report is that Joshua is doing very well. Many of you have been praying for Joshua, and this serves as a reminder that Tenwek’s motto still hold true, “We treat, Jesus heals.” Our prayer now is that Joshua grows to become a godly young man with a passion for serving Christ!

Trip to the US

Next week, Heather and I leave for a quick, 6 day trip to the US for our interviews with World Gospel Mission (WGM), the mission that runs Tenwek Hospital. We arrive in Cleveland on Wednesday evening, and leave for Kenya again the following Monday, with the interviews being in Marion, IN over the weekend. We are hoping to finalize our transition to WGM and move forward with our calling to serve “long-term” at Tenwek. And we are looking forward to seeing the Galat family in Ohio, drinking some Starbuck’s coffee, and spending some time together (15th anniversary coming up the end of this month!). Please keep us in prayer as we travel, and meet with WGM staff, for good health for all, and for our children as they stay behind in Kenya with our Tenwek family.

Grandparents, Uncle John and the Cardiac Team

Uncle John Galat and the "Cardiac Team" recently spent two weeks at Tenwek doing heart surgery. They were such a help to many needy patients!

Uncle John found some time to take his nephews fishing above the dam. Jeremiah caught some sort of bottom dwelling catfish and cooked it up for dinner.

Grandma Galat celebrated her 71st birthday with us in Kenya.

The kids LOVE their Grandma!!

Grandpa Galat could not resist buying chicken feet at the butcher in Nairobi.

Joshua’s Battle

Joshua and mom before surgery, where several people surrounded him with prayer.

Large mass on Joshua's right wrist.

Post removal...

Joshua the day after surgery. All smiles...

Certain patients leave more of an impact on the life of a physician, some because of their unique personalities, and others because of their amazing pathology. When the two combine in the same patient, that impression becomes indelible. Joshua is a sweet, little 18 month old boy, the son of a single and very poor mother from a border town near Tanzania. She noticed a “growth” on his hand, which had consistently grown larger over the past year. Through the friend of a missionary couple here at Tenwek, Joshua was referred for evaluation, and after the funds were scrounged, the journey was made.

The growth on Joshua’s right hand was fairly massive, and about to fungate through the skin on the undersurface of his wrist. While examining him, he managed to smile often, but I could tell the tumor was painful. While my strongest hopes where that this was some more aggressive type of benign tumor, I was also concerned that this could be a rare type of cancer found in children: rhabdomyosarcoma.

During surgery, we used loupe magnifying glasses to make sure no obvious tumor was left behind. Thank the Lord that the tumor did not involve the median nerve, one of the main nerves supplying the hand with vital function and sensation. Tenwek is blessed to have a newly trained Kenyan cytopathologist who received his training at the Mayo Clinic in Rochester (he said he did not know what cold was until he experienced true “cold” during his year in Rochester). Together we looked at a smear of cells from the tumor under the microscope, and found what looked like small “blue cells” mixed with more oddly shaped “spindle cells”…features that are more suggestive of what I feared. Final confirmation will come from the pathologists at Kijabe, a nearby mission hospital.

When viewed from a purely humanistic standpoint, if Joshua’s growth is confirmed to be cancer, the situation appears hopeless with the only option being an amputation of the arm, and with statistical chances of either recurrence or metastasis. However, a missionary colleague reminded me that this isn’t Joshua’s battle to fight, but rather the Lord’s. God is more than able to do a miracle, and we are praying that Joshua receives complete healing. This truth is applicable to our own lives. How often do we feel discouraged, and alone in our weakness, not realizing the truth that God is with us, and waiting with supreme strength to fight our battles? If we would only just submit to the One who knows us, created us, and loves us, I am convinced we would see the miraculous.

2 Chronicles 20:15 This is what the LORD says to you: 'Do not be afraid or discouraged because of this vast army. For the battle is not yours, but God's.

Deut. 31:6 Be strong and courageous. Do not be afraid or terrified because of them, for the LORD your God goes with you; he will never leave you nor forsake you."

Finding Forgiveness…

David's multiple injuries included an open knee fracture, femur fracture, and hip fracture on the right side, and a hip fracture-dislocation on the left side....the perfect example of the multiple injuries that occur with high-speeds.

In all honesty, the continual barrage of road trauma that presents at Tenwek, often patients with multiple open fractures whose care is extremely challenging and labor intensive, stressing our already taxed resources, causes me, as a flesh and blood human, at times to feel some degree of animosity towards certain patients, especially those who cause the accidents, careless drivers, who by their lack of experience, judgment or scruples, put of the lives of many people in danger. Not uncommonly, I see drivers of boda bodas (motorcycle taxis), often 18 year old boys, carrying three passengers while talking on their cell phones, simultaneously looking over their shoulders at interesting roadside phenomenon. Just last week, two patients were admitted to the orthopedic ward with multiple complex fractures, the result of a boda boda accident in which the driver was trying to pass a matatu (van taxi) around a bend in the road. On my own, without renewal of strength from the LORD, physically, emotionally, and spiritually, events such as these can threaten to make the fleshly heart hardened.

Last month, I mentioned a patient “David,” the driver who stuffed 14 passengers into his mini-matatu (seats 5), which, not surprisingly, lost its brakes while going down a hill, causing a massive pre-Christmas Eve crash, resulting in multiple injuries, including the death of two people. David himself was badly injured, including an open knee fracture, femur fracture and hip fracture all on the right side, and a hip fracture-dislocation on the left side. At any other hospital, he would likely have been left in traction for several months…and likely have remained a cripple, unable to walk for the rest of his life. But, at Tenwek, because God has blessed us with the resources to help patients such as David, after several surgeries, he is now able to stand without pain, and soon will be able to walk again. His physical recovery has been nothing short of a miracle. But God’s purposes in David’s life were well beyond the physical.

While rounding on David, I could sense a certain amount of guilt associated with his accident, although mixed with a denial that, at times, caused me to want to shake him and shout, “Do you realize what you have done!?!” Currently, we have a “super-chaplain” on our service, Helen Tangus, who faithfully and daily “rounds” on our orthopedic patients. I pulled her aside one day and asked her to “work” especially on David, and she said “Of course, Daktari, I have been reading scripture and praying with him daily.” Over the next several days, David’s countenance was notably different, a change which could only be the result of a person who had found forgiveness with his Savior, and perhaps with himself as well, a fact Helen later confirmed.

What amazes me is that God is always at work at Tenwek, and in all our lives, even in circumstances which, to us, seem purposeless or random. And His ultimate purpose is to work forgiveness into our lives, made possible only through the death of His Son on the cross…forgiveness which reconciles us to God, and us to one another…forgiveness which frees our conscience from guilt…and forgiveness that allows this simple orthopedic surgeon to see his own need for a Savior, and continue with our family’s calling to alleviate a little suffering in this small part of the world. Thank you for your ongoing support and prayers for our family, and for our patients that we care for in Kenya. We appreciate you!!

Eph. 1:7-8 In him we have redemption through his blood, the forgiveness of sins, in accordance with the riches of God's grace that he lavished on us with all wisdom and understanding.

Col. 3:13 Bear with each other and forgive whatever grievances you may have against one another. Forgive as the Lord forgave you.

Graduation Day 2010

Dan with Mr. Fred Ochieng and Dr. Gerald Angira, both of whom caught a passion for orthopedics while rotating on the service, and will be pursuing further training in orthopedic surgery.

Graduating intern class 2010 with consultants!!

The future of medicine in Kenya, 5 guys very happy to be finished with internship.

Today, we celebrated the graduation of another class of interns, sixteen Kenyan men and women who have been intensively training at Tenwek for the past year. The minor explosion at the lunch catering table, caused by an attempt to add butane fuel directly to an already lit burner used to keep the food warm, resulting in singed arm hair, flaming chapattis on the floor, and a dress that caught on fire, made the event even more memorable. Thankfully no one was seriously hurt, and after this minor disaster was cleaned up, the festivities continued. During the ceremony, each graduating intern received a diploma, a copy of the book “The Purpose Driven Life” and new white lab coat.

Undoubtedly, the most satisfying aspect of the work at Tenwek, and the unifying purpose of all us “western missionaries” who are serving here in rural Africa, is the opportunity to impact the lives of young African physicians. As a consultant in orthopedics, I am privileged to play a role in teaching these physicians who are the brightest and best in Kenya, and of course, to influence them that orthopedic surgery is the ultimate pursuit! And God is doing an incredible work in orthopedic surgery at Tenwek. In addition to Dr. Kiprono, who is currently in his orthopedic residency at Moi University and will be coming on staff at Tenwek as a full-time orthopedic consultant in 2011, two other young men have joined the Tenwek orthopedic bandwagon. Fred Ochieng is a very bright, and godly, young clinical officer, who aced orthopedics during his rotation. He plans to begin an 18 month diploma program in orthopedic surgery, then return to Tenwek to join the team. Additionally, Dr. Gerald Angira, a general surgery resident at Tenwek, rotated with me for 4 months last summer, and recently decided to pursue residency training in orthopedics, also with the plan to return to Tenwek. This greatly excites me to be involved in the “grassroots” development of orthopedic surgeons and clinical officers in a country of 38 million that has, at best, only fifty, less than the city of Rochester, Minnesota!

I have always viewed the work we are doing here as a team effort, all of us joining together in God’s kingdom to accomplish His plans. While I am here on the “front lines,” you could have as much impact in the future of medicine in Kenya, in the training of the next generation of godly physicians. We currently have two major needs, one being the funding for the training of Drs. Kiprono and Angira, and Mr. Fred Ochieng. Unlike in the U.S. where residents get a salary (albeit meager) for their training, residents in Kenya must pay for their own training and living expenses, which costs, on average, $20,000 per year. Thus, most residents have to find “sponsors” before they can even begin, and lack of funds often delays matriculation into programs. By sponsoring one of these fellows, not only would you be helping the future of Kenya, but also Tenwek, as sponsorship also guarantees a commitment to serves at the sponsoring institution upon completion of their training. The second need is for housing of the new interns. As the numbers of interns and trainees increases here at Tenwek, the housing situation tightens. Currently, there are plans for two new intern housing projects, and construction is set to begin on the first shortly. However, the second building is only partly funded, and each missionary consultant has been asked to raise $25,000 towards the completion of this project. If you feel led to join the awesome work that God is doing here at Tenwek in the training of Kenyan health care professionals, let me know and I can provide you with more information! Together we can work to better medical care in this needy area of the world. Thanks for all the encouragement and support you have provided to our family!