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

Sunday, May 23, 2010

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.

Friday, May 14, 2010

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.”


Saturday, May 1, 2010

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 CafĂ©” 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.