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

Saturday, October 13, 2012

Tools for the Toolbox


Patient walking the day after surgery, standing with Dr. Marakalala, orthopedic resident from Botswana training at Tenwek.


Young lady with bilateral femur fractures treated with SIGN nails.


Another patient, up walking the day after surgery.


Happy to have his leg fixed!


Another young man with retrograde SIGN nail.


16 year old boy with Russell-Taylor nail.


X-ray of retrograde SIGN nail.


Femoral Russell-Taylor nail.


Tibial Russell-Taylor nail.


Paul Whiting, orthopedic resident from Tufts, who visited Tenwek in March, presenting our data from Tenwek on open femur and tibia fractures.


Boxes and boxes of Russell-Taylor nails.


All-day job but totally worth it.


"Too-long" nails to be delivered to Cedarville team who will cut nails down to a more useable lengths.


The new orthopedic storeroom is underway! 



One of my most important jobs as a missionary orthopedic surgeon at Tenwek is to ensure that we have all the necessary implants and instruments we need to provide the best possible care for our patients.  Implants and instruments are to an orthopedic surgeon as nails and tools are to a carpenter…without them, our care for the poor here would be extremely rudimentary and subpar.

As the majority of our orthopedic work at Tenwek is trauma-related, we see an exorbitant number of femur and tibia fractures secondary to road traffic accidents.  The “standard of care” for these types of fractures is the intramedullary nail (a long rod placed down the center of the canal, stabilizing the bone while it heals).  At Tenwek, we have two major types of nails: SIGN nails and Russell-Taylor Nails.  Without getting too technical, both of these rods are extremely critical and essential (each with slightly different indications) for treating the numerous femur and tibia fractures we see at Tenwek.

My trip to the States began at the annual SIGN conference, where we presented data from Tenwek on open (bone through skin) tibia and femur fractures treated with the SIGN nail.  Since first introducing these nails to Tenwek in December 2008, just shy of 600 have been performed!  For every SIGN nail done at Tenwek and reported on the on-line database, the SIGN Company replaces these nails at no cost to Tenwek.   Thus, as I left the conference, I carried with me a duffel bag of over 50 lbs of nails and other tools for Tenwek.

After visiting my in-laws and two churches in Phoenix, AZ, I then flew to Indiana to visit our mission agency, WGM, and sort through a massive donation of Russell-Taylor nails provided by Hope Force International.  Donations such as these usually contain a number of “odd” sized nails, either too short or much too long to be used in the majority of patients (unless a dwarf or NBA player).   I segregated two 50 lbs duffel bags of the “choicest” nails (perfect size) for immediate delivery to Tenwek (thanks Todd and Bill!).  Also, I found over 300 nails, size 46cm or above (too long for our patients at Tenwek), which I brought to Dr. Timothy Norman, professor of Biomedical Engineering at Cedarville University in Ohio, who organized a student project to cut and re-machine these nails to more usable lengths.

After several other engagements, including a meeting with the executives of a major orthopedic manufacturing company in Warsaw, IN, I returned to Kenya with 10 checked bags full of orthopedic supplies (which, thankfully, ALL arrived and cleared customs with minimal questions).  And these supplies did not come too soon.  Just last week alone, I personally did 8 Russell-Taylor nails and “team ortho” did another 8 SIGN nails, all in people who would otherwise potentially be permanently lame without these implants.  Instead, these patients were up walking, even the day after surgery, and truly very thankful (see pics). 

These nails provide a significant, yet minority part of our total needs at Tenwek.  And we continue to trust God to provide.   I am humbled by the fact that God is the One who does the work…it seems the harder I personally try, the less fruitful the results.  On the contrary, the more we pray for His provision, the floodgates open.  Thanks again for partnering with us in serving the poor at Tenwek in Christ’s name.  We appreciate your prayers and support!

 Eph 3:20-21 “Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us,  to him be glory in the church and in Christ Jesus throughout all generations, for ever and ever! Amen.”

Sunday, October 7, 2012

Eye-Witness to an RTA


While driving back to Tenwek last Friday with Heather and Jeremiah (and two other kids from Tenwek), as I rounded a gentle sloping curve, I saw two odd-shaped objects in the middle of the roadway off in the distance.  Having just returned from a 2-1/2 week, multivariate trip to the U.S. the night before, I was telling Heather all about the events of the journey.  One of the main reasons for the trip was to present data collected at Tenwek related to the huge rise in orthopedic injuries in developing countries secondary to road traffic accidents (RTA).  Ironically, we were about to witness a tragic, first-hand example of this growing problem.

As we drew closer, it became apparent that the two objects lying in the road were a motorcycle and a man, and we were the first ones on the scene.  Pulling off to the left, I assigned Jeremiah, Joel and David to get the motorcycle off the roadway, while I attended to the obviously-injured, middle-aged man who was lying on his side, dazed, with blood pouring from lacerations on his face and scalp.  Normally, in trauma situations such as this, victims are not to be moved until the cervical spine is stabilized with a C-collar.  However, I was worried that as long as we were in the middle of the road, we were both at risk for being struck by a speeding over-loaded passenger van or semi.  So, after running my fingers down his spine without feeling any obvious abnormality, I grabbed the man by his shoulders and dragged him off the road.  As I was pulling, I could feel crepitus (bones moving) in his right shoulder.  

With the motorcycle and victim now off the road, I could examine him more closely, and confirmed the lacerations, and shoulder fracture, and a potential fracture of his right hip (as his leg was externally rotated and he was not able to stand).  Thankfully, it did not appear that he had any immediate, life-threatening injuries.   Trying to use my newly-acquired (but still inadequate) Kiswahili, I asked the man, now a little more lucid, his name, where he was from, and what had happened.  “I was struck while driving my motorcycle and the car just drove away,” he said, the same hit-and-run story I hear so often.    

Without Emergency Medical Services in Kenya, the next concern was getting this man to Tenwek, which was about 50 km away.  A newly arrived onlooker hailed a passing sedan-car taxi, which stopped to see how he could help.  “How much to take this man to Tenwek,” I asked, thinking that perhaps the driver would not take advantage of the situation.  “Yes, please take me to Tenwek,” the victim said.  “My home is only a short distance from there.”   The quoted price, I thought, was bordering on opportunism.   While others helped the victim into the taxi, I reached into my pocket and gave the driver what I had available, and asked him to please help his fellow brother by driving him to Tenwek.  A few minutes later, they were off.

As I got back into our Land Rover, I noticed the blood on my hands, wondered if I would be seeing this man at Tenwek on Monday, and puzzled at the irony, absurdity and seeming senselessness of this event.  A while later, back on the road to Tenwek, Heather said, “I liked seeing you in action…God planned to have you be the first one on the scene.”  Her words took the edge off some of my raw emotions, and reminded me that the events in life, although at times tragic, are not random, or without purpose.  God is in control.  I was also reminded of the reasons we continue to serve at Tenwek...the need is so great. 

Thank you for partnering with us in this work at Tenwek, so that we can continue to provide “compassionate healthcare, spiritual ministry and training for service.”  We appreciate your prayers and support!