The Next Generation

Expansion of PAACS

Last weekend, I attended the annual Pan-African Academy of Christian Surgeons (PAACS) annual meeting in Chicago in my role as the Regional Director for PAACS Orthopaedics. Biggest news is that two additional programs will be joining the PAACS ortho family: (1) Kijabe/CURE (where we currently serve) and (2) Soddo/CURE in Ethiopia. In January 2019, the total number of residents will increase to over 20!

The PAACS Orthopaedic Council sub-meeting...13 US-based surgeons committed to the training and discipleship of national orthopaedic residents in Africa. 

The main PAACS commission meeting had more than 100 people in attendance. 

Tenwek

Tenwek will graduate our first two residents, Dr. Victor Sowayi, and Dr. Fasto Yugusuk in January 2019.  After graduation, Victor will be serving at Litein Hospital, joining three other PAACS General Surgery graduates at this mission hospital about 50 kilometers from Tenwek.  Fasto, who is from South Sudan, will God-willing return to his home after a few years of work or additional training.  Dr. Amada McCoy, who recently completed a pediatric orthopaedic fellowship at Baylor, joined the consultant team at Tenwek last month.

Dr. Amanda McCoy recently joined Tenwek as a long-term, orthopaedic consultant.

Kijabe 

The Kijabe/CURE program was approved to come under the umbrella of PAACS.  Although the residency was started in 2008, the consultants all agreed that PAACS would add tremendous value in terms of spiritual ministry, discipleship and training.  We recently held our residency interviews and have accepted three quality trainees into the program bringing our total number of residents to 10.  Dr. John Weston and his wife Ali, along with their two children, Gabe and Grace, will join Kijabe in late 2019. John is currently a chief resident at Mayo Clinic and has been accepted into Samaritan’s Purse Post-Residency Program.  

Dr. John and Ali Weston, Gabe and Grace will join the Kijabe team in 2019.  

John and I operated on this young man who received a total hip replacement for severe hip dysplasia. 

Kijabe CURE residents at our weekly PAACS spiritual curriculum bible study. 

Ethiopia

The new PAACS orthopaedic training program beginning in Ethiopia in January 2019 will involve two sites: (1) CURE Ethiopia in Addis Ababa and (2) Soddo Christian Hospital in Southern Ethiopia.  Recently, in my role as Regional Director, I visited both hospitals in Ethiopia, and was struck by the complexity of cases, and incredible talent of the surgeons at both sites.

The extreme work of the surgeons at CURE Ethiopia to correct neglected clubfoot.

The drive to Soddo was beautiful, roads flanked by red fields of teff, the grain used to make the Ethiopian staple food injera.

Dr. Duane Anderson (middle), a very gifted orthopaedic surgeon, has been at Soddo since 2005.  Dr. Brian Hodges (back row right) joined Soddo two years ago.  The three guys in the front are orthopaedic residents from Ethiopia and Kenya.

Global Missions Health Conference 2018

On the tail end of my quick trip back to the states, I attended the annual Global Missions Health Conference in Louisville, KY, where I taught a workshop on casting and splinting, and gave a presentation on PAACS orthopaedics to an enthusiastic crowd.  The conference was attended by more than 2500 medical professionals and students and was a impactful time of networking, and encouraging this next generation of young men and women called to serve in medical missions.

Instructing on the application of an RJ splint.

Great hands-on workshop.

Demonstrating how to reduce and splint an ankle fracture with Dr. Dylan Nugent as the "test subject."

A+ splints.

Psalms 71:14-16

As for me, I will always have hope;

I will praise you more and more. 

My mouth will tell of your righteous deeds, 

of your saving acts all day long - 

though I know not how to relate them all. 

I will come and proclaim your mighty acts, Sovereign Lord;

I will proclaim your righteous deeds, yours alone. 

Brief Galat Family Update - October 2018

The past several months have been incredibly eventful, not surprising for a family of 10! We were in the states for 6 weeks over the summer, and had a fantastic time together. 

One of the reasons for our trip to the states was so that I could take my oral certification exams, defending cases that I "collected" overseas at Kijabe.  I found out I passed the day we returned to Kenya (late August 2018)!  Now, I can officially be called a "Diplomate of the American Board of Orthopaedic Surgeons."  I am so grateful to God for this miracle and for all who prayed me through this process!  

Emma graduated from the Rift Valley Academy in Kenya on July 12, 2018, the day we left for the States.

We transitioned Emma into college at Biola University in California, where she is a freshman studying in the Torrey Honors Program, and majoring in Voice Performance.  The week school started, she went to the music department to inquire about private voice lessons and they asked her to audition.  Long story short, the head professor of voice encouraged her to change her major, offering scholarships, and now she is pursuing her dream!  

Claire is now in her senior year at RVA, busy with multiple activities, and in the midst of applying to colleges. 

What? Josie is now 5 years old and started Kindergarten this year at RVA at the Titchie Swot (which is the British term for primary school).  We've not seen a girl more devoted to learning as Josie!

Jane is now 3, and primarily loves Ethan. 

Last week, we celebrated Ethan's 1st birthday!

While we were in the states, we were thankful to say goodbye to Heather's grandma Stuber before she passed away this month.  Heather is going to travel back to Phoenix for the funeral next week while I remain behind as Mr. Mom.  

This November will mark our 10th year anniversary of life and work in Kenya and our third year serving at Kijabe Hospital, where I continue to work teaching and training the orthopaedic residents.  The Kijabe program was recently approved to become the 2nd PAACS program and a 3rd program will begin January 2019 in Ethiopia.  God is doing amazing things to grow PAACS orthopaedics, which started at Tenwek just 5 years ago!

My hip and knee replacement practice has grown exponentially at Kijabe and now about 40% of what   I do.  The residents love learning about adult reconstruction, but our cases are far from straight-forward.  As such, during our next scheduled home assignment (July 2019-August 2020) I "matched" at Mayo Clinic Arizona for a year long fellowship to bring my skills to the next level.  We are so thankful to be near family during this time!

Overall, God has been incredibly faithful, providing for every need on multiple levels.  

Thank you for your continued love and support of our family!

The Final Countdown (Ten Years in Waiting)

This week, I finalized the twelve surgical cases which were selected for my American Board of Orthopaedic Surgery (ABOS) part-2 oral certification exam, scheduled for July 24, 2018 at 6:30am at the Palmer House in downtown Chicago.  It all felt rather anti-climatic as I clicked the “submit” button around midnight on Thursday, after literally a 10 year process of waiting, trusting, and praying for the board to change it’s decades-old policy to allow me (and others) to “collect” cases while working overseas in missions settings (see When God’s Voice Thunders inMiraculous Ways).  Now, it all comes down to a three hour, grueling oral examination in which I will describe and defend these 12 cases, which were selected from a list of 120 that I did during a six-month period from April to September 2017.  In many ways, those six months were the most difficult of my career as an orthopaedic surgeon, as I felt continually pushed to the edge of my limitations, and had to manage complications which might not have occurred otherwise in a location without resource limitations.  The “strange and bizarre” cases at Kijabe, which differ so greatly from the “bread and butter” cases in the states, I’m sure, will raise a few eyebrows during my exam. 

After 10 years practicing in rural Kenya, it almost feels as if the “strange and bizarre” has become my new “bread and butter.”  Just last week, I did a hemipelvectomy (amputation of the entire hindquarter, including part of the pelvis) on a sweet, 45-year-old lady with dediffentiated chrondrosarcoma of the hip, a case way out of my comfort zone (sorry, no pics on this one).  Working late into the night, tying off large pulsing arteries deep in the pelvis in this HIV+ patient, her blood soaked through my cloth gown down to my skin.  I fearfully wondered if I would now have to take the one-month course of PEP (post-exposure prophylaxis) required after exposure to HIV+ blood.  Thankfully, after consultation with the PEP specialist at Kijabe, that answer was “no,” as these medications are known (by personal experience from another exposure in which a general surgery resident decided to stick my finger with a needle) to cause you to feel as if you’ve gotten the flu after being thoroughly beaten with a lead pipe.   

While I don’t have a hemipelvectomy on my list of 12, I still have some other challenging cases to defend, such as the patient who required an above knee amputation after her total knee replacement became infected with e. Coli, likely obtained at the local hospital she went to for “therapy” after discharge.   Her daughters later explained the conditions at this local hospital were entirely “unsanitary” and her wound left uncovered for days on end.  By the time she returned to Kijabe, her knee was draining copious pus, and she had developed a necrotizing-type fasciitis, which could not be controlled despite strong antibiotics and multiple trips to theatre.  Because I work in a resource-poor setting, other non-conventional techniques will need to be gingerly explained to the examiners, for instance, why I used a shorter plate here, or why I used a SIGN nail there.    Thankfully, though, all patients, whether complicated or not, did remarkably, even miraculously, well.

In the end, it is clear that God is sovereignly orchestrating all these events, from beginning to end, including the exact cases that were selected.  I’m praying this examination will be a testimony to many that God is at work around the world to bring glory to His name through orthopaedic medical missions.  Your fervent prayers are also appreciated during the final prep all the way up to the time of the actual exam.  Pray not only that I pass, but also that God would be glorified through the process, and that He would raise up others to follow a similar path so that PAACS orthopaedics can continue to expand (more on that later!).

Thanks for your ongoing prayers and support!

Imagine!

Beatrice hard at work doing PT after SIGN nailing of all 4 long bones of the lower extremities.

Beatrice standing with new, first-year orthopaedic resident Nobert Langat (left) and chief orthopaedic resident Isaac Kingori (right).

Right femur SIGN FIN nail.

Right tibia SIGN nail.

Left knee x-ray showing both femur and tibia SIGN nails. 

 The result of one of the multiple crashes which took the lives of more than 200 Kenyans in December 2017

Story told with patient's permission.

Kenyans use the word “imagine” frequently after listening to a story that has an unfortunate or unbelievable outcome, but that which might be ironically typical for normal, daily life in this developing nation.  For example…Me: “I just waited in line at the Immigration Office in Nairobi for more than 3 hours!” Kenyan friend: “Imagine!” Or…Me: “The policeman who pulled me over for ‘speeding’ actually suggested I pay him a bribe.” Kenyan colleague: “Imagine!”  Or…me eating lunch at the hospital: “My beef stew is missing the beef.”  Response?  You guessed it.  The word, used in these contexts, carries with it a negative sense of “if only.”  If only things could be different.  If only there was hope for real and lasting change.

Now, imagine yourself traveling cross-country as the front passenger in a matatu (14-seat van used for the majority of public transportation in Kenya), over-stuffed with more than 22 people (a common illegal problem in Kenya), and over-speeding on the main highway in Kenya (two-lane road with on coming traffic).   Imagine your matutu driver operating recklessly, crazily passing large trucks in order to save time, all the while with passenger shouting at him to “slow down” and “take care!”  Now imagine that, while overtaking another vehicle, a large semi comes barreling directly towards you, and with nowhere to turn to the left or right.

This is all Beatrice remembers prior to waking up one week later in Kenyatta National Hospital, with all four large bones of both legs shattered, the only survivor in this horrific December 2017 road traffic accident, only one among many in which more than 200 Kenyans lost their lives during this normally festive, family-oriented, but travel-heavy and now infamous month.   She had been given minimal care at KNH, and still had fragments of bone protruding through the skin in her right thigh.  Desperate, without money to pay for her care, family members requested transfer to Kijabe, where Watsi, (an on-line crowd funding platform), and four donated SIGN nails fixed her broken legs.  Now, she is on the mend, beginning to walk not even a month after her injuries.  When telling Beatrice how fortunate she was to be alive and how amazing, unbelievable and God-ordained the events were which brought her to Kijabe for care, her response was “Imagine!”

So the word “imagine” can also be used positively to respond to a story in which the impossible breaks through in the midst of tragedy, and in the end, all is not lost, futile, hopeless, or ruined.  Here, the positive use of the word carries the sense of “Can you believe it!?”  This is the essence of the gospel.  Imagine!...when we were dead in sin, God made us alive in Christ (Eph. 2:1-10).  Imagine!...every tear will be wiped away, and there will be no more pain or death (Rev. 21:4).  Imagine!...Christ is preparing a place for us in heaven (John14:2-3).  God can do exceedingly, abundantly more than we can ask or imagine (Eph. 3:20)!  Real, lasting change is possible (1 Cor. 6:9)!  Because of Christ, the “if only” becomes the “can you believe it?"  Imagine!

Thanks for all your prayers and support!