The Galat Family

“The Boy Can Walk”

2012-02-03T14:34:00.011-07:00

Kipkoech (now a little over two months since surgery after having both femurs plated, and tibia casted) and his mother.

Kipkoech, walking quite well with crutches. His picture was also in the recent blog entitled "Hope."

Other young boys treated at Tenwek for lower extremity fractures. These three, whom we dubbed "the three musketeers" would daily join for wheelchair mayhem in the Tenwek courtyard.

All toothless smiles after being released from three weeks of traction for a femur fracture.

Last Wednesday, our busy clinic day, while walking across the courtyard from theatre to clinic, I heard a woman’s voice call out, “Dakarti, the boy can walk!” I turned and saw a nicely dressed, broadly smiling woman standing next to a young boy who was leaning on a pair of crutches. The boy looked very familiar, but I struggled to remember who he was of the several dozen young patients I had operated on in the last several months. I then recalled his story (and remembered that I had a picture of him in my recent blog entitled "Hope"). As is all too common in Kenya, while walking on the side of the road, he was hit by a car, and suffered bilateral femur fractures and a left compound (open) tibia fracture. After three surgeries, including plates and screws on both femurs, now only two months after his injury, he was walking quite well and x-rays showed that all his fractures were healing without any signs of infection.

After chatting with the boy and his mother for a while, the woman said, “Thank you for helping my boy walk again.” To be completely honest, when I heard this comment, I immediately felt a degree of pride, as if his ability to walk was somehow about me, and my ability. But then I remembered the entire orthopedic team (nurses, scrub techs, physiotherapists, etc.) that works so hard every day taking care of the many patients like Kipkoech...and I thought of the team of people all over the world who support the work at Tenwek through giving, encouragement and prayer...and I thought about the motto that has been Tenwek’s trademark for decades, “We treat, Jesus heals"...and finally, I was gently reminded by God where I would be without His amazing grace in my own life. I then had the overwhelming sense that all that happens here at Tenwek is NOT AT ALL about me, but rather about God’s unbelievable goodness and grace. I then told her, “Please give thanks to God, because he is the One healing your boy.” “Yes, of course,” she said shrugging her shoulders in Kenyan fashion...“I do!”

Thank you for partnering with us to help boys like Kipkoech walk again so that the name of Christ may be glorified!

Hebrews 12:12-13 Therefore, strengthen your feeble arms and weak knees. “Make level paths for your feet,” so that the lame may not be disabled, but rather healed.

Coffee and the Call of God

2012-01-21T11:38:00.003-07:00

Picking coffee berries from our bush in the back yard.

The beans inside each newly-picked berry must be squeezed out or separated from the fruit, and then allowed to dry.

After drying (using the "pulp natural" method of processing), the parchment covering each bean must be peeled off. The yellowish beans on the right are "parchment coffee" and the beans on the left are the "green beans" which have each been individually hand peeled. This is the longest and most meticulous part of the processing.

Green coffee ready for roasting.

A hot-air popcorn popper serves as an excellent coffee roaster.

Fresh-roasted beans ready for grinding and brewing.

Some brilliant, long-past resident of our house at Tenwek had the foresight to plant a coffee bush in our back yard. And so, last month, we harvested the first crop of our own, home-grown Kenyan coffee (although small enough only for one French-press pot). Processing of coffee, from the picking of ripe berries to the roasting of the “green beans,” was quite involved, but fully worth it after taking the first perfect sip of fresh-roasted coffee.

When Heather and I were researching opportunities for orthopedic mission service in 2006, we stumbled across Tenwek Hospital which happened to be in Kenya. Although at the time we had no clue, geographically, where this small country lie on the African map, in our passion for home-roasted coffee, our hands-down favorite had always been (and still is) Kenyan, with its characteristic “bright citrus notes, and black currant, winey hues” (as described on www.sweetmarias.com). We thought, “If the coffee coming from Kenya is this good, it must be a really cool place to serve.” So here we ironically are, now full circle, thanking God for bringing us sovereignly to this place of service, while drinking a cup of our very own Kenyan brew.

God often works and directs in and through our passions to accomplish the purposes of His kingdom. What are your passions? And how is God directing you to strongly serve Him in and through those passions? Let us encourage one another to step out in in the unique gifting, calling and interests that God Himself has given us. Oh, and once you have tasted home-roasted coffee, you can never go back...nothing else compares!

Delight yourself in the LORD and he will give you the desires of your heart.
Psalm 37:4

Courage

2011-12-13T11:56:00.002-07:00

Walking through Casualty last Friday night, making one more round to see if anything was brewing before heading home for our weekly family “pizza night,” I saw two young Masai men, both significantly bruised and bloody, bandages on their heads, sitting stoically awaiting their turn for x-rays. “What happened to those guys,” I asked a nearby intern, thinking perhaps they engaged each other in a good mid-December drunken brawl. The intern replied, “They were tired of the lion that was killing off their livestock, so together, they speared it.” I could only imagine the scene as it unfolded, an obvious grapple, as evidenced by the wounds sustained by both men, and since they were both still alive, I surmised the lion had met her match. I walked up to one of the men, and looked him in the face, admittedly obviously impressed by the courage he demonstrated. He looked at me, and since I don’t speak a word Masai, I spoke the universal language that all men understand…I gave him the “thumbs-up sign." He responded back with a barely perceptible crack of a smile from the corner of his mouth as if to say, “I killed me a lion today.”

I thought of David, who proclaimed to Saul, when told he was unable to face Goliath because of his youth and size, “Your servant has killed both the lion and the bear; this uncircumcised Philistine will be like one of them, because he has defied the armies of the living God." Sometimes God asks us to do things that seem impossible to us, well beyond our own strength and ability, like for David, killing lions, facing Goliaths, or being a King. But these times are divine opportunities to demonstrate courage, which is more a decision of the will than an emotion of the heart, and undergirded by faith that a stronger Power is at work in our lives, accomplishing great things in and through us. Then, when these great things happen, knowing who we truly are in our own strength, all we can say is, “God, you did that…the Glory goes to You.” Were the Masai warriors afraid when they attacked the lion? Perhaps…but fear obviously did not dictate their actions. Necessity did. Sometimes you just “got to do it,” in faith, and trust that God will give what is needed to get the job done. That’s what the heroes of the faith did, normal men and women like you and me, driven often by necessity and a passion for God’s Glory, refusing to bow to fear and cowardice, willing to trust God’s promise to be near. That’s how great things happen.

Deuteronomy 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.”

Hope

2011-12-04T07:24:00.008-07:00

Young boy with bilateral femur fractures and open left tibia fracture after being hit by a car. Plates and screws for the femurs and a cast for the tibia allowed him to get out of bed early. He quickly became adept with handling his wheelchair.

Young lady at first followup appointment after having long screws placed across her sacrum to hold fractured pelvis in place. I especially like her husband's sweet hat...

The orthopedic surgical team...pushing the large cart of freshly sterilized implants and instruments to theatre at the start of a long day.

Man with acetabular fracture (hip socket) laying in bed in traction for 6 weeks...plently of time for reading and spiritual growth...

We are blessed to have our current set of visitors...from the left, Drs. Gaw and Morris. Dr. Araka (next to me) is the current intern on our service. Yes, I am needing a haircut...

December is classically the season for orthopedic trauma at Tenwek hospital, the busiest month in terms of admissions and surgical cases, most of which are related to road traffic accidents and/or alcohol (which is more easily obtained with the “bonuses” commonly given this month). As if on cue, on December 1st, two young men were admitted (one 18 and the other 20), with incredibly severe pelvic fractures. Both were very inexperienced drivers of “boda-bodas” (motorcycle taxis), and both looked more like 14 rather than their stated age. On December 2nd, three more young men were admitted with severe lower extremity injuries (yes, boda-boda plus alcohol), one man with bilateral open (meaning bone poking through skin) tibia fractures, and femur fractures. Yesterday (December 3rd), a 37 year old man was admitted after falling from a tree. He was paralyzed from the chest down, with two badly crushed thoracic vertebrae. Today, December 4th, is still young…

To be honest, one of the temptations working at a busy mission hospital is to succumb to feelings of hopelessness. Many of the patients we see have injuries and conditions that are well beyond the help of western medicine. Last week, we admitted a 17-year-old young man with a mass on his hip the size of a small football. Biopsy revealed sarcoma, and a simple chest x-ray showed that the cancer had already spread to his lungs and shoulder. How do you explain to a patient this young that he likely only has a few more years to live? Personally, we also feel the physical and emotional burden of continually trying to stay ahead of the relentless workload in our attempts to alleviate suffering in patients. Adding “injury to insult”, tomorrow, December 5th, a nation-wide strike of all national (Kenyan) physicians is scheduled to begin (including, unfortunately, our own interns at Tenwek). If the strike materializes, patients will soon flood into Tenwek, which would literally be one of the remaining few open hospitals in the country. Perfect timing during this busy season…

Yet, we continue to hope, because we know our God specializes in bringing good out of seemingly hopeless situations. This is the essence of the Advent Season leading up to Christmas…at the darkest time in history, the Christ-child, God in the flesh, entered humanity with the sole purpose of redeeming mankind from its bondage to sin through His eventual death on the cross. Imagine the God who is both perfectly just, and perfectly loving, in that he took our sin on His own shoulders! No wonder the angel proclaimed to the shepherds on the night Christ was born, “I bring you good news of great joy!” And God continues to bring hope in the midst of suffering here at Tenwek. He provides the orthopedic implants we need at just the right time, so that we can help many of the patients God sovereignly brings us…the young man with sarcoma accepted his news with peace while clinging to his bible…a 75 year old alcoholic who broke his hip after a drunken fall accepted Christ as his Savior (after he recovered from his delirium tremens)…patients are healed in Jesus' name…

The truth is, we all have hope. The question we need to ask ourselves is: “Where do we place it?” Job security? Money? Position? Family? Education? Entertainment? Food? Do we view these things as our source of hope, or as “gifts” from God who purchased all good things we enjoy by His death on the cross? During this Advent Season, may we all put our hope in the true Source, and worship the Creator rather than the created. Christ is the ultimate gift from God to us…Hope in the darkness…Good news of Great Joy.

Psalm 130:7-8 O Israel, put your hope in the LORD, for with the LORD is unfailing love and with him is full redemption. He himself will redeem Israel from all their sins.

A Father’s Heart

2011-11-12T10:40:00.002-07:00

Two weeks ago, a young 13 year old boy named Washington was admitted to Tenwek after his leg was crushed by a boulder which fell on him while he was bathing in a river. He arrived more than 24 hours after the injury, having been first “treated” at a small hospital near his hometown. His shattered shin bone was plainly visible beneath a huge defect in the surrounding skin. The dirtiness of the river water, combined with the severity of the open wounds and delay in adequate treatment, meant that infection would be inevitable and difficult to treat.

I spoke with the boy’s father, a young man himself in his 30s, not wanting to paint a false picture, explaining that although we would do what we could to save his son’s leg, amputation might be unavoidable. The man seemed to understand and said, “Please do what you can.” So I prayed with him, asking God to do a miracle.

What followed was a series of surgeries to try to control the infection. At Tenwek, for pediatric patients, we use a drug called ketamine, a relative to PCP (angel dust) to provide sedation for short surgical procedures. Ketamine produces a “dissociative anesthesia,” meaning that although the patient is completely awake during the procedure, he neither feels pain, nor is cognizant of his environment. Often, patients under ketamine communicate very interesting things, and, like a truth serum, can reveal the deeper contents of the heart. Washington told us during his first surgery (in which we removed a large amount of dead skin and bone), in very good English: “My name is Washington, as in Washington D.C., and when I grow up, I want to be a doctor.” Then, speaking in Swahili, over and over again he said the word “babba” followed by the same repeated phrase. I asked the scrub techs what he was saying and they translated, “Daddy, don’t leave me.” And his daddy never did, always sitting by his side in the pediatric ward, constantly there.

At first, it looked as if the infection was under control. However, a few days ago, the leg took a major turn for the worse. Despite multiple surgical debridements and treatment with three IV antibiotics, a foul smell began to emanate from the wound, and Washington spiked high fevers. I spoke again with Washington’s dad, explaining the next surgery would need to be an amputation. “How will he walk?” the father understandably asked with a combined look of anger and desperation. Although I try to avoid making promises I may not be able to keep, I told him, “I will personally make sure he gets a good prosthesis from the U.S.”

My experience with Washington and his father opened my eyes to finally notice the many other fathers on the pediatric ward, constantly there, offering comfort in the midst of tragedy and pain. They remind me of our true Father, whose perfectly strong and tenacious love never lets us go…constantly patient…continually there…comforting when we are hurting…upholding when we are weak…providing hope in the midst of darkness.

Romans 8:15: For you did not receive the spirit of slavery to fall back into fear, but you have received the Spirit of adoption as sons, by whom we cry, “Abba! Father!”

If you would like to donate to Tenwek’s Compassionate Surgical Fund, which helps patients like Washington, please email donations@wgm.org and mention project ID 125-35224. Thanks for all your support of our family!

Camping in the Aberdares

2011-10-21T11:57:00.006-07:00

The drive to the Aberdares.

The campsite. Note the small "adult" tent that was pitched under this shelter.

The view from our campsite when we awoke in the morning. The mist in the center of the picture is from the nearby waterfall.

"Native" Jeremiah, barefoot as usual, trying his hand at trout fishing.

To appreciate the size of this waterfall, note the person standing to the right.

Another view...

Trout cooked over an open fire...as the Kenyans' say, "very sweet."

After the rains...

Trying to dry out and get warm. Of note, it is about 50 degrees F.

Jeremiah's legs...remnants of a great weekend.

A few weeks ago, Jeremiah and his entire dorm of sixteen young adolescent males went camping in one of Kenya’s national parks, the Aberdares, a central mountain range about 100 km north of Nairobi, rife with huge waterfalls, forest elephants, rainbow trout, and…rain (the entire water supply of central Kenya comes from this region). The chaperones? Jeremiah’s “dorm dad” (Rodney) and his “genetic dad” (me). After driving 3 hours on slippery dirt roads, stuffed into our “new” used Toyota Regius Ace with 10 somewhat stinky boys, Jeremiah riding shotgun, we arrived at our site and set up camp in the dark. Soon, the sloppy joe meat pot was steaming over the fire, and we settled in for the evening. Rodney and I had no shame in setting up our tent under the makeshift tarp shelter we erected. I found out later why this was such a solid move.

The following morning, while I was cooking breakfast, Jeremiah and about 6 of his buddies emerged from their tents wearing only homemade loin cloths, saying they wanted to “go native” and “blend in” with the environment (which I can assure you did not happen). Aside from this unwanted sight, (which reminded me of a scene from the movie “Lord of the Flies”), the morning was incredibly scenic; and, viewing the surroundings for the first time, I understood why some people call this area the most beautiful part of Kenya. Later, Rodney, an avid outdoorsman, set us all up for fly fishing in the mountain brooks that flowed nearby.

About 1pm, it began to precipitate. At first, this was a novelty for the boys, who were running about, getting pelted with the falling rain and hail, not thinking about how cold they could potentially be in the very near future without dry clothes or a roaring campfire. After a solid two hours and 3 inches of rain, however, the fun was over, and our campsite, including “the adult tent,” was beginning to flood. The majority of the boys took shelter in our van, which was only somewhat dry. We literally built a dike around our tent and dug drainage ditches to protect our only remaining precious resource: dry clothes. The rains let up around 4pm…for about a half hour. It then continued into the evening, and thus we decided to “turn in” early (which for the boys was about 1am). Sometime in the middle of the night, I woke up, noticed that the rain had ended, and looked out the widow of the tent to see the “southern cross” surrounded by the starriest night I have ever witnessed.

The next morning was cloudless, and when the sun edged over the mountains, our campsite began to dry out. After breakfast, Rodney led the boys in a discussion on a Christian view of relationships with the opposite sex, specifically how this relates to the new dating policies at Rift Valley Academy. As I sat listening to these boys share their collective thoughts on the subject (actually with more wisdom than I anticipated), I thought to myself, “Here is an incredible group of young men, missionary kids, each with a unique story of how God got them to this place at this time in life.” And I wondered what each of them would become in the future, products of the rich lives they have been privileged to live.

After one more round of fly fishing, we broke camp and headed home. When I arrived back at Tenwek later that evening, I took a long and very hot shower, amazed at how thankful I could be for something we so easily take for granted. It was a great weekend. Next camping trip in the works: the Suswa caves.

The (Not-So) Typical Work Week at Tenwek

2011-10-09T04:55:00.004-07:00

Jeremiah, recovering with cup of chai in hand, after removal of the plates and screws in his knees and ankles.

Total knee replacement done with implants sourced from Nairobi. The goal is to help patients with bad arthritis, and use the funds generated by this program to subsidize care for the poor.

People often ask “What is your typical orthopedic surgery work week like at Tenwek.” Following is a sampling of last week’s schedule, highlighting the most interesting case for each day, and the teamwork worldwide required to make modern orthopedic surgery possible at our rural mission hospital:

Monday: Intramedullary nailing (with a long rod) of a midshaft femur fracture with nails remanufactured by a team of students and professors from Cedarville College. Often times, and not surprisingly, nails that are donated to Tenwek are of extreme sizes, more appropriate for NBA players than the average Kenyan. This team took 80+ of these excessively long nails, and first engineered, then re-manufactured them to the most common lengths (38, 40 and 42 cm). Thank you Cedarville team!

Tuesday: (1) Knee arthroscopy (knee “scope”) in a 34 year old Maasi man who works as a chef at one of the premier safari lodges in Kenya (arthroscopy equipment donated by an orthopedic surgeon from the U.S.). (2) Revision SIGN femoral nailing in a 29 year old Muslim man who reminds me daily to get him the English Bible he requested (I promised him he WILL get it tomorrow!). SIGN Fracture Care International is a company which designs, manufactures and distributes orthopedic implants to medically underserved countries around the world.

Wednesday: Three month old distal clavicle fracture in a 47 year old man. Tough case…that’s all I have to say about that.

Thursday: Total knee replacement in an Indian-Kenyan man from Lake Victoria. The goal is to use the funds earned from this burgeoning “adult reconstruction” program (hip and knee replacement) to subsidize the cost of orthopedic trauma implants for the poor. In the next four weeks, we have 6 additional cases scheduled!

Friday: Ankle fusion in a 73 year old man who was initially (mis)treated at one of the largest hospitals in Nairobi where his broken and dislocated ankle was placed in a cast.

Saturday: Plate and screw removal in a burly, 14-year-old young man by the name of Jeremiah Galat. He insisted that the anesthesiologist NOT give him any sedation so that after he was given the spinal, he could slap his own legs without feeling it, and try to make me laugh during surgery.

Sunday: Sabbath day off! Thank you Dr. Moore (4th year orthopedic resident from University of Alabama) and Dr. Bacon (not-so-retired orthopod from the U.S. who is with us for 4 months) for taking call this weekend. The orthopedic service at Tenwek could not survive without a regular influx of visitors who sacrifice vacation and holiday time to serve along-side us.

In all we do at Tenwek, our goal is to bring glory to the One who saved us because of His own mercy! Thanks for all your prayers and support!!

Titus 3:4-6 But when the kindness and love of God our Savior appeared, he saved us, not because of righteous things we had done, but because of his mercy. He saved us through the washing of rebirth and renewal by the Holy Spirit, whom he poured out on us generously through Jesus Christ our Savior.

On Call

2011-09-17T11:51:00.002-07:00

Helen Tangus, one of the lead hospital chaplains, prays with a group of patients.

While dozing off around 11pm last Thursday night, our house phone rang and Heather answered. “Do you want to talk to Dr. Galat?” she asked, clearly a call from the hospital. As she handed me the phone, I could hear chaos in the background, children crying and people talking in heightened tones, obviously stressed by whatever situation was unfolding in Casualty. This, in combination with the strong Kenyan-English accent of the caller, made it difficult for me to understand what was being said. I did, however, hear something about a child with a “traumatic amputation” and thought to myself, I had better head up to the hospital ASAP.

When I walked into Casualty a few minutes later, it was far worse than I anticipated. Over in one corner was a young woman whose right arm was wrapped from hand to shoulder with a blood-saturated dressing. Nearby, a small boy lay quietly on a stretcher, his entire right arm missing, with only a compression dressing on the remaining shoulder. Next to him, several staff members were attending an even younger patient, a little girl about two years old with severe facial and scalp lacerations. Between them stood a dazed, young woman with her own injuries, the mother of these two children, herself completely unable to cope with the trauma or offer any comfort. Across the room sat another, almost juvenile-looking injured mother, ignoring her own pain, desperately trying to nurse the crying child in her lap who also had bandages wrapping both legs. Under the dressings were severe abrasion injuries too horrific to describe. “Will you have to cut them,” the mother asked, looking first at the baby’s legs, and then, with desperation, into my eyes. The entire scene was surreal, and for the first time in years, I found myself slightly nauseated.

“What on earth happened here,” I asked out loud. No one was able to give a solid answer…something about a small bus swerving out of control after hitting a donkey. Stories like this are all too common, but what struck me hard that night was the fact that so many of the victims were multiply-injured women and children. “What are God’s purposes in all this?” I thought to myself as I was completing the amputation of the arm of the first young woman at 2am in the morning. The next day I found my answer, at least in part. Person after person: chaplains, visitors from the U.S., and staff heard about the victims of this accident and visited them, offering prayer and comfort and hope. This is the reason Tenwek Hospital exists, and why we are here, so that the arms of Jesus can be extended to those who are suffering. While answers may often escape us, we can continue, in faith, to reach out to those who are hurting, and trust that God’s purposes are always pure, always loving, and never random.

Please pray for the victims of this accident and the many others that we see at Tenwek on a regular basis. Thank you for all your prayers and support!

2 Cor. 1:5 For just as the sufferings of Christ flow over into our lives, so also through Christ our comfort overflows.

An Unexpected Goodbye

2011-08-29T22:17:00.006-07:00

The RVA Crew from Tenwek. Only one student is missing, Brendon Steury.

Settling Jeremiah into his new dorm room.

I will miss regularly interacting with Jeremiah (and wrestling...although less frequently now that he is so big...i.e. more at risk for injury).

As missionaries living and working overseas, “goodbyes” are common, but nonetheless painful, especially when involving those closest to us, and even more so when these goodbyes are unexpected. Jeremiah, our oldest, now a strapping 185lb, 14 year-old freshman in high school, was accepted in April 2011 to the Rift Valley Academy (RVA), a well-known and highly academic mission boarding school about an hour outside of Nairobi on the edge of an escarpment overlooking the Great Rift Valley. About 500 students, K-12, attend this school (which began in 1906), most of which are missionary kids from all over Africa.

The wait list to get accepted to RVA can sometimes be several years long, so when Jeremiah was accepted in April, we were quite surprised. After much discussion and prayer, and with the good advice from many that we should leave the final decision to him, Jeremiah chose, back in April, to defer his acceptance and return to the wait list for the following year. However, when we arrived in Kenya two weeks ago, and after seeing all his friends from Tenwek preparing to go to RVA, Jeremiah began to regret his decision. He came to me and said “Dad, can you call RVA and ask them if that position they offered me is still available.” Knowing the chance of there being an open spot one week from the start of school was next to nil, and wanting to help put the issue to rest for Jeremiah, I said, “Sure, but I don’t think the possibility is good.”

The following day, I emailed the admissions director, just after Heather and I read the devotional in “Jesus Calling” entitled “Entrust your loved ones to me.” We prayed and asked God to open the door if this was His will for Jeremiah’s life. After several hours, and no return email, I decided to call (as Jeremiah originally requested). I reached the assistant principle, and after explaining our situation, and that I knew the request was a longshot, he said, “Let me ask the admissions director…she is sitting right here at my desk!” I could hear her in the background saying “Is that Dr. Galat, Jeremiah’s dad? I was just going to email him to let him know that we have a spot for Jeremiah if he wants it!” This time, we were shocked.

Long story short, we just finished New Parent Orientation with Jeremiah yesterday, and said our unexpected, but peace-filled goodbyes. He is now "on his own" (that is, out of our hands and in God's). It was a hard day for both him and us. But, as is so often the case in our lives, when God works at the last minute and in such a miraculous way, we can be completely confident that He is the one who has done this work. We know we can entrust our son to God, the One who loves Jeremiah (and all our children), far more perfectly than we ever can. Please pray for Jeremiah, that he would adjust well to this new change (yet again), that he would make some really close, solid friends, that he would do well in high school (taking some tough courses), and finally, that he would get fully prepared for rugby season, which starts next spring!

Thank you so much for all your prayers and support!

Home

2011-08-17T02:05:00.001-07:00

It is easy to forget how long and grueling the flight from the U.S. to Africa can be…minimal sleep, the logistics of managing 28 pieces of checked containers, carry-ons, etc., and keeping track of Levi (he is a stealthy little fellow). But God blessed this journey greatly…Delta waived $1200 in excess baggage fees and only 2 of 28 pieces did not arrive in Nairobi (not a bad ratio). Customs officials asked only a few questions, and quickly waived us on through without inspecting any bags (after seeing Claire’s big smile).

We have arrived home…and it does not feel like we have even been away these past 14 months. The sound of dogs barking last night (our first night in Nairobi) was almost strangely comforting, lulling me back to sleep. We have often wondered where “home” is, as we do not own a physical structure. Multiple times we have told our kids that “home” is wherever we are as a family, whether in Phoenix, Ohio, Minnesota, or now again in Kenya. This perpetual earthly roving reminds us that our ultimate home is yet to come: the place where we will never move again, never have to say goodbye, never have to re-adjust, and most importantly, be forever with the One who loves us with perfect love, saving us by His death on the cross. Then, we will truly be Home.

Hebrews 11:13-16 13 All these people were still living by faith when they died. They did not receive the things promised; they only saw them and welcomed them from a distance. And they admitted that they were aliens and strangers on earth. 14 People who say such things show that they are looking for a country of their own. 15 If they had been thinking of the country they had left, they would have had opportunity to return. 16 Instead, they were longing for a better country—a heavenly one. Therefore God is not ashamed to be called their God, for he has prepared a city for them.

Paradox 2.0

2011-08-13T00:03:00.007-07:00

Watching from our balcony the approaching dust storm decending upon the Valley...simultaneously beautiful and foreboding.

As we finish our final few days in America, having completed a good, yet periodically difficult year of furlough, our emotions paradoxically toggle between strong joy and deep sadness (joy in the many memories shared with family and friends as an extreme blessing from God//sadness that we are leaving them for another two years), supernatural peace and self-focused anxiety (peace arising from the knowledge that God has called us, and that He is so near//anxiety when contemplating the seemingly impossible and imminent task of yet another transition, moving our family 10,000 miles overseas, checking 27 pieces of luggage, setting up our “new” house at Tenwek, and resuming responsibility in the orthopedic department), and excitement and fear (excitement to return to the places and the people we love in Kenya//fear of the unknown).

We are reminding ourselves that paradoxical, conflicting feelings are completely “normal” in these times of transition (and thus allowing ourselves to “feel” and to not take ourselves too seriously). But we are also reminded how broken we are, and how much we desperately need Jesus to equip us to accomplish these seemingly impossible tasks which lie ahead. Thankfully, God specializes in doing “immeasurably more than we can ask or imagine” (Eph. 3:21) and we have seen Him do this time and again. Amazing, however, is the paradoxical fact that God works in these impossible ways, in response to the simple prayers of ordinary people. For some reason, God moves when people pray. As such, we are dependent upon, and partners with, you who are committed to praying for us while we serve in Kenya. If you would like to commit to praying regularly for us over the next year, please let us know and we can add you to our prayer team list. Thank you for your ongoing support of our family!

PS. This past year, many people have asked us the question “Why are you doing this work?” (Interestingly, no one finishes the second half of the question which is “when you could have a much more comfortable life here in the states?”), and it has really made us examine our paradigms. Another question (posed in a sermon preached by Pastor Chris Davis this year) helped us resolve this “why” question. He asked “Do you view your gifts as resources to be shared, or earnings to be hoarded?” Bottom line issue…ALL we have is a GIFT from God.

PSS. Heather and the kids have started their own blog, entitled “Real Life…at Home in Kenya” (click to view). Check it out!

Preparations 2.0

2011-07-14T17:17:00.003-07:00

Jeremiah, 13

Emma, 11

Claire, 10

Levi, 7

It feels somewhat like déjà vu with endless lists, errands, purchases, planning, etc. for our impending return to Kenya. Making the task more daunting has been the fact that summer is officially full-throttle in Phoenix, with temps easily into the one hundred teens. Thankfully our family is currently in a much cooler Marion, IN at the WGM headquarters completing a week of Orientation Camp (OC) to prepare us again for the challenges of cross-cultural ministry. The kids are participating in their own program, although Jeremiah is finding time to sharpen his archery skills and catch a few bass. After OC, we head to Mansfield for a week to visit Dan’s family, then to Midwest Camp. We arrive back in Phoenix on August 2nd, to complete the packing process prior to our departure to Kenya August 15th.

Overall, we are so thankful for this year of preparation before our upcoming two year stint in Kenya (through summer 2013). Our goal and prayer at the beginning of this year was that God would maximally prepare our family holistically (mentally, emotionally, physically and spiritually), so that we can, as a family, maximally glorify Christ in the next two years. Sometimes we don’t understand what we are praying, and have preconceived notions on how we think God should answer our prayers, usually in less painful and more convenient ways. But God is not interested in just superficial change, but that which runs deep, into our core.

Thank you for all your prayers and support of our family on this return journey to Kenya!

April 2011 Update

2011-04-10T21:54:00.010-07:00

Galat Ministry Video

A few months ago, we met a young man named Karl Feller (who is a gifted videographer) at a Medsend dinner in Phoenix. He works as a full-time chaplain at a local hospice, but, in his limited free time, uses his cinematographic talents to assist missionaries. He recently shot a short, 5-minute video of Heather and me highlighing the work we do at Tenwek. To view, click here.

Tickets are purchased!

We are very happy to report that we have a date set for our return to Kenya....August 15, 2011! Our original plan was to leave for Kenya in June, but we have some additional required training at WGM headquarters in July. We will begin Kiswahili language training by the end of August (after we settle into our “new” home at Tenwek). Please pray for our family as we plan and pack for this next two year stint in Kenya.

Arcadia Rabbits Beware

Jeremiah’s newest interest is bow hunting with his new compound bow. We currently live with Heather’s parents in a heavily populated, urban neighborhood (Arcadia), which also happens to be overrun with hares. So far Jeremiah has bagged four, the most recent one from 30 yards. I am anticipating that any day now, I will have a visit from the police with questions about a young adolescent male stalking the neighborhood with a compound bow. Jeremiah assures me that he is safe, and that he only kills animals for food (grandma does not like the fact that there are rabbits in her freezer).

Thailand Update

2011-03-22T13:19:00.009-07:00

Examining a young boy with cerebral palsy for hip problems.

Jeremiah and Sutee, hanging out at the House of Love.

Jeremiah adeptly handles a "fish ball" with a pair of chop sticks.

Pickup truck ride to CDPD.

CDPD physiotherapy staff were well-trained.

Jeremiah and I returned Sunday night from our trip to Thailand and were so thankful for the opportunity to participate in the lives of children who would, according to Jesus, be rightly considered the “least of these.” During the week, Jeremiah and I did a study of the book of James, and we were struck especially by James 1:27: “Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress…” There is a tremendous amount of paradox in this because the world completely rejects these kids at the House of Love…orphans, many HIV+, ethnic minorities, disabled…and accepts those who are strong, capable, “loveable.” But God promises to be a Father to the fatherless, the defender of the defenseless…He loves the outcasts and rejected. This is what makes Hope for Hilltribes (and other ministries focused on “the least of these”) so unique and “blessed” by God.

We arrived in Chiang Mai on Monday afternoon and after checking into the “M.D. House” (which proudly advertised itself as the 3rd best hostel in Thailand?), headed to the House of Love via a sweet, three-wheeled “tuk-tuk.” There, we met the kids, including Sutee, a 10-year-old boy who came to the House of Love about 3 years ago…deaf, mute, HIV+ and an orphan with no family, considered the “village idiot” because of his inability to communicate (perhaps the result of having been affected by congenital syphilis which can cause deafness, and the characteristic flattened nose which Sutee demonstrated) and with multiple scars marking the resultant abuse he suffered. According to Kim, the missionary who started the House of Love, Sutee was completely detached emotionally when he first arrived. But now, he is one of the most animated kids I have ever seen, almost annoyingly so, communicating with a self-developed, and fairly sophisticated sign language which included a lot of touching (no concept of personal space with Sutee, but that was just fine). God continues to teach me to love the way He loves.

The following day, we took the kids swimming at a “resort” with a very fine, slightly murky green pool, where there was much frolicking, slashing and cannonballs, as demonstrated by the master, Jeremiah. On Wednesday, it starting raining, and the temperature dropped into the 50’s (according to Kim, the coldest she had seen in Thailand during her 26 year stint), just in time for our 5 hour road trip via pickup truck stuffed with 4 adults and 6 kids into the hills of the ‘golden triangle’ region of Thailand, to the small town of Mai Sariang, the location of the Christian Center for the Development of People with Disabilities (CDPD). Jeremiah and 3 others rode in the back of the pickup, covered by a make-shift cap, but unsealed from the elements. They persevered the cold rain for 5 hours, the trip unbroken except by a short lunch of trademark Thai soup with noodles and “fishballs”(foul-smelling, gelatinous morsels that even Jeremiah -the teenage version of Andrew Zimmern - could barely stomach) at a road-side café. At the CDPD, we met the incredible Thai staff dedicated to ministering to families with disabled children and we delivered the wheelchair Fred brought all the way from Columbus Ohio for a girl with cerebral palsy. We made the return trip to Chiang Mai the following day after staying a night at the “luxurious” Northwest Lodge, where I don’t think the sheets had been changed in at least a month, as evidenced by the strange scent and blood stains which prompted me to request they be changed.

On the return trip, Jeremiah developed a headache, fever and chills, no doubt the result of his cold ride up the mountain the previous day. He had no other symptoms however…no GI distress, no sore throat, no cough…just this recurring and high fever (mixed with a little delirium), held at bay by steady administration of ibuprofen. Finally after two days of worsening symptoms, I started him on antibiotics which I brought along “just in case” and the fever broke. Only afterwards, did he develop a sore throat with inflamed and purulent tonsils…likely strep throat. Thank God for antibiotics!

Overall, the trip was humbling, yet, simply, a lot of fun. Thanks for praying for Jeremiah and I and for praying for these kids. If you are interested in learning more about Hope for Hilltribes, I encourage you to visit Freddy’s website. Let us encourage one another to be involved with “religion that is pure and faultless”…and receive the incredible joy and satisfaction that accompanies it, all made possible by the Cross of Christ.

Mission Trip to Thailand

2011-03-05T11:08:00.004-07:00

I recently received a phone call from one of my best friends in high school inviting me to travel with him to Thailand for a short, one week mission trip. At first, I thought we was joking (as Fred is so gifted), and I quickly dismissed the idea, thinking there was no way with our busy furlough schedule of traveling and work. As a background, a few years ago, God led Fred Haring to start a non-profit organization called Hope for Hilltribes with the purpose of raising awareness and funds for a home in Thailand for women and children affected by HIV/AIDs called the “House of Love.” (Click here for short video highlighting the problem). Following is an excerpt from his website:

The House of Love is a home for women and children affected by HIV/AIDS. This includes women who had been sold into prostitution, AIDS orphans, and children taken out of their homes by the Social Welfare Department because of abuse. Many of the residents do not have Thai citizenship and have few rights in Thailand. Now in its 16th year, the House of Love has been a refuge to approximately one hundred displaced women and children, most of whom have been affected by HIV/AIDS—and many of whom had been trafficked to brothels. While most children have been affected by AIDS, many children deal with the emotional scars from events surrounding their life at home or on the streets or feeling unloved because their family can’t care for them. It’s not just physical and medical needs that the ministry serves, the House Of Love staff also works to meet the emotional and spiritual needs of each child. The House of Love is a home—and, more importantly, it is a family.

After a few day of prayer and processing (and after realizing Fred was serious), I really sensed God urging me to go…and to bring my oldest son Jeremiah along. So, long story short, on March 12th, Jeremiah and I are headed to Thailand for a father-and-son short term missions trip! Our goal is to work primarily with the young boys who live in this home, many of whom do not have a father-figure, showing them the love of Christ. We will also be spending a few days on the border of Myanmar at the Christian Center for the Development of People with Disabilities (CDPD), working with disabled kids and doing some primary care medical work (I need to find my stethoscope – a tool not carried by an orthopod!).

Following is a brief outline of our rigorous schedule:

March 12-14 – Travel to Chiang Mai, Thailand (via LAX, Tokyo, and Bangkok).
March 14-15 – At the “House of Love” working primarily with the boys at this orphanage, hanging out, camping, swimming, connecting.
March 16 – Travel 4 hours by truck to Mae Hong Song Province on the boarder of Myanmar.
March 16-18 – At the Christian Center for People with Disabilities (CDPD), working with disabled kids and holding basic medical clinics.
March 18 – Travel back to Chiang Mai to the House of Love for one more day.
March 19-20 – Back to the U.S.

God is teaching me that prayer is the essence of our walk with Christ (as John Piper says, “feasting at His table of GRACE”). That is the only way we can survive as we press on to serve Christ, and finish this race well. So, here are a few prayer requests for this trip, and if you could join us in this, we are partners together in this work:

(1) That Jeremiah and I would be filled with the Holy Spirit so that we can truly show Christ’s love to the kids at both the House of Love and CDPD.
(2) That we are really able to connect emotionally and spiritually with the kids and staff at both places.
(3) For protection from attacks from the enemy who does not want these kids to find freedom and healing in Christ.
(4) For safely while we travel to remote areas in Thailand.
(5) For connection for Jeremiah and I, as we serve together as father and son.

Thank you for your ongoing support of our family as we are headed back to Kenya this June!

Keeping the Right Perspective

2010-12-12T21:05:00.002-07:00

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

2010-10-22T20:28:00.007-07:00

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”

2010-09-05T18:05:00.003-07:00

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

2010-08-18T20:08:00.003-07:00

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

2010-08-04T11:51:00.002-07:00

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!

2010-07-08T10:10:00.003-07:00

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

2010-06-19T14:47:00.008-07:00

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

2010-06-11T14:20:00.003-07:00

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!

2010-06-04T14:49:00.007-07:00

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

2010-05-23T04:53:00.005-07:00

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

2010-05-14T14:09:00.002-07:00

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

2010-05-01T06:08:00.006-07:00

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

2010-04-17T00:50:00.004-07:00

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

2010-03-26T10:20:00.007-07:00

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

2010-03-01T09:02:00.012-07:00

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

2010-02-07T09:09:00.004-07:00

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

2010-02-07T07:54:00.002-07:00

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…

2010-01-23T05:14:00.002-07:00

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

2010-01-09T12:11:00.004-07:00

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!

Christmas at Tenwek

2009-12-27T12:10:00.003-07:00

The Galat Family Christmas Eve meal.

The result of deprivation: over-exuberance for mundane, hard to obtain items.

Yearly tradition in our house: Christmas books for the kids. This year, they each got a Masai blanket to keep warm while opening presents.

Ruth Melelei and Beatrice Rop gave kongas (aprons) to the orthopedic wives, Mrs. Gaw, Mrs. Greene, and Heather, a very kind and generous gift.

Meshack and Ruth enjoying something new on Boxing Day.

The Wednesday before Christmas was a clinic day, but because of the huge number of admissions, and patients in the queue awaiting surgery, we, being orthopedically blessed with greater numbers at the moment, exercised the divide-and-conquer strategy, thinking that we could win the battle and catch up in time for a quiet Christmas day at Tenwek. Dr. Gaw, and the Kenyan surgical resident and intern hit the battle front head-on in clinic and saw about 80 patients, while Drs. Greene, Kiprono and I flanked the enemy in theater, getting 7 surgical cases done. As Dr. Kiprono and I were leaving around 6pm, satisfied with the day’s work (although with a sore ring finger), a nurse from Casualty ran into theater asking rather excitedly, “Are there any C-collars here?” Kiprono and I looked at each other thinking, “This cannot be good.”

We walked over to Casualty to find it flooded with patients, and the courtyard crowded with a myriad of anxious relatives and onlookers. “What happened?” I asked one of the Kenyan residents. “A mini-matatu (small van holding a maximum of 5 people) was carrying 14 passengers, and while going down a hill, the brakes went out,” he said. I looked over at one older man struggling to breathe, with his chest wall visibly moving out of sync with his breathing, a flail chest. The lady next to him had a deformed forearm and an obviously dislocated left hip, which Kiprono and I quickly reduced. Across the room was an elderly woman with a swollen distal thigh and a small wound over her knee with visible bone peering through. Her breathing was labored. As we went from patient to patient, I felt my anger at this seemingly senseless situation flaring. “Where are the police?” I said out loud, as if I was the only one original enough to pose this grand question that everyone was already wondering. “Here is the driver,” someone said. My first emotion was anger at this man for illegally stuffing so many people into the van, and then his transfer of guilt to the simple mechanical failure of brakes. But after seeing his obviously dislocated hip, femur fracture and open knee wound, the frustration subsided. “They were all on their way to a wedding,” someone said. After hearing that, I just felt tired. After finishing in theater around 10pm, as I walked out into the fresh air of the courtyard, I was met with wailing. My suspicion was confirmed as I was told the man with the flail chest had passed away.

The next day, Christmas Eve, was a new day. The theater staff was super-charged and motivated to clear the board so we could all go home early. By 1pm, starting with 4 rooms, we had cleared another 7 cases. As I arrived home, the kids were gearing up for a serious Christmas Eve Galat family celebration, the main course decided weeks earlier, a rarity at our house in Kenya: cold cut meat sandwiches (salami can run as high as 3200 shillings per kilo, or about 20 bucks per pound!). However, a phone call at 5:30pm threatened to spoil the festivities. “There is a mass casualty going on up in the ER,” the person said on the other line, “and all available doctors are needed now.” As I was putting on my shoes, Emma was obviously upset. “It’s not fair!” she said, “It’s Christmas Eve and we have plans!!” Any “wise” explanation at that moment wouldn’t have mattered, so I just smiled and said, “I’ll be home as soon as I can,” and walked outside into the rain.

A bus carrying many passengers had rolled off the slick road about 10 km from Bomet, and patients were beginning to arrive in Casualty, most of them with minor injuries, but one serious case already in theater. There, the general surgeons had a young man, about 18, on the table with a severely mangled right upper extremity, and a huge laceration of the face and scalp, both ears having been shaved off, the horrible result of being caught between moving bus and road. The only option was an amputation at the level of the shoulder. “He must have been going home for Christmas,” I thought to myself.

After finishing this case, I went back to Casualty, fully expecting to be met with several other orthopedic disasters. However, by some miracle, all the other injuries that arrived were minor, and unbelievably, no fractures! As I walked through the door of my home, just in time for the planned celebrations, Emma burst out with excitement saying, “Dad, God answered my prayers!!” As a family, we attended the Christmas Eve services at Tenwek, then went home and feasted on salami sandwiches, Doritos, Mountain Dew (a rarity in Kenya), and other delicacies, followed by the sharing of our gifts with one another. Emma “splurged” and got me three travel size bars of my favorite soap, Imperial Leather.

Christmas day was much quieter, and we greatly enjoyed having our Christmas meal, meatballs and lasagna, ham and scalloped potatoes, with the Crognales, a missionary family famed for making the best Italian food on the compound. The following day was “Boxing Day” in Kenya, a holiday I am still trying, in vain, to understand. Nonetheless, still a reason to get together and celebrate, so we had a mini orthopedic Kipegange (meaning “party” in Kipsigis), with Meshack, Solomon, and their families, and the Greenes and the Gaws. We wanted to introduce our Kenyan guests to ice cream cones, and Solomon and Beatrice could not understand why Dr. Gaw would be eating what they all thought was the “plastic holder” of the ice cream (i.e. the cone). We all laughed hard, and celebrated together the great things that God has done in and through the orthopedic department at Tenwek…all a result of the advent of Christ as a babe, and through His eventual sacrifice on the cross. The paradoxical mix of sorrow and joy, tragedy and triumph…Merry Christmas and Happy New Year from Tenwek.

Lessons from the Fatherless

2009-12-22T08:31:00.006-07:00

Thanks to the newly-arrived group of Samaritan’s Purse post-residents who just so happen to have as much exuberance for Ultimate Frisbee as I do, and the “slightly” broken left ring finger that resulted from a highly-competitive mid-Sunday afternoon game, I have been forced to take some leave from surgery. This is now my third “major” injury (including a self-diagnosed cracked skull, and a severely rolled ankle) resulting from this innocent-appearing, yet potentially dangerous game (I know what some of you are thinking). True, it is not rugby, or American football, but nonetheless, can be considered a contact sport in the right circles. Thankfully, our orthopedic department is currently expertly covered with Drs. Greene, Gaw and Kiprono, and being Christmas week, although realizing that my aging body is not 25 anymore, the timing was at least ideal. All things work together for good...

As a result, I was able to travel with our family and a group from Tenwek to Mosop Orphanage, one of the facilities supported by WGM, for the annual Christmas “party” with the children who live there (an event I missed last year). After playing many games, we heard the kids sing and recite bible verses, shared some ndazis (fried donuts) and just loved on them a while. When I spend time with these children, who have so little in terms of earthly possessions and relationships, yet seem so content and happy, I am struck by my own discontent. And I am reminded, especially at this Advent Season, that through Christ, we are “adopted” into God’s family, through faith in the work of His Son on the cross. Please keep these children in your prayers, that they would experience God as their true father, and that they would be blessed this Christmas season. Thank you for all your prayers and support!!

But you, O God, do see trouble and grief; you consider it to take it in hand…. you are the helper of the fatherless. Psalm 10:14

Seek justice, encourage the oppressed. Defend the cause of the fatherless, plead the case of the widow. Isaiah 1:17

The Future of Tenwek

2009-12-01T08:00:00.004-07:00

Dr. Kiprono, a hard working orthopedic machine...

Stephen and our favorite patient on the female surgical ward. In Kipsipis, she calls Stephen her grandson, and me, her son-in-law?!

Laughter makes long days shorter...

"Thumbs down" for this unfortunate patient with a massive open knee fracture, another victim of the barrage of Bajaj motorcycle taxi accidents.

This past week, the Galat family celebrated our first year anniversary at Tenwek hospital, and as we went around the table thanking God for the incredible ways he has worked in the past year, my mind wandered back to those tumultuous first few weeks in Kenya, getting settled in a new culture, the new sights, smells…and challenges. I still have the original hand written list of 30+ orthopedic patients handed off to me within 5 minutes of arrival at Tenwek (I thank God I will never have to repeat that initiation!).

When I started in orthopedic surgery at Tenwek last year, it was me and one Kenyan female intern, who obviously was extremely disinterested in orthopedics, having rather been with the little babies in the NICU. Solomon, our chief physiotherapist, and Meshack, our head orthopedic nurse (both critical to our work at Tenwek) were inconveniently on annual leave when I arrived. After a few weeks of pounding (December is the “high season” for orthopedic injuries…Christmas bonuses + time to burn + alcohol - Jesus = Trauma), I found myself thinking, well beyond my comfort zone, “There is NO way I will survive here.” Thankfully, God promises never to give more than we can handle…Solomon and Meshack eventually returned from leave, and various orthopedic surgeon visitors began to arrive (at just the right time) to help with the workload. Then, in April 2009, more quickly than I had envisioned, Tenwek began as a training site for Kenyan orthopedic residents from Moi University in Eldoret.

Dr. Geoffry Kiprono, our most recent visiting resident from Moi, arrived in early November. Kiprono is one of 16 children of his still-living 90+ year-old father (who incidentally practiced polygamy, Kiprono’s mother being the “less favored wife”), and grew up with nothing. However, determined to succeed, he worked hard, and was eventually accepted to medical school. Kiprono first arrived at Tenwek in 2003 as an intern, and being Kipsigis (the most populous tribe in this area), was happily posted to Tenwek as a Medical Officer (MO), in which capacity he worked for 4 additional years. While working as an MO, he was exposed to orthopedics working with Dr. Mike Chupp and other visitors from the U.S., and knew this was his calling. Thus, in the fall of 2008, he began his 4 year orthopedic training residency at Moi, and being sponsored by Tenwek (residents actually have to pay for their training, unlike in the US), will eventually return as a full-time consultant once fully trained. Kiprono is the future of Tenwek…

God has provided exceedingly and abundantly more than I could have imagined over this past year: a highly organized, hard-working, and committed orthopedic surgical team with solid implant selection, a dedicated physiotherapy department, Stephen as our full-time orthopedic RN, various and multiple orthopedic visitors who commit time and energy to Tenwek, a strong teaching program including visiting medical students from Kenya and the U.S., Kenyan interns, residents, and the external rotation for Kenyan orthopedic residents from Moi, all working together as a team to provide our patients with (1) the best possible orthopedic care and (2) the good news of Jesus Christ, Hope for this world. God has done ALL this, and He deserves the praise and glory!

I will make rivers flow on barren heights, and springs within the valleys. I will turn the desert into pools of water, and the parched ground into springs.
I will put in the desert the cedar and the acacia, the myrtle and the olive. I will set pines in the wasteland, the fir and the cypress together,
so that people may see and know, may consider and understand, that the hand of the LORD has done this, that the Holy One of Israel has created it.
Isaiah 41:18-20

When I am Weak…

2009-11-17T11:23:00.002-07:00

Most of the time, I have a lingering sense of my own weakness in this task of orthopedic surgery at Tenwek hospital. The relentless patient load with complex orthopedic problems, coupled with the responsibility of resident training, staff management, and equipment organization combine to often make me wonder, “What on earth am I doing here?” Sometimes, I feel this sense of weakness more acutely.

After a particularly difficult week, I made my way up for Sunday after-church rounds, which are intentionally more leisurely, taking a little extra time to minister to our patients’ spiritual needs, especially by praying with them. This Sunday, however, as I was feeling a little more self-focused and spent than usual, I was determined to do “lightning rounds,” i.e. to get home as fast as I could, so I could do my own thing. Of course, God, in His sovereignty, often has less selfish plans in store for us.

A man was admitted the night before with a femur fracture. As I looked at the x-rays, the multiple lesions peppered throughout his bones belied the cause of the fracture: multiple myeloma in very advanced stages. I knew his days were severely numbered, and as I explained his condition, I sensed God urging me to go further, although this was beginning to cut into my own plans. “Do you know Jesus,” I asked, a valid question in this part of Kenya, because of the candidly honest answers usually obtained. “No,” he said quietly in Kipsigis. “Would you like to?” I returned. “Please.”

There, in the ward, on an early Sunday afternoon, in front of several other patients, this man, for the first time in 70+ years of life, admitted his need for a Savior and gave his remaining days to his Creator. What happened next humbled me greatly, and reminded me that this is God’s business. Several of the young men with tibia and femur fractures called out, “Please pray with me too!” One man named Peter, about the same age as me, also married with four children, asked for a bible in the Luo language. Peter had been admitted the previous week for complications of a femur fracture fixed at another hospital. Being HIV+ (with a weakened immune system) does not mix well with fractures fixed nominally at ill-equipped, and often very unsanitary, hospitals. After lying in that hospital for three months, he begged to be transferred elsewhere, and he was finally released. He traveled directly to Tenwek, and was admitted with pus pouring out of his thigh. We did what we could, removing the infected hardware and dead bone, and stabilizing the fracture with an external fixator. I promised Peter that I would ask one of the chaplains for a Luo bible for him on Monday.

Of course, Monday came and went, the busyness of the surgical schedule causing me to forget about the bible. On Tuesday, Peter kindly reminded me with his big smile that he had not received his promised bible yet. This time I would not forget, I told myself. I did. Thankfully, God’s sovereignty is greater than my male compartmentalism, and on my way to the choo (bathroom), on a normally untraveled route, I ran into Helen, one of the head chaplains. I told her about Peter, and she then promised she would get the bible for him.

On Wednesday, our busy clinic day, I walked to the wards to check an x-ray, and heard a voice from one of the benches outside where our patients “bask” in the sun, soaking up vitamin D, an essential vitamin for healing bone. “Daktari,” Peter called excitedly, “I got my bible!” I was in a hurry and didn’t feel like talking much. “That’s great…are you reading it!?” I called back. “Yes, and I want to know Jesus!” I stopped there, again humbled by my own inadequacies and God’s far greater and perfectly sovereign plan. I slowly walked over, sat down next to him, and there prayed with him to receive Christ as his Savior.

While orthopedic surgery is my primary “function” at Tenwek, my ultimate purpose for being here is to share that Jesus is the greatest treasure our hearts could desire. What is paradoxical and sometimes incomprehensible, however, is the fact that God chooses to do this work through people who are weak, broken, and selfish, ourselves sinners in need of God’s grace. The reason for this is summed up perfectly by the apostle Paul, who referred to himself as “the chief of all sinners,” when he said to the Corinthians that “we have this treasure (Jesus) in jars of clay (broken vessels) to show that this all-surpassing power is from God and not from us.” In the end, the glory goes where it must.

Not to us, O LORD, not to us but to your name be the glory, because of your love and faithfulness. Psalm 115:1

But he said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me…For when I am weak, then I am strong. 2 Cor. 12:9-10

Images from Tenwek

2009-10-30T11:10:00.003-07:00

"The Mystery of History" at Tenwek. All the children dressed up as their favorite character in history and went from house to house, each set up as a different time period in history, and to get a "treat". Jeremiah was a Spartan Soldier, Emma a gypsy, Claire a Grecian princess, and Levi, Cupid.

Emma is growing up!

Cupid getting ready to shoot his "love arrows."

Justice vs. Mercy

2009-10-30T10:44:00.004-07:00

Stolen cell phone in the underpants igniting an extreme case of "mob justice."

The end result of an argument gone very bad.

This morning, on rounds, I was handed a crisp, new “orthopedic service list” by one of the Kenyan medical students, an invaluable tool for tracking our many patients scattered throughout the hospital. The List, kept by our hard-working interns and medical students, includes patient names, injuries and treatment plans. As I quickly scanned the list for any new overnight admissions, one patient distinctly caught my eye: Peter Kipkirui, mob justice victim. The patient had multiple injuries inflicted by blows and pangas (machetes) as a result of vigilante justice, meted out by a group of angry Kenyans. “He must have done something pretty bad,” I thought to myself. I asked the two medical students, Mercy and Justus (no joke), what he had done and they showed me a pelvic x-ray demonstrating what they thought was the reason for this swift punishment. A cell phone that the patient had stolen, and stuffed into his underpants, on x-ray, appeared as a rectangular, outlined skeleton of wires and chips. Later, I was called to the operating room to see a patient who was the victim of another kind of “justice” that unfortunately results from the simple equation: liquor + argument + sharp instrument = severe injuries. The man had the most impressive hand panga cut I have ever seen.

To be honest, as a surgeon dealing daily with injuries caused, in some way, by foolishness, carelessness, jealousy, anger, neglect, greed, etc. (essentially sin), I am tempted to lose compassion, and think, in my heart, “they get what they deserve.” Then, I am quickly disciplined by God as he reminds me of the incredible Grace that was given me, i.e. my sins paid for by the blood of his own Son. It’s a good thing I don’t get what I deserve. All of us receive one of two perfect options: justice or mercy. Either we receive just punishment for our sins…or mercy, embodied in the person of Jesus Christ as we come to Him in faith. The Newsboys sing a song with simple, yet profound lyrics: “When we don’t get what we deserve; it’s a real good thing…when we get what we don’t deserve; it’s a real good thing.”

Eph. 2:4-5 But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions--it is by grace you have been saved.

Behind the Scenes

2009-10-11T05:23:00.005-07:00

Meshack, our outstanding orthopedic charge nurse, was notably happy at the amount of implants donated, in total, two pallets of equipment weighing 800 lbs. The man in the red jacket is a hospital chaplain who kept asking, shocked, "You put those big metal pieces inside someone's body?"

Meshack spent two days organizing and inventorying the donation in the orthopedic storeroom.

Brand new Zimmer ITST (Inter-Troch, Sub-Troch) femoral nailing instrument set.

First patient to receive the ITST nail for a proximal femur fracture. The nail is inserted through two incisions each measuring about 2 cm in length.

Post-op x-ray of ITST nail.

Recently, the Tenwek Orthopedic Department received a huge donation of orthopedic implants, sent by a group called Hope Force International. Several folks from different areas of the country rendezvoused in Memphis, Tennessee to pack two pallets of a board assortment of supplies: nails, screws, plates (in total 800 lbs of equipment!), to be used for the orthopedic care of the people in this poor region of Kenya. Amazingly, Fed-Ex air freighted the pallets free of charge (even upgraded to “express service”), thus the total time from leaving the US to arriving at Tenwek was only 8 days…and there were no issues with customs. Just yesterday, we used one of the nails, the Zimmer ITST (Inter-Troch, Sub-Troch), for an elderly woman with a fracture of her femur caused by an erosive metastasis of cancer. Although this will not cure her disease, now that the fracture is stabilized, she will be able to move without pain.

As I reflect on the incredible generosity of not just Hope Force, but the many other companies and individuals who have donated time, resources, and personal finances to supply Tenwek with implants, so essential to the practice of orthopedic surgery, and the care of our patients, I am humbled and thankful. I think of the SIGN nail company, whose sole mission is to manufacture low cost implants for the poor in developing countries…I think of an individual who bought a set of plates for Tenwek with his own finances…I think of a sales representative from an implant company who gathered and shipped screws and plates on his own time and dime…I think of a group of students from Cedarville College and their mentors who are designing a new nail to be used at Tenwek …and there are many, many others.

Together, these people and groups are serving faithfully in the way God has called, all of great significance to the work here in Kenya. It is a challenge for me to be a good steward of God’s provisions for Tenwek, and for all of us to ask, “God, what would you have me do today?” The majority of times, the work God calls us to goes “unnoticed” by the world, and the results of which may never be realized to the fullest extent in this lifetime (much like the Heroes of the Faith from Hebrews 11). But, faith in this matter is key, believing that God has a grand, sovereign plan for the redemption of mankind, yet somehow, paradoxically, God uses our small acts of obedience to His call, behind the scenes, to bring glory to his Name, and advance His kingdom.

Hebrews 11:1 Now faith is being sure of what we hope for and certain of what we do not see.

The Simple Life

2009-10-03T10:53:00.002-07:00

Jeremiah, Jamie and Peter hanging out at the newly erected campsite.

Drinking coffee by the mud brick fire pit.

Jeremiah pouring a freshly brewed, and very stout, cup of cowboy coffee, a skill he learned from Grandpa Kinkel.

Remnants of a night of big fun...

Over the past week, Jeremiah has been uncharacteristically efficient with finishing his homeschooling assignments. As soon as Latin, literature, Algebra, and history are finished, he is gone…for several hours. “What is he up to?” I asked myself, and, knowing Jeremiah, I figured it involved something related to digging, chopping, cutting and fire. He would show up for dinner covered with sweat and dirt, smelling like a 12 year old + boy, but with a very contented look on his face.

Yesterday, the mystery was revealed, as Jeremiah invited me to see the campsite that he, Jamie and Peter had been diligently working on for days, tucked in a secluded area, what appeared to be a remnant of the high altitude rain forest that used to cover this area. Entering through the back, and going down dirt steps meticulously fashioned, was the fort, a small clearing created by pangas, with a lush canopy, a mud brick fire pit, and a leveled dirt area for sleeping.

When Jeremiah asked if they could sleep in the fort that night, the answer was easy. “Just be careful,” I said as he was gathering supplies: a bucket of Cokes, two onions for roasting in the fire, a package of marshmallows, a bag of Farmer’s Choice sausages (advertized proudly to be at least 62% meat), a panga, OFF!, and materials for making torches (the OFF! was not for repelling insects). I told Heather that the combination of pre-adolescent angst plus indigestion would guarantee about two hours of sleep for the boys.

This morning, I carried fixings for “cowboy coffee” to the fort for the boys…I figured they would need it. Jeremiah had already fried eggs over the fire, and the site was strewn with the remnants of last night’s events. Jamie was finishing off the last of the hideous sausages, and they all smelled like the open pit fire.

As I walked back home, I recalled the worry I had when we first arrived in Kenya, that our children would, in some way, suffer as a result of being here, not having the same opportunities available to kids in the States. And, there are missed opportunities for our children…piano lessons for Claire, violin lessons for Emma, football for Jeremiah, and, more importantly, missed family events with cousins, aunts, uncles, grandparents. But, we have seen God provide for our children in ways far beyond what we think they need, or what we could even provide. Now, we see the incredible blessing of raising kids in a simpler environment such as this. Without TV, soccer practice, McDonalds, school events, (and, for the first three months even, a vehicle), the kids finally have time to be kids, to use their minds, to create, to explore, and just have fun. Sometimes the things we think we so desperately need actually hinder that which our hearts truly desire. The simple life at Tenwek…not so bad after all.

God’s Timing: Lessons in Answered Prayer

2009-09-17T10:44:00.003-07:00

"Spine week" at Tenwek. This patient had bilateral jumped facets at C5-6 and was treated with a posterior spinal fusion. Needless to say, a significant amount of reading (and prayer) went into this case.

"Spine week" continued...This man had a compression fracture at L1, treated with a posterior spinal instrumented fusion T12- L2.

Saturday morning relaxation in mom and dad's bed...

Solomon, our outstanding physiotherapist, with a spine patient sporting a newly applied halo.

The Monacle Man...this patient used a 1/2 pair of glasses, turned upside down, as his monacle to see. Stephen's parents glady provided the 250 shillings (3 bucks) to buy him a brand new pair of Ray Bans.

As a male with a certain amount of pride, it is hard to admit when I need help. About three weeks ago, overloaded with cases, and just plain physically exhausted, I finally admitted to Heather that I cannot continue at this pace alone. She came up with a rather simple solution. “Why don’t we ask God to provide another orthopedic visitor,” she asked. Admittedly skeptical that God would answer as quickly as I needed, we, as a family, began to pray.

About five days later, Russ White, the medical superintendent at Tenwek, approached me in theater. The previous weekend, he had been at the Rift Valley Academy, a boarding school located on the grounds of Kijabe mission hospital, just outside of Nairobi. While there, he had a “chance meeting” with an orthopedic surgeon who had been visiting at Kijabe hospital for about a month. When Russ asked how it was going, the surgeon said, “Fine, but I don’t feel very needed here…there are already 12 orthopedic surgeons at Kijabe!” Russ, as the quintessential recruiter, challenged him to come to Tenwek, where there would be no question about needed-ness. In short, in less than two weeks after we began to pray for another orthopod, Dr. Bob Greene arrived at Tenwek, and he will be here for the next 6 months!!

God’s timing is perfect. Many times, however, unwilling to wait on God to work or provide, I have formed my own plan, gone my own way, and, as a result, missed God’s best, or sometimes suffered undesirable consequences. Thankfully, this time, resisting the temptation to quit, although feeling spent, God gave us the patience to wait, and he provided miraculously, and far more quickly than I believed he was willing or able. Walking home from the hospital today at an early 5pm, I noticed a lighter step…I wasn’t feeling exhausted or angry or overwhelmed.

I am reminded of the verse from Jeremiah 2:13: "My people have committed two sins: They have forsaken me, the spring of living water, and have dug their own cisterns, broken cisterns that cannot hold water.” When we “dig our own cisterns,” they crack, leak, and never maintain the level that we need. We wonder why we feel unfulfilled, stressed, burdened, etc. Why do we feel compelled to forsake our God, who is able to provide in ways far more perfect and complete, fulfilling that which our souls really desire? The simple answer is pride…fear…anxiety…_______. However, when we wait on “the spring of living water,” the result is far beyond anything we are able to provide for ourselves.

Motorcycle Taxi for Hire

2009-09-07T11:33:00.005-07:00

Waiting for customers...

Rigtht leg of 14 year old boy struck by a motorcycle taxi with open femur and tibia fractures.

Over the past few months, we have noticed a huge increase in the orthopedic trauma volume at Tenwek hospital, and now our current census has over 35 patients scattered throughout the hospital (even on the eye ward), making morning rounds a bit of a challenge. I find myself asking questions like, “Where did the patient with the bilateral open tibia fractures go?” and wondering when we will ever catch up. Daily surgery is just an attempt to keep up with the load of cases that continue to pile in, praying that God helps us do our best with each patient that He sovereignly brings to Tenwek. Currently there are 14 patients in the queue needing surgery.

All around Tenwek and the nearby village of Bomet, are what seems like hundreds of new motorcycles, all the same brand, all the same maroon color. To help distinguish one from another, drivers cover the gas tanks with decals that vary from “the mother Mary,” to a “skull and crossbones” (very apropos). Cost of a brand new Bajaj Boxer 5 motorcycle (hot off the production line in India) is a cool 85,000 Kenyan shillings (about 1,100 USD). “How can so many people afford a brand new motorcycle (more than two years average salary in this part of Kenya), and where are they all coming from?” I wondered to myself. What was clear, however, was the fact that the increase in trauma is most definitely related to an increase in motorcycle accidents.

A patient arrived in the early evening last week with an open tibia fracture, wound full of dirt and other debris, the result of…a motorcycle accident. While performing the initial “washout” surgery to clean the open wound, I decided to get to the bottom of this mystery. We use spinal anesthesia almost exclusively for lower extremity surgery, thus our patients are awake during surgery, and often very chatty. I asked him how the accident occurred, and he explained that he is a motorcycle taxi driver, and while carrying a passenger, after passing a large truck, looked over his shoulder at an interesting scene, and…(the stories are all too similar). Getting more personal, I decided to ask where he got his brand new motorcycle, and how much it cost. “About 500 shillings,” he said (i.e. $7). Puzzled, I probed further, “500 Shillings?” “Yes,” he answered, “for 500 shillings per day I can rent a brand new motorcycle, and whatever I make over that I keep for myself.”

A flurry of questions went through my head, as well as a sense of anger and injustice for all the passengers who have gotten injured or killed as a result of untrained, uneducated, and often irresponsible, motorcycle taxi drivers who can rent a motorcycle for almost nothing and, in a millisecond, change their lives or their passenger’s lives forever. “Who then is the real entrepreneurial kingpin behind this phenomenon?” “Where are the regulations?” “Is this really true or is this just one person’s story?” Just today, we cared for a 14 year old boy who was struck from behind by a motorcycle while walking down the road, with open femur and tibia fractures. His life will never be the same.

As we were pulling out of Tenwek to pick up Stephen’s parents in Nairobi, we noticed all the motorcycle taxis coming and going, all Bajaj and all maroon. One man came flying around the corner (faster speeds = more money) with three, young school aged girls on the back (more passengers = more money). After almost running into our van, he stopped directly next to me, and I noticed one girl handing him 100 shillings. I looked directly at him, and with more frustration than I would have liked, I said firmly, “you need to SLOW DOWN!!”

Trauma in developing countries is becoming a worldwide healthcare crisis, on par, or now, even more important than AIDS or tuberculosis. When a young man or women trying to earn a living for their families gets a life-altering injury, the entire family can be thrown into poverty and chaos. We see it every day at Tenwek. Please pray that God would intervene to bring this important issue to the forefront of our leaders, that the subject it would get due attention, and that real change would be implemented.

Proverbs 13:23 “A poor man's field may produce abundant food, but injustice sweeps it away.”

Something More to Offer

2009-08-19T08:01:00.002-07:00

17 year old girl with gun shot wound to right elbow.

Trying to close my bag after a random inspection...I warned them (by experience).

Samson, Emma, and Ema, chillin' on the front porch.

After having flown over 18,000 miles (and six flight segments) to attend the four day SIGN conference in Richland, WA, I finally arrived home at Tenwek last night. The highlights of this long journey (but quick trip) were interacting with the hundreds of international SIGN surgeons, presenting the orthopedic work at Tenwek at the conference, spending time with my Galat cousins and the Pavkov’s (who happen to live in Richland), watching two agents try (in vain) to re-zip one of my bags after inspecting it…and, of course, coming home to my family. The low points were the flight from Amsterdam to Seattle…I sat next to a young girl who I think had swine flu…the flight from Seattle to Amsterdam (déjà vu), and laying awake all last night, trying to solve the world’s problems, still on West Coast time, awaiting a new and exciting day in clinic.

Thankfully, today was a “light” day in clinic…only 60 patients, but again with the “box of chocolate” motif in full throttle. One patient, in particular, was exceptionally challenging, the last patient of the day, a 17 year old girl with a completely deformed elbow from a random gun shot during Kenya’s post-election violence last year. As I examined this young girl’s hand, muscles wasted from the ulnar nerve which had been blown away by the bullet, I thought to myself, “there is nothing I can offer her.” Then, as clearly as day, as if to usurp the lie that just traversed my thoughts (and likely influenced by the fact that I was sleep deprived at that moment), I heard another inaudible voice that said, “How untrue…you have something more to offer.” God’s simple rebuke was loud and clear, and I felt ashamed of my humanism and plain lack of faith, but paradoxically, simultaneously strengthened, at that moment, to give what was needed.

After explaining the grim prognosis, I offered to pray with the girl and her family and they eagerly accepted. I thanked God that the bullet was not one foot to the right (potentially hitting her chest), and for the fact that she miraculously had limited, but pain-free and functional range of motion. Then, I asked God simply to heal her for His sake, and Christ’s glory, and after saying “amen,” I noticed the tears in her eyes. That “something more” was, at that moment, exactly what she needed.

As I walked home, I thanked God for taking me to the “woodshed,” and the reminder of my real reason for being at Tenwek…not just to operate, but to be an agent of healing, both physical and spiritual. What is the “something more” that you can offer those God sovereignly brings into your life? Where can you step out in faith, beyond yourself, to be what God has called you to be, for the sake of others, and for His glory? Let us encourage each other in this and consider the words of the apostle Paul as he wrote about his trials to the Corinthians:

All this is for your benefit, so that the grace that is reaching more and more people may cause thanksgiving to overflow to the glory of God. Therefore 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.

Veterinary Surgery, Corn Rows and Other Miscellaneous News

2009-08-07T07:29:00.003-07:00

Sarah, Claire and Emma, after having their hair braided into corn rows, a process which took literally 5 hours.

Samson, post-neutering, drugged up with valium and ketamine (a medication similar to "angel dust"). He never knew what hit him!

...

Last month, we have had our new niece-in-law, Sarah, and her mom, Cindy visiting at Tenwek, and it was such a great time. Cindy is a CRNA (nurse anesthetist) in Ohio, and when we met at Sarah and Alex’s wedding last November, and she heard about the needs at Tenwek, she committed to come. And with Alex being on tour in Afghanistan for 6 weeks, the timing was perfect.

Cindy’s flight home coincided perfectly with a trip into Nairobi to continue our ordeal trying to finalize our work permits. We always hope that going to Nairobi will offer a few days of needed R&R, but it usually turns out to be almost as busy as our days at Tenwek. Thursday was spent at the Immigration Department (appropriately called by WGM staff the “house of pain and suffering”) in the morning, and then shopping for two months of groceries in the afternoon. The whole day Friday was spent at a non-profit organization in Nairobi which had medical supplies to donate to Tenwek, including 50 walkers, 20 brand new wheelchairs, and two huge boxes of men’s thong underwear??? (which I graciously turned down for some more “needy” organization). Saturday, we made the dusty trek back to Tenwek, and found 12 new patients admitted for surgery.

Last weekend was filled with diversion and excitement as our new dog Samson had “surgery,” as per Claire, “to turn him into a girl” (i.e. neutering). The surgery was a success even though it was done by a bone doctor (guided by a visiting veterinarian)! Sammy continues to grow as he devours everything we feed him.

Next week, I leave for a quick, one week trip back to the states for the SIGN conference in Richland, WA (thanks to the Coventry Award which I received from the Mayo Clinic when I graduated last year). I was asked to give a presentation on the SIGN nail experience at Tenwek hospital, which will also indirectly raise awareness of the work God is doing here. Please pray for “divine appointments” with the many people who will be at the conference, for the kind Dr. Glen Rowe who will be covering the ortho department while I am gone, and for Heather and the kids. Thanks for all the support and prayers you provide for our family here at Tenwek. We appreciate you all so much!

Little Black Book

2009-07-18T08:43:00.008-07:00

The Little Black Book, a log of all orthopedic surgical cases at Tenwek.

A two year old boy with rhabdomyosarcoma of the hand: one of the sad cases in the book.

An example of "MacGyver orthopedics." A periprosthetic femur fracture fixed with a long plate, screws hand-cut to length and cerclage wires.

The book also contains more conventional cases such as this ulnar shortening for ulnar impaction syndrome.

For those who are familiar with John Piper, one of his books succinctly entitled “Don’t Waste Your Life” is a personal favorite. When we left for Kenya eight months ago, Heather’s parents gave us several items they purchased from John Piper’s Desiring God Conference, including the “Don’t Waste Your Life Field Journal,” a little black book intended for…journaling. I use mine to catalogue all the surgical cases I do here at Tenwek, and the daily reminder to “not waste my life” helps keep the daily challenges in perspective. So far I have filled one book and am now on my second. I lost count at 300 about halfway through the first book.

Most other medical specialties allow for board certification of physicians while doing full-time missions: OB-Gyn, General Surgery, Family Practice, etc. However, this is not the case with orthopedic surgery. The American Board of Orthopedic Surgery bylaws currently state that it is a requirement for prospective fellows to work in the United States for two years before allowing them to sit for the oral boards. Thus, although I passed the written boards last summer, as it currently stands, I cannot be fully board certified working as a busy orthopedic medical missionary in Africa.

However, I also believe God is able to do a miracle, and that is the reason I am keeping my “little black book” of Tenwek cases, in the hopes that some day, the policy may change, and I may be able to sit for my oral boards with cases that I have done while following the call of God here in Kenya. The book is not perfect, including a “few” cases treated in ways non-conventional, what I like to call “MacGyver orthopedics” (the show from the late 80s/early 90 in which MacGyver could create anything out of the most elementary supplies). We do what we can with what we have. On the other hand, we are very blessed at Tenwek to have, what I have been told, the best orthopedic inventory in Kenya, thanks to our friends in the US who are so faithful, behind the scenes, working to secure supplies for Tenwek.

How our culture defines a successful life (i.e. wealth, power, status, education ) may actually be a wasted life. On the other hand, what is viewed as a “wasted life” may actually be the most fulfilling, meaningful, and eternal. Paradoxically, in God’s economy, the path to a life not wasted is by the very act of losing it. The challenge is for me, you, all of us. Thankfully, I have a daily reminder of this every time I write a case in my little black book. Let us encourage each other to not waste our lives.

Matt. 16:25-28 Then Jesus said to his disciples, "If anyone would come after me, he must deny himself and take up his cross and follow me. For whoever wants to save his life will lose it, but whoever loses his life for me will find it. What good will it be for a man if he gains the whole world, yet forfeits his soul? Or what can a man give in exchange for his soul? For the Son of Man is going to come in his Father's glory with his angels, and then he will reward each person according to what he has done.

Harvest Time

2009-07-16T07:48:00.002-07:00

Kenya, being a climate which I would classify as “perpetual springtime in Ohio,” enjoys a year round growing season. And although July is the peak of summer fun in the Midwest, in Kenya, it is actually the “coldest” month, with highs in the upper 60s and lows in the upper 40s. Thus, this is the time of year for harvesting maize. And, after a busy week of moving into our new “temporary” housing, and a caseload of almost thirty surgeries, what better way to relax and spend a free Saturday than harvesting maize?

Maize is a critical crop for Kenya, because it supplies the brunt of the caloric energy for daily living in rural Africa in the form of a pasty, tasteless starch called “ugali.” Maize (or corn) is planted, harvested, dried, and ground into a fine meal, then boiled in water, without salt, until it becomes a firm, starchy mass of pure carbohydrates, and the perfect accompaniment for every Kenyan meal. After tasting ugali and out of curiosity, I have asked many Kenyans what, in their opinion, is so special about ugali. Answers vary, but the common underlying thread is that “ugali fills the belly.”

So when Peter Ronoh, our outstanding maintenance man, invited us to his “chamba” (farm) to harvest maize, we were honored. Sarah Galat (our new niece-in-law) and her mother Cindy (a nurse anesthetist), who are currently visiting from Ohio, came as well, and we all had a ball, hand picking and shucking corn and tossing the ears into large piles. It was actually therapeutic, and downright fun. Afterwards, we all enjoyed a cup of hot chai with a large scoop of sugar.

Two thoughts went through my head as I was working in the field. First is the scripture from Matthew 9:37-8: "The harvest is plentiful but the workers are few. Ask the Lord of the harvest, therefore, to send out workers into his harvest field." In addition to our family, about 20 or so of Peter’s neighbors came to help harvest his maize, out of their own free will, without even being asked, or expecting anything in return. They just showed up. With all the help, in less than three hours, almost an entire acre of corn had been handpicked, the job complete. The spiritual harvest is not so, however. According to Jesus, the harvest is plentiful but the laborers are few. If more were willing to just “show up,” would the spiritual work be done?

Second, I asked Peter what he was going to do with all this harvested maize (incidentally a “bumper crop”). “Are you going to sell it?” I asked, in my mind, thinking what the income could buy: schooling for his kids, an addition onto his miniscule two room house, maybe a new dress for his wife, or a few other luxury items. “I would,” Peter answered, “but I get afraid of my kids going hungry if I don’t save enough.” How many of us actually worry that we won’t have enough to eat, even with the downturn of the economy? Incredibly humbling words as we drove back to Tenwek, and prepared a supper of BBQ beef sandwiches for a visiting work team. No room for plain old, bland ugali in our house...

Thanks for your recent prayers and email encouragements. We really depend on your support of the work here at Tenwek. Please let us know how we can be praying for you as well. And please keep Alex (our nephew, and Sarah’s husband) in your prayers, as he is on tour with the Air National Guard in Afghanistan for the next six weeks.

New Family Addition and Other News

2009-06-25T06:09:00.004-07:00

New Family Addition

Poor Emma has been begging for a dog since she was 4 years old. Her persistent requests have always been met with my standard, deflecting answer: “Keep praying and asking God for the right dog.” Well, it seems as if God heard Emma’s prayers, and at the same time, desired to teach me a lesson in giving pat answers. On Sunday, we brought home “Samson,” an extremely malnourished, flea-infested, and likely mistreated puppy, from one of the local orphanages. After three baths and several flea-dips he is finally cleaned up, and becoming more animated every day (from much love and attention). He is actually pretty smart, and as an outside dog, already knows to do his business in one area of the grass! Things with the other Emma (the White’s boxer dog who officially rules the Tenwek compound) are not so hot, however. Just today, dog Emma went directly to this “area” and overrode his business with her own. She’s the boss.

Total Hip Replacement at Tenwek

Last Monday, the first total hip arthroplasty with Kenyan obtained components was performed at Tenwek. Thanks again to Keith Braun who was here to offer moral support, and sweat with me as I cemented in the acetabular component (the plastic socket). The patient has done very well and now is up and about with minimal pain in her hip. We thank God for his incredible faithfulness and favor in allowing us to offer this service for patients at Tenwek.

Prosthetic Limbs at Tenwek

God continues to bring the right people at the right time. Allen Dolberry, a prosthetist (person specializing in the manufacture and fitting of artificial limbs) and his wife Kim, have been at Tenwek for the past month using their skills to serve the poor. Amputations are viewed as a death sentence in Kenya because of the lack of ability to fit prosthetic legs. During the last four weeks, Allen has custom-manufactured and expertly fitted 22 legs so that people without hope can walk again. It is amazing to see people take steps for the first time in years!!

Joint Replacement Surgery in Rural Africa?

2009-06-19T10:10:00.002-07:00

The vast majority of orthopedic surgery at Tenwek is related to trauma: motorcycles, Masai swords, pangas (machetes) and similar instruments of pain and suffering. Often, the patients that present with these injuries are very poor and unable to pay their hospital bills. Since coming to Tenwek, Heather and I have been praying for ideas to provide a means to subsidize the care for the poor and help the hospital financially. Joint replacement surgery has been at the top of the list, although this seemed like an incredibly far off possibility in rural Kenya. As in the US, many people suffer from knee and hip arthritis here. But joint replacements, while common in the US, are performed by only a handful of surgeons in Kenya, typically only in big cities like Nairobi, and fetch a high price.

Knee and hip replacements have been done at Tenwek by visiting joint replacement surgeons in the past, with components donated from the United States, thankfully, most recently just last month. However, with the new stringent rules set forth by the US Department of Justice for implant companies and surgeons, donated implants and supplies are becoming more and more difficult of obtain. So, since coming to Kenya, I have been looking for a local supply of implants for purchase (both trauma and joint replacement), in order to reduce our dependence on donated supplies from the US. Sovereignly, while at the Kenya Orthopedic Society Meeting in Eldoret last March, I was introduced to Rose, a Kenyan lady representing DePuy (a division of Johnson and Johnson), who distributes orthopedic implants in Kenya.

In short, last Monday, we performed the first total knee replacement at Tenwek with components obtained locally in Kenya! Our first patient, “John,” is a very enthusiastic and animated former English teacher who, aside from a little pain with urinating from a Foley attempt gone bad, did very well. I was thankful to have Keith Braun (a visiting orthopod from Mesa, AZ) here to share the moment, and he, at one point, said “Ernie Steury (the first physician at Tenwek) could never have imagined this.” And, next Monday, we have our first total HIP replacement scheduled with local components! We are amazed at the speed at which God has answered our prayers for the start of an ongoing total joint replacement program here at Tenwek as a mean to help subsidize care for the poor! And selfishly, I am excited because joint replacement surgery is what turned me on to orthopedics in the first place.

Please pray that God would continue to bless the orthopedic department at Tenwek, and that the joint replacement program would assist with the overall care of the poor, and viability of the hospital. Pray that our patients would have good outcomes and that God would be glorified through this new work, and that many would hear the good news as a result. Thank you for all your support!

Psalm 113:5-8 Who is like the LORD our God, the One who sits enthroned on high, who stoops down to look on the heavens and the earth? He raises the poor from the dust and lifts the needy from the ash heap; he seats them with princes, with the princes of their people.

Psalm 140:12 I know that the LORD secures justice for the poor and upholds the cause of the needy.

Road Trip to Eldoret: One Body, Many Parts

2009-06-14T12:21:00.006-07:00

Photo op with Dr. Lew Zirkle, founder of SIGN (second from left), and Dr. Lelei, the chairman of the Moi Orthopedic Department (right).

On the road to Eldoret...

Stephen demonstrating his surgical prowess (and lack of restraint) with Dr. Zirkle and I in the background.

I think every man enjoys a good road trip, so when I was invited to attend the demo of the new SIGN hip construct device in Eldoret, it was difficult to turn down. Stephen, Mwangi (the most current visiting orthopedic resident from Moi University), Keith Braun (a visiting surgeon from Arizona) and I piled into the van and, fueled by beef jerky, Costco trail mix (luxuries from the US) and diesel, we made the 4 hour dusty, jarring journey through the famed tea fields of the Kenyan highlands. After chai (tea) and mdazis (little fried doughnuts) at Mwangi’s apartment we checked into the “4 star” Grand Prix Hotel (from the name, you have to know it is fancy).

Eldoret, north and slightly west of Tenwek, is home to Moi University, which has a large teaching hospital, medical school and brand new orthopedic residency program. Tenwek began hosting Moi orthopedic residents in April, which has been mutually beneficial: we provide qualitative (and of course quantitative) training in orthopedic trauma, and the residents provide a much needed helping hand. By God’s grace, this relationship with Moi is growing and strong. Dr. Lew Zirkle, the founder of the SIGN company, which designs and manufactures implants for use in developing countries, was at Moi demonstrating a new implant he developed for hip fracture patients, hence our invitation to attend. Much like the intramedullary nails developed for femur and tibia fractures, the SIGN hip construct is designed to be placed without the use of fluoroscopy, but it has a steep learning curve. Dr. Zirkle would like Tenwek be one of a few institutions to trial the new implant. It was an honor to meet a man dedicated to serving the world’s medically underserved in the unique way for which he was designed by God.

Because RTAs (road traffic accidents) are in no short supply around Tenwek, mainly due to dirt cheap motorcycles from India, no licensure requirements, and improving roads that allow excessively high speeds (it is difficult to go fast when the road is full of pot holes), our trip to Eldoret was cut short to two days…otherwise the cases would just continue to pile up. Thus, after returning late Friday afternoon, the whole of Saturday (12+ hours – only a “half day” as my dad used to say) was spent in the operating room catching up, and treating new admissions. The work load continues to increase, and even with help from visiting residents and surgeons from the US, we are overworked and, at times, overwhelmed.

In what way have you been uniquely designed for God’s purposes, for the service and glory of His Kingdom? If we want to finish well, and live a life of true meaning with eternity in mind, I think this is an important question to ask. It may seem small, the part we are called to play, but like a thread, it is woven into the tapestry of divine history. Find that calling, and by God’s grace, excel in it for Christ’s glory.

The body is a unit, though it is made up of many parts; and though all its parts are many, they form one body. So it is with Christ...But in fact God has arranged the parts in the body, every one of them, just as he wanted them to be...Now you are the body of Christ, and each one of you is a part of it. (1 Cor. 12:12, 18, 27)

Please continue to keep our family in your prayers. We need prayer for strength to persevere, wisdom for the complex cases that present, emotional health to minister to the people that God brings into our lives, and for unity as a family, for Heather as she continues homeschooling, and as we move into new temporary housing next month. Also pray that God would continue to bring short (and longer) term orthopedic visitors to Tenwek to participate in the work, educationally and spiritually, that God is doing here. Thanks so much!

Holistic Ministry: Long term at Tenwek

2009-05-22T10:29:00.004-07:00

Gently used lead aprons recently donated to the orthopedic department.

Chronically dislocated ankle...a challenge to reduce.

Dr. Kisorio and Josh Carter, performing a tibial SIGN nail.

Jeremiah's favorite Jackson's Chameleon appropriately named Feisty.

Prior to medical school, Heather and I spent two years in the Chicago suburb of Deerfield, where I attended Trinity Evangelical Divinity School. While I started with the idea that I would pursue a degree which would prepare me to be a pastor, the end result was far from expected. Through a series of sovereign events, including Heather landing a sweet job in the Missions Department, God resurrected a past dream I thought was long dead (medicine) and combined it with a present calling (missions) to provide a new hybrid vision: Medical Missions. As a culmination of the education at Trinity, I was required to write a final integration paper which I entitled “Holistic Ministry and Medical Missions.” The main premise was that ministry which was most effective was not only “incarnational” but also “holistic” in nature, that is, meeting the needs of the whole person: physical, emotional, cultural, and especially spiritual. Medicine provides a unique opportunity to minister to the physical needs of people, especially the poor, as Jesus has great compassion on, and healed, the sick and needy. But his message never stopped there, the healing serving as a segue to the true need of all people: spiritual healing.

The patients who come to Tenwek for orthopedic care are varied: male, female, young, old…some with acute injuries, others with chronic…some with injuries secondary to foolish decisions, others injured by no fault of their own. The common denominator however, regardless of the etiology, is a need for physical help, which Tenwek is thankfully equipped orthopedically to provide. Thus, our days are spent fixing what is physically broken, using plates, screws, rods, pins, saws, cement, etc. I would not say, however, that this is our primary reason for existence at Tenwek. Although the fixing of broken bodies is of inherent value, if the spiritual needs of the patients are not being addressed, then all we do is merely humanitarian in nature. Rather, we have the opportunity, and responsibility, and privilege to ask patients if they know Jesus, if we can pray for them, or meet their spiritual needs in some other way.

Being at Tenwek provides the opportunity for wide variety of ministry opportunities, and allows us as a family to fulfill the calling of holistic, incarnational ministry. While our work is primarily medical, we are also able to communicate the gospel, teach, preach, lead worship, disciple, and minister to the needs of the poor. I had mentioned a few blogs back that we were praying about God’s plan for our family long term at Tenwek. While the last six months have been full of many challenges, both Heather and I feel that we are to remain and continue at Tenwek beyond the two-year commitment with Samaritan’s Purse. Committing to stay long term presents us with many other new challenges (transitioning to a new mission agency, building a house, etc.) for which we would greatly appreciate your prayers. But, we feel that God has sovereignly and very clearly opened the door for us to be here at this point and time, and we have the responsibility to stay until it is just as clear that we are to be elsewhere. At Trinity, we made the commitment to pursue medical missions full-time as long as God directs, and as he continues, so we will remain. Thank you for all your encouragement and support over the last several months. We appreciate you so much!!

Six months at Tenwek: Highs and Lows

2009-05-15T08:48:00.005-07:00

The sole cause of chronic neck pain in Africa.

Heather, Anna and Bryan.

Dr. Kisorio and Stephen with studious patient who daily reads the newspaper.

"Positive Kisii sign."

A daily reminder that without God there is no way....

Humor is often a healthy means of dealing with daily stress and this is certainly the case for me here at Tenwek. Sometimes you just have to laugh, and as a missionary, this is most often at yourself. One thing I find amusing are the various signs I see erected around Tenwek hospital. Our newest sign, which is posted just beyond the back entrance to the hospital, greets me every morning. It simply reads “No way.” I understand the intended meaning which is “please do not walk on the grass…stay on the sidewalk.” But instead it taunts me daily, simple writing on a wooden placard, reminding me that there is no way I can continue to serve the relentless onslaught of orthopedic patients at the hospital…no way except by the certain grace of God, who continues to provide strength, wisdom, and refreshment at just the right time. I can do everything through him who gives me strength. Phil. 4:13. Another sign was recently posted adjacent to a broken floor drain directly outside my operating room, in order to protect people from stepping into the small opening. It read “Warning. A hole ahead.” I chuckled to myself, wondering if they where referring to me, or to the actual drain hole.

We have now been here six months at Tenwek, and what has amazed me is variability of emotion which has been experienced, by both Heather and me. The spectrum is wide, with the highs high and the lows low. Certainly the biggest joy has been the fulfillment of the calling that God gave us over 17 years ago. Although there were rough patches along the way that threatened to derail the plan, God, by his sovereignty, remained faithful, and brought us here, despite ourselves. This calling encourages us to persevere and continue, even when we feel completely depleted. The orthopedic department is such that when you think the workload is managed, another four highly complex patients from Kisii District Hospital are admitted. Our most recent patient from Kisii was a 19 year old boy with a “floating knee” (both femur and tibia fractures on the same leg). Normally this is not difficult to treat, one incision in the knee with rods in both the femur and tibia. However, the “positive Kisii sign” (as Josh Carter, a medical student/soon to be orthopedic resident visiting from the states coined) was the fact that the tibia fracture was open, two months old, with a 10 cm segment of exposed, dead, infected, putrid bone. Another man recently admitted at Tenwek suffered bilateral femur fractures over a month ago. After lying in skin traction at Kisii hospital for more than a month, he discharged himself, and headed straight for Tenwek. The irony is that the medical officer made him sign a form that he was being discharged “AMA” which stands for “against medical advice.”

God provides continually. In April, Dr. Kisorio, our first visiting Kenyan orthopedic resident from Moi University arrived, and he has been a great partner and helpful colleague with skills well beyond his years of training. Additionally, Stephen Leimgruber, Heather’s cousin and recently graduated RN, arrived at Tenwek for a minimum one year stint with plans for two, and will be working directly in orthopedics. Stephen and Dr. Kisorio (and future visiting residents from Moi) are sharing a two bedroom apartment furnished by funds donated into our project account. As Paul McCartney and Stevie Wonder sang in the 80s: “Ebony and ivory, living together in perfect harmony.”

Heather would testify that homeschooling and the continual, unremitting needs of the community around us provide her greatest source of highs and lows. Although Heather often questions her ability and effectiveness as a teacher, the kids are learning amazingly. Our curriculum focuses on literature, reading, logic and writing…even Claire, in second grade, writes papers full of rich language. The needs around us are massive, and we have often thought that we could give all we have and still not make any effect. I wrote earlier about Anna, whose house we purchased with funds from our project account. When my brother John was at Tenwek, we visited Anna, who although thankful for the gift from you in the states, still feels the daily pressure to feed her children, and provide for their future as a single mother. We are currently “cow shopping” for Anna, who, with this asset, will have both a source of nourishment and income for her family. Thank you for donating into our Samaritan’s Purse account for needs such as these. There are countless other stories of people who have been blessed, in this way, by your generosity.

What we are reminded of daily is simply this: we need Jesus. In truth, we all do, whether or not we know it consciously, or choose to acknowledge it. We just have the luxury of living in a place where we feel it acutely every day. At times, we feel so inadequate, broken, unworthy, unequipped, and ineffective. But I have the sense this is exactly where we are supposed to be. In this way, paradoxically, the power of God is shown through the cracks, so that God, and not us, is glorified.

But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us. II Cor. 4:7

A Willingness to Serve…

2009-05-07T11:52:00.002-07:00

John and Dan getting ready to head to the hospital after a large cup of coffee in the morning.

John and Anna's boys (the lady whose house was purchased from funds you donated to our SP account). They were completely entralled with the SUV we borrowed from another missionary to make the muddy visit to her home (4-wheel drive is very useful in rainy season).

For the past two weeks, we have had a visiting heart surgeon exploring the possibilities of a future partnership for a heart valve replacement program at Tenwek. He also happens to be my oldest brother, John. Because of the nature of this initial “vision” trip, his work at the hospital consisted mostly of general surgery cases, which he has not done since residency, over 20 years ago. Although slightly anxious at first, toward the end, like riding a bike, he was whipping through typhoid small bowel resections, sigmoid volvulus, ruptured appendices, and even an orthopedic case or two (although he did mention that he was reminded why he chose to specialize in heart surgery). His willing to serve in simple ways, at times beyond what was comfortable and easy (could heart surgery be easy??), and in ways not so glorious, was a blessing and example to many here at Tenwek. Perhaps his greatest ministry, however, has been directly to our family. Our kids, loving their Uncle John, no doubt smothered him. We enjoyed our daily meals, and evenings reminiscing, laughing, watching “Planet Earth” and “Blue Planet” DVDs that he brought for us, looking at family pictures, and dreaming of the future. We will miss him when he returns to the States tomorrow, and look forward to what God may have in store for the future. Following is an excerpt from a letter he wrote telling of a young boy he met at Tenwek:

Dear Church Family and Friends- May 1, 2009
Two days ago I met a boy, twelve years old, who I will call “Edward”. Edward’s father had heard that there was a “mzungu,” a white doctor from America, who does surgery on the heart, visiting Tenwek Hospital. He told me that Edward was unable to run and play with the other kids and always seemed short of breath. Edward appeared small for twelve and as he lifted his dirty oversized shirt, which I was told was likely his best, I could see why. Edward’s small chest had been deformed to accommodate his enlarging heart. When I placed my hand over his chest, I could feel his pounding heart and the turbulent blood flow through a narrowed and badly leaking mitral valve. At some point in his childhood, Edward had gotten strep throat that progressed to rheumatic fever, damaging the connective tissue in the valves of his heart, causing them to thicken and contract. Without replacement of this valve, Edward’s heart failure will certainly progress and he will die a miserable and premature death. Simply treating Edward’s strep throat with Penicillin could have prevented this all. Rheumatic fever has largely been eradicated in the United States because of prompt evaluation and treatment of a sore throat. In poor and under-developed countries like Kenya, this is not possible. The damaged valves can be replaced but surgery has been likened to “attempting to mop up the water on the floor while leaving the faucet open.” As I watched Edward walk away, I felt very tired, sad, and overwhelmed by the enormity of the problem and the lack of immediate solutions…

Please keep John in your prayers that God would clearly direct his future, and open doors for heart valve replacement surgery, perhaps as early as next January. We appreciate you so much!

Whatever you do, work at it with all your heart, as working for the Lord, not for men, since you know that you will receive an inheritance from the Lord as a reward. It is the Lord Christ you are serving. Col. 3:23-4.

Memorable Family Events: A Gift from God

2009-04-29T07:31:00.008-07:00

Easter Morning Sunrise Service, extra special with Grandma and Grandpa Kinkel.

"King George" the bacon- and sausage-eating Morey eel.

Claire amidst a sea of tide pools in Watamu, Kenya.

Sunrise on Turtle Bay (photo by Jeremiah).

Jeremiah's baptism.

The last few weeks have been incredibly memorable for our family, full of meaningful events. We were invited to the annual WGM (World Gospel Mission) spiritual retreat at the Kenyan coastal town of Malindi, and every year, the highlight is a baptismal service in the Indian Ocean. When I mentioned the possibility to Jeremiah a few months ago, he felt strongly that he was ready to make this commitment. Then, after Grandma and Grandpa Kinkel heard about Jeremiah's plan, they could not stand the thought of missing this important event, and immediately booked tickets! After picking them up at the airport in Nairobi, we returned to Tenwek for a few short days, which included the Easter Weekend services at Tenwek. The pinnacle was the Sunrise Service, where participates were invited to place flowers on a cross erected on the Robert’s lawn. Later, we enjoyed an Easter meal, at our house, of locally obtained roasted leg of goat!

A few days later, we were off to Malindi, a very poor, yet beautiful town off the Kenyan coast of the Indian Ocean. The timing was perfect, as we all were feeling rather spent from the constant barrage of homeschooling, patients, surgeries, etc. at Tenwek, and the spiritual renewal, connection, and relaxation were a gift from God. Heather and I awoke every morning at 6am for a walk on the beach while the sun was rising in the east, and then back for a perfect cup of Kenyan coffee. There was a new moon the last few days of the retreat, thus the tides were especially extreme, creating a huge mosaic of tide pools containing the most incredible montage of creatures: Morey eels, lion fish, red snapper, starfish, “Nemo” fish, sea urchins, brain coral, magic coral... Every pool was like a natural salt water aquarium designed by God. We all grew in amazement of God’s creativity, wisdom, and power in his creation, all for His glory.

The highlight was Jeremiah’s baptism (which also occurred on Heather’s birthday). After sharing his testimony of what Christ had done for him, he concluded by saying, “I just want to live my life for Him.” I had the privilege of baptizing my son with Roy Lauder, the visiting guest speaker for the retreat. We waded out into the high tide of the Indian Ocean, the water warm like a bath, as the sun was setting, and shared this moment with the 50+ people at the retreat. What a perfect event!

Thank you for the prayers and support you have given our family these last 5-1/2 months. We could not be here without you, and count it a privilege to partner with you in Kenya. Please continue to pray for our family, for Jeremiah that he would grow in his faith, for wisdom and peace and joy for Heather as she manages our home and home-schools, and for me as I continue the work at the hospital. We appreciate you so much!

Naphtali's Lesson in Love: Weekend Trip to Lake Victoria

2009-04-07T12:24:00.005-07:00

Jeremiah showing the "termite queen" he unearthed to all the Kenyan children.

Fishing is the common trade to many on Mfanganu Island.

Jeremiah sorting worm medication during "clinic."

On the beach at dusk, with Mfanganu Island off in the distance.

Two weekends ago, Jeremiah and I were invited to attend a small medical outreach to Mfanganu, a small island with a population of approximately 30,000, directly off the Kenyan coastline of Lake Victoria. Excited to have a concentrated “father-son” time, we stuffed into the small SUV with 6 other people, Jeremiah and I essentially riding in the trunk for the 5 hour painful trek to Mbita, on the Lake Victorian coast. The following morning, we traveled, via an old, hand-made boat, across the strait, to the Island, Jeremiah riding high on the bow to avoid getting soaked like the rest of us (not his first rodeo). Once on the island, we checked into the “guest house,” which was essentially just us…and a host of the most concentrated and diverse variety of insects. I understand now why there is an Entomology Research Center at Mbita.

The most amazing part of the trip was meeting Naphtali, a brilliant Kenyan native of Mfanganu Island, and his family, who are living out daily, in the radical way, the Law of Love. As a young boy, he worked with his father as a fisherman, as so many on the island are employed. However, determined that he would not blindly follow the same pattern, he put his mind to study, and eventually entered the top schools in Kenya. As time passed, he felt called by God to return to the island to serve, and joined Wycliff Bible Translators, translating the New Testament into Suba, the local vernacular. During his translation work, he was moved by the need for practical application of what he was so engrossed in daily. He noticed the large numbers of orphan children on the island, many as a result of HIV/AIDS, and began to take the most needy into his own home. The ministry grew and now, he is the director of the Gethsemane Garden Christian Center, which houses and educates over 450 orphaned children (although now, he does not call them orphans because they have a heavenly Father and they have him).

The medical outreach was to the children of Gethsemane Garden, and once we set up a small clinic, the children began to pour in. Thankfully, Dino and Janice Crognale, both family physicians from Tenwek, were running the show, with Jeremiah and I operating our small, portable pharmacy. Jeremiah enjoyed the responsibility of dosing medications, cleansing wounds, and occasionally, making a diagnosis: “Dad, she needs mebendazole” (medication for round worms). We broke for lunch, and ate a hearty meal of freshly prepared goat liver, (of which Jeremiah ate seconds), and then it was back to work. Towards late afternoon, the "drug seekers" started coming (children who heard we were giving out tasty, grape-flavored, chewable Tylenol), thus I was “allowed” to start seeing patients. A young, and very shy girl sat before me and I asked, “What can I do for you?” “I have a disease,” she said, straight-faced. Expecting the worst, I leaned in and said “What is it?” She replied in the most serious voice, “It is called…the common cold!” I told her that sounded very concerning, but I was confident that she would get better without any tasty, grape-flavored medicine/candy.

On Sunday, before leaving the island, we had the pleasure, and honor, of worshiping with these 450 children of all ages, who were so empty, so poor, possessing only a few material goods, yet so full of God, and deeply loved by one man being practically obedient to the call of God. As part of the service, children were given the opportunity to sing songs they had created. One boy, in particular, sang a strange and powerful melody, a capela, that still goes through my mind today. The entire experience made me consider my own life. Do I have that kind of love, where I would be willing to lay it all down for others? If I am honest, I would say “no…” because I am still so infatuated with “me.” But we are all in process, being changed into the image of Christ, and my prayer continues to be “more of you, less of me,” because on our own, we cannot love with the deep love that is the Law of Christ.

“Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength. The second is this: 'Love your neighbor as yourself.' There is no commandment greater than these." Mark 12:30-31

Beyond Human Understanding…

2009-04-04T12:44:00.001-07:00

Kipkorir is a young, eight year old boy whose mother recently died from AIDS and whose father is HIV positive. One could consider this enough sorrow in a lifetime for any child, however, the tragedy escalated. Kipkorir was struck by a truck, and dragged underneath on a dirt road for a ¼ mile. Somehow he survived and was rushed to Tenwek for medical care. He had multiple, severe injuries, including a skull fracture which resulted in a brain injury causing weakness on the entire right side of his body, a cervical spine injury causing his neck to be twisted to one side, and multiple abrasions, the worst of which being on his left leg, where the dirt road had completely shaved off the outside three centimeters of his ankle and foot during his horrific ordeal. From a medical standpoint, there was not much we could offer, and he was in severe and constant pain, leaving us with a profound sense of helplessness. We initially considered amputating his badly injured leg, but instead decided to give it time. Without proper imaging, or resources, the neck injury was treated with a Minerva cast. As so often occurs at Tenwek, the only real thing we could offer was prayer.

The daily dressing changes for his leg were excruciatingly painful, and, after a while, the cast which was applied for his neck injury caused a large wound on his chin, and had to be removed. However, beyond our hopes, he miraculously began to improve. After the cast was removed, his neck was no longer turned to one side and his pain was completely gone. His leg wound was eventually covered with a skin graft and he no longer suffered from the daily dressing changes. Then, the weakness of his right side began to resolve and he was able to take some steps. Now today, his wounds are healed, he is able to walk some distance with a walker, and he smiles continually. Whenever he sees me the courtyard of the hospital, he chases me in his wheelchair, laughing with delight. The most moving part of the story was, however, watching Kipkorir’s HIV+ father, himself undoubtedly scarred and saddened by his life’s circumstances, lovingly interacting with his son, offering courage, not once leaving his side.

Many times, events occur that are so far beyond our understanding. We may question God’s activity, or wonder why he allows this type of broad spectrum suffering in a young child such as Kipkorir, and thus we may pass judgment on what ought or ought not to be. But, perhaps, while the reasoning may elude us when viewed via our temporal human understanding, more divine purposes might be at work to change all of us, not just temporarily, but eternally.

"For my thoughts are not your thoughts, neither are your ways my ways," declares the LORD. "As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts."
Isaiah 55:8-9.

On Injustice and the Human Condition

2009-03-17T09:01:00.002-07:00

Late last Friday afternoon, I was called to Casualty to evaluate a five year old Masai boy who had sustained a simple forearm fracture about a week ago while playing with his friends. “You’d better put some oil of wintergreen under your nose,” I was warned by the Kenyan intern, referring to the oil used to extinguish the smell of necrotic flesh. As we walked to Casualty, the real story was explained. Apparently, the boy’s father, a Masai with several wives, decided to treat the fracture using an old African method, wrapping the fractured limb tightly with leather strapping. Unfortunately, the boy’s real mother was absent at the time of the injury and treatment, caring for another son who was sick at a local district hospital. After a week in this leather tourniquet, the boy’s arm had completely died, being robbed of vital blood supply, and now he was becoming septic from the gangrenous infection that was developing. As soon as I entered casualty, the smell overwhelmed me. The boy looked sick, hurting, and after one look at the black, necrotic arm, we knew there was only one solution.

Dr. Agneta Odera, a Kenyan surgical resident currently on the orthopedic service, quickly started an IV, while I tried to distract him with “This little piggy…” However, his suffering had been so great, and he was feeling so ill, that the IV barely caused him to flinch. We explained to the boy’s mother, notably angry at the mistreatment of her son by the father, what needed to be done in order to stop the spread of infection. She consented and we quickly wheeled him off to surgery. While we were operating, I could not help but dwell on the injustice of this little, innocent boy’s situation, and the obvious neglect that he suffered by people who were supposed to protect and care for him. “This man deserves to be punished,” I thought to myself while we were closing the wound. Thankfully, the surgery went well, although it is difficult to call an above-the-elbow amputation a success.

Two days later, while rounding, we checked on the boy, and he seemed well, now smiling, even laughing, but yet undoubtedly deeply scarred from the events that he suffered. “The boy’s father has been sent to prison for neglect and child abuse,” Dr. Odera explained. While on the one hand, my personal need for justice in this situation was somewhat satiated by the father’s punishment, I still had the sense that nothing would ever be enough to satisfy this wrong that occurred…nothing, except the blood of Christ, who “himself bore our sins in his body on the tree, so that we might die to sins and live for righteousness; by his wounds you have been healed.” (1 Peter 2:24). In reality, we are all just like this boy’s father, guilty of sin, falling far short, deserving of punishment…yet, in faith, believing, covered by the blood of the One who bore our sin, took our infirmities, and forgave our great sin.

Please pray for this young boy that he would be healed emotionally and physically from this tragic event, and that he would come to know the true Father who always cares, protects, and advocates for him. As for us, it is our privilege to continue in the work here in Kenya to which God has called us. We greatly appreciate your prayers and support!!

Incarnational Ministry

2009-03-06T11:35:00.003-07:00

The Kung-Fu Squatting Pandas: Edwin, Enoch, and Dennis

One of the privileges of being a missionary in Africa is the daily interactions with the Kenyans living around Tenwek. Aside from the daily work in the hospital, there are a myriad of opportunities to be involved in the lives of people, which provides definite mutual blessing. For instance, Heather and I are both involved as “coaches” with Bible Quizzing, a yearly tradition at Tenwek for elementary aged children. Boy and girls who desire to show their biblical and intellectual prowess are divided into teams to study a certain book of the bible (this year the gospel of Luke), and then compete against one another in formal quizzes. Our role as “coaches” is primarily to encourage them in their faith, to mentor them, and be their friend. My team consists of three Kenyans (Edwin, Dennis, and Enoch) and two missionary boys (Andrew and Peter) who strangely named their team “The Kung-Fu Squatting Pandas.” Heather’s team, “The Growing Lilies” (very intimidating) consists of eight sweet, yet highly competitive girls. We compete regularly against one another at every meet, the “Pandas” against the “Lilies,” the boys against the girls, Dan vs. Heather, and the competition is fierce. The Pandas’ secret weapon (Edwin) is a memorizing machine, having memorized word-for-word, 75 verses from Luke.

The privilege of consistently interacting directly with the people you live and work with can be summarized in the phrase “Incarnational Ministry,” a term I first heard from Dr. Paul Hiebert, professor of missions at Trinity, over a decade ago. Literally, incarnational means “in the flesh,” and the concept is that the most effective ministry, the ministry that meets the deepest needs, and has the biggest impact, occurs as we live, in the flesh, long-term, with the people we are called to serve. Incarnational ministry is not exclusive to international mission work. Consider a pastor called to minister to the same congregation year after year, or the teacher called to the same inner-city school, the nurse called to work the same night shift, the business owner called to consistently and faithfully serve others, or the persevering mother inconspicuously raising the next generation of leaders and believers.

Incarnational ministry is not sterile, or remote, but rather gritty, raw, and exposing. When you spend enough time with people, your idiosyncrasies and flaws will eventually become blaringly evident, but paradoxically providing the opportunity to demonstrate our need for forgiveness, and ultimately, a Savior. Our example is the true “Incarnation,” Jesus Christ, “who being in very nature God, did not consider equality with God something to be grasped, but made himself nothing, taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself and became obedient to death-- even death on a cross!” For Heather and I and our family, our calling is to be here at Tenwek, to serve at the hospital, and church, and to minister to the people that God sovereignly brings into our lives.

How about you? What is your Incarnational Ministry? Who have you been called to live among, to serve, and to encourage? Would you ask God “what is your calling for me?” Would you dive off the cliff and say “yes” to God even if your way is uncertain? The only way any of us can, is to truly believe, in our hearts, and by the Spirit’s empowering, that Christ is the greatest treasure that any of us could ever have, and that the life to come is so much greater, and incomparable, to than anything we could ever hope to have here on earth.

Culture Shock

2009-02-26T12:26:00.007-07:00

The Tenwek Girls Boarding School

The Passion Fruit Flower: exotic, unexpected and new.

During our excellent training at MTI last October, we were warned that, at about three months after arrival in country, a transition ensues. The first few months after arrival are more like a honeymoon, the experiences new and exciting, and charged with endorphins. Relationships with nationals are rich and forgiving of cultural differences. Then slowly, the reality of life in a very different country sets in, and what once was exciting becomes puzzling, and what was new becomes old. Cultural differences which were originally fascinating become frustrating, and you begin to ask yourself, “what are they thinking?” For instance, we have the pleasure of living directly across from the Tenwek Elementary Girls Boarding School, which houses and educates what seems to be hundreds of squealing, happy, pre-adolescent girls. Every night at 10:30pm, while I am trying to enter sleep after a long day in theater, in a bedroom that is literally a stone’s throw from the school, there emanates loud talking, laughing, screaming, whistling, pounding, jumping and all sorts of other mayhem. Eventually everyone tires out, and things quiet down…until 5:15am, when I am unpleasantly awakened to the sound of desks screeching across a tile floor as they are being moved back to a locale they should have never left in the first place, a sound that is akin to nails on a chalkboard, or the old alarm clocks of the 1980’s. I am so perplexed as to how anyone can function on such sparse sleep, especially children, as our kids need about 10 hours per night (Jeremiah would sleep 14 if we let him). Deciding I needed to get to the bottom of this, today, I asked one of my Kenyan OR staff what on earth they are doing so early in the morning, and he informed me that the kids wake up every day at 4:30, have some time to freshen up and get ready for the day, and promptly begin school at 5:15am. And, if their marks on the Kenyan national exams are poor, their punishment is more study, more often, and earlier in the morning, including Saturdays…all without any regard of the law of diminishing returns.

What we are experiencing (with this, and other untold stories) is culture shock, which can take variety of forms depending on personality: anger, frustration, sadness, depression, anxiety, panic, fear, apathy, feeling overwhelmed, addictions, obsessions with familiar objects, and physical symptoms such as indigestion, hypertension, and headaches. Some people in missions never recover from culture shock, and this brings them home prematurely. But others work through this inevitable phase, and emerge a changed person, a mix unlike either culture, much like two flavors that become something totally new when mixed together. There is no way to avoid culture shock, but knowing the manifestations and understanding that it is normal, is the key to surviving.

Would you please pray for us during this time of transition? Thanks.

Proverbs 3:5-6
Trust in the LORD with all your heart and lean not on your own understanding; in all your ways acknowledge him, and he will make your paths straight.

Our First Visitors...

2009-02-22T10:01:00.004-07:00

Obscure picture Jeremiah took while on a "field trip" to the slaughter yard.

Mom and Claire feeding orphan "Annie" in the NICU three times daily.

The past two weeks we have been blessed to have Dan Sr. and Lois Galat visiting us at Tenwek. Although they are in their (early) 70s, they survived the long flight without difficulty, including a leg of the journey flying standby. After a few days in Nairobi gathering another two months of supplies and renewing our visas (we have now been in Kenya three months), we made the dusty journey back to Tenwek. My parents, being highly active, quickly found their niche, mom at the NICU caring for an orphan baby girl she and Claire named “Annie," feeding her faithfully three times per day, and dad at the Tenwek butchery. It did not take him long to discover that goat is butchered on Saturdays and beef on Mondays, and Wednesdays, or the industrial size meat grinder that Ernie Steury originally purchased for Tenwek a few decades ago. Meals have been interesting, yet delicious: goat burgers, true mystery-meat samosas, and beef stroganoff made with the tenderloin.

The kids have so enjoyed grandma and grandpa. During the days, mom helped Heather with homeschooling. Dad and Jeremiah took a “field trip” to the slaughter yard, where Jeremiah took many disturbing pictures not appropriate for public display. Nights were filled with games of Uno, Euchre and, once or twice, a movie on the “home theater” system. The highlight of their trip was the Safari on the Mara. We saw every animal in the “big five:” lion and leopard, elephant, rhino and cape buffalo, and the kids had the time of their lives watching hippos, dik-diks, water monitors, baboons, zebra, hyenas, etc. We all came away with a deeper appreciation of the incredible creativity, and complexity of God in His creation, all things made for His glory.

Please keep Dan Sr. in your prayers as he has been fighting a bad sinus infection (hopefully not brucellosis, malaria, or some other African treasure). They leave for the US on Tuesday evening, so please pray that they have a smooth return home, without any problems. We look forward to our next visitors in April, grandpa and grandma Kinkel.

On Safari with Grandma and Grandpa

2009-02-22T09:44:00.000-07:00

SIGN, Fat Embolism, and the Power of Prayer

2009-02-08T13:37:00.000-07:00

Tibial SIGN Nail

Kipkirui, a young 20 year old man, was involved in a RTA (short for road-traffic-accident, of which there is no shortage of here in Kenya) early last week, and sustained a closed tibia (shin bone) fracture. The treatment for this is fairly routine…a large nail placed down the shaft of the tibia to secure the fracture, holding it until healing is complete. We used a new nail system called SIGN, which God miraculously and sovereignly provided through a series of divine events that occurred last fall while we were preparing to come to Tenwek. The SIGN nail was designed specifically for use in third world countries, with the goal of providing equality of orthopedic care around the world. Where patients with fractures used to be in traction for several weeks in bed, or in casts for several months, now with nailing, they are able to mobilize the day after surgery.

Having heard about the SIGN program through a consultant friend at the Mayo Clinic, I applied last summer for Tenwek to be a program site. Once accepted, and after the funds for the manufacture of two instrument sets and the first 100 nails are raised, SIGN commits to continuously provide inventory, free of charge, as long as each case is reported online in the SIGN database. About a month after I applied, I received a random email from an orthopedic surgeon who had been to Tenwek several times, yet I had never met, telling me about a chance meeting he had with a consultant from the Mayo clinic at the annual SIGN conference in Washington State. During casual conversation, they discovered that they both had ties to Tenwek, one had visited, and the other knew me as a resident. This prompted talks about what could be done to expedite Tenwek’s acceptance as a program site, and a week later, I received an email from the SIGN program founder telling me that Tenwek was accepted, and incidentally, the upfront costs for manufacture were already covered! A month later, the nails and sets arrived and were packed in the “Action Packers,” ready for the trip to Kenya. So far we have done eleven SIGN nails, and they have been such a blessing for the work here.

The day after surgery, Kipkirui was doing well, and was able to get out of bed and begin to mobilize. However, later that afternoon, he developed significant shortness of breath, and was noted to be breathing very fast, about one breath per second, and his heart rate was 150. Checking his oxygen saturation, it was well below normal. With this constellation of clinical symptoms in a young patient with a fracture, the diagnosis is fairly obvious: fat embolism. This rare, yet serious complication occurs when bone marrow fat from the boney canal gets into the bloodstream and showers vital organs with emulsified fat, setting off an inflammation cascade, of which the lungs are especially vulnerable. There is debate about when this occurs (i.e. at the time of the initial injury, or when the nail is placed into the canal), but overall, the prognosis is very poor, and even in the best institutions, patients die from fat embolism.

Kipkirui’s condition rapidly deteriorated. Sovereignly, the same orthopedic surgeon who emailed me last September from the SIGN conference (and is currently visiting for 5 weeks), was present with Kipkirui during this ordeal, and explained to him what was happening, and that while we would do all we could to support him while his lungs recovered, there was a possibility that he was not going to survive. The surgeon asked him if he had faith in Jesus, and he assured us that indeed he did. Shortly thereafter, he grew more distressed, as it became more difficult to breathe. Thus, he was transferred to the ICU and intubated with a breathing tube. When I saw Kipkirui in the ICU that night, we were struggling to keep his oxygen saturation above 90%, even with pure oxygen and pressure ventilation. Frothy blood was evident in the suction canister next to his bed, signs that his lung tissue was severely injured from his body’s own inflammatory cells. I went home that evening wondering if he would be alive the next morning. All we could do, at that point, was pray.

The following day, I made my way to the ICU, concerned with what I might find, but hopeful since I had not received any pages. As I walked in the room, Kipkirui was lying in bed, comfortable, still intubated, but awake, following commands, and looking very good. His tube was completely clear of blood, and now, his oxygen saturation was 100%. He honestly looked to me as if he made a complete and miraculous recovery. We are currently weaning him from the vent, and tomorrow, God willing, he will have the breathing tube removed.

Sometimes we pray and God works in powerful ways…other times, He seems silent. Sometimes patients live, and sometimes they die. Overall, we know that our sovereign God has all things under his control, and He does as He wills, according to His purposes, for His glory. Yet, somehow, our prayers play a significant role in this divine drama, a truth that, although beyond our understanding now, has implications for all eternity.

Then Jesus told his disciples a parable to show them that they should always pray and not give up. Luke 18:1

Images from Tenwek

2009-02-06T13:55:00.002-07:00

The Gaw's visited Tenwek the month of January. David is a semi-retired orthopedic surgeon with a lot of wisdom and amazing stamina in the OR. Patsy "adopted" our kids as her own grandchildren for the month.

More Jeremiah photography.

Images from Theater

2009-02-06T13:28:00.002-07:00

I am continually amazed at the complexity of cases that present to Tenwek. This x-ray shows a fracture of the far end of the femur at the knee, in a young 28 year old man. The fracture was open, meaning there were several pieces of bone sticking out of a wound at the knee.

Another example of a massive sarcoma, (a very rare malignancy), in a young patient.

Orthopedic Training, an Update on Anna, and a Request for Prayer

2009-02-06T06:57:00.003-07:00

Orthopedic Resident Education at Tenwek

Last Thursday, Dr. Lei Lei, chief of orthopedic surgery and director of the new orthopedic residency program at Moi University in Eldoret (about 3 hours drive from Tenwek), paid us a visit to discuss the possibility of resident rotations at Tenwek. After a tour of the facilities and a generous lunch at the hospital cafeteria consisting of samosas (deep fried mystery-meat pockets of which, I am finding, every culture has a version) and Stoney (ginger soda), the deal was done. Beginning in April 2009, Moi University will send orthopedic residents for away rotations to Tenwek in two month blocks, thus providing more hands for the workload here, and an opportunity to further establish Tenwek as training institution in orthopedic surgery. Our responsibility will be to provide housing for these visiting residents. Tenwek has an unfurnished house available, and I have committed to providing the furnishings (stove, refrigerator, tables, chairs, bed, etc.) via funds from our SP ministry account. Thank you again to those who have contributed!

Anna’s House Secured

Peter delivered your gift for the purchase of Anna’s home and after a lengthy meeting with all involved parties, the house is officially hers (and she is so grateful)! There are so many needy people here, and we have really been praying about our responsibility in helping meet the needs of those God brings (sometimes literally) to our doorstep. This also requires an incredible amount of wisdom to sort out those with true vs. illegitimate needs. Sometimes this is straight-forward. For example, on Christmas Eve, we had a young man come to our home with a list of items he needed for Christmas dinner. He also possessed a strong smell of alcohol on his breath, thus (as a bright orthopedic surgeon…”strong as an ox and twice as smart”) I put two-and-two together and surmised that he was probably given the list by his wife, along with the necessary shillings, which he likely spent on some Christmas “spirits.” Thus, having realized he could not go home empty handed, he came to us for help. We sat down and had a long talk, and having compassion on him for the thrashing he would likely get when he returned home, I sent him on his way with a few items on the list. Other times, the issues are more subtle, and we have to rely on prayer, and Hannah and Emily for advice.

Long-term at Tenwek?

Our current commitment to Tenwek is via the Post-Residency Program with Samaritan’s Purse, which is for two years. However, we have been praying for some time that God would make clear the next step, (i.e. if we are called to make a commitment to serve here long-term). Many questions arise that currently have no answers. Would our kids be OK? Would their grandparents be OK? Will we stay healthy? Will I be able to get board certified? As such, there are an incredible amount of variables and uncertainties (as there are for all of us, no matter where we are) that would go along with this commitment. For instance, we would have to transition from Samaritan’s Purse (our current sending agency) to World Gospel Mission (the mission that runs Tenwek), and thus go through the application process to make this official. A major change with this transition would be having to recruit a financial support team (we rely upon this to a degree now, but SP does provide a monthly stipend for some of our living expenses). The other major issue is that housing is very tight at Tenwek. Through summer of 2010, we will be staying in long term missionaries’ homes while they are away on furlough. However, after that time, we will be “homeless” (so to speak). Thus, we were told by administration, that if we were to make a long term commitment, we would have to build a new home. Finally, we would need to purchase a vehicle, which we are finding is a very necessary item for a family of six living in remote rural Kenya (it is difficult to hitch a ride to Nairobi with our large family). Please keep us in your prayers for wisdom as we seriously seek God regarding this major decision. In many ways, it would be so much easier not to have to face these issues, serve our two years, and then come back to the states. But, God miraculously opened the doors for us to be here at this point in time, and we are convinced that if he is calling us elsewhere in the end (including back to the states), we should have the same strong sense of direction. Thanks so much for your prayers and support.

Images from Tenwek

2009-01-24T11:41:00.002-07:00

Kayaking down Tenwek River: A few weeks ago, Dr. Ben Robert (ophthalmology) invited me to join him on the maiden voyage down the Tenwek River on his new inflatable Kayak. Hundreds of people lined the river banks watching these two crazy mzungus brave the white water rapids.

Enjoying the Christmas presents from Grandma and Grandpa.

One thumb WAY up! This patient was "stung" by a wooley caterpillar on the left hand and lost all fingers, but was able to keep her thumb. As can be seen in her face, she was perfectly happy with this, stating (in Kipsigis) that she was still able to scratch her head and pick her nose!

On Human Suffering and God’s Sovereignty

2009-01-24T11:19:00.003-07:00

I received a phone call from the surgical resident-on-call last Monday night, concerned about the x-rays of a young, 12-year-old girl. “She had a fracture of her right femur last May and was treated in an external fixator,” he said. “Now her leg is huge, unlike anything I have ever seen before.” When I saw the x-rays, my heart sank. Her femur bone was completely destroyed, missing all the way up to the hip joint, and the hazy appearance of the huge soft tissue mass around it told the real story. Likely, the fracture last May was because her bone was weak from cancer, and a quick review of the old x-rays showed this to indeed be the case. When I met Chebet the next morning, I could not believe the size of her thigh. She weighed only about 60 lbs, half of which was tumor. The mass was literally sucking the life out of her, the large blood vessels of the leg hugely engorged, shunting nutrition and vitality from the rest of her body to feed what was slowly taking over. She was extremely malnourished, emaciated and lifeless, without any hint of emotion, but unable to even move in bed because of pain. When I questioned her parents why they had not sought medical treatment earlier, their concern was finances. I explained that their bill would not be an issue…but now, the only way to treat the cancer would be an amputation at the level of hip joint. Bone cancer usually metastasizes to the lungs, thus a chest x-ray was ordered. Given the massive size of the tumor and her late presentation, we were not surprised to find three golf-ball sized densities behind the heart…

Orthopedics was called to evaluate a 20 year old patient in Casualty with multiple fractures. When Tommy, a visiting medical student from the University of Cincinnati, went to evaluate the patient, he noticed he was not breathing well. A pulse-oximeter (which measures the percent oxygen saturation of hemoglobin) was applied and found to be 50%, a very low value. Getting more of the history, we found that two days prior, he was riding a bike when he was struck by a high speed vehicle, and was originally “treated” in a nearby government hospital. He was referred to Tenwek only after his condition “worsened.” When I came into the room, our anesthesiologist was working, with difficulty, on intubating the patient, straining to see the opening into his trachea through blood and pus. Amazingly, Joel was able to intubate the patient, and his oxygen saturation improved somewhat. An orthopedic review showed an open femur fracture on the right, a closed femur fracture on the left, and a near complete traumatic amputation of his left foot which was conveniently neglected at the outside hospital, and now smelling rancid. Because of the injury to his lungs and overlying pneumonia, we had to perform “damage control orthopedics,” in order to avoid further pulmonary injury. A quick amputation of the necrotic leg, and two tibial traction pins were applied until we could “nail” his femurs at a later time. However, the next day, the patient passed away in the ICU because of pulmonary failure…

Later that afternoon, we were called to evaluate a 43 year old man who was assaulted by some friends, struck in the back of his neck with a “rungu” (large wooden club). He was not moving his extremities, and was noted to have a dislocation of his cervical spine. On review of the x-rays with a visiting radiologist from the University of Louisville, the patient was found to have bilateral jumped facets (similar to the young woman told of previously). However, in this case, the patient was completely quadriplegic. Attempting to reduce the dislocation with tongs and traction, we were successful with relocating one facet, but the other side remained dislocated because a fracture completely sheared the facet from the rest of the vertebrae. The chance of recovery, apart from a miracle, is very slim…

Please keep our patients in your prayers, that God would give us, as their providers and advocates, wisdom and skill in their treatment, and that God’s healing power would be present, especially when the outcomes are well beyond our human ability or resources. We remain so dependent upon God for grace to persevere, for wisdom, for strength, for love, and care...for the benefit of our patients. We do our part, believing, in faith, that all is according to the plans of a sovereign God, who holds our patients' lives in his hands, and determines the number of their days, so that we may confidently say that nothing happens, whether good or bad, outside of His loving and perfect will.

1 Peter 4:19: So then, those who suffer according to God's will should commit themselves to their faithful Creator and continue to do good.

Images from Theater

2009-01-17T00:32:00.002-07:00

Levi did great after his surgery! Thanks for praying for him.

The tallest man in Kenya at 7' 4". I operated on his wife who was a full 2 feet shorter than him.

Jeremiah MD. For science class, Jeremiah observes in the OR and always wants to put on gloves and touch things. Here, he is holding pieces of femoral head in a patient with an old hip fracture.

Images from Tenwek

2009-01-17T00:18:00.003-07:00

Swarmed by school children who have never seen a "Mzungu"

Jeremiah's hobbies: photography and chameleons.

Suspending Judgment (Part 2)

2009-01-16T07:16:00.011-07:00

Anna's mud house.

Two of Anna's children, happy to have new visitors.

Couples are often found, temperamentally, to be complete opposites, and Heather and I are no exception. For example, Heather, by nature, is more generous, and I, on the other hand, tend to be more…“cautious” (as I would like to describe myself). This can, on occasion, cause conflict. But, (as many husbands come to realize), I find that God uses my wife as a tempering agent, challenging me to live more faithfully, as illustrated in the following story.

For some reason, Heather seems to always draw, and befriend, the neediest people. Now, Africa has many such people, but one woman Heather met randomly while walking up a path at Tenwek, is extreme. They began to talk, and Heather was drawn to her warm smile. A few days later, “Anna” stopped by our house to give Heather, as a gift, a small bag of dried beans. This gesture moved Heather to find out more about her situation from Hannah, our (superb) Kenyan cook, who also seems to know everything about everybody. Anna is a single, young Kenyan woman, with 6 children (all from different fathers) living together in a single room mud hut with barely enough food to survive. The hut is owned by her uncle, but she owns the small piece of land on which it sits, an African concept that I still have a difficult time understanding (when you buy property here, everything on it is “a la carte” – the structures, the trees, the tea bushes, etc.). Anna had enough to buy the small plot (invaluable for growing food), but not enough to buy the house. Anna’s uncle recently put the hut up for sale to raise funds for his new house. Theoretically, someone else (besides Anna) could buy it, force her out, and live on her property. Otherwise, with no buyer, the uncle planned to demolish the house and sell the parts as scrap, leaving Anna and six children with nowhere to live.

Through more investigating, Heather discovered that the uncle would sell the house to Anna at a “discounted price,” i.e. for the price of the newer sheet metal corrugated roofing he recently installed (the only thing of real value on a house made of wood, mud and metal sheeting). More investigating through Peter (our Kenyan handyman / private investigator), revealed the whole story was legitimate: Anna has the deed to the land, and the local chief confirmed that her uncle offered to sell the house for the proposed cost of the sheet metal roofing. The only missing piece (recommended by our Kenyan friends and Tenwek missionaries) was a personal visit from Heather to assess the situation.

When Heather presented the entire story to me, and proposed that we buy the house for her, my immediate thought was that of skepticism and judgment. “This sounds too good to be true,” I thought, “and besides, she has made some bad choices in life…I can’t be expected to rescue every needy family in Kenya.” I told Heather I would leave it to her judgment, because honestly, I did not want to get involved. And I felt justified in that my work was being done at the hospital.

Heather made plans with Peter to ride bikes to Anna’s for the visit on Thursday afternoon. That morning, during my time in the word, I read a section of scripture from Luke 3. Crowds where coming to John to be baptized, and he was preaching to them a strong message of repentance, calling them a “brood of vipers,” and stating that “every tree that does not produce good fruit will be cut down and thrown into the fire.” “What should we do then?” the crowd asked. John answered, “The man with two tunics should share with him who has none, and the one who has food should do the same.” Hmm…

Directly after I read this, Heather asked if I would be willing to make the trek instead of her, if by some miracle I got off early from work, as the distance was several miles over very bad roads. I thought to myself, “Here we go…I’m getting roped into this!” “Sure,” I said, “I’ll go if I can,” feeling safe as I have never gotten off early from work here. Of course, several cases did not show up for surgery that day, and for the first time since coming to Tenwek, I was done at noon. Hmm…

Of course, Heather was elated when she saw me at lunch, and said, “Great! I found a bike for you to borrow, and Peter is ready to leave anytime.” I reluctantly agreed (wishing that on my first unexpected afternoon off, I could take a nap or partake of some other self-gratifying activity). In retrospect, I know God sovereignly arranged the entire day. Heather could not have made the ride…it was very difficult and tortuous, over hideous roads…my buttocks is still sore. Moreover, I was swarmed by school children (who had never seen a “mzungu”) and who almost knocked me over while riding. To top it off, on our way home, it began to downpour so that, after our journey, we were covered in mud. But what I witnessed both appalled and inspired me. “How could anyone live like this?” I thought…”seven people in one room the size of my living room…Yet they are so happy.” Anna showed me a small tattered plastic bag that contained a bible and scrap paper full of notes and verses she scratched during the weekly bible study she attends at Tenwek. I came away both convicted of my petty premature judgments (based upon my own standards of what ought to be), and convinced of what we needed to do.

Thanks to all of you who have donated into our project account through Samaritan’s Purse. The funds to purchase her home are a direct result of your generosity and we will let Anna know that this gift is on behalf of our partners, her brothers and sisters.

Suspending Judgment...

2009-01-03T13:40:00.002-07:00

After a long day of surgery, I was called urgently to clinic to see a patient who, I was told, “needed an orthopedic surgeon.” As I rounded the corner, a foul smell filled my nose, and I met a young Kenyan man lying on a gurney. His left leg was covered with a sheet, but I noticed a large lump underneath. He looked sick, with a gaunt face, and sullen eyes. The Kenyan medical intern who had originally summoned me carefully uncovered the largest mass I had ever seen on a patient, at least 30-40 pounds, so large that the patient was no longer able to walk. In my mind, I was reviewing the “differential diagnosis” for this mass, a discipline in medicine in which you consider all the possibilities of the cause of a disease. “Six months ago, he had a biopsy here at Tenwek, and the result was Osteosarcoma,” I was told. Osteosarcoma is bone cancer that frequently metastasizes (spreads) to other areas of the body. Without chemotherapy and urgent removal of the tumor, the five year survival rate is less than 20%. “’He was offered an amputation after his biopsy,” the intern said, “but he refused. Since then, it has grown even larger and now he is consenting.”

While at Mission Training International in Colorado, we were taught that we would face conflicting cultural differences as missionaries in a non-western culture, and that the key to surviving the potential associated frustrations is to “suspend judgment.” Most people are reasonable and rational, and when a situation is viewed through the lens of a different worldview, actions and motives might just make sense. Rather than passing premature judgment based upon your own culture or personal experiences, and assuming ignorance or lack of education, etc. strive for understanding from their point of view.

So why would a young man wait until a mass on his leg has grown to the size of a watermelon, until he is unable to walk, and until the smell is so foul that it sickens those around him, before seeking medical attention? The reason was explained to me by an old general surgeon here at Tenwek. An amputation, in any culture, is not viewed as a desirable surgery. In African culture, however, an amputation is like having a death sentence. Here there are no local prosthetists to fashion prosthetic legs, no Africans with Disabilities Act (ADA) to ensure assessable public facilities and rights for those who are handicap, or wheelchair assessable homes. So even with a growing, painful tumor, an amputation is not considered a viable option. Unfortunately, during that time, the cancer metastasizes to the lungs or elsewhere and then truly becomes a death sentence. The tumor continues to grow until it becomes unbearable, medical attention is sought, and an amputation is finally performed. However, at this point, it is too late, and the patient dies a few months later from metastatic spread of the disease. Word then gets around that if you go to Tenwek and get an amputation, you will die in a few months. Thus, the cycle is perpetuated. Although not based on truth, the patient's reason for inaction now made some sense.

The practice of “suspending judgment” has a definite broader application than just international medcal missions. Consider the relationships in our lives: between husband and wife, father and son, mother and daughter, boss and employee, pastor and congregation, and friends. If we could give each other the benefit of the doubt, and choose to listen and wait before passing judgment, we just might understand.

The Essence of Christmas: Visit to Mosop Orphanage

2008-12-28T07:20:00.004-07:00

(Photography by Jeremiah Galat, 24 December 2008)

On Christmas Eve, Heather and the kids went to visit the children at one of three orphanages supported by the ministry of Tenwek Hospital. Jeremiah, at first, was not excited to go, thinking that staying at home and playing with friends would be much more enjoyable. However, the experience had quite an impact on all our kids, mostly because of the way they were treated as visitors to the orphanage: being greeted with a program, songs, bananas, oranges, mangos, hard-boiled eggs, chai, and unlimited soda. Heather mentioned how humbling it was to be given so much by those who had so little. Later that evening, our family watched “The Nativity Story” on our surround sound home theater system (our laptop, with Sam’s Club Bose speakers), celebrating the birth of Christ. Amazing how the King of the Universe humbled himself to be born as a helpless baby in a stable. And the baby’s visitors, the wisest of the wise (Magi) and the lowliest of the low (the shepherds) demonstrate the fact that Christ is for all people who realize that on their own, if left to ourselves, and by our own means, all is hopeless. More paradox…

1 Cor 1:27-31 But God chose the foolish things of the world to shame the wise; God chose the weak things of the world to shame the strong. He chose the lowly things of this world and the despised things--and the things that are not--to nullify the things that are, so that no one may boast before him. It is because of him that you are in Christ Jesus, who has become for us wisdom from God--that is, our righteousness, holiness and redemption.

Images from Tenwek

2008-12-22T08:51:00.003-07:00

As an astute orthopod, and by the look of his eyewear, I could tell my patient needed a stat ophthalmology consult. He saw Dr. Ben Roberts and had a cataract removed the next day. I thank God for these little bright spots in a long clinic day!

Beautiful Emma decorating Christmas cookies! Our yearly family tradition.

Jeremiah found this baby chameleon at the hospital and feeds it a daily ration of flies.

Becoming Less…

2008-12-22T08:48:00.000-07:00

The young woman with “jumped facets” was placed in a “halo” with hopes that her cervical spine would be stable enough to allow healing over the next few months. However, as I read from my orthopedic textbooks, the recurrence of dislocation is approximately 50% even with a halo in place; and should that happen, the proper treatment is a spinal fusion. As a young, inexperienced surgeon with NO plans for spine surgery anywhere in the near future, my worst fears were confirmed on follow-up x-rays of her cervical spine. “Well, I’ve done all I can by putting her in a halo,” I thought to myself. “I’ll just have to refer her to a spine surgeon in Nairobi.” Thinking that I had devised a good, safe “out” (for myself), I ran my plan by Dr. Russ White, chief of surgery. “That’s fine,” he said, “but without money, no surgeon from Nairobi would ever agree to see her…you’ll just have to do the surgery yourself.” Easy words coming from a seasoned missionary general surgeon known to do everything (even some orthopedic spine surgery). “What are you doing tomorrow?” I asked calmly (on the outside) but with a certain amount of desperation (on the inside). Thankfully Russ was available in the afternoon.

In the US, prior to a surgical fusion for jumped facets, an MRI would be obtained (to evaluate for a herniated disc, which if present, could paralyze the patient). Additionally, spinal cord monitoring would be used during surgery to alert the surgeon of an impending spinal cord injury. Of course, neither are available in a rural Kenyan hospital. Surgery on patients with a spinal cord injury is usually less stressful (strangely comforting to a surgeon with the knowledge that neurologically, you cannot make the patient worse). However, our patient never had any neurological injury, and without a prior MRI or spinal cord monitoring, I kept praying during surgery, “God, let her remain that way.” Thankfully, the surgery went well, and despite our lack of technology, and my lack of experience, the patient awoke from anesthesia moving all four limbs and feeling every touch.

It is amazing how God desires to push us all beyond the edge of our abilities. When we get to the end of what we have to offer, to the end of our experience, our education, our means, our talents and gifts, to the very end of ourselves, the only thing that remains is God. Oddly, according to scripture, this is God’s design, so that Jesus Christ is glorified and His Kingdom is advanced. As John the Baptist replied to those taunting him that Jesus was drawing greater crowds and baptizing more people: "A man can receive only what is given him from heaven….He must become greater; I must become less.” And as Jesus replied to his disciples who were arguing amongst themselves as to who was the greatest: "If anyone wants to be first, he must be the very last, and the servant of all." Dependence on God, serving rather than being served, becoming nothing so that He can become everything, this is the paradoxical design for all our lives. May our eyes be opened this Christmas season to the inexpressible treasure of Jesus Christ and the true joy that can only be found when He is more, and we are less.

A Day in the Life…

2008-12-13T08:58:00.002-07:00

Wednesdays are “clinic day” for the orthopedic department, the one day of the week where surgeries are not routinely scheduled and patients arrive from all over this small part of the world to have their orthopedic issues evaluated. I liken clinic day to Forrest Gump’s proverbial “box of chocolates”…you never know what you’re gonna get. Could it be a draining fistula?...A two month old fracture-dislocation?...An open fracture that’s been festering for the past five days?”

Last Wednesday was extra-special. The “box of chocolates” motif also applies to orthopedic admissions from Casualty (the Emergency Department) from the night before. As of yet, there is no set protocol for the residents to follow regarding orthopedic trauma patients (which I remedied today), specifically regarding when Dr. Galat should be paged. I had hoped, in vain, to do a surgery or two before clinic in order to catch up on the back-log of cases, but when I arrived in the orthopedic ward at 6:30am, I was greeted by three new patients with the most incredible montage of trauma: (1) a female with a cervical spine fracture, a “unilateral jumped facet,” and lumbar spine fractures, (2) a 17 year old boy with a midshaft femur fracture, and (3) a poor young lady with bilateral tibia fractures, one side open (where the bone breaks through the skin), and an open elbow fracture (that thankfully at least had been washed in the operating room the night before). For those without ortho training, let’s just say these are all bad things.

I took a deep breath, cancelled our pre-clinic surgeries, and excused myself to run home for a quick refresher course on the proper treatment of “jumped facets.” This involved screwing tongs into the patient’s skull and using 20 pounds of traction to realign the spine the way God intended. Speaking of which, I (again) was praying the entire time, as I have never seen or done this myself. Thankfully, God intervened yet again, and x-rays after the patient was in traction for 30 minutes revealed perfect alignment of the spine.

Plans were made to operate on the young lady with the open fractures after clinic (I estimated at least 5 hours for the case). But it became apparent that this would not happen after I saw the massive crowds of people already lining up to be seen in the ortho clinic. Solomon (a Kenyan superstar physical therapist/functioning non-operative orthopedist) and I saw close to 90 patients and wrapped up our day at 8pm. By this time, the operating theater day staff was long-gone, having to walk home (sometimes miles) before it gets dark. The “on-call” staff is only available for “true emergencies,” such as perforated colons, not open fractures that have already been washed out. Truthfully, I was somewhat relieved because I was exhausted. I went home and collapsed into bed. The following day, I fixed all her fractures (and another one I found while she was in surgery), fixed the boys femur fracture, and did a few other cases.

Please continue to pray for our family and for our patients here. Because of the sheer volume of trauma cases, the back-log continues to grow. So far, I have 8 cases scheduled for Monday, and the weekend is still young. And, if you are an orthopedic surgeon with an interest in trauma and desire for some excitement, you are welcome to visit! Thank you for all your prayers and support.

More images from Tenwek

2008-12-06T13:38:00.003-07:00

Levi playing "Lion" scaring the Kenyan children.

Jeremiah finds another prize catch!

Heather getting to know some Kenyan children.

Jeremiah is becoming quite the photographer!

Unless the Lord Builds the House: Homeschooling, Flaps and Cut Tendons

2008-12-06T13:26:00.001-07:00

As part of Tenwek Christmas tradition, the kids all gather together to make gingerbread houses in one huge event. Fueled by excess sugar and unbridled creativity, Emma, Claire and their new friend Mercy created a masterpiece that unfortunately crumbled into a pile of rubble by the time I arrived home from the hospital. “That gingerbread house symbolizes how we feel right now!” said Heather.

Heather and I were both struck square in the face by the words of Psalm 127 last week: “Unless the LORD builds the house, its builders labor in vain. Unless the LORD watches over the city, the watchmen stand guard in vain.” We realize that unless our sovereign LORD intervenes in the work we are called to here at Tenwek, that our labor will be in useless. Moreover, unless all we do is infused with love for other people, all our efforts and good intentions are meaningless. “If I give all I possess to the poor and surrender my body to the flames, but have not love, I gain nothing. (1Cor. 13:3)”

Heather’s work here is primarily homeschooling, and she is doing an outstanding job, trusting the LORD to build, provide, and enlighten….all a direct result of your prayers, so please continue! There are a myriad of other opportunities for ministry, especially to orphans, that she is also beginning to explore.

For me, I am reminded daily of my dependence on the LORD in every way for every case. In two weeks time, I have done 32 cases, many complex, that I would never have attempted without God’s direction and wisdom. But since I am the only orthopedic surgeon here, who else will do it?! During my training at Mayo, whenever a patient had a soft tissue defect in the leg after an open tibia fracture that needed to be covered, we would call the plastic surgeons to isolate and swing a piece of muscle tissue (called a “flap”) over the defect. Just last week, I thought to myself, “It would be so valuable to have a plastic surgeon visit Tenwek and show me how to do a flap…I will likely need to know how to do that some day.” Well, that day came last Friday, perhaps a little earlier than I had hoped, aided not by a visiting plastic surgeon, but by prayer and a few good textbooks…so far so good.

Another patient had a small laceration over the undersurface of her thumb and was unable to flex the distal joint, signifying a tendon laceration. I knew that the hardest part of repairing the tendon is first finding the cut ends. This sometimes requires a large dissection, and I am not a fellowship-trained hand surgeon! I took her to the operating room and enlarged the laceration a bit to get a better view. I found the distal end easily, but the proximal end was nowhere to be found, retracted far proximal into the palm of the hand. At this point, a tendon grasper would have been helpful, but Tenwek unfortunately does not have one. So for several frustrating minutes, I blindly (but gently) tried to “fish” it out with forceps and hemostats (not ideal instruments)…no luck. I was dreading the next step. Just then, a visiting minister from Alabama who enjoys watching surgery entered the room. “What are you doing?” he asked. “Trying in vain to find this cut tendon,” I said. “Well then, let’s pray!” said Earl. He offered a simple prayer that God would allow me to find this tendon. Right after he finished, I (again) blindly stuck the forceps about 2 inches down the sheath. But this time, I felt something, and no kidding, I pulled out the tendon! After this, the repair was easy.

Again, unless the LORD builds the house, unless he provides wisdom, and unity in the orthopedic department, and love for our patients, and all the necessary equipment and supplies, our work at Tenwek will be in vain. After all, this is His work. But dependence on God, no matter who we are, where we live, or what we do, is such a good place to be. God is the master builder, and although the process can be painful, and will require faith that seems impossible, the end result will be perfect. Let the LORD build your house. Thank you for all your prayers and support!

Images from Tenwek

2008-12-01T12:01:00.002-07:00

20 year old with leg mass...a malignancy know as adamantinoma.

Pediatric wards at Tenwek.

Our temporary house, where we will stay until next summer (when the family that normally lives here comes back from furlough).

Playing with friends and the turtles in the back yard.

Life at Tenwek

2008-11-30T07:19:00.000-07:00

Having finished our first full week at Tenwek Hospital, we are thankful, and a little tired. We have been so busy setting up, starting homeschooling, and working at the hospital that we totally forgot Thanksgiving Day on Thursday (not a Kenyan holiday). But the tradition here is to celebrate on the Saturday after, so yesterday, all the American families gathered for a full Thanksgiving dinner! The kids seem to be adjusting to our new Kenyan/Tenwek culture. There are many other American children here, and thankfully, the kids all have at least one friend.

Being a few degrees south of the equator, but at an elevation of 6800 feet, the temperatures are perfect, and the sun rises and sets every day at the same time, 6:30 am and 6:30 pm. This is the “hot time of year,” according to the Kenyans (summer time, or the “short rain” season, where it rains a little almost every day in the afternoon). It is difficult to explain that a high of 80 degrees is perfect, compared with the scorching summer heat of Phoenix.

The work at the hospital has been challenging, in terms of volume and pathology. Debilitating bone infections are very common here, some of which have been going on for years…I find myself constantly praying for wisdom for proper management decisions. On Friday, a young 20 year old man came to see me with a large mass on his right leg. He had it biopsied last year and it was found to be a very rare malignancy, one I had never seen before, even at the Mayo Clinic. In my first week, I did 18 cases, and I discovered that the orthopedic supplies are running at a critical low, especially plates and screws.

Please continue to pray for us in our adjustment here:
• Pray that God continues to provide wisdom for Heather with homeschooling, and for me at the hospital.
• Please pray that God provides all the necessary supplies for a fully functioning orthopedic department.
• Pray that God would move people, hospitals and companies to donate finances and supplies for the work here.
• Also, your continued prayer for our physical, emotional, mental, and especially spiritual health is so cornerstone.

Thank you for your support…we appreciate you so much!

Getting Settled…

2008-11-25T12:36:00.002-07:00

On Saturday, after spending two days in Nairobi and buying enough groceries to last for the next two months, we made the 3-1/2 hour trek to Tenwek. The road was much improved since we were last here in 2006, allowing our driver to make good time, Kenyan style. We arrived in the late afternoon, and were greeted by several families living here…Claire and Emma made instant friendships with a little girl named Ingrid.

Being away from surgery for the last few months, I have been very anxious to get started. Of course, “be careful what you wish for.” After church on Sunday AM, I had a tour of the hospital and began to get acquainted with the Kenyan staff and patients, 25 on the service list when I arrived, some two to a bed. I quickly learned the damage that can be done by a “panga,” a large double edged machete.

Since I am supposed to be easing into my schedule here, I have only done 5 cases in the last two days. There are the typical cases you would see in the states (fractures, etc), but also some “atypical.” For instance, today I operated on a man that had a femur fracture three years ago that was never fixed, and thus never healed. So I cut out the non-healed portion of bone, brought the ends together, fixed them with a special plate and screws, and grafted the area with bone from his pelvis. There are also sad cases that should never happen, no matter where you practice. Today, I saw a 4 year old boy who had a simple wrist fracture that his grandpa thought would be best treated by tightly wrapping with a piece of cow leather. His hand was completely dead…tomorrow he will get an amputation.

Please continue to pray for our children. Claire and Emma have been especially sensitive to all the new sights, sounds and smells. In Nairobi, we went a butcher shop, and this must have really affected Claire…two nights ago, I was awoken by soft crying from the girl’s room. When I went to find out what was wrong, she told me she had a dream that she found two baby bunnies, but mom took them from her, and butchered and cooked them. Poor thing!

Although it has only been a few days, we feel so privileged and thankful to God to be here. Thank you for all your prayers and support…we appreciate you so much.

We have arrived!

2008-11-21T05:50:00.000-07:00

After 25 hours of travel time, little sleep, and only one small mishap (a glass of water falling on Levi’s face while he was asleep) we arrived safely in Nairobi last evening! Thank God, there were absolutely no issues or problems with the logistics of the travel, aside from the fact that when we initially checked in at NWA in Phoenix, they were not going to issue our boarding passes because we did not have return flights (Kenyan visas are issued at the Nairobi airport and are only good for three months). But one quick call to Samaritan’s Purse, a subsequent fax, and all was well. We checked 23 items (20 “Action Packers”, 2 duffle bags, and 1 box) filled with homeschooling supplies, orthopedic equipment, household items, etc. totaling 1390 lbs! They ALL arrived in Nairobi and in good condition (at least on the outside). I was a little concerned, because as we were boarding our initial flight in Phoenix, I looked out the window to see the baggage handlers tossing the action packers upside-down on the loading belt. Oh well…

Dr. Russ White, the chief surgeon at Tenwek, kindly met us at the airport, along with his two boys, two Samaritan’s Purse staff and three trucks to haul our stuff (so embarrassing as Americans – why do we have so much “stuff”). We stayed the night at the Mennonite Guest House in Nairobi, and today has involved shopping for groceries with Russ’s wife Beth, buying a SIM card for my Palm Treo, and grabbing a quick latte at The Java House (Kenyan equivalent of Starbucks). The Whites have been such a blessing to us since the beginning...I could not imagine trying to handle all of this without their help. The kids have been playing all day outside in the warm sunshine, meeting new friends. Jeremiah just came in the room after trying to catch skinks all morning and said, “Dad, I love Kenya.” He is in his element. Tomorrow, Lord willing, we head for Tenwek.
Thank you for your prayers during this journey…we remain so dependent upon God’s mercy and grace. Please continue to pray for us now while we get settled in, set up the house, get into a routine, and as I start surgery. We appreciate you all so much!