Dan, Heather, Jeremiah, Tory, Emma, Tye, Claire, Levi, Josie, Jane and Ethan

Saturday, January 24, 2009

Images from Tenwek

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

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.

Saturday, January 17, 2009

Images from Theater

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

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

Jeremiah's hobbies: photography and chameleons.

Friday, January 16, 2009

Suspending Judgment (Part 2)

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.

Saturday, January 3, 2009

Suspending Judgment...

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.