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

Thursday, February 26, 2009

Culture Shock

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.

Sunday, February 22, 2009

Our First Visitors...

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

Sunday, February 8, 2009

SIGN, Fat Embolism, and the Power of Prayer

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

Friday, February 6, 2009

Images from Tenwek

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

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

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.