Road Trip to Eldoret: One Body, Many Parts

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

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

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…

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

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

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…

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.