Something More to Offer

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

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!

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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

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

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

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?

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

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!