The Simple Life

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

"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

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

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.