We Have Arrived!

Saying goodbye to our family at Tenwek. We will miss everyone while we are away~

Levi saying goodye to his good friend Will Manchester.

On the day we left, we spent a few hours at the Giraffe Center. That's right...I think she liked me.

The girls loved feeding the giraffe.

A typical scene during our 24 hour journey back to the U.S. The last leg from Detroit to Phoenix.

Back in the U.S.

After one and a half years of service at Tenwek, over 1000 orthopedic surgical cases, a solid two school years of homeschooling, and many full joys and experiences, we have arrived safely back in the U.S., in Phoenix, staying with Heather’s parents. The kids were ecstatic to see grandparents, and go swimming (yes it is HOT here…I miss the 75 degree perfect weather of Tenwek), but they already say how much they miss their other “home” at Tenwek. Although a year and a half is not long according to adult standards, it is quite a length of time for kids. Levi was wondering why eggs are “white” in America, and Emma could not get over the fact that there was an automatic soap dispenser in the bathroom at the Detroit airport. Jeremiah is already hunting rabbits in the backyard here is suburban Phoenix, and Claire can’t wait to go to McDonalds. We feel so privileged to serve at Tenwek, and look forward to returning, God willing, in about a year.

Update on Maggie

Prior to leaving Kenya on Wednesday, we visited Maggie, the young lady who had a revision total hip arthroplasty in April. She is doing incredibly well, and the limp that she had preoperatively is almost gone, and will continue to improve as she strengthens the muscles around her hip joint (click here to see video of Maggie walking). Her pain is completely gone, and she wanted to express her thankfulness to all those who helped make this miracle possible.

Update on Tenwek C-ARM: Good News and Bad News

Bad news first: A week and a half prior to our departure from Tenwek, the only functional C-Arm at Tenwek stopped working. Our initial assessment was that the hard drive had failed; however, after installing the emergency parts that arrived with our most recent visitor, the same error message occurred. Apparently, one of two CPU motherboards that communicate with the hard drive also malfunctioned (a much more difficult problem to diagnose)…the bottom line issue is that our C-ARM is still not working, making the practice of quality orthopedics much more challenging for our current visitors. Here is an excerpt from the most recent update from the Oswalds: “Please pray for Tim. Without the c-arm he has had to treat some patients without surgery, which means longer hospital stays and possibly less excellent outcomes. While we are only here a couple weeks, this will be an ongoing problem for these patients. As Tim explained, if a c-arm is broken in the states, they just do NOT do the surgery until a working c-arm is accessible. Here, there is no choice.”

The good news: I brought both motherboards with me from Tenwek, and due to the great urgency of this problem, I will fly to Chicago on Sunday, where I will meet with the “guru” of OEC technology, and representatives from the company I have been in contact with from Cleveland, who can hopefully, collectively, diagnose the problem, and fix these motherboards so that our current C-Arm can be made functional again (they have all been incredibly helpful, even calling our tech in Kenya for information). Additionally, this company also has newly refurbished units that are immediately available for purchase, and I will be looking over the options on Monday. Please PRAY that this trip to Chicago would bear fruit, that our current C-Arm will soon be functioning again, and that God provides another C-Arm for use at Tenwek. As such, we need to urgently raise about $40,000 for the purchase and air freight of another unit. If you feel God leading you to give toward this immediate need, please let me know, and I can direct how you can help. Alternatively, you can call Samaritan’s Purse directly at 828-278-1508 (Mary Elizabeth Jamison) or 828-278-1355 (Scott Reichenbach). We are trusting God to provide abundantly for the people He cares for in Kenya. Thank you for all the prayers and support you have offered our family, and for your partnership in this ministry at Tenwek!

Urgent Prayer Request: Broken C-ARM

Examining the machine.

Discussing the options...

One the items that is essential for our broad practice of orthopedic surgery at Tenwek is a 20 year old C-ARM (or fluoroscopy), an old workhorse that provides “real-time” x-rays in the operating room, and critical for certain cases such as hip fractures, and many pediatric fractures. Although heavy and cumbersome (being several generations old) and likely producing significantly more radiation than newer units, it has provided years of faithful service.

About every two months, the image becomes blurry, or the software will not boot properly, an indication of growing age, yet problems always correctable with a quick call to Mr. Ragut, our contracted technician, who, in a few hours, has the machine up and running perfectly again. This past week (about the 2 month mark since the last “event”), while in the middle of a tibial plateau fracture, the image froze on the computer screen. After trying our usual intra-operative troubling shooting methods (like restarting the machine) failed to correct the problem, we finished the case without fluoroscopy, and took the C-ARM out for a better look. Two visiting bio-med technologists examined it, and delivered news I did not expect nor welcome: the hard drive had failed, a permanent and fatal error, which, for a 20+ year old C-ARM, is bad news. The only solution to fix the problem (according to the technologists) is to find an identical hard drive on an identical unit somewhere in the world, a task akin to finding a needle is a haystack.

Thinking that perhaps the shorter term solution is to purchase a new unit in Nairobi (while trying to find this potentially elusive replacement hard drive for the old unit), I solicited quotes which, for me in our mission hospital context, redefined the term “sticker shock.” So I ask for your prayers that: (1) God would do a miracle and allow us to find a replacement hard drive for our current unit (OEC Diagnostics Model 9000 S/N 99-1290), and get it to Tenwek Hospital quickly, (2) God would provide a second C-ARM (either by purchase or via donation) for Tenwek to have as a backup or primary unit, and (3) God, in the meantime, would give wisdom in cases that normally require C-arm. God always seems to push us to the edge of our limits, so our trust in His provision increases. Accordingly, last night, a 12 year old boy was admitted with a femoral neck fracture (perhaps of all the cases that could benefit from having C-ARM, the ultimate).

We hold to God’s promises in scripture and greatly appreciate your prayers…and if you have any leads on a hard drive for a 20 year old OEC model C-arm, or a new or used C-arm, let me know! Thanks for all your prayers and support.

Farewell to Samson

The classic saying goes “it is better to have loved and lost, than never to have loved at all.” With our departure to the states coming up in less than three weeks, we, as a family, have been praying for a good home for Samson, Emma’s “rescue” puppy from the local Umoja orphanage. Emma first met Samson a year and a half ago, when we visited the orphanage with my brother John. He was a subdued, mangy, flea-bitten, scrawny, half-starved, ugly puppy, tied to a three foot length of chain. But from the first time Emma saw him, despite his hideousness, she loved him, and begged to take him home. After a few other visits to the orphanage, and continual requests from Emma (and from the orphanage director) to take him home, I finally relented and on June 14th, 2009, Samson was officially adopted into the Galat family, much to Emma’s delight, and Heather’s chagrin.

With “proper” diet (including Emma’s frequent “breakfasts in bed” for Samson) and smothering love (and several flea baths, immunizations, Frontline, etc.), Samson grew into a large, healthy, and beautiful dog, with bright eyes and laidback personality. As my brother John said, “Samson is the quintessential doggie version of a ‘rags to riches’ story.” Samson had the reputation of being somewhat fat and lazy, which I attributed to living the deserved “good life” after so many initial months of hardship. Several weeks ago, however, we noticed that Samson was becoming more lazy than usual, and slowly, he started to lose his excess poundage. After a round of antibiotics for what was thought to be a bladder infection, he seemed to perk up. However, last weekend, he dramatically worsened, stopped eating and drinking, and by midweek, his gums and eye sclera turned vividly yellow, indicating that his liver was failing, likely secondary to a massive infection that was unresponsive to several antibiotics.

With all the hats that a missionary surgeon wears, the last role I ever thought I would play is that of veterinarian. But on Thursday, after long and tearful goodbyes from the kids, Samson was put to sleep with the most pleasant concoction of drugs I could muster from the Tenwek formulary. A grave was dug next to Sandy, the Chupp’s dog who also passed about 18 months ago (so they could “keep each other company”), a small service was held with several missionary children and Kenyans, and Samson was laid to rest. Emma managed to cram 15 years of dog love into one very full and very intense year. Through her tears, Emma told me she doesn’t think she has any dog love left because she spent it all on Samson… and if you were here to witness it, you would fully agree.

That intense kind of love, the kind that looks through ugliness and sees the potential for what could be, reminds me of the kind of love the Father has for us, who despite our sinfulness, our hideousness, loves us because He loves his Son, who redeemed us , and cleansed us by His blood. Thank you Emma for this lesson, and farewell Samson…you were loved.

Job 1:21 “The LORD gave and the LORD has taken away; blessed be the name of the LORD.”

A New Hip for Maggie

Maggie the second day after surgery.

The day after surgery, Maggie was already walking!

Maggie's preop films demonstrate a black line around all the parts, indicating that they are loose.

Maggie's new hip.

Last fall, while spending a few days in Nairobi resting and restocking supplies, our family (and Stephen Leimgruber, Heather’s cousin/RN who has been working with me in orthopedics for the past year) visited Amani Ya Juu, a ministry for marginalized women in Africa. At Amani, women needing a second chance are trained to create and sew a myriad of items from quilts to aprons, which are then sold at the Amani store, proceeds benefiting the women who live and work at the mission. While Heather and the girls love to visit the store and browse through the beautiful crafts, let’s just say that it wouldn’t be the first-choice hangout spot for the guys (there is even an “Amani Café” on the premises, which serves up non-masculine items such as tomato soup and blue cheese and pecan salad).

Earlier that particular day, feeling quite good about myself, and noting all the needy people in and around Nairobi, I was giving the kids one of my “fatherly lectures” on intentional ministry to strangers, saying that “we need to be willing to sacrifice our own agenda when an obvious need comes to our attention,” rather than turning a blind eye. While at Amani, Stephen decided to test me, to see if I “practiced what I preached,” by introducing me to Maggie, who works in the store at Amani, greeting every customer with a big smile and a hug. Stephen noted that she had a terrible limp, and thought perhaps there was something we could do for her. The desire to protect “my time” while on “R&R” in Nairobi, coupled with my desire to be doing some other activity during our precious few days away from the daily pressures of orthopedics at Tenwek other than shopping, mixed with a general dislike for random “curb-side” consults, made my initial greeting less enthusiastic. However, Maggie’s warm personality, and obvious pain with every step, quickly endeared me to her, and as she shared her story, I began to feel that this meeting was not random.

Maggie, now 35 years old, had been in an automobile accident at age 16, and injured her right hip. After 8 surgeries (the last being a repeat hip replacement in 2001), she now felt daily pain, with the sensation that the components in her hip where moving with every step, and she resigned herself to the fact that she would never be able to walk well again. However, amazingly, her joy and obvious love for others and for God were completely untouched by her grim circumstances. I told Maggie she should get some x-rays, and I would return the following day to look at them to determine if there was anything remotely possible that we, at Tenwek, could do to help. My skepticism was strengthened when I viewed her x-rays, which showed an obviously loose cemented hip replacement with significant bone loss, problems which were most likely the result of a chronic infection induced during one of her previous 8 surgeries. In my mind, I knew there was absolutely no way we could tackle her huge problem at Tenwek, and the only solution would be to try to get her to the U.S. for her needed surgery (which also seemed impossible with the huge expense). I told Maggie I would do what I could with my connections in the States, and left her with instructions to lose weight, and to see a physiotherapist to help strengthen the muscles around her hip. After two meetings, I felt like I had known her for years.

After several initially hopeful, but ultimately unfruitful leads for Maggie to come to the U.S. for surgery, I too resigned myself to the fact that she was beyond help. But, as is so often the case in these seemingly hopeless situations, when people are praying and when God is sovereignly directing, what we think is impossible becomes unstoppable. In February, when I emailed Dr. Wes Mesko (the joint replacement surgeon from Michigan who comes yearly to Tenwek for the annual Total Joint Replacement week) about Maggie, he felt that if we had the right components, and assuming the current hip was not infected, we could do her surgery right here at Tenwek. When I emailed Rose (the Johnson and Johnson rep in Nairobi who supplies our hip and knee components), to see if her company had these special revision parts in stock, amazingly, they did. During a return trip to Nairobi later that month, I called Maggie to tell her the news and she excitedly insisted I come to Amani immediately to see her. She looked like a different person, having lost over 30 lbs; and her limp (and pain), after months of physiotherapy, had dramatically improved. However, with loose components, surgery was still necessary, and Maggie was given a surgery date.

Maggie’s surgery, which happened just this past week, was one of those cases in which we felt like God was directing every step. With so many variables needing to occur simultaneously for a big surgery like this to even occur, let alone be successful, and with so many things that could have potentially gone wrong in this environment, miraculously, everything went perfectly. I am convinced that we witnessed a modern day “Miracle at Tenwek.” And just today, I checked all of the bacterial cultures we took during surgery, and every single one was negative! Maggie is so thankful because her surgery was possible through donations to our project account at Samaritan’s Purse. In addition to Maggie, eleven other patients had joint replacements, and thankfully, everyone did great, and most are already discharged. God sovereignly blessed the week, and I personally enjoyed taking a break from trauma to do these surgeries with Dr. Mesko (who, as a joint replacement specialist, taught me many of his valuable “tricks”).

I am humbled (yet again), and reminded of our smallness and God’s greatness, yet His desire to break in and miraculously touch the lives of people such as Maggie. This is God’s work, not ours, at Tenwek, and he is using it to glorify his son, Jesus Christ, in whose name patients are helped. Thank you for your ongoing prayers and support of the orthopedic ministry at Tenwek…without this partnership, this work would not be possible. Please continue to pray for Maggie and all the patients at Tenwek that God would be glorified in their lives.

Matt. 20:30-34 Two blind men were sitting by the roadside, and when they heard that Jesus was going by, they shouted, "Lord, Son of David, have mercy on us!" The crowd rebuked them and told them to be quiet, but they shouted all the louder, "Lord, Son of David, have mercy on us!" Jesus stopped and called them. "What do you want me to do for you?" he asked. "Lord," they answered, "we want our sight." Jesus had compassion on them and touched their eyes. Immediately they received their sight and followed him.

Trip to Malindi: Refreshment on the Coast

Ready for a day in the sun.

Jeremiah displaying one of two Wahoo that he caught.

Dr. Ben Roberts, ophthalmologist at Tenwek, and great friend, conquered the barracuda.

Our collective Tenwek families recently spent 5 days at the WGM Kenya Spiritual Retreat in Malindi, on the Kenyan coastline of the Indian Ocean. Sessions of solid biblical teaching from Stan Key, mixed with a few extra days of family fun in the pool, body surfing during high tide, prayer walks on the beach, exploring the tide pools, Kayaking, two birthday celebrations (Levi and Dan) and a day of deep sea fishing made for some serious spiritual, physical, mental and emotional refreshment, and one of our best family vacations ever. We see so clearly how God provides for us at the right time as we wait upon him.

The next several weeks are going to be extremely busy for our family and in the department of orthopedics. April 26-30th is the 4th annual “total joint camp,” and this year will be different in that all the implants will be provided by the local Johnson and Johnson Company in Nairobi (rather than as donations from the US). This is important as we seek to have an ongoing, independent, viable joint replacement program at Tenwek, which will, Lord willing, help subsidize orthopedic care for the poor. We have at least 10 patients in the queue for surgery, including a very sweet 37 year old lady named Maggie who injured her hip as a teenager in a car accident, and since then has had three hip replacements (the current component are loose, and she can feel them moving with every step). Please keep our patients in prayer, that all would go smoothly, that there would be no complications, and especially that God would be glorified through this work.

As a quick update on our family, our tickets to return to the states have been written! Apart from any natural disaster such as a volcanic eruption in Iceland, we will return to the states on June2nd for a year of furlough. We continue to pray and wait for God’s direction, and Lord willing, we will return to Tenwek in the summer of 2011. Please continue to pray with us, as there are many details still to work out. We are so privileged to be serving with you at Tenwek, and continue to view all that the LORD does as a partnership, working together to serve patients with (literally) broken bodies, train nationals in the field of orthopedic surgery, disciple young African physicians, and spread the “light of the knowledge of the glory of God in the face of Christ (2 Cor. 4:6).” Thank you for all your prayer and support!

Sunsets in Kisumu: New Lessons in Trust

After over 16,000 miles of air travel, and countless miles on the road, Heather and I finally made it back to our African home after a six day visit to the U.S. It was good to see the kids again, and they seemed happy we were home, although I suspect they also had a good time staying at friends’ houses, and of course, taking a break from homeschooling. The trip, overall, was tiring, but fruitful.


The day after I returned to Tenwek, I (Dan) was on the road again, this time headed to Kisumu, where I attended the Kenya Orthopedic Society’s 4th Annual Meeting, the theme “The Road Carnage Continues,” a very apropos title highlighting the significant increase in road trauma over the past few years, which, according to a few of the papers presented, is directly correlated to the onslaught of duty-free motorcycles imported into the country for use as taxis (called boda-bodas). One presenter, an official with the World Health Organization (WHO), remarked that Kenya, being one of the top 10 countries in the WORLD for road trauma, has the dubious honor of being selected for a new decade-long initiative exploring ways to decrease the tremendous burden of injuries and death that result from road traffic accidents. I gave a presentation on “Open Fractures of the Tibia,” and thankfully discovered that the American style of power-point presentations (including creative slides and mild humor), was well received.


Kisumu, on the Kenyan shores of Lake Victoria, is a beautiful city, famous for tilapia and Nile Perch, and now more famous as the home of Obama’s father. In fact, a new airport was just built to accommodate the increased number of tourists, and a new 5-star hotel is being erected. After striking out at several “lesser” hotels, John Tanksley and I thankfully found two rooms at one of the “3-star” hotels in town, “The Sunset Hotel.” Although “3-star,” I discovered, was a truly meaningless designation, (I was stung on the toe by some unknown African life-form at night, and the A/C leaked a huge puddle on the floor of my room), the hotel DID live up to its name…the view west over Lake Victoria, at sunset, was absolutely incredible.


While sitting out on the porch the final evening watching the sunset, as the colors changed every minute, from yellow, to orange, to red, to purple, I was overwhelmed with a sense of God’s goodness, of His delight in His own creation, His steadfast faithfulness, and His concern for humanity. Amazing how God uses his creation to point us to Him, to remind us how glorious He is…and how small we are; to show us His dependability…and remind us of our volatility; to demonstrate His power…and our weakness; and to show us His grace…and our need for it. Pondering all this placed, in my heart, a deeper trust in the God who pursues us because he loves us, and desires to meet with us, and to show us that He is the culmination of everything, the sum of all we strive so hard to find.


Psalm 8:3-4 “When I consider your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is man that you are mindful of him, the son of man that you care for him?”

The Tree Fortress, Update on Joshua, and Trip to the US

Grandpa Galat, Peter White and Jeremiah nailing the floorboards, which were very green and hard as a rock causing many nails to "ping" off the hammer. One stray nail eventually ended in Jeremiah's foot, requiring an "extraction" in the orthopedic clinic, a tetanus shot, and a week of antibiotics.

One of the members of the heart team told me, "You know, I saw the strangest thing today as I was looking out my bedroom window...a motorcycle carrying ten foot lengths of board, long-ways!" I chuckled to myself, knowing exactly where the driver was taking the wood.

The finished product...

The Tree Fortress

Jeremiah has been asking for months for me to help him build a tree house, and I had been able to successfully deflect his advances with a variety of good excuses. However, when Grandpa Galat arrived, he changed his recruiting efforts, and very soon the project was underway. What I thought was going to be a small wooden platform in a nearby tree became, with the influence of Grandpa, a 7x10 foot veritable fortress, which was big enough to raise some eyebrows and eventually require a permit from the Tenwek Building Committee (we have discovered that Jeremiah continues to be good at getting Heather and I in trouble). After many long hours, numerous motorcycle taxis carrying loads of fresh-cut lumber, two day-trips into the bush to harvest bamboo for the roof, and a trip to Casualty for a rusty nail in Jeremiah’s foot, the project is now complete. Jeremiah and Peter got a small taste of responsibility… and the joys of working with Grandpa Galat (they each only got yelled at twice)!

Update on Joshua

After removing the large mass on Joshua’s wrist, the initial pathology looked like a type of serious childhood cancer. However, after the long three-week wait for the final report from Kijabe hospital, amazingly, the mass was deemed to be a benign fibroma! With the mass removed, hopefully it will never be a problem again, and the latest report is that Joshua is doing very well. Many of you have been praying for Joshua, and this serves as a reminder that Tenwek’s motto still hold true, “We treat, Jesus heals.” Our prayer now is that Joshua grows to become a godly young man with a passion for serving Christ!

Trip to the US

Next week, Heather and I leave for a quick, 6 day trip to the US for our interviews with World Gospel Mission (WGM), the mission that runs Tenwek Hospital. We arrive in Cleveland on Wednesday evening, and leave for Kenya again the following Monday, with the interviews being in Marion, IN over the weekend. We are hoping to finalize our transition to WGM and move forward with our calling to serve “long-term” at Tenwek. And we are looking forward to seeing the Galat family in Ohio, drinking some Starbuck’s coffee, and spending some time together (15th anniversary coming up the end of this month!). Please keep us in prayer as we travel, and meet with WGM staff, for good health for all, and for our children as they stay behind in Kenya with our Tenwek family.