Black Mamba and Discipleship

Tabasco, a relative "lightweight" in the heat index, but still a classic.

Impressive, but not quite living up to its name.

Heavyweight, essentially "on fire."  Dangerous to children, pets and "sensitive areas" as the warning label below indicates. 

At first glance, I thought this warning label was a joke; but I can assure you, it is not.

The men's intern and resident bible study where one of the first questions asked each time is "Where is the Black Mamba?"

Every other week, approximately 20 interns, residents and consultants gather for our ongoing men’s bible study.  Because many of these trainees work long hours and have limited time to prepare food, we (the missionaries) regularly provide a meal for the study (usually some sort of stew with rice, chapatti and slaw).  Early on in the study, I introduced my Kenyan brothers to a little bit of classic Americana: Tabasco sauce (of note, Kenyans do not generally prefer spicy food).   Dr. Russ White, always the instigator and never wanting to be outdone, then introduced a hot sauce boldly entitled “100% Pain”.  The sauce was indeed hot, but I taunted Russ by saying the product was mere “child’s play.”  Then few months later, he kicked it up a notch and brought out this tiny, little bottle of sauce (that actually had a warning label on it) composed of a few simple ingredients: chocolate habanero peppers and concentrated capsaicin.  I thought the name of the sauce, “Black Mamba,” was intriguing and quite apropos for our study, as this snake is both indigenous to Kenya and highly venomous.  I started with a scant 3 drops on my plate of food, and noticed out of the corner of my eye the devious, slight smile on Russ’ face.   A few bites into my food, feeling suddenly flushed and sweaty, I discovered the general principle that degree of heat is inversely proportional to the size of the bottle.  “I’m going to pay for this later,” I kept thinking to myself as I stubbornly finished my plate to the laugher of the entire group.  Of course, I received no sympathy from my wife the next day, who just rolled her eyes with every complaint of severe abdominal cramping. 

One of the best parts of being a medical missionary is the opportunity to disciple the interns and residents who train at Tenwek - men who will be the future leaders of medicine in East Africa.  We just finished a study on the “good kings of Judah” and are now in the book of Daniel, our goal being to study the men in scripture who were themselves leaders, whether good or bad, in order to learn from their lives, their victories and mistakes.  A continual theme in our study is that “life is short” and therefore we must use our God-given gifts to serve others, thus fulfilling the law of Love in Christ.  Their spiritual (and physical) hunger is amazing, and while the missionaries provide the meal, the interns and residents do all the leading of discussion and hosting.   At times, when I am alone in the morning praying, meditating and reading, I am overwhelmed with a sense of thankfulness for the privilege of being a small part of something great that God is doing, best summarized in the Tenwek mission statement: “compassionate healthcare, spiritual ministry and training for service.”

Thank you for all your support of our family.  Please pray for these leaders as we continue to teach and train, not only in medical education, but also in spiritual formation.

New Life: Another “Miracle at Tenwek”

 Jeremiah, age 15.

 Emma, age 13.

 Claire, age 11.

 Levi, age 8.

Chuma, age 1-1/2.

The abbreviated version of the story is this: We are expecting Galat child #5!  For those interested, the extended version (or “the rest of the story”) follows, which includes themes of forgiveness, grace, and second chances. (Note: You may want to read first and “screen” before allowing younger readers to view.)

 Levi, our fourth child, was born in 2004, in the midst of a very busy orthopedic residency at the Mayo Clinic.  A few months after his birth, the chronic exhaustion, stress, financial strain and an element of selfishness caused me to think that perhaps four was enough, and I began to look into more permanent options for “family planning.”  Although Heather was not in full agreement, and my motives were based more on fear (rather than faith in God’s ability to sustain with His unlimited grace), I proceeded with a vasectomy.  However, as time went on, and our stations in life changed, I began to feel a sense of regret at making such a permanent decision.  Additionally, because Heather was not “fully on board” with the initial decision, she carried with her a wound, as this had not been a mutual choice based on prayer and/or a sense of God’s leading, but rather one made out of questionable motives.  As years passed, we both desired to have more children, but were resigned to the fact that this option was no longer a possibility.         

In 2008, prior to leaving for our first stint in Kenya, God began to take me through a refining process (actually, probably better described as a breaking process) as I realized I had a sinful habit-pattern of independent (i.e. God-less and Heather-less) decision-making and that repentance was necessary.  As these various “one-way” decisions were brought to light, I became committed to “making right” these wrongs done towards my God and my wife, and we saw God’s grace pour into our lives as I took these steps of faith.  However, as there was nothing I could do to “make right” the decision to permanently restrict the size of our family, I could only ask Heather for forgiveness, which she freely and graciously gave.     

As a physician, I knew about vasectomy reversals, a microscopic procedure in which the small tubes which were cut during the initial vasectomy are delicately reconnected with suture about the diameter of a hair.  But I thought this was an impossibility, as this surgery is completely elective and entirely expensive (between $5,000 and $20,000).  Additionally, the success rate is not 100%.  Even so, God continued to bring this to my mind, not via guilt, as if I had to pay for my sins by getting a reversal, but rather in a gentle and encouraging way, as if He was saying, “Are you going to trust me?”  So I researched options on-line and even contacted a few places in the U.S.   In August 2009, I was scheduled to travel back to the U.S. for a conference and I thought, “OK, here is my window of opportunity.”  Since Heather had fully forgiven me, she was supportive (yet not requiring).  Thus, we decided to pray (this time together) that if God would work out the fine details, I would have it done while in the U.S. for this conference.   However, the reversal surgeon I had chosen was not available during my “window of opportunity” so I thought to myself, “Good, now I am off the hook” and I put this possibility, with good conscience, to rest.

Shortly after returning from the U.S., I met Dr. Samuel Thompson, a visiting urologist at Tenwek who had come to help with the large numbers of backlogged urology cases.  One Wednesday night, he came to our men’s resident and intern bible study.  Afterwards, I was making conversation with him, and innocently asked, “What is your area of interest in urology?”  His answer almost startled me.  He said, “General urology is what I do, but my real interest is in vasectomy reversals.”  “Really,” I said with a sense of God’s providence at work, and proceeded to tell him a large chunk of our story.  After I finished, he said, “You know, if you could find me an operating microscope, an available operating room, 9-0 suture and microsurgical instruments, I would be more than happy to do this for you right here at Tenwek.”  Suddenly, I was placed back on the hook.  But God, in His mercy, was again overwhelming us, and Heather and I, together, felt like the circumstances were way too specific to not be from God.  So on September 28, 2009, I underwent the first and only vasectomy reversal ever at Tenwek (and perhaps all of Kenya and maybe even East Africa) in an empty operating room in the Eye Ward (which had all the necessary equipment and was providentially closed as the eye team was away for an outreach). 

After three years of waiting without any results (and truthfully, with some disappointment), we thought that perhaps this act was just for the purpose of obedience and faith.  Then, when we least expected it, God shocked us with this news that we are expecting.  We kept it quiet until Christmas Eve, so that we could give the news to our kids as a Christmas present and their total surprise was captured on video (click here to view).  We are thankful to God for this new life, born out of forgiveness, grace and second chances.  And we are so thankful for the ways you have followed our story, supported us with prayer and finances, and simply loved us.  We are imperfect humans just privileged to do our small part in God’s great plan to reconcile us to Himself and to each other.  Please pray with us for the health of this new life, for a safe and healthy pregnancy (Heather is constantly tired and nauseated), and that our family would bring glory to the One who is worthy of our lives.   May God give you strength and blessing in this New Year!

One Life

Yesterday, after a long and tiring day of surgery, I came home to find an email informing me that my brother Mike’s son, Josiah Galat, was found dead with stab wounds outside his campus residence at the University of Toledo.  Shocked by this unexpected news, I grabbed my phone (which displayed several notices of missed calls from my parents) and made calls to my family to try to get more details.  I first spoke with my father, who told me that Josiah called his mom in the final minutes of his life, and then my brother, who was completely exhausted after being up all night, yet reaffirming his faith in Christ and God’s sovereignty.  Last night, sleep was cut short as thoughts and prayers for my brother, his wife and boys flooded my mind.

Today, the work continued at the hospital.  Thankfully, we were able to get four operating rooms, helping to clear some of the patients from the long pre-Christmas queue.  Four new admissions today, however, with more certainly to come.   Tonight, hungry for more information, I found several news articles on the internet which reported that Josiah was involved in an apparent altercation with his roommate that escalated into this tragic event.  The other boy, Erik Littleton, is in the hospital, himself with multiple stab wounds.  Many parts of this story do not make sense to me.   

I spoke with Heather and the kids and we all agreed that, if possible, I should fly back to the states for the funeral, even though it would mean leaving on Christmas day.  As I called Delta, I prayed, asking God to provide a reasonable fare and good itinerary.  For once, Delta was especially kind on the phone and within a few minutes, the ticket was purchased at $1000 less than I was able to find on-line.  So, I will be leaving Christmas evening, and returning to Kenya before the New Year.  God is so good to provide this opportunity to be with my brother and family during this time of grieving. 

As Heather, the kids and I have sat together to process this news, God has opened the doors to some really meaningful conversations.  What we have concluded together as we consider Josiah’s untimely death at age 20, is that we have one life to live which is unpredictable and short, and that Jesus is so worth living this one life for in a radical, “all-in” way.  One day, whether tomorrow, or 70 years from now, we will all stand before our Creator, and give an account for what we did with that one life.    

Please especially keep my brother Mike and his wife Sheila and their other sons (Alex, Mason and Jared) in your prayers.   Please also pray for my travels to the U.S. and that my time with my Galat family, although short, will be very meaningful.   Thank you for your ongoing prayers and support of our family as we continue, in faith, to serve at Tenwek Hospital in Kenya.

Even in the worst circumstances...

Two weekends ago, I received a call from Seno, the surgical resident on call, who explained that he had admitted a patient with bilateral panga (machete) wounds to both arms.  “It was pretty bad when we washed them in theatre, almost completely amputated on both sides,” he said with less jocularity than is usual for Seno.  Panga wounds from domestic conflicts are, unfortunately, all too common in this part of Kenya, where firearms are illegal, and sharp instruments are usually the weapons of choice.  “We will take him back to theatre on Monday for a second look,” I said.

When patients are attacked with a panga, they usually have tell-tale “defensive” wounds; i.e. cuts on the forearms and hands when the upper extremities are instinctively used to protect the more “necessary” parts of the body, such as the face and chest.   However, when we examined the patient in theatre, I noticed that his wounds were not the characteristic defensive wounds we normally see, but rather higher up at the elbow, entirely identical on both sides, and with multiple skin cuts at the same location.  As the wounds were opened again, Seno’s initial assessment was corroborated.  Indeed, both arms were nearly amputated, but thankfully with the brachial artery and median nerve to both arms spared, which would mean some function if we were able to save the arms from infection or other complications.  As I contemplated the nature of these wounds, trying to think like a medical forensic scientist, I said to the team, “These wounds look more deliberate than normal…let’s investigate further tomorrow during rounds.” 

The next day, I had a meeting to attend, so Dr. Rowe performed morning rounds, and when I reconnected later with him and the team, Glen relayed the patient’s horrific story that he had discovered that morning.  Apparently, the patient was captured by some assailants (the details of course, obscured, as usual), tied at the wrists, and with arms outstretched, had both elbows hacked with a panga, one at a time, in the attempt to cut off  both arms.  “I wonder what he did?” I said out loud as I tried to keep from imagining the sickening events of this scene.  

I noticed that Glen was telling the story with slightly more excitement than I would have expected.  He went on to explain that after the team listened to this patient’s story, he shared with the young man about Jesus, who loved him despite anything he had done or any events that had happened to him.  “The patient gave his life to Christ right then and there,” Glen said with the passion that I so appreciate in him.   The next morning, the patient’s transformation was completely evident, as he was no longer quiet and stoic, but rather smiling, talking with other patients, and exhibiting joy that no solitary human could muster with a story such as his.     

The daily work at Tenwek carries with it a frequent absurdity as we encounter patients with unbelievable stories such as this young man’s.  Just a few days ago, I amputated the arm of an 8 year old boy whose wrist was wrapped so tightly with leather (by a local “bone setter”) that the entire arm became gangrenous.  Yesterday, while in casualty evaluating a patient, the nurses hurriedly rushed a young girl of about 12 on a stretcher into the room for evaluation.  She was covered with dirt, apparently buried alive, and now cold and lifeless.  She was the age of my own daughters.  Another man beat his wife to death before catching himself on fire with diesel fuel.  To be honest, the mixture of emotions that I feel – anger, hopelessness, disbelief, numbness, etc. – when I encounter patients such as these threatens to discourage and/or cause my heart to harden.  But then, God reminds me that even though circumstances may seem senseless, He is in control, blameless, and so able to work all things together for good.  After all, His ways are above our ways, and His thoughts above our thoughts.  So we continue to serve, believing (often despite our feelings) that God is at work all around us here at Tenwek, even in the midst of the worst of circumstances, and that Jesus is the answer to what our hearts truly long for… hope, healing, and forgiveness.     

Thank you for your ongoing support of our family…your prayers truly sustain us in our daily work at Tenwek!                

 

Tools for the Toolbox

Patient walking the day after surgery, standing with Dr. Marakalala, orthopedic resident from Botswana training at Tenwek.

Young lady with bilateral femur fractures treated with SIGN nails.

Another patient, up walking the day after surgery.

Happy to have his leg fixed!

Another young man with retrograde SIGN nail.

16 year old boy with Russell-Taylor nail.

X-ray of retrograde SIGN nail.

Femoral Russell-Taylor nail.

Tibial Russell-Taylor nail.

Paul Whiting, orthopedic resident from Tufts, who visited Tenwek in March, presenting our data from Tenwek on open femur and tibia fractures.

Boxes and boxes of Russell-Taylor nails.

All-day job but totally worth it.

"Too-long" nails to be delivered to Cedarville team who will cut nails down to a more useable lengths.

The new orthopedic storeroom is underway! 

One of my most important jobs as a missionary orthopedic surgeon at Tenwek is to ensure that we have all the necessary implants and instruments we need to provide the best possible care for our patients.  Implants and instruments are to an orthopedic surgeon as nails and tools are to a carpenter…without them, our care for the poor here would be extremely rudimentary and subpar.

As the majority of our orthopedic work at Tenwek is trauma-related, we see an exorbitant number of femur and tibia fractures secondary to road traffic accidents.  The “standard of care” for these types of fractures is the intramedullary nail (a long rod placed down the center of the canal, stabilizing the bone while it heals).  At Tenwek, we have two major types of nails: SIGN nails and Russell-Taylor Nails.  Without getting too technical, both of these rods are extremely critical and essential (each with slightly different indications) for treating the numerous femur and tibia fractures we see at Tenwek.

My trip to the States began at the annual SIGN conference, where we presented data from Tenwek on open (bone through skin) tibia and femur fractures treated with the SIGN nail.  Since first introducing these nails to Tenwek in December 2008, just shy of 600 have been performed!  For every SIGN nail done at Tenwek and reported on the on-line database, the SIGN Company replaces these nails at no cost to Tenwek.   Thus, as I left the conference, I carried with me a duffel bag of over 50 lbs of nails and other tools for Tenwek.

After visiting my in-laws and two churches in Phoenix, AZ, I then flew to Indiana to visit our mission agency, WGM, and sort through a massive donation of Russell-Taylor nails provided by Hope Force International.  Donations such as these usually contain a number of “odd” sized nails, either too short or much too long to be used in the majority of patients (unless a dwarf or NBA player).   I segregated two 50 lbs duffel bags of the “choicest” nails (perfect size) for immediate delivery to Tenwek (thanks Todd and Bill!).  Also, I found over 300 nails, size 46cm or above (too long for our patients at Tenwek), which I brought to Dr. Timothy Norman, professor of Biomedical Engineering at Cedarville University in Ohio, who organized a student project to cut and re-machine these nails to more usable lengths.

After several other engagements, including a meeting with the executives of a major orthopedic manufacturing company in Warsaw, IN, I returned to Kenya with 10 checked bags full of orthopedic supplies (which, thankfully, ALL arrived and cleared customs with minimal questions).  And these supplies did not come too soon.  Just last week alone, I personally did 8 Russell-Taylor nails and “team ortho” did another 8 SIGN nails, all in people who would otherwise potentially be permanently lame without these implants.  Instead, these patients were up walking, even the day after surgery, and truly very thankful (see pics). 

These nails provide a significant, yet minority part of our total needs at Tenwek.  And we continue to trust God to provide.   I am humbled by the fact that God is the One who does the work…it seems the harder I personally try, the less fruitful the results.  On the contrary, the more we pray for His provision, the floodgates open.  Thanks again for partnering with us in serving the poor at Tenwek in Christ’s name.  We appreciate your prayers and support!

 Eph 3:20-21 “Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us,  to him be glory in the church and in Christ Jesus throughout all generations, for ever and ever! Amen.”

Eye-Witness to an RTA

While driving back to Tenwek last Friday with Heather and Jeremiah (and two other kids from Tenwek), as I rounded a gentle sloping curve, I saw two odd-shaped objects in the middle of the roadway off in the distance.  Having just returned from a 2-1/2 week, multivariate trip to the U.S. the night before, I was telling Heather all about the events of the journey.  One of the main reasons for the trip was to present data collected at Tenwek related to the huge rise in orthopedic injuries in developing countries secondary to road traffic accidents (RTA).  Ironically, we were about to witness a tragic, first-hand example of this growing problem.

As we drew closer, it became apparent that the two objects lying in the road were a motorcycle and a man, and we were the first ones on the scene.  Pulling off to the left, I assigned Jeremiah, Joel and David to get the motorcycle off the roadway, while I attended to the obviously-injured, middle-aged man who was lying on his side, dazed, with blood pouring from lacerations on his face and scalp.  Normally, in trauma situations such as this, victims are not to be moved until the cervical spine is stabilized with a C-collar.  However, I was worried that as long as we were in the middle of the road, we were both at risk for being struck by a speeding over-loaded passenger van or semi.  So, after running my fingers down his spine without feeling any obvious abnormality, I grabbed the man by his shoulders and dragged him off the road.  As I was pulling, I could feel crepitus (bones moving) in his right shoulder.  

With the motorcycle and victim now off the road, I could examine him more closely, and confirmed the lacerations, and shoulder fracture, and a potential fracture of his right hip (as his leg was externally rotated and he was not able to stand).  Thankfully, it did not appear that he had any immediate, life-threatening injuries.   Trying to use my newly-acquired (but still inadequate) Kiswahili, I asked the man, now a little more lucid, his name, where he was from, and what had happened.  “I was struck while driving my motorcycle and the car just drove away,” he said, the same hit-and-run story I hear so often.    

Without Emergency Medical Services in Kenya, the next concern was getting this man to Tenwek, which was about 50 km away.  A newly arrived onlooker hailed a passing sedan-car taxi, which stopped to see how he could help.  “How much to take this man to Tenwek,” I asked, thinking that perhaps the driver would not take advantage of the situation.  “Yes, please take me to Tenwek,” the victim said.  “My home is only a short distance from there.”   The quoted price, I thought, was bordering on opportunism.   While others helped the victim into the taxi, I reached into my pocket and gave the driver what I had available, and asked him to please help his fellow brother by driving him to Tenwek.  A few minutes later, they were off.

As I got back into our Land Rover, I noticed the blood on my hands, wondered if I would be seeing this man at Tenwek on Monday, and puzzled at the irony, absurdity and seeming senselessness of this event.  A while later, back on the road to Tenwek, Heather said, “I liked seeing you in action…God planned to have you be the first one on the scene.”  Her words took the edge off some of my raw emotions, and reminded me that the events in life, although at times tragic, are not random, or without purpose.  God is in control.  I was also reminded of the reasons we continue to serve at Tenwek...the need is so great. 

Thank you for partnering with us in this work at Tenwek, so that we can continue to provide “compassionate healthcare, spiritual ministry and training for service.”  We appreciate your prayers and support!

Technology in Rural Kenya

Jeremiah and his Dad in front of the newly arrived C-ARM crate - weighing in at nearly a ton.  Jeremiah is now officially a few millimeters taller than me (and a full 20 lbs heavier).  I fear that soon, I will no longer be able to "take him."

Wheeling the C-ARM into operating room #4 for the "first case," a 40 year old man with a displaced femoral neck fracture that Dr. Rowe fixed with cannulated screws. 

Benard, our excellent IT guy at Tenwek after just setting up the new computer in our orthopedic threatre room.  I spend part of my weekend on call installing the wall-mount system. 

 

The Galat family is currently in an extended season of visits from friends and family from the States, and we are loving it!  Just recently, Sonny Sazdanof (a chiropractor from Arizona) and his wife Esther, visited for two weeks along with Heather’s parents, Steve and Jill Kinkel.  During the usual tour of the hospital we give to visitors when they first arrive at Tenwek, as I was showing Sonny our facilities, he turned to me and said, “I had no idea.”

Like Sonny, I am sure most people imagine the practice of orthopedic surgery at a mission hospital in rural Kenya as extremely rudimentary, with inadequate facilities and equipment, and, at best, outdated methods of fracture care.  And although we are still not at the level of the typical hospital in the U.S., our technology continues to increase in way that surprises even me.

When I returned to Kenya a year ago, our PACS (computerized x-ray) system was in place and I was overjoyed at the thought of never having to search for a hard-copy x-ray again.  And now, through the donation of a faithful supporter and a company in California, we even have wall-mounted computers displaying digital x-rays in our orthopedic operating rooms (it feels a little like I am back at Mayo!).  Additionally, we just received our newly donated C-ARM which will allow us to perform cases requiring intraoperative imaging simultaneously.  An EMR (electronic medical record) system is even in the works for the very near future.

The reality is, however, that we are still a mission hospital in rural Kenya, struggling to keep adequate supplies to care for the relentless needs that present to our doors daily.  The orthopedic service alone currently has over 40 patients, and in going through the list tonight, we have 17 in the queue needing urgent surgery.  Although we may have the technology, sometimes we lack the trauma implants to even do the work.   But we continue to trust God to provide for all our needs, as He knows them even better than I do.  Just recently, I received an email from a supporter in the States saying that he had received a donation of 5 pallets (!) of orthopedic nails (the same nails we use regularly here at Tenwek for femur and tibia fractures) and he wanted to give them all to us!   

The underlying truth that keeps us persevering is the fact that Tenwek is God’s work…a not-so-small mission hospital in rural Kenya that He is using to glorify His Name.  And that is our underlying purpose for being here…to tell every one of the Hope and Healing that they can have in Jesus’ name.  Thank you for partnering with us!  We appreciate your prayers and support!