Blood: Post-Easter Reflections

As an orthopedic surgeon, I am often chided by fellow colleagues from other “more refined” surgical specialties that I am a mere “blue collar surgeon,” with marginal intellect, who uses barbaric tools such hammers, nails and screws, to fix broken bones through large, bloody incisions.  More than once I have heard the quip about orthopedic surgeons being “strong as an ox and twice as smart” and I try to take it in stride, replying with my standard rebuttal about being glad that at least I don’t have to operate on the colon or some other "less-glamorous" body part.   I love the banter, and surmise the reason it exists is to help us lessen the stress in our high-stakes profession as missionary-surgeons at a busy mission hospital in rural Kenya.

 While I understand that most of what is said about orthopedic surgeons is solely in jest, it is true that our surgeries are significantly bloodier than the average general surgery case (such as a thyroidectomy where blood loss can be measured in a few cc’s).  It is not uncommon for a hip fracture case to have 500cc or more in blood loss.  Once, during cleanup of the operating room after a particularly extensive and bloody orthopedic case, a suction container filled with about a liter of blood slipped out of the hand of one of our team members, and hit the floor, spraying the wall and ceiling and covering our poor anesthetist in blood.  And more than once, I have finished a case only to find that blood has soaked through my surgical gown to stain my scrubs underneath, or that blood dripping from the operating room table has completely soaked the hems of my scrub pants (especially if I forget to wear my rubber boots).  And I wonder why Kenyans are staring at me, wide-eyed, as I walk obliviously through the courtyard of the hospital wearing bloody scrubs or why my wife refuses to give me a hug at the end of the day until I have taken a cleansing shower. 

For the average person, the sight (or even the thought – sorry!) of blood can be sickening. But for those daily exposed to the sight, smell and feel of blood, the visceral reaction blood evokes can be lessened, until it becomes quite mundane and unremarkable.  Perhaps, like the desensitized surgeon, we as Christians have also lost our appreciation of the significance of blood.   We forget that our forgiveness was bought not with our “good deeds” but with the literal flow of blood from the hands and feet of God Himself (Hebrews 9:22: “Without the shedding of blood there is no forgiveness”).  And we forget that the price of our freedom from sin was literally paid with the currency of blood (Revelation 1:5: Jesus “freed us from our sin, by his blood”).   During this post-Easter season, let us encourage one another to ponder the incredible sacrifice that Christ paid for us on the cross, and pray that God re-sensitizes our hearts to the wonder of Christ’s blood that has set us free.

“Amazing Grace, how sweet the sound

Amazing Love, now flowing down

From hands and feet that were nailed to a tree

As Grace flows down and covers me”

The Mysteries of Life, God’s Sovereignty and Free Will

Heather is now 18 weeks pregnant, and today, we had an extensive ultrasound of our new baby.  As we watched with amazing clarity the intricate anatomic details of this new little life unfold before our eyes (current technology is absolutely amazing), we couldn’t help but worship God for this miracle: toes, fingers, and details of other “parts” all being perfectly knit together by a sovereign God who wills, as he chooses, to create, in a truly mysterious way.   Our baby has no choice as to its sex, body shape, hair or eye color, the family it will be born into, its nationality, or even aspects of its personality.  But, like all of us, as per God’s mystery and perfect design, our baby will have a choice (despite these “non-options”) what to do with them, and whether or not to follow the One who willed to create this life.  In the end, we are all stewards of the life that God gives us, and we will be responsible to give an account of what we have done with the gifts He has given.  Yet, all is completely by Grace, so that in the end, any good that comes from our choices will be turned back as praise to Christ, who made everything possible by his sovereign death on the cross for our sins.  As is the mystery of new life, so is this mystery of God’s sovereignty and our free will.

By the way…it’s a girl!!         

Transitions 2013

The orthopedic team on my final day of work, prior to leaving for our next scheduled furlough.

Encouraging a patient about to be discharged from the hospital. 

Praying with a patient during morning rounds.

 

 

Dr. Kiprono and I performing a total hip replacement in a 50 year old male with bad arthritis.

 

Tomorrow night, the Galat family (minus Jeremiah) will be flying back to the U.S. for our scheduled furlough.  As such, the last few weeks at home have been a flurry of packing, organizing, planning, and saying goodbyes to our many good friends, both American and Kenyan.  Naturally, this time of transition brings with it also a wide variety of paradoxical emotions, and while a few tears have been shed by our kids, we are also encouraged by the sense that this pain of transition is not as sharp as it has been in the past.

Times of transition also bring reflection.  The changes that have occurred in the orthopedic department since our first arrival to Tenwek in November 2008, are amazing.  Back then, the “team” consisted of me, and a clinical officer intern who had absolutely no interest in orthopedics.  In contrast, on my final working day last Thursday, the team consisted of 12 people (consultants, residents, interns, and essential visitors), all committed to compassionate orthopedic care of our patients.  However, this number is continually in flux (six left the following day), and we struggle to adequately cover a service that is relentlessly growing, averaging 40-50 inpatients at any given time (47 on my last day), mostly from trauma related to road traffic accidents.  During the last year, over 2000 major orthopedic surgeries have been done (including 32 total hip and knee replacements), in operating rooms that are open 24/7.  

The commitment to education and training via Tenwek Orthopedics remains essential to our purpose.  Dr. Kiprono Koech joined the team in 2012 as the second orthopedic consultant (and my partner).  His calm demeanor, excellent surgical ability and leadership skills belie the fact that he just recently finished his residency, being years ahead of his peers.  In August 2013, Dr. Will Moore, a post-resident from Samaritan’s Purse, will round out the team as our third consultant.  We continue to train orthopedic residents from Moi University, and just recently added a second rotation for orthopedic residents from Kijabe hospital.  And we continue training the general surgery residents and interns based at Tenwek.    Plans are in the works to start our own Tenwek-based orthopedic residency, God-willing in January 2015. 

But most importantly, and the reason that we continue at Tenwek, is the ongoing emphasis on spiritual ministry.  In the past year, more than 30 patients have committed their lives to Jesus Christ as a direct result of the orthopedic ministry at Tenwek.  On morning rounds, while hectic, we try to daily take time to pray with patients and share with them the good news of Jesus Christ.  A short word of encouragement, a small prayer, or giving of a bible can make a life-changing difference, and we have seen God do significant miracles of His Grace.  

In short, while there are many challenges that that we will inevitably face, the future is bright and many good things are on the horizon.  We have no other choice but to trust God to continue this work that He started.  Tenwek’s vision statement of “compassionate healthcare, spiritual ministry and training for service” continues and only through teamwork is this possible.  Thank you for all the support of our family in so many ways: prayer, words of encouragement, financial support, short-term visits, etc.  We, as a family, are honored to serve at Tenwek and God-willing, will continue for many years to come! 

Please keep us in prayer as we travel back to the U.S. for this HMA (homeland ministry assignment) of 6-7 months (we hope to return shortly after the birth of our new baby, due August 10th!).  Jeremiah will join us in the U.S. the end of March, after finishing this current term at RVA.  Please also keep Dr. Kiprono and team in prayer as they continue the busy orthopedic work at the hospital.   

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!