Coffee and the Call of God

Picking coffee berries from our bush in the back yard.

The beans inside each newly-picked berry must be squeezed out or separated from the fruit, and then allowed to dry.

After drying (using the "pulp natural" method of processing), the parchment covering each bean must be peeled off. The yellowish beans on the right are "parchment coffee" and the beans on the left are the "green beans" which have each been individually hand peeled. This is the longest and most meticulous part of the processing.

Green coffee ready for roasting.

A hot-air popcorn popper serves as an excellent coffee roaster.

Fresh-roasted beans ready for grinding and brewing.

Some brilliant, long-past resident of our house at Tenwek had the foresight to plant a coffee bush in our back yard. And so, last month, we harvested the first crop of our own, home-grown Kenyan coffee (although small enough only for one French-press pot). Processing of coffee, from the picking of ripe berries to the roasting of the “green beans,” was quite involved, but fully worth it after taking the first perfect sip of fresh-roasted coffee.

When Heather and I were researching opportunities for orthopedic mission service in 2006, we stumbled across Tenwek Hospital which happened to be in Kenya. Although at the time we had no clue, geographically, where this small country lie on the African map, in our passion for home-roasted coffee, our hands-down favorite had always been (and still is) Kenyan, with its characteristic “bright citrus notes, and black currant, winey hues” (as described on www.sweetmarias.com). We thought, “If the coffee coming from Kenya is this good, it must be a really cool place to serve.” So here we ironically are, now full circle, thanking God for bringing us sovereignly to this place of service, while drinking a cup of our very own Kenyan brew.

God often works and directs in and through our passions to accomplish the purposes of His kingdom. What are your passions? And how is God directing you to strongly serve Him in and through those passions? Let us encourage one another to step out in in the unique gifting, calling and interests that God Himself has given us. Oh, and once you have tasted home-roasted coffee, you can never go back...nothing else compares!

Delight yourself in the LORD and he will give you the desires of your heart.
Psalm 37:4

Courage

Walking through Casualty last Friday night, making one more round to see if anything was brewing before heading home for our weekly family “pizza night,” I saw two young Masai men, both significantly bruised and bloody, bandages on their heads, sitting stoically awaiting their turn for x-rays. “What happened to those guys,” I asked a nearby intern, thinking perhaps they engaged each other in a good mid-December drunken brawl. The intern replied, “They were tired of the lion that was killing off their livestock, so together, they speared it.” I could only imagine the scene as it unfolded, an obvious grapple, as evidenced by the wounds sustained by both men, and since they were both still alive, I surmised the lion had met her match. I walked up to one of the men, and looked him in the face, admittedly obviously impressed by the courage he demonstrated. He looked at me, and since I don’t speak a word Masai, I spoke the universal language that all men understand…I gave him the “thumbs-up sign." He responded back with a barely perceptible crack of a smile from the corner of his mouth as if to say, “I killed me a lion today.”

I thought of David, who proclaimed to Saul, when told he was unable to face Goliath because of his youth and size, “Your servant has killed both the lion and the bear; this uncircumcised Philistine will be like one of them, because he has defied the armies of the living God." Sometimes God asks us to do things that seem impossible to us, well beyond our own strength and ability, like for David, killing lions, facing Goliaths, or being a King. But these times are divine opportunities to demonstrate courage, which is more a decision of the will than an emotion of the heart, and undergirded by faith that a stronger Power is at work in our lives, accomplishing great things in and through us. Then, when these great things happen, knowing who we truly are in our own strength, all we can say is, “God, you did that…the Glory goes to You.” Were the Masai warriors afraid when they attacked the lion? Perhaps…but fear obviously did not dictate their actions. Necessity did. Sometimes you just “got to do it,” in faith, and trust that God will give what is needed to get the job done. That’s what the heroes of the faith did, normal men and women like you and me, driven often by necessity and a passion for God’s Glory, refusing to bow to fear and cowardice, willing to trust God’s promise to be near. That’s how great things happen.

Deuteronomy 31:6 Be strong and courageous. Do not be afraid or terrified because of them, for the LORD your God goes with you; he will never leave you nor forsake you.”

Hope

Young boy with bilateral femur fractures and open left tibia fracture after being hit by a car. Plates and screws for the femurs and a cast for the tibia allowed him to get out of bed early. He quickly became adept with handling his wheelchair.

Young lady at first followup appointment after having long screws placed across her sacrum to hold fractured pelvis in place. I especially like her husband's sweet hat...

The orthopedic surgical team...pushing the large cart of freshly sterilized implants and instruments to theatre at the start of a long day.

Man with acetabular fracture (hip socket) laying in bed in traction for 6 weeks...plently of time for reading and spiritual growth...

We are blessed to have our current set of visitors...from the left, Drs. Gaw and Morris. Dr. Araka (next to me) is the current intern on our service. Yes, I am needing a haircut...



December is classically the season for orthopedic trauma at Tenwek hospital, the busiest month in terms of admissions and surgical cases, most of which are related to road traffic accidents and/or alcohol (which is more easily obtained with the “bonuses” commonly given this month). As if on cue, on December 1st, two young men were admitted (one 18 and the other 20), with incredibly severe pelvic fractures. Both were very inexperienced drivers of “boda-bodas” (motorcycle taxis), and both looked more like 14 rather than their stated age. On December 2nd, three more young men were admitted with severe lower extremity injuries (yes, boda-boda plus alcohol), one man with bilateral open (meaning bone poking through skin) tibia fractures, and femur fractures. Yesterday (December 3rd), a 37 year old man was admitted after falling from a tree. He was paralyzed from the chest down, with two badly crushed thoracic vertebrae. Today, December 4th, is still young…

To be honest, one of the temptations working at a busy mission hospital is to succumb to feelings of hopelessness. Many of the patients we see have injuries and conditions that are well beyond the help of western medicine. Last week, we admitted a 17-year-old young man with a mass on his hip the size of a small football. Biopsy revealed sarcoma, and a simple chest x-ray showed that the cancer had already spread to his lungs and shoulder. How do you explain to a patient this young that he likely only has a few more years to live? Personally, we also feel the physical and emotional burden of continually trying to stay ahead of the relentless workload in our attempts to alleviate suffering in patients. Adding “injury to insult”, tomorrow, December 5th, a nation-wide strike of all national (Kenyan) physicians is scheduled to begin (including, unfortunately, our own interns at Tenwek). If the strike materializes, patients will soon flood into Tenwek, which would literally be one of the remaining few open hospitals in the country. Perfect timing during this busy season…

Yet, we continue to hope, because we know our God specializes in bringing good out of seemingly hopeless situations. This is the essence of the Advent Season leading up to Christmas…at the darkest time in history, the Christ-child, God in the flesh, entered humanity with the sole purpose of redeeming mankind from its bondage to sin through His eventual death on the cross. Imagine the God who is both perfectly just, and perfectly loving, in that he took our sin on His own shoulders! No wonder the angel proclaimed to the shepherds on the night Christ was born, “I bring you good news of great joy!” And God continues to bring hope in the midst of suffering here at Tenwek. He provides the orthopedic implants we need at just the right time, so that we can help many of the patients God sovereignly brings us…the young man with sarcoma accepted his news with peace while clinging to his bible…a 75 year old alcoholic who broke his hip after a drunken fall accepted Christ as his Savior (after he recovered from his delirium tremens)…patients are healed in Jesus' name…

The truth is, we all have hope. The question we need to ask ourselves is: “Where do we place it?” Job security? Money? Position? Family? Education? Entertainment? Food? Do we view these things as our source of hope, or as “gifts” from God who purchased all good things we enjoy by His death on the cross? During this Advent Season, may we all put our hope in the true Source, and worship the Creator rather than the created. Christ is the ultimate gift from God to us…Hope in the darkness…Good news of Great Joy.

Psalm 130:7-8 O Israel, put your hope in the LORD, for with the LORD is unfailing love and with him is full redemption. He himself will redeem Israel from all their sins.

A Father’s Heart

Two weeks ago, a young 13 year old boy named Washington was admitted to Tenwek after his leg was crushed by a boulder which fell on him while he was bathing in a river. He arrived more than 24 hours after the injury, having been first “treated” at a small hospital near his hometown. His shattered shin bone was plainly visible beneath a huge defect in the surrounding skin. The dirtiness of the river water, combined with the severity of the open wounds and delay in adequate treatment, meant that infection would be inevitable and difficult to treat.

I spoke with the boy’s father, a young man himself in his 30s, not wanting to paint a false picture, explaining that although we would do what we could to save his son’s leg, amputation might be unavoidable. The man seemed to understand and said, “Please do what you can.” So I prayed with him, asking God to do a miracle.

What followed was a series of surgeries to try to control the infection. At Tenwek, for pediatric patients, we use a drug called ketamine, a relative to PCP (angel dust) to provide sedation for short surgical procedures. Ketamine produces a “dissociative anesthesia,” meaning that although the patient is completely awake during the procedure, he neither feels pain, nor is cognizant of his environment. Often, patients under ketamine communicate very interesting things, and, like a truth serum, can reveal the deeper contents of the heart. Washington told us during his first surgery (in which we removed a large amount of dead skin and bone), in very good English: “My name is Washington, as in Washington D.C., and when I grow up, I want to be a doctor.” Then, speaking in Swahili, over and over again he said the word “babba” followed by the same repeated phrase. I asked the scrub techs what he was saying and they translated, “Daddy, don’t leave me.” And his daddy never did, always sitting by his side in the pediatric ward, constantly there.

At first, it looked as if the infection was under control. However, a few days ago, the leg took a major turn for the worse. Despite multiple surgical debridements and treatment with three IV antibiotics, a foul smell began to emanate from the wound, and Washington spiked high fevers. I spoke again with Washington’s dad, explaining the next surgery would need to be an amputation. “How will he walk?” the father understandably asked with a combined look of anger and desperation. Although I try to avoid making promises I may not be able to keep, I told him, “I will personally make sure he gets a good prosthesis from the U.S.”

My experience with Washington and his father opened my eyes to finally notice the many other fathers on the pediatric ward, constantly there, offering comfort in the midst of tragedy and pain. They remind me of our true Father, whose perfectly strong and tenacious love never lets us go…constantly patient…continually there…comforting when we are hurting…upholding when we are weak…providing hope in the midst of darkness.

Romans 8:15: For you did not receive the spirit of slavery to fall back into fear, but you have received the Spirit of adoption as sons, by whom we cry, “Abba! Father!”

If you would like to donate to Tenwek’s Compassionate Surgical Fund, which helps patients like Washington, please email donations@wgm.org and mention project ID 125-35224. Thanks for all your support of our family!

Camping in the Aberdares

The drive to the Aberdares.

The campsite. Note the small "adult" tent that was pitched under this shelter.

The view from our campsite when we awoke in the morning. The mist in the center of the picture is from the nearby waterfall.

"Native" Jeremiah, barefoot as usual, trying his hand at trout fishing.

To appreciate the size of this waterfall, note the person standing to the right.

Another view...

Trout cooked over an open fire...as the Kenyans' say, "very sweet."

After the rains...

Trying to dry out and get warm. Of note, it is about 50 degrees F.

Jeremiah's legs...remnants of a great weekend.

A few weeks ago, Jeremiah and his entire dorm of sixteen young adolescent males went camping in one of Kenya’s national parks, the Aberdares, a central mountain range about 100 km north of Nairobi, rife with huge waterfalls, forest elephants, rainbow trout, and…rain (the entire water supply of central Kenya comes from this region). The chaperones? Jeremiah’s “dorm dad” (Rodney) and his “genetic dad” (me). After driving 3 hours on slippery dirt roads, stuffed into our “new” used Toyota Regius Ace with 10 somewhat stinky boys, Jeremiah riding shotgun, we arrived at our site and set up camp in the dark. Soon, the sloppy joe meat pot was steaming over the fire, and we settled in for the evening. Rodney and I had no shame in setting up our tent under the makeshift tarp shelter we erected. I found out later why this was such a solid move.

The following morning, while I was cooking breakfast, Jeremiah and about 6 of his buddies emerged from their tents wearing only homemade loin cloths, saying they wanted to “go native” and “blend in” with the environment (which I can assure you did not happen). Aside from this unwanted sight, (which reminded me of a scene from the movie “Lord of the Flies”), the morning was incredibly scenic; and, viewing the surroundings for the first time, I understood why some people call this area the most beautiful part of Kenya. Later, Rodney, an avid outdoorsman, set us all up for fly fishing in the mountain brooks that flowed nearby.

About 1pm, it began to precipitate. At first, this was a novelty for the boys, who were running about, getting pelted with the falling rain and hail, not thinking about how cold they could potentially be in the very near future without dry clothes or a roaring campfire. After a solid two hours and 3 inches of rain, however, the fun was over, and our campsite, including “the adult tent,” was beginning to flood. The majority of the boys took shelter in our van, which was only somewhat dry. We literally built a dike around our tent and dug drainage ditches to protect our only remaining precious resource: dry clothes. The rains let up around 4pm…for about a half hour. It then continued into the evening, and thus we decided to “turn in” early (which for the boys was about 1am). Sometime in the middle of the night, I woke up, noticed that the rain had ended, and looked out the widow of the tent to see the “southern cross” surrounded by the starriest night I have ever witnessed.

The next morning was cloudless, and when the sun edged over the mountains, our campsite began to dry out. After breakfast, Rodney led the boys in a discussion on a Christian view of relationships with the opposite sex, specifically how this relates to the new dating policies at Rift Valley Academy. As I sat listening to these boys share their collective thoughts on the subject (actually with more wisdom than I anticipated), I thought to myself, “Here is an incredible group of young men, missionary kids, each with a unique story of how God got them to this place at this time in life.” And I wondered what each of them would become in the future, products of the rich lives they have been privileged to live.

After one more round of fly fishing, we broke camp and headed home. When I arrived back at Tenwek later that evening, I took a long and very hot shower, amazed at how thankful I could be for something we so easily take for granted. It was a great weekend. Next camping trip in the works: the Suswa caves.

The (Not-So) Typical Work Week at Tenwek

Jeremiah, recovering with cup of chai in hand, after removal of the plates and screws in his knees and ankles.


Total knee replacement done with implants sourced from Nairobi. The goal is to help patients with bad arthritis, and use the funds generated by this program to subsidize care for the poor.


People often ask “What is your typical orthopedic surgery work week like at Tenwek.” Following is a sampling of last week’s schedule, highlighting the most interesting case for each day, and the teamwork worldwide required to make modern orthopedic surgery possible at our rural mission hospital:

Monday: Intramedullary nailing (with a long rod) of a midshaft femur fracture with nails remanufactured by a team of students and professors from Cedarville College. Often times, and not surprisingly, nails that are donated to Tenwek are of extreme sizes, more appropriate for NBA players than the average Kenyan. This team took 80+ of these excessively long nails, and first engineered, then re-manufactured them to the most common lengths (38, 40 and 42 cm). Thank you Cedarville team!

Tuesday: (1) Knee arthroscopy (knee “scope”) in a 34 year old Maasi man who works as a chef at one of the premier safari lodges in Kenya (arthroscopy equipment donated by an orthopedic surgeon from the U.S.). (2) Revision SIGN femoral nailing in a 29 year old Muslim man who reminds me daily to get him the English Bible he requested (I promised him he WILL get it tomorrow!). SIGN Fracture Care International is a company which designs, manufactures and distributes orthopedic implants to medically underserved countries around the world.

Wednesday: Three month old distal clavicle fracture in a 47 year old man. Tough case…that’s all I have to say about that.

Thursday: Total knee replacement in an Indian-Kenyan man from Lake Victoria. The goal is to use the funds earned from this burgeoning “adult reconstruction” program (hip and knee replacement) to subsidize the cost of orthopedic trauma implants for the poor. In the next four weeks, we have 6 additional cases scheduled!

Friday: Ankle fusion in a 73 year old man who was initially (mis)treated at one of the largest hospitals in Nairobi where his broken and dislocated ankle was placed in a cast.

Saturday: Plate and screw removal in a burly, 14-year-old young man by the name of Jeremiah Galat. He insisted that the anesthesiologist NOT give him any sedation so that after he was given the spinal, he could slap his own legs without feeling it, and try to make me laugh during surgery.

Sunday: Sabbath day off! Thank you Dr. Moore (4th year orthopedic resident from University of Alabama) and Dr. Bacon (not-so-retired orthopod from the U.S. who is with us for 4 months) for taking call this weekend. The orthopedic service at Tenwek could not survive without a regular influx of visitors who sacrifice vacation and holiday time to serve along-side us.

In all we do at Tenwek, our goal is to bring glory to the One who saved us because of His own mercy! Thanks for all your prayers and support!!

Titus 3:4-6 But when the kindness and love of God our Savior appeared, he saved us, not because of righteous things we had done, but because of his mercy. He saved us through the washing of rebirth and renewal by the Holy Spirit, whom he poured out on us generously through Jesus Christ our Savior.

On Call

Helen Tangus, one of the lead hospital chaplains, prays with a group of patients.


While dozing off around 11pm last Thursday night, our house phone rang and Heather answered. “Do you want to talk to Dr. Galat?” she asked, clearly a call from the hospital. As she handed me the phone, I could hear chaos in the background, children crying and people talking in heightened tones, obviously stressed by whatever situation was unfolding in Casualty. This, in combination with the strong Kenyan-English accent of the caller, made it difficult for me to understand what was being said. I did, however, hear something about a child with a “traumatic amputation” and thought to myself, I had better head up to the hospital ASAP.

When I walked into Casualty a few minutes later, it was far worse than I anticipated. Over in one corner was a young woman whose right arm was wrapped from hand to shoulder with a blood-saturated dressing. Nearby, a small boy lay quietly on a stretcher, his entire right arm missing, with only a compression dressing on the remaining shoulder. Next to him, several staff members were attending an even younger patient, a little girl about two years old with severe facial and scalp lacerations. Between them stood a dazed, young woman with her own injuries, the mother of these two children, herself completely unable to cope with the trauma or offer any comfort. Across the room sat another, almost juvenile-looking injured mother, ignoring her own pain, desperately trying to nurse the crying child in her lap who also had bandages wrapping both legs. Under the dressings were severe abrasion injuries too horrific to describe. “Will you have to cut them,” the mother asked, looking first at the baby’s legs, and then, with desperation, into my eyes. The entire scene was surreal, and for the first time in years, I found myself slightly nauseated.

“What on earth happened here,” I asked out loud. No one was able to give a solid answer…something about a small bus swerving out of control after hitting a donkey. Stories like this are all too common, but what struck me hard that night was the fact that so many of the victims were multiply-injured women and children. “What are God’s purposes in all this?” I thought to myself as I was completing the amputation of the arm of the first young woman at 2am in the morning. The next day I found my answer, at least in part. Person after person: chaplains, visitors from the U.S., and staff heard about the victims of this accident and visited them, offering prayer and comfort and hope. This is the reason Tenwek Hospital exists, and why we are here, so that the arms of Jesus can be extended to those who are suffering. While answers may often escape us, we can continue, in faith, to reach out to those who are hurting, and trust that God’s purposes are always pure, always loving, and never random.

Please pray for the victims of this accident and the many others that we see at Tenwek on a regular basis. Thank you for all your prayers and support!

2 Cor. 1:5 For just as the sufferings of Christ flow over into our lives, so also through Christ our comfort overflows.