VF: Kenya - part 3

My normal day! Each morning we met around 7:00am to run the list and review the xrays of the patients that came in the night before. Tenwek is blessed to have a digital xray system that works most of the time. The census (number of orthopedic patients in the hospital) varied from 25-50 patients spread out among the various wards of the hospital - orthopedics, male surgical, female surgical, pediatrics, wound ward, etc.  Open fractures were very common, many presenting to the hospital days after sustaining their injuries. The vast majority of the fractures we saw were the result of Road Traffic Crashes (RTCs). The taxi system includes the Bota-botas (motorcyles driven by teenagers who feel that 4+ people on one motorcycle is a good idea) and Matatus (mini-vans that pack in 12-20 people). Bad roads, high speed, alcohol, and crowded streets insure job security for orthopedists for many years to come.

 

We met here each morning for xray review! 

This is a 'small' list of patients! 

This is the male surgical ward. Most of the wards are this style with one large room and multiple beds per room. Each bed has its own mosquito net. Sometimes two patients share a bed. It gets pretty snug to round on people that close together. The patients are incredibly respectful of each other's privacy even in that close quarters.

 A young man (9 yrs) with a left femoral shaft fracture in traction and bilateral forearm fractures.

After rounds we would meet at the surgical board to divide up the cases and go over the cases for the day.  The board below is a typical board. Of the five total ORs, two are devoted to orthopedics. It was typical to get 3-4 cases done in a day. Above, the general surgeons are also meeting to discuss their cases.

Below, we are getting ready for my first case in theater (OR) - a young man with distal femoral shaft fracture from a RTC.

The day typically ended around 5:00pm and whatever cases were not done were simply moved to the following day. 

Two major differences between Kenya and the USA: First, in the USA, everything is disposable. In Kenya, everything is reusable - gowns, drapes, towels, traction pins, bovies, scrub brushes, etc. Second, in the USA a premium is placed on efficiency, turnover time, and productivity. The Kenyan culture is a far more laid back culture without the idolatrous desire to squeeze every ounce of productivity out of a day. A very refreshing perspective. 

More to come...

Venture Forth: Kenya - part 2

Don't feel too sorry for us because we weren't exactly roughing it! Tenwek Hospital is supposedly the most visited mission hospital by short-term healthcare personnel in the world averaging 150-200 visitors per year. They are used to visitors and have a well-oiled machine for getting people oriented and integrated into the hospital.  We stayed in the guest house, a large building of apartments just down the hill from the main hospital replete with a comfortable bed (minus the annoyingly small mosquito net), hot showers, coffee maker, fridge, oven, and microwave. 

The grounds of the hospital are immaculate! A team of workers are charged with maintaining all the flowers, shrubs, and other green plant things that grow basically year-round in the nearly perfect climate. (That covered building below is a basketball court!)

To make you feel even more sorry for us, we were blessed to be able to go on a one-night safari to the Fairmont Masai Mara Safari Club Resort. About a two-hour drive down the absolute worst road I have ever seen, we arrived Saturday morning in time to get checked into our Five-Star Tent! (No Joke) We enjoyed a delicious lunch, went on a four-hour safari drive through the Maasai Mara that afternoon, came home for a fantastic dinner, and went to bed. We were awoken the next morning at 5:30am with Hot Chocolate and got ready for a short 2 hour safari drive after which we came back to a ridiculously nice breakfast!

Oh, and we saw plenty of African critters! Our driver was Sammy, a safari veteran of 10+ years who has the best job ever! He basically gets to go mudding in that Land Rover every day and drive around and show people critters.

It was a wonderful African experience and one that we hope to share again with our children and possibly other friends in the future. Now I should probably get to work posting pictures of the real reason we went to Kenya. Coming soon...

Venture Forth: Kenya 2013 - part 1

I finally made it! Nearly eight years ago while a seminary ,  a small group gathered in a small office in west Texas to dream and pray about the possibility of working among a people group of North Africa. Since that time several of that group have made North Africa home while others have still not set foot on the great continent. I was in the latter...until last month!  

My wife Jennifer and I were blessed to go to a small rural hospital in western Kenya called Tenwek Hospital, a mission hospital with a fantastic reputation and a strong medical presence in the region.  A robust orthopedic practice has arisen over the past several years with the arrival of Dr. Dan Galat, an excellent orthopedic surgeon with passion for the kingdom of God and dreams to serve for many years. Since then, Kiprono Koech, an African-trained orthopedic surgeon has joined Dr Galat as a full-time orthopod. They, along with residents, visiting surgeons, and an excellent hospital staff, run a very busy orthopedic service filled with some of the worst injuries (at least that I have ever seen). During my time there I was blessed to work alongside Dr Galat and Dr Koech to put people back together! 

Tenwek Hospital is a 300+ bed mission hospital located in Bomet, Kenya. It was begun by a Christian missionary physician in 1959 and has grown to a thriving hospital with residency programs in Family Medicine, General Surgery, Clinical Officer training (similar to a Physician Assistant), and Internship programs. Residencies in Orthopedic Surgery and Ophthalmology are planned along with a potential for a Pediatric Surgical Fellowship in a few years! The hospitals sits at approximately 7000 feet above sea level nestled among beautiful countryside and beautiful people.  It has five fully functioning operating rooms where procedures from open heart/valve replacement to abdominal tumor resections to complicated fractures are dealt with.  But most importantly it has fantastic people with huge hearts for serving the people of western Kenya in the name of Jesus. 

Way more to come...

The Adventure...

This is not how I planned it! Orthopedics wasn't on the horizon and Detroit, MI was a city of which I had only heard stories (most of them bad!). My first experience with orthopedics was a 'fluke' because of a schedule change! And yet here I am! I graduated from medical school in Kansas City in 2009 and began my residency in orthopedic surgery.  My wife, Jennifer, and our three sons - Garrett, Luke, & Bryan - do life here in the Detroit metropolitan area and have quickly become accustomed to living among so many Michiganders. 

Currently I am a year from being done with residency with big dreams! To look at the world with even so much as a cursory glance reveals an overwhelming abundance of poverty,pain, and injustice. We need look no further than our own backyard - the Motor City. Very few cities have seen the extremes of both wealth and poverty than has Detroit. Poverty, crime, and hopelessness abound in this place we call home. And yet even in the face of the desperation of Detroit, its dire circumstances pale in comparison to the plight of those in developing countries. The "Bottom 2 Billion" people on the globe live on less than $2/day and are disproportionately affected by disease and death. HIV/AIDS, tuberculosis, malaria, and cholera all prefer the poor. And yet the biggest killer of the poor is not even on that list - trauma. Injuries, many of them orthopedic, kill more people worldwide than HIV/AIDS, tuberculosis, and malaria combined! 90% of these injuries occur in developing countries where less than 10% of the world's orthopedic surgeons work. Trauma has rightly been called the "Neglected Epidemic" with a predilection for the poorest people on the planet.

For whatever reason, Africa holds a special place in my heart. Toward the end of my seminary training, I joined a group of students to pray for the people of North Africa and the possibility of one day working among such a people. Some in that group got there much sooner and call this region of the world home. Others will probably never go.  Africa has plenty of orthopedic injuries thanks to imported Chinese motorcycles, few traffic laws, poor roads, and the need for animals, foot pedestrians, buses, taxis, and herdsmen to use the same path from point A to point B. And what happens to people who sustain such injuries? Not much. People there have very few options. Most end up seeing a traditional "bone-setter" who has little to no medical training and thus the rates of nonunions (unhealed fractures), malunions (fractures that heal crooked), and osteomyelitis (infections) are very high. One general surgeon put it this way about one north African country.

"I can tell you what Orthopedic care is available here. It is plaster of Paris. Anything more advanced is basically not going to happen... Many patients with orthopedic injuries do not come to the hospital, preferring traditional bone-setters, who are probably about as effective as most hospitals. Then they come with malunions, nonunions, chronic osteo[myelitis], etc. Anyway, there is a huge need and very little available."

 My dream is that this will one day no longer be the case. My dream is that Jesus' prayer for God's will to be done on earth as it is in heaven will come true. My dream is justice for a people that I look forward to serving and learning from. It is no less than the adventure and calling of a lifetime - my lifetime, however long or short that may be. What that will look like is to be determined but until then we venture forth with passion, faith, and a dream. Let the adventure begin! Blessings...