Kenya - part 4

My first night on call! We arrived at the hospital a couple days before New Years having landed in Nairobi a few days earlier to spend time with precious friends and celebrate the birth of the their new daughter. I received a tour of the hospital by Mrs Patsy Gaw, a retired RN from Nashville who has been to Tenwek several times with her husband David Gaw - a retired orthopedic surgeon from Nashville. Seeing firsthand the hospital campus and the many patient wards left me with a deep sense of respect for the work going on at Tenwek and the sense of calling upon the people who call Tenwek home.

Tenwek is one of the few hospitals in the area with emergency services 24 / 7 / 365. There are several government hospitals that many people will go to first but if it is too complicated for them to handle (which is most things), they refer them to Tenwek. Orthopedics has been a strong point of Tenwek for many years even before the arrival of Dr Galat because of Dr Chupp, a general surgeon who because of the immense orthopedic need started doing orthopedic cases with the help of his Campbell's Orthopedics textbook and delivered fantastic care for a decade or more prior to Dr Galat's arrival. Needless to say, Tenwek has built a reputation of offering excellent orthopedic care for many years and the people of western Kenya know it.

My first call night was somewhat busy, not so much because of the number of patients that came in but the severity of the injuries seen. New Years Day during the day with remarkably quiet but the evening brought work. I received a call from the general surgery intern Liz (by the way, she is absolutely awesome!) who said " I have three patients to run by you. You should probably come see them." I walked up the hill to Casualty (we call it the Emergency Room), a medium-sized room with curtains to divide patients' beds from each other.

#1: 50 year old male involved in a RTC (Road Traffic Crash) with bilateral lower extremity fractures - a Left severely comminuted distal femur fracture. A right comminuted tibial plateau fracture. Both injuries were thankfully closed (no bones sticking out).

 --- We placed his right leg (tibial plateau frx) in a long leg plaster splint and placed a  tibial traction pin in his left leg (femur frx). He was fixed a few days later with a left retrograde femoral SIGN nail and a right tibial hybrid ring external fixator. Will show pics of that later.

#2: 35 year old male involved in a RTC 2 days prior with a dislocated left hip in immense pain. He went to the government hospital who said he should really go to Tenwek.

Xray - Left Hip Dislocation with Posterior Wall Acetabular fracture

Wonderful Team in OR - Liz & Daniel

Tenwek is blessed to have a CT scanner that worked most of the time I was there.  It cost $100 for a CT Scan in a region where the average income for most families is around $750/year! Oh, and its powered by 50 car batteries linked in series to provide the power for it (no joke!)

CT Scan: You can see the large divot in the femoral head and the large piece inside the joint. No bueno!

--- He dislocated his hip two days prior in a RTC and no attempt had been made to reduce it (put it back in the hip socket). We took him to the OR and under sedation worked to reduce his hip. While reducing it, we never got the satisfying 'clunk' we hope for when the hip goes into the joint. It was very unstable and continued to pop back out as soon as we felt it was in. Above, you can see the team there that night in the OR placing a tibial traction pin in his affected leg. As you can see from the CT scan image above, the reason for the hip's instability was a piece from his broken hip socket was pulled into the joint keeping the hip from reducing. He was taken the OR where we extracted the piece of bone from the joint and plated the back wall of the hip. Fixation pics later.


#3: 3 year old girl with a right elbow injury with a displaced and 180 degree rotated lateral condyle fracture after falling out of a tree. She was pinned the next day. Sorry I don't have xrays of her elbow. 

Needless to say, there wasn't alot of sleep that night.

More to come...

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...