A day of contrasts

Simultaneous work on the hand and head

I’ve done many different types of trauma cases over the years but today was a first! Not in terms of the actual operative work, but the circumstances.  In local villages they have instituted the concept of community police. Our young patient was one volunteer who helped form the police force. It seems that he arrested a man last week, who took his revenge against the volunteer today – with a machete! He presented to Tenwek with massive bleeding from the head and a nearly amputated right thumb. It appeared that he tried to deflect at least one blow with his hand. My role was to guide an African intern through a debridement of his skull fractures and repair of his head lacerations. It appears the attacker struck with full force to the back of the head with at least four blows.  The widest wound had a three inch segment of skull where the machete had severed off the outer layer of bone, coming dangerously close to getting into the brain.  

Intern and medical students

What strikes me as so ironic is that vicious attacks like this occur frequently, but my experience of Africans are that they are warm, kind and extremely courteous people. The patients here go out of their way to say thank you, even if they don’t speak English. One terminally ill lady today, was insistent that I understood what she was trying to say after we had finished a painful procedure. She said the same Kipsigi word over and over – an OR tech finally translated it as “thank you very much.” The families here will understand very little of what I say, but they nod in affirmation that I’m trying.  Most times, I think I could be describing Disney World and they would nod just the same.  But they continue to thank me over and over, because they know that I am not one of them, yet I came to help them in their need. I came to do what they cannot do for themselves and that they could never repay me. What they probably don’t know, is that I do this because Christ came to help me in my need.  He did for me what I could never do for myself – he offered me life eternal knowing that I could never repay him for his mercy.  I am here to offer these people compassion and love, because God loved me first! 

Arrival!

The Mennonite guest house in Nairobi

After nearly 20 hours of flying and 8 hours of layovers, I arrived safely in Nairobi last night. I was met at the airport by Gerard, a driver for World Medical Mission. He took me to the Mennonite guest house where I arrived, found my room, and settled in for a hard sleep.  I awoke at 6:00 Kenya time (7 hours ahead of Eastern time) and managed a short bit of exercise before breakfast.  Jonathon, the other World Medical Mission driver then picked me up and we made the 4+ hour journey to Tenwek.

If you’ve never seen Nairobi, it’s a mixture of modern urban hype and drastic poverty. Billboards in English advertise electronics, phone services, perfumes, and personal products. Anyplace nice, like the guest house I stayed in, has protective walls, gates and armed guards. Outside are people, literally everywhere. There is not a street that you don’t see people walking along. In fact, in the 4 hours to Tenwek I didn’t see a quarter mile of road without passing someone walking. In the city, people in suits scurry by people wearing rags and digging in garbage cans.  Occasionally, we’d pass a private school where the children could be seen in their uniforms – a colorful sight with promises for the future.

 In the countryside, the school children were the only ones that appeared to have decent clothing. Sustenance farms with mud huts scatter the country side. Young boys and men herd cattle that are so emaciated you can see their ribs.  Women do the heavy work here- you can see them bent over carrying water, goods or sacks of plants harvested to feed the animals. A few balance them on their heads just like the pictures we’ve all seen. 

The driving itself is the craziest thing you could imagine! It’s a wonder we didn’t have five accidents on the way here. Describing it is beyond my writing abilities! I hope you never have to risk experiencing it. But, the one thing that is certain, these roads, these conditions and especially these drivers lead you straight to prayer.  A continuous prayer for safety, a prayer for poverty that seems beyond fixing, a prayer for people who struggle with the simple everyday things I’ve taken for granted nearly every day of my life. My gratitude to God for my birth in America competes with my guilt for waiting so long to care about what I’m seeing.  I think if everyone who’s blessed to be born in America could see these things, there would be no more poverty. You can’t stand to look, but you also can’t look away!

But there are signs of hope. I barely noticed, but there was one two story dwelling that I passed by. The architecture looked very -familiar to me – then the sign explained it all! I'm not sure if the picture shows it on this blog, but it says Habitat for Humanity. It's the only one I saw but it's a start.

I finally arrived at Tenwek where I attended lunch at one of the full time missionary's home. I had time to unpack, get oriented to the hospital, get my internet working and settle in for some Bible reading before the real work begins in the morning - or so I thought. A call from a doctor I hadn't met came to my room in the late afternoon. I'm not sure how he even knew I was here! The patient had traveled seven hours to come here and had waited all day. He'd been seen by several doctors closer to home but his 6 month problem is only getting worse. After seeing him with two residents, I'm unsure of exactly what he has - and I'm the expert here now! I left home 48 hours ago wondering what lies ahead - and my first puzzling patient took less than 3 hours to present to me. So, I'm hitting the books tonight - I have no CT scan, no MRI, no ultrasound, no expensive antibiotics, and only basic lab support. At home, this would have been easy! Welcome to Africa!

Tenwek Hospital

I will be serving at Tenwek, one of the largest mission hospitals in Africa. It is located in the Western Highlands of Kenya, 240 kilometers (150 miles) from Nairobi in the Bomet District of Kenya's Rift Valley Province. Tenwek provides primary health care to 600,000 Kipsigis people within a 32 kilometer radius and serves a referral center for a much larger region. 

Tenwek Hospital is administered as a subsidiary of the African Gospel Church, a protestant denomination in Kenya, in cooperation with the World Gospel Mission.

The World Gospel Mission is the primary mission affiliation for Tenwek Hospital, providing career missionaries and development resources.

The World Medical Mission, a ministry of Samaritan's Purse, is utilized by many short-term visitors and missionaries who serve at Tenwek for periods of weeks up to two years. They have made virtually all of my travel arrangements and have really made the trip planning easy. Chad Cole is my coordinator and I want to thank him and everyone at WMM for their dedicated support. 

A surprising response

As I have been preparing for my trip, I've had to inform my patients who may need me in my absence of my impending plans. I have been overwhelmed by the warm responses that I've received!  I thought some patients would be upset about my lack of availability (as I've seen from past vacation trips) but so far none have been. It seems that I underestimated the value that the average person sees in mission work. I try to offer a brief explanation of my role in PAACS and its goals and values. But, there is just never enough time to do it justice. I was especially moved today by a longstanding patient who gave me an affectionate touch on the back while stating her intention to pray for me. I can think of no better way to support me and the work I hope to do.

Early this morning the men in my Discipleship class at SECC laid hands on me and prayed for me, my family and my mission trip. While I expected prayers from this remarkable group of men, I was deeply moved by their prayer and their pledge for prayer support for me in the days ahead. I don't exactly know why I've been surprised by these outreaches of affection. But it has shown me that the concern for the poor and the needy runs throughout our culture. I pray that my mission will help raise awareness and concern for the people of Africa and that collectively, we can bring God's hope to them!

PAACS - the Pan African Academy of Christian Surgeons

I will be serving in Africa with the Pan African Academy of Christian Surgeons. PAACS began with the realization that Africa is suffering from a dramatic shortage of surgeons. The problems are many:  

• Mission agencies are closing hospitals and diminishing support
• the number of medical missionaries is declining
• African medical students are seeking better paid specialties than surgery (which should be a warning to us as we seek reform in our health care delivery)
• African surgeons can make orders of magnitude higher salaries in the developed world

PAACS envisions African surgeons living the Gospel and healing the sick. The training programs exist to train and disciple African surgeons to glorify God and to provide excellent, compassionate care to those most in need. My role will be to assist in the training of these African surgeons - lending my expertise in Head and Neck surgery. Surgeons in Africa must be true generalist - covering all surgical problems whereas developed countries divide and subdivide into specialties. I will try to post some of my activities day by day to give a better picture of the work PAACS is doing at Tenwek hospital in Bomet, Kenya.

The Countdown Begins!

Sue and me at Tenwek  (Bomet, Kenya February, 2010)

My departure for Africa is now less than a week away and my mind has turned fully to what lies ahead. I dreamed last night that I was at Tenwek, ordered a salad for lunch and nearly ate it before realizing that I was now back in Africa! The raw salad would most likely given me a good case of stuff that most people don't like to read about on blogs! The worst part of the dream was when I realized that I had not only forgot my Cipro, but I hadn't packed my anti-malaria medicine! The dream was vivid enough that I woke up in a panic before realizing I was still at home and my medicine was sitting just a few feet from my bed next to my partially packed suitcase. My mind has clearly begun the departure process.

When I think about it, there is a mixture of excitement, anxiety, hope and fear. How could anyone not be excited about Africa? The anxiety and fear come from a realistic view of what I'm about to do. Halfway around the world await patients who speak a language I don't understand. Surgical residents also await who will look to me for wisdom and guidance about diseases that they likely know more about than I do! So what do I have to offer? Why then am I even going? When I take a deep breath and calm my fears some things become more clear. I may not know tropical medicine but I know surgery. God gifted me in this area and 15 years of meticulous surgical thinking and refining of my surgical skills may lend some grounds by which I can be helpful. I can also lend some companionship and encouragement to the residents and their full time missionary mentors. In the end I have to trust that with a humble attitude and a servant's heart that I may be useful to those who live in the trenches and provide care for the needy each and every day. My short visit will just be a glimpse of their lives and the work they carry out for God's glory.

My first thoughts on missions

My interest in missions goes back to childhood. I remember a missionary priest visiting our church and thinking that his life was so meaningful and adventurous. As boys are prone to do, I fantasized about exploring the jungle and leading the natives to enlightenment. On television, I saw the surgeons on MASH doing the impossible - operating until they were ready to fall over from exhaustion, taking care of friends and enemies, enduring hardship for the sake of others, camping everyday! That seemed right up my alley! While I would like to say that those childhood daydreams faded, I remember being on my trauma rotation in medical school and fondly thinking back to those ideas. I loved my trauma experiences in training because of the pace, the excitement, and the obvious need that exist in those situations. It's not hard to feel useful when a trauma patient presents and time is critical.  So from my early childhood I had the idea that someday I would participate in missions. At that time, I never thought it would wait until I was 45 years old before getting started on it! As to the delay, I have no valid reasons, only excuses. As excuses go, they're not bad - years of training, medical school debts to pay off, kids to raise, soccer teams to coach. But in the end, they are all excuses and not worth the time I've already devoted to justifying them. I have been called by God to serve and I'm so thankful for the talents he's given me to be capable of this service. I wonder if this work wasn't the real reason God gave me the gifts he did. Certainly, I didn't earn those gifts - my intelligence wasn't of my own making, the coordination of my hands didn't develop through my own efforts, the ability to remain calm in the midst of chaos was there before I knew I'd need it. So, I'm excited to finally be fulfilling a boyhood dream, an adolescent calling, and a man's call to service. All made possible through the blessing of the one true God!

Starting my blog

Bill Wiggs MD and I looking over a CT of a maxillary sinus tumor

The question is why blog? I think the primary motivation is that despite my best intentions, I have not been able to share my experiences with everyone that I wanted. My February mission trip to Africa was transformational, yet I have not adequately shared this good news. God has blessed me in so many ways! So, as I prepare for my second mission to Africa I wanted to have a way to share with those who may be interested. Who knows, maybe this will be a personal diary that only I am aware of! That would be ok! The danger in this blog is that I use it for the wrong purpose. I want to share my experience first to Glorify God and  give thanks for the opportunity he provides, second to share those blessings with others. The danger for me is that I use this to glorify myself - to build my reputation for doing good, to look good to others, to reap praise for my efforts. In fact, I seriously debated not doing this to prevent my over-sized ego from getting out of control. In the end, I'm taking the risk and opening myself up for the advancement of God's kingdom in whatever little way he may choose to use me. I hope to share honestly on this site and hope that whoever follows along will realize that I'm not perfect and that God isn't finished with me yet.

6 year old with a trach for respiratory papillomatosis