Monthly Archives: October 2012

Wednesday Clinic

Wednesdays are famous at Kijabe Hospital as the day of the orthopaedic surgery clinic.  Clinicians in other departments try not to order X-rays on Wednesdays, as the huge volume of orthopaedic patients causes terrible delays.  As you approach the hospital on Wednesday mornings, a line of matatus delivers its human cargo of injured and infirm.  Wheelchairs with no rubber left on the wheels screech across the road.  Crude home-made crutches and walking sticks assist the more able- bodied.  Strikingly sophisticated urban Somalis stride past in black burkas and elegant suits.  Their rural country men are equally striking with red-dyed beards and traditional clothing.  Parents carry small children with splints and bandages telling the opening lines of their story of suffering.  A typical Wednesday clinic sees between 120 and 160 complex patients evaluated by the Kijabe Hospital orthopaedic team.

The severity and complexity of the patients’ problems is beyond what would typically be seen at even the most advanced referral hospital in the US.  Due to the severe limits on accessibility of care, patients tend to put up with far too much and present only when the problems are very difficult to treat.

In the US, I would see a patient with  a dislocated hip from an automobile accident or ski injury a few times per year.  These patients are typically writhing in agony as the dislocated hip bones rub against each other and the adjacent sciatic nerve.  The treatment is to urgently put the patient under anesthesia, and pull the hip back into the socket.  The patient experiences immediate and lasting pain relief, and usually goes on to have no complications or further problems.

I saw a lady today who slipped in soapy water while cleaning a floor, dislocating her hip.  As I flipped through her chart in the examination room, I noticed that this had happened in June.  She looked pleasant and comfortable as I was talking with her.  As I continued to flip through her chart, though, I couldn’t find anyplace documenting that the hip had been put back in the socket.  It slowly dawned on me that she was sitting there, with a hip that had been dislocated for  four months!     After her injury in June, she hadn’t sought treatment for about a month, just put up with an excruciatingly painful hip.  She then sought treatment at another facility, where they had tried unsuccessfully to pull her hip back in.  It then took her another three months to gather the resources to make the trip to Kijabe for treatment.  At this point, it will require a major surgical procedure to put her hip back in the socket, and there’s a high chance the hip has lost blood supply and will die.  What would have been a brief but miserable outpatient event has turned into a life changing and potentially crippling injury.  All due to poverty and lack of access to basic medical care.

 

This serious little girl suffers from a similar lack of access to care.  After suffering a fall from a tree, this eight year old child was found not to be able to move her left arm.  She was admitted to another hospital, but once discharged received no further care.  Now about 6 months out from her fall, her wrist is held rigidly flexed, unable to be extended.  Piecing the history together here is often challenging, partially due to language barriers, and partially due to lack of communication between clinicians and patients.  I’ve noticed that the Kijabe staff takes great effort to make sure the patients are kept well informed and are encouraged to ask questions.  In any event, it would appear that this little one suffered a stretch to the nerves to her arm, called a brachial plexus injury.  Most of the nerves recovered, except for the one responsible for the ability to extend the wrist.  Hopefully, a series of casts will allow the wrist to be stretched back in to position, and a small surgical procedure called a tendon transfer will restore near normal hand function.

The last case of the day is truly heartbreaking.  An elderly woman presented with a mass on her upper arm, slowly growing for months to years.  The X-ray reveals a disturbing appearance, likely representing  a very large and dangerous malignancy called chondrosarcoma.  We scheduled a biopsy, hoping we’re wrong.  The good news would be that her shoulder has been destroyed by tuberculosis, as at least that would be treatable.

 

The thing that gives me hope, the reason I feel called here, is that Kijabe Orthopaedics is teaching a new generation of kind, dedicated, Christian, highly trained orthopaedic surgeons.  Kenya has more than it’s share of orthopaedic problems, but the suffering is compounded by the lack of access, due to poverty and the lack of orthopaedic surgeons in the country.  You could choose to say the situation is hopeless, and the suffering is overwhelming.  Or you could say that this remarkable group of men and women is doing something about it, and tomorrow will see a little less suffering.   I can’t tell you how privileged I feel to be a part of this team.

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Musings from the other half…

Lest this blog of ours becomes a little “one-sided,” I thought it best to add my own comments on how we have been settling in at Kijabe!  There maybe some slight difference in emphasis, which I feel is important to capture!

We have been here in Kijabe almost a month now.  Some days it feels like we have been here for years.  Everything seems comfortable, familiar and easy.  Other days we wonder how on earth we ever got to this point!  Daily life seems insurmountable, every task a mammoth chore, and with that comes the realization that we are completely out of our depth.  But then, Grace abounds and we wake up the next morning to a bright and wonderful day in our new home.

The kids love their new school at the Rift Valley Academy.  Every Friday night there is an activity for all the younger students.  Last Friday night, they went on a hayride around the campus and then roasted marshmallows over a bonfire.  On Monday evening, they each teamed up with an older student and went on a “coke date.”  My kids had their first large dose of caffeine in Kenya, after which they were sent home to bed!  They love their teachers and get to have many play-dates with their new friends.  My mother’s heart is quite full – we are so thankful that their transition has been so easy and so filled with fun!  The fact that Bosco is here with us has been the biggest blessing.  Our family is complete!  Bosco walks with us to school everyday, which is only about five minutes from our house…albeit up-hill the whole way!  No leash is required and he is quite the popular furry friend amongst the students there.

We are managing Michael’s diabetes as well as can be expected.  We found the most wonderful Diabetologist (which I didn’t even know existed until we got here) in Nairobi.  He is a young doctor with type 1 Diabetes himself and wears the same pump as Michael.  He is on hand to look over Michael’s blood sugar readings (via the internet) and adjust his insulin doses as necessary.

Mike and I are taking daily Kiswahili lessons.  This is a job in and of itself.  The Kiswahili that I learned from my time in Tanzania (almost a decade ago) is coming back to me slowly but surely.  It is fun to go to the market and practice what we have been learning.  The market is just down the road in the centre of the village.  It comprises of table after table filled with the freshest fruit and vegetables…pineapple, papaya, mango, zucchini, Irish potatoes (!), bell peppers, juicy tomatoes, sugar snap peas…and the list goes on.  Our meat comes from the market in Nairobi.  We order it in bulk and last night I spent over an hour cleaning up five kilos of chicken!  It comes deboned with the odd bit of bone, gizzard, gristle and feathers!  It brings a whole new meaning to the term “fresh and organic.”

Driving on the main roads here is a little sketchy!  It’s almost as if each vehicle on the road is engaged in a game of truth or dare!  Mike has done a wonderful job of navigating the roads into and around Nairobi.  I have yet to venture that far in our car.  For now, I am sticking to the roads in the village and that is quite enough for now!  Mike, on the other hand, is living out a life-long dream of having a 4-wheel drive on mucky, bumpy roads.  In an effort to display his “off road” skills last weekend on a day safari in Nairobi National Park, he turned off onto a narrow dirt path that led down to a lake.  He wanted to get closer to some giraffes that were drinking by the water, however, in his enthusiasm he misjudged the slope and we found ourselves sliding sideways down the hill towards the crocodile infested water!  I decided at that point to take the wheel!

The community of people we have found here is fantastic.  Each person has an incredible story of how they came to be here and are literally giving their lives away on a daily basis to serve others…inspiring, challenging and enriching.

Thank you, as always, for standing with us in prayer, and for allowing us this humbling opportunity to serve God’s people in Kenya.  Being here has surpassed our wildest dreams.

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Workin’ Man

I’ve started working at Kijabe Hospital, and it’s obvious to me that all the effort to get here has been worth it.  The hospital is running even better than when I visited in 2011, thanks to the hard work of a group of engineers from Engineering Missionaries International.  We’ve gotten to know two of them pretty well, Jim and Julie Taubitz.  I’ve never been so appreciative of the efforts behind the scenes.  Sitting here in a little village on the side of an escarpment in the middle of nowhere in Africa, it’s obvious that the line between an efficiently run hospital and complete chaos is pretty thin.  Things I’ve always taken for granted are tenuous here: an adequate and clean water supply, stable electrical grid with generator backup, waste disposal, buildings that don’t fall down, sanitary conditions.

My work schedule right now includes two days per week in the hospital and three days per week in kiswahili school.  Edward Amalo is an amazingly patient, kind teacher with a gift for teaching swahili to wazungu (“Europeans”).  Learning a new language at age 48 is much harder than learning orthopedic surgery, and I feel like there’s smoke coming out of my ears by the end of a lesson.  I get frustrated and confused, but Edward just reassures me “polepole”, or “go slowly.”  I was feeling pretty down about my progress, but got a big boost this weekend.  I went out for a mountain bike ride, and quickly got really lost.  When you leave the village, you’re immediately in dense jungle, on the steep face of the escarpment.  I tried to get back to Kijabe by line of sight, but wound up completely disoriented and in a farmers’ front yard.  I was delighted to be able to be able to ask some basic questions, and even more excited when he asked me questions that I’d learned in class!  It felt like progress, and I made it home in time for dinner.

The work at the hospital couldn’t be more rewarding.  The orthopaedic surgery staff is amazing, tirelessly dedicated to serving the needy and vulnerable.  I’m the only non-Kenyan in the ortho department, and they’ve been very gracious as I try to learn both Kiswahili and the nuances of orthopaedic surgery on the equator.  Except for tuberculosis, most of the patient presentations here are not subtle.  Due to the lack of available health care, patients tend to present late in the disease process, or with severe and untreated injuries.

One of the first patients I saw in clinic was a strapping, athletic appearing 19 year old man.  As he walked in to the exam room, he looked perfectly normal, except that he was three feet tall.  He was walking on his knees, and his legs were simply missing from just below the knee.  He had tennis shoes on his stumps facing backwards, which allowed him to walk around on his knee caps.  As I obtained the history from him, he relayed that both of his legs had been amputated when he was 7 months old, as the doctor thought he had cancer in both legs.  While this is not possible, I also noticed that he was missing some fingers from one hand.  Putting this together, it’s likely that he had meningococcemia, an often fatal infection which frequently leads to multiple amputations.  I think the doctor likely made a very rapid and accurate diagnosis 19 years ago and made the difficult but life-saving decision to amputate this baby’s legs and fingers.

This young man has grown up in a culture which often looks upon disability as a curse for wrong-doing of the disabled person or his parents.  There are no accessible toilets, public facilities, or any laws I’m aware of protecting the disabled.  Instead of being crushed by his burden, this young man has made a great life for himself.  He has trained as an airplane mechanic, and leads a good life.  He came to Kijabe because he’s never been able to afford prosthetic legs.  On testing the muscles to his stumps, he has tremendous strength and control, and there’s every chance he will be walking tall with prosthetic legs in the near future.  I’m excited to follow him along as he is fit with his prosthetic limbs and begins the rehabilitation process to use them.

The orthopaedic clinic here has been described as “back breaking.”  The waiting room has to be seen to be believed.  This past week, the team saw 125 complicated patients, from all over Kenya and as far away as the Horn of Africa and Democratic Republic of the Congo.  Each patient is accompanied by family members, so literally hundreds of people mill about vying for a spot in the queue.  For many of these patients, this clinic visit is the one shot they have at a normal or improved life.  They simply have no other access to orthopaedic care.  While sitting in my exam room seeing patient after patient, it’s important to remember that for this patient, the next 20 minutes may mean the difference between a productive and pain-free life, or one of disability, shame, and poverty.

We saw one child who had a real near-miss.  About a week earlier, he’d developed a severely swollen painful knee.  He’d been seen at a local clinic, where a knee xray was done and correctly read as normal.  He was sent away with reassurance, but became worse.  When his father brought him to the  ortho clinic here, he had a severely infected joint, and probably early bone infection, or osteomyelitis.  If not treated emergently, this can lead to crippling joint destruction and chronic draining bone infection.   The ortho team whisked him away immediately for surgery, and there’s every chance he can lead a normal life.

The compassion, care, and attention to detail shown to the patients by the Kenyan staff inspires me to try and be a better doctor.  This is healthcare the way we imagine it, the way it should be, perhaps the way it once was.  Though finances are always tight for the hospital and the staff, financial considerations fly out the window when a sick and poverty stricken patient needs help.  Doctors and staff contribute to the “Needy patient fund” to help defray expenses, and the hospital bill is figured out after the patient is getting well, not as a determinant of care.

On the home front, we’re settling in to our house and life in Kijabe.  Only three weeks here, and we’ve already seen five different friends from Bend!  Heidi and Fiona Wright came over with Bosco and came out to Kijabe for a visit.  Ken Wytsma had a stopover in Nairobi after a trip to Ethiopia, and we were able to join him for lunch.  Chris and Madelle Friess have been in Kijabe for a couple of weeks now, and we’ve gotten to go on some great adventures with them.  This past weekend, we drove about an hour to Crescent Island, the site where “Out of Africa” was filmed.  Really a peninsula into Lake Naivasha, Crescent Island has one of the highest densities of game in Africa.  It’s wild to just park your car, go for a walk, and be surrounded by wildebeest, zebra, giraffe, gazelles, and a few buffalo and hippos.  No lions or elephants, so it’s safe to hike around, and the guides tell you how to stay away from the hippos and buffalo.  We had a great hike, Chris and Madelle identified dozens of bird species, and some giraffes wandered by as we finished our lunch.  Perfect day.

We also got to visit Nairobi National Park with the Friess’, and ran into some pretty scary animals there.

We seem to be settling in, and this is really starting to feel like home.  The kids are thriving in their new school, and they’re both delighted that homework doesn’t start here until 4th grade!  Our team leaders, Scott and Jennifer Myhre, have really helped our transition with advice, reassurance, and home cooked meals.  The whole community really reaches out to newcomers, and we feel very welcomed.  Please stay tuned for further updates!

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