Monthly Archives: December 2012

Father of Lights…

Many have asked how our family will be spending Christmas this year in Kijabe, so here goes…

Mike and I spent the whole of last night staying awake trying to comfort our dog, Bosco, who was in great distress.  For those of you who don’t know, Bosco came with us to Kenya from Bend.  We got him nine years ago as a puppy before the kids came along.  He was panting excessively and we were sure, in the dead of night, that he was going to die.  I pleaded with God to spare his life.  By the time the sun had risen, I was making a frantic call to the vet in Nairobi.

In the meantime, the kids woke early, eager to get into the Christmas spirit.  Mike drove Bosco to Nairobi, while the kids and I headed up to the school.  There was a large group of people gathered there ready to deliver Christmas hampers to needy families in the area.  These hampers included: flour, oil, sugar, salt, maize-meal, tea, margarine and matches.  We loaded up our group of eight into a four wheel drive and set off to navigate the swampy, mucky lanes down which many of the families that we were to visit lived.

Having lived in Africa for a number of years already, I have seen desperate poverty many times before.  But today, it was different.  Somehow, on the eve of Christmas, these peoples situations drove a stake into my heart.  The first family we visited included a Grandfather (who was 94 and blind) and his wife.  Together they were rearing their 8 year old granddaughter.  They live in a small hut with some wooden chairs and a table.  For Christmas decorations, they had tied a piece of twine from one end of the room to the other and had hung colored pieces of torn and tattered paper on it.  The child’s parents had both died, who knows from what exactly.  What would happen to this dear child when her grandparents died, which cannot be too far away.

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The next family we visited was a young mother, with three children under the age of 7.  When we started to listen to her story (which was translated from Kiswahili and English into Kikuyu, her mother tongue) we learned that she was in fact the grandmother.  The children’s parents were gone.  This grandmother in her one bed-room shack was tasked with feeding, clothing and educating these three children.  The walls were made of mud and sticks with an area outside for making a small fire to cook.  A hen pecked its way around the mud floor of the house, nibbling on bits of nothing that had fallen to the ground.  When it jumped up onto a small table, Jane looked at me with wide eyes!  The hen is allowed on the furniture!!

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The last family comprised of yet another single grandparent who was rearing her three grandchildren, all under the age of nine.  Both of their parents had died.  Again, we were ushered into their home with open arms and grateful smiles.  This sho-sho (grandmother) took the plastic bag of food in her arms and danced around the small room with glee.  She spoke through the translator and expressed how grateful she was to God that she would now be able to feed her children on Christmas day.

Feed her children.

Not provide gifts for them, or a new dress to wear to church the next morning.  To feel them with rice and bread and maybe some vegetables from the small farm she had to the side of her house.

I sat there with both Michael and Jane and tried to understand how all of the families we met this morning, with pathetically little, had so much JOY and thanksgiving.  Each one of them praised God for His provision this Christmas.

I thought of how I had prayed to God the previous night for Bosco’s healing.  How does He answer such different prayers?  Does He see them as equal cries from the heart?  I don’t know the answer, but what I do know is that our God is a father of lights.  In grim, desperate, and horrid situations, He brings His light and peace.  It doesn’t make any sense at all.  That these people we met with this morning could be so thankful to God in heaven for the meagre amount that they have.  But they are, and they continuously sing it from the rooftops.

“Every good gift and every perfect gift is from above, coming down from the Father of lights with whom there is no variation or shadow due to change.”

We sat tonight as a family and read the Christmas story from the Bible and proclaimed our thanksgiving…

For a warm bed.

A dry house.

Enough food so that we never have to go hungry.

Our health.

And yes, for Christmas presents in the morning.

Tomorrow, we will be cooking a turkey and having dinner with 8 other friends at our house.  Ruth (whom I first met in Tanzania) is staying with us for the week, which is a treat!

We wish you all a very happy Christmas.  May you know His light in your life, the greatest gift of all.

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Thank you Akbar

Ann and I have really settled into our lives here.  We’ve both gotten so involved in our work here that we’re having to make decisions about “balance.”  The volume of work is limitless.  You’ve probably heard the starfish parable. If not, it’s a good thing to google.  Both of us are trying to help each starfish, but also address the systemic reasons that the starfish are all washed up on the beach.  So if there’s no end to the work, when do you go home?  When is the need of the hospital, or a patient, or a colleague,  less urgent than the need to have dinner with the family, celebrate a birthday, or get a good night’s sleep?  Everybody faces these issues, but the decisions just seem a little more stark here.

As a physician in the US, I had the luxury of a cadre of super-specialists around me.  Rarely did I have to make the difficult decision alone.  And almost never did I have to stray outside my comfort zone of orthopaedic and hand surgery.  If I started to tip toe towards the edge of my comfort zone, there was always an endocrinologist, an internist, an oncologist, a neurosurgeon, or some other genius available to share the burden.  Almost daily here, I have to grab my phone and access an app called “Up to Date”, a huge library of medical information available online.  Then I sit down with the patient’s chart and write orders for medications I’ve never heard of before.  It’s very humbling, and would be terrifying, except there’s no one else to do it.  So my best effort is what the patient will get.  I’m sure I’ll get used to it, but right now it makes for some pretty interesting thoughts as I drift off to sleep.

One of the problems I see regularly here, which is rare in the US, is chronic osteomyelitis.  This ten dollar medical name refers to a “chronic”  (longstanding” infection of bone “osteo-bone, myelitis-inflamation, or in this case, infection.)   Rarely seen in the US, it’s common enough in Africa to have its own abbreviation, “COM”.  COM is a disease of poverty.  Healthy, well fed individuals almost never suffer from COM. IMG_0427 Our immune systems are so strong, we fight off these types of infection before we even know we have them.  Occasionally, a healthy child in the US comes in with acute (short lived) osteomyelits, but the condition is treated with surgery and antibiotics as an emergency, and this almost always leads to a permanent cure.

Where children are malnourished, weak, have other disease like HIV or TB, and have limited access to health care, COM is rampant.  Everyday in clinic, we see children and adults come in with foul-smelling sinuses in their leg, arm or spine, draining pus for years on end.  The chronic drainage and infection saps their immune system even further, putting them at risk for further complications.  The chronic infection leads to loss of employment, dropping out of school, multiple surgeries and hospitalizations, amputations, great expense, and in general, a deteriorating quality of life.

It’s difficult or sometimes impossible to cure COM.  The bacteria settle deep inside the bone, the weakened immune system puts up an inadequate fight, and the patient is committed to a long course of disease and treatment.  Properly treated, however, many patients with COM can return to a productive, near normal life, and some are cured.

This past week has been tough. I’ve had to tell two patients, and their families, that the back pain they came in with was due to a malignancy called multiple myeloma.  In the west, good treatments are available for this condition.  These patients, however,  don’t have access to adequate treatment.  Chemotherapy is available in Nairobi, but it’s extremely expensive.  Patients may have to choose whether to extend their lives with expensive treatment, or to forego treatment to avoid leaving their surviving spouse and children penniless.  Thankfully, an oncologist is currently visiting Kijabe and has helped greatly with these patients.

After the multiple myeloma patients, we began treating a two year old child with hip pain.  The pain has been going on for a couple of months, and the child can no longer walk.  Xrays show that the hip is being eaten up, either by  tumor or infection.  It turns out the little man is HIV positive, most likely since birth, which means the destructive process in his hip could be any one of a long list of infections or even lymphoma.  I operated on his hip yesterday, and it looks like it was probably tuberculosis in his hip.  We’ll find out in a few days.  Believe it or not,  TB might be the best news he and his mother could have gotten.  TB in the joint tends to be less destructive than other infections, and usually responds to medications.  The hope is his hip may be functional, allowing him to walk again.

As we were getting ready to start our next surgery, we got word that there was an emergency in “casualty” (Emergency Room in the US).  An angry ex-husband had tried to kill his 25 year old ex-wife with a machete.  Some good Samaritans eventually pulled the man away, but not until he had cut through her scalp, her ear, the bones and nerves of her forearm, and her elbow joint.  IMG_0501It’s hard to imagine the horror this young lady has been through:   there’s a significant difference between the random violence of a car wreck and the intentionally inflicted violence of a machete wielded by someone you once loved.

By this point in the day, I was kind of wondering what I was doing here.  I was tired, dejected, and feeling a little overwhelmed.  I went in to orthopaedic surgery because I love fixing people when they’re broken.  Most frequently, patients are much better, near normal, once they heal up from their surgeries. But on this day, all I could see was cancer, AIDS, TB, and violence.  And, ever so gradually, it became about me.  I was tired, I was dejected, I, I, I….

Who would have thought that strength and encouragement would come from a patient with chronic osteomyelitis?  Akbar is a young man from the Oromo tribe, one of the most ancient cultures in Africa.  Oromo means “The Powerful”, and Akbar  fits the description.  He’s 17 years old, but not much bigger than my 8 year old son.  The Oromo live in a remote, desolate, difficult land, and have survived  drought and famine for over a thousand years. Akbar is tough.  I first met him strolling around outside the hospital, with his brother and another clansman who was raised in Nairobi.  Akbar speaks the Oromo tongue, his brother speaks Oromo and Kiswahili, and their clansmen speaks English and Swahili.  So to talk with Akbar, I would talk to the clansman in English, he would speak to the brother in Kiswahili, and the brother would speak to Akbar in Oromo.  Reverse the process for Akbar to answer me.

You would think all this translation made for poor communication, but Akbar and I seemed to be able to get the point across.  The point was this:  he had a huge hole in his leg.  He had suffered from chronic osteomyelits for over two years, and had had to suspend his education due to the chronic, foul drainage IMG_0506from his leg.  He’d had surgery at a hospital in his area to clean out the infected bone. IMG_0505 This surgery was extremely well done, leaving Akbar with very little remaining infection, but a hole the size of a baseball in his leg.  As he removed the bandage from his leg in the hospital courtyard, we were looking at the exposed surface of his tibia.  Akbar is tough.  He’d just travelled for days to get here, without so much as a tylenol for pain, but he was cheerful, and excited to move forward with his treatment.  We found ourselves laughing and hi-fiving as we translated back and forth through our linguistic maze.

The surgery to cover the hole in Akbar’s leg is a pretty straightforward application of orthopaedic and plastic surgery techniques, and should give him a stable, pain free and non-draining leg.  IMG_0511His goaIMG_0514_face0l is to go back to school next year, and I believe with his positive attitude, he’ll do it.  His resilience and joyfulness shone a light on my fatigue and discouragement, and even made me a little ashamed of my lurking self-pity.  At the end of this draining week, I thank Akbar the Powerful  for the gift of hope and enthusiasm.

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