Jonah’s surgery was delayed, again. He was really not waking up from his surgery, so we have ordered an EEG to see his brain wave activity. This will be completed in a few hours. As I was writing in the chart for the EEG, Jonah’s little friend Saidimo came in to see him. Remarkably, as soon as Saidimo called Jonah’s name, Jonah opened his eyes and looked straight at him! This happened several times, so I don’t think it was a coincidence. We’ll get the results of the EEG and make some decisions about Jonah’s surgery. Thanks for hanging in there with us.
Monthly Archives: October 2013
Jonah continues to struggle along. He’s breathing on his own, blood pressure and heart rate are stable, but he’s still in the ICU. He’ll occasionally respond or open his eyes, but is very weak.
Thankfully, he’s stabilized as much as he’s going to in the short run. Our plan is to go ahead and try to complete his surgery tomorrow. There’s risk in proceeding, but there’s also risk in delaying.
Laura, the missionary in contact with Jonah’s parents, has sent along this picture of Jonah’s parents.
On a more positive note, Saidimo, Jonah’s friend from Samburu, is recovering very well from his surgery and is walking better and better every day. David, the guardian who accompanied Jonah and Saidimo on the plane, was very sick with TB when he arrived. He’s doing well, and tests show no trace of TB. As he’s been infectious to others, he’s had to wear a mask since he arrived. I haven’t seen his face since he got off the plane, but I saw him smiling, mask free, on my way into the hospital today.
Now’s the time to pray. Please share Jonah’s plight with your bible study, book club, etc.
“Rejoice in hope, be patient in tribulation, be constant in prayers.”
If there’s one overarching feeling since moving to Kenya, it’s one of inadequacy. There are just so many people who are so sick, so in need of so much more than I can provide. Impossible choices, weighing what this man, woman or child needs, compared to what I can provide for them. Kijabe hospital is an unbelievable oasis of love and competency, but is incessantly overwhelmed by unending demands on its limited resources.
I haven’t always been a Christian. I know that label makes some peoples’ skin crawl, and I don’t like some of the connotations myself, maybe “follower of Christ” is better. Whatever you call it, I’ve arrived there by a number of different roads. Some have been direct experiences of the mystical, others more practical. The sustaining structure of my faith, however, is that it helps me make sense of the world that I see, taste, breathe. If I look at the world without blinking, with the insulation removed, my mind has trouble making sense of the paradox. How can so much evil, so much suffering, exist alongside such sublime beauty and structure. How can a God who loves infinitely allow so much suffering in his creation?
For me, the question contains the answer. A God who loves so much He would release control, allow free will, allow betrayal. A God who loves so much He would love anyway, knowing the cost. A God who loves so much he would suffer and die so his children could live. Love involves risk. Risk of loss, risk of rejection. Maybe ultimate love involves ultimate risk. So I’ve turned it all over to a God who I believe risked it all to be in relationship with us, with me.
This all helps me make sense of a child like Jonah.
Jonah was scheduled for his big spine surgery today. Weeks of anticipation, discussion, tests, consultations. Weeks of TB medications, good nutrition, surrogate mom’s and dad’s scooping him up and taking him on “walks” in his wheelchair. We got Jonah to the OR early, before he could sneak some rice or milk from another child on the ward. With Jonah on the OR table but not yet asleep, I got a call from our anesthesiologist: ” Don’t put him to sleep, we may not have an ICU bed and ventilator for him after surgery, a neurosurgery patient just had to be put on a ventilator.” We can only have five patients at a time on a breathing machine here.
Jonah was taken back to the waiting area, and we went ahead with another surgery, then later in the day got the go-ahead to proceed.
Finally, Dr. Muchiri (the gifted head spine surgeon here), myself, and the anesthesia team were all set to go.
Jonah’s a bright little boy. In his region, they don’t really keep track of birthdays, but he’s about eight years old, same as my son Michael. He’s been in the hospital about three weeks, so he knows my face, and he likes it when I take his picture with my phone and show it to him. He doesn’t speak English or Swahili, only his native tongue Samburu, so we can’t talk much. Lying on the OR table, hundreds of miles away from his parents and unable to speak to anyone in the room, he was scared. I grabbed his hand, just the same size as Michael’s, and he squeezed hard. If I even looked away to get some piece of equipment organized, he squeezed harder and used his other hand to pat my arm. I played “spider” walking my fingers up his arm to tickle him, and his little body was wracked with giggling. We kept this up until the intravenous propafol put him off to sleep.
Finally, Jonah was under anesthesia, and we then rolled him prone (onto his stomach) for the surgery. We all paused and watched the monitors. Smooth sailing! Unlike the previous attempt, Jonah’s blood pressure and heart rate remained stable. We proceeded with the surgery.
Surgery for TB of the spine involves two general stages. First, the spine is opened, and the tissue compressing the spinal cord is “debrided”, or removed. The second stage involves stabilizing the segments of the spine destroyed by the infection. The first stage went very well: the spine was opened, and the pus, dissolved bone and soft tissue fragments were removed. We were gratified to see the sac around the spinal cord begin gently pulsing, indicating the paralyzing pressure on the spinal cord had been relieved.
There exists an unspoken communication between surgeon and anesthesiologist. The surgeon’s job is to complete the surgery. The anesthesiologist’s is to care for the patient during the surgery. A thin sheet of sterile cloth separates us. But both surgery and anesthesia have a certain tone, pace, and rhythm. And when that rhythm is disrupted on either side of that sheet, you just know. As we finished the first stage of Jonah’s surgery, we could sense a change in the tone of the anesthesiologist. A quick glance at the monitors showed the reason: Jonah’s blood pressure and heart rate had plummeted.
We quickly called for suture to quickly close the foot long spine incision. Rather than the usual meticulous layer by layer closure, skin, muscle and connective tissue are swept up in deep sweeps of a large needle, closing the incision in seconds. Sterile drapes torn off, and we flipped Jonah onto his back. Monitors flat line. No pulse. No blood pressure. For the moment, Jonah is not alive.
In this rare situation, the surgeons are perfectly positioned to provide chest compressions (CPR), while the anesthesiologist administers fluids and epinephrine, or adrenaline. We compressed his little heart to provide blood flow to his precious brain, and to allow the life saving epinephrine to circulate through his body. As we did CPR, we also prayed out loud for his life. Twice we paused the chest compressions, only to see that he still had no heart rate or blood pressure. I was starting to think about what I would tell his parents. Miraculously, on our third and perhaps final pause, Jonah’s heart took over! His heart rate and blood pressure, while not normal, were remarkably good.
We got Jonah to the ICU and connected him to a ventilator to breathe for him.
Thankfully, his pupils were reactive, some indication that he did not suffer brain damage from the stoppage of his heart. His blood pressure and heart rate normalized. And I just received a text from the anesthesiologist in the ICU: “Jonah awake and off the ventilator”! He survived.
Jonah’s still got a rough road ahead. Once he’s stabilized, we have to go back to surgery to stabilize the segments of the spine destroyed by infection. After that, he’s got a long recovery ahead of him
The only way I can make sense of all this is by surrendering to a God who loves Jonah, who loves me, and who understands suffering. To believe that there’s a bigger picture than pus and paralysis and a scared little boy. And to believe that there’s a God who loves each one of us so much he allows us to be a part of His plan. Thanks for praying for all of us.
The two boys from Samburu are doing well. Saidimo, the boy with chronic osteomyelitis (bone infection) of the shoulder and hip had his surgery done on Thursday. He’s done great! He had an active infection in the shoulder
, and we removed some infected bone and put him on antibiotics. The hip had been previously damaged by infection, but he had no active infection that we could see. The problem with his hip is that the leg had become contracted to the point where it was very difficult to walk. The surgery relieved the contracture in his hip, and he’s starting to get up and around. We have high hopes that he’ll be able to walk with nothing more than a bit of a limp. Time will tell. Here’s a short video of him getting off the missionary flight with the hip severely contracted, and now with the contracture released and his leg out straight. vimeo.com/77347277
Jonah’s surgery is scheduled for Tuesday. He’s had a complete evaluation by a pediatric cardiologist in Nairobi. He has no problem with the heart, so it seems the blood pressure problems we experienced are from the large TB abscess behind his heart. When he arrived at Kijabe, he was very weak and painful. Now with a couple of weeks of TB medications and nutrition, he’s very comfortable and much stronger. We now find him sitting up in bed under his own power, something he couldn’t have attempted when he arrived. So he’s going into the surgery in the best shape he can be in.
We’re worried about his surgery. When we attempted it before, he couldn’t tolerate the anesthetic and we had to abandon the surgery. The pediatricians, anesthetists, and surgeons have all done everything possible to give him the best chance for the surgery. We’ve also had to discuss this with his parents, who realize the gravity of the situation.
Already, the needy patient fund has been able to provide care for
Esther, the baby with the knee infection, and Saidimo, as well as paying for Jonah’s MRI and pediatric cardiology consult in Nairobi. Thank you all for your generosity in spreading the word about these kids, praying for them, and donating to help pay for their care.
One of the most difficult things about operating on Jonah is that he’s the same age as my son Michael. I can’t imagine Michael being far away, in the hands of people I’d never met, and about to undergo a surgery that he may possibly not survive. The faith and trust of his mother is overwhelming. Please pray for all of us.
Thanks for all of your love and support of Jonah. We’re going to delay his surgery for a week, for a couple of reasons. With support from the vulnerable patients’ fund, we’re going to send him back to Nairobi for an echo cardiogram. His difficulty under anesthesia is unusual for a child, and we want to make sure he doesn’t have either an accumulation of tuberculosis fluid around his heart, or a previously undiagnosed congenital heart abnormality. In addition, many of the pediatric ICU doctors will be out of town over the next few days. Jonah’s going to be pretty sick in the days after the surgery, and we want all hands on deck to give him the best care possible. He’s doing fine, comfortable, and cheerful. Through Laura, the amazing woman who discovered Jonah’s plight, I’ll be communicating the delay to his parents. Thanks for keeping him in your thoughts and prayers.
Click here to watch Jonah’s arrival at the Kijabe airstrip:
Jonah had a very rough day today. As planned, we took him to the operating room for surgery. Depending on how things went, we were contemplating one big surgery, or splitting it into two different operations, one on the front of his spine, and one from the back. The surgery from the front will take the pressure off of his damaged spinal cord, hopefully allowing recovery of his paralysis. The surgery from the back will stabilize the bones that have been destroyed by infection.
He was put under general anesthesia, and positioned on his stomach so we could begin the operation on his back. As the skin incision was made, however, his blood pressure and heart rate dropped dangerously low. After quickly stitching up the skin incision, we got him lying on his back again, and his blood pressure stabilized. It appeared that positioning him on his stomach had caused the large abscess in his chest to press against the heart. We decided to try positioning him on his side, to allow the surgery on the front of his spine, through the chest cavity. Our hope was that if we could quickly open his chest and remove the pus from behind his heart, his blood pressure would stabilize. Unfortunately, as soon as we positioned him on his side, his blood pressure dropped again.
At that point, we woke him up from anesthesia without doing the surgery. He’s doing fine, in no pain, and his blood pressure and heart rate are normal again. He’s in no immediate danger.
The problem is, he won’t live long without the surgery, but the surgery itself could be very dangerous or even fatal. I’ve been in contact with the kind woman who sent Jonah here, and she’s been in contact with Jonah’s parents.
They have already had to make the terribly difficult decision to send him here, realizing he had no hope in Samburu. They would like us to go ahead with the surgery, knowing the risks involved.
So Jonah needs your prayers. The pediatricians and internists are evaluating him thoroughly again, seeing if there’s anything that can be done to help him tolerate the surgery. We don’t have a definite plan, but tentatively are planning on returning to surgery on Friday.
Thank you , thank you , thank you. Thank you for caring about Jonah, thank you for responding, and thank you for donating to the Kijabe Vulnerable Patients Fund. Here’s what you’ve done:
2,900 views confirm that people care about the suffering of others.
Over $6,000 donated proves that you can make a difference.
Jonah will have his surgery fully paid for by your generosity. This will happen within the next week. Yesterday, he traveled to Nairobi by ambulance, had his MRI of the spine completed, and returned safely to his bed at Kijabe. We found him early this morning with a long stick, wacking his friend from Samburu to wake him up to play!
Jonah and his buddy will have their surgeries fully funded by your donations.
And let me tell you a story about Esther.
Esther is six weeks old. Her mother has five other children, and has been left penniless when her husband disappeared. When Esther developed a joint infection (acute septic arthritis), Esther’s mother took her to a local hospital. Not realizing the emergency nature of the condition, the hospital admitted her to the hospital and put her on IV antibiotics. Unfortunately, no surgeon was available to drain the pus out of her tiny knee, allowing the infection to invade the bone. Tragically, this hospitalization drained what tiny savings the family had, leaving them with the clothes on their back and one cow.
Realizing that her baby was not improving, Esther’s mom bravely took her from the hospital and brought her to the emergency room at Kijabe, arriving about two weeks ago. Once there, she was told the serious nature of the condition, and that her baby would need emergency surgery to open the knee joint and adjacent bone, as well as six weeks of antibiotics. In a panic, she fled with her baby, sure she could not afford the hospital fees for all of this. She told the nurses she would try to sell her cow, their last source of income and nutrition, and disappeared into the night.
An angel, disguised as an emergency room nurse, persisted in finding and talking to Esther’s mom in the middle of the night, and convinced her to return, and that we would find a way to pay for Esther’s care. Of course, this kind nurse had no way of knowing how this would happen. And that’s where you come in!
When Esther was brought back to Kijabe, we quickly took her to the operating room and cleaned out the infection.
The surgery went very well, though we did find some joint damage from the infection having a week to settle into the joint. Esther has responded beautifully, transforming from a sick, painful, screaming baby to a delightful bright eyed beauty! Possibly my happiest moment yet at Kijabe was taking Esther’s hospital bill down to the finance office, writing “Paid for by the Orthopaedic Vulnerable Patients Fund”, and sending Esther and her mother home to her four siblings and the cow!
This happened because of you!
Your donations go a long way here. $6,000 wouldn’t pay for your first day in the hospital in the US. But we have paid for Esther’s care, will pay for Jonah’s and his buddy’s surgery, and will have enough left over to pay for four more patients’ surgery!
We’re off and running. We’re taking care of the poorest of the poor, those who are terrified to even come to the hospital. Those ready to sell their last possession to take care of their child. Those who have no choice but to fall into the safety net of the love and support of others. It’s an almost impossible testament to the love in your heart, that you are helping the most vulnerable from thousands of miles away. From Jonah, from Esther, and from me, thank you.
You’ve gotten Jonah this far, he should have surgery within a week. But his little body has a big struggle ahead, both enduring the surgery and recovering from tuberculosis. What he needs from you now is prayer: prayer for his recovery, prayer for his parents, and prayer for his future.
If you’d like to make a tax-deductible donation, click on this secure link:
As a “Guest”, look for the drop down menu which will allow you to select a fund, and click “Orthopaedic Vulnerable Patient Fund”