Posts Tagged With: osteomyelitis

Hope

As we’re closing in on the end of the second year since we left Bend, some things are starting to seem normal which probably shouldn’t.  While many Kenyans in and around Nairobi or other large cities lead lives similar to people in the US or Europe, far more live in rural areas with little access to health care.  As a result, we see things at Kijabe that are unimaginable in the western world.  And sometimes I forget what a shining star, what a ray of hope, Kijabe represents.  There are times when I feel overwhelmed by the need, and feel hopeless myself.  But what always brings me back to enthusiasm are meeting patients whose lives are changed by this little hospital.

Yesterday, we operated on one patient, all day.  The main road to Kijabe is called the Nairobi-Nakuru highway.  It was recently listed by a British firm as one of the 22 deadliest stretches of road in the world. 

Poor road conditions, insane passing maneuvers, huge trucks, overcrowded buses,  motorcycles, pedestrians, goats, cattle, donkeys, and the occasional baboon all combine for an experience that would be comical if it weren’t so deadly.

There’s a surprisingly sharp turn on this highway, near the city of Nakuru, about 80 miles north of here.  About two years ago, a large fuel tanker lost its breaks, slammed into oncoming traffic, killing many.  The truck then began leaking fuel.  As local villagers rushed to gather the valuable fuel, it burst into flame, incinerating many more.  Unbelievably, this just happened again.  This time the truck exploded immediately, so no crowd had gathered, so I guess that’s a horrible silver lining.  Fewer people were burned this time.  The local hospitals were quickly overwhelmed, both by the number and seriousness of the injuries, so Kijabe received some of the most severely injured.

The first patient we treated was a 46 year old woman, Jane, who’s legs were severely crushed.  She was awake and alert, but in incredible pain.  Examination of her legs showed they were both dead, and her crashing vital signs showed that the acid and potassium leaking into her body from the dead legs was quickly causing her heart and other organs to fail.  As she was on a ventilator, with a breathing tube, she couldn’t give informed consent for surgery.  I phoned her brother on his mobile, letting him know the gravity of the situation.   We rushed her to surgery for emergency amputation of both legs, but to no avail.  She succumbed to her overwhelming injuries a few hours later in our humble intensive care unit.

Another victim, Jacob, had injuries which seemed incompatible with life.  He had shattered all four of his limbs, including both femurs (thigh bones).

Both Femurs Fractured

Both Femurs Fractured

His forearm bones on the right were sticking out through the skin.  His left wrist was broken.  His right ankle was dislocated and crushed, and most of the bones in both feet were crushed.  He had second degree burns from the mid-shin down to the toes.  His rib cage had been crushed, with fractured ribs on both sides and a chest xray that showed his lungs were bruised and filling with fluid.

left femur fracture

left femur fracture

open forearm fracture

open forearm fracture

skull, wrist, and foot xrays

skull, wrist, and foot xrays

Burned and Broken Ankle

Burned and Broken Ankle

crushed and burned ankle

crushed and burned ankle

right femur fracture

right femur fracture

Keeping Jacob alive would be a challenge at the best university hospital in the US or Europe.  And this is where Kijabe is beyond belief.  Using patched together instruments, donated ventilators and surgical equipment, patients like Jacob are routinely given state of the art trauma care.  We were allowed a brief surgery to stabilize the most urgent problems, and the patient was then whisked to the ICU to support his breathing, blood pressure, receive transfusions, and pain control.  Several days later, we were given the go-ahead to complete his trauma surgery.  He entered the operating room at 8 am as a shattered person, and was wheeled out at five pm, ready to get out of bed.

Everything fixed, ready to get up out of bed!

Everything fixed, ready to get up out of bed!

The amount of teamwork this requires is beyond description.  I’ve seen shows on TV where surgical teams rehearse complicated surgeries ahead of time.  None of that happens here.  When the situation calls for it, everyone just shows up, does her or his job without fanfare, and gives the patient hope for a decent life.

Amazing Anesthesia Team

Amazing Anesthesia Team

Today in clinic, one of the clinical officers from the outpatient department came in with an xray, to ask us about a child she was seeing.  Eight year old Samuel and his mother had been sent to Kijabe to have his leg amputated.  He’d been seen at a large national hospital a few months ago with leg pain, and sent away with pain killers.  A few weeks later, the main bone between the knee and ankle protruded out of his skin.  He’d been living like this for several months, before being seen at another hospital, which referred him to Kijabe for amputation.

I reviewed the xray with a junior orthopaedic resident,

Protruding bone due to osteomyelitis

Protruding bone due to osteomyelitis

who I asked to describe the findings and make the diagnosis from the xray.  He did well, answering correctly that this was chronic osteomyelitis, a deep infection of the bone frequently seen in malnourished children.  As the infection worsens, parts of the bone die, and then migrate out of the skin until they fall out.

I was grinning from ear to ear, both because the resident was doing well, and because I knew that Samuel did not need an amputation.  We rushed over to the outpatient department to meet Samuel and his mother.  As we entered the room, we were greeted by the familiar stench of infected, dead tissue.

I carefully explained to Samuel and his mother that, though he would not need an amputation, he had a long road ahead of him.  With good nutrition, several surgeries,  and months of antibiotics, this can almost always be cured or brought under excellent control.  Children who have been ostracized and unable to attend school can have a decent life, can have hope.

I then asked the resident to perform a “sequestrectomy”, or remove the dead bone.  This is usually a large surgery, done under general anesthetic.  However, with Samuel’s bone sticking out through the skin, there was no reason not to remove this part of it immediately.  As the tissue is dead, there is no sensation.  With some hesitation, the resident put on gloves, and tentatively gave the exposed bone a pull and a twist.

protruding dead bone

protruding dead bone

Dr. Nyambati's first sequestrectomy!

Dr. Nyambati’s first sequestrectomy!

Bone Removed

Bone Removed

To his, and Samuel’s amazement, the dead bone eased out of the infected leg.  It took a bit of convincing, but Samuel eventually understood that he was going to keep his leg!

Samuel after "sequestrectomy"

Samuel after “sequestrectomy”

Hope.

For Jane and her family, we failed.  But they know, and they told us, that we did everything we could for her.  In Kenya, that means a lot.  They know we really cared about her, talked to her before surgery, suffered a little with her.  They are grateful for what we did, even though we feel we failed.  I guess that gives me hope.  For Jacob and Samuel, conditions which would frequently be crippling or fatal can be treated.   They can both have hope for a good life.  And all of these people come to Kijabe because this rather small, nondescript building on the side of a muddy escarpment means hope.  Probably the hardest part of living and working here, both for Ann and myself, is swinging between despair at the overwhelming suffering, and gratefulness to be a part of something so amazing.  As always, thank you for being here with us, supporting us and praying for us.

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Jonah has made it through surgery!

Today was Jonah’s big day, and all of your prayers and support have paid off.  He was actually looking around the operating theatre a bit before anesthesia, the most alert he’s been since his cardiac arrest.  Every patient gets prayed for as they undergo anesthesia here.  For Jonah, we paused a second time just before we began the operation, surrendering him to the God who created him.

Surgeons don’t usually pay much attention to the anesthesiologist’s monitors, but both Dr. Muchiri and I kept an ear, and occasionally an eye, tuned in to Jonah’s heart rate and blood pressure.  Jonah wouldn’t be Jonah if he let us relax completely, but he remained remarkably stable throughout the surgery.  When we re-entered his spine, we found almost no evidence of the TB which had caused the paralysis.  The prior operation, in concert with the five anti-TB drugs, seems to have already nearly eradicated the infection.  The operation proceeded slowly but smoothly.  When we finally installed the metal “cage” which supports the front of his spine, and tightened down the wires which secure the rods in the back of his spine, Jonah had grown almost three inches!  He has been so folded over from the spine destruction, he’s always looked quite small.  With his spine straightened out, he looks like a pretty normal eight year old.

This little man still has a huge road to travel.  He’s in the intensive care unit, as planned, on a breathing machine.  Strong narcotics for his pain.

Jonah resting comfortably in the ICU

Jonah resting comfortably in the ICU

A total of six antibiotics.  Tubes coming from everywhere.   A long list of potential complications.  He still needs to wake up from all the surgical and cardiac arrest trauma.  After that, assuming all goes well, we wait to see how much his spinal cord can recover.

My dream, and my plan, is to take a little walk with Jonah in his village in Samburu.

Samburu women who have sewn clothes to support Jonah's family

Samburu women who have sewn clothes to support Jonah’s family

The women in his village have gotten together to sew clothes to sell at the market to help his family.  I just met a pastor who speaks his language and is serving the nomads in his area.  So many people here and around the world have reached out to him.  I feel connected to his fate, as are all of you who’ve prayed for him and sent your love and support.  I can’t know God’s plan for his life, but he’s already touched more people than many of us ever will.  I’ll keep you up to date on his progress over the next days and weeks.

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Jonah struggles on

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.

Jonah resting comfortably in the ICU

Jonah resting comfortably in the ICU

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.

 

 

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The Samburu Duo

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

Saidimo's shoulder with chronic osteomyelitis (bone infection)

Saidimo’s shoulder with chronic osteomyelitis (bone infection)

, 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

Saidimo after surgery, leg nice and straight.  Next step, learning to walk again!

Saidimo after surgery, leg nice and straight. Next step, learning to walk again!

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.

Jonah sitting up under his own power!

Jonah sitting up under his own power!

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 after surgery

Esther after surgery

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.

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Update on Jonah…

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:

Over 2900 views!

Over 2900 views!

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!

The Samburu duo will have all of their care paid for.

The Samburu duo will have all of their care paid for.

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.

Esther going under anesthesia

Esther going under anesthesia

Esther's little knee

Esther’s little knee

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!

Happy Baby!

Happy Baby!

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:

https://public.serviceu.com/PaymentForm/9555/?OrgKey=a55524e4-734a-4e10-beb4-66cc087f7988&RN=201238557&SGUID=a1c6c04b-2eb0-40bf-90ce-e344de9257b0&RN=911913837

As a “Guest”, look for the drop down menu which will allow you to select a fund, and click “Orthopaedic Vulnerable Patient Fund”

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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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