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Starting to say good-byes

April 7, 2011

Good-bye Dr. Lugaria

Sadly, it’s time to start saying good-byes here in Eldoret. Work is piling up at home, and I’m already planning for the next hurdles which include but are not limited to coming home, starting a busy university service, taking mock oral boards, loving on Ginnie and the kids etc.

As with all my prior trips, there won’t be time to debrief and decompress. In some ways this blog helps to provide some record of the events of each trip when I have time to come back and think about the possibilities of where we might serve after residency training is over.

I made some photo collages to give to the surgeons that I worked with here at MTRH. There are a good group of surgeons. In fact, I was amazing at how they were trying to help me determine and overcome the problems with an open heart facility here at MTRH. There were also sincerely interested in the possibilities of the link for training with South Africa. Once again, it never ceases to amaze me how dedicated these guys are to improving healthcare in SA.

Thanks Dr. Jumbi

I’ve tried to stay in town on the weekends to study. But I seem to manage to get involved with other things. One week was the trip to Tenwek, another the High Altitute Training Center, the next the SA trip, and this coming weekend I have a trip to Webuye. Webuye is about one hour out of town. Apparently, Profs Tenge and Otsyula run a huge primary clinic day that sees over 2000 patients in one day. So they are always looking for doctors even if it is a surgery resident like me who is far removed from primary care. I’ll be brining my stethoscope and definitely my camera.

I heard about this opportunity from Katherine, the administrative assistant in the MTRH Surgery Department Office. I was dropping off some pictures from my MacBook Air for the Profs when she told me about the opportunity. It will be good to go out to a district hospital. It always help to see the need in person. I’m sure there will be a lot of people there with HIV sadly.

On a humorous note, since my last two posts have been filled with gloom, the Mac vs. PC war occurs even here in Africa. Katherine was amazed by how light and slim my MacBook Air was. The pictures tell you which one she preferred. I hope I haven’t started a bad precedent for Matthews who often supplies laptops for the people here at the hospital. Ah, Apple how you cleverly or is it deviously lead people to desire your products.

The big PC or the slim Mac

The Mac wins


Spears and worms

April 6, 2011

One long tape worm...

My first operative day back from SA was extremely busy. Paul and I worked hard to save the life of a young woman who had been stabbed with a spear by a male neighbor. Apparently she intervened to prevent this man from spearing his wife. (The domestic violence rate in Kenya is >65% by report of some of the Peace Corps workers here on site at IU). Unfortunately, this woman had five perforations in her bowel that required resection. She also presented to MTRH very late and was in severe shock by the time we got her to theatre. She was not able to bounce back after being down for so long and expired that night.

In addition to trauma, we see other strange things such as tape worms. I took this long one out of the bowel that same day. I didn’t have my usual camera so the detail are slightly fuzzy, but you get the idea.

It’s incredible how high the domestic violence rate is. We also see other tragic things such as child abuse especially sexual abuse. One poor 8 year-old child was in casualty (emergency room) with a permanent physiologic defect from abuse in addition to psychological trauma.

These are the days when the patients and families need more than just medical treatment. They need hope.

Musings of Barnard

April 6, 2011

Churchill Wisdom

Sometimes people are driven by an insatiable need to achieve a level of success unparalleled by others. One person in particular is a South African cardiac surgeon, Dr. Chris Barnard. He was most notable for performing the first human heart transplant in the world making a mark forever on cardiac surgery and medicine. (Achieving a PhD in two years and postulating one of the now key principles behind intestinal atresia wasn’t enough.) I had the opportunity to visit the museum honoring this achievement while in SA. The museum is actually in the hospital where the transplant was performed, and it’s complete with mock-ups of the operating theatre depicting the event.

One of the most interesting exhibits in the museum contained two letters. The exhibit was entitled “Chris Barnard’s answers to probing questions by an interested party provide insight into the character of the man ‘Who was first’. ”

The questions were written by an Iranian in 1976. Barnard’s answers follow each question.

1. What is the greatest problem of our epoch?

  • The population explosion.

2. Under the prevailing world situation what would you predict to be the future of human civilization?

  • Another global war with the use of atomic bombs.

3. Is religion more effective than law in providing for the peace and tranquility of human being?

  • No.

4. What would you wish for the future of the world?

  • For nations to break out of their various camps and join together in a common effort to solve the problems.

5. What is your opinion and concept with respect to life after death?

  • I don’t believe in life after death.

6. What are the most important factors of success and development in your community?

  • The most important factors in success and development in the community are a gradual understanding that, irrespective of religion, colour or creed, people must be given the opportunity to exploit their inherited abilities.

7. What are the outstanding actions which you were not aware or could not carry out in the past, for which you now feel sorry?

  • The only actions that I really feel sorry about are that I did not spend more time with my parents when my father was still alive and when my mother was still able to enjoy my company.

8. What makes you most happy or sad in your life?

  • Achievements make me most happy in the world and failure makes me the most sad.

9. Which book have you found most interesting?

  • The Bible.

10. Based upon your past experience, what would be the best advice you could grant me?

  • To accept life the way it is and the way it progresses.

Sadly, Barnard had three failed marriages and died alone in 2011. At the beginning of the museum’s mini-documentary on Barnard, the film has a quotation from Churchill (see picture above) which I believe is a truism about success. It is a never-ending pursuit. Barnard by all accounts was a terror in the OR, and in fact, he stopped operating when as he said putting on set of gloves was no longer exciting. I’m not sure I want to achieve his level of success.

South Africa there and back–Glad to be back

April 6, 2011

The Harris Family

Well, South Africa was certainly a whirlwind trip. It takes about 12 hours of flying to get from Eldoret, Kenya to Capetown, South Africa (three flights and two 1/2 commutes on either end). But it was worth it to make connections with the Harris family. They are fellow travelers to Togo. Dave is a cardiothoracic surgeon and his wife Hilary is an anesthesiologist.

It was great to meet them in person and to talk to them about their dream to be part of a open heart surgery facility in Africa. One of the options includes Cape Town. They attend a newly built church that is looking to purchase an international school that is immediately adjacent to their church.

It’s difficult to know when the school will be purchased, or if a free-standing hospital will be the final option for the school. Time will tell.

Hopefully, they will come up to Kenya sometime to work up here with Prof Otsyula and his protege Ondigo. It is also quite possible that some of the CT team can go down to Cape Town to train with Dave. He has an amazing private and public practice that would be stellar for learning.

Certainly if I came to MTRH, he could be a big asset to me as a senior cardiac surgeon with plenty of experience with complicated cases.

I also had a great opportunity to visit with some friends of mine from Michigan. I hadn’t seen the Sterkens since 2006. It was great to layover in Johannesburg (aka Joburg) and spend some time with them. I knew their oldest son when he was just a baby. He know has the cutest South African accent.

At the Sterkens

Even though it had been 5 years, it felt like yesterday when I last saw them. What a blessing to visit with them. Joburg and Capetown are very nice places to live. In fact, the year-round nice weather reminds me of Southern California.

Some of the small towns that I visited in Cape Town were exactly like Santa Barbara. Ah, it would be tough to live in SA. But in all honesty, I was glad to come home to Kenya. Hmm, maybe home is a poor choice, since home is in Indy where Ginnie and the kids are. Perhaps it would be better to say that I really missed the Kenyans at MTRH and in town.

It is possible that if I had more time to interact with the staff at the various SA hospitals, I would have felt differently. One interesting thing I noticed in SA is the large number of Indians/Pakistanis that worked at the hospitals. Apparently, the pay and work environment in SA must attract a fair number of nurses from overseas.

On a humorous side note, tile all over the houses in SA is quite popular. It is also quite dangerous as evidenced by my camera shot as I was falling to the ground. Thankfully, I managed to protect my camera by some miracle.

Caution tile is slippery

No really--tile is slippery

Cardiothoracic Tuesday and South Africa or Bust!

April 4, 2011

Prof Otsyula instructing his mentee

You may remember a 1980s rock song entitled “Manic Monday”. If last Monday was manic, Tuesday hit like a tornado. I had planned to do some small cases with the CT surgeons, finalize some preparations for my five-day trip to South Africa and hopefully catch up on some administrative tasks. But God had a different plan.

The first case started almost one hour late. Then it got complicated fast. At the critical portion of the operation, there was a significant hemorrhage from a major blood vessel (aorta). It took quite some time to obtain adequate exposure to definitively address the bleeding. It was so significant, that I scrubbed in with the professor and his colleague to help out. There were at least two distinct occasions after that when I remember praying for God to keep this patient alive while we worked hard to manage the situation.

Thankfully, we finally managed to get control and finish the operation. It required a lot of effort since the surgeons here don’t use magnifying surgical loupes or headlights which provide significantly improved vision and accuracy when sewing on vessels. To top it off, we didn’t have the right sutures to effectively sew on the aorta and pulmonary artery. The Prof said that was the worst case he had seen for this operation in 20 years. I can believe it. I thank God that  patient survived and for his guidance on our hands.

The rest of the day was much less eventful. I actually had the chance to “pay forward” what Dr. Matthews did for me the first week in Eldoret. There is a family here of a busy US surgeon that I was able to take around town and help them finding some shopping venues for a few hours. At the same time I was able to finish my preparations to head to South Africa.

Cardiothoracic day at MTRH

I am heading to South Africa to do two things–visit with some old friends Dick and Kirsten from our church in Ann Arbor who are know living in Johannesburg (Jo-burg) and to meet for the first time some fellow travelers to Togo Dave & Hilary. Both are physicians. Dave in particular is a CT surgeon looking like me to establish a cardiac surgery facility in a resource-poor area in Africa. Eldoret might be a good option.

Pediatric Surgery Monday

April 4, 2011

The two Profs talking about retirement and the future.

I really enjoy operating with the senior surgeons at MTRH. You learn so much from those who have gone before. (Definitely a biblical concept that is emphasized over and over). These senior surgeons have been in the trenchs for decades in some instances, but yet they come to work everyday. They tolerate the inefficiency of the system and do the best that they can for the patients–day after day and year after year. It’s interesting to listen to their perspectives and stories.

Last Monday, I had a unique opportunity to talk to Prof Otsyula and Prof Tenge (Kuremu). (We call them “Prof” not professor in the academic realm, and Doctor or “Daktari” in the clinical realm.) Otsyula is a cardiothoracic surgeon who trained in the UK. Tenge is a pediatric surgeon who trained in Durban, SA. The two profs were expressing their frustration about how slowly the system changes, and how Kenya could be in a position to be part of the developed world–contributing to research, technology etc.

[Otsyula in particular is probably feeling his age and his pending retirement acutely as he is 65 and will be leaving at 70. It’s hard to be the solo practitioner on call for your field for twenty years. So I am sure that he is looking forward to having time in his village and simply walk up and down the streets talking to members of his tribe.

What was most striking about the conversation is that both expressed hope that things would continue to improve even though it’s a roller coaster of progress for them instead of a steady increase in progress as we see in the US. They were also astounded that Americans can not manage their finances well enough to plan for retirement. In fact, they even worry about some aging Americans who are MTRH faculty and have no retirement plan, no health insurance etc.

Operating with Prof Tenge

I have to wonder how often do we chafe in our system when things aren’t done that day. What would we feel like if we waited decades and only saw the roller-coaster of progress–big ups and big downs. What would make anyone want to continue like that? Is this how the Israelites or at least the prophets felt in the Old Testament? Fortunately, there is hope as God’s love is consistent. I’m grateful for this constant in my life.  For these two profs, I don’t know if they are Christians, but I can say they run the race with perseverance. I only hope I can do the same as Paul writes in Hebrews 12.

“… let us run with perseverance the race marked out for us, 2 fixing our eyes on Jesus, the pioneer and perfecter of faith. For the joy set before him he endured the cross, scorning its shame, and sat down at the right hand of the throne of God. 3 Consider him who endured such opposition from sinners, so that you will not grow weary and lose heart.”


The Prof of Peds Surgery placing his own IV...another example of servanthood

Sunday–Sirikwa, recovering from sickness

April 1, 2011

Many apologies I just realized that this post auto-published before it was done. So unfortunately some of you received this by email before it was ready. Ah, the joys of navigating the internet connections in Africa. Surprisingly the connection here in Cape Town is worse than Johannesburg (Jo-burg as the locals call it) or Eldoret. It’s fascinating to me that in a big city like Cape Town that the internet is so hit and miss. (I will be posting about why I’m in South Africa soon I promise–I have posted some pictures on FB if you can’t wait).

In any event, this post is really about last Sunday in Eldoret. I had the pleasure of attending Sirikwa Pentecostal Church. I went with one of the Peds ED attendings Rose House who attends College Park in Indy. It always nice to have someone help you find a place to attend church especially when you are a new mzungu in town. (You can check out Rose’s blog by clicking they link on her name). Rose’s church is very involved with the new ABWE mission hospital in Togo. Readers of the blog may recall that Ginnie & I served there in 2010. Rose is heading to Togo next week. I’m excited to see what blessings the Lord brings.

The church service was very good. The sermon was a discussion on the ten commandments in particular lust and what happened with David, and how he violated more than one commandment with his actions. I took several videos of the worship and communion time. I know Matthews would have liked the Swahili video clip that I had. But the acoustics were so bad that the camera he lent me picked up a ton of reverb. So despite my best audio manipulations (which are very many), I won’t be able to post that clip. But two of the communion clips (unfortunately in English) were okay. So I’ll post them.

It was great to be among the Kenyans. Even though we were the only two white people there, I still felt welcome. The rest of the day was spent showing some pictures of Togo to Rose and thinking about whether or not I should come down to South Africa. In the end I did decide to come, and I will talk about why in the next post.

This past Sunday, I was also grateful that I recovered from the cold/flu that was running around Eldoret. It wiped me out. I couldn’t understand why I was tired and achy for days in a row. I would often come back from work and go to bed by 9 pm and sleep until 6AM the next morning. Thankfully, I’m on the mend.

I do have one special prayer request:

For Cindy–a missionary from our church in Indy, who recently wrote that she is being forced to leave Pakistan likely permanently after spending decades there serving the Afghan refugees.

–I can only imagine how hard this will be for Cindy to leave after all her service. Apparently the climate towards Christians serving Afghans in Pakistan is worsening daily. She writes in here last update–

“I choose to believe this promise of God: Luke 11:13 If you then, though you are evil, know how to give good gifts to your children (and I know how much my parents love me!), how much more will your Father in heaven give the Holy Spirit to those who ask him!”

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