Monday, November 27, 2017

It's Been A Year!?

Alright, no gory pictures this time.

This past weekend we celebrated our second Thanksgiving here (we don't actually celebrate on Thursday since it's not a Kenyan holiday)...Turkey Trot 5K, big lunch with the other missionaries, afternoon of football, evening of pies and a movie.  I've been reflecting on the past year and find myself so grateful, echoing the words of King David in Psalm 86, "I will give thanks to You, O Lord my God, with all my heart, and will glorify Your name forever."

So instead of telling you about another panga attack, I want to share just a few of the highlights from the past year, in the hope that you can catch a glimpse of what God has been doing here at Tenwek.
There are several neurosurgeons who have visited Tenwek previously and helped lay a crucial foundation for neurosurgical care here, but prior to our arrival last September, Tenwek had never had a full time neurosurgeon.  Word is getting out and this first year alone there were over 500 patients admitted to the neurosurgical service, with an additional 150 patients consulted on.  Of the nearly 350 operations performed, the majority were of an urgent or emergent nature wherein significant delay would have likely resulted in neurologic compromise or death.

There is a neuro team forming and we now have two dedicated neurosurgical OR nurses.  Prior to them I would have to run around each morning preparing everything for my cases and was mentally exhausted before even starting a case.  Now they're learning the nuances of what we need and are often reminding me of things I'm forgetting.  I've also acquired a right-hand man at the hospital, a clinical officer (similar to a physician assistant in the States) that helps me see patients in the clinic, triages consults, and scrubs with me in the operating room.  And while not strictly neuro, there is a physical therapist and clinic nurse, who have been instrumental in helping us expand our services for children with hydrocephalus and spina bifida.  I cannot speak highly enough of these five individuals.  Their hard work and commitment to our patients has been such a blessing to me.
Our neuro team
during a visit this summer to Uganda where we learned how to better care for children with spina bifida and hydrocephalus
My clinical officer and I with one of our patients
I am in the process of renovating Tenwek’s oldest operating room to allow it to function as the neurosurgical OR.  It had largely become neglected and mostly only used for minor cases, but just last week we removed a large brain tumor, clipped a ruptured aneurysm, and did a craniotomy for someone with face pain.  Not bad for a room with only one intermittently working surgical light (we still have some things to replace).  There have been numerous companies, more than I can name here, that have been generous and donated so much of the equipment that is allowing me to do these kinds of cases that previously I wasn't able to do.

I’ve also been able to network with a few other neurosurgeons in the country.  Just this week there are two from Nairobi coming to visit Tenwek to discuss the possibility of having their residents rotate here and spend time with me next year.  After their visit we will travel together to a neurosurgical society meeting on the coast where I have a scheduled lecture, followed by a trip to Mozambique where I will give another presentation and take an exam to officially join the ranks of accredited neurosurgeons in Kenya. 
The OR prior to beginning renovation
A picture of the OR this past week.  We've still got some things to fix but we're making progress.
It’s taking time but we feel we are making meaningful relationships in our community.  Alisa is carrying on a women’s ministry that was so dear to her during our time in Rochester, a Bible study called Side by Side that is designed to encourage wives of the doctors here in their medical marriages.  I have been in charge of organizing our weekly Bible study with the surgical residents this past year.  Discipling those young men and women to use their training as surgeons to serve others and glorify God is one of the aspects of my work here that I most treasure.
Our community threw Emery Chepkemoi a Kipsigis baby shower,
one of the most touching times we've had this past year.
We recently took a group of the residents to paint classrooms in one of the local children's homes
Our Wednesday night study with the residents
Lastly, there’s been so many of you who have supported us in various ways. We really see this as your coming alongside us and participating in the work here...be it through acquiring hospital supplies, sending care packages, random emails to say hi, praying for our family, financial support...even coming to visit!  Your love and encouragement mean more than you know.
Dr. Brett Dietze,
neurosurgeon from Texarkana, TX, and the official Friends of Tenwek
Champion of Neurosurgery
Dr. Rod Rozario (far left), neurosurgeon from Bangor, ME, and Mr. Tim Odell (far right), neurosurgical physician assistant from Spartanburg, SC
Necon and Jeni Warrior, friends of ours since high school, and their 3 kids, Lydia, Levi, and Isaac
Team Mayo - Drs. Andy Foy (pediatric neurosurgeon actually from the Medical College of Wisconsin but trained at Mayo) and Michelle Clarke, spine neurosurgeon from Mayo,
along with Mr. Aaron Mueller, spine rep extraordinaire and his wife Kelly
Dr. Avital Perry, good friend and former
co-resident at Mayo
My parents Billy and Sandy Copeland, and grandparents Warlick and JoAnn Thomas
Alisa's parents Dean and Laura Wright
Alisa's sister Jenni Bills
As we begin this second year at Tenwek, we recognize even more the importance of supporters like you.  Please continue to keep our family in your prayers...and keep those random emails coming.

As you consider your end-of-the-year giving and plan for next year, please consider the work here at Tenwek.  For details on how to give monthly or with with a one-time gift, visit www.samaritanspurse/wmmgiving and follow the prompts.

Thanks again for partnering with us this first year in Kenya.

Will

Celebrating Alisa's 35th birthday

Thursday, June 1, 2017

Where are the locking caps?!

Flossy came into casualty paralyzed.  She had been assaulted and the CT scan of her neck confirmed a severe dislocation of her spine that had resulted in a spinal cord injury.
Sixteen hours after we placed her in cervical traction, her spine had realigned.  We were then able to take her to the operating room to perform a spine fusion, which uses screws and rods to hold the spine together while it heals.  One of the big differences between practicing in Kenya as opposed to the US is the fact that I am keenly aware of my finite amount of resources here.  With every spine fusion I do I try to carefully discern what the minimum number of screws is that I can use and still provide the best care for my patient.  And I try to keep an accurate inventory of how many screws and other necessary implants I have left.  I'd decided I would use six screws for Flossy's case and then after surgery leave her in a neck brace while she recovered.  

Well, I hadn't done such a good job of keeping an accurate inventory.  Here I was in surgery, feeling good about the six screws I'd just put in, and about ready to finish the case and get on with my Saturday.  After you've placed your screws and put in the rods that connect those screws, you have to put in what are called locking caps, one for each screw, to keep the rods in place.  I knew I was running low on those, but for some reason I'd thought I had at least enough of them to finish this case; it was only six screws after all.  So you know I felt like an idiot when I opened the lid to the locking caps and saw only three sitting there.  I rummuged through the rest of the set, thinking surely they'd been misplaced, but I couldn't find any.  I had already begun to strategize how I could most effectively use those three caps when suddenly I remembered that Alisa had told me the day before that a newly arrived visitor to Tenwek had dropped off a package at our house with some supplies.  I had told some people back in the US of my locking cap shortage and was expecting some spine equipment to be arriving soon so I quickly unscrubbed from the case and ran home to see if this package had what I needed.  It was like Christmas morning when I tore the box open and sitting there in a Ziploc bag were over a dozen locking caps!  Still out of breath, I made the run back up to the hospital, scrubbed in, and finished Flossy's case.
Flossy's X-rays after surgery showing realignment of her spine, with the rods and screws holding things in place.
Dr. Al Rhoton was one of the most influential figures the world of neurosurgery has ever known; you'd be hard-pressed to find a neurosurgeon anywhere who doesn't know the significance of his efforts.  He used to say that if God had come to earth and had told him as a young man, "Al, today a boy is being born who is going to develop a brain tumor that will cause him to become deaf, then unable to walk, and ultimately this tumor will take his life.  However, if you go through 12 years of schooling, then 4 years of college, 4 years of medical school, 7 years of residency, sit through countless exams, sacrifice time with family and friends, at the end of all those grueling years you at last will become a neurosurgeon.  Yet all that time and studying will be not for the sake of saving the lives of thousands, but that of only this single boy.  Would the sacrifice be worth it?"  And Dr. Rhoton always said with conviction, "Of course it would."

Jesus tells a somewhat similar set of stories.  The first recalls a shepherd who had 100 sheep.  One day he discovered that one was lost so he left the 99 and went after the one until he found it.  And when he found it and returned home, he called his friends and neighbors, saying "Celebrate with me, for I have found my sheep which was lost!"  The second story tells of a woman who had ten silver coins but lost one.  She lit a lamp and swept the whole house and searched carefully until she found it.  And when she'd found it, she called her friends and neighbors, saying "Celebrate with me, for I have found the coin which I had lost!"

Neither of these stories likely resonates with you much.  I'm no shepherd, and shoot, if I'm sweeping my house and come across a coin, I'm likely to just add it to the pile and throw it in the trash.  Certainly I'm not shouting from the rooftop that I found it.  But I bet most of us can feel the emotion in the third story Jesus told.

There was a father who had two sons.  After what must have been years of tension with his father, the younger son had had enough and requested his half of the inheritance.  He figured he was better off on his own.  So he took his money and left to indulge himself, but quickly squandered everything he had.  A severe famine came to the land and the son hired himself out to feed a man's pigs their slop and soon found himself longing to eat with the pigs.  Jesus said, "But when he came to his senses, the son said, 'How many of my father's workers have food to spare, and here I am starving to death!  I will return to my father and say to him, 'I have wronged heaven and you.  I am no longer worthy to be called your son.  Make me like one of your hired workers."  So the son returned to his father, fully expecting a public reprimand at best, a door slammed in his face at worst.  But while he was still a long way off, his father saw him and was filled with compassion for him.  He ran to his son, threw his arms around him and kissed him.  And the father called together all his servants and held a feast, saying 'This son of mine was dead and is alive again; he was lost and is now found.'

When I read this story and think about my relationship with my son Liam coming to the point where he walks out of my house in haste, disgusted with me, to go at life on his own, my stomach goes in knots.  What it would feel like to wonder if I'd ever see him again, if we'd ever speak.  And to think about him suffering alone in the world, realizing the effects of his decisions but doubting that he could come home, again makes me pang.  But how quickly I too would run out my front door at the first sight of his return.  No matter what he'd done, no matter what he'd said, I would want him to know that I loved him and forgave him. 

Of course in this story the father represents God.  And the way that father felt about his son is the way God feels about me, who has been that indulgent son, and who too often still tries to sneak out the back door.  And it's how he feels about you.  And it's how he feels about the people coming here to Tenwek in need, many of whom find themselve at a place in life where they are with the pigs so to speak.

Just like I dropped what I was doing, scrubbed out of my case, and went running home to search for a locking cap, so God pursues us.  And just like that father who went running to greet his repentant son, God eagerly awaits us to turn to Him.  Some people critique medical missions, fretting that it's not realevangelism, or suggesting that it's a waste of time and resources when there will always be countless people to be treated.  But like Dr. Rhoton, if all my studying, if all my training, if all my efforts here at Tenwek, no matter how many the years, were only for the sake of treating one person who might come to understand God's love for them and His desire to give them life to the fullest, my response would be the same..."Of course it was worth it."
Flossy on the day of her discharge.  It was nothing short of miraculous.  She was walking the halls without help, feeding herself, and waving;)
Work at the hospital continues to be fulfilling.  On March 14th, the nationwide doctors strike ended...after 100 days.  Fortunately, the hospital census and my work load has become more manageable as a result.  

And after she made us wait a few extra days, we finally welcomed another little girl into the world last week...Emery Laura Chepkemoi Copeland, born May 24th.  We will call her Emery, but our Kenyan friends are already lovingly calling her by her Kipsigis name, Chepkemoi.  I'm so proud of my superwoman wife.  Alisa walked up the hill to the hospital in labor, birthed a kid at 11:03pm, then walked back down the hill and was in our bed by 12:45am.  She and Emery are both doing well.  If only I could say the same for Nora who has been dealt the harsh reality that she's no longer the baby of the family.

Thanks to the many of you who support us in various ways, including those individuals and companies who so generously provide equipment and supplies for the hospital.  I hope Flossy's story is a tangible example of what a real difference it makes.

Will

Monday, March 6, 2017

Panga attack

As one of the few hospitals still fully functioning in western Kenya, we are seeing more and more patients like John here at Tenwek.  As you may know, there has been a nationwide doctor's strike here in Kenya since December 5th of last year.  That means that for the last 13 weeks all government hospitals in the country have effectively been shut down with no doctors to care for their patients.  
John came in to casualty with his brain quite literally hanging out of his head. He'd been yet another victim of a panga (machete) attack.  In addition to the chop through the back of his head, he'd been hit higher above his ear and deep in his forehead, as well as having his finger nearly taken off.  We took him to the operating room where I amputated the exposed and contaminated brain, then patched the covering of the brain using tissue from his thigh.  Next to me were two general surgery residents washing out and closing his other scalp wounds while an orthopedic resident repaired his finger.
The strike has drastically changed the already busy workload here at Tenwek and the way I have to practice neurosurgery.  I'm seeing far more patients than I could ever treat...victims of assault or accidental trauma, those with brain tumors, or with spine infections, or babies with hydrocephalus. Patients that need an operation to save some aspect of their neurologic function, or even more, their life.  And that's to say nothing of the many with degenerative spine conditions causing them "only" pain, affecting their quality of life and often compromising their ability to work and provide for their family.  The latter have been destined to a long waiting list.  For the others I have had to resort to offering surgery only to those who I judge to be able to benefit most from my efforts.  And the ones I triage out I can't just send somewhere else.  There isn't a somewhere else for the vast majority of our patients who can't afford the prices of the few private practices still open in the country.  And that means I have to look a mother in the eyes and tell her I can't operate on her 7 year old son with a brain tumor because I'm estimating that his prognosis will be worse than the 14 year old girl in the bed next to him who came in with an intracranial hemorrhage from a vascular malformation, which if I remove will likely allow her to live an otherwise normal life.  Or telling every adult I suspect has a malignant brain tumor that I can't help them, like the 34 year old father of two I saw this week who may have his life extended by a few years with an operation.  
Two of my patients sharing a bed, a more common occurrence now during the strike.
The young man on the right is my most recent panga attack victim from last week.
When I reflect on the needs of so many hurting people and am at times tempted to give up, I'm reminded of Jesus, who made it his mission to serve others, even the "least of these", in the hope that they would come to know of God's love for them.  When Jesus was asked what the greatest commandment was, he answered and said "Love the Lord your God...and love your neighbor as yourself."  He told his followers that "By this all men will know that you are My disciples, if you love one another."  The New Testament writer Paul went so far as to say, "The only thing that counts is faith expressing itself through love."

It's a privilege to serve alongside my Kenyan brothers and sisters here at Tenwek, where we are trying to live out these words by loving our neighbors as we would ourselves.  Often it means providing care to patients with little or no resources to offer the hospital in return.  Or working longer, busier hours and taking on additional responsibilites as the hospital capacity overflows.  It means keeping our doors open and continuing to serve when so many around us have chosen not to.
Our 5 little monkeys lined up on the Maasai Mara during a recent safari.  How cool is that?!
Our family is doing well.  For the last two months I've been taking Swahili classes in the mornings, then trying to cram a full days work into the afternoons.  Perhaps not the wisest timing on my part, but I'm really enjoying it and think it's important to learn the language so I can best connect to the people here.  If you haven't heard, we're expecting our sixth baby in May...our fifth girl.  Heaven help us.  

Thanks for your continued support.  Please know it means so much to us.

Will

Sunday, January 22, 2017

Mimi

I have a college degree in communications but I am a poor communicator.  Day to day life overtakes me and there is always an excuse not to write, call, text, or reply.  This is true regardless of which side of the world I am living.  New experiences have piled in my mind to tell you - our first Christmas season in Kenya,  a special visit to a village church, our first Kenyan birthday party, and more.

But today all I can write about is Mimi.

Will's grandmother, Charlotte Copeland, passed away on Thursday morning.  The news that Mimi had died came suddenly and unexpectedly.  We love her so much.  The distance between Kenya and Arkansas is always far but feels even greater as we try to grieve from miles away.

One of the last things she asked of me this summer before we moved was for a hand-written letter with news about the kids.  I never sent one.

These are my thoughts that I wish I had communicated to her had I known...

Mimi, 
I remember being at your house one day and you were admiring my mothering saying "Hon, how do you do it all?" And I laughed and said, "Oh Mimi, but you've done it all too!" And you said, "You know, you just do what you have to do, don't you?"

Those words "you just do what you have to do" have come to my mind often.  

You just do what you have to do...

When I am weary, when I am lonely, when I am overwhelmed.

You just do what you have to do.

And I think about how that rings true in your life.  You have set a high standard of what it means to do what you have to do - of making the right choice day after day, of living faithfully and loving well.  

I love this about you.  You passed this on to your son, Billy, and he passed it on to Will.  These men carry these traits of you.  Now I get to reap the great benefits of your legacy.  

Your legacy of living faithfully and loving well.  

Our fourth baby, Charlotte, carries your name because we hope that she can follow in this same example that you have set.  You are a true reflection of Christ and that is the greatest hope we can have for her.

Thank you so much for that.

Charlotte and Charlotte
On Thursday night, our family sat down and talked about the many things we remember and love about her...

Liam looked forward to motorcycle rides to her house with Pops (Billy).
Hayden remembers having a special morning with Mimi, making macaroni and cheese and cookies, just the two of them.
Harper loved popsicles at her house and remembers Mimi teaching her how to clap to turn the lamp off and on in her hallway.
Charley loved playing tea party with Mimi and going upstairs to see her purses.
We all remember celebrating Mimi's 87th birthday and Nora's 1st birthday together this summer.
We all loved the cards and gifts she never forgot to send on birthdays, holidays and anniversaries. 
We all remember how she loved Pawpaw.
We all loved how thrilled she always was to see us and be with us.  
Birthday celebration this summer
My grandmother has dementia and was moved to a nursing home not long ago.  Mimi began visiting her there.  I loved her so much for that.  And this summer I told her thank you for taking the time to go see her even when my grandma doesn't know who she is.  And Mimi said, "Oh, it just brightens my day to see her!"  It brightens HER day to visit my aging grandma in the nursing home.  Mimi was a rare and bright light in this world. 

We honor your memory across the ocean, Mimi.  We praise God for you and the glory you brought Him.  May we serve others here in Kenya as you did in your life. 

Tuesday, November 15, 2016

A boy named Gideon

Gideon is a 17 year old boy whose parents brought him to Tenwek in a coma.  I did a double take at his head CT when the resident came to tell me about him...it showed the largest brain tumor I think I've ever seen! 
The tumor looked to be outside the brain, so while Gideon was unresponsive, I thought if we could remove it and take the pressure off his brain, perhaps he'd have a chance at some improvement.  We took him to the OR urgently that night and, as I feared, the tumor had developed an extensive vascular supply so that even as we made the incision and peeled down his scalp his skull was bleeding in countless places.  The hospital's only electric craniotomy drill had broken just a few days prior so we had the tedious task of removing his skull using a hand twist drill and manual saw.  I had planned to open the covering of the brain over the center of the tumor and begin removing pieces of it, but quickly realized the tumor was way too bloody for that tactic.  So instead I opened along the margins of the tumor in hopes of perhaps coming around it.  The neurosurgeons reading this know what happened next though.  The tumor was putting so much pressure on the brain, the minute the brain was exposed it began herniating toward us, begging to get away from the tumor.  I knew between the brain trying to squeeze out of the head and the tumor bleeding, we needed to move fast.  I've never done what I did next, and my mentors at Mayo would cringe had they been watching.  The plane between the tumor and the brain was actually pretty favorable so I literally ran my hand between the brain and the tumor all around its margins until I was able to remove the thing in one chunk.
Even later that night in the ICU Gideon began to open his eyes and over the course of the next week he made a remarkably full recovery.  Thankfully, and somewhat surprisingly, his tumor was a benign tumor called a meningioma, so I'm hopeful he's cured.

Gideon really endeared himself to me and the day he came back to clinic a month after surgery was a special day.  I believe God spared Gideon's life and I shared with him the following scripture from the book of Jeremiah.
   
"For I know the plans I have for you," declares the Lord,
"plans to prosper you and not harm you, plans to give you a hope and a future."

I believe that's true for Gideon and I believe it's true for my family here in Kenya.  
It’s hard to believe I'm finishing my seventh week of work here at Tenwek.  Certainly it has had its challenges and many days we still feel unsettled, but there has been something entirely fulfilling about serving the people here and being where we’re confident God has led us.

Work at the hospital has been plenty busy.  Just yesterday I gave a lecture to the residents, performed three operations while bouncing back and forth to clinic to see 31 patients, and had a ruptured aneurysm come to casualty (what we call the ER here), which I added to the already two cases scheduled for today. I have good help though.  The surgical residents here are great and interacting with them has been one of the most enjoyable aspects of my work.

Operating is almost always an adventure.  More days than not I feel out of my element.  Either I’m doing cases I’ve rarely (or never) done, or even in those cases I would otherwise be comfortable, I often don’t have some piece of equipment and am left needing to improvise.  I’ve found myself in the middle of many cases feeling way in over my head, being keenly aware of my own limitations as a surgeon, and asking God to intervene.  That is a humbling situation to be in and it’s teaching me a reliance on Him I’ve not previously allowed.

Thank you so much to the many of you who have supported us in various ways.  Please know your support makes a real difference for us and is so encouraging as we continue to settle in to our new home here in Kenya.

Will