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.