Thursday, December 31, 2020

What a Year!

As we move into a new year, it is hard to believe that in January, we will have completed six years of work at Tenwek Hospital. This time of year is often a time of reflection: on the passing year, the coming year, successes, failures, goals, hopes, dreams, losses. In essence, we reflect on life. This year has been the most taxing of our life in ministry and probably the hardest since we have been married. We find ourselves reflecting on that realization, recognizing that we got married at the beginning of a grueling five years of surgical residency and have certainly had plenty of struggles in the past decade. This year has been difficult.

Madison and a friend on the beach in Rhode Island.

One of the things that we have tried to balance, as missionaries, is how to be honest and open in our struggles while wrestling with the idea of maintaining the confidence of our friends, colleagues, and supporters. It is easy to become fearful about showing struggles, conflict, or pain. Fearful that others will not understand. Fearful that if supporters know we struggle, our support will wane. Fearful that if our organization becomes aware that we are flawed, we will be asked to leave Tenwek. Fearful that those we love and serve will know our inadequacies, and if they do, that will make our lives even more challenging.

Yet despite always wanting to be better, we are still just us. We understand in our heads that we are inadequate, but at some deep heart level, we want to be more adequate than we are. We want to say that we have welcomed the challenges and thrived. We want to embrace the idea that God is using hardships to refine us. We want to report that we enter this year with a new sense of calling and purpose.

But the truth is that, as for many of you, this year has been hard. We are tired, worn down, and have questioned our purpose. We have been hurt, we have experienced grief and loss, we have felt the loss of control (or what we thought we controlled), we have been abandoned and betrayed, we have felt incompetent and ineffective. And for those of you who know us well, those are not feelings we relish! Further, we have endured the harsh reality of not living up to expectations, others’ and our own.

This year, the costs of medical missions and cross-cultural ministry seem to have piled up. I read the following statement in a blog. “When people said missions was going to be hard, I assumed that meant I’d be cold or face difficult living conditions or struggle with the language. But for me the hardest part is what goes on in my head—like feeling discouraged or getting frustrated with companions or not liking talking to strangers—just dealing with all the ups and downs, the rejection, the change.” This resonates deeply with our experience. It is hard to have these struggles even while we feel a (mostly self-imposed) need to maintain a fa├žade that conveys that we have it all together. At some level, we had the expectation that after some years, things would get easier. Maybe not easy, but easier.

And still... 

This year, we were scheduled to be back in the US for our home assignment or furlough time. While most of that time was in Rhode Island, it did not look at all like we had planned. In coming back, we arranged a time of debriefing and counseling at Alongside, an organization that works with those in ministry and missions, mainly pastors and cross-cultural missionaries. Our family was able to spend 3 weeks of intensive time there, an experience that was validating, educational, thought-provoking, affirming, full of truth and wisdom, and allowed us to begin the process of healing and moving forward. The staff of Alongside were both genuinely compassionate and really good at what they do. This allowed us to hear the truth that they spoke into our lives. We spent mornings in seminars about a variety of topics: grief and loss, anxiety, anger and forgiveness, moral injury and burnout, and conflict, as a few examples. We participated in both group and individual counseling times. We rested and processed in a way we had not been able to give ourselves permission to do. We wrestled with hard questions. Is this just a stressful season or is this unsustainable? Would it be the right time to leave or would we be giving up? Can we be effective and healthy in the work we are doing? Is it about effectiveness or obedience? What might it look like to move forward in a healthier way? What sacrifices are good and right? What sacrifices are damaging? How do we develop Godly grit without falling into the trap of Godless grind? We struggled knowing that we needed to make some immediate decisions based on Madison’s return to in-person school in mid-January. Tough things to contemplate, and it was good to have the time and space to begin to do so.

This last month has been a roller coaster, but in the messy and uncomfortable process, we have begun to glimpse hope, which is no small thing. In acknowledging and allowing ourselves to experience the grief, we have been able to begin the healing process. And after prayer, thought, and wise counsel, we decided to book our tickets back to Kenya in January. We have identified some tangible changes that we believe will help us to thrive rather than to simply get through the crises. One, we identified a need to strengthen our community. Despite the fact that we live in a community, we have not had true or real community. Being strong introverts, we tend to minimize our need for others. We need to do this life with others in a desperate way. Two, we need to work at not conflating our worth, or inherent value, with our significance, or the work that we do. The work that we do is good, but it does not define our value as people. The clear danger in this error in thinking is that when we fail in the things we do, we feel as though we have lost our worth and meaning, and this leads to shame and disappointment. Three, we need to strive for sabbath and margin. Over the years, we have read and heard so many thoughts about the importance and purpose of sabbath rest. We have not embraced these ideas. We tend to use days off from the hospital for more work, to catch up on things that we have neglected, or to prepare for things upcoming. We cannot continue this trend. This will mean changing some of our clinical, educational, and administrative structures. This may mean we are not as productive. We hope it means that we better honor Christ in our lives. Four, we need to learn to grieve and lament the losses we experience. Whether it be patients who die, colleagues who leave the field, or our daughter moving to boarding school, we need to lament in a way that acknowledges the pain of loss and the hope we have in moving on.

Even in the midst of the pandemic, we were able to enjoy times of refreshing together as a family.

We write all this to you, those who love us, pray for us, encourage us, and support us, in an effort to be vulnerable and humble. We need you to know that we have been and are still, (though to a lesser degree) struggling. We believe this sort of honesty is desperately needed, and we realize that will never be possible unless we try. We need prayer. We need encouragement. We need accountability. We need love and acceptance. We need hope that the path is worth the cost. We want to thank each of you for standing with us and giving us the space to share these things. We want you to have permission to be honest and share, as you desire, your own struggles as we pray for you.


As we move forward into this year and return to Kenya, here are some ways you can continue to support us and care for us as you have so well these past years.

1.      Pray for Madison as she returns to RVA. This was a tumultuous year for her as well (as I mentioned in our last blog). It will have been 10 months since she was last in in-person classes. Many of her friends from last year graduated, and some of her closest friends are not returning to RVA. This will be a time of transition for her, much like starting over 

2.     Pray for Bob and me as we work out our roles, positions, and responsibilities going forward. We want to make good decisions, not only for ourselves but for our colleagues and co-workers as well. Pray that we would be able to implement the changes we have identified.

3.      While for many of us this has been a difficult year financially (we very much understand this), if you find yourself in a position to allow some extra financial support, would you consider Alongside? We would love others to have the opportunity that we have had there. They subsidize the cost of their programs through donations and have scholarship funds for those who need extra assistance.

4.      Hold us accountable in those changes we have identified. We love emails (or even snail mail) that lets us know you are thinking about us. Feel free to ask the hard and probing questions, but give us grace in our responses. We enjoy encouragement as well!


Wednesday, August 5, 2020

Letting Our Souls Catch Up

I read a story sometime back and was recently reminded of it again. I don’t know whether it is true, but it resonated with me, expressing quite simply how I feel right now.

Lake Victoria, Kisumu, Kenya

Many years ago, European missionaries landed in Mombasa, a port city in Kenya, and hired a group of local men to travel with them inland to help carry their luggage and supplies. For the first several days of travel, the pace of the missionaries was faster than that of the Kenyans, with the missionaries pushing the Kenyans to go faster and travel more distance with each successive day. Finally one morning, the Kenyans refused to leave camp. The missionaries, confused by this, as everyone seemed healthy and able to travel, asked why. “We cannot travel today,” the leader replied, “we have travelled so far and so quickly that we must wait for our souls to catch up with our bodies.”

That feels like a really good way to describe our current situation, waiting for our souls to catch up with our bodies.

Recently, things have been incredibly difficult for us. The ongoing struggles inherent in the work we do, challenges within the residency program, unexpected (and expected) departures of colleagues, and the superimposed stress of COVID, which we are only beginning to see at our hospital, but to which we have already devoted tremendous monetary and mental resources, have added to the chronic stress of living and working cross-culturally in a resource-limited setting.

In March, Madison came home from school after the school dismissed two weeks before the second-term vacation with less than 48-hours-notice for the students. This was necessary given the international nature of the school. The increasing cases of COVID in our region created difficulties for travel both within Kenya and throughout sub-Saharan Africa as various countries imposed lockdowns. Following that first rushed departure, there have been numerous departures of Madison’s friends, each rather sudden and with little time to say appropriate goodbyes. This has, understandably, resulted in tremendous sadness. While we have thoroughly enjoyed having Madison back with us, she is currently the only individual in her age range at Tenwek, which has also meant intense loneliness for her in this time.

Bob helping Madison with her online school work

Our original plan was to be back in the US for our furlough, or home ministry assignment (HMA) during the months of November and December of this year (you may recall that we are taking 1-2 month HMAs every 12-to-18 months). However, given the totality of our situation, we've decided to move up our departure date for HMA and now plan to return to the States in September. This works well at this time given that Madison’s school will not go back to in-person classes and is continuing online course work until at least January.

Our plan is to leave Tenwek in early September and spend the remaining part of this year back in the States doing our HMA. While we would love to meet with as many of you as we can during this time, we recognize the limitations and safety precautions needed, and we don’t want to put anyone at risk. We still have little idea what the schedule and circumstances will look like exactly given the uncertainty and changes that seem to occur on a daily and weekly basis in this time. We continue to learn to hold all things loosely and with open hands.

Madison and I shopping once travel restrictions were lifted. PC: Julie Ganey

While these months have not looked like we would have envisioned (for any of us, we realize), we trust that God continues to love and care for us deeply and personally. I’ve been reminded of Jeremiah in his writing the book of Lamentations, how beautifully he expresses the paradox of knowing that God is faithful and yet struggling to convince himself of this. In Lamentations 3:21-24, after expressing deep sorrow and pain, he writes,

21 But this I call to mind,
    and therefore I have hope:
22 The steadfast love of the Lord never ceases;
     his mercies never come to an end;
23 they are new every morning;
    great is your faithfulness.
24 “The Lord is my portion,” says my soul,
    “therefore I will hope in him.”

Sometimes this recognition doesn’t come naturally, and we must make ourselves remember the truths we know. Even as we wait for our souls to catch up with our bodies, we know and trust that our hope is in Him.

We thank you for your prayers, your love, your encouragement, and your support!


Bob, Andrea, and Madison

Saturday, March 21, 2020

Update in a Time of Uncertainty

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Like so many of you, our lives have changed and are changing. Several times in the past several months, we have had experiences that we have remarked we never could have imagined happening when we came to Kenya. Clearly, this is one of those situations for all of us.

We want you to know that we are praying for all of you. Each of you is in a very different place and situation, and each is being affected differently by the virus and its effects on our lives. In many ways, we struggle to know how to pray. That’s okay. We pray that God will be glorified. We pray that He will work for good in each of our lives, regardless of what that might look like, and we pray for peace that passes understanding to guard our hearts and minds in Christ Jesus. We are grateful for the many that have reached out to encourage us or let us know you’re praying. We would love to know how each of you is in this time. We thought it was also worth letting you know about our situation.

Kenya is early in our course of COVID-19. The first case was diagnosed about a week ago, and we are now at 7 cases in the country. The Kenyan government has done a remarkable job of responding quickly and appropriately to the threat. Schools are closed. Gatherings greater than 10 people are not allowed, including worship services. We hope and pray that these early interventions will flatten the curve here, and we are grateful to live in a country that does public health so well!

School closures means that Madison is home. It was very difficult for her to say goodbye to her friends on such short notice without knowing what the future holds as they return to many countries all over sub-Saharan Africa and the world. However, it is really good to have her home, and she is making the best of a disappointing situation.

For Bob and me, this week has looked somewhat like a normal week – cases, patient care, resident education, research meetings, mentor group. In other ways, it has looked very different, likely a foreshadowing of things to come. In the world of missions, we often end up doing things that need to be done but without preparation or experience, just learning as we go. There has been more of that than normal this week as we work on hospital preparations and contingency plans, quickly becoming infectious disease experts, or at least learning all we can about this particular virus, and trying to apply what limited information we have about the disease to our context. 

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Our tailors are making masks to help augment our supply.

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All visitors and staff are now being screened for their risks prior to entry to the hospital or Tenwek clinics.

Bob, with his public health and epidemiology background, has been especially engaged in the planning. We are putting together special isolation wards, taking stock of our limited supplies, and thinking through what care for COVID-19 patients looks like in rural Kenya. Bob has been part of the communication team for the hospital. An important part of crisis management is controlling the messaging. Bob developed the acronym CARES with his team as part of our messaging, and our communication now centers on the message: Tenwek CARES
  • Clean Your Hands
    • Wash your hands frequently with soap and water and use hand sanitizer.
    • Clean surfaces as the virus can live up to 2-3 days after contact.
  • Avoid Infection
    • Do not touch your eyes, mouth, or face.
  • Reduce contact
    • Limit your contact with others.
    • Don’t shake hands.
    • Limit social gatherings.
  • Eliminate sickness
    • Cover your cough.
    • Stay home if you are sick and if you do not require being in the hospital.
    • Do not spread the disease to others.
  • Seek medical attention
    • If you experience these symptoms - fever, cough, and difficulty breathing AND you have a history of travel within the past 14 days to a country with the virus, contact with someone who may have COVID-19 within the last 14 days, close contact with an individual with a history of respiratory illness and travel within the last 30 days, or worked in a health care facility in the 14 days prior to symptom onset.
    • If these symptoms are mild, you should stay home and avoid contact with others. If your symptoms worsen, seek the advice of your doctor.

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The Tenwek Hospital banner.

My own experience with curriculum development has been quite beneficial as I have been able to develop learning modules for our staff including one for healthcare workers and one for non-healthcare workers. These have been and continue to be widely distributed as a way for our community to be educated about the virus and our response to it. Check them out: (for non-healthcare workers) and (for healthcare workers). Feel free to share as education is an incredibly important tool to combat the spread of COVID-19.

None of us know what the future holds or how this virus will impact us. We try not to fear but to have sound minds in working to limit the spread and to serve our communities. We will put our efforts into loving our neighbors.

Monday, December 2, 2019

Violet, Yves, and Mercy: The Gifts That Will Keep Giving

This time of year, there are abundant opportunities for generosity as so many take the time to intentionally reflect on blessings in this season of gratitude and gift-giving. One of the greatest blessings that we have is to be part of training and discipling an incredible group of surgeons. And we are filled with gratitude for those of you who invest in this work and allow us to be here. In this season, as you look for opportunities to invest and give generously, would you consider helping to train a surgeon for sub-Saharan Africa?

Spiritual Retreat in October

Consider the statistics:

  • 5 billion people in the world lack access to safe surgical care. The world population is 7 billion.
  • In rural Africa, there is on average one surgeon for every 1 million people (this would be as if the state of New York had 20 surgeons - in reality, there are more than 4,300 surgeons).
  • The best way to allow for sustainable surgical care in sub-Saharan Africa is to train national surgeons to provide quality surgical care. In Kenya, it costs about $100,000 to train a surgeon compared to $1 million to train a surgeon in the US.
  • To date, Tenwek has graduated 14 general surgeons and 2 orthopedic surgeons, with one more of each graduating this December.
  • 100% of our graduates live and work in Kenya, all participating in education of medical students, interns and/or surgical residents.
  • Many of our graduates work in places where there would otherwise not be surgical care were it not for their presence.
  • In 2020, a hospital in Kenya, will begin its a new surgical training program staffed by 3 of our general surgery graduates and 1 of our orthopedic surgery graduates. This training program will be the first surgical residency run by all graduates of our program and represents a significant milestone for Tenwek.

But beyond the statistics are real people - individuals with a desire to love God and serve others through surgical care. I'd like to take a few minutes to introduce you to our three new general surgery trainees who will begin their training this January. All three of them have been serving here at Tenwek in various capacities over the past two years. Each of these new residents is a dedicated and capable individual, and we look forward to the opportunity to invest in their lives, both in their growth as surgeons and in their maturation as Christ followers. To help you get to know them, I asked each of them to briefly answer three questions: 1. Why do you want to do surgery? 2. What do you see yourself doing after training? and 3. What does a position in the Tenwek surgical residency program mean to you?

Violet Otoki

Violet Otoki: Violet has served as a medical officer (general practitioner) as part of our cardiothoracic surgical team for the past two years and desires to pursue formal surgical training. Violet says:

1. I have been a sickly child for a bigger part of my life, battling with allergies and reactive airway disease. I had tonsillectomy done and when I got to see one being done during my elective year, I wanted to see and learn more in and about surgeries.

2. I would to continue practicing and serving where The Lord calls me to. I have a burden for those particularly with cardiac diseases, and if God wills it, that is where I would like to serve.

3. Tenwek, being a Christian institution, provides ground for both professional growth and spiritual ministry, both to me, being core in the service I hope to provide as a doctor.

Yves Yankunze

Yves Yankunze: Yves is our first Burundian trainee. Burundi currently has 14 surgeons for 10 million people, with the majority of those surgeons living and working in the capital city. Yves has also served at Tenwek for two years as a medical officer on the cardiothoracic surgery service with a dream of ultimately training in surgery.

1. In Burundi, as in most of Third World countries, access to surgical care is a big challenge. I feel like I am called to be part of those who are contributing to fill this gap.

2. After training, I want to go back to Burundi to practice surgery and help train the next generation of Burundian surgeons.

3. To me, Tenwek surgical residency program is a very unique place in sub-Saharan Africa where you can find permanent and visiting surgeons highly skilled and committed to pass their knowledge and skills to residents. I am blessed to be part of this program and I am sure that at the end of my training I will be not only a good surgeon but also a mature disciple ready to share the love of Christ to the most in need.

Mercy Mitei

Mercy Mitei: Mercy has served as a medical officer for two years with the OB/Gyn team here at Tenwek with an ultimate goal of pursuing general surgery training.

1. I love surgery because it combines a quest for knowledge with a way to serve, to save lives, and to alleviate suffering. I have chosen to pursue General Surgery in particular because it will help me provide a wide spectrum of care to patients across all ages.

2. After my training, I would be happy to work in a surgically needy area. There is a great need for surgical services in sub-Saharan Africa, including Kenya. My hope would be to help bring surgical services close to the people who need it most. I am confident that God order my steps for the next step after residency.

3. This is a precious God-given opportunity to acquire not only surgical knowledge and skills, but also spiritual mentorship necessary for service as a Christian surgeon.

As you can see, these applicants are incredibly gifted and will quickly contribute to the residency program. As we look forward to what these next five years will bring, would you consider supporting these new trainees as they begin their surgical training? As mentioned above, in Kenya, it costs about $100,000 to fully train a resident. This covers their stipend, room and board, and other associated costs. Over his or her lifetime, a surgeon will perform about 10-15,000 surgeries, meaning that the cost is only $10 per surgery enabled.

One-time or sustaining gifts can be given at and 100% of your tax-deductible donation goes to supporting the trainees.

May you be richly blessed in this season even as you bless others!

Monday, July 15, 2019

Celebrating the Wins

Angie (vascular surgeon), Fridah, and me operating

Working as a surgeon at Tenwek is difficult. Our patients often wait to seek treatment until the illness or disease has been going on for some time or until symptoms become unbearable. The advanced state of disease makes it less likely we can do much to help, or when we can, makes operating more difficult. Patients are commonly malnourished, and any surgeon will tell you that that impacts surgery and makes patients less likely to heal and more likely to suffer complications. We don’t have the same options for diagnosis, intervention, or treatment. And sometimes patients don’t do as well as we would like, hope, or pray. And this takes a toll.

Most surgical departments throughout the world, including ours, hold a periodic conference known as the Morbidity and Mortality conference, or M&M. The purpose is, as a department of faculty, residents, and students, for us to look at the complications and deaths that occur on our service, and to examine what we could have done differently to prevent the outcome. The focus is to learn how we can prevent the same thing from happening again. This time helps us honor our patients and remember the gravity of what we do, and that is good. But there are times when the losses can almost overwhelm, and if we are not careful, they can become our focus, even to our own detriment.

This past year has been a difficult time for me for several reasons. One has been struggling with the constant loss we experience here as I continue to invest myself in caring for patients only to have them die despite my and our team’s best efforts. I have found this cycle of investment and loss to be one of the things that really impacts me in a deep way. Part of my nature as a surgeon is to remember the losses but to easily forget the wins. Maybe this is something we all struggle with.

Recently, as part of our M&M time, we did a reverse M&M, where, instead of looking at our bad outcomes, we looked at some good outcomes. We looked at times where because of diligent care and attention to detail, patients did well. And we gave glory to God for His healing in situations where healing shouldn’t have occurred. As simple and obvious as this practice of celebration and thankfulness may seem, I don’t think many of us practice it nearly enough.

A more experienced and wiser missionary once told Bob and me that every 6 months, we need to take time to reflect on the things that God has done. So, as we return to the States for a brief time of meeting with friends, family, and supporters, I just want to share with you a few patient stories where God has allowed us - Bob, me, our residents, the anesthetists, and the nursing staff - to be a part of His works, and where it feels encouraging and good to celebrate the wins. Please note that each of the pictures shared below are with the consent of the patient involved.

AK – She is a 16-year old patient who after seeing a lot of doctors came to Tenwek and was diagnosed with a specific kind of tumor that causes extremely high blood pressures (>200/100) and a fast heart rate. The tumor releases the same chemicals as if you were to see a lion right in front of you, but instead all the time without provocation. Usually, these tumors are located in a small gland that sits above the kidney, but hers was located right between the aorta and the inferior vena cava, the two largest blood vessels in the body. Further, it was big, and there was some concern it was attached to other organs. Not only is this a tough area of the body for the operating surgeon to work, it requires a diligent anesthetist, as with manipulation of the tumor, there can be huge changes in blood pressure, requiring various medications to stabilize the patient throughout the case. Bob and Sinkeet, one of our fourth-year residents, did an amazing job of resecting the tumor, and our anesthetists did a great job on their end. AK was able to leave the hospital on the fourth day after her surgery, off blood pressure medications, and feeling great!

RB – He is a 19-year-old man who had substantial trauma to his head. He was transferred quickly from a hospital 1.5 hours away only to arrive being unable to talk, move, or open his eyes. For medical people, his GCS was 3 (the lowest the scale of evaluating someone’s alertness goes; comatose is 8). But, he had a complicated bleed in his brain that if alleviated there could be a small potential to have meaningful recovery. So, the team (Bob, Fridah, another of our fourth-year residents, and Kiniga, a second-year resident) decided to operate, understanding that his function may never return. To our surprise, his recovery was outstanding. By the time of his discharge from the hospital, he was giving high-fives and texting on his phone.

RB's CT shows a large bleed (white) extending to both sides of the brain.

Fridah, RB, and Bob when he came back for his follow-up appointment

AJ – He is a 29-year old man, with a wife and 8-month old daughter, who was admitted with what initially was thought to be an infected fluid collection in the muscles of his back and hip. He had been worked up for 9 months at other hospitals for what was thought to be a back problem, and when he was admitted to Tenwek, he was unable to walk or extend his leg due to the pain. We quickly realized his real problem was an aneurysm, or ballooning of the wall, of his aorta, that large blood vessel. We also realized that it was an aneurysm likely caused by infection and would require a very complicated surgical procedure. God had already arranged that a vascular surgeon, a good friend of ours from medical school, was coming in a quick enough time frame that we could wait for her arrival. She, Fridah, and I, were able to repair the aneurysm, which turned out to be caused by tuberculosis. He was able to leave the hospital one week after his operation and is looking forward to returning to his job as a ranger in Masaai Mara National Park.

AJ's CT showing a large irregular aneurysm

Angie and I with AJ on his day of discharge. Notice how he is able to stand and extend his leg

MA – She is a 41-year old woman, who had several months of worsening yellowing of her eyes, or jaundice, found to be due to a tumor in her pancreas or the duct that drains the bile from her liver. Her workup didn’t show that the tumor had spread, but often we find that when we actually start the operation, there is spread of disease that our imaging was not able to detect that makes the cancer inoperable. This has happened a couple times before, and in fact, I’ve never actually been able to complete this operation, known as a Whipple procedure. This again is a difficult operation, requiring removal of some of the intestine, part of the pancreas, and part of the bile drainage duct, and rerouting all of that in a different way. It necessitates careful surgical technique, as well as good anesthesia care and good postoperative care. Sinkeet and I were able to successfully complete the operation, for which we were incredibly grateful, given that she is so young. And further, she has done remarkably well postoperatively. She is now 12 days out from the operation, and should be going home soon.

MA, Sinkeet, Araka, and I several days after surgery

In each of these cases, each of the operating surgeons and residents understood his or her own limits as well as the difficulty and gravity of the cases with which we were dealing. Situations like this in our context require that we truly understand the need to rely on God as the author of life. We fully realize that the definition of “good” is not how we feel at the end of the case or whether the patient goes home or the case is a success or whether the outcome is the one we prefer. We know and have seen that God uses even the outcomes that we would not have chosen. We are simply grateful for the gift that it is when God allows us to participate in His work.

But as human surgeons with human emotions, we find ourselves really hoping and praying for some times when we can see immediate results of healing. And when we can celebrate with patients and their families. And these past few weeks, God has given us the gift of outcomes that leave us encouraged and refreshed even in times of difficulty.

Saturday, March 23, 2019

Advancing Education and Teaching for Tomorrow

It hardly seems possible that it’s the end of March. These past weeks and months have been so busy and have flown by. January marks the beginning of our academic year, and so this always proves to be a busy time of saying good bye to our graduates and welcoming and orienting new residents to the program. This year is no different.

Residency and Training

We started the year with the addition of five new surgical residents – 3 orthopedic and 2 general surgical. Adjusting to the volume of work, the schedule, and the expectations at Tenwek is not an easy transition, and these five are so far doing a great job. As much as we love the chance to welcome new residents, this always means saying good bye to our graduates, which is bittersweet. This year, we had four graduates, 2 from general surgery, making our 13th and 14th general surgery graduates, and 2 from orthopedics, our first 2 orthopedic graduates. A really great part of graduation was the fact that all of our alumni returned to celebrate graduation with us! Another exciting part of graduation was that we were able to hire on at Tenwek one of our two general surgery graduates, Justus Lando, who has been a great addition to the department and works in both general surgery and endoscopy.

2019 General Surgery and Orthopedic Residents and Faculty
PC: Angela Many

Tenwek Surgery Alumni and 2019 Graduates
PC: Angela Many

Just last week, we had the privilege of holding our White Coat Ceremony. This ceremony gives us the opportunity to welcome our new residents formally into the program and to celebrate the advancement of each class of residents to the next year. Through the process of presenting each resident with a white coat, we remind ourselves of what God has called us to, having called us to be physicians and surgeons.

Andrea presenting a certificate to Dr. Moenga, second year resident
PC: Angela Many


I (Andrea) have often told people that I didn’t realize how much I loved education until I came here. Both Bob and I have found it incredibly fun and rewarding to teach on rounds, in the ICU, in clinic, and in the OR. But, we have also really enjoyed having occasions to expand that to more formal teaching opportunities, including opportunities to help develop and increase surgical education beyond Tenwek and throughout the region.

About 15 months ago, an opportunity was presented to me to be involved in the development of a surgical curriculum for junior residents, those in their first two years of training, that focuses on foundational principles and science basics of surgery. Through the College of Surgeons of East, Central and Southern Africa, our regional surgical oversight organization, this has involved me writing, editing and organizing surgical topics into monthly topics and weekly sub-topics as a combination e-learning modules and in-class structured time. I have had the opportunity to work with surgeons throughout the region in this process of development, including traveling to Rwanda and Ethiopia, in addition to holding trainings here within Kenya. This has given me an opportunity to learn more from other surgeons around the region as well as to play a role in advancing surgical education. This year, in January, we began teaching the module curriculum with the release of 3 months’ worth of content. It is fun and exciting to see, at least here at Tenwek, how the residents are enjoying the mixed formats. Even some of our other trainees here at Tenwek have been asking to take part in what we are doing. At this point, four months of content is fully complete, with others in various stages of completion. There is still a tremendous (and at times, nearly overwhelming) amount of work to be done. But, as this remains deeply meaningful and worth it to me, I hope to be able to continue the process to its completion.

Modular Curriculum

For Bob, involvement in advancing surgical education has involved education specifically in the area of research. Bob has served as Tenwek’s Director of Research for the past few years. Because of being asked to do this role, he has been in the process of doing course work toward a Master of Public Health degree with an emphasis on epidemiology, which he will complete in May. This has been incredibly beneficial in allowing him to better understand and teach research principles and practice, which is an important part of surgery and surgical education. In keeping with this, Bob wrote the curriculum on research and statistics, which was the first module that was rolled out in January. Interestingly, this coincided with our biennial basic science conference through PAACS, a two-week intensive learning time for all PAACS first- and second-year surgical residents. We were asked to assist with a research workshop for these residents, the basis of which was the module curriculum, with workshop time devoted to practical skills needed for research and to helping these junior residents develop research projects that they will work on during their years of residency.

Bob teaching the research module


We continue to be grateful that Madison has adjusted well to boarding school at Rift Valley Academy. We look forward to having her home for the entire month of April for vacation, and we deeply miss her presence here when she is away. As much as we know that Tenwek is where we are supposed to be right now, we continue to find the separation from family (and friends) difficult. We are grateful for technology that allows us to stay in contact, but we look forward to opportunities to be together when we can.


One of the things we have learned (at times more painfully than others), is that a consistent part of working in missions is change and a reality that is often different than our expectations. There are sometimes new additions to our surgical group; this year we brought Lando onto the team, which has been great. However, there are the losses as well, which always feel too frequent. Over the next few months, we will have several departures as people move on to other ministry opportunities. We would ask for your prayer in these very difficult times of transition. A specific concern is our orthopedics department, which currently has only one full-time faculty member and she has only been here a few months. While we have had a number of short-term visitors, which has been a huge gift and blessing, in order for the department and training program to thrive, we need an increase in faculty, both for clinical care as well as for training and education.

Brief Time Back in the U.S.

When we returned to Kenya this past year, our goal as we go forward in missions was to spend the majority of our time here in Kenya. We decided that we would try to spend a few weeks each year in the U.S., alternating years between Rhode Island and Indiana. This July and August, we will spend about 6 weeks in Indiana, spending time with family and friends, and connecting with supporters. We are excited to have this time, and hope and pray it will be fruitful and good. If you are in Indiana and interested in connecting with us, we'd love to hear from you!

As we are back in the States, one of our priorities will be some support raising. Over the past several months, we have had a few supporters who have been unable to continue to financially invest in our ministry here at Tenwek. Even in these short years we have been at Tenwek, we have seen how God provides and is faithful in this area of our lives. And we are excited to see how He provides. If you would be able or willing to increase your support, we would be grateful. Online giving can be done through or contact (765) 671-7241 or

Wednesday, November 14, 2018

Diana's Smile

Diana’s smile is amazing. I met Diana in August. But, it took until quite recently for me to see that smile.

Before I share Diana’s story, I want to briefly introduce some background on story-telling. In the past few years here at Tenwek, I have learned the difficulty in sharing someone’s story, especially with attention to the different contexts from which we come. I have found this to be true in sharing my own story but find it especially difficult in appropriately conveying another’s experiences. Especially when involving injustice, it can be difficult to fairly tell a story without worsening biases a reader may already have about the subject or topics of the story. Again, this can be a particularly challenging aspect of sharing a story that crosses cultures. 

I also need to say that Diana’s story is really difficult to share. It is unfair and full of injustices. I have done my best to share her story in a way that brings dignity and honors the image of God in all persons involved without cheapening or minimizing her trauma or that of those who have gone through similar experiences. Diana has eagerly given her full permission for this story to be shared and for the pictures that celebrate God’s work in her life and our participation in and witness to that work to be a part of the story. Telling this story is a collaborative effort. I have written the story from my perspective; Julie Ganey, whose role in this story through her work with Tabitha Ministry was incredible, took all the pictures. Together, we pray that the words and pictures convey the “beauty from ashes” that is this story.

​Injuries are a huge part of what we see as doctors at Tenwek. In addition to accidental injuries, many injuries are intentionally-inflicted, perhaps due to land disputes or livestock ownership issues or in situations of domestic violence. Diana was admitted in August with severe head injuries, deep cuts through the skin and bone such that the brain was visible, as well as multiple other deep cuts and injuries to her back and arms and amputation of two of her fingers. These were violent injuries, clearly meant to do serious damage or cause death. Diana was brought in several hours after her injuries, and immediately taken to the operating room, where her wounds were washed out and repaired. Her physical wounds, that is.

Over the next several days, we began to see that as severe as Diana’s physical wounds were, equal in severity were the non-physical wounds. And those wounds cannot be sewn together and repaired in a few hours of time in an operating room. Diana struggled to eat. She was tearful. She would not make eye contact. She rarely spoke and relied on her sister to answer questions; I did not even realize she spoke English.

We began to hear parts of Diana’s story – she had been injured by a man, not her husband as she is not married. It was not the first time; she had old scars. She was scared. Over several days to weeks, we prayed for her on our team rounds, and we spent time with her later in the afternoons. We felt a deep desire for her to know her worth, both to us and to a God who loves her with an incomprehensibly immense love. We wanted her to know that she was deeply cherished. Our chaplains and social worker came and met with her, and over the course of those few weeks, she came to know the radical love of Jesus who cares so profoundly about each of us.

As we began to make plans for her discharge from the hospital, we had questions. Was it safe for her to return home? Did she have a community to support her? How could she better understand who Jesus is and how God can work in her life?

Throughout our few years here, Bob and I have seen numerous examples where the ideal person is available at a time when their particular, unique skill or expertise is needed. For instance, a patient with a complex vascular problem is here the one week of the year that we have a vascular surgeon available. In these times, we have become deeply grateful for and found a new appreciation in the way that God uses the Body of Christ – our various gifts, desires, enjoyments, strengths – for His glory. We have become keenly aware of our own small part in this picture. While most often I’ve seen this happen through medical providers, in this situation, God used Tabitha Ministry and some other missionary and Kenyan friends.

Tabitha Ministry ( is a ministry to Kenyan women in the area surrounding Tenwek Hospital. It started out of a home Bible study but has grown to a network of thousands of women learning the Bible and caring for one another. It was started by a missionary friend, Linda, and a Kenyan woman, Peris Rotich. As Diana was in the hospital, I reached out to Linda, Peris, and another friend who works with Tabitha, Julie, in hopes that they could meet with Diana so that perhaps she could be connected to a group of women from Tabitha, near her home, who might be able to provide continued support and encouragement. God used the Tabitha leaders in beautiful and wonderful ways to minister to Diana, and I began to hear more of Diana’s story through them.

​Diana is one of eight daughters and no sons. Had she been born into a family with sons, likely her life would have been much different. If she had a brother, as her parents aged, they would have been cared for by a son and daughter-in-law. Instead, Diana was chosen to stay with her parents and care for them, both as a financial provider and for their daily needs. Diana is a teacher, and her home is on the same plot of land as her mother and father’s.

Diana is not allowed to marry. As an unmarried woman, Diana is vulnerable, lacking the protection a husband would afford her. And there are men in her community who take advantage of her vulnerability. She has three children with two fathers. A particular man in her community, the father of two of her children, periodically comes to her house to spend the night, and at least once prior to this story, he has abused her violently enough to leave scars.

One morning, as he prepared to leave the house, he suddenly turned violent, taking a machete and attacking her, even as she tried to run away. Leaving the house, she screamed for the neighbors before she collapsed, and he escaped. The neighbors came, and when they saw the severity of her injuries, they assumed she was dead; she scared them when she asked them to take her to the hospital. The first hospital they took her to saw how bad her injuries were and wouldn’t even allow her into the hospital, sending her instead on to Tenwek with a blanket to soak up some of the blood. Tenwek is an hour and a half of very bumpy dirt roads from her house. Diana said she didn’t even feel the trauma of the ride as she was unconscious.

As the women from Tabitha talked to Diana, they were able to share personal experiences and situations and encourage her in her newfound faith. They spent hours over several days with her acknowledging her trauma, allowing her to talk and process the situation, and hearing her fears. They prayed, shared scripture, and sang songs with Diana before her discharge. And they arranged for Diana to have women visit her at her home through a Tabitha group nearer to her. I am so very grateful for the time these women spent pouring into the life of another woman.

A little over a week ago, Julie, Peris, and I had the opportunity, along with several women from Tabitha who joined us at various points on the journey, to visit Diana in her home. We met her parents and children and had a beautiful time of hearing Diana’s story. She related that in that moment as she was escaping, as she was fearing for her life, she just cried out to God, that he would forgive her and forgive this man. Hearing her say that reminded me of Christ on the cross. She said she had heard about Jesus all her life but had never known him until she was in the hospital. 

Diana and her family told us of the many ways in which God intervened on her behalf that day and the way He has changed her life since. Her family was supposed to be away, yet their plans had changed, and they were around. In this very remote area, a car just happened to be passing by the neighbor’s house, and the driver offered to drive her to the hospital for no charge. When they arrived at Tenwek, Diana’s mother was told that she would need a blood transfusion and also given an estimate of the cost of the hospitalization and surgery. She was overwhelmed wondering where she would find family to donate blood and money to pay. She happened to run into another relative who was at the hospital for an unrelated reason, and that relative organized family members to donate blood and contribute to the cost of her care. She talked about God’s work in her life including the way that He has miraculously taken away her fear, her nightmares, her anger and her bitterness and her shame. We shared chai (Kenyan tea) and songs and prayer and hugs. 

I will not pretend to understand why these things happen or why sometimes evil seems to prevail in this world or give easy answers. Nor do I want to naively overlook or simplify the trauma that she or others have experienced. But, I do know that God’s work in Diana’s life is obvious. Her smile is not one of naivete or ignorance or denial. Her smile is that of someone who knows the love of God in a real way.

Diana is in the middle with the blue head scarf, her 4 year old son in the front center.  The rest are Tabitha bible study leaders, friends, neighbors and relatives.