Monday, September 13, 2021

Balance, Rhythms, and Senior Year

It is hard to believe it's been five months since I last gave any sort of update. Time flies. I was reflecting this past week that a year ago, Labor Day weekend, we flew back to the States for 4 months of debriefing and home assignment. It's been an incredibly tough year-plus, but we are grateful for the love and support shown to us by so many friends and family. I thought it might be good to just update you on how we are doing as a family and what each of us is up to.

Drop-off day for senior year!

Bob and I feel like we have both found balanced schedules and healthy rhythms that work for us in life and work. Surgical training continues to be a major part of our lives. We conducted our interviews for residency in August. We selected 4 individuals who will start the residency program in January. We are incredibly excited for this group of trainees and look forward to sharing more about them in the near future. We have also enjoyed the opportunity to mentor graduates from surgical training at Tenwek. Fridah is a general surgeon at a mission hospital in Nairobi. She was one of the first trainees that Bob and I had the privilege to see through from interviews to graduation! Her husband, Ian, is an orthopedic surgeon working in a difficult area of Nairobi. It is encouraging to see all that they are doing to improve surgical care in Kenya, especially in places that might not typically have such excellent and compassionate care.

Meeting up with Fridah and Ian in Nairobi

Bob continues to be very involved in research and mentorship here at Tenwek. He is working hard to increase the research coming out of Tenwek and sub-Saharan Africa, which is vital for representation of our context in the medical and surgical literature; in other words, it helps the scientific community know what is going on in sub-Saharan Africa. We recently had a manuscript accepted for publication in the preeminent surgical journal, which was a huge accomplishment! While currently in the editing process, it should be published soon. I continue to focus heavily on surgical curriculum development. I had the huge honor of recently being accepted to the American College of Surgeons Academy of Master Surgeon Educators and will be inducted in October. We also both have presentations at the upcoming American College of Surgeons meeting, which though virtual again this year, should be fun.

Madison just started her senior year of school at Rift Valley Academy. After a 7-week break from school, she was ready to go back. She has great friends this year and is really enjoying her classes so far. She is in the midst of completing college applications and essays. Over these past 18 months, she realized how strongly she feels about justice and equity, especially related to the law. She has decided to pursue advocacy work and is applying to schools with that focus in mind. It's amazing to see how this combines so many of her interests (art, writing, reading, learning), gifts (compassion and kindness), and beliefs (human equality and love of others).

Madison's dorm parents were kind enough to take a photo on the first day of school.

As we have realized that this is Madison's last year in Kenya, we have made an effort to visit some places that she enjoys for what will likely be her last opportunity. During this August vacation, we spent several days in the Kenyan rainforest, about 4 hours north of here. It's Madison's (and our) favorite place in Kenya for its serenity and tranquility. It has amazing wildlife, specifically birds. The longer we have been in Kenya, while we appreciate the large game and traditional safari wildlife, we have found that we love seeing birds. Although Kenya's land area is 6% that of the U.S., it has nearly the same number (and a few more) bird species. Because we visited in August, we also got to appreciate the peak of butterfly season in the rainforest, which is amazing!

Hiking together in the rainforest.

One of our favorite butterflies, the Blue Mother-of-Pearl butterfly.

Madison and I looking at and photographing butterflies.

Throughout the upheaval and uncertainty of the past 18 months, we are grateful for God's faithfulness and for the many lessons we have learned. Through struggle and hurt, as we lean on those we serve with here and those of you in the U.S. who love and support us, we have found solidarity and empathy that isn't always apparent when things are easy. We realize the shared struggles and common hardships. We know that these things make us stronger and that we are better able to love others in their hardships by experiencing our own.

Enjoying lunch in Nairobi before heading back to school.

Monday, April 5, 2021

Why I’m Rethinking Asking God to Use Me

We came to Kenya in January 2015. After four months of language school, we arrived at Tenwek in time for a mass exodus of families. To put this in perspective, the Tenwek expatriate community went from over 40 kids to 3 within two weeks of our arrival. For some, it was leaving the field for furlough. For others, it was a permanent departure. Nevertheless, we arrived when many were leaving, and they left jobs that needed to be picked up. We were new to the mission field and eager to begin serving after years of preparation.

Because of the paucity of people available, upon our arrival, Bob was asked to take over leading one of the training programs at Tenwek. We were told that: (1) There was no one else available to take on this particular role that needed to be filled, (2) Bob was the obvious choice to do it (largely due to point 1), and (3) There were less than two days to turn things over to Bob before the person running the program was leaving. 

Bob didn’t feel prepared, didn’t necessarily want to take on the role, and felt a bit overwhelmed by the idea of leading a training program as a brand-new missionary. Yet, he was available to fill the role.

And God brought us to Tenwek to use us, right?

At the time, we didn’t think too much of the situation. After all, it was an anomaly. Surely, missions isn’t always like this…

Spoiler Alert

Over these past six years, we have observed that, unfortunately, our experience was not an anomaly. We’ve seen similar situations time and time again, for ourselves and others. New missionaries on the field, those returning after leave, expatriates, and Kenyans.

There is always too much to do in missions and never enough people to do it all. So, when our primary goal is to get it all done, our focus becomes how we and others can accomplish the work. This often and unfortunately means preferencing the programs that we want to see succeed and the good things that we want to see achieved over the people with whom we serve, live, and work. This approach has increasingly grieved us as we’ve seen the damage done to those we care deeply about. And if I’m honest, this was one of the reasons we were feeling quite burned out last September.

Our Identity

In our time at Alongside, we learned to think about identity or how we think about who we are as people like a three-legged stool.

The three legs of that stool are:

·       Value – who we are as children of God and as God’s image-bearers. This is inherent, immutable, and universal.

·       Significance – what we do. This includes our jobs, roles, hobbies, and the positions we hold.

·       Community – where and with whom we belong. This is our group, our tribe, those who know us, accept us, and give us our sense of inclusion.

For all of us, one or two of these tend to be stronger but a healthy identity requires some balance of the three.

Bob and I realized through our time of processing at Alongside how much our identity is derived from our significance and what we do. Who are we? We’re surgeons, missionaries, parents, and educators. I’m a wife. He’s a husband. I’m the Assistant Program Director of the surgical residency. He is the Director of Research for Tenwek. My work is important to me and my identity is tied to doing it well. When my competency at any (or in some cases, many) of these roles is drawn into question, my sense of identity is rocked.

My idea of what it means to be a “good missionary” is often based on whether I or others perceive that I am doing enough and doing it well.

I don’t think we’re the only ones who form our identity from our significance. While I can’t say it’s uniquely American (I don’t have knowledge of enough cultures to make that claim), I do think that for many Americans, significance is the major component of identity. One only has to think about the typical questions asked in getting to know a new person. Right after the introduction comes the question, “What do you do?”

As American cross-cultural missionaries, we carry this cultural value with us. We not only derive our identity but define our success and, in some cases, justify our existence in missions based on what we do. How many patients do I treat? How many roles do I have? What am I doing? Am I busy enough? At times, we almost wear our jobs, our roles, and our busyness within those tasks like a badge of honor.

Our God-Image

Voltaire, the French Enlightenment author

“In the beginning, God created man in His own image, and man has been trying to repay the favor ever since.” Voltaire

I’ve heard this quote in various forms, attributed to several authors and thinkers, but this is the oldest version I can find. It strikes me as profoundly accurate. Each of us has a conception or an image of God. While we like to think that our idea of God most closely reflects the reality of who God is and what God is like, our image is shaped by our experiences. Often, this is the behavior of or messages we receive from those we trust or who are authority figures for us. If my parents were perfectionists and had high expectations for my performance, I may see God as first and foremost holy, unyielding, and expecting my perfection. If I had a Sunday school teacher who taught me about God’s grace and forgiveness, I may come to see God as primarily loving. Sometimes, it is a cultural perspective that informs how I think about God. If my culture values a certain characteristic, I may come to see God as having that characteristic. The way we conceive of God informs how we imagine that God thinks of us. It also determines how we think about ourselves and how we relate to and lead others.

Godly grit versus godless grind

Godly grit and godless grind

My American culture prioritizes significance and emphasizes an identity dependent on what I do. Because this is the case, it is easy to assume that God emphasizes the importance of significance in identity as much as I do. This has the potential to profoundly impact the way I view and treat myself. Do I reduce myself to the jobs I do, the roles I play, or my accomplishments? Or do I elevate my own identity based on those roles, jobs, and accomplishments? What happens if I apply that paradigm to others? Do I reduce others to their roles? Do I think of them more highly when they have more tasks? Or when they're accomplishing great things?

If we reduce ourselves and one another to purpose, utility, roles, responsibilities, jobs, callings, tasks, and accomplishments, it becomes dehumanizing. The complexity of identity should encompass who we are as image-bearers of God and our belonging in community. A unidimensional idea of identity drastically diminishes the value we assign to ourselves and others. I wonder if this doesn’t augment the godless grind, the unpleasant and unholy cycle of just enduring that results in burnout, rather than promoting Godly grit, a divine perseverance and passion that allows us to thrive long-term.

Why would I not ask God to use me?

I’ve begun to wonder if, in asking God to use me, what I’m doing is asking God to prop up my identity by increasing my significance. Over these years of missions, I have found myself feeling guilty if I think I am not doing enough or if I think that others will think I’m not doing enough. If I see a role going unfilled, I have tended to ask the question, “If I don’t do it, who will?” I fall into the patterns of comparison. If I’m not taking call every other day or leaving the hospital after dark when someone else is, am I really doing enough to earn my spot in missions? Unconsciously, I can turn that same attitude on others. Are my colleagues pulling their weight? If I see a role going unfilled, I may ask the question, “Why isn’t that person doing it?” Perhaps I conflate what I or others am desiring with what God is desiring.

Perhaps it reflects that I don’t trust God’s control if I constantly fill the gaps in my human effort regardless of the consequences.

This has caused me to reflect. What if I stopped asking God to use me? What if, instead, I asked God to prune me or to grow others with me in community? Would that strengthen the part of my identity that comes from community? Or what if I asked God to give me a deep, transformative knowledge that I am God’s masterpiece and that those I encounter daily are God’s works of art? Would that strengthen the worth and value part of my identity? Would it help me understand God in a more holistic way?

I have a deep desire to be a part of what God is doing in this world. I want to participate in kingdom work. But my identity desperately needs more balance. I don’t want to create God in my image of hyper-valuing tasks. I don’t want to reduce myself and others to jobs, roles, and duties. I don’t want to dehumanize or devalue others. I don’t want to prioritize programs over people. I want my ministry at Tenwek to be holistic and life-giving.

I want Godly grit, not godless grind.

I feel like I’ve begun to have a sense of the problem, at least in my own life. But at times, fixing it seems impossible. I’m still learning how not to feel guilty about things going undone. I’m still learning how to approach my life in missions without a myopic focus on what I’m doing and how well I’m doing it. I’m still learning how not to view others through the lens of productivity and performance. But maybe part of it begins with asking God to help me know my worth and develop my community but not to use me.

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

Image result for power love sound mind bible

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.