Hi,

It is Friday afternoon about 3:15 pm. What seemed like a fairly full day in the operating room ended on the early side. Hence, we have about a 3 hour wait here before we go to the airport. This morning I gave a brief lecture after the chapel service. We received some nice gifts. For me, a wood antelope, a Masai belt and an African shirt. Ward Oakley and his son William left a few minutes for their hike up Kilaminjaro. We have everything packed.

I have attached a copy of a picture that is on the website of our guide for the safari. The guide is Magic Bilkhu. The lady is Sha'mara his girl friend. The website is http://safarimagiceastafrica.com.

We are starting to look toward our trip home but I wouldn't say we are winding down. The work will continue until our departure on Friday. I am in the operating room right now waiting to do a minor case. We are reminded regularly how good the conditions are at home. None the less, I am continually impressed with what amazing surgery the surgeons do here. Dr. Kingori is currently releasing burn contractures of the hand of a small child and doing so well that plastic surgeons at home would be impressed. He and Dr. Sitati are extremely, high quality surgeons and physicians.

We are, rather suddenly, off tomorrow. Apparently, there is a day off at the end of Ramadan. It is not a set date but is announced by the leadership of the muslim community. They decided on last Saturday that tomorrow would be the national holiday. I don't know what we might do as yet.

I haven't included a lot of pictures, because I forgot to bring my card reader for my camera. The pictures from my phone aren't bad but aren't great either. For those that have been here before I include a picture of the road that approaches this hospital border="0" from the main road. It was graded for the 100th year celebration and mostly the presence of the vice president of Kenya. I think it will be ok until the first heavy rain. The second picture is the food prepared for the celebration. Also I have included a picture of Dr. Topple, the founder of KORC, and the rest of the staff making rounds.

The Graded Road	Food at the Celebration   (Click on pictures to enlarge)
Ward Rounds with Dr. Topple

During the visit of the Vice president, he found out that we do total joints here. He referred his pastor on Monday who will have a knee replacement on Thursday. That is a good referral.

Today, I made a contribution to the "Poor patients fund" thanks to the generosity of the people who contributed to the church for my trip. The people who work here are very grateful. Thank you so much. I am blessed by all of you and most certainly Blessed by our Lord.

Doug and Laura.

Dear Friends,

Today was the celebration of 100 years service of PCEA Kikuyu Hospital. It was started by the Scottish Missionaries. They moved to this area to get out of the Malaria infested zones that was killing many of them. They were given 1800 acres to develop, to serve, educate, and treat medical problems of the people of this area. It has resulted in the formation of the hospital and the establishment of the Alliance High Schools that have been the very best schools in Kenya. There is also a teacher's college and the new and growing PCEA University. Also, there is a campus of Nairobi University on the land.

Today started with Laura and I doing rounds in the wards. We then walked up the hill to the general hospital. The guest of honor was the vice president of Kenya, who toured the hospital including a small display of the workings of the Rehab hospital. He appeared very interested in the total joint replacements that he didn't know were done here. I think we picked up a referral of his pastor for total knee replacement. He saw me and asked if I worked at rehab. I told him that I was a visitor and was pleased to meet him. We then went across the street to the grounds of the Church of the Torch where the ceremonies took place. It was a typical Kenyan celebration that those of you who have been here would recognize: introductions, a small devotional service, various groups singing or dancing, then the speeches, Oh, the speeches - various politicians and clergy. The leadership was asking for many things from the government. Some of the clergy actually chided the vice president for the governments immorality. Good way to make friends!? The politicians present were all of the President's party and took the opportunity to rip the Prime minister and opposition's party.

Finally, after several hours there was food. Better than the usual fair but similar to the church dedications.

This afternoon Stan Topple and I took a five mile hike through the country side. It was fun. Several people we passed greeted Stan by name. He is quite revered here for his role in starting the rehab hospital. He is leaving tomorrow to work at a hospital in the north Maua.

We had a light dinner at his house of cheese sandwiches or peanut butter and jelly. Also, some wonderful carrots and best of all some Toblerone dark chocolate. It was good to have a smaller meal. I don't think I have gained weight but I must be accommodating to Kenyan food. I also believe they are cooking a little to our taste. I think I said that before.

We have worshiped everyday this week. We need to leave before church is done tomorrow to go on our planned activities so we hope the Lord will forgive us for missing church.

Our prayers our with you all. Please pray for Elizabeth as she approaches the birth of her baby.

Doug and Laura

We just finished the second week. The interesting thing about the operating room cases is that they were all cases we would do at home: a total hip, a rotator cuff repair, a hip fracture, a hand injury and an achilles tendon lengthening. The last is not a frequent case but familiar any way. I spent most of the day as the only surgeon in the OR but Dr. Kingori came along to look at the shoulder surgery and fix the hip. Dr. Sitati was up at the general hospital taking care of the fracture. I have been pressing him to use more of the equipment and things such as Ace bandages that have been sent.

Tomorrow is the big celebration of the 100th anniversary of PCEA Kikuyu General Hospital. Laura and I have received official invitations. It is supposed to start at 10 am. We need to leave the Rehab compound about 9:30 to beat the Vice President of Kenya who is supposed to land on the rehab ground in his helicopter. I suspect it won't start on time, and it will be done the Kenya way as an event that is done when it is done and not as a timed American event. Yesterday, they delivered a lot of fresh vegetables to the hostel kitchen. Several cooks worked on the back patio outside doing prep work; unfortunately, I didn't get a picture.

Sunday, we plan to visit the orphaned animal center, the giraffe center, Kizuri beds, have lunch and go to Nakumatt to get tea and coffee. Also, I hope to find hand sanitizer to put out at the hospital.

I don't think I have mentioned Francis. He is one of the people that hang out around the general hospital. talking to white people. It seems he tries to talk to everyone he sees. He is very persistent at trying to pry names, addresses, pictures from those of us he meets. He has invented some work out pants with big pockets that he wants to market in the US. Laura and I walk the mile or so around the hospital perimeter several times per week. At first we tried stone walling him, then we decided to ask him more questions than he asked us. We were feeling like we weren't quite handling him like our Lord might. So while reading a book called the Shack, which reminds us of how incredibly loving our Lord and God is and thinking of how they treat the poor and different, it came to us that we could handle him in a different way. We decided to tell him that we would be friends but we wouldn't give him our addresses, email or other demographics and we wouldn't take any gifts or arrange for export. We now talk about the days activities and about him, redirecting the conversation when it drifts. Now we don't feel guilty about putting him off or that we treat him poorly. It has been a good lesson for us.

Laura thinks she might like to stay longer; I am starting to think I am looking forward to coming home.

Thanks again for your support and prayers.

Doug and Laura

Jambo,

Laura and I were taking a walk today talking about our experiences when we realized that more than half the time has passed. It certainly goes by quickly. There were about 100 people for clinic yesterday and 7 surgeries today. There have been so many operations for chronic infections. At home we rarely see this problem. The fractures we treated today were all at least 3 weeks old. Two were elbow fractures in children and one a very bad femur fracture in a 90 year old woman who had been in the hospital for two weeks waiting to get enough money to pay for the operation. It is always difficult to use old equipment that you have to occasionally do improvisation. That is, however, one of the attractions in what we do as orthopedic surgeons. Any way, God is so good that the surgery turned out very well.

Looking ahead, we are going out for Indian food tomorrow night. I hope to get some tea and coffee at Nackumatt, the Kenyan equivalent of Walmart. Friday is the 100 year celebration of PCEA Kikuyu Hospital. The president of Kenya was supposed to come but is in New York. The vice president will come. The clinic and surgery are cancelled. Maybe we will go to Kizuri beads, the giraffe center and animal orphan center on Saturday.

Also, for those on the last trip, who went to Kimuka in Masai land. The elders were asking for help with a girls and boys schools. They have become a reality.

Some of you will remember the British expatriate doctor who had a knee replacement the first time he was here. You may remember that we spent a weekend with his wife. He was in the clinic with his wife yesterday. They have changed their ministry focus from street boys to poor woman and brought one with them who needed a new brace. It was nice to see them. I will probably do some more surgery for him next April if I can come.

That is all for now.
God is so good.
Doug and Laura

To all:

It is early Sunday evening, I don't know exactly when I will get this out to you, as there isn't any internet connection at present.

We left the hostel at 7 am on Saturday with Magic Bilkhu a guide who is the friend of Flo and David Neirmeyer and whom Charlie and I spent a couple days last year. He is very knowledgeable. Also, he is a good driver. The roads are for the most part just as bad as ever but we did hit some stretches of good road. It took 5 hr. and 15 minutes to reach our camp called J & K Mara camp. For those who have been to Keichwa Tembo camp, this camp was much more isolated and much more rustic. The energy for lights is all solar. There are flush toilets. The shower uses a canvas bag, which is filled by one of the attendants (all Masai warriors). He asks if you are ready, lowers the bag, which appears to hold about 5 gallons. You then release the lever by pulling a chain and you have a not bad shower. The tents were a bit dark at night. It is quite isolated too; you hear a lot of sounds. There are warriors around the camp night and day. The service and food were excellent. There are 14 tents holding 2 people each. I think there were about 18 total last night.

The Saturday afternoon started with a visit to a Masai village. We went in a hut, sang and danced with the women and warriors. I think I jumped as high as one of the warriors (the sign of a mighty warrior and attractive to females). He probably let up on me. We bought a few things and were off to the afternoon drive. One of the advantages to our location near so many Masai villages was the chance to see the animals in the middle of the villages and leaving in the morning. The highlight of this visit was the Wildebeest migration; countless animals milling their way across the plain and when they all run, it is a thunder of hooves. We saw a lot of lions and it seems less than usual numbers of elephants and giraffes. Sunday, we were up at dawn and on the road to see a beautiful sunrise.

The picture is of Laura, myself and Moses the Masai warrior at sunrise.
(Click on picture to enlarge)

The highlight of this morning was coming upon a very sleepy leopard in a tree with his Wildebeest hanging from a limb below. We were only about 30 yards away. We also saw a baboon capture a baby antelope. I didn't realize they were omnivores. I always pictured the docile animal. After breakfast on the plain, we departed for Kikuyu arriving back here about 5 pm.

The manager of the camp also went with us on the drives. He sat up high and was able to see a lot of animals we would have missed. His name was Moses and he has two wives.

Also on the way back we picked up two Masai people walking on the road. The first was young and got off to finish his walk through the fields. The other appeared to be about 70 years old and was starting a 60-mile walk to a meeting of Masai elders. He was grateful to say the least. He told us of a smoother road which we took. He has no documentation of his birth date and estimated his age as 34!!!!!

Thanks for your patience reading this long email and for your prayers.

God bless you all.

Doug and Laura

PS: It is Monday afternoon; nothing much new to report. Just the usual amazing day at the clinic.

Dear friends and family,

We have reached the end of our first week away. Tonight I think we became part of the community. We were invited by Peter Kairie to attend the community fellowship at Dr. Kingori's house. There are thirteen houses in the compound including many of the people with whom those who have been here are acquainted. It is basically a monthly gathering like small groups at any church except these people belong to many churches but are glad to worship together. There is singing, prayer, scripture, discussion and food. Laura and I had a wonderful time.

Yesterday I gave my lecture to the Kenya Orthopedic Association which was also Grand Rounds for the Nairobi University Medical school orthopedic department. I was the second person to speak at a grand rounds as they have just been started in preparation for the first group of residents in the first orthopedic surgery residency in Kenya. Here to fore, they trained mainly in Uganda or England. The lecture was well received and sparked a lot of good questions.

Laura had her first ride in the front of a van in Nairobi rush hour traffic. A thrilling experience to be sure.

Work is going well at the rehab center. The usual unusual cases. Laura's brother who is in his last year of orthopedic surgery training was remarking that he had never seen the cases Laura has been seeing. She has been an integral part of the team both on the wards and in surgery.

Tomorrow we go to Masai Mara for safari. We are driving there so it should be an interesting trip. We return Sunday night. Another orthopedic surgeon is coming from North Carolina with 2 nurse anesthetists. He has a similar practice to mine and is about the same age. His name is Ward Oakley. I have met him briefly at a meeting last spring.

More about the safari on Sunday. Thanks for your prayers.

Doug and Laura

To all of you that have not had the VAN RIDE experience in Kenya, I will explain a bit. The roads are not very good or not good at all with huge potholes, ruts, water and people. So riding in the front seat is like going to Disney World and riding one of the scary rides.Thus Doug's comment about letting Laura have the experience in the front seat. Liz

From Doug: I am pretty tired tonight. My lecture this afternoon went well, there were about 60 people or so including students. We had some good discussion. Turns out they are starting an orthopedic surgery residency in Sept and are going to send residents to KORC to get elective surgery experience since 99% of the orthopedics at Nairobi General Hospital is trauma.

I took a brief nap this afternoon. I do feel very tired tonight. Hopefully I can sleep ok.

I let Laura sit in the front seat of the hospital van we took to Nairobi. Everyone needs that experience.

Doug

To all:

Today started with the chapel for the entire hospital, both the General hospital and KORC. The scripture was from Jonah 1:1-10. The sermon stressed taking the correct direction and not running away down another direction.

Rounds at the General hospital revealed two open fractures that had been admitted and had initial cleaning up. There was young lady with a coagulation disorder with clots sent to her feet. We would never see a case like that in the US. In the operating room, there were two hip fusions in teenagers with hips destroyed by chronic infection. I have never done a hip fusion in the US. Also, Laura and I repaired a broken humerus which was what I like to do and reduced an eight year old's wrist fracture. I did a skin graft today also. Haven't done that since maybe 1979. Came out well. You would have been proud of me Larry.

I am going to give a lecture on "Current Trends in Arthroscopic Surgery" to the Kenya Orthopedic Society tomorrow in Nairobi. I don't usually but lectures like that on my CV but this one I will definitely enter.

The food in the hostel has even been spiced with curry and another spice "masala" that tastes like curry. I haven't had to use my own garlic and pepper yet.

Laura has been learning a lot. She will be the expert on the effects of infected hips. I suspect that very few other residents in orthopedic surgery will have the same experience. She is excellent at closing surgical incisions, being the first assistant and has been placing screws during fracture surgery.

Our love and best regards to all,
Doug

Hi,

There are four people from Ireland working at the Compass school some. They say since it moved to a new location, the site and buildings are much better and they seem to be doing well. They moved after a lot of tension with the church of the Torch. The church, which fired the minister that caused the problems, would like them to move back but that doesn't seem likely to happen.

Also, the Irish people are building a new kitchen at the old people home. It is inside with a brick stove, large mixer and refrigerator. It is about the same size as the hostel kitchen.

Speaking of the kitchen, we had rice with curry last night. Really good cream of tomato soup tonight. The usual chicken potatoes with corn bean stew etc are still here as well as the cooked cabbage and carrots. Haven't need to use the garlic and pepper shakers just yet.

Love,
Doug

The clinic today was not too taxing. Scheduled one arthroscopy for tomorrow. Only three cases so far but there is a trauma at the general hospital that needs to be done when they can pay.

I think Laura has been having a good experience. Already a bunch of things she will only see rarely at home.

Love,
Doug

To all,

We had an uneventful trip. All the flights were on time, all the boxes and suitcases were on the plane. We got up and went to the Church of the Torch. It was a combined English and Kikuyu service because of the church elections today. 95% Kikuyu and 5% English so we had to listen carefully. We had a Chai tea in the vestry afterwards. There was a retired pastor there who had lost both his son and his wife in the political upheaval last January.

We plan to keep a low profile today. We will walk up to the general hospital to check it our and unpack the boxes.

Hope you are well. Thanks for your prayers and support.

Doug and Laura