Saturday, October 31, 2020

Second Week

 I have been working steadily. It is hard to know where to start.  I spent Monday, Wednesday and Friday in the operating theater and Tuesday, Thursday in clinic.  I definitely need to remain flexible as things change moment by moment here.  Wednesday was a big day in theater.  We had a large Carotid Body Tumor which is a benign mass that originates from the largest artery in the neck that runs up to the brain.  These tumors are found at high altitudes so they are not uncommon here.  What was unusual is the large size of this mass.  It ran from the lower neck up to the base of skull.   There was much preparation for this case.  The patient was at risk for stroke and multiple nerve injuries.  I consulted another visiting surgeon for his help during the case.  We prayed a lot with the patient but eventually felt resection was her best option.  Our first objective was to make sure she did not have a stroke as we were going to have to tie off the main artery supply to the tumor and the brain.  While the patient was still awake we began surgery and identified the carotid artery. We clamped this for 5-10 minutes and made sure she had no signs of stroke.  She did well so we placed her under anesthesia and proceeded with surgery. Below is a video of the mass for those interested.  No it is not the heart in the neck, that is a pulsating mass!

God was amazingly faithful and we were able to resect the entire mass.  She is recovering well. Swallowing is often an issue after these surgeries but she is swallowing well.  The day after surgery the first thing the patient wanted to do when we rounded on her was pray to thank God for what he did.

There have been many other stories to tell.  2 patients arrived in casualty this week with airway blockage from tumors.  These were advanced tumors and both patients needed to be taken immediately to the operating room for urgent tracheostomy.  Fortunately I brought some tracheostomy tubes as supplies are very low.  Both patients survived and are in the hospital recovering.  

Clinic has been very busy.  We have put a limit on the number of daily patients to try to prevent congestion.  But even with this limit we are working well into the night.  My favorite clinic story of the week was a 56 year old male with tremendously enlarged neck masses on each side.  Examination revealed a tumor behind the nose.  I reviewed the findings with patient and his son.  I explained the seriousness of this as this was unresectable disease.  He did not know the Lord and after discussion and prayer he gave his life to the Lord.  We were able to give him a bible in his tribal language and he left clinic with gratefulness and knowledge that he would live forever in the Kingdom of God.  Although I desire for each of my patients to be healed in body as spiritual healing is so much greater.  We celebrated that day as the kingdom of heaven enlarged!

Thank you for your faithful prayers. We remain healthy and protected.  COVID continues to spread amongst the staff.  3 staff members in the Dental area have now tested positive.  Praise God we are well.

Chase and Jimmy Miller

Saturday, October 24, 2020

First Week

 It has been a busy first week.  God has been faithful to put patients before me that I know are from Him.  There are many others as the word gets out that ENT is here.  It is hard to walk through the hospital without getting stopped numerous times to discuss a Tenwek employees ENT issues or the problems of their family or someone in their tribe.  

When we arrived Sunday afternoon first stop was to the new Eye Dental building.  Here ENT has a clinic room to see patients and store equipment.  The room had been taken over by garbage and animals.  We spent several hours cleaning and putting together the room for clinic on Monday.  Praise God the electrical equipment all works including the SMR unit, chair, and microscope.  

We spent Monday in clinic screening patients for surgery.  I am teaching 2 family practice residents and they are eager to learn and are hard workers.  I am praying that God will work out who is to have surgery as the problems are massive.  Many cancers advanced in staging.  All coming for a cure, no one else has been able to help.  In this culture the oldest son is responsible for the parents so often the sons are bringing in the elderly parents.  

Tuesday early morning I was called to the OR for a young man who was assaulted with a machete causing a deep laceration in the front of the neck. The surgical residents were exploring the wound and noted that the voice box and airway had been injured.  The injuries were all repairable and he is healing well on the ward.  It never fails to impress me how the Lord brings these kinds of injuries in when there is the right specialist available!

I spent Wednesday removing a cancerous mass from this patient's salivary gland.  Another surgeon had attempted to remove the tumor and it recurred quickly.  We worked a big part of the day meticulously removing the tumor and sparing the nerve that moves the face.  She did well and is home recovering now.

I have also operated on a young women who looks like she has TB and an advanced cancer of the voice box.  She is on the wards and we are awaiting culture results and biopsy reports.  please pray for her this is serious and life threatening.

My last surgery on Friday was a 17 year old female with a large mass in her neck.  We explored the neck without any biopsy or CT scan results to save her money.  We were grateful to see that this was a large benign cyst that was easily removed.  She was discharged this morning.  For those that like the details photo below!

The last thing to mention is COVID.  Yes it is here.  we have had 49 cases, 12 deaths, and recent hospital staff have become positive.  Please pray for our protection!

Thank you for your prayers.  I could not do this without the strength of the Lord.  I give Him all the Glory.  He leads us in paths of righteousness for His name's sake!!

Chase and Jimmy

Saturday, October 17, 2020

Made it to Nairobi

 We are safely in our hotel in Nairobi.  The flights were uneventful Praise God.  All our luggage made it safely.  We have learned to be as wise as serpents and when the medical bags arrive with chalk like "X's" on them we have learned to wipe them off with Clorax wipes.  We rolled right through customs carrying 5 large bags with medical equipment and water filters.  Praise God again for His faithfulness.  It is 1 AM here and we are wide awake because of the 8 hour time change.  We pray for a miraculous sleep and an eventful drive tomorrow up to Tenwek.  That will take the majority of the day as we need to pick up food supplies.

Thank you to all the faithful prayer warriors out there that lifted us up.  We will have no internet again until Monday or Tuesday but will keep you updated.


Chase and Jimmy

Friday, October 16, 2020

 On our way       OCTOBER 2020PRAYER LETTER


The Lord will fulfill His purpose for me; your love O Lord endures forever – do not abandon the works of your hands.

Psalm 138: 8


We are heading back to Kenya 10/16 through 11/15.  The call of God to continue to walk in His purposes weighs heavy upon us.  He has assured us of His angelic protection during this time of pestilence and unrest. COVID has reached the rural hospital of Tenwek but the numbers are small and manageable.  The mortality is high because the missionary physicians have chosen not to use respirators on these patients.  The international travel ban has been lifted in Kenya since September but there have been few visiting short-term physicians to bring relief to the resident missionaries.  Many of the long termers have returned to the states so I can imagine it is a desolate place right now.  We are praying we can bring a refreshing wind to a dry and weary land.  


We will arrive carrying more ENT instruments to continue to build the Otolaryngology equipment.  We received a top of the line nasal endoscope from Storz which ENT and neurosurgery will use frequently.  20 hearing aids have been donated and I am bringing all the supporting supplies.  I have completed a surgical tray of ear instruments so that we can now restart ear surgeries at Tenwek.  We pray that all the supplies will be invisible as we cross the border.  God has been so faithful with this in the past.  


Dispersion of water filters will again be Jimmy’s mission.  This year there are constraints on our ability to go out into the rural areas and to attract crowds.  We are asking the Lord for divine appointments as Jimmy goes about his day on the hospital grounds.  Schools remain out of session so his focus will likely be more on orphanages and churches.  Pray that the living water of Jesus is received.


We will be visiting Kitoban Children’s Home throughout our month-long stay.  We love walking along side them and investing in the wonderful work of the Lord here.  Over the last year we have been able to provide further water tanks for the grounds.  We are hoping to help in the much-needed dining hall project this trip.  But most of all we look forward to reconnecting with Alice, Samuel and the children.


Thank you for your faithful prayers for our health and safety.  Please pray that the kingdom of God will enlarge and that His people are healed.  That the praises of God will be on our lips and a witness to His Glory.


Chase and Jimmy Miller
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Monday, November 18, 2019

last week at Tenwek

It was an incredibly busy 2nd week at Tenwek Hospital.  The clinical officers are on strike again which has forced patients away from governmental hospitals and more to hospitals like Tenwek where the CO's are continuing to work.  This has filled the wards up to overflowing.  this creates issues with surgical patients and post operative bed shortages.

My clinic days were overwhelming.  I had more than 100 patients waiting to be seen.  I wish I had a photo of the registration line but I was literally afraid to be seen outside as the patients were pressing in and so desperate to be seen.  I could not see everyone that needed a visit despite staying in clinic as late as 10:30 at night one evening.  God was so faithful to strengthen me for those long days.

The operating theater days were also very busy my second week.  I took care of a variety of problems including a bronchoscopy, tracheostomy for airway issues in a child, mandible reduction for a motorbike accident, large maxillary cyst, parotidectomy and allergic fungal sinusitis.

The case that stands out the most was a young 18 year old muslim women from Somalia.  She had the worst case of allergic fungal sinusitis I have seen.  this is a condition where fungus gets into the sinuses and then the body develops an allergic reaction.  this caused significant inflammation pushing on her eye, lacrimal system and eroding the bone that separates the sinuses and the cranial cavity.  I approached this endoscopically despite the relatively few instruments we had.  the women was quiet preoperatively and did not appear to speak English unlike her husband who did all the speaking.  she took a very submissive role to him. Preoperatively I asked to pray for the patient and explained that I would be praying in the name of Jesus and they were accepting of this.  We discussed the seriousness of her condition and that surgery alone would not be curative. she would need medications postoperatively.  the surgery took 5 hours and was very extensive but I was able to remove all the fungus and infection in the sinuses.  the next morning on rounds the patient was alone without her husband.  I explained the extent of surgery and that Jesus was her healer.  I shared what He had done for her and who Christ was.  She engaged in the conversation in perfect English and was listening intently.  She was being treated like she mattered and was loved for who she was.  she did not have to hide.  In the end she asked, "will I ever see you again?" and the tears welled up as I realized the life she was going back to. Lord, please redeem her and provide for her!

there are so many other stories that bring Glory to God.  He was truly bringing His people in and ministering to them one by one.  I am blessed to be an instrument in His hands!

chase miller

Sunday, November 10, 2019

A busy week at Tenwek

It has been an incredibly busy first week. I was unsure what to expect as the last ENT surgeon had a relatively slow 2 weeks in August.  We set up our new clinic space on Sunday afternoon in the Eye Dental Building. We have one room next to the dental team.  I had previously shipped a motorized ENT chair and SMR unit which houses suction and pressure and many of our instruments.  We brought medical equipment and supplies to equip the room this year.

Monday was our first clinic day and it went well into the night.  I screened over 35 patients and started scheduling surgeries.  The process is involved for them to get clearance from the government to have NHIF coverage for procedures.  Fortunately this process has been fairly quick this year and surgeries are being scheduled.  I also had 4-5 patients on the wards waiting for me on Monday!

Tuesday AM was my first OR day and I had 4 cases scheduled, none of which got performed because of the trauma that came through casualty the night before. We spent the day establishing difficult airways and draining facial abscesses.  Airway management is very difficult here and I was thanking the Lord that we were able to establish all the airways. Unfortunately our first patient died later that day due to a fulminant facial infection and overwhelming bacterial infection.

Wednesday was clinic day again.  I worked until 10:30 that night seeing over 50 patients.  Most of the patients are very complicated with advanced disease.  Add the language barrier and that makes for a long day.  I am amazed how the Lord steered patients specifically to me that had problems that were more in my field of specialty.  I had Jimmy up in clinic that day helping with instruments, cleaning the room and by the end of the night he was taking the patient histories!

Thursday was an OR day that was full of cancelled patients from Tuesday including a couple tonsillectomies, parotid neoplasm and an urgent airway.  God graciously got me through each case. My difficult airway was a 73 year old male with a laryngeal tumor.  He claims a 2 week history of problems but he was emaciated, anemic and in distress.  His son relayed that he was a smoker and when inquiring about his faith reportedly he did not have a faith.  Praise the Lord he gave his life to the Lord yesterday which is another story to share later!

In the middle of the night Thursday I was called urgently to care for a 6 year old with airway obstruction. she had a rare narrowing in her mid trachea (breathing passage) related to having a breathing tube in place recently for pneumonia.  Her history is that she fell into a latrine and aspirated the contents of the latrine.  She was recovering from pneumonia but was developing progressive airway compromise.  Again God paved the way.  She had a breathing passage the size of a pin but miraculously we were able to improvise with available equipment and dilate her airway open.  She is recovering well now and breathing issues have resolved.

Friday was busy OR day again with 2 nasal tumors. the second case was quite difficult with much bleeding. God was gracious to carry us through and we were able to remove the malignant tumor despite all the bleeding.  He will likely need further radiation treatment once we know the pathology results.  Amazingly he went home the day after surgery!

This weekend has been busy with an 18 month old baby again with serious airway obstruction.  She has remained with a breathing tube and we have been unable to extubate her. In fact she has self extubated her breathing tube twice.  On Saturday morning we had a very difficult time replacing the tube and she arrested requiring CPR and resuscitation.  I could see nothing but swelling when I finally placed the tube but miraculously we got her airway secured AGAIN BY THE GRACE OF GOD! We will likely need to perform a tracheostomy tomorrow.

God has been faithful to be by my side and to bless His Kenyan people.  Thank you for all the prayers as I labor through all the work that presses in on me.

Chase Miller

Wednesday, November 6, 2019

Water filter delivery is 'up and running'!

Jimmy and Geoffrey getting ready for water filter delivery
We made it safely to Tenwek Hospital in Bomet, Kenya last Saturday!  Prayers answered for me, Jimmy, as I went through customs without one bag being searched.  All 115 water filters, drill bits and some medical equipment intact and ready to be used.  That is always a stressful time for me, but the Lord works on me to give it to Him and not to worry and when I do...I get through with His help!!

First trip out was quite an adventure.  A one hour boda boda (motorcycle) ride to a small school (Lelbarak Primary School) that had been struggling with water issues.  On our way out, we had a rear tire flat, but thankfully we came across a small duka (small shop) that repairs tires!  It was quite a ride, but finally made it to our destination.
Met with the head teacher and the chairman of the school board and got them setup with multiple filters and containers.  They were very thankful!!!
New filters and buckets at Umoja Children's Home
The above picture is from Umoja Children's Home - Joseph, in the middle, runs the orphange with his wife and he tracked me down because they have more children now at the home.  Their need for more clean water has increased tremendously!  Here they are showing off the new filters and buckets!

Thank you for your prayers and support - please keep Chase in your prayers for rest and sleep at night.  Her clinics have been swamped with patients and has been working late into the night, but even in the midst of this busyness, we see glimpses of God's hand on His people!

Peace and Blessings,