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