First week March 13-18, 2023

 Praise the Lord I arrived safely with no travel issues.  My luggage was marked for inspection but when I ran my bags through the bagger scanner the inspector was asleep!  All the metal instruments and supplies went unnoticed.  This was a big concern as I was transporting quite a bit of expensive equipment including $20,000 of hearing aids.

Kenya has continued to be in a serious draught.  This has driven up the cost of food goods on top of the already inflated prices from COVID.  The country has been obviously struggling.  This includes the hospital systems, like Tenwek, as the government has not been making the government health system payments.  Simple supplies in the hospital are just not available-like paper towels, toilet paper.  Repairs of medical devices are lagging making it more difficult to care for patients.  I have noticed the resident staff moral is low as they struggle to get what they need to care for patients.

                                     waterfall that feeds hydroelectric plant is significantly reduced

                                               Locals are fishing in dried up river bed for food

My first week has been a real challenge.  The clinic was very busy as patients rushed to be seen and get on the surgery list.  The medical problems have been very challenging.  I am focusing on ear surgery this trip.  My first Operating day I cared for a 5 year old girl with acute mastoiditis (complication of ear infection) and a rare disorder Histiocytosis X.  She underwent a very difficult surgery.  If the pathology report confirms this disease she will need chemotherapy.

We also did 2 emergency tracheostomies (surgical airways) for men who were in respiratory distress from cancer of the voice box.  They are both in the hospital waiting for their pathology reports to confirm cancer.  They have advanced cancer and they will lose their voice box if we do surgery.

A young girl 7 year old girl ran into the road at night and was hit by a vehicle.  She has a traumatic brain injury and is recovering slowly.  I was asked to see her for noisy breathing.  She has scaring in her airway related to having a breathing tube in place when she was in the ICU.  This is a difficult problem to care for here as we don't have the endoscopic equipment needed.  We took her to the operating room and dilated her area of scarring.  She is much improved now and I am praying this will continue.

                       We removed a noncancerous mass of the salivary gland in this patient on Friday.

I am also caring for a muslim women who presented with infection at the base of her skull.  This has caused loss of function of many of her cranial nerves and she has formed clots in her main venous system. She has had a loss of voice and trouble swallowing.  On Thursday she underwent a difficult drainage of the abscess by a wide neck incision to gain access.  She will be in the Hospital for 2 weeks to receive IV antibiotics and blood thinners.  I believe the Lord will use this time to minister to her and her family.  I am praying for salvation for this family.  I have had several opportunities to speak about Jesus and his healing power.

                           For the medical people this CT scan shows a high abscess at the skull base

The work is hard and long but my love for the Lord drives me forward each day.  I trust Him to give me all that I need for the day.  Thank the Lord that His grace is sufficient for His power is made perfect in my weakness

Thank you for your faithful prayers. 

Chase Miller

I will be traveling this Friday 3/10/2023 back to Tenwek Hospital.  The medical focus of this trip is ear diseases.  Our spiritual mission is to break the chains of sickness and darkness; to bring those that do not know Him to the saving grace of our Lord Jesus Christ. The Lord so graciously gave us an ENT microscope on our last trip in October and we have the necessary instruments to tackle some of the advanced ear diseases we see.  I am bringing with me an audiologist to help with hearing tests and hearing aid fittings.  Dr Cam Kirchner is also coming to help with the more advanced ear cases.  This will be a difficult trip so I am seeking your prayers for strength, wisdom, and more faith to believe that God will completely heal his people.  

 

There are more restrictions on supplies that we are able to bring into Kenya.  I have been working over the last months acquiring the necessary extra supplies for ear surgeries.  Kenya is now applying a Tarif to all donated supplies up to 22%.  Any expired equipment or medications are no longer allowed to cross into Kenya.  Please pray that we cross invisibly into Kenya.

 

Otologic Surgery (ear surgery) is highly technical and the difficult cases are challenging for the occasional ear surgeon like myself.  Please pray that God will guide me and give me courage as I tackle some very tough situations.  Dr Kirchner will only be staying for 2 weeks so I will be on my own the rest of the month.  

Jimmy will be arriving to Tenwek Hospital the last 2 weeks. There is a cholera outbreak in the surrounding town of Bomet so we are expecting his water filters to be even more useful this trip.  Pray for opportunities at schools and orphanages.  Pray for open doors to preach His Gospel to those that do not know Him.

 

Thank you for your faithful prayers,

 

Chase and Jimmy Miller

 

Last week

 This was a week full of surgeries.  Many patients have received notification of NHIF approval for surgeries.  This is the governmental healthy insurance which costs 500 Ksh per month ($5.00). Even with this low monthly fee many are not able to afford.  We needed to triage patients with the more treatable diseases over those with advanced diseases because of the limited time.

This patient is a victim of the medical system.  I saw him in Feb 2022 and he underwent a tracheostomy and biopsy for a laryngeal cancer.  Unfortunately the biopsy was negative.  We have found inaccurate results with pathology specimens quite frequently as they are sent to Nairobi for evaluation.  He was seen in Nairobi and several other hospitals near him since February.  He returned to Tenwek when they heard I was visiting again.  His exam now revealed advanced cancer involving the neck and larynx.  We reviewed our findings and his poor prognosis.  We talked of eternal life and the love of Christ.  He was broken and desired to give his life to Christ.  On Tuesday 10-25 he said the Sinner's prayer and gave his life to Christ. Although we could not offer him a physical healing he was a new creation in Christ.  He left with a smile on his face!  He will be seen in the oncology center and offered palliative radiation therapy.

This patient had a large cyst in the sinuses that had grown over the years and slowly affected her vision.  She underwent endoscopic drainage for return of normal vision.  She was a grateful patient!  We give all the glory to God for restoring her.

This precious boy has HIV and presented to the hospital very sick.  He has been in and out of surrounding hospitals over the last month for complications of an ear infection.  Although he would improve on IV antibiotics in the hospital, he would decline as soon as he was discharged.  His viral loads were high suggesting he has not been taking anti retrovirals for his HIV infection.  He had acute mastoiditis, an infection of the bone behind the ear.  He underwent urgent mastoidectomy on Friday.  Although the surgery was difficult, we were able to drain the infection and he was improved the day after surgery.  He is very weak and protein deficient.  He needs our continued prayers!

Friday night was a busy night.  As I was completely the mastoid surgery, 3 traumas came into the casualty area.  One depicted below was cared for by the visiting cardiothoracic team.  

He fell out of a tree and landed on a fence post.  Amazingly, when the team opened his chest he only had a small liver lacerating and bruising of his right lung.  He will walk away from this, Thanks be to God!

    At the same time there was a young man who sustained trauma to his larynx from a punga knife.  He underwent neck exploration, repair of the injury, and stabilization of his breathing passage.  Another man had a human bite amputating his right ear.  

Thank you for the constant prayers.  I arrived home last night and am resting today.  I can't thank God enough for all He did.

Chase

A day at Tenwek

 I thought I would give you a snapshot of an ordinary day at Tenwek.  The morning walk to clinic is cool 50 degrees but there is hope of warmth to come.

"...that you may know the HOPE to which he has called you the riches of his glorious inheritance in the saints and his incomparably great power for us who believe." Ephesians 1:18

The topography is unlike anything you would see in the states.  the trees are lush, roads dusty, and the smell of cow manure in the air.

Morning rounds are always an adventure.  There is no privacy for these patients.  Families intermingle and help each other with translation of the languages.  Families are responsible for supplying their loved ones with food. the hospital cafeteria burned down several years ago.

This trip I have had 3 residents to teach.  2 family medicine residents and 1 general surgery resident.  I could not do the work without them.  We have been averaging 30-50 patients a day in clinic.  Each patient takes a fair amount of time once the language is translated and the electronic record is completed.  

ENT team

As usual, clinic is full of patients with advanced problems.  These require a lot of prayer and discernment on who to treat.  below is a 34 year old man presenting with pain in the left face.  This has been a long standing problem but recently has become painful.  Pain is usually a sign of malignant change.

This year the Lord has blessed us with new equipment.  I have been looking for an operative microscope to use in the operating theater.  I have a smaller microscope that I use in the office for minor procedures but a more advanced microscope for bigger cases has been a great need. I have been using the neurosurgical microscope for emergencies but it is often not available when needed.  A donor bought a microscope for the ophthalmology operating theater and it arrived last week.  To everyones surprise it was an ENT microscope, not Eye.  It was generously given to me.  What an amazing blessing!  I have done 2 ear cases so far and have another one scheduled for this week.  There is a tremendous amount of chronic ear disease here.  Again very advanced disease so we need to pick and choose those we think we can help.

I spent Thursday and Friday in the operating theater this week.  These days were designated Kenyan holidays but the staff graciously came in so I could care for the many surgical patients.  We removed tonsils, did sinus surgery and ear surgeries.  All the patients have done well which can only be by the Lord's hand in these circumstances.  I am forever grateful and give all honor and glory to the Lord.

Thank you for your continued prayers for the patients and for God's work!

Chase

AIC Cure Hospital, Kijabe Kenya

 Praise God I arrived safely last Saturday with uneventful travels.  I did get stopped at the border and searched.   I was sternly told that even donations are now taxed.  But God was gracious and we were able to pass through without extra Tarif.  Please pray Jimmy is as fortunate.  He begins travels on Sunday.

My first week was at AIC Cure Hospital doing cleft lip and palate surgeries.  We had a small team of eleven with 4 surgeons.  What a privilege to be involved in a such a transformative surgery.  The children are precious in God's eyes and yet the world would say they are cursed.  Well God turned a curse into a blessing 29 times in one week!

We saw children from near and far.  One family came from eleven hours away in a Somalian refugee camp in northwest Kenya.  Mother had her bilateral cleft lip repaired at age 8 in this same hospital.  She brought her 3 year old boy for repair.

One of the biggest joys this week was to be involved in bringing the baby to mom after surgery.  It is a powerful moment when mom sees her baby for the first time again.  It is like a second birth when she lays eyes on her transformed baby. 

We left the week grateful for all God did.  He brought many from far and near.  He transformed lives with a visible change that declares his Majesty and Glory.  These children are blessed and wonderfully made-

Psalm 139:14 " I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well."

I am off to Tenwek now for 3 weeks.  Please pray for restoration this weekend before I start up again on Monday.

Thank you for your faithful prayers,

chase

Arrived home safely

 We arrived home safely and are COVID negative!  A few travel issues required us to come home 2 days earlier than planned but we are grateful there were no major issues.

As I reflect on the month, I see God's hand on so many details.  He orchestrated patients to be seen, all the help I needed in clinic, and miraculously healed his people. I am grateful for my neurosurgical colleagues who were so helpful on several cases.  Enock had a benign growth in his sinus that was impinging on his eye and brain.  He underwent excision of the mass.  It was quite difficult to remove but we were able to save his eye and there was no cerebral spinal fluid leak.

I enjoyed teaching the general surgery resident assigned to me.  His name is Yves, from Burundi.  He tells me his height is a trait found in his tribe.  He certainly learned how to handle trauma this month.

There are always the cases that break my heart.  Shown below is an 18 year old male and his older brother who came to clinic early in my trip.  They had traveled far to get help.  They had no money and no place to stay locally.  Fortunately his care was covered by student health insurance.  Ricky presented with left ear pain and decreased hearing.  On exam he had fluid behind his left ear drum.  He also had a large mass in the back of the nose suggestive of a malignancy.  His scan showed a large unresectable mass.  We did a biopsy and connected him with the oncology team who will likely treat him with chemotherapy and radiation therapy.  He is going to have a difficult course ahead of him.  We prayed for God's healing power.

The hearing aid business was a blessing as usual.  I was able to fit 10 patients with hearing aids this trip.  I had some powerful aids donated from a hearing aid company and these were perfect for my severe hearing loss patients.  I connected with a deaf interpreter and was able to fit 2 teenagers that had profound hearing loss.  This was the first hearing aids these kids owned.  We were also able to connect them with sign language school which will give them another tool to communicate with in school.

Thank you for your prayers and support.  I look forward to sharing God's faithfulness now in the states.  I am planning on returning again in August.  

Blessings,

Chase Miller

God Heals!

 What a blessing to be part of all God is doing for His people at Tenwek Hospital.  I continue to be amazed at how well patients recover despite lack of updated equipment, substandard sterility, and minimal instruments.

This is the young girl we operated on for the cerebellar abscess and chronic ear infection.  She is fully recovered with no permanent deficits.  God's miraculous healing power!

I have seen lots of trauma cases this trip.  Not only road traffic accidents but also tribal violence.  The panga is the weapon of choice in this area.  The deep belly adds weight for slicing even through bone.

This elderly women was assaulted with a panga weapon which sliced right through her mandible bone (lower jaw).  Her husband was killed.  She came to us for repair 6 weeks after the injury.  She was unable to eat because of the malunion of the mandible bone.

The next gentleman sustained a panga injury to the face.  He presented with facial paralysis and a large laceration that was closed at an outlying hospital about 48 hours prior to presentation.  With close examination there was slight movement of his lower lip so I know the main trunk of the nerve was not severed.  He underwent exploration of the wound.  We were able to find the distal branches of the upper face that were severed.  We then identified the main trunk of the nerve and followed this to the area of trauma.  The nerve branches were sutured together which would give him better chance of recovery.

He had a recovery I can not explain medically.  It usually takes 1 year to see recovery of the reanastamosed branches.  Post op day 1 he had almost complete recovery where he was paralyzed prior to surgery.  God is Good!

We are preparing to leave now. As always it is so sad to be leaving such a beautiful country and wonderful people.  I have promised to come back soon as there are some many others that need treatment.

Thank you again for your prayers!

Chase