Saturday, November 14, 2020

Fourth Week

 This is a 2 year old boy with what was described as noisy breathing. he was not walking and developmentally behind.  over the last 3 weeks his breathing has worsened to the point where he was weak and eating poorly.  below is a photo of us in the operating theater urgently treating his upper airway blockage.  

This is a difficult surgery in a US setting but in a resource poor hospital we were hoping for a miracle.  The patient had papillomas on his vocal cords and just below the cords.  these were large and blocking his ability to breath.  With the tools that we had we were able to remove enough to stabilize his airway.  We were able to avoid performing a tracheostomy which was the likely outcome I told his teenage mother. All glory goes to the lord.  Below is the patient post operatively, breathing easily and ready for discharge to home.

He will need further follow up as these can return.  But this was a great witness of the power of God to his young mother.

We did many other surgeries this week.  Below is a vascular malformation in a 12 year old that was removed.  Unfortunately he had to return a second time to the OR today for bleeding. 

God was so present this week as we worked steadily to try to accommodate all the patients needing surgery.  The surgery resident worked tirelessly and I am so grateful for his help.  Despite the long hours in the OR and clinic there were many that will have to wait.  It breaks my heart to leave them but I know that is God calling me back again soon.  We are on our way home now.  We have arrived at Nairobi airport after our 5 hour drive.  We have 5 hours waiting and then off to Germany, Newark, and hopefully Rochester by late Sunday night.  Thank you for prayers for safe travels.

Sunday, November 8, 2020

Third Week


Kenyan scenery at the top of Motigo

I continue to see as many patients as possible in clinic.  It seems it is never enough and many leave disappointed that they can not be seen.  The theme remains the same, advanced disease in young patients.  they have traveled from hospital to hospital trying to get care.

This 28 year old man had surgery previously with return of disease several years later.  He has noted an increase in size in his neck mass and has been seeking local healers.  You can see the multiple small slashes which are superficial cuts being made near the disease to treat the mass.  The patient does not know his previous diagnosis and has no medical records to help us.  CT scan is done and there is a large unresectable mass running from the base of skull the his chest.  Biopsies were performed to try to get a diagnosis to help him.  Tragically, it takes 3 weeks to get pathology results and I will be gone by then.  This story has repeated itself multiple times this week.

There have been other surgical cases that have been treatable and for this I am very grateful.  I have repaired facial fractures from a motorbike accident, performed sinus surgery for extensive nasal polyps, removed a salivary gland mass, and several tonsillectomies.

I have also continued to fit hearing aids for those in need. below is a young man thrilled with his new hearing aid.  He has had multiple ear infections since he was young and has lost both tympanic membranes and his ear bones.  This has left him with a significant hearing loss.  The aid will significantly improve his quality of life.

This coming week will be another busy one as we select those patients in most need of surgery.  Please pray that God be Lord over the schedule and we can operate on those He choses.

Chase and Jimmy Miller

Friday, November 6, 2020

A Different Kind Of Mission This Year

 I've been out and about visiting schools, but not going out as far due to COVID.  It is here and actually on the increase and I believe many Kenyans are tired of the mask wearing and distancing because we rarely see it.  Anyone coming into the hospital needs to wear a mask but not everyone is compliant!  Tenwek Hospital is very busy and full at the moment and the COVID ward is full as well.

The below information is from a weekly update from the acting CEO of Tenwek Hospital on COVID-19:

The Republic of Kenya has seen its highest daily numbers of COVID-19 positive test results. The COVID-19 pandemic is still very significant, and this has been very evident also for us here at Tenwek Hospital. Since the end of September our total number of COVID-19 cases diagnosed has more than doubled and our number of staff diagnosed with COVID19 has increased from 1 person to 17 people. This brings our current totals to: 
88 Total diagnosed 
14 Deceased 
36 Discharged for home care 
21 Still receiving care in CHACU (COVID Unit) and Lower Holding Area (14 awaiting test results) 
17 Staff members (also on home-based isolation) 

We do feel safe here and we are some of the first short-term missionaries back at Tenwek in 7 months.  I find that this trip, for me, Jimmy, has been one of listening, learning and fellowship.  Listening to my Kenyan friends and how they have suffered during this pandemic.  I hear and see their anguish having little food, their children out of school and so many businesses closed.  It takes a toll on this country and its people.  Suddenly, we have much in common because of this pandemic and we share ideas and come together in prayer for each other and our families.

Learning that a day's wage is between $4.50 - $6.00 per day or @ $136.00/month!  When school was out because of the COVID, the teachers did not receive any pay.  There have been more robberies and break-ins to homes in this area than ever before.

Being asked to sit and have chai and to be asked to pray over the time together means so much more to me now than ever before.  I'll sit with the Kenyan staff from the guesthouse and we will have some serious conversations and we will also laugh and have some fun.  It's been a different trip for me, a bit slower but still giving out and setting up the water filters and also spending a little more time talking and getting to know the people.

I still get a kick out of some of the ingenious ways to transport things:

Large water filter project for next week at the Bomet Annex Medical Center

Thank you for your thoughts and prayers,
Jimmy and Chase

Sunday, November 1, 2020

Sunday, a day off


The waterfall and hydroelectric plant are roaring during the rainy season.  We took a long walk today past the waterfalls and up to Motigo Tea Factory.  The views are spectacular and the appearance so different than anything you would see in the states.  The land is extensively farmed by individual family plots.  The roads are dirt and the traffic is all motor bikes.  We see all sort of transport on the back of the motor bikes. The only thing I have not seen on a bike is a cow but I am watching and am sure that has been tried!  I am enjoying a day off full of rest and thankfulness for all God is doing in this place.

Have a blessed Sunday,

Chase Miller

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