Second week

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 The country has remained in a bit of turmoil this week as impeachment proceedings for the Dupute continued.  He was successfully impeached on Friday but there has been no political unrest fortunately.  The health care system remains in shambles with no negotiations moving forward.  To give you an idea of what the new health system is suggesting it appears that comprehensive family practice care for 1 year will be reimbursed at 900 shillings (about 7 USD).  The hospital is struggling to survive on a cash only basis.  But we were all reassured to see there is a corruption free zone in Kenya as below!


Despite the financial issues I have remained busy in the ENT clinic and operating room.  I have been removing tonsils, laryngeal papillomas, dilating tracheas for subglottic stenosis and removing nasal and sinus polyps. Below is a large benign tumor of the salivary gland that was removed on Thursday.  This was a bit tricky without the usual facial nerve monitors that we have in the states to help prevent facial nerve injury.  She did well and went home with a big smile!

                      

We repaired a 4 month old with bilateral cleft lip this week.  I worked with a Ethiopian plastics surgeon from Tenwek Hospital.  These surgeries are life changing for these families.



On the sadder side, my 18 year old boy with nasopharyngeal carcinoma returned 1 week later cyanotic with worsening difficulty breathing.  His biopsy results are still pending but based on his Ct findings this is stage 4 disease.  His family has no money and they were not subscribers of the previous health care so his financial state was extreme poverty.  The hospital was unable to provide any financial support for an urgent tracheostomy to help his breathing.  Even if I had paid for his surgery, they would not have had the finances to afford chemoradiation therapy.  After a long discussion they decided to take him home to die.  We prayed in earnest for him and I was assured that he would soon be in heaven with Jesus.

We had a similar case of an elderly man with advanced esophageal cancer.  He had paralysis of both vocal cords and a narrowing of his trachea to 5 mm in the mediastinal region.  I was asked to obtain a secure airway so they could start palliative chemotherapy.  He did not have the funds to afford the needed tracheostomy and G tube for feeding.  He also was likely not to have the funds to afford chemotherapy.  The family made the difficult decision to take him home with the support of hospice.

Please continue to join me in prayers for these tough decisions and for the provision of care for these precious people.

In Christ,  

Chase Miller

see our nonprofit website for more information on the work God has called us to. www.purewaterforafrica.org

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