How Two Calves and Les Mis Revived My Tired Soul

One of the calves...

The taunting look of one of the heifers...

Branding calves at a roundup a few weeks ago...perhaps their elusiveness today was payback.

Desert Cattle Ranching

Emma with Abby

Jeremiah on Abby along the dirt road to the ranch.

Jeremiah and Emma are both becoming quite proficient with horseback riding.

Two nights ago, while anxiously cloistered in our bedroom studying (yet again) for my upcoming orthopedic board exams, my father-in-law, Steve, came to me with a favor to ask.  “The cows got out,” he said, “and I was wondering if you had some time to help me rustle them back in.”  A little background…Heather’s parents own a ranch called “Coon Creek” in the high desert of Arizona which is surrounded by the Tonto National Forest.  A small, spring-fed creek runs directly through the middle of the ranch, supplying precious water, and with it, the ability to grow fruit and nut trees, and have cattle and horses.  My father-in-law received word that some of the cattle which reside on the ranch busted out of the fence, and were grazing in the national forest.  I’m sure I had a bewildered look on my face as I thought to myself, “I know absolutely nothing about herding cattle.”  But thinking I might need a break from intense studying and that an interesting diversion might be fun, I agreed to go.

This morning, Jeremiah, Levi, Steve, Marko (my nephew) and I left at the crack of dawn for the ranch, a beautiful two hour drive through the desert mountains.   As I watched the sun rise over the Superstition Mountains, sipping a fresh cup of Guatemalan Organic, and sitting in a comfortable air-conditioned pick-up truck cab, I had no clue how painful it would be to rustle a mere 5 head of cattle back on the property, inside the fence.  As we drove the last 10 km on the dirt road to the ranch, there was absolutely no sign of the cattle, aside from a smattering of cow patties in varying degrees of age.  We started our search by driving around the 80 acre property on quads looking intently, but with no luck.  We finally surmised that they must have traveled south, along the lush creek bed, in search of fresh water and grass.  I began tracking them along the creek, following a subtle trail of flattened grass.  As I followed the creek bank, the patties appeared (and smelled) more and more fresh, and I began to be tormented by the accompanying flies, signaling that I must be near.  Finally, a few hundred yards up the creek, I spotted a grey cow, quietly chewing her cud.   I doubled back, calling out to Steve and Jeremiah loudly that I had found them.

By the time they made their way to where I was, the stealthy cattle had somehow disappeared.  So we spent the next hour or so looking again.  I kept saying to Steve and Jeremiah (who, I am sure, were wondering if the heat was affecting my brain), “I promise you, they were just here.”  Finally, we discovered that the cows (spooked by my loud calling to Steve and Jeremiah) drove themselves up the steep creek bank, onto the dirt road, and back to the main entrance.  They would have just gone in themselves had we left the gate open.  After re-grouping, our brilliant plan was to flank them on either side while funneling them through the gate.  I took the high ground on a steep slope above the gate, determined to let nothing past.  However, two yearling calves ran fast and sure-footed directly past me, up the mountainside.  I ran after them, hooting and hollering, thinking that perhaps all this noise would help.  Rather, the more I yelled, the faster and further up they ran, periodically stopping to tauntingly look back at me, as if to say, “you will NEVER catch us.”  And I never did.  I lost them at the top of the ridge, panting, lightheaded and parched in the 100+ degree heat. 

I made my way back through the maze of cacti and brush to the main gate.  Thankfully, at least Jeremiah and Steve were able to get the three other cows through the breach in the fence back onto the property.  I broke the bad news that I had failed to corral the other two calves.   So after taking a short break, eating a few apples and drinking some cold water, we headed back out on the quads to continue our search.  As we drove along the property edge, we spotted the three cows that had just been driven back inside the fence.  Amazingly, along with them, was one of the calves!  The other calf was about a hundred yards beyond, but still outside the fence.  I thought I would redeem myself by trying to drive him, by foot, along the fence line back to the main gate.  However, I lost sight of him (again), and made the hot, rocky, prickly trek back (a second time) to the main gate.   Now firmly worn and overheated, we gave up, and decided to head back to the ranch house for a cool rest.  However, along the way, we again spotted the herd of newly-rustled cattle, and  somehow, the other calf had joined them too (I am certain he was looking, smugly, directly at me).  So now, after all that striving, the cattle were safely accounted for.  

When we arrived back in Phoenix later this afternoon, I was exhausted and laid down, intending to take a short (few-minute) nap.  I must have been out for some time, as Heather woke me from a deep sleep, in which I was having some intense (but not remembered) dreams.  The kids wanted to watch Les Miserables, and needed help in setting up the sound.  Still in a fog from the nap, I thought I would sit down and watch with them for a few minutes.  However, I was quickly engulfed in this incredibly beautiful and tragic story of law vs. grace that is portrayed in the two main characters.  By the end, I was deeply touched (perhaps primed by the cattle wrangling, subsequent mild heat stroke, and deep, interrupted sleep) and struggling to hold back tears that seemed like they just needed to flow.  

After the movie was finished, I went on a walk, and poured out my heart to God, asking Him what all this was about.  What he showed me was surprising:  I have recently been trying to live my life much like I tried to “round up” those two calves earlier today; by my own strength, and without God’s help and grace.  And this has left me frustrated, and incredibly dry.   I have been trying to “round up” managing my family, being a missionary, running an orthopedic department, garnering equipment and supplies, managing a team of people, planning a symposium, studying and passing an upcoming exam, buying furniture, packing a container, and having a new baby, ALL on my own strength, without grace.  And it’s no wonder I am feeling so worn!  God has not made any of us to live by our own strength, or to say “I got this…I can do it on my own…I don’t need help.”   But the truth is that none of us can “do life” on our own.  We may be able to for a time, some longer than others; but eventually, we will crash and burn. The danger in this type of independence is that we can miss grace, much like the dutiful and law-keeping Inspector Javier (who actually thought he was doing God's work).  Our only hope is God’s incredible grace, embodied in His Son who died for us on the cross!  We all need Jesus, and He is what our hearts are longing for.   The "calves" will take care of themselves (like they did today despite all my striving)...we just need to place our trust in Him and receive His grace!

 

Quick May 2013 Update

Just a brief update on the latest news from the Galat Family.  We have been in the states since late February and much has happened!

Career Missionaries with WGM

Our family spent the month of March traveling, visiting churches, supporters, family and friends, and we were so blessed everywhere we went.  Out first stop was at World Gospel Mission headquarters, in Marion, IN, where we were commissioned as career missionaries!   We are thankful for the ministry God has given us at Tenwek, and look forward to our return.  Aside from the orthopedic service at Tenwek, we plan to continue our focus on resident discipleship, orphan ministry and church leadership.  Thank you to all who have joined “Team Galat” in prayer, support and love over the years!   For information on how you can partner with our family, and in the work at Tenwek, you can click here.

New Orthopedic Residency in the Works

One of the most exciting new developments in orthopedics at Tenwek is plans for a new orthopedic residency!  We will be partnering with the Pan-African Academy of Christian Surgeons (PAACS), a U.S. based organization which supports surgery training programs in Africa, to provide education and discipleship for African Christian orthopedic surgery residents based at Tenwek.  Our tentative plan is to interview prospective residents in October, and begin formal training in January 2014 (a full one year earlier than I had been hoping and praying)!  For information on joining us by helping to sponsor future orthopedic residents, please email me directly.

The Orthopedic Team at Tenwek just prior to my departure in late February. 

 

Mama and baby

Heather is now officially in the third trimester at 28 weeks and feeling well.  The “short list” of names for our baby girl continues to grow with the help of eager cousins here in Phoenix, including but not limited to Charlotte, Ruby, Hattie, Darcy, Willow, Harriett, Daisy, Cora, Collette and Lulu.  Do you have any suggestions?    

 Jeremiah – Joined us in late March, and we love having him around.  He is my workout partner in the early AM, and is determined to keep me fit…yesterday we worked the punching bag.  When not doing on-line school, he is busy earning cash by doing projects for grandpa.    

 Jeremiah and his g-pa.

 

 New table Jeremiah built himself, others soon to be available on Craig's List. 

Emma – Continues to sing, and is now starting private voice lessons.  Additionally, she was invited to practice with a choir at All Saints Episcopal Church here in the valley.  Mostly, she misses our dog Chuma who we left behind in Kenya.   

 

Claire - Excited to celebrate her 12^th birthday this month and for her upcoming, extended “daddy-daughter date.”   Next weekend, Claire and I will travel together to Florida to organize a huge donation of orthopedic suppplies (and perhaps slip away to a water park for a few hours!)

Levi - Loves his cousin Marko, and together they scheme how they can obtain more Legos.  Marko came to me today with a 1000 Kenyan Shilling bill, wanting to sell it for some quick cash for a new Lego set.  He said he “found” it in his toy box…hmmm…

Thanks again for all your prayers and support!  We couldn’t serve at Tenwek without your partnership.

Blood: Post-Easter Reflections

As an orthopedic surgeon, I am often chided by fellow colleagues from other “more refined” surgical specialties that I am a mere “blue collar surgeon,” with marginal intellect, who uses barbaric tools such hammers, nails and screws, to fix broken bones through large, bloody incisions.  More than once I have heard the quip about orthopedic surgeons being “strong as an ox and twice as smart” and I try to take it in stride, replying with my standard rebuttal about being glad that at least I don’t have to operate on the colon or some other "less-glamorous" body part.   I love the banter, and surmise the reason it exists is to help us lessen the stress in our high-stakes profession as missionary-surgeons at a busy mission hospital in rural Kenya.

 While I understand that most of what is said about orthopedic surgeons is solely in jest, it is true that our surgeries are significantly bloodier than the average general surgery case (such as a thyroidectomy where blood loss can be measured in a few cc’s).  It is not uncommon for a hip fracture case to have 500cc or more in blood loss.  Once, during cleanup of the operating room after a particularly extensive and bloody orthopedic case, a suction container filled with about a liter of blood slipped out of the hand of one of our team members, and hit the floor, spraying the wall and ceiling and covering our poor anesthetist in blood.  And more than once, I have finished a case only to find that blood has soaked through my surgical gown to stain my scrubs underneath, or that blood dripping from the operating room table has completely soaked the hems of my scrub pants (especially if I forget to wear my rubber boots).  And I wonder why Kenyans are staring at me, wide-eyed, as I walk obliviously through the courtyard of the hospital wearing bloody scrubs or why my wife refuses to give me a hug at the end of the day until I have taken a cleansing shower. 

For the average person, the sight (or even the thought – sorry!) of blood can be sickening. But for those daily exposed to the sight, smell and feel of blood, the visceral reaction blood evokes can be lessened, until it becomes quite mundane and unremarkable.  Perhaps, like the desensitized surgeon, we as Christians have also lost our appreciation of the significance of blood.   We forget that our forgiveness was bought not with our “good deeds” but with the literal flow of blood from the hands and feet of God Himself (Hebrews 9:22: “Without the shedding of blood there is no forgiveness”).  And we forget that the price of our freedom from sin was literally paid with the currency of blood (Revelation 1:5: Jesus “freed us from our sin, by his blood”).   During this post-Easter season, let us encourage one another to ponder the incredible sacrifice that Christ paid for us on the cross, and pray that God re-sensitizes our hearts to the wonder of Christ’s blood that has set us free.

“Amazing Grace, how sweet the sound

Amazing Love, now flowing down

From hands and feet that were nailed to a tree

As Grace flows down and covers me”

The Mysteries of Life, God’s Sovereignty and Free Will

Heather is now 18 weeks pregnant, and today, we had an extensive ultrasound of our new baby.  As we watched with amazing clarity the intricate anatomic details of this new little life unfold before our eyes (current technology is absolutely amazing), we couldn’t help but worship God for this miracle: toes, fingers, and details of other “parts” all being perfectly knit together by a sovereign God who wills, as he chooses, to create, in a truly mysterious way.   Our baby has no choice as to its sex, body shape, hair or eye color, the family it will be born into, its nationality, or even aspects of its personality.  But, like all of us, as per God’s mystery and perfect design, our baby will have a choice (despite these “non-options”) what to do with them, and whether or not to follow the One who willed to create this life.  In the end, we are all stewards of the life that God gives us, and we will be responsible to give an account of what we have done with the gifts He has given.  Yet, all is completely by Grace, so that in the end, any good that comes from our choices will be turned back as praise to Christ, who made everything possible by his sovereign death on the cross for our sins.  As is the mystery of new life, so is this mystery of God’s sovereignty and our free will.

By the way…it’s a girl!!         

Transitions 2013

The orthopedic team on my final day of work, prior to leaving for our next scheduled furlough.

Encouraging a patient about to be discharged from the hospital. 

Praying with a patient during morning rounds.

 

 

Dr. Kiprono and I performing a total hip replacement in a 50 year old male with bad arthritis.

 

Tomorrow night, the Galat family (minus Jeremiah) will be flying back to the U.S. for our scheduled furlough.  As such, the last few weeks at home have been a flurry of packing, organizing, planning, and saying goodbyes to our many good friends, both American and Kenyan.  Naturally, this time of transition brings with it also a wide variety of paradoxical emotions, and while a few tears have been shed by our kids, we are also encouraged by the sense that this pain of transition is not as sharp as it has been in the past.

Times of transition also bring reflection.  The changes that have occurred in the orthopedic department since our first arrival to Tenwek in November 2008, are amazing.  Back then, the “team” consisted of me, and a clinical officer intern who had absolutely no interest in orthopedics.  In contrast, on my final working day last Thursday, the team consisted of 12 people (consultants, residents, interns, and essential visitors), all committed to compassionate orthopedic care of our patients.  However, this number is continually in flux (six left the following day), and we struggle to adequately cover a service that is relentlessly growing, averaging 40-50 inpatients at any given time (47 on my last day), mostly from trauma related to road traffic accidents.  During the last year, over 2000 major orthopedic surgeries have been done (including 32 total hip and knee replacements), in operating rooms that are open 24/7.  

The commitment to education and training via Tenwek Orthopedics remains essential to our purpose.  Dr. Kiprono Koech joined the team in 2012 as the second orthopedic consultant (and my partner).  His calm demeanor, excellent surgical ability and leadership skills belie the fact that he just recently finished his residency, being years ahead of his peers.  In August 2013, Dr. Will Moore, a post-resident from Samaritan’s Purse, will round out the team as our third consultant.  We continue to train orthopedic residents from Moi University, and just recently added a second rotation for orthopedic residents from Kijabe hospital.  And we continue training the general surgery residents and interns based at Tenwek.    Plans are in the works to start our own Tenwek-based orthopedic residency, God-willing in January 2015. 

But most importantly, and the reason that we continue at Tenwek, is the ongoing emphasis on spiritual ministry.  In the past year, more than 30 patients have committed their lives to Jesus Christ as a direct result of the orthopedic ministry at Tenwek.  On morning rounds, while hectic, we try to daily take time to pray with patients and share with them the good news of Jesus Christ.  A short word of encouragement, a small prayer, or giving of a bible can make a life-changing difference, and we have seen God do significant miracles of His Grace.  

In short, while there are many challenges that that we will inevitably face, the future is bright and many good things are on the horizon.  We have no other choice but to trust God to continue this work that He started.  Tenwek’s vision statement of “compassionate healthcare, spiritual ministry and training for service” continues and only through teamwork is this possible.  Thank you for all the support of our family in so many ways: prayer, words of encouragement, financial support, short-term visits, etc.  We, as a family, are honored to serve at Tenwek and God-willing, will continue for many years to come! 

Please keep us in prayer as we travel back to the U.S. for this HMA (homeland ministry assignment) of 6-7 months (we hope to return shortly after the birth of our new baby, due August 10th!).  Jeremiah will join us in the U.S. the end of March, after finishing this current term at RVA.  Please also keep Dr. Kiprono and team in prayer as they continue the busy orthopedic work at the hospital.   

Black Mamba and Discipleship

Tabasco, a relative "lightweight" in the heat index, but still a classic.

Impressive, but not quite living up to its name.

Heavyweight, essentially "on fire."  Dangerous to children, pets and "sensitive areas" as the warning label below indicates. 

At first glance, I thought this warning label was a joke; but I can assure you, it is not.

The men's intern and resident bible study where one of the first questions asked each time is "Where is the Black Mamba?"

Every other week, approximately 20 interns, residents and consultants gather for our ongoing men’s bible study.  Because many of these trainees work long hours and have limited time to prepare food, we (the missionaries) regularly provide a meal for the study (usually some sort of stew with rice, chapatti and slaw).  Early on in the study, I introduced my Kenyan brothers to a little bit of classic Americana: Tabasco sauce (of note, Kenyans do not generally prefer spicy food).   Dr. Russ White, always the instigator and never wanting to be outdone, then introduced a hot sauce boldly entitled “100% Pain”.  The sauce was indeed hot, but I taunted Russ by saying the product was mere “child’s play.”  Then few months later, he kicked it up a notch and brought out this tiny, little bottle of sauce (that actually had a warning label on it) composed of a few simple ingredients: chocolate habanero peppers and concentrated capsaicin.  I thought the name of the sauce, “Black Mamba,” was intriguing and quite apropos for our study, as this snake is both indigenous to Kenya and highly venomous.  I started with a scant 3 drops on my plate of food, and noticed out of the corner of my eye the devious, slight smile on Russ’ face.   A few bites into my food, feeling suddenly flushed and sweaty, I discovered the general principle that degree of heat is inversely proportional to the size of the bottle.  “I’m going to pay for this later,” I kept thinking to myself as I stubbornly finished my plate to the laugher of the entire group.  Of course, I received no sympathy from my wife the next day, who just rolled her eyes with every complaint of severe abdominal cramping. 

One of the best parts of being a medical missionary is the opportunity to disciple the interns and residents who train at Tenwek - men who will be the future leaders of medicine in East Africa.  We just finished a study on the “good kings of Judah” and are now in the book of Daniel, our goal being to study the men in scripture who were themselves leaders, whether good or bad, in order to learn from their lives, their victories and mistakes.  A continual theme in our study is that “life is short” and therefore we must use our God-given gifts to serve others, thus fulfilling the law of Love in Christ.  Their spiritual (and physical) hunger is amazing, and while the missionaries provide the meal, the interns and residents do all the leading of discussion and hosting.   At times, when I am alone in the morning praying, meditating and reading, I am overwhelmed with a sense of thankfulness for the privilege of being a small part of something great that God is doing, best summarized in the Tenwek mission statement: “compassionate healthcare, spiritual ministry and training for service.”

Thank you for all your support of our family.  Please pray for these leaders as we continue to teach and train, not only in medical education, but also in spiritual formation.

New Life: Another “Miracle at Tenwek”

 Jeremiah, age 15.

 Emma, age 13.

 Claire, age 11.

 Levi, age 8.

Chuma, age 1-1/2.

The abbreviated version of the story is this: We are expecting Galat child #5!  For those interested, the extended version (or “the rest of the story”) follows, which includes themes of forgiveness, grace, and second chances. (Note: You may want to read first and “screen” before allowing younger readers to view.)

 Levi, our fourth child, was born in 2004, in the midst of a very busy orthopedic residency at the Mayo Clinic.  A few months after his birth, the chronic exhaustion, stress, financial strain and an element of selfishness caused me to think that perhaps four was enough, and I began to look into more permanent options for “family planning.”  Although Heather was not in full agreement, and my motives were based more on fear (rather than faith in God’s ability to sustain with His unlimited grace), I proceeded with a vasectomy.  However, as time went on, and our stations in life changed, I began to feel a sense of regret at making such a permanent decision.  Additionally, because Heather was not “fully on board” with the initial decision, she carried with her a wound, as this had not been a mutual choice based on prayer and/or a sense of God’s leading, but rather one made out of questionable motives.  As years passed, we both desired to have more children, but were resigned to the fact that this option was no longer a possibility.         

In 2008, prior to leaving for our first stint in Kenya, God began to take me through a refining process (actually, probably better described as a breaking process) as I realized I had a sinful habit-pattern of independent (i.e. God-less and Heather-less) decision-making and that repentance was necessary.  As these various “one-way” decisions were brought to light, I became committed to “making right” these wrongs done towards my God and my wife, and we saw God’s grace pour into our lives as I took these steps of faith.  However, as there was nothing I could do to “make right” the decision to permanently restrict the size of our family, I could only ask Heather for forgiveness, which she freely and graciously gave.     

As a physician, I knew about vasectomy reversals, a microscopic procedure in which the small tubes which were cut during the initial vasectomy are delicately reconnected with suture about the diameter of a hair.  But I thought this was an impossibility, as this surgery is completely elective and entirely expensive (between $5,000 and $20,000).  Additionally, the success rate is not 100%.  Even so, God continued to bring this to my mind, not via guilt, as if I had to pay for my sins by getting a reversal, but rather in a gentle and encouraging way, as if He was saying, “Are you going to trust me?”  So I researched options on-line and even contacted a few places in the U.S.   In August 2009, I was scheduled to travel back to the U.S. for a conference and I thought, “OK, here is my window of opportunity.”  Since Heather had fully forgiven me, she was supportive (yet not requiring).  Thus, we decided to pray (this time together) that if God would work out the fine details, I would have it done while in the U.S. for this conference.   However, the reversal surgeon I had chosen was not available during my “window of opportunity” so I thought to myself, “Good, now I am off the hook” and I put this possibility, with good conscience, to rest.

Shortly after returning from the U.S., I met Dr. Samuel Thompson, a visiting urologist at Tenwek who had come to help with the large numbers of backlogged urology cases.  One Wednesday night, he came to our men’s resident and intern bible study.  Afterwards, I was making conversation with him, and innocently asked, “What is your area of interest in urology?”  His answer almost startled me.  He said, “General urology is what I do, but my real interest is in vasectomy reversals.”  “Really,” I said with a sense of God’s providence at work, and proceeded to tell him a large chunk of our story.  After I finished, he said, “You know, if you could find me an operating microscope, an available operating room, 9-0 suture and microsurgical instruments, I would be more than happy to do this for you right here at Tenwek.”  Suddenly, I was placed back on the hook.  But God, in His mercy, was again overwhelming us, and Heather and I, together, felt like the circumstances were way too specific to not be from God.  So on September 28, 2009, I underwent the first and only vasectomy reversal ever at Tenwek (and perhaps all of Kenya and maybe even East Africa) in an empty operating room in the Eye Ward (which had all the necessary equipment and was providentially closed as the eye team was away for an outreach). 

After three years of waiting without any results (and truthfully, with some disappointment), we thought that perhaps this act was just for the purpose of obedience and faith.  Then, when we least expected it, God shocked us with this news that we are expecting.  We kept it quiet until Christmas Eve, so that we could give the news to our kids as a Christmas present and their total surprise was captured on video (click here to view).  We are thankful to God for this new life, born out of forgiveness, grace and second chances.  And we are so thankful for the ways you have followed our story, supported us with prayer and finances, and simply loved us.  We are imperfect humans just privileged to do our small part in God’s great plan to reconcile us to Himself and to each other.  Please pray with us for the health of this new life, for a safe and healthy pregnancy (Heather is constantly tired and nauseated), and that our family would bring glory to the One who is worthy of our lives.   May God give you strength and blessing in this New Year!