Case(s) of the Week: Corneal Transplants

The cornea is the clear "windshield" of the eye.  If anything causes it to opacify (as in photo #1) or become warped, vision is lost and the patient is rendered blind.

Photo #1:  Severe Limbal Vernal Conjunctivitis with corneal overgrowth in a teenager

In Africa, many lose their vision from corneal diseases such as trachoma (chlamydia of the eyes transmitted by flies (#2a & #2b)), ulcers (#3) and keratoconus (warpage/bulging of the cornea (#4)). 

Photo 2a:  Masaai woman with trachoma

Photo 2b:  Above woman with trachomatous corneal scarring, right > left;

also with cataracts in both eyes causing "white pupils"

Photo #3:  Boy with severe allergies (giant papillary conjunctivitis) causing "shield" ulcer

Photo #4:  Teenager with keratoconus (notice the cone shape of his corneas)

These blinding diseases often cause permanent damage, requiring corneal transplantation to recover sight.  Transplanting the entire front of someone's eye is no small task.  Here is the story of how God enabled us to undertake such a project at Tenwek.

During residency, Dr. Sadeer Hannush (corneal specialist at Wills Eye Hospital) was a mentor to me, and we discussed the possibility of some day setting up a transplantation program in Africa.  So it was with much excitement in March 2010 that Sadeer stepped off the airplane in Nairobi with his teenage daughter Monica and a large ice cooler.  Inside the cooler were 30 corneas given by American organ/tissue donors and the Lions Eye Bank of Delaware Valley.  Bringing human tissue on an airplane across several international borders was NOT an easy task!

Dr. Hannush, Cropseys and Monica in our home at Tenwek

In order to establish a permanent transplant program at Tenwek, Dr. Hannush was able to persuade several companies (Lions Eye Bank of Delaware Valley, Moria, Alcon, AMO, Wills Eye Hospital and BioTissue) to donate over $200,000 worth of tissue, surgical supplies and instruments.

Dr. Hannush presenting the eye staff with a new Goldmann Tonometer donated by Wills Eye Hospital for checking intra-ocular pressures

Dr. Hannush performed 22 corneal transplants in four days while at Tenwek.  These are likely to have been the first transplants of any kind done in Western Kenya or at Tenwek.

   Dr. Hannush doing a corneal transplant at Tenwek with Dr. Roberts assisting

Since that week, we have received many shipments of corneas from Delaware Valley as well as the Alabama Eye Bank.  Can you believe that a box of fresh corneas can be sent via Fed Ex from the U.S.A. to Tenwek in 4 days?!  Over the last year and a half, Dr. Roberts and I have performed over 50 corneal transplants.  The eye unit is now receiving referrals from all over Kenya.  We even received an e-mail inquiry for a boy in Cameroon, West Africa, through a crazy connection with Dr. Hannush's church in Pennsylvania.  Dr. Ben Roberts just performed the boy's transplant surgery last month at Tenwek.

A corneal transplant in Nairobi costs thousands of dollars, and the waiting lists can be over 6 years.  Due to the generosity of U.S. eye banks and other donors, we've never had to turn anyone away for lack of money, and we've been able to keep our waiting list under 6 months.

There are many stories to share from this program.  One that really struck me was the story of Silas.  Silas is a university-educated teacher in his early thirties with keratoconus.  As his disease progressed in both eyes, he found himself unable to teach.  He saw the best eye care providers in Kenya, but was left blind because he was unable to afford transplantation.  He told me that he had nearly lost all hope for life and God.  Dr. Hannush was able to transplant his right cornea in March 2010.  He recovered 20/20 vision as his eye healed!  He told me God had given him back his life.  He was so excited to be able to see again and to teach his students.  Just before I left Kenya, he became one of only two patients at Tenwek to have his second eye transplanted.  See both patients pictures below.   

Silas, one week after his first transplant (left eye).  

Note: Africans often do not smile for “formal” pictures.  He really is happy -- trust me!

 Silas, the day after his second transplant (right eye) just before we left Kenya.

Kiptum (a teenager with keratoconus), one day after transplantation #2.  He was my only other patient to have both corneas transplanted before we left Kenya.

In conclusion, we are very thankful for the more than 70 patients who have received their sight back through this transplant program.  We pray that many more will continue to be blessed in body and soul over the coming years at Tenwek.

*All patient photos and stories used with permission*

He had no name

He was the third foster baby that we had this summer in Kenya. He only stayed in our house for a week, but he has stayed in my heart and in my mind every day since then. If you could know this baby, then he might stay with you for a while, too.

This baby boy was wrapped in a blanket at the door of a church somewhere near Tenwek. The police found him and brought him to the hospital. Because he was in good health, he came to our house the next day. He received immediate, constant, and enthusiastic affection from Anna and Abi. Lots of it.
He was beautiful! In my opinion (general consensus?), many Caucasian babies seem to require several months to grow into themselves before they become cute, but this baby boy, like most African babies, was unbelievably cute. The only thing that may have detracted from his cuteness was his scabies. I discovered his scabies when I began to feel strangely itchy myself. A small price to pay to be able to take care of such a sweet baby.
We began to pray for his birth mother, who is certainly facing bitter circumstances. And we began to pray for God to work in the hearts of a family (who must be residents of Kenya) who would adopt him.

He had no name.

This was a jarring thought to me. He was about four months old, and he was well-fed, indicating that he surely had a name and a mother who took good care of him. But suddenly he lost his identity, his family, his name.

I gave him the name Joseph. Joseph is a common name in Western Kenya, but I chose it for another reason. I chose the name Joseph as a reminder that God can use baby Joseph's life the way he used the life of Joseph in the first book of the Bible. The original Joseph was also abandoned by his family and faced severe trials as he grew to adulthood. In the end, however, Joseph testified that "God meant it for good" as God used Joseph's awful past in order to bring good for thousands of his people. Let's pray and believe that God will do the same in this Joseph's life.

Busy

We thought everyone would be asking "So, how was Kenya?"  A lot of times they don't, and maybe this is because we have managed to keep people abreast through this blog and other means.  Instead they ask "What is it like being back in the US?"

This is a great question, because it takes a bit of consideration, and with any luck, the fruit of the conversation may be of benefit to both people.

If I were to pick one word, it would be Busy.  On one level, this is surprising.  After all, this is America, land of convenience and efficiency.  Websites open instantly.  You can drink water straight out of the tap. You can drive (at night) to a grocery store that is open (at night) and well-stocked (always) on excellent roads with traffic lights that have little triggers to turn green when people drive up.  Usually, conversations are shorter, because I don't have to repeat myself three times to get my American accent understood.  Meals instantly appear from freezers and/or delivery vehicles.  You get the idea.

And yet, we feel like we are running around constantly, with far fewer hours than we need for the tasks before us.  Why?

#1: We are sort of working from home, which means that all of our planning, networking, and presenting goes from the moment we wake up, until the moment we go to sleep.  This maximizes our productivity. Except that it doesn't.  Because of #2:  We have multiple small children.  This effectively means that we may as well stay on "Africa time", because that is really the only option available to us.  And #3: America is a land where your productivity is a common proxy for your worth, and thus being here makes us all feel that we have to be producing all the time if we are worth anything.  We are definitely talking about quantity over quality here.

And thus, without doing any medicine, in a land full of "time-saving" devices and systems, I feel busier and less efficient.

And yet, at the heart of things, none of the above are the root reason.

The year before us is somewhat daunting.  We have a lot of catching-up to do, a lot of training to complete, and a lot of support to raise.  I overstretch myself trying to get all this done.  I have confidence that this path we're on is one that God has started.  In fact, he promises to finish it (Phillipians 1), but I take it on myself.  I show my lack of trust in God's faithfulness by bearing these burdens myself.  Seemingly, this is what Paul calls starting with the Spirit, then finishing with the flesh.  (Galatians 3) Just as the burdens of patient care in Africa could loom too large for my abilities, so now.  And just as then, God is not calling me to do all things perfectly, but to obey and trust him with the times and gifts he has given me.

Can I rest?  Do I dare let things out of my control?  Will I trust God that he will complete his work in us?  Will I honor him by recognizing that it is not dependent on me?

Isaiah 30:15: "In repentance and rest is your salvation.  In quietness and trust is your strength."

Take a deep breath.  Know that he is God.  He will be glorified in the earth.  This is against our culture in a big way.  And, you who read this, I pray that God would lead you in it.  As you read this, please pray for us that we would led as well.

Prescription for Renewal

This last week, many of the McCropders got a chance to do something they've never done before:  speak at a CME conference.  During our last year at Tenwek, a general surgeon named Mike Cheatham came for a few weeks with his family, and got to know us.  He helps put on an annual conference called "Missionary Medicine" which provides CME (continuing medical education) along the lines of things doctors would encounter if they were trying to practice overseas for the first time.  The conference lasts for a day and a half and leads into Samaritan's Purse's annual "Prescription for Renewal," a time for doctors to get together in Asheville, NC for spiritual retreat.  Jason, Alyssa, Eric, and Rachel were able to give the majority of the dozen or so lectures presented at the CME seminar (John was supposed to be there too but was unable to come due to...family issues!).  It was a great chance for us to tell our story to a larger population, give thanks to SP and the post-residency program for the support they've provided, and reconnect with friends.

As we joked several times during the conference, we were basically the youngest docs there, and felt rather underqualified for the task at hand, but really enjoyed a chance to lecture and teach people some of the things we've learned these past 2 years.  Eric gave lectures on suffering, typhoid, malaria, and the "word and deed" aspect of medicine.  Jason gave lectures on the public health value of surgery and late presentations of surgical diseases, as well as the value of educating nationals as a missionary doc and the McCropder story.  Rachel spoke on HIV in pregnancy and OB in a resource limited setting, and Alyssa talked about vaccine preventable diseases (all this to say if you'd like a 30-45 min lecture on any of the above topics let us know!).

It was a great weekend, and the leaves were at peak color in Asheville, so the setting was beautiful.  We hope lots of people were able to connect with our story and will come visit us in Burundi in years to come.

Introducing the Newest McCropder

We (the Cropseys) were excited to be heading to the University of Michigan hospital at 2:00AM last Thursday.  Cropsey #3 had given us a few false alarms the week before, but it now appeared his arrival was imminent.  John was scheduled to speak at the Prescription for Renewal Conference in Asheville, NC later that evening along with the other McCropders.  His flight was booked for 1:50PM in the afternoon.  Since this was a third baby for Jess, surely we thought he would arrive relatively quickly and John could still catch his flight in time for the conference.  Well, things don't always go as expected!  By late morning, it became apparent that this baby wasn't coming anytime soon due to his poor head positioning, so John canceled his trip.  The munchkin finally arrived at 3:28PM, October 13th, weighing 7 lbs, 15 oz and measuring 20 inches long.  After prolonged negotiations, nearly requiring arbitration, a name was decided just in time for discharge:  Samuel Isaiah Cropsey.  

Elise & Micah were super excited to greet their new little brother.  Elise definitely has natural mothering abilities, but Micah will need some continued coaching about what it means to "be gentle" with Baby Sam.    

It's been a harder transition than expected...thus the long delay in getting this blog up.  We're pretty tired, but very thankful for all the support that we have.  Our parents have been awesome.  Many thanks to the Mc__ders and others who covered John's conference slots at the last minute.  We'd appreciate your prayers for our family as we continue to adjust.  We're looking forward to introducing our newest member to many of you soon!

Obamania Lives On in Kenya

Sorry for the post lapse.  We've all been down in North Carolina for an excellent conference (more later), except the Cropseys, who have been otherwise occupied (more later).

For those who don't remember "Strawberry-Flavoured Magic Obama Chewing Gum", I really can't blame you, because it was quite a while ago.  But lest you think the lack of Obama posting means that Kenya has bailed on their presidential enthusiasm, we have a follow-up for you.  Obamania in Kenya has waned somewhat, but overall they remain strongly behind the American President.

One of my favorite manifestations of this is the Obama belt-buckle.  There are many of them, manufactured in China and imported with impunity, with seeming disdain for the American phenomenon in which the Obama fans and the Belt-Buckle fans don't really overlap that much.  My favorite one is one where you can see the President, but if you rotate it slightly, an image of the first family is reflected.

At any rate, about a month before we were leaving, I told all our guy interns that I would pay double for an Obama belt-buckle.  One of them graciously took me up on it, and actually gave it to me as a gift.  The accessory is actually too shiny to photograph very easily, but you can see me sporting it below.  I still have it, so ask to see it any time.

One day in the hospital, someone passed me this (below).  That's right, a $1,000,000 US bill with Obama's picture.  But it gets better, because this is actually an evangelistic tract, if you magnify the print on the back of the bill.  I looked up the company that made them, and it's an American company, so I guess they manufacture these for use in Kenya.

One of our Kenyan friends shared this picture with us, which is a sign in a Kenyan village, that apparently was the ancestral home of President Obama's family, complete with genealogical lineage.

Kenya does have a unique claim on Obama, but the spirit of East African unity means that Obamania is far from limited to Kenya (as seen in John's eye trips to Tanzania and Sudan).  Here is a snapshot of "Obama Shop" (a.k.a. Obama-rama) taken in Burundi, so we have more to look forward to.  (Note: if you look closely, you can see a woman behind the glass motioning for the photographer not to take this picture.)

Eric's New CD: Kenyan Recordings

I've been writing songs since I was sixteen.  I'm not sure why I started, but there were certainly times when I thought their primary benefit would be that I would land a record deal and perform music for a living.  If you are reading this blog, then I probably don't have to tell you that this is no longer true.  However, music has continued to play an interesting role in my life, and "the boundary lines have fallen in pleasant places."

When we were at the aforementioned World Harvest Mission retreat in Kenya, I got the chance to play some of these songs for my fellow missionaries.  I saw on their faces a resonance with the joys and sorrows that I was trying to tell the story of.  And it was great.  (If you want another perspective on that, as well just a great piece of writing, click here.)  

And that's what I hope this project is:  Another way for people to experience the story of our journey to a far-off place full of hope and grief, beauty and pain.  I have printed 200 copies of a CD that is a collection of songs I recorded and/or wrote in Kenya.  Some I have posted on the blog before; some are new.  All are pretty raw, but all strive to tell the story of this certain place and time.

Quantity

Now and Then: 1 CD $7.00Now and Then: 2 CDs $13.00Now and Then: 3 CDs $18.00Now and Then: 4 CDs $22.00

If you're interested, you can buy 1 (or more) copies here for $7 (shipping included), just to cover the cost of the printing.  The Paypal link is here for online purchase, or email me for an address to send a check.  We'll ship it out to you as soon as we can, traveling around as we are.  $5 if you get it in person, and for mp3 fans, click here for free download.  For a sampling, click here.  Happiest listening.

World Harvest East Africa

Just before we came home to the States, Alyssa and the McLaughlins got a chance to attend the World Harvest Mission's first (but hopefully not last) East Africa retreat.  This was very gracious of them, since we weren't technically WHM missionaries yet.  It was a fun 4 day retreat in Mombasa where we had a chance to meet different missionaries working in Kenya, Uganda, and South Sudan.  WHM is not a big mission, so the group size was small enough that we got to meet everyone.  A great group of quality people, one we are proud and excited to be a part of.  Here 's a photo of our group (everyone except Rachel and Ben, actually, since he was napping at the time).

And if you're interested, here are some blogs that these folks are writing.  Good stuff there.  We'll most likely include them in our blog roll in days to come.  Just in case you need more blogs to read. :)

Scott and Jennifer Myhre (field leaders, 2 docs working at Kijabe in Kenya)
Travis and Amy Johnson (Uganda, FP doc and his family)
Bethany Ferguson (South Sudan)
Scott Will (South Sudan)
Michael and Karen Masso (South Sudan)
Jessica Ankney (FP doc in Uganda)
Anna Linhart (Uganda)

A Month of Goodbyes

By the time we left Tenwek, I must say that we McCropders all felt thoroughly appreciated!  Kenyans are very good at saying goodbye.  They have ceremonies and speeches and times of gift-giving.  Our missionary community, too, was very gracious in their send off.  Driving away for the last time (for now), I had no regrets about this person or that person who I wish I could have seen again, or someone I hadn't gotten a chance to say goodbye to.

The goodbyes started early August, actually, a month before we left.  Since the Cropseys left a month before the rest of us, no one wanted to throw two goodbye parties, so we said goodbye early!  The Tenwek missionaries threw us a party and (even though we're a bunch of wazungus/white people) gave several nice speeches.  Here we are outside the party getting a group photo:

Then there were goodbyes from our Kenyan friends.  We had a musical coffeehouse night that all of the interns and many residents attended...full of music, snacks, and laughter.  The Bible studies that many McCropders had been a part of had goodbyes, too.  Pizza, meals, beautiful gifts of baskets and such.  We were also invited out into the village for chai one last time.

 Our church had several goodbye moments.  During the last Sunday service, Eric and Jason were able to lead worship and sing some of our favorite Swahili songs.  We were all invited up for a sendoff prayer as well.  That night, many people gathered together again in the church for a musical celebration and again, well wishes and a send-off to the McCropders in thanks for our service.

 And finally, the morning of our departure, the surgery department had a special thanksgiving worship service and passed along gifts and thanks to Jason and Rachel.  We feel so blessed to have been a part of this community for the past two years.  Goodbyes were well said, but still hard, and we look forward to hopefully returning someday, if nothing else to greet all the people who treated us so well and so kindly.

Relentless Recruiters

The McCropders have always been pretty shameless about recruiting people to join us either short-term or long-term.  We believe that everybody has skills or resources that can be used to further God's work around the world.  We realize that not everyone is called or suited to pack it all up and move overseas, but there are many ways to be involved from the U.S.A. as well.

With that said, we'd like to make our readers aware of some "job openings" on the McCropder team.  And don't worry, your last name doesn't need to have any portion of McCropder in it!

1)  We would really like an early elementary teacher to join our team in Burundi starting the Fall of 2013.  By that time (Lord willing), we will have finished our 10-month French language program in France and be in Burundi.  We anticipate that our first year in Burundi will be composed mostly of learning Kirundi (local language), building our houses, and setting up things at the hospital.  In order for us to properly invest in language and cultural learning, we will need someone to teach our precious children.  [In 2013 -- Anna (3rd grade), Elise (1st grade), & Micah/Abi/Maggie (Pre-school).]

2)  Since we will also need to build houses, we would love to have someone with construction and/or engineering experience to oversee that project.  We don't have a timeline yet as to when construction would begin, but we're estimating Summer/Fall 2013.  We'd also love to have some input from architects as we work on the design of our houses.

Note:  Individuals volunteering for these positions would be expected to raise financial support for their travel and living expenses.

If you or someone you know might be interested in exploring either of these possibilities, please contact us.  Of course, these are not the only two needs that we anticipate, so please get in touch with us if you want to talk about how your skills or resources might be useful to the work in Burundi.