Big Rig Send-Off

By John Cropsey

The McCropders have finished packing a forty foot, metal clad box with what remains of their earthly possessions mingled together with "essentials" for their work and ministry . . .  generators, welders, motorcycles, drill presses, axes, six foot steel pry bars, sledge hammers, indestructible Kevlar soccer balls . . .  OK, we even let the girls put a few things on too.  However, given the shear amount of testosterone contained with in this shipping container, it was only fitting that her sendoff be performed by two beastly wreckers and a maxed-out big rig chassis.  Feast your eyes on the video below of nearly 40,000 pounds being dead-lifted off the ground and onto a semi chassis as my son Micah and I revel in the music of big diesel.

(click this link if you have trouble playing the video above)

Credits: background music "Green" by Kissinger.

The McCropder men take our hats off to the ladies of the team who have been willing to say "au revoir" to homes, goods and the financial security of a higher tax bracket.  Instead, they risk losing that which remains to the bottom of the high seas or into the hands of brigands by land as our metal box journeys from the shores of the USA to the landlocked interior of Africa.  As we bid "a Dieu" to our container and its contents, we rest knowing that our Heavenly Father knows exactly what we do and do not need to minister His Good News most effectively in Burundi.  If these mere earthly things would hinder us or our brothers and sisters in fruitfulness, may they come to rest at the bottom of Davie Jone's locker.  

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*

COTW - Boss has a Loose Screw or Two

Most people probably think their bosses have a few loose screws from time to time.  And who can blame them?  The pressure of being the Big Cheese, or as we say in Kenya, Samaki Mkubwa (the Big Fish) can be enough to make you crack.  With the added stresses of Africa and supervising the McCropders, our Samaki, Jim Vanderhoof, finally succumbed.

It was a rainy evening at Tenwek when the phone rang.  I answered, and it was the lovely Mrs. Vanderhoof.  She and Jim happened to be visiting Tenwek for some important meetings (Jim's the country director for WGM).  Mrs. V stated that Samaki had been reading in bed when his glasses fell apart.  They observed that a screw had come loose, but was nowhere to be found.

Life's just not fair.  The boss just needed a little break from the madness while enjoying a leisurely read, and his glasses fell apart.

It was sometime later when he felt some mild eye irritation.  Upon inspection, they noted a foreign body in his eye.  Mrs. V exclaimed over the phone, "I think his missing screw landed in his eye, but he didn't realize it until now!?!"  I told her this was impressive and well worth a look.  Jess and I quickly prepared the camera in anticipation of this very blog.

Yes, I'm enjoying every minute of it!

Indeed, Jim's loose screw is identified!

        

After a little numbing drop, Jim's screw was retrieved.  He has since made a full recovery.  But still, one has to wonder how Samaki could not feel a screw hit his eye.  He must have grown some thick scales in his line of work to be able to blunt that kind of pain from his consciousness.  

Eye M.D. to 10 Million

Click here for a great article on John's work from the American Academy of Ophthalmology's Online Magazine. It has some great Q&A with John as well as a chance for him to use all that cool, obscure lingo that only ophthalmologists use, like "VR surgery with ILM peels." Awesome.

Tanzania Surgical Safari 2010: To Tanganyika and Back Again

I'll be honest, life's been a bit crazy lately and the impending Tanzania (TZ) trip wasn't helping much in that category.  For the past six months I had been struggling with bureaucracies to get a Tanzanian medical license despite having spent a lot of money.  I was tired enough that the prospect of not getting my license and having to cancel the trip actually had a bit of appeal.  But, sure enough, my medical license was approved with just a bit of time to spare.  Then there was packing. 

The week leading into the expedition I was away at a much needed retreat in Mombasa and could not be involved in packing whatsoever.  As I left for Mombasa, I knew we were critically low on viscoelastic (a clear gel needed for eye surgery which had been on order for 6 months and still hadn't arrived!) and our portable surgical microscope was broken.  Both are essential.  I was consciously trying to trust God and the eye staff, but the OCD devil in me sure wasn't happy.  He was saying, "Think of the 40+ person team and hundreds of patients in TZ depending on you.  Think of the thousands of dollars invested.  All it takes is one thing missing (viscoelastic, microscope, generator, blown microscope bulb with no spare, wrong power cord...) to ruin the mission." 

No worries.  Even if I wasn't feeling particularly up to going on a surgical expedition, apparently God was interested in making it happen.  The eye staff seamlessly packed without me, and honestly, they did a much better job than I could have done.  During my week away in Mombasa, a visitor from the USA brought out the part needed to fix the microscope, and, although 6 months late, we finally received our order of 1,000 vials of viscoelastic.  Wow.  So off we left for Nairobi packed into the Jolly Green Giant (perhaps her max load to date) to spend the night near the airport.

We were up at 5:00 am to catch our Cesana Caravan from Wilson Airport.

After a small hassle from the customs folks about our strange, expensive-looking eye equipment, we were in the air with AIM AIR.

After one refueling stop and 5+ hours in the sky, we officially reached the "back forty" of TZ.  Our airstrip was on the edge of Lake Tanganyika (world's longest lake) and at the foot of the Mahale Mountains which form the boundary of Mahale National Park, one of the more remote national parks in the world.  Once dropped off on its shores by airplane or boat, it is accessible only on foot. 

  

Above: the Tenwek Eye Unit team at Mahale airstrip with our fancy new scrubs.  Thanks Ben!

 

We were then transported to the local government health center by helicopter.  Our equipment had to go by boat.

As expected, the helicopter got the local kids (and me) worked-up into a frenzy.

 

The obligatory Obama twins were spotted once again, just as they were upon our landing in Akot, Sudan earlier this year (below).  

This whole trip was organized by Hope of the Nations Bible College in Kigoma, TZ.  They stopped classes for the week and boated all the students and faculty down the lake to assist us in caring for the patients physically and spiritually.  They also held kids' clubs and went into the community to mobilize the blind and share the good news of Jesus Christ, The Hope of the Nations.  Below are some of the the key organizers and docs involved. 

  

(Left to Right: me; Dr. Norbert - medical director of the health center who invited us; Dr. Kabadi - Tanzanian ophthalmologist and friend of Dr. Norbert, Dr. Steve Anderson - ophthalmologist joining us all the way from Indonesia; Dr. Len Ramsey - medical doc and the chopper pilot with Hope of the Nations! 

First, we settled into our abodes for the week.  My bed was strategically placed under the lake front window to absorb in sponge-like fashion as much rainfall as possible during the night storms coming off the lake.

 

Next, we screened the patients already waiting for us, and we got the OR up and running.  Our very first case that evening was on our own team member who gashed his hand upon arrival by falling into the lake onto sharp rocks.  Thankfully, we had a microscope for his tendon repair.  Other than some numbness of the pinky, he's got full function of the digit despite having me for his hand surgeon using ophthalmic suture.

  

Below: patients on post-operative day #1waiting to have their patches removed.  This is always a special time.

  

We had several patients originating from the other side of Lake Tanganyika (Democratic Republic of Congo, aka former Zaire).  They tended to be on the smaller size as you can see from the picture below.   

 

An Mzee quietly enjoying his first look around in a long time. 

This lady obviously has a huge goiter, but also notice the white pupils.  Those are blinding cataracts.  We did surgery on one eye with great success, but when she heard that her doctor loved Jesus, she was a bit upset.  She was Muslim and couldn't believe someone who loved Jesus would do something like that for her.  She did get over her perplexity and had her other eye done at the end of the week.  She was seeing 20/25 when she left!  She begged us to remove her goiter, but obviously, this was not the setting to attempt such a feat.  

Below is another woman who was accompanied by her daughter and granddaughter.  She left one happy grandma. 

This is the last day's post-ops.  They were a particularly fun group.

All in all, we saw over 400 patients.  Many were given their sight back just with simple glasses that could not otherwise be obtained easily in this area, but seventy eyes needed surgery (mostly cataracts) in order to see again.  Many heard about Jesus for the first time in this mostly Muslim area, and many professions of faith were made.  Ten were baptized publicly on the shore of their village on the last two days of the outreach.  God was touching the lives of these folks indeed.  

I, too, was deeply refreshed during the quiet morning hours spending time in prayer and God's Word at the lake's edge.  God needed me to have my vision for life and ministry renewed as well.  God didn't need me to go on the trip.  I needed to be on the trip.

  

As I sailed away from this little peninsula for the airstrip, it was evident that God had been at work in me and through me, despite of me.  God is good.  Thanks for all of your prayers.   

This Just In...

From one of our correspondents in the field, Dan Galat. Possibly the ultimate matatu decal -- pretty much impossible to beat.

The Luxury Shuttle featuring Jesus and the Playboy Bunnies.

This gives El-Shedai & Rihanna a run for their money.

Favorite Matatu Decals

Most vehicles in Kenya, especially the matatu "taxis", have phenomenal decals, giving a glimpse into the owner's mind. Tangential thinking, one of my specialties. Thus, I, John, have been commissioned to digitally capture as many as possible for the McCropders. I shamelessly photograph other vehicles whenever possible. I rarely drive without myself or shotgun having a camera ready at all times, and matatu stops in large cities are a proverbial gold-mine. Of the top 50+ captured so far, here are just a few of our favorites to wet your appetite.

Driver and the "fare collector" enticing passengers with a handsome pose for the camera. We weren't sure if PACE MAKER is referring to what the matatu does or what is keeping it alive.

It's not an easy job. Right or left, gas or brake, EL-SHEDAI or RIHANNA?

Tough decisions must be made daily by matatu drivers the world over.

AMPHIBIAN ASSAULT: a plague of biblical proportions indeed.

STUNNING LIKE MY DADDY: Who knew a van could look so good?

The Small Lamb (right) takes on the much larger LAPTOP INTERNET on the Mombasa-Nairobi gauntlet.

CRUNK Aint DEAD: Crunk has a special place in our hearts as it was actually used by the McCropder boys. Anyone have any ideas outside of The Emperor's New Groove (Jay's favorite movie), who Crunk might be? This one if for you, Dykstra.

After leaving Crunk, we then boarded Baby Face with 30+ passengers (official counts all concur, 30+) for the last leg of our journey that day. A picture of Baby Face and Fader was a must.

OBAMA, NIKE swoosh. Yes we can. Just do it!

ISRAEL VIBRATION: Perhaps this is the feeling one gets when alignment gets neglected for too many years. Luckily, this guy has four spares on the roof when all four wheels go simultaneously. Interestingly, there is an ISRAEL VIBRATION JR., but he has been illusive to capture on film.

Speaking of JR's, here's TORMENTA 2. Appropriately named. This will be anyone's fate who dares book a ticket to ride. (Below the windshield says in silver, blood-dripping letters NO PHOTOGRAPHY). It had to be done.

The sheer energy and money that went into this paint job is mind boggling. She does look like a comfy ride though.

Many thanks to Scotch and Baby Face for their contributions to the collection. If you want more, let me know. This is just the tip of the burg, baby.

Yours Truly,

Crops

Mashujaa (Heroes') Day

One of the disadvantages of living in another country is that uniquely American holidays (such as the Fourth of July and Thanksgiving) are not recognized which means that we still have to go to work unless we use a vacation day.  On the flip side, we do get to celebrate Kenya’s holidays.  Kenyatta Day, celebrated on October 20^th, honors all the heroes who died fighting for independence and was named after Kenya’s founding president, Jomo Kenyatta.  The new constitution (adopted only a few months ago) renamed this holiday “Mashujaa Day” (meaning Heroes’ Day).  In a speech today, President Kibaki stated, “Mashujaa are men and women who have made a lasting mark in the lives of fellow Kenyans and in the history and development of our country. They are men and women who have taken great risks in service to save, advance and protect their fellow citizens. These are also men and women whose hard work, courage and perseverance have had a great impact on the socio-economic well being of our people.” 

Photo:  Mzee Jomo Kenyatta

We had our own little Heroes’ Day celebration tonight at Alyssa’s house.  Those in attendance each shared about personal heroes, almost all of whom were family members -- grandfathers, grandmothers, mothers, & fathers.  We appreciate all the heroes in our lives who have influenced us and given us a wonderful heritage.  Happy Mashujaa Day!      

This photo was taken on 20/10/2010 @ 20:10PM!!

COTW - Mr. Jeram and Neurofibromatosis Type I

Let me introduce you to Mr. Jeram.  He developed a transportation empire in the Rift Valley during colonial days using scores of donkeys and oxen.  His wealth and generosity became famous, and his place of residence was given the name Kapjeram by the Kenyans. 

  

One of his many sons married the woman above in the blue sari and moved to England where he also became a wealthy businessman.  After he died, every year her children would ask what she would like for her birthday, and every year she would say, "I want to return to Kenya and sponsor an eye camp in honor of Jeram for the people he loved."  This past week her dream came true.  

On Friday, May 28th, two well-dressed Indian businessmen (one being the gentleman in the previous picture with children on his lap - a grandson of Jeram) came to the Eye Unit to meet with me without prior notice.  They wanted the Tenwek Eye Unit to staff their UK-based Jeram Foundation's inagural event because of its reputation in the community.  Much to my surprise, the event was scheduled for the following Saturday with members of Parliament to be in attendance and 25 descendants of Jeram coming from England, Uganda, Kisumu, Nairobi and Mombasa.  

The Eye Unit staff worked hard to make the necessary preparations (medications, tents, PA system, radio advertisements, 100’s of flyers to communities and schools . . . ).  On Saturday, we drove our bus and Land Cruiser 50 km into the bush to Kapjeram. 

We saw over 600 patients over the next 8 hours (we didn't get started till 10 am because the bus got stuck in the mud for a couple hours until a tractor arrived to pull it out).  Within an hour of starting, we began bussing surgical patients back to Tenwek where David Sawe, our ophthalmic clinical officer, started performing cataract surgeries that afternoon and evening.  

I took a quick break from screening to give an impromptu speech to the dignitaries, family and guests.  Unfortunately, I followed the eloquent Member of Parliament.  Among other things, I tried to express how the love God had shown us at Tenwek was the reason we now expressed love for them in our eye work.   

Many people had blinding eye conditions such as cataracts and glaucoma.  Below are some of the ladies with cataracts waiting for their pre-operative eye measurements back at Tenwek Eye Unit, getting a word of encouragement from one of the hospital chaplains.

By Saturday night, we had 72 patients crammed into 36 beds.  After a total of 6 round trips with our bus and Land Cruiser over the next few days, we had completed nearly 90 surgeries!  Despite its last minute feel, the eye screening was massive and flawlessly organized by our veteran eye staff, namely Richard Tonui.  We then worked several late nights to finish all the surgeries.  I am proud to be part of such a team! 

Unfortunately, we weren’t able to help everyone.  We had three kids like this little girl who was blind from meningitis.

One of the more interesting cases of the day, our CASE OF THE WEEK (COTW), was an 18 year old boy who was crippled and hiding his eye under his hat.  Per a relative, he began having eye problems at the age of 3.

On exam, his eyelids were like a "bag of worms."  His left eye still saw a bit, and it seemed odd that a tumor 15 years old hadn't completely blinded his eye and killed him by now.  We got a little more history and found that his mother also suffered from a similar disease.  Up close, he had some interesting nodules on the iris (colored part) of his good eye called Lisch nodules - small glial hamartomas.  This clinched the diagnosis of Neurofibromatosis (NF) Type I, part of the Phakomatoses family of diseases.  

His eyelid tumor certainly is from a neurofibroma, but an optic nerve glioma may also be growing behind his eye as they are also seen in NF-1.  He is likely crippled from neural and bony lesions associated with NF-1.  In fact, I was able to get in touch with a hospital that operated on his leg three years ago, and they had removed a neurofibroma from his knee.

For the real dorks in the crowd, I remember that NF-1 is on chromosome 17 because there are 17 letters in NEUROFIBROMATOSIS.  NF-2 is on chromosome 22.  Easy enough, ehh?  

The Phakomatoses are autosomal dominant with the exception of those that have a "W", Sturger-Weber (Encephalotrigeminal Angiomatosis) and Wyburn-Mason (Racemose Hemangiomatosis) as well as Ataxia-Telangiectasia.  This means that the patient has a 50% chance of passing his disease to each future child.  All of his siblings and mother should also be screened for NF-1 and its associated tumors, which are many.  The Jeram Foundation has agreed to sponsor him for a CT scan and then reconstructive surgery at Tenwek.  We thank God for sustaining the eye unit through this past week.  I pray that the gift of sight many received will enable them to also see the gift of life that God offers to them freely.