To Save a Tooth

By Stephanie 

In some ways living in a medical community in rural Burundi can mean minor medical problems get diagnosed much faster then they would in the US. If you see a new rash on your child's arm you can just run over to your neighbor the pediatrician, or if you’re having persistent abdominal pain your teammate, the ER doc, can do an ultrasound on you in the comfort of your own living room. But one area of medical care that we have no resources for here in Burundi is dental care. We have had dentists interested in joining our team, but reality is that routine dental care is beyond the financial ability of the average Burundian. Here in Kibuye when patients have a tooth abscess the medical care that they receive is getting their tooth pulled, usually being unwilling to pay the less than $3 to have the area numbed first. 

In mid September our 10 year old son began complaining of tooth pain. He’s never had a cavity and saw the dentist in the US this summer, so we assumed that his pain was related to a new tooth coming in and pushing on his other teeth. However, as the week progressed so did our son’s pain, to the point that he wasn’t getting any sleep and we had him on ibuprofen and tylenol around the clock. Then he started being lethargic, staying in bed all Saturday while his friends ran around the compound. By evening he had a fever despite the tylenol. We also noticed that one of his adult teeth had become wiggly.

We went to Saturday family worship with our team and asked for prayer. After the service a teammate offered the name of a dentist in the US, Dr. Hank Willis, who has willingly consulted on their dental questions in the past. We e-mailed him right away and immediately received a response. We sent him some pictures and he asked us some questions. Our son didn’t seem to have pain when we pressed above his teeth and in fact we weren’t even exactly sure which tooth was having the problem.  One of the questions Dr Willis asked was about reconstructive work to our son’s teeth. We missed that question at first as we answered others, but then realized that our son had had a chip to his left lateral incisor fixed this summer. Could that be the problem? The chip was the result of a fall 2.5 years ago. Dr Willis told us the tooth was probably necrotic and our son would need a root canal. He was even kind enough to offer to do the root canal for us …. if we wouldn’t mind flying to Idaho.  

                                                                                                                               Dr. Hank Willis

This threw us into high gear. Where could we go in East Africa to get a dental opinion we could trust and the level of care we wanted for our son? We had heard that there was a Canadian dentist who was setting up an office in Kigali, Rwanda. But we weren’t sure if his practice was open yet. Was he in Rwanda or Canada at this time? How do we get in touch with him on a Saturday night in order to arrange to travel ASAP? Well, we turned to another team friend and missionary in Gabon, Dr. Drew Huang. Drew is one of those guys who knows everyone! We gave him a call and sure enough he had the private e-mail address of the Canadian dentist in Rwanda, Dr Jesse Wong. We e-mailed Dr Wong and started our son on oral antibiotics. 

Early the next morning we received an e-mail back from Dr. Wong. He was indeed in Rwanda and could see us at 8am Tuesday morning. We booked airline tickets for two, a hotel, arranged transport, then borrowed Rwandan money and SIM cards from teammates. We also hunted down our passports which were in the capitol for visa renewal.  As we arranged all this our son was back out playing with friends, only occasionally complaining of pain. Had we not consulted Dr. Willis we probably would have believed that the antibiotics were taking care of the issue and stayed put in Kibuye. 

Monday we began our journey to the dentist with a 3 hour car ride to the capitol where we were able to find the correct office, wait for someone to arrive, and pick up our passports. We then flew to Kigali. And as is typical with African travel, the airport visa line was long, our hotel driver was not there to pick us up, our SIM card did not work…. but we sorted things out and got to our hotel.

Tuesday morning we went to the office of Dr. Wong at DMC Dental. The clinic was 

clean and modern, even having a TV mounted in the ceiling for our son to watch as they worked on his tooth. Dr. Wong was quick to see the issue on x-ray, a large infection above the tooth that had been chipped in the fall years ago. The infection was so large that Dr. Wong left the hole in the tooth open to drain overnight. Our poor boy spent the rest of the day spitting out draining puss and watching The Peanuts Movie in our hotel room. On Wednesday morning we returned to DMC Dental where Dr. Wong cleaned out the tooth again. He really wanted to finish the root canal for us then, but there was still too much drainage from the infection. He put medication in the tooth and we will return to Rwanda in November to assess the infection and hopefully finish the root canal.

  

During this episode our son asked us “What would have happened if I were a Burundian?” So we talked about the lack of pain control that would have been available to an average Burundian boy, the delay in diagnosis because of the cost of a medical consult, and how his adult tooth probably would have been pulled.  Medical care is improving in Burundi, but there is still a long way to go. Events like this make us feel our privilege in being able to access the best medical and dental care for our kids, even if it means traveling to another country. 

What Goes Around, Comes Around: An Ear for an Ear

by Jess Cropsey

In 2010 at Tenwek Hospital in Kenya, John fixed the earlobe of a patient who came in for cataract surgery. The patient seemed more happy about his ear than having his sight restored. Almost 9 years to the day later, John found himself in need of a similar favor.  

We were just wrapping up a heated game of Dutch Blitz with the Fader family on Saturday evening when some of the kids decided it would be a great idea to play a trick on Uncle Jason (who chose to spare us all from a humiliating defeat and change the oil in the van instead). The weapons of choice (water balloons) were switfly loaded and plans were made. John, Heather, kids and I stealthily crept out to the “man cave” where Jason was busy at work. Unfortunately, he was underneath the vehicle, surrounded by lots of items that really shouldn’t get soaked. So, the kids left, disappointed that their plans were foiled.  However they quickly perked up when I suggested that we switch targets to John. We waited for him outside while he talked to Jason.  And we waited.  And we waited some more.  Seriously, how much is there to say at 9PM?  At one point, we even knocked over an empty crate thinking the noise might cause him to come out to investigate.  Alas, no.  After more waiting, John finally emerged, but the noise had made him suspicious. He spotted us right away and made a mad dash for the house.  We were on his heels and had him surrounded when he said, “I think I ripped my ear.”  Not sure whether he was fibbing to get out of his predicament, we paused … and wondered whether it was okay to pelt him with a water balloon even if he was actually hurt.

A quick glance proved he had indeed torn his ear on a branch, but it wasn’t bad enough to stop him from grabbing a balloon from one of the kids and smacking me in center of the back.  My aim was right on too though.  Our ammo was quickly exhausted and we took a closer look at the injury to analyze the extent of the damage.  I wasn’t about to touch it (just writing about it gives me the shivers), so I took a picture for him to look at.

It was decided that a few stitches would be required to repair it properly.  Fortunately, Darrell Baskin, former teammate & retina specialist who happened to be around for a 2-week visit, was up to the task.

Patient being prepped for surgery

Cleaning of the surgical site

Surgery commences, and micro-surgery for that matter!

Viewing for Micah & Sam made possible by the surgical camera

Post-op

Happy patient & surgeon!

The offending branch was cut down the next day to prevent future injury.

For more stories about times we've had to treat each other, visit these links.  Not surprisingly, this isn't the first time John has had to have a teammate stitch him up.

https://mccropders.blogspot.com/2014/12/some-of-reasons-why-we-love-uncle-carlan.html 
https://mccropders.blogspot.com/2018/04/medical-evacuation-part-2.html   

Marsupial Moment

By Julie Banks

This year I find myself teaching Science for the first time at KHA.  My degree is a Bachelor of Music with a major in Vocal Performance, so it seems somewhat natural for me to teach music, composers, drama, dance, and other such arts.  But Science is different.  Daily I’m surrounded by these doctors who were Biology and Chemistry majors and would be far more qualified to teach our students’ science class. But here I am!

Thus far our Sonlight curriculum has had us exploring all sorts of interesting and exotic animals.  Many days we read books, look at pictures, and do worksheets and crafts.  Probably much like a North American Science class.  But I’m sure our conversations about our real life experiences with these animals are much different than the conversations you might hear in a 3^rd grade classroom in the States! 

KHA 3rd Graders: Alma, Ben, Zeke

These MK’s, or “Third Culture Kids,” absolutely amaze me with the knowledge they already have just from living this globe-trotter life their families have been called to embrace.  Alma, Ben, and Zeke have lived and traveled all over the world!  Between these three precious ones, they probably have traveled to somewhere between 20-25 countries!  One has plenty of Arctic Canadian wildlife stories, another has ridden a camel at the Pyramids of Giza, another’s car was invaded by wild monkeys.  They’ve seen wildebeest graze the savannah and giraffes stretch their long necks to feed on acacia branches.  They’ve encountered hippos in the wild, and stared wide-eyed at kingly lions.  Sometimes physician training takes our families to Asia where our kids have had the chance to see pandas in their Chinese home, or ride elephants through the jungles of Thailand.  These three kids have even seen the rare spectacle of penguins that live on the beaches of South Africa.

But this week I finally found an animal (and a continent!) that they have never seen:  Australia’s beautiful kangaroo.  These marsupials are a true wonder from their soft pouches to their knock-out punches.  I tied a “pouch” onto their bellies and we stuffed little “joeys” inside and took them for a bouncy ride.  

We even tried eating greens like a kangaroo!  

Next I snuggled the triplets into their own cozy pouch (read: missionary-sized duffle bag) to watch a video of kangaroos bouncing and boxing. 

What a fun day.  We learned.  We laughed.  I thank God that He is challenging me to stretch past my comfort zones. 

We are four weeks in to the school year and today my son casually asked me the same question many adults love to ask 8 year olds, “What’s your favorite subject in school?”  And do you know what?  I surprised even myself by saying “Science!”

Well, I guess this music girl did end up bringing a little “drama” into Science class after all!

Magic Feet

by Lindsay Nimmon

"Mama always said there's an awful lot you can tell about a person by their shoes. Where they're going, where they've been. I've worn lots of shoes. I bet if I think about it real hard, I could remember my first pair of shoes. Mama said they'd take me anywhere. She said they was my magic shoes." Forest Gump shared this little insight with a lady while sitting on a bench, waiting for a bus in the movie by the same name released in 1994. Mama may have said something slightly different if she had lived in Burundi. Here, you can tell an awful lot about a person by their feet -- where they've been, perhaps their occupation, the economic constraints on their lives.



In Kibuye, most of the time, there are no magic shoes taking people places. There are just the bare feet of our neighbors. These feet are covered in red dirt from the dusty paths they tread on each day, from the fields they hoe and cultivate. These feet are covered in soot from standing and raking in piles of charcoal. These feet are calloused and cracked from years of walking many hours to their places of work.



People’s feet are their primary mode of transportation most of the time. Children walk for water or chase their family’s goats through the countryside. Teenagers play soccer in a field by the church. Men herd cattle and push bikes loaded with merchandise.

When feet don’t work well, life in Kibuye is particularly challenging. That long walk to work and the physical labor that follows is slow and even painful. It means falls when the paths become slippery mud in the rainy season. 

Some feet get covered in shoes only for church on Sunday or a special event. These shoes are scrubbed and dried in the sun - sometimes after each use. They are prized and cared for as such.

The bare feet of villagers here may not take them anywhere as Mama said, but their feet do take them everywhere they need to go. The places they’ve been are embedded in the lines on their soles. Feet in Kibuye tell a story - a story of poverty and need, of hard work and tenacity, of strength and long-suffering.

Global Missions Conference Africa 2019

(by Eric)

As some of this readership knows, Rachel and I met each other in Louisville, Kentucky in 2003 at an annual event called the Global Missions Health Conference.  We have been back to that conference a half dozen times since then, including a bit of a capstone last year, when the we (the couple who met there) moderated a panel on "Marriage and Missions".

Halfway around the world, a sister event was established in Nairobi, Kenya, about 7 years ago.  This GMHC (rebranded this year to GMC-Africa) had a few partners from the West (or "Global North", i.e. the USA and Europe), but is truly an African run and led event, where Christians, especially in health professions, gather together to share about the question: "How do we pursue the mission of God in his world?"

For several years here at Kibuye, we have offered a small sponsorship of senior medical students at Hope Africa University to attend this conference.  Sometimes we've had as many as a dozen of them take the long bus ride to Nairobi, and their report has always been excellent.  However, early September being a bit of a difficult time for our teammates to travel (e.g. end of summer, start of school), it's been a challenge to get there ourselves to participate.  

This year, I was pleased to get to travel with our Burundian Medical Director at Kibuye, Dr. Gilbert, to GMC-Africa.  The two of us had a great time together, and I got to see a few old friends from Kenya (in addition to some HAU graduates now studying in Kenya).  The sessions were truly encouraging, especially regarding the quality of the African leaders and speakers.

So, what is an African-led missions conference like?  Generally, two things stuck out to me.

1.  Wholistic Mission Comes Much More Naturally to Africans

As someone who has thought a lot and presented multiple times on the wholistic nature of the Gospel and the Mission of Christianity, I have often received responses from my fellow Westerners like "Wow, I've never really thought about this before."  The presenters at this conference took the question for granted.

"Wholistic mission is looking at the total needs of the total person because the total man is broken."
"We say 'Complete the Task".  But we have not asked 'What is the completed task?'"

This guy, Rev. Dr. Dennis Tongoi kept me scribbling notes the whole time, thinking "that's what I've wanted to say!"

I'm so glad that our African brothers and sisters have resisted the false dichotomy of word and deed.  Another presenter asked "If you had to choose to only read your Bible (without praying) or only pray  (without reading the Bible) for 2 years, which would you choose?"  Answer:  "I hope you think that is a ridiculous question.  May the day come when we react the same way to the idea of 'Should we be doing word ministry or deed ministry?'"

2.  Call to the Global South

As the below table from the Pew Forum shows, the global distribution of the world's Christians has shifted dramatically in the last century (see also this article from the Washington Post).  The "Global South" is the term used to refer to Africa, Asia, and Latin America.  Note from the last column that most of the World's Christians live in the Global South today, a percentage that is only expected to increase in coming decades.

Given this reality, the question that (rightly, I think) preoccupied the African audience of this conference was "What are we going to do about it?"  The prevailing sentiment was that it's time for Africa (and yes, Shakira was quoted) to step up and lead, and not wait for other countries to get on with the work of Christianity in the world.  There was a definite willingness to continue to partner with brothers and sisters (like me) from the Global North, but they emphatically wanted to see this task as their task as much, if not more so, than a task belonging to another culture.

And from what this conference displayed of the leadership potential of that Global South, I was encouraged to hear it.

The Saga Continues

Summer is the Empire Strikes Back of the school calendar. Everybody goes off on their own adventures, but Han gets frozen in carbonite and Luke loses a hand. It’s not until we return to school and everyone is back together that we are able to save Han and defeat Jabba together. Sure, the Empire is building another Death Star, but you know that by the end of the school year we are going to be clapping our hands out of time to the music with Lando and dancing with Ewoks. 

In case my analogy is unclear, I look forward to the start of the school year in Kibuye. I appreciate the book recommendations my students have to offer from what they have read over the break. Their insights into Endgame and what might come next in the Marvel Cinematic Universe are worth evaluating together. A new school year means a new round of Learning Experience Days is before us, another era of history to explore, new books to dissect, and another year of fellowship as a team. 

Despite all the excitement of a new year, there are also some key characters missing. There are now four Kibuye Kids attending high school in Kenya. The dynamic in our Kibuye classroom is different without them and parents and siblings feel their absence. It is not just these few missing people, but we all have loved ones who live half a world away from Kibuye. It is almost as if the Empire is building a new Death Star, but the Rebellion remains scattered. 

Many of the people who make a place feel like home are missing. It can feel as though there are perhaps multiple homes. Life continues in those multiple homes even as life continues in Kibuye. It is a difficult reality that our loved ones experience suffering while we are far away. Several of us on this team have suffered the loss of a loved one in the past two years. Many of our friends and family members who are far from us have experienced disease, divorce, or death. Just this morning, my family received news of friend diagnosed with a rare condition causing multiple cancers throughout her body. 

Simply put, this school year brings with it an array of emotions and spiritual challenges. I want to be present for so many people in so many different situations. I especially want to be there for those who have lost a loved one and for those whose prognosis is terminal. I want to make things better.

In the opening scenes of Avengers: Endgame, Tony Stark adrift in space, says he hoped to pull out one more surprise and miraculously make it home. He has come to the end of his resources. Although Tony is saved by someone else in this particular situation, there comes a time for all of us when our ingenuity, our strength or agility, our charisma, or sheer fortuitousness will not prevail. When difficulties come for us or for our loved ones, when push comes to shove, to what or whom can we turn? 

Unsurprisingly, I am no one’s Luke Skywalker. I cannot make boarding school closer to home, heal the terminally ill, or save anyone. Praise God, that He has given us a Savior who is good, faithful, and all powerful who can address each of these struggles. Jesus knows intimately our burdens, fears, and circumstances. Jesus does not rescue us with an Iron Man snap of his fingers. No, our rescue required much more than that. My sin demanded the shame and brutality of the cross. Christ bore the annihilating blaze of God’s wrath for me. No mere snap of the fingers, but a descent into the raging chaos of Hell was necessary to secure my salvation. To seal the deal, Jesus rose from the dead to ensure that nothing would ever separate me from Him again. 

In Fellowship with others is where the victory that Christ has claimed is most assuredly felt and realized. God has brought us together as the body of Christ and Jesus himself bears our burdens and those of our loved ones, near and far.  This school year, I am most excited to see Jesus transform lives and carry each of us into deeper relationship with Him. 

Boarding School: Blessings, Losses, and Trust

(by Heather Fader)

In this season, I cannot yet write a comprehensive blog post about the subject of boarding school, as we are in the throes of transition to this new stage of life.  We are one of the three Kibuye families whose children have begun high school at Rift Valley Academy in Kenya.  Without a doubt, it is a fabulous opportunity for our kids to be at such an incredible place.  At the same time, this brings changes that must be processed and losses that must be grieved.

Rift Valley Academy is an absolutely phenomenal school.  Alumni attest to that, including Jason and other family and friends.   And after attending orientation there this weekend, I am beyond impressed with the staff, academics, dorm life, student care, family support, and school culture.  RVA’s vision is well-thought-out and extremely well-executed: 

Burundi Girls turned RVA High School Students

RVA Cafeteria - impressive!

RVA Chapel - Students gather here 5x/week

And the students generally thrive and grow to love it.  These young people are bright and brave.  The two returning RVA students from Kibuye, Jonah (grade 12) and Matea (grade 10), are quite settled and happy there.  Even my brand new ninth grade daughter, while perhaps slightly homesick and at times overwhelmed, is having a great time with old friends and new friends.  She is giving positive reports on her classes and teachers as well.  We are confident that she and the other Kibuye kids will continue to thrive there.    

But. Even so, my heart just aches as I miss my child.  Our missionary callings involve a lot of separation and loss, but for many of us, this separation is among the very most painful. 

Burundi families at RVA this past weekend

So we remind ourselves to remember what we know to be true.  God is loving and faithful and good, and he loves my child more than I ever could.  He has already shown such grace in bringing these four Kibuye kids to such an amazing place where they can learn and thrive at RVA.  He works in ways we do not understand in order to bring about growth that we cannot even imagine.  He is present in new dorm rooms and present in the tears of the mamas missing their children.  He can redeem all things.  He answers prayers. 

“The wonderful thing about praying is that you leave a world of not being able to do something, and you enter God’s realm where everything is possible.  He specializes in the impossible.  Nothing is too great for his almighty power.  Nothing is too small for his love.”  - Corrie TenBoom

Ella moving into her new dorm room

Maddy (friend from Bujumbura), Anna Fader, and Ella Sund outside their dormitory

The students from Burundi on the first day of class.  Please pray for these five.

But Not Forever

by Rachel

Gloria was a well nourished, healthy pregnant lady when I saw her in the hospital last month, all smiles.  She was pregnant with twins, already at her due date, with a previous C-section for her first delivery.  We made plans to do another C-section for her later in the day.  I delivered her babies, one boy and one girl, beautiful children without problems.  There was some extra bleeding during surgery, but we treated it appropriately and she did fine.  The whole family was full of joy at the blessing of these twins.  I got a call later that afternoon.  Gloria was bleeding again.  I made some recommendations, and the on call doctor also decided to give a blood transfusion.  Then around 9pm I got another call.  She was not doing well…could I come right away?

I ran up to the hospital.  The bleeding had stopped but Gloria was sitting upright in bed, gasping for breath on oxygen.  Her eyes were wide and the room was tense.  I quickly stopped her transfusion, fearing a transfusion reaction.  The team surrounded her bed, running for medications, pulling out all the stops.  No change.  Finally we moved her to the operating room where there was a better oxygen supply.  She lay on the table, struggling, staring into my eyes, so afraid.  We intubated her, and pulled almost half a liter of fluid out of her lungs.  She was literally drowning to death.  Minutes later, her heart stopped.  When I went back to tell the family they couldn’t even look at me.  They just turned and walked away.  I walked home after midnight, feeling discouraged and beaten.

The day before, I had finished the final proofreads on Eric’s book (see here).  It’s a terrific book, full of promises and light in the darkness, but also full of stories of real people we’ve seen over the years, many tragic stories of sickness and death and doubts.  It left me feeling raw, and with Gloria’s death coming on the heels of my read of the book, it all felt like too much again.  Why are you not acting, God?  How long, Oh Lord?

But as is often the case, God provides answers that I need to hear at just the right time.  Days earlier, I had been listening to a sermon series from my home church in Ann Arbor.  The pastor, Brian Gregory, has been preaching a series on Daniel.  Honestly, other than the fiery furnace and lion’s den, I’ve never given much time to reading through the book of Daniel, but was powerfully impacted by this message on Daniel 8 (if you’re interested, you can hear the whole sermon here).  Daniel has a vision of the future, a terrible future full of the wicked prospering and the innocent suffering.  And the summary of Daniel’s response is basically, “How long, Oh Lord?”  The response from heaven is: “A long time.  But not forever.  Because the Lord will act.”  So Daniel is very sick and grieved.  But then he gets up and continues the work that he has been given to do by the king.

I couldn’t get this message out of my head.  It resonated with all my emotions and longings that week after Gloria died.  All of creation is crying, “How long, O Lord?”  We know that the world is broken.  We know things are not supposed to be this way.  And I think if the response from heaven was, “not much longer,” it would feel false.  It would feel like vain hope, because we KNOW that things don’t seem to be getting better as quickly as we would like.  God is acknowledging that the world will not change quickly.  Not for Daniel.  Not for us.  Perhaps we will not see justice in our lifetimes.  But the promise is, and I choose to believe it, that this world and its troubles and its injustice WILL NOT last forever.  Because the Lord will act.  I can’t see how Gloria’s life turned out the way I wanted.  The systems are broken, and on some level we failed her.  But God promises that even this death, even this sorrow, even this story, will be redeemed.  I can hold on to that.

So, as Daniel did, we grieve.  I think that’s important, not to gloss over the pain that we experience.  As most of us know, one can grieve and have hope at the same time…they are not mutually exclusive.  I grieve for Gloria’s family, and her babies that will grow up never knowing their mother.  But then I also get up and continue on in the work that God has prepared for me.  Longing for the day that he will make all things right, but working in the “not yet” of today, knowing that the sorrow will last for a night, perhaps a long night, but joy comes in the morning. 

Eric's Book: Promises in the Dark

(from Eric)

Several years ago, I drafted a series of stories and reflections from my life as a missionary doctor.  The stories center around the theme of "Walking with Those in Need Without Losing Heart".

Jesus calls his followers to enter into the broken places of the world.  That much is clear.  This may be on a personal level, like a family member dealing with a divorce or a chronic illness.  This may be on a vocational level, as a social worker or an inner city teacher or a missionary doctor.

We are called to walk with those in need.  And it takes its toll on us.  How do we avoid burn-out on the one hand and cynicism on the other?  How do we remain faithful in the midst of the tension that is our broken world, where the promises of God are not yet fully realized, and where even their smallest glimpse can be hard to find?

My hope is that this book has something valuable to add to these questions.  I'm excited to say that, after several years of refining, Promises in the Dark: Walking with Those in Need Without Losing Heart will be available October 14, 2019 (less than 8 weeks away!) from New Growth Press.

It's already available for pre-order on Amazon at this link.

Here are a couple endorsements that I've been glad to see:

“Eric McLaughlin brought me to tears with this honest look at the difficulties of the life of a compassionate caregiver. When dealing with this broken world, there are no simple answers. But there can be hope. Promises in the Dark is essential reading for anyone who walks with others through suffering and questions how to keep on going.”
- Dr. Kent Brantly, Ebola survivor; coauthor of Called for Life

“Why do we love lawyer and doctor shows? We know both worlds bear extremity, suffering, and passion, and that is at the core of what intrigues and terrifies us. Eric McLaughlin, a missionary physician, engages the raw and compelling questions of what it means to be human and trust God in the face of a world that is stark and at times cruel. Eric offers no simple answers or trite truisms. Instead, he invites us to engage the questions with the confidence that there is nothing we face that Jesus has not first entered. The song sung in this brilliant book is that death is real and horrible, far more so than our antiseptic Western world can bear, but death never gets the final word. There is something about life and love that lingers far longer than heartache, and it is this story that enables us to enter all other losses with hope. This book will intensify your passion and encourage you to live the best story ever told.”
- Dan B. Allender, Professor of Counseling Psychology and Founding President, The Seattle School of Theology and Psychology

“What does a lived-out faith look like in the throes of an African field hospital? In a world of disease, death, and brokenness—of broken promises—how does one live as a light to the world? The answers to these questions are to be found in the pages of this honest book.”
- Michael Card, Songwriter, Bible teacher

COTW: Hip Dislocation

By Jason
We have not posted any "Cases of the Week" (COTW) lately, despite the fact that every week we are all presented with something that expands our minds and keeps our noses in the books.  So much of what we see are common diseases/injuries that present long after they started, for one reason or another, which makes them more difficult to treat.
This case is no exception. It was a young man in a car accident who had a posterior hip dislocation.

We see these once every month or two.  But this one had occurred several weeks before he came to the hospital.  I remember years ago when I treated my first patient with a hip fracture, I looked in a great book called Primary Surgery, which gives incredibly poignant advice on most anything a surgeon would encounter in a developing world hospital and how to treat it with limited resources.  The picture that accompanies hip dislocations is below:

This seems to imply that putting the hip back in the socket takes about as much force as patting a dog on the head.   I have found that this picture grossly under estimates the amount of force necessary, especially for a hip that has been dislocated for a few weeks.  For our patient we gave a spinal for complete relaxation (sometimes we can do it with just sedation).  Then we tried pulling up on the patient's leg while he was on his back (this often works, but requires a pretty strong back on the part of the healthcare provider it requires moving the patient to the floor, so that no one would fall off the bed.  See poor example below.). 

When that didn't work we flopped the patient back up on the OR table and progressed to the maneuver in the first picture, but we couldn't generate enough force.  So finally we had a medical student sit on the patient's calf while another held the ankle and then did some gentle rotations, swinging the patient's leg back and forth and then we heard it - the wonderful clunk of a reducing joint.  Maybe this can be named the "Kibuye Method for Reducing Hips" in the next edition of Primary Surgery!  The patient did well and was eventually able to walk again without any difficulties.