By John W. Thompson, M.D.

This is a diary of Dr. John Thompson, an Orthopedic Surgeon, on his three weeks at Kijabe in April 2001.

Between our trip to Kenya in April, 1999, and our present trip things have changed with the airlines. We could not get American to give us a free ride on our two bags of medical supplies. We were told that so many people were making the same request, that about a year ago they changed their policy and stopped letting extra baggage, even though they may be medical supplies, go through for no charge. This time it cost us $300 for the two bags.

The eight hours we spent in the hotel in Zurich were welcome because we slept very soundly. The flight out of Zurich was delayed because flights into Zurich from other European cities were late and therefore our flight was delayed while we waited for those passengers.

When we arrived in Nairobi, all of our bags accompanied us. It has been raining and the roads are full of deep puddles and huge pot holes. Last year, Kenya was in the midst of a severe drought, so the greenness of the landscape is a welcome relief.

We went to the Mayfield Guest House for about two hours until the shops opened. We met a couple, there, who had made the trip to visit their 18 year old daughter who was spending a year teaching at an elementary school not to far from Kijabe. She graduated from the Irish equivalent of high school last June and will start “university” in the fall.

On our last two trips, we stayed in an apartment which was nice but rather small. This year we have been assigned to what will be known as the “Orthopedist’s House.” Several months ago, a visiting orthopedist and his wife, were assigned to this house. It was so dark, damp, and just generally uncomfortable, that they donated the money to renovate it. We are the first to stay in the refurbished house. The living room wall was pushed out, and skylights installed, in the extended ceiling, as well as windows all across the front. This cost about $3,500. The house has four bedrooms, a very large living/dining room and a rather nice kitchen.

This evening we were invited to dinner at the McMillian’s house. He is the head of the General Services activities of the hospital. Last year he was in the process of developing a new water supply for the hospital. They had found a spring, about two kilometers from the station, and in digging this out, they found that it was much more extensive than anticipated. They kept digging until they came to a granite head wall out of which emanated about eight springs. They had to put up a concrete wall or dam and topped that off with concrete so the water source is completely sealed off from the outside. He said the water is bacteria free.

Just as we were going to bed I received a call to the OR. One patient had been thrown to the ground in an MVA and had abraded an area about 2 1/2 inches in diameter over his left shoulder, that went down to the muscle. The other patient was a young man who had fractured his proximal ulna and also dislocated the radial head at the left elbow. He had a puncture wound over the area of the radial head so we just irrigated it out and scheduled him for surgery in the morning.

April 6-

The young man with the fracture dislocation of his left elbow was taken to surgery this morning. I put a plate on the fractured ulna but unfortunately, I yielded to Dorcas, and didn’t get an X-ray in the OR while the patient was still anesthetized. When the x-ray was done, much to my dismay, I found that the radial head was still dislocated. We had to take him back to the OR to correct this. He had knocked off a piece of the radial head, and this was keeping it from dropping back into the joint. When I placed this fragment, in its proper position, the radial head reduced quite nicely.

The second case was an older woman who had a “pathologic” fracture of the left femur, caused by some type of cancer. It was obviously, a metastatic lesion. the fracture was fixed with a rod, and then I packed “bone cement” into the femoral canal to try and strengthen that area. She probably won’t live more than a few months, but she will at least be able to get out of bed.

April 7-

The major part of the day was uneventful, being occupied with reading and listening to music. At about 6 PM I was called in to operate on a nineteen year old young man who fractured his left tibia and fibula when a tree fell on his leg. The tibial fracture was open and the wound was quite dirty. We had to irrigate the would extensively and also had to scrape dirt off of the end of the bone. We then applied an external fixation device to stabilize the fracture. I got back to the house at about 8:30 PM.

April 8-

In the church service this morning there was no mention made of the fact that that today was Palm Sunday. It was just a typical service in the AIC congregation. There were some birds flying around in the church catching moths, but otherwise the service was the same as we have experienced when we have been here in the past.

This afternoon, the telephone rang, and of course I thought it was the hospital. Much to my surprise it was a friend of long standing, Fred Shively who lives in Indiana. Fred and his wife Kay, arrived in Kenya on Wednesday for a conference of Church of God pastors which starts in Mombasa tomorrow. We had corresponded with them, via e-mail, regarding our respective trips to Kenya. I had suggested to them that it would be interesting if they could visit Kijabe. The missionary, Don Riley, with whom they are staying, brought them out from Nairobi. After a rather circuitous search, they finally found someone who knew where we were staying and then they called us. Betty had seen the car go by our house at least twice, and wondered to herself when she saw the lettering on the door, what a car from the Church of God would be doing at Kijabe. She didn’t say anything to me about it or I might have remembered that the Shively’s were to be in Kenya at this time. We visited for awhile and then took them down to meet Ted and Colleen Tsugimoto, who are leaving for Congo tomorrow. They were able to spend a few minutes talking with Ted and Colleen before they had to start back to Nairobi. It was interesting to learn that Colleen was acquainted with Don Riley’s triplets, who were in the same class at RVA as one of the Tsugimoto children, several years ago. Mr. Riley and his wife had been missionaries in Tanzania for several years before they moved to Nairobi.

We hadn’t seen the Shively’s for several years. It is rather ironic that we met in Kenya several thousand miles from our respective homes.

We had an invasion of flying ants tonight. They came in under the doors. They have two pairs of wings and apparently their life span is very brief, at least in the flying stage. The rain seems to bring them out. It has been raining quite heavily the past two days. The rain comes in sudden squalls with large rain drops which beat heavily on the skylights and metal roof, causing a great deal of noise.

April 9-

The concrete area just outside the back door was covered with the wings of the flying ants. What happens to the ants is not clear, but the wings are discarded after their brief time of flying.

I met the new orthopedist today. He is from London and his name is Richard Brueton. He has taken early retirement from the British NHS and is now going to Bible college. He thinks that he may want to work in a hospital such as Kijabe, so is here to get a taste of a mission hospital. Two medical students arrived from the UK today. They go to the University of Sheffield. One is a Kenyan although he has lived in England long enough to speak with a British accent.

One of the patients we operated on today had injured his left thumb, with a machete, back in 1990. He had some type of surgical procedure done on it in 1995, but continued to have exquisite pain when one area was touched. He had a swelling or “mass” in this area. He wanted his thumb amputated because of the pain. When I made an incision over the mass, it became obvious that there was a “tumor” as the source of the swelling. The mass was about 5mm in diameter. I think that it might be what is called a glomus tumor. If I am correct, by excising the tumor his pain should be gone.

Dr. Brueton saw a 12 year old girl who fell out of a tree two months ago and has not been able to put any weight on her right leg since. Xrays showed that she had a fracture dislocation of her right hip, but in addition, she has signs of osteomyelitis involving the entire femur and possibly the pelvis itself. Her chest Xray was also abnormal so we really don’t know exactly what is wrong with her. We will probably try to drain the distal femur tomorrow, which is the area of the most obvious bony changes due to the osteomyelitis. This patient was subsequently found to have a bacterial endocarditis. She is critically ill.

It rained again today but after a brief downpour it stopped. The rain has caused the area to be lush and green which is in direct contrast to when we were here in February, 2000.

April 11-

Last night we really had a severe rain squall sweep through. The wind howled and the rain came down in torrents. Today dawned rather clear, and by mid-morning it was a beautiful, warm, sunny day.

Today was also clinic day. The parade of unfortunate people who come through the clinic is hard to imagine. The pathology is also astounding. There is a distinct contrast between the Kenyan “haves” and “have nots” and this was manifested in the clinic today. I saw two women patients, one in the “private” office and one in the general clinic who were very fashionably dressed and who spoke very good English. They both were obviously much better off than the average Kenyan.

We had seen a 10 year old girl in the morning, on rounds, who supposedly had the onset of severe pain in her left leg, just below the knee, on Sunday. Her lab work suggested an infection, and clinically she had findings consistent with acute osteomyelitis. We took her to surgery this afternoon and found a considerable quantity of pus just under the periosteum, the tissue that typically lies on the bone. I put two drill holes in the bone for drainage, and the first one yielded some more pus. Hopefully, the infection can be controlled with IV antibiotics, now that the bone has been decompressed.

Dr. Brueton told me today that he plans to be married in July. He is a 56 year old bachelor but since he retired from the NHS he said that he could focus his attention on other things and discovered that this lady, whom he has known for several years, was very appealing. He asked me if I thought that he was too old to marry and I said that I didn’t.

April 12-

The day again dawned clear with only a few scattered clouds. This was not a harbinger for the rest of the day, for it was a very trying one. Our first case was a 73 year old Kenyan man who told Dr. Brueton that he had left his home at 5 AM Tuesday morning to get to the hospital for his surgery. He had to walk 25 kilometers to get to a place where he could get a vehicle. He apparently got a ride to another site where he was able to get a ride in a Matatu to Kijabe. He had a mass in his left thigh that was about the size of a small turkey. It was the most incredible thing that Dr. Brueton and I had ever seen. It is probably going to turn out to be a malignant liposarcoma.

The second case was a three year old girl who developed an osteomyelitis of her right femur about a year ago. One of the problems that develops in osteomyelitis, is that some of the bone actually dies to form what we call a “sequestrum.” In this case she had a sequestrum about 4-5 inches long that once had been the posterior half of her femoral shaft. It was really a difficult job getting it out because of all of the scarring from the infection and previous surgery. The third case was 12 or 13 year old boy who had started having problems with his right shoulder in October, 2000. The xrays showed the entire upper third of the right humerus to be involved in some type of destructive process, probably TB, which had caused the upper arm to be very swollen. When Dr. Brueton made an incision into the mass, some “caseous”(cheesy) material started to ooze out. After he had evacuated the cavity of most of this “stuff” with his finger, the cavity started to well up with blood. We felt that there was so much exposed bone due to the pathologic process, that when the pressure was released it allowed the bone to bleed. About the only thing we could do was to pack the cavity with gauze and hope that in time it will clot enough to allow us to pull the packing and close up the wound. This was one of the most difficult days of surgery that I have had here, and in some ways was harder than most days when I was operating at St. Vincent hospital.

April 13-

Another gloriously sunny day in Kenya. The temperature is in the high 70’s to low 80’s yet many Kenyans are seen walking up the road, in front of the house, wearing relatively warm jackets.

It seems that each day brings evidence of another medical tragedy. This morning we saw a 16 year old Masai girl with a painful right hip. On exam she had a large mass that encompassed her entire right buttock and anterior pelvis. The xray of the pelvis showed a large calcified mass that involved her right hip joint with some bulging of the bone into the pelvis. It also extend over the entire right side of the ilium(pelvic bone). It is most likely a chondrosarcoma, which is a malignant cartilage tumor. There is no possibility of resecting it in this setting. It would be a formidable task in the most sophisticated hospital in any Western Industrialized country. We are going to biopsy it tomorrow, if we can talk the OR crew into doing it on a Saturday.

Thankfully, when I checked the dressing on the little boy with the shoulder surgery from yesterday, the dressing was dry and not soaked with blood. This gave me hope that when we take the pack out tomorrow, that it won’t bleed as badly as yesterday.

Tonight was the night of the monthly Kijabe station pot luck. Many of the staff attended the meal. We met a young man who attended Duke University, whose home is in Lake Oswego. He had heard of Bethany Children’s Hospital through a friend and contacted Dr. Bransford about possibly visiting. He has been here a month and is staying until the end of June. He is making some instructional videos for Dr. Bransford. He said that he had to learn video editing here. He is entering medical school at the Univ. of N. Carolina in the fall. The Bransfords have another guest with them for awhile, a young man who will be graduating from Vanderbilt Medical School in June and then will start an ENT residency. We have really met some interesting people here. It seems strange to run into a person from our town, ten thousand miles from home.

April 14-

Today is as sunny as yesterday. Kijabe means, “place of the wind,” and it does live up to its name. Although it is sunny and there are only a few scattered clouds in the sky, the wind is blowing as it did yesterday.

Dr. Brueton and I took the little boy with the shoulder problem back to the “theater” today, and when he pulled out the packing, there was only a small amount of bleeding. We just put on a compression dressing and hoped that the bleeding will stop.

It really seems strange to walk around on the wards with grasshoppers and crickets as your ever present companions. Betty started working in Central Supply on Wednesday, and has commented about the cupboards where the ward supplies are stored, being full of dead moths. The nurses and the patients seem oblivious to their insect visitors. The culture is so different than that to which we are accustomed. On the Pediatric Ward, they leave the door to the outside open and this allows the grasshoppers ready access to the ward. I can remember how disturbed the nurses would be at St. Vincent’s if a few flies were seen on the wards.

Betty had commented to the young man that runs the Central Supply, that it seems Kenya is more advanced than some of the other African nations. He responded by saying that Kenya would be far more advanced if it weren’t for the “tribalism” that is so prevalent. He told her that there is a district some distance north of Kijabe, into which a Kikuyu dare not venture for fear of his/her life. That is how strong the tribalism is.

Today I was talking with Dr. Kim Smith, who is in her third year here, who said that when Jomo Kenyatta was president of Kenya he tried to downplay the tribalism. He came from the majority tribe, the Kikuyus, and therefore did not need the co-operation of the minor tribes. President Moi came to office upon the death of Pres. Kenyatta and has been president since. He comes from a small tribe, and in order to stay in power he needs the help of several of the other minority tribes to form a coalition that can oppose the Kikuyus. Thus he stimulates the tribalism, and Kim Smith said that tribalism cannot be decreased until he is out of office. History suggests that the presidents of most of the African nations, once elected, are in power for life. They do have elections, the last one in Kenya was in December of ‘97, but he weathered the opposition then and I don’t what the length of his term is before new elections occur. When we were here last year, two of his major opponents were ambushed in an assassination attempt and were almost killed.

April 15-

Easter Sunday in Kenya. The church did not look any different than last Sunday. There were no decorations, no big choir number, and no flowers adorning the altar, but the message, delivered by a Kenyan minister, was the same as we would have heard at OSLC. We sang two very common Easter hymns and the sentiment of the congregation was much the same as at our home church. We were given a ride back to the house by Mr. Turkey, his wife, and daughter. He has been teaching at Moffat Bible College for about 15 years. His wife’s name is Phyllis and their daughter is named Karen.

On rounds we came on one of the US medical students whose name is Carmen Teague. She completed seminary at Gordon Conwell in Boston, and during her senior year there felt the urge or “call” to go to medical school. Following her graduation she and her husband moved back to, I think she said N. Carolina, so he could go to law school. While he was in law school she completed the required under graduate premed courses she lacked, and then she entered UNC Medical School in 1997. She will be starting a general medicine residency after graduating in June. As on previous visits to Kijabe, we have met some very interesting people on this trip.

We were invited for Easter dinner to the Rich’s. He is the dentist here, and they live next door. They have been at Kijabe for about 14 years. He said that he came out shortly after graduating from dental school for a short period. He met his wife here and carried on a courtship via letter. He then returned to the US and they were married. He set up practice in a small town in N. Carolina but after about three years realized that if he didn’t see a patient, that patient had access to the other dentists in town. At Kijabe that was not the case. He and his wife decided that they should return to Kijabe and, except for furloughs, they have been here ever since. He does all aspects of dentistry including orthodontics and jaw fractures. Much to our surprise we had turkey for dinner. Dr. Rich said that it is difficult to get turkeys in Kenya. There is apparently only one grower in the country and the mission staff must order their Easter turkeys in November. They order 60 and they are sent as they mature. The missionaries freeze them as they arrive and by Easter all 60 have been delivered.

John Le Carre has written a book about Kenya called, “The Constant Gardner.” In it he deals with the rampant corruption that is so prevalent here. We learned, from Dr. Rich, that it is illegal to sell the book in Kenya. If the customs agents had searched our luggage it probably would have been confiscated.

April 16-

Easter Monday is a holiday in Kenya so only emergencies are dealt with in the OR. So far none have come in and it is now 6:30 PM. On rounds we found that the wound on the thigh of the little girl, from whose femur I removed the large sequestrum on Thurs., was healing very nicely without any drainage. She was discharged and her mother will dress the wound using “sugar dressings,” at home. Richard Brueton mentioned that the ancient Egyptians used honey as a wound dressing. The osmolarity of the honey and sugar must be so high that they act as bactericidal agents.

The only break from the usual routine was a trip to the RVA Arcade(the only local store). Sue Bird, the wife of one of the general surgeons, gave Richard Brueton and I a ride. The Birds have two daughters who rode up to the Arcade on the top of the vehicle. The younger one, about 9, said that that was the “station kids thing.”

This afternoon one of the Rich girls called to tell us that there was a colobus monkey in one of the trees in their yard. We went out and looked, and indeed high in the tree there was a large black monkey with a long bushy white tail, a rim of white around its face and back perched on one of the branches. It was looking very warily at the dog which was barking furiously at the base of the tree. The monkey was responding in its own way which was a kind of bark that sounded like a “belch.” It jumped from one tree to the next until it was in one of the trees out in front of our house, where it stayed for some time. After the neighbor’s dog and children lost interest in it and moved on to other activities, Betty saw it scamper down the tree to the ground and run up the hill toward the forest from whence it came. Miriam Rich told us that it was quite unusual for that type of monkey to venture so far from the forest alone. It is really a large monkey probably being about 24-30 inches from nose to the base of the tail which was about as long as the body if not longer.

April 17-

Africa has numerous “plagues” that are well known such as malaria, sleeping sickness, AIDS, TB, and so forth but to that list I think that osteomyelitis must be added to the list. This morning, I was asked to see a 10 year old Masia girl who had been admitted about a week or ten days ago with a history of having fallen two weeks before, injuring her left hip. When she was admitted she was febrile and wouldn’t bear weight on her left leg. At first she was treated for malaria and possible typhoid fever. When her fever didn’t respond to that treatment the doctor caring for her asked for an orthopedic consult. By now she was walking and did not seem as sick as earlier. Her pelvic xrays were essentially negative, although I was somewhat suspicious of a lesion in the proximal femur. Xrays today revealed that she had a minor fracture of the hip joint which would have explained her inability to bear weight. However, I thought that there was some fullness or swelling around the proximal femur. Richard Brueton agreed with me so we explored the area and we found an abscess. Hopefully, we got her early enough to possibly give her a cure.

I saw the pathology report on the lady with the pathologic fracture of the femur. It was thyroid cancer. The man with the painful thumb did indeed have a “glomus tumor.” The young girl with the osteomyelitis of the femur and the endocarditis died today.

April 18-

Another day in the Orthopedic Clinic at Kijabe. The parade of human misery continues. The untreated or maltreated trauma we see really is appalling. In a modern western country many of these patients could be salvaged but here only a few can be helped. One such case was a boy of about six who had a fracture of the medial epicondyle of the left humerus several months ago. It was not adequately reduced, which requires an open reduction, and he now has a fixed deformity with his elbow at 90 degrees of flexion. The ulna has subluxed because the capitellum, with which it is supposed to articulate, is gone(it died). As Dr. Bransford says there are only 17 orthopedists in the entire country so it is no wonder that the people get the treatment they do.

There is another plague here at Kijabe and that is poverty. I saw two patients today who needed biopsies but they didn’t have the money to make the required deposit for the surgery. One of the patients was a young man with a very firm mass that encompassed his entire right buttock. It is probably is a malignant tumor so it may not make any difference.

We finally got the path report on the tissue removed from the little boy with the shoulder mass. The diagnosis was a Ewing’s tumor which is a very aggressive malignant tumor of bone that is treated by very heavy chemotherapy in the US and other industrialized countries. Without it the boy’s life expectancy is short.

When I got back to the house Betty told me of her adventure today. She went with three other ladies and about three of their daughters, to buy an African dress. One of the ladies was Kenyan and she took them to the place where she buys her fancy dresses. It was in the Eastly section of Nairobi, which is a very dangerous place for whites to venture. They had to hire a cab to take them into the shops, because their Kenyan companion said that a car driven by a white woman wouldn’t make it out of the neighborhood. Betty said that it was really scary.

April 19-

Today we got the pathology report on the large fatty tumor that we resected from that man’s left thigh. It was liposarcoma, which is a malignant fatty tumor, and it confirmed my suspicions. This trip I have seen more malignant primary muskuloskeletal tumors than I have seen in my entire career.

Richard and I operated on a man today, who had fractured both bones of his left forearm in November, and who did not have it reduced. We had to take down both fractures and fix them with plates and screws. It was rather difficult. Following that we removed a long plate from a young Somali man’s right femur. He had fractured it about two years ago and was having pain in the area of the plate. It was really difficult because the first screw driver we were given didn’t fit the screws exactly. We finally were given one that worked and from then on it went much more easily.

April 20-

Another surgery day at Kijabe. We often don’t know from one day to the next what we will have on the schedule, and today was an example. We knew about the man with the fractured femur who was scheduled to have a rod inserted but we didn’t know about the man with a six week old fractured patella that was admitted yesterday evening. Richard did the rodding and he indeed had his “baptism of fire” at Kijabe. The patient was a very muscular young man who probably weighed 240 lbs. It was really hard to get the fracture reduced in light of the fact that the fracture was two weeks old. We got it accomplished but not without a lot of pulling and tugging. The fractured patella proved to be difficult also, because of the fact that it was six weeks old. It is next to impossible to get a perfect reduction of a fracture that is this old.

April 21-

A quiet day.

April 22-

This was the last Sunday service we will attend, at Kijabe, this trip. The speaker was an Australian man who teaches at Moffat Bible College. After church, Jan Olander one of the ladies that went with Betty on Wed., took us around Moffat. She and her husband have been teachers at Moffat for seven years, but have been in Africa for 17 years. Her husband has a PhD in education. He also has had two coronary by pass operations. He is the first male in his family to live past fifty. In spite of these health problems, he has continued to teach here, thousands of miles from the cardiac specialists who have cared for him in the US. This is real dedication to one’s ministry.

April 23-

Unless we have some emergencies, tomorrow, today was my last scheduled day in the “theater” at KMC this trip. We seem to be having a run on non-unions of unreduced forearm fractures. Richard and I did another one today. The patient sustained the fracture last August. It is difficult to imagine going around for almost nine months with a painful non-union of a fractured forearm. This one was about as hard to do as the one we did last week. When we were finished she really had quite good rotation(pronation-supination) of the forearm.

As is so typical of KMC, it takes all day to do four cases. Dr. Mead, an orthopedist from Bethany, came up to do an operation on a young woman he had seen at a clinic in Nairobi. This case delayed the last case of the day which was a young man who had lacerated his great, second, and third toes with a machete two days ago. He almost succeeded in amputating the second toe, which was attached only by the skin on the medial side of the toe. The laceration went into the joint of the great toe and also into the proximal interphalangeal joint of the second toe. He also had almost amputated the tip of the third toe. He had been seen at a clinic out in the “sticks” and they sutured the lacerations with what looked like “rope” it was so large. He may well lose the second toe but I thought that is was worth trying to save it.

While writing this I thought that I heard a knock on the back door and when I opened it, there was a Kenyan teenager asking for work so that he can pay his school fees. I told him that we are only short termers and that I didn’t know what work was needed to be done. One feels so sorry for these people, but at the same time, there are regular workers assigned to take care of the yards. I told him to have Elisha, the general boss of the housing maintenance, to give him a note detailing what work he could do. The boy looked rather dejected as well he might considering his situation.

April 24-

I thought that yesterday would be my last day in “theater” this trip but I was wrong. About 4:30 PM I was called into see a young boy who had cut his foot with a “panga” which is some kind of a large knife that the Kenyans use. The cut was on the top of his foot and started about two inches above the base of the big toe and angled across the top of the foot ending near the end of the second toe. He cut the long extensor tendon to his great toe, cut into the lateral side of his first metatarsal, and partially cut the extensor tendon to the second toe. As I was finishing this case, Richard Brueton stuck his head through the door saying that he had brought a patient in from the rural clinic he went to today. It was a young Masai man who had killed a lion with a spear, but in the process the he had gotten his hand in the lion’s mouth and had lost the middle finger on one of his hands, as well as sustaining lacerations of his forearm. Richard was going to take care of this patient while I went to the house because we were having a guest for dinner. We had invited Carmen Teague, a medical student for dinner. She went to seminary after college, and now is graduating from medical school in about a month.

April 25-

Our last day at Kijabe happens to be another Orthopedic Clinic day. We have taken a lunch break after a typical morning clinic. As always, it is a continuing parade of patients with really difficult problems for which there is often no effective treatment. The boy with the Ewing’s Sarcoma of the humerus returned today, and I referred him to the Kenyatta Hospital in Nairobi hoping that he might get the chemotherapy he needs. The man with the liposarcoma also returned. He travels over 200K to get to Kijabe and he has to spend one night someplace before he arrives here. I asked him where he slept last night and he said, “by the river.” I don’t know if that meant he just camped out or not. He was really appreciative of the surgery.

We finally finished in the clinic at about 4:30. Betty reported that the distribution of the gifts for the missionaries was very funny. The ladies acted like kids as they selected their share of the things we brought out. These things included chocolate chips, angel food cake mix, muffin mix, macaroni and cheese and so forth. They really thanked the Mission Committee, at Our Savior’s, for thinking of them.

April 26-

We departed Kijabe at about 0700. It had rained much of the night and it was still raining when we left. The Rift Valley was shrouded in a heavy cloud cover so we were unable to see any of it on our way in to Nairobi. Once in Nairobi, the traffic became as insane as usual. The roundabouts are primarily a game of “chicken.” One driver tries to bluff out all the other drivers and at times there were some very close calls. It was certainly nicer being in the Kenyatta Airport during the day than at night as we have been on all of our previous trips to Kenya.

As we started to fly over the Sahara Desert, the haze or dust was so heavy that we really couldn’t see much of the terrain, which was unfortunate.

How did this trip compare to the previous three? It was probably as satisfying or maybe more so than when we were at Kijabe in February, 2000. We became friends with some very wonderful people whom we had not met before. Dr. Richard Brueton, the visiting orthopedist from London, was a delight. It was easy to work with him and he was very eager to learn as much about Kijabe as time would permit. The Richs were also very warm and friendly. We called on Miriam a lot for questions we had and the Easter dinner at their house was very nice. They have a large, well organized library, and both Betty and I borrowed books from the fill the hours after we had read the books that we brought from home. I think I read 12 books, including the fifth volume, “Closing The Ring,” of Churchill’s history of WW II. We both read LeCarre’s new book, “The Constant Gardener,” which we learned is banned in Kenya because of his out spoken attack on the governmental graft that is so rampant in Kenya. Betty felt that her work in Central Supply was greatly appreciated by the Kenyan running it, because he was alone. She felt satisfied that she had made a contribution to the hospital. Numerous people asked when we were going to return. Dr. Bransford asked, last night, when we were scheduled to return. It certainly makes us feel good when they ask those questions because if they didn’t we would feel that we were not welcomed back. In some ways I think that these trips do us as much good as we do the patients. When we see how the missionaries live, doing without a lot of the things that we find so pleasurable, and especially how the Kenyans live, it certainly makes us feel very thankful for what we have, and also makes feel very humble. The missionaries are devoting their lives to trying to better the spiritual and physical well being of the Kenyan people and it really is humbling to see what they do. Many of them do not speak enough Kiswahili to be able to tell them the Gospel, but by providing help for their physical problems, it brings them into the hospital where the staff make certain that they hear it.