Among the hundreds of cases that I have done in Kenya so far, these few stood out.
This patient had a glomus jugulare tumor, which is a tumor that arises from the skull base where the jugular vein exits the brain. The former ENT here removed the tumor a few years ago in a major skull base operation which required sacrifice of her facial nerve. This left her with a facial paralysis; far from just a cosmetic issue, facial paralysis can cause blindness from inability to close the eye, nasal obstruction, and difficulty eating because the lips don’t close. Fortunately, her eye has been doing okay, but she was having significant problems eating. Last week, I performed an orthodromic temporalis tendon transfer, which moves the insertion of the temporalis muscle from the mandible to the corner of her mouth. I took fascia from her quad muscle and placed it along her upper and lower lips (under the skin, of course) to attach to the temporalis muscle. Eventually, she will learn to bite down when she wants to smile to activate the muscle to pull her mouth upwards and back. This procedure has largely been replaced in the US by a much more complicated free muscle transfer from the calf to the face, which, by connecting to the working facial nerve on the other side, can provide a spontaneous smile without having to consciously think about biting down. In our resource-limited setting, such a procedure isn’t feasible. Figuring out when to just get by versus “go for the gold” is a difficult part of medical work here in Kenya. She is very happy with the results so far.
At this point I have seen hundreds of patients, and I am starting to recognize regional differences in culture, resources, and education. From the map, you can see that the southwest of Kenya has several cities large enough to be named, and a more lush climate. The northern and eastern parts are much drier and less developed. Moreover, the borders between Somalia, Ethiopia, and Kenya have been hotspots of Al-Shabaab terrorist attacks over the past 15 years. People from these areas face hardships from every angle.
The other day, I saw a precious 3 year old girl, let’s call her Zyiar, from the region marked with the star on the map. For the past 6 months the side of her face has been swelling. Eventually, her father took her to missionary outpost located a few hours from their home. The missionary then called our hospital to arrange for us to see her urgently. It took some time for her father to raise the funds to make the long journey to Kijabe, but thankfully they made it safely. Friends of Kijabe is a US based nonprofit that raises funds for needy patients and infrastructure at the hospital. They were able to cover the theatre bill for Zyair’s biopsy, which we performed the next day. There is still a long road to recovery for Zyair, but God has already worked a miracle to bring her this far. She is truly precious in His sight.
This Somali patient came to us with his face wrapped in about 12 feet of gauze. Apparently this tumor has been growing for years. He had a biopsy report from a small hospital up north that claimed the lesion was an inflamed epidermal cyst (basically a pimple). Trusting that the doctors were right, they simply continued to wrap up his face, even as the growth was eating through the bones of his face and jaw. We were able to remove the tumor, along with his mandibular ramus and the lateral maxilla.
To fill the resulting defect, we look tissue from his lateral thigh and attached it to the circulation in his neck. He had wound healing issues, and was in the hospital for about a month after surgery. While not an ideal situation, he was a captive audience for the chaplains in the ward to share about Christ daily. I saw him in clinic this week, after a month at home, and was amazed at how his wounds have come together. He needs radiation to decrease his chance of recurrence, which he is going to start in a few weeks. Building a reputation of trust among the Somali people living in Kenya is a powerful way to engage this notoriously difficult people group.
The sign that greeted us on rounds each morning for the packing changes
Hope you found these cases interesting and inspiring.
Thank you for your prayers and support.
Kenya Hear 
Amazing
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