Doctor's Diary, Part IV: Empowering Women in Africa

Dr. Bill Frist, the former U.S. Senate majority leader, is an accomplished heart and lung transplant surgeon who trained at Stanford University and was among those who pioneered heart transplants. A Tennessean, Dr. Frist opened the first transplant center in the South at Vanderbilt University. In 1994 he left medicine and was elected to the U.S. Senate. He promised to serve only two terms, so at the end of last year, after 12 years, Dr. Frist retired.

During the four years that he was majority leader, Dr. Frist continued his practice of going to Africa on medical missions, and he began to see that the power of healing can go a long way to improving America's reputation in the world and, more importantly, providing peace and stability in the region.

Dr. Frist is back in Africa, traveling with his wife, Karyn, and Franklin Graham, the president of Samaritan's Purse, and is blogging for

Feb. 8: Women's Empowerment

The more time you spend in Africa, the more you realize that the future of the country lies with the empowerment of women. When it comes to water, it’s the women who walk for hours daily to collect sufficient water for the family — time that could be spent more productively with the children. With HIV, probably the single most effective thing a government or community can do is to provide primary education for the young girls … yes, primary general education.

Today we saw the empowerment of women at its best. This morning we visited a remarkable place, Mani ua Juu (means “higher peace” in Kiswahili) in Nairobi, an innovative, entrepreneurial training project that teaches sewing and marketing for African women whose lives have been afflicted by wars and ethnic conflicts.

We met about 20 women all sewing in a long, busy row on those 1950s style Singer sewing machines. Each woman had a powerful story, having had to leave their native country (these women represented 8 different countries) because of conflict. At the self-sustaining center, they learn sewing skills so they can provide for their families; they sell the goods through a wonderful shop on the ground floor and they even have their own Web site (

Click here to visit the Samaritan's Purse Web site.

Most of these women have been marginalized by war in their home countries and carry the burdens of poverty, corruption, and war. The women are empowered spiritually and physically through their work at the center. It is a holistic project in that the women are strengthened in their Christian faith through prayer, daily devotions, and weekly Bible studies.

Karyn, and all of us, purchased beautiful goods made by these remarkable women. I bought Karyn a brightly colored hand bag, and Karyn bought a surprise hand-crafted cross for a special person in Washington (I won't give away the secret!).

We were off to Wilson Airport, the private air field that is so full of history, much of it romanticized in literature. I recall the first time I actually piloted a plane from this historic field – I imagined an oil-soaked, sack-cloth perched high on a pole that was ignited at the end of a dirt field so that the tail-dragger could safely land as the sun had set (That’s what I had read about years ago).

On that first flight, I flew a Caravan (the African workhorse because of its carrying capacity and short field abilities) to southern Sudan. But because of security reasons and the ongoing fighting in the South, we first flew to Entebbe, then Bunia, then into the southern Sudan. When we came close to the Sudanese border we dropped down to tree top level for security reasons (bombing was still going on at that time). We flew for about an hour just above the trees to the isolated dirt strip that had been abandoned for years in Mundri county, near Lui and the clinic that Samaritans Purse was about to open. The next day we were operating by flashlight in a deserted school house. (The rest of that story for another day … back to the airport and the present day.)

At the airport Karyn and I and Dr. Furman dropped in to speak to the missionary pilots and support personnel at AIM-Air, who have flown us in and out of the bush in Africa over the years. I was introduced by pilot and now great friend Jim Streit, who inspires me with his commitment to serving others. These Christian mission pilots are committed to helping others, ferrying missionaries and supplies all over east central Africa. They specialize in sweltering deserts, rain forests, war zones, mountain highlands, and barren landscapes that are “remote, dangerous, and almost unreachable.” Using aviation, they “go the extra mile to help others meet their calling to ‘Go and make disciples.’” They are a selfless and remarkable group. As a pilot and as one who has benefited so directly from their services (personally in Chad, Sudan, Kenya, Tanzania, Uganda, etc), I am really thankful.

Click here to watch video of Dr. Frist in Africa.

We flew about 240 kilometers east, over the majestic Rift Valley, to Tenwek Hospital, landing on a dirt, rough field, cleared of goats and cows with a low pass, to be welcomed by about 100 schoolchildren who flooded out from the surrounding areas to see the big metal bird descend from the sky. We were met by Dr. Mike Chupp, the orthopedic surgeon at Tenwek who with his wife Pam arrived 11 years ago with World Gospel Mission.

The plane was left in the field, a guard hired to watch it overnight for $5. After a bumpy 20 minute ride to the hospital, Mike and I made rounds on the patients to be operated on tomorrow.

I won’t get too much into the medical aspects, but have to mention one patient. Kala is an 11-year-old boy who in the middle of the night about 2 weeks ago was awakened by a hyena that had broken into his one-room mud hut. The hyena had attacked his older brother, amputating 3 of his fingers and biting off a huge section of his back. The hyena attacked his grandfather and then Kala. (The tribal people explained to me that this is unusual behavior for a hyena – they usually bite once then back off to assess whether or not a carcass is dead … but not on this night.)

His grandfather began to bleed profusely from his neck wound. Kala was attacked in the face and had a huge section of his left cheek, mouth and lip bitten off. The old man died on the one-hour journey to the hospital but Kala survived. He was operated on today by two volunteer surgeons from World Medical Mission (Samaritans Purse) who had come to operate at Tenwek for 2 weeks from Massachusetts and Illinois (They had done so on four previous occasions as well). His face and lip and mouth have been totally reconstructed and he can now live a normal life, saved by the grace of volunteer doctors, a mission hospital, World Medical Mission and the pilots who bring the doctors here.

I also met Kibet K. and his mother. Kibet is 12 years old and was fine until last April when he felt some upper back pain. A neighbor had active tuberculosis. In November he developed weakness in both legs. By December he was bedridden. At Tenwek the diagnosis of Pott’s Disease was made. I examined him and indeed he was paralyzed below the waist. He had good sensation in his legs, but some rigidity as I passively flexed and extended his lower extremities. His x-rays were consistent with the diagnosis. I graduated from medical school in 1978 and I have never seen a case of Pott’s disease with infection that had invaded the spine with consequent paralysis.

Click here to view photos of Dr. Frist's mission to Africa: Essay 1 | Essay 2 | Essay 3.

In Africa you see things frequently that you would never, ever see in the United States. On examination his back revealed a huge mass between his scapulae (shoulder blades); this was the massive abscess that caused this boy’s paralysis. Tomorrow morning we will do an operation that is very rare in the United States – though in Africa at Tenwek it is not uncommon! Will it be successful? How will he do? Will he die? Will he ever walk again? Tomorrow we will know …

Feb. 9: Operating in Rural Kenya

Seven a.m. in a beautiful, green region of Kenya with rolling hills, and it's time for surgery. Little did I know what would unfold that day. But I was happy to be back in the operating room. We left the mission home on the hospital property of Dr. Mike and Pam Chupp to head up the hill to the operating room suites.

On arrival we were told by another surgeon, “Change of plans … we have an emergency life-or-death case.” A 22-year-old Kipsigis tribesman had come in having been shot in the head with an arrow. The arrow, still present but firmly lodged deeply in the man’s skull, entered at the base of the neck and penetrated about 7 inches toward his nose. It would prove to be a full and fulfilling day.

We changed into our scrubs in the newly constructed operating pavilion in rural Kenya and said hello to Kibet (who we had examined last night) just before he was put to sleep for his surgery. We would tackle his case first as the emergency patient was being prepared for surgery by another surgical team. A last look at the x-rays and then out to the scrub sink to wash our hands for 10 minutes … no different that in the U.S.

Kibet was explored through a left thoracotomy (chest incision). There were a lot of adhesions surrounding the lung that had to be taken down sharply. The large mass inside the young boy’s chest was isolated and entered, with tuberculosis pus spilling into the chest cavity.

The infected, crumbling, mushy bone of the spine was excised and a bone graft taken from the boy’s hip was inserted after extensive debridement of the infected wound. The healthy bone graft was wedged into position to replace the necrotic bone, with a few bits of rib inserted to fill the surrounding area. He was placed in a full chest cast to ensure stability.

I had never seen Pott’s disease so extensive, literally eating away the spine with the abscess mass pushing on the boy’s spine which explained his paralysis. But today’s successful decompression should allow Kibet to walk again. It will take a couple of months for full recovery. But later in the day when we visited him in the recovery room he was smiling without pain.

Tenwek Hospital has a fascinating story that tells much about the history and importance of the medical mission field in Africa. It started ever so modestly in 1937 as a medical dispensary was staffed by two nurses until the prophetic arrival of medical missionary Dr. Ernie Steury in 1959. Dr Steury, who died in 2002, is the heart of Tenwek Hospital. He created the hospital's motto, “We treat. Jesus heals.”

Tenwek has grown over the years to 270 beds with doctors seeing thousands of patients each year from throughout western Kenya. World Medical Mission got their big start in 1979 here when Dr. Dick Furman and Franklin Graham visited the facility and were told by the venerable Dr. Steury that there was an urgent need for more doctors. Right then and there Franklin Graham promised that they would find doctors who would come and serve short-term missions there to assist the full-time mission surgeons. An idea was born and a promise made. The idea was fulfilled a few days later when Dick and Franklin, while still in Nairobi, received a call from a doctor who said he wanted to serve in Africa, and they replied that they knew the perfect place!

And indeed, word spread and their promise to provide doctors to supplement the care at Tenwek has been fulfilled over the last 25 years. Most of the surgeons we operated with today were volunteers with WMM, as well as the two medical students I met from my own Quillen Medical School in East Tennessee, Lauren Chipman, with her husband Steven and Chris Dill. In fact this year 30 doctors and medical students from WMM served at Tenwek.

I’ve removed knives from the heart, treated gun shot wounds to the chest on more occasions than I’d like, but I have NEVER seen a patient shot in the head with an arrow until today. It’s a long way from the floor of the U.S. Senate.

The arrow was removed successfully from Kisma without hemorrhage, although the broad penetrating arrowhead made the surgical exposure very difficult.

I rotated to the next room where Dr. Carol Spears was the chief surgeon on a sigmoid volvulus, or a twisting of the far end of the colon which leads to obstruction of the bowels, and death of that portion of the colon. Another success story!

We bounced out of the operating room in the early afternoon and went to the endoscopy suite where Dr.Chupp and Dr. Spears placed an esophageal stent for cancer in 47-year-old Somalian Ali Hussein G.

The stent holds open the 9 centimeter area of the esophagus that had obstructed and prevented the patient from eating for days on end. He will go home later today and be able to eat. Dr. Russ White is the thoracic surgeon here at Tenwek and he has discovered an extraordinarily high incidence of carcinoma of the esophagus in the Kalengi tribal people. We don’t know why, but with more research will be able to figure it out.

Two years ago the room that is now the endoscopy suite was the main OR. But in August the new operating room pavilion opened up. Ten years ago I had brought Dr. David Charles, a neurologist to Tenwek with me from Washington for a visit; he returned as a medical doctor with WMM several years later with his wife Julia, an architect, who helped design the fantastic OR pavilion we operate in today.

Back to the OR for a left colectomy for colon cancer (picture) and then to the wards for rounds. The need in Africa for medical services is great. It is not unusual to see two patients to a bed – sometimes three. On rounds we met the 38-year-old Kenyan who had an abdominal aortic aneurysm repaired by Dr. Chupp and visiting surgical resident Rona Norelius from New York. We examined the African who had multiple perforations of his jejunum secondary to tuberculosis (TB is rampant with the high incidence of HIV – they go hand in hand); he is recuperating nicely.

Probably 80 percent of the medical ward is HIV positive. Probably 60 percent of the surgery patients are HIV positive and approximately 40 percent of the new mothers are HIV positive. We have much more work to do on HIV … I am covering that elsewhere over this month, but I do need to thank President Bush for his unprecedented leadership in supplying much more funding than anyone in the world to fight this condition. Testing for HIV is much more acceptable today than last year when I was in Kenya; that is progress.

Karyn spend the day on rounds with us, meeting with the mission families, touring the Umora (“Unity”) Orphanage in an adjacent village Silibet. She especially loved the orphanage, home to 23 young children.

I have gone on too long on the surgery, but the one to one connections are what compassion is all about. Though I am here a lot, I never cease to be overwhelmed by the kind and generous hearts that I see each time I operate at mission hospitals in Africa. This connectedness I believe can be used as a currency for peace around the world.