WORLD’s 2018 Books of the Year
KIJABE, Kenya-For doctors like Richard Bransford, enemy warfare begins in the womb. The spinal column fails to form, an infection leaves fluid on the brain, or genetic makeup jumpstarts any number of crippling diseases. In Africa, where Bransford works, such disabilities are both more common and less treated than in the United States. The UN estimates that up to 20 percent of the population in some African nations is disabled.
For over 40 years Bransford has been up at dawn most mornings to engage the assorted enemies assaulting children born with physical and mental abnormalities. When I first visited him in Kenya at Kijabe Hospital in 2001, he arrived at the hospital at 6 a.m. to do rounds, had breakfast at home with his family at 7:15-a short walk up the hill perched above the Great Rift Valley-and was back in the operating room for surgery by 9.
That day he supervised 12 cleft lip and cleft palate operations in two operating rooms. That year he performed over 1,500 surgical procedures at Kijabe, including treating 1,000 children from all over Africa for some form of hydrocephalus (fluid on the brain) and related spina bifida (where an unformed spinal column leaves an exposed sac of fluid). On Fridays he took a break from the surgical schedule-and traveled Kenya's rural byways and villages with one of 13 mobile medical clinics.
This November I caught up with Bransford at Joytown, a school for disabled children about 90 minutes' drive from the hospital in the town of Thika. Within minutes of Bransford's arrival he spied a 9-year-old boy with cerebral palsy slumped in a wheelchair and initially unresponsive to his questions. Bransford continued to smile and chat with the boy as he tightened the laces on his heavy, leather orthopedic boots. He checked the leg braces, then said, "OK cookie, let's get you out of here." Hoisting the boy from his wheelchair, Bransford had him doing paces on orthopedic parallel bars, back and forth, turning his twisted torso with difficulty, while the doctor closely eyed his progress and the bend of his legs.
As the boy grew more agile, his face opened into a smile, and Bransford said, "What's your name?" Daniel, he replied. "Oh, are you like Daniel in the lion's den?" asked Bransford.
If a disabled child can aim to be a conqueror, then this 70-year-old surgeon aims to be with him in that fight. Bransford has battled alongside thousands of handicapped children-and adults-to help them lead more productive lives and in many cases save them from early deaths. For a general surgeon trained over 40 years ago at Johns Hopkins and the University of Nebraska, that often has meant coaxing specialists to Kenya to show him new techniques-or performing surgery with a textbook open beside him.
This year Bransford received international recognition for that diligence: An American Medical Association Excellence in Medicine Award and the American College of Surgeons 2010 Surgical Humanitarian Award. And for a lifetime spent tending not only the medical but also the spiritual needs of African children, Dr. Richard S. Bransford is WORLD's 2010 Daniel of the Year.
In choosing Bransford we seek also to pay tribute to other medical missionaries-professionals around the world who long ago chose to forgo healthcare debates, malpractice dilemmas, and risk management seminars in order to serve the underprivileged, the neglected, the war torn, and the lost.
They do so with daily risk and sometimes pay the ultimate price. This year in Haiti 75-year-old Dr. Zilda Arns died when debris struck her head in the January earthquake as she left a church where she had just given a speech. The Brazilian pediatrician had for over 30 years run a Catholic charity that successfully reduced infant mortality by more than half in over 30,000 rural South American communities.
In Afghanistan, among the 10 aid workers killed by Taliban gunmen in August were eye doctor Tom Little, who had served in the country since 1976, and dentist Thomas Grams, who gave up private practice in Colorado 10 years ago so he could work alongside medical missionaries.
As Bransford puts it: "I really want to serve a God of miracles. I want to put my foot into the Jordan before the waters separate."
The risks and the demands of field medicine aren't static. As Bransford's skill and reputation have grown, along with his experience in finding ways to treat all the maladies Africa has thrown at him, the work has carried him from hospital battlegrounds to live-fire war zones-in Somalia, Rwanda, Democratic Republic of Congo, and Sudan.
Whatever the setting, Bransford has fought antagonists outside the womb as well: heads of families ready to leave disabled children to die; UN refugee camp bureaucrats who refuse to process sick or war-injured children for treatment; donors ready with grant money but not for "elective surgery" to correct childhood disabilities; or Islamic militias in Sudan and elsewhere who make more work for him by raping and maiming Christian women and girls.
In Sudan he rescued one orphaned baby he found beside her mother, dead of gunshot wounds, and carried her through border control at Nairobi's airport without incident. He flew to Kijabe a mother named Mary, arms burned so badly by Islamic militias raiding Christian villages in south Sudan that she could not move them beyond 45-degree angles. Surgery made them mobile again.
"Dick is one of those rare and special people who seem to live outside of the world's structures of propriety and prudence," said Mike Delorenzo, a pilot who has accompanied Bransford into war zones. "He will go places few doctors would consider sensible, and while other docs were eating dinner, Dick would just be getting started on one of two club feet."
In Somalia during the 1993 civil war, Bransford and a colleague stepped in to fill the gap in medical care. "When we arrived in Mogadishu there were three machine-gun nests run by the U.S. Marines across the street from what was a theater. We'd see 300-400 patients a day onstage there."
As word got around that these were Christian physicians, Bransford began to receive vague threats. "We have less than 100 Christians here and if we find them we will shoot them in the street," a Somali told him. After the medical team departed, Bransford learned that his translator was found shot dead in the street.
Oddly enough, those wartime experiences stirred a longing to serve Muslims. "Muslims are not won by argument, but by compassionate care," he learned. And some of the most provocative conversations he has in Islamic-dominated countries take place over the operating table or at bedside: "When I walk into the pediatric ward and see the multitude of disabled children, He gives me a compassionate, and passionate, heart to first care for them in Christ's name and to seek the means of being able to share Christ."
Bransford first came to Africa as a medical student in 1966. He wound up at Kijabe, a small mission hospital run by Africa Inland Mission (AIM). "If you closed the front door and put beds in front of the door, you'd get 55 beds," he said. The hospital had one doctor, and nurse midwives were delivering babies in a closet.
He returned to the United States to complete surgical training, served in the Air Force, then joined AIM, and headed back to Africa-first to then-Zaire (now Democratic Republic of Congo), then to the Comoros Islands. There, only four years out of surgical training, he became chief of surgery at a 350-bed hospital.
By the time he returned to Kijabe in 1977, Bransford was a husband and father of five children. His wife Millie, now married to Bransford 45 years, had just delivered twins. The couple would later adopt two disabled African boys-one now in high school and the other a freshman in college.
The two largest killers at the hospital then were measles and whooping cough. Today those have been replaced by HIV/AIDS and tuberculosis. Bransford began a practice then of never turning away a patient because the family couldn't pay, but he says he often was offered payment in cows.
Bransford praises his general surgery training at the University of Nebraska, which he said was not as rigorous as Johns Hopkins, where he went to medical school, but where "I could live with my own soul because they treated people as people." But driven by need-"and not because I knew what I was doing but because I could read the books"-he began doing more and more orthopedics.
A visit to Kajiado Child Care Center, a school near Nairobi, shaped his vision for working full-time with the disabled. "There were 75 kids, and at least 50 had polio," Bransford recalled. He couldn't walk away from them, so he began devising ways to transfer the polio victims to Kijabe.
"That was the beginning. Polio led to clubbed feet, and clubbed feet led to bad burns needing surgery to prevent contractures. These children were worthless to families because they couldn't herd goats and cows. So worthless, we discovered, they could be educated."
Soon a parade of specialists made their way to Kijabe at Bransford's request, and Bransford was finding ways to school some former patients in what he was doing. A Chinese surgeon from Los Angeles taught Bransford how to implant shunts to drain fluid for hydrocephalus and spina bifida patients. Ear, nose, and throat doctor Jim Wade began making regular visits to perform cleft lip and cleft palate repairs-in 10 years, Bransford said, he has done over 1,600 at Kijabe.
In 1998 Bransford contacted Dr. Leland Albright, then chief of pediatric neurosurgery at Children's Hospital of Pittsburgh and one of the world's leading researchers in cerebral palsy. Bransford was trying to locate a textbook edited by Albright. When he told Albright about his cases, Albright said, "Why don't I just come out?" That began annual trips, where Albright did surgery in three-week stints while training doctors and nurses.
Today Kijabe is a sprawling complex with six different units, nine operating rooms, and over 200 beds. In addition to general medicine, the hospital specializes in orthopedic care and treating children with physical disabilities. That's in large part because Bransford started BethanyKids in 2001, a nonprofit based in the United States and Canada that runs the orthopedic program.
Through BethanyKids the hospital now has the only accredited program for pediatric surgeons in East Africa, and a complementary program for nurses. In 2009 it performed more than 2,500 operations on kids with severe disabilities. Each month it runs 10 mobile clinics to outlying areas, including refugee camps in the north where over 300,000 mostly war-displaced people from Somalia, Sudan, Ethiopia, and Eritrea live. "We are the only hospital that is doing this kind of work between Cairo and Cape Town," said Bransford.
The work doesn't end with discharges. BethanyKids has set up a network of volunteers throughout Kenya to do follow-up care. That includes basic preventative procedures for infection, checking on post-op care, and discipling patients in the gospel. Through that follow-up, Bransford said, volunteers see hundreds of converts to Christianity each year.
What's also unique: BethanyKids runs the program for just under $1 million a year. A spina bifida operation that costs $50,000 in the United States costs $500 here, and Bransford receives the $70 shunt (along with many other supplies) for free.
But as Bransford likes to say, "The only sure thing here is change." This fall Dr. Albright arrived at Kijabe to assume Bransford's role as professor of pediatric neurosurgery-making way for Bransford's anticipated stepping away from full-time duties at the hospital in 2011 (he changes the subject if the word retirement is mentioned)-and a likely move back to the United States.
"Our role is reproducing ourselves, whether it's spiritually by leading people to Jesus Christ or medically in trying to find people . . . willing to use the skills they have and leverage them into more skills," Bransford told me.
But he and others at Kijabe worry that U.S. medical education isn't preparing doctors for work in Africa and elsewhere. U.S. training is "state of the art," said Bransford, and doctors end up with an education so expensive they can't afford to think of serving anywhere except a specialty practice with large fees and steep overhead: "We need to say, "What's in that for Africa? What's in that for the poor, the hurting, the unsaved?"
Mark Newton, an anesthesiologist coaxed to Africa by Bransford, has served at Kijabe for 14 years. He believes in the longer investment: "This hospital is like this because people have committed for long periods of time. Dick's been here a long time." Doctors who come for short or long periods, said Newton, also need to train others. "The educational system that's built up here is the result of doctors staying here and working and investing in the next several generations."
I asked Bransford, are you worried that a new generation will commit three to four years to a place where you've made a 40-year commitment?
"My concern is not skills. It's relationships. With the type of work we do, if we don't have that bond with the moms or the parents, we really can be hurting, not helping," Bransford said. "That's part of the threat to us-and part of the privilege. Part of what keeps you driven here is building relationships. And it's hard. But if you have people without relationships, no matter how good they are medically, they won't succeed."
Relationships are front and center at Joytown, where Bransford, his surgical duties curtailed, now spends at least one day a week. BethanyKids took over helping to operate the boarding school 10 months ago when Kenyan government support dropped off. Started in the 1960s by the Salvation Army, it has a defunct swimming pool once used for therapy, a wealth of stray wheelchairs in disrepair, and only three physical therapists with two assistants to cover the needs of 340 mostly primary-school-aged disabled children.
Students attend classes but have few extracurricular activities. They live in rooms that sleep 12 with dorm mothers, and most have family visits once a month. Like Daniel, who was hoisted to the bars by Bransford, many have cerebral palsy. Others were born with spina bifida, or deformed by breech birth, or have a congenital disease.
Many are incontinent, yet all laundry at Joytown is done by hand. BethanyKids is near completion of a new laundry building, which will include washing machines.
Lacking sufficient adult supervision, the less disabled push those in wheelchairs. And sometimes sit two to a wheelchair. Bransford watches the students intently, searching out those who might benefit from some specialized intervention. He examines one child, a 9-year-old named Antony with cerebral palsy, and determines with a therapist that something is needed. Soon they have Antony on an examining table, his thin legs bent over a tin basin, and Plaster of Paris bandages unwinding and rewinding around each foot up to his thighs.
Antony's leg tendons are severely contracted, and surgery for him isn't an option. So Bransford stretches them out by applying leg casts that the therapist will gradually cut from the back to allow the tendons to relax, straightening his legs. Quickly smoothing plaster over dripping gauze with gloved hands, Bransford becomes less surgeon and more sculptor, humorist, artist. When the plaster dries he measures, then draws lines on each cast indicating where the therapist should cut later. "He will have some pain," said Bransford, "but he will walk, I think he will."
Optimism about outcomes runs hard into opposition: After all, Bransford is trying to fix people the rest of the world doesn't see as useful. Sometimes at medical conferences in the United States colleagues will ask, particularly in reference to spina bifida patients, "Why do you have so many?" And Bransford says that he replies, "It's just that most of yours are aborted."
In Africa the disabled are also liable to be discarded. Francesca, a spina bifida patient who did not arrive at Kijabe until she was 19 years old, spent a childhood avoiding members of her family who wanted to poison her, who thought she was a curse. "I was always alone, always wet, always smelly," she said.
Bransford had to amputate her lower right leg; in fact, she was a patient on his ward when I visited in 2001. But now she is mobile with the help of a cane, able to control her bladder, and helping to run Joytown. Bransford said she led over 50 disabled people to faith in Jesus Christ in the last 15 months. Francesca also is married-and expecting a baby.
"There was a time when I had mothers and fathers come with their kids. And I was comfortable telling them all the negatives-your child won't walk, won't be able to hold his urine. And often then they would leave. It wasn't worth it."
Then, said Bransford, "I got tired of playing God. I wasn't being fair. So I told them the same thing but I also told them their child might be the most intelligent person in the room, might bring them joy, might make a difference."
Contemplating a U.S.-based career change hardly means stepping away from the threat and the privilege. As Bransford's tasks at Kijabe have lessened, he's found more opportunity to travel to countries considered closed, even hostile, to faith-based medicine. "I may not be bright enough to be frightened," he sometimes says, but the reality is he continues to go where the need is-and doors open as a result.
Read profiles of past Daniels of the Year.