“Only the disciplined ones are free in life.
If you are undisciplined, you are a slave to your moods.  
You are a slave to your passions.”
-Eluid Kipchoge, Olympic marathon winner and world record holder

Kenya, a medium-sized country with a population of just over 50 million is known for its dominance in medium, long distance and cross country running. It is amazing how an ethnic minority that makes up only 0.06 percent of the world's population has dominated by winning over 80 percent of the world's long-distance races. Even more astonishing is the fact that the runners are primarily members of the Kalenjin tribe and its subgroup called the Kipsigis. A considerable amount of worldwide inquisitiveness and interest generated research with a view to explain this formidable achievement of a little-known remote tribe confined to a tiny speck of the globe.

Some ethnologists believe that the Kipsigis originated from the north and were originally part of Pharaoh's army in Egypt. They are said to have parted ways following their dissatisfaction with the Pharaoh for their lack of acumen in army warfare.

Almost all champions hail from Kenya’s Rift Valley province, situated about the middle of Kenya, which itself lies about the middle of the continent of Africa, dead on the equator!

The Formation of the Great Rift Valley

The Great Rift Valley of  Africa is a 6,000-mile long  crack in the earth's crust, stretching from Lebanon to Eastern Africa. Its a massive land depression formed approximately 20 million years ago when two parallel fault lines pulled apart. Subterranean thermal energy forces tore apart the earth’s belly causing huge masses of the earth’s crust to sink between parallel fault lines, at the same time forcing molten rock in volcanic eruptions to create lofty mountains and escarpments and great lakes. It even caused  partial drifting apart of the continents of Africa and Asia resulting in the formation of the Red Sea.

Kenya’s Rift Valley province lies within the eastern fork of the Great Rift Valley which runs from the Middle East (Becca Valley of Lebanon, Syria, Jordan Valley and the Dead Sea) and extends southward through the Red Sea, into  Eastern Africa and south to Mozambique.  The western fork of the Great Rift Valley begins at the Abyssinian mountain range in Ethiopia, courses around the western borders of Uganda and Tanzania, and extends southward to Malawi.

It transpires that this strikingly sublime and divine fragment of the valley lies at an altitude of 8000 feet above sea level. Historically this prime, land, heavily enriched with fertile volcanic soil was a portion of the British colonial “White Highlands,” reserved by the colonial masters exclusively for themselves as the chosen land. This was the main bone of contention between the colonialists and the colonized and was later hotly pursued and vigorously fought over and freed by the Mau Mau.

The Kalenjin Tribe

Physiologically, such high-altitude environmental conditions boost bone marrow to produce more numerous and bigger red blood cells. These cells are responsible for carriage of oxygen in the body. Moreover, the lifestyle of the Kalenjin tribesmen in the landscaped rolling hills is simple, natural, and pastoral. There are no industries and, because schools are few and far between, the children often run to and from school up to 10 miles away, meandering up and down the lush hills and valleys.

This coupling of physiology and high-altitude atmospheric environment has given rise to considerable increase in their lung capacity resulting in much higher consumption and utilization of oxygen and energy.  Likewise, the favorable metabolic changes in the body brought about by this favorable environment favors better utilization of carbohydrates and fats.

In evolutionary terms, there is an ongoing interaction between environment and genetics aiming toward better and optimal adaptation. The resultant genetic changes may be subtle initially, but become fully established later with the passage of time.

I had my share of managing a diversity of orthopedic problems afflicting this select segment of society. One day in my outpatient clinic, parents brought a baby with severe deformity of both feet. This child had clubfoot deformity at birth, i.e., the feet were twisted, rotated, and turned inwards at the ankle and foot joints.

The stark irony was this was the firstborn male child of a world-renowned champion marathon runner, a “superhuman” of perfect physique and anatomy, who had earned the distinction of being one of the best long-distance runners in history.

Even though this deformity of feet is surgically amenable and fully treatable in mild and moderate cases, there is almost always residual stiffness and scarring of joints in the more severe cases. This is because these children are often born with associated wasting of the muscles of feet and calves, a handicap which unfortunately imposes limitation to full normal recovery.

Remote Medical and Surgical Challenges

Working as a physician and surgeon in distant and remote parts of Kenya was often demanding, if not intimidating. Diagnostic and therapeutic facilities were equally at a premium. A wide clinical acumen encompassing all medical and surgical subspecialties is an invaluable asset. One must be prepared to improvise when faced with limited facilities and with no specialized professional help for hundreds of miles.

Under these restrictive constraints, having arrived at a diagnosis, the surgeon must weigh the risk/benefit ratio of the treatment to be meted out and have the confidence and courage to perform the best possible surgical procedure under the circumstances.

There are situations, for example, in cases of blunt head injuries, wherein the absence of other ancillary investigative facilities and modalities, the diagnoses must be based primarily on history and physical examination. The surgeon must then embark on the modus operandi of a life-saving action of literally opening the head by drilling holes in the bones to drain the blood clot compressing the brain.

Although a basic level of general nursing is available in some district hospitals, specialized nursing is out of the question. The clinician must then play the important role of a nurse. This may entail several day and night visits to the bedside of a seriously ill patient.

In the case of a chest infection or injury, following the surgical procedure of draining the chest for fluid or blood, one must take personal responsibility to ensure the underwater seal in the drainage bottle is connected and placed correctly so as to prevent re-entry of air into the chest cavity. Non-observance of these important precautions would otherwise result in serious complications leading to death of the patient