19.12.14

For Unto Us a Child is Born

(from Eric)

In the last several decades, international health efforts have significantly reduced the number of children under 5 years old who die.  It's quite a victory, though there is a long way to go.  Kids still die in terrible numbers from stupid stuff like malnutrition, diarrhea, and pneumonia.  But they do it a lot less frequently than they used to.

There is, however, one section of this problem which has had a notable lack of progress, and it is the neonatal period, or the first month of life.  If you get sick during this period, your chances of survival aren't nearly so much improved as if you get sick later.  The graph now looks like this:


If you can survive the first day of life, your chance of being a neonatal mortality is cut in half.  If you can survive the first week, it is cut in half again.  In other words, this is a very very high yield time to intervene.

So, why hasn't it changed much?  I don't know.  Maybe people think it's too expensive or technological.  If you walk through an American NICU, you will probably think so.  Maybe the pediatric people saw it as more of a maternal problem than a kid problem, and the maternal health people saw it as more of a pediatric problem.  I don't know.

***
Our time in Kenya gave us a good vision of the possibility of intervening for these little kids, and arriving here, Alyssa was determined to get a little neonatology department going.  The hospital administration graciously gave her a room in the maternity building, and Jason had a few incubators built from local materials.

It was a bit of a rocky start.  Just after the opening of the service, I covered for Alyssa during a one-week absence.  We had a few premature babies.  We weren't reliably weighing them (which is absolutely essential in these cases), and all the moms were saying that they had no milk because they had no food because they were stuck in the hospital with their premature baby who wasn't growing because they had no milk because...  It was enough to be quite discouraged.

But she persevered.  (My single contribution was realizing the inaccurate weight problem was because the nurses and students didn't know how the use the scale.  I wish all solutions were that simple.)

Now that Alyssa is gone, I have gravitated over to Pediatrics, and I found a marvel.  Somehow, in the last few months, this service has transformed itself into something young, simple, but very legitimate.  My first day rounding, I found about a dozen patients on neonatology.  The increase in numbers is expected, since there is absolutely nowhere else to go to get care for these kids, so they get referred to us.  I approached it with a bit of trepidation, but I found reliable records and growing babies.  A few antibiotics, a good feeding regimen, and mother's milk.  And you can save so very many lives.  Lives that will hopefully have many decades in front of them.

That first day I had the privilege of discharging this little baby (seen here in Jason's homemade incubator, modeled after those used at Tenwek in Kenya):


This little one was born around 900 grams (i.e. just a shade under 2 pounds).  900 grams!  Here, in rural Burundi!  In a wooden box made by Jason.  Milk and a few antibiotics.  There are many that size that we lose, and we will continue to lose them.

But not all of them.

Not this one.

Here at Christmastime, we celebrate the coming of a baby.  God didn't skip that step.  It has been said that, in the incarnation, God ennobled the human race, and that we are to treat others with even more dignity because, not only are they made in God's image, but one time for all, God was made in our image.  And so a baby came.  A baby like this one.

Yes' ashimwe. (Jesus be praised)

15.12.14

What Is "Normal" Anyways? I'm Starting to Forget...

by Jess Cropsey

3 days ago, on Friday...

It started off as a "normal" morning -- John headed off to work at 7:30, the kids were getting ready for school & eating breakfast.  I was in the bedroom when I heard a knock at the door and one of the kids said, "She's trying to give us a chicken!"  I wondered who this person could be and hurried to the door to find a nicely dressed lady on the porch with her son, a rooster, and a box with holes in it.  She told me in halted English that her son was one of John's surgical patients and that she was so happy that her son could see well again.  (He has a rare syndrome called homosystinuria which, in his case, caused blood clots, seizures, and dislocated lenses in the eyes.)  John was able to successfully operate on both of his eyes and also got some special medication when he was in the U.S. for a conference a few months ago.


She continued to tell me that the rooster was for John and the items in the box were for the kids.


There was much excitement over the rooster and many pleas not to eat it right away.  The box with holes contained two pigeons which the kids were even more excited about.  The lady gave me all kinds of tips about how to care for them, what kind of cage to build, etc.  She thought it would be a good idea to release them in a room for a little while so that they weren't cramped in the box.  I decided that I'd prefer not to have bird poop all over my bathroom, so I let them loose in the schoolroom bathroom instead since we were approaching a weekend.


I'm not really a country girl nor an animal lover, but our family now owns a rooster and 2 pigeons.  Construction has begun for a bird house and plans are in place to turn the chicken into Christmas dinner (a 5:00AM wake-up crow isn't fun!).


Later that afternoon, we had a party for the construction workers to celebrate the completion of our house.  The McLaughlins had a goat roast (with 5 goats!), but after that it was decided that a whole cow was more economical and tastier.  The butchering of the cow began yesterday and all the kids wandered over to see the cow spread out all over banana leaves on the ground.  It was a pretty morbid sight.



Sammy & I checked on the food preparation progress throughout the morning.

Bananas cooking in water

Boiled bananas cooling on banana leaves so that they can be peeled

Bananas now being fried in oil to give them a crispy outside

The final meal (for over 100 workers!) included some meat and several fried bananas in a tasty sauce with a side of zucchini bread and a soda.  Yum!  


Boys helping to pass out napkins


As an early Christmas gift, we also distributed hats, many of which were donated by our church in Ann Arbor.  These were a huge hit!



As we were exiting the schoolroom earlier in the day, Heather commented how today would make a great blog and I had a moment of pause.  Oh yeah, I guess it would.  This isn't a usual day (at least for most Americans), is it?  I almost forgot.  It's all starting to feel so normal...



8.12.14

Christmas Catalog: Feed Our Hungry Patients

(from Eric)

Once again this year, KibuyeHope.com is presenting an alternative Christmas Catalogue: ways to support the work and community of Kibuye as a gift in honor of someone during this holiday season.  Click here for the full list of this year's options.

We would like to draw your attention to one item in particular: Our hospital feeding program.  Similar to many hospitals in our part of the world, there is no kitchen or feeding program for patients hospitalized here.  Patients depend on their family to bring them everything to eat and drink.  Given the poverty and hunger of Burundi at baseline (Burundi was recently given the dubious distinction of "hungriest nation in the world"), this only gets worse in the hospital, resulting in even worse nutrition right when they most count on it for their healing.

So, the problem is more than discomfort.  It is wounds that don't heal.  Moms that don't have enough milk for their premature babies.  Kids who can't beat their otherwise treatable infections because their bodies aren't strong enough.  In short, it is the cornerstone of all we're doing.

For this reason, we are starting in 2015 the first hospital feeding program.  2 meals a day, a mix of "Busoma", a nutritional grain mixture already made on site here, and other nutritional staples available in the region.  How much does it cost to feed one hungry patient at Kibuye for a week, thus enabling the healing of their whole body?  $3.

A few suggested pricing options for Christmas ideas:
$3 - feed a patient for a week
$13 - feed a patient for a month
$40 - feed the entire hospital for a day
$100 - feed the entire pediatric service for a week
$270 - feed the entire hospital for a week
$425 - feed the entire pediatric service for a month

You guys are bright folks who have likely already figured out that you can donate any amount to get any permutation of the above numbers.  All you have to do is click here, and enter your dollar amount (where it may already say "$3").  Gifts are tax-deductible.

Thanks for thinking of Burundi this Christmas season.  We are convinced that there is no better way to support the work of this hospital and this community than to follow one of the simplest mandates we've ever been given, to provide food for those who are hungry.

Here is a video of Alyssa (done by Carlan) with some great information about malnutrition in our area and the Busoma community feeding program already in place (not to be confused with the hospital feeding program to be soon implemented.)

 

5.12.14

What's in the bag?

By Jason

Heather and I have been in the States this past month.  We came back to be with family after my grandmother passed away.  We also used this opportunity to get a breather from the never-ending responsibilities at Kibuye, to attend a medical missions conference, and to stock up on some supplies.
After being at Kibuye Hope Hospital for a year there are some things that we found we needed/wanted at the hospital and at home, so being back in the States (with an Amazon Prime trial) gave us a great opportunity to acquire many of these things.  We are taking back quite a smorgasbord of items in our suitcases and it causes me to cringe thinking of trying to explain to the TSA agent the various items we have in our bags.  Here is a sampling of what we packed in our suitcases.
A huge monkey wrench to do maintenance on the water system
Contact paper to make the Operating Room windows opaque

A new biography about a Burundian runner
Various medical textbooks for me and for students
A nail gun air compressor to run the anesthesia machine
Air hose and other things to hook up the air compressor to the anesthesia machine

A flower box which will be used to soak long instruments in sterilizing solution.  I also got some catheters that aren't available in Burundi so that I can do prostatectomies.
Some spices not found in Burundi

Various homeschooling/ESL books
Pictures from a Burundian refugee family we met in Pittsburgh - to be delivered to her family in Bujumbura!

Some plumbing putty and goop for various persistent water leaks

Intramedullary nails to replace the ones we have used already

Skin graft meshing plates (it is amazing what you can find on e-bay!)

Spray bottles for prepping patients in the Operating room with Betadine

Wire clippers for various orthopedic procedures

And more...
Tums, Iron, Bowel prep pills (some medications aren't easily accessible)
Asbestos repair kit (leaky roof in the hospital)
Nail brushes (for cleaning hands before surgery)
Fuses for our van
Drawer sliders for a desk I am building
Speakers for the Operating Room (its nice to listen to music during long operations)
Foot pedal to operate the endoscope
Ultrasound machine which was repaired while we were back
Table Saw blades for various construction projects
Headlight (it's hard to operate when the lights go out)
Transformer (to convert 220v to 110 volt electricity)
Humby knife (used to remove skin to use for skin grafts in burned patients)
Nasal Canulas (for giving oxygen to patients)

Please pray that we'll just breeze through customs. : )

1.12.14

(Some of the Reasons) Why We Love Uncle Carlan

by Rachel

I think that if you asked missionary parents what some of their biggest fears are, or some of the biggest sacrifices to taking their kids to the missions field, one of the most common responses would have to do with health care for their kids.  We know missionaries that have moved to rural parts of Chad, India, and Tanzania, to name a few, and have been hours and hours of rough travel away from clinics and hospitals.  These are brave parents that have much faith.  Over the years, I have come to realize how unique our situation is, to not only have access to a doctor but to MANY doctors, not only access to a clinic but to a whole hospital which, while it has its limitations, is set up to provide most of the care we and our kids could possibly need.

Everyone on our team has their role to play.  Alyssa acts as the official "team physician" but the rest of us fill in for more specific situations (no one on the team has let me deliver their baby yet...ahem...).  When Carlan joined our team, we initially thought of him as another primary care doctor, but he has rapidly created an important new position and emergency room at the hospital.  We also had no idea how important it would be to have an ER doc as our neighbor.  Maggie actually stuck a bean up her nose last December.  I guess I always thought, who are these kids sticking beans up their noses and in their ears?  My daughter, I guess.  Carlan was able to fish it out with some random ENT equipment that we found on the bookshelf.

In the past month, we have had several more serious mishaps that Carlan has helped to patch up.  First, Sammy accidentally got his entire pinky fingernail ripped off while outside playing with rocks.  I have no training in fingernail repair, but Carlan was quite familiar with the necessary steps to making sure that the fingernail WILL someday grow back (seems to be a success so far).


Then last week, Maggie fell off a retaining wall outside our house and we immediately suspected a broken arm.  We called him and he arrived to do a complete exam in less than 2 minutes.  He and Eric carried her up to the hospital, got an X-ray, diagnosed a "greenstick fracture" (like an incomplete break in an immature/young bone), made her a splint, wrapped it up with fun bright blue wrapping, and brought her home.  It was literally less than an hour since they had left.  I know of no place in the entire world where you can get care like that.


And really, he's very affordable. :)  He would probably see us for free, but in the interest of generating some more income for the hospital we did pay the specialist fee of 10,000 Fbu.  I would say that the care he provided was definitely worth the $6.50.  In all seriousness, we are so grateful for the protection that God has given our families, for the provision of equipment and doctors when there IS a problem, and for good med-evac insurance when the problem is beyond us.  We pray for much more of the same in the years to come.

Of note, I had just finished writing this post when John stopped by.  His face accidentally collided with a metal pole.  Guess who sewed him up?  Our team seems to be a bit more accident prone than usual lately...



28.11.14

We’re not the best people for this job…

(by Carlan)

…our students are.

As we say “au revoir” to another group of bright, talented med students it strikes me again how true that statement really is. To watch how natural they are with patients, how easily the adopt the role of educator and advocate, how quickly they laugh and make everyone around them laugh fills me with a profound gratitude for what God is doing here and that we, a ragtag group of knuckle-headed missionaries, get to be a part of it.

One of my attendings in residency liked to say, “If a picture is worth a thousand words, a video is worth a thousand and one words” (to discourage the use of movie clips in grand rounds presentations). Though I would never contest the wisdom of such a seasoned medical educator, I humbly submit to you the following film, prayerfully intended to convey in sound and image what we are hoping to be in word and deed.


Please click here if you can't see the embedded video above or just want to see the bigger, higher definition version.

26.11.14

Teaching Bioethics

(from Eric)

For the last 3 sessions of the Christian Philosophy of Medicine course, I had our students break into groups of 3 or 4 and present the following cases.  Very interesting discussions ensued.  Just for those who are curious, here were the 8 cases presented, 7 of which are more or less based on true stories we have experienced in the last few years (the exception is the Ebola case)


1. A man comes to you, admitting to having visited a prostitute last week.  This week, the prostitute texted him, saying that she is HIV+.  He wants an HIV test.  It is negative, but you explain that it takes weeks to months to convert an HIV test.  He is married, and does not want to tell his wife, because he regrets his actions, but knows that his marriage will be over if he tells her.

2. A patient is hospitalized on the service where you are the doctor.  1 day later, he is confirmed to have Ebola.  Your service has 3 nurses, 1 man and 2 women, all married, and one woman has 3 children.  None of them want to treat the patient, being afraid of contracting Ebola.  The hospital has decided that only 1 nurse will treat the patient, to limit exposure, and it is for you to decide who.

3. A 70 year old lady presents in a coma, and is put on a mechanical ventilator.  The next day, CT of the brain shows massive cerebral hemorrhage.  Recovery is impossible.  She is a widow with 2 sons that are present.  One wants her to remain on the ventilator, in whatever circumstance, which could be months.  The other wants to withdraw care of the ventilator, given that she will never survive without it.

(This is the most "American" of the cases, and as I have seen before, most Africans consider withdrawing care a form of euthanasia, a terminology distinction which I discourage, since I don't think it helps them to discuss the issue with others.  It always highlights to me the difference in thinking about such a case and experiencing such a case.)

4. A 75 year old man presents with epigastric pain and severe anemia.  He is transfused and endoscopy shows an unresectable gastric cancer.  Before rounds the next day, the patient’s son comes and asks you if it is cancer and if it is treatable.  You explain what was found, and he asks you not to tell the patient, because it would cause him to despair.

5. You are the medical director at a hospital where there is one unit of O-neg blood left, and none at your referring blood supply hospital.  You have a 5 year old girl with severe malaria in respiratory distress with a hemoglobin of 2.5.  At the same time you have a postpartum lady with a hemorrhage, now controlled, mother of 5 children young children, who has a hemoglobin of 3 and a blood pressure of 70/30.

(This is one of the most common scenarios.  In fact, right after the discussion, someone came to interrupt the class to tell me we had a patient in an eerily similar situation.  However, I'm not sure there's a real good way to talk about it.)

6. A mother of 8 is hospitalized for a C-section for baby #9 at the same time that baby #8, age 15 months, weight 3.5 kg is hospitalized for severe acute malnutrition due to family food shortage and poverty.  The mother agrees to a tubal ligation, but the father refuses.  The mother asks you to do it and not tell the father.

(This generated the liveliest discussion, which was a lot of fun.  I had to cut it short.)

7. A 30 year old woman comes with severe anemia and respiratory distress after a femur fracture.  She needs blood and surgery to survive.  Your hospital has a policy of paying a deposit before surgery due to a high rate of repayment.  The patient cannot pay.  What to do?  The following week, the medical committee is meeting, of which you are the president.  Your hospital has not been able to pay salaries for the last 2 months.  Do you try and change the pre-payment policy?

(Also common and relevant, but pretty painful to talk about.)

8. A 40 year old mother of 3 children has HIV and is on ARVs (antiretroviral therapy).  She started the ARVs 18 months ago, and has been getting slowly better, despite a hospitalization for dysentery.  At this visit, she says that she visited a prophet on the border of Tanzania last week, who prayed for her healing from HIV.  She believes that she is now healed, and has stopped her ARVs.  She does not want to be retested, because she already knows by faith that she is healed.

(This one was harder to discuss than I anticipated, and maybe could be given more time and depth the next time around.)

24.11.14

My Adventures in the Local Primary School

by Jess Cropsey

The Kibuye primary school is located right next to the hospital, but what goes on at this place has been somewhat of a mystery.  We’ve enjoyed stopping by from time to time to watch the after-school drumming practice, but usually try to avoid that area around noon when school is dismissed and swarms of children are all over the place.  I’ve had an interest in being involved there somehow, but haven’t felt like I had any extra reserves for that until recently.  A few months ago, I started dialoging with the principal (who also was one of John’s surgical patients) about being involved with teaching English and we tossed around a few possibilities.   



In the end, it was decided that I would teach the two 2nd grade English classes twice a week. In addition to their regular subjects, students study Kirundi, English, French, & Swahili, so the teachers have a high bar but very few resources to help them in their lesson planning or for classroom activities.  It’s a good day if each kid has a notebook and pen.  When I pulled out my pack of colored notecards, there were many “Yooooos!” uttered throughout the room.  The teacher was even straining to see the pictures from Dr. Suess’ ABC book.  The hand puppets that I used to model a simple dialogue almost put them over the edge!  With nearly 70 students in each class, it’s difficult to find ways to give everyone a chance to practice, but I’m learning to be creative.  Group/pair work is a foreign concept, so we’re slowly trying some new things.  I have really enjoyed this opportunity and it’s definitely a highlight of my week to walk into those classrooms and hear a resounding chorus of “Good morning, Teacher!”  



I also discussed with the principal the idea of enrolling Sammy in the pre-school class, primarily for the purpose of giving him the opportunity to learn more Kirundi and develop relationships with Burundian kids.  When I had back surgery right at the beginning of the school year, life got a little hectic and I thought I had missed my chance.  As it turns out, I was talking to the principal several weeks later and found out that they were in fact just beginning class that very week.  I decided to give it a shot.  I went to the parent meeting and was told about the “uniform”, which is any red shirt (orange or pink are close enough) with dark pants, and materials that they would need for class (a pen & notebook).  The following day we arrived for the first day of class.  Sammy was eager enough to go, but not too keen on me leaving him by himself.  I was also hesitant since I had no idea what was going to happen, so I stayed.  For the first week, there was no classroom available, so we sat outside on some mats.  They have absolutely no toys, games, or materials (Sammy’s 16-pack of crayons caused quite a stir), so the teacher did some listen and repeat exercises aimed at teaching the names of various body parts (primarily for our benefit, I assume).  The class kept Sam’s attention span for about 45 minutes and then he was ready to go.  I thought that was not too bad for a just-3-year-old boy, so we said our goodbyes and went home.  Over the last few weeks, we have had lots of positive experiences interacting with the other kids in the class and it’s great Kirundi practice for me.  For a variety of reasons, it has become clear to me that I need to stay in class with Sammy.  Expectations here are very different.  Nobody seems to be concerned about leaving a class of twenty 3 to 6 year olds completely unattended for 45 minutes until the teacher arrives.  After a few trial classes, I have decided on a 3 times a week schedule with the goal of 1-1/2 hours each time.  So far, so good.    


This school weighs on my heart as I see the brokenness and long for better opportunities for these kids.  Yet, it feels impossible.  How can the cycle of poverty, lack of resources, etc. ever be broken?  Please pray for me & Sammy as we develop relationships with students and staff at the school.  Pray for wisdom as we look for ways to be a blessing.  And pray for these kids and teachers to find creative ways to meet the many challenges that they face.  My prayer is that Kibuye Primary School will become a model of educational excellence in the years to come.            

20.11.14

COTW: Duct tape fixes everything

(New perspectives on our life and team being almost invariably a good thing, both for you our readers as well as for ourselves, we are happy to welcome Greg, our visiting anesthesiologist, and his reflections.  He and his wife Stephanie host a family blog, and you can find the link on the right sidebar.  -Eric)

Last night, my wife heard a knock at our kitchen door.  It was one of the medical students.  “Duct tape! Greg said you have duct tape!” she told him that she had returned the duct tape to the other visiting missionaries who had the foresight to bring such an essential tool.  And off the med student ran to find the duct tape. Now, we are relatively new to life among the Mcropders, so this would fall within the category of “new experiences” for us.  I have never before had to send a medical student to my house to get duct tape to make my anesthesia machine work.  

My name is Greg, and my wife, three children and I are serving along side the Mcropders in Kibuye for 9 months.  Yesterday evening, I was outside searching for an internet signal, when one of the hospital employees found me and handed me a note.  There was a 5 year old girl who had just arrived in the ER with multiple machete wounds to the head, inflicted by a “crazy person” in her village.  She had a skull fracture and was in a coma.  Agneta, our visiting surgeon from Kenya, had evaluated her and decided she needed to go to the operating room immediately for a decompressive craniotomy and exploration.  They called me because I am the visiting anesthesiologist.  

They have been doing surgery at Kibuye for many many years.  However, it was not until after I arrived 2 months ago, that we starting performing surgery under general endotracheal anesthesia.  Before yesterday, we had done a total of 4 general cases.  This very hurt little girl would be the fifth.  So, I went to work preparing the anesthesia machine, connecting it to the air compressor, then connecting it to the oxygen cylinder.  Unfortunately, this time, there was a large leak of oxygen around the connection between the tank and the machine, making it impossible to maintain pressure in the machine.  Sadly, I did not realize this until after the child was intubated on the OR table.  We managed to limp along until the student could return with the duct tape which we used to position the tubing at just the right angle to minimize the leak ... but it was not pretty.  In fact, it looked a lot like a sophisticated medical device ... held together with duct tape.

Back in the US I don’t see many craniotomies on 5 year olds, but I have to say, I was astounded by the work that Agneta did.  The child’s skull looked like a jigsaw puzzle.  Agneta, somehow took it all apart, repaired a dural tear, controlled the bleeding, and then reconstructed the puzzle, using Jason’s Dewalt drill and multiple sutures.  The girl remained stable throughout surgery, and was extubated (breathing tube removed) at the end of the case.  This morning, she remains in a coma but is otherwise stable.  We are praying that as the swelling in her brain subsides over the next few days she will wake up and make a full recovery.  

We are all so grateful to have had Agneta here this month.  She was trained at Tenwek hospital, with Jason as one of her teaching attendings.  She has a brilliant mind, gifted hands and a compassionate heart.  It has been massively encouraging to spend this month with someone who has benefited so much from the desire that God has given the Mcropders to teach and train African physicians.  Sadly, she returns home tomorrow.  And I can’t help but think that if this little girl had come in a few days later, she would have had little to no chance of survival.  We praise God for His gracious provision for our team, for our hospital and for this little girl.

18.11.14

Testimonies from our Medical Students

(by Eric)

Some things are easy to write about.  And some things are just as (or even more) important, but hard to write about, so they feature less in the blog.

One of the core items of our work here is the education and discipling of Burundian medical students (some are also from other countries in the region: Rwanda, Congo...).  It's a primary reason we're here.  As Carlan put it, "We're not the best people for this job.  Our students are."  Burundi has one of the lowest doctor/population ratios in the world, and these students form part of the remedy for a country with no to minimal access to quality health care.  So, we educate them.  Day in and day out, we are surrounded by uncomfortably large crowds of students.  They are bright and talented, and they are learning.  They will be a tremendous blessing wherever they are.

But what will they do?  What will guide them?  Will a good education be a ticket to a land with less need, or a way to simply increase personal prosperity, or will it be a calling, a gift of God for his purposes and not their own?

And this is discipleship.  Less tangible.  Harder to measure.  Like many less-tangible and hard-to-measure things, it is among the most important things of life.  We lead bible studies.  We teach classes.  And more than anything, we live side-by-side with them, and in our brokenness, God's grace shines through.

Currently, we are coming to the end of a 4-month stint with 34 medical students.  I will try to share a couple testimonies from them.  It is fitting for an American to write about this, just before Thanksgiving, since we are very thankful for these students, for their testimonies, for their growth, and for the opportunity that we have to be part of their lives.

Last Thursday, at our most recent bible study, 4 students volunteered to share testimonies.  Normally, these are incredible stories about the students' lives growing up, losing parents in wartime, being put in jail, unexpected deaths of siblings.  But this time their testimonies were about their time here at Kibuye. Here is a summary:

One young lady spoke of how she had neglected the church for several years, being sure that God was with her when she did good deeds.  But she was haunted by never doing enough, and every year she would promise God that next year, she would do better.  She said that here at Kibuye, for the first time, she knows that Jesus loves her, not because of what she does, but because of his love.  And this is transforming her.  She said that here she saw a miracle:  humble specialist doctors.  (This is a theme we have encountered.)  Doctors who care more for their patients, doctors who pray with them, who lead worship for the staff to sing.

Another lady spoke of how her time with the student outreach group has transformed her.  I love these stories.  The students from the city are often quite shocked by the poverty here, and form a Christian outreach group, to pray for their patients in the evenings, share with them, and collect money to buy them food or maybe medicines.  This is independent of us missionaries, which is probably the best kind of testimony.  =)  She spoke of how nervous she was going out to talk with these patients, but how the patients put her at ease, and with time she has grown in her capacity to pray and share with them, more than she would have imagined.

The next day, after the final lecture that I gave in the Christian Philosophy of Medicine course (this one on facing suffering), another student asked to talk to me.  She said that, prior to coming to Kibuye, she saw medicine as a job.  She wanted to do the right thing for her patients, to avoid her supervising doc pointing out her misdeeds.  But now, for the first time, she thinks she loves her patients, and she wants to treat them because she has found a new care for them inside her.  She said she now sees medicine as a calling, and is trying to figure out what God is calling her to do.  She wanted to know about missionaries.

After arriving here, she kept asking her friends what these Americans were doing here.  They gave such answers as "Maybe they are just adventurous tourists" or "Maybe they've always wanted to live in Africa" or my favorite "Americans do all sorts of weird stuff!  Who knows!?"  But she said, those answers didn't pan out.  We had our little kids with us (another common theme), and she couldn't even imagine bringing her little kids up to the country from the capital.  She recognized that we were here to try and follow God, to serve Burundi and to see him glorified here.  She wanted to know how we decided that was what God was calling us to do.  So we spent an hour talking about how much potential she has to glorify God in her country, about keeping our eyes fixed on Jesus, and about exploring possibilities with her church to join together and maybe send out some doctors to serve.

These words are joy and life to us.  We know that we live out these things so misshapenly, with so little grace, and often so much frustration.  And yet we believe ardently that here, seeking God and his will, we can all together find the source of life and of joy.  And so to find our students recognizing this same true source, is a great encouragement.