COTW: Arm Paralysis

(from Eric)

3 weeks ago, I was covering Urgences (i.e. the ER) in Carlan’s absence, and the nurse showed me a new case.  He is a 60 year old man, very polite despite his problems, laying flat on his back, with arm paralysis, specifically bilateral shoulder and elbow paralysis, though he could still shake my hand weakly.  He said it had been there for a few weeks, and he had gotten some injections at another hospital that had helped, but now it recurred (which I doubted then, and I still doubt now).  

I examined him and found more or less what he said:  flaccid paralysis in the shoulders and elbows of both arms, no spinal deformity, but an odd bulging of his lumbar spine, which he said was painful, though he didn’t complain of leg problems, just general weakness.

I was wishing for an MRI, so I could look at his spinal cord, and wondering what on earth we could do to diagnose or treat this guy.  His lumbar spine bulge could have been TB of the spine, but it didn’t explain his arm symptoms, since a spine problem there would only affect his legs and bowel and bladder function.

So I ordered an xray of his cervical spine and another of his lumbar spine, and sent him off to our temporary xray tech: Jason.

Several weeks ago, we inaugurated our digital xray system here at Kibuye.  It seems out of place, in our otherwise very basic hospital, but Jason prioritized it on the grounds that it will save the hospital money, improve record keeping, and hopefully improve the quality of our films.

Digital X-ray at Kibuye
But the only guy in the department that could work a computer was getting married and was gone for a few weeks, so Jason became the xray tech, and so he took the films of my patient.  I didn’t really expect to find much, since only the bones are visible, and I though the heart of the problem was in the spinal cord.

Mais voilĂ !  However, we found that our gentleman had compression fractures in both his cervical and lumbar spine, at levels which could certainly explain his systems.  He was placed on some steroids, while we pondered what to do.

What caused this problem?  He’s not a really old guy, with no other evidence of osteoporosis.  It doesn’t look characteristic of multiple myeloma.  TB of the spine?  In two locations?  I’ve never seen that.  We checked his HIV status, and I emailed two Tenwek friends with more experience than me, and they both responded in the same fashion:  They have never seen TB of the spine in multiple locations separated by such a great distance.

So what is it?  Probably cancer.  Metastatic from somewhere.  Where?  Does it even matter?  We certainly can’t treat it at this advanced stage.

He stayed on our service for 2 1/2 weeks, each day polite and gentle, even when he lost his ability to shake hands.  Several times, he quietly suggested that we change his medicine, because the present one wasn’t helping.  We again explained that, unfortunately, there are not any other ones to give him.  His wife stayed with him, and continued to meet me with a smile each day.

Monday, we sat down and talked more in depth.  We explained that we have nothing further to offer, and that he could go home if the family could find a way to transport him.  They said OK, and took the information in the typically stoic way of people who have never expected their lives to be free of such tragedies.  We prayed together.  They thanked us.  We expressed our regrets that we couldn’t do more.  

And now he is home.  And we continue to pray for him.


Tools of the trade

By Jason
As much as we try to be minimalists here in terms of supplies and equipment in order to keep costs down, there are some things that are very hard to be without and still provide good quality medical care.  X-ray is one of those things.  Up until a few months ago, this 1978 model veterinary x-ray machine was providing the only x-ray capability we had at Kibuye Hope Hospital.

In addition to not having enough strength to do x-rays that require high penetration (chest x-rays, abdominal x-rays, spine x-rays), it was always tough to keep a good supply of the film and the chemicals needed to process the film due to shortages in the country.  But now, thanks to the generous donation of some friends, we have a brand new x-ray system.

  Not only does it have enough "oomph" to do all the x-rays we need, but it is also digital, so that there is no need to have film or chemicals to process the images.  This has given us a tremendous boost in the level of care we can offer here.  Below is a comparison of the old and the new.  The first one is a mid-shaft femur fracture in case you can't tell!


The Man Cave

by Jess Cropsey

It’s hard to believe that we haven’t officially blogged about the place that is so dear to several team members.  It also doesn’t seem appropriate that I am the one writing this blog, but since those who frequent the "Man Cave" would rather spend every spare minute of their crazy busy schedules working on construction projects in said location, I decided to take a stab at it.  

The “Container-Plex” as it is most often called (although it has other names such as “the Man Cave” and “HOE=Heaven on Earth”) was actually the first McCropder building project to be completed....because, of course, it is by far the most important.  The container-plex is John & Jason's brain child and the fulfillment of their boyhood dreams as missionary kids in Africa.  The ends of the structure are the two shipping containers that arrived this past year.  The bottoms of these containers were painted with oil and then set on concrete bases to deter termites and other critters.  For more about how these containers got onto the concrete slab in the first place, solely by manpower and some logs, watch the videos below.


Jason applying the coat of oil to the bottom of Container #1

The containers have been painted and Carlan has some top-secret, artistic plans for the exterior.  (The guys promised the gals to make it look nice since it is in the dead center of the residential housing, with a ring of future houses planned to encircle the shrine....because, as I said before, it is the most important building.)  The space in between these containers was bricked in and a roof constructed in order to create a giant workshop which is absolutely loaded with enough tools and gadgets to make any handyman drool.  

Many of the kids have tagged along with the dads to work on various projects such as storage shelves at the hospital, a sample “crib” for the nursery, and a sample incubator for the NICU.  I think that we should be able to formally add “Workshop 101” to the Kibuye Hope Academy curriculum pretty soon!    

As much as I make fun of the guys for their over-the-top love of this place, I am very grateful to have handy-men on the team.  When you live in Central Africa, it's important to know how to fix things yourself.  I also got a Lego table in the bargain, complete with a trap door for easy clean-up!  That's right...now it's the ladies' turn to drool.  


Burundi Tourism

by Jess Cropsey

Since we first arrived in Burundi (almost a year ago!!), we have tried to keep our flow of visitors to a minimum in order to more deeply invest in Kirundi language study, relationships with Burundians, and the myriad of tasks associated with moving to a new place in a foreign land.  Now that our "visitor moratorium" has ended, we are looking forward to welcoming some special visitors over the coming months, including some family.  Of course, people want to spend time at the hospital and see the work that's going on there, but it's also nice to sneak in some fun trips.  The question is -- what is there to see and do in one of the poorest countries in the world?  Due to Burundi's dense population and its political crises, there are no large game reserves to attract tourists (like Kenya or Tanzania) or world-famous gorillas (like Rwanda).  However, we have been pleasantly surprised by some quaint little spots that we have discovered, and most of them all within a 45-minute drive of Kibuye!

1)  Karera Falls - this is a great little park that has several different waterfalls.  Chances are high that you'll be the only ones there and walking sticks are included in the nominal entrance fee.  :)  Our team took a trip here in December and enjoyed a nice picnic lunch after our hike.

2)  (Southern-most) Source of the Nile...believe it or not, is in Burundi!  It was discovered by a German explorer, Burkhart Waldecker, in the 1930s.  The pyramid shown below (since his quest for the source began in Egypt) was erected at the top of the hill from which the spring flows, which also happens to be located on the Congo-Nile Continental Divide.

They've done a nice job making this site friendly to tourists, without being over-the-top touristy (which I'm pretty sure is impossible to find in Burundi).  There are some beautiful concrete & stone picnic tables and nice gazebos for relaxing, enjoying the view, picnicking, and/or shooting footage for Star Wars VII.  

3)  Hot Springs - We were told about this place while we were visiting the Source of the Nile.  Literally, you drive for about 15 minutes until the road comes to a dead end.  That's how you know you're at your destination.  It's amazing how this gorgeous spot with several different warm pools still seems so untouched, natural, and wild.  We're hoping that the water was warm enough to kill any unfriendly, microscopic creatures that might have been living in the water.  There was a Burundian soaking in there with us (see if you can find him), so hopefully that means it was okay to get in!  I imagine that there was a place very much like this in the Garden of Eden.  

4)  Of course, there are also many local trails to be explored nearby and what better way to do that than on a "piki"!

5)  Kibuye Rock is a must-see for any Kibuye visitor.  The 20-30 minute walk uphill from the hospital offers a lovely view of the hospital grounds and some cool big rocks to play on, in addition to an almost-guaranteed tour group of 20+ Burundian children.    

6)  A little further away, near Bujumbura (Burundi's capital) is beautiful Lake Tanganyika, the longest and second deepest lake in the world.  The views are spectacular, but beware of crocs, hippos, and schistosomiasis (also known as "schisto", which is now part of Sammy's vocabulary).

So, the next time that you happen to be in our neck of the woods, we'd love to show you around and hopefully over the years we'll discover many other charming little spots in this beautiful country!


Kibuye Hope Academy Year 1

by Heather

The last school bell has rung for the first official school year of Kibuye Hope Academy.  Actually, we didn't have a school bell.  We had five school-aged kids, a couple of moms-turned-elementary-teachers, many books, and a lot of fun doing school in our two-room schoolhouse.
Kibuye Hope Academy School Building 2014
The school year began in our temporary home in Banga, where we emphasized hands-on science.  Upon moving to Kibuye, we expanded our curriculum and began meeting in this school room:.
The big kids (grades 1 and 3) had their own classroom for exploring history and science from Ancient Egypt to outer space. Meanwhile the younger kids gathered for preschool here:
And now the kids (and moms) are mostly ready to advance to the next grade.  Except that the older kids are continuing their math and English classes with their mothers through the summer, due to the December arrival of most of the school books.  We also continue French class throughout the summer, and every day we all have informal Kirundi study everywhere we go.

Life here includes constant social studies lessons for these kids, as they are now advanced students in Survey of World Cultures. Our 9-year-old did kindergarten in Kenya, first grade in the USA, second grade in France, and third grade in Burundi.  That has definite perks, and at the same time, we're looking forward to staying in the same location for the next school year.  Happy summer to all.


Bon Voyage, Carlan!

Today marks, in some ways, the end of an era.  After almost two years of being together as a team, from Albertville France to Bujumbura, Banga, and Kibuye, Carlan is starting off the wave of HMAs/furloughs.  He left Kibuye this morning and will fly back to the US for three months state-side on Wednesday.  We are sad to see our energetic, hardworking, fun loving, awesome teammate and wonderful uncle to our kids say goodbye until October.  As a team, we decided it would be best to stagger our time away from Kibuye for the sake of the hospital and the sake of the medical school, but it doesn't make it easier for the rest of us to be apart.  Once Carlan returns, it's Alyssa's turn to go and then the McLaughlins and then…well, you get the picture.

So, pray for Carlan's trip back to the States, for safe travels and good times of fellowship and connection.  Pray for those of us here at Kibuye, trying not to let Carlan's newly formed ER crash and burn without him (!).  He has spent many hours in tireless service at the hospital, renovating and creating a new emergency room where there really was not one before.  We are blessed to have him as part of the McCropders, and eagerly anticipate his return.


Artemis Award

The American Academy of Ophthalmology has chosen this year's recipient of their Artemis Award, which recognizes a young ophthalmologist who has demonstrated professional caring and service to an exemplary degree.

Click here to read a great article about John!
First cataract web


On Being Rich, Part 2: New Houses and Goat Roasts

(by Eric)

The first of the McCropder families is in a permanent house.  We, the McLaughlins, moved in about 3 weeks ago, and have been loving the space and the sense of settling.  Thanks to all that have made this possible.
Celebrating my 33rd birthday in the new house.  (Yes, that is quite a couch.)
After several years of living in temporary housing (since we left our home in 2009, remember that saga?), the luxury of this nice house all to ourselves weighs on us a bit.  This is certainly added to by the poverty that is all around us.  We've written about these tensions before (and I'm sure we will again), but there is another side to that coin.

A while ago, we decided that, at the end of every major construction project (like a house) we will celebrate in traditional Kirundian fashion:  A Goat Roast.

Everyone takes the afternoon off, and all the workers get to sit down, rest, drink a Fanta, and enjoy a goat-based meal.  And, like every good African ceremony, no one can enjoy themselves unless there are several speeches made (a phenomenon inexplicable to us Americans).  So last Saturday, we hosted the first of these feasts.
Several workers getting the meal ready
Anna helping out, peeling boiled plantains
Five goats were purchased, and several crates of sodas.  The meal was rounded out by boiled and fried plantains topped with a tomatoey sauce.  Roughly 100 guys (and a few ladies) came to enjoy the food, the drinks, and the speeches.  I received a lot of applause for my line of "Nizeye ko, mu misi iza, tuzokwubaka izindi nzu, kandi tuzofungura izindi mpene nyinshi", which translates as "I hope that, in the days to come, we will build more buildings, and we will eat many more goats."

And that's kind of the point.  Not the goats, but the fact that our presence here has been employing over a hundred people steadily, some of them for close to a year now, and with the expansion projects of the hospital, I wanted to encourage them that we hope there will be steady employment for them for quite a while.

There are days that, from a development standpoint, it seems that one of the best things we do is just to live here and be (relatively) wealthy westerners.  There couldn't be a more uncomfortable role for us, but if you look, you can find signs of development.  More builders riding bikes to work instead of walking.  That guy is wearing a nice new shirt.  That other guy got glasses.  And these things weren't gifts.  It was a result of needed, viable employment, and in the process, needed buildings are built, and these guys provide for their families while increasing their skill level and work experience.  Here's the group (it's a bit hard to appreciate how many of them there are here).

So there is a lot to celebrate:  The comfort of a new home, the completion of a long process, the necessary help from a bunch of workers, and the steady employment of the equivalent of a decent sized village.  A good day.


Drummers of Burundi

by Rachel

If you are a careful observer of our blog, you'll notice that for several years now, in the upper left hand corner of our blog header picture, is an image of an African man in a toga.  It's actually one of the famous Burundian drummers.  Seriously, this is one of the main things Burundi is known for.  I've been able to watch snatches of a few performances and it is quite impressive.  Over a dozen men with large drums, singing, dancing, jumping, drumming.  A group of female dancers usually joins them at some point in the performance for cultural dancing as well.

Well, we have our own little group of lesser known but still impressive drummers here at Kibuye, the "Kibuye Primary School" drumming troupe.  Every weekday afternoon in December we heard them practicing for an upcoming competition.  Far from being wearing, it was actually quite fun to hear the drumbeat wafting across the hills.  I missed it when January started, and was excited when they started up again this month.  The practice sessions are usually composed of 10-15 kids between the ages (I would guess) of 8 and 13 drumming big kettle drums stretched with animal hides, clicking sticks, beating drums, shouting songs.  The kids like to go out to the field by the hospital and watch them practice.  Here's just a taste that I captured on my camera phone this week:

For the "official" Burundian drummers, you can watch someone else's You Tube video below.


A Glimpse Into the World of Eyes

by John & Jess Cropsey

When we moved to Kibuye in November, there was a small, unused room at the end of the hospital that was full of ancient eye equipment, worn eye charts, and assorted glasses and lenses -- remnants of an eye program that operated on a weekly basis years ago, with all those requiring surgery sent to the capital city several hours away.  Before we could start patient care, some major renovations were needed.  Until recently, it wasn't uncommon to see the odd combination of construction and medical supplies.

The operating room under construction, temporarily used as a lecture hall for the Hope Africa medical students rotating on ophthalmology.

While construction was underway, it was necessary to figure out what supplies are available in the country.  One of the ophthalmologists in Bujumbura was very helpful in connecting John with the right folks for acquiring glasses and medicine.

The display case that John built for glasses.  We have discovered that glasses are a highly desired item in Burundi and patients are eager to have them, even if they don't really need them!  

Today, the Kibuye Eye Clinic has around 80 patients each clinic day and approximately 10 operative cases each week.  

Since there was no existing eye program when we arrived, the hospital administration needed to hire new staff to work with John.  On the team, there is 1 general doctor (hoping to complete an ophthalmology residency program in the future), 2 nurses, 2 general workers, and 1 cleaner.  None of them had any experience with eye care, so they’ve had a steep learning curve over the last few months.  They are working hard (including some very long hours on clinic days) and are doing a really good job. 

The next step for the eye program is to start mobile clinics.  Since eye care (and surgical care in particular) has never been routinely available in this part of the country, there is a big need for education in basic eye care.  For example, our family recently went to visit a friend.  While we were there, Jess noticed a young neighbor boy with an eye problem (photo below -- boy in the front, far right).  John took a look and told him to come to the clinic the next day.  It turns out he had a large foreign body stuck on his eye that had been there for several months.  The mother said that she never brought him to the hospital because she thought it couldn’t be cured.  John was able to remove it from his eye and hopefully with time his cornea will completely heal.  Basic education could go a long way in decreasing the number of patients who come to the hospital too late.     

One young patient has been on our family's heart and mind the last few weeks.  His name is Butoyi and he has been diagnosed with retinoblastoma (cancer of the eye).  Treatment involves chemotherapy which is not available anywhere in the country of Burundi.  So, he and his father recently traveled to Rwanda where there is a new program for children with retinoblastoma.  The disease is advanced and he was very quiet on our journey to and from the capital city to get passports for them to leave the country.  Please pray for this young boy, his family, and the medical staff that are caring for him.  

There is still much to be done, but we are so thankful for how God is growing this work and we pray that it is a blessing to many.