On the Consumption of Termites

From Guest Blogger Abraham Paternoster, who is more than half-way through his six-month stint with the team in Burundi

            If you want to come into contact with as many living organisms as possible, visit a jungle. If you want to come into contact with as many insects as possible, visit a jungle with a flashlight. If you want to come into contact with and eventually eat insects at the bargain price of 6¢ a pile surrounded by friendly onlookers, visit Kibuye. While Burundi may not be at the top of many culinary tourism lists, I think it’s fair to say that the team has been intrigued by several types of fare here. Bananas, manioc, roasted goat, and now termites have in varying degrees captured the attention and adventurous spirits of Kibuye’s ex-pats.

            What to say about downing these protein-rich arthropods? Tastes like bacon bits, according to some. Its subtle flavor might be improved with a pinch of salt and, properly seasoned, could conceivably make a delicious party snack at a gathering of open-minded individuals. I highly recommend this as a literal illustration of G.K. Chesterton’s statement about the relationship between an open mind and an open mouth. Other evaluations likened the taste to nuts or suggested they be sprinkled on top of a salad or taken with coffee. Perhaps the only downside to this otherwise pleasant and enriching dining experience is the somewhat unpleasant thought that you are, in fact, eating a bug. That and the legs that get stuck in your teeth.

            Recent visitors Drew and Kim Huang had their curiosity stirred upon hearing that these delicacies were available at the dukas (vendors of local produce) just behind the hospital, so a couple weeks ago they invited the Fader girls and myself to walk up with them to buy the little creatures. For 200 Burundian Francs the woman combined two small handfuls of termites and put them in a little bag for us, but not before offering a few to Drew to see if he would actually eat them. He obliged her and the many spectators that had gathered by popping a couple right then and there, much to their astonishment and delight. We thanked them and carried our prize home, Anna holding the samples we’d been given and eagerly sorting out the heads as the tastiest pieces.

            We arrived back at the Quadplex and proceeded to offer our purchase to all and sundry near and far; several obliging souls partook and found satisfactory while others resisted even the heartiest coaxing. If you’ll pardon the expression, once one peeked, one’s interest either piqued or peaked. It was only among the children that the buggy flavor was occasionally measured and found wanting, suggesting that the composition of cooked termite can go against the child’s sensitive palate. The termites did feature as a sort of a party snack later that evening during a board game, however, lacking salt or other embellishment, they were eaten but gradually and remained unfinished at the game’s close.

            In case a merely descriptive account leaves the visually-inclined readers unconvinced, please refer to the pictures below (photocreds to Drew Huang).


Welcoming World Med

by Rachel

January has been a month full of visitors.  Last week, we were privileged and excited to welcome a group of six from World Medical Mission.  WMM is a branch of Samaritan's Purse (SP), and we McCropders have enjoyed a long relationship with them these past years.  World Med is committed to supporting missions hospitals around the world by sending short term doctors for coverage and assistance and, recently, by sending recent residency grads for a two year stint through the Post Residency Program (PRP).  Even before our two year tenure as Post Residents, World Med has been important in our paths to get to the missions field. Jason Fader remembers WMM calling his (physician) father in Kenya years ago, offering a short term doc so his family could take a needed vacation.  World Med helped arrange a short term trip for Eric and me to Bangladesh in 2007 so I could learn vesicovaginal fistula surgery.  I have never been anything but impressed working with SP and WMM.

And now, several years later, World Med contacted us to see if they could evaluate us as a potential site to send docs in the future (through the PRP or short term help).  We have been overwhelmed by the support shown to us through SP and were thrilled to welcome them for a week.  The team consisted of Dick Furman (World Med's founder), his granddaughter Ebby, Ed Morrow (head of WMM for 15 yrs), Paul Osteen (surgeon and friend of ours from Tenwek), Allan Sawyer (an OB-GYN who has served on many short term trips), and Roy Graham, one of Franklin's sons.

Dick and Ebby getting ready to watch John do surgery
They jumped right in, going on rounds, sitting through morning staff reports (in French of course), observing surgeries, touring the area, providing advice and wisdom from their many collective years working with missions hospitals.

Paul checking out the eye equipment

Allan helping out on rounds
We really enjoyed getting a chance to socialize and visit with old friends.  They also got a chance to go and visit some local attractions like Kayero Falls.

Roy and Ed at the Cropsey house
Trip to Kayero Falls along with Nathan ad Michelle Rose, friends of Carlan

It was great to see everyone and we hope to continue our relationship with World Med for many years to come.  Thanks for the visit!


HMA and Ophthalmology Miracles

From Alyssa

So our team has unfortunately entered a season of someone almost always being gone from Burundi. We all arrived in Burundi together but now, for medical education and patient care reasons, we can't all leave at the same time. And our terms with Serge require four years in Burundi and one year "Home Ministry Assignment"- which can be divided up flexibly. What is the purpose of HMA? According to Serge, "Home Ministry Assignment provides time for field workers and their families to be physically and spiritually renewed, to reconnect with family and friends, to retool for future ministry, and to reassess their calling in God's Kingdom work."

So, all that to say, Carlan was in the US for three months last summer, I'm in the US for four months now, McLaughlins will leave when I get back, etc. It's sad to not be all together in Burundi, but I'm enjoying seeing family & friends, being back at my home church, "retooling" in several key educational areas to hopefully benefit the Burundian medical students, and representing the team with mutual connections in the US. And I also of course am enjoying the amenities of consistent water, electricity, internet, favorite foods, etc.

Being Stateside, I had the privilege of seeing the final results of the video crew who came out to Burundi from Serge a few months ago. Unfortunately my teammates at Kibuye don't have the internet bandwidth or data to view such things, so they will have to take my word on what a great job the videographers did! I love how beautifully the first video captures what amazing work God does through John Cropsey in the eye ward. He's only the second eye surgeon in the whole country of Burundi and he literally gets to make blind people see! Also, the English voice-over for the patient in the video was a med students who generously and cheerfully worked many hours with the video team and who was greatly impacted by her four months rotating with us at Kibuye to the point that she is now considering missions and caring for the underserved through medicine.

[Here's the link if you can't see the video below: http://vimeo.com/113349898]


And the second video ties in well with the blog Heather wrote a few days ago about cleft surgery and Serge. It highlights the vision of our mission agency and features footage from Burundi and clips of interviews with both John and me.
[Second video link: http://vimeo.com/113346454]



Cleft Week

By Heather

Today at the hospital, I saw a 17-year-old who has an unrepaired cleft lip.  Can you even imagine going to school with an open cleft lip?  In a place where many people believe that genetic malformations like this are the result of a curse?  I did not have the heart to ask whether I could take his picture, but you can imagine that an open hole from his nose through his lip makes him look like a sure target for a whole lot of teasing in any school in the world.  This young man is here at the hospital today, because tomorrow, his lip can be repaired. 

Our friend Drew, a craniofacial plastic surgeon, is here for the week, and we are so glad for his visit.  Most of our team met Drew several years ago when we were all working in Kenya.  Drew and his wife, Kim, have traveled the world, working in hospitals on three continents.  They came to us this time with quite a bit of luggage for a 10-day visit.  They brought precious gifts like chocolate, and they also brought lots of instruments needed for cleft lip and palate operations.  
In anticipation of this week, the hospital arranged for radio notifications all over the country to alert patients of this opportunity.  Normally in Burundi, there is no one who can close cleft lips or palates, except for occasional visiting teams of plastic or ENT surgeons.  So this week the Kibuye Hospital hallways are crowded with patients hoping for cleft lip and palate repairs.  Some of the little ones have been too malnourished to schedule for surgery, but quite a few cases can be done this week.
This little sweetheart’s lip was repaired yesterday, and she should go home in a few days. 

Our sending organization’s name has recently changed from World Harvest Mission to Serge.  I was thinking about this today, because the word serge means to stitch together two rough edges of material to make a strong seam.  I wonder whether repairing cleft lips would almost qualify as serging. 

Please pray for the operations this week and for the patients as they heal.  May they grow to be people who praise the God that loves to heal brokenness, to create beauty, to stitch together rough edges.     


Free Fungus Tea

(from Eric)

Several months ago, I snapped a picture in a local grocery store of a row of the latest locally-produced beverage:  Free Fungus Tea.  It was a nice social media moment, with lots of proposed commentary on why one would want to name a beverage "Free Fungus Tea", and several urges to buy a bottle and inform the wider world.

Well, the next time I returned, I found only a single bottle.  I guess it was a hot seller.  I quickly procured it, and shared it with a few McCropder teammates (Rachel, Jason, and Greg) a week later (in order to have a broader base of opinion).  John, of course, would have been the go-to guy for the fullest color commentary, but he was, alas, unavailable.

Then, of course, our computer died, and with it, access to the pictures.  Then we got our computer back, but it didn't seem like a good Christmas post.  However, New Year's being a holiday well-fitted for beverage-related stories, I present to you our findings:

Here is the bottle along with a couple glasses of its contents.  I had a medical student (who happened to stop by the next day) translate the Kirundi tagline, and apparently it extols the many health benefits of this drink.

Here is the back label:  The Kirundi-English combo is not as surprising as you would think.  You never know what language people will go with here, but generally, if you want to show yourself progressive, English in the way to go, and I think we can all agree that Free Fungus Tea is nothing if not progressive.

I love the "Arise & Shine Company", because it is, in my mind, a quintessentially African enterprise name, which is to say that it is explicitly biblical but the connection with the product remains a big foggy.  The ingredients seem benign enough (we think that "Mate" is supposed to be "Malt", but we're not sure), with the exception of the "starter culture".

And for the tasting:

Well, having reviewed the title, it did taste quite a bit like a spiced ice tea with a "starter culture", though I'm not sure we could have identified such a flavor beforehand.  Another way of putting it would be a Southern Fruit Tea (yum!) that's been in the fridge a couple weeks too long (not as yum!).

So, yeah, it wasn't that great.  

And I can't say that I felt particularly healthy afterwards, despite all their claims.

So, not terrible, but can't truthfully recommend it for your upcoming New Year celebration.

Perhaps the best part came afterwards.  Akin to the treat in the cereal box that is waiting for you when you finish is the hidden logo of the bottle.  Look closely.

That's right, each bottle of Free Fungus is bottled in an old Heineken bottle.  ? Starter culture ?

But, a month later, at the same grocery store, there was a new batch of Free Fungus, with a slightly spiffier label to boot.  Apparently, someone is loving it.  Microenterprise at its best.


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)


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...


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.)



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. : )


(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...