16.4.14

There Is No Home Depot

(by Eric)

In other news, the building of homes continues.  Rachel showed a nice collection of photos regarding the onsite construction of our four homes.  It's wonderfully fascinating.  But there is another element to this that I would describe as not-as-wonderfully-fascinating:  The purchasing of materials.

Here is a picture of a typical shop in the Quartier Asiatique, or the "Asian quarter" of the capital city, your district for all of your construction needs (and I do mean needs, as opposed to wants).


This is it.  The whole shop.  Stuff plastered on every surface.  You decide you want to buy something, and the proprietor sends a troop of guys to an off-site warehouse who return carrying your purchase, and then you haggle a bit over the tip.  Random thoughts concerning the construction materials purchasing process in Burundi:
  • One sink fixture is about $8.  This other one is $120.  Really?  How am I supposed to know the difference?  Warning:  there is a whole level of manufactured junk that never gets imported to the West, and it is here for the purchasing.  I bought 3 door handles/locks for our house.  2 didn't work right out of the box.  Which brings me to point #2:
  • If you have a trustworthy friend who can buy things for you, it is gold.  We are very thankful for our friend who does this for us, though there are still some things (tiles, for example) that are better to purchase yourself.
  • These items sometimes have prices on the item, usually in permanent marker, literally ON the item.  But usually not.  So you ask the guy, and he gives you a price.  Really?  You have hundreds of prices in your head at any given time?  You're making this up, aren't you?
  • "Available" can be a nebulous term.  We bought our tiles after asking a paint place what was available from their book.  "You can sell us any of these colors?  Really?  Any of them?  OK, we'll take that one, and purchase our tile accordingly."  Then it wasn't available.  Anywhere.  In the country.  "Well, that color is close to this other color."  No it's not.  Which brings us to:
  • There is not another color between Cream and White.  Why would you even ask?
  • Lastly, I have no idea what I'm doing.  A toilet here, a light fixture there, bathroom wall tiles here, a shower head there.  We'll see where all this leads.
Think of us the next time you run down the street to Home Depot to grab a few things...


30.3.14

It takes many villages

(by Alyssa)

I was thinking this morning during church (lots of time to think during Kirundi church!) about how blessed we all are. By no means are we in this alone! Here are a few of the "villages" I thought of who make our crazy, joyful, overwhelming, fulfilling, paradoxical lives possible:

1) Our families. Without exception we have 8 sets of families behind us and supporting us all the way. That is certainly miraculous and we thank God for our parents, siblings, etc. who pray for us, send us care packages, and encourage us continually - all of us, not just their own kids and grandkids!
McLaughlin and Pfister families meeting us in the Nashville airport coming back home from Kenya August 2011

Carlan's parents at a team cookout in France
2) Missionary colleagues and friends in Burundi. Some of you may have seen John's delicious birthday dessert yesterday on Facebook which included treasured oreos and special friends in Bujumbura. We're blessed to have the Millers, Bonds, and so many others welcome us with hospitality, wisdom, commiseration, and fun on our many trips to Bujumbura. What a treat to share this journey with like-minded friends and colleagues!
Janette Miller with the McCropder girls in Bujumbura 
3) Friends. It's amazing to see how friends from childhood, college, med school, residency, etc. continue to love and support us in creative and generous ways no matter where we live. This last month, some friends from my church in Birmingham decided to raise money for a NICU and peds ward for our hospital. Two of their precious boys are NICU survivors and they were saddened and inspired to help when they heard of the loss of this premie due to lack of oxygen or incubators:

I have been blown away by their care and generosity. Please read their blog here to be encouraged at God's work in their sons' lives and in the lives of our smallest patients here in Burundi! 

4) Medical colleagues around the world. Jason mentioned this in the last post as he talked about consulting orthopedic docs. I, too, have consulted pediatric rheumatologists, hematologists, cardiologists, dermatologists, infectious disease specialists, etc. as I take care of patients and diseases very much beyond my expertise! Like the below patient who likely has linear scleroderma withering/contracting her left arm and leg: 
I didn't know for sure what the diagnosis was and didn't know whether to try steroids or not. Within just a couple days I had email responses and recommendations from THREE pediatric rheumatologists!  

5) World Harvest Mission. We continue to be so thankful for the loving care and support of our mission agency. And as we speak, our Africa field directors are driving for hours and hours across 4 countries to come visit us and encourage us! Read their blog here

6) Burundian colleagues. We have been welcomed warmly by our new Burundian colleagues despite our cultural blunders, language mistakes, and missed social cues. The hospital staff is friendly and gracious and working hard to care for the patients in compassionate ways while struggling along with us with limited resources. As I was rounding on peds Saturday, 3 med students on another service showed up to help just as I was feeling completely overwhelmed realizing none of the 25+ patients had vital signs taken due to a severe nursing shortage. They cheerfully jumped in and helped where needed. 
Our Burundian medical colleagues
Pediatric Team

7) Caring strangers. We've had several visitors recently who were in Burundi for other reasons and stopped by Kibuye for a quick tour and maybe a meal. And these folks have generously included us in their packing bringing baby blankets for the NICU, toys for the peds ward, valuable medical supplies, and special treats like Girl Scout cookies and a bracelet making kit for the missionary kids. Surprisingly to us (a reminder that we're not in Kansas anymore), the directions for the bracelets were only available on YouTube - our internet is generally not fast enough for that! But after a few hours we got enough of the video to load to figure out the basic pattern. The girls loved it and are proudly wearing their new bracelets! 

8) People translating valuable resources into French. As we work to translate medical presentations, we've been pleased to find dictionary.reverso.net and other sites that help with complicated French medical vocabulary. And as we lead a Bible study for the medical students, we've been thankful for the following two resources that many people put a lot of work into translating:



9)Supporters. We wouldn't be here without the generosity of so many people sacrificing monthly to support us financially and prayerfully. God has demonstrated His faithfulness again and again in providing for our every need and we are grateful!

10) Team. I'm blessed daily by the "village" of McCropders surrounding me! What a joy to not be alone in the daily challenges and successes we face! Today we enjoyed a kids' concert (led by their music teacher Rachel), Toby's 1st birthday celebration, and team worship (including songs from Kenya, France, and the US).

Happy 1st birthday, Toby! (April 1)
"Community is a way of living: you gather around you people with whom you want to proclaim the truth that we are the beloved sons and daughters of God." Henri Nouwen

29.3.14

COTW: Orthopedics

By Jason

Many would agree that the first year of residency might be the steepest learning curve of the many years of medical training.  So many new terms, new responsibilities, new sights and smells. So much to read. My time so far at Kibuye is certainly rivaling my first year of residency.  One area in which I am having to learn a lot is in orthopedics.  I do not have a lot of experience in orthopedics, but I see a lot of it here, so my various ortho textbooks are open frequently, and many e-mails are sent to various orthopedic colleagues for advice.

Fiston is a 4 year old boy who broke his femur.  So I read about traction and spica casts and variations based on age.  Spica casts wouldn't really work here, so I decided to put Fiston in traction for 4 weeks and then took off the traction and mandated that he stay in bed for another week to let the fracture heal. So one day (during the week he was supposed to be on bed rest) I walked outside to find him like this:
His mother saw me and shouted to him to sit down, so he jumped down into the wheelchair.  Hopefully 4 weeks of traction was enough.  I guess you just can't keep some kids down.

24.3.14

A Glimpse of My Patients Today

(from Eric)

Today, the Adult Medicine service, where I am working, has only seven patients.  This is not shocking, given that these patients (unlike the children under 5 and pregnant ladies) do not get subsidized care from the government, but as I like to say, we still have more than enough pathology to keep our medical students on their toes.

To give a glimpse of our work here, I thought I would describe these people.
  1.  A 45 year old lady with diabetes that really needs insulin at home, as it is impossible to control with pills.  However, insulin injections are impossibly expensive requiring home monitoring and refrigeration (read: electricity that is reliable).  So we've been doing our best.  She is not well-controlled and will certainly have complications, but maxing out pills has at least brought her excessive urination down to a level where she can sleep better at night.
  2. A new lady, about 40 years.  Her referral came with a concern of asthma.  Our initial note mentioned maybe meningitis.  Now we're thinking strep throat with difficulty swallowing.  Yeah, I guess we're a bit in the dark.  Thankfully she's breathing OK and I don't think she has meningitis, but it's a little hard to tell what to do for her.  So, we'll keep going another day and see if we make progress despite all that.
  3. The male ward is especially dark when the power is out, most mornings recently, because there are no windows.  Like "hold up your cell phone flashlight to let me write a prescription" dark.  The first guy has bloody urine, fever, and anemia.  I agree with the diagnosis of complicated malaria, but his test is negative.  Well, it's not a perfect test.  Is he doing better with malaria treatment?  Somewhat?  We transfused him, but our blood count machine is currently unavailable due to lack of a voltage regulator.  Checking his kidney function is out for the same reason.  I would love to check his urine (which is still bloody), but we apparently don't have any more collection cups.  Nevertheless, he's maybe getting better, so we'll keep going.
  4. A 45 year old man who came in dying from what Carlan noted to be an acutely failing heart valve.  He was initially sharing an oxygen concentrator with another guy, literally passing the mask back and forth.  I didn't think he would make it, but he has pulled through, becoming a chronic heart failure patient, now going home today on a couple meds.  We wanted a chest x-ray, which isn't working for us right now, so he will try to get one in town and come back with it to clinic next week.  We took a few moments to pray before leaving, thanking God that he is still with us, and asking for his healing to continue.
  5. An 18 year old girl who was admitted from John's eye clinic last Friday.  She was fine 10 days ago and now is blind.  Her eye exam shows unmistakable signs of high pressure inside the skull, but from what?  We have no way to know, and thus our few possible interventions are more likely to hurt than help.  We gave her a few medicines over the weekend, but she's not doing any better.  The family wants to go home, and so we say OK, make a few decisions about what to do at home, and she will visit John next week.
  6. A 50 year old lady who came in Saturday in a coma.  Test was positive for malaria, but she wasn't responding well, so we added antibiotics for bacterial meningitis.  She is now slowly waking up, so though her medicines are expensive, I think they saved her life.  She still has a fever.  It's getting better though, and I hope it's gone tomorrow.
  7. A 35 year old lady who groans in pain constantly.  She arrived Friday in obvious signs of end-stage kidney failure.  She needs dialysis, but we can't even check her Creatinine or Potassium.  Full of fluid everywhere, we gave her meds to get her to urinate some more, but her symptoms are severe and months old.  Now we're shifting to comfort measures, but not really succeeding.  She is unhappy, and generally seems to think that we would help her more if we wanted to, which is pretty crushing for us.  Carlan came and ultra-sounded her belly, and found the problem.  After talking with Rachel, we've decided it's likely an ovarian cancer which has permanently blocked the urinary system.  She's too sick to operate on.  So maybe it's good to know, but I would trade that for a stronger pain medicine for her.
So, it's a mixed-bag, with some victories, even some very unanticipated ones.  And they come very much in spite of our insufficiencies.  But the difficulties can really make us feel like "what are we doing here?"

In Luke 7, there is a story where John the Baptist sent his followers to Jesus to ask "Are you the one who is to come, or shall we look for another?"  This is John's flagging confidence in the face of his own trials.  It's his weakness, but it's hard to blame the guy.

Jesus tells them to go back and tell John that they are seeing the blind see, the sick get well, lepers cleansed, the lame walk, and the poor have good news preached to them.  In other words, John, I know it's hard, but my kingdom is going forth even when it doesn't feel like it.  But if you look for it, I think you can see it.

And we can.  In fact, we see every last thing on that list, right down to the lepers.  Our systems are broken, our resources inadequate, and our abilities insufficient.  And through those things, newness comes.  In the darkness shines a light much brighter than that of a cell phone flashlight, and it will continue even if the electricity never comes back on.

18.3.14

The Well: Living Out God's Pursuing Love in Burundi

I wanted to share this link...my story was accepted for publication by Intervarsity's "The Well," an online publication for women in graduate school.  It's nothing that our "faithful readers" haven't heard, but for our newer blog readers, the article tells the story of our team, and my own calling in particular.

http://thewell.intervarsity.org/in-focus/living-out-gods-pursuing-love-burundi

It is an encouraging thing for me, that on the days that I feel the most useless, the most purposeless, the most discouraged, God reminds me that He is using the story of my life, the story that HE is writing, to encourage others.  I pray it may always be so.

14.3.14

How to Build a House

by Rachel

We wanted to give everyone an update on how the houses are progressing!  Initially we had been told that if the funding was all present, our houses would all be completed and ready for move in within three months.  Good thing we all have experience with African time frames and didn’t REALLY believe we’d be in our homes by Christmas!  With that said, things really are moving along.  And to be fair, I think we counted 11 building or improvement projects going on at the same time here at Kibuye.  Some have been completed (such as Carlan’s newly renovated ER) some are almost done (John’s eye ward) and some are just beginning (the Faders’ house).  Other projects include a dorm for the students, the water pump/pipes/collecting tank for the hospital, and “container plex”, a building with 2 shipping containers for walls that will serve as a storage area and workshop for the guys.

Currently, the McLaughlin house is the farthest along, with a potential move in date maybe in the next month or two.  It has been fascinating to watch everything take shape in a land with no heavy machinery, no power tools, and not much electricity.  We are living less than 50 yards away from four home constructions, which start around 7am and continue on Saturdays, and yet there have been only one or two days with enough noise to cause an inconvenience (the days they found a chainsaw somewhere to cut up fallen trees).  

Here’s how it all began.  Step one: level the ground.  Equipment needed: lots of hoes.




Step two: pour the foundations  Equipment needed: shovels/hoes, plastic buckets to carry concrete, large plastic tub for mixing concrete.

(the concrete mixing station, with Cropsey house in the background)
 

 (concrete footings with rebar, the current state of the Fader house)
(concrete foundations of the McLaughlin house, back in November)

Step three:  lay the bricks.  Equipment needed: bricks, little shovel thingies to smooth cement, levels.  Fascinating to watch the rapid progress.  Normally there would be about a dozen guys all laying bricks together working in teams of two.  All the walls went up on the McLaughlin house in about 2 weeks max.  It was fun to check on the house daily for those weeks!

Step four: concrete ring beam and support pillars.  You can see spaces in between the brick walls above.  These are filled in with concrete pillars.  Below, you can see Alyssa's house last week, ready for the top "ring beam" of rebar and concrete.  More bricks will go above this up to the roof level.  Equipment needed: guys bending rebar by hand.  Concrete.




Step five: cement the interior walls and floors.  Step six: decide where to put electrical outlets and such.  Equipment: one piece of of chalk and two inexperienced home owners who have no idea what they're doing.
 (Rachel and Toby in the kitchen, marking where we want light switches.  It was over a month later, after the spaces had been made for wires, that we realized we should have included an outlet here for our fridge.  Doh!  We have made many such mistakes, not being home builders or architects ourselves).

Step six: window frames/door frames.  Equipment: one welder and a bunch of metal.  Step seven: Roof!  Equipment: roofing sheets, nails, scaffolding made of wooden branches.

You can see another view of the scaffolding here in the Cropsey living room, more or less as it currently stands today.

 Step eight: interiors.  This is where the McLaughlin house is right now.  The plumbing is being put in. A carpenter will come to put in cabinets and cupboards, then floor tile will be laid.  Glass for the windows, and interior doors.  We've had to purchase a lot of what we want, and Eric has spent a light of time drawing designs for everything from the security gates on the windows to the bathroom layout to the cupboard design.  Steep learning curve.  Hopefully it will all turn out ok in the end!

("ladders" used to paint in the McLaughlin living and dining room)

(McLaughlin kitchen)

Thanks to everyone who has generously contributed to our home construction.  We are so excited to have a real home of our own after many years of sojourning!

10.3.14

In Church

from Heather
Disclaimer:  the church services here at Kibuye are conducted entirely in Kirundi.  So we don't really know what exactly is said or prayed.  This is what we can figure out.

Church starts around 9:30am on Sundays.  Most of us arrive closer to 10am, at which time most of the church has not yet arrived.  Seating is self-assigned on wooden benches without backs.  Interestingly, the benches fill from front to back of the building, and people pack in pretty tight on each bench.  Why don't we fill in from the front this way in Michigan?
First various choirs sing with choreographed dance steps.  In December the McCropder team sang Christmas carols in English and Kirundi.  Without the choreographed dance part.  Maybe someday we'll add that.

Singing is usually accompanied by an electric piano and by a drum made out of a huge metal barrel. We are starting to pick up some of the songs that are sung frequently, and we have Kirundi songbooks as well.  We look forward to the day when we can understand the meaning of the songs - I especially wonder about the song during which everyone dances around with boxes or books on their heads.

One time Anna and Elise participated in the children's choir.  Here's a video of their choir practice.  It's quite a catchy song.  We've been singing it for weeks.
video


No children's program here, so some of the young kids and some parents slip out of church after the offering and before the sermon.  The service usually ends between 12 and 1:00pm, and then we shake several hands along the short walk back home.  

Sitting in church, not understanding more than a few words per sentence, I like to think about the universal church praising God in many different countries and in many different languages.  
May the peoples praise you, O God;
may all the peoples praise you.
May the nations be glad and sing for joy,
for you rule the peoples justly
and guide the nations of the earth.
Psalm 65:3-4

6.3.14

On Being Rich

(from Eric)

Every weekday morning, from 7:30-8:00, there is a hospital staff devotion.  Many of our hospital staff are pastors, since no pastor can afford to be a pastor full-time here, so there are no shortage of people to share.  One of the pastors, who is also an administrator, spoke yesterday on Jesus's story of Lazarus and the Rich Man (Luke 16), a somewhat thought-provoking and even disquieting story for many of us.  I didn't catch that much of it, since it was 100% Kirundi, but I did understand the first thing he said when he finished reading the story.  "This rich man...We are all of us rich men."

I think what he meant was that, because we have jobs or are students who could get higher education, we are rich men.  Never mind the lack of electricity in your home, the complete absence of means of transportation beyond a bicycle, and the occasional periods of hunger when your food supply becomes a bit insecure, you are rich in comparison and you know it.

And therefore we must identify ourselves with the rich man in this story and the warnings that go with it.  And that takes courage.

It doesn't take a lot of imagination to guess how such a statement would make us feel.  We are quite a bit wealthier.  Orders of magnitude, really.  We have been on an airplane.  Many times.  We occasionally eat out at a restaurant where one person's meal could be $10 or more.  We have laptop computers.  I personally have never, not even once, had to worry about being hungry as a result of not having enough money.

There is a funny little mind trick we often play on ourselves, which is to compare ourselves to those richer than us, even if that segment of the population is small.  Why do we do this?  It's because being rich feels uncomfortable.  We feel obligated in vague ways.  We maybe feel guilty.  I know this because I live in a place where it is impossible to avoid feeling rich.  I cannot read Lazarus and the Rich Man and feel comforted.  I have to feel challenged, because I am the rich man.

I would rather identify with the poor man and hear a simple promise of comfort that is coming, but I must admit that this is yet another way or neglecting the reality of the poor in our midst.  If I'm the poor guy, then I remove my duty to help the real poor guy.

It's easier to avoid this feeling in the US.  I can find wealthier people, and maybe see myself in the poor role.  And if I remember global statistics on poverty, I can use it as a moment to do a theoretical thought exercise to be thankful that I "at least have something" and "am not as needy as I could be."  But in the end, this is a mistake, a falsehood.  Comparing ourselves to a global standard is not an exercise to appreciate things on a relative scale.  It is rather the truest and most absolute way to locate ourselves on the scale of poor to rich.  But it's too much to bear.

I'm writing this now for two reasons.  The first is to share a part of our struggle, in our continuing attempt to describe a holistic image of our lives here.  The second is to encourage us all, as a first step, to own our role as the wealthy.  I claim no virtue in having done that, because here it is utterly inescapable.  However, I keep coming back to this as an essential first step in stewarding well what we have been given.  To deny it is to run from the whole question of how to own anything.  But maybe, if we can do this, we can see a bit clearer as our hearts and our minds try to figure out how to manage resources in the world that God loves and in which he has placed us.

21.2.14

Avoiding Caput Medusa - or - Try and Keep Your Cross-Cultural Teaching Simple

(from Eric)

We are in the throes of clinical teaching here at Kibuye.  In French.  To a group of Burundians.  Who are on their first hospital rotation.  And we're still learning how to do it.  So we try out some new things.

I asked my students what some topics were that they wanted to learn about.  Perhaps that was the first mistake, because it is certainly possible to be too early in your education to know what you need to know.  They said psychiatric disease, liver failure, kidney disease, and hypertension.  I would have only picked one of those things.

But, I did ask, so I tried to follow through.  The next day, I sat down to try and do a little extemporaneous talk on liver failure.  Every time I try and do this, I discover that I don't know significant amounts of vocabulary necessary for the topic.  And I discover that when it is too late to turn back.  So you just try pronouncing the word with a French accent.  If they repeat it back, you're good.  If they don't, you give it a second try for good measure.  Third blank looks gets an attempt to explain it.  Fourth blank looks abandons the topic.

We started with a list of symptoms of chronic liver disease.  They got a few of them.  Ascites.  Jaundice.  But they weren't getting anything associated with portal hypertension.  So I asked them:

(in a French accent) "Hypertension Portal?" (it's also good to try and reverse the orders of words)

Flash of recognition.  Good.  Success.  "OK, can you name any signs of portal hypertension?"  Blank stares.  OK, I should explain it to them.  "So, when the blood going to your liver gets backed up, the blood gets sent on alternative pathways in various parts of the body, and that leads to varicose veins there and possible bleeding problems."

If you are impressed that I could explain that in French, then you shouldn't be, since, though I got an "E" for effort, they obviously didn't really understand me.  OK, moving on:

"Esophageal varices?"  OK, good, they've heard of that one.  "The same problem in another place?"

No response.

"Hemorrhoids?"  I think they get the word, but they seem more confused.

"Caput medusa?"  Very confused.  "Medusa, do you know her, from Greek mythology?"  Nothing yet.  "A lady with snakes instead of hair."  Mouths agape with astonished stares.  "Uh, yeah, I guess it does sound a bit frightening..."  

This is where I realized I had certainly gone too far, but now, with the totality of their interest directed towards me, what am I to do?

"Well, picture a face with a bunch of snakes coming out, and then picture the belly button with dilated veins sort of coming... out... instead..."

One of them ventures boldly:  "You can see that, just by looking?!"

Uh, yeah, but I don't think it's as dramatic as you are thinking...
Medusa

Caput medusa
Another day in our lives.

 Wikipedia France has informed me that "la tĂȘte de Medusa" is, in fact, the French term.

17.2.14

Valentine's Day

by Jess Cropsey


It's been a little while since we've given an update from the "home front".  Kibuye Hope Academy just finished its 24th week of school last week and we closed the week with a smashing Valentine's party!  (We like to do holidays as big as we can here!)  Thanks to the advanced planning and generosity of Grandma Cropsey, there were plenty of crafts, decorations, and goodie bags.  (She's already scheming how to get post-Valentine's sale items to us for next year!  Can you tell she has a little experience with this?)



The McLaughlin family brought some delicious sugar cookies with sprinkles and frosting which everyone enjoyed. 





The kids worked hard on cards for each other (and for the adults too).  



 Each of the older kids got a special sticker/coloring book, courtesy of Carolyn Bond (our new World Harvest colleague in Bujumbura).  She also brought special Valentine's M&Ms and Dove chocolate hearts.


In the evening, we had a team potluck dinner for Carlan's missions pastor who was here for a short visit.  We all enjoyed our traditional homemade pizzas, although this time there were a few heart-shaped ones!  

Sending our love to all our friends & family on the other side of the ocean!  Hope you had a special day with those you love.  We missed you!