Maban Cataract Camp, South Sudan

By John Cropsey

These past 6 days, I have witnessed pure beauty.  The closest thing I can compare it to is the feeding of the 5,000, except we were given an impossible sea of blind people to treat.  The eye team of Kenyans (from Tenwek Hospital), Burundians (from Kibuye Hospital) and South Sudanese (Samaritan's Purse) cared for over 1,500 patients in Maban, Upper Nile State, South Sudan, and performed 512 cataract surgeries on some of the world’s most difficult cataracts (lots of band keratopathy and pseudo-exfoliation with zonular instability and tiny pupils - I call it Sudanese eye).  This region has no access to eye care.  The nearest ophthalmologist in Juba is a three-week journey by 4x4.  Thankfully we could be flown in by MAF (Missionary Aviation Fellowship).


Maban is currently home to a massive refugee population fleeing active conflicts in South Sudan and Sudan just to the north.  The majority of the surgeries were for patients who were blind in both eyes and teetering on death’s doorstep.  Imagine being a blind refugee in a place where food and water are scarce, violence is endemic and the plagues of the earth freely reek havoc in congested, makeshift camps (HIV, TB, leprosy, dysentery, trachoma.…) with over 100,000 refugees struggling to survive in a land not their own.  In fact, several blind patients sustained significant injuries just trying to get to us.

Caring for that many patients in such a short period takes a coordinated, team effort which was spearheaded by Samaritan’s Purse and the Maban County Hospital.  The UNHCR (United Nations High Council for Refugees) provided three commercial buses for transporting patients by the 100’s each day from four large refugee camps and the "host" community.  MSF (Médecins Sans Frontières/Doctors Without Borders), the Red Cross and others also helped publicize and aid patients to the camp.

Here is how each day would start.  Examine the 80 - 90 post-op patients from the day before.  Organize the queue of 80-90 patients to be operated on that day who had already been previously screened.  Begin the surgeries while other clinicians would screen 200 - 300 new patients being bussed in by the UNHCR each day.  Here's a video of what that looks like.


Here are just a few of their moving stories:

This mother brought her three children to us, all bilaterally blind from cataracts (note the white pupils in the close-ups below).  Can you imagine being in her shoes fleeing a war zone and with all your children having gone blind with no hope of getting them care?
Eldest daughter
Middle Daughter
Youngest son
David Sawe, Kenyan cataract surgeon extraordinaire, performed heroic bilateral surgery on all three kids in succession.  
The kids getting pre-op anesthetic injections followed by the "Super Pinkies" to compress the orbit and eye prior to surgery.
The eldest went first.  All three had successful bilateral surgery.

Below is a mamma who fell and presumably fractured her hip on the way to see us.  She wanted eye surgery so bad her son brought her to the camp in a wheelbarrow and straight into the operating theatre.  She refused to be taken for x-ray or have her hip examined.  She desperately wanted to see again and wasn't going to let her hip stop her.
Getting escorted to the front of the line in theatre in a wheelbarrow.
Post-op and SO HAPPY.  She only has one tooth so its hard to see the smile:)

On our last day there, I had the chance to watch 81 post-ops get up and walk home simultaneously.  I'll be honest.  It put a tear in my eye.  As I strolled back to the SP compound for the last time, I saw this post-op granny who had been totally blind briskly making her way home through the village.
We praise God for all He enabled us to accomplish on behalf of the blind of S. Sudan on this trip.  I am also incredibly proud of this 100% African team (ok, I am a partial exception but my role was very small), in particular, its talented Kenyan leaders, David Sawe, Jarred and Brenda.   TIA (This is Africa) today folks, Africans caring for Africans.       


Ku Muyangayanga and Forays into the Community

by Jess Cropsey

People often assume that our children are fluent in French and Kirundi (or at least one of them, right?)  Well our kids certainly have been exposed to multiple languages and have picked up lots of useful phrases along the way, but most of them could not carry on a very long or significant conversation….yet.  In order for this to happen, you need LOTS of input in the target language.  (Remember it takes kids 2-3 years of input in their first language before they start talking much.)  

Serving together as a team is a HUGE blessing and I wouldn’t trade it for the world.  Our kids have built-in friends that have traveled the globe with them since they were really young.  The one down-side to this (and it may be the only one) is that it provides little motivation for our kids to have relationships outside of the American bubble.  When that is combined with the fact that all of their classes are in English (except French & Kirundi), it leaves very little time in their day when they are exposed to French & Kirundi.    

I would really love to spare my children the many hours of grueling toil in language learning as an adult, but even more than that I have been praying that each one of them would have a special Burundian friend.  Believe it or not, it takes a lot of effort to provide these kinds of opportunities!  The language and cultural barriers are immense in addition to the sheer curiosity that people have about our children that can lead to negative experiences for them (being stared at, teased, laughed at, touched, …).  

One small baby step that we are taking is sending some of our kids for small periods of time to the local Burundian school (that educates 1,200 kids from pre-K to 9th grade).  Last week Wednesday was our first foray this school year.  Since Anna is significantly more advanced in her French than the others, she went to the 5th grade French class.  It sounds like the level was great for her and provided a good academic challenge.  You can pray that she will make some good friends in that class.  

Due to some miscommunication (which happens frequently around here!), Micah, Abi, Elise, & Sam ended up all together in the pre-school class learning some Kirundi instead of French.  The pre-schoolers are adorable and our kids had a good time.  The teacher, Thérèse is the same woman who comes to our school to teach Kirundi twice a week, so the kids already had a rapport with her.  

Our most recent visit on Wednesday to the 2nd grade French class was a little less successful.  The emphasis was on reading French and the younger kids have only been working on listening comprehension and speaking, so they struggled to enjoy the class.  The good news is that they were begging to go back to Kirundi pre-school class!  :)  The jury is still out on how to best proceed with this group.  

The kids do have Kirundi and French class every weekday, so they have a lot on their plates learning 3 languages.  This week in Kirundi class, we inadvertently got focused on learning words related to buying goat kebobs, so we decided to take a trip to practice our newfound vocabulary!  I was surprised at how tender and delicious they were and will definitely be going back for another round at some point in the future.  Déo and Danyeli (the “abayangayanga”) also became favorites in my book because they shooed away a man who was in my face asking to take Sam home with him.  That’s what I call good customer service!  

So please pray that our kids would continue to develop good relationships with each other and that they would grow in their love for the people, culture, and languages of Burundi.  And pray for wisdom for us moms as we try to find creative ways to engage our children in the local community and provide them with good learning experiences.


Congo Eye Surgical Safari - Trip II

by John Cropsey

In January 2014, the Department of Ophthalmology at Hope Africa University’s Kibuye Hospital opened its doors with the stated mission of ERADICATING PREVENTABLE BLINDNESS IN THE GREAT LAKES REGION OF CENTRAL AFRICA.  What can I say, I like to dream big.  We started with one crazy ophthalmologist, five untrained staff, an old paper eye chart and a big vision.  Today, we have a capable staff running a pretty well-oiled clinic and specialized surgical theatre. 
The Kibuye Eye team posing for a fun photo with an old box of glasses
First Retina Surgery in Burundi          First Corneal Transplant at Kibuye
Most importantly, we are training the future of African healthcare professionals with over 100 medical and optometry students having completed rotations with us already.  We have also just joined forces with a brand new ophthalmology residency program in Rwanda and together we plan to train the future eye surgeons and physicians of the Great Lakes.  It’s a great start to what we hope to build into the major referral eye hospital for the region.

But our vision extends beyond that.  Burundi (10 million plus) sits on top of Lake Tanganyika with Tanzania and Democratic Republic of Congo stretching along either side and Zambia 500 km away sitting to the south.  Twelve million people live on the edges of the lake with virtually no access to eye care.  There is good reason for this.  This basin is geographically isolated, sitting in the heart of Africa with the impenetrable Congolese rainforest to the west and steep mountains rising out of the lake to the east leading to the vast East African plains of Tanzania.  The region has been plagued by decades of war and instability making it one of the poorest, least developed places on earth, yet it remains one of the most densely populated areas of Africa.  In other words, a virtual gold mine for any eager ophthalmologist willing to work around a few “road blocks”.

Our vision is to divide this population of roughly 20 million (Burundi + Tanganyika basin) into groups of 1 million and begin building primary eye care infrastructure (blue dots around the lake) with a floating referral eye hospital that can service the primary eye clinics around the entire lake.  Today, I want to share with you how we are embarking on this voyage with our pilot program at Nundu in Fizi, South Kivu, DRC.
The "Master Plan" for the Tanganyika Basin

We first visited Nundu Free Methodist Hospital in Fizi in February 2015 at the invitation of missionaries working there.  Fizi is home to 400,000+ people.  During that visit, we asked the hospital to identify a healthcare professional to come train with us at Kibuye in order for them to have the knowledge base to begin providing very basic eye care and compiling surgical cases at Nundu.  Dr. Songolo was selected and joined us for one month at Kibuye.  He happened to arrive just as Burundi descended into political chaos in late spring, but he stuck it out and finished his month of training.

Between June and September he compiled a list of nearly 100 patients requiring sight-restoring surgery at Nundu.  So this October we decided to pay him a visit.  What does that entail?  

Step 1, getting visas for the eye team.  Since rules change constantly and there are many layers of bureaucracy this required trips to get passport photos, vehicle documents and immigration papers in the capitol 2.5 hours away.  We received our visas just days before departure.  

Step 2, packing everything you will need to to do eye surgery in a setting with no electricity and minimal running water.  And note, this has to fit into or on top of the eye clinic’s 1986 Landcruiser, affectionately named “Umutama Kazi”, i.e. the “Old Lady”.  This includes generators, surgical microscopes, surgical supplies, exam equipment, meds etc…

Step 3, decide if security is good enough to carry out the mission.  This requires gathering intel from folks on the ground and from news sources.  BBC was reporting an ambush of a military envoy delivering civil servants’ pay near a town we would be passing through.  Eleven soldiers were killed and 20K stolen.  Concerning.  My Congolese contacts on the ground assured me this was to the north of the town.  Security was “good” passing to the south where we needed to go.  Hmm.  Tough call.

Step 4 getting to and successfully crossing the border.  This is VERY stressful.  The Congolese border guards were particularly “thirsty” this day and worked us over trying to leverage extortions of one kind or another.  Thankfully, the medical director from Nundu arrived as the “Old Lady” was about to be opened-up for full inspection.  He had a word with the boss man who happened to have presbyopia.  After an impromptu eye consult and a pair of reading glasses dispensed, we were on our way relatively unscathed.  

Step 5, traversing the main “highway” of Eastern Congo linking north to south.  This is a dirt road requiring one to ford at least three rivers where bridges have been washed out and to drive over several other bridges that look like they could be the next to go.  The road weasels its way sandwiched between the water and the mountains sitting on the lake’s edge.  From the border to Nundu it is about a three hour bone-rattling journey.  There are road blocks along the way where one must negotiate and pay not inexpensive “tolls” for the use of their fine road.
We thanked God when we arrived safely.  The previously mentioned missionaries were not at Nundu this time around, so we were hosted by the nationals.  I slept in a tent on top of the Old Lady while the staff were given rooms in nearby homes.  We were well fed by our hosts, but the diet is quite different than the Burundians'.  Most of the team found it difficult with the daily fofo working to block the colon while some form of ensuing dysentery fought hard to overcome the fofo beazor.  It really puts the bowels into a difficult paradoxical position, constipation with diarrhea.  Is that possible?  The bad news, there was no running water or privacy.   I found myself wanting to go to the pit latrine nearest me, but I could not gather the courage to sit down as there were roaches of unnatural size emerging in large numbers from the crumbling concrete “toilet” and I feared some cess-pool dwelling creature would lay its fangs into my back-side if I got too close.  Thus, my best option was using the toilet (with no seat or running water) in the Congolese house down the hill where I also took my bucket baths at night.  The bathroom door was constructed of a see-through sheet hanging in the breeze-way between you and the living room where tout le monde (everyone) was listening to the muzungu no doubt work out his issues.  The silhouette as I was taking a quick bucket bath at night by flashlight had to be equally frightful.  But, I digress.

We got right to work the next day and by the end of the week we were able to preform 63 sight restoring surgeries and carry out screening clinics at Nundu and two other locations.  We also met with local officials and other NGOs about bringing eye care services to Fizi going forward.  There is currently no eye care of any kind, even in the territorial capital of Baraka.  While in Baraka, I visited the MSF (Doctors Without Borders) hospital to discuss the situation there.  Baraka felt like a town in the wild, wild west, only in Africa.  Ironically, between Nundu and Baraka we drove through a UN refugee camp with over 10,000 Burundians living in make-shift dwellings on the side of the mountains.  It brought home the fact that Burundi’s problems are no joke either.  I can’t imagine how much fear one must feel to make the choice to flee to Eastern Congo of all places.   
 Morning post-op checks
Happy post-op mamas who are no longer blind!
This man and his wife waited all week so we could do his other eye if we had time at the end.

As part of our team, we flew in a special friend from Tenwek Eye Unit (Kenya), Richard Tonui, to help train our team how to carry out surgical safaris in some of the world’s most challenging environments.  Richard has over 25 years of eye care experience going to tough places in Africa.  We also had two Congolese students with us, a medical student and an optometry student, both of whom did an amazing job helping us navigate local logistics and care for lots of patients.  One of the students has agreed to help found our first eye clinic in Fizi when the time comes.  He happens to be the brightest one to come through Kibuye to date.  
Richard Tonui from Tenwek Hospital
Saying goodbyes to Nundu with a shout out to First Pres in Chattanooga, TN, for the fantastic eye clinic hats
Saying goodbye to Naomi, the daughter of the medical director

So, the future is exciting even though we are still just a drop in the bucket when it comes to the needs of this region, but Jesus loves to start with an act of faith as small as a mustard seed and see it grow.  We pray this small seedling that we are trying to nurture in Fizi will grow-up and begin multiplying other clinics up and down Lake Tanganyika.  


A New Author

By Nicole

I’m quite new to the McCropder group, just beginning my third month in Burundi. I graduated from Renssealer Polytechnic Institute three years ago with a degree in Business Management with minors in Architecture and Psychology, and subsequently spent a year teaching high school economics in Cullinan, South Africa. I joined Serge shortly after and through an unexpected turn of events, God called me to Burundi. So here I am, straight out of upstate New York, doing work that I find very exciting, but unfortunately is probably not very exciting to read about. I work in the accounting department of Kibuye Hope Hospital and oversee the finances for the teams various construction project. 
I hope to begin to branch out a bit and do some work in different areas of the hospital. One of those areas is the new hospital canteen. Work on the canteen began a number of months ago, and concluded this past week. We celebrated its completion with a ribbon cutting ceremony and small reception in the new building. Jason was given the honor of cutting the ceremonial ribbon along with Dr. Wilson, the hospitals’ Director of Medicine.

The canteen will provide simple food and drink options for hospital staff, outpatients, and guests which were not available before. While I hope the canteen will help to generate additional revenue for the hospital (there’s the boring accounting talk), I am most excited about the opportunity it provides us to care for our patients and their families well.

I also look forward to many more ribbon cutting ceremonies as we continue to build and expand here at Kibuye!


National Doctor Housing Project

by Jess Cropsey

One of the most recent projects to be completed here at Kibuye is the national doctor housing project.  Previously, the team of Burundian doctors that works with us were living in some pretty outdated missionary homes.  We have always wanted to have Burundian professionals living and working closely with us, so we decided to build a new housing complex for them next to our new houses.  These houses were completed during the summer, and the work crew has been doing some landscaping over the last couple of weeks which made me want to grab my camera and share a few shots with you.

This is the first unit, closest to the entrance gate, and it is currently occupied by Dr. Wilson, the Medical Director (see photo below).  We are thrilled that his wife Jeanine & young son decided to move here to Kibuye from Bujumbura.  Many professional families live apart because it is difficult to find work in the same place and most of the Kibuye doctors travel back to Bujumbura on the weekends to be with their families.  Jeanine is now a full-time language instructor in English, Kirundi, & French, primarily for many of us.  

This is the same unit viewed from the entrance gate.  The small building is a cookhouse & storage place for food & other items.  

The unit below is the middle unit in the triplex.  It has a shared dining room space for all the single doctors or those whose families live elsewhere.  They tend to eat their meals together.  There are also two bedrooms, a bathroom, and a living room that is currently being used by two single male doctors.  (You can see the McLaughlin house in the far right of the picture.)

This is the 3rd unit and it is just opposite the McLaughlin’s house.  We made this unit into two separate single units, each with their own living room, bathroom, and bedroom.  We wanted the versatility of single units for different doctors that might come along like a married couple with no children or a single female.

We are really happy with how these turned out and hope that having these new neighbors will give us more opportunities to fellowship with our Burundian colleagues.  A special thanks to all of you who gave financially to make this project possible!  


COTW: Neonatal Jaundice

By Alyssa

We have been slowly developing a neonatology service here at Kibuye. We now have a renovated dedicated room for the service, five incubators, nasal feeding tubes, oxygen (sometimes), official protocols, and a trained pediatric team to evaluate and care for these tiny patients on a daily basis. But until now we have not had any treatment available for babies with jaundice. Neonatal jaundice is very common and is easy to treat with special blue lights. If left untreated, however, the babies can have serious consequences including neurologic damage and even death. We searched for the blue lights in Burundi but were unable to find them, so I began looking at options for purchasing them elsewhere. An option from India fell through as it was too difficult logistically to arrange for shipping the materials to Burundi. Finally a google search resulted in a perfect solution for our situation - the Bili-Hut created by Little Sparrows Technologies. What is the Bili-Hut? "Low-cost portable phototherapy to treat neonatal jaundice. Anywhere."

Conversations with the brilliant founders of this company (Donna Brezinski, MD and Gary Gilbert, MD) resulted in the generous donation of a device for our use at Kibuye Hope Hospital. A visiting surgeon brought the machine out in his suitcase. Our engineer set up the battery back up system so the machine can run continuously despite power outages. I trained the peds staff on how to identify and treat jaundiced babies. Eric met with the Bili-Hut creators in the US. And voila! We've now treated five babies with neonatal jaundice. And it works!

I remember previous cases of neonatal jaundice. I would explain the risks to the families and recommend they take their baby to Bujumbura for phototherapy. Out of dozens of cases, though, only one or two had the resources to travel to Bujumbura for care. We treated the others with sunlight, but that's certainly not the most effective treatment and it runs the risk of skin damage from the sun and hypothermia due to the babies being outside in the cold (yes it can get cold here). We had at least two babies die from complications of jaundice (kernicterus for medical readers).

But this week we cared for a jaundiced 3lb premature girl. Her initial bilirubin was quite high - high enough to cause neurologic damage. We placed her in the Bili-Hut and within 2 days her bilirubin was down to almost normal. She's doing well now after the phototherapy, and the Bili-Hut is available for the next patient. I'm thankful to be part of the ever-expanding team of people who make this care possible for our tiny patients.


Book of the Month: Being Mortal

(by Eric)

Several years ago, we did a BOTM post on Atul Gawande's book Better.  Gawande is a surgeon and writes with an incredible sensitivity and appreciation for digging deep enough into an issue to appreciate its nuances.  His style is reminiscent of a medical Malcolm Gladwell.

I first heard about his new book Being Mortal one Sunday at Kibuye, when Jason was reading it outside his house on his Kindle.  (Marvels of technology...)  Arriving back in the US, my desire to read it intensified.  Why?

Because Gawande has raised issues that American society has a desperate need to have articulated.  The population is aging, and the idea I hear the most is this:  I would be happy to live and long and productive life, or I could die tomorrow.  It doesn't matter.

However, this is an awfully incomplete sentiment, since the majority of people will not experience either of these alternatives.  The norm, for better or worse, has become a life that ends only after a significant period of increasing dependence and disability.  And we don't know what to do about it.  So we don't really talk about it, and we barely think about it.

Enter Being Mortal.  One of its main points is that the medical field is ill-equipped to navigate this conundrum, because it is a kind of historical accident that society has ended up putting the aging culture in the hands of the medical establishment.  So, as a doctor, the book is useful in helping me recognize my own feelings about aging and end-of-life care.

It is a very personal book, where Gawande shares stories from his grandmother-in-law and his father, and well as a wonderful story about his grandfather in India, which he uses to debunk the idealism of the traditional model of caring for the aged at home.  He talks about deciding when too much medical care is too much.  And he talks about retirement communities, assisted living, nursing homes, and hospice, all in great depth.  He often speaks about how things don't work, but he also showcases several people thinking outside the box to find improvements and bring these important aspects of society into better focus.

He doesn't answer all the questions, but he gets our cerebral wheels turning, and does leave the reader with some helpful take-home points.  He is (as far as I can tell) a nominal Hindu and a functional secular humanist, so he doesn't have much to say about death itself (and what may or may not come after).  As a Christian, I can look elsewhere for that.

Rachel and I find ourselves discussing his ideas with almost everyone we meet.  We've roundly recommended it, and even bought it for some people.  As one reviewer said:  Only read this book if you will ever grow old and/or die.



by Heather

This past weekend, on a walk to visit some friends who live in the countryside, we learned about the verb kwikorera.  It might be my new favorite verb in Kirundi. Kwikorera means "to put something on one's head."

Even better, there are in fact two verbs in Kirundi which mean "to put something on one's head," the nuance being the degree of formality with which one carries the object on her head.  The picture at right, informal yet impressive, shows a classic display of kwikorera.  Thousands of Burundian kids carry water from a well in these yellow containers.

The more formal kwiremeka is shown below.  When people go visiting, they bring gifts for the hosts (rice, eggs, fruit, vegetables, or even chickens) in these hand-made baskets called ibiseke.  When the visit concludes, the hosts fill the baskets with return gifts and then escort the visitors back home, carrying the baskets on their heads beautifully and effortlessly, like this:
Of course when we try, it looks more like this, straining, teetering, awkward.  We actually dropped a basket on Saturday, breaking a dozen eggs.  I have given up hope for myself.

Along our walk we encountered various others who were out kwikorera style, including the women and children pictured below.  This is the most common local method of transporting things, it seems, and the items most frequently found on heads around here are:
1. baskets of all sorts, often carrying food
2. boxes with unidentified contents
3. sticks and firewood
4. jugs of water
5. hoes

It looks painful to the neck, doesn't it?  Our experienced friends tell us that it's not painful unless the load is particularly heavy.
I am considering adding kwikorera practice to our children's daily list of chores.



by Rachel

Eric and I have both been working a bit during our time in the US.  It's been interesting to stick a foot back in the waters of American medicine...interesting and nostalgic and informative and affirming (in many different ways), and sometimes a bit discouraging as well.  Sometimes it feels like my profession is passing me by and I'm losing the ability to practice in the States.  Atul Gawande wrote an excellent book called "Better," which I read several years ago, and as he writes about surgeons who perform better than others and have consistently better outcomes, I worry that in the US my patients would be better served with another doctor.  This is something I don't have to worry about in Burundi because it's just me (that's of course not to say that I don't strive for good outcomes!).

Honestly, working in the US was never part of my plan, ever since deciding on a career in medicine at the age of 16.  After graduating from residency in 2009 until now, I've spent approximately 2 years practicing medicine in Kenya, 1 1/2 years in Burundi, and 2 1/2 years doing a whole lot of different "stuff," but no medical practice.  So for the last six years, I have not once practiced independently in the States.  A job opened up for me to return to my former hospital, St. Joseph Mercy in Ann Arbor.  It's an ideal setup, as I already know most of the attending docs, nurses, and support staff, and I know the building and in general the flow of things.  I've been staffing the resident clinic and working on labor and delivery 6-8 shifts a month, and in general I've really enjoyed myself.

But if I'm being honest, I didn't sleep the night before my first shift.  The things I've forgotten are quickly relearned, and the new updates in standards of care took less than a day to read through.  But the computer system is a different story.  The operating room scares me.  My colleagues talk about robotic surgery and new equipment that lets you perform hysteroscopes in the office.  It's taken my teammates and I six long, sometimes painful years to develop a new set of skills to help us function in Burundi.  Skills like, how to speak in French.  How to deal with the advanced presentations of some common diseases.  How to manage malaria, typhoid, HIV.  How to deal with our patients dying, over and over and over again.  How to function without support systems and colleagues in our specialty.  How to relate to a patient that is literally worlds and cultures different from us.  And I wonder...if these new skills will only serve me overseas, and if returning to the US will only serve to illuminate the ever-expanding gap between what I used to know/US medicine, and what I know now/African medicine.

Several years ago, I attended a breakout session at the GMHC (Louisville conference) led by Suzie Snyder.  It continues to be one of the most influential talks I've ever heard, on the subject of being a working doctor missionary mom (because, really, there's not a lot of us out there).  One of the things she said that day was on the subject of maintaining credentials, staying up to date with your medical skills.  She said, "What God helped you to attain, he will help you to maintain."  I've clung to that many times these last six years, taking my oral boards, coming back into US medicine for a season.  He has brought me to this place, called me to this life, and will equip me with the skills and knowledge I need to do what He has asked me to do.

But there are those moments of doubt.  A lot of them, actually.  And I just wanted to share briefly how God has affirmed me several times these last months, that the skills I've developed aren't just applicable overseas.  That I might just still have a little to offer US medicine, too.

My first day of clinic (after the sleepless night), one of my first patients was French speaking from the Congo.  None of the office staff spoke French (there's a blue translation phone usually used for this purpose).  But I was able to go in to the room, greet the patient and her husband, and discuss the problem, confirming that they understood all the counseling done up until this point.  It was a shining moment in my day.  There have been no French speaking patients since that time.  Maybe it was God's special treat for my first day.

Then, Friday night, I had an overnight shift in the hospital.  A woman came in with twins in labor.  The first baby was head down, but the second was breech (feet first).  The two options for delivery would be a C-section to minimize risks of the breech delivery, or to attempt a normal delivery and pull the second baby out breech.  Her attending hadn't done many breech deliveries and wasn't comfortable with the idea, so asked me if I would help out, as the patient strongly desired a normal delivery.  Now, by the end of residency I had only done about 5 breech deliveries, but after 6 years overseas, I've probably done 30-40.  So, an "African" skill.  The woman did beautifully, and I guided to resident to deliver both babies safely.  Again, an affirming moment from God.

Not every day is affirming.  And then, not every day is overly challenging.  I still look forward, a LOT, to returning to practice medicine in Burundi.  It's what I'm called to do, what I trained for, what I love.  But in the meantime, it's nice to know that God continues to equip, and provide, and help me to grow, for EVERY situation.


Au Revoir, Drs. Toney & Erika!

by Jess Cropsey

Several weeks ago, our team and the Burundian doctors at the hospital had a send-off party for two of our colleagues as they head to residency programs in other countries.  Right now, Burundi has no medical residency programs which means that doctors who want more training after medical school must do so elsewhere.  (One of our future goals is to have certain residency programs available here at Kibuye, so you can pray to that end.)  

Dr. Toney has been working with John in the eye clinic since its inception in March 2014 and we are thrilled that he has been accepted to an opthalmology training program in Tanzania.  He has worked very hard during his time at Kibuye and has served as a behind-the-scenes leader and administrator on the eye team.  

Dr. Erika has spent the majority of her time at Kibuye working with Alyssa on pediatrics.  It was special to hear the praises of her peers at the party as they described her work ethic and dedication to patients.  Erika is now getting ready to begin her pediatrics residency in Kenya.

We are grateful that these doctors have found high-quality residency programs in Africa for their training.  The "brain drain" has been a huge problem for many countries and according to a recent article, Burundi is the least able country in Africa to retain their best and brightest.  Professionals (in many fields) leave to find work or to receive graduate-level training in more developed countries and often do not come back to their home country.  There are many reasons for this and we are not trying to blame anyone.  But it is a challenging reality, so our prayer is that these doctors will have good jobs in Burundi waiting for them when their training is complete.  Thankfully, Toney was born at Kibuye and his family is from this area, so he is very interested in returning.

To Toney & Erika, thank you for your faithful service to the patients at Kibuye Hope Hospital, for your friendship, and for your dedication to further your education.  You will be greatly missed here!  We will be praying for you as you adjust to a new place and face the challenges of medical training.  Imana ibahezagire!

Please pray for the remaining doctors at Kibuye, particularly over the coming weeks as the hospital is significantly under-staffed.  Please also pray for wisdom for the hospital administrators as they choose applicants to fill these pretty big shoes.