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.


1,000 Cases; 100 SIGN Nails

By Jason

This past month we crossed over 2 significant numbers here at Kibuye Hope Hospital.  The first number is 1,000.  1,000 = the number of major operations done here since January 2014 when I started operating here.  This does not include the 450 endoscopies, nor does it include the 1,600+ minor surgeries nor the 800+ c-sections that others have done in this time period, nor all of the gynecological operations that Rachel has performed.

The other number is 100, which is the number of SIGN nails that have been done here since we started them in March of 2014.  SIGN nails are an ingenious system of fixing broken legs by inserting a metal rod through the bone to stabilize it.  It allows the patient to be out of bed the next day, rather than spending months in bed with traction or months in a cast.  Perfect for the developing world, the SIGN nail does not require all the expensive and sensitive equipment that nails in the West require.  In fact I have put in some SIGN nails when the electricity is off with just a headlight.

Two reflections... first, there is a well-known African proverb which says "it takes a village to raise a child."  The same goes for getting an operation done.  God has compiled an amazing surgical/hospital team which has enabled an increased capacity and quality in the ORs.  We can now routinely do 6 major operations in a day, but this requires electricity, oxygen, stocked sutures, efficient cleaners, sterilizers, organized instrument sets, and good scheduling, among a multitude of other things.  It is no easy task to even pull off even one operation in rural Africa.  I am very thankful for a surgery team that is molding together well.

Secondly, I see it fitting that the 100th SIGN nail that was done here at Kibuye was done by my surgical interns - I didn't even need to scrub in.  In fact, I was giving a lecture to medical students at the time, because I was confident in their ability to do a good job, and indeed, they did.  I feel that this encapsulates much of what we are trying to do here - training the next generation of African medical professionals in their own setting to provide excellent care for their own people.

We are already looking forward to the next 1,000 cases and the next 100 SIGN nails.


Traditions and Presence

By Alyssa

After two years in Burundi, it still feels like we're just getting started learning about the Burundian culture. I experienced a new cultural event last weekend when I attended a baby presentation for the son of our hospital's medical director. In many ways, Burundian culture is more formal than ours. Burundians seem to enjoy ceremony, protocol, speeches, tradition. This was evident in many ways at the "fĂȘte" ("party" in French) last Saturday. I had heard mixed things before attending the event regarding the purpose and what would happen, so I was interested to see how things played out. (NB I'm still not completely sure I have all the facts right, so take my observations below with a grain of salt!)

"Where are you from?" Burundians answer that question very specifically. Even if they have moved to the city and been away from their childhood home for years, they are "from" the rural hill where they grew up, and usually their relatives still live there. For official family events, they return to the "urugo" (homestead). So we traveled almost 2 hours on dusty roads to the province of Rutana, stopping en route to meet relatives coming from Bujumbura and Makamba. After exchanging greetings, we continued in a caravan and arrived together at Jeanine's parents' urugo. This was evidently the first time she returned with her husband and child to her traditional home since her marriage. The "dot" (French) is the first big event between the two prospective families. At that event, the family of the groom negotiates with the family of the bride for the dowry (cows, money, etc.). And they evidently promise to bring the bride back someday to visit. So the firstborn baby presentation is the culmination of that promise.

The kids in this rural area were pretty curious about the cars and the muzungu driving (me)! 

 Baby Jolison - our neighbor at Kibuye and the guest of honor at the fĂȘte
 Preparing the gifts for the family
 Fantas (Kirundi word for all sodas - like Coke in the South!) are obligatory for these events

 Dad, Mom, and Baby in the center of the room - they seated me in the chair just to the right of them! Always hard to know what to do with the "Muzungu Status." But guests are certainly considered a blessing and are given respect and honor as a result. 

 Family of the wife on the left - being photographed individually

 Family of the husband on the right with the ubiquitous cameras

 Fantas - I love that tradition - especially as being enclosed in a tarp tent on a hot day is pretty dehydrating! Citrus Fanta is key to these interesting but long events! 

 The grandfathers each made multiple speeches with humorous repartee across the room at each other. And the maternal grandfather invited Wilson to visit Jeanine's childhood bedroom - a symbolic expression of an enthusiastic welcome. 

The grandmother on the left of me was the other guest of honor at the event as the baby was presented to her

As I participated in this cultural ceremony, I kept asking myself, "What am I supposed to be doing? What gift should I bring? Do I need to make a speech? Am I dressed right? Should I talk more with the person seated next to me? Or less? Should I finish the food on my plate or leave some behind? Should I accept a second Fanta or decline? What should I say to the hosts in greeting and in leaving?" 

It slowly dawned on me as I sat in that honored seat in the hot tent, that I didn't actually need to "do" anything. It wasn't about "doing;" it was about "being." My presence was what spoke to the family. Many folks thanked me for coming and expressed their genuine welcome and gratitude for my participation in the event. This is contrary to my personal culture where I struggle with the idol of productivity. Sitting there for hours didn't feel productive to me - shouldn't I at least be developing relationships with folks in conversation? But, as it turns out, I was developing friendships - in the Burundian way - by being present at this momentous family occasion. Obviously there are pros and cons for each of the different cultural styles of friendship, but in this case I can certainly learn something from my Burundian hosts and value being present with friends more highly than my personal agenda. As Jim Elliot said, "Wherever you are, be all there!" 

Beautiful scenery at the end of the dry season in Rutana


Long-Anticipated Arrivals

The number of North Americans at Kibuye has more than doubled after an influx of new and returning friends over the weekend.

The Cropsey family is back; praise the Lord!  And our teacher has returned; hooray!  We have missed them every single day this summer, and this picture shows how glad we are to have them back:

Arriving with the Cropseys, the Caleb and Krista Fader family is here to continue learning Kirundi before jumping into all the work ahead.  The urgent need for Caleb's engineering skills has been quite apparent, as their first 24 hours at Kibuye included about 20 hours with no electricity.  We hope that Caleb can facilitate getting a generator system in place later this year.  : )  In the meantime, we love having them here with their adorable 1-year-old, Liam.

Also, Nicole has come from New York to help in the business office, among other things, for which we are very grateful.  We really look forward to getting to know her.  Below you see her first experience in front of the church at Kibuye as she was introduced to her new community yesterday.

And pictured above on the left, the Jesh and Julie Thiessen family from Canada has arrived as well.  Jesh, a surgery resident, is here to operate and teach in the hospital for 10 weeks.  They have jumped right in, helping from the moment they arrived, and even before, as they brought all kinds of helpful items for us and for the hospital in their luggage.

We thank God for bringing each of these people here to Kibuye.  Please pray for them as they settle in.


Staring Into the Dark

(by Eric)

A few of us first met Travis in 2010.  He's a family medicine doc like me, and had just come to Uganda to lead Serge's team there.  He's instantly likable.  Intelligent and perceptive, with a heart that greatly loves God.  He's just a couple years older than me, with a wife and three young kids.

Travis has cancer.  A medical anomaly, he was found to have advanced colon cancer several years ago.  He had to leave the field and move back to the US.  He has been through chemo and surgery.  From what I can tell, God has drawn him more to himself during this process.  I'm sure it doesn't always feel that way for him.  And now the cancer is back.

I first met Sarah in 2004 in rural Honduras.  She was getting ready to start medical school, but was already repairing hernias.  She is only person I have ever met who fell asleep taking the MCAT and still got into medical school.  She came and spent time with us in Kenya.  Then she finished her surgery residency and became a post-resident in Zambia, where I had spent two months as a medical student.

Sarah is vibrant and sharp, with an infectious energy.  I was so excited when I learned she would be in Zambia, knowing that she would be a great blessing to the people there.

Now Sarah has stage IV breast cancer.  She might be younger than I am.  She has started chemo.  Surgery is not currently an option, given the spread of the disease.

God, how can you allow this to happen?  I get that nothing can separate them from your love.  I even get that you may heal their hearts and their relationships through the sickness in their bodies.  At least, I sort of get it.  But the question remains:  God, how can you let this happen?


Sunday morning at church.  We were singing.

Confession:  My mind wanders terribly during worship songs.  I know this is the case for everybody, but I'm fairly convinced it's more for me.  I analyze everything to death, and plus I'm a musician.  So, I guess I have a hard time not being distracted by the very things that help other people to focus.  

But we were singing about Christ our refuge.  We sang about weak being strong, and Christ being the Lord of all the storm.  About our hope being built on nothing besides Christ.

And praise was flowing from my heart.  Why?  Because of my friends with cancer.  Bad cancer.  Scary, life-threatening cancer.

Because I'm reminded that I need a refuge.  Because we are weak.  Because we are in a storm.  Because all our other hopes are failing us.


My teammates poke fun at my tendency to write in a melancholic tone.  And I can laugh along with them.  But I can't seem to stop writing that way.  Because Jesus is the light of the world.  If you stare into the dark, it ought to be transformed by his presence.  If it's not, then it's all for naught.

I can't always find his light.  But sometimes I can.  And that's usually enough for me to continue in the hope that, seen or unseen, his light is always there.  I can stare into the dark precisely because I have hope.

Much of the time, it doesn't feel that dark.  I don't really feel like I need a refuge.  I feel like I can hope in myself, and I'll probably be just fine.  I don't look for the light.  And so, I'm distracted by the chord changes, the timing of the powerpoint slide changes, and just about anything else.

And the point is this:  I'm wrong.  In moments like that, I need the Light of the world just as much, if not more for my self-deception.  Travis and Sarah can't hide it.  Much of the rest of the time, we think we can.  We cover it up, and we play a game to our detriment.  We miss out on praise.

What Travis and Sarah and their families are going through is, in many ways, unique from me.  In other ways, it is an unmasked form of something that is universal.

"Nothing is covered up that will not be revealed, or hidden that will not be known." - Luke 12:2

"the secrets of his heart are disclosed, and so, falling on his face, he will worship God and declare that God is really among you." - 1 Corinthians 14:25

This is very good news.  This must be very good news.  Let us live in the light.


Going Home

by Jess Cropsey

In exactly one week, our family will be getting on an airplane to head back to Burundi.  We have had a wonderful couple months here in the United States, but all of us (even the kids) are excited to go back home.  We've had some discussions with the kids about the "yuck duck" and the "yeah duck" (modeled with two rubber ducks) that harkens back to our cross-cultural training in Colorado.  The "yuck ducks" are missing grandparents, aunts/uncles, and cousins.  The "yeah ducks" are being able to play with dear friends again, being in their own rooms and having their own toys.

And for me, it really does feel like going home this time.  In Kenya and France, it just wasn't quite the same feeling of being home.  We knew those places were temporary.  As I thought about this, I realized that this will be the first time that the kids & I have left the United States for a place that we've already been to before!  Our first three trans-Atlantic flights were all going to a new & unknown place (Kenya, France, Burundi).  This time, we know what we're in for and what to expect -- the grocery stores, the currency, the food & other items that are available, the roads, the people, the language (to some extent anyways), etc.  We have a beautiful home that we are going back to, a team that has become like another family, and Burundian colleagues who are dear friends and wonderful ministry partners.  

Please pray for us as we travel next week (Wednesday, August 26th - Friday, August 28th).  Several other teammates (new & old) as well as a visiting general surgeon & his family will be traveling at the same time.  It will be a time of transition at Kibuye as a large group of ex-patriates descend upon this rural place that has been relatively quiet for the last few months.  And pray for our new teammates in particular, Caleb & Krista Fader (engineer/nurse) and Nicole Christenson (finance) as they settle into life & ministry with our team.  

A few of the amazing people we've been able to spend time with this summer:


In Praise of American Seasons

(from Eric)

Well, our time in American is more than three months now, with more than that to come before we return to Burundi.  We are probably as settled as we are going to be, which is to say "sort of".

One of the questions we get from people is "what do you enjoy the most about being back in the US?"  This is a good question.  It's good, because it is likely to yield some interesting information for the question-asker, but it's also good because it pushes us, the missionaries in the US, to a useful type of reflection.

Because there are lots of really great things about being back in the US.  The top of that list is our family and friends.  We love being here because this is where so many people that we love and have missed live.   It is here that we get to be a part of birthday celebrations, attend graduations, and see new nieces when they are still newborns.

But we also enjoy ice cream.  We enjoy the quiet serenity of driving after dark on a well-lit road.  We enjoy frank communication styles.  We enjoy Trader Joe's and Target.  We enjoy the way that Americans take so much problem-solving initiative.

Yet I thought I'd mention here one of the things that I appreciate more and more as time goes on:  Seasons.  We've spend the better part of 5 years in the equatorial highlands of Africa.  Both in Kenya and in Burundi, we've lived above 6000 feet, and within 5 degrees of the equator.  (Kenya was less than a degree!)  People almost invariably assume that we live in a hot humid place, and almost all our visitors comment on how great the weather is at Kibuye.  And it's true.  Believe me, we don't take it for granted, since almost all our missionaries friends are sweating it out somewhere else!  At Kibuye, highs range from 60 to 80 degrees (depending mostly on the clouds and rain), and it can dip down into the high 40's at night.  At least, we think so.  No one has a thermometer, and there is no weather service, so we're just guessing.

And yes, it's perfect.  And there is some changing of the environment as the rainy and dry seasons alternately unfold.  But it feels the same.  And as the months go by, I miss the seasons.  I miss being cold, and I sort of even miss being hot (though we can visit Buja for that).

Because the seasons are beautiful.  Right now in Ann Arbor, everyone is outside, taking advantage of the few months of summer.  Fruit trees are producing.  Outdoor festivals are almost every weekend.  It's light until after 9 pm, which is just shocking.  On the equator, sundown is always between 6:15 and 6:30.  One African friend exclaimed that he can't eat dinner if it's still light outside, which is a thought that never would have occurred to me.  But now, we can sit outside after dinner and watch fireflies come out.  Bugs that light up!  Can you believe it!

Maggie understands the seasons.  Ben (who is 4) is a bit hazy on the details.  He gets the order mixed up.  Or he thinks that Fall is when things grow.  But then, the last time he saw the leaves all change color and fall off the trees, he was one.  So, this will be fun to watch.  Apples to pick, sweaters to don, leaves to rake (definitely a blessing and a curse, I know), football to watch.

I'm even glad that we're going to be here for part of the winter.  The burst of warmth when you walk out of a cold wintry day into a warm building is a beautiful thing.  For that matter, walking out into the cold isn't so bad for the first few moments.  Bare tree branches against a clear sky, and everyone sipping their warm beverages.

And the whole thing is such an amazing cycle.  Death, resurrection, death, resurrection.  I'm guessing that the dry and rainy seasons could create the same thing for Africa, but it doesn't hit me the same way (probably because I'm not farming.  And I'm an American).  But every spring feels like the first spring.  Like, even though the season has never failed to come, part of me didn't believe it would come this year.  That, this year, it would just stay gray and cold.  But it doesn't.  And so, if we're wise, we're continually celebrating the season that is before us, because it hasn't been here long, and it won't be long before it's gone again.

It's a beautiful image, both for what it is, and also for what it can teach us.

Happy Summer.


One World Futbol Story

One World Futbols are a huge hit here at Kibuye.  These ultra-durable soccer balls are made by a company with a mission to give them away in places like Kibuye.  A young patient of Jason's, pictured below after several operations on his left leg, is forever changed and thankful.  One World Futbol's website published the story. You can click here to see the short story of this remarkable boy's experience with Kibuye Hospital and a One World Futbol.