27.6.17

If I Want To Be Here To Help...

(by Eric)

It's been a particularly hard stretch on the adult medicine service.  Of the last ten patients admitted to our service, seven have died.  It's been a mixture of problems.  Our malaria epidemic is tailing off, which means that our most-treatable problem has become less frequent.  We've had several infrastructural difficulties, with oxygen shortages during long blackouts, and currently our X-ray machine and our blood count machine aren't working.  Certainly some of these things have made a negative impact.  The biggest factor is just that the patients only come to the hospital because their situation has become so dire.

However, when they arrived, I had hope (if not certitude) that they would get better.  They didn't arrive with an obviously mortal problem.  It was only after several days of steady worsening despite all we could do that it became evident.  That's a particular challenge, since it feels like their being in the hospital is associated with them getting worse, instead of better.  With death, instead of life.  I know it's not like that, but that cognitive knowledge doesn't automatically vanquish the feeling.

We have new medical students this month.  Very green, but making steady progress.  For almost all of them, they have never been this entwined with taking care of sick people before.  I wonder what kind of toll this is taking on them.  It's obvious that it's difficult.  Is this just a necessary crucible?  Can I say something to help them endure, beat off cynicism, and retain hope?

***

After rounds, while walking through the hospital, I shook hands with one of our nursing assistants.  She used to be on my service, but is now on another service.  I say hi, and remember that her adult son was hospitalized last year with a bad case of nephrotic syndrome.  I ask her how he is doing.  She says he is doing fine at home, with no medicines.

This morning, I was taking our kids on an "adventure walk", back through the small footpaths in the hills.  I passed a guy carrying a baby.  It's a little odd to see a guy carrying a baby.  Then, I realize I know him.  It's the (hopefully formerly) abusive husband of my paralyzed pregnant patient Spes, that I wrote about previously.  The baby looks good, and I turn around to see Spes walking towards me with a cane.  She smiles at me and shakes my hand.  The fact that she can make it this far on her own, and that her incredibly fractured life is doing this well is a joy.

***

Over the last several years, I have come up against these questions many times, with students or with new or visiting doctors, and each time I'm of course talking to myself as well.  Two things, in particular, continue to be an encouragement for me.

First, if I want to be here to help, I have to be here when I can't.  Every time when my patient unexpectedly dies, or the test comes back positive for the non-treatable possibility, or I'm forced to admit that my last therapeutic option just isn't working, part of me wants to abandon ship.  Part of me wants to run away from all that I can't do.  I know that running away won't help my patients, but I guess I want to pretend that such situations don't exist, at least not in such a common and stark form.

You can't know ahead of time who you can help, and the patients won't divide themselves up like that anyways.  Sometimes we can make a great medical impact.  Other times, we can't.  The two are inextricably linked.  Part of what we love here is the chance to dramatically alter someone's life for the better.  Yet there is another side to that coin, because the magnitude and frequency of the tragedies go up, in a seemingly proportionally manner.  It is something to be endured, but not just endured.  This other, and difficult, side of the coin is another place where we have to learn to trust God and find some way to bless and comfort these patients with the blessings and comfort that God has given us (2 Cor 1:3-4).

Second, as Paul writes: Fight the good fight.  It feels like a fight.  It is a fight.  But it's a good fight.  So let's keep fighting it.

***

I've been reading Keller's book Every Good Endeavor, and he is posing these questions about our professions.  What are your professions' idols, hopes, and fears?  What is the storyline told by your profession?  How can Christ complete the story in a different way?

I don't yet have a concise answer for these questions regarding the medical profession.  Surely, there are many things we fear.  We fear that we will make some great mistake.  We fear that the trust people place in us will be misplaced.  We fear not making any difference.  

The storyline of medicine says that people's bodies and minds can be broken, but that medicine, if properly developed and applied, can fix them.  It's not a bad storyline, and I'm grateful for its recognition of the brokenness of my reality.  However, the solutions do leave us wanting oftentimes.

What does the story of Christ have to say?  I think it's that both the brokenness and the healing run deeper than we know.  It's not just my patient's body that is broken, but also our society and my profession, as well as my own heart.  There are cracks all through, and no one helps from a standpoint of being completely whole.  

But the healing is part of a redemption deeper even than the fissures of our brokenness.  Yes, the healing comes through a faithful and just application of the principles of medicine, and we ought to be thankful and use it as well as we can.  But our great hope is that the extent of the healing going on in the world does not end with the limits of medicine.  God is bringing his newness in every way, in every domain, in every corner of this earth.  Through us, and thankfully in spite of us and beyond us.

20.6.17

Internet: The Hardest Part of My Job?

(from Eric)

We've never explicitly blogged about the work that has gone into enabling us to blog from rural Burundi.  Maintaining "reasonable" internet access has been quite a journey since 2013, and though we've made a lot of progress, I'm sure it will continue to be a big issue in years to come.  Given the distance between us and many of the people that know and support us and our work, internet has been an essential tool.

I'm only half joking when I refer to it as "the hardest part of my job".  Comparing to some of the dramatic hospital experiences we have, it may not seem like much.  However, I have felt so ill-prepared to try and handle this technical area that it has, at times, been a primary source of stress for me.  My team has always been gracious towards my insufficiencies, but it has been an ongoing struggle for me not to feel their frustrations with our internet as personal failings.  But enough about that.

2013:  When we first arrived, we hoped to be able to use USB flash modems to connect to the internet via the mobile network.  Everyone in the city thought this should be doable, and we talked to several people in the mobile world here to inquire about it.  However, as it happened, Kibuye campus was uniquely located in the shadow of a hall that lay between it and the nearest mobile towers.  Thus, the signal was limited, and no mobile company seemed to do anything about it.  So, the first few months were characterized by long periods of waiting on this little modem to download emails.  If you gave it about 15 minutes, it might have loaded a web page.  But usually not.
USB flash modem
2014:  After several months, we came to grips with the idea that the best option for us was a satellite modem (VSAT), which was reliable, but quite expensive for what you get.  We were obviously bandwidth limited (mostly 512 kbps) and most of the next several years, we were also data limited (each family usually got about 3GB/month).  I won't tell you how much we paid for it.  =)  It was an essential service, and usually worked pretty well when the power was on.  However, it developed a bad habit of getting fried by lightning, and the modem had to be replaced several times.
Our VSAT with nearby lightning rod
 2017:  After 3 years of VSAT usage, one of our Burundian friends helped us get connected to a mobile company, who was willing to run a fiber-optic line to Kibuye, which increased our bandwidth about 10 fold.  It was several months in the installation, but a beautiful day when the fiber (seen here on a "natural pole") arrived on campus.  We have noted that, even with the increased power outages (currently often less than 4 hours of power per day), we have enjoyed an improved ability to communicate with the rest of the world.<4 able="" and="" been="" better="" communicate="" day="" electricity="" frequently="" have="" hours="" more="" of="" outside="" p="" per="" still="" the="" to="" we="" with="" world.="">
Fiber optic cable looped over the last tree
How does a signal get from this single point to the rest of the campus?  That question has been a saga in and of itself, which many chapters and lots of help from many people.  Suffice to say that the current set-up has some kind of connection in every home, though we have all spent many hours sitting outside the "internet cafe" at the container-plex (our central hub for internet) during various phases of these connections breaking down.

Homes are connected via a combination of directional antennas, CAT-5 cable, coaxial cable, and a cool new unit from Ubiquiti called the AirMax Rocket.  They all come together in one of our old container crates, that has been converted into our internet hub: a combination a wires, switches, and multiple layers of electrical protection.
A converted container crate, now our internet box
How does a doctor learn how to do all this stuff?  He doesn't.  I still feel like I don't have any idea what I'm doing oftentimes.  However, we have been blessed with much great advice and help, most notably from Shawn Quinn and his friends at MoxieGroup.  He has been out here twice, most recently brought his family.  Thanks to all!
The Beloved Quinn family with their Knox teammates

11.6.17

Top 10 Things I'll Miss About Burundi

(from Audrey)  

A week from today, I’ll be flying back to the states after nearly ten months here in Kibuye. In honor of those ten months, I’d love to share ten things I know I’ll miss about Burundi:

1. The night sky. Besides charcoal fires, the mountain air in Kibuye is the cleanest I’ll probably ever breathe. The pure atmosphere and the lack of electricity mean that nights are heart-stoppingly beautiful. During a new moon, the stars burn in a multi-colored display of inconceivable distances. You can even see another galaxy with your naked eye if you know where to look.

2. The weather. Crisp and chilly in the mornings, hot but breezy in the afternoons, and almost never humid, thanks to our 6,000 ft elevation. Windows are always open and there’s no need to heat or air conditioning. It’s lovely. Rainy season and dry season each have their own particular beauties.

3. Community living. The kind where you’re close enough that if you get horribly ill, your neighbors will probably know it before you even tell them and will ask if you need anything. 

4. “Miss Audrey, watch this!” “Miss Audrey! Come tell us a story!” “Miss Audrey, wanna play capture the flag?” “Miss Audrey, come see my guinea pig!” “Miss Audrey, come sit in this hammock!” I love all the kids on the compound and how they clamor for attention even if I just walk past them on my way to the hospital.

5. Hearing choir practice from all the churches dotted around the valleys. The choruses echo through the mountains like birdsong every Wednesday and Saturday in addition to Sundays. 

6. Fresh avocados and pineapples and oranges and lemons and passion fruits from the market each week. The avocados here are enormous, at least four times the size of American avocados, and incredibly cheap. I’m typing this while eating some freshly made guacamole I quickly whipped up in my kitchen. Mmmm.

7. Hikes up to Kibuye Rock, or the Far Kibuye Rock, or on the big 8-mile loop past the cell towers across the valley. (We’ve only got a few big landmarks.) 

8. Jeannine, my French language tutor, who is quiet but loves to laugh. She is so patient with me and I’ve loved learning new aspects of Burundian culture as we talk about food and education and work and family life. It’s also fun when she asks me questions about American culture (“How do American parents talk to their children about relationships and dating?”), which forces me to think about my own culture in a new way as I try to explain it—especially when I have to stumble around with broken French!

9. Seeing kids’ faces light up when they discover a new fun science fact or when we get to do an experiment. I’ll miss the way they all wanted to race me to the school when the bell rang and took pride in being THE VERY FIRST person in their seat for science class. I’ll miss the chorus of “Awwwwwww but that’s a cliffhanger!!” when we had to stop a read-aloud book in the middle of the chapter at the end of class.

10. Learning from the dedicated doctors here, both the Americans and their Burundian colleagues and students. The doctors here are great teachers and I’ve been able to absorb much more than most pre-medical students ever get the chance to observe! But I haven’t only learned about diagnosing sickle cell anemia or performing a c-section or interpreting ultrasounds. Beyond the medical, I’ve learned a lot about compassion and perseverance. 

The doctors here persevere even when they have to use headlamps for surgeries because the electricity keeps cutting out, and even when there’s no running water and the wards are hot and crowded and smelly, and even when they have 95 inpatients on their service (for something like 40 beds), and even when malaria medicine runs out. I’ve seen amazing abilities to keep a sense of humor and to creatively solve problems. I’ve seen rejoicing when a patient on the brink of death returns to health and grief when children die because they dared to be sick in the third-poorest country in the world. I’ve seen how medicine needs the soul and body of the doctor as well as the patient. 

I’m so thankful for my almost-year here in Kibuye, Burundi. It has confirmed my desire to become a doctor and to work in underserved areas. It has also taught me gratitude for the body of Christ as an active community, even if there’s conflict or lack of resources or homesickness. I look forward to flying back to America, but I’m guessing that I will soon miss my life in Burundi.    

6.6.17

Weddings, Funerals, and other General Confusions

by Rachel

There are days in this crazy life I’ve chosen where I totally feel like I’ve made it.  Meaning, communication seems clear, the system is understandable, my life is full of rhythm and routine and all is well.   I go grocery shopping without getting lost.  The milk I ordered actually shows up in the amount I ordered.  I can lecture in French and sit through a meeting and understand the ideas discussed, and once in awhile I can even say a few lines in Kirundi.  But, rest assured, those days are so not the norm!  Even after four years I still feel like I flounder through most of my days.  Easier than the beginning yes, but “arrived”?  Hardly.

I heard another missionary once say that every year he spends in his host culture he is able to understand another 1% of what’s going on.  So based on that, I should be understanding about 4% of what happens around me!  That might be underestimating, but in all honesty the longer I’m here, the more I realize I don’t know.

This “principle” can be illustrated by a couple of sort of humorous but definitely misunderstood events I’ve attended this last year.  My teammates and I are invited to a goodly number of weddings every year.  Social events like this are understood to be important for relationship building and community involvement, but they can also be decidedly uncomfortable...sometimes quite time consuming, definitely difficult in terms of communication, and awkward socially.  So we usually send a “team representative” and share the load.  Last August, Caleb and Krista and I decided to go to the wedding of  one of the hospital nurses.  Wedding invitations always include the location of the ceremony and reception, but not exactly an address.  More like the name of the church and the neighborhood it’s in (and we’re not really familiar with neighborhoods in Gitega).   So, off we went, dressed in our wedding finest.  The wedding was taking place at a Catholic church and after asking around we were told it was located on the far end of Gitega.  Easy enough, there’s a large Catholic church right on the road that we’ve passed many times.  We parked and went in to the huge sanctuary.  At the front were no fewer than 6 couples getting married at the same time!  We found a seat towards the back, as the service had already started.  But after a few minutes of searching, we all realized that 1-we didn’t recognize any of the guests, 2-we didn’t recognize any of the couples, and 3-this actually wasn’t the right church.  

Back to the car.  We followed some sketchy directions down a side road, and then multiple other side roads while getting directions from another half dozen passers-by.  We finally found the “paroisse Yoba”, probably a 10 minute walk from the last church, and walked in just in time to see the bride and groom walking out down the aisle (along with 3 other couples, must have been a very popular day to get married!).  On the upside, it was a very short time commitment. :)


On the other side of the spectrum, one of our long time hospital employees, Jean Dukundane, died a few weeks ago.  He has faithfully served in the surgical department since the 1980s, and his death is a significant loss to Kibuye.  Wanting to pay my respects, I paid close attention to the information of the service and burial.  It was to take place the day before Easter, in our local church, starting at 11am.  So, John and Caleb and I walked up around 11:15 and found a seat in the back.  The pastor spoke for a very long time in Kirundi, and we understood almost none of it.  The Bible passage was Matthew 27, Jesus’ crucifixion, so I spent some time pondering if this was either an appropriate passage for a funeral service or perhaps this wasn’t actually the funeral service.  After about an hour, I finally realized that 1-I didn’t recognize any of the hospital staff there, 2-there was no casket or photo or anything, and 3-I actually wasn’t in the right place (found out later it was jut a regular Easter Saturday church service).  I walked up to the hospital and found the “viewing” in our morning staff room, 1 1/2 hours after the event was supposed to begin.  From there, everyone DID go to our local church for the funeral service, which began around 1pm.  


We’re trying, we really are.  And in my better moments I laugh all of these things off.  It can be hard and frustrating and uncomfortable to try to participate in something without knowing any of the “rules” or instructions or social/societal cues.  But, we press on because we know it’s the right thing to do.  And every time gets a bit easier.  I went to a wedding in Gitega last weekend (at the “original” Catholic church from the first story) and we made it to the right place at the right time, and it was nice!  I take heart that maybe if I can understand just 1% more each year, by the time we’re done in Burundi maybe I’ll be getting close to understanding half of what takes place around me. :)  But it also helps to continue to enlarge my perception of the world, to see new ways and ideas of doing things, to realize that things aren’t always easy for the immigrants in MY home, and to remember that no matter where we are on this earth, we are foreigners in a foreign land, looking forward to a permanent home.


4.6.17

The People Behind the Scenes

by Jess Cropsey

We are privileged to work alongside some amazing people here in Burundi.  Behind every big "accomplishment" -- a new building, a new program, a special event -- there are dozens (or more) of Burundians who have made it all happen.  These people have graciously guided us as we have transitioned to life in this very different place.  They have endured our cultural blunders and language stumbles time and time again.  We could not be here and do what we do without them.      

Today, I want to introduce you to a friend of mine, Thérèse, and give you a small peek into her life.  She is a well-known figure in the Kibuye community.  As a teacher for the last 33 years, she has taught many of the adults & children in the area at some point in their lives.  She is a widow in her 50’s, with three grown children (one of whom is married to the head nurse in the eye clinic) and three grandchildren.  When her twins were 6 months old, her husband got sick and within 24 hours died of an unknown illness.  Being a widow in a paternalistic society like Burundi is incredibly difficult, yet somehow she has managed to flourish and thrive.  

Thérèse is one of the lucky ones because she actually has a job, though the pay is less than $50 a month.  While teaching is her “day job”, she stays busy with tending her fields, pastoring at her church, being involved in local community government, and starting or participating in various community organizations.  She maintains more than 10 fields scattered throughout the local area where she grows peanuts, peas, beans, corn, soy, wheat, and sorghum.
  

She is a Free Methodist pastor and is active in her local church where she preaches, sings, plays the drum, and assists those in the congregation with food & clothes.  Given that she is a widow herself, she has a special heart for these women and has been involved with an organization called Sister Connection that provides financial assistance and vocational training for widows.  She also organizes a day of prayer once a month with and for these women. 

Thérèse is incredibly industrious and knows how to make soap, soy & peanut milk, and avocado oil.  She shares this knowledge with others, particularly those who are too poor to buy oil in the market or to own a cow (for milk that children and pregnant women desperately need in this malnourished country).  [Interestingly, the avocado oil can be used for cooking, for lighting lamps, and as a hair product.]  In addition, she teaches basket-making, sewing, and cooking.  

She is also a representative for her local district in a health care association that assists its members with hospital bills (for a small membership fee of less than $10/year).  She also started a small association for widows at the local Kibuye church.  Every month, these women contribute 1,000 frambu each (about 50 cents) and save their money together until they have enough to buy something as a group (like a goat).  

You would think that all of these activities would keep her plenty busy, but she is also studying in a degree program designed for teachers to advance their training and provide an opportunity for further study in a university.


Despite the challenges that Thérèse sees in her community and experiences herself, she is full of joy.  She loves the Lord and takes great delight in teaching children.  She is incredibly patient and full of life.  It has been an honor to get to know her over the last few years and we have been blessed to have her as a Kirundi teacher for the missionary children at Kibuye.  Below is a photo from a visit we made to her home a few months ago.  
  

Always a teacher, she is constantly trying to help us learn Kirundi, with every greeting and every activity.  Below, the kids are removing corn kernels from the cob (which will later be taken to the mill to turn into flour).  All the while, she is patiently reviewing basic vocabulary with the kids.  


Here she is again in "teacher-mode" from a home visit two years ago, showing us how to cook a Burundian meal.




Learning how to make bricks...


This unexpected friendship with someone whose life is so different than mine has been a blessing to me.  She has taught me about contentment, perseverance, and patience and it has been a joy to share life with her.    


These photos are from the "putting the baby on the back ceremony" for her grandchild, which is basically the Burundian equivalent of a baby shower.