16.1.18

Beautiful Burundi

(from Eric, with help from everyone)

Burundi, like anywhere else, is a mixture of brokenness and beauty, of glory and shadow.  And this blog has told its share of tragedies.  Today, however, we'd like to honor the goodness and the wonder that is around us in Burundi, country of a thousand hills, country that reflects the glory of its Maker.

So here's a feast of photos that we've collected over the years.  There are two focal points here.  The first is the beautiful green landscape.  The second is the beautiful people of Burundi.  Over the years that we have been here, the people of Burundi have been examples to us of joy, love, enduring forgiveness, hard work, undying hope, intelligence, and great kindness.  We have seen faith and self-sacrifice that we pray that God will enable us to emulate.

VoilĂ !  Beautiful Burundi:























5.1.18

Heroes Come In All Sizes, or, How Guinea Pigs Exemplify Christ

by Carlan

[Trigger warning: this post involves a story about experimentation using animals. To skip to the spiritual lessons learned, skip down to "Heroines #1".]

Sherlock Holmes statue in London (courtesy: Wikimedia Commons)
I read the adventures and further adventures of Sir Arthur Conan Doyle's most famous character when I was in elementary school. If I learned one thing from Sherlock Holmes it was to be observant. So when we lost three patients in two days, only one of which I expected to die, I wanted to know why. Often we do not have enough information to accurately diagnose our patients' diseases and causes of death are no different. These cases were no exception. One presented very late with miliary tuberculosis (pretty sure of that diagnosis based on the X-ray), one had terminal renal failure and heart failure, and another had passed out after drinking too much on Christmas and started complaining of back and abdominal pain. Disparate cases, to be sure. But all had received Ceftriaxone within 6 hrs of dying (for concurrent pneumonia, urinary tract infection, and febrile diarrhea in the setting of leukopenia, respectively).

Could the Ceftriaxone injections be implicated in the timing of these patient deaths? A bad batch? A problem of labelling in the factory? Some toxic transformation while in transit or sitting on our pharmacy shelves? The imagination can run wild, but we needed data. One cannot make bricks without clay.

At my hospital in California, I could talk to the pharmacy committee and we might send a sample to be confirmed in a reference lab with mass spectroscopy and other advanced chemistry. In a land where 90% of the population farms without tractors or plows, that won't work. What would Sherlock Holmes do?

We could inject a healthy volunteer with Ceftriaxone and watch what happens. I could never ask a patient or colleague to consent to this, given that there is a risk that the Ceftriaxone was contaminated with a fatal poison, so I would need to be the volunteer. But wait...could a goat stand in the place of the volunteer? I would ask Silas, our chaplain who is also a veterinarian and pig farmer.

An experiment must have documentation.
Silas recommended we choose a more diminutive species. Could we find some "cobayes" to use? I did not know that word in French, so I asked about rabbits while looking it up in my dictionary. We have some rabbits on campus. That would be OK, according to my friend Silas, but we could probably find some cobayes even in the community around Kibuye. Alors! I found that word in the dictionary: guinea pigs. We have guinea pigs on campus too. I would need the permission from some kids before using their pets as guinea pigs for a science experiment.

Our multi-talented chaplain, missionary kid, and guinea pig "volunteers."
Heroines #1: our team kids. With a healthy amount of trepidation, a surgeon's daughter agreed that she could furnish three guinea pigs for this experiment knowing that it could save patients' lives. This pre-adolescent girl already had internalized the central ethical tenet that allows me to support animal research for healthcare - human life, as bearing the image of God, is more precious than animal life.

Heroines #2: those guinea pigs. As I was talking with this heroine, we both realized the connection between Christmas and these research subjects. They were risking their lives to save others. It might be a stretch to say that the guinea pigs were willing to die to save others, but they were standing in the place of myself and my patients so that we would not be exposed to a certain risk.

In any case, I'm glad to report that all three guinea pigs came through the process fine and dandy. Eliminating the impossible, I'm concluding that these patients died of their diseases and not our treatments. Thanks guinea pigs! Thanks intrepid missionary kids! But most of all, thank you Jesus, for absorbing not only risk, but wrath rightly deserved, for me and so many of our patients and colleagues.
Alive and well after 100 mg/kg of Ceftriaxone. Yay for guinea pigs!