by Michelle Wendler
We hope you enjoy this glimpse into what it's like for a kid living on our team here at Kibuye. Some highlights are: watching locals eat termites, and hiking to the top of Kibuye rock.
(from Eric)
This life is not an experience I have procured by planning. It is a gift.
This life --
with its interpersonal conflicts,
unexpected medical problems,
pizza nights at Kibuye,
the writings of CS Lewis,
needs to learn how to communicate with teenagers,
Rachel's steady love,
the popping sounds of sheet metal roofing expanding in the sun,
eucalyptus branches in the wind,
a poor country not prospering the way we wish it would,
laughter at the stories of Wayside School,
watching grown-up movies with our kids,
birdsong a bit louder than distant church music --
This life is not an experience I have planned and executed.
It is a gift unfolding.
By Jason Fader
Recently I moved a table onto our front porch for a place to do computer work, since the view of the green grass, tight hedges, and various fruiting trees was simply gorgeous. I love landscaping here at Kibuye - in fact there are fewer things I enjoy more than listening to a John Piper sermon while mowing the lawn or trimming hedges. And these few months towards the end of the rainy season here in Burundi provide ample opportunities for these activities.
Recently I also noticed two trees near our house that were
dying, and one was leaning somewhat precariously over our neighbor, Alyssa’s,
house. My brother Caleb called some local
loggers to come cut down these trees before they caused significant damage
by falling.
During the felling process, ropes are used for pulling the tree in the desired direction. Normally this works well, but on the occasion of felling these trees near our house, one of the ropes broke, which caused the enormous tree to fall directly towards our house. Thankfully there was a robust avocado tree in its path, and the tree fell in the Y of the avocado tree, resulting in half of the tree precariously perching over our house! After much mental maneuvering, we decided the best plan was to pull the half-felled tree through the Y in the avocado tree until it wasn’t suspended over the house and then chop it up from there.
So we chained the tree trunk to our 2 Landcruisers in parallel and put them in 4-low, and then we created all kinds of carnage to the perfect lawn as the tires dug in and spun and the trunk plowed right through a row of pretty hedges – but thankfully, the plan worked, and the house is still standing.
Due to the misfallen tree, 3 others were damaged and so we
had to take down a total of 5, which certainly detracts from the scenic view
that I had loved gazing at from the front porch. I have recently become interested in grafting
avocado and mango trees so, not to worry, I have about 250 avocado and mango
trees to choose from to replace these that have come down.
by Craig
In September 2023, we bought a machine to make our own bricks for construction projects at the hospital. This machine makes bricks by compressing soil mixed with cement, and the combination of compression and cement makes them resistant to damage from weather. These blocks have a special shape which allows them to interlock with all their neighbors above, below, and side to side. This means when building a wall, we don’t need to use any mortar to bind the bricks to each other like we do with the traditional bricks. These bricks go by different names, Interlocking Stabilized Soil Blocks (ISSBs), Compressed Earth Blocks (CEBs), but we have just been calling them Crix (a stylized portmanteau for "Craig’s Bricks"). It's an honor (but not my idea) to have my name integrated, but it’s not because I deserve any credit for them, I am just the person who is most excited about them.
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| Our press, when it was still shiny and new, and some of the first Crix it produced |
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| side by side comparison |
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| stock of traditional bricks (top) and Crix (bottom) |
There are a few good reasons why I am so excited about Crix, and why you should be too! They save on time, labor, fuel, firewood, sand, and cement; and all of those things lead to saving money. They also look really smart…in my opinion.
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| These Crix walls look nice, right?! I know, I know, it looks like the Crix on the right have been mortared in place. But truly, they have been dry-stacked, and we just filled in the chamfer with a tiny bit of mortar to make it look a little nicer. |
Traditional, local made bricks in Burundi have served us well for many years, but there are some inherent characteristics that can be improved upon. Those bricks are stabilized by heating them with a large fire, which consumes a lot of firewood – a precious commodity in Burundi. They also are far from uniform in shape, which requires a lot of mortar to make up for the inconsistencies. I measured a typical section of wall and estimated that only 52% of the wall was made of bricks, the other 48% was mortar! Another challenge is that these bricks are made in various locations around Kibuye and need to be transported here. This increases the cost, and is dependent on the availability of diesel, which can not be taken for granted here. Whereas, Crix don't require any firewood, they are uniform, use almost no mortar, and are made right here on site.
But, just because Crix offer an improvement on all of those challenges that are baked into the local bricks, doesn’t mean they are a slam dunk solution. Bringing in a new technology like this can really upset the order that we have worked for a long time to establish. Even though it seems much easier and faster to build with Crix, it is completely different from what the masons are used to doing, so it takes a lot of adjustment for them to get comfortable and fast at laying the Crix. We also didn’t really know if the community or the hospital administration would like Crix, they have a different value system than an American engineer. And, we needed to invest quite a bit of time and money into buying the equipment and learning how to use it well, before we could start to save any time or money in the construction process. Regardless, there will still be some applications where traditional bricks are more appropriate...but now we have options.
So, after buying the machine, we started slow and small in our brick production. We played around with our soil mixture and moisture content, the force required for compression, and the rhythm of many people working together to use the machine safely. We only produced 20-50 bricks per day in those first days. But steadily we improved our production to grow to roughly 200 per day! We also started using the Crix for small, low-risk structures to see how they would perform, how the masons would use them, and how others would like the look of them.
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| Two days worth of production in the early days |
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| Our very first structure being built... a chicken coop |
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| A privacy wall (left) and some small cookhouses (top and right) |
First, we agreed to pay our workers per brick produced instead of per day of work, which took our daily production from 200 to over 400. But, it became hard to sift our soil fast enough to keep up with the brickmakers, so we built a rotary sifter to speed up that part of the process. We also realized that it was difficult and slow for the masons to cut the Crix, when laying them. So to help with this, we built a slicer to add on to our brick press, which slices the bricks before they have hardened, as they are being ejected from the press.
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| Compressing a Crix |
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| Approximately 400 Crix made in one day |
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| Top: Dirt being shoveled into the rotary sifter Bottom: Turning the crank on the end where the rocks are removed |
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| Nicely sifted dirt piling up |
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| Brick slicer in action |
After making these improvements we were able to build some larger projects with great success, including a 150-meter perimeter wall around hospital staff housing, and a new kitchen/dining area for the hospital.
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| 150-meter wall made of roughly 9,000 Crix |
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| New hospital kitchen and patient dining area under construction |
This technology has proven itself to make a positive impact in the construction practices at Kibuye. But, if we zoom out and look at all of Burundi, then it is just a drop in the bucket. That’s why we recently took the opportunity to help facilitate a workshop in Bujumbura focused on this technology. I took seven of our workers who have been involved in making Crix to teach others what we have been learning over the past 8 months. It was awesome to see our guys – many of whom have not finished high school – teaching a group of architects, engineers, and professors about how to make and use Crix!!
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| Our workers (in yellow shirts) attending the workshop |
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| they were featured in the presentation |
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| participants sifting soil |
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| answering participants questions |
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| everyone was excited by the first brick |
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| All the participants and facilitators of the workshop |
(from Eric)
I can't honestly say that I enjoyed the whole of A Tale of Two Cities, but I thought the ending was fantastic. Sydney Carton is a lawyer and a scoundrel (or "ne'er-do-well" or "blackguard" or pick you colorful Dickensian description). He is talented but shameful, and he knows it. Yet, he bares an uncanny resemblance to a good man who has been unjustly sentenced to death. He chooses to switch places with him for the sake of the good man's liberation, and as he goes to the end of his life, he utters the immortal words:
"It is a far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known."
Without devaluing Carton's sacrifice, I have often thought of the way that his whole life was imbued with new meaning when his actions redeem the life of one man. Why is this important to me? Because my attempts to be a healer in rural Africa are a mixed bag of outcomes. Yes, some people are healed, but so many people continue to suffer and die, and on a day to day basis, this can easily crowd out the amazing victories. And they are amazing; make so mistake. They are of inestimable value. They are transformed lives, each of which is enough to imbue meaning to the entire existence of an otherwise scoundrel.
But we won't feel this, unless we proclaim it.
So, in the spirit of "far better things that I do", here are four simple but glorious stories from recent Kibuye life:
1. Tiny baby. Big Milestone
Last week, on the hospital employee WhatsApp group, this picture circulated with numerous celebratory responses and emojis of dancing women.
The story of the Kibuye NICU is a long one, and we don't always see these little ones survive. But this one did. And all of Kibuye is rejoicing.
2. Kidney disease gone
About six months ago, the internal medicine service hospitalized a young mother. She was swollen from head to toe. Her kidneys didn't filter well, and they were leaking protein at such a rapid rate that she looked like a terrible care of malnutrition no matter what she ate. We could easily figure out the problem, but our medicines weren't helping very much. She needed a biopsy and a pathologist and all sorts of treatment that we knew she wasn't going to get. But we put her on a bunch of water pills to take the swelling down, and hoped that it would at least make her life a little better for the time being.
A couple weeks later, she went to refill those water pills at a distant pharmacy, and the pharmacy gave her diabetic medicines by mistake. Not being diabetic, this sent her into a hypoglycemic coma that nearly killed her. Her family rushed her back to Kibuye, where we fixed her sugar problem, put her back on the right pills, and gave our government colleagues the necessary feedback about the error in the private pharmacy so they could investigate. The situation continued to be desperate.
Six weeks ago, she came to see me in clinic, and I hardly recognized her. Gone was the puffy face and the malnourished air. She smiled at me. I double checked the name on her file. Not only was the problem better, but this was despite being off her medicines for a week. We confirmed that her kidneys were now functioning totally normally. I told her to come back six weeks later to see if this was sustained. Last week, she showed up in good health with normal testing. We sent her home with no treatment, and we thanked God together.
3. Full continence
One of the possible, but rather difficult, repairs of congenital problems that our surgeons tackle here is anal/rectal malformations, i.e. babies born with no way to pass stool. This becomes an emergency after birth, and a provisional solution is made by creating a colostomy in the newborn.
Later on, when the baby is a bit bigger, there is a more complicated procedure to basically create what wasn't there at birth, i.e. a functioning outlet for stool. Given the intricate nature of this surgery, the difficulty with anesthetizing little babies, and their ongoing nutritional challenges, it's not hard to imagine why these are difficult patients. But one of the greatest challenges is a fully functioning sphincter so that the child will grow up without fecal incontinence.
Two weeks ago, just such a follow up kid showed up. Doing well. Growing. Full continence.
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| He wasn't too happy to see the doctor but mom was ecstatic |
4. Redemption after Loss
We do a lot C-sections. Last Thursday was yet another C-section. But this one had a known backstory. A couple years ago, this mom had carried her baby nearly to term only to lose the pregnancy. She came to Kibuye where it was found that she had a bunch of big fibroids in her uterus and she was scheduled for surgery to remove them.
She did well for her surgery, and afterwards got pregnant again. This baby went all the way to term and the couple's first baby was delivered healthy this past week (6-pound girl!). The health baby was carried to the side warmer where another doctor was diligently training a new nurse about how to resuscitate newborns and care for them well after delivery.
***
May you also have grace today to see the goodness of your life and work.
Nadia was admitted to my service last night. Two months ago, she delivered twins. One of them is doing well, but the other has had trouble and is admitted to our NICU. So she's been living at Kibuye taking care of her babies.
Apparently, last night, she went to get some dinner and had difficult breathing all of a sudden. She stumbled into the Emergency Room where her oxygen levels were super low and she was breathing way too fast. Her blood pressure and heart rate were also quite high. She was admitted to internal medicine where we did all the available tests that might help her, concluding finally that her heart is bad and her lungs have suddenly filled with fluid.
We're doing what we can, but I fear for her. I fear that we won't be able to pull her out of this, and that her twin babies will lose their mother, who seemed perfectly well twenty-four hours ago. Despite maximal oxygen therapy, she still has low oxygen levels and is breathing quite fast. Our team is gathered around her bed.
***
Also admitted to our service is Pastor Elie. Elie was a chaplain at Kibuye for decades. He's retired now, but has massively out-of-control diabetes. Despite all our effort, he has lost tons of weight, and he gets admitted for a few days during most months of the year. His disease is super challenging, but he's survived a lot longer than most people around here with a similar problem because of ready access to the hospital.
As soon as he feels better, he's usually wandering around the hospital talking with old friends. In fact, this morning, we passed by his room and he wasn't there.
***
Gathered around Nadia's bed, we have made all our medical decisions. She is still not doing well. Her mom has the healthy twin bundled up on her back. I'm wanting to pray for her. My Kirundi prayers are quite halting, but since Nadia is conscious, it seems like praying in Kirundi might encourage her.
Suddenly Pastor Elie walks up. He knows that we came by his room when he was out chatting. We answer his questions, and then I ask him if he would be willing to lead us in a Kirundi prayer for Nadia.
He answers without hesitation. "This is my job." He places his hand on her shoulder and begins to pray. From his words, I can tell that he is aware of her situation and that her other baby is already admitted in the hospital. Apparently, Elie's visits to the hospital help him keep his ear to the ground.
It's a beautiful picture. One obviously ill patient leading us all to pray for the healing of another. We do not help each other to healing only from some kind of disease-free platform of security. We are wounded healers, just like our Savior.
***
And then there's me. My body is more or less intact, but my heart is struggling. I'm leading my team of students and nurses, teaching them the best way to take care of these patients, but knowing that we won't succeed in a good number of cases. We're praying for healing and compassion and understanding, and even as we pray, I'm struggling to believe for these things. I wish my heart could be content with the situations in which I find myself, content to just be faithful in the daily work in front of me, but it's hard. My heart doesn't react the way I wish it would.
In the television series The Chosen, the producers gave James the Lesser (or "little James"), one of the disciples, a physical disability, and then Jesus sends him out to heal. He struggles to understand why he is not healed, and how he could be a vessel for healing when he is himself broken. The scene is extra-biblical, but the themes discussed are not. Jesus speaks of God being glorified from James praising Him even though is not healed, precisely because he knows that there will be healing in the end.
Healing for Nadia and Elie. Healing for my own heart and all of us striving to bring life and wholeness in the midst of our own brokenness. Wounded healers all.
***
48 hours later update: "Nadia" has actually done much better than I was expecting. In a way that we don't often see here (without super intensive care), she has been pulled back from the brink and is breathing much better (though still on a lot of oxygen). Sometimes I'm hesitant to hope in such situations, since we're not out of danger, but I'm grateful for how it's going and pray it will continue.
***
7 days later update: "Nadia" discharged home today. Her baby was also discharged, so they will actually go home. Just taking some pills. So thankful!
(By Caleb)
Training is a cornerstone of what our team does here at Kibuye. Most of our team is involved in training surgeons, doctors, and nurses, but on the construction team we also have an apprenticeship program where masons, carpenters, iron workers, and welders can be trained by those already in the 'guild'.
When the first members of our team arrived in 2013 my brother ran the construction crew when he was not in the operating room. He strongly encouraged this apprenticeship program and to this day the construction leadership team still reminds me, "But Doctor Fader said we must always be teaching..."
Each year now for most of the last 10 years we've had a cadre of apprentices in various trades enter the year-long program. In order to enter the program, one must show good work ethic, a willingness to learn, and must be able to provide one goat for the induction ceremony/feast at the end of the year. The goat sacrificed represents the life-long dues required by the guild. Most of the time these apprentices are chosen from among our hard-working laborers. Hence a goat represents about 2 months' salary for them: no small sacrifice!
In November we celebrated the induction of 10 new members into their respective guilds. Since there were 10 of them it was decided that instead of 10 goats we should just get one very large cow. Each of these 10 graduates were allowed to bring their extended families to witness the event. There were speeches, pictures, laughs, and lots of beef shared around. Each graduate was presented with tools of the trade by their primary teacher such as a trowel, level, measuring tape, etc. As expected, it was a lovely team-building experience.
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| Our foreman, Sadiki, welcoming everyone. Graduates are seated in the front row. |
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| Cooked bananas, french fries, and lots of beef. |
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| Savella receiving the tools of her new trade! |
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| Skillfully adding the finishing touches... |
(from Eric)
On Friday, the hospital inaugurated a new district health office. In addition to being a church hospital and a teaching hospital, Kibuye is the referral hospital for Kibuye Health District, a geographic area of over 200,000 people. Anyone sick in that area goes to one of 18 health centers in the district which refer necessary cases to the hospital. Of course, we also get cases from all over the country and neighboring countries because of specialized care here, but we are the primary hospital for this catchment area, and this health district is administered and supplied by the district health office.
Their office was insufficient and helping them build a better office just outside the hospital wall also liberated some valuable real estate within the hospital that the old office was taking up. So we partnered with them to build a new office building. The building is lovely, and governmental dignitaries were invited to cut the ribbon.
The guest of honor was Burundi's Minister of Health. Newly appointed to the presidential cabinet in the last few months, this was her first visit to Kibuye. Burundi's amazing traditional drummers pounded and danced out a welcoming rhythm as the Minister's vehicle arrived, and we formed a receiving line, of which I was about number eleven.
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| Burundi's Traditional Drummers with the new district health office |
As the Minister proceeded down the line, I shook her hand and said "Welcome to Kibuye." Over the thrum of drums behind us, she said "I know you. I met you in Banga when you were learning Kirundi. You had babies with you."
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| A journalist caught the moment where the Minister tells us she remembers us |
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| Future Kibuye kids at Banga. |
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| Mama Lea - Toby's favorite nun |
