COTW: Continuity

 by Rachel

When we moved to Africa to begin practicing medicine, there were several things that I knew I was giving up...some not so hard to say goodbye to (electronic medical records and litigation!), and some, like a wide range of medicines and technology and support services, more so.  One sad thing to give up was the idea of patient continuity.  I really enjoyed the chance to develop a relationship with a woman during the course of her pregnancy and deliver her baby and even follow up in the subsequent years (of course, residency was only four years long, but I still had some special patients during that time).  Here in Burundi, continuity is a challenge.  I function primarily as a consultant--I don't do normal pregnancy surveillance and almost never do deliveries except for C-sections.  Women come with a problem, I give advice and treatment, and then almost never see them again.  When I do, it's a rare gift.

When we returned from the US in 2016, there was a patient waiting for me named Odette.  A colleague had done an ultrasound in my absence and found what looked like an abnormal pregnancy.  I repeated the ultrasound and found a normally developing pregnancy, her first, but also a huge fibroid, more than 10 centimeters, filling up the lower portion of her uterus.  She came back many times in the following seven months for ultrasounds.  She rarely spoke but her husband and I conversed often in French.  In my head, I continuously ran through all of the potential complications that were awaiting her.  But lo and behold, she arrived at term without incident and we delivered a healthy baby boy by C/S.  I asked her to come back 6-8 months later and we removed the fibroid.  I thought that would be the end of the story and our relationship.

But then again she returned, now in the spring of 2018, with another pregnancy.  Her uterus looked perfect, but given the two surgeries, we scheduled another C/S and I performed it just before a scheduled six month in the US.  And now, just a few weeks ago, she came with her third pregnancy, already in the final weeks.  I performed a C/S on Tuesday and delivered her third and final baby.  It was oddly touching to me to be able to safely bring all three of her children into the world.  I don't know if she ever realized how remarkable that was.  She and her husband don't even live in our health district...they come from another province in the country.  So many women never show up for their scheduled surgeries, or labor begins too early and they deliver elsewhere.  I take vacations occasionally (!) and spend six months out of the country every few years. But everything lined up perfectly in this case.  

I didn't take any pictures...I always feel oddly awkward about taking pictures of my patients...but I will certainly remember the privilege given to me by Odette and her family. It's a small but tangible reminder of God's provision and a giving back gift of grace to me, even of the small things I feel like I've given up for His service.  

2020 and the Goodness of Passing Time

 (from Eric)

Yesterday afternoon, I was scheduled to be working from home.  But there was a request for me to come up and do an echocardiogram.  So I came up, and one echo turned into two, which was followed by an impromptu admin conversation on a diversity of issues.  Eager to get back to the kids and the tasks I had left behind, I bolted out the hospital staff gate at my normal "American" tempo that easily outdistances any Burundian 2:1.  (To be fair, any Burundian could outdistance me on foot, especially at long distances; they are just not usually in a hurry.)

Halfway home (meaning 100m from the gate), passing between the school and the church, I am hailed in French by a Burundian guy in a sport coat who is awkwardly holding a large sac in one hand and a roller luggage in the other as he tries to catch up with me.

"Bonjour Docteur!"

I don't recognize him, and since there are often random people trying to stop me, often with the hope that the conversation will eventually get around to me financially supporting their personal project, or at least getting my telephone number, I cautiously respond with what I hope is friendly-but-not-overly-welcoming.

"Bonjour."

He continues in French: "I just wanted to say 'hello' to you."

Me, hesitatingly: "Hello."

He switches into what I would have previously called "broken English".  Now, after several years working in a foreign language, I call it "impressive English."

"Maybe you don't remember me."  I don't, and I guess he can see it on my face.  "Several years ago, we came to the hospital with my father, and you took care to heal him.  We were so happy.  He is passed now, last year in 2019, but after you healed him, he was at home for three more years, and we were so happy.  I remember how you talked to us when we were in the hospital.  I saw you and I wanted to thank you and to greet you."

"Oh, thank you for giving me this news of your family," I reply, trying to match his cadence.

"My wife is here."  He gestures behind him to a smiling woman following us at about 50m, holding no luggage other than a bundle of blankets that probably hides a baby somewhere.  "Our baby was sick, and we brought her to be healed.  Dr. Alice (sic) gave her treatment, and now she is healed, and we are going home.  But I saw you, and I wanted to thank you for your effort for my father.  We were happy that he was with us for three more years."

I wave at the mother and she waves back and smiles.  "Thank you for telling me.  I am happy your baby is okay, and I wish you a good journey.  Please greet your family for me and for Kibuye."

He smiles, and they continue (more slowly now), down the road as I enter to gate to our housing area.

***

I am sharing this story in 2020, which may be the most concretely characterized unit of time ever.  Our frustration with 2020 makes us talk of "wanting to send it back" or "kick it to the curb and move on."  We compare it to a dumpster fire, and then feel we've insulted dumpster fires.  The general sense (and oh I've felt it!) is that we just want to get this year behind us.  Though I am 110% sympathetic, we need to recognize the shortcomings of this desire, since A) January 1, 2021 is unfortunately nothing magical, but more importantly B) Time is more magical than we give it credit for.

So a few thoughts on Time and Timing from my roadside interaction yesterday:

***

1. Beautiful Interruptions.  I didn't want to go up to the hospital yesterday afternoon.  I didn't want 10 minutes of work to turn into 45.  But aside from the benefit of the actual work, I probably would have given up that time just for the encouraging interruption on the way home.  

Generally speaking, I dislike and resist interruptions.  They are out of my control and not according to my plan.  But I am a Christian, and as such, I have to reckon with Jesus, who simultaneously lived with an intense vision towards a specific goal (his death and resurrection) and yet welcomed interruptions with grace (e.g. blind Bartimeus or the bleeding woman).  Jesus understood what I affirm in my head and don't really believe in my heart - that God is at work all around, and therefore things outside my control may be much better than I think they are.  A beautiful interruption reveals the incredible fallacy of my heart that my will is the only force for good in my life.

2020 is full of life interruptions.  Could it be that those interruptions are hiding some redemption somewhere?  And I don't need to know what that redemption is in order to be hopeful that such a redemption might somehow exist.

2. Delayed Gratification.  As years in Burundi roll on, these kind of episodes get more frequent, and we more frequently don't remember the original circumstances.  Last December, we were crossing the border to Tanzania.  The border guard told me that he had come to Kibuye with his wife, because they had had no children, and now they had a 3 year old healthy child.  I gestured to Rachel who was waiting in the car.  She came in, and he brightened up.  "It was you!  Look, here on my phone, here is our child!"  No memory, but lots of joy.

It's the passing of time.  It's the slow turn of the earth and all that happens under the sun.  Our lives bounce off of someone else, and we quickly lose sight of their trajectory, but it is altered nonetheless, just as ours is because of them.  We can't remember all the events that made it so, but we are changed because of the time in which we live and in which we interact with others.

One of the things for which 2020 cannot stop the clock is our hearts.  The Bible often uses seed analogies to talk about this.  That which is planted in us continues to grow and change.  By God's grace, life is still happening, and we are still becoming.  "A fallow field is never dormant."

3. The Whole of Time is Greater than the Sum of its Events.  There is something bittersweet about being thanked for taking care of someone who has died.  In this case, the son was thankful because, even though his father is gone, he had three more years to spend together.  What did his father do with that time?  Maybe a lot.  Maybe he helped many people or bequeathed great wisdom to his kids.  Or maybe not.  I don't think that what he accomplished was the point.  The phrase "spending time" puts our focus on those events that took place in between, but Time is something else in addition to that.

Think of a long friendship.  Think of a healed wound.  Think of a beautiful song.  There is no way to experience the beauty of a 8-minute song in 4 minutes.  Time itself gives something to the experience.  Even more minutely, think of a drawn-out note within a beautiful song.  It is Time itself that blesses the moment.

Maybe 2020 won't be much to look back on.  We joke about the "skinniest photo album ever".  But "not much to look back on" doesn't mean less to experience now.  As much as I want to put my head in a hole for the remaining months of this infamous year, the goodness of passing time remains before us, and I'm thankful for the interruption and delayed gratification that reminded me of it.

Psalm 77: Following Unseen Footprints

 (from Eric)

This is from a few months ago, and I didn't know it had been posted until now.  I made this short video for our home church in Ann Arbor, Knox Presbyterian Church, which speaks some of the (especially early) 2020 experience for our team along with some thoughts about the way Psalm 77 speaks to that experience.

Another Anniversary

(by Jess)

Today marks one year since Matt and I arrived in Kibuye! To celebrate, we wanted to share our top 10 Kibuye moments and thanksgivings.

10. Getting to develop trust and friendships with the construction crew. Just this evening after work, Matt was able to reflect and celebrate with Quinzaine the foreman about the building progress and the community's affirmation of the Pediatric Ward and the pre-school building they are close to completing.

---

9. Hosting family and friends here. We had two of Matt's siblings come from Congo to see our world in rural Burundi. I benefited from my sister-in-law's cooking lessons.

---

8. Celebrations! Thanksgiving, Christmas, Easter, Fourth of July. Can you guess which one this picture captures?

---

7. Hiking to the "far" Kibuye rock, an outcropping with 360 degree views that is about 20 minutes walk from home. 

---

6. Visiting our househelper Acheri at his home. Heather and Keza joined and we all enjoyed the tour of their minifarm complete with a cow almost ready to give birth, pigs, chickens and rabbits.

---

5. Not in Kibuye, but we loved joining the Cropseys and Faders for a beach vacation on Lake Tanganyika.

---

4. Heart and Soul Retreat, facilitated by the Knox Presbyterian team in February. We felt loved on and invested in.

---

3. Runs, walks, bike rides around the rolling red hills covered in bright green fields. We have pounded the 5km loop countless times, but it still feels refreshing.

---

2. Designing and building the new 8-plex residence that will soon house one family and eventually several other doctors and visitors.

---

1. Friendships - grown in all the birthdays, brunches, and Bible and book studies we have enjoyed these last 12 months.

Thanks for a wonderful year, Kibuye! God has blessed us through you by providing us a "pleasant place" to live and serve (Ps 16:6). Let's see what the rest of 2020 brings.

COVID Miracle

 By Alyssa 

If there is one thing I think we have all been learning through this pandemic, it is that we actually have zero control over our lives (as much as we like to pretend otherwise). No matter how much Herculean effort we put into planning, everything can be derailed in a moment. And having had that fact pounded into my head over the last 6 months, I celebrate that it is most definitely a COVID miracle that I am writing this post from my home in Kibuye! 

Plan A: Take a five month home assignment in the US to reconnect with supporters and family, speak at conferences, debrief the last couple years in Burundi, update medical board exams, work on my master’s in medical education, etc. Attend CME conference in Greece on my way back to Burundi. Arrive in Burundi April 5, 2020. 

Plan B: Greece conference cancelled. Rebook flights to fly to Burundi directly. Arrive March 28. Send passport to Burundi embassy in D.C. to get visa date changed to reflect March 28 arrival. 

Plan C: Receive call from Burundi embassy that my passport is being returned to me with no new visa. Burundi airport closed March 22. Stuck. Wait. Find temporary job in Birmingham at local health department until return to Burundi is possible. 

Waiting indefinitely was very hard. My bags were packed and I was ready to get back to my life in Burundi. And yet, there were mercies in the waiting, too. Having spent 10 years overseas, I had not had occasion to lean in to my passport country for a long time. And seeing the struggles and suffering firsthand in America - racism, uncontrolled pandemic, polarizing politics - provided the opportunity for me to grow in compassion and to learn so much (learning that will continue for a lifetime). I also connected with my local church more deeply than I have in years, and I remembered what I love about Birmingham and the people there even as I also saw injustice in new ways through my work with the homeless population. 

Plan D: Get special authorization for a visa on arrival in Burundi thanks to the incredible efforts of our Burundian partners. Fly commercially to Ethiopia. Take a humanitarian flight to Burundi on August 5. 

As the flight into Ethiopia began to land, I could see thick clouds out the window. The landing gear went down and I briefly saw hills and trees, but then the plane took a sharp turn upwards into the sky! We climbed and climbed, and then finally the pilot said he couldn’t land due to the clouds, so he was going to a nearby airstrip to wait for the weather to clear. We flew 30 minutes to Dire Dawa, Ethiopia: a dry, dusty place near the border of Somalia. There we sat on the plane for 5 hours waiting to return to Addis Ababa while the humanitarian flight went to Burundi without me. 

From my quarantine hotel in Ethiopia, I investigated various options for getting to Burundi, but with the airport still closed to commercial flights, options were extremely limited. I would need to wait 2 weeks to get on another humanitarian flight. Thankfully, on day 8 of quarantine (and after another negative Covid test), they let me leave the hotel room and stay with a missionary family in the city which was literally and figuratively a breath of fresh air. 

Plan E: Complete 14 days quarantine in Ethiopia. Fly to Burundi on August 19. Complete 14 days quarantine in Burundi. 

This time, things actually went even better than planned! The flight was entirely uneventful, and my luggage arrived with me. The Burundi airport was very well organized with socially-distanced queues, hand washing stations, temperature checks, and forms to complete about symptoms and about quarantine. All the passengers were tested for COVID on arrival and then we stayed in a quarantine hotel for 24 hours until we found out the results. Thankfully everyone on the plane tested negative, so they released us from the hotel to finish quarantine at home. I came up to Kibuye the next day and spent my Burundi quarantine time settling into my house after 9.5 months away and getting re-oriented to team life and work. Tomorrow is the last day of my second quarantine, and I will head back to the hospital on Wednesday! 

So is the COVID miracle Plan E? Sort of. It truly is a miracle that I was somehow able to get back to Kibuye during a pandemic with a closed airport and an expired visa - and that I stayed healthy through it all. And we have several teammates waiting in the wings in North America who would appreciate your prayers for a similar miracle (but without the Plan D derailing)! For me, though, I think the miracle is a deeper settling into my Heavenly Father’s care for me no matter how many “worst-case scenarios” come true. [And of course I realize that none of this was truly “worst-case” - it just felt like it at times!] But I’m an Enneagram 1 (the perfectionist) and Myers-Briggs ISTJ and a firstborn - basically I like plans, lists, routines, schedules. When I travel, I think through what could go wrong and I make contingency plans in my head. I evaluate speed bumps along the way with straightforward reasoning and logic. But these weren’t speed bumps - they were mountains! And no amount of planning or reasoning was going to make them go away! And, as everyone reading this knows, there has been no routine for the last 6 months! Living in Africa has definitely grown my resiliency in the face of uncertainty - but these trials have tested that to the max and forced this thinker to reckon with feelings, too! Yikes! ;) Psalm 77:19 says, “Your way was through the sea, your path through the great waters; yet your footprints were unseen.” That verse was very meaningful to me when our team dealt with the flash flood years ago (see post here), but it is also relevant today. God provided a way back to Kibuye for me through seemingly impossible circumstances. And at times I didn’t see his footprints ahead of me, and I had no idea what he was doing. But he kept reminding me of his presence and his steadfast love along the way, and he kept teaching me and growing me through the waiting. I hope I will remember that miracle the next time I’m tempted to anxiously make contingency plans and doubt his care. Thank you to all of you who have been praying for me through all the waiting and travels! 

Ethiopia Hotel Room Quarantine

Flying to Burundi! 

COVID testing in Burundi

Lake Tanganyika 

HOME! 

Hope For The Hopeless

 By Michael Harling

Do you ever notice how bad things seem to stick in your brain so much easier than good things.  In psychology it's known as negativity bias, a tendency to form stronger memories more quickly after negative events. Of course it's unhealthy, and arguably unbiblical, to only remember the negative.  But it's a struggle that can be a tool in medicine.  Part of our training during residency is knowing how to hone in on problems, to constantly expect disaster, and learning what we can do to prevent it.  This constant vigilance against bad outcomes can make it hard at times to remember good ones.  What easily sticks out is when patients don't do well and I consequently spend hours ruminating over what could have been done differently.  The patient I was operating on in the last newsletter had a complication after surgery and died as I was taking him back to the operating room.  I have thought of him often over the last few weeks and have been learning how to lay these difficult times before the feet of Jesus.  But rather than dwell on that challenge, today I want to share a praise.   Meet Hosiane:

I met this 7 year old girl in clinic earlier this year.  Her mom had brought her because she had vomited almost every single day of her life since birth - often several times a day, after most meals, and especially at night when she lay down to sleep.  The first thing that popped into my head was that I wanted to get a CT scan of her abdomen, but CT scans are incredibly expensive, even more expensive than an operation.  So I gave her a bill for the operation with the plan to do exploratory surgery (that is to say, I didn't know the diagnosis before operating on her, I was truly operating to "explore" her abdomen).  After returning home to find the funds and paying, she was on the schedule for July 10th.  She wound up being the last case of a long busy day, and before going back to the OR I reminded her mom that I wasn't sure what I would find or if I would be able to fix the problem.  In the OR I found something called malrotation.  Basically her intestines had twisted around themselves and were stuck in the wrong places which was chronically blocking food from getting out of her stomach.  After very carefully peeling the intestines apart and removing attachments that weren't supposed to be there I was able to put everything where it needed to be.  (For the medically inclined it was a really interesting presentation of chronic malrotation with the proximal jujunum crossing just below the terminal illium and wrapped twice around the mesenteric stalk, let me know if you want pictures!)  I went out to talk to her mother afterward and share the good news, that I had found the cause of the problem and that I was able to fix it.  She confessed to me that she almost didn't bring her girl back to the hospital, she was convinced her daughter was going to die.  The picture above is her 5 days after the operation getting ready to go home.  She hadn't vomited once since her operation.  Praise God that He protected and sustained her until she could come to the hospital. Praise God that he prompted her mother to bring her back.  Praise Him that it was a fixable problem and that we were able to correct it.  Praise Him that she recovered so well and so quickly.  Praise Him that this mother who had lost hope for her daughter left the hospital with a smile on her face.  I think the name of our hospital captures it so well:  Hopital Espoir de Kibuye - Kibuye Hope Hospital.  Praise Him that we have a chance to relieve suffering, to give hope for today, and to share our hope for eternity.

"Unless the Lord builds the house, its builders labor in vain. Unless the Lord watches over the city, the watchmen stand guard in vain." Psalm 127:1

Soli Deo Gloria,

Michael

Year 8 Is Going to be Great!

by Jess Cropsey

It's that time of year when we all start to see back to school posts on social media, although this year will certainly be unique as school will look different for most teachers, parents, and students. In two weeks, we'll begin our 8th year of school at Kibuye Hope Academy, the small school we have for our team's kids. Ironically, it's going to look a lot more like the first year than ever before with me and Heather as the main teachers and only six students....but hopefully not for long! 

In recent weeks, we've said goodbye to the three teachers that have faithfully served our team families for the last 2+ years. Kayla finished her 2+ year term with us in May and will be starting a new job at a school in Michigan in just a few days. As the main classroom teacher for our 11-year-olds for the last two years, she invested deeply in meeting the needs of this diverse group of learners. She excelled in asking good questions, sharing her love of writing, tracking student progress, and a host of other skills. We already miss her presence on our team and at the school.

Scott & Lindsay Nimmon have been with us for the last 4 years. Scott -- history buff, king of the cheesy dad joke, lover of all things Star Wars & Marvel, and teller of fantastic tales -- took on the formidable job of classroom teacher for the middle schoolers. His infectious smile and humor were able to cheer even the most moody among them, and the kids adored him. Lindsay has served as our principal, bringing our school to a new level in organization and rigor. Learning experience days, artist & musician study, and clubs were also her brain children and have brought richness and depth to our learning community. Their family is now settled at Rosslyn Academy in Nairobi where they will continue to minister to third culture kids.