Enduring Hard Times

 By Alyssa 

As part of the Serge conference, Rose Marie Miller asked me to share a brief testimony about how I endure hard times. How do I persevere through all the challenges of the last few years? Rose Marie is quite a testimony to endurance herself. She and her husband Jack started Serge (World Harvest Mission) 40 years ago and now, at age 97, she is still serving and sharing the gospel with Asian communities in London. She reminded us of the importance of being "anchored in the Word of God," learning to pray in our weakness and helplessness (Rom 8:26), and inviting others to pray with us and for us. She also invited two couples to share powerful testimonies of how God has sustained them through the past two decades of service in Ireland and Uganda/Kenya through many hardships. I'm earlier on in my journey and know there will be many unseen curves ahead and ups and downs, but I thought I would share an excerpt of what I shared at the conference here in the hopes that it would encourage our blog readers who have also endured with our team over many years!

From Spain talk June 2022:

...I really appreciated the thoughts Rose Marie shared about the God of first causes - that we can believe that God is indeed sovereign and loving in every event - whether joyful or sorrowful - in our lives. He doesn’t usually take away the hard times but he does bring Himself - His loving, good, and comforting self - which enables us to endure. 

...There have been many hard times over the last couple years for me and our team: pandemic, hard goodbyes, armed robbery at Kibuye, major team transition, Jennifer Myhre’s accident, conflict, and personal struggles. There are days when I think about how much easier it is to treat malaria or parasites than it is to deal with complicated relational dynamics and cross-cultural communication. If only a given situation had a clear diagnosis and treatment, a beginning and an end! So what does endurance look like? As I’ve been reflecting on this and looking up verses on endurance, I think it begins with lament in the present - in community. From there it moves to remembering the past with gratitude and looking to the future with hope. 

1) Lament. So this first step is actually the hardest one for me as it means I actually have to admit that life is hard and painful at times. As a thinker, my M.O is generally to ignore or deny my feelings. If I can think myself out of a situation, I will give that my best shot! It sometimes takes me a long time to even be aware of my feelings - and then I usually want to hide them from others even if I acknowledge them to myself and to God. But of course this only works temporarily and does not lead to long-term endurance of hard times. Lament means bringing to God my feelings, thoughts, and experiences in all their raw intensity. It means acknowledging and grieving losses and struggles. As we read in Romans 8, the creation groans as it waits for glory; we groan as we await redemption of our weak bodies; and the Spirit groans as he intercedes for us. And groaning or lamenting in community takes courage - especially for those of us who don’t have a natural “debriefer" in a spouse. But lament is not complaining or griping but following Jesus’ example who ran to His Father when his soul was overwhelmed with sorrow and courageously asked his friends to pray with him. And I have found that thankfully my friends and teammates are better at listening empathetically and praying with me than the disciples were at that moment in the garden! 

2) Remember the past with gratitude. In the midst of present hard times, I find it helpful to look back and remember God’s faithfulness in the past and how He has brought me this far. I think about how He gradually and gently called me to this life and work and how he has been with me and our team through all the ups and downs along the way. And I think back even farther to being a 10-year-old kid alone and paralyzed in an ICU bed. I had an illness called transverse myelitis which meant that I just woke up one July morning unable to walk or feel anything from my chest down. This was obviously quite a traumatic experience for me and my family. But God did indeed answer the prayers of His people and do a mighty work in my life during those two years of relearning how to walk and run again. My favorite verses became Isaiah 40: 30-31: “Even youths grow tired and weary, and young men stumble and fall; but those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint.” Most people with transverse myelitis end up with significant long-term impairments, but God provided the miracle of near-complete healing for me. And He also taught me about perseverance in hard times, about giving Him glory for healing, and He affirmed my interest in medicine which had already been developing for several years. Looking at the past with gratitude for me is sometimes as simple as being aware of the amazing fact that I can put one foot in front of the other and walk and seeing that as evidence of God’s hand on my life for so many years. 

3) Finally we look to the future with hope. Hebrews 12:1-3: “Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles. And let us run with perseverance the race marked out for us, fixing our eyes on Jesus, the author and perfecter of faith. For the joy set before him he endured the cross, scorning its shame, and sat down at right hand of the throne of God. Consider him who endured such opposition from sinners, so that you will not grow weary and lose heart.” We are surrounded by a community of witnesses to the goodness of God and this enables us to courageously repent of sin and scorn shame - including the shame that comes from human frailty and hindrances and not always getting it right. There is joy set before us just as there was before Jesus. And He is the one who is perfecting us and walking with us during hard times. As I said before and as Paul Miller writes, the J-curve always curves back up eventually to full redemption of everything broken in us and in the world around us - God making all things new. In view of that hope we can endure. Paul reminds us in 2 Corinthians 4 that looking ahead to the eternal weight of glory enables us to not lose heart in the present. Our current afflictions even prepare us for this eternal glory! When I’m discouraged by the magnitude of malnutrition in Burundi or the children who die from illnesses that are treatable elsewhere in the world or the students who struggle to learn or apply critical thinking or communication and trust struggles or differing opinions and conflict, I remember that it won’t always be this way. I can’t fix these problems, but I can look to my Savior who will one day usher in eternal glory so much greater than anything I can imagine. 

So that’s my encouragement to all of us jars of clay today who feel fragile and who are sometimes overwhelmed by the sufferings and trials of life. Lament in community. Remember with gratitude. Look forward with hope. 




“May the God of endurance and encouragement grant you to live in such harmony with one another, in accord with Christ Jesus, that together you may with one voice glorify the God and Father of our Lord Jesus Christ.” Romans 15:5

Three Proverbs

By Alyssa 

 1. Haraka haraka haina baraka. Pole pole ni mwenda. (Swahili: Quickly, quickly brings no blessing. Slowly, slowly is better.) 

2. Petit à petit l’oiseau fait son nid. (French: Little by little the bird makes her nest.) 

3. Buke buke ni rwo rugendo. (Kirundi: Slowly, slowly goes the journey.) 

 Proverbs are frequently used in Burundi to indirectly express important truths. Many of them are too complicated and sophisticated for me to understand with my direct American cultural framework (even when translated into English)! But I frequently reflect on these three similar proverbs which I learned when living in Kenya, France, and Burundi as I find their message quite relevant in my daily life. 

Practically speaking, I recite these proverbs to myself when I’m overwhelmed by the task at hand - packing or unpacking for cross-continental journeys, catching up on dozens of emails after vacation, rounding on dozens of pediatric patients, facing a to-do list that seems like it will never be completed. Little by little, slowly slowly, one thing at a time. Take a deep breath and be a faithful little bird in taking each next step rather than stressing about all that is still unfinished. 

 These proverbs are also relevant from a big picture perspective on our team’s life and work in Burundi. Our team recently returned from the Serge mission-wide conference which included over 600 people! The last conference was 6 years ago as it has been delayed the past 2 years due to the pandemic. One of my favorite parts of the conference are the prayer times where each team shares joys, struggles, and prayer needs. Since I hadn’t seen some of these colleagues for 6 years, it was so encouraging to realize all that God has done around the world since the last conference: new churches planted and growing even during the pandemic, new businesses thriving as means of Gospel-transformation, new teams getting started in new countries, children we prayed for who are now 6 years older and doing well, outreach to new people groups, etc. Our team also remembered how much the hospital has grown since the last conference, how God has sustained our team through lots of transition, and how Burundi has developed and stabilized in encouraging ways. 

Medical missionaries at the conference

Serge East Africa missionaries

Our team sharing prayer requests

Some of the current and former Kibuye team members who were at the conference

 Looking back at how far God has brought us in 6 years is encouraging, but often in the present we experience hard times and don’t know how they will turn out. We also heard much during the conference prayer times about present difficulties, concerns, and heartaches. In the day to day struggles it can be hard to see the hand of God and the arc of redemption of all things. These proverbs remind me of the importance of daily faithfulness in small things as we slowly do the work before us one patient at a time, one email at a time, one complicated interpersonal interaction at a time. I believe that 6 years from now, we will look back and be amazed at God’s care for us and for Burundi through all the ups and downs of the slow journey. But today I am encouraged by the missionaries who have been serving for many more years than us and who continue day by day in the small unglamorous work of language learning, making friends, supporting teammates, managing finances, caring for their families, and answering email - for the world’s good and God’s glory.

A Semester in the Life of a Teacher

By: Erica Ause

Teaching anywhere is never the same from one day to the next. And here it is no different. With smaller classes and an interesting environment, there are many ways to keep class lively! Next year I will be teaching mainly math and science for grades 2-8, as well as PE. The T-shirt pictured above is my Math Test Day Shirt, and I hope it will give the kids something to laugh about on otherwise stressful days!

This semester in writing the students learned how to write essays, as well as fictional stories. For their writers celebration, they read aloud the work they had done and then displayed the long and hard process they took to get from their first idea to their final draft. The whole team was invited, and everyone was really impressed by all their hard work!

Science was filled with experiments, presentations, and STEM activities. The students melted chocolate in a self-made a solar oven, discovered what material was the best type of insulation, shared presentations on Archimedes, explored how light reflects, and saw first hand magnetism caused by electricity (seen in the video above).

We had a special guest come to class to take apart my broken cell phone. He is the brother of a team member who was visiting for a couple weeks, and blew the children away with all that was hiding inside the little thing. It was sad to see my phone taken apart, but we did it for science!

They really got moving this term in PE with Zumba classes from a visiting doctor, and dance lessons from three of our teammates. They learned line dancing, and a whole hip hop choreography that they will present on the last day of school. They worked really hard, and loved every minute of it!

Gymnastics was another fan favorite of this year. They practiced balance and team work while making really cool poses and routines. They are not as easy as they look.

I'm not sure if this is because I am the PE teacher, or because my class is all boys, but breaks are usually spent getting some extra time at the gym. It's fun to teach them new ways to get stronger, and to watch them enjoy exercising.

One of the unique parts about this school is that we have something called Learning Experience Days. These are when we spend the day learning about something outside of curriculum. This semester, we explored outer space, the eye, and milk. A doctor who is here for a few months has his masters in space studies, so we felt very fortunate to learn about it from an expert! The first three pictures are from this day. We saw a student in a makeshift astronaut uniform (helmet is Tupperware), and how big the solar system is on a smaller scale, amoung other things. The picture on the top right is the day when we learned about the eye. The same doctor who studied space, is... you guessed it... an ophthalmologist. So, he also taught us about the parts and the function of the eye. The picture here is of a student dissecting one of the many goat eyes he was able to buy. Some of the kids really got into that one! The last five pictures are of our milk day. We went to the home of a hospital employee who has many animals and saw how cows are milked, fed and taken care of. It was a beautiful farm and helped us understand the difference between how we get the raw milk we drink here, and the milk we drink in the Western World.

And of course there are many ways that school spills over into my every day life. From having students help me organize the PE materials, waking up early to put fake snow out to announce the "snow day", celebrating my birthday with a cucumber and carrot snack (in the shape of a flower), and reading to the young ones who will be in school in just a few years. There are so many ways that being a teacher impacts my life outside of the classroom, and that I wouldn't any of it!

Seven Soekens in Burundi

Hi! We are the Soeken family! There are seven of us. Tim (dad), Rachel (mom), Timothy (13), Stephen (9), Carey (7), Joseph (5), and Samantha (2). We have temporarily joined the Kibuye team for the period of February – May, 2022. We are loving it! Since you may have seen us in random photos or heard mention of us, we were invited to write a short introduction to our family.

Tim (dad) is a US Air Force ophthalmologist. This academic year Tim is completing a Global Ophthalmology fellowship for the Air Force via the University of Michigan. This year has included trips to Kenya, India, time in in Michigan, and now almost 5 months at Kibuye. After we complete our time here in mid May, Tim will return to active duty and will help lead all the humanitarian ophthalmology mission trips on behalf of the US military.

Rachel (mom) stays home with the kids. This spring Rachel is doing part time home school, learning a little bit of French, and trying to keep the family running on all cylinders. She is helping to teach elementary Art once a week at KHA. That has been so fun for her to be involved in the school in this way. She also loves going up to hold babies in the NICU. The hospital is an amazing place for sure! 

Our kids are Timothy-7^th grade, Stephen-3^rd grade, Carey-1^st grade, Joseph- 5 years old and Samantha-2. All the kids are LOVING Kibuye life. The older three kids attend KHA for about half their subjects and stay at home for math and reading. The two littlest just enjoy playing at home. Each of our kids have asked at different times if we can stay forever! They have loved being outside and making new friends. One of their favorite new things about Burundi is the wild chameleons. We have a new one in the house about once a week! They like to keep them for a couple days and then let them go. They are so cool! 

 

What does Tim do while he is in Kibuye for this Global Ophthalmology fellowship? Tim works with 2 ophthalmologists and 2 ophthalmic clinical officers. You may have seen them over time. From left to right, there is Dr. Leopold (ophthalmologist), Emmanuel (OCO), Herve (OCO) and Dr. Jean Claude (retina specialist). Tim has previously completed a cornea fellowship so he spends some of his time teaching best practices for cornea here and some of his time is spent learning how to practice ophthalmology in a low resource setting. Tim thinks the world of each of these four men and would happily work with them for a lifetime if he could! They are all incredible clinicians, surgeons, mentors and friends. 

 

Below are a few of Tim’s favorite stories from work here in Burundi. This is Saleche. This is a great visual example of the bilateral blinding cataracts that we see here every day. He walked in guided by a caretaker because he could only see light. After the patch was removed on post-op day 1, he could see again from his new left eye! The funny side note here is that he was so excited to walk around the clinic by himself, since he could finally see from his left eye, that he walked his right shoulder into the door quite dramatically. He hopes to return to have his right cataract removed soon!

This is the BEST story! Isaac is a 10 year old boy that I met early last week. He presented

one week after he was hit in the eye. He had what we call a hyphema. Initially it was not

concerning, so we just treated him medically. However, within 2 days his eye pressure sky

rocketed and we increased medical therapy and recommended that he have a “washout” of the

blood the following morning. Unfortunately, Isaac did not show up the next morning. He did

not return for a whole week. And, when he did his eye pressure was even higher and he was

100% BLIND in that eye. I was devastated. And to make it worse, he father had just paid for the

surgery. I was very conflicted but agreed to still perform the surgery. I honestly do not think

that the boy or his father understood the situation. I told Rachel about the situation, and told

her of my total hopeless outlook. But, Rachel being Rachel said, “OK, I will pray for him.” I

thanked her for her kind gesture, but I still expected only a depressing outcome. I went and did

the surgery. Nothing unexpected happened during the surgery. The boy went to sleep. I

prepped the eye, washed out blood, removed a large blood clot, and sutured the single small

incision. The eye was patched and the boy awoken and taken to recover overnight. The next

day I was seeing the usual flow of post-ops and I was handed his chart. On the place for vision

for his right eye I saw “6/24”. I expected “NPL” (no light perception, how we write total

blindness). I asked someone to verify, I said they probably checked the wrong eye, it should say

“NPL”. But, I was wrong. Isaac could see! What a happy surprise! I was totally wrong! God is

good!

Kibuye has really become a home away from home! We love it here! The community has been so welcoming and we know we have made friends for life. What a joy and blessing it has been to our family to be here for this short time! 

A Reflection on Psalm 46

By Glory Guy Psalm 46 – God is Our Fortress “God is our refuge and strength, a very present help in trouble. Therefore, we will not fear though the Earth gives way, though the mountains be moved into the heart of the sea, though its waters roar and foam, though the mountains tremble at its swelling.” Psalm 46:1-3 If you know me, you know that I don’t do boats. As a little kid, I loved being on the water, and as an adult I still love being IN the water, but boats of most varieties are not my thing (kayaks are fine, but that’s a different story). I have a sensitive stomach, so I don’t like the feeling of constant motion that comes with the rocking of a boat on the water. The feeling of going up and down, the swaying associated with sea legs is not my cup of tea, so if I can avoid the feeling of being on a boat, I do. A few weeks ago, I flew 16,000 miles in a week, for a quick trip from Kibuye to the United States to sign some papers for graduate school, and over the course of this trip I acquired a severe bout of vertigo. Not an episode of vertigo that lasts a couple hours and is relieved by a combination of medication and lying down in a dark room, but a full on twenty-four days of non-stop vertigo, and honestly it is still not totally gone. This was a nightmare for me, I was bedridden whenever I wasn’t standing in front of a classroom, and I spent most of my time in the classroom with my head on my desk trying to make the world stop spinning. In a particularly bad moment, I fell down flight of tile hotel stairs because I just wasn’t able to get my footing. The medication that is usually given for vertigo made my condition worse, like standing up and immediately toppling over, worse. After several other trial medications and no results, we decided to see what a steroid dose would do to my system. Through all of this, my frustration with the Lord was through the roof. A lot of my prayer looked like, “Lord, what are you doing? Why is this happening? I feel like a shell of a human, make it stop, I can’t do this anymore, please.” No change, world spinning. During week three in anger, “Are you even here?” Sometimes a question, sometimes a challenge. Everyday check ins from neighbors and friends in the States, “any better?’ The only way I could describe it to those around me was to say I felt like I was on a boat. Flipping through the Scriptures, I landed on Psalm 46, one of my favorites. A Psalm that proclaims hope in all circumstances, one that remembers the power and the presence of our Father on high with great conviction. Reading through the words that I had prayed through many times, I found myself with a new perspective on verse 2 “Therefore we will not fear though the Earth gives way.” Sometimes, a misalignment of the inner ear convinces my finite body that the Earth is giving way, that there is motion where there is none. The lack of control that comes with earthquakes is mimicked by my inner ear, along with the fear, the physical imbalance, and the wonder at what the Lord is doing. Astounded by and jealous of the Scripture writer’s ability to believe and proclaim the promises of the Lord, I found myself asking “Is God actually my fortress? Is He actually a present help in my trouble?” It certainly didn’t feel like it. When Sunday morning rolled around, I realized it was Easter. This changed everything. The existence of this day means that regardless of how many times I cry out to the Lord saying “are you even here?” the answer will always be yes. Through Jesus’ sacrifice, He took the separation that I deserve. So, even when it doesn’t feel like it, I know, with complete certainty, that the Lord is with me. He promised, and in Jesus’s death He keeps His ultimate promise, His great rescue of His people. Jesus cried “It is finished” on the cross for me, so that the girl face down in her bed in the dark at 3 pm knows that she is not alone. The world is spinning, but Jesus is on that boat with her. He was alone so I would never be. Maybe the Psalm 46 psalmist was also struggling to believe what is true, and the words are not written in shouted confidence on the spiritual mountain top, but from the pit, in the dark, promises whispered and preached over himself. A promise foretold, words spoken and written in hopes that they would be believed. The prayer of a weary and feeble heart like mine, reminding themselves of the goodness of God in the truth of His presence, repeated in verses 7 and 11, “The Lord Almighty is with us; the God of Jacob is our fortress.” My fortress, my stabilizer, the one who is with me in the boat, whether literal or caused by the disruption of the inner ear. The words whispered in truth, we have nothing to fear, because He is with us, our safe place to hide.

Resurrection Hope

 by Rachel

Happy Easter from the Serge Kibuye team!  We spent the day together as a team, as we always do, feasting at a brunch potluck with our Burundian neighbors, worshipping together, and finally hunting for Easter eggs.  I love these small and large team traditions, and the passing of Good Friday death into Easter Sunday resurrection in community.

The events of the weekend gave me a chance to think about resurrection…about Jesus’ resurrection and our hope, as Christians, of eternal life.  But also about all the small moments of resurrection and redemption that we see around us all the time, if we have eyes to see.  I was reflecting mainly on a special story that I got the privilege to be a part of last month.  Eric and I shared part of this story doing our time in the US in 2018, so if you got the chance to be at one of our presentations, the story might sound familiar to you, too.

Triphonie first came to see me at the end of her fourth pregnancy, about seven years ago now.  Her baby had died before being born, and upon investigating a bit more, I found out that she had no living children.  All of her first four pregnancies had resulted either in the baby dying before labor (in the last 1-2 months of pregnancy), or stillbirth, where the baby died during or shortly after labor.  It was devastating for her, and difficult for us as the medical team to be a part of as well.  I asked her to come and see me during her fifth pregnancy in hopes that it would end differently.  Many times in Burundian medicine, we are shooting in the dark, without tests and labs to guide us, unsure of a diagnosis, trying treatments that aren’t necessarily proven to be of strong benefit.  This was the case with Triphonie.  But we did simple interventions: a monthly ultrasound, aspirin and vitamin tablets, steroids to help the baby’s lungs mature, and ultimately a Cesarean delivery a month before her due date.  And miraculously, her baby was born alive, a little girl weighing just four pounds, who spent several weeks in our neonatal unit and went home healthy.  I would see Triphonie and her daughter from time to time around Kibuye, her daugh
ter usually wearing an amazingly frilly party dress, both with big smiles on their faces.  Do I remember all of my patients and their stories?  Honestly, no, but Triphonie’s face and her story are indelibly burned in my memory.  

Now, fast forward five years.  It was just another OR day for me that Thursday morning in March…I had a list of C-sections to do that had been scheduled by my generalist colleagues.  And I walked into the OR, and there was Triphonie getting her spinal anesthesia and smiling at me.  She had come for her 6th pregnancy, a repeat C-section, and I was able to deliver her second living, healthy baby girl (full term this time).  I asked my intern, who was doing the C-section with me, to translate to Triphonie how excited I was to be here, how thankful I was that she had two babies now, and that I still remembered all of her story.  My intern, Patricia, said to me, “I remember her too.  I was the medical student who cared for her baby in the NICU.”  

It’s hard to explain how profound and impactful this is for me, on so many levels.  First of all, this is a lady whose losses were incredible, and yet here at Kibuye, she received hope and ultimately new life in the form of her two daughters.  She persevered, she tried again, and God put us in the right place at the right time to be able to participate in that gift of resurrection and redemption.  In those moments when we’re stuck on that fourth pregnancy, the loss and the death and the brokenness (not unlike Good Friday), I have a story to cling to now to remember that this is not the end.  Not for Triphonie, not for me.  Sometimes we get to see the curtain pulled back and witness the NEXT pregnancy, the success, the miracle.  The Easter Sunday.  Sometimes we don’t see it, but it’s always going to come in some form or another.  And this story helps me remember that.

Secondly, we’ve been in Burundi for nine years now.  We came in with so many dreams and ideas and plans.  Things have been infinitely harder than anticipated, or things have been harder in unexpected ways.  Things haven’t always looked how we thought they would.  But still, nine years later, our team is still here.  And that nine years of constant presence and partnership with our Burundian colleagues means that sometimes we can look back and see how changes have come, slowly by slowly.  Sometimes I can be part of someone’s story in a way that I couldn’t have been in we had only stayed a year or two.  For Triphonie, I’ve had the chance to treat her during three different pregnancies over 7 years.  That continuity is amazing to me.  Or in another aspect, there was no NICU when we arrived nine years ago…there were cardboard boxes at the foot of the mom’s bed for the preterm babies.  Triphonie’s baby is alive because of care provided by our competent NICU staff and locally made equipment like incubators.

Finally, perhaps my favorite part of the story was Patricia’s involvement.  Not only did I have continuity with Triphonie, but Patricia had gotten to know her five years earlier as a medical student, and now here she was doing a C-section as one of our stage professional interns.  Our team has been able to teach and train now hundreds of students at multiple and progressive levels, impacting health care throughout the entire region.  All the stories that have impacted me….have also impacted other Burundian doctors as well.  They remember these stories of hope and resurrection and redemption, too.  

So on we go, in this Easter world where there is a promise of already and challenge of not yet.  I am so grateful for the chance to reflect back on these stories, which give me hope for the road ahead.  The tomb is empty.  Death has been defeated.  We wait with expectation. 

Hip hip hooray for medical education

(by Ted John)

A few months ago, I wrote a post on medical education and my experience organizing a 2-week dental course for the medical students, which you can read more about here. It was the first time teaching such a course at our hospital and the first time for me to coordinate/organize a course. Since we don’t have any dentists on site, teaching was done exclusively through audio/video recordings and live video conferencing.

Fast forward a few months, and I have now finished coordinating a new course on orthopedics and trauma. Here’s a table to give you an idea of how they were similar and different, at a glance.

	Dental	Ortho/Trauma
Number of students enrolled	46	52
Duration of course	2 weeks	5 weeks
Number of instructors	3	6
Number of (different) lectures	9	29
% of lectures taught in English (PPT slides in French)	78%	26%
Method of instruction	tele-education	in-person (some distance learning)

Of course, there are a number of other differences. For example, the scope of the ortho/trauma course was broader, but more related to general surgery (at least as it pertains to trauma). Thus, while it would be ideal for orthopedic surgeons to teach the more strictly ortho topics, we did the best with what we had in terms of available expertise. In what other context could you imagine an ortho/trauma course taught by a motley of 4 general surgeons, an ER doctor, and a visiting orthopedic surgeon? 😄

Lecturing in our newly renovated classroom

Another big difference was that not all students were present for the in-person instruction at Kibuye. At any given point in time during the course, there were 8-16 students doing clinical rotations off-site in Bujumbura. As a result, it required more effort and coordination to ensure that these students could have timely access to recorded lectures and corresponding slides. The usual routine was that as soon as an instructor finished giving their lecture, they would send me their recorded audio file, which I would then upload to Dropbox (along with their slides). Then there’s the logistics of administering quizzes and exams in two locations simultaneously, getting scanned copies of the completed off-site quizzes, and grading and reporting all students’ results in a timely manner. Doing this in the US with high-speed internet and ubiquitous Wi-Fi would be challenging in and of itself, so accomplishing this in our context is nothing short of incredible.

Medical students taking one of their weekly quizzes

Here’s a condensed list of the content we covered:

• ATLS/Burns
• Trauma of the spine and chest
• Trauma/fractures of the upper extremities (shoulder, humerus, elbow, forearm/wrist, hand)
• Trauma/fractures of the lower extremities (hips, femur, knee, ankle)
• Musculoskeletal infections and tumors
• Differences in the pediatric population (plus congenital abnormalities)

Skeleton models of bones and joints were available for students throughout the course 

Much of the content goes well beyond the expertise of a typical general surgeon, so we are thankful for a French textbook that we used as the foundation for our instruction. In reading through this book and preparing slides, I’m certain that each instructor learned something in the process, whether deepening their own medical/surgical knowledge or perhaps learning additional French words for specific terms. For instance, I learned that the commonly used English abbreviation ORIF (open reduction, internal fixation) does not translate exactly into French as with other terms and is probably closest to réduction sanglante avec contention interne (which is literally “bloody reduction with internal compression/immobilization”). One can only wonder if this is actually what is colloquially used in France. In this sense, it felt like I was earning continuing medical education (CME) credits.

We’re also thankful for Joel Post, an orthopedic surgeon who visited for 2 weeks during the middle of the course. We intentionally planned the course to correspond with when he was around so that we and the students could benefit from his expertise. With Dr. Post’s fellowship training in orthopedic oncology as well as traumatology, he was the perfect person to give the lectures on osseous tumors and ankle fractures (which I view as generally more complex both in terms of injury patterns and management). As I sat in the back of the room listening to him, with stories of patients from his own current clinical practice, I couldn’t help but think, “Wow, this is so interesting. I wish Joel could teach all the ortho lectures!”

My family with Joel just before his return to the US

Overall, though, I’m quite pleased with how the course turned out, and I think the students learned a lot. As with the dental course, I recognized the top performing students, but this time with little bags of calcium supplements (tums) for fun. I even trialed an electronic post-course survey through google forms to solicit feedback, the template for which others can continue using in future courses going forward. In response to the question of what was the best part of the course, a good number of students said “everything”. Yet, I know there’s room for improvement, and will take to heart the students’ suggestions for the next time this course is taught again in a couple years. For now, I can redirect my attention elsewhere, perhaps in helping with the start of a surgery residency training program in the coming months. Tibia continued...

Group photo with the Kibuye cohort of students at the end of the course

4 Brief Cases from a Surprisingly Encouraging Clinic

 (from Eric)

(Note: These windows into my life and work are undeniably medical.  My experience is that the non-medical folks divide pretty quickly into the camps of "Boring!" and "So fascinating!"  I offer this in hopes that it will be helpful to medical readers as well and those non-medical folks who find such things interesting.)

For many years, Wednesdays have been my day for offering Internal Medicine specialty consults.  It started as a small clinic, and has steadily gained steam to the point that it's quite a long, busy day every week.  I have (somewhat) jokingly also called it my "bricks without straw" clinic, or alternatively my "everyone gets amitriptyline" clinic.  Suffice to say that managing complex chronic medical diseases in our context is often really hard.  Some days are quite exasperating, but there are usually some people that I feel that I've been able to really help.  Aside from that, I always have a post-graduate intern doctor with me and a couple medical students, so there are also unique educational opportunities.

This past Wednesday was a public holiday in Burundi (commemorating the death of President Ntaryamira in 1994, who was shot down in a plane with then Rwandan President Habyarimana).  Technically, this would mean I wasn't seeing consults like normal, but I figured I might as well be there.  It turned out to be a pretty busy day, and most of the people who came had been given a follow-up appointment for that day after past visits or past hospitalizations (because we forgot it was a holiday).  In the end, there were a number of really encouraging moments, and I thought I'd share 4 of them, both for the purposes of encouragement and interest.

1. Leonidas is a 35 year old man who was hospitalized on our service a couple weeks ago.  He came in with whole-body swelling (imagine an enormously swollen person and then double that) along with trouble breathing that needed oxygen therapy.  His swelling seemed to be from a severe kidney disease (mixed nephrotic/nephritic for medical folks), but his lungs were super wheezy, which

 seemed weird (though not impossible) for the expected "water on the lungs" that seemed most likely for him.  We were giving him huge doses of IV Lasix (to try to help him pee off the excess fluid) with absolutely no effect.  We had a thought that he could have a rare inflammatory vasculitic syndrome that was causing his lungs and kidneys to both fail together.  In absence of any tests to confirm that, and with his life obviously threatened, we started him on steroids.  His lungs were getting better, and he got off oxygen, but given our failure to get his swelling down at all, we recommended he go to Buja to see a kidney specialist, and he agreed.

    Fast forward to clinic, a man walks in, smiling at me, and I don't recognize him in the slightest.  It's Leonidas, whose kidneys started working, and our medicines caused him to lose OVER 25% of his body weight in fluid.  He's walking around and feels quite good.  I'm shocked, and we laugh together at the surprising goodness of it all.  Turns out he didn't have any money to go to Buja, so he's been haunting the hospital grounds for a couple weeks, waiting to see me in clinic.  I was afraid all our medicines could have hurt his kidneys more with such a dramatic response, but they are almost back to normal.  We adjusted his meds, and set him up to come back in a month.

2. Gloria is a 48 year old woman hospitalized last month with new onset diabetes who came in in a coma from diabetic ketoacidosis (DKA).  Despite the low mortality rate of this problem in the US, most of these patients used to die here.  Starting around 3-4 years ago, we found a way to reduce the cost of blood sugar testing at the bedside, which enabled us to test more frequently, and patients generally do much better.  Gloria had the added blessing of showing up when Carlan was in the ER, which meant a quick diagnosis and initial treatment.  She went home after about 5 days.  We stopped her injectable insulin (super hard to maintain in a village home with no electricity), and hoped her metformin pills would do the trick.  They're working beautifully.

3. Esperance is a similar lady, but she's only 16.  She also came in with new diabetes and a coma with DKA.  We hemmed and hawed about stopping her insulin to try pills.  It shouldn't work.  She should be dependent on injectable insulin.  But here's the funny thing.  Here in Burundi, I see numerous young skinny patients with diabetes who can be well treated with pills for years.  Given how huge of a difference that makes in their lives in this context, we usually try and usually succeed.  But 16 years old?

    As it turns out, I wasn't around the day she came back, and our Burundian doctors tried the pills.  Their gamble paid off, and she is doing great.

4. Charlotte is a 52 year old lady that I diagnosed with severe heart failure (ejection fraction of 15%) in 2017.  She easily would have died around that time without intervention.  She has been incredibly faithful in taking her medicines and coming back every 6 months to see me, even though she feels totally fine and is able to farm in her fields like everyone else.  We rescanned her heart, and it's still obviously sick, but significantly better than 5 years ago.  She'll continue a half-pill twice a day and we'll see her again in October.  We thanked God together for the past 5 years of health that she has received.

A view of my consult room.  I didn't see this lady last week, but she's been seeing me for years and always comes at the end of the day full of smiles and joking.  She's my biggest fan.

Kibuye Weather Station

 by Michelle Wendler

We are happy to unveil the new Kibuye Weather station (thanks to a combined gift from our family to Carlan). 

So far the local weather and weather patterns have been sort of a mystery to us. But now we can see how much it is raining, how cold it gets at night, what the humidity is, the solar radiation, UV index, and more! It's been so much fun finally seeing all these stats, and we want to share them with you! All the data 24/7 is available online (except if we have an extended power outage). Feel free to check it out, and share it with those who might be interested in these sorts of things.

Link to the weather station:

Weather Station Link

Here are a few pictures to help you navigate the info you can get. Here's what the most current weather would look like:

Under charts and graphs you can see what the last 24 hours has been, or change the date (see example below) to see data for the last week, month, or even longer. We installed the station the end of February, so we only have been collecting data since then. 

If you like graphs:

If you like tiles:

Working hard during a thunderstorm:

And there are many more features, I just highlighted a few. And you can even download the Ambient Weather app (see picture below) to have the data easily accessible to your phone. 

One final note, if you ever check and there's no recent data, that means we don't have power and the battery backup has run out of juice as well. But once power is restored, then the data should be available again.