Taken Away My Shame

by Rachel 

Every Monday I have OB-GYN clinic at the hospital. It usually runs from 9a-5p and I see sometimes over 40 patients. The pathology is variable, but the type of women that come to see me is also quite variable. Sometimes it’s a little hunched over old widow, wearing no shoes and a dirty wrap, coming to see me for her uterine prolapse. Sometimes it’s a fancy looking woman with well done hair and perfume, accompanied by her husband holding car keys and a giant stack of medical tests, seeking help for infertility. I see farmers and teachers, nurses and business women. They come from Kibuye, Gitega, Bujumbura, and even sometimes Tanzania. Young and old, rich and poor. All seeking the hope of healing in some way or another. That last piece can be hard to remember in the crush of the day, with a long line of patients and a large stack of charts waiting. Trying to get through the day, skipping lunch, going as quickly as I can...but trying to remember the humanity of each person and their own brokenness in some form or fashion. That they need hope. 

One such patient came to see me about nine months ago. She was actually a nurse, a maternity nurse no less, at a different hospital. Her first pregnancy had ended in disaster: she went into labor at term with a healthy baby but her baby's heartbeat had started to look distressed. They performed a C/S for her, but her baby died just after birth. This is sadly not an uncommon scenario, but for it to happen to someone whose profession is to deliver healthy babies...a double blow. There is a falsehood that I probably subscribe to at some level as well, that a better job or more financial resources somehow guarantees a certain outcome in health and in life. This is not always true. 

Well, she was pregnant again, now just 5 months after her first loss. I placed the ultrasound on her belly and we were both surprised to see not one but two heartbeats: twins. This is usually joyful news, but does cause a bit more apprehension for the obstetrician! Her risk of another loss due to miscarriage or fetal death was somewhat higher, so we made plans to follow the pregnancy more closely, having her come back for follow-up visits every 4-6 weeks. And I can say that the rest of the pregnancy was wholly unremarkable. I wasn't even the one to follow her for the most part, my generalist colleagues being fully capable to perform her ultrasounds and follow the babies' growth. Her C/S was scheduled at 37 weeks' gestation. I don't even do very many C/S any more, because there are so many well trained doctors working at Kibuye these days, but that morning I happened to walk into the OR before the day had even started, and she was already on the OR table, prepped and ready to go. So I scrubbed in, said a prayer, and began the surgery. 

First, a girl. I held her up over the drape for the mom to see her and announced, "Bukuru!" The traditional Kirundi name of an older twin. The baby girl screamed her lungs out, and the mom began sobbing. Then, a boy. "Butoyi!" The younger twin. I likewise help him over the drape and the mom sobbed harder. It was, like the pregnancy, an unremarkable C/S. But as I closed up the layers and dressed her incision, a song that we sometimes sing in church came to my mind. "My beautifier, you've taken away my shame, you've taken away my pain. You've made my life so beautiful." And I couldn't help but think about how this pregnancy HAD taken away shame for my patient. Shame of feeling like she had done something wrong, that despite her profession she couldn't save her first baby. Cultural shame of not yet being a mother. These two babies HAD taken away the pain of childlessness and the loss of her first baby. Maybe not completely, as cases like this are intense joy mixed with intense pain, but healing has begun. The loss of her first baby will always linger, but redemption is now happening. Life is being made more beautiful for the loss and the pain and the joy and the new life. And I'm glad that God allowed me to be a part of it.

Shopping

(by Michelle Wendler) 

Here's a glimpse into what shopping in one of the country's largest "malls" looks like.

You first need to navigate a 40 min drive from Kibuye to Gitega. The road is challenging in many ways, from livestock, to pedestrians, and many bikes. And everyone trying to avoid the many potholes and other cars and motorcycles on the road. 

Here are some pictures I've taken of people transporting along the roads:

Once arrived the "on foot" part of the adventure begins. There is no "parking lot" here. You can park along the road or in front of a little roadside shop and walk to the mall. Crossing the streets is always fun, with cars, bikes, pedestrians in a mishmash trying to avoid each other. Many horns honking, people yelling, frantic running when the right moment comes. If you are a white person, you can expect to hear many people yelling "muzungu!!" because it's so rare to see one here. I've actually never seen another muzungu in the market. 

Along the main road is the fabric district with many little shops selling bolts of African fabric and many people sewing using pedal sewing machines. 

Upon entering the mall there are many ground level little booths where people are selling many things, like shoes, beans, rice, metal objects, fabric, etc. Most of the clothing items are not new, but are second hand. The shoes are washed to look pretty good though. And the prices are right. A pair of kids shoes will cost around 20,000 fbu with is around $5. 

Once in a while you might have to dive out of the way of someone transporting fresh meat to the meat shop. Fresh meat is usually a freshly butchered cow skewered on a pole and being carried by two men as blood drips on the ground. 

If you are looking for clothing you climb stars to the second story of a two story building. I've often wondered the journey of each item of clothing. I've seen an item with a Marshalls clearance tag, then a thrift store tag. They ship these clothing items in large bundles tied in twine to Africa from all over the world. The 2nd hand items that couldn't find a home elsewhere are welcome here. Sometimes there are piles on the floor to look through, or neat piles folded on tables. Sometimes you can find shops that actually hang things with homemade hangers. 

Bartering is the name of the game. People will be yelling one price while the shop owner is trying to get a higher. I've found that I always need to go with a local who knows the actual price that things should cost...otherwise I'll pay 10x the correct amount. 

Another thing to get used to how they will try to draw you into their shops. Sometimes they will grab your hand and pull you in. But seeing kids and babies everywhere is something I enjoy. This is a culture that loves family and kids. The little ones will often stare at my because it might be the first time they will have seen a white person. 

The vegetable market is outdoor but covered and is situated along the street. I love the colors in this part of the market. Thankfully I don't have to come all this way to buy our perishable items because we pay a local to come and do a large purchase for our team once a week. Such a gift, especially with gas prices and availability being so problematic. 

Malaria, Mystery and Mitigation

 (from Eric)

One of the obvious differences in practicing medicine in Africa versus the USA is that there are diseases that you have to master here that you wouldn't know how to treat had you not come.  Foremost among these is malaria.  Despite a few locally acquired cases in Florida and Texas this past summer, malaria is basically unheard of in the United States.  At the end of medical school in the US, I had learned some about the disease, but only really on a theoretical level.  I had forgotten most of what I learned, and certainly had no practical experience.

Malaria parasite infecting a red blood cell

But on a worldwide level, this disease is huge.  There were about 250 million cases last year, with over 600,000 deaths, and 95% of them are in Sub-saharan Africa.  Malaria is transmitted by mosquitos that infect the blood, and it can cause lots of different complications in the brain, in the lungs, in the kidneys, in the spleen, etc.

Here in Burundi, for many years, malaria was my number one diagnosis.  As in, more than 50% of my patients were admitted with some severe complication of malaria such as kidney failure, severe anemia, or a deep coma.  Many of them died, but because of good treatments that are available, most of them could live and their recoveries were sometimes quite dramatic (and very gratifying!).  It's a complicated disease, and so it was probably the disease that I spent the most time teaching my medical students about.

Malaria is around all year, but it is also highly seasonal.  I think it was 2017 and 2018 that Burundi declared back-to-back epidemics (with 2019 numbers being quite high but no epidemic officially announced).  The number of cases was more than 80% of the total population.  Most everyone was getting malaria.  Many people got it multiple times in the same season.  Then, starting in 2020, the epidemic rates seemed to be decreasing.

Enter 2023: This year, we have had virtually no malaria.

We are now at the end of the would-be "malaria season" and yet the numbers never rose.  Less than 1% of our tests are positive.  I have no malaria patients on my service, and because of the significant contribution this disease makes to hospital census, for the first time since our team arrived, instead of a steady rise in patients numbers, hospitalizations are actually down.

Kibuye's head lab tech performing malaria microscopy

What happened?  Good question.  There are very effective malaria prevention strategies, including indoor residual spraying and distribution of insecticide treated bed nets.  There is a national malaria program that is hard at work, but as far as I know, they were hard at work even when Burundi was suffering repetitive epidemics.  Médecins Sans Frontières (i.e. "Doctors without Borders") provided a great service to our hospital for a couple years, paying for treatment of all patients hospitalized for severe forms of the disease. But it seems hard to understand how that effort would result in so much prevention.

Christianity refers to an idea called "common grace".  This is a characteristic action of God, who sends rain and sun on everyone, the evil and the good, the just and the unjust (Matthew 5:45).  Across the country, Burundi has experienced common grace in the reduction of malaria this year.  Long may it last.

It strikes me that this situation demonstrates two characteristics of common grace.  First, it is mysterious.  Why did this happen?  Is there a direct cause? Nothing leaps to the eye.  But understanding something is not a prerequisite for being thankful for it.  Second, it is easy to overlook.  Being thankful for the absence of something is not what any of us are good for.  Something amazing has happened to Burundian health this year, yet we are all prone to overlook it because it is something amazing that did not happen.  It gives me pause to think what other grace in my life might be mysterious or invisible enough for me to overlook it.

Water Security at Kibuye

(By Caleb)

In university my studies focused mainly around Water Resources Engineering.  Surprisingly, in my current role here at Kibuye, I do not get to put my degree to use very often, strictly speaking.   However, over this last year, a very generous gift from a friend of the team has enabled us to make a concentrated effort to increase both the quality and quantity of water available at the hospital.  

Despite our best efforts over the last 10 years the hospital continued to experience periodic water outages.  As you can imagine, the lack of water affected the ability of the hospital to function at just about every level.  With the construction of new ferro-cement water tanks, new pipelines, some new controls and a new disinfection system, I hope that our water woes will mostly be behind us!

Planning out the location for these new tanks and a pump house.  There is space for five tanks, but we started with 3.  Each tank can hold 100,000 liters.

Setting out. 

Laying the foundation.

Beginning to lay the reinforcement and starting to construct the small pump house in the background.

With the ground slabs poured, they begin to tie the reinforcement of the walls.

With the reinforcement cages finished, the plastering begins. 

Two tanks complete and curing under hessian coffee sacks.  

Finishing the plastering on the inside. 

A visit from a local inspector.  

After close review, final approval received!  

Tanks complete!  Only awaiting paint after curing.  The hospital's water storage used to be a mere 60,000 liters.  Now with these tanks we have 360,000 liters.    

More curious inspectors checking on the filling process.  

This is our new Ultraviolet disinfection system.  Recent water quality testing showed that we can now drink the water straight from the tap!  

     

Article from Eric at MereOrthodoxy

 Hi everyone.  I recently had an article published at MereOrthodoxy.com on the subject of Lamenting and Rejoicing at the Same Time.  I'm glad for a chance to share it in that venue, and here is the link for any of you that would also like to read it.

(image just a screen shot.  Click the link above to read)

When I'm not treating children...

by Jenn

Before moving to Burundi, I would say I had a black thumb and knew nothing about animals. If I had read a book in the past 10 years, it was likely about the developing fetus, NOT how animals develop.  

Three and a half years after moving here though, I can say that I have become a budding gardener, and have successfully watched the process of chicks hatching.  I phrase the latter that way, because it's truly magnificent how LITTLE I contributed to the process of chicks hatching.  

Maybe not all of you know, but about a year ago, just after arriving back from home assignment, I had a hen house constructed and brought home some cute 3-month old pullets. 

Eight to be excact. But in a few short weeks, we realized that in fact we had one cockrel. 

Two terms I learned at that time : pullet - a young female chicken who will grow into a hen. Cockrel - a young male chicken who will grow into a rooster.  The girls named him Handsome.  

Sadly, he became too lound and so he .... well, let's just say he's not around anymore...

The seven ladies grew like weeds and started producing eggs around 5-6 months of age. Which is pretty typical. Good job ladies. We have been enjoying lovely eggs for the past year. They produce 4-7 eggs/day. 

One day a few months ago, I noticed one hen having some odd behavior. She was not leaving the coop and sat on all of the eggs all of the time. She would leave the coop maybe once to eat, drink, and poop, but otherwise didn't move much. I wondered if she was getting sick, but then a lightbulb went of... she's brooding! 

Another term I learned - brooding - when a hen spends most of her days and nights sitting on the eggs in order that they may hatch. She wanted to be a momma. 

This is great IF you have fertilized eggs and want chicks. I didn't think I had time or bandwith at the time so I tried to break her habits. Note, she does not lay eggs when she's broody, so we weren't getting any from her during this time. I gently took her off the nest multiple times a day and encouraged her to NOT brood, but to no avail.  

Enter Issac. 

A teammate was gifted a rooster one sunny Friday afternoon and he asked if he could "store" his rooster in our coop until....well, let's just say the plan was to have him go to the same place Handsome went...

I said sure, and another lightbulb went off.  CHICKS!

I won't go into details, but suffice it to say all of the ladies produced fertilized eggs for at least 10 days, some for two weeks! 

Another thing I learned - the momma hen actually doesn't produce fertilized eggs. Well, maybe she was fertilized, but she wasn't producing egs... therefore no fertilized eggs.  She was already in broody mode, so her little hen body had stopped producing eggs when she went into "I want to be a momma" mode.  

How do I know they were fertile? Well, I did a lot of reading (because - see first paragraph - I had NO idea what I was doing) and realized you could look in the yolk for a white dot with concentric circles starting to form. So that's what I did.  Here's an example of one of the eggs I cracked 24 hours after Issac's arrival.

You'll see a tiny white dot - the egg is fertilized!

Since the ladies produce tons of eggs, and the momma can't sit on dozens, I marked some with a sharpie and let her continue to sit on those, while collecting and eathing the others that the other ladies were laying. 

Something else I learned, you CAN eat fertilized eggs.  They don't develop unless they are incubated. 

I also read about candeling - an essential step to see if your eggs are developing, or if she is just sitting on eggs that will become rotten. I didn't get a good picture of me doing it, but here's what candeling an egg each step of the way should look like.

Also - clearly I need more experience in this... see later in the story. 

Twenty-one days went by (that's how long... or SHORT it takes for a chick to go from the picture you see above to a fully developed chick that can stand, eat, and drink just after it hatches! God's design is amazing!)

I let the momma incubate her eggs in the coop becuase I really didn't have another place to put her. Not ideal, but it worked. 

The first chick "pipped" (made the first crack in the shell) one morning but when I came back it looked like the other ladies had started to peck at the chick in its egg. Not good - they will attack it and kill it. So I moved the momma, the hatching chick (who I didn't think was going to make it) into a bin and put the bin in our half bathroom with a space heater.  Well, the chick made it! And was named Cookie. Then another one hatched the day after!  They huddled under their momma and they were SO cute. 

The first 5 chicks that hatched did really well and are still growing! Two other chicks hatched but they didn't survive, and three of the eggs didn't develop (hence my need for improving my candling skills.  Despite the brief sadness of the two not surviving, we were thankful for the 5 that made it! 

Once there were no more eggs to sit on, the momma hen was getting quite restless, standing up in the bin and trying to get out.  So we moved them to the back portch.  That lasted for a few days until they all started escaping the enclosure.  

We decided to put the momma back outside where she could eat, drink, poop, scratch, and move about on her own terms. 

And the chicks went back into the bin in the bathroom with the space heater. 

They too started to get a little restless, and so we created a little enclosure inside the chicken run so that they could have their own outside space.  Not pictured, but we created a little slatted door/gate so that they coudl get in and out of this little corner but the bit ladies could not. 

They are super happy outisde! 

They still come in at night and sleep in the bin.  

Amelia, Madelyn, and Mark have LOVED this experience, and I have learned a lot on the way. And let's be honest, I've loved it too! 

Touch base in a few weeks... maybe then we will know if they are cockrels or pullets! (We're hoping for 5 girls!) 

KHA Graduation - So Long, Farewell

2023 Kibuye Hope Academy Graduates

This weekend marked another milestone for our lives here at Kibuye. We graduated another class of 8th graders from Kibuye Hope Academy. Our graduates were Liam Banks and Maggie McLaughlin. This year was unique because it was the first time we graduated a student who has done every year of her education at KHA. Maggie was a kindergartener the first year KHA officially began. Liam’s first year at Kibuye was his 2nd grade year. And here we are, many years later with two 14 year olds! For both the McLaughlins and us (the Banks), these are our oldest and first to graduate Middle School. 

Our whole team gathered together and the school was transformed into the stage for the afternoon. Liam and Maggie entered to Pomp & Circumstance wearing graduation caps homemade from cardboard and local Burundian fabric. 

Glory Guy, our Middle School teacher, served as Master of Ceremonies and dazzled us all with a colorful speech walking the graduates through all the books they have read in Middle School and the life lessons gleaned from each book.

The four Middle Schoolers (Liam, Maggie, Ben McLaughlin, and Zeke Banks) treated us to a performance of Do Re Mi from the musical, The Sound of Music. I've been their music teacher for 7 years, and have really enjoyed seeing them grow as musicians and singers. Great job guys – you nailed it!

Both Liam and Maggie gave speeches that were thoughtful, insightful, and even funny. The younger generation of Kibuye kids has been blessed by these two older ones who have taught them, played with them, and set a good example as diligent students. 

Our three teachers – Glory, Erica, and Jenny – joined together to present them with their diplomas and be the first to congratulate them. Liam and Maggie were excited to officially move the tassel and be declared graduates of Kibuye Hope Academy!

One advantage to our life here at Kibuye is the closeness of our teammates. In many ways we function as a very big family. The kids even call the adults Aunt & Uncle. So it was very fitting for the dads to join the graduates and pray a blessing over them on behalf of all the Aunts and Uncle on the team.

May the Lord bless you and keep you...

After a big thank you to our wonderful teachers, the entire school gave an amazing performance of So Long, Farewell. It was a perfect way to end our graduation, saying goodbye to our teachers who have finished their term with Serge, and goodbye to Liam and Maggie as they will go off to RVA in Kenya next year. 

We know the Lord has great things for KHA next year and the years to come. But for now, it was nice to pause and praise Him for this year, this season, these teachers, and these kids. 

Aunt Eunice bringing some California flair to the event!

A trip down memory lane with photos of these kids through the years