A Tale of Tele-Education: Mouth Matters

(by Ted John)

A big part of our ministry in Burundi is medical education, a topic which has been previously written about and most recently here. A couple years ago, there was a major change in re-structuring the medical school curriculum such that med students would do nearly all of their clinical rotations at our hospital (whereas it was only about a third of their clinical time with us in previous years). Awesome! This continuity and increased face time had many positive implications, including more opportunities for building relationships at a deeper level and for medical education and discipleship. 

Not surprisingly, this transition also came with some added responsibilities, including the organization and teaching of more coursework, much of which was previously taught elsewhere by others. Thus, there has been increased time and effort putting together resources, creating PowerPoint presentations, and organizing courses to fulfill the med school curricular requirements (especially if it’s the first time a course is being taught at Kibuye).

It makes sense that the pediatric course would be taught by pediatricians, and we are thankful that the knowledge and expertise was contained within teammates on site. It’s no small task to organize a 75-hour pediatric course! But what about the courses for which we don’t have the specialties represented here at Kibuye? For example, Cardiology, Psychiatry, ENT, PM&R, Dentistry, Ortho, and the list goes on. Well, nowadays with modern technology, it’s possible to do this creatively in the truest sense of tele-education and distance learning using a combination of audio and/or video recordings and live video conferencing, often in both English and French.

I am certain each course has its own story behind it, but I will share a little about my personal experience of how I (a general surgeon) ended up organizing a 2-week, 15-hour dental course (“cours de stomatologie” in French), implemented and completed in December 2021.

Med student courses are usually taught in the hospital chapel

Back in August 2021, not long after I returned to Kibuye, I remember having a conversation with one of our teammates about how the dental course had been postponed due to the challenge of finding instructors. Then I thought about my dentist friends in the U.S., many of whom I had befriended when I was a med student at the University of Michigan (which also has an excellent dental school!). So, I contacted some of these friends (big thanks to Amy, Dave, and Ben), who all expressed interest in being part of the development of this course.

What went into putting this course together? In a nutshell, these were the major steps that occurred during the subsequent 3 months (in mostly chronological order):

•         Determine educational content based on provided learning objectives and context
•         Organize the material into 1-hour lecture blocks
•         Divide work amongst presenters
•         Create PowerPoint presentations
•         Translate English slides into French, if applicable
•         Pre-record each presentation as a video, in French if possible
•         Write quiz/test questions for each lecture (and translate into French)
•         Coordinate selected lectures over live video conferencing (Zoom) over different time zones
•         Proctor, grade, and submit results of quizzes and final exam

Dr. Ben Kang giving a lecture on inflammatory diseases of dentistry over live video conferencing (Zoom)

Things didn’t always go according to plan due to unforeseen circumstances, and an element of flexibility was required. For example, on the first day of the course, we had planned for a live Zoom lecture, but earlier that same day, lightning struck the hospital and damaged the Wi-Fi equipment. As a result, I had to re-arrange the schedule and show a pre-recorded lecture instead. It also happened that there was a concurrent anesthesia course, so the schedule had to be adjusted a couple times such that there was no overlap.

Dr. Dave Chiu giving a lecture on the temporo-mandibular joint

In the end, the content was delivered, even if not in the originally planned order, and all the students passed the course successfully (which I’ll take as a surrogate measure that some learning has taken place!). I even recognized the top performing students with a new toothbrush each.

I also gained some cultural insights about teeth and dental care in Burundi. For example, have you ever thought about what people in other countries and cultures do with their baby teeth? Most Burundians apparently throw it under their legs (described to me in the manner of hiking a football) and say the phrase, “nyamanza tora iryinyo ryawe unsubize ryanje ryiza,” which rougly translates as “a small bird will take your tooth and give you another (permanent tooth) that’s better.”

While I was glad when the course was over, it was definitely meaningful and worthwhile to be able to be part of teaching and equipping these future medical doctors with basic dentistry knowledge. Since it was the first time teaching this course, there was more upfront time and energy invested in content creation. But in future years, we should be able to use the same didactic content, and focus our attention instead on how to make the course better.

Group photo with all 46 students at the end of the course

What’s next? Well, there's actually a 45-hour "synthesis" course already underway, which is being coordinated by Eric and taught by many of our teammates. After that, I'll be coordinating a new 45-hour trauma / orthopedic course, currently being prepared for a tentative start date in mid-February. It’ll be a bigger undertaking than the dental course, but thankfully we have a French textbook as a reference and 5 surgeons involved (one of whom is an orthopedic surgeon who will be visiting Burundi at that time).

Looking back at my own med school days, I can say that I took the courses and the quality of education for granted. Funny how God is using my role as an educator now to give me a new perspective and deeper appreciation for anyone and everyone involved in medical education.

A Glimpse Into Daily Life

(by Michelle Wendler)

I've been doing a weekly interview with one of the local women to find out what daily life is like here in rural Africa. Here are some things I've learned.

Sleeping: 

Most villagers have a wooden bed frame with a mat made of reeds placed on top of it. To make it softer they might put down banana leaves under the mat. The majority have blankets but not the very poor. It's been cold lately...dropping into the low6 60's and even 50's at night. I'm cold on my warm mattress and with my comforter. When I asked how they stay warm at night she said they clutch their clothes around them and are very happy when the sun rises. 

There are no cribs for infants, they co sleep with the parents. The bed is placed against the wall and the baby sleeps between the wall and the mother, with the father on the other side of the mother. The mother will create a barrier between her and the baby so when the baby wets, it doesn't get her wet. 

Eating:

Most people have two plates, one plate for the children to eat off of (at the same time), and another for the parents and very small children. But very poor families will all eat off the same plate. An interesting side note; if your father-in-law visits, the daughter-in-law cannot eat off of the same plate. But his grandson can. And the daughter-in-law is supposed to be quiet in his presence and only speak of things that are important. 

Upper class families will have a table and chairs, but lower income will sit on boxes or small wooden chairs. But poor and upper class will always have at least one chair in case a visitor comes.

The majority of the population here in rural Burundi eat two meals a day. The rich can eat 3x per day, and the very poor, usually only one time per day. Unless you are very wealthy, breakfast is only consumed by small children (under school age) and is usually a small portion of the previous night's dinner that has been set aside and kept overnight in a small container. Refrigeration is unheard of here. Most school age children go to school hungry and eat their first meal at lunch time. 

Beans + one other side (corn, salad, sweet potatoes, potatoes, bananas and rice...(rice if you are rich) is what is eaten for lunch and dinner 98% of the time. Meat will be eaten sometimes only 2-3x per year at Christmas, New Years and maybe Easter. 

Water is the main source of hydration, but it's not purified. Many kids have stomach and digestive issues because of this.

Most people can't afford things like eggs, milk, and other fruits and veggies because they cost too much. Sometimes 11 people can live under the same small roof...kids, relatives, workers etc and it would be expected to give everyone the same portion. 1 egg costs around 500 fbu and the daily wage is around 3000 for those who have a job. Many are just farmers who live off what they grow.  If you have many mouths to feed, an egg by itself isn't going to satisfy but it might break the bank. I asked about the possibility of people raising chickens for their own eggs, but that would require a chicken coup, food for the chickens, and medicine. All that on the front end...when most people can't afford the next meal. The woman I was interviewing said that if someone is given a rooster which costs around 15,000 fbu, they would most likely take it to the market to buy a lot of "filler" type food instead of having one small meal of meat. 

Hygiene:

No showers or baths around here. Sponge baths. Not everyone can afford soap. After you clean yourself you rub on palm oil. The wealthy use margarine (Blue Band) or lotion. I have been using their version of margarine (Blue Band) and my skin feels amazing. 

Marriage:

If a couple wants to get married, their family / church / neighbors / elders traditionally ask them: 

1) Do you have a blanket?

2) Do you have a pot?

3) Do you have a bed?

These three items are considered necessary for starting a marriage.

Child care:

At age 5, the kids start to carry infants (2 months and beyond) on their backs. If the parents are too poor to afford a child care helper, then the kids stay home from school to help watch the younger siblings so the parents can work in the fields.

Status:

And lastly, a sign of wealth here are shoes / flip-flops / sandals. Those who own shoes are considered upperclass. 

I hope to do more of these interviews in the future and will share what I learn about the lives of our Burundian brothers and sisters. 

 

COTW: Tuberculeus Adenitis, PEPFAR and Education

 (from Eric)

Over the weekend, some of us were talking about the recent lack of medical blogs.  This is largely driven by the fact that, when you've done something daily for several years, you start to think "what is there to talk about?  It's just everyday normal stuff."  Not only is our daily work not-normal for the majority of this blog readership, but we in the daily grind need fresh ways to "see" what is around us, particularly when it proclaims goodness and hope, though the white noise of the everyday threatens to drown it out.

So, in that spirit, our first Case of the Week (COTW) in the last 11 months.  =)

My first morning back on Internal Medicine last week, my students guided me to the bedside of a new patient.  A young man in his early thirties, he had swelling on both sides of his neck that was quite painful, in addition to multiple weeks of fever and poor appetite.  Just before coming to the hospital, he had gone to a local nurse-run health center, which had tested him for HIV, which was positive.

The students wanted to know if I knew what was causing this neck swelling.  Yes.  Yes, I do.

Note the swelling on the side of the neck and the skin breakdown where it had been oozing.

Painful swelling of the lymph nodes on either side of the neck muscles in an untreated HIV+ patient with a couple weeks of fever and poor appetite in Burundi is about 99% certain to be Tuberculosis.  In fact, he even had the classic matted appearance and evidence of past oozing fistulizations which are typical of TB. We put him on TB medications (which are free) and contacted our HIV nurses to come and get him into the system to start ARVs in the next couple weeks (which will be free).  He slowly started to feel stronger and we let him go home yesterday, but he'll return in a week to start HIV medications.

***

For me, this guy is about as simple as my cases get, but I peel back the veneer of a To-Do list checkbox and find a number of things to celebrate:

1. THE PATIENT: This young man is probably going to do great.  Yet without a proper diagnosis and the medications for his problems,  he would likely die, from his TB alone, even more so from HIV.  His TB is curable.  With proper treatment, he can live a long and healthy life with his HIV.  It is a changed life, and I got to be a part of it.

2. PEPFAR: I don't think that most Americans are aware that the US has spearheaded the largest global health effort against a single disease (until Covid) via PEPFAR, which is the US President's Emergency Plan for AIDS Relief.  It was started in 2003 by George W. Bush, and has continued since then.  This fund has provided care in over 50 countries and is estimated to have saved over 20 million lives, largely in Sub-Saharan Africa.  The US is not extraordinary in regards to foreign aid compared to other rich countries, but PEPFAR is a great example of something America has done that has truly changed millions of lives.  

15 years ago, medicines for HIV would likely have been unavailable for this young man.  Around 10 years ago, it was found that, if someone is well treated with ARVs for their HIV, their ability to spread it to someone else drops dramatically, which has caused policy makers to try to get everyone with HIV on treatment, since it was prevention as well as treatment.  Now, though considerable challenges exist in implementation, the difference feels palpable to me.  Yes, this guy came in with previously undiagnosed HIV, but these cases feel increasingly uncommon.  This is a very good thing.

3. EDUCATION: I don't know the mental image of the above story that automatically comes to you.  But if it didn't include the white coats of at least 15 trainees or various stripes (medical, nursing, allied health), then it wasn't accurate.  All of this was an opportunity for these growing professionals to see a problem that they should be able to correctly diagnose and manage the next time.  HAU currently has hundreds and hundreds of graduates that trained at Kibuye that are now working all over the country and the region, and this was another small moment to help them to do that future work better.

First Term Tidbits

(reflections from Jenn and Michael Harling, penned by Jenn)

Kibuye team sending us off in prayer. 

We left Burundi for home assignment one month ago. We were with family throughout the holidays and have settled in Greenville, SC where we will spend the next five months. In addition to spending time with family, we attended a debrief at SIM* afterwhich, thanks to grandparents, Micahel and I were able to spend 24 hours alone to have a "mommy daddy date."  While we couldn't discuss everything that was going through our minds, a subject that we both had been mulling over was the fact that we agree that we not only "survived" our first term, but feel like we "thrived."  How did this happen? Short answer, God's grace and mercy.  Long answer, below:

At SIM home office for debrief

1. While the Holy Spirit continues to do work in our lives in identifying sin and refining us daily, a huge lession we learned during our transition from passport country to our host countries (France and Burundi) is this: It is essential to have our identity firmly established in Christ, not work. Before our international move, Michael grappled with this extensively, as he described in this wonderfully-written newsletter.  I highly recommend you click the link and at least skim it. (Bonus, see a picture of little Amelia and Madelyn at the bottom). Michael's difficulty with this and his idolization of work led him to be an irritable and grumpy person a lot of the time (HIS words!) and blinded him from the fact that indeed his identity was not in the right place. We aren't perfect people - God is still doing wonderful work on our hearts, but we are immensely grateful that the Holy Spirit made this evident before we even left Greenville.  

The way I struggled with this issue is that when we arrived to Kibuye, I wanted everyone to think I was super smart. The problem was, I wasn't super smart in many things including malaria diagnosis and treatment, all-things-malnutrition, and many other things not to mention performing in an underdeveloped setting. I'm thankful that this desire to have a good outward identity coincided with our journey through the Mentored Sonship Program (see number 3).  By the work of the Holy Spirit, I saw that I was too concerned about what others thought of me and not fully accepting of my acceptance and identity as a daughter of Christ.  We are sons and daughters of Christ primarily, put on earth to do His will.

2. A second key thing is that, thanks to our great pre-field training we received at SIM and MissionPrep, we were strongly encouraged to walk into our host country with a learning attitude.  This helped us to determine quickly that we needed to have discernment of what is controlable and what is uncontrolable in our context.  Of course there's the caveat that in reality nothing is in our control ultimately.  So I use the word "control" here to mean the things which we can affect due to our efforts. I'll give an example.  There are no ventilators in our hospital except for the anesthesia machines used in the OR. If a patient were to need ventilatory support, it's up to someone to manually compress the bag of air that is connected to the tube going down the trachea to ventilate the lungs. Would it be physically possible for Michael or me to spend all night at the hospital bagging the patient so that hopefully the lungs/body would improve enough so that we could stop in the morning. Yes, we are physically capable of staying awake more than 24 hours. But that's not sustainable by any means. So in that case, it's truly uncontrollable. And as miserably hard as that is to accept, we have to.   

3. Mentored Sonship Program - this is a program that is mandatory for all those who are going to serve with Serge. It is "a one-on-one mentoring program designed to help you truly live out the power of the gospel in your daily life."  We went through this program during our first term, it was truly transformative and it's timing was essential for us. You can learn more about it here. 

4. Another huge thing we found extremely helpful and key in many interpersonal relationships is that you need to let the small things go.  (That's not to say there isn't a place for conflict, there most certainly is!  In fact one of the Sonship lessions talks about peace making (healthy conflict) vs. peace keeping (unhealthy avoidance).). But, for example, is there something that's done a little different than you would do it but in the light of eternity has no weight? It's probably ok to let it go. This is key for living in a group of ex-pats who have to live together in a little community, see each other and interact together every day, and depend on each other every domain of life all while living under the stress of cross-cultural living, cross-cultural working, and living thousands of miles from friends and family. Grace is huge; Grace is necessary; sometimes it's best to let the small things go. 

5. Happy wife, happy life. Jk. But kinda not.  Being on the same page in marriage is SO important.  By the grace of God, Michael and I have a strong passionate calling to do what we do where we do it. I won't dwell on this issue, but it's something we've seen play out in a great way in our cross-cultural lives. 

___

I'll say this again, we aren't perfect! Did we have struggles during our first term? Yes. Was it hard to be so far from family and friends in the United States? Yes.  Did we feel a need for this home assignment and some time away from the field? Absolutely.  But by God's grace, we had an excellent first term and we are so grateful for that. We are thankful for this home assignment but also are excited to return to Kibuye to continue the work there. 

*If some weren't aware, we are also using this HA to transition from SIM to Serge.

Merry (late) Christmas from the Harlings ◡̈ 

Homecoming

 (from Eric)

We arrive in Bujumbura late Sunday night, crawling to our hotel beds with an intense relief coupled with a wonder at how we have been underestimating the amazing phenomenon of laying down and stretching out your legs to their full length.

Four in the morning.  I'm awake for no reason other than that it is dinner time in the US.  Laying on the bed in the pitch black, I hear the call of a Robin Chat that has no business to be making noise at this hour.  I'm smiling because I had forgotten about the birds.

Six in the morning.  I still haven't fallen back asleep and Rachel and the kids couldn't be woken up by all the Robin Chats in the world, so I decide to sneak outside.  The hotel is on the edge of Lake Tanganyika, and maybe I'll go sit on the beach.

As I walk by the pool, a flock of terns soars overhead, and then a solitary African Kite.  I pass by what I have always thought of as a mango tree, though I've never seen it bear any fruit.  I walk out to the beach and notice that the incredible rise of the lake level (over 2 meters!) that we had been experiencing when we left in June has finally started to recede.

African Kite (from an online image)

The sky is gray in the early morning and so is the water.  The surface on a lake this big is never totally calm, but it's pretty close this morning.  Dotted around in the distance are fisherman who have spent the night on the water, fishing mostly for tiny ndagala that you eat whole after they have been dried or fried.  The boats are spread out in every direction, usually in pairs.  I know that soon, they will head into shore.  One of the pair will have an outboard motor and will tow its partner in.

Lake Tanganyika fishermen out on the water (from an earlier visit)

Behind me, a pair of security guards are next to a sleeping dog and chatting indistinctly in Kirundi.  The words are too low for me to try and understand, but the familiar cadence falls on my ears from the first time in over six months.

Closer in, about a hundred feet offshore and another hundred to my left, I see a dark silhouette above the water's surface and realize with a start that this is what I was hoping to find.  A hippo is silently making its way down the shoreline in my direction.  He ducks underwater but surfaces again thirty feet closer.  I'm sitting on a small rock wall that encloses a little cabana where hotel guests can share a drink.  When the hippo is directly in front of me, an incredibly long ribbon of dark lake birds rises from the water and flies over it in a huge V that has devolved into a zigzag.  

The only picture I actually took this morning

I suddenly realize the hippo has turned and is heading quite quickly towards me.  He's still a ways out, but remembering the nearby sign which correctly describes the hippo as "l'animal le plus dangereux en Afrique", I decide to swing around and watch from the other side of the rock wall.  As I lean forward on the wall from my new vantage point, I feel a quite sharp pain in my right palm.  I look down to confirm what I had suspected, that I had accidentally put my hand down on a intozi, or pincher ant.  I wince and shake out my hand.  The hippo stops 25 feet from the shoreline, changes direction, and continues down lakeshore toward the Congo border.

I realize that the restaurant is probably open, and decide to go and find a cup of coffee.

***

So many things that I have slowly come to know well.  So many that remain mysterious.  Calm.  Routine. Surprise.  Wonder.  Beauty.  Majesty.  Pain.  Wild?  Yes, but it's such a familiar wild.

It's good to be back in Burundi.

That I might sing Your praise and not be silent (Ps 30:12)

By Julie Banks

Psalm 102:5

Sing to Him, sing praises to Him; tell of all his wondrous works!

Adding music to any gathering automatically adds joy, doesn't it?  It's hardly possible to gather very long with Burundians without a song breaking out.  I guess that culture has rubbed off on us a bit from the youngest to the oldest.  Well, here is a small snapshot of the past month in Kibuye as we have celebrated the Holiday season in music!

A few weeks ago I was blessed to join the worship team at our local church and lead worship for a Sunday morning service. What a great group of dedicated worshippers. 

We celebrated Thanksgiving together with people from 6 different countries and languages.  Fortunately for us a missionary that serves in a different part of Burundi who plays the violin was in town, so we formed a girls trio with Ruth on the violin and Glory on guitar. It’s so rare for us to hear very many different instruments here.  Now I really understand why the Psalms say to praise Him on stringed instruments!  It’s so beautiful! 

This same violinist, Ruth, had an impromptu worship session with our professional pianist, Michelle.

One sunny Saturday afternoon we kicked off Advent with carols together as a team at the Wendler house.  Michelle played piano as we gathered around hymnals and little ones played on the jingle bells.

When several Medical students were struck with Covid, I went to their dorm and stood outside the windows worshiping and praying in Kirundi, French and English.

Our family quartet went caroling door-to-door delivering Christmas treats with Christmas cheer.

Christmas Eve was a wonderful celebration together with Anna and Jason Fader leading us in Carols of worship while the kids stood as a living nativity complete with the Little Drummer Boy.

Liam (12) was able to share his gift of vocal harmonizing in a duet with Mom.  I admit I got a little misty-eyed when we sang “…mother and child…”  I remembered being pregnant with him over the Christmas holiday and appreciating the miracle of the birth of my own son.  And now he is 12, leaving his childhood and beginning his journey to becoming a young man…sigh… but I digress.  Back to Christmas!

Zeke (10) sent us on our Merry way with a harmonica rendition of O Tannenbaum.

Up next is the welcoming of the New Year with our local church.  They are having a big concert and celebration with a couple of us participating in the music.  If you are in the Kibuye area January 1, join us as celebrate what God has done for us in 2021 and as we welcome 2022 and look forward to what He will do this year.

Psalm 126:1-3

When the Lord restored the fortunes of Zion, we were like those who dreamed.  Our mouths were filled with laughter, our tongues with songs of joy.  Then it was said among the nations, “The Lord has done great things for them.”  The Lord has done great things for us, and we are filled with joy.”

Blessing Those Who Bless Us

 By Julie Banks

We love this time of year for many reasons at Kibuye!  One of the things we love doing every Christmas Season is gathering together all the staff that work for the missionaries and telling them how much we love them and showering them with gifts.  These wonderful people work so hard for us, and with us, every day.  They cut our grass, (with a machete!) wash our sheets, (with a bucket!) make us tortilla chips (starting from flour!), and soothe our crying toddlers (with their own baby tied onto their back). 

We visit their homes and try to get to know their family, do everything we can to ensure that their children can attend school, rejoice with them when a child brings home a good report card, celebrate their new babies, and cry with them when a baby doesn’t make it.  These wonderful people fill our homes and compound with laughter, singing, and enable us to go about what God has called us to do, while also maintaining a house of peace for ourselves and for our families.  Thank YOU – our readers and supporters – for praying for our community and giving generously to the work that goes on here.  Your abundance gives us the opportunity to bless those who bless us, in Jesus’ name.

Shout out to Heather and Eunice who organize all of our staff!  They put in countless hours of administrative work, conversation in Kirundi, and provide emotional support for us and for our workers.  Thank you, Heather and Eunice!

Cooking in (Burundi) Style

The hardest part about moving here was getting used to cooking. At first, I had no idea how to clean my vegetables, where to find oil and spices, if I should use filtered or tap water, how to make simple things like beans, and how to find variety in what I could cook. The longer I have been here, however, the more I appreciate the adventure, creativity, complexity, and enjoyment that are found in the simple task of making a meal. Because literally every dish I make comes with a side of adventure, that is a pretty good place to start.
One evening, I was making a very simple quinoa salad with lemon, sautéed green peppers, roasted potatoes, raw tomatoes and olives, with a honey mustard dressing. Simple right? I started cooking at around 5:30 pm, you know, to get a head start. I turn on our amazing and electric oven to roast the potatoes. Boom, the power goes out. Shoot. I text a neighbor to see if I can use their gas oven and they graciously oblige. I run to put the potatoes in to roast, then start getting ready to go to an empty house to use the gas stove for the rest of the meal. Boom! Power is back on, what a nice surprise. Thankfully, I get through all the stovetop cooking and then...bam, no power again! Where's my flashlight? No idea, its totally dark, and time for me to check on my potatoes. I finally find my light and head outside for the darkest 10 second run of my life. I make it to the house, the lights come back on, I check the potatoes, and the lights turned back off. They need a few more minutes, so I race home quickly to avoid the darkness. As I am cleaning the kitchen and setting the table, the power comes back on again, and the wind starts to howl outside which can only mean one thing, rain. I'm not talking a Seattle type of mist your face rain, I'm talking a downpour, soak your potatoes in three seconds kind of rain. I run back over, get my well enough cooked potatoes and run home JUST as the rain starts to pour, and quietly thank the Lord for saving my potatoes.
And now for the main courses of complexity, creativity, and enjoyment.
A good place to start is milk. It comes straight from the milk man and then needs to be boiled. Once that is done, you let it cool and skim off the film th that forms on the top. From there it goes into a jar and into the fridge.

The next day, when you pull it out, there is a layer of cream that has formed on the top. You can see it in the above picture, if you look closely. Some people use this in their coffee, but I scrape this off, and put it in a jar in the freezer to make butter with later. Now, if we drink all our milk that week, great, but if not, it is a great opportunity to make cheese!

The kind of cheese I learned to make here is made with herbs, garlic salt, and red pepper flakes. It is delicious! Homemade cheese and crackers are a special treat and a ready to eat dinner (if you make them ahead of time of course). As I mentioned before, the cream on top of the cooled milk can be stored in the freezer and used later to make butter. It just needs to be put into a blender or food processor and blended until a cloudy liquid separates from the butter! Yummy!

About six months into living here, I switched to a malaria medication that gave me really bad stomach pains (I have since switched back, thank goodness). In my ignorant opinion, the reason it was causing me pain was because it was an antibiotic, and my diet is lacking in probiotics. So, after some research, I learned that the whey left behind in cheese making can be mixed with honey and lemon to make a delicious probiotic lemon soda!

It took some time to ferment, so I figured I would ferment something else along with it. I really love sauerkraut, but of course, I haven't found it here. However, we have tons of cabbage. I tried it and it was delicious!

Because the nearest place to buy bread is 3 hours from my house, my bread making skills have gotten a lot better over the past months. And it's so tasty!

Although you can buy peanut butter here, it is not my favorite. But we can get peanuts! So, I started making my own peanut butter a little while ago, and let me just say, I will never go back, and neither will my roommates.

Now that we have covered some of the basics, there is also the understanding that if there is any fun or special meal I want, I have to make that too from scratch! Pizza?Ravioli? Potato chips? Sushi? Pot Stickers? While I've made all of these, let's just say, we only eat them on special occasions.

Sometimes it can get overwhelming thinking about all that needs to be done in the kitchen around here. But overall, I look forward to the days when I have time to spend in my favorite room in the house.

New Pediatric Building

By Alyssa 

I am so excited to report that our new pediatric building is open!!!! 130 beds, 3 stories tall - all designed and constructed specifically for the children of Burundi! Son Excellence, the President of the Republic of Burundi himself came on November 17 to inaugurate the new building as part of his Caravan of the Torch of Peace. The patients and peds staff are so happy with their beautiful new building, and I love seeing the children sharing meals together in the grassy courtyard or playing in the playroom or just calmly resting and recovering in clean, bright, well-ventilated wards. And no one has to share a bed or sleep on the floor anymore! 

Welcome sign and archway for the President

Meeting the President on the red carpet

Officially opening the pediatric building 

Team docs and engineer with the US Ambassador to Burundi

Hospital playroom 

Neonatology resuscitation and phototherapy 

Patients in the new building

Patients sharing food - meals are always a communal event in Burundian culture. The patients love this grassy area behind the building. 

During my speech here to the hospital staff and community leaders, I mostly talked about our vision for the pediatric service at Kibuye:

Our vision is to welcome children, families, staff, and students to the Kibuye Hope Hospital pediatric service as Jesus welcomes us; to provide competent, compassionate care; and to make the most of every opportunity to train the next generation of healthcare workers. 

I shared Matthew 19:13-15 where Jesus blesses the little children and I talked about the riches of God's compassion in Ephesians 2 and how we likewise want to welcome children and show them compassion. I also talked about my own experience as a pediatric patient at age 10 when I was paralyzed and in an intensive care unit with an illness called Transverse Myelitis. I talked about how I remember the healthcare workers who showed me compassion during my 2 years of recovery as I relearned how to walk. I'm so thankful to God for healing me, but I'm also thankful for how He used that experience in my life to stir my interest in becoming a pediatrician in order to care for other children like me - hopefully with compassion and competence! And finally I talked about the importance of lifelong learning as we all seek to improve in our understanding of medicine and as we teach students and even patients and parents on the three pediatric sub-services of neonatology, inpatient malnutrition, and general pediatrics. 

It's been a long journey in coming to the inauguration of this building. Four years ago, the fundraising process began with this video and blog post. Watch the short video for great footage of what the peds service looked like before! 

Ultimately over 100 people gave generously to enable this project to go forward. Because of their generosity, we were actually able to adapt the plans to include a third level so that we would have space for all the pediatric patients including neonatology. The nonprofit eMi sent multiple teams of engineers, architects, and others to design and oversee construction. We're especially thankful for Andy Bradshaw and Mathieu Lembelembe who joined our team for many months to oversee this enormous project - the first three-story building at Kibuye. 

eMi design team with hospital staff on the building site

Video of early construction

Pediatric staff on the ground floor in the middle of the construction process 

Andy Bradshaw and Mathieu Lembelembe with Serge Kibuye team touring the building before the roof was on 

Team touring the top floor near the end of construction 

So thankful for all these construction workers! 

And now the patients are all in the new building! Praise God from whom all blessings flow! 

Two happy pediatricians!