My Pain Obsession

(by Greg)

It is hard for me to watch people suffering in physical pain.  That is not to say that it is easy for others.  But as an anesthesiologist, part of our work is to control pain, before, during and after surgery.  There are even “pain specialists” now in the US and other countries, anesthesiologists who go on to do further sub-speciality training in pain management.  Unfortunately, in most hospitals in low and middle income countries, pain, and especially post-op pain, is often ignored.  Most patients with fractured legs or perforated intestines, receive Tylenol, and nothing more.

There are a multitude of barriers to providing people with effective pain control at Kibuye.  For one thing, our patients rarely complain of pain.  Africans in general are extremely stoic.  On top of this, our physicians are swamped with patients, and so pain evaluation and treatment takes a back seat to things like fluids and oxygen and antibiotics.  And I understand all this.  But last fall, I decided that perhaps the Lord was calling ME to try to tackle this problem.  And so I started with the advice of Atul Gawande, in his book Better, who suggests that one of the steps in becoming a “better” physician is to mesure something … anything.  I found two eager medical students who were willing to spend an hour every day for two months, measuring pain scores and vital signs on all of our post-operative patients.  I was grateful to have found a facial pain scale that had been translated into Kinyarwanda, and so could be easily understood by our patients who speak Kirundi.

At the end of this 2 month period, I began to do pain rounds everyday with my students, implementing the World Health Organization 3 level pain scale to guide our treatment,  and we continued collecting data.  This data will now provide the material for the theses presentations of 4 of our medical students.  But, what brings me the most joy is that we have been able to prove that providing adequate pain control is possible even in a rural African hospital.

Now I am not one to celebrate victories, much to my shame.  And while this all sounds good, on a daily basis I am much more prone to melancholy, frustration that more cannot be done, worry that when I leave for home assignment all of this will come to a halt and wishing I could find a way to put a sustainable system in place to continue this project, which admittedly has become a bit of an obsession for me.

Despite my negative attitude, one evening while at dinner, Jesh sent me a photo.  It was of one of the medical students rotating on his surgery service. She was using her phone to show the above mentioned pain scale to a patient.  Now this was a student who was not involved in this pain project and who had not yet rotated on my service.  But she had heard from others about what we were doing and she took it upon herself to find a copy of this pain scale and start evaluating the pain level of her patients.  I am so grateful to Jesh for taking the time to send me this photo, because it was a reminder that God is often doing things that I am completely unaware of.  I am completely insufficient for this work.  But His grace is made perfect in my weakness, and He is continuing to bring transformation, beyond what we are capable of, for His glory and for His love of people who are suffering.  Please pray that this work will continue, even in my absence, and pray for our patients.  Please pray for me to have opportunities to share this work with others.  I would love for other hospitals around Burundi and around Africa to invest in this work.  But I am confident that God will continue this work, with or without me.


Picture Post

By Alyssa

Enjoy these pictures some recent visitors took that hopefully give you an idea of life at Kibuye these days!

 Tea fields
 Construction on the new pediatric ward

 Rachel doing a C-section
 John operating
 Nursing students
 Eric teaching

 Dr. Alliance
 OB team

 Kibuye Hope Academy
 Local primary school
 Kids teaching kids - love it! 
 Beautiful Burundi
The above pictures are all courtesy of Jenni Keiter who works with eMi (Engineering Ministries International)

The below pics were taken by Scott Myhre. We had such an encouraging visit with our Area Directors Scott and Jennifer and are so thankful for their leadership and wisdom over the years!
 Surgery rounds with Ted

 Amazingly this little girl went home today after 98 days in the hospital! This pic was taken a few weeks ago. 

 Kayla teaching the fourth graders at KHA
 Malnutrition program

Twins who are thriving with their happy mother

And finally this last picture was taken just a few days ago by Dr. Alliance's brother as we celebrated Keren's first birthday. We're so happy to have Burundian families living here at Kibuye with us!


I am a Child of God

(from Eric)

I find myself prone to a lot of ups and downs.  Not in a worrisome way, but it is still troubling.  If I'm at the hospital and my patients are all doing well, then I feel great joy at my life and who I am.  On the other hand, if there is a run of bad outcomes, I can feel quite down.  Then, if I go and have a good conversation with a teammate, I can feel great.  A little while later, someone comes to me with a new problem that wasn't on my radar, and I feel like a failure.  I try to shake it off and remind myself of the bigger picture - that there will always be some problems and that there are good things as well.  And that works.  Sort of.

Up and down.  Up and down.  Sometimes quite rapidly, actually.  I feel free sharing about it because 1) it's undeniably true, and 2) I'm pretty convinced that I'm not alone in this.

What's going on inside of me?  I believe it's a question of where I'm rooting my identity and my worth.  My ups and downs are telling me that I have founded my identity on what I do - on my successes and failures.  Since my life is inevitably a mix of successes and failures, my perception of self-value rises and falls like the tides.  To the extent that my heart embraces the Christian truth that my identity is rooted in the unchanging grace of God, that he has loved me and adopted me as his son for no other reason than his unmerited love, my sense of value finds a firm foundation.

So, my ups and downs mean that I've put my faith in the wrong place, namely in myself.  I know this, and what's more, I've known it for a long time.  So why is it still a struggle?  I think it's because some deep part of me really wants to earn my own value, and thus I rebel against grace.  I know it's a non-starter, but the battle rages on.  Recognizing my reticence to such amazing love gives me further reason to thank God for the unconditional nature of his acceptance of me.

So, pray for me.  In fact, pray for us all.  Our team is passionate about our work, and so I don't think it's a stretch to say that we are all tempted to place our identity in the wrong place.  We need frequent, even constant reminders that we are God's children by his grace.

There is a popular church worship song these days which I have enjoyed on this theme.  A couple of weeks ago in our local French service, Dr. Alliance's wife Cynthia led us in singing this song.  The power at the church was out at the time (but not the hospital!), so I got to enjoy it a cappella with a single drum made out of an ancient 50-gallon shipping drum with a cowhide over it.  Enjoy.


Ultimate Community

by Stephanie 

Sundays, I think they’re pretty great. Church, time with family, time for long walks and at 3pm comes the pinnacle of the week for many on our teammates: ultimate frisbee. 

I had never played ultimate frisbee before coming to Burundi. And for those of you who have never played, this is the gist: There are two teams and one frisbee. The goal of a team is to pass the frisbee person to person down the field into an end zone to score a point. Once a person catches the frisbee they cannot move from the spot where they are standing, they must pass the frisbee to a teammate. The frisbee can move in any direction. The opposing team tries to block passes and intercept the frisbee. The game is fast moving with a lot of running up and down the field following the frisbee. Making the game a little more challenging is the fact that the field we play on is not exactly even, there are many divots and even a gigantic baptismal hole just beyond one end zone.

To be honest, although the rest of my family plays weekly, I still don’t often play. However, you can find me hanging out on the sidelines, cheering on the players and socializing with the spectators. There are always plenty of spectators! 

One Sunday afternoon I took a long walk with some of the ladies on our team. We crossed the main road and then walked up a series of paths to an area where none of us had been before. After quite a ways a teenager started walking with us and practicing his English. When we asked him to point us back towards Kibuye he led us down tiny paths and back to the main road. Then, he shook our hands and said “Goodbye, see you at 3 for frisbee.” I was shocked. This kid lived pretty far from us, and yet since that day I’ve seen him many times on the sidelines of the field watching the game and eager to practice his English.

I think this story points to the greatest part of Sunday’s ultimate frisbee games, the community it’s brought together. The Burundian doctors and their wives, people who work as guards or making busoma, and students from the local elementary school all join together with our teammates of all ages on the field, eager to play. Another group joins together on the sidelines to chat and cheer them on. There is also usually another group of spectators gathered on the road on rout to or from the hospital and wondering what game is being played.  Frisbee is not a game the Burundians grew up playing, it was introduced to Kibuye by our team and has really taken off. In fact, I’ve recently seen young kids in our community playing frisbee with the lids to oatmeal cans on the dirt paths by their homes. 

For Carlan’s birthday this year he decided to take our ultimate game up a notch and host a tournament.  He even made a trophy for the winners. 

Four teams signed up for the tournament. One of the teams was made up entirely of Burundians, the FC Busoma team. This was the first time that we’d played with one team being just Burundians.  They dominated the field! It was incredible! I was playing for another team and yet I couldn’t help but cheer when they scored because the speed and agility with which they played was astounding. Although we all played hard that day, FC Busoma took home the trophy. Everyone was quite excited about the well deserved win!  


COTW: A Beloved Flower (Guest post from Dan Galat)

(from Eric)

This past week, we hosted a team of orthopedic visitors from Samaritan's Purse.  The two orthopedic surgeons were from Kenya, Drs. Dan and Jomo.  Dan and his family are old friends of our team, and several of us lived across the yard from him back in Kenya.  It was a delight to see them, and they made a significant impact in the lives of lots of families, bringing advanced orthopedics care that would be otherwise inaccessible.

One of the nice things about visitors is getting to see your own familiar context through the eyes of someone else.  With that in mind, here is Dan's blog about a young man that he operated on, which is a great story in and of itself, but also contains some of his glimpses of Kibuye.

(and just for kicks, an ancient blog from 2010 about John and Jason going inter tube rafting in Kenya with Dan's son.  Dan enjoyed reminiscing about this story when he presented last week at Grand Rounds.)


Pi Day

by Jess Cropsey

Our entertainment options are more limited here (which I actually love) -- play outside, watch a movie, ride a bike, read a book, play a game, do an arts/craft project, ...  There are no museums, playgrounds, libraries, shopping malls or amusement/water parks.  In fact, many of the moms and kids can go several months without ever getting into a vehicle.  So, we often go big when it comes to small holiday celebrations.  You know, to spice things up a little bit!

As a math educator, I couldn't pass up the opportunity to celebrate Pi Day on Thursday, March 14th (which also happens to be Albert Einstein's birthday).  My 6th-7th grade math class looked at the frequency in which digits appear in Pi.

My 2nd grade class read Sir Cumference and the Dragon of Pi and then completed an exploration activity similar to the one by the young boy (named Radius) in the story.  They discovered that a little more than 3 pipe cleaners (cut to the size of the diameter of the circle) were needed to go all the way around a circle.

Both classes also contributed to a paper chain representing the first 100 digits of Pi, with each color representing a specific digit.

During the lunch hour, we had a school-wide party.  In groups, kids measured the circumference and diameter of some of the yummy food contributed by the moms (pizzas, a giant circle cookie, quiches, pies) as well as circular objects in the room.  


Of course, I made them record their data and do some number crunching to discover the relationship between the circumference and diameter of a variety of circles before they could eat!  Talk about motivation...

Math often gets a bad rap and many people have negative experiences with math class in school, so it was delightful to see all of the kids so excited about Pi Day.  While we were stuffing our faces with "pie", we listened to several students who had worked on memorizing the digits of pi.  The prize-winning student memorized the first 100 digits!  Incredible.

While these kids will never need to know more than the first 3 digits of pi, the lessons learned from setting a goal and seeking to achieve it, exercising their brain power, and wondering at the beauty & order of God's creation (even evident in mathematics) are all life-long.