Legacy and Multiplication: Meeting Dr. Clarisse again after a long time

 (from Eric)

This weekend, I was taking a walk around our housing area with Toby. Standing near where the Harlings live, I saw a Burundian family that I didn't recognize. As I got closer, the dad greeted me in good English with a smile. While wondering who he was, I saw the mom come up behind him, holding an infant in her arms:

"Dr. Eric. It's been a long time. Do you remember me?"

My mind struggled for a moment to put together the different threads when you see a familiar face in an unexpected context. Then the lights came on.

"Dr. Clarisse?"

She smiled.

"Wow. It has been a long time. I thought you were far away."

"Yes, but we are visiting a few months in Burundi, and we wanted to visit Kibuye, because we haven't been here since I was a medical student. It's amazing the work that you have done. It's so transformed. You should be very proud."

"Thank you, Dr. Clarisse. You graduated when? Almost ten years ago?" She nods. "And then you started PAACS surgical training at Galmi Hospital in Niger. You have finished now?" She nods again.

I had heard that Dr. Clarisse had graduated as a general surgeon this past year, and that she and her husband, with a desire to continue to testify to the love of Jesus in a Muslim context, had signed up to be missionaries with SIM and were moving to the north of Togo.

"Dr. Clarisse, I heard that you were moving to Togo now that you are done?"

Her husband nods with a smile. Clarisse says "Yes. You know, for so many in my class, our time at Kibuye with you was so influential in terms of understanding mission, and helping us think differently about medicine."

"Well doctor, I can't tell you how encouraging it is to see you. It encourages us, after so many years, to see how Kibuye has helped people like you to develop a vision of serving the Lord as a doctor."

***

Click here for a great story from Dr. Clarisse via MedSend.

Click here to support Dr. Clarisse and Audace in Togo via SIM-USA.

Dr. Clarisse (center) and classmates at the end of their Kibuye time in 2014

Dr. Clarisse and Audace with their family

New Serge Video: A Day in the Life

Here is a new video from our organization Serge: Grace at the Fray featuring different work being done by them in four different countries, including Burundi.

An Aerial Tour of Kibuye

(by Michelle Wendler)

We are so thankful for all the support we have received over these 10+ years of ministry here at Kibuye. When the team arrived there were only a few hospital buildings and a handful of houses for the staff. But as you can see, much has changed! We hope you enjoy this aerial tour of our hospital and community here at Kibuye. 

A Wedding and a Funeral

 (from Eric)

Saturday, Rachel and I were in the city to attend the wedding of Dr. Jean de Dieu. Jean de Dieu was once our medical student at Kibuye. He graduated about five years ago, and shortly after, he got a job working as a generalist doctor at Kibuye, mostly on the maternity service. We have seen him grow in his ability to take care of patients and lead in many different hospital areas. He does so calmly and wisely, being the kind of doctor that we would both want to work with and also be treated by.

Jean de Dieu and Guillaine: the happy couple

So it was a joy to go to his wedding. We had received the invitation and knew where the church was because of some other weddings a few years ago. We got there in the pouring rain, only to find it empty. We called a friend who informed us that the church of the same name is now in a different part of town, but he would meet us at a known landmark and direct us. So we drove through the rain of Bujumbura, finding our friend and letting him guide us (a bit late) to the ceremony. 

The power was out, but the church was well lit with natural light. Honestly, we couldn't hear much because of the rain on the metal roof sheeting, but we could see a joyful couple become one, so I guess that's all that mattered. Right at the moment of the processional, the power came back on. The timing was perfect in my opinion, since they had planned an awesome dancing-exit/conga-line, and the blasting music served the effect very well indeed.

The elegant reception

It was joyful. Joyful for Dr. Jean de Dieu, and that joy spilled over, even to me. Later, at the reception in another part of town, we saw former students that we hadn't seen in years, church friends that we met when we first came to Burundi, as well as numerous current hospital staff who had found a way to the wedding despite a nationwide fuel shortage.

***

But we had to leave before the very end of the reception. We needed to get back to our hotel. We had a funeral to attend.

I met James Paternoster my first year of medical school where he was working with the Christian medical student group via Intervarsity. He was then the same age that I am now. In James, I found a wise and extremely well-read friend. In his family, Rachel and I found a warm and welcoming home. 

James grew up in Nigeria and Niger, and when we decided to move to Africa with the Cropseys and Faders, James formed part of the three-headed think tank we referred to as the Lyntelnoster. After less than a year in Kenya, we found ourselves organizing a mini-retreat and we needed a speaker. James agreed to come out and visit, and I'm so glad I got to be in Africa with him. 

James on the far left leading our retreat

This past January, James was diagnosed with a glioblastoma in his brain, and after 10 months of very faithfully walking that road, he passed away. I was honored to record a short eulogy and send it for the memorial service, of which Rachel and I now needed to get back to the hotel for the livestream.

We got to see friends on camera, friends singing in praise of God, friends sharing about James and what he taught them. James' eldest son Abraham (and possibly Kibuye's most legendary intern ever) spoke well of his dad. 

It was sad and sorrowful, and...joyful. As the homily said: The opposite of joy is not sorrow, but hopelessness. And James' memorial service was definitely not hopeless.

A good friend shared at the service these words from James just before he passed away: "Joy is deep. The fear comes and goes, and when it comes, it's hard. But joy is deeper and it remains."

***

The juxtaposition of the wedding and the funeral was striking, but not as weird as one might think. James' wife Barb talked about how much "James loved a good funeral", because of how it could be a reflection on a life well-lived, and a good marriage is part of such a life. The joy of the wedding was different than the joy of the funeral. One was happy and the other sorrowful. Strange that we can still somehow know the thing we call joy in the midst of both of them. Humankind is not usually so discerning, but somehow we figured this one out.

James' second son Paul led the congregation is a catechism reading:

Q: What is your only comfort in life AND death? (you can guess where I added the emphasis)

A: That I am not my own, but belong with body and soul, both in life AND in death, to my faithful Savior Jesus Christ

Saturday gave us a chance to reflect on both life and death, and to remember that our comfort in both is one and the same.

A Kids Perspective of Kibuye

 by Michelle Wendler

We hope you enjoy this glimpse into what it's like for a kid living on our team here at Kibuye. Some highlights are: watching locals eat termites, and hiking to the top of Kibuye rock. 

Here's another little clip of Gabrielle and Isaiah discovering a little creature here called the Bagworm Moth Caterpillar. 

This Life

(from Eric)

This life is not an experience I have procured by planning. It is a gift.

This life -- 

with its interpersonal conflicts, 

unexpected medical problems, 

pizza nights at Kibuye, 

the writings of CS Lewis, 

needs to learn how to communicate with teenagers, 

Rachel's steady love, 

the popping sounds of sheet metal roofing expanding in the sun, 

eucalyptus branches in the wind, 

a poor country not prospering the way we wish it would, 

laughter at the stories of Wayside School, 

watching grown-up movies with our kids, 

birdsong a bit louder than distant church music --

This life is not an experience I have planned and executed.

It is a gift unfolding.

Tree vs House

By Jason Fader 

Recently I moved a table onto our front porch for a place to do computer work, since the view of the green grass, tight hedges, and various fruiting trees was simply gorgeous.  I love landscaping here at Kibuye - in fact there are fewer things I enjoy more than listening to a John Piper sermon while mowing the lawn or trimming hedges.  And these few months towards the end of the rainy season here in Burundi provide ample opportunities for these activities. 

Recently I also noticed two trees near our house that were dying, and one was leaning somewhat precariously over our neighbor, Alyssa’s, house.  My brother Caleb called some local loggers to come cut down these trees before they caused significant damage by falling. 

During the felling process, ropes are used for pulling the tree in the desired direction.  Normally this works well, but on the occasion of felling these trees near our house, one of the ropes broke, which caused the enormous tree to fall directly towards our house.  Thankfully there was a robust avocado tree in its path, and the tree fell in the Y of the avocado tree, resulting in half of the tree precariously perching over our house!  After much mental maneuvering, we decided the best plan was to pull the half-felled tree through the Y in the avocado tree until it wasn’t suspended over the house and then chop it up from there.

So we chained the tree trunk to our 2 Landcruisers in parallel and put them in 4-low, and then we created all kinds of carnage to the perfect lawn as the tires dug in and spun and the trunk plowed right through a row of pretty hedges – but thankfully, the plan worked, and the house is still standing. 

Due to the misfallen tree, 3 others were damaged and so we had to take down a total of 5, which certainly detracts from the scenic view that I had loved gazing at from the front porch.  I have recently become interested in grafting avocado and mango trees so, not to worry, I have about 250 avocado and mango trees to choose from to replace these that have come down.

Maybe there is a lesson in all of this which I can mull over while mowing the lawn:  it is wise to deal with felling the dead trees before working on the hedges and grass, not the other way around.  The same seems to be true for landscaping – start with the trees, then bushes, then the flowers, then plant the grass.  I.e. get the big things in life figured out first, and the small things should come after.  Broad brush strokes, then the touch up.  Matthew 6:6 – “Seek first the kingdom of God and his righteousness and all these things will be added to you.”

Crix!!

by Craig

In September 2023, we bought a machine to make our own bricks for construction projects at the hospital. This machine makes bricks by compressing soil mixed with cement, and the combination of compression and cement makes them resistant to damage from weather. These blocks have a special shape which allows them to interlock with all their neighbors above, below, and side to side. This means when building a wall, we don’t need to use any mortar to bind the bricks to each other like we do with the traditional bricks. These bricks go by different names, Interlocking Stabilized Soil Blocks (ISSBs), Compressed Earth Blocks (CEBs), but we have just been calling them Crix (a stylized portmanteau for "Craig’s Bricks"). It's an honor (but not my idea) to have my name integrated,  but it’s not because I deserve any credit for them, I am just the person who is most excited about them.

Our press, when it was still shiny and new, and some of the first Crix it produced

side by side comparison

stock of traditional bricks (top) and Crix (bottom)

There are a few good reasons why I am so excited about Crix, and why you should be too! They save on time, labor, fuel, firewood, sand, and cement; and all of those things lead to saving money. They also look really smart…in my opinion.

These Crix walls look nice, right?!
I know, I know, it looks like the Crix on the right have been mortared in place. But truly, they have been dry-stacked, and we just filled in the chamfer with a tiny bit of mortar to make it look a little nicer.

Traditional, local made bricks in Burundi have served us well for many years, but there are some inherent characteristics that can be improved upon. Those bricks are stabilized by heating them with a large fire, which consumes a lot of firewood – a precious commodity in Burundi. They also are far from uniform in shape, which requires a lot of mortar to make up for the inconsistencies. I measured a typical section of wall and estimated that only 52% of the wall was made of bricks, the other 48% was mortar! Another challenge is that these bricks are made in various locations around Kibuye and need to be transported here. This increases the cost, and is dependent on the availability of diesel, which can not be taken for granted here. Whereas, Crix don't require any firewood, they are uniform, use almost no mortar, and are made right here on site.

But, just because Crix offer an improvement on all of those challenges that are baked into the local bricks, doesn’t mean they are a slam dunk solution. Bringing in a new technology like this can really upset the order that we have worked for a long time to establish. Even though it seems much easier and faster to build with Crix, it is completely different from what the masons are used to doing, so it takes a lot of adjustment for them to get comfortable and fast at laying the Crix. We also didn’t really know if the community or the hospital administration would like Crix, they have a different value system than an American engineer. And, we needed to invest quite a bit of time and money into buying the equipment and learning how to use it well, before we could start to save any time or money in the construction process. Regardless, there will still be some applications where traditional bricks are more appropriate...but now we have options.

So, after buying the machine, we started slow and small in our brick production. We played around with our soil mixture and moisture content, the force required for compression, and the rhythm of many people working together to use the machine safely. We only produced 20-50 bricks per day in those first days. But steadily we improved our production to grow to roughly 200 per day! We also started using the Crix for small, low-risk structures to see how they would perform, how the masons would use them, and how others would like the look of them.

Two days worth of production in the early days

Our very first structure being built... a chicken coop

A privacy wall (left) and some small cookhouses (top and right)

We learned a lot along the way, and eventually found success in our small production and construction. And, everyone involved seemed to like the Crix! So, we started to ramp up the production in order to do bigger projects. 

First, we agreed to pay our workers per brick produced instead of per day of work, which took our daily production from 200 to over 400. But, it became hard to sift our soil fast enough to keep up with the brickmakers, so we built a rotary sifter to speed up that part of the process. We also realized that it was difficult and slow for the masons to cut the Crix, when laying them. So to help with this, we built a slicer to add on to our brick press, which slices the bricks before they have hardened, as they are being ejected from the press. 

Compressing a Crix

Approximately 400 Crix made in one day

Top: Dirt being shoveled into the rotary sifter
Bottom: Turning the crank on the end where the rocks are removed 

Nicely sifted dirt piling up

Brick slicer in action

After making these improvements we were able to build some larger projects with great success, including a 150-meter perimeter wall around hospital staff housing, and a new kitchen/dining area for the hospital.

150-meter wall made of roughly 9,000 Crix

New hospital kitchen and patient dining area under construction

This technology has proven itself to make a positive impact in the construction practices at Kibuye. But, if we zoom out and look at all of Burundi, then it is just a drop in the bucket. That’s why we recently took the opportunity to help facilitate a workshop in Bujumbura focused on this technology. I took seven of our workers who have been involved in making Crix to teach others what we have been learning over the past 8 months. It was awesome to see our guys – many of whom have not finished high school – teaching a group of architects, engineers, and professors about how to make and use Crix!! 

Our workers (in yellow shirts) attending the workshop

they were featured in the presentation

participants sifting soil

answering participants questions

everyone was excited by the first brick

All the participants and facilitators of the workshop

A Tale of Four Patients: An Exercise in Opening Our Eyes

 (from Eric)

I can't honestly say that I enjoyed the whole of A Tale of Two Cities, but I thought the ending was fantastic. Sydney Carton is a lawyer and a scoundrel (or "ne'er-do-well" or "blackguard" or pick you colorful Dickensian description). He is talented but shameful, and he knows it. Yet, he bares an uncanny resemblance to a good man who has been unjustly sentenced to death. He chooses to switch places with him for the sake of the good man's liberation, and as he goes to the end of his life, he utters the immortal words:

"It is a far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known."

Without devaluing Carton's sacrifice, I have often thought of the way that his whole life was imbued with new meaning when his actions redeem the life of one man. Why is this important to me? Because my attempts to be a healer in rural Africa are a mixed bag of outcomes. Yes, some people are healed, but so many people continue to suffer and die, and on a day to day basis, this can easily crowd out the amazing victories. And they are amazing; make so mistake. They are of inestimable value. They are transformed lives, each of which is enough to imbue meaning to the entire existence of an otherwise scoundrel.

But we won't feel this, unless we proclaim it.

So, in the spirit of "far better things that I do", here are four simple but glorious stories from recent Kibuye life:

1. Tiny baby. Big Milestone

Last week, on the hospital employee WhatsApp group, this picture circulated with numerous celebratory responses and emojis of dancing women.

This little baby was born at less than 1000g (about 2 pounds), and went home at about double that weight and in good shape. If you've ever had the chance to follow a very small preemie, you know that it is a patient process. Feed, sleep, feed, weigh, feed some more. Small unremarkable days that form a steady trend towards a transformed life. This photo was from a return visit, demonstrating that the baby is continuing to grow well at home.

The story of the Kibuye NICU is a long one, and we don't always see these little ones survive. But this one did. And all of Kibuye is rejoicing.

2. Kidney disease gone

About six months ago, the internal medicine service hospitalized a young mother. She was swollen from head to toe. Her kidneys didn't filter well, and they were leaking protein at such a rapid rate that she looked like a terrible care of malnutrition no matter what she ate. We could easily figure out the problem, but our medicines weren't helping very much. She needed a biopsy and a pathologist and all sorts of treatment that we knew she wasn't going to get. But we put her on a bunch of water pills to take the swelling down, and hoped that it would at least make her life a little better for the time being.

A couple weeks later, she went to refill those water pills at a distant pharmacy, and the pharmacy gave her diabetic medicines by mistake. Not being diabetic, this sent her into a hypoglycemic coma that nearly killed her. Her family rushed her back to Kibuye, where we fixed her sugar problem, put her back on the right pills, and gave our government colleagues the necessary feedback about the error in the private pharmacy so they could investigate. The situation continued to be desperate.

Six weeks ago, she came to see me in clinic, and I hardly recognized her. Gone was the puffy face and the malnourished air. She smiled at me. I double checked the name on her file. Not only was the problem better, but this was despite being off her medicines for a week. We confirmed that her kidneys were now functioning totally normally. I told her to come back six weeks later to see if this was sustained. Last week, she showed up in good health with normal testing. We sent her home with no treatment, and we thanked God together.

3. Full continence

One of the possible, but rather difficult, repairs of congenital problems that our surgeons tackle here is anal/rectal malformations, i.e. babies born with no way to pass stool. This becomes an emergency after birth, and a provisional solution is made by creating a colostomy in the newborn.

Later on, when the baby is a bit bigger, there is a more complicated procedure to basically create what wasn't there at birth, i.e. a functioning outlet for stool. Given the intricate nature of this surgery, the difficulty with anesthetizing little babies, and their ongoing nutritional challenges, it's not hard to imagine why these are difficult patients. But one of the greatest challenges is a fully functioning sphincter so that the child will grow up without fecal incontinence.

Two weeks ago, just such a follow up kid showed up. Doing well. Growing. Full continence.

He wasn't too happy to see the doctor but mom was ecstatic

4. Redemption after Loss

We do a lot C-sections. Last Thursday was yet another C-section. But this one had a known backstory. A couple years ago, this mom had carried her baby nearly to term only to lose the pregnancy. She came to Kibuye where it was found that she had a bunch of big fibroids in her uterus and she was scheduled for surgery to remove them.

She did well for her surgery, and afterwards got pregnant again. This baby went all the way to term and the couple's first baby was delivered healthy this past week (6-pound girl!). The health baby was carried to the side warmer where another doctor was diligently training a new nurse about how to resuscitate newborns and care for them well after delivery. 

***

May you also have grace today to see the goodness of your life and work.

Awaiting Provision

by Rachel

Several months ago, I shared a message at family worship from 1 Kings about the prophet Elijah. I've been working my way through a Bible study entitled "Elijah: Faith and Fire" by Priscilla Shirer, and one of the chapters felt particularly meaningful to me, so I thought I'd share it with our team (and now with all of you). In 1 Kings 17, Elijah shows up to the Israelite king, Ahab, and shares a word from the Lord that due to Ahab's wickedness and Israel's rebellion, God is sending a drought on the land. He leaves the palace and ends up going into hiding for three years. God hides Elijah in a small ravine with a brook...and how does Elijah get food? "The ravens brought him bread and meat in the morning, and bread and meat in the evening." 

 So here at Kibuye we don't have ravens, but we have the African pied crow, which must certainly be a close cousin. These are not anyone's favorite birds. They look angry/evil (with beady eyes), they make a lot of noise, and they steal things and cause a nuisance. We have amassed some stories of them over the years in their devious behaviors...stealing eggs and produce from our market baskets, killing small animals (even pet chicks), and even one year swiping Easter eggs from our Easter egg hunt (and somehow managing to open them and eat the candy inside). I gather that ravens are much the same. These are not the kind of birds or animals that seems generous in any way. Bring food? Absolutely not--they are much more likely to eat it for themselves! And in addition, they are found on the list of "unclean" creatures that God forbids the Israelites to eat in His law. And yet this unimaginable event is how God chooses to provide for Elijah, for years. When the brook dries up and Elijah has to go elsewhere, God sends him out of Israel to a pagan land (the homeland of Queen Jezebel, actually, who is trying to kill him) and has him go to an impoverished widow to ask for food, of which she has almost none. A foreigner, bottom of society, vulnerable, starving woman. Another unimaginable provision. 

Shirer points to Ephesians 3 at this point. "Now to him who is able to do exceedingly abundantly above all that we ask or think, according to the power that works in us, to Him be the glory in the church by Christ Jesus..." She writes in her study, "God can craft solutions and remedies for me beyond my ability to reason...your loving Father has categories of answers, solutions, and options for you and your life that you don't even know exist...have you fully trusted him to do what he wants to do, the way he wants to do it?" 

There's a lot of application here for us in Burundi. We're wrapping up another wonderful school year at KHA, but we're awaiting the provision of another teacher or intern for next year. It seems to us that providing another teacher would be a great way for God to meet our needs! But is that how he will work? Will he send someone now, or later, or never (or maybe he'll send YOU!)? There are so many lives being changed at the hospital, but we pray for more staff and better outcomes. Will God provide miraculous healing, lower patient numbers, send extra staff? Or will He use this season to help us lean into him more? I need to remember to trust him to work in the way he wants to work. I need to remember that he has solutions that I can't imagine. I need to remember that he will always provide for us, in his perfect way. 

Don't you want to teach these adorable kids?

This baby was born prematurely at less than 2 pounds, but is doing well and just went home (topping the scales at over 5 lbs!)