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!)


International Women's Day 2024

(by Julie) 

March 8th is International Women’s Day. It comes and goes every year without much fanfare in America. But we have found that it holds a certain importance in many African countries. Not the least of which is Burundi. 

We as a missionary community have been involved with the local womens' celebrations for several years now. Every year a fabric is chosen and as many women as are able use it to make a dress or skirt. It’s always so much fun to see the creativity in all the beautiful dresses! 

At the end of the day, women who work at the hospital join together for a Fanta and a few words. Someone from each department of the hospital says a few words of appreciation for what the women bring to the workforce and to Burundian families. 

I shared a short message based on Psalm 45. I encouraged the women that the “King is enthralled with your beauty.” (Psalm 45:11 NIV) In fact, before that in verse 10 it says, 

“Listen, daughters, and pay careful attention: 
Forget your people and your father’s house. 
11 Let the king be enthralled by your beauty; 
honor him for he is your lord.” 

Meaning what? Forget your label, your title, your role, or whatever you're comparing to others. Forget what lies may have been spoken over you or about you concerning your worth. Let, allow the Lord to tell you who you are. Because what he is telling you is “You are beautiful. You are a perfect creation. You are my daughter.” We honor the Lord when we let him give us our worth. He is enthralled, captivated by your beauty and who you are. 

We had fun reading the psalm together and delighting in how God delights in his daughters as princesses. Verse 13 says “her gown is interwoven with gold.” Well, the chosen fabric this year has what looks like gold thread woven into the design! So I encouraged them to remember, every time they put on this dress, that the King is enthralled with their beauty. If we forget what the world or the enemy tells us, we will be able to let the king be enthralled with our beauty. 

It was a great day with lots of smiles and lots of pictures! Thank you for your prayers for Kibuye, and for the women in particular to be respected and honored by the men around them.


Wounded Healers All

(from Eric)

Nadia was admitted to my service last night. Two months ago, she delivered twins. One of them is doing well, but the other has had trouble and is admitted to our NICU. So she's been living at Kibuye taking care of her babies.

Apparently, last night, she went to get some dinner and had difficult breathing all of a sudden. She stumbled into the Emergency Room where her oxygen levels were super low and she was breathing way too fast. Her blood pressure and heart rate were also quite high. She was admitted to internal medicine where we did all the available tests that might help her, concluding finally that her heart is bad and her lungs have suddenly filled with fluid. 

We're doing what we can, but I fear for her. I fear that we won't be able to pull her out of this, and that her twin babies will lose their mother, who seemed perfectly well twenty-four hours ago. Despite maximal oxygen therapy, she still has low oxygen levels and is breathing quite fast. Our team is gathered around her bed.


Also admitted to our service is Pastor Elie. Elie was a chaplain at Kibuye for decades. He's retired now, but has massively out-of-control diabetes. Despite all our effort, he has lost tons of weight, and he gets admitted for a few days during most months of the year. His disease is super challenging, but he's survived a lot longer than most people around here with a similar problem because of ready access to the hospital. 

As soon as he feels better, he's usually wandering around the hospital talking with old friends. In fact, this morning, we passed by his room and he wasn't there.


Gathered around Nadia's bed, we have made all our medical decisions. She is still not doing well. Her mom has the healthy twin bundled up on her back. I'm wanting to pray for her. My Kirundi prayers are quite halting, but since Nadia is conscious, it seems like praying in Kirundi might encourage her.

Suddenly Pastor Elie walks up. He knows that we came by his room when he was out chatting. We answer his questions, and then I ask him if he would be willing to lead us in a Kirundi prayer for Nadia.

He answers without hesitation. "This is my job." He places his hand on her shoulder and begins to pray. From his words, I can tell that he is aware of her situation and that her other baby is already admitted in the hospital. Apparently, Elie's visits to the hospital help him keep his ear to the ground.

It's a beautiful picture. One obviously ill patient leading us all to pray for the healing of another. We do not help each other to healing only from some kind of disease-free platform of security. We are wounded healers, just like our Savior.


And then there's me. My body is more or less intact, but my heart is struggling. I'm leading my team of students and nurses, teaching them the best way to take care of these patients, but knowing that we won't succeed in a good number of cases. We're praying for healing and compassion and understanding, and even as we pray, I'm struggling to believe for these things. I wish my heart could be content with the situations in which I find myself, content to just be faithful in the daily work in front of me, but it's hard. My heart doesn't react the way I wish it would.

In the television series The Chosen, the producers gave James the Lesser (or "little James"), one of the disciples, a physical disability, and then Jesus sends him out to heal. He struggles to understand why he is not healed, and how he could be a vessel for healing when he is himself broken. The scene is extra-biblical, but the themes discussed are not. Jesus speaks of God being glorified from James praising Him even though is not healed, precisely because he knows that there will be healing in the end. 

Healing for Nadia and Elie. Healing for my own heart and all of us striving to bring life and wholeness in the midst of our own brokenness. Wounded healers all.


48 hours later update: "Nadia" has actually done much better than I was expecting. In a way that we don't often see here (without super intensive care), she has been pulled back from the brink and is breathing much better (though still on a lot of oxygen). Sometimes I'm hesitant to hope in such situations, since we're not out of danger, but I'm grateful for how it's going and pray it will continue.


7 days later update: "Nadia" discharged home today. Her baby was also discharged, so they will actually go home. Just taking some pills. So thankful!


The Very First....

 (By Caleb)

Training is a cornerstone of what our team does here at Kibuye.  Most of our team is involved in training surgeons, doctors, and nurses, but on the construction team we also have an apprenticeship program where masons, carpenters, iron workers, and welders can be trained by those already in the 'guild'.  

When the first members of our team arrived in 2013 my brother ran the construction crew when he was not in the operating room.  He strongly encouraged this apprenticeship program and to this day the construction leadership team still reminds me, "But Doctor Fader said we must always be teaching..."  

Each year now for most of the last 10 years we've had a cadre of apprentices in various trades enter the year-long program.  In order to enter the program, one must show good work ethic, a willingness to learn, and must be able to provide one goat for the induction ceremony/feast at the end of the year.  The goat sacrificed represents the life-long dues required by the guild.   Most of the time these apprentices are chosen from among our hard-working laborers.  Hence a goat represents about 2 months' salary for them: no small sacrifice!

In November we celebrated the induction of 10 new members into their respective guilds.  Since there were 10 of them it was decided that instead of 10 goats we should just get one very large cow.  Each of these 10 graduates were allowed to bring their extended families to witness the event.  There were speeches, pictures, laughs, and lots of beef shared around.   Each graduate was presented with tools of the trade by their primary teacher such as a trowel, level, measuring tape, etc.  As expected, it was a lovely team-building experience.  

Our foreman, Sadiki, welcoming everyone.  Graduates are seated in the front row.  

Cooked bananas, french fries, and lots of beef. 

However, this year was extra special.  For the first time in these last ten years we had our first female graduate.  Her name is Savella and not only did she finish this year-long apprenticeship in a field absolutely dominated by men, but she was anonymously voted by the whole mason's guild as one of the top two graduates!!  As our foreman was announcing the results of the vote he opened with, "Now please hold on to your hearts...."  Everyone is very proud of Savella and we are so pleased to have her as a part of our construction crew.  

Savella receiving the tools of her new trade!  

Skillfully adding the finishing touches...


Threads of Years Long Gone: Ministers, Babies, and Reasons for Reconsidering Hope

 (from Eric)

On Friday, the hospital inaugurated a new district health office. In addition to being a church hospital and a teaching hospital, Kibuye is the referral hospital for Kibuye Health District, a geographic area of over 200,000 people. Anyone sick in that area goes to one of 18 health centers in the district which refer necessary cases to the hospital. Of course, we also get cases from all over the country and neighboring countries because of specialized care here, but we are the primary hospital for this catchment area, and this health district is administered and supplied by the district health office.

Their office was insufficient and helping them build a better office just outside the hospital wall also liberated some valuable real estate within the hospital that the old office was taking up. So we partnered with them to build a new office building. The building is lovely, and governmental dignitaries were invited to cut the ribbon.

The guest of honor was Burundi's Minister of Health. Newly appointed to the presidential cabinet in the last few months, this was her first visit to Kibuye. Burundi's amazing traditional drummers pounded and danced out a welcoming rhythm as the Minister's vehicle arrived, and we formed a receiving line, of which I was about number eleven.

Burundi's Traditional Drummers with the new district health office

As the Minister proceeded down the line, I shook her hand and said "Welcome to Kibuye." Over the thrum of drums behind us, she said "I know you. I met you in Banga when you were learning Kirundi. You had babies with you."

A journalist caught the moment where the Minister tells us she remembers us

I couldn't believe it, to say the least. Banga? Banga is where our team spent three months in 2013 when we first arrived, fresh from French language school but wanting to get a small smart on Kirundi language study before moving to the hospital.
Future Kibuye kids at Banga.

It wasn't the easiest three months. In fact, the "green soup" that we ate every night for dinner has become a bit of team lore. The electricity and water were usually out, and thus staying healthy was quite a challenge. I remember one night walking outside to see the adjacent hillside aflame (apparently a "controlled" burn for farmers) and wondering where the fire would spread.

During meals, the nuns who ran the guesthouse and restaurant, in order to help out high-chair-less parents (and to amuse themselves), would take Toby (who was about 5 months old) around and greet the other patrons. Apparently one of those patrons was the future Minister of Health, who came to Banga for a malaria training event.

Mama Lea - Toby's favorite nun

Now the Minister is at Kibuye, cutting a ribbon and remembering our team fondly. The ceremony began, and the governor of our province gave some opening remarks. Bishop Deo did a wonderful job discussing the work of the Free Methodist Church's institutions at Kibuye and their involvement in health care, including some upcoming plans. Then the minister took the podium and gave a very favorable speech. She again mentioned to everyone meeting our team in 2013 and remarked on our love for their country. She said that she would like to take a tour of the hospital afterwards, and spend close to an hour being guided deftly by Dr. Gilbert our medical director. All in all, a very successful visit.


The collision of past and present filled me with gratitude. It was the gratitude of someone who had been living on the back side of a tapestry, where all the threads are knotted and seemingly disorganized as they do their best to get from here to there. Then, for just a moment, you're allowed to catch a glimpse of the other side of the tapestry, where a beautiful, complex image has been created by those same threads.

You see that there were a couple stitches way over there, and then the thread disappeared for so long that you thought it was gone, and then it resurfaces in just the right place. And that makes you reconsider the other threads. It gives you hope for the other long-invisible strands. Or maybe this one over here has always bothered you, and you wish it would be gone. But maybe it actually plays a role in a bigger picture. It's been a source of tension, but maybe it's like the musical tension of a passing note to a beautiful chord. Who knows?

No thread makes a tapestry. Rather it's all the threads together. It's the whole of all our lives and days and interactions, woven together by One whose perspective is so much bigger than ours that it's like how the heavens are higher than the earth. It's incredibly hopeful, and also incredibly humbling.

Is that what Banga was for? Probably not, or rather maybe one thing among many. Who knows? The point is that there are these moments where you see a bigger story and though you may not have much more of an idea of what's going on than you did before, you now have a reason to hope that there actually is a bigger story. And that changes everything with regards to how you look at the beautiful and the problematic that surround you even now.

Is that what the Minister's visit to Banga and now to Kibuye was for? Maybe a bit, but she is not just a character in our story any more than we are just characters in hers. Surely God has many plans for her life in so many other domains. And so we see that the big Kibuye tapestry is itself a piece within the tapestry of Burundi, within the tapestry of His kingdom throughout His creation.

It's too complex. It makes our heads swirl. No one could weave together such a complicated web of billions of people's lives into a single beautiful work of art. But if someone could... If someone is, then that One is most worthy of praise.

(On a more personal level, here's a song I wrote a while back on a similar theme: The Weaving of My Days, also on Spotify and other streaming sites)


I Bless the Rains Down in Africa

by Rachel 

If anyone knows anything about Africa, usually they can at least hum the above line from Toto.  It's a great song.  Most of my life I thought the line was "I MISS the rains down in Africa," which I think fits with the longing of the song, but anyway.  I've been thinking about that song a lot lately as Burundi has had a pretty epic rainy season this year.  

Now that we've been living here for 10 years, the dry and rainy seasons (instead of a classic summer/winter pattern seen in northern climates) have become second nature to us.  The rains usually stop in mid to late May, bring in the annual dry season.  Upsides of this would be massive amounts of solar energy for our powerpac, easy drying of clothes on the line, and reliably dry days and nights for outdoor activities.  Downsides would be massive amounts of red dust everywhere!   By September the rains usually return, maybe 3-4 times per week until May (with a one month pause in Dec/Jan).  Obviously if you are a subsistence farmer, these seasons are quite important for the growing of various crops.  In fact, if the rains are late (like a year ago), harvest comes late as well meaning that hunger and malnutrition increase until the harvest arrives.

This year, the rains were a welcome return by the first week of September.  We love the sound of rain on our metal roof, and all the dust washing away.  The profusion of green leaves, grass, etc is pretty amazing in this lush climate.  However, what was NOT normal this year was the volume of rain.  The rains came hard and fast and constant...in fact, there have been weeks where I don't think we saw the sun at all.  There is an aid website called Relief Web that publishes data on things like food security and humanitarian crises.  You can see the table below from the end of December featuring above average rainfall projected through February.  While not as severe as some parts of Kenya, rainfall has been 50-70% more than average this year.

We drove a Burundian friend to Gitega last month and asked him about the community and their thoughts on the rainfall.  He replied that when people see this volume of rain, they worry about famine.  Below are some pictures that Eric and I took on a recent walk around Kibuye.  Notice the brown stalks of corn, dead from flooding, and even the flooded rice patties in the valley.  Rain has also caused some significant erosion behind the hospital as part of the hillside washed away.

Flooding fields and dead corn plants

Erosion behind the hospital

Flooded rice fields

I love rain.  I think it brings green and life and beauty.  But if I was a subsistence farmer living in Burundi, and if my crops died I had no other way to feed my family, I would be worried right now.  Could you pray for our friends and neighbors, that God would provide the right amount of rain for crops to grow?  That they would have enough food to feed their families, even miraculously so?  It's quite possible that numbers will swell in our malnutrition program this spring as well.  You all contributed over $75,000 to that fund in the month of December, which is amazing!  If you'd still like to give, here is the link.

Burundi looked good in this report from November, with only a few regions being "stressed."  This might change in the next report.  Also, as you can see much of the region is in crisis, sometimes due to war in addition to natural factors.


On the Eve of Christmas

 (from Eric, adapted from our family Christmas newsletter)

Exodus 36:7: The materials were sufficient for them to do all the work. There was more than enough. 

I read this obscure verse this morning. It is describing how the people of Israel gave so much of their personal belongings to make the furnishings of the tabernacle that the craftsmen in charge told them to stop. “There was more than enough.”

Do you hear that provision? It hits my heart like a feast. We’ve known some times like that in 2023. We have seen our medical school flush again with graduates after several years of dryness. We have seen busy schedules align so that we can sign a new 5-year contract with our Burundian partners in good faith of what God will do in the future. We have seen patients healed and funds provided and small steps made towards better care given in the name of Jesus. We have celebrated together with our team what God has done in 10 years here. What have you experienced where it felt like “more than enough”?

But maybe those words sound less like a feast and more like a taunt. Where was the provision last week when we fought hard for a young man with kidney failure, only to have him die suddenly the day after (what we thought was) a successful discharge? Burundians’ crops are flooded this year, heralding a season of exceptional hunger. We didn’t see our daughter for 3 months while she started school in Kenya. Meanwhile, we’re covering extra classes for our boys because we don’t have enough teachers to help us this year. Where have you felt like “there was more than enough” just doesn’t measure up to reality?

Then I think about Christmas. I think about 400 years of biblical silence followed by a nearly unmarked birth in a stable in a small town. In fact, it was the most extravagant, overflowing, lavish gift ever, the epitome of “more than enough”. That was the reality, but in many ways, it didn’t feel like it.

Here on the equator, the sun rises year-round about 6 am. About 15 minutes before that, when it’s still dark, scores of birds wake and sing to greet the day that is not quite here yet.

The sky is dark, but the air is full of song.

It’s beautiful, and it’s every morning for us. It is glory mixed with darkness, but it lets us know that the day is at hand. It’s a good reminder for both the moments where we feel God’s provision as well as the times when it feels so absent.

The night of Jesus’s birth, angels sang God’s glory. The sky was dark. The air was full of song. This seems to be characteristic of God. Often in joy, often in sorrow, but always looking forward to his coming.

We pray grace to you this season to be able to hold on to this promise in both the ebbs and the flows that you experience.



 By Alyssa

As one of the most developed hospitals in a small country, we get our share of VIPs, and there is always a tension at to how much time and energy to spend on them versus the rest of the patients. My sense is that this is a challenge in lots of places but especially for mission hospitals in developing countries where the goals of medical excellence, compassionate care for the poor, quality education for trainees, and financial sustainability can sometimes seem impossible to pursue simultaneously. 

Kibuye Hope Hospital's vision is to: 

"Develop a university hospital of excellence where the love of God is manifested to his creatures."

Our mission is:

"To glorify God through quality physical and spiritual care accessible to all and through the training of healthcare professionals and disciples of Jesus Christ."

I'd like to share about a few patients I saw yesterday who aren't particularly prominent by the world's standards but who I hope experienced the love of God at our hospital. I would love for them to walk away from this place after receiving quality healthcare by compassionate healthcare workers with the sense that they are seen and known as Very Important People in the eyes of our Heavenly Father.

1) Mama D (pictured above with one of our nurses, picture taken with permission). This mama is so faithful to care for her little girl through so many heartbreaking challenges over the last few months. She has been in and out of the hospital multiple times and has often stayed for weeks at a time due to complications from probable tetanus. Her mother faithfully keeps every appointment, feeds her and give her meds through an NG tube (and amazingly, the little girl is not losing weight or malnourished), and is attuned to every new symptom that means she needs to bring her back to the hospital. We had the chance to encourage Mama D yesterday that she is doing such a great job in caring for her daughter, and she just beamed. She and her husband display great faith in praying for their daughter and not despairing despite the myriad of challenges their little one faces. 

2) "Isaac" is a 13-year-old boy who came to his follow-up appointment in peds clinic yesterday for cyanotic congenital heart disease. When they checked his oxygen level in triage, they were so concerned that they sent him to the emergency room instead of clinic. But then they came to find me and I explained that his oxygen levels are always that low. Sure enough, Isaac entered my clinic walking and talking normally a few minutes later despite his oxygen saturation of 65%. Isaac is one of the oldest patients I have seen here with cyanotic congenital heart disease (probably Tetralogy of Fallot for the medical folks). He's actually still attending school and can walk short distances around the hill where he lives. It's difficult to decide what medicines to treat him with because the medical literature generally assumes patients with this condition had surgery to repair it as infants. He's currently taking three heart meds and seems to be relatively stable, so we refilled the prescriptions and gave him a follow-up appointment in three months. 

3) "Emmy" is the 7th child in her family and there were complications with her birth. She was resuscitated for a prolonged period of time and that resulted in neurologic complications. Now she is 2-years-old but doesn't walk or talk or even sit up on her own. This is unfortunately a very common story here. Her mom brought her to peds clinic to see if we could help with her development. Emmy smiles and seems aware of her environment but has very little muscle tone. We gave her a referral to a center nearby that provides physical therapy, but there's not a lot else we can do for her. We did explain that she is a beloved child of God, and her mom readily agreed! 

4) Mama A brought her son to the hospital because of a huge tumor in his eye. She heard that there was a center here that could treat this condition, so she traveled from quite far away with her son and his little brother. The boy has now been hospitalized in the malnutrition service for over a month. Unfortunately the cancer (retinoblastoma) was very advanced and already metastatic when they arrived. We have given chemotherapy with the goal of palliative care (to shrink the size of the tumor and decrease his pain), but the boy is still not well enough to eat or drink or talk. He will likely go home tomorrow to continue palliative care. I hope the mother leaves with the sense that she did everything she could for her child and that there is no shame or curse associated with the condition he has. I will miss greeting her and the little brother each day. 

5) "Arthur" is a 4-year-old boy with epilepsy who came to clinic for follow up. Thankfully his seizures are well controlled on treatment. He has only had one seizure in the last year. He has some developmental delay as well, but he is making good progress. His mother is pleased with how he's doing. We refilled the medication and gave him a follow-up appointment for early next year. 

We want to keep growing and improving in the level of care we can provide for all the patients at Kibuye Hope Hospital. And yet as some of these stories show, we can't always provide physical healing for them given the resources available in our setting. But no matter what medicines or treatments are available, we desire that the love of God be manifested to all the patients along with their family members. Our specific pediatric vision includes the phrase "welcoming children, families, staff, and students as Jesus welcomes us." Please pray that this vision will be realized more and more in this beautiful corner of the world.  


Making Virtual a Reality

While a good understanding of anatomy is important for the practice of medicine, it's foundational for the practice of surgery.  Knowing the relationships between structures can be the difference between curing the patient and causing irreparable harm.  Because of its foundational nature, in the U.S. anatomy and physiology is one of the courses taught early in medical school.  Around 90% of U.S. medical schools include cadaver dissection as a part of their curriculum.[1] Even as the pedagogy for medical education is transitioning to a flipped classroom model, the importance of in person time studying cadaveric anatomy is not lost on educators.  In fact, according to anatomy course directors, one of the most common weaknesses in anatomy curriculum was insufficient dissection time, a problem which was only exacerbated by COVID. [1] 

There are many factors that prevent us from maintaining and using an anatomy lab as a part of our medical curriculum here in Burundi.  Both the formaldehyde and refrigeration options for preserving cadavers are very expensive.  Then comes the practicalities of maintaining constant electrical supply or the safe handling and disposing of large quantities of hazardous chemicals.  All this says nothing of the cultural and ethical implications of obtaining cadavers on a regular basis...

So, what are we to do?  

Well, 11% of U.S. medical schools also utilize virtual software to enhance, and in some cases replace, the cadaver dissection portion of their anatomy courses.  In the post COVID era, a full 23% more plan to incorporate Virtual Reality in their anatomy curricula.  [1] While the data is a little old at this point, a 2015 meta-analysis of the educational effectiveness of 3D visualization technologies in teaching anatomy showed that it 1) improved factual knowledge, 2) improved spatial knowledge acquisition, and 3) improved user (aka student) satisfaction as compared to all teaching methods. [2]

Visiting resident Yves Yankunze having some one-on-one teaching time.  We had recently discussed hiatal hernias, so I was pointing out the relationship between the esophagus, vagus nerve, diaphragmatic hiatus and aorta/aortic hiatus.

Since I had the headset and anatomic models ready to go in our (mostly) unused OR 1, I was able to have an impromptu teaching session for the nurse anesthetist students rotating at our hospital.  It was a chance to show them the relationship between the upper airway, the trachea and the esophagus.  A critical understanding for successful and safe intubation of patients. 

When set up in the classroom, other residents are able to follow along with the teaching as I guide the student wearing the headset toward the relevant and important anatomy.

After a few back-and-forth emails, the medical director for The Standford Virtual Heart program graciously provided me with a copy of the software.  So after we finished our chapter on congenital heart defects, our residents had a chance to explore the defects and their associated flow patterns and murmurs in virtual reality.

For now, I'm focusing this virtual experience on our current batch of surgical residents.  Their need for recalling and understanding anatomy is the most pressing.  But the trial run has been well received and quite helpful.  I'm excited about the possibility of significantly expanding our use of VR into the anatomy course taught at Hope Africa University.  

Afterall, it's hard to build a solid house without a solid foundation...

[1] Shin M, Prasad A, Sabo G, Macnow ASR, Sheth NP, Cross MB, Premkumar A. Anatomy education in US Medical Schools: before, during, and beyond COVID-19. BMC Med Educ. 2022 Feb 16;22(1):103. doi: 10.1186/s12909-022-03177-1. PMID: 35172819; PMCID: PMC8851737.

[2] Yammine K, Violato C. A meta-analysis of the educational effectiveness of three-dimensional visualization technologies in teaching anatomy. Anat Sci Educ. 2015 Nov-Dec;8(6):525-38. doi: 10.1002/ase.1510. Epub 2014 Dec 31. PMID: 25557582.