Book of the Month: Factfulness

by Rachel

It's actually probably been years, but we used to have a blog feature entitled "Book of the Month."  There are a number of books our team has read which have informed our views and thoughts.  You're welcome to check them out here.

So, a few months ago I was reading Melinda Gates's new book, The Moment of Lift.  Excellent book, by the way (even though it's not the focus of this post).  I loved getting to read about the amazing work the Gates Foundation is doing to promote the development and empowering of women around the world.  Each chapter focuses on a different aspect of difficulties that women face, and people/organizations around the world working to ensure that each woman is seen as a life that is valuable; in fact, a life that has equal value to those around her.  Apparently, when the Gateses were forming their organization, they leaned heavily on the advice and wisdom of a man named Hans Rosling, a medical doctor and professor of international health.  He too had written a book....so off I went to check it out.

Hans Rosling was a Swedish doctor who spent years working in Mozambique and the Congo.  He then moved into more public health roles and investigated a number of disease outbreaks (including the 2014 West Africa ebola epidemic).  He passed away in 2017, and the book Factfulness was his last work.  Dr. Rosling's premise is basically that the world is a much better place than we think it is.

He uses a number of actual statistics from the world--infant mortality, life expectancy, kids attending school, average household income, even number of endangered species--to demonstrate that while most people interviewed will guess that things are getting worse, statistics show the opposite: that things have actually been improving over the past several generations.  Not only does he use statistics to demonstrate this, but the book is divided into 10 chapters of WHY he thinks we view the world the way we do.

As an American, coming from one of the most affluent countries in the world, who has now moved to Burundi, one of the most impoverished countries in the world, reading the book was actually surprisingly eye opening.  I tend to think of the world as either the "American" camp or the "Burundian" camp, while in reality there are so many more middle countries than either extremely rich or extremely poor.  You can't put Burundi in the same category as South Africa, or Egypt, or Thailand, or India.  Life expectancy and income are much higher for the average citizen of one of those countries than Burundi or Malawi, for example.  Rosling demonstrates that many of us use an "us and them" mentality when we look at the world, instead of recognizing that there are many different levels of poverty and development, and that the difference between a salary of $1/day and $4/day can have exponential benefits for the individual and society.

One of the lines Rosling uses towards the end of the book is this: The world can be bad, but getting better at the same time.  He's not asking us to pretend that everything everywhere is ok.  It's clearly not, and there are many many problems to overcome and injustices to surmount.  But, we can also celebrate the work and developments that have occurred over the last 100 years, even 10 years, as well.  That knowledge can give us hope that our efforts and the efforts of so many are not in vain.

As an addendum, I'm including some of his data graphics below.  The book is full of them, and it's a book that's fun and easy to read.  You can also compare your knowledge of the world to various Nobel laureates, billionaires, scientists, and chimpanzees...and see how you stack up. ;)

Thesis Whirlwind

by Logan

Whew! In some ways it feels like I can finally come up for air. The specialist doctors at Kibuye have just finished a ridiculously busy time, supervising research, editing papers, and judging the thesis defenses for over 40 medical students in about a month’s time. 

Carlan Wendler, Alliance Niyukuri, George Watts, Greg Sund, and Logan Banks chat in between students' theses

Why this sudden sense of urgency?

Burundi recently changed the way that they authorize doctors to practice medicine in Burundi. In the old system, as soon as a medical student defended their thesis (a final research project that is the final step before finishing medical school) they could apply for a license and start practicing as a physician. There was no pressure to finish before a certain deadline, so the work that this thesis project represents could be spread throughout the year. This also means that the work for the specialist doctors that act as “directors” of the students could be spread out as well. If someone was directing 4 or 5 students, they could do perhaps one a month so that the work wouldn’t be overwhelming.  

But a few months ago, the government said they would only authorize these new physicians once per year. This meant that a large group of medical students were suddenly desperate to finish their final research projects before the end of the year. 

What is it like to direct a thesis project?

The student comes to a specialist and asks them if they would be their director. Depending on their workload, availability, and other factors, the doctor agrees. The director helps the student come up with a research idea, review the research process, edit the paper (several times actually — which is more like a book, with an average length of around 60 pages), and help the student get ready to present the research and answer questions about it in an oral “defense.” This represents several weeks to months of work for the student, and several days to weeks of work for the director. 

When the student is ready to defend their thesis, the director recruits two other specialists to sit on the “jury” with them, and after a 15 minute oral presentation by the student, each person has a chance to make comments about the study and to ask questions to the student. 

Jason Fader, Alliance Niyukuri, and Ted John sit on a jury

The whole process from start to finish takes over an hour. Then the grade is given, and the student immediately takes the “Serment de Genève”, the French equivalent to the Hippocratic Oath.  

Just some of the 41 medical students as they take their "Oath" after successfully defending their theses.

This process was then repeated over 40 times between December 6th and January 11th. 

Greg Sund, Rachel McLaughlin, and Logan Banks celebrate with the new doctor Abel Nzoto after he successfully defended his thesis.

As you can imagine, this was an incredibly busy time for all the doctors at Kibuye. There are 10 specialists doctors currently at Kibuye. 41 students x 3 doctors per jury = roughly 123 times that a combination of 3 doctors sat on a jury. Some days there were 5 theses in the same day. That is nearly 8 hours of defenses. Sometimes one doctor would sit on 3 juries in the same day, reading and critiquing research in French for 5 hours. During this month-long period, one doctor actually sat on 26 juries, 9 of which as the director. 

This also meant that all the other doctors at Kibuye (the Burundian generalists and interns in the Stage Professionnel program) all had to pitch in to help the hospital services continue to run smoothly during this time. There were days that I was supposed to be rounding on Pediatrics that I could hardly make it over to the ward. I am so thankful (and I know all of us are) to the other doctors on our services that helped keep things going during this hectic time. Carlan even organized a “Thank You” dessert for our Burundian colleagues.

"Thank you! Thank you! Dear Colleagues!"

We are so thankful for the help from all the doctors at Kibuye. We are so thankful for all of these new doctors that just finished their theses. These 41 new doctors represent so much more than the work that went into the past month. They represent years of hard work -- on their part, and on the part of all the professors that taught them (whether in the classroom or on the wards) how to care for their patients in a compassionate, Christ-like way. 

Forty-one new doctors to help care for patients in Burundi (and beyond). What an answer to prayer!  That makes all this craziness worth it. 

But for the moment at least, I know that we are all ready for a nice long break from any more theses.  

Introducing the Harlings!

Michael, Jennifer, Amelia (4), Madelyn (2) and Mark (3 months)

Hello! We are the Harlings! Michael and I met in residency orientation in Greenville, SC, in 2012, and on our second date, Michael told me that he was planning on going to Africa to be a medical missionary.  Here we are, married and three children later, moving to Burundi to be a part of this wonderful team! 

 Engagement Pictures (January 2013)

Some of the few moments we were able to see each other in the hospital during our training! (2013)

The road to where we are today has been somewhat of a tortuous one, but we have seen God's hand and have felt peace that passes all understanding throughout this whole process.  God is awesome.  When I look back at the past two years preparing for the work we are just now starting, I truly can say I am in awe of who He is, and how He has transformed us in this process. 

I graduated from my pediatric residency training in June 2015, and Michael still had two more years to finish his surgical residency.  The plan was for him to finish in June 2017, for us to raise our financial support and finish our pre-field training during the end of 2017 and early 2018, moving to Cameroon in early spring 2018.  Cameroon visas, check.  Immunizations for Cameroon, check.  Purchases made specifically for a house and home we were planning to build in Cameroon, check.  With essentially all of our goodbyes said and the moving company coming the next day, we received an email saying Cameroon was too unsafe for us to move.  So many questions - Why, God, have you allowed us to come this far only to allow this trajectory to come to a screeching halt? 

Our “staging area” – things to get packed into our container destined for Cameroon. 

Because of this stop, our family had the opportunity to live in Paris for a year to learn French which was such an amazing year of spiritual/emotional/marital growth. We met some lifelong friends while attending language school, and we now speak French which has opened a ton of opportunities in Africa.  We learned about this tiny country called Burundi.  We learned about our identity in Christ. We learned (and learned again and learned again and learned again) how to be flexible and to hold onto our plans loosely. We learned intensely about God's sovereignty and how deeply He loves us and how He has perfect plans for us. 

The Eiffel Tower! 

We are thankful for the stop, but we do mourn the loss of what we thought would be.  The people we were planning to work with in Cameroon are good friends of ours.  I would have been able to serve a large pediatric population and Michael would have part of a flourishing PAACS program there.  

After finishing language school in June, we moved to Burundi for a "vision trip" for two months, then returned to the US in September for the birth of our third child, Mark.  We return to Burundi in just two weeks! 

We are so excited to join this team and further grow the friendships that started during our two months at Kibuye in the summer.   We are thankful for this great opportunity to serve God at Kibuye Hope Hospital! 

-Jenn 

Wearing Many Hats, or, Resolutions

by Carlan

One of the first things to strike me about the life of a missionary ER doctor was just how many hats one has to (gets to?) wear. In addition to the typical set of responsibilities, renovating a closet to become an ER, training staff on some key aspects of emergency care, teaching med students, and investing in the spiritual maturation of those same folks, my first year in Burundi had me scrambling to learn about international labor laws, graphic design, tree husbandry, the nutrition provided by various staple crops, and IT network management. In this last year or so, I have gotten to learn about publishing a Kirundi translation of a Bible study, managing a non-profit board, coordinating a multi-center research protocol, concrete crush pressures, architectural project management, international conference planning, plumbing codes, cabinet construction, the Alexandrian (allegorical) hermeneutical tradition, African Christologies, and, best of all, fatherhood.

Most days, it feels like what I do has relatively little to do with the training I received in med school and residency. I am extremely grateful for the support of my residency program, LAC+USC Emergency Medicine, for allowing me to pick up shifts when I come back on furlough and I will never forget my time at Verdugo Hills Hospital as a (sometimes) solo practitioner. I love getting to practice my speciality. Yet this chance to reinvent myself every year is one of the hardest, best things about life in Burundi. Each day is an opportunity to become more like the person I want to be: creative, helpful, encouraging. The risk of intellectual stagnation is pretty low for most missionary doctors...at least all the ones I know.

Having all these opportunities to learn and grow comes with a potential pitfall as well: distraction unto dissipation. My mom told me when I was young, “If you can do one thing in this life with excellence, you’ll be doing better than most.” I resolved that day that I would be excellent at something before I died...not so much out of vainglory but because aspirations ought to be towards excellence. That pathway was laid out in relatively simple terms throughout my pre-deployment life: study hard, learn the material set before you, and demonstrate your competence every time a test presents itself. That is, after all, the only way to get to and through medical training. Yet even during residency, the breadth of possibility was challenging my notion of excellence.

Emergency medicine as a field is wider than many and as deep as any. One somewhat snarky professor used to say that an ER doctor needs to know 20% of what a cardiologist knows, 30% of what a trauma surgeon knows, 15% of what an ENT knows, 25% of what a pediatrician knows, 10% of what an internist knows, 15% of what a radiologist knows, 25% of what an toxicologist knows, etc., etc. If you add it all up, we are supposed to know 300% of what one can know and to access it within 10 seconds of needing it, all while resuscitating a crashing patient. Even if he overestimated our abilities, something in that statement rings true. I would only add that for missionaries you need to multiply it by a factor of 10.

The hard hat of construction project manager.

So how does a missionary ER doctor decide where to focus his (admittedly short-lived) attention?

In 2020, I want to do less. Pardon my grammar, I want to do fewer [things]. My grandpa used to say, “Life is just a series of decisions made based on priorities.” So this year, my resolutions are only three:

I know no one is wearing a hat, but sometimes we have to put on a suit to sit on a thesis jury.

• to tell & show Jesus every day that I love him
• to take Michelle on (at least) two dates without distractions (aka, sans child)
• to take (at least) one photo with our daughter that is so epic/fun/beautiful that she’ll ask me about it when she is older

I know she's also not a hat, but I have been called "the doctor who wears a baby" by one visitor.

How about you? What are you relationship resolutions for 2020?

Washing Feet

Every Monday and Friday women and children from all over Gitega province walk to the hospital, sometimes from homes that are many hours away, to receive a meal and a 1kg bag of busoma from the hospital feeding program. And each Monday and Friday from 10-12:30, Susan and Annick set up a station in the corner of the feeding program pavilion to meet with people. Mamas (and a few Papas) come with problems and questions of all kinds. Susan shakes each person’s hand and listens to their concern. She measures tiny arms and checks for other signs of malnutrition such as blonding hair and eyelashes, puffy cheeks, swollen bellies. Many of the people have questions about topics besides just malnutrition. Their eyesight is failing - can she get them in to see the ophthalmologist? Their baby has a bump on his head - should they see a doctor? Their child has been having constant diarrhoea - can she give them de-worming medication? Sometimes people tell her about how their roof leaks in rainy season, that they are unable to buy notebooks for school, have no blankets to keep their child warm or no ability to produce milk for their infant. As Annick translates, Susan responds to each person to the best of her ability, knowing when someone really needs to see a doctor and when there are other ways to help. She gives out a blanket here, a jar of milk there, buys a hand-woven basket from a widow who needs that money to get through the week. She listens and responds, and even when there is nothing she can do to help, still at least someone has listened to them with a compassionate ear.  

Annick and Susan meeting with people at the feeding program

Susan with a baby that she helped to relocate and support after the baby's mother died

The other aspect of what she does is basic wound care. Sometimes others from our team come and help with this, like myself, Stephanie, who is a trained nurse, and some of the older kids on the team as well. Susan has visitors bring Band-Aids, gauze, disinfectant spray, and antibiotic cream over from North America. Equipped with these items in her first aid kit, we do our best to clean, disinfect, and cover the various wounds that people present us with. Some of the wounds are terrible to look at, dirty and infected, caked around with dust from the roads, still unhealed from the time of injury many days or even weeks prior. 

A few weeks ago I was feeling discouraged about how much our wound care was actually helping. That day I had peeled off a Band-Aid from a wound I had cleaned and dressed the week before, and seen that it had barely healed. This is not at all an uncommon occurrence. Later that day, I shared my discouragement about this lack of healing progress with Dr. Rachel. She informed me that malnutrition is a large contributor to why many of these injuries heal so slowly. She told me that some of these injuries are systemic and that our care will not cure them without the underlying cause being remedied. Yet, Rachel also encouraged me by reminding me that the wound care that we are providing has more purpose than just treating the wounds themselves. It also demonstrates to the people who come that there is someone out there who cares enough about them to touch their dirty feet, their sores, and their imperfections. To clean them. To tend to them. Having someone take the time to care for them in this way can provide a different kind of healing to many of these people who may not receive that kind of interaction regularly. Susan told me once that one of the main reasons that she provides wound care is to build relationship. I can see now how caring for someone’s wounds can build relationship and trust even without using words. This is huge for those, like me, who can’t yet speak much Kirundi. 

Much of what I end up doing when helping with wound care at the feeding program is cleaning people’s feet. For these people living in desperate poverty, shoes are uncommon and they work daily in rocky fields and walk long distances down hard, dusty roads. Thus, many of their injuries are on their feet and it is very hard to keep those injuries clean. Using saline and gauze we clean out each wound and proceed to wipe away the layers of dirt around it before applying a sterile Band-Aid. About a week ago, while cleaning around an ulcer on someone’s ankle, an image came clearly to my mind. Can you guess what it was? The image of Jesus washing the feet of his disciples. I heard a Tim Keller sermon recently in which he said that in Jesus’ time touching someone else’s feet was considered a task that not even servants were allowed to be told to perform. From poverty and the dirty, dusty roads of Israel, people’s feet became so mangled and filthy that it was beneath the duty even of a slave to have to wash them for someone else. Yet, Jesus does it. 

John 13: 2-5 and 12-17 (NIV) says:

The evening meal was in progress, and the devil had already prompted Judas, the son of Simon Iscariot, to betray Jesus. Jesus knew that the Father had put all things under his power, and that he had come from God and was returning to God; so he got up from the meal, took off his outer clothing, and wrapped a towel around his waist. After that, he poured water into a basin and began to wash his disciples’ feet, drying them with the towel that was wrapped around him...When he had finished washing their feet, he put on his clothes and returned to his place. “Do you understand what I have done for you?” he asked them. “You call me ‘Teacher’ and ‘Lord,’ and rightly so, for that is what I am. Now that I, your Lord and Teacher, have washed your feet, you also should wash one another’s feet. I have set you an example that you should do as I have done for you. Very truly I tell you, no servant is greater than his master, nor is a messenger greater than the one who sent him. Now that you know these things, you will be blessed if you do them.

In this passage, the king of the universe stoops down and washes the feet of those that he loves so much, even though they are about to betray him. And he commands us to follow his example and to do the same. The wound care that Susan and others are doing at the feeding program is a very literal way to follow that command. Though in most situations, “washing someone’s feet” may not look like physically taking their foot in your hand and scrubbing, in the case of the work that is being done by people providing wound care at the feeding program, it does literally mean just that. What a beautiful and concrete opportunity to physically do for others what Jesus has metaphysically done for us.

Noheli Nziza!

Christmas Eve is nearly over which means Christmas day is nearly here! The last several weeks leading up to today have been filled with celebrations and events surrounding the Christmas season.

Following our busy Thanksgiving meal, team members started decorating, playing Christmas music, and putting up their trees. Some visitors also began to arrive from the US; Rachel's mum came out this year for the holiday season and Kayla's parents as well.

Christmas Leopard

At school, the kids, under the direction of our talented music teacher, Julie Banks, began preparing for the annual Christmas play. Over the month of December, they performed it several times including at the hospital and the feeding program, as well as in the Kirundi service at our local church, and at the Christmas party for our Burundian house helpers. Everyone did a great job! The audience especially enjoyed when Maggie (playing Mary) walked behind the set and came back with a balloon under her dress signifying her pregnancy with the baby Jesus. The play was narrated in French and Kirundi by two of the KHA students, Piper and Liam.

"Wee" three kings

A whole heavenly host

Performing at the hospital

Performing at the feeding program

The second-last Friday of school before the holiday break, Jean, Rachel's mother, led a learning experience day. The kids had the opportunity to explore Christmas traditions from cultures around the world including India, Germany, and Mexico. Part of the day included making a Christmas food from that culture to share. As expected, that turned out to be a very popular and delicious activity. The groups also learned how to sing "Silent Night" in German, Spanish, and Hindi.

Making Christmas snacks

At the doctor's bible study we wrapped up our book study for the year with some cookie decorating and other treats. Some of the Burundian doctors had never decorated Christmas cookies before, so it was a novel experience. Ted and Mattieu acted as judges and selected the most creative, most delicious-looking, and most "Christmas-y" cookies from amongst all those that were decorated.

As Christmas approached, there was a "White Elephant" Party for the adults and several parties for the kids as well, most of which involved playing the game Just Dance. We also had the special treat this year of having several of our musically-talented Burundian friends host a Christmas coffee house night in which they played and sang while the rest of us were able to chat and enjoy some yummy snacks and hot beverages. At the end of the night they opened up the floor and we had a few people go up to the mic and sing or play the keyboard. John even broke out his saxophone!

John on the sax and Eric on piano

Throughout the month, the kids made several videos at school creatively depicting parts of the Christmas story. These were shared at Friday morning chapels and were accompanied by many laughs. They were meaningful and also lots of fun. On the last day of school, we had a half-day of cookie decorating, games, and Christmas stories.

Christmas chapel

Just making sure that the icing does, in fact, taste good...

Today, in the early evening, our community gathered together for a Christmas Eve service. Eric led us in traditional carols and Rachel in Scripture readings. It was a beautiful service focusing our hearts on the coming of our king.

Tonight, people are enjoying meals together and hurrying their kids to bed in preparation for the big day tomorrow. There will be a French and a Kirundi service at our local church tomorrow and Carlan will be sharing the message at the French service. After that, several of the kids and adults will be heading up to the hospital to distribute some small Christmas gifts and to sing some carols in the wards.

Though there is no snow here, we are all finding ways to celebrate the season. Many of us are thinking of family back at home and sending our love from afar. Wishing all of you much joy this Christmas season from the team at Kibuye! In Kirundi we say Noheli Nziza!