The Saga Continues

Summer is the Empire Strikes Back of the school calendar. Everybody goes off on their own adventures, but Han gets frozen in carbonite and Luke loses a hand. It’s not until we return to school and everyone is back together that we are able to save Han and defeat Jabba together. Sure, the Empire is building another Death Star, but you know that by the end of the school year we are going to be clapping our hands out of time to the music with Lando and dancing with Ewoks. 

In case my analogy is unclear, I look forward to the start of the school year in Kibuye. I appreciate the book recommendations my students have to offer from what they have read over the break. Their insights into Endgame and what might come next in the Marvel Cinematic Universe are worth evaluating together. A new school year means a new round of Learning Experience Days is before us, another era of history to explore, new books to dissect, and another year of fellowship as a team. 

Despite all the excitement of a new year, there are also some key characters missing. There are now four Kibuye Kids attending high school in Kenya. The dynamic in our Kibuye classroom is different without them and parents and siblings feel their absence. It is not just these few missing people, but we all have loved ones who live half a world away from Kibuye. It is almost as if the Empire is building a new Death Star, but the Rebellion remains scattered. 

Many of the people who make a place feel like home are missing. It can feel as though there are perhaps multiple homes. Life continues in those multiple homes even as life continues in Kibuye. It is a difficult reality that our loved ones experience suffering while we are far away. Several of us on this team have suffered the loss of a loved one in the past two years. Many of our friends and family members who are far from us have experienced disease, divorce, or death. Just this morning, my family received news of friend diagnosed with a rare condition causing multiple cancers throughout her body. 

Simply put, this school year brings with it an array of emotions and spiritual challenges. I want to be present for so many people in so many different situations. I especially want to be there for those who have lost a loved one and for those whose prognosis is terminal. I want to make things better.

In the opening scenes of Avengers: Endgame, Tony Stark adrift in space, says he hoped to pull out one more surprise and miraculously make it home. He has come to the end of his resources. Although Tony is saved by someone else in this particular situation, there comes a time for all of us when our ingenuity, our strength or agility, our charisma, or sheer fortuitousness will not prevail. When difficulties come for us or for our loved ones, when push comes to shove, to what or whom can we turn? 

Unsurprisingly, I am no one’s Luke Skywalker. I cannot make boarding school closer to home, heal the terminally ill, or save anyone. Praise God, that He has given us a Savior who is good, faithful, and all powerful who can address each of these struggles. Jesus knows intimately our burdens, fears, and circumstances. Jesus does not rescue us with an Iron Man snap of his fingers. No, our rescue required much more than that. My sin demanded the shame and brutality of the cross. Christ bore the annihilating blaze of God’s wrath for me. No mere snap of the fingers, but a descent into the raging chaos of Hell was necessary to secure my salvation. To seal the deal, Jesus rose from the dead to ensure that nothing would ever separate me from Him again. 

In Fellowship with others is where the victory that Christ has claimed is most assuredly felt and realized. God has brought us together as the body of Christ and Jesus himself bears our burdens and those of our loved ones, near and far.  This school year, I am most excited to see Jesus transform lives and carry each of us into deeper relationship with Him. 

Boarding School: Blessings, Losses, and Trust

(by Heather Fader)

In this season, I cannot yet write a comprehensive blog post about the subject of boarding school, as we are in the throes of transition to this new stage of life.  We are one of the three Kibuye families whose children have begun high school at Rift Valley Academy in Kenya.  Without a doubt, it is a fabulous opportunity for our kids to be at such an incredible place.  At the same time, this brings changes that must be processed and losses that must be grieved.

Rift Valley Academy is an absolutely phenomenal school.  Alumni attest to that, including Jason and other family and friends.   And after attending orientation there this weekend, I am beyond impressed with the staff, academics, dorm life, student care, family support, and school culture.  RVA’s vision is well-thought-out and extremely well-executed: 

Burundi Girls turned RVA High School Students

RVA Cafeteria - impressive!

RVA Chapel - Students gather here 5x/week

And the students generally thrive and grow to love it.  These young people are bright and brave.  The two returning RVA students from Kibuye, Jonah (grade 12) and Matea (grade 10), are quite settled and happy there.  Even my brand new ninth grade daughter, while perhaps slightly homesick and at times overwhelmed, is having a great time with old friends and new friends.  She is giving positive reports on her classes and teachers as well.  We are confident that she and the other Kibuye kids will continue to thrive there.    

But. Even so, my heart just aches as I miss my child.  Our missionary callings involve a lot of separation and loss, but for many of us, this separation is among the very most painful. 

Burundi families at RVA this past weekend

So we remind ourselves to remember what we know to be true.  God is loving and faithful and good, and he loves my child more than I ever could.  He has already shown such grace in bringing these four Kibuye kids to such an amazing place where they can learn and thrive at RVA.  He works in ways we do not understand in order to bring about growth that we cannot even imagine.  He is present in new dorm rooms and present in the tears of the mamas missing their children.  He can redeem all things.  He answers prayers. 

“The wonderful thing about praying is that you leave a world of not being able to do something, and you enter God’s realm where everything is possible.  He specializes in the impossible.  Nothing is too great for his almighty power.  Nothing is too small for his love.”  - Corrie TenBoom

Ella moving into her new dorm room

Maddy (friend from Bujumbura), Anna Fader, and Ella Sund outside their dormitory

The students from Burundi on the first day of class.  Please pray for these five.

But Not Forever

by Rachel

Gloria was a well nourished, healthy pregnant lady when I saw her in the hospital last month, all smiles.  She was pregnant with twins, already at her due date, with a previous C-section for her first delivery.  We made plans to do another C-section for her later in the day.  I delivered her babies, one boy and one girl, beautiful children without problems.  There was some extra bleeding during surgery, but we treated it appropriately and she did fine.  The whole family was full of joy at the blessing of these twins.  I got a call later that afternoon.  Gloria was bleeding again.  I made some recommendations, and the on call doctor also decided to give a blood transfusion.  Then around 9pm I got another call.  She was not doing well…could I come right away?

I ran up to the hospital.  The bleeding had stopped but Gloria was sitting upright in bed, gasping for breath on oxygen.  Her eyes were wide and the room was tense.  I quickly stopped her transfusion, fearing a transfusion reaction.  The team surrounded her bed, running for medications, pulling out all the stops.  No change.  Finally we moved her to the operating room where there was a better oxygen supply.  She lay on the table, struggling, staring into my eyes, so afraid.  We intubated her, and pulled almost half a liter of fluid out of her lungs.  She was literally drowning to death.  Minutes later, her heart stopped.  When I went back to tell the family they couldn’t even look at me.  They just turned and walked away.  I walked home after midnight, feeling discouraged and beaten.

The day before, I had finished the final proofreads on Eric’s book (see here).  It’s a terrific book, full of promises and light in the darkness, but also full of stories of real people we’ve seen over the years, many tragic stories of sickness and death and doubts.  It left me feeling raw, and with Gloria’s death coming on the heels of my read of the book, it all felt like too much again.  Why are you not acting, God?  How long, Oh Lord?

But as is often the case, God provides answers that I need to hear at just the right time.  Days earlier, I had been listening to a sermon series from my home church in Ann Arbor.  The pastor, Brian Gregory, has been preaching a series on Daniel.  Honestly, other than the fiery furnace and lion’s den, I’ve never given much time to reading through the book of Daniel, but was powerfully impacted by this message on Daniel 8 (if you’re interested, you can hear the whole sermon here).  Daniel has a vision of the future, a terrible future full of the wicked prospering and the innocent suffering.  And the summary of Daniel’s response is basically, “How long, Oh Lord?”  The response from heaven is: “A long time.  But not forever.  Because the Lord will act.”  So Daniel is very sick and grieved.  But then he gets up and continues the work that he has been given to do by the king.

I couldn’t get this message out of my head.  It resonated with all my emotions and longings that week after Gloria died.  All of creation is crying, “How long, O Lord?”  We know that the world is broken.  We know things are not supposed to be this way.  And I think if the response from heaven was, “not much longer,” it would feel false.  It would feel like vain hope, because we KNOW that things don’t seem to be getting better as quickly as we would like.  God is acknowledging that the world will not change quickly.  Not for Daniel.  Not for us.  Perhaps we will not see justice in our lifetimes.  But the promise is, and I choose to believe it, that this world and its troubles and its injustice WILL NOT last forever.  Because the Lord will act.  I can’t see how Gloria’s life turned out the way I wanted.  The systems are broken, and on some level we failed her.  But God promises that even this death, even this sorrow, even this story, will be redeemed.  I can hold on to that.

So, as Daniel did, we grieve.  I think that’s important, not to gloss over the pain that we experience.  As most of us know, one can grieve and have hope at the same time…they are not mutually exclusive.  I grieve for Gloria’s family, and her babies that will grow up never knowing their mother.  But then I also get up and continue on in the work that God has prepared for me.  Longing for the day that he will make all things right, but working in the “not yet” of today, knowing that the sorrow will last for a night, perhaps a long night, but joy comes in the morning. 

Eric's Book: Promises in the Dark

(from Eric)

Several years ago, I drafted a series of stories and reflections from my life as a missionary doctor.  The stories center around the theme of "Walking with Those in Need Without Losing Heart".

Jesus calls his followers to enter into the broken places of the world.  That much is clear.  This may be on a personal level, like a family member dealing with a divorce or a chronic illness.  This may be on a vocational level, as a social worker or an inner city teacher or a missionary doctor.

We are called to walk with those in need.  And it takes its toll on us.  How do we avoid burn-out on the one hand and cynicism on the other?  How do we remain faithful in the midst of the tension that is our broken world, where the promises of God are not yet fully realized, and where even their smallest glimpse can be hard to find?

My hope is that this book has something valuable to add to these questions.  I'm excited to say that, after several years of refining, Promises in the Dark: Walking with Those in Need Without Losing Heart will be available October 14, 2019 (less than 8 weeks away!) from New Growth Press.

It's already available for pre-order on Amazon at this link.

Here are a couple endorsements that I've been glad to see:

“Eric McLaughlin brought me to tears with this honest look at the difficulties of the life of a compassionate caregiver. When dealing with this broken world, there are no simple answers. But there can be hope. Promises in the Dark is essential reading for anyone who walks with others through suffering and questions how to keep on going.”
- Dr. Kent Brantly, Ebola survivor; coauthor of Called for Life

“Why do we love lawyer and doctor shows? We know both worlds bear extremity, suffering, and passion, and that is at the core of what intrigues and terrifies us. Eric McLaughlin, a missionary physician, engages the raw and compelling questions of what it means to be human and trust God in the face of a world that is stark and at times cruel. Eric offers no simple answers or trite truisms. Instead, he invites us to engage the questions with the confidence that there is nothing we face that Jesus has not first entered. The song sung in this brilliant book is that death is real and horrible, far more so than our antiseptic Western world can bear, but death never gets the final word. There is something about life and love that lingers far longer than heartache, and it is this story that enables us to enter all other losses with hope. This book will intensify your passion and encourage you to live the best story ever told.”
- Dan B. Allender, Professor of Counseling Psychology and Founding President, The Seattle School of Theology and Psychology

“What does a lived-out faith look like in the throes of an African field hospital? In a world of disease, death, and brokenness—of broken promises—how does one live as a light to the world? The answers to these questions are to be found in the pages of this honest book.”
- Michael Card, Songwriter, Bible teacher

COTW: Hip Dislocation

By Jason
We have not posted any "Cases of the Week" (COTW) lately, despite the fact that every week we are all presented with something that expands our minds and keeps our noses in the books.  So much of what we see are common diseases/injuries that present long after they started, for one reason or another, which makes them more difficult to treat.
This case is no exception. It was a young man in a car accident who had a posterior hip dislocation.

We see these once every month or two.  But this one had occurred several weeks before he came to the hospital.  I remember years ago when I treated my first patient with a hip fracture, I looked in a great book called Primary Surgery, which gives incredibly poignant advice on most anything a surgeon would encounter in a developing world hospital and how to treat it with limited resources.  The picture that accompanies hip dislocations is below:

This seems to imply that putting the hip back in the socket takes about as much force as patting a dog on the head.   I have found that this picture grossly under estimates the amount of force necessary, especially for a hip that has been dislocated for a few weeks.  For our patient we gave a spinal for complete relaxation (sometimes we can do it with just sedation).  Then we tried pulling up on the patient's leg while he was on his back (this often works, but requires a pretty strong back on the part of the healthcare provider it requires moving the patient to the floor, so that no one would fall off the bed.  See poor example below.). 

When that didn't work we flopped the patient back up on the OR table and progressed to the maneuver in the first picture, but we couldn't generate enough force.  So finally we had a medical student sit on the patient's calf while another held the ankle and then did some gentle rotations, swinging the patient's leg back and forth and then we heard it - the wonderful clunk of a reducing joint.  Maybe this can be named the "Kibuye Method for Reducing Hips" in the next edition of Primary Surgery!  The patient did well and was eventually able to walk again without any difficulties.

Zigama Mama

Zigama Mama logo, designed by Carlan

by Rachel

I've always been interested in the idea of public health.  People have likened the idea of medicine in the developing world (or elsewhere) to pulling drowning people of of a raging river.  Public health is going upstream to figure out why so many people are falling into the river in the first place.  Of course, if all your time is spent saving the drowning, it's pretty hard to find the time to pull yourself away to take a walk upstream.  Important and necessary, but challenging to prioritize none the less.

After six years here, Eric and I decided to take that walk.  Ever since the first months here at Kibuye, I have been noticing a huge amount of uterine rupture (UR) cases.  They are very rare in the US, but we have about 20 cases per year here (Side note for the medical folks: I looked at cases of UR from 2015-2017 and found 55, which is over 1% of our deliveries. !!??  Only about 50% of there are on uteri with previous scar.  So we have a huge amount of UR on unscarred uteri, which is pretty rare in the medical literature.  Harder to prevent for sure...).  A big risk factor for UR is labor after a previous Cesarean section.  Everyone in the health community "knows" this, but given broken systems and difficulty in education, many women who are at risk for UR continue to labor at home, in their villages, way after their due dates, instead of receiving a scheduled C-section or coming in to the hospital to deliver under surveillance.  Some show up with three previous C-sections, in labor, and don't even know their due date.  If only we could find a way to get these ladies to come in sooner, to decide if a C-section is the best decision, and to choose a date for that C-section, maybe we could prevent some of these cases of UR.  At the very least, we can decrease complication rates of infection, hemorrhage, fetal distress, etc, which are all higher in women with emergent vs scheduled C-sections.

Enter, Zigama Mama.  This is technically Kirundi for "protect the mother."  Our Burundian friends say that's not exactly the way they would say it...but we decided to use the phrase anyway given its catchy nature! :)  Our hospital is the referral site for 17 health centers in our district.  Any woman needing a C/S or increased surveillance would get sent from them to us, which also explains why our C/S rate is about 30% of our deliveries each year (instead of the national average of 6%).  The idea of Zigama Mama was to look at all of our C/S data from the health centers for one year, then do a training session for the nurses at the health centers.  The intervention is simple:  every woman with a previous C/S, even one, gets identified by the nurses, written into a register, and then she gets a "coupon" for a free ultrasound at Kibuye.  While ultrasounds are recommended in pregnancy, they are cash pay ($5) and most women can't afford them.  So, the free ultrasound is the incentive to come to Kibuye, where I can confirm their due date and decide if a C/S is indicated or not.  If yes, I schedule it.  If no, I encourage the women to come to the hospital (not the health center) for monitoring as soon as labor starts.  That's it.  We'll look over the next year to see if our rates of emergent C/S and UR decrease.

Training on Postpartum Hemorrhage, using resources from Laerdal Global Health

We had the initial training session last week.  Honestly, I wasn't sure how it was going to go.  Eric made up a schedule that involved a start time of 8:30.  At 8:30 on Thursday morning, only one person (out of the possible 35) was there.  However, people trickled in over the next hour and in the end, 16/17 health centers were represented!  We presented the rationale for the program, the nuts and bolts, and then had several hours to do some training for the nurses on post-partum hemorrhage and neonatal resuscitation, as well as share a meal together in the canteen.  It was great to see our Burundian doctors coming in to help out with the hands-on training programs.

We divided up into groups to practice techniques on a uterine model for treating PPH

Dr Ladislas, one of the Burundian docs on my service, also did a great job leading one of the groups

On Monday morning, I actually already had four ladies show up with their Zigama Mama coupons!  I'm excited to see how this intervention can have a positive impact on the health of women in our district.  There remain so many barriers to access to care, but hopefully, little by little, we can chip away at them.

The Zigama Mama ultrasound coupon

Kibuye Couture

By Julie Banks

Zeke, Julie, and Liam

When you come to Burundi, one of the first things you will notice are the colorful clothes.  Especially in our rural village of Kibuye, it’s quite rare to see a woman dressed in “western clothing.”  Women normally have two pieces of fabric that make up their daily clothes.  They wrap one piece around their waist as a skirt and the other serves multiple purposes: a shawl, a baby carrier, a towel to clean messes, a make shift sack to carry potatoes, and more. 

The fabrics are absolutely mesmerising! Bright statements of joy radiate against a sometimes dry and dusty background. 

It didn’t take long for us to want to join in with these beautiful people and try on these bright colors!

Greg, Anna, Alyssa, Heather, Keza, George, Abi, Madeline, Micah, and Susan

Fabric is sold in pieces that are 1x4 meters.  It's a wax-covered cotton which has a slight stiffness and a nice sheen.  The fabric supplies are constantly changing, so if you find one you like, you better buy it quick or you may never see it in the shops again! 

These little shops are found in the town of Gitega and in the city of Bujumbura.  Each shop is maybe 2x5 meters large where they sell fabric and sew on a few machines that sit outside.

Selecting your favorite pattern and colors is no small task – so many choices! 

Shopping for fabric can be a little overwhelming as you have to negotiate the price (normal in this culture) and we often draw a crowd of curious onlookers eager to see what we are buying.

After we buy our bright fabrics, it's time to talk to our favorite seamstress, Mama Mugisha.

This sweet woman is Dina, but everyone calls her "Mama Mugisha" (moo-ghee-shah).  She is an atelier or seamstress/tailor.   Incredibly talented.

Mama Mugisha is so fun to work with.  She is creative, confident, and highly skilled!  I love scrolling through Pinterest with her asking, "Est-ce que vous pouvez faire ça?"   “Can you make this?  Can you do that?”  She always says, "Oui!  Je vais essayer!"   “Yes!  I will try!”

There are, of course, no thin paper patterns sold in nice little envelopes here.  But Mama Mugisha can simply look at a photo or drawing, take our measurements, and then come back a week later with a finished product really close to, if not exactly, what we ordered!

Kayla designs the cutest clothes!

No patterns.  No electricity necessary.  Mama Mugisha's team works with sewing machines that are powered by a foot pedal – maybe like one you could find in an antique shop in the States.

Logan and I recently asked Mama Mugisha to make scrub tops for our physician supporters in the Missouri Association of Osteopathic Physicians & Surgeons.  They wore them with pride while Logan spoke at their annual conference in April.

Missouri Association of Osteopathic Physicians & Surgeons

When I asked Mama Mugisha to make a large order of shirts for us, she clapped her hands in laughter and hugged me saying, “Now you are my little sister.  You are family.  Because of you at Kibuye my children can have an education and the people who work for me can send their children to school.”

So it’s a win-win!  We and our friends get to wear these beautiful Burundian clothes, and she and her family (and her workers' families) are blessed in the process!

Me showing pictures of people wearing Mama Mugisha's creations to her husband.  He was so thankful for us, and impressed with his wife's work!

From Kibuye kids to adults, we all love incorporating the local fabrics into our wardrobe!  We try to have fun with what we wear and not take ourselves too seriously.  Here are a few snapshots of us in our finest Kibuye Couture!

Burundi Day at KHA

Zeke, Biniyam, Sam, Liam, Ben

Jonah bringing Kibuye Couture to RVA's Spring Banquet (with Ella & Matea)

Stephanie made graduation caps out of this beautiful fabric for our 8th grade grads and for Scott who completed his Masters degree.

Anna, Scott, Ella

We love twinning!

Alyssa and Alma 

Logan and Julie

Matea and Ella

Susan and Alma

Team Triplets!  Alyssa, George, and Abi

One Sunday I showed up at church matching two friends from the village!

So, whenever you come to Kibuye, we will take you fabric shopping and let you meet the marvellous Mama Mugisha!

Wilderness Medicine Club

(by Greg)

The children on our team get a great deal of exposure to the practice of medicine.  Many of them have physicians or nurses for parents.  Their neighbors (and therefore "aunts and uncles") are healthcare providers.  They get regular opportunities to visit the hospital, and occasionally to do a bit of light wound care.  And now, thanks to Wilderness Medicine Club, some of them know how to suture, how to evaluate for cervical spinal cord injuries and what to do in case of a snake bite, grenade attack, tornados and bear encounters, among other things.  Because you can never be too careful.

Alyssa and I signed up to lead a twice a month Wilderness Medicine Club over the past several months for three of the middle schoolers.  It was a lot of fun, using a combination of didactic teaching, workshops, clinical scenarios and YouTube videos.

This was day one of their training.  They wandered upon this poor victim who had apparently just experienced a head trauma .... while opening a bottle of ketchup.

On the final day we held a "mega-code" creating the perfect storm of disasters to which the students had to respond.  Jimmy the mannequin (who normally lives in our closet but occasionally makes an appearance to frighten team children or our house helper) was minding his own business, walking along the edge of a wall (which his parents had told him not to do), when he took a nasty tumble, had a head injury, then went into cardiac arrest, then (after being successfully resuscitated) was found to have an open tibia fracture.  And then, wouldn't you know it, a snake came out of nowhere and bit him.  We opted out of adding in a tornado scenario, as they are quite rare in Burundi.  

Some of the smaller children came across this traumatic scene and were very curious.

No scar revision will be needed for this banana!