A Fanta to End the Mourning

(by Eric)

Last week I received a text.  It was from our friend Pastor Luc, who is the assistant administrator at our hospital.  It said that he unexpectedly lost his mother that morning.  I was saddened for him, and touched that he would think to text me at a time like that.  Luc is a very solid guy.  When we first arrived, he drove us around to introduce us to the local administrators and the chief of police.  In light of our coming, he convinced them to add two new police officers to the Kibuye campus.  During a rain storm a few weeks ago, I was trying to get an urgent message to him, but the cell connection was cutting out.  Next thing I knew, he was at my door with a big umbrella and some rainboots.

Sunday marked the seventh day since her passing, and we were invited to a traditional gathering to mark the end of the initial mourning period.

An aside:  As I share impressions of Burundian culture, I'm sure that I'm getting things wrong sometimes.  I'm sure I will be able to re-read this in years to come and think "Wow, I really didn't understand that at all."  In a sense, I hope I will, since that will mean that I've grown in my understanding of this world around us.  But I will share it as I understand it, nevertheless.

We drove out in a little caravan of about 5 vehicles at 1pm.  Everyone was in a suit.  We left the tarmac after a few minutes, but the dirt road remained good.  Luc was in the car in front of us, and was frequently stopping to pick up more passengers.  It was obviously getting full up there, so we signaled that we could take some as well.  We arrived at the parish church, which has a gathering area.  A young mentally-handicapped guy came out and immediately hugged the three white guys in suits, and insisted on introducing us to various even-now-unidentified people.  There were a lot of hospital acquaintances there, and so we chatted a bit.  After a while, they showed us to a shaded area, and gave us the benches of honor, to the side of the head table where the family sat.

They passed out your choice of soda: Fanta Lemon, Fanta Orange, Coca Cola, or Schweppes Tonic Water.  We all enjoyed a beverage, and sang a few hymns.  Then Luc made a short speech, as did another guy from the crowd.  Then they passed out the envelopes.

The envelopes are for donations.  The donations, as I understand it, are for the payments of the debts of the person who has passed away.  In a sense that seems harsh, to come knocking for a debt after a death, but in a land of a lot of debt, and no small amount of death, it's probably necessary to have some security in the lending process.  We were told that, for older people, there is usually a second such ceremony during the dry season, since other people will then come from further away to collect further debts.

This is still uncomfortable territory for us, and probably will be for a long time.  As Americans, the purest friendships are void of financial matters.  We just like "being together".  Africans tend to value interdependence and solidarity in lieu of independence and "freedom".  So, being a part of this process assures them that they are integrally linked into the broader community.  That being said, we're still Americans, and so we feel the discomfort.  However, we took an envelope and tried to guess what would be appropriate for our friend, comforted by the fact that his character assures us that he will steward whatever gift well.

People came and brought them up to a little conical basket which is typical of Burundian style.  Then, before we knew it, they were closing the basket, and we three had to rush up and put in our donations before it was too late.  Thus ended our dream of inconspicuously participating in community life.  There was gentle laughter, and we sat down, chatted some more, shook a bunch of hands, and made our way home.


Case of the Week: Acute Flaccid Paralysis

(By Alyssa)

I met Claudine on one of the first days I rounded on pediatrics. She was 4 years old and I was immediately struck by how sick she was. She had been admitted severely anemic (Hemoglobin of 3) with a diagnosis of malaria. As she was comatose and had had several seizures, she was also treated for meningitis. She had already received a blood transfusion and a couple days of IV medications by the time I saw her but she was still completely unresponsive. She required intubation and mechanical ventilation but that’s not possible here. I spoke with the family explaining the gravity of her condition and we prayed with them together as a team. I alerted the on-call doctor and asked him to keep a close eye on her - he was called to evaluate her several times due to high fever, difficulty breathing, and seizures. I really didn’t expect Claudine to survive. But each morning I came back to pediatrics and found her still there. She began to open her eyes and look around the room. But she still didn’t speak or move. We discovered one day that she actually could follow commands with her eyes. But she was completely paralyzed to the point of being unable to swallow or speak. Possibly a post-infectious Guillian-BarrĂ© syndrome, possibly something else. We needed to give her nutrition somehow as it had now been over a week since she had been able to eat or drink anything. I discovered some pediatric nasogastric tubes in the back supply room. The nurses had never placed or used an NG tube before, so I inserted it and explained it to them. But then I realized we didn’t have any formula to put in it nor was there any milk available (cows produce very little milk here) and the family couldn’t afford to buy milk. So I talked with my teammates and the families agreed to donate milk each day for this little girl. Anna even helped me deliver it to her one day. And we taught the mother how to put the milk in the NG tube. After a few days, Claudine regained the ability to swallow, so we removed the tube and she was able to eat. The last day of her hospitalization she could speak very softly and barely move one hand. 

She came back today for a follow up visit and I feared she would be emaciated and still extremely weak. But, amazingly, miraculously, she looked like a completely normal 4 year old girl! Walking, talking, active - I wouldn’t have even known it was her if I hadn’t recognized her mother. I loved sharing this excitement over her healing with the pediatric team as the medical students and nurses rejoiced with us. We praise God for bringing healing to her and for reminding us in this way of His love for these precious children. 


On a Thursday Afternoon

Today the kids and I (Heather) were wondering what goes on up at the hospital on a Thursday afternoon.  We walked up with a camera in case any of you faithful readers were curious as well.
Thursdays at 4:00, Alyssa teaches the medical students how to do pediatric physical exams.  Abigail happily sat in today so that the medical students could practice checking her ears and eyes.

Then we found Carlan as he was walking between buildings on his way to examine a patient.

John was building walls for the eye ward operating room.

And Jason was scrubbing for surgery.  In this operation he actually drained 2 liters of pus from the leg of a 10-year-old girl with pyomyositis.

So that's what we found happening at the hospital at 4:30 on a Thursday afternoon.


First Impressions: Poverty

The blog silence for the last few days is largely a result of us not being sure what to say about beginning work.  Our own processing is so much still in process that it's hard to articulate anything to share.  It's a lot to take in, and one could slice it on any plane.  So I'll pick one aspect, not because it gives a comprehensive perspective, but because it might be adequately bite-size.  The good news is that we're not going anywhere, so if you keep reading the blog long enough, a holistic picture of life at the hospital ought to emerge sooner or later.

Taking care of patients here is hard.  We understand limitations, but we are all hit by a whole new level of limitations.  One of the largest of these is poverty.  This is not new, but it is at a whole new level.  According to GDP, Burundians on average make about 1/3 of what Kenyans take home.

Example:  Rounding on the medical service yesterday, and we see a man in his 50's with urinary obstruction.  We can determine that it's due to his large prostate.  That part doesn't cost anything (ask your neighborhood urologist why).  Jason can take his prostate out.  Great!  We can help this one.  Let's do it!

Problem.  There's a decent chance his urinary obstruction has made his kidneys function poorly enough to be dangerous for his surgery.  And actually hospital policy means he needs a few labs before going to the OR.  OK.  Our lab can check those!  Let's do it!

Problem.  It's too expensive.  It's probably at least $8 to get all those lab tests and he doesn't have the money.  His family is coming tomorrow.  Maybe they will have something…

This is an illustration.  In most other cases, the problem of the grinding poverty here comes into play right at the beginning, so they wouldn't make a very interesting illustration.

Poverty calls everything into question.  "Standards of Care" are almost always income-dependent.  Everything we know of such standards is therefore subject to drastic reevaluation.  This test for this problem.  This medicine for this benefit.  Is it worth it?  Well, what does this cost mean to you?  There is often no straight answer to this question, so it gives us a great sense of "shooting in the dark".  Was that the right decision?  I think so, but how can I know?

And this, of course, is humbling.  Or maybe humiliating.  Sometimes the difference is hard to tell.  And maybe not all that important in the end.  Humility (or maybe humiliation) seems to be one of the hallmarks of our clinical beginning here in Burundi, as it has been throughout our time of language learning.

It's not a new thing.  It's certainly not a bad thing.  But it's hard.  Pray for us as we go.


McCropder Docs Invade the Hospital

(by Eric)
Today, January 2nd, 2014, is the official start of the hospital work of the six McCropder doctors.  We have been involved in various ways in the past couple months, even with some clinical work, operating, and consults, but our Burundian doctor colleagues (and 1 American visiting doc) have continued to work in the hospital, thus allowing us for the most part space to work on homes, community relationships, and language study.
My impression of the community anticipation of this is that it is high.  People are excited to see the white coats, and the influx of more advanced care into this community.  24 medical students are slated to arrive on Saturday, to begin on Monday, this group for 4 months.  There are five Burundian general doctors (no residency training) at the hospital, and for the most part, we have been teamed up with them, to learn the ropes.
We got together to pray last night and talk about excitements and anxieties.  Some thoughts:
-It's been a long break from clinical medicine.
-Are we really going to do this in a foreign language (or two?)
-There is so much that needs to change.  How do we balance being leaders with respecting what has been going on, and not changing too much too fast?
-John is opening a new department today, and will be training his small staff on a brand new type of care.
-McLaughlins' kids will be having some time alone with a Kirundi-speaking nanny each week from now on.
-O God, help us to love.  Whatever we do, let us do it with your love.
-We are so thankful to have come this far, having been shown so much faithfulness by so many friends and strangers, and most of all by a Savior who has loved us and called us to a good work.