A Song for the Day

Today was another smallish size day for the Internal Medicine service here at Kibuye, so I thought I'd give another random sampling of patients.  We had 7 total (i.e. one for each medical student.  Yes, we have a lot of students.  But they are good at learning from each other's cases…)

1. Jean-Phillipe (no real names) is a 32 year old guy with HIV who has been here 27 days.  We've done some good things for him.  We have successfully treated his tuberculosis, and corrected his HIV-med regimen (he was only taking them half the time…).  We've tried to check his CD4 count, but they only send them once a month, and I guess there is a quota, and we missed out last month.  But he still has nightmares and vomiting.  And now he says he looses consciousness.  I'm not sure he would know, because he is always alone.  We've tried everything.  The student suggested some HIV-related brain lesion, which is a good idea, but we can't test for it or treat it.  I talked to Jason and he may get an endoscopy tomorrow.

2. Juvenal is 47, and is his neighbor in the isolation building.  He doesn't have HIV, and is being treated for TB also.  He's a bit better, but not enough, so now we're entertaining concomitant emphysema, given a long smoking history.  He maintains a good spirit despite a long hospitalization.

3. Across the little hall is Luc, a 29 year old taxi-driver with severe malaria: blood in the urine and vomiting.  He was treated with quinine at another hospital.  We brought him in and gave him the exact same treatment, and he is getting better.  I don't know why this happens.  What goes on at those other places?  Are they missing frequent doses?  At any rate, he is looking better, but had a fever last night, and I can't figure out why.  For now, we're hoping it doesn't come back tomorrow.

4.  Rounding out the 4 beds in isolation (all mine for the time being) is Gloriose, a 70 year old lady who came in with dysentery, and sure enough, got better with appropriate treatment.  It's nice to have something go smoothly.  She's going home today with some Cipro.

5.  Gilbert is a 35 year old guy who admits to being a vrai buveur (a real drinker), which might not have been so bad if he didn't also have Hepatitis B.  He's in florid liver failure, and there is not much we can do.  We gave him some diuretics, and drained 4L from his belly.  But then Friday he slipped into a coma.  Honestly, I'm surprised he's still alive.  His coma is a bit lighter, and we're trying to treat everything we can, but he's very sick.  He has a couple faithful friends with him that seem to appreciate that we care about him.  We prayed with them on Saturday.

6.  Marie is 70 years old, and showed up last week all confused.  It seems to have been a bladder infection, and she is getting better with antibiotics.  It's a good simple case for the students, because they can never believe that a bladder infection would do that.  But then, there are only 2 neurologists in the country, and they are long overdue for their neurology course, so it's a little hard to blame them.

7.  Our last girl is Goreth, a 23 year old high school student (due to financial problems, high school often goes until the mid-20s) who came in Saturday:  difficulty breathing, semi-conscious, big swollen legs, and distended neck veins.  Sure enough, we did an echo of her heart, and found severe heart failure.  Why?  I don't know, but I suspect bad valves, maybe rheumatic, based on her echo.  She had a low blood pressure when she came in, and almost all such patients die here.  However, she is still alive, and even looks a little better today.  We keep praying that she can get through.

7 cases.  7 individual stories.  We will see how they continue on.  They bump into us.  We bump into them.  Life.  Death.  Healing.  Scars.

A couple years ago, I wrote a song about Revelation 22 called The Leaves of the Trees.  This vision of the heavenly city speaks of a Tree of Life.  But that's not all.  The leaves of that tree are for the healing of the nations.

And sometimes that idea makes me ache.  Because it rings so true.  Yes, we need life, and badly.  Pure unspoiled and unthreatened life.  But we are who we are, wounds and all, and the fact that God would take that in hand, and provide us with healing, in addition to life, strikes me as a beautiful salve.  A key that fits the lock of our brokenness exactly.  There is joy, and there is sadness.  There are scars, and there are so very many moments in which all we do is just palliative.  Maybe even every moment.

But at the end, there is a promise.  There is life and healing for all our wounds.  There is, simply, that which we need.

(to listen, click on the play button.  Download for free.)

WORD (and deed)

(by Eric)

Many years ago now, we chose to title this blog "Word and Deed", and I can tell you that I would have nabbed wordanddeed.blogspot.com if the domain hadn't been already occupied.  (Strangely, mccropders.blogspot.com was still available.)

I think that people probably read what they want to into that title.  The people who want to champion the "Word" will react with "Yeah!  You gotta have Word with the Deed."  Others who want to champion the "Deed" will react with "You bet!  The Deed is just as important as the Word."  And that's fine.

However, the point of the title is that we are committed to the ever-difficult task of holding on to both of these things as intrinsic and important at the same time.  It is not Word for the sake of Deed, or Deed for the sake of Word, but rather Word AND Deed.  We believe that both are essential in God's eyes.

But that doesn't mean that we always have a 50/50 split in each of our days.  It varies from season to season, and some of us are more Word, and some are more Deed.  Since arriving to Kibuye, I would say that Deed has been a larger part of my work.

But these last few weeks, that has been changing.  I have been offered many more opportunities to speak, and I hope that we will always rise when such opportunities come.  Four elements of my week:

1.  This past Tuesday in Bujumbura, the Christian Medical Student Fellowship held the first annual Christian Health Care Providers Conference.  It was a great time, very encouraging, and we decided to take the van down for the day, including 8 medical/nursing students and two of our Burundian docs.  The morning of departure, I was asked to give some closing remarks, and so I spent the drive down working out with Alyssa what to say.

2.  Thursday evening, I lead my half of the med student bible study, which takes place every Thursday night.  This has been a great way to develop ideas on a more in-depth basis, and yesterday we talked about legalism in the church, which is a very a propos topic for anyone, but maybe especially for us here.

3.  Friday morning, I took the plunge and spoke for the first time at hospital devotions.  The bishop of our partner church here has apparently voiced an opinion that a high priority for the church here is to really learn what it means to find salvation in God's grace, and not in the good works we do.  We have found nothing in our experience that suggests otherwise.  Quite on the contrary.  So I spoke on Philippians 3, and where we put our confidence.  

4.  And then, just a few hours later, I spoke for our Friday afternoon lecture.  Our med school's curriculum has a curious little course, required for all students, called "Christian Philosophy of Medicine".  We were asked to teach half of it (10 hours), and our subjects will include:  Imitating God as a Physician, Medicine in the Kingdom of God, Vocation, Holism, Evangelism, Facing Limits, Facing Suffering, and Bioethics.  

It's an exciting opportunity, because the junction of medicine in faith is an interest that runs straight down the middle of our time.

So we speak.  We discuss.  It is Word, and it is Deed.  Pray for us, that we would speak truth and speak it in love.  Pray for those who hear, that it would edify them.

One Hen and other African Children's Stories

(from Heather)

For anyone who is interested in children’s picture books highlighting African children and African cultures, here are three of our favorites which might be available at a local library.  Our elementary school-aged kids particularly like these books, all of which are based on true stories, and all of which have fantastic illustrations.

One Hen: How One Small Loan Made a Big Difference - by Katie Smith Milway – a fun look at micro loan enterprises through the story of a young boy in Ghana who gets a chicken and an idea.

I Lost my Tooth in Africa – by Penda Diakité - the experiences of a girl visiting Mali, West Africa, with themes of losing a tooth, raising a chicken, experiencing a different culture, and traveling to and from Africa.

The Boy who Harnessed the Wind – by William Kamkwamba and Bryan Mealer - a true story of a boy from Malawi whose ambitious ingenuity helps him overcome obstacles.

Landscaping 101

by Rachel

Now that two houses are completed (the Cropseys were able to move in to their place several weeks ago, hooray!) and two more are well on their way (Alyssa's house is getting cabinets and closets, almost done, and the Faders' house has a roof), we are turning our attention more to the surrounding landscape.

Ogden house garden

One of the original houses at Kibuye, the so-called "Ogden house,"  has a grassy yard and many nice flowering plants and trees.  One of the older missionary wives told us that in its heyday, the yard looked like something out of Better Homes and Gardens and it's fallen far since then.  But we still think it's quite nice (and wonder what it USED to look like!).  It gives us an idea of what would some day be possible at the new homes.

poinsettia trees

Ogden house arbor

flowers picked from Kibuye campus

Basically, we built our homes in an undeveloped area, slight hill, mostly scrubby trees.  The McLaughlin house is at the "top" of the property, and there is a gradual slope down to the Cropsey's house, at the "bottom" of the property.  Not being a civil engineer (I think this is who would be the expert) I really have no idea about water systems and retaining walls, but an awful lot of cement and concrete and stone was used to put up walls and gutters and septic tanks and the like.  It seemed like overkill, but then we had three days of torrential downpours at the beginning of October.  It was quite a kickoff to the rainy season, and potentially damaging, as the rains caused stripping of topsoils, floods, and leaks.  It's the kind of rain that can damage crops and cause erosion.  And in our own homes, we were able to see the power of the rain on a muddy hillside.  Over the course of an hour, the Cropsey yard turned into one giant swimming pool, almost flooding their downstairs basement.  There was standing water and mud everywhere.

The original lot before home construction

So the guys got back to work and started relandscaping our yards.  First, they dug holes and installed drainage systems under our wall.  Then they dug trenches across the yards, filling them with stones to serve as drainage fields.  

Landscapers hard at work

Grass clumps after planting

They planted grass…and when I say planted grass, I mean they literally took little clumps of grass and stuck the clumps in hundred of little holes all across the yard (no sod or grass seed here, I guess).  They fixed gutters and roofs.  And after all that, the rains stopped. :)  But probably not for long, as the rains usually continue more or less through April.

McLaughlin side yard, "finished product"

We are also excited about the possibility of having flowers and fruit trees in our yards.  The more greenery we can have, the less damaging the rains will be.  Plus, after cutting down so many trees to build our homes we're feeling a bit like the Onceler from the Lorax, or maybe Sauruman from Lord of the Rings.  We love trees, and hope to replant everything that was lost.  Carlan has started a little nursery of trees/plants, and the hospital has also hired an "agriculturist" to help with the hospital property and our homes as well.  Much has already been planted and we look forward to seeing how things grow and develop in the next 10 years.

Carlan's tree nursery

Carlan supervises the younger generation

COTW: Loss and Redemption

by Rachel

One of the downsides to being a physician in our setting is lack of follow-up.  We don’t have “continuity” patients the way docs in the US do.  I remember one of my attending docs at St. Joe’s, where I did my residency, telling me once that he had just delivered the baby of a woman that he also delivered 20+ years earlier (he had delivered her and now, 20 yrs later, he was delivering her baby, if that makes sense).  Delivering two generations in one career, wow.  Here at Kibuye, I see women for a day or two and then they disappear.  Sometimes there are sad stories, sometimes happy, but I don’t know if I’ll ever know the rest of the story or experience the rest of their lives.

Today I got to experience two stories.  A story of loss, one that I hope will one day experience redemption but that time is not yet.  And a story of redemption that had a history of great loss, great pain, but now joy.  The first woman had been on our service for several days.  She has a healthy 9 year old, but 6 years ago her second baby died just after a C-section for unknown reasons (common here).  Then she had a miscarriage.  Now she was coming in a week after her due date.  We did a few small things to try and get her labor going naturally, but this morning she had a low-grade temperature and had made no progress so we decided to repeat the C-section.  There had been no evidence whatsoever of fetal distress.  My student and I did the C-section and pulled out a very limp, misshapen baby.  There was a heartbeat, but the baby did not breathe.  Minute after minute my colleagues worked on the baby.  She took a few shuddering breaths, but that was all.  I was stunned.  How could we explain this to the mother?  After such a tragedy six year ago, she had waited and waited for this child, only to experience tragic loss again.   What is there to do?  What is there to say?

As we were finishing up in the OR, a second woman came in to the hospital.  Fourteen years ago, she was a teenager in labor.  Long labor.  The baby didn’t come and didn’t come and eventually when she was able to push the baby out, it had already died.  Worse yet, due to the length of the labor, she developed a fistula.  Many of you reading already know what that is (many famous talk show hosts and activists have raised awareness of this terrible problem).  Basically, a woman with prolonged labor who doesn’t have safe access to a C-section can develop a hole in between the bladder and vagina.  It happens because the long labor puts enough pressure on healthy tissue to cause the death of that tissue.  After the fistula forms, she leaks urine constantly, causing her to smell, to develop infections, to be ostracized by her family and community, and sometimes to be divorced by her husband.  

This lady suffered for 10 years.  And then, hope arrived.  The organization Doctors Without Borders set up a training site for fistula surgery in Gitega, 30 minutes away.  She received surgery, and it was successful.  Now, four years later, she arrived at Kibuye, pregnant with her second child, coming for a C-section that is available to her now.  I delivered the baby, a boy.  He was beautifully healthy, with screaming lungs and pink tinged skin.  This woman has waited for fourteen years, and this afternoon she held a baby in her arms.  

That’s the story of redemption.  I didn’t see the beginning of her story, but I’m privileged to be a part of the next beginning, the new beginning.  It was, for me, a day of loss and redemption, so common here in our setting.  Highs and lows, joys and triumphs, successes and failures.  We don’t always get to see the redemption story that we long for, at least not here on earth.  May the second be a story that carries me through the days of loss like the first.  Days that have come, that will come.  May these two women be stories that remind me that someday, all of our losses will be gathered up, all our our tears will be dried, and we’ll see a beautiful picture of love and grace woven together to make up our lives. 

Dogs: A Cross-Cultural Window

(from Eric)

There are no dogs here at Kibuye.  I mean, none.  It's getting a bit weird, because now if we (or especially the kids) see a dog, it's more of a mix of fascination and trepidation than it should be.  Why don't they have dogs?  Doesn't everywhere have dogs?  You can form your own hypotheses as well as we can.

A couple days ago, one of the hospital staff was sharing in morning devotions from Revelation 22, where it says "Outside are the dogs…", referring here (presumably) to a shameful or evil person.  Calling someone a "dog" seems to have the same meaning for Americans as it did for the 1st century church as it does for Burundians.

But that was not the speaker's assumption, and for somewhat compelling reasons.  "Before I go on," he said, "I think I must explain what this means, because I have heard that for Westerners, dogs are good things.  People even consider dogs like their children.  Even better than their children.  So, maybe, when Americans refer to a person as a 'dog', it is a compliment.  We know this is true, because they even let dogs go in their car!  But, for us, you must know, that it is not a good thing to call someone a dog."

Their is a wealth of cross-cultural observation there.  First, Westerners and their dogs.  They are, in fact, a member of the family.  They are well fed and groomed.  They are up-to-date on their vaccination schedules, and if sick, sometimes get very advanced medical treatment.  So, in some ways, the speaker was right:  Often, we do treat dogs as our children.  They do ride in our cars.  In favor of that, God has made these creatures, and we care well for them.  Perhaps the odd thing is why calling someone a "dog" is still derogatory in American English.

Now, the flip side.  When the speaker mentioned that dogs are allowed to ride in cars, everyone laughed, including all the Americans.  John turned to me and said, "Maybe they wouldn't have a dog in their car, but they would have goats and chickens."  And that is the amazing truth.  Americans couldn't imagine riding several hours with your family goat or a couple chickens, but for Burundians this seems pretty normal, and seemingly not at all unsanitary in the way a dog would be.  

Several years ago, Tracy Kidder wrote a book called "Mountains Beyond Mountains."  More than the content of the book, we frequently quote the title, as a way of say "I never dreamed there were this many layers of complexity and opportunities for confusion."  Dogs.  Never thought much about that one before.  I would have put there mostly in the category of "things our cultures have in common".  

Mountains beyond mountains.