We’re not the best people for this job…

(by Carlan)

…our students are.

As we say “au revoir” to another group of bright, talented med students it strikes me again how true that statement really is. To watch how natural they are with patients, how easily the adopt the role of educator and advocate, how quickly they laugh and make everyone around them laugh fills me with a profound gratitude for what God is doing here and that we, a ragtag group of knuckle-headed missionaries, get to be a part of it.

One of my attendings in residency liked to say, “If a picture is worth a thousand words, a video is worth a thousand and one words” (to discourage the use of movie clips in grand rounds presentations). Though I would never contest the wisdom of such a seasoned medical educator, I humbly submit to you the following film, prayerfully intended to convey in sound and image what we are hoping to be in word and deed.

Please click here if you can't see the embedded video above or just want to see the bigger, higher definition version.


Teaching Bioethics

(from Eric)

For the last 3 sessions of the Christian Philosophy of Medicine course, I had our students break into groups of 3 or 4 and present the following cases.  Very interesting discussions ensued.  Just for those who are curious, here were the 8 cases presented, 7 of which are more or less based on true stories we have experienced in the last few years (the exception is the Ebola case)

1. A man comes to you, admitting to having visited a prostitute last week.  This week, the prostitute texted him, saying that she is HIV+.  He wants an HIV test.  It is negative, but you explain that it takes weeks to months to convert an HIV test.  He is married, and does not want to tell his wife, because he regrets his actions, but knows that his marriage will be over if he tells her.

2. A patient is hospitalized on the service where you are the doctor.  1 day later, he is confirmed to have Ebola.  Your service has 3 nurses, 1 man and 2 women, all married, and one woman has 3 children.  None of them want to treat the patient, being afraid of contracting Ebola.  The hospital has decided that only 1 nurse will treat the patient, to limit exposure, and it is for you to decide who.

3. A 70 year old lady presents in a coma, and is put on a mechanical ventilator.  The next day, CT of the brain shows massive cerebral hemorrhage.  Recovery is impossible.  She is a widow with 2 sons that are present.  One wants her to remain on the ventilator, in whatever circumstance, which could be months.  The other wants to withdraw care of the ventilator, given that she will never survive without it.

(This is the most "American" of the cases, and as I have seen before, most Africans consider withdrawing care a form of euthanasia, a terminology distinction which I discourage, since I don't think it helps them to discuss the issue with others.  It always highlights to me the difference in thinking about such a case and experiencing such a case.)

4. A 75 year old man presents with epigastric pain and severe anemia.  He is transfused and endoscopy shows an unresectable gastric cancer.  Before rounds the next day, the patient’s son comes and asks you if it is cancer and if it is treatable.  You explain what was found, and he asks you not to tell the patient, because it would cause him to despair.

5. You are the medical director at a hospital where there is one unit of O-neg blood left, and none at your referring blood supply hospital.  You have a 5 year old girl with severe malaria in respiratory distress with a hemoglobin of 2.5.  At the same time you have a postpartum lady with a hemorrhage, now controlled, mother of 5 children young children, who has a hemoglobin of 3 and a blood pressure of 70/30.

(This is one of the most common scenarios.  In fact, right after the discussion, someone came to interrupt the class to tell me we had a patient in an eerily similar situation.  However, I'm not sure there's a real good way to talk about it.)

6. A mother of 8 is hospitalized for a C-section for baby #9 at the same time that baby #8, age 15 months, weight 3.5 kg is hospitalized for severe acute malnutrition due to family food shortage and poverty.  The mother agrees to a tubal ligation, but the father refuses.  The mother asks you to do it and not tell the father.

(This generated the liveliest discussion, which was a lot of fun.  I had to cut it short.)

7. A 30 year old woman comes with severe anemia and respiratory distress after a femur fracture.  She needs blood and surgery to survive.  Your hospital has a policy of paying a deposit before surgery due to a high rate of repayment.  The patient cannot pay.  What to do?  The following week, the medical committee is meeting, of which you are the president.  Your hospital has not been able to pay salaries for the last 2 months.  Do you try and change the pre-payment policy?

(Also common and relevant, but pretty painful to talk about.)

8. A 40 year old mother of 3 children has HIV and is on ARVs (antiretroviral therapy).  She started the ARVs 18 months ago, and has been getting slowly better, despite a hospitalization for dysentery.  At this visit, she says that she visited a prophet on the border of Tanzania last week, who prayed for her healing from HIV.  She believes that she is now healed, and has stopped her ARVs.  She does not want to be retested, because she already knows by faith that she is healed.

(This one was harder to discuss than I anticipated, and maybe could be given more time and depth the next time around.)


My Adventures in the Local Primary School

by Jess Cropsey

The Kibuye primary school is located right next to the hospital, but what goes on at this place has been somewhat of a mystery.  We’ve enjoyed stopping by from time to time to watch the after-school drumming practice, but usually try to avoid that area around noon when school is dismissed and swarms of children are all over the place.  I’ve had an interest in being involved there somehow, but haven’t felt like I had any extra reserves for that until recently.  A few months ago, I started dialoging with the principal (who also was one of John’s surgical patients) about being involved with teaching English and we tossed around a few possibilities.   

In the end, it was decided that I would teach the two 2nd grade English classes twice a week. In addition to their regular subjects, students study Kirundi, English, French, & Swahili, so the teachers have a high bar but very few resources to help them in their lesson planning or for classroom activities.  It’s a good day if each kid has a notebook and pen.  When I pulled out my pack of colored notecards, there were many “Yooooos!” uttered throughout the room.  The teacher was even straining to see the pictures from Dr. Suess’ ABC book.  The hand puppets that I used to model a simple dialogue almost put them over the edge!  With nearly 70 students in each class, it’s difficult to find ways to give everyone a chance to practice, but I’m learning to be creative.  Group/pair work is a foreign concept, so we’re slowly trying some new things.  I have really enjoyed this opportunity and it’s definitely a highlight of my week to walk into those classrooms and hear a resounding chorus of “Good morning, Teacher!”  

I also discussed with the principal the idea of enrolling Sammy in the pre-school class, primarily for the purpose of giving him the opportunity to learn more Kirundi and develop relationships with Burundian kids.  When I had back surgery right at the beginning of the school year, life got a little hectic and I thought I had missed my chance.  As it turns out, I was talking to the principal several weeks later and found out that they were in fact just beginning class that very week.  I decided to give it a shot.  I went to the parent meeting and was told about the “uniform”, which is any red shirt (orange or pink are close enough) with dark pants, and materials that they would need for class (a pen & notebook).  The following day we arrived for the first day of class.  Sammy was eager enough to go, but not too keen on me leaving him by himself.  I was also hesitant since I had no idea what was going to happen, so I stayed.  For the first week, there was no classroom available, so we sat outside on some mats.  They have absolutely no toys, games, or materials (Sammy’s 16-pack of crayons caused quite a stir), so the teacher did some listen and repeat exercises aimed at teaching the names of various body parts (primarily for our benefit, I assume).  The class kept Sam’s attention span for about 45 minutes and then he was ready to go.  I thought that was not too bad for a just-3-year-old boy, so we said our goodbyes and went home.  Over the last few weeks, we have had lots of positive experiences interacting with the other kids in the class and it’s great Kirundi practice for me.  For a variety of reasons, it has become clear to me that I need to stay in class with Sammy.  Expectations here are very different.  Nobody seems to be concerned about leaving a class of twenty 3 to 6 year olds completely unattended for 45 minutes until the teacher arrives.  After a few trial classes, I have decided on a 3 times a week schedule with the goal of 1-1/2 hours each time.  So far, so good.    

This school weighs on my heart as I see the brokenness and long for better opportunities for these kids.  Yet, it feels impossible.  How can the cycle of poverty, lack of resources, etc. ever be broken?  Please pray for me & Sammy as we develop relationships with students and staff at the school.  Pray for wisdom as we look for ways to be a blessing.  And pray for these kids and teachers to find creative ways to meet the many challenges that they face.  My prayer is that Kibuye Primary School will become a model of educational excellence in the years to come.            


COTW: Duct tape fixes everything

(New perspectives on our life and team being almost invariably a good thing, both for you our readers as well as for ourselves, we are happy to welcome Greg, our visiting anesthesiologist, and his reflections.  He and his wife Stephanie host a family blog, and you can find the link on the right sidebar.  -Eric)

Last night, my wife heard a knock at our kitchen door.  It was one of the medical students.  “Duct tape! Greg said you have duct tape!” she told him that she had returned the duct tape to the other visiting missionaries who had the foresight to bring such an essential tool.  And off the med student ran to find the duct tape. Now, we are relatively new to life among the Mcropders, so this would fall within the category of “new experiences” for us.  I have never before had to send a medical student to my house to get duct tape to make my anesthesia machine work.  

My name is Greg, and my wife, three children and I are serving along side the Mcropders in Kibuye for 9 months.  Yesterday evening, I was outside searching for an internet signal, when one of the hospital employees found me and handed me a note.  There was a 5 year old girl who had just arrived in the ER with multiple machete wounds to the head, inflicted by a “crazy person” in her village.  She had a skull fracture and was in a coma.  Agneta, our visiting surgeon from Kenya, had evaluated her and decided she needed to go to the operating room immediately for a decompressive craniotomy and exploration.  They called me because I am the visiting anesthesiologist.  

They have been doing surgery at Kibuye for many many years.  However, it was not until after I arrived 2 months ago, that we starting performing surgery under general endotracheal anesthesia.  Before yesterday, we had done a total of 4 general cases.  This very hurt little girl would be the fifth.  So, I went to work preparing the anesthesia machine, connecting it to the air compressor, then connecting it to the oxygen cylinder.  Unfortunately, this time, there was a large leak of oxygen around the connection between the tank and the machine, making it impossible to maintain pressure in the machine.  Sadly, I did not realize this until after the child was intubated on the OR table.  We managed to limp along until the student could return with the duct tape which we used to position the tubing at just the right angle to minimize the leak ... but it was not pretty.  In fact, it looked a lot like a sophisticated medical device ... held together with duct tape.

Back in the US I don’t see many craniotomies on 5 year olds, but I have to say, I was astounded by the work that Agneta did.  The child’s skull looked like a jigsaw puzzle.  Agneta, somehow took it all apart, repaired a dural tear, controlled the bleeding, and then reconstructed the puzzle, using Jason’s Dewalt drill and multiple sutures.  The girl remained stable throughout surgery, and was extubated (breathing tube removed) at the end of the case.  This morning, she remains in a coma but is otherwise stable.  We are praying that as the swelling in her brain subsides over the next few days she will wake up and make a full recovery.  

We are all so grateful to have had Agneta here this month.  She was trained at Tenwek hospital, with Jason as one of her teaching attendings.  She has a brilliant mind, gifted hands and a compassionate heart.  It has been massively encouraging to spend this month with someone who has benefited so much from the desire that God has given the Mcropders to teach and train African physicians.  Sadly, she returns home tomorrow.  And I can’t help but think that if this little girl had come in a few days later, she would have had little to no chance of survival.  We praise God for His gracious provision for our team, for our hospital and for this little girl.


Testimonies from our Medical Students

(by Eric)

Some things are easy to write about.  And some things are just as (or even more) important, but hard to write about, so they feature less in the blog.

One of the core items of our work here is the education and discipling of Burundian medical students (some are also from other countries in the region: Rwanda, Congo...).  It's a primary reason we're here.  As Carlan put it, "We're not the best people for this job.  Our students are."  Burundi has one of the lowest doctor/population ratios in the world, and these students form part of the remedy for a country with no to minimal access to quality health care.  So, we educate them.  Day in and day out, we are surrounded by uncomfortably large crowds of students.  They are bright and talented, and they are learning.  They will be a tremendous blessing wherever they are.

But what will they do?  What will guide them?  Will a good education be a ticket to a land with less need, or a way to simply increase personal prosperity, or will it be a calling, a gift of God for his purposes and not their own?

And this is discipleship.  Less tangible.  Harder to measure.  Like many less-tangible and hard-to-measure things, it is among the most important things of life.  We lead bible studies.  We teach classes.  And more than anything, we live side-by-side with them, and in our brokenness, God's grace shines through.

Currently, we are coming to the end of a 4-month stint with 34 medical students.  I will try to share a couple testimonies from them.  It is fitting for an American to write about this, just before Thanksgiving, since we are very thankful for these students, for their testimonies, for their growth, and for the opportunity that we have to be part of their lives.

Last Thursday, at our most recent bible study, 4 students volunteered to share testimonies.  Normally, these are incredible stories about the students' lives growing up, losing parents in wartime, being put in jail, unexpected deaths of siblings.  But this time their testimonies were about their time here at Kibuye. Here is a summary:

One young lady spoke of how she had neglected the church for several years, being sure that God was with her when she did good deeds.  But she was haunted by never doing enough, and every year she would promise God that next year, she would do better.  She said that here at Kibuye, for the first time, she knows that Jesus loves her, not because of what she does, but because of his love.  And this is transforming her.  She said that here she saw a miracle:  humble specialist doctors.  (This is a theme we have encountered.)  Doctors who care more for their patients, doctors who pray with them, who lead worship for the staff to sing.

Another lady spoke of how her time with the student outreach group has transformed her.  I love these stories.  The students from the city are often quite shocked by the poverty here, and form a Christian outreach group, to pray for their patients in the evenings, share with them, and collect money to buy them food or maybe medicines.  This is independent of us missionaries, which is probably the best kind of testimony.  =)  She spoke of how nervous she was going out to talk with these patients, but how the patients put her at ease, and with time she has grown in her capacity to pray and share with them, more than she would have imagined.

The next day, after the final lecture that I gave in the Christian Philosophy of Medicine course (this one on facing suffering), another student asked to talk to me.  She said that, prior to coming to Kibuye, she saw medicine as a job.  She wanted to do the right thing for her patients, to avoid her supervising doc pointing out her misdeeds.  But now, for the first time, she thinks she loves her patients, and she wants to treat them because she has found a new care for them inside her.  She said she now sees medicine as a calling, and is trying to figure out what God is calling her to do.  She wanted to know about missionaries.

After arriving here, she kept asking her friends what these Americans were doing here.  They gave such answers as "Maybe they are just adventurous tourists" or "Maybe they've always wanted to live in Africa" or my favorite "Americans do all sorts of weird stuff!  Who knows!?"  But she said, those answers didn't pan out.  We had our little kids with us (another common theme), and she couldn't even imagine bringing her little kids up to the country from the capital.  She recognized that we were here to try and follow God, to serve Burundi and to see him glorified here.  She wanted to know how we decided that was what God was calling us to do.  So we spent an hour talking about how much potential she has to glorify God in her country, about keeping our eyes fixed on Jesus, and about exploring possibilities with her church to join together and maybe send out some doctors to serve.

These words are joy and life to us.  We know that we live out these things so misshapenly, with so little grace, and often so much frustration.  And yet we believe ardently that here, seeking God and his will, we can all together find the source of life and of joy.  And so to find our students recognizing this same true source, is a great encouragement.


Operation Christmas Child

Well, it appears to be "shoebox" season again.  Our team is obviously closely connected to Samaritan's Purse, and as part of our Post Resident Orientation we DID get a tour of the OCC headquarters, but my history with the shoeboxes goes back to college.

One of the campus ministries I was a part of in the Twin Cities took an evening in December back in 1999 and volunteered at a SP collection center.  Inside the warehouse, there were thousands and thousands of donated shoeboxes ready for reviewing and packaging.  My job was to open each box, make sure that there were no inappropriate items inside, and then send it down the conveyor belt for packaging.  It was fun to see what people placed inside their boxes and imagine the look on a kid's face when they received one of the first gifts of their lives.

Fast forward 15 years.  I don't think OCC has ever delivered to our region of Burundi, but hopefully someday.  As I look around at all the Burundian children here at Kibuye, I am always struck by how little they have.  Toys are literally sticks and bits of trash.  Alyssa tried to do a developmental evaluation of kids and realized that no kid under school age knows how to hold a pencil because they don't have any.  No crayons, no markers, no pencils.

So with that in mind, I thought I'd compile a brief list of things that I think would be awesome gifts to include in your shoebox this year.

1.  Baby dolls (for girls).  I had no idea the kind of uproar that Maggie's Baby June doll would create when we took it out of the house for the first time.  The local kids loved it.  Toby's babysitter loved it.  I took it up to the hospital to use as a delivery model and everyone stared and wanted to touch it, including the nurses (one took it and I wasn't convinced she was going to give it back!)  It seems like no one here has ever seen such a thing.  So, girls of all ages would love a little doll, bonus points for dark skin.

2.  Matchbox cars (for boys).  Small, fun, hours of entertainment.  We would pass these out at Tenwek sometimes and kids confined to their beds would run the cars all over the bed for hours at a time.

3.  Crayons and paper/coloring books (see the above comment on holding pencils).

4.  Picture books.  I wouldn't have thought of this one before, since most books are in English and most kids in the shoebox distribution areas don't speak English.  But again, when a kid has nothing, no books in ANY language, picture books can be an amazing past time.  For example, we bring the Jesus Storybook Bible to church many weeks and draw a crowd of kids every time we open it.  The pictures are beautiful, there are tons of them, they tell the story of Jesus, even without understanding the words.  And the JSB isn't that expensive, less than $20 on amazon.

For more info on the OCC program, check out www.samaritanspurse.org  


Happy (Second) First Anniversary!

by Rachel
Part of the deal with our transient lives as of late is that we have a lot of first anniversaries, but no second anniversaries.  We are hoping that this phenomenon will change for us now that we are settled in Burundi.  November 1 marked one year from our arrival to Kibuye.  So, while we have already had our one year in Burundi anniversary, there was much happy reminiscing on Halloween 2014 that one year ago we had been packing up and preparing to leave Banga for language study.

Coming to Kibuye felt like paradise in some ways, the freedom of having our own place, running water, steady (steadier) electricity, putting down roots.  A year later there are days when it feels less like paradise, but never the less all of us are still so grateful to be here.  So many changes in this one year.  Three homes have been completed.  We have been working in the hospital for 10 months already.  The kids have completed a school year and started another.  We've gotten to know our house helpers and even to communicate with them in Kirundi (some of the time).  This year, we also have new temporary teammates, and team gatherings are getting bigger and LOUDER all the time!  It's starting to be ... home.  

We look forward to another year of changes as 2015, and we also look forward to celebrating our first SECOND anniversary as the McCropders at Kibuye.  It has been a year of blessing and increased dependence on the One who led us here, and He will continue to lead for all the years to come.