Kwikorera

by Heather

This past weekend, on a walk to visit some friends who live in the countryside, we learned about the verb kwikorera.  It might be my new favorite verb in Kirundi. Kwikorera means "to put something on one's head."

Even better, there are in fact two verbs in Kirundi which mean "to put something on one's head," the nuance being the degree of formality with which one carries the object on her head.  The picture at right, informal yet impressive, shows a classic display of kwikorera.  Thousands of Burundian kids carry water from a well in these yellow containers.

The more formal kwiremeka is shown below.  When people go visiting, they bring gifts for the hosts (rice, eggs, fruit, vegetables, or even chickens) in these hand-made baskets called ibiseke.  When the visit concludes, the hosts fill the baskets with return gifts and then escort the visitors back home, carrying the baskets on their heads beautifully and effortlessly, like this:

Of course when we try, it looks more like this, straining, teetering, awkward.  We actually dropped a basket on Saturday, breaking a dozen eggs.  I have given up hope for myself.

Along our walk we encountered various others who were out kwikorera style, including the women and children pictured below.  This is the most common local method of transporting things, it seems, and the items most frequently found on heads around here are:
1. baskets of all sorts, often carrying food
2. boxes with unidentified contents
3. sticks and firewood
4. jugs of water
5. hoes

It looks painful to the neck, doesn't it?  Our experienced friends tell us that it's not painful unless the load is particularly heavy.

I am considering adding kwikorera practice to our children's daily list of chores.

Skills

by Rachel

Eric and I have both been working a bit during our time in the US.  It's been interesting to stick a foot back in the waters of American medicine...interesting and nostalgic and informative and affirming (in many different ways), and sometimes a bit discouraging as well.  Sometimes it feels like my profession is passing me by and I'm losing the ability to practice in the States.  Atul Gawande wrote an excellent book called "Better," which I read several years ago, and as he writes about surgeons who perform better than others and have consistently better outcomes, I worry that in the US my patients would be better served with another doctor.  This is something I don't have to worry about in Burundi because it's just me (that's of course not to say that I don't strive for good outcomes!).

Honestly, working in the US was never part of my plan, ever since deciding on a career in medicine at the age of 16.  After graduating from residency in 2009 until now, I've spent approximately 2 years practicing medicine in Kenya, 1 1/2 years in Burundi, and 2 1/2 years doing a whole lot of different "stuff," but no medical practice.  So for the last six years, I have not once practiced independently in the States.  A job opened up for me to return to my former hospital, St. Joseph Mercy in Ann Arbor.  It's an ideal setup, as I already know most of the attending docs, nurses, and support staff, and I know the building and in general the flow of things.  I've been staffing the resident clinic and working on labor and delivery 6-8 shifts a month, and in general I've really enjoyed myself.

But if I'm being honest, I didn't sleep the night before my first shift.  The things I've forgotten are quickly relearned, and the new updates in standards of care took less than a day to read through.  But the computer system is a different story.  The operating room scares me.  My colleagues talk about robotic surgery and new equipment that lets you perform hysteroscopes in the office.  It's taken my teammates and I six long, sometimes painful years to develop a new set of skills to help us function in Burundi.  Skills like, how to speak in French.  How to deal with the advanced presentations of some common diseases.  How to manage malaria, typhoid, HIV.  How to deal with our patients dying, over and over and over again.  How to function without support systems and colleagues in our specialty.  How to relate to a patient that is literally worlds and cultures different from us.  And I wonder...if these new skills will only serve me overseas, and if returning to the US will only serve to illuminate the ever-expanding gap between what I used to know/US medicine, and what I know now/African medicine.

Several years ago, I attended a breakout session at the GMHC (Louisville conference) led by Suzie Snyder.  It continues to be one of the most influential talks I've ever heard, on the subject of being a working doctor missionary mom (because, really, there's not a lot of us out there).  One of the things she said that day was on the subject of maintaining credentials, staying up to date with your medical skills.  She said, "What God helped you to attain, he will help you to maintain."  I've clung to that many times these last six years, taking my oral boards, coming back into US medicine for a season.  He has brought me to this place, called me to this life, and will equip me with the skills and knowledge I need to do what He has asked me to do.

But there are those moments of doubt.  A lot of them, actually.  And I just wanted to share briefly how God has affirmed me several times these last months, that the skills I've developed aren't just applicable overseas.  That I might just still have a little to offer US medicine, too.

My first day of clinic (after the sleepless night), one of my first patients was French speaking from the Congo.  None of the office staff spoke French (there's a blue translation phone usually used for this purpose).  But I was able to go in to the room, greet the patient and her husband, and discuss the problem, confirming that they understood all the counseling done up until this point.  It was a shining moment in my day.  There have been no French speaking patients since that time.  Maybe it was God's special treat for my first day.

Then, Friday night, I had an overnight shift in the hospital.  A woman came in with twins in labor.  The first baby was head down, but the second was breech (feet first).  The two options for delivery would be a C-section to minimize risks of the breech delivery, or to attempt a normal delivery and pull the second baby out breech.  Her attending hadn't done many breech deliveries and wasn't comfortable with the idea, so asked me if I would help out, as the patient strongly desired a normal delivery.  Now, by the end of residency I had only done about 5 breech deliveries, but after 6 years overseas, I've probably done 30-40.  So, an "African" skill.  The woman did beautifully, and I guided to resident to deliver both babies safely.  Again, an affirming moment from God.

Not every day is affirming.  And then, not every day is overly challenging.  I still look forward, a LOT, to returning to practice medicine in Burundi.  It's what I'm called to do, what I trained for, what I love.  But in the meantime, it's nice to know that God continues to equip, and provide, and help me to grow, for EVERY situation.

Au Revoir, Drs. Toney & Erika!

by Jess Cropsey

Several weeks ago, our team and the Burundian doctors at the hospital had a send-off party for two of our colleagues as they head to residency programs in other countries.  Right now, Burundi has no medical residency programs which means that doctors who want more training after medical school must do so elsewhere.  (One of our future goals is to have certain residency programs available here at Kibuye, so you can pray to that end.)  

Dr. Toney has been working with John in the eye clinic since its inception in March 2014 and we are thrilled that he has been accepted to an opthalmology training program in Tanzania.  He has worked very hard during his time at Kibuye and has served as a behind-the-scenes leader and administrator on the eye team.  

Dr. Erika has spent the majority of her time at Kibuye working with Alyssa on pediatrics.  It was special to hear the praises of her peers at the party as they described her work ethic and dedication to patients.  Erika is now getting ready to begin her pediatrics residency in Kenya.

We are grateful that these doctors have found high-quality residency programs in Africa for their training.  The "brain drain" has been a huge problem for many countries and according to a recent article, Burundi is the least able country in Africa to retain their best and brightest.  Professionals (in many fields) leave to find work or to receive graduate-level training in more developed countries and often do not come back to their home country.  There are many reasons for this and we are not trying to blame anyone.  But it is a challenging reality, so our prayer is that these doctors will have good jobs in Burundi waiting for them when their training is complete.  Thankfully, Toney was born at Kibuye and his family is from this area, so he is very interested in returning.

To Toney & Erika, thank you for your faithful service to the patients at Kibuye Hope Hospital, for your friendship, and for your dedication to further your education.  You will be greatly missed here!  We will be praying for you as you adjust to a new place and face the challenges of medical training.  Imana ibahezagire!

Please pray for the remaining doctors at Kibuye, particularly over the coming weeks as the hospital is significantly under-staffed.  Please also pray for wisdom for the hospital administrators as they choose applicants to fill these pretty big shoes.

1,000 Cases; 100 SIGN Nails

By Jason

This past month we crossed over 2 significant numbers here at Kibuye Hope Hospital.  The first number is 1,000.  1,000 = the number of major operations done here since January 2014 when I started operating here.  This does not include the 450 endoscopies, nor does it include the 1,600+ minor surgeries nor the 800+ c-sections that others have done in this time period, nor all of the gynecological operations that Rachel has performed.

The other number is 100, which is the number of SIGN nails that have been done here since we started them in March of 2014.  SIGN nails are an ingenious system of fixing broken legs by inserting a metal rod through the bone to stabilize it.  It allows the patient to be out of bed the next day, rather than spending months in bed with traction or months in a cast.  Perfect for the developing world, the SIGN nail does not require all the expensive and sensitive equipment that nails in the West require.  In fact I have put in some SIGN nails when the electricity is off with just a headlight.

Two reflections... first, there is a well-known African proverb which says "it takes a village to raise a child."  The same goes for getting an operation done.  God has compiled an amazing surgical/hospital team which has enabled an increased capacity and quality in the ORs.  We can now routinely do 6 major operations in a day, but this requires electricity, oxygen, stocked sutures, efficient cleaners, sterilizers, organized instrument sets, and good scheduling, among a multitude of other things.  It is no easy task to even pull off even one operation in rural Africa.  I am very thankful for a surgery team that is molding together well.

Secondly, I see it fitting that the 100th SIGN nail that was done here at Kibuye was done by my surgical interns - I didn't even need to scrub in.  In fact, I was giving a lecture to medical students at the time, because I was confident in their ability to do a good job, and indeed, they did.  I feel that this encapsulates much of what we are trying to do here - training the next generation of African medical professionals in their own setting to provide excellent care for their own people.

We are already looking forward to the next 1,000 cases and the next 100 SIGN nails.

Traditions and Presence

By Alyssa

After two years in Burundi, it still feels like we're just getting started learning about the Burundian culture. I experienced a new cultural event last weekend when I attended a baby presentation for the son of our hospital's medical director. In many ways, Burundian culture is more formal than ours. Burundians seem to enjoy ceremony, protocol, speeches, tradition. This was evident in many ways at the "fête" ("party" in French) last Saturday. I had heard mixed things before attending the event regarding the purpose and what would happen, so I was interested to see how things played out. (NB I'm still not completely sure I have all the facts right, so take my observations below with a grain of salt!)

"Where are you from?" Burundians answer that question very specifically. Even if they have moved to the city and been away from their childhood home for years, they are "from" the rural hill where they grew up, and usually their relatives still live there. For official family events, they return to the "urugo" (homestead). So we traveled almost 2 hours on dusty roads to the province of Rutana, stopping en route to meet relatives coming from Bujumbura and Makamba. After exchanging greetings, we continued in a caravan and arrived together at Jeanine's parents' urugo. This was evidently the first time she returned with her husband and child to her traditional home since her marriage. The "dot" (French) is the first big event between the two prospective families. At that event, the family of the groom negotiates with the family of the bride for the dowry (cows, money, etc.). And they evidently promise to bring the bride back someday to visit. So the firstborn baby presentation is the culmination of that promise.

The kids in this rural area were pretty curious about the cars and the muzungu driving (me)! 

 Baby Jolison - our neighbor at Kibuye and the guest of honor at the fête

 Preparing the gifts for the family

 Fantas (Kirundi word for all sodas - like Coke in the South!) are obligatory for these events

 Dad, Mom, and Baby in the center of the room - they seated me in the chair just to the right of them! Always hard to know what to do with the "Muzungu Status." But guests are certainly considered a blessing and are given respect and honor as a result. 

 Family of the wife on the left - being photographed individually

 Family of the husband on the right with the ubiquitous cameras

 Fantas - I love that tradition - especially as being enclosed in a tarp tent on a hot day is pretty dehydrating! Citrus Fanta is key to these interesting but long events! 

 The grandfathers each made multiple speeches with humorous repartee across the room at each other. And the maternal grandfather invited Wilson to visit Jeanine's childhood bedroom - a symbolic expression of an enthusiastic welcome. 

The grandmother on the left of me was the other guest of honor at the event as the baby was presented to her

As I participated in this cultural ceremony, I kept asking myself, "What am I supposed to be doing? What gift should I bring? Do I need to make a speech? Am I dressed right? Should I talk more with the person seated next to me? Or less? Should I finish the food on my plate or leave some behind? Should I accept a second Fanta or decline? What should I say to the hosts in greeting and in leaving?" 

It slowly dawned on me as I sat in that honored seat in the hot tent, that I didn't actually need to "do" anything. It wasn't about "doing;" it was about "being." My presence was what spoke to the family. Many folks thanked me for coming and expressed their genuine welcome and gratitude for my participation in the event. This is contrary to my personal culture where I struggle with the idol of productivity. Sitting there for hours didn't feel productive to me - shouldn't I at least be developing relationships with folks in conversation? But, as it turns out, I was developing friendships - in the Burundian way - by being present at this momentous family occasion. Obviously there are pros and cons for each of the different cultural styles of friendship, but in this case I can certainly learn something from my Burundian hosts and value being present with friends more highly than my personal agenda. As Jim Elliot said, "Wherever you are, be all there!" 

Beautiful scenery at the end of the dry season in Rutana