Child Life Specialists at Kibuye

By Alyssa

For the last few months we've averaged 60-70 kids on our pediatric service (including malnutrition and neonatology) and another 20+ kids on the surgery service on any given day. One thing I've lamented about the situation for these kids is that they didn't have any stimulating activities available to them. The kids with leg fractures, for example, stay in traction for 4-6 weeks. They feel pretty well but have nothing to do but lie in bed until their bones heal. And one consequence of severe malnutrition is apathy. The most malnourished kids just lie still with no interest or energy to interact with the world around them. Emotional and sensory stimulation (i.e. play therapy) is one of the necessary steps in the treatment plan for them recommended by the World Health Organization - arguably just as important as feeding them, keeping them warm, and treating their infections.

What I've always loved about children's hospitals is the way they go out of their way to make kids feel welcome and cared for. I remember being a 10 year old in the hospital myself and being amazed to find a playroom with so many crafts and toys and activities to help pass the long hours.

Well, I'm excited to announce that we now have Child Life at Kibuye!

Susan and Judith (in the above 2 pictures) visit the 6 different hospital rooms with pediatric patients every afternoon and spend hours going to each bedside to provide attention and care. They provide educational play for all ages, and the kids just light up when they enter the room. It's made my job easier as the patients are less afraid of foreigners now - even scary ones with stethoscopes! And the malnourished and orthopedic patients have especially benefitted from this special attention and love. 

So what is "Child Life?" I'm happy to report that this description from the Boston Children's Hospital webpage actually describes what Judith and Susan are doing with our patients here in Burundi:

Child Life Specialists enhance a patient's emotional, social and cognitive growth during a hospital stay, giving special consideration to each child's family, culture and stage of development.

Using developmental interventions and play, they help patients and families adjust to and understand the hospital and their medical situation. Child Life Specialists:

• Help patients develop ways to cope with fear, anxiety, separation and adjustment to the hospital experience
• Provide consultation to the health care team regarding developmental and psycho-social issues
• Provide preparation and individualized support before and after medical procedures
• Facilitate developmentally appropriate play, including medical play, at the bedside, in activity rooms and in clinic areas
• Initiate tutoring services

 But, we have a special added component to our child life program that Boston Children's probably doesn't have. Because who understands child life better than children themselves?! The missionary kids regularly participate in coming to the hospital to play with the inpatients or give eggs to the kids in the outpatient malnutrition program. And of course all the patients and parents love to see them coming!

Jesus said, "Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these." Matthew 19:14

Maracuja Madness!

by Rachel

Burundi is a country obviously known for its bananas (if by obviously I mean we mention it a lot to people).  We are also able to get pineapples, oranges, and mangoes in season.  Apples are available as expensive imports from Kenya, and occasionally we'll find a watermelon or some gooseberries as well.  It's not a huge variety (and boy do we miss berries of all sorts) but it's good.  One of the available fruits that I haven't yet mentioned is something I had never tried before our arrival in Burundi: the passion fruit.  It's also known locally as "maracuja."  The fruit is slightly larger than the size of a golf ball and when ripe has a deep purple exterior.  The inside is an orangish-yellow pulp with black seeds.  To eat them, we cut them in half and suck out the inside, or use a spoon to scoop it out.  It's a little bit tangy/tart and a little bit sweet, along the lines of citrus.

Ben demonstrating the inside of a passion fruit

 When we moved into our house, now just over 2 years ago, a number of plants were planted in our yard...mostly saplings, but some flowers and vines as well.  Passion fruit is a vine that tends to wrap around trees for growth.  We were hoping to get it (and some bougainvillea) to grow on the brick walls around the housing area, but so far it hasn't attached well.  It HAS flourished, however, propped up by sticks or attached to bushes.  We returned in January to find no fewer than 10 mature passion fruit vines around the edges of our yard, and they have really been producing.  It doesn't seem to be seasonal, and so most weeks we have a "harvest" of 20-40 ripe passion fruits.  You can see one of the vines below, which is actually growing on a loquat tree (apparently a fruit but not one that I've ever enjoyed).  All of the little green globes are passion fruits in progress.

How many passion fruits can you see here?  More than 15!

So, what do you do with passion fruits?  The kids love to eat them, but you can only eat so many, I suppose.  I have been scouring the internet for recipes and have found some winners so far.  I have made passion fruit sorbet in our ice cream maker, passion fruit cake w/ passion fruit icing for Ben's birthday party last March, and last week I stumbled upon a super yummy passion fruit curd (this might sound weird if you've never heard of lemon curd, but it's a sort of spread, like a cross between jam and pudding).  I feel like a passion fruit meringue pie should be possible, but haven't tried it yet.  We'll see what new creations reveal themselves in the weeks to come!  I read online that these fruits are hard to come by in the US, available only in specialty grocery stores and sometimes costing up to $3/apiece so you might have to come visit us if you want to try them. :)  If you find yourself with your own overabundance of passion fruit, drop me a note and I'll send you some recipes.

Passion fruit birthday cake

COTW: The Last Living Child

By Alyssa

Ten-year-old Claver was admitted to our pediatrics service 2 1/2 weeks ago as a last resort. He had been previously hospitalized elsewhere where he was treated for malaria, bacterial infection, and severe anemia. But despite 6 blood transfusions, he continued to be severely anemic. In fact he seemed to have worsened bloody urine after each blood transfusion. The situation was made more dire by the fact that he had 2 sisters who died with the same symptoms - one at age 5 and the other at age 11. His father also has had similar symptoms intermittently in life (and ended up being hospitalized at another hospital while Claver was at ours). And the family lost one baby at birth, so Claver is the only remaining child.

Our initial physical exam revealed a very sick boy with difficulty breathing, extreme pallor, a large spleen (see picture below), and fever. He was barely conscious on admission. His initial hemoglobin level was 2.6 (normal is 12-14).

We kept transfusing him and he kept bleeding. Thankfully we had blood in our blood bank at the time - not always a given here. After a transfusion when he was more conscious, he would cry out, "I'm dying! I'm dying!" His mother cried often, too, seeing her suffering son and knowing he would likely die like his siblings. We added steroids in hopes that that would stop his body from destroying the needed red blood cells. I consulted a pediatric hematologist friend in the US who kindly sent an email to all her colleagues for help with this challenging case. They of course were used to much more information (lab tests, etc.) being available for an ICU case like this, but they rose to the challenge and helped us consider possible diagnoses and treatments. And they even looked at his blood smear slide which we sent back to the US with a visitor. After 4 transfusions, he was still losing a lot of blood and at that point we could no longer get an IV in him despite many attempts. A visiting surgeon came to the rescue and placed a central IV line - something very rarely done here.

After the fifth blood transfusion (at our hospital, 11th in total), he started to turn the corner. He stopped calling out that he was dying and he stopped hiding under the covers. He no longer looked deathly pale. He began to eat a bit and after a couple days started to sit up. We continued his treatment for pneumonia but we no longer needed to give him any blood. And today he happily went home - see him and his joyful mother in the picture below. His father also recovered and came to pick him up. We still don't have a clear diagnosis (probably a familial hemolytic anemia of some sort) and it's possible he could become ill with the same symptoms again, but we'll celebrate the victory today. I really cringed every morning I came into the hospital those first few days expecting to hear he had died in the night. But God saved him. These are the miracles to remember - the glimpses of what will come one day fully when there is no more sickness or death.