Blood Drive, Burundi Style

by Rachel

I work with a lot of blood.  Obstetrics is probably one of the bloodiest fields in medicine...and I sort of sheepishly admit that I love the mess.  I mean, I prefer it when the patients lose LESS blood rather than MORE blood during their surgery, but the sight of a hemorrhaging patient certainly doesn't make me faint.  I do feel a weighty sense of responsibility when it comes to blood transfusions, though.  Our blood bank will occasionally run out of blood, and sometimes there are even national shortages, so I sometimes make the decision not give someone a unit of blood, even if their hemoglobin is low, because we're saving that last unit for something really critical.  I have been amazed time and time again how sometimes even just one or two units of blood will literally save my patients from dying.  One unit of whole blood can restore their bodies to living, functioning organisms instead of deteriorating, dying creatures.  Even just last year when I was practicing briefly in the US, I was shocked at the availability of blood.  The postpartum hemorrhage protocol at our US hospital was to type and cross SIX UNITS of blood with one quick phone call.  Sometimes we don't have 6 units total at Kibuye.

And, unfortunately, getting more blood here is hard.  The hospital is not authorized to collect our own blood.  Instead, there are national collection and distribution centers (which makes sense, I suppose, to maintain a level of quality screening for the blood).  This had been hard when we have dying patients and some known O negative blood donors on our team, but the hospital can't even stock blood collection kits in the lab for emergencies.

So, I was super happy to hear this week that the local collection center in Gitega was coming on Wednesday to organize a blood drive at Kibuye!  Ironically, my lecture to the medical students on Monday was on anemia (and transfusion reactions) and at the end, I exhorted all of them to come and give blood on Wednesday, to set a good example as providers.  They all laughed nervously (making me wonder, as usual, if there was some cultural faux pas that I had just made).  But come Wednesday, I came up to our morning devotions/staff room and found it full of close to 50 people on the benches, waiting to donate blood!  Many were hospital staff, and some were patients' families (perhaps lured by the promise of a free Fanta and bread after the donation!).

It was no Red Cross bloodmobile, but some elements were the same.  I got my blood pressure taken, then sat at a table with a man and his notebook to answer "the questions."  In the US, it's stuff like, have you ever had mad cow disease?  Or, have you ever had sex, even once, with a man who's had sex with a prostitute in Asia before the year of 1965, or things like that.  Here, I was asked, "Are you married?"  "Are you pregnant?"  "OK, here's your collection bag."  Super smooth. :)  And no one checked to see if I was anemic... but hey, I'm sure I was fine!  We sat on benches around the outside edges of the room and blood flowed into collection bags on the floor.

And then, after the bag had finished filling, we got our choice of refreshments!  Toby "helped" me drink my Sprite and eat my roll.  It was fun to feel like a part of the hospital community, rallying to provide life saving measures for our patients.  I hope they come back in another 2-3 months so we can keep the blood drives going.  We can't give blood in American any more (due to living in a malaria endemic area), so I'm glad that our blood can go to good use on a continent that has become such a part of our lives.

The Word and the Rain: A Day in the Village Church

(from Eric)

"For as the heavens are higher than the earth,

so are my ways higher than your ways

and my thoughts than your thoughts.

For as the rain and the snow come down from heaven

and do not return there but water the earth,

making it bring forth and sprout,

giving seed to the sower and bread to the eater,

so shall my word be that goes out from my mouth;

it shall not return to me empty,

but it shall accomplish that which I purpose,

and shall succeed in the thing for which I sent it.

For you shall go out in joy and be led forth in peace."

-Isaiah 55:9-12

After months of working up the necessary gumption, I finally agreed to go and visit a friend's church in the role of guest preacher.  For nearly four hours, we sat up front in the seats designated for honored guests.  For nearly four hours, I tried to find the magic internal trick that will allow me to just let go and enjoy the process unfolding all around me.

View from the Honored Guest seats up front

But I can't.  The best I can seem to do is a big mixed-up bag of emotions.  Why does this have to take so long?  Isn't it great that we can just enjoy being here and not worry about the passing of time?  My kids will never last this long.  Hey, they're not doing too bad after all, and people don't seem to mind that they wander around a bit.  Why wouldn't you choose a key before you started playing together?  Well, I guess they don't seem to mind, so why should I?  Seriously, a 15 minute prayer 3.5 hours into the service?!

I'm getting ready to preach on the Prodigal Son, and I am dogged by the suspicion that there is something terribly "elder brother" about my heart at this very moment.  Why can't I turn off my judgements and my criticisms?  Why do I insist that I know better how things should be running?

Finally, I stand and walk to the pulpit.  The pastor's son is translating my French into Kirundi.  There is a single microphone, which I argue that he should use, since most people couldn't understand my French anyway.  He tells me that would be less proper, and not to worry, because his voice carries well.  

So we begin.  We talk about Jesus eating with the "sinners" and the tax-collectors and how it made the religious folks quite upset.  We talk about the younger son and the way that his request for his inheritance is such an astonishing insult.  The son leaves and lives like a fool.  Then famine comes, and he is ruined and thus humbled into going back to his Father to beg forgiveness.  I'm trying to point out that the story is, up until now, all too typical.  Bad decisions leading to severe consequences.  But now the Father will re-enter the story, and his grace will knock the story off its tracks.

It starts raining.

It has rained once in 4 months.  Everything is dry and baked.  The clouds have been gathering, but mostly as a tease.  We're waiting for rain.  But now?  Now, when I'm talking into a distorted microphone, relying on an unamplified translation, in the middle of a long echoing church with a tin roof?

I pause.  I look at my translator.  He gives me a reassuring glance.  "They can hear you.  Don't worry."  The rain falls harder.  It's a deafening deluge.  I'm shouting as loud as the distortion can handle.  My translator shouts next to me.  People are still looking at me.  Can they even hear me?  Should we just stop?  The two us start taking turns with the mic.  In the end, I gave the mic totally to him.  I'm yelling my French into his ear, and he is yelling his Kirundi into the mic.  I take the mic back to give a final "Amen" and then we sit down.

I wonder if that accomplished anything.  I came to try and share the grace and love of God in his word, and I felt like I was yelling into the void.  

The word of the Lord does not return void, but it accomplishes what it is sent to do.  Coincidentally like the very rain that possibly hid my words.  What happened there?  I don't know, but in one sense or another, the word of the Lord was spoken, and that is something good.

Afterwards, they pull together a welcome meal for us.  Beans, rice, chicken, peas, fried potatoes and plantains, cabbage and Fanta Citron.  While we eat, speeches are made.  They speak of the rain as a umugisha.  Une bénédiction.  A blessing.  It has come to bless our gathering and the words that were spoken.

***

Hours later at home, the tension still rings in my heart.  Appreciation and humility wrestles with self-righteousness and superiority.

I am the parched field.  I crackle in response when I ought to be flexible.  I don't grow.  I don't produce fruit worth consuming.  If a fire is lit in just the wrong place, I might be quite out of control.  I am the elder brother.

The word of the Lord is like the rain.  It goes forth irresistibly, bringing life, replacing thorn and brier with cypress and myrtle.  "You shall go out in joy and be led forth in peace."  For this my soul thirsts.  Maybe I was the only one who heard those words this morning.  Maybe I was the one who needed it most.

A New NICU

By Alyssa 

I'm not a big picture person. I tend to focus on the details of the task in front of me and to think about how to best care for the particular patients and families I'm seeing. It's overwhelming for me to think about the bigger picture of changing an entire system. But God has continued to surprise me by bringing people into my life who complement my detail-oriented perspective with big dreams for future change. This is most evident in the evolution of our care for premature and sick newborns at Kibuye.

 January 2014. When I first began practicing pediatrics at Kibuye, I found the premies in cardboard boxes completely covered with layers of (often wet) blankets, sometimes with gloves filled with warm water next to them. The babies weren't even included in the hospital census as individual patients, but were lumped in with their mothers. Most premies died in these conditions. I began small steps to open charts for the premies, to round on them daily as a pediatric service, to give them antibiotics and aminophylline as needed, and to attempt kangaroo care instead of cardboard boxes.

 But thankfully the Grant family dreamed much bigger than I did. They were friends of mine from Alabama and had 2 children who were NICU survivors - at the NICU where I worked during my residency training. When they heard about the plight of these premies, they quickly raised funds for us to build our first NICU. 

 We opened in May 2014 with 4 homemade incubators (thanks to Jason Fader - not just a surgeon!) and 3 beds for mothers. 

This new space worked pretty well for 2 years, but it quickly became crowded. Last spring we had 14 babies and mothers squished in there or overflowing into OB rooms. Plus the Burundian tradition is to bring new mothers gifts of produce, so the room quickly became an attraction for critters. Again, I started small with encouraging the hospital janitors to clean more frequently and thoroughly - and I continued to care for the patient in front of me. But teammate Caleb Fader, engineer extraordinaire, dreamed bigger...

And voila! Our new 11 bed NICU! The construction team tore down walls and the ceiling, vaulted the ceiling and added skylights, painted and put down floor tile, and invented these ingenious combo mother/baby beds. 

 They also improved on the incubator design in several key ways. They can be opened from either side for the mother to access from the bed or the peds team to access for care, there are fewer holes for critters to sneak into, and the lights are easy to turn on or off as needed to regulate the baby's temperature. Our other engineer Tony is also bring special thermometers back from the UK for each incubator. 

 Mother/Baby bed design

 And this is still the Benjamin and Jud Grant NICU complete with beautiful artwork from their mother Melanie. The blue machine on the right is a phototherapy machine for jaundiced babies - also an ingenious design courtesy of Little Sparrows, a Boston based company started by a neonatologist there. 

 And then last week just as we moved into the new NICU, a team of electricians showed up. Jonathan (pictured above) has 2 kids who are NICU survivors (twins born at 28 weeks 18 years ago) and thus he was especially concerned about our problem with power outages at night. The power is out for about 8 hours every night and thus the tiniest babies get too cold even with kangaroo care. One 29 week twin actually died last week from hypothermia while the power was out. So Jonathan developed a battery backup system and installed it for a trial incubator. It works! We put the surviving twin in there (weighing just 2 lbs) and the lights stayed on almost all night. I'm so thankful for innovative folks who care about these babies! 

 And speaking of innovation, based on a design we saw at a similar hospital (Kibogora in Rwanda), the construction team put lockers outside for the patients to keep food in. So now there is no more food in the NICU! Hoping that will help maintain hygiene for our babies.

 The peds team is thrilled with how easy it is to care for babies in this new setting. And it's convenient, too, being right next to our other peds patients rather than in a separate building with the OB patients. 

And we have one fancy infant warmer donated by World Medical Mission (Samaritan's Purse) that arrived on a container last week that is perfect for placing IVs in tiny babies with adequate lighting and warmth. No more bringing premies outside to place IVs! 

So thanks to all the big picture people who made this NICU a reality in our corner of the world - including the many supporters who dreamed big about what their dollars could do far from home. 

On Not Re-Inventing the Wheel

(By Alyssa)

After only 3 years here in Burundi, we’re a relatively new team, and thus we’re so thankful for the opportunities we’ve had to learn from those who have gone before us. Last week we hosted our first sickle cell clinic at Kibuye Hope Hospital. This would not have been possible without the work of Travis Johnson and other Serge colleagues in Bundibugyo, Uganda who developed a sickle cell program there several years ago and shared their protocols with us. Like we see here in Burundi, Travis (a family practice doc) noted high rates of kids in their community with sickle cell disease complications and mortality as well as misconceptions as to the cause of the illness. He then created a detailed plan to support these families through education, medical treatment and prevention, and to introduce them to the hope of the gospel. They met monthly together so they could encourage one another in facing this difficult lifelong disease and receive medications to prevent complications. 

I’ve been diagnosing and treating lots of patients with sickle cell disease over the last couple years, but I had never had them come to the peds clinic all on the same day. Last week was a bit chaotic but was a good start to our sickle cell clinic at Kibuye. 

The med students helped me complete a special chart for each patient which includes what complications they've faced, relevant family history, and a protocol to help rural health centers know what to do if the patients come in with a fever or another acute problem. 

 Like I said, it was a little chaotic and we drew quite a crowd of interested onlookers when we brought out toys and activities for the kids. Of note the sweet little guy on the mom's back above is the last remaining child in the family. He's three years old and loves to greet me on the road or in the hospital with an enthusiastic laugh and handshake. His father has also died, so pray for strength and hope for his mother and for health with fewer complications for Samweli. 

 Jess and Susan and the kids came up to help entertain the patients during clinic

 Thanks to our teacher Miss S for translating the Prodigal Son into Kirundi so we could share that story with the kids. 

 After the Bible story, a med student and I taught the parents about sickle cell while the kids played and did a craft. It was much calmer playing inside the conference room rather than out in the courtyard! 

 The parents asked good questions at the end and seemed to be encouraged through the opportunity to learn more about their children's illness, to receive medications (penicillin and folic acid) to help prevent complications, and to know they weren't alone in facing this lifelong challenge. Thanks Travis, Derek, and others for doing the initial planning for this program and for sharing your hard work with us to the benefit of our Burundian patients! 

When It Rains, It Pours...Containers

by Jess Cropsey

We are still in the thick of dry season and it hasn’t rained in over 3 months.  Jiggers (sand fleas that burrow into your toes) have been plentiful and there’s lots of dust to go around.  But it has been “raining” shipping containers!  Four different containers will have (likely) arrived before the real rains begin, with #3 making it up the hill on Friday evening.  This one held medical supplies generously donated, packed, and shipped by World Medical Mission (branch of Samaritan’s Purse).  

Originally, the container was scheduled to arrive on Friday morning, but there has been a fuel shortage in the country for several months and there was no diesel available on that day for the truck coming up the mountain, so it had to be transferred to a lower-quality truck which happened to have fuel.  It made it to Kibuye late at night on Friday and unfortunately the driver attempted too wide of a turn in the dark (no street lights here!) and it got stuck.  

So on Saturday morning, John & Caleb eagerly searched the man-cave for items that could be used to free the beast.  Armed with an enormous sledgehammer, a metal tread, chain, tow rope, and the Old Lady (the eye clinic land cruiser), we headed off to see what could be done.  

You'll often find thorns like this on the back of trucks to prevent bikers or passengers from trying to get a free ride up the mountain.

After 20 minutes of scheming and getting things in place, it was decided to call in some reinforcements (namely the nearly 300 workers that are employed at Kibuye on a multitude of construction projects).  

Here is the first round of workers on their way to help out

Some were delegated to push on the tilted side of the truck, others rode in the back of the Old Lady to add some more weight providing more traction, and others pulled the tow rope from the front.  George & I were responsible for documenting the event (a very important, but slightly less dangerous job).  

Much to everyone’s delight, the plan worked like a charm and the truck was on its way to the unloading zone.  Click here to watch a quick video of the momentous occasion!

John was bursting with pride for his baby and her great strength.  This will go down in the history books of the Old Lady, even topping the time she jumped the fancy vehicle from the US Embassy.  Reportedly, she had to tow the truck 7-8 more times throughout the day when the truck dropped off heavier equipment at other locations.      

The photo below shows the container at the unloading zone, an almost-completed maintenance area with different container bays for welding, wood shop, & vehicle maintenance.  In the background (far left), you can see the new laundry area under construction as well.  

Lots of great stuff was unloaded that day -- orthopedic surgical equipment, incubators, warming tables for newborns, anesthesia machines, tons of surgical instruments, backpacks loaded with goodies for graduating medical students, a hammer mill and drying bins for the new Busoma plant, and much more!  

Surprisingly, we also discovered a mysterious box of rings (apparently priced to be sold for $220 each on some cruise line).  Not sure how or why those ended up on the container or what in the world we're going to do with them!  Finger splints (since they appear to be too long for the typical finger to bend)?  

We are extremely grateful to the many folks at World Medical Mission who packed this container and for the people who gave financially to make it happen.  We’d also like to thank a generous ophthalmologist who donated his office equipment to the eye clinic after retirement and folks at Langhorne Presbyterian Church (PA) who packed it all into three enormous 1,000 lb+ crates (one shown below).

  
We really appreciate the very long list of people who gave in various ways to serve Kibuye Hope Hospital by sending this container.  The equipment will be invaluable in helping us improve the quality of care for our patients.