Gerson L'Chaim Prize Winner

It is with a great deal of excitement that we are proud to announce that Jason was selected yesterday as the winner of the first ever Gerson L'Chaim prize.  The grant gives $500,000 to help us complete the new hospital ward, buy needed orthopedic equipment (Jason does unique developing world surgeries for multiple types of fractures, allowing people to walk immediately instead of spending weeks in traction), and expand the lab facilities at the medical school.  Below is the announcement video and the official press release.  We are grateful for this gift and hope to steward it well.

LONE SURGEON SERVING MILLIONS WINS INAUGURAL $500,000 GERSON L'CHAIM PRIZE 

 

Dr. Jason Fader of Burundi: Only Full-Time Surgeon Outside Capital City, in Nation of 10 Million People

 

Dr. Jason Fader--a son of medical missionaries, and on a team of American physicians in Burundi, the world's hungriest nation--will bolster his work with $500,000 from the first-ever Gerson L'Chaim Prize for Outstanding Christian Medical Missionary Service.

"Because of this prize, hundreds of people will walk, thousands will receive care, and tens of thousands will be helped by the doctors we will train," Dr. Fader said.

The L'Chaim Prize, the largest ever in clinical care, is from the African Mission Healthcare Foundation (AMHF)-founded by New York entrepreneur Mark Gerson and his friend, Dr. Jon Fielder, a medical missionary serving in Kenya.

"Missionary doctors are the untold humanitarian story of our era," said Gerson, who underwrites the prize with his wife, Rabbi Erica Gerson. "Forsaking every comfort and convenience, they bring skilled, compassionate care to the continent's poor. Across Africa, Dr. Fader and his team are a link in a string of unsung heroes."

With the L'Chaim prize, Fader and his colleagues--serving with the agency SERGE--will:

■ add critically needed hospital beds at rural Kibuye Hope Hospital

■ create Burundi's first postgraduate medical training

■ expand lower-limb fracture care in a nation that travels by foot

"It's hard to overstate the effect," Fader said. "In one of the world's poorest countries, a prize of this magnitude, in one hospital, is far reaching."

In Burundi--called the world's hungriest nation by the World Bank--only 13 surgeons serve 10 million people. Fader and his on-the-ground team, however, have trained doctors, increased surgical procedures, and upgraded and expanded medical facilities. Every team member raises his or her financial support and has learned both French and Kirundi. Since 2013, the team has served at the Kibuye Hope Hospital, the teaching hospital for Hope Africa University Medical School.

"To move forward, to provide higher volume and better quality care, and to train more national healthcare workers, we have to expand the hospital," said Fader, who intends to serve in Burundi "for many years to come."

Across Africa, medical help is the most endangered species. Since missions and agencies peaked in the last century, the docs still on the job, and their African colleagues, operate on shrinking support despite a rising tide of complex medical challenges-from AIDS to surgical problems to cancer. Fielder and Gerson, with friends and supporters, formed AMHF to bolster Africa's medical heroes and their institutions.

Kid's Prayers and Their Fruit

(from Eric)

Several years ago, in attempt to engage our kids more in bedtime prayers, we came up with a simple system for prayer requests.  We ask them three things:  What are they thankful for?  Who is a friend they want to pray for?  And who is a sick person they want to pray for?  It worked well, I guess.  Maybe a little too well, as I don’t seem to know how to get them to pray for anything else as they get older.  Oh well.  There are worse things.

A couple years ago, I wrote about the time that Maggie, then age 4, wanting to pray for a young boy named Emmanuel at the hospital that she had overheard me talking to Rachel about.  I was reluctant, knowing that the boy’s prognosis was very poor, and fearing having to discuss his death with Maggie.  However, he got better despite my pessimism, and I saw the grace of God through my daughter’s faith.

About a month ago, Maggie and Ben were stuck on their third prayer request.  They couldn’t come up with a sick person to pray for.  So I asked them to pray for a young man named Claude  on my service.  He was 34 years old, and came in with raging meningitis in a deep coma.  We started him on antibiotics, but after about three days, he wasn’t waking up, and almost just as bad, he had stopped making urine.  I was worried about him, and so he came to mind.

We prayed several nights in a row for Claude, and it prompted some interested conversations about “why people are in comas”, etc.  He didn’t immediately get better, but after a couple more days, he woke up.  A few more days and his urine returned, and his kidney function started improving.  He went home in good shape.  It wasn’t impossible, but it was definitely against my expectations.  I remembered Emmanuel from a couple years ago.  I decided to do this more regularly.

After Claude, I moved on to the next case.  Gloriose was 45.  We weren’t sure if she had bad meningitis or bad malaria, but she was alternating between comatose and agitated enough to rip out her IV.  It had been several days on maximal therapy without a lot of benefit.  I told my students I was going to ask my kids to pray for her.  The kids were fine with that.  Her sixth day in the hospital, I walked in to find her sitting on the edge of her bed.  She shook my hand, meeting me for the first time.  I also saw her six-month old baby in the bed next to her.  I sent her home today, so thankful that her baby has a mother.

“The prayer of a righteous man is powerful and effective” - James 5:16

I memorized this verse when I was a teenager.  I don’t know what I thought it meant then.  Maybe I thought it meant that people who followed God’s commands really well could pray and their prayers would change things more than someone who prayed who didn’t follow God’s commands as well.

And maybe that’s basically right.  But it gets more complicated the more deeply I believe that the only righteousness that I have is that which was given freely to me by God because of his unmerited love.  By his gift, I am righteous, so I guess my prayers are powerful.

And it gets a bit more complicated when I think about my kids.  I don’t believe that they are heard because of their obedience to God’s laws.  I do believe their prayers are powerful, and only partly because of what I’ve seen.  Beyond that, it just comes easy to trust that their prayers are heard.  

Maybe I believe that because they are my kids and I love them, and I can’t imagine not wanting to listen to them praying for someone who is suffering.  Maybe God feels the same about me.  Maybe that’s the love that made him sacrifice so much to make me righteous.  Maybe it’s the same love that gives my prayers whatever power they may have.

The Brick Factory

by Jess Cropsey

Our faithful readers will know that there’s been a LOT of construction happening at Kibuye over the last 3 years.  Brick is one of the main “ingredients” that is used for beautiful buildings such as this newly completed local school building.  You will often see stacks of bricks cooking in a field or sitting by the side of the road waiting to be sold (for about 1 cent a piece).  

For Kirundi class at Kibuye Hope Academy, we recently took a field trip (literally walked through a field to get there!) to a local “brick factory” to find out more about this process.  We met Irakoze who graciously explained how you mix some dirt but mostly clay (ibumba) together and then put it into a wooden mold (iforoma).  

After sprinkling a little dirt on top (to keep it from being too sticky I assume), you pull it out of the mold and set it in neat rows in the sun to dry for 2 days.  Irakoze was kind enough to allow the kids to mix the clay with their feet (gukata ibumba) and make bricks using the mold.  Not sure if he’ll end up keeping them!  

After the bricks (amatafari) have hardened and dried in the sun a couple of days, they are stacked to the side until there are enough to make an ifuru (shown below).

The holes at the bottom are filled with wood to make a fire.  The holes are then covered up and the outside of the brick oven is covered in mud or leftover clay to keep the smoke & flames inside.  

The bricks cook for about 3-4 days and after that time the color will change from the original gray to a reddish color.  Once the bricks are cooled, the mud is removed and bricks are taken from the top.  The final step is probably the most labor intensive of them all -- getting the bricks from the field to the side of the road in order to sell them...without a vehicle, a couple at a time.  It gives me a new appreciation for all the work that went into making our own homes, not to mention the many other hospital & community buildings that have been built at Kibuye by many Burundian craftsmen (and women).  Murakoze (thank you) Irakoze and our Kirundi teachers for such a wonderful learning opportunity.   

  

Guinea Pig Love

by Rachel

Well, in order to try and balance out all the depressing posts (from us) and news (from the US) these days, here's a fun little post to cheer everyone up.  :)  Kibuye has been overrun with guinea pigs!  Turns out some of our new teammates are animal lovers.  There was a fundraiser at a Bujumbura school...you know, some schools in America sell wrapping paper or magazines?  Well, in Burundi apparently they sell guinea pigs and rabbits.  Once the kids heard that guinea pigs were $1 and rabbits were $1.50, well, the orders started pouring in.  Darrell graciously brought back several cardboard boxes full of furry little bits of love.  Seven guinea pigs and one rabbit.

Caramel and Maggie

Alma and the "clan"

 The kids have had a blast feeding them grass, lettuce, carrots and even (surprisingly) pineapple.  They have used all the leftover bricks piled by the Baskin house to make little "homes" for the guinea pigs to run around in.

Guinea pig playpens/houses!

The rabbit palace

 And then, of course, what's the use of only one rabbit, who's a boy no less?  The last Buja trip brought back two more cute little baby bunnies, a big hit.  Hoping that these little ones last a long time and continue to bring much joy to the team!

Abi and a new baby bunny!

Furrowed Like the Field: Another Hard Day

(from Eric)

O God, I am furrowed like the field.  Torn open like the dirt.  -Andrew Peterson

Today was a hard day at the hospital.  It shouldn't have been that way.  It's Saturday.  I only go in to round.  It takes a couple hours at most.  And my adult medical service is currently less than ten patients.  It should have been easy.

But it wasn't.  I always start rounds by asking about new patients, so I can maintain an active list of everyone I'm taking care of.  There was one new patient, a young guy in a coma, probably from malaria.  There had been another new case, a 60 year old guy with severe malaria, but he died during the night, only about four hours after his first dose of antimalarial medicine.  

I read through the chart as the student told me the story.  He had actually spent the last seven days in the hospital, as the caretaker for another patient, which means he got malaria here at the hospital.  Two days ago, he wasn't feeling well, and he wanted to be seen.  Registration told him that he needed to pay the 1200 Burundian francs (about 50 cents) to see a doctor.  Normally this cost is not prohibitive, but he refused, whether out of severe poverty or foolishness, I'll never know.  He got sicker, and then went back to the ER last night, his blood swimming with parasites, and his platelet count bottommed out.  We could only offer too little, too late, and he died.  

It's so incredibly senseless.  He had a simple disease for which we have medicines.  It's not usually 60 year old men who get so sick from malaria, since they have a partial immunity.  He was already at the hospital.  50 cents.

We pray, and we start rounding.  The second case is a lady that came last Tuesday.  Apparently, in June, she got into an argument with her husband, and he locked her into a room, occasionally sending her a bit of food.  He never let her out.  At all.  Until Tuesday, when his neighbors and the local administrator showed up and forced him to come to the hospital.  Now she is wasted, too weak to sit up without help.  She has tuberculosis, at least in her spine, and probably in her lungs, probably as a result of her weakened state.  The husband and her family are supposed to be staying with her in the hospital, but they are always trying to skip out on her.  Yesterday, we talked to the nutrition service about adding oil to her porridge to help her nutrition.  They brought a supply to last the weekend, and her sister-in-law apparently stole it and took it home.

Her belly is distended, especially in her pelvis.  I think maybe her bladder is retaining urine, so after rounds, I grab the ultrasound to see what I can find.  I find a tiny beating heart.  A baby.  She is pregnant.  I wonder when in this tragic story she became pregnant.  I wonder if we can get her through it, and what kind of circumstances this baby could be born into.

I pass by the ER to take care of one last thing and to tell my nurse about the pregnancy.  A mom is holding her chunky five-month old, who was just referred from a health center.  Before our eyes, the baby stops breathing, and mom bursts into sobs.  We rush to get oxygen started.  I notice that the baby's tongue is pale, and pull his eyelid down to find an utterly white conjunctiva.  The baby has died from severe anemia, and there is no way we can transfuse him fast enough to get him back.  We stand with the mom.  She sobs and buries her head into the side of my med student.  We pray.  We cry out for peace.  For peace that passes understanding.

***

I thought about not writing this blog.  I didn't want to share it on the heels of Rachel's story about T.  Believe it or not, we want to balance these things out. Our lives have a lot of light, as well as a lot of darkness.  Everyone's life does.  I decided to share it for two reasons:  First, I just need to get it out.  I need to tell the stories, because there is some small comfort in sharing it, like someone else really does share the burden.  But second, I am writing this because this is how it's been this week.  I don't know why.  I think that things just come in waves, sometimes.  But I know that many of us have had very hard outcomes in the hospital.  So, in the interest of full disclosure:  Voilà.  There you have it.

What do I do with this?  I don't know.  I came home, and I found headphones (so as to listen loudly) and played Andrew Peterson's "The Sower's Song" multiple times.  It starts: O God, I am furrowed like the field.   I can identify with that.  Certainly I have rubbed shoulders with some people who can.  It ends with a near-shout: [The word of the Lord] will not return void!  You will be led in peace and go out with joy.  I try to follow the sweep of it, to identify with the promise at the end, just as I identified with the sorrow at the beginning.  It helps somewhat.  It feels good to shout a promise, sort of like a defiance of the darkness, even if I don't see what is going to happen.

What's lost is nothing to what's found, and all the death that ever was, if you set it next to life, it would scarcely fill a cup. - Frederick Buechner

I saw this as well this morning.  When I found that baby on ultrasound, I caught a great profile image, with the curve of the nose, the chin, the shoulder, the elbow and the hand all visible.  We told the mom, this long-suffering tortured mom.  She looked at the screen and her voice caught in her throat:  Akomeye?  Is he OK?  Yeah, I think he's fine.

Light and hope.  There is more than we think there is, even on the bad days.

We do not know what to do, but our eyes are on you.  - 2 Chronicles 20:12

COTW: Wrong Decisions

by Rachel

It’s been a rough couple of weeks, clinically speaking.  I have heard it said that in missionary medicine your highs are higher and your lows are lower...and I feel like that’s been the case for me recently.  In fact, some days the space between triumphs and failures are measured in seconds and minutes.  That does put me on quite a roller coaster of emotions.  There have been a number of maternal and fetal deaths lately, which weigh heavy on my heart.  In the last 3 days alone I have come face to face with the reality of gut-wrenching evil, watched a woman slip away before my confused eyes, and have to live with the knowledge that a decision I made, for right or for wrong, contributed to another woman’s death.  Days like this, the magnitude of the decisions I make as a physician loom larger than normal.  We all make decisions, all the time, about so many things.  Usually those decisions matter so little in the grand scheme of things.  But sometimes in medicine, they cost a life.

I am tempted at the end of the day to come home and wallow in my sorrow.  To grieve over all that’s wrong with the world, and to focus on the sadness.  There is so much to grieve, on both sides of the ocean right now...for friends and family in both our communities.  But I think back to the Israelites in the midst of their wanderings, and in the midst of their years of rebellion and captivity.  God gave them signs and wonders, stones and altars along the way so that when things got difficult, when it seemed like God no longer cared, they could look back and remember his faithfulness.  So tonight, that’s what choosing to do, too.  I’d like to share a story of faithfulness with you.

What started off my “rough couple of weeks” was one patient in particular.  Her name is T.  She first came to see me in April at the beginning of her 5th pregnancy. She had a history of preterm deliveries and one term fetal death before a C-section...so, no living children.  I wish this story was more exceptional but it’s a sadly common story.  We came up with a plan to try and prevent her from having another preterm delivery.  I did a few ultrasounds, she started on some medications, and we decided to admit her to the hospital at some point in the future to give injections to help the baby’s lungs mature faster in the event of a preterm delivery.  Fast forward to mid-October.  T was hospitalized on my service; her water had broken.  According to her chart, she was now just 4 weeks before her due date, and the baby’s heartbeat was strong.  We rejoiced together, and planned a C-section to deliver this baby.  In the back of my mind, I put on my mental checklist to go back to my office and check the ultrasound records to confirm her due date.  But the day was busy, as most are.  The morning passed in a whirlwind and soon I was walking into the operating room where she was already prepped and draped.  I made the skin incision, and opened up the uterus.  I slid my hand inside to cup the baby’s head...and again, in the back of my mind, thought to myself, this head seems smaller than I expected.  I delivered a crying baby girl and showed her to T, then passed her off to the nurse.

But as I sewed up the uterus, I kept turning to look at the baby girl.  She was no longer crying.  The nurse seemed solemn, and within minutes whisked the baby off to the NICU.  She came back to say that the baby was much smaller than normal for this age, just under 3 pounds.  As soon as the case was done, I hurried off to the NICU.  The NICU nurse and the students were assessing that the baby was actually 8 weeks early, not 4 weeks.  I found the time to check my ultrasound record.  They were right.  I hadn’t double checked the due date...the chart was wrong, and I had delivered the baby too early.  My moment of joy over T’s first live born baby instantly disappeared, replaced by a sinking pit of despair in my stomach.  I ran through justifications in my head (her water was broken anyway, maybe the baby has a better chance to survive now, it wasn’t ME that wrote down the wrong due date) but I still felt personally responsible.  We could have waited a few days and given those steroids to help the baby’s lungs mature, but we didn’t, or we could have tried to let her mature in the uterus for a few more weeks, but we didn’t, and now she was having difficulty breathing in the NICU.

I went home defeated.  I didn’t go back up to the hospital the next day (I only work three days each week) but I didn’t want to ask Alyssa about how the baby was doing.  I felt ashamed.  That afternoon, a friend called and as we discussed the case she reminded me that I was neglecting to leave space for God’s sovereignty.  True, our decisions can be weighty and life-changing, but ultimately, God is the one in control, not me.  The next day I returned to the hospital.  My student found me, and gave me good news that in fact T had been hospitalized several weeks earlier and had been given those important steroids.  I visited the NICU and her baby was off oxygen and breathing better.  T was recovering well from her C-section.  

As I type this, T’s baby is now 2 weeks old.  No baby of hers has ever survived this long.  She is still tiny and still vulnerable, but doing well.  From time to time, especially on my difficult days since then, I poke my head in the door of the NICU and my eyes meet T’s, as she holds her daughter.  We smile.  I wave, and then close the door.  God’s sovereignty.  His faithfulness.  It is hard not to be overwhelmed by thinking of all the babies this week that don’t have mothers, or the mothers who don’t have babies.  There are many.  But from time to time, redemption happens, and I pray that I can always bring these redemption stories to mind.

The L'Chaim Prize Finalists Announcement

The L'Chaim Prize is an award granted annually to help the work of a long-term medical missionary serving in Africa.  We are thankful and excited that Jason Fader is among the four finalists for the inaugural L'Chaim Prize.  If he is chosen from among the finalists, this $500,000 award would help Kibuye Hope Hospital in these ways:  to help build a surgical ward, to fund a post-graduate medical education program (which would be the first of its kind in the country of Burundi), and to acquire orthopedic supplies which would enable us to surgically repair broken hips, femurs and tibias.  

You can click here to view a 2-minute video from the African Mission Healthcare Foundation.  The video includes footage from Kibuye, and it explains the interesting origin of the prize and introduces the finalists and their projects:  https://www.facebook.com/AfricaMHF/ 

It is hard to ask for prayers that we would win, since we know 2 of the other finalists, and the work of any of the finalists could greatly benefit from such a generous gift.  May God's will be done!

Ecole Fondamentale de Kibuye

by Jess Cropsey

Those of you with school-age kids are at least a month into the start of the new school year and have (hopefully) survived all the craziness that goes with the beginning of school - shopping for supplies, buying new clothes, figuring out schedules, meetings, etc.  Here in Burundi, the local students are just finishing their second week.  Over the last two years, enrollment at Ecole Fondamentale de Kibuye (EFK) has sky-rocketed and they were quickly running out of classroom space.  A few months ago, we decided to build a new building containing 3 classrooms and new offices.  This beautiful space was finished just in the knick of time and is now packed with 8th, 9th, & 11th graders.

Life is a lot simpler here in many ways, yet school can still be a hardship for families for different reasons.  Students aren’t required to have much (a couple notebooks and a pen), but even that is difficult for many families to afford.  Scissors, glue sticks, binders, crayons, colored pencils and many things that Westerners take for granted are simply never found in the vast majority of schools here.  

Over a year & a half ago, I started collecting school supplies for EFK to send on a shipping container.  Donations came in from a variety of places.  One couple from Pennsylvania donated some inheritance money that paid for enough basic supplies for 1,100 backpacks.  Our church in Michigan did a colored pencil drive during their summer Kids’ Camp last year.  Another church in Pennsylvania bought and assembled little packages of crayons.  We also got some leftover supplies from the Ann Arbor Public Schools.  Many others gave monetary gifts, balls, more crayons, etc. and in the end there was lots of fun stuff to go around for all of the nearly 1,500 students ranging from K-11th grade.  

I’m grateful for the opportunities I’ve had to get to know the teachers & kids at this school and it was truly a delight to be able to bring some joy to their classrooms with these gifts.  I told them they came from many friends in the USA who love them, pray for them, and value education.  I encouraged them to work hard for God and for their futures.  Please pray that this school would be a place that develops the character of these young people & trains their minds so that they may become godly leaders in their families, communities, and country.

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!