Lessons of a Lost Backpack

by Carlan Wendler

The San Diego Wendlers on the Metro

On Saturday, my brother and his family, Michelle, her sister, and myself visited the Louvre Museum in Paris. We got a bit of a late start and between jet lag and sheer, utter boredom at perambulating through vast halls of incredible art, the kids (ages 4, 3, and 1) began to make their discontent known. So my brother and I set off to pick up the rental car from across town and drive back to pick up the rest of our family.

After a Metro ride to the Place d'Italie, we realized that the office that had our car was actually in Montparnasse. It was another simple Metro ride to Montparnasse, a few conversations with folks in the station regarding where to find the car rental office and a ten minute walk there. After waiting in line, translating order details, and selecting the appropriate car seat based on kilograms, we had another ten minute walk and a few conversations with folks as to where the "parking" office of this particular car rental agency was.

Mona Lisa smiles...or not

"You go through the bar, down the elevators to Level -3. Then find the stairwell and walk up to Level -2. Across the parking from the stairwell you should see a sign for a different car rental agency. Your company uses that same office and staff."

Wow! Things in France are different!

The French have this whole notion that geography dictates personality (e.g., people from the Savoie region where the language school is located are broadly caricatured as aloof, private, slow to warm up to new people but fiercely loyal, intensely compassionate to their friends, and extremely hardy). I don't know that I'm clever enough to make judgments on people's personalities based on knowing their whereabouts growing up, but I can see how geography has dictated the ways car rental companies solve their business problems. Paris is dense, old, and labyrinthine. If you rent out cars, you find a hotel or mall  with a big parking lot and use some of their space. If there are other companies doing the same thing, you band together to economize on overhead.

Two hours into a process that I thought might take one those were not the thoughts going through my head. I was rather worried about the women and children and trying to keep ahead of the communications so that they would know what to expect. And in that distraction, I left my backpack containing the keys to the car we had driven from Albertville to Paris and my wife's and my passports.

This I did not realize until we had reconvened at our rented apartment and started supper.

"Michelle, where did you put my backpack? I'd like to take some Tylenol [also in the bag]."
"You took it with you when you left the Louvre."
"Are you being funny, because this headache is not funny."
"No. Remember, you had to come back and give me my water out of the backpack before you left."
"... [frowny face]..."

Through the glass storefront...right where I left it

A quick review of our contorted journey around Paris left two places the backpack could have been left: the first car rental office or the last one in the parking lot where we actually picked up the car. My money was on the first but by this time on a Saturday the offices were closed or closing. Customer service lines don't seem to operate in the same way in Paris, on the weekend, before the nation votes for two finalists in the presidential elections, that they do in the States. The car rental agency said, in brief, "You'll have to wait until things open up again on Monday morning." A quick call to the US Embassy in Paris to notify them that our passports were misplaced and ask if anyone had reported them was met by three answering machines before we got an operator who transferred us to a recorded message that pointed us to a website or e-mail address. "Our commitment is to respond within 48 hrs to all e-mails sent to this address." Yikes!

Nothing more to do that night but pray.

The Good Lord provides the next day

The next day we put all our contingency planning into effect and we prepared to send everyone else on to Albertville while I stayed in Paris to recover the backpack on Monday morning. By God's grace, we got through to a plucky customer service agent on Sunday morning and she put into effect a plan that eventually led to the return of the backpack that afternoon. Everyone else had left, so I had some time to think while riding on the Metro again and sitting in a car rental office again. And that's when I began to see some parallels between walking amidst Greco-Roman statues in what was once the palace of French kings (before Louis XIV moved the royal family to Versailles) with kids who were bored to tears and my experience around Paris and a lost backpack.

My good Father, God, has a plan for my life, prepared day-by-day and hour-by-hour. Riding the Metro around Paris with John Mark while the women and children languish in a less frequented hall in the world's largest art museum was within His will for that day. Misplacing the backpack and working through all the efforts to recover it and stick to the itinerary we had established in advance was in God's plan for us. Cramming all of my visiting family + Michelle into one car while I drove by myself to try to catch up was also the path He had laid out for the day.

The frailty of my faith in my Father might look different than the feebleness of my nieces' and nephew's confidence in their parents' plan, but I have a feeling that if I were to slow down and try to observe the place God had brought me to in each moment, I would observe things more remarkable than even the Winged Victory of Samothrace.

Saving Kids from Eye Cancer

(by Darrell)

Retinoblastoma is the most common intraocular tumor in children and represents 11% of all cancers in the pediatric population.¹  Thanks in large part to early presentation and advances in treatment in the United States, less than 3% of all patients with this cancer die, whereas in Africa, the mortality rate is 70%.²  

However, in Burundi in particular, it is worse: since John started the eye clinic in early 2014, he has seen between one to three children per month with this aggressive eye cancer.  He has yet to see one child survive.

There is nowhere in Burundi for these children to receive treatment (for the affluent, there are options just across the border in Rwanda), and after watching so many die despite taking heroic surgical measures, John decided in January to initiate Burundi’s first chemotherapy program for retinoblastoma.

John recruited a group of us, including Alyssa, Logan, Dr Parfait and myself, to travel to Kabgayi Hospital in Rwanda to meet and learn about the treatment of retinoblastoma from a British ophthalmologist named Dr. Keith Waddell.  When I first shook hands with Dr Keith, I had the distinct impression that I was meeting the most important person I had never before heard of.  He immediately memorized our names (and checked them twice) and then ushered us into a sitting room where he began to unfold the story of the years-long attritional war he had been waging with retinoblastoma in Uganda.  His keen eyes, unflagging energy, and ability to remain undeterred in his telling of this history despite my numerous questions were impressive, but all of that quickly paled in comparison with what we encountered afterward in the eye unit.  As we walked into the ward, many of his patients greeted him in possibly the warmest manner that I have ever witnessed—handshakes (of course), then hugs, and later even sitting in his lap and playing with him.  His patients (I actually started to type “children” there) loved him, and  one of the parents even referred to their child as “his” daughter.  There we witnessed true love between doctor and patient. 

All of these patients (with perhaps one or two exceptions), had had one eye removed by him, and sometimes he’s had to remove both eyes.  Many of them have had more than 6 cycles of chemotherapy that have, on each occasion, put them at a high risk for infection and death.  But every four weeks, they continue to come back.

Dr Keith has treated close to 500 patients with retinoblastoma, and he has documented all of their clinical courses in meticulous, working-late-into-the-night detail.  He has published some of his data^3,4, but as he puts it, he needs to find some additional time to finish it before he dies, which could happen at any time.  He is 80 years old after all.

John and I both hope to be old men like him one day (many here at Kibuye maintain that I already achieved old man status last October when I hit 40); regardless, Dr Keith is truly a remarkable person who has fully embraced his calling from God to serve the least of these.  I don’t think we could have assembled and inspired our retinoblastoma team without seeing Dr Keith and his team in action.  In fact, we now have five patients scheduled, nutritional status permitting, to begin chemotherapy on May 2^nd.

Ever since I had the privilege of spending many of my Mondays during fellowship on the Ocular Oncology service at Wills, I have wanted to be like Jerry and Carol Shields who direct it and care for retinoblastoma patients.  If I hadn’t been called to Africa, I would have wanted to pursue a career in their field.  Little did John Cropsey know that ordering chemo drugs one night back in January was going to lead to just the confirmation that I needed from God to stay the course here in Burundi.  Maybe even as long as good old Dr Keith has.

Figure 1. Some of the cancer patients of Dr. Keith

Figure 2. Dr. Keith teaching and caring for patients

Figure 3. Dr Keith in center along with his assistants plus our team.

Bibliography

1.     Wong JR, Tucker MA, Kleinerman RA, Devesa SS. Retinoblastoma incidence patterns in the US Surveillance, Epidemiology, and End Results program. JAMA Ophthalmol. 2014;132(4):478-483. doi:10.1001/jamaophthalmol.2013.8001.

2.     Kivelä T. The epidemiological challenge of the most frequent eye cancer: retinoblastoma, an issue of birth and death. Br J Ophthalmol. 2009;93(9):1129-1131. doi:10.1136/bjo.2008.150292.

3.     Waddell KM, Kagame K, Ndamira A, et al. Clinical features and survival among children with retinoblastoma in Uganda. Br J Ophthalmol. 2015;99(3):387-390. doi:10.1136/bjophthalmol-2014-305564.

4.     Waddell KM, Kagame K, Ndamira A, et al. Improving survival of retinoblastoma in Uganda. Br J Ophthalmol. 2015;99(7):937-942. doi:10.1136/bjophthalmol-2014-306206.

Learning Faith From My Patient

(from Eric)

Seven days ago, I received a 60-year old man on my service.  His past history is still a bit fuzzy, but it seems that he had a hemiplegic stroke two years ago, probably secondary to his chronically high blood pressure.  On the day of his arrival at the hospital, he had been riding in a car and fallen rapidly into a coma.  Now he isn't waking up.

He has had a lot of fevers.  And his blood pressure has been very high.  It could be caused by any number of infections, and it could be something non-infectious (like another massive stroke).  In many ways, he's like a very complicated American medical patient (but with the possibilities of malaria and tuberculosis), but without any of the American diagnostic tools.  I have no idea what his electrolytes are, and I would really love a CT scan of his brain.

After seven days, he hasn't woken up at all.  His fevers are still coming.  There are a few more things we can try, but they are more and more in the "last ditch effort" category.  I wasn't even sure that his family would even want us to continue trying, so after rounds today, I went back with my student to talk with his wife.

I hadn't talked much with her before, but her constant presence had been noticed, as well as her poise.  She quickly dismissed my student's translation work, saying that she could understand my French fine.

I started from the beginning, explaining the problems that had brought them to us, and the difficulties that we have had in treating him.  I pointed out all the problems that had not improved, despite all the attempts we have made.  I tried to lay out the options before us, stumbling somewhat for the appropriate cross-cultural and cross-linguistic way to express that I wasn't sure if it was worth continuing to treat new possibilities or not.  I wanted to know what she thought.

She listened calmly as I alternately explained and bumbled along.  She was attentive but never interrupted.  When I finally stopped, she said "But you must remember that there is a good God.  And he can do anything.  You must remember that.  He can do anything."

"Amen," I say, "and God loves your husband."

"Yes, he loves him!" she continues.  "He has protected him for sixty years.  We will see what happens, but you go ahead and do what you think is good.  God will do it."

So we prayed there together.  We asked God to heal this man whose healing seems impossible to me, but does not seem impossible to God.  We asked him to give him and his family comfort and peace, and a continued ability to trust in him during these difficult times.

My student and I walked out, as I said, "Well, she is a strong woman.  Much stronger than me."

My student laughed.

***

I have seen similar responses from Christians in America.  In the face of overwhelmingly probable terminal disease, some people will persist not only in saying that God can heal them, but that he will.  Personally, I don't work that way.  I honestly don't know what God will do, and I've seen a whole lot of cases where the disease takes its terminal course.  And I don't say otherwise.

These words can look like denial.  But I don't think they are.  At least, not always.  I remember years ago, when I was in medical school, and my friend was dying from cancer.  She said over and over again that God was going to heal her.  She never talked about an alternative.  Her cancer advanced more and more.  She was bedridden and intermittently confused.  During a lucid period, someone spoke to her about God healing her, and she said "He has already done it."  She was right.  And she died in peace.

She wasn't in denial.  She was defying death.  It took her life, but there was resurrection waiting, and I don't think that, anywhere along that road, death's sting took hold of her.  And maybe that's the difference between denial and defiance.  The difference between the response of fear and the response of faith.  The litmus test is, when it doesn't go how we hoped, when the disease starts spiraling in every direction, the response of faith can embrace it.  It doesn't recoil in fear and say "but I knew you were going to heal me!  Why did you let me down?"  It recognizes that its trust in God was well-placed from the start, and that it is still well-placed.

I don't know what's going to happen to my patient.  And I don't know for sure whether his wife's words are a response of faith or of fear.  But there is a strength and a peace about her that makes me bet on the former.

Resurrection and Pâques

(from Eric)

If you don't know a given French word, it's usually worth trying out the English word in a French-ish accent, and you often get lucky.  And then sometimes you don't.

"Easter" is a word with an unexpected French equivalent: "Pâques".  The word "Passover" is also translated into French as "Pâques".  It is, in some ways, a more sensible choice than "Easter", which has cloudy and likely pagan origins.  Sitting in the French service of our Burundian church this morning, I heard maybe my first Easter sermon ever preached from Exodus.  But for a francophone, this is logical.  It's the same word.  The connection between Passover and Easter is already made.  Thus, the ways in which Jesus is prefigured by the substitutionary sacrifice of the spotless lamb are maybe more obvious than in English.  This is a good thing.

It got me thinking.  I generally think of the death of Christ as belonging to Good Friday and the resurrection of Christ as belonging to Easter Sunday.  I have no specific desire to separate the two, but I certainly do want to remember and celebrate them both.  And thus, our Pâques celebration felt a bit like a francophone version of a Good Friday service.  If Easter is Passover, then we understand Jesus' death, but there is nothing that I can see in the Passover imagery that would have ever imagined that the sacrificial lamb would rise from the dead.  Call it "Pâques" or "Easter", but we cannot forget the resurrection.

Maybe this is important to me because it seems like a little example of a bigger trend.  Generally, I feel that I grew up with a better understanding of the meaning of the death of Jesus than of the resurrection of Jesus.  And I still think that this is true of modern western Christianity.  Jesus has died, and this means forgiveness and purification.  But he also lives.  What does this mean?

The world that I live in needs forgiveness, just as the world that I come from does.  But my world here has an unavoidable brokenness that remains, even beyond its need for purification.  Our patients pass away, too soon and too often, from things that are too preventable.  The widow doesn't get justice.  The family doesn't have enough food.  A young generation doesn't have enough opportunities to change what needs to be changed.  Our world cries out for newness, for wholeness, and our sinful hearts are at the center of this cry, but they are sadly not the only thing broken about this creation.  What does the resurrection mean?  Whatever it means, we somehow know that we need a whole lot of it.

In the center of Easter stands a new man:

Be still.  A man who seems to be

A gardener rises out of the ground,

Stands like a tree, shakes off the dark, 

He is the first fruits, the promise of a renewal that will leave nothing untouched.  All things will be placed under his rule, including finally death itself.  Paul says that we are like kernels of what resurrection will make of us.  What will it be?  We don't know exactly, but we cannot sideline the hope of resurrection because of its mystery.  What will it be?  Glory and freedom from death.  Beyond that, we look to our resurrected Lord and Savior to give us a glimpse, the same Lord who proclaims that he is making all things new.

Resurrection hope has broken into our world.  We wait for its completion.  We yearn as we wait, but may our expectation of what will be change change how we wait.

(1 Cor 15, Rev 21, poem: Wendell Berry 1983-IV)

Palm Sunday Reflections

(By Alyssa)

“The whole crowd of disciples began joyfully to praise God in loud voices for all the miracles they had seen: Blessed is the king who comes in the name of the Lord! Peace in heaven and glory in the highest!” Luke 19:37-38

“As he [Jesus] approached Jerusalem and saw the city, he wept over it and said, ‘If you, even you, had only known on this day what would bring you peace - but now it is hidden from your eyes…’” Luke 19:41-42

Overwhelming joy and glory followed immediately by great sorrow and then righteous anger. I can relate to these paradoxical Palm Sunday emotions. Some days it seems that too much is broken all around us and it’s a miracle that any of our patients survive. Yesterday the power was out almost all day which meant we couldn’t use the oxygen concentrators and the hospital was out of oxygen tanks. And there is limited diesel in the country (I checked three gas stations before I found any on Friday), plus it's expensive, which means we can’t run the generator all day long. And there are over 90 patients just on the pediatric service (with 50 beds) several of whom need oxygen. Yesterday morning in the midst of pouring rain I tried to find a solution to provide oxygen for my little patient Elie who had oxygen saturations of 70% due to acute chest syndrome from sickle cell disease. He’s been admitted many times (below picture from last August) and he really needed to be in an ICU yesterday. We managed to get him a blood transfusion and then the power finally came on again in the evening and we prayed for a miracle. He survived the night, thankfully, but the power is out again now. It’s easy to despair that these broken systems will ever be made new and it’s so sad to see patients suffer as a result, especially ones I know so well like Elie and his loving mother. 

But there is still joy in the midst of the sorrow. I was invited to speak on Thursday at the 3rd National Conference of Christian Health Professionals in Burundi. This is a conference put on by the Christian Medical Student Fellowship group here, and our team has participated each year with Eric speaking the first year and John the second. The theme this year was the "Kingdom of God and his Justice Beginning with You and Me"". They asked me to speak about innovation in neonatology in Burundi as an example of solutions to the challenges of health in Burundi. It’s encouraging to see students recognizing the progress we’ve made in neonatology at Kibuye over the last couple years, and I was thankful for the opportunity to reflect on how God has enabled us to care for 172 babies over the last 6 months in creative ways as a community despite limited resources. But the conference also brought me much joy and hope in interacting with many of our current and former Hope Africa University medical students who truly are leading the way in caring for the least of these in Burundi. They’re volunteering their time to care for HIV/AIDS orphans, starting projects to provide health insurance to rural impoverished families, and looking for creative solutions to improve the maternal and infant mortality rates in Burundi. They are persevering in faith despite the many challenges and they give me hope when I think about the future here. Jesus did indeed bring God’s Kingdom to earth and, while we won’t completely see the fulfillment of that till eternity, we can still joyfully praise him for the miracles we see around us like these students, even as we are sorrowful over the not-yet aspects of his Kingdom like our patients without oxygen. 

French Class for Beginners - with video!

(from Julie)

Burundi is one of many francophone countries in Africa. French is the official national language, and therefore the language of Hope Africa University, the hospital, the exams given to medical students, and all other official work. Because a working knowledge of French is imperative to function in Burundi, all physicians (and families) went to language school in Albertville, France for 10 months before moving here. For some of us (Banks and Baskins), that was just last year so French is fresh on the minds of our children who attended the local French public school. Some of the older children here have been speaking French as long as they can remember so it is second nature to them. Others were babies or toddlers when their family was in France so they really weren’t speaking much of any language yet! So we have a wide variety of mastery of the French language at Kibuye Hope Academy. 

We have divided the students into three French classes. Heather Fader teaches French II & III which focuses on conversation and grammar. I teach the beginning French class. Some children started the school year knowing how to count to ten, and maybe how to say “Bonjour!” But for the most part, we are starting from scratch. All students have French class everyday for half an hour, which is not enough to become fluent, but we hope to give the kids a solid base on which to build as they continue to be exposed to this beautiful language in Africa and around the world. 

In my French I class, we try to have as much fun as we can! I find that vocabulary tends to stick better if they can use it in a game. 

While learning the pieces of clothing, we played a silly dress up game where they got to tell each other (in French) what to wear and giggles abounded at the site of a small five year old trying to hold up adult sized pants or skirt.

While learning food and drinks, we turned the classroom into a little French restaurant and invited the class’s families to “dine”. The kids learned all the vocabulary, drew food on paper, cut out their pictures of each item, created the menu, learned how to say “what would you like?” After practicing on the French II Class, they were finally ready to serve their families – in French!

We even made a video of a game we play often. It’s like “I Spy” but we say, “Je vois (I see) ________.” We had fun making the video and who knows – maybe we will make an entire series! 

Kibuye Hope Academy - French 1 - Trouver l'objet from The Banks Offshore on Vimeo.

Thank you for your continued prayers for our children, for creativity in teaching in a resource-limited environment, and for language learning for the whole team! Merci beaucoup!