Childhood Vignettes

We all have vignettes of childhood that stick with us into adulthood. They make us feel happy or sad. We may or may not completely understand them. But no matter the feelings attached to them or our understanding of them, they often define our adult outlook on what is normal.

As we raise or help to raise children in this culture so different from our own, we try to insert “normalcy” into family, team, and school life. And yet, we know that our children will grow into adults who remember very different vignettes from the ones that shaped us.

As you enjoy the following stories of childhood here in Kibuye, I hope you laugh as we do but also use it as an opportunity to get to know these Kibuye Kids and their normal lives.

Vignette #1: A child excitedly emerges from the bathroom proclaiming, “The toilet is making noises, Mommy. I think the water just came back on.”

Vignette #2: With a puzzled look, Girl asked, “Americans wear shoes inside their house?” After learning that this was in fact sometimes true, there was a pause for processing, and then, “Very….silly.”

Vignette #3: As one child watched another walk down the hall with a long piece of thin white paper draped over her head and down her back: “You look like a bride. All you need is one of those mosquito nets that brides wear.”

Vignette #4: Upon returning to school from lunch break, one of the children put one arm into a sweatshirt while engaged in conversation. As she put the other arm in, she jumped and checked her shoulder. “Oh,” she said, “I thought I still had my chameleon on my shoulder. He was there all through lunch.

Vignette #5: After her mother had chosen some solid colored fabric (something difficult to find in Burundi) and her grandmother worked hard to recover their family’s couch cushions, Child (who is used to all the bright Burundian prints) grumbled that the furniture was so boring now.

Vignette #6: While writing a blog about guinea pigs together, the students wanted to describe the cages. One mentioned that he put containers in his guinea pigs cage so that they could play or hide. Another student promptly raised her hand to volunteer her concern that container wasn’t an accurate word and might give people the wrong impression. After all, to her the word container was associated with 40’ shipping containers instead of something that once held margarine.

Vignette #7: Many families enjoy homemade pizza and a special drink on the weekend. Thus, nine out of 10 Kibuye kids agree that a square is the normal shape of pizza, and they all enjoy Fanta Citron (said in great French accents) or BOOM Juice.

*Since these stories belong to the children and not me, I decided not to include any names.

Kibuye Kids Clubs

by Julie

We teachers and parents work together daily to do our best to bring our children a good education, making sure they stay current with their core subjects.  But, as we all experienced growing up, school is much more than reading, writing and arithmetic.  

For our children, French and Kirundi are daily classes, as they are growing up in a tri-lingual community.  Burundi doesn’t have theatres or museums for fieldtrips, so we have added a “composers” class as well as an “artist” class to expand their knowledge and interaction with the arts. 

But what about extra-curricular activities?   Clubs?  Lindsay and Scott Nimmon (our teachers) had a great idea to add a few Clubs to our school program this year and opened it up to any adult team member who wanted to offer a club to our kids.  This provides the children an opportunity to explore something they may not normally focus on, as well as an opportunity to interact with other adults on the team. 

I saw this as an opportunity to offer Ballet to the younger girls.  While I am far from Prima Ballerina, it is something I have loved all my life.  Many good life lessons rest in ballet: self-control, self-awareness, poise, grace, and patience.  Plus, little girls just love to dance!  

We don’t have a studio, mirrors, or a ballet bar of course, but missionary kids are raised to be flexible… so we make do with what we have!

Another club offered this year is Chess Club.  Logan takes a little time away from the busyness of the hospital a few times a month to spend quality time with the kids who are interested in chess.  

Chess is a wonderful game that can be enjoyed by the amateur who has merely learned how each piece moves, or the experienced player who has studied the masters.  Logan does a great job of challenging each student on his or her own level.  

He creates puzzles for them to solve, lends his chess books to those that are interested, shares his unique collection of chess pieces, and reinforces the hard-to-learn lesson of winning and losing well.

Scott Nimmon is offering a Logic Club to those who are looking to challenge themselves mentally.   They explore the mind and how each person receives information and perceptions that follow.  

They make observations, tackle problems, and ask questions.  Good thinking skills will definitely benefit these students in their future education, careers, and relationships.

The kids are having a great time with their clubs and are already buzzing with ideas for clubs next semester.  These children are blessed to be surrounded by adults who have such diverse interests, experiences, and talents.  

Stay tuned for what clubs will be offered next semester… Gardening? Running? Film-making? Choir? Woodworking? Baking? Mechanics?  Just a few ideas being tossed around…we will see!

The Gas We Pass

(by Greg)

While it is true that our bean consumption has increased dramatically since our return to Burundi, this blog post is about another kind of gas.  I am talking about oxygen.  

When we first came to Burundi, friends back home would sometimes ask me what I missed most about working in the U.S.  My answer was always oxygen.  As an anesthesiologist working in the U.S., I took oxygen for granted.  While we need O2 to run our anesthesia machines and to treat patients whose oxygen levels are low, at every hospital I have worked at in the U.S. oxygen came out of almost every wall of almost every unit of the hospital.  I never gave much thought as to where this oxygen came from, assuming rather that it was delivered by the oxygen fairy, who I like to call Florence, or Flo for short.  But somehow, upon my arrival to Burundi, it seemed to me that Burundi must have been outside Flo’s service area.  

While we had a few small oxygen concentrators with which we could give low levels of oxygen to patients in need, we relied on larger cylinders to run the anesthesia machine.  The hospital purchases these in the capital, however, once purchased we often burn through our supply within a couple weeks and then have nothing for 3 or 4 weeks until the next purchasing.  Almost daily, a medical student would approach me to ask for help getting oxygen to a patient in need.  And most days, our small supply of concentrators were all being used by other patients.  For years it was not uncommon for patients and especially children to die for lack of oxygen.  It was heartbreaking.  

So, after a donation to our team fund, we were able to purchase a large, industrial strength oxygen concentrator.  This concentrator was shipped over on a container in 2016.  And last month, an engineer from Samaritan’s Purse, David Bucklin, who has experience with installing this machine, flew to Burundi to help Caleb, our engineer, set it up.  Accomplishing this involved some major hospital renovations, including clearing out an entire room to house this machine alongside the generator.  Caleb and David got it up and running and we now have continuous oxygen piped through the walls to our 2 operating rooms as well as the NICU.  As the hospital continues to grow, we will add oxygen supplies to other departments of the hospital as well.  I am incredibly grateful for all the work and money that went into this project.  It has dramatically changed my life and even more so for the lives of our patients.  It is truly a lifesaving gas.  I guess that is why we can’t live without it.

David installing the copper pipes through the attic.

David and Caleb standing on dangerously thin ceiling material.

Our shiny new machine.  Isn't she beautiful?

And this is the wall of our OR.  It might not look like much, but it will without a doubt save many lives for many years to come.

More Goodbyes, More Hellos

(from Eric)

Goodbyes
This past weekend, our team said goodbye to Nicole Christenson, who has been a loved and valuable part of our community and this work for more than the past two years.  From the beginning, she has earned the Ultimate Flexibility award, when her planned destination (South Sudan) was no longer an option, and she agreed to come and find a new and unexpected home at Kibuye.

In addition to her primary work with managing all of our project finances, she has filled countless niches, including (but not limited to) teaching classes at our school, hospital librarian, wedding attendee (and thus team representative), girls' sleepover host, book study leader, violinist, costume enthusiast, and general source of Kibuye social impetus.  And then there was that memorable time when she took a last minute flight to Kenya to play courier for a pump controller for our well.  Her departure was scheduled, and we pray God's blessing on her (and a certain someone) as life is forged anew in America.

Everyone loves Nicole!

The new tradition of the departing "Victory Tunnel"

Hellos
As missionary life would have it, this goodbye is accompanied by some introductions.  Our old stomping grounds in Albertville, France, have welcomed two families who are stopping there (for a while) on their way to join us in Kibuye.

Ted and Eunice John hail from SoCal, and many of us know Ted from his days at UM medical school and then St Joe's residency.  They are their two super-cute boys (including a second Toby!) are currently in language school.  Ted is a general surgeon who came out to visit a few years ago.  Their bio page is up on the sidebar.

The John family

 Jesh and Julie Thiessen (et les enfants) are a Canadian couple.  Jesh is also a general surgeon (#surgicalhelpisananswertoprayer) and Julie previously taught primary school in Burundi.  In 2015, they came out for several months near the end of Jesh's surgical training.  They are also in language school with the Johns.  You can also find their bio on the sidebar.

The Thiessen family

Several cool things about these families joining us.  Obviously, we are thrilled to have more surgical help in the pipeline.  Both families are also coming for their first two years through the Post-Residency Program with Samaritan's Purse, where many of us started in Kenya, thus completing the great circle of life.

In Memory of Sylvestre

(from Eric)

The Kibuye Community lost a friend and colleague two weeks ago.  Sylvestre was easy to recognize at the hospital.  He worked in the finance department, and he moved in a wheelchair.  He was generally quiet, but could surprise you with good French, and flip into Swahili and even English if needed.  All this showed that he was a man with quite a story to tell, though he wasn't one to bring it up quickly.

When we first moved to Kibuye, Sylvestre was actually living in a room across from his cashier's office.  He moved out in 2013, when he got married.  He and his wife Violette then had two little girls.

About a month ago, he was brought into our Emergency Room with persistent fevers.  What followed was a month of trying to offer him the best we could.  As it turns out, rural Africa is a hard place to be paralyzed, for reasons that extend beyond the lack of smooth roads for your wheelchair.  We eventually found the source of his extensive infection.  It took a while because of his lack of sensation, and by the time we did, the infection had gotten a crucial head-start.  Despite lots of surgical and medical interventions, he slowly deteriorated, and finally passed away at the age of 43.

At his funeral, his brother-in-law gave a short history of his life, which I had some friends translate for me:

Sylvestre was a local kid, from another rural area that abuts Kibuye.  After finishing secondary school, he was attacked with machetes in the crisis of 1993 and left for dead.  Somehow he was brought to Kibuye Hospital, which was staffed at the time by a woman surgeon who cared for him and finally arranged for him to go to Kenya for more care.  While he was there, he continued his studies at a university level (and thus the Swahili and English).  They even said that he studied in the US for three years afterwards, (though we haven't been able to confirm that).  He came back and started working at the hospital in 2009, and was married in 2013.

Here are a few pictures of Sylvestre:

Sylvestre with his older daughter, from his FB profile picture

Another awesome FB shot with the humorous caption: "My souvenir from when I was in Scandinavia.  It was last week."  Was he ever in Scandinavia?  Certainly not the week prior, but maybe that's a reference to the photo? 

The pallbearers taking his coffin to the grave.

It's hard to watch a friend slip away, even harder when you are part of the team taking care of him.  Hard when you know that another medical system could have saved his life.  Now he is gone, and his widow and their daughters will go on.  His life, for all its tragedies, had much to celebrate.

And the story is not done.  Resurrection is our end.  He is now more whole than any of us.  We will see him again, and when we do, not only will his body be whole, but all of our linguistic and cultural barriers will be dissolved, and we will be able to know one another, even as we are now known by our Father who holds us always in his hands.

Facing African realities - in the profession of nursing

by Krista

Taken from: 

http://www.nationalnursesunited.org/issues/entry/ratios

A couple months ago, one of my friends from nursing school in Chicago shared a link on Facebook to a National Campaign for Safe RN-to-Patient Staffing Ratios in the US. The proposed safe ratio for Pediatrics was 1 nurse to 3 patients. And, in the States, I actually whole-heartedly agree with that proposition. But, then here- I had just finished shadowing a nurse at Kibuye Hospital on the Pediatrics service, and her nurse to patient ratio that day was 1 nurse to 34 patients. Quite the contrast!

One of my life-long dreams has been to practice nursing in Africa, and it was one of the reasons we joined this team here in Burundi. In the last two years since we moved here, I have spent most of my time at home with our young boys, only occasionally making it up to the hospital for Grand Rounds or special occasions.

But then - this year, a team of our doctors started a program (actually, the first in Burundi) to treat Retinoblastoma (“RB” - eye cancer) with chemotherapy in pediatric patients. When they first asked if I could help out with the program, I was terrified. I hadn’t spent much time at the hospital yet, but I had been there enough to know that chemotherapy in this setting scared me: most of the kids in the program would be malnourished, overcrowding and poor sanitation in our hospital is a constant challenge, and nursing and medical supplies are limited. I was used to pristine, sterile hospitals (well, hem/onc floors at least) around Chicago, with the best of the best supplies at my fingertips. But, before long, I found myself working 12-16hr shifts during chemo weeks with a group of incredible RB kids. And now, I’m so glad our docs here had the guts to say, “Let’s do this!”

My Staff ID badge for Hopital Espoir de Kibuye

Living my dream working as a nurse in Africa

Drawing up chemotherapy medications

Our first round of chemo, we started with mattresses on the floor in the cleanest room we could create and only 4 patients

However, the transition hasn't been easy for me. I miss monitors. I miss pharmacists. I miss ports and central lines. I miss J-tips. I miss EMRs that remind me when a med is due or an order is outstanding. I miss IV pumps (Yes- I had to reteach myself how to calculate drip rates!). I miss saline flushes. I miss oxygen piped through the walls. I miss wall suction. I miss Child Life Specialists. I miss Respiratory Therapists. I miss Rapid Response Teams. I miss a lot of things about working in the States. But these kids, though… Totally make it worth it.

12 kids in the chemo program during the latest round of chemo

Using the iPad for some distraction for the kids

Our youngest child in the program- only 8 months old

These two patients were the best of buddies, but unfortunately the one on the left passed away last month

These two patients are good friends too- sharing a meal together. God, please keep them healthy!

During our second round of chemo, one of the new patients developed a fever and was vomiting. Oral Tylenol wasn’t an option, but we didn’t have any suppositories. We waited almost an hour before one of the nurses from Pediatrics had time to come hang IV Tylenol. I had never hung IV Tylenol in the States. I didn’t know how to set it up or where to get it from in our hospital here. I was the only nurse working in the RB program at that time, and I realized that I really needed to spend some time with the nurses on other services to see how things work here from a nursing perspective.

So, I’ve started shadowing whenever I can. And wow, have I been amazed. My first day, I worked in Pediatrics with an incredible nurse, Joyeuse. There were 117 patients on the peds service that day and only 4 nurses. Here, they don’t assign patients to nurses - they assign whole rooms full of patients. She had three rooms with about 10+ patients each in them. Overnight, there is usually only 1 nurse, maybe 2, per service.

But, I don’t want to communicate that working in the US was “easier” than it is working here. I have never been more stressed as a nurse than I was working nights on a busy adult med-surg floor in Chicago. It’s just different- some things are easier, some things are harder- it’s just…different. Yes, there were more resources there, but there were also more expectations on the nurse. In a hospital in the States, you have almost any resource you can think of to help prolong someone’s life. Of course, they don’t always work, but there is a big responsibility on the nurse and the patient-care team, to try absolutely everything. But here- along with a lack of resources, comes a sort of fatalistic mentality. If you don’t have access to the supplies needed to save a life- then they die. Whether it’s wrong or right, there isn’t the same amount of pressure here as in the States to keep people alive. I imagine that will change as our hospital grows and more and more interventions become available. But, right now… it’s just different.

Here, each patient is required to have a caregiver (usually a family member) at the bedside at all times- to help feed, bathe, assist them to the bathroom, etc. In the States, that was all my responsibility. Here, if you work night shift as a nurse, you actually have a bed in an on-call room and you often sleep from the last med pass at 10pm until the next med pass at 6am (unless you are working maternity or surgery- Labor and traumas can't wait!) The nurses here couldn’t believe that in the States, I worked from 7pm to 7am as a night-shift nurse on peds and didn’t get a bed, and certainly never slept during my shift!

Room with 10 beds in it for those working night shift here

There are some similarities though. One of my favorite things about working in the States was the awesome team of nurses I worked with. We helped each other out. Yesterday, I worked with Divine (one of the Peds nurses) in the NICU – she had 18 patients… 18 NICU patients- by herself!!! So, Joyeuse came to help her out, placing lines, inserting NG tubes, and administering medications. They were totally there for each other. I love that.

The full NICU

Nurse Divine checking on one of the NICU babies

NICU babies sharing a bed- can you find the two babies?

Divine and Joyeuse inserting an NG tube into a baby who only weighs 950g

Divine and Joyeuse starting an IV on one of the NICU patients

We hope to hire a Burundian nurse in the RB program soon, but for several different reasons, we have not yet been able to. Right now, volunteers are key. The first few rounds, our awesome doctors functioned as nurses, helping administer the chemo and monitor patients at the bedside. My sister-in-law, Heather, has been helping out as our “pharmacist”, drawing up meds while we administer them. And in September, we had some new team members join our group. Among them were the Sund’s (Stephanie is a nurse and Greg is an anesthesiologist) who have been such a huge blessing to the RB program.

Working with an awesome team - Dr. Logan, Dr. Parfait, Heather (my sister-in-law) and Stephanie (the other nurse)

Heather helping us out by drawing up meds on chemo days

 A fantastic hem/onc nurse, Becky Cook, came from Kijabe Hospital in Kenya with a wealth of information which helped us to get our program up and running

And she brought Stephanie Cox, an audiologist who performed baseline hearing tests on all of our RB kids

So, even though there are a lot of differences between practicing here as a nurse and practicing in the US, a couple of the most important things remain the same in both places:

1)   Teamwork.

2)   And a heart for the people we are caring for.

The wonderful team of nurses on the Pediatric service

Some of the incredible kids in our RB program