My Dummies

by Greg Sund

It seems like lately I have been surrounded by dummies.  No, not my teammates.  I mean mannequins.  Big ones, little ones, they are everywhere.  That is because I have been teaching a “Réanimation” course for the medical students.  I could not imagine teaching Réanimation without teaching basic life support skills, such as CPR and assisted ventilation.  So, after digging through a container of donations from Samaritan’s Purse, I came across a large pile of dummies, which I have brought to the hospital for use in teaching the medical students these life-saving skills.  I have also learned that if you are going to carry a full sized child mannequin (fully dressed) to the hospital, you probably should not carry it on top of a bunch of other boxes and then proceed to drop it repeatedly.  I was met with some looks of horror by Burundian women passing by.  I don’t think they had ever seen a mannequin before and thought it was a real child, perhaps my child (it was also white).

My teammate George has graciously opened up his office to myself and some of the other “office-less” doctors, however, I have recently sensed some regret from this decision, as I have started to leave these mannequins strewn about his office.  The full sized child mannequin has actually terrified quite a few people as they walked into his office.  Thankfully we now have a working defibrillator just a few hundred yards away.  

The students have seemed to really enjoy learning these skills, something that few of them have been exposed to before.  Last week we worked on adult CPR and ventilation and today Alyssa led a class on Helping Babies Breath (complete with more creepy dummy babies).  Some of our middle schoolers have even jumped in to help with translating and also doing some CPR teaching themselves!  It has been a lot of work, but also a lot of fun.  Soon, the mannequins will have to return to the deep dark hole from whence they came.  But fear not (George), they will return (to your office) next fall, when the new group of medical students arrive (or sooner, if I get bored).

Learning Experiences

Believing that learning should give expression to worship, knowing that Third Culture Kids (TCKs) can live in a culture yet remain very much outside of it, and wanting to have time myself to explore more of Kibuye gave birth to learning experience days at Kibuye Hope Academy (KHA) this school year. The kids have dissected owl pellets, “followed” birds on migration journeys, categorized rocks, seen eye dissections, watched a friend’s heart beat on a sonogram, and become inventors. We have taken time to stand in awe of the things around us as part of the curriculum. In leading these days, adults have learned for the first time or all over again about these topics and felt the energy that comes from learning in community and in living ways.

The most recent learning experience day focused on trees. Through the rings on a fallen tree, kids learned how to tell how old it was and the historical events the tree had lived through. Our particular tree was part of a world where John F. Kennedy was president of the United States, and the space race was on. It was alive during the Burundian civil war, could have watched Michael Jackson’s music video for “Thriller” (if trees did such things), and witnessed our team’s arrival.

On a nature walk, the kids pondered what a tree actually is and discovered that a banana tree is not actually a tree. They saw, touched, smelled and learned to identify several local trees. They discovered that trees are a wonderful resource that God gave us for many practical and aesthetic purposes, but that replenishing this resource is vital. Without this last step in utilizing trees, deforestation and erosion happen and animal habitats are disturbed or even destroyed. Burundi itself used to be covered in trees that are now firewood or charcoal, and animals that used to be here are no longer. Forests are now farmland used by subsistence farmers who make up a large portion of the population here.

In the afternoon, we piled 19 people into the 11 passenger “school bus” and headed to the coffee washing station where we learned from a local Burundian man (and George who translated) about the process of getting coffee from tree to exportation. The kids see coffee trees all along local paths, but on this day, they touched the coffee cherries straight from the tree, saw the machine that takes the cherry husk off and sorts the beans, climbed on the vats where the coffee beans soak after being husked, and ran their fingers through the beans drying in the sun on huge tables where workers sort the beans into three categories. Students walked through the warehouse where the coffee is stored in burlap sacks until it is transported to Gitega and stood on the scale that weighs each sack to be loaded on the truck.

Trees are a fascinating and useful part of God’s creation. The coffee washing station is just one example of the ingenuity and backbreaking work local Burundians engage as they attempt to provide for their families. Learning by experience allows all of us to see more the creative provision of our God as we worship him through the joy of becoming educated. Getting outside the school walls gives us a glimpse of the country and the people God has called us to. 

Dear Super Yacht Owner

My family and I are currently studying french at a language school in France. We noticed your incredible super yacht in a harbour in France a few weeks ago while we were on a road trip with my visiting family. Your yacht was incredible to say the least. Multiple decks, 2 helicopter pads. I couldn’t help but think of the indoor pools, jacuzzis, probably multiple kitchens and I sure hope there is a theatre room or two or three. I did notice a few vehicles on one of the many decks. That must be nice that you can bring them with you.

Welcome aboard our "yacht"

It holds 7 passengers including driver

I was amazed by your yacht and aside from gawking at it, I decided to look it up on wikipedia. You should know it is really easy to find. It is the fourth largest super yacht in the world and the largest by volume. And $600 million dollars to build!  Since you can take 40 guests, I bet everyone wants to be your friend. Do you need all 80 crew members on every trip you go on?

I wanted to apologize for the english only speaking lady who tried to come aboard. That was my mom. She thought if she asked, you might let her on but I told her it was unlikely. It seems that your security people do an effective job of screening unwanted visitors.

I am writing to tell you that your super yacht really amazed me; in fact, part of me imagined what my life might be like to have one. But know that I wouldn’t trade my life for your boat. Not in the slightest. In fact, my family and I just booked our flights to Burundi for July 2018. We have been working towards this opportunity longer than it took to build your boat and we couldn't be more excited. 

I will get to use every bit of experience and training I have accumulated over the course of my life. I will be working with an incredible team of medical and non-medical staff. We get the privilege to serve in ways few people do, and to be the hands and feet of Jesus to the best of our abilities.

Not only that, we have a family, church and group of friends excited to be a part of the mission we will be joining.

I hope you enjoy your yacht, my regards to your guests. And if you think your yacht is exciting, you should see what is happening in Kibuye! 

Sincerely, 

Jesh

Alors il dit à ses disciples: "La moisson est grande, mais il y a peu d'ouvriers. 

Priez donc le maître de la moisson d'envoyer des ouvriers dans sa moisson."

Matt 9: 37-38

May Day

Incognito as ever

On the first of May  - which in many parts of the world is Labour Day / Labor Day / Workers Day / Fete du Travaille  (and in other parts of the world is merely 3 days before Star Wars Day “May the Fourth be with you”), some of us took part in some local festivities. Here in Burundi it’s a national holiday - one of the 12 or so during the year - but outside of Religious holidays (Easter, Christmas, All-Saints day) and various patriotic national holidays (independence day, unity day, 3 separate memorial days for 3 different assassinated presidents) it’s only May 1 and Jan 1 that are left. So it’s apparently a fairly big deal.

We gathered about 13 of us into the Land Cruiser - and headed for the ‘capital’ town of our district. It’s just a short drive away - even shorter if you take the back way - but I was instructed that driving a Land Cruiser full of people on the goat path was not recommended (it can be done….trust me).

Being a rather significant institution in our district - the Hospital was at the head of the whole thing.

 Part of the reason that we were going was that two of the girls had practiced a dance routine with some of the girls from the local school that sits just between our houses and the hospital.

...and for some reason, I forgot to wear my shirt.   Next time. 

The details - of course - were rather sketchy. What exactly they were doing, what they were supposed to wear, when we were to go, where we should be etc -  were all details that were only to be unveiled at the appropriate time. For us, as guests in a foreign land, that time seems to often be “just after something has happened.” Whenever these kinds of ceremonial events take place, it seems to often be difficult to navigate the expectations, protocol, assumptions that surround any kind of thing.

Last week when our team was having a discussion on cultural intelligence, the example came up that Canadians apparently have one of the lowest scores in the world for ‘power distance’ - meaning we are not comfortable with the fact that there is a large distance in hierarchy between those at the top and those at the bottom.

Personally, I feel like I am probably even dragging the collective score for other Canadians down - so suffice it to say that living in a place where protocol, respect for positions, authoritarian style of leadership, deference to one’s superiors, elders etc - is not something that I find easy to navigate.

Clearly some people knew how to get a better view - and this was before everything had even started.

So after the 'parade' part was done - and the kids marched in with the kids from our local school, and everyone marched past the platform and gave their respects to the local dignitaries who were there (which quickly included the contingent from the hospital) - the event itself started. 

One of the staple parts of any Burundian event of note it seems is always The Drummers. Burundi has a long and proud tradition of drumming - in fact Burundian drumming is recognized on the  UNESCO list of  "Intangible Cultural Heritage".  For comparison - that's alongside French Gastronomy, Turkish Storytelling etc. (neither US nor Canada has any).  And they are so amazing to hear and watch. 

Everyone wants to see the Drummers!

Once things got going the Kibuye school girls (including Matea & Anna) got up to dance. It, of course, was a bit of a spectacle that they were up there with the other girls.

 I speak essentially ZERO Kirundi - but there is one word that I recognize as it's shouted at/to me dozens of times a day: Muzungu.  Pretty much what I could understand was that the announcer (who seems to be ever present and constantly shouting into a microphone at these kinds of events) kept saying something like "Wow -look at Kibuye School  -they even have Muzungus with them!"

So apparently the fascination with others culture goes both ways

Pretty soon after the girls were finished dancing we realized that we should probably get back as it was a school day for our kids, and it was well past lunch, and it looked like this thing could go on for hours.

 Unfortunately, SOME of us had been seated in places of honor, right in the front row of the stage - and the kids were standing at the back of the platform. But - since we can move around without ever attracting any attention - we simply snuck off to the side- and I'm quite sure not one person even noticed. 

So that is apparently what a Fete du Travaille celebration is like.  Or perhaps not. Maybe that was a total anomaly - or maybe its exactly what everyone in the country experienced. One more experience that we had - showing that we really have no idea what goes on all around us every day.

Reflections from Rachel

by Rachel Buikema

I have only four weeks left in my nine-month term at Kibuye. I’m very excited to be going back to family and friends in the land of Krispy Kreme and Chick-fil-A, but I can already feel my heart breaking as I prepare to leave this place. 

For the past eight months I’ve been helping to teach the children on our team. Before coming to Burundi, I had never travelled outside of North America. That didn’t stop me from deciding to come here for nine months. I do not speak French or Kirundi (the local language), I had never met anyone on the team, and I was coming all by myself. I also had no teaching experience. I had no idea what I was doing! A few weeks in, one of my teammates asked me what was the bravest thing I’ve ever done. Without hesitation, I said it was coming here. I knew so little about where I was going and what I was going to be doing. I have been blessed to see God’s grace carry me though.

I was diagnosed with generalized anxiety disorder a couple years ago. My anxiety kicked into high gear about a month before leaving for Burundi. I felt like I was going to throw up almost every day. I normally love food, but not only was I not hungry, the thought of food was revolting. I was dreading saying goodbye to my loved ones for nine months. There were days when I thought that I was not going to be able to go through with this. I was terrified of the future and I had no idea what I had gotten myself into.

Had I known what that was going to be like before signing up for this, I probably would not have agreed to come. I certainly don’t regret coming—the opposite is true. I’m so glad I stepped out of my comfort zone to see the incredible work going on here. I was only able to do that by God’s grace and because we do not have to take the future nine months at a time.

Max Lucado has a wonderful book called Traveling Light (I highly recommend it!) in which he examines the 23^rd Psalm. Each part of the psalm corresponds to a burden that we often bear unnecessarily. The chapter about the burden of worry really resonates with me. He begins with some examples that seem absurd: a four year old who worries how she will ever pass a calculus class or an eight year old who worries if he’ll be a good parent. That’s simply ridiculous to think about. They don’t need to be worrying about such things yet.

Psalm 23:2 says, “He leads me beside still waters.” God is not behind us, waiting for us to move forward, but rather he is in front of us, clearing the way and encouraging us to follow. He gives us guidance when necessary. Hebrews 4:16 says, “Let us therefore approach the throne of grace with boldness, so that we may receive mercy and find grace to help in time of need.” The key phrase there is “in time of need.” Just as an elementary school teacher would not teach his students what they need to know in college, God does not give us all of the help that we need for the future right now. He gives wisdom when the time comes. So by the time that four year old gets to calculus and that eight year old becomes a parent, they will have what they need in order to be successful in their calling. By the time I arrived in Bujumbura (the capital city), God had given me the strength I needed to get to that point. He has continued to provide what I need as I need it throughout my time here.

As I reflect on my experiences in Kibuye and look ahead to the next chapter in my life, I can feel the anxiety welling up inside me again. How can I manage another transition of this magnitude? Every single day I need to remind myself of God’s promises. I’m working on abiding by Matthew 6:34: “So do not worry about tomorrow, for tomorrow will bring worries of its own. Today’s trouble is enough for today.” Instead of splitting my mind between today’s to-do list and tomorrow’s tasks, I need only focus on what’s happening now. There are so many things we could worry about: How will we cope with the loss of a loved one? What will we do if we lose our job? How will we possibly get through all of the hardships that will inevitably come? God will provide help at the right time. He has promised to never leave us or forsake us, and we serve a God who keeps His promises. Where he calls us, he will equip us.

Relating to John in Prison

(by Eric)

We beseech thee, give us that due sense of all thy mercies, that our hearts might be unfeignedly thankful.  -Book of Common Prayer

(if you want to read the context, you can read Luke 7:18-23)

Samuel van Hoogstraten (1627-1678)

Lord, I feel like John in prison.  He sent his followers to ask the question that burned inside him.  Is the kingdom of God really coming?  Is it really near?  Because this world still seems so incredibly broken, so unredeemed, so worn and tattered and heading inexorably towards death, not life.  Now that you've come, Jesus, are you really making all things new?  Are you really reconciling all things to yourself?  I can understand that I wouldn't see your final, perfected work right now, but this hardly feels like new creation at all.  So, go and ask Jesus, "Are you really the one who was to come, or should we be waiting for someone or something else?"  I know that I've felt, seen, and even proclaimed this myself in the past, but it's just terribly hard to believe right now.

So, his followers went and put the question to you.  Your response is telling.  In that hour, you healed sicknesses and handicaps.  You chased out demons, and you told the messengers to go and tell John what they had seen:

The blind see.  The lame walk.  Lepers are cleansed.  The deaf hear.  The dead are raised up.  The poor hear the good news.  And blessed is the one who is not offended by me.

What did John think when he received that news?  We don't know.  It seems that you wanted him to notice that the signs of the kingdom of God were bursting into bloom all around you.  It seems to be a way of saying, "No, John, you're not wrong.  See the evidence that God's kingdom comes in my wake."  I think that the reasons John was wondering in the first place was because he didn't see transformation on that larger scale that he expected, and likely in particular because of his own personal predicament of being imprisoned.  I can understand his sentiment.  

How did John receive the response of his followers?  Did he understand?  Was he encouraged?  Did he have more peace and faith in the days that followed in his prison cell?  Nothing ever really did change for him on a personal level.  He never got out of prison.  In fact, he was killed.

"John, have faith.  Trust me.  All things are not yet made new, but there are signs.  There are in-breakings.  There are first fruits, seals, down payments, promises of a bigger thing to come."  Let the signs give their witness and hang in there.  Can I do that?

The funny thing is that Kibuye, every day, is quite similar to Jesus' testimony.  Here, because of God, blind people see, the lame walk, and people with terrible medical conditions (including the occasional leper) are healed.  People that are all but dead are seemingly resurrected (the French call intensive care "reanimation"), and the poor hear and see the good news that God is near, offering life, both eternal and abundant, offering forgiveness, offering adoption into his family.  It's easy to imagine someone coming to visit and having the type of encouragement that it seems Jesus is wanting to give John.  "See the signs!  It's real!"

But I see all the rest, as well.  Emelyne is only 14, and she is so suddenly on the brink of dying.  Emmanuel shouldn't have to die, and yet I fear he will this very day.  Floribert and Pascal are the same.  The lame man who had a terrible stroke is likely to remain lame just to go home and get bedsores and die.  The blindness from meningitis is not getting better.  Poor patients who suffer and die because they are poor in a poor country.  Broken systems with decisions that impede even the little that we can do.  Fractured relationships in families and friends.  Misplaced hope and desire leading to depression.  Broken connections to God, to ourselves, to each other, to our work, to the earth.  Sin.

The "signs" don't feel like enough.  The promise seems way too big for the signs to be adequately convincing.

Blessed is the one who is not offended by me.  ...who doesn't lose faith because of me.  ...who doesn't stumble on account of me.

Why did Jesus end his message with that?  How does one get offended by this?

Sometimes we might say, "Look, what I'm about to say to you is hard.  Please, don't get offended.  Rather, hear me out.  I know it's hard, but don't close your heart at the tough words.  Hear me out.  Don't lose faith.  Don't fall.  Hang in there."

I guess it's like that.  Jesus is admitting that it's hard, but he gives us an admonition to persevere.

I keep coming back to Paul Miller's description that we live in the desert created by the distance between our hopes (or promises) and the reality in which we find ourselves.  We can give up on the hope (and thus, despair).  We can give up on the reality (and become delusional).  Our we can dwell in the desert between the two, with one arm on each, feeling the tension pulling us apart at every moment.  The good news according to the Bible is that God always seems to be showing up in the desert.

"Have patience, John.  Trust.  Let the signs encourage you, if they will.  Maybe they won't.  But the promises are true.  Live in the desert for now.  Do what you can where you are.  The kingdom of God is coming.  I am coming soon."

Paternalism

by Rachel

“We want autonomy for ourselves and safety for those we love.”  —Atul Gawande

 I’ve had a lot of bad outcomes lately.  I guess things tend to run in spurts…bad things come in threes, or multiple patients come in with the same diagnosis after months of not seeing that diagnosis at all.  Lately, I’ve been thinking about multiparity, or really, grand-multiparity.  For the non medical folks, “parity” refers to the number of times a woman has given birth.  When that number reaches 5, she falls into the category of “grand.”  When I was doing my training in residency, it often seemed that the first pregnancy was “the worst."  Meaning, if you were going to get a complication, it would more often happen with the first one.  Walking in to Labor and Delivery and seeing a whole unit full of “nullips” (first time delivery) meant a long day and/or night of unknowns while we watched and managed and hoped that a C-section wouldn’t be necessary.  A unit full of women who were on their second or third deliveries was much more upbeat, fast paced, certain.  Of course, it wasn’t very common to have a unit full of women on their 5th, 6th, or 7th deliveries.

Burundi is very fertile country, in more ways than one!  The average woman will have 6 babies in her lifetime.  My clinic is flooded with women who can’t conceive, so it stands to reason that for every one of those women, there’s another on her 10th pregnancy.  And, soberingly, a woman stands around a 1:30 chance of dying due to a pregnancy complication during her lifetime (UNICEF statistics from 2010).  It also stands to reason that the MORE pregnancies you have, the more risk you expose yourself to.  I had an attending who liked to say that getting pregnant was the most dangerous thing a woman could do with her life.  OK, I think that’s a bit extreme.  But oftentimes, especially in the US with a well developed medical system, we forget about the potential risks of pregnancy and childbirth, especially because the risks seem so minimum in comparison to what you get out of the deal.  Even with all my training and knowledge of the complications of pregnancy, Eric and I decided to go through the process three times! (And let me tell you, I do NOT take the fact that we had three uncomplicated deliveries and three healthy kids for granted).

So, back to my bad outcomes.  I had two maternal deaths in March with almost identical stories, women who should have had a straightforward delivery.  Two previously healthy women, both on their 7th pregnancies, both with 6 living children, who presented to another hospital after prolonged labor.  Both had a ruptured uterus (where the uterus basically tears open because it’s been working so hard to get the baby out) and a dead baby.  Both received surgery to attempt repair, which failed, and were transferred to me for “better management”.  Both arrived in shock.  Both received hysterectomies to try and stop the bleeding.  Both died within 12 hours of arrival due to coagulopathy.  

I felt very powerless in the process.  I felt like my best efforts were not good enough.  And I felt regret for a system that tries but isn’t good enough to save these women and ensure their children grow up with a mother.  And finally…I felt myself wishing these ladies had just stopped having babies.  If only they had decided 5, or even 6, was the perfect number of children.  If only.

These are not the first two women who have died after similar circumstances.  In fact, after doing some research I found that it’s shockingly common in the developing world to develop a ruptured uterus because of long labors or limited access to care.  And experiences like this color my opinions and decision making.  If it can happen to those two women, why not others?  

So I keep advocating for better care, and better birth control.  I perform a C-section for a woman…it’s actually her 5th, and she has two living children.  The surgery is a mess and takes forever, due to layers upon layers of scar tissue.  At the end I tell her that we should tie her tubes because this is getting too dangerous for her.  She refuses.  Multiple times.  I take one tube, and then the other, in my gloved fingers and think about how easy it would be to tie her tubes right now, even without her knowing.  Even without her consent.  Surely, she doesn’t have enough knowledge or experience to know how dangerous another pregnancy could be for her.  I could probably be saving her life if I tied those tubes.  Or at least, saving her from terrible complications in the hands of the next, possibly unexperienced doctor who tries to perform another C-section on her in the future.  I am the one who spent years and sweat and tears and money to receive my medical training, to be able to advise and treat…my knowledge base is far superior to her own.  

And then I think about why I am here in Burundi.  About how much I care for these women, all of whom have suffered so much at the hands of family, husbands, an incompetent medical system, life.  About how they are all fighters, and how I want what’s best for them, to empower them.  And I realize that taking away one of the only choices she has, to make a decision for her, is exactly what I’m fighting against.  And I slip the uterus back into her pelvis and close up the layers, and hope that she never gets pregnant again….but if she does, I hope, I hope, I hope that she lives through it.

I don’t know.  I doubt myself.  But I know that change does not come by taking away autonomy.  I want these women to be safe, yes.  But there are other ways to bring safety.  If only…