Many First Times

(By Ted)

When was the last time you experienced or did something for the first time? 

For our family, this past year has been filled with many first-time experiences. It was our first time moving to another country (France) then yet another (Burundi). It was Eunice’s first time learning to drive stick shift (awesome!). It was my first time getting a speeding ticket in another country, while in France (not so awesome). It was Toby’s first time attending a French preschool, where French was the only language spoken around him all day. It was Amos’s first birthday shortly followed by his first steps walking on his own. And the list goes on… 

For me, specifically in the context of the hospital here in Burundi, first time experiences are a daily thing. Such experiences typically come in the form of an operation I’ve never performed (that would be typically done by other surgical specialists in the US) or in a disease I’ve never treated or managed before (like osteomyelitis in children). Some of such first-time operations these past 3 months for me have included a cleft palate repair, an excision of gingival mass, a hip replacement, and an ectopic pregnancy. 

Before getting to Burundi, I knew I would be in a radically different hospital environment, and I expected to be learning a lot of new information outside the scope of my training and background in general surgery. With a few months now under my belt, I can attest that there is never a day that goes by where I am able to say to myself, "Self, you knew how to take care of every patient that you encountered today." Fortunately, there is a more experienced and well-seasoned surgeon, Jason Fader, available to mentor us and guide us through the foreign and unknown. 

Still, even for things I know and was trained how to do, the pre-operative workup, the intra-operative steps, and post-operative management are totally different, and I am essentially having to reprogram my mind how to think. For example, even a simple biopsy to determine whether a mass is benign or malignant is something which we nearly always obtain in the US to guide our management for surgical diseases. Here, pathology services are not available, and if we think a biopsy would be helpful, we can get results in a few weeks by sending a tissue sample back with a short-term visitor or teammate who is heading to the US in the near future. As another example, we have no CT or MRI imaging, so as a result, we rely heavily on physical exam and ultrasound. 

Having so many first times in the hospital context can be challenging and exciting at times, and can bring a sense of great accomplishment. Other times, it can trigger a sense of feeling overwhelmed, inadequate, or helpless. In the medical world, where competence and performance are valued and praised, you would be hard-pressed to find general surgeons (and other physicians) admitting to feelings of inadequacy, which would be a sign of weakness. Conversely, in the context of a mission hospital in a low-resource setting, I would say that you would be hard-pressed to find missionary doctors who are not experiencing inadequacy or helplessness at some level. And I think there is Biblical truth to be found in this. I am reminded of the 2 Corinthians 12: 9-10, when Paul writes: 

But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong. 

I know that I don’t have all the answers, and that there is a steep learning curve of working in a mission hospital, which keeps me on my toes and keeps me humble. Though experiencing many first times is not comfortable, it is in this state that I am forced to turn to Jesus and to rely on Him, and this is good.

Umutama Power

(warning:  this blog post contains shameless introspection and unabashed navel gazing)

(by Greg)

Among the team of long-term missionaries here at Kibuye, I am the oldest member.  I am 44.  In Kirundi there is a word for “old man” which is Umutama.  In Burundi, it is an honor to carry this title.  After our arrival, once we sorted out that I was in fact 2 months older than George Watts, members of our team began to address me by this title, not so much as a sign of respect but rather as a reminder that I am no longer a spring chicken.  In fact, one of the missionary kids on our team started calling me Umutamakazi, which means “old woman”, just in case I had any delusions that my new nickname might actually be for the purpose of honoring me.  Some of the Burundian hospital staff have also started calling me Umutama.  By the way, this title came with an “umutama walking stick”.  With my dying breath, I am to pass this stick along to the next in succession, perhaps to George. 

I do realize that I am far from what most Westerners would consider to be “old”, but given the constant reminder of my revered position on this team, over the course of the past year, I have started to reflect more and more on my life, and what it will look like at the end.  This reflection has not necessarily been a moribund or negative process, but rather has caused me to think more deeply about what is really important in my life.  As the author  Columba Stewart wrote, “Awareness of mortality exerts a unique power to focus the mind and the heart on essentials”.  There are still a lot of things I want to do.  I want to travel to New Zealand.  I want to visit the Lagavulin distillery in Scotland.  I want to learn how to play Settlers of Catan.  In reality, I probably will not get to do all of the things left on my “bucket list”.  Lets face it, Settlers of Catan is a young man’s game. I might live for another 50 years, or I might die before I finish this …. sentence.  

But above all of these bucket list items, I want to be able to say at the end of my life that I loved my family well, that I served in my profession with dignity, diligence and compassion and that I ran my race not for my own glory but for the glory of Jesus Christ, living a life that was a display of His Gospel.   Have I been doing this?  Not perfectly and not nearly as well as I would like.  There is at this point in my life unrest within me that I need to address.

I want to be able to share the Good News, which someone once shared with me, with my children, my friends, and my patients at the hospital.  In order to do the latter, I need to learn Kirundi (as most of our patients do not speak English or French).  Their response to this offer will never determine the physical care I provide to them, but I want them to at least be given the opportunity to respond.  Learning a new language is not easy to do when you are an Umutama.  There was an article in Time a few months ago that said that scientists have determined the age after which you can no longer become fluent in a new language. I opened the article with much anticipation, hoping the magic age would be around 50.   It’s 12.  That certainly extinguished any flicker of hope left in me that this might be possible.  But I will keep trying and I hope and I pray that one day, maybe in a year, maybe in 40 years, I will be able to express, in Kirundi, the Gospel of Jesus and what He has done for me to the people of Burundi.  By then, I think I will have truly earned the title I was given 40 years earlier.  Now, if someone will hand my me walking stick, I’ll be on my way.

Eternal Medicine

(By Jesh)

This week I joked with my medical students that we were running an “eternal medicine” service. Surgery is very different than internal medicine and surgeons often feel that internal medicine rounds take an eternity thus the name “eternal medicine.” This is no disrespect to my internal medicine colleagues for whom I am very grateful…I could not manage their patients whose problems tend to be more mentally complicated than my surgical patients, thus the difference in our rounds.

The surgery service peaked this last week at 61 inpatients so at 4 minutes per patient, it would take my medical students and I roughly 4 hours to see everyone. Thus our rounds seemed to take an eternity. It was a good process though because it forced our medical students to present only those signs, symptoms or tests that are important rather than giving the typical drawn-out bedside patient presentation. 

It meant no beating around the bush!

Sometimes during eternal rounds and all the business of the day it is easy to forget the real “eternal medicine.” Not endless surgery or internal medicine rounds but the life that comes through a relationship with Jesus Christ. It is this life-giving relationship that changed my life. It allows me to wander into the surgical world of pain and suffering and yet have immense joy in sharing surgical principles with my students and compassion to my patients. It also drives us as a surgical service to do and expect high quality work because we report not only to boards and certifying organizations, but also to a living God. It’s also the hope we can offer to someone in death because it truly is eternal in nature.

Jesus answered, “Everyone who drinks this water will be thirsty again, but whoever drinks the water I give them will never thirst. Indeed, the water I give them will become in them a spring of water welling up to eternal life.” 

John 4:13-14

Dry Season (music video)

by Logan

During last year's dry season I had a crazy idea: what if I took a time-lapse video of my walk across the field to the hospital?  If I took a photo every day, just one step further, perhaps it would tell the story of dry season.  You could watch the field grow more and more yellow and dusty as the season progressed, and then at the end, watch the return of green grass.

It actually worked out pretty well, and I was pleased with the result, except that it was completely silent.  I asked our musician teammate, Eric McLaughlin, if he had written any songs that would go well with the theme of dry season.  He recommended a song called Banga Hill, that he had written during their very first dry season in Burundi.  It talks about our need for God's grace to "rain" into our lives, washing away our sins and quenching all our thirsts.

Enjoy!




For I will pour out water on the thirsty land, and streams on the dry ground; I will pour out My Spirit on your offspring, and My blessing on your descendants. 
-Isaiah 44:3

Blessed are those who hunger and thirst for righteousness, for they shall be satisfied.
-Matthew 5:6

Now on the last day, the great day of the feast, Jesus stood and cried out, saying, "If anyone is thirsty, let him come to Me and drink.”
-John 7:37

Jesus answered and said to her, "Everyone who drinks of this water will thirst again; but whoever drinks of the water that I will give him shall never thirst; but the water that I will give him will become in him a well of water springing up to eternal life.”
-John 4:13-14

More of Eric's music can be found here.

Serge East Africa Retreat

(By Alyssa)

Most of the team recently attended the Serge East Africa retreat that occurs every four years.

Retreats provide an opportunity for us to get away from the hustle and bustle of life in Burundi and to reconnect with God, each other, and Serge friends doing similar work in the region. The theme of the week brought by speaker Greg Thompson was "Life in the Wilderness." In Exodus, God leads His people in the wilderness - not an easy place but the place where God was with them by day and by night. We had no trouble applying the imagery of wilderness to our lives in East Africa - places where we lack clarity & control, sometimes powerful and beautiful places but where we don't always understand what's happening. We identify with Martin Luther King, Jr. who said, "Always there's a wilderness before us." But wilderness doesn't have to be a place of despair. Instead it is a place of invitation by our Beloved Heavenly Father to be embraced, transformed, and consoled by Him alone which leads us to join Him in consoling and loving others. We appreciate your prayers for our team that these truths would sink deep into our lives and overflow to those around us.

And to update you on our ever-growing and transitioning team, check out this video that we shared at retreat - created by our oldest team kid Jonah Watts:

And a few more retreat pictures:

Our talented teammates leading worship 

Communion

Fun time with friends

Beach soccer

Running on the beach at sunrise

Beautiful creation drawing us to our Creator

Solar Power at Kibuye

(By Caleb) 

It has been a busy summer in Kibuye.  Among the many comings and goings, regional conferences, the arrival of new teammates, etc. we welcomed a whole new level of power to Kibuye hill….solar power.  

It takes a team to bring something like this to fruition.  It all began with a group of electricians and solar experts working for a non-profit called International Technical Electric and Construction (ITEC).   ITEC installed a solar system about 25km from us for a partner organization.  They visited our hospital while here and asked if we had ever considered solar power for Kibuye Hope Hospital.  It was not too long after this that we began receiving only an hour of power per day from the national grid and diesel was becoming extremely hard to find. If diesel became available at a gas station 30km away, we had to first get a special letter from our Provincial Governor to allow us to buy a very limited quantity and then race to the station before it was all gone.  Lines at gas stations could reach one hundred cars long.  We had to cut way back on the number of hours we could provide power to the hospital. This had dramatic effects on patient care: those who needed oxygen could not get it, premature babies were not able to be warmed in incubators, and essential surgeries could not be performed, etc. We were becoming hamstrung.  

Something had to be done. 

In September of 2016, ITEC came to Kibuye for a preliminary survey.  This group of gentlemen immediately impressed us. They were professional, very knowledgeable, and delightful to have around.  In the following months ITEC proposed a solution they call a Power Pac: a 40-foot container that they build out and pre-wire in their warehouse in Pennsylvania complete with batteries, inverters, and switchgear. The solar panels, distribution wire, and mounting equipment are shipped in a separate container.  Our team held many discussions about this solution and finally decided this was right for Kibuye.   

A design based on current need and future growth was decided upon: 122.5 kW of solar panels, 90 kW of battery inverters, 120,000 Ah of batteries, 176 kW generator and a new transformer dedicated to the hospital.   The design could also be easily expandable as the hospital grows.     

A preliminary planning sketch

The piers for the Power Pac were poured and we waited for the right time to level the corn field to prepare for the solar array

Volunteers at ITEC spent countless man-hours throughout 2017 and early 2018 purchasing equipment, building and testing the Power Pac.  The two containers shipped from Pennsylvania in March of this year and came via New York City, Atlantic Ocean, Mediterranean Sea, Suez canal, changed ships in India, the port of Dar es Salaam and then finally by road to Burundi.  

To our great relief the containers arrived safely in early June 

Greg Sund diligently "supervising" the unloading of the solar panels

The Power Pac was set in place by two cranes, one of which must have been from the WW2 era. 

The container moving attracted lots of curious onlookers 

The team laying out the supports for the solar array under the watchful eye of Jack Myhre, our highly-skilled engineering intern

Digging postholes by hand

Dressed in his awesome pink bathrobe, our charismatic and resourceful welder puts the final touches on the array supports

Solar panel supports ready for the arrival of the ITEC team.

Power Pac and new generator covered and prepared. 

Work commences

Strong and willing hands.

Solar array going up panel by panel. 

First array installed

Always donning proper safety equipment, these men are pulling the supply wire to the hospital.

350 panel array complete!  

Inside the Power Pac 15 battery inverters hang on the right side...

....and the switchgear and battery bank on the left.  

Just a few of the 28 ITEC expert volunteers who came to install the Power Pac  

We have been enjoying seamless 24/7 power at the hospital for almost 4 weeks now.  The oxygen concentrator can satisfy the endless demand, incubators stay warm, operations can happen at all hours of the day or night, lab results never have to wait and x-rays can be taken when needed.   The impact of this work on the ability of Kibuye Hope Hospital to care for patients will surely be felt for years to come.    

We are very grateful to many for the their hand in this project: 

Funding: African Mission Healthcare Foundation and the Christian Broadcasting Network, Isaiah Mission Foundation, David Pyott Foundation, Brenden and Jenece Hanks and a number of other generous individuals.   

ITEC Volunteers: 28 men and women from North America who came and served this community with their skills and always did so with a smile.

Jack Myhre: Engineering Intern working at Kibuye for the summer did a vast majority of the site preparation planning and design.

 (NB:  A majority of these pictures came from the ITEC blog which chronicles the 5-week installation process)