Wearing Many Hats, or, Resolutions

by Carlan

One of the first things to strike me about the life of a missionary ER doctor was just how many hats one has to (gets to?) wear. In addition to the typical set of responsibilities, renovating a closet to become an ER, training staff on some key aspects of emergency care, teaching med students, and investing in the spiritual maturation of those same folks, my first year in Burundi had me scrambling to learn about international labor laws, graphic design, tree husbandry, the nutrition provided by various staple crops, and IT network management. In this last year or so, I have gotten to learn about publishing a Kirundi translation of a Bible study, managing a non-profit board, coordinating a multi-center research protocol, concrete crush pressures, architectural project management, international conference planning, plumbing codes, cabinet construction, the Alexandrian (allegorical) hermeneutical tradition, African Christologies, and, best of all, fatherhood.

Most days, it feels like what I do has relatively little to do with the training I received in med school and residency. I am extremely grateful for the support of my residency program, LAC+USC Emergency Medicine, for allowing me to pick up shifts when I come back on furlough and I will never forget my time at Verdugo Hills Hospital as a (sometimes) solo practitioner. I love getting to practice my speciality. Yet this chance to reinvent myself every year is one of the hardest, best things about life in Burundi. Each day is an opportunity to become more like the person I want to be: creative, helpful, encouraging. The risk of intellectual stagnation is pretty low for most missionary doctors...at least all the ones I know.

Having all these opportunities to learn and grow comes with a potential pitfall as well: distraction unto dissipation. My mom told me when I was young, “If you can do one thing in this life with excellence, you’ll be doing better than most.” I resolved that day that I would be excellent at something before I died...not so much out of vainglory but because aspirations ought to be towards excellence. That pathway was laid out in relatively simple terms throughout my pre-deployment life: study hard, learn the material set before you, and demonstrate your competence every time a test presents itself. That is, after all, the only way to get to and through medical training. Yet even during residency, the breadth of possibility was challenging my notion of excellence.

Emergency medicine as a field is wider than many and as deep as any. One somewhat snarky professor used to say that an ER doctor needs to know 20% of what a cardiologist knows, 30% of what a trauma surgeon knows, 15% of what an ENT knows, 25% of what a pediatrician knows, 10% of what an internist knows, 15% of what a radiologist knows, 25% of what an toxicologist knows, etc., etc. If you add it all up, we are supposed to know 300% of what one can know and to access it within 10 seconds of needing it, all while resuscitating a crashing patient. Even if he overestimated our abilities, something in that statement rings true. I would only add that for missionaries you need to multiply it by a factor of 10.

The hard hat of construction project manager.
So how does a missionary ER doctor decide where to focus his (admittedly short-lived) attention?

In 2020, I want to do less. Pardon my grammar, I want to do fewer [things]. My grandpa used to say, “Life is just a series of decisions made based on priorities.” So this year, my resolutions are only three:

I know no one is wearing a hat, but sometimes we have to put on a suit to sit on a thesis jury.

  • to tell & show Jesus every day that I love him
  • to take Michelle on (at least) two dates without distractions (aka, sans child)
  • to take (at least) one photo with our daughter that is so epic/fun/beautiful that she’ll ask me about it when she is older

I know she's also not a hat, but I have been called "the doctor who wears a baby" by one visitor.
How about you? What are you relationship resolutions for 2020?


Washing Feet

Every Monday and Friday women and children from all over Gitega province walk to the hospital, sometimes from homes that are many hours away, to receive a meal and a 1kg bag of busoma from the hospital feeding program. And each Monday and Friday from 10-12:30, Susan and Annick set up a station in the corner of the feeding program pavilion to meet with people. Mamas (and a few Papas) come with problems and questions of all kinds. Susan shakes each person’s hand and listens to their concern. She measures tiny arms and checks for other signs of malnutrition such as blonding hair and eyelashes, puffy cheeks, swollen bellies. Many of the people have questions about topics besides just malnutrition. Their eyesight is failing - can she get them in to see the ophthalmologist? Their baby has a bump on his head - should they see a doctor? Their child has been having constant diarrhoea - can she give them de-worming medication? Sometimes people tell her about how their roof leaks in rainy season, that they are unable to buy notebooks for school, have no blankets to keep their child warm or no ability to produce milk for their infant. As Annick translates, Susan responds to each person to the best of her ability, knowing when someone really needs to see a doctor and when there are other ways to help. She gives out a blanket here, a jar of milk there, buys a hand-woven basket from a widow who needs that money to get through the week. She listens and responds, and even when there is nothing she can do to help, still at least someone has listened to them with a compassionate ear.  

Annick and Susan meeting with people at the feeding program
Susan with a baby that she helped to relocate and support after the baby's mother died

The other aspect of what she does is basic wound care. Sometimes others from our team come and help with this, like myself, Stephanie, who is a trained nurse, and some of the older kids on the team as well. Susan has visitors bring Band-Aids, gauze, disinfectant spray, and antibiotic cream over from North America. Equipped with these items in her first aid kit, we do our best to clean, disinfect, and cover the various wounds that people present us with. Some of the wounds are terrible to look at, dirty and infected, caked around with dust from the roads, still unhealed from the time of injury many days or even weeks prior. 

A few weeks ago I was feeling discouraged about how much our wound care was actually helping. That day I had peeled off a Band-Aid from a wound I had cleaned and dressed the week before, and seen that it had barely healed. This is not at all an uncommon occurrence. Later that day, I shared my discouragement about this lack of healing progress with Dr. Rachel. She informed me that malnutrition is a large contributor to why many of these injuries heal so slowly. She told me that some of these injuries are systemic and that our care will not cure them without the underlying cause being remedied. Yet, Rachel also encouraged me by reminding me that the wound care that we are providing has more purpose than just treating the wounds themselves. It also demonstrates to the people who come that there is someone out there who cares enough about them to touch their dirty feet, their sores, and their imperfections. To clean them. To tend to them. Having someone take the time to care for them in this way can provide a different kind of healing to many of these people who may not receive that kind of interaction regularly. Susan told me once that one of the main reasons that she provides wound care is to build relationship. I can see now how caring for someone’s wounds can build relationship and trust even without using words. This is huge for those, like me, who can’t yet speak much Kirundi. 

Much of what I end up doing when helping with wound care at the feeding program is cleaning people’s feet. For these people living in desperate poverty, shoes are uncommon and they work daily in rocky fields and walk long distances down hard, dusty roads. Thus, many of their injuries are on their feet and it is very hard to keep those injuries clean. Using saline and gauze we clean out each wound and proceed to wipe away the layers of dirt around it before applying a sterile Band-Aid. About a week ago, while cleaning around an ulcer on someone’s ankle, an image came clearly to my mind. Can you guess what it was? The image of Jesus washing the feet of his disciples. I heard a Tim Keller sermon recently in which he said that in Jesus’ time touching someone else’s feet was considered a task that not even servants were allowed to be told to perform. From poverty and the dirty, dusty roads of Israel, people’s feet became so mangled and filthy that it was beneath the duty even of a slave to have to wash them for someone else. Yet, Jesus does it. 

John 13: 2-5 and 12-17 (NIV) says:

The evening meal was in progress, and the devil had already prompted Judas, the son of Simon Iscariot, to betray Jesus. Jesus knew that the Father had put all things under his power, and that he had come from God and was returning to God; so he got up from the meal, took off his outer clothing, and wrapped a towel around his waist. After that, he poured water into a basin and began to wash his disciples’ feet, drying them with the towel that was wrapped around him...When he had finished washing their feet, he put on his clothes and returned to his place. “Do you understand what I have done for you?” he asked them. “You call me ‘Teacher’ and ‘Lord,’ and rightly so, for that is what I am. Now that I, your Lord and Teacher, have washed your feet, you also should wash one another’s feet. I have set you an example that you should do as I have done for you. Very truly I tell you, no servant is greater than his master, nor is a messenger greater than the one who sent him. Now that you know these things, you will be blessed if you do them.

In this passage, the king of the universe stoops down and washes the feet of those that he loves so much, even though they are about to betray him. And he commands us to follow his example and to do the same. The wound care that Susan and others are doing at the feeding program is a very literal way to follow that command. Though in most situations, “washing someone’s feet” may not look like physically taking their foot in your hand and scrubbing, in the case of the work that is being done by people providing wound care at the feeding program, it does literally mean just that. What a beautiful and concrete opportunity to physically do for others what Jesus has metaphysically done for us.


Noheli Nziza!

Christmas Eve is nearly over which means Christmas day is nearly here! The last several weeks leading up to today have been filled with celebrations and events surrounding the Christmas season.

Following our busy Thanksgiving meal, team members started decorating, playing Christmas music, and putting up their trees. Some visitors also began to arrive from the US; Rachel's mum came out this year for the holiday season and Kayla's parents as well.

Christmas Leopard

At school, the kids, under the direction of our talented music teacher, Julie Banks, began preparing for the annual Christmas play. Over the month of December, they performed it several times including at the hospital and the feeding program, as well as in the Kirundi service at our local church, and at the Christmas party for our Burundian house helpers. Everyone did a great job! The audience especially enjoyed when Maggie (playing Mary) walked behind the set and came back with a balloon under her dress signifying her pregnancy with the baby Jesus. The play was narrated in French and Kirundi by two of the KHA students, Piper and Liam.

"Wee" three kings

A whole heavenly host

Performing at the hospital

Performing at the feeding program

The second-last Friday of school before the holiday break, Jean, Rachel's mother, led a learning experience day. The kids had the opportunity to explore Christmas traditions from cultures around the world including India, Germany, and Mexico. Part of the day included making a Christmas food from that culture to share. As expected, that turned out to be a very popular and delicious activity. The groups also learned how to sing "Silent Night" in German, Spanish, and Hindi.

Making Christmas snacks

At the doctor's bible study we wrapped up our book study for the year with some cookie decorating and other treats. Some of the Burundian doctors had never decorated Christmas cookies before, so it was a novel experience. Ted and Mattieu acted as judges and selected the most creative, most delicious-looking, and most "Christmas-y" cookies from amongst all those that were decorated.

As Christmas approached, there was a "White Elephant" Party for the adults and several parties for the kids as well, most of which involved playing the game Just Dance. We also had the special treat this year of having several of our musically-talented Burundian friends host a Christmas coffee house night in which they played and sang while the rest of us were able to chat and enjoy some yummy snacks and hot beverages. At the end of the night they opened up the floor and we had a few people go up to the mic and sing or play the keyboard. John even broke out his saxophone!

John on the sax and Eric on piano

Throughout the month, the kids made several videos at school creatively depicting parts of the Christmas story. These were shared at Friday morning chapels and were accompanied by many laughs. They were meaningful and also lots of fun. On the last day of school, we had a half-day of cookie decorating, games, and Christmas stories.

Christmas chapel

Just making sure that the icing does, in fact, taste good...

Today, in the early evening, our community gathered together for a Christmas Eve service. Eric led us in traditional carols and Rachel in Scripture readings. It was a beautiful service focusing our hearts on the coming of our king.

Tonight, people are enjoying meals together and hurrying their kids to bed in preparation for the big day tomorrow. There will be a French and a Kirundi service at our local church tomorrow and Carlan will be sharing the message at the French service. After that, several of the kids and adults will be heading up to the hospital to distribute some small Christmas gifts and to sing some carols in the wards.

Though there is no snow here, we are all finding ways to celebrate the season. Many of us are thinking of family back at home and sending our love from afar. Wishing all of you much joy this Christmas season from the team at Kibuye! In Kirundi we say Noheli Nziza!


All She Wants for Christmas Is...

... her two front teeth. 
Thanks for modeling Alma Watts (3rd grade)

And a teacher for the 2020-2021 school year would be great too!

If you're having trouble viewing the video, try clicking https://vimeo.com/378512631.

As Julie mentioned in the video, when people in the States hear about what we're doing in Burundi, one of their first questions is, "What do you do about education for your kids?" Educating our team's kids has been a big part of my role here, along with many other moms and teachers. God has been so good to provide us with our special school, Kibuye Hope Academy, that is a unique hybrid model:  a small Christian school and homeschool co-op all rolled into one.

Most years, we have been fortunate to have teachers come alongside us in educating our kids. Scott and Lindsay are in their 4th year with us as teachers and Kayla is in her second. All three of these amazing teachers will be finishing their terms at the end of the school year and moving on to other opportunities. They have invested deeply and given generously of their time and talents for our kids, which has blessed our team's families and the country of Burundi. We're really going to miss them!

Learning Experience Day on plants

1st-3rd grade, PE class

5th grade, eating cream puffs in honor of a book they read

Given the number of kids and the range of grades next school year (1st--8th grade), we are praying that God would send us TWO teachers for the 2020-2021 school year. That would be a wonderful gift to our team this Christmas season. Please join us in praying for God's provision and sharing about this opportunity on social media (and with all of your teacher friends).

If you are a teacher who wants to support medical education in Africa, get to know some fun and unique TCKs (third culture kids), live in close community with other missionaries & Burundian doctors, see more of the world, and experience life in Africa, we'd love to talk with you and answer any questions you might have. Please contact jessicacropsey@serge.org.

For similar opportunities with other Serge teams in Africa, visit https://serge.org/type/missionary-kid-teachers for more details.


A View from the Construction Sites

Hello! My name is Jessica Lembelembe. My husband, Mathieu (Matt) and I are here in Kibuye for a 6 month season supporting construction at the hospital...and on a few other building sites nearby! We are happy to be here and share a bit about what's going on in our corner of Kibuye.

First a little more about us: Matt is an architect with Engineering Ministries International (EMI). Because we are based in East Africa, he had the chance to visit Kibuye on several short term project trips, when a team of engineers and architects have come to develop and flesh out the hospital masterplan. Since we met in 2016, Matt's been telling me about the project, and when we got married last year, he promised to bring me along to see this special community. We were happy when the position for a temporary construction manager in Kibuye opened up at a time when we were also available for a new assignment. So here we are!

Taking a tour through the blog archives, I found several posts that tell the story of how the hospital has expanded and already fulfilled parts of the 20 year growth plan. One of the earliest steps in the process was the development of a physical masterplan with the help of a team from EMI in 2013 (see post here). If you look at the Vision tab on the blog you'll see the picture below, showing how the hospital looked when the Serge team first arrived. It had about 100 beds and many medical students - but not many doctors.

Fast forward to 2019, and this is the view we saw when we arrived:

All of those new blue and red roofs represent growth in this community. And recently, the team celebrated the fact that there are now over 20 Burundian doctors serving alongside international doctors. God has been moving in this place!

From our vantage point, getting to dive into this movement of God midstream, it is so encouraging to look back and to look ahead with hope. Often, the daily work of building up institutions, and hospital wards, is slow and tedious. Transformation is hard to put your finger on. So we hope that this little tour of construction sites around Kibuye gives you a taste of the new life that is unfolding here.

Looking back, I found a post about the impact that new ORs have made on the hospital - allowing the staff to multiply the number of surgeries offered each month. Medical staff and patients are also benefitting from the new surgery patient ward (photo below), which Matt helped design on a previous project trip to Kibuye. Seeing it completed now is gratifying for the whole Kibuye team, and the EMI team, too!

Just next to the surgery patient ward is the future paediatric ward - which will soon be the biggest structure on campus.

The roof trusses are already installed, and soon, there will be more blue roofing sheets covering this three story building. We hope it will be open to serve kids by June next year. This will add 130 more beds to the hospital's capacity, bumping the total to 359! Why do we need so many beds? At the height of malaria season this year, there were 130 kids admitted to receive treatment by Alyssa and her team, but many were sharing beds with other patients, because the current ward is too small.

The muddy site above might not look like much now, but in a matter of months, it will be home to more doctors and their families who come to live and work in Kibuye. Part of the long term vision for the hospital, of course, is to ensure that Burundian medical staff, including specialists, are equipped to lead here. See the digital render of the future 8-unit residential building below.

Another fun ongoing project is the construction of a basketball court (below) in the nearby town of Bukirasazi. Clearly, Kibuye hospital provides essential services that are appreciated by families in the region, but recreation space for youth is also important to the community. So the Kibuye team is sponsoring this project to build stronger ties with our neighbors.

It's not only physical transformation of this village that encourages us. We can see God moving in the lives of the construction crew, too. Meet Quinzaine (red hat next to Matt below), the foreman of all the construction workers. He has served here faithfully for years, and is an expert brick layer. He is also a respected leader, and he coordinated the crew under him to contribute part of their salaries to purchase a drum set for our local church worship team. He traveled to Bujumbura himself to pick it up, and the gift was received by the congregation with much jubilation when it was unveiled for the first time on a Sunday morning.

I am encouraged to see such clear evidence of God's creativity and generosity in the crew of masons, welders and plumbers who work long hours to build this place, brick by brick. Their ownership of the hospital and the church assures me that the good work going on today will continue for generations to come.

Matt and I taking in the view of Kibuye from above.


Giving Thanks in Community

by Rachel

This past week our team celebrated our 7th team Thanksgiving dinner together at Kibuye.  I don't think many people have actually been at all 7, but as our team has grown and expanded and changed over these past years, the team Thanksgiving dinner has remained a special and much loved event.

Thanksgiving is a time when most people bond together and share a special meal as a family.  We, who are far away from our biological families, enjoy getting a chance to feast together, share special foods and memories, and celebrate where God has brought us.  Most photos I saw from Thanksgiving in the US this year involved 8-10 people sitting around a table together.  We, on the other hand, had 70 people breaking bread together: Americans, Canadians, Burundians, and even a Congolese, Brit, Aussie, and French thrown into the mix.  People who have been here for a week, and people who have been in Burundi more than 50 years.  You might wonder what this even looks like!  Here's an example of the shoe pile outside the front door (which is just one of the doors...there were just as many shoes at the second door).

We must have had over 20 pies, not to mention cookies and puddings and the like.  Teammates cooked up endless side dishes and salads and there were 2 hams, 3 turkeys, and goat meat.  And then, when no one could eat another bite, we sat down together and praised God for his faithfulness and his provision and his blessing.

I think what makes this such a special day for me is not JUST the excellent food, but a real sense of feasting, in community together.  People bringing out their carefully hoarded cans of blueberry pie filling and French fried onions and cranberry sauce, their brown sugar and pecans that have been saved all year for THIS moment, to share together with other people who will also love and appreciate it.  It's about a celebration of making it through another year together, in hopes that next year we will all be back in the same place doing the same thing.  It's even about, and I don't think that this is being overly dramatic, rebelling against the darkness and the despair all around us.  In Every Moment Holy, the Liturgy for Feasting with Friends begins:

"To gather joyfully is indeed a serious affair, for feasting and all its enjoyments gratefully taken are, at their heart, acts of war.
In celebrating this feast we declare that evil and death, suffering and loss, sorrow and tears, will not have the final word....
May this feast be an echo of that great Supper of the Lamb, a foreshadowing of the great celebration that awaits the children of God."

A foreshadowing of the feast to come.  It gives me goosebumps, and elevates our party from a chance to gorge ourselves into a great celebration, tinged with hope and longing.

God has created us for community.  The psalms are full of thanksgiving in community.  I probably would not have this type of community anywhere else in the world, but I am grateful to be here, living and serving alongside my friends.  There's a group of weaver birds that have moved into the pine tree in our backyard.  There must be 50 nests hanging up there, with a constant chattering and singing and flurry of activity.  It's all done in the shadow of a giant hawk nest, a hawk who can be a predator but in this case is apparently a protector.  The image reminds me of our team.  We are all together, sometimes crowded, sometimes noisy, sometimes frantic, sometimes chaos.  But all beautiful, in the shadow of the Almighty who guards and protects and guides us (of course he's not safe, but he's good).  And our thanksgiving together can be something more than each of us can give alone.