Wilderness Medicine Club

(by Greg)

The children on our team get a great deal of exposure to the practice of medicine.  Many of them have physicians or nurses for parents.  Their neighbors (and therefore "aunts and uncles") are healthcare providers.  They get regular opportunities to visit the hospital, and occasionally to do a bit of light wound care.  And now, thanks to Wilderness Medicine Club, some of them know how to suture, how to evaluate for cervical spinal cord injuries and what to do in case of a snake bite, grenade attack, tornados and bear encounters, among other things.  Because you can never be too careful.

Alyssa and I signed up to lead a twice a month Wilderness Medicine Club over the past several months for three of the middle schoolers.  It was a lot of fun, using a combination of didactic teaching, workshops, clinical scenarios and YouTube videos.

This was day one of their training.  They wandered upon this poor victim who had apparently just experienced a head trauma .... while opening a bottle of ketchup.

On the final day we held a "mega-code" creating the perfect storm of disasters to which the students had to respond.  Jimmy the mannequin (who normally lives in our closet but occasionally makes an appearance to frighten team children or our house helper) was minding his own business, walking along the edge of a wall (which his parents had told him not to do), when he took a nasty tumble, had a head injury, then went into cardiac arrest, then (after being successfully resuscitated) was found to have an open tibia fracture.  And then, wouldn't you know it, a snake came out of nowhere and bit him.  We opted out of adding in a tornado scenario, as they are quite rare in Burundi.  

Some of the smaller children came across this traumatic scene and were very curious.

No scar revision will be needed for this banana!



by Rachel

Janvier, my very first thesis student, at his graduation
One of the most painful and yet ultimately enjoyable tasks that we as doctors do at Kibuye is supervising thesis projects.  Just as a recap of the Burundian medical education proces, students attend medical school as a university degree right out of secondary school.  They typically spend 6 years in the program—3 as basic science/classroom learners, and 3 as clinical learners.  This is where we interact the most with them.  They do clinical rotations at Kibuye and we lecture and provide more bedside-type teaching.  At the end of all their clinical rotations, students have to sit for a type of oral exam, and then they develop and present a thesis project.  This is probably styled like a US PhD sort of setup (albeit at a lower academic level), where the student presents their research and then defends it to a jury of 3 doctors.  

Now, some of us doctors are more academically inclined that others in terms of research, but every student needs an advisor for their project, and when there are 50 students and about 10 doctors in the Hope Africa University system, well, we get called upon quite a bit to act as directors.  Funny enough, it’s been a steep learning curve.  I did some (ok, a) research projects in residency, but there was a team of people to help me out—statisticians, epidemiologists, research interns, and sub-specialized attending doctors.  They told me how to design the study, ran all my stats, and helped me interpret the results.  I just had to help collect the data, do some background research, and then present the work.

So I’ve now been the thesis director for about 13 students who have graduated, with several more in the works.  The process typically begins something like a student approaching me and we have a conversation like,

Student: “Hello doctor.  I would like to do a project in Obstetrics and I was hoping you would be my advisor.” 
Me: “OK.  What did you have in mind?”
Student: “Maybe something with C-sections.”
Me:  “That’s very broad.  How about something more specific?”
Student: “Maybe indications for C-sections.”

Which, as any researcher out there would know, is not really a research project.  Many discussions and emails later, we usually land on a project which may or may not be valid (how would I know? I’m not a researcher).  Then the student spends months combing through (or looking for) old charts, reading textbooks and journal articles, and formulating a usually quite large (90-100 page) book.  We revise, I ask for p values and then can’t remember how to actually calculate a p value (but I know it’s important) and back and forth we go until the presentation day.  This is the more fun part.

One of our students, Innocent, presenting his data
What we didn’t realize at the beginning was that after a student defends their thesis project, they actually become a doctor.  They take their oath by holding the Burundian flag and from that moment forward, they can practice medicine.  It’s not after graduation, like we initially thought.  So this presentation day is extremely important (it is understood that the student will pass…if the project would not yet receive a passing score, they would not be allowed to present).  Many many friends and family come.  Fancy clothes are worn.  The room is decorated with flowers and special table cloths and water bottles are set out for the jury.  

Really, we are totally engaged and attentive during the presentation!
The student presents, the jury asks questions, and then deliberates on the score for 10 minutes or so.  Then the student returns and the score is read aloud amidst much clapping.  Then the Geneva Declaration is recited by the student as they hold the flag (and sometimes the Bible) and there is much more clapping and many more pictures.  And voila.  There is another doctor to care for the sick in Burundi.

Aimable gives his oath
Nadia reading the oath

So after all the work and difficulties and misunderstandings and time, getting to participate in these thesis projects is a culmination of what we have come here to do.  Training African medical professionals.  Many years ago we started here with the premise “We’re not the best people for this job.  Our students are.”  On thesis presentation days we start to realize that dream.  Hearing a student, no, doctor, recite the oath for the first time is always a little emotional for me.  I remember the day I took my own oath, “many years ago” now, on a cloudy May day in California, and remember the privilege and weight of responsibility given to us.
Christiane, one of our current stage professionels. 
Our student Bertrand, after finishing his thesis.
I solemnly pledge to dedicate my life to the service of humanity…
I will maintain the utmost respect for human life…
I will practice my profession with conscience and dignity and in accordance with good medical practice…
I will not use my medical knowledge to violate human rights and civil liberties, even under threat…

I make these promises solemnly, freely, and upon my honor.




My brother and his wife and their four kids were here over Christmas and we had a fantastic 3-weeks together. It’s the second time we’ve seen them since 2014, the third time since 2010. Yet we feel so close to them.  The same day they left our two older kids flew back to Kenya for their second term of school at Rift Valley Academy. Our house suddenly got a lot quieter as we dropped from 12 people to 4. (and to understand fully you would have to know some of those 8 who left)

Once again we have a shift in our family, these bonds that tie us to those closest to us. Two of our kids won’t be home for three months, and I won’t see my brother for who knows how long. 

Family relations are an odd thing at the best of times, but being on the other side of the world from parents and siblings, and cousins and everyone else makes these bonds more peculiar.

A few months ago in our team bible study, we were discussing how true community has the same characteristics of a family, including non-selectivity. You don’t choose what family to be born into, you don’t choose what children to have, and even though you chose your spouse, the family that you will end up becoming is not the direct result of precise decisions along the way.

What does it mean to have non-selective compassion, concern, empathy for those around you? 

It's is hard.

It is hard in Kibuye, it’s hard in urban Chicago, it's hard in rural Texas, and suburban Edmonton. 
While it may look very different, there is nothing unique about God’s call to all who could claim to be his people to love those around them. 

There have been many times in my life where I just feel like walking away from someone, or some situation entirely because it seems like the easiest thing to do. 

And yes, while it is possible to walk away from family, most everyone has a stronger sense of tie to family than any other relations. Even as a child, you know that you don’t really have a choice. No matter how much your siblings aggravate you, there’s really nothing you can do about it. That’s why as a child the almost mythological option of running away is so huge. How many of us didn’t at least once in our childhood think / dream /threaten/attempt to run away? ( If you say ‘no' - you probably either don’t remember well, had no siblings, or are some kind of freakishly forgiving person)

I guess that’s why there’s a saying "you don’t get to choose your family" (at least I think that’s a saying, if not…it should be)

This is probably why in such independent and individualist societies, we’ve reduced the entire concept of ‘family’ down to it’s smallest possible division. Only your immediate, nuclear family, which have statistically become smaller and smaller.  Fine, I’ll love my ‘family’ - but let’s make that word include as few people as possible. 

The divorce rates we are all impacted by must be a sign of our refusal to accept this non-selectivity, this non-negotiable set of relationships.  If a marriage turns south or gets too hard, we leave because “it’s not what I signed up for”.  But isn’t that the whole idea of non-selectivity, that we may get something we didn’t choose? 
Our kids will turn out the way they do - and for many parents, that will bring heartache, even disappointment at decisions made.  But does that mean you ask them to leave the family? That you decide what they’ve done makes them no longer worthy of being a part of the family? 

Non-selectively loving others is hard. It’s hard in extended family, it’s hard in your neighbourhood, it’s hard in all of our jobs, and it’s hard on this team. (Except you Greg - clearly)

Having kids travel two countries away to attend 9th grade seems strange to me, even though we’ve now done it two times. Does that make our family weaker?  A few years ago I would have replied with an unqualified ‘yes.’  Now that we’ve experienced it, however,   I have a very different viewpoint. 

There are (by my count) 21 kids here in Kibuye who call me ‘Uncle George’ on an essentially daily basis - yet some of the children of my biological family really don’t know me that well, some I’ve never met. 

I think the problem is made worse by my pathetic communication. There are many people who I care about, and think about often, but never get around to calling or writing.

Family is vitally important. The kind that we immediately think of when we say ‘family’ - our siblings, our parents, our kids. So is extended family.  So is community.  So is everyone else.

I guess what I’ve come to realize even more clearly regarding these kind of tight communal relations is that they go both ways.

We have to be open to seeing how we can show grace, compassion, kindness to those around us.  Reducing ‘family’ down to the smallest possible definition is exactly what the bible scholar who was questioning Jesus was trying to do when Jesus responded with the story we call the Good Samaritan.

“Fine," the man seemed to be saying, "I should love ‘my neighbour’ - but let’s be clear who exactly is in and who is out when we say that.  I need a clear line in the sand of how many people I need to be kind to - because it’s hard and I sure to want to show grace to too many people.”

The other thing is that not only do these bonds need to extend out, but we need them to come back towards us.

What is clear is that you can’t thrive without a group of people around you. This life does not work out so well as a solo gig.  There are plenty of people who can accomplish certain things without a strong support network (accumulating financial security, personal goals, etc.) -but to really have a full, engaged, rich life like I believe God designed us to have you simply must have people around you who are more than just co-workers, neighbours, or people you spend holidays with because you share some biological bond. 

We need each other. 
The other needs us.

If being part of this team has taught me anything (and it has taught me A LOT - especially Greg) is that doing life with others in an almost completely integrated way (friends=neighbors=colleagues=church=school=etc) is that it’s hard - but it is such a full, rich way to live. 

It is probably the most obvious when there is some acute problem, an emergency of some kind.  Someone suddenly finds out a family member has died, someone needs a medical evacuation, someone gets very sick. As a team we've gone through a lot of really hard things over the last few years - deaths of parents, sickness, and many other really, really hard things. 
However, that is only the most obvious.  When you look closer you see that through all the mundane, the small hurts, the kind words, the grace, the tension, the loss of personal freedom, the gain of communal joy -that this is how God has made us.

To live - in some way - in communion with others. 
To be part of a family, no matter what that looks like.

Heart & Soul

by Jess Cropsey

It just so happened that a Baptist, an ecumenical charismatic, a Christian Reformed, a non-denominationalist, another charismatic, and a Lutheran "randomly" met at a Presbyterian church in Ann Arbor, MI in the early 2000s.  This special place called Knox Church became the birthplace of our team so many years ago.  And so, it was with great delight that we welcomed three couples from that church to Burundi in May to go through the "Heart & Soul of a Real Marriage" course with our team.

The three team families sent by Knox (first to Kenya in 2009, then Burundi in 2013) with the 3 couples from Knox (Tom & RuthAnn, Steve & Mary, John & Kathy)

They arrived loaded with all kinds of necessities (standardized tests for the kids, math books for next school year, parts for the solar power pack, a replacement for a broken computer monitor) and LOTS of goodies too -- special kits for couples and singles, individualized requests from each family unit (cheese was a popular one!), at-home date night ideas, books & resources, and games/snacks/crafts for the kids.  It was like Christmas!

We crammed the first 6 (of 12) lessons from the Heart & Soul program into an already busy work/school week (the May 1st holiday was a big help!).  John & Kathy put together an amazing program for the kids while the adults were in "class".


Each visitor also brought along additional gifts and interests to bless our team.  

Tom and John busied themselves in the workshop making shelves for the school and the hospital

Mary taught a couple watercolor classes to our kids

She also taught knitting to some of the missionaries as well as some local women

Steve took on juggling and yo-yos!

Kathy helped organize our school library

John taught the kids a lesson about banana trees

We managed to fit in some cultural experiences too -- a trip to the nearby waterfalls, hearing the testimony of a local Burundian couple, a home visit, and a tour of the hospital and its various programs.

Although we had lots of fun together, we also waded through some deep waters -- past wounds that impact our relationships, protective layers that we put up to avoid getting hurt again, God's design for marriage and relationships and how that has been damaged since the Fall, and how the gospel relates to each of these areas.  Please pray for each of us as we process and discuss the material that was presented.  Pray that our marriages and relationships would grow deeper as a result.  

We want to say a big THANK YOU to the many people who worked hard to make this trip happen -- those who helped with logistics, those who traveled to be here & all the preparation that entailed, those who prayed, and those who gave gifts and/or financial support.  It was a really great week!  

We look forward to welcoming the team back in February 2020 to go through the second half of the course with us!

Our traditional team send-off, the "tunnel of love".