13.11.19

Crossing Continents

By Alyssa

It's been a while since we've talked about the transitions of crossing continents and reverse culture shock here, but since missionaries spend 20% of their time (1 year out of 5) in the US, it continues to be a reality for all of us. And now it's my turn again. I arrived in the US a little over a week ago and will be here for the next five months. Since I just celebrated 10 years in medical missions, I have done this "home assignment" gig several times before and one would think that would make it easier. But the flip side is that it has now been 10 years since I have lived in the US, so actually it seems like more of a foreign place as time goes on.

So what is entailed in the home assignment process?

1) Gearing up. Logistics need to be arranged such as flights, car, housing, etc., but the main focus of this gearing up time is preparing to leave my Burundi home for five months. That means thinking intentionally through each of my various roles and making sure someone is covering them in my absence. It inevitably comes up when a teammate is gone that people realize just how much they were doing that we weren't aware of! And suddenly we're left wondering: Who has the key to the storage container? Who is feeding the bunnies and chickens? Who is boiling eggs for the malnutrition program? In my case, I tried to make a list a couple months in advance and to divide things up amongst my gracious colleagues. Of course I did forget a couple things and have already been asked where the documentation sheets are for the malnutrition program and what to do with the monthly pediatric mortality discussion notes. Thankfully there is WhatsApp to keep communication lines open! Since our housing is limited, the other aspect of my prep time was getting my house set up for visitors to stay there in my absence. That means hiding the imported chocolate chips (sorry, visitors!;)) and breakable items so that families with toddlers will be comfortable there and letting Heather know where guest sheets and towels are, etc.

Three days before I left, our shipping container showed up which was great timing as I was able to unpack the infant formula and the vitamins for sickle cell patients and get them to Logan to use in my absence. 

Gearing up is also a good time to take updated pictures of Burundi life to share with folks in the US:
The new pediatric building - three stories tall! The roof will be on by the end of the year! 




2. Goodbyes and the "Wood between the Worlds." Our team values intentional goodbyes and demonstrating our love for one another during transition times. Since I have a big birthday coming up this month, they even planned a special pizza night and early birthday party for me! And then most of the team managed to show up at 10am on a Monday morning for prayer and our traditional "tunnel of love" send off. I will miss them all so much these next few months!





Next comes the "Wood between the Worlds." For those familiar with C.S. Lewis's book "The Magician's Nephew" that was the in-between place that was quiet and peaceful. For me Europe is a nice place without the stresses of either Burundi or America. It's familiar since I lived there for a year during French language study and it's a great place to just blend in, unwind, and enjoy the scenery. (And it works out well for me that one of my best friends lives there, so I have free lodging!)
Best swing ever! 
3. Re-entry. Back on the other side of the pond, I'm welcomed enthusiastically by my family. Family time is the definitely the highlight of home assignment!
Nieces and nephew
Celebrating Lily's 6th birthday with a special trip with Aunt Alyssa to the American Girl store in Nashville
Enjoying fall leaves on a hike with my Mom and Maisy
And then I hit the ground running! Off to the Global Missions Health Conference where I spoke about rural medical education, reconnected with old friends, worshipped in English, represented Serge to prospective missionaries, and promoted Eric McLaughlin's amazing book. 
Matt and Joanna at the Serge booth with Eric's book. We gave away 50 copies to those interested in potentially becoming Serge missionaries!
My favorite part was getting to catch up with teammates Caleb and Krista Fader who are also currently on home assignment - for a whole year! 
Now on the other side of jet lag, I'm in cross-cultural (sort of) observation mode: What are people wearing? Oh, drinking straws are out? Interesting that there are TV screens on all the gas pumps. How do I communicate in a way that makes sense to people in this context?
And of course I'm doing the usual tasks of dentist appointments, eye exams, haircut, getting phone service, etc. I'm hoping to make significant progress on my thesis for my Master's in Clinical Education over the next few months in addition to the usual speaking engagements and travels around the country. I appreciate your prayers for grace, curiosity, and joy through one more transition and I know teammates would appreciate the same when it's their turn for crossing continents.


11.11.19

Radically Dissimilar but Full of Promise

(from Eric)

My intern is presenting a new case:

"The patient is a 20 year old male from Makebuko commune who is presenting with two weeks of cough and increasing difficulty breathing."  He moves from section to section of the well-established presentation format.  It's oddly a bit like a familiar song, and each word creates suggestions in my mind as to what this young man's problem is and what we should do for him.  The intern's information is a bit scattered, since he is still learning, but the structure is like a couple of deep wheel ruts that keep him from straying too far.

He tells us about his past medical history, including a seizure disorder, for which he is on chronic medicine.  He talks about a developmental delay.  Then he gets to the physical exam.  "His weight is 23 kilos" (about 50 pounds).  23 kilos?  Yeah, he is the size of a child.  Does he speak?  No, he's never spoken.  Does he walk?  No, he's always been bed-ridden.  He has some bedsores, but they are clean.

This is actually an incredible story here in Burundi.  There is a bit of context that is necessary to understanding just why this is so incredible.  People with significant handicaps usually don't survive very long here.  In fact, I have never seen someone this disabled who has survived to this age.  They are often neglected and devalued.  Even if they are not, something goes wrong.  They have an injury or an infection somewhere that goes unnoticed for too long.  Until it's too late.

"Well," I say to my gathered team of nurses and students,"this family deserves our admiration for taking such good care of their child for so long."  Actually, his family abandoned him a long time ago.  He's been raised by Catholic nuns in a home for handicapped children.  "Oh," I say, "then I guess we owe that admiration to the nuns.  They have shown just how serious they are that every person bears God's image.  Let's try and do our best to continue the same while he's under our care here in the hospital."

After we're done discussing, we head out to starting seeing our patients.  We go from bed to bed.  After we finish our normal wards, we head over to see an old man who has suffered a massive stroke. When the surgery ward building was built in 2016, we added 8 very nice private rooms.  They each have private balconies, and the best of them are on the second floor with a gorgeous view of the Burundian hillsides.  I jokingly call the top one the presidential suite.  The old man's family has a bit of money, and he is hospitalized on the bottom floor.

View of the balconies of the private rooms (on the right)
When we leave the room, I get ready to leave the building, but the intern says, "No, upstairs."  Who is upstairs?  "The young boy that came in yesterday."

We climb the stairs, and there, in the 2nd nicest private room, is our new patient - all 23 kilos of him curled up into a fetal position, breathing oxygen through a pair of nasal prongs.  He's dressed in a nice t-shirt, and his helper is in the bed next to him.  It's a truly beautiful moment, and it reminds me of two quotes:

"The church exists to set up in the world a new sign which is radically dissimilar to the world's own manner and which contradicts it in a way which is full of promise." - Karl Barth

"So the last will be first, and the first will be last." Jesus in Matthew 20:16

I shared the application of the second quote with my team, even before we left his room.  I thanked his caregiver for her great work, and she smiled at her feet in obvious embarrassment.  Here, in a world full of scarcity, the church (and as a confirmed Protestant, I give my Catholic brothers and sisters full appreciation for their example-setting in this arena) has taken a small non-verbal boy, who doesn't usually even survive to this age, and hospitalized him next door to the presidential suite.  He bears God's image.  The last has become first.  The church has set up a sign which has contradicted the world in a way which is full of promise.  We were there to see it.  It was just a glimpse of what's to come.

5.11.19

A Way Forward

(by Greg)

According to the World Health Organization and the World Federation of Societies of Anesthesiologists, a country the size of Burundi should have 600 physician anesthesiologists.  Today, if I include myself, there are 8.  Most of the anesthesia care in Burundi is carried out by non-physician anesthetists, who are working under difficult conditions, without supervision, with inadequate supplies, sometimes without even the most basic equipment including oxygen.  For anesthesia care to advance in this country, what is needed is more physician anesthesiologists, to teach, to lead, and to advance the peri-operative care of this country.  People around the world are dying each and every day for lack of access to safe and affordable anesthesia care.  If you live in the US or Canada, you don’t see them, and you don’t hear their stories, but they are there.  This is the reality.  

This problem is not isolated to anesthesia.  In most of Sub-Saharan Africa there are not enough doctors of every speciality, but obviously God prepared me to speak into this particular problem, in this place and time.  

Last night, I had a wonderful opportunity to gather with the other anesthesiologists working in Burundi, in the hopes of creating a society, recognized by the government, which can lead the way forward in this struggle.  These are men who trained in Burundi, Belgium and France.  They understand the magnitude of the challenge that lies ahead, and they are ready to fight for the needs of their country.  It was an honor to be invited into this group.  I want to do everything I can to strengthen and encourage them.  

The anesthesiologists of Burundi (I am the one second from the left)

Next week I will be travelling to Chicago to present to the board of PAACS, the Pan-African Academy of Christian Surgeons.  A small group of anesthesiologists working in Africa will be pleading for them to allow us to begin training programs under their umbrella for physician anesthesiologists in Africa.  If you are reading this blog, would you pray for this meeting, and for a way forward in this global challenge?

The needs at our hospital in Kibuye are massive.  Many days I feel overwhelmed.  And then when I step back and consider the needs at Kibuye multiplied by tens of thousands of other hospitals that are facing the same challenges, the burden is crushing.  All this drives me to my only hope, God, who cares more about this problem than I do, who alone can speak creation out of nothing, who loves us and who loves our patients.  His love is so great that He sent his Son Jesus to offer us eternal healing from our broken condition, and eternal hope.  It is because of Him that my family and I are here in Burundi.  It is because of Him that our team has been able to work here for the past 5 years.  And it is because of Him that one day this massive burden will be lifted.  

Behold my servant, whom I uphold, my chosen, in whom my soul delights;
I have put my Spirit upon him; he will bring forth justice to the nations.
He will not cry aloud or lift up his voice, or make it heard in the street;
a bruised reed he will not break, and a faintly burning wick he will not quench;
he will faithfully bring forth justice.
-Isaiah 42:1-3

2.11.19

Here Comes the Bride

By Julie Banks

A beautiful thing happens in Kibuye in the fall.  Dry season ends, and rainy season begins.  But it is not just the appearance of rain that signals the beginning of a new season.  We receive a uniquely beautiful gift.  The jacaranda trees bloom.  Bright purple blossoms seem to appear overnight drawing our eyes up these tall trees.  But they are in bloom only for a brief amount of time which makes the experience rare and special.  The violet flowers are so delicate that the lightest rain, or a drifting gust of wind, will cause the petals to fall out of the trees.


This is my fourth "fall" at Kibuye.  So it's my fourth time seeing these jacarandas bloom.  In past years I remember saying "oh those are pretty" or maybe I even snapped a picture on my phone.  Perhaps I was too distracted by the start of a new school year.  Maybe I was feeling sorry for myself because I missed Midwestern falls with orange and yellow leaves that crunch when I walk.  I don't think I ever truly saw the jacarandas.  Until this year.  This year I saw them.  I really saw them.


For a brief time, everyday I stepped outside, I noticed the jacaranda blossoms.  Tiny purple flowers fell into my hair as I walked.  Purple petals covered the ground around me.  I looked down at my feet where each step was cushioned by a delicate flower.  As I walked, my heart fluttered, and I thought, "I feel like a bride!"


It was as if someone had gone before me to sprinkle flowers along my path.  And then I remembered the image of the Church - us - as the bride of Christ. My neck lengthened as I walked a little taller.  A little slower.  I felt anticipation.  I felt loved.  I felt seen.  I felt... beautiful.

Here, in the midst of poverty, struggle, sickness... was beauty.  God was literally laying down for us a beautiful carpet of purple to walk upon as we walked our everyday paths.  Our path to KHA to teach the kids.  Our path to the hospital to see patients.  Our path to the neighbor's house to say hello.  Our path to Church.  For a brief moment these worn down walkways looked like a beautiful isle prepared for a bride.


And then I thought about the color of these petals.  Purple.  Royalty.  Priesthood.  Kingship.  This purple ground belongs to the King.  The King is here.  The words take off your sandals for the place where you are standing is Holy ground echoed in my ears.  The Most-Holy is here.  He is at Kibuye.  He loves Kibuye.  He loves these people.  He is already working in this place, and somehow we have been invited to join Him on the journey.

Pray for us on our path in Kibuye.  Sometimes rocky.  Sometimes muddy.  Sometimes beautiful.  May we hear God's voice.  May we see His blessings.  May we continue to be awed by His grace.  His love.  His forgiveness.  And may we, as brides, draw others to Christ.


And the Spirit and the bride say, ‘Come!’ And let him who hears say, ‘Come!’ And let him who thirsts come. Whoever desires, let him take the water of life freely. Revelation 22:17.

Photos by Darrell Baskin and Julie Banks