Global Missions Health Conference 2020

 by Logan

Last weekend was the 25th anniversary of the Global Missions Health Conference, normally held in Louisville, KY.  This year, however, the conference was completely virtual due to COVID-19. I was really impressed with the virtual format, especially since this was the first time they did it completely virtually. Over 2000 attendees logged on to a newly redesigned website to worship together, learn from each other, and get inspired about medical missions and God’s call for their lives. 

There were some incredible plenary speakers, sharing about topics such as hearing God’s call to go to difficult places, the Christian response to the coronavirus pandemic, and dealing with mental health issues overseas.  There were some great times of worship, as well as a variety of different breakout sessions.  I led a breakout session about healthcare education as mission. 

My hope was to inspire people who are interested in missions and global health to consider healthcare education as a primary way to answer God’s call to missions.  I shared about what we are doing at Kibuye Hope Hospital, with medical student education, the current stage professionnel (“internship”) program, as well as our desire to see FM and surgical residencies start in Burundi. I talked about how medical education multiplies the effect one person might have, because they are playing a role in treating all the patients that their learners will see in the future. I also discussed the value of discipleship and mentoring relationships that develop naturally as a result of education.  

I used Moses’ interaction with God at the burning bush (from Exodus chapters 3 & 4) as an illustration of a way to respond to potential resistance to medical mission work in general, and specifically medical education missions. I don’t think the talk is currently available, but I believe all of the sessions will be uploaded soon at medicalmissions.com.

In recent years, our team has been well represented at this conference. In 2019, Alyssa Pfister was on a panel discussion about medical education, and led a breakout session about rural medical education. In 2018, Eric and Rachel McLaughlin moderated a panel discussion about missions and marriage, and Eric also spoke about resiliency in missions, using chapters from his book, Promises in the Dark, as illustrations.  

The GMHC is intricately linked to the story of our team in a number of ways. For example, Eric and Rachel actually met at the GMHC in 2003, so the conference serves as an anniversary of sorts for their relationship. The original “McCropder” team was officially formed at the GMHC in 2007, and it was through connections that were made there that they landed at Tenwek Hospital for the Samaritan’s Purse Post-Residency Program. I would be willing to wager that this connection to the GMHC is probably true for so many other medical missionaries.  

Personally, I first attended the GMHC in 2008, when I was a third-year resident at Cox Family Medicine Residency in Springfield, MO. It served as an informal interview weekend as I was applying to the Via Christi International Family Medicine Fellowship. This fellowship led me to Tenwek Hospital and is where I first connected with the McCropders.  

In fact, I remember that a strange thing happened at that conference.  I was listening to the plenary speaker talk about how important it is for God’s word to spread all over the world and how we need to be willing to take it there, even if it’s difficult, when I heard a word from the Holy Spirit say, “Learn French.”  I even wrote it in my notes.  But I had no idea what it meant.  I had studied Spanish, and had been on medical missions trips to Bolivia, and had always assumed that learning Spanish would serve me on the mission field someday. Little did I know! It was also at the GMHC in 2013 when Julie and I felt God stirring our heart towards long-term medical missions, and eventually led us to Burundi to rejoin the same team we had first met in Kenya. 

God has a way of using this conference to speak in a unique way and guide His followers on the path that He is leading them. If you didn't get a chance to attend this year, I hope you will have the opportunity someday in the future. 


COTW (x2) : PSGN and diaphragmatic hernia

(from Jenn)

I've seen such a variety of diagnoses during my short period of time here at Kibuye.  I find myself reading more articles and textbooks now than I did even during residency.  I love learning and I love this job. Some diseases are impossible to diagnose  (ones where you need renal biopsies, or specific antibody or serologic testing for... which we don't have available here) while some, if you know what to order, are a joy to work through.  

For example, we had child present with edema, hypertension, and cola-colored urine.  We (the students and interns and I) worked through the differential diagnosis. On admission the doctor had asked for a study of the urine, but the lab stated the urine was to discolored and wouldn't work.  So we worked through the differential - they considered nephrotic syndrome and congenital heart disease, renal insufficiency.  I said that these were good ideas, but we should try again for a urine analysis.  It came back the next day positive for blood (causing the cola-colored urine), but only mildly positive for protein.  For the diagnosis of nephrOTIC syndrome, on expects to see A LOT of protein in the urine. So this diagnosis didn't quite fit. I asked the team to try to come up with another diagnosis to put on the differential. Someone suggested nephrITIC syndrome and I agreed.  I asked the team if they knew one more test we could do to try to narrow down the diagnosis, and we decided to obtain an ASO titer.  If positive, it tells you that the patient has had a recent infection with Group A Streptococcus (AKA the bug that causes strep throat and scarlet fever, which can eventually cause glomerulonephritis OR rheumatic heart disease).  It came back positive. So we had the diagnosis - Post-streptococcal glomerulonephritis.  

While most of the time it's fun to figure out a diagnoses, a class of diagnoses that are not so fun are congenital malformations concerning major organs that, here, result in rapid decline and death.  

This baby was born at term or near term and had rather significant respiratory distress right after delivery and was therefore transferred to us in the NICU.  The baby's distress did not improve, even with high amounts of oxygen so we decided to obtain an x-ray which showed this. 

This is a large diaphragmatic hernia - where the diaphragm does not develop correctly leaving the possibility for the intestines and sometimes the spleen and kidney to enter into the chest area.  This causes a problem because the lungs therefore cannot develop correctly.  With many disease, there is a range of severity. Sadly for this baby, the lungs seemed to be quite underdeveloped which could not be fixed by a surgery.  

Fortunately this is not the norm. More times than not, the NICU is full of babies born too early who need a little bit more time to grow and develop, who need to be closely monitored for infection and who need to live in a controlled setting before being able to go home.  


"Let the little children come to me"

It is a short Bible story that appears in three Gospels, and here is my summary: Adults think that Jesus shouldn't be bothered with kids during his tour of public ministry. But when they try to keep the kids away from him, Jesus becomes angry and says: "Let the children come to me. Don’t stop them! For the Kingdom of Heaven belongs to those who are like these children."

We read this passage during Tuesday night Bible study recently, and it was a needed reminder to me that God values me and all people, not because of how smart, good, useful, productive or mature we are. Kids are not known for leading the human race in those characteristics.

God loves kids as they are and thinks they are important enough to spend time with them and bless them. One Bible commentary says this about the end of this story in Mark 10:16, "Jesus' loving action vividly illustrated that His blessing is freely given to those who receive it trustingly. The intensive compound verb "blessed" (kateulogei, imperf., occurring only here in the New Testament) emphasizes the warmhearted fervor with which Jesus blessed each child who came to Him."

So Jesus didn't just tolerate the kids; he wholeheartedly, gladly, intentionally blessed each child.

This past year, God has given Matt and I an opportunity to see just how much he loves his kids in Burundi. Because nearly all of our work here has revolved around kids in some way (it just played out that way), we have started to notice how much He is intervening on their behalf to bless them, care for them and remind us all that they are important.

Of course the main project that brought us to Kibuye was the Pediatric Ward at the hospital. When we arrived, I was surprised to see that it was the largest building on the campus, more than twice the size of the next biggest ward. Why? Because almost half of Burundi's population is under the age of 15. And because kids are important to God.

The playground at the Peds ward was completed this week!

Another construction project that Matt immensely enjoyed was the preschool and kindergarten for the local primary school. I loved watching the design evolve to take into account the future users - very short learners! Hence the windows arranged at various heights, the benches built into windows, and the minimal use of steps. We loved seeing kids of all ages who were magnetically drawn to it and intuitively explored it. Hopefully it serves them and their teachers well! (You can see some of the new pre-school students in Jess's blogpost.) Why spend time creating such a beautiful space? Because kids are important to God.

All smiles and giggles!

My roles in Kibuye have gravitated toward serving kids, too. I've already blogged about boiling lots of eggs each week for kids who are supported by the malnutrition program at the hospital. But I also get to jump in on the occasional sickle cell clinic to color with kids. Because playtime is important, too.

Elise and I joined the med students and interns to color with about 50 kids last week. 

I've had fun connecting with the Serge kids, too. I start my weekdays with "read-to-self" time with elementary boys at KHA, and I look forward to spending time with the older girls during our weekly crochet club. 

Our current crochet project is to create a few of these octopuses to give to preemies at the hospital. Apparently the squishy arms remind babies of the umbilical cord and comfort them.

Honestly, I'm not a exactly a "kid-person" who just can't get enough of them, and yet, God is opening my eyes to see what he sees: not just their future potential, but their present value and God's image in them that is worth celebrating, serving and just plain getting to know. I am glad that this Kibuye season turned into a reminder for us of how important these little ones are to Him.

And maybe, keeping these kids in view will make me a little more like them, more ready to notice and receive God's kingdom and the unmerited blessing Jesus offers.


Saving Face, Part 2, “Shame, Pain, and Beauty”

 by Carlan

The Sunday after my ladder fall, as I was feeling just good enough to get out of the house, I decided to attend the French service at our local church here in Kibuye. I took some Tylenol and headed up the dirt road to the mud brick and plaster building at the center of our campus. It was my first time out in the community with my “new” face and I got more than the usual number of stares from kids and adults as I passed them on the trail. With two black eyes, a swollen lip, and healing wounds all over my face, I know I looked like a frightful sight, but I had to go up to God’s house and give thanks for the ways He had protected and preserved me.

During the singing time, we sang a 4-line song called “My Beautifier” by a Nigerian musician named Chris Shalom. I cannot vouch for the singer-songwriter’s character or doctrine and I likely would never have heard this song were it not for the committed musicians of our local congregation. It is a simple song yet it prompted some deeper reflections that I want to share with you. The four lines are:

My Beautifier, You’ve taken away the shame // You’ve taken away the pain // You made my life so beautiful (repeat first two lines) // You’ve made me just like You.

My first thought centered around that title “Beautifier.” I smiled at the creative use of language — the term is immediately comprehensible even though I was pretty sure it is a neologism. (I checked, neither the Oxford English Dictionary nor Merriam-Webster have definitions for “beautifier”.) It also made me think of the similar term, “beatify,” which, to my understanding, is the penultimate step in the Catholic process of investing people with the title “Saint.” In a much more profound way, Christ is the One who declares us and makes us to be saints, holy ones...not on the basis of good works we have done or miracles we have performed, but on the basis of His perfect life and vicarious death and resurrection.

The removal of shame occupied me next. Having just felt the eyes of my neighbors fall on my disfigured face, that line struck a visceral chord in me. Jesus takes away my shame. It is my shame. I deserve it. And He removes it, not by snapping His fingers and causing it to disappear, but by bearing it Himself. He took it upon His person and suffered dishonor for His beloved sheep.

The same process happened for pain. Having spent the prior five days with daily pain, thinking about the effect of Christ’s work, the relief He brought through His own afflictions, humbled and encouraged my heart. This is truly a beautiful life, the one purchased by Christ.

By the time we got to that last line, I was starting to tear up. “You’ve made me just like You.” I’m aware of my lingering sinfulness and the struggle to daily love like Jesus loves...but Romans 8:30 says, “those whom He predestined He also called, and those whom He called He also justified, and those whom He justified He also glorified.” All those verbs are past tense. So in some very real but difficult to realize way, having been predestined, Christians are already glorified. And while all people are image-bearers of God, there is some special way in which the Redeemed are image-bearers of Christ. That is, after all, why we are called “Christians” (little Christs, Acts 11:26).

So my facial injuries, the source of my shame and pain, are somehow useful in making me just like Jesus. He was beaten and disfigured, like one from whom men hide their faces (Isaiah 53:3). Could my facial injuries help me to identify with Jesus Christ? Could the visible wounds and scars serve as a reminder to me and others of what the Son of God suffered for His Passion? I will then count them as a blessing and a gift, if they make me more like Jesus.

However, beyond even the cosmetic, the character development that God is working through this trauma and its sequelae conforms me more into the image of the suffering Servant, the Lamb of God, the once-for-all Sacrifice for Sin and the Great High Priest. Wow! I have a hard time wrapping my head around the genius of God that can convert something like smashing your face into the ground into a treasure of character growth and sanctification, but I that is what He did for me all in the span of singing a few lines over and over again. May Jesus Christ be praised!

Here is the Chris Shalom YouTube video — song starts around 0::45s


Return of the Students

by Rachel

Ever since arriving in Burundi, medical education has been our number one priority at Kibuye.  We've helped hundreds of new doctors graduate from Hope Africa University in the last seven years, and watching students grow in their clinical knowledge and decision making continues to affirm our calling.  What many of you may not know is that during 2019, students almost disappeared from the hospital entirely.

Burundi currently has three medical schools: the national university of Burundi in Bujumbura (which is free to those who are accepted), Hope Africa, and the University of Ngozi.  Students would apply to each school separately that they wanted to attend, and HAU attracted many students from around the East Africa region as well as some Francophone countries in West Africa. Then the medical school admissions process in Burundi underwent some changes.  All students were now required to take the same entry exam and, based on their results, were assigned to a medical school to attend.  Unfortunately, as HAU and Ngozi are not free schools, not everyone who was assigned to these schools wanted to attend.  In fact, while all these issues were sorted out, there were almost two solid years where we had no new medical students starting at all.  Given the fact that they spend 3 years doing pre-clinical years in Buja before starting clinical rotations at places like Kibuye, we didn't notice the deficit right away, but early 2019 the students started disappearing...first from peds, then OB-GYN (two services that also have a strong presence at the university's clinic in Buja, where many students had already completed their required rotations), and then less so medicine and surgery.  

When we started teaching January 2014, we each had about 4 students per service, all brand new.  But by 2019 there were routinely 8-10 experienced students on each service, doing admissions, taking call, and assisting in surgeries.  Their absence was a shock to our hospital system, where we were depending on their presence to fill in important roles in the work force.  Enter the idea for our stage professionelle program.  Little by little, we recovered from the absence of our students by hiring more nurses and training recently graduated doctors.  We found our new normal and there were a lot of blessings in the new system.

And then, finally, the students returned!  It began as a trickle this summer, but by early fall we had a quorum of over 20 new students starting their clinical years at Kibuye.  The current group will spend the majority of their next three clinical years here, as opposed to previous groups that would spend perhaps 4 months/year at Kibuye and the rest of the time in Bujumbura.  I was able to begin the OB course again (I'm losing count but this is at least the 5th group I've taught the class to) and we had both externs and interns on service (students who are brand new and students who have already completed their rotation on service and are returning for a higher level of responsibility and education), as well as 3 stage professionelles (SP) and generalists.  We no longer have to rely on the students so heavily to fill in personnel gaps, which frees them to be able to take time to learn well and ask questions.  Alyssa started up Bible Study for the students and we are all enjoying a chance to both teach new faces and watch our SPs develop as "consulting" doctors and teachers as well.  Looking back at my journal entries from 2019, it was a really challenging season on my service.  But now it's a great chance to look back and see how God has been providing for the hospital, and how the lack of students actually encouraged the development of other staff which will hopefully provide a more solid education for our students.  


Saving Face, Part 1, "Saving Faith"

by Carlan

(WARNING: the photos at the end of this post show significant facial trauma. You can stop scrolling once the text ends to avoid seeing my face split open.) 

This is not the post I expected to write this week. My plan was to offer some reflections on home-building in rural Burundi and to highlight the work of so many precious souls who have crafted a lovely house for the Wendler family. Instead, I would like to tell you a story about how God builds character and community out of the strangest of substrates.

On Tuesday afternoon, I set up a ladder against the side of our house in order to install some security lights. As I made my way up the ladder, tools in hand, the base of the ladder shifted and slid out behind me. I fell hard in a kind of slapping motion, landing on the ladder with my face impacting a rung and the tile-covered floor. Conscious but a little stunned, I cried out in pain as I opened my eyes to see fragments of my two front teeth strewn in front of me and felt the warm rush of blood start pouring from my shattered nose (it was coming from my deep forehead and lip lacerations too, but I didn’t know that at the time).

Immediately, the two Burundian workers who were at the house with me ran to my aid. As I lay facedown on the ladder/ground, they called for help and assessed the situation in Kirundi that I could not quite catch. In what seemed like an impossibly short period of time, Michael Harling, our neighbor and, conveniently, a surgeon, was on the scene asking what I needed. Seeing the growing puddle of hemorrhage around my head, we both thought that something to put pressure on the bleeding wounds would be useful and Michael LITERALLY GAVE ME THE SHIRT OFF HIS BACK. Someone tied the shirt around my forehead like a bandana and when enough men arrived, they transferred me off of the ladder onto the ground nearby. Eventually they walked me into the house and sat me down on a chair, which was very kind but had the unfortunate side effect of making me feel very faint. I asked to lie down so that I wouldn’t pass out and they laid me on the floor again.

This is where I heard it. “Yapfuye. (He died.)” I honestly did not have the strength to muster a Monty Python-esque, “I’m not dead yet!” All I could do at that point was breathe and try to remain conscious. But I want to point out that at least some of these men feared the worst for me AND THEY KEPT WORKING TO HELP ME. Theirs was a type of saving faith — a belief that I could still be saved. And it is a gift.

At some point other doctors arrived, my neighbor Ladislas Mashimango, our team leader Eric McLaughlin, and John Cropsey brought a Land Cruiser as close as it could come. My “paramedic” team carried me from house to vehicle and someone drove us to the ER. Being recumbent had fortunately restored perfusion to my brain and I no longer felt like I was going to pass out, but it had the effect of filling my throat with blood and secretions, which I had to swallow or somehow spit out (not as easy as it sounds when your upper lip is ripped through the side and septum of your nose).

I remember Michael telling me that they were going to have to operate under general anesthesia to stop the bleeding and repair my face. I remember John asking me when I ate last and me talking about an oral-gastric tube to pump my stomach from the blood I had already swallowed. I remember the ER nurses, including one of the newest members of our team, Hosanna, taking vital signs and putting in an IV. It was a comfort to hear their voices. And as they transferred me from exam table to stretcher to go to the OR, I opened my eyes to see Ezechiel Bucumi, our househelper, standing next to me with a piece of cloth, wiping the spittle from my mouth as I tried to clear my airway. Ezechiel is wonderfully intelligent and hard-working, very capable (the French would call him “polyvalent”) but he has no medical training and I was a bit surprised to see him in the ER. He reminded me of Mary Magdalene and the other women who went to Jesus’s tomb that Sunday morning with nothing left but love in their hearts. Ezechiel never went to college or studied medicine, but HE WAS GOING TO DO EVERYTHING HE COULD TO HELP ME. His is a type of saving faith — a belief that he could somehow be useful. And it is a gift.

We got to the OR and the team worked through the pre-operative checklist. I remember everything up to and including the burn of the Propofol (anesthesia medicine) as it entered my vein. I know that I received absolute peak clinical care from our hospital — the best we are capable of (which is really quite outstanding by global standards). What I don’t know is if surgeons Jason Fader and Michael felt nervous operating on a teammate or if nurse anesthetist Pamphile Muvunyi was anxious about intubating his first white patient. Whatever their concerns might have been, they PRESSED FORWARD IN ORDER TO HELP ME. Theirs also was a type of saving faith — a belief that the instruction and experience they had received would be useful to save my face. And it is a gift.

The anesthesia and operation were successful. I’m recovering now and with time will again be able to breathe through my nose and eat a carrot. Before concluding, however, I want to return to that notion of how God builds character and community out of the strangest of substrates.

I think that in my spiritual walk I tend to think about my relationship with God as a diad - Him and me, giving and receiving, listening and talking, back and forth. I conceive of saving faith as something between God and the individual…and it is. But it strikes me as I recount this story of how God spared me from cosmetic and cranial disaster that He endowed many, many people with faith, hope, and love in the process. I wonder if there is not some analogy hidden in these events, a way of seeing relationships in community.

Some relationships seem dead or beyond repair. Some situations without any solution. “Yapfuye.” Is God calling me…you…to keep trying for reconciliation in hope and faith? Shall I keep praying for his salvation and keep hoping that she stays sober this time?

Some problems seem way out of my league or way beyond my comfort zone. Is God calling me…you…to show up anyways and look for any small task I can do to help? I’m not empowered in politics or public health but can I look out for my neighbor and make sure she knows where to find hope in times of trouble?

Sometimes the fear and anxiety rises within me to the point where I doubt everything. Is God calling me…you…to trust that what He has already given you is sufficient for today’s challenge? Shall I proceed believing that God’s word is true when it says it always accomplishes its mission? Shall I risk my marginally peaceful Facebook feed or my “gets along well with others” work reputation to confess Christ before others?

God is doing His work. He is saving souls and reconciling people to Himself and each other. He chooses to use people in this process, a privilege I will never be able to comprehend. May He grant me faith like my team of Burundian and American rescuers & caregivers showed. 

The culprit ladder and deck, washed clean by my Burundian rescuers.

   The aforementioned shirt-wrap and flapping lip.
Thumbs up for skilled surgeons and anesthetists...and nasal packing.

With all the dressings down, back at the scene of the incident.

I would be remiss if I didn't thank all of you who have been praying for my family and me during this time. We are humbled to dust by the overwhelming show of love and support that you have made. Thank you 1000 times over!


COTW: Getting Malaria — in the United States

by Logan

My family has been back in the US since mid-April when we evacuated from Burundi during the early stages of the coronavirus pandemic.  A few weeks ago I started feeling a little run down, and I noticed I was running a low grade fever, around 100.3.  I just felt completely worn out.  The next day, I was tested for COVID-19, but the test came back negative.  

The fever continued, and the fatigue gradually worsened.  By Thursday I could hardly get out of bed and could hardly eat.  I was alternating between ibuprofen, tylenol, and sleep.  I was trying to stay hydrated.  I was having headaches, back pain and muscle aches.  In the middle of a COVID pandemic, I assumed I had gotten a false negative result, and I went back to the hospital for a recheck.  This second test also came back negative. 

I thought, “If I’m not turning the corner by Monday, I will have to go in to the hospital and get this checked out.”  Far from turning the corner, the fever just kept getting worse, gradually increasing over the course of the week from 100.9, 101.4, 101.8, up to 102.5.  Some days I couldn’t get the fever to break at all, and I would just shake with chills for hours.  Other times, when the fever would break for a few hours, large drops of sweat would break out on my face and arms, and I would soak the sheets in sweat.  

Monday morning came, (now day 10 of fever) and I could tell I wasn’t over whatever ailment I had. So I started getting ready to go to the emergency room.  As I thought about what questions they would ask me, I briefly considered that there is a species of malaria that can lie dormant in the liver and then relapse months or even years later.  I thought this highly unlikely, but tucked it away to mention it to the ER doctor as part of the differential diagnosis for this undifferentiated fever for over a week.  

In the ER, they drew some blood and sent it off to the lab, and a little while later the ER doc came in to see me. I recognized him from when I was a resident and on faculty in this hospital. He greeted me, listened to my heart and lungs, and we discussed what might be the cause of my illness. We discussed COVID, aseptic meningitis, and other possibilities. As he was beginning to leave, I told him that I knew it was really rare, but since I spend most of my time in Africa, should we consider a relapse of the dormant stage of malaria. He scratched his chin and said, yes, that possibility exists, and we could run some labs to look for that.  Before he left the room, the nurse poked his head in and said, “The lab is on the phone, they are looking at your CBC, and they want to know if you have recently been out of the country.”  

“Yes,” I said, and he disappeared again back to the nurse’s station.  Momentarily, he popped back in and asked, “...Exactly where have you traveled? The ER doc and I exchanged a knowing glance. Apparently, the lab saw some “inclusion bodies” on the CBC and suspected it might be malaria, and they wanted to order a thick and thin smear to confirm.  

No less than five lab techs came up from the lab to practice preparing a thick and thin malaria smear, something they rarely get the chance to do in Springfield, Missouri.  A few fingersticks later and I was leaving the ER with an anti-malarial prescription and follow-up with the infectious disease doctor later that week. 

After a day or two the fevers began subsiding.  The smears, which were sent to the CDC for confirmation, returned with a diagnosis of Plasmodium vivax, one of the types of malaria that can cause the dormant stage in the liver. After finishing the first medicine, I have to take another medicine, primaquine, to clear the liver or any remaining “hypnozoites” (from the Greek which means “sleeping animal”).  

Logan's malaria smear
A few images from my malaria smear

What have I learned from this experience? Well, for one thing, I learned that although rare, it is possible to develop malaria after you’ve been out of an endemic zone for longer than 6 months. Let this bizarre case be a warning to any international travelers to remember to keep malaria in your differential even months or years after you have left an endemic area.  

I also learned how absolutely miserable it feels to be sick with malaria -- and I didn’t even have “severe” falciparum malaria. I have a new respect and empathy for the hundreds and thousands of patients we treat for malaria at Kibuye Hope Hospital. I only had a brief experience with this illness and I was blessed with immediate access to care. But my mind wanders to the 8,000,000 Burundians who were diagnosed with malaria last year, and how many ended up having severe complications, like seizures, coma, respiratory distress, severe anemia, renal failure, and even death.  I also have access to primaquine which will treat the hypnozoites, but what about those who will experience recurrences and relapses in Burundi because medicines like primaquine aren't available? 

I’m thankful for this brief opportunity to share this illness with the people I serve in Burundi. It highlights that although we have come a long way to bring healthcare and education to this remote part of Africa, we still have a long way to go. 

"And let us not grow weary of doing good, for in due season we will reap, if we do not give up." Galatians 6:9


Technical blog glitch: You may have missed the last 8 posts

Our team has just realized that there was a glitch with our blog feed since mid-August.  This seems to have been most significant in that the emails that carry our posts to many readers were stopped.  We think that we've fixed it.  So you can go to wordanddeedafrica.com to read what you missed or click on the following links:

Year 8 is Going to be Great!

Hope for the Hopeless

COVID Miracle

Another Anniversary

Psalm 77: Following Unseen Footprints

2020 and the Goodness of Passing Time

COTW: Continuity

Back to School


Back to School

by Jess Cropsey

Schools, parents, and students around the world are facing unprecedented challenges these days in regards to education. Burundi is no exception, although the challenges here are different. Since Covid numbers have been low, the government chose not to close its schools in March and opened as usual in September. Yet, teacher shortages, limited resources, and overcrowding are common struggles for schools here. 

In Kibuye, the student population for our local school has grown 23% since 2016 and currently numbers over 1,500 students. For the last two years, there has not been enough classroom space for the kindergarten/pre-school class. Thanks to the generosity of donors in the U.S. and the amazing ingenuity and work of the Kibuye construction crew, this beautiful building was completed this week in just 3 months!

The building has three classrooms that will eventually be home for three levels of early education (Pre-K 3/4, 4/5, and kindergarten), options usually only available in larger cities. The building also has interior classroom dividers so that it can open into a large meeting space for community events, parent-teacher meetings, etc.

Wooden divider doors to separate the classrooms

Multiple classrooms being used for a meeting space

Matthieu, our outstanding architect/all-around construction guru on loan from EMI, did such a great job adding really unique touches to the building, making it a particularly striking sight for all the traffic that passes on their way to the hospital. Adults and kids alike have been mesmerized by the fun, bright colors. In Matt's words, "Our construction workers are happy with their work; they have received words of encouragement from passers-by and the community. Shadrack, one of our smart and hard-working workers together with other painters worked until 10PM the last few days. Their excitement, sense of ownership and dedication to this project and other projects here in Kibuye make me a happy architect and construction manager."

View from the road

Proud construction workers

Although classes officially started yesterday, we had a nice opening ceremony today (which included sodas and speeches, of course) for the school administrators, teachers, construction workers, parents, and new students. We pray that this building will be a blessing for the community and a wonderful place for students as they begin their journey of learning.  

One of the school teachers along with her granddaughter, 
a new pre-school student

Parents and new pre-school students

Excited pre-school students

More cute students


COTW: Continuity

 by Rachel

When we moved to Africa to begin practicing medicine, there were several things that I knew I was giving up...some not so hard to say goodbye to (electronic medical records and litigation!), and some, like a wide range of medicines and technology and support services, more so.  One sad thing to give up was the idea of patient continuity.  I really enjoyed the chance to develop a relationship with a woman during the course of her pregnancy and deliver her baby and even follow up in the subsequent years (of course, residency was only four years long, but I still had some special patients during that time).  Here in Burundi, continuity is a challenge.  I function primarily as a consultant--I don't do normal pregnancy surveillance and almost never do deliveries except for C-sections.  Women come with a problem, I give advice and treatment, and then almost never see them again.  When I do, it's a rare gift.

When we returned from the US in 2016, there was a patient waiting for me named Odette.  A colleague had done an ultrasound in my absence and found what looked like an abnormal pregnancy.  I repeated the ultrasound and found a normally developing pregnancy, her first, but also a huge fibroid, more than 10 centimeters, filling up the lower portion of her uterus.  She came back many times in the following seven months for ultrasounds.  She rarely spoke but her husband and I conversed often in French.  In my head, I continuously ran through all of the potential complications that were awaiting her.  But lo and behold, she arrived at term without incident and we delivered a healthy baby boy by C/S.  I asked her to come back 6-8 months later and we removed the fibroid.  I thought that would be the end of the story and our relationship.

But then again she returned, now in the spring of 2018, with another pregnancy.  Her uterus looked perfect, but given the two surgeries, we scheduled another C/S and I performed it just before a scheduled six month in the US.  And now, just a few weeks ago, she came with her third pregnancy, already in the final weeks.  I performed a C/S on Tuesday and delivered her third and final baby.  It was oddly touching to me to be able to safely bring all three of her children into the world.  I don't know if she ever realized how remarkable that was.  She and her husband don't even live in our health district...they come from another province in the country.  So many women never show up for their scheduled surgeries, or labor begins too early and they deliver elsewhere.  I take vacations occasionally (!) and spend six months out of the country every few years. But everything lined up perfectly in this case.  

I didn't take any pictures...I always feel oddly awkward about taking pictures of my patients...but I will certainly remember the privilege given to me by Odette and her family. It's a small but tangible reminder of God's provision and a giving back gift of grace to me, even of the small things I feel like I've given up for His service.  


2020 and the Goodness of Passing Time

 (from Eric)

Yesterday afternoon, I was scheduled to be working from home.  But there was a request for me to come up and do an echocardiogram.  So I came up, and one echo turned into two, which was followed by an impromptu admin conversation on a diversity of issues.  Eager to get back to the kids and the tasks I had left behind, I bolted out the hospital staff gate at my normal "American" tempo that easily outdistances any Burundian 2:1.  (To be fair, any Burundian could outdistance me on foot, especially at long distances; they are just not usually in a hurry.)

Halfway home (meaning 100m from the gate), passing between the school and the church, I am hailed in French by a Burundian guy in a sport coat who is awkwardly holding a large sac in one hand and a roller luggage in the other as he tries to catch up with me.

"Bonjour Docteur!"

I don't recognize him, and since there are often random people trying to stop me, often with the hope that the conversation will eventually get around to me financially supporting their personal project, or at least getting my telephone number, I cautiously respond with what I hope is friendly-but-not-overly-welcoming.


He continues in French: "I just wanted to say 'hello' to you."

Me, hesitatingly: "Hello."

He switches into what I would have previously called "broken English".  Now, after several years working in a foreign language, I call it "impressive English."

"Maybe you don't remember me."  I don't, and I guess he can see it on my face.  "Several years ago, we came to the hospital with my father, and you took care to heal him.  We were so happy.  He is passed now, last year in 2019, but after you healed him, he was at home for three more years, and we were so happy.  I remember how you talked to us when we were in the hospital.  I saw you and I wanted to thank you and to greet you."

"Oh, thank you for giving me this news of your family," I reply, trying to match his cadence.

"My wife is here."  He gestures behind him to a smiling woman following us at about 50m, holding no luggage other than a bundle of blankets that probably hides a baby somewhere.  "Our baby was sick, and we brought her to be healed.  Dr. Alice (sic) gave her treatment, and now she is healed, and we are going home.  But I saw you, and I wanted to thank you for your effort for my father.  We were happy that he was with us for three more years."

I wave at the mother and she waves back and smiles.  "Thank you for telling me.  I am happy your baby is okay, and I wish you a good journey.  Please greet your family for me and for Kibuye."

He smiles, and they continue (more slowly now), down the road as I enter to gate to our housing area.


I am sharing this story in 2020, which may be the most concretely characterized unit of time ever.  Our frustration with 2020 makes us talk of "wanting to send it back" or "kick it to the curb and move on."  We compare it to a dumpster fire, and then feel we've insulted dumpster fires.  The general sense (and oh I've felt it!) is that we just want to get this year behind us.  Though I am 110% sympathetic, we need to recognize the shortcomings of this desire, since A) January 1, 2021 is unfortunately nothing magical, but more importantly B) Time is more magical than we give it credit for.

So a few thoughts on Time and Timing from my roadside interaction yesterday:


1. Beautiful Interruptions.  I didn't want to go up to the hospital yesterday afternoon.  I didn't want 10 minutes of work to turn into 45.  But aside from the benefit of the actual work, I probably would have given up that time just for the encouraging interruption on the way home.  

Generally speaking, I dislike and resist interruptions.  They are out of my control and not according to my plan.  But I am a Christian, and as such, I have to reckon with Jesus, who simultaneously lived with an intense vision towards a specific goal (his death and resurrection) and yet welcomed interruptions with grace (e.g. blind Bartimeus or the bleeding woman).  Jesus understood what I affirm in my head and don't really believe in my heart - that God is at work all around, and therefore things outside my control may be much better than I think they are.  A beautiful interruption reveals the incredible fallacy of my heart that my will is the only force for good in my life.

2020 is full of life interruptions.  Could it be that those interruptions are hiding some redemption somewhere?  And I don't need to know what that redemption is in order to be hopeful that such a redemption might somehow exist.

2. Delayed Gratification.  As years in Burundi roll on, these kind of episodes get more frequent, and we more frequently don't remember the original circumstances.  Last December, we were crossing the border to Tanzania.  The border guard told me that he had come to Kibuye with his wife, because they had had no children, and now they had a 3 year old healthy child.  I gestured to Rachel who was waiting in the car.  She came in, and he brightened up.  "It was you!  Look, here on my phone, here is our child!"  No memory, but lots of joy.

It's the passing of time.  It's the slow turn of the earth and all that happens under the sun.  Our lives bounce off of someone else, and we quickly lose sight of their trajectory, but it is altered nonetheless, just as ours is because of them.  We can't remember all the events that made it so, but we are changed because of the time in which we live and in which we interact with others.

One of the things for which 2020 cannot stop the clock is our hearts.  The Bible often uses seed analogies to talk about this.  That which is planted in us continues to grow and change.  By God's grace, life is still happening, and we are still becoming.  "A fallow field is never dormant."

3. The Whole of Time is Greater than the Sum of its Events.  There is something bittersweet about being thanked for taking care of someone who has died.  In this case, the son was thankful because, even though his father is gone, he had three more years to spend together.  What did his father do with that time?  Maybe a lot.  Maybe he helped many people or bequeathed great wisdom to his kids.  Or maybe not.  I don't think that what he accomplished was the point.  The phrase "spending time" puts our focus on those events that took place in between, but Time is something else in addition to that.

Think of a long friendship.  Think of a healed wound.  Think of a beautiful song.  There is no way to experience the beauty of a 8-minute song in 4 minutes.  Time itself gives something to the experience.  Even more minutely, think of a drawn-out note within a beautiful song.  It is Time itself that blesses the moment.

Maybe 2020 won't be much to look back on.  We joke about the "skinniest photo album ever".  But "not much to look back on" doesn't mean less to experience now.  As much as I want to put my head in a hole for the remaining months of this infamous year, the goodness of passing time remains before us, and I'm thankful for the interruption and delayed gratification that reminded me of it.


Psalm 77: Following Unseen Footprints

 (from Eric)

This is from a few months ago, and I didn't know it had been posted until now.  I made this short video for our home church in Ann Arbor, Knox Presbyterian Church, which speaks some of the (especially early) 2020 experience for our team along with some thoughts about the way Psalm 77 speaks to that experience.


Another Anniversary

(by Jess)

Today marks one year since Matt and I arrived in Kibuye! To celebrate, we wanted to share our top 10 Kibuye moments and thanksgivings.

10. Getting to develop trust and friendships with the construction crew. Just this evening after work, Matt was able to reflect and celebrate with Quinzaine the foreman about the building progress and the community's affirmation of the Pediatric Ward and the pre-school building they are close to completing.


9. Hosting family and friends here. We had two of Matt's siblings come from Congo to see our world in rural Burundi. I benefited from my sister-in-law's cooking lessons.


8. Celebrations! Thanksgiving, Christmas, Easter, Fourth of July. Can you guess which one this picture captures?


7. Hiking to the "far" Kibuye rock, an outcropping with 360 degree views that is about 20 minutes walk from home. 


6. Visiting our househelper Acheri at his home. Heather and Keza joined and we all enjoyed the tour of their minifarm complete with a cow almost ready to give birth, pigs, chickens and rabbits.


5. Not in Kibuye, but we loved joining the Cropseys and Faders for a beach vacation on Lake Tanganyika.


4. Heart and Soul Retreat, facilitated by the Knox Presbyterian team in February. We felt loved on and invested in.


3. Runs, walks, bike rides around the rolling red hills covered in bright green fields. We have pounded the 5km loop countless times, but it still feels refreshing.


2. Designing and building the new 8-plex residence that will soon house one family and eventually several other doctors and visitors.


1. Friendships - grown in all the birthdays, brunches, and Bible and book studies we have enjoyed these last 12 months.

Thanks for a wonderful year, Kibuye! God has blessed us through you by providing us a "pleasant place" to live and serve (Ps 16:6). Let's see what the rest of 2020 brings.


COVID Miracle

 By Alyssa 

If there is one thing I think we have all been learning through this pandemic, it is that we actually have zero control over our lives (as much as we like to pretend otherwise). No matter how much Herculean effort we put into planning, everything can be derailed in a moment. And having had that fact pounded into my head over the last 6 months, I celebrate that it is most definitely a COVID miracle that I am writing this post from my home in Kibuye! 

Plan A: Take a five month home assignment in the US to reconnect with supporters and family, speak at conferences, debrief the last couple years in Burundi, update medical board exams, work on my master’s in medical education, etc. Attend CME conference in Greece on my way back to Burundi. Arrive in Burundi April 5, 2020. 

Plan B: Greece conference cancelled. Rebook flights to fly to Burundi directly. Arrive March 28. Send passport to Burundi embassy in D.C. to get visa date changed to reflect March 28 arrival. 

Plan C: Receive call from Burundi embassy that my passport is being returned to me with no new visa. Burundi airport closed March 22. Stuck. Wait. Find temporary job in Birmingham at local health department until return to Burundi is possible. 

Waiting indefinitely was very hard. My bags were packed and I was ready to get back to my life in Burundi. And yet, there were mercies in the waiting, too. Having spent 10 years overseas, I had not had occasion to lean in to my passport country for a long time. And seeing the struggles and suffering firsthand in America - racism, uncontrolled pandemic, polarizing politics - provided the opportunity for me to grow in compassion and to learn so much (learning that will continue for a lifetime). I also connected with my local church more deeply than I have in years, and I remembered what I love about Birmingham and the people there even as I also saw injustice in new ways through my work with the homeless population. 

Plan D: Get special authorization for a visa on arrival in Burundi thanks to the incredible efforts of our Burundian partners. Fly commercially to Ethiopia. Take a humanitarian flight to Burundi on August 5. 

As the flight into Ethiopia began to land, I could see thick clouds out the window. The landing gear went down and I briefly saw hills and trees, but then the plane took a sharp turn upwards into the sky! We climbed and climbed, and then finally the pilot said he couldn’t land due to the clouds, so he was going to a nearby airstrip to wait for the weather to clear. We flew 30 minutes to Dire Dawa, Ethiopia: a dry, dusty place near the border of Somalia. There we sat on the plane for 5 hours waiting to return to Addis Ababa while the humanitarian flight went to Burundi without me. 

From my quarantine hotel in Ethiopia, I investigated various options for getting to Burundi, but with the airport still closed to commercial flights, options were extremely limited. I would need to wait 2 weeks to get on another humanitarian flight. Thankfully, on day 8 of quarantine (and after another negative Covid test), they let me leave the hotel room and stay with a missionary family in the city which was literally and figuratively a breath of fresh air. 

Plan E: Complete 14 days quarantine in Ethiopia. Fly to Burundi on August 19. Complete 14 days quarantine in Burundi. 

This time, things actually went even better than planned! The flight was entirely uneventful, and my luggage arrived with me. The Burundi airport was very well organized with socially-distanced queues, hand washing stations, temperature checks, and forms to complete about symptoms and about quarantine. All the passengers were tested for COVID on arrival and then we stayed in a quarantine hotel for 24 hours until we found out the results. Thankfully everyone on the plane tested negative, so they released us from the hotel to finish quarantine at home. I came up to Kibuye the next day and spent my Burundi quarantine time settling into my house after 9.5 months away and getting re-oriented to team life and work. Tomorrow is the last day of my second quarantine, and I will head back to the hospital on Wednesday! 

So is the COVID miracle Plan E? Sort of. It truly is a miracle that I was somehow able to get back to Kibuye during a pandemic with a closed airport and an expired visa - and that I stayed healthy through it all. And we have several teammates waiting in the wings in North America who would appreciate your prayers for a similar miracle (but without the Plan D derailing)! For me, though, I think the miracle is a deeper settling into my Heavenly Father’s care for me no matter how many “worst-case scenarios” come true. [And of course I realize that none of this was truly “worst-case” - it just felt like it at times!] But I’m an Enneagram 1 (the perfectionist) and Myers-Briggs ISTJ and a firstborn - basically I like plans, lists, routines, schedules. When I travel, I think through what could go wrong and I make contingency plans in my head. I evaluate speed bumps along the way with straightforward reasoning and logic. But these weren’t speed bumps - they were mountains! And no amount of planning or reasoning was going to make them go away! And, as everyone reading this knows, there has been no routine for the last 6 months! Living in Africa has definitely grown my resiliency in the face of uncertainty - but these trials have tested that to the max and forced this thinker to reckon with feelings, too! Yikes! ;) Psalm 77:19 says, “Your way was through the sea, your path through the great waters; yet your footprints were unseen.” That verse was very meaningful to me when our team dealt with the flash flood years ago (see post here), but it is also relevant today. God provided a way back to Kibuye for me through seemingly impossible circumstances. And at times I didn’t see his footprints ahead of me, and I had no idea what he was doing. But he kept reminding me of his presence and his steadfast love along the way, and he kept teaching me and growing me through the waiting. I hope I will remember that miracle the next time I’m tempted to anxiously make contingency plans and doubt his care. Thank you to all of you who have been praying for me through all the waiting and travels! 

Ethiopia Hotel Room Quarantine

Flying to Burundi! 

COVID testing in Burundi

Lake Tanganyika 



Hope For The Hopeless

 By Michael Harling

Do you ever notice how bad things seem to stick in your brain so much easier than good things.  In psychology it's known as negativity bias, a tendency to form stronger memories more quickly after negative events. Of course it's unhealthy, and arguably unbiblical, to only remember the negative.  But it's a struggle that can be a tool in medicine.  Part of our training during residency is knowing how to hone in on problems, to constantly expect disaster, and learning what we can do to prevent it.  This constant vigilance against bad outcomes can make it hard at times to remember good ones.  What easily sticks out is when patients don't do well and I consequently spend hours ruminating over what could have been done differently.  The patient I was operating on in the last newsletter had a complication after surgery and died as I was taking him back to the operating room.  I have thought of him often over the last few weeks and have been learning how to lay these difficult times before the feet of Jesus.  But rather than dwell on that challenge, today I want to share a praise.   Meet Hosiane:

I met this 7 year old girl in clinic earlier this year.  Her mom had brought her because she had vomited almost every single day of her life since birth - often several times a day, after most meals, and especially at night when she lay down to sleep.  The first thing that popped into my head was that I wanted to get a CT scan of her abdomen, but CT scans are incredibly expensive, even more expensive than an operation.  So I gave her a bill for the operation with the plan to do exploratory surgery (that is to say, I didn't know the diagnosis before operating on her, I was truly operating to "explore" her abdomen).  After returning home to find the funds and paying, she was on the schedule for July 10th.  She wound up being the last case of a long busy day, and before going back to the OR I reminded her mom that I wasn't sure what I would find or if I would be able to fix the problem.  In the OR I found something called malrotation.  Basically her intestines had twisted around themselves and were stuck in the wrong places which was chronically blocking food from getting out of her stomach.  After very carefully peeling the intestines apart and removing attachments that weren't supposed to be there I was able to put everything where it needed to be.  (For the medically inclined it was a really interesting presentation of chronic malrotation with the proximal jujunum crossing just below the terminal illium and wrapped twice around the mesenteric stalk, let me know if you want pictures!)  I went out to talk to her mother afterward and share the good news, that I had found the cause of the problem and that I was able to fix it.  She confessed to me that she almost didn't bring her girl back to the hospital, she was convinced her daughter was going to die.  The picture above is her 5 days after the operation getting ready to go home.  She hadn't vomited once since her operation.  Praise God that He protected and sustained her until she could come to the hospital. Praise God that he prompted her mother to bring her back.  Praise Him that it was a fixable problem and that we were able to correct it.  Praise Him that she recovered so well and so quickly.  Praise Him that this mother who had lost hope for her daughter left the hospital with a smile on her face.  I think the name of our hospital captures it so well:  Hopital Espoir de Kibuye - Kibuye Hope Hospital.  Praise Him that we have a chance to relieve suffering, to give hope for today, and to share our hope for eternity.

"Unless the Lord builds the house, its builders labor in vain. Unless the Lord watches over the city, the watchmen stand guard in vain." Psalm 127:1

Soli Deo Gloria,