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”).  

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