COTW: Platelet Count of 1

 (from Eric)

Something that initially surprised me about African medicine was the breadth and severity of blood disorders, the field which medicine calls Hematology.  People's first guess is Infectious Diseases and, in particular, what we call "Tropical Diseases" (e.g. malaria, typhoid, tuberculosis and a host of crazy parasites like the Loa loa we diagnosed in a guy's eye this week).  This is all true, but pretty much every field of medicine is dramatically affected by its context, and this seems particularly true of hematology in Africa.

I have come to accept as "not too bad" blood values that get you admitted to an ICU in the United States (which has been weird for me on at least two occasions when I have encountered such patients working the US on different leaves from Africa).  

You can read here about some great old cases from Alyssa, including when she visited Burundi from Kenya, and our lowest-ever hemoglobin level from Rachel here. We have been astounded what people can live through and often wished for a hematology specialist to help us wade through the strange waters we're trying to navigate.

Last month we received a 22 year old young lady in our emergency room with a profuse nose bleed.  In such cases that are bad enough for a Burundian to go to the hospital, we often find that their platelet count is low.  Platelets are one of the blood components that are necessary for blood to clot.  A normal count is somewhere north of 125-150.  The average reader of this blog is likely somewhere around 300.  When you get below 50, you can start to have trouble, and even more so if you get below 20.

This young woman's platelets were 2.  I've seen <10 lots of times, but never 2.  Well, of course, she's having trouble not bleeding.  Carlan and his team went to work getting her immediate bleed under control, and with quite good effect, considering her low platelets.  She was transfused, and the next morning, we rechecked her blood.

Now, her platelets were 1.  Or maybe I should say her platelet was 1?  Maybe we can't call it a platelet "count" at this point?  Can you "count" to 1?

What to do?  Her other blood components looked alright (except her red blood cells which were expectedly low given her hemorrhage), and so we were hoping that she had a condition called ITP, where your body forms antibodies against your own platelets, which causes them to be destroyed.  Why did we hope this?  Because we could treat it with steroids.  There may be a lot of medicines that we can't always access, especially for severe blood diseases, but we have steroids.

We started her on treatment, and 3 days later, we checked her again, and her platelets were 13.  Or as I liked to say: "13 times higher than before!!"  This was still really low, but much better and well on her way to getting out of the immediate danger zone.  Sure enough, her bleeding was soon well-controlled, and she was able to go home on pills with the chance to follow-up in clinic with hopes of a complete resolution.

***

On a related note, several years ago, Hope Africa University sponsored a young graduate named Dr. Ferdinand Nduwimana to go to specialty training in Senegal in what is called Biologie Médicale, which doesn't have an exact American equivalent, but is like a mix of laboratory medicine and non-tissue pathology.  He returned to HAU several years ago, and has been helping greatly in the medical school in Bujumbura.  He also comes up to Kibuye a couple times a month to work on developing our laboratory and its personnel, and to provide some advanced testing.

Dr. Ferdinand growing our laboratory capacity

Yesterday, when one of our intern doctors asked me about a guy from Tanzania who came with a white blood cell count of 342 (normal <10), I was delighted to see that Dr. Ferdinand happened to be around.  His invaluable help showed us within hours what the likely diagnosis was, and how he might pursue further treatment in Tanzania, if possible.  

***

For all that we cannot do, there is much to be thankful for.

Time to say Hello

(from Ben)

St. Patrick’s Day was this past week. I hope everyone wore green! Even though it’s only a few days after St. Patrick’s Day, I’m reminded as I write this of a different holiday - Halloween. On Halloween of last year, I landed in Bujumbura for the first time and began what I had been working toward for many years.

Let me introduce myself. My name is Benjamin Roose. I am a new general surgeon working at Kibuye Hope Hospital.

I hail, like several from the team, from Michigan. I grew up near the ring-finger middle knuckle and, though I spent my college and medical school years in Ohio, I returned to Michigan for general surgery residency at St. Joseph Mercy Hospital.

That particular hospital happens to be where Jason Fader and Ted John trained. It met Ted there as he was three years ahead of me in our surgery program. Through Ted, I learned about Jason Fader and surgery at Kibuye. As I became friends with Ted and listened to him share his excitement about what was happening at Kibuye, I began to want to go there myself.

I spent several short term trips at other mission hospitals which strongly influenced my desire to work in that setting. I was accepted into Samaritan’s Purse’s post-residency program and made plans to follow Ted abroad. I spent a year and a half working in southern Illinois, and then went to Switzerland for six months to learn French. This all led to finally, on Halloween of 2021, landing in Burundi for the first time.

In the past 5 months I’ve learned so much! The challenges are endless. However, I’m blessed to have excellent leadership and colleagues in the surgery department. More than that, I’ve found the community here Christ-like and welcoming. I’m happy to be here and glad to finally introduce myself to all the friends of Kibuye through this blog!

The band gets back together… Me and Ted on my first day.

Matchy-Matchy

 

By Julie Banks

As a non-medical member of our team, and a person who can get a bit grossed out just hearing the doctors' conversations, I am often searching for ways to connect with what is going on at the hospital. So when International Women's Day began to approach, I jumped into action! This holiday is recognized all over the globe, but I must say it is particularly fun here in Burundi. 

Of course it is a day to recognize the progress that women have made, and to stand up for the rights of women. But it is also a festive day where women are able to leave their housework, their work in the fields or their jobs for a brief moment to gather with special women in their lives. And to enjoy a Fanta!

One of the things that is most anticipated is the Women’s Day FABRIC! Every year there is a fabric created and sold especially for this date. It seems to be designed and sponsored each year by a different branch, or ministry, like the Department of Agriculture for example. As March approaches, women begin to wonder what the fabric will look like, and they begin to make plans for their dress that they will make from this special cloth. Once the fabric is “released,” it is still very much a secret and is passed off to the purchaser discretely in a sack. 

I particularly enjoyed getting caught up in the intrigue, the clothes, and the whole “girly” feel of the preparations and the day itself.  All the women and girls on our team ordered fabric and then gathered together with a seamstress to be measured for our custom skirts. She made about 15 skirts, a matching purse for Alyssa, and surgery cap for Rachel in just a few days. Rush, rush; hush, hush!

Tuesday, March 8th arrived and we all wore our matching skirts and dresses as we went about our day. 

After school and towards the end of the work day, our team brought cookies and treats to the hospital canteen where we treated the female hospital staff to Fantas and fun! 

I absolutely loved seeing every woman’s unique design. Their personality and creativity really shined through. 

We prayed, read some scripture and assured them that God has a plan for each of their lives. He created them uniquely beautiful and talented and has called them "wonderfully made." We thanked them for the work they are doing for the Lord at the hospital and assured them that they are valued daughters of the King. 

After Fantas came picture time outside on the lawn! Giggles flooded the air, selfies were happening, and smiles were non-stop as it turned into a big photoshoot! I was thinking that wearing this fabric together was so much more fun than any t-shirt I have ever worn for an event. 

It honestly felt more like a group of bridesmaids in dresses that were alike, but different. Seriously, some of these girls were really rockin’ their Women’s Day designs! It was fun to feel like a part of their world for a brief moment, when I can often feel so different. Cute clothes and sugary drinks? Umm, yes I can join you in that!

But Kibuye was not the only place where women were celebrating. These types of gatherings were taking place all over the country. Quietly in homes, in restaurants, at churches, or even just on the side of the road. Our Burundian friends told us that it's a day that women love because they just get to be together.

It continues to be fun to see this fabric pop up around Burundi weeks, months or years later. Here is Rachel with her Women's Day cap standing in front of curtains made from 2020's fabric! 

Even some guys couldn't resist the fun and had to jump in on the photoshoot! 

Our worship team also sported Women's Day shirts, ties, and dresses.

Can't wait to see what the fabric looks like next year!

Where there’s a will there’s a whey… and other really gouda cow puns 👌

By: Jenny 

    Our monthly learning experience days made their long-awaited return to KHA last month, starting with a day dedicated to cows. The day was broken up into a trip to a local farm, cheesemaking, research projects and read aloud time with some of our favorite cow themed books like “Click, Clack, Moo”. I hope you enjoy all the pictures and favorite memories of this dairy good day. (The puns are only going to increase throughout this post...you’ve been warned 😅 )

    All families were invited to visit a small farm down the road that is home to several dairy cows, pigs, guinea fowl and even a turkey!

     We were able to observe the milking process, pet a few of the ladies and even see a newborn calf… and by newborn, I mean she still had her umbilical cord attached! Many were sad to have just missed the birthing process the night before, now that would have been an udderly memorable field trip!

     Our trip to the farm was followed by several Cow themed activities including research projects, crafts and Cheese Making! The cheese making activity was taken up by Julie and Glory and included a lot of dancing around the kitchen with witty middle schoolers rattling off the most amoosing cow puns.

 

      The younger kids learned all sorts of fun facts about the care and keeping of cows. Did you know some cows have waterbeds in their stalls? I’m serious, waterbeds! We learned that many people are responsible for the health and well-being of dairy cows including, the farmer, handler, veterinarian and even a nutritionist. Cows eat a variety of grains and have a special salad that includes cotton. Students were surprised to learn just how much work and resources go into keeping the cows in a good mooood. The older students worked on researching different cow topics. “The Cow Comic” was born from this activity and I couldn’t be prouder of puns these kiddos produced.

    The day ended with a cow themed P.E. class which was thoroughly enjoyed by all. They played games like “don’t wake the cow”, wherein the kids lay on the floor while a lone “cow” tries to wake them up. The catch? All they can do to wake them up is moo. (It was quite entertaining)

      Just like that, our cow themed learning experience day came to a wrap. Thank you all for reading along and enjoying the day with us, I hope didn't butcher the jokes to much. (butcher, get it? ... Okay, I'm done now)

Kibuye Pediatrics

 By Alyssa 

Pediatric team in front of our new building

So what's it like to be settled into the new peds building? We have now been in our new three-story pediatric building for 3 months, and it has made a huge difference for staff and patients. Last week we had 95 pediatric patients divided between the neonatology, inpatient malnutrition, and general pediatrics services. But since our new building includes 125 beds, we had plenty of space for everyone! Just a few months ago, that many patients would have meant mattresses on the floor or patients sharing beds. It makes such a difference having all the patients in one place, too. Before we had this building, our patients were spread out in four different buildings around the hospital campus, but now everyone is near which makes it easier to find help and supplies if a patient isn't doing well. 

As an example, I was in clinic 2 weeks ago when I received the following text from a medical student (my translation from French): "Bonjour, Doctor. The baby we discussed this morning is doing very badly and has a very distended abdomen with vomiting. I believe it is an emergency for this baby." The post-call team had mentioned the admission of this baby in our morning report discussion, so I knew he had a surgical problem that needed urgent attention. I stopped by the OR on my way and asked our capable surgeons if they could move this case up.  They said they could operate on him next and began preparing the room. On arriving at the patient's bedside, I found the medical student, nursing student, and nurse all ready to help. The baby was definitely as sick as the med student said - which is an important skill for which I congratulated the student later - recognizing a baby that needs immediate attention. Because there were so many staff and students easily accessible in our new building, we were quickly able to stabilize the baby with fluids, NG tube, oxygen (in-wall oxygen in every patient room!), etc. as well as to talk with the mother to explain the situation and pray with her. And within minutes the baby was on his way to the operating room where our surgeons fixed the problem and saved his life. This baby had been to three different hospitals in rural Burundi before coming to Kibuye - delays which nearly resulted in his demise - but thanks to a team effort and quick thinking on the part of the medical student, he went home with his happy and grateful mother (picture below). I think the hospital motto explains well how God brought about healing in this case and so many others that we see each day, "Dukorera Imana ikiza itanga ubugingo." Loose translation: "We work with God; He heals and gives life."

So being able to quickly walk up or down the stairs to the centrally located nursing stations and find help is a huge benefit of the new building as is having enough beds for every patient. Another benefit is the lighting and ventilation that makes rounds and patient care so much more pleasant for everyone. Before, nurses would need to bring patients outside to look for IVs in the sunlight, but now they have well lit treatment rooms and procedural areas where it's much easier to place IVs quickly and sterilely. And in a land where most people can't afford diapers, having well-ventilated rooms and tile floors that are easy to clean certainly improves the olfactory experience on rounds! 

Twins - they can still share a bed! But everyone else gets their own!

Aren't the patients seriously the cutest ever? Totally brings a smile on the long days when there are so many of them to see and so much work to do. 

But the patients would tell you that the best part of the new building is the playroom and the swing-set! As far as I know, this is the only hospital in Burundi with a play area for kids! The med students love bringing the children to play and sent me these pictures over the weekend. I love seeing their hearts of compassion for the patients even as they are learning more of the medical knowledge they need to care for them. 

One of our teachers had little white coats made for the children to play with so they wouldn't be so frightened by our white coats - they seem to like them!

What these pictures of cute children don't convey is that we have challenging days, too, as we care for the littlest Kibuye patients. Sometimes they have really sad outcomes or come from difficult situations. Many have severe malnutrition and the families struggle to find enough food or to bring them to the hospital in time. Yesterday we saw 100 (!) children with sickle cell disease which meant a long and exhausting day even as we sought to show them the love of Jesus as we gave them their medications and taught them more about this difficult and painful diagnosis. And this week we said goodbye to another doctor (in the dark red shirt in the picture below). He received an exciting promotion in Bujumbura, but it's a sad loss for our team and means we are now even more short-staffed. 

I was encouraged this week as I read and reflected on 2 Corinthians 4: "Therefore, since through God's mercy we have this ministry, we do not lose heart." The whole chapter is brilliant and reminds me that though we do indeed face afflictions and human weakness, these point us to the "light of the gospel of the glory of Christ" and the "all surpassing power [that] belongs to God and not to us." One day we will fully experience the eternal weight of glory and all these transient struggles will be redeemed. Therefore, by God's mercy, we can persevere in heart, head, and hands each day as the Kibuye pediatric team while we wait for eternity.