Neonatology!

(by Jenn Harling)

Hey Everyone!

I'll re-introduce myself as I still consider myself one of the "newer" team members... but in all acutality we've been here since January 2020!  I'm Jenn Harling, married to the ever-so-talented Michael Harling (surgeon / IT extrodinaire / internet guru / biomed guy / fixer of all the things our children break) and mom to Amelia, Madelyn, and Mark.  I'm a pediatrician but I like to call myself a self-trained budding neonatologist. I love all the children of Kibuye and really enjoy treating all of them, but there's something about those newborns that gets me!  While Alyssa is here, I focus mostly in Neo, but while she's gone I cover all of peds.  And I also love love love teaching... but that's for another blog.  Since our return from home assignment in July 2022, I've been working to improve the quality of care given in the Neo unit with small changes here and there. I attended a Neonatology conference in Tanzania in October 2022 and lerned so much and am excited to hopefully implement a lot of what I learned over the years to come.  

Our unit in the new Peds building (if you want more on that, you can see one of Alyssa's old posts about the opening of the peds building... actually there are TWO posts... here's the other one) is on the top floor and can hold about 40 babies.  One thing I think is really neat and possibly unique is taht the mothers get to have a bed on our unit as well.  You can see in the video that the "incubators" are attached to the end of a patient bed. The mothers stay in the bed and are the major caregivers to their babies. This is necessary as sometimes we have very high ratios of patients to nurses. 

Recent changes include a hand hygeine initiative, using a white board to track patients, keeping nurses in the unit rather than having them rotate to different services, and re-vamping some of our protocols.

Rather than ramble on and on, I thought I'd just give you a tour in person!  Hope you enjoy the petit tour. 

(Also, this is my first time uploading ... ahem... trying to upload a video so let me know if it doesn't work and I'll ask my husband for advice 😂)  

The 6 Ps

The 6 Ps of Acute Limb Ischemia Driving in Burundi

by Eunice John

For non-medical people (like myself), in medicine, there is something called the six Ps of acute limb ischemia, which occurs when there is a sudden lack of blood flow to a limb. Doctors often use this in the assessment of whether the limb can be saved with emergency surgery or not. 

The “Six Ps” include pain, pallor, poikilothermia (aka perishingly cold per the graphic below), pulselessness, paresthesia, and paralysis. 

Many years ago, even before our family’s arrival, a teammate(s) creatively came up with another “Six Ps” but for driving here in Burundi…and the story begins: 

Our family doesn't travel away from Kibuye too often. And I would say even our teammates who have to travel more (i.e. to the capital, a 2.5-3hr drive one-way), still only drive down maybe 2-3 times/month. While Burundi is indeed beautiful, driving here can definitely be stress-inducing, for both the driver and passenger(s) alike! 

Back in Dec 2019, there were 2 weddings on the same Saturday in Bujumbura, the largest city and former capital. Our family and some teammates were headed to one (for which our oldest was the ring bearer!). A couple other teammates were headed to the other. Before leaving Kibuye, I was asked to pray over the travels ahead. I prayed and we were on our way.

Maybe an hour into our drive down the mountain, we see some…traffic?? There is a line of vehicles backed up and definitely NOT moving. We slowly come to a stop. Why are they all stopped? What happened up there? Where is “up there”? How long has everyone been here? How long will we be here? Oh no…we’ve already driven over an hour…there’s no turning back. Are those people getting off that bus and walking??

While one of our teammates got off to do some scouting, the rest of us hung out in the car. Another teammate jokingly noted that I hadn’t prayed for all the six Ps! 

Well, fast forward to this past December, our family was driving back to Kibuye after some holiday travels, and I kid you not: during those 2.5-3 hours, we encountered all six Ps* (some more than once!). All that to say, these sorts of things tend to stick to my brain, so I wanted to share them with all of you. Now, in no particular order… 

We pray for protection from… 

1. Potholes

2. Pedestrians 

3. Presidential parades and the likes (this one was a sudden but short one)

4. Pikis (Swahili for motorcycle) 

5. Puke (we give each of our kids an empty "Blue Band bucket" aka margarine tub, to use as a barf-bucket; the sanitizing wipe from Ethiopian Airlines came in handy!) 

6. Pluie (French for rain) 

Note: In this picture, you can see pluie (look closely at the dashboard), pedestrians, and pikis! 

In all seriousness, we always pray for travel mercies and are thankful for every uneventful trip on the road. The next time you’re on the road or you think of our team and wonder how you can pray for us, you can just remember the 6Ps and our travels in general! 🙏

*The 6Ps were very slightly modified for this post. There is actually another P that is not listed here for mindfulness reasons. 

The start of a surgical residency at Kibuye

 

From the onset of the team that is represented by this blog, a deeply-felt calling has been not only to provide excellent healthcare for those who might not otherwise have access to it, but also to train others, namely African nationals, to do the same.  Over the past nearly 10 years here in Burundi, this has systematically progressed from teaching medical, anesthesia, ophthalmology, and nursing students, to teaching newly graduated doctors in our Stage Professionelle program. And now a new level of training has begun. 

In September 2022, after about 6 years of curriculum development, dozens of official and unofficial meetings with stakeholders, ministers, and medical educators, and lots of prayer, we officially launched a 5-year Surgical Residency Program here at Kibuye Hope Hospital.  The program is unique in that it is a joint effort between 2 partners:  Hope Africa University and PAACS.  Hope Africa University provides academic support and in-country recognition/legitimacy in the form of a Masters Degree in General Surgery.  PAACS (The Pan-African Academy of Christian Surgeons) provides international recognition, curriculum and conference support, as well as financial underwriting of the program.

In a country which is among the most surgeon-deficient in the world, the training of local doctors, in their own country, in a hospital with a high surgical patient load, is sorely needed.  Two residents started the program in September 2022, and two more joined them just this month.  We hope to enroll 2 new residents each year.  

Last weekend, a special ceremony took place in which the 4 residents were presented with white coats as well as their 2-volume surgical text which will serve as the core of their reading material over the next 5 years.  Families, friends and colleagues gathered to celebrate the commencement of this program, also reflecting upon the great responsibility the residents have undertaken.

Our hope is not only to develop excellent surgeons who will provide decades of competent and compassionate care for patients here in Burundi, but we also pray that their care for patients would be deeply molded by their faith in Jesus.  May they be kingdom-builders in exercising the gifts and opportunities that God has given them.

Our hearts are full of gratitude for all those who have supported the conception of this program through giving advice, prayers, encouragement, and technical and financial support – and for all who continue to make this program possible.

 

Part of the 250 page dossier submitted to the Ministry of Education

The 4 new surgery residents

A foot washing ceremony attempting to model the type of surgeons we want them to become

The 4 surgical residents and 4 surgeons