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.