Threads of Years Long Gone: Ministers, Babies, and Reasons for Reconsidering Hope

 (from Eric)

On Friday, the hospital inaugurated a new district health office. In addition to being a church hospital and a teaching hospital, Kibuye is the referral hospital for Kibuye Health District, a geographic area of over 200,000 people. Anyone sick in that area goes to one of 18 health centers in the district which refer necessary cases to the hospital. Of course, we also get cases from all over the country and neighboring countries because of specialized care here, but we are the primary hospital for this catchment area, and this health district is administered and supplied by the district health office.

Their office was insufficient and helping them build a better office just outside the hospital wall also liberated some valuable real estate within the hospital that the old office was taking up. So we partnered with them to build a new office building. The building is lovely, and governmental dignitaries were invited to cut the ribbon.

The guest of honor was Burundi's Minister of Health. Newly appointed to the presidential cabinet in the last few months, this was her first visit to Kibuye. Burundi's amazing traditional drummers pounded and danced out a welcoming rhythm as the Minister's vehicle arrived, and we formed a receiving line, of which I was about number eleven.

Burundi's Traditional Drummers with the new district health office

As the Minister proceeded down the line, I shook her hand and said "Welcome to Kibuye." Over the thrum of drums behind us, she said "I know you. I met you in Banga when you were learning Kirundi. You had babies with you."

A journalist caught the moment where the Minister tells us she remembers us

I couldn't believe it, to say the least. Banga? Banga is where our team spent three months in 2013 when we first arrived, fresh from French language school but wanting to get a small smart on Kirundi language study before moving to the hospital.

 

Future Kibuye kids at Banga.

It wasn't the easiest three months. In fact, the "green soup" that we ate every night for dinner has become a bit of team lore. The electricity and water were usually out, and thus staying healthy was quite a challenge. I remember one night walking outside to see the adjacent hillside aflame (apparently a "controlled" burn for farmers) and wondering where the fire would spread.

During meals, the nuns who ran the guesthouse and restaurant, in order to help out high-chair-less parents (and to amuse themselves), would take Toby (who was about 5 months old) around and greet the other patrons. Apparently one of those patrons was the future Minister of Health, who came to Banga for a malaria training event.

Mama Lea - Toby's favorite nun

Now the Minister is at Kibuye, cutting a ribbon and remembering our team fondly. The ceremony began, and the governor of our province gave some opening remarks. Bishop Deo did a wonderful job discussing the work of the Free Methodist Church's institutions at Kibuye and their involvement in health care, including some upcoming plans. Then the minister took the podium and gave a very favorable speech. She again mentioned to everyone meeting our team in 2013 and remarked on our love for their country. She said that she would like to take a tour of the hospital afterwards, and spend close to an hour being guided deftly by Dr. Gilbert our medical director. All in all, a very successful visit.

***

The collision of past and present filled me with gratitude. It was the gratitude of someone who had been living on the back side of a tapestry, where all the threads are knotted and seemingly disorganized as they do their best to get from here to there. Then, for just a moment, you're allowed to catch a glimpse of the other side of the tapestry, where a beautiful, complex image has been created by those same threads.

You see that there were a couple stitches way over there, and then the thread disappeared for so long that you thought it was gone, and then it resurfaces in just the right place. And that makes you reconsider the other threads. It gives you hope for the other long-invisible strands. Or maybe this one over here has always bothered you, and you wish it would be gone. But maybe it actually plays a role in a bigger picture. It's been a source of tension, but maybe it's like the musical tension of a passing note to a beautiful chord. Who knows?

No thread makes a tapestry. Rather it's all the threads together. It's the whole of all our lives and days and interactions, woven together by One whose perspective is so much bigger than ours that it's like how the heavens are higher than the earth. It's incredibly hopeful, and also incredibly humbling.

Is that what Banga was for? Probably not, or rather maybe one thing among many. Who knows? The point is that there are these moments where you see a bigger story and though you may not have much more of an idea of what's going on than you did before, you now have a reason to hope that there actually is a bigger story. And that changes everything with regards to how you look at the beautiful and the problematic that surround you even now.

Is that what the Minister's visit to Banga and now to Kibuye was for? Maybe a bit, but she is not just a character in our story any more than we are just characters in hers. Surely God has many plans for her life in so many other domains. And so we see that the big Kibuye tapestry is itself a piece within the tapestry of Burundi, within the tapestry of His kingdom throughout His creation.

It's too complex. It makes our heads swirl. No one could weave together such a complicated web of billions of people's lives into a single beautiful work of art. But if someone could... If someone is, then that One is most worthy of praise.

(On a more personal level, here's a song I wrote a while back on a similar theme: The Weaving of My Days, also on Spotify and other streaming sites)

New Chaplains and New Chapels

 (from Eric)

When our team returned from the Serge conference last month, we found a new face leading morning chapels at the hospital.  Last year, after decades of faithful service, Pastor Pascal Nyawenda retired from his role as a Kibuye Hospital chaplain.  Now, Pastor Mélance has arrived to fill that void, joining Pastor Silas and Madame Pascaline on the chaplain service dedicated to spiritual care at the hospital.  It has been a joy to see the enthusiasm and energy that a new person has added to the team's work.  We see them praying with inpatients and outpatients, and if you take the time to ask them, they will enthusiastically share stories of healing, repentance, conversion, consolation and faithful presence.

Pastor Mélance, Pastor Silas, and Madame Pascaline

One of the things that I love about our chaplains is that they embrace not only the spiritual care of patients and their family members here at Kibuye, but also the employees and the numerous students that pass through the hospital at different stages of training.

Ever since the beginning of the Covid-19 pandemic, it has been a challenge to decide how to handle the long-standing practice of daily times of morning prayer/singing/devotions from 7:30 to 8:00 each morning.  After trying a number of different models, the hospital leadership restarted this practice a couple months ago.  The response from students and staff has been encouraging with an enthusiastic participation.

The chaplains' response to this was to reflect on how best to use this reinstated time to engage well those that are involved.  They are planning a number of different activities, but one of them is to dedicate one week per month to a thematic message.  The idea is, instead of a different speaker and theme each day, there will be one speaker on a chosen theme who will give four different messages from Monday to Thursday, and then Friday will be dedicated to Q&A.

I had the honor of being the inaugural speaker for a theme week, the chaplains asking me to speak on "Walking with Those who Suffer".  On Monday, I spoke on suffering according to the Bible.  On Tuesday, I spoke on the significance of a God who has suffered and died.  On Wednesday, we talked about consoling the sufferer, and on Thursday, we talked about Finding Hope.  Even this week, it seems that these messages have changed the tenor of some of our conversations about our work in ways that I think are positive and authentic.

I wasn't sure what to expect in the Friday Q&A.  I appreciated what the chaplains were doing by leaving that time for more interactions, but I wasn't sure how people would respond.  After an initial long silence, the questions started to come and had no difficulty filling the time.  They asked about God's redemption of evil and the presence of temptations in their lives.  They asked why prayer matters if God is sovereign.  They asked about the difficulties of caring for the whole person when the work is voluminous and overwhelming, as well as the proper way to talk about the offer of eternal hope with someone who has just receiving hope-shattering news.  In other words, they didn't pull any punches!

Pray for these chaplains in the months to come and for the patients and staff and students that they will impact.

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.

Hope is a Gift

(from Eric)

Several weeks ago, I was working through a series of questions that my publisher New Growth Press wanted me to answer as they work to promote Promises in the Dark:

The questions are about facing discouragement, feeling weak, and overcoming the fear of hoping.  Good questions that are very much in line with the content of my book.

But it's hard for me to answer the questions, because I am, at this moment, having difficulty facing discouragement, feeling weak, and overcoming the fear of hoping.  Which just goes to show that being able to articulate your thoughts and put them on paper doesn't equal the end of the heart struggles.  My cadre of internal medicine patients at the hospital is having a hard run.  As I'm typing answers to these questions, my colleague texts me to tell me of the unexpected death of a young patient I saw just yesterday.

This is hard for me at the moment because of my patients, but it can be anything - family, friends, life, the world around us, anything - it can be hard to look at our world honestly and find the courage to hope.

The next question reads, "You write about times where you have been afraid to hope due to dire circumstances.  How did you overcome that fear in order to reach for God's promise of hope?"  Have I really done that?  If I have, then why can't I do it now?

In an effort to get some momentum, I start with some exposition on the subject:

My primary job is to care for the sick bodies of poor people in an underserved setting.  I often lose that battle, and because of that, I can be quite guarded in my hope.  "Hope deferred makes the heart sick," says Proverbs.  If someone's hope gets dashed every time they don't win the lottery, we would blame their expectations rather than the winning number.  Sometimes it feels like that for me.  Sometimes the odds don't favor hoping.

The crucial difference between my world and the lottery illustration is God's promise.  God has not promised me the lottery, but something far better.  He promises that he is always present, that he is always at work, that he is for me in my efforts to care for the poor and needy, and that he is making all things new.  We are not called to hope for the sake of optimism.  We are not called to hope based on the natural odds of the world around us.  Christians are called to hope because they believe that God's promises are true, and that he will actually act to fulfill them.  We "factor God in" to our circumstances, and as we do, we find reason for unexpected hope.

The next part draws me up short, because I know I haven't yet answered the part of the question that says "how do you overcome that fear in order to reach for God's promise of hope?"  My writing stutters.  I'm always struggling to hope, even now...  I don't know what to write.  My head has already said its piece, but my heart is finding it hard to trust in the very promises I just cited.

I'm sitting at my desk, looking out at my backyard.  Stuck.

My phone fires off a series of chimes, which probably means a message from a Burundian colleague, given the Burundian habit of chopping a message into multiple short texts.  I'm hoping it's not more bad news.

The message is from a medical-student-turned-colleague who worked at Kibuye for a while before going to work at our sister hospital in the capital city.  I had sent a 24 year old woman with persistent, terminal kidney failure down to see a kidney specialist, though I had no real hope that she would be able to go, or that it would make much difference if she did.  Her kidney disease was too severe (for medical folks, a Creatinine >25 mg/dl) and too persistent (a couple months).  It was shocking that she was still alive, but she didn't seem to have a curable problem.

At any rate, this colleague is texting to tell me that they decided to just hospitalize her and monitor her while giving her some fluids.  After a few weeks, they are now sending her home with basically normal kidneys.  He thought I'd want to know.

I'm shocked.  I'm struggling to hope, even now...  I look back at the half-finished thought on my computer screen.  I wrote that three minutes ago, and now my heart is filled with unexpected joy.

The timing of these events stuns me.  It feels like a brief moment of clarity.  I needed exactly what came.  I shift from staring out the window to looking instead at my stunned reflection.  My driving thought is "I will either live like God is actually, really at work invisibly in the world around me, or I won't.  What will I do?"

I continue the paragraph:

I'm struggling to hope, even now.  The struggle is not resolved, and the fear is not yet overcome.  But in my experience, hope is a gift - even an unlooked-for gift.  Just when I'm so afraid to hope, there is some unexpected goodness, some healing, some newness that teaches me again to hope.

Book of the Month: Factfulness

by Rachel

It's actually probably been years, but we used to have a blog feature entitled "Book of the Month."  There are a number of books our team has read which have informed our views and thoughts.  You're welcome to check them out here.

So, a few months ago I was reading Melinda Gates's new book, The Moment of Lift.  Excellent book, by the way (even though it's not the focus of this post).  I loved getting to read about the amazing work the Gates Foundation is doing to promote the development and empowering of women around the world.  Each chapter focuses on a different aspect of difficulties that women face, and people/organizations around the world working to ensure that each woman is seen as a life that is valuable; in fact, a life that has equal value to those around her.  Apparently, when the Gateses were forming their organization, they leaned heavily on the advice and wisdom of a man named Hans Rosling, a medical doctor and professor of international health.  He too had written a book....so off I went to check it out.

Hans Rosling was a Swedish doctor who spent years working in Mozambique and the Congo.  He then moved into more public health roles and investigated a number of disease outbreaks (including the 2014 West Africa ebola epidemic).  He passed away in 2017, and the book Factfulness was his last work.  Dr. Rosling's premise is basically that the world is a much better place than we think it is.

He uses a number of actual statistics from the world--infant mortality, life expectancy, kids attending school, average household income, even number of endangered species--to demonstrate that while most people interviewed will guess that things are getting worse, statistics show the opposite: that things have actually been improving over the past several generations.  Not only does he use statistics to demonstrate this, but the book is divided into 10 chapters of WHY he thinks we view the world the way we do.

As an American, coming from one of the most affluent countries in the world, who has now moved to Burundi, one of the most impoverished countries in the world, reading the book was actually surprisingly eye opening.  I tend to think of the world as either the "American" camp or the "Burundian" camp, while in reality there are so many more middle countries than either extremely rich or extremely poor.  You can't put Burundi in the same category as South Africa, or Egypt, or Thailand, or India.  Life expectancy and income are much higher for the average citizen of one of those countries than Burundi or Malawi, for example.  Rosling demonstrates that many of us use an "us and them" mentality when we look at the world, instead of recognizing that there are many different levels of poverty and development, and that the difference between a salary of $1/day and $4/day can have exponential benefits for the individual and society.

One of the lines Rosling uses towards the end of the book is this: The world can be bad, but getting better at the same time.  He's not asking us to pretend that everything everywhere is ok.  It's clearly not, and there are many many problems to overcome and injustices to surmount.  But, we can also celebrate the work and developments that have occurred over the last 100 years, even 10 years, as well.  That knowledge can give us hope that our efforts and the efforts of so many are not in vain.

As an addendum, I'm including some of his data graphics below.  The book is full of them, and it's a book that's fun and easy to read.  You can also compare your knowledge of the world to various Nobel laureates, billionaires, scientists, and chimpanzees...and see how you stack up. ;)

Super-Mom

-by Carlan

My superhuman wife & our baby.

My wife has super powers. She wasn’t always this way. A year ago she was your typical drop-dead gorgeous, incredibly-talented, multi-lingual, polymath concert pianist and composer. It was somewhere mid-Spring 2019 that something activated in her psyche, like a dormant gene waiting for the right circumstances to express itself. I think it had something to do with motherhood.

“There’s a loose bolt on the road ahead, don’t hit it!” “That ladder doesn’t look like it’s tied down well enough on that truck to the left!” Michelle’s threat-radar had quadrupled in sensitivity overnight, especially while driving.

“Did you hear that? Either a moth had a hiccup in the attic or something’s wrong with Gabrielle!” [Nothing was wrong with our daughter, so I hope that moth had a glass of water or something.] Super-hearing: activated.

Carrying a baby while performing such tasks as making oatmeal, pouring a cup of tea, brushing teeth, and having a phone call requires upgraded cerebellar function (balance, coordination). [Though I’m not saying that we haven’t broken a glass or a plate while trying to do too much at once since our little bundle of joy entered the world.]

But most impressively, Michelle has developed some kind of invulnerability to sleep deprivation. I went through med school and residency. I have had to stay up for 30 hrs straight every fourth day for weeks on end. However, I can count on one hand the number of times my wife has gotten more than a 4 hr block of sleep over the past six months. Yet every morning she smiles and coos and makes friendly faces to the source of her insomnia. Incredible!

Catching a quick nap together while reading Babywise.

Becoming a parent changes things...maybe everything. Caring so much about the welfare of another (helpless) human being provides fertile ground for worry and fear. Expectations for what you are going to get done in a day now that you are looking after another (helpless) human being must be adjusted. And yes, fatigue is a real threat to joy and contentment. Yet I hope that by stopping to look back over the past several months, God’s great grace can be made evident and obvious.

Paul, no underachiever himself, wrote in 2 Corinthians 12:9, “I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me.” He was struggling with a trial that wouldn’t go away and prayed for deliverance. The way of Christ was not a way out but a way through the pain. “My grace is sufficient for you, for my power is made perfect in weakness,” is what Jesus told Paul. It turns out that the best thing for us helpless human beings is to regularly face challenges beyond our natural abilities so that God’s superhuman power can work in us.

Eric's Book: Promises in the Dark

(from Eric)

Several years ago, I drafted a series of stories and reflections from my life as a missionary doctor.  The stories center around the theme of "Walking with Those in Need Without Losing Heart".

Jesus calls his followers to enter into the broken places of the world.  That much is clear.  This may be on a personal level, like a family member dealing with a divorce or a chronic illness.  This may be on a vocational level, as a social worker or an inner city teacher or a missionary doctor.

We are called to walk with those in need.  And it takes its toll on us.  How do we avoid burn-out on the one hand and cynicism on the other?  How do we remain faithful in the midst of the tension that is our broken world, where the promises of God are not yet fully realized, and where even their smallest glimpse can be hard to find?

My hope is that this book has something valuable to add to these questions.  I'm excited to say that, after several years of refining, Promises in the Dark: Walking with Those in Need Without Losing Heart will be available October 14, 2019 (less than 8 weeks away!) from New Growth Press.

It's already available for pre-order on Amazon at this link.

Here are a couple endorsements that I've been glad to see:

“Eric McLaughlin brought me to tears with this honest look at the difficulties of the life of a compassionate caregiver. When dealing with this broken world, there are no simple answers. But there can be hope. Promises in the Dark is essential reading for anyone who walks with others through suffering and questions how to keep on going.”
- Dr. Kent Brantly, Ebola survivor; coauthor of Called for Life

“Why do we love lawyer and doctor shows? We know both worlds bear extremity, suffering, and passion, and that is at the core of what intrigues and terrifies us. Eric McLaughlin, a missionary physician, engages the raw and compelling questions of what it means to be human and trust God in the face of a world that is stark and at times cruel. Eric offers no simple answers or trite truisms. Instead, he invites us to engage the questions with the confidence that there is nothing we face that Jesus has not first entered. The song sung in this brilliant book is that death is real and horrible, far more so than our antiseptic Western world can bear, but death never gets the final word. There is something about life and love that lingers far longer than heartache, and it is this story that enables us to enter all other losses with hope. This book will intensify your passion and encourage you to live the best story ever told.”
- Dan B. Allender, Professor of Counseling Psychology and Founding President, The Seattle School of Theology and Psychology

“What does a lived-out faith look like in the throes of an African field hospital? In a world of disease, death, and brokenness—of broken promises—how does one live as a light to the world? The answers to these questions are to be found in the pages of this honest book.”
- Michael Card, Songwriter, Bible teacher

Two Graces for the First Day Back

(from Eric)

Our family returned back to Burundi last week, and Rachel and I restarted work in the hospital on Monday.  I had been seeing my hospitalized patients for a couple days, but yesterday was my first day in clinic.

The day starts out with Alyssa sharing at hospital devotions.  She leads the hospital staff through a small gratitude exercise, passing out sheets of a yellow legal pad for us to write down those innumerable gifts that God has given us that we are so apt to forget.  We close with a prayer and a few announcements, and the day starts.

The medical student who is working with me (and serving as Kirundi translator) walks with me to my clinic office, where an old man is waiting outside the door with his clinic sheet.  She exchanges a few words with him, and tells me "I think he has Parkinson's Disease, or something like that."  I start with surprise and then recovering, ask them to come inside.  Sure enough, this old man has come all the way from Tanzania because of a tremor which seems consistent with Parkinson's.  I have not yet found any real treatment options for Parkinson's in Burundi, and I doubt his rural outpost of Tanzania has better options.

I grab a bottle of Sinemet out of my office drawer, and I say to my student in French, "I don't make a habit of bringing medicines from the United States, mostly because we want to support Burundian supply chains.  But, you see, my grandmother passed away a couple months ago.  She was a wonderful and lovely woman.  My grandfather asked me to go through the medications she left behind, to see if any would be useful for Burundi.  The only one that seemed useful to bring back was this medicine for Parkinson's.  This bottle won't last forever, but I hope it will help him feel better for a while."  Turning to the man, I continue,  "I don't see that many patients with Parkinson's, and I wondered whether I would find any before the medicine expired, but lo and behold, you are my first patient back, and it's precisely what you need."

My student gives me a look that says, "Do you want me to tell the patient all that?"  Yes, I do.  I watch my patient's face light up with joy and profound gratitude on hearing the story of his medication bottle, and I think about the beauty and the probability of this moment.

A couple patients later, I see a 50-year old woman with heart failure.  She is a village lady that I diagnosed a couple years ago.  "She's only taking this one medicine now?" I ask.  "How is she doing?"  My student and the woman chat for a few sentences.  "She says that she feels very well.  Before, she couldn't even walk, and everyone told her that she would never get better.  Now she thanks God because she is even able to work in her fields, though she does get tired sometimes."

I smile at my student.  These cases can seem so rare sometimes.  I pick up my folded sheet of yellow legal paper from the morning hospital devotions.  "Did you hear what Dr. Alyssa said this morning?"  My student nods.  I say, "I'm going to write this lady down on my paper."

***

The thing is, since returning to Burundi, my most frequent prayer has been that I would be able to see God's hand at work in my life and in the world around me, day by day.  Kicking off my first clinic day with these two stories seems to be Grace to me in the form of an answered prayer.

Many other days are just discouraging.  Today was much more that way.  My patients are mostly sick and none of them seem like they're getting better.  Is God at work?  Do I just need eyes to see it?  Walking home through the gate, there is a vivacious chatter of a flock of weaver birds who have taken refuge in one of our tall eucalyptus trees.

It's a thing of beauty and of joy.  But is it really just a tree and some animals?  Or are these small wonders windows that peek into God's work in the world and his glory?  On one hand, I'm not interested in rose-colored glasses, but I need not exchange them for blinders either.

I think the answer to such questions always requires some kind of faith, in the end.  Either faith that it's just a coincidence or faith that it's something more.  Either faith that it's just a bird, or faith that it's a glimpse of the light of the world.  I'm not talking about faith as some arbitrary choice.  We reason and we discern, but there does seem to be some irreducible element of choice that remains.  How will we see the world?

I really do hope to see the world with gratitude for all that God does.  And at least for today, it seems like a reasonable approach.

***

(for those interested in slogging through this question with the great Blaise Pascal, here is a quote that is most rewarding is you can persevere through the tangle of double negatives:

“The prophecies, the very miracles and proofs of our religion, are not of such a nature that they can be said to be absolutely convincing. But they are also of such a kind that it cannot be said that it is unreasonable to believe them. Thus there is both evidence and obscurity to enlighten some and confuse others. But the evidence is such that it surpasses, or at least equals, the evidence to the contrary, so that it is not reason which can determine men not to follow it, and thus it can only be lust or malice of heart. And by this means there is sufficient evidence to condemn, and insufficient to convince; so that it appears in those who follow it that it is grace, and not reason, which makes them follow it; and in those who shun it, that it is lust, not reason, which makes them shun it.”)

Dry Season (music video)

by Logan

During last year's dry season I had a crazy idea: what if I took a time-lapse video of my walk across the field to the hospital?  If I took a photo every day, just one step further, perhaps it would tell the story of dry season.  You could watch the field grow more and more yellow and dusty as the season progressed, and then at the end, watch the return of green grass.

It actually worked out pretty well, and I was pleased with the result, except that it was completely silent.  I asked our musician teammate, Eric McLaughlin, if he had written any songs that would go well with the theme of dry season.  He recommended a song called Banga Hill, that he had written during their very first dry season in Burundi.  It talks about our need for God's grace to "rain" into our lives, washing away our sins and quenching all our thirsts.

Enjoy!




For I will pour out water on the thirsty land, and streams on the dry ground; I will pour out My Spirit on your offspring, and My blessing on your descendants. 
-Isaiah 44:3

Blessed are those who hunger and thirst for righteousness, for they shall be satisfied.
-Matthew 5:6

Now on the last day, the great day of the feast, Jesus stood and cried out, saying, "If anyone is thirsty, let him come to Me and drink.”
-John 7:37

Jesus answered and said to her, "Everyone who drinks of this water will thirst again; but whoever drinks of the water that I will give him shall never thirst; but the water that I will give him will become in him a well of water springing up to eternal life.”
-John 4:13-14

More of Eric's music can be found here.

Baby Moses & Mama Clairia

By Susan

About 5 months ago, a baby boy was born in a field just up the hill from our hospital. For reasons we will never know, the mother left the baby there and disappeared. Thankfully, a hospital worker heard crying, and found the baby very shortly after, and quickly brought him to the hospital.  Our pediatrician checked him over and miraculously he appeared to be healthy. Due to the risk of being born and left in a banana field, he was put on a course of IV antibiotics to make sure he didn’t contract an infection. 

Like all the patients at Kibuye Hope Hospital, this baby was required to have a caretaker. Someone to be with the patient at all times, to help with their care.  Since this little baby had no one to take care of him, some of the other mothers in the NICU pitched in to help. Despite needing to care for their own premature babies, they helped with his feedings and care for him for the first couple of days he was there. We knew we needed a new plan to care for this precious baby. By this time, I had started calling this sweet orphan, Baby Moses.  

Alma & Baby Moses

The book of Exodus contains a beautiful adoption story of a Hebrew woman who had a son at a time when
 the Pharaoh ordered all Hebrew male infants to be put to death.  Instead, the Hebrew mother found a basket, waterproofed it,  placed her son inside, and gently sent him down the river.  Not long after, one of the Pharaoh’s daughters caught sight of the basked and retrieved the young baby.  She eventually adopted him into the royal family and named him Moses (Exodus 2:1-10).  This is the same Moses who grew to be an important leader, a prophet, and a faithful servant of God. It's a story about a child being rescued from certain death, a story of God's providence, but also a story of the compassion and care of this Princess. 

Clairia, months into her care.

At the same time that Moses was in the NICU, there was an 8-year-old with a terrible bone infection recovering in our surgical ward.  Clairia had been in the hospital for many months at this point and had endured several painful procedures and surgeries.  I had gotten to know Clairia and her mother quite well after spending time visiting and playing with Clairia each day.  It’s common here to refer to women as “Mama “ + the name of their oldest child. I admired Mama Clairia. She was quiet, gentle, patient and faithful.  She was right next to her suffering daughter every minute of the day, holding Clairia down during painful dressing changes with tears in her eyes, and comforting her in quiet whispering and prayers.  

Finding joy in the midst of pain.

Learning how to walk again.

When I explained to Mama Clairia that we had a 2-day old baby with no one to care for him....there was not a moment of hesitation.  She said that if she could remain in the surgical ward by her daughter’s side, then she would be happy to care for Baby Moses.  Now she not only cared for her sick daughter but for a newborn.  She never complained.  She never asked for anything.  She had spent months in the hospital, away from her home, her husband and her other 4 daughters, and now cared for a newborn. Yet she was content. I have learned so much and still have so much to learn from this faithful and beautiful, strong and quiet woman.

She treated Moses like only a loving mother could. Changing him, feeding him, singing softly to him, whispering in his ear. Burundian culture has a special ceremony for the first time a baby is tied to its mothers back (where it will spend the majority of the next year!) I had the privilege of being there when Mama Clairia tied Moses on her back - caring for him as her own.

After spending 6 full months in the hospital, it was finally time for Clairia to leave our hospital and return home.  Before they left, Mama Clairia came to me and explained that she, too, was an orphan.  She told me that she believed Moses was still far too young to leave in someone else’s care, and that she really wanted to continue caring for him in her home. She told me that if she had to give him up, that her heart would break.  Moses was 3 months old when he finally left the hospital grounds for his first time ever and got to go home....his new home.  

Giving Moses his last bottle before he left the hospital

Finally going home

Every Friday I have the privilege of seeing sweet Baby Moses, as his foster mama brings him back to the hospital to collect more formula that we have been providing for him.  He is growing and thriving...and is loved.

A few weeks ago, our family ventured out one Saturday morning to find the home of Mama Clairia and Baby Moses.  Even though we took someone with us to translate who was born and raised in this area, it was still not really possible to understand directions. So we arranged to meet her at the closest road. She jumped in the back of the truck (with Moses on her back) and lead us the rest of the way.  We followed a series of small dirt paths, each getting consecutively smaller until finally, the Land Cruiser couldn’t fit anymore. We parked the truck there on the footpath, bananas on one side, coffee bushes on the other, and followed Mama Clairia to her house.

Mama Clairia's home

Their home was a small, mud-brick home, with a neatly swept dirt yard surrounded with a fence of woven sticks. We ducked through the short door, to be greeted in the one room. It was maybe the size of our girls' bedroom. But instead of housing two girls beds, their clothes, books and space to play - this room was everything. This is where the eight of them sleep, where they eat, and where the girls do their schoolwork. There is a small room off the back of the house for cooking and a little hallway that connects the two spaces, which they use to store a few hoes and small cook pots.

They gathered up enough chairs from neighbours so that we could sit in their neat, one-room house. They told us how happy they were to have Moses in their family. How the girls adored having a brother. How Papa Clairia didn't hesitate when his wife told him about the child. As we sat and visited they told us about their hope that Clairia will be able to return to school this fall, and how they hoped they could find someone to sell them milk for Moses. Like most families around here, they struggle to feed their children. They don't have luxuries like running water or electricity, and they work hard to just survive. Yet this couple was eager to extend what they had, to help care for this child who had entered the world in such dire circumstances.

Their family insisted in walking us back to the truck, and as we did Alma and Clairia ran up ahead. To see the two girls, my daughter and a  girl who had been immobile, in horrible pain, and sad for so many months, skipping down the path was a gift I can't describe. 

There are a lot of hard things here, and getting to glimpse just a little bit into the lives of Claria, her sisters, her mother and father, and her new baby brother help me to see that in a new light. Both the extent of difficulties, the depth of sorrow, the complexity of poverty - but more importantly the joy of hope, and the light of love. 

I don't know much about Egyptian princesses, but I find it hard to believe that Pharaoh's daughter had anything on this woman. Mama Clairia did not take in a child to care for in the lavish excess of a palace, but she truly sacrificed what little she had to take him in. She has no servants and attendants, and unlike Pharaoh's daughter, she doesn't send to find a woman to help care for the child. She walks all the way to our hospital every week. She cares for him. She literally carries him. 

I don't know how this story will end. In a place like Burundi, it really could go so many different ways. But what I do know is this woman, who grew up an orphan, who now lavishes care and love on six children has taught me so much. 

What sacrificial love it.

What true care for others looks like. 

What contentment can actually look like. 

Relating to John in Prison

(by Eric)

We beseech thee, give us that due sense of all thy mercies, that our hearts might be unfeignedly thankful.  -Book of Common Prayer

(if you want to read the context, you can read Luke 7:18-23)

Samuel van Hoogstraten (1627-1678)

Lord, I feel like John in prison.  He sent his followers to ask the question that burned inside him.  Is the kingdom of God really coming?  Is it really near?  Because this world still seems so incredibly broken, so unredeemed, so worn and tattered and heading inexorably towards death, not life.  Now that you've come, Jesus, are you really making all things new?  Are you really reconciling all things to yourself?  I can understand that I wouldn't see your final, perfected work right now, but this hardly feels like new creation at all.  So, go and ask Jesus, "Are you really the one who was to come, or should we be waiting for someone or something else?"  I know that I've felt, seen, and even proclaimed this myself in the past, but it's just terribly hard to believe right now.

So, his followers went and put the question to you.  Your response is telling.  In that hour, you healed sicknesses and handicaps.  You chased out demons, and you told the messengers to go and tell John what they had seen:

The blind see.  The lame walk.  Lepers are cleansed.  The deaf hear.  The dead are raised up.  The poor hear the good news.  And blessed is the one who is not offended by me.

What did John think when he received that news?  We don't know.  It seems that you wanted him to notice that the signs of the kingdom of God were bursting into bloom all around you.  It seems to be a way of saying, "No, John, you're not wrong.  See the evidence that God's kingdom comes in my wake."  I think that the reasons John was wondering in the first place was because he didn't see transformation on that larger scale that he expected, and likely in particular because of his own personal predicament of being imprisoned.  I can understand his sentiment.  

How did John receive the response of his followers?  Did he understand?  Was he encouraged?  Did he have more peace and faith in the days that followed in his prison cell?  Nothing ever really did change for him on a personal level.  He never got out of prison.  In fact, he was killed.

"John, have faith.  Trust me.  All things are not yet made new, but there are signs.  There are in-breakings.  There are first fruits, seals, down payments, promises of a bigger thing to come."  Let the signs give their witness and hang in there.  Can I do that?

The funny thing is that Kibuye, every day, is quite similar to Jesus' testimony.  Here, because of God, blind people see, the lame walk, and people with terrible medical conditions (including the occasional leper) are healed.  People that are all but dead are seemingly resurrected (the French call intensive care "reanimation"), and the poor hear and see the good news that God is near, offering life, both eternal and abundant, offering forgiveness, offering adoption into his family.  It's easy to imagine someone coming to visit and having the type of encouragement that it seems Jesus is wanting to give John.  "See the signs!  It's real!"

But I see all the rest, as well.  Emelyne is only 14, and she is so suddenly on the brink of dying.  Emmanuel shouldn't have to die, and yet I fear he will this very day.  Floribert and Pascal are the same.  The lame man who had a terrible stroke is likely to remain lame just to go home and get bedsores and die.  The blindness from meningitis is not getting better.  Poor patients who suffer and die because they are poor in a poor country.  Broken systems with decisions that impede even the little that we can do.  Fractured relationships in families and friends.  Misplaced hope and desire leading to depression.  Broken connections to God, to ourselves, to each other, to our work, to the earth.  Sin.

The "signs" don't feel like enough.  The promise seems way too big for the signs to be adequately convincing.

Blessed is the one who is not offended by me.  ...who doesn't lose faith because of me.  ...who doesn't stumble on account of me.

Why did Jesus end his message with that?  How does one get offended by this?

Sometimes we might say, "Look, what I'm about to say to you is hard.  Please, don't get offended.  Rather, hear me out.  I know it's hard, but don't close your heart at the tough words.  Hear me out.  Don't lose faith.  Don't fall.  Hang in there."

I guess it's like that.  Jesus is admitting that it's hard, but he gives us an admonition to persevere.

I keep coming back to Paul Miller's description that we live in the desert created by the distance between our hopes (or promises) and the reality in which we find ourselves.  We can give up on the hope (and thus, despair).  We can give up on the reality (and become delusional).  Our we can dwell in the desert between the two, with one arm on each, feeling the tension pulling us apart at every moment.  The good news according to the Bible is that God always seems to be showing up in the desert.

"Have patience, John.  Trust.  Let the signs encourage you, if they will.  Maybe they won't.  But the promises are true.  Live in the desert for now.  Do what you can where you are.  The kingdom of God is coming.  I am coming soon."

Language and Great Laughter

(from Eric)

Language struggles are a part of our everyday life.  After many years, you become comfortable with French, but your patients only speak Kirundi.  The students can interpret for you, but not if they are from Cameroon, or not if the patient comes from Congo and only speaks Swahili.

Yesterday, I had a patient who struggles with language.  She is 43 years old.  Through the help of my student interpreter, I learn that, a few months ago, her speech started to become harder to understand, and this gradually evolved to where she can now only grunt.  She can understand Kirundi.  She can write without difficulty.  But she cannot pronounce anything.  She also cannot swallow.  Jason put a scope in her esophagus and all looks structurally fine, so he sent her to me with the idea of a neurological problem, maybe a mass growing somewhere in her brain.

It's hard to imagine what that's like.  To watch your ability to speak (in such an oral culture) slip away relentlessly.  I ask her to sit on the table, in order to check some other basic neurologic function in the face.  Fung'amaso.  I fumble on close your eyes, but she gets the idea.  Uravyumva?  I touch her forehead and ask if she can feel it.  Next, I want to see if her mouth muscles have any weakness, so I ask her to smile.  Now, in Kirundi, the word for smile (gutwengatwenga) is a form of the word for laugh (gutwenga).  Twenga, I say.  I think she understands what I'm asking, but her smile bursts into an embarrassed laugh.

Then she continues to laugh.  She puts her head down on her knees and laughs until tears run down her cheeks.  She can't stop laughing.  Her sister laughs.  The med students laugh.  I attempt a whole sentence in Kirundi: Uratwenga kuber'iki? (Why are you laughing?)  She looks up at me and bursts into a fresh round of laughter.  It's unclear at this point whether the roots of her tears are from humor or from sorrow, but somehow it's clear that there is joy in there, regardless.

This moment is a pretty good picture of our lives here.  I doubt we can find a diagnosis for her.  Even if (1) one of the three CT scanners in the country is working, and (2) she can find the $100 plus transport to get a scan, then (3) it is extremely unlikely that she could find anyone to fix it, even if we found something.

And yet, she laughs.  Her yellow teeth are bright against her dark face, and she makes me laugh.

There is sorrow, and in the midst of it, there is great joy.  And often, like yesterday, there is one of us random Americans in the middle of it, not at all sure what's going on, but finding the grace to enjoy the moment nevertheless.  In a nutshell, this is our life at Kibuye.

It could be better.  Yes, it could, and we long for redemption and for healing and for all the barriers that keep us from knowing each other well to fall away.  We long for God to fulfill his promises to save us utterly and completely.

But it could be worse.  I wish I could have helped this lady more, but I'm quite certain that, when she and her sister return home, and her family asks how it went, that along with more tears and more frustration, there will also be more laughter.  God's redemption and his grace are already at work among us.  They are the rip in the curtain that the light shines through.  These peals of heart-filled laughter from a woman who can no longer speak a single word are the first fruits of the fulfillment of the promises that God has given, and that he will, in the end, keep.

***

On a somewhat related theme (I feel like there is a connection here, and maybe you'll find it better than me), here is a great quote from Frederick Buechner's conversion (from The Sacred Journey):

And then there came one particular sermon with one particular phrase in it that does not even appear in a transcript of his words that somebody sent me more than twenty-five years later so I can only assume that he must have dreamed it up at the last minute and ad-libbed it and on just such foolish, tenuous, holy threads as that, I suppose, hang the destinies of us all. Jesus Christ refused the crown that Satan offered him in the wilderness, Buttrick said, but he is king nonetheless because again and again he is crowned in the heart of the people who believe in him. And that inward coronation takes place, Buttrick said, "among confession, and tears, and great laughter." It was the phrase great laughter that did it, did whatever it was that I believe must have been hiddenly in the doing all the years of my journey up till then. It was not so much that a door opened as that I suddenly found that a door had been open all along which I had only just then stumbled upon.

Heroes Come In All Sizes, or, How Guinea Pigs Exemplify Christ

by Carlan

[Trigger warning: this post involves a story about experimentation using animals. To skip to the spiritual lessons learned, skip down to "Heroines #1".]

Sherlock Holmes statue in London (courtesy: Wikimedia Commons)

I read the adventures and further adventures of Sir Arthur Conan Doyle's most famous character when I was in elementary school. If I learned one thing from Sherlock Holmes it was to be observant. So when we lost three patients in two days, only one of which I expected to die, I wanted to know why. Often we do not have enough information to accurately diagnose our patients' diseases and causes of death are no different. These cases were no exception. One presented very late with miliary tuberculosis (pretty sure of that diagnosis based on the X-ray), one had terminal renal failure and heart failure, and another had passed out after drinking too much on Christmas and started complaining of back and abdominal pain. Disparate cases, to be sure. But all had received Ceftriaxone within 6 hrs of dying (for concurrent pneumonia, urinary tract infection, and febrile diarrhea in the setting of leukopenia, respectively).

Could the Ceftriaxone injections be implicated in the timing of these patient deaths? A bad batch? A problem of labelling in the factory? Some toxic transformation while in transit or sitting on our pharmacy shelves? The imagination can run wild, but we needed data. One cannot make bricks without clay.

At my hospital in California, I could talk to the pharmacy committee and we might send a sample to be confirmed in a reference lab with mass spectroscopy and other advanced chemistry. In a land where 90% of the population farms without tractors or plows, that won't work. What would Sherlock Holmes do?

We could inject a healthy volunteer with Ceftriaxone and watch what happens. I could never ask a patient or colleague to consent to this, given that there is a risk that the Ceftriaxone was contaminated with a fatal poison, so I would need to be the volunteer. But wait...could a goat stand in the place of the volunteer? I would ask Silas, our chaplain who is also a veterinarian and pig farmer.

An experiment must have documentation.

Silas recommended we choose a more diminutive species. Could we find some "cobayes" to use? I did not know that word in French, so I asked about rabbits while looking it up in my dictionary. We have some rabbits on campus. That would be OK, according to my friend Silas, but we could probably find some cobayes even in the community around Kibuye. Alors! I found that word in the dictionary: guinea pigs. We have guinea pigs on campus too. I would need the permission from some kids before using their pets as guinea pigs for a science experiment.

Our multi-talented chaplain, missionary kid, and guinea pig "volunteers."

Heroines #1: our team kids. With a healthy amount of trepidation, a surgeon's daughter agreed that she could furnish three guinea pigs for this experiment knowing that it could save patients' lives. This pre-adolescent girl already had internalized the central ethical tenet that allows me to support animal research for healthcare - human life, as bearing the image of God, is more precious than animal life.

Heroines #2: those guinea pigs. As I was talking with this heroine, we both realized the connection between Christmas and these research subjects. They were risking their lives to save others. It might be a stretch to say that the guinea pigs were willing to die to save others, but they were standing in the place of myself and my patients so that we would not be exposed to a certain risk.

In any case, I'm glad to report that all three guinea pigs came through the process fine and dandy. Eliminating the impossible, I'm concluding that these patients died of their diseases and not our treatments. Thanks guinea pigs! Thanks intrepid missionary kids! But most of all, thank you Jesus, for absorbing not only risk, but wrath rightly deserved, for me and so many of our patients and colleagues.

Alive and well after 100 mg/kg of Ceftriaxone. Yay for guinea pigs!

Kibuye Christmas Pageant (video)

By Logan

Twice a week, over 150 chronically malnourished children, along with their mothers and perhaps a couple brothers and sisters, make the long walk to Kibuye to receive a cup of warm fortified porridge called Busoma and a small sack of the nutritious flour to take back home with them. 

Last week, they also received something else -- a special performance of the Christmas story by the kids of Kibuye Hope Academy. The children have been working very hard on this Christmas pageant for several weeks now — rehearsing during music class, as well as in French and Kirundi classes, and even working on their singing, dancing, or speaking lines after school let out. 

Under Julie’s direction, and with the added musical talents of Michelle Wendler, the kids sang songs, danced, and shared the message of the hope of Christmas with over 500 people at the hospital on Friday. Ella Sund told the story in French, and Anna Fader spoke in Kirundi. 

They first performed at the outpatient malnutrition Busoma program, then performed a second time in a courtyard adjacent to the hospital. I was rounding in the Pediatrics ward at the time that they were setting up for the second performance, and there was a rustle of excitement that went through the hospital. Everyone that was healthy enough went outside to see what was going on. Most of the patients on my ward (and therefore, my rounding team as well) decided to take a break from rounding and went outside so we could all watch the show. 

Here is a video I took of the second performance. Julie introduces the group and describes what they are going to present. Silas, one of the hospital chaplains, translates into Kirundi for her. After it is finished, she also shares the gospel in a simple way and invites anyone who wants to know more to speak with the chaplains. I am so proud of the work that the kids and teachers put into sharing the love and hope of Jesus’ coming with the hospital community. They scheduled two more performances this holiday season: one yesterday at the local elementary school (pic below), and finally at our local Kibuye church service on Christmas Eve. 

Here are a few pictures of the first performance at Busoma, and some of the second as well.  While I thought that they all did a great job, I was surprised to also find myself impacted emotionally as I watched first the angels, then the shepherds, and then the wise men, all bowing down before the newborn king of kings. Especially as they sang “Noel, Noel” in three different languages.  I thought about how we will one day bow before the throne, along with people from every tongue, tribe, and nation. 

And at the local elementary school yesterday...