COTW: Continuity

 by Rachel

When we moved to Africa to begin practicing medicine, there were several things that I knew I was giving up...some not so hard to say goodbye to (electronic medical records and litigation!), and some, like a wide range of medicines and technology and support services, more so.  One sad thing to give up was the idea of patient continuity.  I really enjoyed the chance to develop a relationship with a woman during the course of her pregnancy and deliver her baby and even follow up in the subsequent years (of course, residency was only four years long, but I still had some special patients during that time).  Here in Burundi, continuity is a challenge.  I function primarily as a consultant--I don't do normal pregnancy surveillance and almost never do deliveries except for C-sections.  Women come with a problem, I give advice and treatment, and then almost never see them again.  When I do, it's a rare gift.

When we returned from the US in 2016, there was a patient waiting for me named Odette.  A colleague had done an ultrasound in my absence and found what looked like an abnormal pregnancy.  I repeated the ultrasound and found a normally developing pregnancy, her first, but also a huge fibroid, more than 10 centimeters, filling up the lower portion of her uterus.  She came back many times in the following seven months for ultrasounds.  She rarely spoke but her husband and I conversed often in French.  In my head, I continuously ran through all of the potential complications that were awaiting her.  But lo and behold, she arrived at term without incident and we delivered a healthy baby boy by C/S.  I asked her to come back 6-8 months later and we removed the fibroid.  I thought that would be the end of the story and our relationship.

But then again she returned, now in the spring of 2018, with another pregnancy.  Her uterus looked perfect, but given the two surgeries, we scheduled another C/S and I performed it just before a scheduled six month in the US.  And now, just a few weeks ago, she came with her third pregnancy, already in the final weeks.  I performed a C/S on Tuesday and delivered her third and final baby.  It was oddly touching to me to be able to safely bring all three of her children into the world.  I don't know if she ever realized how remarkable that was.  She and her husband don't even live in our health district...they come from another province in the country.  So many women never show up for their scheduled surgeries, or labor begins too early and they deliver elsewhere.  I take vacations occasionally (!) and spend six months out of the country every few years. But everything lined up perfectly in this case.  

I didn't take any pictures...I always feel oddly awkward about taking pictures of my patients...but I will certainly remember the privilege given to me by Odette and her family. It's a small but tangible reminder of God's provision and a giving back gift of grace to me, even of the small things I feel like I've given up for His service.  

Post-Graduate Interns: A Major Highlight

(from Eric)

One of the perennially funny things about blogging is how you can look back and notice how you've missed something major.  Such is the case for our post-graduate internship program.

A reform in medical school curriculum back in 2011 set the roadmap for graduates from Burundi to follow medical school with a one-year post-graduating "rotating" internship (meaning that they rotate through several different specialties during this year).  This is what is done in other countries in our region, and what several of us help to supervise when we lived in Kenya.

The program hasn't yet begun on a national level, but many doctors will go somewhere in the country for something similar but less formal, called in French a "stage professionnel".  Many of our graduates have expressed interest in more training after graduation, and we have been eager for several years to take young doctors through a more formal and intensive "stage professionnel", following the model of the internships to come.

After several years in planning, we started this program on May 1, 2019.  We took eight doctors, and later expanded to twelve.  They spend 3 months each on Internal Medicine, Surgery, Pediatrics, and OB-GYN.  They take lots of call, and they see patients in clinic.  They have weekly lectures and reading assignments, and they have been a big part of a weekly doctors' bible study.  Because of their dedication, they have, in many ways, been the heartbeat of the hospital these last several months, and we are so thankful both for them, and for who they are becoming.

Several of the "stage professionnels" with "Papa Banks", their fearless leader

Last night, we all had a dinner ceremony together to celebrate the end of this program for the first five doctors.  Since these five all went to medical school at HAU, we have known them since their very early clinical rotations as a student.  We got to see them progress steadily towards graduation.  Now, we have seen them grow tremendously this year into true colleagues.  It is a delight to think of them going out to truly bless the population of Burundi with their intelligence, their hard work, their practical capacity, and their love for Christ and the people of Burundi.

Congratulations to Dr. Cesarine Nishimwe, Dr. Emmy Prince Ndengeyingoma, Dr. Moïse Niyuhire, Dr. Christian Niyoyitungira, and Dr. Olivier Hakizimana.  Thank you for trusting in a new program and for blazing a trail that many can now follow.  May God bless you and guide you in the days to come.

Some pictures from last night's fête:

Five finishing doctors with their certificates

Eric and Dr. Gilbert (Kibuye's medical director) congratulating Dr. Prince

All but one of the current post-graduate interns

Video messages from those who couldn't be present

Cutting Madame Cynthia's awesome cake

Now we look forward to another year.  We have 6 doctors that are roughly halfway through the curriculum, and another six who began on May 1.

Holiday Giving: the Kibuye Feeding Program

(from Eric)

As we wrap up our time in the United States, several people have asked us about special needs for Kibuye during the holiday season.  Though you can give to many projects and missionaries that can be perused at serge.org (all of which are tax-deductible and will be used to a worthy cause), we'd like to highlight the Kibuye Feeding Program.

Burundi is arguably the hungriest country in the world per the Global Hunger Index.  They didn't have data to include Burundi in this year's ranking (though they have recently topped it), but they still note Burundi as the country with the highest rate of kids who don't reach the full height potential due to nutritional "stunting".  We learned early on that malnourished patients don't heal, and thus, in 2015, Kibuye became the 2nd hospital in Burundi to feed their patients, a move which, thanks to dedicated staff and generous donations, transformed our ability to bring health to our population.

Also included in the Feeding Program is a twice-weekly Busoma (the multigrain nutritional porridge manufactured on the hospital campus) distribution program for identified malnourished children in our community.

These programs combined cost about $6500 per month, which purchases about 20,000 patient meals and supports the nutrition of about 250 children and their families at home.  So, please pray for provision for this program and consider giving to it.

You can easily turn this gift into an alternative Christmas present by dedicating a gift to someone.  Here are a couple ways to put the numbers together:

• $8 feeds a hospitalized patient for a month
• $10 feeds a malnourished child in the community for a month
• $56 feeds the pediatric ward (and their moms) for a day (during the busy season)
• $135 feeds all the hospitalized patients and their caregivers for a day
• $312 feeds all the malnourished children with Busoma on a given day who come to the twice-weekly program
• $1700 feeds the pediatric ward (and their moms) for a month
• Be Creative and mix these numbers as you will!

Burundi Feeding Programs three logos: Serge/Hospital/Friends from Radio Friendly on Vimeo.

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.

Lesson Learned from African Roads

(from Eric)

Stephanie wrote a while back about their misadventure on Burundian roads, but after our past weekend, it seems that there is (perhaps unfortunately) more to share.

Our family is heading back to the US for a spell in about six weeks.  As Rachel and I thought about it, we weren't at all sure that our kids had even gotten in a car since early January.  Such realizations can give one a bit of cabin fever, so we thought we'd have a family weekend down on a beach resort on Lake Tanganyika.

The drive down was three hours, one of which was on Route Nationale 16.  Here is a picture:

Lesson 1:  Even though something carries a national highway designation (and there isn't a level above this, though many roads are nicer) you cannot make assumptions.  

And a GPS on your phone is invaluable, but there should be limits to the extent you trust a road that you have not yet seen.  But we arrived safe and sound, and were treated the following morning to one of the loveliest rainbows we have ever seen.  

Lesson 2:  African beauty is all around us.  Getting out can help us to see that, and we need to see it.

The kids wanted to do nothing else but swim.  We splashed and floated and played.  We applied sunscreen liberally and then reapplied in an hour.  And we promptly got burned.

Lesson 3:  White missionaries in equatorial Africa are among the pastiest white people you will meet.  

It's a little difficult to explain exactly why this is the case, but it is undoubtedly true.  Maybe it's that we take the perfect weather for granted too often, or the cultural norms that cover most of your body most of the time.  I don't know.  But the combination of pasty whiteness with the intense equatorial sun means that there is nothing that you can do to sufficiently protect yourself.

Two mornings later, and we're ready to head back to Kibuye.  Despite being in the full swing of rainy season, our time at the beach was rain-less.  Until we got in the car.  Right around the time we hit RN 16 in all of its unpaved, rutted glory, the rain starts falling.  We made a game of it.  Whenever a particularly hairy section was coming up, we would tell the kids that we could do this only by "grunt power".  Everyone in the car would then grunt loudly until we cleared the present obstacle.

About two miles from the end of the bad road (and about 1 hour from Kibuye), we came face to face with an obstacle that no amount of grunting was going to help.  A river was running across the road.  It was solid water for about 30m across, and we had no idea how deep.  The river was swift.  We stopped at the edge and studied it for a while.  A couple guys with bicycles waded through the downpour.  At least where they stepped, it came up to knee deep, and threatened to knock them over.

I forgot to take a picture.  Luckily, on returning to Kibuye, I found a picture of it on google images.  Here is RN 16 at the moment of our encounter:

Lesson 4:  Hold your travel plans loosely and prioritize safety.

After considering our options for about 20 minutes, we decided that this wasn't going to work, and proceeded to travel back on wet, bad (and increasingly dark) roads for the next 4 hours in order to get to the capital city, where our very gracious friends the Guillebauds put us all up for the night at the last minute's notice.  Yes, we wanted to get back, and yes, we needed to get into work the following morning.  But sometimes things happened.  

On the flip side, our trip back down the mountain did get us another stunning view (during a brief pause in the rains, see Lesson 2 above).  The hills of Burundi followed by the largest lake in Africa, followed by the Congolese mountains.

So, this morning, after more than doubling our trip the day prior, we drove another three hours back to Kibuye, where we were delighted to be home.  Six weeks until we get in a car again?  Definitely doesn't sound too long.

Lesson 5:  The quickest way to solve your African wanderlust/cabin fever problem is just to go somewhere.  Anywhere, really.

***

As a final aside, whenever Rachel and I travel, we are struck anew at the difficulties people undergo to seek care at Kibuye.  Burundi is a small country (about the size of Massachusetts), so to say that every week we get patients from every province in the country, that doesn't seem like too big of a deal.  But it is not a uniformly accessible country.  The areas that we were slogging through were the provinces and communes that usually elicit a "well, that is a bit far" response from me when I think about my patients.

Lesson 6:  Good roads are not just a matter of convenience.  They save lives.  Take a moment and thank God for the roads that you have.

Beautiful Burundi

(from Eric, with help from everyone)

Burundi, like anywhere else, is a mixture of brokenness and beauty, of glory and shadow.  And this blog has told its share of tragedies.  Today, however, we'd like to honor the goodness and the wonder that is around us in Burundi, country of a thousand hills, country that reflects the glory of its Maker.

So here's a feast of photos that we've collected over the years.  There are two focal points here.  The first is the beautiful green landscape.  The second is the beautiful people of Burundi.  Over the years that we have been here, the people of Burundi have been examples to us of joy, love, enduring forgiveness, hard work, undying hope, intelligence, and great kindness.  We have seen faith and self-sacrifice that we pray that God will enable us to emulate.

Voilà!  Beautiful Burundi:

In Memory of Sylvestre

(from Eric)

The Kibuye Community lost a friend and colleague two weeks ago.  Sylvestre was easy to recognize at the hospital.  He worked in the finance department, and he moved in a wheelchair.  He was generally quiet, but could surprise you with good French, and flip into Swahili and even English if needed.  All this showed that he was a man with quite a story to tell, though he wasn't one to bring it up quickly.

When we first moved to Kibuye, Sylvestre was actually living in a room across from his cashier's office.  He moved out in 2013, when he got married.  He and his wife Violette then had two little girls.

About a month ago, he was brought into our Emergency Room with persistent fevers.  What followed was a month of trying to offer him the best we could.  As it turns out, rural Africa is a hard place to be paralyzed, for reasons that extend beyond the lack of smooth roads for your wheelchair.  We eventually found the source of his extensive infection.  It took a while because of his lack of sensation, and by the time we did, the infection had gotten a crucial head-start.  Despite lots of surgical and medical interventions, he slowly deteriorated, and finally passed away at the age of 43.

At his funeral, his brother-in-law gave a short history of his life, which I had some friends translate for me:

Sylvestre was a local kid, from another rural area that abuts Kibuye.  After finishing secondary school, he was attacked with machetes in the crisis of 1993 and left for dead.  Somehow he was brought to Kibuye Hospital, which was staffed at the time by a woman surgeon who cared for him and finally arranged for him to go to Kenya for more care.  While he was there, he continued his studies at a university level (and thus the Swahili and English).  They even said that he studied in the US for three years afterwards, (though we haven't been able to confirm that).  He came back and started working at the hospital in 2009, and was married in 2013.

Here are a few pictures of Sylvestre:

Sylvestre with his older daughter, from his FB profile picture

Another awesome FB shot with the humorous caption: "My souvenir from when I was in Scandinavia.  It was last week."  Was he ever in Scandinavia?  Certainly not the week prior, but maybe that's a reference to the photo? 

The pallbearers taking his coffin to the grave.

It's hard to watch a friend slip away, even harder when you are part of the team taking care of him.  Hard when you know that another medical system could have saved his life.  Now he is gone, and his widow and their daughters will go on.  His life, for all its tragedies, had much to celebrate.

And the story is not done.  Resurrection is our end.  He is now more whole than any of us.  We will see him again, and when we do, not only will his body be whole, but all of our linguistic and cultural barriers will be dissolved, and we will be able to know one another, even as we are now known by our Father who holds us always in his hands.

Kibuye Kitchens

by Julie

When people ask me what I miss about living in a developed country, my answer is usually: restaurants. I love going out, looking at menus, visiting local dives, trying new things, sitting in coffee shops. I love traveling to new places by soaking in the atmosphere of a restaurant – the lighting, the music, the smells, the sounds of sizzling coming from the kitchen. And ok, I’ll admit it, I like going out because it means I am not cooking or doing dishes! I finish my meal and someone magically whisks away the dirty dishes and I enjoy a cup of coffee and possibly a yummy dessert. Going out to eat has always been a treat, but since living in rural Burundi for almost a year, I have really come to appreciate the luxury of restaurants!

So what DO we do for meals here at Kibuye? Without restaurants or any prepackaged, frozen, or boxed food options, planning ahead is a must for every meal. I am definitely not a chef, but I have learned so much about cooking – and life in general – from the other women on our compound.
With limited ingredients available locally, these women amaze me in their creativity and “can do” attitudes! What they can prepare, some days without electricity or running water, is inspiring.

We all hail from different parts of the US, Canada, or UK, so each of us have different dishes that we cook to make our homes feel like “home”. For me it’s cornbread in a cast iron skillet when I’m homesick.  For Lindsay it’s the days-long process of making sauerkraut. Even with our different “specialties” and “go to” dishes, we all use the same basic ingredients, so there are some similarities in our weekly menus.

Breakfasts are usually oatmeal or zucchini bread, eggs and whatever type of fruit is in season. Bananas are plentiful and always a favorite! Very rarely someone will make a treat like donuts on a weekend, but ohhhhh, there is nothing better than biting into a piping hot homemade donut! Unfortunately (or fortunately?) they are very time consuming to make, so for the most part – we try and keep it simple.

All the Kibuye families seem to have the staple “rice and beans” at least one day per week. There is one type of bean produced locally and we all buy about 1 kilo dried beans every week. The dusty beans must be carefully inspected by hand before soaking because the bag is peppered with sticks, rocks, dirt and little bugs who love to burrow inside the beans. But they are very affordable, as is the rice. Many families have a big batch on hand not only for their family, but also to help feed the Burundian househelpers, gardeners, and night guards who help us with everyday life.

Another dish that appears almost weekly in most of our kitchens is pizza! Pizza has always been a favorite of mine. But I must admit I liked it because it was so easy. I could order right from my phone, wait about 40 minutes for the doorbell to ring, serve it on paper plates, and voila! Easy delicious meal with no clean-up!

Here in Burundi, “pizza night” is still just as fun, but it is anything but easy. If you have ever made your own pizza dough, you know it must rise, be rolled out, and placed on a carefully prepared pan. None of us have pizza stones, so most pizza at Kibuye is baked on a rectangular cookie sheet. We make our own pizza sauce from tomatoes grown locally, but Italian seasoning is not something you can buy here, so we have all packed some in our suitcases (or asked visitors to bring some with them!).

The cheese stands alone

We can purchase only one type of cheese in a shop about 30 minutes away. It is generic in its flavor, probably best described as a cousin to Colby or perhaps a very mild cheddar. So it’s not exactly mozzarella, but it’s our only option, and it works for us! Popular pizza toppings among the families are green bell peppers, onions, pineapple, and sometimes imported canned mushrooms or olives. Pepperoni is a rare treat from America that gets used only for special occasions!

Making pizza by flashlight

All meat, for that matter, is sort of a “special occasion” thing. There is a boucherie (butcher shop) about three hours away in the capital city, Bujumbura, but getting meat up the hill to us is no small feat. Someone from our team goes to Bujumbura at least once a month, and they may go by the boucherie, but there are many obstacles. The shop is not open on Sundays, and we tend to go to Bujumbura on the weekends. When we do buy meat, we put it in a freezer bag, which sits in a hot car for a few hours driving up the hill. We must put it in the freezer the moment we arrive at Kibuye, but often our refrigerators are without power for 12+ hours, so the meat may not sufficiently freeze quickly enough. I have unfortunately thrown out more precious meat than I would like to admit, so we have learned not to buy that much, and don’t depend on having meat a lot. The whole compound is either full-time or part-time vegetarians, by necessity if not by choice.

We make sure our families are getting protein from non-meat sources, but this highlights one of many reasons there is so much malnutrition in Burundi. If our families, who have refrigerators, electricity, cars, and money, struggle to get protein into our diets, imagine how much more difficult it is for the average Burundian to incorporate meat into theirs!

Some Burundians might periodically buy a goat kebab, or brochette, sold at a local stand in our village. They are really tasty, and it’s fun to watch them cook, but you need to buy them on the right day, at the right time, if you want good meat!

Some days I can allow my mind to drift away to large grocery stores and cool restaurants. I can even feel sorry for myself at times that I don’t have everything at my fingertips like I used to. And yet, when I look around me, it seems almost ridiculous the amount and variety of food that I do eat here compared to the Burundians we see every day. It is a paradox. In some ways we feel like we “do without”, but we know we also have much more than is necessary. So this is what we grapple with. Even food reveals our sin nature. But we carry on, being thankful for what we have and letting ourselves splurge on occasion without guilt.

We appreciate your prayers as we daily face the severe poverty around us, wanting to help, but wanting even more to help empower the future leaders of this nation to care for their own. Pray for our families. Pray that our homes and dinner tables will be places of peace, laughter, and thankfulness.

And if you ever come visit us in Burundi, you will have the opportunity to taste African rice and beans and goat brochette from the village, but you may also be surprised by the culinary creations you will find in any of our homes!

Bon appetit! 

COTW: The Continuing Story of the Kibuye Triplets and the New Peds Building

(By Alyssa)

I’d like to introduce you to one family who will benefit from the new peds building (click link to see a 3 minute video). Some of the long time blog readers might remember the story of the triplets who Eric wrote about 2 years ago.

Well, the two remaining triplets are now 2 1/2 years old and they’ve been hospitalized three times on the malnutrition service - spending months of their lives at our hospital. 

October 2015 (10 months old)

Their mama understands what nutrition they need and does her best to care for them at home, but repeatedly she watches them become thinner and sicker, and finally she decides to take the arduous four hour walk to our hospital carrying both kids. I recently read a study highlighting the high (20%) mortality rate of twins in sub-Saharan Africa - three times that of non-twins - and that includes countries with much better infrastructure than Burundi. So it’s easy to imagine that the mortality rate of twins or triplets in Burundi is much higher. We always have several sets of twins in the hospital - usually premies in the NICU and kids on the malnutrition service. It’s so hard for mothers who are also malnourished to have enough milk for two babies at once. 

One of the twins with Anna in April 2016 (16 months old)

Eliana (left) and Rita (right) are both 2 1/2 years old!

So for Emery and Rita it’s two steps forward and one step back - especially this month. They were doing great and ready to go home (though still only weighing 10lbs and 13lbs) but I wanted them to stay in the hospital a little longer so they could learn to walk with Judith and Anna through some intensive physical therapy. 

May 2017 (2 1/2 years old)

Learning to stand

Emery learning to walk with Judith

I regret that decision now as they both caught serious infections in the hospital partly as a result of our overcrowding and they almost died. Praise the Lord who healed them one more time! They’re thankfully heading home once again now, and the mother will continue the physical therapy at home. But I look forward to the day when we will have a new pediatric ward with enough beds for each patient and a dedicated play room to help with the development and sensory stimulation for these kids. And I hope that when patients are no longer sharing beds, that the risk of them also sharing infections will decrease dramatically. Please pray with me for Emery and Rita and the many other patients we take care of with severe malnutrition and pray for God to provide the funds for a new well-lit, clean space in which to care for them. 

Going home in June 2017, pictured with Anna and Abi Fader