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.

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."

Dollar Street

(from Eric)

Via the BBC, I happened upon this very intriguing site yesterday, and I feel it's worth passing on.  Anna Rosling Rönnlund started the site as a way to "visit" homes and cultures and families all over the world.  Numerous countries are represented, and they are ranked on the home page according to monthly salary (the lowest being $27/month, a lady in Burundi in a province south of us).  

The base page is here.

You can enter and tour everyone's home.  For instance the tour of the Burundian lady's home, including her awesome toothpaste storage technique and her even more awesome smile can be found here.

You can also sort the homes by various filters.  For instance, you can sort for "Places Where Guests Are Served Dinner" all across the world here, or "Jewelry" all across the world here.

As American expatriates living in Burundi, we live in a world of extremes.  Both the wealth of our home country and the poverty of our host country can be very uncomfortable.  In the past, when we've recognized these extremes, we've wondered what the "global mean" is.  That's not exactly the point of this website, but it does give some wonderfully diverse glimpses into the homes of the world.  All from the convenience of your home internet connection (if you have one.  =)  )

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! 

On Thievery and Treasures on Earth

(from Eric)

Two weeks ago, I was feeling like I had begun to get back on my feet.  Things had been going fine, but re-entering life at the hospital and the university after nine months away definitely left me with the impression of needing to dig myself out a bit.  There is just no escaping the accumulation of things that are waiting for you after such a period of time.

But it was going well.  I had just given a lecture that I thought went off well.  And now I was heading down to join everyone for a Chinese New Year party, where Grace was making dumplings, which are certainly a rare treat here in Burundi.  Rare and yummy.  I got there a bit early, and so I sat down and opened my laptop up (I had it with me since I came right from the lecture).  I put the finishing touches on a first draft of a new educational program and was quite satisfied with how it was turning out.

We had some dumplings (I might have had more than "some"), and then as it was getting dusk, we walked out to the field next to the church.  Our schoolteacher had miraculously procured a bunch of Chinese paper lanterns, and so for the next fifteen minutes, we were helping the kids get them lit and watch them sail off into the quickly darkening equatorial sky.  Of course, there was the usual gaggle of young male onlookers, especially since we were doing something so conspicuously odd.

When we were done, we said goodnight to the observers, and headed home.  About three minutes later, as I was carrying a tired Toby in our front door, it hit me.

I had set my computer down to help with a lantern and left it there.

I sprinted back, searching with my flashlight.  The computer was gone, and so were the gaggle of young strangers.  A swift multi-person search into the nearby area ensued, the local police took some details, and our good Burundian friend (who thought he had recognized a couple of those guys passing by) headed out into the dark hills to try and ask around.

It was my 6-month old MacBook Pro.  It is password-protected, with no power cable, and about 20% battery life.  I can't imagine what a rural Burundian is going to do with it (especially since Macs are utterly unknown in this country).  I offered a substantial reward.  Many friends were searching the hills for signs of its whereabouts.  It was even announced in church.

Two weeks later, there is no sign of it.

Coping with this has been a multi-faceted experience.  First, there are the logistics.  It's a substantial financial hit.  But we'll live.  I thankfully had a back-up from three weeks prior, but still I had done a lot in those three weeks, and I am still annoyed by discovering yet another document that isn't on the back-up.  It will be several months before I can get a new computer (though I'm borrowing an extra).

It was hard for a couple days to walk around and wonder at the people I was seeing.  Was this unknown young man the guy who took my computer?  Does he know who did?  It's not a very fruitful lens for the world around us that we are called to sacrificially love and serve.

One of our teammates' first concerns was that, if they caught this guy, he wouldn't be subject to undue punishment.  It's not impossible that local village punishment could result in him never being able to physically take anything ever again.  So, we pray for our enemies.  We pray for their repentance.

In a certain sense, I don't really blame whoever took it.  These folks almost invariably live on the brink of poverty and even starvation.  I am obviously wealthy.  The rich white doctor can buy a new computer (and in fact, I can.)  They might be able to easily sell this for (if they knew it's worth) three years of the average Burundian GDP per capita.  I doubt he went out that night with an intention to steal.  He didn't break into anyone's house.  He just seized an opportunity afforded by my mistake and distraction.

On the other hand, it's stealing.  It's not good for him, any more than it is for me.  And if he would do it to me, he might also do it to others, and those other people might suffer a lot more from it.  I've thought about this in the very gracious response from my Burundian friends.  They have really exerted themselves to try and find this computer.  I think that is because they care about me and value the work I do.  But also I think they don't like the idea of someone in their neighborhood who is willing to steal valuable things from other people when the opportunity arises.

In the end, there is trust.  God, I believe you have called me here to do this work.  Why have it hampered in such an unjust way?  I don't know.  When we don't know, we are called to trust.  Called to consider the possibility that there could be a reason beyond what we can figure out.  At the very least, we are called to keep going despite the setback, trusting enough to release whatever hesitations and unforgiveness are in our hearts.

"Do not lay up for yourselves treasures on earth, where moth and rust destroy and where thieves break in and steal, but lay up for yourselves treasures in heaven, where neither moth nor rust destroys and where thieves do not break in and steal.  For where your treasure is, there you heart will be also."  Matthew 6:19-20 

Teaching and Learning

(By Alyssa)

Sad to say goodbye to this great group of peds interns who have been working with me for the past 2 months. They have certainly made my job easier as they have worked hard, studied diligently, and cared for patients compassionately. And I was especially proud of them today as they rose to the challenge of teaching nutrition to our malnutrition service. Fifty to seventy patients continue to come to the hospital twice per week for our outpatient malnutrition program. These children suffer from hair loss, swelling, apathy, skin changes, and other evidence of both acute and chronic malnutrition. And in this country with extreme poverty and a falling economy due to the political situation, it’s hard to know how to teach the mothers about foods that are both nutritious and affordable. Most of the medical students grew up in the city in more affluent families, so it can sometimes be difficult for them to relate to our rural, impoverished patient population. But they related admirably today. They had previously researched what foods were available in the community and for what price and then they asked questions while they taught the mothers about the foods included in a balanced diet. Protein is the hardest food for these patients to find as was confirmed today. Only two or three mothers raised their hand when asked if they could buy eggs for their children (eggs cost 10 cents each) and few had access to milk. But many could buy the tiny salted fish that come from Lake Tanganyika, so that was helpful to discover. Peanuts are also readily available. The mothers asked questions as well such as whether to add salt during or after cooking or what kind of oil to use. It was great to see them engaged and responsive to the presentation. I do hope for more for these precious patients - more food, more education, more growth, more opportunities - but I’m thankful today for the hope for the future reflected in the medical students as they taught, learned, and cared thoughtfully in a challenging situation. 

Christmas Catalog: Feed Our Hungry Patients

(from Eric)

Once again this year, KibuyeHope.com is presenting an alternative Christmas Catalogue: ways to support the work and community of Kibuye as a gift in honor of someone during this holiday season.  Click here for the full list of this year's options.

We would like to draw your attention to one item in particular: Our hospital feeding program.  Similar to many hospitals in our part of the world, there is no kitchen or feeding program for patients hospitalized here.  Patients depend on their family to bring them everything to eat and drink.  Given the poverty and hunger of Burundi at baseline (Burundi was recently given the dubious distinction of "hungriest nation in the world"), this only gets worse in the hospital, resulting in even worse nutrition right when they most count on it for their healing.

So, the problem is more than discomfort.  It is wounds that don't heal.  Moms that don't have enough milk for their premature babies.  Kids who can't beat their otherwise treatable infections because their bodies aren't strong enough.  In short, it is the cornerstone of all we're doing.

For this reason, we are starting in 2015 the first hospital feeding program.  2 meals a day, a mix of "Busoma", a nutritional grain mixture already made on site here, and other nutritional staples available in the region.  How much does it cost to feed one hungry patient at Kibuye for a week, thus enabling the healing of their whole body?  $3.

A few suggested pricing options for Christmas ideas:

$3 - feed a patient for a week

$13 - feed a patient for a month

$40 - feed the entire hospital for a day

$100 - feed the entire pediatric service for a week

$270 - feed the entire hospital for a week

$425 - feed the entire pediatric service for a month

You guys are bright folks who have likely already figured out that you can donate any amount to get any permutation of the above numbers.  All you have to do is click here, and enter your dollar amount (where it may already say "$3").  Gifts are tax-deductible.

Thanks for thinking of Burundi this Christmas season.  We are convinced that there is no better way to support the work of this hospital and this community than to follow one of the simplest mandates we've ever been given, to provide food for those who are hungry.

Here is a video of Alyssa (done by Carlan) with some great information about malnutrition in our area and the Busoma community feeding program already in place (not to be confused with the hospital feeding program to be soon implemented.)

 

HopeBurundi/HUNGER from Kibuye Hope on Vimeo.

COTW: Buying Time

(from Eric)

Claudette was first admitted to the hospital 6 weeks after having a baby, just after the cut-off of getting "free" care from the government.  She had swollen legs and a blood pressure through the roof.  Her eyes were blurry.  She is 23 years old.  Her baby (as would be normal here) stayed with her, but (as would not be normal here) she was otherwise quite alone.  I believe she has a husband, but I never saw him.  We started her on some medicines, hoping that this was a weird late manifestation of a pregnancy complication, and that she would get better soon.

She felt better a few days later, and we discharged her.  She hung around, waiting for her family to show up and pay her hospital bill.  They didn't.  About a week later, still waiting, she got sick again, not having bought her outpatient pills either.  Blood pressure still high, this time with fluid in her lungs, making her breathing very difficult.  We admitted her back into the hospital and started her back on treatment.  We checked her kidney function, and found that she didn't really have any (in American units, a Creatinine of about 22, but in our units >1500, which makes it sounds even worse).  At this point her prognosis is getting worse.  The baby is still her only companion.  We don't have a hospital cafeteria (yet) and the other patients' families were helping her to find some food.

Somewhat against expectations, we pull her out of her crisis, tried to control her blood pressure a bit better, to protect what little kidney function is left.  Finally, she is stable, and we discharge her again from the hospital.

She waits some more.  No one comes.

On the day that we admitted her to the hospital for the 3rd time (due to another downturn in absence of appropriate support), a family member shows up.  They want to go home.  I don't blame them, but now is not the moment.  I know her prognosis is poor.  I know we can't change that.  I want her and her baby home, too, but I think if we wait a day or two, we can get her a longer stay at home before she gets home.

We're buying time.  Often, that's exactly what we're doing.  It's the reality of medicine in a mortal world.  Even if you "save a life" of an otherwise young healthy person, you're really "buying time", just more of it.

In a sense, that's what we all want.  More time.

For Claudette, for her baby, there's not that much we could do to buy her much time.  She needed dialysis weeks ago.  She needed intensive monitoring of her blood pressure and her electrolytes.  And she didn't get that.  But hopefully she got some time.  

And maybe we would all do well (since we are all in the same scenario after all) to shift our focus from the amount of time to the type of time, the quality of the time.  Time for Claudette to be at home.  Time for her to share in family meals.  Time with her baby.  Time for her baby to get week-by-week a little older, in hopes of doing better when Claudette is no longer there.

After a couple more days and a couple more discussions with Claudette and her lone family member, we sent her home, paying for her hospital stay from the Needy Patient Fund.  The fact that I haven't seen her now in a few weeks is potentially a good sign, but not necessarily.  But my time spent with her is, at least, a good reminder.  The importance of the time we have.  The importance of how we spend this time.  May it be well-spent.

On Being Rich, Part 2: New Houses and Goat Roasts

(by Eric)

The first of the McCropder families is in a permanent house.  We, the McLaughlins, moved in about 3 weeks ago, and have been loving the space and the sense of settling.  Thanks to all that have made this possible.

Celebrating my 33rd birthday in the new house.  (Yes, that is quite a couch.)

After several years of living in temporary housing (since we left our home in 2009, remember that saga?), the luxury of this nice house all to ourselves weighs on us a bit.  This is certainly added to by the poverty that is all around us.  We've written about these tensions before (and I'm sure we will again), but there is another side to that coin.

A while ago, we decided that, at the end of every major construction project (like a house) we will celebrate in traditional Kirundian fashion:  A Goat Roast.

Everyone takes the afternoon off, and all the workers get to sit down, rest, drink a Fanta, and enjoy a goat-based meal.  And, like every good African ceremony, no one can enjoy themselves unless there are several speeches made (a phenomenon inexplicable to us Americans).  So last Saturday, we hosted the first of these feasts.

Several workers getting the meal ready

Anna helping out, peeling boiled plantains

Five goats were purchased, and several crates of sodas.  The meal was rounded out by boiled and fried plantains topped with a tomatoey sauce.  Roughly 100 guys (and a few ladies) came to enjoy the food, the drinks, and the speeches.  I received a lot of applause for my line of "Nizeye ko, mu misi iza, tuzokwubaka izindi nzu, kandi tuzofungura izindi mpene nyinshi", which translates as "I hope that, in the days to come, we will build more buildings, and we will eat many more goats."

And that's kind of the point.  Not the goats, but the fact that our presence here has been employing over a hundred people steadily, some of them for close to a year now, and with the expansion projects of the hospital, I wanted to encourage them that we hope there will be steady employment for them for quite a while.

There are days that, from a development standpoint, it seems that one of the best things we do is just to live here and be (relatively) wealthy westerners.  There couldn't be a more uncomfortable role for us, but if you look, you can find signs of development.  More builders riding bikes to work instead of walking.  That guy is wearing a nice new shirt.  That other guy got glasses.  And these things weren't gifts.  It was a result of needed, viable employment, and in the process, needed buildings are built, and these guys provide for their families while increasing their skill level and work experience.  Here's the group (it's a bit hard to appreciate how many of them there are here).

So there is a lot to celebrate:  The comfort of a new home, the completion of a long process, the necessary help from a bunch of workers, and the steady employment of the equivalent of a decent sized village.  A good day.

At Our Hospital…

(from Eric)

At our hospital, there are a lot of bare feet.  There are also a lot of open-toed shoes worn by medical professionals.  Lastly, there are special close-toed shoes you can put on if you are going into the operating room.

At our hospital, there are sometimes goats.  Not big ones usually, but little black goats, inside the hospital grounds, skipping in between the buildings.  Someone is usually following them, to get them out.  But they are there nonetheless.

At our hospital, there is no parking lot.  This is because there are remarkably few cars.  Most people arrive at the hospital by walking.  If they cannot walk, they will sit on a bicycle, while their family pushes it, or maybe be carried in a hand-made litter with poles.

At our hospital, jeans are “dress clothes,” because they are fancy, I guess.  I’m not arguing.

At our hospital, the nurses will sit outside the pediatrics ward to work on putting a new IV in a child, because it’s simply not well-lit enough inside.

At our hospital, we needed to check a lady for protein in the urine, but we had run out of test strips in the lab.  Then we remembered that another patient of ours had bought some test strips for his diabetes (from a nearby town), and those strips checked both sugar and protein in the urine.  So our diagnostic plan for the day was to ask the second patient if he wouldn’t mind giving one of his strips to the first patient to check for protein.  He didn’t mind at all.

At our hospital, there are not many shops in the neighborhood, but you can buy scratch cards to add minutes to your mobile phone.  The story is that, a while ago, a certain woman was brought to the hospital paralyzed and then abandoned by her family.  In the face of this difficult situation, the hospital eventually decided to give her one of the private patient rooms, which is where she now lives, invariably in good spirits, earning her living by selling mobile phone minutes, 30 cents at a time, for honestly a pretty steep rate, but hey, she’s got a corner on the market.

Pretty much all of these distinctives are the result, directly or indirectly, or poverty or scarcity, and our attempts to live life in the face of it.  And there are disadvantages to each of them (e.g. there are reasons why US hospitals required closed-toe shoes), and if all goes well, I imagine some of these things will change.  

However, there is a humanizing informality about all these things, as well.  There is a redemption in the response to the scarcity that creates a home-ness, a sense of “our hospital.”

On Being Rich

(from Eric)

Every weekday morning, from 7:30-8:00, there is a hospital staff devotion.  Many of our hospital staff are pastors, since no pastor can afford to be a pastor full-time here, so there are no shortage of people to share.  One of the pastors, who is also an administrator, spoke yesterday on Jesus's story of Lazarus and the Rich Man (Luke 16), a somewhat thought-provoking and even disquieting story for many of us.  I didn't catch that much of it, since it was 100% Kirundi, but I did understand the first thing he said when he finished reading the story.  "This rich man...We are all of us rich men."

I think what he meant was that, because we have jobs or are students who could get higher education, we are rich men.  Never mind the lack of electricity in your home, the complete absence of means of transportation beyond a bicycle, and the occasional periods of hunger when your food supply becomes a bit insecure, you are rich in comparison and you know it.

And therefore we must identify ourselves with the rich man in this story and the warnings that go with it.  And that takes courage.

It doesn't take a lot of imagination to guess how such a statement would make us feel.  We are quite a bit wealthier.  Orders of magnitude, really.  We have been on an airplane.  Many times.  We occasionally eat out at a restaurant where one person's meal could be $10 or more.  We have laptop computers.  I personally have never, not even once, had to worry about being hungry as a result of not having enough money.

There is a funny little mind trick we often play on ourselves, which is to compare ourselves to those richer than us, even if that segment of the population is small.  Why do we do this?  It's because being rich feels uncomfortable.  We feel obligated in vague ways.  We maybe feel guilty.  I know this because I live in a place where it is impossible to avoid feeling rich.  I cannot read Lazarus and the Rich Man and feel comforted.  I have to feel challenged, because I am the rich man.

I would rather identify with the poor man and hear a simple promise of comfort that is coming, but I must admit that this is yet another way or neglecting the reality of the poor in our midst.  If I'm the poor guy, then I remove my duty to help the real poor guy.

It's easier to avoid this feeling in the US.  I can find wealthier people, and maybe see myself in the poor role.  And if I remember global statistics on poverty, I can use it as a moment to do a theoretical thought exercise to be thankful that I "at least have something" and "am not as needy as I could be."  But in the end, this is a mistake, a falsehood.  Comparing ourselves to a global standard is not an exercise to appreciate things on a relative scale.  It is rather the truest and most absolute way to locate ourselves on the scale of poor to rich.  But it's too much to bear.

I'm writing this now for two reasons.  The first is to share a part of our struggle, in our continuing attempt to describe a holistic image of our lives here.  The second is to encourage us all, as a first step, to own our role as the wealthy.  I claim no virtue in having done that, because here it is utterly inescapable.  However, I keep coming back to this as an essential first step in stewarding well what we have been given.  To deny it is to run from the whole question of how to own anything.  But maybe, if we can do this, we can see a bit clearer as our hearts and our minds try to figure out how to manage resources in the world that God loves and in which he has placed us.

First Impressions: Poverty

The blog silence for the last few days is largely a result of us not being sure what to say about beginning work.  Our own processing is so much still in process that it's hard to articulate anything to share.  It's a lot to take in, and one could slice it on any plane.  So I'll pick one aspect, not because it gives a comprehensive perspective, but because it might be adequately bite-size.  The good news is that we're not going anywhere, so if you keep reading the blog long enough, a holistic picture of life at the hospital ought to emerge sooner or later.

Taking care of patients here is hard.  We understand limitations, but we are all hit by a whole new level of limitations.  One of the largest of these is poverty.  This is not new, but it is at a whole new level.  According to GDP, Burundians on average make about 1/3 of what Kenyans take home.

Example:  Rounding on the medical service yesterday, and we see a man in his 50's with urinary obstruction.  We can determine that it's due to his large prostate.  That part doesn't cost anything (ask your neighborhood urologist why).  Jason can take his prostate out.  Great!  We can help this one.  Let's do it!

Problem.  There's a decent chance his urinary obstruction has made his kidneys function poorly enough to be dangerous for his surgery.  And actually hospital policy means he needs a few labs before going to the OR.  OK.  Our lab can check those!  Let's do it!

Problem.  It's too expensive.  It's probably at least $8 to get all those lab tests and he doesn't have the money.  His family is coming tomorrow.  Maybe they will have something…

This is an illustration.  In most other cases, the problem of the grinding poverty here comes into play right at the beginning, so they wouldn't make a very interesting illustration.

Poverty calls everything into question.  "Standards of Care" are almost always income-dependent.  Everything we know of such standards is therefore subject to drastic reevaluation.  This test for this problem.  This medicine for this benefit.  Is it worth it?  Well, what does this cost mean to you?  There is often no straight answer to this question, so it gives us a great sense of "shooting in the dark".  Was that the right decision?  I think so, but how can I know?

And this, of course, is humbling.  Or maybe humiliating.  Sometimes the difference is hard to tell.  And maybe not all that important in the end.  Humility (or maybe humiliation) seems to be one of the hallmarks of our clinical beginning here in Burundi, as it has been throughout our time of language learning.

It's not a new thing.  It's certainly not a bad thing.  But it's hard.  Pray for us as we go.

COTW: Appendectomy

By Jason

This is not a typical "Case of the Week" (COTW).  It is also not a case that occurred in Kenya.  I have been working here in Michigan for the last few months at a local hospital and this "case" has happened over and over again, which is one reason it is so remarkable. I will contrast it to an analogous situation in the developing world to give a sense for why it is so amazing.

It usually starts with a page from the ER - a patient has early appendicitis based on the CT findings.  Antibiotics are given.  The ER then transfers the call to the nurse in charge who calls in the Operating Room team - An anesthesiologist, a scrub nurse, a circulating nurse and a recovery room nurse.  While the patient is being transferred upstairs by a transporter person, I log in to the hospital computer system from my couch at home and look at the CT scan (which has usually already been read and reported on by a radiologist) and review the patient's medical record.  As I drive into the hospital, my preference card is pulled by a nurse in the operating room, which lists the sutures, staplers, scalpels, drapes, laparoscopes, needles, medication, ports, and even steristrips that I prefer.  These items are all obtained from the supply room and the room is set up.  I see the patient and dictate a note into the phone, which is typed up and can be reviewed within 30 minutes.  After the anesthesiologist and nurse do their assessments of the patient, we go back to the clean, well-lit, 68-degree operating room.  The patient is put to sleep flawlessly, and I make my incisions.  All of this - from the initial page to incision - routinely takes about 1 hour.  The operation goes well and all the equipment functions perfectly.  The patient goes to the recovery room and will usually be discharged home about 90 minutes after the operation ends. 

How would this go in Burundi, if the same patient showed up to Kibuye Hospital?  The patient probably wouldn't even come to the hospital until a few days later, so the appendix will likely be ruptured.  No CT scan for diagnosis...there is not even an x-ray machine at this point.  Hopefully the phone lines are working, otherwise someone is sent to our house with a note to request me to come.  The single room ER is staffed by a medical student and a nursing student, who are seeing a couple other patients concurrently.  Through them translating, I would get the patient's story and decide how to proceed.  I might try to do an ultrasound, but I am certainly  no radiologist.  We would transport the patient to the Operating Room ourselves and prepare the patient.  I would try and find some suitable suture among some expired donated supplies or low-cost substitutes from India and find a sub-optimal set of instruments which have been sterilized in a pressure cooker over an open fire.  A nurse with no formal anesthesia training would give the patient Ketamine - an anesthesia drug which is primarily relegated to veterinary use in the US.  The patient might be given oxygen through the only machine that can provide it in the whole hospital.  The electricity may or may not be on.  It went out 12 times one recent afternoon.  If it goes out, we will operate by flashlight until someone can power up the 40-year-old generator.  He will be transferred to the ward, where 1 nurse is taking care of 15 or more patients.  The patient will probably do OK, but will remain in the hospital for about 5 days for further antibiotics. 

The differences are astonishing.  No doubt the mortality of such a procedure is 10 or 100 fold different between the two settings...that is, if the Burundian patient manages to get to see one of the 9 surgeons in the country.  May God continue to allow us to play a small role in rectifying this situation through training quality doctors and nurses.

Sutures at hospital in Michigan

Sutures at Kibuye