COTW: 6 years old

By Alyssa (written Sunday, Feb 21)

One of my first patients when I began work in Burundi over two years ago was a little 4 year old girl named Jeanette. She was unable to walk due to severe joint pain and she needed a blood transfusion. We diagnosed her with sickle cell anemia. Near the end of that hospitalization she began to walk again and recovered from that painful crisis.

 I decided at that point that I would like to follow up with her regularly and explained this to her mother. This was asking a lot of her mother as there was no known concept of regular doctor visits unless you were sick, and she had to walk many miles to come with Jeanette’s little brother on her back and sometimes carrying Jeanette as well. But she came. I consulted with some hematology doctors in the US on what we could do for sickle cell patients here and we did our best for her (and for our many other patients with sickle cell) with prophylactic antibiotics, folic acid, and pain medications. But Jeanette frequently was re-hospitalized with malaria, serious infections, severe anemia, and painful crises. You might recognize the below picture from the composite pic in our blog heading above. This was taken when she was 5 years old. 

I didn’t see Jeanette for many months after that hospitalization and I wondered how she was doing. She came back last week. Her mother was very excited to see me and said Jeanette had been asking if she would see me. Their financial situation had worsened so they had been unable to make the trip for her regular visits, but now Jeanette was sick again so they came back. I printed the above picture and Jeanette and her mother were happy to have it. Rachel mentioned that she saw the little girl carrying it around with her around the hospital while on her mother's back. 

But this time Jeanette was very seriously ill with shortness of breath, evidence of sepsis, and malaria. We treated her with our strongest antibiotics, quinine for malaria, oxygen and a blood transfusion. But after a couple days she wasn’t improving and she was no longer able to talk or move the right side of her body. She still greeted me weakly with a left-handed handshake on Friday morning, but it was clear she had had a stroke - one of the many possible complications of sickle cell disease. She died Friday night. Yesterday morning her grief stricken mother asked if there was anything that could be done to help with the hospital bill. She didn’t want to leave without paying but another family member was hospitalized as well and there was no money left to pay Jeanette’s bill. Thankfully we have a Needy Patient Fund for just such a case and we were able to pay her bill from that. The mother was overwhelmed with gratitude and expressed over and over how thankful she was for all we had done for Jeanette. I never know quite how to respond to such conversations - the precious little girl died, after all, what did we really do to help her? 

The translation of Jeanette’s Kirundi name is “I believe God.” And the faith of her mother who chose that name for her was very evident. Even in the midst of her tears of grief, she believed. And in observing her faith, I was reminded of God’s presence as well - even in the valley of the shadow of death. God is indeed the refuge and strength, an ever present help in trouble, for the families of the four young patients we lost at the hospital this weekend and for us as well. This world is broken and it’s not supposed to be this way. But it won’t be this way forever. And God gives more grace. “Jesus loves the little children…” and I’m thankful to know them and love them, too, in His strength. 

I close with one of our team’s favorite quotes which we’ve certainly shared here before but is apropos now:

"What about when the boy is not healed? When, listened to or not listened to, the prayer goes unanswered? Who knows? Just keep praying, Jesus says. Remember the sleepy friend, the crooked judge. Even if the boy dies, keep on beating the path to God's door, because the one thing you can be sure of is that down the path you beat with even your most half-cocked and halting prayer the God you call upon will finally come, and even if he does not bring you the answer you want, he will bring you himself. And maybe at the secret heart of all our prayers that is what we are really praying for.”                                          -Frederick Buechner

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 

Farewell, First Students!

by Rachel

About 25 months ago, we started work at Kibuye Hope Hospital for the first time.  Looking back, I’m pretty sure I didn’t have much of a clue what I was doing.  I didn’t know where to find things, how to get things done, who anyone was...and certainly not how to educate medical students in French.  But, despite that, one week after our start date at Kibuye, our first medical students arrived.  This was their very first clinical rotation.  Many didn’t know how to use a stethoscope, and when I asked if they had questions they wondered if I could teach them how to take a blood pressure.  I didn’t know how to say 50% of what I needed to say and when I’d try out a new medical term, they had no idea if it was a real word or not!  It was so, so basic.  I think those first three months we learned a lot from each other.  And at the end of their time with us, it was fun to see how much they had grown and learned.  I guess I had grown and learned a lot as well.

Fast forward two years, and this past week the same class was saying goodbye to Kibuye.  They came up once in 2015 as well (Eric and I were in the US though and missed seeing them) and now were spending their last 3 month block at Kibuye.  It was a pleasure to see students again and remember names.  It was nice to watch them care for patients in a competent manner and complete tasks they couldn’t have 2 years ago.  The longitudinal education we can provide here is actually really encouraging for me.  

The students threw us a goodbye/thank you party as they got ready to leave on Wednesday night.  They’re heading back to Bujumbura for the last 11 months before graduation, finishing classes and rotations, developing research projects, writing and defending theses, before hopefully graduating this December.  We enjoyed a delicious meal, kind speeches, lots of pictures, and several fun musical numbers performed by the class.  In my experience, Africans seem to do a good job “appreciating” people, and we felt very appreciated.

I am excited to see where this class goes in the next years.  It would be great to welcome some back to Kibuye as interns or doctors.  They will always have a special place in my heart as our very first HAU class.

Thoughts on Returning to Burundi

(from Eric)

Having accomplished the rare “just before departure” blog communication a couple weeks ago, I have been wanting to follow that up with some initial thoughts on returning to Burundi.

It is the rainy season here in Burundi, and today was a sunny day.  What that means is that the rains still come, but they come quick and sharp and are followed by period of bright equatorial sunshine.  Within a half an hour, the temperature drops fifteen degrees, and this has happened multiple times today.  As soon as the big dark clouds pass, the sun comes back out, and I take my jacket off.  Again.  I have some bread dough rising, and I have pulled it onto the porch and then back into the sunshine multiple times in the two hours since I made it.

It struck me that today’s weather is a pretty good image for what it’s like to come back to Kibuye.

After a long series of flights, we arrived ragged and exhausted to stay at a guesthouse near the airport.  I slept well that first night (having slept zero during the journey) and when I awoke, I heard birds.  It’s the sound of the year-round six o’clock East African sunrise, and I’ve grown to love it over the past six years.  I walked out onto the back veranda and saw palm trees and bright flours.  I heard the distinctive ibis call.  After a while, we wandered over to breakfast and had a scalding cup of chai and a mediocre (but distinctively Burundian) omelette.  It was all wonderful, and I realized how much I had missed it.

I’ve had a lot of moments like that.  The kids running around the neighborhood, playing outdoors for hours at a time.  The return of Friday night homemade pizza.  The green hills all around and warm greetings from friends.  I was walking up to the hospital in the rain yesterday to round.  I was carrying my umbrella, and a lady that I passed was hurrying along with a mid-sized banana leaf over her head.  They are the warm and sunny moments.

Yet there are other times.  On Wednesday, three out of my eight hospitalized patients died in the space of twelve hours.  For at least one of them, I kept wondering the entire next day whether I could have avoided his death if I had done something different.  One of the others was a young mother in her thirties, dying slowly from liver cancer.  We would go and see her every day, watching her waste away, being cared for by her ten year-old daughter.

The overall transition has been more than we expected, which is probably just a sign of misplaced expectations.  But much has changed.  It took several pretty full days to move back into our house.  We have met lots of new teammates.  There are some solutions to old problems, but now there is a whole new set of problems to navigate.  It felt like we had been gone a long time.  However, a couple weeks later, that time seems to be quickly shrinking.

I’m thankful for the cloudy moments as well.  Being back in the hospital has been a good reminder of just how worth doing this work is.  These problems are worth working to solve.  It is, in fact, a joyful thing to be able to be a part of it.  There is a lot of goodness happening all around us.  Yes, there are many things we have to put up with.  Yes, the power can go out for 3 days at a time.  Yes, I have to keep bringing the dough under the porch eaves, because it is raining for the third time in three hours.  But in the end, the dough will rise, and the bread will be made.  It may just need a little more time.

“The kingdom of heaven is like leaven that woman took and hid in three measures of flour, till it was all leavened.” - Matthew 13:33

COTW: Happy Visit

By Alyssa 

I was walking home for lunch on Monday when a lady stopped me to enthusiastically greet me and introduce me to her smiling toddler Desi who was running around in the grass outside the maternity building. She looked vaguely familiar, but I couldn't place her until she began to remind me of her story. Desi was born at 27 weeks gestation weighing only 900grams (2lb). Babies that small and premature don't generally survive here in Burundi. But she delivered at Kibuye Hope Hospital at just the right time in May 2014 and Desi was the first infant we placed in our new homemade incubators (designed and built by Jason Fader with the help of a Burundian carpenter). 

Desi at age 2 days

Desi at 2 weeks old - receiving IV antibiotics and aminophylline to prevent apnea of prematurity as you see above his incubator

Happy mother with 2 week old Desi

Anna nicknamed him "Baby Doll" as he was so tiny

Amazingly, against all odds, Desi thrived.

Desi at 6 weeks of age ready to go home from the hospital

I always wondered what happened to Desi. He was still pretty tiny at discharge (4lb) - did he succumb to an infection or to hypothermia? Did the mother have enough milk for him? Would he have long term complications from prematurity? 

It was a gift this week to see him at age 19 months happy and healthy and on track developmentally.

And I was so encouraged that Mama Desi (women are named here by their firstborn) wanted to visit the NICU and encourage the mothers there with their own 1000g babies who think the day will never come when they will go home. She stayed a long time there answering their questions and encouraging them while Desi ran around exploring the place where he spent his first 2 months of life. 

There aren't very many Desis running around in Burundi. Most babies born that early don't survive. In fact we unfortunately lost a baby this week born at 28 weeks gestation. But seeing Desi on Monday encouraged me and gave me hope for the future. As we tediously make feeding calculations and treatment decisions for the 11 premies currently in our NICU, celebrating each day's weight gain and each happy discharge, who knows what's possible? Thanks to all who helped develop our NICU here and who hope with us for more joyful stories like the gift of Desi. 

Holidays at Kibuye

By Alyssa

We've experienced quite the joyful holiday season the last month here in Burundi with many encouraging visitors and community events and thought we'd share some (actually many!) pictures of our celebrations.

 We all enjoyed the traditional drummers at a Ministry of Health sponsored event at Kibuye...

 especially Micah...

and Liam!

And what fun it has been to welcome many family visitors over the past month - and to take them all to the nearby waterfalls:

 including Jessica's brother Jeremy,

 most of the extended Fader family, 

and my parents. 

 Micah welcomed lots of guests for his 7th birthday party (above and below)

 And we gained three new pets (above left) and also enjoyed the nearby hot springs (above right)

 Lots of cousin fun!

Visiting the southernmost source of the Nile River. The visitors who previously lived on the Nile in South Sudan were especially interested in this tourist attraction!

 Christmas activities included singing in church, 

visiting the hospital to share the Christmas story and pass out donated baby blankets and toys, 

 a med student Christmas party, 

 a kids' nativity play, 

making gingerbread houses, 

 delicious meals together, 

 a white elephant gift exchange,

 smiling for the camera, 

a movie, 

and an ultimate frisbee game. 

 And there were lots of group games for New Year's...

...and the traditional ball drop. 

 Our team enjoyed being a part of two traditional dowry ceremonies over the holidays - always interesting to experience new cultural events and to honor our Burundian friends and colleagues by participating in and learning about these ceremonies. 

And we put our visitors to work, too! :) Our visitors have blessed us so much with their thoughtful questions, encouraging presence, and also their ingenuity and industriousness in jumping in to help out in so many ways including with the satellite internet (above), 

 photography opportunities, 

and teaching. 

And finally, we all appreciated the year end hospital party yesterday which was quite the community event! 

 Employees who have worked at Kibuye Hope Hospital 10 years each received a goat

 and those who have worked more than 20 years received a bicycle. In speaking with the employee who has been working here the longest (40 years), I was so interested to hear his perspective. He's seen a lot of changes over the years and is happy to continue in his work on the pediatrics' service. I'm thankful for his wealth of experience and that he and many others were honored at the ceremony yesterday. 

 The speeches were inspiring

 and the gifts much appreciated. 

 And of course everyone enjoyed the meal together. 

We're so thankful for our community here at Kibuye and look forward to many more years of holiday celebrations here with our Burundian and missionary neighbors!