Already and Not Yet

By: Erica Ause

One of the hardest parts about living in Burundi is learning to hold the hardness of life together with the beauty, joy, and love that is found here. 1 John 3:2 says, "Dear friends, we are already God’s children, but he has not yet shown us what we will be like when Christ appears. But we do know that we will be like him, for we will see him as he really is." Basically, while Christ did come and bring us Heaven after death, we are still waiting for when he comes again and brings the new heaven and new earth that will be without pain and suffering. It is the already, and the not yet and is our reality, whether we see it or not. But in this part of the world, it is unavoidable.

This past year I taught writing to an American boy who lives in Congo, and he expresses it well in a poem he wrote about his country:

Congo
Violent, Peaceful
Fleeing, Praying, Helping
Sad and beautiful country
DRC

This poem shows the understanding of a child that the world is not good nor bad. It is both at the same time. There is fleeing, praying and helping that exist together. There is sadness and beauty alongside each other. There is violence and peace in the same places. This 10-year-old boy encourages me to follow him in his acceptance that this is how the world is and to see both as equal realities.

A place that our team experiences this dichotomy most acutely is in the Hospital. I want to spend a little time sharing a little of what happens at the hospital where our team serves.

Some Background:
When the team arrived in Kibuye in 2013, there was already an eighty-bed hospital with about ten houses for staff. Now, the hospital has around 350 beds and there are about thirty houses for doctors This is a large change and has created more chances for doctors to be trained, to be given jobs, and for care of patients in and around Burundi. The hospital is connected to a university in Bujumbura, the largest city in Burundi. Therefore, many medical students come to Kibuye to do their internships needed for school. The services include OB GYN, pediatrics, urgent Care, Family medicine, ophthalmology, and surgery, along with food distribution, and courses for medical students taught by the doctors, discipleship and prayer. So far Kibuye has graduated around 310 African doctors since 2014. It is quite a large operation happening!
Below are some pictures of graduation celebrations, our team (+some visitors) moments of teaching and surgery. Everyone hard at work!

I asked several doctors here what the hardest and best parts are about the hospital. Overall, their responses reflected the simultaneous hope and suffering that I have come to understand over my year and a half here. One med student said that the best part is “when I get to see a patient happy because she was able to help them. But the hardest part is to see patients get worse and worse and to be unable to help them.” This is the already and not yet. Yes, there are some amazing things happening here, and people are healed who would never have had a chance without this hospital. And there are still people that die because the world is what it is.

One doctor told me that the best part is "watching a lady hold her first baby after multiple losses" and getting to be a part of that moment. The greatest challenge is seeing a patient whose illness you recognize, whose treatment you know, but also knowing the treatment isn't available in this country, and is too expensive. Yes, there is hope, but often it feels like there isn't enough.

I think the most notable line in the poem Congo is "Fleeing, Praying, Helping". Sometimes, the problems weigh so heavy that I do feel like fleeing, but really the answer is to pray. To pray that God would help us feel the sadness, see the beauty amidst it and move forward to help. This is an exhausting state to live in, but I wouldn't change it, because it reminds me how much I need to depend on God to help me live in the world we have been given.

I will leave you with an illustration. My roommate Jenny was an occupational therapist before she was a teacher. She has used this skill to love and work with the children in the hospital who needed help in that area. One child she worked with was an 8 year old girl who came in for malnutrition. When she arrived she could hardly sit up on her own, was very weak, and seemed to have some sort of mental and physical delay. Many people said that her situation was too hard and unknown, and that there was no way to help her. But God kept putting her on Jenny's heart, and every day she went to pick up this little girl, play with her, stretch and use her muscles, and try to make her laugh. Over the next few weeks, she started to walk on her own, to recognize Jenny, ask when she was coming, and get herself out of bed when she saw her walk into the room. She began to play, smile, and enjoy herself; all things no one ever thought she would be capable of. Jenny said a hard goodbye to this girl she had grown to love as she was releases from the hospital having made some improvements. Months later, this little girl came walking and smiling back into the hospital, all chubby and strutting like she owned the place. How good is our God!!
Telling you this story could go many ways, but what I want to highlight is how this miraculous story is an example of sadness and beauty, of already and not yet. It is representative of the healing that happened on this earth when Jesus brought the kingdom down. And yet, we are still not in the home we were made for. Just as this girl's healing happened in a hospital, which was not her home. We can only continue to pray that little Joy will grow knowing the Lord and eventually find her eternal home with our Lord and Savior.
Joy at the beginning of her stay doing some exercises with Jenny:

Joy when she came to visit a couple months later:

This picture has nothing to do with the hospital, I just love it a lot. These girls were SO EXCITED to have their pictures taken, they just couldn't control their giggles!

(It's also the only picture on this blog that I took, the others were taken by a number of different people in our community).

Please just pray for this place. For the people who live and work here, and for those who come to stay at the hospital! Thank you all for your ongoing support and care. Love to you all.

Press CTL+P to Print

Though the origins of this poem apparently date back to the 13th century, Benjamin Franklin famously quoted it in the preface to Poor Richards Almanack.  He added the line "A little neglect may breed mischief..."  It's an adage that frequently proves true for us.  Never mind the fact that entropy seems to work a little harder here... Machines that are broken often stay that way and projects get stalled all because a single, simple, part is missing.  Amazon Prime hasn't quite made it to our doorstep... and often replacement parts aren't even available or the problem we're facing is such a unique scenario that no affordable commercial solution exists.

Enter the world of additive manufacturing.  

While it may seem like something out of the future the idea of printing something in 3 dimensions is surprisingly old, dating back to a short story from 1945!  It wasn't until 1987 that the first commercially available printer was manufactured, but the cost ($350k at the time) kept it well outside the range of consumer use.  It wasn't until the 2010's that printers using a plastic filament (Fused Deposition Modeling) started to be produced at more consumer-friendly prices.  Today you can pick one up for under $200, though quality at that price point will definitely suffer.

As a graduation present for finishing my surgical residency my in-laws bought me this printer:

It travelled a long way before finding its resting place here in Burundi.  So how have I been putting it to use?  Well for starters there are some convenience items like this spice rack:

And some fun items like this catapult we printed for technology club:

And then there are the practical things, like the antenna brackets we use to optimize Wi-Fi signals over long distances:

These brackets have been in use for over a year and other than the steadily accumulating dirt and spider webs they're still working great.

While I wish I could say I designed all these things I've only just started dipping my toes into the world of 3d modeling.  Most of the above designs I found on Thingiverse, a collection of freely available 3d models.  More recently though I've had a couple projects where I couldn't find anything that suited my needs:

This little reflector wound up in a custom desk lamp I made.

After setting up the new hospital network, I've transitioned into working on a server which will eventually allow us to access digital x-ray images anywhere in the hospital.  It will also likely service our electronic health record whenever we decide to cross that bridge.  In this process I realized I was missing a bracket for mounting a couple hard drives in the system.

After a little design work and ~7hours of printing:

It's pretty satisfying seeing something go from design to functional product over the course of a couple days!  

While it's not quite as simple as pressing CTL+P to print it's proven super useful at solving some of the unique problems and challenges we face.  I'm already eying my next printer to speed up print times and expand the materials I can use to print.  Now to figure out how to get it here...

-Michael

New Teammates!

It seems like there are always comings and goings here at Kibuye, with the comings of course being more fun that the goings!  We wanted to take chance to introduce you to some of our new current/upcoming teammates.

First of all, we are really excited that after many years of prayer for an engineer to support Caleb Fader in his many crucial roles at the hospital, we were approached by an awesome couple that has been living in Bujumbura for the past few years.  Craig is a mechanical engineer and Vanessa has a masters degree in sustainable development.  They and their two young children, Wren and Bram, are currently raising support in the US and are hoping to arrive at Kibuye sometime in January.  If you'd like to help support them, click here.

Secondly, as we've posted about many times before, teachers are essential to our team's health and longevity here at Kibuye because they shoulder the majority of the task of our kids' education.  We have absolutely loved having our current three teachers here these past several years, and are thrilled to announce that one of them, Jenny Sorondo, has decided to stay on as a long term teammate and teacher.  She'll be needing extra support as well as she transitions from short term to long term (if you're interested, click here).  

Joining Jenny in fall of 2023 will be a new teacher, Meg Strickland.  Meg is currently teaching elementary school in Georgia and will be coming to work at KHA for two years.  You can support her here.  And finally, speaking of teachers, we are still in need of one more teacher starting in the fall of 2023 for (preferable) middle school ages if you or anyone you know is interested in hanging out with some totally awesome, fun kids (not that I'm biased).

And, while I'm mentioning new teammates, I also wanted to introduce Dr. Selina Thomas.  Selina arrived at Kibuye in June through the Samaritan's Purse Post Residency Program for two years (and hopefully longer!).  While we have had, and even currently now have, post residents serving at Kibuye before, Selina is our first primary care/non-surgeon.  She's residency trained in family practice, which means that she's very versatile.  We've enjoyed getting a chance to have her rotate around on our different services and she has been a great asset.  

Kibuye Pediatrics Video

By Alyssa

Thanks to the incredible work of Serge East Africa Media, we are happy to share this short video with you of the development of Kibuye Pediatrics over the last couple years! I love seeing the before and after shots of our new pediatrics building, and I also love that three languages and multiple Burundian and American voices are included here. Hope these images bring joy and encouragement to you today. Thanks so much to all who contributed to make our new pediatric building a reality! 

Click here to watch the video:

https://vimeo.com/755442280 

Kibuye Pediatrics Team

Photo credit for all photos in this post: Serge East Africa Media

A Kibuye Sabbath Poem

 (from Eric)

The day spins and the week whirls
and I am drawn again
to wrestle with the cantankerous back door lock
in order to walk out onto the back porch.

To look again on the line of trees

steady and long-suffering, 

though they bend constantly in the wind.

To hear the rustle,

bounding through the upper boughs

until they settle again exactly as they were.

To see the cedar and the bamboo and the hibiscus

planted as saplings by my friend

now reaching overhead and thriving,

rooted for the future.

In the shade of the porch roof,

the concrete is cool

unyielding and refreshing as an anchor.

The half-wall we built as a possible screened-in porch,

still open after many years,

and now a seat

on the edge of shade and sun.

The nearby bird-calls,

constant and so close,

yet I can never seem to find them.

The laughing dove, yes,

but this crescendo-ing call might be a chat or a shrike;

I'm not sure after all these years.

Domesticated mysteries.

Overlook them all your life if you wish,

they stand ready to be a source of wonder

whenever you would be open and quiet.

I return to the porch when the day roils,

to remember that it is,

and that there is something else.

The sunlight alternately dappled and matte

as the clouds move across a heaven so low

compared to the steadfast love of the Lord.

I return to be reminded who I am.

Where I am.

To see again a moment in a story

with a beginning and a flow and an end.

To feel again the warmth of the sun,

the brush of the breeze,

the crackle of grass at the end of the dry season.

To remember the textures, the layers

of unmerited glory that surround me

in the peace and the pain

of this given life.

A Creative Take on Passports

This year I have the privilege of teaching eighth grade for the first time, with two students who I had in class last year in 7th grade. These two are bright, kind, thoughtful, witty AND have had their feet in more countries in thirteen years than most people do in a lifetime. Their passports are well worn and full of stamps. One of my favorite occurrences in our classroom is when we are reading a novel or discussing a history topic and one of them pipes up with a big smile and says “I’ve been there!!”

Though there are many complexities in the life of a third culture kid, one that seems to come up often is the country of residence versus passport country conversation. In History this year we are tackling American Government, and that brings up the conversation of identity, what it means to have an American passport but having not spent significant time living on the continent stamped in gold on their passport cover. As we discussed aspects of their lives that feel American, English being their native language, some awareness (if not affinity for) American football, a love of Disney+ and Chick-Fil-A nuggets, there are others that come up that make them feel distinctly not American, like the fact that they greet neighbors in three languages, they have sat through 5+ hour worship services in one of the two languages that is not their first, they receive groceries in a basket on their doorstep every week, and they don’t have a cell phone at the age of 13. They talk about the fact that they know they aren’t Burundian, but they don’t really feel all that American either.

So, our first project in History class this year was to create a passport that felt like it represented their personal experience. Though we laughed at the idea of handing in a paper booklet at the Bujumbura airport’s border control, they both jumped at the opportunity to create a passport that felt individual to them. They designed the cover with colors or logos or designs that they feel represent who they are, they filled the inside with Burundian fabric and printed out stamps from the places they have been and the places they want to go. This week we hung those projects on our wall, so that as we study American government and we lose sight of why we study our country’s history when we don’t live there, we can look at a visual representation of who we are, colorful and bright and multi-cultural, also with the reminder that our true citizenship is in the Kingdom of God not in any Earthly country or region or continent. “But our citizenship is in heaven. And we eagerly await a Savior from there, the Lord Jesus Christ“ Philippians 3:20

Kibuye Construction Update

 (By Caleb)

It seems like it has been a minute since I've posted anything regarding current construction efforts at Kibuye.   In addition to one larger construction project we are doing a lot in the way of shoring up the basic infrastructure of power, water, and internet.  So here is what's happening in my world: 

Student Center

Typically medical students at Hope Africa University spend their first three years in Bujumbura in the classroom.  They then move up to Kibuye for their next three years doing their clinical rotations in addition to taking various courses taught by Serge faculty and others.  Many of these students come from Bujumbura and find that life can be a bit slow up here in our rural setting.  

A few years ago, Matt Lembelembe (an eMi architect) was here filling in for me while my family was on home assignment.  He was asked to design a student center that would house three main functions: a cafeteria, a library, and a place to relax and hangout.  Matt came up with a wonderful design and thanks to funding from AMH we are a few short weeks away from completing the construction.   I have no doubt that the students will really enjoy this space for years to come.  

The library will be on the first level and an upper terrace will allow the students to take in the beautiful view of the Burundian countryside.  

The building has 3 levels.  On the right will be the hangout area with couches, pingpong, foosball, and other necessities.  The middle section will be where food will be served. And to the left will be the library and upper terrace.  

The middle section where the students will be served daily meals.    

Matt incorporated some interesting architectural features like the way the roof is hidden behind a parapet and the fun stone work at the ends of the building.  

Increasing Solar Power

As our facility has grown, so has our power demand.  With large donations from IMF, AMH, and Southwest Medical Clinic we are currently in the middle of a large power supply upgrade project.  Once again our friends at ITEC have graciously agreed to help us with the design and implementation.  Our solar field will more than double from 122kW to 284kW.  We will also upgrade our batteries from outdated lead-acid to the new Lithium Iron Phosphate technology.  It has been a logistical mind-bender as the pieces to this upgrade have had to come from all corners of the globe: panels and accessories from Pennsylvania, inverters from South Africa, and batteries from China.  

In preparation for the ITEC installation team coming in January of 2023, we have been busy with preparing the solar field.  15 of our strongest men literally moved a mountain to create the exact 10 degree slope to the north and the space to install these panels.  We are now building the structure which will support the new panels for decades to come.   

Our masons getting the alignment of one of the support legs just right.  

The future site of the expanded solar field.

A view from across the valley of the new solar site as well as the new pediatric building and maintenance area.  

Water Expansion

Similarly, as the hospital facility has expanded our water demand has increased significantly.  We are currently in a the midst of a project to increase both the quantity and the quality of our water supply.  Land has been leveled and prepared for some large storage reservoirs which we will begin constructing this month.  We have installed hundreds of meters of new pipe to upgrade our water distribution and will also install a new ultraviolet disinfection system.   

The site of the new water reservoirs leveled and cleared and ready for construction.  

Network Expansion

In addition to being an amazing surgeon, Michael Harling also has a keen self-taught understanding of networking.  He, along with the hospital's two IT technicians, has taken on the project of expanding a stable network across the hospital campus.  This has involved a lot of hot and dirty work like climbing through small attic spaces.  As one can imagine, these efforts will be greatly appreciated by our medical and nursing students as so many essential resources for education and research are available online.   

Micheal and his eager assistants.  

Teaching Pediatrics To Interns in 3 Months: A "How-To" guide

(by Jenn)

Spoiler Alert! It's impossible to teach all of Pediatrics in 3 months.  Thie blog post is more of a recounting of how I have ATTEMPTED to achieve this difficult challenge.

Many of you have probably heard of the "Stage Professionnelle" program that we offer at Kibuye Hope Hospital, a 12-month long rotating internship for doctors who have graduated medical school who want more training before heading off to practice medicine. They spend 3 months each on Pediatrics, Internal Medicine, Surgery, and OBGYN afterwhich they receive a certificate of completion.  So during these 3 months on Pediatrics, we try to teach them as much as we can... this is how we have attempted to do it...

Alyssa had already started a curucilum based on a book "Blueprints" which is a guid for basic pediatric ideas. It's usually used by medical students on their Pediatric rotation in the United States, but thoguht it woudl be a good base for doctors here, as there was a short period of time to learn things.  The goal was to cover one chapter a week. 

Then I arrived in 2019 and was asked to be / volunteered to be (becasue it sounded fun!)  heavily involved in the education of these interns.  Here are the "steps" I've gone through in morphing this curriculum which is still in flux! 

• As one about to teach Pediatrics in Burundi, I took everything I ever learned in my Peds training and put it into a context of a developing country with low resources with diseases not commonly found in the United States.
• I started making powerpoints that fit the needs of what I needed to teach each week. 

• Little by little, I translated powerpoints into French. (because honestly my medical French was not that great. "Blueprints" is in English, and I needed to know how to say many of these things in our "work language" - French.) 
• I gave a 1-hour lecture per week for 3 months on 12 important Pediatric topics.  

                                                        

• After giving lectures for a few months, I realized that maybe I added too much of what I shouldn't have (minutiae regarding specialty labs, MRIs, etc which are difficult to find in our context), and not enough of what I should have (more on physical exam, treatments that are available here, etc). 
• Re-vamped lectures. 
• I gave these lectures weekly over 2 years during our first term.  I made small adjustments after each lecture, trying to taylor the learning time to fit the needs of the learners. I added in French articles from time to time on difficult subjects. 

We ask for feedback from our interns after they ahve completed the rotation and one time someone said they wished there were more clinical scenarios accompanied by questions about treatment so they could learn what to do practically. 

My residency program director in Greenville, SC noticed a long time ago that our pediatric board pass rate was not great for our graduates. She created a ciruculum where we would study a chapter or two in our huge Peds textbook, would have 50 take-home questions that we would have to answer and turn in, and also would have daily lecutres for one month pertaining to the subject for the month. 

This commentary and feedback from the intern along with the curriculum that I went through during my 3-year pediatric residency made a lightbulb go off in my head.  What if I try to do something similar with the interns here!?

Now, along with continuously altering my teaching style, powerpoints, and material, I am starting to write questions (and then translating them into French) that are relevant to our context but also teaches them things that they may need to know if they ever do a pediatric residency in another country.  I'm hoping that this will increase their willingness to study/look for answers and ultimately improve the care provided to children in Burundi. 

I love this part of my job and consider it a priviledge to teach these docs.  Now, back to writing questions and translating them ◡̈ 

Interesting Cultural Facts and Observations from Living Abroad

(by Michelle Wendler)

So after living on three different continents over the last few years and traveling pretty extensively, here are some observations.

1) Beauty is culture-specific. For example, here in Burundi, being heavy (fat, overweight) is considered beautiful. To compliment someone you tell them how fat they have gotten and describe the body parts that appear especially fat. To tell someone they are thin is a huge insult! (don’t ask me how I know this…)

2) Sealed off houses and climate control is more of an American thing. So far I haven’t stayed in one international house (hotels are different) that has climate control (like whole house heating and air conditioning). People open windows, use fans, or fire places (or portable heaters). This has very real implications in Burundi at elevation (brrrr. lately it's been getting down into the 50's F in our bedrooms at night) and in France when a heat wave strikes (sweltering).

3) Cold cereal options outside of America are: Corn flakes, and cocoa clams / flakes / balls. Basically I haven’t found many options outside of this in Europe or Africa, except Muesli, which is oatmeal with raisins or seeds mixed in.

4) Carpet is an American thing.

5) Wearing shoes inside a house is a big no no internationally. We have gotten so used to taking our shoes off when we go inside that when we were reading a book to Gabrielle the other day and it showed kids inside at the dinner table wearing shoes she couldn’t stop commenting that "they are wearing their shoes inside!“

6) Drinking a lot of water (like during meals, and carrying a water bottle or thermos around with you) is really an American thing. Here in Africa I hardly ever see people drink water…I mean I know they do….but I never ever see it. And at meals if I offer it, they will only drink after the meal is completely over but never during. In France, if you carry a water bottle around with you as you go shopping or walking you may get snide remarks like “are you a dog that needs to drink water all the time?” Oh and I should also mention that ice isn’t a European or African thing. They think it’s really unhealthy to drink something cold. 

7) Sleeping with head out of the covers (even babies and children) is not a Burundian habit. They think it’s so weird that we don’t sleep with our head under the covers. It makes since though…because that keeps them protected from mosquitos and other things that may be crawling inside the house at night. 

8) And finally, certain colors aren’t considered gender specific here in Africa. Pink, purple, red…flowers etc…men and women can wear these no problem. The brighter the better.