Sliding Down Mountain Roads

(by Stephanie)

“What about driving down the road at sixty-five miles per hour, only a few feet away from cars going the opposite direction at the same speed? Someone would only have to jerk his or her arm and you would be dead. I don’t think that’s morbid; I think it’s reality”
- Francis Chan, Crazy Love

To say I don’t like driving, or rather being a passenger, in cars in Burundi is an understatement. It terrifies me. During my first African driving experience, many years ago, I was listening to the book Crazy Love by Francis Chan. I distinctly remember listening to the part of the book quoted above and thinking, “The fact that I could die at any moment is at the forefront of my mind, this driving is insane and if we make it to our destination it will be a miracle." 

The majority of the roads in Burundi (aprox. 92%) are not paved. They are red dirt roads, rocky and rutted and slippery when wet. They are not heavily traveled by vehicles, which makes me feel safer, but driving on them leaves me feeling nauseous and tense as we bump and bounce and I try to brace myself from hitting my head on the ceiling.

Thankfully the main road from Kibuye to the capitol Bujumbura is paved. This is the road we as a team travel most often. It is a curvy mountainous road with areas of steep drop offs and many people, even small children, walking along the sides of the road. There are bicyclists, with their bikes overloaded, whizzing down the hills, and young men on bikes holding on to the back of vehicles to be pulled up the hills. There are boys and men who climb onto the back bumpers of semi trucks and hang on, catching a ride, as we drive behind them praying that none of them fall off and slip under our car. 

It’s a two lane highway with no lines dividing the lanes or restricting cars from passing one another around blind curves. This means that often you will see a vehicle coming directly at you as it tries to pass another vehicle. Potholes are another part of life on the road here. There are many, they are large, and people drive around them in the wrong lane. 

All these unsafe driving conditions have always driven me to prayer. However, my prayers while driving have changed over the years. They have gone from a place of anxiety to a place of utter surrender. I so obviously have no control over what happens in that car, over life or death or what any other driver will do. But, reality is, I never am the one who has control, even when I am sitting in my living room. God holds our lives in his hands and every breath that we take is allowed by His will. It’s just that driving brings this awareness to the forefront of my mind and I have to remind myself of these truths. I continue to pray as we drive around every curve, that God will continue to sustain our lives, and I get to praise Him when we’re still breathing on the other side.

Last month our family decided to go to Bujumbura for the medical school graduation and a little R&R. We left Kibuye as soon as the sun was up and it was still morning when we began our decent towards the capital. The road was wet from recent rain and as we rounded a sloped curve of the road our car began to swerve. I heard my husband say, “I don’t have control” as he tried his best to straighten us, but we slid into oncoming traffic. Our car slammed into the side of a smaller car and scraped along it's side until we came to a stop, in the wrong lane, facing a blind curve. We quickly shuffled our kids out of the car and across the street, afraid that another car would come around the curve and strike ours. By God’s provision three of our national partners were driving in a car behind us, they pulled over and came to our aid, helping Greg communicate with the other driver, who only spoke Kirundi. They stuck with Greg throughout the entire, complicated, multi hour process of negotiations and paperwork. Other teammates in another vehicle were also heading to the capital for graduation and soon arrived to help.

Our youngest was a bit shaken, as expected, but as we helped him retell the story of what happened we couldn’t help but highlight the wonder of the situation. Never before have we had teammates and national partners traveling behind us and available to help. We lost control before coming to the steep drop offs. The car in the other lane was a small one, not a tractor trailer or a bicycle, and it was not a head on collision. No one was injured. No one was walking along that side of the road to be struck. And there was an area across the road where it was safe for us to stand and for other vehicles to pull over. We do not know why we were in an accident, but, for being in an accident the situation could not have been better, and we see God’s provision over the situation, and on the peace that we all felt as we climbed back into cars and finished our trek to the capital.

The car, which has been named the Black Mamba, is now all fixed up and sporting 4 new tires with good tread. 

Driving on the Left

Unlike Jason, the rest of us grew up driving only on the right side of the road, and therefore adjusting to Kenyan driving takes some intentionality. Today, I drove into Nairobi for a national family medicine meeting. It was a good meeting, and I met some impressive folks. The six or seven hours of driving gave me a chance to see 3 giraffes and a baboon alongside the tarmac, and also some time to consider the nuances of driving on the left, and the mistakes often made when switching sides.

1. Getting into the car on the passenger side when you're the driver (novice mistake #1).

2. Taking your right hand turns tight and/or without looking both ways for traffic.

3. Taking your left hand turns wide and/or spending too much time watching for opposite traffic.

4. Turning on the windshield wipers instead of your turn signal (since they are on opposite sides).

5. Neglecting your rearview mirror, since you're not used to looking for it on your left.

6. Hugging the shoulder, which may not really be all that bad an idea.

(And not related to the side-of-the-road issue, but related to driving in Kenya:)

7. Not knowing how fast you can go, because there are no speed limits, but you can still get pulled over (by a cop standing on the side of the road, because they have no vehicles) for speeding, though they have no radar gun or other monitoring device.

8. 3+ lane roundabouts. Enough said.

Here's a map of where in the world they drive on the right (red) or left (blue). Interestingly, although most of the world used to drive on the left (including the US), only 34% of the world currently does.

The 6 Ps

The 6 Ps of Acute Limb Ischemia Driving in Burundi

by Eunice John

For non-medical people (like myself), in medicine, there is something called the six Ps of acute limb ischemia, which occurs when there is a sudden lack of blood flow to a limb. Doctors often use this in the assessment of whether the limb can be saved with emergency surgery or not. 

The “Six Ps” include pain, pallor, poikilothermia (aka perishingly cold per the graphic below), pulselessness, paresthesia, and paralysis. 

Many years ago, even before our family’s arrival, a teammate(s) creatively came up with another “Six Ps” but for driving here in Burundi…and the story begins: 

Our family doesn't travel away from Kibuye too often. And I would say even our teammates who have to travel more (i.e. to the capital, a 2.5-3hr drive one-way), still only drive down maybe 2-3 times/month. While Burundi is indeed beautiful, driving here can definitely be stress-inducing, for both the driver and passenger(s) alike! 

Back in Dec 2019, there were 2 weddings on the same Saturday in Bujumbura, the largest city and former capital. Our family and some teammates were headed to one (for which our oldest was the ring bearer!). A couple other teammates were headed to the other. Before leaving Kibuye, I was asked to pray over the travels ahead. I prayed and we were on our way.

Maybe an hour into our drive down the mountain, we see some…traffic?? There is a line of vehicles backed up and definitely NOT moving. We slowly come to a stop. Why are they all stopped? What happened up there? Where is “up there”? How long has everyone been here? How long will we be here? Oh no…we’ve already driven over an hour…there’s no turning back. Are those people getting off that bus and walking??

While one of our teammates got off to do some scouting, the rest of us hung out in the car. Another teammate jokingly noted that I hadn’t prayed for all the six Ps! 

Well, fast forward to this past December, our family was driving back to Kibuye after some holiday travels, and I kid you not: during those 2.5-3 hours, we encountered all six Ps* (some more than once!). All that to say, these sorts of things tend to stick to my brain, so I wanted to share them with all of you. Now, in no particular order… 

We pray for protection from… 

1. Potholes

2. Pedestrians 

3. Presidential parades and the likes (this one was a sudden but short one)

4. Pikis (Swahili for motorcycle) 

5. Puke (we give each of our kids an empty "Blue Band bucket" aka margarine tub, to use as a barf-bucket; the sanitizing wipe from Ethiopian Airlines came in handy!) 

6. Pluie (French for rain) 

Note: In this picture, you can see pluie (look closely at the dashboard), pedestrians, and pikis! 

In all seriousness, we always pray for travel mercies and are thankful for every uneventful trip on the road. The next time you’re on the road or you think of our team and wonder how you can pray for us, you can just remember the 6Ps and our travels in general! 🙏

*The 6Ps were very slightly modified for this post. There is actually another P that is not listed here for mindfulness reasons. 

Through Snow and Mud

For a couple of months, we are living in St. Joseph, MI, a few miles inland from Lake Michigan, where I am doing some hospital work.  It's been a mild winter, but maybe it's starting to catch up.

Last night, it dropped about 4 inches of snow, and another 6 or so accumulated during the day.  As I headed out for some of my first winter driving in a few years, I was "momentarily transported back to Kenya".  In fact, there were several ways in which the experience was reminiscent of driving in Africa.   The following thoughts ran through my head this morning, and would have been true of any given drive in Kenya:

• Wow, it would be great if I had 4-wheel drive.  Instead, I have a 2-wheel drive van.
• Where is the road?  Well, it must be somewhere between those 2 mailboxes (or trees)
• Wow, the Lord has made a beautiful place here.  If I try to look around and enjoy it, I'm sure to die.
• Slowing down may actually be more dangerous in this situation.
• I'm so glad no one really cares if I stay in my own lane.
• Well, there are worse things than getting stuck.
• The best thing about this situation is that there are not many other cars on the road.
• When in doubt, trust the ruts that are already in the road.
• Of course, one never quite knows where those ruts led the last person.
• Oh look, they didn't really lead them very well.  Better get out of the rut.
• Lord, thank you, thank you, thank you for bringing me safe and sound from point A to point B.

Driving back from visiting some friends.  John has skillz.  We never got stuck.

Life on the Highways

This week at a conference, someone asked us to draw a picture of what our lives look like these days. I drew our family driving in the car.

In the last month, our family has driven over 5000 miles. Other McCropder families are traveling similar paths. We welcome your prayers for safety and sanity in the car as we traverse the country to attend conferences and courses, to speak at various events, and to see friends and family.

We are figuring out some of the tricks of handling life on the road:

We utilize free wi-fi and free refills at many a McDonalds.

We try to coordinate pit stops with friends when we travel to the same locations. This may not happen again for several months, but Maggie and Abi did enjoy playing together at this playground in Ohio a few weeks ago.

At a McDonalds in Connecticut, we learned to suggest simultaneous straw drinking so that we can get back in the car faster and keep driving.

We encourage children to entertain themselves quietly in the car, even if that means letting them practice photography skills with the digital camera. This is Anna's best photograph from New Hampshire.

You may notice that Abi is holding a bag in the picture. Perhaps you recall a disaster or two with her carsick stomach in Kenya. We are extremely thankful to report that she has only been that carsick once in the USA so far. I'll always remember central New York for last week's clean-up effort.

2000 miles later, our family is now in Colorado for a course at Mission Training International. Here we are enjoying the beauty of the Rocky Mountains, and we feel very thankful for all the wonderful people we have been blessed to see all across this beautiful country.

Life on the Highways

This week at a conference, someone asked us to draw a picture of what our lives look like these days. I drew our family driving in the car.

In the last month, our family has driven over 5000 miles. Other McCropder families are traveling similar paths. We welcome your prayers for safety and sanity in the car as we traverse the country to attend conferences and courses, to speak at various events, and to see friends and family.

We are figuring out some of the tricks of handling life on the road:

We utilize free wi-fi and free refills at many a McDonalds.

We try to coordinate pit stops with friends when we travel to the same locations. This may not happen again for several months, but Maggie and Abi did enjoy playing together at this playground in Ohio a few weeks ago.

At a McDonalds in Connecticut, we learned to suggest simultaneous straw drinking so that we can get back in the car faster and keep driving.

We encourage children to entertain themselves quietly in the car, even if that means letting them practice photography skills with the digital camera. This is Anna's best photograph from New Hampshire.

You may notice that Abi is holding a bag in the picture. Perhaps you recall a disaster or two with her carsick stomach in Kenya. We are extremely thankful to report that she has only been that carsick once in the USA so far. I'll always remember central New York for last week's clean-up effort.

2000 miles later, our family is now in Colorado for a course at Mission Training International. Here we are enjoying the beauty of the Rocky Mountains, and we feel very thankful for all the wonderful people we have been blessed to see all across this beautiful country.

Achebe's Truth - or - My Automotive Misadventures Beside the Tea Plantations

I just returned from a week-long conference on HIV medications, and I'm planning on sharing a few observations from an interesting week. However, I first want to share our journey back to Tenwek, which was an unexpected epic.

The journey from Nakuru (where the conference was) to Tenwek should take about 3 hours, and about halfway back, you pass through the town of Kericho, which is the heart of tea country, in part because of the profuse amount of rain the area gets. It's actually incredibly beautiful.

As we came to the outskirts of Kericho, the weather became typical, that is, a torrential downpour. And here the road narrows quite a bit. I was driving a van (not ours, but a borrowed one) with another missionary doc, and four of our Kenyan staff. Up ahead, an oversized lorry/truck was heading towards us, so I was hugging the shoulder.

What happened next was a blur, but it involved the wheel slipping off the shoulder, popping back on to the tarmac, hydroplaning across the width of the road at least twice, narrowly missing several oncoming cars, spinning 180 degrees, and sliding backwards off the road, stunned and shocked that we didn't tip over, which I had felt to be inevitable.

We quickly found that no one was hurt. We voiced a prayer of thanks, and I got out to inspect the vehicle. One of the rear tires was flat, the rubber having pulled away from the metal rim. So, we found the jack and the spare (fortunately in perfect condition), and changed the tire out. All this was accomplished in pouring rain.

An aside: I have a baseline essential tremor, a shaking that usually isn't very noticeable. But cold and adrenaline are two things that can exaggerate it quite a bit, the result being that I was shaking quite a bit by this point.

We got back in the car (which unfortunately still required A/C despite being freezing, to avoid fogging the windows), drove into the town, found a petrol station, and had all the tire pressures checked. As we got through to the other side of town, we heard a weird clicking noise from where we had changed the tire. We stopped, and a couple of us watched the car driving forward to confirm that nothing looked loose. Perhaps the alignment had gone a bit awry. We decided not to worry about it until, a few kilometers later, there was a distinct clunking sound, followed by a loud grating noise. We quickly pulled over, and got out to investigate.

The wheel had fallen off. That's right. The whole tire and wheel had fallen off the axle, and a total of zero lugnuts remained. However! The saving grace was that, though it had fallen off, it had remained upright in the wheel well, and so the whole car was resting on the upright wheel and the axle and brake disc never hit the ground.

So back out into the pouring rain. We recovered one lugnut from alongside the road, and after much discussion, took one nut from each of the other wheels, put a total of four on the tire, and drove back into town to an auto dealership that had stayed open late since they had heard we would be coming.

And so we arrive at Kericho Toyota, more soaked to the bone that I have ever been (my shoes are still too wet to wear 48 hours later), freezing cold, muddy, with me shivering like a psychiatric patient who has been on meds way too long.

They took immediate pity on us, brought us some coffee, and within a couple hours had replaced the lugnuts, repaired the tire, and test-driven the car, pronouncing it safe to drive. The owner of the place had extra pity on me, and gave me a bright yellow (and dry!) Toyota t-shirt to change into.

I'm glad it was bright yellow, since it would make us a bit easier to see, since we were now going to have to drive 2 hours home in the dark, which in Kenya is a situation we try very hard to avoid. It was still pouring rain. The end story is that we arrived safe, and I learned that Kenyans have an inexplicable habit of turning their brights on when they approach another driver at night, which is particularly difficult when it is pouring rain, and even worse when you are shaking like someone about to have a seizure.

And so it is that Rachel found me arriving home at 9:30pm, in squishing shoes, with a pronounced tremor, and a bright yellow Toyota t-shirt that she had never seen before, but thankfully, completely well and safe.

One last note: The odds of tail-spinning through a busy main road, and neither hitting anyone nor flipping the vehicle is low. The odds of your tire falling off your car, with no damage to anyone or the vehicle is also very low. The odds of both events happening in the space of 90 minutes is very much lower. And so we thank God, who sustains us in many ways, recognized or otherwise.

(a hint on the Achebe reference)

Medical evacuation, part 2

By Alyssa 

In the last few years of team life, we have experienced several "all hands on deck" crises - such as the flash flood at the waterfall in 2016 and the failed coup d'état in 2015. These events definitely bring us together as a team in ways beyond what we experience through day-to-day life and work together. We regularly reference those intense bonding times and they go down in team history to be retold again and again. Well, we recently added another crisis to the team lore with our second medical evacuation (for the first one, read here.)

Similar to family life, each of us has team "roles" in addition to our hospital, school, and community work - tasks such as facilitating the weekly market order or the vehicle upkeep. One of my roles is to be team doctor. Usually that means handing out Zofran for stomach bugs, answering questions about malaria prophylaxis, or maybe putting steri-strips on a wound.

Cleaning and steri-stripping a minor wound for Abi

But last month our team dealt with an unexpected medical crisis for a visiting American boy that went way beyond minor! Cole was visiting with his family so his father, a surgeon, could help cover the surgery service for Jason. One day after running Cole complained of leg pain. As he was a healthy, active 12 year old, we didn't worry too much about it, but the visiting orthopedic doctor did check him out during lunch. The next day his leg was still hurting and he had developed a low grade fever, so we brought him up to the hospital for x-rays and lab tests. The x-rays were normal but the labs showed signs of infection and inflammation, so we started antibiotics. The leg still looked normal with no visible wound, swelling, or redness. The following day, however, he developed swelling in the leg and an ultrasound revealed a deep fluid collection near the bone. He definitely needed to have it drained in the operating room. We looked into sending him to Kenya for the operation, but it would be at least 24 hours before there was an available flight, and almost all the orthopedic surgeons we knew in Kenya were at a medical conference in Greece. We had a visiting American orthopedic surgeon at Kibuye, and he and Cole's father, also a surgeon, decided it was better to operate right away. Thankfully the surgery went well and the surgeons found and drained the infection near Cole's fibula. We now had a diagnosis: acute osteomyelitis (infection of the bone.) We hoped Cole would begin to recover with continued IV antibiotics.

Pre-op on left, post-op on right

The next morning, Cole was sitting on the couch reading a book when I came to check on him and give him his antibiotics. I listened to his lungs and noticed crackles in the left base that weren't there before. Then we checked his oxygen level and discovered it was lower than it should have been. And then he had another fever and significant tachycardia (fast heart rate), too. These were all concerning symptoms and meant without a doubt that we needed to get Cole to a hospital with an available intensive care unit ASAP! We were concerned the leg infection was now in his bloodstream and he could develop septic shock as a result.

This is the moment when the team mobilized into high gear like a well oiled machine. We were few in number as most of the doctors were at the medical conference in Greece, but everyone remaining dropped everything and came running to do the work of many more people. These are the folks you want by your side in a crisis! As Cole's dad spent hours on the phone with the med-evac company, the Serge Kibuye team packed up all the suitcases for the family of 7, looked at flights and arranged guesthouses for the mom and other four children in Kenya, drove cars (including a makeshift ambulance for Cole, his dad, and me) to Bujumbura, made lunch and fed all the kids, facilitated quick goodbyes, texted our Kenya connections to receive the family in Nairobi, connected with Kenyan doctors/hospitals, and of course monitored and cared for Cole. He got worse with a medication reaction just before we got into the vehicles to head for Bujumbura but thankfully responded to a breathing treatment.

Susan driving our "ambulance." A definite answer to prayer is that Cole actually started feeling better, and his oxygen levels increased as we drove down the hill towards the airport. The lower altitude and the vancomycin helped, but mostly people were praying around the world! Thank you! 

We waited for the airplane with our Serge teammate and peds ER doc Randy Bond, and thankfully Cole remained stable in the interim. Again Serge teammates served the family by caring for Cole's siblings and mother until their flight the next morning.

Cole and his father flying to Nairobi

Driving right onto the runway in our "ambulance" with our special patient 

As we drove back to Kibuye the next day and recovered from the chaos of the previous few days, Cole and his family's journey continued in Nairobi. He went back to the operating room multiple times and was finally stable enough to fly back to America where he was immediately hospitalized in Michigan for a few more days. And two and a half weeks after the ordeal began, he finally went home (though he will continue treatment for several more weeks from home.)

Cole thanking the Kibuye kids for their Get Well cards. Even the kids prayed for Cole and cared for him!

Thinking of Cole on Good Friday brought new meaning to Isaiah 53:4 where we learn that Jesus carried our pain and suffering. And that hope encourages me as I think of the pain and suffering my Burundian patients face as well. We all wait for the day when all things will be made new and there will be no more sickness or suffering or pain. In the meantime, I'm thankful to be waiting with my amazing friends and teammates! 

Planes, Trains, and Automobiles

Actually, no trains, but we are driving and flying these next few days. Alyssa, Heather and I (Jason) are heading to Burundi for a week. We will take the 1.5 hour flight from Nairobi to Bujumbura tomorrow and then drive 3 hours up to Kibuye Hospital that same afternoon. We will be joining the only doctor there to help out at the hospital. During the week we are there, we hope to get a better sense of how the hospital functions, discover what needs exist, and develop relationships with the staff and medical students. We pray this trip would help us understand the place better and know how best to invest and plan for our futures there.

Alyssa and I have both brushed up on our C-section skills, Heather is excited to test out the French she has been studying, and Heather and Alyssa are looking forward to seeing Burundi for the first time. You could pray for a successful trip and also for Anna (who gets to stay in Nairobi with her Uncle Eli and Aunt Bethany and cousins) and for Abi (staying at Tenwek with Cropseys). We will report when we get back (no internet at Kibuye, yet).

In Praise of American Seasons

(from Eric)

Well, our time in American is more than three months now, with more than that to come before we return to Burundi.  We are probably as settled as we are going to be, which is to say "sort of".

One of the questions we get from people is "what do you enjoy the most about being back in the US?"  This is a good question.  It's good, because it is likely to yield some interesting information for the question-asker, but it's also good because it pushes us, the missionaries in the US, to a useful type of reflection.

Because there are lots of really great things about being back in the US.  The top of that list is our family and friends.  We love being here because this is where so many people that we love and have missed live.   It is here that we get to be a part of birthday celebrations, attend graduations, and see new nieces when they are still newborns.

But we also enjoy ice cream.  We enjoy the quiet serenity of driving after dark on a well-lit road.  We enjoy frank communication styles.  We enjoy Trader Joe's and Target.  We enjoy the way that Americans take so much problem-solving initiative.

Yet I thought I'd mention here one of the things that I appreciate more and more as time goes on:  Seasons.  We've spend the better part of 5 years in the equatorial highlands of Africa.  Both in Kenya and in Burundi, we've lived above 6000 feet, and within 5 degrees of the equator.  (Kenya was less than a degree!)  People almost invariably assume that we live in a hot humid place, and almost all our visitors comment on how great the weather is at Kibuye.  And it's true.  Believe me, we don't take it for granted, since almost all our missionaries friends are sweating it out somewhere else!  At Kibuye, highs range from 60 to 80 degrees (depending mostly on the clouds and rain), and it can dip down into the high 40's at night.  At least, we think so.  No one has a thermometer, and there is no weather service, so we're just guessing.

And yes, it's perfect.  And there is some changing of the environment as the rainy and dry seasons alternately unfold.  But it feels the same.  And as the months go by, I miss the seasons.  I miss being cold, and I sort of even miss being hot (though we can visit Buja for that).

Because the seasons are beautiful.  Right now in Ann Arbor, everyone is outside, taking advantage of the few months of summer.  Fruit trees are producing.  Outdoor festivals are almost every weekend.  It's light until after 9 pm, which is just shocking.  On the equator, sundown is always between 6:15 and 6:30.  One African friend exclaimed that he can't eat dinner if it's still light outside, which is a thought that never would have occurred to me.  But now, we can sit outside after dinner and watch fireflies come out.  Bugs that light up!  Can you believe it!

Maggie understands the seasons.  Ben (who is 4) is a bit hazy on the details.  He gets the order mixed up.  Or he thinks that Fall is when things grow.  But then, the last time he saw the leaves all change color and fall off the trees, he was one.  So, this will be fun to watch.  Apples to pick, sweaters to don, leaves to rake (definitely a blessing and a curse, I know), football to watch.

I'm even glad that we're going to be here for part of the winter.  The burst of warmth when you walk out of a cold wintry day into a warm building is a beautiful thing.  For that matter, walking out into the cold isn't so bad for the first few moments.  Bare tree branches against a clear sky, and everyone sipping their warm beverages.

And the whole thing is such an amazing cycle.  Death, resurrection, death, resurrection.  I'm guessing that the dry and rainy seasons could create the same thing for Africa, but it doesn't hit me the same way (probably because I'm not farming.  And I'm an American).  But every spring feels like the first spring.  Like, even though the season has never failed to come, part of me didn't believe it would come this year.  That, this year, it would just stay gray and cold.  But it doesn't.  And so, if we're wise, we're continually celebrating the season that is before us, because it hasn't been here long, and it won't be long before it's gone again.

It's a beautiful image, both for what it is, and also for what it can teach us.

Happy Summer.

Community (Kibuye-style)

There are probably many things that make living here a fairly unique experience for our team. Living in arguably the worlds poorest, hungriest, least medically served country will do that. The water, power, internet, and fuel shortages all can have a major impact on our lives. Learning to live as a visible minority where it seems not only culturally acceptable but expected, for people to shout at you as you walk past  - is something most of us did not grow up knowing. Living in a ’town’ that has no stores, where the two dining options are the canteen at the hospital (which serves rice & beans) and the guy across the dirt road who hangs up a goat in the morning and slices off chunks for his ‘house specialty’ (AKA: only thing he makes) of goat kabobs, does take some getting used to.

But in some ways that is all the context for our lives here - what is more impactful is the day-to-day living, the reality of the mundane, every-day, normal-life stuff. What is in many ways so unique about being a part of this work, of this team, is how the things like going to work, kids going to school, having neighbours, driving to the store are all so massively impacted by one overarching reality - we live as a very tight-knit community. 

The kids (and a few adults) on Haloween

Before our family moved up here to join the Kibuye team, I had a different understanding of community. Our family has known neighbourhoods with a very strong sense of belonging, and community, with block parties, and community gardens, and neighbours who all know each other. We’ve know ex-pat communities where you spend incredible amounts of time together. We have strong extended family bonds. We have great groups of friends. We’ve known work colleagues that became so much more than just that. And then -  there is the community that is rural, mission compound living. 

Eric once told me that one time when he was back in the US, someone was describing how Amish life is different than the society around them. Most people in the West tend to have a circle of friends, a circle of people you work with, a circle of people from church, the circle of the people who live next to you, the circle of people whose kids go to school with your kids etc etc etc  - and some of those circles overlap to some degree with others.  For the Amish, the Venn Diagram of those circles is basically one perfect circle. It dawned on him that that’s essentially life here for our team in Kibuye.

For security there is now a fence/wall around our living space here -  which is totally normal for Burundi, every house in any city or town has a wall around it, and even out here many mud-brick houses have some kind of fence or wall around them. This, unfortunately, does give a bit of an in/out, us/them divide, that is hard to ignore and overcome. However, within this living space are our missionary families, most of our Burundian doctors, and a couple of other Burundian hospital employees. This gives us a strong sense of living truly together, in the same place, sharing common space, with yards that all run together and no clear delimitations inside. I feel like there are almost as many times that I have shared files with my teammates by physically carrying a USB drive to their house as I have to attach it to an email - which is a testament to not only to the close proximity of our houses but also the slow and unreliable internet connection. We can hear the kids in school from our house when something really funny happens (or when a bird or some other creature gets in) because the school is literally 20m from our front door in the middle of our shared living space.

Sometimes the ‘rural’ part of ‘rural, mission compound’ feel like it sticks out a bit more than others - like when you see a pregnant mom giving her sons a ride on a motorbike, or when the kids have rabbit races for a birthday party game, or when kids come in from playing in mud and have to have the egg-sacs of jiggers removed from inside their feet. (Pro-Tip: if you have a weak stomach, probably don’t Google “jiggers”). There is non-stop tree climbing, fort-making, running around, bike riding, and a lot of kids who think the rule ‘wear shoes to walk to school’ is an unacceptable imposition on their personal freedom. However, the thing that really sets this life apart from what we’ve known before however is the tight-knit community. 

Yes, we have a grassy area around our house that one could consider “our yard” but more often than not there are a bunch of kids playing there and none of them are our kids. There are 14 kids here who call us ‘Aunt' & ‘Uncle’ and about 18 adults our kids refer to as the same - not to belittle the relationship we have with our biological nephews and nieces - but because the relationship between the kids and the adults here is so close that using any title that doesn’t connote a true family tie feels strange and artificially distant. 

Yes, the people who live in the house next to us are our ‘neighbours’ -  but they are also our co-workers, team leaders, friends, our kids teachers, our bible study group, the parents of our kids friends, our students, our worship community, and people we share vehicles with, our exercise group, that friend who will fix your car, and so much more. It means we all gather together on Christmas Eve for a service of carols & readings, we share communion together, we are together for birthdays - it's not uncommon that groups of us go on vacations together, and it's every single able-bodied person on-deck  for unloading the 40' containers of medical supplies and personal goods when they arrive. 

It means that there are impromptu games of capture the flag, or ultimate frisbee including everyone on the compound who’s interested. 

That means our kids think that some Sunday afternoon having essentially all the adults playing with them is a normal activity.  

Kids as young as 4 or 5 playing with the big kids, their own parents, the Burundian docs, their Aunts & Uncles - all running around together in a giant game where teammates are frequently shouting to each other in one of three languages. It's the kind of inter-generational, inter-cultural dynamic that honestly is pretty rare to see.

Obviously, there are sacrifices that everyone has to make in order for this kind of community life to work.  You wouldn’t be able to survive very well here with the standard western mindset that I think to some degree we all were raised with of “but I have the right to…”  We all have to give up certain freedoms  - for the sake of families with kids at different ages, or no kids, for our Burundian neighbours, for those whose family patterns and schedules may look a bit different than ours, and more.

We come to agreements on things that seem to be best for the common good: don’t knock on other people’s doors at 6.30am, no toy guns, all kids go home at 6.00pm when it gets dark (and the mosquitos come out!), a group of guys run early mornings - so girls can run afternoons, let people know when you’re going to the city so they can put in orders for ‘the grocery store’, if you borrow tools - put them back, try to remember to sign out cars on the schedule. It means we all have to come to common agreements on things that we have different opinions on like how much diesel we’re willing to burn to keep the generator running when there is no electricity and a diesel shortage, family pets, and who gets to use the vehicles to go where during the kids' school holidays.

Honestly, I can’t think of another situation where our family would ever have this kind of close-knit community living.  If you were to attempt something like this in North America you’d clearly be some kind of nouveau-hippy commune. It’s hard to imagine a group of eight or so families deciding to buy vehicles together instead of each having their own, to share an internet connection, to build houses together on the same plot of land, to build a small school that’s essentially a home-schooling co-op lead by the teachers in the group, so that one (or both) adults in the families can work together at a small hospital. But that’s essentially what we have. It’s what we do. I must admit it all kind of snuck up on me - we moved up here from Bujumbura, and I didn’t really notice it until we were here a while. (OK - well that perhaps sounds a little cult-like…)

But this is our life now. To be perfectly honest I’m not sure it’s something that I would have chosen, but not only is it the only way we survive here, it's the only chance we have to thrive here, and it’s also a pretty special way to share life. Clearly this type of community drastically affects each of us, but I think for the kids on the team, it’s giving them a sense of what it can mean when you intentionally give up individual rights for the sake of others - and I hope that’s an embodiment of the gospel that has a lasting effect on how they chose to invest their time, abilities, and resources for years to come.  

Kibuye during Covid-19

(from Jenn)

Can we talk about the "19" of Covid-19?  Doesn't 2019 seem soooooo long ago!?  Maybe we had problems in 2019, but as we look back we may wish we could have told our 2019-selves "buckle up, the world as you know it is about to change drastically."

Although we spent two months at Kibuye in the summer of 2019 (July-August), I'd say our true missionary career started here mid-January 2020.  It's been a bit bizarre living here these past four months as our world has changed due to the pandemic.   Our lives would look so different if we were in the States right now. As an outpatient pediatrician, I would probably be doing telemedicine there.  As a general surgeon, maybe Michael wouldn't be doing as many elective cases.  Here, it's (almost) life as usual. There have been no big changes mandated by the government except for the fact that the airport has been closed for almost two months and there was a mandatory 2-week quarantine for anyone who flew into Bujumbura. Schools are still running, churches are still gathering, and people are still working.

How do you stop work when a majority of the population earns their daily wage then goes to buy food for dinner? How do you stop schools when there is no online option? How do you tell people to stock up on food when only 9.3% of the population has access to electricity?

At Kibuye, of the remaining seven family-units, five of them contain doctors so most of us are leaving the compound and working at the hospital as per usual (plus face mask usage).  We still have family worship on Saturday afternoons, each family on a blanket on the floor of the outdoor pavilion. The remaining children are still attending school and because there are so few left, social distancing even in a classroom is possible.

We haven't seen a wave of patients severely ill with respiratory disease, at least on the adult side.  In Peds, it's "bronchiolitis season" and therefore we are seeing a lot of respiratory illness, and even subsequent death which unfortunately is not uncommon for this season.  Is it Covid-19? I don't know, and we probably never will because of the limitations in testing for the virus and because of the lack of specificity of symptoms for the disease.  We have heard of some people in Kibuye with anosmia, the loss of sense of smell, which is a more particular symptom.  As not many other things cause that symptom, it could cause one to assume that it is circulating here.  Thus far, however, we are thankful to have avoided any crisis.

This week is also a very big week in Burundi; May 20th is Election Day.  There have been multiple political rallies (even one just outside the hospital), which have been peaceful.  We hear campaign cars driving by at least 2-3 times day giving their information in Kirundi and playing music.   Please pray for peace leading up to and after Election Day.

A Month of Goodbyes

By the time we left Tenwek, I must say that we McCropders all felt thoroughly appreciated!  Kenyans are very good at saying goodbye.  They have ceremonies and speeches and times of gift-giving.  Our missionary community, too, was very gracious in their send off.  Driving away for the last time (for now), I had no regrets about this person or that person who I wish I could have seen again, or someone I hadn't gotten a chance to say goodbye to.

The goodbyes started early August, actually, a month before we left.  Since the Cropseys left a month before the rest of us, no one wanted to throw two goodbye parties, so we said goodbye early!  The Tenwek missionaries threw us a party and (even though we're a bunch of wazungus/white people) gave several nice speeches.  Here we are outside the party getting a group photo:

Then there were goodbyes from our Kenyan friends.  We had a musical coffeehouse night that all of the interns and many residents attended...full of music, snacks, and laughter.  The Bible studies that many McCropders had been a part of had goodbyes, too.  Pizza, meals, beautiful gifts of baskets and such.  We were also invited out into the village for chai one last time.

 Our church had several goodbye moments.  During the last Sunday service, Eric and Jason were able to lead worship and sing some of our favorite Swahili songs.  We were all invited up for a sendoff prayer as well.  That night, many people gathered together again in the church for a musical celebration and again, well wishes and a send-off to the McCropders in thanks for our service.

 And finally, the morning of our departure, the surgery department had a special thanksgiving worship service and passed along gifts and thanks to Jason and Rachel.  We feel so blessed to have been a part of this community for the past two years.  Goodbyes were well said, but still hard, and we look forward to hopefully returning someday, if nothing else to greet all the people who treated us so well and so kindly.

200,000

One of the many things I was hoping to accomplish before we leave for Kenya was to get our 1995 Toyota Camry over 200,000 miles. Not that I was driving with abandon, but we did preferentially use this car over the past few months. Just in time, we have passed this mark with 5 weeks until our departure. The amazing thing is that the car still has no major problems. As the McCropders plan what kind of car to buy in Kenya to share amongst ourselves, my experience with this Toyota will certainly push me to put my vote in for another one – though maybe a Landcruiser instead of a Camry. I wonder how many miles we can clock on our McCropder vehicle over the next many years. Perhaps not 200,000, since the road conditions can be slightly more challenging in Kenya!

ZM Part II: Into the Community

by Rachel

At the risk of inundating all of you with more Zigama Mama news (see here for part I), I wanted to continue to share the next part of the story with everyone.  When ZM was set up, part of the program was not just training nurses and doing ultrasounds/scheduling C-sections, but actually going out to each of the 17 health centers in our district to make sure the program was going ok, requirements were being followed, and collecting some data sheets from each center.

I've actually been really excited about this part.  I've come to realize that in my six years here in Burundi, I have become very much a creature of habit.  I used to think of myself as somewhat adventurous, but now I go to the same places and do the same things every day.  I shop in the same one store, I take the same route to Bujumbura, I visit the one tourist destination by us (the waterfalls), I walk the same path to the hospital every day.  Even in Buja, we visit the same restaurant, the same grocery, the same hotel with swimming pool.  Part of this is finding the thing you like and sticking with it, part of it is that there's just not many new places to go or opportunities to go there.  Or that everything starts to look the same, and you wonder if it's worth the effort to keep exploring.  But the health center visit was a chance for me to actually venture off the beaten paths (sometimes literally) and see a totally different aspect of life here.  Months went by with many cancelled trips and I started to despair that these visits were ever going to happen...but as usual here, all of a sudden one day last week the pieces came together and the next day I found myself in the hospital truck with one of my OB nurses and the district health officer and we were off!

We are located in Gitega province, right in the middle of the country.

For those of you who don't know the system, Burundi is divided up into provinces, much like states in the US.  We're right smack in the middle, Gitega province (which is the most populous overall, according to Wikipedia at least).  From a health standpoint, each province is divided up into districts, and each district has its own hospital.  So, we are Kibuye district.  Then, each district is divided up into communes, and there are 4-5 health centers spread across each commune.  We have 4 communes and 17 health centers in our district.  Health centers are mostly like outpatient clinics, except that they will do "small surgeries," occasionally admit patients, and all do basic maternity care--prenatal visits and deliveries.  Each health center will refer their complicated cases to us at Kibuye Hospital, and our ambulance is responsible for going out to each health center to pick up the transfer, no matter what time of day or night.

The first thing that impressed me was the actual travel to each health center.  We were on paved roads for the first 5-10 minutes of the day and then spend another hour on dirt roads, usually smooth but occasionally a bit hairy given the recent rains, before we arrived at the first health center, Mahonda.  So, driving a decent vehicle still took over an hour from the hospital to the health center.  Most patients are not in decent vehicles--they walk, take bicycles or small motorcycle taxis, or sometimes ride in a rickety-looking station wagon-type taxi.  Thankfully, women is labor who need a transfer get to ride in the ambulance, but still...if the transfer is because she needs an emergent C-section or the baby is in distress, there is no quick way to do this.

Road leading to Mahonda health center

Road leading away from Buriza health center

The second thing that impressed me was the actual center and staff.  They have a hard job--located in the middle of "nowhere," seeing sometimes 100 patients a day in a much more resource limited setting than Kibuye, with no doctors to ask advice from.  The nurses need to be able to do suturing, wound care, deliveries, general medicine and pediatrics, and then figure out who needs to be transferred vs what they can handle themselves.  And they know that they can call an ambulance and at minimum, it will be over an hour before the ambulance shows up...if it's not out picking up a patient from a different health center first, or even worse, broken down and out of commission for days or even weeks.

CDS Mahonda staff, along with my OB nurse Moussa and the district health officer, Melance

CDS Buraza, one of the "super" health centers in the center of their commune

CDS Buriza, the newest health center in our district (opened by the president a year ago in August)

Finally, my third observation was just a reminder about how hard it is for my ladies to access care.  Even with free care for pregnant women, and community health centers.  Even with Zigama Mama offering free ultrasounds and consultations.  There are still barriers.  The nurse at Mahonda told me that patients have been refusing to come to Kibuye for a free ultrasound because it still costs 16,000 Fbu in transport costs to even GET to the hospital (reference: around $6 roundtrip.  also reference: for our househelpers, who make more money than the average Burundian, this would be about 4 days' wages).  This is on some level very discouraging--we remove one barrier only to discover that there are so many more still to be surmounted.  But on another level, little by little, barriers ARE being removed.  I was excited to see that each commune has a special, "super" health center being developed, where the government is committed to posting a midwife and improving training protocols and available medications for mothers and newborns.  I am happy to see that, even despite distances and transport cost, over 200 women have decided to make the effort to come in to Kibuye for a free ultrasound and consultation.  I am encouraged to see many nurses and other workers committed to providing health care in challenging places without many resources available to them.  And I hope our program and visits are encouraging to them, too.  To the nurses, to the women--they are seen, they are heard, they are loved.  Someone cares enough to try and make their lives a little bit better.

Thanks to all of your for your support and enthusiasm for our project.  I look forward to seeing its impact continuing to unfold over the next year, and even beyond.

Beautiful terraced hills on the road to Buriza