Click Here To Get Rich Quick

If you are reading this and you live in the U.S. or Canada, I have good news for you.  You are already rich!  I know you don’t feel rich, but if you could just take a step back and see your life and your wealth on a global perspective, I am sure you would agree with me … you are rich.

As we head into the Christmas season, you will undoubtedly be inundated with letters, e-mails, advertisements asking you to give to any number of charities.  I am writing this blog post to implore you to consider giving and to consider giving generously.   I have heard people argue against the idea of giving to charity for several reasons:

“Charity does not make a difference” - I could tell you hundreds of stories of lives that were massively impacted by even small amounts of giving.  I could tell you stories of lives that were saved by even small amounts of giving.  Charity does make a difference.

“Charity does more harm than it does good” - Historically, there have been charities that no doubt did more harm than good.  Even 10 or 20 years ago, this was true.  Thankfully today, we stand on a mountain of research and experience which most charitable groups use to guide them in doing development and relief work that is both empowering and sustainable for the people they serve.

“I won’t give money to a group that is going to take out 10 or 20% ‘overhead’.  I want my entire donation to go toward the cause”. - Let me ask you a question.  Let’s say you want to donate $100 to the charity of your choice.  You have 2 options.  You can have the entire donation go directly toward the beneficiaries, and then your money ends.  Or you can allow the charity to take 20% of your money and invest it in hiring talented leadership, marketing and further fundraising, which will increase your $100 over the next 5 years to $1,000.  Which would you choose?  We would never buy stock in a company that paid their employees nothing, did nothing to market their product, and did nothing to grow their company, so why do we hold NGOs to this impossible standard?  For an excellent TED talk on this subject, click  HERE

So, in my attempt to help you wade through the mountain of letters, emails and ads you are going to receive this month, I would like to suggest, implore, beg you, to consider giving to one of the following three causes.  These are all groups which I have been directly involved with, which are having a massive impact in what they are doing, and which you will likely not receive a single solicitation for this month (aside from this one … from me).

1.  Lifebox is a UK based charity whose goal is to provide every hospital in the developing world with high quality, durable pulse oximeters.  These small hand-held devices are used all over the hospital, but are especially valuable in the O.R. where they give you continuous measurement of a patient’s heart rate and oxygen levels.  With very little effort on my part, Lifebox has provided me with a total of 8 pulse oximeters which I have distributed to Kibuye hospital as well as 2 other hospitals in Burundi which were greatly in need of these life-saving tools.  They are eager for me to identify and make contact with other hospitals in Burundi who are in need of these machines. They rely on donations to continue this. This is truly life-saving work.

Lifebox

2.  Yezelalam Minch was founded by Birtukan, who grew up a World Vision sponsor child.  This entirely Ethiopian-run NGO provides food, education and healthcare for 1500 orphans in and around Addis Ababa.  I have served for several years on the U.S. Advisory Board for YZM and have been able to follow the amazing work they are doing.  They rely heavily on families in the US or Canada who are willing to sponsor a child in need as well as one time donations to sustain their operations.  This is a project very dear to the hearts of Stephanie and I.

Yezelalem Minch

3.  Kibuye Hope Hospital - If you have been following our blog or our story for any length of time, you probably guessed that Kibuye Hope Hospital would make my “top 3” list of giving options this year.  This is an amazing hospital and an amazing ministry, which continues to have great financial needs, which you can help with.  Here is a link to their giving catalog.  Donations can be made through Paypal:

Kibuye Hope Hospital

Stretched

One of the things I both fear and love about working in a place like Kibuye is that you are constantly stretched beyond your skill level.  Stretched because of lack of resources, lack of specialists, language barriers and a million other reasons. 

Friday morning, Joseph, our Burundian anesthetist, came to tell me that there was an urgent Cesarean section.  This is not unusual.  It seems that people in Burundi do not travel at night, even when experiencing life threatening emergencies.  Therefore, women in obstructed labor often present for C section first thing in the morning, once the sun rises.  Joseph then told me that the woman’s blood pressure was 190/120.  Well, yes that is a problem.  He then explained to me that she was also alternating between seizing and unconscious.  She had full blown eclampsia.  

Now, as a practicing anesthesiologist in the US, I have read about eclampsia many times, such as during medical school and while studying for my board exams 10 years ago.  But I have never actually seen a patient with full blown eclampsia.  That is because patients with PRE eclampsia are identified early with good prenatal care and if things show even a hint of progressing to eclampsia, they are transferred to a center which specializes in this life threatening problem, such as the University of Washington, where they are managed by a team of specialized anesthesiologists, intensive care doctors and OB/GYNs.  

So, as my mind is racing trying to retrieve any bit of memory about management of eclampsia, I follow Joseph to the Maternity ward.  When we find her she is unconscious, and within 2 minutes starts convulsing.  They cannot find any fetal heart tones (they use a small wooden tube which they place on her belly and hold the other end to their own ear).  Their best guess, she might be 20 weeks pregnant.  I remember that we need to give magnesium.  But first we need an IV.  We spend about 7 or 8 minutes trying to find a vein, but find nothing.  I decide we can’t wait.  I ask them to take her to the OR as fast as they can.  I run to Jason’s office to retrieve his ultrasound machine.  When she gets to the OR I ask them to hold her head still while I put an 18 gauge IV catheter in her internal jugular vein under ultrasound guidance.  It works, we have IV access.  Now, how much magnesium do I give?  I can’t remember if it is 2 or 4 grams.  No one else seems to know.  There is no high speed internet to look this one up, and since we seem to only have a few vials left, we give 2 (it turns out the correct answer was 4, but thankfully 2 seemed to work).  

On weeks when I am not here, there are 2 options for anesthesia for cesarean.  Spinal or Ketamine.  Problem is, her platelet count is dangerously low (26K), so spinal could cause bleeding around the spinal cord which could paralyze her.  Ketamine will make her blood pressure even higher, which could cause heart failure or a stroke.  But thankfully, this week, we have compressed oxygen and so we can do a real general anesthetic.  We get her off to sleep, the national doctor performs the C section, while Jason is performing another urgent C section in the other OR.  As we suspect, the baby is stillborn.  

During the surgery we continue to give more magnesium and clonidine to lower her blood pressure.  We find another peripheral IV (much easier while she is not having seizures).  She wakes up and we remove the endotracheal tube.  Now after most C sections the women return immediately to maternity where they are checked on by a nurse once in the morning and once at night.  I suspected she would not survive without more intensive monitoring.  So, we brought her to our “recovery room” right next to the OR, so that we (Joseph and I) could continue to watch her vital signs and continue to give her magnesium for the next 24 hours.  Now that we are post-op, I finally look at her pre-op labs.  She has both renal failure and liver failure.  Her urine catheter is putting out what looks like mostly blood.  And there are still a line-up of scheduled surgeries to get through, including our next patient a 6 month old with cleft lip who has been waiting for me to arrive so he could have this done.  

Joseph goes to maternity and finds a nursing student who can sit with the patient.  I take a blank piece of paper and make a graph where she can chart vital signs and urine output every hour.  I don’t have the experience to know what this woman’s chances of surviving at this point are, but I suspect they are low.  I pray for her.  

Throughout the day, by God’s grace, her blood pressure remained stable.  She had one more seizure a couple hours after the C section which we treated successfully with more magnesium and valium.  

This morning I found her wide awake. The family tells me she had no seizures overnight.  Her blood pressure is normal.  Her urine now looks like urine. The nursing student had stayed with her all night and completed my vital sign chart, filling in every hour except 3 AM.  I am shocked with delight.  I now believe that this woman is actually going to survive.  

This case stretched me.  This is not the only case that stretched me yesterday, but this is the one that stretched me the most.  I am grateful for the intensive and compassionate care that was given to this woman, especially by Joseph and this nursing student.  I have heard health care professionals in the US say they could not come and work in a place like Burundi because they are not “good enough”.  Many of them are much better than me.  They are smarter than me, more skilled at performing procedures, and better looking than me.  All that you really need to come and work in a place like this is the willingness to be uncomfortable and the willingness to be stretched.  

Back In The Saddle

This past weekend I got the opportunity to return to Burundi.  I am here for three weeks to help out with teaching and also to help Jason with a few more complicated surgeries.  My route here took me through Dubai on Emirates.  It was a very comfortable flight.  It is  my hope that by mentioning how comfortable this Emirates flight was, that they will somehow stumble across this blog post and be so flattered that they will upgrade me to business class on the way home (Emirates ... are you listening?).

At the airport I was greeted by Caleb Fader (Jason’s brother and our newest Kibuye team member and engineer) and my friend George Watts (PhD in business, teaching at the Hope Africa University campus in Bujumbura).  It was great to catch up with them, their wives (Krista and Susan) as well as Randy and Carolyn Bond before heading up to Kibuye Saturday afternoon.  

It has been great to be back here, to see the team again and to see the progress being made at the hospital.  Monday we did 5 cases in the OR.  For any of my nerdy anesthesia friends reading who might be curious, Jason performed the following surgeries:

• inguinal hernia repair on a 2 year old (under Ketamine)
• palmar cyst removal (under axillary block)
• epigastric hernia (also ketamine)
• intramedullary nailing of a femur fracture (under spinal) - yep, without intra-operative X ray
• urethroplasty (under spinal)

We do have a handful of cases lined up while I am here that will require general endotracheal anesthesia, and thankfully we have a few full cylinders of oxygen!

This morning, before morning report, I went for a 4 mile run with Jason, Caleb and Joel Miller.  We ran on paths I had never explored during our previous time here which were beautiful.  We were greeted at every turn by Burundian women with hoes over their shoulders and children with notebooks in hand for school, often staring at me, sometimes laughing, probably wondering why that pasty muzungu in the back is having so much trouble breathing.  

Today, I was asked to sit on a board of 3 physicians for the thesis defense of one of the graduating medical students.  I was chosen for this because I am a specialist ... and because I have a pulse.  This was my first thesis defense, but I am told there will be many more in my future.  The student presented his research on Burn Injuries at Kibuye hospital, a very common problem all over Africa due to cooking methods using open fires around small children (no, that is not some sort of advocacy for all you helicopter parents out there).

I am excited to see what the next 3 weeks will bring.  As much as the pace of life here is slower than that in the US, it is never boring.  Although to be honest, I actually enjoy boring once in a while.  

Jason and Joel in our seats of judgement

A selfie of me with the church and hospital in the background ... and a chicken

The Monster Inside of Me

Lately I have been thinking a lot about money, probably too much.  I suspect this preoccupation has been triggered by the large pay cut I am about to get as we transition to becoming missionaries.  

It has come to my attention that money is very important to people (that’s right captain obvious).  However, it is not the money itself that I think reveals so much about us as people, but rather what we do with that money, why it gives us so much satisfaction, and why we spend so much energy laboring for it, and then worrying about it once we get it.  

Tim Keller once asked the following question: Five people are sitting around a table drinking wine.  How do you tell which one is the alcoholic?  The answer is, it is not the one who drinks the most wine.  No, you take the wine away from them and see which one starts to melt down.  Which one becomes angry and agitated?  That is the alcoholic. 

It is the same with money.  I think most of us have come to believe the lie that money will make us happy.  For some of us, it is what we can buy with that money.  For some of us, it is the security (or rather, the false security) that money gives us.  For some of us, it is the feeling of superiority that having a larger bank account than our neighbor, gives us.  But if you want to find out what someone’s heart is truly set upon, take that money away … and watch them squirm.

We saw this most tragically when the stock market crashed in 2008.   One study in the British Medical Journal suggested that the money lost in this crash resulted in approximately 5,000 suicides.  I suspect the emotional impact on many families was much more wide spread.  There is a monster living inside us.  Most of us do not even know that he is there.  But he is there, and he is eating away at our souls.  

You might think that since I am giving up the “American anesthesiologist lifestyle” and the salary that accompanies it, I am immune from this idolatry.  I am not.  I have spent far too much time “counting the cost” of what we are going to do.  Now, I know, with my head, that more money will not give us satisfaction in this life.  I know this in my head, but yet the monster inside me continues to wage war in my heart.  

It has been said that Jesus talked more about money than about heaven and hell combined.  He did this not because money was so important to Him, but because He understood the destructive effect it has upon us (even 2000 years ago).  And He talked about it because He loves us, and He wants us to let go of this clenched grip that we have on money before it destroys us completely.  God Himself gave up the riches of heaven, and entered into the poverty and filth of life among us, so that by His substitutionary atonement for our sins, we might be made rich, forever.  It is my hope in this alone which will ultimately defeat the monster.

For you know the grace of our Lord Jesus Christ, that though He was rich, yet for your sake He became poor, so that you by His poverty you might become rich. - 2 Corinthians 8:9 

Intern Graduation

So tie me to a post and block my ears
I can see widows and orphans through my tears
I know my call despite my faults
And despite my growing fears

-Mumford and Sons

Last week was a pivotal week for our family.  Stephanie and I travelled to Philadelphia to the headquarters of Serge, the mission agency we have applied to for support in returning to Burundi.  The first two days were spent being interviewed and assessed. Wednesday morning, we were escorted on a tour of historic Philadelphia while the leadership team from Serge had a conference call with our team leaders in Burundi as well as the East Africa regional leaders to decide our fate.  Wednesday afternoon we were brought back to the office where we were told we had in fact been invited to join the Burundi Serge team as long-term missionaries.  

The lyrics above are from a song called The Cave by Mumford and Sons.  Somehow these lyrics worked their way into my head last week and seemed to summarize with great precision how Steph and I felt.  To be honest, I am not sure exactly what this song is about.  I am pretty sure that Mumford and Sons did not write this song about long term medical mission work.  But nonetheless, this is how we feel.  We feel like we NEED to be tied to a post, because despite the certainty that we feel regarding our calling, this is hard, and our flesh cries out “don’t do it!”.  The tears are shed in part because of our concern for the people of Burundi, but in this moment we are mostly just sad to leave the life we have come to love in Bellingham.  We know our call, we believe that God has prepared a place for our family in Burundi, and He has done this not because of our abilities or our strength, but DESPITE our faults and despite our fears. 

So, now, we move on to the next stage of our journey, support raising.  We cannot return to this work without significant, monthly support from people willing to partner with us to improve healthcare in Burundi.   And so, in the coming weeks and months we will be having conversations with many people asking for help.  Not an easy thing for us to do.  Our hope is that by next summer we will have raised the support we need to begin language training, then return to Burundi, to live, to teach, to learn, and to see how God will use us, despite our faults and fears.  

Our time in Philadelphia was wonderful.  We went through this assessment with 9 other people, applying to work on 4 different continents.  We were greatly blessed to get to know them as well as the team of people working at Serge headquarters and the Serge leadership team.  We left Philly with tremendous confidence in this organization and we truly believe that they will do everything in their power to care for us and to love and serve us well in the coming years.  

As for the title of this blog post, you may remember that during our previous 9 months in Burundi, my official title was “Intern”.  John Cropsey, our team leader, derived great joy from reminding me daily, often hourly, that I was “the intern”.  Well, now that Serge has approved us, I am pleased to report that I am no longer an intern.  I am told that this transition in my position has left John in a state of despair, as he now has no one left to boss around.  So, for anyone interested, the position of intern is now open and seeking the right whipping boy to fill these size 9 shoes.  

Surrender

I have been thinking this week a lot about faith.  Faith is still in many ways to me a mystery, but God is revealing to me slowly, and sometimes painfully, what it means to live a life of faith.

Our family has decided to move forward with plans to return to Burundi "long-term", (eg. a 5 year commitment).  What does that mean?  That means we apply to the missionary agency which supports our team in Kibuye (Serge).  In September, Stephanie and I fly to Philadelphia to be assessed regarding our fitness to serve "long-term".  And if Serge believes we are "long-term" material, they will help us prepare to spend the next several months raising support, for our income, our travel expenses, our health insurance, and anything other expense that one might encounter in Burundi.  If we are able to raise the support we need, then next summer our family will go to Colorado for a month to the Missionary Training Institute, where we will receive further training and preparation for "long-term" service.  Then at the end of August we will move to France for 6 months .... to learn French.  Then .... Burundi.

I will confess that this decision is a painful one for me.  To be honest, I like working in a hospital with oxygen and running water and patients who speaks English.  I like living close to my parents.  I like spending time with my friends here.  I like the church we are a part of.  I like drinking straight from the faucet!

But we cannot deny that God's hand led us to Kibuye Burundi, and that He has prepared a place for us among the team that is serving there.  We love the team at Kibuye.  We love the country.  Our family in so many ways thrived during our 9 months serving there.  So why is this so hard?  Why is this such a struggle for me? 

I am starting to understand that struggle (of any sort) give us the opportunity to surrender to God. And I believe it is this surrender which prepares our hearts to truly trust in God.  Struggle gives way to surrender and surrender gives way to faith and faith opens the door for God to work in us and through us, according to His perfect and gracious will.

There are still many steps to take before we return to Burundi.  There are many ways that God could close this door.  And so, we surrender even this, the certainty of our future, to Him. 

We will keep you posted as things progress and would ask that you, our family and friends pray for us, to surrender, to have faith, and for His plans to be done.  His plan is much better than ours.

In the beginning

Today is a very important day in Burundi.  Today is election day in Burundi.  Today is a day that has caused much fear and anxiety, as well as much strife and violence for the people of Burundi.  Although no one doubts that the current president will win this election, what people fear is what this will trigger over the next few days and weeks.  The blog below is one I wrote five years ago, to begin my series called the "History of Redemption".  As I re-read this, I can't help but consider how drastically different life would be in Burundi today if people understood and believed these words, that "In the beginning, God created ...".  If we really understood the implications of these words, we would all be led to a posture of humility and gratefulness, with hearts of surrender to God.  There would be no war, no fighting.  There would be peace.  Today, as we who love Burundi are praying for peace, we would ask those of you who pray, to pray with us, for peace.

Blog post for Genesis 1:1-2

“In the beginning, God created the heavens and the earth.  The earth was without form and void, and darkness was over the face of the deep.  And the Spirit of God was hovering over the face of the waters.”

How often do I meditate on God as creator of heaven and earth?  How often do I ponder the enormous implications of these first words of scripture?  How often do I tremble beneath the weight of this truth, that every heartbeat, every breath, every step is only because God created the heavens and the earth?  How often do I thank God for creating man in His own image?  How often do I worship God and give glory to Him because He is the creator of ALL things?

We live in a society that tells us that maybe God exists, but He certainly did not create the heavens and the earth.  Yet here we have these words, in this book, which has proven trustworthy and true time and time again telling us that this is a lie.  I am reminded of Paul’s words to us in Romans, “For although they knew God, they did not honor him as God or give thanks to him, but they became futile in their thinking, and their foolish hearts were darkened.  Claiming to be wise, they became fools, and exchanged the glory of the immortal God for images resembling mortal man and birds and animals and creeping things.” - Romans 1: 21-23.  How often do I mourn for lost and broken sinners whose hearts are darkened?  How often do I mourn for our society that does not recognize God as creator of the heavens and the earth?  How often am I jealous for God to receive the honor He deserves?

How often am I anxious because I have forgotten that God who created all things is sovereign over all He created?  He is sovereign over Seattle and He is sovereign over Sudan, and He is sovereign over everything in between because He created the heavens and the earth.  How often do I forget that God sits enthroned as king forever?

These first words in Genesis spoken to us BY GOD (see 2 Timothy 3:16) tell us volumes about the attributes of God.  He is sovereign, He is omnipresent, He is eternal, He is mighty, He is light, He is spirit, He is creative!  How often do I meditate on the attributes of God?  How often do I think about the creativity I see expressed in art and music and literature and recognize those gifts as a dim reflection of that awesome creativity of God who created ALL things? 

In the beginning ... God.  Not, in the beginning .... me.  What a wonderful reminder that this is His story, not mine.  God is the author, God is the producer, God is the hero.  Yes, we are invited into this story, but let us never forget that it is His story.  Let my reading of scripture always be through that lens.  This is God’s story.

And how quickly I forget that this same Spirit of God which in the beginning was hovering over the face of the waters, now lives and moves inside me?  This living Spirit was poured out into each of us who has believed in Jesus Christ.  This mysterious Spirit of God is the very essence of the Christian life, quickening our affections for Jesus Christ, God’s Son, and guiding and instructing us day by day.  And this same Spirit was there, at the very beginning of all creation!

Today, I sit at this computer and write these words because “In the beginning God created”.  You woke up this morning and got out of bed because “In the beginning God created”.  We go to our jobs, and care for our children, and dream and plan and laugh and cry because “In the beginning God created”.  The breath you just took which sustains you even now, you took because “In the beginning God created”.  

These are weighty words, because without them, nothing would follow. Nothing.  Ponder these words daily, “In the beginning”, meditate on them, worship God the creator who speaks them and who fulfills them, the God who acts and who saves, the God who sits enthroned over every square inch of His creation, and as He looks upon it He declares “MINE”.  

God created the heavens and the earth.  He filled the void and gave form to the earth.  He brought light out of darkness.  He is the Alpha and the Omega, the beginning and the end.  He did all this to bring glory to Himself, because He is the only one who is worthy to be glorified.  And we were created to worship Him.  Let us today humbly bow before our Creator, with much fear and trembling and awe.  

His Name Was Ronnie

We are very grateful for all those who have been reading and following our blog, and we don't want to stop blogging just because we have returned from our 9 months in Burundi.  We do plan to continue to post updates on our lives and our future plans in the coming months, but in the meantime, it feels like we should be posting something, anything.  So, what does one write about after returning to life the US after 9 months in Africa?  Perhaps one resurrects blog posts from years past!

Those of you who are not a part of our local church in Bellingham may be unaware that I used to blog quite frequently for our church.  A few years ago I did a weekly series of blog posts called The History of Redemption.   I decided that I would try to pull up a few of these and re-post them here.  But to start with, I thought I would re-post a blog I wrote which gives a bit of background and explanation as to how this blog series came to be.

His Name Was Ronnie

Although I never met Ronnie, although he was not famous, although we lived thousands of miles apart, he had a significant impact on my life and my faith, and I felt compelled to write a few words about him.  Back in 2010 I saw a video of a sermon preached by a young man from an Acts 29 church in Texas.  It was not your typical sermon, but was rather a series of 47 portions of scripture put together, memorized and recited before the church by a man named Ronnie Smith.  Something about watching this 28 minute video moved me deeply.  I saw in what Ronnie had done, something genuinely beautiful.  And when you experience something you believe to be genuinely beautiful, you cannot help but to share it with others.

And so, I committed myself to memorizing this work, which Ronnie called “The History of Redemption”.  I must have watched this video 50 or 60 times.  And I must have talked about it so much, that pastor Rob eventually asked me to write a weekly blog post on each of these 47 sections of scripture for our church.  And so, over the course of 2011, that is what I did.  I invested countless hours in reading, listening to, memorizing and writing, all catalyzed by what Ronnie had done.  He was a young man, about my age, and I knew nothing else about him, except that he was a faithful servant of Christ who was a part of a church in Texas.  

Last week, Ronnie was murdered in Benghazi, Libya.  He was living there with his wife and young son, and was working as a chemistry teacher at the international school, and he was shot dead while jogging.  I believe that God called Ronnie and his wife to move to Benghazi, one of the most violent and broken cities on this planet, because He (God) loves those people.  And Ronnie and his wife went because they had been filled with a hope that extends into eternity and they desired to share this hope with those who have no hope.  Although I never met Ronnie, and I still know very little about him, I am quite sure that he understood the very real possibility of facing death in a place such as this.  And still he went, to love and to serve the people of Libya and to love and serve his God and Savior.  Ronnie paid the ultimate price for his obedience to Christ, and I am confident that in the moments following his death, he heard the voice of God Himself gently whispering in his ear, “well done, good and faithful servant”.

Although today we are saddened and grieve the loss of Ronnie, his life was not wasted.  And today, be sure of this, that Ronnie is not sad.  

I praise God for Ronnie’s life.  His was a life lived with absolute direction and purpose for the glory of God.   And as we have brothers and sisters in our church preparing to move to the Middle East, motivated by the same love that motivated Ronnie, this is a painful reminder to me, to not only encourage them and support them and pray for their fruitfulness, but also to pray for their safety, to pray daily, to pray without ceasing.  It is also a reminder to me that ultimately our hope is not in the length of our days or what we accomplish, but in a God who can and will use our lives to bring glory to Himself.  For He can use all things for good for those who love him and are called according to His purpose.  Ronnie’s life was a testimony to his love for God, and now our prayer is that God would use his death as a catalyst for the forwarding of the Gospel and the hope to which we cling.  This is a worthy cause.  There is no greater cause.  

Below is a link to the video of Ronnie preaching “The History of Redemption”:

http://vimeo.com/17577695

“Precious in the sight of the Lord is the death of His saints” - Psalm 116:15

Re-entry

Throughout our time in Burundi we heard other missionaries speak of how difficult it was to return home to the U.S. after living in rural Africa.  Some call this “re-entry” or “reverse culture shock”.  So, I thought I would write a brief update on how our re-entry is going, for anyone who may still be checking in with this blog.

We have now been home for 10 days, and I will admit that there are certainly challenges with returning to our pre-Burundi lives.  The first challenge was getting over the physical side of re-entry, including jet lag, change of diet, etc.  But as our bodies now seem to be better adjusted to the time difference as well as all the processed foods we cannot seem to avoid here, now we are left with the emotional challenges.  

I had heard missionaries talk about how hard it was to come back to a country with so much convenience, only to hear those around them complain incessantly.  What I have rather found is that it is ME who I find complaining.   As an example, we moved back into our house last Monday, and Stephanie called a local provider to sign us up for internet.  After five days, and three phone calls back to this company, we still did not have internet.  Somehow this frustrated me to no end, and somehow I seem to have forgotten that we spent the past 9 months in a home without internet, and often without electricity.  Yet in Burundi I just accepted it as part of life.

For me, the hardest part of re-entry has been this feeling of unsettled-ness.  As much as I love Bellingham, somehow it feels less like my home than it did before we went to Burundi.  To be honest, I can’t figure out where my home is anymore. I long for a sense of feeling settled, of feeling like I am finally home.  And in my 41 years of life, so far, I can’t seem to find it.  

Last year I was talking to another missionary who told me that she struggled with this same feeling.  And after much prayer, she felt God telling her that she would not find her home until she found her home in Him.  When she said this, the following quote from C.S. Lewis came to my mind:

“If I find in myself a desire which no experience in this world can satisfy, the most probable explanation is that I was made for another world.”

We have been welcomed back to Bellingham with so much love by our family, our friends, our church, my co-workers, and we are so grateful for this community.  But in the end, I believe, we were not made for this world, but for another.  And so, until we reach that home, we remain unsettled.

European travels

When we originally arranged our travel home from Burundi we allotted a 3 day layover in Paris.  When we decided to leave a little early, our 3 day layover turned into a week layover.  Our good friend at Serge was on the phone with the travel agent and gave us our options for flights home.  Surprisingly, the cheapest option (from Tanzania) was through Dubai and then to Zurich.  We were able to keep our return Brussels to Seattle flights.

Our trip started with a short flight (3 hours) from Kigoma to Dar Es Salaam.  We then had a 7 hour layover in the Dar Es Salaam airport, we boarded our next plane at 11pm and flew overnight to Dubai, landing at 6am. In Dubai we had a 10 hour layover, with some very tired kids. We headed out of the airport to the Dubai mall before most stores were even open and pumped our kids full of chocolate milk and chocolate muffins then, before the sugar high could wear off, we began the process of dragging our kids all over Dubai, showing them the Burj Khalif (tallest tower in the world), the Dubai Mall (because a trip to Dubai is just not a trip to Dubai without seeing at least 1 shopping mall), and the old market (souk).

From there we flew to Zurich.  When we found out we were going to Zurich we were very excited to get to see Switzerland.  But everyone we talked to said the same thing "well, that should be ... expensive".  Yes, Switzerland is very very expensive.  We had heard that our friend Alyssa had a good friend who lived in Zurich, so we e-mailed her just asking for ideas of "reasonably priced" places to stay and fun things to do.  We did not expect an invitation to stay with her and her family, but that is what we got.  And they were amazing.  They put us up in their home, they fed us, they showed us some of the most beautiful places around Zurich.  They guided us to their favorite hotel in the Swiss Alps for 1 night, then surprised us by showing up at that hotel the next morning, after transferring all our luggage (which we had left at their apartment) to a locker at the train station, just so that we could have an extra couple hours in the Alps.  It is impossible to put into words how beautiful Switzerland was, and how much more beautiful it was because of the kindness and hospitality of this family who we had never met before.

After Switzerland, we took the train to Paris, where we spent the last 3 days (as planned), and did all the things you are supposed to do in Paris (Eiffel tower, Notre Dame, Louvre, etc).  Touring Paris with a 6 year old also means you are touring the bathrooms of Paris, which were lovely.

So, this afternoon we took the train back to Brussels where we are scheduled to fly out tomorrow morning.  Back home.  Back to reality, as we know it.

Burj Khalifa, Dubai

The trains in Switzerland have playgrounds on them!

Lucerne 

Swiss Alps

Bini's favorite place in Paris ... our hotel room. 

The Mona Lisa, surrounded by American tourists! 

Me with my tiny coffee, holding on to my tiny man bag.  Could I be more Parisean?

At the Palace of Versailles, I saw this statue behind Bini, and said, "hey Bini, that looks like us", to which he replied, "yeah, it DOES look like us ... but I don't have wings ... and you don't have a six pack"

Now THESE girls look Parisean

A Grain of Wheat

"What we do for ourselves dies with us. What we do for others and the world remains and is immortal."

- Albert Pine

"Truly, truly, I say to you, unless a grain of wheat falls into the earth and dies, it remains alone; but if it dies, it bears much fruit." - John 12:24

There is a cycle found all throughout nature.  This is the cycle of death and rebirth.  I am extremely hesitant to call the last 9 months our family spent in Burundi a "sacrifice".  It was a joy for us to be in Burundi, to live next to these families that are sacrificing not months but years and decades.  It was a joy to see so much of the beauty of Africa.  I often enjoyed the work I was doing in the hospital. But there was some level (however small) of sacrifice involved in this work, and it seems to me that sacrifice of this sort involves this pattern of death and rebirth.  Certain comforts of life in the US had to be forgone and sacrificed in order to enter into this work.

Even as I write this I am on a train travelling through the Swiss Alps looking out the window at one of the most spectacular landscapes I have ever seen.  And what I see is fields of grass and forests of trees all born out of this cycle of death and rebirth.  Every tree I am looking at started with a seed, buried under the soil, under the cover of darkness, which one day sprouted above ground and grew over years and years into an object of beauty and glory.  But without the time spent buried and in darkness, the beauty would never have come to be.

This cycle of death and rebirth I believe is part of God's plan for creation and also of His plan for our rescue.  WIthout the sacrificial death and burial of Jesus Christ, there would be no hope, no true life, no glory.  It was this cycle of death and rebirth that has led to glorification of Christ, which He has called us to trust in and to hope in.  According to His own testiomny, out of His death and His resurrection, we are given a new life, an eternal life.

And so, we take what we have, and we bring it to God and we offer it back to Him, knowing that He will call us to sacrifice and suffer, sometimes in dark places, but that out of the ashes of any sacrifice will rise new birth, new life, and fruit.  And we thank Him for the beauty of His plan, and for letting us play some small part in His story.

"But he was pierced for our transgressions;

he was crushed for our iniquities;

upon him was the chastisement that brought us peace,

and with his wounds we are healed."

Isaiah 53:5

Hidden Gems

Up until a few weeks ago, I knew almost nothing about Kigoma, Tanzania.  As the political situation in Burundi deteriorated, our team met to discuss the possible evacuation routes and it was explained that Tanzania was the closest border and that Kigoma was the nearest town with an airport.  Last week after the embassy told us to leave Burundi and we made the decision to go through Tanzania, one of the "Canadian refugees" staying at Kibuye told us that him and his family come to Kigoma for vacation and that it is their favorite place in the world.  They gave us the contact information for the missionary guesthouse where they stay and so on Sunday we ended up at Jakobsen beach in Kigoma Tanzania.  

To be honest, even as I write this blog post, I have feelings of guilt.  We are not supposed to be on vacation right now.  We are supposed to still be in Kibuye, finishing our last week there, packing our house and saying our good-byes.  But here we find ourselves, in one of the most beautiful places I have ever seen, as Burundi remains in a frightenly precarious situation.

Yesterday, I woke up, walked outside our room at the guesthouse and stood about 6 feet away from a family of zebras lounging about.  They did not seem alarmed at my presence in the slightest.  I then spent the next several minutes trying to decide if I should wake the kids to see this amazing site (as this almost never happens in Bellingham!) or let them sleep.  I decided to let them sleep, and thankfully the zebras were still there when they woke up, surrounded by about a dozen Vervet monkeys.  

After breakfast we went on a long walk along the shore to a hilltop hotel for lunch (and internet).  The coast along Lake Tanganyka is incredible.  Steph said she felt like she was hiking through Ireland.

This morning, Ella and I had a special Daddy-Daughter adventure (the other 2 kids opted to spend the morning swimming at the beach).  We hopped in a taxi and travelled about 20 kilometers south of here to a town called Ujiji.  Once again, I had not heard of Ujiji until recently, but it is the site where David Livingstone met Henry Stanley and exchanged those famous words "Dr. Livingstone I presume".  The story of David Livingstone's life has been a great fascination for me, and even more so after our time in Burundi.  Livingstone was a Christian missionary, physician and explorer who was ultimately searching for the source of the Nile River (which was later found to be about 30 minutes from Kibuye, Burundi).  In his search for the Nile he mapped out huge sections of Africa.  Ella and I had both read his biography, so to get to go to Ujiji was for both of us a completely unexpected treat.

Tomorrow we leave Tanzania, and Africa as well (for now).  We will be spending a week in Europe on our way home.  Our love for Africa has only grown during our time here, and we are so grateful to God who has opened the doors for us to have this time together as a family in the heart of Africa, where we now leave a big chunk of our hearts as well,

Happy Evacuation Day

I wonder if Hallmark has ever considered making a "Happy Evacuation Day" card.  As our new friend George reminded us, "it is like a vaca ... but with an "e" at the beginning.

I am happy to report that we are safe and sound in Tanzania.  I am tempted to recount the story of our day with details of how we sped to the border under the cover of darkness, then ran through a hail-storm of gun-fire in order to make it to safety.  But our evacuation experience was a bit less stressful than all that.  

This morning Jason lesiurely drove us to the Tanzanian border, which took about 3 hours.  The drive was lovely.  After reading the news reports of over 100,000 refugess fleeing Burundi, I was expecting to stand in a line at the border for hours, maybe days.  There was no line.  I walked right up, paid our visa fees, waited for about 15 minutes.  Then Jason drove us across the street where there was a line of taxis.  We transferred our luggage and drove about an hour to a missionary guesthouse in Kigoma, on the shore of Lake Tanganyika.  I imagined we would be walking for hours with our luggage surrounded by a sea of refugees, but that simply did not happen.  The guesthouse we are staying at for the next 3 days could not be more beautiful, with monkeys, zebras and our kids spent all afternoon swimming. 

We were given three options for leaving Burundi.  Yesterday we received an e-mail that the US government was chartering a plane to fly US citizens from Bujumbura to Kigali.  However, they said they would take people on a first come first serve basis, with no gaurantees, and that we would be asked to reimburse the US governement $620 per person ... for a 30 minute flight ... and would be on our own after we got to Kigali.  Thanks US governement!  Our second option was to drive to Rwanda. We were told that many US and Canadian citizens were taking this option.  We chose option #3, Tanzania.  It was the closest border, we had not heard of any unrest or blocked roads on the route to Tanzania.  The downsides: the visa fee and once you reach Kigoma, you still have to take a flight (or a 48 hour train ride) to reach the closest major airport in Dar Es Salaam.

Our hearts are still heavy thinking about what the future of Burundi will hold, as well as the futures of our Burundian friends who remain, and our missioanry friends, some of whom have also left the country and some of whom are staying to continue to serve in the hospital where they are much needed.

Time To Go

Well, how can I sum up the past few weeks in Burundi in a single blog post.  Not easy.  Although we have tried to remain somewhat silent about all that is going on, it seems that Burundi has finally made the national news this past week, so I thought I would update anyone reading this blog about where things stand right now.  

So, after weeks of political protests in the capital (Bujumbura), some of which turned violoent, on Wednesday, there was a military coup.  The airport was shut down as were all the borders.  Our embassy told us to stay at home and sit tight.  On Friday, the coup leaders gave themselves up.  That morning the embassy told us to stop sitting tight, and start getting out.  Same message from the Canadian embassy.  Apparentely the Rwandans and Congolese were one step ahead of us, because their embassies told them to get out weeks ago.  

So, we are still in Kibuye, where thankfully, all has remained calm, and we are making plans to evacuate soon, across to a neighboring country (I was told I should not make public exactly where we are going).  Two days ago, while there was a lull in the violence in Buja, 3 Canadian missionary families living in Buja came to Kibuye to get away from the unrest.  They all moved into our quadplex of apartements, which we have now converted into our "Canadian refugee camp" (see photo below).  Today 2 of the families found lice in their children's hair.  Now all we need is an outbreak of dysentery to complete the refugee experience.

This is our families first coup.  Although as I said we have felt safe up-country, there is still an element of fear for our safety (especially when they told us every possible way out of the country was blocked). There has also been sadness for this country that we have grown to love, compounded with the sadness of saying goodbye to all of our freinds here.  So how do I deal with fear and sadness?  I pray and I make jokes.

We are praying for peace here.  We are praying for the families we are leaving behind.  We know God is good and we know that He loves this country more than we do.  

Canadian refugees.  They can look so pathetic sometimes.  I think I saw that guy at our local Bellingham Costco.

The Freedom of Simplicity

Last Friday was my birthday.  In rural Burundi, there are no places to buy presents, there are no restaurants to go to for a birthday dinner, and there is no Scotch.  So, how does one celebrate a birthday in a place like this?  Since we came to Burundi last August, each member of my family has had a birthday here, and so we have learned how to celebrate without all the frills of a typical birthday celebration in the U.S.  This is in many ways freeing, and gives people an opportunity to express their creative side.  I had a wonderful birthday, and felt greatly loved by my family as well as by the community we are living amongst here in Kibuye.  So, how did we celebrate my birthday?

The day started with my usual Friday morning jog with Joel and John.  After returning, the kids cooked breakfast for me and gave me their gifts, including home-made cards, crafts and home-baked cookies.  Later that day they shared with me the music video they put together to one of my favorite songs.  Steph and the kids had a school field trip planned that day, so I thought I would hike up to Kibuye rock to be alone and reflect on my life.  However, I have been here long enough to know that there is nowhere in Burundi where you can go for a walk and be alone.  So, off I went, and as usual was quickly accompanied by about a dozen Burundian children, who followed me all the way to the rock, and then sat with me, for my entire time on the rock, and then walked all the way back home with me, all the while trying to talk to me in Kirundi.  So much for solitude.  

That evening we had all the other muzungus over to our house for cake, tea and board games.  They gave me cards, a stick of pepperoni, homemade trail mix, and Joel recited a poem that he wrote for me (see below).  They also sang for me the birthday dirge, taught to them by Frank Ogden and sung with great morose: “Happy Birthday, Happy Birthday, Pain and sorrow fill the air, Death and Dying everywhere, Happy Birthday”.  

Saturday afternoon, John gave me his gift, my much anticipated “piki” (motorcycle) ride.  Much thanks to Jason who let me use his motorcycle.  John led me through about 30 minutes of dirt paths to the top of a hill with one of the most spectacular views of Burundi I have seen.  It was such a joy and I am pleased to announce that I have since decided to retire from medicine to pursue a career as a motorcyclist.  

To finish off the weekend, Heather arranged on Sunday for us all to drive to Mweya, a local town where there is a bible college and a couple who hosted us for the morning.  There were 2 visiting pastors (from Washington state!) who led us in an open air church service on top of Mount Hope, and afterward we had a wonderful potluck lunch.  

I think I will likely remember this birthday weekend for the rest of my life.  And all this took place without expensive gifts or dinners … and somehow without Scotch.  

Joel’s birthday poem:

Today’s the day our ode to give

Two score and one is a long time to live

We’ve only know you a few months tis’ true

Bur friends are made quickly in this milieu

Your gentle spirit is evident to all

And among Burundians you sure are tall

Thoughtful and concerned for patients and students

Does that grace extend even to rodents?

When you pray and sing it seems that you know

The One who has called you to step out and go

Despite the risks you’ve brought kids and wife

Choosing Kingdom over the so-called “good life”

The faithful obedience is to me an example

We can trust God’s provision to be more than ample

In this year and in the ones yet ahead

May most of your patients be alive and not dead

May the gases flow freely and the access be easy

May those early morning runs not leave you too wheezy

Keep seeking and serving in this year 41

Happy birthday intern, AKA Greg Sund.

Mweya as seen from Mount Hope.

Shay's birthday card.  A few more years in Burundi and I could look like this guy.

Imbeba

(By Stephanie)

I learned a new word in Kirundi this week Imbeba. Imbeba is rat or mouse, the language doesn’t differentiate, but I certainly do.  For the animal I saw running full force towards me along the kitchen counter was most certainly a huge, hideous rat, not a cute little mouse, who admittedly would still be unwanted, yet not seem quite so disgusting.  

So in light of trying to be grateful in all circumstances here’s my gratefulness around the rat:

I am grateful the electricity has been on in the evenings this week, so I could first spot and then be on guard against the rat. 

I am grateful for whomever installed the door between our kitchen and living room which I was able to slam shut and contain the rat. 

I am grateful for guards who, upon my request, searched my kitchen for the rat (but they didn’t find him). 

I am grateful I was able to bring a bit of laughter into our guards night with my reaction to seeing a rat. 

I am grateful it was a rat and not a bat or a snake. 

I am grateful that I am now less bothered by the cockroaches, ants and termites that reside in our kitchen because I see them as less bothersome than a rat. 

I am grateful that it has taken 8 months of living in this house and hearing much movement of rats and skinks in our ceiling before one has found it’s way down into our house.  

Back in November Greg and I were awakened by an earthquake. It wasn’t very strong and didn’t last very long. Greg later told me that his fear during the quake was the prospect of the ceiling collapsing. The ceiling wouldn’t crush us, as it’s not very heavy, but the thought that terrified him was picturing all the rats that would land on us. 

So, after seeing the size of the rat in our kitchen, I am even more grateful that the ceiling held together during the earthquake. 

Our rat is still at large, but we have neither spotted him, nor any further evidence of his presence in our house. For this, I am also quite grateful! 

New Experiences

One aspect of living in Burundi for 9 months that I have greatly appreciated is the frequent occurrence of “new experiences”, both inside and outside of the hospital.  Today, as I was providing anesthesia for a 3 year old girl, face down, while John our ophthalmologist was lying on his back  on the floor, operating on her eye from below, I began thinking about some of the most memorable new experiences that I have had during our time here.  So, I thought I would jot down a few of them.  

1. Taking our pet chicken for his daily walk around the compound.  We keep her in a pen most of the time because among the missionaries families here, every other “pet chick” has been picked off by hawks or owls when we were not watching.  We hope Pickley will make it to an age where she can roam freely and defend herself from those winged meanies.  
2. Leading critical care rounds.  In the U.S. this would be performed by someone, oh, I don’t know, let’s say “qualified” to do this.  
3. Delivering a baby by C section.
4. Sticking a needle into someone’s eye socket.  John has graciously offered to teach me how to do a retrobulbar block, to anesthetize an eye.  This is a procedure that anesthesiologists are often taught about but which is usually performed by the ophthalmologist in the U.S.  Fear of litigation is minimal in Burundi.
5. Eating termites.  
6. Being asked to reanimate a child who had gone blind.  Yeah, I failed.  
7. Being given a rooster as a thank-you gift for preaching.
8. Neonatal resuscitation. Although back home I am occasionally called on to assist the pediatrician and respiratory therapist with airway management, my role in this is limited.  In Burundi, I have lost count of how many babies born by C section I have had to “reanimate”, with my only resource being the maternity nurse who normally just shakes the baby until they ether revive ... or not.
9. Paying 60 cents for a stick of roasted goat meat hanging on the side of a dusty road.  Yes, I am planning to take de-worming meds once we get home.  
10. Trying to keep it together while being coughed on by patient with tuberculosis.  Our isolation ward is simply a brick building which they assure me has “good ventilation”. 
11. Working in the O.R. alongside such critters as flies, wasps, skink lizards, rats and once a bat.  My students quite enjoyed watching my reaction to the bat.  I think it is completely natural for a grown man to cry from time to time.