Graduation

I realize yesterday was Christmas and right now I should be posting about our first Burundian Christmas, however it takes a few days for us to organize our thoughts and our photos.  So for now, I will post about last weekend.

Last weekend, the team from Kibuye drove down to Bujumbura for Hope Africa University’s graduation.  I would love to share stories from the day … however, I seem to have blacked out from heat exhaustion for most of the 7 hour ceremony.  Here are some photos that I apparently took with my camera.

All the “professors” with a doctorate degree were asked to wear this outfit … please try not to be jealous.

At least I wasn't the only one who looked ridiculous.

There were over 600 students graduating, about 30 from the school of medicine, pictured here.

 One highlight of the day was a visit by the Burundian drummers.  These guys rock hard ... and barefoot (on rocks).

Scrubin' In

December at Kibuye has a very different feel because there are no students here.  The last group finished at the end of November, and the next group does not arrive until January.  In some ways this means more work for those of us who are not students, and in other ways, it means less.  The OR feels especially different, because for most of the year, there are about a dozen students observing or scrubbing in for each case.  So, being the opportunistic parasite that I am, I decided to take this time to ask Rachel (our OB/GYN) if I could scrub in with her for a C section.  She graciously said yes, and Thursday I got to do something I haven't gotten to do since my intern year ... scrub in to an operation.

It was great fun, and I am happy to report that both mom and baby survived the operation.  I asked Jacky, our anesthetist, to take a few photos.

I think this photo displays the confidence with which I carried out the operation.

I think this photo displays the regret that Rachel immediately felt in agreeing to let me "help her".

The Field

There is a large field that separates our house from the hospital.  Most days I cross this field 3 or 4 times going back and forth to the hospital.  The field has on it a church, a soccer field, and three large palm trees.  At anytime, this field may also be filled with children playing soccer, goats or cows grazing, farmers crossing with hoes slung over their shoulders, or a variety of other scenes of daily life in Burundi.  I have grown to love this field.  The field itself has paths dug across it, which from a birdseye perspective, transform it into the shape of the Burundian flag, with the three palm trees serving as the three stars at the center of the flag.  Rumor has it that the president of Burundi has visited Kibuye several times and has commented on his fondness for this field (a source of much pride for the people of Kibuye).

One thing I love about this field is the sky above it.  It is crystal blue, and as you turn around 360 degrees, you get a sense that you are truly in the heart of Africa, enjoying the splendor and majesty of this created landscape.  I realize that the sky here is no different than the sky I normally look at back home, however, it somehow looks different to me here.  I suppose it is a matter of perspective, as the same object can appear largely different when viewed from different angles.  And I am again filled with gratitude for the daily opportunity to see the beauty of this world, from a very different place and a very different perspective.  

A Weekend in Buja

This past weekend our family was able to get away to Bujumbura for 3 nights for a little rest and relaxation.  We stayed at a resort on the beach of Lake Tanganyika.  It was beautiful and it was refreshing and we got to eat hamburgers.

Here are some photos:

On the drive down the mountain to Buja

Because sometimes you just need to pack up your couch and go

The kids on the lake with the mountains of Congo behind them

Friday afternoon we drove down the road to another resort which had 2 chimpanzees, one of them free roaming, who greeted us all with hugs.  This photo is Greg playing with the chimp.  Greg is the one wearing the baseball hat.

While we were eating lunch, the chimp snuck up to our table and stole Mekdes' Fanta.  Ella tried to wrestle it out of his hands but apparently he REALLY wanted it.

Emotional Roller Coaster

Life here is filled with moments of encouragement as well as moments of discouragement.  I suppose my life was similar in this regard back home, however, here the lows seem to be a little bit lower and the highs seem to be a little higher.  Last week was one of those high moments.  The group of medical students rotating at Kibuye for the past 4 months finished their rotations and returned to Bujumbura.  Although it was sad to say goodbye to so many new friends, the week was filled with listening to students share about their experiences at Kibuye and the teaching they received, some of them sharing this with tears in their eyes.  They were all so grateful for the training they had received under our team, as well as the national doctors at Kibuye.  

Thursday night we had our final Bible study with the students.  At the end of the evening we sang worship songs together in French and Kirundi, and the students shared with us how much their time at Kibuye meant to them.  While at Kibuye, some of these students took time twice a week to gather their money, and visit the same patients they were caring for, sharing the gospel and paying for medications, food and even soap for some of the poorest patients in our hospital.  

Friday night the students threw a party at their dormitory and invited all the attending physicians and their families to join them for music, dancing and food.  It was a beautiful evening, filled with laughter and joy, and was yet another reminder for me of why God has called me here.  

Eric awarded stethoscopes to the 5 top scoring students.  

a video!

Kibuye videos

A couple videos to give you a glimpse of life at Kibuye:

http://www.vimeo.com/kibuyehope/prelude

https://vimeo.com/113219412

Waterfalls

Last Sunday we loaded the van with a group of 14 people (our family, 4 medical students, a national doctor, two visiting doctors and two teachers) and Greg drove us to the waterfalls, about 45 minutes from Kibuye.  The falls were amazingly beautiful and the day was relaxing and fun. There are a total of 5 waterfalls in the park and a guide who spoke French hiked with us from waterfall to waterfall, showing us the way. As we hiked to the 5th waterfall we were delighted to come across some trees full of monkeys, way up high, scattering and leaping from branch to branch. 

The Bean

Friday afternoon, I got a phone call from Carlan, our E.R. doctor (American) who said he had a 1 year old girl who had aspirated a dry bean and was in respiratory distress.  He explained that we had only 2 options.  Option 1 - there was one pediatric fiberoptic bronchoscope in Burundi at the University hospital in Bujumubura.  He had already spoken with the specialist in charge of this instrument who said he would accept the child if we could get her to Bujumbura.  Option 2 - have Agneta (our visiting surgeon from Kenya) perform a thoracotomy, open up the trachea, and try to retrieve the bean directly.  After much discussion with Agneta, Carlan, and also Randy Bond (American pediatrician who happened to be visiting from Buja for the day), we decided this child’s best chance of survival was a trip to Bujumbura.  

Getting her to Bujumbura, that is the tricky part.  There is an ambulance at the hospital, however, it is not authorized to leave our district.  So, we decided to drive her ourselves.  We discussed intubating her at Kibuye, then bagging her for the 3 hour drive to Bujumbura.  However, after assessing her, Randy felt that it would be safer to drive her breathing on her own, and have everything we needed in the car to intubate if she decompensated.  But they would need someone to travel with her who could intubate her if she decompensated.  So, I said I would be happy to go.  

So, we loaded up a car with the child, her parents, Randy and Carolyn Bond (who were driving back to Bujumbura at that time anyway) and their friend.  We managed to cram a large oxygen tank in the back of the car, to give oxygen by nasal cannula as we traveled, and I hopped in the back with the child, a pulse oximeter and a backpack full of airway equipment.  We made it safely to Bujumbura, and drove straight to the entrance of the ER at the University hospital (reportedly, the best equipped hospital in Burundi).  The first person we found was a medical student who told us they could not accept the patient, because they did not have any oxygen.  I was extremely grateful to have Randy with me, who has years of experience working in hospitals in Africa, because he insisted they show us to the ER, where there was in fact an oxygen tank (but not much else).  So, we hooked the baby up to oxygen and called the doctor who said he would accept the patient.  He assured us he would be there right away.  After an hour and a half, no one had shown up to see the child.  In fact, the whole time we were waiting in the ER, we did not see anyone except the medical student and some nurses.  There were no monitors, no equipment, just 3 beds and (thankfully) an oxygen tank.  

We gave some money to the parents for food and transportation back to Kibuye.  And we prayed with them.  I found out today, that the child did eventually receive her bronchoscopy and they did retrieve at least part of the bean.  They are taking her back for another bronchoscopy tomorrow.  

When we first arrived here, I asked someone where was the best place to go in Burundi for medical care.  Their response was “just don’t get sick here”.  I said yes, but if I DID get sick, where should I go?  The answer was again, “just don’t get sick here”.  I am starting to understand.  I am grateful for the extraordinary measures that Carlan and Randy went through to save this child’s life.  Sadly, I am sure that there are countless other babies in this country who have been in this same situation and died, because no one would take extraordinary measures to save them.  I am grateful for the team here who has committed their lives to serving here to improve the healthcare system in Burundi.  And I am deeply grateful for their hearts of compassion.  

A Strange Thing’s Been Happening

(by Stephanie)

Occasionally during our first month in Burundi I’d turn on the faucet and no water would come out. Often this was because the electricity had been out for too long and we’d run out of water that had pumped from the well. But occasionally, when I’d get frustrated at the lack of running water, I’d look up from the kitchen sink to see a young Burundian girl filling a yellow vegetable oil container with water from our spigot, which stops the flow of water into our house. She’d then hoist the water container onto her head and head up our walkway, balancing it with one hand as she opened our gate and started her trek home. A slap in the face of perspective, I can get frustrated when water doesn’t run only because I have a house that has running water. And then, a few weeks back, the water stopped running. After 4 days without water we had water again, and enough water pressure to actually take a shower, it was a cold shower, but I was so grateful! I was pretty much giddy with joy over a cold shower.

During our first few weeks here we thought Ella was getting contact hives from something, then we realized she was getting flea bites.  Our couch was full of fleas, our house became full of fleas. Fleas are not so easy to get rid of in Burundi. It just so happened that I was reading the book The Hiding Place by Corry Ten Boom. In the book Corry talks about her sister insisting that we are to obey the Bible and give thanks in all situations and so her sister thanked God for the fleas in their concentration camp bunks.  Later they found out that the reason the Nazi guards would’t come into their bunk room was because of the fleas. I felt compelled to thank God for the fleas and although I don’t have any deeper/Godly reason for why we have fleas, I can tell you that having fleas resulted in our having a higher level of joy about the new living room set we were able to get. Every time I sit on our new couch I am grateful. Our couch, which is not a thing of luxury by any american standards, feels like an incredible gift to us. 

We have slow internet, we’ve mentioned that before (4 minutes of that blue bar loading g-mail yesterday) but about 3 weeks ago something happened to the lines that bringing internet into our house.  So, to get online we’d have to go for a little walk and stand outside of the containerplex or the fourplex to pick up a wireless signal.  Did I mention it’s rainy season?  Yep, so standing outside for slow internet to load.  At least once I heard the click of a Burundian’s cell phone camera as it snapped a picture of me, the crazy muzungu (white person) sitting outside with my laptop. Yesterday, thanks to some new equipment brought by someone traveling from the states, we now have internet in one room of our house.  It’s amazing how grateful one can be for slow internet, when It’s enjoyed without critters crawling about you.  

All this to say that a funny thing that I’ve been noticing in this life we’re experiencing here is that daily, almost continuously I am feeling grateful and because of that gratefulness I’m experiencing deeper joy.

There’s this way of life here where nothing is expected, so much is out of our control, or the control that we perceive that we have back in the states, that I just end up feeling grateful when I turn the faucet and water comes out, or eat something and don’t feel sick, In the states I could drive around all day and never stop to praise God that I didn’t get killed or hit anyone. In Africa driving is like one long intense prayer for survival (because it’s CRAZY!) followed by rich praise in God’s great mercy for seeing you through to your destination. 

When I expect things, like lights to turn on, I get frustrated when they don’t. But here, electricity being out is expected, so when it comes on it is met with an exuberant outcry of joy. If it’s on in the morning and we can brew coffee then there is even greater rejoicing! When nothing is expected everything seems like a gift. 

Tonight, we have electricity, we have running water and I’m blogging from my bedroom, I have this little apprehension that if this triad of comfort happens too often I’ll forget to be grateful. 

 The view from our kitchen sink

Our "internet cafe" at the containerplex

The second general anesthetic at Kibuye

Jason informed me last night that he had scheduled another case for today that would need general endotracheal anesthesia.  It was a 4 month old in need of a thoractomy with a giant congenital cyst obliterating her left lung.  For those of you reading this who do not work in the medical field, I will tell you that this is a case I would NEVER do in the US.  This is a case that would be referred to a Childrens hospital and performed by a pediatric thoracic surgeon with a pediatric anesthesiologist.  But, we are in Burundi, so we just do it ourselves.  

I am not going to lie to you, sphincter tone was high this morning.  After 2 hours of searching for an IV, the surgeon finally did a saphenous cut down, and off we went.  No arterial line, no central line, and just a 3.5 endotracheal tube that we shoved down the right mainstem bronchus for one lung ventilation.  Thankfully, the surgery went great, the kids woke up needing a little oxygen, but is now off oxygen and back in his bed with mom.  

And I am guessing that I will sleep better tonight than I did last night.

Our miss list

I certainly don't want to complalin about life here.  All in all, things here are going great.  We have all adjusted well to life in Burundi, and we are truly enjoying this time.  However, I would be lying if I said there were not some things that we missed about life back home.  So here it is, our "miss list":

Greg's miss list:

1. Family and friends - this is far and away the thing we miss most.  We are grateful for all the new friends we have made here, but we still miss, everyday, our parents, our friends and our church.

2. Consistenly running water - recently there has been an issue with our well, and so most days we have had very little running water.  And yes, I am beginning to emit a foul odor.

3. Consistent electricity - this has gotten better since the rainy season began (we have hydroelectric electricity).  But for the first several weeks, it seemed like we had more time without electricity than we did with it.

4. Fast internet - The slowness of our internet has certainly caused me to be less consumed by internet, which is probably a good thing, but still I miss my addiction.

5. Fabric softener - yes, I like my socks and undies to be soft and supple, and if loving this is a crime then lock me up and throw away the key.

6. Being able to hop in a car and run to the store or to Lake Padden.

7. Understanding people when they try to speak to me.

8. My bed.

9. My dog (we had to have Summit put to sleep before we left)

10. Scotch

What I miss from work:

1. Having more than 2 options to give patients for anesthesia (at home I have 3!)

2. Being able to give patients the medications they need to be comfortable (and sometimes to survive)

3. Clean toilettes

4. Understanding people when they try to speak to me.

5. Working suction

6. All the Skagit Valley Hospital nurses, surgeons and anesthesiologists.

7. Purell

8. An operating room without flies.

9. Having an intestive care unit to send patients to when they are critically ill.

10. Scotch

Steph's miss list:

1. Running lake Padden with friends, I miss the beauty, I really miss the talks.

2. My Thursday morning Bible studies, and the ladies who got up at 5 am to grow with me.

3. Jumping in the shower without pausing to kill the critters that have crawled up from the drain

4. Flipping a switch & having a light come on, and then stay on without flickering. Not a huge fan of fluorescent lighting.

5. My bathtub

6 . A glass of wine, especially ones drunk on the front porch while talking to my favorite neighbor.

7. Being able to go out and not be stared at.

8. My stove, and the fact that it doesn't take matches to light it.

9. Wearing pants

10. My pillow!

Burundi needs more surgeons

Last week I had the chance to go to two conferences in Bujumbura.  The first was a conference of the Christian Medical Association of Burundi.  Tuesday morning, Eric, Alyssa and I piled into the van with about 12 medical students for the 3 hour drive to Bujumbura.  It was a great conference, filled with stories of God's grace and provision in so many ways.  We drove back to Kibuye that afternoon.  Then on Thursday, Jason and I piled into the van again with about 12 medical students for a 2 day conference of the Burundian Society for Surgeons.  It was fascinating for me to learn more about the state of surgery all over the country.  I recently learned that there are only about 15 general surgeons in Burundi (a country of over 10 million people) and from what I understand, they all work in the capital, Bujumbura (aside from Jason).  I also learned that there are 3 other anesthesiologists (Reanimateurs) in Burundi, all of whom work in the capital.

After being here for 2 months, one thing that is obvious is that Jason needs help.  He needs help because there are so many people here who need surgery.  He works 7 days a week and there is just not enough time to operate on everyone who needs surgery.  He does general surgery, orthopedic surgery, neurosurgery, pediatric surgery, and urology.  And he would love some help.

During this surgery conference I also got to learn a bit more about Jason's vision for Kibuye.  He wants to start a residency program for graduating medical students who want to become general surgeons.  In order to do this though he needs a second surgeon and a long term anesthesiologist.  At the conference I learned that Burundi once had a general surgery residency program which involved 2 years of training in Bujumbura, then 2 years in France, then one more year in Bujumbura.  Sadly, this program was shut down during the civil war, and has yet to be re-started.  Another problem is that most of the surgeons trained in this program left for greener pastures (or wealthier pastures) and the other problem is that those who stayed all work in the capital.  There is no one (aside from Jason) working in rural Burundi.  

So, where is the hope?  Well, there was an announcement made at this meeting that pending the approval of the East African Coalition for Surgery, Burundi plans to re-start the surgery residency program next year.  This is good news, but obviously it would be years before anyone finished this program and is ready to practice alone.  Jason also got to meet with the other general surgeons at this conference and expressed his interest in starting a program at Kibuye as well. The other surgeons welcomed him and seemed very receptive to his plans.   It was also encouraging to meet several of the graduating medical students who very much want to become surgeons. 

This week a visiting surgeon who was a resident in Kenya under Jason arrived to serve here for a month.  It is greatly encouraging to meet this woman who has already benefited from the heart for teaching that God has given Jason.  I feel like her being here has given me a window into the future of surgery in Burundi.  And there is hope.

Eric speaking at the Christian medical conference (they informed him the night before the conference that he was one of the speakers).

Dinner Friday night in Bujumbura, with Jason and three of the medical students eager to enter into surgery.  One of them from Uganda, one from Kenya and one from Burundi .... and we are eating at an Ethiopian restaurant.  It was truly a pan-African experience.

Spider Trivia

Given our slow internet service, we were wondering if any of our blog followers might be able to identify the spider pictured below.  We would also be curious as to whether or not it is poisonous.   Stephanie and two of the other wives noticed it while in our garden.  One of these women called the guard over and asked him (in Kirundi) if it was dangerous.  He said something (in Kirundi) and she translated for us, “I think he said that you can eat this spider ….. no, wait … he said this spider will eat you”).  Slight difference.  

Whoever can correctly identify this spider will win free room and board in beautiful Kibuye, Burundi (airfare not included).

Reanimation update

Yesterday, the first group of 6 medical students finished their Reanimation rotation at Kibuye hospital.  To celebrate, Stephanie and I inivited these 6 students over to our house for dinner last night.  I can't tell you how much I have enjoyed working with these students.  They are bright, hard-working, eager to learn, kind and compassionate with their patients, they all speak between 3 and 5 languages and switch back and forth with great ease, and each of them grew up in a country ravaged by civil war (something they rarely talk about).

Last night, one of the students who is actually from the D.R. Congo began talking about the teaching he has received at Kibuye and how drastically different it is from anything he had ever experienced before.  The students at Kibuye work with doctors who are patient and kind to their students and their patients.  They are doctors who are humble enough to admit when they have made a mistake and also to admit when they don't know the answer to a question.  As this student was talking I thought I sensed his voice beginning to crack a bit, and then he admitted that he gets emotional when he talks about this.  

It occured to me that with all the changes going on at this hospital with this team of American physicians, perhaps the greatest change is that of atmosphere.  This long-term team (and I hope the short-termers like us as well) are modelling for dozens of students each year what it means to be a physician who is humble and patient, and who treats his or her students and patients as human beings created in the image of God.  And these students will then graduate and go on to be leaders in their hospitals and their communities and I believe they will become the kind of doctors that they are studying under now.  Last night was a great reminder to me of why we are here. 

Five of the six students (the sixth was out of town)

I also got this new fancy stamp!  I am told that you are not a real doctor in Burundi until you have your own stamp.  Also, I could not officially graduate this group of students without this stamp.  What does one need to get ones own stamp?  About $25 and a short trip to Gitega.  No need to show any proof that you actually are a physician.  Next week I am thinking of becoming a neurosurgeon!

The Rainy Season has Begun

Last week daily storms would roll in with the sound of thunder, then torrential rain. The deep trenches dug around our house suddenly make sense. And yes, that is our laundry on the line. 

The Beauty of Burundi

Greg and I are in Gitega this weekend, a city located about a half hour from Kibuye, and we have (slightly) faster internet access, so we are taking this opportunity to upload some photos of this beautiful country.