Recess

Who needs monkey bars when you have an Avocado tree in the schoolyard?

Well Sent

One thing about our time in Burundi that I don’t feel like we have properly addressed yet is that fact that behind our family coming here are a great number of people back home who sent us.  We were sent in many ways and by many people.  And I am sure many of the people reading this blog are the same people who provided for us with financial donations, prayers and words of encouragement as well as support in many other ways.  Here are some of the ways in which we were “well sent”.

1. Many people donated generous financial gifts to help our family with the cost of airfare, visas, malaria meds and countless other pieces of this trip.  We are deeply grateful for all of your support.
2. My anesthesia group (Bellingham Anesthesia Associates) gave me the nine month sabbatical to make this trip a reality.  Our CEO also worked on many pieces required for this trip to come to fruition, including health insurance, credentialing paperwork and malpractice insurance issues.
3. Our children’s teachers in Bellingham were generous with their time in helping prepare our family for this time and specifically for helping Stephanie prepare to enter the world of homeschooling.
4. My band back in Bellingham “Runaway Truck Ramp” hosted a surprise party/fundraiser for the hospital here in Kibuye.  It was such a wonderful time with friends from work and our local church attending and giving generously toward the Kibuye hospital expansion project (https://www.whm.org/project/details?ID=19170)
5. The staff at the hospital where I work  threw another party two nights before we left for Burundi and took up a collection for our trip.  Again, we felt so deeply loved by the thought and effort that went into these two parties.
6. The hospital where I work also donated many supplies which I was able to bring with me to use in our work here.  We have already started using the ear tubes!
7. Our friend Ethan volunteered his time and skills as a real estate agent to help us rent our house while we are away.
8. As we were driving toward the airport on our way to Burundi, our dear friend Kim stood with her son Harper on the overpass by our house with a giant sign saying “We love you to Burundi and back!”.  
9. My parents have provided much support for us in many ways, one of which was allowing us to move in with them for the six weeks prior to our departure while our house was being rented.  
10. We have received many e-mails, phone calls and other personal messages of support and encouragement in the weeks and months leading up to our departure.
11. The week before we left, the elders of our local church (Redeemer) had a going away party for us.
12. And on our final Sunday in Bellingham, our church family gathered around us, laid their hands on us and prayed for our family and for God’s work in Burundi (http://redeemernw.org/).

There are many other ways we were blessed by our friends and family and we want to again say, thank you, thank you, thank you.  We truly feel loved.

“By this we know love, that he laid down his life for us, and we ought to lay down our lives for the brothers .... Little children, let us not love in word or talk but in deed and in truth.” (1 John 3:16,18)

Kim Brown, Skagit charge nurse and party hostess extraordinaire

Final send off at Redeemer church

Réanimation

Soon after we arrived in Burundi, I was informed by the dean of the medical school that I am a “Réanimationist”.  I am still not sure exactly what a Réanimationist is, but I have to admit, the title is pretty cool.  In fact, I am considering having business cards and T shirts made up.  Greg Sund,Réanimationist, MD.  

As to what the practice of reanimation involves, the answers I have received have been mixed.  As I now understand it, it does NOT involve copying cartoon characters.  And I am not in fact expected to bring dead people back to life.  And after some clarification, it turns out that I am not expected to give the power of vision to children who have gone blind from meningitis (yes, I was asked to consult on a patient for this very reason).  

From what I now understand, it involves a combination of anesthesia and critical care medicine, with an emphasis on resuscitation.  The reason my new title is important is because all medical students in Burundi are required to rotate through one month of “Reanimation”.  Given that the medical school here has no reanimationist, this requirement has gone unable to be fulfilled for many of the medical students (apparently, there are 3 or 4 “Reanimationists” in the country, but they do not have enough availability to get all of the medical students through this rotation).

So, I was asked if, during my time here, I would lead a monthly Reanimation rotation, with 6 students each month, in the hopes of getting 30 or 40 students through this requirement while I am in Burundi.  I said yes, and this past week, we began.  

Mercifully, they chose 6 of their best English speakers to ease me into this new role.  Our schedule involves 2 lectures each week, mornings in the O.R. learning about anesthesia, then spending 3 afternoons each week rounding on critically ill patients, which we are asked to consult on by various services (Peds, Internal Medicine, Surgery).  To be certain, this afternoon portion is a role I am far removed from back in the U.S.  I did 3 months of critical care rotations during my residency, but since then, the only time I am invited into the ICU is when someone needs to be intubated or needs an invasive line.  So, I am hitting the books, and trying to dredge up all those critical care memories that have been suppressed for years.

The first week has gone surprisingly well.  And I have actually found myself enjoying my time on rounds.  There are plenty of moments that involve me stepping out of my comfort zone (eg. rounding on a patient in isolation with multi-drug resistant tuberculosis).  But the students are wonderful.  They are diligent, and compassionate, and they are learning so much with so few resources (no ipads, no computers, and the only books they read are a handful of medical books in English which are kept at the hospital … then they are required to present all this information in French).  

So, the next time you are feeling less than animated … feel free to call me … Greg Sund, Réanimationist ….. MD.

All is Well

We got a kind e-mail from a friend saying that the pictures on the blog are beautiful, but what is really going on behind the scenes, how are WE doing?

The short answer to that is that we’re doing well.  We like it here.  

Ella told us that she had decided she was going to like Burundi the first night we arrived in Buja, Biniyam made his love clear two days later when we arrived in Kibuye and he ran from room to room declaring his love for each item he found in our house. Mekdes has just been hard to keep back, at 7:30 in the morning she is ready to get outside and play.  Greg has had a different experience than the rest of us, jumping into work at the hospital the day after arriving in Kibuye.  It wasn’t until later that week that I went on a tour of the hospital, a “child friendly” tour, and was overwhelmed by the in-your-face reality that this is an impoverished nation.  I’m amazed that he gets up each day and enters that world, beyond our bamboo fence, and overall he likes what he’s doing. Me, I came to Burundi with very low expectations. I thought bugs would be everywhere, I though toilet paper would have to go into the trash (as it does in other African and Asian countries that we’ve visited), I figured we’d mostly be living out of our bins and that we wouldn’t taste cheese for the next 9 months. My low expectations served me well, because I was elated when I found out toilet paper can be flushed! I’m still amazed at the lack of bugs in our house, and the lack of concern about bugs that the other missionaries seem to have.  I was so excited that we can buy cheese at the store only 1/2 hour away from us (all the rice, beans and veggies we eat are so much better with cheese!) and I really like our house.  Our house is definitely quirky, but there are ample hutches and shelves for us to unpack our six bins of belongings and feel at home.  During our first week here the other families hosted us for dinner each night, the meals they made were delicious and gave me hope that with some creativity we can eat well with the limited ingredients available.  We also found out that because we are at a high elevation, there are no poisonous snakes here, the mosquitos are few (but we still take malaria prophylaxis) and it’s not muggy.  We’ve actually been cold more often than too hot, since I’m not a lover of heat, this is a good a thing.

 There are developed nation conveniences that we miss, consistent electricity- it seems to be off here more often than on, and always seems to go out during dinner. We miss the ease of jumping on the internet as it is not only very slow here, but our MB usage is limited because of the high cost.  And the convenience I miss the most is the ability to just run to the grocery store and the ease of getting food.  

It goes without saying (yet I’ll say it anyway) that we also miss time with our friends and family back home. We love hearing what you’ve been up to, so please keep those comments, questions and e-mails coming. 

A day at the hospital

It is still difficult for me to fully express all my thoughts regarding work at the hospital, but I thought I could start by at least describing a typical day for me.  The day starts at 7:30 AM with morning report, which is preceded by morning devotional time.  All the medical students and some of the staff gather in a small room where they sing a worship song in Kirundi.  This is my favorite part of the day.  I dont know what it is about Burundians, but man can they sing. 

After this song, there is a short message from the hospital pastor (also in Kirundi), then the medical student who was on call the previous night gives report on new admissions and issues with inpatients. This happens in French, so I at least have some small idea of what is going on.  After this I usually go on rounds with the surgery team.  

This is one of my favorite patients to visit on rounds  He has been in traction ever since I arrived here, with no ipad, no TV, and yet still with a smile on his face.

The muzungu (white man) in the middle of the photo is Jason, our general surgeon.  He is also our orthopedic surgeon, neurosurgeon, urologist, sometimes anesthetist, handyman, exterminator, and much more.  And he does all these things well.  Most of the time, Jason is surrounded by at least a dozen medical students.

After rounds, I head to the OR, where Jacky (the full time anesthetist) and her team of 4 students have started preparing the first patient for the day.  I try to teach the medical students and the anesthesia students as much as my limited French will allow me to.  Often I am reduced to using English with a French accent or just speaking English really loudly, hoping that somehow that will make them understand.

After our arrival, it was disovered by the other missionaries that I did a cardiac anesthesia fellowship.  Somehow, this qualified me to perform and interpret transthoracic echocardiograms.  Today I was requested by the ER to perform another one, my fifth since I have been here.  One of them was on a 1 day old baby.  Thankfully, todays patient was an adult.

The day I took these pictures and wrote this blog turned out to be a very difficult one.  For our second case of the day, Jason operated on a 1 year old with a giant abdominal mass.  Although the tumor turned out to be likely benign, there was another cancerous tumor on his liver which was not able to be resected.  And there is no chemotherapy in Burundi.  So, likely this child will die within a few months.  Then, around 2 PM, there was an emergency C section.  The baby was delivered quickly but came out not breathing.  After about 20 minutes of ventilating him with an ambu bag, I decided to intubate him,  I am not sure, but I think this may have been the first patient ever intubated at Kibuye (there are no ventilators here, and in fact, there are no ventilators anywhere in Burundi).  With a team of about 6 people (students and lab technicians), we worked on resuscitating this child for the next 3 hours.  For lack of IV access I tried things I have never done before (like attempting an intraosseous line as well as attempting a femoral cut-down ... both unsuccesfully).  To top things off, the phone network was down, so no one could get a hold of Alyssa, our pediatrician.  Finally we found a medical student to run to Alyssa's house to bring her to this very sick child.  By this point, the baby had started breathing on his own, so I removed the endotracheal tube.  However, he was still very weak and sluggish.  

Alyssa came up with a plan to keep the baby in a room next to the operating room so the baby could have oxygen overnight, and to have the mother stay with the baby.  When she went to talk to the mother, she discovered that after the C section, the mother had been found dead in bed, we don't know why.  The baby survived overnight but died the next day. 

This was a difficult day.  I am doing things here I am not qualified to do.  I am told by the other missionaries that this is just part of life here.  Now, if you will excuse me, I am going to curl up into the fetal positioin and dream of doing lap cholecystectomies on healthy patients with Mike Erie while getting prank phone calls from Tyler Leedom in the O.R. next to mine at good old Skagit Valley Hospital.

Mekdes' 9th Birthday

On Saturday we got to celebrate Mekdes’ 9th birthday. What did Mekdes request for her birthday? A mango! Unfortunately no mangos came with last weeks fruit delivery, and none were to be found on the blankets laid out on the side of the road in the nearby village. But, one of the other families here put the request out that mangos be brought for Mekdes by a family traveling from Buja the day after Mekdes’ birthday. So, Mekdes did get her mangos, special delivery, and enjoyed them thoroughly.  What other gifts can be found around here for a 9 year old girl? Well Greg and I gave her a bucket. Yep, a big blue bucket, with the explanation that if she finds a chameleon she can make a habitat and keep it for a pet. We also did bring a small lego dolphin set from home for her. Ella made her an origami swan mobile and the “older girls” put their creative minds together and made a very cool Barbie house out of cardboard boxes and whatever else they could find.  

 On Saturday afternoon, after an unsuccessful chameleon search, we held a birthday party for Mekdes’ and her friends.   We ate cake and played pin the tail on the chameleon.  Later in the afternoon  we took a bunch of the kids for a little hike up to Kibuye Rock. The walk is through the village and up a path, about 20 minutes from our house. We gathered quite the crowd as we went through the village as kids like to follow and watch us. It was Mekdes’ first time to Kibuye Rock and she had a lot of fun climbing about and playing with her friends.  

 Beyond the village kids and our kids in this picture you can see the hospital, the group of buildings in an L shape. Beyond the hospital in the field is the church and beyond the field and under the trees is our house (not able to be seen in the photo).

The local children mostly just quietly watch us, we’ll exchange greeting in Kirundi and  sometimes they try to practice some english, typically it’s “Hello, how are you? What is your name?” The boy pictured below said “Photo?” as I passed, so I took his photo and then showed it to him on my camera. I really like the photo. 

o.  

Let the School Year Begin!

There has been Great excitement this week as our kids have started school here at Kibuye Hope Academy. The school is a very cute building with 2 classrooms, a bathroom and a kitchen.  Excitement is added to the structure by the fact that there are two bats hanging from the external rafters of the school, about 5 feet from the schoolhouse door.  I see some science lessons on bats in our children’s future.  

There are a total of 8 children attending Kibuye Hope Academy, all are the children of the team of American doctors that we have joined here.  There are four “older girls” including Ella and Mekdes, who range from 2nd to 4th grade, and four kindergarteners. 

Two of the mothers here are teachers by profession, we are so grateful that they were able to use there educational knowledge to pick out the curriculum and arrange the class schedules as well as teach our kids some of their subjects.  

We also have one full time teacher, a young woman from Canada who arrived at the same time we did.  She is very personable and our kids adore her.  

I’m also doing some teaching this year. I’m teaching history to the kindergarteners and science to the older girls. I’m also teaching Mekdes her math and language arts, as she is the only 3rd grader.  

I took some great pictures on the first day of school, but alas, the SD card was not in my camera… so here are some pictures from the second day of school.  

After school on the second day the kids had arranged a celebration at “guava fort” ( the guava tree in the school yard that they made into a fort last week). There was popcorn, flavored water and singing.  It was a lovely event.  

Slow of speech

There is a lot I could write about my work at the hospital, but I suppose I will start with an answer to the question, “what has been the most difficult thing about serving in Burundi?”.  For me, the answer has been language.  The language of Burundi is called Kirundi.  It is in the same group of languages as Swahili.  The language used in business and politics (and healthcare education) is French.  Very few people speak any English at all.  This was not a surprise to me, and I spent a considerable amount of time before we came here preparing for this by studying French independently.  However, while it was easy to find computer based resources for studying French, it proved very difficult to find any native French speakers in Bellingham to practice with.  Add to this my aging 40 year old brain, which is not nearly as spongy as it used to be.    

So, what is it like for me to teach anesthesia to medical students and anesthetists in French?  Imagine teaching a discipline which took 12 years of higher education to learn, but with the vocabulary of a 4 year old.  It is hard.  It is exhausting.  It is often painful.  It is probably even more painful for them to listen to me than it is for me to struggle with every word.  But they have been gracious.  And I am encouraged by the other missionaries I am working with, most of whom spoke little or no French 2 years ago, and now are able to converse with great fluency, using complex medical terminology.  

Compounding this difficulty is the fact that most of the patients speak no French at all, only Kirundi.  As it turns out, there are almost no resources to learn Kirundi outside of Burundi.  So, I came with a handful of greetings and basic words (eg. water, coffee, chicken), but other than that, I’ve got nothing.  Thankfully, we now have a Kirundi language tutor to meet with us once a week to help us get at least a basic framework for communicating with the locals. However, I had my first lesson today, and my tutor’s parting words of encouragement to me were, “with you, I don’t know if I will succeed”.  I am hoping something was lost in translation.

In all this, I am comforted by the biblical account of Moses, who was self-described as “slow of speech and tongue” (Exodus 4:10).  And God’s response?  “go, and I will be with your mouth and teach you what you shall speak”.  I know that I cannot succeed in this based on my own ability to learn French and Kirundi, so, I go with the hope that God is with me and can use me even with my stumbling tongue.

Now we are in denial

Woops, I meant, now we are in de Nile!  Today was our first Saturday at Kibuye and we thought we would spend a relaxing day at home.  However, after breakfast, John Cropsey stopped by our house to invite us to join him and a few others on a short day trip to the source of the Nile river, which happens to only be about an hour drive from Kibuye.  Well, we could not say no to that offer.  It is the rainy season now, so as you can see from the photos it is a bit cloudy and rainy, but nevertheless, it is still beautiful.  This is the southern-most source of the Nile river and was discovered in the 1930s by a German historian and explorer.  Above this area, you can hike to a small pyramid atop a hill, built by the same explorer, with stunning views of the Burundian countryside all around.  

Notice the bathrooms just upstream from the source of the Nile:)

And apparently it is okay to let your kids take their shoes off and walk around in it

This photo was taken BEFORE we discovered there was a bat hanging just behind Steph's head

Writer's block

All in all, I would have to say that our first four days in rural Burundi have been wonderful.  There have been the usual challenges of life in Africa (eg. intermittent electricity, needing to filter your water, the occasional unwanted house guest … eg. termites, geckos and maybe mice), but overall, it has been really really great.  The long-term missionary families here have been incredibly gracious and helpful in getting us settled in.  We have had so many new experiences, sights, sounds, and smells, that I have no idea where to begin.  I suppose over the next few months stories will come out and descriptions of all the ways that life is different here will be articulated, but for now, I just don’t even know where to begin.  So, a few photos.  

Fun with mud

Our home ... for 9 months

 Bini, the African warrior

Ella on the road to our house

Settling in

This will have to be a quick post, but I wanted to let anyone watching our blog to know that we arrived safely in Kibuye yesterday.  It is stunningly gorgeous up here, green and lush.  Our new home is surrounded by all sorts of flowers and plants we have never seen before.  The kids have been running around having so much fun with all their new friends that we think they might explode.

Only problem so far is the internet, which is slow and apparently they have been having problems with usage, so the team here has asked us to try to limit our usage.  So, we are hoping to post some photos soon, but might be a couple more days ... sorry.

But all is well, and we hope to blog more soon.