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.