Pics from Ethiopia

A few more pics from our week in Ethiopia.  

Stephanie loves the Noonday company, not only does she love their jewelry but the whole premise behind the company is to train/ empower/ employee women in developing nations and help these women step out of poverty. So, she was very excited to discover that we could visit the site where  Noonday's Ethiopian jewelry is made. We were able to see the women at work and do a little shopping in their store.    

We did not expect horseback riding but the kids were able to go for a little ride at the restaurant where we had lunch. 

We visited a shop where women who were once fuelwood carriers ( a very physically taxing job) were trained to make scarves. They allowed our kids to try their hands at looming.  My favorite quote of the day came from Mekdes "I never in my life thought I would loom!" 

We got the chance to visit with our sponsor child (as well as my parent's sponsor child)

Yezelalem Minch 

We visited Yezelalem Minch's feeding program where the girls enjoyed helping serve meals to the children. 

The kids have enjoyed seeing the donkeys all around Addis, we don't see donkeys in Burundi.

We stayed at the The Family Morning Coffee Guesthouse  which is run by our friend Birtukan. We love staying here for so many reasons but one of the biggest is that our kids feel like this guesthouse is their Ethiopian home, with the warmth of Birtukan and her family.

They have a rooftop deck with the best views in all is Addis.

On Tuesday we drove 5 hours south towards Hawassa, the birthplace of our son Biniyam.

 We saw camels on the way. 

We stopped for lunch at this lake, which had an amazing assortment of birds, and a few large tortoises.

The view from our hotel on Lake Awassa.

We took a little boat ride to see hippos!

Monkeys!

Our friend Abel, who we met when we adopted Mekdes now has his own company specializing in helping connect families who have adopted in Ethiopia with birth family.  He is amazing and his gentle guidance and advice was invaluable to us this week.

http://www.bridgetoethiopia.com/

We had a wonderful week and believe we were successful in instilling a love and appreciation for Ethiopia in our children. 

Ethiopia

Every since we adopted Biniyam and Mekdes, we have wanted to return to Ethiopia as a family.  So, we hatched an elaborate plot.  We decided to move to Burundi for 9 months, so that we could take a week of that time to fly to Ethiopia, on a much shorter flight, and for a much cheaper price.

For those of you who have been following Ella's blog, you have probably figured out that we are in Ethiopia this week.  Since the kids are on spring break (yes, it is always spring in Burundi), we thought this would be a good week to travel.  We have been having a wonderful time, spending time with our friends Birtukan and Nesibu, eating delicious Ethiopian food, and now en route to Awassa, in the south of Ethiopia to visit the birthplace of both Bini and Mekdes.  We love Ethiopia, and our time here has been wonderful.  We love the culture, the people, the food ... even the weather.  Of course, how could we not love a country that gave us 2 out of 3 of the greatest gifts we have ever received.

This is my seventh time visiting Ethiopia and Stephanie's fourth.  We used to think we were sort of "roughing it" when we travelled to Ethiopia.  Now, after 6 months in Burundi, Addis Ababa feels like the lap of luxury.  There is shopping, great restaurants, and fast(er) internet.  This got me thinking, where in the world could we spend 6 months after which BURUNDI would feel like the lap of luxury .... maybe Florida?

A few picutres, more to follow at a later date.

We stopped at this lake on our way to Awassa today for lunch.  They had an amazing assortment of birds, as well as a few large turtles.

Sunset over Lake Awassa.

Biniyam passed out in the back after an afternoon of swimming at the Sheraton.

Running

I do not enjoy running.  I do not understand people who enjoy running.  But what does one do for exercise in rural Africa, in a place with no gym, no bicycles, no swimming pools?  It turns out, you run.  We are grateful to have about a 3 mile dirt road extending from the hospital compound out into the countryside.  And about 3 times a week, Stephanie and I manage to get out and go for a run.  Usually Stephanie goes in the afternoons with Heather, or with one of the many short term visitors passing through.  However, it is not considered culturally appropriate for women to run in shorts, or even pants …. so they run in long skirts.  Sound like fun?

John Cropsey and I go (weather permitting) 3 mornings each week before hospital rounds begin.  When John is off curing blind people in Congo, I go by myself.  We do not wear skirts.

So what is it like to run in Burundi?  When we first got here, it felt a lot like having a heart attack.  Given the almost 6,000 feet elevation, I managed to really stress those coronary arteries, and thankfully, after a few weeks, the chest pain went away, and now I am left only with my own sub-average physical condition to blame for my fatigue.  The path is beautiful however, with gently rolling hills, alternating between wooded forests and open valleys of tea and vegetable crops.  We are usually at some point spotted by Burundian children, who run after us screaming “Muzungu, muzungu!”.  Occasionally you sneak up on a little one by him or herself who sees you and bursts into tears, running away from you as fast as they can.  Muzungu means “white person” or “foreigner”.  On some days, a group of ambitious children will start running with you, often in flip-flops, or even barefoot (even over rocky terrain).  You may also come across a herd of goat or cattle.  

When we first arrived in Burundi, on our drive from Bujumbura to Kibuye, we drove for about 1 hour up a steep incline, where I saw several large groups of men and women running (I presume, for exercise).  Given the mountainous topography of Burundi, and I assume a similar East African genetic make-up, I was left wondering why it is always the Kenyans and Ethiopians who win the world’s major marathons.  When I asked this question, the answer I got was “their poverty”.  In order to make it as a marathon runner, you have to have some amount of money to enter races, to travel, or at least have someone with money to sponsor you.  And that is what they do not have.  We pray with time, this will change.  Given the endurance of those little kids in flip-flops keeping up with the likes of a specimen like me, I have no doubt there is potential for marathon greatness out here in the mountains of Burundi.  

The Deanimationist

As I have mentioned in a previous blog post, one of my roles here is as the hospital’s “Reanimationist”, the U.S. equivalent of an intensive care specialist.  I am serving in this role in a hospital with no designated ICU, no ventilators, limited tests available, and limited medication options.  As you can imagine, when a truly critically ill patient comes to Kibuye, there is often little we can do for them.  In fact, my Reanimation team (myself and 6 medical students each month) has lost so many patients, that some of the missionaries have re-named it the “Deanimation service”.  I guess that would make me the Deanimationist.  This past week saw a large number of critically ill patients, so I thought I would give you an snapshot of the past week.  It is not easy for me to summarize all that happened this week.  It was an emotionally difficult week, but I think the experiences that I have had give me a deeper understanding of the needs and the limitations of working at a hospital in rural Africa.  And I hope that this understanding will help myself and others to continue to work to bring about change, so that perhaps, one day, with time and effort and by the grace of God, my Deanimation team will truly be a Reanimation team.

Monday - Monday morning, Jason asked for a Reanimation consult on a 10 year old boy who underwent surgery last week for chronic osteomyelitis.  He went into surgery malnourished but otherwise healthy.  However, over the weekend, he seemed to be declining and the surgery team did not know why.  He also had a white blood cell count of 44,000.  Leukemia?  Lymphoma?  There is no way to diagnose this and no chemotherapy even if you could diagnosis.  He also seemed to be getting more and more edematous and had not urinated in 2 days.  So, I asked my medical students, what SHOULD we do for him?  We should get a Creatinine.  But our lab’s Creatinine machine is broken.  We should get some electrolytes.  No ability to do that either.  So I move on to the next question, what CAN we do?  We can test for malaria.  We did, it was negative.  We can test for sickle cell disease.  Also negative.  We can do an abdominal ultrasound.  I asked Carlan to do this.  No signs of hydronephrosis, but he did have acute cholecystitis (inflammation of the gallbladder).  Strange for a 10 year old to have this problem.  What else can we do?  Nothing.  Over the course of the next 2 days, he became less and less responsive and Wednesday night he died.  I have no idea why.

Tuesday - Rachel had a patient with a post-partum hemorrhage.  We went to the OR, Rachel stopped the bleeding, we gave her as much IV fluids as we could, gave her another unit of blood (her 4th), and she seemed to be doing okay.  That afternoon I ordered a CBC, and Wednesday morning I got the results.  Hemoglobin of 1.4 (normal is above 13).   She was awake and alert with a normal blood pressure.  I suggested perhaps another unit of blood ..… or maybe 5 more units of blood.  I heard she ended up getting 2 more units.  By Friday she was smiling and asking if she could go home.

Wednesday - I was doing a spinal for one of Jason’s surgeries while our community health worker (who sometimes doubles as an anesthetist) was giving Ketamine next door for a C section.  I walked next door the moment the baby was delivered.  Despite a normal fetal heart rate before the C section, the baby came out not breathing, and with no pulse.  The nurse and I did CPR for 20 minutes, but with no response.  The child died.

Thursday - Thursday afternoon, Jason had a 6 year old boy with what looked like a bowel obstruction.  We took him to the OR, Jason opened him up and found a perforated colon.  He resected the bowel, and all seemed to be going well, until about halfway through the case, the blood pressure started to go down.  I gave fluid, no response.  I gave Ephedrine, no response.  His blood pressure was 40/20.  I gave epinphrine.  That helped, but was short lived.  I injected an ampule of epinephrine into his bag of normal saline.  That helped, but I have never given an infusion of epi through a peripheral IV and we have no ability to start a central line here.  At the end of the case I extubated him and brough him to our recovery room.  We have no recovery room nurses, and no ICU nurses, so I sat with him.  I checked his blood pressure every 10 minutes and watched his pulse oximeter.  I made sure he continued to get fluid and his next round of antibiotics, assuming he was septic.  At 1:30 AM, I convinced myself that my being there was not going to change his course, so I went to bed.  At 3:30 AM, he died.  I wish I had not gone to bed.

Friday - Another reanimation consult, a 7 year old girl with stiff neck, headache and “ascending paralysis”.  Guillan-Barre?  Transverse Myelitis?  We have no plasmapheresis in Burundi and no IgG.  She was crying and in pain.  I asked the student what she was receiving for pain.  He said nothing.  I ordered Tylenol.

Looking back over this week, a week with so many losses, it feels like the only good thing I succeded in was giving Tylenol to a dying girl in pain.  Maybe that is all I could do.  Maybe that is enough.  I wish I could do more.  

Name That Creature - Round 2

Those of you who know me well, know that one of my biggest fears is snakes.  And coming to Africa for 9 months only kindled that fear.  In the months leading up to our departure for Burundi, I spent WAY too much time on the internet trying to figure out which snakes inhabited Burundi.  Well, we are five months into our time here, and so far, the kids saw one live snake (slithered into the bushes before they could get a good look at it), and we have seen about 4 or 5 small dead snakes (we assume they were killed by locals).  I still keep a close eye on where I am walking, but I was greatly comforted by Carlan, who has served as our ER doc here for over a year and said he has not seen one snake bite come into the ER (someone else already suggested that might be because they all died before getting to Kibuye). 

But, nonetheless, in the last 2 weeks I have come across the following, and again, having limited internet access, I thought I would throw it out there to our blog readers, to see if anyone could identify the following creatures.  Hank, you still with us?

The following was about 12 inches long and moved very quickly (like a snake), but from what I could tell it had no face.  When we asked our house helper he seemed to be trying to tell us that it had a mouth on each end of it's body and that if it got close to you, it would latch on and "suck".  Perhaps some kind of fast moving, extra large leech?

The second one is definitely a snake, but I don't know what kind.  On my way home from work last week I saw some of the workmen standing around this small snake that they had just killed.  Unfortunately, they seem to have bashed in it's head, making identification more difficult, but I thought perhaps someone could identify it based on it's markings.

The Trajectory

trajectory |trəˈjektərē|

noun (pl. trajectories)

1 the path followed by a projectile flying or an object moving under the action of given forces

As we enter into our fifth month living here in Kibuye, much of what was unique and sometimes shocking to me at first has now become very ordinary.  I suppose this would be true of almost any job.  For example, I have become used to being asked to perform an echocardiogram on a 1 week old (I still have no idea what I am doing, but at least I am now no longer surprised when I get the request).  I have become very used to the fact that I am working at a hospital with no running water (although there is a large water tank being installed just up the hill from the hospital which should resolve this problem soon).  But what is still exciting to me is the trajectory that this hospital is on.  The long term team of missionaries arrived here at the end of 2013, and the amount of change that has occured since then is astounding.  No matter where you walk around campus you will see evidence of recent change, from state of the art ultrasound machines in the E.R. to a new dormitory for the medical students, and so much more.  

Recently, when the team from Samaritan’s Purse was visiting, Jason gave a presentation explaining the 20 year plan for Kibuye.  This was the first time I had seen this plan, and it is a site to behold.  There was a team from Engineering Ministries International, who visited Kibuye even before the missionaries arrived and drew up plans for a new hospital with a new ER, eye unit, ICU, patient wards, 6 O.R.s and much much more.  There are also plans to build a large conference center in hopes that this will become a meeting site for international medical conferences.  And when I look around, even 1 year into the plan, I see so much of it has already started to happen.  What I also appreciate is that the 20 year plan revolves around empowering and equipping the local Burundians to affect this change.  It is not Americans who are out there day after day laying bricks and digging trenches, it is Burundians, hundreds of them.  And while there is still a notable presence of “muzungus” walking about the hospital each day, the goal is to teach and train Burundians to do this same work, thus making ourselves obsolete.  This will take time.  As Carlan told me, “this is not a sprint, it is a marathon”.

In 2010, I got to visit Tenwek hospital in Kenya for 3 weeks (it was there that I met the Mcropders).  Tenwek is a rural mission hospital, which was served for years by a singe missionary surgeon, I believe starting in the 1960s.  Today, Tenwek is described as the “Mayo clinic of Africa”.  And this transformation took place because over the years there was a dedicated group of Christian men and women who committed their lives to serving, caring for, and empowering a people group in need of better health care.  I am so excited to get to be here now, at the place where Tenwek was 40 years ago, and to have this vision of what Kibuye will one day become, because of the love of a small group of men and women who have laid down the riches and comforts of American life, to love a people in need.  And they do this in response to the love of a Savior, who laid down the riches and comforts of heaven to love and to serve them.

Finished:  The new medical student dormitory

Just beginning: new housing for the Burundian national docs, being built adjacent to the missionary housing

Almost finished: a new morning report building (also where the med student lectures will take place)

The physicians who serve Kibuye (minus Alyssa who is in the U.S. and one more national doc)