A Boy and His Bird

For Biniyam’s 6th birthday we gave him a little chick. Because a chick would be lonely on its own we also gave his sisters a chick to share.   

“Pickily Pickle-Juice Pickle” is the name Bini chose. 

The picture above brought to mind one question, how long could a bird SO loved survive? Well, much to everyones surprise, she has survived a month and a half, making her the longest living chick in our little muzungu village.  Her sister, the girl’s chick, unfortunately lasted less than 24 hours before it was picked off by a bird of prey.  Since then many other pet chicks have been picked off by the brazen and ruthless crows and hawks that circle the skies above us. 

It has been fun to see Biniyam take on the roll of father and protector of his little chick, guarding her every move when out of her pen and gently instructing her on where she should go to hunt for grasshoppers. 

He obviously adores her (as do all the kids) and we are really hopping that she survives the rest of our stay in Burundi. 

Answering your Questions

Well, we’ve been in Burundi for 7 months now, so I figured it was about time I got around to answering some questions that I’ve received in e-mails. A teacher once told me that if one person asks a question 5 others are wondering the same thing, so I decided to answer privately asked questions on this public blog. 

Why do you have guards?

I think the simplest answers and the one I assume is true is that we have guards because there have always been guards.  The house we’re living in has been in use since the 80’s by different missionaries and as a guest house and I get the impression that our guards have been here for a very long time.  The house is actually the property of the hospital and the guards are hospital employees.  

Do you feel you need guards?

To this question I would have answered “No” when we first arrived but over time I have really come to appreciate the fact that we have guards. So although “need” may be too strong of a word I do like having guards. Here’s why:

1) We obviously have more things than the average Burundian. Our house is open during the day as the house helper works and we come and go.  We do lock up our passports and valuables in a locked wardrobe, but it is nice to know someone is watching our house and our stuff, so even the things left outside, like umbrellas or soccer balls, don’t disappear. 

2) Our kids run free outside, there are three different groupings of houses and 3 different guards. It’s nice to know that there are other eyes loosely watching out for our kids and making sure no one is lurking about who shouldn’t be on the property. 

3) It’s very dark here at night. When I’m walking alone back to our house in the dark it is nice to have light from the guards fire and know that there are eyes watching out for me. 

4) When there are loud sounds in the night (usually avocados falling from hight trees onto tin roofs) it is nice to know someone is outside and aware. 

5) When our kids shed their shoes or leave toys around the yard their stuff ends up neatly placed back by our kitchen door. 

6) When I put a solar charging devise outside and then am away from the house when the rain rolls in, the guards move my devises safely under cover.

7) When I would forget to put the rooster in the box at night they chased him down and put him in so he wouldn’t wake us all up early in the morning. 

8) Our day guard washes our laundry. He does an amazing job getting clothes stained orange (from the red earth here) back to their original colors. 

How do “you” do laundry?

Since I already mentioned it above I’ll answer this question now too. 

In the mornings I put some clothes in a bucket and a little container of detergent outside our kitchen door.  Our day guard then fills a big tub of water from the spigot and washes our clothes by hand.  He then hangs them up to dry and at the end of the day, if it hasn’t rained, he folds the clothes, places them back in the bucket and puts the bucket of clean clothes in our kitchen.  Sometimes the clothes are still damp and end up hung around our house to finish drying.  During rainy weeks our laundry stays on the line for a few days trying to dry. If the laundry stays on the line for too long not only does it smell musty but moths can lay eggs in the material and then when you wear the clothing a grub will burrow under your skin.  This has only happened to a member of our family once. (I’ll admit it was me, I pulled a grub out of my hip with a pair of tweezers.) But, I feel it’s a small price to pay for having someone else fold all my laundry, a job that I feel I’m constantly doing back in the states. 

Our guard watching our kids play with fire. Roasting corn over the guards fire has become a favorite activity.

Why medical education in Africa?

It is not entirely clear to me how I ended up with my family in Burundi.  I did not grow up wanting to be a physician.  I did not grow up particularly interested in Africa.  In fact, given my parent’s work, and my language study in college (Arabic), one might have suspected I would end up drawn to the Middle East.  However, sometime between finishing high school and finishing residency, I found myself more and more drawn to the continent of Africa.  It was not until my first year out of training in 2006 that I did my first short term medical mission trip, to Ghana.  I loved it.  I loved everything about that trip.  I loved the people I met, the work I was doing, and once I returned home, I could not wait to go back.  

So, why Africa?  The only answer I can come up with that makes any sense to me is that God has placed a love for Africa in my heart (and thankfully in the heart of my wife as well).  He has called me and my family here.  He has placed this desire in us, and He has opened the doors for us to respond to that desire.

So, why medical education?  My first several short term trips to Africa involved me DOING anesthesia, without much opportunity to teach.  Over the years, through personal experience as well as through reading several books on development work, I have been convicted that my time and effort are better invested in teaching rather than doing.  

Last weekend, as we were returning to Burundi, we spent Saturday night with our friends Randy and Carolyn Bond in Bujumbura.  Randy is the dean of Hope Africa medical school.  We got to talking about our love of maps, and he pulled up the map below to show me.  It is from a website called World Mapper.  This map shows the world’s countries enlarged or shrunken based on the percentage of physicians that country has working in it.  In case you missed it, Africa is the thin stripe right under Europe.  

So, why medical education in Africa?  I guess this is why.

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.