A few random events

The past couple weeks have been good.  I feel like we are starting to hit our stride with living here.  There continue to be challenges, but overall, we feel well and are grateful to be here.  I thought I would describe a few of the highlights from our past couple weeks.

Last Friday evening, the 4 anesthesia students as well as the full time anesthetist here came to our home for a visit.  It was wonderful to see them all out of the hospital, and to have the opportunity to serve them tea and zuchinni bread.  They came bearing gifts as well, a beautiful basket filled with 3 pineapples (one for each of our kids).  We found out the following day that it is Burundi tradition that when someone brings you a basket such as this, you remove the gifts, then place something back into the basket as a gift for the visitor.  I wish we had learned this one day sooner.

I have now twice had the opportunity to visit other churches outside Kibuye with the local missionaries.  I am eager to accept these invitations because to be honest, I am getting a little stir crazy here on “the compound”.  Both times involved 30 to 45 minute drives through beautiful hills and villages.  Both times involved being greeted by mobs of people (mostly children) and both times involved being seated behind the pulpit facing the congregation (yep ... awkward indeed).  Oh yeah, and both times involved services lasting 4 hours (our Kibuye church service only lasts for 3 hours).  The first church we visited presented us with gifts halfway through the service, a small gift-wrapped box containing 4 eggs.  They also presented our local Burundian pastor with a live chicken, which rode home with us in the car.  Mekdes joined me for the second visit, and somehow managed to sit through the entire 4 hour service.  This was undoubtedly a miracle. I later found out that she’d completed a full week’s worth of math in the math workbook she brought with her, with the entire church watching her.  After each service, we were again mobbed by hundreds of people who wanted to shake our hands and then just stare at us.  I guess this must be what Brad Pitt feels like when he goes out in public.  Yeah, that’s right ... I just compared myself to Brad Pitt, what of it?

The past couple Monday afternoons, Steph and the kids visited the hospital, bringing paper and crayons to draw pictures with the kids in traction.  These poor kids lay there in bed for weeks at a time with nothing to do, and they seem grateful for the distraction of a bunch of Muzungu kids playing with them.  On their first visit to the hospital Steph and the kids were a bit surprised by the herds of rats scurrying around the ward.  The rats here are not shy ... and they appear to be well fed, sometimes more well fed than the kids in the hospital.  In fact, we’ve been told that the malnutrition rate among children in Burundi is 60%, but that’s a topic for another post. 

We are continuing to learn new things, and meet new people everyday, and are grateful to be here, and to have the strength to continue in this ministry.

Free Range Children

I have fond memories of childhood.  The long summer days when I’d jump on my bike and join the other members of the Camouflage Club (previously known as the Clue Club) in the woods near our house to build our fort, climb trees, solve whatever mysteries came our way. We’d be off on our own playing outside until my parents, quite literally, blew a horn signaling it was time to come home. 

I’ve often bemoaned the fact that the world we live in is too different for me to allow our children the same freedoms I had.  When we moved into the our house back in the US I was excited about the woods that lay beyond our fence, “The mysterious beyond” we labeled it and encouraged our kids to go explore.  That is, until we saw the tarp, the sleeping bag, the evidence of a campfire.  We live in a small city, there are many homeless, occasionally they camp just beyond our fence.  Neighborhood kids are fun when home, but often busy with activities, or our kids have activities. If they want to play at a park, I’m there with them.  I don’t want to be a helicopter parent, but in the US it is hard to have free range kids.  

On our first day in Kibuye, Anna, the other 9 year old, asked if the girls could join her for a walk.   “We don’t know, can they? Is it safe?” And so our motto came to be “If Anna’s parents let her do it, then it’s okay, you can too.” And off our girls went with Anna into the woods to walk past tea fields and Burundians hoeing and to find a mound of red earth just beyond the bamboo fence. They spent they next few days shaping the clay into bowls and animals, creating “claytopia”. Ella even had a Burundian boy paint her face with the red clay.  (We like to tease her in saying that we’re pretty sure this means that they are now engaged.) They let Biniyam join them and I unpacked in peace and strange silence. 

That night I had a nightmare in which I was back in the US.  I was unpacking and Biniyam ran into the room, he said some people brought him home and wanted to talk to me. They were from DSHS and they said they had found my 5 year old wandering around town by himself and why wasn’t I watching him? Once awake I found the dream amusing, pointing to the big reason I don’t allow my children to roam free in Bellingham. I’m afraid of other people, that they will hurt my kids or what hassle they will make for me. I fear people looking at their phones while they drive and not watching for kids crossing the street. I trust my kids, I don’t trust the community at large.

But here they have a controlled area in which to roam, and it’s of a pretty good size.  There is one short road and rarely does a car open the barrier and drive slowly through.  They have multiple houses in which to play (for example, I currently have 3 children playing at my house, none of whom are mine, my children are playing at someone else’s). Before school they will often head out and find friends to play with and after school until dinner they’re with friends.  They spend a lot of time in our “art studio” room drawing their characters for whatever storyline they have going that day and then they head outside to act out their stories. They catch toads and lizards, they climb trees, they play chase, they build forts, they solve mysteries. They don’t complain of boredom, they don’t beg for media time, they fall asleep quickly and sleep through the night. This is my favorite part of our life here in Burundi, watching our kids experience this childhood of freedom and exploration. 

Making history can be painful

The anesthesia students have been very excited this week.  That is because today, we scheduled the very first surgery under general endotracheal anesthesia at Kibuye hospital.  There has been an anesthesia machine in the OR since I arrived, but it had not been set up or used until today.  This week, Jason and I worked on getting it ready to go, connecting an oxygen tank to one port, an air compressor to another and filling it with expired halothane and expired CO2 absorbent.  So what could go wrong?

After discussing the plan with the students, drawing up the medications and preparing the intubation equipment, I handed my ipad to one of the students and asked him if he would take a couple pictures of the intubation to memorialize this historic event.  So, we injected the induction drugs, and this patient turned out to be one of the most difficult intubations I have ever encountered.  The reason for the surgery was to remove a tumor on his neck.  This tumor was apparently distorting his airway, making visualization of his vocal cords almost impossible.  So, what should have been a 15 second induction of anesthesia turned into a 45 minute scene of chaos and mayhem.  At one point I could not ventilate the patient and so his oxygen level dropped to undectable  levels.  The medical student with my ipad continued to take pictures this whole time, 133 photos to be exact.  And I remember thinking at one point that I REALLY wished I had not asked someone to take photos of this historic event.

Alas, by the grace of God, the endotracheal tube finally found its home, the man had his surgery, woke up and appears to be doing fine, and hopefully our next general anesthetic will go a little smoother than this one.  

A few of the less incriminating photos .....

This is the air compressor which is driving the anesthesia machine.

Our quirky house

We really do love our house here in Burundi.  From what we know, it was built in the early 1980s and was the home of Frank Ogden, an American missionary surgeon who lived here for many years (for those of you employees of Skagit Valley Hospital, Frank worked for a period of time at SVH during the Burundian civil war .... small world).  We love the yard with all of its beautiful trees and flowers, we love all the space we have inside (much more than we expected).  However, there are a few things about our house that I can only describe as .... quirky.  Such as:

This cheetah skin hanging on one of our walls

Or this machete and spear which we found in our bedroom the day we moved in.  I like to imagine Frank using these to fend off attacking lions.  Although, I dont think there are any lions around here.

Or this antique phone .... ironically hanging right above the internet modem.

And this, my favorite part of our quirky house .... electricity central.  In the middle of this rats nest of wires is a switch which we have to turn on everytime we want to take a hot shower.  Some days, this elicits a small spark, which is very exciting.  Dont worry grandparents, we have STRICTLY forbidden our children from EVER entering this room.

Home sweet home.

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.