I’m currently writing from the CMDA CME conference - an incredible opportunity for missionary health care professionals (mostly in Africa and Asia) to receive relevant continuing medical education without flying back to North America. There are 715 people here at this conference representing 75 countries! It’s been fascinating to learn from experts on many topics that will directly apply to our setting in Burundi - such as methods of teaching medical students and residents, HIV/AIDS updates, caring for patients cross culturally, teaching newborn resuscitation, understanding and avoiding physician burnout, practical ultrasound and echocardiography use, etc. The other fabulous aspect of this conference is reconnecting with friends and colleagues doing similar work around the world - such as my friends from Tenwek in Kenya, other World Harvest (Serge) missionaries, and those we worked with when we were with the Samaritan’s Purse post residency program. As I’ve conversed with these friends who understand our work but have never personally seen our setting in Burundi, I thought I’d share with you some of their questions and my answers after 9 months in Burundi and 4 months of working at Kibuye Hope Hospital:
Has the situation at the hospital been better or worse than you expected?
Better. When I visited Kibuye in 2011 there was no running water or supplemental oxygen and there was only one physician for an 80 bed hospital. After seeing that situation, while still in Kenya I began learning how to perform c-sections thinking I may need to take call for the whole hospital. I also had no idea how the medical education situation would work and feared I may be asked to teach biochemistry or some other preclinical course. Now in 2014, there are 5 general Burundian doctors who aren’t specialized but who do c-sections and take primary call for the hospital - which means I don’t have to do c-sections! (I prefer to focus on resuscitating the babies anyways.) These colleagues are excellent resources for us as we learn this new system and work together. As of one month ago, running water became available in the hospital. Hopefully that will significantly decrease our infection rates as handwashing becomes more widely practiced. And as I’ve previously mentioned, we do have the oxygen concentrators to provide supplemental oxygen for 4 kids at a time. And I'm teaching the students relevant and applicable pediatrics and internal medicine - within my field!
What have been the biggest cultural challenges you have faced thus far?
For me the cultural challenges have been in the area of education. Of course learning styles and education methods differ across cultures. Similar to a French or Belgian system, teaching often takes a shame-based approach in Burundi. I struggle to know when to observe and learn from cultural differences and when to step in and redirect the focus of medical education.
What has been unexpected about your work in Burundi?
The need to prioritize. In previous work settings, I’ve had limited time (such as 2 years in Kenya) to observe, evaluate, and make changes in systems issues. Now we really have no defined end date for our work in Burundi and yet we also see so many areas of brokenness in the system. The temptation is to try to improve on too many things at once rather than taking the time to recruit national partners and staff ownership of various new ideas or changes. I’m learning to allow margin in my life and to wait and observe when possible tackling only a few small changes for now because there isn’t a big time pressure. We’re not building a 300 bed tertiary care center in a day!
How is it going teaching in French?
Better than expected. There has been a very steep learning curve over the last few months in the area of French medical vocabulary. But, as those are words we learn and then use quite regularly, the information sticks more readily than some of the vocab lists memorized in France. All 6 of the docs on our team are functioning well in French both on the wards and in the classroom setting - certainly with grammatical errors but with gracious students who seem to understand us without difficulty. And the same focus on prioritizing applies to medical education. We can’t build a complete clinical education program for the last year (7th year) medical students this year, but we can begin with the 5th years and seek to improve on the program each year along with our partners in Bujumbura. As I said, I have lots of new ideas for teaching in a more interactive manner after this conference - we’ll see how it works in real life and in French!
5th year med students with Rachel and me
Classroom where we teach daily
How has your team been received by the hospital staff?
Enthusiastically. We certainly have put a strain on the system adding 6 doctors at once but we’re thankful for the warm reception of the hospital staff and the willingness to work together to improve health care delivery and medical education in our setting.
What is the dominant religion in Burundi?
Statistics demonstrate that Burundi is about 60% Catholic, 25% Protestant, and 10-15% Muslim. We find that most people are familiar with the basic truths of Christianity but that it’s variable how deeply those truths have penetrated into their lives thus discipleship is a big need.
Bible study with the med students
Do you have ______ in your setting? These are the questions asked by the presenters at this conference. Fill in the blank with ventilators, defibrillators, dialysis, various drugs or vaccinations, etc.
Usually our answer is no. But the one exception today was yes to rotavirus vaccine - evidently unique compared to other countries as most others did not have access to it. So there’s one advantage Burundian kids have - hopefully less rotavirus induced diarrhea and dehydration.
What mission do you work for?
As of two weeks ago, that answer changed. No, I didn’t change mission agencies, and I’m still very happy with and thankful for World Harvest Mission - but the name changed. Basically the name “World Harvest Mission” was confusing for people as we don’t actually do agricultural work and there are many organizations with similar names. So now we are “Serge: Grace at the Fray.” A serger is evidently a machine used in sewing to make rough edges smooth and this is our work. We see many rough edges in our own lives and in the lives of the Burundians and the broken systems, economy, etc. and we are so thankful for the work of grace transforming us all for God’s glory. Check out the new website here with an excellent video explaining the name change.
A few Serge missionaries
Fun connection - a nurse who worked at Kibuye Hospital between 1980 and 1982! Loved hearing her stories of what it was like there as a young nurse and showing pictures of how things have changed.
If you have other questions for me, comment below!
