Burundi

Amahoro! (Peace - Kirundi greeting.) We certainly experienced God's "amahoro" last week as we were affirmed in His leading us to Burundi as a team long term. We pray that "amahoro" will continue to reign in Burundi for many years to come. As you can see from the map, we didn't travel too far from Kenya - a short 90 minute flight from Nairobi to the capital of Bujumbura. We certainly noticed some similarities in another East African country but a lot of differences, too, culturally, linguistically, and materially.

Our host, Bishop Buconyori, and his daughter and her husband greeted us warmly at the airport and prayed with us prior to our 2 hour drive up country to Kibuye Hospital. Our team currently includes 8 adults and 6.5 children but only three of us traveled to Burundi this time around.

Kibuye Hospital, new maternity building

Sunday afternoon we enjoyed hiking near the hospital

Behind me down the hill is the hospital

Ariel view of Kibuye

I enjoyed rounding with the medical students each day on the various services (pediatrics, internal medicine, obstetrics). Dr. Marx in the above picture is Hope Africa University faculty and we look forward to working with him in the years to come.

Women and children waiting for immunizations

Medical students Blaise and Isaac with me and a malnourished 2 year old

This child fractured her femur one week ago in a bicycle accident but her mother wasn't able to bring her to the hospital until now. Bicycles are a very common mode of transportation in Burundi.

Busoma for breakfast - a type of nutritious porridge

I so appreciated the opportunity to teach such eager medical students. They desperately need more teachers and thus are forced to learn a lot from outdated textbooks. I found them to be bright, enthusiastic learners who asked insightful questions and learned quickly. It's so much fun to teach students who really want to learn!

Jason, Heather, & I identifying the proposed location of our future houses - quite close to the hospital and to the medical student housing. I didn't know surveying building sites would be part of my missionary job description!

Faders and I outside Kibuye Hospital

Teaching medical student Noel how to do a paracentesis

Rounding with medical student Alliance

The students requested teaching on examining a newborn

Elementary school children. There's not enough space for the kids to go to school all day, so 600 kids attend school in the mornings and 600 in the afternoons. As you can see if you look closely, most of the children have no shoes.

Resuscitating a baby born by C-section without oxygen. There's only one small oxygen concentrator for the operating room and no oxygen on any of the wards. Thankfully the baby was ok. The other surprise was the lack of running water in the hospital - the pipes are there and evidently worked in the past, though, so hopefully the solution won't be too difficult. It was so helpful for Jason and I to work in the hospital so we now know how to prepare. For instance, we will begin looking for an oxygen concentrator to bring with us! And for some advice on setting up the lab (currently only hemoglobin, malaria smear, type and cross, and HIV test is available - no WBC, platelets, coagulation studies, creatinine, electrolytes, CSF cell count, etc.). But I was thankful to discover that care for children under five, pregnant women, and people with HIV or TB is provided by the government free of charge, so I think we'll keep quite busy!

We enjoyed a fun game night with the medical students. This class of 16 students is in their 6th out of 7 years of medical school at Hope Africa University. When more teachers are available at Kibuye Hospital (us!), the students will spend most of their 6th and 7th years at Kibuye. After hanging out with the students last week, I'm really excited to work with them more when we return as well as to mentor and disciple them and enjoy more game nights!

Hope Africa University in Bujumbura. We will likely lecture here at times, but most of our teaching will be clinical up at Kibuye.

View from HAU

Children at a deaf school in Bujumbura we visited saying, "I love you"!

We won't need to learn sign language, but we will need to learn both French and Kirundi fluently. We have new motivation for language study after discovering how necessary both languages are for everyday life. Few of the rural patients spoke any French (only Kirundi) but morning report, interactions with hospital staff, and even customs at the airport was all in French. We plan to study French in Albertville, France for 10 months beginning September 2012 and then to study Kirundi on arrival in Burundi in 2013. It's a long road ahead but we are so thankful for this opportunity to live in this beautiful county and to serve these beautiful people with God's "amahoro".

Village living

I enjoy living in community with other missionaries. Because Tenwek is a large mission hospital with a nursing school, two residency programs, and an internship, more than 50 Americans live and work in this area. The church service at the hospital on Sundays is primarily attended by hospital staff and missionaries and thus is mostly in English with a few Swahili songs. I appreciate being able to worship in English and understand the service. My Kenyan friends and colleagues also speak fluent English and, because they are mostly physicians who have lived in Nairobi, they are quite familiar with Western culture and several have even traveled overseas. These facts have made my cross cultural adjustment a bit easier, but they also mean I'm more removed from the average villager than I would be in another rural setting - and than I likely will be in Burundi. I'm grateful for the opportunity this weekend to experience village life a little more intimately.

Janet invited several of us to her church and to her home. The church recently built this beautiful new building but has yet to finish the roof, windows, or floor, so they are raising funds for this project.

View from the church with traditional Kipsigis homes - round mud structures with grass roofs

For the church offering, people brought produce, sugar cane, and even this chicken. These items were then sold and the money was contributed to the building fund.

View from the outhouse :)

Heather and Anna enjoying their meal of beans and rice

Janet's house

Chicken coop

Janet and Richard with their children Mercy and Emmanuel

In intern Bible study last week, we discussed the story of Isaac blessing Jacob and Esau. This story made a lot more sense to people who come from a similar culture where the oldest son is blessed and meal preparation takes a lot longer as you have to kill the animal first and then cook it. It's interesting to note the similarities between the rural culture here in Kenya and that of Bible times. I look forward to learning more about rural living in the years ahead.

The verse I shared with the congregation during our introduction as guests is relevant no matter where you live, though:
"Mungu kwetu sisi ni kimbilio na nguvu, msaada utakaonekana tele wakati wa mateso." Zaburi 46:1
"God is our refuge and strength, a very present help in trouble." Psalms 46:1

Easter weekend

We've enjoyed a beautiful Easter weekend here at Tenwek - and long, too, as Good Friday and Easter Monday are Kenyan holidays. I love four day weekends! Those of you who read my most recent email update (message me your email address if you want to be added to that list) may think a lot of what we do here is sad and depressing, but that's not true. There is a lot of joy in our day to day lives, too, as we participate in the beginnings of God's new creation. Because Christ has risen and conquered death, we see victory, sometimes clearly visible in this life, sometimes in the hope of eternity. Below are some pictures of joy and fun and beauty this weekend:

Ariel view of Tenwek hospital - green roofs in the center of the picture

My friend Agneta and I climbed Mt. Motigo on a truly Good Friday

We met a few friends at the top

Easter egg hunt on Saturday

Abi showing me her eggs

An impromptu biology class - turtle autopsy - note Peter's shirt :)

Future medical students

Most everyone came to watch - even though "Baringo the Turtle" didn't smell so great

Cause of death: Metastatic Cancer
Primary source: unknown

After the turtle dissection, Abi & Anna came over to paint pictures

Sunrise service bright and early Easter morning. Everyone brought flowers to place on the cross.

Abi and Maggie with "Aunt Sasa" on Easter morning

Elise and Micah with patient station dog Emma

Easter dinner at the McLaughlins - me, McLaughlin family, Fader family, Brown family, Carrie

It truly has been a wonderful weekend and it's not over yet as we still have plans for Ultimate Frisbee today. But I did miss something special back in Nashville - my whole family together except me. Pictured left to right: Lauren, Wei Chi, Grandma Pfister, Leslie, Bud, Emma, Dad, Samuel, Mom. And I haven't even met my niece Emma yet!

Emma (pictured with Gigi - my mom) was welcomed into the covenant family at her baptism on Palm Sunday

Do you ever wish you could be in two places at once or have everyone you love in one place? I'm thankful to know that will happen in eternity and it will be more beautiful than we can even imagine. Christ is Risen!

Middle schoolers, power outages, board meeting

For the last three months, I've been meeting with this small group of middle schoolers as they study the book of Luke. Three of the students memorized 75 verses from Luke! All of them studied hard and hopefully learned truths from God's word that will be applied in their lives for years to come.

At the end of each month, the students were quizzed on what they learned. Our team came in second place! But hopefully through the competition, the Word of God was made real and active to all the kids. I'm thankful for the opportunities I had as a child to hide God's word in my heart - I still remember those verses today and hope these children will as well.

As we walked home from the last quiz, we discovered power outages (again) but for a good reason this time - several huge trees fallen during a storm on our power lines.

As 2 year old Abi said when she came to my dark house a couple days ago, "Sasa house, [no] whoo hoo?" Whoo hoo is power as that's what we say when the power comes back on!

Maggie says, "No Bob?" Meaning she can't listen to her favorite Veggie Tales music when there's no power!

We're all getting used to the frequent power outages, though. With no power, I can still: read outside while it's daylight, play with the kids, go running with friends, eat dinner by candlelight - frequently scrambled eggs as the stove is gas but the oven is electric, use my cell phone, make a list of all the things to do when the power comes back on - like write this blog and lots of emails, & go to work as the hospital runs on a generator. The unpredictability is frustrating, though, as we never know when the power will go out or if it will be out for 30 minutes or 3 hours.

The Myrhes, pictured here with the McCropders, are used to power outages, though, having lived for many years in rural Uganda. We likely will be, too, in Burundi, though maybe we'll bring a generator with us! We loved having the Myrhe family visit us at Tenwek a couple weeks ago and were thrilled to hear that their proposal to the World Harvest Mission board to open the new site of Burundi was unanimously approved! Scott and Jennifer Myrhe, currently working at Kijabe hospital, will be our Africa field directors with World Harvest Mission as we head to Burundi long term. Our official individual approval won't come from WHM until our interviews and orientation in Philadelphia in September, but things are moving forward and we're excited!

The most recent McCropder team photo including our newest member: Baby Benjamin! Pictured from left to right: Fader family, me, McLaughlin family, Cropsey family.

Quadruplets Going Home!

"Your kingdom come, your will be done, on earth as it is in heaven." Matthew 6:10

It's unsettling to live daily in the visible tension between Kingdom here and Kingdom to come. Through the life, death, and resurrection of Jesus, His kingdom came to earth. I see evidence daily of lives changed as a result, brokenness repaired, healing provided, needs met. But I also see many areas and lives where the fabric of Shalom - the peace and wholeness that God intended and desires - is broken, evidence that the kingdom is not yet fully here. A new mother with congestive heart failure and atrial fibrillation suffered a stroke two weeks ago and lost the ability to move her right side. Her mother assisted her in caring for her newborn infant. She became stable clinically and was discharged home but did not actually leave the hospital as the family was unable to pay the bill. Last night, she died. Maybe she had another stroke. Maybe she had an arrhythmia from her heart condition. We'll never know. Now there is a mother-less baby who will need to drink cow's milk in order to survive as formula is unaffordable for the family. In addition to the emotional pain he will experience from growing up without a mother, he'll be at risk of anemia and diarrheal disease and malnutrition as a result of not having breastmilk.

This is just one example of the extremes of life and death that we face literally on a daily basis here as we strive to bring the hope of the Gospel to a broken world that does not know of Christ's triumph over sin and death in the resurrection. "For now we see in a mirror dimly, but then face to face. Now I know in part; then I shall know fully, even as I have been fully known. So now faith, hope, and love abide, these three; but the greatest of these is love" 1 Corinthians 13:12-13. In the dimness, we catch glimpses here and there of our bright eternal future in the new heaven and the new earth, when faith, hope, and love remain forever and when death and suffering will be no more. I happily rejoiced in one of those glimpses today:

Quadruplets - extremely unlikely to occur spontaneously (incidence of 1: 571,787), and, in this setting, unlikely to occur in a mother who actually had prenatal care and was able to deliver at a hospital with one of the biggest neonatal nurseries in the country. Even so, without continuous fetal heart rate or contraction monitoring, the boy baby slipped out and delivered vaginally before adequate preparations could be made. Mom was quickly wheeled to the OR for a cesarean section to deliver the three remaining babies - amazingly, all born quite vigorous. But at 1kg each (2lbs) and 29 weeks gestation, their chances were slim in our setup without TPN (IV nutrition) or ventilators or continuous vital sign monitors. They certainly suffered from complications of prematurity - respiratory distress syndrome, hyperbilirubinemia, anemia requiring blood transfusions, apnea of prematurity, feeding intolerance, even bronchiolitis, and, by far worst of all, the dreaded necrotizing enterocolitis. All four babies had serious signs of nec and we unfortunately lost one of them as a result. The other three became quite wasted as we were unable to provide them with adequate nutrition through their long periods of feeding intolerance. We tried multiple courses of antibiotics as well as other meds and, eventually, very slowly and haltingly with frequent setbacks, they began to feed better and gain weight. Now, the three quadruplets are three months old and 2kg (>4 lbs) each, feeding well, and going home today! Truly a miracle to celebrate! Bwana asifiye, as we say here (praise the Lord)!

Kipchumba (name means boy born in the presence of a white person) looks curiously at this mzungu (white person) as I help get him ready to go home today. Incidentally, one of his sisters is Chepchumba - can you guess what that means?

Proud father

The family bought these nice, new, "smart" clothes to go home. The babies will grow into them eventually! They even bought diapers - I've only seen a handful of Kenyan babies with disposable diapers in my 1 1/2 years here. I had to show the nursery nurse how to put the diaper on the baby! It certainly is a special occasion!

"O LORD, you hear the desire of the afflicted; you will strengthen their heart; you will incline your ear to do justice to the fatherless and the oppressed." Psalm 10:17-18