What is normal life?

I've reached the point in living in Burundi where my life seems normal. My routine is established and I expect to daily see colorfully clad mamas with babies on their backs and produce on their heads, to admit multiple children with malaria each day, to have red dirt perpetually on my shoes, and to exchange Kirundi greetings and handshakes dozens of times per day with patients, families, staff, even teammates. And so I forget to blog because I forget what is unique or notable about my life here. 

But life is full, whether it's normal or not. I was pleasantly surprised yesterday to have a new group of nursing students correctly describe the differences between meningitis and cerebral malaria. A visiting nurse from our sister hospital in Rwanda facilitated productive and interesting discussion yesterday afternoon with our new NICU team and we were able to make some progress in our plans for caring for the premies. Jonas understands the importance of maintaining some records for the malnourished kids in the hospital's feeding program and is now weighing them every week. Pastor Luc approached me yesterday excited about starting up Bible study again with the new group of med students coming next month. We unfortunately had a too-small premie die because the power went out and he couldn't keep warm without the incubator. Within a few days, Ezekiel had hooked up the incubators to the hospital generator so now they will stay warm even when the power is out. I enjoyed participating in the intimate and worshipful communion service at church on Sunday - even though it meant 4 hours of church! And for the first time ever, the sermon was preached in French (with Kirundi translation) so I could actually understand it (thanks to a visiting preacher from Congo). And we played a very competitive and fun game of ultimate frisbee on Sunday afternoon. Hopefully the below pictures will help round out the description of normal life here in Burundi! 

A Sunday afternoon hike

Typical sight at the hospital. I've actually started looking at all the colorful material worn by the women lately in thinking of curtains for my house. :) Let's see, how would that look in my bedroom…?

Cooking a goat feast in celebration of the completion of the McLaughlin's house

 Saturday activity cooking plantains

 The Cropsey family was so sweet to include me on their recent vacation here in Burundi on Lake Tanganyika - just a few hours from here (or longer if you get very lost on dirt roads and keep having to stop to ask directions in Kirundi - providing significant entertainment for many villagers shocked to see white people driving through their village attempting to speak Kirundi!) 

 Worth the trip! Beautiful sunsets and surroundings. Don't get in the water at dusk or dawn, though, cause you can't see what's coming! (Think crocs or hippos. :))

Love hanging out with these precious children

Surprise event in Bujumbura on the way back home - World Cup game on the big screen at one of our favorite restaurants. And we were eating with our Belgian friend Annelyse and her husband while watching the Belgian team beat the Algerians! What fun! 

Another Sunday hike to Kibuye rock with Anna and Elise and lots of Burundian kids

With a stop in the NICU on the way back - they love coming up to hold the babies and the mothers love having little visitors

Now we have four working incubators! 

Twins! 

Our miracle baby born at 900grams finally reached 2kg (4 pounds) and went home with his happy mother. 

 Kibuye Hope Hospital

Babies on oxygen

Sharing a meal on the peds ward

Our new NICU sign in honor of Benjamin and Jud Grant

 Community project building a new church (to the left of the old church) 

A roof for my house

It's guava season so kids are climbing trees to pick them and eating them everywhere

I enjoyed helping with some manual labor on Saturday - feeding cable into pipes to bury our internet

 Maggie and Ben also wanted to help with the manual labor - creating a brick path in the yard

Love this team! 

Injustice and healing

(Written Saturday)

So yesterday I was feeling quite overwhelmed by the injustices around me - severe malnutrition, extreme poverty, unemployed nursing and medical school grads compounded with severe nursing and doctor shortages everywhere in the country, outdated treatment protocols, health disparities even here between the rich and poor. And then I read an article from the Atlantic (http://www.theatlantic.com/features/archive/2014/05/the-case-for-reparations/361631/) about the history of racism and discrimination in the US and felt that there is significant injustice and corruption everywhere. And it seems like there’s nothing I can do about it. 

But today I began the day helping with three adorable kids and then walked up to the hospital on a gorgeous sunny day. The rainy season seems to have ended and everything is brilliantly green. I greeted some pastors chatting on the field, entertaining them with my attempts at Kirundi, and then spoke to the girl herding goats at the hospital entrance. I headed straight to the pediatrics ward where I found a hard working nursing student eager to help me evaluate the patients. I was overwhelmed with thankfulness to discover Willy, a 6 year old who was critically ill and very close to death with sepsis and malaria, now talking, shaking my hand, and on the mend. And Joselyne, too, a one year old who’s been in the hospital for 8 days with very slow improvement on several different meds, now is recovered and going home. The mothers in the new NICU, dressed in their traditional colorful wraps, greeted me warmly and proudly showed me their premature babies who are mostly gaining weight. And a hospital employee’s son is now feeling much better after several days with high fevers. I walked home thankful for this place, thankful for this life I lead, thankful for these beautiful children, thankful for God’s mysterious, healing work in their lives and in mine. 

And I remember today that He is just. Corruption and injustice will not go unpunished. I pray for the Gospel to continue transforming this world that we live in - just as it continues to transform our own hearts and lives - on the hard days and the encouraging days. 

“But Job desperately clings to such a God, one who encourages us to offer everything to Him, every joy and every sorrow. All our broken hearts. All our contrite spirits. Because He is worth [worthy of worship] it.” From “A Sacred Sorrow” by Michael Card

“The leaves of the tree were for the healing of the nations.” Rev 22:2

Q & A

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!

Picture update

Life is full these days - without a lot of margin but with many joys in the midst of the busyness. 

 Like these beautiful Burundian children who joined me on my hike Sunday

 And these adorable missionary kids putting on a concert for us

 Our African field directors with World Harvest and their family came to visit us and encourage us. I loved exploring with them on a hike, and, as you can see from Elise's grin, the teenagers were a big hit (and help!) with the kids here. 

 I continue to be amazed at the beauty around me - especially juxtaposed with the poverty and injustice which I often see simultaneously. 

The Myhres and Bethany (another World Harvest friend and colleague who works in Kenya) led team discussion on a very insightful and relevant Henri Nouwen article (linked here if you're interested). These times of discussing and worshipping together & hearing Scott, Jennifer, & Bethany's perspective on solitude, community, and ministry in Africa were a real encouragement to me. Jennifer also joined me on pediatric rounds one day. With 20 years of experience as a pediatrician in Africa, she offered a lot of wisdom and insight into the daily challenges of this field. I was blessed and strengthened by the visit of these friends in our larger African World Harvest community - we're certainly not in this alone! 

 And hospital work is surchargé (overloaded) these days. April is rainy season which means RSV bronchiolitis and malaria season at the same time. We have record numbers of kids hospitalized (40 patients yesterday!) but there are moments for thanksgiving in the work, too, as kids get better and as the medical students go above and beyond their usual responsibilities to help care for the patients. 

 Premature twins with their boxes on mom's bed - still working on getting the NICU ready

 But we're making progress as you can see in this picture 

 Evaluating a small patient

Nurse Bénigne working hard (putting Quinine in an IV bottle for a patient with malaria) and always with a smile

I enjoy daily greeting the workers in the Busoma plant. Busoma is a mixed grain with soy, sorghum, and maize that has been produced by the hospital for years in an effort to address the significant malnutrition here.  

 A food scientist with USAID toured the Busoma plant last week. It was interesting to hear his perspective on this product and to connect with others seeking to make a difference in the significant (60% in children under 5!) malnutrition rates in Burundi. 

Please pray for me to continue to have my eyes open to see the joys and thanks of each day rather than being overwhelmed by the work and the brokenness in the system. And pray for the patients to get better and go home! 

Rounds, Oxygen, & a NICU

We've had some visitors lately who took pictures of rounds at the hospital. Here's what most of my mornings look like:

 Teaching students 

 Waiting for the student to come up with the right answer

 Things can get a little crowded!

 Charting (in a fraction of the time it takes in the US! - a side benefit)

 And, of course, caring for patients 

 My clinic where I see patients on Wednesdays. I'm really enjoying the continuity of following these patients, though it requires multiple specialty hats! In clinic today I saw patients with sickle cell disease (hematology), epilepsy (neurology), congenital malformation of a leg (neonatology/orthopedics), severe malnutrition with stunting (nutrition), genetic syndrome (genetics), & chronic ear infections (ENT). No simple well child checkups here!  

Nursing students are a big help in getting IVs in patients 

In other news, we've really struggled lately in finding enough oxygen for the patients who need it. We brought 4 oxygen concentrators with us on the container (thankfully donated!), but they're all 110V, so they require either a transformer or one of our few 110V outlets here with a plug converter. Basically we can provide oxygen for up to 4 patients at a time - out of approximately 80 patients in the hospital. I often have 4 patients on pediatrics alone who qualify! And that doesn't leave any oxygen for the operating room or anywhere else. We lost a premie last week because he was taken off oxygen prematurely in the middle of the night. And when the power goes off (sometimes for several hours per day), no one gets supplemental oxygen. There are hard ethical questions sometimes on a daily basis deciding who gets the oxygen - I've dealt with these questions with limited ventilators in the ICU in Kenya, but never with something as simple and (relatively) harmless as oxygen by nasal cannula. 

In the midst of these challenges, I have been so encouraged to see help on the way via some friends in Birmingham, AL. The Grants are friends from my church (Red Mountain Church) there and have two children who are NICU survivors. In honor of their sons, they are raising funds for our new NICU and pediatric wards here - to include oxygen! People have already given so generously and we've started renovating a room in the OB ward for a small NICU. It's now painted and we're just waiting for incubators to be constructed so we can start caring for our smallest patients in a warmer, cleaner, more controlled setting (the premies are currently in boxes on their mother's beds in the open ward when they're not doing kangaroo care - skin to skin - with the mothers). Please go to the Grants' blog here and read about their experience and our hopes for these new centers of care for Burundian children.