What a week!

This last week here in Kibuye, Burundi has been anything but ordinary! Here's the week in review in pictures to give you a glimpse of what new experiences I've been learning and growing from:

 My teammate Jessica unfortunately had to fly unexpectedly to Kenya for emergency back surgery. Read more about her adventure here. We're so thankful she's back now and so many prayers for healing have been answered. And prayers were also answered for all of us as we cared for the 3 Cropsey children as a team - a week is a long time for little ones to be away from their parents (in another country) and I learned a lot about kids and parents and myself through the process of helping with these precious children. 

 Being responsible for small children at home and at the hospital simultaneously is not my usual life - especially when one of the kids at home got sick. I'm amazed at the perseverance and patience of parents! I really appreciated the flexibility of these medical and nursing students, too, with all the events of the week. I was especially encouraged to hear that one afternoon when I was unavailable to teach, the medical students took the initiative to teach the nursing students how to resuscitate newborns - just what one would hope for and hopefully lives will be saved as a result! 

 At least I didn't have to do any shopping this week - here is our produce being delivered! Of course it wasn't ideal that our phones were all cut off this week - thankfully it's a small campus, but one thinks twice about whether to walk to the other side to ask someone a question. Next week will include a trip to Gitega (30 minutes away) to get the phones straightened out but we're making do in the dark ages now - and we still have internet thankfully! 

 Ironically the chronically malnourished kids above in the outpatient feeding program and the severely malnourished kids below in the inpatient malnutrition ward had to wait an extra hour to eat on Tuesday because of a documentary being filmed here about malnutrition! 

 The families were gracious and accommodating to the Belgian film crew from UNICEF. I survived my first experience being interviewed in French on camera (as the pediatrician caring for the malnourished kids) and will be interested to see if they end up using the part I was in. I'm coming to understand just how much material gets cut in a video before the final product - way more than I ever realized as a viewer. I also learned that even before the editing process, many activities are planned that don't even end up getting filmed in the first place. I guess flexibility is the name of the game - and patience as just getting the cameras to the appropriate settings takes forever!  

 Obviously a film crew of approximately 15 people attracted quite the crowd! 

 Sweet Jonas continues to care so faithfully for the malnourished children in the feeding program and you can see above how the kids love him. I took a step closer to this child after this picture and she immediately started crying! :) 

 So another new event of the week was teaching kindergarten math. It got easier as the week progressed and I figured out more how to prepare but I had no idea just how challenging 30 minutes with 4 five year olds could be! They all work with such different paces and interests and knowledge bases and diligence and listening skills. How do elementary school teachers do it with 20 kids in a class all at different levels! The kids are precious and I love being their "aunt" but I'm also happy to go back to teaching 25 year old med students! 

 So after the UNICEF film crew on Tuesday, we hosted a second film crew from Serge on Thursday! Above is me trying to grasp the goals and hopes of this project - quite different from those of the prior crew or of the single videographer who was here a few months ago. I think this is the end of video crews for a while - who knew Burundi would be such a photogenic place?! 

 Pediatric patient care continued throughout the week but with more photographs than usual. 

 I loved getting to greet Shalom on the walk home from work yesterday - he's a little boy who was on our service for a couple weeks with persistent fevers but who is now healthy and started school this week. 

 And finally, the head nurse on pediatrics got married recently out of town and so I hosted a small gathering for the peds team to congratulate her today. As you can see below, I was a little underdressed - still figuring out these cultural expectations! But it was fun to share time together outside the hospital and I am thankful to feel more and more connected to the staff. 

 Oh, and the other event of the week was getting tile installed for the floors of my new house - well, mostly - the calculations evidently weren't accurate and they ran out of the bathroom wall tile. Another learning process - always buy extra boxes of tile when you're building a home in Burundi! But what did get finished looks great and I'm happy with the progress of my house. In fact I think I may hang out there for a couple hours tomorrow recovering in peace and quiet from the very full last week!

Cross cultural hospitality

I didn't realize until I moved to Africa how strongly culture influences the way we visit people and welcome them to our homes. Who initiates the visit - the guest or the host? Does the guest bring a gift? Does the host offer refreshments? If so, what - chai, soda, water, a full meal? What does one talk about? How long does the visit last? Who decides when the visit is over and how do they express that? Does the host "release" the guest or does the guest decide to leave? Does the host walk the guest to the door, to the gate, to their home? Is a reciprocal visit expected? What about a thank you note?

Being the stranger in a new culture (and an introvert) means these interactions are frequently quite awkward. I remember welcoming an intern to my home in Kenya for dinner. I expected her to come late and so was prepared for that. We ate dinner together and then I served chai and dessert. After dessert, I was completely out of anything to say and yet she still sat at the table. I wondered if she would ever leave. I asked more questions about her family. It was getting near bedtime by now. I stood up and cleared the table. Finally I said something to the effect of, "Well, I guess you probably have a lot to study; I don't want to keep you from it." And she expressed her thanks and left. It wasn't till months later that someone explained to me that in Kenya, the host releases the guest rather than the other way around!

I've been observing and learning hospitality here in Burundi - often by trial and error. One is more often to be served Fanta than chai here. And the guest initiates the closing of the visit. I welcome the medical students into my home each week for Bible study. They don't seem to mind being crowded into a small space (24 students plus 6 leaders in my small living room last week - can't wait to get into my new house where I'll have more space for entertaining!), but they don't know what to do with a plate of cookies. The concept of "serve yourself" is evidently very American. I put out napkins and welcome them to the table, but still they stay seated. I think I'm probably supposed to bring the tray around to each person and serve them on a plate with a utensil. They do seem to like the sweet cookies (biscuits in French/British English), though!

Last weekend I welcomed overnight cross cultural guests for the first time. My Belgian friend who I met in France lives in Bujumbura and is married to a Burundian, so she, her husband, and a friend came to Kibuye to visit. I learned a lot! Again "servez-vous" proved difficult as I served pizza and explained to the Burundian friend that he could serve himself and his gracious response (in French) was, "I'll just watch what you do first cause I've never done that."(!) They seemed to like the American dishes, though, such as pizza, honey chicken curry, macaroni and cheese, and granola. We enjoyed playing games Saturday night and I introduced them to the game of "spoons". They seemed surprised by my house décor - the many books and picture frames and mirrors - and they liked looking at my children's books. We spoke exclusive French all weekend and I added words to my vocabulary that don't come up every day at the hospital - like "toaster" and "deck of cards". I have renewed motivation to continue working on French after a pretty exhausting (linguistically) weekend! Below are some pictures of our shared adventure to the southernmost source of the Nile as well as hiking near Kibuye. One other cross cultural surprise was that my friend's husband couldn't understand why it was annoying to me and my friend to have Burundians following us everywhere shouting "mzungu" (which means "white person") - another cross cultural challenge for me to still get used to - always being signaled out as a stranger! Pray for me to keep learning and growing in understanding the Burundian culture as well as Kirundi and French!

 That little hole begins the great Nile river!

 Kibuye Hope Hospital in the background

 Interesting trees

I learned this tree is actually used to welcome royalty (back when there was a monarchy here) or the president. No wonder it's such a unique looking tree! 

Baby steps together

On arrival in Burundi last year, I knew the statistics for malnutrition (60% of kids under 5 are chronically malnourished and stunted in their growth - one of the highest rates in the world) and I also knew that Kibuye Hope Hospital manufactured a grain called Busoma (mixture of corn, soy, and sorghum) to help combat malnutrition in the region. I had participated in a conference in Kenya in 2010 learning the appropriate management of severe acute malnutrition according to the World Health Organization. But I had no idea how all this would play out in everyday life as a pediatrician in Burundi.

As I started to evaluate kids, I quickly realized that the statistics were correct. Most of them were malnourished and most were stunted in their growth as a result. It was overwhelming to me, though, to figure out what to do about it. We couldn't follow the 10 steps of treatment from the WHO because we didn't have access to the appropriate formula and nutritional supplements. We needed government approval for that. And even it we could, the kids would just go back to their same settings with limited food (especially protein) and would fall back into malnutrition.

But then I discovered I wasn't the only one thinking about the plight of these malnourished kids! World Relief has a very well developed program for evaluating kids in our community for malnutrition and educating the parents on how to feed them more nutritiously with available and affordable foods. So I began referring kids to World Relief when they left the hospital. The medical director of our hospital agreed that a malnutrition ward would be helpful and got the ball rolling with the application to the ministry (department) of health. World Relief also agreed with this plan (as previously they had to send kids to a hospital in Gitega for more specialized care - 30 minutes away by car which is unaccessible for most people around here), and they helped facilitate the application process with their connections. I discovered that a feeding program already existed at the Busoma plant and that 30 malnourished kids were receiving food supplements twice a week there through the work of a cleaner in the hospital named Jonas. Through the help of the nursing and medical students, we began weighing and measuring these kids and evaluating them more thoroughly. USAID representatives visited and talked about how we could fortify Busoma. And Friends of Hope Africa University (a supporting US based non-profit organization) began talking about writing grants and raising funds for expanding the Busoma project to provide nutrition for each hospitalized patient. So we continue on this path together. I'm humbled to think of how God has directed us thus far and am hopeful for the future of these precious children. And I'm so thankful I'm not doing this alone!

Medical student Elvis (left) and hospital worker Jonas (right) weighing a child in the feeding program. Amazingly the Christian medical student group (of which Elvis is a leader) has decided to raise funds to help feed these malnourished children. I'm so encouraged by their hearts to serve and give!

Eating Busoma

Precious children and mothers

Cooking meals at the hospital - the patients' families prepare their food as we don't yet have a cafeteria or hospital kitchen 

Representatives from the Burundian Ministry of Health touring the Busoma plant and officially opening the malnutrition center at Kibuye Hope Hospital

Our new malnutrition ward (above)

Proof that I was there (on left above) for the ceremony and initiation of our program :)  

In addition to the anticipated speeches, many supplies were delivered including vitamins, scales, cups, antibiotics, etc. Unfortunately we're still waiting for the delivery of the special formula and feeding supplements! Like I said, baby steps. But it's encouraging to see progress. 

Lake Kivu, Rwanda

The campground Kumbya on the shores of Lake Kivu in Rwanda has been a retreat for missionaries for 70 years. And last week I appreciated the opportunity to experience Kumbya myself as I attended a conference/retreat there with 120 other missionaries from Burundi, Rwanda, and Kenya. That was my first visit to Rwanda and it was interesting to explore the similarities and differences between the neighboring countries Burundi and Rwanda. The languages are similar but we found we were unable to guess which language would work with people as we asked directions along the way - we tried English, French, Swahili, and Kirundi and sometimes one worked, sometimes another. But it is a blessing to be able to communicate, even if it is laborious after multiple attempts! And after 9 hours of driving, we were thrilled to be greeted by this beautiful site of Lake Kivu:

It was a bit more rustic than I expected, but morning and evening campfires were definitely one of the highlights of the week - especially when people shared imported marshmallows for s'mores! 

It's always a treat to worship in English and this camp struck a great balance of organized activity and free time. I appreciated the multi denominational unity as we shared with one another. 

My favorite free time activity was the 3km swim to Three Hump Island - on the left above. I love swimming and have always been thankful for my lifeguard and swimming lesson instructor days. That's a skill I've resurrected a few times in teaching missionary kids how to swim, including last week! 

My head is one of the dots in the water on the right next to the boats - evidently a little off course! 

Wish I could have taken a sunrise picture while swimming, but it was incredible to see - this is the view from land thanks to Janette Miller's photography. 

Here I am coming back from the swim in the middle seat of a dugout canoe (no round trip for me - over an hour of swimming was long enough - maybe I'll train for next year!)

My cheering squad was waiting for me with pancakes and smiles

Abi and I enjoyed kayaking together

Never thought I'd water ski in Africa! 

Sunday morning worship service on the lake

Monkeys visited us in the mornings - cute until they try to steal your breakfast!

This picture is Kibagora Hospital - our sister hospital that is just up the road from Kumbya. I enjoyed the opportunity to tour their facilities and see their incredible view!

As their new peds ward is under construction, this unicef tent functions as a temporary ward - it's hot in there! 

View from the hospital

The Fader family and me

My small group for the conference. The topic for the week was forgiveness - a relevant topic for everyone. The discussions were especially interesting as people with years of experience as missionaries in East Central Africa shared about forgiveness in an African context, related to the Rwandan genocide, Burundian war, and simply cross cultural differences in many areas. I appreciated their wisdom, honesty, and focus on grace - extending and receiving grace when confused by culture. And my small group was a great blessing to me as we shared about applications in our lives of where we have given and received forgiveness in the past and where we need to do so now. 

While it was an encouraging and fun week, it was also great to arrive back in Burundi! Each time I leave and return, this place feels more like home as what was once odd is now familiar - like cow crossings  on the highway. 

And finally, a sunset over Kibuye Hope Hospital  - back to work in Burundi