To do list, condemnation, and perspective

I suspect many of you can relate but as it gets closer and closer to my departure for the U.S. (for a four month home ministry assignment), I've been feeling more and more overwhelmed by the to-do list that seems to only grow and never shrink! It stresses me out to not have enough hours in a day to get things done and to consequently feel like I'm letting people down. Case in point: yesterday at 2pm I received a phone call that the construction workers/foremen/plumber/electrician were waiting for me to come answer questions as my new house nears completion. At the same time I was trying to print an article on edema in children to share with a student preparing a presentation who wanted to review her power point with me. And I was already late to meet with a nursing student who was asking advice about what she needs to prepare to be a school nurse when she graduates in December. And a mother with 3 month old baby who is blind and developmentally delayed was waiting for me to go over lab results with her. I basically was late for everyone and the article never did get printed. I hate disappointing people! And I also hate feeling unproductive because I get interrupted from finishing tasks and so I don't get to check them off my to-do list. And when I get stressed, it's not a pretty sight!

"Martha, Martha," the Lord answered, "You are worried and upset about many things, but only one thing is needed." Luke 10:41-42
"There is therefore now no condemnation for those who are in Christ Jesus…to set the mind on the Spirit is life and peace." Romans 8:1, 6

Why am I so quick to feel condemned? Judged by myself and found wanting even if I don't also feel the judgment of anyone else? I forget all too easily to fix my eyes on Jesus, to cast my burdens on him, and to rest in my identity as a beloved daughter. I appreciate your prayers that even as I continue to do the work I'm here to do that I would simultaneously set my mind on the Spirit and experience life and peace as a result whenever I am tempted to feel condemnation.

One way to tackle the to-do list is to recruit helpers! The girls are putting 30 children's vitamins in each bag to give out to malnourished kids. Happy and cheerful helpers! 

Another good plan sometimes is to drop everything for a day and join God where He's already working. We found out last minute about a Christian medical conference in Bujumbura sponsored by the Christian Medical Student Fellowship here in Burundi. That sounded like an ideal activity to be a part of so we filled up the van with students and drove to and from Buja on the same day to participate in the conference where Christian health professionals (mostly Burundian) were encouraged and inspired together by talking about the Kingdom of God. The above picture is the beauty of the drive from Kibuye to Bujumbura - the blue line in the middle is the mountains of Congo on the other side of Lake Tanganyika - rarely are they that clear. Of course the drive is also exhausting and motion-sickness-inducing but the beauty often overshadows those elements.  

The highlight of the conference was Ivan's testimony. He shared how when his class came to Kibuye in January of this year for their first clinical rotations they were shocked by the significant physical and spiritual needs they found in this rural area. They prayed and worshipped together weekly and eventually began to compile their resources to buy food or medicine for patients and they also began to pray and share the gospel with patients, visiting them even when they weren't on call or scheduled to be at the hospital. He shared story after story of people who felt loved and cared for and who then responded to the gospel, some just before dying. Others experienced miraculous healings like a young boy hospitalized for 4 months with a traumatic brain injury who now is well and able to play soccer with his friends. I loved how his stories contained examples of "word" and "deed" - caring for people in a holistic way in their suffering. It was encouraging to hear how God was at work in ways previously unknown to us.  

And it was worth giving up a day of "productivity" to spend time with these fabulous med students sharing this experience and fellowshipping with them and others who share a similar vision for caring for patients with compassion and holistic care. 

Another fun recent break was Sammy's 3rd birthday party. What could be more fun and rejuvenating than watching adorable kids hitting a piñata and then eating cake and ice cream together?! 

Team time is certainly a joy - and isn't it a miracle to get all those people looking at the camera and mostly smiling with no one screaming?! The kids are growing up. So thankful for this special group of friends! 

 And finally, I felt refreshed on a peaceful walk home from the hospital today after a downpour. It seems everything is brighter and clearer and more beautiful here after the rain. I think there may be a lesson there somewhere. :) 

Do you see the rainbow? Promises abound! 

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.