Hospital Pictures

We've enjoyed a good week on the pediatric service - truly a gift after we lost several patients last week. I'm thankful for the pediatric team - including nurses, medical students, and nursing students - caring for these patients and families well. 

 This little girl had sickle cell disease and was quite sick with an infection requiring our strongest antibiotics (we only have 3 IV antibiotics available here). This is her walking home - she was unable to walk for the first week of her hospitalization. We were all excited to see her able to walk again. 

 This little cutie had a severe asthma exacerbation. We thankfully were able to give her oxygen due to some donated oxygen concentrators that came on the container. I took this picture the day she went home. 

 This mama had twin premature babies. Unfortunately we lost one to infection last week. The remaining one - Butoyi - is now almost one month old and is feeding well and gaining weight. He should go home in a few days. 

 Lots of education is going on these days with the new medical students. This is their first clinical experience and they are very eager to learn. I recruited 2 cute helpers to teach them how to examine children. This is Abi letting them examine her eyes. And below is Anna having her ears examined by 25 medical students! She was a patient teacher. :)

 This little boy has a very large spleen due to recurrent malaria. 

 And this 10 year old girl named Alice was critically ill and in a coma with meningitis. I really didn't think she'd survive as she was completely unresponsive and unable to protect her airway (which means she would have needed a breathing machine in a setting where that was possible). But she woke up after 2 days of IV antibiotics and then made a complete recovery. We thanked God together with her and her mother for her healing. 

Medical team of Kibuye Hope Hospital January 2014

We're so thankful to partner with our Burundian colleagues who understand the medical and educational system as well as the culture and language so much better than we do. 

 A nursing student starting an IV outside in the light - it's very dark in the pediatric ward, especially when there is a power outage! 

 Twins who required resuscitation at birth, now doing well

 Premie in a cardboard box. We're hoping to build incubators soon! This baby and her twin brother have kept relatively warm, but have had a hard time gaining weight. 

 Read the story of this little friend's miraculously recovery here. 

 And, finally, here is most of our pediatric team. The medical students change rotations about every 2 weeks, and I will miss these 5 students when they leave on Monday. I love to see their compassion for the patients and enthusiasm for learning. But there will be 5 new students on Tuesday, so we'll start again! 

In the Hospital - First Impressions

In lieu of an organized, well thought out blog post, I thought I'd share with you some "stream of consciousness" after my first 10 days of full time hospital work (currently on pediatrics). Life's too busy these days to synthesize it all into a neat little package. Hopefully pictures will follow soon. 

1) I much prefer being a doctor to being a full time language student! I'm so glad to be doing again the work I've been trained to do and that I enjoy. 

2) But no language study time was in vain. I spend 90% of my time at the hospital speaking either French or Kirundi - and I continue to learn new words in both each day. Such as the word for seizure in Kirundi and the word for Sickle Cell Anemia in French (both learned during rounds today and needed with subsequent patients later in the day). 

3) My re-integration into work began very difficultly with the loss of a 3 year old patient just 30 minutes into my first day. Thankfully we haven't lost any since, and we sent 4 patients home today miraculously recovered who would have received ICU care with intubation and mechanical ventilation in a more developed setting. I had doubts that any of those 4 would survive, but thankfully God can heal even when we don't have the resources we need to care for them well. 

4) Kids are adorable. Even though the majority of them are terrified of the mzungu (white) doctor. I know it's time to send them home when they finally warm up enough and feel well enough to shake my hand and take a sticker. Their smiles, and those of their beautiful mothers, totally make my day! 

5) The first few days back, especially, I remembered frequently my own teachers - my attendings in residency, mentors and colleagues in Kenya, even my French teacher. As I was confronted with limitations - what we can't do for patients here either because we lack the meds, the lab tests, or the finances - I realized how suboptimal the situation is for patients. I feared my former attendings would cringe to see how I wasn't intubating the child with meningitis and a Glasgow Coma Scale of 5 or how I continued to give empiric antibiotics with no x ray for possible pneumonia or how we are keeping the premature twins warm in a cardboard box with a hot water bottle & many blankets because we don't have incubators. And my French teacher would definitely cringe to hear my many grammatical mistakes in the course of a day! But, in reality, those things are related to my own insecurities and not to what those mentors would actually think. Each day I make new decisions as to what areas we can improve and what areas need to stay the same for now. And, actually, Kibuye Hope Hospital does make a significant difference in many patients' lives and provides a higher level of care than is available in most other places outside of Bujumbura. It's a new challenge for me to leave this work in God's hands, trusting Him to show us in His timing what and how to improve. It's His work, after all! 

6) The medical students know a lot less than I expected, but they are learning rapidly and working hard. I'm enjoying being back in the teaching role again and it's actually kind of nice to start at the beginning with them. When given the choice, they definitely prefer suboptimal French to fluent English, though, so, like I said, I'm learning the French medical vocabulary along with them. 

7) Our work with the students is much more than I expected. We're actually teaching courses, writing exams, and giving grades - not just teaching on the different rotations as I anticipated. A book I'm reading on teaching cross-culturally is quite insightful and helpful as the system is quite different than what I'm used to. And thankfully, there are 6 of us professors here, so the work is divided amongst us. 

8) Two newborns were resuscitated in the last week and have survived who would have almost certainly died if we weren't here. Praise the Lord for training in neonatal resuscitation and for the opportunity to train others to do the same in the future! 

9) A 4 year old girl with possible post-infectious Guillain-Barre syndrome needed milk via a nasogastric tube because she was paralyzed and couldn't swallow. For some reason milk is hard to find here (the cows produce a fraction of the milk that cows produce in other places). So the missionary families graciously agreed to donate some of their milk to the little girl for a few days. I've never physically carried milk up to a patient before and can't imagine how that would be perceived in the US! But I didn't see another option, and thankfully, she received sufficient nutrition for those few days. Today, though still very weak, she is able to talk and swallow, so we removed the NG tube. Another beautiful healing! 

10) Other diagnoses from the past week on the pediatric ward: malaria, malaria, malaria, anemia (lowest hemoglobin thus far 2.2), pneumonia, meningitis, hydrocephalus, Down syndrome, possible sickle cell, splenomegaly, possible congenital heart disease, unknown genetic syndrome, entamoeba histolytica, urinary tract infection, abscesses, status epilepticus, otitis media. 

First Burundian Christmas

 Read the McCropder blog here for the details of our container's arrival for Christmas. I'm loving feeling more settled and at home with my new and old belongings. And perfect timing as I had Christmas presents for the kids on the container! 

Kibuye Hope Hospital - the Burundian flag is perfect Christmas colors :) I'll be seeing this site all the time beginning Thursday when I start work full time. 

Making Christmas cookies

The land is all cleared for my future house site! And see the McLaughlin's house behind with significant progress completed. 

Christmas Eve service (above and below pics)

My Charlie Brown Christmas tree

The families on my team were so sweet to include me in their Christmas traditions. I spent the night with the McLaughlins and loved celebrating Christmas morning with their enthusiastic and adorable kids (above and below pics). 

I also introduced a Pfister tradition of sausage and egg soufflé on Christmas morning

I enjoyed an incredibly delicious ham dinner with the Cropsey family and other guests on Christmas

And game night is always my favorite! 

Medical school professors or Robin Hood drama? Not sure, but I did enjoy participating in Hope Africa University's graduation on December 20th - even with the required stylish hat. :) 

My favorite part of the graduation ceremony was the Burundian drummers - very impressive! 

Christmas Eve

Micah, Elise, and Sammy adding Baby Jesus to my advent calendar on Christmas

Singing "O Come All Ye Faithful" in English and Kirundi in church 

And just before Christmas, several of us attended a special service at another local church. It wasn't an uneventful day as you can read here! 

I appreciated the opportunity to witness a baptism service for the first time here

In the baskets are live chickens given as gifts in the service

Anna discovered the chicken waiting place and decided to teach them the alphabet in French while they waited. Never a dull moment around here! 

Merry Christmas and Noweli Nziza! 

Burundi Tourism

Yesterday we traveled all in one van on a big adventure to a waterfall. We awoke to rain and muddy roads and really didn’t know where we were going or what we might find when we got there, but everyone was game for the adventure and so off we went with 8 adults, 8 kids, 4 baby dolls, rain gear, picnic lunches, and motion sick bags. We stopped for directions a few times - challenging given that we didn’t know the Kirundi word for “waterfall” - and provided significant entertainment to local villagers as they curiously observed a van full of wazungu (foreigners) driving by. And despite work being done on the dirt road, which made it barely wide enough for our van to pass, we arrived uneventfully after an hour’s travel over log bridges and through eucalyptus forests at the gate to the park entrance. The four park attendants put on their official hats as we pulled up and took our admission fees. We were the only people there and I wonder how many days pass without any visitors. It’s unfortunate that it is so remote and unknown because it truly is a beautiful location - complete with four waterfalls and well maintained hiking paths to reach each of them. The kids were amazing hikers and travelers; the weather was actually perfect while we were there and then rained the rest of the day; and we enjoyed exploring a new place together that we will definitely visit again. What a fun start to our two day team retreat!  

See One, Do One, Teach One

See One, Do One, Teach One

A common phrase in medicine is “See One, Do One, Teach One” - referring to the order of learning procedures and other things. Rarely does it actually play out that way - more often it’s: “See many, then do many, then teach others.” But sometimes things are different here in the developing world and this week I ended up skipping steps one and two altogether and just starting with step three! The course is called “Helping Babies Breathe” and focuses on the resuscitation of newborns - targeted to train health professionals (such as midwives & nurses) in the developing world with limited resources. Now, when it comes to neonatal resuscitation, I have indeed helped hundreds, if not thousands, of babies to breathe in the 8 years that I’ve been a doctor. But our training as pediatricians in the U.S. is quite different and includes a more advanced skills set such as intubation, chest compressions, and epinephrine. I was aware of the existence of the “Helping Babies Breathe” program and knew that it could be quite helpful in this setting and thus registered to take the instructor’s course at a CME conference in April 2014. I didn’t intend to teach it until then! But on Tuesday, a visiting American nurse gave me the French HBB materials and asked me to teach the course to the midwife students on Wednesday. These particular students will be finishing their rotation here this week, so this is their last opportunity to learn these important concepts which truly could save many lives. And so, a bit reluctantly, I reviewed the materials and noted the various steps of neonatal resuscitation emphasized (and those minimized or left out altogether) in preparation to teach. It made a huge difference that everything was already translated into French - and I learned some new vocabulary from reading it.  Then Tuesday night I was sick with a stomach bug (unfortunately a part of life here) and as it got closer to 4pm on Wednesday I was seriously asking myself what in the world I was doing?! Yes, I had reviewed the material, but not thoroughly, and I didn’t have the theory or the steps well understood myself, nor did I have a plan for helping the students practice these things. I haven’t watched any deliveries since arriving here, so I don’t know what is done typically and what may need to be re-taught. And to be teaching these unfamiliar concepts in French & weak physically from sickness seemed too much. I knew I was insufficient to teach this course and breathed a quick “God, help!” prayer as I walked to the hospital. Well, it seems to me that sometimes God strengthens us powerfully to move mountains and other times He simply sustains us to do the work He has given us to do one step at a time. This was one of those sustaining times. He gave me strength to stand physically; He caused the students to be attentive and eager to learn; He enabled me to speak and understand the French I needed; and He provided the materials & knowledge to help me teach. It wasn’t perfect by any means and I can think of several things I would have done differently - I’m not canceling my reservation for the course in April! - but He gave good gifts of grace and strengthened me once again in my weakness. And, hopefully, He will enable these students to make a difference in caring for babies and mothers throughout the country of Burundi.