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. 

A day in the life...

So, first off, a disclaimer: today was not a typical day! But, nonetheless, I thought you might be interested in what a work day in Burundi at Kibuye Hope Hospital sometimes looks like:

6am - wake up and get ready for the day
7:30am - Staff devotions at the hospital. Today it was the last day for some of the nursing students so there were many speeches, songs, prayers, and well wishes. This is all in Kirundi, so we follow along with the singing from the hymnals and do our best to catch words here and there in the other parts. The hardest part is when important announcements are made in Kirundi and we’re left in the dark - or when jokes are made or stories are told about bazungu (foreigners) and everyone looks at us with laughter (good-natured, of course) but we have no clue what was said. Today I understood a student start a story with, “We know how much bazungu love dogs (cue laughter from the crowd). Well, once there was....” I have no idea what followed. Oh, well - I was excited to at least understand a whole sentence!

8am - Morning report (in French). The student who was on call the night before presents the new admissions (from after 5pm) and any issues overnight and we discuss the cases together. There is a doctor on call at night, but they aren’t called for everything, so there are sometimes surprises in the morning. Today the student presented 2 new admissions - a 10 year old in a coma with seizures from malaria and a 3 year old with a repeat asthma exacerbation. I was concerned for possible meningitis in the 10 year old, so I planned to do a lumbar puncture (spinal tap) immediately after morning report. 
9am - I examined the kid with asthma and asked the student to take her to the operating room where we have a working 110V plug for a nebulizer (breathing) treatment (imported machine from the US that we found in the storeroom here). I examined the 10 year old in coma and then searched for the supplies for doing a lumbar puncture (in 3 different places in the hospital). While walking back to peds, the mother of a premie found me and explained there was a problem with the NG tube I had placed yesterday to feed the baby. I couldn’t understand what the problem was, though, so I walked back with her to the OB ward for a translator. The nurse helped solve the problem and I was consulted on two other sick babies while there. Started antibiotics on them. Found out that the baby of Felicité who was very sick yesterday is doing much better today and can now breastfeed again. Also very excited to see the twins of Joline gaining weight and ready to go home. They (a boy and a girl) were born at 32 weeks and 1500gms (3.3lbs) and it’s quite miraculous that they survived - even without incubators or oxygen or phototherapy for jaundice. Praise the Lord! Took a quick picture to print and give to Joline. (The picture from the last blog post of the premie in the box was one of the twins.)

9:15 - back to peds with the LP supplies. While getting set-up, got a phone call from visitors who were lost in route. Giving French directions on the phone is not yet comfortable for me, so I handed the phone to the student. Then we did the lumbar puncture, checked the boy’s glucose level, and took the spinal fluid to the lab. Just in time as the visitors walked up at that moment. So, during our year in France, we were warmly welcomed by the evangelical protestant church in Albertville. And there was an amazing connection in that the pastor’s daughter was actually a missionary in Burundi! We met Annelyse in France and she joined us for dinner a couple times there and we’ve enjoyed connecting with her more here in Burundi. Well, she got married on Saturday and I was so thankful to be able to attend the Belgian/Burundian wedding ceremony in Bujumbura. And then it was a blessing to welcome our pastor and his family here for a quick hospital tour today as they were on the way to the nearby waterfall. 

 Annelyse's wedding in Bujumbura

Pastor Christian Mary, his wife, daughter, and son-in-law Daniel

The church in Albertville welcomes so many missionaries year after year and patiently listens to our broken French and endures our awkward attempts to greet them with the French bisous (kisses on both cheeks). It was a joy to be able to show them what our life looks like after France and what they are helping us prepare for with their patient and likely painfully slow French conversations in the church lobby. We connected with other teammates on our hospital tour and ended with the kids showing them their school and even speaking French with them. Anna wrote a sweet letter in French for them to bring back to the church from us. (Heather continues to teach French class for the kids every afternoon.) 

10:45am - As we finished tea at my house, Carlan called to say the second group of visitors was at the hospital looking for me. And then a medical student walked up with Brad, the leader of the second group. I quickly explained the lunch menu to Francine, who helps me at home, said goodbye to our French/Belgian visitors, and then headed back up to the hospital with Brad. He and his colleague Brian and their families work as missionaries in Germany with Cadence International, a mission agency serving the US military. They visit Burundi twice a year doing trainings for the military here on post traumatic stress disorder and other things and I was connected with them through a mutual friend. They also came to see the work at the hospital just for a couple hours. They were gracious to join me and the medical students on hospital rounds and simply observe what goes on with our, currently, 21 pediatric patients - mostly with malaria, meningitis, pneumonia, gastroenteritis, and/or malnutrition. A new patient began seizing during rounds, so we gave meds and prayed with that family. Several patients were well enough to go home, so that's always a blessing. And the lumbar puncture for the 10 year old did not show meningitis, so that was helpful to know. 

12:30pm - Hospital tour, this time in English! I really enjoyed hearing the perspective of both groups of visitors today as they observed our work here and asked many insightful questions. I can get so bogged down in the tasks of a day, so it's helpful to see things again with fresh eyes and to explain what we're doing and why we're here. Really, it is a joy, and I'm thankful for God bringing me here and strengthening me daily for this unique work. 

1pm - lunch with the visitors at my house exchanging stories and encouraging one another

 2:30pm - finishing the tour with the new construction - my house now has bricks! I'm loving watching the daily progress.

3:15pm - back up to the hospital. Did some teaching and reading on a new patient with likely Stevens-Johnson syndrome. Talked with 2 colleagues about her and got a more detailed history from the mother. Evaluated the sickest kids again and was thankful to find they were no longer seizing and the kid with asthma was improved. Remembered we had some donated meds for asthma and so went to the back store room to find them and give them to the patient. Talked to Ezekiel (electrician and skilled maintenance man) about the 110V plugs not working in peds and he was able to fix and label a couple of them. 

4pm - gave lecture to all the medical students on the topic of "Fever of Unknown Origin". Power went out near the end and so the projector stopped working, but overall, I think it went well. 

Beautiful late afternoon at the hospital

5:15pm - walked home. Here are some pics from my commute:

 Soccer game

Volleyball game

Cows

5:20pm - home again to discover that the pincer ant parade route went just past my house. We watched the parade from a safe distance. 

Quiet evening at home, thankful for a joyful, encouraging, and blessed, albeit busy, day. Visitors are indeed a blessing, in more ways than one!

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!