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

Source du Nil

David Livingston wandered all around Burundi, Lake Tanganyika, and north and south of here searching for the elusive "Source of the Nile". Some people say Stanley and Livingston had their famous meeting ("Dr. Livingston, I presume") here in Burundi and there is a rock to commemorate the event near Bujumbura. Unfortunately, Livingston never discovered the source and he died trying. It's been interesting to read a biography on Livingston recently and to track his routes on a large African map my grandpa gave me - many of his stops were quite near here. But, many years after his death, the southernmost source of the Nile was in fact found in Burundi - that is the southernmost source of Lake Victoria that then eventually becomes the Nile. Burundi lies right on the continental divide, so it makes sense that the source would be here. Just south of the ridge pictured below, water flows south instead of north. A German explorer discovered this source of the Nile here in Burundi in the 1930s and we visited it recently - less than an hour from Kibuye. 

 They've built up the site for tourism purposes, though we enjoyed being the only tourists there. The hole beneath our feet is the source of the Nile. 

 Erica is a Burundian doctor I work with and I'm enjoying getting to know her more

 That tiny stream somehow becomes the great Nile river that I could see from an airplane once on a flight over Africa

 Burundian scenery

 The German explorer built a pyramid to commemorate the connection to Egypt

 The extent of my own explorations - climbing the pyramid :)

 McLaughlin family (except Toby)

 Rachel and I on the continental divide

 Hot springs nearby

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!