22.5.17

The East African Community Conference on Health and Research

(By Logan)

Introduction
A couple of months after our family arrived at Kibuye last fall, the team received an important email from the rector of Hope Africa University. 

He informed us that there was going to be an international medical conference in the spring hosted by the East Africa Community Commission on Health and Research. This was apparently a large annual conference that was held in a different East African country each year (Kenya, Tanzania, Uganda, Rwanda, Burundi, and South Sudan). This year was Burundi’s turn to host and the university wanted a strong showing at the conference.  If there was any way possible we should try to submit a proposal that we could present at the conference. There was only one problem: we found all this out only 2 days before the deadline for abstract submissions. 

However, it seemed like there was precious little time to dedicate to writing up abstract proposals for a medical conference that none of us were really familiar with. Everyone was engrossed in full-time work at the hospital. 

Everyone, that is, except me. 

I had not yet started full-time at the hospital, while I adjusted to life in Burundi and studied the local language of Kirundi. Of course, I had also not participated in any research whatsoever in Burundi. 

After letting the team know that I was willing to help expediently write some abstract proposals (OK, it’s possible I used the phrase “throw something together”), I learned that there were some possible submission ideas already on the team. Working feverishly, along with Eric and Alyssa, we submitted two applications, squeaking them in just under the deadline. 

With that off my plate, I promptly forgot all about it. 

For about the next 4 months that is. To be more precise: until 3 weeks prior to the conference. That is when I found out that our proposals had actually been accepted as poster presentations. That meant that I had less than 3 weeks to make all the arrangements to attend the conference in Bujumbura, turn the hastily prepared abstracts into professional appearing academic posters, and then figure out how to even get a poster made in rural Burundi. 

Methods
With a lot of help from Eric, Alyssa, and even a colleague from Cox FMR the posters came together. I found out that one of the lab techs at Kibuye Hope Hospital knew a guy who could make the poster in nearby Gitega. About a week before the conference, I entrusted to him the USB drive that contained pdf’s of the posters. And then I waited.

And waited.

Each day for that next week I would stop by the lab and check with him on how the posters were coming along. He assured me they were being made and I would have them before the conference. Finally, on the night before the conference, at 7:30pm, the posters arrived via motorcycle taxi. With fold-creases and just a little mud splashed on them, they certainly had the appearance that they had just arrived by motorcycle taxi. But with enough pressing and a warm wash cloth the wrinkles and mud stains came out.

Results
I made it to the conference and started to put up the posters in the poster area, which was actually an area outside under a breezeway by which people would pass during breaks. As I was working, I was standing on the carpet in the middle of the aisle, checking to make sure the poster was level, when an employee came over to me and said, “Excuse me, you can’t stand here, the President is walking here.”

“Oh! I’m so sorry!” I said, jumping back quickly and looking around. But then I got confused because there was literally no one around.


I looked back at the employee, trying to understand. “Ohhhh! I get it!” I thought out loud. “You mean, that, like, at some point in the future, the President WILL walk on this carpet, so I should get off of it now… Ummm.  Right!  Of course! No problem.”

The conference got underway, and the President did in fact walk on that carpet. There were many opening speeches by many dignitaries in the East African Community, including the U.S. Ambassador to Burundi as well as His Excellency the President himself. 


Alyssa and Sonia, one of our Burundian colleagues at Kibuye, were also able to come down to Bujumbura to attend the conference and present the new Kibuye NICU design as an example of low-tech and low-resource techniques to help decrease neonatal mortality.  



Discussion
The theme of the conference was “Outbreaks, Epidemics, and Antimicrobial Resistance”. There were some interesting presentations ranging from efforts to limit the purchase of over-the-counter antibiotics to the demonstration of antimicrobial resistance from cultures of hospital cockroaches. It was especially interesting to see the antibiotic sensitivities presented in regards to the common antibiotics that we use at Kibuye since we don’t actually have the ability to do microbiology cultures. But at the same time it was quite alarming, because we could see just how much resistance is developing to these common drugs, even though they are often the only option we have available.

Conclusion:
Overall, this was a good opportunity to share our work with the East African Community, as well as learn from and be inspired by what some of the larger hospitals and medical schools are doing in this part of Africa. I’m not sure where the conference will be held next year, but I think it would be worth attending again. As long as I’m not “pulling it together” at the eleventh hour.




(the cockroach abstract, for those interested...)



13.5.17

Lost at Home

(by Nicole)
I’m currently three weeks into my four-month long home assignment, so it seems like a good time to address the phenomenon of reverse culture shock while it’s fresh. Let’s take a brief look at where I’ve just come from:  I love the community living in Kibuye; we live together as a team with common purpose. I am constantly surrounded by people who know me and love me well, whom I have been intentionally doing life with for the last two years. We’ve had countless shared experiences and built a team culture that this blog can only provide glimpses of.

This is not the first time I’ve been back to the US since I arrived in Kibuye. In fact, I’ve been back twice in the last two years for special events. These visits were both very brief and didn’t require me to really enter back in to the culture. This time feels altogether different. I have four months. That’s enough time to get involved, to build routines, to invest. I didn’t expect to feel differently though, so the culture shock I’ve experienced really snuck up on me. I’ve felt a sense of social anxiety that I’ve never experienced before. I’ve found myself in tears even on my way to join my friends at bible study. My body has decided to find new ways to react to stress so I’ve found that I now start to get hot and sweat when I’m nervous (thanks for that, self). I’ve also noticed my hands shaking but, that could be because of the excessive amounts of coffee I’ve been consuming to fight the lethargy I’ve been feeling. I’ve never been good at dealing with large amounts of unstructured time; I like to have a plan and stick to it, yet here I am with four months of time and minimal structure other than my already scheduled speaking engagements. (This particular tension has eased a bit as I’ve gotten involved in a bible study, scheduled French tutoring, and added a few other regular commitments to my schedule – but initially it was a major cause of stress.) It’s just in the last few days that I’ve realized I’m enjoying driving again. I still feel isolated and lonely when I spend more than a couple of hours at home. I don’t like having to schedule time with people more than a week in advance, and then having to travel to see them. I miss walking out my front door and going to my neighbor’s house to have tea and talk about our days. In Kibuye I see the same people every day and they know pretty much everything happening with my life (I’m an extrovert and a verbal processor so the people around me tend to know just about everything about me.) I don’t like having to recount the last year to people instead of just the last few hours.


Even as I write and think back to how intensely I was feeling these emotions a week ago, I realize they are slowly fading away. I’m slowly finding my way back into American culture and have some great friends who listen and seek to understand what I’ve experienced. I’m thankful for the paradox of emotions I’m feeling because it means I am at home in both places. Even as I wrestle with the negative impact of reverse culture shock, I am elated to have the next few months to spend with family and friends and to invest in my home church which has invested so much in me. I praise God that in this season I have two places to call home. 

Kibuye, Burundi

Poughkeepsie, New York

12.5.17

Divine Love

(By Susan)

What i'm about to tell you is a love story.  This is one of the greatest love stories I've ever experienced.  It involves unconditional love, costly sacrifice, incredible patience and perseverance.  But this is not your usual love story.  This is the love story between a young a very  sick little girl and her older brother, and I have been deeply blessed to have seen this love story up close.

5 year old Divine came to our hospital at the end of December and was admitted for severe malnutrition. Really, really severe malnutrition. For weeks, she lay in bed, barely conscious and barely alive. Her mother was unable to stay at the hospital, and since our hospital requires each patient to always have a caregiver, her brother was given the job of caring for little Divine. From that point on, her 12 year old brother, Moise, was always at the side of her bed.





 He did jobs that I have never seen any 12 year old boy do before; change his sister, clean up diarrhea, wash and clean his sister, feed her, give medication, and sleep next to her (in the same bed, often with other patients) in a very crowded room filled with lots of fussy, malnourished babies and toddlers and their care-givers.

Weeks after she had been admitted,  I walked into the room one day and found her sitting up in bed.  I was shocked.  She still had a feeding tube in and was still on oxygen...but for the first time, I felt like she was going to make it.  For the first time she was interested in playing, and even though she was extremely weak, she was determined to pick up blocks and try to throw a toy at me.
Divine had a type of malnutrition that is a bit deceiving to those of us that don't have a medical background.  She actually looked a bit chubby.  Her body was puffy and swollen, due to a lack of protein.  As she was fed a high protein formula through her feeding tube over the next few days, her swollen body dramatically changed. She suddenly had a tiny little body that looked like pictures that I have only seen in my high school textbooks of holocaust victims.  Just looking at her tiny little skeletal frame, my throat would tighten and would get choked up.
 Divine is special.  She has some developmental delays, that mean that although she is 5 years old, she has never walked and has never clearly spoken.  I feel certain that if Divine had the help that we offer in Western countries;  therapy, special education, healthy food etc. that she could thrive.  However, there's not much aid for special kids like Divine here in Burundi, so I can only imagine that most days Divine sits on a mat in their mud hut, neglected, while her single mother is out working in fields, fighting to get enough food to feed her hungry kids. 

Almost every day for 4 months, I visited Divine and played with her.  Moise was never far from her bed.  Boys his age should be in school and outside playing soccer with their friends, but Moise patiently sat by her bed, tenderly caring for his weak sister. 

He was never embarrassed of his sister, but would clap and cheer and rejoice in her progress.  During those 4 months, we saw some amazing changes in Divine.  She grew stronger, was eating more, was more talkative, was working with our hospital's physiotherapist, and was actually able to start walking with the aid of a walker.




Of course, she had some setbacks, like coming down with malaria and another infection.  In spite of the tough times, it was exciting and rewarding to see her gain weight, strength, and see her play and smile every day. Moise became a strong voice and an advocate for his sister, pushing for his little sister to get more physiotherapy time, and be able to borrow a walker.   




On April 12th, after so many months in our malnutrition service, Divine was discharged and Moise carried her home...we would later learn just how far he had to carry her!  Both Dr. Alyssa (our paediatrician) and I never had the chance to say goodbye to them before they left, so the  following weekend, the two of us along with my 10 year old son Micah, set off to try to find Moise, Divine and their home.



 It took about an hour of driving, a few wrong turns, and then about another hour of hiking on little dirt trails following an old man with a machete before we found them. 

They were a little shocked - and honestly a bit scared - that a group of 3 bazungus (white people) just showed up at their home,  but after offering gifts of beans, rice, Busoma cereal and a soccer ball, they were much more receptive to us!


This family lives in unbelievably extreme poverty. Their house is made of home-made mud bricks, a grass roof, dirt floor, and that's about it. To a person walking by, you would say that they have nothing.  Absolutely nothing.  I would have totally thought this had I not gotten to know Moise and Divine.  What I learned is that while they are the poorest people I have ever met, they are rich in other things.
If I'm honest, it's hard to imagine anything for Divine other than a dismal life filled with a lot of suffering, pain and hunger.  However, I have to remind myself that our Father loves Divine so much more than Moise or anyone else does or ever could.  That pain, sickness, and poverty don't get the last word. That the sacrificial love that Moise showed for his sister, is merely a poor reflection of the divine love God has for little Divine, and for every single person on this earth.
      This is how we know what love is: Jesus Christ laid down his life for us.  And we ought to lay down our lives for our brothers {and little sisters} 
1 John 3:16

1.5.17

Cleft Camp

(by Greg)

In the work of medical missions there are certain opportunities that we are invited into where one is able to transform someone’s life in a very short period of time.  Cleft surgeries are one of those opportunities.

Last week, Kibuye finished up two weeks of “cleft camp”, a time dedicated to operating on kids (and sometimes adults) with cleft malformations.  The camp was supported by Smile Train, who flew the world’s greatest cleft surgeon (at least we think he is the greatest), Drew Huang to Kibuye to work with Jason (the world's most outstanding medical missionary), who himself is getting certified to become a Smile Train surgeon.  I flew down from France to help with anesthesia care and we were also joined by a wonderful OR nurse from Samaritan’s Purse, who helped Jason and Drew and brought some fabulous equipment with her.  

In two weeks we operated on 21 children with cleft lips, palates and one cleft eye (something I had never seen before).  We also operated on one adult with a cleft lip, one of our Kibuye construction workers.  We had several others scheduled for surgery who unfortunately had to be delayed because they were too malnourished to make it through surgery, or they had another infection (such as malaria).

It was so exciting to be a part of these life changing surgeries, and as with any new experience in Africa, I continue to learn through these experiences.  As an example:

On one of our first days operating, at the end of the surgery, I carried the child to our recovery area and gently laid him down on one of our three beds.  The mother sat on another bed, with a look of terror on her face.  Given my lack of Kirundi, I could not ask her what was wrong, but quickly it dawned on me …. if she has never seen someone recover from anesthesia, she might not realize that it was normal for her child to still be asleep.  In fact, she had assumed that I was carrying her DEAD child back to her.  I quickly found a Burundian medical student and asked them to explain that the surgery had gone very well and that her child was alive and would wake up slowly over the next hour or two.  As soon as this was explained to her, her face transformed as a huge smile broke out.  

From that time on, as soon as returning a patient to recovery, I asked for a translator to assure the parents that all had gone as planned and that their children were very much alive and well.  


Below are some photos of our camp.











25.4.17

Lessons of a Lost Backpack

by Carlan Wendler
The San Diego Wendlers on the Metro
On Saturday, my brother and his family, Michelle, her sister, and myself visited the Louvre Museum in Paris. We got a bit of a late start and between jet lag and sheer, utter boredom at perambulating through vast halls of incredible art, the kids (ages 4, 3, and 1) began to make their discontent known. So my brother and I set off to pick up the rental car from across town and drive back to pick up the rest of our family.

After a Metro ride to the Place d'Italie, we realized that the office that had our car was actually in Montparnasse. It was another simple Metro ride to Montparnasse, a few conversations with folks in the station regarding where to find the car rental office and a ten minute walk there. After waiting in line, translating order details, and selecting the appropriate car seat based on kilograms, we had another ten minute walk and a few conversations with folks as to where the "parking" office of this particular car rental agency was.
Mona Lisa smiles...or not

"You go through the bar, down the elevators to Level -3. Then find the stairwell and walk up to Level -2. Across the parking from the stairwell you should see a sign for a different car rental agency. Your company uses that same office and staff."

Wow! Things in France are different!

The French have this whole notion that geography dictates personality (e.g., people from the Savoie region where the language school is located are broadly caricatured as aloof, private, slow to warm up to new people but fiercely loyal, intensely compassionate to their friends, and extremely hardy). I don't know that I'm clever enough to make judgments on people's personalities based on knowing their whereabouts growing up, but I can see how geography has dictated the ways car rental companies solve their business problems. Paris is dense, old, and labyrinthine. If you rent out cars, you find a hotel or mall  with a big parking lot and use some of their space. If there are other companies doing the same thing, you band together to economize on overhead.

Two hours into a process that I thought might take one those were not the thoughts going through my head. I was rather worried about the women and children and trying to keep ahead of the communications so that they would know what to expect. And in that distraction, I left my backpack containing the keys to the car we had driven from Albertville to Paris and my wife's and my passports.

This I did not realize until we had reconvened at our rented apartment and started supper.

"Michelle, where did you put my backpack? I'd like to take some Tylenol [also in the bag]."
"You took it with you when you left the Louvre."
"Are you being funny, because this headache is not funny."
"No. Remember, you had to come back and give me my water out of the backpack before you left."
"... [frowny face]..."

Through the glass storefront...right where I left it
A quick review of our contorted journey around Paris left two places the backpack could have been left: the first car rental office or the last one in the parking lot where we actually picked up the car. My money was on the first but by this time on a Saturday the offices were closed or closing. Customer service lines don't seem to operate in the same way in Paris, on the weekend, before the nation votes for two finalists in the presidential elections, that they do in the States. The car rental agency said, in brief, "You'll have to wait until things open up again on Monday morning." A quick call to the US Embassy in Paris to notify them that our passports were misplaced and ask if anyone had reported them was met by three answering machines before we got an operator who transferred us to a recorded message that pointed us to a website or e-mail address. "Our commitment is to respond within 48 hrs to all e-mails sent to this address." Yikes!

Nothing more to do that night but pray.

The Good Lord provides the next day
The next day we put all our contingency planning into effect and we prepared to send everyone else on to Albertville while I stayed in Paris to recover the backpack on Monday morning. By God's grace, we got through to a plucky customer service agent on Sunday morning and she put into effect a plan that eventually led to the return of the backpack that afternoon. Everyone else had left, so I had some time to think while riding on the Metro again and sitting in a car rental office again. And that's when I began to see some parallels between walking amidst Greco-Roman statues in what was once the palace of French kings (before Louis XIV moved the royal family to Versailles) with kids who were bored to tears and my experience around Paris and a lost backpack.

My good Father, God, has a plan for my life, prepared day-by-day and hour-by-hour. Riding the Metro around Paris with John Mark while the women and children languish in a less frequented hall in the world's largest art museum was within His will for that day. Misplacing the backpack and working through all the efforts to recover it and stick to the itinerary we had established in advance was in God's plan for us. Cramming all of my visiting family + Michelle into one car while I drove by myself to try to catch up was also the path He had laid out for the day.

The frailty of my faith in my Father might look different than the feebleness of my nieces' and nephew's confidence in their parents' plan, but I have a feeling that if I were to slow down and try to observe the place God had brought me to in each moment, I would observe things more remarkable than even the Winged Victory of Samothrace.

22.4.17

Saving Kids from Eye Cancer

(by Darrell)

Retinoblastoma is the most common intraocular tumor in children and represents 11% of all cancers in the pediatric population.1  Thanks in large part to early presentation and advances in treatment in the United States, less than 3% of all patients with this cancer die, whereas in Africa, the mortality rate is 70%.2  

However, in Burundi in particular, it is worse: since John started the eye clinic in early 2014, he has seen between one to three children per month with this aggressive eye cancer.  He has yet to see one child survive.

There is nowhere in Burundi for these children to receive treatment (for the affluent, there are options just across the border in Rwanda), and after watching so many die despite taking heroic surgical measures, John decided in January to initiate Burundi’s first chemotherapy program for retinoblastoma.

John recruited a group of us, including Alyssa, Logan, Dr Parfait and myself, to travel to Kabgayi Hospital in Rwanda to meet and learn about the treatment of retinoblastoma from a British ophthalmologist named Dr. Keith Waddell.  When I first shook hands with Dr Keith, I had the distinct impression that I was meeting the most important person I had never before heard of.  He immediately memorized our names (and checked them twice) and then ushered us into a sitting room where he began to unfold the story of the years-long attritional war he had been waging with retinoblastoma in Uganda.  His keen eyes, unflagging energy, and ability to remain undeterred in his telling of this history despite my numerous questions were impressive, but all of that quickly paled in comparison with what we encountered afterward in the eye unit.  As we walked into the ward, many of his patients greeted him in possibly the warmest manner that I have ever witnessed—handshakes (of course), then hugs, and later even sitting in his lap and playing with him.  His patients (I actually started to type “children” there) loved him, and  one of the parents even referred to their child as “his” daughter.  There we witnessed true love between doctor and patient. 

All of these patients (with perhaps one or two exceptions), had had one eye removed by him, and sometimes he’s had to remove both eyes.  Many of them have had more than 6 cycles of chemotherapy that have, on each occasion, put them at a high risk for infection and death.  But every four weeks, they continue to come back.

Dr Keith has treated close to 500 patients with retinoblastoma, and he has documented all of their clinical courses in meticulous, working-late-into-the-night detail.  He has published some of his data3,4, but as he puts it, he needs to find some additional time to finish it before he dies, which could happen at any time.  He is 80 years old after all.

John and I both hope to be old men like him one day (many here at Kibuye maintain that I already achieved old man status last October when I hit 40); regardless, Dr Keith is truly a remarkable person who has fully embraced his calling from God to serve the least of these.  I don’t think we could have assembled and inspired our retinoblastoma team without seeing Dr Keith and his team in action.  In fact, we now have five patients scheduled, nutritional status permitting, to begin chemotherapy on May 2nd.

Ever since I had the privilege of spending many of my Mondays during fellowship on the Ocular Oncology service at Wills, I have wanted to be like Jerry and Carol Shields who direct it and care for retinoblastoma patients.  If I hadn’t been called to Africa, I would have wanted to pursue a career in their field.  Little did John Cropsey know that ordering chemo drugs one night back in January was going to lead to just the confirmation that I needed from God to stay the course here in Burundi.  Maybe even as long as good old Dr Keith has.

Figure 1. Some of the cancer patients of Dr. Keith


Figure 2. Dr. Keith teaching and caring for patients

Figure 3. Dr Keith in center along with his assistants plus our team.

Bibliography

1.     Wong JR, Tucker MA, Kleinerman RA, Devesa SS. Retinoblastoma incidence patterns in the US Surveillance, Epidemiology, and End Results program. JAMA Ophthalmol. 2014;132(4):478-483. doi:10.1001/jamaophthalmol.2013.8001.
2.     Kivelä T. The epidemiological challenge of the most frequent eye cancer: retinoblastoma, an issue of birth and death. Br J Ophthalmol. 2009;93(9):1129-1131. doi:10.1136/bjo.2008.150292.
3.     Waddell KM, Kagame K, Ndamira A, et al. Clinical features and survival among children with retinoblastoma in Uganda. Br J Ophthalmol. 2015;99(3):387-390. doi:10.1136/bjophthalmol-2014-305564.
4.     Waddell KM, Kagame K, Ndamira A, et al. Improving survival of retinoblastoma in Uganda. Br J Ophthalmol. 2015;99(7):937-942. doi:10.1136/bjophthalmol-2014-306206.