Dear Super Yacht Owner

My family and I are currently studying french at a language school in France. We noticed your incredible super yacht in a harbour in France a few weeks ago while we were on a road trip with my visiting family. Your yacht was incredible to say the least. Multiple decks, 2 helicopter pads. I couldn’t help but think of the indoor pools, jacuzzis, probably multiple kitchens and I sure hope there is a theatre room or two or three. I did notice a few vehicles on one of the many decks. That must be nice that you can bring them with you.

Welcome aboard our "yacht"
It holds 7 passengers including driver
I was amazed by your yacht and aside from gawking at it, I decided to look it up on wikipedia. You should know it is really easy to find. It is the fourth largest super yacht in the world and the largest by volume. And $600 million dollars to build!  Since you can take 40 guests, I bet everyone wants to be your friend. Do you need all 80 crew members on every trip you go on?

I wanted to apologize for the english only speaking lady who tried to come aboard. That was my mom. She thought if she asked, you might let her on but I told her it was unlikely. It seems that your security people do an effective job of screening unwanted visitors.

I am writing to tell you that your super yacht really amazed me; in fact, part of me imagined what my life might be like to have one. But know that I wouldn’t trade my life for your boat. Not in the slightest. In fact, my family and I just booked our flights to Burundi for July 2018. We have been working towards this opportunity longer than it took to build your boat and we couldn't be more excited. 

I will get to use every bit of experience and training I have accumulated over the course of my life. I will be working with an incredible team of medical and non-medical staff. We get the privilege to serve in ways few people do, and to be the hands and feet of Jesus to the best of our abilities.

Not only that, we have a family, church and group of friends excited to be a part of the mission we will be joining.

I hope you enjoy your yacht, my regards to your guests. And if you think your yacht is exciting, you should see what is happening in Kibuye! 



Alors il dit à ses disciples: "La moisson est grande, mais il y a peu d'ouvriers. 
Priez donc le maître de la moisson d'envoyer des ouvriers dans sa moisson."

Matt 9: 37-38


May Day

Incognito as ever
On the first of May  - which in many parts of the world is Labour Day / Labor Day / Workers Day / Fete du Travaille  (and in other parts of the world is merely 3 days before Star Wars Day “May the Fourth be with you”), some of us took part in some local festivities. Here in Burundi it’s a national holiday - one of the 12 or so during the year - but outside of Religious holidays (Easter, Christmas, All-Saints day) and various patriotic national holidays (independence day, unity day, 3 separate memorial days for 3 different assassinated presidents) it’s only May 1 and Jan 1 that are left. So it’s apparently a fairly big deal.

We gathered about 13 of us into the Land Cruiser - and headed for the ‘capital’ town of our district. It’s just a short drive away - even shorter if you take the back way - but I was instructed that driving a Land Cruiser full of people on the goat path was not recommended (it can be done….trust me).

Being a rather significant institution in our district - the Hospital was at the head of the whole thing.

 Part of the reason that we were going was that two of the girls had practiced a dance routine with some of the girls from the local school that sits just between our houses and the hospital.
...and for some reason, I forgot to wear my shirt.   Next time. 

The details - of course - were rather sketchy. What exactly they were doing, what they were supposed to wear, when we were to go, where we should be etc -  were all details that were only to be unveiled at the appropriate time. For us, as guests in a foreign land, that time seems to often be “just after something has happened.” Whenever these kinds of ceremonial events take place, it seems to often be difficult to navigate the expectations, protocol, assumptions that surround any kind of thing.

Last week when our team was having a discussion on cultural intelligence, the example came up that Canadians apparently have one of the lowest scores in the world for ‘power distance’ - meaning we are not comfortable with the fact that there is a large distance in hierarchy between those at the top and those at the bottom.

Personally, I feel like I am probably even dragging the collective score for other Canadians down - so suffice it to say that living in a place where protocol, respect for positions, authoritarian style of leadership, deference to one’s superiors, elders etc - is not something that I find easy to navigate.

Clearly some people knew how to get a better view - and this was before everything had even started.
So after the 'parade' part was done - and the kids marched in with the kids from our local school, and everyone marched past the platform and gave their respects to the local dignitaries who were there (which quickly included the contingent from the hospital) - the event itself started. 

One of the staple parts of any Burundian event of note it seems is always The Drummers. Burundi has a long and proud tradition of drumming - in fact Burundian drumming is recognized on the  UNESCO list of  "Intangible Cultural Heritage".  For comparison - that's alongside French Gastronomy, Turkish Storytelling etc. (neither US nor Canada has any).  And they are so amazing to hear and watch. 

Everyone wants to see the Drummers!

Once things got going the Kibuye school girls (including Matea & Anna) got up to dance. It, of course, was a bit of a spectacle that they were up there with the other girls.
 I speak essentially ZERO Kirundi - but there is one word that I recognize as it's shouted at/to me dozens of times a day: Muzungu.  Pretty much what I could understand was that the announcer (who seems to be ever present and constantly shouting into a microphone at these kinds of events) kept saying something like "Wow -look at Kibuye School  -they even have Muzungus with them!"

So apparently the fascination with others culture goes both ways

Pretty soon after the girls were finished dancing we realized that we should probably get back as it was a school day for our kids, and it was well past lunch, and it looked like this thing could go on for hours.

 Unfortunately, SOME of us had been seated in places of honor, right in the front row of the stage - and the kids were standing at the back of the platform. But - since we can move around without ever attracting any attention - we simply snuck off to the side- and I'm quite sure not one person even noticed. 

So that is apparently what a Fete du Travaille celebration is like.  Or perhaps not. Maybe that was a total anomaly - or maybe its exactly what everyone in the country experienced. One more experience that we had - showing that we really have no idea what goes on all around us every day.


Reflections from Rachel

by Rachel Buikema

I have only four weeks left in my nine-month term at Kibuye. I’m very excited to be going back to family and friends in the land of Krispy Kreme and Chick-fil-A, but I can already feel my heart breaking as I prepare to leave this place. 
For the past eight months I’ve been helping to teach the children on our team. Before coming to Burundi, I had never travelled outside of North America. That didn’t stop me from deciding to come here for nine months. I do not speak French or Kirundi (the local language), I had never met anyone on the team, and I was coming all by myself. I also had no teaching experience. I had no idea what I was doing! A few weeks in, one of my teammates asked me what was the bravest thing I’ve ever done. Without hesitation, I said it was coming here. I knew so little about where I was going and what I was going to be doing. I have been blessed to see God’s grace carry me though.
I was diagnosed with generalized anxiety disorder a couple years ago. My anxiety kicked into high gear about a month before leaving for Burundi. I felt like I was going to throw up almost every day. I normally love food, but not only was I not hungry, the thought of food was revolting. I was dreading saying goodbye to my loved ones for nine months. There were days when I thought that I was not going to be able to go through with this. I was terrified of the future and I had no idea what I had gotten myself into.
Had I known what that was going to be like before signing up for this, I probably would not have agreed to come. I certainly don’t regret coming—the opposite is true. I’m so glad I stepped out of my comfort zone to see the incredible work going on here. I was only able to do that by God’s grace and because we do not have to take the future nine months at a time.
Max Lucado has a wonderful book called Traveling Light (I highly recommend it!) in which he examines the 23rd Psalm. Each part of the psalm corresponds to a burden that we often bear unnecessarily. The chapter about the burden of worry really resonates with me. He begins with some examples that seem absurd: a four year old who worries how she will ever pass a calculus class or an eight year old who worries if he’ll be a good parent. That’s simply ridiculous to think about. They don’t need to be worrying about such things yet.
Psalm 23:2 says, “He leads me beside still waters.” God is not behind us, waiting for us to move forward, but rather he is in front of us, clearing the way and encouraging us to follow. He gives us guidance when necessary. Hebrews 4:16 says, “Let us therefore approach the throne of grace with boldness, so that we may receive mercy and find grace to help in time of need.” The key phrase there is “in time of need.” Just as an elementary school teacher would not teach his students what they need to know in college, God does not give us all of the help that we need for the future right now. He gives wisdom when the time comes. So by the time that four year old gets to calculus and that eight year old becomes a parent, they will have what they need in order to be successful in their calling. By the time I arrived in Bujumbura (the capital city), God had given me the strength I needed to get to that point. He has continued to provide what I need as I need it throughout my time here.

As I reflect on my experiences in Kibuye and look ahead to the next chapter in my life, I can feel the anxiety welling up inside me again. How can I manage another transition of this magnitude? Every single day I need to remind myself of God’s promises. I’m working on abiding by Matthew 6:34: “So do not worry about tomorrow, for tomorrow will bring worries of its own. Today’s trouble is enough for today.” Instead of splitting my mind between today’s to-do list and tomorrow’s tasks, I need only focus on what’s happening now. There are so many things we could worry about: How will we cope with the loss of a loved one? What will we do if we lose our job? How will we possibly get through all of the hardships that will inevitably come? God will provide help at the right time. He has promised to never leave us or forsake us, and we serve a God who keeps His promises. Where he calls us, he will equip us.


Relating to John in Prison

(by Eric)

We beseech thee, give us that due sense of all thy mercies, that our hearts might be unfeignedly thankful.  -Book of Common Prayer

(if you want to read the context, you can read Luke 7:18-23)

Samuel van Hoogstraten (1627-1678)
Lord, I feel like John in prison.  He sent his followers to ask the question that burned inside him.  Is the kingdom of God really coming?  Is it really near?  Because this world still seems so incredibly broken, so unredeemed, so worn and tattered and heading inexorably towards death, not life.  Now that you've come, Jesus, are you really making all things new?  Are you really reconciling all things to yourself?  I can understand that I wouldn't see your final, perfected work right now, but this hardly feels like new creation at all.  So, go and ask Jesus, "Are you really the one who was to come, or should we be waiting for someone or something else?"  I know that I've felt, seen, and even proclaimed this myself in the past, but it's just terribly hard to believe right now.

So, his followers went and put the question to you.  Your response is telling.  In that hour, you healed sicknesses and handicaps.  You chased out demons, and you told the messengers to go and tell John what they had seen:

The blind see.  The lame walk.  Lepers are cleansed.  The deaf hear.  The dead are raised up.  The poor hear the good news.  And blessed is the one who is not offended by me.

What did John think when he received that news?  We don't know.  It seems that you wanted him to notice that the signs of the kingdom of God were bursting into bloom all around you.  It seems to be a way of saying, "No, John, you're not wrong.  See the evidence that God's kingdom comes in my wake."  I think that the reasons John was wondering in the first place was because he didn't see transformation on that larger scale that he expected, and likely in particular because of his own personal predicament of being imprisoned.  I can understand his sentiment.  

How did John receive the response of his followers?  Did he understand?  Was he encouraged?  Did he have more peace and faith in the days that followed in his prison cell?  Nothing ever really did change for him on a personal level.  He never got out of prison.  In fact, he was killed.

"John, have faith.  Trust me.  All things are not yet made new, but there are signs.  There are in-breakings.  There are first fruits, seals, down payments, promises of a bigger thing to come."  Let the signs give their witness and hang in there.  Can I do that?

The funny thing is that Kibuye, every day, is quite similar to Jesus' testimony.  Here, because of God, blind people see, the lame walk, and people with terrible medical conditions (including the occasional leper) are healed.  People that are all but dead are seemingly resurrected (the French call intensive care "reanimation"), and the poor hear and see the good news that God is near, offering life, both eternal and abundant, offering forgiveness, offering adoption into his family.  It's easy to imagine someone coming to visit and having the type of encouragement that it seems Jesus is wanting to give John.  "See the signs!  It's real!"

But I see all the rest, as well.  Emelyne is only 14, and she is so suddenly on the brink of dying.  Emmanuel shouldn't have to die, and yet I fear he will this very day.  Floribert and Pascal are the same.  The lame man who had a terrible stroke is likely to remain lame just to go home and get bedsores and die.  The blindness from meningitis is not getting better.  Poor patients who suffer and die because they are poor in a poor country.  Broken systems with decisions that impede even the little that we can do.  Fractured relationships in families and friends.  Misplaced hope and desire leading to depression.  Broken connections to God, to ourselves, to each other, to our work, to the earth.  Sin.

The "signs" don't feel like enough.  The promise seems way too big for the signs to be adequately convincing.

Blessed is the one who is not offended by me.  ...who doesn't lose faith because of me.  ...who doesn't stumble on account of me.

Why did Jesus end his message with that?  How does one get offended by this?

Sometimes we might say, "Look, what I'm about to say to you is hard.  Please, don't get offended.  Rather, hear me out.  I know it's hard, but don't close your heart at the tough words.  Hear me out.  Don't lose faith.  Don't fall.  Hang in there."

I guess it's like that.  Jesus is admitting that it's hard, but he gives us an admonition to persevere.

I keep coming back to Paul Miller's description that we live in the desert created by the distance between our hopes (or promises) and the reality in which we find ourselves.  We can give up on the hope (and thus, despair).  We can give up on the reality (and become delusional).  Our we can dwell in the desert between the two, with one arm on each, feeling the tension pulling us apart at every moment.  The good news according to the Bible is that God always seems to be showing up in the desert.

"Have patience, John.  Trust.  Let the signs encourage you, if they will.  Maybe they won't.  But the promises are true.  Live in the desert for now.  Do what you can where you are.  The kingdom of God is coming.  I am coming soon."



by Rachel

“We want autonomy for ourselves and safety for those we love.”  —Atul Gawande

 I’ve had a lot of bad outcomes lately.  I guess things tend to run in spurts…bad things come in threes, or multiple patients come in with the same diagnosis after months of not seeing that diagnosis at all.  Lately, I’ve been thinking about multiparity, or really, grand-multiparity.  For the non medical folks, “parity” refers to the number of times a woman has given birth.  When that number reaches 5, she falls into the category of “grand.”  When I was doing my training in residency, it often seemed that the first pregnancy was “the worst."  Meaning, if you were going to get a complication, it would more often happen with the first one.  Walking in to Labor and Delivery and seeing a whole unit full of “nullips” (first time delivery) meant a long day and/or night of unknowns while we watched and managed and hoped that a C-section wouldn’t be necessary.  A unit full of women who were on their second or third deliveries was much more upbeat, fast paced, certain.  Of course, it wasn’t very common to have a unit full of women on their 5th, 6th, or 7th deliveries.

Burundi is very fertile country, in more ways than one!  The average woman will have 6 babies in her lifetime.  My clinic is flooded with women who can’t conceive, so it stands to reason that for every one of those women, there’s another on her 10th pregnancy.  And, soberingly, a woman stands around a 1:30 chance of dying due to a pregnancy complication during her lifetime (UNICEF statistics from 2010).  It also stands to reason that the MORE pregnancies you have, the more risk you expose yourself to.  I had an attending who liked to say that getting pregnant was the most dangerous thing a woman could do with her life.  OK, I think that’s a bit extreme.  But oftentimes, especially in the US with a well developed medical system, we forget about the potential risks of pregnancy and childbirth, especially because the risks seem so minimum in comparison to what you get out of the deal.  Even with all my training and knowledge of the complications of pregnancy, Eric and I decided to go through the process three times! (And let me tell you, I do NOT take the fact that we had three uncomplicated deliveries and three healthy kids for granted).

So, back to my bad outcomes.  I had two maternal deaths in March with almost identical stories, women who should have had a straightforward delivery.  Two previously healthy women, both on their 7th pregnancies, both with 6 living children, who presented to another hospital after prolonged labor.  Both had a ruptured uterus (where the uterus basically tears open because it’s been working so hard to get the baby out) and a dead baby.  Both received surgery to attempt repair, which failed, and were transferred to me for “better management”.  Both arrived in shock.  Both received hysterectomies to try and stop the bleeding.  Both died within 12 hours of arrival due to coagulopathy.  

I felt very powerless in the process.  I felt like my best efforts were not good enough.  And I felt regret for a system that tries but isn’t good enough to save these women and ensure their children grow up with a mother.  And finally…I felt myself wishing these ladies had just stopped having babies.  If only they had decided 5, or even 6, was the perfect number of children.  If only.

These are not the first two women who have died after similar circumstances.  In fact, after doing some research I found that it’s shockingly common in the developing world to develop a ruptured uterus because of long labors or limited access to care.  And experiences like this color my opinions and decision making.  If it can happen to those two women, why not others?  

So I keep advocating for better care, and better birth control.  I perform a C-section for a woman…it’s actually her 5th, and she has two living children.  The surgery is a mess and takes forever, due to layers upon layers of scar tissue.  At the end I tell her that we should tie her tubes because this is getting too dangerous for her.  She refuses.  Multiple times.  I take one tube, and then the other, in my gloved fingers and think about how easy it would be to tie her tubes right now, even without her knowing.  Even without her consent.  Surely, she doesn’t have enough knowledge or experience to know how dangerous another pregnancy could be for her.  I could probably be saving her life if I tied those tubes.  Or at least, saving her from terrible complications in the hands of the next, possibly unexperienced doctor who tries to perform another C-section on her in the future.  I am the one who spent years and sweat and tears and money to receive my medical training, to be able to advise and treat…my knowledge base is far superior to her own.  

And then I think about why I am here in Burundi.  About how much I care for these women, all of whom have suffered so much at the hands of family, husbands, an incompetent medical system, life.  About how they are all fighters, and how I want what’s best for them, to empower them.  And I realize that taking away one of the only choices she has, to make a decision for her, is exactly what I’m fighting against.  And I slip the uterus back into her pelvis and close up the layers, and hope that she never gets pregnant again….but if she does, I hope, I hope, I hope that she lives through it.

I don’t know.  I doubt myself.  But I know that change does not come by taking away autonomy.  I want these women to be safe, yes.  But there are other ways to bring safety.  If only…


The Good News About The Bad News

“Either this man is dead, or my watch has stopped” - Groucho Marx

On Friday, while I was working in the OR, a medical student came to find me and told me there was a woman in maternity who was in cardiac arrest and needed reanimation.  I went with them to find a woman lying lifeless in her bed.  I told one of the students to start CPR and another to start an IV through which we could try to give her a dose of adrenaline.  No one knew how long she had been in cardiac arrest.  I opened the flashlight app on my iPhone and checked her pupils.  They were fixed and dilated.  I told the medical student to stop CPR.  Her brain had ceased to function.  This time death was irreversible.  

They called me because my title at Kibuye is “Réanimateur”, apparently “one who brings dead people back to  life”.  This is the francophone equivalent of anesthesiologist/critical care physician.  Judging from my success rate, I would have to say, I am not very good at my job. I would like to create another name badge that is instead labeled “Déanimateur” and see if anyone notices.  

Success rates for resuscitation after cardiac arrest vary depending on where the arrest takes place.  In the US, rates of success for out-of-hospital cardiac arrest are between 10 and 12%.  In-hospital arrests fare a bit better, around 25%.  That is in settings with defibrillators, powerful medications, and often teams of specialists.  While I have been able to successfully “reanimate” some patients who arrested in the O.R., I believe my current out-of-OR success rate at Kibuye is 0%. 

And so, I am left to ponder the finality of death.  Even after a successful reanimation, I have not reversed death, I have only postponed it, sometimes for a few days, in the best case scenario for years.  But it will come, both for the patient and for me.  Death awaits us all.  And yet, our hearts hunger and thirst for eternity.  Where did this hunger and thirst come from?  If death is a natural part of life, why are we utterly devastated when it arrives, for us or for those who we love?  And why have I dedicated my professional life to fighting against something that has already won?

All this might cause me to fall into despair, but for the hope I have in the reality of eternity.  I no longer believe that death is the end.   I have placed my hope in One who can reanimate, with a success rate of 100%, and not for days or years, but for eternity.  

“For we know that if the tent that is our earthly home is destroyed, we have a building from God, a house not made with hands, eternal in the heavens.” - 2 Corinthians 5:1

Most of the world’s religions claim that an eternal life with God is possible.  However, most of those religions claim that we can achieve this eternal life by our own efforts, by following a list of do’s and dont's, by being “good enough”.  But those of us who have tried to be “good enough” realize that we will continue to stumble and fall, that our righteousness cannot save us because we are too weak.  But there is one faith that admits that we will never be “good enough” to merit an eternal life with God.  And so, God entered into this world and lived that “good enough” life that we continue to fail living.  And not only that, He exchanged His throne for a cross, on which He suffered and died.  And through this substitutionary death, He created a way for all of us who are not “good enough” to merit this eternal life.  It is no longer based on our merit, it is based on His.  After His crucifixion and death, God in the personhood of Jesus Christ was raised from the dead, conquering death once and for all.  This was witnessed by more than 500 people (see 1 Corinthians 15:6), many of whom went on to testify to what they had seen and many of whom were willing to be put to death because of their confidence in what they had witnessed.  And now, thanks to His life, death and resurrection, death is no longer the end.  It is only a portal, through which those of us who are not good enough can pass into a better, more beautiful, more joyful and eternal life with God and with His Son, Jesus.  Death has been defeated through it’s own poison, which was swallowed up by God Himself.   

“But God, being rich in mercy, because of the great love with which he loved us, even when we were dead in our trespasses, made us alive together with Christ - by grace you have been saved - and raised us up with him and seated us with him in the heavenly places in Christ Jesus, so that in the coming ages he might show the immeasurable riches of his grace in kindness toward us in Christ Jesus.  For by grace you have been saved through faith.  And this is not your own doing; it is the gift of God.” - Ephesians 2:4-8


Lesson Learned from African Roads

(from Eric)

Stephanie wrote a while back about their misadventure on Burundian roads, but after our past weekend, it seems that there is (perhaps unfortunately) more to share.

Our family is heading back to the US for a spell in about six weeks.  As Rachel and I thought about it, we weren't at all sure that our kids had even gotten in a car since early January.  Such realizations can give one a bit of cabin fever, so we thought we'd have a family weekend down on a beach resort on Lake Tanganyika.

The drive down was three hours, one of which was on Route Nationale 16.  Here is a picture:
Lesson 1:  Even though something carries a national highway designation (and there isn't a level above this, though many roads are nicer) you cannot make assumptions.  

And a GPS on your phone is invaluable, but there should be limits to the extent you trust a road that you have not yet seen.  But we arrived safe and sound, and were treated the following morning to one of the loveliest rainbows we have ever seen.  

Lesson 2:  African beauty is all around us.  Getting out can help us to see that, and we need to see it.

The kids wanted to do nothing else but swim.  We splashed and floated and played.  We applied sunscreen liberally and then reapplied in an hour.  And we promptly got burned.

Lesson 3:  White missionaries in equatorial Africa are among the pastiest white people you will meet.  

It's a little difficult to explain exactly why this is the case, but it is undoubtedly true.  Maybe it's that we take the perfect weather for granted too often, or the cultural norms that cover most of your body most of the time.  I don't know.  But the combination of pasty whiteness with the intense equatorial sun means that there is nothing that you can do to sufficiently protect yourself.

Two mornings later, and we're ready to head back to Kibuye.  Despite being in the full swing of rainy season, our time at the beach was rain-less.  Until we got in the car.  Right around the time we hit RN 16 in all of its unpaved, rutted glory, the rain starts falling.  We made a game of it.  Whenever a particularly hairy section was coming up, we would tell the kids that we could do this only by "grunt power".  Everyone in the car would then grunt loudly until we cleared the present obstacle.

About two miles from the end of the bad road (and about 1 hour from Kibuye), we came face to face with an obstacle that no amount of grunting was going to help.  A river was running across the road.  It was solid water for about 30m across, and we had no idea how deep.  The river was swift.  We stopped at the edge and studied it for a while.  A couple guys with bicycles waded through the downpour.  At least where they stepped, it came up to knee deep, and threatened to knock them over.

I forgot to take a picture.  Luckily, on returning to Kibuye, I found a picture of it on google images.  Here is RN 16 at the moment of our encounter:

Lesson 4:  Hold your travel plans loosely and prioritize safety.

After considering our options for about 20 minutes, we decided that this wasn't going to work, and proceeded to travel back on wet, bad (and increasingly dark) roads for the next 4 hours in order to get to the capital city, where our very gracious friends the Guillebauds put us all up for the night at the last minute's notice.  Yes, we wanted to get back, and yes, we needed to get into work the following morning.  But sometimes things happened.  

On the flip side, our trip back down the mountain did get us another stunning view (during a brief pause in the rains, see Lesson 2 above).  The hills of Burundi followed by the largest lake in Africa, followed by the Congolese mountains.

So, this morning, after more than doubling our trip the day prior, we drove another three hours back to Kibuye, where we were delighted to be home.  Six weeks until we get in a car again?  Definitely doesn't sound too long.

Lesson 5:  The quickest way to solve your African wanderlust/cabin fever problem is just to go somewhere.  Anywhere, really.


As a final aside, whenever Rachel and I travel, we are struck anew at the difficulties people undergo to seek care at Kibuye.  Burundi is a small country (about the size of Massachusetts), so to say that every week we get patients from every province in the country, that doesn't seem like too big of a deal.  But it is not a uniformly accessible country.  The areas that we were slogging through were the provinces and communes that usually elicit a "well, that is a bit far" response from me when I think about my patients.

Lesson 6:  Good roads are not just a matter of convenience.  They save lives.  Take a moment and thank God for the roads that you have.


Kibuye Community

Though Christian community is described in Scripture, we often define it by our experience. In North American culture, community is most often made up of many different groups of people who represent different spheres of our lives. There are colleagues, church congregations, homeschool co-ops, play groups, and classmates with very little overlap between the people in these spheres of life. In Kibuye, however, community is different. We work with and for the people with whom we worship, converse with in our neighborhood, play with outside with, and (especially for our kids) go to school with.

Sometimes, this reality is hard. Whether we admit it out loud to one another or not, everyone wishes for a bit of space from each other at times. That characteristic that grates on you in one person can become all you can see if you are not determined to overlook it. When conflict arises, it threatens all that we are as a team if it is not dealt with in a God-honoring way. There is no room for gossip or uncontrolled tongues. Living in community like ours can feel like a tall order. 

Recently, however, an event brought to light all the wonderful things about community like ours. When the child of a visitor became seriously ill, big decisions had to be made on behalf of their family. The care required meant that our team helped to pack suitcases, load cars, drive in a country they’d never driven in before, care for children that weren’t biologically theirs, substitute teach. In essence, our team had to sacrifice for love - for the love of a visiting family, for the love of one another. 

Difficult as this was, I was struck with how seamlessly it happened. In a matter of hours, each child had an adult to look to, classes were covered, medical care was given, a caravan drove to the city. No one complained - not even the kids. Everyone just did their part. Because that’s what community is: loving each other even when it is hard, even when it requires sleeping in a bed that isn’t yours or doing a task that is outside your wheelhouse or holding your tongue or overlooking an offense or comforting those in need - deep need.

Living in close community like ours where everything overlaps and your neighbors are your church friends are your colleagues (or schoolmates for the kids) is challenging and unlike the community I am used to in North America. I suspect it is a challenge we’d all trade in now and then for something easier and more familiar. But, the beauty of this difficult and complex community is often exposed as it was in the particularly challenging time when the depth of care for one another shines through and even spills over into the lives of others.

Isn’t this what Jesus has called us to? If we do, minister, heal, and educate without love, all our effort is for nothing. Please pray for our team as we live out this delicate thing we call Christian community.


Medical evacuation, part 2

By Alyssa 

In the last few years of team life, we have experienced several "all hands on deck" crises - such as the flash flood at the waterfall in 2016 and the failed coup d'état in 2015. These events definitely bring us together as a team in ways beyond what we experience through day-to-day life and work together. We regularly reference those intense bonding times and they go down in team history to be retold again and again. Well, we recently added another crisis to the team lore with our second medical evacuation (for the first one, read here.)

Similar to family life, each of us has team "roles" in addition to our hospital, school, and community work - tasks such as facilitating the weekly market order or the vehicle upkeep. One of my roles is to be team doctor. Usually that means handing out Zofran for stomach bugs, answering questions about malaria prophylaxis, or maybe putting steri-strips on a wound.
Cleaning and steri-stripping a minor wound for Abi
But last month our team dealt with an unexpected medical crisis for a visiting American boy that went way beyond minor! Cole was visiting with his family so his father, a surgeon, could help cover the surgery service for Jason. One day after running Cole complained of leg pain. As he was a healthy, active 12 year old, we didn't worry too much about it, but the visiting orthopedic doctor did check him out during lunch. The next day his leg was still hurting and he had developed a low grade fever, so we brought him up to the hospital for x-rays and lab tests. The x-rays were normal but the labs showed signs of infection and inflammation, so we started antibiotics. The leg still looked normal with no visible wound, swelling, or redness. The following day, however, he developed swelling in the leg and an ultrasound revealed a deep fluid collection near the bone. He definitely needed to have it drained in the operating room. We looked into sending him to Kenya for the operation, but it would be at least 24 hours before there was an available flight, and almost all the orthopedic surgeons we knew in Kenya were at a medical conference in Greece. We had a visiting American orthopedic surgeon at Kibuye, and he and Cole's father, also a surgeon, decided it was better to operate right away. Thankfully the surgery went well and the surgeons found and drained the infection near Cole's fibula. We now had a diagnosis: acute osteomyelitis (infection of the bone.) We hoped Cole would begin to recover with continued IV antibiotics.
Pre-op on left, post-op on right
The next morning, Cole was sitting on the couch reading a book when I came to check on him and give him his antibiotics. I listened to his lungs and noticed crackles in the left base that weren't there before. Then we checked his oxygen level and discovered it was lower than it should have been. And then he had another fever and significant tachycardia (fast heart rate), too. These were all concerning symptoms and meant without a doubt that we needed to get Cole to a hospital with an available intensive care unit ASAP! We were concerned the leg infection was now in his bloodstream and he could develop septic shock as a result.

This is the moment when the team mobilized into high gear like a well oiled machine. We were few in number as most of the doctors were at the medical conference in Greece, but everyone remaining dropped everything and came running to do the work of many more people. These are the folks you want by your side in a crisis! As Cole's dad spent hours on the phone with the med-evac company, the Serge Kibuye team packed up all the suitcases for the family of 7, looked at flights and arranged guesthouses for the mom and other four children in Kenya, drove cars (including a makeshift ambulance for Cole, his dad, and me) to Bujumbura, made lunch and fed all the kids, facilitated quick goodbyes, texted our Kenya connections to receive the family in Nairobi, connected with Kenyan doctors/hospitals, and of course monitored and cared for Cole. He got worse with a medication reaction just before we got into the vehicles to head for Bujumbura but thankfully responded to a breathing treatment.
Susan driving our "ambulance." A definite answer to prayer is that Cole actually started feeling better, and his oxygen levels increased as we drove down the hill towards the airport. The lower altitude and the vancomycin helped, but mostly people were praying around the world! Thank you! 
We waited for the airplane with our Serge teammate and peds ER doc Randy Bond, and thankfully Cole remained stable in the interim. Again Serge teammates served the family by caring for Cole's siblings and mother until their flight the next morning.
Cole and his father flying to Nairobi
Driving right onto the runway in our "ambulance" with our special patient 
As we drove back to Kibuye the next day and recovered from the chaos of the previous few days, Cole and his family's journey continued in Nairobi. He went back to the operating room multiple times and was finally stable enough to fly back to America where he was immediately hospitalized in Michigan for a few more days. And two and a half weeks after the ordeal began, he finally went home (though he will continue treatment for several more weeks from home.)

Cole thanking the Kibuye kids for their Get Well cards. Even the kids prayed for Cole and cared for him!
Thinking of Cole on Good Friday brought new meaning to Isaiah 53:4 where we learn that Jesus carried our pain and suffering. And that hope encourages me as I think of the pain and suffering my Burundian patients face as well. We all wait for the day when all things will be made new and there will be no more sickness or suffering or pain. In the meantime, I'm thankful to be waiting with my amazing friends and teammates! 


(By Caleb)

It is with great joy that I get to introduce the newest member of the Serge Kibuye team: Jonathan Nelson Fader.  Jonathan was born on March 27that Kijabe Hospital in Kenya under the excellent care of Dr. Catherine Chen.  Dr. Chen also delivered our other two boys: Liam in Chicago and Gavin in Kijabe.  Krista explained how this unusual circumstance came about in a previous blog.  We are currently still in Kenya awaiting Jonathan’s passport and enjoying the new dynamics of having three boys. Rejoice with us as we thank God for this good, good gift.  

Jonathan, 15 minutes after entering this world 

Every good and perfect gift is from above, coming down from the Father of the heavenly lights, who does not change like the shifting shadows.  James 1:17


Sliding Down Mountain Roads

(by Stephanie)

“What about driving down the road at sixty-five miles per hour, only a few feet away from cars going the opposite direction at the same speed? Someone would only have to jerk his or her arm and you would be dead. I don’t think that’s morbid; I think it’s reality”
- Francis Chan, Crazy Love

To say I don’t like driving, or rather being a passenger, in cars in Burundi is an understatement. It terrifies me. During my first African driving experience, many years ago, I was listening to the book Crazy Love by Francis Chan. I distinctly remember listening to the part of the book quoted above and thinking, “The fact that I could die at any moment is at the forefront of my mind, this driving is insane and if we make it to our destination it will be a miracle." 

The majority of the roads in Burundi (aprox. 92%) are not paved. They are red dirt roads, rocky and rutted and slippery when wet. They are not heavily traveled by vehicles, which makes me feel safer, but driving on them leaves me feeling nauseous and tense as we bump and bounce and I try to brace myself from hitting my head on the ceiling.

Thankfully the main road from Kibuye to the capitol Bujumbura is paved. This is the road we as a team travel most often. It is a curvy mountainous road with areas of steep drop offs and many people, even small children, walking along the sides of the road. There are bicyclists, with their bikes overloaded, whizzing down the hills, and young men on bikes holding on to the back of vehicles to be pulled up the hills. There are boys and men who climb onto the back bumpers of semi trucks and hang on, catching a ride, as we drive behind them praying that none of them fall off and slip under our car. 

It’s a two lane highway with no lines dividing the lanes or restricting cars from passing one another around blind curves. This means that often you will see a vehicle coming directly at you as it tries to pass another vehicle. Potholes are another part of life on the road here. There are many, they are large, and people drive around them in the wrong lane. 

All these unsafe driving conditions have always driven me to prayer. However, my prayers while driving have changed over the years. They have gone from a place of anxiety to a place of utter surrender. I so obviously have no control over what happens in that car, over life or death or what any other driver will do. But, reality is, I never am the one who has control, even when I am sitting in my living room. God holds our lives in his hands and every breath that we take is allowed by His will. It’s just that driving brings this awareness to the forefront of my mind and I have to remind myself of these truths. I continue to pray as we drive around every curve, that God will continue to sustain our lives, and I get to praise Him when we’re still breathing on the other side.

Last month our family decided to go to Bujumbura for the medical school graduation and a little R&R. We left Kibuye as soon as the sun was up and it was still morning when we began our decent towards the capital. The road was wet from recent rain and as we rounded a sloped curve of the road our car began to swerve. I heard my husband say, “I don’t have control” as he tried his best to straighten us, but we slid into oncoming traffic. Our car slammed into the side of a smaller car and scraped along it's side until we came to a stop, in the wrong lane, facing a blind curve. We quickly shuffled our kids out of the car and across the street, afraid that another car would come around the curve and strike ours. By God’s provision three of our national partners were driving in a car behind us, they pulled over and came to our aid, helping Greg communicate with the other driver, who only spoke Kirundi. They stuck with Greg throughout the entire, complicated, multi hour process of negotiations and paperwork. Other teammates in another vehicle were also heading to the capital for graduation and soon arrived to help.

Our youngest was a bit shaken, as expected, but as we helped him retell the story of what happened we couldn’t help but highlight the wonder of the situation. Never before have we had teammates and national partners traveling behind us and available to help. We lost control before coming to the steep drop offs. The car in the other lane was a small one, not a tractor trailer or a bicycle, and it was not a head on collision. No one was injured. No one was walking along that side of the road to be struck. And there was an area across the road where it was safe for us to stand and for other vehicles to pull over. We do not know why we were in an accident, but, for being in an accident the situation could not have been better, and we see God’s provision over the situation, and on the peace that we all felt as we climbed back into cars and finished our trek to the capital.

The car, which has been named the Black Mamba, is now all fixed up and sporting 4 new tires with good tread. 


On Teaching And Huey Lewis

(by Greg)

A few years ago I saw Huey Lewis in concert (yes, he still rocks).  He had some new material, but as you can imagine, Huey Lewis can’t really have a concert without playing “The Power of Love”.  He introduced this song with something to the effect of “when I wrote this song in 1985 I never imagined I would have to sing it every single day for the rest of my life”.  I got the impression he wasn’t as excited about singing this song as we were about hearing him sing it.

Back to Huey in a bit.

I did not come to Burundi to DO anesthesia, but rather to teach.  We are surrounded by an ocean of students, nursing, anesthesia and medical students.  Some students are assigned to my service for a day, some for a week, others for a month.  And so, I have an opportunity each and everyday to teach.  And given the limited duration I will have with each student, I have spent a significant amount of time reflecting on what is most important and how can I convey that information in a meaningful way.  Given that most of these students will work in settings with limited resources, how does one teach resuscitation and critical care to students who will work in hospitals without ventilators or defibrillators, and sometimes without oxygen.  

As a result, I have been trying to decide what are the 8 or 10 lessons I can teach that will impact the care these students can deliver, lessons that might one day save the lives of their patients.  And how can I present these topics in a way that will be cemented in their memories when presented with these problems in the future.  I have developed a series of “mini lessons” that I try to give every student who works with me.  And, as a result, I find myself giving the same “mini lessons” week after week, sometimes day after day.  And as I was teaching yesterday once again about the systematic approach to hypotension, the words of Huey Lewis returned to me ….. “when I signed up for this, I never thought I would be teaching the same lesson every day for the rest of my life”.  

It can be draining for sure.  And there are students who leave me frustrated and discouraged, and there are others who invigorate me and leave me filled with hope for the future of health care in Africa.  But deep down I feel confident that this is exactly what the Lord has called me to right now, and that there is no better way I could invest my time than in repeating these lessons day after day.  How does one find the strength to persevere in the face of monotony and sometimes discouragement?  Perhaps the answer is found in the words of Huey Lewis himself.  Maybe, just maybe it is found ..... in the power of love.  

Don't need money, don't take fame
Don't need no credit card to ride this train
It's strong and it's sudden and it's cruel sometimes
But it might just save your life
That's the power of love
That's the power of love
First time you feed it might make you sad
Next time you feed it might make you mad
But you'll be glad baby when you've found
That's the power that makes the world go round.