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.



Dollar Street

(from Eric)

Via the BBC, I happened upon this very intriguing site yesterday, and I feel it's worth passing on.  Anna Rosling Rönnlund started the site as a way to "visit" homes and cultures and families all over the world.  Numerous countries are represented, and they are ranked on the home page according to monthly salary (the lowest being $27/month, a lady in Burundi in a province south of us).  

The base page is here.

You can enter and tour everyone's home.  For instance the tour of the Burundian lady's home, including her awesome toothpaste storage technique and her even more awesome smile can be found here.

You can also sort the homes by various filters.  For instance, you can sort for "Places Where Guests Are Served Dinner" all across the world here, or "Jewelry" all across the world here.

As American expatriates living in Burundi, we live in a world of extremes.  Both the wealth of our home country and the poverty of our host country can be very uncomfortable.  In the past, when we've recognized these extremes, we've wondered what the "global mean" is.  That's not exactly the point of this website, but it does give some wonderfully diverse glimpses into the homes of the world.  All from the convenience of your home internet connection (if you have one.  =)  )


Qu'est-ce que tu aimes faire ? -- Kids Video

by Logan

Julie has really enjoyed working with the kids of Kibuye Hope Academy in French class.  Several months ago, she posted the first video from their class: Trouver l'objet where they play an I Spy type game.

"Qu'est-ce que tu aimes faire" means "What do you like to do?"  The kids got to decide what things they like to do and make a short video about it.  Enjoy the peek into life here at Kibuye, as they share these activities with you in French.  If you don't speak French, then enjoy the mini-French lesson!

Qu'est-ce que tu aimes faire ? - Kibuye Hope Academy from The Banks Offshore on Vimeo.


Language and Great Laughter

(from Eric)

Language struggles are a part of our everyday life.  After many years, you become comfortable with French, but your patients only speak Kirundi.  The students can interpret for you, but not if they are from Cameroon, or not if the patient comes from Congo and only speaks Swahili.

Yesterday, I had a patient who struggles with language.  She is 43 years old.  Through the help of my student interpreter, I learn that, a few months ago, her speech started to become harder to understand, and this gradually evolved to where she can now only grunt.  She can understand Kirundi.  She can write without difficulty.  But she cannot pronounce anything.  She also cannot swallow.  Jason put a scope in her esophagus and all looks structurally fine, so he sent her to me with the idea of a neurological problem, maybe a mass growing somewhere in her brain.

It's hard to imagine what that's like.  To watch your ability to speak (in such an oral culture) slip away relentlessly.  I ask her to sit on the table, in order to check some other basic neurologic function in the face.  Fung'amaso.  I fumble on close your eyes, but she gets the idea.  Uravyumva?  I touch her forehead and ask if she can feel it.  Next, I want to see if her mouth muscles have any weakness, so I ask her to smile.  Now, in Kirundi, the word for smile (gutwengatwenga) is a form of the word for laugh (gutwenga).  Twenga, I say.  I think she understands what I'm asking, but her smile bursts into an embarrassed laugh.

Then she continues to laugh.  She puts her head down on her knees and laughs until tears run down her cheeks.  She can't stop laughing.  Her sister laughs.  The med students laugh.  I attempt a whole sentence in Kirundi: Uratwenga kuber'iki? (Why are you laughing?)  She looks up at me and bursts into a fresh round of laughter.  It's unclear at this point whether the roots of her tears are from humor or from sorrow, but somehow it's clear that there is joy in there, regardless.

This moment is a pretty good picture of our lives here.  I doubt we can find a diagnosis for her.  Even if (1) one of the three CT scanners in the country is working, and (2) she can find the $100 plus transport to get a scan, then (3) it is extremely unlikely that she could find anyone to fix it, even if we found something.

And yet, she laughs.  Her yellow teeth are bright against her dark face, and she makes me laugh.

There is sorrow, and in the midst of it, there is great joy.  And often, like yesterday, there is one of us random Americans in the middle of it, not at all sure what's going on, but finding the grace to enjoy the moment nevertheless.  In a nutshell, this is our life at Kibuye.

It could be better.  Yes, it could, and we long for redemption and for healing and for all the barriers that keep us from knowing each other well to fall away.  We long for God to fulfill his promises to save us utterly and completely.

But it could be worse.  I wish I could have helped this lady more, but I'm quite certain that, when she and her sister return home, and her family asks how it went, that along with more tears and more frustration, there will also be more laughter.  God's redemption and his grace are already at work among us.  They are the rip in the curtain that the light shines through.  These peals of heart-filled laughter from a woman who can no longer speak a single word are the first fruits of the fulfillment of the promises that God has given, and that he will, in the end, keep.


On a somewhat related theme (I feel like there is a connection here, and maybe you'll find it better than me), here is a great quote from Frederick Buechner's conversion (from The Sacred Journey):

And then there came one particular sermon with one particular phrase in it that does not even appear in a transcript of his words that somebody sent me more than twenty-five years later so I can only assume that he must have dreamed it up at the last minute and ad-libbed it and on just such foolish, tenuous, holy threads as that, I suppose, hang the destinies of us all. Jesus Christ refused the crown that Satan offered him in the wilderness, Buttrick said, but he is king nonetheless because again and again he is crowned in the heart of the people who believe in him. And that inward coronation takes place, Buttrick said, "among confession, and tears, and great laughter." It was the phrase great laughter that did it, did whatever it was that I believe must have been hiddenly in the doing all the years of my journey up till then. It was not so much that a door opened as that I suddenly found that a door had been open all along which I had only just then stumbled upon.


Looking for Some New Recruits

by Jess Cropsey

As our team has grown, the needs at the hospital and the scope of our work has also expanded.  And so we find ourselves needing more help in certain areas.  We're hoping that you, our faithful readers, will help us cast our net wide and pass this information along to anyone who might fit the bill.  And please be praying that God would provide the right people to help us in these critical areas.  

(Term:  1+ years)

  • Partner with our on-the-ground engineer (the highly talented Caleb Fader) to oversee hospital construction projects and renovations
  • Assist with maintenance for hospital buildings, equipment, grounds, & vehicles
  • Train local workers
Requirements & Critical Qualities:
  • Prior experience in developing world preferred
  • Resourcefulness, patience, & perseverance
Related Blog Stories:

(Term: 5 years)

  • Develop hospital chaplaincy program
  • Assist local chaplains with patient outreach at the hospital
  • Oversee discipleship programs for medical students and hospital staff
  • Assist with missionary team care
Requirements and Critical Qualities:
  • Prior experience in pastoral care, discipleship, and/or counseling
  • Language learning abilities (fluent French and some Kirundi important)
Related Blog Stories:
(Term:  2+ years)

  • Track project construction income and expenses
  • Assist with hospital project/team administration and logistics
  • Find and apply for grants (optional)
  • Create fundraising materials (optional)
Requirements and Critical Qualities:
  • Some experience with basic bookkeeping
  • Good organizational, social, and communication skills
  • Prior experience overseas and/or with a NGO would be great!
Related Blog Stories:
I'm sure you're surprised to see no blog posts in this department!  :-)  While this unglamorous, behind-the-scenes work doesn't lend itself to interesting blog posts, it is critical work.  None of the projects (like the new surgical ward or the upcoming pediatrics ward) could happen without someone keeping track of things.  

(Term: 1+ years)

  • Repair and maintain hospital equipment
  • Train a small team of local technicians
Requirements and Critical Qualities:
  • Prior experience in developing world preferred
Related Blog Stories:

(Term: 2 years)
We are always looking for teachers to help us educate the many kids on our team.  There is a huge need for teachers on many other Serge fields as well.  

Related Blog Stories:
Kibuye Kids Clubs
Africa Class
The Brick Factory (field trip)
Gearing Up for School