Wow, Burundi is nothing like what I expected! I have always pictured Africa as a place with
nothing but enormous fertile grasslands, wild rainforests, massive deserts and huge populations
of people living in desperate conditions fighting to survive mass famine and global poverty.
After doing my research and learning that Burundi is the second poorest country in the world I
was expecting to be blown away by poverty. I thought that our drive from Bujumbura (the city
where we landed) to Kibuye (the city where we are working) would consist of endless dusty
villages with dirty, starving people, struggling in their quest to survive under the scorching
I didn’t even need to wait to see the Republic of Burundi in daylight to realize how wrong
I was. Once again, my self-centered, western ethnocentrism got the best of me. This is a
beautiful country! The entire country is full of rolling mountains and lush, fertile valleys. Most
importantly, the people aren’t starving. Burundi is an exceptionally fertile place and it has three
growing seasons. It is said that as long as you aren’t too lazy to plant seeds that you won’t go
hungry in this place.
The people of Burundi live in small, but clean houses surrounded by the people they love, their
favorite people in the world. Every evening this place comes alive with children running around,
playing football (the real kind) on the grassy field in the center of our village while the adults sit
around in friendly conversation happily enjoying the end of another great day. After leaving one
of the wealthiest counties in the world to spend two months working in one of the poorest I am
seriously doubting the standard that our society uses to measure wealth.
Chris and I traveled to Burundi with an experienced surgeon, Dr. Gordon Jacobs, who has been
to Africa dozens of times for medical missions. Our main priority and the reason that we are
here is to work with the Burundian medical students. We are working with the entire class of 27
students of fifth year med students (first clinical year after four years of undergrad education)
at Hope Africa University. The students are wonderful and eager to learn. They also have
great bedside manner and show genuine interest in their patients. However, this is their first
clinical experience and they are not yet familiar with the way things work in a hospital. Right
now we are working with them to help them get the most out of their clinical experience. We
are teaching them simple things like how to take accurate histories and physicals, and what
information about their patients is important to gather on pre-rounds so they will be prepared
for rounding with their attending. Today we noticed that they have not yet been taught sterile
technique or surgical knot tying so we plan on hitting those subjects soon to allow them to be
able to scrub in and assist on cases in the Operating Room. …
My last patient of the day yesterday was a 3 day old child who was born prematurely. When
we saw him he wasn’t feeding so we planned on giving him fluids and operating on him in the
morning to see why he was vomiting up all his food. Late last night Chris and I returned to the
hospital because I had a bad feeling that no one would be able to get IV access. When we found
him he was lying in his grandmother’s arms and besides his heavy respirations he was barely
moving. His mouth was dry indicating severe dehydration. He still hadn’t tolerated a meal and
he still was not getting IV fluids. As Chris and I examined the child all of the adults stared at us
helplessly, wondering what we were going to do. We had to look into their scared eyes and shrug
our shoulders while feeling quite convinced that their child wasn’t going to survive the night.
We prayed for the Child and left the hospital knowing that there was nothing left we could do.
When we returned to the hospital this morning, the baby looked much better. One of the medical
students with us spoke to the mother and told us that the child tolerated his milk the night before
and was becoming increasingly active. As the day went on today he has continued to improve.
The hospital staff was able to start an IV line and he responded so well to the fluids that the next
time we searched for him he was with his mother in the postpartum floor of the hospital, looking
like a normal infant. I am convinced that God’s saving hand touched him sometime late last
night and that we witnessed a miracle today.
Picking up on Will’s story of the young child which we did not think would survive the night:
he is still alive and doing well. He was transferred back to the maternity area where he could be
with his mother after they saw how well he was feeding. Thank you for your prayers and praise
Will and I continue to learn more about this country. Words like “amahoro” and “urokoze”
working their way into our dictionary as we try our best to communicate with patients who
only speak Kirundi. Still, other words like “bon jour,” “merci,” “fievre,” “diarrhée” and other
French words slowly creep into our dictionary as we communicate with the national doctors and
students. When we are not rounding in the hospital, we are often teaching the medical students
about how to take a good history and physical, how to tie surgical knots, tidbits on why you
give one medication instead of another. At other times, we might go out for a walk in the lush
countryside, abundant with vegetables, to the local market where everyone stops what they are
doing just to watch us. We seem to draw a crowd no matter where we go — some crowds bigger
Will and Dr. Jacobs performed a prostatectomy (removal of the prostate) on an 80 year old man
the other day. The surgery went well until, during his recovery, the fluid that was meant to wash
out his bladder to keep it from clogging ran out. More complications made things even worse
and we decided to pray with the small group of medical students around us; we prayed for his
healing and for our wisdom to know what to do. Around 11PM, we were very worried about
his condition and we woke up Dr. Jacobs to check on him because we could not get the drain to
work and he was in severe pain. When Dr. Jacobs checked him, he decided we needed to return
About the time all the operating room and all the ancillary staff (the techs and anesthesiologist)
were called in, the power in the hospital went out. The hospital is prepared for blackouts since
they are common. A battery powered operating light and foot-powered suction system is what
we had to rely on. After the surgery began, they found large clots in his bladder, replaced the
drains and prayed for God’s healing. Today, the man is in great health and praises God for
saving his life. The students also told us how appreciative they were that, in such a critical and
emergent time, we took a few essential minutes to pray – something they do not see often. They
pondered at how we can do nothing unless God allows us to do so. A good lesson we can all
keep in mind.
It’s 7 pm in Kibuye, Burundi. The sun is sinking fast, only a small part of it can be seen above
the distant rolling hills. There’s a large field in the center of the town square. Cows are grazing
on one end, goats are on the other. The church is in the center and lovely voices can be heard,
lifting up the Lord in song. Three white adults are out there as well and they are throwing a
strange white disk back and forth. Children are noticing the three Mazungos (white people)
and running out to play yelling “Mazungo here, Mazungo HERE!” Soon hundreds of children
are running around laughing and enjoying the unusual game that they are playing. They shriek
with amazement as the white disk sails over their heads and never seems to drop like the grass
balls and left over bricks that they are used to playing with. The sounds of laughter and worship
combine together and echo around the village as the sun disappears behind the distant hills.
Nearby is a hospital. It’s not that big, especially when you consider the distances people travel
to get here. Some have come from as far away as the Tanzanian Border; over 100 miles away
while others come from the opposite direction, near the Congo. There aren’t very many roads
here so they usually come on foot or, if they are lucky, by bicycle. They bring their families with
them too. Who knows how long they will have to stay at the hospital? They can’t leave their
children at home for an indefinite period of time.
The healthier patients and their families are able to sit outside. There are a few picnic tables
and two brick huts. The huts are for cooking though and are constantly full of dark smokes as
patient’s families prepare rice and beans for them and themselves while they are in the hospital.
As the sun sets it starts to cool down outside and everyone moves inside. The hospital goes from
being fairly uncrowded with only the sickest people lying bored in their beds to a packed hostel,
way beyond its capacity.
Nearby is a post-op patient. He had an incarcerated inguinal hernia. Before his surgery he
basically had two possible scenarios. Worst case: the hernia could strangulate, ending his life.
Best case: The hernia would cause him so much pain that he would never be able to farm again,
his only means of supporting himself and his family. He and his wife spent their life savings on
the ambulance ride to get to the hospital. They couldn’t afford the procedure and all they had left
was their cow. This precious cow had supplied clean milk to their family every day for years.
They were prepared to give up their cow in order to pay for the hernia repair but a generous
donor from America covered the expense of the surgery. On hearing the news that they could
keep their cow the patient broke into joyous laughter. His wife started dancing. His hospital
stay of one week complete with a hernia repair, and daily wound dressings will cost less than
60 American dollars. A similar patient in the United States would pay between $20,000 and
Any doctor will tell you that most of a diagnosis comes from a good history and physical, not
the extra tests you order. You use tests to confirm what you already know or rule out something
more dangerous. The bulk of a doctor’s time is spent doing a history and physical.
The med students we met at Kibuye didn’t get that teaching point yet. We were working with
the fifth year medical students; this sounds like they should know a lot. However, in Africa, the
first four years is like an undergraduate degree in science. The students we met were fresh out
of their basic science teaching and thrown into an unknown world of disease, nursing protocols,
European shame-based learning, and most importantly, patients with whom they had no idea
how to communicate.
We decided that the students needed a basic understanding of the history and physical. For
the next month, we pounded into them the understanding that a history is perhaps the most
important tool a doctor has. We even gave them homework; something no muzungu doctor
had ever done before! We walked through taking a patient history in class as Will and I acted as
patients. When the homework came in, we saw an improvement, but noticed that they still did
not quite get it. This time, we gave them another assignment: find a patient of their own and do
a complete history and physical. And, we decided we would test them! They had to perform a
basic 15 minute physical exam in front of us on another student. The worst part, in their minds, is
that we made the history and physical exam due on the same day (3 weeks later)!
As time moved on, we gave more lectures on how to ask about what brings someone to the
hospital, their past medical issues, surgeries, medicines, even their spiritual beliefs. We began to
notice that their morning reports were slowly improving as they integrated what we taught them.
They began to tell us when the symptoms began, what made it better or worse, the quality, if it
radiated, the severity, when it was better, what the patient thought it was, associated symptoms
and other important details. The physicals started to include general appearance, listening to the
heart and lungs, feeling the abdomen, and pinpointing other important abnormalities. Then the
day came for them to turn in their homework and do the observed physical. To our amazement,
they mostly did a remarkable job and we could see the improvement from the previous
homework. We were excited to see the change and looking forward to what can be accomplished
in another month.
About one fourth of the students could speak English well. Another fourth was mostly fluent.
The third fourth had some difficulty, but could usually express themselves in English. The last
fourth had a great difficulty with English, but got better as time went on. Their classes are
taught in English so we did not feel bad making them use English, but we had interpreters as
needed. As Hope Africa University serves many different Central African nations, some of the
students were from Kenya, the Congo, Rwanda, Uganda, and Tanzania. Surprisingly, some of
the students did not even speak the language of Kirundi and had a hard time talking with patients
Most of the students were actively involved in their home churches. Either their family is part
of the Free Methodist organization in their home town or they had been raised in the church.
Others were new Christians and found Hope Africa University as a way to pursue what they
thought God has called them to do. Still others may not know much about God, but they are
taught every morning before morning report when they hold devotions. One weekend in church,
the students sang a Kirundi – English mix of “Lord I Lift Your Name on High.” They ended their
time in Kibuye with prayers for their future studies, compassion for their patients and for safety
of travel both on my part and theirs.
Last month a man arrived at Kibuye Hospital. Like everyone else living in the Gitega province
of Burundi he was a farmer. The man was walking with an elderly woman. She was mumbling
words that were not comprehensible and had no idea where she was or what was going on. She
had been wandering around his field and he said that no one knew anything about her. Even
though the nearest hospital was in Kibuye, a small village that is half a day’s walk away, the
farmer decided he could not just give the old woman a meal and send her on her way. So, he
had left his field and home and escorted her to the hospital. A quick physical exam in the ER
suggested that she had suffered a large stroke. The medical student on call informed them that
she would need to be admitted to the hospital and immediately the poor farmer pulled out his
wallet and paid for her admission.
Soon the farmer’s wife arrived and the two of them went to the hut behind the hospital and
prepared a meal of rice and beans for themselves and their new acquaintance who had no way of
getting food without their help. Without complaining they loved and cared for the woman like
she was their own family member. By this time it was getting dark and there was no way they
would be able to make it to their farm before nightfall. They decided to spend the night at the
hospital and hope that the patient’s family would show up soon so that they could get back to
The next day they woke up and made their patient some busoma for breakfast. They made a few
phone calls hoping to find out where this woman came from but after having no luck returned
to her bedside to talk to the physician who was making rounds. The doctor told them that the
patient’s stroke was severe and she was not likely to survive. The man and his wife sat down,
trying to figure out what to do. The thought of leaving this woman alone at a hospital with no
one to care for her and pay her bills was out of the question. This woman was their “neighbor”
and the only acceptable option for them was to take care of her until her family arrived or she no
longer needed to be in the hospital.
Days went by and the woman showed very little progress. The man and his wife stayed at her
side and took care of all of her needs as their precious bean crop sat untouched in a field, half a
day’s walk away. The days turned into weeks and they didn’t complain, they continued to smile
at the doctor making his rounds every morning and spent their afternoons cooking food, washing
clothes, and emptying bed pans, all for a woman who they didn’t even know. After three weeks
the woman passed away quietly in her sleep. Her family never showed up. The man and his
wife mourned the loss of this stranger as they paid her hospital bill and gathered their belongings
to make the long walk home. After thanking the doctor for his service and saying goodbye to
some of the patients with whom they had become friends, they stepped out of the hospital gates,
ready to return home and resume their regular lifestyle.
Once again I am wondering what type of standard we use to measure wealth. People living in
the United States and other “wealthy” countries would never be able to afford the time to take
multiple days out of their busy lives in order to care for a complete stranger. I, for one, would
never be willing to make such a big sacrifice, especially for a complete stranger. But here, In
Burundi, the second poorest country in the world, a man can take almost a month off of work
with no advance notice in order to do what he believes is his moral responsibility. Hearing about
this man reminds me about one of Christ’s stories. Jesus said:
“A man was going down from Jerusalem to Jericho when he fell into the hands of
robbers. They stripped him of his clothes, beat him and went away, leaving him half
dead… A Samaritan, as he traveled, came where the man was; and when he saw him, he
took pity on him. He went to him and bandaged his wounds, pouring on oil and wine.
Then he put the man on his own donkey, took him to an inn and took care of him. The
next day he took out two coins and gave them to the innkeeper. ‘Look after him,’ he
said, ‘and when I return I will reimburse you for any expenses you may have.’”
“Go and do likewise.”
Chris and Will:
Thank you for continuing to support us as we struggle to be a “neighbor” to our patients here in
Burundi. We have a long way to go before we can match the sacrifices made by the farmer in
Burundi or the Samaritan in Christ’s story. We are thankful that the Lord is sovereign and that
His will is being done, even as we struggle to feel like we are helping. We are thankful to have
been at Kibuye Hope Hospital with excellent doctors who have experience in difficult situations
like the patients I described above. Continue to pray for the skilled physicians who teach and
minister to the medical students who come to Kibuye for training. May God’s grace be upon
“This is Africa”
We first heard these words shortly after arriving in Burundi. Two of our bags missed a connection somewhere between Toronto and Brussels and as we left the Bujumbura airport I asked the missionary who picked us up if the airline would get the bags to Kibuye in the next few days. He laughed and said, “Probably not, this is Africa.” The bags arrived 15 days later.
Since then I have had plenty of reminders of where I am and, “This is Africa,” has become a regular part of my vocabulary. Sometimes I say it after a funny experience like trying to explain to the night guard how a telescope works, sometimes it’s a strange experience like when a huge swarm of termites came up out of the ground around our house and flew up in to the sky in numbers that dimmed the light of the sun. But as bizarre as these experiences have been, my time in the hospital is where I am most frequently reminded that “this is Africa” and I’m not in Michigan anymore. Where else would I have a day like last Friday?
It began like a normal day, I was nearly finished with rounds when a midwife came to me and asked me if I would like to deliver a baby. I said “ok” and followed her to the delivery room. The mom was a 20 year old and this was her first pregnancy. As we waited for the baby the midwife handed me a pair of scissors and told me to cut. “What? No! An Episiotomy? I’ve never done one of those before and I’m pretty sure they have no proven benefit.” The nurse laughed and one of the Hope Arica med students explained to me that here in Burundi they are often indicated because they don’t have the resources to manage obstructed labor that we have in America. I obliged and made the cut and was shocked that my patient wasn’t screaming in pain. Shortly after, a healthy boy arrived. We resuscitated the infant and I returned to the woman to deliver her placenta. But it didn’t come. Instead there was another head! She had twins and no one knew it! I delivered another healthy boy and as I sewed up the episiotomy I laughed to myself thinking “This is Africa,” and I thanked God that the twins were born without complications and that I was here to help.
After the delivery of unexpected twins I continued rounds. Normal stuff, at least for Africa: In one bed there was a child who was attacked by a hyena. Next to him was a boy who fell out of a tree and broke his femur. A few patients had meningitis (an infection of the central nervous system), and lots of patients had malaria so we monitored their progress. Then we got to our last patient of the day: Nefosha, a 19 year old woman with a damaged heart valve and severe heart failure.
I didn’t think it was possible but somehow Nefosha looked even worse than she had the day before. In addition to her usual shortness of breath and exhaustion she had severe chest pain. Her heart was beating so hard that her entire left chest rose and fell with each beat but her pulse was too weak to be felt. She had developed an irregular heart beat (something was wrong with her heart’s electrical system) and in order to know what was wrong we needed to look at an EKG. Unfortunately the nearest hospital with an EKG machine and medications to treat arrhythmias was in Gitega, 45 minutes away.
We called the hospital and they said we could come but their cardiologist was gone. They would be able to get an EKG for us but they would need me to come with her to read the EKG and determine what medicine she needed.
An hour later I was taking my first ambulance ride in Burundi. A couple interested medical students went with me and we were successful in getting an EKG. Unfortunately she had a condition called atrial fibrillation and the hospital in Gitega didn’t have any medications that would be useful for treating it. We asked if we could use their defibrillator but it was broken. We were out of options. There was nothing left to do but pray. In America she could get her valve repaired and most likely the repair would allow her to live a healthy life. She would be able to finish college, get married, have children, and have so many of the other things that we take for granted. But instead she was moaning in pain, clutching her chest, and gasping for air as her concerned family took turns comforting her.
As the ambulance took us back to Kibuye there was a beautiful sunset in the distance and I found myself hoping that she was seeing its beauty, knowing that it might be her last chance. We arrived after dark and took her back to her bed. The students and I ate a late dinner and returned to the hospital to check on her. No improvement. She was breathing slower, and no longer had the strength to cough up the fluid accumulating in her lungs. Her sister was lying in bed with her and the rest of her family surrounded her bed. Without a miracle she wasn’t going to make it through the night. We asked the family if we could pray for her and Blaze, one of the students, asked God to perform a miracle.
After the prayer Blaze asked me if I knew what her name meant. He told me that her name, Nefosha, means “I dance for God”. I held Nefosha’s hand and while she slowly slipped out of consciousness I was overcome with a feeling of peace. I realized that God was going to do a miracle in her life that was far more spectacular than the one we had in mind in our prayer. He was preparing for Nefosha to be free again. She would no longer have to gasp for air while her heart nearly beats out of her chest. Instead God was going to allow her to live up to her name. How foolish of me to hope that she was admiring a sunset during our ambulance ride! She was preparing to be dancing for God, in the beauty of His kingdom!
1 Corinthians 15: When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: “Death has been swallowed up in victory.”
“Where, O death is your victory?
Where, O death is your sting?”
I can’t wait to see Nefosha again, living up to her name, in the presence of our King.
“This is Africa.”