Boots on the Ground 8: Will

Posted on Jul 16, 2012 | 1 comment

Nefosha 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,...

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Boots on the Ground 7: Will

Posted on Jul 16, 2012 | 0 comments

“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...

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Boots on the Ground 6: Chris & Will

Posted on Jun 12, 2012 | 0 comments

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 them...

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Boots on the Ground 5: Will

Posted on Jun 12, 2012 | 0 comments

Will: 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 their farm. 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...

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Boots on the Ground 4: Chris

Posted on Jun 12, 2012 | 0 comments

Chris: 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...

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Boots on the Ground 3: Will

Posted on Jun 12, 2012 | 0 comments

Will: 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...

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