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Wednesday, March 20, 2019

Kibuye, the presence of hope and a model of perseverance

This week in Kibuye was our fourth trip in 8 years of cheering from the sideline as our Serge team established an outpost of medical education and care for the poor in rural Burundi. The team has tripled in size, as has the compound of homes, as has the hospital, with new wards, oxygen, a solar electric system, new operating theatres, appropriate-technology locally fabricated incubators for premature babies, specialized ophthalmology equipment and an expanded plant to make nutritional supplements. If you build it they will come, and hundreds of patients present each day, attracted by the competence and compassion. They come in labor to deliver their babies, they come with festering wounds months old, they come with broken bones and traumatic injuries, malarial fevers and twisted bowels.

How does an initial group of medical students find themselves over a decade later staffing a simple hospital, pushing the boundaries to make it a premier teaching center in a very needy place?

Vision, certainly, for investing in a rising generation of local doctors, for hands-on care for the poor with as much excellence as limited resources will allow. Connections, partnership, fundraising, for sure, hundreds of thousands of dollars worth of construction and equipment to just get some space and light and cleanliness, some water and power, nothing fancy. Courage and patience, to live initially in crowded spaces without amenities, to plug through language learning and to see problem after problem beyond any easy solutions. Humor I think, to not let the setbacks swallow you, and community, the kind of friendship that steels one to put their kids and lives on the line as part of something larger.

But mostly, it’s endurance.  Being present in a hard place, listening to local partners, voluntarily setting aside the path of quick fixes or domination and working from the ground upward. This visit we stayed in a lovely guest apartment, with hot running water (solar), plenty of electricity, appliances, a comfortable bed. We rounded with the team on patients who had vital signs documented, who were getting IV medications, who were recovering from complicated surgeries. We attended church where the Gospel was powerfully preached, and where the pianist, guitar, and vocalists led with talent and Spirit. It was not always so. Coming in 2019 one might not appreciate the pouring out of life necessary to negotiate, to construct, to organize, to build relationships, to adapt. 

As we head towards a decade, the momentum is palpable, but the challenges never cease.  In the last week, for instance, the hospital lost several generalist doctors to transfers to the city, entered a period where no medical students (upon whom much of the care falls) will be rotating for the foreseeable future, had one Serge doc leave suddenly for a family funeral and faced a planned week of specialty surgeries thrown into question when another visiting missionary doc got held up by visa issues. It is a resilient community but the prospect of trying to stretch to cover even greater gaps, when already working crazily hard, looks daunting.
Please keep this team in your prayers. Rapid, expanding development stretches the soul, too. They work in three languages, continuously.  Caleb our engineer supervises 146 Burundian construction workers, meaning they have a steady meaningful job that provide for their families, but it's a huge weight of responsibility to do that and keep the essential infrastructure intact. We have ten doctors with very little specialty overlap, so everyone is full-on at all times, but even moreso now with the staffing gap. Pray for supernatural patience and quick resolution on hiring more local doctor help. Our docs do much more than patient care; they disciple the chaplains and students, work with the administration on vision and planning, lead Bible studies, travel to Bujumbura to teach medical school classes. Though we have 3 full-time professional teachers for the 18 school-age kids, six other moms (some of whom are trained teachers too) pitch in several class periods per day. Without a school, none of the other work would go forward. And the 15 non-doctor adults not only build buildings and teach school, they work with the malnutrition programs, help with microenterprise, raise funds for the neediest patients, track all the donor spending and administer projects like ward construction, care for wounds, help with the retinoblastoma program, provide lactation consultation for the NICU moms, invest in therapeutic play with admitted kids, run an informal preschool (there are 7 kids too young for school yet!), and spend many hours investing in hospitality. All while living in intensely interdependent community, where the grocery store is hours away and every normal life activity is harder than you thought it should be.

We are hopeful for them, and for Burundi. The first two Burundian specialists (surgery and ophthalmology) have been appointed, both men who were trained with the help of this Serge team. The vision is to raise up a new generation of Burundian young leaders who can help their country overcome the effects of genocide and poverty. It is starting to happen.

Tuesday, March 19, 2019

Bujumbura Welcomes YOU!!

Between 10% and 20% of Burundi’s population lives in the sprawling lakeside city of Bujumbura. Wide avenues and palms, portside industry, gracious beaches, crumbling concrete buildings dotted with ambitiously modern ones, throngs of bicycles carrying anything from matoke to passengers, chaotic intersections, vibrant informal housing areas, a tropical sunshine and a mountainous view into Congo. Grilled fish and sweet mangoes, dust washed by afternoon downpours, a cool breeze by evening. A population which has known unspeakable trauma, wary and yet determined to emerge into the world scene. Universities, cafes, orphanages, markets, coffee roasting, artsy sewing projects. The early morning flood of villagers descending the surrounding hills on foot, carrying baskets on their heads or pushing carpentry projects on bikes, chatting with school mates or stopping to buy bread. Bright colors and matching patterns in the cloth wrapping women’s waists. Central Africa with a French touch. An international church committed to reconciliation, preaching a Gospel of peace, embracing all ethnicities.

We spent four days in the city to visit our team leaders Randy and Carolyn. They are second-career missionaries, people who left behind academically renowned and reasonably lucrative careers, a beautiful suburban home, young adult children, nearness to friends and family . . . and decided to invest their 60’s into one of the poorest countries in the world. Randy serves as the Dean of Hope Africa University’s medical school, and Carolyn teaches English. By the words “dean” and “professor” you should not conjure images of paneled ivory towers or comfortable lecture halls.  Instead, picture the kind of vision and audacity that makes this continent shine (even as it frustrates some of us to distraction): a university founded on sheer determination, by Burundian exiles in Kenya during a genocide, who then returned to their capital to equip a new generation with hope.  Cement buildings, cluttered offices, throngs of students, pockets of well-equipped resources like labs or microscopes but minimal basics like computers or books.  Packed classrooms where students must sometimes compete for chairs. The scramble to keep up with changing government targets as this emerging economy makes abrupt decisions about education. Up to a quarter of students coming across the borders, mostly from Congo, because they have no options nearer to their homes.
Randy’s job might best be pictured as designing 60 or more simultaneous but non-overlapping pathways through a maze. Medical students enter from several countries, after various courses of study, and embark upon pre-clinical classes and clinical rotations designed to produce competent doctors in 6 years. Only at any given time, any given course may or may not have funding or professors or space, so it turns into a multidimensional jigsaw. Randy designs curriculum, arranges professors, teaches in the classroom and on the wards, coordinates visitors, contracts with the public University or private experts for specialized instruction not possible from HAU staff, negotiates with hospitals for rotations, and even raises money for scholarships. Carolyn gets assigned English classes, from beginner to graduate, from ten students in a discussion group to 60 in a crowded classroom, usually with only a week or less notice, constantly changing schedules and hours.  HAU is a bilingual university, where French and English are both used for instruction.

Serge Bujumbura needs help. Hope Africa has hundreds of Engineering, IT, and nursing students with few qualified teachers. We could use 2-5 year commitments from people with a master’s or beyond in those subjects, or any of the basic sciences. The medical school can use pre-clinical science (pathology, anatomy, etc.) professors as well as specialists to teach shorter courses such as neurology or psychiatry . . . these can often be done in 2-4 week blocks. Speaking French is a plus, but we can send you to France for a year to learn first if you are long term.

The good news is this: because of the Bond’s service the last five years, over 200 new doctors have been added in a country with one of the lowest doctor-to-population ratios in the world. A hundred more are in process. They have entered into the Christian community of the city, mentoring and supporting other workers, preaching in their church, offering hospitality. Burundi is not an easy place to get to, or to stay in, but there are many young families making it work.

Email us, or use this Go Form link to get more information. You may enter a difficult path, but you will never regret it.

Monday, March 11, 2019

4 days, 3 countries, 2 borders, 1 graduation: A thousand kilometers of East African roads

Early Wednesday morning, we packed and cleaned and loaded our car with our foster-son John, his fiancee Paula, their son Jeremiah, and John's mother , our former neighbor, Coslianta, for the all-day drive from our town of Nyahuka near the western border of Uganda with Congo, to the capital Kampala. Hot air blowing in the windows, Jeremiah taking it all in wide-eyed to process later with his mom, stops for the usual fast-food of roasted chicken on a stick and greasy chapatis folded into thin plastic bags, speed bumps and small towns and papyrus swamps and conversation shouted over the noise of a Landrover diesel and the open windows. Scott had decided to treat us all to the Fang Fang hotel, an older Chinese-run establishment in the center of town so we would be close to the graduation ceremonies the next day.  Once we settled in the rooms we regrouped at a restaurant for the celebratory graduation meal, including John's sister Aidah who grew up with Julia and lives in on the outskirts of Kampala, and another foster-son Ivan who now studies nursing in the area. We all asked John questions about his life, allowing him to give testimony to the faithfulness of God in providing for him after his father died and brothers pushed him and his mother off their land. Thanks to good advice and mentoring from then head-teacher Isingoma Edward, after a good six-year preparation from Christ School at O and A level, he took his math skills to a business college and studied accounting.  It is a rigorous course, and I remember visiting him at school at one point and worrying over his health. But he persevered, and after several attempts and retakes (which is standard) passed the CPA exam. That meant he was one of 444 new CPA's certified in 2018 for the entire country of Uganda.

negotiating for lunch

festive dinner

Thursday we were up and out early, as the CPA crowd are counter-culturally sticklers about time. We were to be in our seats at the much fancier hotel a block away by 8 am, for the ceremony which would end at noon. This is actually a pretty inspiring process, seeing someone we have known since he was one year old become the 5th total CPA in our district of 250,000 people. CPA's are the backbone of integrity, the essential guardians of the process of development. Pray for John now as he manages the funds of Christ School, BundiNutrition, Hospital grants, and much more. Hundreds of families, thousands of people, depend upon the accuracy and incorruptibility of this work.

By Thursday afternoon, we left the family in Kampala and it the road again, trying to make it to Mbarara by dark. After a few attempts we found a lovely reasonably priced roadside hotel. We scrutinized the 6-page menu to choose our dinners, only to find out that not everything in Uganda has changed: only three choices were actually available. We ate our roasted chicken and chips in a banda surrounded by flowering bushes and the deepening night.

Friday morning we got an early start for the actual Uganda-Rwanda border south of Kabale, unsure if it would be passable. Due to a diplomatic dispute, Rwanda has forbidden its citizens from crossing there into Uganda, and Uganda had had miles of trucks backed up. We still hoped it would be open for foreigners and for once were thankful for our Kenya tags. It was a ghost town, only a handful of people, no lines. . . but thankfully OPEN.  But no matter what is there, rule #1, you can't rush a border process.  The stamping, waiting, immigration, customs, scrutinizing papers, checking the car, buying new insurance for the new country . . it takes 1-2 hours regardless. And kudos to Rwanda, they checked our temperatures even though there was no actual questions about Ebola exposure.

This perfectly demonstrates where we are here: computerized systems in place, but without the kind of IT support, electricity constancy, training, reliability to make them useful, so the old-fashioned make-do of holding a ribbon to type it in manually. Aspirations of efficiency overlaid with the reality of innovation and spunk.

 We were in Rwanda before noon, the odd switch from driving on the left to the right, the neat paved roads, the orderly towns, rice paddies, terraced hills, noticable decrement in French signage and clay-tile roofs in favor of English/Kinyrwanda and Mbati (corrugated metal roofs). Soon we could see the city of Kigali approaching, a hilltop metropolis of paradoxical wealth. Rwanda runs a tight ship. Rules are followed. It feels like an anomaly, every motorcycle boda with only two passengers and BOTH wearing helmets without fail, extremely conservative speed limits followed closely. I think the sense of predictability and security appeals to Westerners, as there are many in Kigali, with impressive hotels and abundant restaurants.

Kigali in the distance

every single boda, helmets and limited to one passenger

clean streets, bicycles transporting milk . . we saw a billboard for "the land of milk and wifi" which sounded pretty idyllic

In Kigali on Friday we visited missionary friends we had met though our Kijabe/RVA days, another dual-doctor family with kids overlapping ours but younger, and spent the night with yet another family whose daughter was in Julia's class. Through these families we connected with a group of visiting surgeons returning from Goma in the DRC full of stories, and a woman who was moving to a remote hilltop mission station in South Sudan (and who wanted to tour the former president's home-turned into an art museum, which had a lot of genocide history associated). It was an evening to remember the richness of the community of fellow pilgrims and be inspired by what others are doing: hydroelectric projects, outpatient clinics, sewing business for poor women, training pastors, agriculture support, funding hospital buildings, leading Bible studies, chairing an international school's board, etc. just from that group.

Saturday, the final leg of travel, up and out just as the sun rose, with a stop to stock up on water and snacks and fuel for the car because we've done this road before.  Once you leave Kigali and head south, options thin out. Soon we reached the Rwanda-Burundi border, equally slow for no apparent reason as we only saw five other people pass through in the hour-and-a-half we were there. But there were three police inspections including looking through our things in the car in the hundred meters between the border buildings and the final gate, there was the fun of resorting to Swahili with the Kirundi/French speakers to change money and buy insurance, there was the very cheerful Rwandan border clerk who wished me a belated happy women's day. 

Burundi at last, a palpable shift in level of development. Our team uses the hashtag #beautifulburundi and it truly is, rolling hills, lushly green, red clay, winding roads. It is also a place that has suffered, and that remains suspicious. We had at least a dozen police-stops.  Two asked for sodas (euphemism, small amount of money). One went through an entire car inspection, signal lights, brake lights, etc. A couple looked at our import papers.  Most just smiled, wanted to try out their English, entertained themselves with our answers and our car. We began each encounter with "Amahorro" the Kirundi word for peace, used as a greeting, and that surprise generally set a comfortable tone.

Between the border, the curvy roads, the constant police checks, progress is steady but it takes about 7 hours to get from Kigali to Bujumbura. A taste of the roads below:

And finally, our destination since we left "home" Wednesday, Randy and Carolyn Bond's home in Bujumbura. The Bonds are our team leaders here, working with Hope Africa University as Dean of the Medical School (Randy) plus Pediatrics professor, and professor of English (Carolyn) plus running a virtual guest house of respite for our other team in the hills as they come to the city, and many other visitors as well.  We've had long talks, meals, processing and debriefing, talking about the future, meeting their friends, participating in Church and a small group worship time, and just catching up our friendship.  More on Burundi next post! But these connections make the miles worth while.

 Bujumbura International Community Church

View from the Bond's looking north over the outskirts of the city