Letter 5

Since Adrienne has done most of our communicating so far I thought I should take a turn. I have
been pretty busy at the hospital. It has been a really great experience for me. I wish we could stay
longer. Iʼve enjoyed working with the medical students from Hope Africa University. There are 16 of them
and I have been doing a fair amount of teaching. I give a lecture once or twice a week on some topic that
has come up during the week, and Iʼve been helping them learn how to do a history and physical. I spent
the first half of our time taking care of the patients in the mens ward and in isolation. For the last two
weeks I have been taking care of all the pediatric patients. There are on average 30 or so patients, with
8-10 new cases per day. Iʼve also been doing a lot of work in the emergency room. I get called up there
at least 5 times a day.
" Iʼve gotten pretty good at dealing with malaria. Probably 40 % of the pediatric patients have
malaria. I also see quite a bit of typhoid, pneumonia, asthma, malnutrition, diarrhea. Then there are
broken bones, osteomyelitis, and skin infections. Iʼve had two cases of measles.
" This week was kind of a rough week for me in terms of the patients I saw. Iʼve learned that it is a
relatively common thing to go to the local traditional healer (not sure if heʼs a witch doctor or just a guy
with a pair of scissors) and have him cut off your babyʼs uvula at around 1-2 months. Iʼm not sure what
the indications are for a uvuloplasty, but I think it has something to do with how much he thinks you will
pay him to do it. Anyway, on Tuesday this week he must have somehow contaminated his scissors
because one of my patients, who was recovering nicely from pneumonia developed a raging throat
infection when his mother took him out of the hospital for a few hours to have his uvula removed. It took
me two dayvvvvvvvvvvvvzvs to figure out why he had suddenly developed a new fever. Then Saturday I
saw a patient in emergency who had had the same procedure done on Tuesday, who could barely
breathe because his throat was so swollen from infection.
" On Wednesday a 14 year old girl came into the hospital. She had fallen and hurt her wrist two
weeks before. Her whole forearm swelled up and so she went to the traditional healer who made some
marks on her arm. A week later she came to the surgeon who visits us on Saturdays and he said she had
osteosarcoma and ordered an x-ray. By the time I saw her she had had compartment syndrome for two
weeks and her hand was contracted. Dr. Rusher and I went ahead and did a fasciotomy because the
texts we read said go ahead and do it even weeks late, but her arm was full of necrotic mush. Iʼll be
surprised if she ever is able to use her hand.
" On Thursday night(actually Friday morning) I was called down to the hospital to see a 4 year old
girl whose parents had found her lying on the floor on returning from work at night. When I saw her she
was having trouble breathing. She was a diffusely hypertonic, and not really responsive. Then I went to
look in her mouth and realized that her jaw was so tightly closed her cheeks were bleeding (at one point
later after we relaxed her a little she snapped a tongue depressor in half with her teeth—lesson learned).
I got the treatment for tetanus started right away. It was amazing to see how quickly her breathing
improved after a dose of rectal diazepam. She seemed to be doing ok for the first 24 hours. The spasms
were mostly confined to her jaw. I thought maybe she had partial immunity. But then she died. It was
pretty hard for me. (Iʼve had more patients die in the last six weeks than in the whole of medical school).
" It hasnʼt been all bad though. I had a 2 year old who was severely malnourished and had
measles. He got to a point where he was so weak that he got a sacral decubitus ulcer from laying in bed.
He was so malnourished he had lost his appetite. So I took Claytonʼs formula (he doesnʼt need it
anyway) and started him on 2-3 big cups of milk a day. About three days later he started to eat porridge
and then about three days after that he started eating solid food. Now his ulcer is starting to heal and he
is eating well. He still cries every time he sees me though. Now I have a standard order set I use for
malnourished kids.
" There are a lot of needs at the hospital. A new x-ray machine and some training for the x-ray
technician would be great. The lab could use a little help. There are some tests that would be really
useful and wouldnʼt cost too much in materials or training to implement. And there is a chronic lack of
qualified staff. The nurses are stretched thin and the doctors even thinner. But they do a great job caring
for patients with the resources at hand. And there seems to be a real commitment on the part of the
church and Hope Africa University to turn Kibuye hospital into a university hospital where the medical
students can receive a quality education.
" In other news we have really enjoyed being here. We have pretty nice living arrangements with
electricity and running water and a stove. Bentley and Clayton have both had a couple bouts of
gastroenteritis, but they are doing well now. I spend most of the day sneezing…there is a lot of mold
everywhere in the air, but especially for some reason in the pediatric ward. Also life is a lot better since
we convinced Ezechiel to get us real coffee grown and roasted in Burundi instead of Nescafe.
" This is Adrienne now. Not sure what I can write after reading Davidʼs part. Can you handle all
that? I had a great week. I have been enjoying the mornings with the boys- we have developed a bit of a
“routine”- which can change any given day!! They eat breakfast right away and take their malaria
medicine- the giving of malaria medicine has changed since the beginning- I started by dissolving it in
their oatmeal which was a total fail because that pill is awful tasting. Then I moved to putting it in their first
bite of food, but too often Bentley would chew it with his food and that was problematic- and now I am
proud to say I stick that pill right on their tongues and they swallow it with a small drink of juice! Go boys!!
After breakfast we usually either color or dance around the living room. I turn up the music loud and we
have a lot of fun. Even Ezechiel will come in to dance with the boys. Thatʼs really the end of our routineanything
else goes after that! Lately Clayton has been waking up too early so I put him down for an early
nap and I go up to the hospital and visit David with Bentley strapped to my back. Oh and I found a secret
walking path that I love!! If you go behind the hospital and turn right there is a long narrow path that goes
about 5 km (Iʼm told) it winds through banana trees, up and down hills, corn fields, and gardens. It is very
peaceful. The other day I got to the top of the hill and looked out over the country side and just on the
other side was a thunderstorm- I could see the rain pouring down and I could hear the thunder- it was
amazing. The people love to see me walking with the boys. The come out of the fields and call all their
family members to come see the mzungos! They are so kind.
" I often get asked what I do or if I am in the medical profession to which I proudly respond, NO!
Although secretly sometimes I think it would be neat to be a nurse. Well, the last few days I have been
going up to the hospital and into the pediatric wards and a couple other places- I love following David and
the medical students around- itʼs fun to interact with the patients too. However, they are no longer patients
with symptoms and diagnoses- they are people with faces and names. No longer can David say, “So I
have this patient….” He now says their name or reminds me what bed theyʼre in. There is a little boy who
needs a leg amputation because of osteomyelitis- he currently is in a wheel chair and has been waiting
for an operation for about 2 weeks. He is always with a young girl who has osteomyelitis in her femur. I
love seeing their sweet little faces- they play ball with Bentley sometimes- and I gave them each a blue
teddy bear. Well, she had an operation today (I didnʼt know till later). So David comes home and tells me
a patient was prescribed a medication that she was allergic to (from another doctor)- and he was glad he
went to check on her because he changed it to the correct medication- turns out it was Diona- my heart
sank- “My Diona?” I asked. Also, I was walking around the hospital today when David went to find the little
girl with tetanus and he couldnʼt find her- one of the med students came and said she had died. I had to
walk out of the ward- it was heartbreaking. Her death probably could have been prevented, but there
arenʼt enough nurses to ensure adequate medical treatment during the night. There is a real opportunity
to minister to patients and families in the hospital. If we return to Burundi, I really want to learn Kirundi- or
have a translator- so I can pray with patients and be with them- there is a chaplain, but I think I would
enjoy doing that too (on a much smaller scale than the chaplain).
" There are days when I canʼt wait to get home and eat ice cream and go to my parks and see my
people and do my thing, but overall I really like it here. Itʼs a totally different life, but itʼs a good life. David
often pulls out the hymn book and sings to Bentley on the couch- itʼs really sweet. There is no place to
spend money here- no billboards and advertisements- I think God has really prepared us in our lives to
do this kind of thing- I think Davidʼs chill enough to handle the hospital- the lack of cleanliness and
western procedures for doing things a certain way- plus he loves teaching the students. Heʼs unbelievable
with them- I was so impressed! I love interacting with the students too. I think the medical school at Hope
Africa is such a great educational system- to produce native doctors to go out and help people here is
really going to make a difference- keep praying for them! The first class graduates in December 2012 (I
think).
" This is our last week in Kibuye. Pray for us- pray that it would be a great week filled with joy and
encouragement. Pray for David as he continues to serve his patients. Pray for us as we say good bye to
many people we have come to enjoy- A few of Davidʼs patients have been in the hospital since heʼs been
there- I think it will be difficult to leave them without finishing their care. Pray for this country. Pray for
peace in Burundi- you cannot fathom the stories we have listened to about the genocide that occurred
here…. Pray that the people would be able to forgive one another for the horrible things that happened.
Pray that people would stop putting their faith in witch doctors- they do terrible things to children. There is
a lot of that up here and I just donʼt understand. Also, please pray for Dr. Rusher as we prepare to leave.
He lost his wife to cancer about 3 years ago and I think he is really lonely. I think he really enjoys having
David around and seems to appreciate the boys and their youthfulness. Pray that he wouldnʼt feel lonely
and also for his relationship with the students to strengthen.
" We are so thankful for your prayers and your encouragement. Our time here has been
unforgettable. David has been really able to help people- and God has really been doing a good work in
our hearts. He has grown us together- allowed us to connect with other missionaries- with Burundiansand
with our children.
Love,
David, Adrienne, Benny and CREATON (turns out itʼs Creaton and not Clinton!!!!)