Day 13 of the Odyssey.

Belovèd,

The hour draws late.  You have my promise that this missal will ramble, but I will give my most valiant effort to provide for you a brief account of my perspective of our last two weeks.  Should it wax overly verbose, I beg your indulgence. 
We have been, thus far, blessed. The Scriptures assert that we will be known by our love for one another.  To the extent that I have been able to observe, this has been well-demonstrated.  Yesterday we were deprived of the company of several of our number due to the expiration of their leave from hospital duties in the states.  Their absence stings sharply, save that they removed with them the last remnants of some respiratory plague that I have thus far managed to avoid.  Our forest canopy excursion of last weekend apparently incited the ire of some of our allergies, but I remain relatively booger-free.  If my fortune holds out likewise regarding Kunta Kinte’s revenge, I shall count myself blessed indeed. 
All told, we have eschewed several potential ills.  Traveling mercies have abounded, the fare is, at worst, palatable (with the possible exception of the fried whole-sardines that were served up the other day), our spirits remain healthy, and we are enjoying our work.  As far as that’s concerned, my own experience is somewhat divergent from that of my peers.  While their souls languish in the hospital, I spend my time in the laboratory.  I’ve always had an affinity for laboratories.  Most of the people there are without communicable diseases, there are lots of nifty scientific-looking glass thingies, and I get to see color changes in glass tubes.  The only appreciable difference in this lab is that it is situated at the top of a hill looking out on the Rwandan country side.  The view is truly spectacular. 
They call this place “The Land of a Thousand Hills.”  They undersold themselves. Land of a Thousand-Foot Hills would be more apt.  I am convinced this oversight was intended so as to not intimidate American missionaries.  I find myself gasping for breath half way to breakfast in the morning.  I’m sure it has something to do with the elevation.  Yeah.
At any rate, the people in the lab at the top of the hill (when I finally manage to claw my way up there) are a lot of fun.  A couple of them speak decent English.  They said today that my French was “mediocre.”  I believe that’s because their vocabulary doesn’t include the word ‘abysmal.’  Whatever the case, we have a good time.  They all enjoy laughing, and seem to have a pretty good outlook.  The first day I worked with them I had been there with one of the better English-speakers for about 2.5 hours and I noticed we were alone.  About that time he looked at his watch and said, “We are late for tea.” 
“What?”
“Tea.  At 10:00 we have to go to tea time.” 
Doubting, but not challenging the imperativity of tea time, I followed him up and down a series of inclines to the Kanteen across the street from the hospital where we enjoyed a cup of African tea and some kind of fried biscuit thing.  The African tea was more like tea-twinged milk sweetened with sugar and served at a temperature approaching that of the surface of the sun.  The consistency biscuit thing was reminiscent of various sporting implements with which I have collided in my ill-fated athletic endeavors, but it tasted pretty good too. 
This picture has repeated itself in one way or another daily since our arrival.  In the last couple of days they’ve incorporated me into the lab work, and it’s pretty entertaining.  I find it an interesting indictment of our system that after four years of medical school I’ve had to come to Africa in order to do a Gram stain.  Should I grow tired of the bacteria, there are always birds to photograph.

Having realized that we are in a part of the world with endemic species of chameleons, I made it my aim to find one.  It didn’t take long.  Walking along a pencil cactus hedge I spotted three of them basking in the sun.  I am convinced that they are the neatest vertebrates extant in Creation.  As if they weren’t adequately fascinating with their independent turret-eyes and lobster hands, they have prehensile tails.  Let us not forget the tongue trick.  These notwithstanding, some species have horns like triceratops.  Top that.  Ok, ok, plants that eat things are pretty awesome too, but I digress.
Nightly we take the opportunity to share time pondering The Word.  We have undertaken to go through II Timothy.  Given our diversity of perspectives it makes for a most edifying discussion, at least by my account. 

Evenings are relatively free, offering the opportunity for much-needed introspection.  It is my hope that my friends have found these times of meditation likewise regenerating. Having been given a sweet—albeit brief--respite from many of the concerns inherent in the eighth semester of a medical education, I find myself pondering questions of Creation and its Author the resolutions of which I have had to defer until such a time as I could muster adequate resources to attempt their cogent incorporation into my meager synthesis of His work.  Words fail me to express the value of the precious hours I have been given to consider these matters.  I can’t really explain this impulsion save that it is inherent in my creation.  I’m far from unique in this regard.  Seeing the same deep-seated passions, though to different ends, among my brethren I am constantly reminded of what it means to be but a member woven into the Body of Christ.  Each of us is such a small part, some more honorable than others, but each so valued by God that He considered it preferable to sacrifice His own Son for our individual and collective redemption than to allow our bearing the full consequences of our transgressions.  It’s a love that I can’t understand.  It’s a love that I cannot get over, and I pray I never shall.  What wondrous love is this, O my soul, O my soul…

Grace in Christ,
--Goose.

Today marks the 6th day out of 14 that we will spend working in the hospital. So far I think I can speak for everyone when I say that this has been a great experience. It is interesting to compare and contrast how medicine is practiced in different parts of the world. In the laboratory here, for instance, we are unable to get some of the most basic of tests such as sodium and potassium levels. The machine that analyzes white blood cell counts was out of commission for several days so we were unable to check WBC on anyone. Although every good physician should determine whether or not a test will alter his patient's management before ordering it, this is done more regularly over here. Not only does the hospital not have access to many tests that we would consider standard, but some of them must be obtained in Kigali which is not only expensive but also time consuming for the patient. My hope is that the exposure to this type of medicine will enlighten us to the way medicine used to be practiced, where sound thinking and a skilled physical exam were used to make the diagnosis and tests and imaging were used to confirm the clinician's diagnosis.

This is the third time I have been to Africa. As I'm sure many others have already mentioned, this is the prettiest country I have been to in Africa and undoubtedly one of the prettiest on the whole continent. We are currently in between the dry and rainy seasons. The soil is rich and the vegetation lush. The rolling hills and tropical rain forest keep the scenery interesting. I discovered that the termites that fly around at night are, in fact, edible. Just ask Goose.

As we move forward I ask for safe travels for the residents and Dr. Simmons as they begin their journey back to the U.S. I also ask for prayer that our focus remain in God and what he has in store for us in the coming weeks.

God Bless
William

Good morning

What a beautiful place to wake up for a couple of the Baxter kids!

Mea Culpa, Mea Culpa, Mea Maxima Culpa...::beats chest vigorously::

Dear friends, loved ones, snoopers, and others genuinely caring about our progress,

I am Goose, our intrepid blog boss.  I was trying for a title that sounded less self-aggrandizing, but I'm a sucker for alliteration.  After some bumps in the road, some my fault, some beyond my control (I'm going to blame most of my inadequacies on the latter...) it appears that the blog is up and more or less running.  Or crawling, depending on the typing speed of the day's blogger.  Internet-related troubles aside, things are going particularly well in the Southern Hemisphere (the water really does spin the other way down here!) or at least in the part of it in which we currently find ourselves. 

Luckily for me, I am surrounded by a crew much more technologically-savvy than I, and so they have, by and large, been able to update despite my electronic ineptitude.  That said, you have my solemn vow on a stack of pancakes that I will do all that is within my considerabl(y miniscule) power to see to it that our blog keeps you daily appraised of our progress. 

As always, we thank you for your financially supporting our coming, your prayerfully supporting our working and the constant encouragement which you bring to each of us with your emails. 

Hold fast, and keep the Faith (but not to yourselves.)

I remain yours in Christ,
--Goose!

Sunday 2/23

Hello. The internet has been down at the university (where we get access), so these posts may be out of order.

Today (Sunday) is a beautiful day - sunny and clear, with a slight breeze - the perfect day for rest. The weather has been getting progressively nicer with each day.

In the morning, we went to the local church. The doors lead into a huge room (like an auditorium) with hard wooden benches that radiate from the pulpit located in front of the church. In the hour or so that we were there, we heard various choirs. None of us understood the words, but that was definitely not necessary to appreciate and enjoy the singing. We also introduced ourselves to the congregation at some point.

We left before the sermon, which we would not have been able to understand, and came back home to listen to a recording of one of Tim Keller's sermons. He spoke about how our approach to life's difficulties is determined by what we focus on.

The afternoon was spent in various ways. Some went to the hospital with the Albertsons for spiritual rounds, some went to town, some went to a soccer game down the hill, and some just spent the time relaxing.

Annie

Muraho from Rwanda! This is Sarah Kelley updating. I have not had a chance to read what Bragg wrote, so hopefully I won't repeat what she said. For those of you who don't know, Sarah Bragg and I have been roommates for 4 years in Mobile, both have red hair, and are going into Med/Peds and Peds, respectively. We are both working in the NICU with Dr. Whitehurst up here. All in all, we have a lot of the same stories.

Today wraps up three days in the hospital. It's amazing the perspective us team members have gained in such a short period of time. The conditions with which the families and patients cope while here are truly mind-boggling. For instance, in the US, patients' family members often complain because someone doesn't like the lunch provided by the hospital. Here, family members must cook and provide food for the patients themselves. This can be a real problem if a family member is not able to stay 24/7 and is only able to visit once a day. Can you imagine breast-feeding twins on one meal a day, or recovering from major abdominal surgery with so little nutrition? We've already seen these scenarios first-hand.

In addition, family members are forced to sleep in the bed with the patients, or even worse, on the ground. They must also do the patient's laundry. (Side note: this makes for some very "distinct" smells with cloth diapers in the NICU.) I say all this not to be negative or sad, but to admire the resiliency of the patients and their families staying at Kibagora Hospital. We don't know how good we have it back at ole USAMC/ USACW.

And finally, patients can't leave until they pay in full. Wow. Nothing more I need to say about that.

On a lighter note, this place is straight out of a movie - absolutely serene. (See picture below. Sorry if it's grainy.) It is so lush and tropical, so green, and the views are breath-taking. Out schedules are a little less strenuous than at home (maybe not true for the 4th years), and it is so refreshing to have such wonderful conversations with one another and make new friendships. To me, that is one of the most rewarding and memorable aspects of a trip like this. If you are ever worried because you haven't heard from your loved one, take that as a sign that we are enjoying our free time too much to take an internet break. It's nice to unplug sometimes.

And now, some last minute observations. I'm trying to be somewhat concise because I could write 10+ pages. I always used to get in trouble because I was too superfluous in high school.
-Every Rwandan hospital must have a cow on facility to provide milk for the nutrition program, which is only available to some kids. One time the cow got loose and kicked a toddler but he was ok.
-Goose gives great massages, just ask William Black.
-Grass is cut by men swinging machete-like instruments hacking at the ground. It's wild and makes my back hurt just looking at it.
-Here is a picture of me doing a lumbar puncture on a newborn, because my boyfriend doesn't believe that I've ever done one. I was not successful. Dr. Whitehurst got crystal-clear CSF on his first try, using his non-dominant hand. Boss.

 



Today was our team's first day working in Kibogora Hospital. Our day began by joining the hospital staff during their daily morning devotional. Although the entire service, including musical worship, was in a language completely foreign to me (Kinyarwandan), there was one thing that became extremely evident during this time of worship:

Our God is a wonderful creator who deserves the worship of His creation.

How unfathomable, yet how awesome, is it to realize that for every moment we sit in our home churches or have a private meeting with God through quiet time that, at the same time, there are people all across the globe doing the same. People who were made perfect in God's image, yet who are so different than us. People living within a different cultural atmosphere, with different economic resources, raised with a different way of thinking about the world around them. However, despite all of these differences there is one fundamental thing that does not change...the fact that He deserves our worship.

"For you alone are holy. All nations will come and worship you, for your righteous acts have been revealed." Revelation 15:4

This time of worship was so humbling. To see the joy of the Lord reflected in the hearts and faces of strangers living half-way around the world from everything I have ever known and to realize that we all love the same Father. What could make your heart more full than to have the privilege of worshiping the One you love surrounded by a diverse family of believers who share your deepest love?

Lord, I pray I will never forget to give you the worship you deserve. I pray that during times of discouragement that I will remember that the body of Christ does not consist only of the visible Church around me, but instead it is composed of a diverse, powerful body comprised of believer from around the globe. All who are made in the perfect image of Christ. Amen.

-Jennifer

First Day in Kibogora

Today we woke up to a rain storm on our first morning in Kibogora. It is so nice to sleep when it is raining, especially when you can hear it through the open windows with the cool air coming in. Yesterday we traveled around 5-6 hours from Kigali to Kibogora. Rwanda certainly lives up to its name:"The Land of a Thousand Hills." This made for beautiful scenery for our drive! The land is so lush and green here - certainly not what I was expecting of an African nation. In place of deserts and grassy planes, there were hills upon hills - some covered in trees and others covered with crops of coffee or banana trees. This is certainly a beautiful place! Our drive included an hour segment through the rain forest. This was a very exciting part of the trip because we got to see Colobus monkeys right by the road - they did not seem afraid of humans or our cars! After we got through the rain forest, we came to a more rural area of the country where the people where very intrigued by our two buses of clearly non-native people. The closer we got to Kibogora, the more excited the locals were to see us coming through. The children would shout the word "muzungu" at our buses with laughs, smiles, and waves. Muzungu is a word that literally means foreigner but in more recent times the connotation has changed to mean "white person." The Rwandan people have been very welcoming to us and seem generally happy about our arrival. One of the main things I have noticed since my arrival here in Rwanda is how joyous the people are! What a beautiful way to live - I hope to soak some of that joy up while I am here.

Today was our first day in Kibogora hospital. It was quite an experience. We started our day with a morning devotion in the hospital with all of the native workers. It was complete with a sermon, prayers, and songs all in Kinyrwandan. It was an honor and a joy to witness the Rwandans worshiping our Lord in their own way! We were given the opportunity to stand up and introduce ourselves to the people we would be working with and then it was off to our respective sites for the day.

Our students, residents, and attendings are working in 5 different areas - OBGYN, Pediatrics, Internal Medicine, Surgery, and Orthopedic surgery. I spent my time in the NICU today which was a very interesting experience since I just came off of a month of NICU in the states. The level of care that we are able to provide here in Rwanda is limited due to a lack of supplies and technology. In the states, many of these babies would be getting lab work (electrolytes and complete blood counts) daily as well as various imaging techniques as necessary. We had one baby in need of an echocardiogram which could have been completed within the hour in the states. Here in Kibogora, it is not an option. This is not to say that the medical personnel here do not provide great care - you can see the compassion in their eyes and smiles as they care for their own sick and wounded. It is simply an interesting comparison to the complexity and thoroughness of care in the states. It makes you wonder if all of the lab work and imaging that we spend many precious dollars on in the states is entirely necessary.

I can't wait to see how my time here in Rwanda will affect me as a physician and a human. I hope to learn many things - spiritually, professionally, and personally - during this journey. I am sure that God has many great and challenging things in store for us while we are here!

Sarah Bragg

And So it Begins

Today we will start our adventure to Africa. For many of us, it will be our first time on this vast continent. It has taken much thought, consideration and effort to the logistics of this trip – travel arrangements, lodging, and editing of luggage. As we sit on this plane headed from Chicago to Istanbul, I feel like I am beginning to realize that this journey I have talked about, thought about, and certainly prayed about is finally beginning. At this point, we have checked all of our luggage, successfully navigated security screenings in Atlanta and Chicago, and are nearing the halfway point of this trans-Atlantic flight to Istanbul. There were two calls for medical attention while aboard this aircraft for passengers not involved with our group. Lucky for them, we had 5 MD’s and 11 almost-MD’s on board. They ended up being minor concerns and the rest of the flight went smoothly.

Parents, friends, and loved ones: I can happily report that all of the team members, albeit sleepy, have arrived in Istanbul safe and sound and are doing well at this point. Please continue to pray for our safety and for smooth passage as we continue onward towards Kibogora.