Contentment

Mwiriwe (Good afternoon)!  It’s been a great day here in Rwanda.  Starting out my day with my Bible, journal, and this view: not too shabby!  I know I’ll be quite underwhelmed by my backyard view upon returning to Mobile (rusting patio furniture).  We are currently studying 2 Timothy, but I got very sidetracked this morning.  I was thinking about Paul, the author of this book.  He was imprisoned, flogged, beaten with rods, stoned, shipwrecked, etc, in his sufferings for Christ.  I wondered, was he was ever angry or resentful?  What if he hadn’t had perfect peace in his Savior- that there was a plan in all his suffering?  He knew the truth of who God is and he chose to forever focus on Him instead of his sufferings and circumstances.  Because of him (and his superb writing skills/inspiration from God) we have a majority of the New Testament!

I found comfort in this for myself and for my team.  We have watched things not go as we planned here.  The hospital lacks basic labs that we would write for in a second back home.  There are many medications we would rely on that are not available.  There’s no CT machine (what would the USA ER do?!), no Echo, no ventilators, no crash carts, and the list goes on.  Communication barriers are obviously very real.  Babies that would have a fighting chance in the US have passed away.  Patients come in with burns, ingestions, and scars from initially visiting the ‘traditional healers’ or the not so PC term, witch doctors.  We don’t understand why some of the medical decisions are made.  It can be very frustrating when we watch what we don’t believe is enough being done or even the wrong things being done.  I pray today Lord, give us a heart like Paul! In the midst of what seems like defeat, may our path not stray from You.  Satan is on the prowl right now.  He senses our exhaustions, frustrations, and discouragements, and if only we will let him, he will feed those feelings with the ultimate goal of bringing on our destruction.  That makes me want to fight back!

“Be self controlled and alert.  Your enemy the devil prowls around like a roaring lion looking for someone to devour.  Resist him, standing firm in the faith, because you know that your brothers throughout the world are undergoing the same kind of sufferings.” 1 Peter 5:8-9

While we can’t always understand and see the purpose in the hardships of life, we can know that God is good.  I long and pray for full contentment in Christ and nothing else.  And to accept the knowledge that I may not know this side of heaven why some things happen the way they do, but if I understood all that he did and all that he was, he wouldn’t be God, he’d just be one of us!  Patients are dying and suffering and that is so tough to watch.  We have sick and hurting family back in the States.  But You are in each and every event that takes place here, back home, and everywhere in between.  We don’t understand it all, but we don’t need to, just give us the strength to trust you in the hard times and be content in the fact that you know so much better than we do.  Whatever our sufferings, help us to rejoice in them as Paul did!  Our troubles and heartache only show us that we were made for something better, that we do not belong in this world.  And somehow he’s using these struggles to draw us closer to himself. 

“He will wipe every tear from their eyes.  There will be no more crying or pain, for the old order of things has passed away.” Revelation 21:4

I am loving peds.  I asked Cody yesterday if it was inappropriate to write in my note- “general appearance: SO FREAKING CUTE!” Unfortunately, he said to not EVER do that… One of my babies in the NICU who was malnourished did a good job gaining weight and went home yesterday! I missed him this morning… Destin is the boy with the terrible empyema who Shannon chest tubed last week.  His Xray looked so much better and clinically he is much improved.  He was SO close to smiling yesterday when we taught him how to fist bump.  This morning, we handed out beautifully handmade dresses to the kids, boys and girls alike (it is very, very hard to tell the difference between boys are girls here because the girls have short hair and the boys wear dresses.).  They loved that.  They are also obsessed with pictures.  If ever I have a kid who is scared for me to examine him, all I have to do if take out my phone and take their picture and they are enthralled.  I will have to come up with better tricks for American kids who would be very unimpressed with that trick.

We have less than a week here in Kibogora! Pray that our hearts are refreshed and we are carrying out the work God brought us here to do. Murabeho!

-Elizabeth

Playing and Praying

Thursday turned out to be a lighter day in surgery.  With our our rounds and cases completed before lunch, Francie and I decided to go back to the hospital to make “spiritual rounds” with our patients on the women’s surgical ward. Many of these ladies are our post op patients; a few are awaiting surgery. Our goal was to pray for them and inquire about their relationship with Jesus, hopefully sharing the good news of the gospel with some.

Before entering the ward, we stopped outside, sat, and prayed for God to use us to encourage these ladies and to give an English-speaking nurse time to translate for us. (I knew a total of five Kinyarwandan phrases.) After praying, along came Emmanuel, an amazing OR nurse who was extremely helpful to us as we stumbled through our first days in the Kibogora Surgery Department.  His wife Marian, a social worker in the HIV clinic, was with him.  As we told them of our plans for the afternoon, Emmanuel offered to be our translator if we could wait until he had his lunch. We were thrilled to do this since he is a believer in Christ and understands English well!

Over an hour passed and we had been using the time to send and read emails (our only wireless access is at the hospital, a 5 minute walk from our house.) I went to look for Emmanuel and found him in the admissions office. He had been given an unexpected assignment and with much apology said he would not be able to go with us. Not to be deterred, Francie and I decided to take a deep breath and go pray with the ladies anyway.

Nurse Safi greeted us as we entered the nurses’ station. We asked her permission to pray with our patients and got her to write down the Kinyarwandan phrases for “We want to pray for you” and “God bless you.”  Armed with our two new phrases we stopped at the first bed to pray with Jacqueline, a small lady with multiple problems who had received a skin graft the day before.  She didn’t respond much to us, only opening her eyes for a few seconds, but we both kneeled by her bed, put our hands on her, and prayed – in English, of course. When we finished, every eye in the room was on us (15+ patients and many family members). The next patient, a 74 year old little woman, looked wary but a huge smile spread across her face as we said, “ We want to pray for you” in Kinyarwandan. She took our hands and we again prayed for her healing and for God to draw her to Himself.

From there almost every patient and family member (a few were sleeping, we think J), now knowing what we were up to, waited and watched as we went bed to bed, praying specifically for their medical condition, their spiritual condition, and for God to bless their family with adequate food, clothing, and shelter – real issues to many of these dear people. Tears came to our eyes as many softly spoke prayers in Kinyarwandan as we sought the Lord on their behalf. Most did not understand our words, but we are pretty sure they understood our heart.

God instructs us to pray in Scriptures such as Philippians 4:6-7 which says, “Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.”  Amazingly, He chooses to involve us in His work in people’s lives as we pray. I would say our whole team is growing in making prayer one of our first action points in caring for our patients…

…Then Friday evening, Emmanuel and Marian came to our home so we could meet their 3 and 5 year old boys. We shared a meal with them and then had a fun time talking and playing with the boys. They especially enjoyed playing games on Carl’s iPhone.

Toward the end of the visit, Emmanuel looked across the room to where the majority of the group was sitting and said, “ I would like to play for you.” Our eyes immediately went to the large piano just behind the circle of people. 

“Oh, you play the piano?” I asked.  Emmanuel just smiled and said, “Maybe some of you can play, too.”   “Oh,” I responded, “I wish I could play, and unfortunately no one else on the team plays either, except Francie”, who replied, “I don’t play much in front of people. Usually just at home by myself. But please, Emmanuel, you play for us!”

At that invitation, Emmanuel immediately dropped his head…and began to pray in Kinyarwandan! It took a few seconds for us to realize what was going on.  At first I thought he was praying about what to play…but quickly realized the whole conversation had been about praying together for each other! As the situation sunk in we realized we had told this dear brother that no one on our team could pray, except Francie who only prays at home alone!

Emmanuel then stood up and began saying his goodbyes and for some reason (Shock? Embarrassment?) we let him leave without an explanation of the misunderstanding. So in retrospect, we see the error of our ways and plan to plead ignorance (or super language blunder) when he returns from a trip on Wednesday. We are hoping Emmanuel knows we can and do pray. Carl has one of us pray before every surgery, but who knows?!

Oh the joys of the language barrier! So for our final week and a half here, please pray (or play) for clear communication with our Rwandan co-workers and patients.

Becky Bryars

“Likewise the Spirit helps us in our weakness. For we do not know what to pray for as we ought, but the Spirit himself intercedes for us with groanings too deep for words.”  Romans 8:26  (Thankfully)

1 step forward and 2 steps back

Disappointment and heartache permeated through our group today. We started the day with a sort of “victory,” as Dr. Peevy, Ms. Peevy, Britni, and I began to think that we were truly making a difference and changing the protocol of newborn resuscitation here at Kibogora Hospital. 

We started the day early, as one of the Neonatology nurses called Dr. Peevy, saying in her best English, “Neonatology Emergency.” After rushing down the hill to the hospital as the rest of the group went to the church service, we found a 20-hour old premature baby boy in respiratory failure. After a few minutes of bagging the baby, we decided that we must intubate, or else the child would surely die.

Let’s just say that neonatal intubation, here at Kibogora Hospital, is not the norm. Given that, it took nearly ten minutes to find the necessary equipment. After a few minutes, we had a pink baby boy with oxygen saturation between 60-70%. We looked at one another, realizing there was no ventilator capability, and Dr. Peevy posed the question, “What next?” The immediate response was that we should pray. I turned to the oxygen saturation monitor and watched in true wonder and awe as the monitor read “99%.” While some people in this world would attribute this to mere coincidence, I cannot help but know in my heart of hearts that God was intervening at that point. We then realized that, without a ventilator, someone must manually bag the endotracheal tube to continue ventilating the child. Britni and I looked at one another and immediately decided that we would take it upon ourselves to speak for the group of students and commit to taking shifts to manually ventilate the child in his time of need.

There was only one last hurdle: Did the mother even want this intervention to take place? We have come to realize that resuscitation at end of life is frowned upon here in Rwanda. But this was different… this was the beginning of life; a life that, in the United States, would surely survive. To our great surprise, she desired for this intervention to continue. Feeling renewed, Dr. Peevy gave the nurses detailed instructions how to ventilate the child, as this is a BRAND NEW concept to them. As we left the hospital after 2 hours of resuscitation, the baby boy was stable, breathing on his own, maintaining oxygen saturation of 99%, pink, and only requiring 10 manual breaths every 5 minutes or so. We felt as though this was our “golden opportunity” to show the staff of Kibogora that persistence in resuscitation efforts could truly pay off.

Feeling renewed, Britni and I devised a schedule for all members of our group to cover shifts from 5pm-8am to monitor the baby, as these are the hours when the hospital staff is primarily the skeleton crew. Everyone was hopeful and eager to participate, even if it meant walking in pairs in the dark down the hill to monitor this child for 3 hours in the middle of the night, only to wake up the next morning to return to their normal duties.

Dr. Peevy and a few others checked on the baby around 3pm and his course was steady. As 5pm came along, we realized that the person responsible for the first shift had not been informed of this. Bryan, Luke, and I decided to walk down and cover the shift. We were not prepared for what we were about to face. As we walked in, we immediately noticed that the nurse had her hand on the Ambu bag, but was not ventilating the baby. We realized that the baby was not breathing and took over to try to ventilate. The child’s skin was dusky grey and though the stethoscope available was not the best quality, we were fairly certain the heart was not beating. Bryan and Luke continued to bag as I ran up the hill to get Dr. Peevy. When he returned with me, we came to the conclusion after 10 minutes that the baby had no signs of life and removed all tubes and lines.

It was quite the somber walk back up the hill to our house. Thankfully, Dr. Peevy had already informed the group by phone that the baby had passed, so we did not have to break the bad news. Thoughts of doubt, anger, sadness, uncertainty, and incompetence were like a whirlwind in my mind. And I know the same is true for the others. How could this happen? God has a plan for everyone, but this child had a fighting chance, in our opinion. A very good chance in the U.S.

Walking into this trip, I think that each of us had a realistic understanding that we were not going to “change the world” or even just change medicine in this culture. But, in small ways, we aim to make a lasting impression on the way certain medical situations are handled. However, we have run into some fairly strong opposition, as we have realized that things do not just change overnight or even in the 3 weeks we will be at this hospital. At the end of the day, though, we do not cause any change. We may work for it, but God is ultimately responsible for any change that can be accomplished. Who knows if they will set aside the impromptu Neonatal resuscitation kits we prepared after we leave? We can only trust in God that an impact has been made and that they have learned from our example through Him.

Distraught, I for some reason decided to check my email. God is truly great, as a perfectly appropriate answer was waiting for me. My mother had responded to an email, which I shared with the group. In short, she encouraged me to pray the Serenity Prayer.

“God, grant me the peace to accept the things I cannot change, the courage 

to change the things I can, and the wisdom to know the difference.”

Also in her email, she reminded me that in one short week, Easter will bring the celebration of the Resurrection.

“Keep your head up though. Easter is near and so are miracles and new life.”

Despite the happenings of today, we remain in good spirits. Yes, we feel somewhat defeated, as we felt as though our efforts would be fruitful and this child would pull through. Bent, but not broken, we feel inspired to remain enthusiastic about any future opportunity to foster change here at Kibogora.

-William

Kibogora 5K

In Sporting News the Inaugural Kibogora 5K took place this morning. The course was a grueling 3.1 miles set at an altitude of 7,000 ft with 2 prominent hill climbs. One of which is a half-mile slow climb affectionately known as the “Soul Stealer.” The field of competitors looked primed for glory as the race began. It was a demanding day that ended with Leanna Guinn barely nudging out 1^st place, setting a course record with 21:00 minutes. The group was rounded out by the back and forth battle between Bryan Sirmon and Cody Penrod, which resulted in a unanimous tie for 2^ndplace with a very competitive time of 30:25 minutes. The race was nearly sanctioned by the Rwanda Track and Field Association. All results are subject to appeal. We would like to thank our sponsors as well as God for no injuries or spontaneous pneumothoraxes.

- Associated Press

Kumbya

Mwaramutse (Good Morning),

Yesterday was an adventurous day for us. We made plans to leave Kibogora and hike to a local mission retreat about 3.5 miles away. This retreat is named Kumbya and is located on 10 acres of land that comprises a peninsula on lake Kivu. We left for our hike mid-morning carrying along with us a few snacks and plenty of water for the day. Our hike took us through an amazing landscape between the lakeshore and the surrounding mountains. The countryside contained many small huts built from mud bricks which sat on parcels of land covered with banana plants, coffee plants and various other crops. To add to the picturesque countryside we had the opportunity to interact with many people along the road. Many adults responded well as our group made attempts to greet them with in the native language of Kinyarwandan. Yet, some of the younger children would greet us in English with an enthusiastic, “Good Morning. How are you?”

We arrived at Kumbya around noon and found an open area along the lakeshore to relax and take in the scenery. We enjoyed a mid-day meal of snack bars as we watched the locals paddle canoes and fish in the lake. Our conversations drifted away from the usual subject of the economic and governmental hardships that plaque the history of this nation to the beauty of the countryside and the environmental wealth of this place.

We watched as an ominous appearing cloud approached yet refused to cut short our time on the lakeshore. As the rain began to pour down several made a break for Kibogora while a few of us stayed behind. We sat on the covered porch of an uninhabited house on the lake as the storm moved in. We laughed and talked as the storm moved though. As the rain stopped we set out for Kibogora and enjoyed a somewhat dry walk home.

- Luke

Week Two in Kibogora

For a review of some of our experiences in week two see: http://kjacksonp.blogspot.com

Hello! Well it’s mine and Lukes third full day here in Rwanda and I would say that we are adjusting well. I mean of course I’m still waking at about 1-2 oclock in the morning unable to go back to sleep so I’m pretty exhausted but other than that it’s going great. Luke and I started on the surgery team and we have been extremely busy. When we arrived we were definitely on an adrenaline rush. We were in Africa, meeting all of our friends, and ready for the adventure ahead! I can say now that the adrenaline has worn off and the tiredness has set in. I am impressed with the rest of the team and the energy and enthusiasm they are still able to put forth. I believe everyone is looking forward to a restful and rejuvenating weekend.

William and I went on a little exploring adventure today down to a local school. There is a medical student from New York, Carie, who took a sabbatical from school for a year to live here in Kibogora. She invited us to come play soccer with her and some of her friends and we were excited to be able to go. We had the basic idea of the direction to the school and after a few minor detours we found where we were supposed to be. From our complex to the school was probably about half mile walk and very steep decline down to the ”soccer field”. The children immediately swarmed William and his camera. Very shortly after we started playing we realized that a torrential downpour would be upon us soon, and also on Williams camera. We hightailed it back saving the camera but in the process almost dying ourselves. The steep decline turned into our Mount Everest and we were barely able to make it back without a lung exploding.

We are having a wonderful trip. There are many many heart breaking cases here for sure, but also some that offer hope. It’s would be easy to look at the despair and become overwhelmed and lost in the pain of the people here. But we must always remember the hope that we have in Christ. I’ll end with a verse: 

1 Peter 1:3-5; “According to his great mercy, He has caused us to be born again to a living HOPE through the resurrection of Jesus Christ from the dead, to an inheritance that is imperishable, undefiled, and unfading, kept in heaven for you, who by God’s power are being guarded by faith for a salvation ready to be revealed in the last time.”

-Bryan