My COVID-19 Vaccine Adventure

 After getting stuck in the US during the early months of the pandemic, I took a humanitarian flight back to Burundi in August 2020 (and ended up stuck in quarantine in Ethiopia for 2 weeks en route). At the end of December 2020, I began to see pictures of all my doctor friends getting vaccinated. It was so hard to feel like I was missing out on that protection of a vaccine - particularly working as a doctor in a country without ICUs or ventilators. But with borders and airport closed for many months, Burundi seemed to have avoided the brunt of the first and second waves of Covid. We weren't seeing many patients in the hospital with serious respiratory disease and national Covid numbers were pretty low. In early 2021, however, as numbers began to creep up in Burundi and vaccination became more available in other countries, we began to wonder when it would be possible for us to be vaccinated. Then a few months ago, vaccines began to be available in other African countries. This was when we really started pursuing any possible leads to get vaccinated. We hit quite a few dead ends in this search which became more and more concerning as the delta variant of Covid reached Burundi in July and numbers really began climbing nationwide. Multiple staff members of our hospital became ill and our Covid isolation unit was full. The Minister of Health announced Burundi would accept vaccines, but evidently they are still preparing the infrastructure and systems to roll out vaccination here. Finally, after months of waiting, I heard of the possibility of getting vaccinated in a nearby country and decided to give it a try (not knowing if the whole trip would be in vain or not). 

Here's the story of my journey. Hopefully it will result in gratitude for the easy accessibility of vaccines in many countries and in prayers for the least accessed countries to gain both vaccines and the systems needed to implement widespread vaccination. 

Step #1: Drive 3 hours each way to Bujumbura two days before flight for the official travel Covid test (which can only be done in Buja). Add two extra hours when a truck overturns and blocks the dirt road that is already the detour to the city.

 I honestly did not believe that the road would get unblocked in time for my Covid test and thought my whole journey was derailed just 10 minutes from Bujumbura. I mean how does a semi-truck get righted and moved on a windy, mountainous, pothole-filled dirt road in Burundi? In the end, I don't know how it got unblocked, but my team was praying for me even when I was faithless and languishing in the heat and surrounded by a crowd of onlookers. God answered those prayers, and I made it to the national testing site with time to spare. 

Traffic jam when everyone tried to take the road at the same time after it was unblocked

Step #2: Get the first of four Covid tests - before departure and on arrival in each country. Pray for negative results x4. Again, remarkably, my test was negative and I was cleared for travel. 

Step #3: Drive down to Bujumbura again 2 days later for flight. Pray another truck doesn't overturn! 

Step #4: Arrive at airport and show Covid test result and travel documents four times at various checkpoints. Go through security twice. Check in luggage. Try to convince airline agent that carry-on bag is not too heavy. 

Step #5: Get on my first flight in 13 months! I was so relieved just to be on the plane and going somewhere! 

Step #6: Quarantine hotel for one night while waiting for arrival test results. This not being allowed to leave my hotel room brought back some flashbacks from my travels in 2020, but thankfully it was short-lived! I was free the next morning to visit with my friends. 

Step #7: Enjoy a sweet visit with special friends. 

Step #8: Register for the vaccine and explain why it has taken so long to get my first dose (because no vaccines yet available in Burundi). 

Step #9: Get vaccinated! I really didn't believe it was happening till the shot went into my arm. I've never been more thankful for a sore arm in my life! God is so good to answer the prayers of many - and to guide the vaccine developers and COVAX donors and the systems and supply chains all along the way. 

Pfizer #1 for Pfister! 🎉

Step #10: Repeat the Covid tests and travel and hotel stay on return to Burundi. Thank those who covered the pediatrics service and the team leadership job for me in my absence. 

One last delicious meal with these sweet and encouraging friends

Step #11: Make plans to hopefully repeat the entire process at least 21 days later! Keep praying for vaccines for those who don't have the privilege or finances to travel to another country for vaccination. 

https://covid19.who.int

Culture and Coronavirus

A couple friends recently encouraged me to write from my unique perspective of living and working as a doctor in a limited resource setting for ten years but now being Stateside for this pandemic. So I’ve resurrected this old blog. 

“Is it safe there?” 

When people find out where I live in East Africa, this is frequently one of the first questions asked. I think this reveals a presumption (at least among middle and upper class Americans) that physical safety should be a priority. Safety was probably always an illusion, but in the light of this pandemic, the veil has been torn away and suddenly nowhere is safe. No one is invincible in facing COVID-19. And, while hand washing and social distancing will hopefully help, we ultimately can’t protect our loved ones either. Life feels like a zero sum game at the moment - there are only so many masks, ventilators, and rolls of toilet paper to go around. And that’s terrifying - particularly for those of us from privileged nations who have always assumed there would be advanced healthcare (and TP) when we needed it. My Facebook feed shouts that doctors around the world are afraid, and I see the terror in people’s eyes at the grocery store too. 

Two of the four basic medical ethics principles are autonomy and justice. Autonomy emphasizes the patient’s right to choose or refuse medical care, to be involved in the medical decision making process. Justice highlights access to care and ensuring equal basic liberties for the highest number of people. American culture tends to prioritize autonomy - it goes along with our focus on individualism and freedom. Maybe it stems from the “protestant work ethic” - we want to believe that if we work/study hard and make wise choices, we will be rewarded with a good job, a nice place to live, security, and quality healthcare (no matter the cost). Of course the “American dream” has been unattainable for millions of Americans suffering the consequences of systemic racism and economic inequality. And I won't touch on the theological issues of the American dream or protestant work ethic here. But in the era of COVID-19, autonomy is being threatened for all Americans because there simply aren’t enough testing kits or masks or ICU beds to go around, and, with the orders for social distancing and lockdown, we also lose the autonomy to decide where we go and how we live.  Suddenly the ethical principle of justice is first and foremost - focusing on the needs of the many rather than the rights of the few. 

Both Burundi and Kenya (where I have lived for most of the last 10 years) are collectivist cultures. Individual autonomy is not really prioritized. Families make decisions together, and the emphasis is on what is in the best interest for the community. Our missionary team functions that way, too - which can sometimes be a shock to new people who are accustomed to North American independence! We collaborate on decisions about vehicles, pets, kids’ schooling, security plans, work hours, construction priorities, and, lately, COVID distancing measures. This is hard for us. Hard and good. For me, being single, it is mostly reassuring to know that I am not alone in making tough decisions and that someone always has my back. I belong to a diverse team with a wide range of experiences, personalities, and areas of expertise AND a mutual desire to serve and care for others. But autonomy vs. justice plays out in Burundi, too, on our team even now weighing different perspectives on what constraints to require in seeking to “flatten the curve,” and at the hospital. Even before the current coronavirus, we have had to make painful decisions about which patients get oxygen or a hospital bed or surgery. Who has the best shot at survival? Who has the most urgent need? How can we help the most number of people - and continue doing so for years to come (which means instituting reasonable work hours for hospital staff)? 

These are hard days in our world. And suddenly we are all living in limited resource settings. I personally am struggling that I don’t have the autonomy to jump on an airplane and fly to Burundi. And I fear that injustices will worsen in many contexts - with the vulnerable and marginalized suffering even more from food insecurity, inadequate healthcare, and the achievement gap. But I also have hope. Because in some ways this coronavirus is a great equalizer. Around the world we have the opportunity to be united in our shared struggle, to love our neighbors in practical ways and maybe, in the end, to rethink some of the ways we live our lives. Maybe the next time I talk about my work in Africa, I won’t get as many questions about safety but will get more questions about how to join in the work God is doing in the most underserved corners of the world - even if there is some risk involved. 

Summer events

Sorry for neglecting this blog for awhile. I've been writing some posts on the team blog, but I've also been generally documenting my life in Burundi less frequently the longer I live here. When life seems "normal," it's hard to remember what other people might find interesting or noteworthy. But here are a few pictures from the last few months to summarize events of the summer on 3 continents.

Serge has a conference every 3 years with all their missionaries. Loved getting to take part in this big event for the second time. Above - our Kibuye team. Yes, we're growing! There will be 45 of us here in Burundi by the end of this month! Excited to welcome new teammates and friends. Below - many of the conference participants from around the world. Loved getting to connect with folks from both similar and different fields and to find lots of common ground with both. It was an encouraging and refreshing time together. (I'm in the middle-left in a purple shirt.) 

After the conference in Spain, I headed back to Burundi for about 6 weeks:

The peds team did some more teaching and learning with the outpatient malnutrition families. I was thrilled to see how much the students learned this time about how well the mothers understand their kids nutritional needs. The mothers struggle with poverty, limited resources, and a plummeting economy, but the students were impressed with how much they understood and how well they cared for their children despite the many obstacles. 

We got a new hospital sign thanks to a creative and artistic intern!

I was honored to be included in a traditional ceremony to put the baby on the mother's back. After the baby is a couple weeks old, family and friends gather for a meal and prayer, the father announces the baby's name, and the grandmother carefully ties the baby on the mother's back for the first time. We all cheered for Baby Micah! 

A couple days after this ceremony, I got back on an airplane to visit my third continent of the summer - North America! I so loved getting to participate in lots of family time during my month in the US. 

 We love our family vacations at Rosemary Beach! 

The big impetus for this trip was a huge family milestone - 40 years of marriage for my amazing parents! My sisters and I hosted 90+ of their closest friends to toast this feat and thank God for their faithfulness and love all these years. 

I also got to meet Baby Maisy and spend lots of time with these 4 precious nieces and nephew - including ice cream at Jeni's, first day of kindergarten and 3rd grade, swimming and hiking, and special one-on-one birthday dates with each of them. 

And then it was back to my normal Burundian life but still with a couple of special events beyond the usual patient care, student education, and team life:

 We started a new sickle cell clinic (above)

 And I loved attending the dowry ceremony and wedding for Francine and Desirée. 

 Beautiful scenery even at the end of dry season

 Entertaining the crowd with pictures and rock, paper, scissors while waiting for the wedding to begin 

 So how does a Burundian village wedding compare to a Nashville 40th anniversary? Well, both had lots of food: 

But in America you serve yourself, whereas in Burundi you're given a plateful - always including Fanta. 

 In Burundi, someone brings around a tub to wash hands before the food - especially important as there aren't usually enough forks to go around. 

But in America, you get cake! 

 There are speeches (toasts) in both 

and lots of happy family and friends!

Christmas at Kibuye - with family!

What a joy it was to welcome my parents to Burundi for two weeks at Christmas! I'm so thankful that they were able to come despite the insecurity in Bujumbura and experience my life at Kibuye. Being only their second trip to Africa, they were quite courageous to come and in the end they really enjoyed my peaceful Kibuye world. The pictures below summarize our fun and memorable adventures together over the last two weeks:

Christmas day delivering gifts and sharing the Christmas story with kids at the hospital

Ultimate frisbee game on Christmas

Hike to Kibuye Rock for an arial view of the hospital

Incredibly powerful and beautiful waterfalls complete with downpour in rainy season (four different waterfalls we hiked to in these four pics!)

Visiting the southernmost source of the Nile River with friends

Touching the Nile River

Pyramid at the source of the Nile built by the German explorer who began walking in Egypt and discovered the source of the Nile here four years later in the 1930s

My mom jumped right into our elementary school teaching students and teachers 

Christmas Eve dinner with friends and family

Quite the crew at Kibuye for the holidays - likely the largest group of expats in the country these days - the benefit of living outside Bujumbura in a peaceful rural setting 

Christmas morning church service - we even formed a "choir" and sang ourselves to the entertainment of everyone :)

My view from the front of the church as we sang "Joy to the World" in English and Kirundi 

Visiting the babies and mothers in the nursery on Christmas with new hats and blankets. My mom and I are holding twins wrapped in new blankets which my sweet 5 year old niece purchased with her own money for the babies. 

Gotta love the Christmas tradition of watching "It's a Wonderful Life!"

Christmas morning after our singing debut

Lots of "friends" on our Boxing Day hike

Loved having these amazing houseguests. Not sure who was welcoming whom as they cooked for me and helped organize my house and even made coffee every morning - so sweet! 

While my mom was teaching kiddos, my dad loved getting to go on the weekly construction tour and see all the progress around the hospital and housing area

Beautiful Burundi - picture on the continental ridge

The first fire in my fireplace!

My dad helping with our satellite internet

Both my parents enjoyed going on rounds with me and seeing my work firsthand for the first time

New church under construction

My mom enjoying the kids during the frisbee game

First day together in Burundi on the shore of Lake Tanganyika

They took lots of pictures of me, too, in the nursery...

...and during my Grand Rounds presentation to the hospital staff...

...at Bible study with the med students in my home...

...on rounds...

...and in Radiology. 

My parents are both curious about new places and cultures and asked great questions. Here's my dad learning about Busoma (the grain we manufacture here) in the old site (above) and the new (below). 

And here's my mom learning all about the exciting plans for the new school building

As all the Burundians said, I have young (and fun) parents! 

Lots of cooking together

My mom engaged well with the 100 outpatient malnutrition program kids as she shared the Christmas story through a translator

And we will always remember our rainy adventure in the hot springs - and the fact that we discovered there were snakes there after we got out! 

Thanks for visiting, Mom and Dad, for a fabulous Christmas together!