We're in Burundi. You may be wondering where Burundi is. I, myself, was wondering the same thing a few months ago. It is a very small country in central Africa, just south of Rwanda. Tanzania sits to the south and east while the Democratic Republic of Congo sits to the West.
So, how did we end up in a small country in East Africa? Let me start at the beginning.
I met Michael Harling in Greenville, South Carolina, in 2017. I had just started my orthopaedic surgery residency and he had just finished his general surgery residency. He and his wife Jenn, a pediatrician, decided to go into full time mission work and ended up at Kibuye hospital in Burundi. I followed their journey via their blog over the next six years. I reached out to him in 2021 when I had some elective time in my fifth year of residency to see if I could come operate at Kibuye, but through various circumstances I ended up going to Malawi instead. After finishing fellowship a few months ago and when my locums job fell through, I contacted Michael again and asked if they could use an unemployed orthopaedic surgeon at Kibuye. They were extremely welcoming and we began to plan our trip out to Burundi. Michael was also excited about William coming with, as I had described his many talents-legal & tiny home building.
I learned more about Burundi and the hospital in our preparation. The population of Burundi is around 13 million, with 40% under 15 years old. It consistently ranks among the poorest countries in the world. The main economy is agricultural, including coffee and tea. There are very few doctors in Burundi, with a rate of about 0.05/1000 people. The world health organization standard is 1.5/1000 people, and in the EU the rate is 3.5/1000 people. In Burundi, there are only three orthopaedic surgeons, and all of them are located in Bujumbura, the main city. They only see patients who are able to pay for surgery, which is a small minority of the population.
Kibyue hospital is located in rural Burundi, about a two hour drive from the main city, Bujumbura. There are four general surgeons, three from the US and one from Burundi. They have three OR's and do an insane amount of cases. About 30-40% of their cases are orthopaedic, which is incredible given that they do not have formal orthopaedic training. It would be as if someone came to me asking me to remove an appendix, knowing that no one else is available and if I can't do it, the patient dies. I honestly don't think I could do it. But they learned orthopaedics on their own, and they do an amazing job.
Kibuye hospital also recently started a PAACS program, or Pan-African Association of Christian Surgeons. PAACS is a residency program for African medical students to become surgeons, with the goal of keeping local doctors in their home countries. They currently have 6 residents and a visiting resident from Cameroon. While I'm here, one of my duties will be giving ortho specific lectures to the residents and working with them to improve their ortho skills. One of my other goals is to go through all of the ortho equipment and implants and help to organize these. Over the years, the hospital has received many donations, but sometimes it's hard to know how to effectively use the equipment with the resources available.
So, on October 11, after a lot of planning and 30 hours of traveling, we arrived in the dark in Bujumbura and stayed the night at a hotel in the main city. The next morning, we had breakfast and saw the lake, which had signs warning us about hippos. Welcome to Africa.
(side note: the official language of Burundi is French. The original language is called Kirundi, but Burundi was colonized by Belgium, so that's how they ended up with French).
One of the surgeons picked us up from the hotel and drove us two hours through winding roads to Kibuye. We settled into the guest house, which we share with other visitors. We have our own room but share a bathroom, kitchen, and common room. We got a tour of the hospital, the OR, and the solar field (which William was particularly interested in).
The next morning, they already had cases for me. The first was a 30M (30 year old male) involved in a motorbike accident ten days ago with a left femoral shaft fracture, left patella fracture, and left tibial plateau fracture which extended into the tibial shaft. Complex trauma to say the least! I struggled through it with one of the general surgeons, and I think it turned out fairly well considering the circumstances. Like most developing countries, there is no intraoperative X-ray (called fluoroscopy), which makes the surgeries much more difficult. You only get to review your work with a final XR, done after the patient has left the OR.
Before:
After:
Over the weekend, we went with some of the other visitors (a couple from the Netherlands) to some waterfalls about 45 minutes away.
Later in the day we went with Jenn to visit one of her friends, who was recovering from a spinal cord injury. He no longer needed a wheelchair, so William helped bring it back to the hospital for someone else to use. He loved it.
Tomorrow, I start my first full week in the OR, and I know they have some challenging cases on the books. Stay tuned.
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