Wednesday, October 3, 2018

A Lady with Cancer


A lady was brought to casualty.  She was in her 40s, and was in desperate pain.  She had been diagnosed with cancer a couple of years prior.  She and her family had been referred to an oncologist.  But someone who called himself a doctor had told them that the hospitals would give her poisons that would make her feel terrible.  The “doctor” instead offered them “supplements” that “will make her feel better and treat the cancer more effectively.”  They chose to use the supplements, and so the cancer grew, otherwise untreated.  She had now developed abdominal pain that rapidly worsened, and was brought to us. 

She was miserable, unable to find a comfortable position.  Her abdomen was greatly distended and tender.  Ultrasound showed her abdominal cavity was almost completely filled with her spleen and liver, packed with cancer.  She was rail-thin, and her nail beds were almost white.  Surely she had a dangerously low red blood cell count.  We started all the “doctor things,” ordering meds and blood and labs and such. 

The family had many questions.  They were kind, educated people.  They said she had been doing so well on the supplements but seemed suddenly to have worsened.  I struggled with what to say.  They had been fooled by a quack, who had been taking their money while the cancer grew.  The cancer was a type which tended to respond well to chemotherapy, and the family had good insurance which would have paid for the chemo, which added to my frustration.  But here she was dying, well beyond most intervention.  We came up with a plan to evaluate her pain and contingencies for the findings. When they asked why she was so sick despite the expensive supplements I tried to gently explain that the cancer had been growing and would soon take her life, and that the supplements had done nothing.  They were quiet. Perhaps they were unsure of my advice.

Her condition worsened and she became unresponsive. I realized that she was near death, and that her illness had progressed well beyond our ability to rescue her.  I felt a push to help the family with realistic expectations.  If her heart stopped, we needed to know what to do.  I told them that her condition was very serious and she could die at any time, that we would continue to treat her well, but the end would come soon. They were not expecting such news, and the truth of the consequences of their earlier decision became an unspoken reality in their faces.  I explained that when her heart stopped, we could try to resuscitate her, but the efforts would probably be unfruitful and dramatic.  The chest compressions would break ribs and the electrical shocks would make her convulse.  None of those actions would change her overall condition.  On the other hand, when her heart stopped, we could treat her with dignity and not do those other dramatic acts.  I recommended this latter course.

We had a time of prayer, and I was very glad to learn that she was a devoted Christian.  There were tears.  The family withdrew to consider.  I checked the clock.  I was about an hour late in going home, and other staff were available to take over her care, but I wanted to stay.  I needed to stay.

The family returned.  They were confident in their decision to go the way of a quiet end with dignity.  To my surprise, they asked me not to continue with CT scans and surgical referral, as we had previously planned.  I took a little time to finish the paperwork, then the family and our excellent resident and I began to push her on her bed to the ward.
As we neared the ward, her breathing slowed.  The ward wasn't ready for us and we paused at the entrance.  Hearing her breathing slow further, I told the family that she was finishing, and we turned  into a side hall.  I was so very relieved that we had discussed the plan for her end when we were in Casualty.   We prayed again, commending her soul to the Lord, thanking Him for an end to her suffering, and rejoicing, with sorrow, for her promotion to Heaven.  Her breathing stopped altogether. 

The family thanked us for our efforts and asked God's blessing on us.  Then they departed.  We did the necessary things for the body, and I walked home.

The walk home normally takes four minutes.   It seemed much longer this time.  My patient had been a young woman with three kids.  Her cancer had been very treatable.  She died “needlessly.”  She and her family had been deceived by a charlatan, with deadly consequences.  A grievous injustice.  I felt sick.  But God remains Sovereign.  “See now that I, I am He, and there are no other gods beside Me. It is I who put to death and I who give life.  I have wounded, and it is I who heal, and there is no one who can deliver from My hand.”  Deut 32:39.  Both were true.  The deceiver had profited from malpractice and she had consequently suffered and died.  And God was sovereign in the whole event.  Surely, He was grieved by the sin of the situation as He is with all sin.  I was grieved, too.

Martha and Meredith and James were already sitting at supper.  I washed and sat.  Martha asked what kept me, so I told the story.  Tears came, which was surprising.  I don't remember being that emotional at the death of a patient since my time in a combat hospital in Afghanistan.  Surprising, but welcome.  James gave me a long hug. 

I believe that God arranges for us people to intersect with each other for a reason.  So why did He put me in contact with that family, with that lady?  I hope that I was able to guide them medically and spiritually in an important time.  I hope that it was right to choose less medical intervention and more spiritual support.  But those God-arranged intersections usually have purpose for both parties.  What was I to learn?  I think I was supposed to be reminded that ideas matter, and that we must be teaching to prevent the suffering that comes from deception and greed.  I think I was supposed to feel a little of God's grief at the brokenness of this world, and cry about it.  And ultimately I think I was supposed to really live in a situation in which medicine was largely futile, but God's sovereignty was the source of all comfort.  Ps 116:15: “Blessed in the sight of the Lord is the death of His holy ones.”

Thursday, May 3, 2018

God's Kindnesses in Tragedy


I believe we just saw a situation in which God let us know that an event which we would call tragic was actually according to His will.

Casualty (our Emergency Room) was quiet in the cool of the morning.  The three beds were empty and the staff were chatting socially.  Our Family Medicine Resident, Yulu, and our PA, Derek, and I decided to hold a resuscitation drill.  We invited the Casualty staff, and two nursing students were interested in participating.  I went to the storage area on the far side of the hospital compound and brought out our old CPR manikin and the ventilation bag and mask which we had stored with it.  We moved our “crash cart” and its defibrillator next to the bed and started to attach leads to the manikin “patient.”  I was disappointed to see that all of the defibrillator pads had been used but not replaced from storage, so made the journey back across the compound to retrieve a new supply while Yulu taught the students some of the operations of the defibrillator.  After I returned, we showed the nursing students how to attach the cables and leads properly and we proceeded with our teaching case drill. 

Abruptly, one of the clinical officers stuck her head in the door and said, “We need you.”  A lady had been brought by her family, unresponsive.  The lady was young, about 40 years old, and did not appear to be chronically ill.  But she was entirely unresponsive.  We all joined in her care.  She was breathing rapidly and her heart rate was a little fast, but she had a normal blood pressure.  Her blood sugar was normal.  Why couldn’t the monitor read her oxygenation level?  We tried another device with no success and gave her 100% oxygen.  Her heart sounds and lung sounds were normal.   Her eyes were open but pupils weren’t reacting very well.  The family said nothing unusual had happened and there had been no trauma.  She had taken her usual medications.  Her daughter, a young adult, was distraught.  What was going on?

Yulu said, “She has stopped breathing and has no pulse.  Start CPR.”  We brought the “crash cart.”  We needed to attach defibrillator leads.  Glad for our opportunity earlier, I handed the pads to the student nurse and said, “Attach these.  You know how.”  And she did.  I was also glad we had discovered earlier that we needed to resupply the pads.  We didn’t need to shock our patient, but we kept the defibrillator in case the situation changed.  We used our suction device (glad we had that out for the drill).  We asked for a bag and mask, and I was again disappointed that all had been used and not replaced.  But we had the one that we had been using for training with the manikin, and brought it out.  There had been no delay. 

Our patient had normal electrical heart rhythm on the monitor, but no pulse.  We gave adrenaline and started chest compressions which produced an excellent pulse.  Then she regained her own pulse so we stopped compressions.  Still no oxygenation level on the monitor.  We tried to intubate but the situation made it technically difficult.  So we used one of the only LMA devices in the hospital to be able to breathe for her.  It worked well. 
Someone had called for the chaplains, and our Evangelist, Nancy, came.  I explained the situation to her and that we had tried everything but we were not being successful.  We prayed and she went to the family to update them.

Then our patient's pulse stopped again, and we started chest compressions again and called for the ultrasound machine and looked at everything but we couldn’t find a reason for the dysfunction.  Normal hydration, normal lungs, anatomically normal heart but now with slow beats, no unusual fluid anywhere.  The blood count returned with near-normal values.  No clues.  We tried fluids, drugs, maneuvers, and more, to no avail.   Her own heart rate had slowed to about 20.   She was dying.

The pulse would sometimes return and we would stop compressions, then the pulse would go and we would resume compressions.  We rechecked the history with the family and reexamined her and asked for ideas.  The Medicine team came and helped with ideas, compressions, and tries. 

Yulu said, “Shall we continue?”  I was surprised that I had lost track of the time.  I asked how long we had been doing CPR.  “About 40 minutes, Daktari.”  We looked again with the ultrasound machine.  The heart movement was minimal.   Any further action was futile.

Nancy was there.  I told her that we had done everything possible in our hospital and that she had died.  We needed to speak with the family.  She said we should wait and that she would prepare them.

We stopped the resuscitation attempt at 11:55.  We reviewed the events of the attempt, asked for questions and asked if anyone had concerns or reservations or burdens.  We should have prayed collectively, but several did individually. No one knew where Nancy had gone with the family, so I called her.  “Dr. Jim, come to the Chapel.”  There were sounds of singing in the background of her call.

Yulu and I went to the Chapel, which is in the heart of our hospital compound.  There were over twenty people – family, neighbors, friends; they had come as soon as they heard something was wrong.  The daughter was sitting and crying just inside the door, being hugged by two ladies on either side.  Our Chaplain was speaking to them, mainly in the Kimeru language.  It became obvious that some in the group only spoke Kimeru, though some also responded in English and Swahili.  Yulu and I sat among them.

After the Chaplain finished his words, he asked us if we had something to say.  Yulu stood and gave a very compassionate account of what had been done, speaking mainly in Swahili with some English.  Well said.

Then a mature lady stood and gave one of the finest speeches I ever hope to hear.  She spoke directly to the daughter, who was still in school and had lost her mom and still had younger siblings.  And she spoke indirectly to the rest of us.  The lady introduced herself as a neighbor.  She gave testimony to the life of the fine and generous lady who had died.  The mature lady explained that when she was a girl, she had three younger sisters.  Her mother died giving birth to the only son.  The death occurred at our hospital long ago.  And despite heroic efforts, the boy died, two days later.  And the lady gave testimony as to how God had raised her, and had seen to it that she had what she needed.  She was not allowed to leave her education, and the community had joined with her in raising the family.  All of her siblings had finished their education and were well.

She said to the daughter, “You will finish your education.  God will be your parent.  And you will find Him faithful, as I did.  We will see to you and your younger ones.”  She challenged all of us to do this.  It was a beautiful act of the Body of Christ in the midst of a very difficult time.

I needed to say something, too, and the Chaplain gave me the time.  So I spoke to the family and told them some of the remarkable things that had happened that morning.  I can’t remember the words, but the sentiment went something like this:

Lord, God of the Universe, who made our souls and gave us life, you say in your Word in Psalm 116, “Precious in the eyes of the Lord is the death of His saints.”  You also have said , “'See now that I, I am He, And there is no god besides Me; It is I who put to death and give life.  I have wounded and it is I who heal, And there is no one who can deliver from My hand.”  We surely did not ask for this event today and we do not know its purpose.  But it is clear from these people gathered that this was a loved woman who was very important in the lives of many.  And believing the testimony presented here that she was one of your children, we know she is rejoicing with You right now. 

Lord, it is remarkable to me that as we were trying to keep this lady alive, we had everything available to us right away.  Even the things we found missing in the morning, we had replaced.  Even the training we did this morning helped us be prepared to help her.  We had all of our tools, even the uncommon ones, immediately available.  We had lots of help.  Even now gathered here, this excellent lady was here to give us a very fine word and encourage us all with her testimony of your goodness.  I believe you have arranged all these events to show that you brought this about in Your perfect will and for Your perfect purpose.  We are not so foolish as to think we know better than You.  We bow to Your wisdom and Your timing.  We are grieved at this loss, and we ask for Your blessing.  You have said, “Blessed are those who mourn, for they shall be comforted.”   Let it be so. 

It was difficult to leave this gathered group.  God was doing something.

Three days later, I met with our Chaplains for our weekly combined training session.  They spoke of the death and what happened after.  They said the family were so appreciative.  The family were grieved, to be sure.  They were mourning, but not as those who have no hope.  They were mourning as those who have confidence in a sovereign, good God who had seen to it that all human effort had been tried.  There was no reason to despair that the medical care had been poor or uncaring.  It was the best available, with many good doctors and nurses and clinicians trying their best for a very long time.  This was something that God had done.  What a kindness!

I am convinced that God’s highest plan was for this lady to be “permanently healed,” as Nancy calls it, and go to Heaven.  And in His kindness, He arranged for there to be no “what ifs” regarding the medical care.  What must that mean to the daughter?  What does that mean to those of us who tried and “failed?”

There are times in the service of the Good King when I have to kneel down, put my sword down, and just worship because of something He has done. 

Friday, March 3, 2017

Chogoria Chaplains' Excellent Work


The Chaplains in Chogoria continue to carry an enormous burden of care.  Right now in Kenya, the government doctors have been on strike for three months, and many of the patients who would normally go to the government hospitals have sought care at the Mission Hospitals.  Consequently, the workload for Chogoria has increased dramatically.  Sadly some of the government-sponsored doctors who work at Chogoria felt compelled to join the strike, so staffing is decreased despite the increased workload.  In the middle of the struggle are our magnificent Chaplains.  

Every month, our Chaplains produce a report of their activities.  I thought I might reproduce their most recent report here to give you an idea of their wonderful work.  They don't just sit around in the office waiting for work.  They are out in the wards and offices and waiting areas and counseling rooms, actively doing the King's work.  I am intensely proud of them.  Please pray for them and for all the Chogoria staff who are carrying the day, showing the compassion of Christ to patients who otherwise may feel abandoned.  

CHAPLAINCY REPORT FOR FEB 2017
Ø  The chaplaincy team consist of the following staff members:
Ø  Rev Roy Kamau-------------------------Chaplain
Ø  Mr  Fredrick Muguune -----------------Evangelist
Ø  Mr Eliphas Mutegi-----------------------Counselor/Preacher
Ø  Mrs Trizah Mugendi---------------------Volunteer Evangelist


Above: Chaplaincy team

ACTIVITIES
Ø  Daily Ward  preaching
Ø  Daily Bed to bed witnessing
Ø  Daily Departmental preaching/prayers
Ø  Daily bereaved  prayers at the mortuary
Ø  Daily  counseling when called upon
Ø  Once a week staff worship on Mondays
Ø  Monthly staff intersession (1st Wednesday)
Ø  Fortnight chaplaincy committee meeting
Ø  Waiting bay prayers at 12.45 pm daily
Ø   Thursday intersession                                                                                                                                       

ACHIEVEMENTS ;  

The new year has started off well with God finding favour with us in the ministry. The workload has gone up due to increased number of patients because of striking doctors in government  institutions but we are not complaining. However many new souls have continued to come to the Lord and a number of physical healings have been identified .   
                                                                                                      
Ø  Ward preaching----------------48
Ø Bed to bed witnessing --------1750
Ø  Departmental prayers----------52
Ø  Counseling----------------------80
Ø  Bereaved prayers--------------18
Ø  Received salvation------------40
Ø  Bibles distributed--------------42
Ø  Waiting bay prayers-----------27
Ø  Thursdays prayers -------------5

CHALLENGES
New converts followups still remain a challenge but we are trying to link them to churches so they can grow. The manpower still remains few compared to the demands.


 Above; Chaplain praying with patients in the ward


Above: Eliphas encouraging a young man who was recovering from a very challenging situation


Above: Mrs Mugendi handing over a bible to a patient who has accepted Christ.


Above: Mr Mbae with studying the scripture with a patient who loved Jesus


Above: Chaplaincy team with donated items.


NB Last month Bibles distributed were 38 not 3 as indicated.
              May God continue to bless the good work to His glory


  Report compiled by
 Eliphas  Mutegi

 Secretary

Thursday, October 20, 2016

A family visiting Chogoria is featured in World Medical Mission's "On Call"

Back in June 2016, the Roskos family served in Chogoria through World Medical Mission.  WMM sent a journalism team to tell their story.  And in the fall-2016 edition of WMM's magazine, "On Call," we can read all about it!  Try the link below or past this into your browser to download the PDF:

https://www.samaritanspurse.org/medical/on-call-newsletter/

Latest edition of "On Call"

Saturday, September 24, 2016

Chogoria's Evangelist has stories to tell.

We are very proud of our Chaplaincy Department.  They are doing an amazing work at our hospital, working very hard to minister to the patients, families, and staff. On a typical workday, our hospital has about 160 inpatients, 400 outpatients, many visiting family members, and 400 staff members.  Our Chaplaincy Department is comprised of four people, and we also have an ordained minister as our Counselor.  (He also has a professional counseling degree).

Mbae Frederick Muguune is our Evangelist.  He has faithfully served at the hospital for 15 years.  He was born at Chogoria Hospital and was treated there as a boy.  This is a man who loves the Lord and serves Him well.

We knew that many would be interested in some of Mbae's stories of the Lord's work at our hospital.  So we hope you will take the time to watch the video of Mbae introducing himself and telling the story of a boy who needed some timely intervention.  Follow the youtube link:

Mbae introduction and The Boy Who Asked for Prayer



Monday, October 19, 2015

He had some unfinished work

Here's the story of a guy who got some extra time.

I usually participate in Medicine Ward Rounds on Saturdays when I'm in Chogoria.  This past Saturday, during rounds, we saw a patient sit up in bed, gasp for breath, then collapse.  When we hurried over to assess him, we found him to be pulseless.  Dr. Juliet started chest compressions and I hustled to my office and retrieved our only well-broken-in defibrillator.  When we attached the defibrillator pads, we saw ventricular fibrillation, which is a fatal heart rhythm.  We shocked him and saw a return to a more normal rhythm.  Not really normal, but not fatal.  His heart rate gradually increased and even became a ventricular tachycardia, nearly pulseless.  Juliet shocked him again and ultimately his rhythm became normal and his breathing resumed.

The man didn't wake up, though.   His primary illness was heart failure.  We had ultrasounded his heart a couple of days prior, and we were compressed with how poorly his heart was contracting.  Now, after being in a fatal rhythm, requiring CPR and two shocks, his already-underperforming heart was pretty beat up.  His pulse was barely palpable, and very little blood was going to his brain.  We ultrasounded his heart again, and it was barely squeezing.  At times, the squeeze didn't even produce enough pressure to open the aortic valve.   I honestly didn't expect him to last very long, even an hour or two, and strongly recommended that his family transfer him to a hospital with an ICU.  And, of course, we prayed.

Dr. Juliet after the successful defibrillations.

Today, two days later, during rounds, I was stunned to see him sitting up and talking lucidly!  Amazing!  He is eating and feeling better.  I do not speak his language, but with our nurse interpreting we tried to let him know that he had died two days ago and, by God's grace, we had been able to revive him.

Surely, this was a man who must have some unfinished work.  He collapsed during one of the few hours of the week when he would have been directly observed and we could have intervened.  The defibrillator is not often available.  People who are defibrillated do not often survive the "code."  And his heart is badly diseased.

Further, we left the defibrillator on the ward that night, which is not our usual practice.  And Juliet was called by the nurses later that night.  The nurses were performing chest compressions on him.  And Juliet defibrillated him again.

So during rounds today I called Chaplain Roy for a consult.  He came with Evangelist Mbae.  I explained the situation, and they engaged.  It turned out that our patient needed to reconcile with God.  So they all prayed.  Fervent, active prayer.

Evangelist Mbae and Chaplain Roy in action

Hopefully, our patient will live on and his family will be able to afford a transfer to an ICU.  But even if not, I think he has had the immeasurable gift of some days to reconcile with the King.

I am so grateful to work in this Mission hospital.  My intern colleagues are compassionate and learn skills quickly.  And my Chaplain colleagues are also compassionate and can engage in the Great Work freely.  How could it be better than that?

Sunday, July 12, 2015

The Story of Boaz

We came to Kenya to help start a Christian Family Medicine Program, so young East African doctors could take the Gospel and better medicine to their people.  We prayed (and many of you prayed) that the Lord would bring such young, motivated doctors here.  And we came without knowing whether the prospective residents would come.  And we have learned again that when the Lord is up to something, you can trust him with the personnel issues.

We recently went through the resident selection process.  I am most very glad to announce that Boaz Niyinyumvu is our first resident.  Here is his story.



My name is Boaz Niyinyumva.  I am 31 years old.  I am the fifth child in a family of seven, three girls and four boys.  All my sisters are married.  I am an uncle of seven children.  My youngest brothers are still in high school.  There is a difference of nine years between myself and my next youngest sibling.  They were not expected to come.  I was born in Bujumbura, the capital of Burundi, in a small city called Kanyosha.  I grew up in a Christian family with a normal middle-class life.  I grew up with a Christian education.  I loved going to school.  When I was 3-5, I was following the older kids going to school, and I wanted to go, but they would always bring me back.  I had to wait until I was 7 years old.  According to my mother, I was an active boy, running everywhere, and according to my mother I was smart, asking questions of the old people.  At 7 years I went to school and started primary school.  So, I had a Christian education and went to Sunday school.  I grew up with acknowledgement that there is a supreme God in heaven who cares about children but hates sin.  I was told about Satan, the enemy of God’s people.  I was taught that when you sin you go to hell, but if you don’t sin you inherit the Kingdom of God.   I grew up with that.  Also deep in my heart I felt a deep connection with God.  I grew up as a normal child. In my classes, I was always first or second or third.  I started serving God in Sunday school, participating in Sunday school choir, singing or doing outreach in the city to tell other children that God loved them, and inviting them to come to church. 
Physically, intellectually, I was good and my family was providing what I needed and I grew up with this knowledge.  I tried not to do evil and didn’t want to go to hell.
In 1991, I was 7 years old.  I remember that there was a small crisis in Burundi but it didn’t last long.  One night there was a rebel movement from DRC attacking Burundi.  They said it was a Hutu movement fighting against Tutsi government.  I was too young to know what was going on.   In 1993, war broke out in Burundi while I was starting fourth year of primary school.  That’s when things started to change in Burundi, my life, and my family.  There were democratic elections and a Hutu president was elected.  There was a coup in October which led to the death of that president by the military.  The president was Hutu and at that time the military was about 99% Tutsi.  So it became a war of Hutu against Tutsi.  They were revenging against Tutsi, and the Tutsi said they were defending themselves.  A Hutu would be killed here, and a Tutsi somewhere else.  Tutsi would attack Hutus in their cities, and they would attack back.  If a Hutu was living in a Tutsi city, he moved to a Hutu city.  Hutu and Tutsi neighborhoods were separated.  If you wanted to go to town and you were a Tutsi and had to pass through a Hutu area, you had to pray, and vice versa.  They hunted each other.  It started slowly and became worse.
In 1994, my father and other families decided to take us to DRC (Democratic Republic of Congo) in Uvira, in south Kivu.  Hutus and mixed Hutu and Tutsi went to Tanzania and Congo.  Because there was war in Rwanda, some went to Western countries.  We went to DRC with other Christians.  There life changed for me from a normal boy who loved school to a refugee boy who stopped studying.  As a refugee in DRC, you had no rights.  Soldiers from Congo would take you to prison and require money to be given them, though you had done nothing.  You had no right to run a business.  Many soldiers were not good, but were jealous of Burundians being helped by UN organizations.  So when we arrived in DRC, we were living like refugees but had money for a while and lived in a rented house.  After five months, our money had run out and we started struggling.  The government did something which led to the international community closing all borders.  None could come from Burundi, to pressure Burundi to stop killing.  No food could come to us.  My father had stayed in Burundi and had been sending us food.  Now no food could come.  We were isolated and had nothing and began struggling. I was not going to school and was 10 years old.  As a boy in Africa you have to make the family survive.  My brother and I started a small business of selling plastic in the market.  If we got money, we bought food for lunch.  In evening, if sold enough, we bought food for evening food.  At 6 PM, because there wasn’t much electricity, we sold evening petrol/oil for lamps.  We would call out “petrol” in the streets.  Whoever needed it would tell us to come.  If they learned that we were refugees they wouldn’t buy or would laugh at us.  Until nine we would go from road to road yelling “petrol.”  From that we made our family survive that period of isolation away from Burundi in DRC.  We were taken from the city and were isolated in a refugee camp.  It was 175 km from the city and 70 km from the road.  It was very far.  We lived there for months.  There were so many cases of diseases.   Diarrhea, salmonella.  People dying because we had little care and were far from the UN or MSF (Doctors Without Borders) doctors, who were not well equipped.  I saw a lot.  People dying.  I sympathized and wondered what I could do.  A voice came to me to do medicine so when I saw those things happening I could do something.  It was like a voice, like a wish.  Because life was hard, my family and others from the same city decided to go back to the city.  It was far, and we were forbidden by camp rules to go back.  We had to sell everything we had to get transport.  We sold blankets, tent, pans, to get money for family.  We left at night to sneak past guards, and when made it to the main road caught a bus back to the city. 
When we arrived in the city, we went to Bethany church.  We slept there and lived the same life, selling plastic and petrol.  In 1995, after a year in DRC, we came back to Burundi.  Things were worse in Burundi.  Our house was destroyed to the foundation.  They even removed the stones and took everything.  We went to live in another refugee camp in Burundi, and it was the same.  We saw a lot.  Those diseases, cholera, malaria, dysentery, malnourished people, eating only maize and beans and not enough.  There was so much killing that no one was cultivating and they were fully dependent on support.  I was moved again to go into medicine.
Because there was so much killing between Hutu and Tutsi there were two Hutu rebel movements fighting against the Tutsi government after the coup.  My father decided to take us back to DRC in 1996.  After five months, war broke out in DRC.  Rwanda was part of the war, as were Uganda and Burundi.  Rwandese said they were chasing Hutu movement and accused them of committing genocide.  When war broke out in DRC we had to flee from Uvira to another city by the lake called Mboko.  When those soldiers came, they killed every Hutu they met on the way, accusing the Hutus of committing genocide.  They invaded.  I saw many people killed.  If they found a person hiding in the bush, they burned the bush and killed the person. 
We decided then to come back to Burundi.  We thought, “If we have to die, let us die in Burundi.”  There were rumors saying that if you were a boy over 18, the soldiers would give you poisoned food that would kill you after six months.  So all Burundians were afraid of going back on the road.  Those soldiers had been killing many people.  Because we made a decision to go back to Burundi and our only way was by that road and the lake had been closed, we decided to do this:  Ladies would go by the road and boys would go by the lake, though it was forbidden.  The day came for us to leave.  My mother and sisters and other ladies packed their things to go by road.  My father and my brother went to the lake to look for a boat to take us at night.  Four hours later, I was at home alone.  A voice came to me and talked to me.  It said, “Go into the house and take your bag and follow your mother.”  Without hesitation I entered, took my bag, and followed the way my mother and sisters took.  I asked people if they had seen my mother.  I went until I reached a market with a big mango tree around 4PM, and I slept there near the road.  While sleeping I heard voices say “That’s Boaz.”  That was the group of Burundians including my mother.  They gave me a fabric to dress in so I would look like a girl.  So I went in the group of ladies and passed the station of soldiers without problem and reached Burundi.  The same day I left, my father and brothers died.  According to the witnesses, they went in 3 or 5 boats on the lakes and met the marines’ boat from Burundi.  The Burundi marines tied them and threw them in the lake.  They were unable to escape.  But that is how I survived.
We reached Burundi and lived in the camp again for two weeks.  The government and church sent people to take us from the camp.  We started struggling for life.  The head of our family was gone.   It was difficult to make ends meet.  My sisters stopped studying but went into small business.  Before my father died, he and some of his friends had made an agreement that if one of them died the others would take care of the families.  One of these friends came and told me and my sister we could go to school and he would provide school fees.  In 1996, I went back to school.  This friend of my father had a family with many children.  He helped us and paid school fees not only for us but also for his family of 5 or 6 children.  In afternoon I made money on a bicycle taxi.  I did that for 3-4 months.  One day I remember that I took a person from a Hutu area to Tutsi area late in the day.  He gave me a lot of money for that.  Once I arrived at a military post station.  They told me that if I had a problem I was on my own.  They took my money and my bike and they beat me.  They wanted to kill me, but the chief of the station came and ordered them to give me back my money and bike.  It was dark, around 7, and the chief told them to find me a place to sleep and bring me back alive in the morning.  They gave me food and a place to sleep.  They soldiers did those things and I was sent back home.  Saved again.
Life was not easy.  We had no money, and I asked myself how I would do medical studies.  But if God has a plan, no matter what, it will happen.  In those hard times of studying, I finished primary school with good grades.  At the end of primary school there is a test to determine whether the student can go to secondary school.  The test was very hard.  Many people struggled and had to re-do the test many times.  Two thirds of the 30 people in my class had already taken the test several times.  When I took the test, three of us succeeded on the test and I was the only one who had taken it the first time.  I got entered into secondary school with little school fees.  God did that.
I went to public school.  I succeeded in high school.  After 4th year, there was another national test to decide whether the student does science or technical studies.  I succeeded in the test and was given my choice.  I chose my school.
 When in high school, in second year, I gave my life to Jesus in a Bible study.  I had grown up fearing God and punishment.  But that year in 1998 in a Bible group, the preacher spoke of God reconciling himself with the world.  Jesus reconciled God to His people, as our creator.  That day, based on my experience, I told God I was his.  I saw God changing my life in many ways.  Because when I succeeded in that exam, my family and school were very far apart.  Two buses every day both ways, which I couldn’t afford.  How would I be going to that school?  I had an aunt who lived near that school but in a Muslim family.  It was hard for me to leave my home and live in that family where there were 19 children from one man and three wives.  It was hard for me to go there but I went there and lived with them, which was difficult to do physically, mentally, spiritually.  Very hard.
After the 4th year of high school, my pastor’s son asked me, “How do you live in a Muslim family?”  The pastor’s son was little, maybe 12 years old.  He went back to the family and told them about me, and that I was involved in kids’ ministry.  He went and asked his family if they could let me live with them. The whole family accepted and in my fifth year, my pastor came and asked me, “Would you mind if you would leave where you are now and live with us?”  I said I would ask my mother.  My mother said to ask my current host. I did, and he didn’t mind.  So I was taken from the Muslim quarter to the highest quarter of the city, calm and distinguished.  In the Muslim quarter, I lived in a room with 5 or 6.  But there, I got my own room.  Life went on changing.  I had been going to school on foot, but in my new home I was taken in a car.  At 1 PM I was being picked up. They really did a great job with me and took good care of me. A sudden change.  I studied and finished secondary school.  Then I took the test that determines your future.  If you do not pass it you are done with school.  If you do well, you have a chance of doing university, for me medicine. 
I was the second person at my school to succeed on that test.  They gave us forms to fill for what we wanted to take.  We had three choices.  I put first and second choices medicine, third choice low.  The first person also had asked for medicine.  But she was not given medicine.  She had higher marks than me.  But I was given medicine.  God did that, too.  I had to wait one year because we were so many students waiting for university and there were many strikes.  During that year of waiting I was deeply involved in VBS with children, working with Korean missionaries.  One day after a session, a Korean missionary asked me about my studies.  I told him what was going on.  He asked how many universities we had.  I told him which I wanted.  He said they would be paying it for me.  So my medical training was covered!  But on the third year those missionaries had to go back, so that was a problem.  How would I get fees to finish my training?
I was class representative for the first years of medical school.  We were having difficulty finding a teacher for genetics.  An American came to teach it.  During class he stopped class and asked me if he could pray for me.  In my heart I hesitated because everyone would know I had a problem.  I wanted to refuse, but a voice told me “Why refuse?”  So I allowed.  He prayed for me.  After praying, he said, “God told me to help you.  How can I help you?”  I told him.  He said, “From now until you finish your medicine I will take over.  I will give you medicine, pocket money, and will be helping your family.”  At the same time, my pastor’s wife whom I consider as my other mother introduced my biological mother to a Christian NGO called SISTER CONECTION helping widows. So my mother was receiving financial support from the NGO which made my life comfortable.  I had not been able to help my family much.  My church at high level also joined in my education.  So I was favored by God in many ways.   
Thank you God; you have your ways.  I never had a problem with school fees when I was at school.   God made it possible what He told me in refugee camp.  He helped me in all those tests when I was in difficult moments.  When I ever had a problem He brought a solution to the problem.  He made it possible for me to do medicine, even with solutions to every problem.  When I was doing medical studies in internship, we had to go up-country.  When up there, I met these people living in bad conditions.  Very poor.  Could not afford the least medical care, even paracetamol, less than a cent.  They could not pay for a blood smear.  My heart went to them.  God told me, “This is where I want you to be, to walk with these people.”  I felt I was part of them, it was part of me.  I made a decision that’s where I belong.  When I finished I went in January with a mission team in DRC.  Where we went, we went to serve very poor people who cannot afford treatment of malaria, which was almost free.  It was a calling for me.  “This is what I want you to do.”  This is the kind of place where things happen.  Because I have lived in those conditions, I feel that I can do more.  I left DRC with the heart of being a medical missionary.  My background, internship, first visit as medical doctor were directing me where and what to do.  I had a dream to do pediatrics.  I love kids.  So I wanted to be a pediatrician to do congenital heart defects.  Maybe a pediatric cardiac surgeon.  But God was directing me differently.  The first Sunday back home in Burundi from DRC, I met a pastor from here in Kenya.  They had a Christian NGO establishing contact with Burundian evangelical colleges.  He spoke English and my pastor had told me to interpret for this pastor.  I interpreted for him when he was preaching.  Afterwards I said “Thank you for the sermon but my pastor asked me to stay with you for a short moment of his absence.”  During that time, the visiting pastor wanted to know about me and I gave him a brief part of my story - I told him who I was.  He asked if I wanted to do more studies.  I said “Of course.”  He asked if I could come tomorrow for an introduction.  Next Monday I went to his hotel.  I met Ted Burnett.  He said he also wanted to know about me.  We talked and he told me that his father was one of the doctors who started one of the missions hospitals here.  I don’t remember which.  So I gave my email.  Two weeks after, I got an email from Bruce Dahlman telling me he got my email and asking if I was interested in Family Medicine.  He gave me the name of someone who could help me understand.  He gave me the email of a doctor in Burundi who was one of my teachers.  Eric gave me a brief view of Family Medicine and what it is.  I read about it and it was just who I am supposed to be and where I am supposed to go.  It was like an answer.  “This is what you have to be to go where you have to go.”  And considering the mystery of how it came to be known to me is part of the answer.  It is not chance.  It is not just something that happens. “It is me sending to you.”  So I applied.  When I applied, I had only just worked for two months after medical school.  I spoke of that to other people we were with in Congo and they decided to support me through the program.  That family of American medical missionaries was ready to assist me.  God has made it all possible.  And here I am.

THIS IS MY SHORT STORY OF MY LONG LIFE.