Dr. Jennifer Harling, a pediatrician and medical missionary in Burundi, shares her experiences and challenges in providing healthcare in a low-resource setting. She discusses the decision to do medical mission work, the background of Burundi and the hospital where she works, the language and cultural challenges she faced, and the improvements she has made in neonatal care. Dr. Harling also talks about staying inspired and connected, her role in medical education, and the importance of finding a balance between work and personal life.  In this conversation, Jennifer shares her experience of working as a physician in a low-income country and the challenges of balancing work and family. She emphasizes the importance of prioritizing what is important for each season of life and not sacrificing personal well-being and family for work. Jennifer also discusses the need for longevity and sustainability in this type of work and the importance of finding a balance to avoid burnout.

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Short Bio: Jennifer Harling is a medical missionary serving in Burundi in Eastern Central Africa. She grew up in Georgia and attended the University of Georgia for undergraduate studies, Mercer University School of Medicine for medical school, and Greenville Memorial, now Prisma, for pediatrics residency.  She met her husband, Michael, in 2012 during their intern year in Greenville, and seven months later were married and now are a family of five.  Jennifer and Michael  started working at Kibuye Hope Hospital in January 2020 and have been there since.  Jennifer serves as the head of pediatrics at Kibuye Hope Hospital which includes general pediatrics, inpatient malnutrition, and neonatal services. She is also in charge of the neonatal unit and has become very passionate about neonatal care in the past few years. When she has free time, she can be found working in the garden, tending to her chickens, or making mozzarella cheese. 

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The transcript of today's episode can be found below 👇

Shelly-Ann Dakarai (00:01.38)

Well, hello everyone. Welcome back to another episode of the Global Needed, a podcast. I'm Bozu. How are you today?

Mbozu Sipalo (00:08.896)

Good, how are you?

Shelly-Ann Dakarai (00:10.78)

Doing great, a little cold, but doing good. So today we are excited to have Dr. Jennifer Harling as our guest today. Dr. Jennifer Harling is a pediatrician and a medical missionary serving in Burundi in Eastern Central Africa. Dr. Harling and her husband Michael have been working at the Kebuye Hope Hospital since January, 2020. Dr. Harling serves as the head of pediatrics at Kebuye Hope Hospital.

which includes general pediatrics, inpatient malnutrition, and neonatal services. She is also in charge of the neonatal unit and has become very passionate about neonatal care over the past few years. Jen, welcome to the podcast.

Jennifer (00:58.69)

Thank you so much. It is such a pleasure to be here. I am honored to be able to talk with you ladies today. And I've been really excited about this.

Shelly-Ann Dakarai (01:08.42)

Yes, we have been excited as well. So I just want to jump right in. You are originally from the US, and you and your husband moved to Burundi to work in the Caboo Yay Hospital in 2020. And I know you had three young kids. I think they might have been four, two, and three months old. Tell us a little bit about what made you decide that you wanted to do medical mission work.

Jennifer (01:28.078)

That's right.

Jennifer (01:32.934)

Oh, I'll try to make this story short. But I did a lot of short term medical mission trips growing up and in high school and college and med school. And then my intern year of a residency in Greenville, I met Michael, my husband now, and we started dating. And on our second date, he said, well, I feel called to be a surgeon. He was in surgical training at that point.

surgical, I feel called to be a medical missionary as a surgeon in Africa. And so if you don't think that's something you could do, we should probably break up. So I told him, let me pray about that and I'll get back to you. And you know, here we are. Ten years later, we've been married ten years. We have three children. How we got to Burundi, we were originally gonna go to Cameroon in 2018.

but there was some civil violence unrest there, so we were told we couldn't go there. We went to language school and then, you know, by providence heard about Kibuye Hope Hospital and we moved to Kibuye in 2020 and have been here since.

Shelly-Ann Dakarai (02:52.677)

Okay, so for those who are not really that familiar with Burundi, can you tell us a little bit about the country and then specifically where you guys are?

Jennifer (03:01.678)

Sure, Burundi is a tiny country. It's about the size of upstate South Carolina, and it's got 12 million people in it, which makes it one of the most highly dense populated countries in the world. It unfortunately is also one of the poorest countries in the world and has one of the highest hunger index indices. It is located right below Rwanda.

and all of the conflicts that you hear about that happened in Rwanda also affect this country as well. And so anything that you hear about conflicts there, they're similar here. It just hasn't been as publicized. Where we are, we are in the interior or the rural part of the country. We, I would say we serve, you know, the southern part of the country, but we actually have people coming even from Tanzania.

borders us on the east side because they hear of the good quality of care that we give at our hospital. We have right now about 10 missionary doctors who work at our hospital, all expats from the United States, and we cover most of the general specialties, OB, surgery, internal medicine, and pediatrics. And yeah, our hospital is about a 350-bed hospital.

Yeah, I'll stop there and see if you have more specific questions about that.

Shelly-Ann Dakarai (04:37.748)

So how long has that hospital been there? Is it a governmental run hospital or is it a missionary run hospital?

Jennifer (04:49.854)

Yeah, it's been here, oh, many, many years. I wanna say back to the 60s. I'm not 100% sure about that. It is a missionary hospital started by the Free Methodist Church. And it was mostly Free Methodists. There's missionary and then, you know, along the time there've been not many doctors here. And then in the 90s.

And during times of crisis, it would drop down to either one or zero doctors. And then our team who came, they came in 2013, a group of six doctors and their families, and they chose Burundi because they not only wanted to come serve, but they wanted to come and teach and train up people so that it would have kind of a rippling effect. And so,

About 10 years ago, there was no water, no running water in the hospital. There was on and off electricity. And when the previous head of pediatrics, who now still works here, she's still my colleague. She has another administrative job in the hospital as well. But she, when she arrived here, the preemie babies were put into cardboard boxes in a room. And so.

All that to say, over the past 10 years, things have really changed. We now have reliable electricity, thanks to solar power. There's a company called iTech who helps out with that a lot. We have running water, thanks to our amazing team of engineers, one of which is a expat missionary, and he's on our team still, and he did a lot of water engineering, so we have wells and purification.

And that's kind of the general idea of how this kind of unique group of ex-pec doctors came to all be located in this very rural, very poor, very underserved pocket of Burundi.

Shelly-Ann Dakarai (07:09.704)

Okay. Um, Boz, it looked like you had a question.

Mbozu Sipalo (07:18.359)

I guess I did have a question linked to your involvement in Kibuye, the actual hospital. How is it that out of all the hospitals in Burundi, that's the hospital that expert community decided to base at?

Jennifer (07:41.966)

That's a good question. Originally they were speaking to Hope Africa University. I don't know how they ended up having a contact at that university, but it's the university based in the capital. And Kabouye was one of the primary, or one of the teaching hospitals, is now the primary teaching hospital for the university. So that's how they got hooked up. They initially spoke with

somebody at Hope Africa University and told them about this hospital. But yeah, I think the model we're talking about missionary, it is a missions hospital, but I think you can have different types of missions hospitals. Ours is still pretty much completely Burundian run. The administration consists of all Burundians except for my colleague Alyssa, who is in the-

the assistant medical director role, and that is held by a missionary. But other than that, we do not have administrative roles. We basically come in as a support for the hospital and the university to be providers, but also to be educators for their medical students who come through the hospital, which, you know, comes with definite struggles you're working in across cultural environment.

all the time, cross-lingual, you know, we're speaking different languages, we're all speaking second languages. I mean, Kirundi is the, you know, the first language here for most. And then everyone is speaking their second language, which is French. And so that can bring some difficulties, but I really do like that, you know, if something terrible were to happen and we had to go or something like that, I don't think the hospital would crumble.

which is really reassuring. We don't plan to leave. Let me make that clear. I just think that puts the hospital in a really unique and really sturdy position.

Shelly-Ann Dakarai (09:53.028)

Yeah, that's pretty great that there is local administration and local oversight and that you guys are in a supportive role. So I think that's pretty amazing that, and I like that model that they set up. So you talked a little bit about everybody speaking a different language. So...

Did you know how to speak French before you went there? What was that like for you now having to live and work in some language that's not your native tongue?

Jennifer (10:28.318)

Right, no, I did not speak any French before knowing that we were going to come to Burundi. So after we realized that Cameroon was not going to be an option, we lived in a town outside of Paris for 10 months specifically to do language school. And so it was 10 months of intensive, you know, eight to five-ish, eight to three-ish.

school where we just went and learned French, which honestly was so nice that Michael and I were kind of like laughing in the first couple months of language school. Like we all we have to do is learn a different language. Like that's it. Like nothing else because we had both just gotten out of residency. And so it was kind of a breath of fresh air just to sit and learn use a totally different part of our brains and learn French. So yeah.

Shelly-Ann Dakarai (11:26.084)

Wow, so quite an experience. And I take it your children are now bilingual as well, correct?

Jennifer (11:34.154)

Oh, I wish. Amelia, our oldest at the time, well, our oldest, at the time she was two and three, and she has a beautiful accent, and she was fluent when we lived there. Madeline was about eight months, and then ranged to 18 months when we left. And she also has a good accent and is learning French really quickly and really easily. And then Mark was in my belly, so.

Shelly-Ann Dakarai (11:35.848)

Okay.

Shelly-Ann Dakarai (11:58.64)

Okay.

Mbozu Sipalo (12:00.363)

Just linked to the French speaking topic. Why did you decide to move to a French speaking country in Africa as US doctors? Was that an intentional move or, um, yeah, what was the thought process behind moving to a French speaking? Cause you mentioned Burundi or Cameroon and it sounds very intentional.

Jennifer (12:24.69)

Initially when we were moving to Cameroon we were going to go to Mbingo Hospital, which is in the English speaking part of the country. So we originally did not plan to learn a language. When we realized that Cameroon wasn't an option, we knew we wanted to go somewhere in Africa, and a lot of the other hospitals we were considering spoke French.

And so that's what led us to go to language school. Bingo Hospital, we were gonna join another group of physicians and go there as a team as well. But the team chose this hospital, before we became a part of it because they truly wanted to go, they had a cohort who wanted to go together somewhere and they thought it would be a unique.

it is quite a unique thing to have, you know, six doctors and in total is like 10 people who want to move to one location and help and serve. And so they saw that as an opportunity to move to maybe a more difficult place, you could argue, or a place that maybe not a single doctor would move to because, you know, to live and work here,

I will just say I'm thankful for my community of friends and coworkers, you know, that I can, who can rally around me when things are going, when things are very difficult. Whereas if I were a standalone doctor, it would be, I think, difficult to work here. And so that was their goal, is to find somewhere that's extremely impoverished and extremely underserved.

and in a place where they could teach. So they were definitely looking for a teaching hospital.

Shelly-Ann Dakarai (14:26.46)

Right, right. You know, when I read the story of how that your team started, it was a group of physicians who chose to go together. And I never really thought of that, but that does make a huge difference. If you can go as a team, you're able to do a lot more, a lot faster, and you might be able to deal with, as you said, some of the challenges a little bit better than if you're a solo doc going in and then getting to know, you know...

the new culture and then also trying to do the healthcare and also trying to do the teaching. So yeah. So you know, we talked a little bit about like your start in what got you to Burundi. Can we switch gears and now talk about now that you're here, you're there, you just moved, you have little kids, you and your husband and you're about to start working. What was that experience like for you? What was the hospital like? What was neonatal care like?

when you got there in 2020.

Jennifer (15:26.75)

When I got there in 2020, like I said, Alyssa, my colleague Alyssa Feaster, she's a med Pete's doc who focuses on beads mostly, she had developed a neonatal unit with about 20 mom baby beds. And so the mom would sleep on the bed and then there would be a box, a wood box at the end for an incubator with

little, I don't know what else they call, well, they're incandescent lights, but it's almost like a reptile thing with a thermometer and it keeps the box warm. And so that's what the new nail unit, we had one warmer at that point. We had one or two ports for oxygen and if we needed more, we'd have to bring in, generate little mobile generator, oxygen concentrators.

So that's kind of what the neonatal unit looked like. It was she and I as pediatric providers. We have generalists, Brundi and generalists, who kind of come and go. There was no one who was like actively working on our pediatrics, in our pediatrics department. So that's kind of what it looked like. And interestingly, when I showed up in 2020,

another family physician who's here, Dr. Logan Banks. He was taking, he had taken the role of head of pediatrics while this was gone. And he, because of COVID and they were about to go on home assignment anyway, they left early, reasonably so, because the borders were shut down shortly after that. And so I became head of pediatrics four months into working in Sub-Saharan Africa.

And so that was terrifying and I just, yeah, I learned a lot. I feel like I grew a lot spiritually, emotionally. And you know, the first six months, I, well, I would say the first two weeks of working in our hospital, I saw more death than I did in residency. And that was probably, that was the hardest thing. It is still the hardest thing.

Jennifer (17:51.258)

of the job here. And I would come home and just cry a lot. And I still do cry a lot because of the utter, you know, just sadness that I see every day because of lack of resources or lack, you know, lack of maternal knowledge to take folic acid or lack of...

nurses being adequately trained to know how to resuscitate babies or to deliver babies so they don't have as much asphyxia and I'm not bashing our nurses it's just the it's this you know it's kind of a trickle down effect where

Jennifer (18:33.89)

that the training, maybe they did get trained, but there's no continuing education and no continual re-upping your skills. And so I really, during that first year, I was like, what is wrong with me? Like, I cannot continue like this. I cannot come home and like emotionally just like lose it every week. And so I really had to start diving into

like why I was feeling this way. And I read a lot about secondary trauma and secondary traumatic stress and just realizing that I am really being affected reasonably so by all of these really bad and terrible things that I'm seeing. And so I just started to have to realize how to cope with grief and how to...

process grief. And I really had to do that within like in the first year because I realized I was not going to be able to go on. And there's some great quotes that I have started to write down and I read I go back and read from time to time. I'll read one of them. This is from a grace disguised by a man who lost his wife and children in a car accident but

He said, they learned that tragedy can increase the soul's capacity for darkness and light, for pleasure as well as for pain, for hope as well as for deduction. The soul contains a capacity to know and love God to become virtuous, to learn truth and to live by moral conviction. The soul is elastic like a balloon, it can grow larger through suffering.

can enlarge its capacity for anger, depression, despair, and anguish, all natural and legitimate emotions whenever we experience loss. Once enlarged, the soul is also capable of experiencing greater joy, strength, peace, and love. What we consider opposites, east and west, night and light, sorrow and joy, weakness and strength, anger and love, despair and hope, death and life, are no more mutually exclusive than winter and sunlight.

Jennifer (20:52.214)

the soul has the capacity to experience these opposites even at the same time. And so I had to learn that I could experience, I could, personally, I am not experiencing death of a child, but I am watching mothers experience death of a child, and I'm watching as I do not have the capacity or the equipment to save babies, mostly. And so I had to just really...

figure out how to hold on, hold on to the tension of loss and joy at the same time. Like I could not just say, okay, this was a terrible day. So I'm gonna be very sad the rest of the day. I like, this is very sad and I'm thankful I have this job. And I really had to learn how to process grief and keep going because, I'm sorry, I can't keep going like this. And so I'm not sure if that's the direction you wanted.

that question to go, but that's really something I had to do pretty immediately off of that.

Shelly-Ann Dakarai (21:58.232)

No, thank you so much for being vulnerable and sharing with us your experience. No, so no, thank you so much. I remember I'm originally from the Eastern Caribbean, but I had done medical school in a US-type setting and trained there, but then chose to go back and serve in my country for a couple years before moving back to do residency. And I do remember that first day that I went to the hospital.

I went home and cried. And because you deal with the tension of knowing what could be and dealing with what you have in front of you and the unfairness of that some days is a lot to deal with. When, you know, none of us really choose where we are born and struggling through that. So I appreciate you sharing your journey with us.

So you talked about, you know, having to deal with that secondary trauma, but still get up every day and go to work. So tell us a little bit about some of those changes that you were able to make from a medical standpoint and what inspired you to make some of those changes.

Jennifer (23:14.538)

Yeah, thanks. The, I think the thing that inspired me to make those changes is that one, I was seeing a lot of death in the neonatal unit. And we do see death in pediatrics and malnutrition as well. But the majority was in the neonatal unit. And I started to look into, you know, developmental help, you know, goals by the UN and sustainable health developmental goals and.

it looked like everything was coming down except for neonatal mortality. And so I was like, well, I'm in a low-income country and I have the ability kind of to maybe make an impact here. And so I just started trying to think through things that I could change in a safe and appropriate way. I mean, some of the tiniest thing, well.

It sounds tiny, but it actually is a lot of work. I created a nasal cannula cleaning system for our unit, mostly, you know, Peds and Neonatology, where beforehand, the nasal cannulas would get reused, but they wouldn't really get washed in between. So they would just come get thrown to the side and then maybe wiped or maybe not, but.

developed like a bucket system with disinfectant. I read a lot of stuff by WHO and how to disinfect like, the WHO was like, we don't recommend doing this, but if you have to, I'm like, thank you for acknowledging that sometimes countries have to do that or places have to do that. So, I developed like a cleaning system and that was my big project. Took about a year to get into place. It's funny, I was listening to a podcast by Dr. Anne Hansen.

I don't know if you know her, but she developed the Dream Warmer fascinating product. You should look into it. But she's like, yeah in our NICU, I think she's at Boston Children's. She's like, yeah, we do a quality improvement, you know, about once a month. I think that's what she said. Like once a month, that's amazing. It takes me about a year to implement a quality improvement project. But anyways, that took some time. And then after that, I started focusing more on neonatal care. I realized that all the babies in our

Jennifer (25:30.198)

hospital born that are healthy or not, we're not getting hats after birth. I was like, why is that? And no one was providing hats. So I developed a system where we have local women, actually have one sitting right here. We have local women make these hats, and I pay for them by some of our donor money. And so it creates jobs for local women, and it gives hats to every baby born in our hospital. So that was.

one of my projects. That's also part of a thermoregulation project I have going on with a student for a thesis project. I want there to be a better thermoregulation bundle because we all know that during the first, it's really important to get that baby warmed back up after birth. So as it stands, they weren't getting hats, now they are. And they're putting the babies on the chest, but then they're moving them directly to the warmer, which does not work. So I'm hoping to get them.

skin to skin for at least an hour after birth, putting a warm something over them. And so that's gonna be one of my, another project I have. I am writing a neonatal manual in French so that we can use that at the hospital to highlight some of the protocols that we've had in place for a while, but also I wrote a new feeding protocol based on some new evidence about using

formula, preterm formula for fortifying milk, which was, there was a non-inferiority trial in JAMA and there's other hospitals that are doing it even in Tanzania, so I am implementing that in ours, which is showing really neat results already. I haven't done this yet, but I wanna get in a better rhythm of teaching helping babies breathe. We kind of just do it twice a year now. I really wanna get into a habit of doing helping babies breathe more often.

and really just improving our protocols for the neonatal unit in general. That's a very generalized statement I realize, but like for jaundice, right now we don't have the best way to test bilirubin. The lab comes back normal sometimes when the baby's orange, and so I'm looking into getting a transcutaneous bili monitor. There's a really neat product coming out, maybe.

Jennifer (28:00.058)

called Picturus. It's where you use a card and you put it on the baby's skin, use your smartphone. So that's in trial periods right now. They validated it for white skin but not for black skin yet, so waiting for that to get validated and maybe we could use that. Those are just a few of my things.

Shelly-Ann Dakarai (28:24.744)

So thanks so much. That's quite a lot of improvement efforts that you are taking on. Like you said, some hospitals do one a month, but they have entire teams that are dedicated to this. And so that's impressive what you guys are trying to do. And I think it highlights a lot of things that are taken for granted in units that are well established. And many of it.

folks who listen to this podcast are either going to be, some are going to be in low resource settings and some are going to be in what we call higher resource settings. And so in some situations, you don't even think about what happens to the nasal cannula. You just say, oh, put the baby on remare. And that's all that you need to do. But in some places you have to learn to clean that and things like that. So those are all pretty great initiatives. How do you keep...

Jennifer (29:06.424)

Right.

Shelly-Ann Dakarai (29:17.556)

inspired in terms of, you know, staying connected and knowing that you, like you said, you wanted to do some of these changes, but there's still a lot going on that you have to do. You have the PED side of things, you have the neonatal side of things, and just general administrative things. How do you keep inspired? How do you, you know, what to keep going on and how do you stay connected to the medical community?

Jennifer (29:43.882)

Oh, I think those are probably two different questions. How do I stay, how do I keep going, I guess is one of those, and how do I keep moving forward? I do realize this is not a faith-based podcast, but I can't ignore the fact that my faith is really what keeps me going. And then the side of the medical community, before a couple of years ago,

Shelly-Ann Dakarai (29:55.288)

Yes, yes.

Jennifer (30:13.846)

I didn't really, I would really just read a lot of, I was really just trying to learn medicine that applies to my setting. How to treat malaria, how to treat typhoid, how do you diagnose tuberculosis in a child and things like that. So I was reading a lot of medical literature about.

things that I was seeing. And then after I felt like I kind of had that under my belt, I'm no expert by any means, but I feel like I know how to treat malaria now. And I know how to recognize signs of typhoid and et cetera. And then I really started to focus on neonatology. I'm like, well, I'm not a neonatologist. I don't feel adequate. I don't feel adequate in a lot of things in my life. I don't feel adequate to be practicing medicine in a low...

resource setting or treating malaria or things like that. But the Lord sustains me, so I keep going. And so I was like, well, I really don't feel adequate to do neonatal medicine. But at the end of the day, there are four aspects of neonatal medicine. Thermoregulation, respiratory, alimentation, and avoid infection. Like, well, okay, I can try to do this. Thanks.

But I did want to learn, I wanted to do it right. I didn't want to just be like, okay, well let's try these things. So first I started trying to read a lot of neonatal literature, textbooks, like how do you treat bronchopulmonary dysplasia if you don't have a surfactant or ventilator. Okay, well CPAP, okay, well we don't have any of the tools. Well, should I try to do, you know, low income setting CPAP with like a water bottle? I was like, I just.

I think I can eventually get the right tools. So let's just hold the phone on that and focus on feeding. Well, okay, we have what we have. We have what we need for feeding. We have NG tubes, we have moms, and we have breast milk. So let's revamp that. I went to a neonatal conference in Tanzania and I learned a lot about feeding protocols. It's like, well, I can, for now, use some money and buy formula to fortify milk. So.

Jennifer (32:26.09)

That was a relatively easy thing. It's not sustainable. Why? Because I'm paying for the formula. And so that is something that I have to mentally remember and look for a solution in the future. But you're not using a ton of formula. You're just adding tiny, tiny bits to the milk. And so that's kind of what I was focusing on, like how to.

do neonatal medicine. And I really felt alone in the beginning, which is I'm hopeful this podcast will help people start to kind of make a network to where like, oh, how did you deal with that? Oh, I did this and it worked out where I did this and it didn't work. So don't try that. And so, but then I went to this conference in Tanzania. So where I met a ton of people who are doing the same thing, and it was really helpful to learn what others have tried.

And so I worked on the feeding protocol first, and then I really, this year, worked focusing on CPAP, bubble CPAP. We will never, I don't wanna say never, I do not foresee us having ventilators in the foreseeable future. It's too expensive, patients can't afford it. When you're doing medicine in this type of setting, there is, what if, see if I can remember it, affordability.

quality and sustainability. And you cannot have all three at once. You have to pick two. So you can have affordability for the poor and you can have sustainability, but you cannot have, you know, US standard of care. You can have, you know, you can think about it in multiple different ways. But so for our situation, could the missionaries pull together and buy a ventilator?

could we ask donors to buy a ventilator? Absolutely. But one, who gets that one ventilator? Two, who runs the ventilator? We don't have respiratory therapists. Three, who trains the person to run the ventilator? Four, who cleans the supplies? Because we don't, you know, consumables are very difficult to get, you know. There's just so many things that you don't think about. I would say for anyone working in the States, just go around and thank your ancillary staff.

Jennifer (34:49.506)

for me. Just say I'm thankful you're here. I'm thankful you have a job. I'm thankful you do whatever you do to support our NICU. Like your job does not go unnoticed because oh my word, I would love to have a respiratory therapist, you know, just to teach my nurses how CPAP works. I mean, I'm, you know, I'm trying to teach them how it works and I'm trying to make videos on how it works and, but I can't be there every moment and every day. And so, yeah.

I don't know, I feel like I'm rambling a lot, but all that to say, the NICU, the Incubator podcast, I listened to that a lot. And at first I was like, I don't know if they're gonna be talking a lot about, about what I need to hear, but that's how I found one podcast by a gal who, what was her name? Katherine Horan, who had done Doctors Without Borders and some of the stuff that she said, I really resonated with.

oh man yeah and so I was really appreciative for that podcast and Dr. Anne Hansen was on there and it just seemed like and I met Anne at this conference in Tanzania so it's just like I was just giving get receiving these little gifts like you're not alone and there's other people that are interested in this and there's other people who have experienced the exact same things that you're experiencing.

And so I'm thrilled about this podcast and I am thankful. And then, you know, I'm not gonna take neonatal boards, but you know, the incubator has these board review questions and I am just kind of trying to figure out how I can learn neonatology, what I need to know to give the best care to our little babies.

Mbozu Sipalo (36:43.598)

Can I just chime in and say amazing work you're doing as someone who worked in a low middle income country and I'm a low middle income country working doctor. I understand the complication and the frustration and just how difficult it can be to get things going in a low resource

Jennifer (36:54.388)

Yeah, thanks.

Mbozu Sipalo (37:08.058)

What is the neonatal space like in Burundi? Are there any neonatologists there? And as someone who is a pediatrician working in the neonatal space, how is the government supporting you? Or what kind of support are you getting in country whilst you're establishing these neonatal wards in such a rural setting in Burundi?

Jennifer (37:36.014)

Well, thanks for the encouragement. Really appreciate that. The neonatal space, there is, that I know of, one part-time Italian neonatologist who works at a hospital way in the north part of the country in Ngozi. And because we are a missionary hospital, I don't know if the government knows what we are doing.

not like we're hiding it and not like they're not interested. It's just like, I can't just call up the minister of health and tell them, hey, I'm really working really hard on this neonatal unit. Especially because I'm not Burundian. It's, you know, they say every year that you live in a country, you learn like 1% of their culture. So I know about 4% of Burundian culture. So I, you know, I probably could work really hard to try to get in touch with.

people in the government, I just haven't gotten there yet. Secondly, the neonatal unit up in Gozi, she told me that Nest was starting to talk to them. And that is about the extent of it that I know of. She goes back and forth to Italy a lot. And so that is that space. Is that what you were asking? Are you wondering what our neonatal unit looks now? Because it does look different.

We do have a new building. I'll just go there. So we, in 2020 to 2021, Alyssa, my colleague, and many others on our team raised money. We have a lot of US donors who built a beautiful three-story pediatrics building. We have the largest building in the hospital. We also have the highest number of patients a lot of the time. And so we have a Peds floor, a malnutrition floor, and a neonatal floor. I like to spend my time upstairs.

I still love all the other patients and I ran on them multiple times the week. So anyway, the neonatal unit now has about 40 beds and we still have the mother baby beds. I'm working on getting the beds to where they they're metal. I'm working to where they can get inclined a little bit so the moms can do kangaroo care better. Our incubators are good. They're not great and they can overheat or underheat the babies so I'm really pushing for.

Jennifer (40:02.046)

more kangaroo care. And so we have a nursing station. We have oxygen for every bed. And so, praise the Lord, that's such a huge gift. And so we don't have to be figuring out one who does and doesn't get oxygen, and two, like we don't have to move babies around a lot. We have some phototherapy units, and my husband, even though he's a surgeon, also does a lot of biomedical engineering, and he and one of the other engineers are working on

how to do better phototherapy lights for our little incubators that we have. Yeah, and we just started doing bubble seat pap. So we're working on figuring out how to put the bottles so they don't tip over and things like that. So that's kind of what our unit looks like. We have two radiant warmers where we welcome babies. And so, yeah, it's kind of what it looks like physically. And then what neonatology looks like. There's no neonatal society, I think.

they might be working on developing a Burundian neonatal society. There is a pediatric society. I think there are about 20 something pediatricians for 12 million people. And there are actually 6 million under 18 year olds in the country. So the age pyramid goes like this as many low and income countries have, you know, they're very young country. And so I think it's about one.

I can look it up, I just did a PowerPoint about this. It was like in the U.S., or in Georgia, I did Georgia, because I was born in Georgia. In Georgia, there are like one pediatrician for 1,500 kids. That's a lot, but, and then in Burundi, there's one pediatrician for 240,000 children. So all that to say. That is, hopefully answers your question.

Mbozu Sipalo (42:00.378)

Yes, it has. Thank you.

Shelly-Ann Dakarai (42:04.609)

Yeah. You highlighted a lot of things there when you were talking in terms of the number of patients per provider. And in a lot of countries, the pediatrician is the specialist physician. And many neonates, the majority of neonates, are not necessarily cared for by neonatologists. So that just kind of highlights how things are different in different places. So you know.

Jen, you're doing great work. Don't sell yourself short on your specialist position caring for neonates and doing an amazing job. And then the other quick thing I wanted to highlight from what you were talking about is that sense of not feeling alone and just knowing that someone else is doing something similar. And like you said, this is the goal of these podcasts, especially this global neonatal podcast, is to really show, to talk to folks who are living it, doing it every day so that it might inspire someone else.

Jennifer (42:34.55)

Thank you.

Shelly-Ann Dakarai (42:59.456)

So this is great and just the connection is what keeps everyone going on those tough days. Yeah. So we talked a little bit about the unit. I just wanted to ask a quick question about those incubators. Are those wooden incubators that you guys built or is it incubators that you brought in?

Jennifer (43:22.622)

they are built in-house. It was an idea, I believe, from Tenwick Hospital that was originally, who originally used this idea and are one of our, one of our surgeons is brothers with the, one of our engineers and so I believe it was them, them two who kind of got together, improved it a little bit and then our carpenters and folks.

developed the design for the incubator. We had to import the thermostats, so that did have to be imported. Those are not local materials, but other than that everything is locally sourced and locally made.

Shelly-Ann Dakarai (44:10.364)

Okay, that's again pretty impressive. So we talked about, you know, how you got to Perundi. We talked a lot about the neonatal care and the services that were there and what you've done to change things. I just want to talk a little bit about the medical training now that we're kind of getting close to wrapping up. Tell us a little bit about your role with medical students and the medical school there.

Jennifer (44:37.73)

Good question. We are, like I said, the primary teaching hospital for Hope, Africa University, which is a Christian university in Pugetboro, the capital. But all the students come up here to do all of their

clinical learning and clinical rotations. So, Burundian medical schools are different than American medical schools. You do not have to do, you don't do undergrad and then med school. You do a six year combined kind of humanities and liberal arts first for two or three years. And then you do your medical training the following three years. It used to be four years. It used to be a seven year medical education track.

But the government just shortened it to six, hoping that the students would go do a 12 month rotating internship. We have, the missionaries here have created a 12 month rotating internship. So if I say interns, that's what I'm talking about. So the medical students, they do their three years in BUJA, and then they start coming up here for clinical rotations and coursework. So they do some basic sciences.

in Buja and they come up here to take a pediatrics course which is a 75 hour course. So Alyssa and I and sometimes another colleague teach that course in the afternoons. And so you know we only teach that every 18 months to every two years because we get a cohort of students to take it at once so we're not doing it every you know every time a new group of students comes up. So that's their coursework.

And then they rotate on pediatrics two times. One as they're called externs, which is younger group, like in their fourth or fifth year. And then they come in as they're called interns, which is not the interns I was talking about before, not the 12 month rotating internship. So they come in again as like senior med students and they do another.

Jennifer (46:39.926)

three month rotation. And so during those rotations, I try to do teaching time with them in the morning and I give them some curriculum to read. And I give them an exam actually at the end, which is not required by the university. I just wanted to do that. I love medical education. There was really no curriculum. When I arrived, Alyssa was doing a great job teaching everyone like she would teach the students. But when I took it on, I am

so disorganized if I don't have a plan. So I created a plan, you know, like, oh, these senior medical students will be with us for three months, so I'll make a three month teaching schedule and I'll make sure I cover the essential topics when they go through their pediatrics rotation. And I made, yeah, so I did PowerPoints and stuff for that. And so that's the medical student curriculum. We also give them oral exams at the end of their training. And so we...

We do that as well. And we also have, aside from the medical school, we have this 12 month rotating internship where we get to receive students who have graduated in med school. It doesn't have to be from our med school, but any med school in Burundi, and they come and do an extra 12 months of training in PEDS, internal medicine surgery, and OB-GYN, so that they're more capable to care for patients in Burundi.

And so that's, and I developed a curriculum for that too. Alyssa again, was doing something before me, but I like a plan. So I made a curriculum for that PowerPoints and reading and quizzes and kind of like prep-like questions or board-like questions. They're not that hard. They're not as hard as pediatric board questions, but I kind of make vignettes and questions. So hopefully they're learning.

Shelly-Ann Dakarai (48:38.02)

Yes, thanks so much. So education is important because we have to have another generation of providers, you know, coming up all the time. So that sounds like a pretty important work that you're doing. A lot of work, but pretty important work.

Jennifer (48:47.69)

Yeah, absolutely.

Jennifer (48:54.23)

Yeah, I love it. I love teaching, especially when the students are passionate about learning. It makes the teaching so much more fun. And I would say the majority of our students are just like little sponges. They just, they want more and more information. Even the nursing students who I'm not responsible for, you know, even though I'm like completely overwhelmed one day, they'll ask lots of questions. I'll be like, you know, let's just come in this room and I'll give you a quick, a quick lesson about pulmonology or something like that. And...

man, it's like I gave them all $1,000. Like they just are hungry for information and there's just not enough people to sit down and just meet them where they are and educate them. So I'm so thankful for the opportunity that I have. I could spend every single minute of every single day of every single year on education and there would still be more. Everyone, like once a week, I get asked to teach them English as well. So there's just such a thirst and hunger.

for learning and that makes it fun. And that also I think is what pushes me to keep going as well because there's such a need. Such a need. You know, I could move back to the States and.

sure, you could go to rural parts in America where there's need and there, you know, there is need, but not to this extent. And so not that like I'm special or putting myself up on a on a pedestal or anything, but it's a unique opportunity to, I could just anywhere I look, I could, I could teach someone something and it's, it's encouraging. Probably not my husband, he's probably the smartest person I know, but

other than that. It's fun. It's a really fun. If you like teaching, this is a great, great job.

Shelly-Ann Dakarai (50:46.136)

Right. Bozu, do you have any final questions for Jen before we start wrapping up?

Mbozu Sipalo (50:57.654)

No questions at the moment. I do have but I can see it's only five minutes so I'll just like maybe talk to you offline one of these days because I'd love to connect with you and over the newborn toolkit which was translated to French and we haven't gotten an in yet in the Burundi space so it would be great to actually have a word with you on how we can host the resources that you have like the manual your

you're creating or any other resources in French, because we're building that repository of information for the French neonatal health workers. But also just a big encouragement for you. It's great that you're a faith-based medical doctor working in Burundi in a very, it sounds like a very stressful environment. So it's great that your faith keeps you going and that you have this community of

Christian medical doctors rallying with you as you change a lot in that space. So just encouraging you as well, just like Shelly Anne was doing, good, you're doing such great work. And yeah, praying that, yeah, just that fire keeps on burning and you keep on making more impact. Yeah.

Jennifer (52:17.334)

Thanks so much. I really, really appreciate the encouragement. Yeah, it's helpful on the hard days to think back about those encouraging words. So I really do, really do appreciate it.

Shelly-Ann Dakarai (52:34.168)

And so Jen, is there anything that we didn't cover that you wanted to touch on?

Jennifer (52:40.938)

No, not big subjects. I think something to for anyone in this line of work, something that I would encourage you to do is find something outside of work that you love. I have three kids that keep me busy a lot. I actually help teach in their school too, which is fun. And I also have chickens. I have nine chickens. So, you know, we get fresh egg and I make cheese. So these are things that

do not pertain at all to global medicine or, you know, neonatology necessarily, but I think in any line of work, there needs to be other things besides work and just balancing the work-life balance. I mean, we didn't even get into that as women in medicine, but balancing that work-life, you know.

how much you can't split yourself into two, which I'm sure a lot of working moms or women would like to do, or three. And so just figuring out what's important for that season because seasons will change. And so just briefly, I know we're probably out of time, but my husband's a physician too, and so we actually time share. So I only work at the hospital two, two and a half days a week.

the other time that I'm at home, I'm working on curriculum and stuff, but, or feeding chickens. But mostly really trying to do things that I can't do at the hospital at home when my children are in school or out playing and figuring that out so that I can be home if they need me, especially for my four year old who's not in school yet. So I'm sure things will change once Mark, our youngest is in school and that will be a different season. But for the moment, I would say don't.

sacrifice what you think are the important things for work. I mean, like I said, there could be 10 of me and all the work would not be done at the hospital. And so I could spend all my time at the hospital and sacrifice my mental wellbeing, as well as the wellbeing of my children and husband. But I've chosen not to do that. And that was a hard choice because there are people...

Jennifer (55:00.558)

there are children dying. I mean, this sounds so, it sounds so crazy to say. And not that like, not that me being there five days a week would necessarily change 100% the mortality. I think it would probably help. I could teach more. I could show how to do things properly. I could teach more helping babies breathe. But, you know, one of the best things that I think about over and over is we're searching for longevity and sustainability.

over dependency. And so yeah, that's what I would say as an encouragement to there's always going to be more work, there's always going to be children and patients that are suffering. And one don't think that one you can you can fix it all by being there. And two, if you want to be in a situation or a setting like this for a long time, you cannot be 100% at the hospital for your even if you're single, you cannot be 100%

at the hospital because you'll lose your mental sanity and then you're not good for anyone. So that was kind of a tangent but that is something that I think is quite important as people are working in low-income countries. The work is stressful and hard and there's not enough people and there are not enough resources and so if your goal is sustainability and longevity you really have to figure out how you can move forward in a in a good way.

Shelly-Ann Dakarai (56:29.904)

Thank you, Jen. So many pearls and words of wisdom in there. We really appreciate you coming on to the podcast and sharing your journey and these pearls with us. So as we wrap up, how can folks connect with you if they wanna collaborate or just ask more questions or just get to know a little bit more about the work that your team's doing?

Jennifer (56:52.114)

Yeah, I am happy to receive emails. I love talking with people who are in similar situations. I don't know if I'll be a big help or not, but I'm happy to be someone to listen to things that people are going through or bounce ideas off. My email can be in the show notes, but it's also jenn H-A-R-L-I-N-G, at gmail.com. And...

Shelly-Ann Dakarai (56:55.387)

Okay.

Jennifer (57:19.69)

We have, if you're interested more about what our team does here at Kibuye, we, there is a, a team blog that has anything from, you know, 3d printing that my husband does to medical stuff, to what the children are doing in school. And that website is mccr And I'll hopefully we can put that in the show notes as well.

Shelly-Ann Dakarai (57:41.38)

Yes, we'll definitely put all of those in the show notes so folks can connect with you if they want to. All right.

Jennifer (57:47.246)

Okay, well this has been such a pleasure and I'm just really thankful to meet you ladies and yeah, hopefully this will be encouragement to anyone working in these kind of settings that you're not alone and keep going. You're doing a good job.

Shelly-Ann Dakarai (58:06.162)

Thank you so much Jen and we'll see you guys with our next episode. Bye.

Jennifer (58:12.727)

Bye.

Mbozu Sipalo (58:15.959)

Thanks.