Keloids and Peanuts Keeping the Doctor Busy

Time flies when you are having fun and also when you are busy. I must say that my days are not always fun, but often busy. Dr. Aboiyar, the family medicine physician who is now a diplomate in otolaryngology, has been taking some well earned vacation time. Therefore, my days have been a little fuller than usual. In addition, we have two family medicine residents rotating on the service. While they try to help when they can, it does take time to teach. I do, however, find the teaching part of my job very rewarding. I feel that I can make a more lasting impact as well as making a difference for a larger number of people by equipping young Nigerian doctors with more knowledge and skills to better treat patients.

This week is barely half over and I have found that we have done quite a bit clinically. On Monday, we were in the operating room all day for our regularly scheduled operating day. Dr. Aboiyar came off of vacation for a few hours and repaired an eardrum beautifully and with very little help from me. I then went on to remove a tumor off of a vocal cord and then removed a thyroid gland. We got a late start, so the day went a little long.


Tuesday was normal clinic day. I coached the residents through seeing and treating our patients. Along the way we had a two year old boy come into clinic with a peanut in his airway. Peanuts are a mainstay in the Nigerian diet and there is little education at this point about safe foods for young children. Consequently, peanut aspiration is a common problem. This young boy had aspirated his peanut five days prior. He lives near the capital city of Abuja, a three hour drive from Jos. Medical care is so expensive there, that his parents brought him to Jos University Teaching Hospital (JUTH). The ENT surgeons at JUTH don’t have their equipment up and running yet, so they sent the patient on to Evangel Hospital, where the boy arrived five days after aspirating the peanut. He was obviously having some difficulty breathing, so we rushed through our patients in the clinic and got to the operating room in the afternoon. In the operating room, I found half of a peanut firmly lodged in his windpipe (trachea) just below the voice box (larynx). I suspect that he would have developed infection, a blocked airway, and eventually died had he not been treated. He was doing very well and went home today with very happy parents.


Today, we went to the operating room with an extra, overbooked case. This young man has many tumors called keloids that have been growing over the past 10 years. A keloid is scar tissue that has gone wild and continues to grow. Clearly, this is the worst case I have ever seen, much less operated on. Dr. Aboiyar and I spent several hours excising the keloids and then remodeling the skin on his neck. There are other large but significantly smaller lesions on the other side of his neck. I was very pleased with the initial outcome.


I still need to find time this week to take care of a couple of patients in the hospital with broken jaws. I think my remaining time in Nigeria will go very quickly, just because it is so busy. I look forward to the weekends for a little more fun, which will also make the remaining days go by even quicker.

Michael Mitchell, MD