Patient Profile: Mr. A’s Laryngectomy

Left to right: One of Mr. A’s 50 children, Mr. A, Dr. Mitchell, Dr. Aboiyar (ENT apprentice)

Mr. A is a 65 (best guess since birth dates are often not recorded) year old male from the Tiv tribe. He was evaluated by a local ENT surgeon and found to have cancer of the larynx. The surgeon recommended laryngectomy, which is the surgery that removes the voice box and leaves a hole in the neck to breathe through. Another option is radiation therapy which is the usual initial therapy in the states, and has very good results. Radiation is not as controlled or as effective in Nigeria. Mr. A decided to have radiation in March 2008. It did not work and his cancer returned and was blocking his airway by July 2008. He was to have surgery at the University Hospital, but there were logistical problems and the surgery was going to be postponed until September or even November. The ENT surgeon asked if we could do the surgery here at Evangel Hospital. I agreed and I assisted him in the laryngectomy in late August.
Unfortunately things have not gone well and the patient has had multiple complications. His wound completely broke down and opened up. His feeding passage (pharynx) opened up as well. Much of this was a result of the radiation which causes poor healing in the tissues that have received radiation. Mr. A has gone back to the “main theatre” (operating room) four times to try and close the wound. We have taken tissue from his chest and put it up into his neck to try and cover the wound. He has remained in the hospital for 5 weeks. I have been seeing him daily. The University ENT surgeon has left the care to me. He did not foresee the long hospital stay, and the ENT surgeon has actually gone to India for a six week training course. Fortunately one of Mr. A’s sons has been staying with him for the entire time and doing excellent nursing care. The son has been doing the tube feeding, dressing changes, tracheotomy tube cleaning, and even monitoring his oxygen saturation with a pulse oximeter.
We are discharging Mr. A to his home, though he is not healed. He lives in a village about a 6 hour drive from here. He was supposed to go home yesterday, but his hospital bill is 200,000 Naira ($1,800), and he did not have the money on him. A patient or family member must pay in cash in full before the patient is allowed to leave the hospital. If the patient dies, the hospital will hold the body until the bill is paid by the family. Fortunately Mr. A is a relatively wealthy farmer. He has made a lot of money from his crops over the years. He has had seven wives, four are now living. He has 50 children that his accompanying son is aware of. One of his sons is coming later today to pay the bill. Mr. A will return to our clinic in 2 weeks. We pray that some healing will have taken place.

Michael Mitchell, MD

Happy Nigerian Independence Day

Today, Wednesday, October 1st, is a national holiday in Nigeria. We congratulate Nigeria on 48 years of independence. The Federal Republic of Nigeria is a federal constitutional republic comprising thirty six states and one federal capital with a population of about 140 million. Nigeria gained its independence on the 1st October, 1960 and became a republic on October 1st, 1963. Nigeria re-achieved democracy in 1999 ending almost thirty three-years of military rule between from 1966 until 1999. The last major uprising here in Jos was in 2001 when there was sectarian violence between Muslims and Christians. Other than the rebel group in the far south, Nigeria is politically calm for now.
The celebration in Jos is subdued, compared to American Fourth of July festivities. Most workers have several days in a row off. Elective and routine care at Evangel hospital is shut down and there is no school today. As a matter of fact, school has been out for 3 days. Monday and Tuesday were last minute holidays in observance of Sallah, the end of Ramadan. Muslims have had their own celebration as they are completing a 4 week period of fasting. During the day, roughly 6:30 am to 6:30 pm, they did not eat or drink. Roughly half of Jos is Muslim. Many of our patients at Evangel Hospital are Muslim, despite our strong Christian emphasis.

Please join us as we pray for the country of Nigerian: for strong leadership and for strong leaders full of integrity who will work hard to make a better life for all Nigerians.



President Umaru Yar'Adua




Michael Mitchell, MD

Our “Adopted” Family Member

Tonight we spent the last evening with our beloved house guest, Shannon Castle, MD. She has been with us for over three weeks and the time has flown. Shannon is a 28 year old general surgery resident from San Diego. She came to do a four week rotation at Evangel Hospital. Her original living arrangements were a little cramped with two other medical students in a one bedroom apartment, so we invited her into our large home. She has been rooming with Camille. Shannon has become an honorary Mitchell. We have enjoyed her company and she has been a great role model for the kids. Dr. Bill Ardill, the general surgeon, has benefitted from her hard work and expertise in the hospital as well. We will all miss her.

Michael Mitchell, MD

A familiar sight on the streets of Jos

I spend a lot of time in the car with Alphonsus every day. We see some pretty unusual sights as we are driving around. Attached is one of my favorites that I see quite regularly. I still can't figure out how they get the bulls into the back end of a pickup truck. This is a familiar sight since the road to the school also happens to be the road to the butchers!

Nigerians are pretty fussy about having their picture taken. You must ask if you can "snap" them. They may or may not let you. I took the liberty of taking this picture since the guy's back was turned. The bull had too many other things on his mind.

You can also see large mattresses balancing on the heads of the driver and passenger of the achabas (motorcycle taxis), goats (dead or alive), families of four, and even a large office desk. Our furniture that we ordered was delivered this way!

Car rides offer some daily entertainment. They also offer some time for serious conversations. My driver asked me just this week out of the blue how you could know for sure if you are a Christian. It was a great privilege to talk with him and remind him of the great gift of salvation we are given in Christ and God's forgiveness even when we are disobedient. Alphonsus is really growing in his faith and his understanding of the Lord. What a joy to have these moments!

Lisa

Wee Sachets of Porridge

Since we’ve been here we’ve enjoyed spending time with the medical students who are working at Evangel. We have particularly had fun with the Irish medical students, Gemma and Gary. They are pretty funny, especially Gary. I had always thought that the weird sayings you hear people say when they imitate Irish people were just stereotypes, but they’re TRUE. Gemma and Gary would both use the word “wee” all the time. Our favorite was when Gary talks about his “wee sachets of porridge” which are really just instant Quaker Oat packages. At our going away dinner for Gemma, Gary got it in his mind for me to teach him how to solve a Rubik’s cube. So I sat there for about an hour just attempting to teach him how to solve this cube. Well… maybe not for the whole hour. I spent a lot of time making fun of him. I thought guys had better spatial skills than girls but I guess Gary is an exception. As far as Gemma, she is really cool. One time when she and the other med students came over, we got to talking about Ireland and stuff. I actually found out a lot. I’m in the process of convincing my parents to let us go there for our family vacation on the way back from Nigeria. That would be exciting. Plus, the accent is so cute.
Hannah (17)

JETS

As I ponder how to answer the latest question, forty faces look back at me expectantly in silence. I begin writing in response and behind me instantly I hear the scritch scratch of pens as my students diligently copy down every word and mark I write. This is typical of every class that I have taught so far at JETS (Jos Evangelical Theological Seminary.) These first year pastoral students are very eager to fill the gaps missing in their English which may be their second, third, or even fourth language. English is the official language of Nigeria. It unites the several hundred different dialects spoken across the country and provides a language for government, business, and even the Church.

Many of my 37 male students and 3 female students are from the bush. They have come to one of the most prestigious seminaries in Nigeria and will study for 2-3 years before returning to their homes to be pastors and leaders in their communities. Initially, their greater understanding of the English language and its structure is preparing them for learning Greek in their second year of seminary. Their knowing English also enables them to communicate with church members and potential converts from outside their tribe. It also enables them to communicate with other missionaries as well as be able to read textbooks and articles published to further their theological education.

There are two things I love about my new job: my wonderful students who are exuberant about their faith and so appreciative of the time I spend with them, and my delightful colleague, Abigail Hunt. Abi was singlehandedly teaching a class of 80 students before I was recruited to split the class with her. We now each have our own class of 40. I really appreciate the time she is spending with me helping me to know what to teach and looking over my shoulder a bit to make sure things are going well. I couldn’t have asked for more . . .a lovely Nigerian sister in Christ to fellowship with and exchange teaching ideas and tips with. Abi is also enjoying looking at the materials I brought from the US; quality, current materials are in short supply here. I do not even have a class set of books to refer to. One whiteboard is all I have, so much of the class time is spent calling out or writing (and erasing) the board. I have had several students approach me and ask about my nice grammar workbook that I refer to often in the classroom. Unfortunately, it costs more than half a month’s wages for them. An impossible sum for most of them and certainly for the school to provide!

I look forward to each Tuesday and Thursday morning that I get to spend with these future leaders of Nigeria!

Purity Retreat for Boys

Last weekend was tons of fun. I went to the Hillcrest Purity Retreat for the whole weekend. All of us figured out very quickly that there was a trampoline on the compound and that was where we spent pretty much all of our free time. Because no one has trampolines here I was the only one that could do any sort of flips. All of the Nigerians were going wild because of the fact that I could do a back flip on a trampoline. Besides the fun, the sessions were quite helpful. Coach Tolar was my small group leader and he had many great points on the matters we were discussing throughout the weekend.

Sterling (15)