Miango Break

We just returned from a three-night holiday at the Miango Rest Home. It is a retreat center that was established in the 1940’s as a place for SIM (our organization) missionaries to vacation and get out of the heat that oppresses the rest of Nigeria. Miango and Jos are on a 4,000 ft plateau so the temperatures are much milder. Most of the year temperatures are 70-80 degrees Fahrenheit, though it is fairly humid most of the time. It is very pleasant if you are sitting in the shade with a nice breeze. Miango is in a lovely location, about 50 kilometers outside of Jos, where we live. It is next to a small village in a rural location surrounded by weather worn granite formations and farmland. We found it a nice change from the city living. The constant beep-beep of motorcycle taxis was noticeably absent.


The retreat functions more as a group retreat center now and not as many missionaries come for rest only. Two missionary groups were having regional conferences while we were there. We were one of three families there for rest and relaxation only. Activities included, tennis, hiking, volleyball, games, movie-watching, shopping, car driving lessons, teenage hanging out and goofing off, reading, and much visiting. All meals were provided, so Lisa had a nice vacation.


Highlights of the trip for me included a hike to the top of a nearby small dormant volcano with a panoramic view of the plateau. We packed 16 adults, teens, and kids into the van and drove a couple of miles down the road for that little outing. Another highlight was the tour of the Miango Rest Home and Kent Academy , which is the boarding school that was established in 1945 and part of the campus. The guide was Dr. Bill Ardill, who was born in Jos and went to school at Kent Academy. He is now the general surgeon here at Evangel Hospital, where I am working. His knowledge of the area and history of the mission is vast.

The most poignant part of the tour was the small cemetery behind the chapel. SIM missionaries who died in Nigeria are buried there. There are many stories of children and adults who lost their lives. There is a pilot who died on a test flight. Also buried is a four year old boy who drowned in a small pit that had been dug by the gardener without the knowledge of the parents. An elderly woman missionary who died in her sleep is there; she was known for always walking the long road between Miango and Jos. Two of the first known cases of Lassa fever are buried here; one was the missionary patient, the other was the physician who cut herself during the autopsy and contracted the disease. Several infants were buried there, including the Ardill’s own baby who died at birth. Many of the names on the tombstones were familiar to us as we have learned the names of the SIM community. It is clear, that there has been sacrifice among the families that have served in Nigeria.

Greater love has no one than this, than to lay down one’s life for his friends. John 15:13

Michael Mitchell, MD

Varsity Basketball

This past week Hillcrest had tryouts for the basketball team. We had about 35 or 36 players tryout so Coach split us up into three teams, Varsity, JV 1, and JV 2. I was the only sophomore that made varsity. I have found that sports is the best past time for me here. If I am not playing basketball on our compound or at Hillcrest I am playing soccer with Gwakman, Victor, and the other Nigerian boys in the neighborhood.

Sterling, 15

Solar Powered Hearing Aids

We encounter many patients with hearing loss. Many have loss due to infections and large holes in their ear drums or missing bones. Some of these patients can be helped with surgery. Many have nerve damage that cannot be helped with surgery. Often the nerve damage (sensorineural hearing loss) is the result of a strong antibiotic that is used to fight life-threatening infections. We use the same antibiotic in the United States but we are able to better control the blood levels of the medicine. I have seen many deaf and partially deaf patients here in Nigeria. Many can be helped with hearing aids. We are fortunate enough to have a fairly good audiometry booth that is sound proof and reasonably well equipped. It is certainly the best facility in our region. Audu and Ben, assistants in the ENT clinic, fit many patients every week with hearing aids. Because most hearing aids require batteries that don’t last long, we have solar powered hearing aids for the poorer patients. These were developed by a non-profit ministry called ComCare, Inc. They sell the aids to ministries for the cost of their supplies. These aids work very well for our patients who cannot afford to replace batteries on a regular basis. The aids are also rugged and can last a few years. Our Hausa language teacher is still wearing his solar powered hearing aid that he was given 5 years ago.
I have included a couple of photos of patients. One young woman has been blind since she was a baby. She is continuing to lose her hearing. We have been able to help her with an aid. Another woman had a life threatening infection after an abortion. She was treated with the antibiotic that poisoned her inner ear. She is orphaned and has no family to help her with the cost of medical care, much less a hearing aid, a common situation in our region of Nigeria where there is no medical insurance. Patients pay cash for all medical care. They often go to family to help pool the finances to pay for medical care. Thanks to generous donors, we were able to provide both young women with solar powered hearing aids. One will now have better opportunity of communicating in her dark world. The other will hopefully be able to find work since she can better communicate.Michael Mitchell, MD

Victor

I thought I would take the time to introduce you to Victor. Our family is quickly becoming attached to this 9 year old boy and his 14 year old cousin, Gwakman. Victor reminds me of a young male, Nigerian version of Camille: very charming, very bright, talkative, and precocious. He wanders over to our house daily to visit us as well as enjoy some of the things that you see pictured on the table, very luxurious things at that: clean, tasty water; high quality English books, and best of all plentiful food! In addition to these items, he is always hopeful of getting a chance at playing electronics which he has to work for in the form of reading English for 20 minutes (by Emily’s orders!)

This Saturday morning, Victor was at our door with his bright smile at 7am. Good thing we are always up around 5am! He came to retrieve a forgotten item from the movie night before. There is always a little hopeful look in his eyes . . . I can’t blame him since he usually only gets one meal a day. I promptly told him to go around to the back patio which is just outside my kitchen door. While I got busy in the kitchen with breakfast dishes, Victor enjoyed his peanut butter sandwich and water, happily chattering my ear off.

Today’s topic was school. Victor really likes school except for when the teachers beat him with a bamboo cane! Not just him, but all the students! This is an accepted form of discipline in Nigeria. Forgot your homework? Made a failing grade? Disrespectful behaviour? There is one solution for all. (No wonder my students at the seminary treat me with such respect!) Victor would like to be either a doctor or an agricultural scientist so he can feed lots of people. He makes very good marks in school and also speaks three languages: Tarok, Hausa, and English. We have great hopes for this little boy who has captured our hearts.

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