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)

Football

In Nigeria, everything revolves around football. Real football, not the American game that you don’t actually play with your feet. During the Olympics, while my dad and I were sitting in the clinic, we could hear the whole hospital around us roar whenever Nigeria scored a goal. People would crowd around TV’s in the general ward to watch the games or watch on cell phones that picked up analog directly. Everyone watched the games, and bringing up the final where Argentina beat Nigeria for the gold medal was a touchy subject for a couple of weeks. But not only does everyone watch football; they all play since they are knee high. Even the toddlers will run after the ball and kick at it. Football is the neighborhood social event. Any footballs in the neighborhood are used so much that they quickly break or go missing. Currently our family has the only intact football in the neighborhood, so we always have kids knocking on our door asking to borrow it. The other day one of the boys who lives down the street knocked on our door while I was baking muffins, asking if I could come out and bring the football with me. I told him I would finish the muffins and then bring out the ball. When I came out about half an hour later, I was surprised to find that he had rounded up what appeared to be the entire Evangel compound for a game. Not only all of the elementary school aged boys, but also high schoolers, residents, and doctors were out to play. The teams were already divided, the order decided, and the only thing missing for the game was the ball. One of the older players called for me to toss him the ball, pointed to which team I would play for, and the game started immediately.
Since that game I have been playing with the same group of high school students every day. Playing football has been a great way to get to know people in the neighborhood other than the ones under the age of twelve, who just roam loose in packs. People here are often named after people in the Bible or days of the week, so of the five or six guys that I play with, two are named Joshua and two are named Monday (Sterling’s football coach’s full name is Sunday Monday). Playing football has also turned out to be the perfect solution to my problem of figuring out how to exercise every day in a safe and culturally acceptable way. Jogging outside the compound is not particularly safe, especially for white women alone. It is possible to jog around the compound, but it is a fairly small loop and stays muddy most of the time. Football is a fun way to keep fit and has been a good way to connect with all of our neighbors at the same time.

Morning Report

Every week day morning at 7:30 we have morning report. There are a team of doctors who are take in admissions and do the initial evaluation and treatment. They work hard and often have sleepless nights. The complexity of the admissions varies greatly. There has been an increase in the number of trauma patients. This has been attributed to an increase in the “achabas”, which are the motorcycle taxis used by many for transportations. There are rarely helmets worn.
Patients with malaria, typhoid fever, and retroviral disease (local name for HIV) are commonly admitted as well. The house staff take care of obstetric and pediatric emergencies.

The picture shows the three house officers who had been on call the weekend before. They are sitting under their respective lists of admissions –and one mortality. They are a hard working bunch, who are eager to learn. Every morning they discuss their management of the patients and we will often use the opportunity to discuss the appropriate diagnosis and management of a patient.
Michael Mitchell, MD

A New Routine in Nigeria

I don’t know which wakes me up first each morning: the sound of our two ferocious Dachshund guard dogs barking at the neighbors as they rouse, the distant high-pitched beeps of the achabas (motorcycle taxis), or the Nigerian radio music that is floating over the fields in through our open windows. Before sunrise I roll out of bed, remembering to turn on the hot water heater so I can have warm water for showering, before I head off to the kitchen. I immediately start a load of laundry in the washer since it will take a couple of hours to finish. Maybe today I can squeeze three loads of laundry out of my machine that holds about a third of my machine at home. I turn on the water pump to fill up the outside tank so we will have adequate water flowing into the house. The tricky thing is to remember to turn it off. Then finally I fill the indoor water filtering system so we will have plenty of drinking water for breakfast.

One of the wonderful advantages of having to cook each meal every day is that two or three times a day our family is gathered around the table. After a nice breakfast courtesy of our morning cook Emily, everyone races off their separate ways. I am left to rinse the dishes and begin filling out marching orders. I consult with Zaineb to plan out a menu since she is my expert on local ingredients and their availability and correct price. Alphonsus is sent off to the market with a list and a close estimate of the cost involved. What I do in about 45 minutes in America will take him literally hours with every item bartered for. Because everything is on a cash basis here, I must carefully count out the money and send him on his way. Then Zaineb and Asibe (our latest helper who is a widow supporting four children at home), get their instructions. Finally, I can start my day.

On Tuesdays and Thursdays starting next week from 9:30am-10:45am, I will begin teaching an English class at the Jos Evangelical Theological Seminary (JETS.) Abigail Hunt, a Nigerian teacher with many years of experience, was singlehandedly teaching a class of 75+ first year students. We are going to split the class and work together to get the job done. I will very much appreciate her experience and guidance, her knowledge of the customs and the seminary, and her very sweet personality. I am nervous and excited all at the same time as I take on my first official English class with two thirds of my masters completed. I’m sure I will have many stories in the future to update you with! The picture included was my first day on the JETS campus. I will be wearing Nigerian clothes regularly. I look forward to helping these future pastors and Bible teachers improve their English speaking, reading, and writing as well as fellowshipping with these dear brothers and sisters in Christ.

Fridays are my day at Hillcrest School. I am the local trumpet/brass expert and am teaching music three periods over the course of the day. The high schoolers, middle schoolers , and the sixth graders are a lot of fun to work with and really appreciate the extra attention they are getting. On November 7th, there is going to be an Honors recital. I am helping several of the kids get ready for this recital. I will be thrilled if by the end of the year we are making some beautiful music together!

My schedule is picking up, and I am really enjoying being out and about and interacting with the Nigerian people and the missionary kids. Oops! Time to turn the outside water pump off!

Lisa

Clinic and Culture

Half of watching my dad work is seeing surgeries, and the other half is sitting in clinic with him while he sees patients. I always thought of clinic as the boring side of surgery, but nothing is boring here. The patients that walk through the exam room door are always interesting. One of the patients that came through the clinic the other day was a Fulani man and his son. “Here they come, the real African gypsies,” Audu, the ENT assistant, told me as they walked through the door. And they do resemble gypsies; the father and son were small, worn looking people with much jewelry and heavy tattooing. The Fulani are a primarily Muslim tribe that live in the dusty desert of northern Nigeria. They live on meager means, scraping an existence by raising cattle. This family, however, was wealthier than usual and could afford a doctor’s visit. Audu told me, “They may be Fulani, but they are rich. This man, he have all the cows.” His son was small, malnourished, and had a large mass coming out of his ear. Dad and Dr. Aboiyar put a drain around the mass and prescribed antibiotic eardrops. At the end of the visit when the Fulani man pulled out his money to pay medical fees, he was very careful to turn his back to us so we would not see how much money he had or where he kept it.

About a week later, the man returned with his wife and another child. This time he also brought his wife with him to see this white doctor who could cure anything. He showed us the mass in his son’s ear, which had gone down significantly during the course of the antibiotic drops, and asked, “Can you also make my son a little fatter?” His wife insisted on being seen as well for headaches and dizziness. My dad agreed and prescribed Vitamin C and Tylenol in exchange for a photograph of the family. The Fulani woman was very pleased. She spoke no English, but she kept holding up two fingers and through a translator enthusiastically requested a second copy of the photograph. As the family left she swung her baby onto her back and tied him on with one hand, while with the other hand she waved two fingers to remind us, two copies! Audu told us that when they got back, they would gather the whole village together and tell about these people who were white from head to toe. Next time, he expected, they would come with even more people to be seen by the white doctor.

-Emily

Settling Down

Life has been getting a lot better for me as we get farther and farther into our experience. I have my general routine down now though I still do not have a regular breakfast figured out. Every Monday, Wednesday, and Friday I lift weights after school then shortly afterwards I have a basketball practice until 5:30 and then I head home to do homework and eat. On Tuesdays I attend Praise Team practice after school. Praise Team is a band made up of high schoolers that are interested in music and we lead worship once a month in the church service. Thursdays are a free day for me, I generally lift weights and then head home on the earliest bus back to the compound I can find a ride with. After the school week is over we get a bunch of guys together and sleepover at someone’s house. Term “sleepover” is not very accurate though since no one gets more than a few hours of sleep. I then have all day Saturday to relax and do whatever I want whether it is homework or hanging out with my friend Jacob on the compound. The dullest day of the week is Sunday. We wake up, go to church, do homework, and relax all day. There isn’t much time to do anything during the day.

Sterling (15)

Slowing Down in Nigeria

Things have pretty much settled down, and the general pace of life has slowed immensely. It hasn’t gotten any less interesting though. Dinners are now filled with the sharing of the hilarious events of the day. We tell about the crazy things achaba drivers do and the things they transport (Emily saw an achaba that was carrying the driver, a passenger, and two goats.), the funny stories of what friends do during school (Sterling had an eyebrow wiggling contest with another student), and interesting (or disgusting, depending on the way you view it) cases that dad and Emily see in the hospital. I have also observed that many of the habits our family had back in the States have helped us adjust more keenly to life in Jos. First of all, being late is somewhat expected. Church “starts” at nine o’clock, but nobody shows up until nine-thirty. Also, mom’s talent for getting bargains has come in handy quite a lot in the market.
School is… different. Some of the classes are not as advanced as what I am accustomed to, and classes are a bit boring for me at times. On the other hand I have officially befriended every girl in my grade. They’re all very nice and at least 60% of them have a sense of humor! It’s kind of funny, but the Nigerian girls seem to have similar personalities to the friends I had back in America.
I’ve officially taken up the role of hostess, as I am now sharing my room with a surgical resident from San Diego for the next three to four weeks. Her name is Shannon, and she was going to have to sleep on a couch in the STA quarters because it was getting so crowded over there, but dad stepped in and asked if she would like to live with us. At first, I was kind of bummed. I’d just gotten into a routine, and now I was going to have to tweak it for the convenience of this stranger. I really don’t mind anymore. She’s very nice and extremely cool. She’s young enough to understand how I work, and I enjoy talking to her.
All of these things have come together to create an enjoyably relaxed atmosphere, and I often find myself in that peaceful, Sunday afternoon mood. Love you all!
Camille, 13

Organization is a Gift

Suture and meds on back table.

Daily I develop an appreciation for the westerners who have sacrificed much to stay here for many years. They have learned to cope with the many inconviences of living in an impoverished country where water and electricity are inconsistent. I am also slowly understanding the difficulties that the Nigerians must overcome in their day to day lives. Keeping that in perspective helps me to be patient as I try to do my job at Evangel. I try to recognize my obstacles as challenges and not get too frustrated.
One of the larger challenges Evangel Hospital is the disarray of equipment and supplies. Items that are considered “consumable” or “disposable” in America are reused here in Nigeria until the life is truly gone out of them. This is because the hospital does not have the budget to restock the items. Fortunately we are throwing away used tape, gauze, gloves and needles. Other items, however, like plastic tubing for ventilators, breathing tubes, suction canisters, electocautery cords and wands, cloth towels and gowns are reused. Bottles of lidocaine (numbing medication) will stay on the shelf gathering dust until every last drop is used out of the bottle.
The utilitarian waste-not-want-not mentality translates to the “durable” equipment as well. Otoscopes, suction machines, surgical instruments, are all kept, whether they are functional or not. An instrument is not thrown out, no matter how much rust is on the instrument. Many of the instruments are made of a lesser grade stainless steel and were designed for one time use or are simply of poor quality. In the mindset here, something is better than nothing. Rarely is an instrument or piece of equipment thrown away, no matter how rusty or unusable it may be to me.

Home-made unlabeled sterile saline in the middle bottles.

Add to this the random storage method. Sutures of like kind are not necessarily kept together. Specialized instruments or attachments are not necessarily kept together. Topical use sterile saline (salt water) for irrigating wounds is home-made and kept in unlabeled bottles. Duringsurgery, there are no needle counts or sponge counts.

The ENT instrument and supply cabinet in the operating room.

One of the obstacles in staying organized is the lack of suitable storage items. There are few adequate storage cabinets. The cabinets that are here are wooden with warped doors. There are also open wooden shelves. There is no climate control in the hospital. Even the operating room has open screened windows for ventilation. The air is very humid in the wet season and dry and very dusty in the dry season. Most of the shelves and cabinets are made of inexpensive wood which is susceptible to the elements and insects. The wood either warps or is eaten up.
As I organize and rearrange, I am trying to think of ways to help my Nigerian colleagues sustain the order and hopefully be more efficient in the future. This is in hopes that they will be able to better care for more patients in the future. I know things probably will not be maintained in the way that I would keep them. I am hoping however that I can do things like acquire better storage cabinets and containers so things will be a little cleaner and easier to find in the future.

The Plastic instrument tray with clean sterile insruments, just opened.

Michael Mitchell, MD