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

Shopping with Alphonsus

A driver is very important in Nigeria for a new Bature (white person) on the block. Alphonsus is that important person for us. First of all, he gets us from here to there safely every day. In a country where there are no traffic or street signs, no traffic lights, and a million motorcycle taxis (achabas) whizzing inches away from you at all times, this is a major accomplishment. Second of all, he is our translator and negotiator. He helps me to communicate and get the best deal on food and necessary items. (The Bature price is often double the price for Nigerians!) He is also our cultural guide and item locater. Knowing where to find goods saves us a lot of time. There are only a couple stores by American standards in this town of 600,000+; the rest are just shacks with a hodgepodge of items laid out on shelves and tables or the ground.

Earlier this week, our car needed new windshield wipers (this is really important in rainy season when you can fill a 120 liter trashcan full of drinking water within an hour!) After informing Alphonsus of our need, within minutes he whipped the car over to the side of the road. We were wondering why we were stopping. Immediately, several Nigerians ran up to our windows from where they sat in the shade of mango trees. We waited several minutes as the usual polite exchanges went back and forth. . .Ina wuni? (How is your afternoon?) Lafiyah lau. (Fine.) Ya-ya uwargida? (How is your wife?) Lafiyah. (Fine.) Ya-ya yara? (How are the children?) And so on and so forth. It would be quite rude to get down to business quickly even with a stranger! Then to business (but not before we were almost fitted with a steering wheel cover!) The men raced over to a pile of something and the half rotten, filthy tarp covering it was thrown back. The desired windshield wipers were produced and the negotiating began. 900 Naira says the owner. Alphonsus smiles and shakes his head. Is that the final price? He points to my packages in the back. The Bature are new to the country. They have to buy many things. They are running out of money. How could he ask such a price? More handshaking and back and forth. Finally the price is agreed upon, 800 Naira. Quickly, the wipers are installed. Unfortunately, the owner does not have change for my large bills. No problem. Because he knows Alphonsus, I can pay him 200 Naira another time. Within minutes, we are on our way again.

There have been many moments like this (I wish they were all resolved in such a timely manner!) We rely heavily on our driver and our other workers. They help us cope with life in Nigeria and save us a lot of time and energy so that we can do what we believe the Lord has allowed us to come to Nigeria for in the first place. We try to communicate this to our helpers; they really are a blessing to us. They are also quickly becoming a part of our family.

Another standard greeting in Hausa is “Ya-ya aiki?” (How is work?) The proper reply is “Mun gode Allah.” (We thank God.) You see, in a country where the unemployment rate is 40%, a steady income is truly a reason to give thanks to God. When our driver told his wife that he had found steady work, she got on her knees and did give thanks. Alphonsus has had to live separately from his wife and two children for several months after losing everything in a fire. He travels every other weekend 2-3 hours to be reunited with them where they are living in a small village with relatives. We get to meet Alphonsus’ wife very soon. When he gets settled and finds a larger room, they will rejoin him.

Thank you to our friends and family who have provided our support. You are not only helping to provide medical care and relieve human suffering in the name of Christ. You are also providing an income for individuals and families who would otherwise have none.

Lisa

Africa Update

So. Nigeria.

So far, my experience at school hasn’t quite been as scary as I thought it would be. It’s been slightly frustrating but still good. Firstly, I’m not the tallest person in the school. Somehow I got the impression that I was going to be monstrous compared to the other students at Hillcrest. BUT lucky for me there are many very tall people at the school so I don’t feel quite so weird. Plus the people at the school are really nice. It took me a while but I actually feel like I’m starting to become an accepted member of the senior class. Since the school is so small, it was a little hard to get settled in because each class is like a family. School is a little frustrating though because in most of my classes I’m learning things that I’ve already learned at Columbia River. In my English class, we’re reading some of the same books I read as early as my sophomore year in the states. Plus, my biology class uses the same textbook as the course I took last year only the two year course I was in has been rolled in to a one year course here. So it will be easy for the first half of the year, but after that it will get to be a little harder.

Outside of school, we’ve been having a lot of fun. This past week we’ve gotten to know two Irish medical students named Gary and Gemma. Gary is a country boy and has a very strong Irish accent so he’s been the butt of many jokes, jokes of affection of course. He uses all of the stereotypically Irish sayings (his “wee sachets of porridge” have been particularly popular). Gemma is really cool too. We’ve even talked about maybe stopping in Ireland on the way home and visiting them and seeing the pretty landscape. I hope we do. The pictures that the Ardill’s showed of their trip were really pretty. Oh, and we got to know Hanna, the Swiss medical student here. She’s pretty cool too. Dad found out she spoke German and immediately started talking up a storm. It was pretty funny.

Also, this past weekend we went to the wildlife park here in Jos with the Taits and the Gils. That was definitely a new experience. You could get in to most of the animal cages fairly easily. One example was the elephant cage that you could just unbolt the door and get in to the pen with the elephant. Being that the cages were so unsafe by American standards, you could touch and interact with most of the animals. I had a roaring contest with a male lion that was two feet away and only separated by a double layer chain link fence. Oh, and we got to feed chimpanzees. That was fun. If you waved your hands around they would break dance as a trick for the treat.

Well, it’s time for my nightly homework session. But keep us in your prayers. Pray for our safety especially. Between my dad’s driving, my roaring contests with lions, and all the other hazards, we need it.

(Hannah, 17)

Fun Times in Jos

The past couple of weeks have been hard for me. Hillcrest is not the school that I was expecting it to be. Even though I am not having the greatest experience I still feel that I need to be here. I am friends with a guy name Gabe Dvorak who does not want to be here at all. Most of my time at school is spent hanging out with him. His parents have already come to my parents and thanked them for me being friends with Gabe. They are able to get more work done knowing that he is happier and has someone to be his friend.
There are great things about being in Jos. Since there are not a lot of kids around and it is a missionary community it is quite easy to get a group of friends together for a night of video games and food. Every Friday night there is something going on. I missed out on last night’s fun because I was sick but in the short time that has passed since then I have gotten better. We also have a bunch of Nigerian children that have found us to be a great source of entertainment. Whenever we drive by the Nigerian homes on the way to our house on our compound there is a small crowd of little children that chases our car down the road to our house and waits for us to come out and play with them. When we do go out to play with them we bring out paper and crayons so that they can draw or we bring out a soccer ball (which is their favorite) for them to play with. Soccer is the game that we can all play with them. They do not care as much about winning or scoring goals but it is just simply the playing that they love. It is a joy to spend time with these kids. For Hannah, me, and Camille they are our link to real Nigerian life. Because of the fact that we have to attend school during the day we do not get to spend much time with the average Nigerian kids. It is nice to be able to learn about Nigerian culture by spending time with kids that live here and are not a part of the missionary community here in Jos.

Sterling (15)

Genuine Hardships

To many people, poor electricity and rusty plumbing would be greater hardships to overcome than going to school or shopping in an open air market. In Africa however….
School is hard just because I’m the new kid. I’ve got friends, it’s just that it’ll take them a while before they really get to know me and get a feel for my personality. Sterling and Hannah are jumping right in and are already settled with their circle of friends. I make friends in an entirely different manner. I choose a few people to be my best, closest friends. Then, we work together to build a friendship that will last a years and years. I don’t know why I make friends like that, but I do, and it seems to work well; I’ve still got friends that I made in first grade. The downside to that process is that it take quite a while. I’m not sure how that’s going to work since I’m only going to be here a year…. On the bright side, I’m not having any trouble with the classes or the homework. I had been told that the curriculum was very advanced, and that had me worried that I would be placed in a lower level. Not so. I’ve found that Hillcrest is very similar to American private schools. In fact, besides the ridiculously strict dress code and the odd collection of different nationalities, it is exactly like an American private school.
The market is beautiful to look at and offers fun experiences, but when you really get down to hard core shopping, it becomes quite the challenge. The same kinds of items are often sold in the same general section of the market. First, you have to figure out which section you’re going to and what it’s called. This is especially difficult because many missionaries have one name for it, while the Nigerians have their own. Yesterday, for example, my mother was trying to make our driver understand where “Fabric Alley” was. This name was completely alien to him, but when mom mentioned the name of a nearby store, he perked up and said “Oh, you mean *blah blah blah*. Okay, I take you dere.” Finally, you have to pick out what you want and bargain for it. Seeing our white skin, many shopkeepers add several hundred Naira to the price. You can’t seem to eager or to desperate to buy the item, or they’ll know that you want it badly enough that you will give in after a while and pay their price for it. On top of all this, you have to make sure you are dressed appropriately (pants of any kind really aren’t acceptable) and watch your step on the cracked and eroding sidewalks. Mom took Emily and I shopping yesterday. I had just come directly from school, so I was wearing jeans. I was sooooooooo self conscious. I don’t know whether I was imagining it or not, but it seemed like little whispers were following along behind me. The actual shopping was very fun. Walking into a fabric shop is like a giant brain teaser. All the patterns are hung up so that they are overlapping each other, and they seem to blend together in a big, randomly colored blob. A very pretty blob. You have to separate them in your mind lest you be confused to the point of insanity. I ended up getting a pale green with brown stripes. It sounds weird but it’s actually very lovely.
Under normal circumstances, I too would have voted poor electricity and rusty plumbing the worse situation, but being an M.K. tweaks your viewpoints just a bit.

Camille, age 13

Evangel Compound

Internet has been down for the past week...longer than usual according to the locals.

Here are a few photos from around the compound.

Left: The future- Dr. Faeren Aboyar, my protoge'. He is family practitioner

an 18 month fellowship in ENT.

Middle: The past-Dr. Joel Anthis. He did the very hard work of establishing an ENT practice at Evangel Hospital. He was full time staff 2003-2006. He was in town for a visit.

Right: The present- Dr. Michael Mitchell.

This is one of the homes on the high security side of the compound. The drive that goes through the second security point leading to our side of the compound.

Around the hospital court yard. Family of patients live around the hospital and leave laundry out to dry on the hedge.

Hot and cold water on the general male ward of Evangel Hospital. You are looking down at two buckets. Plugged into the wall is a portable water heating element, normally used for heating tea water. No running water is available at this time.

Michael Mitchell, MD

The walk to work is a short 400 yards. I leave through our iron front doors with decorative burglar bars in the window and walk through our “yard” which is gravel and weeds. Within a few feet I pass through the large iron-grill gate to walk to work. Along the way the houses are quite modest. Our nearest neighbors are in a duplex with a rusted tin roof and rusty screens. The occupants are family practice residents and their families. I walk past many buildings and houses that have peeling paint or plaster, rusty roofs, and minimal decor. Weeds grow up here and there. There is some trash here and there. The muddy drive is more potholes than smooth road now during the rainy season. The housing side of the compound would be something akin to the other side of the tracks and a rundown neighborhood in America. Here in Nigeria, however, it is our neighborhood, filled with bright, loving, and friendly people, who also want to have a sense of security.
I walk past a security point with a barrier pole. The pole is counter-balanced with an old automobile engine block, still serving a purpose. At night the pole is replaced with 2 iron doors that have no windows. The gate passes through a cement wall with Constantine wire on top. Just a few feet farther on the right are the Chapel, the new fueling station, and a lean-to where the VVF women prepare meals over open flames. To the left is the hospital with many buildings. The ENT clinic is the newest and nicest. The other buildings have had quite a bit of wear and tear over the years. Mondays are surgery days. I move along a muddy sidewalk lined with hedges to the “Main Theatre”. The hedges are impromptu drying racks, draped with laundry of family of patients who are staying on the compound.
The Main Theatre like the entire hospital has bare concrete floors. The main open area is used for dressing changes and wound care. “My” operating room is one of two at this location. The windows are louvered glass and screens. Everything in the room shows evidence of the “Hamartan”. In the dry season, dust from the Sahara Desert fills the air and settles everywhere. Since the windows are usually open, the dust settles on everything. Efforts are made to clean the main surfaces, but boxes of sutures, cabinets and all the cracks and crevices around the devices and furniture are hard to keep clean.
August 11 was my first day as the consultant surgeon in the operating room. The patient had a severe frontal sinus fracture continuous with a depressed skull fracture, a result of a motorcycle accident with no helmet. RTA’s (Road Traffic Accidents) are very common here, where motorcycles buzz between cars and nobody wears a helmet. During the case, we did not have sufficient plating materials. We did not have a working drill at first. The lighting was not near as bright as I am accustomed to. Still, we managed and the results were satisfactory.
Tomorrow, I have clinic again. I have already had two half-day clinics. I seem to be seeing patients representing both extremes here in Nigeria. There are the worried-well patients who need no treatment contrasted with seriously ill patients with large tumors or chronic draining ears. I have yet to see someone who needed a tonsillectomy, ear tubes, or septoplasty, all of which were very common surgeries in my practice at home.
All the contrasts to life in America are blatant at this point. Life is much different in Nigeria, but I am rapidly acclimating to not only the climate, but also the culture and surroundings. I am inconvenienced often, but I have yet to suffer. I see a great need and opportunity. The people I work with are fantastic. After 12 days, I believe that my family and I will adapt and hopefully make a difference in some of the lives of people who have not been as fortunate and blessed as we have been. I know they will make a difference in our lives. I doubt I will notice the road and buildings at the end of our stay; that is why I point them out now.

Michael Mitchell, MD