A Visitor From Afar

My wife looked at me incredulously, eyebrows raised.
“Yes, that’s where the email came from!”

One could hardly blame her.
Every day we hear of email scams from Burkina Faso and other places.
Yet, I sensed there was something genuine about this email.
3 trips to East Africa had left me with a lifelong love for the continent, its diversity as well as a lasting respect for African people.
Oh yes – and the wildlife…..
But all that’s another story.

And that was how I got to know Mr Emmanuel Onwubiko, a journalist from Abuja, Nigeria.

He had long had difficulty with his breathing, attributed to asthma in his home country.
One day, he found himself in London and visited Professor George Santis, a Respiratory Physician at London Bridge Hospital.

“Mr Onwubiko, you do not have asthma,” came the answer.
“Your breathing difficulties are caused by an enlarged thyroid gland pressing on your trachea (windpipe). You need surgery to remove your thyroid gland.”

“You will need an experienced thoracic/head and neck surgeon to perform this procedure.”

An exchange of emails followed.
Emmanuel was keen to have his operation over and done with as soon as possible and planned to travel here with his sister Francisca.
Their travel visas required a letter from Nigeria’s National Drugs Law Enforcement Agency (NDLEA) as Francisca was travelling on a “virgin passport”. They were asked to wait for 2 weeks before they could collect their travel documents.

2 weeks??
For someone with difficulty breathing?
So I wrote to the Malaysian High Commissioner in Abuja to explain the urgency, adding that this was no bad thing for the Malaysian Health Tourism initiative.
To his credit, things moved briskly after.

Emmanuel and Francisca were to travel from Abuja to Dubai, then to Kuala Lumpur before boarding the last flight that day to Penang, a total distance of over 10000 km.
They were due to arrive at 0100 am.

At Dubai a big sandstorm forced delays to all flights. That meant missing their connecting flight to Penang. A flurry of SMSs through the night saw them both arrive in Penang over 9 hours later. They had been travelling for over 31 hours.

That was how they found themselves seated in my clinic later that day, tired but relieved.
A well built man in his forties with wisps of grey hair, Emmanuel’s quiet exterior concealed a sharp, intelligent and knowledgeable mind. He introduced himself as a journalist, author & activist, pushing for human rights. The strong silent type, he was also very decisive and articulate.
Francisca was warm, effusive and beamed sunshine.
I took to both of them immediately.

The next few days would be spent doing routine tests. I had to repeat his CT scan as London Bridge Hospital had not provided him with the images.

The thyroid gland can become enlarged for a number of reasons. One of the most common, a condition known as multinodular goitre sees the gland replaced by multiple nodules. It is a degenerative condition of the thyroid gland and multinodular goitres can grow very big. The largest I have encountered was almost 1kg in weight!
The problem comes when the enlarged thyroid gland grows into a space known as the thoracic inlet. This is situated at the root of the neck and is a rigid space formed by the collar bones (clavicles) in the front, muscles at the side and the spine at the back. Through this space passes muscles, blood vessels, the windpipe (trachea) and the gullet (oesophagus).
When the thyroid gland grows into this space, it squashes the surrounding structures, especially the trachea and the oesophagus. This leads to difficulty breathing and swallowing. It can sometimes squeeze the trachea, normally 1.5 – 2cm in size to as small as 5mm.

CT scan showing thyroid gland compressing trachea

Removal of the thyroid gland is necessary but in long standing cases, the tracheal cartilages go really soft. This is known as tracheomalacia and it can lead to the windpipe collapsing shut after removal of the thyroid gland!

Sometimes, the portion of the thyroid gland in the chest is so big we have to split the sternum (breastbone) like open heart surgery just to get it out safely.
And all this was in addition to the other known risks of thyroid surgery – loss of voice (due to injury to the recurrent laryngeal nerve) and low calcium levels (injury to the parathyroid glands).

This was what Emmanuel faced.
As he was from far away and repeat surgery would be more difficult, I advised total removal of the gland.
I warned him about all the potential risks of the operation (including tracheomalacia and the possibility of needing to go into the chest) as well as the need to take replacement thyroid hormones for life.

So we went ahead.
I was keen to make sure everything went well.
In the end, we managed to remove it from the neck without having to split the sternum and go into the chest.
His voice and serum calcium was completely normal afterwards.

“He’s OK, everything went well…..” I informed an anxious Francisca waiting outside the Operating Theatre.
“Thanks be to the Lord! Praise Jesus! Thanks be to Jesus!” she exclaimed, throwing herself prostate upon the floor, rolling over and over.
“No need! ….No need!” I added hastily, unaccustomed to this outpouring of emotion.
A man emerged from our Surau (Muslim prayer room) nearby, stared briefly at us then hurried on his way.

His recovery was pretty unremarkable (which was exactly what we’d wanted).
We spoke several times about many things – Penang, Nigeria, Boko Haram, Ebola (Nigeria was declared Ebola free on 20 October 2014 and has been held aloft by the WHO as a shining example of how to beat Ebola), ex President Goodluck Jonathan, etc. The nurses were thrilled to be looking after someone from so far away.

Emmanuel Onwubiko’ book (front)
Emmanuel is a very accomplished writer and activist!

The day finally came when we had to part ways.
He presented me with a signed copy of the book he’d authored. We took some pictures.
He thanked me but in fact, it had been a great privilege to treat him and make 2 new friends.
I’m not sure if I’ll ever see him again but would sincerely love to, if only for tea and a discourse on human rights, Nigeria, Malaysia and the rest of the world.
And if I ever find myself in Abuja looking at Aso Rock, I’ll know exactly who to visit for tea.

Posted 20 April 2015


I got to know about Gleneagles Hospital Penang, in Malaysia from my younger brother Chukwuemeka Onwubiko who did his post graduate program in Malaysia. I then visited the hospital from Nigeria to meet with Doctor Khoo who as I learnt from my research on the internet is an expert in thyroid related problems. After my diagnosis in London Bridge Hospital in the United Kingdom in mid February 2015 and was told that I needed to undergo a surgery to remove a multi-nodular goiter which has inhibited my breathing and swallowing for many years. In early April 2015 I and my sibling Francisca Onwubiko left the shores of Nigeria to travel to Penang, in Malaysia to consult Doctor Khoo Saye Thiam.

After our meeting with Doctor Khoo and the operation done and having just arrived Abuja, Nigeria I can state that I am happy for now to have been through with the procedure and I pray that my current recovery becomes completely successful. I am indeed happy to find a group of hospital workers far away from Nigeria who are so friendly and professional in the ways and manners they attend to their patients. Thank you Doctor Khoo. I will provide further and better narrative soon on the progress of my recovery in Nigeria in line with the prescriptions offered me.

Emmanuel Onwubiko; Professional Journalist/Author and civil Rights activist.


With Emmanuel & Francisca Onwubiko


Aso Rock – someday I’m going to go and see it!