Swallowing in Africa

From lauded clinician, to cancer survivor, to stranger in a strange land – Dr. Lisa Evangalista shares the journey that taught her the world is only changed when it changes you.

Dr. Lisa Evangelista is an Associate Professor and Director of Speech Pathology at the UC Davis Medical Center, Department of Otolaryngology-Head and Neck Surgery. She earned a Doctor of Clinical Science degree from the University of Pittsburgh and is actively involved in clinical practice, academic research and educational training. She is a board-certified specialist in swallowing and swallowing disorders and serves on the American Speech-Language and Hearing Association’s Head and Neck Cancer Committee and on the Board of Directors for the American Board of Swallowing and Swallowing Disorders. She provides comprehensive diagnostics and contemporary management of swallowing dysfunction following surgical interventions and radiation therapy for head and neck cancers. Her research focuses on improving functional clinical outcomes following surgical and medical treatments for head and neck cancers.
“Sometimes in tragedy we find our life’s purpose. The eye sheds a tear to find its focus.”
-Robert Brault

DEPENDING ON HOW YOU look at it, tragedy can break one’s spirit, or it can benevolently provide a magnified lens on what matters most. I was 30 years old when I was diagnosed with blood cancer, the same disease that took my father less than a year prior. Five years after receiving a stem cell transplant for leukemia, I was declared “cured.” Hearing the word “cured” was far less fulfilling than I anticipated, only to realize that my persistent worries about cancer recurrence clouded that joyous moment. Witnessing my anxiety, my oncologist posed a question that challenged me: “Rather than spending all that time worrying about recurrence, how about spending that energy on finding your life’s purpose?”

Hearing the word “cured” was far less fulfilling than I anticipated, only to realize that my persistent worries about cancer recurrence clouded that joyous moment.

That purpose was found in a serendipitous moment when my path crossed with another healthcare provider who also had a stem cell transplant. Their life’s mission was to better humanity by providing free head and neck cancer surgeries in an economically challenged camp in Africa. It was just a matter of months after our acquaintance that I was on a plane with a team of twenty volunteer healthcare providers to teach sustainable care in Kenya.





It is not uncommon to live within a 50-mile radius to a center of excellence for any number of disease processes in the United States, and we often take for granted the ease of access to healthcare we are privileged to have. It was a comfort that was juxtaposed when I arrived at the surgical camp in Kenya and witnessed innumerable patients waiting for care. These patients traveled for days by bus and train from all over Africa including Sierra Leone, Ethiopia, and Sudan without guarantee for care. However, the chance at free healthcare to manage their complex diseases, that would otherwise be unaffordable, was worth their arduous journeys.


The head and neck surgical camp in Kenya provides cost-free care to patients with malignant and benign diseases, and trauma-inflicted injuries to the head and neck. Swallowing difficulties impact a large percentage of patients seeking care at the surgical camp. When it comes to malignant diseases, the risk factors for development of head and neck cancers in sub-Saharan Africa are different in comparison to those of high-income countries. Various environmental exposures, use of Toombak products, and kola nut consumption are known risk factors for head and neck cancers in Africa. Only 5% of patients with head and neck cancer in Africa have timely access to safe and affordable surgeries due to lack of qualified healthcare providers. Limited accessibility to healthcare providers unfortunately results in larger surgical resections and more devastating swallowing dysfunction.

Only 5% of patients with head and neck cancer in Africa have timely access to safe and affordable surgeries due to lack of qualified healthcare providers.

In addition to malignant diseases, untreated benign diseases can lead to significant health burdens. In comparison to other continents, Africa has the highest incidence of odontogenic masses, or tumors arising exclusively from the jaw. While odontogenic tumors are common in the United States, prudent access to dental care proves to be the dichotomous denominator. With limited or absent access to dental care in Africa, these odontogenic tumors often increase in size and impact speech, swallowing, and aesthetic appearance. Large surgical resections are required to manage these benign tumors and can result in patients needing swallowing rehabilitation.

Developing a swallowing educational program in Kenya is an undertaking that allows me to give back to humanity.

While malignant and benign tumors account for majority of head and neck surgeries in Africa, pervasive economic distress has led to an increase in trauma-related injuries. Eldercide, or the unjustifiable killing of persons over the age of 60 years, is unique to the coastal regions of Kenya. The competition for limited resources in Kenya spurred tensions between younger adults and the elderly. Jealousy over generational financial differences motivates younger adults to accuse the elderly of performing witchcraft that has led to drought, crop failure, or livestock deaths. While masked in witchcraft accusations, violent acts against elderly – typically in the form of beheadings – are motivated by regional economic distress, with younger adults seeking to profit from the property of slain elderly individuals. If an attempted beheading is survived, and surprisingly many do, significant trauma to the head and neck can result in long-term swallowing dysfunction.





What I witnessed in that head and neck surgical camp was nothing short of life changing. Entrenched in caring for patients in a limited resource environment, I became keenly aware that it was not solely the patients benefiting from our volunteer services. Working in a resource-constrained setting opened my eyes to the innovation, grit, and dedication that the Kenyan healthcare providers have when it comes to advancing their medical practices. Currently, there are no formal training programs for swallowing sciences in East Africa. With each volunteer trip to Kenya, my curiosity grew about ways to develop sustainable care for patients with swallowing disorders. Together with Kenyan clinicians, we discussed barriers to receiving proper education for swallowing disorders and how collaborative efforts between clinicians from the United States and Africa could navigate those challenges. These conversations led to ongoing momentum towards development of formal education in swallowing and swallowing disorders.


Starting from teaching basic anatomy and physiology one year, to diagnostics and treatments of swallowing disorders the next year, the cohort of Kenyan healthcare practitioners learning to provide care for swallowing disorders grew. My purpose shifted from worrying about my own cancer recurrence to figuring out ways to improve the education of swallowing practitioners in East Africa. Developing a swallowing educational program in Kenya is an undertaking that allows me to give back to humanity. Global outreach has provided an opportunity to close the chapter on what was holding me back and refocus on what is important in life.


As Ralph Waldo Emerson said, “To win the respect of intelligent people and the affection of children, to earn the appreciation of honest critics and endure the betrayal of false friends; to appreciate beauty, to find the best in others, to leave the world a bit better whether by a healthy child, a garden patch, or a redeemed social condition; to know even one life has breathed easier because you lived. This is to have succeeded.”


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