Breast Cancer Mass

A woman in her mid-thirties came to BMC with a large tumor of her left breast which she said had been growing for only 5 months. The mass was so large, in fact, that she wore a cloth like a sling to help manage its weight. There were no external wounds. The nipple and areola (the area around the nipple) were flattened and stretched out. She had enlarged lymph nodes in the axilla (armpit). She had no difficulty breathing and her lungs sounded clear with good air entry. She had no signs of distant metastatic disease.

I performed an ultrasound and found that inside were areas of solid mass and pockets of fluid. Clinically, the tumor appeared to be what is called a Phyllodes tumor or cystosarcoma phyllodes. These tumors can grow very rapidly. Some of these tumors are benign, some are malignant. Either way, the only treatment I could offer was a mastectomy.

After discussing the risks of surgery versus the benefit of a mastectomy, the patient agreed.

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Encounters with Ghana’s (Not So) Sexy Spanish Fly

This post started out as a simple post about the annoying blister bugs we have around our home in northern Ghana. On many occasions they have caused horrible blisters on Heidi and myself and I wanted to learn more about them. I got lost for hours following rabbit trails as I research the subject and it just continued to get more and more interesting. Nothing is ever as simple as it seems. And I kind of love that.

Northern Ghana’s Green Blister Beetle

Lytta vesicatoria

My first step is always to find out what the locals call it. No one I talked to was familiar with the phrase “blister bug.” This particular bug – actually a “green blister beetle” – is known locally as abdulatanka. That’s not a word in an indigenous Ghanaian language but Pidgin English for “Abdullah’s Tanker” – a reference to a Muslim guy driving a fuel tanker. Why? Because the green blister beetle leaks a toxic fluid and has a tanker-shaped back side. Plus the stereotypical big-rig driver in Ghana is a Muslim man with an Arabic name.

There’s a whole scientific family of blister beetles name Meloidae with around 3000 species. One genus in that family is Lytta and the offending blister bug in our encounters seems to fall in that group. Read More

Rainy Season in Nalerigu


In the past several months, I have operated on three six-month old babies for intussusception. Intussusception occurs when the bowel telescopes into itself and cannot exit back out again. Once the bowel is stuck, it begins to swell, the blood supply to that portion of the intestines becomes compromised and it can lead to strangulation of the bowel.

In infants, this disease process often occurs when the lymph nodes become inflamed around the junction between the small and large intestines. The infant has episodic abdominal pain, bloody-mucoid stool, and sometimes an elongated mass can be felt through the abdominal wall. The ultrasound finding is called a “target sign” due to the multiple layers of intestines and the edema in the bowel walls.

Sometimes, if intussusception is caught early enough, a pressurized enema (given by interventional radiologists) is all that is needed to reduce the bowel back out. Here, we don’t have that specialty, therefore, surgery is the only option for treatment. Sometimes, it only requires a little manual pressure to push the bowel out, but more often than not, a resection of the affected bowel is required.

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Ghana’s Historic Mosques: Larabanga

This is one of a series of posts about Ghana’s only six remaining historic mud mosques built in the Sudano-Sahelian architectural style.

The history of the mud mosque in Larabanga is difficult to distinguish from the many myths about it. Its fame and popularity probably owe a lot to the appeal of the mystery and magic in those fascinating legends.

The Many Myths of Larabanga Mosque

Oral and some written historical accounts regarding the founding of the community of Larabanga indicate that it was by a man named Ibrahim Braimah. He was a powerful mallam who came to the region in the 17th century with the Malian invaders that established the Gonja Empire in present-day Ghana’s Upper West Region.

You’ll sometimes hear that the Larabanga mosque was founded in 1421 instead of 1600s and the claim that it is the oldest mosque in all of West Africa. This idea comes from another oral account of an Islamic trader named Ayuba had a dream while staying there instructing him to build a mosque. He awoke to find the foundation of the mosque already constructed. The challenge comes where elements from that oral tradition begin to duplicate and/or conflict with the stories surrounding the mallam Braimah.

Legend has it that after the war in the late 1600s, Braimah threw a spear and determined that he would settle wherever it landed. It traveled through the air and landed on a high spot that seemed unnaturally bright. It was there that he built the mosque and his home. He named the community that sprung up around him “Larabanga” meaning “Land of the Arab.” Read More

Gbariga yɛli, ni, ba wukkim u ka u nya la bunni din kyɛnni sa, ka pa bunni din wa na.

The cripple says, they should lift him up to see something which is headed away from him but not something which is coming towards him.

Mamprusi Proverb