Guns play an important part of life among the Mamprusi and many other ethnic groups in northern Ghana. All the major cultural festivals involve guns being fired. But it might be more accurate to say that guns play an even more important role in death.
When a Mamprusi man dies, three gunshots are fired to announce the news to the community. A deceased woman receives four shots. During funeral observances – especially for important elderly members of the community, many rounds of guns and mortars are fired.
Making black powder 
Firing a gun over a grave at a funeral 
Kambonsi shot guns at Nalerigu’s annual Fire Festival
These guns being fired are not your typical, modern manufactured weapons. They are all homemade guns that come in all sorts of shapes and sizes. They are always muzzle loaders and usually look like single barreled shotguns. Problems arise when those in the firing squads get a bit overzealous and pack too much gunpowder down the barrel.
Our hospital sees its fair share of gun-related injuries. The more of these cases have to do with these DIY weapons exploding in their owner’s hands instead of people being hit by gun shot. Gun owners come in with horrible wounds to their hands that usually require the amputation of fingers.
With Bugum Toobu (Fire Festival) approaching in a few days, we thought it appropriate for Heidi to discuss some of the gun traumas she has dealt with at BMC.
When patients come in with fresh gunshot wounds of the hand, the main goals of treatment are to promote healing without infection and to maximize function. Often, the wounds are dirty and the tissues lacking blood supply begin to die.
First we irrigate and clean the wound. Then the dead or mangled tissue is removed (debrided). Fingers that are partially amputated due to the trauma are assessed for potential of future function. Sometimes, if the finger is not severely mangled, it can be realigned and sutured. Even bones can be set with pins.
Often, the blood supply is damaged beyond repair and the only option is to complete the amputation. If there is any hope for function, we will give it some time and see if it is viable or non-viable.
If there is a major wound of the palm of the hand, I will leave a rubber drain in place to allow drainage of fluid and to reduce risk of infection. The patient undergoes daily dressing changes until healing is complete.
Areas that lack full skin coverage may eventually fill in the gap with new skin, or a skin graft may be performed to speed recovery. The function of the opposable thumb gives the patient the best advantage, but any functioning fingers are better than none. Conversely, not amputating fingers that lack sensation or ability to move will give the patient a “dead weight” that often just gets in the way.
I have been very pleased with the end result for many of these injuries in which the patient is able to maintain some function of the hand. I just wish they were more careful with their guns and didn’t have to come see me in the first place!