Intussusception

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.

** WARNING: GRAPHIC IMAGES **
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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

Three Month Kids’ Update (Photo Gallery)

We end up with a lot of individual photos of the kids that don’t particularly deserve a blog post of their own. So now’s our chance to dump three month’s worth of photos on you. Here you go! Read More

Removing a 7kg Ovarian Tumor

After several months of noticing that her abdomen was increasing in size – looking like she was pregnant but knowing she was not – my 16 year-old patient finally presented to the hospital with abdominal pain.  She was admitted by the medical assistant with the presumed diagnosis of a typhoid induced ileal perforation. One look at her abdomen and I knew that it was a more chronic problem that was causing her pain. Instead of a generalized distention and tenderness of the abdomen which comes from having intestinal contents pouring into one’s abdominal cavity, she looked more like she was 6 months pregnant. On examination of the abdomen, I could feel a large mass that moved when I pushed it and then bounced back into position. The mass was tender. Otherwise the patient appeared healthy. We did an ultrasound to confirm our suspicion and found a large mass with both solid and cystic components. We explained her condition to her and asked for her and her family’s consent to take her to surgery.

** WARNING: GRAPHIC IMAGES **
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A Jingle from Ghana’s Famine of ’77

Forty years ago, Ghana (and much of West Africa) was suffering under a famine. Starting around 1970, the Sahel Drought brought a dramatic change in rainfall and crops began failing year after year. By the late 70s, it was a serious crisis and the people of northern Ghana were suffering horribly.

This all came to my attention recently when a Mamprusi friend shared an jingle he remembered from his youth:

Alikaama zamaanni, Baba yi kyɛŋŋi Gambaga
Alikaama zamaanni, Baba yi kyɛŋŋi Gambaga
“Baba, kulim ka labi na, kyɛm ka labi na”
Ka Baba gyɛ suuri.
“Kulim ka labi na, kyɛm ka labi na”
Ka Baba gyɛ suuri.

I asked another friend who lived in Gambaga at the time if she was familiar with the tune and she sang it for me to record.

It translates to:

At wheat time, Baba went to Gambaga,
“Baba, go home and come back, go and come back”
And Baba was ticked off.

They both recalled how in 1977-78 the government promised food relief and rations of wheat to the starving people of Mamprugu. They would head to Gambaga, the district capitol, for the handouts but they were disappointed over and over at the lack of aid.

One friend recalls that they hired the youth to unload the grain from the trucks. She would haul huge heavy bags all day long until the trucks were empty. Then they would pay her in grain. It was just a small bag that she’d receive but she recalls being happy because they were so desperate at the time. Read More

Animal Names in Mampruli Medical Terminology

We often forget that the fancy medical terms we use in English usually have their roots in Latin and Greek and are actually just simple descriptors. Epilepsy is a classic example coming from the Greek epilēpsia, which is comprised of epi ‘upon’ + lambanein ‘take hold of’.

Mampruli also does that with several sicknesses. For example, stomach issues are described as pukpeeŋŋu  – literally, “hard stomach” – and malaria is called dunsidooru or “mosquito sickness.”

There are also several diseases that are simply named after creatures believed to either cause the illness or that reflect the disease’s symptoms. In traditional African medicine, the preventative and/or curative measures can also be influenced by the animal namesake of the sickness. Read More