Ghana Diaries – Homeopathy in the Field (Part 1)

by Richard Pitt

I had a call last night from the clinic as one of the people there had excruciating pain in the rectum, forcing him to bend double. It came on when he strained for stool and since then has been unable to go. The pain is stitching and is felt in the rectum. At its worst he was rolling in pain on the ground. I gave Colocynth 1m. After taking the remedy he had a slightly bloody stool and some relief. We suspected he had piles but there was no sign of that. He had a feeling as if his anus was becoming prolapsed with the pain. In the morning, I spoke to him again. He slept OK in the night but now is still in pain, which is worse when he feels the need to defecate. He still can’t go again. The pain is still there, but not so bad. I felt that the remedy may have taken the edge of the case, but not gone all the way. All I know of the person is that he is a soft spoken, quite gentle young man. He had apparently been beaten a lot as a youngster by his teachers and hence is quite nervous at times if challenged. So I gave him Staphysagria in 200c. Soon after he began to feel much better and he had a normal stool later that day.

I saw some more patients the next day at the clinic area. One man in his 60’s came to see us. He complained of an intention tremor in his hand, which means that when he does things or holds objects he gets trembling in his hand (extremities, trembling, holding objects on) and he gets jerking in his legs and arms when walking. This all started after he had a stroke which caused him to have paralysis of his legs (extremities, paralysis legs, apoplexy after). I gave him Nux vomica LM 1, based on the paralysis and the jerking. This was all there was to the case. At times it’s possible to get more constitutional symptoms and at other times, there is little more to be gleaned. Also, if there are many people to see, one has to be able to prescribe quite quickly. Every now and then, a case demands much more attention and a more nuanced case taking has to happen but at other times, it is not possible.

Tonight, as I try and work on writing a curriculum for the course we hope to get going here, I am interrupted by my neighbors, knocking on my door, calling me. “Uncle Rich” as they call me. My young neighbor’s mother is not well so I go and see her. She hasn’t been able to go to market for 2 out of 3 days. She is just sitting there, saying she is having a headache, some pains in the body and fever. It is hard to know if fever here is malaria or not. Often fevers are treated as malaria, even if it is not. In other words, all fevers are malaria. But one doesn’t want to leave the fever if it is malaria. All I can get out of her is that she has a pounding headache and she had a salty taste in the mouth. She had pain in the back, neck and chest. No cough, no apparent fever when I felt her head. The main thing is that she just seemed so sad, just sitting there. I had nothing else to go on so I gave her Natrum mur 30c. Another neighbour is hobbling around, saying that her ankle is hurting her. She has been like that for 3 months and the only thing she can tell me is that she jumped off something and injured her ankle in 1983 and her injury has “come back to visit me,” as she said. I gave her Arnica 200c and we’ll see what happens. I will follow with Rhus tox if it doesn’t work. Another day in Ghana.

Four days ago, a young woman in my compound died. I don’t think I knew her as she was apparently often sick, and either inside her house or at the hospital. Apparently she was about 20 years old. The first I knew of this was the sudden wailing of women when they were told the news. I asked my friend’s children in the compound about her but they seemed strangely vague and unmoved by it. “Were you friends with her,” I asked. They said yes but then didn’t say much more and I got the impression they were not that close and that perhaps she hadn’t been around much for a while. When I asked what she died of, they said it was typhoid, but that probably means that don’t really know. Typhoid is quite common here, like malaria and so many diseases are simply put down to one of them. I will have to ask one of the adults more about it. 

I have seen this before when asking patients what they parents, siblings or children die of, and often they don’t seem to know. I’ve had people say things like “stomach pain”, “headache” or “fever.” They often don’t know and it seems that in Ghana doctors tell patients very little about what is going on for them or for their relatives. Apparently, it is common that if you see a doctor and they do tests, they may prescribe a medicine without telling you what it is and if you ask what is wrong, they will shout at you to just take the medicine and don’t ask questions. 

I recently read a great book on Africa called The Scramble for Africa by Thomas Pakenham, describing the colonial land grab for Africa in the late 1800’s and he described the fatalism around death that many Africans seemed to have then, that there is this inevitability to it and when faced with any illness, there is a tendency to simply lie back and wait to die. This may partly explain some of the reactions to HIV/AIDS in Africa when people simply stop eating and fade away. It could be a combination of the disease and the cultural/psychological attitude to it, including the mere stigma of being diagnosed with the disease, which can be a death sentence in and of itself.

I have just returned from the 90th birthday of my Ghanaian friend’s mother. Around 300 people gathered at her home for a massive party, everybody being fed and many men using the opportunity to drink a lot of whisky and other spirits, starting early on in the day. I had the opportunity to treat a couple of people there. Relatives and friends just came up to my Ghanaian friend and started telling us about their condition. One person brought her mother, around 60 years old who was suffering acute anxiety attacks. Two to three years ago, she was knocked down by a bike and hit her head. It seemed not too severe as there was no fracture or concussion but since then she has episodes of acute fear with trembling and a feeling of great weakness in her body. These attacks come on two to three times a month and if bad can last about one week. At other times, she can seem fine. When it’s bad, she can scream and shout and say she is going to die. She doesn’t like to be alone then and is very restlessness. It can be worse at night. She appears as extremely distraught, throwing her arms around. She can feel as if very hot and is restless a lot of the time. 

Since the accident she has also become more anxious about business things. She used to be a successful business woman and was responsible for supporting other members of her family. She used to be very strict about her work, very particular and conscientious. She would be generous but exacting. In the last year, she rented out part of her property to another woman and now she is paranoid that this woman is going to steal her property from her and that she has it in for her. (It is still a common belief that people can be hexed in some way by other people, that bad spirits can be used to get back at people) She is totally distraught about this and when she is having an anxiety episode, she becomes even more obsessed about this. She thinks this woman is out to get her but she is having great difficulty asking this woman to leave once her contract is finished.  Before one year, she never thought these things of other people, including this woman. It seemed to come on gradually over this time.

So, in this case we discussed a comparison between Aconite, Stramonium, Hyoscyamus, Gelsemium, Arnica and Arsenicum album. The etiology of shock, fright with fear of death mostly clearly resembles Aconite, but Gelsemium has to be considered, especially with the trembling and both Stramonium and Hyoscyamus are possibilities for the fright, the fear of being alone and the paranoia. Arsenicum seems to be the most clear remedy underneath for the more constitutional symptoms and also what is happening now with the paranoia that this other woman will take her property away and after having been very exacting and conscientious and financially prosperous in previous years. So, we decided to go with Aconite to begin with. All we had were LMs so she is on LM1 and we will consider following it with Arsenicum album.

One other case was an elderly man who complained of being unable to walk for more than 5 minutes as he gets a weak numb feeling in the right hip which extends down the leg accompanied by an aching pain. I asked him what the pain felt like and all he could say is that it was like being hit by something. I asked if anything else happened before this happened, and eventually he revealed that a little while before these symptoms began, a large brick fell on his toe, which went black and the nail eventually fell off. He felt as if he could lose the toe as it looked gangrenous. So based on this, I gave Arnica and after this Hypericum could be considered.  Obviously Arnica is indicated for the etiology, the pain as if being struck and even the fear of it becoming gangrenous. We shall see what happens. 

We just returned from the rural area about 3 hours outside Accra where we are supporting a homeopathic clinic which is part of a larger clinic offering health care to a number of villages in the region. Even though it’s not far from Accra, there is still no electricity in many villages, including the village where the clinic is. From there, we take a battered old Land Rover, which is at least 25 years old and travel to many other villages, over rutted dirt roads which are often impassable in the rains. Many of the villages are therefore cut off from any larger communities and people often have to walk many miles to get supplies or if they need health care. Even when the roads are passable, there is little public transport for people so often we get people walking 5-10-15 miles to come to the clinic. We are now trying to get out to certain villages and see patients from as many surrounding villages as possible, so our outreach is as broad as possible.

At the clinic itself, people come in for care at all times. It could be a pregnant woman about to have birth, a person who has been injured falling off his motorbike or all sorts of other conditions. Often the clinic is visited by a nomadic people from Nigeria called the Fulani, who wander across the country with cattle, looking for land to graze on, and then moving on. They mostly don’t speak the local Ghanaian languages and so case taking is rather primitive and often one has to prescribe on little information. These people dress in very colorful robes, have great hairstyles and are quite feisty in temperament. They are mostly Muslim and the men can often be seen praying. They are generally tall and thin and look very different to the local Ghanaians. 

The other day at around midnight, a patient was brought to the clinic with pain in his abdomen. He was lying on a bench writhing in pain. It had come on a few hours earlier. He had not eaten anything different to normal and the pains had some on suddenly. He seemed in excruciating pain, centered around the umbilical region. We took him inside and examined him, obviously looking for any signs of appendicitis. He said the pains were better from pressure and sometimes would make him bend double. However, most of the time when he was with us, he was lying out flat on his back or side, often tossing and turning and groaning in pain. Based on the severity of pain and the amelioration from pressure, we gave him Colocynthis 200c. it was given only one time, dry under the tongue. Within one minute he stopped writhing in pain and groaning. He simply lay there, much more quietly. He said to us that the pains were getting better. We stayed with him for another 15 minutes. Apart from a very brief relapse for a few seconds, he remained much relieved, the pain significantly better. We then left him on the bed and came back in about one hour. He was feeling much better by then, so we said he could leave and gave him a few extra doses of the remedy, to be taken only if the pains returned. We heard the next day he was fine.

The following night, a woman came in, also with abdominal pains. She had eaten fried chicken that night, and now a few hours later, she had a lot of pain, again around the umbilical area but also lower down. The abdomen was very tender to touch but there was no rebound tenderness. She said the pains were sharp, like a knife, and were much worse from motion and walking. Even taking a step aggravated the pains. Initially we gave Bryonia 200c based on the pains being worse from jar and any motion. However, after 20 minutes there was no real relief so we gave Nux vomica 200c, one dose. Within one minute she said she felt a change and the pains felt somewhat better. We then stayed with her another 15 minutes, and she had fallen asleep and was resting. We left her in the bed at the clinic and came back one hour later. She was feeling much better by then and so we said she could go and gave her a few doses of the remedy to take with her. She also was fine the next day. 

We had another case of an elderly woman who complained of sciatic pain which she had had for one month. It made her limp and the pain extended down the right leg to the foot. The main other symptom was that her right leg was numb below the knee. The pain in the leg was both sore with some shooting pains. Based on the keynote of numbness with the sciatica we gave Gnaphalium in 200c. She took one tablet a day for 5 days. Within one week, she said she felt 80% better. Although she was still limping some, she was able to walk much better.

When taking the case of many of the women, it is amazing how many children they have had and also how many of them have died. It is not uncommon for a person to tell us that they have had 10 children but 3 or 4 of them have died, and often, as I’ve mentioned before, they can’t tell us how they have died, of what disease or condition. Many of them state these details in a matter of fact way. There is an acceptance of these harsh realities of life, a kind of fatalism that this is the way of things here. However, most of these people probably needn’t have died, and it is simply the lack of medical care and the incidence of diseases like malaria and typhoid that account for a lot of deaths. There must be many other causes of preventable death as well, but life in Africa is tough. It is true that the strongest tend to survive. People can live to a ripe old age here and look in far better shape than most elderly westerners. Their diet is simple but in spite of the limited nutritional value in some of their food they survive quite well on it and the level of physical activity in their lives also keeps them healthy except for the arthritic conditions which comes from repetitive physical work in the fields. 

One of the most serious conditions is high blood pressure and consequent strokes. We nearly always take people’s blood pressure and quite a number of them are really high. This is partly genetic but it is also not helped by the large amount of saturated palm nut oil which is a staple in their food. If very high, these people are put on blood pressure medications as the risk from stroke is high. Also, getting people to modify their diet is often not an option. People eat the same thing every day and the oil they use is cheap or free and it is not easy to talk about not putting it in their food so much. People eat together so one person can’t really decide to radically change their diet. 

Their staple food is either fufu, banku or kenke. Fufu is made from plantain and cassava, whereas banku and kenke are made from maize and often cassava as well. Some banku may only be made from maize. Cassava is the most widely cultivated crop in many rural areas, especially in the south of Ghana, and the process of cultivating it and making it into a form to mix with banku is very laborious. However, its nutritional value is quite limited, especially protein, so in many ways it is not a good staple to use. Maize also is not the most nutritional of foods. The way it’s made in banku and kenke is a thick, pasty doughy, heavy dumpling, which they have with peanut or okra soup, often with dried fish in. Africans like their food heavy. Often they say they don’t feel they have eaten unless they have had this type of food which really fills them.

We saw a 4 month year old child in one clinic who looked very malnourished. She was the youngest of 4 kids in a mother no older than 28. she had chronic diarrhea. The mother was feeding her but there was not enough milk but the local doctor was not advising any supplementation at this time. We discussed that she should introduce some very simple food, like soupy millet as there was definitely not enough food going in, compounded by the chronic diarrhea. I asked what the diarrhea was like and the mother said it was mostly watery. I asked about the color and was told it was green. What type of green I wanted to know and was told it was bright green. Now I was suspected a remedy and so I asked if it tended to look like frog spawn. I was told yes, it does. So now I think I know the remedy. I ask the mother how she felt when pregnant with this child. She said it was a surprise to her. She was not happy at first as she already had 3 children and had very little money and so a fourth child was a great challenge for her. At this point, I felt sure that the remedy was Magnesium  carbonicum. The chronic diarrhea, failure to thrive, the green stool and the struggle of the mother to accept the child and have enough milk all led me to think of this remedy. 

The next day we were in another clinic, 2 hours away with a local pastor who is learning homeopathy. This clinic is very near the Togo border and we had to take the main road to Togo – which is under serious construction and is very dusty and without tarmac for many miles – to get to the clinic. We drove out to a village outside of where he lives and sat under a tree and waited. The first woman who came complained of numbness of the feet, especially the sole and pain in the hip. Her leg movement seemed impaired and she stumbled some when walking. She was 55 years of age and was a farmer. That was the case. We couldn’t really get anything more of relevance from her. We compared Causticum, Cocculus and Conium and chose Conium in the end. We wouldn’t sure of the pathology but it is possible due to wear and tear of work in the fields. It could be the beginning of multiple sclerosis. But Conium has the strongest affinity for numbness and impending paralysis, especially in the absence of any characteristics to help justify the other remedies. It was an example of what I call “default prescribing”, which is a method of having to decide which is the most likely remedy based only on limited information. In the absence of more information to justify any remedy in a case, what is therefore the most likely remedy one can give. This type of analysis is surprisingly common and is not so random as it may seem. There is logic to it as one is always dealing only with a limited amount of information and one only sees a slice of information on any remedy in a given case. So, knowing what the most likely remedy to give based on the unique selection of symptoms in a case is one of the necessary skills for a homeopath. In this case, it would be good to have a little more information to be more confident but we shall see.

We then saw a case of a woman with pain in the leg with lameness. She described the pain as a feeling as if the bone was broken. It is worse from using the leg too much. Although she was only 45 years old, she feels it has come from working too much in the fields. Based on the broken bone feeling and the etiology of strain, we chose to give Ruta graveolens 30c. 

An 80 year old woman came with itching of the skin, intense itching but with no eruption. She also had some numbness of the feet. I suspected Alumina and I asked about her stool. Lo and behold she told us that she had constipation and the stool was like balls, which is a keynote of Alumina. 

A 45 year old woman came with weakness in the back which is worse stooping and she has numb hands. She said she gets anxious and can’t sleep which is always worse from bad news. A nice mental symptom. So, with the aggravation from bad news and the general back symptoms, we chose Calcarea carbonica 30c.

The next day, we were at another village, under another tree and waited there for quite a while. Although the word had been put out that we were visiting the village – a person goes around the village with a bell making the announcement, the only people meeting us there were hordes of children. So we waited about one hour till a man passing asked us what we were doing and after we explained, he asked for his case to be taken.

So, he told us he had an intense eruption and itch in the groin, between the testicles and the thigh. He has to scratch it intensely until it is raw and is < after bathing when it becomes dry. he also said he can feel hungry yet have no appetite, food being tasteless. He said he had low sex desire, only wanting sex once every 2-3 weeks. He had weak erections. In his history he had a goiter removed. He said he is sociable and easy going and if people ask for his advice, he tells things as it is, very matter of fact. I was suspecting a remedy and it was confirmed when I saw he had a keloid scar on his neck and also he showed me a large keloid on his chest. So, we gave Graphites, I think in LM potency. The combination of the keloid scar with the nature of the eruption and position of it, plus his basic nature and telling things as they are, matter of fact like all indicate Graphites.

Next we saw his wife, who came with cramping of the calf, which is worse night in bed. Eight years ago, she had a swelling all over her body, with puffiness and with headache, weakness and breathlessness. It is > now, having taken local herbs for a long time. She gets some heartburn with hiccough after eating. She can be fearful and easily startled from sudden noise and she can feel suddenly guilty and feel she has done something wrong. She feels cold a lot (even in the intense heat) and wants to bathe in hot water. I suspected a remedy and asked her how she feels around people arguing. She said “it’s my job to stop it.” She then explained how in the village she is always the person to get in the middle between people arguing that she will go between people as she doesn’t like seeing people argue. This confirmed for me that she needed a Magnesium remedy and I chose Magnesium carbonicum as she mainly had stomach symptoms as well and Magnesium carbonicum is particularly chilly. 

The next day we had a beautiful Kali carbonicum case in a woman with back pain that she said extended down her leg and especially to her knee.  This pain she said was always < before menses. Well, that was it, but when we looked at her, we could see this strong, forceful, opinionated woman. She definitely knew black from white!!