November 22, 2009

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. She 24 years old. The first I knew of this was the sudden wailing of women when they were told the news. I asked my children friends 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. It is an interesting study to look at the cultural susceptibilities to various diseases and how the same diseases may manifest differently in various cultures and countries.

When AIDS first hit the west, the effect was sudden, violent and acute, similar to the way Syphilis first affected people in Europe back in the late 1500’s. But soon, Syphilis became a chronic disease, similar to the way AIDS has. Syphilis in fact became much more of an epidemic disease than AIDS did, but the issue around AIDS is complicated by the theories of contagion. The theory is that contaminated polio and hepatitis B vaccines, which had monkey viruses in them,  spread these viruses to humans.

However, in Africa now, AIDS is expressing a different phase of the disease, and although it is debatable whether the number of AIDS cases as cited by WHO and others are true – how can they really know, what with all the other diseases and the lumping of them together with TB and Malaria – the fact is that it has manifested in a unique way here, often with people simply seeming to give up the fight.

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.

This was about all we could get from her. So we discussed the case, looking at the etiology of shock, fright and now the acute episodes of fear, especially as if about to die and of being alone and great restlessness, and now the underlying paranoia and deep insecurity, which is in contrast to how she used to be before when maintaining a successful business and being quite on top of things. My friend has spent some time with the Indian doctors from Calcutta who tend to focus much on mental/emotional etiology if it is  there and are much less influenced by the “constitutional” approach to prescribing. They tend not to use the repertory but have a great clinical knowledge and they know Allen’s keynotes backwards. They say that Allen’s keynotes is the most essential symptoms taken from Hering’s Guiding Symptoms and along with Phataks’s materia medica, is the main source of remedy information. They feel Kent’s approach is much too influenced by Swedenborg and taken away from Hahnemann’s original thoughts. They often cite Aphorism 221 in which Hahnemann extorts the importance of etiology in a case and the need for remedies to address this etiology and important symptoms.

I had a few discussions with the Indian doctors about this and while I agree that their more clinical approach can be wonderfully precise, simple and appropriate for the types of cases one sees in India and also in Africa, I also felt at times there is a need to explore more the complexity of a person’s whole story.  I suppose having been more influenced by Kent and then by Vithoulkas, the approach in the west has tended to become more essence/constitutionally based, this method of thinking having been carried on more recently by Sankaran with the ideas of core delusion/vital sensation etc. However, having seen the possible confusion in students and practitioners who tend to make things way too complex and are always looking for some kind of profound inner realm of a person, I can appreciate the simplicity of simply identifying characteristic keynotes, etiology and modalities and prescribing on that – Hahnemann style. As the Indians said, if you feel that every case of Sulphur has to be a ragged philosopher type (theorizing,intellectual, abstract, egotistical etc), then you will often miss it when Sulphur is needed in more immediate and specific situations. This was beautifully revealed when we had a case in the clinic a while ago of a child who came with some epileptiform symptoms (if I remember correctly) and on the case taking, nothing much was revealed until we found that the child had had a severe sore throat a while before these symptoms began and they felt that Streptococcinum was needed as it started from a streptococcus infection. I don’t know if the remedy worked yet, but again, focusing on etiology here seemed a good idea, especially if no other presenting symptoms were apparent. But we also had some discussions about the significance of people being “hexed” by other people.  I felt that this was possibly being focused on too much at times as if it is true that people feel this, then this is often more a cultural response than an individualized one and therefore not useful unless the symptom is particularly strong. In this case, we felt the basic paranoia was important though however she explains it and it was part of our analysis.

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.

I arrived back from the birthday to a service in front of the dead young woman’s house. They were singing hymns and making small speeches. It sounded strangely like being in an English church. Nearly everyone goes to church here. I feel like I’m living in the bible belt. It is very peculiar.  The electricity has gone off so I’m writing this in the heat of my house without any fan to keep me cool. It must be about 100 degrees. Thank god I’m not Natrum mur.

November 24, 2009

This morning I was awoken at 5.30pm by a thirteen year old boy who lives in my compound. “Uncle Rich” he called to me through the window. It’s time to get up. I had promised him I would go to his school with him and talk about food and nutrition. He has been studying it at school and we had a conversation about the food in Ghana and what is good for you. Their basic diet consists of mixtures of maize, cassava and corn, in staples called Fufu, Banku or Kenke. These are gruel type mixtures which are eaten with stews of various kinds, often fish, or vegetables or a groundnut soup. The soup and vegetables are often quite oily, palm oil being the one they use. They don’t eat a huge amount of meat, mainly because they can’t afford to. They eat some white rice and as long as they eat fruit and vegetables, their diet is not too bad. But often, they don’t and they eat too much white bread, white rice and other starch and not enough veges.

As we were walking to his school at 6.25am, he said to me, “Do you have an iron.” I replied I did and he said I should have ironed my shirt. It was true that it wasn’t in the best of shape as I had worn it the day before and was trying to squeeze out another couple of hours of wear but as I was going to his school as his friend and neighbor, he wanted me to look good. But, I did my little talk to them – in spite of my shirt - telling them why Americans are the fattest nation in the world and how, even if Obama passes a health care bill, it is merely the beginning of addressing the chronic disease problem in the country.

Two hours later, I am in the clinic of a Ghanaian homeopath and we are seeing some patients. One 50 year old woman comes in who is terribly fat, not the soft fat of Calcarea carb but solid. She weighs about 230lbs and has a goiter. She has had it operated twice already, once back in 1988 after it first came on when pregnant and again four years ago. At first, she was given drugs and it got better but a year after her child was born, it began to get very big and grew inward, nearly blocking off her windpipe and she would have gasping respiration. It was operated on then but then grew back. Even now, after the second operation, it is very noticeable. She said she has always been overweight, ever since a child, but now is getting worse. She has a variety of pains in the body, including her shoulders. She complained of mucus in the windpipe (larynx) which can make the voice go hoarse. She can cough it up and it’s thick, stringy. But when its bad, she can have a very bad cough which at times has gone on for a couple of months. She says she is feeling tired and weak, even after talking. She also complained of a stitching pain in her chest which goes up to her neck area. She has had it for a while and it comes and goes.

Her diet is not that great, mainly white rice and fish stew. She eats some other vegetables but not a huge amount. She has no particular weather affinity. She was given Calc carb, thyroidinum and focus by this homeopath. I asked her a few more questions and she admitted (her husband confirming) that she used to get very easily irritated, almost everything would affect here. Her husband said that you would see it on her face which would be stern and serious, until the anger bursts out. She said she wants to work hard, but the push is not there now. She is very particular about how things are done and she wants it her own way. She is not diplomatic (her husband says). In the past when angry, she could throw things. I asked if there were any fears and she said that as she lives in Lagos, Nigeria, there is always fear. “You sleep with your eyes open,” she said. There is just tension in living there.

I did a quick repertorization although must confess I already had a remedy in mind:

nat-m. sulph. calc. ferr. iod. sil. aur. sep. ambr. lyc.  2550 2020 2010 1970 1900 1880 1860 1860 1820 1780   1 4 1 3 2 3 2 2 2 2 2  2 3 2 3 3 1 1 2 1 1 2  3 3 2 1 2 3 2 2 1 2 3  4 - - - - - - - - - -  5 2 1 2 1 1 1 4 2 1 2  6 1 3 1 1 1 3 1 3 1 3  7 3 3 3 2 2 2 2 2 1 2  8 2 3 2 2 1 1 - 1 1 - 

So I chose to give her Ferrum iodatum. I didn’t feel she was Calcarea carb. Her body type was much firmer than often seen in Calc and her mental picture, with the anger and the particular nature and intensity didn’t seem clear. Also, the way the anger would be held in until it bursts fits Ferrum nicely. However, the chronic mucus in the larynx and the intensity of the cough she had, along with the obvious thyroid affinity made me consider Ferrum iodatum. Sulphur could be considered here too, but we shall see.
It’s not that easy to get too much information from people. They are not used to talking about themselves in this way and homeopaths here don’t necessarily probe that deeply.