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The creation of an African ‘bloodstream’: Malaria control during the Hitler War, 1942–1945 (Part 6)
KORLE AFTER THE SECOND WORLD WAR
But the major reason that the antimalarial campaign of the Second World War was forgettable is because it was never completed. By 1945, just as Lt. Ribbands and Major Macdonald declared victory over the mosquito, the Allies had opened up the Mediterranean, and transshipment across the Sahara was no longer necessary. The number of troops stationed in Accra dwindled, and the Americans hastily terminated their involvement in the antimalaria campaign. From 1942–45, the Gold Coast government had been responsible for funding only eight per cent of the work done by the Malaria Control Group, while the rest had been covered through the Lend Lease programme (65 per cent) and by the British armed forces (25 per cent). In 1945, the Allied forces left the Gold Coast Public Works Department with the entire cost of maintaining the massive drainage works built on the Korle watershed as well as the responsibility of spraying DDT around the city. A year later, it was evident that the Gold Coast government would never muster enough funding to keep a perpetual campaign against malaria going—the Public Works Department did not even have a budget to screen the windows of bungalows in the city, let alone reinforce miles of concrete embankments along the Odaw River. Major Macdonald’s attempt to squeeze infrastructure funding out of the Americans had worked temporarily, but the war was simply too short to complete the project.
In 1946, crew working for the Gold Coast Public Works Department were further disheartened when aerial photos revealed dozens of quarries, salt pans, and borrow pits around Accra, too numerous to monitor and too expansive to spray regularly. The effects of human habitation had created a niche for mosquitoes to flourish, and any dream of eradication was untenable. The British returned to a policy of malaria management—by relying on quinine prophylaxis and the occasional spraying of waterways to prevent mosquito infestations. In the short term, the effects of DDT made the city notably healthier, and use of the chemical became commonplace. For the price of only four pence a tin, DDT even found its way into homes, where people used it to control lice and bedbugs. Kingsway, the largest department store in Accra, dispensed the drug at their chemist department and advertised it as a product created for the “eternal benefit of mankind.” Unfortunately, the mosquitos in the area quickly developed a resistance to the chemical, as they did in many other parts of the world. By the 1950s, the Korle Lagoon and its tributaries became mired in silt, and malaria was once again endemic in Accra.
When the soldiers were demobilised and the spraying crew departed, the identity of the lagoon as a goddess among the Ga was easily revitalised. In 1946, after several years of bitter disputes over the stool, Nummo Ayiteh Cobblah II was installed as the priest of Korle. Cobblah became a prominent religious leader in Accra, as a moderate during anticolonial riots in 1948 and as a friend to Ghana’s first president, Kwame Nkrumah. When Cobblah was enstooled, he resuscitated the rituals of the annual harvest festival of Homowo, establishing his rights to communicate with the spiritual forces that inhabit the lagoon. As she had for centuries, Naa Korle asserted herself as a moral force within Ga culture, a goddess with the ability to define states of collective well-being in the city.
INTERLUDE: HEALING THE SICKNESS OF COLONIALISM
In the early 1950s, when the colony of the Gold Coast was on the verge of independence, a unique type of healing culture developed among a group of Zarma-speaking migrants from western Niger, known in Accra as the Zabarima. At the time, the Zabarima were the fastest-growing segment of the Muslim population in Accra, reaching 4,000 by 1954. Working in the most menial of jobs, such as carrying loads around the market, recycling used flour bags, or scavenging for used tins and bottles, the Zabarima survived on the margins, and their religious and healing practices reflected their social station. The Zabarima had immigrated from a part of Africa that had been Islamised for hundreds of years, but many of them were also worshippers of a pantheon of deities known as the Hauka (a Hausa word meaning “crazy”). Jean Rouch, a French filmmaker who followed the activities of migrants around West Africa, claimed that at the peak of the Hauka movement, there were approximately 100 Hauka gods in West Africa and that approximately 30 per cent of Zabarima migrants to the Gold Coast were possessed. Unlike Ga priests and spirit mediums, who worshipped and practised in public, the followers of the Hauka operated in secret. Indeed, their ceremonies would have remained largely unknown if not captured on film by Rouch, who was invited to one of their gatherings in a village suburb of Accra.
Jean Rouch’s footage of a Hauka spirit possession ceremony is striking. It includes several men and one woman gathered around a Hauka shrine in a courtyard decorated with fluttering Union Jacks. Rouch, the narrator, tells the viewer that those gathered are suffering from illnesses caused by sorcery and witchcraft and that they have come to seek the help of the Hauka deities. On the cue of a single note from a violin, the participants are slowly filled with spirits representing different colonial characters, perambulating chaotically before the camera, making grotesque faces, and foaming at the mouth. The most powerful god was Gomno, the “governor,” a deity represented by a colourful mound with a pith helmet—an image that Rouch paralleled by interposing a scene of the Gold Coast governor Arden-Clarke wearing full regalia at an official ceremony in Accra. Other prominent characters represented the network of colonial officials, including the train engineer (who marches relentlessly back and forth), the sergeant at arms (who berates the participants), and a doctor’s wife (who mediates disputes). The film climaxes with a series of heated arguments among the spirits, and a frenzied meal of dog-meat soup. After they eat, the spirits slowly leave the bodies of the possessed, and the exhausted migrant workers load themselves onto a truck, bound for their regular lives in Accra.
When Rouch screened the film in Paris in 1954, it created a scandal. Some critics thought the film, entitled Les Maitres Fous (The mad masters), was a fake made with paid actors. Others thought it was a racist portrayal of colonial subjects as ethnographic specimens. Anthropologist Marcel Griaule called the film a “travesty” because it stereotyped Africans as savages; he urged Rouch to destroy it. More recently, Les Maitres Fous has been celebrated because it depicts a form of mimicry that expresses the colonial mentalities of African subjects. As Rouch had always argued, the Hauka cult made a bold statement about the psychological effects of colonialism, representing a kind of social healing that allowed immigrants to cope with their subordinate status under White colonial rule. The “mad masters,” he maintained, were not Africans but the colonial ruling classes, who, within the context of the cult, represented the authoritarian structure of colonialism. The antithesis of benevolent colonialism, these spirits revealed a menacing crowd of military and technocratic elites fumbling about, fighting, arguing, and screaming. Even the character of the doctor’s wife, who plays the role of the mediator among the gods, becomes complicit in Hauka imaginings of colonialism, adding strength to the argument that the colonial subjects of the Gold Coast always regarded medical workers as agents of colonial power.
[This piece is culled from a book authored by Jonathan Roberts, titled: Sharing the burden of sickness: A history of healing and medicine in Accra]
The driver stopped the vehicle at the gate of the large, fenced property along the Nsawam Highway, and Kakraba stepped out to meet the several workers who had gathered to wait for him.
He greeted them and went straight to the point.
“Gentlemen, I am glad to see that you have almost completed the clearing of the land. I’m happy to report that we have concluded all arrangements with Nana Serebour, and construction of the palace will start in a few days.
“I will need you to go and level the ground, and then come back to start this project. Some workers from a construction company will come and join us.
“My plan is to build twenty houses in four months. Then we will do twenty more until we reach two hundred.
“I am relying on you to help me deliver good-quality work to satisfy our clients and, as I have already indicated to you, I will reward you for your work.”
After an hour’s discussion, he closed the meeting and moved to drive away. Wofa Yaw drew closer.
“Director, can you please spare me five minutes? I would like to discuss a small issue.”
“Why, Wofa Yaw? Your wife has threatened to leave you?”
“No, Director. My wife will never leave me. This concerns a young niece of mine.”
“I hope it’s something I can help with. Please sit in the car and let me hear you.”
“Boss, my niece, Beesiwa, is a polytechnic graduate, very beautiful and with very good character.
“Unfortunately, her parents virtually forced her into a relationship with an idiot based in the US, which affected her badly. She has now recovered from that experience and, Boss, I am respectfully asking if you would find a job for her.
“I promise you that you will never regret it.”
“Well, Wofa Yaw, let me meet her and speak with her. I may be able to help, maybe not in the way you expect, but let me meet her.
“I will not be back here for another week, but I will be at the office throughout next week. You can come with her.”
On Monday morning, Wofa Yaw and Beesiwa were seated at the office by nine o’clock. Three young ladies welcomed them warmly, offered them soft drinks and assured them that Kakraba would be there shortly.
They then returned to their desks and sat behind computers with large screens displaying various building designs.
Kakraba walked in and greeted them warmly. After chatting briefly with the three ladies, he ushered Wofa Yaw and Beesiwa into his office.
“Director, this is my niece, Beesiwa. I mentioned her to you when you came to Nsawam.”
“Yes, indeed. Madam Beesiwa, you are very beautiful, just as your uncle said. Wofa Yaw is my colleague.
“We have just started a building project that will take about three to four years. He mentioned that you have a small problem, so I said I would like to meet you and see how I can help.
“So, Beesiwa, please tell me a little about yourself.”
Beesiwa described her childhood, her school experience, her brief work at the bank and the nasty episode with Sammy Abrokwa, which shattered her peaceful life. She also explained how she had been recovering from the experience.
“I am really sorry to hear this,” Kakraba said. “Now, here is what we are going to do.
“We are a small but very busy company. The three ladies out there spend most of the day on site and come back to report on their work in the morning.
“I have three main projects. The big one is an estate project in Nsawam, where your uncle is one of my main colleagues. I need a personal assistant who can take care of my activities, especially when I am not in town.
“Now, we will have to start with trust. Based on what I know about Wofa Yaw, and based on what you yourself have told me, I think we can start on a sound basis.
“So, Wofa Yaw will take you to my home. You can move into one of the four guest rooms.”
“Sir, I have taken some computer lessons, and I have even done graphics and web design,” Beesiwa said.
“Fantastic! I will give you a good phone and a laptop. I will also arrange computer lessons for you.”
“Now, Wofa Yaw, take her home. My sister, Kuukuwa, will meet you and show you around, and then you can return to Koforidua.
“When would you like to start work?”
“Sir, I would like to start today, but I would need to go and bring my things.”
“No problem. Take a taxi to my house, meet my sister, and let me know what you decide.”
Later that day, Kakraba and the three ladies met with some bank officials to conclude the sale of the three buildings at Adabraka.
They closed at five-thirty and, after rewarding the ladies for their hard work, Kakraba got home just after dark.
He was surprised to find Kuukuwa and Beesiwa sitting at the table enjoying supper.
“What’s happening here?” he asked. “Beesiwa, I thought you would return to Koforidua.”
“She changed her mind,” Kuukuwa said. “We went to the mall and bought a few things for her. Then we came back to cook. She has made some nice changes to your bedroom and cooked a couple of interesting dishes. Sit down; we will serve you.”
“Well, I certainly can’t refuse that. It’s been a busy day.
“So, what’s the plan now? Will Beesiwa go to Koforidua tomorrow, gather her things together and come down?”
“No, I will stay here for a while,” Beesiwa replied. “Kuukuwa bought me the things I need, so I may go back next week. I’m ready to start work. What would you like me to start with?”
“Well, you can come to the office tomorrow morning, meet the three girls and get a feel for what we do.
“Since you are living here, at least for now, we can discuss the plans for the next few weeks.
“Sometimes there are gaps when I travel up north. You can take care of things from now. I think the girls would like having someone like you around.”
By Ekow de Heer
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A frequent question following breast surgery is whether human tissue possesses the regenerative capacity to restore an excised organ.
From a strict physiological standpoint, a completely removed breast cannot regrow. Unlike certain organisms that can regenerate complex limbs or organs, adult human tissues—particularly specialised glandular structures—lack the cellular machinery required to rebuild an entire organ after its total surgical removal.
Instead, the body heals the surgical site through processes such as scar tissue formation and re-epithelialisation rather than complete cellular regeneration.
What a mastectomy actually removes
To understand why natural tissue regeneration does not occur, it is important to examine the surgical scope of a mastectomy.
Depending on the type of procedure and the medical reason for surgery, a mastectomy may involve the removal of:
Glandular architecture: The milk-producing lobules and ducts that form the functional core of the mammary gland.
Adipose tissue: The fatty tissue that contributes to breast volume, projection and contour.
Other breast tissue: The extent of tissue removal varies according to the type of mastectomy and the need to achieve appropriate surgical clearance.
Because specialised breast structures are physically removed, the body does not rebuild a complete mammary gland. Instead, healing occurs through tissue repair and scar formation.
Distinguishing residual tissue from “regrowth”
Patients or observers may notice changes in the chest area after surgery, sometimes leading to misconceptions about tissue regeneration.
Skin- and nipple-sparing procedures
Modern breast surgery may preserve the outer skin envelope or, in selected cases, the nipple-areola complex. Small amounts of breast tissue may remain depending on the surgical technique. Any changes in remaining tissue due to hormonal fluctuations represent residual tissue responding to the body, rather than the regrowth of a completely removed breast.
Adipose accumulation
Weight gain after surgery can increase the amount of subcutaneous fat across the chest wall. However, this is part of general body fat distribution and does not represent the regeneration of a mammary gland.
Modern reconstructive pathways
Because a completely removed breast does not naturally regenerate, modern medicine offers reconstructive options aimed at restoring physical symmetry, contour and body image.
The two main approaches are implant-based reconstruction and autologous, or tissue-based, reconstruction.
Implant-based reconstruction
Implant-based reconstruction uses synthetic medical devices, typically filled with silicone gel or saline, to rebuild the breast mound following a mastectomy.
The two-stage process: This approach may begin with the placement of a temporary tissue expander to gradually create space and stretch the surrounding tissues. A later procedure may then be performed to place a permanent implant.
Recovery profile: Implant-based reconstruction generally involves a shorter initial surgery and recovery period compared with procedures that require tissue to be harvested from another part of the body.
Long-term considerations: Breast implants are not lifetime devices and require ongoing medical monitoring. Some patients may need additional procedures over time because of complications or changes in the implant or surrounding tissue.
Autologous or tissue-based reconstruction
Autologous reconstruction uses the patient’s own living tissue to create a new breast mound. Tissue may be transferred from another part of the body, commonly the lower abdomen, using procedures such as a DIEP flap.
Natural look and feel: Because the reconstruction uses living tissue, it can provide a natural warmth, texture and softness. The tissue may also change with the patient’s body weight over time.
Long-term durability: Once healing is complete, autologous reconstruction can provide a long-lasting result without the need to replace an implant. However, some patients may still require further procedures.
Complex surgery: This option usually involves a longer operation and recovery period. In microsurgical procedures, surgeons may need to reconnect tiny blood vessels to establish blood flow to the transferred tissue.
Direct comparison
When choosing between these two reconstructive pathways, patients and their surgical teams must consider several physical, medical and lifestyle factors.
Surgical burden: Implant surgery is generally less invasive, while flap reconstruction involves surgery at both the chest and the donor site.
Foreign material versus native tissue: Implants involve the use of a medical device, while autologous reconstruction uses the patient’s own tissue.
Recovery: The recovery timelines and rehabilitation requirements differ significantly between the two procedures.
Recovery and physical rehabilitation
Recovering from breast reconstruction requires patience, careful pacing and, in some cases, structured physical rehabilitation.
Because implant-based and autologous tissue-flap procedures involve different surgical techniques, their healing timelines and physical therapy milestones can vary considerably.
Understanding these differences is important for patients considering reconstruction, as the choice involves more than restoring physical appearance. It also requires careful consideration of recovery, long-term monitoring, lifestyle and individual medical needs.
Part 2 will examine recovery timelines, physical therapy milestones and other factors patients should consider when choosing between reconstructive options.
By Robert Ekow Grimmond-Thompson
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