Ananse Factor in Medical Practice

Over several ages to date, a wise, cunning, funny and greedy character called Ananse (Akan), Yiyi or Ayee (Eʋe) and Anaanu (Ga) has dominated Ghanaian folklore to the extent that most stories are told with Ananse and/or his son, Ntikuma as the main character(s).

Suffice to say that Ananse is a folkloric character found in most Akan stories and the same character is assigned different names in other languages in Ghana.

Aside Ghana, Ananse is equally found as a main character in other West African and even in the Caribbean folklore, depicted as the father of knowledge, a trickster and a shapeshifter in all told tales.

In folklore, Ananse takes the form of spider. In Ghana, therefore, Ananse is widely used as a connotation for spider, whether it is used in folklore or not. In folklore, however, the Ananse character equally personifies creativity, wisdom, surpassing knowledge, intelligence and complexities of life.

Medical Practice

Ghanaian medical diction has informally or formally adopted certain local words that are acceptable in curative healthcare delivery nationwide or in other West African countries. Notable among these words are Kwashiorkor (a severe form of malnutrition), Apollo; eye disease (haemorrhagic conjunctivitis) and Ananse.

In the case of Kwashiorkor for example, Cicely, Oxon and Lond (1935) reported that the term was coined in the Gold Coast in 1933. Currently, kwashiorkor is used worldwide and even accepted by the World Health Organisation.

Episode 1 of this article, however, touches on the use of Ananse to denote shingles. Just like in folklore, Ananse takes various contextual meanings in medical practice in Ghana.

Shingles

As indicated above, most Ghanaians, especially Akans, refer to shingles as Ananse. However, an Eʋe-speaking person infected with shingles would say Yiyi’s knife has injured him or her.

Shingles, also known as Herpes Zoster, is a viral infection that occurs in humans due to the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. Usually, shingles is a self-limiting, painful, itching and blistering dermatological or skin rash.

People who previously had chickenpox may continue to have the inactive VZV in their nerves, linked to their spinal cords, even after the dotted spots had healed.

It is the inactive virus that becomes active again and causes Ananse (herpes zoster). A temporary weakening in the body’s resistance may trigger the inactive virus to become active again, multiplying and moving along the nerve fibres and leading to the Ananse blisters.

Though the Ananse disease may occur for no obvious reasons, it is common among the elderly, people under stress, people with compromised immunity such as HIV, Hepatitis B and leukemia.

Most people contract shingles only once during their lifetime even though a person can have the disease more than once.

An infected person can transmit the shingles virus to others through close contacts and with the discharges from the rash blisters.

First-time VZV infected people tend to develop chickenpox and may later contract shingles. However, spreading the VZV is rare, especially if the infected person covers the blisters, avoids touching or scratching the rash and practices hand hygiene.

Severity and Fatality

The initial symptom of Ananse is a burning pain or extreme sensitivity in one area of the skin. A reddish rash or spot then develops out of the tingling skin spot within few days, leading to several blisters as the incubation days unfold.

The blisters later begin to ooze out pus. A pus is a thick yellowish or greenish opaque liquid produced in infected tissue, consisting of dead white blood cells and bacteria with tissue debris and serum.

With passage of weeks, shingles symptoms will begin to disappear on their own, though some pain may persist.

In most people with shingles, the blisters usually show on one side of the body and last for about two or three weeks. Available empirical evidence suggests that about 30 per cent of people are hospitalised for shingles due to a weakened or suppressed immune system.

In terms of case fatality rate, the disease causes less than 100 annual deaths worldwide, with most of the deaths occurring among the elderly or people with compromised immune system.

However, diseases caused by wild types of VZV are more severe and fatal in persons with defects in cell-mediated immunity.

In Ghana, the general unsubstantiated belief is that a shingle infected person may die of the disease if the blisters encircle or engulf his or her body.

Treatment and Vaccination

Some shingle infected people in Ghana treat the blisters by smearing palm wine and kola nut juice on the blisters.

However, it is advised that one sees a doctor when infected with shingles. In terms of orthodox treatment, several antiviral medications are used to treat shingles.

This means that self-medication is highly discouraged as these medications are more efficacious if they are taken in prescribed doses and at the most appropriate time within the stages of the disease. As such, seeking for hospital-based treatment for shingles is the best option.

The shingles vaccine also called the Zoster vaccine or shingrix or recombinant zoster is meant to prevent people from contracting shingles.

Vaccine-preventable

Shingrix is given as a shot on the upper arm. The American Centre for Disease Control and Prevention (CDC) recommends that 50 years or more old adults must get two doses of the shingrix to prevent shingles and its complications.

Adults 19 years and older, who have weakened immune systems due to disease or therapy, should also get two doses of shingrix, as they have a higher risk of getting shingles and its related complications.
shingrix is more than 90 per cent effective at preventing shingles. It keeps immunity strong for at least seven years after vaccination.

Ananse disease or shingles is vaccine-preventable, and it can be treated with medications.

In countries with routine childhood varicella vaccination programmes, children are most likely to be vaccinated.

Advisedly, shingrix should be used with caution and under strict protocol in persons with leukemia and other serious medical conditions because the vaccine is contraindicated.

 

BY: Philip Afeti Korto & Adelaide Setordji – Both are health service administrators. Emails: [email protected] and [email protected]