[afro-nets] Traditional Scarifications: A dangerously ignored practice classified

["Dr. Okwen Mbah" <okwenpatrick@yahoo.fr>]

Traditional Scarifications: A dangerously ignored practice classified
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BAFUT CLASSIFICATION OF TRADITIONAL ABDOMINAL SCARIFICATIONS.
   
1. Okwen P Mbah MBBS MD, 
Chief Medical Officer,
St Theresa Catholic Medical Centre, Mambu Bafut.
2. Mbuagbaw Lce  FMBS MD
Chief Medical Officer,
District Hospital Bafut,
NWP Cameroon.
3. Kate Reinsma
Peace Corps Volunteer,
Bafut.
   
Abdominal scarifications are usually done by traditional healers in most parts of sub Saharan Africa after detection of splenomegaly by mothers on their babies or adults. The diagnosis by the traditional healers is usually called ?side pain?, or ?spleen? or in the French speaking areas ?râte?. Occasionally especially in older children, this ?diagnosis? is reached by the mothers or traditional healers after the child complains of chest pain or flank pain, in which case the medical diagnosis is often lobar pneumonia or Pyelonephritis. 

According to trado-practitioners the degree of scarifications depends on the degree of affectation of the individual by spiritual forces and this is deduces by special indices revealed to them by their ancestors. These range from single razor blade cuts to burning of the abdomen with special herbs. The razor cuts range from half to full inch in length. After scarification, burnt concoctions are applied to the bleeding wounds using the bare fingers or immature bean pods.

The cuts are usually made in little shrines using ?new? non sterile double sided blades with ungloved hands. Amongst the 18 practitioners we spoke to all had cuts on finger tips resulting from injury of their own side of the blade.

After following over 100 cases of scarifications in the Bafut health district, the medical teams have been able to come up with the following findings:
* The degree of scarification is directly proportional to risk of sepsis.
* The degree of scarification is directly proportional to malaria parasitaemia in about 70% of cases seen.
* The higher the degree of scarification the poorer the prognosis.
* The higher the degree of scarification the higher the chances for need for transfusion.
* The higher the degree of scarification the longer the hospital stays.
   
The team therefore came up with a classification to quantify cuts and risks of complication. THIS IS THE BAFUT CLASSIFICATION:
- Grade 0 ? Complaints of side pain with resort of traditional treatment but no scars made.
- Grade 1a ? 1 to 5 cuts with closed wound edges and no presence of herbs and burnt concoctions.
- Grade 1b - 1 to 5 cuts with gaping wound edges with or without presence of herbs and burnt concoctions.
- Grade 2a - more than 5 cuts localised to one region with closed wound edges and no presence of herbs or burnt concoctions.
- Grade 2b ? more than 5 cuts localised to one region with gaping wound edges with or without presence of herbs and burnt concoctions.
- Grade 3a - more than 5 cuts spread all over the body with closed wound edges and no presence of herbs or burnt concoctions.
- Grade 3b - more than 5 cuts spread all over the body with gaping wound edges with or without presence of herbs and burnt concoctions
- Grade 4 ? burnt tattoo usually over abdomen in the form of a cross in a circle and usually about 5 inches in diameter. 
   
ADVANTAGES OF CLASSIFICATION
   
In a resource for settings classification greatly ease is a lot of work, the needs for referral, then needs to call the medical officer, the need for transfusion, and an objective means of reaching the patient. These can be listed as follows:
* To determine possible degree of sepsis.
* To determine possible need for      transfusion.
* To determine the need to call for the      medical officer. 
* To determine the aggressiveness of      therapy.
* To determine the need of referral.
* To determine the need for education for      the mother and a family.
   
Shortcomings of the Bafut Classification 

Occasionally, the mothers washed of concoctions before arriving the hospital this may affect the sub classification as ?a? or ?b?. This will therefore reduce suspicion of sepsis; therefore the health care worker has to be very careful with examination and laboratory investigations. 

On other instances, these scarifications may be gone after the patient has been admitted into hospital, therefore do the examination of children in the hospital is necessary. 

There have also been instances where mothers refuse that burned, call questions or hairs on scary fixations should not be removed by the health care worker, this calls for caution and wisdom in dealing with such a situation, the ideal thing will be to remove the herbs and the burnt concoctions, often times this causes the mothers to take the babies out to the hospital. In the developing world where there's no room for Social Security for children and their rights it will be difficult to take any legal proceedings against such mothers will make even the ideal that they had doing what they believe is right for the child. In our cases, we always try to educate patient and the family on the causes of the condition, how to prevent it and the dangers of scarifications. We also keep an eye on them to make sure they do not leave the hospital. The health services of the district also endeavor to educate the traditional healers on regular basis.

PROBLEMS OF SCARIFICATIONS   
  
* Increased Risk Of Transmission of blood borne infection since      the trado-practitioners hardly use gloves.
* Delay in hospital presentation.

My light shall be the thunder's lightenings, and my path the rivers,
My guide the morning star, as I sail home to tata Nzambe.

--
Dr. Okwen Mbah
mailto:okwenpatrick@yahoo.fr