DSCF1471[1]In a modest room with the bare essentials, Janet (my translator) settles in for a day of patients. And I prepare for a surprisingly varied collection of patients with joint pains. The first patients are two older women, each with marked hip pain and likely either severe osteoarthritis or even more serious hip pathology. They limp painfully and have virtually no movement in the hip joint(s). Both of them will need to find a way to make the 10 mile trip to the regional hospital for x-rays, probably a painful trip in a crowded market truck. It is likely to be their first trip ever away from the immediate village area. The next patient was a 5 year old girl with generalized extremity pain, but no swelling or deformity. I had observed her walking slowly to the clinic, trailing behind her mother who would occasionally turn to scold the girl to walk faster. She also needed to be referred, this time for a sickle cell anemia test. Sickle cell disease causes widespread joint pain and is common in this area. The symptoms are worse with “cold” weather, which is anything below 80 degrees in Ghana. Then after thoroughly enjoying the chance to evaluate and treat a few low back pain, shoulder pain, and headache patients, there was a 40 year old patient with pain in the leg joints and moderate swelling of the entire legs bilaterally. One look and I knew this was filariasis (elephantiasis) and needed referral for medication. Filariasis is actually a tiny worm that is contracted through mosquito bites, the very same mosquitos that spread malaria. The worms destroy the lymphatic system causing the swelling. Though the swelling cannot be reversed, antibiotic treatment can kill the worms and prevent further damage and swelling. And now you know a little about my day as a chiropractor in northern Ghana, and a bit of tropical disease trivia. The photo is of my rudimentary office with Janet ready to translate.