The Akan Man

The Akan Man

I was rounding in the hospital recently when one of our Physician Assistants approached me with an unusual request. She asked me to cosign a consent form for a toe amputation on a patient as he was unable to give the consent himself.  This was an unfortunate case and here is his story.

Several months ago, a man was brought to our Emergency Room. He had been left at a local clinic by two men with whom he worked with on a farm. Those men disappeared soon afterwards, and the clinic sent him to our hospital. The only history we were able to obtain was that this man had become confused and walked outside into a grass fire, developing burns on his feet. He was unable to speak and appeared not to understand what was said to him. He was in his late fifties.

The medical term for this was expressive and receptive aphasia. The Emergency Room made sure he was not under the influence of alcohol or drugs and a CAT scan of the head confirmed a diagnosis of multiple strokes. A recent stroke had affected his speech and ability to understand any spoken words.

He was subsequently admitted to the hospital for further treatment of his strokes and his burnt feet. He had a brief period of lucidity in which he was able to state that he was a farm worker originally from Ghana in West Africa, and his mother tongue was the Twi language. He had no family in the United States. He was unable to explain how he ended up working in the small farm in North Carolina.

I have grown up in the West African country of Nigeria, but I had never heard of the Twi language. I looked it up. It is a language of the Akan people of south and central Ghana. It is a dialect of the more well-known Ashanti language. It is spoken by 6 to 9 million people.

The hospital was able to get a translation service with a Twi speaker on the phone. Unfortunately, that was not very useful as he still could not speak any words and appeared not to understand what was said to him. He had no social security card or any legal papers. His foot had developed gangrene in some toes, and these toes needed to be amputated. However, we could not communicate with him to obtain consent for the surgery.

I was asked to see him for Infectious Disease consultation about the gangrene in his feet with possible infection. I was able to advise on antibiotics, but he still needed an amputation.

The hospital social workers contacted the embassy of Ghana who offered no help. Department of Homeland Security as well as the United States Immigration services were equally unhelpful. In the end, the Physician Assistant taking care of him in the hospital asked me to be one of the three physicians to co-sign the consent form on his behalf.

I signed the consent form along with two of his other physicians and finally on the 98th day of his stay in the hospital, his gangrenous toes were removed. He was able to walk around but was still unable to speak and does not appear to understand anything said to him, even through the Twi translator.

Our discharge planners worked tirelessly trying to get him to a nursing home. However, without any legal papers, those homes had not been willing to take him. They were however able to get him temporary medicaid and after 130 days in the hospital, he was finally moved to a nursing home. He was moved back to the hospital after 3 months when his status could not be confirmed. He lived on the third floor of the hospital for many more months until Immigration finally confirmed he was a legal permanent resident and he was finally moved back to a nursing home.

He is still very far away from his family and birth place. In his almost two years stay in the hospital, he has had no visitors, and does not appear to have any close friends.

I wonder how he must feel, unable to speak and also not understand anything said to him while in a place that is so far from his home.

It is however amazing to see the dedication and hard work from his team of doctors, podiatrists, nurses, physician assistants, social workers and others. They have taken great care of this man, selflessly and with tremendous dedication. This makes my faith in humanity stronger than ever before. I hope and pray that our patient is in a place that will provide him equal care and comfort.

Gye Nyame - a symbol of the Akan people of Ghana