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Mr. Emmanuel Addo Agyei was 100 years old at the time of the interview. He is a herbalist with specialization in a delivery and fertility. He has an authorized certificate as a midwife from a government health clinic. He has delivered babies since 1976 in Adenkrebi area (at the boarder of two regions: Eastern region on the north and Greater Accra region on the south). He has been in different regions of Ghana in order to learn from different traditional herbalists about the different traditional medications, as it is the normal practice among Ghanaian herbalists. Therefore, his knowledge reflects the general knowledge of the council of herbalists, of which he is an associate member. The following is the summary of his knowledge on the issue of massaging the head of a baby with hot water.

• The anterior fontanelle or soft spot is regarded as a hole in the skull which was made naturally by the creator of the world.  Every baby is born with it. It closes slowly and seals completely when the baby is one year old. The movements or vibrations of the anterior fontanelle are the result of the heartbeat (Table 1). When the baby is 4 months old the vibrations of the anterior fontanelle are less visible. Mr. Emmanuel Addo Agyei said that there is no need to apply any treatment on the anterior fontanelle.

• The sutures or cracks in the head are not natural phenomenon but rather they appear because of an accident. This belief is based on the fact that the sutures can not be felt in every baby that is born, only in some of them. Mr. Emmanuel Addo Agyei said that he could feel it in one out of seven babies he had delivered.

 

The traditional explanation is that when the baby passes through the narrow birth canal that includes the cervix and the vagina, the pressure on the skull of the baby causes the narrow cracks in the bone of the skull. They should not be there, and an air can pass through them into the head. The treatments and the believed benefits of them in this case are as follows:

1. The massage of the head with hot water helps in closing the sutures in the head.

2. Omega oil mixed with Shea butter and herbs harden the bone of the head.

3. The hot water helps by increasing circulation of the blood to the bone.

These treatments have to be done by a herbalist until the sutures are closed (are not visible) and such treatments usually last for a few weeks.

If the hot water massage was a special treatment done by the herbalist doctors alone, how come it came to be a general practice that is done by women almost in every home?

Somehow, as time passed through generations, this treatment became widely spread among women who were afraid that an air might enter the head of a baby through the fontanelles and the sutures and may cause sickness to the baby (Table 1). The notion of the women that an air enters the head through the fontanelles and the sutures, is confirmed in their eyes by the vision of the vibration of the skin on the anterior fontanelle. This led them to use the hot water on the anterior fontanelle and other areas of the head.

Mr. Emmanuel Addo Agyei advises the women in his village, not to put the hot water directly on the anterior fontanelle but on the sides of the head.

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Table 1: The different views on the anterior fontanelle held by the herbalist and by the women.

 

 

                                                                        

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The answer of the women to question B in the interview "What will happen if they will not massage the head of the baby with hot water?" revealed that 30.3% of the women believed that the anterior fontanelle can not be close naturally. This means that there is high probability that the other 69.7% of the women believed that the anterior fontanelle will be closed naturally. If so, why then, do not they wait to see that these gaps disappear after several months? It is because they are afraid that during the time that the anterior fontanelle is open, some additional damage will happen to the baby (such as air would enter the head) (Table 1).

The women apply mostly the hot water on the anterior fontanelle (see picture 1, right side, marked with yellow color). The next spot in the head that receives their attention is the soft spot at the back of the head namely the posterior fontanelle (see picture 1, right side, marked with light blue color). The least areas in the head that get their attention are the sides of the skull which are massaged briefly with the hot water. Different from the women, the herbalist applies the hot water only on the sides of the head (Picture 1, left side, marked with yellow color).

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Picture 1: Top view of the skull of a baby marked with the most affected areas by the massage with the hot water according to the herbalist and the women (modified pictures from [p3]). 

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