Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters

Abstract

Background: Traditional bonesetters (TBS) provide the majority of primary fracture care in Nigeria and other lowand middle-income countries (LMICs). They are widely patronized and their services are commonly associated with complications. The aim of the study was to establish the feasibility of formal training of TBS and subsequent integration into the healthcare system.Methods: Two focus group discussions were conducted involving five TBS and eight orthopaedic surgeons in Enugu Nigeria. Audio-recordings made during the focus groups were transcribed verbatim and analysed using a thematic analysis method.Results: Four themes were identified: Training of TBS, their experiences and challenges; perception of traditional bonesetting by orthopaedic surgeons; need for formal training TBS and willingness to offer and accept formal training to improve TBS practice. Participants (TBS group) acquired their skills through informal training by apprenticeship from relatives and family members. They recognized the need to formalize their training and were willing to accept training support from orthopaedists. The orthopaedists recognized that the TBS play a vital role in filling the gap created by shortage of orthopaedic surgeons and are willing to provide training support to them. Conclusion: This study demonstrates the feasibility of providing formal training to TBS by orthopaedic surgeons to improve the quality of services and outcomes of TBS treatment. This is critical for integration of TBS into the primary healthcare system as orthopaedic technicians. Undoubtedly, this will transform the trauma system in Nigeria and other LMICs where TBS are widely patronized.

First Aid Practices for Injured Children in Rural Ghana: A Cluster-Random Population-Based Survey

“…Patronage of traditional medical services, especially bone-setters, is widespread in Ghana and other LMICs due to ready availability within communities, apparently low direct cost to patients, and a deep cultural acceptance for their services within the society. [20][21][22][23] Patrons who have had any form of acceptable results from previous experiences with traditional medicine might try the service again when they need it. Conversely, individuals who did not initially receive formal health care for injuries such as a fractured bone may experience substantial delays and associated morbidity and disability when formal care is finally sought.…”

“…A study in Nigeria reported the willingness of traditional bone-setters to undergo some formal training to improve their knowledge and skills. 23 †No member of the reference group would engage in a potentially harmful practice only for the particular injury type. ‡None would engage in a potentially harmful practice only for the particular injury type.…”

Ubuntu ethics and moral problems in traditional bone-healing

“…Thus, TBH has "high patronage and confidence in their communities as about 70-90% of primary fracture care is provided by the TBH in many rural communities in Nigeria." 28 One reason for this patronage is the cultural belief that ailments most often have spiritual components that need to be cured by supernatural means-such as incantations and concoctions. These superstitious means cannot be provided by conventional surgeons.…”

Are Medical Students willing to Patronize Traditional Bone Setters in the Future? A Study among Medical Students of Ebonyi State University Abakaliki, Nigeria

“…16,17 They are not regulated, and thus, quality may be questionable. [19][20][21] In addition to the aforementioned, they hardly refer cases beyond them to hospitals. 11,22 Notwithstanding the shortcomings, there is still a high rate of acceptance and patronage among the populace.…”