Annals of African Medicine Annals of African Medicine Society ISSN: 1596-3519 Vol. 5, Num. 4, 2006, pp. 170-173

Annals of African Medicine, Vol. 5, No. 4, 2006, pp. 170-173

Role of Traditional Bone Setters in Africa: Experience in Calabar, Nigeria

 A. M. Udosen, O. O. Otei and O. Onuba

Department of Surgery, University of Calabar & University of Calabar Teaching Hospital, Calabar, Nigeria
Reprint requests to: Dr. A. M. Udosen, P. O. Box 3702, Unical Post, Calabar, Nigeria, E-mail: udotony@yahoo.com

 Code Number: am06040  

Abstract

Background:  It is a known fact that majority of bony injuries in our society are treated by traditional methods.  Even the elite often-times shows evidence of doubt in the efficacy of orthodox methods of bone treatment.
Method: Interviews using questionnaires were administered to owners of traditional bone centres and their clients respectively.  Eight (8) of such centres were visited in Calabar and their environs.
Results: Results showed that all the practitioners had little or no formal education.  All of them claimed ancestral/supernatural inheritance of the trade and do not want to disclose any secret.  There was complete lack of knowledge of anatomy, physiology and the sources of complications.  They lack basic knowledge of investigations and wound care.  Most of the clients found themselves at the Traditional bone centres (TBC) because of poverty, ignorance and superstitious beliefs.  The traditional bone setters (TBS) do record some success in simple fractures and dislocations but all of them see orthodox bone treatment as rivalry.
Conclusion:  It may be difficult to stop traditional bone setting in our society but may be easy to stop the complications by drawing the TBS together for the purpose of basic education and restriction. Training of more specialists in the area of Orthopaedics and Traumatology and provision of adequate basic equipment/appliances in our health institutions may reduce the rate of “Leaving hospital to the Traditional bone centres against medical advice”.

Key words: Bone setting, traditional

 Résume

Introduction : c’est connu par tous que la majorité’ des fractures d’os sont traites de  manière traditionnelle dans notre société.  Même nos élites ont le plus souvent montre certaines évidences de doute concernant l’efficacité des manières orthodoxe utilisées pour ce genre de traitement.
Méthode : Les interviews utilisant des questionnaires ont été effectues `a l’encontre des propriétaires et pratiquants de l’orthopédie traditionnelle et ainsi qu `a  leurs clients.  Entour 8 (huit) de ces contres ont été visites `à Calabar et ses environs.
Résultat: Les résultats ont montres que aucun ou très peut sont éduques.  Tous soutiennent une héritage ancestrale ou de fer ce super naturel guidant cette pratique et ne veulent en aucun cas en révéler le secret.  Mous avions eu a observer une manque total de connaissance en anatomie, physiologie d`ou la source des complications qui en découle, gés manquent de notions élémentaires pour diagnostiqué et traitement des plaies.  La plus part de leurs clients y viennent a cause de la pauvreté, l’ignorance et les croyances superstitieusement.  L’orthopédie traditionnelle enregistre certains succès dans le traitement des fractures simples et dislocations, mais tous voyons cette pratique comme rival a l’orthopédie moderne.
Conclusion : Nous voyons qu’il est nécessaire de rapprocher les praticiens de l’orthopédie traditionnel ensemble pour le besoin de leurs pratiques une éducation élémentaire.  Voir restreindre leurs pratiques si nous tenons à revoir en baisse le taux de complication survenait de leur pratique.  La formation de plusieurs spécialiste en domaine d’orthopédie et traumatologie, et aussi l’approvisionnement en équipement élémentaire et adéquate pour diagnostiqué dans nos contres de sont pourront redire considérablement «l’abandons des hospitalité en gaveur des tradi-practicients malgré’ leur contre indication promulgue’ par les conseilles médicaux».   

Mots-cles : Ensemble le besoin, traditionnelle

Introduction

Traditional bone setting is a known procedure among Africans, although it is associated with severe complications, such as pain, gangrene, malunion, nonunion, joint stiffness and infections, people still prefer this method of treating fractures.¹ This continued use of TBS by Africans is based on the belief that it is cheaper, more available and results in faster healing than orthodox measures.^1-4

The objective of this study was to highlight the experience with traditional bone setting in Calabar, Nigeria.

Materials and Methods

Eight traditional bone setting centres (TBC) in Calabar metropolis were studied. Questionnaires were administered by a medical social worker and an Orthopaedic technician to both the TBS and their clients. The media of communication were English and Efik languages. Parameters on the questionnaire included the Biodata, reason for patronage of TBS, methods of pain relief and assessment of outcome of treatment. The TBS among other things also answered questions relating to their trade and mode of acquisition of knowledge.

Results

Ninety-two trauma patients from 8 traditional bone centres (TBC) were involved in this study. The male/female ratio of the clients was about 4:1 (72:20). Fifty-four (59%) of the clients were youths aged between 21 and 40 years. Demographic and other characteristics of the clients are presented in tables 1 and 2.

Forms of pain relief used by the TBS included herbs in 9 (10%), mixture of herbs and pharmaceutical agents in 17 (18%) while 66 (72%) had no analgesics. The result of treatment was assessed assatisfactory by all (100%) the clients and practitioners. All the TBS and majority of their clients claimed that traditional bone setting is more effective.

Out of the 8 TBS, only 6 cooperated to respond to our questions.Of the 6, four of the practitioners acquired the skills through family inheritance while 2 got theirs by training on the job. All of them used pulling/massage, herbal bandage and wooden splints during the process. Only 2 had knowledge of the existence/importance of orthodox fracture treatment. Two were willing to refer patients to hospitals but all claimed that investigations such as X-rays are not necessary Five of the bone setters were males and one female, all aged >43 years; 2 had no formal education, 2 primary education and 2 secondary education.

 Table 1: Age and occupation of 92 clients at traditional bone centre   

 Table 2: Reasons for patronage of traditional bone setter by clients

 Discussion

Traditional bone setting is a well recognized and age long practice in African tradition.^{5, 6} The treatment of bone injuries is associated with much mythology and superstition.^{2, 6, 7}   It is a known fact that the repeated manipulation and massage of fractured bones cause severe pain and result in complications such as nonunion, malunion, joint stiffness and infections.^{1, 7 -  9}

In this study, it as found that despite the painful experience by all “patients” and the high rate of complications,100% of them preferred native bone setting to orthodox treatment. The reasons for this included high cost and delay in treatment in hospitals, fear of operation/amputation and “fear of medical jargons and application of plaster of Paris in the specialist centres”.^{10 - 13} There is an erroneous belief in traditional Africa that the only available option for treatment of fractures in hospitals is amputation.It is also believed that the application of plaster of Paris (POP) usually results in atrophy and gangrene of affected limbs. Patient/relations are warned not seek orthodox care when they have fractures/dislocations. These behaviours have placed a great burden on the orthodox traumatologists who spent their expertise in correcting complications rather than practice modern Orthopaedics.^1,5,7 These wrong beliefs can only be eradicated through education, public enlightenment and functional health insurance for all citizens.^1,7

There has always been an attempt by the setters to introduce some forms of pain relief into their practice.¹⁴ This may be as a result of alliance with quack Medicine dealers and some hospital staff.^1,5 This has been noted by some researchers that some hospital workers do offer some services or collaborate with them for some gains.^{1,4,12, 14} It should be noted that the application of analgesics without proper reduction and immobilization of fractures is a futile exercise.^14,15 Ignorance was a major disadvantage among the TBS because the highest educational level attained by the TBS was secondary education in 33% of them. The study shows that it is predominantly a male trade. Only one out of the 6 practitioners was a female. Out of the eight centres visited, only 6 reluctantly cooperated. Majority of them claimed that the trade is hereditary and do not see any need of collaboration with or make referrals to orthodox Practitioners. This attitude is also seen among Indians and the Yorubas.^{7, 8, 11}

In general, they saw orthodox practitioners/researchers as intruders into their business.Furthermore, majority (50%) of those patronizing them were motor cyclists who were predominantly illiterates. This agrees with the findings of other workers in the sub region.^{1, 4, 5, 11, 12} All the TBS use the same method of herbal cream application, native bamboo splinting, frequent pulling and massage. Complications such as tetanus, gangrene and nonunion are usually attributed to charms and witchcrafts. They lack basic knowledge of anatomy and physiology.

This study shows that it may be difficult to stop traditional bone setting in our society but may be easy to stop the complications associated with this procedure.  Training of more specialists in the area of Orthopaedics and Traumatology and provision of adequate basic equipment/appliances in our health institutions may reduce the rate of “Leaving hospital to the Traditional bone centres against medical advice”.

For now, the activities of the TBS is a great hindrance to the practice of modern Orthopaedics in Nigeria and Africa in general.^{9, 13, 16}      It is advocated in some quarters that traditional bone setters should be trained and integrated into our community health system as is done for traditional birth attendants.^{1, 7,8,14}  This may not be may not offer the desired solution.

The national and International organizations including the Nigerian Orthopaedic Association, primary health/Community health providers should take urgent steps to help prevent the complications arising from traditional bone setting.^{1, 4,7,11} This can be achieved through eradication of poverty and ignorance as well as making appropriate legislation to restrict this menace.

Secondly, initiation of community projects that would create awareness among the traditional bone setters and patients could discourage these harmful practices.^{4, 10, 14 - 16} One way of achieving this is to train rural orthopaedic assistants whose primary duty would be to disseminate information, provide emergency trauma care and refer of difficult cases.⁷

Acknowledgement

 The authors hereby acknowledge the sincere efforts of Mr. Dominic Umoh and Mr. Nkebem in collecting the data as well as Mr. Ndifreke Udosen and Mrs. Mercy Udosen for their administrative assistance.

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