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

BACKGROUND

Traditional bonesetters (TBS) provide the majority of primary fracture care in Nigeria and other low- and 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.

Traditional bonesetters and contemporary orthopaedic fracture care in a developing nation: historical aspects, contemporary status and future directions

In developing nations such as Nigeria, where there is a shortage of surgeons formally trained in fracture care, many of the injured seek care from traditional bonesetters. We conducted a qualitative study of fracture care in two settings in Enugu, Nigeria: The National Orthopaedic Hospital Enugu (NOHE) and a traditional bonesetter practice. Primary assessment measures at the NOHE included evaluations of the structure and process of fracture care according to the Orthopaedic Trauma Association's Level 1 Trauma Center Requirements. Further, we conducted interviews of NOHE patients and hospital staff. We also observed fracture care at a traditional bonesetter practice. We observed the traditional care process and interviewed both bonesetters and patrons of the bonesetter practice.Although the NOHE does not qualify for certification as a Level 1 Trauma Center; the hospital does provide quality care. Our observations suggest a tension between Western and indigenous musculoskeletal practices. We propose that bonesetters not only be taught certain injury management techniques but also be incorporated into the Nigerian healthcare scheme. Bonesetters fill a void created by the severe lack of surgeons and further; bonesetters are primarily located in rural areas where they best care for underserved communities. In an integrated scheme, bonesetters would manage fractures for which they can achieve acceptable outcomes, referring others to local hospitals. An integrated model of fracture care is applicable in all developing countries where bonesetters perform a large proportion of fracture care.