RESEARCH ARTICLE


Traditional Bonesetters and Contemporary Orthopaedic Fracture Care in a Developing Nation: Historical Aspects, Contemporary Status and Future Directions



Benedict U Nwachukwu*, 1, Ikechukwu C Okwesili 2, Mitchel B Harris 1, 3, Jeffrey N Katz 1, 3, 4
1 Harvard Medical School, USA
2 National Orthopaedic Hospital, Enugu, Nigeria
3 Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis Street Boston, MA 02115, USA
4 Orthopedic and Arthritis Center for Outcomes Research, Departments of Epidemiology and Environmental Health, Harvard School of Public Health, USA


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© Nwachukwu et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Harvard Medical School, Holmes Society, 260 Longwood Avenue, 2nd Floor, Boston, Massachusetts, MA 02115, USA; Tel: 617-732 5510; Fax: 617- 525 7900; E-mail: Benedict_Nwachukwu@hms.harvard.edu


Abstract

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.

Keywords: Traditional bonesetters, international orthopaedics, non-orthodox care.