The practice of traditional bonesetting: training algorithm

Abstract

Traditional bonesetters (TBS) have been in Nigeria for centuries. Up to 85% of patients with fractures present first to the traditional bonesetters before coming to the hospital and therefore this mode of care delivery cannot be overlooked in Nigeria. We attempted to document the current practice of TBS in Ibadan and their methods of fracture treatment with a view to training and improving the services offered by them. We carried out a literature search to review all previous studies on traditional bonesetters' practice and visited a few of them to document their current practice. The only change in the management of fractures by the TBS over the past 28 years was the use of spiritual methods of healing to treat open comminuted fractures; a technique for which no scientific basis was readily discernible. There is a need to educate and train the TBS in effective management of both open and closed fractures. Such training should be provided by orthodox orthopedic surgeons with a view to minimizing mismanagement of fractures. To this end, we propose a training algorithm.

Fig. 1

After 5 days of treatment by a traditional bonesetter, a 17-year-old university student presented to the accidents and emergency department at University College Hospital, Ibadan. He had sustained an open fracture to his right leg playing football a week before. Clinical evaluation revealed a gangrenous right leg for which he underwent above-knee amputation.

Fig. 2

An herbal cocktail mixed with Schnapps is used as an analgesic before fracture reduction by traditional bonesetters.

Fig. 3

Before splinting and at each bandage change, an herbal concoction blended into a cream is applied with a bird’s feather.

Fig. 4A–C

Materials commonly used for splinting are (A) plywood, (B) hard cardboard, and (C) tree bark.

Fig. 5

Swelling on the distal part of the leg from compression bandaging of the fracture site is common.

Fig. 6

Traditional bonesetters stabilize the limb after splinting and bandaging using stones.

Fig. 7

Traditional culture and beliefs assert that a small gourd placed on the wall acts as a charm to ward off witches and wizards.

Fig. 8

Following a TBS training algorithm could help bring traditional healers into the National Health System at the primary healthcare level, reducing the burden on secondary and tertiary institutions.