Unlike in Nigeria, traditional bone setting is recognised in other parts of the world
Tradition, they say, dies hard. Like many other traditional health care services, traditional bone setting, TBS, is an art that has, according to studies, survived more than 3,000 years in the face of urbanisation and modern technology in the health care sector.
While there may be some variations in treatment, bone setting in countries such as China, India and even Mongolia involves the use of small splints, which keep the broken bones in position. In Nigeria, bamboo stick or rattan cane or palm leaf axis with cotton thread or old cloth is also used. This is wrapped tightly on the injured part and left in place for the first two to three days before intermittent release and possible treatment with herbs and massage.
In many developing countries, bonesetters’ practice has come to be accepted in the society as alternative health care providers. In China for instance, Chinese traditional health care and the Western mode have existed together for decades. Study shows that by 1949, there were about 500,000 Chinese-style doctors trained in care of diseases including pain control, fracture and sprains management. The practice is regulated and practitioners undergo structured training. In India, about 70,000 traditional healers and bonesetters reportedly treat 60 per cent of all traumas. Again, they are accepted, recognised and assisted by government.
In Nigeria, as some analysts say, the origin of the practice is shrouded in mystery but passed on by practitioners from one generation to another. There is no formal training of bonesetters in Nigeria and this has resulted in some notable problems associated with the practice. First, the process of establishment of diagnosis is shrouded in mystery and critics have also noted their inability to identify and refer cases beyond their ability to orthodox hospitals. This contradicts the practice in Turkey, where practitioners usually refer difficult cases to hospitals. Again, the practice is passed on by oral tradition and there is no regulation, review and or peer-criticism all of which would enhance performance. Consequently, a study by Dada A. A. et al maintains that while quality is not guaranteed, complications are also high. This is unlike orthodox training, which is regulated, open and subject to regular review on the basis of new evidence.
As critics argue, a number of complications have been associated with traditional bone setting. These include chronic osteomyelitis, non-union, mal-union, joint stiffness, chronic joint dislocations, Volkmann ischaemia, sepsis and tetanus. It is to avoid such complications that experts advocate a formal training for TBS and their incorporation into the primary care system in Nigeria.
In their study, A. Agarwal and Agarwal R., professors at the University College of Medicine Services, Dehli, India, believe that if its practitioners are adequately trained in the basics of orthopaedic care, TBS could provide essential and culturally relevant health services to their communities. According to them, they can serve as the first point of contact at the primary health care level, reducing the burden on secondary and tertiary institutions.
In their study of the practice of bonesetters in Ibadan, Oyo State, Omololu et al also suggested the need to educate and train traditional bonesetters in fracture treatment to minimise the mismanagement of fractures and reduce the health care burden on secondary and tertiary institutions. Their proposed algorithm training included introduction of radiographs to urban bonesetters, recognition of open and displaced fractures, guidance in the approximate duration of fracture healing and training in recognition of complications of fracture treatment.
Practitioners of TBS should also be made to understand when they should refer a case to the hospital for management. Observers actually believe that government has erred by leaving traditional bonesetters high and dry without rendering any assistance to improve their profession. If they were assisted, they would be of more benefit to the society than they are now.