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Abstract
BackgroundTraditional 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.MethodsTwo 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.ResultsFour 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.ConclusionThis 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.
Highlights
Traditional bonesetters (TBS) provide the majority of primary fracture care in Nigeria and other lowand middle-income countries (LMICs)
Traditional bonesetters receive no formal training in modern orthopaedic care, but mostly acquire informal training from family members as a part of ancestral heritage [3, 4]
Characteristics of the participants Three male and two female traditional bonesetters participated in the Focus group discussion (FGD)
Summary
Traditional bonesetters (TBS) provide the majority of primary fracture care in Nigeria and other lowand middle-income countries (LMICs). They are widely patronized and their services are commonly associated with complications. Traditional bonesetters receive no formal training in modern orthopaedic care, but mostly acquire informal training from family members as a part of ancestral heritage [3, 4] Their practice of bonesetting is unregulated and lacks the basic scientific principles of fracture management as well as infection prevention and control [5]. About 70–90% of primary fracture care is provided by the TBS in many rural communities in Nigeria [9, 10] It is of public health importance that this method of fracture treatment be recognized, formalized and regulated. Some of the reasons why they are widely patronized despite the availability of modern orthopaedic services include the following: sociocultural beliefs, easy accessibility, relatively cheaper cost of treatment and perceived quicker services [1, 5, 11]
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