Patients' perception of traditional bone setting in Calabar

ABSTRACT

Background: Patients with orthopaedic injuries patronize traditional bonesetters in our communities. This study was undertaken to find out and document the reasons and factors responsible for this patronage; who made the choice; the role of healthworkers; patients' perception of the practice and if their experience will encourage or discourage them from patronizing traditional bone setting in future. We also compared the cost between orthodox and traditional bone setting for close humeral and femoral fractures.Methods: A prospective study of patients in three traditional bone setting centres in Calabar. A pre-tested questionnaire requesting information on age; sex; educational level; type of injury; reasons for choice of traditional bone setting was administered. Other details included who decided on traditional treatment; perception of outcome; and the option of choice in the event of a future injury. Results: There were 98 patients with 106 injuries. The male female ratio was 6632 (2.11) and age range was 9 months to 60 years. There were 76 fractures in 68 patients; 28 dislocations and 2 brachial plexus injuries. Traditional bone setting was chosen in 50 patients (51.0) because traditional bonesetters were believed to be more skillful than orthodox orthopaedic practitioners; 32 patients (32.7) thought it was cheaper; 12 patients (12.2) believed orthodox orthopaedic practitioners have no empathy towards their patients and 4 patients (4.1) had no health facility in their locality. In 68 patients (69.4) the locus of decision was external; in 22 patients (22.4) internal and 8 patients (8.2) were encouraged by a healthworker. Complications including pain; mal/nonunion; joint stiffness and contractures occurred in 60 patients (61.2). Treatment outcome was adjudged satisfactory by 48 patients (49.0); fair by 40 patients (40.8) and unsatisfactory by 10 patients (10.2). Traditional bone setting for the management of humeral and femoral fractures was more expensive than orthodox management. Conclusion: Traditional bone setting is popular for varied reasons. The freedom to advertise may have helped to woo a public already biased towards traditional bone setting by cultural attachment. A paradigm shift is necessary to reverse the trend