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Indigenous Medical Knowledge and Bone Setting among the Igbo of Southeast Nigeria

Authors:
_____________________________________________________________________________________________________
*Corresponding author: E-mail: chinwe.okpoko@unn.edu.ng;
Journal of Education, Society and Behavioural Science
26(4): 1-9, 2018; Article no.JESBS.43114
ISSN: 2456-981X
(Past name:
British Journal of Education, Society & Behavioural Science,
Past
ISSN: 2278-0998)
Indigenous Medical Knowledge and Bone Setting
among the Igbo of Southeast Nigeria
Pat Uche Okpoko
1
, Chinwe Catherine Okpoko
2*
, Jasper Kelechukwu Okezie
1
and Chizoba Sebs-Okolo
1
1
Department of Archaeology and Tourism, University of Nigeria, Nsukka, Nigeria.
2
Department of Mass Communication, University of Nigeria, Nsukka, Nigeria.
Authors’ contributions
This article is a collaborative work. Author PUO initiated the title, designed the study and managed the
analysis. Author CCO added the communication dimension to it and provided literature in that area.
Authors JKO and CSO conducted the field work and wrote the preliminary report. All authors read and
approved the final manuscript.
Article Information
DOI: 10.9734/JESBS/2018/43114
Editor(s):
(1)
Dr. Redhwan Ahmed Mohammed Al-Naggar, Professor, Population Health and Preventive Medicine, Universiti Teknologi
MARA, Sungai Buloh, Selangor, Malaysia.
Reviewers:
(1)
Afaf Abdelaziz Basal, Tanta University, Egypt.
(2)
Lawrence Okoye, University of Maiduguri, Nigeria.
(3)
Syed Mohd Abbas Zaidi, Govt. Unani Medical College, India.
Complete Peer review History:
http://www.sciencedomain.org/review-history/26087
Received 15 May 2018
Accepted 24 July 2018
Published 03 September 2018
ABSTRACT
This paper examines the indigenous healthcare practice in Southeast Nigeria and how this can be
integrated into modern healthcare system using bone setting as a case study. Traditional bone
setting continues to enjoy wide patronage despite the availability of modern orthopaedic medicine in
the treatment of bone injuries. The paper studies the basic therapeutic methods adopted in bones
setting and how these can be integrated into modern health practice in Ogboji and Owerre Eze Orba
communities. Indepth interview and direct observation were used to elicit information from the
research subjects, comprising the bone setters, patients and members of the communities.
Research results reveal that people see bone setters as effective way of addressing orthopaedic
challenges and a great number of patients seek their attention before going to modern practitioners,
if the need be. It is seen to be relatively cheaper, the primary raw materials used are adjudged not to
have side effects and amputation is rarely recommended. The study argues that there is need for
synergy between traditional bone setters and orthodox orthopaedic practitioners for enhanced bone
health care.
Original Research Article
Okpoko et al.; JESBS, 26(4): 1-9, 2018; Article no.JESBS.43114
2
Keywords: Bone setting; communication; indigenous knowledge; orthopedic; health care.
1. INTRODUCTION
Indigenous healthcare or traditional medicine
refers to the brand of medical practice which
employs customary method of treatment of
disease and of natural healing. It is transmitted
by word of mouth and by example. The
practitioner of traditional medicine “familiarizes
himself with what constitutes good moral living,
learns to detect by [physical examination] and
spiritual diagnostic signs, how, when and where
departure from the normal or natural has taken
place, and then applies his knowledge and skill,
aided by the various kinds of treatment, to help
bring about a return to the normal and natural”
[1]. He also diagnoses ailments which through
observation, inspiration and experiments may
involve trial and error. Thus, traditional medicine
can be defined as “an art, science, philosophy
and practice following definite natural, biological,
chemical, mental and spiritual laws” [2]. WHO
defines traditional medicine as “the sum total of
the knowledge, skills, and practices based on the
theories, beliefs, and experiences indigenous to
different cultures, whether explicable or not, used
in the maintenance of health as well as in the
prevention, diagnosis, improvement or treatment
of physical and mental illness” [3].
This predates the introduction of orthodox
medicine in the developing world. This form of
medicine has been described as a cultural gem
and it includes all kinds of folk medicine, and
therapeutic practices that had been handed
down by the tradition of a community or ethnic
group [4]. This practice is classified into herbal
medicine, traditional birth attendance, traditional
surgery, traditional medicinal ingredient
marketing, traditional psychiatrics and traditional
therapeutic occultism. Traditional bone setting is
considered under traditional surgery as the
practitioners have to contend with wounds
requiring surgery. In giving treatment, traditional
healers utilize roots, barks and leaves of trees,
and animal parts [1].
Amongst Africans, health and illness have two
basic features: biological and social. The first
recognizes that the human body may malfunction
due to old age, invasion by organism such as
worms, or because of injuries sustained from
accidents
5
. Illness is also believed to result from
bad food, weather changes and poisonous
substances. The social basis of illness on the
other hand derives from such factors as breach
of taboo, dishonored oath and effects of a curse
[5]. In other words, the African recognizes that
the air we breathe, the water we drink and the
food we eat contain millions of micro-organisms
which can be dangerous to human health.
Howbeit, germ theory cannot account for all
illness. For apart from germ, some other factors
that can cause disease are sorcery, spirit
intrusion, diseased objects, ghosts of the dead
and acts of the gods [6].
Consequently, “the traditional healer appeals to
both scientific and metaphysical means in an
attempt to achieve a comprehensive cure of any
malady. Through observations he diagnoses
ordinary illness and through divination, he probes
into the causes and cure of obscure maladies
[6]”. It has also been pointed out that in African
traditional medicine, patient treatment was based
generally on the healer establishing a rapport
between the sick and social groups value
system….This means among others that healers
had to penetrate and manipulate the patient’s
symbolic universe [7]. Ekere submits that
traditional medical practice is based on the belief
that the natural resources have active
therapeutic principles as well as supernatural
forces which can be manipulated by those who
know how, in order to produce healing results [8].
This assumption implies that Africans believe in
using the natural way to treat illnesses rather
than the modern and scientific method that was
brought from the western societies [9]. It is
opined that many African societies were and still
are ahead of European societies in some
aspects of medical science, particularly in areas
of psychiatry and medicinal herbs7. The
traditional medicine practice enjoys high
patronage by the people. As reported by the
World Health Organization, African traditional
medicine accounts for up to 80% of primary
health care needs in Africa [10].
Bone setters or physiotherapists are those who
specialize in the physical manipulation of parts of
the human body. World Health Organization
describes traditional bone-setting as that health
practices, approaches, knowledge and beliefs
incorporating plant, animal and mineral based
medicines, spiritual therapies, manual techniques
and exercises, applied singularly or in
combination to diagnose and treat fracture in
human body [10]. Some handle various types of
fractures and dislocations; others massage
various parts of the body [5]. Thus, they cover
Okpoko et al.; JESBS, 26(4): 1-9, 2018; Article no.JESBS.43114
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among others: bone fractures, dislocation of
joints, ligament sprain, spinal sprain, synovial
fluid and/or lipoma, muscle cramp and mobile
muscular pains [11]. Bone setters are widely
respected in most African societies. Popular
belief holds that they do a better job than the
orthodox ones, who in any case are rare, both in
the rural and urban area [5]. Some acknowledge
however, that bone setters rarely have the
capacity to treat patients with fresh open wounds
accompanying broken bones instead, these
patients are sent to hospital to prevent wound
infection [11]. They are free to come afterwards
for treatment by the bone setter.
The need to integrate indigenous medical
knowledge into modern medicine has figured
very sparingly in the literature of social medicine.
This is in spite of its value in sustainable
healthcare. Howbeit, there is a growing
realization about the need to incorporate local
knowledge into modern knowledge in the effort to
promote sustainable development. For it has
been noted that, there is the need to allow local
knowledge to flourish and contribute to global
knowledge; where people learn from one another
as they also innovate on their own; and where
local and global knowledge inform action and
influence change [12]. It is instructive that
indigenous knowledge relating to nature
conservation, human reproduction, herbal
medicine, maternal and child healthcare and
support system, settlement patterns among
others, are found in many communities in
Nigeria. These need to be retrieved, documented
and disseminated so as to find ways of
harnessing their potentials.
Indigenous knowledge are those knowledge
systems that are unique to a given society or
culture having evolved out of many years of
practical experience and successful adaptation to
solving local problems. It also refers to
particularistic knowledge which marks out one
culture from the other and therefore one ethnic
taxon from others [13]. Such knowledge deals
with the fact or condition of knowing something
with familiarity gained through experience or
association; knowledge originating or being
produced or living naturally in one’s environment;
or ideas, concepts or materials which were
developed internally by a particular group using
both human and natural endowment of its
environment.
Indeed, indigenous knowledge constitutes a body
of ideas, concepts and materials built up by a
group of people through generations by living in
close contact with their environment (both human
and material). In essence, indigenous knowledge
can be acquired through internally generated
methods of learning and expressing grassroot
initiatives in social and technological spheres [7].
It can be expressed literally in scripts (writing) or
orally transmitted. Hence verbal art or oral
literature, customs, beliefs, gestures and material
symbols, among others, constitute some of the
avenues for expressing indigenous knowledge
and concerns. These avenues of indigenous
creativity have been described as cultural
knowledge [7].
In Africa, indigenous knowledge was expressed
in several non-linguistic signs such as objects,
gestures and ritual acts as well as many non-
emotional signs and speech acts which were
both propositional and non-propositional, but
which essentially form part and parcel of the
people’s culture
7
. With indigenous or “cultural”
knowledge, which manifests itself in material and
non-material aspects, man in Africa utilized, and
still utilizes, the opportunities offered by nature to
influence and/or change the environment. While
the material aspect includes all the products of
man’s industry or concrete realities, such as
technology, subsistence, land use and
architectural features, the non-material resources
consist of the worldview, norms, morals,
motivations, language and values etc. shared
and transmitted through generations. Both
material and non-material aspects of culture “are
fundamental in the analysis of cultural pattern
that is the general mode of conduct, systematic
and integrated context of behaviour which is
characteristic of society [14].
It must be pointed out that indigenous medical
knowledge has made invaluable contributions in
healthcare delivery in Africa. This must therefore
be harnessed and integrated into our primary
healthcare system to ensure its sustainability.
Our argument is predicated on the recognition
that “the exclusive application of formal scientific
concept is not enough for the complex task of
achieving sustainable developments against a
background of ecological and cultural diversity (in
Africa). Indigenous knowledge and practices hold
a crucial key to sustainable development” [15]
[including sustainable healthcare].
In a research on traditional medicine, it was
argued that:
“There is enough convincing evidence
that a good number of preparations in
our traditional medicine can hold their
Okpoko et al.; JESBS, 26(4): 1-9, 2018; Article no.JESBS.43114
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own as alternative to the conventional
medicine and can be developed
scientifically…(that) if our traditional
medical practice had been organized
and systematized; if the traditional
medical practitioners had been
communicative, a proper system of
medical practice would have evolved,
and our traditional medical practice
would have been properly integrated into
the modern medical system” [16].
It was also noted that remedies in traditional
medicine consist of formulae from various natural
substances - vegetables and animals used singly
or in combination [16]. “The vegetable remedies
account for 70-80%. These herbal remedies are
either swallowed, rubbed into scarifications,
poured into wounds, boiled and inhaled as
fumes, splashed into eyes, smoked in pipes or
sniffed as snuff. It was also noted that liver
extracts have been used traditionally to treat
pernicious anemia, long before it was discovered
that liver contains vitamins B [12], which is the
only remedy for the disease. And for many years,
quinine remained the major drug for treating
malaria. Cinchona species are well known for
their anti-malaria properties and the constituent
alkaloid quinine is still acknowledged as an
effective drug. Most people in Nigeria also use
Azadirachta indica (Dogonyaro) in treating
malaria. Crude extracts from plants like Brucea
javanica, Simba cedron and Ailanthus altissima
are used in traditional medicine for treatment of
malaria [16].
In his study of health seeking behaviour in
Kenya, it was argued that there is need for
cooperation between modern and indigenous
knowledge systems [5]. Four main forms of
interaction were identified between indigenous
and cosmopolitan medicine. The first form of
interaction is referred to as “sequential zig-zag.”
Here there is oscillation between the two forms of
medicine as a particular illness develops. The
second is supplementary relationship in which
only one of the two forms of medicine can be
used for the management or prevention of a
condition at a particular time. There is also the
competitive interactions. This occurs particularly
when the cause of ailment has biological basis.
The patient therefore utilizes either form of
medicine depending on his/her socio-cultural
background and economic disposition. The last
form of interaction is that of complementarity. In
this form of relationship, people consider both
types of medicine to be necessary for complete
healing to occur. The complementary relationship
is common when chronic illness thought to
involve psycho-social and spiritual factors occur
[15].
This paper examines the indigenous healthcare
practice in Southeast Nigeria and how this can
be integrated into modern healthcare system
using bone setting as a case study. Bone setting
has been in Nigeria for centuries and reports
has it that up to 85% of patients with fractures
present themselves first to the traditional bone
setters before going to orthopaedic hospitals
9
.
Besides, the fear of amputation, high cost of
treatment in orthodox hospitals and the
application of plasters of Paris (POP) in orthodox
orthopaedic centres [4], along with its believed
efficacy, constitute the reasons for the high
patronage of the bone setter. Specifically, the
paper attempts to: (1) ascertain the basic
therapeutic methods adopted in bones setting,
(2) evaluate the place of indigenous methods of
bone setting as a way of addressing orthopaedic
problems, (3) examine the relationship between
modern and traditional practices in this area of
endeavour, (4) determine the place of
communication in the process. This will hopefully
help to provide the way forward while integrating
traditional and modern healthcare practices in
the country.
2. METHODOLOGY
We used direct observation and indepth interview
to elicit information from informants in the two
communities studied. On site visits, in-depth
interviews, and site observation are invaluable
tools for gathering information of this nature.
First, they provide the opportunity to appreciate
first-hand the various therapeutic methods
employed by bone setters; second they allow
flexibility in the manner information is elicited,
thereby giving room for the unexpected to
emerge; and third they provide access to detailed
information commonly associated with qualitative
research.
During our field visit, there were about 50
patients on admission and about the same
number of outpatients in the two bone healing
centres studied. A convenient sampling method
was used for recruiting the respondents, whereby
we interviewed two bone setters, ten patients
and five care givers (those who attend to the in-
patients) in the study communities. Apart from
being the most renowned in the individual
communities, the two bone setters also have
Okpoko et al.; JESBS, 26(4): 1-9, 2018; Article no.JESBS.43114
5
clinics (usually in their personal homes) and long
history of practice. The study recruited the
patients and care givers that were disposed to
answer questions at the time of interview.
Through semi-structured questions and on the
spot assessment we elicited information and
reported our findings qualitatively.
2.1 The Setting
The two communities under study, Ogboji
Orimogu and Owerre Eze Orba, are Igbo by
ethnic origin and they live in southeast Nigeria.
The communities were chosen for study because
of their fame in bone setting in this culture area.
Although a number of communities within the
area practice bone setting, Ogboji Orimogu and
Owerre Eze Orba are renowned for their
resounding prowess in the profession, which is
said to have been handed down through
generations.
Ogboji Orimogu is one of the communities that
make up Ezza ‘nation’. It is situated at the
northern part of Ebonyi State, Southeast Nigeria.
It has a population of about 12,000 people.
Ogboji people are reputed farmers planting such
crops as yam, cassava, cocoyam and rice. They
also produce pottery wares.
Owerre Eze Orba on her part, is one of the seven
villages that make up Orba, a rural community in
neighbouring Enugu State. It has an estimated
population of 15,000. The people are majorly
farmers and artisans. The two communities
under study derive information through different
channels of traditional communication and mass
media. Traditional channels of communication
are informal channels of communication which
are viable in many rural communities in Nigeria.
This is because they are not only available,
accessible and intelligible, but are also owned
and controlled by the people themselves.
The traditional bone setter is often without
western education and do not formally learn the
skill. They claim that the gods choose whom they
wish to use for the healing. They acknowledge
also that the knowledge is inherited and passed
from one generation to another through skills and
experience acquired as part of an ancestral
heritage. This method had existed for decades
and indeed clusters of family and homes practice
it and practitioners keep it as a family secret. Any
person, male or female, from Ogboji can practice
bone setting outside Ogboji community, but
within the community, it is the prerogative of
Omeinyi Alo and Udeogu families who transmit
the trade from generation to generation. In
Owerre Eze Orba, however, it is not just a family
affair, but always transmitted through the first
sons.
3. RESULTS
3.1 Treatment
The bone setters claim to treat all forms of
dislocations and bone fractures as well as
ligament sprains, spinal pains, muscle cramps
and muscular pains etc. Diagnosis in both
centres visited was by observation, running the
fingers through the affected part and applying
pressure when necessary. In Owerre Eze Orba,
Miriogwu (liquid from a mixture of different roots
and herbs), is also applied to trace the fractured
spot.
In both centres, the fractured bone is set raw
without the use of any pain reliever or
anesthetics. The bone is held in place using
thread. The bone setter in Owerre Eze Orba
(Attamah 2017) explains that he rubs the fluid
from the root of okpudele plant (Hymnodictyon
pachayantha), Eluaku, palm kernel oil and ebuba
eke, fatty oil extract from python on the affected
part(s) and thereafter splints it to prevent
movement. On the other hand, the traditional
bone setter (Nwafor 2016) in Ogboji Orimogu
uses palm oil or okwuma (shea butter) on the
affected part(s). He claims that they make the
area soft, ease pain and improve blood
circulation. Thereafter, the back of palm frond,
cleaned and cut to shape and size, is used to
hold the bone in place.
Bamboo stick, raffia cane and/or palm frond
baton, bandage and tissue paper are used for
splinting. The tissue paper prevents the affected
part from being injured further, the baton
provides support and prevents movement of the
bone so as to ensure effective healing, while the
bandage holds the baton firmly. Chijioke Attamah
the bone setter, on February 2017, also informed
us that he places his patients on calcium tablets
to promote bone marrow growth. The patient is
often advised to sit or lie on a mat or hard or flat
surface to enable the bone set properly. S/he is
also advised not to shave his/her hair or cut
his/her nail during the period of treatment. The
bone setters claim that these will compete with
the bone nutrients and consequently inhibit quick
recovery. Again, s/he is not allowed to have sex,
or to take any alcoholic drink. However, if the
Okpoko et al.; JESBS, 26(4): 1-9, 2018; Article no.JESBS.43114
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bone is taking long to heal, the bone setter may
investigate if there are spiritual forces working
against such and then act accordingly. Indeed,
care is generally taken to ensure that the patient
does not move the fractured part.
Treatment at the centres lasts between one to
three months, depending on the severity of the
cases. In cases of open wounds, the patients are
referred to patent chemists or hospitals as the
case may be, who treat the wound first before
bone setting commences. Patients range from
children even infants born with dislocation, to
adults who may be accident victims. They come
from all parts of Igbo land and beyond, including
Rivers, Cross River and Benue states.
3.2 Perceived Efficacy of Traditional
Bone Setting
Bone setting is seen by the study communities
as an effective way of addressing orthopaedic
challenges. The patients interviewed revealed
that they seek care from bone setters for a
number of reasons:
1. The bone setting centres are the closest
and easily accessible source of care for
orthopaedic problems.
2. The cost of treatment is low relative to
modern care. Lack of money does not also
stop treatment as patients could be treated
and allowed to come later to pay. This
could be paid once or in instalments. In
Owerre Eze Orba, indigenes are treated
free of charge because bone setting is
seen as a privileged gift from the gods to
help the community. According to Chijioke
Attamah, “such patients are only expected
to give any gift of interest to them to thank
the gods for the care. Bone setting calls for
selfless service. Besides, the wrath of the
gods will descend on him if he/she charges
his people or others exorbitantly”.
3. The primary raw materials used are
believed not to have side effect.
4. Bone setters rarely amputate their patients.
5. They resort to spiritual forces in extreme
cases, which is in tandem with the people’s
belief.
All these explain why they are highly patronized
in these parts.
3.3 Relationship with Modern Practice
The bone setters interviewed revealed that
modern practitioners discriminate against them.
They see them as illiterate, unskilled and quacks.
Nevertheless, one of the bone setters informed
us that he is often invited on a private
arrangement by doctors in orthopaedic hospitals,
to treat some complicated cases. He also
claimed that his father was approached with an
offer of official appointment in a public hospital
during his hay days, but he turned it down.
On referral to orthodox practitioners, the bone
setters said that they refer cases with serious
wounds for suturing after which the patients
come back for bone setting. They noted that
patients sometimes leave the hospitals in
preference to their services. They both claimed
that they could handle complex bone problems,
fix them and the patients remain healed. They
also claimed that there is no condition that will
make them amputate either the limb or the hand
if the patients or their family consulted them early
enough.
3.4 Role of Communication
In spite of the pivotal role of communication in
health care delivery across the globe, the bone
setters interviewed claimed not to have promoted
their practice in any way whatsoever to the
public. However, further investigation and
interaction with patients showed that their main
source of information about the individual
practitioner is oral communication media,
particularly inter personal communication. Some
of those interviewed called it oral testimonies that
were given by those who were successfully
treated or their relations and friends or both.
Among the sources through which information on
these bone setters reached them are family
visits, meetings and group fora.
4. DISCUSSION
Traditional bone setters play a pivotal role in
orthopaedic healthcare delivery in the two
communities under study. They constitute the
first points of contact for orthepaedic challenges
due to their perceived efficacy, accessibility and
low cost (including their psycho-cultural
attachment). Fractures that fail to heal with the
routine treatment of splinting and massaging are
given further traditional treatment (after
consultation with the gods). This view was also
canvassed by some scholars in their study of
methods of bone setting in Nigeria, pointing out
that further treatment may be given by way of
scarifications, sacrifices and incantations [17].
The study communities hold the therapeutic
Okpoko et al.; JESBS, 26(4): 1-9, 2018; Article no.JESBS.43114
7
methods used by bone setters and the way they
address orthopaedic problems in high esteem
and this is expressed in their increasing
patronage of the process. Earlier studies showed
that the patronage of traditional bone setting in
some parts of Nigeria ranged between 50% and
43% [18,19]. Thus, given the importance of
traditional bone setting to the people of the study
communities, it is vital that the practice be
understood.
Observations made during the study visits
revealed that the roots of plants, shea-butter,
palm kernel oil and python fats and variable
types of splints are the major raw materials for
the treatment of bone challenges. It has been
argued that African traditional medicine is
anchored on the belief that natural resources
have active therapeutic principles …which can
be manipulated spiritually and/or physically by
those who know how to and produce marvelous
results [9]. We also found that the bone setters
used bandage, tissue paper, hand gloves and x-
rays during therapeutic care. One of them also
placed patients on calcium tablets to promote
healing. These materials are generally
associated with orthodox medicine, and along
with the increased patronage of traditional bone
setters, present the need for collaborative efforts,
and a possible synergy between the two
practices. As earlier averred, the high patronage
of traditional bone setting portends that the
orthodox system also has some deficiencies, and
therefore requires an audit in order to correct
their inadequacies [20].
In spite of the increasing patronage of traditional
bone setting and the perceived efficacy of the
process, a number of flaws appear to militate
against it.
1. The informal process of training and
acquiring skills (often hereditary in nature),
including oral tradition, which does not give
room for documentation and formal
transmission of knowledge, thereby
restricting new entrants into the profession.
2. The spiritual undertone of treatment in
some cases, which makes it difficult for the
process to be reviewed and formally
transferred.
3. The drug administration procedures are
seen as a misnomer, leading to
unrestrained criticism from the orthodox
practitioners.
However, given the confidence that the
traditional society has on the traditional bone
setters, it is pertinent that their capacity be built
in a number of areas to enhance their
effectiveness. First, it is vital to improve their
process of diagnosis via the use of radiography
and other modern diagnostic facilities [9]. It must
be noted that some of them have learnt how to
read x-rays and this facilitates treatment.
Second, they need to embrace current drug
administration procedures, including pain
reduction, administration of calcium and other
therapies available in modern orthodox practice.
We have noted in the preceding pages some of
the modern inputs that have been injected into
the traditional practice, including the use of
bandage, POP and tissue paper. These are
some of the ways we can integrate the traditional
healing process into the western modern medical
practice. It is also important that efforts be made
at regulating their practice, including the
establishment of a sound referral system and
adoption of a standard capacity building
programme. Though there may be some inherent
deficiencies as shown above and inadequate
accommodation for in-patients, it is apparent that
they are invaluable to the society. Their inputs
will be optimally utilized if they are trained to
function at the primary level especially in the
rural areas where the demand for their services
is high.
Given that traditional bone setting is generally
rural-based, oral communication can be
employed in a more patterned manner to
promote the practice so as to create public
awareness, enhance process utilization and
provide a platform for integrating traditional and
modern practices. Using this form/mode of
communication, information can be disseminated
at meetings, market places, group fora, churches
and religious gatherings etc. This form of
communication constitute the primary and
efficacious mode of communication among rural
people. As can be seen from our earlier
discussion, the strength of bone setting in these
parts lies in its dynamism and willingness to
incorporate new ideas, including those coming
from its main rival, the hospital [11]. This is
where communication becomes absolutely vital.
5. CONCLUSION
This research has established that bone setters
do not only play a critical role in addressing
orthopaedic challenges in the two communities
studied, but are also increasingly utilising modern
health care materials to improve their services.
The orthopaedic doctors were also found to have
utilized their services while handling some
Okpoko et al.; JESBS, 26(4): 1-9, 2018; Article no.JESBS.43114
8
challenges. Consequently, the need to integrate
the two practices becomes pertinent. This
entails not just the designing of capacity building
and training programmes for traditional bone
setters to improve their services, but also
encouraging orthodox doctors to learn and
incorporate knowledge gained from the
traditional bone setters into their profession. It is
therefore unarguable that bone setters are
integral and indispensable part of our present
health system whose prospects cannot easily be
wished away soon.
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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Okpoko et al.; JESBS, 26(4): 1-9, 2018; Article no.JESBS.43114
9
Oral Interviews
1. Simeon Chita Nwafor (70 years) Ogboji Bone setter
2. Chukwudi Nweke (38 years)
3. Anna Nwafor (55 years)
4. Opoke Stephen (54 years)
5. Onyema Egwu (47 years)
6. Enoch Dimgba (41 years)
7. Silas Onwe (43 years)
8. Attama Chijioke (30years) Owerre Eze Orba Bone setter
9. Mr. Osienu Adams (32 years)
10. Mr. Ezediora Jude (49 years)
11. Mr. Ebuka Ede (32 years)
12. Sunday Ugwuoke (33 years)
13. Ezeorba Osondu (51 years)
14. Eze Chiamaka (31 years)
15. Sunday Okoli (42 years)
16. Clara Eneh (64 years)
17. Ngozika Ossai (50 years)
_________________________________________________________________________________
© 2018 Okpoko et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Peer-review history:
The peer review history for this paper can be accessed here:
http://www.sciencedomain.org/review-history/26087
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Corresponding Authors's E-Mail: owoshynah@yahoo.com Tel: +2348066504953 In Nigeria, the practice of traditional bone setting (TBS) is extensive as in other developing nations. Traditional bonesetters play an imperative role in fracture care. Though, the outcome of the intervention of TBS treatment is usually poor with profound effects on the patient in the future. This study seeks to examine the activities of traditional bone setters on fracture care in Ekiti State, Nigeria. Survey method was applied in the study. 250 questionnaires were administered to owners of traditional bone centres and their clients respectively. Ten (10) of such centres were selected for the study in Ekiti. The findings indicated that majority of the bone setters had little or no formal education. Many of them acquired the schema used through ancestral/supernatural power. The TBS lack basic knowledge of investigations and wound care while most of their clients patronized them because of poverty, ignorance and superstitious beliefs. Provision of adequate basic equipment in health institutions may reduce the rate at which people utilize Traditional bone centres against medical advice.
Article
Full-text available
The practice of traditional bone setting (TBS) is extensive in Nigeria and it enjoys enormous patronage by the populace. However, the outcome of the intervention of TBS treatment is usually poor with profound effects on the patient. There are many publications highlighting different aspects of this subject but none has summarized the entire practice and problems as a single publication. This work aims at reviewing the entire subject of traditional bone setting in Nigeria in a single article to enable easy understanding and appreciation of the practice and problems of traditional bone setting by orthodox practitioners. A total of thirty-one relevant published original scientific research papers involving all aspects of the subject were reviewed and the practices and problems were documented. The results showed that 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. Though the methods of treatment vary, the problems caused by them are usually similar with extremity gangrene being the worst. When attempts have been made to train the bone setters, improvement have been noted in their performance. In other to prevent some of the most debilitating outcomes like amputation, it is suggested that the TBS practitioners undergo some training from orthopaedic practitioners.
Article
Full-text available
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.
Article
Traditional bonesetters (TBS) practice widely in Nigeria. Our aim was to evaluate the types of complications seen in patients previously treated by TBS and to assess factors that may predispose to the complications. We carried out a prospective non-randomized controlled study in a general hospital in southwest Nigeria. All patients brought into the hospital over the 10-month study period with fractures who had been treated previously by a TBS and, as a control, all patients brought directly to and treated by us were studied. Each patient was assessed and prescribed the most appropriate treatment for their fracture: reduction, immobilization (operatively and otherwise) and physiotherapy. Malunion, non-union, delayed union, gangrene, stiffness of joints and loss of joint motion, Volkman's ischaemic contracture and tetanus were all investigated. Over half of the patients in the TBS subgroup had malunion, and a quarter had non-union. Only one out of the 36 (2.8%) had no complaints and was satisfied with the outcome of treatment of his fractures by the TBS. In the orthodox subgroup, there were seven complications as a result of treatment of a total of 49 bones (14%). Most of the complications involved the loss of joint motion. There were no statistically significant associations between the complications recorded and the ages of the patients, types of bone fractured or the duration of treatment in patients who were in the TBS subgroup. The introduction of a health insurance scheme in Nigeria may make it easier for individuals and families to be able to afford proper fracture treatment in hospitals.
Article
The aim of the study was to review extremities amputation cases in a private medical establishment in Port Harcourt with a view to identifying the incidence, indications, and limb status at surgery. Hospital records were reviewed on amputation cases from June 1998 to May 2003. Upper and lower limb amputations done elsewhere with stump reviews by us were included. Thirty-four cases were reviewed, with a male to female ratio of 2.1:1. The 2nd to 4th decade produced 67.6 percent of the victims. Trauma contributed 70.5 percent of the cases, with road trauma contributing 47 percent of the entire series. Gangrene as a result of injury complication was the commonest indication for surgery. Lower limb amputations were commoner (n = 24) than upper limb amputations (n = 10). Below knee amputation was the commonest procedure performed. The percentage of the patients who consulted the traditional bone setter before presentation in hospital was 33%. Complications of injuries arising from road traffic accidents are a major cause of limb loss in our environment. Ignorance and cultural beliefs expose innocent persons to quacks especially traditional bone setters. Education and strong legislation is advocated to prevent unwarranted limb loss.
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