Every weekend, Africans, especially young males, indulge themselves in a new obsession – the Barclay’s English Premier League. The league’s leading teams commonly referred to as the Big Four have fans dotted across the world especially in Africa where the championship is religiously watched. And over a period of time, spectators have developed interests in the clubs thus becoming ardent “fans” of such teams. The clubs with most fans are Chelsea, Manchester United and Arsenal; and every soccer fan wants to be associated with the club they support hence they adorn their club’s paraphernalia even when they are not original merchandises; and the more obsessed male fans go to their local football pitches to relive the experience they’ve seen on the weekly edition of The Greatest Football Show. I’m one of such die-hard obsessively possessive football aficionados.
Last weekend, the much-talked-about Chelsea/Manchester United derby was suspended due to bad London weather although it was a bright sunny Sunday afternoon in the ancient city of Ibadan. To keep ourselves busy with soccer, fans of both teams went to a nearby field to play. After about twenty minutes of amateur football, the makeshift referee pointed to Chelsea’s penalty spot after “Terry” roughly tackled an unleashed “Berbatov”. For few minutes, settled dusts were unsettled as both teams argued the referee’s judgement. But after the extensive argument, the lone striker was called upon to take the spot kick. Instead of coming around, he was found writhing in great pain at the far post. He complained of a “snapped” ankle. As a medical professional, I demanded he’d be driven to the tertiary health facility on the other side of the road, only to have my order rescinded by other team players who considered Agbomola Traditional Healing Home a better choice. This brings to the forefront the age-long supremacy battles between traditional bonesetters and orthopaedic surgeons; doctors and herbalists.
In Asia and most African countries, more than seventy per cent of bone-related ailments are handled by the traditional bonesetters who use crude [and often crook] methods to fix their patients’ broken bones. Unlike Asian countries like China, and India where there are guiding rules that incorporate traditional bone setting practice into mainstream healthcare system, most African health ministries are still undecided on how to regulate traditional bone setting, and classify the bonesetters.
Traditional bone setting is an art that in the face of urbanization, lack of public attention and paucity of modern facilities, has survived more than 3,000 years. It is worthy to note that Hugh Owen Thomas, whose memory is honoured, even today as the Father of Orthopaedics in England, was a traditional bonesetter. Basically, the contemporary simple definition of a traditional bonesetter (TBS) is a lay practitioner of joint manipulation. He or she is the “unqualified practitioner” who takes up the practice of healing without having had any formal training in accepted medical procedures and modern day healthcare which has greatly evolved following advances in technology and medical research.
Unlike other aspects of healthcare, educational status of patients does not seem to affect patronage of the traditional orthopaedics practitioners considering the fact that the well lettered, semi-literate and stark illiterates patronize and consult the various traditional bone healing homes. The patronage that cuts across educational demography is as a result of some peculiar features of traditional bone setting practice that include cheaper cost and utilization of “faster” healing methods without heavy plaster of Paris bandages, no prolonged periods of immobilization, and the non-existence of the greatest fear of all bone fracture patients, the thought of which generates trepidation: amputation.
There are also issues like the apathetic attitudes of orthodox hospital workers, secrecy and the too-good-to-be-true radio and television jingles of the bonesetters who make great claims without mentioning any possible contraindications and side effects. There are also esoteric issues that are peculiar to traditional healers.
Traditional bonesetters are easily accessible and more reassuring than allopathic orthodox medical practitioners in several developing countries, especially in here in Nigeria. They have an awesome home treatment programme and an impressive home delivery system of treatment regimens. Unlike the orthodox health facilities, traditional bonesetters can advertise their products and services in the media, which they often spice up with bogus claims, laughable analyses and fallacy-laden assertions.
Bone setting service seekers know that traditional bonesetters’ proficiency in bone setting is passed from generation to generation without any formal documentation whatsoever. They also know that traditional bone setters are extremely careful about their reputations and for their clients they try to act to the best of their knowledge. Several of these healers have extensive experience and sound knowledge of regional resources, hence their patients feel quite safe. But are they really safe?
It’s true that across the developing countries of the world, traditional bonesetters have strong regional influence and popularity but these doesn’t guarantee absolute safety of their practice. Except in rare cases, traditional bonesetters do not use scientifically proven and approved procedures like radiology for better understanding of what is happening to their patients at the osteoclast/osteoblast level within the fractured bones. In most cases, the only diagnostic procedure that they carry out is to “feel” or “palpate” the fractures with bare hands which is often a direct ticket to missed diagnosis or misdiagnosis. But this doesn’t take anything away from the extensive experience and sound knowledge of experienced traditional bonesetters.
So far, the expert bonesetters that I interacted with in the process of treating Berbatov’s ankle fracture have an unusual accurate yet unlettered understanding of osteology (scientific study of bones) without ever seeing the four walls of any anatomy lecture theatre. This however does not make irrelevant allopathic orthopaedics, the only twist it adds to medical education is the fact that experience and skills should be the focus, not big textbooks and complex terminologies considering the fact that only a few out of the thousands of traditional bonesetters can recite the ABC rhyme correctly, yet they know the physiology and anatomy of bones in relation to the rest of the body.
Furthermore, unlike what orthopaedic professionals would claim, traditional bonesetters contribute a lot to medicine other than the harm gospel that is preached by orthodox health practitioners in the media. Take for instance the challenge that the traditional healers pose to physicians. Like Sir James Paget, foremost 19th century orthopaedic surgeon rightly said in a lecture entitled “Cases That Bone Setters Cure”, he stated that “few surgeons are likely to practice without having a bonesetter for a rival; and if he can cure a case the surgeon failed to cure, his fortune may be made while the surgeon’s is marred”. In essence, and unknowingly, traditional bonesetters help in keeping orthopaedic experts on their toes all the time and abreast of better treatment options.
Still on the good side of traditional bone setting practice, research has shown that several bone setting practices reported in medical literature are either equivalent to or far better in results than orthodox practice. Several researchers had reported better results with bone setting in chronic back pain in several observer-blinded, randomized clinical trials as compared to standard physiotherapy sessions. There are further examples to justify this medical school of thought.
The universally accepted treatment for fracture of forearm bones in adults is open reduction and plate fixation. However, a research team tried the Chinese method of bone separator pads and splint immobilization in 2,221 forearm fractures. They found that the traditional method is not only simple, economical and effective, but also eliminated delayed union or non-union. In another observation, another team of researchers used paper roll spreaders and wooden splints in 147 patients with forearm fractures. They concluded that by preserving inter-osseous membrane, manipulative reduction is greatly simplified and that simple wooden splints were found to be much more effective and satisfactory than plaster of Paris for immobilization of fractures of shafts of both forearm bones.
In the same vein, randomized trials in buckle fracture of the distal radius have shown that they can be effectively treated in soft bandage. The technique is simpler, cheaper and much more comfortable for children. And the modern practice of ‘functional cast bracing’, advocated by Sarmiento and Lata, bears close resemblance to some of the ‘bamboo’ bandaging pattern of Nigerian traditional bone healers, without the local gin of cause.
The many failures of traditional bone setting procedures had created a bad reputation for the practice in several conservative counties and concerned countries of the world. Critics often criticize the “irrational” methods and procedures which usually include esoteric practices like enchantments, armlets, incisions and midnight sacrifices to ward off evil spirits. There had also been copious documentation of gruesome complications occurring as a result of traditional bone setting practices.
Modern practitioners often point out that when bonesetters try to treat more serious injuries, the patient usually ends up requiring operative intervention resulting in diminished chances of successful outcomes. In their opinion, the bonesetters’ main reputation comes from treating minor injuries such as sprains or soft tissue damage. It’s clear that modern health practitioners generally stand against the promotion of traditional medicine and its integration with the modern healthcare delivery system. Thus, there is an atmosphere of mistrust between the two sectors. This is where the health ministry needs to step in.
In most countries of the world, the enmity is not as pronounced as it is in Nigeria and some third world developing countries. In these countries, the alleged antagonism between orthodox and unorthodox practice is a more than a mere exaggeration and practitioners in each field fail to realize that they are actually inter-dependent. This ignorance is the major reason why every attempt to recognize traditional bonesetters as primary healthcare provider has been impossible although the current scenario of healthcare delivery and medical education in Nigeria indirectly lends support for the practice of traditional bonesetters.
The Nigerian healthcare system faces the challenges of a predominance of a rural population (almost three-quarters of the country’s population), low per capita income, inadequate transportation capabilities, overcrowding, illiteracy, corruption, inadequate resources, lack of supporting services such as orthopaedic nursing, unstructured referral practice and an uninsured health insurance system. Modern orthopaedic services and training are most often directed toward the urban population. Who cares for the less privileged?
Over sixty five per cent of hospitalised Nigerians fall below the poverty line because of hospital expenses. Specialised orthopaedic operations requiring a technically up-to-date infrastructure and costly implants are practically beyond the reach of the average Nigerian-on-the-street. In the rural areas, the situation is even worse and more precarious as primary health centres are practically devoid of any orthopaedic services despite the fact that bad roads are ubiquitous and motor bike riders (popularly called Okada riders) who are prone to accidents are now in their millions.
While the Federal Ministry of Health oscillates like a swinging pendulum, orthopaedic care seekers already know that just as certificates are not needed by anybody to deliver babies, no certificate is needed to set bones. And in the face of a much-stone-left-unturned health system, consulting and confiding in traditional bonesetters is a viable low cost alternative. Whether the governments recognize them or not, they have gained the trust of their patients which is the foundation of any good health practice.
Forty eight hours after sustaining the ankle injury, our own Berbatov was back on pitch collecting long and short passes from the midfield, and reeling in laughter which showed that his recuperation is complete without spending fortunes or weeks at physiotherapy rehab.