By Surafel K Gebreselassie
It wasn’t a surprise to see trauma cases every week. They varied from car accidents to simple falls. They were of all ages. The surgical outpatient clinic had just enough things to manage simple fractures and other minor traumas. The room had a desk, two chairs, an examination bed, few materials to make arm slings and simple casts. We also had analgesics and antibiotics.
I was finishing my coffee, one of Ethiopia’s gifts to the world when the nurse alerted me about a patient. It is not a coincidence that coffee originated where mankind did; that is if you believe in science. Many do.
So when Mosisa, a middle aged man from Keffa, was brought drenched in sweat, we were ready to help. He was cutting firewood when he fell. We used to be good at handling trauma. We quickly ticked off the main things; air way, breathing and circulation. He didn’t suffer major injury. His left forearm was swollen and had bruise marks. We send him for X-ray.
The day went buy quickly; a child with snake bite, a girl with a minor cut, a woman with a first degree burn, an elderly man with intestinal obstruction that we had to refer for emergency surgery.
It wasn’t until late in the day that I realized I didn’t see Mosisa back from X-ray. I called the radiology department. He had the X-ray and was sent back with the films but he was nowhere to be found.
Traditional bone setting is practiced in many developing countries. There are over 70,000 traditional bone setters in India, one of the largest groups practicing traditional medicine in the country. Although actual numbers are not available, traditional bone setters are commonly available in Ethiopia and are not limited to rural areas. They offer treatment for fractures and dislocation of bones. They often offer cheaper treatment and are believed to use faster healing methods. Fear of prolonged immobilization, perceived complications such as infections and amputations drives many patients to see traditional bone setters. Where there is lack of access and scarcity of resources, traditional bone setters may be the only readily available option for many patients in many developing countries. While many fractures heal properly with traditional treatment, bone setters often do not appreciate the dangers of tight splints that can, in some instances ,lead to gangrene by cutting out circulations. They often use splints made from split bamboo or strips of wood tightly bound around the limb, and in some cases including local joints. For example, in a study done in Arba Minch Hospital in Southern Ethiopia from 1999 to 2001, there were 49 amputations of which 25 (51%) had been required because of application of tight splints by a traditional bone setter.
It wasn’t just me. It wasn’t just Mosisa who disappeared with his own X-ray films. Many of my co-interns started to see the trend. Some patients would come back the following day or after a day or two with their X-ray films. Those tended to be complicated ones. We never saw the simple fractures again. The patients would walk in, go to the radiology department, pick up their X-ray films and disappear.
There are many smart people in every society although we may not appreciate them readily. One such person living not far from our clinic was a retired high school biology teacher who picked up bone setting. He would send the patients to the clinic where they get free X-rays. The loyal patients would take the films to him as instructed. He would look at the films. Where there is good alignment he placed bamboo splints, charged a few bucks and we no more saw those patients. When he thought it was a complicated fracture or couldn’t read the X-ray well he would send the patients back to the clinic, often the following day or a day after.
I never say Mosisa again. I suspected that he would have had a simple fracture, well aligned, probably had a bamboo splint, paid few buck to the retired biology teacher, went back to cutting his firewood reassured that he is in the safe hands of a clever bone setter in the neighborhood.
References used in the article
J Ayurveda Integr Med. 2011 Oct;2(4):174-8
J Bone Joint Surg Br. 2005 Jan;87(1):102-3.