Towards-Safer-Healing-Navigating-the-Challenges-of-Orthopedic-Care

Towards Safer Healing Navigating the Challenges of Orthopedic Care

One major challenge in orthopaedic practice is the complications that may arise from traditional bone-setting methods among trauma patients. Many pediatric patients who experience trauma often visit local bone setters for repeated massages before eventually going to a hospital when complications arise. By this point, it may be too late to save limbs, forcing doctors, in many instances, to amputate to preserve the patients’ lives. This may result in permanent disability and impairment. EBR’s Dr Brook Genene examines how these traditional treatment methods can cause more harm than good in many cases. He explores potential solutions.

Ayele Sura is a 27-year-old daily labourer living in a small village near Hawassa, the seat of the State of Sidama. He wakes every morning to cut down large trees and sell the wood. His income from this work supports his wife and two children. However, what transpired one morning changed Ayele’s life in ways he could never have anticipated.

While Ayele was performing his daily task, a large log of wood rolled over his leg, shattering the two bones between his knee and ankle. This condition is described as a tibiofibular open fracture.

After the injury, he was initially taken to Hawassa University Comprehensive Specialized Hospital. However, due to family pressure, he left the hospital and chose to visit a traditional bone setter, commonly known as a ‘Wegesha’ in Ethiopia. He was treated using traditional methods involving sticks. Unfortunately, rather than solving the problem, this approach further aggravated his illness. The sticks, often tightly fastened with no room for air circulation, cut off blood flow to the area and caused additional pain.

“I was in excruciating agony, but the Wegesha would come every few days to adjust the sticks and give me Diclofenac for the pain,” Ayele said. When things showed no improvement, he was taken back to the hospital. However, upon arrival, he was in critical condition.

“His red blood cell count was very low when he returned,” said Dr Mengistu Gebreyohanes, an orthopaedic spine surgeon at the hospital. The doctors had no choice but to amputate the affected leg due to inappropriate management. Ayele’s story isn’t isolated. Many people suffer from the consequences of poor care provided by unqualified professionals in trauma related to the musculoskeletal system. Health professionals have been working to address this widespread problem through awareness campaigns and research initiatives nationwide.

The Bone Setting Associated Disability (BOSAD) research team includes orthopaedic surgeons and public health experts from various institutions. They aspire to ensure safe, affordable, and accessible musculoskeletal care, with a special focus on children living in rural areas of the country. BOSAD’s theme is “No More Disability Accepted from Traditional Bone Settings.”

Established six years ago, the institution held its Annual Research Review Meeting on November 22, 2024, bringing together diverse stakeholders from governmental organizations, NGOs, media, research, and other sectors.

During the meeting, BOSAD presented its performance for 2024 and introduced teaching and documentary videos, along with a manual for health professionals. These resources are designed to raise awareness and drive positive change within the community.

Even though orthopaedic services in Ethiopia have increased in the past decade, gaps remain in delivering care to those who need it. The Ethiopian Orthopedic Association was established 25 years ago, and there are now 600 orthopaedic surgeons in the country—a tenfold increase since 2014. The paradox, however, is that despite this increase, complications from traditional bone setters have also risen.

During the research meeting, Professor Biruk Lambisso, a pioneer of orthopaedic surgery at Addis Ababa University, stated that there are now 11 orthopaedic departments training residents across Ethiopia, with two more sets to join soon. He emphasized the need to focus on preventing complications and raising awareness.

“Males between the ages of 6 and 8 years old are the most at risk in Africa due to fall accidents and exposure to traditional bone care,” Professor Biruk said.

According to BOSAD’s research, preventable causes of disability account for 83%, and 50% of individuals have no access to healthcare. Despite there being 250 primary hospitals and 17,000 health posts, 1 in 5 people are disabled.

Health promotion and prevention are vital in addressing this issue. Professor Biruk noted that rehabilitation has been the most significant task of the World Health Organization. “I will make a presentation to the House of Parliament about how vital this issue is,” he promised. The parliament, the Ministry of Labor and Skills, and the Prime Minister’s Office are working to find the best approach to traditional medicine.

Complications from traditional bone care have been described as diseases of poverty. Among the causes of amputation, 86% are due to delayed treatment of open fractures. According to BOSAD’s research, 77% of patients who seek traditional bone care suffer from general complications. Severe complications account for 6.6%, severe infections for 4.8%, and significant amputations for 1.4%. Additionally, 26.7% of patients visit a health facility before seeking help from traditional bone setters.

In a study conducted on pediatric patients, 74.6% were found to be male, with a mean age of 9 years. Additionally, 52.6% of the children were from urban areas, and the mean presentation time was 113 days after the injury. Falls accounted for 76.5% of the injuries.

Eliminating the ‘Wegeshas ‘seems more plausible. Therefore, BOSAD is working to engage informally with traditional bone setters by creating a registry and a common WhatsApp platform for the training team. The development of a training curriculum is also underway.

Selection and training of faculty and support staff who will take over this endeavour are in progress. The training team comprises orthopaedic surgeons, nurses, physiotherapists, public health specialists, Traditional Medicine Practice Council officials, and research and data collection officers.

Locally developed educational materials, including locally designed forearm and arm splints and tibia/fibula fracture splints, are being implemented.

Professor Biruk has mentioned that all other professions are regulated and have oversight, highlighting the need to control traditional bone care. “Other professions also need to register and pay. Fair treatment for all is important. We are dealing with humans, not a building or a bridge,” he noted.

Despite the many strides made, orthopaedic care has its challenges. These include the affordability of modern care, under-equipped health facilities, a limited number of professionals, delayed patient presentation, and complications from traditional treatments such as massaging and bamboo splints.

Experts have suggested that all stakeholders, including those in leadership positions, must be involved in addressing this issue. Many share Ayele’s story; significant work remains to solve this widespread problem. Ethiopia can create a more effective and equitable healthcare system by fostering collaboration among health professionals, policymakers, and community leaders. EBR


13th Year • December 2024 • No. 136

Author

Dr. Brook Genene

Deputy Editor-in-Chief of Ethiopian Business Review (EBR). He can be reached at brook.genene@ethiopianbusinessreview.net


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