Traditional Bone Setting in Pakistan

PERCEPTION OF PEOPLE ABOUT TRADITIONAL BONE-SETTING
A Synopsis for Social Research

By

(Hasnain Ali Shah, Chiniot)

(Shafiq Ahmad Khalid, Narowal)

GC University, Faisalabad, Pakistan.

ABSTRACT: -

The practice of traditional bone-setting is a branch of traditional medicine, which has a great recognition in rural societies of Pakistan but also in urban setup as well. Despite the increasing popularity of this branch of traditional medicine particularly in urban centers, Western health institutions undermine its potency; thus many people who cannot afford the cost of modem healthcare are discouraged from the traditional option. This study was designed to assess the perception and attitude of people towards traditional bone-setting with a view to ascertaining if the practice can be regarded as an alternative therapy. The study seeks to enlighten all the stakeholders in the health care system about traditional bone-setting in Hafizabad city. Data would be generated through quantitative research techniques. Hundred respondents would be involved in the research. The study established in the people suffered from some sort of fractures and practicing traditional bone-setting. People believe in the potency of the traditional bone-setting more than western orthopaedics because it is affordable, accessible and accommodating to patients. It was further established that there is need to integrate the traditional bone-setting into Western orthopaedic practice for sustainable health care system in the area.

Traditional bonesetters (TBS) have been in region for centuries. Most of the 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 societies like Pakistan. We attempted to document the current practice of traditional bone-setting in Hafizabad city 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 traditional bone-setting over the past few 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 traditional bone-setting 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.

INTRODUCTION: -

Indigenous systems of medicine do not limit themselves to just fulfilling the needs of primary health care, but also reach out to specialized areas like treatment of eye diseases, poisons (snake and insect bites), bone setting, and ancient acupressure and so on. Unfortunately these specialized areas are not so well known.

One such popular but little known area is that of bone-setting. Many interesting facts have been described in ancient ayurvedic classics on the management and treatment of fractures including the different kinds of bandages and slings to be used. Orthopaedic cases like fractures - both simple and compound, dislocations and sprains are common in rural and even in some of urban areas. Revitalizing the existing precious science of bone setting would be a cost-effective alternative for the costly "state of the art" techniques of surgical reduction, heavy Plaster of Paris plasters and long periods of immobilization.

The science of bone setting is included in ayurveda. To begin with, there is a detailed study of the types and number of bones. There are five types of bones flat bones, small cubical bones, cartilages, curved bones like rib bones, and long or tubular bones. Traditional bone-setting depends on the manipulative reduction of broken bones, external fixation with splints or with a functional brace that provides limited immobilization of a fracture site and mobilization of other joints. This way, the patient, through the movements that are possible, exercises the limb.

Broken bones are set with tabb or splints. These are varying lengths and sizes of wood in sets of four, firmly tied around the site of the fracture with strings or date palm fronds after padding it with cloth. This method has changed very little over the years. It is equally true that bone-setting, has been accompanied by several complications, some of them serious. This is to be expected because many healers are ignorant of anatomy and modern techniques of the craft. Their shortcomings are particularly exposed when they try setting compound fractures, spinal cord injuries, and difficult fractures.

Closed soft tissue injuries can result from falls, blows, collisions and compressions. They give rise to crushed parts, sprains, contusions or more serious injuries. All are managed with massage and manipulation using a variety of oils, ointments, poultices and bandaging, as well as rest.

OBJECTIVES: -

The objectives of this study are elaborated as under,
1. To gauge the perception of individuals about the methods of traditional bone-setting.
2. The aim of this trial was to establish the effectiveness of traditional bone setting compared with conventional physical and exercise therapy.
3. Compare the cost effectiveness of traditional bone setting and conventional physical and exercise therapy.
4. To know the extent of use of radiography in traditional bone setting and its impact on perception of individuals.

LITERATURE REVIEW: -

The importance of the review of the literature lies in the fact that it highlights the background of the problem to be studied. It also provides further orientations about the problem and eliminates possibility of unnecessary duplication of efforts. In addition, valuable information on research techniques may be gained from reports of earlier research. A few comprehensive studies have yet been conducted in Pakistan on problem under study. However, some of available literature related to the problem under investigation is reviewed under the chapter.

A Ikpeme, A M Udosen, I Okereke-Okpa (2007) conducted study on “Patients' perception of traditional bone setting in Calabar” and concluded that 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.

Dr. M. Radhika (2000) conducted study on “a traditional bone-setting” and concluded that astonishing thing in most traditional centres is that the chief physician is not a qualified vaidya from an institution but carries on the hereditary service of his ancestors. They do not have a prescribed fee pattern. Each patient gives what he can afford as an offering. These centres render invaluable service to the people in their neighbourhood who are mostly villagers, farm workers and tree climbers who definitely cannot afford treatment for fracture in a modern orthopaedic hospital.

Zaproudina N, Hänninen OO, Airaksinen O (2007) conducted study on “Effectiveness of traditional bone setting in chronic neck pain: randomized clinical tria” and concluded that Traditional bone setting, which is a soft manual mobilization technique focusing on the muscles, joints, and ligaments, appears to be effective in cNP. Two thirds of subjects experienced it as beneficial, and it seems to be able to improve disability and pain in patients with cNP. Subjective and partially objective benefits of TBS were found in those patients more than after other interventions, and the effects lasted at least for 1 year.

B. Omololu, S. O. Ogunlade and V. K. Gopaldasani (2008) conducted study on “The Practice of Traditional Bonesetting: Training Algorithm” and concluded that 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

AI Eshiet, AM Udosen, IU Ilor, OE Ngim, SG Akpan (2004) conducted the study on “Methods of Pain Management by Traditional Bonesetters: Experiences in the South-South Zone of Nigeria” and revealed clear evidence of ignorance of a need for adequate and proper analgesia and anesthesia during bone treatment among the TBS and their clients. There is a need to draw the TBS together for the purpose of education and awareness so as to discourage this aspect of harmful Tradition practices in our society.

METHODOLOGY: -

Methodology is the science indicating ways of doing something properly. Methodology deals with the theory of study, the description, the explanation, and the justification of methods, not the application of methods themselves. The aim of the methodology precisely is to help the researchers to understand the broadest possible terms, not the products of scientific and research inquiries, but the process itself because in essence the Methodology is the science of studying how research is done objectively and scientifically.

In present study, field survey was used. Despite few demographic questions, most of the demographic and variable questions were closed ended as needed in the study.

Universe:
The universe of the present study comprises of the individuals having some sort of bone-fractures. Numbers of the respondents is 100. The researchers try to represent the population of district Hafizabad. Hafizabad has traditional bone-setting industry that’s why researcher selected it as a target population.

Sampling:
After selection of the universe, the next step is sampling. For present study haphazard sampling technique is used because the researchers want to represent the maximum representation of the population.

Instrument for Data Collection:
Interview schedule was used as a tool for data collection for the present study. There were following reasons for choosing the interview schedule as a tool of data collection. Target population was not consisting of only literate persons, so illiterate population could also participate. Through interview schedule, researchers could probe and get complete and accurate answers. More responses could receive through this tool for data collection as compared to others and actual respondent alone could answer the questions. While interviewing, the researchers could control the environment, question order, and judge non-verbal behavior of the respondents.

References: -
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4. Oyebola DD. Yoruba traditional bonesetters: the practice of orthopaedics in a primitive setting in Nigeria. J Trauma. 1980;20:312–322.
5. Onuminya JE. Performance of a trained traditional bone setter in primary fracture care. S Afr Med J. 2006;96:320–322.
6. Onuminya JE. The role of the traditional bone setter in primary fracture care in Nigeria. S Afr Med J. 2004;94:652–658.