Traditional bonesetters gaining ‘costly’ patronage

Despite the warnings to Nigerians to refrain from patronising traditional bonesetters due to the consequences, Nigerians have increased their confidence in the practice. ADAKU ONYENUCHEYA writes on the high rate at which Nigerians visit bonesetters for cheap and effective service.

A Visit to Baba Yusuf’s residence, one would think there is an important function, issue of controversy or registration of the Permanent Voter’s Card ongoing, as seen in low cost residential areas, which draws huge crowd.Every morning, as early as 7am, more that 20 people, both old and young, men and women, gather at Baba Yusuf’s residence at Abimbola Street, Agege, Lagos waiting for him to attend to their case.

Baba Yusuf, as fondly called, has an apprentice, who doubles as his personal assistant, giving customers tags according to their order of arrival. He has customers who patronise him from different part of Lagos state. Customers come as far as Ogun state, Kwara state and even the eastern part of the country to patronise him.An example of those that come form outside the state is Mrs. Ruth Oyewo, a woman in her late 30s, who resides in Ogun state. She was involved in a motorcycle accident popularly called Okada, on June 30, 2018, dislocating her patella (knee cap).She said on that fateful day she was coming back form work, the Okada man ran her over and fled.

Mrs. Oyewo’s close friend directed her to Baba Yusuf, assuring her of quality service. Although, this is her first time of patronising a traditional bonesetter, she claims that the treatment she has received so far is encouraging going by her response to the healing process.“Immediately I had this accident my friend directed me to Baba and with the treatment I am receiving, they are really offering the best services here,” she stated.

Mrs. Oyewo is still undergoing treatment at Baba Yusuf’s place.Matthew Ojoko, a man in his early 40s also had similar experience in March 2018. He was involved in a hit and run tricycle. He fractured his patella (knee cap) as well. Since he was aware of the services Baba Yusuf renders, he decided to patronise him.He also affirmed that the treatment he was receiving was of utmost quality as he now uses his leg like when he had no accident. Although, he said his visit to Baba Yusuf was for a last check up.

Indeed, the rate at which Nigerians with various forms of bone ailments, ranging from dislocation, fracture, paralysis, and even scattered bones, visit traditional bonesetters is on the rise.Traditional bone setting is an old practice found almost in all communities of the world. In Nigeria, the practice is extensive with high level of accidents recorded every day. The traditional healers still remain popular despite the high level of education and the existence of modern health care facilities.

Also, In Nigeria, these traditional bonesetters were practicing long before orthodox medicine was introduced to the developing world.Contemporarily, both orthodox and traditional medicines are coexisting side by side and patients patronize both. Basically, in Nigeria, the traditional bonesetters enjoy more confidence and patronage from patients with bone ailments.

The World Health Organisation (WHO) has also not condemned the importance of traditional healers in health care delivery in Nigeria, stating that their worth could not be overemphasised. According to the organisation, “incorporating trained traditional health practitioners in primary health care programmes could be cost-effective in providing essential and culturally relevant health services to communities in developing worlds.”

More so, the traditional bone setting practice is a highly specialized form of traditional medicine, which is popular in Africa because its practitioners lay claims to supernatural influences. It is usually passed from father to son, but some outsiders also receive their training through apprenticeship.WHO in 2002, described 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.”

Director-General (DG)/Chief Executive Officer (CEO), Nigeria Natural Medicine Development Agency (NNMDA), Victoria Island, Lagos, Samuel Etatuvie, told The Guardian: “We have been training and re-training traditional bone setters especially those around this axis. We understand the important of their practice and we know that most of the locals go to them at the first instance.”

The pharmacist added: “Under the training we encourage to refer cases that are beyond them to senior colleagues or orthopaedic doctors.“In recent times, we have not been doing much in this area because of lack of funds. But we are hoping to continue.”According to a review, the practice of traditional bone setting in Nigeria by A. A. Dada, W. Yinusa, and S. O. Giwa, published in the journal African Health Science, in Nigeria, about 85 per cent of patients with fractures present first to traditional bone setters. It is therefore of public health importance that the practice of this discipline be well understood.

The researchers said one of the most important flaws of the practice of the TBS presently in Nigeria is the process of training and acquiring skills in bone setting, which is not formal, undocumented and uncontrolled with attendant continuous decline in imparted knowledge and hoarding of information.They further stated that the practice is passed on by oral tradition and there is no regulation, review and even peer-criticism. Quality is therefore not guaranteed and complications are high. This is unlike orthodox training, which is regulated, open and subject to regular review on the basis of new evidences.

In China, Chinese and Western care had existed together for decades, indeed by 1949 there were about 500,000 Chinese-style doctors trained in care of diseases including pain control, fracture and sprains management. The practice is regulated and practitioners undergo structured training.The researchers said in view of the lack of structured training for TBS in Nigeria, it is therefore not surprising that the practice is associated with so many problems, which include the process of establishment of diagnosis that is shrouded in mystery and a notorious inability to identify cases beyond their ability and consequent non-existence of a referral system.

Usually, following failure of a bonesetter, the patient will voluntarily discharge himself/herself to another bonesetter or to the hospital. This in fact is also unlike what happens in Turkey, where the practitioners usually refer difficult cases.In recognition of these deficiencies therefore, some authors have advocated a formal training for the TBS and their incorporation into the primary care system in Nigeria. This idea is worth trying as training programmes targeted at the bonesetters in Nigeria and other countries have been known to have an improvement in their performance and a reduction in complications.According to the study, though patronage of the TBS is influenced by quite a number of factors, a major reason is the perceived cheaper fees.

The researchers concluded: “In view of the societal confidence, which the TBS enjoy in Nigeria, it is important that efforts be made at regulating their practice including the establishment of a sound referral system and adoption of a standard training curriculum. Though a number of deficiencies of the bone setters have been highlighted in this paper, it is obvious that they can be trained to function at the primary level especially in the rural areas.”

Meanwhile, a research conducted by the Lagos-based CLEEN Foundation in 2003 showed that about 47 per cent of road accidents in Nigeria involved commercial motorcycles, leading to loss of hundreds of lives, while thousands sustained various degrees of injury, including paralysis.Though several states in the country have banned the operation of commercial motorcyclists in the main cities, they still operate in the neighbourhoods. These motorcyclists are no respecter of age when it comes to inflicting people with injuries.

Little Abdullahi Abdulrasak, was also a victim of this evil act when he was two years old. His father, Kazeem, who narrated the ordeal to The Guardian said Abdullahi, whose mother’s shop was opposite their residential building was hit by a motorcyclists while he was crossing over to his mother’s shop. Abdullahi who is the first child of a newly married couple, was taken to a near by private hospital for treatment. On getting there, the aggrieved father said there was only a nurse available to attend to them.

Abdullahi whose shoulder was dislocated from the joint was lifeless like a dead person, but for the first aid he was given, he jacked back to life.According to Kazeem, the nurse directed them to consult a traditional bonesetter, saying an X ray would be dangerous for a little child of that age.His father, who was in tears, as he wouldn’t want to lose the first fruit from his blissful marriage, heeded to the advice of the nurse and was directed to Agege, which he took Abdullahi to.“We were told to take him to the hospital and when we went to a private hospital at Akowonjo we didn’t meet the doctor, a nurse secretly called us aside and said the scan is not good for children of his age that we should take him to traditional bone setters to fix his bones, which we did,” Kazeem said.

Kazeen said it took less that four week for his son to be totally healed. Now little Abdullahi uses his hands perfectly, like he never had an accident. Hussaini Umar Hassan, 23, took over the practice form his aged father, Hussaini Bin-Umar, when he was 19 years of age.When he was growing up, his father taught him the rudiment of the practice until he got aged and could no longer lay grip of solid things.Situated at Isah Street, Agege, is Dr Hussaini Bin-Umar Orthopedic Medical Centre, a small shop, which had various herbal concussions and pictures of patients who are been treated, hung on the wall.

As The Guardian paid a visit to Hussaini, who is popularly know in that neighborhood for his quality treatment, a 16-year-old boy, Musbahu Amzat’s hand was undergoing treatment. Musbahu had a fall a week ago while he was playing football with his friends and then injured his hand, close to the wrist. He has been receiving treatment ever since the fall. Husaaini, Lagos-based indigene of Kano state, had since taken over his father’s job and is highly recommended by Lagosians.

“This job was handed down to me by my dad who had been doing it for more than eight years, since he is now old and can’t handle it, he passed the job to me when I was 19 years old. I watch my dad do the job on his patients for five years.On the cases on bone ailment he has treated, Hussaini said, “We have treated different kind of people from different parts of the country, we have treated different kinds of bone ailments such as bone fracture, dislocation, broken bones, stroke, paralysis, and different kinds of accident cases.

On the number of patients who he attends to daily, he said, “The number of patients we treat per day depends, most times customers come in large numbers, while some times we don’t get customers, but our wish is to see people healthy,”Another is Alhaji Mani Muhammed, who hails from Kano state, but has never visited his hometown ever since he was born. The practice, he said, is in his family lineage. Alhaji Mani Yisa Bone Centre, as known by people, had been in existence since 1974 in Lagos.He said he has had series of cases to attend to from different part of the country.

Speaking on the method of treatment, Mani said the traditional bone-setters make use of traditional herbs, concussions, bandages, and in his own case he sometimes use tablets such as antibiotics and pain reliver, for those that have severe pains.“Patients present different cases such as compact fraction due to accidents, internal fraction, dislocation among others. I do my best to treat them with traditional herbs, sometimes I use tablets such as antibiotics and pain reliver, for those that have severe pains,” he said.

For Hussaini and Baba Yusuf, they use combination of traditional herbs and incantations to treat their patients.When The Guardian visited Baba Yusuf, he was found with a dark small calabash, placing it on the point of injury, doing his incantations.He said, “We use incantation once a person can’t walk and we immediately detect the area where the bones need correction.”

For Hussaini, incantations are applied to situations where the bones are broken into pieces. He said, “When we have patients whose bones are broken into piece due to severe accident, we pick and align it with incantations.”Most patients believed that once a bone is broken into pieces and taken to the hospital, it is amputated, which is what drives them to seek solutions from traditional bonesetters.

On the process of healing, the traditional bonesetters opined that it all depends on the degree of the injury, as it takes a month for severe injuries to heal, while lesser ones takes few weeks. Hussaini said, “We can’t give people exact date when they will be totally healed because the body system varies, some are fast to heal, while some are slow. What we do is that we ask them to come for treatment until they are fine.

“For those who can’t walk on their own, we go to their house to treat so as not to stress their legs.Many patients have claimed that much attention is not given to them at the hospitals, as It takes longer time for a doctor to attend to them.They also said the cost of treatment is cheaper than that of the hospitals.All the patients said they paid N500 for bandage and N5000 for treatment, and in the case of bones that are broken into pieces, the traditional bone-setters said they charge N100, 000 to N150, 000 and most time they offer charity to the less privilege who can’t afford the bills.

The Guardian learnt that it take more than N300, 000 and sometime close to a million naira to treat a patient at the hospital.According to figures, Nigeria has 350 Orthopaedic surgeons to meet the needs of over 200 million Nigerians, whereas, the international standard is one orthopedic surgeon to 200,000 people. But Nigeria’s ratio is one surgeon to nearly 500,000 people.This, the immediate past National President, Nigerian Orthopaedic Association (NOA), Dr Mike Ogirima, said is “grossly inadequate”, noting that the training of more Orthopaedics specialists in various branches of the profession would boost their skill and manpower requirement and stem the trend of medical tourism.He said there is need to train more experts in the care of the injured, calling on government to sponsor surgeons for post fellowship programmes and equip hospitals to offer quality services to patients.

The Guardian learnt that medical practitioners in the government teaching hospitals, as well as the orthopaedic hospitals refer patients to these traditional bonesetters, as claimed by them (bonesetters), but the President, Nigeria Medical Association (NMA), Dr. Francis Adedayo was quick to refute the claims, saying there is no record of such in the country.He said if there were any of such cases, the body would have taking up action against the perpetrators.

Although, he commended the efforts of the traditional bonesetters towards healthcare in the country, he said they would need further education and enlightenment to get the job right.This, he said would avoid complications, which could sometimes lead to amputation, as there are many cases that have led to that, if only the right steps were taken.He said the association would not relent in carrying out strict actions towards any of its member involved in risking the lives of patients. Meanwhile, the traditional bonesetters have called on government for recognition, saying their practice has longed been in existence across the world.The NMA President said the association would look into the issues and develop plans that would benefit the practice.