The continued role of traditional bonesetters in East and West Africa: An expert consensus statement

Abstract

Traditional bonesetting (TBS) is an ancient practice still used worldwide to treat common musculoskeletal conditions, particularly in low- and middle-income countries. This practice is highly controversial, lacking standardized training of traditional bonesetters, and it is associated with a high risk of avoidable life- and limb-threatening complications. In East and West Africa, high-quality and safe modern orthopaedic services remain inaccessible and unaffordable for many patients who then rely on traditional bonesetters for essential musculoskeletal care. Even when orthopaedic services are available, many patients preferentially patronize traditional bonesetters because of traditional beliefs, social pressures, and fear or mistrust of modern biomedicine. Orthopaedic surgeons must raise public awareness of TBS-related complications and engender trust in modern orthopaedic services. However, traditional bonesetters can fill important gaps in musculoskeletal care, particularly in rural areas, provided they undergo basic training. Traditional bonesetters and orthopaedic surgeons alike generally favour TBS practice standardization, regulation, and integration into existing primary care systems, with initiatives to do so showing promising results. Further investigation is necessary to understand the prevalence of TBS-related complications in East and West Africa. To reduce TBS-related complications, we must endeavour to broaden access to essential orthopaedic services as well as train and integrate traditional bonesetters into the healthcare systems of regions where they have practised for centuries.