www.udsspace.uds.edu.gh UNIVERSITY FOR DEVELOPMENT STUDIES THE ROLE OF TRADITIONAL BONE SETTING IN PRIMARY FRACTURE CARE IN THE UPPER WEST REGION: THE CASES OF JONGA, GWOLLU AND DOUNG BONE-SETTING CENTRES. BY CONSTANCE SABIRU AKURUGU THESIS SUBMITTED TO THE DEPARTMENT OF AFRICAN AND GENERAL STUDIES, FACULTY OF INTEGRATED DEVELOPMENT STUDIES, UNIVERSITY FOR DEVELOPMENT STUDIES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF MASTER OF PHILOSOPHY DEGREE IN DEVELOPMENT STUDIES August, 2011 www.udsspace.uds.edu.gh www.udsspace.uds.edu.gh Abstract For majority of people in rural areas, traditional bone setting is the first port of call as well as last resort if orthodox medicine fails. However, traditional bone setting has not been given its due recognition. For instance it is ignored in reports on the state of Ghanaian medicine. Also, some allopathic practitioners contend that traditional bonesetters do try and error and thus are without skills. This study examined the role of traditional bone setting in primary health care in the Upper West Region. The study, located in three Bone Centres in three districts within the Upper West Region adopted a mixed methods research approach. The study adopted a multi-stage purposive sampling technique. In the first stage, a typical case sampling technique was used to select the Bone-setting Centres. In the second stage, intensity sampling technique was used to select heads of bonesetters for in- depth discussions. All patients undergoing treatment at the centres were interviewed. At the institutional level, intensity sampling technique was used to recruit directors and other stakeholders of health care in the Upper West Region. Findings of the study are presented and analysed by cases in the first stage. In the second stage cross-cases analysis is presented, drawing out similarities and contrasting findings among the three cases. Findings of the study include: people from all walks of life and all parts of the country rely on the services of the traditional bonesetters for orthopaedic health care needs; spirituality plays a seminal role, yet in varying degree in the collection of materials, treatment and healing processes of patients; and finally all bonesetters interviewed opposed any moves to integrate traditional bone setting into the primary health care system. This study therefore concludes that albeit criticisms from allopathic practitioners, TBS is highly patronised by the populace and thus contributes greatly to fracture care in the Upper West Region. Thus this study disagrees that the populace should be discouraged from the patronage of traditional bone setting. The study recommends sensitising and training of bonesetters by formal health care institutions as well as integrating traditional bone setting into primary health care systems for culturally acceptable health care service delivery. iii www.udsspace.uds.edu.gh Acknowledgement I am deeply grateful to Dr Daniel Anleu-Mwine Bagah my supervisor, first of all for accepting to supervise this work and secondly for his patience, tolerance and constructive criticisms and suggestions as well as his direction on this work. May the Almighty God whose grace is sufficient for us reward you, Sir. I am immensely indebted to Professor David Millar, Pro-Vice Chancellor of the University for Development studies for his inspiration and contribution to my research proposal, especially at the early stages. Many thanks to Professor Francis Z.L Bacho, Dean, Faculty of Planning and Land Management for the very useful comments he made on my research proposal and Professor Lenny Baer for his fruitful comments on my thesis. I am also indebted to Mr. Gilbert Aasoglenang, Assistant Registrar at the Graduate School, Mr. Simon Bontariba and Mr. Gilbert D. Karbo for their assistance. My profound gratitude also goes to the heads of bonesetters in Jonga, Doung and Gwollu Bone- setting Centres for their warm reception and cooperation through out the entire period of the study. To my lovely brothers: Thomas, Anthony, Clement, Bismark and Alfred, I say a special thank you for your love and care. To all my colleagues who supported me in diverse ways, God richly bless you all! iv www.udsspace.uds.edu.gh Dedication To Mathias my husband, Michelle my daughter and Alice my only sister for their unflinching love and support v www.udsspace.uds.edu.gh iv ....... v vi Page vi ...... xii xiii CHAPTER ONE ......... 1 INTRODUCTION AND STUDY PERSPECTIVE .................... .......... 1 1.1 Background to Study 1 1.2 Problem Statement 4 1.3 Research Questions.............. ... 5 1.3.1 Main Research Questions 1.3.2 Sub-Research Questions. .5 1.4 Research Objectives ...................................................... 1.4.1 Main Research Objective .......................... .6 1.4.2 Sub-Research Objectives ........ ......6 1.5 Scope of the Study 7 1.6 Justification of the Study ............... 8 1.7 Organisation of the Study ...... 9 1.8 Conclusion ....... 9 CHAPTER TWO......... 11 vi www.udsspace.uds.edu.gh LITERATURE REVIEW. .. 11 2.1 Introduction ............... 11 2.2 Conceptual Overview.... ...11 2.2.1 Traditional Medicine ............... ....................... 11 2.2.2 Traditional Healer ....................... 14 2.2.3 Traditional Bone Setting ............................. ..............15 2.2.4 Fracture and Dislocation.................... ..19 2.2.5 The Role of Spirituality in Traditional Bone Setting 19 2.2.6 Traditional Medicine and the Millennium Development Goals (MDGs) ................................................ ...22 2.3 Theoretical Framework 22 2.3.1 The Health Belief Model ............................................. 23 2.3.2 The Health Care Utilisation Model .......26 2.3.3 The Four As Model.. .... 28 2.4 Integrating Traditional Medicine and Allopathic Medicine ................... 29 2.4.1 Framework for Traditional Medicine in Ghana... 31 2.4.2 Integrating Traditional Bone Setting into Primary Health Care ........ 32 2.5 Conclusion 33 CHAPTER THREE 35 RESEARCH METHODOLOGY 35 3.1 Introduction ... 35 3.2 Qualitative Research ....35 3.3 Quantitative Research ........ ....36 3.4 Research Location .......... ..... 37 3.4.1 Geographical Location and Size of the Upper West Region ... .37 vii www.udsspace.uds.edu.gh 3.4.2 Geophysical Characteristics of the Upper West Region ....................... 37 3.4.3 Socio-Demographic Characteristics................................... ................ 38 3.5 Selecting the Study Districts and Cases ... 40 3.5.1 Geographical Location and Size of Study Districts.... .... 40 3.6 Research Design .................... .. 42 3.6.1 Case Study .......... .43 3.7 Sampling .Procedures and Techniques 46 3.7.6 Sample Size... .48 3.7.7 Target Population................ ......................... 48 3.7.8 Sampling Units ......... 49 3.8 Generalisability .................... .49 3.9 Data Sources and Data Collection Techniques ........... 50 3.9.1 Primary Sources 50 3.9.2 Secondary Sources 50 3.10 Data Collection Techniques .................................. 50 3.10.1 Survey 51 3.10.3 In-depth Interview... ........... 52 3.10.4 Observation ................... ...52 3.11 Data Analysis Techniques .. 53 3.12 Quality Control for Reliability and Validity ......................... 53 3.13 Documentation and Management of Data ......... 54 3.14 Stages of Research .............. 54 CHAPTER FOUR .............. ............... 57 DATA PRESENTATION AND ANALYSIS.... 57 4.1 Introduction. .... 57 viii www.udsspace.uds.edu.gh 4.2 Presentation and Analysis of Data on Case Study One (Jonga Bone- setting Centre) ..................... ................ 57 4.2.1 History of Jonga Bone-setting Centre 58 4.2.2 Socio-Demographic Characteristics of Respondents ........................ 58 4.2.3 Sex and Age Range of Respondents...... .58 4.2.4 Level of Education of Respondents ...... .59 4.2.5 Occupations of Respondents.... .59 4.2.6 Hierarchy of Bonesetters and Succession Plan......... .59 4.2.17 The Role of Spirituality in Traditional Bone Setting ............. 66 4.2.18 Integrating Traditional Bone Setting into Primary Health Care System .. .............................67 4.2.19 Successes Achieved by Traditional Bonesetters at the Centre 70 4.3 Presentation and Analysis of Data on Case Study Two (Doung Bone- setting Centre) 70 4.3.1 History of the Doung Bone-setting Centre ....... .71 4.3.2 Sex and Age Range of Respondents ... ...71 4.3.3 Level of Education of Respondents ............. ....... 71 4.3.4 Occupations of Respondents ....................... 72 4.3.5 Hierarchy of Bonesetters and Succession Plan .............. .72 4.3.9 Factors Influencing Patients' Decision to Seek Treatment by Traditional Bone Setting ................................................................................. 75 4.3.10 Patients' Perception of the Doung Bone-setting Centre Prior to Visit ....................................................................... 76 4.3.11 Experiences of Patients at the Doung Bone-setting Centre ...... 77 4.3.12 Skills Level of Traditional Bonesetters .78 4.3.13 Level of Satisfaction of Patients .. .79 4.3.14 Improving Quality of Services ........ ..79 ix www.udsspace.uds.edu.gh 4.3.15 The Role of Spirituality in Traditional Bone Setting ............ 81 4.3.17 Integrating Traditional Bone Setting into Primary Health Care System ......... 83 4.3.18 Successes Achieved by Traditional Bonesetters at the Centre 85 4.4 Presentation and Analysis of Data on Case Study Three (Gwollu Bone - setting Centre) ... 86 4.4.1 History of Gwollu Bone-setting