Lost Limbs, Lives, and Livelihoods

I easily recognized him as soon as I entered his shop to fix my faulty mobile phone. The scar on his forehead was still prominent and as soon as I mentioned his name, Amidu also recognized me.  I had not noticed the pair of crutches beside him until he picked them up and came out from behind the counter to embrace me. After losing contact with each other for so many years, there was a lot of catching up to do as he fixed my phone.

As I watched him fix my phone, Amidu narrated his ordeal after being discharged from the trauma ward. The realization that his right leg was amputated evoked a mix of shock, sadness, and sympathy in me as I listened to him.

Dr. Patrick Maison

Amidu and I first met in the trauma ward of the 37 Military Hospital in Accra about 25 years ago. He was admitted to the ward one week after my admission to the hospital. We quickly became friends because we were of the same age and were both expecting to begin university education that year. Interestingly, we also had similar surgical needs. I had sustained a fracture of the left thigh bone in a car accident while he had a right lower leg fracture after crashing a motorcycle he was riding.

One area where we probably differed was our socioeconomic status. I was from a middle-class family and had parents with tertiary-level education. Amidu was from a less privileged background. None of his parents had attained secondary-level education.

After his assessments, the trauma surgeon kept our fractured limbs immobilized and planned to operate on us 3 weeks afterward. The delay in getting surgery was distressing as admissions into the universities were less than 4 months away. I was therefore not surprised when after a few days of admission, Amidu’s family discharged and sent him to a traditional bonesetter. That was the last I heard of him.

My family also considered sending me to the bonesetter. However, my father insisted on hospital treatment and this decision saved me from the troubles Amidu would endure. I was operated on and thankfully healed in time to enter medical school later that year.

As I watched him fix my phone, Amidu narrated his ordeal after being discharged from the trauma ward. The realization that his right leg was amputated evoked a mix of shock, sadness, and sympathy in me as I listened to him. His parents sent him to a traditional bonesetter who wrapped the limb with sticks to immobilize it and applied some herbs to it. However, during treatment, the leg swelled up, darkened, and eventually was no longer viable. He had an above-knee amputation later when he reported to a hospital. Amidu’s dream of becoming a financial analyst was cut short and he now had to adjust to life with an amputated right leg. I left the shop, happy to have my phone fixed but still had a feeling of disbelief and a sense of empathy for what Amidu had been through.  Later that day, while reminiscing over Amidu’s story, I remembered the many times I had performed amputations on patients under similar circumstances.

In my own practice as a surgeon, I have encountered many patients who declined orthodox treatment for traditional medicine.  Fractures are the most common conditions for which patients in Ghana request to be discharged against medical advice citing financial constraints, preference for traditional bonesetters, and fear of amputations as reasons for the request to be discharged against medical advice. It is estimated that about 78% of all patients with fractures resort to traditional bonesetters for care. However, just as happened in Amidu’s case, most of the people who patronize the traditional bonesetter services later return to orthopedic hospitals with several complications making orthopedic management very complicated, costly, and sometimes leading to limb amputations. This regrettably strengthens the belief of the people that the only treatment option offered by orthopedic methods is amputation.

I have seen children and adults who have had their limbs amputated after being mismanaged by traditional healers to whom they presented with simple fractures and joint dislocations. The methods of treatment of many traditional healers are unproven, most of them have not had any recognized training and there is usually no scientific basis for the techniques they employ. However, they are permitted to advertise their businesses on mainstream media and most of them operate without license. The ignorant public sees their ability to advertise and practice as the government’s approval and so they continue to subject themselves to these practitioners.

It is important to train traditional bonesetters through collaborations with the formal health system to improve their knowledge and skills and also on other priorities such as hygiene and infection control, recognition of the limits of their practice, and the need to refer difficult cases for management at the hospital. There is a need to regulate the practice of unlicensed traditional healers to save the lives, limbs, and livelihoods of people like my friend, Amidu.