Shock and Traditional Healing

Fig. 9.1

Patients arrive at the hospital or clinic by many different means. (a) This patient was picked up on an unlit street after being run over in Kabul. His leg was splinted with available materials; he was thrown into the back of a bystander’s pickup and brought to the hospital. There are no EMT services in many countries. (b) Families carry their injured or ill. (c) They use whatever is available, such as a wheelbarrow. (d) The buffalo ambulance must stop to eat and rest on the way to the clinic

../images/270913_2_En_9_Chapter/270913_2_En_9_Fig2_HTML.png — Fig. 9.2

Unsafe and frankly bizarre forms of transportation are immediately evident on arrival in many low- and middle-income countries. (a) Overcrowded, (b) unconventional use of space, and (c) dangerous equipment. The long handlebars on this *kolyn* make it difficult to turn (d) passenger ignorant of the dangers

../images/270913_2_En_9_Chapter/270913_2_En_9_Fig3_HTML.jpg — Fig. 9.3

This mentally disturbed West African woman was sure her external fixator was the source of the “bad medicine” that was preventing her fracture from healing, and she took the situation into her own hands

Traditional Healers

The practices of traditional healers, bonesetters, and witch doctors, and the beliefs that make them a major contributor to medical care globally, are very much a part of orthopedics in the developing world. Hospital-based surgeons see the mishaps of traditional bonesetters in the form of malunions and nonunion of fractures and at its most extreme, bonesetter’s gangrene (Fig. 9.4). They also see their own patients leave the hospital to be treated by traditional methods. It is important to realize that the majority of orthopedic patients seeking traditional care unite their fractures and heal their injuries, though maybe not as well as we think we could have done (Fig. 9.5). People patronize traditional bonesetters because they are local and readily available, are less expensive than care in a government or private hospital, and are known and trusted entities that satisfy the patient’s and the patient’s family’s cultural beliefs. Fear of amputation is another reason people seek care from traditional healers instead of hospitals [2].