Avoiding permanent disabilities from fractures: Need to seek early treatment at hospitals

It was a normal day for Yahaya (not his real name ), a 16-year-old junior high school pupil from Yendi in the Northern Region, and his friends, when school re-opened early January, this year after the Christmas break.

They engaged in their usual play; jump onto the back of one another.

However, Yahaya’s friend decided to trick him; when he jumped, his friend bent down and he landed on his left arm and fractured his shoulder. He was taken to a bonesetter in the area, who massaged the area with some herbal preparations and bandaged it with an assurance that it would heal in no time.

Back at home, Yahaya could not sleep. He cried throughout the night. He complained of excruciating pain from the fracture. Two days later, he was taken to the bonesetter again for assessment. When the bonesetter tried to remove the bandage, Yahaya’s skin was peeling off. The bonesetter referred him to another bonesetter in the area, who was thought to be more advanced in terms of provision of care.

The ‘advanced bonesetter’, after assessing the condition of Yahaya, advised that he should be sent to the hospital for better care. When Yahaya arrived at the Trauma/Orthopaedic Department of the Tamale Teaching Hospital (TTH), many people at the facility could not breathe as the stench emanating from his fractured shoulder was unbearable.

Avoiding complications

He was immediately amputated to prevent infections from spreading to other parts of his body. Dr Noel Tolgou Yempabe, Head of Trauma/Orthopaedic Department at TTH said Yahaya’s arm would have been saved if he was sent to the hospital immediately the fracture occurred. Dr Yempabe said on the average, TTH amputated a child every month to save their lives because they were always brought late when the situation was getting out of hand.

He said between 2015 and 2018, 36 children were amputated at the TTH and attributed the situation to delay in sending fractured victims to the hospital to be professionally handled for better recovery.

Although injuries can occur in many settings, the majority of them occur on the roads in the country.

Facts and figures

Statistics from the National Road Safety Authority (NRSA) showed that there were 13,645 road crashes in the country in 2018 resulting in 2,341 deaths and 13,677 injuries. In 2019, there were 13,877 road crashes resulting in 2,284 deaths and 14,397 injuries.

Also, statistics from the Komfo Anokye, Korle Bu, Tamale and Cape Coast Teaching Hospitals from June 01, 2017, to May 31, 2018, showed that a total of 4,876 cases of fractures were recorded.

Out of the cases recorded, 3,838 involved adults and 1,038 involved children.

However, while some of the injured are sent to hospital, others prefer bonesetters and only opt for hospitals, when their situation get worse.
Treatment at bonesetters and hospitals, and effects of amputation on individuals.

Bone-setters

There are hundreds of bonesetters across the country. While their contributions to treating injuries/fractures cannot be overlooked, the conditions at some of those facilities leave much to be desired.

An observation of operations at a typical bonesetter will show caregivers using herbal mixtures amongst other ointments to massage their patients prior to bandaging them.

They do not have the appropriate equipment to handle complex fractures. Herbal preparations and other equipment commonly used at the facilities are also not hygienically preserved, which can lead to other infections. In most instances, patients are not given anaesthesia during treatment to reduce pain.

However, this is not the case at hospitals. At hospitals, appropriate injury/fracture treatment protocols are observed to admit and treat patients to avoid infections, reduce pain and for patients to recover well to avoid especially permanent disabilities.

Despite the advantages of seeking treatment for fractures at hospitals, some patients prefer bonesetters because of some factors including; the location of hospitals, costs, and myths.

However, when things do not go well at bonesetters, they proceed to hospitals to salvage their situations. It is important to note that fractured bones can only heal well when they are attended to professionally as soon as the fracture occurs.

What to do

It is, therefore, not advisable to delay the treatment or seek treatment at unprofessional facilities and resort to hospitals only when the situation gets worse.

Dr Dominic Konadu-Yeboah, Head of Trauma and Orthopaedic at the Komfo Anokye Teaching Hospital said when things get worse before patients go to hospital, doctors would have no option, but to amputate them to save their lives, which would result in permanent disabilities.

Dr Konadu-Yeboah argues that the economic impact of amputation on a child is higher compared to an elderly person because the child has more life to be productive hence the need to send fractured children to hospital for treatment to avoid permanent disabilities.

Ghana’s position

Ghana’s initiative to halve road crashes by 2020, and SDG targets
The increasing cases of road crashes amongst other injuries have been a source of misery to many families, whose loved ones are lost through such cases or become permanently disabled.

Therefore, in 2010, the government targeted to reduce deaths and fatalities resulting from road crashes by half by the year 2020.

In 2015, the government also committed to implementing initiatives in line with the goal three of the Sustainable Development Goals (SDGs 3), which emphasises “Ensuring healthy lives and promoting well-being for all at all ages”.

Under this goal, the government is required to undertake measures to halve deaths and injuries from road crashes by 2020.

However, the situation has gone from bad to worse with regard to the targets as data from the NRSA as stated above, have shown that deaths and injuries from road crashes have rather been increasing.

Apart from road crashes, other places where injuries occur include homes, workplaces and schools.

Way forward

As long as we live, injuries are bound to happen. The good thing is that we have the power to prevent and or reduce the injuries as well as minimise their impacts on our lives and the country in terms of the health burden.

Therefore, the need to make hospitals our first point of call for treating injuries cannot be overemphasised.

Individuals must make their environment safe and adhere to safety measures in whatever activity they undertake to avoid injuries, which can result in life-changing experiences.

Road markings and warning signs should be visible on all roads to guide all road users to reduce road crashes.

The government must enforce laws on safety standards as well as commit adequate resources to ensure safety, especially on the roads.

Issues of injury care and prevention should be made part of the school curricula to impart such knowledge to the citizenry to help improve the situation.

This will help to prevent and or reduce injuries and improve productivity to drive the country’s development agenda.

It is recommended the Ministry of Health and the Ghana College of Physicians and Surgeons should train bonesetters on the best ways to treat fractured victims and the need for them to immediately refer patients, whose cases they cannot handle, to hospitals for better care to save their lives and prevent permanent disabilities.