Divergent views have been canvassed on the need to incorporate traditional bone setters in the nation’s health system. A Consultant Special Grade 1 and Head of Accident and Emergency Unit, as well as Coordinator of Arthroplasty  Unit, National Orthopaedic Hospital, Enugu, Dr. Uchenna Katchy, thinks the bone setters need to be checked, that over 90 percent of the 235 amputations at the National Orthopaedics in five years took place due to poor handling of such jobs by traditional bone setters.

In this interview with our Correspondent, Chidi Nkwopara, the surgeon, who has spent 27 years in orthopedic practice, calls for improving the human infrastructure instead of erecting diagnostic centres.

What then is the role of a doctor in the circumstance?

The doctor ensures that a correct anatomical, physiological and biochemical situation is restored post injury. That is exactly what we are doing. It is not exactly the surgery we do that helps the bone to heal. We are only trying to put the bone in such a situation where it will have optimum condition to heal without serious deformity. That is the function of the orthopedic surgeon. The fact that you have been operated upon does not mean that the bone will heal within two or three weeks. It will take that long, natural history of 12 weeks for long bones.

Secondly, there are people with complicated injuries. If you have a compound fracture, there is the risk of infection and there is risk of bleeding to death. Because the soft tissue around has been distorted. It takes a longer time for this type of fracture to heal. You go in for series of reconstructive surgeries. So, it takes a longer time.

Number three, you people with spinal injuries, especially those with what we call permanent injuries. They take a longer time. They have to stay in hospital. You need to rehabilitate them so that they will be able to do one or two things they were doing before. In other words, orthopedic practice takes a longer time for the simple reason that it is the nature of injuries sustained by patient.

Where do local bone setters come in?

It is important that we clarify this. Orthopedic surgery actually developed from bone setting. These things our people do now had been developed in the past but as time went on scientific knowledge came in. You need to know that this is the way fracture heals, that the blood vessels have to mobilize certain components to help the fracture to heal. You need to know that this type of fracture will not heal unless the patient is operated upon.

You need to know that this natural vessel or like you have a pipe passing through a bridge and suddenly you send people there to go and cut the bridge or repair the bridge, and when they go there without knowing that this is the major water supply line, they can damage the pipe and create serious problem for the end users.

So, you need to know that major blood vessels are crossing through these areas of fracture. When you pick up an x-ray, what you will see is bone but the surgeon knows that for you to get to the bone, you need to pass the skin, the fascia and the muscle.

These things will not show in the x-ray but when the surgeon looks at the x-ray, he knows exactly what has happened. So, if you have a fracture that has ruptured a blood vessel and you go to the native bone setter and you are manipulating the patient, he may lose the limb. If you had gone to the hospital and the doctor sees it, he will immediately know that his patient will require an artery repair.

What I am saying that our people should embrace modern medicine. It is dangerous for those who do not know the intricacies of this area of medicine to blindly dabble into it. I think that our government should like at these things without emotions.

I must tell you that out of the 235 amputations done at National Orthopedic Hospital, Enugu, within the last five years, over 90 percent of them were due to complications arising from traditional bone setters. Unless it happens to you, you may not understand what we are saying.

So, the people do not have any knowledge of what they are doing. We are often told that they inherited it from their grandfathers. We shouldn’t be saying this in 21st Century. If the government insists that they have to practise, at least there is the need for them to undergo the basic training of understanding the basic principles of physiology, anatomy and biochemistry. They need to have this knowledge.

Again, if you have fractured an elbow, the natural tendency of the human body after an injury is to swell, and because the bone is in a very tight compartment, it doesn’t expand. It builds up the pressure until it closes the blood vessel. Local bone setters need to know this. They don’t have this information. But when trained orthopedic surgeons see such patients, they know what to do to temporarily alleviate the problem and later address the fracture.

Again, remember it takes high energy trauma to break a bone. The bone is so strong. So, the energy that broke that bone must have destroyed other things in the body. So, the patient may have ruptured the spleen, liver or lungs and has gone to the traditional bone setter. How will he know that the spleen has been ruptured? A lot of people have died because they don’t have the information but once we know that somebody has fractured his bone, we worry about all these other structures in the human body.

There is nothing that is called container contain phenomenon. If you fracture your pelvis, your bladder is there and your rectum is there. So, you can damage all these things. We are not looking at just the pelvic bone because in the x-ray, you are not going to see these soft tissues. But because of our profound knowledge of human anatomy, we know these things exist and that is why I discourage people from going to traditional bone setters.

There are federal medical centres in all the states of the federation. There are primary health centres built all over the place by the three tiers of government. Why wouldn’t our people utilize these health facilities? Why do they always look for a miracle to happen? Let me repeat that it takes not less than 12 weeks for long bones to heal, not less.

Are you satisfied with the medical practice in Nigeria?

Well, I will say yes and no. I will say no in the sense that for many years, especially during the military regime, the health system had been left to rot away. But since the coming of democracy in 1999, there has been a lot of improvement.

If you recall, by the time Nigeria had independence in 1960, University of Ibadan Teaching Hospital was ranking number five in the Commonwealth and was one of the best teaching hospitals in Africa.

What it is today is a different kettle of fish. So, we would want to look at a situation where we will look back at where we were, pre-independence, get back to that particular point and of cause plan beyond that because medicine generally is a dynamic subject. You have new technologies, new findings and so we need to keep abreast with the new findings, especially in the area of technology in medicine.

Does this not translate to how doctors are trained?

I want to emphasize a point that despite the limitations we have in this country, Nigerian doctors are one of the best trained doctors in the world. So, it is still the basic training, the basic sciences like anatomy, physiology, biochemistry, our doctors are well grounded, like in pathology. Medicine actually has a basis. So, for the basis, I will say we are still doing what we are supposed to do.

But we need to get abreast with the modern technology. For instance, if somebody has a low back ache, you will know from your clinical diagnosis that this is acute discprolapse but you will need magnetic resonance imaging (MRI) to confirm the diagnosis. The symptoms of acute discprolapse will not change. The ways of diagnosing the ailment may change but we need to keep abreast with developments.

The doctors are still well trained. They are still the same crop of brilliant children we had in the sixties. We are still having them now but we need to expose them to modern technology.

What are the peculiar problems of orthopedic medicine?

We have just started the joint replacement programme in National Orthopedic Hospital, Enugu, courtesy of the political will of the present Medical Director, Dr. C.B. Eze. We owe a lot to him for having the political will to make us be abreast with our contemporaries abroad. In areas of joint replacement, Nigerians still go abroad to have these surgeries carried out.

But so far, at National Orthopedic Hospital, Enugu, we have 53 successful surgeries, without any complication and we are aiming that by 2011, we be hitting the 100 patients mark. This programme is being supported by Johnson and Johnson.

We collaborate with them a lot and also with our colleagues abroad, like Dr. Sam Orakwe and Dr. Ike Nwachukwu. The programme is aimed at replacing diseased joints. So long as Nigerians are living longer, this issue of knee replacement will be brought to the fore-front.

The programme has been on. Indeed, the first hip replacement was done here in Enugu in 1974, and at that time, not most hospitals in Africa and Europe were doing that. So, 36 or 37 years after, we have to get back to the programme again. It is something that we are very happy to be part of. In this area, we replace the joints and we hope to meet the standard requirements like it is done everywhere. To us, it is a new innovation.

Again, there are other areas like spinal surgery. People are beginning to do modern things in spinal surgery. People are beginning to do new things in trauma.

So, with the way we are going, by 2015 or 2020, Nigeria will be self sufficient in orthopedic practice.
Why does it take a long time for an orthopedic patient to get discharged?

Thank you for this question. There is a natural history of illness. For example, if somebody has malaria, with or without drugs, we know how that will end. Even if a Nigerian does not take drugs when brought down by malaria, because of the immunity he has developed, he may likely be well.

This is unlike the man coming from Europe. So, there is a natural history of illness.
If you fracture the long bones in the human body like the femur, tibia, it takes about 12 weeks to heal. It cannot be shorter than that. And it takes half of that length of time in children. There are also bones in the body in areas we call spongy bones. That area has a high healing rate.

These ones can heal in six weeks. Even if you didn’t go to a hospital and you lie on bed, the long bone fracture will heal.

You must recall that animals in the bush do not have doctors but they have fractures and they heal.

How do you feel when you are cracking bones?

(Laughs) Well, it is like asking Jay Jay Okocha how he feels when he scores a goal. (Laughs again). When you are well trained in this profession and you look at your beautiful results, there is a lot of excitement. It is like a pilot trying to lift an aircraft. No matter how many times he flies, each time he flies an aircraft from London to Lagos, he has a new feeling. So, that is the way we feel. It is an exciting job.

You see a human being that has fractured his bone lying on the bare floor, talking to you standing; he is so dejected and in serious pain and the next day, you fix his fracture and he is up again and smiles at you. There is nothing as satisfying as that.

Now let’s look at the equipment.

In medicine, there is the hardware and the software. The hardware is the building. The software is the human being and also the basic equipment which you can put in the building. You can also classify it as hardware. The equipment is important in medicine but it is as important as the knowledge of the doctor. You know that somebody has a slip disc.

The features are there but you will need to reconfirm this through the use of the relevant equipment. So, the equipment is as important as the personnel and the building. But honestly, the building is not very important.

If you remember, during the civil war, places like Madonna Secondary School, Etiti, and even primary schools were converted into hospitals. Surgeons were there. They were operating and they had very good results. They became professors after the war by publishing their experiences in medical journals.

They didn’t have much of equipment but they had sound knowledge. Let me reiterate, equipment is important but it is not as important as having a properly trained doctor. That is why I use this opportunity to appeal to the federal government to restore the one year abroad training for the resident doctors. It is so important. When a resident doctor goes abroad and is trained, he comes back to his environment and practices his learning.

The training is in the interest of society. It has nothing to do with the individual doctor.

It is not just the government saying a permanent secretary should be flown abroad when he has diarrhea. This should not be the way our health system should run. It should run in such a way that our people are properly trained and the proper equipment is given to them. But if you train a doctor well, he can always adapt to his environment. He can always fabricate equipment himself. But if you go an dump equipment and the man is not properly trained, he cannot use those equipment.

Government is spending so much money, indeed huge sums in buying equipment and buildings because that is what the politician wants to see but he is paying less attention at the human infrastructure, which is the most important.

We need equipment. We need the building. We also need the human capacity, but then, there should be a balance between the three needs. It doesn’t make sense when government goes out to build a diagnostic centre. Diagnosis is not done by somebody walking into a building. If you have an MRI in the building and the doctor does not have the knowledge of how to marry it with the pathology, he cannot make a diagnosis. That is why emphasis must be placed on human capacity. Our doctors must be exposed as much as possible.

Resident doctors should be made to go to Europe. It does not matter if they go there and refuse to return. After all, we export footballers.  The arthroplasty we are building in Orthopedic Hospital, Enugu, is based on one of our colleagues who trained abroad. So, that knowledge he acquired abroad is benefitting the community.

Imagine where we replace people’s hip at N750,000 and people go to the United Kingdom and pay as much as $55,000. So, it is still the emphasis on proper planning. We know that politicians want to commission buildings. The hood does not make a monk, though there is no monk without a hood.

Is there anything that makes you very happy in the practice?

Very many. I have been in orthopedic practice for 27 years. I never had the excitement I am having now in being involved in joint replacement. Somebody has problem on both knees and is on a wheel chair and suddenly, you prepare him for surgery and give him a new lease of life and he walks about. You cannot have a better feeling.