article · BMC Medical Education
In low- and middle-income countries, high trauma rates and limited orthopaedic facilities cause many patients to rely on traditional bonesetters. Earlier attempts to integrate bonesetters into formal healthcare often used hierarchical approaches that risked alienating them. To address this, a novel three-day basic trauma course was piloted in rural Tanzania to promote bilateral knowledge exchange between formal healthcare workers and traditional bonesetters. Fifteen healthcare workers and three traditional bonesetters participated, covering basic extremity fracture care and intersectoral partnership. Trainee test scores rose significantly from an average of 79.1 percent before the course to 86.5 percent immediately afterwards, with knowledge maintained at 89.2 percent one year later. Participants reported changes in their daily fracture care practices, the development of mutual respect, and strong support for expanding this collaborative training model.
Trauma services in resource-limited settings are frequently overwhelmed, leaving communities dependent on traditional practitioners. Hierarchical training can alienate these providers. Demonstrating that equal, two-way education between formal clinicians and traditional bonesetters is feasible helps build trust, improve clinical knowledge, and foster cooperative relationships that can ultimately improve emergency trauma and fracture care in rural regions.
This research represents an applied and tested educational intervention rather than a commercial product. The training model could be adopted and scaled by regional health authorities, non-governmental organisations, and public health programmes operating in resource-limited settings to formalise collaborative care networks. Further commercial or operational scale-up would require larger validation studies, objective practical examinations, and referral tracking systems.
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High trauma rates and limited orthopaedic care services in low- and middle-income countries (LMICs) have led to reliance on traditional bonesetters (TBSs). Previous studies have set up formal training for TBSs to promote integration in the primary healthcare sector. However, the hierarchic structure of these initiatives poses the risk of alienating TBSs instead. Therefore, this study piloted a novel training strategy, by assessing the feasibility of an orthopaedic trauma course, involving bilateral knowledge exchange between both formal healthcare workers (FHWs) and TBSs. In November 2024, TBSs and FHWs from Rorya district, rural Tanzania, attended a three-day basic trauma course, aimed at teaching basic extremity fracture care and enhancing collaboration. Data on demographics, pre- and post-course knowledge, changes in daily practice, and perspectives were collected through tests and interviews. Fifteen FHWs and three TBSs participated in the training. Test results revealed a significant average increase in knowledge, from 79.1% pre-course to 86.5% directly post-course, which was maintained at 89.2% after 1 year post-course. In the interviews, most FHWs and TBSs noted changes in daily fracture care practice, the establishment of mutual understanding and respect, and supported expansion of the training course. The results support the notion that merged training of FHWs and TBSs can improve fracture care-related knowledge of trainees. Wide support was observed for increased collaboration between FHWs and TBSs, indicating that this type of training is feasible and could be expanded into more extensive, formalized programs. Future programs could benefit from performing follow-up practical examination for objective verification of practice changes, referral monitoring and larger sample sizes. Involvement of TBSs in orthopaedic trauma courses for FHWs could enhance training effectiveness and intersectoral collaboration in LMICs. • The first orthopedic trauma course worldwide that is inclusive for both formal healthcare workers and traditional bonesetters. • Fracture care-related knowledge increased and was sustained for up to 1 year post-course. • A majority of trainees reported practice changes following the course. • All trainees supported the bilateral exchange of knowledge and recommended expansion of the program. • Study findings suggest that a collaborative orthopaedic trauma course for FHWs and TBSs leads to increased intersectoral collaboration.
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DOI: 10.1186/s12909-025-07737-z
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