It is usually a difficult transition when one leaves their homeland to establish domicile in a foreign country. That is what my mother cited as her reason for leaving England to return to Nigeria. At that time, I was schooling in New Jersey after having just switched my country of residence for the second time in my life. Having experienced little transition pain I considered myself lucky. Unfortunately, I am not as lucky as I thought. In retrospect, my age deflected much of the pain, only for it to be residually felt in adulthood. As an adult, a sense of identity has remained elusive for me. When asked where I am from, it is difficult to explain that I was born in Nigeria but that I am actually a British Citizen who has been in America so long that he now has no discernible British accent. Hence, why it was important for me to return to Nigeria this summer. In essence, the colloquial and often bandied expression “return to your roots” held great personal significance for me as I readied to return to Nigeria. My return was made all the more sweet because I was returning to engage in something meaningful and to lay the foundation for a career that I hope will remain connected to Nigeria.

My perspective of Nigeria as an adult was very different from my childhood perspective, which had become romanticized with age. I became acutely aware that life in Nigeria was difficult and that many struggled to merely get by. Although I was prepared to make the life style adjustments necessary to transition from Boston to Enugu, I was embarrassed at how difficult this transition was for me at first. However, during my trip I adjusted and begun to take joy in the simpler lifestyle of many in Nigeria.

While I was in Nigeria, I was able to meet my extended family on both my mother and my father’s side. It was a thing of joy for me to see how deep my roots ran. A particular highlight for me was the day that I went to see my 97-year-old grandfather. When I entered his room, he mistook me for my older brother, but when my mother told him whom I was, his eyes lit up. For a man who has more than 20 grandchildren, I was amazed that he was able to recount my narrative without prior information, even asking me when I would finish with medical school. I beamed with pride throughout my time with him and I will never forget his smile when I told him that he would live to see me become a physician.

I am glad that I returned to Nigeria this summer to perform research and to visit my family. I am grateful to Harvard Medical School and the Steamboat Foundation for making this opportunity possible. I have returned with a greater appreciation for the privileges that I have been given and I am all the more determined to make the most of the opportunities afforded me.

– Special Grantee, Ben Nwachukwu

Ben Nwachukwu with Dr C.B. Eze, Chief
Orthopaedic Consultant and CEO of the NOH
(Photo: Ben Nwachukwu)

My experience at the National Orthopaedic Hospital (NOH) was a highly memorable one and many of the lessons that I learned will stay with me throughout my career. Prior to my trip, I was aware that African nations were disproportionately affected by musculoskeletal injury, however I was shocked by the extent of disease burden. While I was at the NOH, I witnessed, among many things, the amputation of a patient’s leg as well as another patient learning that he would never have sensation below his diaphragm. As part of my qualitative study, I conducted patient and physician interviews learning much about the care processes at the hospital and the patients’ perceptions of their care. The most shocking finding from my study has been the impact of traditional medicine on the patient population. Greater than 60% of the patients that I spoke with admitted that they had visited a traditional bonesetter, and the doctors themselves admitted that the popularity of these traditional “doctors” is the biggest obstacle to achieving sound results at the NOH.

Inspired by these events, I decided to travel to a bonesetter in the Ifitedunu Village, where I spent a few days observing traditional fracture care and speaking with patients and bonesetters at the facility. I learned that Nigerians frequent the bonesetters for a number of reasons including poor access to orthopaedic centers, a belief that bonesetters have superior powers, and fear of adverse outcomes at the established Orthopaedic Centers. I also realized that, in certain situations, these bonesetters achieve good results, but in other situations they fail, and it is these failures that eventually present to the NOH. Thus, Nigerian Orthopaedists are caught in a dangerous cycle in which patients frequent traditional doctors and then report to the hospital when their situations are extreme. At this point, the doctors have little recourse other than limb amputation (which unfortunately is much too frequently seen at the NOH) or some other highly invasive procedure.

With this understanding of fracture care in Nigeria, I have begun to formulate an idea of how I hope to become involved in Nigerian healthcare. I believe that the government, NGOs, and private benefactors should direct aid more at the level of these bonesetters as well as at the official hospitals. While this is a radical proposition, it is a proposition that I believe will maximally improve the outcome of musculoskeletal injury in Nigeria. If, as the literature suggests, 80% of the musculoskeletally injured frequent bone setters before frequenting hospitals, then it only makes sense that health care interventions be targeted at the level of the traditional doctors. Programs must be adopted that educate bonesetters on sterile techniques, as well as injury management so that they know when to refer patients to the hospital, thus pre-empting adverse end-points such as limb amputation. Further, Orthopaedic surgeons must develop a spirit of collaboration with these bonesetters so as to ease their integration into the healthcare system. The reality is that there are not enough Orthopaedic surgeons, and these bonesetters serve a need.