ORTHOPEDIC HEALTHARE TRAJECTORIES AND MEDICAL PLURALISM: ABOUT 91 CASES OBSERVED AT YAOUNDE CENTRAL HOSPITAL

Handy Eone. Daniel; Nseme Etouckey. Eric; Essi Marie Josee; Bizole Balepna Dieudonne Yvan; NGO NONGA Bernadette; SOSSO Maurice Aurelien

Volume : VII, Issue : II, February - 2018

ORTHOPEDIC HEALTHARE TRAJECTORIES AND MEDICAL PLURALISM: ABOUT 91 CASES OBSERVED AT YAOUNDE CENTRAL HOSPITAL

Handy Eone. Daniel, Nseme Etouckey. Eric, Essi Marie Josee, Bizole Balepna Dieudonne Yvan, Ngo Nonga Bernadette, Sosso Maurice Aurelien

Abstract :

Introduction: The universalization of cognitive and cultural models has influenced practices of societies, particularly in the health domain. In addition, contact with other societies has favoured the coexistence of opposing cognitive and cultural paradigms, at the origin of the emergence of new therapeutic models and the diversification of therapeutic pathways. As a result, from traditional healers to nurses to modern doctors, medical pluralism has emerged in a society which is losing cultural orientations and is in search of the health factor.

Methodology: This was a retrospective cross–sectional study that lasted four months (from October 2017 to January 2018). The study covered a five–year period between 2012 and 2017. It was carried in the departments of orthopedic surgery and traumatology A and B of Yaounde Central Hospital. Included in the study were patients with fractures of the tibial plateau and humerus sampled during previous MD thesis respectively on the “etiologies, the mechanisms of injury and therapeutic indications of fractures of the tibial plateau of the adult” and on the “performance of the anterior approach in humeral plating osteosynthesis in adult”. Patients were recalled and interviewed for the purpose of completing a data sheet designed for this study. The data sheet made it possible to detect the orthopedic healthcare trajectories taken by the patient as well as the reasons for changing care systems (medical or therapeutic pluralism).

Results: The sample consisted of 91 patients including 42 cases of tibial plateau fractures and 49 cases of humeral shaft fractures. Self–medication was the first resort for most of the patients in event of fractures. Fifty–one percent of the patients first resorted to self–medication. The fact that materials generally used in making local splints were easily accessible at the accident sites, combined with the availability of essential drugs (analgesic and anti–inflammatory drugs) in local pharmacies, constituted the main reason for self–medication in the case of fractures recorded in our series (87.2% of self–medication). The resort to biomedicine and ethno medicine were mainly motivated by the severity of the fractures for the former (66.7% of the resort to biomedicine), and by the beliefs, cultural and religious orders for the latter (these were the sole reason for resort to ethno medicine as first therapeutic option).

Traditional medicine represented the second most practised care system (58.2%), particularly for reasons of complementing surgery through massage sessions with traditional therapists, and also because of difficulties related to surgery (especially financial constraints). Biomedicine was mainly the second resort (treatment option) in our series because of the inefficiency of the previous systems of care attempted by patients (in 60% of cases).

Almost half of the patients systematically did not use a third system of care in our study (46.2% of the total sample) because of their satisfaction with the care received in the previous attempts. Biomedicine was adopted as a third option in 22.4% of the cases and this was mainly when the previous attempts were found inefficient. The most adopted treatment option were those involving auto–medication as a first resort (51.7%).

Conclusion: Auto–medication and ethno medicine were the main care systems adopted as first and second therapeutic option, respectively, in the case of proven fractures in our study, at the expense of biomedicine. In addition, the most common therapeutic pathway was that involving self–medication as a first resort. Consequently, the medical sector seems unable to satisfy the total demand for care, hence some patient go to self–medication and traditional medicine.