Indigenous knowledge of traditional bonesetters and bone setting practice in Southwest Ethiopia: towards integration with modern health care system

Abstract

Introduction

The indigenous knowledge of bonesetters and the practice of bone setting has contributed a lot to the modern medicine, and yet serving as primary source of care in low- and middle-income countries but got little attention. This study explored the indigenous knowledge of traditional bonesetters and bone-setting practice in Southwest Ethiopia.

Methods

A mixed study design approach was done in southwest of Ethiopia, from August 15 to December 15, 2022. A total of 80 traditional bonesetter who predominantly manage injury and disorder to the bone and the musculoskeletal, and also health professionals were interviewed regarding their traditional knowledge and range of practice.

Result

The mean age of the study participant was 69 ± 6 and majority (99%) of them were male. Traditional bonesetters participated in this study primarily acquired their knowledge through family transmission (45%), spiritual belief or divine gift (30%), and observation or experience (25%). Qualitative interviews revealed three themes: transgenerational learning, spiritual grant often linked to twin births, and experiential practice. Most TBSs had over 20 years of experience treating fractures, dislocations, and sprains, mainly at home or via mobile visits. Diagnostic methods included history-taking, palpation, and inspection. Treatment relied on massage, splinting, and natural materials like leaves, butter, and animal skin. All TBSs emphasized that healing power resides in their hands, often viewed as a divine gift.

Conclusion

Traditional bonesetters in Southwest Ethiopia possess rich indigenous knowledge rooted in family heritage, spiritual beliefs, and experiential learning. Their practices reflect deep cultural traditions and community trust, often passed down through generations or revealed through personal experience. Despite limited formal training, they demonstrate diagnostic skill and therapeutic effectiveness using locally available materials. Massage and splinting remain central to their treatment approach. Recognition and documentation of these practices are essential to preserve Ethiopia’s healing heritage. Future collaboration with formal healthcare could enhance integration and mutual learning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-026-07653-5.

Background

The healing techniques, knowledge bases, and beliefs that Indigenous communities have developed over many generations and that are based on their ecological, spiritual, and cultural contexts are referred to as Indigenous traditional medicine [1–3]. Also, the World Health Organization (WHO) define traditional medicine as the sum of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health and the prevention, diagnosis, improvement or treatment of physical and mental illness [4].

Traditional medicine and traditional knowledge have contributed to breakthrough medical discoveries and there is a long history of herbal medicine being translated into effective treatments for health conditions [4, 5]. Among indigenous traditional medicine providers those who practice the management of fracture, dislocation and other Musculo skeletal (MSK) disorder using their indigenous knowledge and traditional skill are called Traditional bonesetters [6–10].

In low- and middle-income countries (LMIC), TBSs were preferred and alternative source of care for MSK and joint injuries, despite the lack of legal recognition for their services [7, 9, 11, 12]. The reasons why communities in LMIC prefer TBSs are the lack of access to or inability to afford modern orthopedic services, as well as the perception that TBSs are better [12–15]. However, despite their contributions, indigenous knowledge and skills of traditional bone setting (TBS) have not gotten the same attention as herbal medicine and are underappreciated because of cultural marginalization and lack of official documentation [11, 16, 17].

Integration through proper documentation, policy support and cultural respect can help to uplift and preserve the practice of TBS side by side with modern health care system through adequate training and support is conceivable [14, 18–23]. To initiate the integration of this two-service assessing and communicating the indigenous knowledge of TBSs is the foundation [24, 25].

Ethiopia is known for its long-standing indigenous knowledge systems such as traditional medicine like traditional bone setting which is commonly called "Wogesha" in Amharic; they are healers who are involved in or connected to bone setting practices [11]. Despite being widely used, still crucial, and having cultural significance, it has not gotten scholarly attention [11, 17]. However, no study addressed indigenous Knowledge of Traditional Bone Setting in the study area. Therefore, this study assessed Indigenous Knowledge of Traditional Bone Setting in Southwest Ethiopia.

Methods and material

Aim of the study

The aim of this study was to assess the indigenous knowledge and practice of traditional bonesetters in Southwest Ethiopia.

Study design and setting

This study employed a mixed-method approach, integrating both quantitative and qualitative research method to explore the indigenous knowledge and practice of traditional bone-setting across the four administrative Zone of Southwest Ethiopian People’s Regional State (Bench-Sheko Zone, kaffa Zone, West Omo Zone, and Sheka Zone) (Fig. 1). The study period was from April 15th to August 25th.

Fig. 1.

Map of study area

Participants, sample size and sampling method

The source populations of this study were all the traditional bone setters, the traditional bone setters with a better experience, and health professionals who lived in southwest Ethiopian. A total of 80 traditional bonesetter identified purposively for in-depth interview, and eight health professionals identified for key informant interview.

Inclusion and exclusion criteria

Traditional bone setters who have lived in the respective zones two generation to ensure the knowledge was indigenous to the local community. Bone setters who took formal training and those who are certified with any of modern health profession were excluded from the study.

Study variables

Socio-demographic characteristics age, occupation, education, income status, and residence.

Variables related to indigenous knowledge and practice Source of knowledge, years of TBS practice, Type of Service provided, pain management technique, Tools used for physical examination and treatment, Treatment outcome, Referral system, payment method, voluntariness to take training, voluntariness to share their knowledge.

Operational definition

Traditional bonesetter a person who practice the management of fracture, broken or dislocated bone using their indigenous knowledge [1, 11, 26].

Data collection tools and procedures

The quantitative data was collected using structured and semi-structure interviewer administered questionnaire by trained data collectors. The quantitative data collected capture demographic information’s, treatment practice and patient outcome. The questionnaire was prepared in English and translated into Amharic then retranslated back to English by different person to ensure consistency. Moreover, the data collectors and supervisors were trained on the method of data collection, ethical issues and the purpose of the study. Both qualitative and quantitative data collection were carried out by trained health professionals with a close supervision. The qualitative data were collected using an in-depth interview, key informant interview, and observation. An interview guide was prepared for both in-depth interview and KII. The qualitative data provided the knowledge system, technique and experience of bone setters. And, also the views of modern health care providers regarding TBS knowledge and practice.

Data analysis and quality assurance

The qualitative data were analyzed using thematic analysis. The audio recorded were transcribed and translated immediately after the interview session. The transcript was imported to Open code software where, open coding was conducted to identify initial concepts. These codes were then grouped in to categories and refined in to broader theme through iterative compassion. Summary map were generated to visualize relationships between themes. To ensure data quality and methodological rigor, peer debriefing and memo writing were used throughout the analysis process.

Result

Socio demographic characteristics of study participant

The mean age of study participant was 69 ± 6 years. The majority of study participants were male (83.8%), 80% of them cannot read or write, 48(60%) were farmer, 54(67%) were rural by resident. (Table 1).

Table 1.

Socio demographic characteristics of study participants

Variable response		N (%)
Gender	Male	67 (83.8)
	Female	13 (16.3)
Educational level	Cannot read and write	66 (80.0)
	Primary level of education	14 (20.0)
Occupation	Farmer	48 (60.0)
	Merchant	15 (18.8)
	Government employee	17 (21.3)
Residence	Urban	26 (32.5)
	Rural	54 (67.5)

Source of Indigenous knowledge of Traditional Bonesetter's in Southwest Ethiopia

The traditional bonesetter's participated in this study describes their source of knowledge of TBS was from family 61(45%), spiritual or gift from God 41(30%), observation or experience 33 (25%) (Fig. 2).

Fig. 2.

The source of indigenous knowledge of traditional bonesetter in Southwest Ethiopia

In-depth interview regarding the source of knowledge produced a knowledge transmission them and three sub themes;

• “Transgenerational knowledge transmission” representing the idea of those TBS knowledge is gained from parent and grand parent

• “Spiritual or natural gift” representing the idea of those participant whose belief is TBS can be indicated being twin births.

• “Careful observation from experienced traditional bone setter” this represents those who gained the knowledge by observing and those who started by massaging their own child.

• - All people cannot acquire the traditional bone setting knowledge and skill, for example my grandfather transferred his knowledge and skill of healing to me because I grew up in his hand by serving him, more than his sons and daughters (P11).

• - It is our tradition that twin born have the power to heal to all disorder including fracture dislocation by massaging, me and my twin brother were serving our community as “Wogesha” for long time (p 24).

• - Before 20 year my first baby failed while playing with her friends, her arm was rotated I could not find someone to help me, I massaged her hand to return to the normal state, after three days she become normal…. then my neighbor started bringing their child when they get fractured…. (p2, 7, 30).

Traditional bone setting practice in Southwest Ethiopia

Regarding the scope of practice TBS 49(61.3%) of the traditional bonesetter's participated in the interview were only bonesetter, while 38.8% of them are both traditional bone-setters and traditional herbalist. Majority of traditional bonesetters in this study experienced giving the service above 20 years. They provide the service primarily at their home and the reaming give the service by traveling to client’s home; in case the client cannot move due to verity of reason.

The most common types of MSK disorder or injuries treated by TBSs were dislocation, fracture, and sprain. Also, traditional bonesetters were asked to tick body part that commonly injured and brought to their attention. TBSs reported that the arm was the most commonly affected body part, followed by foot and leg (Table 2).

Table 2.

Traditional practice of bone setting in Southwest Ethiopia

Variable response		N (%)
Scope of practice (Herbalist and bonesetter or bonesetter only)	Bone setter	49 (61)
	Herbalist and bone setter	31 (39)
Year practicing TBS	Less than 10 years	18 (22)
	11–20 years	26 (32.5)
	above 20 years	36 (45.5)
Types of injuries frequently encountered	Fracture	33 (41)
	Dislocation	36 (45)
	Sprain and/or strain	11 (14)
Place of services provided	Home	21 (26)
	Home and Mobile	59 (74)
Training is important to upgrade knowledge	Yes	78 (98)
	No	2 (3)
Habit of recording	Yes	0
	No	80 (100)
volunteer to transfer your knowledge	Yes	34 (26)
	No	66 (74)
Service payment	Cash	26 (33)
	In kind	40 (44)
	Not at all	14 (20)
Do you have ever referred to health institution	Yes	13 (16.2)
	No	63 (83.8)

Techniques and material used by traditional bone setters to diagnose and treat

The traditional bone setters in the study area, uses hot water, different leaves, butter, fabrics/cloth, wood, animal dried skin to practice the bone setting practice (Fig. 3 a and b). Asking how and what happen or history taking is the main ways of identifying the problem of the serve’s seeker. In addition to this traditional bone setters in the study area inspect and touch to check for type of deformity, pain level, hotness, presence or absence of fracture. However, the treatment is different from one traditional bone setters to another. All clients get massaging service (Table 3).

• I touch by my hand if there is fracture of bone in that are their will be depression while inserting your finger, there for that part should be massaged for three days until the flesh fills the depression…which happens when the fracture bone meet(p8).

• ‘If it was a fracture, I massage the area throughout the day and night for three days if they are children and two days for the case of adults, if it did not resolve within three to four days, I will tell them to visit health institutions.

• ‘I and other TBSs have different therapeutic techniques which depends on the type of injury. No one can reveal its method of treatment for others’

Fig. 3.

a and b Traditional materials used by traditional bonesetters in Southwest Ethiopia

Table 3.

Traditional materials and Techniques used by TBSs in Southwest Ethiopia

Variable	Response		N(%)
Diagnostic techniques	Asking the cause of the injury	Yes	71(89)
		No	9(11)
	Palpation (touching and feeling with the fingers)	Yes	51(64)
		No	29(36)
	Inspection the sign and symptom	Yes	44(67)
		No	22(33)
Treatment techniques	Hand Massage	Yes	80(100)
	Bathing	Yes	21(26)
		No	59(74)
	Keeping immobile (Splinting, binding, bandaging)	Yes	61(76)
		No	19(24)
How do you manage pain	Warm compress		24(30)
	Use butter to reduce pain		35(44)
	Do nothing		21(26)

Perceived healing power

The traditional bone setters expressed their healing power is no dependent on the part injured or types of the problem rather they mentioned that their hand has healing capacity.

• If I caught the case from the very beginning, the injured part will heal soon because I know what to do, how to massage or how to splint still I did not face unimproved person, all villagers’ thanks me, anyone can tell you my name and my popularity

• It is common that young child and adult got fractured, dislocated to visit my home. I do not late to help them with the gift given me from my God

Documentation and Integration of the indigenous knowledge of Traditional bone setting

The traditional and indigenous knowledge of Traditional bonesetters was not adequately recorded in the study area. Thus, this study identified the traditional knowledge which is similar to other part of the countries or abroad and specific to the study area were systematically assessed and documented in this document. Accordingly, the indigenous knowledge of Traditional bonesetters in the study area was dominated by familial transfer of knowledge and skill; to diagnose and treat MSK disorder in the community. The local health system or the local government did not recognize them as alternative medicine. Therefore, their indigenous knowledge and skill did not promote to the level it can benefit the community.

• I worked in emergency clinic for more than ten year I observe and here while community member who have faced MSK injury prefers to go to TBSs, although they can cure most of the time, occasionally patient come with severe complication like infection, and gangrene. Therefore, the service given by TBSs need serious monitoring (P3).

• The knowledge and skill of bonesetters, is on phase of extinction in our community because people go to modern service, but traditional healer skill was left unused. Therefore, it should be recorded and transferred to the next generation (p6)

Discussion

This study qualitatively explored the indigenous knowledge and practice traditional bone setting in southwest Ethiopia.

Knowledge transmission

The theme of knowledge transmission reviled that the knowledge of bone setting is passed down through generation. Majority of traditional bone setters acquired their skill through familial lineage, often learning from parents or grandparents. This indicates continuity of indigenous medical knowledge with in the community. Also, some bone setter participated in this study have showed certain cultural beliefs such as being borne as a twin indicates tendency to become a bonesetter, illustrating that the source of their bone setting knowledge as natural gift or divine calling, suggesting spiritual dimension to the acquisition of knowledge. Other reported learning through careful observation of experienced other traditional bone setters. Therefore, in Southwest Ethiopian TBS knowledge is deep rooted in local culture and has transgenerational significance similar with Ethiopians and other Africans TBSs [20].

Bone setting practice

In addition, 49(61.3%) of traditional bone setter interviewed identify themselves exclusively as a bone setter, while 38.8% practice both bone setting and traditional herbal medicine. Majority of the participant have practiced bone setting for more than 20 years, indicating a long-standing engagement with indigenous healing practice. Although some of the interviewed bonesetter 21(26%) gives the bone setting service by traveling the clients home particularly when the patient was unable to move due to severity of the injury or other constraints, the primary service delivery is home based.

The most commonly treated of MSK condition or injuries were dislocation, fracture, and sprain. Also, the arm is very commonly affected or injured body part and brought to the attention of traditional bone setter followed by foot and leg. More interestingly traditional bonesetter demonstrated some anatomical awareness, describing injuries related to extremities, spine, and joints of the body. These finding suggest the practical significance of integrating the traditional bonesetter involvement in addressing common orthopedic injuries with in the community.

In addition, the majority of traditional bonesetter perceives getting training g is beneficial showed an interest in linking with modern care in information sharing referral, especially through training, and also, they were sending severe cases to hospitals and health centers. This is also in line with similar studies in Africa Ghana [27]. However, some expressed that their knowledge is better than modern care as some health professionals is referring cases to them.

Majority of TBSs participated in this study not receive money in cash for their service, some receive in kind, while few did not receive money at all. Thus, they have to work different job for living. This is in line with finding from India [20, 28].

Diagnostic techniques of traditional bone setters

Traditional bone setter participated in this study reported the primary method of identifying a patient condition involves asking about the nature and cause of the injury. In addition to this inspection, and palpation, allowing traditional bone setters to assess deformity, pain level, hotness, presence or absence of fracture. These help them in diagnosing fractures and dislocations easily as well as whether the affected part is swollen, painful, immobile, misaligned, or produce abnormal sound, which are key indicator of dislocation or fracture. The diagnostic approach reflects practical indigenous knowledge system that relay on history taking and physical examination. The finding is consistent with study conducted other African countries, where traditional bone setters similarly relayed on interviewing and physical examination to diagnose MSK injuries.

Treatment approach of traditional bone setters and Perceived healing power

Traditional bone setters in the study area utilize variety of locally available materials in their practice, including hot water, different medical leaves, butter, fabrics or cloth, wood, dried animal skin. These materials are applied in different combination depending on the types of injury, cultural difference, and individual technique. The treatment approach is different from one traditional bone setters to another. However, massage therapy was common all practitioners, which serve as both diagnostic and therapeutic approach in managing MSK injuries.

Traditional bone setters participated in this study expressed that their healing ability is not necessarily dependent on the type and location of the injury. But they perceived that their hand has inherent healing capacity. In addition, some participant highlighted nutritional support is important in healing process. However, the divine nature of the source of their knowledge impedes upgrading their skill by experience sharing and integrating with the modern medical service [20, 26].

Documentation and integration with modern health care system

In Southwest of Ethiopia similar to most developing countries traditional bonesetters were not registered or accredited by governmental or non-governmental bodies like the civic association to identify them easily [20, 26]. Recognition and documentation of these practices are essential to preserve Ethiopia’s healing heritage. Future collaboration with formal healthcare could enhance integration and mutual learning.

Strengths and limitations of this study

First, the Knowledge and practice of traditional bonesetter’s were assessed solely from the provider's perspective, without incorporating the view of the patient. Second, the study was geographically limited to four zones in Southwest Ethiopia, which may affect the generalizability of the findings. Third, the study did not independently assess the outcomes of treatments provided by TBSs. There’s no clinical verification of success or complications, which limits the ability to evaluate efficacy and safety. Lastly, the translation of interviews from local language may have influenced interpretation of culturally nuanced information.

Conclusion

The finding of this study reveals that TBS in southwest Ethiopia is deeply rooted indigenous knowledge and skill that was sustained through intergenerational transmission, spiritual belief, and experience. As part of their diagnostic procedures, traditional bonesetters conducted a history taking and physical examination, and they used locally sourced materials for therapeutic purposes, including hot water, medicinal leaves, butter, fabrics, wood, and dried animal skin, as well as massage. Additionally, even though incorporating TBS into the contemporary healthcare system is challenging, especially when it comes to cultural and spiritual beliefs about the transmission of knowledge and the power of healing, future research should look into cooperative methods with official healthcare. This involves methodically identifying and recording traditional healing methods to protect Ethiopia's traditional knowledge and enhance its contribution to modern medical knowledge.

Author contributions

KH and DG conceptualized the research idea and wrote the proposal, KH, DG, BE, SE, NE revised and approved the proposal, participated in data collection. DG and NE did data analysis. DG and KH wrote the manuscript. DG,KH, and EF revised subsequent drafts of the manuscript. All authors read and approved the final manuscript.

Funding

The funding for this study was covered by Mizan-Tepi University. The university research directorate monitored and evaluated starting from the proposal until finalization of the research.

Data availability

Data is provided within the manuscript or supplementary information files (Additional file 1).

Declarations

Ethics approval and consent to participate

This study was approved by the Research Ethics Review Committee (RERC) of Mizan Tepi University to be performed in accordance with the Declaration of Helsinki. Letter of cooperation was provided to each Zone and Public health institutions from Mizan Tepi University. Before the start of the study, informed written consent to participate was obtained from all participants after clarifying the objectives, purpose, and the harm and benefits of the study. Also, confidentiality, anonymity, and freedom to withdraw from the study at any time were maintained throughout the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.