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Background <p>Despite the availability of modern orthopedic care, traditional bone-setters (TBS) still play a large role in managing fractures in Guinea. Delayed surgical care for complex fractures where surgery is indicated leads to worse outcomes. Our study aimed to identify the factors that lead people down varying care seeking pathways in Mamou, Guinea. </p> Methods <p>A qualitative investigation was conducted with 52 individuals who had displaced or compound fractures within the past 10&#xa0;years in the Mamou region of Guinea. Interviews were conducted in 3 villages in the catchment area of a private hospital where orthopedic surgical care exists and with patients at the hospital who were planning to receive or had received surgery. Interviews explored participants’ care-seeking pathways for their fracture treatment. All responses were analyzed using a grounded theory approach. </p> Results <p>Participants in our study experienced fragmented care across hospitals and traditional medicine, with 40 (78%) seeing a traditional healer at some point in their care. Lack of financial means was the critical factor preventing access to surgical fracture care, with 40 (78%) mentioning cost as the reason for choosing TBS. Participants considered TBS to be a more affordable, but inferior substitute for their care. Families and communities aggregated funds to cover medical care with costs ranging from $8 USD for an X-ray to $2,000 for an orthopedic surgery. Travel was not a significant barrier to accessing surgical care; participants were willing to travel great distances to seek care from both traditional healers and hospital providers. </p> Conclusion <p>This study highlights poverty as a structural determinant of health for people who experienced complex fractures in Mamou, Guinea. Participants desired hospital care for their fracture management; but it was unaffordable. Strategies to improve fracture care in the region should include consideration of increased governmental subsidies, innovative private and non-governmental payment models, and TBS education to prevent complications. Future studies could determine the level at which costs are affordable thereby helping hospitals determine what percentage of their costs need to be subsidized by alternative payment models.</p>

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“It’s only the money: The hospital is always stronger”— a qualitative study of fracture care pathways in Mamou, Guinea

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月4日

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  • Margaret A. Chell,
  • Thomas F. Jorgensen,
  • Paul Jean-Marie Sidjani,
  • Lamarana Diallo,
  • Tom D. Thacher,
  • Stephen P. Merry

摘要

Background

Despite the availability of modern orthopedic care, traditional bone-setters (TBS) still play a large role in managing fractures in Guinea. Delayed surgical care for complex fractures where surgery is indicated leads to worse outcomes. Our study aimed to identify the factors that lead people down varying care seeking pathways in Mamou, Guinea.

Methods

A qualitative investigation was conducted with 52 individuals who had displaced or compound fractures within the past 10 years in the Mamou region of Guinea. Interviews were conducted in 3 villages in the catchment area of a private hospital where orthopedic surgical care exists and with patients at the hospital who were planning to receive or had received surgery. Interviews explored participants’ care-seeking pathways for their fracture treatment. All responses were analyzed using a grounded theory approach.

Results

Participants in our study experienced fragmented care across hospitals and traditional medicine, with 40 (78%) seeing a traditional healer at some point in their care. Lack of financial means was the critical factor preventing access to surgical fracture care, with 40 (78%) mentioning cost as the reason for choosing TBS. Participants considered TBS to be a more affordable, but inferior substitute for their care. Families and communities aggregated funds to cover medical care with costs ranging from $8 USD for an X-ray to $2,000 for an orthopedic surgery. Travel was not a significant barrier to accessing surgical care; participants were willing to travel great distances to seek care from both traditional healers and hospital providers.

Conclusion

This study highlights poverty as a structural determinant of health for people who experienced complex fractures in Mamou, Guinea. Participants desired hospital care for their fracture management; but it was unaffordable. Strategies to improve fracture care in the region should include consideration of increased governmental subsidies, innovative private and non-governmental payment models, and TBS education to prevent complications. Future studies could determine the level at which costs are affordable thereby helping hospitals determine what percentage of their costs need to be subsidized by alternative payment models.