Integrating Traditional Bone-Setting with Orthopaedic Training in Kenya: A Mixed Methods Study on Decolonising Medical Education

W; a; n; j; i; k; u; M; w; a; n; g; i

Abstract

Background: Orthopaedic training in Kenya remains predominantly based on Western biomedical models, which frequently marginalise indigenous knowledge systems such as traditional bone-setting (TBS). This disconnect highlights a core challenge in efforts to decolonise medical education. Purpose and objectives: This study assessed the feasibility and perceptions of integrating TBS principles into formal orthopaedic training in Kenya. Its objectives were to evaluate orthopaedic trainees’ and consultants’ knowledge and attitudes towards TBS, and to identify TBS practices considered suitable for curricular inclusion. Methodology: A concurrent mixed-methods design was employed between 2023 and 2024. A cross-sectional survey quantified attitudes among 127 orthopaedic registrars and consultants from three national teaching hospitals. Subsequently, 18 in-depth interviews and two focus group discussions were conducted with surgeons, TBS practitioners, and medical educators to explore integration barriers and opportunities. Findings: Quantitative data indicated that 68% of orthopaedic professionals saw potential benefit in learning about specific TBS techniques, primarily for enhancing patient communication. Qualitative analysis identified a central theme: while there was strong consensus on integrating TBS knowledge for its socio-cultural value, significant concerns existed regarding standardising practices and ensuring patient safety. Conclusion: There is recognised, albeit cautious, support for integrating TBS into orthopaedic education as a step towards decolonising curricula. This integration is viewed as a strategy for fostering cultural competence rather than for the direct adoption of clinical techniques. Recommendations: Develop a standardised, critical appraisal module on TBS for postgraduate orthopaedic curricula, focusing on its history, cultural context, and safety considerations. Establish structured clinical exchanges between orthopaedic units and accredited TBS practitioners to facilitate mutual learning. Key words: decolonisation, medical education, traditional bone-setting, orthopaedics, Kenya, integration, mixed methods. Contribution statement: This study provides empirical evidence on the attitudes of Kenyan orthopaedic professionals, offering a framework for culturally responsive curriculum development that bridges biomedical and indigenous knowledge systems.