East and Central African Journal of Surgery Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa ISSN: 1024-297X EISSN: 2073-9990 Vol. 12, Num. 2, 2007, pp. 59-61

East and Central African Journal of Surgery, Vol. 12, No. 2, November/December 2006, pp. 59-61

Causes of Delay among Patients Seen at the Fracture Clinic at Menilik II Hospital.

Asfaw Ayele

MD, Orthopedic Surgeon Menilik II Hospital AA. P.O.Box 25165 code 1000.
E-Mail: Asfdrdilla 07@ yahoo.com

Code Number: js07041

Background: In the third world countries like Ethiopia most patients reach fracture clinic delayed often loosing the golden time. The objective of this study is to analyze the factors causing delays of patients from reaching to fracture clinic early for treatment..
Method: A cross sectional study of 198 patients seen at the Fracture Clinic of Menilik II Hospital between 19/8/06-8/2/06. Only those which were delayed for more than three days were included.
Results: Of the 198 patients interviewed, 144 (72.7%), were males and 54 (27.3%) were females. Their age ranged from 8 to 86 years with a mean age of 38.7. Delay time ranged from 3 days to 365 days with a mean delay time of 25 days. The causes of delays were analyzed. The leading cause of delays was spending more time at traditional bone setter accounting for sixty cases(30%),hospital bureaucracy fifty- five cases(28%),Geographical distance forty-six cases(25%),self neglect eleven cases (6%),helplessness eleven cases(6%),privet clinic seven cases(3,5%),financial problems seven cases(3.5%).
Conclusion: The two leading causes of delay of patients to fracture clinic were traditional bone setters and Hospital bureaucracy. Traditional bone setters luck basic knowledge of how to handle injured parts and impending sign of ischemia. Hospitals have poor registration system and poor filling system.
Recommendations: There is a need for sustained health education to discourage patronage of traditional bonesetters and advertisement of their service on print and electronic media. The medical regulatory bodies should design program that can give basic training to traditional bone setters for safe application of splint and easily identification of sign of ischemia. Improve the working conditions of hospitals by computerizing the registration and filling system.

Introduction

In the third world countries like Ethiopia, the concept of time management is not well appreciated in the society partly due to poverty and ignorance. It is not uncommon to see delays in various activities such as in places of work and at meetings. Times of appointments are often not abided by. Such delays are considered as normal.

Most of the time delays in reporting to hospital and in this case to fracture clinic are quite common. This study was aimed at analyzing the factors contributing to delays in coming to the fracture clinic at Menilik II Hospital in Ethiopia.

Patients and Methods

A cross-sectional study of one hundred ninetyeight patients were interviewed at fracture clinic of Menilik II Hospital from 19/8/05 to 8/2/06.Only those which are delayed more than three days were eligible. Those which are delayed less than three days were excluded from the study.

Results

A total of 198 patients were interviewed at fracture clinic of Menilik II Hospital of which 144 (72.7%) were males and .and 54 (27.3%) were females with a M:F ratio of 2.66:1. The ages ranged from 8 to 86 with a mean of 38.7 years (Table 1). The interval between times of injury and reporting to the clinic ranged from 3 to 165 days with a mean of 25 days.

Causes of delays as reported by the patients were analyzed. The leading causes of delay was initial visit and management by the traditional bone setters accounting for 60 (30%) of cases fallowed by Hospital bureaucracy which accounted for 55 (28%) of the cases, Geographical reasons (long distance) was responsible for the delay in 46 (25%) of cases while self neglect and helplessness accounted for the delay eleven cases (6%) respectively. Management in private clinic and lack of funds were the cause in 7 cases (3.5%) respectively.

The three leading causes of fractures were falls, road traffic crushes, and fights comprising 90% of the causes (Table 2). Farmers, laborers and students accounted for 55% of cases (Table 3.

Table 1. Distribution of patients by age and sex

Table 2. Distribution of patients with mechanism of injury.

Table 3. Distribution of patients by profession

Being on time is the most important thing in the management of fractures. The sooner the reduction of fracture attempted the better the result. Other wise hemorrhage and edema in the soft tissue makes them in elastic and pose a barrier to adequate reduction. It is easier to effect reduction early than late .Un fortunately most of our patients reach to fracture clinic behind time .There are various factors which causes our patients to reach behind time . Among them the leading causes were spending more time at traditional bone setters (Wogesha) and Hospital bureaucracy. Traditional bone setter is a person who deals with massage and thight bamboo bandaging. In recent times it is quiet obvious that bone and joint trauma is the most prevalent in our rural and urban community .The dearth of specialists in this area and the concentration of few in specialized centers have left the rural area and even the urban areas solely to the hands of traditional bone setters .This unfortunate pattern of health arrangement has left the specialist with an option of receiving more of the complicated cases already mismanaged by traditional bone setters. The traditional bone setters are naturally benevolent but unknowingly they left so many patients crippled, disabled, deformed, and gangrenous. Despite all these our society are deeply bound to them due to strong patronage and advertisement of their service on print, electrical media and house to house instigation. Hospital bureaucracy.

Most patients delay at fracture clinic in fearing and/or passing through a tights Hospital bureaucracy and antediluvian type of patient registration at card rooms .Most hospitals have insurmountable bureaucratic chains which are almost bottle neck to the reach of the patient starting from the gate. Most patients with fractures loose their golden time while waiting for card registration(long line up)and/or in finding their old cards which are habitually misplaced due to back ward filling system.

• The two leading causes of delay to fracture clinic were traditional bone setters Hospital bureaucracy.
• Hospitals have poor registration system and poor filling system which also contribute to delay.
• .Traditional bone setters lack basic knowledge of how to handle injured parts and the impending signs of ischemia.

There is a need for sustained health education to discourage patronage of traditional bone setters and advertisement of their service on print and electronic media. The medical regulatory bodies should design program that can give basic training to traditional bone setters to safe application of splint and easily identification of sign of ischemia. Improve the working condition of the Hospital by computerizing the registration and filling system.

1. Role of rural orthopedic and trauma assistances in improving rural orthopedics and trauma care. A.M Udocen department of surgery College of medical science University of Calabar Nigeria.
2. Role of in appropriate traditional splintage in limb amputation. Maldungury Nigeria . R.H Umbro.B.M Galli and N.Ali.
3. Prevention of traditional bone setters gangrene.Eshete87.
4. Campbell ’s operative orthopedics eighth edition .P 723
5. Where there is no doctor a village Health care hand book for Africa revised edition David Warner .1993 P.100-104
6. Out line of fractures including joint injuries eleventh edition Adams .
7. Essentials of general surgery Peter F .Laurence third edition P.166-167.

© 2007 East and Central African Journal of Surgery

The following images related to this document are available:

Photo images