BOSAD study undertake advocacy works in  the last 9 months (July 15, 2021- April 15, 2022)

BOSAD national multicenter study is a web based prospective cohort study at 8 centers from 6 different regions in Ethiopia which aim to investigate the prevalence of bone setting associated complications and reasons for patronizing traditional bone setter over the modern orthopedic care for Musculoskeletal (MSK) injury. At the end of the study, it is believed that it will provide evidence on utilization, scope, safety and integration of traditional bone setting practice with the modern orthopedic care based on the national strategic plan.

The BOSAD study is a three years study in which the national data collection, implementation phase and post implementation impact assessment will take one year for each respectively. Now, it is the 9^th month since we started BOSAD study data collection (Phase-1 activity from July 15, 2021- April 15, 2022). During this period, in addition to the data collection, the BOSAD study national lead team engaged at different advocacy work nationally and internationally. Few of the advocacy work are mentioned below.

1. The BOSAD study overall plan and the pilot phase data was presented for Prof. Osama Farouk from Egypt and Prof. Vivien Lees from Royal College of Surgeons – England.
   Professor Osama is a world class Professor of orthopedic surgery from Assuit University, Egypt with extensive research work and clinical engagement. He is the chief of orthopedic trauma and different committees. Like Professor Osama, Professor Vivien is also one of the giant clinical Professor of plastic and reconstructive surgery at University of Manchester. She is involved in different leadership position including Royal College of Surgeons- England and Global affiliations. Both of them have extensive experience in leading impactful studies, being editor for different journals and mentoring PhD students. We presented the overall aim of BOSAD study and the finding from the pilot phase, and they were very interested on these problem-solving studies. They show magnificent interest to give international mentorship role for BOSAD study.
2. The magnitude of Complications from Traditional bone setting and rational of BOSAD study was presented for Harvard global orthopedics collaborative panel discussion, International Federation of Musculoskeletal Research Societies (IFMRS) annual meeting and Bethune roundtable 2021 discussion at center for Global surgery.
   The Harvard global orthopedic collaborative team are periodically hosting a specific community problem for expert discussion and evidence-based research presentation. One of the topics which was selected for panel expert discussion was “The continued role of traditional bone setters in East and West Africa” where experts from Nigeria, Burkina Faso, Ghana, Ethiopia and Cameron were presented their own research output and their experiences. In this expert panel discussion, the Pilot BOSAD study data was presented to highlight the magnitude of bone setting associated complications, rationally of the study and how to work with traditional bone setters to improve the care given to MSK injuries in low- and middle-income countries like Ethiopia. The study depicted that around 62% of the patients who initially managed by traditional bone setter for their MSK injury and then presented to hospital were having different type of limb and life threating complications including death. The bad truth is that 92% of amputation due to traditional bone setting gangrene was done for pediatric patients, less than the age of 15 years, who didn’t have saying for their management choice, which is actually heart breaking. In general, this expert panel discussion was aiming to standardize and regulating the care given to MSK patients by traditional bone setters, create favorable environment for orthopedic surgeon and traditional bone setter to work together for the improvement of the care, prepare scope of practice for traditional bone setter and train them accordingly. Like the Harvard global orthopedic collaborative, both the IFMRS and the center for global surgery roundtable meeting also hosting yearly program to address problem solving research from low- and middle-income countries where the BOSAD study was presented online and able to sell the idea for international scholars, funders and experts.
3. The BOSAD Pilot study result was presented at Monthly Agelgil session which is organized by Ethiopian Ministry of Health (MOH), Maternal and Child Health (MCH) Directorate.

In order to cultivate the culture of using local research output for policy making and strategic plan development at the MCH Directorate, there is a habit of hosting a “Monthly Agelgil session” which will be held at the MCH directorate office in the presence of invited stakeholders from different directorates, researchers, research advisors, invited guests and NGOs representative. The whole aim of this presentation is to give national recognition for that studied problem and design a national solution on the way to solve the problem in a synergy of all respective stakeholders.

Since the practice of traditional bone setting were common in Ethiopia, it was in the mind of everybody including the directorate leaders and research advisors.

Professor Tsinuel Girma was the first researcher from MOH who brought the idea of presenting the BOSAD study pilot result to respective stakeholder and link the BOSAD national lead team with Prof. Mirkuzie Woldie, senior research advisor, Maternal and Child Health (MCH) directorate, who arrange this opportunity to present the finding at the monthly “Agelgil Session.” The presentation was held at MCH Directorate meeting hall, Addis Ababa and it happen in the presence of MCH directorate staffs, different directorate representatives, researchers invited guests and other stakeholders in person and also it was live streamed via zoom for those who can’t appear in person. The main finding of the pilot study, the aim of the study, way forward and implementation activities were clearly outline and alarm all the participants about the magnitude of the complications. After the presentation was given by Dr. Mengistu Gebreyohanes Mengesha, national lead of BOSAD study, there were reflections, questions and discussion point raised by the participants. The focus of the discussion was mainly on how to offer safe, affordable and accessible MSK care for the patients. Dr. Meseret Zelalem, Director of Maternal and Child health, forwarded her closing remark by mentioning her experience on the prevalence of traditional bone setting related complications during her clinical experience, how to prevent these complications and the need of collaboration of all stakeholders in the realization of this research idea. She gives emphasis as everybody should be the voice for the voiceless pediatric patients who are being commonly suffered with the traditional bone setting management for their injury and presented with limb and life-threatening complications. She also gives direction to start the implementation activities earlier than the scheduled time specifically booklet preparation which will be utilized for media briefing, community health advocacy and promotion activities. Based on the direction given from her, the national BOSAD study team take the responsibility of working on the implementation guide and channel the implementation. The BOSAD national lead team believe as the meeting was big opportunity to meet different stakeholders who will be vital for the implementation phase on the subject matter.