FE3 Ethnography The Gambia

Background Africa is changing rapidly and people are living longer. However, ageing increases the risk of fractures, particularly hip fractures. Hip fractures can have serious consequences, causing pain, disability and sometimes death. To plan future healthcare services, countries need to understand how care is currently organised and delivered, and identify opportunities for improvement. Aims This study aimed to understand how hip fracture care is delivered in The Gambia. Specifically, it sought to: 1. Understand what happens when people experience a hip fracture, including how they access—or fail to access—healthcare services. 2. Describe how services are organised and delivered, and identify factors that support or hinder effective care. 3. Explore the experiences and practices of traditional bone setters in this context. Methods The study was conducted in three parts. 1. Case studies were carried out with 40 people who had experienced a hip fracture, along with their carers or family members. These explored patients’ journeys through care, including points where they entered or left treatment and the effects of the fracture on their lives. Data were collected through observations in clinics and homes, and through interviews. 2. Detailed information about hip fracture care delivery was collected at six healthcare facilities. 38 healthcare professionals participated. Data examined how services are organised, how treatment decisions are made, and factors affecting care delivery. Data were collected by shadowing healthcare professionals, observing clinical practice and conducting interviews. 3. Information was collected from 16 traditional bone setters to understand their experiences and practices in treating hip fractures and how their work interacts with formal (hospital) healthcare services. This ethnographic study formed part of the wider FRACTURES-E3 mixed-methods research programme investigating fracture epidemiology, outcomes and costs in The Gambia, Zimbabwe and South Africa.