Walking sticks for muscle, bone and joint health in rural Botswana:villager perspectives from the World Spine Care MuBoJo project

Objectives: People of rural Botswana rely on walking as their principal mode of transport over long distances and rugged geographical terrain. For those who suffer from Muscle, Bone and Joint (MuBoJo) disorders, navigating spaces and places contributes to everyday burdens that are not well represented in the literature. In this qualitative study we observed the use of walking sticks amongst villagers in rural Botswana and examined how they might support MuBoJo health. Methods: Ethnographic fieldwork over eight months included participant observation, document review, and 70 interviews with 48 participants (35 villagers and 13 healthcare providers). Analysis included constant comparative methods followed by a structured approach to identify and assemble walking stick text for interpretation.Results: Observations and discussions revealed that many walking sticks were handcrafted from natural or household objects. From a therapeutic perspective, homemade and commercial aids were improperly fitted and poorly maintained. Villagers reported walking stick use to: uphold posture and balance; relieve MuBoJo pain; honour fashionable tradition; and assist visually impaired persons to negotiate rough terrain. Non-use was related to fear of dependency on sticks and inability to go without aids once used. Villagers frequently self-prescribed mobility aids, were self-taught in their use, and habitually used sticks on the ipsilateral side of lower extremity involvement. When prescribed by healthcare providers, villagers claimed little or no instruction for use; no educational notes were identified in villager health cards. Conclusions: Many walking sticks are homemade and most are used without professional instruction. To promote MuBoJo health amongst villagers in Botswana, it is essential that healthcare providers are educated to assess and train villagers for mobility aid fit, use, and maintenance. Frequent follow-up observations also are important. Engaging trusted opinion leaders might be valuable to initiate and sustain community-based interventions for walking sticks to support muscle, bone and joint health.