Contributions of traditional medicine to health

Traditional knowledge is also of great value in its contributions to health and medicine. Two of the conference speakers, Dr. Maurice Iwu of Nigeria and Dr. Arturo Argueta of Mexico, are involved in studying traditional medicine and demonstrating its importance for the health and wellbeing of the world's population.

African Medicinal Knowledge

Dr. Iwu is particularly qualified to address this topic, because he is both a researcher at Walter Reed Army Hospital in Washington, D.C. and a Professor of Pharmacognosy at the University of Nigeria, Nsukka, as well a member of a society of traditional healers. He told conference participants:

The only thing that you can say that traditional medicine has in common with modern medicine is the fact that they both cure disease - one heals, the other treats. But, the role of the traditional healer is much broader than that of a Western medical practitioner.

The traditional doctor is a healer, diviner, adjudicator, and protector of his whole community. Therefore, it is only a part of the traditional healer's role that we are discussing when we compare them to modern doctors.

Dr. Iwu described the three members of the traditional healing team: the healer, the spirits, and the patient. Through ritual and ceremony, he continued, a traditional healer communicates with and asks for the help of the indwelling spirits (those that reside in every object, plant, and animal); the invoked deities (minor gods who are asked to intercede with the one all-powerful God); and the ancestors (the patient's predecessors who are available for advice and consultation). These religious or spiritual aspects of the traditional healing process are often misunderstood by Western academics, whose cultural conceptions usually pose a fundamental distinction between "science" and "religion."

Despite these differences in the underlying approaches of traditional and Western medicine, Dr. Iwu noted that of "the more than 130 clinically useful major prescription drugs that are derived from higher plants, over 70 percent of them came to the attention of pharmaceutical companies because of their use in traditional systems of medicine."

Since 1978 his research group at the University of Nigeria, Nsukka, has been systematically investigating the plants used in traditional African medicine. He described the research findings of his group:

To date, we have investigated well over 200 plants and have studied about 26 of them in some detail. In nearly all cases, our laboratory findings support the use of the plant drugs as therapeutic agents. We have established from the analyses of plants used in traditional medicine that the preference is for dietary supplements and masticatories rather than non-edible poisonous species....

In an earlier study, we reported the pharmacological activity and the therapeutic application of over 153 dietary plants used in traditional medicine. We included in our report their botanical names, local names in the three main Nigerian languages (Hausa, Igbo, and Yoruba), their medicinal and dietary uses, and of course their chemical constituents....

[Our research has shown] that a high degree of selectivity is involved in the use of plants in traditional African medicine.

Dr. Iwu pointed out that most of the plants from which these drugs derive are found in tropical forests. Although tropical forests constitute only 7 percent of the earth's surface, they contain an estimated two-thirds of its plant species. Dr. Iwu continued:

Unfortunately, tropical forests are now under siege, threatened by overexploitation, habitat conversion, and the ravages of poverty. It is estimated that over 150 square miles of rainforest are cut down every day in order to accommodate the socioeconomic needs of human inhabitants of forest lands. Habitat conversion threatens not only the loss of plant resources, but also cultural diversity and the accompanying knowledge of the medicinal value of several endemic species.

Economic Needs of Forest Dwellers

In response to these threats he suggested that more attention needs to be focused on the economic needs of forest dwellers, and how their knowledge of plants and other forest resources might be utilized as a "feasible tool for social and economic development." However, he warned against too rapid an acceptance of the premises of recent efforts in what is called "biodiversity prospecting." He argued that the research methodology used by Western pharmaceutical companies is one of identifying biologically active compounds or active constituents from plants and then distilling them into commercial drugs. This methodology, Dr. Iwu said, is "based on the [incorrect assumption] that the plant medicine as constituted is not a medicine but has to be refined to distill the true drug." Under these conditions, developing countries are only suppliers of raw plant materials, rather than being involved in the development and commercialization of the drugs. These circumstances, he argued, resemble the "colonial situation in which tropical countries were raided for cheap raw materials."

In contrast, he described a series of projects that he and his colleagues are carrying out in Nigeria and that attempt to draw on traditional knowledge and ensure that a greater proportion of the profits remain both in the country and benefit local people.

The earliest of these projects was termed Nkana Nzere, which roughly means "a documentation of the arts and norms of the Igbo people." This project was launched in 1982 by the Institute of African Studies, the Faculty of Arts, and the Department of Pharmacognosy at the University of Nigeria, Nsukka. It utilized undergraduate students who were trained in field data collection and sent to their home villages to gather information on human interactions with the environment. Data were collected on proverbs, music, oral history, ethnobotany, indigenous biotechnology, and ethnomedicine.

The success of this project led to the establishment in 1990 of a Biotechnology Development Agency (BDA), comprised of Nigerian scientists, nongovernmental organizations (NGOs), and the private sector. This agency seeks to use "available human and material resources in Nigeria for the conservation of biodiversity through establishment of extractive forestry research parks, initiation of village-based social forestry projects, and conducting investigation into the uses of biological resources in the development of novel pharmaceuticals, cosmetics and food additives." (See box for details.) In turn the BDA initiative led to the formation of a regional organization, Bioresources Development and Conservation Program (BDCP), which pursues the same goals and links similar community-based projects in West and Central Africa.

Mexico's Traditional Medicine Program

Dr. Argueta, an ecologist with the Mexican National Indigenist Institute (INI), also described a comprehensive program underway in his country to protect and preserve the knowledge of traditional healers. This program first sought to document the extent of traditional plant knowledge in Mexico. It included a bibliographic search of all available information on useful plant species, their botanical names, and their ethnobotanical uses. Much of this information existed only in unpublished articles, or in the scientists' files. The program has developed a file on over 3,000 plants, which have nearly 15,000 different uses. This material is being made into the Atlas of the Traditional Medicinal Plants of Mexico, which will contain botanical drawings, indigenous names, and maps of their regional distribution.

A second aspect of the Mexican program is the organization of traditional indigenous healers.

For the past several years INI has been organizing regional workshops to foster the exchange of knowledge among traditional medicinal practitioners. There have already been two national congresses and the formation of a National Council of Traditional Indigenous Healers, which brings together fifty-seven local and regional organizations. There have also been meetings with traditional healers from other parts of the continent, and a technical consultation on traditional medicine with the Pan American Health Organization (PAHO).

In collaboration with these and other indigenous organizations, INI has promoted the introduction of reforms in the Mexican Constitution that recognize the multi-ethnic and pluricultural nature of Mexican society. It has also linked traditional healers and other medical practitioners (for example, midwives) with the national medical system. This work has resulted in greater recognition of the role that traditional healers can play in the delivery of primary health care, the use of traditional healers in regional hospitals that serve indigenous communities, and the sensitizing to and training of medical students in the knowledge possessed by traditional medical practitioners.

For an estimated 4 billion people in the world, traditional health care is very important. The materials and the procedures, the beliefs and ideology, the sacred places and the holy plants - the whole thing - provides health for many people in the world. The trend is toward growth in the next decade.... More and more people from Western societies are using non-Western medicinal plants and traditional health systems. - Arturo Argueta

Traditional Medicine and National Health Care Systems

Following the Mexican presentation, Dr. Gerard Bodeker, an expert on traditional Asian medical systems, spoke from the floor and highlighted the worldwide significance of traditional medicine. He told the conference that the World Health Organization (WHO) has estimated that 80 percent of the world's population, about four billion people, rely upon traditional medicine for their primary health care. He recommended that international agencies think more in terms of promoting traditional systems of health care rather than promoting medicine. Dr. Bodeker said:

When we look at traditional health-care systems, we are seeing systems that are effective, that are locally available, that are affordable, and that are sustainable. On that basis, I'd like to suggest that traditional health care in this Year of Indigenous People should become a priority agenda issue in international and national health planning. It should quite soon become a mandatory component of the health planning equation in all countries that have traditional health care systems.

Dr. Bodeker, a consultant to the World Bank's East Asia and Pacific Population and Human Resources Division, has been helping to design a traditional medicine component for a Primary Health Care Project in Viet Nam. In Viet Nam one-third of all medical care is provided by traditional medicine. This includes the use of traditional herbal medicine for the treatment of malaria, gastrointestinal diseases, and common illnesses such as respiratory disorders, fevers, hypertension, cardiovascular conditions, and rheumatism. Traditional acupuncture is also used in analgesia, anesthesia, and the treatment of central nervous disorders and other neuromuscular conditions.

In Viet Nam, as in other Asian countries, these traditional practices are being modernized and integrated into the national health care system at the central, provincial, district, and local levels. Vietnamese government policy, according to a recent report by Dr. Bodeker to the Bank, is:

...to gather, record and disseminate the medical knowledge of experienced practitioners of traditional medicine [and to modernize] traditional medicine, including the use of modern medical means of diagnosis, scientific evaluation of the safety and efficacy of the plant ingredients in herbal medicines, and drug development programs based on knowledge of the bioactive ingredients and properties of medicinal plants.

His report provides several recommendations on how the Bank and other international donors might support the national government's policies on traditional medicine through financing training, improvement of facilities, equipment purchases, and research.