Traditional Medicine: an Under-utilised Resource

Lucia Ellis

Hotep, I wish to dedicate this presentation to all the children that I know, especially my own biological children, Melinda, Orion, Christophe, and Adrian.

I wish to thank Olodumare, Orisia and my ancestors for the gift of life and knowledge. All that I share with you today would not be possible without my belief in their constant love and guidance. To the convenors of this conference I say congratulations and thanks for the opportunity to present.

My context for developing the topic "traditional medicine: an under-utilised resource" is the quotation

You hearers, seers, imaginers, thinkers, rememberers, you prophets called to communicate truths of the living way to a people fascinated unto death, you called to link memory with fore listening, to join the uncountable seasons of our flowing to unknown tomorrows even more numerous, communicators doomed to pass on truths of our origins to a people rushing deathward, grown contemptuous in our ignorance of our source, prejudiced against our own survival, how shall your vocation's utterance be heard?¹

"Culture is everything"² and the definition of culture I chooses for this discussion is that which refers to the concepts, habits, skills, art, instruments and institutions of a people that allows them to survive and perpetuate themselves.

The traditional health system is a rich cultural heritage as evidenced by its diverse manifestations. the cultural alienation, which resulted from colonialism, is the reason for the questioning of the validity of this system. That these systems are not as developed in Africa or Latin America as in China and Vietnam is linked to the colonial experience. However, they all have the holistic approach as their bases incorporating all aspects of life, physical, spritual and emotional. And despite over five centuries of financial and legal support for conventional medicine, traditional healing practices and beliefs remain dynamic and healthy.

There has been a resurgence of interest in traditional health systems. The reason for this is the realisation that half the population of the world still continue to depend solely or partly on plant based drugs for their health care needs. This in itself is reason enough for paying greater attention to the development of the traditionally used plant drugs. There are other reasons too: such as over-medication which results in a significant number of patients suffering from side effects of the patent synthetic drugs; need for newer leads in the treatment of several chronic diseases and better and cheaper substitutes for already known drugs.

Status of Traditional Medicine in Belize

At its inception in 1986 the Belize Rural Women’s Association (BRWA), an NGO, placed special emphasis on rural health issues, particularly as they affect women and children. The various initiatives of the Association identified the high cost of modern pharmaceuticals for the treatment of ailments, the lack of proper medical and health services and the strong practice of traditional healing in most of the rural areas of Belize as characteristic of the rural health reality. Regarding the former Belize is not unique. The economic crisis of the third world countries and the structural adjustment policies put in place had removed the prospect of quality health care being provided by the state further and further from reality. This situation was true in 1986 and is as true now.

The Belize Rural Women’s Association (BRWA), Ix Chel Research Foundation and Belize Centre for Environmental Studies (BCES) facilitated two symposia for traditional healers in 1988 and 1991. These events along with consultations at the community level through various projects namely the Tropical Forestry Action Plan (TFAP); Natural Resource and Management Project (NARMAP); Forest Planning and Management Project (FPMP) and National Biodiversity Action Project (NBAP) in the period 1992—1998 pointed to the following issues regarding traditional medicine in Belize:

• Definition of the Traditional Health Systems of Belize is lacking
• Conservation and propagation of herbs is important for maintaining a supply.
• Research and Dissemination of knowledge is required.
• Development of protocols for the standardization of the practice was required.
• Involvement of healers and community in the decision-making process
• Exploring the viability of traditional medicine as an economic venture.
• The need for Intellectual Property rights policies

Definition of Traditional Health Systems of Belize

There exists four categories of indigenous practitioners: spiritual or magico-religious healers, herbalists, technical specialists such as snake doctors, and traditional birth attendants also known as midwives, curanderos. There may be an overlap in their roles, these groupings however will facilitate an understanding of the traditional health systems of our cultures.

Traditional healers and their therapies are also promoted to achieve a sense of national unity in our culturally diverse nation. The cultural retrieval activities I have participated in highlight the distinct elements of our healing systems: use of eggs for cleansing by the Mestizo, use of stingray spines for pain removal and termite nest for spiritual cleansing by the Garifuna. There is a tradition of magic and ritual in the herbal medicine of the Maya and Garifuna. The use of sacred copal smoke to ward of evil spirits, and espantajo in infants has its origins in the indigenous religions of both ethnic groups. The use of sympathetic magic (like acts produce like results) is also a characteristic of traditional healing. Who can explain why the sensitive plant, Mimosa pudica, which folds up, can cure insomnia? Similarly, by producing pain, pain is cured, for example, the use of the stingray as a cure for headaches and hot bird pepper for curing poisonwood burns in the eye.

Central to all aspects of traditional medicine in Belize is the usage of the flora from the forests, thus “bush medicine”. The herbs whether having a Garifuna, Maya, Creole, East Indian or Mestizo name are utilized across cultures for various ailments and it is not unusual to find many cross-cultural similarities.

Midwives perform crucial health care functions such as prenatal care, some applying skills such as rotation of the foetus, assistance during labour, delivery and after birth, and often continuing care for newborns, young children and the post-partum mother. Traditional midwives are relied upon to perform the roles of gynaecologist, obstetrician, herbalist and paediatrician.

Regarding the spirituality aspect of healing: the Garifuna still maintain a degree of integrity with its traditional healing practices. The strong acknowledgement of the role of ancestral worship in healing is a major aspect of the Garifuna healing system. The offering of food, the Dugu, Chugu and the mass for the dead share similar characteristics with the rituals that are a part of the Finados practiced by Maya-Mestizo on November 1st and 2nd - All Saints Day and All Souls Day respectively. This points to the inter-ethnic relationship characteristic of traditional medicine.

Despite the resurgence, it must be noted that the feeling of being “backward” when practicing cultural traditions, music, dance, language, religious practices and medicine is still pervasive in the psyche of many. This has led to the decline in the practicing of important healing rituals in communities, example the primicia, the nine-day post maternal care etc. When one understands how colonial powers shaped the societies that they oppressed and kept them oppressed through psychological destabilization and reconditioning we can understand why in spite of the knowledge available we still participate in the denial of who we are and what makes us real.

In our early history our people struggled to maintain a relationship with the cosmos. They were successful and whatever traditions we have today is due to their conscious resistance. They knew that we would need this knowledge in order to survive so they conserved it for us against all odds. However, through the opening of “opportunities”, provided by the colonizers i.e. education, employment, industrialisation, and other institutions we have lessened our understanding of our own cultures and indigenous life styles. We must appreciate that what we are giving up is not equal to what we are getting.

Unfortunately the stimulus for the retrieval of our cultural practices is not coming from within but from outside. Once more we look to the outside for validation.

From the results of an assessment for the Health Sector Reform Preliminary Phase we learn that reasons given for accessing herbalist “bush doctors”, were the high cost of modern pharmaceuticals and the belief in it as a cultural tradition.⁴ This was especially true for the population living in areas, which are frequently inaccessible to medical personnel. Traditional healers are for many the primary source of medical care for the community.

The survey also informed that in the absence of this the amount spent on pharmaceuticals would be $108/month per household.

Research and Documentation

Extensive Research has been conducted locally by New York Botanical Gardens. The National Cancer Institute with the assistance of its affiliate Ix Chel Tropical Research conducted in vitro testing for anti-AIDS and anti-cancer activity. One hundred of the most commonly used plants among healers in Belize have been listed in a book co-authored by Dr. Balick and Rosita Arvigo. Daniel Buffington conducted one of the earlier studies of traditional medicine and healers in Belize in 1983. Additional research include work from local researchers such as Aunt Barbara Fernandez, Medicine Woman, The Herbal Tradition of Belize. Mr. Richard Williams (deceased) also published another compilation of herbs of Belize for use by Belizeans under the guidance of the Research Entomologist of the Government Research Station. These along with A story of Bush Medicine Belizean Herbs and Barks published in 1977 brought the information on herbal medicine to the wider public.

Technical research was conducted by the Ministry of Agriculture and Fisheries through its former training institution the Belize College of Agriculture entitled "The Environmental Requirements of and Propagation of some important medicinal plants". This research provided database giving growth conditions required by five medicinal plants. This would enable mass production by providing the characteristics of local herbs. The Conservation Department of the Ministry of Natural Resources has a herbarium with specimens of all the flora of Belize. The upgrading of the classification was a major project of the Forest Planning and Management Project 1995-1999.

Institutional support for Traditional Healers

“What scientific criteria are appropriate to validate traditional health system? Can there be a method of validation in their own right that is also critical?” This question is raised at every forum where traditional healers and biomedical practitioners dialogue for the integration of traditional health systems into the modern system. Several issues are raised including: How can integration be achieved between two unequally developed systems? Perhaps co-operation, collaboration and mutual respect could be the goal.

Biomedical personnel enjoy the security and protection of professional associations, unions and governmental and non-govermental organizations. Traditional practitioners, particularly in the developing world, often lack the patronage of established institutions in their respective communities. Historically traditional practitioners suffered from both overt and covert discrimination in practicing their profession. Until independence in the 1960s and '70s most of Africa colonial laws considered the practice of traditional medicine as witchcraft and forbade the practice accordingly. In the past 50 years there has been a conceptual evolution of the Western view of indigenous healing systems. Based on the premise that scientific and traditional medical systems share common features, the conceptual framework of interpersonal transaction and group process enhanced the status of the rational practitioner. Health care delivery explores such variables as practitioner personality, therapeutic relationship, shared worldviews hope and positive expectancy. A conceptual framework relating to both the scientific and the indigenous system has begun. In the 1960s researchers from different disciplines anthropology, sociology, psychiatry, pharmacology, and clinical biomedicine demonstrate traditional medicine as an important element in healing process.

Proposed strategies for linkage have implicit in them actions to “identify the professionals and controlling the quacks”.⁶ These actions include: licensing programmes, formalizing selected categories of herbs, training of selected practitioners and hiring them as Ministry of Health employees, and offering cross-cultural training to biomedical establishments and research into pharmacopoeia of traditional medicine. These have been attempted in Belize in a limited way. Whilst some of these will provide some benefit traditional healers are quite sensitive and resentful of the disregard for their expertise. They do not have a record of malpractice that biomedicine has “I have delivered hundreds of babies and none has died in my hands”.⁷ In addition, when the doctors fail them patients turn to traditional healers; it is seldom the other way around.

Embedded in the unique belief systems developed by various peoples are questions about what health is, physical and mental illness, diagnosis, treatment and prevention. These systems are a cultural construct based on experience rather than the narrow definition of "science". Traditional and modern health systems are not dichotomous. They are both products of human knowledge and experience and each can learn form the other for the betterment of people’s health through mutual respect rather than integration.

Exploring the economic viability of herbal medicine

For the industrially disadvantaged but floristically rich countries like ours it is now time to develop more natural resources for addressing our people’s health needs. In the forests of the Southern Region alone (Stann Creek & Toledo Districts) medicinal plant extraction valued at $230,000 occurs annually.⁸

The relationship between the pharmaceutical companies, exporter, extractor and the healer is a sorry one. It is continued exploitation. A small group of people turning our lives upside down and they give us crumbs to participate in this scheme. The marketing of herbs for our own use would need documentation of the prevalent use of plant drugs in their countries, validation of their botanical sources scientific evaluation of their safety and efficacy standardisation of the methods of preparation of plant-based health care products and development of technologies for large scale production for their purified and semi-purified extracts.

We do not need to reinvent the wheel. Many of our Central American countries having the same flora have done research and have the technology that we need. Agencies such as Centro Agronomico Tropical de Investigacion y Ensenanza (CATIE) who by the way have established technical assistance arrangements with our Ministry of Agriculture and Fisheries have a wide database on herbal medicine. In their research Caracterizacion de los sectores asociados a la produccion, comercializacion y transformacion de plantas medicinales in Costa Rica (1994), they outlined the methods used to achieve what is now a viable industry. FARMAYA of Guatemala, Enda-Caribe based in Dominican Republic and the University of the West Indies Faculty of Agriculture are but a few of the resources available to us that we can tap into in order to advance this process.

A detailed diagrammatic scheme of steps required for drug development from plants is presented below.

The Methodology for the study of medicinal plants⁹

A feasibility study conducted as part of a regional effort to asses the entrepreneurial potential of medicinal plants showed that limitations on the production of medicinal plants are: lack of access to credit schemes for projects involving the use of natural resources, inadequate technical assistance and training prevented its development.¹⁰

There are implications for policy changes within many sectors (health, forestry, agriculture, education and trade) if the production of medicinal plants is to become an economically viable venture.

The mechanisms for exporting of medicinal plants are clearly defined and in place. The procedure for the export of flora is co-ordinated across relevant agencies:

• Export Permit for flora and fauna obtained from the Ministry of Natural Resources
• Scientific Wildlife Collection Permit from the Forestry Department. The permit holder agrees to pay $0.50 duty per plant before exporting, and there is a fee of $50 for the permit
• Phytosanitary certificates from the Ministry of Agriculture
• Customs Export Entry Form from the Custom’s Department (free)

The exporters of herbal medicine are limited to two: Agapi Herbs and Ix Chel Tropical Research. Involved in the extraction process are the traditional healer (practitioner), suppliers (collectors) and/or vendors. How much do they earn? How much does the exporter earn? The possibility of value added by providing training and processing technology would increase the margin of profit.

Conservation and Propagation of herbs

A 1998 assessment reported that over 600 of the 3,409 higher plants found in Belize have medicinal use. The issue of conservation of these species has been raised in several fora at the local and regional level. The IUCN and the Forest Department have identified the following herbs as threatened. Of importance are the efforts to include these species in the Wildlife Protection Act list of endangered species. Recommendations have been made to revise the procedure for obtaining a Permit to collect medicinal herbs to include specified volume/quantity of various species that can be extracted within an established quota system for threatened species. Only certified individuals would be able to collect these species. Certification would mean being trained in proper harvesting techniques, replanting etc.

The Terra Nova Forest Reserve established in the Yalbac area in north western Cayo District was an initiative for the conservation of medicinal plants. The original concept of Terra Nova was that it would be a medicinal plant reserve with emphasis on training for traditional healers, research and ecological tourism. The 2,825 hectares of land was the basis of a controversy, which highlighted: the level of foreign interest in medicinal plant in Belize; the unpreparedness of local practitioners to negotiate against the exploitation of indigenous knowledge; the absence of protection from government of our natural resource; mechanisms needed to be put in place and the sector had developed faster than the mechanisms required for equity.¹² Best Enterprise for Sustained Technology (BEST) is the most recent custodian of Terra Nova. In an extensive interview with Programme for Belize (PFB) my understanding is that they are now revisiting the concept. I would like to add here that I have always supported the concept of Medicinal Plant Reserves. Given the level of destruction done by Hurricane Iris in the Toledo District and the potential for that type of damage to occur elsewhere the establishment of Medicinal Plant Reserves throughout the country has become critical.

National Strategies for addressing the issue of Medicinal Plant conservation¹³

Belize became a signatory to the Convention on Biodiversity in 1992. The Belize Biodiversity Strategy and Action Plan 1998-2003 outlines a comprehensive list of objectives and actions to conserve and use sustainably Belize’s Biological Diversity. They address the issue of herbal medicine promotion, utilization and marketing in the following areas:

• Conservation Laws and Policy
• Human and Institutional Capacity for the conservation can sustainable use of medicinal plants
• Research and monitoring and sustainable use of medicinal plants
• Information management
• Community Participation
• Education and Public Awareness
• Institutional collaboration and coordination

Intellectual Property Rights Policies

How to resolve the dilemma of intellectual property rights (patent, marketing) various communal knowledge?

In 1996 under the Natural Resources Management Project (NARMAP) an initiative to determine the level of interest of foreign institutions and companies seeking to collaborate with local institutions in sustainable bio-prospecting was implemented.¹⁴ The task was to outline Intellectual Property Rights models for use of medicinal plants, financial mechanisms for returning benefits to local communities in order to contribute to conservation efforts. This initiative to set up mechanisms for the establishment of supporting policy framework, while admirable was late in the development of the sub-sector, since much extraction had occurred up to that time. Further it was aborted when the NARMAP project ended prematurely. Intellectual Property Rights are a major component of the Biodiversity Action Plan and preliminary discussions have begun.

Conclusion

Traditional medical practices meet central criteria of sustainability by virtue of their legitimacy as part of a community's indigenous health structure. Efforts to promote traditional health care in both developing and developed societies must begin by strengthening the pre-existing pathways of healing traditions in the target culture. The rich traditions of information specific to a community are held tenuously in a population of practitioners of whom we know relatively little. The mechanisms by which these traditions were once transmitted from generation to the next no longer exist due to systematic repression of traditional knowledge by colonial administrators, a breakdown of the apprenticeship system, modernization, acculturation and competition from western biomedicine.¹⁵

To ensure its continuity the practice of indigenous medicine must be placed into a larger cultural, economic and ecological context. To this end cultural organizations must advocate for the legitimacy of traditional medicine as a part of our cultural heritage. They must advocate for its inclusion in our health system. The ILO convention 169 speaks to this.

Economic viability would be promoted through cost recovery via the development of indigenous drugs. This strategy is consistent with efforts of UNICEF and WHO to promote the development and production of local pharmaceuticals and to import only essential drugs.¹⁶

The recognition of ownership and compensation through royalties would engender economic viability and promote the cooperation horizontally among indigenous practitioners and vertically among western practitioners. Reforestation practices to support biodiversity would ensure the supply of medicinal plants.

We must look beyond our borders for models and solutions. Our neighbours in Central America have done extensive research on their plant stock. Advances in technology for processing are also available. The Maroon Health Project in Accompong, Jamaica and the dual services available in the Nicaragua Health System¹⁷ are models of community empowerment through recognizing the value of its indigenous medical knowledge and developing it for treatment and income generation.¹⁸

The limitations and or constraints, which are faced by the traditional medicine, are mainly those that we have placed on ourselves.

The stimulus for conserving has come from outside. Are we not sufficiently interested in what is rightfully ours? Why are we not motivated to participate and advocate for the preservation of those aspects of our culture that is necessary for our survival? Projects come and go with their own agenda. We need to set our own agenda.

Yes colonialism has crippled our ability to perceive it as the health system that we need. Let us not be ignorant of our source. Let us instead do all we can to retrieve what is ours to use. We cannot afford to abandon the way or we will have a price to pay. We are accountable to our ancestors and to our children.

Our children are hope. Ayi Annah adds later in his Prologue in “Two Thousand Seasons”

Remember this: against all that destruction some yet remained among us unforgetful of origins, dreaming secret dreams, seeing secret visions, hearing secret voices of our purpose. Further: those yet to appear, to see, hear, to utter and to make — little do we know what changes they will come among.¹⁹

Endnotes

¹ Armah, Ayi Kwei, Two Thousand Seasons, Heinemann, Oxford, 1973.

² Sister Utrice Leed is a Trinidad born social activist and journalist.

³ “Study of the Ethno-botany of the Mayas of San Jose, Succotz in Belize Central America.”

⁴ Ellis, Lucia. Community Health Needs Assessment. Health Sector Reform Project, Ministry of Health, 1996.

⁵ Campbell, Keith & Michell, Andrew, Survey of Non-Timber Forest Products in Villages surrounding the Columbia River Forest Reserve. Forest Planning and Management Project, Belmopan, 1998.

¹⁹ Armah, Ayi Kwei, Two Thousand Seasons. Heinemann, Oxford, 1973.

© Lucia Ellis, 2003.

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