Indigenous Caribbean Network

Collaboration between Indigenous medicine men and women, and science

Collaboration between INdigenous medicine men and women, and science

1.) Mali, Africa

Researchers cooperate with ‘medicine men’

September 26, 2013 - 07:00

Pregnant women in Mali are dependent on medicine men and women, also called traditional practitioners (TPs) of folk medicine. Researchers are now collaborating with these healers to help improve their practice.

When pregnant or giving birth, women in African countries such as Mali must often rely on the help of healers, or traditional practitioners. (Photo: iStockphoto)

Approximately 75 percent of the population of West African countries rely on traditional plant medicines when they fall ill.

Healers, or TPs, play a key role in the primary health system of Mali’s 14 million inhabitants, including caring for women who are pregnant, giving birth or lactating.

Mali has only one doctor per 20,000 inhabitants. The risk of women dying during pregnancy or during the delivery of an infant is 100 times higher than in Norway.

What happens when TPs and healers have responsibility for treating pregnant women?

Master's degree students at the University of Oslo (UiO) and the Norwegian Institute of Public Health have joined the University of Bamako in interviewing 72 TPs or “medicine men” [although 64 percent of these healers were women] in Mali.

Treating 13 pregnancies per month

The researchers calculated that each TP or healer treated an average of 13 pregnant women per month. The ages of the TPs interviewed ranged from 34 to 90.

A traditional practitioner from Mali who cooperated with researchers from the University of Oslo (UiO). Men and women like him are the backbone of medical treatment in the country, so government health authorities want to bolster their skills with modern research. (Photo: Berit Smestad Paulsen)

“Our study indicates that healers and TPs play an important part in the health care of pregnant women in Mali,” says Pharmacology Professor Hedvig Nordeng of UiO.

The researchers found that TPs in Mali know quite a bit about pregnancies and deliveries. They treat common maladies associated with pregnancy as well as diseases such as malaria.

Nausea and births

Many of the pregnant women who seek help from PTs have problems with morning sickness ― nausea. The TPs generally agree on which plants should be used to treat nausea and dermatitis among pregnant women, Nordeng says.

The researchers also observed that pregnant women with malaria were generally treated with fever-reducing plant medicines.

They catalogued more than 40 different medical plants that were used, and also found that traditional practitioners in Mali know very little about the mental problems that can plague pregnant women.

“We asked the healers specifically if they knew of any treatment for depression in connection with a pregnancy or birth,” says Nordeng.

Mali is the first country in Africa to establish an official quality control system for healers and traditional practitioners. To get certified, TPs have to demonstrate the ability to heal a certain number of patients. (Photo: Berit Smestad Paulsen)

This was a difficult subject. Most of the healers did not know about any medicinal plants that could be used for these kinds of ailments.

The researchers attribute this to the fact that it is taboo to talk about depression in many African cultures. The professor in pharmacology thinks mental health ought to get more attention in Mali.

Safer use of plants

Many TPs use the plant Cola cordifolia in difficult deliveries, because it is believed to help ease the birth.

“The healers often take special precautions when treating pregnant women. They said they refrain from using the strongest parts of certain plants. They also avoided the use of plant parts that taste bitter, because they thought this could lead to uterus contractions and a spontaneous abortion.”

Nordeng says that pharmacological studies have documented that many bitter plants contain high concentrations of alkaloids. Thus, there is scientific support for avoiding these compounds during pregnancy. 

Now the researchers want to interview women in Mali about their attitudes and habits regarding plant medicines and pregnancies. The researchers hope to contribute to the safe use of medicinal plants during the birthing process, or afterwards, when women are breastfeeding.

The healers have main responsibility
Hedvig Nordeng is a professor at the School of Pharmacy at UiO and a researcher at the Norwegian Institute of Public Health’s Division of Mental Health. (Photo: UiO)

Professor Berit Smestad Paulsen of UiO’s Department of Pharmaceutical Chemistry was the first to initiate contact with Mali’s health officials and has played a key role in the project.

Paulsen says healers definitely have the main responsibility for health in countries like Mali.

“This is simply because there are no doctors available for most people.”

“The Mali authorities have created an official quality control system for healers, and are the first country in Africa to do so. Healers cannot be issued a certificate without demonstrating their ability to heal a certain number of people.”

Paulsen thinks this system could serve as a model for other African countries. She has received an EU research grant to continue collaboration with Mali health officials and will initiate similar projects in Uganda and South Africa.

Cheaper medicines

The National Institute of Public Health in Mali has opened a department of traditional medicine. One of the major priorities of the authorities is to bolster knowledge of folk medicine.

Berit Smestad Paulsen is a professor at the Department of Pharmaceutical Chemistry at UiO. (Photo: UiO)

They want to ensure the public gets the best traditional medicines available.

“Traditional medicines are also cheaper than Western medicines,” Paulsen points out.

She has worked with her colleagues in Norway and Mali on laboratory studies to determine the chemical effects of the plants that are used.

Researchers and other partners from Mali will use this information to develop local medicinal products, which will then be made available in the country’s pharmacies.

Four students from Mali have earned their doctorates in pharmacology at the University of Oslo. They are now involved in the study of traditional medicinal plants in their home country.

2.) South West United States Indigenous people.

ELENA AVILA, a psychiatric nurse, donned a headband to join a ceremonial procession with Mayan healers in colorful embroidered dresses and Aztec dancers wearing brightly feathered headdresses.

The procession opened the 12th International Congress of Traditional and Indigenous Medicine here last month, where conventional medicine intersected, sometimes awkwardly, with alternative forms of treatment.

''I practice medicine and spiritual healing simultaneously,'' said Ms. Avila, who treats patients privately and works with doctors. She earned a master's degree in psychiatric nursing at the University of Texas at El Paso, and has called herself a ''curandera,'' Spanish for healer, for the past 20 years.

In the Southwest, this combination is not unusual. Hispanic people and American Indians, who respectively make up 38 percent and 9 percent of the population of New Mexico, often rely on a heritage of herbs, spiritual healing and other folk practices.

In cities like Albuquerque, some pharmacies devote shelves to Hispanic medicinal herbs, and doctors are accustomed to patients' using traditional therapies, like Native American healing ceremonies. In some remote communities, traditional medicine may be the only kind available.

But the use of traditional medicine is not always a function of lack of access to regular health care, said Kim Kinsey, the program manager of primary care planning in rural health programs for New Mexico. For many, it is an alternative. ''People may choose Western medicine,'' Ms. Kinsey said.

''They may also choose to see the curandera or medicine people at the same time,'' she said, referring to traditional Hispanic and Native American healers.

Ms. Kinsey said that the Indian Health Service, for instance, sets aside rooms in its hospitals for medicine people to see patients along with a Western doctor.

According to a report in Archives of Family Medicine in March, 38 percent of patients surveyed at an Indian Health Service clinic in Milwaukee said they had seen a healer and 86 percent said they would consider seeing one.

The weeklong meeting, at the University of New Mexico, coincided with evidence of increasing public interest in complementary medicine, therapies that lie outside the realm of conventional, mainstream medicine.

A report published this month in The Journal of the American Medical Association showed that one in three American adults uses complementary therapies, like chiropractic, acupuncture, homeopathy, herbs and folk remedies.

The report also said that more than half the nation's medical schools offer courses in alternative medical practices, and patients are looking for doctors familiar with complementary as well as mainstream medicine.

''My patients come in with their own remedies, from a community healer or organized or nonorganized traditional healing,'' said Dr. Christopher Urbina, vice chairman of the Department of Family Practice and Community Medicine at the University of New Mexico's School of Medicine.

The remedies brought to Dr. Urbina by his patients include a mixture of alcohol and avocado seeds that patients rub over their joints and poultices, usually of aloe vera and other herbs, for skin conditions.

Traditional medicine was part of Dr. Urbina's own childhood. ''I grew up in a Mexican-American family,'' he said. ''My mother gave me multiple remedies when I was growing up. We always did things before we went to the physician.'' He recalled remedies from the ordinary (drinking chamomile tea to settle the stomach) to the strange (placing sliced potatoes on the head to alleviate fever).

At the medical school, traditional and other alternative therapies are integrated into the curriculum in the context of patient care, in classes and in grand rounds, Dr. Urbina said. Students can attend seminars with alternative healers to develop sensitivity to cultural beliefs of various populations, and patients who ask for healers or traditional therapies are supported, he said.

But patients who avoid conventional medicine can find themselves in trouble. Dr. Jeffrey Sollins, an Albuquerque internist who supplements conventional medicine with complementary therapies, said that patients who used unproved alternative treatments exclusively were taking serious risks.

Dr. Sollins cited the example of parents who reject conventional medicine and refuse to have their children vaccinated. They are putting their children at risk for serious, avoidable diseases, said Dr. Sollins, who is director of an organization called Bridges in Medicine Health Care Inc.

But he added that ''the indigenous practitioners I've met often recognize when they're past their limit.''

As increasing numbers of scientists explore the effectiveness of alternative therapies, doctors may begin to feel more comfortable discussing them with their patients and finding ways of incorporating them into their practices.

Dr. Helmut Wiedenfeld, a chemist at the University of Bonn in Germany, described his research with traditional healers and diabetes in rural Mexico. The World Health Organization estimates that 8 percent of Mexico's population will have Type 2 diabetes by 2005 and this sometimes deadly disease is rampant among Mexican Indians. (In the United States, the rate of Type 2 diabetes among Indians is more than double that of the general population.) A high fat and carbohydrate diet plays a part, and although most rural areas of Mexico are far from fast food outlets, virtually every village has a stand that sells sugary soft drinks, Dr. Wiedenfeld said.

His field work in three Indian villages in Mexico left Dr. Wiedenfeld with considerable respect for traditional healers. Even without the training or equipment to detect levels of blood glucose, the healers could identify the classic symptoms of diabetes, and they treated the disease with an herbal tea brewed from ''cola de caballo'' (equisetum myriochaetum), he said.

In field trials, Dr. Wiedenfeld and his colleagues found that the herbal tea helped stabilize blood sugar levels in female patients who took part in a study.

Dr. Wiedenfeld believes that both the successes and failures of alternative medicine can be quantified.

And, Dr. Urbina added, ''How we live our lives is a balance between the scientific evidence, our understanding of the evidence and our own cultural beliefs,'' he said.

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