Overview on Medicinal
Plants and Local
Communities in Africa
TRADITIONAL HERBAL AND PUBLIC HEALTH
In all countries of the world
there exists traditional knowledge related to the
health of
humans and animals. According
to WHO the definition of traditional medicine may be summarized as the sum
total of all the knowledge and practical, whether explicable or not, used in
the diagnosis, prevention and elimination of physical, mental or social
imbalance and relying exclusively on practical experience and observation
handed down from generation to generation, whether verbally or in writing.
Traditional medicine might also be considered as a solid amalgamation of
dynamic medical known-how and ancestral experience.
The interest in traditional
knowledge is more and more widely recognised in development policies, the media
and scientific literature. In Africa,
traditional healers and remedies made from plants play an important role in the
health of millions of people. The
relative ratios of traditional practitioners and university trained doctors in
relation to the whole population in African countries are revealing. In Ghana,
for example, in Kwahu district, for every traditional practitioner there are
224 people, against one university trained doctor for nearly 21,000
people. The same applies to Swaziland where
the ratios are for every traditional healer there are 110 people while for
every university trained doctor there are 10,000 people.
In the past, modern science has considered
methods of traditional knowledge as primitive and during the colonial era
traditional medical practices were often declared as illegal by the colonial
authorities. Consequently doctors and
health personnel have in most cases continued to shun traditional practitioners
despite their contribution to meeting the basic health needs of the population,
especially the rural people in developing countries. However, recent progress in the fields of
environmental sciences, immunology, medical botany and pharmacognosy have led
researchers to appreciate in a new way the precise descriptive capacity and
rationality of various traditional taxonomies as well as the effectiveness of
the treatments employed. Developing
countries have begun to realise that their current health systems are dependent
upon technologies and imported medicine that end up being expensive and whose
supply is erratic.
Relegated
for a long time to a marginal place in the health planning of developing
countries, traditional medicine or more appropriately, traditional systems of
health care, have undergone a major revival in the last twenty years. Every region has had, at one time in its
history, a form of traditional medicine. We can therefore talk of Chinese
traditional medicine, Arabic traditional medicine or African traditional
medicine. This medicine is traditional
because it is deeply rooted in a specific socio-cultural context which varies
from one community to another. Each
community has its own particular approach to health and disease even at the
level of ethno-pathogenic perceptions of diseases and therapeutic
behaviour. In this respect, we can argue
that there are as many traditional medicines as there are communities. This gives traditional medicine its diverse
and pluralist nature.
Traditional
medicine has been described by the World Health Organisation (WHO) as one of
the surest means to achieve total health care coverage of the world's
population. In spite of the
marginalisation of traditional medicine practised in the past, the attention
currently given by governments to widespread health care application has given
a new drive to research, investments and design of programmes in this field in
several developing countries.
Most
developing countries are endowed with vast resources of medicinal and
aromatic plants. These plants have been used over the millennia for human
welfare in between man and his
environment continues even today as a large
proportion of people in developing countries still live in rural areas.
Furthermore, these people
are precluded from the luxury of
access to modern
therapy,
mainly for economic reasons.
The
demands of the majority of the people in developing countries for
Medicinal plants have been met by indiscriminate harvesting of
spontaneous
flora
including those in forests. As a result many plant species have become
extinct
and some are endangered. It is therefore necessary that systematic
cultivation of medicinal plants
be introduced in order to conserve biodiversity
and protect threatened species.
Systematic cultivation of these plants could only be initiated if there is a continuous
demand for the raw materials.
Numerous
medicines have been derived from the knowledge of tropical forest people and
clearly there will be more in the future. This alone is reason enough for any
and all programmes to be concerned with the conservation, development, and
protection of tropical forest regions. Human needs and problems are a primary
component of any conservation program. This focus on human needs requires
assessing the importance of regional forests in traditional systems of
medicine, and it also requires provisions that allow for any activities to have
minimal negative impact on the accessibility to these medical resources.
Conversely, any and all activities that seek to develop natural products from
these regions need to incorporate explicit reciprocal benefit programs in early
phases of their planning for the people and places from which the products
come. It is clear that our global interdependence is increasing every day, and
one of our primary commitments to maintaining biological diversity in the
tropics requires acknowledging the value of indigenous knowledge and the
importance of traditional medicine to people throughout the tropics.
Concomitant to this commitment is a dedication to returning benefits to
rain-forest-dwelling peoples, to establishing new models of reciprocity, and to
creating models for the sustainable harvesting.
The
documentation of medicinal uses of African plants is becoming increasingly
urgent because of the rapid loss of the natural habitat for some of these
plants due to anthropogenic activities. The continent is estimated to have
about 216,634,00 ha. of closed forest areas and with a calculated annual loss
of about 1% due to deforestation, many of the medicinal plants and other
genetic materials become extinct before they are even documented. Africa has
one of the highest rates of deforestation in the world; for example, Côte
d'Ivoire and Nigeria have 6.5% and 5.0% deforestation per year, respectively,
as against a global rate of 0.6%. Habitat conversion threatens not only the
loss of plant resources but also traditional community life, cultural
diversity, and the accompanying knowledge of the medicinal value of several
endemic species. A majority of the plants found in Africa are endemic to that
continent, the Republic of Malagasy having the highest rate of endemism (82%).
Undoubtedly, medicinal plants and the drugs derived from them constitute great
economic and strategic value for the African continent.
Although the main consumers of
medicinal plants in Africa have been, until
recently, the local population, the field has started to attract a
number of local and
foreign researchers (as during the second
world war) who have discovered the value of
traditional healing. The first undertakings done in this field in Africa
were undoubtedly of
ethno-botanical nature, but since then the fields of study have expanded to
include pharmacology, phytochemistry, chemistry of natural products, organic
synthesis and the usefulness of medicinal and aromatic plants.
Africa
has a long and impressive list of medicinal plants based on local knowledge. Securidaca
Longepedunculata is a tropical plant found almost everywhere in Africa. The
dried bark and root are used in Tanzania as a purgative for nervous system
disorders. One cup of root decoction is administered daily for two weeks.
Throughout East Africa, the plant's dried leaves are used for wounds and sores,
coughs, venereal disease, and snakebite. In Malawi, the leaves are used for
wounds, coughs, bilharzia, venereal disease, and snakebite. The dried leaves in
Malawi cure headaches. The dried leaves act on skin diseases in Nigeria. According to one pharmaceutical researcher,
the root is used in "Bechuanaland" and "Rhodesia" for
malaria while the same part of the plant is used for impotence in "Tanganyika".
Meanwhile, in Angola, the dried root is used as both a fish poison and (in
botanical testimony to the power of love) as an aphrodisiac. The same dried
roots have religious significance in Guinea-Bissau and are understood to have a
psychotropic effect. The root bark is used for epilepsy in Ghana.
The
international pharmaceutical industry in less-industrialised countries has
started developing interest in medicinal plants. The pharmaceutical industry has come to
consider traditional medicine as a source for identification of bio-active
agents that can to be used in the preparation of synthetic medicine. However, they are not looking to study the
rare plant species; they want to test the most commonly-used species. The valuable medicinal plants are those with
the longest track record in the most locations.
Many of the more pharmacologically (commercially) interesting medicinal
plant species in use around the world are employed in more than one community,
and often in more than one country, for multiple uses.
The
natural products industry in Europe and the United States is equally interested
in traditional medicine. In Europe and
in America where the phytomedicine industry is thriving, extracts from
medicinal plants are sold in a purified form for the treatment and prevention
of all kinds of diseases. The sales of
this industry will exceed two billion dollars in the United States in 1996. We
are at a stage where traditional medicine is considered more for its capacity
to generate other medicine than for its own sake.
Research
undertakings and the commercial use stemming from that research have always
relied on information provided by the local communities that, in many cases,
have hardly benefited from the research results. Non-governmental and community-based
organisations can promote strategies that include indigenous knowledge in
natural resource management, and ensure that benefits flow to communities they
represent. The existing literature only
superficially mentions the importance of these communities participating in the
development process and especially in the management of natural resources, and
does not show how this goal can be achieved.
In the past decade there has been much rhetoric on the involvement of
local communities in the implementation of bio-diversity conservation projects.
Nevertheless, some projects have
continued to treat local communities as passive beneficiaries and have not
involved them in project activities and thereby not allowed them to fully
participate in their own development. As
a result, the beneficiaries of these projects often do not assume ownership or
become involved as planned in the project activities. It is therefore important to ask what
participation involves; under that conditions
local participation should take place; who should be involved, how and at what
level. The proposed research project
aims to fill this gap.
The
majority of African countries are currently geared towards the privatisation of
State corporations and government services.
This includes the privatisation of large hospitals where goals of
financial independence have precluded the dispensation of free care and free
medicine. Analysis of various national
policies related to public health and medicinal plants usage has highlighted
some important issues. Among them is the
failure to meet basic health conditions due mainly to the following factors:
inadequate decentralisation of health services; isolation of some rural
communities; and persistence of traditional beliefs regarding pathology. This has led to under-utilisation of
available services in health centres and high cost of services provided by
hospitals in relation to the income of the rural population. Another issue that can be singled out is the
absence of local pharmaceutical production.
Purchase of pharmaceutical imports leads to a heavy loss of foreign
currency, which a development policy focused on available local resources
(mainly medicinal plants) would otherwise have prevented.
In
order to solve the problem in part, many health-oriented ministries are now
encouraging the use of local medicinal plants.
Certain countries have established departments of traditional
pharmacopoeia within these ministries so as to implement this policy. Education ministries have started to
introduce conservation of bio-diversity into their school programmes. The recent establishment of the Ministries of
Environmental and Natural Resources and Offices of Protected Areas and National
Parks in various countries also demonstrates the political will of African
governments towards the conservation of nature and the sustainable use of
bio-diversity.
Many
plants are used for their therapeutic values and this has a twofold effect on the worlds flora. On one hand, the demand for herbs, particularly in parts of Africa, has
brought some plants near extinction. Even the
simplest plant may have a future importance that we cannot predict. Efforts
to develop drugs from medicinal plants should address diseases and health problems seen in developing
countries as well as diseases which primarily
affect developed countries' population.
Saving the world's plant
resources calls for more protection and management, more research, and an increasing level of public awareness
about our vanishing heritage.
Indigenous
and local communities are concerned that the rate of knowledge erosion has never been so high as it
is in the current generation, and that such knowledge
erosion poses an even more serious threat to the conservation of biological diversity than resource
erosion. There is, therefore, an urgent
need to formulate an array of
incentive measures to ensure that members of the younger generations will want to learn, value, adapt and apply
the traditional knowledge,
innovations and practices of their elders.
Within
the framework of the management and conservation of biological diversity, it is
worthwhile noting that at the African level, no exhaustive plan of control and
evaluation of the resources of medicinal plants has yet been proposed.
The
current trend of government policy in African countries to charge for health
care shows the inability of governments to ensure provision of quality services
at an affordable price to everyone and especially to the most vulnerable
groups.
The women healers generally have
specialised knowledge of medicine used during prenatal and post-natal delivery
for the care of women and children. In
urban areas, women healers still make use of traditional medicine to
meet primary health needs or who depend on the provision of these services or
the sale of products from medicinal plants for their livelihood. In the rural
areas, one sometimes travels for several days before finding the nearest
dispensary and pharmacy. In addition to
losing working days, transport fares and the high cost of medicine must also be
taken into consideration. In the past
few years, most developing countries, recognising that they did not have the
means to provide comprehensive health care like some industrialised countries,
have started to become more interested in traditional remedies.
The
lack of health care systems in rural areas forces local people to treat
themselves, either by using medicinal plants or by buying high-cost medicine in
the rural markets. In the rural areas,
as a whole, people begin by treating themselves before going to a traditional
practitioner or a modern doctor.
Medicinal plants are used at an early stage of the disease at low cost
and conveniently replace the indiscriminate consumption of drugs without
prescription. In urban circles, women
healers living in poor suburbs resort to traditional medicine to meet their
primary health care needs or to gain income from the provision of traditional
services or from the sale of products extracted from medicinal plants.
The role of traditional medical practitioners.
The practitioners of traditional medicine specialize
in particular areas of their profession, in the same way as orthodox medical
practitioners. Thus we find some traditional medical practitioners who are
experts in the use of herbs (herbalist), others who are proficient in spiritual
healing, especially the use of incantations, while still others combine both.
There are also traditional bonesetters and birth attendants.
In contrast with western medicine, which is
technically and analytically base, traditional African medicine takes a
holistic approach: good health, disease, success or misfortune are not seen as
chance occurrences but are believed to arise from the actions of individuals
and ancestral spirits according to the balance or imbalance between the
individual and the social environment (Anyinam, 1987; Hedberg et al., 1982;
Ngubane, 1987; Staugard, 1985; WHO, 1977). Traditionally, rural African
communities have relied upon the spiritual and practical skills of the TMPs
(traditional medicinal practitioners), whose botanical knowledge of plant species
and their ecology and scarcity are invaluable. Throughout Africa, the gathering
of medicinal plants was traditionally restricted to TMPs or to their trainees
Photo 1). Knowledge of many species was limited to this group through spiritual
calling, ritual, religious controls and, in southern Africa, the use of
alternative (hlonipha) names no known to outsiders.
It is estimated
that that the number of
traditional practitioners in Tanzania was
30 000 - 40 000 in comparison with 600 medical doctors (Table 1) (MP and
TMP : total population ratios were not given). Similary, in Malawi, there were
an estimated 17 000 TMPs and only 35 medical doctors in practice in the country
(Anon., 1987).
For this reason, there is a need to involve TMPs in national
healthcare systems through training and evaluation of effective remedies, as
they are a large and influential group in primary healthcare (Akerele, 1987;
Anyinam, 1987; Good, 1987). Sustainable use of the major resource base of TMPs
- medicinal plants - is therefore essential.
It is important to note that
even in contemporary rural Africa, there is no doubt about the efficacy of
herbal medicine. Many Africans, especially rural people and the urban poor,
rely on the use of herbal medicine when they are ill. In fact, many rural
communities in Africa still have areas where traditional herbal medicine is the
major and in some cases the only source of health care available. Thus there
can be no doubt about the acceptability and efficacy of herbal remedy within
African society.
However, in many oriental
countries, traditional medicine is officially recognized. China, for example,
is able to provide adequate and constantly improving health care coverage for
its vast urban and rural population precisely because it harnesses the precious
legacy of traditional medicine (Aregbeyen, 1983; Bodeker, 1994). Consequently,
the inability of most African countries to develop their own legacy of
traditional medicine, because it is denied official recognition, is partly
responsible for the current health care crisis in Africa.
TABLE 1.
HOW THE WESTERN
MEDICAL SYSTEM HAS FAILED IN AFRICA
|
·
Facilities are inaccessible for much of the
population. In some urban areas the
average waiting time at a hospital or clinic can be as much as 8 hrs.
·
The staff are poorly trained and
unmotivated. Many staff members
believing they hold superior knowledge, treat patients inconsiderately.
·
Patients are frequently not told the nature and
cause of their illness.
·
There are inadequate technical services leading
to poor quality care.
·
The treatment costs too much, even for state run
hospitals and clinics.
·
Governments spend a large proportion of the Per
Capita gross national product on western health care.
·
Treatment is divorced from the patient's culture,
family and community. Patients are
removed from the family and community, stripped of their identity and forced
into a sterile hospital setting.
·
The treatment only addresses a patient's
biological manifestation of the illness and does not attempt to heal
spiritual aspects of illness.
(adapted from
Lashari 1984:175 - 177, Ojanuga 1981:407 - 410 and Yangni-Angate 1981:240 -
244)
|
Debie LeBeau (1998)
Table 1: Some medicines of plant origin currently used
in modern therapeutics
|
Drug
|
Plant
|
|
Atropine
|
Atropa belladonna
|
|
|
Duboisia
myoporoides
|
|
Ajmaline
|
Rauwolfia vomitoria
|
|
|
Rauwofia serpentina
|
|
Cocaine
|
Erythroxylum coca
|
|
L.Dopa
|
Mucuna deeringiana
|
|
Digitoxin
|
Digitalis lanata
|
|
Emetine
|
Cephaelis ipecacuanha
|
|
Ephedrine
|
Ephedra sppl
|
|
Forskolin
|
Coleus forskohlii
|
|
Hyoscyamine
|
Datura sppl
|
|
|
Hyoscyamus muticus
|
|
Menthol
|
Mentha spp.
|
|
Morphine
|
Papaver spp.
|
|
Ouabain
|
Strophanthus gratus
|
|
Papain
|
Carica papaya
|
|
Physostigmine
|
Physostigma venenosum
|
|
Picrotoxin
|
Anamirta cocculus
|
|
Pilocarpine
|
Pilocarpus jaborandi
|
|
Quinine
|
Cinchona spp.
|
|
Quinidine
|
Cinchona spp.
|
|
Reserpine
|
Rauwolfia serpentina
|
|
Scopolamine
|
Datura metel
|
|
|
Hyoscyamus niger
|
|
Theobromine
|
Theobroma cacao
|
|
Theophylline
|
Theobroma cacao
|
|
D-Tubocurarine
|
Strychnos sppl
|
|
|
Chododendron spp.
|
|
Vincamine
|
Vinca minor
|
|
Vinblastine
|
Catharanthus roseus
|
|
Vincristine
|
Catharanthus roseus
|
|
Yohimbine
|
Pausinystalia yohimbe
|
Prof. Charles Wambebe
(1998)
Medicinal Plants Used by
the Majority of the population and
frequently
cited by most of traditional healers in Tanzania
Plant Part
used Uses
1. Cassis didymobotria L. Leaves Anemia, Athlemintic, laxative
2. Ficus stulhmanii Walp. Stem bark Treats chronic wounds
3. Harrisonia abysinica Oliv. Roots Bilharzia,
chronic wounds
4. Terminalia serica Burch. Roots Diarrhea, vomiting, stomach problems
5. Securidaca longipenduculata Roots Treats
infertility in both men and women
6. Euphporbia quadrangularis Arial parts General body weakness
Pax.
7. Entada abyssinica Steud. Root bark Chronic cough, headache, stomach pains
8. Albizia vesicolor Welw. Root bark Anemia, Athlemintic, sterility in women
9. Strychino heterodoxa Gilg. Roots Inflammations
and fevers
10. Gnidia kraussiana Tuber Constipation, swollen stomach
Dr.CharlesM.Nshimo
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