PARTICIPATORY RESEARCH AND INVOLVEMENT OF LOCAL COMMUNITIES AND TRADITIONAL HEALERS: POTENTIAL BENEFITS AND PITFALLS.

PARTICIPATORY RESEARCH AND INVOLVEMENT OF LOCAL COMMUNITIES AND TRADITIONAL HEALERS: POTENTIAL BENEFITS AND PITFALLS.


Dr. Hellen A. Oketch



GREEN AFRICA NETWORK (Global Renewable Energy and Environmental Conservation Network-Africa

P.O. 58396, Nairobi, KENYA

TEL:254-02-717510

heoketch@africaonline.co.ke





PARTICIPATORY RESEARCH AND INVOLVEMENT OF LOCAL COMMUNITIES AND TRADITIONAL HEALERS: POTENTIAL BENEFITS AND PITFALLS



Abstract



This paper draws upon the experience that GREEN Africa has had in developing a project proposal "Ethnomedicine research, development and demonstration in Rachuonyo District, Western Kenya" and in implementing this project.



The project was conceived in the context of developing a traditional medicinal database comprising the most popularly used traditional medicinal preparations. At the same time the project was intended to re-interest the community in traditional medicines in the hope that they would then appreciate the value of this important healthcare system that is closely available to them.



The project was planned with four main objectives. First was to document the flora and fauna used in ethnomedicine practices and second to pharmacologically evaluate the claimed activities as a means of assessing the efficacy of these traditional drugs and their potential toxicity. It is reasonable to assume that the traditional mode of drug preparation and administration were considered of importance.



The third objective was to document the traditional methods by which the community ensured/ensures a continued supply of the resource materials. The fourth, and perhaps the most important, was to re-popularize the use of popular traditional medicines which we believe could contribute immensely in primary healthcare in a rural area like Rachuonyo. At the time of writing this article the project is still ongoing. During the workshop we will share some of the experiences we have had up to this point as we are implementing the project.



INTRODUCTION



In the beginning all drugs were natural-animal, vegetable and mineral. Primitive people not only discovered that cinchona bark cured intermittent fevers, but they also found out that chewing coca leaves numbed the tongue and reduced the appetite, that feeding ergotized grain to pregnant animals caused those animals to abort, that chewing tea leaves or drinking an aqueous preparation made from the same kept one awake, and that swallowing the latex from unripe capsules of the opium poppy allayed pain. These examples could go on and on because early people were intensely curious, and millions of trials complemented by frequent serendipity revealed many plants useful in treating diseases.



The World Health Organization (WHO) estimates, today, indicate that up to 80% of the World population, mostly in the developing countries, rely on traditional medicine practices for their healthcare needs. In Kenya it has become apparent that a sizeable section of the population still rely solely on traditional medicines for cure. This situation is strengthened by the rising costs in Kenya's formal healthcare system which has rendered a majority of the population incapable of meeting these costs. Indeed in the rural areas most people visit the hospitals and veterinarians only when remedies from their local physicians fail. Most medicines dispensed by such traditional healers are prepared primarily from plant and animal parts and are currently in great demand. Unfortunately the negative attitudes which developed in recent times have led to fewer individuals entering the profession of traditional medicine practice and consequently, mostly of the indigenous knowledge on useful medicinal plants and animals which took years to gather is gradually being lost. This is exacerbated by the reality that few formal studies and research activities have been undertaken to safeguard both the indigenous knowledge and the medicinals involved. In addition it is now apparent that the way these plants are harvested and regenerated will greatly determine their availability in the future.



The main goal of this project is to assist the communities in southern Nyanza Districts in Kenya to make the best possible use of their knowledge and practices relating to traditional medicine and the local medicinal plants. In addition by removing negative attitudes and stereotypes we hope to inculcate positive attitudes and values for these resources and consequently create an interest to ensure their survival for the future generations. In this way we hope to facilitate their conservation.



The specific objectives thus included:



Firstly documentation of the flora and fauna used in ethnomedicine practices and secondly pharmacological evaluation of the claimed activities as a means of assessing the efficacy of these drugs and their potential toxicity. It is reasonable to assume that the traditional mode of drug preparation includes basic rules of manipulation of ingredients that lead to the liberation, or concentration of the active ingredients, therefore the modes of drug preparation and adminstration are considered of great importance during documentation.



The ultimate goal is to make recommendations to the people on the efficacy and safety of these ethnomedicinals. The implementation of such recommendations will provide the underprivileged population with a safe alternative to primary health care through the use of indigenous medicinals for therapy.



The third objective is to document the traditional methods by which the community ensures a continued supply of the medicinal resource materials. This information will be used in formulating strategies for activities to be undertaken to conserve these resources in addition to the planned medicinal plants garden.



The fourth, and perhaps the most important, was to re-popularise the use of traditional medicines which we believe could contribute immensely in primary healthcare in a rural area like Rachuonyo, by setting foundations for an informed decision on using medicinal plants for therapy.



The project is currently ongoing and so far we have only partially accomplished the first objective.



Several practising herbalists and community members have been interviewed. Some of the herbalists interviewed also market their products at the local market in Oyugis town council and were visited both at their working stations and in their homes.



COMMENTS



The field study established a lot of similarity in the uses of plants from one herbalist to another, although the method of preparation differed in some of the cases.



Some of the plants e.g "Akech" are now very rare and the herbalists thus have to make long journeys even up to the neighbouring Country, Tanzania, to get the plant. Because the medicine is very bitter it is referred to as "quinine" in vernacular. Whether it contains compounds similar to quinine would be worth investigating.



Most of the medicines are prepared as a mixture of two or more plants and in most cases the dosage regimen is not well defined.



PROJECT PLANNING



During the project planning we mapped out the area of operation (as shown on the map).

This covers Rachuonyo District.



* We established contact with the local administration: visited the DC, DO, District Education Office and two primary schools where we already had contact and the District Hospital (Oyugis District).



* Response: Most people were positive about the project and were very willing to participate. The administration was supportive. The DC even requested us to try and find out for him during our research, why the response from the local women groups in Development projects, especially in contributing to the then Women's fund was poor.

* Indeed our idea was well received.



* We asked the people what their immediate needs were. Their answer was, for most, to be able to get some form of income generating activity. They sited the case of a development project in a nearby institution, AMANI- a Christian community self-help organization as a model of an organization that would help them. We had thus to discuss our ideas with a number of people. Interestingly the most enthusiastic to join were women! One would wonder whether this is because the team leader in this project is a lady?



* All these discussion were made possible because we have a representative permanently at the rural GAN's station in Rachuonyo District, who identified the interviewees and made arrangements for us to meet with them while there. It took several visits to establish proper communication with these people.



IMPLEMENTATION:



Tools for implementing the project: The main tool is a questionnaire, which is composed mainly of open ended questions. Although response from such questionnaires are much more difficult to analyze than in the case of closed questions, it was felt that the responses from the former type of questionnaires would be more objective that the latter. Such questions enable interviewees to respond more openly and sincerely since their answers are not limited in any way.



Practicing herbalists and people identified by the grassroots coordinator to be knowledgeable in traditional medicine were interviewed.



Where it was possible to go to the forest or location where the plant is usually collected and physically see the plants in their natural habitats, this was done and voucher specimens were also collected (plant specimen showing the important identifying features e.g. leaves, flowers, fruits, were collected and properly prepared as herbarium specimens to be kept at the Herbarium in Botany Department at the University of Nairobi for future reference).



Where it was not possible to see the live plants, samples of available dry material were collected in addition to all the other data in the hope that in future live samples can be collected.



In addition to voucher specimens small samples of plant material was collected, shade dried or sun dried as appropriate for validation later.



Much of the work done has also been documented in photographs and in cases where the interviewers consented the conversation was taped.



EVALUATION: Main constraints/problems encountered and needs constraints/problems.



* Lack of Trust: quite a number of people we talked to indicated they had dealt with researchers like us before, but the information they gave never benefited them. They said people came, often accompanied by foreigners, and asked for information on medicinal plants which they gave and such people never went back to see them again. They felt cheated and robbed of their knowledge. It was a task to convince them that our case would be different. Their only consolation was that we are people they can trace and they felt we were therefore genuinely interested in their needs.



THERE IS A SAYING THAT TRUST IS LIKE A TREE, THE SEED HAS TO BE SOWN AND THE SEEDLING NURTURED IN ORDER TO GROW INTO A TREE. Indeed this is to a greater extent true. We have now sown the seeds and are nurturing the seedlings very carefully lest it be said, "did we not tell you they are not any different from those who came before them". We have actually managed to "win" sufficient trust to operate on mainly because among our team there is a clinical officer from Oyugis Hospital and two primary school teachers. These are people in whom the community have great trust. So for the moment we are riding on their backs. What is most necessary as we have learnt is consistency. Simple things like photographs taken need to be shown to the people and for those who may require copies, these should be provided. We are keeping these photographs at the GAN field station for those who would like to see them.



Monetary gain: for some our project was viewed as a potential source of income. A saviour to help them rise from their poverty. It was not very easy to explain that we really had no money to give and that we are more interested in improving their quality of life with the resources locally available to them. Some people even revealed that there had been commercial collectors to the area who collected Catharanthus roseus, whole plants (mafua) and Carissa edulis roots (Ochuoga) and paid them for their efforts. The argument they put forward is that since these materials are fairly abundant and they are not using all of them right now, why not make money with them? This indeed is logical. However, the question is: to what extend can they exploit these resources in this way without eventually completely totally decimating the species? We are still working to convince them that it would be better to plant these species and exploit the planted ones for commercial purposes.



We had to convince these people that we are actually interested in improving the living conditions back in the village because we had an interest for future purposes. After all, after retirement we will go to live there. Thus we started a Community Development Center - which is also GAN's office. We found it necessary to give a tangible sign of commitment at the community level.



Incorrect Information: It became apparent that if people felt that one had money to offer they can give wrong information in order to be paid. This is mainly so in cases of herbalists who have become commercial i.e. sell their goods for a living. The income for such people apparently is quite good as they make between ksh.300-1000 pd (U$5-17) at Oyugis market the upper limit being realized on market days.



Cross check information given by several people both practicing herbalists and other community members. One can also get to know from the community who is the reliable herbalist.



*No exact translation for some of the information obtained in mother tongue.



NEEDS



* Funds for travel, station operation and small equipment.

* Device a method of building rapport with the community and have them benefit e.g by providing health services two days in a week during which consultation and drugs can be provided free. After all the whole project revolves around attempting to improve the community's health using resources available to them.



REFERENCES



1. WHO. Tropical Disease Research, Progress 1987-88. Ninth Progress Report of the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). WHO: 1990a; Geneva, pp. 14-15.



2. Kokwaro, J.O. 1993, Medicinal Plants of East Africa. East Africa Literature Bureau, Nairobi.



3. Sindiga I., Nyaigotti-Chacha, C. and Kanunah, 1995. Traditional Medicine in Africa. M.P., East African Educational Publishers Ltd. Nairobi.



4.Olembo, N.K., Fedha, S.S. and Ntgaira, E.S. 1995. Medicinal and Agricultural Plants of Ikolomani Division, Kakamega District,, Signal Press Ltd. Nairobi.



5.Obado E.A.O. and Odera J.E. in Ref. No3, pp 153-167