RADITIONAL PHYTOTHERAPY IN ZIMBABWE N.Z.Nyazema, Department of Clinical Pharmacology, Medical School. P.O. Box A 178, Avondale, Harare, Zimbabwe E-mail: Nnyazema@healthnet.zw

• RADITIONAL PHYTOTHERAPY IN ZIMBABWE
  N.Z.Nyazema,
  Department of Clinical Pharmacology, Medical School. P.O. Box A 178, Avondale, Harare, Zimbabwe
  E-mail: Nnyazema@healthnet.zw
  
  Background
  
  In general, traditional medicine has been defined as the sum total of all the knowledge and practices, 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 (WHO, 1978). That being so traditional Zimbabwean medicine might be considered to be the sum total of practices, measures and procedures of all kinds, whether material or not which from time immemorial had enabled the indigenous people to guard against disease to alleviate their suffering and to cure themselves. it is an integral part of the Zimbabwean culture which has been neither static or dead.
  
  However, labels of medical systems, such as "traditional", "modern", "scientific" or "western" are always problematic. The debate over labels will continue, but the labels need to be anchored in practical reality. One cannot continue to presume that one is dealing with discreet categories. When one looks at traditional medicine (TM) one sees a pluralistic and transitional system that is operating at a different level of social integration. "Scientific" medicine (SM) has acquired a superior status because of its ability to control disease and yet TM system in Zimbabwe still retains functional strength because it is more accessible and available to the population. Unfortuately this has been exploited by charlatans who are always difficult to bring to book each time there is accusation of malpractice, which really ought to be a crime according to the Traditional Medical Practitioners Act (Chapter 27:14) Revised Edition 1996.
  
  The Act (Appendix 2.1) has never been effectively enforced to protect the general public from dangerous practices. This has been partly because two very crucial provisions of the Act have not as yet been brought into operation. These are subsection (2) and (3) of section 31 of the Act.
  
  Subsection (2) of section 31 makes an offence for nay to practise for gain or carry on business as traditional medical practitioner, whether or not purpoting to be registered.
  
  Subsection (3) of section 31 makets it an offence for any person who does not hold a qualification of spirit medium which is recorded in the Register, to use the title "Registered spirit medium" or any name, title, description or symbol indicating or calculated to lead persons to infer that he has a qualification which is registered in terms of the Act.
  
  Subsection (5) of section 31 states that subsections (2) and (3) shall come into operation on such date as the president may fix by statutory instrument. Zimbabweans have been waiting for a long time.
  
  Be that as it may TM in Zimbabwe is popular but unfortunately most schools of TM are not accepted by SM. The lack of acceptance is due to the fact that treatment offered by TM have never been rigorously evaluated. In SM theories are formulated and predictions that fit within the overall framework are tested. The biomedical paradigm is not dominant in TM.
  
  A scientific paradigm facilitates the formulation of new theories and testing of predictions that fit within that overall framework. It also, inevitably, leads to a diminished ability to interpret, and even percieve, phenomena that lie outside the boundaries of that paradigm. The Zimbabwe traditional medical practice can lay claims to its own paradigms. It did not, however develop anatomical theories worth speaking of, has known no biochemistry or physiology, but instead it developed subdisciplines in psychology. In fact at times there is resistance to information that directly contradicts its wisdom. The germ theory of disease was non-existent. Its only now that is seems to be appreciated in traditional medical practice but to a limited extent.
  
  Sociology and culture in medicine
  
  The process and management of illness is a subculture of the larger social and cultural universe of a people. Every society, even the most isolated one, carries a subculture on health and disease which defines the nature of illness, its appropriate treatment and the kind of relationships in which treatment can take place. How a person who gets ill behaves is greatly influenced by his belief regarding illness, except in purely physical circumstances for example, in the case of a broken leg. Even in that situation the question "why" has to be addressed. There are three areas in which a person is likely to have illness beliefs:
  
  * The extent to which he believes he is susceptible,
  * His belief of the seriouness of his illness
  * The belief that he will benefit from taking action.
  
  In Zimbabwe, studies have shown that patients seek medical attention more often because of the socio-cultural meaning of illness than because of the seriousness of the disease. For example, facial palsy is deemed more "serious" than severe hypertension and therefore people would seek medical attention for the former.
  
  It is therefore important to differentiate between disease as a biological entity and illnes as a social experience. The western trained doctor manages illness using the biomedical model while the patient might look at it in the context of his social experience. In the developed world, health is valued, in the sense that an individual always wishes to be well so that he is not a burden to his family or society. Unfortunately, some sector of the Zimbabwean population still regard being sick as a source of social recognition. The patient does not have to get well right away. The longer the illness, the broader the symptom, the more the patient may gain in the way of attention and unquestioning acceptance of his limitation with respect to work and other duties. In other words the patient becomes manipulative because of psychological depravation.
  
  In addition to this, in Zimbabwe concepts of disease etiology and therapy now form the basis of most people's understanding of health, illness and curing of disease. These concepts address and attempt to explain several concepts of illness:
  
  * Etiology
  * Time and mode of on set of symptoms
  * Course of sickness
  * Treatment
  
  At times some of these concepts are a mixture of indigenous philosophy, Hippocratic humoral concepts and the concept of "germs" with the germ theory still appearing to be weakest.
  
  Symptoms in the Zimbabwe TM are, to a large extent, considered to be identical with illness and disease; therefore, if there are none of the signs that are popularly considered to be symptoms of a disease, it is assumed that a person is well. When symptoms are present, they are the disease itself: that is, a skin lesion is not a secondary sign that a person has the disease called "sugar" diabetes, the lesions is itself "sugar". By this reasoning the "sugar" is cured if the lesion goes away.
  
  Traditional phytotherapy is applied in accordance with the identity between cause and effect. The effectiveness of phytomedicines has always been judged in relation to how rapidly and completely they alleviate sumptoms and give "ease". Traditionally the actions by which phytomedicines are thought to be are: bittrerness, purging or washing out and drawing out. As the terms imply, expulsion of illness-causing impurities is the primary mechanism by which bodily equilibrium is restored. Once the body has been cleansed, healing processes can begin, entangled with the indigenous mythology and mysticism.
  
  Medicinal Plant Use
  
  There are many plants used for medicinal purposes in Zimbabwe as shown in the tables that follow. Information of plants has been obtained from many traditional healers practising in Zimbabwe, household surveys and reports from the police, particularly on plants that have caused fatalities (Gelfanc et al 1985; Chinemana, et al., 1985; Stott et al., 1988; Ndamba et al., 1994 and Nyazema et al., 1994). Most of these plants have now been collected, prepared and deposited in the National Herbarium in Harare. The scientific name of the plant, its vernacular name, collector and the region in which it grows in Zimbabwe have all been recorded. In adition a reference of plants said or known to be poisonous is also available in "The Poisonous Substances File", kept at the Herbarium.
  
  At times some confusion has occured with the numerous botanical binomials that are used or applied to a plant. The large common names that may be used and the lack of correspondence between the 2 systems have caused problems. Even within the same language, the common name of a given species may vary from area to area, and the same common name may be applied to 2 or more species. The problem can be confounded in many cases if the identity of the plant being studied is not established by proper botanical analysis. Botanists at the National herbarium have been quite helpful to avoid the practice of "translating" herbal names into scientific names in the absence of proper identification.
  
  More than 1000 species of the Zimbabwean flora which contains at least 5000 species have vernacular names. A vernacular name implies that the plant has some use and the lack of vernacluar name indicates possibly, that the plant is not used for medicinal purposes. Some of the plants used are seasonal, now rare to find and may grow at great distances from the traditional healer. Often more than one plant will be used as a remedy by the traditional healer cooked with food, such as porridge, beans etc. or taken simply as an infusion. Wild animal parts and some insects might also be included in the mixture. A plant may be used for more than one disease as can be seen in tables. For example, Cassia abbreviata both the bark and root are used for abdominal pains, constipation and gonorrhoea. What this means is that the plant constituents have several biological effects i.e. laxative and anti bacterial properties. What happens is that, most people consult a traditional healer for symptomatic relief. One traditional healer may prescribe a certain herb for a particular illness, whereas the same herb is given by another healer from another region in Zimbabwe for a very different complaint. Be that as it may, generally, most plants have the same use in different parts of Southern African region. (Watt and Breyer - Brandwijk 1962).
  
  Table 2.1 shows the most commonly used medicinal plants in Zimbabwe, based on the several surveys carried out. Most to the phytomedicines are adminstered orally either as an infusion, decoction or as a powder mixed with food, usually porridge. A few medicines are administered through other routes. For example, Ricinus communis leaves are crushed and inserted into the vagina to induce abortion; Datura stammonium leaves are smoked by asthmatics and Lippia javanica leaves which contain essential oils are rubbed onto the face to reduce convulsions. It is important to note that at times plant material may be mixed together for a particular problem, and parts of animal, insects and bird may be some of the constituents.
  
  Poisoning due to phytotherapy
  
  Acute poisoning due to traditional medicines usually follows a visit to a traditional healer and as a result of the reverence in which traditional healers are held, a history is often unreliable and incomplete. Obtaining specimens of the suspected poisonous plant is often difficult or even impossible but when availabe, are usually seen as crude extracts or a piece of root or bark which obviously defies botanical identification.
  
  Some posionous plants have been well documented as shown in Table 2.2. Whether poisoning by traditional medicines occur as an untoward effect in their 'normal' use or whether it is a result of incorrect use, still remains unclear. Generally speaking there are no specific antidotes for traditional medicines and treatment is based on the clinical picture, therefore a botanical identification of plant poisoning is of academic interest only and does not contribute much to patient management, although it could be of value in establishing a prognosis.
  
  It is important to note that all patients with a history of exposure to traditional medicines be cosidered cases of poisoning. The condition with which the patient presents might be the same problem that prompted a visit to the traditional healer and not the result of the visit.
  
  Some medicinal plants poisoning have been observed in animals. In Zimbabwe poisonous plants that are both extemely widespread and responsible for great losses are fortunately; there are many others with a much limited distribution that are nevertheless of considerable ecomomic importance. It must be stressed that the same species from diferent localitites is not necessarily equally toxic, and in fact it has been found that a plant from one locality may be extremely poisonous whereas the same plant from another locality was completely innocuous (Shone and Drummond, 1995).
  
  The several factors that have been thought to be primarily responsible for giving rise to and increasing the incidence of plant poisoning in Zimbabwe include:
  
  1.Bush fires
  
  Zimbabwe with its 5 month summer rainy season and consequent luxuriant growth followed by 7 month dry season when virtually no rain falls is particularly susceptible to bush fires. The fires denude large tracks of the bush of its grass covering resulting in the deprivation of animals of their major or sole source of food. The fires stimulate plants to send up fresh shoots, and the first to do so with most vigorous shoots are plants which posses a bulb or well developed root system. Most of the poisonous plants in Zimbabwe fall into that category eg. Bophane disticha (cattle killer) and Datura ammonium (thorn apple), consequently many animals succumb to the temptation of eating these shoots which are virtually irresistible to starving animals or to animals whose only other feed is dry and unpalatable.
  
  2.Pre - summer growth
  
  Just before the rains when grazing is very poor, many bulbous and deep-rooted plants, such as Dichapetalum cymsosum and Urginea sanguinea sprout. Animals whose feed has become sparse and unpalatable are vey much attracted to eating these plants and many die. It is also at this time of the year that most farmers move their stock about to spread the grazing and frequently animals are introduced to a camp where a poisonous plant is growing in profusion.
  The movement of animals from one area to another frequently leads to the consumption of unfamiliar poisonous plants before acclimatization takes place.
  
  3.Encroachment
  
  The encroachment of posionous plants may be so extensive that animals are forced to either eat them or starve. The encroachment of Lantana camara (cherry pie) is a notable example in Zimbabwe.
  Poisonous plants such as the Moraea spp (Tulps) may grow in such close relationships with grass that they are unavoidably eaten with the grass.
  
  Phytomedicines used in traditional veterinary practice
  
  Over the centuries Zimbabwean animal breeders have learnt a great deal about animal diseases and tried many kinds of treatment. This knowledge covers nearly all domestic animals and has been passed on by word of mouth from generation to generation, part of it being available to all breeders and part of it being a jealously guarded family secret.
  
  Healers
  
  In traditional veterinary medicine as in modern veterinary medicine, a line can be drawn between the general practitioner and the specialist. The former is often a herdsman, who treats various kinds of diseases by applying what is common knowledge or belief among herdsmen. A specialist is often when the hersdman fails, for example when dealing with a fracture. It is important to note that healers of animals are often healers of humans too. Their knowledge comes from their families or from other herdsmen in the case of common knowledge.
  
  Anatomy
  
  It is not unusual to find that traditional veterinary healers are well acquainted with the various parts of the body of an animal. They know less about human bodies, as human beings are seldom dissected. There are vernacular names for the different parts of an animal, even the smallest parts of theanimal body visible to the naked eye. Unfortunately, there is very little knowledge about the functioning of the organs that both material and immaterial things are thought to play a role in disease causation. Observation of rites and taboos in Zimbabwe is a good example to illustrate the latter, which is important in the maintenance of animal health.
  Treatment
  
  In addition to immaterial form of treatment, Zimbabwean veterinary traditional healers have used material forms of treatment using natural products. Creatures, whole or parts of the animal's body, various kinds of soils and plants are some of the material forms of treatment that have been used. Tables 2.3, 2.4 and 2.5 show different plants that are used commonly for different animals.
  
  The medicinal plants used are not always effective in all cases, but this is true of any approach. However some of the plants have been found to be effective in some cases, for example, Cissus qundrangularis used for the treatment of maggots in animal wounds. It is therefore important to carry out further research on phytomedicines used in veterinary medicine. There is need to find out where traditional practices may be a help or a hindrance in the animal sector and where modern medicine offers a better alternative.
  
  The future
  
  Since 1980 at Zimbabwe's independence, there has been growth of a movement in support of TM. The movement's successs over the last decade has drawn together some remarkably diverse interest into sort of a consensus or a coalition. Not surprisingly, then, at different for a no less than in policy debates, there is a danger for discussions to be at cross purposes. Unfortunately this has resulted in healers being left to practices, as before, unregulated and un-funded by Government, and largely unaccountable in law for malpractice, manslaughter or fraud.
  
  Academic medicine has used specific healers on an ad hoc basis for referrals, for giving medical, pharmacy and nursing science students, while on rural attachment, an insight into traditional medical practice. At times some of the students have carried out scientific studies on healer's therapeutic technique or more often on their pharmacopoeia with a view to the possible application in hospital clinics. This sort of enquiry has to continue to be encouraged among students.
  
  However, there are some who advocate that the position of TM should be kept ill-defined though its use be encouraged and extended piecemeal as conditions suggest. It looks like this will prove medically, administratively or politically practicable not for a long time. The heat and pressure are on. Zimbabwe should go beyond merely extending the present ad hoc system, that some are prepared to admit exists, and make efforts in the future to incorporate the traditinal medical practitioner into some sort of national health service. This to some extent is acknowledged by the Zimbabwe National Drug Policy.
  
  Zimbabwe traditional medical practice is dynamic and adaptive although firmly rooted in the traditions of the past. It has also been acknowledged that the Zimbabwean traditional medical culture has been for decades adapting, adding as well as dropping practices and theories. Some traditional medical practitioners such as traditional birth attendants, for example, have taken a keen interest in modern Primary Health Care training programmes. This dynamism suggests that with appropriate official support and recognition in the future, TM will survive well into the next century, strenghened by modern science, not subsumed by it. But others might argue that government priorities should lie in the future with generating wealth (on the assumption that leads to health) rather than promoting health per se. If that is to be, then there is urgent need to professionalise Zimababwean TM. The profession in the future should have the following characteristics:
  
  a.) Autonomy
  
  The profession retains a measure of independence through its right to regulate itself; both the profesion as a whole and the professional as an individual are thus able to organise and carry out their work without undue interference from the employer or the clients. A start was made with the 1991 Act referred to earlier.
  
  b.)Monopoly
  
  The profession also has a statutory monopoly over a defined sphere of work; the monopoly is maintained by the profession's control over licences to practise its particular kind of expertise - some of the work, however, is divided out among subordinate groups under the profession's control. (Nonetheless, in the case of medicine, there is not necessarily a general monopoly over healthcare - one can still set up a healer so long as no false claims are made as has been the case so far with the HIV/AIDS epidemic; similarly self- medication with defined limits is legal, of course).
  
  c.)Ideology of service
  
  A code of ethics governing relations betwen a profession and the client and limiting competition between professions is formally set out and can be enforced by the profession's own institutions which can be easily set up. This is set out in Part V of the Act. Central to the code is an assumption that service shold replace self-interest in the perfomance of professional duties. In return for social recognition of its special status, the profession is accountable to the public for providing the expected level of service.
  
  d.)Body of esoteric knowledge
  
  A profession is responsible, as 'experts' not only for applying a body of knowledge and skills in practice on behalf of the community but also for teaching and examining recruits to the profesion and for promoting research, particularly in the area of phytomedicines, so that the profession can effectively reproduce both its membership and its expert knowledge. The knowledge itself is normally structured in such a way as to be susceptible to standardised instruction and use.
  
  This is by no means a mean feat. There still exists at present some 'political space' for TM as we know it in Zimbabwe. However, it must be born in mind that a purely political solution to how to accomodate TM may prove in the long term deceptive. Professionalisation at one level is about power, which to some extent may offer immediate scope for political solutions, at another level it is about the long term structuring of indigenous knowledge base, and about how to transmit what is stil relevant to the next generation. The ultimate test of Zimbabwe indigenous medical knowledge, particularly phytotherapy, will in the future be in its success with patients.
  
  REFERENCES
  
  Chinemana, F., Drummond, R.B. et al 1985. Indigenous plant remedies in Zimbabwe. J. Ethnopharmacology 14:149-172
  
  Frohne, D. and Pfander, H. 1985. Poisonous Plants. Wolfe Punlishing Ltd. London.
  
  Gelfand, M., Mavis, S. Drummond, R. and Ndemera, B. 1985. The Traditional Medical Practitioner in Zimbabwe. Mambo Press, Gweru.
  
  Joubert, P. 1984. Acute poisoning with traditional African Medicines. Medicinee International, Dec., 5925-5926.
  
  Ndamba, J., Nyazema, N.Z., Anderson, C., Makaza, N. and Kaondera, K.C. 1994. Traditional herbal remedies used in the treatment of urinary schistosomiasis inZimbabwe. J. Ethnopharmacology 42: 124-132.
  
  Ndamba, J., Nyazema, N.Z., Anderson, C., Makaza, N. and Kaondera, K.C. 1994. The Doctrine of Signature of Similitudes: A comparison of efficacy of praziquantel and traditional herbal remedies used for the treatment of urinary schistomiasis in Zimbabwe. Int. J. Pharmacognosy. 32 (2): 142-146
  
  Shone, D.K. and Drummond, R.B. 1962. Poisonous plants of Rhodesia. Ministry of Agriculture. Natural Resources Board.
  
  Stott, R., Mombe, C.S., Meijer, F., Nyazema, N. and Zhungu, C.S. 1988. Is cooperation between traditional and wetern healers possible? A pilot study from Zimbabwe. Complimentary Medicine Research 3:15-22.
  
  Watt, J.M. and Breyer - Brandwijk, M.G. 1962. The medicinal and poisonous plants of Southern and Eastern Africa. Edinburg and London. E & S Livingstone. Ltd.

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