TRADITIONAL MEDICINE POLICY AND TECHNOLOGY AGENDA: BENCHMARKING THE REALITIES

TRADITIONAL MEDICINE POLICY AND TECHNOLOGY AGENDA:



BENCHMARKING THE REALITIES



Mr. Patrick Omari

(Project Co-ordinating, Traditional Medicine Development Agency)



Subject Terms



An evaluation of Traditional Medicine and the Policy. This paper seeks to compare what has happened after implementing defective policies that we have and what would have happened had these policies not been implemented.



Abstract



Science is a product of intellectual work by persons trained in reflection and analysis to venture beyond what is already known. This exercise in thinking requires a minimum number of conditions, freedom being one of the major ones. This freedom must be enshrined in the constitutions and government policies. The collective wisdom on bio-diversity conservation has been embodied in the cultures of indigenous peoples and passed from generation to generation. It is little wonder that areas of high cultural diversity also happen to be regions that sustain bio diversity in abundance. The link between ecology, primary healthcare and bio diversity conservation is strong and cannot be over-emphasized.



The absurd conviction that some people in society have a monopoly of higher truth and that their cause is more valid than all the rest has led to a situation where any good if unfamiliar is rejected. This has been the case in the development of traditional medicine which some elite and policy makers have deliberately given a pariah status in favour of the fundamentally incompatible market rationality and profit maximization in the name of globalization by vouching for the more fashionable western medicine at the expense of traditional medicine.







INTRODUCTION

Traditional Medicine, also known as ethnomedicine, is a collective term used by medical anthropologists, among others, to describe a highly sophisticated medical system whose roots are indigenous to special cultures of the world (Wembah - Rashid J.A.R: 1994).



Although, whether good or bad is a value judgment, the colonial administrations in Africa deliberately pushed traditional medicine to the periphery by branding it negative magico-religious practice. Consequently, the colonial administration developed neither legal nor institutional framework to regulate the practice.



At Independence African governments inherited a struggling and marginalised institution lacking any professional status which hitherto the practice enjoyed in the traditional societies. May be due to omissions or commission, the new African governments did not enthusiastically take up their duty of determining the role, the direction and the pace of incorporating traditional medicine in the Healthcare delivery system.



Against the afore mentioned odds, uncoordinated development and research focusing on advancing empirical generalizations has been going on with the sole objective of according this practice its honour and merit. These generalizations are based on the premise that disease is a universal problem to all human beings and each human group has its own ways of alleviating sickness.



In Kenya it was during the first decade of independence that the 1966-70 National Development Plan recognized Traditional Medicine. This initial step gave rise to piecemeal development effort but which have lacked radical policy overhaul, which seems to be long overdue.



In this paper, I have endeavoured to show the viability of traditional therapies and methodologies employed by alleviating human suffering while at the same time pointing out some of the legal and technological impediments in developing African traditional medicine into an institutionalized medical system. I have also touched on the local implications of the globalization process as reflected in world trade treaties and convention.



In Kenya today, two types of medical system exist each operating independently, whereas it is acknowledged that more and more people rely on traditional medicine, lack of statistical data has helped advance the view that western medical system is the absolute answer to those in the quest for therapy. A study carried out in Kenya on patterns of Health Facility used showed that 32% of those interviewed indicated that they utilize traditional herbal medicine (World Bank, Kenya Poverty Assessment: 1995).



The pattern of facility use is sensitive to health policies, the nature of disease, the accessibility to the facility and above all the ever overlooked aspect of cultural orientation, in other words, some communities believe that there are some diseases which cannot be cured using modern medicine due to the embedded African beliefs on the causality of disease.



It is widely acknowledged that technology is central in any development process. Different schools of thought define technology differently but there is almost a general consensus that technology and progress are often regarded as more or less synonymous. Any definition adopted implies that one makes choices of words and actions which reflect the instrumental character of technology. In this paper technology is viewed as an object with a function of helping human beings enhance their capability to perform certain activities.



The linkages between policy makers and policy receivers is vital to understanding the meaning and power of public policy. In a very direct sense, society suffers because of government activity.(Garston: 1997). The Kenyan Law, as it stands today, does not support or recognize traditional medicine and practitioners. There is no policy that has been implemented to remedy this situation. This paper critically looks at the scattered legislative statutes on traditional medicine and its practice in Kenya. And finally I have also included some recommendations in the last part of the paper.





TRADITIONAL MEDICINE: The Kenyan Situation



Wembah - Rashid (1994) categorizes traditional medicine practitioners according to the kind of knowledge and skills they possess and what they do in this discipline, that is, what they know and practice. These practitioners are professionals who are qualified and distinguish themselves from quacks due to their fame for successful treatment of patients.



Although there is the unqualified references given to traditional medicine practitioners ranging from witchdoctor, shaman, healer, indigenous practitioners etc. there is a general consensus that there is a category which is recognized by its highly specialized and sometimes diseases specific gurus whose authority and capability is not questionable. However, terms such as diviners, healers, sorcerers, herbalists, circumcisers, midwives, bone setters, witchcraft eradicators and fortune tellers are commonly used to refer to the African Medical practitioners. Kokwaro (1976: 6-5) catalogues methods for preparing and applying traditional medicines in East Africa: they are more or less similar in most ethnic groups. A common thread in these methods of healing is that there is an aspect of spiritual indulgence where the healer tells the patient to believe that the medicine will heal her or him.



In Kenya there has been an effort to recognize herbalists and midwives at least at policy level. The 1996-70 Development Plan incorporated traditional medicine into the health policy in Independent Kenya. Although still vague, the government gave a statement of intent stressing on improving the rural health system and crucial role that traditional medicine will play in the general healthcare delivery system in its 1979 - 1993 National Development Plan. It was stated that a major gap of information relating to the private health sector, both traditional and modern, had lingered for too long in the previous national plans. It was then proposed that during the plan period attempts would be made to fill these gaps through collection of information and determining its relevance and the importance of traditional medicine. There was a proposal to link up traditional medicine and government institution and the encouragement of cadres of selected traditional medical practitioners to serve in government health institutions in the rural areas.



What is not clear is the question whether this might have precipitated the creation of the Centre for Traditional Medicines and Drug Research (CTMDR) in KEMRI (Science and Technology Act of 1997: 1979 amendment). However, Kenya Medical Research Institute (KEMRI) makes a rather interesting definition between modern medicine and traditional medicines and here I quote:

"Traditional medicines are related to drugs in that like drugs, they are used in the diagnosis, prevention and treatment of disease. But unlike drugs, they lack chemical, pharmacological, toxicological and pharmaceutical specifications hat are required to describe modern pharmaceutical (KEMRI 1998: Guidelines on the Conduct of Research)".



This conceptualized definition seems to have pervaded all government policies as reflected in the CAP 244 of the Laws of Kenya, the Pharmacy and Poisons Act. The particular Act of Parliament defines and gives the procedures on how to handle and dispense western medicine. In this corpus of thinking it is only the western medicine which is recognized as a drug. This definition denigrates traditional medicine and in the process legally, though wrongly, making it illegal to administer.



The problem has been compounded by the recent Kenya National Drug Policy (KNDP) development. A plan of operation, which was initiated in 1995 and whose implementation started in 1996, has further continued overlooking traditional medicine. Interestingly the Kenya National Drug Policy only states in vague terms, infact in about five sentences, that traditional medicine will continue to be an essential part of the nations culture and will need to be harmonized with its healthcare systems. And that the Pharmacy and Poisons Board through its committees will determine the suitability of the medicines. (MOH: 1994). This rather hollow statement, without any tangible specifications and procedures, does not help further the cause of traditional medicine. Whereas the same document is very elaborate on how to handle the so called medicine, the same is conspicuously missing for traditional medicine as it is not existing. If for sure this omission is due to lack of information then the same Ministry should have set aside some money to study and come up with a procedure that will regulate traditional medicine.



This is not asking for too much considering that the Netherlands government funded the Kenya National Drug Policy to the tune of US$2,636,000 for a period of five years. Again the World Health Organization gave another grant to the same programme (MOH KNDP Progress Report: 1989). An attempt by the Kenya Natural Drug Policy Implementation Programme to include traditional medicine practitioners in the pharmaceutical legislation amendment exercise through holding multi sectoral workshops has ended up flawed because the final report document does not reflect the views from traditional medicine representatives. Personally having participated in one such workshop, I was dismayed by the doctored report document which did not reflect much of what was proposed. Otherwise this programme presented the best chance for an all inclusive consultation with all stakeholders to harmonize health delivery systems by introducing proper regulatory control on the utilization of both western and traditional medicine especially after the 1989 - 1993 National Development Plan failed to meet its objectives of promoting the welfare of traditional medical practitioners.



Science and Technology



At present a number of institutions in Kenya are involved in the research in traditional medicine. At Kenya Medical Research institute (KEMRI) an integrated multidisciplinary approach is employed where traditional wisdom together with modern medical science is used to screen the traditional medicines. The screening processes at KEMRI is not clinical analyses but is a comprehensive evaluation of safety and efficacy. Kofi-Tsekpo. 1989, says that he considers it necessary that dissemination of research results should be protected for the national interest until sufficient legal framework has been established. What is not clear today is the question as to whether lack of analytical scientific studies on traditional medicine in Kenya is due to lack of facilities or it is due to the national interest and the confidentiality demanded by the traditional doctor. This legal impediment means that there will always be both scientific and academic interest in the study of traditional medicine but there will be little tangible results in the name of scientifically prepared traditional products because there is no protection in terms of copy writes, intellectual property rights and patent rights for the indigenous knowledge custodians.



As long as only herbal medicine practicing doctors are recognized due to the fact that herbal medicine can be analyzed in a scientific laboratory, other categories of traditional medical practitioners will continue suffering. It is true that in old times there were mental diseases and psychosomatic disease specialists counseled and treated these diseases successfully. In modern times psychiatrists are respected people and yet they work on the same basic principle that stress, trauma among other conditions impact negatively on the mental health of a person. For instance, the Turkana up to today respect AKUJ diviners who treat psychological diseases very well although the methodology is not documented (SOPER: 1985).



Science and technology are aspects of culture. Medical technology whether used in traditional medicine or as part of modern medicine is integral to the culture of the people who possess one or the other system of medical endeavour (ODAK: 1998). Prof. Odak further says that many people in this country have claimed that modern medicine is scientific an traditional medicine is not. A fact he considers false. In his view science is a method and procedure that a people devise to help in not only investigating but understanding the nature of physical, natural, socio-psychological and cultural phenomena. I can't agree more especially with the contention that identification of a particular herb as the remedy for a particular disease confirms that traditional medicine has its own investigation procedure. To drive the point home the professor illustrates the issue by saying that traditional doctors don't just walk into the forest and cut any herb but that they select a particular part of a particular plant for a specified illness. Those who are taking scientific knowledge forward bear the awesome responsibility of informing public opinion and those who shape it about the potential risks of applying their knowledge as well as the devices employed. However, distortion of what indigenous technology is still about has led to a situation where this technology is equated to backwardness.



In a broader sense culture should not be seen as a means to achieving some prescribed development rather it should be seen as an end in itself. This means that homegrown solutions and scientific ideologies should influence our development agenda by producing what our local communities need. It is futile for African governments to try and re-invest the wheel, the most promising path is the development of mass consumer goods. Globalization and liberalization does not mean mortgaging our peoples aspirations by importing foreign medicine even those not known to be absolute answers. We can copy the Chinese example where capitalism has failed to penetrate and it is the only successful story where local industries produce enough of what the billions need before exporting. Of course this is the positive side of this communist ideology but it must be acknowledged that the restricted freedom or personal liberty is the negative side of the alluded ideology.



In a nutshell there has been little application of appropriate science and technology to conserve and preserve African traditional medicine. The little that we had has never been participatory thus antagonizing the traditional practitioner a great deal. This has suspended the practice so much such that it looks like it does not concern the government at all. On the international front a number of multilateral agreements have been signed even though their consequences impacts negatively on the development of indigenous societies, Africa included. The Convention on Biological Diversity (CBD) has some positive things on indigenous knowledge. As an international agreement negotiated by governments in 1992, its objective was to protect the survival of biological diversity. However, the recent Genetic Engineering treaties seem to override any good that this convention might have had (Econews Africa: 1997).



The recently negotiated Multilateral Agreement Investment (MAI) by organization for Economic Cooperation and Development (OECD) countries poised to dash any little hope that African countries might have had. It is observed that this is a potential agreement that will send economic, social and cultural rights reeling back to colonial era (Phlane: 1999). The convention has been sired by a gang of 29 countries who have signed it under a cloud of secrecy to vouch for a laissez faire global economy where those with the means will have unlimited access to any resource desired. Ochieng' Philip poses the following questions, "too what extent is the Third World's indigenous knowledge protected from international pillage? Is that world - especially Africa - getting a fair return for the primary resources with which it feeds the maws of the developed world's biotechnological industries? (The Daily Nation: 15 Feb. 1999)". Actually the above questions were prompted by the agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) which is fronted by the World Trade Organization (WTO).



Policy



At independence in 1963 Kenya adopted slogans that the government shall be committed to the eradication of disease, poverty and ignorance. However recent experience shows that the agenda of policy makers in Kenya sometimes does not reflect the peoples perception of sustainable development. Recognizing problems is one part of the policy making process, deciding how to pay the price to solve them is another. This prompts the question as to what makes policy makers commit resources for some policies and not for others. Values, the extent of a crisis, awareness and other factors enter into the equation that determines the answer. But the availability of resources play a large part as well (Garston: 1997). Although there are over sixty pharmaceutical legislative statutes in the Kenyan Laws, there is non which is pro-traditional medicine. To begin with, medical practitioners and Dentists Act (Cap 253) emphatically says that only those with degrees from a recognized university can be licensed to trade as doctors. This means that traditional medical practitioners will remain quacks whether their practice is helping people or not.



Then there is the Witchcraft Act (Cap 150) which criminalizes everything African that relates to traditional healing without giving provision or room for the interpretation to enable one distinguish the positive part of these practices. It is interesting to note that whereas the Ministry of Health is mandated to regulate the health sector, traditional medicine is not cushioned at all as a matter of policy. The Ministry of Culture and Social Services which identifies with the traditional practitioners merely keep a register of these people but does not regulate their practice nor the products which they dispense. TRIPS contradict CBD because by subjecting indigenous knowledge to western style patent the privilege western technocrats and scholars stand to reap the profiting by merely sweet talking the local custodians of indigenous knowledge. This has already happened by the patenting of Neem tree, the Indian rice, etc. And it looks like this reality has not downed on Kenyan policy makers for its potential negative impact on Kenyan medical practitioners among other sectoral groups.



In Kenya most scholars brand those championing the cause of traditional medicine naive. We have been called names. The question they pose is how do we patent concoctions? What invention does a herbal concoction entail? However our assertion has always been the question of whether there can be a way of assisting the traditional doctors understand this animal called patents then our good scientist can assist them with the paper work to secure it however undesirable it might be. What must be acknowledged is the fact that whereas traditional doctors accept the paradigm that their western-trained counterparts have the knowledge that can assist them further their profession, the reverse is not the case. So when governments gang up to negotiate global convention on forests, non of our representatives raise any objection to curtail the illegal harvesting and trading in forest products such as traditional medicine. Instead they would cite the more accepted timber products and also the effect of desertification. Rarely do we hear people protesting that forests are sources of medicine for millions of people.



This has continued to impact negatively on the development and sustainability of traditional medicine. For instance, it is very difficult for one to import any herbal medicine and food supplements simply because the port health officers and the Kenya Bureau of Standards demand for a formal registration license. This license is hard to get in the first place because there is no formal registration procedure that would facilitate registration of any herbal product.



Conclusions and Recommendations



i.) There is a need for those interested in traditional medicine at all levels whether for scholarly reasons, policy, trade, practice, or just interest to form a hegemonic group from where lobbying can be organized to push for the desired changes.



Ii.) A team of policy and legal experts should be constituted to gather the negative factors contained in all national policies and international conventions and publicize them with the view of providing alternative views and petitioning governments to start positive reforms.

iii.) Organizations interested in this field to be given focal point status and matching funds to further this cause.

iv.) There should be regular meetings to exchange views on new developments in the area of traditional medicine.




REFERENCES



1. ECONEWS Africa (1997): Global Convention on Forests Being Sneaked through the Back Door. Vol. 6 No. 8 14th June, 1997



2. Garston N.C. (1997) PUBLIC POLICY MAKING: Process and Principles M.E. Sharpe, New York.



3. IUCN - The World Conservation Union Forest Cover and Forest Reserves in Kenya Policy and Practice. June 1996



4. Jagjit P.K. (1999) MAI Multilateral Agreement and Investment Econews Africa, Nairobi.



5. KEMRI (1998) Guidelines on the Conduct Research, Nairobi, Kenya



6. Kofi - Tsekpo (1989) Advancement in Research and Dissemination of Kenyan Tradition, a public lecture at the Department of Culture, Nairobi, KEMRI, Kenya



7. Kokwaro J.O. (1976) Medical Plants of East Africa, East African Literature Bureau, Nairobi, Kenya



8. Ministry of Health (1994) The Kenya National Drug Policy, Nairobi, Kenya



9. Ministry of Health (1998) Kenya National Drug Policy Implementation Programme, Plan Operation, June 1998 M.O.H, Nairobi, Kenya. Progress Report July 1998.



10. Mudida F. (1998) Profitable Herbal Medicine Business Management Skills, A Workshop Report. (TRAMEDEA, 1998)



11. Soper R.C. (1985) Turkana District Socio - Cultural Profile GOK and UON, Nairobi



12. The Kenya Government (1978) The Medical Practitioners and Dentists Act Cap 253 (Revised ed. 1983) Government Printer, Nairobi.



13. Wembah - Rashid et al., (1994) Cultural Week Symposium Report University of Nairobi



14. World Bank (1995) Kenya Poverty Assessment East Africa, Kenya.