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Use of TM is high in many countries in the developing world. Data presented in slides from:

1. WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002. Publication number WHO/EDM/TRM/2002.1. Available at: http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf

2. WHO Report by the Secretariat on Traditional Medicine. Executive Board 111th Session. December

2002. Publication number EB111/9. Available at: http://www.who.int/gb/ebwha/pdf_files/EB111/eeb1119.pdf


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Figure source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.

Publication number WHO/EDM/TRM/2002.1. Available at:

http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf


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See Notes


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Figure source:WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.

Publication number WHO/EDM/TRM/2002.1. Available at: http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf


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The fact that CAM usage is high and increasing in developing countries indicates that cost and tradition are

not the only reasons for the use of traditional medicine. Many inter-related factors are contributing to the

high levels of CAM use some of these factors are mentioned in the slide.

Health systems in many developing countries are struggling to maintain continuity of care for the

populations they serve this fragmentation of care is occurring at the same time as high levels of chronic

diseases that necessitate such continuity. CAM has been reported to provide a high level of quality in terms

of inter-personal care. This can be postulated as one of the reasons for the popularity of CAM.


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Any attempt to classify traditional medicine is hazardous, as the field is continuously emerging and many traditional practitioners resistformalized classification. A good starting point is provided by the WHO, as outlined in the table in the slide. One should note, however,the absence of multiple traditional healing practices in Africa and South America. Each slide that follows will provide some brief

information on the therapies mentioned in the WHO table. Table source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.Publication number WHO/EDM/TRM/2002.1. Available at: http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf


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The Department of Ayerveda, Yoga & Naturoptahy, Unani, Siddha and Homeopathy (AYUSH) of the Ministry of Health andFamily Welfare of India has a section on Unani at: http://indianmedicine.nic.in/unani.asp

The American Institute of Unani Medicine provides a wide range of further information on Unani at http://www.unani.com


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The Department of Ayurveda, Yoga & Naturoptahy, Unani, Siddha and Homeopathy (AYUSH)

of the Ministry of Health and Family Welfare of India has a section on Naturopathy at:

http://indianmedicine.nic.in/naturopathy.asp


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The American Osteopathic Association website provides a wealth of information:

http://www.osteopathic.org/index.cfm


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The American Chiropractic Association provides a large amount of information at:

http://www.amerchiro.org/index.cfm


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Source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.Publication number WHO/EDM/TRM/2002.1. Available at:http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf


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Source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.Publication number WHO/EDM/TRM/2002.1. Available at:http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf

A discussion of these issues is found on page 21 of the report.


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4"#$%&'(#) =,$%-%(, NCCAM and the National Library of Medicine (NLM) have partnered to create CAM on PubMed, a subset of

NLM's PubMed. This is available at http://nccam.nih.gov/camonpubmed

The Cochrane Complementary Medicine Field was established in 1996 to produce, maintain and

disseminate systematic reviews on TM/CAM topics.


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Source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.




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See Notes


30/72

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31/72

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32/72

NBPage 32

0')%-O U ",>A)#4'"O @"#=,V'";9

WHO defines nine key elements of a national TM/CAM policy:1. Definition of TM/CAM2. Definition of governments role in developing TM/CAM3. Provision for safety and quality assurance of TM/CAM therapies

and products

4. Provision for creation or expansion of legislation relating to TM/CAM providers & regulation of herbal medicines

5. Provision of education & training of TM/CAM providers(Continued)Source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.




33/72

NNPage 33

0')%-O U ",>A)#4'"O @"#=,V'";9

WHO key elements of a national TM/CAM policy (cont.):

6. Provision for promotion of proper use of TM/CAM

7. Provision for capacity building of TM/CAM humanresources, including allocation of financial resources

8. Provision for coverage by state health insurance

9. Consideration of intellectual property issues





34/72

NPPage 34

0')%-O U ",>A)#4'"O @"#=,V'";938%(# l L( %(4,>"#4,$ #::"'#-8 4' !+

m#&'(#) :')%-O '( !+ %9 :#"4 '@ 48, JfPf -'(9&4A&'( Ga%94,(-, '@ ?4#4, L$=%(%94"#&'( '@ !"#$%&'(#) #($ 3'=:),=,(4#"O +,$%-%(,

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Numerical data on TM capacity in China: 600 manufacturers of herbal medicines; 340, 000 herbal farmers:

Human TM resources (525,000 TCM doctors, 10,000 TCM/AM doctors, 83,000 TCM pharmacists, 72,000 TCMassociate doctors)

Hospital resources (2,500 TCM hospitals, 39 TCM/AM hospitals, 35,000 total beds, 127 TM hospitals forminority groups).

170 national and state TM research institutions.Educational resources (30 TCM universities, 3 TM colleges for minority groups, 51 medical technology schools

of TCM).

Source: WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002.Publication number WHO/EDM/TRM/2002.1. Available at:



35/72

NQPage 35

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The case studies are real, from personal experience in Pabna Mental Hospital, Bangladesh.

The names of the cases are fictitious.


36/72

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To learn more about traditional medicine in Bangladesh see the entry in Banglapedia at

http://banglapedia.search.com.bd/HT/T_0207.htm


39/72

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See Notes


40/72

YA%_ Now we invite you to take the module quiz and test your

recent learning.

This module quiz includes ten questions to test whetheryou have internalized the key concepts presented in the

module. The last question focuses on the case study

Note your letter answers (A,B,etc.) on a piece of paper.After completing the quiz you can check the following slidesfor the correct answers and additional feedback.

After the quiz a short summary is provided for this modulepresentation


41/72

PJ

1. Which component is not included in The World Health Organization definition of

traditional medicine?

A Plant, animal and mineral based medicines.B Spiritual therapies

C Allopathic medicines

D Manual therapiesE Exercises

2. Which of the following countries uses the term complementary and alternative

medicine when referring to traditional medicine?

A TanzaniaB Bangladesh

C United Kingdom

D BotswanaE Bhutan


42/72

PB

3. Which of the following statements is not true on the level of usage of traditional

medicine in the developing world?

A In Africa up to 80% use TMB In China, 40% of delivered health care is TM

C In India, 65% of the population in rural areas use traditional medicine to

help meet their primary health care needs.D Traditional medicine is used by only a minority in Bangladesh.

E In Chile 71% of the population report having used traditional medicine.


medicine/CAM in the developed world?

A In the USA, about half of the population have used CAM at least once.B In France, about half of the population have used CAM at least once.

C In Canada, 70% of the population have used CAM at least once.

D In the UK the formal health care system does not encourage use of CAM.E In Belgium, about a third of the population have used CAM at least once.


43/72

PN

5. Which of the following systems of traditional medicine are not mentioned in the

WHO classification system?

A Chinese MedicineB Ayurveda

C Unani

D HomeopathyE African indigenous medicine

6. The National Center for Complementary and Alternative Medicine (NCCAM) at

the National Institutes of Health groups CAM practices into four domains. Which of

the following is not one of the NIH domains?

A Mind-Body MedicineB Biologically Based Practices

C Homeopathy

D Manipulative and Body-Based PracticesE Energy Medicine


44/72

PP

7. The WHO has identified five key needs at national level to ensure the safety,

efficacy and quality of TM/CAM. Which of the following is not one of the five key

needs that have been identified?

A Regulation & registration of herbal medicines..

B Safety monitoring for herbal medicines & other TM/CAM.

C Increased funding for ensuring safety, efficacy and quality of TM/CAM.D Support for clinical research into use of TM/CAM for treating countrys

common health problemsE National standard, technical guidelines and methodology, for evaluating

safety, efficacy and quality


45/72

PQ

8. The WHO has articulated five key needs at the national level for the rationale

use of TM. Which of the following is not one of the five key needs that have beenidentified?

A A national salary and remuneration scale for those practising TM/CAM

B Strengthened & increased organization of TM/CAM providers

C Strengthened cooperation between TM/CAM medicine & allopathicmedicine practitioners

D Reliable information for consumers on proper use of TM/CAM therapiesand products

E Improved communication between allopathic medicine practitioners & their

patients concerning use of TM/CAM.


46/72

PT

9. The WHO defines key elements of a national TM/CAM policy. Which of the

following is not one of the key elements?

A Definition of TM/CAM.B Definition of governments role in developing TM/CAM.

C Provision for creation or expansion of legislation relating to TM/CAM

providers & regulation of herbal medicines.D Defining a desired population to practitioner ratio for each of the types of

TM practised in the countryE Provision of education & training of TM/CAM providers


47/72

PD

10. Reflect on the case study from Bangladesh. Which of the following statements,

in your opinion, is true?

A The practice of pouring of hot oil in Mehrun Nessas ears should not bechallenged as it is part of a traditional practice

B Traditional practitioners can never be integrated into the care of patients

with severe mental illness.C Traditional medicine needs to be understood prior to strategizing

interventions to integrate TM and allopathic medicineD The opinion of the community should be ignored as global medical

knowledge increases


48/72

PW

And now, check out the correct answers


49/72

Pf

1. Which component is not included in The World Health Organization definition of traditional medicine?

A Plant, animal and mineral based medicines. Incorrect-- Traditional medicine refers to healthpractices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines,

spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose

and prevent illnesses or maintain well-being.

B Spiritual therapies Incorrect -- Traditional medicine refers to health practices, approaches,

knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manualtechniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or

maintain well-being.

C Allopathic medicines -- Correct -- This is not included in the WHO definition if traditional

medicine as this is the type of medicine prescribed by allopathic physicians. The WHO definition of

traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant,animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied

singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.D Manual therapies Incorrect -- Traditional medicine refers to health practices, approaches,

knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual

techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses ormaintain well-being.

E Exercises Incorrect -- Traditional medicine refers to health practices, approaches, knowledge and

beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and

exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.


50/72

QC

2. Which of the following countries uses the term complementary and alternative medicine when referring to

traditional medicine?

A Tanzania Incorrect -- The terms "complementary medicine" or "alternative medicine" are usedinter-changeably with traditional medicine in some countries. They refer to a broad set of health care practices

that are not part of that country's own tradition and are not integrated into the dominant health care system.

The term is often used in the United Kingdom and other developed countries.

B Bangladesh -- Incorrect -- The terms "complementary medicine" or "alternative medicine" areused inter-changeably with traditional medicine in some countries. They refer to a broad set of health care

practices that are not part of that country's own tradition and are not integrated into the dominant health care

system. The term is often used in the United Kingdom and other developed countries.

C United Kingdom Correct -- The terms "complementary medicine" or "alternative

medicine" are used inter-changeably with traditional medicine in some countries. They refer to abroad set of health care practices that are not part of that country's own tradition and are not

integrated into the dominant health care system. The term is often used in the United Kingdom and

other developed countries.D Botswana -- Incorrect -- The terms "complementary medicine" or "alternative medicine" are used

inter-changeably with traditional medicine in some countries. They refer to a broad set of health care practicesthat are not part of that country's own tradition and are not integrated into the dominant health care system.

The term is often used in the United Kingdom and other developed countries.

E Bhutan -- Incorrect -- The terms "complementary medicine" or "alternative medicine" are used

inter-changeably with traditional medicine in some countries. They refer to a broad set of health care practices

that are not part of that country's own tradition and are not integrated into the dominant health care system.The term is often used in the United Kingdom and other developed countries.


51/72

QJ


medicine in the developing world?

A In Africa up to 80% use TM -- Incorrect -- This statement is true.B In China, 40% of delivered health care is TM -- Incorrect -- This statement

is true.

C In India, 65% of the population in rural areas use traditional medicine tohelp meet their primary health care needs. -- Incorrect -- statement is true.

D Traditional medicine is used by only a minority in Bangladesh. --Correct -- This statement is not true. TM is widely used in

Bangladesh exact latest data on the level of use is currently beingexplored by researchers.E In Chile 71% of the population report having used traditional medicine.

Incorrect -- This statement is true.


52/72

QB


medicine/CAM in the developed world?

A In the USA, about half of the population have used CAM at least once. --Incorrect]. -- This statement is true.

B In France, about half of the population have used CAM at least once.

Incorrect]. -- This statement is true.C In Canada, 70% of the population have used CAM at least once.

Incorrect. -- This statement is true.D In the UK the formal health care system does not encourage the use

of CAM. -- Correct -- This statement is not true. In the UK 40% of allGeneral Practioners offer some form of CAM referral or access.E In Belgium, about a third of the population have used CAM at least once.

Incorrect. -- This statement is true.


53/72

QN

5. Which of the following systems of traditional medicine are not mentioned in the WHO

classification system?

A Chinese Medicine -- Incorrect -- The WHO Traditional Medicine Strategy

2002-2005, displays a Table on the commonly used TM/CAM therapies and therapeutic

techniques. Chinese medicine is included in this table.

B Ayurveda Incorrect -- The WHO Traditional Medicine Strategy 2002-2005, displays a

Table on the commonly used TM/CAM therapies and therapeutic techniques. Ayurveda is

included in this table.

C Unani -- Incorrect -- The WHO Traditional Medicine Strategy 2002-2005, displays a

Table on the commonly used TM/CAM therapies and therapeutic techniques. Unani is included

in this table.

D Homeopathy -- Incorrect -- The WHO Traditional Medicine Strategy 2002-2005,displays a Table on the commonly used TM/CAM therapies and therapeutic techniques.

Homeoptahy is included in this table.

E African indigenous medicine -- Correct -- The WHO Traditional Medicine

Strategy 2002-2005, displays a Table on the commonly used TM/CAM therapies and

therapeutic techniques. Surprisingly, African indigenous medicine is not included in this

table.


54/72

QP

6. The National Center for Complementary and Alternative Medicine (NCCAM) at the National

Institutes of Health groups CAM practices into four domains. Which of the following is not one

of the NIH domains?

A Mind-Body Medicine -- Incorrect. -- This is one of the four NCCAM domains.

B Biologically Based Practices -- Incorrect. -- This is one of the four NCCAM domains.

C Homeopathy -- Correct -- This is not one of the four NCCAM domains.

Homeopathy is considered a whole medical system, which cuts across all four

domains. Whole medical systems are built upon complete systems of theory and

practice. Often, these systems have evolved apart from and earlier than the

conventional medical approach used in the United States. Examples of whole medical

systems that have developed in Western cultures include homeopathic medicine, a

whole medical system that originated in Europe. Homeopathy seeks to stimulate thebody's ability to heal itself by giving very small doses of highly diluted substances that

in larger doses would produce illness or symptoms (an approach called "like cures

like").

D Manipulative and Body-Based Practices -- Incorrect. -- This is one of the four

NCCAM domains.

E Energy Medicine -- Incorrect. -- This is one of the four NCCAM domains.


55/72

QQ

7. The WHO has identified five key needs at national level to ensure the safety, efficacy and

quality of TM/CAM. Which of the following is not one of the five key needs that have been

identified?

A Regulation & registration of herbal medicines. -- Incorrect -- This is one of the five

key needs identified by the WHO.

B Safety monitoring for herbal medicines & other TM/CAM. -- Incorrect -- This is one of

the five key needs identified by the WHO.

C Increased funding for ensuring safety, efficacy and quality of TM/CAM. --

Correct -- Although increased funding is certainly needed, this is not one of the five key

needs identified by the WHO.

D Support for clinical research into use of TM/CAM for treating countrys common

health problems. -- Incorrect -- This is one of five key needs identified by the WHO.E National standard, technical guidelines and methodology, for evaluating safety,

efficacy and quality. -- Incorrect -- This is one of five key needs identified by the

WHO.


56/72

QT

8. The WHO has articulated five key needs at the national level for the rationale

use of TM. Which of the following is not one of the five key needs that have beenidentified?

A A national salary and remuneration scale for those practising TM/

CAM -- Correct -- This is not one of the five key needs identified by the WHO

for the rationale use of TM.B Strengthened & increased organization of TM/CAM providers. Incorrect

This is one of the five key needs identified by the WHO for the rationaleuse of TM.

C Strengthened cooperation between TM/CAM medicine & allopathic

medicine practitioners. -- Incorrect -- This is one of the five key needs

identified by the WHO for the rationale use of TM.D Reliable information for consumers on proper use of TM/CAM therapies

and products. -- Incorrect -- This is one of the five key needs identified by

the WHO for the rationale use of TM.

E Improved communication between allopathic medicine practitioners & theirpatients concerning use of TM/CAM -- Incorrect -- This is one of the five

key needs identified by the WHO for the rationale use of TM.


57/72

QD

9. The WHO defines key elements of a national TM/CAM policy. Which of the

following is not one of the key elements?

A Definition of TM/CAM. -- Incorrect -- This is one of the key elements of anational TM/CAM policy defined by the WHO.

B Definition of governments role in developing TM/CAM. -- Incorrect -- This is

one of the key elements of a national TM/CAM policy defined by the WHO.C Provision for creation or expansion of legislation relating to TM/CAM

providers & regulation of herbal medicines. -- Incorrect -- This is one of thekey elements of a national TM/CAM policy defined by the WHO.

D Defining a desired population to practitioner ratio for each of the

types of TM practised in the country. -- Correct -- This is not one of the keyelements of a national TM/CAM policy defined by the WHO.

E Provision of education & training of TM/CAM providers. -- Incorrect -- This isone of the key elements of a national TM/CAM policy defined by the WHO.


58/72

QW

10. Reflect on the case study from Bangladesh. Which of the following statements, in your

opinion, is true?

A The practice of pouring of hot oil in Mehrun Nessas ears should not be challenged

as it is part of a traditional practice. -- Incorrect -- This is a harmful practice that

infringes on the human rights of Mehrun Nessa.

B Traditional practitioners can never be integrated into the care of patients with severe

mental illness. -- Incorrect -- The supportive role provided by traditional practitioners

can be invaluable in the integrated care in the community for persons affected by

severe mental illness.

C Traditional medicine needs to be understood prior to strategizing

interventions to integrate TM and allopathic medicine. -- Correct -- There is an urgent

need to gain an understanding of TM in Bangladesh. Research conducted by Future

Health Systems: Innovations for Equity is contributing to this increased understanding

in rural Bangaldesh.

D The opinion of the community should be ignored as global medical knowledge

increases, -- Incorrect -- Community ideas, concerns, and expectations related to

health and health care need to be understood when designing health systems for

the future.


59/72

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60/72

TC

F,(,"#) X,@,",(-,9

1. WHO Traditional Medicine Strategy 2002-2005. Geneva. 2002 Publication number WHO/EDM/TRM/

2002.1. Available at: http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf

2. WHO Report by the Secretariat on Traditional Medicine. Executive Board 111th Session. December 2002.

Publication number EB111/9. Available at: http://www.who.int/gb/ebwha/pdf_files/EB111/eeb1119.pdf3. House of Lords Report on complementary and alternative medicine. Great Britain Parliament House of

Lords Select Committee on Science and Technology. Author: Lord Walton of Detchant (chairman, Sub-

committee I). House of Lords papers 123 1999-00. Publisher: TSO (The Stationery Office).4. Complementary medicine: information pack for primary care groups. Department of Health of the UnitedKingdom. June 2000. Available at: http://www.dh.gov.uk/prod_consum_dh/idcplg?

IdcService=GET_FILE&dID=6166&Rendition=Web

This document aims to provide primary care groups (PCGs) with a reference source on forms of

complementary and alternative medicine (CAM). It begins by defining terms and giving an overview of

current CAM provision in primary care. The main body of the document deals with six individual therapies,namely acupuncture, aromatherapy, chiropractic, homeopathy, hypnotherapy, and osteopathy. In each case

information is provided on conditions which are likely to benefit from treatment, practitioner qualifications, and

registering bodies. The document cites numerous references.

5. The roots of ancient medicine: an historical outline. Subbarayappa BV.

J Biosci. 2001 Jun;26(2):135-43. Full text available at: http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3169&itool=AbstractPlus-def&uid=11426049&db=pubmed&url=http://www.ias.ac.in/jbiosci/

jun2001/135.pdf

This article provides an excellent historical perspective on the development of different systems of medicine.

It covers: Egyptian medicine; Greek medicine; Greco-Arabic medicine; Chinese medicine; Indian medicine;

Ayurveda; Unani; and Siddha.


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TJ


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?:'(9'"9The Global Health Education Consortium gratefully acknowledges the

support provided for developing these teaching modules from:

Margaret Kendrick Blodgett Foundation

The Josiah Macy, Jr. Foundation

Arnold P. Gold Foundation

This work is licensed under aCreative Commons Attribution-Noncommercial-No Derivative Works 3.0

United States License.


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44 traditional medicine final

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