TRADITIONAL MEDICINEAND GLOBAL HEALTH

An Introduction

HERB SHOP IN PERU

UNANI CUPPING IN PAKISTAN

INTERIOR OF A NATIVE AMERICAN SWEAT LODGE. . . AT VA HOSPITAL IN UTAH

Objectives:

Define Traditional Medicine (TM) Explain TM’s relevance to global health Review WHO’s Position on TM Case Studies: Successes and Failures

I. What is Traditional Medicine (TM)?

Traditional Medicine (TM):

“long-standing indigenous systems of health care found in developing countries and among the indigenous populations of industrialized countries” (Bodeker 2006)

sometimes called ethnomedicine since many systems or practices pertain(ed) to a specific cultural group

TM, CAM, or TCAM?

TM practiced outside its area of origin is considered a type of CAM (Complementary & Alternative Medicine).

The globalization of TM has made the terms TM/CAM and TCAM popular.

Class Focus: TM in the Global South.

Q: Is moxa an alternative tx? A: location, location, location

Traditional Medicine Characteristics

What are some similarities and differences compared to biomedicine?

Vitalistic and humoral Holistic and individualistic approach to

pathology Health as balance of body, mind, spirit, society Focuses on healing illness Increasingly influenced by biomedical model

and perspectives

Typology of TM Providers*

Herbalists Manual Practitioners Bonesetters [Traditional Birth Attendants] Spiritual Practitioners

*Practitioners vary system by system

TM’s Role Varies Greatly

Popular Professional Folk

Integrative Inclusive Tolerant

Health Sectors National Health Policy

Traditional Chinese Medicine (TCM) in China

Uses modalities such as herbs, acupunture, tui-na, and qi-gong to maintain yin/yang balance and to regulate qi

Fully recognized in the professional sector; fully integrative government policy

Graduates of TCM colleges licensed as TCM physicians

Ayurvedic Medicine in India

Uses herbs, yoga, massage, meditation, breathing tx, and panchakarma to maintain a bodily balance of vata, pitta, and kapha.

Recognized in professional sector as part of an inclusive health policy

Licensure as ayurvedic physicians

Ghanaian Traditional Medicine

Uses herbs, counseling, and shamanistic-type practices to maintain health as harmony of body, mind, spiritual world, and society

Officially recognized in professional sector by government, whose policy has moved from tolerant to relatively inclusive (in theory)

Registration of healers

Global Trend: Professionalization, Research, Policy Development

Practices range from massage and herbal medicine to shamans and spiritual healers.

Outlawed in the 1930’s, relegated to folk/popular sectors

Elements recognized in the 80’s as having merit

Today, TTM herbal medicine and massage are licensed, regulated, and included in national health policy, and taught at Mahidol University, among other schools

Traditional Thai Medicine (TTM): From Outlaw to In-Patient Care The Rigors of Research!

II. Why is TM relevant to GH?

Five Key Reasons

A. Utilization & Access B. Potential Impact C. Workforce Expansion D. Cultural Competence E. Dollars & DALYs

A. High Utilization & Access Patterns*

For Example: 40% of health care in

China is TCM 80% of Sub-Saharan

Africans use TM Over 70% of Chileans

use TM of some sort Over 60% of rural

Indians use TM *data and graph from WHO Traditional Medicine

Strategy 2002-2005

Factors Underlying Utilization

Availability Cost Medical Pluralism Health Belief Models

B. Impact of TM Models and Practices

Ugandan herbs for herpes zoster in the HIV-infected as effective as acyclovir

Aqueous extract of fennel can help to relieve intra-ocular pressure

Polysaccharides in several Chinese herbs reduce side effects of chemotherapy and decrease tumor size

HIV-positive Ugandans using TM are twice as likely to quit ARV’s within 2 years

30-40% of Nepalese who use TM eye ointments suffered corneal ulceration

Flavonoids in Qing Pi might inhibit effectiveness of Tamoxifen

Potential to Benefit Potential to Harm

B. Impact of TM Models and Practices

Ugandan herbs for herpes zoster in the HIV-infected as effective as acyclovir

Aqueous extract of fennel can help to relieve intra-ocular pressure

Polysaccharides in several Chinese herbs reduce side effects of chemotherapy and decrease tumor size

HIV-positive Ugandans using TM are twice as likely to quit ARV’s within 2 years

30-40% of Nepalese who use TM eye ointments suffered corneal ulceration

Flavonoids in Qing Pi might inhibit effectiveness of Tamoxifen

Potential to Benefit Potential to Harm

Research into the TM materia medica produces new

biomedical drugs that can impact global health:

Artimesinin, derived from Artemisia annua L.

Oseltamivir (Tamiflu), derived from star

anise

C. Workforce Expansion

Traditional Healers can help to fill the workforce shortage (2 million+ HCP’s) HIV/AIDS prevention Health promotion , health care

provision, lay mental health counseling

Curbing harmful TM practices, encouraging beneficial ones

Clinic referrals Crucial points:

Healers can help or harm! Programs can succeed or fail

D. Culturally Competent Engagement

Health-seeking behavior is partially based on EMs

Ignorance or insensitivity may impact success.

Examples: hot/cold dichotomies cerebral malaria Biomedical tx for

proximate causes TM for efficient causes

Call it E. Coli or “Damp Heat,”it’s still the runs . . .

E. Dollars & DALYs

III. What is WHO’s Position on TM?

WHO &TM: A Brief History

1948 WHO’s Constitution defines health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease”

1978: The Alma Ata (Kazakhstan) Declaration on primary care includes “traditional practitioners as needed” and noted that they should be suitably trained

2008: Beijing Declaration on TM TM, primary care, and MDGs as interrelated Varying national needs and circumstances Importance of education, communication, and collaboration

WHO’s: Traditional Medicine Strategy,

Develop sound policy on licensing, regulation, and incorporation

Ensure safety, efficacy, and quality for utilization and surveillance

Provide equitable access to beneficial TM to protect health, promote sustainability, and protect rights

Establish rational use for patients, providers, and health care collaboration between TM and biomedicine

Dr. Chan Endorses TM . . . But Makes An Important Point

Dr. Chan’s Key Point:

“Traditional medicine has much to offer, but it cannot always substitute for access to highly effective modern drugs and emergency measures . . . . This is not a criticism of traditional medicine. This is a failure of health systems in many countries to deliver effective interventions to those in greatest need, on an adequate scale.”

The Challenges Global Health

Utilize the benefits that TM can provide Exploit the potential of TM providers to meet other

primary care needs Devise rational use strategies to maximize

beneficence and minimize maleficence ****************************** 19 WHO Collaborating Centers, including

NCCAM and College of Pharmacy at UI Chicago

IV. TM Successes and Failures

Success: FRLTH--Home Herbal Gardens in South India

Foundation for Revitalization of Local Health Traditions in Bangalore

Researches local herbs for common “OTC” conditions, helps rural families and communities to set up home health gardens (herbs and fruits), and trains in appropriate use

50-80% decline in health care costs among participating families

Importance: families pay 70-85% of healthcare costs, a significant cause of rural indebtedness

190,000 gardens now in use

Success: THETA Uganda--HIV/AIDS Education & Collaboration

Traditional Healers and Modern Practitioners Together Against AIDS and Other Diseases

Collaborates with MoH and research universities to studyTM

Has trained +/- 3000 healers Communities with THETA

trained healers have higher levels of knowledge about HIV/AIDS

Traditional healer referral rates to biomedical doctors increase by 90%

But failures provide a cautionary tale . . .

Ugandan Male with Lymphoma

Sought traditional healer.

Confused by biomedical diagnosis.

Besides, he had no money to pay for chemotherapy since free drugs were unavailable at the time.

Treated by a Traditional Healer

The healer injected the nodes until necrotic.

Healer did not refer to a biomedical provider; nor did he understand malignancy.

Lymphoma spread.

I met this man when he was dying in hospital .

The Bottom Line

Depending on the circumstances, TM is both an important asset of culturally competent global healthcare delivery and a symptom of failure and structural violence.

TM is a tool in a multi-disciplinary GH arsenal Avoid ignorant skepticism & wishful optimism TM and biomedicine: not an either/or scenario