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THE ETHNOMEDICAL USE of BLACK DRINK to TREAT IRON DEFICIENCY ANEMIA in BASTIMENTOS, PANAMA by CASSANDRA NELSON DOOLEY (Under

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THE ETHNOMEDICAL USE of BLACK DRINK to TREAT IRON DEFICIENCY ANEMIA in BASTIMENTOS, PANAMA by CASSANDRA NELSON DOOLEY (Under THE ETHNOMEDICAL USE OF BLACK DRINK TO TREAT IRON DEFICIENCY ANEMIA IN BASTIMENTOS, PANAMA by CASSANDRA NELSON DOOLEY (Under the Direction of Diane K. Hartle) ABSTRACT Iron deficiency anemia (IDA) is the most common nutritional deficiency in the world and intestinal parasites are estimated to be responsible for 30-57% of IDA cases (Yip 2001; Stoltzfus 1997). With an iron-poor diet and the high incidence of blood-sucking helminthes, the people in Bastimentos, Panama struggle with IDA. Black Drink is the ethnopharmacological answer to these pathologies. It is prepared with juice from Citrus aurantifolia, a cast iron vessel, and three biologically active plants, Stachytarpheta jamaicensis, Hyptis suaveolens, and Senna spp. The iron content and the pharmacognosy of the plants used to prepare Black Drink are investigated here. Analysis of Black Drink revealed an iron content of 2.5% indicating a dose of iron comparable to that prescribed by U.S. physicians for IDA. In Bastimentos, Panama, Black Drink is an effective, affordable, two-prong strategy for the treatment of IDA, intestinal parasite burdens, and is congruent with the popular therapeutic traditions. INDEX WORDS: Panama, Black Drink, iron deficiency anemia, intestinal parasites, hookworm, Stachytarpheta jamaicensis, Hyptis suaveolens, Senna spp., Citrus aurantifolia THE ETHNOMEDICAL USE OF BLACK DRINK TO TREAT IRON DEFICIENCY ANEMIA IN BASTIMENTOS, PANAMA by CASSANDRA NELSON DOOLEY B.S., The University of Georgia, 2001 A Thesis Submitted to the Graduate Faculty of The University of Georgia in Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE ATHENS, GEORGIA 2004 © 2004 Cassandra Nelson Dooley All Rights Reserved THE ETHNOMEDICAL USE OF BLACK DRINK TO TREAT IRON DEFICIENCY ANEMIA IN BASTIMENTOS, PANAMA by CASSANDRA NELSON DOOLEY Major Professor: Diane Hartle, Ph.D. Committee: Elois Ann Berlin, Ph.D. Phillip Greenspan, Ph.D. Electronic Version Approved: Maureen Grasso Dean of the Graduate School The University of Georgia May 2004 DEDICATION I dedicate this work to my Panamanian grandmother. I learned that it is possible to be a true wise woman without ever attending school, learning to read, or write. This work is in honor of her abilities as a healer and a botanist. iv ACKNOWLEDGEMENTS I want to acknowledge my mentors from the ICBG-Maya, who gave me my first opportunity to work in the field of ethnobotany, medicinal plants, and drug discovery: Dr. Dave Puett, Dr. Elois Ann Berlin, and Dr. Brent Berlin. Next, I thank Fulbright for the chance to independently create an ethnobotanical study in Bocas del Toro, Panama. The Nutraceutical Laboratories, my major professor, Dr. Diane Hartle, and Dr. Greenspan welcomed me warmly, challenged me in the field of pharmacology, and shared enthusiasm for natural products and countless laughs with me. Finally, my friends and family provided the reassurance and emotional support to persist when I questioned my own abilities. I am deeply grateful to all of these people for their contributions to my success. v TABLE OF CONTENTS Page ACKNOWLEDGEMENTS.............................................................................................................v CHAPTER 1 INTRODUCTION.........................................................................................................1 Fulbright Fellowship in Panama ...............................................................................1 Introduction to Black Drink ......................................................................................1 What is Ethnopharmacology? ...................................................................................2 Ethnomedicine in Bastimentos..................................................................................2 Iron Deficiency Anemia and Intestinal Parasites ......................................................2 Hypothesis.................................................................................................................3 2 BACKGROUND...........................................................................................................4 Geography of the Area ..............................................................................................4 Socio-Economic Situation in Bocas del Toro Province and Bastimentos ................9 Health-Care in Bocas del Toro and Bastimentos ....................................................10 3 IRON DEFICIENCY ANEMIA..................................................................................12 Iron-Containing Molecules in the Body..................................................................12 Iron Absorption and Transport................................................................................14 Iron Storage.............................................................................................................14 Iron Homeostasis .....................................................................................................15 Dietary Sources of Iron...........................................................................................17 vi RDA of Iron............................................................................................................19 Iron Deficiency Anemia..........................................................................................19 Drug Treatment for IDA .........................................................................................26 Iron Toxicity and Free Radicals..............................................................................26 The Case of Iron Deficiency in Bastimentos, Panama............................................28 4 BLOOD-SUCKING INTESTINAL PARASITES ......................................................30 Intestinal Parasites that Cause IDA.........................................................................30 Hookworm Prevalence and Geographic Distribution.............................................32 Hookworm Life Cycle.............................................................................................33 Effects and Symptoms of Hookworm Infection in Humans ...................................33 Ascaris lumbricoides and Trichuris trichiura .........................................................35 Iron and Blood Lost to Intestinal Parasites .............................................................35 Impact of Intestinal Parasites on Hemoglobin ........................................................37 Hookworms During Pregnancy ..............................................................................39 Anthelminthics Reverse IDA..................................................................................41 Anthelminthic Drugs...............................................................................................41 Intestinal Parasites in Bastimentos..........................................................................45 5 ETHNOMEDICAL SYSTEM IN BASTIMENTOS, PA ...........................................47 Ethnomedicine in Bastimentos................................................................................47 Bush Medicine.........................................................................................................47 Medicinal Plant Knowledge ...................................................................................48 Bush Doctors in Bastimentos ..................................................................................48 Role of Humors in Bastimentos Ethnomedicine.....................................................48 vii Blood: The Most Important Humor .......................................................................49 “Low Blood is Not Low Blood Pressure”...............................................................52 6 ETHNOMEDICAL USE OF BLACK DRINK FOR IDA..........................................54 Black Drink Recipe .................................................................................................54 Ethnobotany of the Plants in Black Drink...............................................................58 7 GENERAL METHODS ..............................................................................................64 8 RESULTS ....................................................................................................................65 Iron Analysis ...........................................................................................................65 Pharmacognosy of the Plants in Black Drink..........................................................65 9 DISCUSSION AND CONCLUSIONS.......................................................................76 Future Work: Ministry of Health in Bocas del Toro and Bastimentos ..................80 REFERENCES ..............................................................................................................................82 APPENDIX A. Phytochemicals and Biological Activities in Black Drink...................................95 viii CHAPTER 1 INTRODUCTION Fulbright Fellowship in Panama The author was awarded a Fulbright scholarship to study Ethnobotany in Bocas del Toro, Panama from November 2002- August 2003. Bastimentos is an Afro- Caribbean community and Salt Creek is an indigenous Ngawbe group with their own language. Three hundred botanical specimens were collected and identified at the Autonomous University of Chiriqui (UNACHI), and were deposited at the herbariums at UNACHI, University of Panama, and The University of Georgia. International partners are Botanists,
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