MAGAZINE Cover: Aesculapius, God of Medicine. Design by Peter Davies from a wood­ carving in Chur, Switzerland.

Contents

The staff of Aesculapius by H. Mahler 3

Malaysia's bomohs by J. Dauth 4

Balance between man and nature by X. Lozoya 8

The Science of Life by P N. V Kurup 12

Ayurvedic training by K. N. Udupa 15

WHO's Programme by R. H. Bannerman 16

New status for the hilot by A Mangay-Angara 18

Study Tour in China 22

Plants that heal by 0 Ampofo 26

News Page 31

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2 The staff of Aesculapius BY DR HALFDAN MAHLER Director- General of the World Health Organization

If we had to justify the inclusion mately eliminated. The neglected 80 per include personal hygiene, mother and of traditional medicine within cent of the world's population have their child care (including family planning), the compass of the World rights too; they too have an equal claim nutritional guidance, immunization Health Organization, we need to health care, to protection from the against the major infectious diseases, ele­ look no further than the oppo­ killer diseases of childhood, to primary mentary treatment of all age groups for Isite page. The emblem of WHO superim­ health care for mothers and children, to the common diseases and injury, and a poses on the globe the staff of Aescula­ treatment for those ills that mankind has basic understanding of sanitation and pius, ancient god of medicine, entwined long ago learnt to control if not to cure. environmental hygiene. They can at the by a snake. The god's serpents were said Two years ago we in WHO pledged same time be weaned away from any to lick the wounds and lesions of the sick ourselves to an ambitious target: to pro­ practices that might pose possible risks in their sleep and thus to heal them. vide health for all by the year 2000. This for their patients. For far too long, traditional systems of ambitious goal is, quite simply, beyond The age-old arts of the herbalists too medicine and "modern" medicine have the scope of the present health care sys­ must be tapped. Many of the plants gone their separate ways in mutual anti­ tems and personnel trained in modern familiar to the "wise-woman" or the pathy. Yet are not their goals identical­ medicine. With but 23 years to go, and "witch-doctor" really do have the heal­ to improve the health of mankind and since it is unlikely that the least devel­ ing powers that tradition attaches to thereby the quality of life? Only the oped countries can even dream of having them; the pharmacopoeia of modern blinkered mind would assume that each enough of the orthodox type of person­ medicine would be poorer if one has nothing to learn from the other. nel, it is clear that unorthodox solutions removed from it all the preparations, Unfortunately that divergence be­ must be sought. The training of health chemicals and compounds whose origins tween the two systems of medicine has auxiliaries, traditional midwives and lie in herbs, funguses, flowers, fruits and almost exactly paralleled the division of healers may seem very disagreeable to roots. the world between the rich and the poor. some policy makers, but if the solution Let us not be in any doubt: modern Too often the privileged and well-to-do, is the right one to help people, we should medicine has a great deal still to learn living in large towns and cities, enjoy have the courage to insist that this is the from the collector of herbs. And already access to all the complex technology and best policy in the long run, and is by no a number of Ministries of Health, in the lifesaving apparatus of modern medi­ means an expedient acceptance of an developing countries especially, are care­ cine. Tens of millions of people have no inferior solution. fully analysing the potions and decoc­ such access; for them the traditional This is why WHO has proposed that the tions used by traditional healers to deter­ healer, the herbalist and the traditional great numbers of traditional healers who mine whether their active ingredients birth attendant are the only agents of practise today in virtually every country have healing powers that "science" has health care to whom they can turn. Not of the world should not be overlooked. overlooked. Whatever the outcome of only are most of the rural areas of deve­ For the most part they are already living such scientific testing, there is no doubt loping countries without a single quali­ in those remote communities, intimately that the judicious use of such herbs, flow­ fied physician, but on the average they involved with the life there, conscious of ers and other plants for palliative purpo­ do not have more than one auxiliary their neighbours' needs and trusted by ses in primary health care can make a health worker for 10,000 persons. In them. Many such healers have already major contribution towards reducing a some parts of the world, even when undergone elaborate training in ancient developing country's drug bill. modern medical care is available, the systems of medicine that had evolved The present issue of World Health majority actually prefer the traditional reliable methods of treatment and pat­ illustrates just a few of the aspects of healer, whom they know and trust. terns of medication long before modern traditional medicine in different parts of But the political winds of change that medicine came along. Other healers have the world, and indicates the contribution have been sweeping the world in recent had their skills handed down through the that its practitioners could make towards decades have been matched by winds of generations-the distillation of a surpris­ better health care, and primary health change in community health: a newly ing degree of practical knowledge, skills care in particular-an aspect to be high­ awakened global social conscience and wisdom about the physical, mental lighted at the WHO conference on pri­ requires that the health gap between rich and psychological ills of mankind. mary health care scheduled for 1978 at and poor within countries and between Provided they are willing, such tradi­ Alma Ata in the Soviet Union. countries should be narrowed and ulti- tional healers and local midwives can, at Given goodwill on both sides, such an a very moderate expense, be trained to army of healers, traditional birth atten­

"To treat a mentally-ill young woman, the healer staged a kind of theatrical performance ln which her closest relatives and fellow-villagers each had a role to play"

BY JURGEN DAUTH

"The sky suddenly went dark Whether they are Malays, Indians or soul and their lifegiving power known as and the jungle fell silent", a Por­ Chinese, whether Moslems, Hindus, semanganat. They have not the least ,.. ..,...,"'"'...,. tuguese seaman wrote nearly 200 Buddhists or Christians, all of them doubt that illness is caused by evil spirits. years ago, describing his first en­ remain to this day firmly rooted in the And only the bomoh has mastered their counter with a Malayan bomoh. belief in spirits, their influence on the tongue, can overcome them or can con­ The magic of these spiritual healers may jure up guardian spirits to take their not run to such extremes but, all the place. t The medical treatment undertaken by same, the people of the Malacca peninsu­ ~ ·~~~ la ascribe supernatural powers to the '' the bomoh invariably revolves around a bomohs which are still being demon­ ritual exorcism. The bomoh hands out strated to this day, according to popular amulets against the "evil eye" or pre­ belief. Didn't a bomoh cause the hitherto scribes magic spells which are based on incessant monsoon rains to stop for a astrological lines and may be written on day at the request of the Ruler of Sara­ paper, the leaf of a plant or on leather wak? Didn't another invoke blazing sun­ hide. Texts and magic symbols may be shine for the open-air boxing match of taken from the Koran in the case of Mohammed Ali (formerly Cassius Clay) Moslems, while the Chinese Buddhists some three years ago, while rain poured and Taoists swear by the traditions of down in torrents all round the stadium? their homelands, and the Christians con­ The Malaysians are convinced that these tent themselves with reciting the Lord's things happened. Prayer backwards. However, Professor Paul Chen of the The bomoh may put a medium into a Medical Faculty of the University of trance in order to arrive at a diagnosis or Malaya foresees a more important he lets the illness declare itself from the sphere of influence for the traditional mouth of a hypnotised patient. Incanta­ medicine men. In his view the bomohs tory music on an instrument called a have always ha<;l an essential role to play game/an, dances and burnt offerings- in in the nation's health care, and he is con­ which the hair or finger-nails of the vinced that magic ritual and the psycho­ patient play a major role-complete the therapeutic understanding derived from ritual. it by the Malaysian medicine man, The enlightened student of medicine as well as his subtle knowledge of the may loftily dismiss all this ceremonial as healing powers of Nature, represent im­ Above: A M ...... prepares a so much charlatanry, but that would be portant contributions to medical science. herbaloffering to ward off evil spirits. too hasty a judgment. Because on closer Certainly Malaysia will need its bomohs study black magic is seen as only a ght: A basis of practical knowledge un­ for some time to come, since at present derlies the spiritual healer!srulings on w superficial framework to prepare the only 2,350 modern physicians supply to .eat certain fruits wh!?n tfz~y '"ar. patient for the real medical treatment. It health care to the 12 million Malaysians forbidden-taboo. is precisely in this that Professor Chen while there are 20,000 practising bomohs . '"·"i sees the special advantage that the offering their services. (P 1f0j£. , bomohs have over the modern doctor.

4

In Malaysia- as in most countries of propriate diets or physiology- for exert­ the blood.-pressure to make "bleeding" the world- the doctor hardly has the ing a favourable influence on the course unnecessary. time to concern himself about the psych­ of an illness. The tropical vegetation and tropical ic origins of many illnesses, and the top­ The modern practice of medicine in fauna, with their rich variety of forms, heavy doctor-patient relationship, gener­ Malaysia makes use of the bomoh as an are the sources of the bomoh's pharma­ ally speaking, permits only a scientific assistant at childbirth, for instance, often copoeia, and stocking it is based upon approach. Yet for a long time scientific in collaboration with a state-trained mid­ the knowledge handed down over the medicine has acknowledged that on its wife. And nobody would wish to deny centuries that for every poison in nature own it is incapable of getting to the root that the psychological attitude of the there is a natural antidote. of sickness. mother-to-be has great influence on the The sap of the mangrove trees serves The bomoh, on the other hand, says course of a " natural" childbirth. Individ­ as a remedy for bowel and stomach Professor Chen, lives in the village where ual bomohs are also entrusted with carry­ disorders, causing vomiting which he has inherited his skills from his fore­ ing out mass immunization and help purges the intestines. The betel-nut is fathers, and where he is a respected and the doctors with such tasks as smallpox prescribed for parasitic worms, and the trusted person. He is personally ac­ vaccination. dried roots of the pomegranate can quainted with every one of his fellow­ As regards operations, the bomoh strengthen this action. Pineapple juice is villagers and knows what goes on behind limits himself to ritual bleeding. Accord­ a remedy for indigestion and overeating. the scenes. He can make use of the ing to local belief, blood is the bearer of Skin eruptions, often originating from knowledge that a healthy body needs a the life force and must not be overbur­ poisonous plants or insect bites, can be healthy spirit in a way that few doctors dened. Thus opening an artery may be cleared up by the application of tea-oil. can. So long as belief in spirits is a fact of prescribed for headaches and vertigo; In rural areas, sexually transmitted life, it is useless to inveigh against magic either the skin is pierced or leeches are . diseases are very rare, yet even for these ritual. In any case, superstition is far applied. The bomoh obtains antiseptic the bomoh has a cure. Against syphilis from being confined only to developing preparations from extracts of plants or he may use the root of a certain legumi­ countries- it maintains a clandestine from the poison sacs of certain sea-fish. nous plant which he calls " hantu" or hold even among the crews of moon­ Painkilling potions can be distilled from spirit. The remedy for gonorrhoea bound spaceships. the areka-n ut, better known as the betel­ sounds rather more drastic ; a certain On the East coast of Malaysia I watch­ nut. The right dose of poison taken from green beetle is made into a powder and ed an exorcism of evil spirits carried out one particular fish can sufficiently lower added to the patient's food . Even more on a well-born but mentally disturbed surprising for the scientist is the cure for young woman. The bomoh had staged a toothache in children: a hair from the kind of theatrical production in which tail of an elephant. Against rheumatism, the woman's closest relatives and her the Dayaks of Malaysian Borneo insist, fellow-villagers each had roles to play. It the best remedy is tiger-fat. was noteworthy that the actors in this For sure, religious motives are in­ little play had to demonstrate warm af­ volved for declaring certain plants taboo fection for the patient. Embraces, friend­ and forbidding the combination of cer­ ly gestures and tender caresses were tain foods, but there can be no doubt much in evidence. The play took on an that here too there is a basis of practical increasingly frenetic character with knowledge. Thus mangoes are not eaten dance-like movements, until those taking with sugar, nor water-melons with honey part fell into a trance and finally reached nor heart of coconut-palm with shellfish total physical exhaustion. The coaxing of or oysters. Such combinations are the evil spirit which had caused the ill­ viewed as poisonous or at least highly ness with an offering of food until it . indigestible. Beef, mutton, mangoes and could be caught in a container and pumpkins are to be avoided in cases of packed off on a "journey without fever, eye diseases or gonorrhoea, while return" down the river was merely a eggs and milk are recommended. On the ritual appendage. The young woman was other hand, eggs, dried fish and brown now considered to be cured. I heard that sugar are stricken from the menu in the the bomoh had passed the whole of the case of bronchial troubles. And "the previous day before the ceremony in the worm of night blindness" rises to the house of her family so as to "get in touch eyes if one eats only sweet potatoes or with the spirit". Only in its outward bananas. Vitamin A deficiency can be appearance does this treatment differ Above: Before applying the healing power avoided by a special diet of fish , mutton of his hands, the bomoh tells his patients to from what is accepted in the industria­ breathe deeply and then puts them into a or liver. lized world as group therapy under ex­ trance. Many more examples could be given pensive psychiatrists. of the bomoh's pharmacopoeia. In Pro­ The bomoh also works extensively Right: A healer shows off his totem- the fessor Chen's opinion it contains many with taboos which are invested with source of his magic powers. So long as hidden virtues which amount to the magic powers. Certain foods are forbid­ belief in spirits is a fact of life, it is useless stored-up knowledge of an entire chemis­ den, the physical stresses on the patient to inveigh against magic ritual. After all, try laboratory. Closer study of this could are limited or specific rituals are used to superstition is far from being confined only be of value to modern medicine, once soothe his nerves. This too is a very to developing countries; it is to be met with one discounts the special links with the practical means- among simple people even among the crews ofspaceships heading supernatural; yet this too may have its for the moon! (Photos WHO/I. Dauth) who know little of modern hygiene, ap- psychological advantages. •

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Balance between man and nature

BY XAVIER LOZOYA

Among the countries forming temporary society mainly takes the form medical care are still far from meeting that part of the American con­ of an unequal distribution of resources, the demands of a fast-growing popula­ tinent known as Mesoamerica, means that not all the population is able tion. In the framework of such social, Mexico enjoys a special position to benefit from health care. The result is economic and historic realities, Mexican thanks to the pre-Colombian that 40 per cent of Mexico's population traditional medicine and the medicinal Icultures which once flourished on its today still has recourse to traditional plants themselves are crucially important territory. The wide variety of climates medicine- the medicine of the poor­ to the future development of national and soils found here meant that its in­ which is enshrouded in magic and mys­ public health policies. habitants acquired a profound know­ tery. If we are to elevate the various combi­ ledge of medicinal plants and hence of On the world scene, the study of her­ nations of treatments and drugs to the medical science itself. The ancient Mex­ bal medicine in Mexico is of special point where traditional medicine occu­ icans collected, catalogued and used interest because of three factors: its rich pies the position it deserves, we have to these plants, integrating them into a heritage of curative plants, the continued re-examine and re-value popular medi­ vision of the universe whose basis was as use of such plants among a large propor­ cine so as to bring it level with the mod­ much practical as religious. Although no tion of the population, and the wealth of ern scientific knowledge which now precise documentation remains to us available information- whether historic, serves the health of many people. In about the experimentation that must archaeological, botanical or traditional. order to undertake this laborious task, a have been undertaken at that time, the Moreover Mexico, as a developing coun­ complete analysis is needed of all infor­ information that has been handed down try, is grappling with the reality of vast mation relating to medicinal plants, the testifies to a broad understanding of the public health problems. The efforts made way they are used and their characteris­ curative properties of Mexico's flora. so far to introduce "Western" forms of tics. These studies will enable us to prove The chronicles and manuscripts of that the advantages and benefits of the practi­ bygone age contain descriptions of flou­ cal, empirical knowledge which has sur­ rishing botanical gardens and parks with vived the passage of time. When submit­ rich collections of plants, as well as quite ted to rigorous scientific analysis, the precise information about their use. results could give rise to a new type of Ever since the fusion of cultures that research going far beyond the limits of followed the Spanish Conquest in the chemical and pharmacological analysis, 16th century, Western medicine has tried but not dissociating itself from the anth­ to analyse the ancient medical wisdom, ropological reality in which traditional hoping to find among such cultural relics medicine is so deeply rooted. as remain a correct interpretation of the Starting from this multidisciplinary vision left by those early explorers. In the standpoint and with the object of pro­ course of time a wide spectrum of evi­ moting and justifying the usefulness of dence has emerged from a variety of Mexican medicine, the Mexican Institute cultural sources, all of it tending to con­ of Medicinal Plants (IMEPLAM) has incor­ firm the balance that exists between man porated its activities within the research Above: Traditional medicine in Mexico is and nature. rooted in the rich soil offolk-wisdom hand­ programme of Appropriate Technology As the centuries have unfolded, the ed down from earlier civilizations. at the Third World Centre for Economic rich grain of native knowledge has stead­ and Social Studies ( CEESTEM). ily evolved among the mixed-blooded Right: This old man in the marketplace of We have plenty of information about population of Mexico. Rooted in past Oaxaca, south-central Mexico, is the prod­ Mexican medical plants and will confine civilizations and nourished by fresh in­ uct of the fusion of cultures that followed ourselves here to those with special im­ sights into the art of medicine, that grain the Spanish Conquest in the 16th century. portance for public health, which have Today, 40 per cent of the country's popula­ has ripened into methods of treatment been given priority in IMEPLAM's research tion still has recourse to traditional medi­ which are quite distinct from those based cine, enshrouded in magic and mystery but programme. on modern science, and flourishes today still based on a very practicalfrarnework. Our Institute's systematic study of as what we call "traditional medicine". (Photos WHO) medicinal plants first of all entailed an Unequal development, which in con- interdisciplinary effort to collect a

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Balance between man and nature

Left: A symbol of M exico, the maguey cactus flourishes everywhere. Its fleshy leaves yield a juice which is f ermented into pulque, the national drink. (Photo WHO)

Right : This housewife in the Yucatan peninsu­ la takes for granted the fact that the plants gro wing around her home have medicinal uses. The study of such plants should serve to upgrade the status of popular knowledge, and thus lend scientific support to the practice of traditional medicine. (Photo WHO/P. Almasy)

bibliography of everything published in scientific support to the practice of tradi­ between these substances and the cura­ Mexico from the 16th century until mod­ tional medicine. tive effects attributed to the plant ern times, and to subject it to different Here are some of the most popular remained obscure. Its very extensive use levels of interpretation, classification and Mexican plants, representing the three puts it among the most important plants analysis. This also enabled us to start groups to which priority was given . in Mexican traditional medicine. creating a bank of information on medic­ Casimiroa edulis, Rutaceae. Among inal plants, already in full swing and Plants with cardiovascular the sweet edible fruits described by the illustrating in part what we know about properties: Aztecs figure those of the Casimiroa plants with cardiovascular, anti-diabetic Talauma mexicana (D.C.) Don. Mag­ edulis, a tree mentioned in the descrip­ and anti-parasitic properties. This infor­ noliaceae. This large tree with beautiful tions of the period by the name of mation is being compared with modern flowers has been known and used since " Cochitzapotl"- the fruit that brings botanical studies with the object of iden­ pre-Hispanic times ; its name in Nahuatl sleep. Today, its use is very widespread tifying a group of medicinal plants which (the language of the Aztecs) is Yolox­ almost everywhere in Mexico for the may then be submitted to a global study. ochitl or Heart Flower, and was given beneficial effects on the blood pressure Examining the existing data in Mexico because of the properties attributed to its which are attributed to its leaves and its reveals that, although medicinal plants flower, bark and leaves as cardiac stimu­ seeds. Certainly this is the most favoured have been the object of research under­ lants. traditional prescription for producing a taken at various times and according to A decoction made from the leaves and slight but long-lasting regularisation of the different trends of scientific thought flowers is still used to treat various car­ the blood pressure. that have influenced Mexican science, diac ailments. Scientific research into this Although this fruit has been repeated­ the vast majority of studies made have plant dates from the last century when ly studied over the years, the experimen­ been undertaken unilaterally, aiming at chemical and pharmacological studies tal proof of its action on the blood isolating the active ingredients but confirmed its tonic effect on the heart­ pressure has only recently come to light without ever succeeding in creating a increasing the heartbeat, and regularis­ in our laboratories. We have determined national pharmaceutical industry. That ing cardiac contractions. how the active ingredient present in the is why most studies, while providing The chemical composition of the aqueous extracts used as popular reme­ useful preliminary information, ought Talauma was at least partially discovered dies actually functions. The property at­ rather to be combined with a social around the 1950s, when it was found to tributed to the fruit of " soothing one to objective- that of upgrading the status include certain alkaloids such as talau­ sleep" has been confirmed as resulting of popular knowledge, so as to lend mine and aztequine. But the relationship from reduced blood pressure sustained

10 by dilation of the blood vessels; acting without apparent side-effects. Toxicolog­ similarly employed . Pharmacological on the autonomic nervous system, this ical considerations will require further studies have shown that aqueous extracts facilitates the spontaneous onset of sleep. study. Traditional medicine also uses of Tecoma administered orally cause an The decoction made from the Casimiroa two other kinds of Chenopodium- foeti­ increase in the level of glucose in the also contains another substance possess­ dium and graveolens for the same pur­ blood and thus help to palliate the types ing powerful properties as a constrictor pose. of diabetes for which this treatment is of the womb, which explains why this Cucurbita maxima, D. Cucurbitaceae. particularly indicated. plant is not prescribed for pregnant The seeds of pumpkins cultivated in the Coutarea Latiflora, D.C. Rubiaceae. women. hot lowlands of Mexico are used by local Commonly called " Copalchi", the bark people in the form of an aqueous emul­ of this shrub is traditionally known for Plants with anti-parasitic sion, or as a refreshing drink mixed with its anti-diabetic effect. Its diuretic prop­ properties: sugar, for treating various intestinal erties in particular are valid for diabetics, Chenopodium ambrosioides, L. parasites. These remedies have proved and the increased volume of urine elimi­ Chenopodiaceae. Known in Mexico by effective against tapeworm. They are nated is accompanied within 24 hours by the name "Yapotzotl", its Spanish name also used to treat different forms of a diminution in the amount of glucose is Epazote and its US name American intestinal parasites since they are often, secreted, and results in a general im­ wormseed. It figures in the recipe of though incorrectly, substituted for the provement in the patient's condition. many Mexican dishes and is widely used seeds of Cucurbita pepo L. , which has Traditionally the bark is used in powder as a parasite-expellent. A herbaceous similar but much less specific properties. form decocted in alcohol and adminis­ plant with a strong odour reminiscent of tered orally. camphor and a sharp spicy flavour, it Plants with anti-diabetic There are many such representative owes its anti-parasitic activity to the properties: examples of traditional medicinal plants. volatile oil with a concentration of 0.35 Tecoma mollis, H .B.K. Begoniaceae. The more they are investigated and stud­ per cent contained in its leaves. Under a great variety of popular names, ied in the light of a science which once It also contains such alkaloids as que­ depending on the region of origin, the more reverts to serving the public good, nodopine, colina and tannin, as well as "nixtalaxochitl" refers as much to the more they will contribute to the ascaridole. Its effects are powerful and T . Mollis as to T. Stans, all well-known development of a system of medicine 20 grammes of the plant administered in in traditional medicine for their anti­ adapted to the needs, the cultural the form of a decoction suffices to pro­ diabetic action. It is often associated demands and the overall health of our duce a rapid parasite-~xpellent effect with Leucophyllum tenaxum, which is country. • 11 The science of life

BY P. N. V. KURUP

Human nature instinctively influenced by local civilization, religion food which again is composed of these seeks relief from pain and dis­ and tradition, and have evolved through very elements that replenish or nourish ease. This basic instinct trial and error, keen observation, intui­ the body. Man is therefore a micro­ prompted man, through the tion, accumulated experience, folk cus­ cosm within the macrocosm, the universe, ages, to analyse the phenomenon toms and ancestral beliefs. With the since all the basic constituents of the Iof nature and obtain clues to help him development of civilization these systems universe are also present in him. ameliorate pain and disease. His ex­ attained some scientific status. The When there is an imbalance in any or periences led to empirical methods of concepts regarding the nature of disease all of these essential attributes of the healing which in due course crystallized and its underlying causes are based on body, the individual falls prey to sick­ into distinct systems of medical practice. the fundamental doctrines of each sys­ ness. The mind of a person is classified Although modern or " western" medi­ tem. Whereas the early founders of mod­ broadly into three categories- satva, cine is generally accepted throughout the ern medicine initiated the pattern of ob­ rajas and thamas. This science also clas­ world, yet it has not been able to reach serving the sequence of symptoms for sifies the person according to his consti­ the remote rural areas of the world for diagnosis and prognosis, traditional tution and natural disposition into seven various reasons. The developing coun­ medicine had a highly developed science distinct types based on the three tries, with their meagre financial not only for diagnosis and prognosis but humours. The identification of these resources, cannot avail themselves of the also for determining the cause and treat­ characteristics in a person gives impor­ services of modern medicine in view of ment of diseases. Urine, stool and spu­ tant clues to the physicians as to how to the huge investment involved in estab­ tum tests were conducted by traditional treat the disease and bring the body back lishing and maintaining modern clinics practitioners many centuries before these to its original harmony and health. Thus and hospitals. The traditional systems of techniques were known to modern medi­ Ayurveda looks at the whole body and medicine, however, still tend the health cme. mind, and not merely at external or inter­ needs of most rural populations of the A number of well-defined and well­ nal factors as the contributing causes of world , and find patronage also in urban developed traditional systems are pre­ the disease, in deciding the appropriate areas. valent in various parts of the world. remedy. The traditional healers, herbalists, spi­ Among them, Ayurveda, Unani and It is a fully developed science, with ritualists, and birth attendants constitute Chinese medicine occupy the foremost eight different branches covering the a vast resource of practitioners outside place as the most ancient and best devel­ whole of medical science. A wide range the official health services. Their oped of these systems. Nature cure and of books written by scholars and special­ methods of diagnosis and treatment vary Yoga also have followers in many parts ists have enriched the classical and con­ from region to region, and some of their of the world for their therapeutic value temporary literature of Ayurveda. Its practices are similar to modern medicine. and in general as a means to maintain materia medica is stupendous and con­ For example, in certain tribal communi­ positive health and well-being. tains as many as 8,000 published recipes. ties the traditional healer applies his ear Ayurveda literally means the Science This may be an under-estimate if unpub­ close to the patient's chest to listen to the of Life. The doctrine of Ayurveda postu­ lished recipes held as " family secrets" by heart beats and diagnose disease. lates life as the union of body, the senses, traditional practitioners are also taken Such practices as cupping, cauteriza­ mind and the soul ; the living man or the into account. Some 1,200 drugs are in tion or showering mineral water over the man of action is said to be a well­ frequent use either in the form of single head (for curing headaches), when admi­ balanced combination of three humours, drugs or as compound formulations. In nistered by the practitioners, are said to seven basic tissues and three excretions. the South-East Asia Region, as many as be effective in curing metabolic and Everything in the universe including the 800 pharmacies are active in the private psychic disorders. In South-East Asia the physical body is composed of five ele­ and public sectors, and many employ chanting of mantras (mystic incanta­ ments or substances (panchabhutas), tions) to cure jaundice and even snake namely prithvi, ap, tejas, vayu and aka­ bites is still a prevalent practice. sha. These elements combine in different A patient undergoing Thirummal treatment, in which his body is covered with medicated oil Such traditional methods, grounded in proportions to suit the specific needs of and massaged delicately by hand or foot: one some kind of rudimentary medical prac­ different structures and functions of of the accepted techniques of Ayurveda- the tice, have mellowed in the course of time the body, whose growth and develop­ "science of life ". ( Photo WHOjP. Kurup ) into well-defined and distinct systems ment depend on its nutrition, that is, on

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drugs are determined according to the temperaments. As in Ayurveda, Unani physicians attach great importance to diet as well as medication. The Siddha System of medicine prac­ tised in Tamil-speaking parts of South­ East Asia also has a long and rich tradi­ tion. Its unique feature is that it makes extensive use of minerals and metals, especially mercurial preparations, and has made notable advances in developing organic compounds for treating various di seases. The Tibetan system of medicine has drawn considerable knowledge from Ayurveda and has been influenced by the Chinese system. It also makes use of drugs of plant, mineral and animal ori­ gin. Cauterization at special points in the head is carried out by Tibetan practition­ ers in treating mental disorders. Pulse examination has attained a high degree of perfection especially in the Ayurvedic, Unani and Tibetan systems, which have established a correlation be­ tween pulse behaviour and humoral im­ balance. The institutionally trained tra­ ditional practitioners now take advan­ tage of modern diagnostic aids in their day-to-day practice. Within many of these traditional sys­ tems, facilities are available for impart­ ing systematic and comprehensive train­ Cauterization, the application of heat, is centres in the human body which are ing at graduate and postgraduate levels. a recognized form of treatment for certain termed marma. To treat diseases in or In fact institutional training is almost a mental disorders under the Tibetan system of originating from these marmas, certain century old in this region. In India alone medicine, which draws on both Ayurveda and highly effective techniques are practised there are about 500,000 practitioners, a Chinese traditional healing. in South India. The process, called quarter of whom have received regular (Photo WHO/P. Kurup ) Thirummal, consists of applying medi­ training in recognized institutions, which cated oil all over the body followed by number about 115. Of these, 98 colleges modern techniques for the manufacture various types of delicate massage not exclusively offer training in Ayurveda, of medicines. Traditional methods of only by hand but by foot as well. and most are affiliated to the universities. preparing such drugs are so simple that Pizhichal and Navarakizhi are other The curriculum and the period of train­ they could be easily adopted anywhere in ways of treating various diseases of the ing in most of these in stitutions in India the world. nervous system or of musculo-skeletal have now been made uniform. The A broad spectrum of therapeutic origin and other chronic conditions. Piz­ degree course in these systems is spread methods and techniques available to this hichal is a process in which the physician over a period of five and a half years, science ensures that it commands im­ drips medicated oil in a thin continuous including an internship of one year. mense popularity. The Panchakarma stream at constant temperature and pres­ The students are also instructed in treatment, involving five special techni­ sure on to the body and immediately modern practice in some of these institu­ ques, is considered the most important applies massage. In Navarakizhi, a cer­ tions, though most of the time is devoted for metabolic management and for pro­ tain variety of rice is cooked in a mixture to teaching subjects within the medical viding detoxicating and purifying effects of herbal decoction and milk, and the system concerned. Other practitioners while conferring other therapeutic bene­ jelly-like semi-solid mass is then tied up have acquired professional knowledge fits. This is especially beneficial in the in a small cloth sac. The practitioner and skill through their forefathers or by case of neurological disorders, metabolic massages the patient with this sac, mois­ working as apprentices under hereditary diseases, digestive disorders and respira­ tening in from time to time by dipping it practitioners; 239 hospitals and 15 ,000 tory ailments. into the same hot herbal decoction. dispensaries offering treatment in these Rasayana chikitsa is another techni­ The Unani System owes its origin to systems also exist in India. que which not only rejuvenates the body Greece but has absorbed a great deal In integrating these systems within a and enables the patient to live longer, but from native medical systems during its national health care programme, the first also builds up resistance against various long journey through the Arabian coun­ task should be to make a proper ap­ diseases. tries. This is again based on the theory of praisal of the manpower available to A few other techniques which are of the humours. The temperament of each traditional systems of medicine, its com­ comparatively later origin deserve men­ individual is expressed according to the petence and its capacity. Appropriate tion. Ayurveda recognizes certain vital preponderance of these humours, and training in the shape of refresher or

14 reorientation courses should then be of­ fered to the different categories of tradi­ tional practitioners. For example in the training programme for birth attendants, emphasis should be on basic education • regarding pregnancy and child birth, hygiene, gynaecological complications Ayurvedic tra · and the basic principles of infant and child care. After providing appropriate training, all this medical expertise can be absorbed into the main stream of general BY 1(. N. UDUPA health services for the rural population, so that the largest number of people can benefit from an effective and person­ alized service. India is one of the few As ian Th e undergrad ua te curriculum These traditional practitioners com­ cou ntries w here Ayurveda compnses radi ology, pathology, mand the implicit faith and confidence of has bee n given due recog ­ para sitology, microbiology and prac­ their rural clientele, as they form an nition as a system of medi ­ tical laboratory in struction . Th e integral part of the village life. They can cin e for providing hea lth Ayurvedic principles of surgery. gy­ treat most of the common ailments Icare to the people Althoug h there naecology, child health and other which constitute almost 80 per cent of are refe rences to Ayurvedic prin ci ­ allied su bj ects are also taught Th e diseases. Treatment in these systems is pl es in Ve dic li terature w ritten about train ing in surg ery in cludes th e prin ­ much cheaper, and is especially effective 2000 B C. th e prese nt available li ­ cipl es of management of different terature on Ayurveda starts with types of fracture. and various opera­ in dealing with chronic ailments, allergic Su shruta Samhita and Charaka Sam ­ tive and palliative procedures for conditions and psychosomatic diseases. hita. compiled some time during th e such conditions as urinary stones. They make use of locally available herbs fifth Century B.C From these ancient pile s. fistula e. goitre. lymphadeniti s and other ingredients in their day-to-day documents it appea rs th at education and hern ia practice, and often write out prescrip­ in th is sc ience was initially impart ed Students w anting to undertake tions with detailed instructions for pre­ to highly se lected groups of stu ­ further studies are admitted to post ­ paring the decoction to be taken by the dents. graduate courses leading to the patient. The services of traditional heal­ In more rece nt ti mes it has taken award of a Doctorate of Ayurve dic ers and practitioners could therefore be more th an a ce ntury fo r a standard ­ Medicin e. Th ese consist of three utilized with advantage at primary health ized and acceptable trai ning pro ­ years of pos tgraduate train ing In the centres in remote rural areas. gramme to be introd uced in most of f irst yea r. th e postgraduates re cei ve th e Ayurvedic colleges in Ind ia . Th e advanced training in applied ba sic If the health care delivery system is to admiss ion standard. and th e durati on med ica l sc iences. both Ayurvedic reach the maximum number of people in of th e course and intern ship training. and modern . In th e second and thi rd the shortest possible time, and is to are quite simila r to the trai ning in years they are all owed to spec ial ize become a real instrument in alleviating modern medica l coll eges Thus afte r in one of th e five major disci plines­ human suffering, an open-minded ap­ 1 2 yea rs of educa tion in science and intern al medicine. Ayurvedi c surgery. proach devoid of rigid dogmas is called humanities. five years of train ing in obstetri cs and gynaecol ogy, materi a for. No single system can thrive or be vari ous Ayurvedic subjects are en­ med ica or the bas ic principles of useful to all irrespective of its origin, visaged Pec uliar to this training is a Ayurveda location or merit. Anything that is good thorough grou nding in bas ic princi ­ Doctor of Philosophy degrees in in all these systems should be made pl es- the philosophica l as pe cts of va rious specia li ties ca n also be ob­ life. th e body -mind re lati onship. th e tained at so me universi ties. Th is has available, while false claims or ineffective " humours" of th e body and th eir led to co nsid erable output of re­ practices and faulty approaches that may function. including the best meth ods sea rch materi al w hich could prove be currently in vogue should be eliminat­ for leading a healthy life accord ing to very useful in moderni zing Ayurved ic ed through intensive and systematic the body's constitutio n and the tem ­ inves ti gati on and trea tment research. perament Thus train ing in Ayurveda . both at In our anxiety to make an effective, Th e tec hnical meth odology of cli ­ the undergraduate and postgraduate comprehensive community health service ni cal exa minati on is similar to mo ­ level . has underg one a rap id change available as soon as possible to the max­ dern medic in e. th e primary methods in re cent yea rs M oderniza tion conti ­ imum number of people, the available being th e clini ca l his tory and a fi ve ­ nues and in due course th e differ­ material, financial and manpower fold ph ys ica l exa mination usi ng th e ence between the pattern of modern fi ve sen ses. However. greater em­ medica l training and Ayurvedic trai n­ resources that are rooted in traditional phasis is given to th e constitutional ing w ill be minimal. to th e point medical practices should not be over­ as pe cts of patients. their nutritional w here train ed Ayurve dic and modern looked. In order to reach the masses in status and thei r psychoso matic in ­ doctors shou ld prove complementary the developing countries, there must be tegrity The pulse exa mination form s to each other. Their se rvices could proper planning as well as a building up an impo rtant part of the clin ical then be utilized for health care at of health care facilities with all the lim­ methodology. The pati ent is exa mi ­ various levels. and a better coopera ­ ited resources available. Against this ned and treated as a w hole. unlike tive attitude betwee n the two types background the traditional systems of the modern medical approach w here of practitioners should contribute to ­ medicine and their rich heritage can play a larg e number of speciali sts ma y be w ard s improving the health care of a vital role as an additional or alternative involved simultaneously in such an Ind ia 's vast population both in urban ex aminati on. and rural area s. • approach in a country's Health Delivery Programme. •

15 -----O's Progrannne

The approach will focus on the psychosocial and anthropological aspects of traditional medicine, on acupuncture and other healing methods, and on the claims made for herbs and medicinal plants

BY R. H. BANNERMAN

Traditional and indigenous sys­ tendants, for primary health care services. to implement trammg, service and tems of medicine have persisted This was endorsed the following year by research programmes. for many centuries, even in parts an Executive Board resolution and the June 1976 saw the foundation at WHO of the world where modern idea was given support at the World headquarters of a working group for the I health care is readily available. Health Assembly in 1977, when a resolu­ promotion and development of tradi­ The idea of mobilizing the manpower tion sponsored by several Third World tional medicine. Its aim was to coordi­ component of traditional medicine for Member States was passed by acclama­ nate the various activities relating to the purposes of primary health care, particu­ tion for the promotion and development subject, and it prepared a programme larly in rural areas, has been gaining of training and research in traditional with the following objectives: ground in many countries in recent medicine. - to foster a realistic approach to tradi­ years. An initial beginning was made Several Member States have already tional medicine so as to promote and with traditional birth attendants, initiated training programmes for the further contribute to health care; because of the acute shortage of trained traditional birth attendants, and orienta­ - to explore the merits of traditional midwives. tion courses and seminars for other medicine in the light of modern science A meeting on the training and utiliza­ health professionals. so as to maximize useful and effective tion of traditional birth attendants was In 1976, WHO's Regional Committee practices and discourage harmful ones ; held in 1972 at WHO headquarters in for Africa had " Traditional Medicine - to promote the integration of proven order to develop the kind of training and its Role in the Development of valuable knowledge and skills in tradi­ programmes, research and studies that Health Services in Africa" as the topic tional and modern medicine. could improve the services of these work­ for technical discussion. The Regional High priority will be given to the devel­ ers in their respective communities. Committee for South-East Asia also oping countries particularly with regard In 1974 a joint UNICEF/WHO study on adopted a resolution in the same year to primary health care within the context alternative approaches to meeting basic calling for the promotion of traditional of the country's political structure, eco­ health needs in developing countries and indigenous systems of medicine in nomic resources and development plans. recommended the mobilization and the Region. This was followed by a semi­ Execution of the programme will be training of practitioners of traditional nar in Colombo, Sri Lanka, that made effected in close collaboration with the medicine, including traditional birth at- pragmatic recommendations about how regional offices and, primarily, at the

16 Dr. R. H. Bannerman (right) , Secretary of with the results of surveys and research drug bills of many developing countries. WHO's Working Group on Traditional Medi­ findings, will no doubt assist us all in the Traditional healers and some modern cine, is greeted by Chinese Vice-Premier Chi development of meaningful training pro­ physicians depend to a large extent on Teng-Kuei during the recent Study Tour on grammes for the various categories of herbs and medicinal plants for treat­ Traditional Medicine in Community Health Services in China (see page 23) (Photo WHO) practitioners of traditional medicine. ment. The story of herbal medicines is a Doctors, nurse/midwives, other health fascinating one- quinine, until recently, country level and with active community workers and students of health sciences was the only cure for malaria; morphia participation. will all be encouraged to undergo orien­ remains a most effective pain-reliever ; The suggested approaches include the tation in traditional medicine where ap­ rauwolfia is still widely used for the formulation of national health policies propriate. control of hypertension and certain forms so as to contain provisions concerning Multidisciplinary investigations into of psychiatric disorder, and herbal pre­ traditional medicine and mechanisms of systems of traditional medicine will be parations have been used for many coordination, and better utilization of encouraged, and special attention will be decades to treat rheumatoid arthritis. the useful elements of traditional medi­ given to laboratory and clinical investi­ Recently, we have received serious cine in the country's health care sys­ gations for identifying effective remedies, claims that herbs are being used in tem. The administrative machinery comprising medicinal, plants, animal China, tropical Africa and Central needed to ensure effective planning, uti­ products and mineral substances. Inves­ America for the control of diabetes mel­ lization and supervision of practitioners tigations will also be conducted into the litus. All these claims have to be invest­ of traditional medicine will be reviewed psychosocial and anthropological as­ igated scientifically and authenticated. within the context of the national health pects of traditional medicine, as well as There are clear indications of a major care delivery system. the mechanisms of acupuncture and breakthrough in therapeutics and health A questionnaire has already been other healing methods. care delivery, and those of us involved in designed for the collection of all avail­ Wherever possible, priority will be the traditional medicine programme able information concerning practition­ given to the promotion and development share fully the goal of our Director­ ers of traditional medicine, their training of useful local resources such as herbs for General, that we should achieve total and services to the community. The ana­ the production of medicinal substances; health care coverage for all people by the lysis of information collected, together such action should effectively reduce the year 2000. •

17

New status for the hilot

When 75 per cent of births turned out still to be handled by hilots-traditional birth attendants­ the Philippines' Department of Health decided to re-train them and bring them into the health team

BY AMANSIA MANGAY-ANGARA

Traditional birth attendants­ tality. She performs very few manipula­ hi/ots- have probably been Traditional Birth Attendants tions during childbirth; the newborn is practising their skills in the Phil­ passively received under cover of a cloth ippines since the earliest history Still the greatest barrier to < ~e. alizing to conceal the mother's private parts...... ,.... of the country's predominantly the proper potential of traditional Although some complications in the Malay population. This is suggested by birth attendants (TBAs) today is the mother may result from errors of omis­ the similarity of hilot practices with resistance of some professional health sion by the birth attendant, such as fai ­ those of the bidan of Malaysia and the workers. · Bu.t TBAs still deliver two­ lure to protect the perineum, others may dukun of Indonesia. Such practices pro­ thirds of the babies in the world. follow acts of commission such as apply­ bably emerged out of the necessity for In Asia. Africa and Latin America ing manual pressure on the fundus of the mutual help among womenfolk in the they are accorded, for the most part very, high prestige in theif villages. uterus to facilitate expulsion of the fetus, small villages many centuries before Several countries have already started causing a subsequent rupture. In the case modern medicine was introduced to the on-going training programmes for of the newborn child , errors of commis­ country. th,~~~ women. to e..nsure that they sion are frequent ; it is common for the ln the traditional village society there offer safe midwife'ry practices where umbilical cord to be cut with a non­ have always been such categories of indi­ they will be most eff~ctive. Other sterilized knife or bamboo blade and the genous healers as the herbalist, the bone countries are beginning to encourage application of some powder, chopped setter, the faith healer and the hilot. The them and g,ive them additioqal tobacco leaves or even dried horse latter usually confines her activities to training so as to >gain for them manure on the cord dressing. Practices of attendance at birth and to the care of the increasing involvement in primary this nature are responsible for the high newborn child. Her services vary but health care activities. incidence of tetanus of the newborn in Several countries have also tried to the Philippines. often include offering such assistance explore thei{ full potential in family with household chores as is traditionally planning programmes. They have Until around the early 1950s the demanded by good neighbourly practice proved capable of making useful con­ Government's general attitude had been in the village. It is largely through main­ tributions to family planning com­ to discourage hilot practice and to pro­ taining this combination of services to munication activities in Indonesia mote their replacement by trained the mother, the child and the household (where they are known as dukuns). licensed midwives. In 1954, the Depart­ that the hilot has survived and continues Malaysia ·(as bidans) , Mexico (as ment of Health reviewed the prevailing to be accepted by the local community to parteras) and India (as dais). There is status of midwifery services and found the present day even though modern probably no reasonable alternative for that a large proportion of births (about health care has since become available to government maternal health and 75 per cent) were attended by traditional family planning programmes but to midwives. While infant and mortality the rural population. join hands with TBAs. The findings Unfortunately, the hi lot's practices and . recommer)dations of various rates were high, available trained health have time and again contributed to studies have repeatedly shown that manpower was grossly insufficient to maternal and infant morbidity and mar- thei ,enjoy a relatively high' degree meet the demands for midwifery services, of cr edibil'ity in ,the eyes of villagers particularly in the rural areas. and the urban poor. while their Largely as a consequence of these find­ Mrs Rosa Raymundo, a traditional birth at­ potential for incorporation as partners tendant, dons a plastic apron before bathing a ings, and of the realization that while the in public Health vyork is a very country's population was rapidly on the newborn child, as she has been taught during practical reatity. · special training. (Photo WHO fl. Abcede ) increase its health resources were insuffi­ cient, a revised strategy was evolved.

19 New status for the hilot

Left : Hilot Asuncion Sag ins in pays a pre­ natal visit to a patient. The Philippines' Government has introduced a teaching pro­ gramme to make hilot practice safer for moth­ ers and to encourage the traditional birth attendants , to seek guidance from trained health personnel when needed.

Right: Nurse Felicitas Bautista graphically explains to a class of hilots-in-training the basic steps to be taken when ·attending deliv­ eries. (Photos WHOfJ. Abeede) ~ ', .....

This included some concessions to hilot gramme to make hilot practice safer for birth which has not yet been registered. practice in localities where the services of mothers and to encourage the birth ·at­ After training, the birth attendants orga­ practising physicians or registered mid­ tendants to seek guidance and assistance nize themselves into a local association wives were not available. Within this new from the trained health personnel. which holds monthly follow-up meet­ policy frame, traditional birth attendants This training was first conducted by a ings. At these meetings, the nurse or would receive such training and orienta­ provincial nurse supervisor who had midwife of the rural health unit inspects tion on hygienic procedures and routine herself undergone training under the their kits and evaluates reports of their midwifery practices as would promote midwifery training programme. Her un­ activities. the safety of the mother and the newborn derstudy was a nurse or midwife of the Now that official recognition has been child; they would also be given health rural health unit or puericulture (mother given to the trained hilots, and with the staff supervision and guidance in the and child health) centre, who took over increasing acceptance of the health aux­ course of their work. as instructor of subsequent hilot classes. iliary or aide in providing health care, In 1954, with WHO and UNICEF assis­ The classes are usually organized in the hilot is being encouraged to get tance, the Department of Health initiat­ groups of ten, and the course consists of herself involved in a wider variety of ed the training of hilots as part of the 12 weekly or bi-weekly meetings each community health activities. These in­ country's midwifery training pro­ lasting three hours. Instruction is given clude helping to notify communicable gramme. Priority was given first to staff in the local dialect. A hilot who satisfac­ diseases, organizing mothers' classes, involved in teaching and supervision torily completes a course is given a registering births, helping to arrange such as nurse-midwife supervisors at the UNICEF midwifery kit and issued with a mother and child referrals to the health central level, then at the regional and record book to insert the necessary infor­ centre or hospital, participating in the later at the provincial and local levels. mation needed to register the birth of the housekeeping at the health centre, assist­ This was followed by a teaching pro- child she has delivered or report any ing in community immunization round- 20 ups and collaborating in the family plan­ ing the limited resources and the magni­ traditional birth attendants in practice, ning programme by motivating mothers tude of existing health problems, it will where they live and other useful data and following up those who accept the take some considerable time before the which would enable central and local services. On the whole, hilot training and Government's goal can be achieved. hilot registries to be drawn up. More the broadening of her participation in Therefore the stop-gap arrangements for than 31,000 hilots- both men and wom­ community health work have forged training the hilot and involving her in en- were identified. On the basis of the stronger links between the traditional health services are proceeding with more findings it was calculated that the total birth attendant and the local health staff. active Government support as well as the number who were in practice was be­ She has thus become an important endorsement of various sectors of the tween 38,000 and 40,000, or roughly a resource in the local health service even local community. Increasing attention is ratio of one hilot for every barangay­ though she is still not a member of the being given to the hilot as a potential the smallest local administrative unit health team. She receives neither com­ health manpower resource capable of with an average population of 1,000 to pensation, honorarium nor daily wages being trained and guided to respond to 2,000. The registries that have since come for her services. The remuneration she local community health demands, partic­ into existence will help in identifying receives from the mother may be in the ularly for mother and child care. those birth attendants who need training form of a gift or sometimes in cash, but With a view to obtaining more accu­ and in locating their homes, and will more often her services amount to simple rate information about the hilot man­ thereby facilitate their supervision by the acts of goodwill and good neighbour­ power resources in the country, the local health personnel. The registries will liness. Department of Health carried out a be kept constantly up-to-date and will The Government's goal of ultimately nationwide survey in 1974 with the help furnish other useful information which replacing the hilots with licensed mid­ of a WHO grant. The objective was to will help in designing the hilot training wives remains unchanged. But consider- obtain information on the number of courses in the coming years. •

21

Study ToliT in China

Community health specialists and senior health administrators from 29 developing countries con­ verged on Peking in August to begin a Study Tour on traditional Chinese medicine arranged under the auspices of WHO and UNDP. Dr Bannerman of Ghana acted as Team Leader to the group, and is also the Secretary of the Working Group on Traditional Medicine at WHO head­ quarters. On his return to Geneva he was interviewed for this special issue of World Health.

WH : Dr Bannerman, wha t was the objec­ BA NNERMAN: As was emphasized by the given to the rural areas where 80 per cent tive of' this Study Tour involving so many late Chairman Mao, traditional C hinese of the population live. The doctors are senior health officialsfrom the developing medicine has a great storehouse of now community oriented and 70 per cent countries ? knowledge. C hinese pharmacology is of the graduate doctors work in rural therefore being integrated and various areas. The "mass-movement" has been BA NNERMAN : The main purpose was to in stitutes and hospitals for the practice of responsible for the virtual extinction of give partici pants the opportunity to Chinese medicine have been established. the four pests- rats, flies , mosquitos and stud y how China has harnessed its pre­ At the first national health conference bed-bugs. cious legacy of traditional medicine to held in 1950, three principles were the needs of its vast rural populations, adopted : firstly, to serve the wod·kers, WH : What did you see which might be and has combined the traditional peasants and soldiers; secondly, the pre­ regarded as the kind of simple medical Chinese system with " Western" medi­ vention of disease ; and thirdly, integra­ technology that might well be transferred cine. The group had the opportunity to tion of traditional Chinese and " West­ to and adapted by other countries? study the training of health personnel ern" medicine. In 1953, Premier Chou including practitioners of traditional En-Lai endorsed the fourth principle: BANNERMAN: Offhand, I would say the Chinese medicine and the barefoot doc­ " to combine health work with mass use of acupuncture for the treatment of tors. We also learnt something about the movement". The people are educated to disease, the relief of pain and for pur­ use of medicinal herbs, the preparation combat disease by themselves and not to poses of anaesthesia. About 70 diseases and production of pharmaceuticals and rely exclusively on health workers. can be treated with acupuncture alone the use of special methods such as acu­ The difference between "orthodox" and some 200 when used in combination puncture for treating various disorders and " traditional" medicine is therefore with herbal medicines. Training in the and for anaesthesia. The study was in fact much less pronounced in China. Many use of acupuncture is essential, if the multisectoral, and we were exposed to of the orthodox-trained doctors receive transfer of this technique is to be truly agricultural and irrigation projects, orientation in traditional Chinese medi­ beneficial. The equipment is relatively housing schemes, rural development and cine and practise both systems. It has simple and, in essence, all that one needs so forth. therefore become difficult to draw a defi­ is the acupuncture needle which can be nite line between the two. Their attempts inserted into the appropriate point and WH : One gets the impression that the at integration have evolved into what rotated to and fro with the index finger division which is very noticeable in the rest they now call the 'New' traditional and thumb. But recently an electrical of the world between "orthodox" and Chinese medicine, which can be de­ machine has been developed which intro­ "traditional" medicine is much less pro­ scribed as the application of modern duces regular electrical pulsations to the nounced in China. Is this the case, and to scientific principles to the traditional needle and thus produces the desired what degree has the older system been Chinese system. The integration of tradi­ effect. integrated with more modern aspects of tional Chinese and modern medicine is The application of acupuncture for medicine ? now an established policy and is by no purposes of local and regional anaesthe­ means an expedient. Veteran practition­ sia is well developed. Many procedures ers are involved in shaping the ' New' on the head and neck, such as dental

23 Study Tour in China

Left: The simplest of equipment suffices to prepare traditional herbal medicaments and roll them into pellets. The pharmacopoeia of traditional Chinese medicine has long proved to be a great storehouse of knowledge. (Photo WHO/R. Bannerman)

Right : Health students practising acupuncture techniques on each other. An acupuncture needle carefully planted above this girl's nose will act as a local anaesthetic. The application ofacupuncture for local and general anaesthesia is well developed in China, and is used even for major abdominal operations. (Photo WHO/L. Ambrose)

We saw the highly successful treat­ and discipline we encountered m every wish to follow it as a profession can ment of extensive burns in the general community we visited. become fully qualified doctors through wards by the application of only one set further training in colleges. Work as a of surgical dressings medicated with barefoot doctor has now become an im­ WH: Is the famous barefoot doctor part medicinal herbs and without resort to portant entry point to medical college of the traditional system or is he regarded specially equipped intensive care units ; and university. On the average, they as a totally modern phenomenon of the management of fractures by employ­ spend about two-thirds of their time each Chinese public health ? ing small padded splints ; and the care of year in agricultural work and industry patients with acute abdominal condi­ and the rest in health work. They are tions such as perforated peptic ulcer, BANNERMAN: The well-known barefoot very much a part of their community and appendicitis and extra-uterine pregnan­ doctor is very much part of the tradi­ are selected initially for health work by cy- all of these by combined traditional tional Chinese system. They used to be members of the community. Chinese and " Western" methods. All called "peasant doctors", but acquired these could be readily replicated in many the title " barefoot doctor" not because WH: Your colleagues during the Study developing countries. The techniques for they walk barefoot but as a reminder of Tour came from all parts of the wo rld. Do preparing medicinal herbs and plants as the fact that many of them spent a you feel that they had ideas to offer which powders, tablets and liquid extracts us­ greater part of their time with other China might find worthwhile taking up and ing relatively simple locally manufac­ members of the community in the rice­ adapting? tured equipment proved of great interest paddy fields . to us. What might perhaps be more Barefoot doctors are trained in the first BANNERMAN: We were asked this ques­ difficult to emulate is the capacity for instance for six months, and those who tion in various forms during the tour. hard work, resourcefulness, motivation show keen interest in health work and None of us could really make any con-

24 crete suggestions. We have to remind ture- provided that did not cause unem­ tries required urgent review. Health ourselves that China has a population of ployment in any way. I personally con­ problems were never presented in isola­ an estimated 850 million. The basic sidered the absence of private motor cars tion and the part played by agriculture, necessities such as electricity, water sup­ from the roads a great boon, and the use housing, jobs, water supply, and educa­ ply, adequate sewerage and refuse dis­ of bicycles contributory to good health. tion (academic, technical and political) posal were available equally in both ur­ were all very obvious to the discerning ban and rural areas. The people ap­ WH: It will no doubt take some time for eye. The developing countries certainly peared well nourished and adequately the ideas exchanged during the Study have a great deal to learn from China, housed; everybody was well clothed and Tour to be evaluated. What use is WHO and WHO could well make an in-depth nobody wore rags or went barefoot. We going to make of its new view on tradi­ study of the 'New' traditional Chinese were told that there was total employ­ tional Chinese medicine? system, particularly in terms of cost ment with generous pension schemes for benefits and technical cooperation, with women at 55 years and men at 60, ade­ BANNERMAN: We prepared a question­ a view to adapting the system for use in quate educational facilities and, of naire for the participants before the tour various developing countries that might course, total health care for all. There started and happily there was 100 per be interested. was no evidence whatsoever of the infla­ cent response. Every participant stated The most attractive feature to us from tionary trends that have recently gripped that the tour was truly worthwhile and the developing countries is the extent to the rest of the world. In a situation like should be repeated for other, smaller which China has improved the quality of this one could only marvel and wish a groups on a yearly or even twice-yearly life of her people and achieved total friendly people greater success. basis. Many took the opportunity to re­ health coverage within one generation. There could, however, be greater examine their own priorities and decided There is no such parallel in ancient or mechanization especially m agricul- that national priorities in several coun- modern history. China is unique! •

25 Plants that heal

Plant screenLng has often yielded poor results because traditional healers were not involved; but the advice of good healers ensures at least a 50/50 chance of success

BY OI(U AMPOFO

When, some years ago, I started find a taxi to carry the patient to my clinic. particularly to find substitutes for im­ showing interest in African tra­ On her return she was surprised to see ported drugs. Here are two examples. ditional medicine, like many the patient washing her baby. Her bleed­ The Public Health Department of our other investigators in this field I ing had been arrested by one of the Medical School recently asked us to help doubted the efficacy of ahy of old herbalists who lived a few yards them to fight an epidemic of guinea­ Ithe claims made by our local healers. away. It was this incident which first put worm in three nearby villages. In pre­ Time soon proved me wrong, and luck me in touch with this herbalist. I later vious years, attempts had been made to too came to my aid. It was not difficult to learnt of some interesting cures from treat the yearly epidemic with a combi­ establish contact with two well-known other local herbalists, found out about nation of procaine penicillin and dif­ herbalists in my district and they were their methods and tried them out in my ferent proprietary drugs. The 88 people most willing to pass on their age-long practice. As Director of the new Centre involved in this trial included 18 chil­ knowledge. They were both octoge­ for Scientific Research into Plant Medi­ dren, 20 bed-ridden adults and 50 ambu­ narians with long years of practice cine in Ghana, I now have greater oppor­ lant adults. These were divided into two behind them and were trusted and re­ tunity for doing clinical trials with tradi­ groups of 44 people each. The first group spected by their patients. tional methods. was put on a decoction of pieces of root I also learned to respect them for their It is my contention that to achieve any of Combretum mucronatum, a known wide knowledge of plants and diseases, success in the field of research into tradi­ worm-expeller, at a calculated dose of their frankness and wealth of human tional medicine, we have first to acquire .03 gmjkilo. The second group was given experience. Every other week I would go our knowledge from the traditional heal­ a decoction of Mitragyna stipulosa which with one of them into the bush, collect er himself, try out his methods clinically looks like Combretum mucronatum ; the plants and learn about their uses. These and then, if successful, subject them to calculated dose was .06 gm/kilo. Patients old herbalists were great botanists and scientific analysis. Many plant screening were examined twice weekly. knew something about every plant we programmes have not yielded any fruit­ After one week, examination revealed saw in the bush. They each identified at ful results because traditional healers that there was complete extrusion of the least 200 plants with healing properties. have not been involved in these trials; worms in 43 out of 44 in the first group These traditional herbalists treated a but experience shows that with the ad­ (i.e. 97.7 per cent) and there was marked wide variety of diseases and injuries, vice of the good healers there is at least a reduction in the inflammation around apart from offering maternal and child 50/50 chance of success. care. One day, one of our modern-trained In our clinical trials with medicinal Herbalists at a centre for African traditional t> district midwives was faced with a case of plants, our aim has not only been to find medicine learn how to prepare and process severe post-partum haemorrhage, and cures for diseases in which "Western" roots so as to make the best of their healing properties. ( Photo WHO/R . da Silva) she later told me that she actually ran to medicine is ineffective but also more

26

Plants that heal

Hilleria latifolia - Securidaca Phyto­ longipedunculata - laccaceae Polygalaceae Left: Hille ria latifolia has been proved to act as a filaricide in cases ofguinea- worm infesta­ tion. The bark of Securidaca longipedunculata is useful in treating psoriasis and also has anti­ con vulsive properties. Myrianthus arboreus ; a decoction made from its bark appears effective against diabetes. When suitably prepared, the root of Picralima nitida can heal the skin disease herpes zoster in the space of two weeks.

Right: This woman has come to consult a healer at a centre for traditional medicine. Such healers are respected in their local com­ munities for their wide knowledge of plants Picralima and diseases as well as for their understanding nitida­ and wealth of human experience. Apo­ Myrianthus arboreus - Moraceae cynaceae (Photo WHO JR . da Silva)

the lesions. The wounds healed com­ kaolin or white clay and Piper guineense Two other diseases for which tradi­ pletely after two weeks with local appli­ twice a day, heals the infection in about tional African medicine appears to be cation of sterile palm oil. In the second ten days. Alternatively, the root of Picra­ more effective and less risky than mod­ group, there was complete extrusion of lima nitida is charred with Piper ern medicine are diabetes mellitus and worms in 23 out of the 44 cases (i.e. 52.2 guineense and ground into fine powder, bronchial asthma. For some years now, per cent), with healing of the wounds mixed with kernel oil and applied to the we have been studying the work of her­ after local application of palm oil in two infected area with cotton wool twice balists who treat diabetes mellitus, some weeks. Thus, it was proved that Combre­ daily; for internal application, the black of whose remedies come mainly from tum mucronatum-as the traditional her­ powder is mixed in alcohol and taken, herbal preparations. In particular, the balists claim- is indeed a true expellent one dessertspoonful thrice daily, to allay anti-diabetic activity of herbs of the of guinea-worm. pains; this treatment is very effective and Loganiaceae family has been confirmed We were also able to prove that the healing takes place in 10-14 days. But by our University of Science and Tech­ leaves of Elaeophorbia drupifera and Hil­ perhaps the most dramatic form of treat­ nology. One teacher herbalist claims as leria latifolia, taken in combination in a ment is the use of the root bark of Bala­ high as 75 per cent of "cures" among his palm soup preparation, act as a filaricide nites aegyptiaca, ground into fine pow­ diabetic patients treated with the Loga­ in guinea-worm infestation. der, then made into a paste with water niaceae family. He has successfully treat­ Skin diseases have particularly en­ and applied to the infected area morning ed a patient who developed gangrene and gaged our attention and we have had and night; healing occurs from five to ketosis even though he was on insulin success in the treatment of coccal infec­ seven days. A similar result is obtained injections. A thorough investigation into tions, epidermophytons, allergy and with Securidaetl- longipedunculata root the anti-diabetic property of the Loga­ herpes zoster. Four traditional treat­ bark, which is also useful in treating niaceae seems to be called for. ments of herpes zoster are particularly psoriasis and possesses anti-convulsive The combination of Canthium and interesting. The local application of the properties. Myrianthus bark as decoction or alcohol­ flowers of Hoslundia opposita and red Guinea-worm and herpes zoster are ic "bitters" also appears effective. One cola nut, chewed together and sprayed some of the diseases for which modern patient had his diabetes mellitus arrested on the lesion twice a day, often heals it medicine has so far no effective remedy. when he was treated with this extract for within a fortnight. The local application Traditional African medicine appears to two months. His fasting blood sugar has of guava leaves, ground into paste with be more effective. been normal since. Another colleague

28 who practises dentistry in England per­ powdered Sclerocarya birrea leaves twice teacupful being taken three times daily. suaded a physician friend to try the daily but at the end of the third week, her After one week the fasting blood sugar alcoholic extract on two English patients fasting blood sugar had risen to came down by 120 mgm% and conti­ with juvenile diabetes five years ago. 340 mgm/ 100 ml. Treatment was discon­ nued to fall till it became normal after 11 After two months treatment, it made no tinued and the patient was put on a chlor­ weeks. It has since remained normal. impression on one case but the second propamide preparation, 250 mg twice Incidentally, no treatment was given for improved considerably and her fasting daily for ten weeks. There was mild im­ her hypertension which also automati­ blood sugar has remained normal ever provement but the patient wanted to try cally fell from 180/90 to 140/90. since. They were both on insulin. Costus another herbal treatment. In August Mrs T. 0., aged 59 years, is another schlechteri is another plant claimed by 1976, she was put on Costus schlechteri typical case. She has been a diabetic since some herbalists to be effective against as recommended by a herbalist. Her fast­ 1969, and first reported to us in April diabetes mellitus, and our observation is ing blood sugar rose to 250 mgm% and it 1975 for a prescription for more of the that this plant is effective in some early was decided to try Bridelia ferruginea­ proprietary tablets which she had been cases. ten leaves boiled with one pint of water, taking daily. Her fasting blood sugar was It is in the use of Bridelia ferruginea for one teacupful to be taken three times 252 mgm% and it ranged between controlling diabetes mellitus that I have daily as recommended by a herbalist. 190 mg and 285 mg for 16 months until acquired more experience and hope for There was a steady lowering of the fast­ October 1976 when we decided to put her the treatment of diabetes. Of the 12 cases ing blood sugar till it became normal on Bridelia leaves. There was no signifi­ under treatment, I have selected three as after 12 weeks, and it has since remained cant change for three months and the showing typical reactions to the plant. normal. dosage was increased by 50 per cent. Patient M.A., a woman aged 49 years, Patient L.B., a woman aged 45 years, After another two months, the dose was reported in May 1976 and had been reported for treatment of her hyperten­ doubled as the fasting blood sugar conti­ receiving insulin injections, 44 units daily sion. Routine examination revealed that nued to rise. There was still no significant for the last two years. Her fasting blood she had diabetes mellitus with fasting change for two months and the patient sugar was 242 mgm/ 100 ml. The patient blood sugar of 370 mgm%. We decided was put back on her tablets. It was then looked worried, did not want any more not to give her any "Western" drugs and discovered that the patient had been insulin and preferred herbal treatment. put her straight on Bridelia ferruginea- secretly taking both Bridelia and the She was put on one dessertspoonful of 20 leaves boiled in a pint of water, one tablets together and we concluded that

29 many plants available for bronchial asth­ even stopping them, especially in chil­ Watched by two village women, a herbalist ma the following have been most widely dren. But the best result we have ob­ explains the contents of a pot of mixed herbs used at our Centre: Desmodium adscen­ tained at our Centre is the administra­ and roots to a visiting official (in white suit) . dens- Papilionaceae, Thonningia san­ tion of a combination of Desmodium (Photo WHO/R . da Silva) guinea- Balanophoraceae, and Deinbol­ adscendens and either Thonningia or lia pinnata- Sapindaceae. Deinbollia. The leaves of Desmodium adscendens We undertook a "double blind" clini­ this may have accounted for the ineffec­ can be given in the form of dry powder, cal trial during which 12 randomly tiveness of the former. It would appear one to two teaspoonfuls, according to selected patients were treated with place­ that the traditional drug and the modern age, in warm water in three divided doses bo herbs, that is, drugs having no one acted as antagonists here. This is per day, or it can be made into alcoholic therapeutic value, for three months and true of other patients who are over­ extract. Thonningia sanguinea root is pul­ then for a second period of three months anxious to get well and take both drugs, verized and dried. Two dessertspoonfuls with combinations of Desmodium, Dein­ while patients who take alcohol during of the powder are mixed thoroughly in bollia and Thonningia. The results were Bridelia treatment also show no im­ ten ounces of honey and given in doses of quite clear. All the patients continued to provement. one teaspoonful to one tablespoonful have asthmatic attacks during placebo My own experience in the prophylactic thrice daily. This too can also be pre­ treatment, but eight of them had no use of plants for bronchial asthma will be pared in the form of alcoholic extract. attacks during the herbal therapy. Some supported by Professor Marian Addy, Dry, powdered Deinbollia pinnata root of the remaining four had decreased who has used the same materials in ex­ bark is used differently : one to two teas­ attacks, but the response to the com­ perimental animals. Drugs used for poonfuls of the powder may be taken bined herbs was judged less than satis­ bronchial asthma in modern medicine according to age in palm soup every factory. From our point of view there are mainly applied during attacks other day for two to three weeks, and it is no question that Desmodium and whereas medicinal plants can be used can also be taken in soda water. the other herbal preparation produced a prophylactically until attacks are well Each of these preparations is capable satisfactory response in 75 per cent of the reduced or completely eliminated. Of the of deferring bronchial asthma attacks or patients. •

30 Authors of the month

Dr H. MAHLER is Director-General of the World Health Organization. Mr J. DAUTH, formerly Press Offi­ cer at the Embassy of the Federal Republic·clfGermany in Malaysia, is now working as a journalist in Malaysia. PORTUGAl AND Dr X. LozovA is the Co-ordinator of the Mexican Institute for the WHO WORK Study of Medicinal Plants TOGETHER (IMEPLAM) in Mexico City. Dr P.N.V. KuRUP is Adviser to the Government of India for Indi­ genous Systems of Medicine. Portugal's health authorities first in­ Dr K. N. UoUPA is Professor of vited environmental health experts Surgery and Director of the Insti­ tuteofMedical Sciences at Banaras from WHO to visit the country in Hindu University, Varanasi, India. 1974. following a sudden outbreak Dr R. H. BANNERMAN is Secretary of cho lera . In October 1976, at the of the Working Group on Tradi­ Government's request. a joint tional Medicine at WHO head~ WHO/ World Bank team carried out quarters in Geneva. Dr A. MANGAY-ANGARAisChief of an extensive country-wide sector the Division of Maternal and study of the water supply and waste Child Health, · Department of disposa l conditions. This study pro­ Health, Philippines. vided Portugal w ith an overa ll pic­ Dr 0 . AMPOFO is Director of the · Centre for Scientific Research into ture of the ex isting situation. indi ­ ' Plant. Medicine at Mampong­ cated the constraints that were then Akwapim, Gha.na. limiting the development of this vital sector. and suggested an acti on programme for immediate and long ­ term improvements. One result of the activities that fol ­ WORLD lowed was the convening of a semi­ GREETING CARDS nar on " project preparation and WHO's new programme of Appro ­ evaluation" organized by WHO and priate Technolog y for Health was HEAt.TH held in Lisbon last July Thirty-five given the task of designing this sea­ Portuguese engineers participated son's greetings cards for the Organi ­ ORDER FORM in the seminar. which gave them an zation. In fu ll colour and w ith the opportunity to acquaint themselves theme "Through to a better w orld". Please enter my subscription to " World · Health" as follows: with new trends in planning, design, the cards may be ordered from : The iX and economic and financial evalua­ WH 0 Staff Association. WHO. 1 211 US$ * Sw.fr. * tion. Geneva 27 . Switzerland. or from an y One year 10.- 25 .~ Now a project of assistance to the of WHO's Regional Offices in Alex­ Two years 18.- 45.- basic sanitation sector. with backing andria. Brazzaville. Copenhagen. Three years 24.- 60.- from WHO and the UN Develop­ Manila. New Delhi and Washington. ment Programme (UNDP) . has just The price is US $3 or 8 Swiss francs One. year: 0 started. at an estimated cost of US per packet of ten. and each card is Two years: 0 $250.000. The project w ill last for within the airmail limit Any profits two and a half years and WHO has from the sale of the cards wil l go to Three years : 0 been designated as Executing WHO's Voluntary Fund for Hea lth Agency. A further result of the 1976 Promotion. I enclos~ cheque/ postal order in the amount sector study was the ident ification of ...... •...... of such investment projects as water In the next issue supply and sewerage for Lisbon and Oporto. the second -largest city. The The December issue of World World Bank is expected to assist in Health will be concerned with Mental Health. and wi ll show financing these schemes. and in the how certain countries are dealing first in stan ce a loan is being consid­ with this problem within the • or equivalent in local currency. ered for the improvement of Li s­ framework of their health services. World Health, WHO, Avenue Appia, bon's water supply. 1211 Geneva 27, Switzerland · , ·'