Plant Use in Ante- and Postpartum Health Care in Lao PDR Emma C. S. Lundh Degree project in biology, 2007 Examensarbete i biologi 20 p, 2007 Biology Education Centre and Department of Systematic Botany Uppsala University Supervisors: Lars Björk and Hugo de Boer Plant Use in Ante- and Postpartum Health Care in Lao PDR Master of Science thesis by Emma C.S. Lundh Under supervision of Lars Björk & Hugo de Boer Department of Systematic Botany Uppsala University, Sweden September, 2007 ABSTRACT An ethnobotanical study, combining systematic botany, pharmacology and anthropology was carried out December 2005 to Mars 2006 in Central and Northern Lao People’s Democratic Republic (PDR). The study documents the medicinal use of plants in an important and complicated passage of life, childbirth. Semi-structured interviews were conducted in five rural villages among four ethnic groups on the plants employed during the birth process as well as their associated beliefs. Fifty-four different plant species were found to treat 15 conditions occurring during pregnancy, birth and the postpartum stages. The most common uses of plants were to promote maternal health and postpartum recovery of strength, healing and contraction of uterus, and to promote lactation. Other common reports included reduce postpartum haemorrhage, alleviate postpartum abdominal pain and protect or cure the newborn from infections. An ethnobotanical plant collection including 93 genera in 59 families was made from species with medicinal uses in the five villages. In addition 18 species used in traditional steam saunas as a postpartum health procedure for lowland Lao in urban areas are presented and compared to the plants used in the villages. As a result of the study six species used in postpartum health care, representing four Zingiberaceae genera (Zingiber, Amomum, Alpinia, Elettariopsis) as well as two common steam sauna species (Adenosma bracteosum and Cymbopogon nardus) were selected for Gas Chromatography combined with a Mass Spectrometry (GC-MS) analysis. Identified compounds are presented and their potential effects in comparison to western medicine are discussed. Few studies have been made on plant use in ante-and postpartum health care. The knowledge of medicinal plants presented in this study may provide an important resource for improving maternal and infant health among upland and highland populations, as well as a rich source of further phytochemical, pharmacological and clinical studies on medicinally applied species in Lao PDR. PREFACE In your hand you have the outcome of an ethnobotanical study performed in Lao People’s Democratic Republic (PDR) and financed as a Minor Field Study (MFS) by the Swedish International Development cooperation Agency (SIDA). For those who are not familiar with the word ethnobotany, it refers to the study of the interaction between people and plants, and covers a broad range of different fields and techniques. This study principally encompasses systematic botany, pharmacology and anthropology. Performing an MFS in one of the poorest and least developed countries in the world is a great challenge. Except for the daily complications with language barriers, health, transport and equipment issues, it requires you to become acquainted with cultural worldviews that in many aspects collide with your own worldview, and it makes social skills as fundamental as academic skills. I believe that a combined study of this kind would be favoured if performed in cooperation with specialists from the different fields and on a longer time-span. However, this is rarely the reality, and unfortunately impossible for a Master thesis project/MFS that is greatly restrained concerning the time aspect. Nevertheless, except for educational purposes, an ethnobotanical MFS can be of great value for the local people and for potential future research project. The original aim for the study was to investigate the use of the plant family Zingiberaceae in local health care in rural villages in the National Biodiversity Conservation Area (NBCA) Nakai Nam- Theun (NNT). Pointed out as a biodiversity hotspot and the largest and most well preserved NBCA in Laos, we saw this as an exceptionally interesting area for the study. We also had the opportunity to cooperate with a Lao Ph.D. student, Mr Vichith Lamxay, who was doing research on Zingiberaceae genera. The villages situated in the NNT Conservation Area are highly dependent on Non Timber Forest Products (NTFPs) for survival. This also applies in health care where plants in the remote villages serve as medicine due to the inaccessibility or high cost of modern pharmaceuticals. The project was interview based and it was essential to find a good interpreter, yet this was a difficult task. The most important quality of an interpreter is the accuracy of the information he/she relays, and it is difficult to know in beforehand. The project’s tight budget and the fact that we preferred a female interpreter complicated it further. A female interpreter was preferred as women in earlier studies have been noted to give different answers in the presence of men then those they give when they are alone or in presence of other women. It can also happen that a male interpreter relays different information than a female informant expresses and for example neglect, substitute or fill in answers during interviews in the belief that he has a greater knowledge. We also intended to interview men and women separately because knowledge, gathering and the use of the plants can differ greatly between the genders. Other consideration on working with interpreters is the time aspect, because more time-consuming interviews are tiring for the informants. After two weeks research in the NNT Conservation Area our project took an abrupt turn. Our female interpreter could not longer assist us and we had to return to Vientiane capital in search of a new interpreter. In the mean time regulations concerning the access to the Nakai Nam-Theun NBCA were made more stringent and impeded us to return. We found ourselves forced to change the location of the project. Through contact with the aid organizations ADRA and GTZ we were able to arrange access to some interesting villages in northern Laos. The change of location also required us to change the focus of the study, from Zingiberaceae to a more general view of plants in health care and use during pregnancy, birth and convalescence. My choice of focus on plants connected with childbirth was partly because many of the Zingiberaceae species in Nakai Nam-Theun were used in postpartum health care, and the interesting subject had been given little attention in previous research. Unfortunately the change of focus and study area after our start in Nakai Nam-Theun ii caused some species mentioned from these villages to be classified as having an undefined postpartum use in this report. Also included in the project were interviews performed with steam sauna owners. The idea of making steam sauna interviews arose after our visit to the villages in Nakai-Nam Theun NBCA. Our Swedish supervisor Lars Björk had in his earlier visit to Laos got in contact with a steam sauna manager in Vientiane interested in steam distillation for the production of oils that could substitute the fresh plant material for species not available all year around. Steam baths were found to be an important and common postpartum procedure in the villages visited in Nakai-Nam Theun NBCA. Due to the resemblance of steam sauna to steam bath I believed it also could play an important role in postpartum health care and be an interesting area of investigation. When the project later needed to change location and widen its focus from Zingiberaceae, including steam sauna interviews gave an interesting insight in the postpartum care for lowland Lao. During the interviews the plants’ vernacular names were written in Swedish phonetics since it made it possible to re-read the names with greater accuracy. We chose not to further translate the Swedish phonetic to English because accuracy loss would be inevitable. All local plant names in this report are thus expressed in Swedish phonetics. Swedish contains three more vowels, å, ä and ö which are well represented by to the Lao letters Âx, Áx, Àxó respectively, where x stand for a consonant. In English the Swedish å represent the sound of “a” in call, “o” in “fore” or “ou” in four. The Swedish “ä” is the sound of “a” in back, “ai” in fair or “e“ in best, and the “ö” represent the English “e” in her, the “u” in fur, or short “a” in about. The Swedish pronunciation of “j” resembles the English “y” in many words. However the Lao sound xõ does not exist in Swedish or English and is represented with the symbol ü in this report. It is a nasal sound that lies between the Swedish “u” and “y”. Further guidance in pronunciation of Swedish letters can be found on the web page for Stockholm school of economics (2007). Finally I would like to comment that this ethnobotanical study followed the rules of the Convention on Biological Diversity (CBD) and aims to share experience and knowledge. Although a short study like this might give only limited possibilities, some basic ethnobotanical methods like making plant collections were introduced to the villagers and our interpreters. Voucher duplicates were deposited at the herbarium of the National University of Laos (NUOL). At NUOL some technical equipment was also introduced and left for educational purpose. The contacts established and the interchange of culture and language