Which wav lor hditional medicine?
A "wind of change" is blowing in the field of traditional medicine, as in other fields of health care. lt is only by being visible and active that WHO will keep abreast of a develop-
ment which represents a re-birth of the medicine of the past-and will help to humanise the medicine of today
Traditional medicine responds directly to a given society's needs for psychosocial and physical health and well-being. lt also re- lates to man's whole desire for spiritual and artistic fulfilment. For an African, tradi- tional medicine represents the sum total of practices, measures, ingredients and procedures of all kinds, whether material or not, which from time immemorial have enabled him to guard against disease, to alleviate suffering and to cure himself.
The majority of Asians regard life itself as the union of body, senses, mind and soul;
in accordance with this conviction, they consider positive health as the blending of physical, mental, social, moral and spiri- tual welfare.
The realisation of the prospects inherent in the use of practitioners of traditional medicine as front-line workers in the development of national health systems is conditioned by two independent factors : the changed political power that accom- panied national independence, and the low levels of resources that are available to tackle issues of development. The first factor is related to national group pride, and is associated with past heritage and newly gained national independence. The second factor is linked to utilisation of all available resources. Since the practition- ers of traditional medicine are already well-patronised by members of the com- munities in which they live and work, the adoption of traditional medicine in the design and implementation of national health care systems obviously makes good sense.
A traditional healer in the Congo bottles one of her decoctions. Photo WHO/R. c. da Silva
by Olayiwola Akerele
In 1977, the 30th World Health Assem- bly adopted a resolution (WHA30.49) urging interested governments to give
"adequate importance to the utilisation of their traditional systems of medicine, with appropriate regulations as suited to their national health systems." Both developing and developed countries are showing greater interest in using traditional and indigenous health care resources in imple- menting their national health pro- grammes, particularly at the PHC level in developing countries. The vogue for using natural biological products rather than synthetic ones has been the prime motive behind renewed interest in folk medicine (including the use of medicinal herbs) in developed countries. In many instances, such trends have been backed by appro- priate legislation. Sorne developed coun- tries have already started to examine the possibility of introducing into their nat- ional curricula a number of alternative health systems not at present taught in their medical schools, a development which has already taken place in several developing countries.
Role of WHO
Immediately following resolution WHA30.49, WHO launched a world-wide promotion effort. The success of this promotion can be measured by the grow- ing interest in the subject. lt is also reflected in the large numbers of letters of enquiry and the numerous "internat- ional" conferences that have been held or are being planned, with or without WHO collaboration. There is, in addition, a growing volume of articles on related themes appearing in scientific journals and lay publications, while many institutes and agencies are seeking to associate themselves with WHO as collaborating
research and training centres, or in mak- ing films on different aspects of traditional medicine.
These recent positive developments are largely the consequence of WHO's leader- ship role in the health domain. Endorse- ment by WHO has also encouraged a re- examination of the value of traditional medicine in most developing countries, from which new cultural awareness of, and pride in, traditional values have emerged.
This newly-found national pride would be of little consequence unless it were trans- lated into a meaningful form of action.
WHO's role in this translation process is crucial. One of the most positive things that the Organization has is its credibility, its "non-partisan" involvement. In an area where developing countries are anx- ious to prevent a second wave of exploita- tion, the Organization can be trusted to look after their interests, and to prevent any over-exploitation of the potentials that are present in traditional medicine.
The large number of traditional health practices in specific countries need to be identified, gathered, sifted through and evaluated. The decision whether to make use of them rests ultimately with each country itself These practices, including herbal and home remedies, could consti- tute new tools for use by the health systems; a service-oriented mechanism is needed to make them readily available to suffering humanity. In any event, medical care in most rural as well as some urban areas is a mixture of both traditional and modern medicine. lt is often difficult to determine where one ends and the other be gins.
The field of traditional medicine is an area where various groups with different vested interests, including commercial in- terests, are vying to gain greater prestige and attention; some would like to have 3
WHO's backing for these purposes. WHO's
role must be to channel such initiatives towards the wider goal of equity and service, through careful assessments of the proposals that are submitted.
Critical analysis
What is imperative now is that WHO
should stand back and evaluate the tradi- tional medicine programme. Such a criti- cal analysis will serve to identify, classify and develop the different disciplines in- volved, and to map out clear grounds for further programme growth. Ideally, there should be a solid, steady expansion of concepts and experiences over the next five years.
The programme should continue to act in concert with the Organization's Re- gional Offices, encouraging and support- ing those countries that are ready to use practitioners of traditional medicine within their national health systems, as part of their strategy for "Health for all by the year 2000."
Closer links with other institutions working in this field will broaden WHO's
capacity to respond meaningfully to in- herent pressures and demands that may corne from various quarters.
Three major lines of action suggest themselves :
- Evaluation of traditional medicine and practices. It goes without saying that a kind of "power play" has often prevented the legitimisation of traditional medicine in different societies. lt is therefore all the more important to separate myths from reality. What is the possible value of traditional medicine systems in terms of diagnostic, therapeutic and rehabilitative application? Do we know enough? How can WHO bring the knowledge that is inherent in traditional medicine into the open? WHO could act as a facilitator and stimulator of the public interest that 4
Plant medicines on display in a Bolivian street. WHO collaborating centres are at work identifying patent herbai drugs for such purposes as fertility regulation and treatment of cardiovascular diseases, mental illnesses and diabetes. PhotoWHO/J. Bland
already exists in both developing and developed countries. Modern technology can be used to provide evidence of effi- cacy and safety, or to prove the placebo effect of some of the practices and re- medies that are currently in use in differ- ent countries. (The placebo effect is the positive therapeutic effect that some pa- tients derive from a medicament whose active properties cannot be shown ; this effect is frequently seen in disorders of a psychosomatic nature, and of course the placebo, or inactive drug, is as much used in modern medicine as in traditional medicine.)
The collaborating centres that have al- ready been designated in developing and developed countries will continue to carry out relevant research in ethnopharmacol- ogy, and in traditional systems of medical practice such as acupuncture, as well as undertaking epidemiological follow-up of their use. They will seek inter alia to identify potent herbal drugs for such pur- poses as fertility regulation and treatment of cardiovascular diseases, mental ill- nesses and diabetes, and test the best and safest ways of using them. These practices and remedies could then be made -readily available for wider application.
- Research into traditional medicine as part of a national health system. Apart from China, where a synthesis of tradi- tional and modern medicine is being pur- sued, and such countries as Burma, India, Mexico, Nigeria and Thailand, · where traditional medicine is being developed in parallel with allopathie medicine, not much is known about the possibilities that exist for making use of traditional
medicine technology in national health delivery systems. We need to find out how such proven technology could be incorpo- rated into those national health service systems that are willing to use it. On the basis of research results, WHO will promote the use, where appropriate, of effective traditional medicine and practices at all levels of the health system, but particu- larly through primary health care. WHO
will encourage programmes for setting up herbal gardens, particularly at the family and community level, to ensure that safe herbal remedies are available for self- care.
Certain fundamental problems of inte- gration were identified at a WHO meeting held in Geneva in 1977. For example,
"the impossibility of integrating certain aspects of traditional medicine based on spiritual, moral or other fundamental principles, e. g. exorcism and special heal- ing arts associated with spiritualism ". This and related problems make the issue of programme definition even more pressing. - Training. How do we train traditional practitioners? How do we introduce el- ements of traditional medicine of proven value into the curricula of health workers?
The important thing is to make practition- ers of traditional medicine our allies rather than our competitors; the training of traditional birth attendants in many countries is an excellent example of the possibilities that exist for this type of collaboration.
In order to have a clearer perspective of the social, political and · economic inter- play associated with the definition of a programme in traditional medicine, the opinions of national experts with widely differing backgrounds and experience will be crucial. A proposed Expert Committee meeting which is to examine "the role of traditional medicine in primary health
care" some time in late 1984 should fulfil
this requirement.
WHO's Traditional Medicine programme is at an historical crossroads. Having gen- erated international awareness of the rich- ness and importance of the subject, it can either sit back and become a passive observer and reporter of developments in different settings; or it can maintain its leadership role by actively defining more refined and widespread developments. Clearly the latter course of action is to be preferred. If WHO were to take a passive, low-profiled stance, it would risk being bypassed by events. A "wind of change"
is blowing in this as in other fields of health care. It is only by being visible and active that WHO will remain in the main- stream of this exciting development-a development which represents a re-birth of the medicine of the past, and one which will help to humanise the medicine of
~dey. •
