Qi flows from Beijing to Gaborone (Part 3)
Baboki Kayawe | Friday February 26, 2016 16:48
Commenting on the status of indigenous medicine in the country, University of Botswana’s microbiologist Professor Kerstin Andrea-Marobela says traditional medical systems do form a vital part of primary healthcare, which is used by all sections of society.
However, the fact that the traditional healing profession is not legally recognised, prevents open collaboration. “Referral from healers to clinics do take place, and unofficially also in some cases from clinics to traditional healers,” Marobela says. From research, she says it appears Batswana prefer to have pluralistic health choices. For some conditions one would visit a clinic, while for others one would prefer to consult a traditional healer. She views integrating both regimes a farfetched call.
“Integration means usually the incorporation of a system in a pre-existing framework. In my view that would be difficult for traditional healing systems. I would rather prefer to see a peaceful co-existence, where cooperation on some aspects is possible in a mutual and trustful manner, but where a diversity of health choices remain,” she opines.
According to Marobela, lack of legal recognition of the traditional healing professions is a major hindrance to the peaceful co-existence of the two systems. Consequently, traditional healers are operating in a gray zone where professionals would not want to cooperate with them. “The lack of open and transparent cooperation leads to a situation whereby the profession is seen mainly based on assumptions, than on knowledge. For example, a lot of prejudices exist when it comes to traditional healers. People believe they don’t really know what they are doing, they don’t know the correct dosage, they are somewhat unorganised and don’t have a clue about science, medicine and patient care,” she says.However, Marobela is quick to say this does not imply there are no quacks or business seekers amongst healers.
“There are. But to be honest, you can also find shady characters amongst biomedical doctors. If our concern is to eliminate quacks from true traditional healers, it would be easy to have a traditional healer’s council that would accredit healers. In some countries this is standard practice.” Marobela says they are currently performing studies to scientifically establish whether traditional healer, Gladys Malebo’s ‘Seromabadimo’ has anti-HIV properties. “We are currently working on that. Unfortunately, we were delayed with obtaining a research permit. It looks like we should get it now and we are optimistic that we will soon enroll people who intend to take Seromabadimo or have already taken it, into studies that would utilise the experience that some of the patients already have with Seromabadimo to characterise the medicine in more detail.” Already, however, Marobela’s initial studies are yet to find anti-HIV properties in Malebo’s Seromabadimo.
“That also does not mean that ‘Seromabadimo’ does not ‘work’. We presently simply don’t know until the medicine is more characterised and investigated,” says Marobela.
In 2013 her laboratory report was quoted thus: “The medicinal constituents of Seromabadimo represent botanicals, which have been part of traditional medicine systems and other countries in southern Africa and have been used for generations for the management of several conditions and general well-being”.“It is known that often mixtures of medicinal plants unfold synergetic positive effects, which will not be observed when using individual components as therapeutic agents. Therefore, Seromabadimo is a specific preparation intended to maximise health-promoting effects particularly in an immune-compromised health context.” “It was observed that these attributes contribute to an improved well-being particularly of HIV/AIDS patients. Qualitative laboratory investigations furthermore show a potential of Seromabadimo components to suppress opportunistic infections,” reads the report. Marobela adds that after having a ‘clearer understanding’ on how Seromabadimo works, it would certainly be worth exploring modalities where established HIV/AIDS treatment and traditional treatment regimens come together.
“We should not forget that HIV/AIDS is a syndrome. Medication, be it conventional or traditional can act on different levels – it can interfere with the life cycle of the virus itself. A traditional medicine can boost antiretroviral drugs. There are examples for that.
There are many opportunistic infections, which can be addressed by giving traditional medicine, possibly together with ARVs pending assessment that the traditional medicine does not interact with ARVs in a detrimental manner.”
Moreover, she says there are traditional medicines that can act on parameters that would help a patient to increase weight, combat fatigue and/or boost physical energy.
She further says that cooperation could be useful as traditional medicine could help counteract ARV’s long-term side effects. At the height of Malebo’s claims, the Ministry of Health (MoH) issued a statement to the effect that no cure has been found yet for HIV/AIDS, and also encouraged those enrolled in the anti-retroviral therapy to continue with treatment.
“I do have a very good working relation with the Department of Public Health, which is also in charge of dealing with traditional medicine. When the newspaper article appeared, we had a common dialogue on this matter and we agreed that it would be best to use our scientific knowledge to test the medicine as soon as possible,” Marobela says. Unfortunately, she says funds for such studies were not readily available and the research permit has also delayed.
“I wish also to mention that Malebo first approached the Ministry of Health to register her medicine and they referred her to me for further characterisation of the medicine,” Marobela says.
“She is more than willing to collaborate with us scientists and with the MoH.” Regarding the positioning of Chinese medicine in modern health care, Marobela says the Asian giant is certainly a role model.
“I have entered into cooperation with Chinese scientists to characterise medicinal plants from China and Botswana with the aim of learning from each other how traditional medicines can ultimately be developed into effective health products. This, by the way, is also the perspective of many traditional healers in Botswana.”
She says they would like to see African Traditional medicines properly packaged, and their contents declared and properly marketed so that jobs and small incomes can be created.
The Ministry of Infrastructure, Science and Technology recently commissioned a consultancy to develop a national Indigenous Knowledge Systems Policy. Marobela hopes the draft policy passes in Parliament, as it would help to boost any further development of traditional medicines.
The Traditional Medicine Practice Bill (TMPB), which is expected to help in regulating the practice in the country, is currently at finalisation stage. According to the health ministry’s spokeswoman, Doreen Motshegwa, Botswana continues to consult with other countries that have completed their policies so that, in the end, traditional health practitioners would have a guiding instrument in providing health services to the nation.
The policy was motivated by the World Health Organisation (WHO)’s call that countries should develop traditional medicine practice bills or policies. WHO made the call after launching its first ever comprehensive traditional medicine strategy in 2002.
“The strategy is designed to assist countries to develop national policies on the evaluation and regulation of traditional medicine practices, create a stronger evidence base on the safety, efficacy and quality of the traditional medicine products and practices and ensure availability and affordability of traditional medicine including essential herbal medicines. “It is also designed to document traditional medicines and remedies.”
Asked whether indigenous medicine still has a place in the conventional health sphere, Motshegwa says traditional medicine is among the health alternatives that exist in the country, which the nation is at liberty to access.
“However, there is no evidence on the extent of utilisation of traditional health practice.
Empirically both systems are used. As the Ministry of Health we have established robust collaboration through which we engage and dialogue with one another on issues of importance in this regard,” she explains.
At present, there is a reference committee in place comprising of representatives from difference traditional health practitioners associations and health professionals.
The health ministry says that WHO recognises the importance of the two systems of traditional and western medicine and recommends that they need not clash.
“Within the context of primary health care, they can blend together in a beneficial harmony, using the best features of each system, and compensating for certain weaknesses in each. Deliberate policy decisions have to be made, which is what the ministry will address through current THP bill that is being developed.”
With regards to benchmarking from China, Motshegwa says though the development of the THP is primarily based on experiences and lessons learnt from Sub-Saharan Africa, its finalisation process will take cognisance of other members of the global community. The draft THP bill recommends the establishment of a Traditional Health Practices Council, which upon receipt of an application shall assess and subject the applicant to appropriate practical tests in accordance with the procedures set by the council before granting the-license to practice. *
This article was produced with funding from the China-Africa Reporting Project, coordinated by the University of the Witwatersrand in South Africa. Special thanks to China University of Communication Masters students Ma Xinhu and Hu Xiufang who did translations from Chinese to English. This edition’s insert is the third of a four-part series.
“Consequently, we cannot develop a yardstick upon which we can train and regulate practitioners of indigenous African medicine,” he says.
Perhaps with herbalists, things are slowly changing as practitioners such as Malebo and others have started documenting the tools of their trade.
However, academia in Africa is poorly funded and hence serious research on African herbal medicine is limited.
Even when there is overwhelming evidence, Kikete says the continent lacks indigenous pharmaceutical companies that can translate research findings into commercial ventures such as is the case in China.
“Also, those who run healthcare in Africa prefer to copy paste healthcare models from the West without tailoring them to suit local needs and realities,” Kikete says.
For him, the most important and perhaps most disturbing challenge with African Traditional Medicine is the societal perception that it is retrogressive and must be shunned at all costs. Kikete’s greatest fear is that African countries may expend resources developing it, only for its uptake in the community to be too low to make sense.
Colonialism and the spread of Christianity in particular across the continent, have played a pivotal role in this imaging of indigenous medicine in Africa.
“The early missionaries and colonialists ridiculed, demonised and even banned African Traditional Medicine. At the time many Africans perceived these missionaries to be a superior race and accepted their healthcare models and culture blindly to the detriment of African Traditional Medicine. Even our foods that were nutritionally better and in part responsible for relative longevity then, were discarded in an attempt to ape the whites,” Kikete says.
On a positive note though, the colonists documented the plants they found here.
“At least they documented the plants they found here, even though it may not have been for medicinal reasons,” he says.
“In East Africa they founded a botanical collection called The East African Herbarium, which has been an invaluable asset in medicinal research on plants.”
Though both health systems have been in existence since time immemorial, Kikete commends Beijing for the fact that over the years the Chinese developed a very complex theory of TCM, “That is up to universally recognised by practitioners, the public and the government”.
“This informs the policy on promotion of TCM in China and abroad. Naturally resources follow policy and as such extensive research in Chinese herbs has led to scientific validation of many ancient claims while also discounting others,” he adds.
Moreover, Chinese pharmaceutical companies have been quick to collaborate with research institutions to commercially exploit such research findings. Even in Africa, there is a major footprint of Chinese herbs formulated as modern dosage forms that are convenient for the patient.
In contrast, however, many 21st century African herbal remedies are still marketed in their crude form or as voluminous, bitter and unhygienic concoctions, said Kikete.
“Indeed several indigenous African herbs have entered the formal pharmaceutical system based on indigenous claims of their effectiveness in treating diseases. A good example is pygeum (Prunus africanus). Sadly the pygeum bark is harvested in Africa and exported crude at a pittance to the West,” he says.
“There it is processed into a potent drug for managing prostrate problems and sold for a handsome profit. Of course weak regulation in both the practice of African Traditional Medicine and trade in herbs is the genesis of this problem. But again Africa cannot regulate this effectively because we don’t have ‘experts’ in the formal sense since the practice is largely informal. The converse is true for China,” he explains.
China, meanwhile, has enjoyed global recognition, which is mainly as a result of government efforts to preserve and promote TCM. In addition, Kikete says acceptance outside China by scientists has been as a result of the formalisation of training at university level, which led to research that has now validated many of the ancient claims.
However, like any science TCM has its limitations.
“These limitations are due to the fact that TCM is based on the knowledge of ancient times, which cannot be as wide as today’s knowledge. For example surgery was not done in TCM because knowledge of anatomy and physiology was not adequate at the time,” he says.
However, acupuncture has been shown to be effective in stimulating nerve regeneration after injury or surgery and this is a major area of integration in China.
Africa can draw invaluable lessons from the East, argues Kikete. He says in China, herbal preparations can be used as alternatives to synthetic pharmaceuticals.
“For example some African herbs could stimulate the immune system in HIV and cancer patients with less toxic side effects compared to their western contemporaries.”
For the integration to be effective and achieve fruition he says the issue of acceptance must be dealt with.
Kikete says: “If it is not in your modern culture today to embrace African Traditional Medicine especially the policy maker, health worker and community member, even the most elaborate policy is unlikely to succeed. This can be addressed as a civic education matter and also at school level”.
In Botswana, policy must provide incentives for traditional healers to share their current knowledge with the formal system and find ways to retrospectively search for lost knowledge. This knowledge should then be scientifically tested.
Since African Traditional Medicine has no universal principles of diagnosis and only needs to focus on the effectiveness of the product in treating whatever it is being claimed to be useful for, Kikete says remedies that work should then be standardised and documented while those that do not are discarded.
“Here we will expect some resistance since traditional healers mystify their methods with claims of supernatural influences. Secondly, most have no formal schooling and cannot be brought to class and expected to grasp modern science. More importantly it is the perceived monopoly of knowledge that attracts clients to them and they may not give it up easily.”
However, he says a curriculum could be developed to incorporate African Traditional Medicine into medical practice and training provided both parties are willing to mainstream the practice.
The Ministry of Health could then regulate the qualified practitioners and products, he adds.
“Of course if the market economics make sense, the pharmaceutical sector should be brought on board to manufacture convenient formulations that can guarantee safety and efficacy. As you know the conditions herbs are exposed to during growing, harvesting and preparation cannot be reproducible if every practitioner is left to his own devices.”
* This article was produced with funding from the China-Africa Reporting Project, coordinated by the University of the Witwatersrand in South Africa. Special thanks to China University of Communication Masters students Ma Xinhu and Hu Xiufang who did translations from Chinese to English. This edition’s insert is the last of a three-part series.