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Traditional, Complementary and Alternative Medicine

Traditional, Complementary and Alternative Medicine. Barry Kistnasamy. Emerging Technologies. Tomorrow. Today. I think that TCAM …. belongs to the trash bin has no role or place in health care given its lack of a “scientific base’’ has some therapeutic possibilities. 0.4% Africa.

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Traditional, Complementary and Alternative Medicine

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  1. Traditional, Complementary and Alternative Medicine Barry Kistnasamy

  2. Emerging Technologies Tomorrow Today

  3. I think that TCAM … • belongs to the trash bin • has no role or place in health care given its lack of a “scientific base’’ • has some therapeutic possibilities

  4. 0.4% Africa • 2,56 trillion $ is spent on health globally • 0.4% of this is spent in Africa • Close on 80% of the world’s HIV+ people live in Africa

  5. TCAM spending • China – 30% to 50% of medicinal consumption • Japanese per capita consumption of herbal medicine highest in world • 1400 herbal drugs in EU • ZAR250m on traditional healers • $27b in USA

  6. Financing • Mainly out of pocket • In kind • Few Medical Aids

  7. South Africa’s Quadruple Burden • Natural & Non-natural disasters • Residual of Infectious Diseases • Emerging New Epidemics • Epidemiological Transition

  8. The Economist – Dec 13th -19th 2003 The Economist Dec 13th-19th 2003

  9. Trends … • International migration • Urbanisation • Industrialisation • ‘bacteria move just as fast as capital’

  10. The Human Balance • 35000 doctors • 150 000 nurses • 200 000 traditional healers “co-existence versus integration”

  11. The Supply Chain planning production management Health Health Education

  12. The Regulatory Framework ? SAMMDRA Allied HPC SAQA /CHE Traditional HC Health Health Education

  13. TCAM Research • Institute for Traditional Medicines (CSIR, MRC & WHO) • Indigenous Knowledge Systems • National Research Foundation • Universities • Useful Plants Garden - Kirstenbosch • Ethno veterinary practice Ref: Moorman & Pick, 1998

  14. Distribution • "Ezinyangeni" - the place of healers - Mai Mai: muti capital of Jo'burg

  15. Distribution • Sangomas normally detect two kinds of bad luck • One is inflicted through witchcraft, usually by a jealous rival, the other is caused by unhappy ancestors. It is here that patients are counseled to slaughter a beast to appease and rekindle relations with the ancestors. • Sangomas diagnose and prescribe • Inyangas generally heal, although they can also prescribe, depending on the nature of the problem or whether their ancestors give them the power to help a patient

  16. Prescription Once the muti is obtained, it can be taken in various ways, depending on its form and nature. While some muti is just good for washing with, smearing on one's body, or for burning and inhaling, other muti is designed for elaborate uses like ukuphalaza (regurgitating), ukuchatha (applying by means of an enema), or nokugquma (steaming). BMJ 2001;322:164-167 ( 20 January )

  17. Prescription • "Isende lehashi" (horse penis) "Zamafufunyane" (for nightmares and hysteria), "Owobusoka" (guaranteed to improve the romantic fortunes of a bachelor), "Zikatokoloshe" (to ward off an imaginary evil goblin said to spread terror at night)

  18. Zimbabwe healer moots magic chastity potion

  19. Ayurvedic Preparations • Bronchial asthma, ischaemic heart disease and hyperlipidaemia • Curcumin - rheumatoid arthritis • Acute viral hepatitis • Pterocarpus marsupium effective in reducing levels of blood glucose and glycosylated haemoglobin in patients with non-insulin-dependent diabetes mellitus • Fistula-in-ano patients were randomised to surgery or application of medicated thread (Ksharsootra). Surgical treatment led to a faster cure but recurrence rates were lower with medicated thread.

  20. Traditional Chinese Systems of Medicine • Herbal remedies, acupuncture, acupressure, massage and moxibustion • 40% of all health care delivered in China • The first documented source of Chinese medical theory, the Huangdi Nei Jing ("Inner Classic of the Yellow Emperor") was written between 300 BC and 100 BC

  21. Traditional Chinese Systems of Medicine BMJ 1997;315:115-117 (12 July)

  22. Is it a Communist plot? Norwegian Law Brings Alternative Medicine to the Mainstream Journal of the National Cancer Institute, Vol. 96, No. 4, 254-255, February 18, 2004

  23. Blue Ribbon Panel USA - 1996 • complementary medicine in medical & nursing education • philosophical / spiritual paradigm • scientific foundation • practice & evidence of efficacy & safety • develop national centres of excellence • 30 medical schools involved

  24. World Health Organisation… • adopted a number of resolutions • has a Traditional Medicine programme • 19 collaborating centres in 10 countries • 1996 – 28 monographs of 28 plants South Africa… • political support • NRF / MRC support • various educational initiatives (UKZN, Limpopo, UCT, UWC, Zululand) • Traditional Healers legislation

  25. Is the grass greener? MinnesotaMedicine Published monthly by the Minnesota Medical AssociationJuly 2000/Volume 83 Error in Medicine: What Have We Learned?

  26. Integrated Medicine Initiative • integration • complementarities • rivalry • co-existence

  27. Review of TCAM – major domains • traditional & alternative systems • mind – body interventions • biological – based therapies • manipulative & body movement methods • energy therapies

  28. What are we doing? • enhance curriculum • development of service sites • resource mobilisation (local & international) • documentation • academic exchange & research support

  29. Learning Opportunities • Alternative & Complementary • African systems • Indian systems • Chinese systems

  30. Research agenda… • basic principles & assumptions (rigor & relevance) • strategies for peer review, evaluation & validation research • priority areas may be paediatrics, cancer, mental health & cardiovascular disease, HIV/AIDS • horizontal integration with ethno-botanists, chemists, anthropologists

  31. Operational Research agenda… • develop adverse effects registry • credentialing & practice numbers • coding • billing system • record keeping • values

  32. Conceptual & Contextual Issues • Diagnostic classification • Adequacy of treatment • Placebo vs non-placebo • Outcome measures • Assumptions about randomisation

  33. Program mix Academic development • certificate • diploma • degree

  34. Together…

  35. Thank You! barryk@ebucksmail.com

  36. I suggest that BHF’s interventions in TCAM should be: … • to form a BHF TCAM task group • to sponsor research • have nothing to do with TCAM initiatives

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