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Traditional Medicine And global Health

Traditional Medicine And global Health. An Introduction. HERB SHOP IN PERU. UNANI CUPPING IN PAKISTAN. INTERIOR OF A NATIVE AMERICAN SWEAT LODGE. . . AT VA HOSPITAL IN UTAH. Objectives:. Define Traditional Medicine (TM) Explain TM’s relevance to global health Review WHO’s Position on TM

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Traditional Medicine And global Health

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  1. Traditional MedicineAnd global Health An Introduction

  2. HERB SHOP IN PERU

  3. UNANI CUPPING IN PAKISTAN

  4. INTERIOR OF A NATIVE AMERICAN SWEAT LODGE. . . AT VA HOSPITAL IN UTAH

  5. Objectives: • Define Traditional Medicine (TM) • Explain TM’s relevance to global health • Review WHO’s Position on TM • Case Studies: Successes and Failures

  6. I. What is Traditional Medicine (TM)?

  7. Traditional Medicine (TM): • “long-standing indigenous systems of health care found in developing countries and among the indigenous populations of industrialized countries” (Bodeker 2006) • sometimes called ethnomedicinesince many systems or practices pertain(ed) to a specific cultural group

  8. TM, CAM, or TCAM? Q: Is moxa an alternative tx? A: location, location, location • TM practiced outside its area of origin is considered a type of CAM (Complementary & Alternative Medicine). • The globalization of TM has made the terms TM/CAM and TCAM popular. • Class Focus: TM in the Global South.

  9. Traditional Medicine Characteristics What are some similarities and differences compared to biomedicine? • Vitalistic and humoral • Holistic and individualistic approach to pathology • Health as balance of body, mind, spirit, society • Focuses on healing illness • Increasingly influenced by biomedical model and perspectives

  10. Typology of TM Providers* • Herbalists • Manual Practitioners • Bonesetters • [Traditional Birth Attendants] • Spiritual Practitioners *Practitioners vary system by system

  11. TM’s Role Varies Greatly Health Sectors National Health Policy • Popular • Professional • Folk • Integrative • Inclusive • Tolerant

  12. Traditional Chinese Medicine (TCM) in China • Uses modalities such as herbs, acupunture, tui-na, and qi-gong to maintain yin/yang balance and to regulate qi • Fully recognized in the professional sector; fully integrative government policy • Graduates of TCM colleges licensed as TCM physicians

  13. Ayurvedic Medicine in India • Uses herbs, yoga, massage, meditation, breathing tx, and panchakarma to maintain a bodily balance of vata, pitta, and kapha. • Recognized in professional sector as part of an inclusive health policy • Licensure as ayurvedic physicians

  14. Ghanaian Traditional Medicine • Uses herbs, counseling, and shamanistic-type practices to maintain health as harmony of body, mind, spiritual world, and society • Officially recognized in professional sector by government, whose policy has moved from tolerant to relatively inclusive (in theory) • Registration of healers

  15. Global Trend: Professionalization, Research, Policy Development Traditional Thai Medicine (TTM): From Outlaw to In-Patient Care The Rigors of Research! • Practices range from massage and herbal medicine to shamans and spiritual healers. • Outlawed in the 1930’s, relegated to folk/popular sectors • Elements recognized in the 80’s as having merit • Today, TTM herbal medicine and massage are licensed, regulated, and included in national health policy, and taught at Mahidol University, among other schools

  16. II. Why is TM relevant to GH?

  17. Five Key Reasons • A. Utilization & Access • B. Potential Impact • C. Workforce Expansion • D. Cultural Competence • E. Dollars & DALYs

  18. A. High Utilization & Access Patterns* • For Example: • 40% of health care in China is TCM • 80% of Sub-Saharan Africans use TM • Over 70% of Chileans use TM of some sort • Over 60% of rural Indians use TM *data and graph from WHO Traditional Medicine Strategy 2002-2005

  19. Factors Underlying Utilization • Availability • Cost • Medical Pluralism • Health Belief Models

  20. B. Impact of TM Models and Practices Potential to Benefit Potential to Harm • Ugandan herbs for herpes zoster in the HIV-infected as effective as acyclovir • Aqueous extract of fennel can help to relieve intra-ocular pressure • Polysaccharides in several Chinese herbs reduce side effects of chemotherapy and decrease tumor size • HIV-positive Ugandans using TM are twice as likely to quit ARV’s within 2 years • 30-40% of Nepalese who use TM eye ointments suffered corneal ulceration • Flavonoids in Qing Pi might inhibit effectiveness of Tamoxifen

  21. B. Impact of TM Models and Practices • Research into the TM materiamedicaproduces new biomedical drugs that can impact global health: • Artimesinin, derived from Artemisia annua L. • Oseltamivir (Tamiflu), derived from star anise Potential to Benefit Potential to Harm • Ugandan herbs for herpes zoster in the HIV-infected as effective as acyclovir • Aqueous extract of fennel can help to relieve intra-ocular pressure • Polysaccharides in several Chinese herbs reduce side effects of chemotherapy and decrease tumor size • HIV-positive Ugandans using TM are twice as likely to quit ARV’s within 2 years • 30-40% of Nepalese who use TM eye ointments suffered corneal ulceration • Flavonoids in Qing Pi might inhibit effectiveness of Tamoxifen

  22. C. Workforce Expansion • Traditional Healers can help to fill the workforce shortage (2 million+ HCP’s) • HIV/AIDS prevention • Health promotion , health care provision, lay mental health counseling • Curbing harmful TM practices, encouraging beneficial ones • Clinic referrals • Crucial points: • Healers can help or harm! • Programs can succeed or fail

  23. D. Culturally Competent Engagement Call it E. Coli or “Damp Heat,” it’s still the runs . . . • Health-seeking behavior is partially based on EMs • Ignorance or insensitivity may impact success. • Examples: • hot/cold dichotomies • cerebral malaria • Biomedical tx for proximate causes TM for efficient causes

  24. E. Dollars & DALYs

  25. III. What is WHO’s Position on TM?

  26. WHO &TM: A Brief History • 1948 WHO’s Constitution defines health as “a state of complete physical, mental and social wellbeing, and not merely the absence of disease” • 1978: The Alma Ata (Kazakhstan) Declaration on primary care includes “traditional practitioners as needed” and noted that they should be suitably trained • 2008: Beijing Declaration on TM • TM, primary care, and MDGs as interrelated • Varying national needs and circumstances • Importance of education, communication, and collaboration

  27. WHO’s: Traditional Medicine Strategy, • Develop sound policy on licensing, regulation, and incorporation • Ensure safety, efficacy, and quality for utilization and surveillance • Provide equitable access to beneficial TM to protect health, promote sustainability, and protect rights • Establish rational use for patients, providers, and health care collaboration between TM and biomedicine

  28. Dr. Chan Endorses TM . . . But Makes An Important Point

  29. Dr. Chan’s Key Point: • “Traditional medicine has much to offer, but it cannot always substitute for access to highly effective modern drugs and emergency measures . . . . This is not a criticism of traditional medicine. This is a failure of health systems in many countries to deliver effective interventions to those in greatest need, on an adequate scale.”

  30. The Challenges Global Health • Utilize the benefits that TM can provide • Exploit the potential of TM providers to meet other primary care needs • Devise rational use strategies to maximize beneficence and minimize maleficence ****************************** • 19 WHO Collaborating Centers, including NCCAM and College of Pharmacy at UI Chicago

  31. IV. TM Successes and Failures

  32. Success: FRLTH--Home Herbal Gardens in South India • Foundation for Revitalization of Local Health Traditions in Bangalore • Researches local herbs for common “OTC” conditions, helps rural families and communities to set up home health gardens (herbs and fruits), and trains in appropriate use • 50-80% decline in health care costs among participating families • Importance: families pay 70-85% of healthcare costs, a significant cause of rural indebtedness • 190,000 gardens now in use

  33. Success: THETA Uganda--HIV/AIDS Education & Collaboration • Traditional Healers and Modern Practitioners Together Against AIDS and Other Diseases • Collaborates with MoH and research universities to studyTM • Has trained +/- 3000 healers • Communities with THETA trained healers have higher levels of knowledge about HIV/AIDS • Traditional healer referral rates to biomedical doctors increase by 90%

  34. But failures provide a cautionary tale . . .

  35. Ugandan Male with Lymphoma Sought traditional healer. Confused by biomedical diagnosis. Besides, he had no money to pay for chemotherapy since free drugs were unavailable at the time.

  36. Treated by a Traditional Healer The healer injected the nodes until necrotic. Healer did not refer to a biomedical provider; nor did he understand malignancy. Lymphoma spread. I met this man when he was dying in hospital .

  37. The Bottom Line • Depending on the circumstances, TM is both an important asset of culturally competent global healthcare delivery and a symptom of failure and structural violence. • TM is a tool in a multi-disciplinary GH arsenal • Avoid ignorant skepticism & wishful optimism • TM and biomedicine: not an either/or scenario

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