The speech was first presented at the Toxicological Society of Southern Africa (TOXSA) Conference
It is an honour and a privilege to have been invited to TOXSA to give this talk. My expertise lies in pharmacognosy and analytical chemistry – having spent the past 10 years doing work on the pharmacology and chemistry of medicinal plants. As for traditional medicines, not only have I been involved with them from a scientific aspect, but I am a product of that culture and I can remember using herbal medicines from as far back as I can remember remembering – in other words from my earliest memories.
Traditional medicine has a long history of use world-wide and has not only survived various assaults by Christendom, colonial authorities westernization and urbanization, but to-day thrives and is widely used in all its many and varied forms. The WHO estimates that 70 – 80% of the world population (mostly in the developing world) uses traditional medicines exclusively to meet their health needs.
Traditional medicine remains popular for various reasons – it is a cultural heritage which is closely tied with many ritualistic and religious aspects of life from birth to death and everything between.
- It is more easily accessible for many poor people of the world.
- Traditional medical practitioners are respected members of their communities and provide holistic solutions to the health-care needs of their people unlike over-worked and poorly-resourced western-trained health personnel who tend to medicalize everything. This explains why herbalism which is the cornerstone of traditional medicine now appeals more and more to citizens of Europe and North America. It offers individuals the opportunity to self-medicate and be in control of their own health.
- There is also a general disillusionment and frustration with the failure of allopathic medicines to offer a curative solution to many of the ills of modern society e.g. depression, cancer, and HIV / AIDS. Most modern medicines only offer symptomatic relief (rather than cure) and their use has many side effects.
In the public’s mind traditional is safe because of its length / history of use. In the US surveys have suggested an increase of people reporting use of botanicals or non-vitamin/ non-mineral supplements from 2.5% in 1990 to 12.7% in 1997. 38% of cancer patients and between 14 – 29% of children have used herbal / botanical medicines.
South Africa as is readily acknowledged, is endowed with a rich plant biodiversity – 24,000 indigenous species – strong. 70 -80% of our population use traditional medicine. This correlates to figures from elsewhere in the developing world. In SA, more than 200 000 traditional healers are believed to be practising. Unlike other countries in the SADC region, notably Zimbabwe where one may only practise upon registration with a professional body (akin to the health professions council) in SA anyone can prescribe and dispense traditional medication even when they have no training or claim to the art and science. This may be part of the problem.
But then again, what is a traditional healer. African traditional medicine is generally practiced at three main levels (specializations, if you like), or combinations thereof.
• Diviners / Spiritualists – magico-spiritual, invoke spirits of the ancestors and uses plants, animal parts, rocks or water
• Traditional Birth Attendants (Gynaecologists and Obstetricians, if you like), they are knowledgeable in ante-natal issues and mother and child care
• Herbalist s– use knowledge passed on from generation to generation based on empirical observations. By far the most useful for biological prospectors and pharmaceutical drug discovery.
Regulation of medicines in SA is by the Medicines and Related Substances Act 101 of 1965 with subsequent amendments and this is administered by the Medicines Control Council. Traditional medicine falls outside of this Act for historical reasons however, and this has created many problems. There are ongoing efforts within the MCC to create legal space for traditional and complementary medicines and their practitioners.
Because of the prevailing legal situation and South Africa’s new found enthuasism for all things African, not uncommon in post-colonial Africa, as well as political expediency the terrain of traditional medicine became a battlefield. This battle was largely fought over this society’s response to HIV/ AIDS with activists such as the TAC, politicians, scientists, healers, quacks and pretenders all ranked against one another. And there were no winners – just losers all around.
But this battle royale is also being fought elsewhere albeit on different issues. In the UK the battle pitches HRH Prince Charles and a coterie of GPs and complementary healers against the “medical establishment”.
A few years ago the Prince in addressing the WHO said, “Many of to-day’s complementary therapies are rooted in ancient traditions that intuitively understood the need to maintain balance and harmony with our minds, bodies and the natural world”.
When challenged to produce evidence to support the use of complementary and alternative medicine in the public health sector on of the Prince’s supporters said "I think what this suggestion amounts to is a form of medical apartheid: any therapy which can't trace its origins to what is called the biochemical model should be excluded from the NHS […] The weight of the evidence does suggest that homeopathy is effective."
But then the British can afford to fight in this way and there is certainly no health crisis of the nature we have in Southern Africa. In South Africa while we fought people are dying. Almost everyday the media splashes stories about this or that cure for AIDS or this or that healer making unfounded claims about his treatment.
Let me be clear at this stage and say that we must debunk three myths here
1- that traditional medicine is primitive and has no place in the days of our lives. If this were true it would have long fallen out of use. We know that traditional medicine is a potential asset and in fact provides up to 50% of the pharmaceuticals that have transformed health care in the past century.
2- with regards to pharmaceuticals, advocates of traditional medicine claim that they are toxic and traditional medicine is not. Anti-retrovirals have been called “toxic” and “poisonous” by one camp and “lifesavers” by AIDS treatment activists. We know from basic pharmacology that everything that is ingested has some adverse effect – even water!
3 – that traditional medicine is an alternative science with it’s own principles and laws which are in a different paradigm to so-called western science. This myth is propagated by people who want to discourage enquiry into the use of some of these herbs without proper scientific evaluation.
The then South African Minister of Health in motivating for the Act to govern complementary, alternative, African traditional medicine said “We cannot transplant models designed for scientific validation of allopathic medicine and apply it to other remedies.”
The rejoinder to that would be – if you are going to treat disease which can be explained and diagnosed by allopathic medicine and talk for instance of CD4 and viral loads then that supposed cure should also stand up to the scrutiny of conventional science.
We need to move away from the either or syndrome that is gripping the South Africa. Traditional medicine has a vital role to play; however that role is limited and should be defined. Traditional medicine cannot and should not transplant medical and scientific enquiry. It needs to be put into perspective. And that starts with putting science and ethics into this whole debate.
And the science and ethics of science says that if you are to put out a medicine into the public domain then there must be certain assurances that it is meets three criteria
- that it is efficacious,
- that it is of good and acceptable quality
- and that it’s toxicity profile is understood.
These issues must be addressed in some manner with regards to traditional medicine.
Tuesday, January 12, 2010
Tuesday, January 5, 2010
Come Home Campaign
This article was published originally in The Zimbabwean (http://www.thezimbabwean.co.uk/2009121527495/opinion-analysis/come-home-campaign-let-us-proceed-cautiously.html)
Who does the “Come Home Campaign” serve?
David R. Katerere
I went to see Morgan Tsvangirai speak at a public forum in Cape Town last week. Surprisingly , it was actually my first in-life experience. He was cogent and lucid, humorous at times but not quite the politician on the stump because, of course, he was playing Mr Prime Minister, Mr Inclusive Government, the statesman. And he played it well.
His message was mainly to the Zimbabweans in South Africa, urging them to go back home. He has previously carried this message to the UK, where it did not go down well and ended in some humiliation for him. To his credit, though, he did not shy away from preaching the same gospel, albeit with some caution. But when asked by a member of the audience what opportunities for gainful employment there exist in Zimbabwe to-day, he rightly pointed out that the inclusive government cannot give or guarantee jobs but rather is trying to create an enabling environment for people to pursue economic activity. In his words, “there will not be a time when a line will be drawn in the sand to say things are now good”, it’s time for those in exile to come home; each person, he said, must take a risk and throw in their lot.
The issue of going back to Zimbabwe is indeed a complicated one. In fact is it necessary for people to be urged to go back to Zimbabwe, to go back home, or perhaps in these days of globalization we should actually look at the continued existence of the diaspora as an asset. India has millions of it’s citizens resident around the world; they were not exiled by political turmoil (as in the case of Zimbabwe) but by different accidents of history and personal choices. To-day they form a powerful economic bloc and important pillar to India’s development and international standing. Increasing China and Mexico also have a burgeoning number of non-resident citizens. Prime Minister Tsvangirai should perhaps take a leaf from this. The problem is that the Zimbabwean diaspora was largely spawned by the collapse o f the country and much of it has led to social instability within the region, so it is natural that the leaders of the region are supporting a resolution of the Zimbabwean question in order to put the genie back in the bottle. However it also true that a substantial number of Zimbabwean immigrants are educated and skilled persons who contribute to economic activity in host countries and are the unsung heroes in saving Zimbabwe from total collapse. Tsvangirai did not acknowledge the latter fact. Mugabe has predictably been scathing of Zimbabweans working menial jobs and in a discussion I had with Margaret Dongo, she also appeared blind to this fact that despite Zimbabweans living in some of the most horrendous circumstances, particularly in South Africa, and despite Zimbabweans suffering abuse from locals (read xenophobic attacks), they have continued to work to send money home for their families. And this money prevented total economic collapse the past and is now playing a huge part in stabilizing the current economic situation in the country.
The other worrying part of this blanket call to go back home is that it might inadvertently expose Zimbabweans to xenophobic attacks. In South Africa in a particular, this has been a gathering storm and when locals hear news that “there is progress in Zimbabwe” or “things are getting better”, they appear to find no excuse why Zimbabweans should continue to be sheltered among them. Go back to Zimbabwe, they have said in the past, and vote Mugabe out. And now they say, Go back to Zimbabwe because things are now well, you don’t belong “in South Africa”.
So let us approach the “come home” campaign with some caution. First because it is a good thing to continue to have Zimbabweans in influential positions in other countries of the world – it gives us what in business they would call a global footprint; second, because the idea of home makes little sense in a globalized world; migration is a reality that we have to live with and take advantage of; and third, because it might expose citizens to increased xenophobic attacks.
Who does the “Come Home Campaign” serve?
David R. Katerere
I went to see Morgan Tsvangirai speak at a public forum in Cape Town last week. Surprisingly , it was actually my first in-life experience. He was cogent and lucid, humorous at times but not quite the politician on the stump because, of course, he was playing Mr Prime Minister, Mr Inclusive Government, the statesman. And he played it well.
His message was mainly to the Zimbabweans in South Africa, urging them to go back home. He has previously carried this message to the UK, where it did not go down well and ended in some humiliation for him. To his credit, though, he did not shy away from preaching the same gospel, albeit with some caution. But when asked by a member of the audience what opportunities for gainful employment there exist in Zimbabwe to-day, he rightly pointed out that the inclusive government cannot give or guarantee jobs but rather is trying to create an enabling environment for people to pursue economic activity. In his words, “there will not be a time when a line will be drawn in the sand to say things are now good”, it’s time for those in exile to come home; each person, he said, must take a risk and throw in their lot.
The issue of going back to Zimbabwe is indeed a complicated one. In fact is it necessary for people to be urged to go back to Zimbabwe, to go back home, or perhaps in these days of globalization we should actually look at the continued existence of the diaspora as an asset. India has millions of it’s citizens resident around the world; they were not exiled by political turmoil (as in the case of Zimbabwe) but by different accidents of history and personal choices. To-day they form a powerful economic bloc and important pillar to India’s development and international standing. Increasing China and Mexico also have a burgeoning number of non-resident citizens. Prime Minister Tsvangirai should perhaps take a leaf from this. The problem is that the Zimbabwean diaspora was largely spawned by the collapse o f the country and much of it has led to social instability within the region, so it is natural that the leaders of the region are supporting a resolution of the Zimbabwean question in order to put the genie back in the bottle. However it also true that a substantial number of Zimbabwean immigrants are educated and skilled persons who contribute to economic activity in host countries and are the unsung heroes in saving Zimbabwe from total collapse. Tsvangirai did not acknowledge the latter fact. Mugabe has predictably been scathing of Zimbabweans working menial jobs and in a discussion I had with Margaret Dongo, she also appeared blind to this fact that despite Zimbabweans living in some of the most horrendous circumstances, particularly in South Africa, and despite Zimbabweans suffering abuse from locals (read xenophobic attacks), they have continued to work to send money home for their families. And this money prevented total economic collapse the past and is now playing a huge part in stabilizing the current economic situation in the country.
The other worrying part of this blanket call to go back home is that it might inadvertently expose Zimbabweans to xenophobic attacks. In South Africa in a particular, this has been a gathering storm and when locals hear news that “there is progress in Zimbabwe” or “things are getting better”, they appear to find no excuse why Zimbabweans should continue to be sheltered among them. Go back to Zimbabwe, they have said in the past, and vote Mugabe out. And now they say, Go back to Zimbabwe because things are now well, you don’t belong “in South Africa”.
So let us approach the “come home” campaign with some caution. First because it is a good thing to continue to have Zimbabweans in influential positions in other countries of the world – it gives us what in business they would call a global footprint; second, because the idea of home makes little sense in a globalized world; migration is a reality that we have to live with and take advantage of; and third, because it might expose citizens to increased xenophobic attacks.
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