First World shoul help Tird Worl maintain traditional healing practices. Mel Borins, MD, FCFP. M odern medicine, with its sophisticated and expensive diagnostic.
PERSPECTIVES * PERSPECTIVES
First World shoul help Tird Worl maintain traditional healing practices
Mel Borins, MD, FCFP
odern medicine, with its sophisticated and expensive diagnostic equipment and reliance on costly drugs and treatment technology, plays a minor role in many Third World countries, especially in rural areas. Physicians there, like here, tend to be concentrated in cities and there are often too few of them to even begin to meet the needs of their communities. The physician's role is often played by traditional healers, who are not only more accessible but less costly. In many traditionbased societies healers do their work as devotion, receiving little or no payment for their services. They do not prescribe costly drugs or packaged herbs but suggest that patients collect certain herbs, leaves, berries, flowers, bark and roots, and boil combinations of them to produce teas and poultices. Information about herbal remedies has been passed from generation to generation in many Third World countries. Some, such as Thailand and Indonesia, have tried to encourage their citizens to grow some of the comM
Mel Borins, a clinical instructor at the Faculty of Medicine, University of Toronto, is on the active staff at St. Joseph's Health Centre. 1306
CAN MED ASSOC J 1991; 144 (10)
monly used herbs in their gardens and villages so that the medicines will be readily available. In many parts of the Third World the language of science is still misunderstood and people sometimes refuse to accept it. Medical doctors, because they are so overworked, have little time to spend with patients. In contrast, folk healers speak the language of the people and phrase explanations in a way common people understand. They generally see fewer patients and spend more time with each one - people often regard
them as sage, judge, prophet and mystic, all rolled into one. Patients visit to discuss psychosocial problems, which means the traditional healer acts as a stabilizing influence in the community. He also functions as a social psychiatrist. Almost uniformly, people with diseases of a psychiatric nature visit traditional healers before seeking medical care because they seem better equipped to handle these kinds of problems. One of the tragedies in many Third World countries is that physicians who come from rural areas do not return to their villages after Mel Borins photos
Worker cuts herbs at factory in India LE 15 MAI 1991
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their medical training is completed. They move to urban centres or, even worse, leave to practise in more prosperous countries. When villagers do visit local health centres they sometimes encounter physicians who are strangers and know nothing of their personal and family history. Contrast this with the Maori healer, the Tahunga, who learns the genealogy of every person in his village, back to the beginning of Maori time. He will know about the health problems of the parents, grandparents and great-great-greatgrandparents, and everyone in the family. This familiarity and understanding strengthens the healer's ability to understand and appreciate each person he sees. Since he is part of the community, he is familiar with the cultural, religious, familial and social dimensions of each health problem. Many western nations are interested in studying herbal formulations to isolate their active and toxic ingredients. After this is done pharmaceutical companies develop synthetic drugs that mimic the plant's action. Although this research has helped uncover aids for modern medicine, it does little to help the developing countries. The drugs that are developed are so expensive the Third World cannot afford them. Scientific trials should be performed that make use of crude natural substances as well as synthetic products or extracts. Herbal formulations that have proved successful for generations should be tested to provide supp_ort for continued use in their natural form. We should be encouraging poor countries to support their healing traditions and we should investigate their practices in a more scientific way. We should not be encouraging them to rely only on packaged, processed drugs. There is an urgency to these issues - many plants that have served mankind for generaMAY 15, 1991
A Balian reads healing text
tions are becoming extincIt each year. Traditional healers are an untapped resource in the fight against preventable disease and they should be considered a public-health weapon that can 1be used to combat various probleims rife in the Third World. These include the spIread of disease because of contanninated water and inadequate sewaige disposal. Other problems, s,uch as kwashiorkor, a syndrome caused by severe protein deficienicy, and
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marasmus, protein-calorie malnutrition, are endemic in many countries. So is anemia, goitre and blindness caused by vitamin A deficiency, and numerous preventable tropical diseases. Meanwhile, the number of AIDS cases grows unchecked and a lack of birth control expands the population, making solutions more difficult. Traditional healers could be part of the solution to these problems. Their skills, methods and knowledge about preventive medicine should be upgraded and they should be enlisted to educate their communities. First World countries should assist traditional healing, not try to replace it totally with western medicine. Developing countries such as India, Indonesia, Thailand and China are already looking inward and trying to maintain and strengthen their health care delivery systems before traditional healing becomes extinct. Medical schools around the world should get involved, too, and provide courses on
manipulation,
acu-
puncture, herbal remedies and traditional healing to complement current In Indonesia, a woman sells he,rbs door to door
approaches.
We should tackle preventable disease so that eventually we can, indeed, enjoy "health for all."u CAN MED ASSOC J 1991; 144 (10)
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