Ethiopia 2539 A Qualitative Understanding of Local Traditional Knowledge 0 and Medicinal Plant Use The real figures behind that ' 80%' natural chemists, pharmacologists, an- ] figure thropologists and health-workers have generally pursued their specific re- search interests in this area in relative t this very moment, some- isolation from each other. In Ethiopia, A where in a remote rural commu- there have been few cross-disciplinary nity in the Ethiopian Highlands, linkages among the various approaches a local farmer may have just of researchers or the analysis of their gathered the leaves or roots from a findings medicinal plant found near the home- Moreover, much of the existing lt- stead. In a nearby hamlet, a mother . . . erature on Ethiopian traditional herbal may be in the midst of preparing a tra- medicine is dominated by plant-fo- ditional plant treatment believed to cused work, resulting from the 'main- 'restore strength', relieve stomach ' ~~~~stream research agenda', which has cramps, heal a skin condition, or per- been largl dienban oeiding haps alleviate symptoms of a respira- ieen the spec therapeuti tory tract infection affecting her child. proertes in divid . pla tin It is such routine use of plants by ordi- serh of inf iononth proets nary ember of ocal ommunties search of information on the properties nary members of local communities No. 52 across Ethiopia's diverse rural land- Janluary 2003 scape, which largely accounts for the IKNotes reports periodically on Indigenous Knowledge (IK) initiatives widely cited 80 percent estimate of in Sub-Saharan Africa and occasionally the population wvho continue to rely on on such initiatives outside the Region. It is published bv the Africa Region's traditional plant-derived medicines for Knowledge and Learning Center as their basic health care needs part of an evolving IK partnership (Bannerman, MOH, 1985; Abebe and between the WVorld Bank, communi- Hagos, 1991; IBCR, 1999). ties, NGOs, development institutions Hagos, 1991; IBCR, 1999). and multilateral organizations. The While there is now growing recogni- views expressed in this article are O,ONAL those of the authors and should not be tion that the study of indigenous attributed to the World Bank Group health knowledge and practices re- or its partners in this initiative. A quires an essentially multidisciplinary webpage on IK is av,ailable at/ NNMvWworldbank.org/afr/i k/ research framework, to date, botanists, default.htm %ON ASD 2 of various Ethiopian medicinal plants, researchers have gen- o focused discussions with mothers at local health centres; erally focused their attention on two main sources: (i) the - local market surveys; professional traditional health practitioners and (ii) o questionnaires administered to high-school students; and Ethiopia's ancient medico-religious manuscripts - herbal structured interviews with (both modern and traditional) letters containing elaborate recipes of plant-derived treat- professional health practitioners. ments for a wide range of health conditions (see e.g., Abebe and Ayehu, 1993). By contrast, there have been few studies focused specifi- Preliminary assessment of the data cally on traditional knowledge and practices outside the In-depth quantitative and qualitative analyses of the data 'professional' realm of traditional medicine. The purpose of gathered from these various sources are still under way. Fol- this article, derived from a larger study, is to share some of lowing are some highlights of the preliminary findings of the the findings of current research2 envisaged focusing explic- research. itly on the 'lay domain' of traditional knowledge in the Ethiopian context. The tacit and pervasive nature of traditional health knowledge Objectives and methods In general, traditional knowledge about medicinal plants and its application are very much taken for granted by both The fieldwork-based study aimed to gain insight into the lo- men and women in all the study communities. Such tradi- cal distribution of traditional health knowledge and the uses tional knowledge and practices constitute routine aspects of of various medicinal plants among ordinary men and women daily life and are deeply engrained in the socio-cultural and in rural communities, who constitute the vast majority of economic fabric of these rural societies. This is a significant Ethiopia's population. The overall aim of the research is to finding in itself, as it clearly demonstrates the sheer scope contribute to the growing body of literature and experience and significance (actual and potential) of local traditional pertaining to the role of indigenous/traditional systems of knowledge. knowledge in development. Underlying this objective is the fundamental premise that health constitutes the linchpin of Gender and age dynaamics the development process, viewed at once, both as the means Some general trends could be discerned suggesting consid- as well as the end of development. erable gender and age differences in the type and extent of The fieldwork was carried out with the participation of traditional health knowledge. For example, middle-aged and communities in the rural Bahir Dar Zuria district of Gojam older women and men generally appear to have a greater (now part of the Amhara Regional State) located in the North breadth of medicinal plant knowledge. In addition, men \Vestern Highlands of the country. A combination of research more often demonstrated knowledge of plants primarily pro- tools from various disciplines were employed. Gender con- cured from the wild, whereas women generally showved siderations constituted an integral and cross-cutting aspect greater familiarity with the therapeutic uses of weedy and of the methodology, as important gender factors were ex- semi-domesticated plants found around the homestead. pected to be involved, inter alia, in the distribution of tradi- tional health knowledge and its inter-generational transmis- Main sources of traditional knowledge sion. Among the instruments applied for gathering data 'Routine observation and practice' or 'learning by doing', were: wvas the most widely-cited method through which knowledge o household surveys (viewed as the main component of the is acquired. Here again, a relatively larger proportion of men field work); indicated having obtained their knowledge in this way, sug- o oral histories (based on open discussions with wvidely rec- gesting some notable gender differences in terms of the ognized knowledgeable elders); mechanisms bywhich traditional knowledge is imparted. 3 The medicinal plant resource base Another basic challenge has to do with the dire sanitary The local names and specific uses of more than 80 plants conditions in the rural communities. Indeed, it would seem wvith medicinal value wvere documented throughout the that such communities that rely heavily on traditional plant study. The large majority of these are wild/weedy species, treatments are caught in a vicious cycle, as many of the ail- often occurring around the homestead or farm and requiring ments that the local plant medicines are used for are linked little management. This finding alone is strongly supportive to poor environmental sanitation. Thus, the lack of proper of the original research hypothesis, i.e. that significant latrines, wvaste disposal and clean water can be viewved as the knowledge about medicinal plants resides in the 'non-profes- raison d'ere for manv traditional treatments. Conversely, sional' or public domain. In addition, the local names and however, it can also be argued that, wvere such very basic and specific uses of most medicinal plants cited by different in- vital provisions in place, then health care efforts at the local formants were appreciably consistent. level could perhaps, have been more effectively and appre- ciably targeted at the prevention of some of the more diffi- Role of rural professional health practitioners cult health problems in the area, such as mnalaria. Hence, In general, professional traditional health practitioners these very shortcomings can, in a sense, be viewed as among seem to play a much less pronounced role in the rural com- the greatest impediments to the realization of the full po- munities than has generallv been presumed. It appears that tential of indigenous ingenuity and traditional approaches in most ailments are diagnosed and treated at the household meeting local health needs. level. Very feNw informants reported seeking professional tra- The knowledge transmission process. Exactly howv is tradi- ditional help on a regular basis. Where professionals are con- tional health knowledge transmitted over generations? Are sulted, it is often for their specialized traditional knowledge the traditional mechanisms that have been in place in the and skills pertaining to a relatively limited range of health past still intact? These are complex questions, requiring de- problems. tailed contextual longitudinal-evidence, which is extremely elusive and difficult to unearth. However, one observation The qualities of traditional knowlecdge that may have some relevance to these questions concerns Further reflections about the various features of the tradi- traditional knowledge among children. It Nvas observed that tional knowledge characterised above raise some questions, boys and girls as young as 6-7 years had remarkable 'botani- inherent paradoxes and eye-openers. These relate to the po- cal' knowledge, i.e. the ability to distinguish various medici- tential role of traditional health knowledge, the nature of nal plants growing around the homestead. But what of other the traditional learning process and the intrinsic contrasting aspects of traditional knowledge pertaining to the prepara- features of traditional knowledge. tion and administration of plant medicines and the diagnosis The potential role of traditional health knowledge: chal- of diseases? Could knowledge about these aspects be 'selec- lenges and limitations. The term 'challenge' immediatelv tivelv' threatened? Such important issues wvill be investi- brings to mind the single largest health problem in the study gated through further analysis of the information gathered. area-malaria. However, no specific traditional plant medi- Contrastngfeatures of traditional practices. WVith inereas- cines for malaria were reported. While this raises questions ing interest in the role and value of traditional knowledge regarding how 'new' malaria is to the area, it also seems systems, such knowledge and its application have often compellingly related to the fact that overall understanding sweepingly but perhaps, precariously, become associated of malaria aetiology is extremely poor among the local with positive outcomes Yet, if traditional health systems are people. The latter underscores the urgent need for commu- to be strengthened as a whole, due attention should also be nity-based health education and prevention programmes given to those practices that appear, at least pr2mafctcie, to Nevertheless, some relevant traditional perceptions regard- be less than beneficial. Cases in point are, traditional surgi- ing the general 'ecology' of the disease could be discerned, cal procedures such as the removal of the uvula, tonsils and which may provide an advantageous basis for effective locally teeth, and even graver practices of bloodletting and female adapted health education and promotion efforts. circumcison 3-all of wvhich remain widespread in the study communities. Perhaps even more so than in other aspects, development and practitioners in the closely allied field of the particularly complex issues entailed in such traditional natural resources management. practices, necessitate the utmost socio-cultural sensitivity and a Finally, it has become evident that research and develop- sound understanding of the local context in which they persist. ment efforts must also aim to identify and address the chal- lenges and threats faced by traditional health knowledge sys- tems, in toto. The ultimate goal is to strengthen and improve Conclusion this vast knowledge base for the benefit of the great majority It is anticipated that some significant conclusions ^ill of the developing world who have survived on it for centuries emerge from the ongoing study. What can be generally sur- and will continue to do so into the foreseeable future. mised at this stage, are some of the broader implications and expected contributions of the research. References First, over the last decade or so, increasing interest in tra- ditional knowledge, particularly regarding medicinal plants, Abebe, D. and E. Hagos (1991). "Plants as a primary source has been fraught with debates regarding intellectual prop- of drugs in traditional health practices of Ethiopia" In Plant erty and traditional resource rights. Often, driven primarily Genetic Resources of Ethiopia. J.M.M. Engels J. G. Hawkes by interests and forces external to indigenous communities, and M. Worede (eds.) Cambridge University Press, Cam- these remain extremely complex and indeed, urgent issues bridge.: 101-113. with which policy-makers and stakeholders from both the Abebe, D. and A. Ayehu (1993). Medicinal Plants and Enig- North and South are actively grappling in various interna- matic Health Practices in Northern tional fora. But this highly politicized focus at the global Ethiopia, W'orld Health Organization,Ethiopian Ministry of level seems to have diverted research attention away from Health (Project No. AF/ ETH /TRM/ OO1RB) and the the local context, i.e. from areal understanding of the actual United Nations Development Programme. and potential roles of traditional health knowledge and prac- Bannerman, R.H. 1983 Traditional Medicine and Health Care tices in addressing arguably the most urgent health-care Coverage. WHO, Geneva. needs of growing populations in resource-constrained devel- MOH (1985) Ministry of Health Primary Heakh Care Review. oping countries like Ethiopia. Hence, it is hoped that the Ministry of Health, Addis Abeba. present study and others like it can, in the first instance, help IBCR (1999). Biodiversity Conservation and Sustainable Use to redirect some research attention to the community level. of Medicinal Plants: Project Proposal. Addis Abeba, Insti- Second, as this study has demonstrated, at least in the con- tute of Biodiversity Conservation and Research (IBCR) text of rural communities in the North-Western Highlands of Addis Abeba. Ethiopia, traditional knowledge regarding the use of medici- nal plants is far from being a corpus of wisdom or expertise gnrlhmale-dominated 1 One notable exception is the promising cross-sectoral/ generally presumed to be restricted to the male-dominated multidisciplinary framework adopted by the recently launched World elite of professional traditional health practitioners. Indeed, Bank-supported national R&D project on the conservation/sustainable use of medicinal plants used for human and livestock health care (see IK most of the traditional treatments used in the communities Notes No 35). studied are collected, prepared and administered by ordinary 2 Research in progress (final phase) in partial fulfilment for a DPhil (PhD) degree in Development Studies at the University of Oxford, Oxford UK. men and women at the household level. Hence, this implies 3 Viz.. IK Notes No41 Entrea Elzmnating a Harmful Tr-aditonal Practice. that those 80% of the population, who are said to rely on tra- ditional plant-derived medicines, do not invariably consult I'his article was written by llareya i1assiU, University of professional practitioners. Indeed, the fact that traditional Oxford, International Development Centre, Queen Elizabeth health knowledge is so pervasive and the use of local medici- House (QEH) 21 St. Giles, Oxford OX1 3LA, United King- nal plants so widespread has paramount implications, which dom. Forfurther information, email: simply cannot be ignored by those concerned with health hareyaffassil@green.oxford.ac.uk