Traditional and Modern Medicine in the Context of Globalization NotesKI According to Dr. Erick Gbodossou, President of the NGO Promotion of Tradi- tional Medicine (PROMETRA), traditional medicine--be it African, Asian or Az- tec--can be defined as a system of knowledge, old wisdom, a specific set of prac- tices ensuring the balance of the human being and harmony with the environment. It is the cultural heritage of native populations who practice it. D uring the workshop organized by These concerns are at the heart of traditional healers at the XIIIth the current debate. What are the ad- International HIV/AIDS Confer- vantages of traditional medicine in its ence in Durban, South Africa in July current form at this time of globaliza- 2000, the issue of the legal recognition tion? Also, what are the conditions re- http://www.worldbank.org/afr/ik/default.htm and the legal status of this ancestral quired for traditional medicine in Af- form of healing was once again dis- rica to play a competitive role in the cussed. The healers underlined the im- context of globalization? The answers portant role that they play in the pres- to these questions require a compara- ervation and rehabilitation of their fel- tive examination of the specific charac- low citizens's health, with at least 75 teristics of this form of medicine and percent of the African population using healing with modern medicine, the their services. In addition, traditional study of relevant measures to promote healers play an important role in the its modernization and cooperation with No. 68 treatment of sexually transmitted dis- modern medicine, and finally the iden- May 2004 eases (STDs) and help to control oppor- tunistic diseases in HIV/AIDS patients. IK Notes reports periodically on Finally, they are seriously involved in Indigenous Knowledge (IK) initiatives the search for antivirals; some claim to in Sub-Saharan Africa and occasionally on such initiatives outside the Region. have successfully used plant extracts in It is published by the Africa Region's the treatment of HIV/AIDS patients. Knowledge and Learning Center as part of an evolving IK partnership The absence of protection for and rec- between the World Bank, communi- ognition of their traditional skills by ties, NGOs, development institutions WIPO (the World International Prop- and multilateral organizations. The views expressed in this article are World Bank erty Organization) contributes to their those of the authors and should not be sense of grievance--modern research- attributed to the World Bank Group or its partners in this initiative. A ers have patents and generally enjoy webpage on IK is available at // protection of their intellectual prop- www.worldbank.org/afr/ik/ erty and invention rights. default.htm 2 tification of ways and means to interact with the globaliza- The representations of health and diseases as written are tion process. global and deal with the physical, moral, social, cosmic and religious dimensions. Health is physical, moral, social, and cultural well-being. It can be identified as the strength or Traditional medicine and modern medicine the resistance of the body, the peace and joy of the soul, the In the African context, three fundamental facts separate peace and joy between communities, as well as the security these two forms of medicine: and harmony between societies and nature. Disease is an ill- · The African concept of health and disease being perceived as a body suffering, a state of general regres- · The diagnostic procedure sion affecting the body, the soul, society, and various lives in · The therapeutic approach. nature. These concepts determine the causes of sickness and death. They are caused by various agents: human types The African concept of health and disease agents (enemies, ancestors, witches, spirits, and God), physi- Considerable research and several studies have been carried cal agents (sun, dust, rain, and food). out on health and diseases in Africa. The following paragraph represents the ideas contained in the publication that was The diagnostic procedure supervised by the Ivorian anthropologist, Pr. Harris Memel- According to traditional healers, the affliction motivating Fôté, entitled Representation of Health and Diseases among the consultation is not separable from the global background Ivorians (1988). of the individual and the disease harming him or her. To be more precise, one can distinguish two diagnostic procedures: the first is metaphysical and requires the appropriate means IK Notes and tools. The second is a somatic diagnostic concerning the physical illness or psychosomatic whose symptoms can be known after an apprenticeship with a master. It must be em- would be of interest to: phasized here that a disease freed from its spiritual connec- tions through the appropriate procedure can then be treated Name with traditional or modern medication. However, a disease which is not separated from its spiritual links can conceivably Institution lead to death despite the treatment. Address The therapeutic approach According to Father Cécé Kolié a professor of cultural an- thropology at the ICAO, African therapy considers the three dimensionsofthelifeofapatient:physical,socialandspiritual.. Physical dimension: Empirical treatment of somatic le- sions, or depending on the case, treatments associated with Letters, comments, and requests for publications should be addressed to: protection rites for the reinforcement of a vital principle. Reconciliation, peace, correct social life with the nuclear Editor: IK Notes and extended family and those who have a positive influence Knowledge and Learning Center Africa Region, World Bank on one. 1818 H Street, N.W., Mailstop J8-811 Spiritual and social dimension: Confession, purification Washington, D.C. 20433 E-mail: pmohan@worldbank.org and consecration rites to God, the spirits and the ancestors. When considering the diagnostic and therapeutic procedures and the current practices of traditional healers, one can say 3 that traditional medicine is characterized by a lack of preci- nested in African philosophy. One owes to it the global and sion of the somatic diagnosis and the wide range of therapeu- multidimensional approach to health. Modern medicine capi- tic indications for a given medicine; the lack of stringency of talized on this value, and the WHO adopted it. As a result, the posologies governed by a rigid empiricism, as well as areas like public health, epidemiology, and community poor hygienic conditions; the lack of knowledge by healers health have been enhanced. In addition, the Codex enriched on the limits of their own abilities; and the immaterial as- itself with pharmaceutical products derived from traditional pects of its practice which open the way to witchcraft and pharmacopoeia. quackery. However, cooperation between the two approaches is clearly necessary for cultural and economic reasons. In Côte d'Ivoire, the National Group for Reflection on Traditional Modern medicine Medicine, established on 28th May 1997 by the Ministry of Modern medicine is mainly centered on the human being. Its Health, considered the matter in the context of cooperation, diagnostic and therapeutic approaches align with Cartesian which could lead to the integration of traditional medicine rationality. Moreover, modern medicine is always updated into the national health system. Two options emerged. and advances through scientific research. From its origins till First option: Does co-operation imply an integration of the today, it has been based on a materialistic and objective vi- professionals of both systems by combining, according to an sion of man, natural phenomena and the universe. It started appropriate methodology, the functioning of these two with the mastering of the human anatomy, that is, the objec- medical systems, which would mean a mere unification of tive knowledge of the physical and organic components of the two where both are equally acceptable and respectable? man. It progressed towards pathologic anatomy, which is the The Chinese experience comes to mind, where the Ministry knowledge of cells, tissues, and body parts alterations caused of Health, as well as the communal and regional offices of by pathogenic agents capable of bringing about death. Scien- public health, create traditional medicine units within insti- tific research then led to the study of movements, organ tutions dealing with modern medicine. functions, and constituent systems of the human organism, Second option: Is cooperation not to be based on an indi- which brought about physiology and the physiopathology of vidualization of traditional medicine, the improvement of its afflictions. With the discovery of auscultation and the stetho- organization, its functioning and the implementation of co- scope, clinical semiology evolved to the classification of af- operation mechanisms and collaboration between the profes- flictions and then the segmentation of medical branches into sionals of these two types of medicine? digestive, pleuropulmonary, cardiovascular, endocrinal, osteoarticular and genito-urinary pathologies. The concern Position of the group for proficiency led to specialization. At all levels, modern medicine is an evolving medicine that is open to knowledge The experiments carried out in Benin, Togo, and Mali iden- and progress through continuous research. tify the second option as being the realistic one. It focuses on formal cooperation between the two systems with an in- dependent body of organized traditional healers, the access Cooperation between traditional and modern medicine of traditional medicine to medical assistance programs, a full In contrast to this dynamic Cartesian medicine, one must collaboration between both systems, and a unified health sys- admit that from its nature, traditional medicine does not aim tem comprising alternative medicine. This exists in some at progress. It is not open to innovation, renewal and the pro- African countries such as Mali, Senegal, and South Africa and, gressive modifications of its principles, means, and methods. on a larger scale, in WHO-collaborating health centers. Con- Tradition keeps it static and inward-looking, subjected to the cretely, traditional and modern health practitioners work in passivity of empiricism set rigidly by the elders and followed their respective areas but collaborate in definite fields, espe- faithfully by apprentices. In spite of this, there is the need to cially at the level of care, research, and teaching. As a result: acknowledge its merits. It has a global view of the disease 4 At the health care level, traditional health practitioners and Traditional medicine and globalization medical doctors can exchange patients according to the type of disease to be treated (chronic, psychosomatic, or psychiat- To integrate and work with globalization, traditional medi- ric). There are some examples--in Dakar at a neuropsychiat- cine must reassess and open itself to the requirements of sci- ric clinic and at the Malango Center in Fatick, Senegal, a fo- entific rationality, convert itself in its diagnostic and thera- cal point of both traditional and modern medicine. The peutic approach methods as well as in its deontology. It will Malango Center, located in the Sine region, is an experimen- thus ensure its influence, productivity, and progress as well tal center for traditional medicine that is unique in the world as enhance its therapeutic efficiency and competitiveness. and placed under the supervision of the non-government or- This requires the following: ganization called PROMETRA (Promotion of Traditional · The use of modern medicine's diagnostic means and Medicine). therapeutic control--namely, laboratory analysis, various di- At the research level, cooperation will be possible within a agnostic tests, conventional radiography and tomography, research institute for African pharmacopoeia on traditional tomodensiometry (scanner), magnetic resonance, and all medicine. An example: the Scientific Research Institute of current and future medical techniques. Kinshasa (Democratic Republic of Congo) and in Bamako · Chemical and pharmacological study of medicines in or- (Mali). Within this structure, joint projects will be worked der to determine their components, its active principles, its out and implemented in order to facilitate a real dialogue toxicity, and posology. This will lead to their commercializa- between both types of researchers with the aim of achieving tion nationally as well as internationally. viable and workable results on a large scale. · An introduction in light and heavy pharmaceutical indus- At the educational level, a team made up of traditional prac- tries, which will give the medicines a rational galenic form titioners and doctors can educate traditional healers. Ex- for their conservation, use, and large-scale production. ample: teaching of the FAPEG Method (Self-Proficiency · A training policy for traditional practitioners while giv- Training for Traditional Healers) in Dakar by PROMETRA. ing them basic notions of hygiene, asepsy and antisepsy, This method involves deeply traditional healers in the fight anatomy, physiology, and pathology. The public authorities against STDs, HIV/AIDS and for the protection of maternal should be involved in (a) setting-up traditional medicine and and child health. In schools of medicine and pharmacy, con- traditional pharmacopoeia institutes for chemical, pharma- cepts of traditional medicine and pharmacopoeia could be copoeia and clinical research; (b) setting-up the national or- passed on to students to prepare them for cooperation with ganization of traditional health practitioners; (c) a regular traditional health practitioners. evaluation of the abilities of these organizations through joint (both systems) bodies to ascertain the real impact of their action on people's health; (d) providing legal recogni- tion of this type of medicine; (e) action at the WIPO level to protect traditional knowledge; and (f) the creation and up- keep of protected ethno-botanic gardens to perpetuate veg- etal species used in African pharmacopoeia. This IK Note was written by Pr. Antoine Yangni-Angaté. It was first published in PROMETRA's Médécine Verte No.007, OctoberDecember 2000. For more information, e-mail Dr. Erick Gbodossou : Erick@refer.sn