Special paper 30.pmd
Promotion of Public Health
Care Using African
Systems and Implications
for IPRs: Experiences from
Southern and Eastern
Published by the African Technology Policy Studies Network, P.O. Box 10081, 00100General Post Office, Nairobi, Kenya.
2007 African Technology Policy Studies Network (ATPS)
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South Africa’s Council for Scientific and Industrial Research
Food and Agriculture Organization of the United Nations
New Partnership for Africa’s Development
Traditional and Modern Health Practitioners together against AIDS
African Indigenous Knowledge and Technology Systems in
African Indigenous Knowledge and Technology Systems in
The Role of Traditional Belief Systems in Public Health
Interfaces between African Indigenous Knowledge andWestern Knowledge System in Public Health Care
Implications for Intellectual Property Rights
There are various definitions of Indigenous Knowledge (IK). The term refers to a distinctive body ofknowledge and skills including practices, technologies that have been developed over manygenerations outside the formal educational system, and that enables communities in their specificenvironments to survive (Mascarenhas, 2004). IK contrasts with the international knowledge systemgenerated by universities, research institutions and private firms in that:
IK is generated within communitiesIK is location and culture specificIK is the basis for decision making and survival strategiesIK is not systematically documentedIK concerns critical issues of human and animal life: primary production, human andanimal life, natural resource managementIK is dynamic and based on innovation, adaptation, and experimentationIK is oral and rural in nature
In the past, African indigenous knowledge systems (AIKS) were neglected and marginalized becauseof the periphery nature of Africa in the global economy. The role of AIKS in household food securityand nutrition, as well as in coping with evolving public health problems in Africa, such as the impactof HIV/AIDS, tuberculosis (TB), malaria and other dreadful diseases have, until recently been poorlyrecognized and supported by governmental and non-governmental organizations (NGOs). However,in spite of this marginalization of AIKS, a large proportion of the African people rely on IK systems fortheir daily lives. In various sectors of life, people have not adopted the modern western knowledgeand technology systems because they cannot afford them and they are also unsustainable (Kayaand Materechera, 2004).
In recent years, there has been a dramatic increase in interest in the role that AIKS and technologiescan play in sustainable development. This interest is reflected in a myriad of community basedactivities utilizing AIKS for public health care including human resource capacity building in his area.
The World Health Organization (WHO) (2002) defines public health as an aspect of health servicesconcerned with threats to the overall health of a community. It generally includes surveillance andcontrol of infectious diseases and promotion of health behaviors among members of the community.
Public health promotes not simply the absence of disease but mental, physical, and emotional well-being.
Furthermore, the globalization process has made it imperative that AIKS cannot be ignored as theyare increasingly seen as part of the global body knowledge. It was in recognition of this important roleof IKS in sustainable development that it was identified as one of the flagship programmes of theNew Partnership for Africa’s Development (NEPAD) Southern African Biosciences Network (SANBio)Initiative. The Initiative is establishing biosciences networks of centres of excellence involved inresearch and development in the region. The holistic nature of IKS and its interface with the otherflagship areas (biotechnology & biodiversity & technology) was recognized as an important tool foraddressing the diverse challenges facing the region including public health care issues.
The challenge for African policy makers and researchers is to create the right environment for moreresearch on the role of IKS in promoting public health care issues and sustainable development.
They should take advantage of the forces of globalization, such as the information and communicationtechnology (ICT) to promote collaborative research and networking.
Using documented examples from various countries in Southern and Eastern Africa, the papershows the role of African indigenous knowledge in promoting public health care and associatedhuman resource capacity building. African indigenous knowledge and technology systems are usedin the mitigation of human and animal diseases; and in promoting community food security andnutrition. The paper also presents examples of the interface between African indigenous knowledgeand Western knowledge systems in promoting public health care; and the implications for intellectualproperty rights (IPR).
African Indigenous Knowledge and Technology
The knowledge of and uses of specific plants and animals for medicinal purposes (often referred toas indigenous or “traditional medicine”) is an important component of African indigenous knowledgesystems (AIKS). Saray (2001) shows that in most African countries, traditional medicine is used byroughly 70-80 percent of local populations to deal with their basic health care needs. Like in theother regions of the continent, the Eastern and Southern African regions have some of the richestflora and fauna in the continent. Lowlands, highlands, inland lakes and a variable climate producea multitude of biotopes: semi- deciduous or humid forests, savannah and steppe, Miombo forests, allcontribute to this exceptional bio-diversity of these regions. As will be shown in the following sectionssome of the plant species have considerable economic, medicinal and nutritional values for therural populations.
Both Eastern and Southern African regions have been severely affected by the HIV/AIDS pandemic.
Various efforts including the use of AIKS are currently being promoted in various countries to mitigatethe spread of the pandemic. For instance, a documentation of the activities of traditional healers invarious parts of Tanzania involved in HIV/AIDS mitigation indicates that the immune system of HIV/AIDS patients could be boosted by indigenous medicinal plants with enzyme rich food stuffs. Theseinclude oils from plants, such as soya, cashew and shea butter saturated fats, and wild fruits.
Vegetables with high fibre content that patients were encouraged to consume were helpful in cleansingthe body system. Though these diet and nutritional therapies did not cure the disease, they, however,improved the immune system of the patients. The therapy also involved the elimination of stressbound foods and liquids from patients’ diet, such as coffee, black tea, sugar, salt, white flour as wellas concentrated carbohydrates, such as white rice. Experience shows that the treatment helps toreduce the physical and psychological symptoms that go with the AIDS disease, such as rashes,blisters, respiratory syndromes and stress/depression. The documentation also shows that naturaljuices, and traditional foodstuffs and medicinal preparations can improve the immune system ofAIDS patients and may be far less tedious in relation to their effects and cheaper than a treatmentbased purely on western- oriented medication (Marecik, 2002).
Tanzania is one of the countries in Africa most affected by the HIV/AID pandemic. For many yearsthere have been no drug for the management of the disease. Therefore, due to scarcity of drugs forthe management of the disease many people, in both rural and urban areas, opt for African indigenoushealth and medical services for the control of the disease. For example, Muhanse M4® is a traditional
herbal preparation prescribed by the Munufu Traditional Medicine Research Clinic in Dar es Salaam.
Muhanse M4® has a long history in herbal medicine for boosting the body immunity of people invarious parts of Tanzania, particularly in Mufindi and Kilombero districts. Muhanse M4® is just astandard infusion or weak decoction of ready prepared powder from whole plant or its parts. It hasbeen in use since 1987. In spite of the current availability of modern anti-retrovirals (ARVs), thisindigenous medicine is in continual use among local communities due to its affordability (Mhame,2004).
In South Africa, an indigenous African potato (Hypoxis) that is a medicinal plant growing in KwaZulu-Natal Province among the Zulu people is traditionally used to treat chronic viral and bacterial diseases.
Traditional healers have been using it to treat cancer of the bladder and prostate, and sexuallytransmitted diseases (STDs). Studies done on the plant have shown that it contains two substancescalled sterols and sterolins that are essential dietary fats or lipids. The plant has helped many peopleto recover quicker from chronic and other diseases. It is a partly poisonous root, but with the rightpreparation and dosage, it is an approved immuno booster to assist the body’s natural defencesystem. The University of Stellenbosch (South Africa), for instance, has conducted extensive researchon this traditional medicinal plant and has developed easy to take tablets. There are indications thatalthough the potato is not a sufficient treatment on its own, it could be extremely helpful whencombined with other forms of treatment. Studies in the same university on HIV care revealed that theplant had shown the ability to increase CD4 counts (the amount of white blood cells in the body);stabilise the patient; increase the weight of patients; and decrease the amount of HIV in the body (deKlerk, 2004).
Malaria is another dreadful disease killing millions of people, especially children, in many parts ofAfrica. The Tugen people in Kenya, who are part of the Kalenjin ethnic group living in the Rift ValleyProvince, believe in natural and non-natural causes of illness. Some of the Tugen, for example,believe that malaria is caused by Cheko che makiyo (fresh unboiled milk), dirty water, and ikwek(vegetables), such as Solanum nigram and Gynadropis gynadra. Tugen aetiological beliefs onmalaria are logically valid, especially within the ecological context in which they live. The kipsaketinik(herbalist) generally prescribes and dispenses aqueous medicines prepared from roots, leaves,bark, and other plant or animal part. According to the Tugen indigenous diagnoses, esse (malaria)is the result of excess bile in the body. The bile has to be expelled before healing can take place.
Thus purgation is regarded as the key treatment regimen for malaria. On the basis of this knowledge,different forms of herbal medications are prescribed according to the severity of the illness (Aman,2000).
In Tanzania, indigenous people are actively involved in a malaria control research project in Mtwaraand other areas of the country. They assist in identifying the type of trees whose leaves, barks or rootsare used as medicine to cure malaria. They also identify plant species that are repellent to mosquitoes(mosquitoes are vectors of malaria parasites). This is based on the acknowledgement that manyindigenous groups have excellent knowledge of cures and treatments for some of the most commondiseases that afflict them, and should be involved in studies regarding these diseases (Saifert, 2005).
PROMOTION OF PUBLIC HEALTH CARE USING AFRICAN INDIGENOUS KNOWLEDGE SYSTEMS AND IMPLICATIONS FOR IPRS
As already indicated, traditional medicine plays an important role in public medical and health carein Africa because most people cannot afford Western medical services. In most rural and urbanareas of Eastern and Southern Africa, traditional medicine vendors are a common scene in themarketplace where they are traditional healers and pharmacists. They are the local population’smain medical resource. They are known to possess a special connection to plants, and for theirknowledge of sacred artefacts used to invoke their healing power. Their knowledge comes fromexperience, from trial and error with plant remedies, from methods passed down from generation togeneration. Thus, for example, the Maasai in East Africa use vine to deaden pain; the bark of thebaobab tree that is boiled down to a broth to relieve back pain. Since the baobab tree is held sacred,only the needed portion of the bark is cut. Moreover, the leaves and barks of certain trees are used tostimulate gastric juice secretion in the treatment of digestive disorders. In addition, building on localtraditional medicinal knowledge, a tea made of dried stem barks of ‘Strychnos myrtoides’, is used bythe Zigua, Ndorobo and Maasai in East Africa to enhance the action of chloroquine against resistantparasite in the treatment of malaria ( Kindamba, 2002).
African indigenous knowledge is also widely used in other areas of public health in the two regions.
Saifert (2005) observed that the Sambaa and Zigua in Tanzania and Zulu people in South Africa useplant-based contraceptive methods dating from ancient times. The local people in these ethnicgroups are sensitive to the issue of unwed-mothers who would tarnish the family image, and are alsoconcerned about women’s health. Women are considered an essential pillar in the family structure.
For these reasons, girls are forced by their parents into practicing traditional forms of birth control.
They are given herbal preparations to take on their first menstruation day each month. This plant-based medicine is also used by women who have just given birth to assist their recovery and for thepractice of child-spacing. A number of elderly women in these ethnic groups have been the keepersof this knowledge for generations.
In Ethiopia, local communities in both rural and urban areas use a mixture of coffee powder andhoney, known as, mar ba buna, prescribed by local healers throughout Ethiopia as a medicine totreat diarrhoea, and is reported to be efficient. The coffee has to be roasted and grounded, and thehoney is supposed to be taken from bees preferably in October, when most varieties of flowersflourish. About 50 to 100 grams of freshly grounded coffee powder are mixed with an equal amountof honey in a cup. The patient takes the mixture orally. It is said that diarrhoea stops after taking onedose of this traditional medicine. This is an easy-to-prepare and cost-effective traditional medicinethat could be transferred to other African communities.
Illnesses of the lung, such as asthma, pneumonia, tuberculosis are known by traditional healers inmany parts of Southern and Eastern Africa and treated as such. For instance, there are two types ofhealers in Ethiopian countryside treating various types of diseases: The bone setter called wogeshawho treats fractures, and the medicine man or knowledgeable person called medihanit awakge(medihanit means medicine, awakge means wise) who treats other common illnesses and dispensesherbal remedies. The medihanit awakge provides herbal medicine to treat asthma. Asthma isdistinguished from colds, pneumonia, tuberculosis and other illnesses of the lung by Ethiopian
(Amharic) traditional healers. Pneumonia is very common, associated with exposure to cold air, andtreated with cupping in the home. Tuberculosis or samba nkersa (samba means lungs, nkersameans cancer) is recognized as a more serious and severe illness, treated by isolation due to itscommunicability. There is no stigma or taboo associated with asthma. People are aware that onecan die from asthma. Although it is occasionally seen among children, it is more common amongthe elderly. Children are also thought to grow out of their symptoms. The etiology of asthma isunclear. Some think it is contagious to some extent because it is associated with tuberculosis (TB)that is known to be communicable. Asthma is dealt with by changing residence and moving awayfrom a climate or environment; this makes it worse. It can also be prevented, according to thehealers, by avoiding dust and pollen that make it worse (dust, pollen). It is treated by using a specialhoney called tazma mar, also used for other types of cough. The healing secrets of the medihanitawakge are passed down from generation to the next (ZIRCIK, 2002).
The Suri of the Käfa Region in the Ethiopian Southwest use the crushed leaves of the Evolvulusalsinoides (L.) plant, (locally known as, kéya-guy) to apply to fresh burns. Young Suri children oftenfall into the fire in the centre of the dark Suri hut. Therefore, this is a common community problem.
The Suri and other ethnic groups also use the Rhus natalensis Bernh. ex Krauss plant, (locallyknown as keyáy) leaves as medicine for bleeding wounds. The leaves are chewed and mixed withsaliva and then applied to the open wounds. This indigenous medicinal practice is also used forsimilar treatment of wounds by other ethnic groups in both Eastern and Southern Africa such as theZigua and Sambaa in Tanzania, the Shona in Zimbabwe and Tswana and Zulu in South Africa.
The Giriama community in Eastern Kenya depend on “Arabuko-Sokoke” coastal forests for theirsupplies of medicine and food security. They use plant species to prevent or treat infectious diseasesfor wounds, boils, scabies, diarrhoea, dysentery, gonorrhoea, and syphilis. Annonaceae, Fabaceaeand Vitaceae are the most commonly used plant families. Laboratory tests confirmed that most of theplant species used traditionally to manage bacterial and fungal infections showed strong effectsagainst tested pathogens. The unique Arabuko-Sokoke forests are an endangered biotop due toexpanding settlements and other utilization. In the case of its disappearance, the Giriama could losea source of medicinal plants and several unique species of fauna and flora would lose their habitattoo. The knowledge of the habitat by the Giriama is useful for managing the endangered resourceand provides the basis for its sustainable use (Marecik, 2002).
African Indigenous Knowledge and Technology
Like in other parts of the Africa, food insecurity and malnutrition are major problems facing most ofthe countries in the Southern African and Eastern regions. This is partly due to the arid and semiconditions that exist in most of these countries. The average annual rainfall is less than 600mm.
These arid conditions have adverse effects on food production and expose many households toproblems of food and nutritional insecurity. However, local communities in these countries have overthe years developed different food security strategies and mechanisms for surviving in theseconditions. These strategies include various technologies of food production, processing, preservationand storage that have not received much attention from policy makers and extension workers. Theytend to be underrated and their potential has not been documented and exploited for sustainablecommunity livelihood (Sibanda, 2004).
Indigenous vegetables, for example, often referred to as traditional vegetables, are a commonhousehold food in most of the Southern and Eastern African countries. The majority of the localfarmers cannot always produce and eat exotic vegetables, such as cabbages, carrots, or beet rootsdue to unavailability of seeds and/or high production costs associated with these exotic vegetables.
They, therefore, depend on traditional vegetables as a regular side dish or sauce accompanying thestaple foods, such as maize, cassava, sweet potatoes, millet, and sorghum. The staple foods providecalories needed for the body energy but are very low in other nutrients, while traditional vegetables,such as Amaranthus, Solanum aetiopicum, Manihotesculenta (cassava leaves) and Ipomea batatas(sweet potato leaves), have high nutrient nutritive value (World Bank, 2004).
Most of the indigenous vegetables are produced mainly in home gardens tended by women andchildren. These home gardens are characterized by intercropping systems. This cropping systemhas several advantages to the farmer and the community: it extends the harvesting period and helpsto alleviate seasonal food shortages, thus enhancing the stability of household food access; theyreduce erosion risks by providing increased soil cover and additional crop residues for use as greenmanure and mulch. Such characteristics offer gains in sustainability and in stability for the foodsupply system; the choice of intercrops usually includes legumes and/or oilseeds such as melonseed, groundnut, soybean or sunflower, together with cereals as the dominant crop. In dietary balance,grain legumes, or pulses, contain more protein than cereals and about ten times as much protein asmost roots and tubers (FAO, 1991).
Sun drying of fruits, vegetables and edible insects are common indigenous knowledge andtechnological practices in most of the Eastern and Southern African countries. In Zimbabwe andBotswana, for example, sun drying of food is usually done in two main ways. One method (commonlyused for vegetables) is to immerse the fresh vegetables in salty boiling water for a few minutes toavoid nutrient loss. The vegetables are then dried in the sun for about three days and stored in a safedry place. This method is also applied for drying caterpillars, termites, white ants and other edibleinsects. Another method is to directly spread the food in the sun. The food is first salted if there isdanger of decaying during the drying process as in the case of mushroom or tomatoes. Food dryingis an important activity for women as they bear responsibility for food preparation even during wintertimes and the dry seasons. Sun drying is an affordable technology requiring little or no interventionunder most conditions. Elderly women are the bearers of this knowledge (Zanini, 2002).
In Kenya, the National Museums of Kenya implemented the Indigenous Food Plants Program thatalso involves human resource capacity building and awareness in 1989. Local communities incoastal, central, north-western and western of the country have taken it up as a response tocommunities’ concern over the future of local food resources. Poverty, famine, and malnutrition arecommon in most rural areas despite the fact that local foods are readily available due to the limitedawareness among individuals and households about the nutritional value or cultivation potential ofindigenous edible plants. The younger generation, particularly, tend to reject their traditional foods infavour of exotic and more ‘modern’ foods that most community members cannot afford. In addition,several important species, or varieties of species, are on their way to extinction due to deforestation,overgrazing, burning drought, desertification and bio prospecting.
The Indigenous Food Plants Program in Kenya also promotes the cultivation, consumption andmarketing of African indigenous foods through field demonstrations, educational materials and themedia. Local communities wanted to determine which species could be consumed, draft guidelineson nutrient content and methods of propagation, assess the general value of the species, anddocument the vernacular names. A database containing detailed information on more than 850indigenous food plant species of Kenya is now available to researchers. Local fruits and vegetablescan now be sold at the marketplace, which encourages their cultivation and enhances the localeconomy. By raising the status of indigenous knowledge in the eyes of local communities, thepractice not only helps to alleviate poverty but also increases people’s respect for their own culture(Saifert, 2005).
In 1999, the World Health Organization (WHO) convened a conference of experts from industrializedand developing countries in Teramo, Italy, in collaboration with the Food and Agriculture Organizationof the United Nations (FAO). The major purpose of the conference was to consider the contributionson a global basis of Veterinary Public Health (VPH) programmes to human health, with a particularemphasis on the future contributions that VPH could make in developing countries. The consensusdefinition of VPH at the Teramo meeting was:
“The contributions to the physical, mental, and social well being of humans through an
understanding, and application of veterinary science”.
This definition, therefore, replaced the original definition of VPH in the 1975 joint FAO/WHO technicalreport ‘The veterinary Contribution to Public health Practice’(2) “ as a component of public healthactivities devoted to the application of professional skills, knowledge and resources to the protectionand improvement of human health.” It was believed that this new definition was more consistent withthe original WHO definition of health and also with the values, goals, and targets of the WHO vision‘Health for all in the 21st century”. The scope of VPH was seen to be multidisciplinary, involving notonly veterinarians in government and non-governmental sectors, but other health professionals andscientists as well as paraprofessionals who treat, control or prevent diseases of animal origin.
However, one area that tends to be neglected is the contribution of ethno veterinary to public health.
Ethno veterinary medicine (EVM), for instance, knowledge in African countries is largely containedwithin oral tradition. Past prejudice has prevented this indigenous knowledge system from becomingthe subject of scientific investigation. In other parts of Africa, such as Cameroon, substantial benefitto resource-poor farmers has been shown to be achievable through the evaluation of traditionalmedicines and the subsequent delivery of appropriate information to farmers/livestock managers(Martin, 2003).
In Eastern and Southern African indigenous knowledge and technologies are used to address theproblem of expensive and erratic supply of veterinary drugs and services to seek a sustainable wayof improving animal and human health by a complementary utilization of indigenous and orthodoxmedicines. Benefits are a reduction of dependency on imported drugs and supplies, the possibilityof discovering new drugs and the use of natural drugs with fewer side effects. The communicationand contacts between livestock owners and veterinarians have improved.
As is the case with other Southern African countries, Malawi suffers from major cattle healthproblems viz East Coast fever (ECF), babesiosis, anaplasmosis, heartwater, and endoparasites.
ECF accounts for up to 50% mortality in calves in the Central Region of Malawi and up to 60% lossesin calves and weaners in the Mzuzu area. In chickens the major constraints are Newcastle diseaseand ectoparasite infestation. Control of these health problems using Western drugs by local farmersis not a viable option because of the high cost. Although the Malawi government supplies someveterinary services to the farmers, modern veterinary sector is plagued by numerous constraints,including the erratic supply and prohibitive expense of veterinary drugs and supplies, poorcommunication facilities, and a shortage of manpower.
Therefore, besides the existing veterinary support services, farmers in these rural areas use traditionalmedicines to treat livestock. In the northern region of Malawi, local farmers crush local plants orparts of them and mix them into drinking water for chickens to prevent or cure Newcastle diseaseand diarrhoea. They also used Mucuna puriens and Tephrosia vogelii as insecticides against externalparasites, such as fleas in chickens. The farmers use leaves, barks, roots or whole plant as medicinalmaterials that they claim to treat 17 of the 29 animal ailments. However, the farmers were unable totreat tuberculosis (TB), pneumonia, rabies, and poisonous caterpillars in ruminants and stillbirthand African swine fever (ASF) in pigs.
Indigenous veterinary remedies are mainly made from plants, but also from animal parts, salt, andsoil. The materials are commonly used in combinations; remedies made from only one ingredientwere rare. The local farmers expressed concern that since plants are the most common ingredients,scarcity of plants may decrease the usage of indigenous veterinary remedies. Hence, there is needto encourage the conservation of medicinal plants by both farmers and institutions by establishingbotanical gardens.
The local farmers in the area claimed that ethno veterinary was a common practice in most parts ofNorthern Malawi. Most of the community members have a wide knowledge of indigenous veterinaryremedies. They learn about the remedies from parents or relatives including ancestors. Associationwith ancestors made it difficult for some of the farmers to reveal knowledge about the remediesbecause of fear of being cursed by the spirits of their ancestors. Interviews with some of the farmersindicated that they have been using these remedies for many years. Some of them could not rememberwhen they started using these remedies. The practice was part of the community life. The elders areconcern that this knowledge will be forgotten as more and more young people go to school and stopusing or collecting the indigenous medicines (Kambewa, 1997).
The pork tapeworm, Taenia solium, is a zoonotic tapeworm and increasingly recognized as a publichealth challenge worldwide. This disease is considered one of the neglected diseases by the WorldHealth Organization (WHO). Though WHO identified it as a potentially eradicable disease, it is nowbecoming prevalent disease in Eastern and Southern Africa.
The rural people in various parts of the two regions use numerous ethno veterinary plants for thetreatment of worm diseases in livestock and in humans in the developing world. Plants, for example,
PROMOTION OF PUBLIC HEALTH CARE USING AFRICAN INDIGENOUS KNOWLEDGE SYSTEMS AND IMPLICATIONS FOR IPRS
are used for the removal of the pork tapeworm (Taenia solium). This parasite causes a seriousdisease in humans, neurocysticercosis, and results in epilepsy and often death. The highestprevalence of juvenile neurocysticercosis in the world is in the Eastern Cape Province of SouthAfrica. Porcine cysticercosis affects pigs and is a serious agricultural problem in the same province(Kindamba, 2002).
There are several recent reports of indigenous plants used by resource-poor farmers in Tanzaniaand Kenya to treat cysticercosis in pigs and the adult stages of T. solium in humans. One exampleis lodwa (Embelia schimperi) given by farmers in the treatment of this disease in Tanzania. TheMasai people crush the seeds of this plant and drink it in milk. Embelia spp. also grows in SouthAfrica and the status of its use by local farmers needs investigation. There are also reports in Tanzaniaof a root being used by farmers to “cure” their pigs of infection with cysts (Ngowi, 2003),
The Role of Traditional Belief Systems in PublicHealth
The role of African traditional belief systems in public health care tends to be neglected by individuals,government and development agencies. They often dismiss beliefs and social behaviour assuperstitions and overlook their intrinsic values and functions. In many cases, the superstitions ortaboo are not meant to convey ‘scientific’ facts but to shape thinking, and to control behaviour.
Taboos are ‘social’ rules engrained through the socialization process. Fear is meant to developowing to the belief that violation causes infliction of punishment. In various parts of continent, forexample, there are taboos “regulating” the extraction medicine from plants. These are meant toprotect and preserve medicinal species from extinction.
In central and eastern Zimbabwe and Western Mozambique, there are various indigenous ways andbelief systems of protecting water sources. One of them is to prohibit members of a community toindiscriminately use their household utensils to fetch water from a source. It is not allowed to usepots, cups, or buckets from the users’ homes. Rather, members of the community use a specialgourd, mukombe, that is permanently kept at the spring for only this purpose. Mukombe has a verylong handle that safely prevents the hands or fingers (of the person fetching water) from dipping intothe spring, thus avoiding a potential contamination hazard. Taboos and customs enforce compliance(Sandomba, 2002).
Among the Zigua and Ndorobo in Tanzania, there is a belief that the bark of a tree for use asmedicine should be removed from the sides facing the East and West of the tree only. Extracts fromother sides of the tree are believed to be ineffective because of breaking this rule. This protects thetree from total destruction and hence it survives the extraction.
Interfaces between African IndigenousKnowledge and Western Knowledge System inPublic Health Care
As already stated, due to commercial and sustainable development reasons, African indigenousknowledge systems (AIKS) are increasing becoming an integral part of the global body of knowledge.
Granier (1998), states that indigenous knowledge systems (IKS) can be compared and contrastedwith the counterpart global knowledge system to uncover mechanisms for evaluating the strengthsand weakness of each system. This interactive flow has already resulted in mutually beneficialexchanges of knowledge that have enhanced the capacity of the formal research system to solvepriority problems identified within local communities. Both multilateral and bilateral donor agenciesare now recognizing the role of indigenous knowledge in sustainable development including thepromotion of public health care.
Anand (2005) explains how in most African countries, modern Western systems of thought and life,exist alongside African indigenous knowledge systems. Both systems can be found in all sectors ofsociety, including agriculture, public health, political organizations, conflict transformation, culture,education, technology and even lifestyle. As a result of its affordability and easy access in most localcommunities, indigenous knowledge continues to provide the building blocks for development andpublic health in most African countries, while seeking cooperation with modern knowledge for themutual benefit of the two systems. The following examples from various parts of the two regionsshow this interface between African indigenous knowledge and modern western knowledge systems.
The Tugen people in Kenya treatment of malaria is based on a several interlinked elements: beliefsrelated to causation, the action of effectiveness of ‘modern’ medicines, and the availability of planttreatments. In the treatment of these two diseases, the Tugen also use Western-based health carefacilities and over-the-counter medications. The use of the different forms of treatment iscomplementary. In some instances, retail drugs are displayed for sale alongside herbal medicines.
The fact that these divergent forms of treatment are sold and used either concurrently or alternately,suggests that there is no perceived conflict between the two traditions. Tugen indigenous medicinehas weathered the test of time, especially in view of the widespread Western forms of treatment. Andas long as the Tugen culture exists as an identifiable cultural entity, this autonomous body ofindigenous knowledge for the treatment of disease will remain, because it is both culturally relevantand efficacious.
In Northern Malawi, local farmers practicing ethno veterinary work in collaboration with researchand academic institutions, such as Bunda College of Agriculture (University of Malawi) and the
National Herbarium in Zomba for botanical identification of the indigenous medicinal materials.
They collaborate on trials that can verify the claims of the farmers by using Western scientific methods.
The main goals of the collaboration are to promote the complementary use of indigenous andconventional veterinary medicine for sustainable livestock production, and to promote theconservation of medicinal plant resources. The practice and collaboration is considered a ‘bestpractice’ because ethno veterinary knowledge provides an integrated approach to livestock healthcare that is sustainable economically, environmentally and culturally.
In Tanzania, The Tanga AIDS Working Group (TAWG) strives to alleviate suffering of HIV/AIDSpatients by using indigenous knowledge. The group has treated over 2,000 AIDS patients with herbsprescribed by local healers since it started in 1990. The advantage of the traditional healers is thatthey are more accessible to local people and have gained their communities’ trust through pastexperiences. Traditional healers, modern physicians and health workers have joined forces inTAWG’s programs to effectively treat patients with HIV/AIDS. The impact has been most significantin alleviating the opportunistic diseases brought on by the AIDS virus. The patients who have respondedmost positively have lived longer, by up to five years.
The Tanga regional hospital has allocated a floor to TAWG workers to enable them to test patientsfor HIV, treat them and provide counselling. They have also set up an information centre in town thatconducts active AIDS awareness campaigns and offers a support network to people living with AIDS.
TAWG plans to involve their healers, people living with AIDS and staff working with patients to providemedical care and alternative income generating opportunities, in exchanges of IK with similarcommunities in Tanzania and possibly Kenya and other parts of the continent. Integrating localhealers in AIDS prevention and mitigation strategies increases effectiveness of approach and accessfor poorer patients.
Prometra Uganda is an Association for the Promotion of Traditional Medicine and is promotingtraditional medical knowledge and practices for improved health through mutual co-operation amonghealth care systems. The organization strengthens collaboration between traditional and other healthcare practitioners to encourage knowledge sharing. They advocate and disseminate traditionalknowledge while fighting against harmful practices through local educational programs.
The Traditional and Modern Health Practitioners Together against AIDS (THETA) is anotherorganization in Uganda where traditional and modern health care practitioners work together to fightAIDS and other diseases. Traditional healers are trained as community counsellors and educatorsto assist with basic HIV/AIDS patient care. The organization processes and packages herbalmedicines and also maintains a herbal garden. THETA also hosts a library, publishes a newsletter,organizes monthly speakers and advocates for traditional medicine.
A World Bank-supported initiative in Zambia working to conserve biodiversity for HIV/AIDS treatmentestablished botanic gardens and forest reserves for medicinal plants. Some of the seeds come fromspiritual forests that have been preserved because of the traditional values, norms and taboos
PROMOTION OF PUBLIC HEALTH CARE USING AFRICAN INDIGENOUS KNOWLEDGE SYSTEMS AND IMPLICATIONS FOR IPRS
associated with them. In addition, training and capacity building activities for traditional healersfocus on behaviour modification in relation to HIV/AIDS, understanding eco-systems and legal training.
Knowledge of biodiversity and HIV/AIDS is disseminated through newsletters, radio, TV and theatre.
The project includes an electronic database on medicinal plants and publication of a handbook fortraditional healers to be used in their practice. A literacy program helps illiterate healers register theirpatients and document their indigenous knowledge for future dissemination.
Implications for Intellectual Property Rights
The above discussion and examples from the various countries in the two regions show the greatcontribution and potentiality of African indigenous knowledge and technology systems in the promotionof public health care. Like in other parts of the world, African Indigenous people put great importancein the use of biological materials for medical treatment and food security, conservation and sustainableuse of natural and genetic resources, and a wide range of cultural practices and innovations (Harte,1996).
Since the adoption of the Universal Declaration of Human Rights (UDHR) in 1948, intellectualproperty (IP) has been considered a fundamental human right for all peoples. Article 27 of theDeclaration states that everyone has the right “to the protection of the moral and material interestsresulting from any scientific, literary or artistic production of which he is the author.” Since 1948,many international human rights instruments and documents have reinforced the importance of IPas a human right.
Intellectual property rights (IPRs) are the legal protections given to persons over their creativeendeavours and usually give the creator an exclusive right over the use of his/her creation or discoveryfor a certain period of time. IP protections may include patents, copyrights, trademarks, and tradesecrets. IP is codified at an international level through a series of legally binding treaties (Fourmille,1996; Petern, 1995).
As interest in traditional medicine is increasing, worldwide, indigenous knowledge of the cultivationand application of genetic resources is becoming exploited at an alarming rate. World sales ofherbal medicine alone were estimated at US$30 billion in the year 2000. IPRs should guaranteeboth an individual’s and a group’s right to protect and benefit from its own cultural discoveries,creations, and products. But Western IP regimes have focused on protecting and promoting theeconomic exploitation of inventions with the rationale that this promotes innovation and research.
Western IP law that is rapidly assuming global acceptance, tend to facilitate and reinforce a processof economic exploitation and cultural erosion. It is based on notions of individual property ownership,a concept that is often alien and can be detrimental to many local and indigenous communities. Animportant purpose of recognizing private proprietary rights is to enable individuals to benefit from theproducts of their intellect by rewarding creativity and encouraging further innovation and invention.
But in many indigenous world-views, any such property rights, if they are recognized at all, should be
PROMOTION OF PUBLIC HEALTH CARE USING AFRICAN INDIGENOUS KNOWLEDGE SYSTEMS AND IMPLICATIONS FOR IPRS
extended to the entire community. They are a means of maintaining and developing group identity aswell as group survival, rather than promoting or encouraging individual economic gain.
Problems experienced by indigenous peoples in trying to protect their knowledge systems under IPlaws stem mainly from the failure of indigenous knowledge to satisfy requirements for intellectualprotections. Alternatively, where IP protection could potentially apply to such knowledge, the prohibitivecosts of registering and defending a patent or other IP right may curtail effective protection. Therehas been a clear bias in the operation of these laws in favour of the creative efforts of corporations,for example, pharmaceutical and other industries in industrialized nations. Within the context ofscientific progress, modern IP laws have allowed these industries and companies to monopolize thebenefits derived from their use of indigenous knowledge with disregard for the moral rights andmaterial (financial) interests of indigenous peoples themselves.
Most of the governments in the Southern and Eastern African regions are working both domesticallyand internationally as part of increasing efforts to identify effective means of preserving and protectingthese indigenous knowledge systems (IKS) for future generations, promoting their broader adoption,and protecting them from unauthorized appropriation and commercialization.
On-going discussions in various countries are considering, as one possible approach, theappropriateness of protecting certain kinds of indigenous knowledge systems as a form of IP and, ifappropriate, the best means of applying IPR. On March 24, 2003, for example, after years ofnegotiations and uncertainty, representatives of the San peoples of southern Africa and representativesfrom South Africa’s Council for Scientific and Industrial Research (CSIR) signed a benefit-sharingagreement for a drug being developed from a traditional mainstay of the San diet, that is, the Hoodiaplant.
The Hoodia has been traditionally used by the San to treat stomach pain and eye infections, amongother applications. On long hunting trips through the desert, the San chewed on the stem of theHoodia to suppress their hunger and thirst and boost their energy. In 1995, CSIR researchersdiscovered its qualities as an appetite suppressant, isolated the compound, called P57, in the plantthat curbs hunger, and obtained a patent for it in 1996. The San pointed out that the Hoodia’sdistinctive properties were the exclusive traditional and communal knowledge of the San, passeddown for centuries. Seeking acknowledgement of this fact, and of the collective ownership of thisknowledge by the broader San community, they sued in 2000. This began a long process ofnegotiation with CSIR that only recently succeeded. The San stand to receive six percent of allroyalties when the drug reaches the market. They plan to invest the money, and only tap into theinterest generated to fund community projects. This benefit-sharing agreement between a localresearch council and the San people represents enormous potential for future collaboration, notonly for the San but also for other holders of traditional knowledge (Stahl, 2004).
The above discussion and examples from the various countries in the two regions show the greatcontribution and the potentiality of indigenous knowledge and technology systems in the promotionof public health care, in both human and animal health. The access of the poor local communitiesto their biodiversity including the use of their indigenous knowledge (IK) is the primary means of theirlivelihood and health security. Therefore, the ‘piracy’ of their indigenous biological resources andinnovations through patents and the diversion of their biological resources to global marketsundermines their livelihoods. It also threatens the biodiversity base that they have protected overyears because their survival has depended upon it.
The Convention on Biological Diversity (CBD) as an international legally binding agreement recognisesthe sovereign rights of countries to their biological resources and also the indigenous innovation bycommunities. The CBD gives governments an opportunity to change the regime of bio piracy at theglobal level and replace it with a sustainable and just system in which biodiversity and diverseknowledge systems, and rights of communities whose survival depends on this biodiversity andknowledge are simultaneously protected.
The paper recommends the following:
The importance of increasing in country, regional and continental research anddocumentation of the various uses and commercial value of underutilized plants and otherbiological resources including their contribution to the promotion of public health, foodsecurity and income generation for rural communitiesThe country examples stipulated above show that indigenous medicine and knowledge atlarge are both culturally relevant and efficacious. They should be officially recognized andgiven the status they deserves; need to combine Western and traditional medicines intreating terminal illnesses to develop developing efficient treatments;There is need to recognize certain African belief systems that could play an important rolein promoting public health. Communities could consider developing new taboos for themanagement of natural resources that have become scarceIt is important to develop and harmonize the country’s IKS policies for promoting sustainabledevelopment and public healthThere is need for countries to develop and promote regional and continental IKS in thebiosciences networks for researchers and other stakeholders to share experiences.
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PROMOTION OF PUBLIC HEALTH CARE USING AFRICAN INDIGENOUS KNOWLEDGE SYSTEMS AND IMPLICATIONS FOR IPRS
Dr Hassan O. Kaya, is the Coordinator of the Indigenous Knowledge Systems (IKS) Programme atthe North West University, South Africa. Email: [email protected]
Other Publications in the ATPS Special Paper SeriesSpecial Paper Series 1Globalization and Technology: Africa’s Participation and Perspectives: Concept Paper and Research Agenda byMelvin Ayogu &Osita Ogbu (2002)
Special Paper Series 2Globalization, Markets for Technology and the Relevance of Innovation Policies in Developing Economies by SunilMani (2002)
Special Paper Series 3Biotechnology in sub-Saharan Africa: Towards a Policy Research Agenda by John Mugabe (2000)
Special Paper Series 4The Impact of Globalization in sub-Saharan Africa Countries by Mwindaace N. Siamwiza (2002)
Special Paper Series 5A Blueprint for Developing National ICT Policy in Africa by Clement Dzidonu2002
Special Paper Series 6Impact of Foreign Direct Investment (FDI) on Technology Transfer in Africa by Moses M. Ikiara (2002)
Special Paper Series 7Pursuing Technology Policy Research in sub-Saharan Africa: Reflections on the Dimensions, Applications andImplications of a Methodological Framework by M.H. Khalil-Timamy (2002)
Special Paper Series 8African Response to the Information Communication Technology Revolution by G. Olalere Ajayi (2002)
Special Paper Series 9Information and Communication Technologies (ICTs): Poverty Alleviation and Universal Access Policies by AndrewDymond & Sonja Oestmann (2002)
Special Paper Series 10ICT Human Resource Development in Africa: Challenges, Strategies and Options by T.M. Waema (2002).
Special Paper Series 11Applications of ICTs in Africa: Development of Knowledge Workers in Centres of Learning by John MuraguriWaibochi (2002).
Special Paper Series 12State of Science and Technology Capacity in sub-Saharan Africa by Khalil-Timamy (2002).
Special Paper Series 13Strengthening National Information and Cmmunication Technology Policy in Africa: Governance, Equity andInstitutional Issues by Melvin Ayogu
Special Paper Series 14A Science Agenda from An Afrian Perspective by Turner T. Isoun
Special Paper Series 15International Trends in Modern Bio-technology: Entry by and Implications for African Countries by John Mugabe
Special Paper Series 16Foreign Direct Investment (FDI), technology Transfer and Poverty Alleviation: Africa’s Hopes and Dilemma byMoses Ikiara
Special Paper Series 17Global Governance of Technology and Africa’s Global Inclusion by Banji Oyeyinka
Special Paper Series 18Science and Technology and Poverty Reduction Strategy in Sub-Saharan Africa byO. Akin Adubifa
Special Paper Series 19An Assessment of Science and Technology Capacity Building in sub-Saharan Africa byO. Akin Adubifa
Special Paper Series 20Network as Determinants of Manufacturing SME Cluster Growth in Nigeria Networking Technical Change andIndustrialization: The Case of Small and Medium Firm in Nigeria by Banji Oyelaran-Oyeyinka
Special Paper Series 21Technology Transfer in a Globalizing World: Many Promises, Lack of Responsibility, and Challenges for Africa byM.H. Khalil Timamy
Special Paper Series 22Integrated Value Mapping for Sustainable River Basin Management by Kevin Urama
Special Paper Series 23Wastewater and Irrigated Agriculture Lessons Learned and Possible Applications in Africa by Frans Huibers, LucasSeghezzo and Adriaan Mels
Special Paper Series 24Survey of Indigenous Water Management and Coping Mechanisms in Africa: Implications for Knowledge andTechnology Policy by Femi Olokesusi
Special Paper Series 25Survey of Indigenous Water Management and Coping Mechanisms in Africa: Implications for Knowledge andTechnology Policy by Femi Olokesusi
Special Paper Series 26Water Management and Conflict in Africa: The Role of Management and Technology by Chris Huggins
Special Paper Series 27Markets, Institutions and Agricultural Performance in Africa by Julius Mangisoni
Special Paper Series 28The Biotechnology Revolution and its Implication for Food Security in Africa by Victor Konde
Special Paper Series 29Why Africa has Fallen Short of Building Dynamic Agro-processing Capabilities: Constrains, Options and Prospectsby Wellington A. Otieno and Ada Mwangola
For more information on this series and ATPS Contact:
The African Technology Policy Studies Network
HOLY WATER Regia : Tom Reeve - Sceneggiatura : Michael O'Mahony - Fotografia : Joost van Starrenburg - Musica : Tom Batoy, Franco Tortora - Interpreti : John Lynch, Cornelius Clarke, Lochlann O'Mearan, Cian Barry, Susan Lynch, Linda Hamilton, Deirdre Mullins, Tommy 'Tiny' Lister, Stanley Townsend, Angeline Ball, Ray Cal aghan, Frank Dunne, Adam Astill, Lisa Catara, Dara Clear, Chrissi
Treating the Whole Patient by Elizabeth Fried Ellen, LICSW Geriatric Times November/December 2001Collaboration and communication between psychiatrists, primary care doctors and other physicians are becoming increasingly critical, as both research and anecdotal data are lending empirical credibility to the interdependence of body and mind. Comorbid depression with major medical illne