Local health needs should be paramount in efforts to merge traditional and modern medicine, says Oswaldo Salaverry.
Latin America is home to a wealth of traditional medicines. Around 45 to 50 million indigenous people, mostly in rural areas, rely on them for their day-to-day healthcare and protection from infectious disease. Even in urban areas many traditional concepts and remedies are used in parallel with modern drugs.
In such a setting, policies that bring traditional and modern medicine together are vital to ensuring public health. But combining the two schools is no easy task — it requires a shift in how medicine is taught, researched and practised.
Traditional medicine is often perceived by Western researchers as simply a source of drugs, and plants have made important contributions to modern medicine. For example, quinine, an effective antimalarial drug, comes from the bark of the cinchona tree and has long been used in traditional Latin American remedies.
As the search for active ingredients intensifies, hopes are high that Latin America, home to more than 400 traditional cultures and one of the world's largest reservoirs of biodiversity, will provide a bonanza of new medications.
The Western funders of research, which often dictate policies, tend to focus on diseases of interest to the developed world. This does little to improve public health in the areas where active ingredients come from, and it overlooks the fact that most traditional medicine treats infectious diseases, rather than the complex or chronic diseases of Western cultures.
The intellectual property rules surrounding research findings also pose a challenge. Many indigenous communities in Latin America argue that collective traditional knowledge — about medicinal plants, for example — should be formally recognised and benefits derived from it shared between researchers and communities. But this does not fit into Western patent systems.
The subject is complex and the legislation inadequate. Most countries have patent protection rules that are appropriate to the research laboratory, but few legally recognise ancestral knowledge.
Working in practice
There are also clashes between practitioners of traditional and modern medicine. Many traditional medical practices, such as vertical birth — where the mother kneels or squats during labour — are thought outdated or primitive by modern doctors.
And yet evidence shows that vertical birth can significantly improve the survival rates of newborns in indigenous communities. For example, in Peru, training staff in vertical delivery and other public health actions, almost halved infant deaths between 2004 and 2009.
This example is just one of the results of an innovative regional plan to bring traditional and modern medicine together to improve the health of indigenous people.
The Intercultural Andean Health Plan in Latin America is the result of a treaty between six national health ministries (Bolivia, Chile, Colombia, Ecuador, Peru and Venezuela), known as the Andean Health Organization-Hipólito Unanue Convention.
One of the plan's ambitious targets is to include ethnicity in official health records for the entire region so that health indicators specific to indigenous people can be developed. This would be used to quantify the number of Indians suffering from tuberculosis or HIV/AIDS, for example, but also to recognise cultural illnesses such as susto, a distress syndrome where a person's soul — thought to be lost after an episode of fear — can be recovered with certain rituals. Another objective is to give health personnel intercultural skills.
The plan is making progress on many fronts. In Peru, innovations such as 'waiting houses', which provide accomodation and healthcare facilities to mothers in advance of birth, have achieved dramatic improvements in maternal health indicators.
While part of a modern health system, these facilities allow traditional practices such as vertical birth, consumption of infusions during labour, the presence of the child's father and the use of blankets instead of hospital gowns. These waiting houses increased the national average of births assisted by trained staff from 71 to 83 per cent between 2004 and 2009.
Yet despite the evidence that integrating traditional and modern medicine has tangible public health benefits, and a signed treaty to promote it, health ministries have yet to put enough money into such efforts. Health units that incorporate indigenous practices tend to be few and far between, while ministries continue to focus on a model driven purely by modern medicine.
If policymakers want to improve public health in the most remote and forgotten villages of Latin America they must move from words to action, giving the integration of traditional and Western medicine stronger political support through bigger budgets and continuity of policies.
Oswaldo Salaverry is director of the National Centre for Intercultural Health at the National Health Institute in Peru.