Professional Documents
Culture Documents
Indigenous Health Information and Knowledge Systems
Indigenous Health Information and Knowledge Systems
A Literature Survey1
By
Pedrito dela Cruz and Alana Gorospe Ramos
I.
Introduction
cultures, wherein they stand to lose an invaluable part of their heritage and
knowledge systems (Castro-Palaganas 2001).
Global initiatives to preserve and integrate IK in development programming,
such as the World Banks Indigenous Knowledge for Development Program, have
since sprung into action to counter the diminishing trove of indigenous knowledge,
but limitations exist foremost of which, is that IK has not been systematically
documented:
It is ironic that an awareness of the value of indigenous knowledge
particularly its potential contribution to sustainable development and poverty
alleviation is growing precisely at a time when such knowledge has never
been under greater threat. It is in danger of disappearing not only under
influence of global processes of rapid change, but also because the capacity
and facilities needed to document, evaluate, validate, protect and
disseminate such knowledge are lacking in the South. (SciDev 2005)
Through documentation, we are able to record and preserve indigenous
knowledge for validation and dissemination, but not all indigenous knowledge may
provide solutions to our development problems, nor can they be transferred and
applied to other communities, because they are locale and culture-specific. The
process of evaluation and validation are important to critically assess what and how
IK solutions are able to contribute to sustainable development, and to identify which
do not.
IK has been the basis for local decision-making in communities in the
following sectors (SciDev 2005):
and
soil
IK is also considered a key element of the social capital of the poor, since it
is an asset towards ensuring survival through food production and providing for
shelter, as well as for achieving control over peoples lives (IKPages 2005).
II.
Due to the huge volume of information resources, it was decided that only
literature identified by the experts would be reviewed for this study, however an
extended bibliography would be attached, for those who would wish to review other
traditional medicine resources in the Philippines.
2. Site Visits to Libraries and Information Centers
Library research was undertaken to review information resources and
research documents identified by the experts as well as to locate more materials that
might have been missed, using the book or journals reference list. Citation analysis
of certain materials was also used to enhance identification of the most cited works
in Philippine traditional medicine literature.
The libraries and information centers that were visited were:
F.B. Herrera, Jr. Medical Library
University of the Philippines, Manila
Dissemination Center
Department of Pharmacology
University of the Philippines, Manila
Medical Library
University of the East Medical Center
Filipiniana Section
University of the Philippines, Diliman
Library
Institute of Philippine Culture (IPC)
Ateneo De Manila University
Department of Health (DOH) Central Library
Department of Health Essential National Health Research (ENHR) Office
Health Action Information Network (HAIN)
Reading Room
Philippine Institute of Traditional and Alternative Health Care
Reading Room
Community Medicine (COMMED)
Search terms used were narrowed down to traditional medicine, folk
medicine, herbal medicine, alternative medicine, and medical anthropology
terms which yielded bibliographic records both in library catalogs using LCC and
indexes using MeSH systems, such as HERDIN. The search term traditional
medicine yielded the most number of relevant bibliographic records.
III.
While we can assume that knowledge of the curative virtues of herbs was
handed down from generation to generation, documentary accounts of the curative
virtues of herbs started only during the Spanish period (1521-1898) mainly by
Spanish missionaries. The earliest document is a treatise on indigenous medicinal
plants written by a Franciscan, Father Blas dela Madre de Dios, around 1611, which
was never published. Another unpublished document is that of a manuscript
completed by Father Jose de Valencia in 1669 entitled Flora Filipina, which was also
never published. The strong interest of Spanish missionaries in indigenous medicine
was captured in accounts like that from Fr. Murillo-Velardes Historia de la Provincia
de Philipinas de la Compana de Jesus. Published in Manila in 1749, it referred to a
Jesuit Father Tomas de Montoya, who died in Manila in July 1627, and who was
considered by the natives as their doctor, surgeon and spiritual healer on account of
the knowledge he had gained of some herbs and domestic medicines. Of the
documents produced during the Spanish period, the best known were those of
Father Blancos Flora de Filipinas (published in 1737, 1845, and 1877), which
discussed the use of the medicinal plants, and Dr. Pardo de Taveras, Plantas
Medicinales de Filipinas, published in 1892. (Quisumbing 1951)
The American Period (1898-1935) was characterized by scientific vigor,
during which scientific research papers dealing with medicinal plants were published.
With the establishment of the Government Laboratories, later called the Bureau of
Science, studies were conducted. This was followed by intensive research on the
chemical constituents, pharmacology, and therapeutics of medicinal plants by the
University of the Philippines. Quisumbing (1951) categorized the activities during
this period into: 1) survey; 2) chemical; 3) pharmacognostical; 4) pharmacological; 5)
pharmaceutical; and 6) therapeutical. Surveys on medicinal plants and their uses
were conducted in many parts of the archipelago, resulting to a total of 590 species
surveyed by 1931. Chemical studies dealing with the composition and values of
Philippine foods, and active principles of many Philippine medicinal plants were
undertaken. Pharmaceutical studies included those that were undertaken by the UP
College of Pharmacy, drugstores and private laboratories. (Ibid)
During the Commonwealth period (1935-1941), surveys were extended to
regions not previously explored. Some clinical and chemical investigations were also
made.
The World War II period (1941-1945) did not impede the interest and studies
on medicinal plants. Impetus was given to the cultivation of drug plants, like castor oil
plants, coca plant and a few others. Less than two months after the establishment of
the Occupation Republic, Executive Order No. 14 was promulgated creating a
committee on medicinal plants to study those actually growing in the Philippines and
to propose methods and processes suitable for the local production and manufacture
of medicinal drugs and other preparations (Quisumbing 1951; Maramba-DOH 1993).
In 1992, under the leadership of Dr. Juan M. Flavier, the Traditional Medicine
Unit was formally established at the Department of Health. In 1995, Fidel Ramos
appreciating the potentials of traditional medicine in health, tourism and economic
progress, included this as one of his administrations pole-vaulting strategies.
In order to ensure adequate government support for key areas such as research,
technology transfer, regulation and promotion as well as harness the increasing
participation of the private sector and civil society groups in traditional and
indigenous health, RA 8423 creating the Philippine Institute of Traditional and
Alternative Health Care (PITAHC) was signed into a law in 1997. A cursory review of
PITAHCs accomplishments since it formally operated, shows that it has ably put on
track vital activities relative to its promotion, public awareness, technology transfer
and networking functions. However, other strategic areas like R&D, HRD, and policy
development have not proceeded as envisioned due to lack of resources, and a
redirection of priorities.
In 1998, recognizing the value and increasing appreciation for alternative
medicine, the National Demographic and Health Survey (NDHS) included questions
on knowledge, attitude and practices on the ten DOH-endorsed herbal medicinal
plants and their uses. A section on traditional medicine was again included in the
recently published 2003 NDHS, providing important statistical data from the field to
shed light on actual knowledge and use of these medicinal plants in primary health
care.
In March 2003, DOH, DOST, PITAHC and the National Institute for Health,
started developing a National Unified Health Research Agenda with inputs from the
various consultations that have been and are still being conducted. The research
agenda is expected to include not just bio-medical or pharmacological research on
medicinal herbs, but also on the social and anthropological underpinnings of
traditional health practices.
IV.
Survey of Literature
The academe has been the primary knowledge producer of most of traditional
medicine literature with respect to its cultural and social relevance and historical
development. A good number of documentation has been produced by
anthropologists through ethnographies, a comprehensive record of the culture or
society under study, and primarily an output of anthropological field work wherein the
researcher lives as one with the members of the group he or she is studying.
The literature reviewed in this section, specifically those of Jocano (1973) and
Tan (1987), have been widely cited in traditional medicine resources, as well as by
our key informants. Planta (1999) gives an informative historical account of the
development of traditional medicine during Spanish colonial times. A DOH
bibliographic database on traditional medicine is also reviewed, alongside more
recent health IK documentation such as those by Sia and Galvez-Tan. The following
readings provide an adequate background on the socio-cultural perspectives on
traditional medicine in the Philippines.
The terminal report is divided into 3 major parts: Part 1 covers the objectives
and methodology, Part 2 consists of an extensive annotated bibliography introduced
by informative review essays, and Part 3 presents the results of the TMP survey. No
major updating of the bibliographic report, however, has been undertaken since 1995.
More recent work on traditional medicine research was undertaken under the
auspices of NIRPROMP, one of which was undertaken by Dr. Isidro Sia and a team of
medical doctors of the University of the Philippines, Manila. The project was a
documentation of 15 ethnolinguistic groups in the Philippines, a project that has been
and continues to be the basis for collecting and documenting traditional medicine
practices, specifically plant resources. This study documented health IK of 15
ethnolinguistic groups mostly living in the Cordilleras, Palawan, other parts of
Luzon,and Mindanao.
The International Institute of Rural Reconstruction (IIRR) has long been an
advocate of the promotion and integration of indigenous knowledge in development
planning, all over the world. In aspects of health, the IIRR produced Indigenous
knowledge and Practices on Mother and Child Care: Experiences from Southeast Asia
and China, a resource book on indigenous maternal and child health care (2000). The
book was a result of a workshop attended by 57 IK practitioners from 7 countries. As
an introductory resource, it provides a cross-cultural overview of indigenous mother
and child practices in Southeast Asia and China. It provides much needed focus on
maternal and child health, two of the most marginalized groups in national health care
programmes. In addition to the introduction written by Dr. Jaime Galvez-Tan, there are
extensive discussions of the Philippine experience, e.g. on the chapter on maternal
and newborn care in different cultural settings, accounts from the Blaan in South
Cotabato, the Ifugaos, Kalagan Muslims, Tausugs, and Kalingas, are presented. There
are also Philippine accounts with regards to the care of the sick from two rural
communities in Camarines Sur, and Occidental Mindoro; an account of marriage and
sex rituals among Tausugs and Kalagans in southern Philippines, and an account of a
sibling care practice among the Blaan.
A chapter of the resource book focused on retrieval, documentation and use
of indigenous knowledge, with most of the cases based on community level initiatives
in the Philippines. The cases document some of the success stories in promoting
indigenous practices in maternal and child health using such strategies as community
mobilization, exploration of innovative communication approaches, formal and informal
education strategies and intergenerational attempts to promote indigenous health
practices for mother and child.
De Padua also discusses the 11 major health problems in the Philippines and
provides a quick index of the scientific name of the plant and plant part that have
therapeutic value for such health problem. Part II covers information on 22 medicinal
plants, listing their scientific name, common name in English and a local dialect, a brief
description and localities in which they may be found, suggested preparations and
their therapeutic value.
C. Pharmacological Studies of Philippine Medicinal Plants
A paper by Dr. Jaime C. Zaguirre written in 1944 during World War II entitled
Some Emergency Bedside Preparations of Most Common Local Medicinal Plants,
gives us a rare glimpse of the early exploration of medicinal plants use during that
period. As Zaguirre explained, this was due to the lack of imported drugs as a result of
the war:
In the Philippines, there are no less than eight hundred plants reputed to
possess certain medicinal virtues. Comparatively, very few of them have been
chemically and pharmacologically studied. However, as a result of the present
scarcity or lack of standard medicaments due to war conditions, revival in the
search for local resources has greatly stimulated wide interest particularly
among the medical circle (1944).
Zaguirres paper, which we found at the University of the East Medical Library,
documents attempts to test pharmacological efficacies of certain medicinal plants,
under emergency conditions. Zaguirre gives suggestions as to where these plants may
be found and how best they are administered. Efficacy was essentially measured by
trial and error and the TED (Therapeutic Effective Dose) gathered from the bedside
(1944). According to Zaguirre, the normal process of screening was not followed due
to the urgent need to test for alternative local herbal resources to replace scarce
imported drugs at the time. This paper was again circulated in 1949 primarily among
the Medical Field Service School of the Armed Forces of the Philippines, targeting
medical officers. It saw its final publication in 1955.
Dr. Jocelyn Cruz, in her paper entitled Herbal Medicine-A Viable Alternative
for the Filipino People (1985), documents early pharmacologic tests undertaken by Dr.
Alfredo C. Santos way back in 1927, in which he was able to isolate the alkaloids of
Phaeantus ebracteolatus (kalimatas), but that no attempts to put it to therapeutic use
were ever done. Other scientific pharmacological tests followed but efforts of
researchers were not directed nor managed in a systematic way, perhaps through a
lack of a national programme.
Cruz credits the National Integrated Research Program on Medicinal Plants
(NIRPROMP) for fast-tracking the development of the herbal medicine industry in the
Philippines. It was established to identify priority needs and coordinate efforts to
systematize the study of medicinal plants (Cruz 1989). The program identified two
immediate drug needs: the need to distribute medicines within the reach of most
Filipinos, and the need to discover new or better drugs for common diseases in the
Philippines. To address the urgency of the situation, a rapid screening process to
study the efficacy and safety (toxicity) of medicinal plants was developed. Only plants
that have passed this initial screening were tested further in agricultural,
pharmaceutical and clinical trials (1989).
This literature review looked at pharmacological studies that had been done
at the Departments of Pharmacology of the University of the East Medical Center and
U.P. Manila. Both schools have ongoing programmes to test the efficacy and toxicity of
certain plants, results of which comprise a sizeable databank of medicinal plant
pharmacology. This database is supplemented by studies undertaken by the Philippine
Council for Health Research and Development (PCHRD), which are available through
HERDIN, an online bibliographic database of health literature in the Philippines. There
are approximately 2,000 records on traditional medicine in HERDIN, comprised mostly
of journal articles, research reports, papers and conference proceedings.
D. Mainstreaming Traditional Medicine
With the passing into law of the Traditional and Alternative Medicine Act
(TAMA) in 1997, there have been attempts to promote traditional medicine within the
larger, Western dominated biomedicine culture established in the Philippines. There
have been efforts to sustain this initiative at conceptual and practical levels, primarily
for three reasons: 1) majority of the poor in developing countries such as the
Philippines have little or no access to primary health care, 2) a medical culture based
on Western biomedicine is expensive, and 3) Western medical philosophy has limited
room for acknowledging the psychosocial, cultural and religious basis of traditional or
indigenous health knowledge systems.
Segismundo (1994), in a paper entitled Filipino Traditional Medicine and the
Development of a Relevant Health Care System, presented during the 2nd Asia-Pacific
Social Science and Medicine Conference in Manila, critiqued the inadequacies of the
Philippine health care system: the same problems continued to plague the country
80% of the population suffered from communicable but preventable diseases,
diseases of the heart and malignant neoplasms were on the rise, and infant and
maternal mortality rates were high at 50.3 and one per 1000 live births respectively
(Tan 1991, in Segismundo 1994). She urged the examination of other health care
delivery models more appropriate to our cultural setting, since health cannot be
isolated from its socio-economic, political and cultural context (1994).
She cites Philippine efforts in the 1970s mainly through NGOS and the
CBHPs, which attempted to integrate traditional medicine in their activities, and the
Department of Healths (DOH) institutionalization of traditional medicine into the
Philippine Health Care Delivery System, in 1992. Five other government agencies
were also promoting traditional medicine in collaboration with the DOH. Segismundo
however believed that more work needed to be done if traditional medicine was to
break out of its inferior label (compared to western biomedicine). In this respect, the
Community Medicine Development Foundation, Inc. (COMMED) took up the challenge
to retool its doctors to make them more effective as community doctors (1994). They
were taught how to document, appreciate and integrate traditional medicine into their
local health strategies. Segismundo urged the exploration of frameworks more
appropriate for the Filipino consciousness (1994), She enumerated examples from
Abaya, Osteria and Bennagens community health work.
Castro-Palaganas, et. al. (2001) presents a discussion of the problems in
primary health care delivery in the Philippines where Government has failed in
ensuring access to this basic service in the Cordillera region, home to more than 12
million indigenous peoples (IPs). Because of this, IPs have increasingly turned to
indigenous health knowledge and practices for their health care needs (2001). The
study entitled, Mainstreaming Indigenous Health Knowledge and Practices is one of
the more recent documentation of indigenous health knowledge in the Cordillera
region meant to record and validate certain traditional health practices. It was
undertaken mainly to address the threat facing traditional health knowledge, that they
face the threat of oblivion as younger generations are secularized and modernized
rather than socialized into their indigenous culture (2001). The study focuses on the
Kankana-ey women in Badeo, Kibungan, Benguet Province, in northern Philippines.
A specific focus the book is on indigenous notions of health or kasalun-alan and
the womens life cycle. Womens health is given emphasis in the study, as recognition
of their role as culture and knowledge bearers with regards to health in general (2001).
An analysis of the health situation in Badeo was also presented, supported with
statistical tables on selected health indicators. A discussion of the programmatic
aspects of primary health care support by donor agencies such as the WHO and the
World Bank, and the effects of policy on community health services is also discussed.
To counter the threat of a decline in oral traditions, traditions that have in the
past ensured the intergenerational transfer of indigenous health knowledge, CastroPalaganas, et. al. encouraged the improvement of school curricula to integrate
traditional medicine practices, as well as to encourage the academe to initiate
dialogues and trainings to preserve herbal cures (2001). Mainstreaming indigenous
health knowledge can also be attained if Local Government Units (LGUs) integrate
traditional medicine practices in their local primary health delivery programmes.
Devolution of health services has given LGUs the options to develop more culturespecific programmes.
As attempts to integrate traditional medicine within the formal health delivery
system were taking off, scientific surveys were undertaken to get big picture data on
different aspects of traditional medicine systems. First of these surveys was a study on
Traditional Medical Practitioners (TMPs) by Michael L. Tan (1992). The study
revealed that the Philippines has a significant number of TMPs (1992). The study also
showed that there were different types of traditional medical practitioners, and they
may be grouped into two categories: the empirical (users of medicinal plants) and the
magico-religious (act as medium for spirits; use prayers and sacrificial offerings like
atang). Fifteen provinces and 108 barangays were surveyed. Findings showed that
there was an average of 5.65 TMPs per Barangay or a ratio of 1 TMP for every 320
people. Individual, in-depth interviews were conducted among 224 TMPs. Data on
socio-geographic characteristics, skills acquisition, methods of diagnosis and healing,
and validation were gathered for the survey (1992).
In 1992, the DOH endorsed ten medicinal plants (after scientific testing for
efficacy and safety), through its Traditional Medicine Program. In 1998, the National
Statistics Office (NSO), undertook the National Demographic and Health Survey
(NDHS). The survey aimed to collect statistical data on levels and trends in
demographic and family planning indicators (1998, 2003). Specifically, data on fertility,
family planning, childhood and adult mortality, maternal and child health and
knowledge and attitudes related to HIV/AIDS and other sexually transmitted diseases
(2003) were gathered. A section on Traditional Medicine was included in both the 1998
and 2003 surveys. Respondents were asked regarding their familiarity with the ten
endorsed medicinal plants as well as their perceptions on their intended use (NDHS
1998). Results showed that respondents were most familiar with the medicinal uses of
guavas and garlic (1998).
The 2003 NDHS showed a relative improvement in medicinal plants use, as
compared to the 1998 NDHS. For example, awareness levels for ampalaya as a cure
for diabetes mellitus increased from 5 percent in 1998 to 44 percent in 2003. Quality of
data for traditional medicine also improved with the 2003 NDHS wherein data on
familiarity, as well as use, are presented. Northern Mindanao and the Autonomous
Region of Muslim Mindanao (ARMM) posted the heaviest usage of herbal medicine.
Guavas were used in at least 80 percent of households in ARMM, while garlic was
used in 57 percent of households in Northern Mindanao (2003).
The production of various medicinal plants handbooks by government,
NGOs and academic institutions also helped bridge the information and knowledge
gap among health and community workers. Most of these handbooks contained
information on medicinal plants and their therapeutic uses, aimed at reeducating
health workers, trainors and community members in the importance of traditional
medicine resources. As handbooks, they are written in a simple, easy to understand
format, and translated in the local dialect and illustrated. Examples of these handbooks
are Lampuyan: Ideas for Community Projects on Medicinal Plants (1980) by AKAP, a
community health NGO; Mga Halamang Panggamot (1985) by LIKAS of the Center for
Community Services, Ateneo de Manila University; and Medicinal Plants (A
Compilation, Part 1) by Molino-Barrios for the Capiz Provincial Hospital (1983). Fully
illustrated, these handbooks are important information resources to aid in the
education of people on the value of our indigenous plant resources, and thereby slowly
integrating this important resource into the bigger Philippine medical culture.
V.
It is hoped that the National Unified Health Research Agenda which is now
being developed will address these issues.
Bibliography
Books
Co,
Electronic Sources
IDRC 2005. Readings on Indigenous Knowledge: An Overview. Retrieved July 23, 2005,
from: http://web.idrc.ca/en/ev-3216-201-DO_TOPIC.html
Gorjestani, Nicolas 2000. Indigenous Knowledge for Development: Opportunities and
Challenges. Retrieved October 10, 2005, from http://wb.org
Websites
SciDev.net
IKPages
Biodiv.org