Herbal knowledge on Nicaragua's Atlantic Coast: consensus within diversity

Medicinal plants used to treat snakebite in Central America: Review and assessment of scientific evidence

ETHNOPHARMACOLOGICAL RELEVANCE

Every year between 1.2 and 5.5 million people worldwide are victims of snakebites, with about 400,000 left permanently injured. In Central America an estimated 5500 snakebite cases are reported by health centres, but this is likely to be an underestimate due to unreported cases in rural regions. The aim of this study is to review the medicinal plants used traditionally to treat snakebites in seven Central American countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama.

MATERIALS AND METHODS

A literature search was performed on published primary data on medicinal plants of Central America and those specifically pertaining to use against snakebites. Plant use reports for traditional snakebite remedies identified in primary sources were extracted and entered in a database, with data analysed in terms of the most frequent numbers of use reports. The scientific evidence that might support the local uses of the most frequently reported species was also examined.

RESULTS

A total of 260 independent plant use reports were recorded in the 34 sources included in this review, encompassing 208 species used to treat snakebite in Central America. Only nine species were reported in at least three studies: Cissampelos pareira L., Piper amalago L., Aristolochia trilobata L., Sansevieria hyacinthoides (L.) Druce, Strychnos panamensis Seem., Dorstenia contrajerva L., Scoparia dulcis L., Hamelia patens Jacq., and Simaba cedron Planch. Genera with the highest number of species used to treat snakebite were Piper, Aristolochia, Hamelia, Ipomoea, Passiflora and Peperomia. The extent of the scientific evidence available to understand any pharmacological basis for their use against snakebites varied between different plant species.

CONCLUSION

At least 208 plant species are traditionally used to treat snakebite in Central America but there is a lack of clinical research to evaluate their efficacy and safety. Available pharmacological data suggest different plant species may target different symptoms of snakebites, such as pain or anxiety, although more studies are needed to further evaluate the scientific basis for their use.

Medicinal plants used in the traditional management of diabetes and its sequelae in Central America: A review

ETHNOPHARMACOLOGICAL RELEVANCE

Globally 387 million people currently have diabetes and it is projected that this condition will be the 7th leading cause of death worldwide by 2030. As of 2012, its total prevalence in Central America (8.5%) was greater than the prevalence in most Latin American countries and the population of this region widely use herbal medicine. The aim of this study is to review the medicinal plants used to treat diabetes and its sequelae in seven Central American countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama.

MATERIALS AND METHODS

We conducted a literature review and extracted from primary sources the plant use reports in traditional remedies that matched one of the following disease categories: diabetes mellitus, kidney disease, urinary problems, skin diseases and infections, cardiovascular disease, sexual dysfunctions, visual loss, and nerve damage. Use reports were entered in a database and data were analysed in terms of the highest number of use reports for diabetes management and for the different sequelae. We also examined the scientific evidence that might support the local uses of the most reported species.

RESULTS

Out of 535 identified species used to manage diabetes and its sequelae, 104 species are used to manage diabetes and we found in vitro and in vivo preclinical experimental evidence of hypoglycaemic effect for 16 of the 20 species reported by at least two sources. However, only seven of these species are reported in more than 3 studies: Momordica charantia L., Neurolaena lobata (L.) R. Br. ex Cass., Tecoma stans (L.) Juss. ex Kunth, Persea americana Mill., Psidium guajava L., Anacardium occidentale L. and Hamelia patens Jacq. Several of the species that are used to manage diabetes in Central America are also used to treat conditions that may arise as its consequence such as kidney disease, urinary problems and skin conditions.

CONCLUSION

This review provides an overview of the medicinal plants used to manage diabetes and its sequelae in Central America and of the current scientific knowledge that might explain their traditional use. In Central America a large number of medicinal plants are used to treat this condition and its sequelae, although relatively few species are widely used across the region. For the species used to manage diabetes, there is variation in the availability and quality of pharmacological, chemical and clinical studies to explain traditional use.

Medicinal plant knowledge in a context of cultural pluralism: A case study in Northeastern Brazil

ETHNOPHARMACOLOGICAL RELEVANCE

The study of plant use in contexts of migrations can give important insights to cultural evolution, since people face rapid changes in their environments and often start interacting with native dwellers, both constituting forces that can lead to change. Therefore, this study focused on medicinal plant knowledge and transmission in order to understand what happens to such knowledge when people from several regions converge to a single place already inhabited by native people.

METHODS

The study was carried out in the rural community of Caeté-Açu (known as Capão Valley), placed in the state of Bahia (NE Brazil). Native and migrant people's knowledge on medicinal plans was accessed with a free listing. People were also asked about whom in the community once taught them about medicinal plants. Four groups (native, regional migrants, national migrants and international migrants) were compared in terms of number of cited plants, plant repertoires and knowledge transmission. For each group we also ran simple regressions between age and number of cited plants and residence time and number of cited plants.

RESULTS AND DISCUSSION

We found no differences among groups in terms of number of known species. However, plant repertoires differ in some extent among groups. While migrants claim to have learnt with both native people and other migrants, most native claim to have learned mainly with other natives. Age influences plant knowledge only for the natives, what strengthens evidence that this group's knowledge is based on experience while migrants'' knowledge is based on an active search. Residence time in the community did not influence migrants' knowledge.

CONCLUSION

Native and migrant people have differences in their ways of acquiring medicinal plant knowledge and less popular species are also different between groups. However, we can observe a tendency of fusion and indissolubility of migrant and native knowledge since the new generations are in contact with both sources.

Does plant species richness guarantee the resilience of local medical systems? A perspective from utilitarian redundancy

Resilience is related to the ability of a system to adjust to disturbances. The Utilitarian Redundancy Model has emerged as a tool for investigating the resilience of local medical systems. The model determines the use of species richness for the same therapeutic function as a facilitator of the maintenance of these systems. However, predictions generated from this model have not yet been tested, and a lack of variables exists for deeper analyses of resilience. This study aims to address gaps in the Utilitarian Redundancy Model and to investigate the resilience of two medical systems in the Brazilian semi-arid zone. As a local illness is not always perceived in the same way that biomedicine recognizes, the term "therapeutic targets" is used for perceived illnesses. Semi-structured interviews with local experts were conducted using the free-listing technique to collect data on known medicinal plants, usage preferences, use of redundant species, characteristics of therapeutic targets, and the perceived severity for each target. Additionally, participatory workshops were conducted to determine the frequency of targets. The medical systems showed high species richness but low levels of species redundancy. However, if redundancy was present, it was the primary factor responsible for the maintenance of system functions. Species richness was positively associated with therapeutic target frequencies and negatively related to target severity. Moreover, information about redundant species seems to be largely idiosyncratic; this finding raises questions about the importance of redundancy for resilience. We stress the Utilitarian Redundancy Model as an interesting tool to be used in studies of resilience, but we emphasize that it must consider the distribution of redundancy in terms of the treatment of important illnesses and the sharing of information. This study has identified aspects of the higher and lower vulnerabilities of medical systems, adding variables that should be considered along with richness and redundancy.

Cruise ships and bush medicine: globalization on the Atlantic Coast of Nicaragua and effects on the health of Creole women

OBJECTIVES

Global health research into the relationship between health, economic inequalities, and globalization is necessary to address increasing health disparities in low income countries. Nicaragua has high levels of poverty and extreme poverty when compared with other Central and South American Countries.

DESIGN AND SAMPLE

Photovoice and ethnographic research methods were used to explore health experiences of Creole women in Bluefields, Nicaragua and the intersections between culture, socioeconomic status, and gender. Twelve Creole women participants, ages 18-45.

MEASURES

After initial focus groups, participants used disposable cameras to document health experiences. Follow-up interviews were conducted about the meaning of each photo. Participants then selected photos to be included in a city-wide photoshow.

RESULTS

In initial focus groups, participants described great distress over changes they perceived in Creole culture and how these changes affect the health of the next generation. Participants related most of these changes to the economy and globalization. Photos taken were primarily of aspects of Creole culture, including household practices and traditional remedies from Creole culture.

CONCLUSIONS

Findings on the relationships between culture, disease, and community-identified health risks in this minority population can help health care providers and public health policymakers develop and sustain culturally appropriate health interventions.

Distribution of Herbal Remedy Knowledge in Tabi, Yucatan, Mexico

The distribution of herbal remedy knowledge among a group of people is studied for two main reasons: (1) to identify plants that are promising for pharmacological analysis, and (2) to examine the factors that lead to herbal remedy knowledge erosion as opposed to dynamism in the acquisition of knowledge. The goal of this particular study, which is aligned with the second reason, is to establish the variation in herbal remedy knowledge among the Yucatec Maya in Tabi, Yucatan, Mexico. Free listing and cultural consensus analysis revealed that knowledge about a few medicinal plants and herbal remedies was distributed widely among the Yucatec Maya in Tabi, whereas the majority of knowledge was idiosyncratic. This finding was consistent with other studies of herbal remedy knowledge distribution among indigenous groups in Latin America and Africa. Assessing patterns in the distribution of herbal remedy knowledge is an important next step in determining the degree of dynamism or erosion in knowledge acquisition and transmission in Tabi.

Ethnomedicinal practices and medicinal plant knowledge of the Yuracarés and Trinitarios from Indigenous Territory and National Park Isiboro-Sécure, Bolivian Amazon

AIM OF THE STUDY

We investigated the ethnomedical practices and knowledge of medicinal plant and fungus species of contemporary Yuracaré and Trinitario ethnic groups from Indigenous Territory and National Park Isiboro-Sécure (TIPNIS), located in the Bolivian Amazon region. Our aim was to identify the culturally most significant medicinal plant families, growth forms and species, as well as to assess the current state of knowledge regarding the bioactivity of the most important species, based on available literature data.

MATERIALS AND METHODS

Medicinal plant and fungus species were inventoried during homegarden and swidden sampling, walk-in-the-woods and transect sampling. Data on medicinal uses were obtained from 12 Yuracaré and 14 Trinitario participants.

RESULTS

We commence by providing a brief overview of Yuracaré and Trinitario ethnomedical systems, highlighting the important shamanistic component of particularly Trinitario traditional medicine. The rest of the paper is dedicated to an analysis and discussion based on the 349 inventoried medicinal plant and fungus species. Contingency table and binomial analyses of medicinal plants used versus the total number of inventoried species per family showed that several plant families are significantly over (Piperaceae, Araceae, Solanaceae, Asteraceae and Siparunaceae) and underused (Chrysobalanaceae, Sapotaceae, Lauraceae, Celastraceae and Annonaceae) in traditional medicine in TIPNIS. Also herbaceous plants are significantly overrepresented in the medicinal plant inventory, which is in line with relevant literature. Our ranking of medicinal species according to cultural significance is based on the Quality Use Agreement Value (QUAV) index we developed and presented in a previous paper. Results indicate that the QUAV index's property to mainly select species that combine multiple ethnomedical uses with high informant consensus, justifies its use as a measure of cultural significance of medicinal plants in TIPNIS. Results of a literature search suggest, on the other hand, that the QUAV(s) score of a species could also be indicative of its bioactivity.

CONCLUSIONS

In addition to the QUAV index's value as a tool for assessing the cultural significance of medicinal species, it might also be useful to identify species with a higher likeliness of being bioactive.

Cultural significance of medicinal plant families and species among Quechua farmers in Apillapampa, Bolivia

ETHNOPHARMACOLOGICAL RELEVANCE

Medicinal plant use was investigated in Apillapampa, a community of subsistence farmers located in the semi-arid Bolivian Andes.

AIM OF THE STUDY

The main objectives were to identify the culturally most significant medicinal plant families and species in Apillapampa.

MATERIALS AND METHODS

A total of 341 medicinal plant species was inventoried during guided fieldtrips and transect sampling. Data on medicinal uses were obtained from fifteen local Quechua participants, eight of them being traditional healers.

RESULTS

Contingency table and binomial analyses of medicinal plants used versus the total number of inventoried species per family showed that Solanaceae is significantly overused in traditional medicine, whereas Poaceae is underused. Also plants with a shrubby habitat are significantly overrepresented in the medicinal plant inventory, which most likely relates to their year-round availability to people as compared to most annual plants that disappear in the dry season. Our ranking of medicinal species according to cultural importance is based upon the Quality Use Agreement Value (QUAV) index we developed. This index takes into account (1) the average number of medicinal uses reported for each plant species by participants; (2) the perceived quality of those medicinal uses; and (3) participant consensus.

CONCLUSIONS

According to the results, the QUAV index provides an easily derived and valid appraisal of a medicinal plant's cultural significance.

Xki yoma' (our medicine) and xki tienda (patent medicine)--interface between traditional and modern medicine among the Mazatecs of Oaxaca, Mexico

OBJECTIVES

Little is known about the interface of traditional (generally plant based) medicines and of commercially available pharmaceutical (and related) products. Here we provide a case study to understand how and to what extent traditional and modern medicine have been integrated in an indigenous community and whether these two categories offer a meaningful model for understanding medicine selection. Consequently, this paper explores the use and knowledge of medicinal plants and patent medicines among laypeople living in a rural Mazatec indigenous community in Oaxaca, Mexico.

METHODS

This paper is based on field study over a period of approximately 20 months using participant observation, unstructured and structured interviews including freelisting. The medicinal plant species and commercially available pharmaceuticals were assessed using published biomedical information.

MAIN OUTCOMES

The local ethnopharmacopoeias, emic concepts of illness, epidemiology, and case studies on therapeutic choice were documented. We found that self-treatment is the most common first therapeutic choice. Many of the plant species used by Mazatecs have recognized therapeutic properties, in some cases in vivo and in vitro studies point to well defined pharmacological effects, and in a few cases clinical evidence is available. Likewise, people commonly use patent medicines that are effective in the treatment of the most common health conditions. However, we also documented the medicinal use of some toxic plant species (Aristolochia spp.) and of some patent medicines that are held to be unsafe in developed countries (sodium metamizole).

CONCLUSIONS

When looking at a complex pluralistic medical system an approach that goes beyond the externally imposed dichotomic categories of traditional and modern medicine can be very useful to shed light on other dimensions that underlie the local use of medicines. With the increasing integration of the Mazatecs with the outside world, the concomitant use of both types of resources is constantly changing and helps the Mazatecs in their struggle for health.

Ecological knowledge is lost in wealthier communities and countries

Accumulated knowledge about nature is an important part of people's capacityto manage and conserve the environment. But this ecological knowledge is now being increasingly lost. There have been few cross-cultural and quantitative studies to describe the phenomenon of its loss. Here we show a strong inverse correlation between ecological knowledge and income levels in and among India, Indonesia, and the U.K. (n=1095 interviews). Knowledge acquisition and subsequent saturation occurs at an early age in the most resource-dependent communities, but not in the U.K., where knowledge levels are low and acquisition is slow. Knowledge variance within communities increases in association with ecological knowledge decline and a scale of progressive knowledge loss was revealed with the most rapid rates of loss in industrialized regions. Various studies have described the mutually exclusive relationship between economic growth and environmental conservation; however this is the first to consider the association between economic growth and social capacity to manage the environment. Understanding ecological knowledge loss is importantto understanding the declining capacities of communities undergoing economic development to manage their natural resources and the future of ecosystem diversity in the light of current patterns of economic growth.

Herbal remedies in a Nicaraguan barrio

To become more culturally competent, nurses need to increase their knowledge of the health practices of their immigrant clients. With the growing Latino immigrant community, it is imperative that nurses learn more about the cultures from which the immigrants come. This article examines the use of herbal remedies in treating common illnesses in a barrio in Managua, Nicaragua. Data were collected in a random sample of households in an impoverished community of more than 1,600 persons. The use of herbal remedies occurred in 78% of the households. Herbal remedies were used for a variety of symptoms. There was no difference in herbal remedy use based on age or education. The discussion focuses on the availability and functionality of these herbal remedies for this vulnerable population. Implications are addressed for incorporating this information into nursing practice with Central American immigrants, thereby increasing cultural competence.

Contextualizing the politics of knowledge: physicians' attitudes toward medicinal plants

This article examines how a group of public health physicians in the urban Amazon values medicinal plant knowledge. As biomedical health care providers, physicians routinely draw on scientific plant knowledge. At the same time, as residents of the Amazon and health care providers to the poor, they are aware of and sometimes participate in local systems of plant knowledge. When discussing medicinal plant use, physicians repeatedly mention three themes: science, superstition, and biopiracy. The way in which physicians construct and negotiate these themes is part of the process of maintaining and legitimating their expertise and authority. This analysis finds that context is key to understanding whether, when, and why physicians value certain bodies of knowledge. Locally, in clinics, scientific plant knowledge is constructed as superior. In a global context, however, local plant knowledge is explicitly valued. This situational valuation/devaluation of plant knowledge relates to the positions of power physicians occupy in each context.

Gendering local knowledge: medicinal plant use and primary health care in the Amazon

Local knowledge is becoming increasingly important in primary health care projects. However, these projects often incorporate local knowledge in an uncritical manner. One area where this is apparent is in the lack of attention paid to the gendered nature of local knowledge. I use one example, women's knowledge and use of medicinal plants in a low-income community in the Brazilian Amazon, to illustrate the links among authority, knowledge, and gender. In this article I argue that policy makers must pay attention to the relationships among authority, gender, and local knowledge and examine how the use of local knowledge in development strategies can affect existing (gendered) power relationships. Women's roles as managers of household health (which includes medicinal plant use) are a source of authority for them. Because of that, the way in which local knowledge is incorporated into primary health care programs can have a significant impact on women's authority.