also in this section IPAT sponsors naturopathy symposium

Traditional medicine gets a bit more respect these days

by Eric Jackson

I had been to Embera Puru before, but never at night. The bus driver and a colono passenger helped me out, and as I stepped down four adolescent boys carrying medicine sticks greeted me. Yes, the meeting was on, but some of the traditional practitioners had been delayed, they explained, so my late arrival didn't mean that I had missed much.

Whether one wants to be an MD or a jaibana, burning the midnight oil is required — in the case of Embera Puru, where few homes have electricity, it's literally necessary.

I was offered a simple but tasty meal of rice and stewed chicken, and directed to a house where I was assigned a spot to sleep. Long after everyone else was sleeping, I was playing with my camera and my host was studying by the light of an improvised but effective oil lamp.

In the morning I was handed a plate of hojaldres and pork ribs, and a mug of hot sweet Embera coffee. After breakfast I was directed to the sanitary facilities. The new privies had world-standard toilet seats, something usually not found in Embera facilities. Bathing was done in a little palm frond enclosure with a barrel full of fresh water and a bowl to splash it over my body. Tooth brushing was done with some boiled water. I felt clean and refreshed, ready for a day's reporting.

This was a different kind of medical convention: no air conditioning, no promotional items from pharmaceutical companies, nobody wearing wool coats or silk ties. In fact most of the health care workers weren't even wearing shoes. At this summit about a dozen Embera healers or healers-in-training of various specialties, a Wounaan herbalist, a psychiatrist and other representatives from the national Health Ministry, a Spanish alternative medicine specialist, two Kuna legislative aides and National Indigenous Policy Director Marianela Martinelli sat down to discuss various aspects of health care. There was none of the exclusivity found at your usual medical convention: men, women and children from Embera Puru and nearby Arimae looked on and occasionally had things to say.

Arcenio Bacorizo, a cacique who's better known as a politician and architect but also the son of two herbalist and a man skilled in treating hereditary epilepsy, opened the proceedings. "Many of us, for lack of education or some other reason," he noted, "either say 'I don’t believe in doctors,' or else 'I don't believe in curanderos.' He deplored those ways of thinking, and hailed the opportunity for healers in both traditions to converse and exchange ideas.

Speaking on behalf of the Health Ministry's Traditional Medicine Section, Dr. Enrique Donado explained that his office's existence is "based upon the country's great biodiversity, its millennia-old medical traditions, and the lack of access to conventional medicines for a lot of people." He noted a worldwide movement to incorporate traditional medicine into standard health care systems, largely because groups like the Pan-American Health Organization realized that whatever conventional doctors might say about it, traditional health care is the only service available for much of the world's population, especially for the inhabitants of remote rural areas.

These days the Health Ministry is reaching out to indigenous communities in their own languages as well as in Spanish. Here, people are warned about rodents and hantavirus in Spanish and Embera.

The discussion in many ways centered around ways to standardize and improve traditional health care. The young man who had been hitting the books the night before noted that "among the Embera, there are many jaibanas who do well, but others do badly." Arcenio Bacorizo put it more bluntly: "There are people who begin practicing without sufficient knowledge, and then there are charlatans." How to educate a new generation of traditional healers, and how to weed out the fakers and incompetents, were two of the gathering's central themes.

The cacique has for many years been planning to establish a Mythological Park to preserve and disseminate Embera history, arts and sciences. He explained that an important part of the project will be gardens and orchards where medicinal plants will be grown, and a school and teaching clinic where people can learn how to use them. It can be complicated, he explained, for example because in Embera medicine it can matter a great deal whether a plant is harvested during the day or at night.

Against fears that indigenous herbal lore will be appropriated and patented by multinational pharmaceutical companies, as has happened often enough, the meeting's participants hoped that Panama's recent indigenous intellectual property law would afford some protection. Arcenio Bacorizo's son Yuri, a health care extension worker for the Ministry of Health who is studying to be a jaibana, noted that the regulations to implement this law are yet to be written, but that the twin goals are to prevent piracy while encouraging the exchange of information.

Government funding built Embera Puru's new privies, a mundane but most important development from the public health perspective.

Changing attitudes at the Ministry of Health were also noted. Donado noted slow progress toward including aspects of traditional medicine in standard medical school education, a growing recognition that the public health code needs to be amended to accommodate Panama's indigenous and non-indigenous alternative health care systems, and an unprecedented meeting at the National Psychiatric Hospital at which indigenous physicians were treated with professional respect. "Before this," he said, "it was practically taboo to talk about traditional medicine.

Psychiatrist Guillermo García agreed: "I came to the Darien and saw conventional doctors who lacked ties to traditional medicine. That's changing." He said that his experience is that jaibanas are better at treating certain maladies, while doctors have the advantage in treating others. Addressing his colleagues from different systems, he said "When I come across a difficult case, I'd like your help. When you come across a difficult case, I hope that you'll see, my help."

After lunch the discussion moved to a legislative move to create a National Institute of Traditional Medicine. Sponsored by Ngobe deputy Enrique Montezuma, the idea was first raised by a Basque physician as a way for indigenous people to retain commercial rights to the medicinal herbs that they use. The commercial emphasis, considered somewhat Eurocentric and inadequate for the crucial task of passing on knowledge from generation to generation, quickly gave way. The Kunas, Panama's best-organized indigenous group, made their mark on the proposal and at this meeting explained it to the Embera and Wounaan in attendance. There was general agreement that the proposal would have to be changed to give practitioners from all of Panama's first nations more of a say and to avoid the institute's immersion in the political disputes of the various comarcas. Marianela Martinelli was particularly insistent on this point.

There was plenty of shop talk among healers, and the discussion got around to preventive medicine as well. The big topic was hantavirus, and though nobody claimed an indigenous miracle cure for the disease, Arcenio Bacorizo said that when rats or mice become a problem the Embera have historically spread certain fruits which the rodents can't stand around their communities, which drives the vermin out. Plant-based alternatives to standard snakebite serums, herbal baths to treat certain infections, special diets for different maladies and traditional diagnostic techniques were all discussed in detail. Galileo Alfaro, a Kuna legislative aide who's also educated in traditional medicine, expressed the need for the publication of a multilingual (Spanish, Kuna, Embera, Ngobe, etc.) guide to Panama's medicinal plants as an important early step that the proposed new institute should undertake.

There will be more discussions of this sort around the country, aimed at bringing other indigenous groups and Afro-Antillean herbal practitioners into the circle. The Legislative Assembly is expected to take up Enrique Montezuma's proposal in March.