A quarterly newsletter linkingdevelopment workearound the world

A quarterly newsletter linking development workers around the world

No.48 SEPTEMBER 2001 TRADITIONAL MEDICINES

Footsteps

We then presented a Datura stramoniumplant that we had picked just in front ofthe training centre, and explained howwe use it in hospitals in Congo.Suddenly the audience came back to lifeagain. Everybody knew this plant. Welearned that it was used in the families ofthe participants for many ailments,ranging from toothache to abscesses andabdominal cramps. In the end, we talkedfor over an hour just about the uses ofthis plant!

Traditional andmodern medicine:the need for co-operation

by Markus Müller and Innocent Balagizi

• Medicinal gardens

• Letters

• Case study from DR Congo

• Production of medicines

• Natural medicine:The work of Anamed

• Malaria: a new solution

• Bible study: The gift of traditional medicines

• Resources

• Case study:Traditional practices in childbirth

• Finding community leaders

IN THIS ISSUE

definition of traditional medicine.However, there is a huge variety ofmethods used to treat diseases. Thesemethods are based on personalexperience or on knowledge shared overmany generations. Although there mightbe some good evidence from scientificresearch for the effectiveness oftraditional medicines, people usetraditional methods mainly because oftheir own experience based on their ownobservations. This is, in fact, the onlycommon feature of all the differentmethods of disease treatment that wecall traditional medicine.

To help our understanding, it may beuseful to divide traditional medicine intothree distinct groups:

■ Popular medicine From childhood,people use medicinal plants to treat illhealth and diseases, often with greateffectiveness. In eastern DR Congo,mothers from the Bashi people, forexample, give two or three drops ofsqueezed leaves of Tetrademia riparia fortheir babies to drink in the case ofabdominal cramps. To treat fever, peoplesearch for leaves of the tree Vernoniaamygdalina (commonly known as ‘bitter

Such a strong reaction to traditionalmedicine is found frequently in manyparts of the world. In Uganda, a patienttold me, ‘We all use it but we do not liketo talk about it, at least not in front of amissionary doctor.’

What is traditionalmedicine?Part of the problem is that this is acomplicated subject. There is no one, clear

We opened a seminar about traditional medicine in Asmara,Eritrea with the question, ‘Do any of you have some experiencewith traditional medicine?’ There was a complete, even hostile,silence in the room. Finally some participants said, ‘We areChristians. We have nothing to do with it.’

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These are some of the medicines used in Nebobongo Hospital, DR Congo…

Health problem Latin name of plant Plant part and preparation

nematode worm infection Carica papaya seeds (raw or dried)

infected wounds Carica papaya unripe fruit

amoebic dysentery, asthma Euphorbia hirta whole plant for tea

bronchitis Eucalyptus globulus leaves for tincture

constipation Cassia occidentalis leaves for tea

rheumatic pain Capsicum frutescens powdered fruit for ointment

burns Aloe ferox the gel of the leaves

sleep disorders Passiflora edulis dried leaves for tea

malaria Artemisia annua dried leaves for tea

nausea Zingiber officinale fresh rhizome

Examples of herbal medicines

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leaves’) and to treat intestinal worms, theleaves of the small herb Celosia trigynaare used.

There are two things common to thesetreatments:

• They are provided and used by thepatients or their family members.

• They are free of charge.

Observations about the use of theseplants are exchanged freely betweenfamilies and there are no secrets abouttheir use.

Some medicinal plants are also used asfood, others are only used medicinally.

■ The medicine of the traditional healersFor special health problems that aredifficult to treat, patients seek help frompeople who practise modern ortraditional medicine.

Traditional healers are often specialists.Traditional birth attendants can be foundin nearly every village. Other traditionalhealers are bone-setters or specialists inmental or chronic diseases. Often thework of the healers is not limited tophysical health problems. Social andreligious problems like conflicts betweenpeople, or conflicts between man anddemons or gods, are often seen as thecause of diseases, and so the treatmentinvolves religious or social procedures.

Contrary to popular medicine, thetreatment procedures of the healers aresecret and cannot be discussed openly.They can only be transferred fromgeneration to generation within thefamily of a healer and the healers mustbe paid for their work. The price of thetreatment often depends on the socialstatus of the patient. Payment is oftenmade with goods such as chickens orgoats.

In Christian circles, traditional healersare generally held in suspicion or evenfeared, because they may work withspiritual powers that are in conflict withChristian belief – but there are alsohealers like traditional birth attendantsand herbalists who are well integrated inchurch communities.

FootstepsISSN 0962 2861

Footsteps is a quarterly paper, linking health anddevelopment workers worldwide. Tearfund,publisher of Footsteps, hopes that it will providethe stimulus of new ideas and enthusiasm. It is away of encouraging Christians of all nations asthey work together towards creating wholeness inour communities.

Footsteps is free of charge to individuals workingto promote health and development. It is availablein English, French, Portuguese and Spanish.Donations are welcomed.

Readers are invited to contribute views, articles,letters and photos.

Editor: Isabel CarterPO Box 200, Bridgnorth, Shropshire, WV16 4WQ, UK

Tel: +44 1746 768750Fax: +44 1746 764594E-mail: footsteps@tearfund.org

Language Editor: Sheila Melot

Editorial Committee: Ann Ashworth, Simon Batchelor, Mike Carter, Paul Dean, Richard Franceys, Martin Jennings, Ted Lankester, Simon Larkin, Sandra Michie, Nigel Poole, Alan Robinson, Rose Robinson, José Smith, Ian Wallace

Illustrator: Rod Mill

Design: Wingfinger Graphics, Leeds

Translation: S Boyd, L Bustamante, Dr J Cruz, S Dale-Pimentil, T Dew, N Edwards, R Head, J Hermon, M Leake, E Lewis, M Machado, O Martin, J Martinez da Cruz, N Mauriange, J Perry

Mailing List: Write, giving brief details of yourwork and stating preferred language, to:Footsteps Mailing List, PO Box 200, Bridgnorth,Shropshire, WV16 4WQ, UK.E-mail: judy.mondon@tearfund.org

Change of address: Please give us the referencenumber from your address label when informingus of a change of address.

Articles and illustrations from Footsteps may beadapted for use in training materials encouraginghealth and rural development provided thematerials are distributed free of charge and thatcredit is given to Footsteps, Tearfund. Permissionshould be obtained before reprinting Footstepsmaterial.

Opinions and views expressed in the letters andarticles do not necessarily reflect the views of theEditor or Tearfund. Technical information suppliedin Footsteps is checked as thoroughly aspossible, but we cannot accept responsibilityshould any problems occur.

Tearfund is an evangelical Christian relief anddevelopment agency working through localpartners to bring help and hope to communitiesin need around the world. Tearfund, 100 ChurchRoad, Teddington, Middlesex, TW11 8QE, UK. Tel: +44 20 8977 9144

Published by Tearfund. A company limited byguarantee. Regd in England No 994339. RegdCharity No 265464.

Planting Artemisia annua var anamed inAdol, South Sudan: a community approach. P

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TRADITIONAL MEDICINE

■ Conceptual systems of traditionalmedicine There are also holistic systemsof traditional medicine that are based notonly on observation-based knowledge,but also on well-documented theories ofthe causes of ill health. Ayurveda in India,unani in Arab countries or Chinesetraditional medicine are importantexamples of such systems.

Medicinal plants inprimary healthcare In many countries in the Tropics, peoplehave little access to modern medicine. Inthe remote areas of NE DR Congo wherewe work, there is virtually no infra-structure for the transport of importedmedicines, even if the majority ofpatients could afford them.

Given this background, we wondered ifthe local production of medicines frommedicinal plants could be helpful. Westarted by using some well-knownplants to treat common medicalproblems for which literature aboutdosage, effectiveness and side effectswas available. Later we planted a gardenof medicinal plants and, with thepermission of the regional healthauthorities, we produced and used someherbal medicines when importedmedicines were not available (seeexamples in the table on page 2). Most ofthese drugs were appreciated by patientsand, as a result, several medicinalgardens were established, withtremendous community participation.

In the past few years, DR Congo hassuffered very hard times. Some healthcentres have been completely looted. Insuch cases the local production of herbalmedicines still continued and hasenabled these centres to offer theirservices once again.

A forum of traditional andmodern medicineWe have also encouraged a forum fortraditional healers, medical doctors andnurses, health service administrators andpolitical authorities. Here we discusshealth problems, and the contributionsto healthcare made by both traditionaland modern medicine. Some points havebeen very sensitive. Medical doctorswere sceptical about the effectivenessand possible side effects of traditional

medicine, and questioned the ethicsunderlying this form of treatment.

The traditional healers had learnt,through experience, to be cautious, anddid not want to have their treatmentprocedures investigated without theprotection of their knowledge beingguaranteed. To the surprise of themedical staff, they too complained aboutthe poor ethical standards of modernmedicine.

In particular, our work with Artemisiaannua (from which a new group of highlyeffective anti-malarials was derived – seepage 12) has helped encourage the fullparticipation of all parties in this forum.In working together, we learned a lotfrom each other. We are convinced that,by improving co-operation betweentraditional and modern medicine, weshall make a significantly bettercontribution to healthcare than eithercould do alone.

Markus Müller is a medical doctor andworked for many years in DR Congo. He isnow based at the German Institute ofMedical Mission, PO Box 1307, D-72003Tübingen, Germany.

Innocent Balagizi is a biologist working inBukavu, DR Congo, with special emphasison traditional medicinal plants. His addressis BP 388, Cyangugu, Rwanda.

EDITORIAL

Traditional medicine is a subject that touches everyone, since we are all interested in our own health. Allof us are likely to have experienced some kind of traditional medicine from childhood onwards. Herbalremedies form part of our cultures, but such knowledge is often rapidly being lost. Modern medicinehas most of the answers to health problems, but is not always available or affordable. In addition, manycountries experience considerable difficulties in obtaining medical supplies.

In the Bible in Revelation 22:1-2, we read that God has provided the leaves of the tree of life for thehealing of the nations. So far only 1% of the world’s forest plant species have been screened for theirchemicals. Many more are likely to have healing properties. The biodiversity of our world that weconsidered in Footsteps 47 has many more secrets to discover, unless we are careless of our inheritance.

An estimated 80% of the world’s population still depend on traditional medicines for their healthsecurity. Many modern drugs are made from natural sources, often impossible to manufacturesynthetically. A quarter of all drugs sold in the United States, for example, come from plants.

Encouraging the use of traditional medicines is far from straightforward and we need carefulconsideration and discussion to ensure that only the beneficial aspects are used with safety. However,very little research has been carried out into the effectiveness and safety of their use. Always firstconsult qualified medical expertise. We hope we have provided enough information to encourage bothwisdom and caution. The value of traditional medicines was encouraged by the World HealthOrganisation back in 1987 when it was stated that ‘Member states should: involve traditional healers incommunity based healthcare, support research into traditionally used healing plants and develop anexchange with other countries in the field of traditional medicine.’

Our contributors have all had many years of experience in thisarea and have much to teach us.

Data from Conserving Indigenous Knowledge – a studycommissioned by the United Nations Development Programme

In many countries, people have little access tomodern medicine.

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Other plants are grown just for theirmedicinal qualities and are essential in amedicinal garden. The range of plantswill vary according to country but mayinclude African marigold (Tagetes erecta),tephrosia (Tephrosia vogelii), vinca (Vincarosea), thorn apple (Datura stramonium),annato tree, (Bixa orellana), tithonia(Tithonia diversifolia) and African malve(Hibiscus sabdariffa). Make sure that over-enthusiastic collection does not meanthese plants die out in the wild.

Contour hedgesBefore you plant medicinal plants, plant hedges along the contour lines toprevent soil erosion, fertilise the soil, andprovide shade. The lines should be 2–4metres apart on sloping ground and 5metres apart on level ground. Usefulspecies include…

■ lemon grass (Cymbopogon citratus), amedicinal plant

■ leucaena (Leucaena leucocephala) alegume which improves soil fertility

■ Cassia spectabilis which grows readilyfrom metre-long cuttings

■ pigeon pea (Cajanus cajan)

■ moringa (Moringa oleifera) whichproduces edible leaves and beanswhich are rich in protein, vitaminsand minerals.

Every year at the start of the rainyseason, trim the hedges back to a heightof about one metre, and work the leavesinto the soil.

TreesPlant fruit trees round the edges oralongside the garden. Depending on thesoil, climate and altitude, include mango,tamarind, orange, papaya, guava andavocado trees. All these fruits are rich invitamins A and C.

Plant neem trees if the climate allows.They have many medicinal, insecticidaland other properties. They grow well,even in dry climates.

Planting methodsIf possible, make two gardens – ademonstration garden and a productiongarden. For the production garden, it isuseful to establish a nursery topropagate seeds and small cuttings. It isbetter to sow in alternate lines or to mixup the various medicinal plants, as theywould grow in the wild. In this way theplants provide shade for each other, andit is possible to reap a harvest in thedry season as well.

Learn from experience whetherthe plants grow best in full sunor in the shade, and whetherthey need a lot of water or alittle. Observe carefullywhere they seem to flourishin the wild.

Demonstration gardenSet aside a small area as a demonstrationgarden which you can use for teachingpurposes with medical staff, traditionalhealers, school children and teachers.Plant examples of each plant known tobe used in traditional medicine. Placethis garden near the road – for examplenear the entrance to a clinic or hospital –so everyone who passes can see it.

Label your plantsIn the demonstration garden, give eachplant a label, on which you write boththe local name, the scientific name andits uses. Old iron sheets and plasticbuckets can be cut up to make usefulpermanent labels. Write with apermanent marker. The scientific name isimportant, as visitors from anothercountry – or maybe even from the nextvillage – may call plants by quitedifferent local names.

Medicinal gardens Cultivating medicinal plants ensures that they are preserved for yourown use and for future generations. Many fruits provide medicine aswell as food. These include banana, pineapple, mulberry, passion fruitand pawpaw (papaya). Food plants that also provide medicineinclude onion, garlic, groundnut, cabbage, chilli, coffee, pumpkin,sunflower, sweet potato, rice, maize, ginger, black pepper and sesame(Sesamum indicum).

Information provided byDr Keith Lindsey and DrHans-Martin Hirt ofAnamed, Schafweide 77,71364 Winnenden,Germany.

Orange trees are good sources of vitamins A and C.

Set aside a small area as ademonstration garden.

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THE EDITORFOOTSTEPSPO BOX 200BRIDGNORTH

WV16 4WQUK

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LETTERS

Rain harvestersInformation in Footsteps has helpedpeople build ferro-cement tanks forrainwater. However, many people needto know how they can avoid mosquitoesbreeding in these tanks. Here are somepractical steps I have developed to makea dome shaped cover…

■ Measure the diameter of the top of thetank and add 3–4cm.

■ Cut a piece of string to exactly halfthis length.

■ Mark a centre point on level groundand move the string around this pointto mark a circle on the ground.

■ Dig away some of the soil and pressdown firmly to form a gentle hollow.

■ Cover the soil with paper or sacking.

■ Lay 1/4 inch (6mm) metal wire acrossthe circle in both directions about6–10cm apart and tie together.

■ Also, if available, lay chicken wire ormesh on top.

turn bloody. The calf will die if it is lessthan two months old. If the cow ispregnant, it will just deliver a stillbirth.

The cattlemen call it mborro. It spreadsthrough infected pasture. I suspect thismust be either a bacterial or viralinfection. Does this occur in othercountries? Does any one know thescientific name of this disease and whereand how we can get either a vaccine ordrug to treat this? At present there is notreatment and if one cow contracts thisinfection, then all the other cows in theherd will catch it.

Ngah Edward CITEX Farmers c/o BBH Box 9, Nso, NWP Cameroon

DR D E GOODMAN (CHRISTIAN

VETERINARY MISSIONS) REPLIES:

The health condition you describe fits thedescription of foot and mouth disease. It shouldbe confirmed by appropriate tests through theGovernment veterinary authorities as soon aspossible. There is a vaccine available which may helpto limit its spread. The disease is very contagiousand animals should not be moved to other areas.Consider whether animals brought in from outsidethe area could be the original source of infection.

Christian Veterinary Missions provide aconsultation service to give information onunknown infections in animals. They can send aform for farmers to fill in to enable CVM to answertheir queries. Their address is: CVM, PO Box 166, Turbeville, SC 29162, USAE-mail: cvmvetdrdeg@ftc-i.net

Beekeeping in CameroonWe were pleased to discover Pas à Pas.We are members of the Apiarists ofCameroon (APICAM). We are a veryactive organisation formed 14 years agoand are keen to share our knowledge ofbeekeeping with Footsteps readers.

Ruben NgweBP 14814, YaoundéCameroon

■ Cover with a firm cement and sandmortar (one part cement to three partssand) so the cover is 2–3cm thick.

■ Cover with damp sacking and leaveto harden for several days.

If a small opening is required in the lid,first place a basin or tin between thewires before applying the mortar. Make acover using mosquito netting or a tight-fitting basin.

You can also use this method to make aflat cover – simply make the cover on flatground. However, a dome shaped coveris stronger.

Dickson TenywaThe Rain Harvesters TechniciansPO Box 15131, KibuyeUganda

Nutritional biscuitsI am a nurse and also run a group forsmall children. We teach them how towork and about the word of God. Togain their trust, at the end of the meetingwe give them sweets that we makeourselves, or biscuits that we buy. Thesebiscuits are expensive. We already havesome ingredients like soya, flour, sugar.Do readers have recipes for makingbiscuits so that we can reduce ourexpenses?

Muanda Mimi AntoineBP 277, Boma, Bas CongoDR Congo

Cattle diseaseI am a health worker and use my sparetime to help both peasant farmers andthe large Bororo (cattle grazers) that livehere in Kouhouat in the west ofCameroon.

Recently a cattleman came to me withthis problem. There is a disease that isattacking cows. First the cow beginschewing its mouth seriously, the secondday it starts to produce a lot of saliva andstops eating for several days. After aweek the legs develop a problem and thecow will be unable to move for the nextthree weeks. It rests in the shade.

If it is a female with a calf, the quantityof milk will drop and then the milk will

(Left) One of the Rain Harvesters’ domed covers.

(Right) Some of the members of APICAM inCameroon, with their bees.P

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An alternative treatment is now available for people suffering from tuberculosis. This involvestaking far fewer pills than the current treatment of 16 pills a day. The World Health Organisation(WHO) say the new treatment reduces the number of tablets to as few as 3 or 4 each day takenfor the first 2 months, with just 2 each day for a further 4–6 months. The treatment is also moreeffective in preventing the spread of drug-resistant forms of TB.

The new treatment (known as FDC or fixed-dose combinations) uses combination tablets thatcontain up to four different drugs. It is based on the current recommended DOTS treatmentintroduced by WHO in the mid 1990s. FDC also lowers the cost of treatment.

There are about eight million new TB cases a year and at least two million people die because ofTB each year worldwide. Eighty percent of TB patients are found in Asia and Africa.

At present, TB patients need to take up to 16 pills a day for at least 2 months, and then up to 9pills a day for a further 4–6 months, in order to recover fully. Many patients fail to complete theircourse once they feel better, with the result that they are not cured and drug resistance spreads.

Dr Spinaci of WHO comments, ‘This pioneering work with fixed-dose combinations could also bedeveloped for use in the treatment of other infectious diseases such as malaria and HIV/AIDS.’

Update Alternative treatment for TB

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medicinal properties, to prepare drugsfrom them, to examine patients and,after consultation, provide them withtreatment. As a result, we have usedtraditional medicines to treat malaria,typhoid, amoebic dysentery, intestinalworms, coughs, gastritis, ear infections,rheumatism, impotence and many otherconditions. All the treatments are firsttried and tested. (Of course, for moreserious symptoms, we try to find theunderlying cause if we can.)

We have worked closely with Anamed in South-Kivu, with CRMS (Multi-Disciplinary Research Centre forDevelopment) at Bunia and the PlantTherapy Centre in Bunia, as well as withmany traditional healers.

Some of the problemsWe have found several difficulties:

■ Some patients stop their treatment assoon as they feel a little better and weno longer see them at the centre. Thismakes it difficult to know howeffective the treatment was.

■ When a patient feels better, they oftenrefuse to be examined or have theircondition monitored by ourlaboratory.

■ Patients are very reluctant to pay forherbal treatments even if we just askfor a very small sum.

René Gayana Simbard is the representativefor traditional medicine at Nyankunde,IPASC, PO Box 21285, Nairobi, Kenya. E-mail: ipasc@maf.org

Most of the communities where we workare poor and people often lack moneyfor healthcare. In recent years we havenoticed an increase in the number ofpeople dying from common illnesses,which are easy to treat with medicines.We therefore investigated how we couldmake use of local plants with medicinalproperties to reduce the costs ofhealthcare.

Practical emphasisTo take up this challenge, IPASC set up aresearch project for traditional medicine.IPASC has always included lessons ontraditional medicine in their teaching butuntil recently it did not emphasise thepractical aspects. It has taken nearly twoyears for this dream to become reality.IPASC aims to identify local plants with

by René Gayana Simbard

The Pan-African Institute of Community Health (IPASC) in DR Congo has several departments including training, research, healthcare, mother and childcare and consultation.

CASESTUDY

Working with traditionalmedicines

Using local plants with medicinal properties canreduce the costs of healthcare.

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Here is a list of some of the variedprocesses that can be used. Pages 8 and 9then contain examples of how theseprocesses are used to produce medicinesfrom just seven common plants. Thereare, of course, hundreds of beneficialplants that can be used. We have justselected a few which are widely knownand have been tested, tried andresearched scientifically.

Cold water extractsThis is used for ingredients that aredestroyed by heat. Leaves should be cutinto small pieces. Roots should bepounded. Soak ingredients overnight incold water. Use within one day.

Tea (orbrew)Pour one litre of boiling water over ahandful of herbs. Leave to stand andafter 15–20 minutes filter through a cleancloth. Use within one day.

DecoctionBoil one handful of herbs in one litre ofwater for 20 minutes. Filter through aclean cloth. Use within one day.

SyrupIf the herbs taste too bitter, a syrup canbe made. After preparing a tea ordecoction, filter the liquid and add onecup of sugar to one cup of the liquid.Heat gently if necessary to dissolve thesugar. Use within three days.

TinctureTinctures contain alcohol which helps topreserve the herbal extracts. Use goodquality medicinal alcohol. Usually 100gof herbal mixture is mixed with one litreof an alcohol and water mixture (45–70%alcohol). The mixture is not heated butpoured into a bottle and allowed tostand in a warm place for a week beforefiltering. The higher the alcohol content,the longer the tincture can be kept. With20% alcohol, it should keep for twoyears: 40% or more alcohol contentmeans that it will keep for five years.

OintmentOintments use pure vegetable oil andwax. Good quality palm oil made fromfreshly gathered and processed oil palmkernels is very suitable. You can also useolive oil, groundnut oil or shea butter oil.

Dry the leaves and pound them into afine powder. Mix one cup of this powderwith nine cups of oil. Heat the mixture ina water bath made from two pots. Thelarger outer pot is one quarter filled with

Production of medicinesThe preparation of a medicine from a plant that contains a beneficialchemical varies according to the chemical and the plant. Sometimesthe chemical is extracted from the leaves by the use of boiling water.Sometimes the roots are dug up and ground. The most basic andcommon process for producing medicines is to use liquid and heat.

Warning!There are risks and side effects in usingmedicinal plants. Every herb, as well asevery chemical substance, may have arange of effects; the main effect may bepositive for one patient, negative foranother and even dangerous for a third.For example, a plant that is good for lowblood pressure, may kill a person withhigh blood pressure. In addition, thequantity of active ingredient in a plant canvary according to the variety, the seasonor the age of the plant. For this reason wecannot be held responsible for any resultsof using these herbal recipes. All we cando is encourage you to be careful andobservant.

Keep careful notes and records of allherbs, quantities, treatments and effects.Learn from your own experience, and keepin close contact with other practitioners,so that you also learn from theirknowledge and experiences.

When in doubt, seek help.

water and placed on the stove. The oiland plant material are placed in asmaller inner pot with a lid. Make verysure that water from the outer pot cannotenter the inner pot. Let the water come tothe boil and simmer for 60 minutes.

Do not try and do this without using awater bath, as overheating spoils the oil.Filter the oil through a cotton cloth whileit is still hot. Add one cup of warmed,clean wax (use beeswax, commercialwax or candles) while the oil is still hot,and stir for one minute.

Adapted from the book Natural Medicine in theTropics, reviewed on Page 14.

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TRADITIONAL MEDICINE

Here are just a few examples of the detailedrecipes available in Anamed’s book Natural

Medicine in the Tropics (see page 14).

Some of the plants described here are also toxic (poisonous),and may cause serious reactions if you change the recipe, or

use the plants inappropriately. A number of the symptomsand diseases mentioned, such as cough and diabetes, mayreveal serious underlying conditions. Whenever possible,

people should first consult a health worker or doctor.

We strongly recommend the use of accurate weighingscales. If these are not available, dry the leaves and thenremove all stems by rubbing over mosquito wire. 5g of

dried leaves is approximately equivalent to the amount that will fit, firmly pressed, into a plastic 35mm film

canister. Please monitor the effectiveness of your treatment by using microscopes and other equipment

available in health centres.

OTHER NAMES Zingiber officinale

TO TREAT Travel sickness and nausea

PREPARATION Ginger powder is producedby washing, drying,pounding and sieving therhizome (underground root).

DOSE Take 1 level teaspoon ofpowder 30 minutes before travelling. To avoid nausea, take 1/2 teaspoon of powder 3 times a day.

TO TREAT Bacillary dysentery

DOSE Take 45g of fresh ginger in portions during the day.

TO TREAT Coughs, bronchitis and rheumatism

PREPARATION Make a tincture with 25g of freshly chopped ginger and 100mlof alcohol 70%. Leave for a week and filter.

DOSE Take 10–20 drops of the tincture 3–4 times daily. Also use asan antiseptic for small wounds.

TO TREAT Rheumatism

PREPARATION Make ginger oil by heating 10g of chopped ginger in 50g ofvegetable oil for 1 hour in a water bath. Strain and cool.

DOSE Apply to painful areas.

Ginger

OTHER NAMES Psidium guajava

TO TREAT Diarrhoea and amoebicdysentery

PREPARATION Use a handful of leaves tomake a decoction with 1litre of water. Filter, add 4tablespoons of honey or 2heaped tablespoons of sugar and 1 level teaspoon of salt.

DOSE Drink within 1 day.

TO TREAT Diabetes and cough

PREPARATION As above but omit the honey and salt.

DOSE Drink within 1 day.

Guava

OTHER NAMES Pawpaw, Carica papaya

TO TREAT Intestinal worms

PREPARATION To obtain latex, wash alarge unripe fruit stillattached to the plant, makeseveral vertical cuts 1mmdeep in the skin and collectthe drops of white sap in a clean spoon or cup. The knife andspoon used must be stainless steel, as traces of rust destroythe active chemical, papaine. Be careful to keep the latex out of the eyes.

DOSE For adults, take 4 teaspoons of fresh latex in the morningbefore eating. Repeat 1 week later. For babies of 6 months to 1year give 1/2 teaspoon, for 1–3 years give 1 teaspoon, 4–6years 2 teaspoons and 7–13 years 3 teaspoons.

TO TREAT Dirty wounds – to clean them

DOSE Add a few drops of latex to cool, boiled water.

TO TREAT Indigestion

DOSE Add 1 or 2 drops of latex to your food or chew 3 pawpawseeds.

TO TREAT Amoebic dysentery

DOSE Chew a teaspoon of fresh pawpaw seeds 3 times a day for 7days for light cases. For serious cases, give 1 tablespoon ofground seeds 3 times a day for 7 days.

TO TREAT Open boils, infected wounds and burns

DOSE Wash and cut an unripe pawpaw. With a clean stainless steelknife, cut a slice as thick as a child’s little finger. Lay over thewound and secure with a bandage. Leave for 4 hours; though ifit causes pain, remove earlier. Repeat 4 times a day until allthe infected pus has disappeared. In between these treat-ments, cover the wound with a honey and sugar mixture.

Papaya

Naturalremedies

Please noteAnamed’s recipes are intended to encourage good relationshipsbetween patients and medical health staff. They may help increase therange of treatments available in hospitals, health centres or home. Butplease be careful.

Always seek qualified medical help for serious health conditions.Herbal treatments can also never replace the benefits of vaccination.

Anamed, Schafweide 77, 71364 Winnenden, Germany.Fax: 0049 7195 65367 E-mail: anamed@t-online.de

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OTHER NAMES Azadirachta indica

TO TREAT Malaria

PREPARATION Make 1 litre of tea with 5gdried leaves or 40 freshsingle, small leaves (notwhole bunches).

DOSE Drink 1 litre of tea duringthe day.

TO TREAT Sleeping sickness

DOSE In addition to the recommended medical drugs, drink 1 litre oftea each day.

TO TREAT Head lice

PREPARATION Make a tincture with 10g dried neem leaves and 100ml alcoholand leave for 7 days.

DOSE Use the tincture as a hair lotion 3 times a day for 5 days. Orpound some neem seeds into a paste. Wash the hair eachevening and then rub about 1 teaspoon of the paste into thehair and leave until the next evening. Repeat as necessary.

TO TREAT Skin problems such as acne, fungal infections, psoriasis,scabies and eczema

PREPARATION Make an ointment with 10g of neem oil and 100g of ointment(recipe on p7) or make a tincture using 20g dried leaves and100g alcohol 70% and leave to soak for a week.

DOSE Apply ointment or mix 1 teaspoon of the tincture with 1teaspoon of vegetable oil and rub into affected areas.

TO TREAT Infected burns

PREPARATION Make a decoction with a handful of fresh leaves in 1 litre ofwater. Filter while still very hot to avoid contamination and cool.

DOSE Use to wash the infected burn. Keep the patient under amosquito net to avoid new infection.

Neem

OTHER NAMES Aloe vera, Aloe ferox, Aloe arborenscens

TO TREAT Burns

PREPARATION Cut and wash one leaf.Sterilise a knife in boilingwater and cut away theends and sides of the leaf,then cut through the middle to leave a large surface from theinside of the leaf.

DOSE Rub the juicy side all over the burn. Repeat 4 times a day.

TO TREAT Wounds and ulcers

DOSE Again, rub the juicy side over the ulcer 4 times a day, but alsouse the pawpaw treatment described above.

Aloe

OTHER NAMES Passiflora edulis

TO TREAT Sleeplessness, anxiety andspasms (cramps)

PREPARATION Make a tincture from 10g ofdried young leaves in 100mlof alcohol.

DOSE Use 30 drops 1–3 timesdaily.

TO TREAT Asthma and as a sedative (also for the previous conditions)

PREPARATION Make a decoction by boiling 1 large handful of young leaves in1 litre of water.

DOSE Drink 1 litre of the decoction during the day.

TO TREAT Sleeplessness

PREPARATION Make a decoction by boiling 1 handful of young leaves in just 1cup of water for 10 minutes.

DOSE Drink each evening.

Passion fruit

OTHER NAMES Sweet wormwood, Artemisiaannua

TO TREAT Malaria

PREPARATION Pour 1 litre of boiling waterover 5g of dried leaves or 25g of fresh leaves.

DOSE Divide tea into 4 equalamounts and drink at 6 hourly intervals. Some sugar or honeymay be needed to sweeten the tea. Make each day for 7 days.Never give to pregnant women and only use with youngchildren under medical supervision.

TO TREAT Coughs, colds and sinus problems

PREPARATION Inhale the vapour from hot artemisia tea for 10 minutes, 3 times a day.

Sweet Annie

Photos: Anamed

A Methodist bishop in DR Congo used to forbid the hospitals in his dioceseto use medicinal plants. Many nurses wanted to use these plants, as theywere familiar with their use, but the bishop was frightened of witchcraft,and was determined only to use modern, western medicine in his diocese.When we met him personally, we presented him with the Anamed poster of60 medicinal plants that grow in his country, and the book Natural Medicine inthe Tropics which describes how to prepare and use medicines from these plants. Heimmediately asked if he could treat his own diseases using the recipes in the book. We pointedout to him that this was contrary to his beliefs. He said that such well produced materials in full-colour were certainly not traditional, but modern and scientific, and therefore totally acceptable!

A change of heart

10

TRADITIONAL MEDICINE

FO O T S T E P S 48

A desperate situationToday, western chemical andpharmaceutical firms are rushing topatent the production of medicines fromtropical plants such as the neem andshea butter trees, periwinkle and manyother plants. The healing properties ofmany of these plants is now proven byrecent scientific research, but they havebeen used in traditional recipes for manycenturies.

The situation in many tropical countriesis now quite desperate. The rising priceof medical drugs, modern patenting lawsand the fall in value of local currenciesmean that medical centres sometimescannot afford even the most basic drugs.At the same time, local knowledge andskills about herbal remedies are being

rapidly lost. Many communities arebeing left with no health expertise at all.

Co-operation between all concerned inproviding healthcare – both traditionalhealers and medical staff – is thereforeextremely important for the well-beingof local people.

Getting togetherAnamed is a small, Christian initiative inGermany. They have considerableexperience in providing seminars on‘natural medicine’. These seminarsusually last for one week with about 30people, some of whom are trained inmodern medical practice such as doctors,nurses and primary healthcare workers,and some of whom are traditionalhealers.

Anamed describes natural medicine ascombining the advantages of themedicine of the South with those of themedicine of the North.

Good, traditional herbal medicine isaccessible, uses locally available plants,is relatively cheap (and can sometimesbe paid for in chickens instead of money)and is very personal. Modern medicine,on the other hand, emphasises theimportance of cleanliness and hygiene,and accurate measurement and dosages.So each party has a lot to learn from theother!

Today there is still often deep suspicionand mistrust between traditional healersand hospital workers. We understandboth parties. From the point of view ofdoctors and missionaries, healers instilfear, put curses on people, do ridiculousthings like ‘removing false teeth’, orcause terrible mutilations, thereby oftenkilling people. From the view of thehealer, on the other hand, doctors exploittheir patients, have no understanding ofcultural beliefs and behaviour and donot reveal their knowledge about how toprevent diseases. Many healers believethat doctors do not try to bring goodhealth to the region, but rather seek tomake lots of money by treating a highnumber of ‘their’ former patients.

Mutual respectDuring the seminars, an important firststep is arranging for the healers anddoctors to eat the same meals together,and to sleep in the same houses! Thesecond step is to enable mutual respectto develop by allowing them torecognise that each has successes andfailures in their treatments. The third

CASESTUDY

Anamed‘Natural medicine’

by Dr Hans-Martin Hirt and Dr Keith Lindsey

When Europeans first arrived in Africa, Asia and the Americas andwitnessed practices such as ritual sacrifice and ancestor worship, theyquickly labelled these as primitive. Instead, they introduced thepeople to European customs, culture and religion. However, we nowrecognise that there is much to learn from these traditional cultures. Inrejecting some dangerous practices, many other beneficial practiceswere ignored.

11FO O T S T E P S 48

TRADITIONAL MEDICINE

step is then to begin sharing some oftheir knowledge with each other.

On the last day of our seminars, wediscuss how to organise future co-operation. The medical workers elect one person to be their representative,and the healers do the same. These tworepresentatives meet every month, ormore often when problems arise. Theyact as the formal channel of communi-cation between the groups. Here areexamples of situations that may wellarise:

■ On the morning round, the doctordiscovers a cancer patient has been givendeep, bleeding and infected cuts during thenight by a healer who stole into the hospital!As a result, the doctor calls the medicalrepresentative, who speaks with therepresentative of the healers. In this way, any repetition of this problem is avoided.

■ A diabetic patient is unable to buy insulinand seeks help in the hospital. Workingthrough their representatives, a healer knownfor his success in treating diabetes is found.The hospital offers its laboratory facilities forthis healer to examine, free of charge, thesuccess or failure of his herbal treatment!

Many churches accuse the healers ofpractising witchcraft. In our seminars wealways take enough time to discuss thisvery important issue. It is, however,certainly the case that if a healer hasready access to all the plants he needs,the temptation to use witchcraft will bemuch less. Establishing a medicinalgarden to provide a constant supply ofherbs is vital.

The benefits of theseminarsWe find that bringing togethertraditional and medical healers has thefollowing positive results…

■ The general population is betterinformed, as local health committeeschoose representatives to attend theseminars, who report back to the people.People are better protected from bad anddangerous practices. For example, onesource of HIV/AIDS and hepatitis Binfection in DR Congo is from some40,000 untrained healers who give

injections using unsterilised syringes.Trained healers and traditionalmidwives can provide better treatmentwithout spreading HIV/AIDS.

■ Medical staff learn the value andeffects of medicinal plants, and begin touse them for treatment.

■ Traditional healers learn how to useaccurate doses, to preserve theirproducts better, and the importance ofhygiene.

■ Traditional midwives are no longerforced to practise illegally but, aftertraining, provide better maternity andbaby care.

■ The environment is improved asindigenous plants that are usedmedicinally gain economic value, andwill therefore be protected.

Encouraging goodpracticeWe encourage ‘traditional healers’ topractise natural medicine. This meansthey agree NEVER to:

■ give injections

■ make tattoos

■ practise cuttings (in the hope ofreleasing the pain or bad spirits)

Western (modern) medicine

■ Hygienic

■ Scientific and internationally accepted

■ The medical practitioner has a lot oftraining and understands the body anddisease

■ A full medical examination is given, withlaboratory tests

■ Uses accurate dosages

■ Medicines last a long time

■ Plants are identified by their scientificnames

■ The government controls standards ofmedical practice

■ A large number of patients can betreated, for example during epidemics

Traditional, herbal medicine

■ It uses locally available plants

■ There is no dangerous waste requiringsafe disposal

■ No problems of foreign exchange forexpensive drugs or delays at customs

■ Usually cheap for the patient

■ Creates employment in the medicinalgarden and the preparation of medicines

■ Money paid for treatment stays in thelocal economy

■ Encourages self reliance

■ The healer speaks the same language asthe people

■ Sometimes the only medical helpavailable

Advantages of the two systems

Production of medicinal oils during one ofAnamed’s ‘natural medicine’ seminars. P

hoto

: Ana

med

12 FO O T S T E P S 48

TRADITIONAL MEDICINE

The plant Artemisia annua (wormwood)is the oldest known anti-malarialtreatment, having been used in China forover 2,000 years. It contains the drugartemisinin.

Artemisinin clears malaria parasitesfrom the blood more quickly than any

other drugs and works well againstPlasmodium falciparum parasites that areresistant to other drugs.

Artemisinin productionArtemisinin is now available ascommercially produced products, whichcost between $3 to $20 per treatment. If demand rises, prices are likely to fallfurther.

Artemisinin drugs must be given for atleast five, preferably seven days, if usedon their own. Shorter courses are usefulif combined with other anti-malarialdrugs. This ‘combination therapy’ is agood way forward for preventing multi-drug resistance in the future.

Artemisinins have not been found tohave any serious side effects afterthousands of treatments.

Malaria: a new solutionMalaria is a serious and growing problem world-wide, with about 2.5 million people dying as a result of malaria each year. The malariaparasites increasingly develop resistance to the well-known malariadrugs. New drugs are being developed, but these are often extremelyexpensive and not easily obtained. However, traditional medicineseems to be providing new hope.

Drug resistance

The WHO has asked that artemisinin andother drugs obtained from Artemisiaannua are used only to treat malaria, notas a preventative medicine. They alsorecommend that it is used together withother anti-malarial drugs to preventresistance.

The Anamed hybridAnamed have also developed aparticular variety of Artemisia annua thathas a consistently high concentration ofartemisinin. This hybrid grows up to twometres high with many leaves. Ifquantities are grown in a medicinalgarden and processed carefully andaccurately, Artemisia annua var anamedcan help a hospital to have cheap andeffective malaria treatment.

The seeds of artemisia are very small andsensitive and need a great deal of care.Anamed can provide seed ofthis variety with fullinstructions (see page 14).Though expensive, thiscould prove aninvaluable investment.Once well established,cuttings can be takenfrom the plants foreasy distributionthroughout an area.

■ remove so-called ‘false teeth’ fromchildren (The new teeth of youngchildren who suffer malnutritionshine through the gum. Some believethe ‘old’ tooth must be removed.)

■ practise any form of surgery

■ use any form of witchcraft

■ carry out abortions

■ use excrement

■ give enemas.

Instead, we encourage them to:

■ provide preventive care for theircommunity

■ educate people in preventivehealthcare

■ use medicinal teas

■ use safe recipes to produce medicineslike ointments and oils

■ establish a garden of medicinal andnutritious plants

■ specialise in treating one disease.

Medical workers can increase the scopeof their work significantly by establish-ing a medicinal garden and preparingand using medicines from the plants.

Here in Anamed, we are convinced thatnatural medicine combines theadvantages of both systems. In countrieswhich value the use of traditional herbs,the Ministry of Health can achieve farmore, even on a limited health budget.

Dr Hans-Martin Hirt has many years’experience in rural DR Congo. He and KeithLindsey have a commitment to empoweringand enabling people in their localcommunities through the exchange ofknowledge. Anamed invite readers ofFootsteps to do the same.

Contact: Anamed, Schafweide 77, 71364Winnenden, Germany. Fax: +49 7195 65367 Email: anamed@t-online.de Website: www.anamed.org

Please note that Anamed are unable to eitheridentify or carry out scientific analysis onmedicinal plants for Footsteps readers. Theyare also unable to provide free literature orfunding.

Artemisia annua var anamedgrowing in Bukavu, DR Congo.P

hoto

: Ana

med

13FO O T S T E P S 48

TRADITIONAL MEDICINE

While few would question the benefitsof herbal treatments, there are indeedspiritual powers exercised by somehealers with which Christians shouldnot be involved. In addition, eachculture may know of differentpractices. How can we raise thediscussion of these issues in a way thathelps people to be honest? How canChristians be wise in their approach?Here are some discussion questionsthat may help people find the rightway forward in their culture.

1 In Africa, nearly 80% of the population live inrural areas and depend on the services of

traditional healers. But often little is done by healthworkers and doctors to work with traditionalhealers. Why is this?

2 WHO guidelines encourage co-operation withherbalists and traditional midwives. How is this

being approached in your local health centre?

3 Words such as witch doctor, medicine man,diviner, herbalist, priest, shaman and prophet

are used to describe a range of traditional healers.Discuss the terms used in your area. Which termsdescribe spiritual influences which Christiansshould avoid?

4 Traditional healers often consider not just thephysical symptoms of disease but also the

patient’s mind, soul and body. What advantages anddisadvantages are there in this approach?

5 People who are not Christians often think thatillness or misfortune is caused by both seen

and unseen forces, such as ancestors, spirits,elders or neighbours. How can Christians challengethis approach in a helpful way?

6 What should Christian healthworkers do if localhealers consider the spiritual significance of

their herbal remedies more important than theirmedicinal properties?

Traditional medicines:gifts from God by Eva Ombaka

From the very beginning, we read in Genesis 1:29 how Godplaced plants in our lives. He gave us seed-bearing plants andtrees that bear fruit for our use as food. And so in every place; wetor dry, land or sea, appropriate plants grow (Isaiah 41:19).

• What does this mean in our daily lives and to life on earth?

A body, which is well nourished, is also usually a healthy body.When we eat a balanced diet (Ezekiel 4:9) the food we eat can beseen as preventive healthcare. In addition, God gives us the use ofplants and herbs for curative care, both physical (2 Kings 20:7;Psalm 51:7) and emotional (Psalm 45:8; Genesis 43:11).

• Reflect on how people have used plants, seeds and herbs. What are theconsequences of such use?

Jesus’ ministry included both spiritual healing (Matthew 9:2) andphysical healing. He used divine power (Luke 5:17), faith (Luke 7:6-10; Luke 18:42), touch (Matthew 8:2-3) and even prepared pro-ducts such as the mud and saliva used for healing in John 9:6-7.

There were also rituals associated with cleansing and healingboth in the Old and the New Testament (Leviticus 14:49-57; John17:12-19; Mark 8:22-25).

• Consider the different healing methods that are available today andthe rituals associated with them. Which would you, as a Christian,agree with and why?

Read Philippians 1:9-10 and James 1:5

As we consider the use of traditional medicines, let us makechoices through careful study and observation, asking God forwisdom to see clearly what treatments are best, pure andblameless.

Dr Eva Ombaka is a pharmacist and the Co-ordinator of the EcumenicalPharmaceutical Network. She is based in Nairobi, Kenya. Her e-mail isciss@net2000ke.com

BIBLE STUDY

Discussion questionsTraditional medicine is a term that does not just simply refer toherbal cures for illnesses. It also touches on all kinds of healingapproaches. In this issue we have focused on the enormous benefitsavailable in using tried and tested herbal remedies. However, theboundary between herbal cures and more spiritual influences is notclear. Christians have often avoided all aspects of traditionalmedicine for fear of negative spiritual influences.

14

Across east Africa, thousands of farmers are planting weeds in their maize fields. Though thissounds odd, the technique increases yields by giving the insect pests something else to eatinstead of maize. ‘It’s better than pesticides, and a lot cheaper,’ said Ziadin Khan. ‘It has raisedfarm yields here near Mbita, Kenya by 60–70%.’

In east Africa, maize faces two major pests. The first is an insect called the stem borer. Mostyears, the larvae eat their way through a third of the region’s maize. But Khan discovered that theborer prefers a local weed, napier grass. By planting napier grass in their fields, farmers can lurethe stem borers away from the maize and into a trap, as the grass produces a sticky substancethat kills the larvae of stem borer. (However, in areas of high rainfall, napier can become invasive.)

The second major pest is striga, a parasitic plant that wrecks $10 billion worth of maize cropsevery year, threatening the livelihoods of 100 million Africans. Weeding striga is one of the mosttime-consuming activities for millions of African women farmers. Khan has found that anotherweed called desmodium seems to release a chemical that striga doesn’t like. If farmers plantdesmodium between rows of maize, striga won’t grow.

Khan’s ideas are spreading rapidly. The International Centre for Insect Physiology and Ecology inNairobi, where Khan works, has just finished trials on more than two thousand farms.

Adapted by Fred Pearce from a report on sustainable agriculture by Jules Pretty in New Scientist, February 2001.

Helpful weeds

RESOURCES

The Healthy Eyes Activity BookThis is a health teaching book forprimary school children which provideslots of exercises and activities for use inclass. The 50 pages provide many ideasfor lessons and source materials forphotocopying to use with a class. Thebook provides information on goodhealth for eyes, preventing blindness(especially through accidents) andunderstanding the causes of eyeproblems.

The book costs £3 including postage (fivecopies for £11) and is available from:

International Centre for Eye HealthInstitute of Opthalmology11–43 Bath StLondonEC1V 9ELUK

Fax: +44 20 720 3207E-mail: eyeresource@ucl.ac.uk

Community Development CD-ROM LibraryA new edition of this very useful CD-ROM library has just been published.This is Version 3.0 and contains thecontents of over 1,150 books andnewspapers relating to development.The Footsteps office has copies availablefor £10 (US $15) each, including airmailpostage. Some free copies are availablefor groups without access to foreignexchange. Please write to:

PO Box 200BridgnorthShropshireWV16 4WQUK

Trees for LivingThis newsletter is produced twice a yearto encourage regional networking inagroforestry in southern Africa. Itincludes articles on various useful treespecies, farmer discoveries andimproving soil fertility. For more detailswrite to the following address:

Dr Andreas BöhringerThe SADC-ICRAF Zambezi BasinAgroforestry ProjectMakoka ARSPO Box 134 ZombaMalawi

Fax: +265 534283 or 534298E-mail: aboehringer@malawi.net

BooksNewslettersTraining materials

Natural Medicine in the Tropicsby Hirt and M’Pia (Second edition)

This is an excellent introduction and guideto the production and use of traditionalmedicines. It gives full and detailedinstructions on how to use 65 medicinalplants to treat a wide variety of healthconcerns. The information on pages 7–9was adapted from this book. Highlyrecommended. It is available in English(new 2nd edition, US $19, 42DM), German($16, 35DM), French ($16, 35DM),Ukrainian ($13, 30DM) and Spanish(temporary edition $30, 69DM) includingsurface postage.

Healing Plants in the Tropics

This is an excellent and informative posterwith colour photographs of 60 medicinalplants and describes the diseases andcomplaints for which they may be useful.The poster costs US $13 (30DM) and isavailable in English, French and German, orblank for teaching purposes.

Anamed Malaria Programme

The Artemisia annua var anamed Kitincludes 1,200 seeds and full informationabout sowing, growing and harvesting thisplant. It also has details of networkingbetween participants in the Anamed MalariaProgramme. It costs US $93 (210DM).Please specify country of use as each packis prepared individually.

A detailed list of all Anamed’s publicationscan be seen on their websitewww.anamed.org. For all the abovematerials, please send payment in advanceusing either cheque or bank transfer. Forpayment from banks other than British orGerman, please add $6 to cover bank fees.Write to:

Anamed-versand, Schafweide 77, 71364 Winnenden, GermanyFax: +49 7195 65367 E-mail: anamed@t-online.de

Anamed publications

FO O T S T E P S 48

FO O T S T E P S 48

TRADITIONAL MEDICINE

In Cambodia when someone is sick, theycall the Khru Khmer to treat the bodyand the spirit. For most Cambodians, allsickness is connected with the spirit –whether it is a mental problem or abroken bone. One of the ‘trademarks’ ofthe Khru Khmer is that they ‘blow’ onpeople. It is believed that a spiritpossesses them, and when they blowonto a person the power of the spirit ismanifest.

Much illness in animist societies iscaused by fear, so people look first forspiritual healing in their own culture.Christians need to determine whichpractices are helpful and which areharmful. It is important to build on whatpeople already believe (even if this ismedically unhelpful), as only then canhealth staff begin to influence andimprove the situation. This is true, notjust in Cambodia, but also in othercountries.

For CORD (Christian Outreach Reliefand Development), weekly Bible studieswith staff give a forum for discussion onsuch subjects. During training oftraditional birth attendants, there werealso discussions which opened people’sminds to the knowledge that there arealternatives. As CORD Christian staffdevelop relationships with local people,they can start to talk about release fromfear through the Lord Jesus Christ.

Tea remediesDuring pregnancy and childbirth theKhru Khmer are involved withprotecting the mother and child. They tie

cotton strings with long flattened metalrings around the waist of the pregnantwoman. The string can be expanded asthe pregnancy progresses. The KhruKhmer make a herbal tea for pregnantwomen to drink which helps makes thebirth easy – supposedly by making thebirth passage slippery. Many problemsin pregnancy have ‘tea’ remedies andsome healers show the relatives how toprepare it themselves.

After delivery many people believe thebaby belongs to the spirit world for thefirst three days and only on the fourthday, if they live, is the baby part of thehuman world. The first three days aretherefore a crucial time for protecting thechild. The traditional midwife willprepare incense and fruit as an offeringto the spirits on the fourth day.

Traditional practicesin childbirth

by Barbara Soung and Hang Sorya

Traditional healers are known as Khru Khmer in Cambodia. They learntheir skills from old monks or older male relatives. They are nearlyalways male, though occasionally there are female Khru Khmer. Theirfemale equivalents are the traditional midwives, who often learn someof their skills by watching the Khru Khmer at work.

CASESTUDY

TaboosFollowing delivery, Khmer women are very fearful for their health, astraditionally there are many taboosconnected with certain foods, workingtoo hard, having sexual intercourse toosoon after birth, carrying heavy things orbeing exposed to rain and wind. It isbelieved that if the woman breaks someof these taboos, there are no cures. Shewill suffer for the rest of her life or evendie. This often means that if a mother hasa problem after delivery, the family willlook for the cause among the taboos,instead of taking the woman for medicalhelp.

The need for educationThe Khru Khmer believe that they havethe answer for all illness and continuetreating someone until they die. Theyneed to know which illnesses they cancure and which need medical attention.They need to educate the people in this,too. Some educated people still believein the power of the Khru Khmer but notin their traditional medicine.Others will buy the traditionalmedicines from shopswithout visiting theKhru Khmer.

Barbara Soung andHang Sorya work inPre Veng Province,Cambodia for CORD– a UK-basedinternationalChristian charity.

■ Many of the Khru Khmer practices areunhelpful or harmful. Is it better forhealth staff to look for the goodpractices and build on them, or tellpeople to avoid using them completely?

■ How can educated people be releasedfrom their belief in the power of theKhru Khmer?

■ What problems are CORD health stafflikely to encounter?

■ What similar health taboos and beliefsare practised in the culture where youare working?

Discussion questions

15

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16 FO O T S T E P S 48

playing outside one house.The person living there wasprobably the care-taker for that area – the‘Mama’ or the ‘shepherd’ – always readyto listen, comfort or advise. Everycommunity has one and they can be menor women. To find the care-taker, ask: ‘Ifyou had an emergency at 2am and noneof your family were around, who wouldyou go to for help?’

The News-catchersThese are the people who always knoweverything that is going on. Whensomeone is ill, or dying or has lost theirjob, they always seem to be one of thefirst to hear. To find the news-catcher,you could ask: ‘If a person was known tobe causing unnecessary problems orarguments, who would people talk to inorder to make sure that the message gotthrough to them?’

The BrokersA broker has connections with personalfriends of key people in the governmentor international organisations who canget things done! To find the broker, askwho people would turn to for help to getthings done. Who would they ask for

COMMUNITY DEVELOPMENT

I believe there are four key people inevery community around the world. I’vegiven these people the names, gate-keepers, care-takers, news-catchers, andbrokers. These are the people who reallymake communities function.

How do you learn about eachcommunity? As you talk with people,ask them about how long they havelived in the area, what changes they haveseen in that time, what hopes they haveand what problems and concerns thereare. Then ask questions to discover thereal leaders. When you keep getting thesame names from different people, thenyou know you’ve probably found them.

The Gate-keepersA community’s gate-keeper is the personwho decides whether or not someonegets through the ‘gates’ of thecommunity and is accepted. To find thegate-keepers, ask who has recentlymoved into the area. How do people feelabout them? Are they well liked orthought odd? Why do they feel thisway? Their answer may well be:‘Because so and so told me this…’ andthen you’ve found your gate-keeper.These are influential people whoeffectively control how others feel aboutnew people and new ideas.

The Care-takersThese are the people others turn to whenthey have problems. When I waswalking through a slum in Chennai, allthe children from one area seemed to be

help when, for example, the water tap orpower supply or telephone for their areawas not working?

Find them!Why is it so important to find these fourtypes of people?

■ Firstly, because these are the peoplewith the necessary skills to organisethe community to encourage change –whether this is for advocacy work, orany other development work.

Published by: Tearfund, 100 Church Rd,Teddington, TW11 8QE, UK

Editor: Dr Isabel Carter, PO Box 200, Bridgnorth,Shropshire, WV16 4WQ, UK

Finding the realcommunity leaders

by Robert Linthicum

To encourage change effectively within a community, you need tolearn from the community about their situation. You alsoneed to learn who the real leaders are. Often theelected leaders are not the people who makethings happen in a community.

■ Secondly, because people in thecommunity will first look to see if themost important people areparticipating or boycotting the effort.Then they will decide whether to joinin themselves.

Seek out these key characters and buildrelationships with them. Remember,however, that their interests may notalways be the same as yours or of thecommunity. Seek to work with them andinfluence them. Through the under-standing and support of these leaders,change will be much more likely.

Condensed from an article in TogetherMagazine, Issue 27, World Vision.