HEALTH
CHALLENGES OF 21ST CENTURY
AND
TRADITIONAL MEDICINE IN SAARC REGION
Koirala, Dr Rishi Ram M.D. (Ayu)
Consultant Ayurveda Physician
Registrar, Council of Ayurvedic Medicine-Nepal
Email: ayurveda@wlink.com.np
Abstract
Nobody deny that poverty, malnutrition, hunger, poor
quality of water and sanitation, injuries and violence,
tobacco, indoor pollution, alcohol, unsafe sex etc are
major risk factors for burden of diseases in SAARC countries.
Lower respiratory, prenatal condition, diarrhea-diseases,
TB, asthma, malaria and other infectious diseases are
high in these, especially in rural area. Dyeing for
any person at any age, especially infants and under
five children is still unacceptably high. Life expectancy
at birth is very low, especially for female.
More than 60% of the population of the world has been
using their traditional medicine as a primary form of
treatment, however the potential of indigenous treatment
methods to improve public health is currently undervalued,
which has negative consequences for the quality and
equity of global health. If traditional medicine is
not adequately integrated into policy frameworks for
health care in developing countries, the irreplaceable
social capital accumulated over generations will be
squandered.
To capture, protect, and commercial exploit the natural
resources, medicinal plants, Traditional Medicine and
their related intellectual property rights for the overall
sustainable growth and development of the member-countries.
Preamble
Health is recognized as a fundamental component of well
being. The state of the public health in the world has
recorded tremendous progress. In spite of this improvement,
the world is suffering today from increasing health
gap like the economic gap so glaring between the developed
and developing countries. People in the poor countries
are suffering from preventable common diseases whereas
the people in the developed world are facing the problem
of chronic maladies. Like the wide gulf in health services
between the rich and poor countries there are noticeable
differences between the rich and poor people in all
the countries irrespective of their economic status
regarding access to health facilities.
Trying to address health issue only
from the medical point of view is not only enough but
also may be counter productive. Health is a multi-dimensional
issue involving social, cultural, economical and political
aspects. Moreover each society especially with ancient
conventions has their own traditions of health and disease
and obviously they have survived for millenniums. Therefore,
it is important to give high priority of these values
while formulating policies and activities, rather imposing
globalization on these societies across the board.
The whole population of South Asia
has got a strong tradition of Ayurveda, which has elaborate
traditions of how to conduct oneself during the day
and different seasons. The population at large still
follows a great deal of that tradition. It is evident
from the survey I had conducted in 1996 in six mountainous
village development areas of Nepal in which not a single
qualified medical practitioner was there. The health
of the people was fully taken care of by about 300 traditional
practitioners who used 150 local plants described in
Ayurveda. It shows that the local population has got
still a strong dependence on this traditional medicine.
We cannot imagine a situation especially
in the developing countries without the use of the traditional
medicine and complementary alternatives medicine. It
is a must. It is a positive development that the traditional
medicine is fast invading the developed society, which
is evident from its growing popularity in the countries
like US and some European countries.
Health
challenges in Nepalese context
Poverty, malnutrition, hunger, poor quality of water
and sanitation, injuries and violence, tobacco, indoor
pollution, alcohol, unsafe sex etc are major risk factors
for burden of diseases in Nepal like in other least
developed countries. As result, lower respiratory, prenatal
condition, diarrhea-diseases, TB, asthma, malaria and
other infectious diseases are high in Nepal, especially
in rural area. Reproductive health is still major reason
for death of women and children. Dyeing for any person
at any age, especially infants and under five children
is still unacceptably high. Life expectancy at birth
is very low, especially for female.
The geographical and economic realities
in Nepal exclude dramatic changes in the existing scenario,
and it is inconceivable that the country will be able
to expand and afford the health care system as envisaged.
Essential drug supply is an important component of basic
health care, and currently is insufficient even for
the existing health post for more than a few months.
Furthermore, it is not likely that the situation will
improve in view of the economic indicators of the nation.
The irony of the situation is this that the increasing
provision of health care facilities simultaneously increases
the dependency on the import of drugs.
The numbers of hospitals, nursing homes,
health services and medical colleges in private sectors
has been increasing year by year and there contribution
is remarkable in health sector. The sector has to some
extent forced the public sector to remain competitive.
The good thing is that the competitive and board-based
services are available in qualitative and quantitative
terms.
Despite very poor economic condition
and difficult geographical structure, the nation has
provided primary health care centers for every village
development committee. Nepal has getting tremendous
success in several programs in health sector especially
in immunization, vaccination, family planning, eradication
and others. However, overall health status of the nation
is still unsatisfactory and extreme lack of essential
infrastructure.
Traditional
Medicine in 21st Century
Over two decades ago, the WHO made the Alma Ata declaration
that there should be an international effort to achieve
a level of health for all people that will permit them
to lead a socially and economically productive life,
by the year 2000. It is now disturbingly clear that
this goal has no been reached, and that health discrepancies
have been widened in that time.
A potential reason for the failure
to achieve “health for all” could be the
lack of acknowledgement of traditional medicinal, and
the subsequent neglect of a valuable aspect of health
care delivery. The incorporation of traditional doctors
and medicinal plants into a primary health care is not
only cost effective, but utilizes available resources
in a socially and culturally sensitive manner.
More than 60% of the population of
the world has been using their traditional medicine
as a primary form of treatment, however the potential
of indigenous treatment methods to improve public health
is currently undervalued, which has negative consequences
for the quality and equity of global health. If traditional
medicine is not adequately integrated into policy frameworks
for health care in developing countries, the irreplaceable
social capital accumulated over generations will be
squandered.
Western science has become more interested
in traditional and indigenous knowledge and practices,
realizing that they may hold the key to finding useful
solutions to current problems, often in combination
with modern scientific and technological knowledge.
Despite the growing recognition of traditional and indigenous
knowledge as a valuable, it has generally been regarded
under western intellectual property laws as information
in the “public domain”, freely available
for use by anybody. Moreover, in some cases, diverse
forms of traditional and indigenous knowledge have been
appropriated under intellectual property rights by researchers
and commercial enterprises, without any compensation
to the knowledge's creators or possessors.
The WHO Traditional Medicine Strategy
paper 2002-2005 explains that traditional, complementary
and alternative medicine attracts the full spectrum
of reactions, ranging from uncritical enthusiasm to
uninformed skepticism. Yet the use of traditional medicine
remains widespread in developing countries. In many
parts of the world, policy-makers, health professionals
and the public are wrestling with the question about
the safety, effectiveness, quality, availability, preservation
and further development of this type of health care.
Meanwhile, in many developed countries, complementary
and traditional medicine is becoming more and more popular.
The percentage of the population, which has used complementary
and traditional medicine at least once, is 48% in Australia,
50% in Canada, 42% in USA, 38% in Belgium and 75% in
France. The multinational companies are far ahead in
this field to grab the opportunity.
Traditional Medicine and
Nepal
This country is one of the richest in culture, tradition,
and knowledge of Ayurveda and traditional health practices.
In fact, Ayurveda has a strong cultural and scientific
heritage in this country. Nepal eluded foreign invasions
in its history and has unique socio-cultural and traditional
practices. These practices still exist today, in various
different ways such as: ethnic or tribal groups, social,
familial, generation to generation, ritual, or ceremonial
practices, daily routines or spiritual practices, diets
or self-healing practices, traditional healers, yogis,
monks, lamas etc among the institutional trained practitioners.
The majority of people in Nepal continue
to rely on this system of health care. Ayurveda and
the traditional medical wisdom and practices are prevalent
in the community and are totally dependent on locally
available medicinal herbs, knowledge, technology and
their application. The country has contributed many
valuable medicinal and aromatic plants, locally termed
as jadibuti, and the indigenous people have been using
them in traditional ways for their health and economy
since time immemorial. This system contributes a major
role in the health care system.
Resources
of Traditional Medicinal in Nepal
A. Classical manuscripts:
Ayurveda is a system of health which is based on its
basic principles, the consciousness, proto-elemental,
time, space, and its evolving theories concepts. It
has deep history in taxonomical, pharmacokinetic, pharmacological,
and clinical studies of drugs and the findings are used
for the detail study of individual constitution, pathological
states, disease conditions, drugs, formulations, forms,
and dosages. Therefore, these manuscripts are not merely
documents of individual records, but they provide widespread
theoretical foundation and explanation. There are nearly
4000 copies of hand written manuscripts that exist.
These manuscripts are written on leaf, bark and hand
made papers. The languages are Sanskrit, Pali, Newari,
Nepali and other local languages, and are also recorded
in Tibetan language. The contents of these manuscripts
are concerned with plants, flowers, food, animals, cosmetics,
minerals, tantric, basic principles, life conducts,
diseases, yoga, rituals, environment, astrology, crystals,
Ayurveda philosophy and more. These authentic manuscripts
are the real wealth of this country.
B. Traditional
Practitioners/Healers their knowledge, practices, concepts,
innovations, technology, and recipes:
These groups of traditional practitioners are deeply
rooted in the culture of Ayurveda. They have aspired
to reach the cultural values, norms, and respect of
the people. They are readily available and work as a
member of close relatives or family members. They are
capable of managing a diversity of health problems with
locally available resources. They are the repository
of this culture and science, and are the wealth of the
nation. A large number of the population still depends
upon these practitioners. Traditional and indigenous
knowledge has been used for centuries by indigenous
and local communities under local laws, customs and
traditions. Fundamentally, they follow Ayurvedic, ethno-botanical,
ethno-traditional, tantrik, spiritual and Amchi knowledge.
This knowledge has been transmitted and evolved from
generation to generation. The estimated number of these
practitioners in Nepal is 400,000. Although they are
not included in the official system of health care as
a health practitioner, their role is highly important.
Some of them who are currently practicing are the 23rd
generation of practitioners in their family. This generation
to generation practice is handed down through the family
and also through master-disciple tradition. In a survey
done by consultants, it was found that there were four
hundred fifty five traditional practitioners identified
and interviewed. They were from 142 villages of six
Village Development Councils of the Gorkha district.
Most of the practitioners were familial with the knowledge
passed down through generations
C. Herbal resources
Herbal resources are other forms of Ayurvedic wealth.
The geographical structure and advanced bio-diversity
has made it possible for the Himalayan country to lodge
numbers of valuable medicinal plants. The medicinal
and Aromatic database of Nepal covers 1624 species of
plants found in wild state or cultivated or naturalized
or imported belonging to 938 genera and 218 families.
These are known to be used as medicine in Nepal.
As described in Ayurveda, the Himalayan
Jadibuti are used for healthy body and happy mind. These
are used in different means such as toiletries and cosmetics;
incense and aromas; health promoting agents, supplements
and medicines; natural manures, pesticides; environmental
cleaning and protection; food, food additives and drinks
etc
Some
realities:
• Herbal resources are one of
the major sources of income for those people living
in the rural areas of Nepal. People are dependent on
it for immediate economic benefit.
• Collection of medicinal herbs, their utilization
in local area, raw herb trade in national and international
levels, herbal production, extraction and all other
herb-base activities are fully dependent on the wild
cultivation, except for a few examples.
• No scientific technology and equipment is used
for collection by local people and they are not aware
of knowledge of harvesting. As a result, unnecessary
parts of plants or sometimes whole plants have been
collected instead of the required part. For example,
if only the roots are needed, they pick up the whole
plant; or if only the leaves are required, a whole branch
is cut down. It is another reason why the herbs are
in danger of extinction.
• Smuggling of valuable and rare species, trading
without official registration and recording to save
taxes, collection in unfavorable seasons, are also recognized
as big problems for herbal resources.
• Production units for the production of various
products including Ayurvedic drugs should be actively
promoted by establishing manufacturing units in different
local areas focusing on availability of herbs. Instead
of producing ourselves, we are selling raw materials
at a cheap price and purchasing final products made
from our own herbs at a substantially higher cost.
• The local plant collectors, even local traders,
are not aware of the final destination of their herbs
and the actual value. They determine the price of herbs
by evaluating the economic situation, not by the medical
and other values of the herbs. That is why, instead
of a justifiable sharing of benefit, all benefits have
been flowing into other’s pockets. This is an
evil fate of the poor and innocent Nepalese.
• Careful commercial cultivation of medicinal
and aromatic plants as a natural resource needs to occur
in order to meet national as well as international demands,
and to preserve the natural balance.
• People of Nepalese family have been using indigenous
herbs in their kitchens, whether as spices or medicines.
The history of microscopic and laboratory research is
very recent compared with our ancient manuscripts and
practices. If research serves only modern science (as
seeing most research is funded by I/NGOs), it will never
see the real potential of medical use of our herbs.
• Some of the rare and endangered species of plants
are now seriously under threat since they are being
patented by developed and powerful countries. This is
a result of our individual, institutional and organizational
weakness and negligence. We have nationally published
important authentic texts on our herbs, but have failed
to bring justice to the terminologies, technology and
uses of plants related from Ayurveda and traditional
knowledge, of which we are practicing in our daily life.
• We do not have the set-up or structure for full
pipeline quality control of plants and products, starting
from identification, cultivation, harvesting, drying,
transporting, and semi-processing, along with related
pathological microorganisms, pesticides, chemical fertilizer,
heavy metal tests and certification. Even though we
possess these capacities, they are not of international
standard and no awareness or recognition is given to
the producers and collectors. Therefore, we are failing
to realize and not utilize the full of value of plants.
• An inconsistent and inappropriate revenue system,
which has caused difficulties in the private and general
public.
Institution/organization
of Ayurveda in Nepal
The institution of Ayurveda is the first health service
provider as well as academic health technician-producing
institute, whose inception was before the arrival of
modern medicine. However, the century old heritage is
running at tortoise pace due to extreme lack of responsible
and accountable organizations/institutions for preservation,
promotion, and development of this sector. They are
unable to capitalize on this resource, even in the least
amount.
Ministry
of Health
In the Ministry of Health, the HMG/N has already set
up a focal unit – Ayurveda & Alternative medicine
Branch which is responsible to develop necessary planning,
policies, rules and regulations regarding all kinds
of traditional medicine existing in country and play
vital role in corporation, coordination and direction
other organization related to TM under the ministry.
The following organizations/ institutions are working
currently under the ministry.
• Department of Ayurveda: This
Department is under the Ministry of Health who looks
after government networks of Ayurveda and policy and
planning. The constraints of manpower, visionary leadership,
budgetary allocation, prioritization of activities,
and lack of activity monitoring matrixes has severely
damaged the development of this sector. There are 285
services units in the districts and periphery.
• Ayurveda Hospitals: Two Ayurveda hospitals are
running in Kathmandu and Dang with all sorts of resource
constraints.
• District Ayurveda Health Centers: 55 DAHC throughout
the country
• Zonal Ayurveda Dispensaries: 14 ZAD throughout
the country
• Local Ayurveda Dispensaries: 216 LAD throughout
the country
• Council of Ayurvedic Medicine:
Recently this council began its activities for national
registration and regulation of Ayurveda professional
and traditional healers and academic institutions. Following
three categories of professional has been registered.
1. Ayurveda Physicians: Graduates are
registered as a full fledged member of the council.
2. Ayurveda Para medicals are registered under a sub-committee
of the council.
3. Traditional Ayurveda practitioners are enrolled and
licensed for their practice. For this that is having
three generations of practicing of Ayurveda and at least
minimum of 50 years age groups (deadline is for one
year) are eligible for enrolling. Due to this limitation
of council, many other traditional healers are not able
to get enrollment for licensing practice. The discussion
is going on to amend this clause and incorporate training
component to upgrade their knowledge and bring them
into the main stream.
• Academic Institutions: Ayurveda Institutes:
The first formal technical education started in the
country was in Ayurveda. In 1928 AD Nepal Rajakiya Ayurveda
Vidyalaya was started in Naradevi for the production
of Ayurveda manpower i.e. Vaidyas of all levels up to
Acharya, equivalent to a Bachelor of the present day
standards in contrast to the technical education in
the modern system. In spite of the fact that Ayurveda
is traditional and that formal education began much
earlier than arrival of the modern medical system, since
the advent of “democracy” in 1950, the emphasis
and all out efforts has been on the modernization and
expansion of modern health services. Ayurveda Campus
TU is the continuing institute of Ayurveda Vidhyalaya,
which is operating under severe constraints of budget
and planning. Other training Institutes under MU and
CTEVT in the periphery are running only with vested
business motives.
• Ayurveda Pharmaceutical Sector: There is one
government owned producing unit, Singha Durbar Baidhyakhana
Vikas Samiti (started from Malla dynasty 357 years ago
with a high reputation in its history) running below
capacity and constraints of quality measures. There
are 32 other private Ayurveda pharmaceutical companies,
with limited capacity and some of them are not functioning
all of the time. All these production units are having
problems with quality (in all level), and sustainable
supply of raw materials. They are lacking in quality
production protocols, manpower, and technical assuring
measures.
• Other Public, Development Partners’, I/NGO
and Private Organizations and Institutions involved
in Medicinal plants including NTFP: There is a significant
number of institutions involved in this sector. There
is minimal coordination within the Ayurvedic sector,
which is very important and vital for the overall development
of the country and Intellectual property rights issues.
Constraint in TM in country
context
Traditional medicine in Nepal is still in shadow due
to lack of priority and overall policy, and planning.
Policies are formulated without enough exercise and
discussion, lack of far-sight-ness, and far behind international
standards and trends. Budget allocation makes it impossible
to run activities on a long-term basis. Similarly, there
is extreme lack of sound interrelationship amongst public,
development partners, I/NGOs and private organizations
and institutions to develop policies, planning, and
research work and services activities. Outcomes of research
work- it is difficult to assess the outcomes of all
involved institutions/organizations for their contributory
role in the over-all development of the country and
Intellectual Property rights.
As result, huge amount of national
budget has been flowing out for import of chemical as
well as Ayurvedic drugs where raw material is being
export in cheap cost. Production, manufacturing and
marketing organization of Ayurvedic drugs are in huge
loss due malfunctioning. Natural resources like medicinal
plants, traditional healers, practitioners, manuscripts
are in threat of piracy and intellectual property right
by powerful countries. Health care services are being
dependent to donor countries and commercialized due
to random acceptance of globalization.
It has to be appreciated that the country
has getting success in certain health programs like
family planning, immunization and eradication of several
diseases. But, overall status of the country has remain
stagnant and there is no real improvement as the government
claims.
Strategy
for 21st Century in country context
Ayurveda, unfortunately it has never
received priority in the nation’s five-year planning
and budget allocation for every year, only a repetition
of the assurance that “ Ayurveda and Traditional
Medical practices and production units will be given
priority and developed” as monolog. This sector
has been running without sufficient skillful manpower
and strong leadership since long time. As a result,
the Ayurveda professionals, traditional healers, practitioners,
traders, manufactures, are highly frustrated and dissatisfied.
The country is loosing its real wealth, many of these
resources are in position of extinction, and Ayurveda
is unable to capitalize for the sake of overall development.
Focusing on the panic situation, recently
in Nepal, an authentic and powerful apex body under
the ministry of health has been proposed to be established
which is responsible for identification, utilization,
protection and development of natural as well as cultural
wealth.
Establishment
of National Natural Resources, Medicinal Plants and
Ayurveda Authority
Objective:
To capture, protect, and commercial exploit the natural
resources, medicinal plants, Traditional Medicine and
their related intellectual property rights for the overall
sustainable growth and development of the member-countries.
To meet
the above objective following activities are designed:
A) Establish Documentation, Information
Dissemination and Training centers
Documentation:
- Traditional healers, their recipes, and technology.
- Medicinal and Aromatic plants (MAPs) and flora.
- Classical manuscripts (Old and handwritten).
- Recent development and research.
- Properties right activities.
Information
Dissemination:
- Therapeutic and other values of medicinal and aromatic
plants.
- Research developments, primary health care, diets,
practices, environments etc.
- Market its demand and potential.
Training:
- Primary health workers, health professionals, traditional
healers, school teachers, students, volunteers and general
public, birth attendants, social workers, and women
volunteers.
- Other related field professionals and scholars.
- Resource identification, data collection, and protection.
- Quality and sustainable farming, cultivation, growing,
harvesting, drying, semi-processing, value adding, storing,
transportation, production and trading,
- Inventory of local technology, improving and developing
the appropriate technology and skills, and transferring
these skills to the local community,
- Preservation of species, and sustainable use of nature,
maintaining the environment, and bio-diversity.
B) Research
and Development Center
- Operational Research; Traditional knowledge, innovate
research, family traditional research, community based
research, institutional and industrial research.
- Institutional collaboration, cooperation, goal identification
and plan formation.
- Identification of the importance of Nepal’s
physiographic position and phytogeographic zones.
- Explanation of the history of plant exploration and
recent development in plant science within Nepal.
- Study of the status and value of plant diversity,
the protected area system. and occurrence of endemic
and threatened plant species.
- Resource conservation for medicinal and aromatic plants.
. C)
Intellectual Property Right Research and Development
Center
• Identifying and clustering inventions that have
distinct possibilities of being commercially worked
• Building and strengthening the core technical
and scientific competencies of its various research
groups
• Exploiting external and internal technology
relationships by creating linkages between participation
in national and international research, and development
programs to benefit innovation system
• Identifying and documenting traditional knowledge
for external protection, or scrutinizing filing of non-original
inventions
Capturing the knowledge
• IP declaration form
• The lab note book
Protecting the knowledge
• Decisions regarding patenting
• Keeping IP as a trade secret.
• Drafting the patent application.
• Filing aboard.
• Monitoring the patent application.
Exploiting
the knowledge base
• Licensing of IP
• Publicity
• Collaboration with the industries
• Creation of Digital Library
• Research base interventions
• Transliteration
D. Strengthening
of the existing Institutions / organization:
• Role identification, and monitoring
• Infrastructure, human resource management, financial
and other resources mobilization.
Recommendation:
Integration of Traditional Medicine
into the national health care services is a must for
the developing countries. Traditional Medicines are
more cost effective and reliable and also encourage
reducing dependency for donation for health from rich
countries. SAARC nations are rich in their traditional
medicine and natural resources. The member countries
have good future.
It is not impossible to capture Western
and American markets if they join hands for collective
efforts. Health status of these nations is poor since
they are unable to afford the modern medicine. There
is no the other alternative except integration of traditional
medicine with nation health policy for improvement of
health status.
Focusing
on this situation, the following activities are recommended
for promotion of traditional medicine in SAARC countries.
1. Development of SAARC Herbal Gardens:
For the preservation, conservation, development and
protection of these natural resources, herbal garden
in different altitude of different zone of all countries
should be developed so that rare and endanger species
could be preserved. Not only for the researchers, scientists,
academics and students, would these be wonderful places
to visit for herb traders, manufactures and others.
2. Production and trade of Ayurvedic
drugs:
3. Exchange programs for students and
professionals:
4. Exchange of science and technology:
5. Intellectual Property Right: For
the protection of medicinally and commercially valuable
plant species, traditional knowledge, technology and
product, SAARC countries has to develop a strong policy
that can
6. SAARC-Ayurveda Council:
Conclusion
SAARC-Ayurveda Council is an urgent
need
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