Xki yoma’ and xki tienda Interface between traditional and modern medicine among the Mazatecs of Oaxaca, Mexico

Peter Giovannini & Michael Heinrich Centre for Pharmacognosy and Phytotherapy, The School of Pharmacy, University of London

Separation between research on the use of medicinal plants and pharmaceuticals

 Researchers have focused separately on the use of - medicinal plants (ethnobotany) - pharmaceuticals (pharmaceutical anthropology)  However, we need an integrated understanding of a community’s health seeking  Ethnopharmacology focus on the use and knowledge of local

materia medica

, or ethnopharmacopoeias,

Research questions

• How both

traditional

and

modern

medicine are used in an indigenous community?

• To what extent these categories reflect the local uses of medicines?

• Is this separation useful for ethnopharmacological studies?

Field site: a Mazatec community

 Indigenous people living in Northeast of Oaxaca, Mexico. 70% Mazatec Monolingual  About 400 people  Subsistence economy  Coffee is the main source of cash  Epidemiology similar to other rural communities in developing countries

Cognitive distinction between medicinal plants and pharmaceuticals

 Xki yoma’ (our medicine)  Xka Xki: Medicinal plants (self-treatment and/or tradtitional healer)  Chjota Chjine: Curandero  Xki-tienda (shop’s medicine)  commercially available pharmaceuticals and supplements.

   over the counter medicines prescription medicines vitamins and supplements

Self-medication is usually the first therapeutic choice

Treatment choice in the study site* Self medication & Local health clinic

34% 61%

Self medication

5%

No treatment *Informants were asked to recall sickness episodes in the last 8 days and the treatment they chose. 38 Case studies were recorded.

Contemporaneous use of medicinal plants and pharmaceuticals.

Remedies for self treatment* Only pharmaceuticals 17% 47% Only medicinal plants 36% Medicinal plants and pharmaceu ticals *Remedies used within the 38 case studies recorded

The reality: Integration of knowledge

 Empirical knowledge of pharmaceuticals has been integrated with previously existent empirical use of medicinal plants: - Self-treatment is very common - Pharmacopoeia: Medicinal plants and pharmaceuticals - Empirical use of the remedies Adaptative uses Maladaptive uses

Local use of medicines is beneficial for the most common health conditions faced by Mazatecs.

Pharmaceuticals Medicinal plants Clinical evidence No evidence

5% 33% 34%

In vivo

evidence Same use in different cultures

15% 13%

In vitro

evidence Undetermined Or not efficacious

25% 75%

Efficacious Assessment of efficacy based on the available literature Assessment of the efficacy of the active principle for the local use.

Some medicines used by Mazatecs are unsafe

Medicinal plants: Two of the most culturally important species are toxic: Aristolochia odoratissima Aristolochia pentandra Pharmaceuticals: Undetermined

14%

Unsafe

17% 69%

Safe Assessment based on active principles and whether commercialisation has been restricted or banned in other countries

Mazatecs consider several attributes when differentiating medicine Xki-yoma’ (Medicina de nosotros)

Traditional From inside

Xki-tienda (Medicina de patente)

Modern From outside Cheap Mild (but traditional shamans are considered the strongest) Easy access Expensive Stronger (nga-nio’) Constrained access Less contraindications (less food restrictions) More contraindications (more food restrictions)

The differences on medicines’ attributes influence treatment choice and favours complementarity

The use of both kind of medicines extends the range of options available

Analysis of the use of medicinal plants and pharmaceuticals by native categories of illness

14 12 10 8 6 4 2 0 Fe C ve om r m on c ol D d ia rrh oe H a ea da St ch om e ac h ac Be he lly c ra m ps D ia be Tu te s be rc ol os is Vo Pa m in iti o ng f t he b on es Sw el lin D g ys en te ry Medicinal Plants* Pharmaceuticals* *: at least 2 use reports for the same use

Conclusion

• In the Mazatecs case, pharmaceuticals complement the autochthonous tradition of herbal medicine • The empirical use of both kind of medicines is better represented by several attributes rather than just by the contraposition between “traditional and modern”.

• Ethnopharmacology needs to embrace the integration of multiple forms of medicine on a local level.

Acknowledgements

    To the Mazatecs To the School of Pharmacy for a studentship To Rick Cannell Travel Fund (LSoP for travel grants) To Mexican institution: ITAO, MEXU, UNAM