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Des sources du savoir aux médicaments du futur

 | 
Jacques Fleurentin
, 
Jean-Marie Pelt
, 
Guy Mazars

2. Élaboration des pharmacopées

Alliance of traditional and scientific knowledge in Central America

Jean-Pierre Nicolas

Résumé

Abstract
The ethnopharmacological approach makes it possible for many peoples to have access to suitable and effective therapy, in their own right.
The approach implemented in Central America and developed by the Association "Jardins du Monde" established in Brittany, France aims at studying traditional pharmacopoeias and sharing scientific results with partners working for various N.G.O. with whom they set up strategies for the integration of the scheme to provide primary health care into a general programme for sustainable development (hygiene, food, agriculture, animal health care, environment). It sets up pilot structures for development, including:
- laboratories for the manufacturing of simple medicinesA part of the production of collective gardens is processed by local laboratories. The herbal medicines are prepared according to galenic protocols;
- creation of communal pharmaciesA part of the plants and the by-products produced are offered to the community by health care officers in such communal pharmacies. These products are marketed next to essential medicines so that health care officers and patients may choose the kind of treatment they prefer, and also generate some surplus-value and thus contribute to the salary of the health care officer who is in charge of the communal pharmacy.

Texte intégral

Introduction

1The approach of ethnopharmacology is holistic; it is based on various forms of knowledge and expertise stemming from various areas such as history, anthropology, sociology, botany, chemistry, pharmacology, education, etc.

2Moreover, as it is guided by a code of ethics based on the respect of peoples and cultures, it draws on both traditional and scientific knowledge.

3As a consequence, ethnopharmacology is a science which has a clearly pragmatic dimension. The Breton association "Jardins du Monde" is a good example of such a structure where the ethnopharmacological approach can be translated into practice and implemented in real time. Here is a brief presentation of this structure.

Facts

4Health care and medical treatment for 80% of the world's population stems at present times from the local plants and pharmacopoeias, be it be by free choice or because they have no access to modern medicine. However, in most countries where the health conditions are appalling, there is a rich herbal pharmacopoeia.

5These traditional pharmacopoeias have been elaborated as part of a congruent and complex representation system, in the image of the culture f the people concerned. At the end of the millennium, we can see that these traditional cultures are falling apart, changing rapidly, or even disappearing, as the price to pay to the de-structuring process caused by natural disasters, wars, or pressure from economic competition and the shrinking of land, as a prelude to the steamroller effect imposed by globalisation.

6Knowledge is most often transmitted orally and may therefore get lost when being passed from generation to generation before vanishing irreversibly, thus leaving some peoples deprived of any significant cultural reference marks for the time of their passage on earth. As a consequence, we gradually come to a decline of the cultural diversity of the world's heritage.

7As traditional knowledge is fading away in the distance, the plants to which they referred are suffering a similar erosion. It is therefore urgent to preserve the environments and the species living in it, as well as the cultures of the peoples who are the witnesses of the knowledge and the traditions related to them. Though data collection is an important part of the process to extend the wealth of the world's cultural heritage, we should not be content with just capturing the information collected in a database, but rather make good use of it. An easy way to maintain cultures, knowledge and the plants related to them consists in enhancing and promoting them, and by giving them a forceful meaning by adapting them to the changing society where they live.

8The national and international organisations engaged in North- South co-operation, with W.H.O. support, by developing local pharmacopoeia, try to meet the huge needs of a growing population of impoverished people. However, the promoters of such initiatives try to preserve the autonomy of communities and implement their programs as part of an integrated development.

9Unfortunately, these organisations have no access to the huge bulk of scientific information available in universities and other places to boost the use of herbal pharmacopoeia; neither do they have trained staff or adequate and relevant means of assessment to offer suitable and effective therapies to these communities.

The objectives of and the resources committed by the "Jardins du Monde" Association

10The objective of "Jardins du Monde", a non-profit-making association, is to enhance the use of medicinal plants in community medicine. They work in the field of health care and agriculture, while taking great care not to disrupt biological and cultural diversity. The approach is that of applied ethnopharmacology. The line of action is similar for all their projects in Guatemala (San Marco, El Quiche and Solola districts) and Honduras (Valle and Choluteca districts).

Studying traditional pharmacopoeias

11Ethnopharmacological surveys carried out with people who have acquired traditional knowledge (housewives, healers and midwives) supply a wealth of information in numerous areas.

12Investigating health care systems and therapeutic procedures provide clues about the way these cultures conceive health care, illness and relevant remedies. It also provides information about the way these communities order their cosmovision and apply their operational logic.

13Then, the inventory of medical resources available is established, in terms of human resources (traditional healers, but also therapists trained by the modern health care system), organisations (health care providers), pharmacognosy (plants, minerals, mixtures and chemical medicines) and also in terms of forms of knowledge or practice used for diagnostic, prevention and health care. Concerning medicinal plants, making herbariums leads to botanical identification which can then be used as a basis for bibliographical research, itself the starting point for scientific investigation.

14Once the identification of the plants used has been checked scientifically, bibliographical research can be carried out. After collecting this information, the potential for therapeutical application is assessed and compared to the medical requirements of the communities concerned. A set of medicinal plants is suggested for each pathology. Selection criteria are applied (non toxicity, efficacy, availability). Chemical or toxicological experimentation may be carried out on plants that can be of interest for the community. If necessary, some plants can be submitted to further investigation, particularly concerning parasitology.

15It is necessary to look at things from a distance after this field-work stage and before organising the feedback procedure, when information is returned to the natives for use and adaptation. All projects are submitted to critical assessment on a regular basis, in reference to the objectives and the terms of the contracts made with the communities concerned. Anthropological skills are then essential to translate the information stemming from our scientific system and adapt it to the mode of thinking of native communities.

Adapting scientific data back to the field

16Simplified scientific monographs of medicinal plants (botany, chemistry, toxicity, properties, directions and recommendations for use) are then drafted. These cards make up a scientific database of great value that can be regarded as a link between traditional forms of medicine and modern medicine.

17On the basis of the information collected on these index cards and the knowledge recorded about the representation modes of the communities, we manufacture educational aids and protocols for the preparation of pharmaceutical simples. These are adapted to the community's classification system and their way of life.

18Consulting communities and local health care officers makes it possible to target the specific pathologies to be treated and then design a strategy for prevention and health care. This leads to training courses on the manufacturing of medical simples (tinctures, syrups, ointments, soaps, etc.).

Setting up pilot structures for sustainable development

19The gardens are places to produce vegetable matter, maintain plant nurseries, organise training courses and disseminate information about the use of species appropriate for medicinal applications and for animal for human consumption.

20Courses are organised to train local health care officers who will, among other tasks, look after and promote the gardens. Mothers can take part in garden work and, on that occasion, receive information on prevention measures and elementary medical care.The Association supervises the management of central and community gardens and provides guidance to the leaders and persons in charge. Plants are processed into simple drugs (dried and in packaged) in manufacturing laboratories.

21Most of the community garden production is used to manufacture medical products prepared according to galenic procedures. Drugs, such as expectorant syrups, antispasmodic or anti-parasi- tical drugs, anti-inflammatory or antifungal medicines, ointments and balms are produced. All the stages of the various processes are supervised with great care; moreover their quality is tested in the laboratories of the Faculty of Pharmacy at the University of Lille, France. These remedies are made available to the community in communal pharmacies at reasonable prices. They are sometimes displayed next to essential drugs. Consequently, health care officers and patients can decide which type suits them best. Selling the products generates some surplus value that comes in very handy to eke out the income of the health care officers who are no longer tempted to emigrate to larger farms and remain in the service of community.

22The development of gardens must be complemented with a training course in agronomy so that the effort become a part of a sustainable agricultural development programme. Training courses to grow vegetables in biological agriculture have been organised to spread the idea that a healthy and balanced diet is a necessary corollary to efficacious health care.

Beneficiaries and target groups

23Calls for an intervention generally come from local rural communities. The request is then transferred by N.G.O.s with which the association is signed an agreement ("Pharmaciens sans frontières" Savoie Section, "Vétérinaires sans frontières" - from France and Spain, various dioceses, etc.). The projects to create gardens, the training courses for medicinal plant use, the implementation and management of community pharmacies, and the development of local agriculture are actions that are organised with the assistance of teams including health care officers, women, midwives, agricultural developers, farmers. The result of courses is in all cases monitored after completion by a follow-up system. Village and family communities are the main beneficiaries of all these projects.

24As far as health care is concerned, most interventions are tailored to meet the needs of health care officers people whose duty is then to disseminate the information to the village residents. These officers are in full time service for the community, so that diagnostic and therapy is offered without delay; this service is also made possible by the community pharmacy network which generate sufficient revenue to keep their activity going. The mothers - who are considered as the first link in the chain of health care persons - receive information on prevention measures and primary health care. The training courses induce them to create their own gardens with medicinal plants, so that remedies are at all times at hand.

25The training courses designed for traditional midwife groups offers scientific support and reinforces traditional knowledge. As for developers specialised in cattle breeding, using plants for veterinary treatment is a guarantee for autonomy, enhanced status and efficient help in their action for the sake of breeders. Furthermore, the association provide selected fodder plant seeds for animal feed.

26Concerning agriculture, the training courses given by Jardins du Monde aim at improving family food-producing systems, in order to, first, enhance food quality and diversity - which are a guarantee for good health - and second, raise the household income by ensuring a production of vegetables - which are generally modest - while enabling farmers to sell some products on the local markets.

27Scientific support is necessary for all these beneficiaries, it is even essential for the N.G.O.s which serve as a platform for the training courses and the appraisal of projects. Concerning health care, developing medicinal plants can be done only under the control of a scientific organisation: medicinal plant-based therapies must be safe, appropriate and effective.

Conclusion

28The purpose of this presentation was to describe a way to conceive the feedback process that can be applied to scientific data on medicinal plants. Our effort concerns primarily basic health care initiatives (in particular diarrhoea, acute breathing infections, helminthiasis, amoebiasis and skin affections) and the type of care provided by midwife; they also follow up the development of research in relation to pathologies such as malaria and leishmaniosis. In that respect, the association work in cooperation with scientific teams such as Institut de Recherche et de Développement (in Paris, France) in order to supply the partners doing fieldwork with suitable medication.

29There is still enormous research work to be done in tropical pathologies, an area which has hitherto been neglected by scientists, hoping that it will help us find new solutions that can be adapted to the people's social and economic requirements. This research work can be successful only if it is conducted in a spirit of close collaboration and partnership between scientific competence in the North and traditional knowledge in the South.

Bibliographie

References

NICOLAS J.P. (1999) Plantes médicinales des Mayas Kiché du Guatemala, Paris, Ibis Press, 310 p.

NICOLAS J.P. (1995) De l'importance de l'étude des classifications indigènes au retour de l'information vers les populations concernées. Exemple du Kiché in Bellakhdar et al (eds) La pharmacopée arabo-islamique, hier et aujourd'hui, Rabat - Metz, Al Birunyia, SFE, IEE, 289-302.

Auteur

Jardins du Monde Meilh Ar Groaz 291 90 Brasparts - France Faculté de Pharmacie, Université de Lille II BP 83 59006 Lille - France

© IRD Éditions, 2002

Conditions d’utilisation : http://www.openedition.org/6540