全 文 ：Maintaining Resources for Traditional Medicine: A Global
Overview and a Case Study from Buganda (Uganda)
Alan Hamilton1, Yildiz Aumeeruddy鄄Thomas2
(1 Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, China; 2 Centre d忆 Ecologie Fonctionnelle
et Evolutive, UMR 5175, CNRS, 1919 route de Mende, F鄄34293 Montpellier Cedex 5, France)
Abstract: Presentations at a session of the 13 th Congress of the International Society for Ethnobiology ( ISE, May
2012) provided a global overview of ‘maintaining resources for traditional medicine爷. Two themes received special
attention, transmission of traditional medical knowledge and conservation of medicinal plants. The consensus at the
well鄄attended session was that traditional medicine can play a useful role in primary healthcare, including for chronic
complaints and spiritual problems. However, the use of traditional medicine is declining in many places. Some prac鄄
tical efforts at maintaining resources for traditional medicine are described. A case study for Buganda (Uganda),
given in greater detail, shows that progress in maintaining resources for traditional medicine can be impeded by
forces not directly related to its intrinsic merits. The value of making efforts to maintain resources for traditional med鄄
icine is discussed in relation to its contribution to biocultural conservation, much needed today to counter鄄balance
the homogenising and ecologically destabilising influences of globalisation.
Key words: Traditional medicine; Biocultural conservation; Buganda
CLC number: Q 948. 12摇 摇 摇 摇 Document Code: A摇 摇 摇 摇 摇 Article ID: 2095-0845(2013)04-407-17
Abbreviations: CIDA: Canadian International Development Agency; FAO: Food and Agricultural Organization of
the United Nations; IMF: International Monetary Fund; ISE: International Society for Ethnobiology; NFA: National
Forest Authority (Uganda); NGO: Non鄄governmental organisation; PROMETRA: Promotion de la M佴dicine Tradi鄄
tionnelle; RBG: Royal Botanic Gardens, Kew; TAWG: Tanga Aids Working Group; UK: United Kingdom; US:
United States of America
Introduction
Indigenous knowledge embodied in more tradi鄄
tional societies constitutes a resource still useful for
the development of the same societies today, as well
as for society generally. A large part of this know鄄
ledge can be about plants. Almost all food plants
currently grown were originally developed through
the powers of observation and experimentation of our
ancestors. Plants are the principle ingredients in tra鄄
ditional medicines with evidence that many are effi鄄
cacious ( Holmstedt and Bruhn, 1995; Leaman et
al., 1995; Lewis, 2003 ). However, traditional
medicine is concerned with much more than herbal
remedies. It tends to be more holistic in its approach
to healing than is the case with western medicine,
based on recognition of the oneness of body, mind
and spirit, and the close ties existing between the
health of the individual and the social and natural
worlds. The practices and philosophies of traditional
medicine carry important insights into the meaning of
healthy living, beyond just the treatment of disease.
摇 摇 This paper contains a summary of points made
in presentations at a session on Maintaining Re鄄
sources for Traditional Medicine held in May 2012 as
part of the 13 th Congress of the International Society
for Ethnobiology (ISE) at Montpellier (France). It
also includes a more detailed account of a particular
case (not discussed at ISE) familiar to one of the
植 物 分 类 与 资 源 学 报摇 2013, 35 (4): 407 ~ 423
Plant Diversity and Resources摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 DOI: 10. 7677 / ynzwyj201313006
Received date: 2013-01-14; Accepted date: 2013-05-07
Author for correspondence; E鄄mail: alanchamilton@ btinternet. com
authors (AH)-Buganda in Uganda. The well atten鄄
ded ISE session provided a glimpse of the worldwide
situation, while the Buganda example allows a more
detailed exploration of some of the issues.
Global overview
Two sub鄄themes were selected for special atten鄄
tion at ISE, transmission of traditional medical
knowledge and conservation of medicinal plants.
These themes are interconnected. Continuing trans鄄
mission of traditional medical knowledge will depend
greatly on continuing use, which, in turn, will de鄄
pend on the continuing availability of the plants. For
its part, conservation of plant species will depend
greatly on the attitudes of people living close to
where the plants grow鄄liable to be more positive to鄄
wards plant diversity if this is useful to them.
Twenty鄄nine presentations and strong participa鄄
tion at ISE provided an opportunity for comparisons
between different parts of the world (Fig. 1). ISE is
a scholarly organisation with an ethical calling based
on recognition of the close relationships that exist be鄄
tween cultural and biological diversity and the im鄄
perative of fostering biocultural diversity for the ben鄄
efit of future generations and the planet. The re鄄
search described at the session varied along a spec鄄
trum from more ‘objective academic爷 to more ‘ap鄄
plied participatory爷.
Use of traditional medicine and medicinal plants
today
The term ‘ traditional medicine爷 refers to local
to regional medical traditions known or believed to
be of long鄄standing duration. Sub鄄categories include
scholarly medicine ( with written traditions, inclu鄄
ding pharmacopoeias, and institutionalized ways of
training doctors), folk medicine (orally transmitted
and associated with households, communities or eth鄄
nic groups) and shamanistic medicine (with a strong
spiritual element and which can only be applied by
specialist practitioners鄄shamans) (Pei, 2001, 2002).
Presentations at ISE made it clear that traditional
medicine is further identified by what it is not, that
Fig. 1摇 Locations of field sites of work presented at a session on ‘Maintaining Resources for Traditional Medicine爷, part of the 13 th
Congress of the International Society for Ethnobiology held at Montpellier (France) in May 2012
The numbers refer to presentations by the following: 1. Kariuki and Kibetl; 2. Giovannini; 3. Ouarghidi, Abbad and Martin; 4.
Akobirshoeva and Oudenhoven; 5. Byg, Theilade and Larsen; 6. Gonz佗lez, Theilade and Soerensen; 7. Hoeffel et al. ; 8. Mc鄄
Carter; 9. Ellen and Puri; 10. Carri佼 and Vall侉s; 11. Montanari; 12. P佼voa and Farinha; 13. Bista et al. ; 14. Frausin et al. ;
15. Offringa; 16. Blaikie and Gurmet; 17. Nicolas; 18. Ghimire and Bista; 19. King; 20. Mooney; 21. Mtullu Kasese, Malebo
and Maharaj; 22. P佼voa and Farinha; 23. Glenn; 24. Hamilton; 25. Savajol and Vanny
804摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 植 物 分 类 与 资 源 学 报摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 第 35 卷
is it is not ‘western爷 medicine (variously called al鄄
lopathic, biomedicine, conventional or modern in
the presentations). The dichotomy between tradi鄄
tional and western medicine proved to be a useful
one for discussing many issues, such as the extent of
use of traditional versus western medicine, the relative
values of traditional versus western medicine for treating
specific medical conditions and whether and how prac鄄
titioners of traditional and western medicine can collab鄄
orate. While the general impression of western medi鄄
cine conveyed at the session was of a more or less stan鄄
dardised international system, in fact (as actually de鄄
livered), it can fall far short of any ideal. There can
be severe shortages of doctors, drugs and other es鄄
sential facilities, and drugs can be prone to misuse,
as found in rural Ecuador (Giovannini, 2012).
Plants contribute to both traditional and western
medicine in major ways, even more so if their wider
roles in maintaining health are included, such as
their dietary contributions to food. However, there
are also contrasts, especially with regard to folk
medicine, with implications for approaches to the
conservation of medicinal plants. Traditional medi鄄
cine tends to use locally growing plants, often col鄄
lected directly by household members or herbalists.
In contrast, western medicine uses comparatively few
species (whether used in the preparation of pharma鄄
ceutical drugs or standardised herbal preparations)
and these tend to be marketed widely as branded
products with their botanical ingredients potentially
originating from anywhere. Collecting wild medicinal
plants to feed this market is part of a major industrial
process. The harvesters and local traders may have
little idea of the final destiny of the plant materials
that they are supplying, as reported for Morocco
(Ouarghidi et al., 2012). Approaches to conserva鄄
tion of medicinal plants in such a context are much
the same as those used to combat threats to any over鄄
harvested wild plant resource in commercial demand.
Several presenters described the extent of pres鄄
ent鄄day use of medicinal plants in traditional medi鄄
cine. Widespread continuing use of medicinal plants
was reported for Kenya (Kariuki and Kibet, 2012)
and the Pamirs, Tajikistan ( Akobirshoeva and
Oudenhoven, 2012), while their use is more exten鄄
sive in remoter rural communities in Ecuador and
Nepal compared with those closer to urban centres
(Byg et al., 2012; Gonz佗lez et al., 2012). Rela鄄
tive poverty is mentioned as a major reason for choo鄄
sing traditional rather than western medicine in Bra鄄
zil (Hoeffel et al., 2012), but no such connection
was found in a study in Nepal (Byg et al., 2012).
Several presenters provided information on the
patterning of medical knowledge within and between
communities, carrying implications for those con鄄
cerned with fostering biocultural diversity. Strong
patterning was reported for Vanuatu ( McCarter,
2012; McCarter and Gaving, 2011), while, in In鄄
donesia, a very high degree of species specificity
was found in five communities studied, three on the
island of Seram (Moluccas) and two on Borneo (El鄄
len and Puri, 2012). Communities even on one is鄄
land were found to use remarkably different medici鄄
nal floras. However, more detailed analysis revealed
that species used to treat everyday medical needs
tended to be relatively widely used. These are typi鄄
cally domesticated or cultivated plants or else found
in disturbed areas, and their conservation was con鄄
sidered not to be of any special concern. In con鄄
trast, higher proportions of species used at only one
or a few sites were found to be forest plants, often
with closely related species substituting for one an鄄
other between communities. The conclusion reached
was that this particular ‘ resource pool爷 should be
the one at which efforts at species鄄specific conserva鄄
tion should be directed and where the loss of indige鄄
nous knowledge is most likely. Another contribu鄄
tion, on Mallorca ( Spain ) ( Carri佼 and Vall侉s,
2012a), presented a new statistic for prioritizing
species of medicinal plants. This ‘ Index of Medici鄄
nal Importance爷 ( MI) is calculated as the total
number of use鄄reports cited for a specific use鄄catego鄄
ry, divided by the total number of plant taxa used for
that condition (Carri佼 and Vall侉s, 2012b).
9044 期摇 摇 摇 Alan and Yildiz: Maintaining Resources for Traditional Medicine: A Global Overview and a Case Study …摇 摇
Studies in Mallorca and the Pamirs revealed
that substantial parts of their medicinal floras are
similar to those of other regions, in the former case
with other Catalan鄄speaking areas and with the Med鄄
iterranean generally ( Carri佼 and Vall侉s, 2012b)
and in the latter case with neighbouring Afghanistan
(Akobirshoeva and Oudenhoven, 2012). However,
there are specific local elements in both instances,
suggesting long鄄standing indigenous traditions. Re鄄
search at two sites in south鄄east Brazil and among
ten communities in Colombia revealed notably high
percentages of exotics (47% and 55% of 181 and
80 identified species respectively) (Gonz佗lez et al.,
2012; Hoeffel et al., 2012). This is probably relat鄄
ed to immigrants, especially from Europe, bringing
their ethnobotanical knowledge and medicinal plants
with them.
Declines in traditional medicine and medicinal plants
Presentations for various parts of the world not鄄
ed a decline in the use of traditional medicine. This
was universally seen as related to global cultural and
socio鄄economic change, for instance greater contact
between rural societies and the outside, growing ur鄄
banisation, increasing availability of western medi鄄
cine and declining interest in indigenous traditions
by the young (Carri佼 and Vall侉s, 2012b; Giovanni鄄
ni, 2012; Hoeffel et al., 2012). Reduced family
and community cohesion was mentioned as a critical
factor in Morocco ( Montanari, 2012, 2013 ). A
graph of perceptions of loss of traditional ecological
knowledge for Vanuatu shows a major decline dating
back to at least 1900 (McCarter, 2012). Tradition鄄
al medicine in Kenya is reported to be threatened by
a decline in traditional cultural practices, such as
marriage and initiation ceremonies, at which knowl鄄
edge was traditionally passed down between the gen鄄
erations (Kariuki and Kibet, 2012). The precarious
state of traditional medicine in Mallorca and southern
Portugal is demonstrated by the high average age of
those interviewed in studies of the use of medicinal
plants -77 and >50 years old respectively (Carri佼
and Vall侉s, 2012b; P佼voa and Farinha, 2012b).
Despite this, one of the presenters pointed out that
Europe still offers outstanding opportunities for stud鄄
ies of traditional medicine, urging more European
ethnobotanists to undertake research nearer to home
(Carri佼 and Vall侉s, 2012b).
A major threat to the survival of some medicinal
species ( noted for Brazil, Kenya, Morocco, Nepal
and Tajikistan) is the unsustainable harvesting of
medicinal plants for the commercial market; habitat
destruction and climate change were among other
threats reported ( Akobirshoeva and Oudenhoven,
2012; Bista et al., 2012; Hoeffel et al., 2012;
Kariuki and Kibet, 2012; Ouarghidi et al., 2012).
Depopulation of the countryside, combined with a
lack of interest among the young in traditional medi鄄
cine, is regarded as a major cause of endangerment
to medicinal species and landraces in Portugal
(P佼voa and Farinha, 2012b). This conclusion was
reached after careful documentation of the fate of
populations of three plant taxa used in food season鄄
ing in traditional Alentejo dishes. A baseline survey
in 2002-2003 and a repeat survey at the same sites
in 2011 revealed greater loss of cultivated than wild
populations (33% versus 11% ). The causes of loss
of the populations could be specified case鄄by鄄case
(very unusual in studies of medicinal plant endan鄄
germent). The major reason for decline in the culti鄄
vated populations was the death or out鄄migration of
those elderly people who formerly cared for the
plants. Causes of loss of wild populations were found
to be habitat conversion, the mechanisation of agri鄄
culture and the use of herbicides.
One reason for concern about the loss of indige鄄
nous medical knowledge is because this forecloses
opportunities for using such knowledge for the deve鄄
lopment of new pharmaceutical drugs or formularised
herbal preparations. Where local traditions of indi鄄
genous medical knowledge are critically endangered,
as reported for parts of Brazil and Portugal, then
there is urgency in documenting indigenous medical
knowledge before it is lost ( Carri佼 and Vall侉s,
2012b; Hoeffel et al., 2012).
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Two presenters gave examples of research aimed
at discovering new drugs based on traditional knowl鄄
edge. One was a bibliographic study to identify po鄄
tential sources of anti鄄malarial drugs in the plant
family Annonaceae (Frausin et al., 2012); the oth鄄
er was research with traditional doctors in Thailand
to discover leads for the development of drugs to
treat mild cognitive impairment of the elderly (Of鄄
fringa, 2012). The former study required no legal
or ethical clearance because the information used
was already in the public domain, while the later re鄄
quired meticulous preparation involving complicated
processes of applying for research and ethical clear鄄
ance from a variety of bodies before field work could
begin. The results of the Annonaceae study were
that some species have indeed been used to treat
symptoms of malaria, that the bark is the plant part
most used and that the genera Annona and Xylopia
have the highest number of species with records of
use. The study on leads for cognitive therapy drugs
resulted in the identification of one particularly
promising species, whose scientific identity is cur鄄
rently not being divulged to protect intellectual prop鄄
erty rights.
Transmission of traditional medical knowledge
Mechanisms for the transmission of traditional
medical knowledge were investigated among a Berber
community in the High Atlas Mountains of Morocco
(Montanari, 2012). It was found that family con鄄
nections were major ways that such knowledge is
passed on to the younger generation, women being
the vectors of transmission in the home and garden,
and men mostly in the mountains and at the river.
Findings such as this can have practical implications
for the development of national health systems in so鄄
cieties of all types. Western medicine has made re鄄
markable advances over recent years in treating some
medical conditions, but the standard of healthcare in
western societies also has deficiencies, some related
to the inadequate transfer of health鄄giving knowledge
and practices between generations and within com鄄
munities.
Several presentations dealt with mechanisms of
knowledge transmission and legitimization in Sowa
Rigpa (Tibetan Medicine) (Fig. 2) (Bista et al.,
2012; Blaikie, 2011; Blaikie and Gurmet, 2012;
Nicolas, 2012). Sowa Rigpa is a scholarly medical
tradition associated with specialist healers ( am鄄
chis), whose knowledge and practices are transmit鄄
ted from master to pupil along lineage lines and also
in formal medical schools. Education in Sowa Rigpa
involves a process of listening to a teaching, memo鄄
rizing the teaching using memorizing tools such as
‘trees of medicine爷 in order to meditate on it ( that
is, to become accustomed to it and to incorporate the
knowledge within wider religious concepts), under鄄
standing the teaching and then putting it into prac鄄
tice (Nicolas, 2012). Intuitively, this would seem
to have similarities ( though less formalised) to the
ways in which healthcare knowledge and practices
are transmitted within families, thus providing a spe鄄
cific instance where research into the transmission of
traditional healthcare knowledge could have useful
lessons for wider society.
Fig. 2摇 An amchi (traditional doctor of Sowa Ripa, Tibetan Medicine)
reading the pulse of a village in a Ladakhi village (India). Sowa Ripa
is a scholarly system of traditional medicine, with traditions of
healing passed down between amchis along lineage lines.
Photo: Alan Hamilton 2006
The future of traditional medicine
Many presentations dealt with the future of tra鄄
ditional medicine. From the perspective of the ISE,
1144 期摇 摇 摇 Alan and Yildiz: Maintaining Resources for Traditional Medicine: A Global Overview and a Case Study …摇 摇
the continuing existence of systems of traditional
medicine tied to local biodiversity is a powerful rea鄄
son for wishing such traditions to continue. Howe鄄
ver, not all ethnobotanists accept all aspects of tradi鄄
tional medicine uncritically and, in any event, sys鄄
tems of traditional medicine are not static phenome鄄
na, but continuing to change. Amchis in Nepal are
researching substitutes for endangered species of me鄄
dicinal plants (Ghimire and Bista, 2012). One rea鄄
son for encouraging support for traditional medicine,
mentioned at ISE, is its importance for delivering
healthcare in places where replacement by western
medicine is considered unlikely ( Hoeffel et al.,
2012; Kariuki and Kibet, 2012). Encouraging the
continuing use of traditional medicine can help re鄄
duce dependency on external resources and safe鄄
guard against the misuse of pharmaceuticals drugs
(Giovannini, 2012).
Decision鄄making in healthcare is a matter not
only for planners of national medical services, but
also for individuals. It is common nowadays for peo鄄
ple to have at least some access to both traditional
(or at least ‘alternative爷) and western medicine. A
survey of 62 households in a Moroccan community,
involving monthly recording over a 6鄄month period,
revealed a high degree of rationality in choices made
by those seeking treatment (King, 2012). By ra鄄
tionality was meant that the decisions reached were
found to be in close agreement with the predictions
of a decision鄄making model earlier advanced (Young
and Garro, 1982). Elements of this model include:
(1) if the illness is not serious, then the cheapest
choice is generally taken; (2 ) for milder condi鄄
tions, self鄄treatment is the usual choice, but, if this
is not known, then a healer is usually consulted;
(3) if the illness is serious, then the ‘probability of
a cure爷 becomes a significant factor-in most cases a
physician is consulted, with alternatives ( such as
healers) only approached if this is unsuccessful.
Some presenters mentioned specific medical
conditions for which traditional medicine tends to be
preferred ( Akobirshoeva and Oudenhoven, 2012;
Byg et al., 2012; Carri佼 and Vall侉s, 2012b; P佼voa
and Farinha, 2012b). There is general agreement
that herbal medicine is often sought for milder or
chronic complaints, including digestive disorders.
Herbal medicine can be seen as useful for correcting
imbalances caused by modern diets and lifestyles.
Traditional medicine has a major role to play in trea鄄
ting spiritually鄄related diseases, which typically have
strong associations with local culture and language.
The lack of a common language between patients and
physicians can be a barrier to effective treatment by
western medical practitioners, as reported for Moroc鄄
co (King, 2012). The consensus at the session was
that traditional medicine can often make a valuable
contribution to national healthcare systems, especial鄄
ly at the primary level.
According to one presentation, government re鄄
cognition would be useful for Sowa Rigpa in Nepal,
because this would lead to government support (cur鄄
rently minimal) and reduced dependency on foreign
sponsorship (Bista et al., 2012). Currently, Ayurve鄄
da is officially recognised in Nepal, but not Sowa
Rigpa. Official recognition of traditional medicine
was also considered desirable for Kenya, where a
draft ‘National Policy on Traditional Medicines and
Medicinal Plants爷 exists, but has yet to be enacted
(Kariuki and Kibet, 2012). In contrast to Nepal,
Sowa Ripa has been officially recognised in India,
though only recently (2010), thus joining the al鄄
ready officially recognised and long鄄established me鄄
dical systems of Ayurveda, Siddha, Unani and Yoga,
as well as more recently arrived Homeopathy. Howe鄄
ver, concerns were expressed by one presenter
(Blaikie) during a talk on Ladakh (India) (Blaikie
and Gurmet, 2012) that official recognition could
result in a great expansion of industries producing
standardised herbal products, marketed through
branding and sold internationally. There is a danger
of greatly increased pressure on wild鄄collected and
already threatened species of plants, many difficult
to cultivate in the demanding Himalayan environ鄄
ment. The price of medicines is predicted to rise to
214摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 植 物 分 类 与 资 源 学 报摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 第 35 卷
levels beyond the reach of those local people whose
primary healthcare needs are most acute and who
currently depend upon traditional medicine. More
than this, official recognition is seen as a threat to
the maintenance of biocultural diversity through se鄄
vering links between practitioners, plants and the
practice of pharmacy, through replacing local medi鄄
cal lineages with standardized institutionalised train鄄
ing and undermining the pharmaceutical adaptability
and local experimentation inherent in traditional
medicine.
Several efforts to promote the transmission of
traditional medical knowledge at community鄄level
were reported. In Australia, the Land and Learning
Program of Tangentyere Council has been promoting
the passing on of traditional knowledge about plant
medicines for 13 years (Mooney, 2012). A very ef鄄
fective educational formula has been found, invol鄄
ving elders and indigenous teachers taking students
on bush trips to teach them how to collect and pre鄄
pare medicines, with teachers taking photographs of
the activities. These trips are followed up by using
the photos to prompt students in the classroom to
write accounts of their experiences in their own lan鄄
guages. Booklets are produced containing the pho鄄
tos, as well as typed versions of the students爷 ac鄄
counts, the booklets then serving as teaching re鄄
sources in schools and records of indigenous knowl鄄
edge. Another case is Lo Kunphen Mentsikhang and
School in Mustang (Nepal) providing education in
local healthcare and medicine鄄making for pupils of
Sowa Rigpa (Bista et al., 2012). Two avenues have
been taken to support traditional medicine in Vanua鄄
tu, a ‘bottom鄄up爷 approach involving locally鄄based
‘traditional units爷 around the country and a ‘ top鄄
down爷 approach, which includes the development of
curriculum modules in vernacular languages for
schools (McCarter, 2012). In Ecuador, research
aimed at documenting medicinal species used by the
indigenous Achuar people was followed by the pro鄄
duction of a manual on medicinal plants for use in
primary health care (Giovannini, 2012). Originally
intended for 15 communities, this manual proved so
popular that it has now been distributed within all 72
Achuar communities in Ecuador and by the Ministry
of Health.
Activities aimed at developing effective working
relationships between traditional and western medi鄄
cine were described by some presenters. Traditional
doctors can be open to the incorporation of elements
of western medicine in their practices, as described
for Sowa Rigpa in Nepal, where consideration is be鄄
ing given to their inclusion in the training of practi鄄
tioners ( Bista et al., 2012 ). Phytochemical and
pharmacological studies of some major medicinal
plants used in traditional medicine are being carried
out in Kenya, the results of which are considered
likely to be useful for providing more effective treat鄄
ments in traditional medicine (Kariuki and Kibet,
2012). In Tanga District ( Tanzania), the Tanga
Aids Working Group (TAWG) has been developing
a dual system of traditional and western medicine for
the treatment of patients presenting with HIV / AIDS.
Successful collaboration is reported, marrying tradi鄄
tional and western systems of knowledge and invol鄄
ving three parties-western鄄trained doctors, tradition鄄
al doctors and research scientists ( Mtullu et al.,
2012). Field and in vitro analyses have been used
to determine the efficacy of herbal treatments, with
good results reported. The life expectancies of some
patients with HIV / AIDS has been prolonged by 5 -
10 years.
Conservation of medicinal plants
Some presenters described community鄄based
conservation practices, referring to measures taken
by individuals or communities on their own initiative
that contribute to the conservation of medicinal
plants. Practices reported include the gifting of
seeds and cuttings between neighbours in Alentejo
(Portugal), which has saved some populations from
disappearing (P佼voa and Farinha, 2012a), the de鄄
velopment of substitutes for endangered species by
amchis in Nepal (Ghimire and Bista, 2012) and the
protection of populations of a high鄄value wild medici鄄
3144 期摇 摇 摇 Alan and Yildiz: Maintaining Resources for Traditional Medicine: A Global Overview and a Case Study …摇 摇
nal species close to villages in the High Atlas of Mo鄄
rocco ( Ouarghidi et al., 2012). The latter study
further reported various adaptive management mea鄄
sures taken to help conserve the resources. Some
collectors harvest only at 5鄄year intervals, allowing
the roots to reach a large size and permitting seed to
spread, and some replant small pieces of freshly har鄄
vested roots, which they subsequently care for by
watering. Such protection has its limitations, be鄄
cause it was also reported that some collectors har鄄
vest the plants before the optimal harvest time to lim鄄
it loss through poaching.
Some presenters reported deliberate attempts to
promote the conservation of medicinal plants. These
included educational programmes, for instance inter鄄
pretative walks to observe medicinal plants in Brazil
(Hoeffel et al., 2012), and ex situ measures, most鄄
ly involving the growing of medicinal plants in gar鄄
dens ( Bista et al., 2012; Glenn, 2012; Kariuki
and Kibet, 2012). ‘Sacred Seeds爷 is the name of
an expanding international network of gardens, cen鄄
tred on the William L. Brown Center of Missouri Bo鄄
tanical Garden ( USA ), dedicated to preserving
biodiversity and plant knowledge, especially con鄄
cerning medicinal plants. Applications for inclusion
in the network were invited.
An international programme of action鄄orientated
research was described in one presentation, the aim
being to find answers to the question ‘How can com鄄
munities best conserve their medicinal plants?爷
(Hamilton, 2011). This work involved an interna鄄
tional conservation charity ( Plantlife International)
forming partnerships with botanical institutes or
NGOs in six countries in East Africa and the Hima鄄
layas, which, in turn, worked with local communi鄄
ties to try and produce practical results (Fig. 3). A鄄
nalysis of the results of twelve field projects, com鄄
bined with lessons learnt during four events to share
experiences, led to the construction of a model of
best practice. The model consists of three social
groups (community groups, project teams and policy
makers) and suggestions for actions by each group
and for the forms of relationships between them. The
existence of community groups interested in improving
Fig. 3摇 View of Ludian, Yunnan Province, China. This is a project site of the Kunming Institute of Botany, Chinese Academy
of Sciences, in association with Plantlife International. Participatory research was undertaken to find ways in which the commu鄄
nity could conserve their medicinal plants. The project included support for the establishment of a community organisation, the
Ludian Medicinal Plants Conservation and Development Association, and two community conservation areas in parcels of forest
rich in medicinal plants (Pei et al., 2010) . Photo: Alan Hamilton 2008
414摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 植 物 分 类 与 资 源 学 报摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 第 35 卷
the management of medicinal plants is key. The prin鄄
cipal motivations of the groups involved in the pro鄄
gramme were found to be fairly evenly divided be鄄
tween concern to maintain resources for local health鄄
care and concern for on鄄going financial income based
on the sale of sustainably collected medicinal plants.
The case of Buganda (Uganda)
Introduction: Buganda and Uganda
Traditional medicine varies in detail along with
the diversity of more traditional societies worldwide
and its future will be influenced by diverse local po鄄
litical, economic and cultural variables. The case of
Buganda in Uganda is taken as an example here for a
more detailed exploration of issues influencing its
maintenance. Uganda is a culturally and ecologically
diverse country with 42 indigenous languages belon鄄
ging to 4 language families and with natural vegeta鄄
tion ranging from tropical forest to semi鄄arid savan鄄
nah. Attention is accordingly directed at just one of
the ethnic groups, selected for its relative familiarity
to one of the authors (AH). This ethnic group is the
Baganda, whose land is Buganda, language Luganda
and with associated attributes known as Kiganda.
Table 1 in Annex 1 provides some facts and
health indicators for Uganda. Equivalent data are
given for the UK, enabling comparison with an eco鄄
nomically prosperous country with a well developed
national healthcare system based on western medi鄄
cine. The UK is especially pertinent to Uganda be鄄
cause it was the occupying power during the age of
European imperialism, guided the early development
of its national health system and continues to hold
influence. Table 1 shows that Uganda is a financially
poor country with scant provision of western medical
services, but many traditional doctors (though tradi鄄
tional medicine is not officially recognised). Rural
people tend to have a good knowledge of their local
plants, whether wild or cultivated, related to close
livelihood dependency. Social security is provided
overwhelmingly by the family, not the state, and re鄄
ligion, with its various connections to healthcare,
plays a prominent part in many people爷s lives. A鄄
chievement of good governance has proved to be an
intractable problem in Uganda, as indicated by an
almost complete failure to transfer power constitu鄄
tionally, high levels of perceived corruption and >
600 000 people killed in internal armed conflict
since 1962.
Traditional Kiganda healthcare and an effort to
foster traditional medicine
The following passage by Dr. Adam Kimala, a
surgeon (in the western medicine tradition) provides
a glimpse into the practice of traditional healthcare
in Buganda, as still widely practiced today (Kima鄄
la, 2005): “Parents discovered long ago that in or鄄
der to keep the culture of a society, the children
must be taught how to keep it and pass it over to the
next generation. The mothers are the primary and
most effective teachers. Once a woman is pregnant,
she is prepared to be ready to give birth and breast
feed her child. They get a midwife called a muzaal鄄
isa. . . who collects different herbs for the expectant
mother to bathe, drink and steam. The midwife psy鄄
chologically prepares the expectant mother to be
ready to deliver. By the time she delivers the baby,
she is already given all the tips of breastfeeding,
washing and nurturing the new born baby. The
mother is responsible for the growth and behaviour of
the child. When the child behaves badly, the moth鄄
er is squarely blamed. Fathers are known to relate
well with only well behaved children. Three cardinal
pillars are inculcated in Baganda children; these are
nsonyi, i. e. to be ashamed of wrong鄄doing, ob鄄
wesigwa, being trustworthy, and buntubulamu, a
special human behaviour in inter鄄personal relation鄄
ships not found in the western world. 冶
This passage illustrates the fundamental impor鄄
tance of tradition in Kiganda traditional healthcare,
the major part played by the social environment in
fostering health and the emphasis placed on ascribed
social roles for determining how individuals should
behave. The herbs mentioned are used together in a
concoction called ekyogero, believed to provide
5144 期摇 摇 摇 Alan and Yildiz: Maintaining Resources for Traditional Medicine: A Global Overview and a Case Study …摇 摇
physiological and spiritual protection to the child.
The emphases given to the social and spiritual envi鄄
ronments in traditional healthcare practices in
Buganda place people in a somewhat different psy鄄
chological position with respect to healthcare treat鄄
ments than in the west. Public discourse on health鄄
care in the UK tends to emphasise the rights of the
individual to receive state鄄supplied healthcare ser鄄
vices, with less attention to the duty of individuals to
care for themselves and others.
PROMETRA鄄Uganda is a non鄄governmental or鄄
ganisation engaged in practical efforts to maintain re鄄
sources for traditional medicine ( PROMETRA,
2013 ). Founded in 2000, PROMETRA runs a
school for traditional doctors at Buyijja, a rural loca鄄
tion 60 km from the capital Kampala. Around 100-
150 traditional doctors attend classes once a week to
exchange knowledge on their practices (Fig. 4). A
three鄄year course covers identification of plants and
preparation of medicines, with five specialisations
offered in the final year-herbalism, traditional birth
attendance, traditional bone鄄setting, traditional
mental treatments and spiritualism. A total of 861
traditional doctors had received training at the school
by 2013. PROMETRA readily cooperates with scien鄄
tific organisations ( for instance, supplying samples
of herbal medicines for laboratory testing) and with
the western medical sector ( for instance, encoura鄄
ging patients who cannot be treated by traditional
medicine to visit western clinics). Traditional heal鄄
ers have been found to be open to collaboration with
the western medical sector in this part of Uganda
(Lwanga, 1992). Demonstrations of fish鄄farming,
bee鄄keeping, organic farming and forest restoration
at Buhijja encourage villagers to adopt these health鄄
supporting practices. A herbal processing plant is
being constructed to produce packaged medicines,
thus serving a wider public and providing an income
for local farmers through an out鄄growers爷 scheme.
PROMETRA recognises that poverty is a major un鄄
derlying cause of ill鄄health in this region. PROME鄄
TRA has no ethnic or religious affiliation (but many
of the students are practising Christians or Mus鄄
lims), but is necessarily strongly influenced by the
culture of that part of the country in which it is situ鄄
ated, that is Buganda.
Fig. 4摇 Forest School of PROMETRA鄄Uganda at Buhijja. This is a second year class, learning about
preparation of herbal medicines. Photo: Alan Hamilton 2011
614摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 植 物 分 类 与 资 源 学 报摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 第 35 卷
Problems of access to medicinal plants and of
forest governance
One of the challenges faced by traditional doc鄄
tors around Buhijja is a growing shortage of medici鄄
nal plants, related in part to the destruction of forest
and other more natural habitats. The rate of forest
loss in Uganda at 2. 72% per annum (FAO, 2010)
is one of the highest in the world. Forested land is
being taken for agriculture and trees are being cut
for the manufacture of bricks and charcoal. As a re鄄
sponse, PROMETRA launched a plant nursery at
Buhijja in 2010 to grow seedlings of endangered me鄄
dicinal species, with the intention of distributing
them to surrounding villages through a network of 22
community groups. A major problem then encoun鄄
tered was a difficulty in obtaining seeds of indige鄄
nous species to grow. There is a National Tree Seed
Centre in Uganda ( part of the National Forest Au鄄
thority-see below), but it stocks mainly exotic spe鄄
cies, such as eucalyptus and pine, offering few in鄄
digenous plants. This is symptomatic of the way in
which forestry policy has evolved in Uganda since
the date of its first formulation in 1929. At that
time, the primary purpose of forestry was declared to
be the safeguarding of the environment ( climate,
water supplies, prevention of soil erosion) with a
strong emphasis on conservation of indigenous forest
(Nicholson, 1929). Subsequent revisions of forest
policy have downgraded attention on environmental
protection and indigenous forest, instead making the
planting of fast鄄growing exotic trees a conspicuous
aim. The following passage from a 1974 revision to
forest policy gives a flavour of the casual way in
which environmental protection has come to be seen:
“There are some secondary objectives such as the
protection of water catchments, soils, wildlife and a鄄
menity of land. These however cannot be measured
are dependent on responsible behaviour by (Forest)
Department officials in their provision冶 ( Lockwood
Consultants Ltd., 1973).
It is known that small patches of forest have
long been protected in Uganda for spiritual reasons
(Sembajjwe, 1995), but otherwise little has been
recorded about how forests were managed during pre鄄
colonial times. This may give the impression that
there was little forest management before the arrival
of the British, but this is unlikely to be the case jud鄄
ging by evidence from better鄄studied traditional soci鄄
eties elsewhere in the world, for instance China
(Pei, 2010; Pei et al., 2009). In any event, when
the British created Uganda, uniting Buganda with
neighbouring territories, they chose a federal struc鄄
ture for forestry, with larger forests administered by
a Central Forest Department and smaller forests and
plantations coming under local governments. Local
government at that time was organised broadly along
ethnic lines, which, in the case of Buganda, includ鄄
ed a traditional monarch (kabaka) and a parliament
( lukiiko). This federal structure persisted after po鄄
litical independence ( 1962 ) until 1966, when a
military coup resulted in the abolition of local gov鄄
ernments ( including their forestry units) and the
centralisation of all political power (Karani, 1994).
Various foreign countries have been influential
in the development of forestry in Uganda since inde鄄
pendence. The Canadian International Development
Agency ( CIDA ) funded Lockwood Consultants,
which was centrally involved in the 1974 formulation
of forestry policy. In 2004, several development a鄄
gencies, including that of the UK, were among ex鄄
ternal parties supporting a further radical reorganisa鄄
tion of forestry, with the Forest Department itself be鄄
ing dissolved and replaced by a National Forest Au鄄
thority (NFA). This development was in line with
the economic policies of the World Bank and Inter鄄
national Monetary Fund (IMF) to which Uganda had
become indebted, emphasising shrinkage of the pub鄄
lic sector and empowerment of private enterprise. A
great reduction in staffing resulted, with many fewer
forest officers being posted in the field, and much
practical work in the forests being contracted out to
private operators.
Indigenous forests and trees are in serious trou鄄
ble in Uganda today. If the current rate of loss con鄄
7144 期摇 摇 摇 Alan and Yildiz: Maintaining Resources for Traditional Medicine: A Global Overview and a Case Study …摇 摇
tinues, all forest will be gone by 2050 ( National
Forestry Authority, 2013). The widening circle of
tree destruction for charcoal now stands at a distance
of about 100 km from Kampala. A study of deforest鄄
ation published in 1984 showed that there were few
infringements of forestry regulations prior to 1972,
when they began to increase, often instigated by po鄄
liticians rather than ordinary citizens ( Hamilton,
1984). The 2004 re鄄organisation of forestry stimula鄄
ted even greater illegality, again with benefits accru鄄
ing especially to the relatively wealthy ( Jagger,
2008). The level of perceived corruption in Uganda
reached such a high level by late 2012 that the UK,
along with several other European countries, decided
to withdraw its direct development aid ( Stanners,
2012; Tran and Ford, 2012).
The struggles of the Ugandan state to achieve
good governance of its forests is disheartening from
the perspective of the history of Buganda. Buganda
was a well governed feudal kingdom at the time of its
‘discovery爷 by Europeans in 1862 (Hill, 1961).
The British rulers were so impressed by the govern鄄
mental system that they imposed it on the diverse
tribes which they incorporated into their Protectorate
of Uganda. Kiganda chiefs were posted around the
country to occupy chieftainships, thereby contribu鄄
ting to resentment against the Baganda, still an un鄄
derlying ingredient fuelling political instability (Fall鄄
ers, 2009; Kigongo, 2005 ). During the first 4
years after independence (1962 -1966), when U鄄
ganda continued to be a federal state, the local ad鄄
ministration of Buganda demonstrated its awareness
of forest values by adding over 135 000 ha to its local
forestry estate (Hamilton, 1984). A continuing in鄄
terest in forest conservation still remains among the
Baganda, as apparent from a powerful wave of oppo鄄
sition that greeted an announcement by the President
of Uganda in 2007 that a quarter of the largest re鄄
maining forest left in southern Uganda (Mabira For鄄
est Reserve, 30 000 ha) would be given to a private
company to be cleared for sugar production (BirdLife
International, 2008; Nakkazi, 2011). The Buganda
king-the kabaka (by now only a cultural figure in U鄄
ganda爷s affairs) declared that he would find an e鄄
quivalent area of non鄄forested land elsewhere for the
sugar estate to prevent the forest爷s loss.
Progress with maintaining resources for tradi鄄
tional medicine in Buganda has been impeded by
chronic political problems related, in part, to the
ethnically and culturally heterogeneous character of
the Ugandan state (Fallers, 2009; Kigongo, 2005).
Other factors have played a hand. Christianity, a
powerful force in Ugandan society and strongly
linked historically with western medicine ( Orach,
2009), has tended to be uneasy with traditional
medicine, especially its spiritual aspects. The ad鄄
vice on forestry given by foreign development agen鄄
cies has sometimes been deficient, judging by its
connection with the unsatisfactory revisions of forest
policy in 1974 and 2004. A similar problem is
known from neighbouring Tanzania (Hamilton et al.,
1989). A contributing factor in the case of the UK
could be a decline in the availability of British ex鄄
pertise in tropical forestry. The prestigious Oxford
Forestry Institute, teaching an undergraduate course
incorporating tropical forestry, was closed during the
1980s, later followed by closure of the Forest Re鄄
search Programme of the UK爷s Department for Inter鄄
national Development (Mills, 2006). Additional to
these impediments, the task of managing natural re鄄
sources in Uganda has become much harder over re鄄
cent decades, related to a huge increase in the size
of the population (from 7 million in 1962 to 35 mil鄄
lion in 2013) and much greater demands for wild鄄col鄄
lected natural resources, including medicinal plants
(Hamilton, 2008; Ssegawa and Kasenene, 2007).
Discussion
The two topics selected for special attention at
ISE were transmission of traditional medical know鄄
ledge and conservation of medicinal plants. Here, we
mention the relevance of these processes to the pro鄄
motion of biocultural diversity, a major challenge of
our time (Pei, 2010). Efforts to maintain or restore
814摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 植 物 分 类 与 资 源 学 报摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 第 35 卷
biocultural diversity are needed to counterbalance
the homogenising and ecologically destabilising
forces of globalisation, so prominent today. Desta鄄
bilisation of the entire global ecosystem is now oc鄄
curring (as shown by climate change and ocean a鄄
cidification), fuelled by the demands for resources
and pollution produced by a huge human population
and a drive for economic expansionism associated
with globalisation.
The desirability of pursuing conservation of
biodiversity is apparent at various temporal and spa鄄
tial scales. There are various connections with
health. It is estimated that 22 per cent of plant spe鄄
cies are in danger of extinction (RBG, 2010). Many
species known to be medicinal are included (Schipp鄄
mann et al., 2006) and it is probable that many of
the remainder will prove to have medicinal uses too,
provided that they continue to exist and so available
for research. Benefits will be maximised as much as
possible if the geographically鄄based genetic variation
of all these actually or potentially useful species is
conserved. Although conservation of some genetic di鄄
versity is possible in ex situ collections, the conserva鄄
tion or medicinal plants at the level of detail desirable
can only be approached through in situ means.
More or less all ecosystems today are influenced
in their species composition and functioning by peo鄄
ple. Even so, it is vital to conserve examples of more
natural types of ecosystems, not just to conserve spe鄄
cies diversity, but also to allow them to continue to
supply those provisioning and regulating ecosystem
services with which they are associated and that are
so vital to human health. These services include hab鄄
itats for insects that pollinate nearby crops, local cli鄄
matic moderation (important for agriculture), control
over the quantity and quality of water supplies, and
protection from soil erosion and landslides.
Actions at many geographical and social levels
are needed to counteract the problems of botanical
and ecosystem conservation outlined above. One is
the local level, which is where practical management
of the environment is actually effected. People are
needed at every place, who, as a group, are know鄄
ledgeable about its special natural features, under鄄
stand how these are connected to ecosystems on wi鄄
der spatial and temporal scales and are prepared to
put effort into their maintenance. The use of plants
in traditional medicine represents by far the biggest
category of use of the natural world in terms of num鄄
ber of species (50 -70 000 plant species out of a
global total of 380 000) (RBG, 2013; Schippmann
et al., 2006). It connects people with the details of
their local natural worlds in an unusually intricate
way. Alliances are possible between environmenta鄄
lists, concerned with maintaining the functioning of
ecosystems for longer鄄term advantage (including hu鄄
man health) and local people, concerned with their
own health right now.
Conclusion
Traditional medicine is declining in many places.
This represents a loss of medical and philosophical
knowledge that the world can ill afford to lose. It re鄄
duces the interest of people in the diversity of their
local plants, weakening the foundation for communi鄄
ty鄄based conservation. The case study of Buganda
shows that there can be obstacles to making progress
in maintaining resources for traditional medicine ex鄄
trinsic to its intrinsic worth. Making efforts to main鄄
tain resources for traditional medicine at the local
level can be a hard struggle. Nevertheless, activists
are urged to continue their efforts, in view of the
services that traditional medicine can offer to primary
healthcare, the value to humanity of the health鄄related
wisdom that can be associated with traditional medicine
and the urgency of accelerating efforts to conserve
biodiversity in the face of climate change.
The Kiganda case study and presentations at
ISE draw attention to the role of tradition in health鄄
care. The passing down of health鄄promoting knowl鄄
edge and customs through the generations relies on
the existence of reasonably stable social structures,
for example those connecting lineages of traditional
doctors in Sowa Rigpa. The most fundamental social
9144 期摇 摇 摇 Alan and Yildiz: Maintaining Resources for Traditional Medicine: A Global Overview and a Case Study …摇 摇
institution for passing on health鄄promoting knowledge
and practices is the family. Today, the forces of
globalisation are changing the world at a remarkably
rate. From the perspective of human health, the
counterbalancing advantages of stability and tradition
also need to be emphasised. The health鄄sapping
effects of over鄄rapid social change are evident in the
UK, where large鄄scale changes in family structures
over the last 40 years has contributed to upsurges in
deficient parenting, antisocial behaviour among the
young and heightened incidences of stress and de鄄
pression among school teachers ( Benson, 2013;
Scott et al., 2010, 2012).
Acknowledgements: Alan Hamilton is grateful for grants
made to Plantlife International to further work on the conser鄄
vation of medicinal plants from the Allachy Trust, the Rufford
Maurice Laing Foundation, the Gurney Charitable Trust, the
Tanner Trust and Dr William Hamilton. Patrick Hamilton as鄄
sisted with literature research. We are grateful to all partici鄄
pants to the session organized at the 13th Congress of the In鄄
ternational Society of Ethnobiology, providing many insights
that have informed this reflection. We are grateful to the Cen鄄
tre d Ecologie Fonctionnelle et Evolutive, UMR 5175, CNRS
at Montpellier, which supported the organisation of the con鄄
gress. Finally, we are indebted to the Fondation Yves Rocher
which provided funds enabling attendance by two participants
at the session.
Table 1摇 Facts and health indicators for Uganda with comparative data for the UK. Sources
Uganda UK
AREA, POPULATION AND ECONOMY
Country area (km2) 236 0401 243 6101
Population (millions) (Uganda 2012; UK 2011) 35 873 2531 63 181 7751
Growth rate of population (2012) (World Bank figures) 3. 271 0. 701
Gross Domestic Product at Purchasing Power Parity (2012) (US＄) 1 4141 36 7281
PEOPLE爷S RELATIONSHIPS WITH PLANTS
Primary occupation agriculture (% labour force) (2006-2009) 732 1. 41
Knowledge of useful wild plants (qualitative comparison) More Less
Annual change in forest cover (% ) (2005-2010) -2. 723 +0. 253
DIVERSITY AND CULTURE
Number of indigenous languages 421 71
Traditional family structures maintained (qualitative comparison) More Less
Regular church attendance by Christians (qualitative comparison) More Less
Self鄄declared no religious faith (census figures, 2001-2) (% population) 0. 91 15. 71
HEALTH AND SOCIAL SECURITY
Deaths>1 year old per 1000 births (2011) 64. 31 4. 51
Access to piped water in capital city (2012) 174 100
Annual health expenditure per capita (2009) (US＄) 1181 3 4381
Western鄄trained doctors per 1000 people (2008-12) 0. 11 2. 71
Traditional doctors per 1000 people (1992) 3. 25 >0. 1
POLITICS AND GOVERNANCE
Number of heads of government (1962-2012) 81 111
Number of constitutional transfers of power (1962-2012) 11 101
Corruption Perceptions Index (2011) 2. 46 7. 86
Deaths in internal armed conflict (1962-2013) > 600 0001 4 0001
1 (Wikipedia, 2013); 2 (UBOS, 2011); 3 (FAO, 2010); 4 (Water. org, 2013); 5 (Lwanga, 1992); 6 (Transparency International, 2013)
024摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 植 物 分 类 与 资 源 学 报摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 第 35 卷
Annex 1摇 Background to traditional medicine
and healthcare in Uganda
Table 1 provides some facts and health indicators for Ugan鄄
da, a country where traditional medicine is widely practiced, but
not officially recognised. Comparative data are provided for the
UK, where western medicine is strongly dominant.
Population and economy. Uganda is one of the world爷s
poorest countries. Unemployment is rife, a problem hard to
tackle given the very high population growth rate. Fortunately
for livelihood security, the majority of people belong to fami鄄
lies retaining connection to the land through ownership of
small farms. The UK is a country of similar size, but much
richer financially. Half of the food consumed is imported and
much of the rest produced on large mechanised farms.
People爷s relationships with plants. Many people in Ugan鄄
da have close dependency on plants through their engagement
in agriculture and their use of wild plant resources, including
medicinal plants. Deforestation is rife, contributing to the deg鄄
radation of some ecological services relevant to health, such as
a favourable agricultural climate and adequate water supplies.
Culture and diversity. Uganda is a linguistically much
more diverse country than the UK, with 42 indigenous lan鄄
guages belonging to 4 language families, compared with fig鄄
ures of 7 and 1 for the UK. Many people in both Uganda and
the UK are self鄄declared Christians (85. 2% and 71. 6% re鄄
spectively-2001鄄2 censuses), but regular church attendance
is much higher in Uganda. Churches and mosques are impor鄄
tant community institutions in Uganda, providing measures of
livelihood security and health support to many people.
Health and social security. Many health indicators are
lower for Uganda than the UK and little in the way of social se鄄
curity is provided by the state. There is no universal state pen鄄
sion (＄ 8 840 per year in the UK). Health expenditure per
capita and the number of western鄄trained doctors per 1 000
people are both about 30 times higher in the UK than Ugan鄄
da. The low doctor to population ratio in Uganda is exacerba鄄
ted by large鄄scale emigration of doctors from Uganda to richer
countries including the UK (Mulumba, 2009). An accurate
figure is hard to find, but experienced doctors in Uganda esti鄄
mate that at least 70% of doctors leave Uganda within 4 years
of graduation. The figure in Table 1 for the number of tradi鄄
tional doctors in Uganda comes from research at Gomba,
close to PROMETRA爷s Forest School at Buhijja. The number
found of 3. 2 traditional doctors per 1 000 people is similar to
that reported elsewhere in tropical Africa ( Cunningham,
1993). The figure given for the number of traditional doctors
in the UK is low because little remains of long鄄standing indig鄄
enous traditions of folk medicine (Hatfield, 1999), although
‘alternative爷 medicine of various origins is popular.
Politics and governance. The indicators in Table 1 show
the great difficulties that Uganda has faced in achieving good
governance. The Corruption Perception Index is scored from 0
(highly corrupt) to 10 (not corrupt) (Transparency Interna鄄
tional, 2013). The figure of >600 000 given for the number
of people killed in internal armed conflict is a minimal esti鄄
mate; the true count could be much higher.
References:
Akobirshoeva A, Oudenhoven F, 2012. Use and conservation status
of wild fruit plants in folk medicine of Rushan district of the Pa鄄
mirs, Tajikistan. Montpellier: presentation at 13th Congress of
the International Society of Ethnobiology
Benson H, 2013. The myth of ‘ long鄄term stable relationships爷 out鄄
side marriage. London: The Marriage Foundation. http: / / www.
marriagefoundation. org. uk / .
BirdLife International, 2008. Campaign to save Mabira Forest in U鄄
ganda from sugarcane plantation for biofuels. http: / / www.
birdlife. org / datazone / sowb / casestudy / 231.
Bista T, Bista G, Craig S et al., 2012. Making medicines, making
amchi: efforts to integrate education, clinical practice, medicine
production, medicinal plant conservation, and income generation
in Mustang, Nepal. Montpellier: presentation at 13th Congress of
the International Society of Ethnobiology
Blaikie C, 2011. Critically endangered? Medicinal plant cultivation
and the reconfiguration of Sowa Rigpa in Ladakh. Asian Medicine,
5: 243—272
Blaikie C, Gurmet P, 2012. Mainstreaming traditional medicine:
challenges to biocultural diversity and the road ahead. Montpelli鄄
er: presentation at 13th Congress of the International Society of
Ethnobiology
Byg A, Theilade I, Larsen HOL, 2012. Changes in health and health
care in Nepal. Montpellier: presentation at 13th Congress of the
International Society of Ethnobiology
Carri佼 E, Vall侉s J, 2012a. Ethnobotany of medicinal plants in East鄄
ern Mallorca (Ballearic Islands, Mediterranean Sea) . Journal of
Ethnopharmacology, 141: 1021—1040
Carri佼 E, Vall侉s J, 2012b. Ethnobotany of medicinal plants used in
Eastern Mallorca (Balearic Islands, Mediterranean Sea) . Mont鄄
pellier: presentation at 13th Congress of the International Society
of Ethnobiology
Cunningham AB, 1993. African medicinal plants: setting priorities at
the interface between conservation and primary healthcare. Peo鄄
ple and Plants Working Paper no. 1. Paris: Division of Ecologi鄄
cal Sciences, United Nations Educational, Scientific and Cultur鄄
1244 期摇 摇 摇 Alan and Yildiz: Maintaining Resources for Traditional Medicine: A Global Overview and a Case Study …摇 摇
al Organization
Ellen R, Puri R, 2012. The concept of ‘ core爷 medicinal plants: a
comparative and methodological study of phytomedical resources in
related eastern Indonesian populations. Montpellier: presentation
at 13th Congress of the International Society of Ethnobiology
Fallers LA, 2009. Ideology and culture in Uganda. American Anthro鄄
pologist, 63: 677—681
FAO, 2010. Global Forest Resources Assessment 2010. Rome: Food
and Agricultural Organization of the United Nations
Frausin G, Lima RS, Hidalgo A et al., 2012. Are Annonaceae a
likely source of antimalarial drugs? Montpellier: presentation at
13th Congress of the International Society of Ethnobiology
Ghimire S, Bista G, 2012. Integrating amchi爷s traditional knowledge
and practices for medicinal substitutes and conservation of threat鄄
ened species in the Himalaya. Montpellier: presentation at 13th
Congress of the International Society of Ethnobiology
Giovannini P, 2012. Supporting traditional herbal medicine in Ama鄄
zonian indigenous communities. Montpellier: presentation at 13th
Congress of the International Society of Ethnobiology
Glenn A, 2012. Sacred Seeds: local efforts can cover the globe.
Montpellier: presentation at 13th Congress of the International So鄄
ciety of Ethnobiology
Gonz佗lez ALC, Theilade I, Soerensen M, 2012. Social and ecological
factors influencing medicinal plant knowledge鄄a case from
Boyac佗, Colombia. Montpellier: presentation at 13th Congress of
the International Society of Ethnobiology
Hamilton AC, 2008. Medicinal Plants in Conservation and Develop鄄
ment: Case Studies and Lessons Learnt. Salisbury: Plantlife In鄄
ternational
Hamilton AC, 1984. Deforestation in Uganda. Nairobi: Oxford Uni鄄
versity Press
Hamilton AC, 2011. An evidence鄄based approach to conservation
through medicinal plants. Medicinal Plant Conservation, 14:
2—7
Hamilton AC, Bensted Smith R, 1989. Forest Conservation in the East
Usambara Mountains, Tanzania. Gland and Cambridge: IUCN
Hatfield G, 1999. Memory, wisdom and healing: the history of do鄄
mestic plant medicine. Stroud: Sutton Publishing Ltd
Hill ME, 1961. Permanent way: the story of the Kenya and Uganda
railway. Nairobi: East African Literature Bureau
Hoeffel JLM, Gon觭alves NM, Fadini AB et al., 2012. Pharmacy of
the woods鄄social identity and tradition: the use of medicinal
plants in the environmental protected areas Fern觔o Dias / Minas
Gerais and Cantareira / S觔o Paulo, Brazil. Montpellier: presenta鄄
tion at 13th Congress of the International Society of Ethnobiology
Holmstedt BR, Bruhn JG, 1995. Ethnopharmacology鄄a challenge.
Schultes RE and von Reis S. Ethnobotany: evolution of a disci鄄
pline. London: Chapman and Hall, 338—342
Jagger P, 2008. Forest incomes after Ugandas forest sector reform.
Collective Action and Property Rights. Working Paper no. 92.
Washington, DC: Consultative Group on International Agricultur鄄
al Research
Karani PK, 1994. Sustainable Management of Tropical Rain Forest in
Uganda. London: Commonwealth Secretariat
Kariuki PM, Kibet S, 2012. Conservation of traditional medicine: in鄄
itiatives on sustainable use of medicinal plants for healthcare and
livelihoods in Kenya. Montpellier: presentation at 13th Congress
of the International Society of Ethnobiology
Kigongo JK, 2005. The presence of ethnicity as a paradigm for federal
governance. In: Perez AF, Gueye SP, Yang FG ( eds.), Civil
Society as Democratic Practice. Washington, DC: The Council for
Research in Values and Philosophy, 55—69
Kimala A, 2005. The Granary Kingdom. Kampala: New Era Printers
and Stationers Ltd
King RJ, 2012. Medical pluralism in rural Moroccan community.
Montpellier: presentation at 13th Congress of the International
Society of Ethnobiology
Leaman DJ, Arnason JT, Yusuf R et al., 1995. Malaria remedies of
the Kenyah of the Apo Kayan, East Kalimantan, Indonesian Bor鄄
neo: a quantitative assessment of local consensus as an indicator
of biological efficacy. Journal of Ethnopharmacology, 49: 1—16
Lewis WH, 2003. Pharmaceutical discoveries based on ethnomedici鄄
nal plants: 1985 to 2000 and beyond. Economic Botany, 57:
126—134
Lockwood Consultants Ltd, 1973. Forest resource development study,
Republic of Uganda. Quebec: Canadian International Develop鄄
ment Agency
Lwanga J, 1992. Traditional healers baseline survey in Gomba County
(Uganda) Technologies for Health Care. http: / / www. popline.
org / node / 328013
McCarter J, 2012. Dynamics and maintenance of ethnomedical knowl鄄
edge on Malekula Island, Vanuatu. Montpellier: presentation at
13th Congress of the International Society of Ethnobiology
McCarter J, Gaving MC, 2011. Perceptions of the value of traditional
ecological knowledge to formal school curricula: opportunities and
challenges from Malekula Island, Vanuatu. Journal of Ethnobiolo鄄
gy and Ethnomedicine, 38. DOI: 10. 1186 / 1746-4269-7-38
Mills R, 2006. Preserving the past for the future: the importance of
archival information in forestry. Issues in Science and Technology
Librarianship. DOI:10. 5062 / F46H4FCZ
Montanari B, 2012. Erosion of traditional herbal knowledge: the case
of a Berber community in the High Atlas Mountains of Morocco.
Montpellier: presentation at 13th Congress of the International
Society of Ethnobiology
Montanari B, 2013. The future of agriculture in the High Atlas
Mountains of Morocco: the need to integrate traditional ecological
knowledge. Mann S (ed.), The Future of Mountain Agriculture.
Berlin: Springer, 51—72
Mooney M, 2012. Land learning: using indigenous community
schools to pass on knowledge of traditional medicines. Montpelli鄄
224摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 植 物 分 类 与 资 源 学 报摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 摇 第 35 卷
er: presentation at 13th Congress of the International Society of
Ethnobiology
Mtullu Kasese S, Malebo H, Maharaj V, 2012. Integration and coop鄄
eration between traditional healers, conventional health profes鄄
sionals and research scientists to improve quality of life for pa鄄
tients suffering from HIV / AIDS in Tanga (Tanzania) . Montpelli鄄
er: presentation at 13th Congress of the International Society of
Ethnobiology
Mulumba D, 2009. Policy analysis report: mapping migration in U鄄
ganda. Mbarara: Department of Development Studies, Mbarara
University of Science and Technology
Nakkazi E, 2011. Ugandans mobilize to save Mabira forest from sug鄄
arcane plantation. Ecologist: 20 September 2011
National Forestry Authority, 2013. http: / / www. nfa. org. ug / .
Nicholson JW, 1929. The future of forestry in Uganda. Government
Printer, Entebbe
Nicolas MT, 2012. Tradition and modernity in the education and
teaching of Sowa Rigpa, medicine of the Himalayas. Montpellier:
presentation at 13th Congress of the International Society of Eth鄄
nobiology
Offringa L, 2012. Medicinal plants of northern Thailand used by tra鄄
ditional doctors to improve cognitive impairment in the elderly.
Montpellier: presentation at 13th Congress of the International So鄄
ciety of Ethnobiology
Orach SO, 2009. Is religion relevant in health care in Africa in the
21st Century? 鄄the Uganda experience. Africa Religious Health
Assets Programme Conference. Cape Town: http: / / www. arhap.
uct. ac. za / downloads / Wed / Orach paper. pdf
Ouarghidi A, Abbad A, Martin G, 2012. Evidence that traditional
ecological knowledge and traditional resource management meth鄄
ods combat rarefaction of wild鄄harvested medicinal roots in Mo鄄
rocco. Montpellier: presentation at 13th Congress of the Interna鄄
tional Society of Ethnobiology
Pei SJ, 2001. Ethnobotanical approaches of traditional medicine stud鄄
ies: some experiences from Asia. Pharmaceutical Botany, 39:
74—79
Pei SJ, 2002. Ethnobotany and modernization of Traditional Chinese
Medicine. Aumeerduddy鄄Thomas Y and Karki M. Wise practices
and experiential learning in the conservation and management of
Himalayan medicinal plants. Kathmandu: WWF鄄Nepal
Pei SJ, 2010. The road to the future? The biocultural values of the
Holy Hill Forests of Yunnan Province, China. Verschuuren B,
Wild R, McNeely JA, Oviedo G ( eds.), Sacred Natural Sites.
London, Earthscan, 98—106
Pei SJ, Hamilton AC, Yang LX et al., 2010. Conservation and devel鄄
opment through medicinal plants: a case study from Ludian
(Northwest Yunnan, China) and presentation of a general model.
Biodiversity and Conservation, 19: 2619—2636
Pei SJ, Zhang GX, Huai HY, 2009. Application of traditional knowl鄄
edge in forest management: ethnobotanical indicators of sustain鄄
able forest use. Forest Ecology and Management, 257: 2017—
2021
P佼voa O, Farinha N, 2012a. Assessment of genetic erosion of corian鄄
der (Coriandrum sativum), hart忆s pennyroyal (Mentha cervina)
and pennyroyal (M. pulegium) in Alentejo (Portugal) . Montpel鄄
lier: presentation at 13th Congress of the International Society of
Ethnobiology
P佼voa O, Farinha N, 2012b. Ethnobotany of coriander (Coriandrum
sativum L. ), hart爷s pennyroyal (Mentha cervina) and penny鄄
royal (Mentha pulegium L. ) in Alentejo (Portugal) . Montpelli鄄
er: presentation at 13th Congress of the International Society of
Ethnobiology
PROMETRA, 2013. http: / / www. prometra. org / representations_na鄄
tionales / uganda. html.
RBG, 2010. Plants under pressure—a global assessment. Royal Bo鄄
tanic Gardens, Richmond, UK
RBG, 2013. Plant life is under threat, but how do we know? London:
Royal Botanic Gardens, Kew. http: / / www. kew. org.
Savajol N, Vanny T, 2012. Community involvement in traditional
medicine resources: how to balance livelihood improvement and
the preservation of biocultural diversity. Montpellier: presentation
at 13 th Congress of the International Society of Ethnobiology
Schippmann U, Leaman DJ, Cunningham AB, 2006. Cultivation and
wild collection of medicinal and aromatic plants under sustain鄄
ability aspects. Bogers RJ, Craker LE, Lange D (eds.), Medici鄄
nal and Aromatic Plants: 17. Dordrecht: Springer
Scott S, Doolan M, Beckett C et al., 2012. How is parenting style re鄄
lated to child antisocial behaviour? Research Report DFE鄄
RR185a. London: Department for Education
Scott S, Sylva K, Doolan M et al., 2010. Randomised controlled trial
of parent groups for child antisocial behaviour targeting multiple
risk factors: the SPOKES project. Journal of Child Psychology
and Psychiatry, 51: 48—57
Sembajjwe WSG, 1995. Sacred forests in Ganda society. Uganda
Journal, 42: 32—44
Ssegawa P, Kasenene JM, 2007. Medicinal plant diversity and uses
in the Sango bay area, Southern Uganda. Journal of Ethnophar鄄
macology, 113: 521—540
Stanners P, 2012. Ugandan aid suspended after fraud allegations. Co鄄
penhagen: The Copenhagen Post. 1 November 2012
Tran M, Ford L, 2012. UK suspends aid to Uganda as concern grows
over misuse of funds. London: The Guardian. 16 November 2012
Transparency International, 2013. http: / / www. transparency. org / .
UBOS, 2011. Uganda census of agriculture 2008 / 9 handbook. Kam鄄
pala: Uganda Bureau of Statistics
Water. org, 2013. Country profile Uganda. http: / / water. org.
Wikipedia, 2013. http: / / en. wikipedia. org.
Young JC, Garro LY, 1982. Variation in the choice of treatment in
two Mexican communities. Social Science and Medicine, 16:
1453—1465
3244 期摇 摇 摇 Alan and Yildiz: Maintaining Resources for Traditional Medicine: A Global Overview and a Case Study …摇 摇