It's all been said before. If you are reading this article, then most probably you are familiar with the issue of saving the world's tropical forests. The reasons are manifold: rainforests may contain a future, yet-to-be discovered cure for cancer, AIDS, Alzheimer's, or any of a host of presently incurable diseases; when a stand of rainforest succumbs to the chainsaw or the backhoe, some species may disappear forever, global warming increases, and indigenous peoples risk losing their habitat and way of life; and the medicinal knowledge of the tropical forests, held by indigenous peoples from time immemorial, is in danger of disappearing forever once the forests are gone.
While awareness of the importance of rainforest conservation has reached the international level, solutions for effectively maintaining existing tropical forests while encouraging economic development in poor countries are not simple. For many undeveloped and underdeveloped countries worldwide, tropical forests represent a source of "green wealth" which generates significant amounts of national income. Although "sustainable development" and "successful tropical forest management" are current buzzwords in conservation circles, the management and measurement of traditional medicinal knowledge is more difficult to implement in the countries most often possessed of stands of tropical forests -- less developed countries. When foreign pharmaceutical companies approach poor, cash-strapped countries on a drug-discovery and development quest, what kinds of leverage can those countries use to bargain effectively for a share of the benefits from prospective medicinal discoveries? How much can a Southern country demand from a Northern country for knowledge resulting in a new drug with profits in the billions of dollars?
Steps should be taken to preserve and positively promote traditional medicinal knowledge -- to give it equal footing with Western medicine in order to ensure its survival. Many citizens of poor countries realize that the majority of modern pharmaceuticals originally derived from naturally-occurring compounds found in plants. Too often, however, practitioners of biomedicine denigrate traditional medicine(1) as inferior to Western medicine. But this is not the case in Laos.
A unique system of governmental promotion and protection of the population's traditional medicinal practices has evolved in Laos under the auspices of the Ministry of Health. Established in 1976, the Traditional Medicine Research Center (TMRC)(2) is the only institution of its kind in Laos dedicated to ongoing research on traditional Lao medicine and the use of medicinal plants.
While the government of the Lao PDR (Peoples Democratic Republic) may not have originally intended to use the TMRC as a gatekeeper for inventorying and protecting traditional medicinal knowledge, the reality is that the TMRC is well-positioned to do precisely that. The government's original goals in establishing the TMRC include recording remedies prescribed by traditional healers, completing a survey of medicinal plants across all provinces of Laos, and facilitating the transfer of traditional medicines to in-country, government-sponsored pharmaceutical companies for large-scale production. All details of traditional medicine practiced in Laos are now being recorded: the healers, the medicines used, the locations where medicinally useful plants and animals are located, and so on. Thus the TMRC can, if it chooses, work out just compensation for the communities that assist in any drug discovery process conducted by a domestic or foreign pharmaceutical company.
Lao Traditional Medicine
Even though Western medical practitioners discourage the use of traditional medicine in favor of pharmaceuticals, the majority of the world's population relies on traditional medicine to meet primary health care needs. In Laos, a number of medicinal traditions co-exist and together comprise traditional Lao medicine. These medicinal traditions also vary according to ethnic group; in Laos, the three largest ethnic divisions are the Lao Loum (lowland, mainstream Lao society -- about 50 percent of the nation's population), Lao Theung (midland-dwelling Lao, comprising about 20 percent of the population), and Lao Soung (hill-tribe Lao, or Montagnards, and ethnic Hmong group). These three broad ethnic divisions are broken into smaller ethnic subgroups which exhibit some differences in dialect, customs, and beliefs, including medicinal traditions.
The total population of Laos is approximately 4.9 million. Forty-seven percent of the land mass is covered by tropical forest. In rural villages, where populations range from fewer than 100 persons to several thousand people, the forest is often just beyond the rice fields, within walking or bicycling distance. Stands of secondary growth forest (pa khok) are closer to the field-plots of rice than the denser forest (pa dong) located a few miles farther away. Both forest types contain plants used to treat a variety of illnesses. In addition to having a nearby, government-sponsored clinic or hospital, most villages also have at least a few practicing healers.
Lao healers, whether they are Lao Loum, Lao Theung or Lao Soung, tend to be specialists and treat particular illnesses. In the village of Ban Lak Sebet, I met an elderly woman -- Nou Vimane -- who is a healer. Under the bamboo thatch roof of the house she shares with her daughter, son-in-law, and their children, I asked her questions about the kinds of ailments she specialized in treating. While Nou mainly treated skin problems and other external conditions, she mentioned an old man in the village who was a bone setter. Other villagers were renowned for their ability to treat specific illnesses (due in part to their own experience with the illness in the past).
Nou Vimane was inspired to become a healer because her father was a healer. She accepts payment from patients as long as they are able to pay; often she is compensated for her services with a bolt of traditional cloth, candles, flowers, or some other modest payment. Healers in general are respected and highly regarded by other villagers; they are considered to be significant contributors to the wellbeing of the village.
TM Stations and Working with Traditional Healers
The TMRC has been working with healers such as Nou Vimane at the local level through a network of Traditional Medicine (TM) Stations. Most provinces in Laos have one TM Station, staffed by Lao individuals who in most cases are well-versed in both traditional medicine and Western biomedicine. At the TM Station in Ban Phonsavan, Bolikhamsai Province, healers Boon Kong and Bua Sone see an average of ten patients per week for a variety of complaints. Bua Sone is also the director of the local hospital and had ample training in Western medicine and hospital administration prior to his employment at the TM Station. Boon Kong and Bua Sone work together to invite local healers to workshops held informally at the TM Station. The workshops are a forum where healers can share their experiences in treating patients and learn new or different treatments from one another.
Because many TM Station workers have had dual training in traditional and Western medicine, and because virtually all of them live in local villages, traditional healers regard them as peers instead of adversaries. Many of the TM Station workers are thus able to refer patients back and forth from the hospital to local healers, or to the TM Station, depending on the patient's responsiveness to treatment.
It is also at this local, grassroots level that TM Station staff are recording in ledger books local remedies as described to them by healers, in addition to the remedies they themselves know. Boon Kong and Bua Sone are also growing medicinal plants around the TM Station in experimental gardens to see if the herbs will grow as easily there as they do in pa khok or pa dong forest stands. Large amounts of materia medica are collected, dried and stored at the TM Station, and voucher specimens of popularly used medicinal plants are collected for future botanical identification by botanists with the TMRC and the International Cooperative Biodiversity Program (which works with the TMRC). These specimens will be studied to determine their known medicinal effects, phytochemical properties, and biological activities.
Local Temple-Compounds (Wats)
The TM Stations and local healers are not the only options for treatment. Monks residing in the local wats (Buddhist temple-complexes) are often well-versed in traditional medicine. At one such wat -- Wat Sokphalek -- the deputy director of the TMRC in Vientiane and I were welcomed and shown around the temple compound by an elder Buddhist monk, Achan Phom. Achan Phom had a separate but modest house in the temple compound, which also included an herbal sauna, several cots for resting and for administering therapeutic massage, and an extensive garden in the back for cultivating some of the medicinal plants he used to treat patients.
Achan Phom also stored some dried medicinal plants in his house, close to the household shrine that dominated the room in which we sat. He had gained some knowledge of medicinal plants when he was younger, but most of his present knowledge of traditional medicine he learned from older monks residing in the wat. Phom usually sees patients who have had no success at a clinic or in using medicinal herbs on their own, but some patients prefer to be seen by him first.
The diverse array of traditional Lao alternatives for treatment indicates that traditional Lao medicine is well-integrated in the community. Because the government actively promotes traditional medicine through the presence of the TM Stations and the TMRC, Western medicine and traditional medicine are not held in opposition. And from the point of view of the patient who simply wants to find a remedy, all options are open. Traditional medicine is well-articulated and well-represented throughout Laos. Unlike traditional medicine in so many other parts of the world, it is in the public eye and not hidden from view, and its prospects for survival are favorable. Still, the task of protecting this body of knowledge -- a primarily oral, living tradition which is only recently being recorded -- is not without obstacles and potential legal pitfalls.
The Challenge to Intellectual Property
The ability of intellectual property rights law to protect traditional medicinal knowledge is complicated by Western definitions of what intellectual property is. Knowledge belonging to the public domain cannot be granted special status. Consequently, while a plant cannot be patented, a pharmaceutical company can take that same plant, isolate the compound responsible for its medicinally valuable effects, and then patent that compound under the name of the corporation, claiming ownership of it and receiving all profits from the new drug. The question of whose public domain will benefit from the commodification of traditional medicine should be raised. Foreign, multi-billion dollar pharmaceutical companies rarely exploit natural resources of truly global public domains; they instead transfer knowledge from one public domain (where it is well known) to another (where it is poorly known or unknown) -- such as Western biomedicine and the pharmaceutical industry.
Traditional Lao medicine clearly does not belong to a global public domain. Not yet anyway. And if the TMRC continues to encourage information-sharing between healers and to record remedies, the Lao people -- healers and non-healers alike -- will become more aware that this medicinal knowledge belongs to them and them alone. This activity in itself might help raise public awareness that traditional medicine, as a body of commodifiable knowledge, should be given special consideration when bioprospectors approach the government for permits to search for medicinally useful plants.
The Role of the UIC-Based ICBG in Supporting the TMRC
The International Cooperative Biodiversity Group (ICBG) Program, based at the University of Illinois-Chicago (UIC) and headed by Dr. Djaja Djendoel Soejarto, is assisting the TMRC in the task of discovering prospective medicinal products and in just compensation for the individual healers and communities who work with the TMRC. Like other ICBG Programs worldwide,(3) the UIC-based ICBG Program in Vietnam and Laos is dedicated to a research paradigm of ethical drug discovery. The Program is not merely comprised of scientists from North America or Western Europe; it works in collaboration with research scientists and institutions in Vietnam and Laos as well. All parties work together to ensure that any benefits, profits, or royalties realized from potentially medicinally valuable plants recovered during the course of the project are shared with the communities involved in the ICBG's research.
The ICBG program is a positive step toward the protection of Lao traditional medicine as a kind of national intellectual property and provides both a model and precedent for how North and South should work together. The likelihood that future negotiations between bioprospectors from foreign countries and the respective governments of Vietnam and Laos will take indigenous peoples' interests into account is increased on account of the program. The protocols for benefit-sharing are formalized by a contract between the ICBG and each community with which it collaborates. Such a protocol might be expanded to provide intellectual property protection on a larger scale. So long as the TMRC keeps track of which remedies are unique to which provinces, communities, etc., specific communities can be duly compensated for their cooperation and effort in discovering a useful and profitable compound.
Medicinally valuable plants endemic to more than one part of the world may present a challenge, but such a dilemma should not preclude benefit-sharing with communities directly involved in finding the basis of the next miracle drug. The resulting demand for necessary raw material might then spark a national campaign to help local communities grow, harvest, and market specific medicinal plants.
While the problems in protecting traditional Lao medicinal knowledge from misappropriation by unethical parties have yet to be resolved, it seems that Laos already has a very good system in the existence of the TMRC with its grassroots support and government backing. These kinds of support already represent more than half the battle in implementing an adequate system of protection for traditional knowledge. What is required next is constant vigilance to ensure that bioprospectors do not bypass villagers or the TMRC while negotiating with the government for permission to collect biological and genetic resources in remote provinces.
The Lao government and the TMRC should be in constant communication with one another on these issues (perhaps aided by additional financial assistance from an international foundation devoted to conservation efforts) in order to properly monitor the status and situation of traditional medicine in Laos, whether in Vientiane or in the country's remote provinces.
I would like to thank all of those who helped me in learning further about traditional Lao medicine: Boon Hong Southavong; Kongmany Sydara; Samsanith Bouamanivong; and all researchers with the TMRC: healers Achan Photo, Bua Kong, Bua Sone, and Nou Vimane; as well as Thongsa Kammaseng, headman of Ban Lak Sebet, Bounneuk Thavisouk and Somphane Simmavong, both with the Ministry of Health, Lao PDR. My beginning research in Lao PDR was made possible by funding from the UIC-based ICBG Program in Vietnam and Lao PDR.
References & further reading
Condominas, G. (1998). Le bouddhisme au village: Notes ethnographiques sue les pratiques religieuses dans la société rurale lao (plaine de Vientiane). Vientiane, Lao PDR: Éditions des Cahiers de France.
Chape, S. (1996). Biodiversity, Conservation, Protected Areas and the Development Imperative in Lao PDR: Forging the Links. Vientiane, Lao PDR: 1UCN -- he World Conservation Union.
Chazée, L. (I999). The Peoples of Laos -- Rural and Ethnic Diversities. Thailand: White Lotus Press.
(1). Traditional medicine here refers to any plant or animal-based medicines used by the Lao population in Laos, as opposed to pharmaceutical drugs. Tribal medicine refers to the traditional medicinal systems employed by ethnic minority groups in Laos, as opposed to traditional medicine used by the Lao Loum (the dominant ethnic group in Laos, the ethnic Lao).
(2). The Traditional Medicine Research Center (TMRC) was known as the Research Institute of Medicinal Plants (RIMP) until recently.
(3). See further the article by Katy Moran, in this issue of CSQ.
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