Indigenous Health Knowledge Systems in the Philippines: A Literature Survey1 By Pedrito dela Cruz and Alana Gorospe Ramos

I. Introduction

A rich cultural heritage abounds in the Philippines where there are approximately 110 ethnolinguistic groups. They make up a large portion of the Philippine population, with more than 12 million people. Alongside the three dominant ethnolinguistic groups - the Tagalogs, Visayans and Ilocanos, Philippine ethnic groups are a rich resource of indigenous knowledge (IK). Louise Grenier defines indigenous knowledge as the unique, traditional and local knowledge existing within and developed around specific conditions of women and men indigenous to a particular geographic area (IDRC 2005). The World Bank (WB) defined IK as the basis for community-level decision-making in areas pertaining to food security, human and animal health, education, natural resource management and other vital economic and social activities (Gorjestani 2000). The WB definition is not confined to indigenous peoples alone, but to all communities that have developed their own body of knowledge. Indigenous knowledge is also regarded as traditional knowledge in the literature. The Convention on Biological Diversity (CBD) for instance, defines traditional knowledge as the knowledge, innovations and practices of indigenous and local communities around the world. Developed from experience gained over the centuries and adapted to the local culture and environment, traditional knowledge is transmitted orally from generation to generation. It tends to be collectively owned and takes the form of stories, songs, folklore, proverbs, cultural values, beliefs, rituals, community laws, local language, and agricultural practices, including the development of plant species and animal breeds. Traditional knowledge is mainly of a practical nature, particularly in such fields as agriculture, fisheries, health, horticulture, and forestry (CBD 1992). Socio-economic and political changes however, threaten this abundance of indigenous knowledge, just when there is growing awareness of IKs potential to contribute to poverty alleviation and sustainable development. As local habitats are lost to encroaching industries and populations, local peoples have had to relinquish precious land, flora and fauna. Studies have also noted that increasingly, socialization of indigenous peoples has been into the mainstream culture which is dominated by western science and symbols, rather than into their own indigenous
1

Paper presented at the XIIIth CONSAL Conference, Manila, Philippines (2006).

cultures, wherein they stand to lose an invaluable part of their heritage and knowledge systems (Castro-Palaganas 2001). Global initiatives to preserve and integrate IK in development programming, such as the World Banks Indigenous Knowledge for Development Program, have since sprung into action to counter the diminishing trove of indigenous knowledge, but limitations exist foremost of which, is that IK has not been systematically documented: It is ironic that an awareness of the value of indigenous knowledge particularly its potential contribution to sustainable development and poverty alleviation is growing precisely at a time when such knowledge has never been under greater threat. It is in danger of disappearing not only under influence of global processes of rapid change, but also because the capacity and facilities needed to document, evaluate, validate, protect and disseminate such knowledge are lacking in the South. (SciDev 2005) Through documentation, we are able to record and preserve indigenous knowledge for validation and dissemination, but not all indigenous knowledge may provide solutions to our development problems, nor can they be transferred and applied to other communities, because they are locale and culture-specific. The process of evaluation and validation are important to critically assess what and how IK solutions are able to contribute to sustainable development, and to identify which do not. IK has been the basis for local decision-making in communities in the following sectors (SciDev 2005): Agriculture intercropping techniques, crop diversity, pest control, seed varieties, animal production and healthcare, ethno botanical research; Human Healthcare through the use of traditional medical knowledge and medicinal plants use; Biology botany and fish breeding techniques; Natural Resource Management water management conservation techniques, forestry management; Education local languages and oral traditions. and soil

IK is also considered a key element of the social capital of the poor, since it is an asset towards ensuring survival through food production and providing for shelter, as well as for achieving control over peoples lives (IKPages 2005).

II.

Indigenous Health Knowledge Systems in the Philippines: Objectives and Methodology

The diversity of IK cultural practices and traditions in the Philippines includes indigenous health knowledge systems consisting of traditional healing practices. At present, the Philippines has more than 12,000 species of plants, from which 1,500 species are used by traditional herbalists. It is common knowledge that indigenous peoples have known the healing properties of several herbs for generations. In a country where people, especially in remote areas where a sizeable rural population live, have low access to the formal health care system, traditional healing modalities provide the alternative. Integrating traditional health knowledge systems into the formal health systems not only helps preserve an invaluable and functional aspect of our cultural heritage, but also enhances the formal health delivery system. The WHO has classified the Philippines, along with Hong Kong, Malaysia, Mongolia, Singapore, Thailand, and Australia, as a country supportive of traditional medicine. This means that Government recognizes the role played by traditional medicine, supports its proper use, initiates efforts to bring proven traditional medicine into the formal health service system and takes measures to control its safe practice, despite its not being part of the formal health service system. This study hopes to provide an overview of indigenous or traditional medicine documentation in the Philippines, as part of a global initiative to map, document and organize IK information resources, in aid of their protection and integration into local, regional and national programmes. Though preliminary, this study attempts to identify important indigenous or traditional health systems studies and researches, with a focus on traditional medicine, existing in pre-selected libraries, research and information centers, in government and non-government institutions in Metro Manila. Specifically, the study aims to: 1. Determine current levels of interest and awareness of indigenous health knowledge systems among cultural and information scholars and medical practitioners through an inventory of documentation; 2. Determine the focus or main content of these studies so as to be able to identify research gaps that can be addressed by future studies; 3. Encourage the integration of traditional health knowledge systems into the formal health system to preserve a rich and functional aspect of our cultural heritage and at the same time, enhance the framework of formal health services delivery in the country.

The literature survey attempts to cover the following specific themes: Indigenous and traditional medical practices in the provinces; Various approaches to community-based traditional medicine programs in support of primary health care; Surveys of resources: inventory of medicinal plants; inventory and mapping of traditional healers; Development of new drugs or products to combat diseases that worsen the conditions of the poor (e.g., anti-malarial products from herbs); and Integration of western and traditional medicine, where appropriate, and the implications of such an integration.

Research methodology for the study consisted of the following: 1. Key Informant Interviews a total of seven (7) key informants were interviewed namely: Dr. Jaime Galvez Tan Former Secretary Department of Health (DOH), Philippines Former Director, National Institutes of Health University of the Philippines, Manila Dr. Michael L. Tan Chair, Department of Anthropology University of the Philippines, Diliman Dr. Eufracio Abaya Professor, Department of Anthropology University of the Philippines, Diliman Dr. Isidro Sia Former NIRPROMP Director, Department of Health Head, Pharmacology Department University of the Philippines, Manila Mr. Edgardo Quiros Former Associate Professor, Institute of Library and Information Science, University of the Philippines, Diliman Current Project Manager, BuddyWorks, Telehealth Project Because information resources on the history of traditional medicine in the Philippines were scarce, questions for key informants focused mostly on the development of traditional medicine in the Philippines. Key informants were also asked as to what were the more important theoretical and practical studies on traditional medicine systems in the country that should be reviewed or revisited. They were also asked as to what challenges remained, with regards to the development of traditional medicine in the Philippines.

Due to the huge volume of information resources, it was decided that only literature identified by the experts would be reviewed for this study, however an extended bibliography would be attached, for those who would wish to review other traditional medicine resources in the Philippines. 2. Site Visits to Libraries and Information Centers Library research was undertaken to review information resources and research documents identified by the experts as well as to locate more materials that might have been missed, using the book or journals reference list. Citation analysis of certain materials was also used to enhance identification of the most cited works in Philippine traditional medicine literature. The libraries and information centers that were visited were: F.B. Herrera, Jr. Medical Library University of the Philippines, Manila Dissemination Center Department of Pharmacology University of the Philippines, Manila Medical Library University of the East Medical Center Filipiniana Section University of the Philippines, Diliman Library Institute of Philippine Culture (IPC) Ateneo De Manila University Department of Health (DOH) Central Library Department of Health Essential National Health Research (ENHR) Office Health Action Information Network (HAIN) Reading Room Philippine Institute of Traditional and Alternative Health Care Reading Room Community Medicine (COMMED) Search terms used were narrowed down to traditional medicine, folk medicine, herbal medicine, alternative medicine, and medical anthropology terms which yielded bibliographic records both in library catalogs using LCC and indexes using MeSH systems, such as HERDIN. The search term traditional medicine yielded the most number of relevant bibliographic records.

The combined bibliographic resources from the above institutions and databases hopefully provide an adequate sampling of the documentation on traditional medicine systems in the Philippines.

III.

Overview of the Development of Indigenous/Traditional Medicine in the Philippines

While we can assume that knowledge of the curative virtues of herbs was handed down from generation to generation, documentary accounts of the curative virtues of herbs started only during the Spanish period (1521-1898) mainly by Spanish missionaries. The earliest document is a treatise on indigenous medicinal plants written by a Franciscan, Father Blas dela Madre de Dios, around 1611, which was never published. Another unpublished document is that of a manuscript completed by Father Jose de Valencia in 1669 entitled Flora Filipina, which was also never published. The strong interest of Spanish missionaries in indigenous medicine was captured in accounts like that from Fr. Murillo-Velardes Historia de la Provincia de Philipinas de la Compana de Jesus. Published in Manila in 1749, it referred to a Jesuit Father Tomas de Montoya, who died in Manila in July 1627, and who was considered by the natives as their doctor, surgeon and spiritual healer on account of the knowledge he had gained of some herbs and domestic medicines. Of the documents produced during the Spanish period, the best known were those of Father Blancos Flora de Filipinas (published in 1737, 1845, and 1877), which discussed the use of the medicinal plants, and Dr. Pardo de Taveras, Plantas Medicinales de Filipinas, published in 1892. (Quisumbing 1951) The American Period (1898-1935) was characterized by scientific vigor, during which scientific research papers dealing with medicinal plants were published. With the establishment of the Government Laboratories, later called the Bureau of Science, studies were conducted. This was followed by intensive research on the chemical constituents, pharmacology, and therapeutics of medicinal plants by the University of the Philippines. Quisumbing (1951) categorized the activities during this period into: 1) survey; 2) chemical; 3) pharmacognostical; 4) pharmacological; 5) pharmaceutical; and 6) therapeutical. Surveys on medicinal plants and their uses were conducted in many parts of the archipelago, resulting to a total of 590 species surveyed by 1931. Chemical studies dealing with the composition and values of Philippine foods, and active principles of many Philippine medicinal plants were undertaken. Pharmaceutical studies included those that were undertaken by the UP College of Pharmacy, drugstores and private laboratories. (Ibid) During the Commonwealth period (1935-1941), surveys were extended to regions not previously explored. Some clinical and chemical investigations were also made. The World War II period (1941-1945) did not impede the interest and studies on medicinal plants. Impetus was given to the cultivation of drug plants, like castor oil plants, coca plant and a few others. Less than two months after the establishment of the Occupation Republic, Executive Order No. 14 was promulgated creating a committee on medicinal plants to study those actually growing in the Philippines and to propose methods and processes suitable for the local production and manufacture of medicinal drugs and other preparations (Quisumbing 1951; Maramba-DOH 1993).

The post-war period saw the publication of Eduardo Quisumbings Medicinal Plants of the Philippines. Published in 1951 by the then Department of Agriculture and Natural Resources, the book contains information on 858 species of medicinal plants, of which 63 species are recognized in various pharmacopoeias. All available information on each specie was incorporated in the book, including records wherever the plants occur throughout the world. In the introductory part of the book, Dr. Quisumbing extensively referred to the vast collection of literature about medical herbs in the country in the private library of Dr. Leon Ma. Guerrero (who was a principal researcher and consultant to major medicinal plants studies). He also mentioned the Scientific Library of the Bureau of Science, the National Library, the Library of the University of the Philippines, and the library of the St. Augustine Church. Promotion and utilization of indigenous and alternative medicine in the communities gained headway when Community-Based Health Programs (CBHPs) were founded in the early 70s. The CBHPs, which seek to make health care accessible particularly to the poor, advocated the utilization of indigenous health resources as one of the program pillars. The experience of CBHPs further provided impetus, especially in the rural areas, where the use of medicinal plants for relief of common ailments has never been abandoned since most households and schools maintain herbal gardens. To CBHP implementers, there was a realization that the traditional medicine initiatives under the CBHPs were, in a sense, a review of what the people already knew with the added value of helping expand this stock knowledge (Tan as cited in Maramba-DOH, 1993). A number of researches aimed at determining the acceptability and utilization of medicinal plants has been undertaken during this period. The more significant of these is the 1976 community survey done by Comprehensive Community Health Care (CCHP) of the University of the Philippines to determine when and for what illness of conditions the people use herbal medicine. The first official mandate in that recognized the usefulness of plants for medicinal purposes was issued as a Letter of Instruction from the Department of Education in 1973, which encouraged public schools to have herbal gardens, and for health educators to include medicinal plants and their preparations in the list of available modalities for first aid management. By 1977, the National Science Development Board funded multi-disciplinary research and development activities with the participation of the community (Maramba-DOH, 1993). In 1977, the National Integrated Research Program on Medicinal Plants (NIRPROMP) was organized, with the aim of systematizing the study of medicinal plants in the Philippines with an end goal of providing safe, effective, and affordable pharmaceutical products derived from commonly available plants. The creation of the NIRPROMP signified the renewed interest of government in creating a momentum for medicinal plants or herbal medicinal products in the Philippines. To date, the program has transferred the technology to pharmaceutical manufacturers for the production of 7 herbs in commercial form: Lagundi; Sambong; Tsaan Gubat; Hierba Buena; Acapulco; Atis. Under the NIRPROMP, more than 2,000 abstracts and bibliographies on medicinal plants, which date back to the 19th century, had been published, while the ethno medical use of more than 1,600 plants had been compiled. It has also conducted training programs on the proper use of medicinal plants in various regions of the country.

In 1992, under the leadership of Dr. Juan M. Flavier, the Traditional Medicine Unit was formally established at the Department of Health. In 1995, Fidel Ramos appreciating the potentials of traditional medicine in health, tourism and economic progress, included this as one of his administrations pole-vaulting strategies. In order to ensure adequate government support for key areas such as research, technology transfer, regulation and promotion as well as harness the increasing participation of the private sector and civil society groups in traditional and indigenous health, RA 8423 creating the Philippine Institute of Traditional and Alternative Health Care (PITAHC) was signed into a law in 1997. A cursory review of PITAHCs accomplishments since it formally operated, shows that it has ably put on track vital activities relative to its promotion, public awareness, technology transfer and networking functions. However, other strategic areas like R&D, HRD, and policy development have not proceeded as envisioned due to lack of resources, and a redirection of priorities. In 1998, recognizing the value and increasing appreciation for alternative medicine, the National Demographic and Health Survey (NDHS) included questions on knowledge, attitude and practices on the ten DOH-endorsed herbal medicinal plants and their uses. A section on traditional medicine was again included in the recently published 2003 NDHS, providing important statistical data from the field to shed light on actual knowledge and use of these medicinal plants in primary health care. In March 2003, DOH, DOST, PITAHC and the National Institute for Health, started developing a National Unified Health Research Agenda with inputs from the various consultations that have been and are still being conducted. The research agenda is expected to include not just bio-medical or pharmacological research on medicinal herbs, but also on the social and anthropological underpinnings of traditional health practices.

IV.

Survey of Literature

The academe has been the primary knowledge producer of most of traditional medicine literature with respect to its cultural and social relevance and historical development. A good number of documentation has been produced by anthropologists through ethnographies, a comprehensive record of the culture or society under study, and primarily an output of anthropological field work wherein the researcher lives as one with the members of the group he or she is studying. The literature reviewed in this section, specifically those of Jocano (1973) and Tan (1987), have been widely cited in traditional medicine resources, as well as by our key informants. Planta (1999) gives an informative historical account of the development of traditional medicine during Spanish colonial times. A DOH bibliographic database on traditional medicine is also reviewed, alongside more recent health IK documentation such as those by Sia and Galvez-Tan. The following readings provide an adequate background on the socio-cultural perspectives on traditional medicine in the Philippines.

A. Socio-Cultural Aspects of Indigenous/Traditional Medicine A masters thesis in history by Planta, traces the development of traditional medicine and pharmacopoeia in the 16th to the 19th centuries. According to the writer, it is the first of its kind, attempting to establish the continuity of traditional medicine and pharmacopoeia and to show that traditional medicine and its underlying cures have shown remarkable effectiveness and stability through time (1999). It attempts to portray Filipino culture and society through its traditional medical and healing practices. The study includes a bibliographic review of some of the earliest works on traditional medicine, citing Pardo de Taveras work, Plantas Medicinales de Filipinas (1892) as perhaps the most comprehensive during its time. The thesis ends with a chapter on the American colonial period, focusing on the introduction of the American public health system in the Philippines, and how this has affected the traditional medicine system. Jocanos Folk Medicine in a Philippine Municipality (1973), is credited by fellow anthropologist, Michael L. Tan, as one of the first studies to probe into the broader medical culture, e.g. local concepts of health and illness, embedded in peoples religious and philosophical views. In his preface to the books second printing, Tan attributes his consequent interest in traditional medicine to the insightful ethnography of Jocanos work in Bay, Laguna, Philippines. According to Jocano, the book was written to present an ethnographic account of folk medicine among Filipino peasants in Bay, a municipality of Laguna. It was also written to provide health innovators, a case study on how the local residents are able to meet their medical needs. The study notes that there was a wide acceptance of folk medicine among the local people; this despite the fact that western medicine had been in existence in Bay since the early 1950s, according to Jocano. The study covers local concepts of health and illness, classification of diseases, a system of diagnosis, a chapter on traditional medical practitioners, e.g. albularyos (herbalists), manghihilots (masseurs or bone-setters) and, magpapaanak (midwives), to name a few. Aspects of medical care are also discussed in separate chapters based on specializations in Bay folk medicine, such as: mother and child care, treatment of common illnesses and faith and healing. Studies on local concepts of health and illness have since been subjects of interest in ethnographic literature. Usug, Kulam, Pasma by Tan (1987) perhaps stands as one of the most authoritative discussions of traditional concepts of health and illness in the Philippines. It noted the gap between the professional and the lay perceptions of health and illness, and therefore attempted to bridge this gap through the understanding of indigenous philosophy and knowledge, specifically those relating to health and illness. Basically it draws from a wide spectrum of literature in the social sciences to identify a Filipino traditional medical system from within culture as a whole. Linguistic analysis was used extensively, Tan said, because language is the concrete expression of what we think, as well as the way we think. This analysis also included the connotative aspects of words and ideas, not just the direct and obvious meanings. This approach was inspired, Tan said, by Frakes work published in 1961, wherein he approached the study of illness through ethno linguistic analysis, a study which was able to draw from the Subanuns, their own disease criteria.

The Tan study reviewed a good number of ethnographies, extracting various concepts and issues of health and illness, reflected in local terminology. Tan formulated three theoretical typologies of illness causation based on the literature, namely: mystical theories of illness causation, personalistic theories of illness causation and the naturalistic theories of illness of causation. Tan said that health and illness provide focal points for cognitive frameworks, and as such are useful social metaphors. The human body itself becomes a source of symbolsfor the description of emotional states, as well as social structures. Thus in other languages, the head (ulo) denotes leadership, as the right hand (kanang-kamay) refers to a leaders closest adviser (1987). Tan also recognized the use of traditional medicine as a tool of dominant classes, to propagate the backwardness or primitiveness of a group. He said that a deeper analysis is required to look at aspects of traditional medicine that tend to hide reality, specially if it is used to maintain a certain status quo in a community (1987). With the pronouncement by the WHO that traditional medicine should be developed as a viable alternative to western biomedicine especially in developing countries, the DOH spearheaded the mapping of information resources on traditional medicine in the Philippines with the implementation of the Filipino Traditional Medicine Comprehensive Database Project (FTMCDP) undertaken by the Community Medicine Development Foundation, Inc. (COMMED) in 1995, for the Department of Health (DOH). The FTMCDP is a two-volume compilation of traditional medicine resources in the Philippines which aimed to provide a functional data resource on Filipino traditional medicine, and facilitate its integration into the Philippine health care delivery system (1995). It was a 12-month project composed of 3 major activities: database development, publications and primary research. Its primary research component focused on mapping 191 traditional medical practitioners (TMPs)-their demographics, their healing practices and philosophy, as well as their distribution and networking, within the Philippines. It includes a good number of ethnographies that describe traditional healing practices (both spiritual and herbal-based therapies), historical literature and pharmacological studies on medicinal plants. Food and nutrition traditional practices are also included in this database. Because of the diversity of studies, 19 typologies were initially used to categorize resources. This was later reduced to 6 major themes, which the project team believed, characterized the important aspects of traditional medicine in the Philippines. These are: Religious Practices and Social Well-Being Local Understandings of Illness Causation and Prevention Healing Process Traditional Health Practitioners Food and Nutrition Interaction Between Traditional Medicine and Biomedicine

The terminal report is divided into 3 major parts: Part 1 covers the objectives and methodology, Part 2 consists of an extensive annotated bibliography introduced by informative review essays, and Part 3 presents the results of the TMP survey. No major updating of the bibliographic report, however, has been undertaken since 1995. More recent work on traditional medicine research was undertaken under the auspices of NIRPROMP, one of which was undertaken by Dr. Isidro Sia and a team of medical doctors of the University of the Philippines, Manila. The project was a documentation of 15 ethnolinguistic groups in the Philippines, a project that has been and continues to be the basis for collecting and documenting traditional medicine practices, specifically plant resources. This study documented health IK of 15 ethnolinguistic groups mostly living in the Cordilleras, Palawan, other parts of Luzon,and Mindanao. The International Institute of Rural Reconstruction (IIRR) has long been an advocate of the promotion and integration of indigenous knowledge in development planning, all over the world. In aspects of health, the IIRR produced Indigenous knowledge and Practices on Mother and Child Care: Experiences from Southeast Asia and China, a resource book on indigenous maternal and child health care (2000). The book was a result of a workshop attended by 57 IK practitioners from 7 countries. As an introductory resource, it provides a cross-cultural overview of indigenous mother and child practices in Southeast Asia and China. It provides much needed focus on maternal and child health, two of the most marginalized groups in national health care programmes. In addition to the introduction written by Dr. Jaime Galvez-Tan, there are extensive discussions of the Philippine experience, e.g. on the chapter on maternal and newborn care in different cultural settings, accounts from the Blaan in South Cotabato, the Ifugaos, Kalagan Muslims, Tausugs, and Kalingas, are presented. There are also Philippine accounts with regards to the care of the sick from two rural communities in Camarines Sur, and Occidental Mindoro; an account of marriage and sex rituals among Tausugs and Kalagans in southern Philippines, and an account of a sibling care practice among the Blaan. A chapter of the resource book focused on retrieval, documentation and use of indigenous knowledge, with most of the cases based on community level initiatives in the Philippines. The cases document some of the success stories in promoting indigenous practices in maternal and child health using such strategies as community mobilization, exploration of innovative communication approaches, formal and informal education strategies and intergenerational attempts to promote indigenous health practices for mother and child.

B. Medicinal Plants Inventory An interdisciplinary effort currently characterizes the development and promotion of traditional medicine in the Philippines. The medical sciences have focused their efforts on the material culture, or the materia medica utilized in traditional healing, primarily medicinal plants. Critics however have said that this practice of stripping the herbal medication from its other social functions relegates herbal medicine simply as a modality (Segismundo 1995). From the point of view of

systematic documentation of herbal medicine however, these efforts have produced significant and substantial inventories of medicinal plants and their pharmacological properties. Quisumbings work on medicinal plants (1951) is regarded as one of the earliest and most authoritative texts on medicinal plants. Conditions after World War II during which time imported drugs were scarce, inspired research for this book on Philippine medicinal plants, for their possible therapeutic uses. Entries were accompanied by descriptions of the plant, their pharmacological properties and uses as well as names in the vernacular. There is also a well-discussed section on the early writings of Spanish missionaries on herbal medicine, which had already been cited earlier. Few systematic studies came after Quisumbings post-war book (Co 1977) which was the rationale behind the University of the Philippines Botanical Societys attempt to promote traditional medicine through documentation of medicinal plants and their therapeutic uses. The book entitled, A Manual on Some Philippine Medicinal Plants (1977), sought to enlighten people of the potential healing properties of local medicinal plants. Sections of the book were divided into the following: anti-infectives, antipyretics, anti-rheumatics, food invigorators and hemostatics, antitussives and antiasthmatics, analgesics, tranquilizers and hypnotics, tonics, counter-irritants and antihelmintics, liver-cleansing and vision-aiding, diuretics, expectorants, and even snake bites. Michael L. Tan undertook a feasibility study in 1977, on the integration of a medicinal plants component into CBHPs for the Mindanao-Sulu Secretariat of Social Action (MISSSA). The study entitled Philippine Medicinal Plants in Common Use: Their Phytochemistry and Pharmacology noted a growing interest in medicinal plants and traditional medicine in general among CBHP personnel (1978). CBHPs as mentioned earlier, were tasked to make health care more accessible to the poor, and the use of indigenous medicine was adopted as one of its pillars. But information resources on traditional medicine were still scarce which was the primary reason that this handbook was developed. The handbook discusses more than 200 plants, but Tan cautions in his Introduction that a lot of material had to be excluded, e.g. listings of local names for plants, botanical descriptions, methods of collection, processing and propagation, and even the cultural context of traditional medicine, information often overlooked, according to Tan. Each plant entry in the handbook is accompanied by its scientific and local name, a brief description of the plant and suggested preparations and uses. Some plants noted more for their nutritional value rather than curative value, were also included such as the gabi (colocasia esculenta), a common root crop in the Philippines. Tan followed up this handbook with a revised edition in 1981. It included additional plants and preparations based on the Philippine National Formulary and the Chinese Pharmacopoeia. The revised edition also noted that local programs had begun to develop their own herbal preparations and to document these, showing more heightened community involvement.

Leonardo L. Co followed up his 1977 study by publishing Common Medicinal Plants of the Cordillera Region in 1984. Co observed that during this time, the use of medicinal plants was already being promoted both by government and nongovernment agencies (1984). Published by CHESTCORE (Community Health Education, Services and Training in the Cordillera Region), the publication served to further enlighten readers in the therapeutic properties of certain plants found in the Cordillera region. In the Foreword by the books co-editor Dr. Yvonne B. Taguba, critiques the pharmaceutical industry, pointing out the high cost of essential drugs, brought on by the importation of roughly 80% of raw materials to manufacture the drugs. According to Taguba, the pharmaceutical industry in the country lacked the support of basic research into local resources (1984) that could have made drugs cheaper and therefore more accessible by the poor. The book covers 122 species of common medicinal plants found in the Cordillera region, home to a number of indigenous peoples (IPs). Each plant has an entry name, usually the common name of the plant as it is known throughout the country, the scientific name, the family name and their synonyms (scientific names by which a plant was formerly designated). Other descriptors were plant description, habitat and distribution; parts utilized and indications and directions for use. Illustrations were also provided. By the mid-1980s, the University of the Philippines at Los Baos had scaledup efforts to document information resources pertaining to medicinal plants use in the Philippines. By this time, a number of studies on plant pharmacology had already been undertaken and published, but so far had been unmapped and unorganized. Quintana, in 1989 compiled a bibliography of Philippine medicinal plants entitled, Philippine Medicinal Plants: Abstract and Bibliography mainly to collate and organize references on medicinal plants resources both published and unpublished from the UPLB campus libraries, as well as from other private libraries (1989). Sources for the bibliography were journals from the UPLB Main Library, the International Rice Research Institute (IRRI), the College of Forestry, the DOST and other libraries. Books, journal articles, technical papers, research reports, graduate theses and other information resources were included in this compilation. Medicinal Plants by Ludivina S. de Padua (1996) is one of the more recent publications on medicinal plants therapeutic uses. According to the Foreword, this book is first of a series under the general name, Philippine Plants, conceived to be a series of several booklets (instead of one volume), that approaches plant science from the ecological perspective rather than the purely taxonomic (1996). Philippine Plants updates Plants of the Philippines published in 1971 for the University of the Philippines Science Education Center by the U.P. Press. Unlike other plant inventories already published, de Padua includes a portion on General Information of Philippine herbal medicine development, briefly mentioning new strategies in plant research and institutional changes at the DOH to promote traditional medicine in the country. Part 1 also includes a discussion on plant products and categories, which are essential knowledge for the non-medically trained practitioner. She also discusses collection, preservation and storage techniques of medicinal plants, emphasizing that different plant parts need different modes of collection and storage (1996).

De Padua also discusses the 11 major health problems in the Philippines and provides a quick index of the scientific name of the plant and plant part that have therapeutic value for such health problem. Part II covers information on 22 medicinal plants, listing their scientific name, common name in English and a local dialect, a brief description and localities in which they may be found, suggested preparations and their therapeutic value. C. Pharmacological Studies of Philippine Medicinal Plants A paper by Dr. Jaime C. Zaguirre written in 1944 during World War II entitled Some Emergency Bedside Preparations of Most Common Local Medicinal Plants, gives us a rare glimpse of the early exploration of medicinal plants use during that period. As Zaguirre explained, this was due to the lack of imported drugs as a result of the war: In the Philippines, there are no less than eight hundred plants reputed to possess certain medicinal virtues. Comparatively, very few of them have been chemically and pharmacologically studied. However, as a result of the present scarcity or lack of standard medicaments due to war conditions, revival in the search for local resources has greatly stimulated wide interest particularly among the medical circle (1944). Zaguirres paper, which we found at the University of the East Medical Library, documents attempts to test pharmacological efficacies of certain medicinal plants, under emergency conditions. Zaguirre gives suggestions as to where these plants may be found and how best they are administered. Efficacy was essentially measured by trial and error and the TED (Therapeutic Effective Dose) gathered from the bedside (1944). According to Zaguirre, the normal process of screening was not followed due to the urgent need to test for alternative local herbal resources to replace scarce imported drugs at the time. This paper was again circulated in 1949 primarily among the Medical Field Service School of the Armed Forces of the Philippines, targeting medical officers. It saw its final publication in 1955. Dr. Jocelyn Cruz, in her paper entitled Herbal Medicine-A Viable Alternative for the Filipino People (1985), documents early pharmacologic tests undertaken by Dr. Alfredo C. Santos way back in 1927, in which he was able to isolate the alkaloids of Phaeantus ebracteolatus (kalimatas), but that no attempts to put it to therapeutic use were ever done. Other scientific pharmacological tests followed but efforts of researchers were not directed nor managed in a systematic way, perhaps through a lack of a national programme. Cruz credits the National Integrated Research Program on Medicinal Plants (NIRPROMP) for fast-tracking the development of the herbal medicine industry in the Philippines. It was established to identify priority needs and coordinate efforts to systematize the study of medicinal plants (Cruz 1989). The program identified two immediate drug needs: the need to distribute medicines within the reach of most Filipinos, and the need to discover new or better drugs for common diseases in the Philippines. To address the urgency of the situation, a rapid screening process to study the efficacy and safety (toxicity) of medicinal plants was developed. Only plants that have passed this initial screening were tested further in agricultural, pharmaceutical and clinical trials (1989).

This literature review looked at pharmacological studies that had been done at the Departments of Pharmacology of the University of the East Medical Center and U.P. Manila. Both schools have ongoing programmes to test the efficacy and toxicity of certain plants, results of which comprise a sizeable databank of medicinal plant pharmacology. This database is supplemented by studies undertaken by the Philippine Council for Health Research and Development (PCHRD), which are available through HERDIN, an online bibliographic database of health literature in the Philippines. There are approximately 2,000 records on traditional medicine in HERDIN, comprised mostly of journal articles, research reports, papers and conference proceedings. D. Mainstreaming Traditional Medicine With the passing into law of the Traditional and Alternative Medicine Act (TAMA) in 1997, there have been attempts to promote traditional medicine within the larger, Western dominated biomedicine culture established in the Philippines. There have been efforts to sustain this initiative at conceptual and practical levels, primarily for three reasons: 1) majority of the poor in developing countries such as the Philippines have little or no access to primary health care, 2) a medical culture based on Western biomedicine is expensive, and 3) Western medical philosophy has limited room for acknowledging the psychosocial, cultural and religious basis of traditional or indigenous health knowledge systems. Segismundo (1994), in a paper entitled Filipino Traditional Medicine and the Development of a Relevant Health Care System, presented during the 2nd Asia-Pacific Social Science and Medicine Conference in Manila, critiqued the inadequacies of the Philippine health care system: the same problems continued to plague the country 80% of the population suffered from communicable but preventable diseases, diseases of the heart and malignant neoplasms were on the rise, and infant and maternal mortality rates were high at 50.3 and one per 1000 live births respectively (Tan 1991, in Segismundo 1994). She urged the examination of other health care delivery models more appropriate to our cultural setting, since health cannot be isolated from its socio-economic, political and cultural context (1994). She cites Philippine efforts in the 1970s mainly through NGOS and the CBHPs, which attempted to integrate traditional medicine in their activities, and the Department of Healths (DOH) institutionalization of traditional medicine into the Philippine Health Care Delivery System, in 1992. Five other government agencies were also promoting traditional medicine in collaboration with the DOH. Segismundo however believed that more work needed to be done if traditional medicine was to break out of its inferior label (compared to western biomedicine). In this respect, the Community Medicine Development Foundation, Inc. (COMMED) took up the challenge to retool its doctors to make them more effective as community doctors (1994). They were taught how to document, appreciate and integrate traditional medicine into their local health strategies. Segismundo urged the exploration of frameworks more appropriate for the Filipino consciousness (1994), She enumerated examples from Abaya, Osteria and Bennagens community health work. Castro-Palaganas, et. al. (2001) presents a discussion of the problems in primary health care delivery in the Philippines where Government has failed in ensuring access to this basic service in the Cordillera region, home to more than 12

million indigenous peoples (IPs). Because of this, IPs have increasingly turned to indigenous health knowledge and practices for their health care needs (2001). The study entitled, Mainstreaming Indigenous Health Knowledge and Practices is one of the more recent documentation of indigenous health knowledge in the Cordillera region meant to record and validate certain traditional health practices. It was undertaken mainly to address the threat facing traditional health knowledge, that they face the threat of oblivion as younger generations are secularized and modernized rather than socialized into their indigenous culture (2001). The study focuses on the Kankana-ey women in Badeo, Kibungan, Benguet Province, in northern Philippines. A specific focus the book is on indigenous notions of health or kasalun-alan and the womens life cycle. Womens health is given emphasis in the study, as recognition of their role as culture and knowledge bearers with regards to health in general (2001). An analysis of the health situation in Badeo was also presented, supported with statistical tables on selected health indicators. A discussion of the programmatic aspects of primary health care support by donor agencies such as the WHO and the World Bank, and the effects of policy on community health services is also discussed. To counter the threat of a decline in oral traditions, traditions that have in the past ensured the intergenerational transfer of indigenous health knowledge, CastroPalaganas, et. al. encouraged the improvement of school curricula to integrate traditional medicine practices, as well as to encourage the academe to initiate dialogues and trainings to preserve herbal cures (2001). Mainstreaming indigenous health knowledge can also be attained if Local Government Units (LGUs) integrate traditional medicine practices in their local primary health delivery programmes. Devolution of health services has given LGUs the options to develop more culturespecific programmes. As attempts to integrate traditional medicine within the formal health delivery system were taking off, scientific surveys were undertaken to get big picture data on different aspects of traditional medicine systems. First of these surveys was a study on Traditional Medical Practitioners (TMPs) by Michael L. Tan (1992). The study revealed that the Philippines has a significant number of TMPs (1992). The study also showed that there were different types of traditional medical practitioners, and they may be grouped into two categories: the empirical (users of medicinal plants) and the magico-religious (act as medium for spirits; use prayers and sacrificial offerings like atang). Fifteen provinces and 108 barangays were surveyed. Findings showed that there was an average of 5.65 TMPs per Barangay or a ratio of 1 TMP for every 320 people. Individual, in-depth interviews were conducted among 224 TMPs. Data on socio-geographic characteristics, skills acquisition, methods of diagnosis and healing, and validation were gathered for the survey (1992). In 1992, the DOH endorsed ten medicinal plants (after scientific testing for efficacy and safety), through its Traditional Medicine Program. In 1998, the National Statistics Office (NSO), undertook the National Demographic and Health Survey (NDHS). The survey aimed to collect statistical data on levels and trends in demographic and family planning indicators (1998, 2003). Specifically, data on fertility, family planning, childhood and adult mortality, maternal and child health and knowledge and attitudes related to HIV/AIDS and other sexually transmitted diseases (2003) were gathered. A section on Traditional Medicine was included in both the 1998 and 2003 surveys. Respondents were asked regarding their familiarity with the ten

endorsed medicinal plants as well as their perceptions on their intended use (NDHS 1998). Results showed that respondents were most familiar with the medicinal uses of guavas and garlic (1998). The 2003 NDHS showed a relative improvement in medicinal plants use, as compared to the 1998 NDHS. For example, awareness levels for ampalaya as a cure for diabetes mellitus increased from 5 percent in 1998 to 44 percent in 2003. Quality of data for traditional medicine also improved with the 2003 NDHS wherein data on familiarity, as well as use, are presented. Northern Mindanao and the Autonomous Region of Muslim Mindanao (ARMM) posted the heaviest usage of herbal medicine. Guavas were used in at least 80 percent of households in ARMM, while garlic was used in 57 percent of households in Northern Mindanao (2003). The production of various medicinal plants handbooks by government, NGOs and academic institutions also helped bridge the information and knowledge gap among health and community workers. Most of these handbooks contained information on medicinal plants and their therapeutic uses, aimed at reeducating health workers, trainors and community members in the importance of traditional medicine resources. As handbooks, they are written in a simple, easy to understand format, and translated in the local dialect and illustrated. Examples of these handbooks are Lampuyan: Ideas for Community Projects on Medicinal Plants (1980) by AKAP, a community health NGO; Mga Halamang Panggamot (1985) by LIKAS of the Center for Community Services, Ateneo de Manila University; and Medicinal Plants (A Compilation, Part 1) by Molino-Barrios for the Capiz Provincial Hospital (1983). Fully illustrated, these handbooks are important information resources to aid in the education of people on the value of our indigenous plant resources, and thereby slowly integrating this important resource into the bigger Philippine medical culture.

V.

Conclusion and Recommendations

Ethnographies provide a wealth of information regarding indigenous or traditional health knowledge systems. They are invaluable records of the holistic, cultural and environmental context in which these health systems work. The academe, in collaboration with the Department of Health and other government agencies are sources of these information materials. Publications on plant inventories, as handbooks or academic reference books have been produced by health NGOs as well as the academe. LGUs also produce their own materials in their own local dialects. Pharmacologic studies had been undertaken either by commissioned scientists, academic laboratories or as term papers of students in pharmacology. Generation of field data on traditional medicine use is improving, with data from two surveys of the NDHS (1998 and 2003) documenting knowledge of and actual use of, herbal medicines. However, experts in the field of social and medical anthropology observe that there is no synchronized research agenda on traditional medicine and that research undertakings are highly disparate. According to them, while there are a good number of literatures or studies that are focused on documenting medicinal herbs and their

pharmacological values, or those cataloguing local beliefs and practices, there is a dearth of literature in the country that seek to arrive at a cognitive framework that establishes the socio-anthropological context of these beliefs and practices, including the use of materia medica. They stress the need for more theoretical and interdisciplinary studies that link traditional medicine to discourses in culture theory or social theory. Such admonition is being made in the absence of a strong medical anthropology program, in any major university, that is vital in processing and managing traditional health knowledge, and at a time when the elders who are knowledgeable in indigenous healing are considered an endangered specie. Other palpable gaps in knowledge generation and management that need to be addressed include the following: the need for studies that will enable government as guardian of health and safety to act towards the folkloric-commercial sector especially with this sectors use of the media in promoting commercial products like dietary supplements, or in propagating beliefs that have no sound foundation; the need to give back to the communities the learning on traditional health knowledge systems by way of: a culture-sensitive packaging and dissemination of: a) health education message for the communities, including indigenous communities; and b) how traditional health knowledge can be use in primary health care in rural villages, including lowlands; and the need to establish and disseminate the processes by which communities themselves can document their knowledge;

It is hoped that the National Unified Health Research Agenda which is now being developed will address these issues.

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College of Social Sciences and Philosophy University of the Philippines-Diliman, 1996. ____________. Usug, Kulam, Pasma: Traditional Concepts of Health and Illness in the Philippines. Quezon City: Alay Kapwa Kilusang Pangkalusugan, 1987. Published Proceedings Segismundo, Chona H. The Filipino Traditional Medicine in the Development of a Relevant Health Care System. In Meeting the Health Challenges of the 21st Century: Proceedings of the Asia-Pacific Second Social Science and Medicine Conference Held in Manila 23-27 May 1994. Unpublished Materials Planta, Ma. Mercedes G. Traditional Medicine and Pharmacopoeia in the Colonial Philippines, 16th to the 19th Centuries. Masters thesis, University of the Philippines-Diliman, 1999. Sia, Isidro, et. al. Documentation of 15 Ethnolinguistic Groups in the Philippines. Research report, University of the Philippines-Manila, [no date}. Zaguirre, Jaime C. Some Emergency Bedside Preparations of Most Common Local Medicinal Plants. University of the East Medical Center Library, 1944.

Electronic Sources IDRC 2005. Readings on Indigenous Knowledge: An Overview. Retrieved July 23, 2005, from: http://web.idrc.ca/en/ev-3216-201-DO_TOPIC.html Gorjestani, Nicolas 2000. Indigenous Knowledge for Development: Opportunities and Challenges. Retrieved October 10, 2005, from http://wb.org

Websites SciDev.net IKPages Biodiv.org