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Q’eqchi Ethnobotany and Ethnopharmacology: Results of an Investigation on Women’s Health and Implications for Youth Engagement towards the Conservation of Traditional Medicine J. Michel1, G.B. Mahady2, D.D. Soejarto2, M. Kelley3, R.E. Duartex, Yue Huang2, J. Orjala2, M. Veliz4 and A. Cáceres4 1 University of Illinois at Chicago (UIC) College of Medicine, Chicago, Illinois, USA 2 UIC College of Pharmacy, Chicago, Illinois, USA 3 UIC School of Public Health Chicago, Illinois, USA 4 Universidad de San Carlos Guatemala City, Guatemala Keywords: ethnopharmacology, Piperaceae, Piper hispidum, serotonin Abstract
The present study was a collaborative research project with the Q’eqchi Maya of Livingston, Izabal, to explore the influence of sociocultural factors on the health and well-being of Q’eqchi women and the role of plant medicines in treating women’s health conditions. Data were obtained through participant observation, semi-structured interviews, focus groups, and plant walks with 50 Q’eqchi community members from four principal rural villages and Ak’Tenamit, a local nonprofit organization. Results suggest that traditional roles and perceptions of women in these communities affect community attitudes towards women’s health and health conditions, limit a woman’s access to health care, and influence her health-seeking behavior. Medicinal plants play a significant role in the treatment of conditions related to menstruation and pregnancy, yet data suggest that gender, age, and social rank influence medical knowledge and plant selection. A total of 47 plants belonging to 26 families were documented, with the most prominent plant families being Piperaceae (15%) and Lamiaceae (8%). In providing in vitro biological support for the traditional Q’eqchi uses of plants to treat women’s health issues, 17 plants were submitted to in vitro biological analysis in serotonin bioassays. With one of the highest in vitro activities, Piper hispidum underwent additional phytochemical analysis leading to the isolation of a new compound that showed additional serotonergic activity. In an effort to sustain and foster local interest in traditional medicine, ethnobotanical findings were compiled into an educational curriculum and conservation field guide presented to a local Q’eqchi school. The results of this preliminary work support the traditional use of these plants by the Q’eqchi, justify further research on the use of Latin American herbal remedies for women’s health, and underscore the importance of involving youth in medicinal plant research and traditional medicine conservation efforts.
INTRODUCTION
Guatemala is one of the most ethnically diverse countries in Central America. Indigenous people make up over 41% of the population nationwide (PAHO, 2007). The majority of Guatemala’s indigenous population resides in rural areas with limited access to health care services, rendering health outcomes in this population among the worst in Latin America (PAHO, 2007). The Maya account for 95.7% of the indigenous population in Guatemala (PAHO, 2007; WHO, 2002). The majorities of them reside in rural areas, and rely on a subsistence lifestyle of corn and bean farming. In respect to women’s health, being both indigenous and female, one could say that Maya women are the most marginalized and oppressed population in the nation. According to the Pan American Health Organization (2007), 80% of rural Maya women live in extreme poverty and only 17% receive prenatal care. Furthermore, studies within Guatemala estimate that more than 80% of rural births are attended exclusively by a traditional midwife, and that rural Guatemalans rely almost exclusively on herbal remedies during all stages of their life (Cáceres, 1996; Orellana, 1987; Villatoro, 1996). Yet, both within individual households
Proc. IS on Medicinal and Aromatic Plants – IMAPS 2010 and “History of Mayan Ethnopharmacology” – IMAPS 2011 Eds.: J. Ghaemghami et al. Acta Hort. 964, ISHS 2012
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as well as government health care agencies, women’s health issues continue to come last. Furthermore, with the exception of the research of Cáceres and co-workers that explored the anti-Candida, anti-gonorrheal, and diuretic activity of selected plants (Cáceres et al., 1987, 1995; Giron et al., 1988), few research studies in Guatemala have systematically explored the safety and efficacy of herbal remedies used in women’s health.
The Q’eqchi, also written as “Kekchi”, “K’ekchi”, “Keqchi”, or “Kekche”, are currently the third largest Maya population in Guatemala (700,000) and occupy the largest geographic area of any other ethnolinguistic group in the country (Instituto Nacional de Estadisticas, 2002). Like most Maya communities, the Q’eqchi of the eastern lowlands (Izabal) maintain a rich tradition of medical beliefs and practices that include the use of the native flora to treat a variety of illnesses. Compared to the numerous ethnographic and ethnobotanical studies on the Q’eqchi from the highlands (Cabarrus, 1998; Carlson and Eachus, 1978; Coe, 1999; Collins, 2001; Hatse and De Ceuster, 2001; Siebers, 1998; Wilson, 1995), few studies have focused on the lowland Q’eqchi (Amiguet et al., 2005; Arnason et al., 1980; Collins, 2001; Comerford, 1996) and, prior to the work of this author (Michel, 2006, 2007, 2010), there are no other known ethnobotanical studies of the Q’eqchi from the eastern lowlands of Livingston, Izabal.
Due to the limited number of interdisciplinary studies on the ethnobotany of the Q’eqchi Maya as well as the limited number of biological and phytochemical studies of medicinal plants used to treat women’s health conditions in Guatemala, this study sought to explore Q’eqchi perceptions, attitudes, and treatment choices related to women’s health followed by the biological and chemical investigation of the medicinal plants commonly used. The desired outcomes of this investigation include: to explore the influence of sociocultural factors on the health and well-being of the Q’eqchi women, to provide scientific support for traditional Q’eqchi medical knowledge related to women’s health issues using results of in vitro bioassay and chemical analysis, to involve, inspire and empower Q’eqchi youth to learn and maintain traditional knowledge and preserve the habitat of valuable medicinal species.
METHODS Study Site
The Municipality of Livingston is located in the eastern department (state) of Izabal, a region characterized as “a very humid tropical rainforest” (Holdridge et al., 1971). Livingston sits along the Gulf of Honduras and connects to the Rio Dulce River that serves as the main transportation “highway” to the majority of Q’eqchi communities in the region. With modern healthcare services lacking in most villages, the Q’eqchi must often walk hours through the dense forest to arrive at the banks of the river followed by several hours traveling by dugout canoe or motorboat to arrive at the nearest health clinic.
Collaborative Agreements and Permits
This research was developed as part of a collaborative project between the University of Illinois at Chicago (UIC), the University of San Carlos (USAC), and Asociacion Ak’Tenamit. A Memorandum of Understanding (MOU) was signed between the two universities and supported by Asociacion Ak’Tenamit. Ak’Tenamit is a Q’eqchi-run nonprofit organization that offers education, sustainable agriculture, healthcare, and alternative income generation options for Q’eqchi communities (www.aktenamit.org). One of the authors (J. Michel) served as the Director of Agriculture for Ak’Tenamit from 1998-1999. The relationships of trust built during this time and the annual visits thereafter (1999-2003) formed the basis of informant selection and participation. Institutional Review Board (IRB) approval from UIC as well as plant collection permits from the Guatemalan National Council on Protected Areas (CONAP) were also acquired prior to initiating research.
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Interviews Information from community members is based on unstructured and semi-
structured interviews, participant observation, plant walks, and focus groups related to women’s health conducted during 8 months of fieldwork while on a Fulbright Fellowship (JM). Among the approximately 45 Q’eqchi villages in the Livingston area, four were selected based on their geographic separation from each other and previous contacts made with village women, elders and healers. The “snowball technique” in ethnography was then used to contact friends and family members of each collaborator (Browner et al., 1988). Semi-structured interview questions and focus group guidelines were developed using previous ethnographic reports on Q’eqchi culture (Parra Novo, 1997; Wilson, 1995), field studies related to women’s health (Berlin and Berlin, 1996; Browner, 1985; Castaneda et al., 1996; Lock, 1998), and bibliographic materials on ethnobotanical interview techniques (Alexiades, 1996; Browner et al., 1988). Questions were formulated to explore cultural attitudes towards women’s health and the use of local plants to treat common women’s health complaints related to menstruation and menopause. Plant walks were conducted mostly with traditional healers. During these walks, medicinal plants would be pointed out by the healer as we passed by them. The healer would then explain the medical use of each plant, and how each is prepared and administered. The investigator would take detailed field notes, collect 3-5 plant specimens, and place them in a plant press for identification purposes.
Interviews were conducted in Spanish by the first author and translated into Q’eqchi by a local interpreter, if needed. Interviews began by collecting demographic data on each informant (e.g., age, gender, occupation). Each participant was then asked to share their thoughts about the role of women in their village, any beliefs surrounding women’s health, specifically menstruation, pregnancy, and menopause, and to verbally list plant species they were familiar with for treating women’s health conditions. Interviews lasted anywhere from 30 min to 2 h. (For further details on interview methods and results, refer to Michel et al. (2006)).
Plant Collection and Identification
For each species, detailed field notes on location and morphological characteristics of the plant were taken, as well as information on the preparation, use, and administration of the plant as described by the informant. Whenever possible, five herbarium specimens were prepared for each plant collected, and voucher specimens were deposited and identified at the Herbarium of the School of Biology (BIGU) at the USAC and the John G. Searle Herbarium of the Field Museum in Chicago. At the time of herbarium specimen collection, 100-500 g quantity of plant material was collected, for species that were abundantly available, and then dried in a solar herb dryer for biological and chemical analysis.
Plant Extraction
Samples of 12 of the 48 plants, in amounts of 100-200 g dry weight each, were used for initial biological screening. Plant material was air dried, sifted, and hand-ground in Guatemala using a metal sifter. Sifting was followed by the extraction of approximately 100 g of each dried plant sample with 500 ml of 95% ethanol in a metal percolator. This process was repeated three times in order to exhaust the extraction process. Each aliquot was filtered, combined, and dried under negative pressure on a Buchi rot vapor at temperatures below 40°C, maintained by a water bath. Extracts were stored in small amber glass bottles in a dark refrigerator and then shipped to the College of Pharmacy at the University of Illinois at Chicago for in vitro biological testing at MDS Pharma Services in Bothell, Washington or the Research Center for Botanical Dietary Supplements at the University of Illinois at Chicago, College of Pharmacy.
Serotonin Receptor Binding Assays
The serotonin assay measures the ability of plant extracts to inhibit the binding of
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a radio-a labeled ligand to the serotonin receptor. The presence of such inhibition would indicate that there may be a constituent within the plant that has binding affinity for that receptor. Radioligand binding studies for the serotonin subtypes 5-HT1A and 5-HT5A were performed according to procedures described by Rees et al. (1994) with the purpose of determining the binding activity of ethanol extracts compared to [³H]5-carboxamidotryptamine (5-CT). For the 5-HT7 receptor-binding studies, [³H] LSD was used to measure the binding ability of ethanol extracts. Cell culture conditions, membrane preparation, and assay procedures for this assay were performed at UIC according to methods previously described (Burdette et al., 2003). Details of bioassay procedures are described in detail in Michel et al. (2007).
RESULTS Attitudes and Perceptions Related to Women’s Roles and Women’s Health
Complete results of qualitative data are detailed in Michel et al. (2007). To summarize, a total of 25 Q’eqchi men and 25 women were interviewed, including 5 traditional male healers (“curanderos”) and 4 midwives. Women are seen to have an inherently weaker biological constitution than men, specifically in relation to the experiences of menstruation and pregnancy. Many Q’eqchi also believe that the ‘hot’ blooded condition that accompanies menstruation and pregnancy may affect those that come into contact with her. Consequently, menstruating and pregnant women are often instructed to refrain from participating in certain social activities, from serving food, and from eating certain ‘hot’ foods that would aggravate their constitution. These findings are similar to those identified in other cultures worldwide (Van de Walle and Renne, 2001). Several Q’eqchi women also mentioned that they must ask their husband’s for permission and money to go to the doctor. If they were experiencing issues of gynecological concern, their husband was likely to believe she was being unfaithful in the marriage. Consequently, these women commonly preferred to delay treatment or to try to treat the condition at home, rather than suffer the verbal, and often physical, abuse that accompanied accusations of adultery. Furthermore, their weakened state is believed to make them unsuitable to undergo the rigorous training to become a traditional healer (“curandero”). Curanderos must often venture into the dense forest to collect native medicinal plant species. The Q’eqchi explained that strong spirits also reside in the forest and that a woman’s weaker constitution creates an emotional weakness that would make her susceptible to falling ill to negative energies. Consequently, only men, those who have received the appropriate training, were reported to go into the forest to collect and prescribe native medicinal species. Whereas women interested in the healing profession become midwives, a practice that has become highly biomedicalized in Guatemala (Villatoro, 1994).
Generational Differences in Attitudes towards Women’s Health Education
Preliminary results indicated that attitudes and perceptions related to women and women’s health differed significantly by age group (Michel et al., 2007). The Q’eqchi elders (48 years and older; N=10) had no formal education and were the group who adhered most strictly to traditional Q’eqchi Maya beliefs, which included taboos around discussing women’s health issues. Such matters were considered “too sensitive for young ears” and the youth “too immature” to deal appropriately with such information until they grew older. “They would think it is a joke”, explained one curandero. Elders had a larger repertoire of herbal remedies than the younger age groups, most of which were native wild or cultivated species. Q’eqchi women; mothers and grandmothers, ages 26-47 (N=20), had limited formal education (3rd grade) and most were monolingual (Q’eqchi). These women felt uncomfortable, and initially resistant, when discussing their own health concerns, symptoms and biology. As young women, they had not been told about menstruation, pregnancy, or menopause until they began having symptoms. They felt that not knowing to anticipate symptoms created anxiety around the notion that they could
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signify a more serious condition. They were glad that their children were learning about human biology and physiology in school. Ten young Q’eqchi women (18-25 years old) who were attending Ak’Tenamit’s Tomas Moran School, participated in focus groups nightly for eight weeks. Human biology was a part of their curriculum, and they were much more open to speaking about issues of menstruation. Their knowledge of herbal remedies, however, was limited to the category of menstruation (the one condition they all had experience with) and a few herbs of European origin purchased in the local market (e.g., chamomile, mint, oregano).
Symptoms Related to Pregnancy, Menstruation, and Menopause
The Q’eqchi of Livingston view health as a composite of physical, mental, and spiritual well-being. For example, they believe that a woman’s relationship with her family, her community, and nature has a direct impact on her physical health. Q’eqchi causality of women’s health concerns are also affected by the hot/cold constitution of the body as mentioned earlier; a belief system found throughout Latin America (Hilgert et al., 2007; Tedlock, 1987). Q’eqchi women with ‘cold’ blood are believed to experience menstrual delay, menstrual pain, and menopausal symptoms. Whereas menstruation and pregnancy are ‘hot’ conditions that require cooling medical treatment, menopause is considered a ‘cold’ condition which requires ‘hot’ plant medicines in order to restore balance. A difficult pregnancy and childbirth, multiple births, and an early menarche were also associated with subsequent menstrual pain and debilitating menopausal symptoms. The most common symptoms mentioned related to women’s health complaints included menstrual pain (28%), childbirth (20%), and anemia (11%) (Fig. 1).
Plant-Based Treatments Related to Women’s Health Concerns
A total of 47 plants belonging to 26 families of flowering plants were mentioned for their use in treating a variety of women’s health complaints. 31 species were collected in the field and identified as mentioned previously (Table I). 17 of the 47 plants either could not be located or collected in the field, or were plants found only in the market (Table 2). Market plants were available in bulk, without the presence of fruits or flowers for identification purposes. Table 2 presents the list of probable taxonomic identity of these 16 plants based on the correlation of their common name, use, and the geographic location compared to information from previous publications (Balick et al., 2000; Cáceres, 1996; Orellana, 1987) as well as that found by viewing voucher herbarium specimens stored at the Field Museum of Natural History in Chicago (Standley and Steyermark, 1946).
Results of plant collections were further analyzed using chi square analysis (SPSS) to explore the relationship of healer status and gender on knowledge, selection, and use of medicinal plants. Although the number of plants mentioned by the five male healers (24) and 5 female midwives (31) was not significantly different, the species mentioned by these two groups were found to be significantly different (p<0.01). These 10 healers mentioned a total of 45 plants for women’s health compared with 22 plants mentioned by 40 community members. There was only an 11% overlap between plants mentioned between healers and non-healers.
In relation to plant habitat selection, midwives and community members were more likely than traditional curanderos to utilize medicinal plants that are cultivated (40, 44, 3% respectively), purchased from the market (27, 15 vs. 0%), or collected from open fields (13 and 15, vs. 8%). Curanderos were much more likely than midwives or community members to use medicinal plants native to the area and found only in secondary forest habitats (89 vs. 20 and 26%, respectively) (Fig. 2).
Bioassay Results
17 species were submitted to in vitro serotonin binding assays. Nine species were found to bind to the 5-HT1A receptor, with activity defined as greater than 50% binding at a concentration of 50 μg/ml. At 88%, Cissampelos tropaeolifolia showed the strongest
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binding affinity. Five species displayed significant binding to the 5-HT5A receptor with Cephaelis tomentosa (78%), Piper hispidum (76%), and Hibiscus rosa-sinensis (70%) being the most active extracts. 10 species bound to the 5-HT7 receptor. Piper hispidum (96%), Cissampelos topaeolifolia (94%), and Hyptis verticilata (89%) showed the greatest binding affinity (Table 3).
Isolation of a New Fadyenolide from P. hispidum
Based on the high binding affinity of P. hispidum to the serotonin receptor, further phytochemical analysis was conducted on this species with the aim of identifying compounds that may be responsible for such in vitro activity (Michel et al., 2010). Briefly, bioassay-guided 5-HT1A and 5-HT7 binding data showed that the EtOAC partition of P. hispidum was the most active, with displacement of [3H]-LSD and [3H]-OH-DPAT binding from the 5-HT7 and 5HT1A at 63-96%, respectively, at a concentration of 50 µg/ml.
The ethyl acetate partition (17 g, 2.8%) was consequently loaded onto a 2-L silica gel 60 reverse-methanol-water gradient (50-100% MeOH) to give six fractions that were then combined based on TLC analysis to yield a colorless precipitate. This precipitate was then re-crystallized from methanol/water (70:30) to afford a purified compound identified as 9, 10 methylenedioxy-5,6-Z-fadyenolide (48 mg), as determined by LR-LC-MS, NMR (Fig. 3).
Youth Engagement
The elder Q’eqchi, as well as all of the curanderos who were interviewed, mentioned the loss of traditional medical knowledge among the Q’eqchi youth. None of the curanderos had been successful in recruiting any of their own children or anyone in the community to learn their healing methods and to train to become a healer. Common reasons given included a greater interest in modern technology, a desire to leave the village to work ‘in an office’, and adversity to the extreme physical and psychological challenges of needing to be ‘on call’ at any time of day or night (which often requires hours hiking through the forest in the middle of the night during the rainy season to attend to a patient; often without the aid of a flashlight). The risk of being stung or bitten by a venomous animal while in search of medicinal plants (especially increased if the appropriate spiritual prayers were not made prior to collection) was also frequently mentioned as an undesirable risk for youth to learn the traditional medicine trade.
Upon completion of research collection and analysis, efforts were made by the lead author to increase youth interest in learning and maintaining the medical beliefs of their elders and healers. Using the Rapid Color Guides as a model (created by Robin Foster, Environment and Conservation Programs, the Field Museum of Chicago, IL.), laminated flash cards were created with pictures of the most commonly mentioned native medicinal plants. On the reverse of each card was printed the Latin binomial as well as the common Spanish and Q’eqchi terms for each plant, the habitat of the plant, and the statement: “this is a valuable resource for your healer, kindly respect it!’ An ethnobotanical curriculum was also initiated in collaboration with the Ak’Tenamit Tomas Moran Middle School. Curriculum contents included weekly instruction on the basics of plant identification, collection, and storage. Youth ages 15 and above were asked to develop their own questionnaires regarding plant use in their community and to interview individuals over the weekend. The goal of developing this curriculum was to utilize modern methods of scientific inquiry to inspire, support and encourage Q’eqchi youth to explore local beliefs and customs, thereby taking on positions of leadership both in the pursuit of academic advancement as well as being stewards of Q’eqchi traditional beliefs and systems.
DISCUSSION AND CONCLUSION
Although the collective TM knowledge of the Q’eqchi Maya of Livingston is extensive, at the time this research was conducted, none of the elders or curanderos that
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were interviewed had an apprentice. Considering the oral tradition of this knowledge, as eloquently stated by Mark Plotkin, “Every time one of the old shamans dies, it’s as if a library has burned to the ground” (Plotkin, 1994). Recognizing the lack of knowledge and interest among Q’eqchi youth in preserving and continuing the extensive and valuable traditional knowledge of their elders, the idea emerged to develop an ethnobotanical curriculum for Q’eqchi adolescents. The curriculum would provide Q’eqchi youth with the knowledge and the tools needed to become the ‘researchers in action’, with the intent being to re-establish local value for traditional plant knowledge and to recognize the contribution such knowledge can make towards environmental and cultural preservation (Frey and Cross, 2011). This effort to enrich local youth in TM is in congruence with the overall efforts of the Ak’Tenamit Tomas Moran School which is to appropriately and thoughtfully incorporate aspects of modernity (e.g., access to emergency biomedical care, contemporary education pedagogy) with traditional Maya ways of life (e.g., plant-based medicines, traditional Maya ceremonies and music) in order to improve the overall well-being of these isolated rural communities. We currently do not know whether this curriculum was implemented by the local teachers and if the curriculum has made an impact on sustaining and preserving traditional Q’eqchi medical practices in the area.
Reviews of ethnobotanical literature published over the past several decades have shown that the majority of studies have been descriptive in nature, being concerned primarily with documenting the local names and uses of plants (Cultural Survival, 2010; Paulino de Albuquerque and Hanazaki, 2009; Reyes-Garcia, 2010). Such studies are often criticized for their limited return value to the people who provided such information (Etkin and Elisabetsky, 2005). Perhaps in response to this, a more contemporary branch of ethnobotany has begun to emerge; ‘applied ethnobotany’ defined as ethnobotany as it relates mostly to conservation and sustainable development (Cunningham, 2001). These efforts are often cross-disciplinary, participatory, and geared towards local problem-solving (Hamilton et al., 2003) as it relates predominantly to sustainable land-use (forestry or agriculture), and the development of health foods, pharmaceuticals, or herbal medicines for economic development (McClatchey et al., 2009). Efforts that encourage local youth to participate in documenting and preserving traditional knowledge and plant-based medicines and to explore their impact on the health of their community may strengthen efforts to return benefits in locally relevant, sustainable, and applied ways.
In relation to women’s health, based on the findings of this research, we can conclude that the health of the women in these Q’eqchi villages and the impact on the health of the community is often overlooked and undervalued. Similar arguments have been made in the literature suggesting that, although “women collectively hold the majority (possibly the vast majority) of knowledge about the world’s plants”… “today, when it is perhaps more important than ever, women’s knowledge and management of plant biodiversity are underestimated and undervalued” (Howard, 2006). Overall, ethnobotanical research in Latin America on the sociocultural aspects of women’s health, herbal medicines used to treat female conditions, and the role of women as healers and plant conservationists is largely absent (PAHO, 1999; Howard, 2006). The lack of such data is due, in part, to the historical male dominance of the field, which did not allow researchers to enter the often tabooed topics and practices related to women’s health (Alexiades, 1999; Duke and Vasquez, 1994). As more and more women enter the field of ethnobotany, sensitivity to what Patricia Howard calls “gender bias” has begun to increase as has the recognition, not only for the important role of women in traditional medical knowledge, but also for the difference in ethnobotanical results that can emerge based on the gender of the researcher themselves (Howard, 2006).
In the current research, the prominent role of Piperaceae in both the plants used to treat women’s health complaints as well as the list of plants found to be active in serotonin in vitro bioassays is interesting to note. A recent study among the Q’eqchi Maya of the nearby Toledo district of Southern Belize reflected similar prominence of Piperaceae in relation to psychological conditions (Bourbonnais-Spear et al., 2005) and the resultant activity of such plants in GABA bioassays (Awad et al., 2009). Considering
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the strong correlations between fluctuations in the gonadal hormones estrogen, testosterone, and progesterone and levels of serotonin and gamma-amino butyric acid (GABA), we can conclude that there may be a significant overlap in plants used to treat both women’s health complaints and psychological conditions. Also, these correlations deserve further study. Such findings further underscore the need to more fully explore the psychological aspects associated with such conditions and how they may impact not only women’s health but also the health of their greater community.
Although finding ethnobotanical research in the global public health literature is rare, when one considers the potential impact of applied ethnobotany to human and environmental health, the contributions ethnobotany can make to public health is evident. Indeed, although not termed ‘ethnobotany’ per se, the past ten years has seen an increased recognition of the role plants and traditional medicine play in public health and their impact on health outcomes (Bodeker and Kronenberg, 2002; Alves and Rosa, 2007). Much of this interest stems from the growing popularity of traditional medicine (TM) and complementary and alternative medicine (CAM) worldwide, as well as the recognition that about half of the population in industrialized countries, and as high as 80% in developing countries, use TM as their primary source of health care (WHO, 2002).
As a consequence, interest has been building for a policy framework for TM/CAM. The 2002-2005 WHO Traditional Medicine Strategy provided a framework to explore the public health impact of traditional medicine as the impact relates to four areas of focus: policy, safety, efficacy, and quality. Although the potential impact such a strategy could make on health outcomes is significant, one could argue that the focus on developing national or transnational regulatory efforts for herbal medicines has resulted in overlooking the local social, cultural, and political dimensions of traditional medicine (Bodeker and Kronenberg, 2002; Reyes-Garcia, 2010). For example, Latin America possesses areas of the greatest biodiversity worldwide while also maintaining some of the oldest and most well documented traditional medical practices that continue to serve as the primary sources of medical care throughout the region. Yet plant collection, monitoring and conservation laws, and regulation vary by country and are often poorly documented or enforced. How each country considers the intellectual property rights of indigenous communities and the equitable distribution of benefits arising from their contributions to conservation, research, and natural product commercialization is also poorly known. Yet these elements, missing from the international public health dialogue, lay the foundation for any future endeavors related to the intersection of traditional medicine and the health of the public in Latin America. Efforts to gather researchers, academics, public health practitioners, policy makers, community leaders, and traditional healers from throughout the Americas to discuss current and future regional policy initiatives geared towards conservation and indigenous rights may be helpful as the recognition of the role of TM in public health continues to become more evident.
Traditional medical beliefs and practices impact and will continue to impact public health practices and outcomes in Latin America (Bodeker and Burford, 2007). Documentation of the most prominent endemic plant families and species of the region needs to ensue, as do discussions regarding the regulation of medicinal plants use and conservation and the intellectual rights of indigenous populations. Included in this discussion should be the prominent role of women in local health care systems and the rapid loss of traditional knowledge among more contemporary youth. ACKNOWLEDGEMENTS
In addition to a US Fulbright Fellowship, this research was funded, in part, by NIH grant ATOO2381 awarded to G. Mahady. The contents are solely the responsibility of the author and do not necessarily represent the views of the funding agencies. We would like to thank the healers and community members of Livingston, Izabal and the generous support of Asociacion Ak’Tenamit.
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24
6
Tab
les
Tab
le 1
. Lis
t of
31 p
lant
spe
cies
col
lect
ed f
or th
eir
use
by th
e Q
’eqc
hi to
trea
t wom
en’s
hea
lth
cond
itio
ns.
Q’e
qchi
/ S
pani
sh n
ame
Par
t us
ed
Q’e
qchi
use
s F
amil
y S
peci
es/v
ouch
er n
umbe
r
Rax
Pim
L
f M
enor
rhag
ia, p
ostp
artu
m
hem
orrh
age
Aca
ntha
ceae
Ju
stic
ia b
revi
flor
a (N
ees)
Rus
by; J
M37
a
Num
ay P
im
Lf
Inso
mni
a, e
xces
s bo
dy h
eat
Aca
ntha
ceae
Ju
stic
ia fi
mbr
iata
(N
ees)
V.A
.W. G
raha
m; J
M16
Kam
ank
Lf
Dys
men
orrh
ea,
vagi
nal i
nfec
tion
A
ster
acea
e N
euro
laen
a lo
bata
(L
.) R
. Br.
; JM
31
Gua
rum
o
Lf
Exp
el p
lace
nta,
low
er w
omb,
in
som
nia,
ner
ves
Cec
ropi
acea
e C
ecro
pia
pelt
ata
L.;
JM26
Ra
Mox
L
f C
old
body
, bod
y ac
hes
Cel
astr
acea
e C
ross
opet
alum
euc
ymos
um (
Loe
s. &
Pit
t.) L
unde
ll; J
M13
C
ha c
ha
Lf
Dys
men
orrh
ea
Com
mel
inac
eae
Zeb
rina
pen
dula
Sch
nizl
.; JM
106
Sor
osi
Lf
Dys
men
orrh
ea
Cuc
urbi
tace
ae
Mom
ordi
ca c
hara
ntia
L.;
JM59
C
ocol
mec
a
Rh
Sta
gnan
t blo
od, a
nem
ia
Dio
scor
eace
ae
Dio
scor
ea b
artl
etti
Mor
ton;
JM
08
Bar
ajo
L
f D
ysm
enor
rhea
F
abac
eae
Cas
sia
reti
cula
ta W
illd
.; JM
30
Dor
mil
ona
Lf
Inso
mni
a F
abac
eae
Mim
osa
pudi
ca L
.; JM
57
Ver
bena
L
f R
elea
se p
lace
nta,
er
rati
c m
enst
ruat
ion
Lam
iace
ae
Hyp
tis
vert
icil
lata
Jac
q.; J
M05
Obe
j' L
f D
ysm
enor
rhea
, va
gina
l hem
orrh
agin
g L
amia
ceae
O
cim
um m
icra
nthu
m W
illd
.; JM
04
Utz
Uj
Lf,
Fl
Pos
tpar
tum
hem
orrh
agin
g,
infe
rtil
ity, n
erve
s M
alva
ceae
H
ibis
cus
rosa
-sin
ensi
s L
.; JM
06
Mes
bel
Lf
Lab
or p
ains
, bur
ning
uri
ne
Mal
vace
ae
Sida
rho
mbi
foli
a L
.; JM
94
1 L
f= le
af, F
l = f
low
er, B
k= b
ark,
Sd=
see
d, R
t= r
oot.
246
24
7
Tab
le 1
. Con
tinu
ed.
Q’e
qchi
/ S
pani
sh n
ame
Par
t us
ed
Q’e
qchi
use
s F
amil
y S
peci
es/v
ouch
er n
umbe
r
Xa
bol q
’een
L
f P
ostp
artu
m h
emor
rhag
ing,
fe
rtil
ity,
blo
od c
lots
M
elas
tom
atac
eae
Cli
dem
ia p
etio
lari
s (S
chle
tctd
l. &
Cha
m.)
S
chle
ctdl
. ex
Tri
ana;
JM
63
Ixq
Q’e
en
Lf
Fer
tili
ty
Mel
asto
mat
acea
e C
lide
mia
set
osa
(Tri
ana)
Gle
ason
; JM
50
Ixq
Q’e
en
Lf
Fer
tili
ty
Mel
asto
mat
acea
e H
enri
ette
a cu
neat
a (S
tand
l.) W
illi
ams;
JM
100
Bej
uco
de
ombl
igo
Lf
Rel
ease
pla
cent
a M
enis
perm
iace
ae
Cis
sam
pelo
s tr
opae
olif
olia
DC
.; JM
39
Am
pom
L
f A
nem
ia, b
ody
ache
s P
iper
acea
e P
iper
aer
ugin
osib
accu
m T
rele
ase;
JM
25
Ob’
el
Lf
Dys
men
orrh
ea, g
alac
tago
gue
Pip
erac
eae
Pip
er a
urit
um H
BK
.; JM
03
Nin
qui
ru
chaq
’ q’
een
L
f B
ody
ache
s,
repo
siti
on w
omb
Pip
erac
eae
Pip
er d
iand
rum
CD
C; J
M45
Puc
huq
Lf
Dys
men
orrh
ea, a
men
orrh
ea,
body
ach
es
Pip
erac
eae
Pip
er h
ispi
dum
Sw
.; JM
32
Cai
te d
e D
iabl
o L
f In
flam
mat
ion,
“l
oss
of s
ense
s”
Pip
erac
eae
Pip
er tu
erck
heim
ii C
. DC
.; JM
14
Col
a de
Pav
o L
f B
ody
ache
s P
olyp
odia
ceae
C
amph
ylon
euru
m s
p.;
JM24
A
k P
ere
Tzo
’ L
f P
ostp
artu
m h
emor
rhag
ing
Rub
iace
ae
Cep
hael
is to
men
tosa
(A
ubl.)
Vah
l; J
M33
Kan
del C
he
Lf
Rep
osit
ion
wom
b, in
som
nia,
w
itch
craf
t R
ubia
ceae
R
onde
leti
a st
achy
oide
a D
onn.
Sm
ith;
JM
41
Nar
anja
Agr
ia
Lf
Ner
ves,
inso
mni
a, b
ody
ache
s, b
ody
swea
ts
Rut
acea
e C
itru
s au
rant
ium
L.;
JM27
“Com
o E
scob
illo
” L
f L
abor
pai
ns
Scro
phul
aria
ceae
Sc
opar
ia d
ulci
s L
.; JM
58
Chu
b Ix
im
Rh
Nig
ht s
wea
ts
Smil
acac
eae
Smil
ax d
omin
gens
is W
illd
.; JM
60
Hie
rba
Mor
a L
f A
nem
ia, a
men
orrh
ea
Sola
nace
ae
Sola
num
am
eric
anum
Mil
ler;
JM
72
Xin
xibe
er
Rh
Dys
men
orrh
ea, n
ight
sw
eats
Z
ingi
bera
ceae
Z
ingi
ber
offi
cina
le R
osco
e; J
M01
1 L
f= le
af, F
l = f
low
er, B
k= b
ark,
Sd=
see
d, R
t= r
oot.
247
248
Table 2. Recorded name and uses of plants as used by the Q’eqchi for women’s health
complaints but not collected. Q’eqchi/ Spanish name
Part used1
Q’eqchi uses Family2 Species2
Cotacam Lf Amenorrhea ? ? Culantro Lf Dysmenorrhea Apiaceae Eryngium foetidum L. Manzanilla
Fl Dysmenorrhea,
amenorrhea, insomnia
Asteraceae Matricaria sp.
Pericon Lf,Fl
Dysmenorrhea, amenorrhea
Asteraceae Tagetes lucida L.
Bak chayou/Achiote Lf Accelerate childbirth Bixaceae Bixa orellana L. Chacaj/Indio desnudo
Bk Vaginal infections Burseraceae Bursera simaruba L.
Papay/Papaya Sd Abortive Caricaceae Carica papaya L. Epazote Lf Dysmenorrhea Chenopodiaceae Chenopodium sp. Hierba del Cancer Lf Dysmenorrhea Euphorbiaceae Acalpha indica L. Orej/Oregano Lf Dysmenorrhea Lamiaceae Origanum vulgare L. Romero
Lf Dysmenorrhea Lamiaceae Rosmarinus officinalis
L. O’/Aguacate Sd Abortive Lauraceae Persea americana Mill. Pimienta gorda
Sd,Lf Dysmenorrhea,
facilitate childbirth Myrtaceae
Pimienta dioica L. Merr.
Pimienta negra Sd Facilitate childbirth Piperaceae Piper nigrum L. Yut-it/San Diego Lf Dysmenorrhea Piperaceae Piper peltatum L. Ruda
Lf Dysmenorrhea,
amenorrhea Rutaceae Ruta graveolens L.
Valeriana Rt Nerves, insomnia Valerianaceae Valeriana sp. 1 Lf= leaf, Fl = flower, Bk= bark, Sd= seed, Rt= root. 2 Probable identity.
249
Table 3. Results of in vitro serotonin binding assay for 17 Q’eqchi plants used for women’s health complaints.
Species/voucher number Plant Part
5HT1Aa
(%) 5HT5Aa
(%) 5HT7b
(%) Justicia breviflora JM37 Lf 72 43 70 Justicia fimbriata JM16 Lf 48 28 17 Neurolaena. lobata JM31 Lf NT NT 86 Cecropia peltata JM26 Lf 62 38 81 Hyptis verticillata JM05 Lf NT NT 89 Hibiscus rosa-sinensis JM06 Lf 61 70 NT Clidemia petiolaris JM62 Lf NT NT 44 Clidemia. setosa JM50 Lf NT NT 47 Henriettea cuneata JM100 Lf 55 43 NT Cissampelos tropaeolifolia JM39 Lf 88 51 94 Piper aeruginosibaccum JM25 Lf NT NT 82 Piper auritum JM03 Lf 66 68 83 Piper. hispidum JM32 Lf 63 76 96 Piper tuerckheimii JM14 Lf NT NT 72 Cephaelis tomentosa JM33 Lf 81 78 67 Rondeletia stachyoidea JM41 Lf 51 37 26 Smilax domingensis JM60 Rh 27 2 16
Lf = leaf; Rh = rhizome; NT = not tested. Figures
Fig. 1. Women’s health conditions most commonly mentioned by the Q’eqchi.
0
2
4
6
8
10
12
14
16
18
20
Anemia Childbirth Insomnia
Menopause Menstruation Muscle pains
Nerves Postpartum Pregnancy Urinary Vaginal infection