Pluralistic medical settings and medicinal plant use in rural communities, Mato Grosso, Brazil

2004·13.2 MB·English

by  Mello Amorozo De

Journal of Ethnobiology 139-161 Spring/Summer
24(1): 2004
AND
MEDICAL
PLURALISTIC SETTINGS MEDICINAL
PLANT RURAL
USE IN COMMUNITIES,
MATO
GROSSO, BRAZIL
MARIA MELLO AMOROZO
CHRISTINA DE
Departamento (UNESP),
de Ecologia, IB, Universidade Estadual Paulista
C.P 199 13506-900 Rio Sao
- Claro, Paulo, Brazil
{[email protected].
br)
—
ABSTRACT.
The use of medicinal plants and other traditional forms of treating
communities Mato Grosso nowadays
illness in rural of State, Brazil, that also
depend on modern health care assessed. Forty-four households were
facilities is
modern
surveyed about disease events and the use of health care me-
facilities,
and with medicine during
dicinal plants, consultation practitioners of traditional
the six months prior to research. All manufactured medicines, medicinal plants,
and other therapeutic products present in the household at the time of the inter-
view were recorded. Ninety-three percent of households reported the use of
at
modern
least one of the medical services available as well as the use of medicinal
plants during the previous six months. About 120 plant species were recorded.
The associated use of modern and traditional medical services and the importance
and economic change
of medicinal plants in a context of social are discussed.
communities
vannah
—
O
RESUMO. emprego de
objetivo deste trabalho foi avaliar o plantas medicinais
em
comunidades de Mato
e outras formas tradicionais de tratar doen^as, rurais
Grosso, que atualmente contam tambem com servi^os medicos modernos.
Brasil,
em uma
urn levantamento amostra de 44 domicflios, sobre epis6dios de
Foi feito
modernas
doenga e recurso as diversas opgoes terapeuticas disponiveis, e tradi-
durante os meses anteriores a pesquisa; registraram-se todos os medi-
cionais, seis
camentos industrializados, plantas medicinais e outros produtos de uso terapeu-
presentes no domicflio no momento da entrevista. 93% dos domicflios rela-
tico
um
taram uso de pelo menos dos servi^os medicos oficiais e de plantas medicinais
nos meses Cerca de 120 especies de plantas foram registradas.
seis anteriores.
Discute-se o uso conjunto de facilidades medicas modernas e recursos terapeu-
como bem como num de mu-
sua importancia contexto
ticos tradicionais, plantas,
economica.
e
dan<;a social
—
RESUME. de recherche d evaluer des plantes
L'objectif cette etait 1'utilisation
que approches dans traitement des
medicinales ainsi d'autres tradition nelles le
parmi des communautees rurales du Mato Grosso, au Bre-
maladies habitants
les
communautes ont egalement recours des centres de me-
Aujourd'hui, ces £
sil.
44
dans
moderne, 1'utilisation de plantes medicinales et la consultation de guerisseurs
lews
medicaments commercialisms
AMOROZO
140 No.
Vol. 24,
1
tres produits ayant des proprietes therapeutiques qui se trouvaient presentes dans
93%
les differents domiciles. Pendant ces six mois, des foyers ont utilise au moins
l'un des centres de medecine moderne mis a leur disposition tout en faisant appel
De
aux plantes medicinales. Environ 120 especes de plantes ont ete identifiees.
plus, dans cet article, l'utilisation parallele des centres de medecine moderne et
des ressources therapeutiques traditionnelles, ainsi que l'importance des plantes
medicinales sont discutees dans un contexte de changements socio-economiques.
INTRODUCTION
common
Therapeutic pluralism throughout world and can be under-
the
is
same number
stood as the coexistence, within the society or group, of a of health
and
care alternatives with diverse origins treatment representing different
foci,
systems of medical practice and ideology (Janzen 1971; McGrath 1999; Stoner
Some when
1986). researchers have found that patients and their relatives, con-
may make
fronted with illness, use of the multiple treatment options available,
when
even and
there are clearly established limits functions ascribed to the dif-
From would
ferent coexisting medical systems. the viewpoint of users, then, they
be complementary than Colson Hamnett
rather contradictory (Brunelli 1987; 1971;
and Connell McGrath People pragmatic view treatment and
1981; 1999). take a of
may
are willing whatever be
to try
effective.
Some
scholars stress the importance of the role played by social and political
same and
factors in legitimizing different medical systems within the society al-
lowing them to coexist (Janzen 1971; McGrath 1999). In this view, medical plu-
ralism provides patients and their families with an array of disease concepts and
may
treatment alternatives that be employed not only to obtain resources like
power and and
prestige, material resources, but also to negotiate social relations
(Crandon-Malamud
define cultural identity 1991). Likewise, the persistence of folk
medicine cosmopolitan where modern system well
in settings health care es-
is
sometimes means
tablished is explained as a of the subordinate classes to resist
and
impositions of the dominant medical ideology (Loyola Both pragmatic
1991).
views
sociopolitical contribute to explain medical pluralism in different settings.
In Brazil, different therapeutic traditions have contributed to the formation of
From
and
folk medicine. the sixteenth century on, contact between Iberian indig-
enous peoples of various ethnic groups created a complex combination of elements
from European and
autochthonous medicines; often difficult to identify the
is
it
origin of specific aspects of the folk practices as indigenous, European, or the
work
result of contact (Holanda 1994). African slaves taken to Brazil to in agri-
A
and mining shared
culture further contributed shape medicine. feature
to folk
by some
these different therapeutic traditions the use of plants, at least to extent,
is
to treat illnesses.
At
present, folk or traditional medicine in rural areas of Brazil retains
still
many
some
aspects of the medicine practised in colonial times. For example, prac-
humoral aimed blood
tices related to theory, especially those "purifying' the
at
'
and common;
at maintaining health through hot and cold balance, are very
still
among
the therapeutic use of excreta (like urine and feces) also found rural
is
(Amorozo
people and Gely Fleming-Moran Queiroz The relative
1988; 1975; 1984).
/Summer JOURNAL OF ETHNOBIOLOGY
Spring 2004
141
maintenance
and
continuing on
to their reliance local specialists: curers, midwives, and ben-
praymg among
zedores
More-
others.
environments very
efficiently in search
elements; in general they have a solid and lone-standine know
procurement
modern
have been brought coun
facilities to
some
government
tryside; in
areas,
The modern
itions. introduction of medicine adds another
oj
stic base already established and does not eliminate people's
i
many
medicine. and modern
Instead, in instances, traditional
em
and
Setzer 1985; Wagley 1988). But the increasing influence of national culture
some
certainly leads changes medical kinds
to in local settings; of traditional
may may
community
practitioners disappear or their roles within change
life
(Queiroz 1980). Under the influence of cosmopolitan lifestyles and easy access to
modern may
medical people reduce their use of medicinal plants (Nolan
facilities,
and
Robbins
1999).
The aim work
forms
of this to assess utilization of traditional of treating
is
—
—
illness chiefly the use of medicinal plants by dwellers in rural communities
modern
may
be
affecting this
AREA
STUDY
tudy located in Santo Antonio do Leverger Municipality, Mato
site is
The Cuiaba River
km
which
dominant savannah),
natural vegetation the cerrado (Brazilian
is
human
by
certain extent, altered activities.
This
innings
—
descendants of Portuguese and aboriginal peoples (mainly from the
paulistas
Tupi They came from southeastern Brazil after the discovery of gold.
group).
were work
African slaves, possibly of Banto origin (Bandeira 1988), taken to in
the mines and in sugar cane spirits and sugar factories. The area near the Cuiaba
working
River soon became important for supplying food for people in mining.
The had been only the subjugation or
occupation of these lands feasible after
expulsion of the local indigenous populations.
When began
gold mines were exhausted, the sugar industry to flourish.
the
became most
In the nineteenth century, sugar and cane spirit production the
important economic That industry remained very influential in regional
activity.
importance declined
twentieth century. Later,
politics until the first half of the its
more
number among them construction of technologically ad-
of reasons, the
for
(Povoas
vanced factories in other regions 1983).
from cosmopolitan
Mato Grosso State remained relatively isolated influences.
Pmnomv
stagnated the mid 1970s. Since that time, the settlement of
until
If*
AMOROZO
142 No.
Vol. 24, 1
VARGUVH
DO LEVER6ER
STATE ROAD
SCALE ROADS
COUNTRYSIDE
M
5 10 15 RIVERS
LAKES
LAGOONS,
km O
16
—
FIGURE
Study Funda^ao de Candido Rondon,
1. area. Source: Pesquisa 1991.
farmers from the southern region of Brazil and the establishment of agroindustrial
centers in the state brought about changes in land use and social and economic
conditions.
economy
In the study area, based on subsistence agriculture, artisanal fish-
is
and production manioc home consumption and the urban
eries, of flour for sale in
—
market. Modernization provison water and introduction of
of electric services,
telecommunication and enhancement tourism in the
the of activities
facilities
Spring/Summer JOURNAL OF ETHNOBIOLOGY
2004
143
—
area rapidly changing and with
is this picture, contact the national society
is
intensifying.
decade two
Until a or ago, traditional medical services included various types
of midwives, and some
specialists: curers, benzedores, practitioners of Afro-Bra-
known
modern
zilian sects, locally as tenda or conga. Since medical have
facilities
become more
accessible, fewer of these specialists are providing services. For ex-
ample, midwives no
are longer training their replacements; at the time of this
women
remained
study, there only three or four very old said have been
to in
demand who
as midwives in their time. Curers have a deep knowledge of me-
who know how
dicinal plants and diagnose ailments by
to feeling the
patient's
now
pulse are rare, and none were to be found in the area. In contrast, there are
many
They most important
benzedores. constitute the local representatives of
tra-
ditional medicine at present. Besides ' 'blessing' the person, they also prescribe
ill
'
medicinal plants or allopathic remedies (Amorozo 1999). Also, a great number of
people, mainly those over the age of control a vast repertoire of knowledge
forty,
about medicinal plants. In previous research, about 230 plant species employed
(Amorozo
for therapeutic use have been recorded 2002).
Nowadays, and
state-run health services include a health care center a hos-
pital in the small town of Santo Antonio and three health care posts in the nearby
no and
rural communities. These services attend to the population at cost supply,
depending on some of the remedies prescribed by the physicians. The
availability,
health center operates daily, offering services in general medicine, pediatrics, gy-
necology, and performs some simple laboratory analyses. The
dentistry. also
It
week and more
health posts operate only certain days of the offer limited services.
who
In town, there also one private physician attends to the local population
is
two commercial dru
METHODS
in the area since
(Amorozo
ethnobotany of medicinal plants
treatment (Amorozo For the present
1999).
and
two communities (Varginha Barreirinho)
rural
awav from former
matelv seven kilometers the
was
survey conducted
easy government medical services. In June 1998, a
access to
zone and 24 town). Households
in a sample of 44 households (20 in the rural in
were by systematic sampling, using a sampling interval suited to ensure
selected
20% places (adapted from Bernard 1988). In general,
of the total in the selected
some male head
were with female householders, but in cases, or
interviews held
members took Questionnaires recorded data about
other of the family also part.
mod-
socioeconomic position, disease events, and the use of health facilities (both
em and by family members in the six months previous to the research.
traditional)
were
names medicinal plants used in this period also recorded. In
Vernacular of
medicines
the
interviewed
the
recorded—whether growing near the house-
were
medicinal use
considered of
had been
The already collected
majority of species
gathered or dried.
hold, fresh,
AMOROZO
No.
144 Vol. 24, 1
%
Local health care center
-
1
100
n
2 Local hospital
-
3 Local private physician
-
4 Medicine
in the city
-
5 Medicinal plants
-
6 Benzedor
-
7 Tenda
-
4
2 3 5 6 7
1
Therapeutic resources
households sampled population
—
=
FIGURE sampled
2. Use frequency of therapeutic resources (number of households 44;
population
204).
and (Amorozo was made,
identified 2002), so collection of botanical material
whenever possible, only for those plants that lacked voucher specimens. 1 Data
about medical consultations in the area were also gathered in the health center
encompassing 3320 consultations by general practitioners between June 1997
files,
and
June 1998.
An
index of therapeutic resources utilization was calculated by age group as
= Nn
TRUI
follows: Nri/N, where the number of users of resource in the
£;' is
i
N
age group, and the number of persons in the age group. This index rules
is
out the problem of different numbers of people in the age groups, besides con-
among
densing data about use frequency making comparisons
in a single figure,
them
chi-square
For comparisons, Kendall
easier. statistical correlation coefficient,
(Siegel 1975) and binomial test (Ay res et 2000) were used.
al.
RESULTS
The sample comprised 204 persons, on average per household. Forty-one
4.6
of the 44 households (93%) reported the use of at least one of the local state-run
Among
medical during months the avail-
services the six previous to the research.
medical and were most visited
able services, the local health care center posts the
by respondents and their families (86% of households and 44% of sampled pop-
93%
house-
ulation). Plants were the most used traditional therapeutic resource; of
61% one
holds and of sampled population used medicinal plants to treat at least
by
case of illness in this period (Figure Plant-based recipes can be prescribed
2).
anyone, but older, knowledgeable people and benzedores are the most sought for
such remedies.
Spring/Summer JOURNAL OF ETHNOBIOLOGY
2004
145
+
70
Medicinal
plants
Local
health care center
60-69
n
Local
private physician
Local
QD hospital
50-59
Benzedor
40-49
O
Medicine
in the
city
Tenda
30-39
20-29
10-19
0-9
2
0.5 1.5 2.5 3
1
Index
Utilization
—
FIGURE
3. Indices of therapeutic resource utilization by age group.
in
prime
the
under and
utilization indices (TRUI) were greater for children 10 for adults over
40. In the six months prior to research, 93% of children in this age group and
75% went
of adults over 40 used medicinal plants; they also to health care center
and posts more frequently than did the intermediate age class. Benzedores were
most soucht for treatine children under 10 and, to a lesser extent, adults over 40
typ
medic
therapeutic used were of no statistical significance for
alternative
and They
physician the local hospital.
ties in Cuiaba, the local private
= p<0M),
and 2 medic-
posts
gnificant health care center 10.32,
local (x
-
2
and 2 p<0.001). For the
benzedores 34.22,
inal /?<0.001)
14.24, (\
were
sign
comparisons between age the results
classes, all
under and people aged 40 and
10
w
,
,
and
sought benzedores significantly
People aged 10-39 used medicinal plants
older.
any kind by people over
than Use of therapies of
less either other class (Table
1).
among
was 63% among than males.
14 higher females
some
The the interviews received kind of
majority reported in
of illnesses
minor
or diseases,
ordinary indispositions self-
treatment
(Table In general, for
2).
mainly of medicinal plants
was consisted
medication treatment;
the step of
first it
med-
without
be obtained
can
and medicines that easily
(chds caseiros) allopathic
were physician or health
symptoms there a
persisted or
prescriptions. 3 if
ical If
common
even cases of
would seek further treatment, in
DeoDle
service available,
AMOROZO
146 No.
Vol. 24, 1
—
TABLE
1. Binomial test results for comparisons of therapeutic resources use between age
classes.
Age
classt values)
(z
1X2 1x3 2X3
Therapeutic resource
Health center 4.06* 1.54 2.66*
-3.95*
Medicinal plants 5.43* 2.21*
-3.08*
Benzedores 6.54* 3.14*
= = =
>40.
1 1 0-9; 2 10-39; 3
<
* unmarked
p 0.05; results not significant in
cell.
more
ailments. For example, consultation with a health professional took place in
30%
than of the reported cases of influenza and cold symptoms. Likewise, data
from show symptoms
the health care center that influenza accounted for
files
6%
almost of consultations by general practitioners between 1997 and 1998. Con-
and
sultations regarding respiratory digestive systems ailments, intestinal infec-
and 37% same
tions, helminthiasis accounted for of consultations in the period.
who
two
In the rural places studied, in the absence of the physician, visits only
and
or three times a week, trained health agents provided medicines pri-
local
mary
health
care.
Medical professionals were sought, locally or in Cuiaba, for serious or acute
problems pneumonia) and
(like heart attack, cerebrovascular accidents, trauma,
undiagnosed illnesses. However, this did not prevent patients from seeking alter-
means had
native of healing. For example, two mothers whose young children
been diagnosed with pneumonia reported they sought government-provided
that
When
medical care. the children returned home, the mothers gave them a locally
popular tea prepared with some plants and guinea hen feathers in addition to
the medicines prescribed by medical
the
staff.
The combined modern and medicine
utilization of health services folk ele-
45%
ments, mainly plants, occurred in of reported cases of illness; resort only to
modern 29% with
medicine accounted for of cases, whereas treatment exclusively
plants, and with plants and self-medication with allopathic remedies occurred in
18%
mainly and symptoms
of cases, for influenza cold (Table
2).
With
regard to the medicines inventoried by the time of the interview, alio-
—
TABLE
Health sought
2. facilities in cases of illness.
Cases
(%)
=
Type
of health care (n 121)"
+
Medical professionals traditional medicine (mainly plants) 44.6
Medical
professionals 28.9
Medicinal
plants 9.1
+
Medicinal plants allopathic remedies 9.1
Allopathic remedies
3.3
+
Allopathic remedies medical professionals 2.5
Others
1.7
No
treatment
0.8
same
more
* If than one person in a household had the same disease the same time and treated the
at
way, only one was
case counted.
Spring/Summer JOURNAL OF ETHNOBIOLOGY
2004
147
—
TABLE
Remedies
3. in the households.
Frequency
(%)
=
Mean SD
Range
(n 44) Total
Allopathic medicines 0-29
93.2 5.11 5.19
Medicinal 0-27
plants 88.6 5.86 258
6.01
Commercial 0-2
phytotherapies 18.2 0.27 0.62 12
Miscellaneous* 0-10
34.1 1.29 1.66 34
Plants used the previous
6 months 0-13
93.2 4.27 3.08 188
* Topical antiseptics, medicinal soaps, animal products.
pathic remedies and medicinal plants were found in most households; the mean
number of allopathic medicines per household was around whereas the mean
five,
number was around Some households had
of medicinal plants six (Table a
3).
greater number of patent medicines and /or medicinal plants, eventually provid-
was
ing these to neighbors in need. There a significant positive correla-
facilities
tion between number of medicinal plants reported to have been used in the six
months previous research and the number of medicinal plants present in the
to
=
and between and
household (Kendall Tau 0.40437, p<0.001) also this latter the
=
number of allopathic remedies present in the household (Kendall Tau 0.261316,
and
medicines recorded were mainly analgesics antipyretics,
p<0.01). Allopathic
anthelmintics and remedies digestive system ailments, antibiotics, vitamins
for
and
and remedies urinary hypertension tranquilizers; antisep-
for tract,
fortifiers,
wounds were common. About one
and ointments treating also
tics antibiotic for
and
mainly vitamins, analgesics,
fifth of the medicines, anthelmintics, antibiotics,
was
supplied charge by health services.
free of official
numbered
Plant species recorded in the households by the time of the visit
111; about 83 species were mentioned to have been used in the previous six
(Appendix more
were recorded
months. In about 120 plant species 1). Little
total,
wet
than one-fourth of identified species were native to the cerrado or areas in the
accounted about
region (Lorenzi 1991; Pott and Pott 1994); cultivated plants for
were most com-
Herbs and (31%) the
(37%) trees
half of the total plant species.
more 10% sampled households (Table
mon. and /or found in than of
Plants cited
them were
were mainly cultivated species; at least half of exotic species intro-
4)
more
duced People aged 40 and older kept on average than twice
into the area.
mean
home group under
many likewise,
as plants and plant material at as the 40;
was age group.
number and plant material greater for this
plants
of cerrado
symptoms
Around 30% of these species were employed to treat illnesses or
20% were used treatment of gastrointestinal ail-
system; for
of the respiratory
ments and worms. Urinary tract ailments, hypertension, disorders re-
intestinal
and wounds were
also
female reproductive functions {problemas de mulher)
lated to
by a variety of plants. Seven species were used to prevent or treat mau-
treated
common same
was employ the plant for different
oUw and envy. to
eye)
(evil It
diseases.
AMOROZO
148 No.
Vol.
24,
1
—
TABLE
4. Plant species most frequently present /used in households (%, n
44).
Present
Used
in
last
house-
six
Plant species Utilization hold months
Gossypium
barbadense L. inflammation, "female 23 7
problems"
Lippia alba (Mill.) N.E.Br. tranquilizer 18 14
Coleus sp. stomach /liver 18 9
Justicia cf. pectoralis Jacq. influenza / cold 18 7
Vernonia condensata Baker stomach /liver 18 2
Eucalyptus influenza /cold 14 18
sp.
Stachytarpheta cayenensis (L.C. Rich.) Vahl cough influenza 14 11
/
Punica granatum L. throat inflammation 14 5
X
Ofrws
aurantium
L. influenza/cold 11 16
Petiveria alliacea L. mau-olho 11 9
Rata graveolens L. "female problems" 11 5
Machaerium Raddi cough
aculeatum influenza 9 14
/
Polygonum hydropiperoides Michx. influenza /cold 7 16
Cymbopogon
citratus Stapf. influenza /cold 5 16
Hyptis
spp. influenza /cold 2 14
DISCUSSION
Data presented above show combined employment
the of folk therapies,
mainly and modern
plants, medicine in almost half the reported disease cases.
It
is possible that minor complaints were underreported in the recall survey, which
could lead to an underestimate of exclusive use of traditional therapies, normally
employed
in the first place in such cases, or no treatment at all (Brunelli 1987).
However, data from the sampled households and from the health center have
files
simple people turn
ailments, like influenza or colds,
em
more
The spread adds
of official health care in the present case,
facilities,
tment
opportunities to a context of health care alternatives constructed after
the
medicine
century with medicinal knowledge of indigenous groups from the southeas
A
knowledge was number
apeutic
of local natives incorporated. of cerrado
used todav as remedies were considered erubo (that maeic or medicinal
is.
Anemopaegma
Indians
Macrosiphonia
longiflora,
among and
Protium
vensis, heptaphyllum, Byttneria melastomifolia, others (Albisetti
Amorozo Hartmann Some
Venturelli 1962; 2002; 1967). plants, like Petiveria alii-
used by masters
acea, African slaves in the eighteenth century to poison their
(Santos Filho 1977) were also included pharmacopoeia.
in this
The new modern
therapeutic options brought about by growing access to
medical coincide with changes and production
facilities in traditional subsistence
The
conditions as well as increased influence of urban ideology on rural areas.
impact of scenario on former and dif-
this therapeutic practices practitioners is
ferent in each case: for example, for the studv area, mid wives are no longer nee-