Chapter Nine: The Market ‒ Part II
This month’s article continues to trace the commodification of traditional medicine in two areas of Mulanje Mountain ‒ in the South of Malawi ‒ focussing on scale, storage and how traditional medicines are measured. During fieldwork, I found that traditional medicine is only available in the local market on a small scale. It is sold in either fresh or dried, or in decoctions, sold in reused bottles. These remedies are available at most local markets. Regular visits to the local markets showed that the bulk of traditional medicines comes from plants using the bark, leaves, roots, fruits and flower parts, with the occasional mineral or animal material. When I consulted with a local traditional healer, I noticed that he sold traditional medicines from his clinic, in bottles and small bundles. I also discovered them laid out on a larger − a few metres by a few metres − piece of black plastic at the back of the market where his clinic was. This was the case during the three months of fieldwork but towards the end I saw that a small black mat had been placed on the ground right at the entrance to this trading centre. It was there one day but disappeared a few days later, without my getting the chance to find out how it got there or why it had been removed. On the Phalombe side of the mountain, a man sold a mixture of traditional herbal remedies in reused glass bottles beside the other street traders. From my observations, I drew the conclusion that, in my study area, traditional healers are the main dispensers and vendors of herbal medicines and that the trade by vendors in the markets is relatively small.
Following on from the expansive use of resources in other areas, as explained by one of my interview participants who described the huge demand from the South African traders who came and got traditional medicines from him, leaving him with a blanket, “blankets only”, we can see the impacts of this on local communities. Furthermore, the vast scale of trade in big city markets and muti[i] shops indicates that the demand for traditional medicine remains high in city regions, despite the availability and affordability of modern biomedical alternatives in these places.
A personal visit to the Victoria St Market in Durban, South Africa, highlighted the difference in the scale of trade between the Mulanje markets and those in some large city markets elsewhere. Image II shows traditional medicines piled up on large tables in this city market. There were at least ten such tables in the Victoria St Market, each displaying a variety of both plant and animal materials. The scale of trade in traditional medicines in urban markets in southern Africa gives some indication of the threats to traditional medicine resources, but there is very little data measuring it (McMillen, 2008[ii]). Much of this trade is conducted illegally.
During a discussion about this growing illegal trade, a stakeholder recounted an incident. He said a local healer had been approached by two visitors from South-East Asia, who asked him about the plants growing in the area. They showed him some specimens and asked if he had access to any of them. When the practitioner confirmed that he did, they asked to purchase some. According to my source, the outcome of the transaction was that he gave them a considerable quantity, in exchange for a nominal amount of money. The plants were then smuggled from Malawi to South-East Asia in a vegetable shipment. The increasing demand for African traditional medicine is consistent with the increased interest in MAPS (medicinal and aromatic plants) in general. Since in Africa, much of this trade is unrecorded, the impacts of the loss of local traditional medicines on broader conservation goals is still largely unknown.
A participant said that if these trends continue, traditional medicine will become scarce in local forest reserves, and that “the whole trees will deteriorate”. Expanding on these threats, he added that the wholesale ‘deterioration’ of these trees, “is an indication that once those trees are no more in Malawi, traditional healers will be no more there”. He said that if the trees disappear, then traditional healers “will have nothing to use, which means that if there is unsustainable natural resource management, there will be also unsustainable medicine practices”. He emphasised that ‘natural resources’, also refers, “to the traditional healer himself” and if the healer “goes away, or dies, it means that natural resources, also is dying”. The “knowledge of the use of plants is disappearing faster than the plants themselves” (Anyinam, 1995:323[iii]).
My participants tended to take a pragmatic approach to these issues. Some of were becoming frustrated by the amount of time they were having to spend collecting dwindling herbal medicine supplies. Expanding on what he had said about diminishing resources and the threat to the tradition healer’s knowledge and existence, my interview participant suggested that personal ownership of local resources may protect natural medicines from being overharvested. He noted that personal ownership makes it “very difficult for any outsider to go into the traditional healer’s garden and cut down their trees”. However, the idea of personal ownership reflects a shift in perspective because, in the past, knowledge and resources have been viewed as belonging to the community, and as explained in previous articles, traditional healers harvest resources in the belief that they have been given to them freely by God. Viewing traditional medicine as a personal resource changes these relationships. Nevertheless, most of my participants were convinced that commoditizing traditional medicine could improve their lives.
Anamed (2009[iv]) promotes the herbal aspects of natural medicine in African countries. Blaming governments in both wealthy and developing countries for the poor health outcomes of people living in the rural areas of tropical Africa, anamed advocates, Hirt, Lindsey and Balagizi relate these health inequities with the African proverb: “When elephants fight, the grass dies” (2008:1[v]). In other words, we can see that there are no winners in circumstances where large entities battle against each other over resources; people always suffer most at the grassroots level. Moreover, Hirt et al., (2008) state that while the World Trade Organisation fights for individual intellectual property rights, governments in rich countries continue to:
bully poor countries into observing internationally agreed patent rules, whilst they themselves duck and dive in their own best interests. They also spend more fighting human ‘terrorists’ than microbial ‘terrorists’ such as HIV and malaria plasmodia which kill millions every year. (Hirt et al., 2008:1)
Anamed encourages people to become less dependent on the ‘elephants’ and more reliant on their own resources. They also insist that religion and medicine cannot be separated in an African context (Hirt and M’Pia, 2008[vi]). Some locals mistakenly assumed that my research was part of an anamed project, often saying to me “oh, you are doing anamed”. In rural areas, like those where this study took place, it is uncommon for people to come in contact with western researchers, especially those conducting social science research, so it is not surprising that my study was automatically associated with more familiar Christian-based interests.
The trade in traditional medicine is not confined to particular areas, nor does it flow in one direction only. It is guided by constantly shifting obstacles and opportunities and is difficult to measure in economic terms. Moreover, since traditional medicine is not usually a manufactured ‘product’, it is difficult to place a monetary value on it. My study did not explore these factors in any depth, other than to note that much of the trade in traditional medicine occurs outside of the formal sector, some of it is illegal and mostly it is unrecorded and unmeasured. Sometimes it is traded for cash and sometimes it is exchanged for other goods. Beyond their capacity to harvest traditional medicines from local forest and woodland areas themselves, some practitioners have access to traditional medicines through family ties, whilst others buy from vendors. Some healers living around the mountain move freely across the border to harvest and others have to pay fees to access cross-border resources. These are complex issues that were outside the scope of my study. They are not confined to the trade in local traditional medical resources but are characteristic of the informal markets that dominate trade in Africa and have become a part of the wider political, socio-economic, and conservation debates in the region.
My participants identified a number of other reasons for wanting to commoditize the medicines they use. These reasons relate to the safety, storage, measurability and efficacy of herbal medicines. Some suggested that the official status of traditional medicine could be improved by setting recognisable standards of practices. In Malawi, as in other African countries, various associations have been set up to improve standards and address allegations of malpractice. The standardisation of traditional medicine gives people a more meaningful link between their practices and beliefs. Concerns about charlatan malpractice persist and as I was sitting waiting at a petrol station one day, I struck up a conversation with a security guard. He made a clear distinction between, ‘medicines’ and ‘mementos’, and the activities of, ‘doctors’ and ‘tricksters’. He identified the bark bundle that I carried as a ‘medicine’ and he described a river pendant I was wearing as a ‘memento’, saying that these objects were legitimate objects of healing − which he would never use − but he emphasised that there were many tricksters who use false methods to deceive people into believing things that are untrue, for personal gain. For some local people, the commoditization of traditional medicine minimises this trickery risk.
Monetary gain is not the only motivation for wanting to commoditize traditional medicine. The way materials are stored can determine the quality and durability of remedies, thus determining its longer term value. Quality control is important to traditional medical practitioners, but a participant explained that due to lack of other options, often healers:
just take a tree, or roots and put somewhere, and other houses, are just thatched with grass. When rain comes it means the leaking roof will spoil that. And if someone come to get that root, it means their straight root which is being used, has been maybe affected with some bacteria, some germs and (you) cannot know its expiry date because you just know that, yah, I have put it there, somewhere. (Phalombe, July 2012)
He said that if these resources were converted into tablets, they could be stored safely, and their expiry date would always be known. Many other participants raised the issues of safety and efficacy, agreeing that commoditization was an important way of protecting and preserving resources, both for quality control and long-term marketability. No participant made any suggestion as to which quality control measures should be employed in commercial marketing.
The practice of traditional medicine is described by the World Health Organisation as being safe, affordable and efficacious, yet critics argue that its therapeutic claims have not been sufficiently validated. Tanaka, Kendal and Laland (2009[vii]) point out despite that many remedies have now been scientifically validated, the efficacy of traditional medicine, remains contentious (Phungwako, 2006[viii]). Western scholars, relying on the scientific methodology, still overlook anecdotal testimony when evaluating the efficacy of treatments (Mehl-Madrona, 2007[ix]). The Mulanje traditional healers have not conducted scientifically valid tests on their medicines but they prescribe their preparations based on empirical observations of their healing abilities, through self-testing, on family, friends and apprentices and on patient recovery.
The lack of standardisation of herbal dosages adds another contentious issue to the debate. Interview participants do measure their treatment doses, but not according to the strict quantifications standards that western medical science requires. Treatment doses are mainly measured in cups and some healers use teaspoons, tablespoons and other kitchen implements. Measuring the right dose takes time and care, with one participant saying that when she is measuring out the pieces of bark to make up a remedy bundle, ‘we mix one tree and one and one tree and we [put it] in two piece and cut and put on one row and gave them”. Sodi (2009[x]) explains that in southern Africa, traditional healers do this in order to target the person’s illness more effectively. Dosages vary according to the patient’s size and, “if he’s a child, we measure as a child, and is a big one, a big man, we measure as a big man”. Another participant added that “we have no actual measurement but we tell [the patient] this medicine you can use for three days or either two weeks, if you are not getting well you come and I will give you another medicine”. One interview participant said, “when the patient come, I give the medicine and tell them you must go and cook to your house, and after that you put in the cup, a cup or half cup”. Dosages were imprecise, and what was important was the ratio and composition of the remedy, not the measurement or the quantity. He said he made a note of what he had prescribed though, “because of when he comes again, I see that this problem, I fixed with him and we start another problem”. Some practitioners keep records of their patient’s treatment for the purpose of claiming payments later, others use their records as a teaching tool. A participant said that, “the one who is being taught how to treat these people, is advised to write [it down]”, so that they know they have given a patient, “such a type of medicine as pertaining to such a disease”.
Some of my participants keep journal records of their dreams and the spiritual messages they receive from their ancestors. One explained that when he wakes up he tries to find the person he has dreamt about. Before he does this, however, he writes the dream down while it is still fresh in his mind. He said: “when I woke up, I’m just thinking about going to find that person, and write some, somewhere, eh? On that paper, what I wish is not [to] forget”. Recording these dreams takes self-discipline and another participant added that, “when I dream, I must be sitting. Be order. Write it. Write it. I’ve got books like that, about medicine, of which I wrote”. Another added that my study had motivated him to start keeping records. He said:
what we are doing, it’s part and parcel of learning and because you have asked … how do he keep his records and it has been found he doesn’t have any written documents and he has learnt that to have something in the written form, is very important (Phalombe, June 2012)
All my interview participants were registered and were practicing according to a set of guidelines that have been established by their umbrella bodies, in association with the country’s Ministry of Health (MoH). Many have received training on record keeping, referral procedures and sterility protocols from the MOH but procedures were inconsistent, and few participants reported recording remedies, most saying that they kept these things “in memory”. They do not tend to keep records “apart from keeping them in their heads”. A participant explained that, “all these [remedies] are put in head because we do know that each and every herb has got such [and] such dose and it is never written”. Another agreed, “there is no recording, but [I] keep in mind that I have given … such such person such such a type of tree medicines”. Village birth attendants are the exception to this because, as noted in a previous article, they have been instructed by government to record the details of all deliveries they attend as a matter of routine.
In this article, I have shown that the commoditization of traditional medicine is complex. It cannot be analysed apart from the wider market factors that influence local expectations and conditions. Furthermore, the commercial value of traditional medicine cannot easily be determined on a local level. This is partly because of these wider market exchanges, and partly because it has no recorded economic value in the rural area where my study took place. Although it has a, local value (determined by the provision of affordable and accessible health care to a large proportion of the population), a cultural value, and a conservation value, it remains largely underestimated, highlighting yet another gap in the recorded knowledge of the value of traditional medicine knowledge, practices and beliefs in changing local contexts.
Dr Theresa Jones (PhD) is an intuitive counsellor, incorporating holistic principles and energy healing in her practice, Inner Sense Intuitive Counselling Services. You can contact her on 0458268605
[i] Muti or muthi means medicine
[ii] McMillen, H. (2008). Conserving the Roots of Trade: Local Ecological Knowledge of Ethnomedicines from Tanga, Tanzania Markets. Dissertation Abstracts International. (UMI No. 3312595).
[iii] Anyinam, C. (1995). Ecology and Ethnomedicine: Exploring Links Between Current Environmental Crises and Indigenous Medical Practices. Social Sciences and Medicine, 40(3), 321-329.
[iv] Anamed. (2009). Vision and Mission. Anamed. Retrieved from
[v] Hirt, H. M., Lindsey, K., & Balagizi, I. (2008). Aids and Natural Medicine. Germany: anamed.
[vi] Hirt, H., & M’Pia, B. (2008). Natural Medicine in the Tropics. Germany: anamed.
[vii] Tanaka, M., Kendal, J., & Laland, K. (2009). From Traditional Medicine to Witchraft: Why Medical Treatments Are Not Always Efficacious. PloS ONE, 4(4), 1-9.
[viii] Phungwako, V. J. (2006). A critical analysis of the ethics of integrating traditional medicine into the Malawian health care system. Unpublished master’s thesis, University of Malawi, Malawi.
[ix] Mehl-Madrona, L. (2007). Narrative Medicine: The Use of Story in the Healing Process. Rochester: Bear and Company.
[x] Sodi, T. (2009). Indigenous healers’ treatment methods for some illnesses and social dysfunctions. Indilinga-African Journal of Indigenous Knowledge Systems, 8(1), 59-72.