Plants from many healing landscapes: gathering information and teaching clinicians about the cultural use of medicinal herbs^,

BACKGROUND

The increasingly diverse US immigrant populations, the growing use of medicinal herbs, and the necessity for training in cultural competence have created a need for related educational opportunities for health care professionals. To address these concerns, the Boston Healing Landscape Project (BHLP), together with the Center for Complementary and Alternative Pharmacotherapy of the Massachusetts College of Pharmacy and Health Sciences and the Treadwell Library of the Massachusetts General Hospital, offered a postgraduate education program, “Cultural Use of Herbs in Latino and Haitian Communities—Herbal Tour.” Table 1 provides an outline of the program. This article discusses the challenges involved in creating one of four lectures given during the program, “the Pharmacology of Latino and Haitian Herbs.”

Table 1 Postgraduate course program: “Cultural Uses of Herbs in the Latino and Haitian Communities—Herbal Tour” (April 3, 2004)

A closer look at the rationale for this project focuses on the following trends. Use of herbal supplements in the United States continues to grow. This practice is widespread and extends across the lifespan. Patients with chronic conditions are among the heaviest users, as they constantly search for additional ways to relieve the symptoms of their diseases. Clinicians need information on these preparations, including evidence of efficacy, adverse effects, toxicities, and interactions with drugs, laboratory tests, and surgical procedures [1, 2].

Research indicates that herb use does not change with relocation and more advanced education, challenging the conventional clinician to learn about these therapies [3, 4]. Several reasons for this phenomenon are:

• Knowledge of herbs is a source of pride and identity, as herbs are perceived by patients as “our own medicines.”

• Herbal use is part of cultural tradition, passed down through generations.

• Herbs are relatively inexpensive.

• In many cultures, herbal medicines are used with biomedicine in a complementary rather than alternative approach [5–7].

Today's health care professionals must become “culturally competent” as they care for an increasingly diverse immigrant population [8] and issues of health disparities receive attention. This cultural competence mandate comes from the US Department of Health and Human Services [9], the Institute of Medicine [10], and professional organizations such as the American Medical Association [11, 12] and the American Nurses Association [13]. As practitioners become culturally aware, they communicate more effectively with their patients, discover previously hidden problems, and consequently provide better care [14]. Efforts to create educational programs and information resources to address these trends are underway [15, 16].

Medical librarians can play an important role in supplying clinicians with the information they need to care for diverse patient populations. Librarians can integrate information on traditional healing practices, especially the cultural use of herbs, into this endeavor. Finding such information is difficult and time consuming, because it is currently dispersed through the literature of many disciplines: medical anthropology, ethnobotany, pharmacognosy, sociology, medicine, theology, and others. When discussing topics of immigrant health, all of these fields of study contribute to a knowledgebase on ancestry and healing traditions. Only a few resources attempt this integration, so ample opportunity exists for research and collaboration by medical librarians, drug information pharmacists, public health workers, medical anthropologists, and other scholarly researchers.

METHODS

Gathering information from the above disciplines and converting it to a form that would be easily used by conventional medical practitioners involved many steps. The time-intensive preparation for the presentation, “Pharmacology of Latino and Haitian Herbs,” as well as the accompanying information for the BHLP Website, required numerous visits to several libraries and help with translation and assistance from the healers in the community. Table 2 gives an idea of the variety of references consulted.

Table 2 Sample of information sources

Local healers were a source of information. Medical anthropologists and community members helped identify traditional healers in a given area. Collaboration with a medical anthropologist also shed light on the cultural context of herbal use such as the ritual and religious significance associated with the spiritual elements of their efficacy. Immigrant healers often substitute locally available herbs if they cannot obtain the plants used in their native countries [5, 7]. The local healers and medical anthropologists offered information on such local practices in herbal therapy. In their research, the authors found that traditional healers are often reluctant to discuss herbal use with people from outside their cultural group.

Community members used common names learned in their native language to identify herbal therapies. To obtain comprehensive information about one specific plant, however, its Latin botanical binomial name must be used. Finding and tracing this name as it evolved was probably the most difficult step in the process and often required help from numerous reference resources from different countries. The part of the plant used was another piece of the puzzle, and this information was rarely available. An additional complication was that many remedies contain more than one herb. Consulting the pharmacognosy literature yielded information on chemical structures, medicinal and pharmacologic activities, and limited toxicity data. Often this information was only available in the resources published in the plant's country of origin. Consequently, even when such a reference was available, a translator was necessary. Because the interactions data for even the most studied medicinal plants is primarily hypothetical [17], interaction information remained one of the most desired, yet least available pieces of information. Finally, phytotherapy texts provided information on the medicinal activities, toxicities, and interactions of the herbs.

In creating the lecture, “Pharmacology of Latino and Haitian Herbs,” a medical librarian worked with a pharmacist. Both felt that discussing authoritative information sources was as important as presenting profiles of individual botanical remedies. Thirty-six health care professionals participated in the herbal tour. Continuing medical education (CME) and continuing education units (CEU) credits were awarded. Twelve evaluations were completed. Overall ratings for the pharmacology lecture content and for the presenters ranged from satisfactory to excellent. A majority of the participants felt that the presenters were able to achieve their objectives very effectively or effectively.

After the lectures, the participants took a field trip to two botánicas. Botánicas are specialty stores “that sell medicinal herbs, religious amulets, and other products (e.g., incense, perfume) used for healing remedies” [18]. Immigrant patients feel comfortable going to botánicas because they offer knowledgeable staff, a culturally sensitive environment, and no language barrier. In the botánica, patients do not need health insurance, prescriptions, or other documents. Medicinal agents can be purchased there in small amounts and at low cost [18].

After the herbal tour, ongoing work centers on developing herbal monographs for the BHLP <http://www.bmc.org/pediatrics/special/bhlp/pages/herbs/herbs.htm>. The herbs described are primarily used in Latino and Haitian cultures. Each monograph includes sections on traditional use and ritual or religious significance (if available), as well as mechanism of action, active ingredients, toxicities, scientifically proven medicinal properties, links to additional information, synonyms in relevant languages, references, and a photograph.

CONCLUSION

Haitian and Latino patients use medicinal herbs as part of their traditional healing. For this reason, health care providers need more in-depth education on these remedies and practices. Information related to these herbs is scattered and may be difficult to find. Continued research and funding of projects in this area are necessary to improve health care in these communities. This is an exciting area for medical librarians to contribute their research skills, teaching, and scholarship.