World Medicine and Western Medicine: The Missing Dialog -- Interview, Kaiya Montaocean, Co- Director, Center for Natural

A large majority of the world's people -- estimated by the World Health Organization at about 80% -- use their traditional medicines as primary health care. Yet almost all the funding and scientific attention go to the very expensive corporate/academic medicine from which the majority of the world is excluded. This great divide hurts everyone, including those who do have access to the Western scientific treatments, because even the newest drugs and discoveries are still clearly inadequate; and since traditional medical practices are largely ignored in scientific research and funding, important treatment leads are likely to be lost or greatly delayed.

Kaiya Montaocean, Ph.D. abd, and John Rutayuga, Ph.D., who is from Tanzania, have been working for years to bridge this divide with their Center for Natural and Traditional Medicines (CNTM), headquartered in Washington D.C., which focuses on traditional medicine as primary health care and has a particular interest in HIV/AIDS. The Center began in 1988 within the Green Cross Clinic, at that time a Washington D.C. inner-city clinic specializing in traditional and alternative medicine. In 1988 Green Cross organized a World Conference on Traditional Medicines and AIDS, which was held in Washington that year at Howard University; Montaocean (who prefers to be called Kaiya, without the "Dr.") brought in traditional medicine scholars and practitioners from Africa, China, India, Central America, and South America. The African delegation proposed that Green Cross start a center; Kaiya, who was then doing clinical work at Green Cross, started CNTM, with Rutayuga, who had been a speaker with the African delegation at the Traditional Medicines conference, and with a third co-director, Vera Pratt.

Beginning with the Fifth International Conference on AIDS in Montreal (1989), CNTM has organized funding to bring traditional practitioners to each International Conference, in Montreal, San Francisco (1990), Florence (1991), Amsterdam (1992), Berlin (1993), and Yokohama (1994). (There was no international conference on AIDS in 1995, due to a change in schedule from yearly to every two years; the 1996 conference will be in Vancouver, and 1998 will be in Geneva.)

Currently CNTM is collaborating with a community-based center in Senegal, one in South Africa, one in the Caribbean among the Maroon people, a center in Brazil, and one in India. These centers work to bring together organizationally the traditional medical practitioners of their areas. In the next year or two, CNTM will focus on helping the centers which are already going, and those trying to establish themselves, be able to communicate with each other.

Kaiya, who has a background in physics and the arts and a Ph.D. abd in human ecology, then went on to study Chinese medicine, Native American medicine, and African medicine, through apprenticeship programs of several years' each.

The following interview took place on May 12, 1996

John S. James: What have you seen in AIDS treatment that should be getting more attention?

Kaiya Montaocean: What is happening now is alarming. The lack of genuine collaboration between biomedical professionals and those working in natural and traditional medicines is overwhelming. I have been a bridge, working between the biomedical professionals, and traditional peoples and their medicines. I have been able to see both sides of the bridge. The Center (CNTM) has focused on collecting information, disseminating information, and helping to create and sustain networks so that this dialog could continue.

Traditional medicine, the traditional peoples' voice, is the basis of a world health view. Western synthetic medicine is alternative; it is a crisis intervention medicine, very strong and suitable for short-term interventions. However, it is not economically feasible to produce this medicine for the entire world, the way that we have used it in the U.S. and Europe. But if we change our viewpoint on appropriateness, and put Western medicine in a context of world medicine, it could be used very effectively, to the benefit of everyone. In Europe and the U.S. we are overmedicated with the synthetics. We need to come into balance, too; you see this need in the large alternative/complementary medicine movements in the U.S. as well.

The knowledge of traditional medicine has been preserved through much sacrifice. There has been denial and lack of recognition. Traditional medical people have lived their lives under persecution for the last century and more. What they preserved of their knowledge, so that we can continue their work, they kept at a high price. For when the Western perspective came to the Americas, to Africa, and elsewhere, it came through violence, with the idea of stamping out the indigenous peoples' thought, and their perception of medicine and spirituality, and putting in its place a more colonially acceptable viewpoint of the world. Some that paid the highest price were the traditional medicine people -- whether in Europe with the witches, in Africa with the laws passed by colonial rulers against African traditional medicines, or in South America and Mexico where some of the first who were killed by the Conquistadors were the medicine people. Among the native people in the U.S., there has been a history of traditional doctors being killed; Geronomo himself was a medicine person, who took up war only after his family was annihilated.

In traditional medicines, there has been a long-standing viewpoint of wellness, stability, using the things around you, your mind, your body, your spirit, what you eat, exercises. Traditional medical practitioners use all of these in a systematic fashion to build their specific health systems. So what we have is an evolving, beautiful pattern of global health systems. This dynamic force is particularly important when we are trying to deal with a pandemic like AIDS, which is a global problem. The majority of people living with HIV are in countries where traditional health systems dominate. And with medicine so intricately tied to culture, it is imperative that we look at what these health systems have to offer in this crisis.

The problem today is that it is becoming harder to bring these two sides together, even to talk anymore. What I am being told by traditional medicine people, whom I have respected and worked with throughout the last ten years that I have been working on AIDS (as have they), is that they no longer want to take their energy to talk to people from the Western biomedical viewpoint. They feel that they have not been treated honorably, that their work has been taken, stolen, used inappropriately; they have not been invited on an equal basis to forums and conferences to discuss the issues of world medicine or AIDS in particular. Therefore they want to organize separately.

On the other side I have tried to reach and stay in contact with AIDS leaders involved in the World Health Organization, in the International Conference, in the International AIDS Society (in which I coordinate a caucus on alternative and traditional medicines), in the new AIDS organization of the United Nations. I have known the professionals leading these organizations for years. They are aware that CNTM is working with traditional people and working on AIDS. But when there is a dialog in which all of us should be involved, natural, alternative, and traditional medicines are the least and the last. Each year I have to go and beg. "Let us have a few dollars to bring some traditional people here. Let us have a place in the conference to talk about the treatment research the Chinese are doing in Tanzania. Let us have a few minutes to talk about the fact that the traditional doctors are organizing themselves on a regional basis to deal with AIDS in South Africa. Please let me have a few minutes to talk about what the Indians brought down the Amazon to the cities of Brazil for the people to try with AIDS, which is having some results." These professionals do not want to hear about such advances in the conferences, on an equal basis as they wish to hear about another clinical trial using AZT in combination with other corporate drugs. It seems to me, as a traditional medicine person and a scientist at the same time, that the conversations on the traditional Chinese work in Tanzania, on the Brazilian work, on the African work, are as interesting and important.

Our Center is funded solely by donations; we have no big contracts with anyone. When we organized the traditional medicines parts of the last six International Conferences on AIDS, we have had to find private money to do that, every year, as we have done since 1989 in Montreal. We have helped to organize the presentation of hundreds of abstracts, hundreds of speakers. But every time there seems to be no walking between, no one coming forward from the sector in which there are economic and scientific resources, to help make this happen. People have tried to help, but have been overruled by superiors who said that there was not enough empirical evidence to even consider this information.

This year, CNTM could not spend the considerable resources to make the international phone calls, send out mailings, do all of that, when our constituency, the traditional people, didn't really want to talk any more, because they thought no one was listening. So instead of going to Vancouver this year with even stronger presentations and data (there is more evidence now that some of the treatments and approaches are improving quality of life, and longevity), we will not be giving abstracts, or have big caucus meetings. The International AIDS Society never responded to budget requests made at the Yokohama conference (1994) to prepare for this caucus. There have been no funds made available from anyone to have this become part of the conference. In the last week, people have called me from around the world, asking why we are not organizing traditional medicine presentations this year; people from the Vancouver conference wanted us to. But with what resources?

Every year the traditional practitioners are the last to be considered. They are not exotic, primitive freaks, as some people have them pictured; these are the health workers from their communities. They are the medicine people of the world, and they deserve the respect of another culture, which happens to be more "scientific," happens to approach life in a different way.


As a person working in AIDS, trying to help alleviate that suffering in the world, I find this situation incredibly sad, because when the talking stops, the persons who ultimately lose are the patients. Even patients of Western doctors will likely also go to their Chinese doctor, take their vitamins and herbs, may see a psychic, or a body worker; they will select types of medicines for themselves. They should not be made to feel guilty, or pressured to hide it from one another, as at times I have seen that be very harmful.

And there is a much greater injustice to patients in those parts of the world where there are no Western medications for HIV, and they are told not to use their traditional medicines.

JSJ: The lack of treatment for a great majority of the world's population could become a bigger issue at Vancouver than it has in the past.

KM: When there are no other medicines available, we MUST look to what is around us; we cannot tell people who have this disease to just die.

JSJ: You mentioned the work in Tanzania, Brazil, and elsewhere. Can you give some examples of what is being done?

KM: In the last International Conferences, in Yokohama and before that in Berlin and Amsterdam, there were progressively more detailed studies presented about traditional and alternative medicines and AIDS. These studies started with very little funding and little technical support -- not like a study would start at the National Institutes of Health. They almost entirely started as community-based studies, and coalition, collaborative studies.

For example, one project was started by a coalition of Chinese doctors who came to Washington, D.C., to the Green Cross clinic, so they could observe their first cases of AIDS, as there were few cases in China at that time. China sent six of its finest thinkers in traditional medicine to be with us for almost two months. From that experience, they got some ideas about how they might use Chinese traditional medicine in treating AIDS. They returned to China and designed studies. They could not do them in the U.S., because we could not get permission through the FDA system, so those studies were done in Tanzania, under an agreement between the Chinese government and the Tanzanian government. For over four years now the researchers have been doing clinical trials using Chinese traditional medicine. They have shown both symptomatic improvement and longevity, and even a possibility of sero reversal; this was presented in 1992 at the Amsterdam international conference(1), in 1994 at the Yokohama conference(2), and published later in more detail(3). But there has been no move from any of the scientists who approached me after Dr. Weibo's presentation, so there could be a scientific dialog about how to study this in a more controlled way. The Chinese now want to do viral testing to monitor the virus itself, but there are no funds available, nor the necessary lab facility locally. It is not a question of whether these people want to do "pure" science or not; they do not have the technological support to do it. People in traditional medicines are not trying to hide what they are doing, but often there is not the technology or the resources in that community to do the kind of research done at NIH. This is also a problem in many parts of the U.S. Solving this problem is a question of communication, of dedication to global medicine beyond borders.

It is not a fight. There has been an antagonistic framework; I am not trying to blame anyone for it. We all have to do our best to face this problem together.

What is most disturbing now is the desire on both sides not to deal with each other. From conference organizers and biomedical professionals, I hear, "This is too much of a hassle. We have to pay for these people, they don't make their own money, they don't have institutions which support them, so we have to come up with this money. And then we do not understand each other's language." And on the other side, the traditional medical practitioners are saying, "You want to bring us out of our communities, our work, our livelihood, where we can make some money to feed our family, into these conferences, and we are not treated as equals. They do not listen to us, they act like we are some kind of strange thing, they argue with us when we tell them what is happening, they try to tell us it is not true. We don't want to go there and try to talk to them any more." This is the dilemma.

CNTM will be in Vancouver this year, we will have a table, but I don't know what we will have beyond that, because to have more would require economic and logistical support, which has not been there. We are going back to less than we had in Montreal (in 1989).

JSJ: Have you looked into computer communication? It may be more effective on the whole than the international conference. It costs almost nothing to send a report to hundreds of different people throughout the world. Compare that to flying someone worldwide and putting them in a hotel.

KM: We have a Healing Roots Network, which is in about 40 countries where people are working in traditional medicine as primary health care; it has a section on AIDS. Five years ago we proposed to set up electronic links between these hubs in different parts of the world. We designed regional systems for information to go from the hubs to the community level, through itinerant traditional doctors. The information would be read by a smaller group, then travel by word of mouth, as many of our people are illiterate. We could not obtain the funding. But now that the World Wide Web is set up, this could be an appropriate venue for us to start collaborating with others to make that happen.

Hopefully we can revive this initiative to allow traditional medical practitioners in different parts of the world to communicate with each other. They can keep their points of view. Even if they do not go to meetings where they are treated without respect, they can continue their work and can organize.

For More Information

For more information about projects of the Center for Natural and Traditional Medicine, contact CNTM, phone 202/234-9632, fax 202/332-2132, or mail to CNTM, P.O. Box 21735, Washington, D.C. 20009.

The international conferences have published hundreds of abstracts on traditional medicines. Also, CNTM has additional information on community sessions at these conferences, which the conferences did not include in the published abstracts.

After the Amsterdam conference in 1992, CNTM organized the Natural, Alternative, Traditional, and Complementary (NATC) Medicines Caucus of the International AIDS Society. The Caucus now has branches on every continent that are actively planning regional conferences on NATC therapies and AIDS. The Asian conference will be held later this year; the African conference is scheduled for the spring of 1997, and the European conference for September 1998.

References

1. Lu Weibo, Mbaga IM, Zhuang JD, Shao J, Wu BP, and others. China-Tanzania Coordinating Group of Experimental Therapy on AIDS. Treatment of 158 HIV-infected patients with traditional Chinese medicine in Dar es Salaam, Tanzania. Eighth International Conference on AIDS, Amsterdam, July 19-24, 1992 [abstract # PoB3448].

2. Lu Weibo and others. Clinical observation on treating 112 HIV-AIDS patients with glyke. Tenth International Conference on AIDS, Yokohama, August 7-12, 1994 [abstract # PB0868].

3. Lu Weibo. Prospect for study on treatment of AIDS with traditional Chinese medicine. JOURNAL OF TRADITIONAL CHINESE MEDICINE (China). March 1995; volume 15, number 1, pages 3-9.