Present
State-Of-The Art Of
Traditional
Medicine Practice In Bangladesh
Abdul Ghani
Department of
Pharmacy, Jahangirnagar University
Savar, Dhaka-1342,
Bangladesh
SUMMARY
GENERAL
INFORMATION ABOUT
BANGLADESH
TRADITIONAL MEDICINE PRACTICE IN BANGLADESH
PRACTITIONERS OF
TRADITIONAL MEDICINE
OFFICIAL
STATUS OF TRADITIONAL MEDICINE IN BANGLADESH
Educational institutions of traditional medicine
Production of
Traditional medicines
References
SUMMARY
È
The practice of Traditional medicine is deeply
rooted in the cultural heritage of Bangladesh and constitutes an integral part
of the culture of the people of this country. Different forms of Traditional
medicines have been used in this country as an essential means of treatment of
diseases and management of various health problems from time immemorial. The
practice of traditional medicine in this country has flourished tremendously
in the recent years along with that of modern medicine. As a result, even at
this age of highly advanced allopathic medicine, a large majority (75-80%) of
the population of this country, particularly in the rural and semi-urban
areas, still prefer to use traditional medicine in the treatment of most of
their diseases even though modern medical facilities may be available in the
neighbourhood. However, the concept, practice, type and method of application
of traditional medicine vary widely among the different ethnic groups living
in different parts of the country according to their culture, living standard,
economic status, religious belief and level of education. Thus traditional
medicine practice in Bangladesh includes both the most primitive forms of folk
medicine (based on cultural habits, superstitions, religious customs and
spiritualism) as well as the highly modernised Unani and Ayurvedic systems
(based on scientific knowledge and modern pharmaceutical methods and
technology). These various aspects of Traditional medicine practice in
Bangladesh, their current official status (acceptability, recognition, etc.)
in the country as a means of treatment, and their contribution to, and impact
on, the overall health management programmes of the country are described and
discussed in this paper supported by documentary evidences and scientific
data.
Bangladesh is a small country in South Asia. It
is situated between 20034' and 26038' North latitude and
between 88001' and 92041' East longitude. The country is
bounded in the North and West by India, in the South by the Bay of Bengal and
in the East by India and Myanmar.
Bangladesh has a total land area of 147,570 sq.
km (56,977 sq. miles) and territorial waters of 12 nautical miles. For
administrative purposes the country is divided into 6 Divisions, 64 Districts
and 495 Thanas (Local Government Areas). The country, called a land of rivers,
has a close network of many big and small rivers and their tributaries.
Notable among them are the Padma, Meghna, Jamuna, Brahmaputra, Madhumati,
Surma and Karnaphuli, most of which have their origin in the Himalayas in
India and flow down to the Bay of Bengal. The big rivers bring regular yearly
monsoon floods so vital for the fertility of the low lying cultivable lands of
the country, although over-flooding sometimes causes devastating damages to
life and property.
Principal agricultural crops of the country are
rice, jute, wheat, tea, tobacco, sugarcane, pulses, oil seeds, spices,
potatoes, vegetables, banana, mango, coconut and jack fruit. Principal export
items of Bangladesh include raw jute, jute products, ready-made garments, tea,
hides and skins, newsprint and fish. Bangladesh has a huge natural gas
reserve. Its other mineral resources are lignite coal, limestone, ceramic
clay and glass sand.
Bangladesh enjoys a typical tropical climate
with three main seasons: Winter (November-February), Summer (March-June) and
Monsoon or Rainy season (July-October). The minimum and maximum average
temperatures in the Winter are 52.1°F
and 84°F,
and in the Summer and Monsoon 69.6°F
and 94.1°F
respectively. Average annual rainfall in the Monsoon ranges from 47" to 136".
Humidity is highest in July (99%) and lowest in December (36%).
Bangladesh has a population of about 125 million
people, about 98% of which belong to the same ethnic group sharing a common
language (Bangla) and culture. This linguistic group is called the
Bangalees, which constitute the bulk population of the main
land. The rest 2% is constituted of tribal populations residing in the remote
hilly and forest areas of the country. There are six linguistic categories of
such tribes in Bangladesh who have their own language, culture and life style.
These are:
Kuki-Chin
speaking tribes living mainly in the Chittagong Hill Tracts and numbering
about 600,000. These tribes include the Chakma, Marma,
Manipuri, Mru, Mizo, Kuki, Kumi, Tanchangya and the Bam.
Bara
(Bodo) speaking tribes living in the hills north and north-east of
Bangladesh and numbering about 500,000. They include tribes like Garo,
Tripuri, Bodo, Rangdania, Mikir, Kachari, Riang, Jamatia and some other
smaller tribes.
Khasi
speaking tribes living mainly in the hilly areas north of Sylhet and numbering
about 15,000 only. They include tribes like Khasi and Pnar
tribes.
Munda
speaking tribes living in the plains
and hills of Rajshahi, Dinajpur and Bogra districts and numbering about
130,000. These tribes include the Santal, Mahili, Mundari and Ho
tribes.
Dravidian
speaking tribes which include the Orao and Paharia tribes. There
are about 100,000 of them living in Bangladesh.
Indo-Aryan
speaking tribals, which include the Namasudra, Jaliya Kaibartta, Bede,
Bhuimali and other low caste peoples, live in the plains in smaller groups
amidst the main ethnic group of the country, the Bangalees,
forming a bulk of the total population of the main land. Of these smaller
groups of caste people of the main land the Bedes (Gypsies) are
unique. They are nomadic people, who live on boats and move from place to
place through the rivers and other water ways. They spend a very small period
of time of the year on land. Although they live on the main land amidst the
main Bangalee ethnic group speaking the same language with a slightly
different accent, they have a different culture and life style.
Of the total population of the country only
about 36% are literate and about 20-25% live in the cities enjoying modern
living facilities. The main profession of the village dwellers (who constitute
about 75-80% of the total population) is farming and the country's economy is
based on agriculture. The staple foods of the people are rice and wheat.
However, in recent years there has been a great change in the profession and
life style of the village people due to massive rural electrification and
extension of some modern facilities to the villages. These facilities include
health care services with the establishment of hospitals, health care centres,
family planning clinics, Extended Programme on Immunisation (EPI) clinics,
etc. in the villages. But these services are totally inadequate for such a big
population of the country. On the average, only about 20-25% of the people
have access to modern health care facilities and the rest 75-80% of the rural
population of the main land of Bangladesh still receive health care services
from the indigenous traditional medicine practitioners.
TRADITIONAL
MEDICINE PRACTICE IN BANGLADESH
È
Bangladesh possesses a rich flora of medicinal
plants. Out of the estimated 5000 species of different plants growing in this
country more than a thousand are regarded as having medicinal properties. Use
of these plants for therapeutic purposes has been in practice in this country
since time immemorial. Continuous use of these plants as items of traditional
medicine in the treatment and management of various health problems generation
after generation has made traditional medicine an integral part of the culture
of the people of this country. As a result, even at this age of highly
advanced allopathic medicine, a large majority (75-80%) of the population of
this country still prefer using traditional medicine in the treatment of most
of their diseases even though modern medical facilities may be available in
the neighbourhood.
Although the use of traditional medicine is so
deeply rooted in the cultural heritage of Bangladesh the concept, practice,
type and method of application of traditional medicine vary widely among the
different ethnic groups. Traditional medical practice among the tribal people
is guided by their culture and life style and is mainly based on the use of
plant and animal parts and their various products as items of medicine. But
the method of treatment and application of the medicament are greatly
influenced by the religious beliefs of the different tribes and their concept
of natural and supernatural causes of diseases. For that reason their medical
practice also includes the use of a number of rituals like religious prayers,
sacrifices, offerings in the name of the spirits and gods, incantations and
sometimes tortures. The medicaments, prepared from plant materials and other
natural products sometimes also include some objectionable substances of
animal origin. They are dispensed in a number of dosage forms like infusions,
decoctions, pastes, moulded lumps, powders, dried pills, creams and poultices.
Diets are strictly regulated. Massages, sometimes amounting to almost physical
torture, are also prescribed as parts of treatment. Treatments prescribing
wearing of amulets, garlands of twigs of plants or animal bones and teeth and
drawing of images of supernatural creatures, gods and spirits on different
parts of the body are also in vogue among some tribes . While these items of
treatment are almost common in the medical practice of most of the tribal
groups, their individual weightage and method of application vary from tribe
to tribe.
Among the largest ethnic group, the
Bangalees on the main land, there are two distinct forms
THERE ARE TWO DISTINCT FORM of Traditional
medicine practice:
1.
One is the old
and original form based on old knowledge, experience and belief of the older
generations. This includes:
i)
Folk medicine,
which uses mainly plant and animal parts and their products as medicines for
treating different diseases and also includes treatments like blood-letting,
bone-setting, hot and cold baths, therapeutic fasting and cauterisation.
ii)
Religious
medicine,
which includes use of verses from religious books written on papers and given
as amulets, religious verses recited and blown on the face or on water to
drink or on food to eat, sacrifices and offerings in the name of God and gods,
etc. and
iii)
Spiritual
medicine, which utilizes
methods like communicating with the supernatural beings, spirits or ancestors
through human media, torturous treatment of the patient along with
incantations to drive away the imaginary evil spirits and other similar
methods.
2.
The other is the
improved and modified form based on the following two main traditional
systems:
i)
the Unani-Tibb or
Graeco-Arab system which has been
developed by the Arab and Muslim scholars from the ancient Greek system, and
ii)
the Ayurvedic system
which is the old Indian system based on the Vedas, the oldest
scriptures of the Hindu saints of the Aryan age.
Both the Unani and Ayurvedic systems of traditional medicine have firm roots
in Bangladesh and are widely practised all over the country. Apparently the
recipients of these systems of medicine appear to be the rural people, but
practically a good proportion of the urban population still continues to use
these traditional medicines, although organised modern health care facilities
are available to them. Medicinal preparations, almost all of which are
multicomponental, used in these two systems are invariably made from plant
materials, sometimes with the addition of some animal products and also some
natural or synthetic organic and inorganic chemical substances. Both
indigenous and modern technology are employed in preparing the medicines of
these systems. Plant materials are used in these preparations in a variety of
forms, such as small pieces, coarse powders, as their extracts, infusions,
decoctions or distillates. They are dispensed as broken pieces, coarse and
fine powders, pills of different sizes, in the form of compressed tablets, as
liquid preparations, as semi-solid masses and in the form of ointments and
creams, neatly packed in appropriate sachets, packets, aluminium foils,
plastic or metallic containers and glass bottles. The containers are fully
labelled with indications/contra-indications, doses and directions for use and
storage, just like modern allopathic medicinal preparations.
Among the tribal communities in the hills and
forests usually the chiefs or some elderly people or some specially gifted
persons, respected as highly powerful and knowledgeable members of the
communities, act as the practitioners of traditional medicine. They are also
regarded by the members of their communities as holders of some
supernatural powers, a myth created generation after generation by the
practitioners themselves in order to maintain their superiority status in the
community. Their living style and dresses are also different from those of
other members of the community. This is how they maintain their special status
in the society. These practitioners do not have any formal education or
specialised training for practising traditional medicine. They normally
inherit the knowledge from their practising parents or predecessors or by
working as apprentices of the older practitioners.
Most of the Bedes (Gypsies) on the
main land are snake-charmers-cum-traditional medicine practitioners.
Traditional medicine practised by them is completely different from the above
two forms. In their medical practice, they generally use both plant and animal
parts and their products, but more often animal parts and products. They do
not normally use oral medicine. They mainly use charms, incantations,
amulets and physical torture. Treatments like blood-letting (sucking out of
‘bad blood’ with animal horns), removal of minute living (?) entities from
painful carious teeth with the help of fine plant twigs or leaf-midribs, etc.
are also common with these practitioners.
Among the largest ethnic group, the
Bangalees, on the mainland, which comprises of illiterate,
semi-literate, half-educated and highly educated individuals, there are at
present more than six thousand practitioners of the two traditional systems
(Unani and Ayurvedic) of medicine. These practitioners are either registered
or have been accepted for registration by the appropriate authority of the
Government, the Board of Unani and Ayurvedic Medicine. About 1500 of them are
institutionally trained and qualified, the others are privately trained under
registered qualified practitioners. In addition to them, there are about ten
thousand unregistered traditional medicine practitioners who are practising in
many rural and peri-urban areas of the country. Most of them have no
institutional or professional training and many of them are illiterate,
half-trained or on-trade apprentices and quacks. The practitioners of
traditional medicine in Bangladesh can thus be roughly categorised into the
following groups:
In Tribal Areas:
Tribal chiefs or Medicine men.
On the Main land:
Bedes
(practising Folk and Spiritual medicines).
Medicine men
(practising Folk medicines).
Pirs, Imams and Fakirs
(practising Religious and Spiritual medicines).
Kavirajes (practising
Ayurvedic medicines).
Hakims (practising
Unani medicines).
OFFICIAL STATUS
OF TRADIONAL MEDICINE IN BANGLADESH
È
Unani and Ayurvedic systems of medicine were
officially recognised by the Government of Bangladesh immediately after
independence and at the same time a Board of Unani and Ayurvedic systems of
medicine was constituted. After the introduction of a National Drug Policy in
1982, Unani and Ayurvedic drugs have been brought under the control of the
Drugs Administration Department of the Ministry of Health and Family Welfare
by legislation to control and regulate the commercial manufacturing and
marketing of quality Unani and Ayurvedic drugs. The Board of Unani and
Ayurvedic systems of medicine performs the following specific functions:
registration of the traditional medicine practitioners, recognition of the
relevant teaching institutions, holding of qualifying examinations,
publication of text books, standardisation of Unani and Ayurvedic drugs,
preparation and publication of Pharmacopoeias/Formularies and undertaking
research and development programmes. The Board has by this time published two
National Formularies:- one for Unani and the other for Ayurvedic drugs, which
have already been approved by the Government. They are now in use as official
guides for the manufacture of all recognised Unani and Ayurvedic medicinal
preparations.
A total of 15 Government recognised and funded
educational institutions are currently engaged in the teaching of traditional
medicine and training of traditional medicine practitioners in Bangladesh.
These institutions are situated in different parts of the country. Of them, 10
institutions are involved in teaching the Unani system and the other 5 in
teaching the Ayurvedic system. Each of these institutions has an attached
out-patient hospital which imparts internship training to the graduates while
giving medical services to the out-door patients. These institutions offer a
four year Diploma course and six month internship training. The curriculum of
the courses offered includes anatomy, physiology, hygiene, community medicine,
minor surgery and other relevant subjects of the respective systems. At the
end of the courses, the Board of Unani and Ayurvedic systems of medicine
conducts a qualifying examination centrally. Annual intake of these
institutions currently stands at about 400 students. A Government Unani and
Ayurvedic Degree College has been established in Dhaka with effect from the
1989-90 academic session. This college offers a five year degree course and
one year internship training in the attached 100-bed Traditional Medical
Hospital. The college is affiliated to the University of Dhaka, Bangladesh.
In addition to the above institutional teaching
and training programmes, the Board of Unani and Ayurvedic systems of
medicine is now pursuing a crash programme in collaboration with the WHO to
impart short-term training to 2000 untrained practitioners of traditional
medicine in phases. This is an attempt to give them the minimum level of
training and knowledge so that a second tier of manpower in traditional
medicine health care services can be raised. They are registered in the
category B register. Under a Government Project, entitled "Development of
indigenous systems of medicine (Unani and Ayurvedic) in Bangladesh" the Board
envisages to set up a National Institute of Research in Unani and Ayurvedic
Medicines and a modern traditional medicine production unit in Dhaka. It also
envisages to establish more educational institutions in different parts of the
country for offering Diploma courses in traditional medicine and to develop
and modernise the existing educational institutions of traditional medicines
in the country.
More than four hundred big and small
manufacturers in Bangladesh are now engaged in manufacturing traditional
medicine preparations in various dosage forms using local and imported raw
materials. Some of the important raw materials of plant origin are derived
from the rich tropical flora of Bangladesh. Many of them are imported from
India and Pakistan. The Unani and Ayurvedic drugs manufactured in Bangladesh
not only meet the local requirements but are also exported to the neighbouring
countries. Although many of these manufacturers are still using the
traditional methods of producing these drugs, some of them, like Hamdard Laboratories (Waqf)
Bangladesh, have substantially modernised their factories by installing modern
equipment and machinery. They use modern methods and technology for the
production and quality control of their traditional medicines. Some of these
factories can be compared with any modern pharmaceutical factory of this and
other countries. The presentation and quality of their products are as good as
those of modern allopathic drugs. Many traditional medicine preparations in
Bangladesh are now dispensed and sold from most of the modern allopathic drug
stores, particularly those in the rural and peri-urban areas, and some of them
are even prescribed by the modern allopathic medicine practitioners.
Modernisation and utilisation of modern technology and pharmaceutical
knowledge in manufacturing and quality controlling of traditional medicines
are now rapidly increasing in Bangladesh.
Traditional medicine systems, particularly
Unani and Ayurvedic systems, are now recognised and well accepted as good
alternative systems of medicine in both rural and urban areas of Bangladesh.
Considerable research is now going on in this country both privately and
institutionally to improve the quality of these drugs. Establishment of a
separate Research & Development laboratory by the Hamdard Laboratories of
Bangladesh, a manufacturer of Unani medicines, in order to undertake research
programmes to improve the quality of its current products and to develop new
drugs from indigenous natural sources, bears clear testimony to that.
The effort is not limited to that only. One of
the objectives of the National Health Policy is to encourage systematic
improvement in the practice of the indigenous systems of medicine and to
utilise the additional manpower available in the Health sector. The Government
is also planning to incorporate traditional medicine in Primary Health
Care (PHC) activities. In order to achieve the goal of providing basic health
needs to maximum of the rural people in the shortest possible time with
minimum expenditure, the Government is planning to bring traditional medicine
into the mainstream of the organised public health services and health care
delivery programmes of the country. In an attempt to integrate the traditional
and modern allopathic medicine practices, the Govt. has already started
appointing qualified Hakims and Kavirajes in the rural hospitals and health
complexes along with graduate allopathic medical doctors. With the
encouragement and practical involvement of the World Health Organisation,
efforts are now in vogue in Bangladesh to utilise traditional medicine more
and more in the health care programmes, particularly at the Primary Health
Care level. And this is imparting a positive effect on the overall health
management programmes of the country.
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Bangladesh:
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Islam, Hakim Hafiz Azizul ( 1994), Chairman, Board of Unani and
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