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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

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.

 

GENERAL INFORMATION ABOUT BANGLADESH

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 52.1F and 84F, and in the Summer and Monsoon 69.6F and 94.1F 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

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.

PRACTITIONERS OF TRADITIONAL MEDICINE

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

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.

 

Educational institutions of traditional medicine

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.

 

Production of Traditional medicines

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.

 

References

Ghani, Abdul (1998), Medicinal Plants of Bangladesh: Chemical Constituents and Uses, Asiatic Society of Bangladesh, Dhaka.

Ghani, Abdul (editor) (1990), Traditional Medicine, Jahangirnagar University, Savar, Dhaka, Bangladesh.

Islam, Hakim Hafiz Azizul ( 1994), Chairman, Board of Unani and Ayurvedic systems      of medicine, Dhaka, Bangladesh. Personal communication.

Qureshi, Mahmud Shah (editor) (1984), Tribal Culture in Bangladesh, Institute of Bangladesh Studies, Rajshahi University, Bangladesh.

Rashid, K.M., Khabiruddin, Md. And Hyder, S. (1992), Textbook of Community Medicine and Public Health, 1st edn., RKH Publishers, Dhaka, Bangladesh.

Sofowora, A. (1982), Medicinal plants and Traditional medicine in Africa, John Wiley & Sons Ltd., New York, USA.