I am writing from rural Tanzania, on the edge of the Serengeti, sitting at a small desk in a corner of the Wasso district hospital, surrounded by roots, powders, and eucalyptus leaves. We are working alongside hospital staff, helping to treat wounds and burns and provide supportive treatment to patients we meet on morning rounds with the physicians here. The integrative herbal medicine program is becoming well-established: honey, Usnea, and Opuntia have been in constant use here for over a year now, replacing antibiotic creams and expensive silver cream. On inpatient wards, our interventions consist primarily of hot ginger compress applications, herbal steams, nutritive juices (lots of nettle leaf smoothies) and anti-inflammatory tea (made with tulsi, ginger, and perhaps Carissa edulis leaves).
Since we are working on building a sustainable herbal medicine program, we have avoided bringing herbs from home, or using difficult-to-find plants. We have also done our best to keep things simple. Rather than creating a reliance on Western herbs, complex preparations, or rare botanicals, we want to help establish some basic, effective, and long-term additions to the routine here. It is only this way that herbal medicine will truly become an ongoing part of hospital work – driven by the knowledge of local healers, and embraced by staff (most of whom are enthusiastic about learning simple techniques to help patients – and themselves).
During this process, I am also exploring the interesting ways traditional medicine fits in to the culture. There are the ever-present issues we see all around the world: the old apprenticeship-based model of learning is breaking down. There is a splitting of allegiance between those who would turn to traditional medicine first, and those who first seek out hospital treatment. Due to a lack of communication (and sometimes lack of trust), integrating the traditional with the modern can be difficult. Traditional healers, because of their connection to spirits of place, plants, and disease, are sometimes viewed as interacting with “devils” in a culture that is rapidly embracing Christianity. These are things we see in the United States, too—the perennial plight of herbalists.
But as the population in the US continues to show a growing interest in medicinal herbs, it may be instructive to look at how traditional medicine is defined and perceived in the Tanzanian culture. In the US, using medicinal plants ranges from an occasional cup of tea, to a blend made by an herbalist and taken over time. There are strong pills made from concentrated botanical constituents, and more specialized preparations such as essential oils, short-term “cleansing” kits, topical preparations, and even “herbal” shampoos. In many cases, the cultural attitudes around using herbal medicine are similar to the attitudes around pharmaceuticals: what pill or extract can I take for my disease? Is it strong, pure, consistent in its dosing and effects? Seen through this lens, all that is left of herbal medicine is an ambiguous label of “natural” – in the sense that, once, it came from something found in nature.
But is this really traditional medicine? In Tanzania, the word “traditional” (as it applies to medicine) can actually be translated three ways, and all three meanings apply when talking about herbalism1 The first is asili, literally “nature”. But this word also means foundational, of the roots, embodying essence. Asili implies that traditional medicine is a deep and inextricable part of healing, something that is practiced daily, a basic part of life. Rarely do we see this approach in the US: even if an herb has a traditional use, it is approached on an “as-needed” basis, rather than as something as essential as food. I take asili to mean “tonic herbalism”: the daily communion with what is essential to support optimal wellness. It is fascinating, and reassuring, to encounter this very same concept in the definition of traditional medicine in Tanzania.
The second word is “jadi”, meaning passed down through generations, of the ancestors. This may be the closest to what we think of as “traditional”: it is an old knowledge, our grandparents knew it, it may be relatively low-tech in its preparations and applications. It also implies a reverence and respect for our forebears: in the same way that elders are help up here as sources of wisdom and cultural continuity, so traditional herbalism is thought to hold an important piece of cultural knowledge, passed down through the generations. I also interpret jadi as meaning “traditional use”: held up as equal to the modern clinical trial, the wisdom of the traditional use record should be equally valued when talking about herbal medicine. We run the risk in the US of moving forward, seduced by the wonderful progress in research on the pharmacology and biochemical effects of plants, without keeping one foot firmly planted in the traditional knowledge base of herbal medicine – without remembering jadi. This may lead to some breakthroughs: isolation and concentration of curcuminoids, novel anti-cancer uses for old remedies. But as we’ve seen in the case of turmeric, isolated curcuminoids may not actually be as bioavailable as whole turmeric roots, and we might be able to achieve higher blood levels of the active compounds by simmering whole roots in milk with a little black pepper – a truly “traditional” use, a technology based in ancestral wisdom, medicine with jadi.
The third word is “kienyeji”, and this is perhaps the most neglected piece of tradition in the US context. Kienyeji means “of a place”. It implies connection to, and derivation from, a particular location. It is a source of constant puzzlement for me that we value location for products like wine, or even food, but completely neglect it when discussing herbal medicine. Would you ever dream of saying that a wine made from Nebbiolo grapes grown in Vermont might be the same as one made from grapes grown in Piedmont, Italy? Or that maple syrup from upstate New York might be identical to Vermont maple (pardon the reference to this long-standing rivalry)? Kienyeji brings this point to the fore by reminding us that tradition, like herbal medicine, comes out of a specific place and resonates with location as much as cuisine does. As herbalists, we see this all the time: the approach used in the Southwest is different from that used in New England. The herbs we use in Tanzania are sometimes similar, but often radically different, from those we use at home. Kienyeji reminds us that traditional medicine is tied to the place in which we live, the forests and fields in which we walk, the air and water that we breathe and drink.
As the practice of medicine moves into the future, I am a firm believer that herbalism must play a central role. It helps control costs; it empowers those who learn it; it is a low-tech approach that, especially when focused on commonly available weeds, is eminently sustainable in a range of conditions. But we must also remember that herbal medicine is traditional, and not just a new source of potential drug-like compounds. It has asili, a foundational, tonic quality that requires it to be enmeshed in our lives daily, just as much as food and movement are. It has jadi, an age-old wisdom not only in terms of applications, but also in terms of preparation and delivery methods (think tea or powder versus standardized pill). And it has kienyeji, the signature of place, which implies that herbal medicine must be decentralized, practiced in every bioregion using local plants, to knit us back into our homes, our ecologies – not imported from far-flung corners of the world, or obsessed with the latest expensive exotic. The foundational practice of medicine, passed on through generations and firmly rooted in the terroir of place: this is traditional medicine, this is tonic herbalism, this is what we do.
I leave you with a photo of Sangau Swekei, the traditional Maasai herbalist in his lion-fur-trimmed cape, as he brews a decoction of local roots fresh from the forest. We are different, but we are also the same. And like herbalists everywhere, we are asili—essential.
(Urban Moonshine’s Chief Herbalist, Guido Masé, has spent the last three years traveling to Tanzania in April to work at the Wasso district hospital.)