The presence of primary health care, including Western primary health-care services (PHCs), in rural areas of developing countries is considered by international organizations and policy-makers to be a universal solution for improving human health (1). In these remote and/or impoverished areas, Western health care is often part of a pluralistic medical system in which it coexists with traditional medicine (TM) that includes both self-care with medicinal plants and consultation with specialized traditional healers. Health-care institutions in developing countries consist of governmental health services, nongovernmental organizations (NGOs), traditional healers, and private practice (1). The coexistence of traditional and Western medicine does not imply that they work together well, and Western health care does not necessarily satisfy its end-users. Therefore, integration of Western medicine into local communities faces some obstacles. In terms of Western PHCs, the cost of consultation, high travel distance, perception of illness by patients as non-serious, and impersonal treatment of patients by the medical staff all counteract the use of Western PHCs (1-3). Furthermore, local health beliefs can interfere with the use of pharmaceuticals. For example, it is a common belief in Viet Nam that antibiotics should be used only minimally for someone with a "hot" body (i.e. suffers from fever) because these medicines are considered to be "hot" also, and hence will not have the desired cooling effect (4). Women in periurban Brazil preferred medicinal plants to pharmaceuticals because of the low cost, and because they were perceived to be better medicines than pharmaceuticals, more effective and without the side effects of the latter (3). Hence, in local communities, medicinal plants may be more acceptable culturally and for primary health-care than Western medicine (1).
According to WHO, up to 90% of the population in developing countries uses TM, including medicinal plants, to help meet their primary health care needs (5). WHO's strategy for TM 2002-05 has four main objectives: framing policy; enhancing safety, efficacy, and quality; ensuring access; and promoting the rational use of TM. Among the expected outcomes of this strategy are: integration of TM within PHCs, increased governmental support and recognition of TM, increased recording and preservation of traditional medical knowledge, safety monitoring of herbal medicines (6), increased availability of TM, sustainable use of medicinal plant resources, and basic training in commonly used traditional medical practices for Western health-care providers (5).
Some 30% of the Bolivian population does not receive Western medical care. Moreover, human medical capital is limited, with only one medical doctor for 1000 and 7000 inhabitants in urban and rural areas, respectively (7, 8). Although there has been a threefold increase in the number of clinics and medical staff over the past 30 years, the use of PHCs has gone up by only 13%. The most important reason for the limited use of Western health care in Bolivia is the lack of trust in modern medicine due to financial, psychological, physical, and cultural barriers (9). For example, Andeans perceive the causes of certain illnesses as a disturbed interrelation between themselves, their land, and/or relatives. Therefore, healing should include rituals to restore these imbalances (7). However, Bolivian doctors and nurses often believe that Western medicine is superior to and should even replace TM. This attitude aggravates the fragile relationship between Western PHCs and end-users. All these findings point to an underrepresentation and underutilization of Western health care in Bolivia.
In view of the importance of primary health care for people living in remote areas in Bolivia, and the problems associated with a pluralistic medical system, we evaluated the use of pharmaceuticals and medicinal plants for the treatment of general illness by indigenous community members in the Bolivian Andes and Amazon. …