Herbalism in the Brazilian rain forests

Patrick Cunningham discusses how indigenous Brazilian Indian tribes use herbal medicines and how they have formed a cooperative to ensure a self-sustainable future

The earliest forefathers of the chemical and pharmaceutical industry were the herbalists and medicine men and women who went into the forest to collect the materials from which they made the very first medicines.

They passed their accumulated knowledge from generation to generation, each successor adding his or her experience. They experimented, using their unsuspecting patients as guinea pigs, trying out new plants and new ways of preparing the materials they collected.

In the modern world, these traditional healers have mostly been replaced by doctors and chemists, but there are still many herbalists and shamans dispensing plant extracts. Developed countries in Europe and north America are seeing a revival in herbalism along with other alternative medical systems. In the developing world, herbal medicine remains essential for the majority of the population, for whom there is no alternative.

Brazil is unusual because it is both developed and developing. Many of the people in the major cities of the south-west have a lifestyle pretty much indistinguishable from their counterparts in the developed world. But the rural parts of the interior and the shanty towns on the fringes of the cities host poverty and hardship which can only be termed underdeveloped. Here, Dona Maria on the corner or Senhor Manuel in the market is still the first port of call when illness strikes.

unknown side-effects

In a country with severely limited national health services, the only access which many people have to pharmaceutical products is from unlicensed and untrained shopkeepers. The medicines are often out of date and poorly stored, and those dispensing them have little understanding of their properties or side-effects. Even powerful drugs which would elsewhere require a doctor's prescription are widely available. The drugs companies have frequently been criticised for fuelling demand with sustained advertising, and stand accused of capitalising on the ignorance of the population.

Pharmaceuticals dispensed in this manner are often ineffective and frequently dangerous. Patients can suffer unnecessary side-effects, and inappropriate drugs can leave their symptoms worse. As a result, many poor people have grown to distrust pharmaceuticals, relying instead on the tried and tested remedies used by their forebears.

The traditional herbalists use decoctions, infusions, tinctures, poultices and powders, prepared under poorly controlled, often unhygienic conditions.

Increasingly though, herbal medicines are being produced in a more scientific way. The extract is obtained using a range of well-tried and scientifically controlled processes. It is then mixed, where appropriate, with a sterile, stable base, and dispensed with full instructions by trained primary healthcare workers.

Phytotherapeutic remedies have been found so effective that several plants have been approved for use by the Brazilian health service. Further research has been instituted to assess the effectiveness of other plant remedies, and cash-strapped public health service hospitals and clinics are including the products in their lists of approved medicines.

In the Amazon town of Altamira, the public health hospital is heavily dependent on plant medicines. The municipality produces some, but they also buy products from Farmacia Verde (the Green Pharmacy), which currently has a list of around twenty medicines. These range from analgesics and antiseptic wound healing creams to fungicidal vaginal applications and medicines for bronchial infections and asthma.

Farmacia Verde is unusual in that it is wholly owned by Amazoncoop, a co-operative of nine Indian tribes who live in villages surrounding Altamira, with the participation of two further tribes who live in the town but retain their tribal identity.

The co-operative was set up to help the Indians to become independent of FUNAI, the under-resourced Brazilian government Indian agency, and to offer the possibility of a self-sustainable future.

The tribes cover a broad spectrum, and come from several distinct ethnic groups. The groups which live in the town have a century of contact with mainstream Brazilian culture. Altamira was built on the traditional site of Xipaya and Curuaya villages to accommodate the influx of rubber tappers and settlers just after the turn of the 19th century.

Other tribes have a much shorter history of contact. The Arara and Parakana were first contacted only during the construction of the Transamazon Highway in the 1980s. They suffered catastrophic reductions in their populations from imported diseases like influenza and measles in the years following first contact, as had the other tribes before them. Like most of the village Indians, they still live in mud and thatch villages with no electricity or roads. Access to the outside world is several hours by boat, although villages are nowadays in radio contact.

The co-operative is the brainchild of a group of sympathetic outsiders, including the head of the FUNAI post in Altamira, a Brazilian journalist, human rights lawyers and a pharmacist. It grew out of a charitable primary health care project funded by the Body Shop Foundation.

outside influence

The members of the project's advisory board knew that the immune systems of the village Indians were not ready to cope with the diseases that contact with the outside world brought. This was at a time of huge inward migration by settlers looking to improve their lives in the so-called 'empty' Amazon. The reserves granted to the villages by the Brazilian government were frequently invaded by settlers and loggers, with disastrous consequences for the health of the Indians. FUNAI was completely helpless because of underfunding, so the board decided to help the Indians to establish revenue-generating enterprises which would make them independent of FUNAI and generate enough income to help them to protect their land.

At the same time, they needed access to medical support, so when Dr Lucimar Aires da Souza, a local pharmacist with qualifications in homeopathy, suggested that they establish a medicinal plant garden and laboratory, it made sense.

The medicinal plant garden was joined by other business ventures. The co-operative built an eco-tourism lodge on an island four hours up-river from Altamira, set up to cater for discerning international travellers who are looking for something more adventurous than a package tour can offer.

The Indians had an already established trade in Brazil nuts, for which they were paid a pittance by local middlemen. A deal with the Body Shop secured a simple manual oil extraction plant, training in quality control and processing skills, and direct access to an overseas customer, resulting in much higher income. The main customer is the Body Shop, which uses Brazil nut oil in their shampoos and conditioner products.

The co-operative is hoping to find new international customers for its high-quality oil production, and to diversify its range to include Copaiba (copaifera, various species), Andirroba (carapa guyanensis) and Cumaru (dipterix odorata). Between them, these harbour a wealth of properties useful in medicine and industry. Cumaru (known elsewhere as Tonka; the wood is greenheart) is used in perfumery.

Both Andirroba and Copaiba oils are flammable and can be used to provide heat and light, and are used in soap making. They have medicinal properties, which heal cuts and bruises, and reduce swellings. Andirroba is an effective insect repellent, for use on the skin and for treating wood against insect attack. Copaiba is highly antiseptic, and its anticancer properties are currently under investigation.

Brazil nut oil is excellent for making high-quality soaps and toiletries, and is used medicinally to treat purulent swellings.Cumaru is antispasmodic and regulates the heartbeat. It also eases respiratory infections.

The oil production is a separate business from the medicinal plant garden and laboratory, but there are overlaps. The co-operative intends to develop both.

Although Aires da Souza already had an interest in medicinal plants, she needed to expand her expertise in the identification and extraction of plant materials. Professor F.J. Abreu Matos of Ceara Federal university in Fortaleza is Brazil's foremost expert on medicinal plants, and it was to him that Aires da Souza went to learn more. He has spent over thirty years interviewing herbalists and collecting the plants they use.

He has tested many of the remedies he has collected, and has advised individuals, local organisations, municipalities and even the Brazilian government on the establishment and development of pharmaceutical medicinal gardens.

green pharmacy garden

Matos helped the co-operative plan the medicinal garden, and advised on extraction and formulation methods. Most of the plants used in the Farmacia Verde medicines are well known in Brazil, but the careful extraction and formulation employed in the small laboratory ensures a consistent product.

Although budgets do not allow extensive research, some products have been subjected to assessment. The Ipe Roxo vaginal cream produced by the laboratory for treatment of Candida and other fungal infections was studied in a small trial in conjunction with the University of Altamira. Sixty women suffering similar infections were divided into two groups. One group was treated with the Farmacia Verde cream while the other received a reputable commercial manufactured product. The results with the herbal cream were substantially better than the conventional treatment, based on assessment of vaginal swabs taken before and after the course of treatment.

The vaginal cream is formulated using a standard cream base. The active ingredient is an aqueous extract of Ipe Roxo (tabebuia avellannidae).

Results were even better when the cream was supplemented with a hydro-alcoholic extract of the same plant taken by mouth. Aires da Souza plans to co-operate with the university in further trials of other products.

Another area where the Farmacia Verde products have proved very successful in the local hospital is in the treatment of bedsores. The Comfrey Regenerative Cream uses extracts of Comfrey (symphytum officinale), Meracilina and Babosa (aloe barbadensis), and has proved more effective than its manufactured pharmaceutical counterparts.

In general though, Aires da Souza makes no grand claims for Farmacia Verde products. She says only that they provide relief from commonplace medical complaints at a fraction of the price of their pharmaceutical counterparts.

'The objective of the project is to provide phytotherapeutic medicines which have a scientific basis to communities which lack access to primary healthcare, by providing plants which occur locally which have proven therapeutic action and very low, or no, toxicity.

'We are only at the beginning of something which could be much bigger. Therefore we are always trying to improve, to bring out new medicines which we could include in our range.'

Aires da Souza does not feel that there is any conflict between Farmacia Verde and the pharmaceutical dispensaries in the town; in fact, her husband, who is also a qualified pharmacist, owns one.

Farmacia Verde treats mainly the marginalised people of the poor areas of Altamira, and of course the Indian communities. In the Ipixuna reserve, occupied by the Arawete Indians, there is a major problem with Blastomycosis. The primary healthcare workers in the village have found that a syrup which includes extracts of the plants Chamba (justicia pectoralis) and two species of mint (mentha arvensis and mentha. pulegium) has helped to contain the problem and improve the prognosis for sufferers.

The reputation of the Farmacia Verde medicines has grown over the few short years since it was founded in 1996. It is now experiencing growing demand from the townspeople of Altamira, and is set to contribute to the overall budget of the co-operative. Last year, total sales were over US$36,000.(€40,000)

The co-operative could not have been established without the support of international aid organisations. The land on which the medicinal plant garden is established was given by a local landowner. The establishment of the laboratory was funded by the Body Shop Foundation, as was the development of the products. But this source of funding is drawing to an end, and the co-operative still needs further funds to develop its product range and explore new markets. It also needs funds for additional research.

Overseas partners

Farmacia Verde is just reaching the point of being self-supporting, and will show a profit next year. The longer-term objective is to enter into partnerships with overseas companies to supply high-value herbal products to the international market. Negotiations are already under way with a major UK producer of herbal and homeopathic medicines, and evaluation tests are under way on herbal-based insect repellent candles for the Scandinavian market.

The development of the enterprise is dependent on mutual confidence between the co-operative and its partners abroad.

While eager to earn the funds needed to support the health, education and security of the Indians, the co-operative is careful to consider the longer-term value of the plant knowledge which comes from a long line of herbalists and shamans.

It considers itself to be no more than a custodian of this knowledge, and is conscious of the potential value of genetic and chemical patents. It is, therefore, seeking partners who are prepared to put back into the local communities and environment a little of what they take, in the form of a commitment to develop a mutually beneficial trade. Any takers?