Herbal Medicine in East Africa - our first week

The last leg of our journey to Wasso was on a small, six-seater airplane. In fact, we needed two planes to carry our team of four herbalists, one medical doctor, two medical students and my daughter Uli. It was a beautiful day to fly. A slight overcast, with a cloud ceiling at 7,500 feet, prevented the jarring updrafts that can make for very bumpy rides. We kept low, just under the clouds, flying close to mountainsides covered with cedar forests. Crossing over the Rift Valley, we flew just north of Ol Donyo L'Enkai, the Maasai volcano god, and over the spectacular Lake Natron which was swirling with all sorts of colors: blue to muddy brown, pink, white, emerald green, and all the shades between. As we approached the highlands of the Serengeti (Wasso is on the Eastern edge), the clouds and land met and we flew closer and closer to the hills.
Our pilot, Pat Patten, leads the Flying Medical Service and has well over thirty years of service under his belt in this part of the world. Everyone knows him, and he serves not only as a physician but also as a sort of messenger between the far-flung communities in the area. To signal our arrival at Wasso hospital, he flew down close, pulling a hairpin turn right over the hospital on his way to the long, grassy airstrip. "Only a few termite hills left of the center line," Pat remarked. "Should be a smooth landing." It certainly was. We were greeted at the airport and rode the short distance to the hospital in a land rover and on the back of an open Toyota pickup. It was Easter sunday. The town was still.

After the long weekend, we began our work at the hospital. We were lucky to have had a few days to explore, building our improvised apothecary from the abundant local plants. I noticed that everything seemed about a month behind where it had been last April. Perhaps this was because of a long drought: the rains hadn't come when expected, and rather than beginning in February had waited until March. But now, after just a few strong thunderstorms, the land had burst into green. Resurrection plants were blooming. The aloe sent up tall, riotous red flower spikes. The acacias were covered in delicate, fern-like new leaves - a stark contrast to their long white thorns. We collected Usnea, Bidens, aloe, local mallows and nettles and even a species of Spilanthes. We picked leaves of holy basil off bushes that were ten feet tall. As we were walking by the stream, we found an old Acacia nilotica. The bark is used for intestinal complaints, and has a fantastic combination of tannins and demulcent starches, along with bitter compounds. I'd been chewing on small twigs for myself, and wanted to collect some for patient use. But as we were looking at the tree, an elderly Maasai couple came up to see what we were doing. The mzee (elder) began to explain that the inner bark of the main trunk is the best part to use. But as he attempted to harvest some with his panga (machete), the bibi (grandmother) pushed him aside and pulled out a stout hatchet, long-handled with a metal head. She made short work of the trunk, stripping the rough, dark outer bark from the soft middle layer which we collected for medicine. We left with a backpack full.

Now here for our first week, we are beginning to get into a good workflow. Minor theater is always busy, especially in the mornings: crush wounds with fractures from stonework; burns, cuts and lacerations. An infant with an extensive wound, from the hip to past the knee, revealing underlying muscle and a completely visible knee articulation. A tibia fracture right above the ankle. We are using honey, aloe, and usnea powder and cutting down on iodine (and completely cutting out the bleach that is still used by hospital staff). But perhaps more importantly, herbalists are following physicians on morning rounds in the inpatient wards - male, female, and pediatric - to take case histories, conduct physical exams, and formulate plans for herbal support. We take turns harvesting and preparing medicine, juicing plants and brewing teas and decoctions, for dispensing on the wards. Many blends are nutritive - Urtica and Chenopodium - for the ever-present malnutrition and anemia. Others support organ function, enhance circulation, and provide herbal antibiotic support, using primarily Bidens pilosa, Leonotis species, and Usnea (the latter for urinary complaints). There are a few cases of cholecystitis, with thickly coated yellow tongues, for which we are using a rough, bitter plant in the genus Aspilia. Ginger compresses provide anti-inflammatory support. And finally, respiratory cases of asthma, bronchiolitis, and tuberculosis receive twice-daily fresh whole-leaf eucalyptus steams. One barrel-chested man who may perhaps have obstructive pulmonary disease and pleurisy is always of good humor, smiling and laughing after his steam treatments. The obvious crackles in the lower left lobe of his lungs have disappeared after two days. A three-year-old boy, bright-eyed and curious, has stopped coughing from a combination of antibiotics and herbal bronchiodilators/antispasmodics.

I am extremely grateful to Steven Byers, Iris Gage, and Rob Shapero for their work at the hospital. By acting together as a team, we are able to reach all cases that are amenable to herbal support in a way that would be impossible for a lone herbalist. We spend hours wild-haresting in the countryside and making simple medicine. We help hospital staff by cleaning, folding gauze, and treating wounds. We improve the quality of life of patients who rarely have access to pain and inflammation control. And today we will walk the countryside accompanied by my friend Manasse, who was born and raised just a few miles from here, received his degree as a nurse midwife, and has been studying and practicing herbal medicine. He speaks English well and also knows the Maasai language, so with his assistance we can begin a more systematic catalogue of local medical knowledge - relying on recordings to document informed consent. Our long-term goals include training local staff to continue the practice of herbal medicine here. Everyone is so receptive and interested: our role is to help the hospital administration to realize the benefit of traditional knowldege, judiciously applied, for improving patient care. If we succeed, we will be out of a job here. And that is by far the best possible outcome.