Guest post: A view from Kampala, Uganda

This post is from Dr. Anne Dougherty, MD. She is almost in the middle of a six-week project at Mulago Hospital in Kampala where she is providing support and training to the OB/GYN staff. I will let her words speak for themselves.

Resigned helplessness – that is what the resident’s face said as she answered questions following her presentation.  The patient was a young woman who was transferred from an outside hospital for “confusion and severe anemia.”  On arrival at Mulago, the patient was tachycardic and tachypneic.  Her mental status was altered.  Her abdomen was distended and rigid.   She was bleeding per vagina.  A pregnancy test was performed and was positive.  My assumption at this point is that the patient has a ruptured ectopic pregnancy and is in danger of bleeding to death.  An IV was placed and normal saline was dripping into her vein.  No additional labs or studies were obtained.  This all happened at 1AM.  At 9AM – eight hours later, the resident stood before the department at morning meeting and related this story.  There was no more to the story than what I just told you.  For the last eight hours, the patient had lain in a bed on the ward where a single nurse watched over 40-50 patients with a single IV running crystalloid @ 125cc/hour.  The resident was asked, what did the ultrasound show?  Did you locate the pregnancy? What was causing the surgical abdomen?  Did you draw coagulation studies?  I was struck that in the telling of the story, the resident did not mention that these might be things that she considered.  When asked why such studies were not obtained, she simply stated that it was 1AM.   As if the main referral hospital in the country should close at a certain hour.  Well, as it turns out, it does or at least that is the perception that then becomes a reality.

A horrible inhumane experiment was performed with dogs in which they were placed in a cage with an electrified floor.  There was a high barrier in the cage over which the dogs could not jump.  The first few times the floor was electrified, the dogs tried desperately to get over the barrier, but as time went on, they would curl up in the corner until it was over.  The dogs continued to do this although the barrier was lowered such that the dog could jump over it.   This is not to say that humans are dogs, but it does demonstrate the effect of repeated negative events on the desire to keep trying, to keep striving.

I have seen repeatedly that when even a small challenge is presented here at Mulago, the answer is often, “it is impossible.”  And yet I know that it cannot be as I see some are able to overcome the challenges.  Today, while performing a series of exams on patients with suspected cervical cancer, I ran out of exam gloves.  I asked the “sister” (that is what the nurses are called) if she could get more gloves.  She said, we do not have any more and just stared at me.  She said the person who was supposed to go to the supply annex last night to restock did not turn up and so we were low on supplies.  Not being one to take no for an answer, I persisted.  Well, I said, where can we get them from now?  She said, give me a minute.  In a short time, the “sister” returned with a new box of gloves “borrowed” from another unit.

One of the things about cultural exchange is that you really have to leave yourself at home.  That is, you need to surrender your sense that “this is the way things have to be done.”  As long as you continue to compare here to there, it is easy to be irritated by the way things proceed within the foreign culture and ultimately become very frustrated.  And in that frustration you miss the cultural exchange.  In medicine that can sometimes be difficult.  When you have a patient in front of you who could be helped with a few basic diagnostic tests and swifter treatment, I feel another force at work that is complicated to separate from my own cultural context.  The feeling of responsibility I have to the patient while embedded in my cultural context feels like it stems from an inner part of my being and is so painful to let go even temporarily. And yet, that is really what you have to do here at Mulago or you will be crushed by the tragedy of it.

I am not sure that I understand entirely where the resigned helplessness comes from.  It is likely multifactorial.  Being subjected as a colonial territory plays a part.  Follow that with decades of struggle and war while surrounding countries began to get their independent “legs” under them.  Add in poverty, food scarcity, unemployment, resource shortages and a dejected passivity develops.  I am also quite sure that western world “charity” contributes.  Interestingly though, when you learn the stories behind some of these Ugandans and the life challenges that they have overcome, you are left with paradox.   Ne woman told a story of moving out of her stepfather’s house because he would beat her mother when she showed affection to the woman and her sister.  She moved in with a relative who took her on as household help (a common practice here), but the woman wanted to go to school.  So she moved onto the streets where she tried to earn some money during the day to support her sister and herself and then went to primary school as an adult. She taught herself English while living on the streets.  As a cleaner at Mulago Hospital, someone discovered that she spoke English and promoted her.  She worked her way to a stable job as an administrative assistant.  She continues to go to school and is now married, expecting a baby shortly.  Amazing.  And her story is only one of many.  So many Ugandans have witnessed horrendous violence either at home or at the hands of the government.   Most have been in a home without enough food to feed the whole family.  Many have inherited entire families of 6, 7, 8 children when parents pass away from HIV related illnesses.  They will work against all odds to send those children through school.  The strength and wherewithal to persevere through such trials is more than the average American in 2013 would tolerate I think. And yet that same woman might tell you there are no more gloves.   Such a strange paradox.

Anne K Dougherty MD
Attending Physician, Department of OB/GYN, Fletcher Allen Health Care
Assistant Professor, University of Vermont 

Numen: The Healing Power of Plants

Let's face it, herbalists are lucky. We get to interact with plants and people in a very special way, one that emphasizes an age-old evolutionary connection between the two. This was recently brought home to me, yet again, sitting in circle with a group of herbalists, on a warm October day, after harvesting a bunch of excellent roots. We spent time giving thanks to the land, to the plants, and to the gatherers' hands. We spent time just participating in a moment of deep animal-vegetable relationship, one which humans must have experienced over and over again in the course of our long journey.
In this timeless moment, we tapped into something more than the botanist, with her rich knowledge of the vegetable kingdom, or the physician, with his clear insight into the human body and pharmacy, can routinely experience. Something born of the fact that the roots we pulled, painstakingly, from the soil can help people feel better - and that people, plants, and ecology can all thrive when they actually interact. It's more than observation, it's more than knowledge. It's something akin to the essence of life itself. The ancients called this essence "numen", or spirit-power, life-force. It isn't something that "is", it's something that "does": the counterbalance to entropy, the destroyer-force. It organizes, creates, loves, heals.



The excellent film by Ann Armbrecht and Terence Youk elegantly brings this life-affirming force into view. Through the words of those whose journey is devoted to plants, healing, and ecological connection, the timeless life-power humans have thrived on becomes clear. For me, it is a celebration! Experiencing the images and words Ann and Terry have woven together reinforces the feelings of connection all herbalists have known. But perhaps the greatest gift that they offer is to those who haven't ever felt this life-power for themselves. It is those who haven't tasted the call of springtime roots and greens, who haven't heard the words of mugwort on a full moon night, who have only a vague idea of how individual and ecological health might be connected, that really need to grok this film.
Which is why I'm really excited and grateful that Numen: The Healing Power of Plants is available for free viewing, for ten days starting on October 20th, to everyone everywhere. It is an opportunity for herbalists to celebrate, and be filled and renewed by, the joy of being plant people. But crucially, it is a chance for us to bring nature-based, herbal life-power into the lives of those who haven't really experienced it yet. It is a chance for our families, and our extended communities, to really "get" why we love this art so much, why we have chosen this path. I hope you share this with those you love. Who knows what will follow.

An herb walk through the high Alps

I've been away from technology for a few weeks. Wandering the Alps, valleys where I grew up, in deep old forests carpeted with wild bilberries and up above the treeline in full view of the Dolomites. I've walked some really well-worn paths, visiting with the plants along the way and thinking about consciousness, presence, perception. These mountains are us - or, at the very least, I can feel the boundaries of my consciousness bleed into the the rocks and forests, the trail becoming more than a footpath, the walk becoming a habit the whole ecology has practiced for a long, long time. Do you know what I mean? Mountain telepathy, Euphrasia mind-meld, or really just finally resting in the place where "I" really feels like a composite of everything here.

Start in the warmer valleys, where the water slows down and there are many rock walls. It's shady here, maidenhair (Adiantum) grows thick and wild yam (Dioscorea) vines thread through.

 

By the streams, old friends. Wild monkshood (Aconitum), deadly toxic, hot and dry root by the cool streamside, pops up once in a while. With luck, some late-blooming narrow-leaved orchids (Dactylorhiza traunsteineria) come up in a patch, remembering days from the earlier season. 

 

 

Getting higher up, the spruce stops and a few low junipers and mugo pine are left clinging to the white crumbly soil. Above the treeline, in the bright sun, so many familiar species: first the wild creeping thyme (Thymus serpyllum), classic bronchial remedy that's always found in the kitchen.

Alongside the thyme, eyebright (Euphrasia) appears in big patches, parasitizing the native grasses. It's an old remedy for itchy, tired eyes (especially during allergy season), and has a unique, multicolored flower. The patches are everywhere along the rocky trail.

And, more rare but still fairly available, are clumps of wild gentian (Gentiana campestris), also known as German gentian or field gentian with a characteristic five-parted flower. This isn't the official medicinal species (that's G. lutea), but it is nevertheless still quite bitter and local folk use the whole plant as a digestive aid (even the flower has an intensely classic bitter taste).

Where the grass gets taller, among the Campanula, sit a few Arnica montana plants, with their big, lone, yellow flowers. When I was young, we'd collect these, soak them whole in grappa (60+ percent alcohol), and use the product as a liniment for all manner of bruises, scrapes, falls, and sprains - which often occurred on walks to harvest the Arnica...

And, of course, no walk through these mountains would be complete without the flower that most embodies the spirit of this magical realm. She's soft, silvery, and hardy. Her medicine is that of shining white beauty of the mountaintop, and you can't pick her. Even if you could, the power comes from being there, walking there, sitting up there next to her. Edelweiss (Leontopodium) is the reward for those who breathe the high, clean air. She'll nourish you for a long time. Her mind is my mind.

Herb Power: find your wild ally this summer

Recently, scientists uncovered the remains of a Neanderthal tribe that lived in the area now known as Spain, some 50,000 years ago. Analyzing residue on their teeth, the researchers discovered traces of powerful chemicals: triterpenes and lactones from chamomile and yarrow were still detectable, and indicated that these early hominids consumed these plants, which have little or no caloric value. It’s an intriguing finding: have we been harnessing the power of herbs for that long?

In fact, we may have been herbalists well before we were human – from an evolutionary perspective, at least. Primates are the most enthusiastic, but many other species (from bees to elephants) employ plants just as the Neanderthals seem to have done: small quantities of wild botanicals that have little caloric value are used, deliberately and effectively, to maintain health. While lacking an understanding of physiology and biochemistry, animals (and early humans) still realize that renewing a connection to the wilder side of the dinner plate is a daily necessity.

Christina Warriner studies archaeological evidence to piece together a picture of what how our oldest ancestors nourished themselves. She has come to three basic conclusions: first, ancient diets were incredibly diverse. They were different from region to region, from season to season, and featured a vast amount of different plants as well as some meat and animal fat. Second, all those plants came in small, frequent doses, and included herbs that were relatively “calorie-poor” (as we saw in the Neanderthals). Finally, the plants our ancestors consumed still had large amounts of phytochemicals – plant constituents with biochemical action and that have been largely bred out of modern vegetables. The plants we used to eat had strong, often bitter flavors, were hard to find in quantity, and were – to put it simply – powerful.

What happened? Over all these years, we’ve drifted away from these plants. The diversity of our diet is at an all-time low, starring only corn, wheat and soy (along with traces of other, highly hybridized, veggies). We eat lots and lots of these plants, and almost none of the “calorie-poor” herbs that have been animals’ companions for millions of years. The chemical potency of our dietary plants is all but gone, bred out because of its unpalatable flavor. Many have been telling us that the “Western” diet is killing us slowly, and lies at the root of the modern epidemics of mental and spiritual distress, digestive disease, cardiovascular illness and cancer. They warn us to turn our backs on the modern foods we’ve grown accustomed to – and that our lives may depend on it.

If you’re into herbs, you may have a different take.  It may be possible, and in fact preferable, to restore diverse, wild, powerful botanical chemistry into our daily lives and, by so doing, circumvent the risks of the “Western” diet. It may not be that wheat, soy and corn are killers: it may just be that, without our old allies, our bodies have forgotten how to work properly. They are out of context. And wouldn’t it be great if, by bringing that context back, we could enjoy a modern, urban life without the risks and diseases associated with it? That is precisely what herbs can offer us: they are easy to grow, simple to prepare, and deeply nourishing, enlivening, and restorative when consumed habitually. They provide the context our physiology needs, while linking us back to the wilder side of nature. This wilder side is calling us: it’s green, open, sexy and powerful. With it, we are at our most vibrant.

So herbs are radically different from drugs: they are more akin to physiologic building blocks, the vectors for cross-kingdom signaling, a way for plants to guide us to our best potential. While some can definitely treat disease and infection in the short term, herbs really shine at slowly rebalancing us in our entirety, so that mental distress, spiritual malaise, toxicity and inflammation melt away like snow in warm sunlight. The safe medicinal herbs are often weedy, or at least ridiculously easy to grow, and their preparation and administration are simple and worry-free. And think about what happens when you start to see a dandelion as more than just a pest: could it be an old friend? Could it have something in it that we lack, that used to be as familiar as electricity is today? Strange things start to happen to our ecological and cultural outlook when we begin to ponder these questions.

This is what I encourage you to do: find a wild plant, maybe one with a historical record of medicinal activity, to be your ally this summer. Identify it with certainty, make sure it’s safe. Watch it grow, slowly at first, then faster as it bursts into flower, sets seed, matures its root. Taste it. Harvest it. Sit with it on sunny mornings and through rainy afternoons. This medicine is very real, but it is also very different. If you want to find the true power of an herb, you will have to approach it as a friend, not as an alternative to a pill. In so doing, you won’t just discover medicine. You will come home, too.

The need for long-term thinking in medicine: Cinnamon as a case study

Here in Vermont, we are approaching the first anniversary of a storm that, over less than a day, poured an incredible amount of rain over the mountains, down the streams, and into narrow river valleys. The hill towns were quickly overwhelmed and literally swept away on huge torrents of water. These types of events are outliers, “hundred-year” floods. We tend not to think about them until they happen. If a river floods one spring, and washes away our garden, we could just build a retaining wall and be fine for years. But in Vermont, it seems that sort of thought process may have contributed to the severity of last summer’s event: narrower valleys, more constrained riverbeds, actually increased the torrent’s force and destructive power. As we rebuild, civil engineers are taking this into account.

In fact, there is a growing realization in many professions and disciplines that we need to approach the world with much more long-term thinking. Perhaps pumping out wetlands and building cities isn’t the best idea. It might be smart to consider sources of energy that aren’t going to run out fairly soon. When educating, connection to long-term curiosity might be better than passing the next test. Social and ecological concerns in market-based economies might trump the need to make a buck.

I dare say that medicine is beginning to embrace this trend, too – or at least people are. People who are interested in real food that may not require contaminating the water supply to cultivate, and who feel like this food might be better for their long-term health (though missing the tasty nacho cheese). People who consider a fever the sign of a healthy reactive response, and watch it for a bit rather than immediately suppresing it. People who are beginning to think that diabetes may be connected as much to ubiquitous, unregulated sugar in the food supply as it is to increased weight, lack of exercise, or “poor self-control”.

Which brings me to cinnamon. A recent meta-review found a small but significant effect from the powdered bark of this fragrant member of the Laurel family in treating the elevated blood sugar levels associated with Type 2 diabetes. I recommend this plant to clients concerned about this disease, either as part of breakfast or – my favorite – mixed with stevia, almond butter and cacao and rolled into “bliss balls”. It is best to take it regularly, as part of a long-term habit that includes real, bitter food and lots of movement. In this context it’s delicious, easy to take (doses are in the teaspoon range), and effective. 

The effect is, indeed, small when observed in isolation and for short periods of time. But diabetes (at epidemic levels) isn’t a problem that develops overnight, folks. I doubt anyone in the food industry, somewhere between the middle of the 19^th century and the middle of the 20^th, was saying “whoa - wait a sec, guys. I think that all this tasty sweet stuff (and elimination of all botanical biodiversity in the diet) might actually lead to epidemic levels of a sugar-metabolism disease in the next century!” No, that would have required seriously long-term thinking in matters of public health. And a little more knowledge of the human body.

Well, today we have a little more of  both. But research still looks at botanicals for three to four months most of the time – and this is partly because research is still beginning. When more time and interest are devoted to certain plants, such as the 2012 analysis that showed soy food consumption leads to lower recurrence of estrogen-positive breast cancer, striking results are revealed. But even this research only followed ten thousand women for seven years. Would that we had multi-generational followup data for cinnamon, endive, and dandelion roots! We might see a reversal of the grand experiment in carbohydrate refinement that gave us the current diabetes epidemic.

Short-term thinking gives us a need for dramatic, immediate results that might fit within the constraints of our current research model. This is great for many acute and chronic diseases, but not as great for matters of public health or for analyzing cultural patterns that lead to the diseases themselves.  Often, we learn about these matters from retrospective studies – discovering a problem after it’s already well-established. Long-term thinking takes a break and asks “if left alone, what might this situation look like?” Long-term thinking wonders how the river might handle a hundred-year flood if we hadn’t intervened to alter its course, how a population’s blood sugar might look if we hadn’t altered its food supply. 

Type 2 diabetes is a long-term effect of short-term thinking (satisfy my hunger now, and in a way that can be easily produced, stored, transported and packaged!) Its solution has to be based in long-term thinking, and part of that might very well include herbs such as cinnamon. The reason they are important is that, unlike a pharmaceutical solution, they provide an inroad to self-care based on whole plants and food – elements of life which, along with movement, end up being the keys to successful prevention of diabetes. If your mother started making cinnamon bliss balls when you were little, you might grow up eating them and eventually making them for your friends and family. Who knows what other bizarre plants you might consume along the way. Lo and behold, two generations later population levels of diabetes, obesity and heart disease are lower. I’d give you a rose to celebrate, but we all know there’s no research showing roses are effective as mood-lifters.

Some argue that, since the effect of a botanical such as cinnamon is small compared to conventional drugs, it should be rejected as part of our approach to diabetes. Ironically, the argument is that using cinnamon perpetuates a pill-driven, not lifestyle-driven, mentality for handling the disease. Call me crazy, but I’d respectfully argue that it’s probably pharmaceuticals that are driving this mentality, and that the search for a cinnamon capsule as an “alternative” is a first baby-step towards a different way. In the hands of an herbalist, baby steps turn into hikes in the forest. That could be a good thing – and a complex, multi-layered approach to diabetes that includes cinnamon most certainly is. 

Say what you will about an over-reliance on short-term clinical trials to drive therapy (or just read the British Medical Journal). Aside from the caveats (some of which I mention above), the approach is often a good one. But the offhand rejection of botanicals such as cinnamon, especially when they show promise, is actually harmful to public health. It is also a product of very short-term thinking. This is a problem that we need to resolve if we want to advance the cause of medicine and improve global quality of life – and herbalists, as those who, across the world, know what local plants do, are well placed to be part of the solution. Herbalists know the plants, but they also know that moving your vegetables over a little and supporting the community of cattail and calamus by the riverbank might be a better choice than a retaining wall, though it requires a (small) sacrifice in the short-term. Herbalists know that a bouquet of flowers makes you happy even though there’s not a single study out there to prove it. And they are usually inspiring teachers, too – the perfect choice for a diabetic patient. 

All this requires a change in thinking about medicine. We need to be looking further over the horizon, at a future where the advancement of our species sometimes includes a return to older technologies – not because they’re old, but because they’re damn smart in a long-term context. A future where we observe and mimic nature in designing our systems not because it’s “natural” but because, in the end, it’s in our own self-interest (global warming? Hundred year flood?). Herbal medicine fits in perfectly here. It is the precise modality that offers cultural connection, self-empowerment, ecological awareness, and effective remedies! It is both a blueprint for the future and a safety net for the present. As a design element for the next century of medicine, it can bring long-term thinking into a branch of science struggling with its own pressing challenges, helping it to harness the tools of complexity and deep ecology that are driving other industries. Long-term, complex herbal therapy won’t look as flashy in the short term – but that does not mean it has no value. Give it time, and skilled hands – a garden takes a season to come to fruit.

Plant medicine heals more than just people

We often discuss how effective plants can be at supporting and gently bringing human beings back to a state of "wellness" (meaning that resiliency, vibrancy, passion are maximized). I've spent a lot of time exploring how this happens, reading through the historical record and perusing modern research, and on balance it seems pretty clear that medicinal herbs, trees, mushrooms and more are good at helping folks in need. But that's not what I want to discuss today.
Rather, I'd like to posit the idea that working intimately with the botanical world alters our lives in ways that transcend individual health. Of course, this is not a surprising idea: reality mirrors itself, and the skin is barely more than an illusory boundary. Nevertheless, as a person whose life was redirected, and perhaps saved, by trees and herbs, I want to share three ways in which these allies can have powerful effects beyond the individual.

First, the people. Herbalists, gardeners, and other plant folk are consistently the most cooperative and compassionate people with whom I've had the pleasure of working. They share knowledge freely, contributing to a vibrant living oral (and now digital) tradition. They are often excellent communicators, speaking easily in language of metaphor and myth, forest and field. Even the most "beginning" herbalists have taught me amazing lessons and come up with amazing insights - which is why I avoid ranking plant people based on experience, training, or whatever else. Nature's gifts aren't reserved for the well-learned - and those of us who have spent a lot of time studying may find that, in the end, we return to the simple source of life for lasting truth, and books fall away in the light of the green world. This engenders gratitude, and may be the reason plant people are generally gentle, compassionate, and giving. They are often amazingly creative, too - coming up with new pictures, herbal formulae, and solutions where science falls short. I don't mean to disparage any way of "knowing", as all ways are necessary. I simply feel that knowing through plants is so very beautiful, and makes its people beautiful, too.

Next, herbal medicine has a way of reconnecting our species to nature. Clearly a no-brainer: we get outside more, we tend to eat differently, we appreciate a woodland walk differently when we have an intimate knowledge of the green folk living all around us. This gets into our heads slowly, insidiously, and deliciously. Before we know it, we may find ourselves kneeling on a city sidewalk looking at plantain (the horror)! But I feel like the gift of reconnecting to nature that herbal medicine offers us is most clearly evident in what happens when nature and wild plants are removed from human life: this is what, in Western culture, we've been working on for a few hundred years. The results are dramatic: epidemics of chronic disease affect the population, not because of the rise technological medicine, but because of a removal of traditional medicine! Additionally, to support homogenized, un-wild, unchallenging food systems we are also creating epidemics of chronic disease in the environment: new chemical signals that affect fertility, waste material that alters climate and ecosystem balance, disorganized living arrangements that sprawl over the landscape. I may be overly optimistic, but I believe that we don't need to remove technology to fix these issues: we simply need to bring plants back in to daily life. Once we develop the botanical habit, herbs begin to mess with our heads (where we all too often live). As we lose our heads, we save our spirit - and spirit being all-encompassing and transcending the human species, we participate in a more sustainable dance with the rest of nature.

Which leads me to my final point of appreciation for herbal medicine: mystery. Anyone who has seen a plant effect a cure knows that there is something magical about this process, as it may never be able to be replicated again. The herbalist, plant, and client have somehow managed to work together, in that one timeless moment, and the feeling all (plant included!) are left with is similar to what you feel when you run in to a random friend in a random place at just the right moment. It is synchronicity beyond coincidence, and we glimpse for an instant what it is like to be the immortal Universe. A healing modality that respects and welcomes mystery is my kind of medicine: because in the end, no matter how much we dress it up or understand its details, a human physiology brought back in to balance always reveals an awe-inspiring mystery. All good scientists know this. Einsten, for instance, tells us:

The most beautiful experience we can have is the mysterious. It is the fundamental emotion that stands at the cradle of true art and true science. Whoever does not know it and can no longer wonder, no longer marvel, is as good as dead, and his eyes are dimmed.

I have great faith in the power of herbal medicine to heal not only people, but also culture, species, and ecology. It's really pretty simple: we really need plants in our lives. Even only a little bit. And once their green tendrils begin to grow in our hearts, like the first pea vines of spring, there is no turning back. Thank goodness - thank greenness.
In gratitude, I leave you with the words of Peter Conway, English herbalist, philosopher, and erstwhile humorist.

The future of herbal medicine is the past of herbal medicine - self care & psychedelics - serious...