Our dream is real

This is a transcript / copy of my presentation at the recent Urban Moonshine herbal conference up here in Vermont, on the shores of Lake Champlain, at beautiful Shelburne Farms. It was a great event, I was honored to be able to address the whole group and talk about how to leverage the strengths of herbal medicine to address some emergent threats to medicine as a whole.

Herbalists are all anarchists to a certain degree. In the sense that we want weeds, diversity, and decentralization. Of course we're also dreamers... Sometimes we dream for a really long time! Did you hear a couple of years back about this seed researchers found in Siberia, buried by some squirrel almost 32,000 years ago? They coaxed it into germinating, and it grew and flowered into this beautiful white flower, a plant the world hasn't seen for thousands of years, and that seed held its essence for so long, perfectly encapsulated. That's amazing to me. When I was in Ireland, I was speaking to a botanist who told me how, during the last glaciation, the tops of some hills were left uncovered by the ice sheets, like islands in a slow, white river, and pre-glaciation plants survived up on those hilltops, kept the memory of those old times and re-populated the island after the glaciers retreated. Dreaming of warmer times. Holding the essence. Herbalists are kind of like that too, in a way.

But I'm not here this morning to talk about herbalists. I'm here to talk about medicine.

One thing I noticed in East Africa, where I had the privilege of working for a bit this Spring, was that the system of traditional medicine is being forgotten. Old timers took me around, stripped bark off trees, pointed out how to prepare it in different ways for different conditions. They know this stuff! But the younger folks know it a lot less. They understand that this knowledge exists, they are very curious about it, but it felt very strange when it was me telling them about the medicinal uses of plants that grow all around them, and not the other way around. This is happening all over the world, I fear - it's happening in Italy and the rest of Europe, in Central and South America, and native plant knowledge is endangered in the United States too (see Carlos Ramirez, 2007). Maybe the exporting of Western culture is displacing these older, native systems of medicine - the young Maasai could show me pictures from their Facebook feeds on their cell phones, but couldn't tell me much about the different Acacia species growing by the river. Who's going to keep the roots of medicine alive?

Another thing I noticed, and this was mostly in conversation with the physicians at this rural hospital, was that antibiotics don't really work very well anymore. Pathogen resistance is a very real problem down there. Part of the issue is that folks can buy amoxicillin over the counter, and they do, and take it for every minor respiratory complaint. They take it for three or four days, feel better, then stop. We know it's not the antibiotic making them feel better, it's just a self-limiting viral infection, but the trend continues. So amoxicillin doesn't work at all anymore. Other antibiotics are failing, too - because specific testing is difficult, docs will just prescribe strong, broad-spectrum agents and pathogens are developing resistance to these, too. One physician told me of an untreatable urinary tract infection in an 8-month-old child. She had tried a series of antibiotics. None had worked. She developed a fever - and of course here we're getting concerned about her kidneys, but no antibiotics were working, not penicillin, not sulfa drugs, not cipro. She had multi-drug-resistant E. coli. The physician needed this stuff vancomycin, a ridiculously strong intravenous antibiotic, but unfortunately it was a 9-hour drive away. Eventually it happened, probably not timely enough, and the child improved but having to use vancomycin for a UTI is crazy, because it's the end of the line in terms of antibiotic treatment: if it doesn't work, that's it.
The WHO is recognizing this, and just this month put out a strongly-worded position paper advising physicians to drastically cut back on antibiotic prescriptions, especially in the developing world where they are so often overused. And you know bacteria are savvy, and very well connected: if they're learning these skills in Africa, they'll soon have them the world over. It's kind of like carbon emissions.
We know more and more that the "war on germs" is misguided, for many different reasons. Minnesota just passed a law banning Triclosan - you know about this stuff? It's the agent in antibacterial soaps and cleansers. Promotes bacterial resistance, is a known endocrine disruptor, and is no better than regular soap and water to slow the spread of infectious germs. So great, good job Minnesota, thank you WHO, we're thinking about these issues now - but who's going to help the little girl with the multi-drug-resistant UTI? She has a fever today.

Another thing I noticed is that there aren't enough people in medicine. The hospital I worked at is understaffed - especially in terms of those who can provide basic wound care, nutrition advice, nursing care. Those who practice medicine one-on-one, intimately, are hard to come by. This is hardly a problem limited to the developing world! Primary care providers are scarce here in the US. One in five graduates go into primary care after training. Why? Because all the docs choose to specialize - they go into cardiology, they go into oncology, they fill these specialties because that's where all the patients are, that's where all the money is. Everyone has heart disease. Everyone has cancer. I may be wrong, but it seems to me that if we had more health care providers working one-on-one, intimately, with patients, we might make headway in the prevention of heart disease and cancer. The way to meet these diseases isn't years after they develop, with high-priced and specialized interventions. Why are healthcare costs going up? I wonder. Who is going to work intimately with patients to help prevent the top causes of mortality in our culture?

So medicine is facing huge challenges. They move through the landscape of modern healthcare like giant, unseen beasts we can't seem to control. Everyone is looking for a way to stop them. No one knows what to do, how to track the problem, what the problem even is. Is it economic? Do we need better drugs? Where's the enemy? And at the same time here we are, in our meadows, in our gardens, in our clinics, kitchens, production labs. Where we experience deep, blissful connections with plants and place. Where we watch body, mind and spirit heal and grow. In a dream where there is no separation between us and ecology, between spirit and form. In our dream of flowers.

But there's another problem, too. It's very obvious in this country, but it has occurred, at different times and in different ways, all over the world. We have been wounded - wounded with weapons like the Flexner report, which basically outlawed herbal medicine in the US at the beginning of the 20th century. Wounded by witch hunts, wounded by imperialistic culture and colonialism, wounded by a creeping poison that would seek to co-opt and dilute our diverse, anarchical traditions. Wounded by organizations that would seek to outlaw, trademark, or patent our tradition for profit. Wounded by harsh skepticism (which sometimes borders on racism) aimed at ideas such as qi, vital force, viriditas, the healing power of nature - aimed at our dream.
So that's where we closed the last century, and where we begin this new one. In a dream of flowers, but wounded, wary, unsure if our dream can help to solve the challenges that medicine is facing all over the world, unsure if we even want to wake up and help to fix medicine.

I'd like to tell you a story about the Maasai lands. I was drawn to it because it's ostensibly the story of a young warrior, the best endurance runner of his tribe, and those of you who know me know I like to run, I had a great time running in the savannah and exploring. But really, like all good stories, it's about more than that.

When young Maasai men begin puberty, they stop cutting their hair and leave their villages to gather in "warrior camps", where they train in survival, tracking, endurance, fighting and hunting. Usually this training continues until age 30, and during this time warriors help keep everyone in the surrounding areas secure. Sankei was one such warrior. He wasn't the strongest, nor the bravest, and certainly not best with the spear, but there was one thing he could do well: run for a long, long time without getting tired. This served his companions well on hunting expeditions, where he was often the scout.
One night while they were sitting around the fire, Sankei and his companions heard a rumble which began to grow stronger and stronger, until they could feel the ground shaking beneath them. It was like thunder deep underground, under a clear starry sky. After a minute or so, the sound retreated and faded into the distance. Everyone went out to see if they could discover its source, to no avail. The next night the sound returned, and it was stronger than before, to the point where the warriors were a bit scared to go out into the night to investigate. When, on the third night, the sound came so close they feared their camp would be overrun, the warriors decided that they must track down its source during the day, lest it trample them completely when night returned. Looking at each other, they were all reluctant to accept the mission. Finally it was decided that Sankei would set off the next morning, and that if he wasn't back by early afternoon, his companions would come find him.
It took Sankei little time to find the first tracks. They were enormous, bigger than an elephant's, and led off into the dry savannah. He followed them at a good pace, mindful of his water supply which he carried in a hollow calabash gourd secured with a beaded leather strap. Eventually he reached a dry riverbed, and the tracks stopped completely. No trace on either side, nor upstream or down. Sankei looked up at the noon sun straight overhead, and took another sip of water. The supply was getting low. Time for a rest, he thought.
Perhaps it was the heat of the day, or the exhaustion of the run, or the frustration at having lost the tracks of the giant beast, but Sankei didn't stop to think before lifting a large stone to use as a seat under a shady acacia nearby. As soon as he picked it up, a scorpion hidden underneath climbed onto his foot and stung him with his sharp tail, injecting him with venom. If you know scorpions, you know that while they may not always be lethal, their sting can cause serious distress. Sankei knew he was in trouble. His foot was sore already. Soon it would be throbbing in pain. Forget about running - he would be lucky if he could walk using his stick for support.
In a strange way, this made his resolve all the more adamant. He walked back to the tracks and now, somehow, saw that they clearly crossed the river and headed towards distant hills. Hobbling on his wounded foot, he started to follow them. The sun began its journey down from the top of the sky. He took his last drink from the calabash.
Soon, Sankei felt like he was in a new country. Could I have wandered so far to have lost my bearings, he thought to himself. The trees were unfamiliar. The boulders unrecognized. But still the tracks continued, and still he followed them, with a severely swollen foot and a piercing pain spreading up his leg. He was beginning to feel light-headed, and knew he needed water. That was when he saw the silhouette of a giant baobab tree, halfway up a short hill, not too far away. There he knew he could find shelter, food, and water. He could rest there, and his companions would find him. With his last bit of energy, he dragged his bad leg behind him in a quest to reach the baobab.
He was almost under the tree's branches when he heard the sound, except now it was impossibly close, shaking everything around him, appearing out of nowhere with a deafening roar. His only reaction was to spin around, and in so doing he lost his balance, falling backward just as a colossal rhinoceros charged past him, missing him by inches. The rhino kept charging, straight towards the baobab tree, and when he reached it, head down, plunged his horn deep into the trunk. Sankei watched, stunned, as the rhino bellowed and heaved trying to get loose - to no avail. Finally, with all the muscles of his powerful neck and shoulders rippling with strength, the rhino gave a final twist, and the horn splintered and cracked right off his head. Howling in pain he ran off, defeated.
Slowly Sankei crawled to the tree. From where the horn was embedded in the tree trickled a stream of fresh water. He washed his face, and drank deeply. His wound still throbbing, he propped himself up against the trunk, and fell asleep as the sun went down.
Now what you may not know about baobab trees is that they only flower once a year, at night. The sweet flowers are pollinated by bats, then drop from the tree before sunrise. It happened that, as Sankei slept that night, the baobab bloomed, and was covered with a mass of delicate white flowers. And as the night wore on, before the first rays of the sun, Sankei was covered with them too as each one floated gently to the ground.
The first thing to wake him was the sound of his companion's voice. His friends were crowded around him, shaking him, trying to get him up. He opened his eyes and smiled, telling the story of the huge rhinoceros, the thundering beast he'd tracked, how it had been defeated by the baobab tree. He tried to get up to point out the tree to the other warriors, and show them the massive horn - but his foot, red and throbbing, could not hold him.
His friends looked puzzled at his story. As they stepped aside, Sankei saw a different landscape: acacia trees, a dry riverbed, a large stone. This was where he'd been stung by the scorpion! What was going on? Finally one warrior spoke, saying that they'd found him here, passed out, his foot obviously wounded by a venomous creature. "Your story, Sankei," they told him, "must have been a dream".
As they made their way back to warrior camp, Sankei began to believe that, in fact, he had only been dreaming. The story did seem remarkable, both because of his endurance and because of his sheer luck. Still, he had a strong feeling that the rhino or whatever it was wouldn't return. After the ol'oiboni treated his foot, he left the group to go rest. Sitting there, alone, inside a small mud hut, he began to remove his cloaks in preparation for some good, well-deserved sleep. When he took off his last layer, a delicate, white baobab flower fell to the ground at his feet.

My friends, our dream of flowers isn't a dream. We were all at that baobab tree, we all know it can stop the unseen beast in its tracks. We all drank of its life-giving water. That's why we are all here now. Knowing our dream is real is exciting, it's inspiring, but it should be sobering too. It's up to us to move forward, to track down the challenges of modern medicine until they run smack into the deep, rooted plant wisdom we all have tasted. We have to move forward in spite of our wounds, in spite of how comfortable our dream may feel, in spite of the bullying, derision, co-opting and outright murder that may have wounded us. What does moving forward mean? Think about it today. As you talk about new, accessible models of clinical practice. About using our bodies to relate to and understand a new kind of medicine. About building spirit-bridges to heal people and place. About growing medicine, and applying it to new and intractable diseases - or learning how to treat old problems in new ways. About how to do all this with respect for tradition and a powerful sense of honor. Think about it as you walk by the lake and through the forest and meadows. Our ancestors are counting on us. Twenty-first century medicine is counting on us.
In moving forward, one thing that seems clear to me is that there can be no "us" and "them". Maintaining these  distinctions only keeps the wounds open. In truth, we are all just warriors training together: companions on the journey of medicine, be we herbalists, nurses, physicians, or pharmacists. Companions who work in hospitals, in offices, on tilled soil, in wild valleys, over a massage table, in laboratories. It just so happens that we are all struggling with scary, unseen threats right now, and our companions need help. It just so happens that our companions think we're in a some sort of dream when we tell them about the baobab tree, about the medicine we've found in a weedy, flowering, abandoned lot. Friends, I am here to tell you that the medicine is real. I am here to tell you that the dream is real.