In the traditional cosmology of the Maya people of Mexico and Central America, Itzama denotes the home of the Maya god of wisdom (Itzamna) and place of spiritual and herbal healing. Itzama is therefore a fitting name to be chosen by the Belize Indigenous Training Institute and its associated Q’eqchi’ Maya Healers Association to represent their innovative traditional healing center, botanical gardens, and community-based conservation efforts. Their program, which provides a traditional healing community center and viable methods for the preservation of the regional rainforests and deep cultural traditions therein, serves as an international model for such conservation efforts.
The Role of Traditional Healing in Conservation and Sustainability
Indigenous peoples have long lived in close connection with the natural world. This intimacy with nature has resulted in cosmocentric perceptions of their surroundings (i.e., humans as a part of nature as opposed to humans above nature) as well as an intricate, yet pragmatic, understanding of the natural world. This living with and learning from nature has led to the development of different types of knowledge, passed down generation to generation through predominantly oral traditions. Traditional healing is one such component of this knowledge system and holds countless benefits for community health and global health and wellness.1
Knowledge of traditional healing, as well as an understanding of nature’s utility and natural harmony, is disappearing along with acculturation of indigenous peoples and the loss of the world’s natural areas and biodiversity. Languages can be taken as a marker of cultural richness and indigenous knowledge, and their diversity trends can be extrapolated to quantify the disappearance of cultural diversity.2,3,4,5 All over the world, languages are disappearing at an alarming rate. Of the 15,000 languages spoken 70 years ago, only about 6,000 are still spoken today.4,5,6,7 The Earth’s natural places and biodiversity are inextricably linked to, and being lost concurrently with, indigenous cultures.
Forests are being lost or degraded at a disturbing rate, and trends in biodiversity loss do not bode well either. The United Nations Food and Agricultural Organization (FAO) reports a loss of between 9-12 million hectares (hectare = 2.5 acres) per year from 1990 to 2000.8 FAO reports further that approximately 0.8% of intact forests are being lost annually and that total annual rainforest losses range from 5 million hectares to over 20 million hectares.8 According to the Living Planet Index (LPI)—a marker for biodiversity loss that is based on hundreds of vertebrate species in terrestrial, freshwater, and marine ecosystems of the world—the Earth’s biodiversity is disappearing at alarming rates.9 During the 30-year interval from 1970-2000, the LPI dropped by 37%, and this is indicative of exponential trends.9 Global species extinctions due to human activities are currently 100 to 1000 times that of the natural rate.10
Jeffrey McNeely, chief scientist of the International Union for the Conservation of Nature (IUCN), recently argued that the preservation of indigenous cultures and the tropical forests they live in are inseparable and can only be achieved together.11 Cultural and biological diversity persist in certain areas and notably in mountainous regions.12 Development in the context of good governance could lead to appropriate conservation of forest resources.3 Initiatives that focus on sustainable development and conservation of cultural and biological diversity are necessary, and these efforts could be targeted toward areas of high cultural and biological diversity including mountainous areas.
Traditional healing, including its complex mental, spiritual, physical, and environmental components and effectors of health, is one vehicle for these much-needed sustainable initiatives to occur.1
In dealing with the traditional healing knowledge of a culture, complexities arise with regard to political agendas, cross-cultural information sharing, intellectual property, and benefit sharing.13,14,15 For example, historically, no matter how well-intentioned and wellnegotiated drug development prospecting has been, the benefits rarely matriculate to indigenous communities.15 However, there are a number of studies detailing these complexities and offering suggestions on ways to proceed. Among these are several that discuss underlying forces of globalization and make noteworthy submissions for procedures in ethical cross-cultural exchange.16,17 Better still, perhaps alternative, less controversial, and more direct methodologies aimed primarily towards community benefit should be sought. There are such models in place today. These models need to be developed to their full potential.
An alternative that can circumvent many of these issues and provide viable in situ and ex situ conservation strategies and support for indigenous communities is the development of culturally relative healing centers and herbal gardens for use and educational purposes along with promotion of respect and integration of traditional healing into national healthcare systems.18 Traditional healers and their healing systems rely on the health of the individual in the context of healthful environmental surroundings inclusive of both social and natural worlds.1 Consequently, communities where health promotion by traditional healers is common observe components of environmental harmony and respect as a part of their everyday norm.1
Q’eqchi’ Maya—Traditional Healers of Southern Belize
As an example, we consider the case of the Q’eqchi’ Maya of southern Belize, where a majority of the population uses traditional healing. This trend is consistent throughout much of the world.19 The Q’eqchi’ are one of 20 extant, diverse Maya cultural groups that have inherited and practice certain environmental and health beliefs from ancient Maya civilizations. Recognition of the importance of respect for the environment and sustainability is widespread in Maya groups. The Itza of Peten, Guatemala, for example, integrate their crop cultivation with tropical forest management through complex species interactions.20 Their system is characterized by a cyclical interaction of indefinite forest regeneration in combination with their sustainable use patterns.20 The Lacandon of Chiapas, Mexico, are rainforest farmers who gather wild plants from the jungle and cultivate medicinal plants in their house gardens, milpas, and secondary milpas.21 Milpas are farming plots based, in part, on ancient agricultural methods involving multiple crops and cycles in production and rejuvenation of the land; secondary milpas are plots overtaken by the forest in rejuvenation phases. These practices support the continual regeneration of forest. The Yucatec Maya, of the Yucatan Peninsula, view the land as a living being that needs to be fed, nurtured, and cared for.22 The Q’eqchi’ Maya of southern Belize believe it is essential to be proactive in the conservation of their healing traditions and their environment for future generations.18,23,24,25
Political and Environmental Background of Southern Belize
The homeland of the Q’eqchi’ Maya, the remote and rugged rainforest-laden Maya Mountains range of southern Belize, supports some of the most intact expanses of tropical rainforest in Central America. Due to model conservation practices combined with remoteness of the mountainous area, nearly 80% of the forests are intact.26 Rainfall is high in southern Belize with nearly 431.8 cm (170 inches) per year.27 The underlying geology of the mountains is quite complex, which lends support to highly evolved and delicate ecosystems.18,28,29 The unique conditions the mountains offer, combined with commendable conservation practices on the part of the government and the people of Belize, allow maintenance of a large floristic diversity.18,30,31,32 Recent surveys demonstrate a richness of species and a high likelihood of new species being localized to the area.18,33 The area is increasingly important for biodiversity conservation, as it represents a biodiversity hotspot for the region.34 As elsewhere in the world, outside of the conservation areas, deforestation has been occurring rapidly.
The government of Belize has entered into a co-management agreement with the indigenous Maya people, addressing issues such as intellectual property rights, sustainable development, conservation of culture and biodiversity, and resource management of the area. Despite its richness in culture and biodiversity, the area has many challenges in economic development and remains one of the cash-poor areas of Belize. The Maya people have an urgent need for better training, education, and employment. There is also a community-wide desire by the Maya to maintain a traditional culture and lifestyle, particularly in primary healthcare, both as a means to support elders in the community and to enable the passing on of traditional beliefs and practices to younger generations.23
The Maya generally prefer traditional healing modalities to modern medicine—even in the context of readily available modern healthcare options.21,23 This trend is reflective of indigenous communities worldwide. Indeed, the World Health Organization indicates that, at present, more than 80% of the world’s population in developing nations relies on traditional healing modalities and herbals for primary healthcare and wellness.19
However, many of the plants relied upon by local traditional healers and indeed, in global markets, are taken from the wild; as a result, hundreds of species are now threatened with extinction because sustainable production and harvesting techniques have not been implemented—a fact that works against global health. This situation must be remedied as soon as possible. To augment the success of protected areas in the Maya Mountains and surrounding areas in sustaining medicinal plants, traditional Q’eqchi’ Maya healers are taking an active role. These healers unanimously comment that they must forage farther now than ever before to procure the plants they use in healing their people, which is a consequence of the disappearance of these plants from areas both inside and outside the conservation zones in Belize.23 They cite this as an important motivating factor for their efforts.23
The reasons for the disappearance of certain plants in southern Belize are complex and multivariate. They include global as well as local effectors, including erosion of ecological integrity caused by alteration of the environment by unsustainable harvesting of forest products, unsustainable agricultural practices, natural disasters, and local peoples’ resource exploitation and exchange practices. Local harvesting pressures have significant effects on specific ecosystems in these areas, which in turn could also lead to the extinction or reduction of other species. The species sought for any commercial use must be sustainably procured as has been done traditionally.20,21,23
The preservation of medicinal plants is a key objective of the biodiversity component in conservation programming in Belize and the world at large. There are commendable efforts in ethnobotany and conservation of biodiversity and cultural knowledge in Belize;35 however, these efforts have focused different models on groups other than the Q’eqchi’ and in regions with slightly different floral diversity.25
The Itzama project, initiated by a group of Q’eqchi’ healers and approved by the government of Belize, aims to support this programming by advocating for traditional healing and facilitating indigenous local communities in the inventory, conservation, and sustainable management of medicinal plant resources.
Itzama Project Overview
The Q’eqchi’ Maya communities of southern Belize lead a traditional lifestyle in the montane forests of their homelands, and their traditional medical systems and forest knowledge are still intact as part of their culture today.36 These people have successfully used nature to treat primary and complex ailments for millennia. In an age when more and more people in the world are using viable natural alternatives, the Maya themselves recognize that their medical heritage must be documented, recorded, saved, and implemented more widely.
The Itzama project sets out to address these issues in a novel attempt at sustainable development, biodiversity conservation, and community health through the use of traditional healing systems and rainforest stewardship. The program has been implemented in remote villages of rural southern Belize and surrounding areas that are highly dependent on medicinal plants and traditional healing for primary healthcare.
This initiative is being spearheaded by the Belize Indigenous Training Institute (BITI) and the Q’eqchi’ Maya Healers Association (QHA) in collaboration with the government of Belize and external partners—Inuit Circumpolar Conference; University of Ottawa; Universidad Nacional, Costa Rica; Naturaleza Foundation; and Cleveland State University. They are doing so under strict ethical and research guidelines as determined by the Ethics Committee of the University of Ottawa and Institutional Review Boards of the University of Ottawa and Cleveland State University.
BITI is a Belizean nonprofit organization incorporated in 1998 by indigenous groups with the assistance of the Inuit Circumpolar Conference (Inuit Canada, Greenland, Alaska and Siberia). It is governed by a Board of Directors comprised of representatives from the cultural councils of indigenous peoples including the Q’eqchi’ Council of Belize, the Toledo Maya Cultural Council, the National Garifuna Council, and the Xunantunich Organization. BITI provides practical training in areas that will lead to income generation and employment at the community level as well as training and work in the area of traditional knowledge and cultural heritage. One of the community associations assisted by the umbrella organization of BITI is an organized group of traditional Q’eqchi’ Maya healers called the QHA.
BITI, QHA, and external partners have undertaken the physical development of the Itzama site (center and gardens) and are conducting plant inventories in the Maya Mountains and surrounding areas. They are working to implement traditional sustainable plant propagation techniques and develop culturally ethical conservation strategies.
While relatively modest, this program holds real promise of enhancing the sustainable management of the medicinal plant resources of the area in a way that will enable local communities to reap health and cultural benefits from them without depleting the forests and endangering plant species. This program can serve as a model for similar areas internationally.
Itzama Project Specifics
The QHA was granted a physical site near the Q’eqchi’ villages by the government of Belize, and they have developed indigenous gardens at the site in order to have a nearby source of plant material for treatment in the villages without the need to travel out to the Maya Mountains to harvest medicinal plants. These gardens are also used for healing ceremonies, celebration of the traditional Maya calendar, demonstration of traditionally used medicinal plants and their ex situ conservation, agricultural production for local use, and small enterprise development. Although visits can be arranged, the gardens are not at present open to the general public.
A study of the Q’eqchi’ ethnobotany in the Toledo district conducted before the development of the gardens identified 169 species of medicinal plants used by members of the QHA.36 Many of these plants are rainforest species that were found only in areas of high ecological integrity. To establish the gardens, the QHA made numerous collection trips to areas rich in biodiversity, including the Maya Mountains wilderness areas.18 Over the course of several years, they transplanted thousands of plants (harvested in ecologically sustainable ways) into trial-and-error designed ecosystem microniches created at the garden site. The QHA weeded and irrigated the plants during the dry seasons and consistently evolved its gardening methodologies. The majority of plants cultivated are understory plants of the rainforest, and successfully establishing and maintaining them in the garden setting has been difficult. Many of these plants were sown in lines beneath secondary growth forest from which the underbrush was cleared. Currently, there are more than 100 species being tended in their respective microclimate niches established by the QHA in the gardens.25 The QHA use these plants in ceremonies and to treat a large variety of ailments.
The gardens are currently being developed to train teenagers from the local Maya high school in traditional healing and production of medicinal plants. The Itzama site is also intended to be used as a community center for events and educational activities with younger school children, and eventually as a visitor center. Plants that are not considered sacred but have commercial value for sale locally or for export are being grown in adjacent fields. These include both indigenous plants and those cultivated commercially internationally. Some examples are fevergrass (Cymbopogon citratus, Poaceae), cacao (Theobroma cacao, Sterculiaceae), ginger (Zingiber officinale, Zingiberaceae), allspice (Pimenta dioica, Myrtaceae), several varieties of hibiscus (Hibiscus spp, Malvaceae), and other flowering ornamentals, as well as many others.
Conservation of wild plants within their natural habitat in the adjacent Maya Mountains areas is enhanced by both elimination of harvesting pressure, which has damaged wild stocks elsewhere, and novel conservation strategies, which include the QHA’s direct involvement and leadership in the development of these initiatives.18,23,24,25
The development of the Itzama site is concurrent with the re-integration of traditional healing into the primary healthcare system in associated Maya villages and the local district hospital. Following a workshop with government healthcare workers, the QHA now work with local community nursing assistants, midwives, and village elders to provide primary healthcare in the villages. Difficult medical cases are forwarded to the district hospital where health professionals are working toward their own culturally relative standard with the QHA. This collaboration is a direct outgrowth of the Itzama efforts.
Maya healing is individualized within an inclusive cultural framework. Members of the QHA have different knowledge and experiences, as well as differing expertise. In recognition of this, the QHA has determined a need to develop a coherent, integrated strategy to implement its traditional healing system, both formally in clinics and in informal settings like remote villages, while facilitating the training of a new generation of healers. The traditional healing center will therefore provide a focus for the development and preservation of Maya healing knowledge of the area. The QHA’s center is intended to serve as a cultural center for the Q’eqchi’ Maya communities and will help foster cultural awareness among young people, local visitors, and tourists about the importance of traditional medicines, the ecosystems that produce them, and the culture that sustains them.
The development of a scientific research and conservation center to complement the QHA is also underway. The several hundred species of medicinal plants that have been identified in participatory research with the QHA present a rich source of material for sustainable resource development. Studies will be undertaken to scientifically examine the medicinal plants to better understand the basis of traditional botanical knowledge. Additionally, traditional healing will be studied as an emerging concept in integrative healthcare for indigenous and worldwide communities. Biodiversity resource management, including ex situ and in situ conservation, is a key issue worldwide today, and the programming at Itzama will be linked to the Central America corridor conservation projects.
Rapid Ethnobotanical Surveys (RES), an ethnobotanical methodology developed by Pesek et al, focuses on elucidating the distribution and location of rare, disappearing, and previously unreported species with traditional healers as participatory researchers.18 RES are being conducted to tailor conservation efforts accordingly in southern Belize. The QHA and its partners have identified disappearing and endangered medicinal plant sites in the Maya Mountains wilderness areas, and this work will continue, highlighting species and places for conservation in select areas.18,24,25 Southern Belize is one of the last remaining wilderness areas of Central America in which new species are likely to be found.
Healthcare, Belize, and the Maya
For complex logistic, economic, and cultural reasons, the Maya preferentially gravitate toward the traditional healers for treating most of their common ailments, even when there are modern medical options available. In the more rural areas, modern medical options become cumbersome; nonetheless they are available. The national referral base for medical care begins with the village community nursing assistant, then to the village health center (nurse or doctor), then to Punta Gorda Hospital, and then to Dangriga Southern Regional Hospital or Karl Heusner Hospital in Belize City (the latter being the most technically adept).23
It is difficult, at times, for the Maya and other rural inhabitants to receive modern medical primary healthcare. The Belize government is responding to these difficulties. The government is improving access to affordable quality healthcare by ensuring community involvement in heath and wellness management, expanding the capabilities of rural health posts, and expanding clinical care constructs and education and awareness programming.23 Itzama will accomplish, in a culturally appropriate fashion, all of these objectives and others.
Typical maladies in southern Belize can be generally categorized into several main types: maladies attributable to living conditions, infectious agents, mental health conditions, age-related degenerative disorders (accelerated due to lifestyle/living conditions), and emergency situations including wild animal attacks and snake bites. However, the most common overall health concerns and presenting symptoms are low back pain, headache, arthritis, fever, cough, loose stool, vomiting, skin irritations, mental health conditions, infections, parasites, and general malaise. All of these are dealt with initially by traditional healers, who then appropriately refer difficult cases to conventional practitioners.
Preventive educational programming is of paramount importance as recognized by the front-line providers in this remote and rugged region of Central America. People can be educated as to the pertinent particulars of public health, including education and awareness on issues as diverse as the dangers of overly-processed, nutrient-depleted foods to the deleterious effects of pesticides and herbicides.
Authority in villages is somewhat of a problem in public health and educational issues because more often than not the front-line community nursing assistants are from the same villages as those being treated—“they are no better, they know no better.”23 One innovative technique could be to have these people work with respected elders and traditional healers and perhaps then obtain an internationally-based educational credential. This type of documentation is viewed as favorable and as something that sets practitioners apart from the general public.
Given the respect and knowledge held by the traditional healers, it would seem prudent to work with them in culturally relative educational and healthcare initiatives. Further Discussions
Traditional healing systems are highly individualized to culture and even more specifically to certain healers within their respective cultures. Despite this rich and varied assemblage of healing traditions and healers around the world, there are several cross-culturally reverberant themes in healing.1 These themes, which consistently arise in independently evolving traditions, speak to both efficacy of modalities and commonalities in diverse cultural groups’ perceptions of health and wellness.1 One of these recurrent themes is that true healing occurs with the health of the mind, body, and spirit in the context of healthful environmental surroundings.1 Traditional healers provide sustainable healthcare and imbue a certain degree of respect for one’s environment (implicit in their cosmocentric worldviews). Therefore, by advocating for traditional healing, one would also be advocating for healthful environmental surroundings and culturally appropriate conservation strategies. Indeed, support for indigenous healing efforts internationally promotes conservation of culture (including healing traditions and ecosystems perceptions), biodiversity (both in situ and ex situ), and community health and wellness. Thus, the benefit of large-scale efforts in support of traditional healing in community health, wellness, and education is multifaceted. Traditional healers in primary care enhance community wellness, educate their communities, and enhance overall ecosystem health. Furthermore, if carefully done, supporting traditional healers could well provide multiple opportunities for culturally appropriate economic development in support of culture and biodiversity.
Moreover, and perhaps more importantly, these efforts mark a transition toward a more ethical, equitable, sustainable, and efficacious method of healthcare delivery. The efforts of the Itzama project could spawn a multitude of mutually beneficial learning engagements among traditional healers and other caregivers while simultaneously supporting culturally relative healthcare in the context of more environmentally harmonious healing practices and lifeways.
The authors wish to thank their many supporters. Without their help this work would not have been possible. The authors would like to thank Inuit Circumpolar Conference, Belize Indigenous Training Institute, and the associated Q’eqchi’ Healers Association for their drive in this model programming. The authors also extend their gratitude to the Government of Belize and external partners at the University of Ottawa, Universidad Nacional, Naturaleza Foundation, and Cleveland State University for their continued financial and programmatic support. The Itzama project was funded in part by The World Bank through the Grants Facility for Indigenous Peoples and Naturaleza Foundation (www.naturalezafoundation.org) via charitable donation.
Todd Pesek, MD, Department of Health Sciences and Center for Healing Across Cultures, Cleveland State University, 2121 Euclid Avenue— HS 101, Cleveland, Ohio, United States, and Naturaleza Foundation, Lakewood, Ohio, United States. Corresponding author e-mail: t.pesek@ csuohio.edu; phone: 216-523-7353.
Victor Cal, Belize Indigenous Training Institute, Belize, Central America.
Nick Fini, PE, Marvin Cal, Naturaleza Foundation, Lakewood, Ohio, United States.
Marco Rojas, Pablo Sanchez, Luis Poveda, Herbario Juvenal Valerio Rodriguez, Universidad Nacional, Heredia, Costa Rica, Central America.
Kevin Knight, Sean Collins, John Thor Arnason, PhD, Department of Biology, University of Ottawa, Ottawa, Canada
Note: For more information on medicinal plants in Maya culture, see the book review of Maya Medicine: Traditional Healing in Yucatán on page 66.
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