- An organization of midwives from Panama’s Ngäbe-Buglé Indigenous group use traditional medicinal plants endemic to the region to assist women with pregnancy and childbirth.
- Known as ASASTRAN, the organization trains midwives and traditional medicine doctors to provide health services to remote villages where hospitals and clinics aren’t accessible.
- Deforestation has reduced the availability of medicinal plants in the Ngäbe-Buglé territory, and ASASTRAN is seeking more government assistance to preserve the curative plants.
- For some Ngäbe-Buglé women, traditional curative plants are the only healing options during childbirth, as Western medicine is often unavailable.
KUERIMA, Panama — Once you’re within the Ngäbe-Buglé Indigenous territory in western Panama, the vegetation of the rainforest grows thick and signs of industrial development are scarce. Dirt roads wind up muddy jungled hills to wooden homes with palm-thatched roofs, and the women of the group can be seen carrying babies on their backs in straw bags made of vegetable fibers called chácaras or krä. Unknown to many outsiders visiting this scene of lush green life, they’re also surrounded by medicine for pregnant women.
The culture of Ngäbe-Buglé is ancient and enduring, and the group has maintained its traditions for generations. Birthing rituals among the Ngäbe-Buglé are particularly sacred, and for centuries women have used traditional medicines — from trees, herbs, roots and leaves endemic to the region — to ease pains and assist with complications during pregnancy and childbirth. Often administered by a midwife or traditional medicine doctor, expectant mothers receive multiple natural remedies, usually consumed in the form of teas or liquids, that represent a fundamental custom of the group’s culture.
However, there’s a growing concern within the group that the availability and knowledge of the curative properties of the plants used in childbirth will soon be lost. Deforestation, large-scale crop harvests, climate change and the increasing influence of Western medicine are altering the 7,000-square-kilometer (2,700-square-mile) landscape of the Ngäbe-Buglé territory and threatening long-standing traditions.
It’s for this reason that an organization of midwives and traditional medicine doctors, known as the Ngäbe Association of Agents of Traditional and Natural Health, or ASASTRAN, is working to conserve and safeguard these ancestral plants and the Ngäbe-Buglé’s birthing rituals. They understand the odds are stacked against them.
“The traditional medicines we use during pregnancy and at birth are produced in the forested mountains, and those forests aren’t there anymore,” said Silvia Salina, a co-founder and director of ASASTRAN. “Most of these plants grow wild and can’t be reproduced in a nursery, so we’re doing all we can to create spaces and designate plots of land for their cultivation so that they’re not lost forever.”
Founded in 1998, ASASTRAN started out as an initiative to provide basic health and hygiene services to residents within the Ngäbe-Buglé territory, where many communities didn’t have working toilets until the 1990s. Salina said ASASTRAN realized there was a pressing need to train younger women in the group to act as midwives to teach them how to use medicinal plants to reduce pain and ease the birthing process.
The Indigenous territory, known in Panama as a comarca, lies in a region of dense rainforest and mountains. It’s the largest of Panama’s five comarcas, and the most impoverished: more than 60% of Ngäbe-Buglé’s 215,000 residents live in extreme poverty, according to government figures.
For members of the group who live in remote villages of the comarca, health clinics and hospitals are often unaffordable and difficult to access, requiring long, arduous commutes on foot or horseback through the rainforest. This presents a particular challenge for expectant mothers in the Ngäbe-Buglé comarca, which has both the highest birth rate per family in Panama, as well as the highest maternal mortality rate.
“One of our main objectives has always been to lower the maternal and infant mortality rates in the comarca,” Salina said. “Another has been to preserve the medicinal plants of this region, which need specific conditions to grow and are very delicate.”
Trusted birth option
Since its creation, ASASTRAN has expanded to incorporate and train some 130 midwives and 105 traditional medicine doctors across the Ngäbe-Buglé territory. It has five primary locations within the expansive comarca, and at each site there’s a neighboring plot of land, sometimes as large as 7 hectares (17 acres), where traditional medicinal plants grow wild.
In many remote communities of the comarca, the traditional healer and midwife associated with ASASTRAN represent the lone option for citizen health care, and their services are often preferred by Ngäbe-Buglé women during pregnancy and childbirth to seeking assistance at a hospital.
“I had my first child in a hospital, though I chose to birth my second and third children at my home with the support of the midwives of ASASTRAN,” said Betzaida Rodríguez, a 28-year-old Ngäbe-Buglé woman in the village of Kuerima, about 30 kilometers (19 miles) inland from the Pacific Ocean.
Rodríguez, whose first language is the native Ngäbere, said she didn’t feel comfortable navigating the birth of her first child, her only daughter, at a local hospital in Spanish, and that the attention she received felt impersonal and inadequate. She added that taking Western medicine, instead of the traditional curative remedies of the Ngäbe-Buglé, made her uneasy.
“During the second and third births, I was assisted by women I know, who speak my language and gave me traditional medicine that I’m familiar with,” Rodríguez said. “It was a more personal experience performed by women I trust.”
Disappearance of medicinal plants
Alongside the concrete headquarters of ASASTRAN’s sites in Kuerima and Lajero, located in the hilly rainforests near the Pacific Ocean, there are plots of land where thick vegetation grows wild. Among the dense jungle brush are the trees, bushes, leaves and flowers that, when consumed or processed into teas and liquids, act as remedies for a number of maladies, including headaches, fever, stomach pains, rashes, dysentery, hemorrhoids, and to reduce bleeding and hemorrhaging during the birthing process. In recent years, scientific studies have confirmed the curative properties of numerous Ngäbe-Buglé medicinal plants and their effectiveness in treating illnesses, and note that their extracts are often fundamental in the development of Western pharmaceuticals.
It’s the role of the traditional medicine director on site to oversee the cultivation of these plants, remove their leaves and bark when ripe, dry them in an enclosed laboratory, and process them for consumption. Most of the medicines distributed to community members by ASASTRAN are packaged so they can be boiled and consumed as teas, or are processed into tinctures to be ingested as drops.
For medicines specific to the birthing process, there’s a tea derived from bark and branches, known by the Ngäbe-Buglé as the “regulator,” that’s consumed to accelerate the birthing process and reduce pain. There’s also a tea made from a root endemic to the region that eases contractions and limits bleeding during childbirth, while another native leaf, known as asiria, is said to calm expectant mothers and normalize the heart rate.
Florinda Zurdo, a midwife who cultivates the medicinal plants used during pregnancy on her property, said the Ngäbe-Buglé prefer to withhold the names of these plants, given the risk of theft and invasion by outsiders. While members of ASASTRAN are working to preserve these ancestral plants and pass down knowledge of their curative properties to younger generations, elders of the group say these rare species are increasingly at risk of extinction.
“Many of the native plants here in our region have disappeared,” said Armando Sire, an 83-year-old traditional medicine doctor and ASASTRAN co-founder. Sire, who learned the curative properties of regional plants from his grandfather, said he’s seen the loss of thousands of species of endemic plants to the region during his lifetime.
“I can only recognize around 120 varieties of native plants in this region now, and there used to be thousands,” he said. “It’s a shame because, without the proper understanding of how to keep the plants alive, if you cut them in the wrong place, such as below the leaf or too high on a branch, they are lost and can’t be conserved.”
Although the Panamanian government passed legislation in 2016 to protect the practices and knowledge of Indigenous traditional medicine, the healers of ASASTRAN say that, without further state support or enforcement to protect native lands from deforestation or infrastructure projects, the ancestral curative plants of the Ngäbe-Buglé face an existential threat.
Volunteer midwives and doctors
During its 25 years of existence, ASASTRAN has received some intermittent funding, though the more than 200 midwives and traditional medicine doctors work on a volunteer basis. Despite the lack of funding, ASASTRAN is an organization that includes multiple sites and internal departments, such as human resources, and has trained hundreds of traditional medicine doctors and midwives across the comarca.
A recent program, known as Manchichi, which means “mother and child” in Ngäbere, has been introduced by outside organizations to provide ASASTRAN midwives with training and equipment to conduct health checkups during pregnancy. While the midwives of ASASTRAN say they’ve benefitted from the training and expertise, it hasn’t provided additional funding for the group.
Without further funding or government assistance, the future of ASASTRAN and the cultivation of ancestral plants that are vital to the health needs of the Ngäbe-Buglé could be lost. And that could leave residents of rural villages without options for health care, medicine or birthing assistance.
“Usually it is the people in the comarca with the least amount of resources that come directly to us for medicine and assistance during pregnancy,” said Patricia Mendoza, ASASTRAN’s general secretary. “We work as volunteers and would benefit from more resources, but we know that if we don’t offer support to people in our communities, they don’t have any other options.”
Banner image: (From left) Florinda Zurdo, Silvia Salina and Patricia Mendoza stand in a plot of land near ASASTRAN’s site in Lajero where traditional medicine is cultivated. Image by Adam Williams.
This project was funded by:
Through the Health Innovation call.
In Panama, an Indigenous kingdom fights for its right to the forest
Related Mongabay podcast episode: How the Indigenous Shuar regained their ancestral forest. Listen here:
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