For the Americas: PAHO’s Nation-by-Nation Network and Resource for Traditional, Complementary and Integrative Medicine

For the Americas: PAHO’s Nation-by-Nation Network and Resource for Traditional, Complementary and Integrative Medicine

In the United States, the complementary and integrative medicine dialogue about “traditional medicine” typically looks to Asia. The West-meets-East orientation respects the power and influence of Chinese and Indian traditions. Yet in doing so, both local indigenous practices and the roles of traditional, complementary and integrative medicine (TCIM) in Mexico, Central America, South America and the Caribbean are mostly overlooked.  The Pan American Health Organization (PAHO) recently created a partial remedy for this hemispheric forgetfulness.  A two-year collaborative process with representatives of over 20 nations has created a powerful network and opened access to a nation-by-nation bounty of practices, papers, research, and regulations.

The principal direct beneficiaries are PAHO’s southern members. The Virtual Health Library (VHL) on Traditional, Complementary and Integrative Medicine emerged “to meet the expressed demand of many countries to improve availability of and access to relevant scientific and technical information on this matter,” according to PAHO director Carissa Etienne, MD.

Stimulated by WHO’s Traditional Medicine Strategy

The World Health Organization (WHO), for which PAHO is the Western hemisphere affiliate, effectively drove the development of the VHL with WHO’s 2014-2023 Traditional Medicine Strategy. The document called for integrating traditional medicine into WHO’s mission for universal health care. The document and a 2019 assessment of progress charged all nations with engaging the massive integrative effort needed to optimally employ traditional and complementary medicine in primary care. In 2017, appreciating the preferred nomenclature in many nations for the global movement, WHO expanded its charge from “traditional” to include “complementary” and “integrative.” (Notably, the title of the recent report, begun earlier, only reflects the first 2 appellations.)

In a plenary talk at the recent International Congress on Complementary Medicine Research (ICCMR), Colombian medical doctor Daniel Gallego-Perez, MD, DrPH (cand) explained that in Latin America the “traditional” medicine of India and China and other nations are considered “complementary.” The term “traditional” is reserved for a nation’s indigenous practices. Some nations, such as Nicaragua, have dual laws. Gallego-Perez, who served as a key organizer of the effort also with Natalia Sofia Aldana, MD, MS – who presently manages multiple committees and teams that support the VHL – shared that the tri-lingual (Spanish, English, Portuguese) web-based resource includes both.

The Transformative Force of TCIM Network of the Americas

The organizers note that the TCIM Network of the Americas is itself a key transformative agent. States Gallego-Perez:  “The network brings together a wide diversity of stakeholders, from technical teams of health ministries and PAHO offices, to professional training programs and research groups based at universities, professional associations, relevant NGOs, and national healthcare agencies. We truly believe the network, which continues to expand, is having, and will continue to have, transformative power.” [Full disclosure: I am involved in the network through my work with JACM-Paradigm, Practice and Policy Advancing Integrative Health (The Journal of Alternative and Complementary Medicine).]

Evidence of the network’s transformative power is becoming apparent. The VHL was cited recently by the Minister of Curacao in a presentation that helped roll out the WHO’s updated traditional and complementary medicine plan. The TCIM Network energized Brazil to establish an academic consortium (see below). It catalyzed Peru to create Latin America’s first Collaborating Center on traditional and complementary medicine (see photo). Notably, the working plan between the Peruvian government’s Complementary Medicine Division and the WHO focuses on strengthening the VHL.

The VHL resource in its present form organizes content under 4 chief headings: a directory of agencies and organizations; regulations and policies; document on understanding the therapies; and a consortium spawned by VHI’s networking mission. The network also prizes additional content aggregated for the site: resources for self care from the TCIM perspective, a program for fostering research capacity on TCIM, and a section dedicated to traditional indigenous medicine in the Americas.

The Grey Literature in the MOSAICO Database

Another key resource grew out of respecting that the best guidance for appropriate use of traditional and complementary practices may not come from a peer-reviewed and indexed publication. The Network’s MOSAICO Database on TCIM “seeks to make visible those investigations, and technical documents that are not indexed in other databases, but whose content contributes to the implementation of the TCIM in health systems and services.” MOSAICO is intended as “a tool for health professionals, both in clinical practice, as well as in academic settings, and in health decision-making.”

Under the VHL’s category of Regulations and Policies, one can quickly discover in 12 countries the therapies and practices that are recognized. The Brazilian list is an astonishing set of 29 practices ranging from the familiar (TCM, Ayurveda) to those less so, such as Biodanza and Shantala. Click into Peru and one finds over 50 distinct therapies in the 4 categories (biologic, energy, manual and mind-body). In Mexico, as shared in easily translated Spanish, are the following

  • Medicina Tradicional Indígena
  • Medicinas Complementarias
    • Fitoterapia
    • Acupuntura (Moxibustión, Ventosas, microsistemas de acupuntura)
    • Homeopatía
    • Quiropraxia
    • Herbología

The decision to organize the VHL was made by country representatives at a seminal meeting in Managua, Nicaragua in June 2017. Action was subsequently propelled by face-to-face gatherings associated with broader integrative medicine conferences in Brazil in March 2018, in Cuba a half-year later, and elsewhere.

Tremendous Interest in Latin American Clinicians

For perspective, over 4000 practitioners attended the Brazil meeting, the 1st International Congress on Integrative Practices and Public Health. This level of participation is 250% larger than the best attended functional or integrative medicine gathering in North America. Notably, the Brazilian event was blessed by the national government and organized by the Brazilian Ministry of Health. The interest in TCIM is also high elsewhere. A 2017 conference in Colombia for which PAHO lent its name drew over 2000 participants, with the largest set Colombian doctors.

The importance of indigenous practices is evident in this listing for Ecuador where “Medicina Ancestral-Tradicional” includes 4 categories:

  • Medicina ancestral tradicional indígena
  • Medicina tradicional del pueblo afroecuatoriano (reflecting centuries of African influence)
  • Medicina tradicional del pueblo montubio (a mestizo people in eastern Ecuador)
  • Medicina tradicional del pueblo mestizo (mixed race of Spanish and indigenous)

The VHL also offers links, through the “Directory” section, to a nation’s research institutes, professional associations, chief government agencies, and more. Another celebrates the creation of the Brazilian Academic Consortium for Integrative Health that is led by Ricardo Ghelman, MD. With over 200 researcher members, the Consortium is presently national in scope but “seeks to mobilize researchers inside and outside Brazil, and aspires to be the seed of a regional network of collaboration for research in TCIM.”

The Benefit of More US and Canadian Involvement

The listing for the United States (EEUU) is notably thin. While most nations in the Americas were represented by individuals charged with overseeing traditional medicines, neither the US Indian Health Services nor the NIH National Center for Complementary and Integrative Health (NCCIH) had representatives who were routinely part of the Spanish language conference calls through which the resource was developed. The file on Canada is similarly without much substance despite notice of that nation’s efforts to set a more inclusive policy for traditional practices of its First Nation’s peoples.

One outcome of this lack of participation: just 6 practitioner associations among the dozens that exist are noted in the US. The Integrative Health Policy Consortium, for reference, includes 27 Partners for Health. And this set at the VHL is dominated by just one profession: naturopathic medicine.

The reason for the naturopathic presence is simple: multiple naturopathic doctors and their institutions invested in participating with PAHO. Among these are the peripatetic Jon Wardle, ND, PhD, MPH from the Institute for Technology in Sydney, Australia. Wardle is key faculty member in a series of PAHO-sponsored research training sessions. Another is researcher Ryan Bradley, ND, MPH, director of the Helfgott Research Institute at the National University of Natural Medicine, in Portland, Oregon. Tabatha Parker, ND, currently the executive director of the Academy of Integrative Health and Medicine (AIHM), has been involved via an NUNM affiliation, her AIHM position, and her many years of naturopathic integrative clinical care in Nicaragua.

The doors are open to more collaborators. One of the quietly transformative roles of the TCIM Network for the Americas has been in forging new relationships. They invited representatives from the Academic Consortium for Integrative Medicine and Health and the NIH NCCIH – the two most influential institutional players in integrative medicine – to the 2017 founding meeting in Nicaragua. Some network members developed and delivered a PAHO-traditional medicine panel (see photo and Session 3395) at the 2018 International Congress on Integrative Medicine and Health in Baltimore.

Concurrently, PAHO held a meeting at its Washington, DC offices to explore north-south exchanges involving such Consortium leaders as Rob Saper, MD, MPH, Adi Haramati, PhD and Ben Kligler, MD, MPH. Notably, at the next US Consortium research conference, Wardle will provide the first ever keynote at this event on global traditional medicine policy.

The Network and the VHL are unfinished, unfolding projects. The organizers anticipate that the network and resource will expand to all countries in the region. They recognize that they, in Gallego-Perez’s words, “need extra hands and financial resources to make possible the collective vision that has been cast for this resource, which belongs to all.” It would indeed be in the greatest spirit of “integrative” if the North American community chose not to replicate the US culture typical forgetfulness and dissing of the US’s southern neighbors and instead modeled new forms of respectful engagement in traditional, complementary and integrative health. Optimally, the TCIM Network will indeed be for all of the Americas.