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We have all heard about the prowess of bitter melon/bitterweed or bitter gourd scientifically otherwise known to us Haitians as Asosi or Asowosi. It is believed to be able to treat many conditions from impotence to anemia, diabetes, hypertension, hypercholesterolemia, and some digestive problems. We have even joked about how black castor oil (lwil maskreti/maskriti) is the super medicine that cures all: from falling hair follicles to cold and flu. While writing this article, I drew from my own experiences as a child in Haiti, where both my grandmother and my mother would have a special tea that would correspond to every situation. I cringe to this day at the thought of drinking “Te Asowosi/asosi”. If you ever had it, you know the awful taste. Whenever I was running a fever or had a headache, I knew the Asowosi/asosi was coming. I didn’t like it but l believed it was going to make me better. Home and Folk remedies are usually the first and often the only line of treatment in the Haitian community. The questions at hands are: do these treatments work? Are they safe? Can they alone treat/cure someone and why are so many Haitians resistant to receiving Western Medical Care?
The treatments used by most doctors are known as conventional medicine. Healthcare practices and products that are considered out of the mainstream are referred to as Complementary and Alternative Medicine (CAM). An “out-of-the-mainstream” treatment is considered complementary if you use it along with conventional medicine. An example would be using bitter coffee (kafe anmè) along with painkilling drugs to reduce pains. A treatment is considered alternative if you use it instead of conventional medicine. An example would be using the bitter coffee as your only treatment for headache. Many believe that most Haitians fall in the latter category as our perception of illness falls in a continuum going from natural illness (maladi bondye) to supernatural illness (move lespri/dyab). Natural illnesses are usually of short durations. They may occur frequently and caused by environmental factors such as improperly cooked food, contaminated water, polluted air and etc. Illnesses that are unexpected or unexplained are usually considered by Haitians to be supernatural and very serious. In those cases, many seek out a voodoo priest (ougan) to find out what the spirit advises for a cure.
Our ancestors did not have a history of documentation… so a systemic approach to treatment did not exist. Thus a lot of our medical practices got passed down orally. The fondest memory that can be drawn is how grandma would always brew a pot of Te Jenjanm for the family.
A lot of the “Traditional” or “Alternative” medicines that we are familiar with are cultural traditions passed down from one generation to the next. To quote a colleague, Sherley Accime, a Licensed Massage Therapist and Complimentary Health expert “Our ancestors did not have a history of documentation… so a systemic approach to treatment did not exist. Thus a lot of our medical practices got passed down orally. The fondest memory that can be drawn is how grandma would always brew a pot of Te Jenjanm (Ginger Tea) for the family. Despite the confrontation of western over-consumerism of processed foods, ginger tea would be the remedy to protect the physical body of potential bacteria, aid in digestion, move Qi (life force’s Energy). Another example of cultural retention is being educated as a child to graciously decline invitations to eat from other people’s homes and partake at our nuclear family table. Respectively, modern science confirms the myriad health benefits to ingesting ginger, a knowledge that Haitians carried with them from the root since antiquity; eating at home signified being fed food that is prepared intentionally with ultimate love, care and beneficial spices.”
A study done by the Memorial Sloan-Kettering Cancer Center found that Momordica charantia (Asowosi/asosi) has a number of uses that are thought to be beneficial; including cancer prevention, treatment of diabetes, fever and infections. While it has shown some potential clinical activity in laboratory experiments, “further studies are required to recommend its use”. In regards to the use of asowosi for diabetes, several animal studies and small-scale human studies have demonstrated a hypoglycemic effect of concentrated bitter melon extracts. In addition, a 2014 review shows evidence that asowosi, when consumed in raw or juice form, can be efficacious in lowering blood glucose levels.
As it turns out, we have learned later on that a lot of those practices that our elders couldn’t explain do have scientific merit. Countless of other remedies have made their way into mainstream medicine. A great portion of prescription drugs available stem from our grandmother’s special concoctions. From bitter coffee for headaches (turns out caffeine is one of the active ingredients in Excedrin), to all the benefits of honey, or lime and various other herbs, our culture is rich with ways to alleviate and/or treat many conditions. As valuable as those ingredients that are found in nature and those special concoctions can be to our health, I should caution on the overreliance of these remedies for all illnesses.
“Most alternative or traditional medicine are not necessarily harmful.” says my old friend and practicing Haitian physician Karry Jose Felix. “For a holistic approach of the patient, we have to consider the patient’s beliefs, their traditional background and not just disregarding them. We must always keep in mind the deep impact of the personal beliefs and faith on the patient’s illness course. Our generation should dedicate ourselves to going further than our ancestors and scientifically understand traditional medicines, their contents, properties, indications, side effects, and interactions with other medications; maybe conventional medicine will profit from such research. Our generation also has to educate the Haitian patients to build an environment of trust, to make available and accessible appropriate healthcare facilities and already tested and approved medicine. The task is enormous, but the effort is well worth it.”
Our generation should dedicate ourselves to going further than our ancestors and scientifically understand traditional medicines, their contents, properties, indications, side effects, and interactions with other medications; maybe conventional medicine will profit from such research.
Regular preventive care with a trained physician along with an overall balanced lifestyle is the best approach to health. Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of every 10 deaths among Haitian each year according to the Center for Disease Control (2013). These chronic diseases can be largely preventable through close partnership with your healthcare team, or can be detected through appropriate screenings, when treatment works best. Infections due to living conditions are rampant. Cholera, tuberculosis, typhoid fever, malaria, H-Pylori and many other environmental diseases can be drastically reduced by patients’ adherence to treatment.
Dr. Hans Michel Pierrot, a primary care physician and long term friend and colleague of mine, said: “Picture me doing a consultation in a room where it’s hot, I’m sweating and the noise from outside doesn’t allow me to hear anything from my stethoscope. I am in a center where there is no bed or anything.” It is understandable why a large number of Haitians are apprehensive about seeing a doctor. Many others just simply don’t have the means or access to one. I have even heard some people say “He was fine until he went to see the doctor….”A previous article published here by Dr. Kenny Moise highlighted a lot of the issues that the medical system encounters in Haiti from the inadequate work environment to lack of continuing medical education and instruments etc. That’s a discussion for another day.
From a patient’s perspective, Haitians are faced with many large-scale social forces such as racism, classism, sexism, political violence, poverty and other social economic inequalities that predispose the human body to pathogenic vulnerability. When you have someone who is struggling financially and without a system with free or low cost access to medical care, the urgency to see a doctor is meager at best and often people don’t make it to one until it’s “too late.” The hospital experience in Haiti can be daunting from extremely long waits, to inadequate or antiquated diagnosis equipment, to the inability to purchase or locate the appropriate medication due to lack of funds or simply availability. Many Haitians earn their living on a daily basis, not many jobs offer sick leave, thus a trip to the hospital, which will take an entire day, is also costing the person money. As the saying goes “desperate times call for desperate measures.” Many without the money nor the time to go see a doctor buy medicine on the streets without regards for expiration dates, efficacy, side effects, drug interactions, dosage etc… Improper medication administration/management can lead to dire consequences. The situation becomes a self-fulfilling prophecy, reinforcing the idea that modern or conventional western medicine is bad for one’s health.
The mistrust in doctors and hospitals can be justifiable due to the often-deplorable conditions. Under those stressors, we tend to recapture what our grandmothers have taught us.
The mistrust in doctors and hospitals can be justifiable due to the often-deplorable conditions. Under those stressors, we tend to recapture what our grandmothers have taught us. We attempt to counteract these realities by withholding the practices from our heritage, which is a wealthy blend of our African heritage fused with the Taino culture cadenced with eastern and western influence. A comprehensive approach to health is essential. In order to be and remain healthy, we need to retain a balance diet, adequate exercise, traditional practices where we ingest things that are found in nature to promote homeostasis within our cells, and preventive care with a doctor. A comprehensive health policy and the financing of public health should follow the epidemiology of disease. We need to create the symbiotic relationship between Conventional and Alternative medicine for a comprehensive health approach.
Feature photo: Jovan Julien