Thank you, Hello, Thank you for this presentation. I am really happy that the room is also full. I'm sorry, I cannot comment on your excellent introduction to our panel, because I did not hear the translation but I'm sure that because of the way people were moved, it was something very nice thing, thank you very much.
And thank you for the energetic way you started this panel, you introduced this panel. So, without further ado, as you mentioned, I am going to touch a little on the role of health inequalities of indigenous peoples in traditional medicine, and therefore the place of traditional medicine as a response to health inequalities.
For that, I'm going to tell you about a case, because the indigenous peoples are talking about it as if it were a united whole, something unique but the indigenous people is 360 million people across the 5 continents or even the 7 socio-political regions that we give ourselves as indigenous peoples, it's 5% of the world's population, but also 80% of the world's biodiversity, so it comes from that, indigenous people, this is not a whole, it's very diverse.
So, I will start from an example, the example of Mali, the country of my origin, but more deeply of the community from which I come from, the Touareg community. So, the plan of my presentation will be the context of Mali, the benefits of traditional medicine for the nomadic Tuareg indigenous people, the recognition of traditional health practices, the impact of traditional knowledge on the well-being animals and some examples of the relationship of indigenous peoples to the environment.
So, by way of introduction, traditional medicine remains in great demand in all regions of the world whatever their level of development. In Mali, more than 80% of the population uses it in primary health care, regardless of income level and socio-cultural or economic level.
In 2002, the World Health Organization even put in place its first comprehensive strategy for traditional medicine, one of the goals of this strategy is to assist countries in developing national policies, evaluation and regulations of the practices of traditional medicine and complementary or alternative medicine. In Mali, Burkina Faso, Ghana, Kenya, Nigeria, Uganda, the Republic of Congo, research and evaluation of herbal treatments against HIV, AIDS, malaria, Sickle cell anemia, diabetes mellitus who are in endemic condition in this region.
In addition, Tanzania collaborates with China in the production of antimalarial treatment, so anti-malarial herbal. The price of antimalarial drugs as a result of this research will be US $2 instead of $6 or $7, their current cost.
In the Philippines, training programs in traditional health care have been developed and will be parallel in seven tertiary level educational institutions. For more than a third of the population who do not have access to medicines, in this context, traditional medicine can be a lever for the realization of the right to health. To answer this question, we will first make a brief presentation of Mali, then expose some advantages of traditional medicine, finally we will raise some of the means of recognition of this medicine.
So in the Malian context, Mali is a country of West Africa and it is about 1,240,000 km2, 2 thirds are completely desert. It is also a multitude of ethnic groups, it should be noted that African states are often reluctant to use the concept of indigenous people, that despite the remarkable work of the African Commission on Human and Peoples' Rights where they clearly listed the different indigenous peoples following the countries, and therefore, Tuareg are indigenous peoples in Mali, Niger, Burkina Faso, Algeria and Libya.
As for the Malian economy it is essentially agro pastoral, however this sector does not ensure food security or financing development. Thus, Mali is classified by the United Nations Program for Development UNDP, in 2014 as 179 out of 187, it should be remembered that this index takes into account life expectancy, education and average income per capita.
In addition, Mali is very much a tributor of international aid for its development. Now, there are indigenous Malian localities, where the indigenous peoples live, already difficult to access and that is where this situation is exacerbated by the insecurity that is lingering there, so we have recurring conflicts in these countries.
Some health indicators of Mali, the population is 15,302,000 The average income per capita is 1 dollar, the life expectancy is 57 years old. The mortality quotient is 15 to 60 years for 1000 inhabitants, and 277 for men and 275 for women. The total expenditure on health per capita is $122 a year, the total expenditure on health is a % of GDP is only 7.1%. This is data from the World Health Organization.
So this brief description of the country shows that they are facing enormous difficulties. In addition to this, which affects all Malians, there are disparities according to income levels, the area, therefore rural or urban, and the region of origin.
For example, infintants under 5 mortality rates between regions are 134 for Bamako, which is the capital, and 154 for Koulikoro, which is another southern area, and up to 259 deaths per 1,000 live births in the regions. north of mali where are the indigenous peoples.
The same is true for the number of health structures per region, there are 312 health centers for Sikasso against only 18 for the Kidal region, according to the Research Center of Mali in 2008. These inequalities in health could be explained by the very characteristics of the health system of Mali, so we see how little organized this health system is.
In Mali, as in all African countries, there are two care systems, the conventional system, imported because it is most often introduced by colonization, and the traditional health system because it draws its essence from cultural values.
The conventional care system is pyramidal, basically we have the community health center, it is the functional unit offering the minimum package of activity, the economic viability of this community health center depends on the distance, the size of the population and its rate of attendance, so for a community health center to remain open it must meet certain criteria.
For the distance, it is necessary to extend its activities to populations within a radius of 15km maximum, so if you are not located in the 15km around the health center you will not have access to health care.
For the size of the population, it is necessary to be located in a commune which is populated with about 5000 inhabitants, if you do not fulfill this criterion, you will not have access to the conventional health care provided by the State. And it also requires a 40% attendance rate for the health center to remain open. When health care exceeds the competence of the community health center, patients are referred to the reference health center which is at a higher level and is often located in regional capitals.
These are in turn referenced, the sick, I mean, to higher centers, that is to say, national centers that are located in the capital and represent the top of the pyramid. Next to this pyramid, there is the Department of Traditional Medicine, which is located in the capital Bamako, under the National Institute of Public Health Research.
The country adopted in 2005, the national policy of traditional medicine whose objective, I quote, is to "contribute to the improvement of the state of health of the populations and to the sustainable human development by the rational use of the resources of medicine and traditional pharmacopoeia" according to the Ministry of Health of Mali.
So, in total, there is a three-tiered health system that does not respond effectively to the needs of the entire population, including Tuareg nomads who live far away from the health structures that safeguard their traditional way of life and have a low level of health population density. They often live in small camps very isolated from each other. However, the Malian health system is open to traditional medicine. So what are the strengths of traditional medicine for this indigenous people in particular? And that brings me to talk about the benefits of traditional medicine for the Tuareg nomadic people.
Geographical accessibility is the first asset, as we have emphasized above the geographical accessibility to modern care is often limited for the rural and especially for the Tuareg nomads who live far from the chief towns of communes with community health centers. This condition is aggravated in the current humanitarian context because there is a conflict currently in Mali. But there is no village, a camp so small and so isolated that there is no traditional healer or there is not some local medicine.
So traditional medicine goes into geographical accessibility, offers great hope of reducing health inequalities according to the geographical origin in Mali if we go to the other advantage which is affordability.
In addition, to its geographical accessibility, traditional medicine is also more economically accessible than conventional care. Purchasing power is an important determinant of health since 51.4% of the population in Mali does not have the lowest cost of care, which is between 300 and 600 CFA, or just under 1 US dollar. As well as prescription fees that also exceed the dollar according to the average bank.
This barrier is all the more important in a nomadic environment where often the only source of energy is livestock, which is decimated by climate change, I refer to droughts, growing insecurity with the movement it generates and the banditry that it promotes. However, traditional medicine does not induce operating costs such as those of modern medicine, premises and personal equipment to take away, drug costs, etc.
Indeed, traditional healers often tend in their own concession with plants or materials from the surrounding environment. On this subject, there is a traditional healer, moreover, the only one who has written a book in my community called Fadi, who happens to find my grandmother to point out that their house has always housed one or more patients and that she cares for free. Sometimes, he asks the patients or his family in return to collect the necessary ingredients for the care that they will provide. To care, she says in an indigenous Touareg environment, it is above all an act of love without monetary costs that means such.
So traditional medicine is not only geographically and economically accessible, it is also culturally accessible. So that's what brings us to the cultural accessibility of traditional medicine.
At the round table of financing of the national policy of traditional medicine organized in 2010 in Bamako, the Malian Minister of Health states "we expect partners, support and support a strategic choice that in addition to ambitions for Achieving the Millennium Development Goals and reducing poverty raises a cultural dimension.
Traditional medicine is part of the culture of people who resort to Malians. In general, the original concept of nature includes both the material world, the living or dead sociological environment as well as the metaphysical forces of the universe. This notion is fundamental to seize the medicine of a community which is the reflection of its way of life, of its thought in a word of its culture.
For example, in the indigenous Tuareg society, physical diseases are fundamentally classified as hot diseases, the treatment will have cold substances, to cool the blood and conversely, there are cold diseases whose treatment will be directed by cold treatments sorry. Moreover with traditional medicine, there is no language barrier. However, as we pointed out in Mali the official language is French, Bambara being the most spoken national language with a multitude of detainees who speak neither French nor Bambara. For example, the Tuaregs speak Tamasheq.
Thus, language is a determining factor in the caring/nurturing relationship. When the two people in this dialogue do not understand each other, this may be an obstacle for the patient to express their symptoms and their understanding by the caregiver, on the one hand but also on the other hand it may be a barrier of confidence from the patient to the caregiver and thus an impediment to the expression of his pathology and subsequently, also, the observance of the treatment. In a word, communication between health care providers on the one hand and beneficiaries on the other.
The same is true of other aspects of culture. For example, the Tuaregs are a people where modesty has a very important place. Therefore, they are reluctant to consult with a conventional health worker who is not culturally sensitive because they are afraid of being undressed by the caregiver, for example during the physical examination or the administration of some care.
In conclusion, whatever our level of income, our geographical origin or our interpretation of the disease, there is a type of care available to us in Mali, traditional medicine. With the help of globalization and health inequalities that are only getting stronger how can we then recognize the traditional medicine that finally happens to be the buoy.
So the recognition of traditional medicine in health matters. The WHO's strategies for traditional medicine in 2002 and 2005 revolved around a number of policy issues, promoting the efficacy and safety of the quality of traditional medicine, increasing the availability and quality of traditional medicine. affordability of traditional medicine and the promotion of a judicious therapeutic use of traditional medicine. So, if we go back to the policy point, the implementation of a policy makes it possible to integrate traditional medicine with the national health systems in an appropriate way so it will not be anarchic.
For the promotion, efficiency, safety and quality of traditional medicine this will allow to have enormous health insurance. In order to increase the availability and affordability of traditional medicine here I want to draw particular attention to intellectual property because more and more traditional therapies are acquired and patented by pharmaceutical companies to which profits go without. On the one hand, no, or no, compensation to native people who are the original holders of these treatments. On the other hand, without their free prior consent and with the additional risk of monetary inaccessibility in the long run if its same substances are marketed by pharmaceutical companies.
For the promotion, we can integrate in training the traditional medicine of conventional health care. Providers can encourage research on medicinal plants by creating a partnership with universities, research institutes, disseminated the traditional medical knowledge by their written transcription since they are often held by the elders who will soon leave and who communicates part oral tradition they do not have access to writing.
So, traditional knowledge of indigenous peoples, including traditional medicine, is also useful for animal health and the environment. So, I'm going to mention some of the impact of TK on animals because I only have 5 minutes left to define welfare in animals, so we have to call three big groups of authors. We have Hughes first definition that places the harmony between the animal and its environment at the center of his well-being. Hughes speaks of a state of perfect physical and mental health where the animal is in complete harmony with its environment. In this case we will talk about harmony if the needs of the animal are met. These authors evoke a kind of motivation in fulfilling the needs of animals by using what his environment and nature offers him. Traditional knowledge is made of elements that promote this harmony everything comes as natural, the cattle feed, its care etc., are drawn from nature and the environment in respect of the elements that surround animals. The latter are not locked in cages and manage to meet their needs spontaneously. So I go, there is a part about the adaptation of the animal to the environment and the absence of suffering, I will let you read that since it will be published and we can time, I will not not overuse my colleagues' time, I will touch a little part about the environment. Maybe, I will go directly on the recommendations and I apologize for time management.
So, I'm going to go directly to the recommendations, I'm sorry I can not give you the part on animal health and the environment but the main message is that we see the environment, the indigenous people as alive, as well as animals and we need some harmony to live together.
So, the recommendations for CUMIPAZ and for all the actors here, it will be to encourage the use of both knowledge to reduce suffering in humans and animals and to ensure their fundamental rights to health including the objective 3 of the development of the 2030 Agenda for Sustainable Development, to develop the gesture-made mode and methods of care that have been proven with respect for the intellectual property of indigenous peoples, work on plants and other products used in traditional care for identifying side effects to improve their use, making traditional medicine products accessible for the most vulnerable to access health care, this is a very important point for social justice and building peace.
Developing the use of TK in animals will be freer, eat better and produce without constraint to have a better in animals, we must better preserve the environment. These two elements are essential for sustainable well-being for ourselves, for which we have all committed ourselves through the 2030 development agenda, but also by being peace activists, promoting the transmission of people's traditional knowledge and understandings. Indigenous future generations and new information technologies can play an important role in this.
And I leave you with this word of an elder of this territory, a guna of Panama who says "if you listen to us, the indigenous peoples, you will never be poor.’’ Thank you for your attention.