The University of the West Indies Faculty of Medical Sciences hosted the 13th Biennial Traditional Medicine in the Islands (TRAMIL) seminars and workshops. The events were conducted from February 6 to 9 at the St. Augustine campus and the Centre of Excellence in Macoya. The TRAMIL seminars have been conducted in Haiti in 1984 and in subsequent years, Cuba, Dominica, Martinique, St. Kitts and Mexico. The next seminar is scheduled for Colombia in 2010.

On February 9, an interactive public display was held on the grounds of the UWI Learning Resource Centre. The Caribbean Herbal Business Association featured soaps, creams, and beauty and healthcare products while the Women's Rural Growers Association displayed herbs and plants with some featuring the local names such as chadon beni and pied poule (fowl's foot) also turmeric, aloe plants and sour lemons.

The exhibition gave the public a chance to view the various plants and herbs found locally, while interacting with the individuals who grow and use them. It served as a learning experience, highlighting the potential healing and commercial properties of the country's traditional herbs and plants.

The opening workshop was conducted at the Centre of Excellence in Macoya. The following are excerpts of speeches at the opening by Professor Clement Sankat, Pro Vice Chancellor and Principal of UWI; Dr. Yuri Clement, lecturer in the Faculty of Medical Sciences; Dr. Altheia Jones-Lecointe, Head of Department of Para-Clinical Sciences and Professor Samuel Ramsewak, Dean of the Faculty of Medical Sciences.

I wish to extend a warm welcome on behalf of the St. Augustine campus to the delegates from across the Caribbean and Latin America, coming from over twenty nations, to deliberate on this important health topic – the 13th Biennial Traditional Medicine in the Islands (TRAMIL) Workshop. This is the first such workshop to be held in Trinidad and Tobago since the inception of TRAMIL, over 25 years ago.

Herbal medicines continue to be used by large segments of the population in developing nations. Within recent decades increasing numbers of persons in developing nations using herbal preparations have created a multi-billion dollar industry with the pharmaceutical industry turning their attention to plants in the search for new therapeutic agents. The Caribbean is richly endowed with hundreds of medicinal plants which have been used by our peoples as 'bush' medicines for generations. However, with each succeeding generation this rich folkloric tradition is rapidly disappearing and TRAMIL is determined to document these medicinal plants used by common people in an attempt to preserve our tradition.

The University of the West Indies has had a rich history in the investigation of medicinal plants. A recent review of research done between 1948 and 2001 at the UWI Mona campus, Jamaica showed that of the 334 medicinal plant species identified on the island, 193 have been tested for bioactivity and of these 80 showed reasonable biological activity. 44 natural products were also identified and of these 29 possessed biological activity. Patents and new drugs have been developed.

At the St. Augustine campus the Chemistry Department has led the way in the isolation of numerous natural products from plants. Staff at the Faculty of Medical Sciences has also been involved in research ranging from anti-cancer testing, anti-diabetic testing and hepato-protective properties.

At the present time, with the increasing use of herbal remedies for maintaining health and disease management, TRAMIL provides a platform for the dissemination of sound scientific information. TRAMIL proposes to rationalize the use of medicinal plants, beyond folkloric beliefs, which impact directly on public health.

Over the next 3 days the workshop would be held here at the Centre of Excellence and would have both scientific and associative parts. On this Saturday our activities would shift to the Learning Resource Centre, University of the West Indies where a public display of herbal products and interesting reading material would be open from 10:00am to 5:00pm, followed by an interactive open forum from 5:00pm-7:00pm. Delegates would also be hosted to a tour of our tropical rainforest reserve at the Asa Wright Nature Centre and visit our National Herbarium housed at the University of the West Indies, which documents our diverse flora.

The University of the West Indies and the University of Trinidad and Tobago must be commended for their significant financial and 'in-kind' support of this workshop. I acknowledge the French Embassy for their significant contribution to the interpretation for this workshop. Today would not have been possible without the assistance of the organizing committee and the strong and committed support from UWI and UTT staff who worked tirelessly to make this event possible.

In order to put this meeting in context it is useful for you to know the context of the Pharmacology Department. Pharmacology is one of the units in the department of Para-Clinical Sciences which consists of Anatomical Pathology, Chemical Pathology, Haematology, Immunology, Microbiology and public health and primary care.

This context is important because it establishes the link between the vigorous research which you seek to establish in herbal medicine and the care of patients.

Herbal medicine is universal and has been practiced in all societies at all times. It is medicine that belongs to people. Your organization seeks to refine and develop this medicine, so as to make its use safe and more “evidence based”.

However, today in Trinidad and Tobago as may be true of the wider Caribbean, in spite of us having more doctors than ever before, more imported herbal medicine products than ever before, people have a sense that health care is poorer than ever before.

It has to be remembered that herbal medicine takes place within a context of community, spirituality, a context where people know each other and a “laying on of hands” context.

Today there is a sense of the loss of this communication between patient and doctor, a sense that medical consultation is more of a commercial transaction than healing interaction.

To fill this gap people have to consult those professionals often regarded as charlatans, the obeah men and the spiritualist. We recognize in this room the fact that this healing forum has brought together people from French, Dutch English speaking persons in the region, in a way, that sports and business can never do.

We hope that the energy of this workshop will be used to bring medicine back to the people, to whom it really belongs.

The development of evidence-based medicine over the last century and the increasing use of well-defined single-chemical synthetic drugs, with documented pharmacological properties have widened the gap between mainstream conventional medicine and traditional herbal medicine. But with the continuing use of herbs by many people in the populations of the developing world and an explosion in consumption in the developed world, it is a health issue that warrants urgent attention.

The WHO definition of Traditional Medicine (TM) states that it refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to heal, diagnose and prevent illnesses or maintain well-being.

Why should the mainstream medical profession be interested in herbal medicine anyway? Firstly, many patients are using herbs, and are doing so concomitantly with synthetic drugs, not necessarily with disclosure to their attending physician. Generally, people use herbs to maintain health and to treat specific diseases, and the fact is that most users of herbs adamantly believe that their herbal remedies are equally efficacious or more so than synthetic medications.

However, lest the intrigue gets one carried away, many reports are emerging regarding deleterious herb-drug interactions that physicians must become has been suggested that St. John's wort induces the enzymes that degrades a diverse class of drugs to produce adverse drug reactions. Other popular herbs such as ginseng and even garlic have been shown to interact significantly with conventional drugs to produce adverse effects.

Therein lies one of the main challenges therefore, since it is important to dispel the theory that 'natural' always equals 'safe'.

Plants have evolved elaborate synthetic pathways to produce secondary metabolites over millions of years to protect themselves against predators, including man, animals, fungi, bacteria and viruses. The scientific community recognizes that these unique secondary metabolites may be responsible for the attributed therapeutic benefit.

At the Faculty of Medical Sciences in St. Augustine there are a number of researchers involved in the scientific investigation of medicinal plants, which include ethno-botanical surveys to document usage, in vivo studies in animal models of disease, isolated tissue models and in vitro studies, such as cancer cell lines. The results of these studies would guide further investigation into plants that show promise and possibly lead to clinical trials, the next stage of investigation.

It is my earnest hope that this distinguished gathering of scientific minds and brain power will look to continue your partnership with the relevant governmental and non-governmental agencies in the region to assist in some of the following:

• developing national policies to regulate the proper and safe production, quality control and educated usage of TMs
• documentation with accuracy, the efficacy and side effects of TM and to create an internationally recognized pharmacopeia of the islands
• you must seek to define products that are as effective, reliable and safe but with the ultimate aim of reducing the overwhelming drug bills of these islands.