obliged either to travel long distances to obtain necessary materia medica or
to rely on imported stock, the origin and mode of collection/preparation of
which may be unknown to the prescriber. In the latter case, an important
component of traditional quality assurance is lost. The establishment of
nurseries and farms supplying plant material of consistent quality would
help to minimise accidental overdosage due to natural variability in potency.
Another result of urbanisation in South Africa appears to be ‘the irre-
sponsible quackery and reckless profiteering racket into which the erstwhile
dignified practice of traditional medicine is currently degenerating in the
townships and cities’ (Zondi, personal communication in Ref. 68). This is a
phenomenon of which traditional healers are well aware and which they
seek to eradicate (Kubukeli, personal communication). Registration and
certification of traditional healers, as is required for their western allopathic
counterparts, have been proposed as a solution and may contribute to a
reduction in the incidence of poisoning.
A further problem may be that the South African city dweller, driven by
constraints of time and money, is now self-medicating with TMs ‘counter
prescribed’ by herb sellers plying their trade in the marketplace. The latter, if
motivated by economic necessity alone and lacking the rigorous training of the
TP, may provide inadequate or incorrect information. The best of drugs, in the
hands of the irresponsible or ignorant, is potentially dangerous. It may be
necessary to alert the public, by means of a media campaign, to the hazards of
self-medication with traditional herbs known to have deleterious side effects.
Although it is not possible to say if the South African experience holds true for
other African states, it would be surprising if the effects on traditional medical
practice of cultural disruption occasioned by urbanisation, political unrest,
war or climate change would not be felt throughout the continent.
A study aimed at investigating the potential hazards associated with the
long-term effect of medicinal plants commonly used as TMs in South
Africa tested polar and non-polar extracts of some 50 plant species for
genotoxic effects using in vitro bacterial and mammalian cell assays, such
as the Ames test, VITOTOX test, micronucleus test and comet assay.^69 It
was found that most of the 50plant species investigated caused either
DNA damage (as detected by the comet assay), chromosomal aberrations
and/or non-dysjunction or chromosome lagging in human white blood cells
(as detected in the micronucleus test). A few plants showed frame-shift
mutations in the salmonella/microsome assay. These findings are a cause
for concern and further toxicological studies are necessary before the
species concerned can be prescribed with confidence.
Quality assurance
Quality assurance of medicines rests on the establishment of standards
relating to their identity, purity and potency. This constitutes the first step
Traditional medical practice in Africa | 109