social determinants of health

How self-produced medicines have increased tribal agency and reduced health disparities in Thailand

Modern healthcare is fraught with inequality. The U.S. private system suffers from exorbitant treatment costs, turns a blind eye to chronic conditions, and reflects disparities by ethnicity and socioeconomic status—all of which remain significant barriers to public health. On a global stage, similar patterns are evident: pharmaceutical companies are hesitant to expand into developing countries where they may not profit. However, to combat these disparities, some communities have found agency by producing their own medicine in a sustainable way. In this post, we’ll explore how the Karen (/kəˈrɛn/) tribes of Thailand have found a solution to an issue plaguing the world.

Health Disparities on National and International Scales

To see an example of the disparities created by our healthcare system, one needs to look no further than the absurdly-high prices of insulin, which have risen by 47% over the past 5 years. Many factors are responsible for this rapid increase in price: the “Big Three” corporations that hold an effective monopoly, patents that protect manufacturers, and lobbyists that prevent Congress from reforming healthcare. As a result of these, the ability to access insulin has become a privilege of the wealthy.

A similar connection between accessibility and wealth is prevalent on the global stage: in developing countries, many common and advanced medications are unavailable. According to a UN report by Tefo Pheage, “reduced manufacturing capabilities” in Africa require many countries to exclusively import their medications. This leaves these countries susceptible to the price fluctuations of foreign markets, in turn often becoming inaccessible. As a result, in low-income households, pills like ibuprofen and Tylenol are often in short supply; in under-resourced clinics, ineffective pills (e.g. generic painkillers) are often the only ones available for prescription.

It’s clear that the corporation-centric model of healthcare creates health disparities on both national and international levels.

Disparities in access to healthcare are prevalent on the global stage. Source: “Healthcare Access and Quality Index, 2015” by OurWorldInData (raw data from HealthData) is licensed under CC BY.

On Self-Producing Medicines and Agency

How have communities responded to this inequality? To discuss this with someone with firsthand experience in the matter, I recently conversed with Catherine Ruth Riley-Bryan at the Bamboo School, who works with native tribes of Thailand (read my previous post covering the Bamboo School).

Her school is located in the hilly mountains near the border region between Thailand and Myanmar, an area with winding, snakelike roads. Catherine says, “it can take hours to drive to the nearest hospital.”

In response to the resulting lack of professional healthcare support, she has helped the Karen people produce much of their own medicine. For example, they produce a medicine similar to ibuprofen through an elaborate procedure: creating alcohol from orange peels, adding dried curcumin, and finally, filtering it into a powder… The end result: an orange “painkiller powder” that can be used to combat signs of rheumatoid arthritis, which also doubles as a reliever for dengue fever. 

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The tribe’s medicinal innovations extend far beyond herbal remedies. In our interview, Catherine continued describing other ways through which the tribe repurposed their household ingredients into treatments for illness. Given my personal connection to visual impairments, one example, in particular, stuck out to me: the treatment of certain bacterial eye infections by soaking eye patches in a saline solution to wear overnight. When worn, these patches detoxified bacterial infections in many patients. Indeed, such stories of medical innovations remind us that the expensive ‘modern medicine’ of the West isn’t the only approach. As advanced treatments are inaccessible in infrastructure-limited regions, making medicine from locally-available resources is an innovative way to bridge the socioeconomic divide of global health. 

Not only does self-producing medicines reduce dependence on imported drugs, but it also stimulates independent economic growth. Interestingly, however, such economic development does not parallel the path of biotech startups in America. In the U.S., chemical formulae for organic compounds are patented to prevent rivals from manufacturing them. In turn, this intellectual property commodification stifles healthy competition, resulting in the absurdly-high prices mentioned earlier. Yet, Catherine describes, “we at the Bamboo School plan to share the recipe [for their herbal remedies] with other tribes in the region, who can benefit just as much as we have.” By sharing such knowledge freely and openly, the Karen people are able to ensure that their healthcare system prioritizes human life over individual profit.

However, it is important to acknowledge that their system of medicine suffers from a drawback. As tribe members don’t have the scientific and computational resources that a lab in the U.S. would, they instead iterate upon their medicine the old-fashioned way: swapping ingredients and experimenting for better outcomes. This lengthens the cycle for medicinal development and increases chances of side effects. Additionally, of course, a mixture of local ingredients is often less effective than lab-produced compounds.

Despite this, the Karen tribe serves as a reminder of the importance of remembering the human in medicine. In an ever-globalizing world, healthcare stands at an inflection point between a corporate commodity and a human right: whichever option our society chooses will set a global precedent affecting equality, discrimination, and justice.


Further Reading

Ali, Sadia. “Healthcare in the Remote Developing World: Why Healthcare Is Inaccessible and Strategies towards Improving Current Healthcare Models.” Harvard Health Policy Review, 10 Nov. 2016, www.hhpronline.org/articles/2016/11/10/healthcare-in-the-remote-developing-world-why-healthcare-is-inaccessible-and-strategies-towards-improving-current-healthcare-models.

Hall, John J, and Richard Taylor. “Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries.” The Medical Journal of Australia vol. 178,1 (2003): 17-20.

Peters, David H., et al. “Poverty and Access to Health Care in Developing Countries.” Annals of the New York Academy of Sciences, vol. 1136, no. 1, 2008, pp. 161–171., doi:10.1196/annals.1425.011. 

Featured image by Ajale from Pixabay.

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