Traditional Medicine in Indonesia: Literature Review & Background

Traditional Medicine in Indonesia: Literature Review & Background

Traditional, Alternative and Complementary Medicine in Indonesia

The rich flora and fauna in Indonesia has earned itself the title of a mega biodiverse country[1]. Indonesia is ranked 5th worldwide in terms of its plant diversity with 10% of the world’s flowering species, 25 thousand species of flowering plants, 55% of which are endemic[2] (unique to its geographic region).  With this wealth of biological resources, Indonesia has developed rich traditional medicine knowledge, which is a vital part of the its diverse culture, leading to the growth of a traditional medicine health system alongside conventional medicine health care[3].

This unique and abundant biodiversity has led to the development of industries that rely on medicinal plants.  According to the Ministry of Trade of the Republic of Indonesia (Departmen Perdagangan Republik Indonesia), Indonesia “contains at least 30,000 species of medicinal plants”, of the 40,000 known medical plant species in the world, and which “have been the source of medicinal cures long before recorded history”[4]. The Ministry of Trade promotes the use of these medicinal plants for “Natural Beauty and Spa Industries”, but international interest in medicinal plant concoctions and herbal medicines, known as Jamu, has increased over the past decade. In 2007, Susilo Bambang Yudhoyono, the President of the Republic of Indonesia at the time, declared Jamu an Indonesian brand[5].  According to a Euromonitor International June 2013 report, quoted in a Bloomberg article, “sales of Indonesian traditional medicine are expected to increase 55% to about $800 million by 2017, from about $500 million in 2012”[6].  With rising demand both locally and internationally, the Indonesian government supports and promotes the industry by implementing relevant policies and developing traditional medicine[7].

A significant proportion of Indonesians use traditional medicine: 55%, according to the 1995 National Health Survey7.  Despite the modernization and globalization trends, Indonesians have embraced Jamu as not only a valuable medicinal resource, but as a resource for economic growth.  According to Volume 2 of the Encyclopedia of Medical Anthropology, the Indonesian government considers traditional medicine “an essential resource in the cause of development” and as such, it has become a “progressive tradition”[8] within Indonesian culture.

In the past few decades, regulations and legislation have pushed towards improving the safety and efficacy of traditional medicine in Indonesia with the support of clinical studies.  The number of clinical research studies into the effects of the active compounds in medicinal plants and phytopharmaca is currently limited.  While traditional medicines that have been passed down through multiple generations have empirical evidence, unfortunately there are not many scientific studies to back up claims of the diseases and conditions they are treating or preventing.  A study published in 2014, titled “Jamu: Indonesian traditional herbal medicine towards rational phytopharmacological use” lists studies related to Indonesian medicinal plants, the major compounds found in each of the plants studied and their historical uses in traditional medicine in Indonesia, and concludes that further research and efforts need to be made “standardize the formulae of jamu in order to assure the efficacy and safety”[9].

Information on research studies is available through research journals, mostly with high costs for those without established access (students, professors, researchers, etc).  The information that is currently available in English on traditional medicines and their uses can be found on Indonesia’s National Agency of Drug and Food Control (NA-DFC or BPOM: Badan Pegawas Obat dan Makanan) website[10], but other than this resource, it is difficult to find objective and reliable information or databases in English on Indonesian medicinal plants.

Traditional Medicine Policy

Policies and legislation have developed rapidly over the past two decades, not only to improve safety, efficacy and quality in traditional medicine, but also to protect the cultural, social, economic and political aspects of traditional medicine for the communities that it benefits the most: rural and indigenous populations, and the poor.  The World Health Organization views Traditional and Complementary Medicine (T&CM) as “an important and often underestimated part of health care”[11], which, when “of proven quality, safety, and efficacy, contributes to the goal of ensuring that all people have access to care”11. The WHO’s strategic framework for T&CM over the next decade involves (1) “building the knowledge base and formulating national policies”, (2) “Strengthening safety, quality and effectiveness through regulation” (3) “Promoting universal health coverage by integrating T&CM services and self-health into national health systems”11.  As a complement to this strategic framework, additional recommendations have been made by the WHO for the protection and promotion of T&CM.  These recommendations outline the rationale for protecting T&CM: to protect the indigenous cultures and communities who have passed this knowledge down through generations.  Protecting T&CM knowledge, according a document published in 2002 by Carlos M. Correa from the University of Buenos Aires, would provide equity and preservation, prevent misappropriation, promote self-determination and development[12] for the culture and communities that practice and have developed T&CM.

Important policies related to T&CM have been established by the Ministry of Health in the past two decades, many of which are in the process of being implemented.  The Indonesian Ministry of Health, in 2001, expressed its intention “”to modernize traditional medicine, while retaining its identity”[13], taking into account important Intellectual Property Rights (IPR) considerations for the indigenous cultures where the T&CM has developed.  As part of the modernization process, quality control standards and good manufacturing processes of T&CM and herbal products have been a priority for the Ministry of Health in Indonesia.  Various South East Asian countries have agreed to follow WHO recommendations on the regulation, and thus quality, of herbal medicines[14].  These regulations mainly focus on the safety, efficacy, and registration or accreditation of herbal products, while also limiting the claims or advertising associated with these products.

Data

While Indonesia, with its mega biodiversity, contains 30,000 of the world’s 40,000 flowering plants, 7,000 of those species are “known and used for medicinal purposes”, and only “250 species [are] used in the traditional herbal medicine, Jamu, industries”[15].  A list of registered “Biological medicine ingredients” can be found on the DA-NFC’s website[16] and includes just under 900 species of plants with medicinal properties.  Other sources with information regarding the safety, efficacy and quality of traditional medicines (Jamu) or herbal extracts are currently scattered and fragmented across different sources on the Internet, many of which are not in English.  Currently there is little evidence online (in English) of objective coordination and comprehensive collection of data regarding the natural resources, traditional knowledge and scientific evidence surrounding traditional medicine in Indonesia. India, in an effort to protect its traditional knowledge due to efforts in Europe to patent this knowledge, created the Traditional Knowledge Digital Library [TKDL] in an “effort to protect traditional knowledge from misappropriation”[17].

The DA-NFC’s website is the only online database that is accessible in English, although the actual data in the database itself is in Indonesian.  Information on traditional medicine, registered or approved medicines, or accredited products is difficult to find in English, especially from a single source.  The WHO, as part of its traditional medicine framework, recommends accessibility to objective data on traditional medicine in its member states, which would provide not only the benefit of the availability of information to those who seek it, but would also provide protection and prevent misappropriation of that knowledge.

References:

[1] Megadiverse Countries.  Biodiversity A-Z. http://www.biodiversitya-z.org/content/megadiverse-countries Accessed: May 30, 2016

[2] Biodiversity Facts: Country Profile – Indonesia. Convention on Biological Diversity. https://www.cbd.int/countries/profile/default.shtml?country=id#facts Accessed: May 30, 2016.

[3] 2.2 Traditional Medicine in Indonesia. Trips, CBD and Traditional Medicines: Concepts and Questions.  Report of an ASEAN Workshop on the TRIPS Agreement and Traditional Medicine, Jakarta, February 2001.

[4] Indonesia Herbal: The Traditional Therapy. Ministry of Trade of the Republic of Indonesia. 2012. http://www.kemendag.go.id/files/pdf/2012/12/08/herbal-id0-1354952594.pdf Accessed: May 30, 2016

[5] Traditional Medicine in Republic of Indonesia: Indonesian Traditional Medicine, National Strategy and Scope of Cooperation. N.d. http://www.searo.who.int/entity/medicines/topics/traditional_medicines_in_republic_of_indonesia.pdf Accessed: May 30, 2016

[6] Herbal Remedies Maven Emerges as Billionaire in Indonesia.  Bloomberg. Feb. 20. 2014. http://www.bloomberg.com/news/articles/2014-02-20/herbal-remedies-maven-emerges-as-billionaire-in-indonesia Accessed: May 30, 2016.

[7] Chapter 13 – Republic of Indonesia: WHO Global Atlas of Traditional, Complementary and Alternative Medicine.  World Health Organization. 2005. Accessed: May 30, 2016.

[8] Ember, C.R., Ember, M. Post-Colonial Development and Health. Encyclopedia of Medical Anthropology: Health and Illness in the World’s Cultures, Volume II – Cultures. (2004). Accessed: May 30, 2016

[9] Elfahmi; Woerenbag, HJ; Kayser, O. Jamu: Indonesian traditional herbal medicine towards rational phytopharmacological use. (2014)  Journal of Herbal Medicine vol 4 (2) p. 51-73. http://www.sciencedirect.com/science/article/pii/S2210803314000049

[10] Badan POM: Badan Pengawas Obat dan Makanan. http://www.pom.go.id/new/index.php/home/id Accessed: May 30, 2016

[11] WHO Traditional Medicine Strategy, 2014-2023. World Health Organization. (2013) http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf Accessed: May 28, 2016.

[12] Correa, Carlos M. Protection and Promotion of Traditional Medicine – Implications for Public Health. (2002) University of Buenos Aires. http://apps.who.int/medicinedocs/pdf/s4917e/s4917e.pdf Accessed: May 29, 2016

[13] TRIPS, CBD and Traditional Medicine: Concepts and Questions.  Report of an ASEAN Workshop on the TRIPS agreement and Traditional Medicine, Jakarta, February 2001.  Essential Medicines and Health Products Information Portal, A World Health Organization Resource. (2001) http://apps.who.int/medicinedocs/en/d/Jh2996e/12.5.html Accessed: May 28, 2016

[14] Guidelines for the regulation of herbal medicines in the South-East Asia Region.  World Health Organization, Regional Office for South-East Asia, New Delhi. (2004) http://apps.who.int/medicinedocs/documents/s22299en/s22299en.pdf Accessed: May 30, 2016.

[15] Hanafi, M. Nina A, Fadia, Zorni. Nurbaiti.  Indonesian Country Report on Traditional Medicine. (n.d.) http://www.niscair.res.in/conclave/downloadables/Plenary%20Session%203/Country%20Papers/3.%20Indonesia.pdf Accessed: May 28, 2016

[16] Obat Bahan Alam Indonesia. Badan Pengawas Obata dan Makanan. http://www.pom.go.id/index.php/oai/menu/tanaman Accessed: May 27, 2016

[17] Rastogi, Priyanka. How India is Safeguarding Its Traditional Knowledge From Monopolisation? Mondaq. http://www.mondaq.com/india/x/491576/Patent/How+India+Is+Safeguarding+Its+Traditional+Knowledge+From+Monopolisation Accessed: May 31, 2016

Yogyakarta

Yogyakarta

I stayed in England for a few days to visit family, before heading out to Indonesia.  I had completed my last final exam just a few days before, and was finally beginning to unwind from a hectic and difficult semester.  For the first time I started to look ahead at my plans for Indonesia, and within a few minutes of googling and browsing the Internet, I realized that Vesak/Weisak, the most important day of the year for Buddhists, was the following weekend.  I quickly decided that I had to be at Borobudur temple, the largest Buddhist temple in the world, to celebrate the birth, enlightenment, and death of the Buddha.

I had never been to Yogyakarta, let alone Borobudur, so it was an easy decision for me.  Yogyakarta was also on my list of places to visit because it has a rich history of culture, art, and traditional medicine.  I also was not scheduled to go to the Ministry of Health until the following week.

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Rice paddy fields behind “The House of Nasi Bungkus”, a homestay in Yogyakarta, Java.

I arrived on an evening flight to a humble, but extremely inviting, bed and breakfast run by Anez.  The house sat nestled in a quiet neighborhood a few blocks from an art school.  In the United States we get nicely landscaped and planned parks, this neighborhood had rice paddy fields hiding behind houses instead.  I quickly learned from Anez that this area has a vibrant art scene, and he invited me to an exhibition and music event at a local art gallery.  I jumped on the back of his moped just an hour or so after arriving, and we meandered through narrow streets until we arrived to a bustling art gallery.

One of the things I love to do in my free time, wherever I may be, is to go to art museums.  It helps me reconnect to life and get a different perspective on things, especially now that I have been buried in studies for the past few years.  I drive up to New York City, Philadelphia and Washington DC when I have a few days off and just spend my days looking at the beautiful paintings housed in the amazing art museums there.  Now, I was in Yogyakarta.  Anez had told me about the vibrant art scene in the city, a community he himself is deeply involved with, but I had no idea what to expect.

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Entrance to art gallery at Sangkring Art Space

We arrived to Sangkring Art Space and Anez parked among a sea of mopeds.  I wonder how many Indonesians have trouble finding their bikes because there are always so many that look exactly the same!  The art space was packed with people of all ages.  The event was held in an outdoor space, with the art displayed in a semi open space at the back with a beautifully decorated entrance.  I honestly was not expecting it to be as crowded as it was.  I have visited New York City art museums at busy times, but none of them compared to this.  People stood and sat around chatting, eating, listening to the music and wandering through the art gallery, which displayed paintings made by local artists.

 

 

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Photos: Sangkring Art Space

 

 

 

 

 

 

 

 

The excitement of traveling

The excitement of traveling

I have traveled my fair share, but it was more about moving to a country, rather than signing up for a tour, cruise or a retreat from work.  I stopped traveling for a while (since 2008) while I focused on career goals and work.  I actually settled down in a country and found myself calling it home.  I never thought I would love living in the United States as much I do, but Chapel Hill, North Carolina is such a great place to live: the clear Carolina blue skies, the wonderful weather, the friendly people.  I became extremely comfortable and had put traveling on the back-burner, something I could do once I had finished all my studies.  Then this opportunity to do an internship with the Ministry of Health of the Republic of Indonesia basically fell in my lap, and I was suddenly searching for tickets and planning a whole summer traveling around Indonesia and working in Jakarta.

I lived in Jakarta as a teenager, from the ages of 11 to 15.  I later moved there with my three children in 2002, wanting to expose them to same culture I grew up and love so much.  It is a sort of second home for me.  It is where some of my best friends live, childhood friends.  It is where my parents met in the 1970s.  And while I am not completely fluent in the language, I feel completely at home in the culture.

But at this point, in 2016, I have been away from Indonesia for more than 10 years.  It feels so distant.  The travel jitters have been unbearable.  I know I will get in the groove fast enough, but I feel like a rusty traveler at this point.  Even if you are going to a place you have been before, it is still exciting.  It is a whole set of new experiences waiting to happen.