Carissa lanceolata (conkerberry) is a perennial woody shrub used in traditional medicine by indigenous communities in Western Australia, the Northern Territory and Queensland for various medical conditions such as toothache, respiratory infections and the cleaning of sores, which all strongly indicate an antibacterial activity. A literature review revealed that the wood of this plant possesses significant antibacterial activity, which was found to be related to the presence of eudesmane type sesquiterpenes. C. edulis and C. carandus are frequently used in other traditional systems of medicine in different parts of the world, and thus have also been investigated for bioactive compounds and pharmacological properties. Some of these were found to be in line with the main findings of this work. Carissa lanceolata root was shown to exhibit significant antibacterial activity against both Gram negative and Gram positive organisms. A micro-broth dilution assay was performed on 96-well plates using resazurin as an indicator for microbial growth of Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis and Staphylococcus aureus. Bioassays carried out in this work showed that crude extracts of root bark and wood, particularly their polar constituents were more active against the four strains of bacteria tested. / Chemical investigation of the root bark revealed that it contains a volatile oil, which was isolated by steam distillation as well as solid phase micro extraction. It was found to consist of a single compound, which was identified as 2'-hydroxy acetophenone. The identity of this compound was confirmed by GC/MS and 1H NMR spectroscopy. Furthermore, the eudesmane-type sesquiterpene, carissone, was isolated from the root bark DCM and root wood hexane extracts. Its chemical identity was confirmed by IR, 1 [superscript] H and 13 [superscript] C NMR spectroscopy. The lignan, carinol, on the other hand, was isolated from the moderately polar fractions of the root wood MeOH extract. The obtained IR and 1 [superscript] H NMR data as well as Rf values all correspond to the literature. Two other yet unidentified compounds were isolated, but further studies into their chemistry and antibacterial activity were not possible in this current study. The antibacterial activity of the isolated compounds was considerable, with 2'-hydroxy acetophenone exhibiting the strongest effect, followed by carinol and then carissone.

The use of complementary and alternative medicines and therapies (CAM) in Australia and across the world is becoming increasingly prevalent. The most recent survey conducted by MacLennon et al. in 2004 [2] identified that more than half the general Australian population had used some form of CAM in the previous 12 months before the survey was conducted.[2-4] Up until now, the prevalence of CAM use among elite Australian athletes was unknown. As athletes are constantly looking to gain an advantage over their competitors through physical or psychological interventions or through the application of new technologies, it was hypothesised that the use of CAM in this group would be higher in athletes than in the general population. After surveying 497 elite Australian athletes we found that 93% of this specific population utilised at least one CAM within their lifetime. The 10 CAM (as defined by the Therapeutics Goods Administration) used most frequently were sports drinks, massage, sports bars, cereal bars, multivitamins, aloe vera, sports gels, Pilates, caffeine and yoga. There were no significant differences identified between specific sporting groups- football codes, court sports, field sports, water sports and others, with all groups reporting high usage. Sports physicians, family, coaches and friends were identified as the main sources for product information, with health food shops, sports dieticians and sports physicians being the predominant providers of the actual product. Four CAM sold on the Australian market which purported to decrease the symptoms of delayed onset muscle soreness (DOMS), or reported anti-inflammatory properties which could impact of the inflammatory response associated with DOMS were studied. Lyprinol® (an anti-inflammatory agent), topical Arnica (for symptomatic relief of soft tissue trauma), Tienchi Ginseng (proposed to relieve symptoms of DOMS) and Devil’s Claw (an analgesic and anti-inflammatory agent) were the chosen CAM. Four separate randomised, double blind placebo controlled studies comprising of 20 subjects per study were carried out with the same DOMS inducing methodology (downhill treadmill running) employed. All subjects in each of the four studies had their performance (counter movement and squat jump, maximal force), pain (visual analogue scale and muscle tenderness) and blood parameters (high sensitivity C-reactive protein, interleukin-1A, interleukin-6, tumour necrosis factor-K, creatine kinase and myoglobin) analysed seven times over five days. Lyprinol® did not affect performance, pain or blood markers of muscle damage and inflammation analysed in this study. Despite Lyprinol® being marketed as having “potent anti-inflammatory” properties, Lyprinol® did not demonstrate any antiinflammatory properties in our sample group at a dose of 200mg daily for two months, and did not alter any of the markers of inflammation after a downhill running protocol. A significant difference was identified in quadriceps muscle tenderness between the topical Arnica and placebo groups 72 hours after the downhill running protocol. This indicated that the topical Arnica group experienced less quadriceps pain at this time point, though this was not reflected in the quadriceps visual analogue scale results. There were significant differences identified between the topical Arnica and placebo groups for muscle tenderness in the gastrocnemius and tumour necrosis factor-K concentration at baseline. Further statistical analysis assessing relative changes from baseline did not demonstrate any statistically significant differences between the groups for either of these parameters. We therefore conclude that the symptomatic relief of soft tissue trauma claimed from a topical Arnica product sold in Australia was not conclusively demonstrated in this study. The single, isolated significant difference identified in quadriceps tenderness does not conclusively, from this study, indicate efficacy for the use of this topical Arnica for the relief of soft tissue trauma. Tienchi Ginseng demonstrated the most promising outcomes, with statistically significant differences identified in performance and inflammatory markers in favour of Tienchi Ginseng. Though it cannot be conclusively deemed beneficial for DOMS from this study alone, Tienchi Ginseng warrants further research with larger sample sizes and a similar muscle damage protocol. Finally, Devil’s Claw did not demonstrate beneficial outcomes in regards to DOMS within this study. It actually demonstrated some, perhaps detrimental effects, upon analysis of performance and inflammatory markers. We are unsure of the mechanisms behind these findings, particularly when considering the proposed anti-inflammatory effects of Devil’s Claw. From the literature, Devil’s Claw appears to be beneficial in chronic musculoskeletal conditions however it does not seem to impact on muscle damage and pain resulting from DOMS inducing exercise. The questionnaire study has demonstrated that there is a high usage of CAM among elite Australian athletes, an area up until now that has been unexplored. The onset of CAM use within the Australian athletic population, and the prevalence of CAM use by other professional Australian athletes would be an area to explore in the future. In regards to products which specifically claim to benefit athletes suffering soft tissue trauma such as DOMS, convincing evidence for specific product use was not demonstrated in these studies. Further research involving greater sample sizes may reveal more definitive outcomes, specifically in regards to the use of Tienchi Ginseng. / Doctor of Philosophy (PhD)

Tanzania is endowed with more than 10,000 plant species, of which 1,100 are endemic. The coastal regions host most endemic species, due to its wide range of productive ecological conditions. Over 25 % of all species are used as wild-harvested medicinal plants. About 60% of the Tanzanian population in both rural and urban areas depends on traditional medicine and herbs as their primary health care, and as a means of generating income. This is due to high costs and unavailability of the universal healthcare, which was abolished in 1993. The aim of the thesis is to make a structured and a quantitative investigation to identify traded medicinal plants traded in markets of Dar es Salaam in Tanzania with a purpose to understand the chain and consequences of commercial trade on wild-harvested medicinal plants. A quantitative market research using free list surveys was used in combination with individually repeated in-depth structured and semi-structured interviews. Furthermore, Conservation Assessment and Planning Management method was used to prioritise species that are in need of conservation due to commercial trade. The results show that the chain of commercial trade of medicinal plant species begins in the forest and is then distributed to different stakeholders, such as harvesters, vendors, Traditional Healing Practitioners, consumers and exporters. The research also shows that the large urban and international demand of medicinal plant species supplied by the vendors and exporters is the major threat, specifically to destructively harvested species such as Cassia abbreviata, Zanthoxylum usambarense, Zanthoxylum chalybeum, Myrsine africana, Milicia excelsa and Prunus Africana. These medicinal plants species are up-rooted and/or ring-barked and are therefore in need of conservation. This calls for several conservation guidelines such as policy and regulations, Traditional Ecological Knowledge, education and planting of the medicinal plant species in their natural forests as well as collecting samples of medicinal plant species in a herbarium. Policies can be implemented to conserve these species, for instance only allowing registered practitioners to harvest the medicinal plant species to a level that will sustainably balance the quantity of medicinal plant species in the forest and its supply. In conclusion, an important policy regulation could be an export tax on internationally-traded wild-harvested medicinal that is levied on the purchasing international pharmaceutical companies, which would then be used to fund the conservation of the medicinal plant species to retain a sustainable wild stock. More investigation on the actual population sizes of these plant species is needed in order to secure their existence and contribute to sustainable development both socially and environmentally

The Western liberal approach to informed consent defines autonomy as an independent choice or decision made by an individual as the final authority in medical decision-making. This approach is so dominant that one can fail to see the merits of other traditional and cultural perspectives. In this dissertation, another approach to informed consent is considered -that of communal culture of Africa, a process used in African traditional medicine (ATM) wherein patients make medical decisions and give consent in consultation with the members of their community and the ATM doctor. Often, but not necessarily, the final consent rests on the consensus reached in consultation with the group rather than on that by the individual patient alone. <br>This dissertation argues that the ATM form of consent constitutes legitimate informed consent based on the concept of relational autonomy, commonly called relational autonomy in informed consent (RAIC) in this dissertation. To interpret and enlighten the significance of the ATM approach to RAIC, the analysis in this dissertation examines the ethics of care movement in Western bioethics which also advocates a relational approach to informed consent. This movement presents a concept of persons as relational beings who are socially embedded, thereby interpreting patient autonomy in their relationships with others. This movement provides the hermeneutic to enlighten the significance of the ATM approach as a legitimate model of RAIC. <br>By comparison of the ethics of care approach with that of ATM to RAIC, this dissertation further provides a relational approach to informed consent in order to inform the restrictive emphasis on individual autonomy practiced in Western bioethics, all with a view towards fostering current discourse on global bioethics. The dissertation also provides an applied example of the contribution of ATM's RAIC approach to ethics committees in Africa, focusing in particular, on the decision-making process for patient informed consent. <br>This dissertation is distinct insofar as it focuses on informed consent in ATM, employs ethics of care as a hermeneutic to interpret ATM, advocates integrated model of healthcare ethics committees in ATM. Because ATM forms a large portion of the healthcare systems in Africa, it follows that ATM and its practices should receive more attention in bioethics in the present global era. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

Thesis (MSc (Paraclinical Sciences, Veterinary Science)--University of Pretoria, 2009. / Includes bibliographical references. Also available in print format.

Habilitationsschrift--Mainz. / Includes indexes. Includes bibliographical references (p. [217]-226).

Thesis (Ph. D.)--University of Chicago, Committee on Human Development, December 2003. / Includes bibliographical references. Also available on the Internet.

In Bolivia, indigenous women's desires to give birth in an atmosphere of respect and cultural autonomy, as well as physicians' and politicians' attempts to mold the nation along racial lines, shaped the development of obstetric medicine. Based on oral histories of midwives, nurses and obstetricians, this study uses midwifery as a lens to examine the connections between nation-state formation and the development of obstetric medicine in Bolivia between 1900 and 1982. Putting midwives at the center of a study about nation-state formation reveals complexities that many male-centered studies miss: indigenous, mixed-race, and white Bolivian women played central roles in state projects and, through their embodiment of different forms of womanhood, influenced debates about Bolivian national identity. This study also engages groundbreaking feminist studies of the 1970s and '80s which showed that U.S. and European male physicians created obstetric medicine by pushing female midwives out of the practice. These physicians typically accused midwives of ineptitude and defined childbirth assistance as a scientific medical procedure that should not be practiced by women. While that pattern holds true in Bolivia to some extent, it does not explain the power dynamics that shaped childbirth assistance in Bolivia. Over the course of the twentieth century, Bolivian physician's desires to modernize childbirth assistance and childrearing practices intertwined with the efforts of Bolivia's elite to overcome what they considered the country's "Indian Problem."

This dissertation consisting of three case studies, examines how the intersection of biomedicine and indigenous medicine in South Africa has formed and reformed indigenous medical practice over the past century. South Africa, like many other countries, has emerged from colonialism with the need to reassert its indigenous practices. In the case of medicine, this reformation is of particular importance because the last several decades have seen the development of the HIV/AIDS pandemic. Yet the contemporary discourses and policies surrounding indigenous medicine have much in common with their colonial predecessors. This research is interested in the way medicine has been constituted in a post-colonial context. In particular, how has the intersection of indigenous and biomedicine reconfigured and respatialized medicine in South Africa?The ways the colonial government acted to regulate indigenous medicine in essence simplified the practice and divided it into subcategories- `natural' medicine (e.g. herbs), `modern' medicine (e.g. stethoscopes) and `supernatural,' (e.g. throwing bones). The natural was the only category of practice legal in the country. Even as the government structure changed, and the previously disadvantaged eventually came to lead the country, these categories still persisted. As such, when a crisis like HIV/AIDS strikes and the need to enroll the help of the indigenous healers becomes clear, calls for their regulation, as a way to gain their assistance, are made. Although the current call does not aim to limit the number of healers, there are similar public health goals of rooting out the `bad' indigenous healers.Overall three major findings emerged: First, colonial regulations are re-introduced in a post-colonial context as discourses, which are then reinstated as policies; second, policy over the past century tends to view indigenous medicine in a simplified form (i.e. as plant-based and natural); and third, there is a constant tension between biomedicine and indigenous medicine where biomedicine works to extend its spaces of practice into the indigenous realm.

South Africa is currently revitalising the role of Traditional Health Practitioners (THPs) in the country's healthcare provision. This undertaking is guided by Chinese Traditional Medicine which is said to be one of the most highly developed traditional healthcare systems in the world. Programmes developed by the National Department of Health and other stake holders in the development of indigenous medicine often need to be accommodated architecturally. Collaboration with biomedicine is one of the main programmes aimed at empowering Traditional Health Practitioners of the country. Accordingly, this dissertation is divided into two sections, both based on the current undertakings of collaboration between biomedicine and indigenous medicine in South Africa. Due to the fact that traditional healing systems are less commonly described than biomedicine, the main focus of this study is indigenous medicine and how architecture could be influenced by alternative healthcare practices. The first section (A) is theoretical. It investigates and compares the current architecture that accommodates THPs in rural and urban areas of KwaZulu-Natal. This unveils social, cultural, economic and political factors affecting this architectural genre. The aim thereof is to establish architectural elements to be considered when designing a health care facility for THPs. Section A also explores the current state of healthcare architecture in the country and abroad so as to establish the latest challenges to be addressed by the proposed collaborative healthcare model. Design principles for collaborative architecture accommodating THPs and biomedical practitioners in an urban context of South Africa are then be put forward. Section B incorporates the theories derived from section A, towards the design of a joint indigenous and biomedical healthcare centre for Durban. It gives specific spatial requirements for a collaboration between biomedical practitioners and izinyanga. / Thesis (M.Arch.)-University of KwaZulu-Natal, Durban, 2008.