P-147. Integrating Local Knowledge on Traditional Medicine into Rural Health Care System in Indonesia (INTRAMED) FINAL REPORT

Integrating Local Knowledge on Traditional Medicine into Rural Health Care System in Indonesia (INTRAMED)

P-147 FINAL REPORT

Verania Hödl1, Firdaus G. Siahaan1, Lizah Khairani1, Kusnaka Adimihardja1, Muchtan Sujatno1, Basuki Hidayat1, Rajindra K. Puri2, Christian R.Vogl3, Ulrike Bechtold4, Wolfgang Kubelka5, Harald Wilfing4, Clemens M. Grünbühel6

1

INRIK, Padjajaran University, Bandung, West Java – Indonesia Dept. of Anthropology, University of Kent – UK. Rajindra K.Puri is an independent contributor and final report editor in this project. 3 IfÖL, Institute for Organic Farming, University of Natural Resources and Applied Life Sciences (BOKU), Vienna – Austria 4 BIOS-4, Vienna – Austria. Ulrike Bechtold is an independent contributor in this project. 5 Dept. of Pharmakognosie, University of Vienna - Austria 6 IFF Social Ecology, University of Klagenfurt, Vienna – Austria. 2

TABLE OF CONTENTS

ABSTRACT1111111111111111111111111111111. 4 ABSTRAKT1111111111111111111111111111111. 5 1

PROJECT OVERVIEW ....................................................................................... 7 1.1

Aims, objectives and expected outcomes ......................................................................... 7

1.2

Research location................................................................................................................. 7

1.3

Stakeholders ......................................................................................................................... 8

1.4

Project steps and methodology.......................................................................................... 9

2

SOCIO-ECONOMIC BACKGROUND OF RESPONDENTS............................. 10

3

METHODS, RESULTS AND DISCUSSIONS.................................................... 13 3.1

Available local knowledge in researched villages .......................................................... 13

3.1.1

Domain 1: Knowledge of medicinal plants and their uses ............................................... 14

3.1.2

Domain 2: Common illnesses and medicinal plants used in their treatment ................... 21

3.2

Preparation of medicinal plants to treat common illnesses .......................................... 24

3.3

Scenario Building ............................................................................................................... 30

3.3.1

Identification of health care facilities and problems ......................................................... 30

3.3.2

Community-based scenario about health care services in the village ............................. 38

3.3.2.1 3.3.2.2

4

Community-Based Scenario in Sirnarasa Village ............................................... 43 Community-Based Scenario in Tanjungsari Village............................................ 44

CONCLUSIONS AND RECOMMENDATIONS ................................................. 45 4.1 Opportunities for an integrated health care system: the efficacy of local knowledge and potential constraints................................................................................................................ 45

5

6

4.2

Recommendations and follow-up plans .......................................................................... 47

4.3

Returning results: A medicinal plant booklet.................................................................. 49

APPENDICES ................................................................................................... 50 5.1

Interview Guideline 1: Socio-cultural background and Cultural Domain Analysis ..... 50

5.2

Interview Guideline 2: Preparation of medicinal plant use ............................................ 54

5.3

Scenario Building Guideline ............................................................................................. 56

5.4

List of medicinal plant species in two researched villages ........................................... 67

5.5

Prior Informed Consent form ............................................................................................ 84

REFERENCES .................................................................................................. 85

2

LIST OF FIGURES

Stakeholders involved in INTRAMED research INTRAMED project steps and methodologies Comparison of socio-economic background of residents in Sirnarasa and Tanjungsari Comparison of socio-economic background of health care officers in Sirnarasa and Tanjungsari Figure 5. Number of medicinal plant species freelisted by respondents in Sirnarasa and Tanjungsari Figure 6. Similarity of medicinal plant freelists from Tanjungsari Figure 7. Alternative treatments chosen by respondents in Tanjungsari and Sirnarasa Figure 8. Habitat of medicinal plant species in Sirnarasa village Figure 9. Venn diagram of beneficial and frequently used health care facilities in Sirnarasa Figure 10. Venn diagram of beneficial and frequently used health care facilities in Tanjungsari Figure 11. Present condition of health care services in Sirnarasa and Tanjungsari Figure 12. Business as Usual scenarios in Sirnarasa and Tanjungsari Figure 13. Positive scenarios in Sirnarasa and Tanjungsari Figure 14. Negative scenarios in Sirnarasa and Tanjungsari Figure 15. Example of medicinal plant booklet entry for ginger, in English Figure 1. Figure 2. Figure 3. Figure 4.

8 10 12 13 15 17 22 23 32 34 39 40 41 42 49

LIST OF TABLES Table 1. Sociodemografic characteristics and number of respondents interviewed in two sampled villages Sirnarasa and Tanjungsari 11 Table 2. Medicinal plant species freelisted by at least 10 percent of Sirnarasa respondents 18 Table 3. Medicinal plant species listed by at least 10 percent of Tanjungsari respondents 19 Table 4. Comparison of uses of most frequent medicinal plants listed in Sirnarasa and Tanjungsari 20 Table 5. Common illnesses and medicinal plants used in Sirnarasa 21 Table 6. Common illnesses and medicinal plants used in Tanjungsari 21 Table 7. Sirnarasa preparation of medicinal plants to treat the most common illnesses: compared with published database 26 Table 8. Tanjungsari preparation of medicinal plants to treat the most common illnesses: compared with public database 28 Table 9. Result of weighted ranking of health care facilities in Sirnarasa 31 Table 10. Result of weighted ranking of health care facilities in Tanjungsari 34 Table 11. Identified problems and ranking in health care services in Sirnarasa 36 Table 12. Identified problems and ranking in health care services in Tanjungsari 37

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Integrating Local Knowledge on Traditional Medicine into the Rural Health Care System in Indonesia (INTRAMED) ABSTRACT Existing health care systems in Indonesia can benefit from the utilization of low-cost, locally available resources that are easily applicable, such as medicinal plants. INTRAMED therefore documented knowledge of medicinal plants and their uses in the community as well as initiated participatory approaches to explore community expectations of the future of their health care. The project was conducted among low-income households and health care staffs in two villages in West Java; Sirnarasa is a remote village whereas Tanjungsari is located in a sub-urban area. The results provided insights into locally available knowledge on medicinal plant-based medicines, value and problems of different existing health care facilities, and community perceptions regarding health care. In this research we applied cultural domain analysis method to free list the available knowledge on medicinal plant species, also semi structured interview and group discussions. In each village we involved 30 respondents for interview, mainly came from low-income households, and wider participation during group discussions. The 30 respondents consisted of male and female from common village inhabitants, local healers as well as official health care personnel. INTRAMED documented 161 medicinal plant species from both villages, used to treat more than 50 illnesses, from common colds to hypertension. The locally most known plant species in Sirnarasa was Cecendet (Physalis angulata L.) used to treat muscle pain and rheumatism, while in Tanjungsari was Koneng Gede (Curcuma xanthorrhiza Roxb.) used to treat gastritis. We found that the best known medicinal plants were usually used to treat the most common illnesses. Differ to residents in Tanjungsari, plant-based medicines were preferred by common residents in Sirnarasa since they were cheap, easy to obtain and simple to prepare relatively to chemical-based medicines or so called modern medicines. Group discussions among residents and clinic staff identified health care problems and expectations, of which in both villages the high cost, insufficient number of officials and not enough stock of medicines in local clinic were rated most problematic. In both villages, lack of knowledge in medicinal plant preparation was identified as problem only by community members but not by officials. Community-based positive scenario in both villages expected a cooperative relationship between local clinics, the government, traditional healer and communities to enhance the utilization of medicinal plants. Especially expressed by resident participant in Sirnarasa, improvement in the utilization of medicinal plants was projected to increase household income by production of ready to use medicinal plant based products. Negative scenario revealed that no utilization of plant-based medicine or other traditional medicines, bad quality of service from local clinic were the most unwanted situations expressed by participants in both villages. This research has demonstrated local availability and importance of medicinal plant knowledge in maintaining daily health status of low-income households as well as the obstacles for its utilization in the existing rural health care system. As also has been recognized by numerous development agencies, optimization of locally known medicinal plant use may provide an affordable and accessible health care alternative for communities, which in long term contributes positively in poverty alleviation.

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Integration von traditionellem medizinischen Wissens in das ländliche Gesundheitssystem von Indonesien (INTRAMED) ABSTRAKT Das bestehende Gesundheitssystem in Indonesien kann durch die verbesserte Nutzung kostengünstiger, lokal und einfach verfügbarer Ressourcen gestärkt werden, insbesondere durch die Integration von Heilpflanzen. Aus diesem Grund hat das Projekt INTRAMED das Erfahrungswissen der lokalen Bevölkerung zu Heilpflanzen dokumentiert und einen partizipativen Prozess eingeleitet, der hilft die Vorstellungen dörflicher Gemeinschaften über die Zukunft der Gesundheitsvorsorge zu verstehen. Das Projekt wurde mit Dorfbewohnern aus Haushalten mit geringem Einkommen sowie mit Akteuren des Gesundheitssystems in zwei Dörfern West-Javas durchgeführt (Sirnarasa und Tanjungsari, wobei ersteres Dorf abgelegen, zweiteres in einer sub-urbanen Zone liegt). Der Vergleich der beiden Dörfer brachte Erkenntnisse über lokales Wissen zu traditioneller phytotherapeutischer Medizin und Einsichten zu Problemen mit verschiedenen existierenden Gesundheitseinrichtungen und zur Wahrnehmung des Gesundheitssystems durch die lokale Bevölkerung. Mit der Methode der Analyse kultureller Domänen (CDA) wurden Freelists erhoben, mit denen das vorhandene Wissen über Heilpflanzen gesammelt wurde. Ergänzend wurden halbstrukturierte Interviews und Gruppendiskussionen durchgeführt. In jedem der Dörfer wurden 30 Auskunftspersonen befragt. Die Gruppe der Auskunftspersonen umfasste Männer und Frauen aus Haushalten mit geringem

Einkommen,

darunter

Dorfbewohner,

lokale

Heilkundige

und

Angestellte

im

Gesundheitswesen. Bei den Gruppendiskussionen gab es breitere Partizipation. Mit Hilfe von INTRAMED wurden in den beiden Dörfern 197 Arten von Heilpflanzen dokumentiert, die von der lokalen Bevölkerung verwendet werden um über 50 verschiedene Krankheiten (Erkältung, Bluthochdruck, etc.) zu behandeln. Die bekannteste Heilpflanze in Sirnasa war Cecendet (Physalis angulata L.), das zur Behandlung von Muskelschmerzen und Rheutmatismus verwendet wird. In Tanjungsari war es Koneng Gede (Curcuma xanthorrhiza Roxb.) zur Behandlung von Gastritis. Die am besten bekannten Heilpflanzen wurden für die häufigsten auftretenden Krankheiten verwendet. Im Gegensatz zu Tanjungsari wird in Sirnasa die traditionelle Phytotherape gegenüber modernen pharmazeutischen Medikamenten bevorzugt, da sie für die lokalen Heiler und die lokale Bevölkerung einfach und kostengünstig verfügbar ist und Heilmittel einfach herzustellen sind. In Gruppendiskussionen wurden als dringendste Probleme im Gesundheitswesen die hohen Kosten, der Mangel an Personal und die zu geringen Vorräte an Medikamenten in lokalen Kliniken genannt. In beiden Dörfern wurde fehlendes Wissen über die Herstellung pflanzlicher Heilmittel nur von den Dorfbewohnern nicht aber von Angestellten im Gesundheitswesen bemängelt. Mit Hilfe der Szenariotechnik wurden von der lokalen Bevölkerung die lokalen Probleme in der Gesundheitsvorsorge

und

Krankenbehandlung

identifiziert.

Als

Positivszenario

wurde

eine

verbesserte Zusammenarbeit zwischen lokalen Kliniken, Regierung, traditionellen Heilern und Dorfgemeinschaften mit dem Ziel einer verstärkten Nutzung von Heilpflanzen formuliert. Besonders in Sirnarasa wird dieses Ziel mit der Hoffnung verknüpft, durch die Herstellung von pflanzlichen Heilmitteln Einkommen zu schaffen. Als Negativszenario wurde das Verschwinden des traditionellen Wissens über Heilpflanzen und schlechte Qualität in den lokalen Kliniken genannt. 5

In diesem Forschungsprojekt wurde das Vorhandensein von lokalem Wissen über Heilpflanzen und dessen Bedeutung für die Gesundheitsvorsorge in Haushalten mit niedrigem Einkommen, sowie die Hindernisse für die Nutzung dieses Wissens im lokalen Gesundheitssystem gezeigt. Die verbesserte Nutzung lokaler Heilpflanzen kann sowohl eine leistbare als auch allen zugängliche Alternative für die Gesundheitsvorsorge von Dorfgemeinschaften sein, die langfristig auch dem Ziel der Armutsbekämpfung dient.

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1 PROJECT OVERVIEW 1.1 Aims, objectives and expected outcomes The INTRAMED research project aimed to contribute to poverty alleviation efforts in Indonesia through the acknowledgment and integration of local knowledge of medicinal plant species and their uses by the existing health care system, and the promotion of an affordable and accessible health care service for low-income groups in rural communities. The project had the following objectives: 1. To document locally available medicinal plant species and their uses by local people (with a particular focus on low income families and women), common illnesses and treatment preferences, particularly in regard to the choice between local medicinal plant species and modern medicine; 2. To initiate a participatory process for evaluating this local knowledge by stakeholders; 3. To facilitate participatory community-based scenario building for integrating local knowledge of medicinal plant species into the existing health care system; 4. To understand how differing socio-economic status and access to existing health care services at the village level affect medicinal plant knowledge, use and scenario building; 5. To disseminate the findings to the community, health care workers, government officials and the scientific community.

Expected outcomes from the research project were: 1. Documentation of local knowledge of medicinal plant species and their uses in two West Java communities, evaluated by stakeholders through a participatory approach; 2. A report on the results of community-based scenario building exercises for integration of useful local knowledge of medicinal plants into the modern health care system. The scenarios developed by the communities will be accessible to decision-makers; 3. A Medicinal Plant Booklet for the participating communities and officials, containing the data gathered on medicinal plants, their uses and preparation methods, and the scenarios developed for its integration into the health care system; 4. A joint publication by the project team in a peer-reviewed scientific journal to make the results accessible to the scientific community.

1.2 Research location Two villages in the Province of West Java were selected in order to understand the impact of variation in geography, socio-economic status and access to health care services on medicinal plant use and 7

the potential for integration of traditional knowledge into existing heath care services. Sirnarasa is a remote and isolated traditional village in South Sukabumi district. The local economy is based on subsistence rice farming and gardening. The nearest official health care institution (Puskesmas) is about 18 km away. In contrast, Tanjungsari is a suburban village located in Sumedang district. It is connected to the national road network, and is a market town for trade of local products. There is a higher degree of connectedness to urban hubs and seasonal migration. The nearest Puskesmas is about 1 km away.

1.3 Stakeholders

One group GD

Group II

One group in GD

Group I

Figure 1. Stakeholders involved in INTRAMED research. Legend: ‘Puskesmas’: official institution providing primary health care services at the village level. GD: Group Discussion

INTRAMED identified five stakeholder groups (Figure 1) encompassing village residents, local healers, traditional village-appointed leaders, government-appointed village leaders, and health care workers such as doctors and nurses. Two discussion groups were chosen for interviewing, the first consisting of local residents including healers to confirm data collected on local medicinal plant knowledge, use, location and plant identification, and a second consisting of health care workers. Both groups

identified

local

health

care

issues

and

conducted

scenario

building

exercises.

8

1.4 Project steps and methodology The project was implemented in five phases: (1) a pre-test of the interview manual, (2) work package I to document local knowledge, (3) work package II to conduct scenario building on the future of health care, (4) dissemination of results and (5) reporting and publication. We are currently in the process of disseminating research results in the communities and preparing publications for scientific journals.

1. A pre-test of the interview manual was conducted in both Sirnarasa and Tanjungsari, by interviewing 4-6 potential respondents in each village. Critical adjustments were made to the questions asked which improved the overall interview protocol adopted for the study. 2. Work package I (WP I) aimed to assess local knowledge of medicinal plant species and their uses, common illnesses and treatment preferences. For these purposes, we conducted Interview I (Appendix 5.1) with 30 respondents in each village. Botanical voucher specimens were collected and prepared together with respondents, and later identified by a botanist at INRIK, UNPAD. Group Discussion I (GD I), involving residents and local healers (Group I), was facilitated by researchers to check medicinal plant identifications and other information collected about them. During the early part of WP I we held a workshop in Bandung for the entire research team from Austria and Indonesia, as well as researchers from other relevant institutions in Indonesia. The workshop included a visit to Sirnarasa and was intended to evaluate the preliminary results as well as improve methods for field work. Collected data from all interviews was analyzed using ANTHROPAC software (Borgatti 1996a). 3. Work package II (WP II) aimed to deepen our understanding of how medicinal plants are used and their efficacy, as well as build community-based scenarios regarding health care services in the village, in order to know their expectations and unwanted conditions. Interview II (Appendix 5.2) was conducted to document methods of preparation of those medicinal plants used to treat common illnesses. These local phytotherapies were then compared with reliable source of information, especially from sourcebook of medicinal plants in Indonesia or from South East Asia, to validate their efficacy and to identify potential side effects. Scenario building (SB) involved two Group Discussions each with Group I (common inhabitants and local healers) and Group II (local clinic officers). SB I identified sources of health care and asked respondents to rank them in terms of their perceived benefits and their frequency of use. SB II asked respondents to identify current problems, worries and expectation with these heath care options and to predict what might happen to these options under negative, status quo and positive future scenarios. Two researchers facilitated the meetings, using techniques derived from participatory rural appraisal (Appendix 5.3).

4. Dissemination of research results involved producing a medicinal plant booklet for each community, and other relevant stakeholders. The final design and contents were planned and agreed upon in consultation with respondents. The booklet, published in Indonesian and

9

English, contains information about medicinal plant species and treatments for common illnesses, as well as results of the scenario building exercises.

5. Reporting and publication includes both this final report and at least one scholarly article for the scientific community to be authored by all Indonesian and Austrian partners.

Pre-test interview manual and methodology

WP I

WP II

Assessment of available local knowledge

Scenario Building for Integration

INTERVIEW I

INTERVIEW II

: socio-economy

Preparation of medicinal plant for most frequent illnesses

: plant species,use : frequent illnesses : treatment preferences

PLANT HERBARIUM & IDENTIFICATION

PLANT COMPARISON WITH PUBLIC DATABASES

SB I (GD) : Group I & II Identification of problems in health care services

Draft BOOKLET

REPORTING & PUBLICATION FINAL REPORT

Plant use to treat most frequent illnesses

JOINT PUBLICATION

Field confirmation BOOKLET Production and dissemination

Review Workshop, Bandung, Sept 07

DISSEMINATION OF RESULTS

DATA ANALYSIS II: Participatory Rural Appraisal

GD I : Group I confirmation of plant species, side effects, habitat

DATA ANALYSIS I : Cultural Domain Analysis

SB II (GD) : Group I & II Development of communitybased scenario

DATA ANALYSIS III: Negative,Positive, Business as usual scenario

Figure 2. INTRAMED project steps and methodologies. Legend: ‘WP’: Work Package, ‘GD’: Group Discussion, ‘SB’: Scenario Building, Group I: consist of common inhabitants, traditional healers, Group II: consist of local clinic (Puskesmas) officers.

2 SOCIO-ECONOMIC BACKGROUND OF RESPONDENTS Fieldwork only commenced after a Prior Informed Consent (PIC) form (Rotterdam Convention,1998, Appendice 5.5), explaining the purpose and the use of project outcomes, was signed by the head of each study village. In each location, 30 respondents were chosen to capture variation in sex, household economic status, and knowledge of medical treatments (Table 1). Initially, our assessments of household income levels were based on official data from the village governments and from this information we expected to be able to choose a representative sample covering all income levels. In practice, however, the choice of respondents was influenced by the availability and willingness of

10

villagers to participate. Recommendations from participants helped to identify potential respondents with medical knowledge. Busy work schedules and a reluctance to engage with researchers limited the participation of women.

Table 1. Sociodemografic characteristics and number of respondents interviewed in two sampled villages Sirnarasa and Tanjungsari (both in West Java, Indonesia) Characteristics

Sirnarasa

Tanjungsari

Gender composition

9 female, 21 males

13 female, 17 males

Knowledge of medical treatment

3 health care officers and 1 local

5 health care officers and 1 local

healer (categorized poor)

healer (categorized poor)

Economic status of household

Self-perceived as sufficient: 14

Self-perceived as sufficient: 20

(categorized as poor households

Self-perceived as poor : 12

Self-perceived as poor : 4

30 respondents

30 respondents

by local government) Total respondents

Beside personal data (age, languages spoken, and education), during interviews we also collected socio-economic data on: •

social status (length of habitation, social activities)

•

economic status (ownership of land, means of communication and transportation, average monthly income, surplus income for saving, coping strategy—in case of financial need—and health insurance).

This data gave us a general picture of our respondents’ purchasing power, access to health care services, and available land resources for growing medicinal plant species.

We also asked respondents to assess the wealth status of themselves and their neighbors, both to understand local categorization of welfare and to assure us that we had really targeted the low-income households within the community. While both villages distinguished three categories, rich (kaya), sufficient (sederhana or cukupan) and poor (miskin), the criteria defining the categories sometimes differed. Rich people in Tanjungsari were categorized as having many assets (buildings, land) and businesses, whereas in Sirnarasa the rich were said to have nice furniture, a shop, a car, a lot of land, feedstock, savings and are able to give loans to neighbors. Sufficient people were categorized similarly in both villages as having regular income, a small amount of land, enough for daily meals and clothes, but no capital or savings to invest. Poor people were categorized in both villages as having no fixed employment or irregular income, receiving handouts or aid, being homeless or having a very small amount of land, unskilled and always stressed to fulfill daily needs. These finding assured us that the respondents we had chosen were indeed from the intended target group. In both villages we found that all respondents, including PUSKESMAS health care officers, had average monthly incomes lower than the government determined minimum regional standard salary. This standard, used as a baseline for local companies, is calculated based on the minimum

11

requirements for subsistence. According to the standard for 2006, the minimum for Tanjungsari is IDR 500,000 per month, and for Sirnarasa it is IDR 450,000 per month (UMR 2006).

From a comparison of socio-economic attributes (Figure 3), respondents in both villages have been resident for more than 21 years, use Sundanese as a daily language but also know Indonesian— though more speak Indonesian in Tanjungsari— have no means of telecommunications—though a few had a home phone in Tanjungsari—and mainly used public transport. In both villages, most respondents perceive themselves as being of sufficient wealth status, although in Sirnarasa more respondents perceived themselves as poor than in Tanjungsari, with no surplus income for savings, and would need a loan in case of a financial emergency.

The main differences among respondents were primarily in: (1) occupation, mostly farmers in Sirnarasa while in Tanjungsari were housewives, unskilled laborers, traders, factory workers and pensioners; (2) involvement in social activities, respondents in Tanjungsari had higher involvement in religious and health care activities; (3) education level, in Sirnarasa mainly elementary school education or none at all, but in Tanjungsari mostly high school education; (4) land ownership, in Sirnarasa respondents owned more agricultural land and also land surrounding the house than in Tanjungsari, and (5) health insurance, in Sirnarasa most of respondents did not have health insurance and government-provided health insurance for poor households was greater in Tanjungsari.

Health insurance for poor household No health insurance Owning agricultural land Owning land around the house ≤ 100m2 Elementary school Social activity Socio-economical attribute

Navvy, seller,factory worker,pensioner Farmer Seeking loan from neighbourhood No saving capacity Public transport user No means of communication Sufficient economy (self-perceived) Knowing Indonesian Daily speaking Sundanese > 21 years habitation Age ≥ 50 Age 20-46 SIRNARASA

Average monthly income ≤ standard

TANJUNGSARI

Male respondent Female respondent 0

10

20

30

40

50

60

Number of respondent (low-economy households)

Figure 3. Comparison of socio-economic background of respondents from low income households in Sirnarasa and Tanjungsari. The characteristics in this figure are only the dominant characteristics found in one or both villages.

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Respondents from the health care officers group are economically better off than residents in either village, with obviously better access to health care since they work in this profession, and those from Tanjungsari are clearly better off than their counterparts in Sirnarasa, having access to transport, communication technology and health care insurance(Figure 4).

Having health insurance Owning agricultural land Owning land around the house High school

Socio-economical attributes

Involve in health care activity Seeking loan from neighbourhood Use motorbike,car Owning handphone Sufficient economy (self-perceived) Knowing Indonesian Daily speaking Sundanese < 5 years inhabitation Age 20-46 Average monthly income ≤ standard Male respondent

SRS TJS

Female respondent 0

1

2

3

4

5

6

7

8

9

Number of respondents (health care officer)

Figure 4. Comparison of socio-economic background of respondents from health care officers in Sirnarasa and Tanjungsari. The characteristics in this figure are only the dominant characteristics found in one or both villages.

3 METHODS, RESULTS AND DISCUSSIONS 3.1 Available local knowledge in researched villages To assess local knowledge of medicinal plant species and their uses in the villages, we used data collection tools from Cultural Domain Analysis (CDA) (Weller and Romney 1988). A cultural domain is a category with a set of items that are organized according to rules or criteria that are culturally determined and may be culturally specific (Puri and Vogl 2005). For example, in this research, the relevant domains are illnesses, treatments and of course medicinal plants, all of which we can expect to be shared to some degree within and between Sirnarasa and Tanjungsari villages. Anthropologists use domain analysis to help them understand how people in a society define their world by discovering what categories are important to people, how they are defined and organized and what 13

values are attached to them. Many of these domains are important aspects of what we might call ‘local knowledge’ or ‘indigenous knowledge’. Identifying domains and their structure can be a starting point for understanding knowledge system at a deeper level and comparing the knowledge of people within and between defined social groups (Puri and Vogl, 2005). The tools and methods of CDA are useful to get information with a limited amount of time and a small number of respondents, assuming that the researcher is familiar with the local language, the domains in question, and has already established some rapport with respondents.

In this research we used cultural domain analysis to study the domains of: (1) medicinal plants in order to understand what medicinal plant species are known, and which are known by most people, (2) illnesses, known and experienced, (3) treatments for the experienced illnesses and (4) medicinal plant remedies for treating the experienced illnesses. By understanding these four domains we expected to learn what local knowledge on medicinal plant species was available and whether this knowledge was used given alternative health care services. The domains were elicited in structured interviews with respondents using the freelisting technique and analyzed using ANTHROPAC software (Borgatti 1996a), and results are presented and described below.

3.1.1 Domain 1: Knowledge of medicinal plants and their uses We asked 30 respondents in each village to “tell us what medicinal plants you know”. For each plant name given we then asked for details on the illnesses treated. The freelist data was analyzed using ANTHROPAC 4.97 software (Borgatti, 1996b), which compiles the lists and calculates the frequency of each plant mentioned, the average rank—whether it was listed first, second, etc.—and Smith’s S, a measure of salience that combines the frequency and the rank. The top 15 most frequently mentioned plants and their uses are presented in Tables 2 and 3, while the complete list of all medicinal plants listed can be found in Appendix 5.4. Table 4 lists the uses of those plants that were mentioned by informants in both villages.

The next step was to compare the freelists of the informants for each village. This was done with a similarities programme in ANTHROPAC which creates a proximity matrix from the original freelist matrix. A multidimensional scaling program then plots this data on a two dimensional Cartesian plot, which visually displays similarity between the informants, that is the closer two informants are the more similar are their freelists (Figure 5

and Figure 6). For a widely shared domain, a set of

respondents from the same culture should cluster around the origin of the plot, with perhaps a few outliers scattered around the field. Outliers may be experts (with longer freelists), novices (with short freelists), or even respondents that speak a different language or misunderstood the question (with lists with many unique terms).

Following these interviews, the research team together with respondents collected voucher specimens and photographs of available medicinal plants mentioned, which were sent for botanical identification and storage to INRIK, University of Padjajaran, Bandung, Indonesia. The plant specimens were then 14

identified by Sandra Madonna,S.Si.,M.T., a botanist from Islamic University of Syarif Hidayatullah Jakarta, Faculty of Science and Technology. For those plants which specimens were not available, identification was conducted by comparing local name of plants to the plant database generated from other researches conducted in the same location.

Subsequently, a Group Discussion with respondents and other community members (GD I) was held to clarify and confirm local names and their medicinal uses, as well as collect additional information on the habitat location and side effects of the plants and plant-based treatments.

The results of the data collected on the domain of medicinal plants can be summarized as follows:

1. A total of 81 plant species were freelisted by respondents in Sirnarasa. The average respondent listed 15 plants, with a range from 4 to 28. In Tanjungsari a total of 44 plant species were mentioned, with respondents’ lists averaging 17 plants, with a range from 5 to 34. Quite unexpectedly, only 36 plant species were mentioned in both villages.

As we

expected the remote Sirnarasa, with poor access to health care facilities, listed 22 percent more plants, although for a suburban community the number of plants known by Tanjungsari residents is surprisingly high. These findings demonstrate an abundance of current local knowledge and use of medicinal plant species in both communities.

Specific Sirnarasa; 81

Number of medicinal plant species mentioned by respondents

90 80 70 60

Specific Tanjungsari; 44 Known in Sirnarasa and Tanjungsari; 36

50 40 30 20 10 0

Figure 5. Number of medicinal plant species freelisted by respondents in Sirnarasa and Tanjungsari. 2. A consensus analysis showed high agreement with in each village, though Tanjungsari respondents were more similar (i.e., the cluster around the origin is tighter in Figure 6) than those from Sirnarasa (with a much loser configuration around the origin in Figure 5). This explains the higher stress value for the latter plot (0.255), as there is too much variation 15

among the informants of Sirnarasa to be able to plot their relationships in a two-dimensional space. The picture from Tanjungsari is fairly straight forward to understand, with most residents clustered together in the middle, and outliers being healthcare workers, who tended to have shorter lists and included plants not listed by community members. The plot of Sirnarasa respondents reflects a greater degree of variation between informants. However, as in Tanjungsari, in Sirnarasa we found that most health care officers were outliers, with smaller freelists of different plants than the residents and local healer. From these two figures then, we see that knowledge of medicinal plant species, as indicated by freelists, is fairly similar within communities but differs between local people and most health care officers, which may contribute to an underestimation of local knowledge by officials.

Figure 5. Similarity of medicinal plant freelists from Sirnarasa. Cluster circles drawn and labeled by the author. Stress value of 0.255 suggests three dimensions are needed to accurately display the distribution.

16

Figure 6. Similarity of medicinal plant freelists from Tanjungsari. Cluster circles drawn and labeled by the author. Stress value of 0.145 showed reasonably high confidence of similarity among respondents in the same cluster. 3. With regard to illnesses treated with medicinal plants (see Table 2 and Table 3), simple health problems such as flu, wounds, or eye irritations, or symptoms such as high blood pressure or difficult urination, were predominant. Also, physically demanding occupations and poor sanitation conditions, common among low income households, appear to account for some common medical problems. For example, Sirnarasa’s farmers used medicinal plants uses to treat wounds and muscle pain, but also suffered from hygiene-related illnesses, such as diarrhea and skin infections. Table 4 shows the same plant species can be used for a variety of treatments, and that the two villages often had different sets of uses for the same plants. For instance, Jawer Kotok (Coleus blumei Benth ), is used externally to treat wounds in Sirnarasa, but used internally to treat worms and for post natal care in Tanjungsari. This is not surprising, but we

don’t know yet if this is due to different traditions of plant use, or perhaps, the effects of different environments on the plant’s medicinal properties.

4. The group discussions (GD 1) were received with enthusiasm and high participation, not only from the respondents but also from other community members and village officials. Balanced representation and increased contribution by women during the discussions was an important achievement, critical to start a constructive community participatory process. The GDs confirmed plant names and associated uses, and also evaluated potential adverse effects of use.

17

15 12 12 11 12 16 9 7 11 13 9 9 9

Antanan (Centella asiatica (L.) Urb)

Cangkore (Dinochola scandens)

Jawer Kotok (Coleus blumei Benth. )

Cikur (Kaempferia galanga L.)

Jahe (Zingiber officinale Rosc.)

Koneng Gede (Curcuma xanthorrhiza Roxb.)

Awi Gombong (Gigantochloa verticillata (Willd.) Munro)

Buntiris (Kalanchoe crenata (Andr.) Haw.)

Ki Ajag (Ardisia fuliginosa BI.).

Ki Kunti (Ficus edelfeltii King)

Kukuk (Lagenaria leucantha Rusby.)

Ki Urat (Plantago Major L.) Kacapiring (Gardenia jasminoides Ellis)

3

4

5

6

7

8

9

10

11

12

13

14 15

1

0,117 0,14

0,137

0,162

0,182

0,193

0,258

0,27

0,286

0,295

0,298

0,328

0,42

0,453

0,478

Smiths's S

(1) Eyedrops, (2) Treating coughing,(3) Treating diabetes (1) Disinfectant, (2) Stop wound from bleeding (1) Treating headache, (2) Treating sprained muscles, luxation, (3) To warm body (1) Treating coughing, (2) To warm body, (3) Treating abdominal discomfort-feeling to vomit,gastritis Treating muscular pain, low back pain (due to physical work)

(1) Obat tetes mata, (2) obat batuk, (3) obat kencing manis (1) Disinfektan, (2) Menghentikan pendarahan (1) Obat sakit kepala/pusing/lieur/rieut, (2) obat keseleo, (3) penghangat bayi (1) Obat batuk, (2) penghangat badan, (3) obat seueul (1) Obat sakit badan, pegal linu, sakit pinggang

Obat luka kecil/raheut Obat sakit panas,demam/muriang

Obat sakit panas, demam, muriang

(1) Obat sakit panas, (2) obat iritasi mata (tetes mata) Obat coceng/bocek/koreng (1) Obat batuk, (2) obat iritasi mata (tetes mata), (3) obat coceng/koreng

Healing small wound Treating fever, chills

Treating ulcers (1) Treating coughing, (2) Eyedrops, (3) Treating ulcers Treating fever, chills

(1) Treating fever, (2) Eyedrops,

(1) Treating coughing, (2) Eyedrops, (3) Treating fever

(1) After delivery care, (2) Reconditioning vaginal function

(1) Perawatan setelah melahirkan, (2) Obat rapet

(1) Obat batuk, (2) obat iritasi mata (tetes mata), (3) obat sakit panas

Healing small wound

Treating muscle pain, low back pain (due to physical work), rheumatism

Obat sakit badan, pegal linu, sakit pinggang, encok Mengobati luka kecil/raheut

Plant uses

Plant uses in local terminology

18

Salience value (Smith’s S) reflects the importance and knowable value of subjected plant species according to local culture. The higher the value, the more locally known and important that plant species. Smith’s S value was generated by using ANTHROPAC software (Borgatti, 1996b).

1

20

Babadotan / Jukut bau (Ageratum conyzoides L.)

1

2

Frequency 18

Local Name (Latin Name)

Cecendet (Physalis angulata L.)

No.

Table 2. Medicinal plant species freelisted by at least 10 percent of Sirnarasa respondents. Legend: plant name which is marked means it was listed by respondent in both villages (in Sirnarasa and Tanjungsari)

29 28 28 24 26 12 17 23 24 24 29 9 8 8 8

Sembung (Blumea balsamifera (L.) DC.)

Pecah Beling (Strobilanthes crispus Bl..)

Daun dewa (Gynura procumbens (Lour.) Merr.)


Sampeu dodi (Manihot sp.)

Koneng hideung (Curcuma aeruginosa Roxb.)

Ki Urat (Plantago major L.)

Panglay (Zingiber cassumunar Roxb.)

Koneng Temen / Kunyit (Curcuma longa L.) Kumis Kucing (Orthosiphon staineus Benth.) Sereh wangi (Cymbopogon winterianus Jowitt.) Jambu batu (Psidium guajava L.) Bawang merah (Allium cepa L.)

Katuk (Sauropus androgynus (L.) Merr.)

2

3

4

5

6

7

8

9

10 11 12 13 14

15

Frequency



1

No.

0,21

0,249 0,226 0,216 0,213 0,211

0,266

0,291

0,336

0,344

0,369

0,403

0,418

0,514

0,574

Smiths's S

(1) Treating gastritis, (2) Enhancing appetite, (3) Maintaining stamina (1) Treating rheumatism,muscular pain,sparined muscles (2) Treating uric acid symptom (joint pain)

(1) Obat rematik/pegal-pegal/keseleo/salah urat, (2) obat asam urat

Treating gastritis Treating difficult urination (1) Treating flu and common cold Treating stomachache Treating fever (1) Increasing breast milk production, (2) Treating hot stomach symptom

Obat maag Obat susah buang air kecil (1) Obat flu, (1) Obat pilek Obat sakit perut Obat panas/demam (1) Meningkatkan air susu ibu, (2) obat panas dalam

19

(1) Obat kulit gatal-gatal,(2) obat balur untuk sakit (1) Treating itching,(2) Treating abdominal perut distension (external use)

Treating fever

(1) Obat maag, (2) penambah nafsu makan, (3) peningkat stamina tubuh

(1) After delivery care (reconditioning the womb), (2) Treating worm (helminthic) infection

(1) Perawatan setelah melahirkan (mengecilkan rahim), (2) obat cacingan Obat penurun panas, demam

(1) Treating high blood pressure, (2), Treating reumathism

Treating difficult urination

(1) Obat darah tinggi, (1), Obat rematik

Obat susah buang air kecil

Treating gastritis (1) After delivery care (reconditioning the womb), (2) Treating leucorrhoe

(1) Perawatan setelah melahirkan (mengecilkan rahim), (2) obat keputihan

Plant uses

Obat maag

Plant uses in local terminology

Table 3. Medicinal plant species listed by at least 10 percent of Tanjungsari respondents. Legend: plant name which is marked means it was listed by respondent in both villages (in Sirnarasa and Tanjungsari)

9

3

8

5

7


Ki Urat (Plantago major L.)

Sereh wangi (Cymbopogon winterianus Jowitt.)

Koneng Temen / Kunyit (Curcuma longa L.)

Jeruk Nipis (Citrus aurantifolia Swingle )

Sembung (Blumea balsamifera (L.) DC.)

3

4

5

6

7

8

11

10

Koneng Hideung (Curcuma aeruginosa Roxb.) 3

4

7

16


2

Jambu Batu (Psidium guajava L.) Kumis Ucing / Kumis Kucing (Orthosiphon staineus Benth.)

11


1

9

12


No

Frequency

Obat sakit badan

Obat diare, sakit perut (1) Obat gejala ginjal, (2) perawatan setelah melahirkan

(1) Perawatan setelah melahirkan,(2) obat seueul

(1) Obat batuk, (2) obat panas dingin

(1) Obat seueul/maag, (2) obat mencret, (3) menambah nafsu makan

(1) Obat flu, obat pilek

Obat luka kecil/raheut

Treating muscular pain, body pain

Treating diarrhea, stomach ache (1) Treating kidney stone symptoms (2) Post-natal care

(1) Post-natal care (2) Treating abdominal discomfort, nausea, gastritis

(1) Treating abdominal discomfort, nausea, gastritis (2) Treating diarrhea (3) Enhancing appetite (1) Treating coughing (2) Treating chills

(1) Treating flu and common cold

Healing small wound

Treating muscular pain, lower back pain (due to physical work)

(1) Treating headache (2) Treating sprained muscles (3) To warm body

(1) Disinfectant (2) Stop wound from bleeding

(1) Disinfektan, (2) Menghentikan pendarahan (1) Obat sakit kepala/pusing/lieur/rieut, (2) obat keseleo, (3) penghangat bayi (1) Obat sakit badan, pegal linu, sakit pinggang

Plant use (English)

Plant use (Local vernacular)

Sirnarasa

17

29

8

28

8

24

9

23

29

28

26

Frequency



Obat sakit perut


Obat batuk

Obat maag

(1) obat sariawan, (2) obat sakit badan

(1) Obat rematik/pegalpegal/keseleo/salah urat, (2) obat asam urat

Obat maag

20

(1) Treating gastritis (2) Enhancing appetite (3) Maintaining stamina

(1) Post-natal care (reconditioning the womb) (2) Treating leucorrhea Treating stomach ache Treating difficult urination

Treating cough

Treating gastritis

(1) Treating rheumatism, muscular pain, sprains (2) Treating uric acid symptoms (joint pain) (1) Treating sprue, scurvy (2) Treating muscular pain, body pain

Treating gastritis

Treating cough

(1) Post-natal care (reconditioning the womb) (2) Treating worms

(1) Perawatan setelah melahirkan (mengecilkan rahim), (2) obat cacingan

Obat batuk

Plant use (English)

Tanjungsari Plant use (Local vernacular)

Table 4. Comparison of uses of most frequent medicinal plants listed in Sirnarasa and Tanjungsari. Legend: plant name which is marked means it was listed by respondent in both villages (in Sirnarasa and Tanjungsari)

3.1.2 Domain 2: Common illnesses and medicinal plants used in their treatment Our second domain was concerned with respondents’ experiences and practice in using medicinal plants, we asked “What illnesses have you experienced?” and then for each illness mentioned “How did you treat it?” We then asked “Do you use medicinal plants to treat this illness and what medicinal plants do you use?” The collected data could be treated as a freelist (though not of a cognitive domain) and was analyzed as above using ANTHROPAC to discover the most common illnesses experienced by respondents in both villages (see Table 5 and 6), and to see whether these correlated with the most commonly mentioned medicinal plants from the first freelist.

Table 5. Common illnesses and medicinal plants used in Sirnarasa Illness/Symptom (Local name) Pusing/rieut/lieur/sakit kepala Panas/demam/muriang

Common name

Frequency (%)(n=30)

Smith's S

Headache

53

0,403


Fever, chills

33

0,232

Kukuk (Lagenaria leucantha Rusby.) Kacapiring (Gardenia jasminoides Ellis) Jonge (Emilia sonchifolia (L.) DC.) Koneng Gede (Curcuma xanthorrhiza Roxb.)

Medicinal plant used

23

0,203

Batuk

Abdominal discomfort, nausea, gastritis Cough

30

0,197

Sakit gigi

Toothache

30

0,184

Sakit perut /mules/mencret/diare Encok Pilek

Stomach ache, diarrhea Rheumatism Runny nose, flu Muscular pain, body pain Lower back pain (physical work)

23

0,156

Jambu batu (Psidium guajava L.)

23 17

0,118 0,084

Cecendet (Physalis angulata L.) No information about medicinal plant use

13

0,079


10

0,072


Seueul

Sakit badan Sakit pinggang

Jahe (Zingiber officinale Rosc.) Lame (Alstonia scholaris (L.) R.Br.) Hantap (Sterculia rubiginosa Vent. )

Table 6. Common illnesses and medicinal plants used in Tanjungsari Illness/Symptom (Local name)

Sakit kepala/pusing

Common name High blood pressure Headache

Flu

Flu

27

0.210

Batuk

Cough

27

0.178

Maag

Gastritis

27

0.178

Rematik Pilek

Rheumatism Runny nose Low blood pressure Difficult urination Fever, chills

13 10

0.072 0.072

Cangkudu (Bancudus latifolia Rumph.) Alpuket (Persea gratissima Gaertn.) No information about medicinal plant use Sereh wangi (Cymbopogon winterianus Jowitt) Cikur (Kaempferia galanga L.) Jeruk Nipis (Citrus aurantifolia Swingle ) Koneng Temen (Curcuma longa L.) Koneng Gede (Curcuma xanthorrhiza Roxb.) Sambiloto (Andrographis paniculata Ness.) No information about medicinal plant use

7

0.067

No information about medicinal plant use

7

0.067

13

0.059

Darah tinggi

Darah rendah Susah buang air kecil Panas/demam

Frequency (%) (n=30)

Smith's S

33

0.225

33

0.211

Medicinal plant used

Pecah Beling (Strobilanthes crispus Bl.) Kumis Ucing (Orthosiphon staineus Benth.) Bawang Beureum (Allium cepa L.)

21

Our findings are as follows:

1. Both villages have similar lists of illnesses, though it is noticeable that illnesses associated with urban living and modern lifestyles, high blood pressure and gastritis, were more salient in the suburban Tanjungsari than in the rural Sirnarasa, where instead headaches, respiratory, gastro-intestinal and muscular problems dominate.

2. There appears to be a correlation between the most salient medicinal plant species (domain 1) and the most salient illnesses (domain 2) (see Figure 7). We can conclude that respondents acquired knowledge about the use of medicinal plants that could treat the most common illnesses including some serious problems, rather than just the occasional simple health problem, and that the use of medicinal plants is an important means to treat common health problems (see also Figure 7).

40

Sirnarasa Tanjungsari

35 30 25 20 15 10

Massage

Home medical stock

Diet

Resting

Generic medicine (from small shop)

0

Medicinal plant/Traditional medicine

5 Doctor/Puskesmas

Frequency (mentioned by respondent)

45

Alternative treatments

Figure 7. Alternative treatments chosen by respondents in Tanjungsari and Sirnarasa when they experience health problems (n=30 per village)

3. Unfortunately, respondents found it difficult to recall how exactly they treated past illnesses, for instance whether they had used plants or went to the doctor. However, respondents could indicate preferred treatments available to them for illnesses (see Figure 7). Comparing the two villages, we note that respondents in Tanjungsari have more alternatives than in Sirnarasa. The preference of visits to the health clinic over medicinal plants, the presence of stocks of 22

medicine in the home plus recognition that diet can affect health may be due to higher incomes and higher educational background in Tanjungsari. In Sirnarasa visiting the doctor or village health clinic is not preferred in comparison to using medicinal plants or traditional treatments like massage. In general though, for both villages medicinal plant use was one important choice to deal with health problems among low-income households, especially when the health clinic was far from village and there was no financial support from health insurance (for poor families). The use of generic medicine sold in small shops was also highly ranked. These medicines are cheaper and easier to access than health clinics. On one hand this obviously helps to improve local health conditions, but on the other hand, it may diminish the need for local knowledge, and perhaps also those plant species used to treat illnesses. For instance, no information was available on medicinal plants used for treating headaches in Tanjungsari because respondents said they preferred to buy aspirin.

4. Interviews and GDs showed that medicinal plant species were preferred because they were cheap or free. Visiting the local clinic costs IDR 3,500 (USD 0.35) for registration and IDR 25,000 for treatment including medicines in Tanjungsari. In Sirnarasa, it costs IDR 20,000 to use a public motorbike (ojeg) to reach the clinic or IDR 25.000 for an injection by an official nurse based in the village. The latter is often preferred because it is closer and easy to arrange, whereas the health clinic is considered too far and too bureaucratic. Other reasons given for using medicinal plants included: habit, suggested by relatives, natural, no side

40 35

All species

30 25 20 15

For common illnesses

Most known species

Others (Riverside, Spring, Wilds)

Homegarden;surrounding house (Pekarangan)

Paddy plantation (Sawah)

Mix Garden (Talun)

Seasonal Garden (Kebun)

10 5 0 Forest (Hutan)

Number of Plant species

effects, and sometimes just for trial.

Figure 8. Habitat of medicinal plant species in Sirnarasa village

23

5. Habitats for the medicinal plant species mentioned in Tanjungsari were mainly the homegarden, potted plants in front of the house, and along the road side. Otherwise, respondents bought them from market. In Sirnarasa there were many more places where respondents could find and grow medicinal plants. The most important habitats were forest, seasonal gardens (planted with seasonal crops), mixed gardens (planted by seasonal and perennial species) and areas surrounding the house. Interestingly, plant species that were used to treat common illnesses were found (or grown) in habitats closest to houses. For the sake of convenience and efficiency then, people choose those species close to hand, or insure that preferred species are cultivated nearby. Of course, this does not imply that forest habitats don’t contain medicinal species of importance to local people.

3.2 Preparation of medicinal plants to treat common illnesses Initially, we intended to fully document preparations for all medicinal plant species mentioned by respondents. Given the surprisingly high number of plants mentioned and the limited time available for interviewing, we decided to focus on those plants used to treat the most common illnesses.

1. First, for each common illness, we selected those plants that had the highest frequency of mentioned by respondents. The preparation method of the plant was gathered from at least 3 respondents among those who mentioned the plant’s use during the first interview. Furthermore, we then compared the plant use and suggested preparation with available public databases or books to see whether there is comparable data already published and to check if there were any adverse effects found through scientific research. We couldn’t find comprehensive database supported with clinical test results for the identified plants, therefore, we used at least reliable publicly available sources although unknown whether the plant species had been clinically tested or not. In this research we compared method of preparation published in medicinal plant books by Department of public health of Indonesia (available online at http://iptek.apjii.or.id/artikel/ttg_tanaman_obat/depkes/), Department of Science and

Technology

Environmental

(available

online

Management

at

Institution

http://www.iptek.net.id/ind/pd_tanobat), of

West

Java

government

(http://www.bplhdjabar.go.id/kategori/kehati/), and published books of traditional medicines in Indonesia.

Our results are presented in Tables 7 and 8 below. 1. We found that all of the medicinal plant species used in Sirnarasa and Tanjungsari are already known publicly for their medicinal properties. Some of them are already marketed, for example Curcuma xanthorriza (for treating gastritis) or Orthosiphon staineus (for treating urination disorder), while others, such as Strobilanthes crispus (treating urination disorder) and Physalis angulata (for treating rheumatism, muscular pain) have been scientifically studied. 24

2. We sometimes found differences in the method of preparation in the published sources. The leaves of kacapiring (a Gardenia species) are applied as a poultice to the forehead to treat a fever in Sirnarasa, while the published remedy suggests an infusion to be consumed several times a day!. However, in Tanjungsari, remedies for high blood pressure using cangkudu (Bancudus sp..) and alpuket (Persea sp.) are essentially the same as in the published database.

3. The comparison with published databases was intended to identify potentially adverse effects that are unknown by the community. To the extent that published medicinal plant database mentioned the similarity of the efficacy of local remedies, primarily for the most known medicinal plant species, the comparison may convince scientists that local knowledge should be taken seriously. Our goal is to recognize and revitalize local knowledge of medicinal plant uses in situations of limited health care services, but to do so in manner that reduces the risk of negative effects on health. As we discuss below, the medicinal plant booklet, which will compile the data for use by community members and health care officials, explicitly states that we do not recommend self-treatment with the plants mentioned without prior consultation with indicated resource persons, who are the respondents (minimum 3 people) or local healer who are familiar with the plants and these treatments.

25

Leaf, Root, Shoot,

Root

Abdominal discomfort, feeling to vomit, gastritis (Seueul)

Abdominal discomfort, feeling to vomit, gastritis (Seueul)

Coughing (Batuk)


Jahe (Zingiber officinale Rosc.)

2

Drink one glass 2x per day, before a meal.

Dink one glass 2x per day until coughing reduces.

One finger-size Curcuma root and Lampuyang’s (Zingiber odoriferum Bl.) root are peeled and grated. The fine mixture is pressed through a sieve into one glass. Add brown sugar for taste. The rest of squashed matter can be reused by adding hot water.

One thumb-size root is peeled and grated. The fine mixture is pressed through a sieve into a glass. The remainder may be used again by adding hot water.

Fever

Apply leaves to forehead. Drink one glass 3x per day until fever reduces.

The infusion is taken 2-3x per day.

High fever

For children: apply leaves to forehead. For adult: to be drunk. One mixture is used 3x per day until fever reduces.

(dry) Coughing

Digestive problems, increase appetite

Diuretic, sprue, fever (leaf), diarrhea (root)

Plant use

Method of administration

3 plants are washed, then add a glass of boiling water and let stand for 15 min.

3-5 leaves (should be odd number) are washed then crushed in the hand. Add to a glass of water.

3-5 leaves (should be odd number) are washed then crushed in the hand. Add to a glass of water.

Method of preparation

Root

Root

Leaf, Root

Leaf

Fruit flesh

Part of plant used

Root is peeled and chewed

Root is peeled, and thin sliced. Let shortly in room temperature. Boiled with 5-7 glasses water then sieved.

The extracted water is ingested.

The infusion is taken each 1 glass, 1x a day.

The infusion is taken ½ glass each morning and evening.

Taken every two days.

7 leaves are washed then creased. Mixed with 1 glass of water, filtered, added with bit sugar, mixed. For Diuretic: 30 g fresh leaves are washed and boiled with 2 glasses of water for 15 min.

Half of glass 2x per day, morning and evening


Fruit flesh is squashed then the water extract is drunk.


AVAILABLE ON PUBLIC DATABASE

26

Sastroamidjojo, Seno.Dr, 1997.

BPPT IPTEK http://www.iptek.net.id /ind/pd_tanobat/view. php?mnu=2&id=129

BPPT Teknologi Tepat Guna http://iptek.apjii.or.id/a rtikel/ttg_tanaman_ob at/depkes/buku1/1113.pdf

BPPT IPTEK http://www.iptek.net.id /ind/pd_tanobat/view. php?mnu=2&id=143

BPPT Tekonologi Tepat Guna2 http://iptek.apjii.or.id/a rtikel/ttg_tanaman_ob at/depkes/buku4/4057.pdf

Reference

BPPT Teknologi Tepat Guna: Institution for Research and Implementation of Technology (BPPT) of Indonesia: Book of medicinal plants by Dept. of public health of Indonesia

Jonge (Emilia sonchifolia (L.) DC.

Root

Leaf

Fever, chills (Panas/dema m/muriang)

Kacapiring (Gardenia jasminoides Ellis)

Leaf

Part of plant used

Fever, chills (Panas/dema m/muriang)

Kukuk (Lagenaria leucantha Rusby.) Previously Lagenaria siceraria (Molina.)

Plant name

Plant use (local name)

LOCAL USE

Table 7. Sirnarasa preparation of medicinal plants to treat the most common illnesses: compared with published database

Ki Ajag (Ardisia fuliginosa BI.)

Cecendet (Physalis angulata)

Jambu batu (Psidium guajava L.)

Hantap (Sterculia rubiginosa Vent. )

Lame (Alstonia scholaris L.)

Plant name

Treating ulcers (Obat coceng/bocek/ koreng)

Low back pain due to physical work (Sakit pinggang)

Muscular pain, body pain (Sakit badan)

Stem

Root. leaf, shoot

(Young) Leaf

Stomachache, diarrhea (Sakit perut /mules/mencr et/diare)

Rheumatism (Encok),

Leaf

Gum from shoot

Part of plant used

Stem is cut about 30 cm and peeled. Let stand until the gum comes out to be collected.

II. One plant is washed, small part of leaf, root and shoot are soaked in hot water in a glass. Let stand until leaves are wilted and the water is green

I. One plant is washed, and then boiled with 3 glasses of water until water reduces to one glass. Let it cool down.

4-5 fresh young leaves are boiled with 1-2 glass of water.

3 leaves are washed and crushed, add to glass of water

A branch is cut with knife and gum sap is collected.


LOCAL USE

Toothache (Sakit gigi)

Toothache (sakit gigi)


IN SIRNARASA (Cont’)

The gum is applied onto ulcer. Once per day until ulcer gets dry.

The infusion is taken once a day

A glass of infusion is taken 2x a day

Used as mouthwash. Half a glass 2x per day

A drop of gum is plastered on the aching teeth once a day


Healing ulcer, skin infections

Treating swelling, diuretic, digestive problems for children

Diarrhea, stomachache

Diarrhea

Diarrhea, dysentery

Plant use

Stem

Leaf

Leaf

Leaf, bark

Bark wood

Part of plant used

Not known

Plastered the warm leave on the swollen part.

The infusion is drunk at once.

10 g fresh leaves are washed, crushed finely then add ¼ g salt and ½ hot water. When it is cool, sieved into glass.

Swelling: 5 fresh leaves are washed and heat up above fire flame until wilted.

The juice is drunk

The infusion is taken.


Leaves and bark are pounded

10 g bark wood is boiled with a glass of water for 15 minutes.



27

BPLHD Jabar (http://www.bplhdj abar.go.id/kategor i/kehati/etnobotani .cfm?doc_id=166)

http://iptek.apjii.or. id/artikel/ttg_tana man_obat/depkes /buku3/3-105.pdf

BPPT Teknologi Tepat Guna

http://iptek.apjii.or. id/artikel/ttg_tana man_obat/depkes /buku1/1-242.pdf


Sentra Pengembangan dan Penerapan Pengobatan TradisionalPemda Jawa Barat, 2001, Harada,K.,Rahay u,M, Muzakkir,A.2002

Reference

Leaf

Treating high blood pressure (Darah tinggi

Flu

Coughing (Batuk)

Coughing (Batuk)

Alpuket (Persea gratissima Gaertn.)

Sereh wangi (Cymbopogon winterianus Jowitt.)


Jeruk Nipis (Citrus aurantifolia Swingle )

Fruit

Root

Stem

Fruit

Part of plant used

Treating high blood pressure (Darah tinggi)

Cangkudu (Bancudus latifolia Rumph.) or (Morinda citrifolia, L.)

Plant name


The fruit is cut and pressed to extract liquid. Extract is mixed with 1 teaspoon honey.

3-5 thumb-size roots are washed then crushed. Add to 1 glass drinking water and 1-2 spoons honey. The mixture is sieved to collect the water.

10 stems and 10 leaves of citrus (Citrus aurantifolia) are washed then boiled in 5 l water.

3 leaves are washed then put into hot water. Let cool down.

2 ripen fruits without seeds are crushed and sieved to extract the water. Add 20 ml honey and 80 ml water, mix well.


LOCAL USE

1 spoon of mixture, 3x a day, until better. Not for patients with gastric problems.

Coughing

Coughing

To warm the body

After boiling, the steam is inhaled once per day at noon. During inhalation, to cover body/head with cloth is suggested.

1-2 spoons of mixture, 3x a day until cough reduces.

Treating Hypertension

Treating Hypertension

Plant use

The infusion is taken 1 glass per day.

The mixture is taken ½ glass per day until improvement is observed.


Fruit

Root

Shoot (above root)

Leaf

Fruit

Part of plant used

1 fruit is sliced and squashed to get the water. Added 1,5 spoon sweet soy sauce and bit salt. Mix well

1 thumb-size root is peeled and grated. Added 1 glass of hot water and bit salt, then sieved.

5 shoots are washed and boiled with 1 glass of water for 15 minutes.

3 leaves are washed then added with 1 glass hot water. Let it cool down

2 ripe fruits are crushed and sieved to extract the water. Added 1 spoon honey, mixed well and resieved.


The mixture is taken 1x a day until cough reduces.

The filtrate is taken.

The infusion is taken each ½ glass, 2 x a day in the morning and afternoon

The 1 glass infusion is taken at once.

The filtrate is taken 2x a day.



Table 8. Tanjungsari preparation of medicinal plants to treat the most common illnesses: compared with public database

28

BPPT IPTEK http://www.iptek.net.id/i nd/pd_tanobat/view.ph p?mnu=2&id=131





Reference

Leaf, shoot

Leaf

Leaf

Tuber

Rheumatism (Rematik)

Difficult urination (Susah buang air kecil)

Difficult urination (Susah buang air kecil)

Fever, chills (Panas/dema m)

Sambiloto (Andrographis paniculata Ness.)

Pecah Beling (Strobilanthes crispus Bl.)

Kumis Ucing (Orthosiphon staineus Benth.)

Bawang Beureum (Allium cepa L.)

Root

Gastritis (Maag)


Root

Part of plant used

Gastritis (Maag)


Koneng Temen (Curcuma longa L.)

Plant name

IN TANJUNGSARI (Cont’)

Take ½ glass, 2x a day until the pain relieved.

The blend is taken 1 glass per day.

The mixture is taken 2x a day, once in the morning before meal, and at night before sleep.


2-3 tubers are peeled and ground finely. Added 1-2 spoons of cooking oil.

The mixture is applied for external use on the back or forehead.

No information

No information

5-7 dry leaves and shoots are boiled in 3 glasses water until water reduces to one glass. Let cool, then sieve.

1-2 thumb-size roots are peeled and grated. Mix with ½ glass drinking water and 1 teaspoon honey, then sieve. Let stand until solids have sunk. The clear liquid on top is used. 1-2 thumb-size roots are peeled and sliced/grated. Boiled in 5-7 glasses water then sieved. The filtrate is mixed with 1 spoon honey.


LOCAL USE

Tuber

Leaf

Diuretic agent, kidney stone, diabetes, hypertension and rheumatism Fever, abdominal distension

Leaf

Leaf, shoot

Fever, skin infection, diabetes, ear infection and abdominal distension

Diuretic agent

Root

Root

Part of plant used

Gastritis

Stomach disorder

Plant use

Tuber is peeled and thin sliced. Added sufficiently cooking oil and eucalyptus oil.

The mixture is rubbed to the back , stomach, or forehead.

The water is 2x per day in the morning and afternoon, each ½ glass.

The infusion is drunk at once.

25 g fresh leaves are boiled with 2 glasses of water for 15 minutes. When it is cool, sieved into a glass.

25 g fresh leaves are boiled with 2 glasses of water for 15 minutes.

The infusion is taken 2x per day in the morning and afternoon.

The infusion is taken each 1 glass, 1x a day.

Root is peeled, and thin sliced. Let shortly in room temperature. Boiled with 57 glasses water then sieved. For fever: 5 g fresh leaves and shoots are washed and added hot water. When it is cool, sieved into a glass.

The mixture is taken before meal or after having fatty meal.


400-800 mg (1/5 – ½ tea spoon) of Curcuma powder is mixed with bit water.



29

BPPT IPTEK http://www.iptek.net.id/ind/ pd_tanobat/view.php?mnu =2&id=274

BPPT Teknologi Tepat Guna http://iptek.apjii.or.id/artikel/ ttg_tanaman_obat/depkes/ buku1/1-212.pdf

http://iptek.apjii.or.id/artikel/ ttg_tanaman_obat/depkes/ buku1/1-275.pdf


BPPT Teknologi Tepat Guna http://iptek.apjii.or.id/artikel/ ttg_tanaman_obat/depkes/ buku1/1-027.pdf

BPPT IPTEK http://www.iptek.net.id/ind/ pd_tanobat/view.php?mnu =2&id=129

No published information

Reference

3.3 Scenario Building Scenario building (Wollenberg,E., Edmunds,D. Buck,L. 2000) is a participatory approach to develop a community’s thinking about what might happen in the future, and what the community might do with regard to alternative futures. The aim of scenario building in this project was to stimulate the communities to consider their expectations and fears in terms of health care services for the future. We anticipated that the communities would come up with ideas on how they would make the most of existing local knowledge and official services.

We conducted Group Discussions (Sheil,D.,Puri,R.K.,et al. 2002, World Bank,1999), as method applied in Scenario Building (SB I and II), with Puskesmas officers and community residents separately, in order to facilitate free discussion about the specific interests of each group providing a secure surrounding. Four smaller discussion groups allowed us to also segregate samples by sex (male and female) and age (young and old) categories. We asked each of these groups to focus on health care facilities that have been used by communities and to list problems related to them, and used the tool of weighted ranking to record their preferences on all those identified health care facilities and problems (Puri,R.K. and Vogl,C.R. September, 2005). Furthermore, in the subsequent GD in second scenario building which was held some days after the first scenario building, we asked participants to develop positive, negative and ‘business as usual’ predictions of what they think might happen in 5 to10 years if the condition of health services were to stay as is, worsen, or improve. We invited all village inhabitants to participate in the Scenario Building process, not just our interview respondents, and achieved enthusiastic participation of about 50 people during each of the discussions. GDs with Puskesmas officers in Tanjungsari were more difficult to organize due to busy work schedules and reluctance to participate in the process. The division of four smaller discussion groups in GD with Puskesmas officers was based of seniority in term of working time, so we had male/female senior and junior grouping.

3.3.1 Identification of health care facilities and problems We asked each group to make a list of health care facilities and sources that they know and then to rank them along the dimensions of ‘beneficial’ and ‘frequency of use’, using a weighted ranking method (Puri and Vogl 2005). Each group was given 100 counters which they had to distribute across the items being ranked such that more counters indicated a more ‘beneficial’ or more ‘frequently used’ health care facility. The exercise can also be described as “voting” for items, though the voting is intended to be a result of a consensus agreement reached by members of the smaller group. Each group thus produced two weighted rankings (see Tables 9 and 10). Follow up discussion also sought to clarify what ‘beneficial’ and ‘frequency of use’ meant for the groups. The participants in both villages came up with similar definitions of a beneficial health care facility as helpful, give benefits for health, provide something that can cure with no side effects, cheap, easy to get and something that must

30

exist, whereas a frequently used facility was defined as being used often, more than 3 times, habit, routine, and repetitive use.

Table 9. Result of weighted ranking of health care facilities in Sirnarasa WEIGHTED RANKING RESULT: COMMUNITY IN SIRNARASA Beneficial No

1 2 3 4

Frequency of utilization

Health Care Facilities/Source Male (Elderly)

Male (Young)

Female (Elderly)

Female (Young)

Total

Male (Elderly)

Male (Young)

Female (Elderly)

Female (Young)

Total

Local clinic Medicinal plant use Medicine from kiosk

16 53 12

10 60 10

15 30 24

12 29 26

53 172 72

7 50 13

20 60 10

12 38 10

5 45 5

44 193 38

Local healer Total

19 100

20 100

31 100

33 100

103 400

30 100

10 100

40 100

45 100

125 400

WEIGHTED RANKING RESULT: LOCAL CLINIC OFFICERS IN SIRNARASA Beneficial Health Care Facilities/Source 1 2 3 4 5 6

Local clinic Medicinal plant and animal use (Self treatment)


Male (senior) 27

Male (junior) 28

Female (senior) 48

Female (junior) 38

31

38

31

28

141

Male (senior) 30

Male (junior) 20

Female (senior) 40

Female (junior) 20

128

42

13

33

25

Total

Total 110 113

Local healer, Spiritual leader Medicines from kiosk

8

0

0

4

12

0

12

0

15

27

10

22

0

15

47

16

36

10

25

87

Massage, acupuncture Herbal seller Total

16 8 100

12 0 100

16 5 100

13 2 100

57 15 400

6 6 100

19 0 100

17 0 100

7 8 100

49 14 400

The results from the weighted ranking exercises were drawn as Venn diagram (Dryamedia, 1996) to illustrate the view of participants about (1) health care facilities/sources that they knew, (2) which facilities were considered important/beneficial and (3) how often those facilities were used. The size of circle for each health care facility represents the benefits that were received by participants, while the distance to the participant’s circle represents the frequency of utilization. The bigger the circle, the more beneficial, and the closer the circle, the more frequently that facility was used by participants. Figures 10 and 11 combine the results of the smaller groups, but a break down of the data is shown in Tables 9 and 10.

31

Medicine from Kiosk Local clinic Local healer

Medicinal plant use

Community Sirnarasa

Massage, Akupunktur

Local healer, Spiritual leader

Herbal seller

Medicine from kiosk

Local clinic

Medicinal plant & animal use (Self treatment) Local Clinic Officers Sirnarasa

Figure 9. Venn diagram of beneficial (size of circle) and frequently used (inverse of distance to circle) health care facilities in Sirnarasa

Community in Sirnarasa The Venn diagram above shows that Sirnarasa residents had fewer alternatives for health care in comparison to local health care officers, who had better financial conditions and access to transportation. Community members, mostly low-income farmers, indicated that medicinal plant use was the most beneficial and most frequently used health source, while the local clinic was reported as the least beneficial one. Medical supplies sold in kiosks were the least frequently used, probably due to a general lack of cash.

Within the community, there was general agreement on these results. However, both groups of women tended to rate medicinal plants, healers and the kiosk approximately equally in terms of perceived benefits while both groups of men weighted the benefits of medicinal plants much higher than the three other options. Interestingly, the elder men apparently made greater use of the local 32

healers than the younger men, who rated the local clinic as second best option after medicinal plants. Both groups of women apparently used local healers as much or more than treating themselves with medicinal plants. Men therefore seem clearly more confident to treat themselves with medicinal plants than women.

Health Care Officers in Sirnarasa The variation between benefits and frequency of use among health care workers was noticeable, while the local clinic was perceived to offer the most beneficial services, self treatment with medicinal plants/animal based was apparently being used more frequently. Within the group however, young men used the kiosk most frequently, followed by the clinic, and massage/acupuncture treatments. It was also surprising that while the healers were not even rated in terms of benefits, the group of young men used them about as frequently as medicinal plants. Young women also rated clinics highly, but in term of frequency of utilization, they used the kiosk (25%) and medicinal plants more frequently (25%) than local clinics (20%),. Senior women ranked the clinic as most beneficial and also used it most frequently, but while medicines from the kiosk were seen to have no benefits (0%) for them, they were in fact used as the general trend suggests (10%).

Practicality reason in accessing health care products emerged as a significant factor for participants. Thus the participants, common residents in Sirnarasa, asked for training on how to prepare medicinal plants so they can be stored and then used whenever needed. Furthermore, they hoped to posses processing tools and to get input from expert on how to improve the quality of medicines from plants so that this could become an income generating activity in the future. The provision of trainings and processing tools were expected from local government and local clinic, We conclude that medicinal plants are still perceived to be an important and frequently used health care option for all respondents in Sirnarasa.

33

Table 10. Result of weighted ranking of health care facilities in Tanjungsari WEIGHTED RANKING RESULT: COMMUNITY IN TANJUNGSARI Beneficial No

1 2 3 4 5 6

Health Care Facilities/Source


Male (Elderly)

Male (Young)

Female (Elderly)

Female (Young)

Total

Male (Elderly)

Male (Young)

Female (Elderly)

Female (Young)

Total

Local clinic, hospital

18

44

20

30

112

51

40

23

35

149

Private doctor, nurse Self treatment, traditional medicine Medicine from kiosk Alternative healer, spiritual leader Massage, acupuncture

7

22

28

12

69

0

24

26

11

61

50 9

15 8

32 7

33 17

130 41

42 0

11 14

37 5

26 17

116 36

0 16

5 6

7 6

0 8

12 36

0 7

6 5

6 3

0 11

12 26

Total

100

100

100

100

400

100

100

100

100

400

WEIGHTED RANKING RESULT: LOCAL CLINIC OFFICERS IN TANJUNGSARI Beneficial Frequency of utilization Health Care Facilities/Source

Male (senior)

Male (junior)

Female (senior)

Female (junior)

Total

Male (senior)

Male (junior)

Female (senior)

Female (junior)

Total

50

55

20

65

190

35

35

55

90

215

30

20

30

20

100

30

25

25

7

87

2

Local clinic, hospital Private doctor, nurse

3

Self treatment, traditional medicine

4

10

11

2

27

25

15

3

1

44

Medicine from kiosk

5

5

6

1

17

5

5

1

1

12

Alternative healer, spiritual leader

10

10

17

10

47

5

20

8

1

34

1

4

5 6

Massage, acupuncture Total

1

0

16

2

19

0

0

8

0

8

100

100

100

100

400

100

100

100

100

400


Private doctor, nurse

Medicine from kiosk

Massage, Acupuncture

Alt. Healer, spiritual

Local clinic, hospital Community Tanjungsari


Alternative healer, Spiritual leader

Medicine from kiosk

Massage, Acupuncture

Private Doctor, Nurse

Local clinic, Hospital

Local Clinic Officers Tanjungsari

Figure 10. Venn diagram of beneficial and frequently used health care facilities in Tanjungsari

Community in Tanjungsari 34

Tanjungsari Residents In comparison to Sirnarasa, Tanjungsari’s residents had more alternatives when they faced health problems, which could be seen from the Venn diagram above. Undoubtedly due to differences in geographical situation and access to infrastructure. Even a certain preference for treatment alternative still could be seen, the overall preference seemed shifted to modern facilities. Local clinics were visited more frequently, although traditional medicines are being rated as the most beneficial. The use of private doctors and nurses was ranked third. Part of this discrepancy is caused by the fact that older men rated the benefits of local clinics as very low (18%), yet this group claimed to visit them more often (51%) than other options.

Local clinic officers in Tanjungsari This noticeable shift to modern health care services could also be seen among local clinic officers, who unsurprisingly rely on their colleagues for health care services, and in general saw little benefit in traditional or alternative sources. However, health care workers did use self treatment with traditional medicines (11%) more than might be expected considering how low they rate their benefits (6.76%). This was especially the case for older males, who rated the benefits of medicinals poorly (4%) but then rated their frequency of use as third most important (25%)! Likewise younger men who saw little benefit in alternative healers (10%) yet rated their use (20%) higher than that of self-treatment with medicinals (15%). Furthermore,..the weighted ranking result for young women showed that they relied most heavily on clinics (90%), and rated the benefits of private care higher (20%) than their frequency of use (7%).. It might because the group of young women in fact aspired to private care but couldn’t afford it yet.

In sum, these weighted ranking results in both villages show a strong contrast between community members and health care workers, especially in the suburban Tanjungsari. They also show a general shift in preference toward modern medical care in the suburban community, where younger adults visit clinics, kiosks and private doctors roughly four times as frequently as they use traditional medicines and healers. In Sirnarasa, the younger adults appear to still rely on traditional medicines and healers, four times that of clinics and kiosks! Still, with the exception of health workers in Tanjungsari, most people involved still see medicinal plants as being beneficial, and all participants continue to rely on them even when they rate them so poorly. In the same occasion, afterward we facilitated a weighted ranking exercise to identify and rank problems related to health care services and also to explore the factors that may influence these problem. Tables 11 and 12 list these problems and also present the aggregated sums of the four small groups for the community and the healthcare workers. Empty boxes mean that the group did not list and therefore did not rank the problem. The right column lists informants’ reasons for these problems. While we have given the sum totals of the ranking exercises in Tables 11 and 12, they do tend to have obvious differences between the opinion of community members and the health care officials. Thus we first discuss the variation within the communities before comparing them to each other.

35

Table 11. Identified problems and ranking in health care services in Sirnarasa Weighted Ranking in Sirnarasa Rank

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Identified Problems

Cost for health service Lack of knowledge and experience among youth about traditional medicine Far distance to local clinic Transportation Belief and habit in community that oppose modern health service Insufficient number of health care personal

Community

Local clinic officers

Total

68

92

160

38 59

113 74 59

Low income, poverty They who started no using traditional medicine anymore Geographic condition Only public motorbike available

56 18

56 54

Local culture Regulation from government

40

43 40

It has side effect Poverty The location to get plants are far, lifestyle of preferring easiest way

113 36

36

Medicine from kiosk sometimes is not suitable Low education

43

Lack of interest to prepare medicinal plant (youth) Insufficient stock of medicines in local clinic and nurse

40

36 35

35

35

Low education, lack of information

20

28 20

The patient still has to pay and treated by last resources Not known

7 400

7 800

28

Uneven job division among health care officers 400

Not known

35

36

Time consuming in getting the service Low awareness among community about health care Health insurance doesn't guarantee the service at hospital Geographic condition

40

Influential factors

Geographic condition

Not known

Of the 15 problems listed in Sirnarasa, only three were shared by both groups: health costs, distance to services and number of medical personnel present. The distance to services also added up the health cost as there was very limited transportation. Their ranking of problems shows a very different even contradictory perspective toward health care. Whereas the community is most worried about the loss of traditional knowledge and practice among the youths, the clinic officials perceive the presence of traditional culture and beliefs to be the obstacle to better health care! Transportation difficulties are more of a problem for the clinic staff while issues concerning personnel and availability of quality medicines are more of a problem for the community. But both weight money problems as a medium priority.

36

Table 12. Identified problems and ranking in health care services in Tanjungsari Weighted Ranking in Tanjungsari Rank

Identified Problems

Community

Local clinic officers

Total

Influential factors

1

Cost of health care (expensive)

85

101

186

2

Service is not satisfactory

119

42

161

Low income, transport cost, price of medicine Too many patients, unfriendly, low number of officers

3

Insufficient facilities

65

43

108

Low of financial support

28

35

63

Too many regulations, lack of socialization, chaotic system

6

Bureaucratic (registration and picking up medicines) Medicines in kiosk: expired ones are still sold, high side effect, dosage is too high Alternative medicine: high risk

7

4 5

8 9 10 11

58

58

Insufficient stock of medicines

55 40

Low of financial support, low stock

The diagnostic is not detail Limited opening hours Time consuming to get the service

37 25 22

37 25 22

Too many patients, low competency Officers have many places to visit Limited number of officers

Lack of knowledge about medicinal plant preparation

20

20

18 7 400

18 7 800

12 13

Not being checked Trust, incorrect diagnostic

55 40

Medicinal plants are not easy to find Worry to try alternative medicines

400

Laziness, no research, expert doesn't share the knowledge, inherited knowledge, competition, no effort to study the knowledge Limited land, only some people grow the plants, need time to take care of plants Not known

Of the 13 problems listed in Tanjungsari, four were shared by both groups and all except three listed concern bureaucratic details of running a clinic that is understaffed and overworked. The top ranked problems for community members were poor service and facilities, expense of health care, and a lack of trust in kiosk bought pharmaceuticals (suspicion of over prescribing (the medicines with high side effect were sold), expired medicines, etc.), while at the end of the list, weighted with less than 10 percent, appear problems related to the use of medicinal plants. Local clinic staff seemed share the belief that health care is too expensive and that their own facilities were lacking and indeed their own capabilities as providers needed strengthening, particularly with regard to training. They are also worried about the value of alternative medicines, but did not mention cultural barriers to getting residents to come to clinics or use modern medicines. For both villages, our findings are as follows:

1. The major problems related to modern health care services (local clinic, hospital, village nurses) experienced by both groups, the community and local clinic officers were: high cost, insufficient number of personnel, low stock of medicines, low competency and inefficient administration. 2. A problem in using traditional medicines, which in both villages was identified only by community members but not by officials, was a lack of knowledge about medicinal plant preparation, which in Sirnarasa is especially acute among young people who have also lost interest in using traditional medicines.

37

3. Pharmaceutical medicines sold in kiosks are one of the important sources for maintaining health in the community, especially in the suburban settings and where people have enough money to afford them. The communities noticed that sometimes expired medicines were sold and also the effects were not as expected. 4. In Sirnarasa, the local culture was found to be a constraint by the clinic officers in regard to implementation of a modern approach. The persistence of local beliefs and habits were said to be opposing modern knowledge. Conversely, the communities saw the loss of their traditional knowledge as a major problem for maintaining their ability to take care of themselves. These opposing points of view may adversely influence the appreciation of local knowledge and cooperation between officials and community.

3.3.2 Community-based scenario about health care services in the village In the second Group Discussion, we presented the analysis of the previously weighted rankings and asked the participants to imagine the future of health care in three scenarios given the present set of conditions and problems they had identified (Figure 11 Fehler! Verweisquelle konnte nicht gefunden werden.). In Sirnarasa and Tanjungsari, the discussion with common inhabitants (Group I) and health care officers (Group II) was conducted in different time and place. For group I, it took place at one of the resident’s house around late afternoon while for group II was at the local clinic, after working hour. Each discussion needed about 3 hours and facilitated by 2 researchers by using charts, story board and colorful pens as supportive means.

The questions being asked were: (Wollenberg,E., Edmunds,D. Buck,L. 2000) 1. What do you think might happen to you in the next 10 years if the health care services stays like now (scenario 0, or business as usual scenario). See Figure 12 2. What do you think might happen if the situation gets better – what do you think as the best health care services? (positive scenario). See Figure 13 3. What do you think might happen if the situation gets worse - what don’t you want to happen? (negative scenario) (see Figure 14).

The figures produced below were drawn by the research team based on the results of the discussions. Written in the colored box are the main stakeholders (community, health care officers, local healer, local government officer), organization (kiosk, local clinic, university) and also practice of medicinal plant utilization which were identified by participants during the scenario building. In the blank boxes are the conditions of present, predicted, expected or unwanted in relation to the ones written in colored box. The arrow shows quality of relationship and qualitative measure of utilization between stakeholders/organization/practice. The solid arrow describes the good relationship and high or medium utilization while the discontinue arrow means insufficient or bad relationship and low utilization.

38

High utilization

Community

Kiosk

Local healer, traditional medicine use

Weak relationship

Local clinic (Puskesmas) and officers

especially trad.medicine for self-treatment

High utilization,

- Uneven job division

- Insufficient medical stock

-Time consuming to visit village - Insufficient number of officers

- Limited transport to village

- Expensive - Far from village

Insufficient support

Kiosk

Community

Medium utilization

- Worry to try alternative medicine

- Lack of knowledge about medicinal plant preparation

Low utilization

Expired medicines are still sold, high dosage,high side effect

- Not curing, not convincing, high risk

Doubtful relationship

- High working load

- No reward for health care officer

- Limited opening time

- Bureaucratic, time consuming

- Low diagnostic competency

- Insufficient medical stock

- Insufficient number of officers

- Service is not satifactory

- Expensive



-Medicinal plants are not easy to find

Local healers, Traditional medicine use

Unsatisfactory relationship

Local Government, Health Dept.

Present Condition of Health Care Service in Tanjungsari

based traditional medicines whenever they experience illnesses. These choices depend on practical, economical reasons and also personal preference.

39

Communities are main users of health care services. The communities use service from local clinic, local healer or do self-treatment by utilizing plant/animal

communities. Local healers, which may be officially registered or not, are providing health care service for the communities, usually for cheaper price.

village level which receives financial support from local government and responsible to implement local regulations and to provide health care services for village

received from central government for development of public health care service in the area. Local clinic (Puskesmas) is the lowest official health care service in

Local government (provincial and district level) are responsible to issue as well to implement regulations on public health care and to allocate annual budget

Legend:

Figure 11. Present condition of health care services in Sirnarasa and Tanjungsari

- Geographical constraint

- Belief and habits oppose modern approach - Low awareness about health care

- Low education

- Lack of knowledge and interest among young people about traditional medicine

Low utilization

Medicines not suitable


Present Condition of Health Care Service in Sirnarasa

PRESENT CONDITIONS OF HEALTH CARE SERVICE IN SIRNARASA AND TANJUNGSARI

Lost of knowledge and tradition to use medicinal plant Number of sick people will increase Low nutrition, low life expectancy, mortality rate of mother and infant will increae.

Low utilization


Bad relationship

-

-

-

Cost of health service will increse Unsatisfactory service Difficult to find doctor



Figure 12. Business as Usual scenarios in Sirnarasa and Tanjungsari

-

-

-

Community


Business as Usual Scenario in Sirnarasa

- Epidemic illnesses might increase

- Health condition decrease

- Necessity to open public discussion about situation

- Increase complain to Indonesian Doctor Association and to head of local clinic

- Shifting toward private health service or traditional medicines

Higher utilization

Higher utilization

Community


Unsatisfactory relationship

Private health services

Target Healthy Indonesia 2010 will not be achieved

Local Government, Health Dept. Insufficient support

40

- Local clinic will not be functional

-Human resources will decrease


Business as Usual Scenario in Tanjungsari

Scenario Business as Usual : What do you think might happen in next 10 years if the situation of health care service stays like now?

Community

Optimum utilization

Priority of wanted: 1. Improved health status through utilization of modern and traditional medications 2. Aware about health care 3. Owning ready use product from medicinal plant, become more accessible fo community 4. Understand the work of local clinic 5. Able to prevent illnesses 6. Increasing income from selling the ready use product 7. Improved knowledge through exchange experience with local clinic officers 8. Conserving medicinal plant species and its utilization

Cooperative relationship

Educational institution


High utilization, cooperative relationship


Priority of wanted: 1. Good service 2. Coordination between government, clinic and community 3. Sufficient financial support from government 4. Health insurance for poor people (askeskin) is easy to process and treated appropriately 5. Sufficient medical equipment 6. Medicines can be given for free 7. Providing advice about health care for community 8. Sustainable health care 9. Exchange knowledge with local healers 10. Develop cooperation with educational institution.

Supportive & Coordinative relationship

High utilization

Community

Increase welfare

Better living condition

2. 3.

Improved health status

1.

Priority wanted:


Good facilities Good service Sufficient and good quality of human resources

4. 5. 6.

Expected follow up from Intramed: Socialization of the results Training for med.plant preparation

-

Medicinal plant can be conserved 3.

2.

41

Providing rewards for health care officers

Sufficient stock of medicines

7.

Improving health status 3.

Affordable 2.

1.

Priority wanted:

Significant support

Priority wanted: 1. Medicinal plant can be cultivated (in pot, polybag)


Good relationship


Positive Scenario in Tanjungsari

Strong government supported by healthy citizens

Figure 13. Positive scenarios in Sirnarasa and Tanjungsari

Priority of wanted: 1. High utilization of medicinal plants through: cultivation strategy available processing tools production of ready use product network between expertcommunity improved medicinal quality conservation of medicinal plant species 2. Network between local healer and nurse


Cooperative & coordinative relationship

Priority of wanted: 1. Cooperate with community to enhance utilization of traditional medicine. 2. Empowering community about importance of health care 3. Pay attention to the problems in health care 4. Enhance the processing and utilization of medicinal plants 5. Commit to improve health care service in local clinic and hospital

Positive Scenario in Sirnarasa

Scenario + : What do you think might happen if condition gets better? What do you think as the best health care service?

e ti v p ra shi e op ion Co lat re

Priority of unwanted: Scarcity of medicinal plant species


Doubtful relationship


Figure 14. Negative scenarios in Sirnarasa and Tanjungsari

No utilization

Community

Negative Scenario in Sirnarasa

Community is disadvantaged Demanding community for a perfect health service Medicine manufacturer will gain the most benefit

1. 2.

3.

Priority of unwanted:

Priority of unwanted: 1. Cost for health care is so high, unaffordable 2. Bad service: health service doesn‘t respect the patients, no money no service 3. Health insurance for the poor will not be accepted 4. Not enough number of officers 5. No information regarding new coming epidemic and prevention methods 6. No health care program, ie. Family medical garden, health care awareness

No utilization

Community


Bad relationship



Lack of health care officers Too much workload

5. 6.

42

Unsatisfactory patient and officers

Low quality of human resources

4.

8.

Unfriendly

3.

No rewards for health care officers

Insufficient facilities

2.

7.

Bad service

1.

Priority of unwanted:

Unsupportive

you want to happen in health care service?

Negative Scenario in Tanjungsari

- : What do you think might happen if condition gets worse? What don’t

Priority of unwanted: 1. Lost of knowledge and tradition to use medicinal plant 2. Community has bad opinion about local clinic (high cost, complicated administration, liar).

Scenario

3.3.2.1

Community-Based Scenario in Sirnarasa Village

Present Condition At present, participants in Sirnarasa village primarily use traditional medicines and local healers to deal with daily health problems. However, a tendency among young people to abandon the use traditional medicines was reported. The local clinic was far from the village and considered expensive, taking into account the additional cost of transportation. Local clinic officers also found it time consuming to visit the village due to its remoteness and poor transportation links. Besides those constraints, the local clinic had its own problems of insufficient staff, equipment and medical stocks, which was blamed on insufficient support from local government. There was modest interest from the head of the local clinic to promote the utilization of traditional medicines in the area, but in general clinic staff tended to view the local culture as an obstacle to providing modern health care.

Business as Usual Scenario When asked what they expected would happen in next 10 years if the situation stayed the same, all participants (community and local officers) agreed that there would be increased loss of local knowledge and hence decreased use of medicinal plants, a lower health status in the community indicated by an increased number of sick people, low nutrition and high mortality rate of infants and mothers. It was also expected that the cost of health care service at the clinic would increase, but service would decrease.

Positive Scenario Participants in Sirnarasa wanted a health care system in which community, local clinic officers, local government and also educational institutions would cooperate in synergy. Community members also expressed a desire for support to enhance the utilization of medicinal plant species through training in cultivation methods and preparing medicinal products, which would make them more accessible for community use and for marketing as an income generating activity. A conservation strategy for medicinal plant species and the knowledge needed to utilize them were also considered important. Local clinic officers expected sufficient financial support from government in order to be able to provide affordable, good quality and sustainable health care service. A good relationship between community, local healers, local clinic officers and educational institutions, as experienced during the INTRAMED project, was greatly desired as well as a network to exchange knowledge.

Negative Scenario In the negative future scenario, the participants feared the increasing scarcity of medicinal plant species and the loss of knowledge of their use. Also, they expected the clinic to become unaffordable and the service to worsen. Local clinic officers were afraid of facing increasingly negative opinions from the community which might lead to a lack of trust and a breakdown of their relationship.

43

3.3.2.2 Community-Based Scenario in Tanjungsari Village Present Condition Unlike Sirnarasa, the local clinic in Tanjungsari is the main health care service used by the participants, in spite of the high cost and other unsatisfactory incidents they experience during a visit. Local clinic officers felt unrewarded for such a heavy workload, due to limited number of staff to deal with such a high number of patients. Medicinal plants and other traditional medications were used only modestly, mostly because people didn’t know how to prepare them and also because the plants were not easy to find. Furthermore, there was some doubt about the efficacy of using traditional medicines. In all of participants scenarios, the key factor is financial support from the government, which they see as critical to their futures.

Businesss as Usual Scenario If the health care situation stays as it is now, in next 10 years the participants projected there would be behavioral shift within the community from visiting the local clinic to using private health service and/or traditional medicines. They also feared an increase in complaints and demands for public hearings because of the declining quality of the clinic and a decrease in the health status of the community. Also, the government’s target to achieve a ‘healthy Indonesia’ by 2010 would not be successful.

Positive Scenario In their positive scenario, the future health care system would have significant increased financial support from government to reduce the cost of using the local clinic, to improve the quality of equipment and staff and also to provide rewards for staff. With a better relationship between the community and the local clinic, the village’s health status would improve. With regard to medicinal plants, the community hoped to have higher utilization of medicinal plants through cultivation and conservation. As a follow-up to the INTRAMED project, they hoped for training in preparing medicinal plant treatments.

Negative Scenario In participants negative scenario, the government would be unsupportive, which would lead to declining service and poor quality of the local clinic, which would disadvantage both the community and also clinic staff. Again, a bad relationship between the two groups is envisioned in this future, something that is considered very dangerous for the health of the community. The utilization of traditional medicines would also decline and only medicine manufacturers would see benefits under this scenario. The scenarios developed by the communities of Sirnarasa and Tanjungsari were different, with the former much less dependent on the government health care services, and the latter seeing their future as very much tied to government support for local clinics. Both communities would like an affordable, friendly and high quality service from their local clinic. There is also a desire to enhance the use of traditional health care, especially the use of medicinal plants, at least to offer more alternatives for maintaining their health status and, in some cases, to even develop small communitybased enterprises to promote the commercialization of traditional medicines. 44

4 CONCLUSIONS AND RECOMMENDATIONS 4.1 Opportunities for an integrated health care system: the efficacy of local knowledge and potential constraints PUSKESMAS, the government supported health clinic at the village level since 1974, has been widely recognized by communities as their primary health care service provider. Despite limited finance and facilities, Puskesmas has become the government’s main pillar in maintaining the health status of communities. Together with availability of pharmaceutical medicines for sale in kiosks, Puskesmas policies have influenced the decisions made by communities in choosing their health care treatment, from reliance on traditional medications to adoption of modern ones to some combination of the two. Unfortunately, many communities find Puskesmas expensive, particularly those who live in remote areas with poor infrastructure and the service remains inaccessible for people without money.

In parallel with the use of service from Puskesmas, many of these communities continue to rely on traditional knowledge of medicinal plant use to remedy daily health problems. INTRAMED research documented this local knowledge of medicinal plant species and their uses among low-income households in Sirnarasa and Tanjungsari communities. Our findings showed abundant potential knowledge held not only by local healers but also by common inhabitants, even in Tanjungsari where the clinic was easily accessible. This local knowledge was a preferred alternative to treat health problems in both villages, as it was cheap, easy to get and simple to prepare, especially for those in Sirnarasa who had limited access to other health care services. Furthermore, the best known medicinal plants were also those used to treat the most common illnesses found in the communities. This finding supports our conclusion that local knowledge on medicinal plant use is important for maintaining the health status of low-income groups in these communities. Regardless of the advantages given by modern health care intervention in villages through distributing medicines in kiosks and Puskesmas, this intervention seemed has triggered a new reluctance in communities, especially the youths, to use their knowledge. The ‘easy to access’ medicines from kiosk and the mainstreaming of modern health care services have triggered the case that young people find it unattractive to prepare traditional remedies and furthermore, don’t want to be associated with what they perceive to be the past, and so discard their traditions for what they perceive to a more progressive future.

A key issue with the acknowledgment of local knowledge lies with the scientific uncertainty of its validity. In this research, the application of participatory approaches to evaluate and to gain common agreement toward the efficacy of medicinal plant-based treatments has proven successful to reduce uncertainty about their medicinal uses, side effects and methods of preparation. Comparison with public databases also provides some assurance of the validity of these uses, though we would support greater testing of remedies and preparations to compliment that being carried out solely on plant compounds themselves. We find this approach a constructive way to recognize local knowledge of medicinal plant-based treatments, rather than relying exclusively on scientific testing. 45

Moreover, development interventions can benefit from the results of the community-based scenario building exercises, which were able to identify the problems faced by communities and showed their expectations and worries regarding the future of their health care system. One outcome from these exercises was to enhance community recognition of the value of their medicinal plant knowledge and use as an alternative treatment in the health care system.

Therefore, considering the potential of local knowledge and the limited service provided by government institutions, which is not expected to improve in the near future, it appears to be the right time to suggest that Puskesmas staff work together with communities to integrate their knowledge and use of medicinal plants into the primary health care system. Such aims are not solely to provide economically affordable and accessible health care treatment, but also to conserve beneficial local knowledge and medicinal plant diversity for a self-sufficient and sustainable health care system in the village. But the success to integrate beneficial local knowledge into the health care system in the village seemed being determined by policy and human factors. INTRAMED revealed that the local culture was found to be a constraint by the clinic officers in regard to implementation of a modern approach. The persistence of local beliefs and habits were said to be opposing modern knowledge. Even if policies allow, this unconstructive attitude should be taken into consideration and need to be changed to achieve the objective of integration.

From policy point of view, since 1982 Indonesian government has regulated the use of traditional medicines by issuing a decree of the Ministry of Public Health (SK No. 99a/MenKes/SK/III/1982), recognizing traditional medications as one of the alternatives to improve health condition of communities. This decree was strengthened by issuance of Indonesian government regulation UU RI No.23/1992 which established traditional medication in a formal structure of the health care system in Indonesia. The implementation of traditional medication practices and marketing of traditional medicines was specifically regulated in decree No. 1076/Menkes/SK/VII/2003. The decree No. 1076/Menkes/SK/VII/2003 promotes the formalization of traditional healer under surveillance of official health institutions in district and village level. Also the definition of traditional medications, procedure for registration and permit issuance for traditional healer, medical practice regulations, assistance and surveillance procedures and also sanction, which apply to all registered traditional healers. Puskesmas and the health care division (Dinas Kesehatan) of the local government are the main actors for the implementation of these policies at the village level. Therefore, from a policy point of view, there is strong support for the integration of local knowledge into the health care system.

Unfortunately, in practice such integration is not that easy. The main hindering constraints from policy and from people attitude point of view can be summarized as follows: 1. Although they exist, regulations concerning the use of traditional medications are still incomplete. Therefore, Puskesmas has been focused to dispense services based on modern approaches. 2. Scientific research about traditional medicines is present but peripheral in University Research Programs. Clinical research on traditional medicines is still very limited. 46

3. Mainstreaming the modern science in medical education system influences the attitude of doctors and health care officers who have acquired their knowledge based on modern science. Their point of view often considers local knowledge as unscientific or not clinically proven, which inhibits the recognition of local knowledge as legitimate, as well as evading cooperation with communities that still depend on these treatments. 4. Furthermore, medical schools do not spend enough time teaching traditional medication. For example, in the Faculty of Medicine at Padjajaran University in Bandung, Indonesia, only 1 hour per semester is dedicated to traditional medicine. This system resulted Doctors with low knowledge and appreciation toward traditional medication. 5. Finally, those Puskesmas that have initiated programs to integrate traditional medication, for instance through the TOGA program (Tanaman Obat Keluarga or family medicinal plant garden), face financial difficulties to maintain the program.

4.2 Recommendations and follow-up plans 1. As a result of the participatory processes initiated by INTRAMED, the participants were able to articulate their expectations for the future of their health care. They want primary health care services that are affordable and accessible, acknowledge the beneficial aspects of local knowledge, and involve their communities. Utilization of all potential local sources will provide communities more alternatives in choosing the kind of health treatments according to their preference, belief and capacity. This expectation is inline with WHO resolution 1997: “community health care services cannot be well distributed without involvement of traditional medication system which is rooted within the community.” 2. INTRAMED research findings demonstrated the continuing use of medicinal plant species among low-income households in Sirnarasa and Tanjungsari villages. This local strength should be recognized and utilized by Puskesmas as a main pillar of the health care provision for the village. 3. Indonesia formally recognizes three forms of natural medicines, which are (1) jamu: defined as natural medicine from plants or animal, minerals, or a mixture of those components that have been used for generations based on experience, (2) standardized herbs: natural medicine that has passed scientific pre-clinical tests and the composition has been standardized, (3) phytopharmaca: natural medicine that has been tested for its safety and medicinal properties through scientific pre-clinical and clinical tests. Considering the 3 forms above, jamu is the most acceptable form to promote medicinal plant species used in both research villages. 4. As also expected by participants in the research area, better cooperation between the community and Puskesmas is needed in order to exchange knowledge and improve the quality of medicinal plant preparations, as well as marketable products. Joint training programs about plant species, their preparation and application which involve both parties would be a good option. It would be important to include local healers and those key persons who provided recipes included in the INTRAMED Booklet (see below).

47

5. The training could be followed up with a program to start household medicinal plant gardens (TOGA) and build upon the existing techniques for cultivation and conservation of medicinal plant species. We suggest that the selection of which medicinal plant species to be planted are not conducted as in the previous TOGA program, where the trainers decided upon plant species, but the plant species which are locally grown and found beneficial by the inhabitants should be cultivated. 6. Furthermore, there is a need to explore the possibility of producing ready to use medicinal plant products (jamu), which could provide additional income to the community. This has been explicitly requested by Sirnarasa participants. This expectation needs support in form of training and also financial means for buying processing equipments. The respondents mentioned government who is expected to provide this support. 7. Locality is an important factor in medicinal plant use, because different areas usually have different terminology for illnesses and plant species, and also different use and methods of preparation for the same plants. That variations in illness term, name of plant species, plant use and method of preparation are present and significant has been aptly demonstrated by INTRAMED results. Therefore, we recommend applying similar local participatory approaches in any efforts to utilize local knowledge. 8. Taking into account present constraints and health care policies, we recommend the development of a comprehensive curriculum in medicine and pharmacological study of traditional medicines. Moreover, there is a need for a nationally accredited traditional medicine university (as in China, Vietnam, and even the US and Europe) where it is possible to obtain a medical degree. 9. Lastly, national regulations are needed to provide guidance and authority to medical doctors who have acquired degrees in traditional medicine. Follow up plans of INTRAMED include dissemination of results in national seminars in Indonesia and publication in several national and international journals. •

To ensure the scientific plant names before being published in international journal and to further explore the utilization of the medicinal plants based on scientific and public sources, a careful research has been conducting by two diploma students in Department of Pharmacognosy, Univ.of Vienna under supervision of Prof.Dr. Wolfgang Kubelka.

•

24-25 October 2007: INRIK presented relevant results in Conference of National Committee Man and Biosphere – LIPI (Indonesian Science Institute), in Cibodas, Bogor Indonesia. Topic: Natural Conservation of Biodiversity based on Local Culture.

•

This research has resulted interdisciplinary findings which can be published in different scientific journals, depending on the interest and expertise of each Intramed research team. Therefore, the publications of the results are decided to be discussed after the final report is completed to sharpen the specific issue for publication. In general, the scientific publications target Journal of Anthropology Indonesia, Medicinal Plants Network News, Journal of Ethnobiology and Ethnomedicine.

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•

INRIK has received request from Puskesmas in Sirnarasa for the booklet resulted from INTRAMED research. They have a plan to build secondary local clinic nearer to the village and to implement TOGA (family medicinal plant garden) program with the community.

•

The interdisciplinary approach used in this research is planned to be promoted among Indonesian research forums in order to acknowledge the potency of local knowledge for community welfare.

4.3 Returning results: A medicinal plant booklet A Medicinal Plant Booklet for each village contains the findings of the INTRAMED project including a selection of medicinal plants and their preparation to treat common illnesses, results from the scenario building process, and photographs from research activities. For each village, 100 Indonesian and 20 English copies were printed and distributed free in January 2008 to communities, Puskesmas, local government (Dinas Kesehatan) officials, and other relevant institutions in Indonesia. The distribution of booklet for the community was set up in an informal meeting in the village by inviting the respondents and other residents. The researchers recalled the objectives and the process of the research. The communities were enthusiastic to receive the booklet and hoped there will be follow up from the research, such as training for medicinal plan use and financial support for making ‘ready to use’ medicinal plant product, which expected to be initiated by local government and Puskesmas. An example of a booklet page can be seen in Figure 15.

TREATMENT FOR COUGHING:

GINGER

Throat ache, itching 4.5 cm

Picture of plant

15 cm

4.5 cm

Local name: JAHE

Diagnosis

Common name: GINGER Scientific name: Zingiber officionale rosc. Local uses: TREATING COUGHING Plant description: LONG SHAPE OF LEAVES Plant habitat: HOMEGARDEN (KEBUN) Plant parts used for medicine: ROOT Harvest method: DUG Other ingredients needed: 1 CITRUS

Preparation: one thumb-size root is grated and sieved to extract the juice. Mix juice with extract from one citrus. Sieved ginger can be used once more time by adding hot water. Dosage: to drink 3 x a day until cough reduces Sources of Information: Enjay, Hari, Tuti (Ciptarasa hamlet) 1 cm

3

15 cm

Figure 15. Example of medicinal plant booklet entry for ginger, in English 49

5 APPENDICES 5.1 Interview Guideline 1: Socio-cultural background and Cultural Domain Analysis Atribut: Latar Belakang Kondisi Sosial-Kultural Responden

Attributes: Socio-Cultural Background of Respondent

Nomor: Tanggal: Interviewer:

No.: Date: Interviewer:

Nama responden: Jenis Kelamin : Umur : Tempat lahir : Bahasa sehari-hari: Pekerjaan: Pendidikan terakhir: Agama : Alamat :

Name of Respondent: Sex: Age: Birth place: Daily language: Occupation: Latest education level: Religion: Address:

Pertanyaan Saringan

Screening Question: What is your residential status in this village? 1. Permanent 2. Temporary (If the answer is no.2, stop the interview)

Apakah status kependudukan keluarga Bapak/Ibu di Desa ini?

1. Penduduk tetap 2. Penduduk sementara ( Jika nomor 2 terpilih, stop wawancara)

A. Pengetahuan tentang pengobatan tradisional

A. Knowledge on Traditional medicine

1. Menurut Bapak/Ibu, apa itu pengobatan tradisional? 2. Apakah Bapak/Ibu pernah menggunakan pengobatan tradisional? A. Ya (teruskan ke No.3), B. No (teruskan ke No.4) 3. Apabila Bapak/Ibu pernah menggunakan pengobatan tradisional, apa alasan utama memilih pengobatan tradisional tersebut? • Karena murah • Mudah didapat • Warisan turun-temurun • Karena khasiatnya • Karena saran dokter/mantri/dukun/bidan • Tidak mengandung zat kimia (alami) ............................................................ (jawaban boleh lebih dari satu) • Jika alasannya murah : tolong bandingkan antara biaya pengobatan tradisional dengan modern (puskesmas, mantri,dll) • Jika alasannya mudah didapat: tolong bandingkan berapa banyak waktu dan jarak tempuh yang dibutuhkan sampai responden mendapatkan pelayanan pengobatan tradisional dibandingkan dengan pengobatan modern. 4. Aktivitas pengobatan tradisional: apa saja aktivitasnya, sejak kapan praktek itu mulai dikenal

1. What do you think is traditional medicine? 2. Have you ever used traditional medicine? A. Yes (continue to No.3), B. No (continue to No.4) 3. If you have ever used traditional medicines, what was the reason of using that treatment? • Cheap • Easy to get • Inherited knowledge • The effect • Suggested by doctors • Natural • ZZ. May be more than one answer • If the reason is cheap: compare the cost with modern health care service • If the reason is easy to get: compare the time needed and distance in order to get modern health care service. 4. Traditional medicine activities: what kind of activities, since when is it recognized by the community? 5. Who are involved in those activities? 6. Who are benefited by traditional medicine activities? And why? 7. How is the acceptance of the community? (ask separately the acceptance of common community members and the government employees/medicinal officers) 50

masyarakat? 5. Siapa yang terlibat dalam kegiatan pengobatan tradisional tersebut? 6. Siapa yang mendapat keuntungan dari pengobatan tradisional tersebut? Alasannya? 7. Bagaimana penerimaan masyarakat (pisahkan antara masyarakat awam dan para petugas puskesmas/pemerintah desa) terhadap aktivitas pengobatan tradisional?

CULTURAL DOMAIN ANALYSIS B. Free listing

B. Free listing

Domain 1: pengetahuan mengenai jenis tanaman obat dan penggunaannya

Domain 1: knowledge on medicinal plant species and its utilization

1. 2.

Tolong sebutkan semua tanaman obat yang Bapak/ ibu ketahui beserta khasiatnya Gunakan ranking: tolong ranking/urutkan semua tanaman obat tersebut dari yang paling sering digunakan s.d. yang tidak pernah digunakan

1. 2.

What kind of medicinal plants that you know and to treat what illness? Use ranking: rank those plants from the most frequently used to the one which has never been used.

Domain 2: Common experienced illnesses Domain 2: Penyakit yang pernah diderita

1. Tolong sebutkan semua penyakit yang pernah dan masih diderita oleh Bapak/Ibu (contoh: penyakit A, B, C) 2. Gunakan teknik ranking dengan meminta responden mengelompokkan jenis penyakit yang paling sering s.d. jarang diderita. Tanyakan apa yang dimaksud dengan kategori sering/jarang. Domain 3: Cara pengobatan untuk setiap penyakit yang disebutkan Catatan: utamakan penyakit yang menempati ranking tertinggi (jika banyak sekali nama penyakit yang disebutkan)

1. (Untuk setiap penyakit yang disebutkan) apa tindakan yang Bapak/Ibu lakukan? Catat urutan jawaban seperti yang disebutkan oleh responden.

1. Please tell me the illnesses that had and have been experienced by you 2. Ranking: ask respondent to rank the most often to the rarest experienced illnesses. Ask for the explanation of categories, i.e. what is often or rare

Domain 3: Method of treatment for each mentioned illness

Note: prioritize the illnesses on the top ranks (in case too many illnesses are mentioned) 1. (For each mentioned illness), what kind of treatment was/is taken? Write down the answer in order it is mentioned by respondent. Domain 4: Knowledge on medicinal plant to treat mentioned illnesses 1.

Domain 4: Pengetahuan mengenai penggunaan tanaman obat untuk setiap penyakit yang disebutkan 1.

2. 3.

2. 3.

For every mentioned illnesses, what medicinal plant can be used? From where do you get the plants? Who does collect it and prepare it?

Tahukah Bapak/Ibu tanaman obat apa yang dapat digunakan untuk mengobati setiap penyakit yang disebutkan di atas? Darimana didapatkanya tanaman tersebut? Siapa yang mengambil dan mengolahnya?

51

Socio-Economical Attributes A. Status sosial

A. Social Status

1. Sudah berapa lamakah keluarga inti Bapak/Ibu tinggal di Desa ini? 1. Kurang dari 5 tahun 2. 5 - 10 tahun 3. 10 - 20 tahun 4. Lebih dari 20 tahun 2. Apakah keluarga inti Bapak/Ibu memiliki hubungan kerabat dengan keluarga lainnya di Desa ini? 1. Ya 2.Tidak ( Jika "Tidak" terlingkari lanjutkan ke nomor 4) 3. Apakah jenis hubungan kekerabatan tersebut? 1. Hubungan perkawinan 2. Lainnya, sebutkan __________________ ( Jawaban boleh lebih dari satu ) 4. Apakah keluarga Bapak/Ibu termasuk keluarga tertua di Desa ini? 1. Ya 2.Tidak 5. Bagaimanakah peran sosial keluarga besar Bapak/Ibu di Desa ini? 1. Berperan di bidang agama 2. Berperan di bidang pemerintahan desa 3. Berperan di bidang perekonomian 4. Lainnya,sebutkan .......(Jawaban boleh lebih dari satu)

1.

How long has your (nuclear) family been living in this village? 1. < 5 years 2. 5-10 years 3. 10-20 years 4. >20 years 2. Does your family have kinship with other families in this village? 1. Yes 2. No (if No, continue to question number 4) 3. What is the type of the kinship? 1. Marriage 2. Other Z (answer may be more than one) 4. Is your family considered as ‘eldest family’ in this village? 1. Yes 2. No 5. How is your family’s role in this village? 1. in religious activities 2. village administrative 3. in the village’s economic activities 4. OthersZZ (answer may be more than one)

B. Gambaran Umum Rumah Tangga

B. Household - General Picture

6. 7.

6. 7.

Jumlah dan komposisi umur anggota rumah tangga Apakah latar belakang pendidikan setiap anggota keluarga?

Jenis Rumah (dinilai oleh pewawancara) a. Permanent b. Semi-Permanent 9. Keadaan rumah (dinilai oleh pewawancara): a. bersih b. Sedang c. Kotor 10. Luas pekarangan (dinilai pewawancara): a. Luas b. Cukup luas c. Sempit d. Tidak ada

Number and age composition of hh membersZ What is educational background of the entire household member? 8. Type of house (interviewer’s observation) a. permanent b. semi-permanent 9. Condition of the house (interviewer’s observation a. Clean b. Ok c. Dirty 10. Size of front house garden (interviewer’s observation) a. Big b. Medium c. Small d. Not available

C. Kondisi Sosial Ekonomi

C. Socio-Economic Conditions

11. Status sosial ekonomi (intepretasi pewawancara) a. Kaya b. Sedang c. Miskin 12. Menurut pandangan pribadi, termasuk kelompok ekonomi manakah keluarga Bapak/Ibu? 1. kaya 2. sedang 3. miskin 4. sangat miskin Mengapa Bapak/Ibu anggap demikian? 13. Apakah jenis alat komunikasi yang dimiliki? 14. Apakah jenis alat transportasi yang dimiliki? 15. Luas dan jenis lahan yang digarap oleh rumah tangga (ukuran dalam istilah lokal) .........Pemilik lahan...... 16. Jenis dan jumlah ternak (sebutkan) .........Pemilik.... 17. Apakah pekerjaan utama dan tambahan setiap anggota keluarga? 18. Dimana lokasi tempat bekerja? 1. Dalam desa: ZZ.. 2. DI luar desa: ZZZ. 19. Berapakah pendapatan rata-rata rumah tangga per bulan? Siapa yang berkontribusi pada pendapatan? 20. Berapa rata-rata kelebihan pendapatan setelah digunakan untuk keperluan sebulan? 21. Bagaimana memenuhi pengeluaran yang tidak terduga, khususnya biaya berobat?

11. Economical situation (interviewer’s observation) a. Rich b. Medium c. Poor 12. According to your opinion, to which economic group does your family belong? 1. rich 2. medium 3. poor 4. very poor Could you explain why do you think so? 13. What kind of communication devices do you have? 14. What kind of transportations do you have? 15. Size & type of field cultivated by family (size in local term) ZZZ..the ownerZ. 16. Type and number of cattle ZZ..the ownerZ. 17. What is the main and secondary occupation of each household member? 18. Where do they work? 1. In the village:ZZ.. 2. Outside village: ZZ. 19. How much in average is the household income per month? Who does contribute to the income? 20. How much in average is the balance per month? 21. How do you deal with unpredicted expenses, especially for medication purposes? 22. Do you have health insurance? What kind of it?

8.

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22. Apakah Bapak/Ibu memilki asuransi untuk pengobatan? Apakah jenisnya? D. Perilaku sehat-sakit

D. Health related Behaviour

23. Menurut Bapak/Ibu, apakah yang disebut sehat? 24. Menurut Bapak/Ibu, apakah yang disebut sakit? 25. Apa yang Bapak/Ibu lakukan untuk menjaga kesehatan?

23. What do you think of being healthy? 24. What do you think of being sick? 25. What do you do to stay healthy?

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5.2 Interview Guideline 2: Preparation of medicinal plant use A. Sampling tanaman obat & penyiapannya

A. Medicinal plants sampling and its preparation

A.1. Pengambilan tanaman

A.1. Plant Sampling

1. Nama tanaman (catat seperti disebutkan oleh responden): 2. Nama penyakit yang diobati / terminologi lokal mengenai penyakit: 3. Apa ciri-ciri tanaman tersebut yang dikenali oleh responden? 4. Adakah kemiripan dengan varietas lain? 5. Lokasi pengambilan tanaman (peta desa dapat membantu): 6. Kapan tanaman obat dapat diambil/dipanen? (apakah tergantung perkembangan tanaman atau waktu tertentu?) 7. Bagaimana cara pengambilan tanaman obat tersebut? 8. Bagian mana dari tanaman tersebut yang digunakan sebagai bahan obat? 9. Bagaimana ciri-ciri khusus bagian tanaman yang digunakan tersebut? 10. Siapa yang umumnya mengambil tanaman? 11. Untuk setiap jenis tanaman obat, buat digital foto, voucher/herbarium tanaman seperti metode dalam Alexiades,1996. A.2. Pengolahan: 1. Berapa banyak dari bagian tanaman tersebut yang digunakan pada pengobatan untuk satu kali pengolahan ? 2. Adakah tanaman atau bahan lain yang digunakan sebagai campuran pada pengobatan tersebut? 3. Jika ya, sebutkan tanaman atau bahan campuran tersebut dan jumlahnya 4. Sebutkan secara lengkap cara penyiapan dan pengolahan tanaman obat tersebut, mencakup: • Bahan (jenis dan jumlahnya menurut ukuran lokal) • Alat yang digunakan • Cara pengolahan 5. Berapa biaya/modal yang diperlukan untuk pengolahan tanaman obat tersebut? 6. Apakah ada ritual / syarat khusus pada saat pengambilan tanaman, pengolahan, dan penggunaan dari tanaman obat tersebut?

A.3. Aturan Pemakaian: 1. Bagaimana cara pemakaian / pemberiannya? 2. Berapa banyak obat tersebut digunakan ? Berapa kali dalam sehari? 3. Berapa lama obat tersebut harus digunakan oleh pasien? 4. Apakah pemakaian obat tersebut dikombinasikan

1. Name of plant (written as said): 2. Name/ local terms of diseases that can be cured by applying the mentioned plant: 3. What is the characteristic to recognize the plant? 4. Is there any similarity with other varieties? 5. Location of sampling (village map can be helpful) 6. When can the plant be collected/harvested? 7. How is the method of harvesting? 8. Which part of plant is used as medicine? 9. How is the characteristic of this part? 10. Who do usually harvest the plant? 11. For every plant species, please prepare the digital photo and voucher/herbarium as mentioned in Alexiades,1996.

A.2. Preparation 1. How much from the part of the plant is used for each time preparation? 2. Are there any additional mixtures in this medicine? 3. If yes, what is it and how much? 4. Please tell us the preparation of the medicine from the plant, including: • Ingredients (name and amount) • Tools • Preparation procedure 5. How much does it cost for each time preparation? 6. Are there necessary rituals involved during harvest, preparation or administration of the medicine?

A.3. Administration 1. 2. 3. 4.

How is the method of delivery? How much is the dose? How long is the duration of the treatment? Is the administration of the medicine combined with other medicines? If yes, please explain it. 5. Is there any necessary storage process before or after the use? (explain) 6. If there is no sign of recovery, how long should the patient keep using this medicine? • ForZ days/week,etc • Stop directly Reasons:ZZ 7. Are there any restrictions regarding the application of the medicine? i.e. babies, pregnant women, combination with other medicines,etc.

54

dengan obat pemakaiannya.

lain?

Jelaskan

bagaimana

5. Apakah ada proses penyimpanan tanaman obat sebelum dan atau sesudah digunakan? (jelaskan) 6. Bila tetap tidak sembuh, sampai berapa lama obat ini masih harus digunakan ? • selama ZZZhari/minggu/bulan/tahun • langsung dihentikan Alasannya: 7. Adakah larangan untuk pemakaian obat tersebut ? Misalnya tidak boleh digunakan pada balita / ibu hamil/ lanjut usia atau digunakan bersamaan dengan obat lain?

A.4. Ethnomedicinal Aspects 1. 2. 3. 4.

How are the symptoms of the disease? What do you think cause the disease? What do you think how the medicine work? How is the response of the patient who takes the medicine? 5. Are there any side effects / overdose possibility from the application of the medicine? Have you ever had unexpected experience after the application of the medicine?

A.4. Aspek Ethnomedicine 1. Bagaimana ciri-ciri penyakit tersebut di atas? 2. Apa perkiraan anda mengenai penyebab penyakit tsb? 3. Apa perkiraan anda mengenai cara kerja obat tersebut dalam tubuh? 4. Bagaimana respon tubuh pasien selama pengobatan? 5. Adakah kemungkinan efek samping / overdosis dari obat tersebut? 6. Pernahkah ada pengalaman yang tidak diharapkan setelah penggunaan obat tersebut?

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5.3 Scenario Building Guideline

SCENARIO BUILDING I SCENARIO BUILDING GUIDELINE Identifikasi cara pengobatan dan masalah pelayanan kesehatan Identification of health care sources and problem in health care service

One group GD Group I

Group II

One group in GD

Lakukan proses scenario building secara terpisah antara kelompok (masyarakat umum + traditional healer) dengan kelompok pegawai kesehatan formal (dokter puskesmas, mantri,bidan) Conduct scenario building process separately between group of (common inhabitants+traditional healers) and the group of official health care personels (doctor, mantri, bidan). Definisi: Skenario adalah cerita mengenai apa yang mungkin terjadi. Skenario akan sangat berguna ketika menghadapi situasi dengan kompleksitas dan ketidakpastian yang tinggi. Skenario dapat berupa gambar, foto, cerita, drama, peta, atau kombinasi berbagai media.

Definition: Scenarios are stories of what might be, thinking of the future. It is a useful tool where complexity and uncertainty are high. Scenario can take form of pictures, photos, written stories, dramas, videos, maps, or any combination of these and other media.

Tujuan Skenario : 1. Untuk mengetahui harapan atau masa depan ideal yang diinginkan oleh masyarakat (yang berkaitan dengan pelayanan kesehatan) 2. untuk mengetahui harapan masyarakat berdasarkan situasi saat ini sebagai landasan. Apa yang mungkin terjadi di masa depan jika kondisi berjalan tetap seperti saat ini. 3. memfasilitasi partisipan diskusi menentukan strategi atau arah bagaimana mereka dapat mencapai harapan ideal dengan titik awal saat ini (dalam konteks pelayanan kesehatan).

Purposes of scenario: 1. to learn what are community’s hopes or ideal future (regarding the health care service) 2. to learn what are the community’s expectations, with starting point of current condition, of what likely to occur in the certain time in the future if the current trend continues. 3. to facilitate participants determining the strategies or pathways on how they can get from the present to the ideal future (in the context of health care service).

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SCENARIO BUILDING I :

SCENARIO BUILDING I:

Tujuan : Informasikan pada seluruh partisipan bahwa peneliti ingin berdiskusi mengenai masalah yang dihadapi oleh partisipan dalam hal pelayanan kesehatan.

Objective: Inform all participants that the researchers want to discuss abut problems that are faced by participants in term of health care service.

Persiapan untuk diskusi: • lakukan ice breaking games • siapkan kertas ukuran besar • alat tulis • digital recorder • satu peneliti memfasilitasi, satu peneliti mencatat proses • biji-bijian,minimal @ 100 butir • siapkan potongan kertas bertuliskan, misalnya nama buah-buahan, untuk latihan weighted ranking.

Preparation for discussion: • conduct ice breaking games • big size paper • stationaries • digital recorder • one researcher as facilitator, the second researcher makes note on the process.

A. Identifikasi cara pengobatan yang ada:

A. Identification of existing health care sources: • •

Bagi partisipan ke dalam kelompok-kelompok kecil berdasarkan jenis kelamin dan usia (laki-laki tua, – muda, perempuan tua,-muda). • Tunjukkan rangkuman hasil interview I mengenai cara pengobatan penyakit yang pernah digunakan responden. • Minta setiap kelompok menuliskannya di atas kertas dan minta kelompok untuk menuliskan jika ada cara pengobatan lain yang ingin ditambahkan. • Contoh pertanyaan: tolong sebutkan semua cara pengobatan yang bapak/ibu ketahui. • Minta setiap kelompok untuk: • Menuliskan di atas kertas nama-nama anggota kelompok, jenis kelamin dan usia • (dengan fasilitasi) membuat kesepakatan dengan seluruh partisipan apa yang dimaksud •

•

• •

Divide participants into small groups based on sex and age similarity. Present to the participants the result from Interview I about the way of treatments / health care sources when the respondent experience illnesses. Ask every group to copy the list on their paper and ask them to add if there are other health care sources they know. Example of question: please tell us all health care sources that you know. Ask every group to: • write down the name, sex and age of all small group members. • (by facilitation) develop agreement with all participants on the meaning of criteria ‘important / beneficial’ and ‘frequently used’. • do weighted ranking for all health care sources based on (1) its importance and (2) 57

•

o

o

o

o •

dengan kriteria ‘penting/bermanfaat’ dan ‚sering/tidak sering digunakan. Melakukan weighted ranking untuk setiap cara pengobatan berdasarkan (1) pentingnya / manfaat yang dirasakan dan (2) frekuensi penggunaan. Bagikan masing-masing kelompok 100 biji dan minta setiap kelompok untuk mendistribusikannya kepada masing-masing cara pengobatan yang sudah dituliskan sebelumnya. Semakin (1) penting/besar manfaat atau (2) makin sering digunakan cara pengobatan tersebut, makin banyak jumlah biji yang diberikan. Jelaskan bahwa cara pengobatan yang mendapatkan 30 biji berarti cara pengobatan tersebut dianggap 3 kali lebih penting daripada cara pengobatan yang mendapat 10 biji. Setelah selesai, tulis jumlah biji yang diberikan untuk masing-masing cara pengobatan. Beri beberapa contoh dan latihan mengenai weighted ranking. Contoh: buat weighted ranking berbagai macam buah-buahan berdasarkan ukurannya. Semakin besar ukurannya, semakin banyak jumlah biji yang diberikan untuk nama buah tersebut. Jika durian mendapatkan 30 biji, and mangga 10 biji, berarti durian 3 kali lebih besar daripada mangga.

B. Identifikasi masalah dalam pelayanan kesehatan yang ada: •

•

•

Minta setiap kelompok, untuk menyebutkan semua masalah yang dirasakan dalam hal kesehatan. Untuk setiap cara pengobatan yang telah diidentifikasi sebelumnya, tanyakan adakah masalah yang dialami oleh anggota kelompok ketika menggunakan / berhubungan dengan cara pengobatan tersebut? Minta setiap kelompok untuk: • menuliskan seluruh list masalah. • menuliskan masalah tepat disebelah nama cara pengobatan yang terkait.Contoh: Rumah sakit: mahal, jauh, pendaftaran memusingkan,etc. • di kertas baru: minta setiap kelompok untuk menuliskan (urutkan ke bawah) semua masalah yang ada. Masalah yang sama dituliskan satu kali saja. • membuat kesepakatan dengan seluruh partisipan apa yang dimaksud dengan kriteria masalah ‘penting’. • melakukan weighted ranking untuk semua masalah menurut kriteria masalah yang penting. • Jangan lupa menuliskan nama anggota setiap kelompok, jenis kelamin dan usia di setiap kertas yang digunakan oleh kelompok.

frequently used. Distribute 100 counters to each group and ask them to distribute it among the list of health care sources that have been identified giving more counters to those that are more important or more frequently used. o Explain that 30 counters on one item and 10 on another would mean that the former was trice as important as the latter. o

o

Whenever ready, write down the number of counters given for each item.

•

Give several examples and exercises about weighted ranking. Example: weighted ranking among fruits based on the size. If durian is weighted 30 counters and mango is 10, it means that durian is 3x bigger than mango.

B. Problem identification in existing health care services: Ask participants in small group to tell all problems they have in relation to health care. • For every health care sources that have been identified previously, ask the group whether there are while using those health care sources? . Ask every small group to: • write down the list of the problems. • write down the problems right after the related health care sources. Example: Hospital: expensive, far away, complicated registration process, etc. • use new paper, ask every group to list all identified problems. The same problem should be written only once. • develop agreement with all participants on the meaning of criteria ‘important’ problem. • weighted ranking all problems based on criteria important problem. • remind the group not to forget to write down the name, sex and age of all small group members. •

C. Identification of relevant factors that influence the problems: •

By using the same paper as for problem listing, ask every group to write next to each problem: relevant factors that influence the problem (might be positive or negative influences). Example of question: what factors might influence the problem (might be making 58

C. Identifikasi faktor yang berkaitan / mempengaruhi masalah:

it better or worse)? Example: problem identified is difficulty to meet mantri because he is rarely at home, busy visiting his patients in the village. • Collect all the paper from every group. • Inform the participants that the researchers will wrap up the result of today discussion and will present it in the next meeting. Make agreement on the date for the second scenario building meeting. •

Gunakan kertas yang sama untuk rangkuman masalah, minta kelompok untuk menuliskan di samping setiap masalah : faktor apa yang berkaitan atau dapat mempengaruhi masalah tersebut (untuk menjadi lebih baik atau lebih buruk). Contoh pertanyaan: faktor apa saja yang dapat mempengaruhi masalah tersebut (dapat menjadi lebih baik atau lebih jelek) • Contoh: masalah sulit menemui mantri, karena mantri selalu tidak ada di tempat - sibuk berkeliling desa. • Kumpulkan semua kertas hasil setiap kelompok. • Informasikan bahwa peneliti akan merangkum semua hasil diskusi hari ini dan akan ditunjukkan lagi pada diskusi berikutnya. Buat kesepakatan kapan pelaksanaan scenario building II. •

MATRIKS ANALISA CARA PENGOBATAN DAN MASALAH PELAYANAN KESEHATAN

Catatan : Analisa ini dilakukan oleh peneliti ANALISA CARA PENGOBATAN 1. Buat rangkuman dari hasil seluruh kelompok berdasarkan jenis kelamin dan usia. 2. Buat tabel distribusi seperti contoh di bawah: Cara pengobatan Pengobatan sendiri Puskesmas Paraji

Penting / manfaat LK tua 1

60

Frekuensi penggunaan

LK md

PR tua

PR md

Total

LK tua

LK md

PR tua

PR md

Total

90

20

40

210

20

60

90

40

210

0 10 30 20 60 30 0 10 20 60 40 0 50 40 130 50 40 0 40 130 1 60 adalah jumlah biji yang diberikan untuk cara pengobatan ‘puskesmas’ oleh kelompok laki-laki tua. Hasil analisa dapat dibuat dalam bentuk diagram Venn; besar lingkaran menunjukkan manfaat (makin besar ukuran lingkaran, makin bermanfaat), jarak ke lingkaran tengah menunjukkan frekuensi penggunaan institusi tersebut oleh kelompok (makin dekat makin sering digunakan).

Diagram Venn ini dapat diartikan bahwa pengobatan sendiri dirasakan paling bermanfaat dan sering digunakan ketika seluruh partisipan mengalami masalah kesehatan jika dibandingkan dengan institusi Puskesmas atau paraji. 59

Catatan: nilai manfaat / frekuensi penggunaan untuk tingkat kelompok (berdasarkan usia dan jenis kelamin) mungkin berbeda dengan hasil total seluruh kelompok.

Sumber: Driyamedia untuk KPDTNT. Berbuat bersama berperan setara : acuan penerapan Participatory Rural Appraisal.November 1996. pg.115-122.

ANALISA MASALAH 1. Buat rangkuman hasil identifikasi masalah dari seluruh kelompok berdasarkan usia dan jenis kelamin. 2. Buat tabel distribusi seperti dibawah ini: Contoh: Masalah Jarak fasilitas jauh Registrasi sulit Tanaman sulit didapat

LK

LK md

80 10 10

0 10 90

Nilai penting PR PR md

10 30 60

0 60 40

Faktor yang mempengaruhi Total

90 110 200

Bbbbbbbbb Ccccccccccccc Ddddddddddd

Kesimpulan SELURUH KELOMPOK (Aggregate): Urutan pentingnya masalah 1 2 3

Masalah

Tanaman sulit didapat Registrasi sulit Jarak fasilitas jauh

Faktor yang mempengaruhi aaaaaaaaaaaaa bbbbbbbbbbbbbb ccccccccccccc

3. Untuk mengantisipasi tidak tercakupnya masalah yang spesifik kelompok (berdasarkan usia dan jenis kelamin), maka di table kesimpulan yang akan digunakan dalam tahap scenario building II, gabungkan 5-10 masalah terpenting dari setiap kelompok. • Contoh: dari tabel di atas, jarak fasilitas yang jauh berada di urutan terakhir dari daftar masalah yang dianggap penting oleh seluruh kelompok. Tetapi, jika dilihat dari hasil setiap kelompok, maka masalah jarak fasilitas yang jauh adalah masalah paling penting menurut kelompok dewasa/tua. Sumber: Puri,R.K. and Vogl,C.R. A Methods manual for ethnobiological research and cultural domain analysis: with analysis using ANTHROPAC. September 2005.

Note : this analysis is conducted by the researchers. ANALYSIS OF HEALTH CARE SOURCES 1. Summarize the results from all small groups. 2. Create distribution matrix as below: Health care sources Self treatment Puskesmas Traditional healer

Importance

Frequency of use

Men

boys

Female

F_teen

Total

M_old

M_you

F_old

F_you

Total

60 0 40

90 10 0

20 30 50

40 20 40

210 60 130

20 30 50

60 0 40

90 10 0

40 20 40

210 60 130

1

1

60 is the amount of counters that were distributed by the group of men for the importance value of ‘Puskesmas’. 60

The result of analysis can be presented in Venn diagram; the size of circle reflects the benefit (the bigger the size means the more beneficial) and the distance to the circle of group reflects the frequency of utilization (the closer the distance, the more frequent).

Venn diagram above suggests that self-treatment is perceived by all participants as the most beneficial and most frequently used by participants when they get ill, in comparison to Puskesmas and Traditional healer.

Source: Driyamedia untuk KPDTNT. Berbuat bersama berperan setara : acuan penerapan Participatory Rural Appraisal. November 1996. pg.115-122.

PROBLEM ANALYSIS: 1. Summarize the results from all small groups. 2. Create distribution matrix as below: Example: Problem Distance Registrastion Difficulty to find medicinal plant

Men

boys

80 10 10

0 10 90

Importance Female F_teen

10 30 60

0 60 40

Influential factors Total

90 110 200

Bbbbbbbbb Ccccccccccccc Ddddddddddd

Conclusion from all participants (Aggregate): List of importance 1 2 3

Problem

Difficulty to find medicinal plant Registrastion Distance

Faktor yang mempengaruhi aaaaaaaaaaaaa

bbbbbbbbbbbbbb ccccccccccccc

3. In order to involve the group-specific problems in the aggregate table, to be used later in scenario building II, the 5-10 most important problems from each group should be listed. • Example: from the table above, the distance comes at the end of the aggregate list. But it is actually the most important problem according to the group of men.

Source: Puri,R.K. and Vogl,C.R. A Methods manual for ethnobiological research and cultural domain analysis: with analysis using ANTHROPAC. September 2005.

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SCENARIO BUILDING II Membangun Community-Based Scenario Development of Community-Based Scenario

Persiapan untuk diskusi: • lakukan ice breaking games • siapkan kertas ukuran besar • alat tulis • digital recorder • satu peneliti memfasilitasi, satu peneliti mencatat proses 1.

2.

3.

4.

5.

Presentasikan hasil identifikasi masalah dan insitusi kesehatan dari scenario building I. Ceritakan bahwa gambaran tersebut adalah kondisi sekarang. Tanyakan apakah seluruh partisipan setuju dengan gambaran tersebut. Informasikan kepada partisipan bahwa diskusi kali ini bertujuan untuk menggali (1) harapan / keinginan juga yang tidak diharapkan oleh masyarakat dalam hal pelayanan kesehatan dan (2) mencari jalan keluar yang mungkin untuk memecahkan masalah yang sudah diidentifikasi untuk mencapai harapan. Informasikan bahwa peneliti hanya memfasilitasi saja, tidak ada kepentingan akan hasil akhir. Partisipan bebas untuk mengutarakan keinginnannya. Bisa ditambahkan bahwa hasil diskusi ini akan merupakan keinginan dan rencana masyarakat untuk peningkatan pelayanan kesehatan. Ini bisa diusulkan kepada pemerintah daerah, misalnya kepala desa atau kepala Puskesmas. Peneliti akan mendokumentasikan hasil diskusi ini dan nanti akan dibagikan kepada masyarakat desa. Bagi partisipan ke dalam kelompok-kelompok kecil berdasarkan jenis kelamin dan usia (lakilaki tua, – muda, perempuan tua,-muda).

Preparation for discussion: • conduct ice breaking games • big size paper • stationaries • digital recorder • one researcher as facilitator, the second researcher makes note on the process. 1. Present the result of identification of problem and institution from scenario building I. Ask the participants for agreement. 2. Inform participants that discussion this time is aimed to (1) explore the community’s hope / expectations as well as the unexpected situations in term of health care services and (2) to find the possible pathway to solve the identified problems and to fulfil the expectations. 3. Inform the participants that the researchers have no interest in the outcomes of the discussion. Participants are encouraged to express their thoughts freely. 4. Suggested to inform the participants that the result of the discussion might be documentation on community’s expectation and plans for improvement of health care services. This can be further proposed to local government, such as village’s head or head of Puskesmas. Researchers will document the results of this discussion and later will be distributed to the villagers. 5. Divide participants into small groups based on sex and age similarity.

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A. ‘BISNIS AS USUAL’ SKENARIO

B. ‘BUSSINESS AS USUAL’ SCENARIO

Tujuan 2: untuk mengetahui apa yang dibayangkan akan terjadi oleh masyarakat jika kondisi (pelayanan kesehatan) tetap seperti sekarang

Purpose 2: to learn what community’s predictions when the conditions of health care service stay the same.

Metode: Skenario Proyeksi

Method: Projection Scenario

1. Minta seluruh partisipan untuk memilih waktu tertentu dimasa depan sebagi titik akhir proyeksi, misalnya, 10 tahun ke depan. 2. Buat kriteria bersama mengenai kondisi sekarang. 3. Dibandingkan dengan kriteria tersebut, bagaimana menurut partisipan kondisi sekarang? 4. Fasilitasi partisipan dalam kelompok-kelompok kecil untuk membayangkan apa yang akan terjadi pada mereka (dalam 10 tahun kedepan) jika kondisi pelayanan kesehatan tetap seperti sekarang. Minta setiap kelompok untuk menggambarkan atau menuliskan hasil perkiraan tersebut. 4. Minta salah satu anggota kelompok untuk mempresentasikan scenarionya didepan peserta yang lain. Fasilitator mencatat penjelasan yang dipresentasikan. 5. Fasilitasi diskusi dengan menanyakan: • Apa yang diperkirakan akan terjadi? • Masalah apa yang akan menjadi lebih baik/buruk? • Bagaimana partisipan mengetahui suatu kondisi menjadi lebih baik atau buruk?

1. Ask all participants to select specific time in the future to use as endpoint for projection, i.e. in coming 10 years. 2. Produce criteria of existing conditions. 3. Compared to the criteria, what do the participants think about present condition? • Using the institutional diagram and identified problems, invite participants to reflect in small group about what will happen in (10 years) to them if the condition of health care services stay the same. Ask every group to draw or write down the predictions. 4. Ask one representative of each group to present their projection scenario in front of other participants. Facilitator is responsible to record the presentation. 5. Facilitate the discussion about: • What do they think might happen? • Which problems

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B. POSITIF SKENARIO : Sirnarasa / Tanjung Sari yang diinginkan

B. POSITIVE SCENARIO : Sirnarasa / Expected Tanjung Sari

Metode: Skenario Visi

Method: Vision Scenario

Tujuan 1 : Untuk mengetahui APA YANG DIINGINKAN oleh masyarakat berkaitan dengan pelayanan kesehatan

Purpose 1: To know WHAT do the people WANT with regards to the health services

1. Tanyakan pada partisipan, seperti apa kondisi pelayanan kesehatan yang mereka inginkan. Catatan : hasil dari pertanyaan sebelumnya mengenai ”apa yang dianggap penting dalam pelayanan kesehatan” dapat dijadikan alat bantu. 2. Minta partisipan dalam kelompok kecil untuk menuliskan apa yang mereka inginkan dalam hal pelayanan/fasilitas kesehatan. Contoh pertanyaan : ”pelayanan kesehatan seperti apa yang Bapak/Ibu inginkan ? Pelayanan kesehatan seperti apa yang dianggap terbaik?” Tips : sebagai pancingan dapat diberikan contoh berdasarkan kriteria dari proses sebelumnya apa yang dianggap penting oleh partisipan dalam hal pelayanan kesehatan. 3. Beri waktu partisipan untuk berfikir mengenai keinginan mereka sendiri. 4. Minta satu wakil dari setiap kelompok untuk mempresentasikan skenarionya di depan peserta lainnya. Gunakan flipchart, gambar untuk membantu. Presentasi ini sebaiknya disertai dengan penjelasan dari presenter (jangan lupa, penjelasan ini dicatat oleh fasilitator kedua). 5. Fasilitasi presentasi dengan menanyakan : • Apa yang akan berubah dalam kehidupan partisipasi jika keinginan ini terpenuhi ? • Siapa yang diperkirakan akan diuntungkan dan dirugikan ? 6. Tujukkan hasil seluruh kelompok dan konfirmasikan pada participan kesamaan/ ketidaksamaan antara skenario hasil kelompok. 7. Tugas fasilitator kedua : jadikan skenarioskenario yang memiliki kesamaan cerita/alasan menjadi satu skenario (integrated scenario). Mungkin saja dihasilkan lebih dari satu integrated scenario.

1. Ask every participant about the expected condition of health services that they want. Notes : the result from the previous question about “what is important in the health services” could be used as the supporting materials. 2. Ask the participants in the smaller group to write down what they want in the regards of health services. For example : “what kind of health services that you want ?” or “Which kind of health services that you regard as the best?” a. Tips : to provoke the participants, we can give them some examples based on the criteria used in the previous process regarding the participant’s opinion about what’s is important in the health services. 3. Give the participants time to think about their own will. 4. Ask a representative of each group to present their scenario in front of other participants. Use flipchart, graphic to support the presentation. This presentation is better supported by the explanation from the presenter. (This presentation nd should be noted by the 2 facilitator). 5. Facilitate the presentation by asking : • What will change in the participatory process if the will is fulfilled? • Who are going to gain and who are going to loose? 6. Show the result of all groups and confirm to the participants about the similarities or un-similarities of the scenario of each group. nd 7. Task of 2 Facilitator : to cluster the scenarios with similar story and reason into one scenario (integrated scenario). It is possible to have more than one integrated scenario.

64

C. NEGATIVE SKENARIO : Sirnarasa / Tanjung Sari yang tidak diinginkan

C. NEGATIVE SCENARIO : knowing the unwanted

Tujuan 3: mengetahui apa yang diperkirakan oleh masyarakat akan terjadi jika kondisi pelayanan kesehatan menjadi lebih jelek daripada sekarang

Purpose 3: To know WHAT do the people expect if the health services become worse then at the present.

1. Tanyakan kepada partisipan, apa kondisi pelayanan kesehatan yang tidak diinginkan oleh mereka / dikhawatirkan akan terjadi. 2. Minta partisipan dalam kelompok kecil untuk menuliskan apa yang tidak mereka inginkan dalam hal pelayanan / fasilitas kesehatan. Contoh pertanyaan : ”pelayanan kesehatan seperti apa yang Bapak / Ibu tidak inginkan ? Pelayan kesehatan seperti apa yang dianggap jelek ? 3. Beri waktu partisipan untuk berfikir mengenai keinginan mereka sendiri. 4. Minta satu wakil dari setiap kelompok untuk mempresentasikan skenarionya di depan peserta lainnya. Gunakan flipchart, gambar untuk membantu. Presentasi ini sebaiknya disertai dengan penjelasan dari presenter (jangan lupa, penjelasan ini dicatat oleh fasilitator kedua). 5. Fasilitasi presentasi dengan menanyakan : 6. Apa yang akan berubah dalam kehidupan partisipasi jika keinginan ini terpenuhi ? 7. Siapa yang diperkirakan akan diuntungkan dan dirugikan ? 8. Tujukkan hasil seluruh kelompok dan konfirmasikan pada participan kesamaan/ ketidaksamaan antara skenario hasil kelompok. 9. Tugas fasilitator kedua : jadikan skenarioskenario yang memiliki kesamaan cerita/alasan menjadi satu skenario (integrated scenario). Mungkin saja dihasilkan lebih dari satu integrated scenario.

Beri partisipan istirahat sekitar 10 menit. Fasilitator mempersiapkan integrated scenario (untuk setiap +,0,- scenario) di atas kertas untuk kemudian di ranking bersama-sama dengan partisipan di tahap berikutnya

1. Ask every participant about the un-expected condition of health services which they don’t want / afraid to happen. 2. Ask the participants in the smaller group to write down what they do not want in the regards of health services. For example: “what kind of health services that you don’t want?” or “Which kind of health services that you regard as not good?” 3. Give the participants time to think about their own will. 4. Ask a representative of each group to present their scenario in front of other participants. Use flipchart, graphic to support the presentation. This presentation is better supported by the explanation from the presenter. (This presentation nd should be noted by the 2 facilitator). 5. Facilitate the presentation by asking : 6. What will change in the participatory process if the will is fulfilled? 7. Who are going to gain and who are going to loose? 8. Show the result of all groups and confirm to the participants about the similarities or un-similarities of the scenario of each group. nd 9. Task of 2 Facilitator : to cluster the scenarios with similar story and reason into one scenario (integrated scenario). It is possible to have more than one integrated scenario.

Make 10 minutes break. Meanwhile, the facilitator resume and prepare the integrated scenario (for each +,0,- scenario) on the paper to be ranked by all participants during next step.

65

SKENARIO RANGKING

SCENARIO RANKING

1. Presentasikan seluruh gambar/hasil integrated scenario (+,0,-) beserta kriteri/ciri-ciri yang dihasilkan untuk setiap skenario 2. Tanyakan apakah semua partisipan setuju dengan gambaran dan criteria tersebut, ataukah ada yang perlu diubah. 3. Dengan menggunakan criteria diatas, ranking berbagai integrated scenario berdasarkan mana yang paling diinginkan (untuk scenario + dan 0) dan yang paling tidak diinginkan (untuk scenario -) oleh seluruh partisipan. 4. Fasilitasi diskusi mengenai situasi jika scenario (+,0,-) yang menempati ranking tertinggi menjadi kenyataan: • Apa yang diperkirakan akan berubah/terjadi pada kehidupan masyarakat? • Menimbang kondisi sekarang, apa yang perlu dilakukan agar (-) scenario tidak terjadi dan (+) scenario terjadi? • Siapa actor yang berperan dalam perubahan tersebut? 5. Dengan menimbang kondisi sekarang, integrated scenario yang mana yang diperkirakan oleh partisipan paling mungkin terjadi untuk (+,0,-) scenario? Mengapa?

1. Presenting all the pictures/result from integrated scenarios (+,0,-) with criteria resulted for each scenario. 2. Ask for opinions from all participants. 3. By using the criteria, ask participants to rank those integrated scenarios based on the most wanted scenario (for + and 0 scenario), and the most unwanted (for – scenario). 4. Facilitate discussion about what happen if the scenarios (+,0,-) in highest rank take place: • What do they think will change or happen in their daily life? • Considering present condition, what should be done to prevent the (-) scenario doesn’t take place, and the (+) scenario takes place? • Who are the actors which play role in those changes? 5. Considering present condition, which integrated scenario (+,0,-) might take place? Why?

Di akhir diskusi, presentasikan seluruh scenario (+,0,-) kepada seluruh partisipan dan informasikan bahwa kita berencana menuliskan seluruh hasil penelitian ini (termasuk tanaman obat dan penyiapannya) dan memberikan hasilnya kepada masyarakat agar dapat digunakan. Tanyakan media apa yang mereka inginkan (buku, kalender, poster,etc.)

At the end of discussion, present all the scenarios (+,0,-) in front of participants and inform them that we plan to write down the all results (including the identified plants, recipes) from this research and give it to the community. Ask them in which kinds of media they want to have it (book, calendar, poster).

References for Scenario Building method: 1. Wollenberg,E., Edmunds,D. Buck,L. 2000. Scenarios; as a tool for adaptive forest management. CIFOR Indonesia. 2. Puri,R.K. and Vogl,C.R. September 2005. A Methods manual for ethnobiological research and cultural domain analysis: with analysis using ANTHROPAC. 3. Driyamedia untuk KPDTNT. November 1996. Berbuat bersama berperan setara : acuan penerapan Participatory Rural Appraisal. pp.115-122. 4. Sheil,D.,Puri,R.K.,et al. 2002. Exploring biological diversity, environment and local people’s perspectives in forest landscapes: methods for a multidisciplinary landscape assessment. CIFOR Indonesia 5. Global Business Network. The Mont Fleur Scenarios: What will South Africa be like in the year 2002?. Deeper News Vol.7.No.1 6. Bloor,M., Frankland,J., Thomas,M., Robson,K. Focus Groups in Social Research. Forum Qualitative Social Research.Vol.3, No.4. November 2002. 7. Milliken,W.Conservation,Economics,Traditional Knowledge,and the Yanomami: Implications and Benefits for Whom? In Human Impacts on Amazonia. The Role of traditional ecological knowledge in conservation and development. Ed.Posey,D.A.and Balick,M.J.2006.Colombia University Press,NY.

66

1

1

1

5

Bawang bodas

Haur koneng

Sembung

Kunci Lapa

Cabe

Gedang rayun

Antanan

Allium sativum L.

Bambusa vulgaris Schrad.

Blumea balsamifera (L.) DC.

Boesenbergia rotunda (L.) Mansf.

Capsicum annuum L.

Carica papaya L.

Centella asiatica (L.) Urb.

2

3

4

5

6

7

8

15

1

7

2

Bawang ganda

Allium cepa L.

1

0.420

0.114

0.003

0.014

0.080

0.001

0.003

0.050

Sembung

(1) After delivery care ,(2)abdominal discomfortfeeling to vomit,gastritis

(1) Perawatan setelah melahirkan,(2) obat seueul

Pepaya

Antanan

Healing small wound

Body and muscle pain (1) After delivery care, (2) Reconditioning vaginal function


Obat sakit badan/pegal linu, melenturkan otot

(1) Perawatan setelah melahirkan, (2) Obat rapet

Cabe rawit

Lower back pain

Obat sakit pinggang Kunci

Bambu kuning

Bawang putih

Bawang merah

Local Name

Treating jaundice

Rheumatism

Insect bite

Local Use

Obat sakit kuning

Obat encok

Obat digigit serangga

Local Use

IN SIRNARASA

Freq. Smith's

Local Name

Scientific Name

2

6

1

19

28

1

2

8

Freq.

0.045

0.141

0.022

0.028

0.516

0.024

0.033

0.211

Smith's

Menurunkan demam (daun)

(1) Meningkatkan air susu ibu, (2) obat anti nyamuk

Mengeluarkan bisa ular

Obat mencret


Obat hepatitis

Menurunkan kolesterol

Obat panas/demam

Local use

IN TANJUNGSARI

Fever (leaf)

(1) Increasing breast milk production, (2) Mosquito repellent

Snake bite

Treating diarrhea

(1) After delivery care (reconditioning the womb), (2) Treating vaginal discharge/leucorrhoe

Hepatitis symptom

Reducing cholesterol

Treating fever

Local use

Antitoxin toward Pithecelobium jeringa (jengkol)

Sastroamidjojo

67

IMPGC (http://www.impgc.com/plan tinfo_A.php?id=14)

For atony of intestines and stomach, indigestion, rheumatism, neuralgia.

(1) Sastroamidjojo, (2) Pemda Jabar

IMPGC (http://www.impgc.com/plan tinfo_A.php?id=1887)

Internal use for coughs, indigestion, diarrhea, sprue, and colic (rhizomes and roots), and as external treatment for ringworm, rheumatic, wounds, swollen abdomen (rhizomes and roots).

Difficult urination (leaf), enhancing appetite, treating jaundice (flower), digestive problem, helmintic (gum sap)

Sastroamidjojo

Enhance appetite (root), maintaining stamina (leaf), gastric problem, stomachache, helminthic (gum sap)

ASEAN Centre for Biodiversity (http://www.aseanbiodiversi ty.org/medicinal_plants/pag e2.htm)

Arteriosclerosis, asthma, bladder, bronchitis, cancer, influenza, leukemia (bulb).

Antiemetic, hemostatic, and antispasmodic (bark)

IMPGC (http://www.impgc.com)

Common cold, bronchitis, jaundice influenza

Reference IMPGC (http://www.impgc.com/plan tinfo_A.php?id=77)

Medicinal Use

PUBLIC DATABASE

MEDICINAL PLANT SPECIES FREELISTED ONLY BY RESPONDENTS IN SIRNARASA AND TANJUNGSARI (1)

5.4 List of medicinal plant species in two researched villages

13

3

8

17

Jawer Kotok

Ketimun

Koneng hideung

Kunyit/kon eng

Koneng gede/kone ng lalab

Sereh

Dadap

Coleus blumei Benth.

Cucumis sativus L.

Curcuma aeruginosa Roxb.

Curcuma longa L.

Curcuma xanthorrhiza Roxb.

Cymbopogon winterianus Jowitt

Erythrina subumbrans (Hassk.) Merr.

11

12

13

14

15

16

17

2

3

1

5

Kalapa

Cocos nucifera L.

10

5

Jeruk Nipis

0.057

0.068

0.270

0.129

0.068

0.006

0.309

0.076

0.102

Kelapa

Jawer Kotok

Body and muscle pain

(1) Disinfectant, (2) Stop wound from bleeding Treating high blood pressure

Obat sakit badan, pegal linu

(1) Disinfektan, (2) Menghentikan pendarahan

Obat darah tinggi

(1) Obat sakit panas, (2) obat iritasi mata (tetes mata) (1) Fever, (2) Eyedrops

Dadap

Sereh wangi

Koneng gede

Body and muscle pain, lower back pain (due to physical work)

(1) Obat sakit badan, pegal linu, sakit pinggang (1) Treating sprue, scurvy, (2) body and muscle pain

Kunyit/konen g/koneng temen

(1) Abdominal discomfortfeeling to vomit,gastritis, (2)diarrhea, (3) Enhancing appetite

(1) Obat seueul/maag, (2) obat mencret, (3) menambah nafsu makan

(1) obat sariawan, (2) obat sakit badan

Koneng hideung


Obat sakit badan

Timun

Jeruk nipis

(1)Coughing, (2)Chills

Local Name

Local Use

Local Use

(1) Obat batuk, (2) obat panas dingin

IN SIRNARASA

Freq. Smith's

9

Local Name

Citrus aurantifolia Swingle

Scientific Name

1

9

29

25

17

1

26

3

8

0.026

0.216

0.576

0.283

0.336

0.021

0.357

0.078

0.203

Freq. Smith's

Obat panas dalam (daun)

(1) Obat flu, (1) Obat pilek

Obat maag

Treating hot stomachache symptom (leaf)

(1) Flu and common cold, (2) runny nose

Gastritis

Treating gastritis

(1)Gastritis, (2) Enhancing appetite, (3) Maintaining stamina


Obat maag

Reduce smell

(1) After delivery care (reconditioning the womb), (2) Treating worm (helminthic) infection

Coughing

Coughing

Local use

Menghilangkan bau

(1) Perawatan setelah melahirkan (mengecilkan rahim), (2) obat cacingan

Obat batuk

Obat batuk

Local use

IN TANJUNGSARI

To treat spleen afflictions (bark), after giving birth treatment (young leaves), eye-wash (juice of leaf)

68

IMPGC (http://www.impgc.com/planti nfo_A.php?id=2032)


(1) Sastroamidjojo, (2) Pemda Jabar, (3) LIPI

(1,2,3) Enhance appetite, digestive problems, stomachache, obstipation (rhizome), (2,3) skin infection, treating seizures, hemorrhoid, enhance breast milk (rhizome) Treat minor cuts and bruises (poultice of leaves), against internal disorder (extract leaves)


(1,2) Skin itching, ginggivitis (rhizome), (2) fever, diarrhea, short breath, enhance appetite (rhizome), (3) treating malaria, helminthic, sprained muscle, rheumatism (rhizome)

(1) Sastroamidjojo, (3) LIPI


Diuretic (seed), to treat dyspepsia in children (leave juice),treat blemished skin, heat rash (fresh fruit), a poultice for burns, sores and softening the skin. (1,3) After delivery treatment (40 days), ulcers (rhizome), (3) helminthic, obstipation,enhance appetite, healing wound (rhizome)

Sastroamidjojo



Reference

Diarrhea (root), helminthic (leaf), Difficult urination (gum sap)

(1) Sore throat (gum sap), (2) coughing (fruit), bronchitis, flu (leaf), dysentery (root) (1) Antitoxin (water of young coconut), ulcer and swelling (fruit), burnt wound and hair treatment (coconut oil), (2) diarrhea, dysentery (root), enhance stamina (coconut water)

Medicinal Use

PUBLIC DATABASE

Local Name

Handeuleu m

Cikur

Buntiris

Paria

Kumis kucing

Alpuket

Mahkota dewa

Cecendet

Seureuh

Scientific Name

Graptophyllum pictum (L.) Griff.

Kaempferia galanga L.

Kalanchoe crenata (Andr.) Haw.

Momordica charantia L.

Orthosiphon stamineus Benth.

Persea gratissima Gaertn.

Phaleria macrocarpa (Scheff.) Boerl.

Physalis angulataL.

Piper betle L.

18

19

20

21

22

23

24

25

26

6

18

1

1

4

1

7

11

2

0.047

0.479

0.011

0.016

0.072

0.020

0.194

0.296

0.027

Freq. Smith's

Treating muscular pain, low back pain (due to physical work), rheumatism? (1) Eyedrops, (2) Disinfectant , (3) Treating sprue, scurvy

Obat sakit badan, pegal linu, sakit pinggang, encok

(1) Obat tetes mata, (2) desinfektan, (3) obat sariawan Sirih

Cecendet

Diabetes

Alpuket

(1) Lower back pain, (2) abdominal discomfort, gastritis

(1) Obat sakit pinggang, (2) Obat seueul

Mahkota dewa

Kumis kucing

(1) Treating kidney stone symptoms, (2) After delivery care

(1) Obat gejala ginjal, (2) perawatan setelah melahirkan

Obat kencing manis

Paria/pare

Buntiris

(1) Treating fever, (2) Eyedrops,

Eyedrops

Cikur/kencur

Handeuleum

Local Name

(1)Headache, (2)sprained muscles,luxati on, (3) To warm body

Fever

Local Use

Obat tetes mata

(1) Obat sakit kepala/pusing/l ieur/rieut, (2) obat keseleo, penghangat bayi (1) Obat sakit panas, (2) obat iritasi mata (tetes mata)

Obat sakit panas

Local Use

IN SIRNARASA

8

1

5

5

29

6

1

28

2

0.186

0.023

0.139

0.132

0.227

0.146

0.032

0.120

0.062

Freq. Smith's

(1) Obat batuk, (2) obat gatal, (3) obat keputihan

(1) Coughing, (2) skin itching, (3) Treating vaginal discharge/leucorrho e

Treating high blood pressure

(1,2) women health, coughing (leaf), toothache/swollen gum (gum sap), (2) sprue, eyedrops, boil (leaf),

Rheumatism and swelling (leaf)

Dysentery (fruit skin), anti-tumor and ulcer (leaf),

(1) Diabetes, (2) rheumatism,uric acid symptoms (3) Treating high blood pressure (1) Obat diabetes, (2) obat rematik, asam urat, (3) obat darah tinggi

69


Sastroamidjojo

BPPT-Teknologi Tepat Guna Pengelolaan Tanaman Obat (http://iptek.apjii.or.id/artikel/tt g_tanaman_obat/depkes/buk u5/5-074.pdf)

BPPT-Teknologi Tepat Guna Pengelolaan Tanaman Obat (http://iptek.apjii.or.id/data/tan aman/kat_mid.htm)

IMPGC (http://www.impgc.com/planti nfo_A.php?id=204) Treat jaundice (leaf), diabetes, rheumatism and snakebite (fruit), induce abortion (dried root).

(1) Sastroamidjojo, (3) LIPI


Headache, smallpox, rheumatism, stiff joint, earache (juice of leaves), spetic wound (dry leave), expel intestinal worms and gonorrhoea (root)

(1,3) Kidney stone symptoms, bloody urine (whole plant), (3) treating high blood pressure (leaf)

Pemda Jabar

Obat darah tinggi

Obat darah tinggi

Reference ASEAN Centre for Biodiversity (http://www.aseanbiodiversity. org/medicinal_plants/page4.h tm)

Abdominal distension, coughing, boil, swelling

Diuretic and to treat ulcer, hemorrhoids, gallstone and liver disease (leaf)

Medicinal Use

Treating sprue (flesch), kidney stone, high blood pressure, gastritis (leaf), diabetes, toothache (seed). Leaf has antibacterial activity.

Difficult urination

Fever, chills

Fever

Coughing

(1) Treating high blood pressure, (2) hemorrhoid

Local use

PUBLIC DATABASE



Obat panas/demam

Obat panas

Obat batuk

(1) Obat darah tinggi, (2) Obat buang air besar berdarah

Local use

IN TANJUNGSARI

Labu siam

Kacibeling

Salam

Jahe

Lampuyan g

Sechium edule(Jacq.) Sw.

Strobilanthes crispus Bl.

Syzygium polyanthum (Wight) Walp.

Zingiber officinale Rosc.

Zingiber zerumbet (L.) Rosc. ex Smith

33

34

35

36

Katuk

32

Sauropus androgynus (L.) Merr.

5

12

1

2

1

0.081

0.286

0.022

0.013

0.017

0.005

0.073

1

Bako

Rhizophora apiculata Blume.

30

31

7

Jambu batu/biji

Psidium guajava L.

29

0.007

0.094

1

Ki Baruntas

Pluchea indica (L.) Less.

28

0.117

4

9

Ki Urat

Freq. Smith's

Plantago major L.

Local Name

27

Scientific Name

Bakau

(1) Healing small wound, (2) Skin itching

Eyedrops

(1) Obat luka kecil/raheut, (2) obat gatal

Obat sakit mata

Jahe

(1) Treating coughing, (2) To warm body, (3) Treating abdominal discomfortfeeling to vomit,gastritis Body and muscle pain (for massage)

(1) Obat batuk, (2) penghangat badan, (3) obat seueul

Obat sakit badan, pegal linu (untuk pijat)

Lampuyang

Salam

Diabetes

Pecah beling

Treating kidney stone symptom

Obat gejala ginjal

Obat kencing manis

Labu siem


Obat darah tinggi

Katuk

Jambu batu

Diarrhea

Obat diare/sakit perut/mencret

Baluntas

Ki Urat

Local Name

Diarrhea

Healing small wound

Local Use

Obat mencret


Local Use

IN SIRNARASA

3

2

1

28

4

8

1

8

3

23

0.081

0.051

0.018

0.419

0.108

0.209

0.033

0.213

0.074

0.291

Freq. Smith's

Obat kembung, maag

(1) Obat luka memar, (2) Obat demam

Obat diabetes (daun)


Abdominal distension, gastritis

(1) Bruise, (2) fever

Diabetes (leaf)

Difficult urination

Antidiabetic (leaf), diarrhea (leaf and bark extracts), against itches (leaf -external use)

Enhance appetite, stomachache, treating seizures/convulsion for children, diarrhea (rhizome)

Sastroamidjojo

70



Diuretic (leaf)

Dry cough, enhance appetite, digestive problem, diarrhea, gastritis (rhizoma), snake bite and rheumatism (rhizoma, external use)

BPPT-Teknologi Tepat Guna Pengelolaan Tanaman Obat (http://iptek.apjii.or.id/artikel/tt g_tanaman_obat/depkes/buk u1/1-275.pdf)

IMPGC (http://www.impgc.com/planti nfo_A.php?id=1807) Arteriosclerosis, hypertension, diuretic and anti-inflammatory (leaves and fruits) Treating high blood pressure

Increase breast milk production, treat fever, ulcer and boil (leaf)

(1) Increasing breast milk production, (2) Treating hot stomach symptom

(1) Meningkatkan air susu ibu, (2) obat panas dalam

Obat darah tinggi

BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/tt g_tanaman_obat/depkes/buk u1/1-258.pdf)

Dysentery

Christophe Wiart. Medicinal Plants of Asia and the Pacific, P:153, CRC Press, June 2006.


Healing wound (leaf)

(1,3) Diarrhea, dysentery, sprue (leaf), (2) coughing (leaf)

Obat luka (daun)

Obat sakit perut

Treating stomachache


For fever, as a diaphoretic and astringent (root and leaf); antidysenteric and increases nerve strength (leaf).

Treating vaginal discharge/leucorrho e

Obat keputihan


(1) Treating ulcers, kidney stone (wholeplant), (2) coughing (leaf and root)

Reference

Local use (1) Treating rheumatism,muscula r pain,sparined muscles (2) Treating uric acid symptom (joint pain)

Local use

Medicinal Use

PUBLIC DATABASE

(1) Obat rematik/pegalpegal/keseleo/salah urat, (2) obat asam urat

IN TANJUNGSARI

2

1

Meuhmal

Laja

Lame

Bayem Beureum

Tepus

Kapol

Alocasia indica (Lour.) Spach

Alpinia galanga (L.) Sw.

Alstonia scholaris(L.) R.Br.

Alternanthera amoena (Lem.) Voss.

Amomum sp.

Amomum cardamomumL.

3

4

5

6

7

8

4

6

6

1

1

Kucay

Allium tuberosum Rottler ex Spreng.

2

20

Babadotan / Jukut bau

0.022

0.024

0.034

0.093

0.076

0.017

0.015

0.453

Freq. Smith's

Ageratum conyzoides L.

Local Name

1

Scientific Name Healing small wound

Local Use Fever (root and leaf)

Medicinal Use

Obat batuk

Desinfektan

(1) Obat sakit pinggang, (2) obat panas

Treating coughing

Disinfectant

(1) Lower back pain, (2) Fever

BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_obat/depkes/buku2/2019.pdf)



IMPGC (http://www.impgc.com/plantinfo_A.php?id=306)

IMPGC (http://www.impgc.com/plantinfo_B.php?id=1776)

Sastroamidjojo

Reference

PUBLIC DATABASE

Not known (1) Rheumatismexternal use (whole plant), (2) stomachache Sastroamidjojo ( rhizome), (3) coughing (seed)

Headache (leaf)

Against tumours,intestinal Perawatan disorders, fatigue, After delivery urinary incontinence setelah treatment melahirkan (plant);applied to bites, cuts and wounds (leaves and bulbs). Useful in inflammation, (1) obat seueul, (1) Abdominal spleen (rootstock); discomfort, maag, (2) otorrhoea (juice of the penambah nafsu gastritis, (2) petiole), stomach ache enhancing appetite makan (rhizome). (1) Digestive problems, after delivery treatment, (1)Coughing, (2) skin infection (root), (2) (1) Obat batuk, Treating fungal skin Dysentery and skin (2) obat panu infection infection (root), feel to vomit (seed) (1) After delivery (1)Toothache, (2) (1) Obat sakit treatment (bark), (2) Contraceptive gigi, (2) dysentery (bark), (3) pengganti pil KB agent fever, stomachache, dysentery (bark)

Mengobati luka kecil/raheut

Local use

MEDICINAL USE OF PLANT SPECIES IN SIRNARASA

MEDICINAL PLANT SPECIES FREELISTED ONLY BY RESPONDENTS IN SIRNARASA (1)

71

Kawung

Nangka

Kanyere

Artocarpus heterophyllus Lam.

Bridelia retusa (L.) Spreng.

15

16

Pinang

13 Areca catechu L.

Arenga pinnata (Wurmb) Merr.

Ki Ajag

12 Ardisia fuliginosa BI.

14

Kacang tanah

11 Arachis hypogaea L.

Jambu dwipa/monyet

Sirsak

Anacardium occidentale L.

Local Name

10 Annona muricata L.

9

Scientific Name

1

1

6

1

11

1

1

1

0.007

0.007

0.200

0.013

0.182

0.002

0.022

0.026

Freq. Smith's

Disentri

Obat sakit perut

Dysentery

Stomachache


Obat sakit badan, pegal linu

Healing of abscesses, snakebite,glandular swellings,pharyngitis (latex ); on wounds (heated leaves); for asthma, fever and diarrhea (root extract) On wounds (bark); as a contraceptive, in hypertension and diarrhea (stem bark decoction).



Sastroamidjojo


Helminthic, wound, coughing, body slimming and diuretic (seed)

(1) Diarrhea, (2) pustular ear infection

(1) Diare,(2) Obat conge

Obstipation, sprue (water from stem)

Sastroamidjojo

Treating ulcers (gum sap)


BPPT IPTEK (http://www.iptek.net.id/ind/pd_tanobat/view.php?id=263)


Reference

PUBLIC DATABASE

Obat Treating ulcers coceng/bocek/koreng

Treating symptom Obstipation, joint pain of diarheal(seed) vomiting

Diarrhea, dysentery (young fruit, bark, leaf), obstipation (ripen fruit)

(1) Treating sprue, scurvy, (2) Reducing fever

(1) Obat sariawan, (2) Obat sakit panas

Obat muntaber

Treating obstipation (bark), sprue and acne.

Medicinal Use

Stomachache

Local Use

Obat sakit perut

Local use



72

2

Koneng Tinggang

Tawuluh

Curcuma purpurescens BL.

Cyclea barbata (Wall.) Miers

24

25

2

2

Congkok

23 Curculigo orchioides

1

4

Hanjuang

Pacing

Cordyline fruticosa (L.) Chev.

1

22 Costus speciosus Sm.

21

Condiacum 20 varicyatum Bl.

Puring

4

Alocasia macrorrhizos (L.) Schott.

Taleus hideung / sente

19

1

Taleus balitung

18 Colocasia sp.

5

0.012

0.041

0.053

0.022

0.002

0.013

0.037

0.006

0.089

Freq. Smith's

Gambas/Papasan

Local Name

Coccinia grandis 17 (L.)Voigt

Scientific Name

Abdominal discomfort, gastritis

(1) Insect bite, (2) snake bite, (3) healing wound

(1) Healing big wound, (2) Disinfectant

Obat seueul/maag

(1) Obat gatal, gigitan serangga, (2) penangkal racun ular, (3) obat luka (1) Obat luka besar, (2) disinfektan

Obat sakit panas

Fever

Obat sakit Body and muscle badan, pegal linu pain

Treating a boil

Soothing foot skin

Obat bisul

Obat kulit kaki pecah-pecah

Coughing

(1) Fever, (2) difficult urination

(1) Obat sakit panas, (2) obat susah buang air kecil Obat batuk

Local Use

Local use


Leaves as antipyretic and stomachic.

Against boils. In Indonesia, cures scable: kudis.

Antiinflammatory, stimulant and anthelmintic (rhizome); Hemorrhoids, asthma, jaundice, as an aphrodisiac and a tonic (rhizome); in piles, debility and impotence (roots)

Tuberculose, abortus, menorrhagia, hematuria, hemorrhoids, diarrhea, dysentery, gastritis and bleeding wounds (whole plant).

Coughing (gum sap)

(1) Treating chicken pox (root), (2) fever (root), (3) stomachache (stem), (4) ulcers (seed)

Medicinal Use

ASEAN Centre for Biodiversity (http://www.aseanbiodiversity.org/medicinal_plants/page2.htm)





Not known

http://iptek.apjii.or.id/artikel/ttg_tanaman_obat/depkes/buku1/1014.pdf

Not known

Sastroamidjojo

Reference

PUBLIC DATABASE


73

1

9

Randu

Babanjaran

Ki Kunti

Kacapiring

Ki Cantung

Eupatorium inulifolium H.B.K

Ficus edelfeltii King

Gardenia jasminoides Ellis

Gigantochloa apus Awi Tali Kurz

Awi Gombong

Eriodendron afractuosum DC.

Gigantochloa verticillata (Willd.) Munro

Goniothalamus macrophyllus

28

29

30

31

32

33

34

1

9

13

2

8

7

Jonge

Emilia sonchifolia (L.) DC.

27

12

Cangkore

Dinochola scandens

0.019

0.258

0.002

0.140

0.162

0.058

0.074

0.154

0.329

Freq. Smith's

26

Scientific Name

Local Name Local Use

(1)Coughing, (2) Eyedrops, (3) Treating ulcers

(1) Obat batuk, (2) obat iritasi mata (tetes mata), (3) obat coceng/koreng

Fever

(1)Coughing, (2) Eyedrops, (3) fever

(1) Obat batuk, (2) obat iritasi mata (tetes mata), (3) obat sakit panas Obat sakit panas

(1) Healing small wound, (2) Fever

(1) Obat luka kecil/raheut, (2) obat sakit panas

Obat sakit Treating fever, panas,demam/muriang chills

Skin itching

Treating chills

Obat sakit panas, demam, muriang

Obat gatal

Abdominal discomfort-feeling to vomit, gastritis

Obat seueul/maag

(1) Obat tetes mata, (1) Eyedrops, (2) obat batuk, (3) obat (2)coughing,(3) kencing manis diabetes

Local use


Sastroamidjojo

Coughing, asthma, intestinal infection, uretritis, hair treatment (leaf), difficult urination, kidney stone (bark)

Headache, dyspepsia, nervous disorders, and fever (root), jaundice and diseases of kidneys and lungs (fruit), febrifugous poultice (leaf).

Not known


Not known

Hidayat,A. 2002 (http://www.unej.ac.id/fakultas/mipa/vol3,no2/amrun.pdf)


Problems with bowel, relieve cut (plant), eye inflammation, headache (leaf), diarrhea (root)

Anticancer

BPLHD Jabar http://www.bplhdjabar.go.id/kategori/kehati/etnobotani.cfm?d oc_id=165

Reference

Coughing, eyedrops

Medicinal Use

PUBLIC DATABASE


74

2

3

Hui areuy

Jukut Kakasuran

Ipoemoea batatas (L.) Lam.

39

Lagenaria leucantha Rusby.

Harendong

Singkong

Manihot esculenta Crantz

45

Melastoma 46 malabathricum L.

Limus

7

2

1

4

Tangkur Gunung

Mangifera foetida Lour.

2

9

Korejag

44

42

Laurentia longiflora (L.) Paterm. Lophaterum gracile 43 Brongn.

41

Kukuk

4

Imperata cylindrica (L.) Eurih Beauv.

38

40 Isachne globosa O.K

2

Hibiscus rosa-sinensis Jukut L. wawaderan

37

1

Sariawan

Helicia robusta Roxb. R.Br.ex Wall

36

4

Kalingsir

0.154

0.013

0.025

0.030

0.012

0.137

0.055

0.021

0.115

0.007

0.005

0.035

Freq. Smith's

Gynura procumbens (Lour.) Merr.

Local Name

35

Scientific Name

(1) Obat (1)Stomach upset, diare/sakit diarrhea (2) perut/mencret, toothache (2) obat sakit gigi

Healing wound

(1) Body and muscle pain, (2) chills

(1) Obat sakit badan, (2) obat panas dingin Obat luka

Aphrodisiac

Obat kuat

Eyedrops

Fever, chills

Obat sakit panas, demam, muriang Obat tetes mata

Disinfectant

Desinfektan

Treating boil

(1) Healing small wound, (2)body and muscle pain

(1) Obat luka kecil/raheut, (2) obat sakit badan Obat bisul

Disinfectant

Desinfektan

Disinfectant

(1) Treating a boil, (2) Treating jaundice

(1) Obat bisul, (2) Obat penyakit kuning Desinfektan

Local Use

Local use


Not known


Reference

PUBLIC DATABASE

ASEAN Centre for Biodiversity (http://www.aseanbiodiversity.org/medicinal_plants/page 5.htm)


Not known

BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_obat/depkes/bu ku4/4-057.pdf)

Not known

Ludvik,B., Neuffer,B., Pacini,G. 2004.

Pemda Jabar

For smallpox, diarrhea (leaf) IMPGC (http://www.impgc.com/plantinfo_A.php?id=1039) healing wounds, skin diseases (bark, root)

For headache, colds and fever; treats gastric constipation.

Used against trichophytosis, scabies and eczema (seeds).

High fever (fruit)

Diabetes

Coughing and runny nose (whole plant)

Soothes irritated tissues, IMPGC (http://www.impgc.com/plantinfo_A.php?id=478) relaxes spasms, excessive and painful menstruation(leaf), mumps, fever,sores (flower)

The plant is used for kidney troubles. A decoction of plant is used for treating dysentery.

Medicinal Use


75

3

Cau Omas

Rambutan

Palungpung

49 Musa sp.

50 Nephelium lappaceum L.

Neyraudia madagascuriensis

57 Piper aduncum L.

Pinanga coronata Bl.ex Mart Bl.

Ki Rapet

Parameria laevigata 55 (Juss.) Moldenke

56

1

Sawuheun

54 Panicum palmifolium

2

3

Bingbin beureum

Ki Seuseureuhan

1

1

Surawung

53 Ocimum basilicum L.

2

Honje

1

52 Nicolaia speciosa Horan.

51

1

Cau lampung

48 Musa sp.

1

2

0.040

0.048

0.004

0.007

0.008

0.023

0.015

0.011

0.081

0.005

0.008

Freq. Smith's

Cau gembor

Local Name

47 Musa sp.

Scientific Name

Obat tetes mata

Obat batuk

Obat mencret

Obat luka kecil

Eyedrops

Coughing

Diarrhea

BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_obat/depkes/buku5/5 -070.pdf)

After delivery treatment (fresh shoot)

Healing small wound

Treat a boil (gum sap)

BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_obat/depkes/buku1/1 -226.pdf)

Not known

After delivery BPPT-Teknologi Tepat Guna treatment , (http://iptek.apjii.or.id/artikel/ttg_tanaman_obat/depkes/buku3/3 dysentery, ulcers and -092.pdf) wound (bark)


Treating runny nose for children

Obat pilek anak

Digestive and nervous systems, easing flatulence, stomach cramps, colic and indigestion (leaf)

Not known ASEAN Centre for Biodiversity (http://www.aseanbiodiversity.org/medicinal_plants/page5.htm)

Fever

Obat sakit panas

Not known

Reference

PUBLIC DATABASE

Fever (roots); disease of the tongue IMPGC (http://www.impgc.com/plantinfo_A.php?id=2181) (bark); headache (leaves external use).

Medicinal Use

Use as deodorant.

Diarrhea

Stomachache

Obat sakit perut Obat mencret

Rheumatism

Toothache

Fever

Local Use

Obat encok

Obat sakit gigi

Obat panas

Local use



76

1

1

Ki kumat

Polygonum posumbu H. Baran

Hareueus/Arben

Tiwu koneng

Kaso

Salak

Cariang

Ilat

Sadagori

Beleketebe

Polygala paniculata L.

Rubus rosifolius Sm.

Saccharum officinarum L.

Saccharum spontaneum L.

Salaca edulis Reinw.

Schismatoglottis rupestris Zoll.

Scleria purpurascens Steud.

Sida rhombifolia L.

Sloanea sigun (B.) Szysz.

60

61

62

63

64

65

66

67

68

69

1

1

1

2

1

1

1

3

3

Ki Tajam

Polygala glomerata Lour.

59

1

Bubuay

Freq.

Plectocomia elongata Mart. Ex Bl.

Local Name

58

Scientific Name

0.028

0.010

0.027

0.036

0.008

0.010

0.002

0.020

0.006

0.055

0.056

0.008

Smith's

Obat luka kecil

Obat bisul

Obat bisul

Obat luka

Healing small wound

Treating a boil

Treating boil

Healing wound

Treating a boil


Skin itching, boil, ulcer helminthic (leaf), sprue, swelling and insectbite (root)

Not known

Nasution, R.E. 1993.

Acne

Not known

BPPT-Teknologi Tepat Guna Diarrhea (sruit flesch) (http://iptek.apjii.or.id/artikel/ttg_tanaman_obat/depkes/buku1/1256.pdf)


Treating burning sensation, blood diseases, hemorrhagic diathesis (plant), diuretic (root).

(1) Healing big wound, (2) Disinfectant

(1) Obat luka besar, (2) desinfektan

Obat bisul


Coughing, muscle pain (stem)

Treating jaundice


Not known


Sastroamidjojo

Not known

Reference

PUBLIC DATABASE

Obat sakit kuning

Skin itches (leaves, external use); fevers (decoction of the leafy stems).

Asthma, sprue, kidney (whole plant) Gonorrhoea and lumbago (infusion of aerial part), applied to wounds (leaf)

Medicinal Use

Eyedrops

Skin itching

Treating rheumatism

Stomachache

Coughing

Local Use

Obat tetes mata

Obat gatal

Obat rematik

Obat sakit perut

Obat batuk

Local use



77

1

3

2

Hantap Beureum

Ki Lebur

Ki Koneng

Sterculia javanica R.Br.

Symlocos brandisi

72

73

74

1

Ki Cengkeh

Hamirung

Urophyllum arboreum Korth.

Vernonia anthelmintica (L.) Willd.

78

79

1

4

Karas Tulang

Turpinia montana

77

2

Kuray

Trema orientalis Bl.

76

Arcangelisia flava (L.) Merr.

2

Hantap

Sterculia rubiginosa Vent.

75

4

Reundeu

Staurogyne elongata

71

3

0.002

0.019

0.090

0.005

0.005

0.023

0.009

0.015

0.061

0.055

Freq. Smith's

Jotang

Spilanthes acmella L.

70

Scientific Name

Local Name

Obat sakit gigi

Toothache

Toothache

(1) After delivery care, (2) muscular pain, (3) Treating scar

(1) Pelengkap jamu untuk melahirkan (peupeuh), (2) obat sakit badan, (3) menghilangkan bekas luka Obat sakit gigi

Hemorrhoid

Treating jaundice

Treating kidney stone symptoms

Fever

Toothache


(1) To warm body, (2) abdominal discomfortfeeling to vomit,gastritis

Local Use

Obat buang air besar berdarah

Obat sakit kuning

Obat kencing batu

obat panas

Obat sakit gigi

Obat kencing batu

(1) Penghangat badan, (2) obat seueul

Local use


BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanama n_obat/depkes/buku3/3-150.pdf)

IMPGC (http://www.impgc.com/plantinfo_A.ph p?id=937)

Not known

Anthelmintic, scorpion bite antidote (seed)

Diarrhea, coughing for children (leaf)

IMPGC (http://www.impgc.com/plantinfo_A.php ?id=1830)

Not known

Jaundice, worms, indigestion (decoction of the stem);clean wounds, ulcers (decoction of the wood); fever and sprue (stem sap); dysentery (flowers)

Serves as diuretic.

IMPGC (http://www.impgc.com/plantinfo_A.php ?id=892)

For malaria, toothache (flower); promotes salivation (seed); to treat dysentery (plant); used as a bath for relieving rheumatism.

ASEAN Centre for Biodiversity (http://www.aseanbiodiversity.org/medic inal_plants/page7.htm)

Reference

Medicinal Use

PUBLIC DATABASE


78

Kareo

1

3

0.020

0.064

(1) Eyedrops, (2) Healing small wound, (3) Treating high blood pressure (1) Eyedrops, (2) coughing

(1) Obat tetes mata, (2) obat batuk

Saga

Albasiah

Lidah buaya

Nanas

Sambiloto

Seledri

Sukun

Abrus precatorius L.

Albizzia lebbeck Benth.

Aloe vera L.

Ananas comosus (L.) Merr.

Andrographis paniculata Ness.

Apium graveolens L.

Artocarpus communis Forst.

2

3

4

5

6

7

Local Name

1

4

7

2

3

1

6

0.026

0.078

0.175

0.044

0.061

0.033

0.152

Freq. Smith's

IMPGC (http://www.impgc.com/plantinfo_A.php?id =96)


Treating high blood pressure (dry leaf)

Obat darah tinggi (daun kering)

Fever (leaf), and enhance breast milk secretion (fruit skin).

BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_ obat/depkes/buku2/2-029.pdf)

BPPT-Teknologi Tepat Guna Hypertensi, abdominal distension (http://iptek.apjii.or.id/artikel/ttg_tanaman_ and to treat feeling to vomit (leaf) obat/depkes/buku1/1-031.pdf)

BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_ obat/depkes/buku1/1-027.pdf) Fever, skin infection, diabetes, ear infection and abdominal distension (whole plant)

(1) Treating high blood pressure, (2) muscle and body pain

(1) Obat darah tinggi, (2) obat pegal-pegal Obat darah tinggi

BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_ obat/depkes/buku1/1-022.pdf) Helminthic, diuretic, fever and enhance digestive system (fruit)

Tonsil infection (young fruit)

Obat sakit amandel (nanas muda)


As a tonic, asthma, boils, bruises, burns, stomach cancer, common cold, cough, jaundice, hepatitis, stomach ulcers, hair fall, prevents opportunistic infections in cases of HIV/ AIDS.

Obat darah tinggi

ASEAN Centre for Biodiversity http://www.aseanbiodiversity.org/medicinal _plants/page1.htm)

Leaves and seed treat eye diseases, dysentery and hemorrhoids while bark for ulcer.

(1) Treating kidney stone symptoms, (2) unsatisfied incontinency

(1) Kencing batu, (2) jengjeuriheun


Reference

Treating sprue, sore throat and cough (leaf).

Medicinal Use

Treating hot stomach symptom

Local Use

PUBLIC DATABASE

Obat panas dalam

Local use

MEDICINAL USE OF PLANT SPECIES IN TANJUNGSARI

Scientific Name

BPLH Jabar (http://www.bplhdjabar.go.id/kategori/k ehati/etnobotani.cfm?doc_id=165)

Not known

Eyedrops, after delivery treatment

MEDICINAL PLANT SPECIES FREELISTED ONLY BY RESPONDENTS IN TANJUNGSARI (1)

Amomum dealbatum Roxb.

Hangasa

1

81

80

(1) Obat iritasi mata/tetes mata, (2) obat luka kecil, (3) obat darah tinggi

79

Belimbing

Cangkudu

Tapak doro

Limau

Wortel

Tikal Balung

Jabung

Daun dewa

Ilalang

Melati

Averrhoa carambola L.

Bancudus latifolia Rumph

Catharanthus roseus (L.) G. Don.

Citrus mitis Blanco

Daucus carota L.

Equisetum arvense L.

Erigeron sumatrensis Retz.

Gynura procumbens (Lour.) Merr.

Imperata cylindrica L.

Jasminum sambac (L.) W.Ait.

9

10

11

12

13

14

15

16

18

Local Name

8

Scientific Name

1

1

24

1

10

3

3

1

7

4

0.032

0.033

0.404

0.02

0.055

0.070

0.044

0.025

0.177

0.103

Freq. Smith's

Lower back problems and rheumatism, diuretic (whole plant)

Headache (leaf), muscle pain (root)

(1) Treating ulcer, (2) kidney troubles and dysentery (plant)

Diuretic (root)

(1) Setting fracture bones, (2) Tootache Treating kidney stone symptoms

(1) Treating high blood pressure, (2), reumathism Treating high blood pressure (root) Fever (leaf)

(1) Obat patah tulang, (2) obat sakit gigi Obat ginjal

(1) Obat darah tinggi, (1), Obat rematik

Obat darah tinggi (akar) Menurunkan panas (daun)

Against pain during mensturation, cosmetics (flower)

Hypertensi and maintaining healthy eyes (root).

For healthy eyes



(1) BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_ obat/depkes/buku1/1-139.pdf), (2) IMPGC (http://www.impgc.com/plantinfo_A.php?id =2467)





Applied externally to calm insect bites, to heal buboes, to promote the growth of hair, to treat cough and to soothe inflammation (fruit juice); to ease childbirth (roots) and to cure flatulence (distilled oil of the leaves).

Treating high blood pressure (leaf)

Obat darah tinggi (daun)

Kesehatan mata

ASEAN Centre for Biodiversity (http://www.aseanbiodiversity.org/medicina l_plants/page2.htm)

BPPT IPTEK (www.iptek.net.id/ind/pd_tanob)at/view.ph p?id=5

Hypertensi, hepatitis, fever, influenza, coughing, soothening foot skin (ripen fruit),stomachache (leaf)

Treating high blood pressure All parts of the plant are used for diabetes, leukemia, apply on wounds, as anti-cancer.


To halt hemorrhages, hemorrhoids (ripe fruit); fevers (dried fruit or juice); headache, chickenpox, on ringworm (leaves); antidote (roots)


Diabetes

Reference

PUBLIC DATABASE Medicinal Use

Local Use

Obat diabetes

Obat darah tinggi

Obat darah tinggi

Local use



80

12

Sampeu dodi

Kemuning

Pisang

Pala

Kamandilan

Mamangkokan

Beras Ketan Hitam

Manihot sp.

Murraya paniculata (L.) Jacq.

Musa paradisiaca L.

Myristica fragrans Houtt.

Nasturtium montanum Rolfe.

Nothopanax scutellarium Merr.

Oryza sativa var. glutinosa

21

22

23

24

25

26

27

26

2

2

2

2

1

2

Singkong

Manihot esculentaCrantz

20

1

Kunir putih

0.070

0.061

0.026

0.052

0.047

0.024

0.345

0.056

0.023

Freq. Smith's

Kaempferia rotunda L.

Local Name

19

Scientific Name

IMPGC (http://www.impgc.com/plantinfo_A.php?id=1 046)

Blood disorders (stem juice and root); dysentery and diarrhea (fruit); diabetes, uremia, nephritis, gout, hypertension and cardiac diseases (ripe fruit) Insomnia (fruit), abdominal discomfort (oil from fruit) Treating asthma, cystitis and fever and cold (whole plant)

Use as hair tonic/alopecia (leaf)


Healing wound (gum sap)

Coughing and runny nose Stomachache in children (leaf) (1) Treating high blood pressure, (2) Hair treatment


Obat batuk pilek

Obat sakit perut pada anak (daun) (1) Obat darah tinggi, (2) Obat rambut

Obat balur untuk keseleo, bengkak, lebam,memar

A decoction of rice, is demulcent, refrigerant drink in febrile and Treating sprained inflammatory diseases, finely muscles, swollen powdered rice flour may be used limbs, bruises (external for erysipelas, burns, scalds. use)

NOT KNOWN


ASEAN Centre for Biodiversity (http://www.aseanbiodiversity.org/medicinal_ plants/page5.htm)


BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_ob at/depkes/buku3/3-080.pdf)


Soothening skin, treating irregular menstruation (leaf), toothache (bark)

Fever

Obat penurun panas, demam

Obat luka (getah)

ASEAN Centre for Biodiversity (http://www.aseanbiodiversity.org/medicinal_ plants/page5.htm)

For headache, colds and fever; treats gastric constipation

(1) Stomachache (leaf), (2) Increase blood pressure (leaf)

(1) Obat sakit perut (daun), (2) Menaikkan tekanan darah (daun)

Reference

PUBLIC DATABASE

Mencegah macammacam kanker

Medicinal Use

(1) BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/artikel/ttg_tanaman_ob at/depkes/buku3/3-058.pdf), (2) IMPGC (http://www.impgc.com/plantinfo_A.php?id=6 79)

Local Use (1) Abdominal distension (rhizome), (2) mumps, wounds Different kind of cancer and swellings (rhizome and plant)

Local use



81

Local Name

Pandan wangi

Memeniran

Kemukus

Jengkol

Suji

Kamboja

Jambu jepang

Delima putih

Lobak putih

Scientific Name

Pandanus amaryllifolius Roxb.

Phyllanthus urinaria L.

Piper cubeba L.

Pithecellobium lobatum Benth.

Pleomele angustifolia n.e.Brown

Plumeria rubra L.

Psidium guajava L.

Punica granatum L.

Raphanus sativus L.

28

29

30

31

32

33

34

35

36

3

5

2

2

3

1

1

10

6

0.079

0.129

0.057

0.055

0.078

0.031

0.031

0.165

0.161

Freq. Smith's


Diarrhea (leaf)

Dysentery and diarrhea (fruit rind and bark); as a vermifuge (root bark)

Diuretic, diphteri and coughing (bulb)

Treating symptom of diarheal-vomiting

(1)Diarrhea (2)cancer

Treating difficult urination, symptom of kidney stone

Muntaber

(1) Obat mencret, BAB berdarah, (2) obat kanker

Melancarkan kencing


Treating boil, ulcer, tootache (gum sap)

(1) Treating a boil (leaf), (2) toothache (gum sap)

(1) Obat bisul (daun), (2) Obat sakit gigi (getah)



Treating bloody urine and deficiency of vitamine B1 (leaf)




Obat darah tinggi

Ulcers, wound, boil (leaf, fruit skin)


Asthma, gonorrhea, gleet and inflammation of the bladder (fruit).

Fever in children

Obat panas pada anak

Jejengkoleun (kulit buah)


Diuretic, kidney stone, fever, and diarrhea (whole plant)

(1) Hemorrhoid, (2) Treating shortness of breath

(1) Obat ambeien, (2) obat sesak nafas

BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/data/tanaman/kat_mid. htm)

Reference

PUBLIC DATABASE Sedative against restlessness (infusion of leaves)

Medicinal Use


Local Use

Obat darah tinggi

Local use



82

28

Batrawali

Kadongdong

Jati

Pungpurutan

Sonchus arvensis L.

Spondias pinnata(J.G.Koenig ex L.f.) Kurz

Tectona grandis L.

Triumfetta rhomboidea Jacq.

Zingiber cassumunar Panglay Roxb.

38

39

40

41

42

1

1

Santigi

Selada batu

43

44

24

3

1

2

2

0.03

0.033

0.267

0.084

0.024

0.059

0.196

0.054

Freq. Smith's

Ricinus communis L. Jarak

Local Name

37

Scientific Name


(1) Maintaining stamina, (2) Treating heart disease symptom

(1) Menjaga stamina, (2) Obat jantung Obat ginjal

Anti-inflammatory

(1) Skin itching,(2) abdominal distension (external use)

(1) Obat kulit gatalgatal,(2) obat balur untuk sakit perut

NOT KNOWN

Ozaki,Y. Kawahara,N., Harada,M. 1991. Anti-inflammatory effect of Zingiber cassumunar Roxb. and its active principles. Chem Pharm Bull (Tokyo), Sep;39(9):2353-6

IMPGC (http://www.impgc.com/plantinfo_A.php?id=2 311) Diarrhoea, dysentery and gonorrhoea (leaf).

Hemorrhoid


Treat bronchitis (bark decoction), inflamed eye lids (ash from wood) and anuresis (root); to relieve the swelling of eyelids (charred wood); as a hair tonic (wood oil).

Obat ambeien, buang air besar berdarah


Stomach ache, dysentery, rheumatism and swollen joints (bark), against bilious dyspepsia (fruit), earache (fruit juice).

Reducing blood sugar (leaf)

ASEAN Centre for Biodiversity( http://www.aseanbiodiversity.org/medicinal_p lants/page7.htm)

Leaves and root used as diuretic and febrifuge; for bronchitis, asthma, pertussis and jaundice, treatment of coughs in phthisis, prevent urolithiasis (root).

Menurunkan kadar gula darah (daun)

(1) Skin itching, (2) malaria

(1) Obat kulit gatalgatal, (2) obat malaria


Reference

PUBLIC DATABASE

Treat obstipation


(1) Obstipation (leaf), (2) toothache (gum sap)

(1) Susah buang air besar (daun), (2) obat sakit gigi (getah)

Medicinal Use


Local Use

Local use



83

5.5 Prior Informed Consent form Persetujuan Pelaksanaan Kegiatan di Desa Tanjung Sari, Kabupaten Sumedang 24/J06.22/LL/2006 Pelaksana kegiatan : UPT. INRIK (Indonesian Resource Centre for Indigenous Knowledge). Salah satu Unit Pelaksana Teknis di bawah Universitas Padjadjaran, Bandung. Berkedudukan di Jl. Dipati Ukur No.35, Gedung A, Lt. 4 Bandung. Kegiatan INRIK adalah melakukan pendokumentasian dan pengkajian tentang sistem pengetahuan dan teknologi lokal dalam manajemen sumber daya alam. Kegiatan: Penelitian mengenai Integrasi pengetahuan lokal mengenai tanaman obat ke dalam sistem kesehatan di perdesaan Indonesia Tujuan Penelitian : o mempelajari pengetahuan masyarakat mengenai tanaman obat dan sistem pelayanan kesehatan di desa o mengumpulkan sampel tanaman obat o membangun rencana bersama masyarakat desa mengenai pemanfaatan pengetahuan tentang tanaman obat untuk peningkatan pelayanan kesehatan Lokasi penelitian: Desa Tanjung Sari Waktu Penelitian : Agustus 2006 – Februari 2007 Metode: wawancara penduduk, pengamatan langsung, grup diskusi, dan pengambilan contoh tanaman. Hasil penelitian: Hasil penelitian akan disosialisasikan kembali kepada masyarakat. Informasi dari responden akan digunakan sebagai bahan analisa dan bahan publikasi di jurnal ilmiah. Sampel tanaman obat akan digunakan sebagai bahan perbandingan dengan koleksi yang sudah ada, dan akan disimpan/dikoleksi di Universitas Padjadjaran untuk kepentingan keilmuan. Hasil penelitian tidak ditujukan untuk kepentingan ekonomi.

.................., ................... Menyetujui, Nama: Jabatan: Prior Informed Consent for Research Implementation Tanjung Sari Village, Sumedang District 24/J06.22/LL/2006 Research Institution: UPT.INRIK (Indonesian Resource Centre for Indigenous Knowledge), under University of Padjajaran, located at Jl. Dipati Ukur No. 35, Gedung A, Lt.4, Bandung. INRIK’s main activities are documenting and analyzing local knowledge and local technology in natural resource management. Activities: • Research on integration of local knowledge on medicinal plants into rural health care system in Indonesia. • Research objectives: To study community knowledge on medicinal plants and health care services in the village To collect medicinal plant samples 84

To develop community-based plan about utilization of medicinal plant species for improving health care services. Research location: Tanjung sari village Research duration: August 2006 – February 2007 Research methods: interview, observation, group discussion and plant sampling Research results: the documentation and analysis will be socialized to the community. Information from respondents will be used for analysis and publication in scientific journals. Sampled medicinal plants will be used for comparison to the existing collection, being collected and stored at University of Padjajaran for scientific purposes. The results of this research will not be used for gaining economic benefits.

• • • •

ZZZZZ, ZZZZZZZ

Agreed by:

Name: Position:

6 REFERENCES 1. Adimihardja K. Anthropologi Kesehatan Reproduksi. 2004 (unpublished work). 2. Adimihardja K. Jawa Barat: Sumberdaya Manusia dalam Perspektif Sosiobudaya. 2005 (unpublished work). 3. Agoes A, Jacob T. 1992. Pengobatan Tradisional di Indonesia. In Antropologi Kesehatan Indonesia I : Pengobatan Tradisional, Jakarta: Penerbit Buku Kedokteran EGC. 4. Bastos, G. N., et al. “Antinociceptive effect of the aqueous extract obtained from roots of Physalis angulata L. on mice.” J. Ethnopharmacol. 2006 Jan; 103(2): 241-5. 5. Bernard HR. 2002. Research methods in anthropology - Qualitative and quantitative approaches. Walnut Creek, USA: Altamira Press. 6. Bloor,M., Frankland,J., Thomas,M., Robson,K. Focus Groups in Social Research. Forum Qualitative Social Research.Vol.3, No.4. November 2002. 7. Borgatti. 1996a. ANTHROPAC 4.97 4.0. Natick, MA: Analytic Technologies. Software 8. Borgatti. 1996b. ANTHROPAC 4.97 4.0 Methods Guide. Natick, MA: Analytic Technologies.The Manual. 9. Carlson T. J. 2001. Language, ethnobotanical knowledge, and tropical public health. In On Biocultural Diversity: Linking Language, Knowledge, and the Environment, ed. Maffi L, 30:489 pp. Washington: Smithsonian Institution Press. 489 pp. 10. Costa-Neto E. M. 2002a. The use of insects in folk medicine in the state of Bahia, Northeastern Brazil, with notes on insects reported elswhere in Brazilian folk medicine. Human Ecology 30(2) 11. Costa-Neto E. M. 2002b. The use of insects in folk medicine in the state of Bahia, Northeastern Brazil, with notes on insects reported elswhere in Brazilian folk medicine. Human Ecology 30(2) 12. Departemen Kesehatan RI, Direktorat Jenderal Pengawasan Obat dan Makanan, 1984, Suntingan Naskah Populer Obat Tradisional, Jakarta, Departemen Kesehatan RI direktorat Jenderal Pengawasan Obat dan Makanan 13. Departemen Kesehatan RI, Direktorat Jenderal Pengawasan Obat dan Makanan, 1985, Suntingan Naskah Populer Obat Tradisional, Jakarta, Departemen Kesehatan RI direktorat Jenderal Pengawasan Obat dan Makanan 14. Departemen Kesehatan RI, Direktorat Jenderal Pengawasan Obat dan Makanan, 1986, Suntingan Naskah Populer Obat Tradisional, Jakarta, Departemen Kesehatan RI direktorat Jenderal Pengawasan Obat dan Makanan 15. Departemen Kesehatan RI. 2002. Profil Kesehatan Indonesia 2001. Jakarta

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16. Djumidi,H.Apt, dkk, 1997, Inventaris Tanaman Obat Indonesia (IV), Jakarta, Departemen Kesehatan Badan Penelitian dan Pengembangan Kesehatan 17. Dryamedia. 1996. Berbuat Bersama Berperan Setara: Acuan Penerapan Participatory Rural Appraisal untuk Konsorsium Pengembangan Dataran Tinggi Nusa Tenggara. Bandung 18. Esche,Doris, 1989, How To Use Herbal Medicines, Solo 19. Fadzelly,A.B.M., Asmah,R., Fauziah,O. Effects of Strobilanthes crispus Tea Aqueous Extracts on Glucose and Lipid Profile in Normal and Streptozotocin-Induced Hyperglycemic Rats.Plant Foods for Human Nutrition, Vol.61,No.1/March2006. 20. Global Business Network. The Mont Fleur Scenarios: What will South Africa be like in the year 2002?. Deeper News Vol.7.No.1 21. Harada, dkk, 2003, Taman Nasional Gunung Halimun: Menyingkap Kabut Gunung Halimun, Bogor, Kerjasama JICA,P2B, BALAI TNGH dan Dirjen PHKA 22. Harada,Kazuhiro; Rahayu,Mulyati; Muzakkir,Anwar, 2002, Medical Plants of Halimun National Park, West Java, Indonesia,Bogor, Biodiversity Conservation Project-JICA 23. Hargono D. 1992. Tumbuhan Obat dan Pelayanan Kesehatan. In Antropologi Kesehatan Indonesia I : Pengobatan Tradisional, Jakarta: Penerbit Buku Kedokteran EGC. 24. Heyne, K. 1987, Tumbuhan Berguna Indonesia Jilid I (terj. Badan litbang Kehutanan Jakarta), Jakarta, Yayasan Sarana Wana Jaya 25. Heyne, K. 1987, Tumbuhan Berguna Indonesia Jilid II (terj. Badan litbang Kehutanan Jakarta), Jakarta, Yayasan Sarana Wana Jaya 26. Heyne, K. 1987, Tumbuhan Berguna Indonesia Jilid III (terj. Badan litbang Kehutanan Jakarta), Jakarta, Yayasan Sarana Wana Jaya 27. Heyne, K. 1987, Tumbuhan Berguna Indonesia Jilid IV (terj. Badan litbang Kehutanan Jakarta), Jakarta, Yayasan Sarana Wana Jaya 28. Heinrich M. 2001. Ethnopharmazie und Ethnobotanik. Stuttgart, Germany: Wissenschaftliche Verlagsgesellschaft Stuttgart. 29. Hoareau L, DaSilva E. J. 1999. Medicinal Plants : a re-emerging health aid. EJB Electronic Journal of Biotechnology Vol.2 No.2(August 15):56-70 30. INRIK, 1999, Laporan Akhir Penelitian Leuweung Titipan: Tanah Harapan Warga Kasepuhan di Kawasan Gunung Halimun Jawa Barat (Pendekatan Partisipatif dalam Pemetaan Tanah Adat), Kerjasama INRIK dengan Yayasan KEHATI. 31. Ludvik,B., Neuffer,B., Pacini,G. 2004. Efficacy of Ipomoea batatas (Caiapo) on Diabetes Control in Type 2 Diabetic Subjects Treated with Diet. Diabetes Care 27: 436-440 32. Martin G. J. 2004. Ethnobotany : A Methods Manual. 33. Miles M. B, Huberman M. A. 1994. Qualitative data analysis: an expanded sourcebook. California: Sage Publications. 34. Milliken, W. 2006. Conservation,Economics,Traditional Knowledge,and the Yanomami: Implications and Benefits for Whom? In Human Impacts on Amazonia. The Role of traditional ecological knowledge in conservation and development. Ed.Posey,D.A.and Balick,M.J.Colombia University Press,NY. 35. M. Sangat, Harini; A.M. Zuhud, Ervizal, K., Damayanti, Ellyn. 2000. Kamus Penyakit dan Tumbuhan Obat Indonesia (Etnofitomedika), Jakarta, Yayasan Obor Indonesia 36. Narayan D., Chambers R., Shah K. M., Petesch P. 2000b. Voice of the Poor: Crying Out for Change. New York: Oxford University Press. 37. Nasution,R.E.1993. Prosiding Seminar dan Lokakarya Nasional Etnobotani II. Yogyakarta 2425 Jan. 1995. Buku 1 : Tumbuhan Obat. Puslitbang Bio LIPI, Fak. Biologi UGM, Ikatan Pustakawan Indonesia. Ikatan Pustakawan Indonesia (IPI), Jakarta. 38. Nugroho,A., Nurfina SU.,Apt. 1998. Manfaat dan Prospek Pengembangan Kunyit, Ungaran, Trubus Agriwidya 39. Poverty Group of the World Bank. 1999. Consultation with the Poor: Methodology Guide. 40. Puri, R.K. and Vogl, C.R. September 2005. A Methods Manual for Ethnobiological Research and Cultural Domain Analysis: with analysis using ANTRHOPAC 41. Sastroamidjojo, Seno.Dr. 1997. Obat Asli Indonesia, Jakarta, Dian Rakyat. 42. Sentra Pengembangan dan Penerapan Pengobatan Tradisional-Pemerintah Propinsi Jawa Barat. 2001. Tanaman Obat di Propinsi Jawa Barat: Karakteristik dan Khasiatnya, Bandung, Unpad Press 43. Sheil,D.,Puri,R.K.,et al. 2002. Exploring biological diversity, environment and local people’s perspectives in forest landscapes: methods for a multidisciplinary landscape assessment. CIFOR Indonesia 44. Sub Balai Perlindungan dan Pelestarian Alam Jawa Barat. 1984. Laporan Risalah Kawasan Suaka alam di cagar Alam Gunung Halimun, Bandung, unpublished. 86

45. The World Bank. 2005. Indigenous Knowledge Program. http://www.worldbank.org/afr/ik/index.htm 46. UNESCO. 2003. MOST Clearing House: Best Practices on Indigenous Knowledge. http://www.unesco.org/most/bpindi.htm#definition. 47. UPT. Balai Penegmbangan Kebun Raya LIPI. 1999. Koleksi Tumbuhan Obat Kebun Raya Bogor Vol.I No.3, Bogor,UPT. Balai Pengembangan Kebun Raya LIPI 48. Vogl C.R., Vogl-Lukasser B. 2004. Tools and Methods for Data Collection in Ethnobotanical Studies of Homegardens. Field Methods 16(3):285-306 49. Wayland C. 2001. Gendering Local Knowledge: Medicinal Plant Use and Primary Health Care in the Amazon. Medical Anthropology Quarterly 15(2):171-88 50. Weller S.C., Romney K.A. 1988. Systematic data collection. Newbury Park, California: Sage Publications. 51. WHO. 2004. World Health Report 2003. Geneva 52. Wijayakusuma, Hembing. H.M, Dalimarta, Setiawan, Setiawan Wirian, Agustinus, T.T., Tanaman Berkhasiat Obat Indonesia, Jakarta, Pustaka Kartini 53. Wijesekera ROB. 1991. Is there an industrial future for phytopharmaceutical drugs? An outline of UNIDO programmes in the Sector. Journal of Ethnopharmacology 32:217-24 54. Wollenberg,E., Edmunds,D. Buck,L. 2000. Scenarios; as a tool for adaptive forest management. CIFOR Indonesia.

WEBSITES : 1. 2. 3. 4.

ASEAN Centre for Biodiversity (http://www.aseanbiodiversity.org/medicinal_plants/) BPLHD JABAR: http://www.bplhdjabar.go.id/kategori/kehati/etnobotani.cfm?doc_id=165 BPPT-IPTEK Tanaman Obat Indonesia: http://www.iptek.net.id/ind/pd_tanobat/index.php BPPT-Teknologi Tepat Guna (http://iptek.apjii.or.id/) : Pengelolaan Tanaman Obat, buku terbitan Department Kesehatan Indonesia (Medicinal Plant Processing book published by Indonesia Department of Public Health) 5. IMPGC International Medicinal Plant Growers Consortium ( http://www.impgc.com/) 6. INTISARI Magazine: http://www.indomedia.com/intisari/ 7. Plants for A Future: http://www.pfaf.org 8. Ujung Kulon Conservation Net: http://www.ujung-kulon.net/daftar_flora.htm

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P-147. Integrating Local Knowledge on Traditional Medicine into Rural Health Care System in Indonesia (INTRAMED) FINAL REPORT

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