Nov 18, 2015

Wary of Mainstream Medicine, Immigrants Seek Remedies From Home

New York Times
November 13, 2015

On a recent afternoon, Ina Vandebroek was poking around the shelves of La 21 Division Botanica on the Grand Concourse in the Bronx. Its narrow aisles were crammed with thousands of votive candles, herbal potions and brightly colored plaster statues of saints.

Dr. Vandebroek, a Belgian-born ethnobotanist, paused to gaze at herb-infused oils. The vials had names like Amor Prohibido (“Forbidden Love”), for those in search of adventure, and Conquistador, for the timid — both of them big sellers. Bendicion de Dinero Al Hogar (“A Blessing for Money in the House”), which comes in a spray, is also popular. But Dr. Vandebroek was not there to jump-start a flagging love life or curry the favor of spirits. La 21 Division is a regular stop for her, a mile or so from her laboratory at the New York Botanical Garden, where she is the assistant curator of economic botany.

She is conducting a multiyear study of the folk remedies sold in New York’s botanicas, more than 100 emporiums that offer products for all that ails the body, mind and soul to a clientele mainly consisting of Latino and Caribbean immigrants. She is compiling guides in English and Spanish describing the plants and their uses. Her goal is to promote “culturally effective and sensitive health care” for a community that is chronically underserved by mainstream medicine.

“I came to NYC in 2005 and expected immigrants from the Caribbean to use very few plants for health care because most of the medicinal plants they know from their home countries don’t grow here,” she said in an email. Instead, she was amazed to find that Dominicans in New York, for example, use more than 200 plant species for medicinal purposes.

The guide, to be published next year by the Botanical Garden, will include precautions on potential side effects and toxicity. Dr. Vandebroek hopes that people will take the guide with them when they visit their doctors to help initiate a dialogue, and alert them to possible adverse interactions with pharmaceutical drugs.

Dr. Vandebroek has conducted field work in the Caribbean and consulted with local experts like Eliseo Trinidad, the owner of La 21 Division. Mr. Trinidad, 63, slim and youthful, attributed his health (and the fact that he does not have a single gray hair on his head) to his lifelong use of herbs. “People know a lot more about natural healing today than when I started the business 20 years ago,” he said. “Our sales of plant products have tripled.”

Mr. Trinidad, who was born in the Dominican Republic, pointed to packets containing dried herbs from Peru: There was horse tail (Equisetum giganteum) for bladder problems; palo de Brazil (Caesalpinia brasiliensis) for cleansing the kidney; and anamu (Petiveria alliacea) for fevers and arthritis. He said the botanica business is highly seasonal. With winter approaching, remedies containing bitter orange, lemongrass and guanabana, which are thought to ward off colds, are selling well.

In a narrow refrigerated room at the back of the shop, Dr. Vandebroek took down from a shelf a bag of plant stems with floppy banana-shaped leaves attached, flown in fresh from the Dominican Republic. “Insulina,” she said, adding that the plant (Costus igneus), closely related to ginger, is used by people with diabetes to lower blood glucose levels. But does it work? One study involving rodents said yes; another study said no. And insulina has not yet been tested on human subjects. As with so many other plant-based medicines, questions remain about insulina’s effectiveness.

Scientific uncertainty, however, need not depress sales: According to the World Health Organization, 80 percent of people in the developing world use medicinal plants as part of their own care.

“A lot of medical research still needs to be done,” said Dr. Vandebroek, adding that until the 19th century, physicians were generally botanists as well. According to a 2012 study published by the National Institutes of Health, nearly half of all new drugs approved for use in the past 30 years were developed from natural sources, mainly plants.

Traditional knowledge of plants often fades as people move to cities. But the opposite is happening in New York’s immigrant communities, where the latest wave of people from Mexico and Central America and Dominicans, Puerto Ricans and Jamaicans have been comparing notes on using herbs and foods as medicines.

“You go to a Latino grocery store,” Dr. Vandebroek said, “and you overhear someone on the checkout line talking about, say, cucumber being good for hypertension.”

But she added, “People are sometimes afraid to talk to doctors about their use of plants.” Beyond the language barrier for Spanish-speaking patients, there is the perception that medical professionals frown upon herbal remedies.

Dr. Vandebroek asked botanica users if they believe there are conditions that doctors do not understand or cannot cure. Nearly 80 percent said yes. Caribbean therapies often target maladies that have no equivalents in conventional medical diagnosis, she said, like empacho (gastrointestinal blockage).

Dr. Vandebroek said many Dominicans believed that drugs merely hid the pain of disease but did not cure it. Herbs were thought to expel the root causes of illness.

Michele Dominguez, a 33-year-old Bronx resident who has worked at La 21 Division Botanica for five years, said many people came because of money problems. “They tell us, ‘What can I use when I go to the casino?’ We tell them, ‘O.K., you can’t just take an herb or burn a candle and get money. You need to pray, you need to cleanse your body, your spirit of negative auras, of anything that may be blocking you.’”

Eline Trinidad, a 32-year-old nurse from Orlando, Fla., who was visiting her family in the Bronx (and who is not related to the botanica’s owner), has made such cleansing a part of her routine. When she is feeling stressed, she boils medicinal plants and bathes in the water.

Ms. Trinidad saw no contradiction between her use of herbs and her career in mainstream medicine. “I believe the two systems can work hand in hand,” she said. “But not all doctors understand.”

With the help of a $130,000 grant from the Cigna Foundation, the Botanical Garden offers training for doctors to help them better understand their patients’ cultural beliefs. So far, 740 medical students and practicing physicians have gone to the garden’s tropical conservatory to learn about medicinal plants and to participate in role-playing exercises. “It is all about promoting increased trust between health care providers and their patients,” Dr. Vandebroek said.

Issues of trust and culture are not the only things that have made some immigrants leery of mainstream medicine. Doctors’ visits are expensive, and herbs, selling for a few dollars a bag, are cheaper than prescription drugs.

According to a study by the Commonwealth Fund, 43 percent of Hispanics in the United States do not have a primary personal care physician or health provider. More than one-third lack health insurance, nearly double the rate for blacks and triple that for white Americans.

High costs and cultural differences have created a troubling disconnect between many Hispanics and the health care system. It is a rift that Dr. Roger Chirurgi, program director for the emergency medicine residency for the New York Medical College at Metropolitan Hospital Center in Manhattan, would like to heal.

“There’s a lot of people who we’ll see at repeat visits, and they’ve never taken their medicine,” Dr. Chirurgi said. “That’s why I’ve been taking my residents to the Botanical Garden for the past three years, to try to become more culturally sensitive and to be able to break through that barrier.”

Dr. Chirurgi now routinely asks patients if they are using herbals when he takes their medical history. He worries about the dangers of unregulated remedies that lack dosage guidelines and scientific evidence of their efficacy. “I want to make sure that they are safe, and don’t interact with the drug that I am prescribing,” he said. Still, he conceded that herbals may be helpful, if only as placebos. “If you believe that something will work,” he said, “it may actually work in some cases.”

A version of this article appears in print on November 15, 2015, on page MB1 of the New York edition with the headline: Seeking Remedies From Home .

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