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Medicinal plant use and knowledge for Monteverde residents based on age and education

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Title:
Medicinal plant use and knowledge for Monteverde residents based on age and education
Translated Title:
El uso de las plantas medicinales y el conocimiento para los residentes basado en la edad y la educación ( )
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English
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Gurgiolo, Cassandra
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Botany, Medical   ( lcsh )
Sociology and economics   ( lcsh )
Botánica, Sociología médica y economía
Tropical Ecology 2006
Medicinal plant use
Ecología Tropical 2006
Uso de plantas medicinales
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Reports   ( lcsh )
Reports

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Abstract:
Approximately 80% of the world population relies on medicinal plants from the forest, home gardens, or market as a primary form of healthcare (Alcorn 1995). However, increased development and deforestation in recent years may be compromising the practice of natural medicine among the inhabitants of many developing countries. Interviews with 33 residents of Monteverde, Cost Rica examine both the current level of knowledge concerning natural medicine and its practice based upon age and educational level. Statistically significant positive linear relationships were found between both utilization and knowledge of medicinal plants and age. Knowledge and utilization of medicinal plants decreased weakly with increasing educational level; however age may be a confounding variable, as education was correlated with age. Despite the lower number of natural treatments cited by the youngest participants, the practice of natural medicine is indeed still prevalent among residents of Monteverde, demonstrated by the average number of ailments for which participants used medicinal plants, 11 out of 16. As the species of plants cited are mostly exotics or garden-variety natives, the results of this study do not have strong implications for conservation. Nevertheless, considering the lack of affordability of pharmaceutical products, it is fortunate that medicinal plant knowledge has survived in this community.
Abstract:
Aproximadamente el 80% de la población mundial recurre a las plantas medicinales del bosque, los jardines, o en el mercado como una forma primaria de mantenerse con salud (Alcorn, 1995). Sin embargo, en los últimos años ha aumentado el desarrollo y la deforestación que pueden poner en peligro la práctica de la medicina natural entre los habitantes de muchos países en desarrollo. Entreviste a 33 residentes de Monteverde, Costa Rica para examinar el nivel de conocimiento sobre la medicina natural y su práctica con respecto a la edad y el nivel de educación.
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Text in English.
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Approximately 80% of the world population relies on medicinal plants from the forest, home gardens, or market as a primary form of healthcare (Alcorn 1995). However, increased development and deforestation in recent years may be compromising the practice of natural medicine among the inhabitants of many developing countries. Interviews with 33 residents of Monteverde, Cost Rica examine both the current level of knowledge concerning natural medicine and its practice based upon age and educational level. Statistically significant positive linear relationships were found between both utilization and knowledge of medicinal plants and age. Knowledge and utilization of medicinal plants decreased weakly with increasing educational level; however age may be a confounding variable, as education was correlated with age. Despite the lower number of natural treatments cited by the youngest participants, the practice of natural medicine is indeed still prevalent among residents of Monteverde, demonstrated by the average number of ailments for which participants used medicinal plants, 11 out of 16. As the species of plants cited are mostly exotics or garden-variety natives, the results of this study do not have strong implications for conservation. Nevertheless, considering the lack of affordability of pharmaceutical products, it is fortunate that medicinal plant knowledge has survived in this community.
Aproximadamente el 80% de la poblacin mundial recurre a las plantas medicinales del bosque, los jardines, o en el mercado como una forma primaria de mantenerse con salud (Alcorn, 1995). Sin embargo, en los ltimos aos ha aumentado el desarrollo y la deforestacin que pueden poner en peligro la prctica de la medicina natural entre los habitantes de muchos pases en desarrollo. Entreviste a 33 residentes de Monteverde, Costa Rica para examinar el nivel de conocimiento sobre la medicina natural y su prctica con respecto a la edad y el nivel de educacin.
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Sociology and economics
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Medicinal plant use
Ecologa Tropical 2006
Uso de plantas medicinales
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Medicinal Plant Use and Knowledge for Monteverde Residents Based on Age and Education Cassandra Gurgiolo Department of Public Health, Johns Hopkins University ABSTRACT Approximately 80% of the world population relies on medicinal plants from the forest, home gardens, or market as a primary form of hea lthcare (Alcorn 1995). However, increased development and deforestation in recent years may be compromising the practice of natural medicine among the inhabitants of many developing countries. Interviews with 33 residents of Monteverde, Cost Rica examine both the current level of knowledge concerning natural medicine and its practice based upon age and educational level. Statistically significant positive linear relationships we re found between both utilization and knowledge of medicinal plants and age. Knowledge and utilization of medicinal plants decreased weakly with increasing educational level; however age may be a confounding va riable, as education was correlated with age. Despite the lower number of natural treatments cited by the youngest participants, the practice of natural medicine is indeed still prevalent among residents of Monteverde, demonstrated by the average number of ailments for which participants used medicinal plants 11 out of 16. As the sp ecies of plants cited are mostly exotics or garden-variety natives, the results of this study do not have strong implications for conservation. Nevertheless, consider ing the lack of affordability of pha rmaceutical products, it is fortunate that medicinal plant knowledge has survived in this community. RESUMEN Aproximadamente 80% de la poblacin del mundo usa plantas medicinales del bosque, los jardines, o el mercado para mantener salud (Alcorn 1995). Sin embargo, el desarrollo y la deforestacin en los ltimos aos pueden influir la prctica de medicina natural en tre los habitantes de muchos pases en desarrollo. Entrevist 33 residentes de Monteverde, Costa Rica para examinar el nivel del conocimiento sobre medicina natural y su prctica con respecto a edad y nivel de educacin. Hay rel aciones lineales, positivas y estadsticamente significativas entre ambos la utilizaci n y el conocimiento de plantas medicinales y la edad de la persona. El conocimient o y la utilizacin de plantas medicina les disminuieron dbilmente con niveles de educacin ms altas; sin embargo la edad puede ser una variable que confunde, porque la educacin estuvo asociada con la edad. A pesar del n mero ms bajo de tratamie ntos naturales citados por los participantes ms jvenes, la prctica de la medicina natural es todava predominante entre residentes de Monteverde, debido a el nmero de en fermedades para lo cul los partic ipantes usaron plantas medicinales. La mayoria de las especies de plantas citadas es ex tica, por lo cual los resultados de este estudio no tienen implicaciones importantes para la conservacin. Por los precios elevados de los productos farmacuticos en el mercado, afortunadamente el conocimiento de medicina natural ha sobrevivido en esta comunidad. INTRODUCTION: Utilitarian arguments for conservation of tropi cal forests emphasize that species must be preserved because of their rea lized or potential utility to humans (Alcorn 1995). Indeed, forty two percent of the worlds top selling drugs are derived from natural sources, and 1

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pharmaceuticals from genetic resources are valu ed at $75-150 billion annually (Kate and Laird 1999). Bioprospecting companies such as the Instituto Naciona l de Biodiversidad (INBio) are attempting to find novel chem ical compounds, genes, macro and micro organisms and other valuable natural products to create new medicines and consumer products (Sittenfield et al. 1994). For ex ample, the use of rosy periwinkle ( Catharanthus roseus ) for treating childhood leukemia and Hodgkins disease illustrates the pharmaceutical potential of tropi cal forests and the need for their conservation (Balick 1997). Artemisia annua, an herbal remedy used in China for almost 2000 years has proven effective against resistant st rains of malaria (Balick 1997). Pursuit of miracle drugs to treat cancer, neurological disorders, and infectious diseases is the developed worlds view of the medicinal value of tropical conservation. However, according to the World Health Organization over one-third of the world population, primarily in developing countries lacks access to essential medicines. Moreover, of the six billion people in th e world, only about one billion utilize manufactured pharmaceuticals to maintain health and treat illnesses (Alcorn 1995.). The remaining 5 billion obtain medicines from the forest, home gardens, or local market. In Belize up to 75% of the primary health car e is provided by traditional healers using medicinal plants (Balick 1997). As habitat de struction increases in developing countries, availability of natural resources for medi cinal application is greatly diminished. Furthermore, the influence of industria lized nations may contribute to a loss of culture, tradition, and knowledge of medicinal plants and natural remedies. A study among the native inhabitants of the Atlantic Fo rest in Caicaras, Brazil (Begossi et al. 2004) documented patterns of medicinal plant uses based on age. Caicaras depended 2

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predominantly on small-scale agriculture until the last 20 years when tourism increased dramatically. Through interviews research ers found the greatest amount of medicinal plant knowledge among older individuals (aged 40 and over) in th e population, indicating that information is being lost. There is evidence that development may l ead to the loss of traditional knowledge. A study among communities in Sierra de Mana ntlan of western Mexico (Benz et. al 2000) revealed that knowledge of medici nal plant uses was lower among more modernized communities. Reduced knowle dge and use of medicinal plants was associated with the loss of indigenous langua ges and reduced community remoteness, as well as the presence of indoor plumbing and modern medical infrastructure. Many generations of the historically remo te town of Monteverde, Cost Rica have relied on natural remedies from local forest farms and gardens to treat minor illnesses from headaches and gastrointestinal problem s to asthma and insomnia (Libman 1999). In the past lack of access to pharmacies and medical infrastructure may have contributed to dependence upon natural medicine. Yet, as modern institutions become more common and encroachment upon the forests increases, the vertical transm ission of biological knowledge from one generation to the next is uncertain. The presence of more expensive manufactured drugs as medical alternatives as well as the discouragement of natural medical practice from Western thought may influence younger indivi duals. Since the average annual income for 2000 in Costa Rica was U.S.$4,062 per capita, increased dependence upon more expensive pharmaceutical products would have prominent economic implications (Estado de la Nacion 20 06). This study examines the current level of medicinal plant knowledge and use for Monteverde residents based upon age and 3

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education. MATERIALS AND METHODS Study Site Monteverde, Puntarenas province, Costa Ri ca was chosen for its rich biodiversity, proximity to tropical lower montane wet forest history of natural medical practices, and increased development in the last 20 years. This is essential to the study in that rapid development may contribute to cultural differences between generations. Until the mid 1980s Monteverdes economy was based on small single-family farm s. Electricity has only been installed in some parts within the last 10 year s. However, ecotourism has eclipsed agriculture as the principal source of income fo r the town (Nadkarni, 2000). In only two decades Monteverde has become a world-renowned destination for tourists, receiving an estimated 120,000150,000 visitors (M. Hidalgo, President of Local Tourism Board) to 200,000 visitors annually (Key to Co sta Rica, 2006). Data were collected from October 24 to November 15, 2006. Interviews of local residents were conducted in the homes of participants, in local businesses, and in the center of Santa Elena, Costa Rica. Selection of Participants Recruitment of the thirty-t hree participants was based upon convenience sampling with restrictions on place of origin and age. Only persons over the age of 20 and raised in Monteverde or the adjacent towns of Guacima l, Las Juntas, and Tilaran were asked to participate in this study. Because the transm ission of biological and medicinal knowledge is in part a social construct, it may be infl uenced by family values and tradition as well as socioeconomic status (Cox 1997) To help control for these potentially confounding 4

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variables, efforts were made to interview several members within the same family. Conduction of Interviews Participants were interviewed in Spanish, in-p erson without the aid of a recording device. Interviews were based on a standard questi onnaire (Appendix 1), which consists of several questions regarding the interviewees backgrounds as well as their use and knowledge of natural treatments for 16 common a ilments. Participants were told at the start of each interview that questions con cerned practices in the treatment of common illnesses rather than use and awareness of me dicinal plants to avoid potentially biased answers. Utilization and knowledge were measur ed as the number of ailments out of a possible 16 for which the participants stated using or naming a natural treatment. It is important to note that this study does not concern itself with the number of medicinal plants used or known; if partic ipants cited more than one medicinal plant for an ailment, it was counted as only one treatment. To qua lify as a natural reme dy, the treatment must be available in a form not manufactured by pharmaceutical companies. This included all plants and agricultural products. Price Determination for Pharmaceutical Drugs In order to quantify the economic burden of purchasing manufactured pharmaceuticals, prices of common medicines were collected at Farmacia Vitosi, one of only two pharmacies in the Monteverde region. Prices were converted from Costa Rican colones to U.S. dollars and adjusted for 12 pills. The recommended dose for each medicine is two pills every four to six hours. 5

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RESULTS Use and Knowledge of Medicinal Plants Based on Age A significant positive linear relationship exis ts for age and utilization of medicinal plants (regression, R2 = 0.355, p < 0.001, n = 33; figure 1 A) as well as for age and knowledge of medicinal plants (regression, R2 = 0.322, p < 0.001, n = 33; figure 1 B). However when data points from participants aged 20-23 (n = 5) were removed from the analysis, the trends become much less appa rent and the results for both utilization and knowledge are no longer statistica lly significant (regression, R2 = 0.099, p = 0.108, n = 27 and R2 = 0.069, p = 0.185, n = 27, respectively; figure 2). Interestingly, females stated using medicina l plants more often than males (t-Test, t = 3.04, df = 32, p < 0.005); also they were able to name more natural remedies (t-Test, t = 3.48, df = 32, p < 0.005). Visually, the majo rity of points representing female participants lie above the best fit line, while many points re presenting male participants lie below the line (Figure 1). The mean fe male age was 43.47 14, while the mean male age was 34.43 14. Use and Knowledge of Medicinal Pl ants Based on Educational Level There is a negative linear trend between educational level an d use of medicinal plants, however the results are not st atistically significant (regression, R2 = 0.099, P = 0.074, n = 33; figure 3 A). Similarly, there is a negative linear relationship between educational level and knowledge of natural medicine (regression, R2 = 0.088, P = 0.095, n = 33; figure 3 B) Age and educational level were inversely related (linear regression test, R2 = 0.361, P-value < 0.001). Conversations w ith interviewees and other residents of Monteverde indicate that the majority of younger individuals te nd to be more highly 6

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educated than their parents and grandparents. For example, the average educational levels were 11.9 years 3.5 for the 20-29 year old in terviewees, 9.1 years 4.0 for the 30-39 year olds, and 6.4 years 5.1 for participants 40 years and over. A0 2 4 6 8 10 12 14 16 18 02 04 06 08 0 Age (years) Male Female R2 = 0.3545 p < 0.001 B0 2 4 6 8 10 12 14 16 18 02 04 06 08 0 Age (years) Male Female R2 = 0.3092 p < 0.001 Figure 1. A. Use of Medicinal Plants Based on Age. Participants were asked what they use to treat 16 common ailments. Treatment s measures the number of ailments for which participants used natu ral remedies. B. Knowledge of Medicinal Plants Based on Age. Participants were asked to name a medi cinal plant or natural remedy for 16 different ailments. Both use and knowledge of medi cinal plants increase with age. Males interviewed tended to be of younger ages, while the age of females has a more even distribution. 7

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AR2 = 0.0998 0 2 4 6 8 10 12 14 16 18 01020304050607080 Age (years) BR2 = 0.0691 0 2 4 6 8 10 12 14 16 18 01020304050607080 Age (years) p = 0.108 p = 0.185 Figure 2. A. Use of Medicinal Plants Ba sed on Age (27-76 years). Data from the 20-26 year old group was removed, revealing a weak er relationship between age and number of natural remedies used to treat the 16 ailmen ts. B. Knowledge of Medicinal Plants Based on Age (27-76 years). Data from the 20-26 year old group was removed, revealing a weaker relationship between age and number of known natural treatments for the 16 ailments. 8

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AR2 = 0.1066 0 2 4 6 8 10 12 14 16 18 0 5 10 15 20 Educational Level (years) p = 0.074 BR2 = 0.0963 0 2 4 6 8 10 12 14 16 18 0 5 10 15 20 Educational Level (years) p = 0.095 Figure 3. A. Use of Medicinal Plants Based on Educational Level. Participants were asked what they use to treat 16 common ailments. Treatments measures the number of ailments for which participants used natural remedies. B. Knowledge of Medicinal Plants Based on Educational Level. Participants were asked to name a medicinal plant or natural remedy for 16 different ailments. Both use a nd knowledge of medici nal plants decrease weakly with increased educational level. 9

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General Observations All interviewees used and were able to cite me dicinal plants for at least 2 ailments out of a possible 16, with the average number of natural treatments used and known being 11.06 and 11.58, respectively. Table 2 summarizes the most frequently cited medicinal plants and their indications. Only 45% of the plants listed are native to th e Neotropics, while the majority are introduced. Many species are cu ltivated in gardens and prefer disturbed habitats (Bernhardt 2004). A ll of the participants acknowledged family members, including parents, grandparents, aunts, uncles, cousins, and in-laws as the source of cited natural remedies. Younger particip ants aged 20-23 (n = 5) were often more hesitant in responding to the questions and expressed doubt when citing a medicinal plant. Two stated that other family members such as pa rents or grandparents prepared teas and other treatments, which the participants were unabl e to identify. When asked what he used to treat sore throats, one 20 year old shrugged and stated that he did not know. At that time that interviewees moth er interjected, I make llanten tea for you. She laughed and said to me, He drinks it; he just doesnt know what it is. Use of natural medicine varied little w ith knowledge of natural medicine, indicating that if participants knew of th e natural remedy, they most likely used it as part of their healthcare routine. The vast majority of inte rviewees (n = 30) expressed a preference for natural medicine over pharmaceutical produc ts, with only one participant (aged 30) preferring pharmaceutical drugs and two participants (aged 20 and 28) expressing no preference. The most frequently cited reas on for favouring natural medicine was reduced secondary effects (n = 24). One participan t (aged 76) complained that when she took acetaminophen for a headache, it provoked stomach pains, or if she used decongestants 10

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she became drowsy and lethargic. Participants (n = 21) claimed that natural remedies, especially teas prepared from dried medicinal plants, were as effective in relieving their symptoms without side effects. Many interv iewees (n = 11) acknowledged the high cost of manufactured medicine as a deterrent fr om its use. One interviewee (aged 28) who preferred natural medicine in conjunction with pharmaceutical medicine stated that if she was ill and had money, she went to the pharmacy, but if she did not have money, she went to her grandmothers garden. Table 1 displays the prices of several common medicines used to treat cold and flu sy mptoms as well as stomach problems. The pharmaceutical drugs ranged in price from U.S.$2.80 to U.S.$8.40 for 12 pills. Tradition and custom were also consistently mentioned (n = 7) as influencing healthcare choices. Table 1. Common Pharmaceutical Products, Indications and Prices collected at Pharmacy Vitosi located in the cen ter of Santa Elena, Costa Rica Medicine Use Price (for 12 pills) Pseudophedrine Nasal decongestant $8.40 Panadol Colds, flu, sore throat, fever, cough $4.80 Tapsin Colds, flu, sore throat, fever, cough $3.00 Aceatminophene Headaches $2.40 Comtrex Colds, flu $5.00 Lomotil Stomach problems, diarrhea $7.20 11

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Table 2. Common Medicinal Plants Cited by Monteverde Residents. Common Spanish/English Name Scientific Name (Family) Origin Medicinal Use Ajo/Garlic Allium sativum (Liliaceae) Europe Intestinal parasites, antibacterial, antiviral Apazote/Wormseed Chenopdiaceae ambrosioides (Chenopodiaceae) Neotropics Parasites China Impatiens walleriana (Balsaminaceae) Africa Antibiotic, relieves itching of insect bites Canela/Cinnamon Cinnamomum zeylaanicum nees (Lauraceae) Asia Stomach problems, nausea, diarrhea Coco/Coconut Cocos nucifera (Arecaceae) Neotropics Parasites Dormilona/Mimosa Mimosa pudica (Mimosaceae) Neotropics Sedative, pain reliever, dental pain Guajava/Guava Psidium guajava (Myrtaceae) Neotropics Diarrhea, bleeding gums Hierbabuena/mint Mentha citrata, M, crispa, M. piperita (Labiatae) Europe Calms nerves, antibacterial, stomach problems Jingibre/Ginger Zingiber officinale (Zingiberaceae) Asia Antibacterial, natural stimulant, sore throats, colds and flu, digestion Juanilama Lippia alba (Verbenaceae) Neotropics Digestion, relaxant, colds, flu Limon/Lemon Citratus spp .(Rutaceae) Asia Colds, flu, sore throat Llanten/Plantain Plantago mayor (Poaceae) Unknown, cosmopolitan Colds, flu, sore throat, cough Manzanilla/Chamomile Matricaria chamomilla and Anthemis nobilis (Compositae) Europe Mild calmative, relaxant, digestive stimulant Menta/Mint Mentha rotundifolia (Lamiaceae) Neotropics Vomiting, antibacterial, calms nerves Oregano Lippia graveolens (Verbenaceae) and Origanum vulgare (Lamiaceae) Neotropics and Europe, respectively Stomach problems, colds, cough, flu Papaya Carica papaya (Caricaceae) Neotropics Digestion, stomach problems Romero/Rosemary Rosemarinus officinalis (Lamiaceae) Europe Stomach problems, digestion Ruda/Common Rue Ruta graveolens L. (Rutaceae) Europe Ear infections, inner ear pain Sbila/Aloe Vera Aloe vera (Liliaceae) Africa Burns, insect bites, gastritis Tilo Justicia pectoralis (Acanthaceae) Neotropics Mild sedative Zacate de Limon/Lemon Grass Cymbopogon citratus (Poaceae) Asia Colds and flu, pain reliever, inflammation, relaxant 12

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DISCUSSIONS Results of the study demonstrate an increase in use and knowledge of medicinal plants with increasing age. The results agree with the study by Begossi et al. (2004), in which the highest levels of medicinal plant know ledge were found among the older members of the population. The potential cause of the positive relationship between age and knowledge or use of natural medicine ma y be explained in part by increased development. Older individuals we re raised in an environment much different than that of their children and grandchildren. One 40 year old resident of Mont everde stated that during his early childhood, there was no elec tricity in the town and people had to purchase supplies from neighbouring Guacima l or Las Juntas, which was a two-day journey on horseback. Many interviewees over the age of 40 were delivered at home by midwives, because the nearest hospital was in Puntarenas. This sharply contrasts the Monteverde of today with modern clinical facilities and several fulltime physicians. Yet, the trend becomes much weaker when the data for the 20-23 year olds were removed. It appears that the lack of use and awareness of natural medicine is mainly among the youngest interviewees while adults in their late 20s and 30s generally exhibited a breadth of knowle dge comparable to older indi viduals. A possible hypothesis is that adults in their early 20s are less likely to have children than adults in their late 20s and beyond. It could be that knowledge of natu ral remedies is gained when individuals bear the responsibility of caring for the health of their families. This may be the critical point where they develop an interest in heal thcare and begin to ask older family member for advice in treating common illnesses. Furt hermore, conversations with locals and observations of family dynamics indicate that it is common in Monteverde for children to 13

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live with parents until marriage, regardless of ag e. If the 20-23 year old interviewees are living with their parents, th en it is possible that they are unknowingly using natural remedies, which may have caused inaccurate re sponses for use. In this case, there may have been a large gap between use and. knowledge. The interviews in which the participants stated that other family memb ers prepared remedies for them support this hypothesis. Treatments prepar ed by other family members could explain why these interviewees were unable to cite using specific medicinal plants. The extensive preference of natural medicine over pharm aceutical products, regardless of measured practice or awareness, is also consistent. It appears that females were generally more knowledgeable and more likely to cite using natural medicines than males, whic h is consistent with the study conducted by Begossi et al. (2004). They found that the greatest knowledge tended to be among women, many of them housewives, with a mean age of 46 years. Traditional gender roles may explain this trend, as it is typically wo men who care for ill family members. Yet, many men identified uses for a substantial num ber of medicinal plan ts and there was less variation in knowledge among males than fe males in the Begossi study. However, the observed relationship in my study may be confounded by age, as females had a higher mean age than males. The trend between educati onal level and use and knowle dge of medicinal plants may become significant with a larger sample size. However age potentially confounds the relationship, as educational level and age were inversely related among study subjects. An even distribution of participants from all ages and educational backgrounds is necessary to determine whether the negative linear trend between educational level and 14

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practice and awareness of natural medicine is substantial. This is difficult due to characteristics of the study site; the conversations with resi dents of Monteverde indicate that the trend between age and e ducational level is typical of the town and not a result of sampling methods. The older generations simp ly did not have the same opportunities to attend school as their children and grandc hildren have had; many were required to contribute to their families livelihood at early ages. Overall the data suggest that age signif icantly influences practice and awareness of natural medicine, however a substantia l amount of knowledge remains among younger individuals in their late 20s and early 30s. It seems, therefore, that strong cultural traditions can coexist with increased development. A comparative analysis of the medicinal plant knowledge possessed by tradi tional healers in more isolated Amazon versus in the more developed Andes, rev ealed that healers in the Andes possessed a greater degree of biological, medical, and taxonomic knowledge, despite higher modernization and lower biodiversity in th e region (Vandebroek 2004). Determination of ethnobotanical knowledge among Tzeltal Maya children in 1968 and again in 1999 showed no difference in the number of plant sp ecies that children aged nine to twelve could correctly identify, despite increased m odernization in the 30 years between studies (Zarger and Stepp 2004). The practice of natural medicine is i ndeed still prevalent among residents of Monteverde, demonstrated by the generall y high number of ailments for which participants cited using natural remedies. As the species of plants utilized are mostly exotics or garden-variety natives, the results of this study do not have strong environmental implications. Although conserva tion of tropical forest is paramount for a 15

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variety of other reasons, it does not play a prominent role in the preservation of traditional medicinal knowledge among Montever de residents. Nevertheless, the social implications of the study are immense. C onsidering the lack of affordability of pharmaceutical drugs, it is fortunate that medi cinal plant knowledge has survived through land development, increased populations, a nd the tourism explosion. As mentioned before, the average annual per capita income in Costa Rica is less than U.S.$5,000; thus many families may only be able to budget $10 or $20 per month on healthcare. From the list of prices for common manufactured medicines (Table 1), the economic burden of purchasing these products is obvious. Contrastin gly, most of the medicinal plants cited can be grown in gardens practically for free. This study reveals a s ituation where culture, tradition, and nature contribu te to improved quality of life for people in the community. Future studies should examine the wealth of knowledge among locals concerning exclusively native plant species. ACKNOWLEDGMENTS I would like to thank Alan Masters got his inst rumental help in the design of this study and analysis of data, as well as Karen Masters and my fello w C.I.E.E. students for their aid in recruitment of study participants. I w ould also like to thank the family of Reina Cruz and Leonel Arguedas for sharing their knowledge of medicinal plants with me. Thank you to Tom and Cam for editing this pape r and most importantly thanks to all of my interviewees. 16

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LITERATURE CITED Alcorn, Janis B. 1995. The Scope and Aims of Ethnobotany in the Developing World. In: Ethnobotany: Evolution of a Discipline Richard E. Schultes and Siri von Reis, eds. Dioscorides Press, Portland, Oregon, pp. 27. Balick, M.J., R. Mendelsohn, R. Arvigo, and G. Shrophire. Valuation of Extractive Medicines in Tropical Forests. In: Principles of Conservation Biology Second Edition. Sineauer Associates, Inc. pp. 535-536. Begossi, Alpina, Natalia Hanazaki, and Jorg e Y. Tamashiro. 2002. Medicinal Plants in the Atlantic Forest (Brazil): K nowledge, Use, and Conservation. Human Ecology. Vol. 30. No. 3: 281-299. Bernhardt, Ed. 2004. Tropical Medicinal Plants for Natural Health Care. Impreso San Isidro, Costa Rica. Benz, Bruce F., J. Cevallos, E.F. Santana, M.J. Rosales, and S.G. Raf. 2000. Losing Knowledge About Plant Use in the Sier ra de Manantlan Biosphere Reserve, Mexico. Economic Botany. Vol. 54: 183-191. Cox, Pal A. 1997. Indigenous Peoples and Conservation. In: Biodiversity and Human Health Francesca Grifo and Joshua Rosenthal, eds. Island Press, Washington D.C., pp. 207-218 Libman Amy. Fall 1999. Biologi cal Inventory and Local Knowledge in Locating Medicinal Plants. In: Tropical Biology and Conservation C.I.E.E. 39-50 NA. [2006.] Estado de la Nacion Costa Rica: Estadisticas So ciales. Available [online]: http://www.estadonacioncr.cr NA. [2006.] Key to Costa Rica: Four Alterna tives to Monteverde. Available [online]: http://www.keytocostarica.com/ecotour-monteverde.htm Nakarni, Nalini M. and Nathanie l T. Wheelwright. 2000. Introduction. In Monteverde: Ecology and Conservation of a Tropical Cloud Forest Nalini M. Nakami and Nathaniel T. Wheelwright, eds. Oxford University Press, New York, pp. 3-11. Sittenfelf, Anita and Renata Villers. Costa Ricas INBio: Collaborative Biodiversity Research Agreements with the Pharmaceutical Industry. In: Principles of Conservation Biology, Second Edition. Sineauer Associates, Inc. pp. 500-504 Vandebroek, Ina, Patrick Van Damme, Luc Va n Puyvelde, Susana Arrazola, and Norbert De Kimpe. 2004. A comparison of traditional healers' medicinal plant knowledge in the Bolivian Andes and Amazon. Social Science & Medicine. Vol.59, Iss. 4: 837845. 17

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Zarger Rebecca K. and J.R. Steep. 2004. Pers istence of Botanical Knowledge among Tzeltal Maya Children. Current Anthropology. Vol. 45: 413-418. Zuchowski Willow. 2005. A Guide to Tropical Plants of Costa Rica. Zona Tropical, Miami, FL. pp. 122. APPENDIX Cuestionario Nombre: Cuantos aos tiene usted? Donde naci usted? Donde fue criado/a? Cuantas generaciones de su familia han vivido en Monteverde? Cual nivel de educaccion ha completado usted? Colegio, unversidad, etctra? Cual especialidad de estudio tuve? Cual es su ocupacin? Cuando le duele la cabeza que hace usted para aliviar el dolor? Donde aprendi este remedio? Q uien selo recomend a usted? ...para la gripe o resfriados ...para alergias, asma, o problemas con respiracion ...para la garganta irritada ...para la tos ...para dolor de estomago o diarrea ...para nauseas o vomitos ...para dolor de las muelas ...para picaduras de los insectos (Que usa como un repelente o para aliviar el dolor) 18

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...para parasitos ...para insomnio, falta sueno ...para tratar nervios o para relajar ...para tratar letargo/para tener mas energia ...para infeccions de los oidos y para dolor de los oidos ...para vision y la salud de los ojos ...para quemaduras Usted sabe de cualquier remedio natural para dolor de la cabeza? ...para la gripe o resfriados ...para alergias, asma, o problemas con respiracion ...para la garganta irritada ...para la tos ...para dolor de estomago o diarrea ...para nauseas o vomitos ...para dolor de las muelas ...para picaduras de los insectos (Que usa como un repelente o para aliviar el dolor) ...para parasitos ...para insomnio, falta sueno ...para tratar nervios o para relajar ...para tratar letargo/para tener mas energia ...para infeccions de los oidos y para dolor de los oidos ...para vision y la salud de los ojos ...para quemaduras 19

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Generalmente, usted prefiere medicamentos de la farmacia o medinca natural? Por qu? Cuando usted visita los doctores para tratar algunas de estas enfermedades, que le recomiendan ellos? 20

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