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El uso de las plantas medicinales y el conocimiento para los residentes basado en la edad y la educacin
Medicinal plant use and knowledge for Monteverde residents based on age and education
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.
Text in English.
Sociology and economics
Botnica, Sociologa mdica y economa
Tropical Ecology 2006
Medicinal plant use
Ecologa Tropical 2006
Uso de plantas medicinales
t Monteverde Institute : Tropical Ecology
1 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 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 utili zation 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. A s 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 med icinal plant knowledge has survived in this community. RESUMEN Aproximadamente 80% de la poblaciÃ³n del mundo usa plantas medicinales del bosque, los jardines, o el mercado para mantener salud Alcorn 1995. Sin embargo, el desarrollo y la deforestaciÃ³n e n los Ãºltimos aÃ±os pueden influir la prÃ¡ctica de medicina natural entre los habitantes de muchos paÃses en desarrollo. EntrevistÃ© 33 residentes de Monteverde, Costa Rica para examinar el nivel del conocimiento sobre medicina natural y su prÃ¡ctica con respe cto a edad y nivel de educaciÃ³n. Hay relaciones lineales, positivas y estadÃsticamente significativas entre ambos la utilizaciÃ³n y el conocimiento de plantas medicinales y la edad de la persona. El conocimiento y la utilizaciÃ³n de plantas medicinales dismi nuieron dÃ©bilmente con niveles de educaciÃ³n mÃ¡s altas; sin embargo la edad puede ser una variable que confunde, porque la educaciÃ³n estuvo asociada con la edad. A pesar del nÃºmero mÃ¡s bajo de tratamientos naturales citados por los participantes mÃ¡s jÃ³venes , la prÃ¡ctica de la medicina natural es todavÃa predominante entre residentes de Monteverde, debido a el nÃºmero de enfermedades para lo cuÃ¡l los participantes usaron plantas medicinales. La mayoria de las especies de plantas citadas es exÃ³tica, por lo cu al los resultados de este estudio no tienen implicaciones importantes para la conservaciÃ³n. Por los precios elevados de los productos farmacÃ©uticos en el mercado, afortunadamente el conocimiento de medicina natural ha sobrevivido en esta comunidad. INTRO DUCTION: Utilitarian arguments for conservation of tropical forests emphasize that species must be preserved because of their realized or potential utility to humans Alcorn 1995. Indeed, forty two percent of the worldÂ€s top selling drugs are derived fro m natural sources, and pharmaceuticals from genetic resources are valued at $75 150 billion annually Kate and
2 Laird 1999. Bioprospecting companies such as the Instituto Nacional de Biodiversidad INBio are attempting to find novel chemical compounds, ge nes, macro and micro organisms and other valuable natural products to create new medicines and consumer products Sittenfield et al. 1994. For example, the use of rosy periwinkle Catharanthus roseus for treating childhood leukemia and HodgkinÂ€s disease illustrates the pharmaceutical potential of tropical 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 strains of malaria Balick 1997. Pursuit of miracle drugs to treat cancer, neurological disorders, and infectious diseases is the developed worldÂ€s view of the medicinal value of tropical conservation. However, according to the World Health Organization over one third of the world popu lation, primarily in developing countries, lacks access to essential medicines. Moreover, of the six billion people in the world, only about one billion utilize manufactured pharmaceuticals to maintain health and treat illnesses Alcorn 1995.. The remain ing 5 billion obtain medicines from the forest, home gardens, or local market. In Belize up to 75% of the primary health care is provided by traditional healers using medicinal plants Balick 1997. As habitat destruction increases in developing countries , availability of natural resources for medicinal application is greatly diminished. Furthermore, the influence of industrialized nations may contribute to a loss of culture, tradition, and knowledge of medicinal plants and natural remedies. A study amo ng the native inhabitants of the Atlantic Forest in Caicaras, Brazil Begossi et al. 2004 documented patterns of medicinal plant uses based on age. Caicaras depended predominantly on small scale agriculture until the last 20 years when tourism increased
3 dramatically. Through interviews researchers found the greatest amount of medicinal plant knowledge among older individuals aged 40 and over in the population, indicating that information is being lost. There is evidence that development may lead to the loss of traditional knowledge. A study among communities in Sierra de Manantlan of western Mexico Benz et. al 2000 revealed that knowledge of medicinal plant uses was lower among more modernized communities. Reduced knowledge and use of medicinal pl ants was associated with the loss of indigenous languages and reduced community remoteness, as well as the presence of indoor plumbing and modern medical infrastructure. Many generations of the historically remote town of Monteverde, Cost Rica have relie d on natural remedies from local forest, farms and gardens to treat minor illnesses from headaches and gastrointestinal problems 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 transmission 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 individuals. Since the average annual income for 2000 in Costa Rica was U.S.$4,062 per capita, increased depen dence upon more expensive pharmaceutical products would have prominent economic implications Estado de la Nacion 2006. This study examines the current level of medicinal plant knowledge and use for Monteverde residents based upon age and education.
4 M ATERIALS AND METHODS Study Site Monteverde, Puntarenas province, Costa Rica 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 MonteverdeÂ€s economy was based on small single family farms. Electricity has only been installed in some parts within the l ast 10 years. However, ecotourism has eclipsed agriculture as the principal source of income for the town Nadkarni, 2000. In only two decades Monteverde has become a world renowned destination for tourists, receiving an estimated 120,000 150,000 visitor s M. Hidalgo, President of Local Tourism Board to 200,000 visitors annually Key to Costa 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 busines ses, and in the center of Santa Elena, Costa Rica. Selection of Participants Recruitment of the thirty three participants was based upon convenience sampling with restrictions on place of origin and age. Only persons over the age of 20 and raised in Mont everde or the adjacent towns of Guacimal, Las Juntas, and Tilaran were asked to participate in this study. Because the transmission of biological and medicinal knowledge is in part a social construct, it may be influenced by family values and tradition as well as socioeconomic status Cox 1997 To help control for these potentially confounding variables, efforts were made to interview several members within the same family.
5 Conduction of Interviews Participants were interviewed in Spanish, in person witho ut the aid of a recording device. Interviews were based on a standard questionnaire Appendix 1, which consists of several questions regarding the intervieweesÂ€ backgrounds as well as their use and knowledge of natural treatments for 16 common ailments. Participants were told at the start of each interview that questions concerned practices in the treatment of common illnesses rather than use and awareness of medicinal plants to avoid potentially biased answers. Utilization and knowledge were measured a s 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 participants cited m ore than one medicinal plant for an ailment, it was counted as only one treatment. To qualify as a natural remedy, 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 w ere 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. RESULTS Use and Knowledge of Medicinal Plants Based on Age A significant positive linear re lationship exists for age and utilization of medicinal
6 plants regression, R 2 = 0.355, p < 0.001, n = 33; figure 1 A as well as for age and knowledge of medicinal plants regression, R 2 = 0.322, p < 0.001, n = 33; figure 1 B. However when data points fr om participants aged 20 23 n = 5 were removed from the analysis, the trends become much less apparent and the results for both utilization and knowledge are no longer statistically significant regression, R 2 = 0.099, p = 0.108, n = 27 and R 2 = 0.069, p = 0.185, n = 27, respectively; figure 2. Interestingly, females stated using medicinal 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. Visual ly, the majority of points representing female participants lie above the best fit line, while many points representing male participants lie below the line Figure 1. The mean female age was 43.47 Â± 14, while the mean male age was 34.43 Â± 14. Use and K nowledge of Medicinal Plants Based on Educational Level There is a negative linear trend between educational level and use of medicinal plants, however the results are not statistically significant regression, R 2 = 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, R 2 = 0.088, P = 0.095, n = 33; figure 3 B . Age and educational level were inversely related linear regression test, R 2 = 0.361, P value < 0.001. Conversations with interviewees and other residents of Monteverde indicate that the majority of younger individuals tend to be more highly educated than their parents and grandparents. For example, the average educational levels were 11 .9 years Â± 3.5 for the 20 29 year old interviewees, 9.1 years Â± 4.0 for the 30 39 year olds, and 6.4 years Â± 5.1 for participants 40 years and over.
7 A 0 2 4 6 8 10 12 14 16 18 0 20 40 60 80 Age years Treatments Male Female B 0 2 4 6 8 10 12 14 16 18 0 20 40 60 80 Age years Treatments Male Female Figure 1. A. Use of Medicinal Plants Based on Ag e. Participants were asked what they use to treat 16 common ailments. Â¨TreatmentsÂ¨ measures the number of ailments for which participants used natural remedies. B. Knowledge of Medicinal Plants Based on Age. Participants were asked to name a medicinal plan t or natural remedy for 16 different ailments. Both use and knowledge of medicinal plants increase with age. Males interviewed tended to be of younger ages, while the age of females has a more even distribution. R 2 = 0.3545 p < 0.001 R 2 = 0.3092 p < 0.001
8 A R 2 = 0.0998 0 2 4 6 8 10 12 14 16 18 0 10 20 30 40 50 60 70 80 Age years Treatments B R 2 = 0.0691 0 2 4 6 8 10 12 14 16 18 0 10 20 30 40 50 60 70 80 Age years Treatments Figure 2. A. Use 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 natural remedies used to treat the 16 ailments. B. Knowledge of Medicin al 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. p = 0.108 p = 0.185
9 A R 2 = 0.1066 0 2 4 6 8 10 12 14 16 18 0 5 10 15 20 Educational Level years Treatments B R 2 = 0.0963 0 2 4 6 8 10 12 14 16 18 0 5 10 15 20 Educational Level years Treatments Figure 3. A. Use of Medicinal Plants Based on Educational Level. Participants were asked what they use to treat 16 common ailments. Â¨TreatmentsÂ¨ 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 and knowledge of medicinal plants decrease weakly with increased educational level. p = 0.074 p = 0.095
10 General Observations All interviewees used and were able to cite medicinal 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 the Neotropics, while the majority are introduced. Many species are cultivated in gardens and prefer disturbed habitats Bernhardt 2004. All of the participants acknowledged family members, includi ng parents, grandparents, aunts, uncles, cousins, and in laws as the source of cited natural remedies. Younger participants aged 20 23 n = 5 were often more hesitant in responding to the questions and expressed doubt when citing a medicinal plant. Two st ated that other family members such as parents or grandparents prepared teas and other treatments, which the participants were unable to identify. When asked what he used to treat sore throats, one 20 year old shrugged and stated that he did not know. At t hat time that interviewee s mother interjected, I make llanten tea for you. She laughed and said to me, He drinks it; he just doesn t know what it is. Use of natural medicine varied little with knowledge of natural medicine, indicating that if partic ipants knew of the natural remedy, they most likely used it as part of their healthcare routine. The vast majority of interviewees n = 30 expressed a preference for natural medicine over pharmaceutical products, with only one participant aged 30 prefer ring pharmaceutical drugs and two participants aged 20 and 28 expressing no preference. The most frequently cited reason for favouring natural medicine was reduced secondary effects n = 24. One participant aged 76 complained that when she took acetam inophen for a headache, it provoked stomach pains, or if she used decongestants
11 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 interviewees n = 11 acknowledged the high cost of manufactured medicine as a deterrent from 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 grandmother s garden. Table 1 displays the prices of several common medicines used to treat cold and flu symptoms as well as stomach problems. The pharmaceu tical 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 center 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 Hea daches $2.40 Comtrex Colds, flu $5.00 Lomotil Stomach problems, diarrhea $7.20
12 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/Cin namon 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 Rose marinus officinalis Lamiaceae Europe Stomach problems, digestion Ruda/Common Rue Ruta graveolens L. Rutaceae Europe Ear infections, inner ear pain SÃ¡bila/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
13 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 knowledge 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 may be explained in part by increased development. Older individuals were raised in an environment much different than that of their children and grandchildren. One 40 year old resident of Monteverde stated that during his early childhood, there was no electricity in the town and people had to purchase supplies from neighbouring Guacimal or Las Juntas, which was a two day journey on horseback. Many interviewees over the age of 40 were delivered at home by midwives, becau se 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 th at 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 knowledge comparable to older individuals. 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 natural remedies is gained when individuals bear the responsibility of caring for the health of their families. This may be the critical poi nt where they develop an interest in healthcare and begin to ask older family member for advice in treating common illnesses. Furthermore, conversations with locals and observations of family dynamics indicate that it is common in Monteverde for children t o
14 live with parents until marriage, regardless of age. If the 20 23 year old interviewees are living with their parents, then it is possible that they are unknowingly using natural remedies, which may have caused inaccurate responses 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 members prepared remedies for them support this hypothesis. Treatments prepared by other family members could explain why these i nterviewees were unable to cite using specific medicinal plants. The extensive preference of natural medicine over pharmaceutical products, regardless of measured practice or awareness, is also consistent. It appears that females were generally more know ledgeable and more likely to cite using natural medicines than males, which 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 yea rs. Traditional gender roles may explain this trend, as it is typically women who care for ill family members. Yet, many men identified uses for a substantial number of medicinal plants and there was less variation in knowledge among males than females 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 educational level and use and knowledge of medicinal plants may become significant with a larger sa mple 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 ne gative linear trend between educational level and
15 practice and awareness of natural medicine is substantial. This is difficult due to characteristics of the study site; the conversations with residents of Monteverde indicate that the trend between age and educational level is typical of the town and not a result of sampling methods. The older generations simply did not have the same opportunities to attend school as their children and grandchildren have had; many were required to contribute to their familie s livelihood at early ages. Overall the data suggest that age significantly influences practice and awareness of natural medicine, however a substantial amount of knowledge remains among younger individuals in their late 20s and early 30s. It seems, ther efore, that strong cultural traditions can coexist with increased development. A comparative analysis of the medicinal plant knowledge possessed by traditional healers in more isolated Amazon versus in the more developed Andes, revealed that healers in the Andes possessed a greater degree of biological, medical, and taxonomic knowledge, despite higher modernization and lower biodiversity in the 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 species that children aged nine to twelve could correctly identify, despite increased modernization in the 30 years between studies Zarger and Stepp 2004. The practice of natural medicine is indeed sti ll prevalent among residents of Monteverde, demonstrated by the generally 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 conservation of tropical forest is paramount for a
16 variety of other reasons, it does not play a prominent role in the preservation of traditional medicinal knowledge among Monteverde residents. Never theless, the social implications of the study are immense. Considering the lack of affordability of pharmaceutical drugs, it is fortunate that medicinal plant knowledge has survived through land development, increased populations, and 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 e conomic burden of purchasing these products is obvious. Contrastingly, most of the medicinal plants cited can be grown in gardens practically for free. This study reveals a situation where culture, tradition, and nature contribute to improved quality of li fe 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 instrumental help in the design of this study and a nalysis of data, as well as Karen Masters and my fellow C.I.E.E. students for their aid in recruitment of study participants. I would also like to thank the family of Reina Cruz and Leonel Arguedas for sharing their knowledge of medicinal plants with me. T hank you to Tom and Cam for editing this paper and most importantly thanks to all of my interviewees.
17 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. Si neauer Associates, Inc. pp. 535 536. Begossi, Alpina, Natalia Hanazaki, and Jorge Y. Tamashiro. 2002. Medicinal Plants in the Atlantic Forest Brazil: Knowledge, Use, and Conservation. Human Ecology. Vol. 30. No. 3: 281 299. Bernhardt, Ed. 2004. Trop ical 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 Sierra 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. Biological 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 Sociales. Available [online]: http://www.estadonacioncr.cr NA. [2006.] Key to Costa Rica: Four Alternatives to Monteverde. Available [online]: http://www.keytocostarica.com/ecotour monteverde.htm Nakarni, Nalini M. and Nathaniel T. Wh eelwright. 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 RicaÂ€s 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 Van Puyvelde, Susana Arrazola, and Nor bert De Kimpe. 2004. A comparison of traditional healers' medicinal plant knowledge in the Bolivian Andes and Amazon. Social Science & Medicine. Vol.59, Iss. 4: 837 845.
18 Zarger Rebecca K. and J.R. Steep. 2004. Persistence 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: Â¿ CuÃ¡ntos aÃ±os tiene usted? Â¿ DÃ³nde naciÃ³ usted? Â¿ DÃ³nde fue criado/a? Â¿Cuantas generaciones de su familia han vivido en Monteverde? Â¿ CuÃ¡l nivel de educaciÃ³n ha completado usted? Â¿Colegio, universidad , etcÃ©tera ? Â¿ CuÃ¡l especi alidad de estudio tuv o ? Â¿ CuÃ¡l es su ocupaciÃ³n? Â¿ CuÃ¡ndo le duele la cabeza que hac e usted para aliviar el dolor? Â¿ DÃ³nde aprendiÃ³ este remedio? Â¿ QuiÃ©n selo recomendÃ³ a usted? ...para la gripe o resfriados ...para alergias, asma, o problemas con respiraciÃ³n ...para la garganta irritada ...para la tos ...para dolor de estÃ³mago o di arrea ...para nauseas o vÃ³mitos ...para dolor de las muelas ...para picaduras de los insectos Que usa como un repelente o para aliviar el dolor
19 ...para parÃ¡sitos ...para insomnio, falta sueno ...para tratar nervios o para relajar ...para tratar le targo/para tener mÃ¡s energÃa ...para infecciones de los oÃdos y para dolor de los oÃdos ...para visiÃ³n y la salud de los ojos ...para quemaduras Â¿Usted sabe de cualquier remedio natural para dolor de la cabeza? ...para la gripe o resfriados ...para ale rgias, asma, o problemas con respiraciÃ³n ...para la garganta irritada ...para la tos ...para dolor de estÃ³mago o diarrea ...para nauseas o vÃ³mitos ...para dolor de las muelas ...para picaduras de los insectos Que usa como un repelente o para aliviar el dolor ...para parÃ¡sitos ...para insomnio, falta sueno ...para tratar nervios o para relajar ...para tratar letargo/para tener mÃ¡s energÃa ...para i nfecciones de los oÃdos y para dolor de los oÃdos ...para visiÃ³n y la salud de los ojos ...para qu emaduras
20 Â¿Generalmente, usted prefiere med icamentos de la farmacia o medi c in a natural? Â¿Por quÃ©? Â¿ CuÃ¡ndo usted visita los doctores para tratar algunas de estas enfermedades, que le recomiendan ellos?