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Case Study Caribbean

A 43-year-old female of Caribbean descent presents at a community clinic in Miami, FL,


complaining of abdominal pain, cramping and bouts of diarrhea. She states this is her first visit to
the clinic, and that she doesn't trust "modern medicine." She is clearly nervous and agitated.
The physician proceeds slowly in an effort to obtain an accurate patient history. She begins with
a few short questions about what's been going on with the patient, wherein she learns that the
patient has recently consumed a considerable amount of "bush tea" to take care of "the worms in
my stomach". The patient states that "the worms have come out", but that her symptoms remain.
In Dominican culture and throughout the Caribbean, bush teas are used for the prophylaxis and
treatment of a wide variety of ailments; in rural Dominica, where access to health care is limited,
herbal medicine is the first response to less urgent illness, particularly intestinal worms.
Rural Dominicans believe that humans are born with an empty worm bag, a designated worm-
reservoir organ in the abdomen, and that intestinal worms are acquired over ones lifetime by
inadvertently ingesting small amounts of soil from gardening. People who regularly drink it tea
claim to rarely see worms in their stool because of the teas prophylactic effect, while people
who drink it only when they feel cramps around their worm bag claim to observe the worms in
their stool because of the ability to flush-out the worms within 12 days.
Interestingly, the active ingredient, terpene ascaridole, in oil of Chenopodium ambrosioides is a
known pharmaceutical anthelmintic used against tapeworms, roundworms, and hookworms. It
has also been shown to be a potent inhibitor of Plasmodium falciparum growth in vitro.
Furthermore, acids extracted from the second most commonly used bush tea (Aristolochi species,
or twef in Patois), have been shown to exhibit potent inhibition of larval growth, again lending to
the potential antiparasitic effect of bush medicines.
Despite the antiparasitic capacity that may be present in local bush tea preparations, the most
important ethnocultural factor to consider is that these herbal home remedies exert a placebo
effect. Cultural beliefs about bush medicines provide mind-body benefits for those in rural areas
with limited access to health care. For example, Dominicans believe bush teas to be a treatment
for frights, or prolonged, distressed states caused by emotional overload, leading to
disturbances in internal balance. Drinking bush tea serves to balance out the state of fright
brought on by overload of fear, panic or worry. The bush species effective for frights differ from
those used for intestinal worms.


What do you think about herbal remedies?
What sort of treatment would you prescribe to this patient?
Doctors need to respect the beliefs of their patients, however this often poses serious medical
implications. Do you believe in the need for an open dialogue between healthcare providers and the
public?
Have you ever tried an alternative medicine remedy yourself? Describe you experience.