First published in Jivaka Journal 

In this report, I would like to share what I have learned about an indigenous ethnic minority group, the Karen people of Burma, focusing primarily on the condition of their traditional herbal medicine. By drawing information from my experiences in the refugee camps and from conversations I’ve had with people about life inside Karen State, I will conclude with what I know about the current work being done to preserve the herbal traditions of the Karen; specifically the courageous and visionary efforts of the Karen Environmental Social Action Network (KESAN).

As a result of the long-term refugee situation of the Burmese Karen population, I have seen an overall loss of herbal traditions combined with an unsustainable reliance upon modern medicine distributed in camp.

History and Introduction

The Karen are an ethnic minority living in Burma (now Myanmar) and Thailand. They trace their ancestry to Mongolia and Tibet, and claim to have been the first inhabitants of what is now Myanmar, arriving sometime in the 5th century B.C. Not long afterwards, the more aggressive Burman ethnic group moved into the central plains and pushed the Karen up into the mountains of what is now Karen State. They assumed control of the country, established great kingdoms and subjugated the ‘lesser’ hill tribe Karen. Thus the seeds of the current conflict were sown centuries ago.

In the early 1800s, British colonialism took place and the Karen fared quite well; they were thankful to see the Burman conquered by the British and so were quite loyal to the crown. Missionaries, especially American Baptists, were popular among the Karen. Along with conversions to Christianity, these missionaries brought education and literacy to the Karen.

As a result, an improved and sophisticated determination to stand up to the Burman began to grow. In 1949, the country gained independence, leaving the Burman ethnic group in control and the Karen began fighting a revolution that continues to this day.

The present military regime in Burma, the State Peace and Development Council (SPDC), perpetrates abuse on a mass-scale against their people — including ethnic Burmans.
However, they have a particular hatred for the Karen and their 56 year old revolution. In the 1970’s, after two decades of unsuccessful fighting against the guerilla warfare of the Karen, the military regime began specifically targeting civilians. Since then, many have sought refuge in neighboring Thailand. Despite this continuous movement, though, the majority of the Karen struggle to live in their homeland, the Karen State of Burma, along the Thai border.

The Kingdom of Thailand has responded to the plight of the Karen by establishing camps along its border, but Thai Authorities severely limit the actions and movements of both the refugees and the International Non Governmental Organizations (INGOs) that support them. The first official camp was founded in 1980, and over the years, numerous others have been established, consolidated, and relocated. Currently there are 7 Karen camps offering safety to over 100,000 legally registered refugees. The largest camp has over 40,000 inhabitants. The Karen are safe here, have access to clean water, shelter, food, and basic medical services. However, they now face a new psychological struggle as they have been trapped in camps for years with little hope of going home.

There are also Karen villages in Thailand. Many of these Karen are Thai citizens, either being born in the Kingdom or having lived there long enough to obtain papers. These villages serve as accurate models of what Karen villages might be like in Burma when there is peace and freedom. An herbal medical tradition still exists, but the rapid growth of Thailand’s economy is severely threatening its survival. In the meantime, many have attempted to study this traditional medicine, but little has been translated into English.

My experience in the last two years has primarily been with the refugee population. My wife and I spent almost one year living with the refugees in a remote camp. I taught English classes, trained local English teachers, and participated in a variety of other developmental activities. Through my experience with my students and day to day life in the camp, I learned a lot about refugee life and the Karen in general.

The transformation that the refugees have undergone during their time in camp is enormous. Most notably, I observed an unhealthy dependency on INGOs. These INGOs provide emergency food rations, basic necessities like mosquito nets and clothes, and education in the form of teacher subsidies, textbooks, notebooks, pens and pencils. In addition, several medical INGOs offer basic health care and training.

In my opinion, the refugees’ reliance on camp healthcare has become the most threatening impedance to the survival of the Karen in the future, especially after repatriation. For example, at any indication of not feeling well, a “para” is prescribed. This is the status quo throughout the community. Paracetemol (called acetaminophen in the U.S.) is the cure-all, handed out like candy by the INGOs in camp. I had no idea how widespread this treatment was until another English teacher told me that the clinic has been nicknamed the “paracetemol hospital.” He mentioned that every illness is treated similarly.

In addition to this unhealthy reliance on western medicine, the Karen continue to look at the British, or “white skinned” as their potential saviors; a direct effect of colonialism and missionary work from years ago. We have returned to the area in the form of development workers, teachers, doctors, and missionaries. Basically, in the eyes of the Karen, we offer hope for a better future. By adopting our ways, young Karen believe that they can potentially leave behind the nightmare that is their reality. Sadly, it is this type of extreme vulnerability in the refugee population that threatens their cultural identity and ultimate survival upon repatriation.

It saddens me to see the Karen in camps losing their rich herbal tradition. When I look at their future repatriation to the mountains of their homeland, I see a major obstacle in terms of healthcare. The INGOs will be gone, and there will not be any “para” available for free. At the moment, their knowledge of traditional herbal remedies remains stronger than their understanding of the pills that they are given. However, what they are unwilling to admit is that they will have to rely on these traditional remedies when they return home, and this knowledge is fading with time.

In contrast to life at camp, the Karen struggling to survive in Burma continue to practice a traditional livelihood out of necessity. They live off of their land by farming, hunting,

gathering wild plants, fishing, and then trading what they have grown and collected. They possess a working understanding of traditional medicine based on the rich biodiversity of the forests because they have no other options. This type of necessity for survival is nonexistent in the refugee camps because the INGOs continue to provide basic necessities, including western medicine.

The Refugee Population

As mentioned above, my main concern within the Karen refugee community is the unhealthy reliance on INGOs. Though I respect the services they are providing and understand the need for food rations and other basic necessities, as time passes, it saddens me to see the Karen unable to provide for themselves. I truly believe that it is the very nature of the long-term refugee situation that has produced this unhealthy reliance.

Years ago, refugee camps were created as a temporary relief from an emergency situation. The Karen arrived with no food or shelter. The INGO’s were successful in meeting the needs of the refugees and have continued to this day in the same capacity. Unfortunately, the Karen are still unable to return home. It has been more than 20 years since the establishment of these refugee camps. In my opinion, the emergency has stabilized, and the greater need has evolved into one of development. The refugees need skills to prepare themselves for successful reintegration in Burma.

In 1984, the BBC (Burmese Border Consortium) was set up to respond to the needs of the refugees. Currently they provide bamboo and wood posts for house construction, mosquito nets, sleeping mats, and food rations in the form of rice, chili peppers, salt, oil, yellow mung beans, and fish paste. They are also working to relieve the Karen of their heavy reliance on INGO’s by developing programs aimed at empowering the refugees with sustainable life skills. For example, efforts are being made to create more gardens, thus providing more nutrition while at the same time reinforcing self reliance skills which will prove necessary upon repatriation.

Malnutrition is not as large a problem as is often seen within refugee situations, but nutrition continues to concern the BBC because it supports an unhealthy reliance on and consumption of “para.” The ultimate issue is the lack of space for growing vegetables, especially leafy greens. There is little room to grow farm vegetables or herbs like garlic, onions, lemongrass, basil, or cilantro, and many families cannot afford to buy them elsewhere. Thus even the most basic preventative herbs are not being used.

I admire the volunteer doctors that travel to the camps and spend their time working for the refugees. Their hard work is certainly needed and well-received. However, it is my experience that many of the numerous medical INGOs seem to be “imperialistic” when it comes to their health care. There is no effort on their part to maintain the Karen’s traditional knowledge of medicine. Most symptoms are remedied with a good dose of “para,” even though there may be equally effective traditional remedies available in camp to cure and/or prevent illness. “Para” will often eradicate these symptoms of disease, but there is little education among the Karen about the effects of a daily regimen of these pills. In addition, those that rely on this medication believe that it is a “cure-all,” when in reality, the cause of illness is rarely found.

There is another aspect of the relationship between the Karen and modern pills that concerns me. In their minds, and their vocabulary, there is no difference between medication such as “para” and vitamin supplements that are often prescribed and provided for them. For example, many women are given iron to combat a fairly common anemic condition. Ironically, most are reluctant to take these vitamins because they believe that it is unhealthy to take “medicine” everyday. The irony is that they do not mind taking “para” when they feel dizzy or unwell, a condition that usually occurs as a result of not taking daily vitamins. The pills, both medication and vitamins, are provided free by the INGOs.

Unfortunately, Karen traditional medicine, along with most alternative treatment options, is overlooked and even frowned upon. One experienced Karen medic I spoke with told me that he knew some traditional remedies, but that his faith in them had diminished. There is little effort directed towards empowering the people to develop and pass on their traditional practices, all of which have the potential to be invaluable upon repatriation.

Many Karen refugees are now posing the question, “Where will the INGOs be when the Karen are once again living in the remote mountains of their homeland?” They have voiced their concerns regarding the lack of health and medical education in camp. They understand western medicine is necessary at present, but also know that it will not prepare them for when

they return to the mountains. Several Karen are passionate about reviving their herbal traditions and feel it is their best tool for survival after repatriation. They are also aware of the rich preservation of Thai herbal tradition, including massage, preventative herbs in the diet, and other more practical techniques practiced in remote villages, and hope to employ something similar within their own villages.

I would like to mention one incredible program in the camps, and elsewhere along the border, that has tapped into the rich herbal traditions of Burma. A drug rehabilitation and addiction education program called the Drug and Alcohol Recovery and Education (DARE) Network was created in the Mae Hong Son Province of Thailand. DARE utilizes a remarkable blend of traditional herbs to help in the detoxification treatment of patients. The treatment they have created involves the use of Burmese herbal traditional medicine, herbal sauna, traditional massage and acupuncture (darenetwork.com). They have had astounding success in detoxification treatments for dependencies on everything from alcohol to opium. Most of the herbs are obtained in the forest and mixed by local Burmese herbalists in one of the camps.

Karen Youth

Another primary limitation in the perpetuation of the practice of Karen traditional medicine can be found in the youth in the refugee camps. Since some families have been in camps for over 20 years, and most for around ten, there is now a substantial population of children born in camp. These children spend their days in crowded classrooms and continue to eat poor quality rice and rations. They know little of their parents’ lives back in the homeland and many have no idea where rice comes from, other than on trucks. Since the Karen were traditionally farmers, and their homeland remains undeveloped, it can be assumed that growing rice will be a necessary skill upon repatriation. Without the knowledge of how to live off of the land and provide for themselves, their future remains unclear.

Karen youth also grow up accustomed to going to the Out Patient Department (OPD) at the slightest feeling of illness for some sort of pill. Reliance upon herbal tradition has been neglected and the community members that practice this type of medicine are generally looked down upon as “less developed” than the medical INGOs.

On the other hand, there still remains a lingering interest in Karen traditional medicine within the youth population. Some understand the importance of this wisdom and are motivated to learn more about it. I would often speak of the positive effects of learning this type of healing modality as opinions in these matters carry far more weight when spoken by a foreigner than when taught by their own community members.

Although the youth deny it, and the elders exaggerate it, there is certainly a loss of respect towards elders as well as the Karen traditions. Students look to the outside world for education and miss out on the valuable wisdom that their elders possess. Unfortunately, most of this wisdom cannot be transferred through practical hands-on experience.

Additionally, Thai law prohibits refugees from leaving the camps. In a few camps located in the remote mountains, it is possible for them to go into the forests to collect what is available, but this is a rare benefit. In fact, the refugee situation has tightened significantly in recent years. There are now barbed wire fences around the two largest camps and travel outside is almost completely forbidden. That being said, I was fortunate enough to be able to join a group of my students for an early rainy season forest vegetable collection. We collected several varieties of wild vegetables. Each contained a preventative or curative property that my students had learned from their parents and I was thoroughly impressed with their knowledge. Afterwards, I noticed more and more of these wild medicinal vegetables and fresh roots being carried and eaten throughout the camp.

Fortunately, the Karen that have migrated into smaller semi-secret villages in Thailand are more knowledgeable of the local medicinal herbs. One man I know cured his hepatitis with a traditional remedy, mostly containing a fresh green leaf translated as “horse hoof leaf,” which is quite common to the area. Similarly, these Karen use many other herbs for preventative and curative measures. Some are collected from the forests, but many are found along the road or trail. They have no access to the clinics in the refugee camps and so have employed their traditional medicine as a case of necessity. However, even here, the youth are not interested, especially since they have established contact with mainstream Thai culture which looks down on “hill tribes.”

Karen in Burma

If we look at the Karen in the refugee camps, we can see that their suffering is primarily psychological. However, the Karen in Burma face both extreme mental and physical suffering. Most are struggling to survive with little money, food, and almost no medicine. In addition to this, they continue to suffer under an abusive military regime that denies them basic human rights. Mandatory labor, forced relocation, extrajudicial killings, torture and rape are only a few of the injustices that the ethnic minorities face in Burma.

The Karen in Burma generally consist of two main groups, although throughout the year it is common for people to be a part of both. One group lives in villages, mostly high up in the remote mountains of Karen State. The other group is known as the Internally Displaced People (IDPs). It is estimated that there are over 2 million IDPs in Burma with almost one million hiding in the most remote mountains of Karen State. The SPDC regularly patrols the ethnic minority areas and continues to relocate remote villages in order to control them better. At the sight of the SPDC, villagers will flee into hiding and become IDPs. Some remain IDPs for a few days or weeks, but some live as IDPs for years, constantly moving from one hiding site to another.

A friend of mine from a village in Karen State explained to me the situation in his village. He said that there is little modern medicine, and even less money to buy it. As a result, they have an extensive working knowledge of traditional remedies. In many cases it is all they have. For example, malaria is quite common among his students and the villagers. To treat it, one must go into the forest to search for a specific tree to use its bark. According to my friend, the tree is rare and it takes a lot of time to collect the needed remedy, which is an effective treatment. This is a desperate use of the traditional knowledge, and according to my friend, they would prefer having modern medicine. He has asked foreign volunteers for medicine or money to purchase it.

IDPs

As mentioned above, the other group of Karen in Burma is the Internally Displaced People. Their lives are total desperation. They are homeless, in hiding, and barely surviving. They face the worst situation of all, surviving for months on what they can find in the jungle. Malaria and diarrhea, two easily curable conditions, are slowly killing IDPs because they have no access to treatment. They have some knowledge of forest medicine, but are limited to what is growing around them and/or in season. Even more problematic though, is that they do not have any food, clean water, or shelter.

There are organized groups of Karen medics braving the mountains to provide basic care to the IDPs, but they are severely limited to what they can carry on their backs. Their work is all modern, having received medical training in Thailand, so there is little effort to utilize the available resources in the jungle as medicine. The situation is entirely desperate, and most emergency help is overwhelmed by the need and the danger. Volunteers do their best to offer basic hygiene training to prevent disease, but their knowledge and/or use of available herbal remedies is almost nonexistent.

SDPC

Interestingly enough, the ruthless military regime in Burma encourages the use of traditional herbal medicine. Since the colonial era, the Burman have been obsessively anti-imperialistic. They continue to dismiss western medicine and embrace their own and Chinese medical traditions. They encourage the population to continue to use these traditional remedies both directly and indirectly by having one of the worst health care systems in the world. In 2000, the World Health Organization (WHO) ranked Burma’s overall health system 190th out of 191 countries.

The mentality of the Karen is to oppose just about everything about their oppressors, the Burman. In the past they accepted the British, mainly because they defeated the Burman, and assumed better leadership for Burma. Now they try to follow our western ways, whatever they are. In rejecting the Burman culture, traditional herbal prescriptions included, and embracing western concepts of medicine, the Karen are expanding the distance between themselves and their oppressors.

KESAN

A shining light that I have been lucky enough to see is the grassroots Karen Environmental Social Action Network (KESAN). In fact, I can say that my whole inspiration for this work has been from them. They are a highly motivated and dedicated group of young Karen working to educate their community and the world about the importance of re-establishing the link between the natural environment and their livelihood. They contribute their research to numerous international environmental groups to raise awareness on a global scale of the environmental destruction in Burma that is leading to loss of livelihood for countless people. In addition, they strongly believe in the local knowledge and empowerment of villagers to create their own futures. While the Karen struggle to protect their homeland from the ruthless military regime, KESAN works hard to reinforce sustainable community development.

One of their current projects involves educating the Karen in the importance of protecting their community forests. I participated in one of their trainings in the camp. It involved me facilitating a discussion about the role of traditional cultural medicine, especially in Karen State. The conclusion was that there were several reasons why it needs to be preserved and many ways in which it can be done. I have also explained to students the hazards of modern medicine and the terrific value of their traditional practices.

My students and colleagues have been quite open and genuinely interested in our classroom discussions about preserving traditional medicinal knowledge. Some in the camp have taken it to the next level by going to their elders and learning about their traditional medicine. There is an evident pride in these actions; a pride that I typically do not see among them. This is something that is culturally theirs; something to be passionate about during a time of insecurity and sadness where there is little or nothing to be proud of.

KESAN is now in the process of recording what traditional herbal knowledge remains, both in the camps and in Karen State. They understand the importance of traditional medical knowledge and they are dedicated to preserving it. Their plan is to create a reference book to distribute throughout communities both in the camp and in Karen State.

KESAN recently initiated another traditional medicine project in Karen State as well. Members of one local village came together to create and encourage traditional medical educational programs for their youth population. The project gained incredible momentum and has received support from the village authorities and local Karen leaders. They were allotted ten acres of protected forest area to use for identifying, collecting, and replanting medicinal plants. As a result, local herbalists are now able to teach and produce natural treatments for malaria, tuberculosis, acute respiratory disease and menstrual problems, all of which are common to the area. News of this project has spread to surrounding villages, along with a renewed interest in the preservation of traditional medicine and its practical applications.

KESAN is now seeking funds to build an herbal clinic and store-house for their growing number of supplies. They hope to attract villagers from surrounding areas with treatment and/or available training upon its completion. We hope to inspire a similar interest within the camps.

In conclusion, although the herbal traditions of the Karen are alive, especially in Burma, there are severe threats to the continuation of it. This is particularly true among the refugee population. Traditional herbal medical training and herbal reference books are perhaps the best means to facilitate the continuation of Karen herbal traditions, both in camp and in Karen State. In addition, the role of the “white-skinned” must not be underestimated. Visiting herbalists and/or volunteers must continue to emphasize the validity of traditional herbal medicine. We also have a financial responsibility to support and expand the efforts of KESAN and small village initiatives in their struggle to keep Karen traditional medical knowledge alive.

The accompanying photography is from Karen villages. Reproduced with permission from DARE network, www.darenetwork.com.