HerbalGram: The Rich History, Current State, and Possible Future of Natural and Traditional Medicine in Cuba

Many aspects of Cuba exist largely untouched by the sands of modern time, as evident by the classic cars and old buildings of chipping paint that characterize the island. In contrast, Cuba’s strong system of natural and traditional medicine has steadily evolved and reflects a full range of historical experiences within the island and its people.

The narrative of Cuban natural and traditional medicine (NTM) begins long before its current state of stability. Centuries ago, violent colonization threatened the survival of indigenous natural medicine. Later, the importation of African slaves introduced new NTM practices that also fused with and revived those of the natives. With the Revolution, NTM was discouraged by the government in place of modern medicine, a situation that continued despite the United States’ severe trade embargo that has economically and politically isolated Cuba for 5 decades. During this time, NTM was maintained within Cuba’s diverse ethnic and religious groups.

Beginning in the early 1990s, however, NTM no longer flourished solely within these spheres. As a result of the country’s worst economic crisis, caused by the collapse of the Soviet Union, the effects of the trade embargo strengthened and NTM received government endorsement and gained country-wide usage. It has retained this prominence for the last 20 years.

Potentially on the horizon is a significant event that could again alter Cuba’s NTM—an ending of the US trade embargo. If realized, the island will likely experience increased development, globalization, and modernization, including access to Western pharmaceutical medicines—which raises the question: Will Cuba’s NTM endure?

Cultural History

Possibly the first version of Cuban NTM was practiced more than 1,000 years ago by the Taino Indians, a subgroup of the Arawaks who migrated to the island from the Greater Antilles in the 9th century.^1,2The first known people to introduce agriculture to the island, Tainos cultivated some medicinal plants in small gardens, including such plants as almácigo (gumbo limbo, Bursera simaruba, Burseraceae) and bija (annatto, Bixa orellana, Bixaceae), said Francisco Morón, MD, PhD, director of the Central Laboratory of Pharmacology at the Medical Sciences University of Havana (e-mail, August 19–November 24, 2009).

As the Tainos seemingly did not have a written language, most of what is known about them comes from observations documented by Spanish colonizers, Dr. Morón continued. According to these reports, the Tainos’ tradition of medicine, which was often infused with religious ritual, mainly relied on medicinal plants, teas, diet, and massage. Behiques, or healers, used certain medicinal plants with hallucinogenic properties, like the tropane alkaloid-containing jimson weed (Datura stramonium, Solanaceae), to enhance divinity. When practicing the exorcism of spirits and illness, they followed established and strict guidelines, he said.

Few additional documented details about the Tainos’ natural medicine system exist, however.

“The Spaniard Conquest was extremely cruel, and Cuban natives were almost exterminated a few years after Columbus’s arrival,” said Dr. Morón. Though historians are not completely certain what caused the estimated 95% decrease in the island’s Taino population, some think it was a combination of the “fierce and bloody battles of conquest,” along with disease, famine, infant mortality, and suicide.²

With Taino survivors and descendants isolated from Cuban mainstream society, much of their NTM was likely lost or restricted to small areas of the island, said Gabriele Volpato, a PhD student at Wageningen University in the Netherlands who has conducted ethnobotanical research in Cuba (oral communication, July 13, 2009). When new ethnic groups came to Cuba, they likely adopted and modified some of the Tainos’ traditional medicine and mixed this with their own practices, he added.

NTM in Cuba has become a diverse mix of customs and practices, with influences from the Spanish colonizers, African slaves, and immigrants from China, Haiti, and other Caribbean islands.^3,4

“Every one of these [groups] contributed in some way to the medicinal plant use in Cuba,” said Volpato. Because the ethnic groups in Cuba adopted, altered, and diffused much of each other’s traditional medicine, it can be difficult, yet culturally interesting, to determine in which group a certain practice or belief originated, and how it was later modified, he added.

When Africans were taken to Cuba as slaves beginning in 1510,^5,6they carried a few plant species with them and also learned about Cuban medicinal and magical plants, said Dr. Morón. Some researchers say the African traditional and religious practice of medicine and its subsequent fusion with indigenous and cultural Cuban customs has contributed the most to Cuban herbal materia medica.³

“It is well known that owners of slaves received medical care and remedies prepared by the oldest slaves,” Dr. Morón continued. “But they consulted in secret because the ‘white society’ considered the African remedies as black magic.”

Africans incorporated their belief in orichas, or deities relating to natural habitats, with the Catholic devotion to saints.⁵This formed the early version of Santeria, a religion based on the belief that only wild plants, herbs, and weeds are alive with a divine power that heals and fortifies health.⁷Santeria healers, also known as santeros or babalawos, use plants in rituals that often include an initiation of the patient into Santeria based on the belief that the patient’s illness is a sign from the orichas.⁵Plants are then directly administered to patients in various forms, such as blood purifiers or herbal baths, or they are applied to patients’ dwellings through plant-based house cleaners.⁷

With the decline of the slave trade, Chinese laborers began to be imported in 1847 to work on sugar plantations.⁸Over the next 25 years, more than 100,000 Chinese came to the island, bringing with them the unique practices of Traditional Chinese Medicine (TCM).

When walking through the Barrio Chino (Chinese neighborhood) in Havana, passersby could smell the distinct aromas of Chinese herbal formulas, such as yaocha (medicinal tea), roots, leaves, bark, and dried reptiles. Pharmacies that prepared and sold the herbs often imported their ingredients from China, used the native Cuban flora, and bought herbs from local yerberos (herbalists). The public soon became rather fascinated with this new culture’s unique system of medicine, and though few TCM doctors were accredited by the government, TCM practices expanded as the Chinese community spread across the island.

Cuba’s ethnic and religious groups continued to use and modify NTM for many decades, but large scale NTM acceptance was deserted with the development of Western pharmaceutical drugs during the beginning of the 20^thcentury, said Dr. Morón.

Evolution of NTM through Cuba’s Recent Political History

The Revolution

When young revolutionary Fidel Castro entered the scene, NTM was further abandoned and replaced by an emphasis on modern Western medicine. Castro pledged to bring health to all people of Cuba, and once the Revolution triumphed in 1959, he held up to his claim.⁹His new government created a national health system, the Ministry of Public Health (MPH), which aimed to introduce more affordable medicines, more access to Western drugs, the nationalization of private clinics and pharmaceutical companies, and social and rural healthcare services at little or no cost.¹⁰Many Cubans, including those who largely depended upon NTM in the past, now experienced affordable access to nationalized healthcare services for the first time.

Two years after the Revolutionary government took control, the United States enacted a trade embargo against Cuba in order to undermine the Castro government and its ties to the communist Soviet Union. Trade with Cuba was banned, thus preventing the purchase of medicines and medical supplies, among other goods and products, directly from the United States.¹¹But because Cuba relied upon the Soviet Union and the Council for Mutual Economic Assistance for 70–90% of its trade, the embargo initially had little effect on Cuba’s healthcare, and the country continued to have a steady supply of pharmaceuticals and medical devices.^11,12

While the government focused on modern medicine, it also promoted a unified, collective identity, which was common within many Communist movements. This affected the use of NTM, especially in urban areas of the country.⁵While encouraging a general, yet narrow, “macro-identity” of being Cuban, the government discouraged many religious and traditional practices, including NTM, said Volpato.

“When Castro took power, he introduced a very strong political ideology based on everybody working toward a common goal,” Volpato added. “This in some way broke apart micro-identity in Cuba.”

Some sources have reported that health professionals were sanctioned if MPH discovered any “unorthodox” practices, such as suggesting herbal remedies or practicing other NTM modalities,^12,13though Dr. Morón said he does not recall this happening. Additionally, all but one Chinese pharmacy gradually closed down beginning in 1961.⁸Dr. Morón confirmed that many pharmacies did close during the beginning of the 1960s, but said he thinks this was more due to the Revolution’s nationalization of businesses.

This national lack of support for NTM remained for several years, but it would not last as Cuba would soon experience the biggest crisis in its history.

“All of this changed upon the fall of the Soviet Union,” said Volpato.

El período especial

Beginning in the late 1980s, the Soviet Union, once the largest country in the world, began to disintegrate, and by 1991 it had completely dissolved.¹⁴Cuba lost about 80% of its exports, experienced an almost 80% decrease in the value of its imports, and its overall economy fell 40% over the next 4 years.^11,12The government deemed this era of economic crisis El período especial, the Special Period.

Further worsening Cuba’s situation, in 1992 the United States passed the Cuban Democracy Act (CDA),¹⁴which was said to promote democracy in Cuba by further isolating the island and made the embargo the most stringent in the world.⁵The CDA prohibits trading medicines or medical devices with 10% or more of their components made by a US company or foreign subsidiary of a US corporation, and it also bans ships that have docked in Cuban ports from docking in US ports for 6 months. CDA also states that medicine and medical supplies for humanitarian aid can be sent to Cuba only once the Cuban government holds free and fair elections. As the pharmaceutical industry is largely controlled by North American transnational corporations, these new provisions made it extremely difficult and expensive for Cuba to import pharmaceuticals. Spending on the health sector decreased from $227 million to $56 million, including a 67% decrease in spending on medical and pharmaceutical imports.¹³

“The Cuban Democracy Act caused an additional damage to [the] health system because it increased the blockade, or embargo, in a very critical economical and trade period of Cuba,” said Dr. Morón. “To diminish the impact of the lack of drugs, it became imperative to speed the introduction of herbal drugs and other traditional and complementary treatments into the health system.”

In a country forced to find alternative and affordable methods of healthcare for its people, NTM ascended to a never-before-seen nationalized level of promotion and usage, a period that some call Cuba’s “Green Revolution.”¹⁵

The situation was likely “either treat yourself with herbal medicines or don’t treat yourself at all,” said Volpato.

As the Soviet bloc was collapsing, Cuba’s Minister of Health approved 51 medicinal plants to treat certain ailments in 1990, and one year later the government established a national directive for NTM integration into the national healthcare system.¹⁶Primary schools began teaching children about the uses of medicinal plants and how to grow their own herbs, and MHP began working with the Ministry of Agriculture to grow plants for food and medicine in state-run farms.¹⁷

In 1994, the government added many NTM products to the essential drugs list,¹⁸and MPH founded a state commission for NTM development in 1995,¹⁶which aimed to provide a foundation for NTM development throughout the country.^19,20In 1999, the National Program for NTM was created, relying on acupuncture and other forms of TCM, homeopathy, chiropractic care, and 100% native medicinal plants, which was the first type of complementary medicine approved by the national health system, said Dr. Morón.

Now considered by the government as a discipline of scientific medicine, NTM has been accepted by most in the medical sector.¹²Although some practitioners were initially hesitant to accept NTM, the overall transition was eased somewhat by the fact that the government had sponsored some small-scale, pre-Special Period medicinal plant work, said Dr. Morón. Additionally, practitioners were sent a national formulary and educational materials created by 17 Cuban scientists in medicine and biology.¹²Meanwhile, the government began to introduce the Cuban people to newly-nationalized NTM through public awareness campaigns distributed through TV, radio, or print media.^5,12,13

“People welcomed very well the use of traditional plants and complementary medicines,” said Dr. Morón. “Indeed, they never quit traditional health practices.”

Weakening its discouragement of religious and ethnic-based NTM, the government legalized shops selling religious-oriented plants, such as those used in Afro-Cuban religions.⁵Orally-passed down NTM knowledge, such as the traditions of Santeria, was also documented, and these texts are sold in state-run gift shops. The Cuban people could now openly embrace the ties between NTM and Cuban culture.

“Since the early ‘90s, people started returning to their original identities,” said Volpato.

As ethnic and religious groups maintained their NTM throughout the Revolution, some sources note considerable sharing and “borrowing” among the government, the local level, and religious and non-religious groups during the creation of the national NTM system.⁵A comparison of the plants authorized for public sale by MPH in 1999 and those used in ethnic religious-based practices, such as Santeria, shows that at least 93% of the plants used within secular and religious contexts were the same species.

According to Dr. Morón, medicinal plants introduced into the Cuban healthcare system were chosen mainly based on scientific workshop reports from TRAMIL (a program of applied research for traditional popular medicine in the Caribbean), as well as US, British, and other foreign pharmacopeias; Martindale’s Extra Pharmacopoeia; and Cuban research results. Through ethno-pharmacological research conducted by a network of collaborators, TRAMIL aims to establish the security and efficacy of medicinal plant-based practices on various Caribbean islands.¹⁹It originated in Haiti and the Dominican Republic, and Cuba became an official member in 1986.

In 2005, 8 faculty members from several US medical schools legally traveled to Cuba to observe the country’s integrated healthcare system. During the tour, organized and led by Cuba’s MPH, Ben Kligler, MD, an associate professor at Albert Einstein College of Medicine, took note of the government’s positive attitudes toward its NTM-infused healthcare system.

“The fact is that they have a lot to be proud of,” said Dr. Kligler, adding that Cuba’s health statistics reflect this (oral communication, July 30, 2009). As of 2008, the average life expectancy at birth for male and female Cubans was 78 years, one of the highest in the world,²¹and the healthy life expectancy at birth was 68.5 years.²²These statistics are comparable to those of the United States, where the average life expectancy at birth is 77.5, and the healthy life expectancy at birth is 69 years old.¹⁸The United States, however, spends $6,714 on healthcare per person while Cuba spends $363. Dr. Morón said that he attributes the good results at a lower cost to the Cuban healthcare system’s focus on preventative medicine, community-level primary healthcare, the abolition of private healthcare, and state subsidies for the healthcare system.

At the hub of the Cuban government’s NTM activities, the National Center for the Development of Natural and Traditional Medicine develops, integrates, coordinates, and monitors the application of traditional medicine, and it promotes the use of natural products throughout the country.²³Its large network extends throughout 14 regional centers, 7 spas, and all the services of the NTM department’s polyclinics, comprehensive rehabilitation services, hospitals, and research institutes. According to the National Center, its NTM health services and products are based on Cuban research results. Natural products are manufactured by the state in national pharmaceutical factories or in local pharmaceutical production labs, and the State Control of Drug Quality Center (SCDQC) is responsible for approving and controlling all drugs and their quality, said Dr. Morón. Phyto-therapeutics and other natural products are regulated by a SCDQC guide and the Cuban Minister of Health recently released a resolution listing approved NTM, he added.

Herbal medicines are a significant part of the national NTM system, as the island currently produces 300 metric tons of more than 100 different species of medicinal plants in 124 ranches throughout the country.²⁴Some reports show that herbal medicines have replaced 80% of the pharmaceuticals previously used by Cuba’s people.²⁵

State-run pharmacies offer or are solely dedicated to NTM medicines and herbal products.¹²Additionally, many professional practitioners, such as medical doctors, nurses, or physical therapists, provide NTM services and have had considerable NTM training during their medical education.¹⁶

“I had the impression that physicians in general consider alternative therapies totally acceptable,” said Dr. Kligler. “It also seemed that, from primary care doctors, there’s a real openness to the fact that a lot of people use herbals. [In Cuba,] it is important for everybody to know about [natural and traditional medicine] and know that it is available.”

Hospitals and polyclinics all over the country offer a wide array of NTM services. The most commonly used of these procedures includes TCM (acupuncture, digitpuncture, moxibustion, and therapeutic massage), medicinal plant therapies, apitherapy (the medicinal use of products made from honey bees), homeopathy, thermal medicine (medicinal water and mud), ozone therapy, and physical and rehabilitation medicine, said Dr. Morón. Citing the Public Health Ministry’s annual statistical report, Dr. Morón noted that in 2008 more than 21 million Cuban patients were prescribed traditional medicine, 12.6 million (60%) of whom were in a primary healthcare setting, 6.8 million (32%) in stomatological care (dentistry), and 1.8 million (9%) in hospitals. Every hospital in Cuba offers acupunctural analgesia for some surgical procedures,¹⁶which was used in over 9.1% of the 336,622 major surgeries performed in 2008, he added.

While many in the United States likely turn to complementary and alternative medicine for affordability reasons, Dr. Morón explained that both NTM and conventional Western medicine in Cuba are subsidized by the government, meaning that there is no significant difference in cost for customers. He added that, in his experience, each drug prescribed typically costs between 1 and 3 Cuban pesos (equal to $0.04 to $0.12 USD).

Although Cuba’s National Program of NTM has increased the use of NTM within the country’s healthcare system, doctors are not obliged to employ it over conventional treatment, said Dr. Morón. “Medical doctors and [dentists] are free to prescribe their patients the best available treatment,” he said.

During his time in Cuba, Dr. Kligler observed a similar situation. “My impression is that natural and traditional medicine is seen as another tool in a large tool box,” he said, noting that pharmaceutical companies do not have the same influence on doctors as is sometimes the case in countries where Western pharmaceuticals are common.²⁶

Also unlike the United States, and many other countries, Cuban medical students are required to undergo NTM instruction in order to obtain their medical degree.¹⁶Degree plans reserve significant time for this required curriculum, and different aspects of NTM modalities are implemented at varying levels throughout the 6 years of schooling.

The education of future doctors on NTM is one of the major reasons why the Cuban government’s NTM program has been so successful, said Dr. Morón. Not only does this education lead to better NTM treatment results than if doctors were less educated in NTM, but it is also important in developing broad acceptance of NTM as a legitimate medical science, he added.

Dr. Kligler said he observed a strong commitment to include NTM in medical education, and that acupuncture and botanicals are the best-incorporated modalities. Though the amount of focus on NTM differs with each university and faculty, he said that “every primary care doctor gets a decent amount of [NTM] exposure and training.”

Undergraduate work usually begins with an introduction to acupuncture and basic medicinal plants, intertwined with the main curriculum.¹⁶During the third year, the student will learn how to incorporate NTM into medical examinations, such as by using the TCM techniques of inspecting a patient’s tongue and pulse. Subsequent years can include instruction on NTM treatments for certain conditions, advanced diagnostic NTM techniques, and Chinese medicine philosophy. Students are required to complete a 40-hour intensive NTM course during their fifth or sixth year, which includes clinical rotations in an NTM clinic where they can implement all they have learned.

After graduating, physicians must complete 2-year residencies, which involve 120 hours of more advanced NTM work. After the residency, they have the option to do a second residency that features more NTM instruction or completely focuses on NTM, or they can choose to do the 4-year NTM residency that teaches different philosophies and more advanced techniques. Health professionals other than physicians have the opportunity to obtain a 2-year masters degree in NTM, which focuses on research methods and NTM therapy testing.

While progressive, this educational system is not without its challenges. Because those who administer most NTM services, such as acupuncture and herbal treatments, are primarily medical doctors, Dr. Kligler said he wonders if their level of NTM expertise is lower than those who have specialized in only one or a few NTM modalities or systems.

Additionally, it is sometimes unclear what the NTM curriculum should feature and focus on, especially when teaching the important topic of herb-drug interactions.¹⁶Finding an adequate supply of NTM instructors can also be difficult, as the government recently started requiring all professors teaching medical students to have training in NTM, and it is sometimes unclear which faculty members are qualified.

Dr. Morón, who was in charge of Cuba’s medicinal plant and NTM research programs from 1987 until 2005, said that scientific research has been a priority in Cuba for some time.

“To be objective, I must [say] that the Cuban Revolution, and particularly Fidel Castro, have established a clear policy to develop and encourage scientific research since 1959,” he said. “So, medicinal plants and NTM has followed the same support.”

“I am ready to get more funding and supplies for our research work on medicinal plants,” he said. “They are never all we would like to have. The main research limitations concern hard currency funding and technology supply, where the US embargo has impact.”

Dr. Kligler, likewise, noted that lack of funding for NTM research is one of Cuba’s biggest challenges.

Though clinics and hospitals have small in-house studies of specific NTM therapies, little financial funding has caused a lack of largescale research on NTM’s efficacy and impacts on the people’s health.¹⁶A review of botanical papers published in select Latin American countries from 1984–2004 shows that Cuban authors published 182 papers, or 2% of the total.²⁷This has perhaps contributed to some of the skepticism and debates within Cuba’s medical community, most of which focuses on whether or not NTM can provide safe and efficacious options, Dr. Kligler continued.

“It’s the same type of skepticism that we have here,” he said, “the difference there being that word from the top from the health ministry is that it will be integrated in medical education.”

The use of NTM in present-day Cuban society is generally common and widespread. With the revival of Afro-Cuban religions following the Soviet Union collapse, religion-based NTM has spread and become somewhat modified, said Volpato. More and more, Cubans are joining Afro-Cuban religions such as Santeria and are using the medicinal plants that are central to the religion’s spirituality. These practices, however, are believed to be increasingly focused on generating revenue and catering to foreign tourists.⁵The majority of Cubans cannot afford to be initiated into the religion, which can cost from US $500–$2,000, the same amount as 3 to 12 years of the average annual state salary of US $162.

As an alternative to government-run pharmacies and clinics, urban Cubans can seek NTM treatment from santeros and yerberos, the latter of which are required to complete a 2-week course on the benefits and complications of certain herbs in order to obtain their herb selling license.¹⁶Customers can also purchase fresh herbs or herbal formulas in markets and local herb shops.¹²

“In urban areas, people use medicinal plants but rely much more on the knowledge of others, mostly of medicinal plants sellers,” said Volpato.

Cubans living in rural and mountainous regions of the island, however, have a culture intertwined with NTM as a means to address health issues and make an income.

“You’ll still find a lot of people that base their livelihood not only on medicinal plants, but also on cultivation in home gardens,” said Volpato. “Medicinal plant markets in cities need to be continually supplied with plants.”

In the mountains of Eastern Cuba, people use many formulas that contain multiple plant species, some of which are based on the same ingredients used by their ancestors.³The herbal drink pru, for example, is believed to have originated among African or French-Haitian immigrants who came to Cuba in the late 1700s.²⁸

In rural areas of Cuba, the preparation and dosage of medicines usually depends on individual experiences and family traditions. If the remedy does not consist of multiple species, rural Cubans can prepare them at home. If it is more complex, however, yerberos will sometimes sell them.

Tainos who survived the times of colonization orally passed down their traditions and practices to their descendants, some of whom still live in the mountainous regions of eastern Cuba, said Jorge Estevez, a Taino from the Dominican Republic and workshop coordinator at the Smithsonian National Museum of the American Indian (NMAI)-George Gustav Heye Center in New York (oral communication, June 12, 2009).

“It’s in the isolated regions of the country that you find people who have retained this incredible traditional knowledge,” said Estevez.

Present-day Tainos base their medicine system on a connection with and respect for the spirits of medicinal plants. Behiques establish a relationship with the plants through dreams, visions, and ceremonies, and before taking a plant to use medicinally, the behique will leave something behind for its spirit, said Jose Barreiro, a Taino Cuban and assistant director of research at the NMAI on the National Mall in Washington, DC (oral communication, June 2, 2009). Barreiro has spent time with Taino healers in Caridad de los Indios, a remote Cuban village near Guantanamo.

Tainos use about 40 to 50 common medicinal plants, most of which are picked by behiques based on traditional knowledge, said Barreiro. Tobacco (Nicotiana tabacum, Solanaceae), for example, is often part of Taino healing practices and is blown over the bodies of ill persons.

Once almost completely covered in dense vegetation, only 20% of Cuba is now covered by forest.³But because economic development is lacking, it remains one of the most bio-diverse islands in the world, with more than 6,500 vascular plant species, half of which are native to the island.²⁹

While government-run pharmacies reportedly use herbs only cultivated on farms, many yerberos use wild-collected plants. It has been reported that more and more yerberos seem to be disregarding traditional rules regulating the location, quantity, and frequency of collecting plants.⁵While cultivation by yerberos does seem to be increasing somewhat, so is the number of yerberos providing medicinal plants for the urban Cuban population, as Cubans often choose the convenience of yerberos in place of growing their own plants.

Populations of the native plant manajú (Garcinia aristata, Clusiaceae) are decreasing, and despite its endangered status, it is sold in many Havana herb shops for its use in rituals or in medicinal preparations to treat asthma, bronchitis, catarrh and pneumonia.³⁰Similarly, pino macho (Caribbean pine, Pinus caribaea, Pinaceae), used to treat foot and nail fungus, breathing and circulatory problems, and also used in pru, is another vulnerable medicinal plant that can still be found for sale in several Havana herb shops.

The government stresses cultivation in order to have a sustainable supply of medicinal plants, so the risk of medicinal plant overharvesting is not overwhelming, said Volpato. Concerns are usually pertinent only with certain species, such as those in high demand for their medicinal or ritual uses, he continued. But even in this case, many wild harvesters will use other species of the same genus with similar properties when the wild availability of the original species is reduced.

While US President Barack Obama extended the embargo for another year in September 2009, he has lifted significant restrictions on the island. His administration has also begun to hold talks with the Cuban government.³¹And while only the US Congress can end the embargo during a non-democratic Cuba, it is discussing lifting certain aspects of the embargo if there is support from a significant number of members.³²Only time, and politics, will tell, but it seems that a lifting of the embargo is a realistic possibility.

If the US embargo comes to an end, Cuba will certainly experience change, from an influx of foreign tourists to the reopening of international trade. Importantly, Cubans will likely have increased access to pharmaceuticals and medical devices, a situation that could arguably lessen the need for and dependence on NTM.

The ending of the embargo could potentially have special significance for Cuba’s ethnic groups, including the remaining Taino descendants, whose medicinal practices have endured despite an almost-complete eradication of their entire existence.

While recognizing that the Tainos have maintained certain traditional customs, Estevez of NMAI said that if the embargo is lifted, modernization could wash over the island.

“Some people may be drawn to modernization, but naturally, some people will also still be drawn to and fascinated with the traditions,” said Estevez. “I could only hope that if the embargo is lifted, that some people will continue these traditions.”

“I’m sure it will have some impact,” said Barreiro, Estevez’s colleague at NMAI. “But a lot of people have died and gone to heaven, or elsewhere, predicting the demise of the Taino. But much of it is still there . . . These medicinal beliefs are fairly deeply held,” he continued. “These traditions tend to not be lost but assimilated into the other populations.”

Just as the implementation of the US embargo was a product of politics, Volpato thinks the broader consequences of its lifting will also depend on the specific policies that are adopted.

“If the embargo will be lifted in a type of capitalist context, there will be increased opportunities and increased technologies for many Cubans, though many people will be lost on the way,” said Volpato. “These people will still use medicinal plants and grow them in home gardens. The use of medicinal plants is and will be related to the recovery of identity, as well as to basic livelihood needs.”

When considering more specific effects of an embargo lifting, Volpato foresees a positive impact on the market of medicinal plants through the probable exportation of many species, especially those used in Afro-Cuban religion.

“It could spread the economic opportunities of people involved in this market, but at the same time it could threaten some species,” he said, noting that increased market opportunities could lead to over-harvesting.

In addition to economic benefits, a lifting of the embargo could also ease and increase the frequency of NTM-related academic exchange.

“If there were less restrictions, [collaborative research] would be a tremendous influence,” said Dr. Kligler. “[Being able to study Cuba’s NTM system] would be a tremendous benefit or potential benefit, if we were able to have more active academic networking.

“One thing that would be fantastic is that there is a huge group of medical education students [in the United States] interested in doing exchanges. I think that for students in the States to see what it means to have real access to healthcare and to have real access to this integrated system [would be a great opportunity],” Dr. Kligler continued.

Dr. Morón of Cuba agrees. “I do believe, if it happened, Cuban and US scientists and health professionals would exchange results and useful experiences, as well as develop common research projects in the field of [natural and traditional medicine],” he said.

Even if access to more expensive pharmaceuticals and a Western medicine system were to become available, this would not change Cuban NTM, said Dr. Morón, echoing the words of Raul Castro, current President of Cuba: “Traditional and natural medicine is not a necessity of poverty; it is an option of richness.”³³