There’s a plant for that

South Africa’s indigenous medicinal plants

Under the unblinking gaze of the autumn sun, the colour drains from the woody shrubs (myrothamnus flabellifolia) growing on the bare rock of the mountain slopes. Some almost as tall as a human in summer, they shrink as the days shorten. Their fan-shaped leaves curl and close. As winter arrives, life quietly departs. 

Or does it? The isiZulu name for the shrub is ‘uvukwabafile’ – ‘wakes from the dead’. Within hours of the first summer rains that release the heat from the earth, the extensive roots of the uvukwabafile plants begin to stir, intercepting the water collecting in rocky crevices. The apparently lifeless leaves unfold. When the sun next rises, the shrubs stand tall and green once again, restored to their original glory. These miraculous resurrections occur every year in the mountains across South Africa, Botswana, Zimbabwe, Mozambique, Malawi, Tanzania and Kenya. The shrub can survive losing up to 95% of its water content and recover almost instantly when it rains. (For comparison, most plants can tolerate losing 10-20% of their water content before experiencing significant stress.)  

For centuries, the indigenous peoples of Southern Africa have used uvukwabafile – also known as the resurrection plant – to restore health to the sick or injured. Smoked or prepared as a tea or tonic, it is used to treat mood disorders, infectious diseases, respiratory issues, inflammation, and kidney ailments, among others. Research has found that the plant contains a wide and varied collection of essential oils and bioactive ingredients. A 2020 literature review, led by Joseph Erhabor of the University of the Free State, found that these include compounds with anticancer, anti-inflammation, antimicrobial, antioxidant, antimicrobial and antiviral properties. 

The resurrection plant is one of an estimated 3,400 medicinal plants in Southern Africa. According to Sibusiso Xego, a traditional health practitioner and researcher at Cape Town University of Technology, indigenous medicinal plants are a cornerstone of spiritual and physical wellbeing in South Africa. “If we trace back to ancient times, our grandmothers and grandfathers used medicinal plants as the main form of medicine. It’s part of everyday life.” 

Sustainable harvesting 

Despite their medical and cultural importance, many of South Africa’s medicinal plants are endangered. With their natural habitat shrinking due to urban development, agricultural expansion, and climate change, the plants are particularly vulnerable to overharvesting.  To reduce pressure on remaining wild populations, some researchers and traditional health practitioners are looking for ways to propagate indigenous medicinal plants.  

This is more challenging than it may seem. 

For some traditional healers, the medicinal properties of the plants are bound up in their wild state. Research shows that some wild and cultivated plants may indeed have different medicinal profiles. That’s because some of the plants’ medicinal compounds are a response to external conditions like drought or insect attacks – conditions that farmed plants wouldn’t typically experience. Xego’s research involves comparing the active compounds of cultivated plants with wild varieties, and exploring how to adjust growing conditions to maintain the medicinal properties that the plant would have in the wild.

“In my research that I've done with wild ginger I saw that there is not much difference [in the medicinal compounds] when you cultivate the plants [hydroponically] and when they grow in their natural habitat,” she says. In fact, propagated plants may have the edge because they are protected from adverse conditions linked to climate change. 

Wild ginger, or African ginger (Siphonochilus aethiopicus) is a forest dwelling plant with elegant sage-green leaves and pale pink, tissue-paper blooms. Long used to treat coughs, allergies and inflammation, wild ginger contains compounds with studied antimicrobial, anti-asthmatic, anti-inflammatory, and antimalarial activities. Naturally occurring from tropical Africa to southern Africa, African ginger has all but disappeared from the wild in South Africa today. That’s partly because, as striking as the plant is, its most valued parts are its roots.

However, Xego’s research has found that the bioactive ingredients of wild ginger are also found in the leaves, which makes room for sustainable harvesting practices. Xebo is working with other traditional healers to share her findings and to increase the acceptability of propagated plants in traditional medicine.

 “When we talk about sustainability, we are talking about the ability to maintain our natural resources,” she says. Maintaining our natural resources requires us to be adaptive, she adds. We need to use technologies to find ways of growing traditional medical plants faster than usual –   without changing their medicinal properties. 

Something to chew on

Traditionally, medicinal plants in South Africa have been the guardians of spiritual and psychological wellbeing as well as physical health. Kanna (sceletium tortuosum) or kougoed (‘chew(able) things), for instance, has long been psychological aid among the San and Khoikhoi peoples. An unassuming ground-cover succulent, kanna occurs naturally in semi-arid regions of the Eastern and western Cape. In spring, it produces flowers with lemon-yellow centres and white petals so fine they could almost be eyelashes.  

Hunters and pastoralists in Namaqualand and the Karoo reportedly chewed fermented kanna during prolonged hunts to relieve stress and fatigue, and at other times for social relaxation. One of kanna’s active compounds is a mood-booster called mesmerine, which is unique to sceletium succulents. Like some antidepressants, mesmerine works by increasing the availability of the feel-good neurotransmitter serotonin in the brain. Kanna is also reported to improve concentration and cognitive function. In the upswelling of interest in the therapeutic potential of psychoactive drugs, kanna has come under a global spotlight for its mood-boosting effects, and can be purchased online in tea and supplement form.  A patented extract of Kanna, dubbed Zembrin®, has also reached the shelves.  

While the commercial potential of South Africa’s medicinal plants could in theory benefit local communities, in practice, commercial operations often don’t follow fair benefit-sharing practices. Despite the cultural and historical value of the plants, traditional knowledge holders are rarely compensated fairly for the knowledge that gave rise to the product. 

In South Africa, traditional health practitioners are also not recognised in the healthcare system. Many South Africans will consult both traditional healers and doctors, who operate in different domains and may provide contradictory advice.

Xego argues that bridging the gap between traditional practitioners and doctors, and combining knowledge, could have significant benefits for patients. Collaboration could enable traditional healers to refer patients to doctors for diagnoses, for instance, while doctors could refer patients to traditional healers when plant medicines would be beneficial. This kind of integration of Western medicine and traditional medicine is already taking place in other African countries, including Ghana, Botswana, Zimbabwe, Liberia, Sierra Leone.

 Closer collaborations between traditional healers, researchers, and conservationists may also yield effective strategies for conserving South Africa’s medicinal flora. The work of Xego and others to conserve South Africa’s medicinal plant heritage offers hope that the fragrance of wild ginger flowers will one day return to our forests, and that the resurrection plant will continue to shrug off death for centuries to come.

One shot, better defence against cervical cancer

Photo: cottonbro studio, Pexels

Women have a better shot at avoiding cervical cancer thanks to the single-dose human papillomavirus (HPV) vaccination, which has now been approved in South Africa.

The much-anticipated transition from the current two-vaccination strategy aligns with recent evidence-based World Health Organisation (WHO) recommendations.

Health experts who participated in a recent “Women Up To Know Good” webinar, titled “HPV at your cervix” emphasised the effectiveness and affordability of the single-dose strategy in low- and middle-income countries.

HPV vaccinations are the most effective available tool for preventing cervical cancer. Usually administered to girls under the age of 15, the vaccine triggers an immune response that later protects against strains of HPV – the virus responsible for the development of virtually all cervical cancer cases.

Comprehensive roll-out of the single-dose vaccine is one part of a multifaceted approach to eliminating cervical cancer in Africa. To eliminate cervical cancer globally, the WHO set the following goals for 2030:  90% of girls vaccinated by age 15; 70% of women screened for HPV (by a high-performance test) by age 35, and again at 45; and 90% of women with cervical cancer receiving treatment.

However, resource constraints have seen low- and middle-income countries moving slowly to reach these targets. The success of South Africa’s school-based programme, initiated in 2014, illustrates how targeted interventions can help low- and middle-income countries (LMICs) to reach vaccination targets.

Clearing cost hurdles

At the GIFT webinar, leading cervical cancer expert Professor Lynette Denny of the University of Cape Town, Dr Zizipho Mbulawa of the National Health Laboratory Services and Walter Sisulu University, and physician scientist Dr Ruanne Barnabas of Harvard University discussed ways of increasing the accessibility and uptake of vaccinations and cervical cancer screenings.

Barnabas shared findings from research she and her colleagues conducted in Kenya that provided the evidence for the WHO policy change recommending the one-dose vaccine. The study showed a 98% vaccine efficacy against HPV 16/18 – the strains that are most strongly linked to cervical cancer.

 “After three years, single-dose HPV vaccine efficacy remained high and durable,” Barnabas said, adding that the vaccine also provided protection against other HPV strains.