The column below was contributed by Kate Dieringer
A truck rumbles past with ‘Artemisia annua for life’ painted in careful blue letters.
In countries across the African continent, outlets for buying, selling and propagating Artemisia for personal use and for profit are infiltrating the market on malaria treatment. Alongside boxes of Coartem and Panadol in rural village tuck shops and urban pharmacy stalls, one can now find small plastic bags of dried Artemisia for sale to the general public. The plant is advertised as beacon of hope in the context of health facilities void of medicines and clinicians. It is said that because this plant is the basis for antimalarial treatment, one can break free from the binds of the global pharmaceutical companies by ingesting powder or tea made from its leaves. Purveyors instruct consumers to simply light a fire, boil water and create tinctures to cure malaria, all outside the purview of the health system.
Non-pharmaceutical use of Artemisia annua
The alarming reality is that this dangerous practice of forgoing medical treatment and opting for ‘natural malaria medicine’ is being introduced to developing countries, from abroad. ANAMED (Action for Natural Medicine) is one such organization that is potentiating non pharmaceutical Artemisia use.  The organization is headquartered in Europe and spearheaded by a qualified pharmacist. The mission is centered on providing solutions to death and disease imposed by pharmaceutical companies, corrupt governments and poor infrastructure. This has serious implications for population and individual outcomes, and the World Health Organization has subsequently issued a position statement regarding the non-pharmaceutical use of Artemisia annua for malaria. The statement reinforced the need for extensive research to demonstrate the safety, efficacy and impact on parasite resistance of this method. 
Collaborating with traditional healers is an important component to bridging the gap between belief systems, modern medicine and indigenous practices. But while working in Malawi on malaria programming, I was angered and alarmed to hear that the organization was discouraging community members from seeking medical care for malaria and teaching the ‘science’ and ‘dosing’ of Artemisia at home. My patients were often discussing concocting Artemisia teas, instead of seeking treatment at medical facilities. Of course plants contain medicinal properties that are the basis for modern pharmaceuticals. But this was something different, something both dangerously commercial and overtly misguided. People were beginning to adopt this method and had access to the plant. I decided to attend a workshop, in order to understand what exactly was being taught in the program.
The People’s cure
At the workshop, I was concerned to find local doctors, community health workers, NGO technical staff and religious leaders all in attendance for the week long training. Each focus country has an ANAMED representative that teaches the prescribed curriculum. While nutrition and crop diversification were covered in the course, much of the content was centered on bypassing the challenging health system by creating ‘medicines’ from plants found locally. Honey for burns. Papaya for gastrointestinal worms. Eucalyptus for pneumonia. Then, the testimonials came for Artemisia.
Participants attested to personal experiences ‘curing’ malaria in their homes and communities by pounding the leaves into flour to mix with cornmeal and by administering measured ‘doses’ of tea to their children. I asked if the patients who received this treatment were tested and properly diagnosed, trying desperately to steer the conversation towards the scientific method and evidence based medical practice. But the distributed textbooks and unsubstantiated testimonials were referred to as proof that this method worked. Artemisia annua is touted as an effective way to unbind people from the fetters of the oppressive system.
The framework of the training was driven by social ownership and co-operative management of the economy, which I support in many contexts. But I found it most disconcerting to hear leads of child health programs and clinicians reporting that they were interested in growing Artemisia in their homes and treating people with it outside of the hospital setting. ANAMED operates in 15 countries, and every workshop ends with the distribution of an Artemisia annua plant to each attendee. Everyone goes home with a piece of ‘medicine’.
Divergent methods, shared goals
From diet supplements to homeopathic remedies, alternative therapies are generating big business worldwide. But there is no room for using Artemisia in this manner, under the guise of engendering self-reliance. Instead of encouraging people to risk disability and death by not seeking proper treatment, this particular organization could mobilize efforts to work with governments on strengthening supply chain, drug costing and service delivery.
While ANAMED argues that its efforts are empowering the powerless, this infusion of misinformation discourages progress. Sovereign nations have not historically benefited from interventions that cause citizens to become further entrenched in positions of vulnerability. Moving forward, it is important to understand and engage on this issue. How should the malaria community intervene and seek to address this concerning practice, as the movement gains more traction in communities desperate for solutions?
We all have to go a little rogue in our work. I may even sign up for another workshop, to gain audience and understand the scope of the problem further. But I won’t be advising that those highly prized plants handed out at the trainings be used for anything other than décor or mulch at home, until research suggests otherwise.
Links and reference
The opinions expressed in this column are those solely of the author and do not reflect those of the author’s current or previous professional affiliations.
Kate Dieringer RN, BSN, MPH worked as a technical advisor for the Malaria Alert Center/Centers for Disease Control and Prevention (College of Medicine, Malawi) providing support for malaria programming and operational research initiatives in Malawi. Her background combines global health and emergency/trauma clinical services. She is invested in malaria prevention and control through community based partnerships, as well as health systems strengthening and investment in human capacity. Kate’s scope has focused on Latin America and the Caribbean and Africa regions involving HIV, malaria and maternal child health programming. Currently, she is working with Partners’ in Health Haiti on capacity building and clinical program implementation.