Some selected Nigerian medicinal plants and their uses. Source: Abd El-Ghani [51].
\r\n\tThe emergence of novel prion strains in animals, which include the only evidenced zoonotic prion C-BSE causing vCJD in humans, has created an important public health concern. Currently, new threats to human and animals may develop because of the plausible zoonotic properties of scrapie, L-BSE and the recently emerging chronic wasting disease in Europe.
\r\n\tThis book will gather experts in prion diseases and present new scientific advances in the field and relations with other amyloid neuropathologies.
The development and use of traditional herbal medicine (THM) have a very long historical background that corresponds to the Stone Age. In the continent of Africa, the practice of traditional healing and magic is much older than some of the other traditional medical sciences [1] and seems to be much more prevalent compared to conventional medicine. African traditional medicine is a form of holistic health care system that is organized into three levels of specialty, which include divination, spiritualism, and herbalism, though these may overlap in some situations [2, 3].
A traditional healer is one who provides medical care in the community that he lives, using herbs, minerals, animal parts, incantations, and other methods, based on the cultures and beliefs of his people. He must be seen to be competent, versatile, experienced, and trusted [4]. In other definitions, priestesses, high priests, witch doctors, diviners, midwives, seers or spiritualists, and herbalists are included. Traditional medical practitioner (TMP), however, seems to be a modern acceptable concept agreed on by the Scientific Technical and Research Commission (STRC) of the Organization of African Unity (OAU), which is now African Union (AU). In specific cultures, these people go by their local names, depending on their tribe, such as Sangoma or inyanga in South Africa, akomfo, bokomowo in Ghana, niam-niam, shaman, or mugwenu in Tanzania, nga:nga in Zambia, shaman or laibon in Kenya, and babalawo, dibia, or boka, etc. in Nigeria [5]. It is commonplace to see traditional healers dressed in certain peculiar attires, with head bands, feathers, and eyes painted with native chalk.
Figure 1 below is a typically adorned traditional healer from South Africa.
Spiritual healer or Sangoma from South Africa (Source—Ancient Origins).
Traditional medicine is viewed as a combination of knowledge and practice used in diagnosing, preventing, and eliminating disease. This may rely on past experience and observations handed down from generation to generation either verbally, frequently in the form of stories, or spiritually by ancestors or, in modern times, in writing [6]. It has also been said that before attaining knowledge in traditional African medicine, one is often required to be initiated into a secret society, as many characteristics of this form of medicine can only be passed down to initiates. The importance of traditional medicine, however, dwindled during the colonial period, whereby it was viewed as inferior to Western medicine. It was thus banned completely in some countries due to its association with witchcraft /voodoo, supernatural, and magical implications, in which case, it was also termed “juju” (Nigeria) or “native medicine,” since it made use of charms and symbols which were used to cast or remove spells. Some forms of treatment may also involve ritual practices such as animal sacrifices to appease the gods, if the ailment was envisaged to be caused by afflictions from the gods, especially in the treatment of the mentally ill patients.
In African traditional setting, there was always an explanation as to why someone was suffering from a certain disease at a particular time. According to Ayodele [7], diseases mostly revolve around witchcraft/sorcery, gods or ancestors, natural, as well as inherited. Illness in the African society is different from the allopathic Western medicine point of view. Illness is believed to be of natural, cultural, or social origin [8]. Cultural or social illness is thought to be related to supernatural causes such as angered spirits, witchcraft, or alien/evil spirits, even for conditions now known to be well understood in modern medicine such as hypertension, sickle-cell anemia, cardiomyopathies, and diabetes. African traditional beliefs consider the human being as being made up of physical, spiritual, moral, and social aspects. The functioning of these three aspects in harmony signified good health, while if any aspect should be out of balance, it signified sickness. Thus, the treatment of an ill person involves not only aiding his/her physical being but may also involve the spiritual, moral, and social components of being as well. Many traditional medical practitioners are good psychotherapists, proficient in faith healing (spiritual healing), therapeutic occultism, circumcision of the male and female, tribal marks, treatment of snake bites, treatment of whitlow, removal of tuberculosis lymphadenitis in the neck, cutting the umbilical cord, piercing ear lobes, removal of the uvula, extracting a carious tooth, abdominal surgery, infections, midwifery, and so on. According to Kofi-Tsekpo [9], the term “African traditional medicine” is not synonymous with “alternative and complementary medicine.” African traditional medicine is the African indigenous system of health care and therefore cannot be seen as an alternative.
Herbal medicine is a part and parcel of and sometimes synonymous with African traditional medicine. It is the oldest and still the most widely used system of medicine in the world today. It is used in all societies and is common to all cultures. Herbal medicines, also called botanical medicines, vegetable medicines, or phytomedicines, as defined by World Health Organization (WHO) refers to herbs, herbal materials, herbal preparations, and finished herbal products that contain whole plants, parts of plants, or other plant materials, including leaves, bark, berries, flowers, and roots, and/or their extracts as active ingredients intended for human therapeutic use or for other benefits in humans and sometimes animals [10, 11].
Herbal medicine is a special and prominent form of traditional medicine, in which the traditional healer, in this case known as the herbalist, specializes in the use of herbs to treat various ailments. Their role is so remarkable since it arises from a thorough knowledge of the medicinal properties of indigenous plants and the pharmaceutical steps necessary in turning such plants into drugs such as the selection, compounding, dosage, efficacy, and toxicity. The use of herbal medicines appears to be universal in different cultures. However, the plants used for the same ailments and the modes of treatment may vary from place to place. The plants used for medicinal purposes are generally referred to as medicinal plants, i.e., any plant in which one or more of its organs/parts contain substances that can be used for therapeutic purposes, or in a more modern concept, the constituents can be used as precursors for the synthesis of drugs. For example, a number of plants have been used in traditional medicine for many years without scientific data to back up their efficacy. In this case, these plants, whole or parts, which have medicinal properties, are referred to as crude drugs of natural or biological origin. They may further be classified as “organized drugs,” if such drugs are from plant parts with cellular structures such as leaf, bark, roots, etc., and “unorganized drugs,” if they are obtained from acellular portions of plants such as gums, balsams, gels, oils, and exudates. Compared with modern allopathic medicine, herbal medicine is freely available and can easily be accessed by all [12, 13]. As a result, there is limited consultation with traditional healers because there is a fairly good knowledge of common curative herbs especially in the rural areas except in the case of treatment of chronic diseases [12]. Even where consultation is done, there is lack of coherence among traditional healers on the preparation procedures and correct dosage of herbal medicines [14]. However, according to WHO [15], at least 80% of people in Africa still rely on medicinal plants for their health care. In Nigeria, and indeed the entire West Africa, herbal medicine has continued to gain momentum, some of the advantages being low cost, affordability, availability, acceptability, and apparently low toxicity [16, 17].
A detail of plant parts used in herbal medicines is as follows:
Roots—i.e., the fleshy or woody roots of many African plant species are medicinal. Most of the active ingredients are usually sequestered in the root bark rather than the woody inner part.
Bulbs—A bulb is an underground structure made up of numerous leaves of fleshy scales, e.g., Allium sativa (garlic) and Allium cepa (onions).
Rhizomes—Woody or fleshy underground stem that grows horizontally and brings out their leaves above the ground, e.g., Zingiber officinale (ginger), which is used for respiratory problems; Imperata cylindrica (spear grass) for potency in men and Curcuma longa (turmeric), an antioxidant, anti-inflammatory, and anticancer drug.
Tubers—Swollen fleshy underground structures which form from stems/roots, e.g., potatoes and yams such as Dioscorea dumetorum (ona-(igbo)) for diabetes and Gloriosa superba for cancer.
Bark—The outer protective layer of the tree stem or trunk. It contains highly concentrated phytochemicals with profound medicinal properties. A host of plants have barks of high medicinal value.
Leaves, stems, and flowers of many plants are also medicinal.
Fruits and seeds also contain highly active phytochemicals and essential oils.
Gums, exudates, and nectars, which are secreted by plants to deter insects and grazing animals and to seal off wounds, are very useful in the pharmaceutical industries.
Sale of herbs in form of dried or fresh plant parts is as lucrative as the prepared medicines. They are usually displayed in markets and sold with instructions on how to prepare them for maximum efficacy.
Figure 2 is a photograph of an herbalist displaying his herbs for sale.
Herbs on display (Source—Ancient Origins).
In many areas of Africa, the knowledge of plant species used and the methods of preparing and administering the medication, especially for serious ailments, still reside with traditional healers. Secrecy and competition still surround the use of these medications, with the healers often being reluctant to hand down their knowledge to anyone but trusted relatives and initiates [18].
Methods of preparation of herbal medicines may vary according to place and culture. The plant materials may be used fresh or dry. With experience, a particular method is chosen to increase efficiency and decrease toxicity. Generally, different methods of preparation include:
Extraction—This is prepared with solvent on a weight by volume basis. Sometimes, the solvent is evaporated to a soft mass.
Infusions are prepared by macerating the crude drug for a short period of time in cold or hot water. A preservative such as honey may be added to prevent spoilage.
Decoctions are made by boiling woody pieces for a specified period of time and filtered. Potash may be added to aid extraction and as preservative.
Tinctures are alcoholic infusions which if concentrated may be diluted before administration.
Ashing—The dried parts are incinerated to ash, then sieved and added as such to water or food.
Miscellaneous—Other types include liniments for external applications in liquid, semi-liquid, or oily forms containing the active substances; lotions which are liquid preparations intended for skin application. Poultices are prepared from macerated fresh part of plant containing the juice from the plant and applied to skin. Snuffs are powdered dried plant inhaled through the nostrils. Dried plants may be burnt, and their charcoal is used as such. Gruels are cereals/porridges made from grains, to which dried powdered plant or its ash is added to be taken orally. Mixtures are sometimes prepared with more than one plant to give synergistic or potentiating effects of the composite plants.
There are also different methods of administration. Apart from the common routes such as oral, rectal, topical, and nasal, other methods include smoking a crudely prepared cigar containing dried plant materials or by passive inhalation. Others are steaming and inhaling the volatile oils exuding from the boiling plant material. These can be used to relieve congestion, headaches, or pulmonary problems. Sitz baths are used for piles [19, 20].
Information on plants is obtained through ethnobotanical surveys, which involves the study of plants in relation to the culture of the people. Many plants are used in African traditional medicine, but little information is available on their active ingredients/constituents. Ethnobotanical surveys involve the interaction with the people and their environment and are therefore participatory approaches, in which local people are able to contribute their knowledge on the uses of plants within their environment. This may involve the identification, documentation, conservation, and utilization of medicinal plants. Much of the ethnomedicinal information is largely not validated. In Nigeria, a number of authors have published a lot of data on plants with their curative values [16, 20, 21]. These provide a vast array of information for scientific research and validation. Preliminary scientific knowledge is drawn from studies on in vitro and in vivo bioassays on crude extracts of various plants.
Using plants as medicine provides significant advantages for treating many chronic conditions. For example, information from folklore medicine in Nigeria has it that Rauvolfia vomitoria is used for treating hypertension and other nervous conditions while Ocimum gratissimum is used for treating diarrheal diseases. Others include Citrus paradise seeds for resistant urinary tract infections, pure honey for chronic wound treatment, Carica papaya seeds for intestinal parasites, Garcinia kola seeds for pain and inflammation, and Aloe vera for skin diseases. The same is also true for plants from other African countries [22]. Knowledge of most of these curative properties was accumulated over time from evidence-based observations. A few examples of some Nigerian plants and their uses are shown in Table 1.
Family | Specie | Local name | Part used | Medicinal uses |
---|---|---|---|---|
Acanthaceae | Acanthus montanus | Stem, twig | Syphilis, cough, emetic, vaginal discharge | |
Amaranthaceae | Amaranthus spinosus | Whole plant | Abdominal pain, ulcers, gonorrhea | |
Apocynaceae | Alstonia boonei | Root, bark, leaves | Breast development, filarial worms | |
Bombacaceae | Adansonia digitata | leaves, fruit, pulp, bark | Fever, antimicrobial, kidney, and bladder disease | |
Combretaceae | Combretum grandiflorum | Ikedike | leaves | Jaundice |
Euphorbiaceae | Bridelia ferruginea | iri, kirni | leaves, stem, bark, root | insomnia, mouth wash, gonorrhea |
Hypericaceae | Harungana madagascariensis | Otoro, alilibarrafi | Stem, bark, root bark | piles, trypanosomiasis |
Fabaceae | Afzelia africana | Apa-igbo, akpalata | leaves, roots, bark, seeds | gonorrhea, hernia |
Liliaceae | Gloriosa superba | mora, ewe aje, baurere | tubers, leaves | gonorrhea, headlice, antipyretic |
Some selected Nigerian medicinal plants and their uses. Source: Abd El-Ghani [51].
Table 1 shows some selected Nigerian medicinal plants and their uses.
The curative properties of herbal medicine are validated through scientific investigations, which seek to understand the active chemistry of the plants [23]. The therapeutic activity of a plant is due to its complex chemical nature with different parts of the plant providing certain therapeutic effects. Chemical components or phytochemicals found in plants that are responsible for the various therapeutic effects include alkaloids, glycosides, tannins, acids, coumarins, sterols, phenols, etc. Many modern pharmaceuticals have been modeled on or were originally derived from these chemicals, for example, aspirin is synthesized from salicylic acid derived from the bark of Salix alba and the meadowsweet plant, Filipendula ulmaria. Quinine from Cinchona pubescens bark and artemisinin from Artemisia annua plant are antimalarial drugs. Vincristine and vinblastine are anticancer drugs derived from Madagascar periwinkle (Catharanthus roseus), used for treating leukemia. Morphine and codeine, derived from the opium poppy (Papaver somniferum), are used in the treatment of diarrhea and pain relief, while digitoxin is a cardiac glycoside derived from foxglove plant (Digitalis purpurea) [22, 24]. Medicinal plants are also important materials for the cosmetic industries.
The use of herbal drugs dwindled toward the end of the 19th century due to the advent of synthetic chemistry. However, there was a resurgence of interest in plant medicines in more recent years, as synthetic drugs became less effective due to high levels of resistance and also due to higher toxicity and cost. It is estimated that more than half of all synthetic drugs in use are derived from plants [25].
In African traditional medicine, the curative, training, promotive, and rehabilitative services are referred to as clinical practices Clinical practice can also be viewed as the process of evaluating conditions of ill-health of an individual and its management. These traditional health care services are provided through tradition and culture prescribed under a particular philosophy, in which the norms and taboos therein are strictly adhered to and form the basis for the acceptability of traditional health practitioners in the community they serve [26].
According to the World Health Organization (WHO), health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [15, 27] and views health as one of the fundamental rights of every human being. The combination of physical, mental/emotional, and social well-being is commonly referred to as the health triangle.
The recognition of disease and illnesses in traditional Africa meant that every society needed to devise means of containing its problem. Worldwide, different societies have different herbal traditions that have evolved over a long period of time. Similar to modern day Western treatment patterns, African traditional societies also involved herbalism, surgery, dietary therapy, and psychotherapy, in addition to traditional exorcism, rituals, and sacrifice [28]. These medical technologies had evolved even before the coming of the “white man” (Arabs and Europeans). Successful treatments became formalized, sometimes with prescriptions of correct methods of preparation and dosage. In addition, the ingredients and the manner of preparation varied with the ailment but were also dependent on various factors such as geographical, sociological, and economic, but the significant point was that in many cases, patients were cured of their physical or psychological ailments [29]. In African traditional medicine, traditional health practitioners (THP) assess patients in order to diagnose, treat, and prevent disease using their expertise by the following methods:
Divination means consulting the spirit world. It is a method by which information concerning an individual or circumstance of illness is obtained through the use of randomly arranged symbols in order to gain healing knowledge. It is also viewed as a way to access information that is normally beyond the reach of the rational mind. It is a transpersonal technique in which diviners base their knowledge on communication with the spiritual forces, such as the ancestors, spirits, and deities [30]. It is, therefore, an integral part of an African traditional way of diagnosing diseases. The “spirit world” is consulted to identify the cause of the disease or to discover whether there was a violation of an established order from the side of the sick person. This is established through the use of cowry shells, throwing of bones, shells, money, seeds, dice, domino-like objects, or even dominos themselves, and other objects that have been appointed by the diviner and the spirit to represent certain polarities on strips of leather or flat pieces of wood. The divining bones that form the large majority of the objects include bones from various animals such as lions, hyenas, ant-eaters, baboons, crocodiles, wild pigs, goats, antelopes, etc. The bones represent all the forces that affect any human being anywhere, whatever their culture [31]. Because of the revealing powers of divination, it is usually the first step in African traditional treatment and medicine [32].
Oral interviews are sometimes used by some traditional healers to find out the history behind the sickness, where they have been for treatment and how long the person has been in that condition. This approach enables them to know how to handle the matter at hand. In some cases, the healer might require other family members to speak on behalf of the sick person in cases where the patient is not able to express him/herself. In modern times, after the healing process, they also advise their clients or patients to go for medical diagnoses to confirm that they are healed, and the medical reports sometimes serve for record keeping for future reference and are a way of assuring other clients of their ability and credibility. Due to the holistic approach of the healing process, the healers do not separate the natural from the spiritual or the physical from the supernatural [33]. Thus, health issues are addressed from two major perspectives—spiritual and physical.
Spiritual-based cases are handled in the following manner:
Spiritual protection: If the cause of the disease is perceived to be an attack from evil spirits, the person would be protected by the use of a talisman, charm, amulets, specially designed body marks, and a spiritual bath to drive the evil spirits away. These are rites aimed at driving off evil and dangerous powers, spirits, or elements to eliminate the evils or dangers that may have befallen a family or community [34].
Sacrifices: Sacrifices are sometimes offered at the request of the spirits, gods, and ancestors. Sometimes, animals such as dogs and cats are slaughtered or buried alive at midnight to save the soul of the one at the point of death, with the belief that their spirits are strong enough to replace life [30]. There is also the view that because they are domestic animals and are very close to people, sometimes when they see that someone very close to them is about to die, they offer their lives for that person to live. This is true especially where the animal dies mysteriously; thus, it is believed that it had offered its life in place of the life of its owner. Rituals are sometimes performed in order to consecrate some herbs without which the medicine is meaningless. Divine and ancestral sanctions are considered necessary before and during the preparation and application of medicine [35].
Spiritual cleansing: Spiritual cleansing may be required of the sick person to bathe at specific times for a prescribed number of days either with water or animal blood poured from head to toe. This practice is common among some communities in Ghana [34].
Appeasing the gods: If a disease is perceived to be caused by an invocation of a curse or violation of taboos, the diviner appeases the ancestors, spirits, or the gods according to the severity of the case. The individual is often required to provide certain items for sacrifice and/or libation, such as spotless animals (dove, cat, dog, goat, and fowl), local gin, cola nut, eggs, and plain white, red, or black cloth. These items are usually specified by the gods. The used items may be thrown into the river, left to rot, or placed at strategic places, usually at cross roads at the outskirts of the community, depending on the nature and severity of the case [36].
Exorcism: This is a practice of expelling demons or evil spirits from people or places that are possessed or are in danger of being possessed by them. Many of the traditional communities believe that illness, especially mental illness, is mostly caused by evil spirits. Exorcism can only be performed by a religious leader or a priest who has the authorities and powers to do so. Sometimes, an effigy made of clay or wax would be used to represent the demon and would ultimately be destroyed. Exorcism may be accompanied by dancing to the beating of drums, singing, and sometimes flogging the individual or touching him/her with strange objects such as animal tails and other objects to chase out the spirit. The possessed individual would be somewhat agitated but would only calm down as soon as the spirit is removed from the body. Exorcism is practiced, not only in Africa but also in ancient Babylonian, Greek, and other ancient cultures of the Middle East. This practice is also performed for those who are mentally challenged. In their view, until the possessed person is delivered from the power of that evil spirit, the person will not have his or her freedom. Hence, the practice of exorcism is considered necessary [37].
Libation: Libation involves pouring of some liquid, mostly local gin on the ground or sometimes on objects followed by the chanting or reciting of words. It is usually regarded as a form of prayer. The liquid could also be water or in modern times, wine, whisky, schnapps, or gin. Some cultures also use palm wine, palm oil, and coconut water, while some others use corn flour mixed with water [38]. Libation pouring as is practiced in some communities has three main parts, namely invocation, supplication, and conclusion.
Invocation: They first invoke the presence of the almighty God, mother earth, and the ancestors. According to the practitioners of libation pouring, offering the ancestors and spirits drink is a way of welcoming them
Supplication: After invocation, requests are made to the invoked spirits, gods, or ancestors to intercede on their behalf for mercy and forgiveness of offenses such as taboo violations and to seek for spiritual consecration (cleansing) of either the community or individual(s). The content of the prayer is usually case specific [38].
Conclusion: At the end of the libation pouring, they thank the invoked ancestors and spirits. They finally invoke curses on those who wish them evil or failure, meaning that in the process of prayer, it would be unwise to seek the welfare of one’s enemy. Therefore, those who wish evil (i.e., enemies, witches, and people with evil powers) on them should fall and die [8]. In this process, the person pouring the libation would be pouring the drink or liquid on the ground as he is reciting the prayers, followed by responses to each prayer point by observers.
If the illness is of a physical nature, the following approaches are exploited:
Prescription of herbs: Herbs are prescribed to the sick person according to the nature of the illness. Each prescription has its own specific instructions on how to prepare the herb, the dose, dosing regimen, and timeframe
Clay and herbs application: Application of a mixture of white clay with herbs may be relevant in some of the healing processes. The mixture is applied to the entire body for a number of days, especially in the case of skin diseases. The view is that the human body is made out of the dust or ground; therefore, if the body has any problem, you would have to go to where it came from to fix it. The use of clay with some special herbs is also sometimes used for preventive rituals to ward off the evil spirits responsible for illness.
Counseling: The sick person is sometimes counseled on the dos and don’ts of treatment, the foods to eat or avoid, to be generally of good behavior as established by society and culture, failure of which the good spirits would withdraw their blessings and protection and therefore, open doors for illness, death, drought, and other misfortunes. This is mostly done when it is an issue of a violation of a taboo [39].
The THPs use experience, added to the accumulated knowledge handed down by their ancestors in order to provide effective and affordable remedies for treating the main ailments (such as malaria, stomach infections, respiratory problems, rheumatism, mental problems, bone fracture, infertility, complications of childbirth, etc.) that afflict populations of the African region and in addition offer counseling/advice and solutions to prevent future reoccurrence.
As there is an African way of understanding God, in the same way, there is an African way of understanding the visible world around us—the cattle, trees, people, and cities, as well as the unseen world, the supernatural world of spirits, powers, and diseases [40, 41]. People developed unique indigenous healing traditions adapted and defined by their culture, beliefs, and environment, which satisfied the health needs of their communities over centuries [15]. Different ethnic groups and cultures recognize different illnesses, symptoms, and causes and have developed different health-care systems and treatment strategies. In spite of these, profound similarities exist in the practice of traditional medicine in different African countries. The increasing widespread use of traditional medicine has prompted the WHO to promote the integration of traditional medicine and complementary and alternative medicine into the national health care systems of some countries and to encourage the development of national policy and regulations as essential indicators of the level of integration of such medicine within a national health care system. The peculiar practices of some countries are described below:
In Ghana, herbal medicine is usually the first approach to treat any illness, especially in the rural areas. Lack of access to medical facilities, poor roads/infrastructure, and affordability of treatment are some of the main reasons for the prevalent use of traditional healers. Besides, ratio of medical doctors to the patients is about 1:20000, while for traditional healers, the ratio is 1:200. This plays a major role in health care decision making. Other influencing factors, such as financial situation, education, and advice from friends and family, contribute to choice of type of health care [42]. Traditional medicine has a long history in Ghana. This knowledge is typically in the hands of spiritual healers, but the vast majority of families have some knowledge of traditional medicine, which is often inherited and passed down through the generations via folklore.
Most people in Ghana fully accept modern science-based medicine, but traditional medicine is still held in high regard. They believe in the physical and spiritual aspects of healing. Herbal spiritualists collectively called “bokomowo” indulge in occult practices, divinations, and prayers and are common all over the country. Tribal vernacular names of traditional healers include “gbedela” (Ewe), “kpeima” (Dagomba), “odunsini” (Akan), and “isofatse” (Ga).
In some Ghanaian communities, especially in the Akan communities, traditional healers and practitioners are of the opinion that disobeying taboos is one of the ways that could lead to severe illness to the person(s) or community involved [43]. Taboos form an important part of African traditional religion. They are things, or a way of life, that are forbidden by a community or a group of people. One could also become sick through invocation of curses in the name of the river deity, Antoa, upon the unknown offender.
In today’s Ghana, a traditional Medical Directorate has been established in the ministry of health to provide a comprehensive, recognizable, and standardized complementary system of health based on excellence in traditional and alternative medicine. Establishing centers for integrating scientific research into plant medicines and incorporating traditional medicine into university curricular are now the current status in Ghana [44]. Also, degree-awarding traditional medical schools now train and graduate traditional medical doctors.
The first principle is diagnosis followed by complex treatment procedures using plants from the bush, followed by many rituals, the ultimate aim being to cure disease. Serious or chronic illnesses require “chizimba,” which means sealing a disease or illness away forever. This involves killing a lizard and burning the heart with roots of certain trees and grinding with charcoal. Tiny cuts are made on the ailing area and left breast and the mixture rubbed into the cuts.
Plants may be used singly or in combination with other plants. The plant parts are harvested fresh, pulverized, and left to dry first, then soaked in water or other solvents like local gin. Some plant materials are burnt as charcoal and used as powder. Six major types of treatment common to the 72 or more ethnic groups in Zambia include drinking, eating, drinking as porridge, making small cut on skin and applying, bathing with herbs, dancing to exorcize spirits, and steaming with boiling herbs. The Zambian traditional healer is called Nga:nga [45].
In Tanzania, traditional medicine has been practiced separately from allopathic medicine since colonial period but is threatened by lack of documentation, coupled with the decline of biodiversity in certain localities due to the discovery of natural resources and excessive mining, climate change, urbanization, and modernization of agriculture. Traditional medicine in Tanzania is used by people of all ages in both urban and rural areas for both simple and chronic diseases. The traditional healers are of four different types: diviners, herbalists, traditional birth attendants, and bone setters. Erosion of indigenous medical knowledge occurred as most of the traditional health practitioners were aging and dying, and the expected youths who would inherit the practice were shying away from it and those in the rural areas dying of AIDS. Another constraint to the development of traditional medicine in Tanzania was lack of data on seriously threatened or endangered medicinal plant species [46]. As it stands today, the traditional medical practice is under the Ministry of health. Efforts are being made to scale up traditional medical practice by creating awareness of the importance of traditional medicine and medicinal plants in health care and training of traditional health practitioners on good practice, conservation, and sustainable harvesting [47].
Traditional medicine features in the lives of thousands of people in South Africa every day. In fact, it is estimated that 80% of the population uses traditional medicines that are collectively called muti. Muti is a word derived from medicinal plant and refers to traditionally sourced plant, mineral, and animal-based medicines.
In addition to herbs, traditional medicine may use animal parts and minerals. However, only plant muti is considered a sustainable source of medicines. South African traditional plant medicines are fascinating with so many colors, forms, and effects. It is an art to know these and to use them correctly to bring about health and harmony, which is the aim of all true traditional healers. The plant muti is commonly sold in specific sections of the open markets in South Africa, as shown in Figure 3.
Muti market in Johannesburg (Source—Ancient Origins).
Figure 3 shows a muti market in Johannesburg.
The traditional healers known as the Sangoma or Inyanga are holders of healing power in the southern Bantu society. In a typical practice with a female traditional practitioner, the methods used depended on the nature of the complaint. For example, headaches are cured by snuffing or inhaling burning medicines, bitter tonics are used to increase appetite, sedative medicines for depression, vomiting medicines to clean the digestive system, and antibiotic or immune boosting medicines for weakness or infection. She often counseled patients before administering appropriate healing herbal medicines [48].
As in many countries in Sub-Saharan Africa, Kenya is experiencing a health worker shortage, particularly in rural areas. Anecdotal evidence suggests that globally, traditional medical practitioners (THMPs) are the only point of contact for at least 80% of the rural poor [10]. In Kenya, very little quantitative evidence or literature exists on indigenous medicine and the health practices of alternative healers or the demand for traditional medical practitioners or on the role that they play in providing particular health services for the rural poor. As a result, TMPs currently do not have sufficient formal government recognition and are often sidelined in Human Resources in Health (HRH) planning activities; further, their activities remain unregulated. Community-derived data show that hospitals are preferred if affordable and within reach. There is also significant self-care and use of pharmacies, although THMPs are preferred for worms, respiratory problems, and other conditions that are not as life threatening as infant diarrhea and tuberculosis [49].
Traditional Medicine Practitioners in Kenya generally known as “laibon” far outnumber conventional or allopathic providers. Their practices are no different from other African countries. In many cases, they combine both modern and herbal medicines, especially if they are afflicted by chronic ailments such as HIV/AIDS, hypertension, cancer, and diabetes [50].
The various ethnic groups in Nigeria have different health care practitioners aside their western counterparts, whose mode of practice is not unlike in other tribes. The Yorubas call them “babalawos,” the Igbos call them “dibia,” while the Northerners or Hausas call them “boka” [5]. Traditional/herbal medicines have impacted the lives of people, especially in the rural areas where access to orthodox medicare is limited [51]. Apart from the lack of adequate access and the fear of expired or fake drugs, the prohibitive cost of western medicine makes traditional medicine attractive. Various training schools exist for both herbal medicine and homeopathy, and as such, most modern traditional health practitioners have great knowledge of pharmaceutical properties of herbs and the shared cultural views of diseases in the society and they combine their knowledge with modern skills and techniques in processing and preserving herbal medicines, as well as in the management of diseases. In oral interviews with two modern traditional medicine practitioners, Dr. Anselm Okonkwo of Saint Rita’s Ethnomedical Research Center, Enugu, Nigeria, a Veterinary doctor, and Mr. Uche Omengoli of CGP Herba-Medical Consultancy and Research, Enugu, Nigeria, a medical laboratory technologist, both revealed that their knowledge and ‘gift’ of medical practice were handed down by aged relatives who were also in the practice by both tutelage and supernatural means. Knowledge was however improved by further training, interaction, and discussion with colleagues, consultation of books on herbal medicine, and the Internet. They claimed that the practice was very lucrative, especially since some ailments that defied orthodox medicine such as epilepsy and madness could be completely treated by traditional medicine. The two men divulged that the old concept of secrecy and divination is gradually fading away and being taken over by improved skills, understanding, and use of modern equipment where necessary. Both however agreed to the “mystic” or esoteric power of plants, which they sometimes employ in their diagnosis and treatment. An Enugu, Nigeria-based nonprofit organization, the Association for Scientific, Identification, Conservation and Utilization of Medicinal Plants of Nigeria (ASICUMPON), of which the writer is a member, is committed to “highlighting the usefulness of medicinal plant resources and scientific assessment, preparation and application of these for the betterment of humanity and as Africa’s contribution to modern medical knowledge,” under the chairmanship of Reverend Father Raymond Arazu. Another prominent member of the association, Professor J.C. Okafor, who is a renowned silviculturist and plant taxonomist, is helping members to identify and classify plants. The group also shares and documents evidence-based therapeutic knowledge. Such groups and training schools exist all over Nigeria. ASICUMPON has published a checklist of medicinal plants of Nigeria and their curative values [19]. Other books have likewise produced useful information [16, 21]. The greatest problem still facing herbal medicine in Nigeria is lack of adequate standardization and safety regulations [52]. However, the interest and involvement of educated and scientific-minded people in herbal medicine practice have to a great extent demystified and increased the acceptability of these medicines by a greater percentage of would-be skeptical populace. A photograph of Dr. Anselm Okonkwo is shown here in Figure 4, who is a veterinary doctor and a typical educated and knowledgeable herbal practitioner with the writer after interviewing him.
The writer with Dr. Okonkwo of St Rita’s Ethnomedical Research Center, Enugu, after the interview.
An adverse drug reaction is defined as “a harmful or troublesome reaction, due to intervention related to the use of a healing substance, which envisages risk from future administration and requires prevention or explicit treatment, or alteration of dose and method of administration, or withdrawal of the medical substance.” Any substance with a healing effect can generate unwanted or adverse side reactions. As with synthetic drugs, the quality, efficacy, and safety of medicinal plants must also be assured. Despite the widespread use of herbal medicines globally and their reported benefits, they are not completely harmless. In as much as medicinal herbs have established therapeutic effects, they may also have the potential to induce adverse effects if used incorrectly or in overdose. The likelihood of adverse effects becomes more apparent due to indiscriminate, irresponsible, or nonregulated use and lack of proper standardization. These concerns have been the focus of many international forums on medicinal plants research and publications [53]. The rich flora of Africa contains numerous toxic plants, though with interesting medicinal uses. The toxic constituents (e.g., neurotoxins, cytotoxins, and metabolic toxins) from these plants can harm the major systems of the human body (cardiovascular system, digestive system, endocrine system, urinary system, immune system, muscular system, nervous system, reproductive system, respiratory system, etc.) [25].
In a survey in Lagos metropolis, Nigeria, among herbal medicine users, it was found that herbal medicine was popular among the respondents but they appeared to be ignorant of its potential toxicities [22]. Several herbal medicines have been reported to have toxic effects. Current mechanisms to track adverse effects of herbal medicines are inadequate [15, 54, 55]. Consumers generally consider herbal medicines as being natural and therefore safe and view them as alternatives to conventional medications. Only very few people who use herbal medicines informed their primary care physicians. It is therefore likely that many adverse drugs reactions go unrecorded with either patients failing to divulge information to health services, and no pharmacovigilance analyses are being carried out, or the observations are not being reported to appropriate quarters such as health regulatory bodies. Establishing a diagnosis of herbal toxicity can be difficult. Even when herbal-related toxicity is suspected, a definitive diagnosis is difficult to establish without proper analysis of the product or plant material. Very few adverse reactions have been reported for herbal medicines, especially when used concurrently with conventional or orthodox medicines [15]. The results of many literature reviews suggest that the reported adverse drug reactions of herbal remedies are often due to a lack of understanding of their preparation and appropriate use.
In a research of liver and kidney functions in medicinal plant users in South-East Nigeria, it was found that liver problems were the most prominent indices of toxicity as a result of chronic use [56]. Figures 5 and 6 refer to the effect of consumption of herbal medicines and length of usage respectively, on serum enzymes, as an index of liver function. Toxic components in these herbs such as alkaloids, tannins, oxalates, etc., may likely be responsible for such observed toxicities.
Serum enzyme levels in herbal medicine users (test group) and nonusers (control).
Effect of length of use of herbal medicine on serum enzyme levels.
Another important source of toxicity of herbal medicines worth mentioning is microbial contamination due to poor sanitary conditions during preparation [57]. Toxicity may also arise as a result of herb-drug interaction in situations where there is co-administration of herbal medicines with some conventional drugs or supplements [11]. Incorrect identification and misuse of plants may also lead to toxicity.
It is therefore pertinent at this time to present correct, timely, and integrated communication of emerging data on risk as an essential part of pharmacovigilance, which could actually improve the health and safety of patients. This calls for improved collaboration between traditional practitioners and modern health care professionals, researchers, and drug regulatory authorities. The latency period between the use of a drug and the occurrence of an adverse reaction, if determined, can also help in its causality assessment in pharmacovigilance management [25]. Such information can be invaluable in the interpretation of drug safety signals, and facilitate decisions on further protective actions to be taken concerning future use.
Plants have been the primary source of most medicines in the world, and they still continue to provide mankind with new remedies. Natural products and their derivatives represent more than 50% of all drugs in clinical use, of which higher plants contribute more than 25%. These are no doubt more important in developing countries but quite relevant in industrialized world in the sense that pharmaceutical industries have come to consider them as a source or lead in the chemical synthesis of modern pharmaceuticals [24, 58]. A number of African plants have found their way in modern medicine. These plants which had been used traditionally for ages have through improved scientific expertise been the sources of important drugs. Examples of such drugs and their sources include:
Ajmalicine for the treatment of circulatory disorders and reserpine for high blood pressure and mental illness both from Rauvolfia serpentina, L-Dopa for parkinsonism is obtained from Mucuna species, vinblastine and vincristine used for the treatment of leukemia from Catharanthus roseus, physostigmine from Physostigma venenosum, or “Calabar bean,” used as a cholinesterase inhibitor, strychnine from the arrow poison obtained from the plant Strychnos nux-vomica, atropine and hyoscine from Atropa belladonna leaves. A host of other African plants with promising pharmaceutical potentials include Garcinia kola, Aframomum melegueta, Xylopia aethiopica, Nauclea latifolia, Sutherlandia frutescens, Hypoxis hemerocallidea (African wild potato), and Chasmanthera dependens as potential sources of antiinfective agents, including HIV, with proven activities [59], while Cajanus cajan, Balanites aegyptiaca, Acanthospermum hispidum, Calotropis procera, Jatropha curcas, among others, as potential sources of anticancer agents [60]. Biflavonoids such as kolaviron from Garcinia kola seeds, as well as other plants, have antihepatotoxic activity [61].
Both Western or traditional medicine come with their own challenges. Currently, there are many western drugs on the market which have several side effects, in spite of their scientific claims. In like manner, African traditional herbal medicine or healing processes also have their own challenges. The following are reported as some of the advantages and disadvantages:
African herbal medicine is “holistic” in the sense that it addresses issues of the soul, spirit, and body. It is cheap and easily accessible to most people, especially the rural population. It is also considered to be a lot safer than orthodox medicine, being natural in origin.
Some of the disadvantages include improper diagnosis which could be misleading. The dosage is most often vague and the medicines are prepared under unhygienic conditions, as evidenced by microbial contamination of many herbal preparations sold in the markets [57]. The knowledge is still shrouded in secrecy and not easily disseminated. Some of the practices which involve rituals and divinations are beyond the scope of nontraditionalists such as Christians who find it incomprehensible, unacceptable, and difficult to access such services [8, 62].
Long before the advent of Western medicine, Africans had developed their own effective way of dealing with diseases, whether they had spiritual or physical causes, with little or no side effect [63]. African traditional medicine, of which herbal medicine is the most prevalent form, continues to be a relevant form of primary health care despite the existence of conventional Western medicine. Improved plant identification, methods of preparation, and scientific investigations have increased the credibility and acceptability of herbal drugs. On the other hand, increased awareness and understanding have equally decreased the mysticism and “gimmicks” associated with the curative properties of herbs. As such, a host of herbal medicines have become generally regarded as safe and effective. This, however, has also created room for quackery, massive production, and sales of all sorts of substandard herbal medicines, as the business has been found to be lucrative.
African traditional herbal medicine may have a bright future which can be achieved through collaboration, partnership, and transparency in practice, especially with conventional health practitioners. Such collaboration can increase service and health care provision and increase economic potential and poverty alleviation. Research into traditional medicine will scale up local production of scientifically evaluated traditional medicines and improve access to medications for the rural population. This in turn would reduce the cost of imported medicines and increase the countries’ revenue and employment opportunities in both industry and medical practice. With time, large scale cultivation and harvesting of medicinal plants will provide sufficient raw materials for research, local production, and industrial processing and packaging for export.
The scope of herbal medicines in Africa in the near future is very wide, but the issue of standardization is still paramount [64].
This therefore calls for ensuring that the raw materials should be of high quality, free from contaminations and properly authenticated, and samples deposited in University, National, and Regional herbaria. There is need for pharmacopeia to provide information on botanical description of plants, microscopic details, i.e., pharmacognosy, origin, distribution, ethnobotanical information, chemical constituents and structures, methods of quality control, pharmacological profile and clinical studies, including safety data, adverse effects, and special precautions [21, 62]. Such wealth of information will no doubt bring about uniformity in production quality. Rather than viewing African herbal medicine to be inferior, it may yet turn out to be the answer to the treatment of a host of both existing and emerging diseases such as malaria, HIV/AIDS, ebola, zika, etc., that may defy orthodox medicine.
Future perspectives in this area include:
All countries in the African region must seek to recognize traditional medical practice by putting out regulations and policies that will be fully implemented to ensure that the THPs are qualified and accredited but at the same time respecting their traditions and customs. They must also be issued with authentic licenses to be renewed frequently.
Incorporation of systems that will provide an enabling environment to promote capacity building, research, and development, as well as production of traditional herbal medicines of high standards.
Harnessing the importance of traditional herbal medicine and integrating the conventional medicine to combat priority diseases such as malaria, HIV/AIDS, diabetes, sickle cell anemia, hypertension and tuberculosis.
Raising the standards of African traditional herbal medicine to international standards through intercountry collaboration.
These if achieved would put African herbal medicine in an admirable position in the World health care system.
Despite decades of research and engineering works on urban flood disaster prevention and reduction, flooding-caused death and economic loss continue to rise. On a global scale, flood disasters affected 2 billion people in the period between 1998 and 2017 [1]. A report by UNISDR [2] revealed that 43% of natural disasters occurred during the period of 1995–2015 were related to floods. These events affected more than half (56%) of all people who suffered from any type of natural disaster with a flood-induced death rate of about 26%. Data from the Emergency Events Database (EM-DAT) also clearly indicates that flood disaster events have increased significantly in the number over the last decade. On a regional scale, the Expected Annual Damage (EAD) from river flooding reaches €6.4 billion and the Expected Annual Population (EAP) exposure to flooding is about 195.000 people in Europe [3]. Between 2000 and 2005, Europe suffered nine major flood disasters, which caused 155 casualties and economic losses of more than €35 billion [4]. On a national scale, for example, direct flood damages for the water year 2016 totaled US $57 billion in China [5]. In Japan, a torrential downpour in July 2018 caused 223 deaths and inundated 29,766 houses with the total economic damage as high as 1,158,000,000,000 JPY according to the Ministry of Land, Infrastructure, Transport and Tourism, Japan [6].
\nThese water-related disasters were not solely caused by natural hazards. Rather, most of the major risks and disasters are triggered by vulnerable conditions of societies. Additionally, the lack of resilience and adaptive capacity are factors that make societies or social-ecological systems unable to deal with changing environmental conditions and natural hazards effectively. Thus, there is a growing need to better understand the effectiveness of efforts and investments in resilience building that can help to minimize losses and assure a quick recovery during and after a natural hazard event.
\nIn the 20th century, the main approach to deal with flood risk has often been the adoption of control-centered strategies, attempting to prevent flood disasters from happening. This approach is evidenced by the worldwide development of water infrastructure such as dam, levee, and diversion channel. Although this approach can provide substantial protection against floods, including reducing flood fatality significantly, it does not cope with changing environments. With climate change, the magnitude of a 100-year flood in the future may become much higher than a 100-year flood today. Consequently, a levee designed to resist a 100-year flood today could fail to function in the near future. More importantly, levee creates dilemmas because building stronger levee to reduce flood risk in turn may encourage more development in flood-prone areas, resulting in high flood risk. As more people and assets are concentrated in flood-prone areas, a higher levee to resist a large flood may cause higher damage should the levee breach. A study by Ferdous et al. shows that flood death rates associated with the 2017 flooding in Bangladesh were lower in the areas with lower protection level. Indeed, various studies so far have led to a general notion that a sole focus on resistance to flooding can be costly in terms of human life, property, and infrastructure. In places where the infrastructure or regulatory controls fail to provide adequate protection against unexpected events, flood risk management should rely more on the combination of hard and soft countermeasures.
\nThus, the development of new approaches to deal with flood risk or the pursuit of paradigm shift in flood risk management is an urgent demand. In recent years, the concept of resilience has been gaining more recognition and momentum and is evolving to become a cornerstone for new approaches in flood risk management [7, 8, 9, 10, 11]. Building a flood-resilient city is a strategy for building a future in which we can live with floods and has become a widely known catch phrase. Streetscapes for vulnerable and resilient cities are illustrated in Figure 1. A vulnerable city may suffer from flood disaster, but a resilient city may allow residents to enjoy flood watching. As a matter of fact, resilience is explicitly incorporated in the United Nations (2015) Agenda for Sustainable Development: Goal 11 encompasses making cities and human settlements inclusive, safe, resilient, and sustainable.
\nVulnerable and resilient cities (drawn by Alice Wang based on [12]).
The resilience is a relatively new notion referring to the ability of a system, community, society to defend, react and recover quickly and easily from the damaging effect of realized hazards. The large amount of research works has contributed to the development of better understanding of the concept and its applications is currently being discussed in various fields from flood management, transportation, drinking water supply to power supply with the recognition of the difficulty of defining resilience precisely. Restemeyer et al. [13] attempted to develop a strategy-based framework to allow scientists and governmental bodies to evaluate the flood resilience of cities, whereas van der Vaart et al. [14] tried to crystallize suggestions for some of the core bottlenecks of the implementation of flood resilience strategies via an expert group workshop.
\nAlthough the concept of resilience has obtained a foothold in international academia and practice, playing increasingly important roles in the fields of ecology, spatial planning, social science, structural engineering and flood risk management as demonstrated by an ever increasing number of entries in scientific books and articles, its implementation in practice remains not always to be a matter of course. For example, a review work of resilience practice in New Taipei City showed that although New Taipei City government actively promotes resiliency in various sectors, particular townships are facing different challenging such as rapid urbanization and the lack of emergent facilities [15].
\nA technical issue, which could be considered a barrier to the development of resilience-based risk management approach, is that the definition of resilience varies from engineering, ecology to sociology. It may not necessary or even not possible to have an unanimous definition of resilience for all fields, an assessment of major definitions of resilience and its relationship with other concepts such as vulnerability and coping capacity will promote cross-sector communication and contribute to refinement of the concept and establishment of resilience-based or resilience-centered risk management discipline.
\nTherefore, the general aim of this chapter is to provide a concise analysis of different definitions of resilience in relation to flood risk management and to explain the commons and differences between conventional flood risk management and resilience-based flood management. Besides, it is intended to present a mathematical formulation of resilience for better understanding and assisting in-depth discussion. Moreover, it gives an account of the current application of resilience-based flood risk management concept. Nevertheless, it should be mentioned here that the analysis of definitions and discussion of current applications is not aimed to be comprehensive but selective.
\nWhile it appears intuitive to most people, the notion of resilience proved to be extremely difficult, if not impossible to define in a general and comprehensive way. Numerous qualitative and quantitative definitions have been proposed in different fields from ecology, engineering, social sciences to psychology. Some of them were explained as follows.
\nIn ecology, the concept of resilience was first introduced by Holling [16], which states that the resilience is defined as “the magnitude of disturbance that can be absorbed before the system changes its structure by changing the variables and processes that control behavior.” Another definition is “the capacity of a system to absorb disturbance and reorganize while undergoing change so as to still retain essentially the same function, structure, identity, and feedbacks” [17]. The focus of this definition is on the dynamics of the system when it is disturbed far from its modal state. As explained by Holling [17], the first definition concentrates on stability near an equilibrium steady state, where resistance to disturbance and speed of return to the equilibrium are used to measure the property, and such a notion may be termed engineering resilience. The second definition emphasizes conditions far from any equilibrium steady state, where instabilities can flip a system into another regime of behavior, which can be termed ecological resilience. Wording differently, ecological resilience is not just about being persistent in a certain state but also allowing the evolution of the system to new equilibrium states.
\nMeanwhile, Youn et al. [18] defined engineering resilience as “the sum of the passive survival rate (reliability) and proactive survival rate (restoration) of a system.” Similarly, the American Society of Mechanical Engineers (ASME) defined resilience as “a system’s ability to rapidly recover to the full function after disruption.” Haimes [19, 20] defined resilience as “the ability of system to withstand a major disruption within acceptable degradation parameters and to recover with a suitable time and reasonable costs and risks,” which highlights the recovery time and associated cost. He stressed that the resilience of a system is threat-dependent, and some particular states of a system are inherently more resilient than others. This notion requires the characterization and assessment of resilience to be specific to the threat under consideration. A system may be resilient to certain types of hazard but may not be so to another type of hazard. For example, flood-tolerant evergreen tree species of the Amazonian floodplain forests may suffer from seedling mortality due to draught. A poor coastal community in the Mekong Delta area may be resilient to damage from storm surge but could be very vulnerable to water pollution. A population might have resilience (immunity) to flu A but could be easily infected by Covid-19.
\nIn addition to the type of threat, the present work suggests the explicit consideration of the maximum magnitude of the threat or the upper limit of disturbance that a system can withstand before it loses all functions. For instance, the IPCC story of “1.5 degrees Celsius limit” [21] tells greatly increased risks if global warming exceeds 1.5°C above pre-industrial levels and even “catastrophic” impacts to our world if we warm more than the target.
\nAn underlying assumption in resilience study is that all systems have a certain degree of resilience. A system loses its resilience or loses its structure and functions only when the disturbance is too large to be coped with by system’s capacity. However, how the largeness of disturbance should be defined remains little explored. In other words, the critical point is not easy to determine. Up to now, resilience study has been largely disconnected to threshold assessment. So, a dilemma is how we could quantify resilience without knowing the conditions under that a system would collapse and lose it all functions. Besides, the upper limit or elasticity of a system depends on the type of threat because the system responds to different type of threat differently. Furthermore, system capacity is time-dependent and may be affected by surrounding conditions. Therefore, there could be a spatial–temporal variation in the upper limit of a system to withstand disturbance. As a result, the determination of the upper limit or quantification of system capacity considering its spatial–temporal variation in relation to the type of threat is an important step to operationalize the concept of resilience.
\nAllenby and Fink [22] defined resilience as “the capability of a system to maintain its functions and structure in the face of internal and external change and to degrade gracefully when it must.” A new and important point in this definition is its inclusion of exit strategy. However, this important aspect has received little attention in the field of flood risk management so far. The idea of degrading gracefully when it must also serve as a call for more in-depth study on the upper limit of a system to different types of hazards.
\nIn social sciences, Adger [23] defined social resilience as “ability of groups or communities to cope with external stresses and disturbances as a result of social, political, and environmental change.” The Community and Regional Resilience Institute [24] defined the resilience as “the capability to predict risk, restrict adverse consequences, and return rapidly through survival, adaptability, and growth in the face of turbulent changes.” Keck and Sakdapolrak [25] defined social resilience as “comprised of three dimensions: coping capacities, adaptive capacities, and transformative capacities.” What is important is that people are included in socio-ecological resilience discourse and such a coupling added new values to classical ecology in which humans are treated as external.
\nIn economics, resilience is defined as “the inherent ability and adaptive response that enables firms and regions to avoid maximum potential losses” [26]. It can be further classified into static and dynamics resilience. Static economic resilience is referred as the capability of an entity or system to continue its functionality like producing under a severe shock, while dynamic economic resilience is defined as the speed at which a system recovers from a severe shock to achieve a steady state [27].
\nVugrin et al. [28] defined system resilience as “given the occurrence of a particular disruptive event (or set of events), the resilience of a system to that event (or events) is the ability to reduce efficiently both the magnitude and duration of the deviation from targeted system performance levels.” There are three key factors in this definition: (1) the disruptive event, (2) the efficiency of recovery of the system, and (3) the system performance.
\nIt can be noted that a common feature among ecological, economic, and social resilience is that they do not demand the return to its original state but allow for regime change.
\nBased on these above-mentioned explanations, a graphic all-inclusive representation of resilience is provided in Figure 2. It is important to note that the social-ecological resilience may lead to a new equilibrium state depending on the combined effects of human restoration efforts and the workings of nature.
\nGraphic illustration of different concepts of resilience.
Conventional flood risk management focuses on the reduction of both flood probability and flood-caused damage. Flood probability reduction is pursued by technical measures such as dam and levee construction to keep flood waters in river channels. Resistance is a keyword to describe this practice. On the other hand, flood damage reduction is pursued by vulnerability reduction. Vulnerability is a concept that originated from social sciences and evolved to be a major framework in risk science and management and related academic fields, although a general and unanimous definition of vulnerability remains non-existent. One of the widely known definitions is given by the United Nations Development Program (UNDP), which describes vulnerability as “a human condition or process resulting from physical, social, economic and environmental factors, which determines the likelihood and scale of damage from the impact of a given hazard” [29]. A mathematical expression of vulnerability may be given as below
\nwhere exposure is defined as the degree, duration, and extent to which a system is subject to perturbation. Susceptibility refers to the factors and attributes that make a community or society more or less likely to be negatively affected by perturbation. Coping capacity is defined as the ability to cope with, or absorb and adapt to, hazard impacts [30].
\nAs resilience is the capacity to absorb, to recover and to adapt, the coping capacity of vulnerability bears some similarity with resilience. Wording differently, there is a resilience thinking to a certain extent in conventional flood risk management. Nevertheless, the prevailing notion in conventional flood risk management is stability and persistence while the socio-ecological resilience does not only stress absorption and recovery but also emphasize the adaptation and transformation to a new equilibrium state. Such an evolutional perspective can be considered as one of the most important difference between conventional flood risk management and resilience-based approach. As pointed out by Chaffin et al. [31] that social-ecological systems should be managed holistically for either increased resistance to undesirable change or the ability to transform a system to a more desirable state.
\nThe difference between resistance and the ability to absorb in resilience concept deserves some more discussions. The ability to absorb can be considered having two parts: ability to resist and ability to tolerate. Therefore, the ability to absorb in the concept of resilience may be interpreted as the ability to resist to external force first and then to bend if the force is too strong to resist but not to break. Because of the existence of various flood defense infrastructure, this interpretation is crucial for development and application of resilience-based management approaches at the top of conventional measures.
\nResistance-centered flood control approach does not consider maximum possible resistance and assume the level of resistance is limitless with technology development and economic growth. To be specific, levees are traditionally designed based on a quantity named probable maximum flood at the location, which is the level of protection levees are supposed to provide. Up until recently, many river managers believed that the level of protection can be raised high enough as long as the societal capacity to commit resources to levee construction becomes available. With or without consideration of resistance limit is one of the separation points between resistance-centered and resilience-based approaches.
\nThus, in developing resilience-based flood management approaches, the concept of engineering resilience or resistance can be applied to design and assessment for structures such as dam and levee while the concept of social-ecological resilience is useful in formulating flood adaptation strategy and determining acceptable level of risk and designing ways to deal with residual risk. Such an understanding can obviously help decision-makers do better flood management. The old mindset of confining flood waters in river channels and belief that levees can be constructed high enough to prevent overflow and strong enough to prevent any breach are wishful thinking. River overflow and levee breach have been occurring across the world even without climate change, and climate change is increasing its frequency and intensifying the magnitude. In light of the inevitable, the confinement or resistance approach appears not sustainable and a shift from confinement to living with water is indispensable.
\nBased on the afore-mentioned definitions and analysis, a mathematic formulation was proposed here to facilitate in-depth discussion of resilience, which follows a logistic equation as below
\nWhere R is the state of recovery (mathematically R = N/Nin: N: current state, Nin: original state), r is recovery rate, K is the carrying capacity of a system.
\nIntegration of Eq. (2) yields
\nwhere R0\n = N0/Nin is the deviated state of the system due to disturbance. Since R asymptotically approaches the carrying capacity K as time approaches infinity, it means a full recovery to the original state when K=Nin. It indicates partial recovery if K < Nin, and a new and better equilibrium if K > Nin. This can be interpreted as that a large carrying capacity is a premise for a system to have ecological resilience. If the capacity is not large enough, the achievable state of recovery is back to the normal at the best or even worse as being repaired. On the other hand, the speed of recovery may be expressed as
\nwhere T is the intrinsic time of recovery, which is a function of local attributes including local natural landscape and local community structure. Res is the external resources used for restoration, which is a function of the magnitude of disturbance and local attributes as well. Resin is the internal resources available for restoration. This indicates that the less time the system uses for recovery, and the less the amount of external resources needed for recovery, the more resilient the system is. The availability of Resin is carrying capacity-related, and it depends to a large extent on governmental polies and decisions of how to mobilize internal sources. It also implies that the recovery rate may largely depend on external help if disturbance is too large for the internal mechanism to function. An illustration of resilience-dependent recovery based on Eq. (3) is given in Figure 3.
\nVisual representation of resilience-dependent recovery process (low resilience: Repair; good resilience: Restoration; high resilience: Enhancement).
Compared to previous studies, such a mathematical expression of resilience can be used for both qualitative and quantitative discussions and to analyze the effects of more factors, especially the time of recovery and the amount of potentially used resources. For example, the recovery processes of vulnerable developing countries tend to rely largely on international aids, which reflects low resilience according to Eq. (4). Moreover, the outcomes are often superficial reconstruction without resilience building due to its limited capacity as can be explained by Eq. (2). As a result, recipients of relief aid lose their initiative to fend for themselves and repeat the cycle of disaster-aid-reconstruction-disaster. Quantitative or semi-quantitative assessment of the dependency of recovery rate on external source using mathematical formulas can certainly facilitate better decision-making regarding the long-term resilience building.
\nThe earthquake and tsunami that hit Japan in 2011 cost $235 billion economic damage according to the World Bank. Six years later, Japan’s Reconstruction agency announced that out of the 150,000 evacuees who lost their homes, 50,000 of them were still living in temporary housing. The reason behind the delay is the lack of construction workers and rising cost of building materials. This case proved that large dependence on external resources could delay the recovery process greatly and resilience building should be promoted to reduce a system’s dependency on external sources.
\nThe importance of resilience building in flood risk management has been well recognized as evidenced by large amounts of academic articles on resilience. In practice, however, resilience concept tends to be only marginally applied as a supplement to flood risk management. There are several well-known initiatives such as Rockefeller Foundation’s 100 Resilient Cities programme (100RC) [32], the UNISDR Making Cities Resilient campaign, and the OECD Resilient Cities project [33]. These programs are mainly intended to promote resilience as a source of policy inspiration, and the development of policy instruments for cities to address immediate shocks and long-term stresses that undermine the functions of cities.
\nIn the paper by Gralepois et al. [34], the flood defense strategies in six European countries (Belgium, England, France, the Netherlands, Poland, and Sweden) are analyzed. Although they do not find radical changes in either of the countries, they do find that the defense strategy in all countries has created more room for local, private, and individual responsibilities. In all countries except Sweden, defense remains the primary method of protection, leading the authors to conclude that flood defense has remained a cornerstone of European flood risk management.
\nThe paper by Gersonius et al. [35] addresses the debate as to how transformations from resistance-based to resilience-based approaches can be achieved by studying the implementation of various measures that aim to enhance the flood resilience of the Dutch “Island of Dordrecht.” The case illustrates that a multilayered, i.e., diversified, approach is more effective and efficient than its resistant, i.e., flood defense dominated, counterpart and provides substantial co-benefits. However, it is incompatible with the existing institutional framework. Such an incompatibility may be considered a challenge that will also be present in other countries with an established institutional framework for resistance-based approaches. Then, the authors recommend searching for ways to reinterpret existing frameworks and applying them differently by setting up pilots and experiments to foster social learning.
\nThe paper by Hegger et al. [36] assesses the now prominent assumption that a diversification of flood risk management strategies leads to resilience. They propose that the resilience concept should be operationalized into three capacities: capacity to resist, capacity to absorb and recover, and capacity to adapt and transform, and they compared six countries’ achievements in terms of these capacities. The work found that having a diverse portfolio of strategies in place contributes to resilience, especially in terms of the capacity to absorb/recover and the capacity to adapt and transform. However, the authors also stated in this work that they see different ways to be resilient. The importance of explicating the normative starting points of flood risk governance in a country, considering the unavoidable trade-offs between the three capacities, and assessing strategies’ fit with existing physical circumstances and institutional frameworks was further elucidated in the work.
\nDespite various efforts to adopt resilience-based approach to flood risk management, the actual application or the operationalization of the resilience concept remains to be explored, planned, tested, and evaluated. At present, many flood-prone regions have good pre-disaster preparation such as flood hazard map, evacuation plan and early warning system. However, few municipalities have resilience-based post-disaster recovery plan or guideline prepared before disaster. Instead, what was often seen is ad hoc recovery plans after disasters.
\nThe Cedar Falls is a residential community located in Eastern Iowa. A good practice of the city is that it has a hazard mitigation plan, which includes a series of future hazard mitigation activities involving a wide range of hazards including floods [37]. Although one of the goals of the plan is to return to pre-disaster or improved conditions as soon as possible after a disaster occurs, the emphasis is placed on prevention than rebuilding. Technical advices on recovery process are limited and general. Suggestions such as “Continue membership with the National Flood Insurance Program (NFIP)” or “Establish and/or maintain Continuity of Government plans to handle post disaster operations (i.e. animal disposal, clean-up, demolition) are important but insufficient.
\nEPA developed a Flood Resilience Checklist [38] to help communities identify ways to improve their resilience to future floods. It includes five areas: (1) Overall strategies to improve flood resilience; (2) Conserve land and discourage development in flood-prone river corridors; (3) Protect people, businesses, and facilities in vulnerable settlements; (4) Plan for and encourage new development in safer areas; (5) Implement and coordinate stormwater management techniques throughout the whole watershed. The five areas can be regrouped as overall strategies (area 1) as well as specific strategies (areas 2–5).
\nThe area of Overall Strategies to Enhance Flood Resilience is designed to promote the integration of the community’s comprehensive plan and other community’s plans such as open space or park plans with a flood management plan including both structural and non-structural measures. It also promotes community participate in the National Flood Insurance Program Community Rating System. For specific strategies such as Incentives for restoring riparian and wetland vegetation in areas subject to erosion and flooding and Acquisition of land (or conservation easements on land) to allow for stormwater absorption, their importance are well recognized and have been pursued in various ways. A representative case is the Room for the Rivers program along the Rhine and Meuse Rivers, which started from 2006 with a $3.3 billion budget from the Dutch government. Flood risk management strategies in the Netherlands have traditionally focused on reducing the probability of flooding [39] by means of dikes, pumps, and canals. After experiencing severe flooding in the 1990s, the Dutch government decided to safeguard flood-prone areas by stepping back from the river to enable the rivers to safely discharge far greater volumes of water. The program resulted in a reduction of water levels by 10–19 cm during high water in target river reaches. Although the primary goal of the Room for the River program is flood attenuation, it also recognizes the importance of esthetics and cultural and ecological elements and has increased biodiversity as the project transformed 4576 acres of land back to natural conditions. Therefore, such an initiative functions as an opportunity rather than a solely means to fix a problem because it is designed not only for river management, but also for social and economic advances.
\nIn the meantime, some U.S. communities have also implemented their own Room for the River strategies to deal with flooding. The Iowa River Corridor Project [40], begun after a severe flood in 1993, compensates farmers who permanently stop farming fields in floodplains. Much of the 50,000 acres involved have reverted into natural wetlands, grassland, and bottomland forest, and provide habitat for wildlife. The Napa River in California often floods between November and April. The $400 million Napa River/Napa Creek Flood Control Project is lowering dikes, creating floodplains and a bypass, relocating bridges, and restoring 900 acres of wetlands according to “living river” principles. Floodplain and wetlands restoration projects are also ongoing in other parts of the U.S. such as Illinois, Massachusetts, Missouri, North Dakota, Minnesota, Oklahoma, and Wisconsin.
\nOn the other hand, studies focusing solely on disaster recovery have also progressed greatly in parallel to resilience research. Smith and Wenger [41] defined the disaster recovery process as “the differential process of restoring, rebuilding, and reshaping the physical, social, economic, and natural environment through pre-event planning and post-event actions,” while Schwab et al. [42] defined recovery as “Recovery includes restoring housing, transportation, and public services; restarting economic activity; and fostering long-term community redevelopment and improvements. The definition adopted by the UN Office of Disaster Risk Reduction is “decisions and actions aimed at restoring or improving livelihoods, health, as well as economic, physical, social, cultural and environmental assets, systems and activities, of a disaster-affected community or society, aligning with the principles of sustainable development, including build back better to avoid or reduce future disaster risk.” This definition emphasizes both returning the community to normality, which is a short-term objective and sustainable development to be less vulnerable and more capable of dealing with future disaster risk, which is a long-term goal and this long-term goal implies building back a better state, similar to the multi-equilibrium state concept in socio-ecological resilience. Therefore, the dialog between flood resilience researchers and disaster recovery planners should be promoted because it can deepen the understanding of resilience by resilience researchers and contribute to better recover planning for long-term resilience. In other words, the integration of conventional disaster recovery planning with resilience concept is a pathway for resilience building.
\nScience has revealed that the human immune system has 2 broad functions: (1) defending our body’s health and (2) maintaining our body’s health. Similarly, resilience can be viewed as urban’s or community’s immune system to natural disasters, possessing two functions: (1) resisting to disturbance and (2) maintain its viability. To date, resilience has been mainly understood as the system’s capacity to restore its structure and functions. However, we chose to use the word of viability to emphasize our understanding that resilience is not limited to bouncing back but can bounce forward. In general, there are three options for a damaged system: (1) full restoration, (2) repair, which means the restoration with replacement, and (3) restoration with enhancement. For example, if the life of a city once flooded is now fully back to pre-disaster conditions, then such a situation is full restoration. If the disaster’s impacts can never be fully erased from the city, it is a case of repair. For example, the city of New Orleans was severely damaged by Hurricane Katrina in 2005. Fifteen years after the disaster, the population of New Orleans has shrunk from 10 to 15 per cent, especially it lost many African Americans residents, who were either killed in the hurricane or could not afford to come back. This situation led some researchers to declare the housing recovery in New Orleans a secondary disaster [43, 44]. The Great East Japan Earthquake of 2011 and the vicious tsunami that followed it caused widespread destruction in the Tohoku region. Rikuzentakata City in Iwate Prefecture is one of the most badly hit cities in the disaster. The recovery plan focuses equally on reconstructing and improving damaged transport networks along the coastline, re-establishing affected local businesses and empowering the disaster-struck agricultural and fishing industries which used to thrive in the area. For the restoration of urban districts, it promoted the introduction of universal design, aiming to create more opportunities for people with disabilities and the elderly to work and do sports as well. Furthermore, residential houses and hospitals have been moved to much less disaster-prone locations. As shown in Figure 4, it is a large-scale project. In total, 298 ha of residential areas were relocated to relatively higher grounds. Such a scale of disaster-mitigation-driven relocation is unprecedented in Japanese history. Furthermore, the coastal protection system has been resigned innovatively. As illustrated in Figure 5, it consists of a double-dike structure with a vegetation zone in-between and submerged breakwater at the front. In light of these developments, Rikuzentakata City can be considered a successful case of restoration with enhancement.
\nRelocation from low-lying lands (light blue) to high grounds (brown) in the city of Rikuzentakata after the Great East Japan earthquake (source: the city office).
New protection system along the coast of the city (source: the city office).
A critical issue in choosing recovery path is the financial cost. The cost of each option may vary greatly, so that resilience building could be constrained by local economic condition. In general, sustainable, resilient water management can be considered costly since it involves engineering and land use challenges and often a long-term process. The financial sustainability of resilience building and enhancement has been largely neglected up to now and deserves serious in-depth study. It is our belief that resilience building should be pursued in relation to economic growth in developing countries. In developed countries, solutions harnessing flood risk while unlocking further development potential should be explored, which require innovation. However, as we may face multiple pathways for building a resilient tomorrow, further studies should be conducted to develop optimal design approaches for resilience building with more than one objective.
\nFinally, it should be mentioned that conventional flood risk management is probability-based. It deals with the magnitude of potential consequences due to an event or disturbance with a chosen probability of occurrence. It provides little insights into the nature’s or society’s self-restoring or anti-disturbance function and is unable to cope with events with magnitudes of impact exceeding the chosen level. By contrast, resilience-based management is not constrained by likelihood of occurrence and can accept extremely large shocks by allowing adaption to new regimes. Therefore, it is more capable of and more flexible in restoring or reestablishing an affected system. Furthermore, resilience enhancement strategy can lead to better knowledge fusion than conventional flood risk management approach.
\nThis work was supported by Sophia Research Branding Project.
\nThe authors declare no conflict of interest.
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