The Government of Panama has made considerable efforts to register and train traditional birth attendants and to integrate them into the country's health care system (137).
Although there is only one chiropractor practising in Panama, both the United States and Canada have been sending chiropractic missions to Panama since 1997 (65).
Law 4376 of August 1999 created the Area of Traditional Medicine under the National Directorate of Health Promotion. The Area is charged with developing a strategy of action for the incorporation of traditional medicine into primary health care, including research on medicinal plants.
The Carta Organica Administrativa de la Comarca (138), following Executive Decree 194 of 26 August 1999, governs traditional medicine in the Ngöbe-Buglé region. Article 258 of the Carta classifies traditional medical specialities, the services they offer, and their legal status regarding diagnosing ailments and dispensing medicines.
This same article recommends that traditional and allopathic medical practitioners cooperate and collaborate together.
Article 257 creates the Special Medical and Technical Commission to bring together traditional medicine and allopathic medicine. Articles 261 and 262 refer to the organization of botanical gardens for the scientific study of medicinal plants and propose the publication of texts and health manuals.
Article 266 defines the functions of the Special Medical and Technical Commission, including the following:
• coordinating with the national health system:
• certifying traditional health practitioners;
• organizing the methodology for a study of traditional medical practice;
• educating the public about scientific investigations into the methods, uses, and effects of traditional medicine;
• preparing a health infrastructure plan for the community;
• studying the medical history of the Ngöbe-Buglé.
In recognition of the existence, contribution, and importance of traditional medicine to the health of indigenous communities, Article 3 of Law 36 of 3 October 2000 (138), a nationally applicable law, created an autonomous institute of indigenous traditional medicine. The institute recognizes, protects, and promotes traditional knowledge related to the medicinal properties of plants, access to genetic resources in indigenous regions, and the return and distribution of benefits from the commercial application of this knowledge.
In Article 4 of Law 36, it is stated that at the institute there will be one representative of each indigenous community, one representative of traditional medicine practitioners, the Minister of Health or designate, and one representative of the Panamanian Medical Association.
Article 7 establishes traditional medicine as the patrimony of the communities from which it comes and advances the conservation and promotion of traditional medicine in indigenous areas. It also states that allopathic medicine should not be forced upon these communities. Article 8 recognizes traditional health systems in indigenous communities. Article 10 mandates indigenous authorities to mount a campaign of protection, promotion, and conservation of traditional medical practices.
Article 21 orders the establishment of a Faculty of Medicine and a Faculty of Pharmacy of indigenous materia medica and their use in the treatment of sickness. The rest of the articles of Law 36 refer to access to resources, benefit sharing, intellectual property, and the commercialization of medicinal plants.
Licensing legislation regulates chiropractic educational standards and practice (81). A chiropractic law was adopted in 1967, permitting chiropractors to "examine, analyse and diagnose the human body by way of any method physical, chemical, electrical, or the use of x-ray" and provides for "the adjusting, manipulation and treating of the human body" (65).