Sociodemographic profile of the study population

The average age of respondents was 45 years, with a minimum of 14 and maximum of 76 years. 64.2% were women and 35.8% men. The highest level of education completed was highschool, with an average of 5.3 years of education (incomplete primary). The occupation of the participants were housewives (57.7%), agricultural activities (30.2%), various trades (5.7%), employees (3.8%), students (3.8%); and traders (1.9%).

73.6% is from Riachuelos, 18.9% comes from elsewhere in Veracruz and 7.5% of other State in Mexico. 11.5% spoke an indigenous language, predominantly Totonaco in 71.4% of cases, while 28.6% said they speak Zapotec, an immigrant corresponding sector of other states, mainly of Oaxaca.

Home Remedies and its importance as a strategy for teaching and learning in the family.

98.11% of respondents admit having been taken home remedies based on medicinal plants, mainly for health and for being cheaper than allopathic medicine, also by tradition or taste and eventually out of curiosity. In the process of teaching and learning within the family, 67.3% refers to parents who are best taught the art of home remedies within the family and 32.7% indicated that grandparents. In the nuclear family it is where knowledge is transmitted from parents to children more effectively and practices it, since 84% say they induce their children to consume home remedies often in contrast with 16% prefer not to. This process is reinforced when the grandparents are present.

From the sector that transmit their knowledge to their children, 95.3% provided the remedy and explained to them the components of the mixture and process for preparing them; the rest is limited only to provide them without explanation. While it is obvious that a simple explanation does not enable the user remedies constitute an expert herbalist, but are basic principles to become a guardian of family health. In this process, the woman is the one who has a central role in the preservation and transmission of traditional knowledge, because 100% admitted that are most interested in learning these methods within the family; and especially women in adulthood, for this role in the overall home care, including health of the family, which coincides designated by OMS (1995) and ^{Zapparoli (2012)} "... females carry most of the weight in terms of respect for the responsibilities associated with the vital functions of the family, including health".

The main reason for providing home remedies is to improve health by 81.1 % of respondents, and is a complementary practice primary care system that are currently performed by going to the clinic that the State Health System provides. Families turn to the doctor or healer according to the perception of the signs and symptoms of the disease and have their own access to allopathic medicine. This relationship is part of the process of the mixed model of care in which the patient's need to restore their health with the State to guarantee an intercultural context.

The worldview about health and disease. Regarding the disease origin, there is a strong perception that they are linked to changes in consumption patterns between families, linked to the intake of industrialized products. 67.3% related diseases with an unbalanced diet, bad habits by substituting natural foods by processed. Also, in the same proportion they relate to the supernatural elements to which people are exposed, admitting that some people may be caused to other evils mainly due to envy; hence 94.3% agree that one must resort to sorcerers to counter, assuming they know healers to cause illness and diseases, but also know how to remove them.

The economic value and use of medicinal plants. Although, 71.2% indicated not to spent money on buying medicinal plants, 28.8% admit to having spent $117.88 pesos a year on average for this item, with a maximum of $1 200.00 pesos which is very low compared to the expenses incurred in allopathic medicine, $3 896.34 pesos on average and a maximum of $50 000.00 pesos in the case of families with relatives with chronic degenerative diseases. Also admitted selling medicinal plants; however, declare to acquire these therapeutic resources by collecting (20%), buy them at the local market (11%) and 69% grown in the family garden, where some species coexist tolerated and encouraged other protected-plants tolerated arise spontaneously in areas of anthropogenic vegetation that are left there without receiving any handling or care, wild but this strategy is to follow the disturbed areas. The protected arise spontaneously within the field of crops (weeds) or the garden and care recipients directly and consciously made the management to protect the plants. The fostered arise spontaneously within the crop or the garden and indirectly receive some care from the farmer, and management consciously done to encourage growth and development of spontaneous plants, including its dispersion, ^{De Wet et al. (1975)}, (Figure 2).

Figure 2 Medicinal plants operated in the family garden and in the kitchen plus cutting equipment. 

In addition to conserve germplasm, preserve traditional management techniques for the maintenance and reproduction of the garden, the species composition and the topological arrangement are defined to make them more functional and productive. Empirically recognize that intra and interspecific competition from vegetable conduct to a more and better synthesize these active ingredients that give them greater therapeutic efficacy. ^{Acosta (2001)} states that researching and knowledge of healers, herbalists, is crucial to ensure the supply of medicine to the future trying to find and cultivate high-value medicinal plants that enable rural families to improve their economic situation.

The material evidence is reflected in cutting tools and cleaning the kitchen garden, which demonstrate that many ways in which they interact with plants, these instruments are kept in the corner of the house or in the garden itself, always as testimony to the way in which they are grown, harvested and preserved plants for tea or infusion, treating minor ailments and more aggressive (Figure 2).

For the primary health care is quite vast the medicinal flora used in the Totonac region. More than 54 species were identified, of which people use as complementary and most often the fragrant avocado (Persea americana Mill.), palo colorado (Hameliapatens Jacq.), the purple bougainvillea (Bougainvillea spectabilis Willd.), basil (Ocimumbasilicum L.), arnica (Heterothecainuloides Cass.), aloe (Aloe barbadensis Mill.), soursop (Annonamuricata L.) and epazote (Teloxysambrosioides (L.) WA Weber) (Table 1).

Table 1 Medicinal plants mentioned as most frequently used in the family. 

The 32 diseases mentioned are grouped into thirteen major categories, highlighting those related to digestive, respiratory, metabolic, skin disorders and trauma disorders; headache and toothache, among others (Table 2).

Table 2 Most common disorders in families. 

Knowledge as a syncretic act. It is the family space propitious where the parents transmit knowledge, and ancestral wisdom to their children, as manifested by Genaro, who realized that his father was a midwife attending mainly his family: "... my father saw my nieces, my sisters and my mom, because my aunt, the midwife sometimes failed, even with him I learned how to remove the veins of the plant (ribs), how it should be washed well and put them to boil in a large saucepan, exclusively for that and how to filter the mixture; in cases of vaginal inflamed as to how to put to cook with cooking oil acuyo leaves (Piper auritum Kunth) and Santa Maria (Tanacetum parthenium (L.) Sch. Bip.) and how to wrap them in a clean cloth, he studied and also had many books as me "(^{Huesca, 2013} Pers. Comm.). A similar case is that of Amelia who learned from her mother as much housework as the art of healing, for 40 years makes what she calls giving birth: "... I learned because my mother and my aunt who were midwives took me with them when they went to see sick people..." (^{Pérez, 2013} Pers. Comm.).

The obvious construction of ordinary dialogue between biomedical and traditional knowledge specializes in them their medical practice and those who interact with these therapists. This kind of learning gather circumstantial actions that are added to them, at least in theory and in this particular case, a complementary relationship coexistence and mutual respect. The testimony of these actors also reflects its relationship with allopathic medicine, as manifested by Genaro when referring that he was invited by a doctor of the Mexican Social Security Institute (IMSS) to work as a cook in his private clinic, but when he demonstrated skills in births, his involvement was even more: "... I worked with her as a cook, and as she attended patients at home she used to tell me, when they get sick, you call me on the phone when they're bad, I would help her and I learnt about giving birth, I also learnt how to put a shot and serum as well... she saw that I liked giving birth and said: you going to help me; with that knowledge I came here to Hueytepec where I started giving birth with all the people here ..." (Jardínes, 2013 Pers. Comm.).

The allopathic doctors, have recognition of the quality and effectiveness of traditional medicine practitioners. The head of the medical field unit (UMC) said: "... the midwives are highly skilled people, have so much intuition and insight to know when a baby will be born, that even scares, they never have infected babies, there rate of infections in children born in hospital than those born with them is higher... " (^{Huesca, 2013} Pers. Comm.)

Sharing knowledge is also given from allopathic medicine to practitioners of traditional medicine, which is confirmed by the statement made by the doctor on duty in Hueytepec "... four active midwives have just returned from a course taught by the IMSS, where they were trained in the proper use of pine teams, sterilized delivery equipment, especially to prevent cases of congenital tetanus caused by cuts with rusted scissors and contaminated with Clostridium, they received precise information that if they bathe babies using herbs, these must be clean and well boiled, and avoid waste in the navel..." (^{Pérez, 2013} Pers. Comm.).

The contributions of official medicine is recognized when an interviewee says "... the community was not very clean, we started with the program opportunities with the participation of the community starting to sweep and whitewash, with the arrival of the UMC the issue of health is already communautaire acquis and generally it improved: the chigger, malaria, among others were eradicated" (^{Jardines, 2013}. Pers. comm). Similarly, the medical staff of the clinic accepts the skills of midwives and open channels of dialogue to accept its teachings and ask explicitly to be instructed "... teach me, you know why you practice it and so we both learn" (^{Pérez, 2013} Pers. Comm.). However, the levels of understanding and language system in each health care has sometimes a few troubles, since the midwives apply what popular wisdom has taught them, as in the following words"... we go with the moons' dates and they do not" (^{Huesca, 2013} Pers. Comm.).

There is social recognition no matter the gender of the midwife, as expressed by Amelia "... Genaro, my respect for him as well, I recommend him as if he was a doctor, this man is even better than us, if the babe has already been born baby and fifteen or twenty minutes have passed, and the placenta does not come out, he applies an injection and take out the placenta, not even hurting them; I've had a childbirth with him already..." (^{Pérez, 2013} Pers. Comm.). The above mentioned person do notes: "... when there is no medical authorization to inject the patient, I give make them chew mint leaves (Mentha L.) with salt, which provokes disgust", thus achieving in the mother a violent act as inertia and promptly ends with the expulsion of the placenta.

UMC staff on duty, remain vigilant to ensure that midwives only act in cases of extreme urgency, as long as there is no endanger the life of the mother, this occurs in the framework of the NOM 007SSA2-1993, which is an indicator of management quality on health nationally and internationally to raise the survival rate level. The application of the rule has brought a limitation on the functions of midwives, but there is not also a full understanding of justification. The following quote contextualizes this feelings: "... right now we do not see births, because in a course in Veracruz we were told only to visit each month to watch them go well,... we cannot do anything ourselves. We are several midwives here but we all have said so in the social network or health committee ... that's why we no longer work since 2011, because according to them many women would die; neither me nor my colleagues ever lost a patient, they do have losses in the hospitals and continue working" (^{Huesca, 2013} Pers. Comm.).

Although this legal provision limits the midwives, they continue practicing for various reasons, such as cultural, economic and capacity of hospitals. In this regard, the UMC chief refers that Genaro disobeyed the indication to not attend births and answered to the call of four births, one of them of high-risk, and says: "... I've had that failure about him, even though he informs to be attending a childbirth and that everything is in order, the medical staff remains alert for any obstetric emergency..." (^{Jardines, 2013} Pers. Comm.). Amelia also states "... in an emergency will not let the person die, but if it is high-risk and is scheduled, we do not put our hands on it..." (^{Huesca, 2013} Pers. Comm.).

Another factor of persistence of traditional practice is the close relationship between midwives and patients as they treatment them in their own language and have their confidence, as there is a belief among women that if they go to the clinic, their going to have a surgery to avoid having more children. In the Totonac region, their traditional doctors are midwives, healers and indigenous or half-blood sorcerers, who know of medicinal plants for delivering babies and also for relieving physical and inner illnesses. They are people who acquire a privileged status within their communities and they are respected within the families who come to receive their services. There is a bond established between traditional medicine practitioners and their patients and go beyond the cognitive aspect, an example of this is that the midwives and obstetricians are also called "grandmothers or grandfathers" of new borns, and they correspond them and name them "navel grandchildren"

The loss of traditional knowledge and attitudes that were part of the healing process and that augured good life for the newborn are lost by several causes, that in words of Genaro reflect his feelings "... they used to have a habit of making a party, killing a turkey or a pig and made mole, tamales and gave food to the midwife, now days we don't even get any food at all... also perfuming the babies with incense, lighting twenty-four candles, walking the child in there, I did all that for the child to grow pretty" (^{Jardines, 2013} Pers. Comm.). Nevertheless, there is no disappointment or frustration for them, only survives the love and respect for them as their "navel grandchildren".

In the field of modern medicine, the practice leads to the medical staffto gain a better understanding ofthe sophistication of local knowledge systems and incorporate them into their own, as the doctor says "... I tell them not to stop taking the drug and drink guaya tea (Melicoccus bijugatus Jacq.) as drinking water, they like it because it is not bitter". Discloses quite satisfied that injured patients sap palo colorado (Hamelia patens Jacq.) and accelerates healing; know of other cases in which ingest muicle (Justicia spicigera Schltdl) increasing the hemoglobin levels...", goes on saying " there are many cases of anaemia associated with poverty, there are campaigns for its detection, but they do not come despite that the children are pale, present rickets, unwillingness and they do not do well in school" (^{Jardines, 2013} Pers. Comm.). However, regretting that the present education sector in the town is still helpless to join the dialogue on this knowledge, above all by the lack of knowledge and commitment to community health.

The living pharmacy in the courtyard of the UMC of Hueytepeces represents a sign as a symbolic act of the complementarity and mutuality-regime achieved; the doctor exhibits pleased a small plot where midwives grow some plants they use in their ethnomedical practice.

As we can see, this social phenomenon is complex, where the participation of different actors (families, authorities, doctors, healers, patients) form a functional system regarding health care and it is quite important to understand it for the effective implementation of initiatives towards its strengthening and, as mentioned by ^{Mata (2002)}, not only about production, but also regarding technology, the services, incomes, in all the dimensions for a better life quality. The risk in the development of process, the aggression is not focused only on the environment, it also involves cultural and social aspects that also have a significant impact (^{Bes, 1997}).

The United Nations Industrial Development Organization (UNIDO) reported in 1998 that, without counting with users of medicinal products derived from industrial processes of medicinal plants, it has been calculated that there are about 1500 million people turning to vegetable traditional therapies. Therefore it is urgent to preserve the traditional knowledge and implement its dissemination and preservation in order to contribute to the welfare of social subjects and care of natural resources.