As an intern for Wuqu’ Kawoq, I hope to initiate environmental health programs in some of the communities where we work. In July and August, to improve my Kaqchikel fluency and learn about daily life in rural Guatemala, I lived with a family in Santa Catarina Palopó, a community on the shore of Lake Atitlán in Sololá.
On some evenings, I helped the girls make corn tortillas on the plancha, a flattop metal plate warmed over a wood fire. One night, their sister-in-law, M, visited with her baby daughter to help us. The fire began to smoke profusely. M kneeled down to look inside the plancha. Thick, black smoke billowed out of the opening, swirling in a dark cloud around her and her daughter, who was strapped comfortably to her back. M rearranged some of the wood then blew on it to ignite the flames. Particulates and ash flew into the air around their faces.
While I spent my days interacting with the family and exploring the community, at night I read research articles relevant to my interests. Through my studies, I learned how certain environmental factors, including wood smoke, harm human health. For instance, in rural Guatemala and Zimbabwe, babies born to mothers cooking with biomass fuels like wood are more likely to be low birth weight (LBW), even after correcting for confounding factors (1, 2). Premature and LBW babies have a higher relative risk of acquiring potentially lethal infections, including acute respiratory infections (ARIs) like pneumonia (3), one of the most significant causes of child morbidity and mortality in Guatemala (4). In India and Zimbabwe, children living in households that use biomass fuels were more likely to have recently suffered an ARI than those from households using cleaner fuels (5, 6).
I could go on. I could recount how every morning I heard the older women cough up phlegm and struggle to climb the stairs to their homes or tell you about the woman I met whose baby daughter died of an ARI. I could mention how exposure to pesticides and consumption of unclean water also hinder child and maternal health. However, my point is that these chronic environmental exposures, though perhaps individually inconsequential and difficult to detect, interact synergistically to harm the impoverished and marginalized who use wood fires, lack access to clean water, and handle potent agricultural chemicals. Bearing witness to this preventable suffering, it is tempting to focus on proving associations between environmental exposures, morbidity, and mortality. However, though important, once such associations are detected, bare epidemiology cannot tell us which interventions might be effective or how culture, daily life, and beliefs affect illness experiences.
For this, the things I learned while living in Santa Catarina Palopó is invaluable. For instance, I understand that the amount of smoke released from a fire depends on which kinds of wood are used to build it, and that planchas and open fires are used not only to cook meals and boil drinking water but also to heat the home. Indeed, I spent many chilly evenings huddled over a smoky fire to keep warm. Such comfort could not be sought from a gas or electric stove or even a highly fuel-efficient plancha.
Replacing open fires and planchas with “improved” cook stoves is effective in some contexts. In others, it is not. Perhaps in our communities, education is the best way to help people. To genuinely relieve suffering and promote wellness, we must abandon our premonitions and seek a local perspective. By living with and talking to those affected, we can come to understand the problems as they face them and the solutions most appropriate for their communities.
(1) Boy, E., Bruce, N. and Delgado, H. (2002). Birth weight and exposure to kitchen wood smoke during pregnancy in rural Guatemala. Environ Health Persp, 110 (1), 109-114.
(2) Mishra, V., Dai, X, Smith, K.R., Mika, L. (2004). Maternal exposure to biomass smoke and reduced birth weight in Zimbabwe. Ann Epidemiol, 14(10), 740-747.
(3) Barrlett, A.V., Paz de Bocaletti, M.E., Bocaletti M.A. (1991). Neonatal and early postnatal morbidity and mortality in a rural Guatemalan community: the importance of infectious diseases and their management. Pediatr Infect Dis J, 10, 752-757.
(4) Grangnolati, M., Marini, A. (2003). Health and Povery in Guatemala (World Bank Policy Research Working Paper 2966). Washington, D.C.: World Bank.
(5) Mishra, V. (2003). Indoor air pollution from biomass combustion and acute respiratory illness in preschool age children in Zimbabwe. Int J Epidemiol, 32, 847-853.
(6) Mishra, V., Smith, K.R., Retherford, R.D. (2005). Effects of cooking smoke and
environmental tobacco smoke on acute respiratory infections in young Indian children. Popul Environ, 26(5), 375-396.