By Dianna Douglas
Cooking indoors over firewood and dung is a tough habit to break for billions of poor people around the world. But Sola Olopade, MD, professor of medicine and family medicine, found a way. He wanted to stop women from hunching for hours over open fires inside their houses, cooking with babies strapped to their backs. The air in such houses quickly becomes filled with toxins, and the women and children have a host of bad health consequences.
“It’s the most unclean combustion you can get,” Olopade said in his seminar earlier this month at the MacLean Center for Clinical Medical Ethics. “The women and children have coughs, headaches, runny noses, chest tightness.”
Those are just the health problems he could measure. “I wonder what kind of cognitive dysfunction people develop in spaces where the carbon monoxide is so high.”
Unfortunately, the billions of poor people who cook their daily meals over firewood and dung have few other options. Without electricity, Olopade said, “energy poverty drives people to use whatever they can get their hands on.” But Olopade was determined to see whether education and a little technology could make it less dangerous for people to breathe inside their houses.
Olopade, who is clinical director of the University of Chicago Global Health Initiative, went to two small villages in his native Nigeria, ready to distribute energy-efficient ceramic stoves. He believed the simple stoves could make an enormous improvement in the community’s health. His team measured the air quality inside 100 homes, and found heavy metals, carbon monoxide, and particulate matter more than twenty times the World Health Organization acceptable standards. The researchers also educated the community about the dangers of exposure to smoke from using firewood to cook indoors and the benefit of using the new stoves, handing out brochures about cooking in their native dialect.
“I told them without medical jargon that this was killing people,” Olopade said.
Three months after giving the stoves to the families in the villages, Olopade returned. He took the same air quality measurements, repeated the survey of symptoms and saw a remarkable improvement. Carbon monoxide and particulate matter levels were dramatically lower, much closer to the WHO standards.
“People were very happy with the stoves. They’re very simple. They’re lined with ceramic which retains a lot of heat and promotes more complete combustion of the firewood or biomass fuel,” Olopade explained.
The women were burning the same fuel – cow dung, agricultural waste, and firewood – but the stoves had kept most of the pollutants from pouring into the homes. With this small change, “you can really improve the indoor environment,” Olopade said.
The health benefits were drastic. Before the intervention, many of the children and most of the mothers suffered from dry cough, runny noses, burning eyes, breathing difficulties, chest tightness, headaches and dizziness. All of these health problems plummeted after they started cooking on the clean stoves.
“Just by engaging the community in partnership, educating them on the dangers of exposure to toxic fumes and giving people efficient stoves, without changing their lives much, the change in symptoms is dramatic,” Olopade concluded.
Women and children also performed better on the pulmonary function test after the intervention. Olopade’s study is evidence that the 2 million deaths every year caused by indoor air pollution are easily preventable.
On a larger scale, the National Institutes of Health has begun tackling this problem with the US Department of State. Last September they began a program to distribute 100 million fuel efficient stoves across the world. The program is called the Global Alliance for Clean Cookstoves.
“Clean stoves could be as transformative as bed nets or vaccines,” Secretary of State Hillary Clinton said in announcing the effort last year.
With the humanitarian award from the Chest Foundation, Dr. Olopade paid $21 for each stove, a model which he confessed isn’t affordable for most of the world’s poor. The good news is that much cheaper stoves – and stoves that people can build themselves – are becoming available.
“The entrepreneurial model where they manufacture these stoves themselves using local materials are more sustainable than going around distributing stoves,” Olopade said.
He noted that such programs exist in other developing countries, like Haiti, India and Kenya. Distributing stoves is a stop-gap measure until such programs are operational, he said.
Entering the homes of poor families in Nigeria and finding ways to fix an enormous health problem there was particularly meaningful for Dr. Olopade.
“Most of these children look like my own children,” he said. “It’s been a great opportunity to be able to go back to Africa to do research. The opportunity to learn from these people and to understand disease better is tremendous.”
Each academic year, the MacLean Center for Clinical Medical Ethics organizes a series of lunchtime seminars by physicians, biologists, economists, social scientists and other experts covering the biggest questions in health care and ethics. This year’s theme is “Health Disparities: Local, National, Global,” and the series was put together with the Urban Health Initiative, the Global Health Initiative, and Finding Answers. ScienceLife will carry regular coverage of this unique series, and video of the lectures will be posted when available.