26 Oct 2012
I was working in the pharmacy, filling prescriptions and giving patients instructions about how to take their meds. I picked up the next patient chart. Leticia, 51 years old. The only things the physician prescribed for her were adult vitamins an albuterol inhaler.
Curious, I thought. I, like many, think “asthma” when you say “albuterol”. But asthma is not that common in Guatemala. I looked further at the chart. Under diagnosis the physician had circled COPD, chronic obstructive pulmonary disease.
Curiouser and curiouser. I learned that the biggest risk factor for COPD is tobacco smoke. The continuous exposure to noxious inhaled substances leads to a chronic inflammatory response in the airways and lungs, and eventually to destruction of tissue. But it is uncommon for indigenous women to smoke in Guatemala. It is considered unattractive, and it is expensive.
I collected the albuterol inhaler and the vitamins. Standing at the edge of the waiting room, I called Leticia’s name.
A short woman with greying hair stood up. I would have guessed her to be over 60. Slowly, she began hobbling over. When she reached me we sat down so that I could explain her medications.
“Hello, Doña Leticia. I have your albuterol inhaler. Have you used one before?”
“Ah, sí. Muchas veces.” Many times.
To satisfy my curiosity, I asked her if she had ever smoked.
She had not. But she did say, “My breathing used to be very bad until I came here. Now with the medication and with the new stove you built me, everything is much better.”
I told her that I was very glad to hear it.
Taking her medicine, she said that I was very kind and kissed me on the cheek.
Looking back on Leticia’s chart I saw that her illness had indeed been bad. At least once, she came to clinic wheezing.
The wrecked lung tissue of COPD has problems with gas exchange and cannot acquire enough oxygen for the body’s energy needs. It is no surprise that one of the most common symptoms is dyspnea, fancy Medicalese for trouble breathing. And the body’s gasping for breath only gets worse over time.
In developing countries 50% of COPD deaths can be attributed to biomass fuel inhalation. Of these deaths, 75% are women.
In Guatemala two-three of every four families cook over open fires inside their home. Which means that every day until her late 40s, when Pop Wuj built her a stove, Leticia had been in close quarters with the smoke of biomass fuel. When she played at home as a child while her mother cooked, and when she became a mother cooking for her own children.
The WHO projects that COPD will become the third leading cause of death worldwide in 2030. The increase is attributed to both tobacco use and the burning of fuel indoors. From the website: “At one time COPD was more common in men. [However] because of increased tobacco use among women in high-income countries and the higher risk of exposure to indoor air pollution (such as biomass fuel used for cooking and heating) in low-income countries, the disease now affects men and women almost equally.”
Step 1 in the treatment of COPD is to stop smoking. Only smoking cessation and supplemental oxygen, which involves wearing a mask and wheeling around an oxygen tank, have been shown to improve survival. But “stopping smoking” in a country like Guatemala means stopping cooking your food. Not an option. Or it could mean acquiring a new wood-burning stove. If you have help.
Over twenty years Pop Wuj and its volunteers have built over 500 stoves for families in Xela’s surrounding communities. Each costs about USD $100 and 30 volunteer-hours to build. Throughout Guatemala other organizations are doing similar work.
There are health benefits and more to replacing open fires with wood-burning stoves. The stoves’ chimneys deposit the smoke outside the home, decreasing smoke inhalation. Going from a fire on the ground to a stove top above waist height keeps women from constantly bending over, which hopefully reduces lower back pain. More efficient burning saves money spent buying or time spent – by women and children – collecting the firewood.
There’s a song by a singer/songwriter from Xela that’s very popular during acoustic in vivo nights. The voice sings about wanting to escape to the sky from this ground holding him down. It asks his sweetheart to imagine how his trapped body feels now, wanting air. It is called Sin Respirar. Without breathing.