Grajeda, Laura

Public Health



Peru- Cardiopulmonary complications among high-altitude urban dwellers in Peru

Altitude-related illnesses is an important field of investigation relevant to the 140 million people worldwide who live at high altitudes. The most commonly fatal altitude-related illnesses are chronic mountain sickness (CMS) and high-altitude pulmonary hypertension (PH). It had been estimated that 5–15% of high-altitude residents may develop CMS; however, the prevalence of altitude-related cardiopulmonary illnesses is not well characterized neither the influence of other risk factors such as exposure to biomass fuels. In rural populations of the Peruvian Andes, the use of biomass fuels for cooking is highly prevalent if not exclusive. Biomass fuel exposure has been shown to increase the risk of pulmonary and cardiovascular diseases, but its effect on the risk of altitude-related illnesses has not been previously investigated. Since 90% of rural households worldwide use biomass fuels as the main source of domestic energy, the population attributable risk may be of public health significance. We seek to characterize the prevalence of high-altitude related cardiopulmonary illnesses in individuals exposed to daily biomass fuel smoke through the development of a cross-sectional study of 400 high-altitude dwellers in Puno, Peru (3825 meters above sea level): 200 subjects who live in rural households exclusively using biomass fuels and 200 subjects living in urban households exclusively using propane or electricity.

Public Health is about people and it exists for the people. Everything that we do should be oriented to improve peoples’ quality of life through keeping and strengthening their health. Public Health is about listening peoples’ needs, feelings and ideas and sharing with them our ideas and passion to collaborate and find solutions to public health issues together. My research experience was about the introduction of two types of improved cookstoves in communities from Peru. Our goal was to compare between their traditional cookstove, a locally made cookstove and a commercially available cooktove. The comparison was based on three aspects: their ability to reduce indoor air pollution within the kitchen, the effect in the respiratory system measured as lung function and if the cookstove meets and adapts to the preferences and culture of the communities. The third aspect of the cookstove evaluation was the one which shaped me the most and triggered on me a new way to see public health. My background is in biochemistry and microbiology focused primarily in lab work. Therefore, quantitative assessments like evaluation of indoor pollution or lung function are activities I enjoy and I consider very important aspects on research. However, I learned how quantitative assessments should and need to be complimented by qualitative research. It is possible to have an almost perfect cookstove capable of reducing indoor air pollution and improving lung function over time but if this cookstove doesn’t comply with family needs and cultural preferences a high probability exist that people won’t used it. For example, Puno is a city in Peru at approximately 3800 meters over sea level; it is usually very cold and has an atmosphere with low oxygen concentration. People in the communities usually have big families, cook twice a day, have a diet based on potatoes and quinoa and cook mostly with the dung obtained from their cattle. People in these communities needs a cookstove big enough to have sufficient burners to cook for the entire family, efficiently enough to cook food rapidly in low oxygen environment, with a combustion chamber that allows the accommodation of dung and with a system that also provides heat to the house. Not every cookstove design applies to every community, no even on communities from the same country. Cultural aspects and family preferences should be considered before implementing any public health intervention. Information on qualitative aspects are mostly obtained by direct observations or in depth interviews. These types of approaches allows a more intimate connection with the community, to comprehend their attitudes to share their feelings and to understand better how the public health problematic interacts with culture and what might be a better public health solution. Therefore, what shaped me the most was the experience of spending time with the community and interacting with them. I learned that public health is not only bringing theoretical sound solutions but listening and building solutions together


Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

July 2019



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