Nicholson, Andrew

School of Public Health

MSPH

Peru

Cardiopulmonary effects of biomass fuel exposure among high-altitude

Cardiovascular disease (CVD) is the leading global cause of morbidity and mortality, and exposure to biomass fuel smoke from cooking is the third leading contributor to CVD worldwide. However, population-based studies demonstrating this risk are lacking, and there is a paucity of studies evaluating whether clean fuel cookstove interventions reduce this risk of CVD.  Furthermore, there is limited understanding of how airborne exposures lead to CVD. There are multiple known genetic, metabolic, and environmental causes of atherosclerosis leading to the development of CVD. Endothelial release of nitric oxide (NO) is a defining characteristic of non-diseased vessels, and reduced release of NO is indicative of endothelial dysfunction, one of the earliest steps in the development of atherosclerosis. Vascular stiffness develops in the setting of marked decreased endothelial function and is an intermediate maker of CVD risk. Decreased heart rate variability is considered to be an independent marker of increased CVD risk. We will enroll 150 women who are primary household cooks in Puno, Peru (3825 m above sea level) and perform a field intervention trial of liquefied petroleum gas (LPG) stoves to replace traditional biomass cookstoves to reduce household air pollution. We will evaluate household air pollution, endothelial function, vascular stiffness, and heart rate variability at baseline (prior to randomization) and 3-weeks and 3-month after LPG stove intervention or continued use of traditional stoves in the intervention and control arms, respectively. At the end of the study, all control participants will receive a LPG stove and one-year supply of gas. We hypothesize that reduction in household air pollution will be associated with improved markers of CVD. 

Global Health Mentor/PI: William Checkley, MD

Prior to arriving in Lima, Peru, my thesis proposal outlined the project I would be working on in addition to my goals, objectives, and deliverables for the field placement. At the outset, the overarching goal of the experience was “to advance knowledge in the area of the link between nutrition and asthma risk among adolescents in Peru.” Reflecting now, with my time in Lima behind me, I am pleased to be leaving 1. with greater knowledge in this area, 2. more analytically savvy, and 3. with a better grasp on what public health research entails. This experience challenged me both academically and personally and I will take the lessons and skills I have gained with me as I move on to the next step in my life. 

My interest in this field placement experience in Peru was multifold. Primarily, I chose this practicum experience because I wanted to contribute to a project that covered both nutrition and noncommunicable diseases. Although asthma may not have been the outcome of my choice, it was rewarding and enlightening to learn about a condition which I previously knew little about. Moreover, this practicum offered a unique opportunity to work on an increasingly popular topic, the gut microbiome. In addition, it presented an opportunity to gain experience in all aspects of the research continuum.

Working in a setting like Peru, I learned a great deal about systems-based challenges associated with working in a developing country and how to consider and account for cultural norms in all aspects of the research project. Although I was fairly well-versed in Spanish prior to coming to Peru, it helped to learn from those on the research team how to be culturally appropriate in what I did and wrote for the study. Similar to a rate-limiting step in chemistry, there are often hurdles (bureaucratic and otherwise) to overcome before even starting a research project. I was lucky in that the IRB for my research project was approved before I arrived in Peru. One of the biggest takeaways was learning firsthand the ebbs and flows of global health research and how to best work through unexpected and expected challenges of research. I also learned the value of developing good, free-flowing communication with those on the ground and forming a hard-working team for the study; especially when you will not be in-country for the entirety of the study and rely on others to collect data, it is imperative to have consistent communication and a good team on-site to rely on.

Prior to this experience, I had grown accustomed to just seeing numbers, prevalence rates, percentages, etc. on paper with no more than a feint impression of the actuality that exists behind these numbers. When I explained to local Peruvians that I was working on a project about asthma, they would, without fail, recount the story of someone they know personally who is suffering from asthma. For me, these encounters, coupled with my day-to-day activities, speaks volumes in comparison to the facts and figures on the page. Encounters like these helped bring a sense of purpose to the work.

Looking back, this time in Peru was a formative and tremendously rewarding learning experience for me. Not only was it my first time working in a developing country, but it was the first time being given a considerable amount of responsibility on a research project. I look forward to leveraging the skills and knowledge I gained from this experience in all aspects of my life: academic, professional, personal, etc. In terms of future career goals, I learned that research in the medium-term is what I would like to do, but not in the long-term; instead, I would like to pursue medicine and bridge my passion for population-level health with delivering healthcare as a doctor.

People

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

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...

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...

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases
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February 2020

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