Arts & Sciences
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 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.
Global Health Mentor: William Checkley, MD
Medical Director, Johns Hopkins Medicine International
When I arrived in Puno at the beginning of the summer I didn’t quite know what to expect. The van ride from the airport in Juliaca to Puno was my first of many opportunities to see the dry countryside around the city of Puno and, as I approached the city, the marvelous view of Lake Titicaca. I went to the countryside many more times over the course of my stay in Puno, since much of the research involved comparing rural and urban populations. I felt pretty confident about my Spanish skills after spending a semester in Spain but quickly learned that many people in the rural areas preferred to speak Aymara, a pre-Inca indigenous language.
For about half of my time in Puno I worked on research that was investigating cardiovascular complications among urban and rural residents of Puno. Part of the reason Puno was chosen is that the city sits over 12,000 feet above sea level (higher than any U.S. city), and there is a lack of research about cardiovascular outcomes in people who live at high altitudes. A technician from the United States was also in Puno to perform the echocardiograms so we went to the countryside most days, since he had visited earlier in the year to complete the echocardiograms of a sample of urban residents. This really showed me the challenges of doing research with a rural population and with limited time and resources. Most people did not have cell phones or landlines (some did not even have electricity or running water) so to make appointments for echocardiograms, staff would have to physically go to the countryside (about an hours drive) a day or two before to schedule the appointments and hope that the participants remembered them or attempt to track them down if they did not show.
During the rest of my time in Puno, I worked on gathering data for a particulate matter study. This involved leaving a birdcage rigged with equipment to measure ambient air pollution in peoples’ kitchens for 24 hours. Participants from this study were from both rural and urban areas, since people in rural areas usually used wood burning stoves that emitted more pollution and urban residents generally used gas or electric stoves. This research can show the level of particulate matter people are exposed to on a daily basis in both urban and rural zones.
Overall, this program allowed me to work and live in a place I might never have gone to otherwise and gave me a hands-on experience with the rewards and also the frustrations of international research. It made me excited to continue my studies in public health and to seek out more research opportunities in the future.