Towards a better understanding of the social contexts for participating in improved cookstove field intervention trials
Daily exposure to biomass fuel smoke is a risk factor unique to low- and middle-income countries. Approximately 50% of all households and 90% of rural households worldwide use solid fuels as the main domestic source of energy. Rural households in resource-poor settings use biomass fuels almost exclusively for cooking. Individuals living in rural villages are particularly vulnerable to exposures of hazardous levels of indoor air pollution from incomplete combustion of biomass fuels. However, the health benefits of the introduction of improved cookstoves programs remains poorly documented and characterized. Moreover, it is unclear how willing an individual is willing to wait to receive an improved cookstove if they are asked to participate in a randomized field trial. The proposed research placement takes advantage of the infrastructure and ongoing data collection efforts at our field sites in Puno, Peru. We seek to characterize attitudes, preferences and beliefs that influence the use and adoption of improved cookstoves in resource-poor settings. Specifically, we plan to better understand factors affecting the willingness of individuals to participate in randomized field trials of improved cookstoves.
William Checkley, MD
My time spent in Puno, Peru, a total of 6 months, was an incredible one! The experience itself pushed me in ways that I did not expect. Having never travelled outside the United States prior to this trip, I knew that spending 6 months in a foreign land, speaking a different language, surrounded by a different culture was going to be quite the challenge. As daunting as this huge step seemed, it was something that I had wanted to do for years. Having not had the opportunity to study or travel abroad growing up or in college, I saw this 6 month practicum requirement as part of the Health Behavior and Society department MSPH program as possibly my last chance to immerse myself in a new culture and grow as an individual.
Upon arrival to Puno, I was extremely nervous. These nerves came from my fear of not being able to communicate. Although prior to this experience I had taken Spanish classes for years, I never really felt prepared to put myself in a situation where English was not a fallback option. I felt as though my head was going to explode by the end of the first day, partly from my frantic searches through my brain for the right word or the right conjugation, and also partly from the effect of the altitude on my body. However, by the end of my time in Puno, I was able to hold conversations in Spanish with much more ease.
Puno is definitely a special place in Peru. At such a high altitude (a whopping 12,556 feet), the first few days can be really hard. However, born and raised a southern California girl, it was the cold of Puno that got me the most as many days the temperature dropped below 20°!
The conditions that those individuals who live in the rural parts of Puno (known as the “campo”) live in surprised me a lot. Specifically with regards to my project on cookstoves, I was amazed by how much smoke the women (and sometimes children) would have to endure on a daily basis in order to cook meals for their family. There were many times when I was unable to sit in the cookstove hut with the participant because of my inability to see or breathe due to the overbearing smoke in the air, yet these women endure this exposure every day! This experience alone really drove home the idea that cookstoves play a big role in the daily lives of families in the campo, specifically women, and if we as researchers can find a way to improve this one component of a rural family’s everyday life, it is truly worth the effort.
As tough as some days could be, the people in the campo that I had the pleasure of meeting made it all worth it. There were 3 types of people I met in the campo: some who were a bit shy and nervous around me, some who treated me in no special way, and some who were overjoyed by my presence. Those individuals who were overjoyed to meet me were those that gave me the fondest memories to reflect on. These individuals would do little things that always brought a smile to my face such as invite me into their cooking hut for tea, homemade bread, and good conversation, or ask for a picture with me, or even just play with my hair. These moments are my favorite because these are the moments where I was learning just as much about their culture as they were learning about mine.
My time in Peru truly opened my eyes to what else is out there in the world and has made me so very thankful to have what I have, live where I live, and be who I am. The people in the campo of Puno, Peru live in what I would call harsh conditions, but they are happy people who love and embrace their very colorful culture and thrive with each other to the best of their abilities. I am extremely proud of the project that I completed during my time in Puno, but I am most of all extremely happy and fortunate to have been given the opportunity to experience all that I did. This project made me realize how valuable social-behavioral research is to the field of global health because I was able to see firsthand the positive value which merely interacting with a population offers.
Older woman living in the campo of Puno, Peru adding fuel (cow dung) to her traditional cookstove as she begins to cook breakfast for her family in the very early morning. To her right you can see a very large pile of cow dung that has been brought inside and piled up in order to keep it dry during the approaching storm:
This is me with a rural woman who participated in the observation portion of this study. While taking a break between cooking breakfast and lunch, this woman took the opportunity to teach me how to spin Alpaca fur into nice elegant strands. As seen in this photo, she found my abilities (or lack thereof) to be quite amusing:
Pictured here is an improved stove made by PRISMA (a local NGO). Those who adopt this stove have the benefit of still being able to use the same type of no-cost fuel as with a traditional stove, such as the cow dung in the sack to the left of the stove, while also greatly reducing their exposure to smoke and particulate matter:
In this photo, I am wearing a handmade, traditional hat of a local rural community known as Thunco, which is intended to be worn by single women in search of husband:
Pictured here is one of our staff members, Candy, conducting an in-depth interview with a rural woman about her use, opinions and perceptions of various types of cookstoves: