Nepali Times
Life Times
Worse than cigarettes


Imagine burning a thousand cigarettes in a room and inhaling this smoke everyday. This is what happens in many households across Nepal which burn wood and dried cow dung to use as cooking fuel in their kitchens. No wonder many Nepalis especially women who do the cooking are afflicted with chronic lung disease as early as 40. Many die prematurely because of heart failure, which is secondary to chronic lung disease.

Kirk Smith from the University of California in Berkeley who has been working on indoor air pollution for decades, estimates that each year two million people die worldwide from this pollution. This figure is stunning because it rivals the annual deaths caused by either tuberculosis or malaria, two age-old scourges of humans.

But why has there been no substantial improvement in this area when people have been aware of this problem for decades and clean stoves are easily available? Even in Nepal, researchers including senior physician Migrendra Raj Pandey published an extensive monograph called Chronic bronchitis and corpulmonale in Nepal. This was an epidemiological study conducted in the early 1980s in four areas of Nepal's three different geographical regions.

Yet medical records from hospitals around Nepal (and across South Asia) still point to a disproportionate number of women in their forties and fifties who suffer from chronic lung disease due to wood and cow dung smoke.

Just replacing old stoves with newer, cleaner ones or installing efficient chimneys does not seem to solve the problem. Many national and international organisations are already doing this.

In Nepal a problem is considered to be significant only if it has immediate consequences. Smoke in homes takes years to cause permanent physical ailments like chronic lung disease. People do not seem to mind the initial burning or tearing of the eyes. Some feel that smoke keeps rooms warm, while others believe the roof will cave in with termite infestation in the absence of smoke.

In addition, most researchers barring a few, are foreigners based outside Nepal who are far-removed from this problem. We need young, local, medical and engineering professionals and social workers to solve this unique problem and save the lives of thousands of Nepali women.

1. Bhushan Tuladhar
Thank you Dr. Basnet for raising this important issue. It is good to see a doctor raise this issue.

Nepal has made some progress in promoting clean fuels and stoves such as biogas and improved cook stoves. Use of solid fuel for cooking, which is the main cause of smoke in the kitchen, has declined from 83 percent in 2006 to 75 percent in 2011. And even among those that use solid fuels, many are now starting to use improved stoves. However, I agree we still have a long way to go. Although you have said that "Just replacing old stoves with newer, cleaner ones or installing efficient chimneys does not seem to solve the problem," I would argue that using a simple improved cookstove which can be built locally for about Rs. 500, instead of a traditional one, can go a long way in addressing this problem. Extensive research done by ENPHO for AEPC in Nepal has shown that these simple stoves can reduce air pollution (particulate matter less than 2.5 microns and carbon monoxide) by more than 60%. Although most of the kitchens still had pollution levels higher than WHO guideline values, it is a big improvement and together with better ventilation and improved cooking habits, the simple improved stoves can save thousands of lives.
WHO reports that indoor air pollution results in the loss of 7,500 lives each year. This can be significantly reduced through simple measures such as improved stoves, biogas and better ventilated kitchens. Research also shows that a child living in a house with smoky kitchen is 2.3 times more likely to suffer from pneumonia, which is one of the main killers of Nepali children, than a child living in a house with a clean kitchen. I therefore request doctors to prescribe improved stoves to everyone, particularly children who suffer from pneumonia.

2. Bhushan Tuladhar
One more comment, on 18 June 2012, Annapurna Post reported that Bitijor VDC of Sindhuli has declared itself as "indoor smoke free village" after 343 houses installed improved cookstoves. It is good to see villages taking pride in becoming smokeless. Hopefully this will become a nationwide campaign just like the "Open Defecation Free (ODF)" campaigns that has resulted in more than 400 VDCs in Nepal becoming ODF.

(11 JAN 2013 - 17 JAN 2013)