Three decades ago, Dr Mirgendra Raj Pandey and his team showed that indoor pollution from open hearths was a major cause of ill health in Nepal. This prompted the construction of better chimneys and smokeless 'chulos' to help people breathe better. But the problem persists, as women continue to cook on open hearths; nearly 2 million people in the developing world have died prematurely due to indoor pollution.

Recently, Hillary Clinton took up this cause by helping introduce more efficient, inexpensive and user-friendly stoves in village homes in the developing world. A program is to be headed by the United Nations Foundation, which is a charity. Despite the existence of such programs, one of the most common problems seen in hospitals in Nepal today, especially in the winter time, is chronic obstructive pulmonary disease (COPD).

An important finding from Dr Pandey's early works in Jumla, rural Kathmandu and the Tarai was that women suffered much more from COPD, leading to early heart failure and death, regardless of the fact that they smoked much fewer cigarettes, bidis, and tamakhu than men. There was an obvious correlation between the high prevalence of COPD and the hours spent cooking with firewood and cow dung patties in soot-filled kitchens.

Besides COPD, a host of other problems are caused by smoky homes and open fireplaces: eye problems, heart problems, lung cancer, pneumonia, and burn injuries, especially to children who play around open hearths. Burn injuries are particularly troublesome, given that even if a child survives being burnt by a fire, the initial injury may lead to burn contractures of the surrounding skin. This requires 'release' operations, which may not be feasible in a village in Nepal.

Despite these dangers, villagers are reluctant to change their cooking habits, as for them, smoke provides warmth during winter and prevents termites from eating away their roofs. It is apparent that villagers are not informed of the dangers of the open hearth, or do not understand its effects yet. This lack of education lies at the root of the prevalence of COPD. Disseminating information and ensuring its understanding will be as important as installing a new stove or chimney. Without it, programs such as the one initiated by Clinton are bound to fail, regardless of their good intentions.