Diana Wangari, Kenya (First published in The Star, Kenya on 25 May 2013): By the time the cock crows, Sarah Wambui is already up and in the kitchen preparing breakfast. Contrary to the usual modern kitchen where tea is boiling on the cooker or for those fortunate enough, the coffee maker is on, she places her pot on top of three stones with firewood underneath which is her designated ‘cooker’. Furthermore, her kitchen is a mud hut built a few meters away from the main house perhaps to shield any guest from the thick smoke emanating from it. It is in this make shift kitchen that I found her busy blowing into the flame using a steel pipe to keep the fire going.
A few months ago, Sarah had been rushed to hospital as she was having labored breathing even at rest. By the time a doctor was seeing her, her face and lips had turned blue. Sarah is just one of the many people who suffer from Chronic Obstructive Pulmonary Disease (COPD) which means her lungs are not able to acquire and supply enough oxygen to her body. It is a group of chronic lung disease which leaves the patient breathless with excessive abnormal sputum and a chronic cough.
Due to the extended nature of the cough, it is often referred to as ‘smoker’s cough’ and rightfully so since the main risk factor is tobacco smoking. Unfortunately, it is not just the tobacco users who are at risk, second hand smoke or passive exposure leaves you at an equal risk, if not more, since the smoke hits you directly without passing through any filter as it does in a cigarette. Perhaps next time, you will care less that people will judge you as a ‘snob’ and tell your colleague not to smoke near you.
The World Health Organisation estimates that 5.4 million people die from tobacco use. Therefore in a country such as Kenya where prevalence of smoking in women is less than 1 per cent whereas in men it is at 22 per cent, tobacco use is definitely not the main risk factor for COPD in women. The cause is much more insidious and hence less thought of; indoor air pollution. Women who use biomass fuels for cooking or women like Sarah who still rely on ancient methods such as firewood.
Singly, indoor air pollution resulting from the burning of wood and other biomass fuels is estimated to kill 2 million women and children each year. Once your airway has been compromised you start struggling with breathing, this at times goes unnoticed as most women will attribute it to exhaustion from their daily chores. The assumption comes as no surprise in a country where women are expected to have a hands on contribution to taking care of the children, maintaining the house and still find time to carter to their husband with no help or miraculous sprouting of an extra set of arms from their back.
The problem is that by the time these women seek medical attention, it is often too late and they end up succumbing to heart failure with peripheral edema. In other cases, the fact that they ‘need air’ yet there is a limitation in their lungs sends them to their graves. According to the Global Alliance Against Respiratory Diseases (GARD), a project by the WHO, 65 million people have moderate to severe COPD and of these more than 3 million died of COPD in 2005, this corresponds to 5 per cent of all deaths globally.
Dr Mecha, a senior lecturer in respiratory diseases based in the school of medicine, University of Nairobi says there is insufficient data in Kenya in regard to COPD due to lack of awareness, “People tend to think that it is only those who smoke that are at risk of getting lung diseases. This is a misguided notion as we diagnose many people with respiratory diseases yet they have never touched a cigarette a single day in their lives.” He went on to add that occupational factors should also be considered in non smoking COPD. Those working with chemicals that produce vapours or fumes which could be irritants are also at risk.
Some of the patients who did not use biomass fuels were reported to have worked at one point in their lives in an industrial plant or farm where they had to use insecticides. “It is unfortunate that most patients with non-smoking COPD are women who ignore their symptoms and only come in the end stages of the illness. Worse still, some of these women leave in remote areas and they often pass on before reaching the hospital. There is definitely a need to spread awareness on COPD to reduce mortality,” he said. For diagnosis purposes, a simple and painless test known as spirometry is used. The test measures the lung’s capacity when the patient blows into a tube.
Imaging techniques such as a chest X-ray can also be employed in a diagnosis, although they might indicate a normal lung picture and hence the clinical symptoms must always be remembered. Unfortunately there is no cure for COPD and hence it can only be managed. Management involves relieving of symptoms where medication such as corticosteroids can be used, improvement of health status and tolerance to exercise, prevention and treatment of complications.
But the most important aspect is prevention since COPD develops slowly and is often diagnosed past the age of 40 when the disability is substantial. There is need for public education to recognise that sputum production, chronic cough and more importantly difficulty in breathing are not trivial symptoms to be ignored.
Tuberculosis and lung cancer are not the only respiratory conditions to fear. It is projected that the total deaths from COPD will increase by more than 30 per cent in the next 10 years unless preventive measures are taken. So the next time you want to ‘save costs’ by not using the electric cooking, consider whether the amount you are saving is worth your life.
Diana Wangari, Kenya
Citizen News Service - CNS
(First published in The Star, Kenya on 25 May 2013)
