Eat, Sleep, and Breathe Guatemala

By Edna Bissoon

I spent the Summer of 2019 in Jalapa, Guatemala a small rural city about 2 hours from the capital. As soon as I arrived I felt at ease because Jalapa has a bustling city center surrounded by untouched forestry, beautiful rolling hills and horses dotting the pastures. However, it took me a few days to realize that the best part of this agricultural region is the people. Everyone I met was extremely warm and helpful, making me immediately feel at home. My research team was no exception.

I worked on the Household Air Pollution Intervention Network trial (HAPIN) which is funded by the NIH and the Bill and Melinda Gates Foundation. This is a multinational randomized controlled trial to study the effects of indoor wooding cooking on the health of pregnant women and their babies once born. Globally, nearly 3 billion people rely on solid fuels for cooking and heating. In 2016, Household air pollution accounted for 3.8 million deaths according to the WHO.  Women and children are the populations largely affected. There is already evidence to show that there are associated health risks with indoor wood cooking such as pneumonia, cancer, hypertension, atherosclerosis, respiratory impairment, more preterm births, low birth weight and stunting of children.

In this trial recruiting 800 pregnant women, the control arm continues to use their indoor wood stoves, while the intervention arm uses liquefied petroleum gas stoves donated to the households. Women must be 18-34 years old and be between 9 and 20 weeks of gestation. Each mother and child are followed until the child is 1 year old. The team conducts repeated personal exposure assessments of household air pollution such as collecting blood and urinary samples for biomarker analysis.

The primary outcomes are low birth weight, severe pneumonia incidence, child stunting and blood pressure, along with investigating many secondary outcomes. Ultimately, the goal of the HAPIN trial is to provide robust evidence to inform policies on the health gains that can be obtained by scaling up LPG stoves among vulnerable populations.

I was lucky enough to work on many aspects of the HAPIN trial as well as its substudies. Alongside the research team, I was involved with recruitment, follow up visits, biospecimen collection and educational components. We worked largely in rural community clinics and the homes of the participants. It was incredible to see all that can be done in these clinics with such little resources. Also, visiting participants’ homes truly emphasized that understanding a person’s health status requires one to understand a person’s lifestyle and social context. Likewise, it was natural to build a strong rapport with participants after trekking to their homes and meeting their families, with some visits lasting as long as an hour or two. While getting to some of these rural villages was at times challenging, every day was an adventure!

Additionally, I worked in the Hospital Nacional de Jalapa, which is the main hospital in the city. There I joined another group of HAPIN researchers conducting a longitudinal pneumonia surveillance study, where we followed all HAPIN babies that contracted pneumonia. We measured pulse oximetry, respiratory rate and anthropometry. Also, when the HAPIN women came in to give birth, we would follow up with them and track their health status or complications. Finally, I was also able to work on a substudy where we conducted surveys, focus groups and dynamic working groups to understand participants’ perceptions of plastic trash burning and implications on health.

Agricultural fields near participants’ homes in the mountains of Jalapa.
Walking through pastures to get to a participant’s home.
One of the many community health clinics where we recruit and enroll participants.
LPG stoves being installed for the intervention group.
Collecting data from participants.
The emergency room at the Hospital Nacional de Jalapa.
The research team of the pneumonia surveillance clinic at the Hospital Nacional de Jalapa.
The Labor and Delivery room at the Hospital Nacional de Jalapa.
Thank you to my knowledgeable and hardworking research team for the kindness and for exposing me to so much!

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