August 2014 Archives
Pillarisetti A, Smith KR. HAPIT: Household Air Pollution Intervention Tool. Global Alliance for Clean Cookstoves Webinar. Washington, DC: August 14, 2014.
Nice, brief origin story of Oral Rehydration Salts and their deployment in Bangladesh. In particular, I enjoyed the parts describing the challenges of translating the science into practice in the field. Many of the lessons are relevant to our work in household energy and health.
- Use competent, well-trained field workers — and figure out clever ways to incentivize good, thorough work.
So how did BRAC tackle this daunting challenge? A three-month field trial in 1979 tested whether mothers recalled BRAC field workers’ instructions on how to prepare O.R.S. This was no easy task considering that poor, illiterate households did not have measuring spoons or cups.
BRAC’s verbal guidelines included the dangerous symptoms of diarrhea, when to administer O.R.S. and how to make it with a three-finger pinch of salt, a handful of sugar and a half liter of water. In another critical step, monitors returned to villages days or weeks after the initial instruction to quiz the mothers. Health workers were paid according to how many questions their subjects answered correctly, thus incentivizing quality instruction and not just the number of lessons. The trial found that verbally trained illiterate and semi-literate rural mothers could make properly formulated O.R.S. that passed laboratory tests.
- Ensure that field workers believe in and, when appropriate, use the items and practices they are promoting.
[Mr. Fazle Abed, BRAC’s founder and chairperson] identified other early hurdles that slowed the adoption of O.R.S. by mothers. After inquiring about slow adoption in some villages, he found that only a fraction of health workers believed in O.R.S. themselves; they didn’t even use it to treat their own diarrhea. To dispel doubts among trainers, BRAC brought them from the field to research labs in Dhaka to scientifically show how O.R.S. worked. Health workers were then advised to convince distrustful villagers by sipping O.R.S. during household training sessions.
- Don’t ignore the men, who have disproportionate sway over household decisions in many parts of the world.
After this breakthrough, adoption of ORS increased but then plateaued. Again, Mr. Abed tried to find the root of the problem. He enlisted anthropology students in Dhaka to interview people about why they weren’t using O.R.S. They found that men were alienated from the discussions between female health workers and mothers and so withheld support for O.R.S. In villages, “we had to take men into confidences so we told them exactly how O.R.S. worked,” Mr. Abed recalled. When men were included in discussions, adoption of O.R.S. increased significantly.
Obviously not a perfect analogy. ORS is curative — a response to ill-health — and requires a change in treatment behavior. Arguably the need for ORS decreases in a world with adequate access to clean water and sanitation — but absent that panacea, removing barriers to affordable, easy treatment is essential. The shift we seek to encourage, towards clean cooking, is meatier — it requires big changes to routine behavior. The lessons above still hold, though. We need field workers who believe in the interventions (and, conversely, interventions worthy of their belief), we need to compensate them well, and we need buy-in from whole communities.
People silently struggle from all kinds of terrible things. They suffer from depression, ambition, substance abuse, and pretension. They suffer from family tragedy, Ivy-League educations, and self-loathing. They suffer from failing marriages, physical pain, and publishing. The good thing about politeness is that you can treat these people exactly the same. And then wait to see what happens. You don’t have to have an opinion. You don’t need to make a judgment. I know that doesn’t sound like liberation, because we live and work in an opinion-based economy. But it is. Not having an opinion means not having an obligation. And not being obligated is one of the sweetest of life’s riches.
There is one other aspect of my politeness that I am reluctant to mention. But I will. I am often consumed with a sense of overwhelming love and empathy. I look at the other person and am overwhelmed with joy. For all of my irony I really do want to know about the process of hanging jewelry from celebrities. What does the jewelry feel like in your hand? What do the celebrities feel like in your hand? Which one is more smooth?
This is not a world where you can simply express love for other people, where you can praise them. Perhaps it should be. But it’s not. I’ve found that people will fear your enthusiasm and warmth, and wait to hear the price. Which is fair. We’ve all been drawn into someone’s love only to find out that we couldn’t afford it. A little distance buys everyone time.
Professor Kirk R. Smith in an editorial in Science:
Along with advanced biomass combustion, biogas, liquefied petroleum gas, natural gas, and other clean fuels, electric cooking needs to be directly incorporated into modernization plans for the world’s poorest people.
For those worried about CO2 emissions from power plants, consider that modest efficiency measures that reduce 3% of electric power consumption in rich countries (which are also largely supplied by coal) would “free” enough electricity to supply half of all biomass households with induction stoves. New supplies of electricity would produce far less than a 1% increase in global CO2 emissions.* It is not the cooking of the poor that threatens the climate.
Switching from solid to clean forms of energy can bring more health benefits than nearly any other modernization, including clean water and sanitation.† It is too early to tell whether induction cooking can be successfully promoted in biomass-using rural areas, but not too early to predict that electric cooking appliances will be attractive to people as electricity becomes more reliable. Although in one sense the most mundane of energy issues, given that billions do not use modern fuels in their households and suffer great impacts on health, welfare, and the local environment as a result, finding solutions for providing electricity has important implications for global health and sustainable development.
NY Times story about Richard Hendrickson:
Twice a day, every day, he has recorded the temperature, precipitation and wind from the same area of Bridgehampton. He has been at it through 14 presidencies, 13 New York governorships and 14 mayoralties in that city 96 miles away. The Weather Service says he has taken more than 150,000 individual readings.
His is the longest continuous streak in the history of the Weather Service, which has 8,700 such volunteers nationwide, including 55 in the New York area. The agency says he is the first to serve for more than eight decades. And to answer the obvious question, yes, he has been known to take the occasional vacation. In his 20s, he went to New Zealand — “as far away as you can get,” he said. His mother filled in at the weather station.
Mr. Hendrickson’s daily diary, kept since Jan. 1, 1931, records weather data and family matters. The Weather Service recognized Mr. Hendrickson last month with an award named for him. He said he did not realize until after a ceremony in Upton that he was getting the Richard G. Hendrickson Award, and he sounded embarrassed that the meteorologists had made such a fuss. He did not mention that notables like Benjamin Franklin and George Washington had kept weather records or that Thomas Jefferson had done so from 1776 to 1816 — less than half as long as he has.
Incredible. He started when he was 17. He’s 101 now. 101.
Hard to imagine today, when we expect these things to occur on their own, without intervention. I like this better. Routine thoughtfulness.