Exploring smoke: an ethnographic study of air pollution in rural Malawi

Abstract

Air pollution adversely affects human health, and the climate crisis intensifies the global imperative for action. Low-/middle-income countries (LMIC) suffer particularly high attributable disease burdens. In rural low-resource settings, these are linked to cooking using biomass. Proposed biomedical solutions to air pollution typically involve ‘improved cooking technologies’, often introduced by high-income country research teams. This ethnography, set in a rural Malawian village, aimed to understand air pollution within its social and environmental context. The results provide a multifaceted account through immersive participant observations with concurrent air quality monitoring, interviews and participatory workshops. Data included quantitative measures of individuals’ air pollution exposures paired with activity, qualitative insights into how smoke is experienced in daily life throughout the village, and participants’ reflections on potential cleaner air solutions. Individual air quality monitoring demonstrated that particulate levels frequently exceeded upper limits recommended by the WHO, even in the absence of identified sources of biomass burning. Ethnographic findings revealed the overwhelming impact of economic scarcity on individual air pollution exposures. Scarcity affected air pollution exposures through three pathways: daily hardship, limitation and precarity. We use the theory of structural violence, as described by Paul Farmer, and the concept of slow violence to interrogate the origins of this scarcity and global inequality. We draw on the ethnographic findings to critically consider sustainable approaches to cleaner air, without re-enacting existing systemic inequities.

Shifting Positionalities in a Time of COVID-19: The Transnational Public Health Doctor and Ethnographer

“…I also aimed then to work with participants in the village to co-develop potential “cleaner air” solutions, but this was left open to reimagining after the initial phase. Further details of the project and our epistemological approaches have been published elsewhere, in the main ethnographic paper and supplementary materials ( Saleh et al, 2021 ).…”

“…In research terms this is also played out in the academic imperialism which had asserted control over the relative valuing of knowledges, the extractive nature of knowledge production, and the presentation and dissemination of the academic product in global health research to date ( Hountondji, 1997 ; Abimbola, 2019 ; Abimbola and Pai, 2020 ). Whilst these matters may initially seem conceptually far from the “field,” in terms of the Malawian village where the ethnographic project was based, overarching colonial legacies and enduring economic relations continue to touch individuals’ daily lives here in myriad ways ( Saleh et al, 2021 ). The influences of these complex historical and political factors were evident from the start of the research project, with further developments in response to the advent of the COVID-19 epidemic in Malawi.…”

“…This highlighted the shared learning emerging from the project, as we heard about local smoke-producing practices, and participants’ responses to smoke, whilst bringing new ways of quantifying smoke levels. Local wisdom around fuel use and place of cooking did take into account avoidance of smoke to an extent for instance, although much of our learning was also around the wider restrictions in lived experience which often made longer-term health concerns relating to smoke a secondary consideration ( Saleh et al, 2021 ).…”

“…Village residents often described COVID-19 as “matenda a ku towni” (disease of the town), or even “matenda a anthu okudya za mafuta” (disease of people who eat relish containing oil, ie., rich people). For members of the village community who encountered ample risks and hardships in the course of their daily lives, it seemed that the threat posed by this disease was more of a theoretical one than a fear rooted in lived experience ( Saleh et al, 2021 ). This echoed in some ways residents’ initial responses to the idea of smoke as a potential source of harm, which was introduced in the original project.…”

“We threw away the stones”: a mixed method evaluation of a simple cookstove intervention in Malawi

“…Air pollution -and fine particulate matter (PM 2.5 ) in particular -is a widely recognised risk factor for cardiorespiratory and wider systemic disease, and the interactions between airborne particulates and climate change also have repercussions for health [1][2][3] . In Malawi, which is largely rural, air pollution is a persisting problem, stemming mainly from domestic cooking: Malawian households cook on average three times per day, using biomass fuel (usually firewood) on three stone fires 4 .…”