Stephen Bailey is a freelance journalist and EDF’s London and South feature writer of the year.

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Stephen Bailey is a freelance journalist and EDF’s London and South feature writer of the year.

Indoor pollution is deadly for the poor

On a trip to Nepal, Stephen Bailey discovers a toxic link between poverty, childhood illness and climate change.

The field workers and I head into ‘The City of Devotees’ to research the deadliest childhood illness in the area.

They pass Hindu shrines that are smeared with red dye and covered with bright flags. Traders try to catch passing tourists, and young men speed past on motorbikes.  

Then we head into an alleyway, into tight courtyards and warrens of dark homes, where life is as much rural as urban.

Krishna Laxmi and Prithvi Laxmi share a name but are not related. They are working together on an ongoing study of childhood malnutrition and intestinal diseases in Bhaktapur, Nepal.

Today, they are talking to people about pneumonia, the respiratory disease that accounts for 16 to18 per cent of deaths in the area’s under-fives.

Chamchala at her stove
Chamchala at her stove Stephen Bailey
Chamchala Chyatta, a smiling 24-year-old mother of two, shows them her home.

It’s typical for the area. The house is almost pitch-black in parts, despite the late-morning sun.

Each of the four storeys is just a single bare room with a wooden ladder leading up through the floor to the next level.

Chamchala’s traditional kitchen has a cooking stove in the corner – and it is these devices that play a major role in the area’s respiratory illnesses.

Krishna and Prithvi are under the supervision of Dr Ram K Chandyo at the Kathmandu-based Institute of Medicine (IoM).

His team has a paper due to be published which shows an association between kerosene use in the cooking stoves and pneumonia.

Now the price of kerosene has gone up and people are returning to solid fuel – wood and residual crops – which has an even greater risk.

Dr Ram says that, in his experience, people use the fuel they can afford, whatever the public health message.

‘We can say use gas, it’s a cleaner fuel,’ he explains, ‘but they often can’t afford it, whatever we are saying.’

The IoM has between 40 and 45 academics and field workers based at Bhaktapur’s Siddhi Memorial Hospital, a women and children’s hospital run by a not-for-profit NGO.

The doctors’ most common cases are respiratory disorders and paediatrician Dr Abhay Mandal points out that parental smoking is also a major risk factor for pneumonia.

During the Nepalese winter, night-time temperatures fall well below zero. Central heating is a rare luxury; it’s normally as cold inside as it is outside, so dangerous fuels are also used for heating and lighting.

All these particles add up to a growing health problem.

The UN found strong evidence that indoor pollution causes pneumonia and other acute respiratory infections, killing more than 7,000 children a year.

And a World Bank report found that a fifth of all deaths in developing countries are down to climate change, including air pollution.

typical cooking area
A typical cooking area Stephen Bailey

The poor of the developing world are swapping indoor wood fires in the countryside for the outdoor pollution of big cities, the report said.

The urban poor in places like Bhaktapur face both problems at once.

They get the pollution of the rapidly growing Kathmandu metropolis 16 kilometres away, and the indoor pollution of cooking and heating styles that are more about poverty than tradition.

Nepal has seen major health improvements – the life expectancy has more than doubled since the 1950s – but the infant mortality rate is still 10 times that of Western Europe.

The Nepalese government and the Alternative Energy Promotion Centre recently paid for 475,000 mud and brick stoves with small chimneys to take the smoke outside – but there is still work to do.

Chamchala has heard about these stoves but her choices are determined by harsh economics.

‘I know a bit about the health problems,’ she said. ‘But we have to use whatever we can afford.’

With thanks to the Siddhi Memorial Hospital

Foodbanks being used to plug state gap


Liverpool Cental Foodbank Volunteer Andrew Lewington.

Andrew Lewington stood surrounded by food – great stacks of supermarket-brand cereal and tinned vegetables. Last Christmas he was literally starving. The 29-year-old, who is 173 centimetres tall, weighed less than 51 kilograms.

He had quit his job at the supermarket after an armed robbery there, but that decision meant he could not get Jobseeker’s Allowance straightaway. So he went days without food. Only when he called in to visit family members did he get a meal.

Andrew’s story is not unusual at Liverpool Central Foodbank. When I visited on 5 December 2012, manager Paul Edwards told me: ‘It’s heartbreaking to see people walk in here and [being too weak] to carry the bags [of food] home.’

As we spoke, British Chancellor George Osborne was making a speech in the faraway grandeur of the House of Commons, outlining the plans in his Autumn Statement.

The situation in Liverpool, already the most deprived authority in England, as well as in other communities, is going to get even worse in the New Year. Most working-age state benefits will go up by one per cent, which is less than half the rate of inflation. The Citizens Advice Bureau said the changes will hurt many families already on a ‘financial cliff edge’ after years of cuts.

As Osborne made his speech, the Foodbank’s development manager, James Sloans, watched the first people come in clutching their vouchers. He rattled off some frightening statistics: last year they fed around 150 people a month. Now it is feeding around 400. ‘We will feed 5,000 people next year,’ he warned.

The foodbanks, which are part of a network run by The Trussell Trust, stress that they are not here to replace the state. But some staff feel that they are starting to be used that way anyway, especially by the job centres.

James Sloans said that 43 per cent of the people who come to the Liverpool Central Foodbank have had their benefits delayed. He believes the system is bottlenecked and cannot cope with rising demand.

But it was the online money lenders that really frustrated him. ‘I would make pay-day loans illegal,’ he said. ‘They are causing huge problems and they are taking advantage of people in need.’

The day I visited was quieter than usual and most of the 17 people who came in over the two-hour period were unemployed single men. In the café, people sat down to free coffee and mince pies before they took their food home.

Stuart ate a free bowl of steaming hot scouse, the meat stew that gave Liverpool’s people their nickname. The 47-year-old has an anxiety disorder; he has also had his colon removed because it was full of benign tumours. Now, Stuart has suddenly been passed fit for work – after four years off sick – and has lost his fortnightly £198 ($322) Employment and Support Allowance.

Between mouthfuls of food, and ‘thank-yous’ to the volunteer staff, he said: ‘I only had enough money for the bus fare to get to my aunt’s.’ Stuart’s foodbank voucher meant he will go home with enough crisis food to last three days.

Two young men came in from a hostel. One of them, admitting he had done ‘silly things’ for money, raised his tracksuit trouser leg to reveal an electronic tag. ‘I’ve worked in the past; I’m not a bum,’ he said. ‘I got laid off about eight months ago…I haven’t got any GCSEs.

‘I’m only fit for factory work. Years ago, you could just walk into factory work, but now there’s that many people applying for jobs it’s harder.’ He admitted to feeling ‘degraded’ about coming in – ‘I don’t even like signing on,’ he added.

‘We had a lorry driver the other day, who had worked 30 or 40 years,’ said James Sloans. ‘He was a typical guy, trying to put a brave face on it. It was a massive issue for him to come into a foodbank and ask for help. He was quite embarrassed.’

He remembered one woman, a full-time employee of a housing agency, ‘crying her eyes out’ when she came in with a voucher.

Volunteer Kathleen Quayle added: ‘You can be jogging along; then you lose your job and your whole world is turned upside down.’

The volunteers foresee big problems from April, when Community Care Grants are replaced by a new system administered by local councils. The worry is that councils are in such dire straits – Liverpool budgeted to save £91 million ($148 million) last year – that they will try to spend as little as possible on the new system.

The Liverpool Central Foodbank has stockpiled about 10 tonnes of food, mostly stored at its warehouse in nearby Speke, as it expects the food crisis to worsen. In December, Mayor Joe Anderson pledged £50,000 ($81,000) towards the city’s foodbanks and warned Liverpool has been hit by a ‘triple whammy’ of the recession, public spending cuts, and changes to the benefits system.

Andrew, who was going hungry for days on end last year, is working again, and in his free time he is volunteering at the Foodbank. And the food he boxes up is donated by people from the same deprived community that is being hit hardest by the cuts.

This final safety net is being provided by those most in need.

For information on how to donate to the project, visit the Liverpool Central Foodbank website.

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