Published: 04/09/2019

By Holly MacCormick, originally published on Scope

In 2004, epidemiologist Stephen Luby, MD, his wife and his four children moved to Dhaka so he could investigate emerging infection hotspots for the U.S. Centers for Disease Control and Prevention. Luby was focused on his research on influenza and pneumonia for the CDC, but it was hard to ignore the ever-present threat of lung-choking air.

In his story for the latest issue of Stanford Medicine magazine, Rob Jordan describes how the poor air quality in Dhaka prompted Luby and his team to search for sources of air pollution.

‘When you open the door to go out in the morning, there’s a haze of smoke that hits your face,’ said Alex Yu, MD, a postdoctoral scholar in infectious disease who works in Luby’s Stanford lab. ‘You have a chronic low-grade cough. We call it Dhaka lung. People don’t want to go out, but life has to go on.’

In Dhaka, the air quality index is often at or above 150, a level that’s considered unhealthy for all groups of people, but it spikes between the months of November and February, the article states.

At the suggestion of a Bangladeshi colleague, Luby installed air particulate sensors in Dhaka households as part of a 2011 influenza and pneumonia study. He was skeptical that air pollution had much to do with pneumonia.

“I was looking at it primarily through the lens of the pathogen — what organism was causing problems,” Luby said. “I was not attuned to air quality. I hadn’t really thought about the science.”

The results of that study showed that air pollution had massive impact on respiratory infections in Dhaka. The study also revealed that the biggest determinant of indoor air quality was sources of pollution outdoors. The problem was that most public health efforts to address air quality in Bangladesh focused on indoor air quality alone.

Luby’s search for those sources quickly pointed to the brick kilns that only operate during the dry months between November and February — the same time of year when outdoor pollutant concentrations in Dhaka reach their peak. During these dry winter months, the brick kilns of Bangladesh belch out up to 53 tons of carbon monoxide per season, the article states.

Nearly eight years of research, analysis and on-the-ground negotiations later, Luby is now ready to unveil and implement a plan he hopes will transform the brick kiln industry in Bangladesh and, one day, all of South Asia. The plan includes improving combustion efficiency in kilns to reduce emissions by more than 80 percent, providing loans for cost-saving kiln upgrades, and providing credits to kiln owners for tracking emission reductions.

“It’s different from a medical model that says let’s wait until they get sick and treat them in clinic,” Luby said. “We need to think, like a physician, about how we can treat the environment.”

Photo credit: A brick field smokestack emits black smoke in Gazipur, Bangladesh.© 2014 Probal Rashid, Courtesy of Photoshare