Pollution and frail lungs

This article is based on my sole observation of clinical examination of patients of one month till 16 years over the period of one month across both government and private hospitals. The underlying reason to draft this article without further waiting for more data is to substantiate the urgency to bring upon the alarming health situation facing Nepal. For the western world, the industrial revolution was a great success in terms of technological development, but let it not be forgotten that the so-called golden era negatively impacted the environment by polluting the water we drink, the air we breathe and the soil where plants grow. These adverse effects have also spilled into Nepal, thus challenging the pronounced concept of an untainted Shangri-La. 

Clearly, urbanization and industrialization are reaching unprecedented and upsetting proportions worldwide and our country is also in this race. 

Rising air pollution resulting from a slew of factors like wildfires and emissions are exacting a heavy toll on the entire population, including children.  

According to UNICEF, air pollution poses one of the most serious threats to children’s health, and more so an alarming percentage of children live in places where air quality is literally toxic to breathe, consequently risking their chances to grow into healthy adults. Being a pediatrician, who genuinely wants to see improvements in children’s health, it saddens me to observe that the children, the future of this nation, are growing by breathing in unhealthy air. The cost of toxic air is bound to be enormous and long-lasting. 

Data from a study conducted by the Ministry of Health and Populations in 2023 show that air pollution leads to 42,100 deaths every year in Nepal—with under-fives accounting for 19 percent of deaths and those above 70 years of age accounting for about 27 percent of deaths. 

Per the findings, air pollution is responsible for reducing the life expectancy of an average Nepali by 4.1 years. Data on the major causes of deaths in Nepal also show that air pollution is a major contributor to the top five causes of death, namely chronic obstructive pulmonary disease or COPD (66 percent), ischemic heart disease (34 percent), stroke (37 percent), lower respiratory infection
(47 percent) and neonatal deaths (22 percent). 

In the last few months, I have witnessed across the government and private hospitals a soaring number of cases related to air pollution such as respiratory conditions like pneumonia, bronchitis and asthma.  Out of 10, I see seven cases related to diseases associated with air pollution. So, the question is why are children vulnerable? Children have developing lungs and brains, which make them especially susceptible to air pollution. It is an obvious fact that children have weaker immune systems than adults, exposing them to viral, bacterial and other infections. 

Due to other metabolic factors and physiological structuring of lungs, young children breathe faster than adults and take in more air relative to their body weight, often through the mouth, which takes in more pollutants. Habitually, children spend more time closer to the ground, where some pollutants reach peak concentrations. Worst of all, their knowledge on wearing protective devices is limited.

All these factors can exacerbate underlying health conditions and go further in impairing children’s physical and cognitive development. Consequently, air pollution leads to a chain of health effects, thereby affecting the children’s ability to attend and meet educational standards and social functions. 

The effect of air pollution is so far-entrenching that it takes a lay person quite some time to even comprehend the situation. I have clinically examined newborns whose parents complain of the latter experiencing exertion while breathing, coughing, or wheezing, slow development and perinatal disorder, leading me to raise questions about the parents’ past or present occupation and surroundings.

My findings show that almost all of the parents in question started working in hazardous environments. A few of the surveyed parents indicated that they had been experiencing miscarriages and early deliveries, apart from under-weight newborns.  

Medical journals and research have indicated that this is a classic case of air pollution. Fine and ultrafine particulate matter can make it through airways and reach the bloodstream, causing serious illnesses. Through breastfeeding, mothers are likely to pass these pollutants into children. Making lay persons understand all this requires an engaging conversation since many perceive that the effect is short-lived and won’t persist for generations to come. 

These findings are based on the observations I made while operating in a confined space of 100 sq ft for four hours daily for a limited period of time. My write up does not justify the appreciative work of other senior and junior pediatricians. According to the Medical Council of Nepal 2020, there are 690 registered pediatricians in Nepal and presumptions can be made on the volume of outpatients suffering from diseases linked to air pollution. If I am overwhelmed with the cases, then let’s put simple math into work and do the calculation and workload of each pediatrician. 

Add to this grim scenario decades-old data that we still rely on to measure the population’s access to healthcare. Back then, the population’s access to medical intervention within a 30-min walk was 61 percent, which has not improved due to the state’s low funding on healthcare. The data are vague on the percentage/number of the children affected. It will be safe to surmise that the children are not taken into account as they cannot coherently express their illnesses, thus they are likely to be at a disadvantage.