Saturday, March 9, 2019

A blurred view of a bright future

March, 2018;

I couldn't sleep.  My mind was racing, even in the semi-conscious state of near-sleep in the early hours of the morning. Excitement, nervousness, anticipation, hope,  so I turned on the lamp and reached for my notepad

Late last evening, I delivered my friends Karen and Yoram to their hotel, crashed in a rented room at 0130, finally turned out the lights at 0215 and my eyes sprang open at 0530.

Today could be the beginning of something wonderful. It has already been wonderful; a parallel world that I dropped into in June 2009, going on 9 years now. This trans-formative experience was brought to me by the late Barbara Latenser, a remarkable burn surgeon whose friendship I was blessed to acquire through the American Burn Association and its international outreach efforts. If my dream comes true, Yoram and Karen will return to Lusaka, Zambia having signed a MOU for the distribution of institutional high efficiency wood-fired cookstoves and medical autoclaves though the Churches Health Association of Zambia (CHAZ).

It will be a lifeline for InStove, the little aspirational NGO with which I have been associated since the beginning of 2013. It will be an opportunity for CHAZ to acquire a revenue producing activity that contributes to stability in funding unrelated to dependence on international aid. It will be an opportunity for countless health care institutions including hospitals and rural health clinics to reliably run their surgical and obstetrical services in places where an unreliable electrical grid and the  need to purchase diesel fuel to run a generator to produce electricity threaten the ability to sterilize surgical tools. It will represent a major step forward in my personal dream of seeing mission hospitals in Zambia to become champions for the use of improved cookstoves in the communities they serve. It could lead to improved personal and public health, improved local and regional environmental akafaaf

I awoke thinking of Harriet. I met her in August 2011. She is now 10 years old. She had been in horrible pain for a month when I met her. In her small village, a day's walk/bus trip from St. Francis Hospital in Katete, Eastern Province, Zambia;  her curiosity and desire to help her mother with the task of preparing the family's nshima (a form of corn grits) caused her to suffer scald burns to both of her hands. In the hospital one month later, the back of her hands was a sea of bloody granulation tissue. Finger bones were exposed, as well as open joints of fingers on both hands.  The right thing to do was to shorten many fingers and use living tissue and skin from the palmar side of her fingers to cover and preserve one functional joint on each finger.  Harriot's mother, barely 19 years of age herself, borrowed a cell phone and called her village to talk with the child's father. He refused to provide consent for shortening fingers, so we operated to place skin grafts and make her large wounds into very small wound, knowing full well that she would develop severely deformed fingers and be highly disabled for life.

Harriet's injury was preventable, as are most burns of that nature, by adoption of a method of cooking safer than a pot perched precariously over a bonfire. For every disabling burn, 100 or more  Zambian women are relentlessly damaging their health and that of their young children by chronically breathing the smoke from cooking fires.

One does not need to discover new scientific truths, develop magical new electronic devices, move from the reality of poverty to the fantasy-land of virtual reality. Simple tools built from common materials and plenty of footwork on the ground in rural parts of Africa will suffice to change the face of the future for millions of families across a continent.

We live in the present, informed by the past, but without an ability to clearly see into the future. So we endow that unfocused view with our hopes and dreams. Big dreams start with small steps. We have taken small steps, and are now about to take the first of some bigger steps. They are steps of hope, steps of faith, but grounded in the conviction that the work already done has proven the case, the relationships we have to work with are solid, with partners of integrity, already vetted through their demonstrated commitment to the welfare of their country and a long history of toil to that end.

Later this morning we met with our Zambian guests and transported them to InStoves workshop, where we showed them all the steps in producing an institutional cookstove. Our two founders, our talented young graduate school engineer, soon to finish his masters degree after studying the factors that contribute to the user experience in adapting to a new method of cooking using a high efficiency wood fired cookstoves.  Yoram and Karen picked up parts and examined them, compared parts to complete stoves, asked questions and concluded that our methods are quite compatible with their understanding of Zambian industrial capacity. Karen was particularly impressed with the humble nature of our operations, reflecting that a prime organizational value of CHAZ is a humble heart.

We convened at InStove headquarters over hot tea and began exploring one another's motivation for seeking a conversation about partnership. We discovered an amazing alignment of mission and vision for making a measurable improvement in the lives of others, a growing confidence that our shared vision could be well supported by the products we produce that have already been placed with end-users. We explored the models of collaboration with which each organization has experience and learned that neither organization is skilled or experienced in testing and developing a market based model of technology transfer. We finished our morning session with a sense of alignment of mission and vision, but many questions about how one takes vision and converts it to policy, partnership and business practice.

We moved on to a simple soup and bread lunch, where a lively conversation over Zambian civil society, tribal life, geopolitical influence and view of progress and cultural change occurred. The conversation and laughter flowed. We then returned to Colgan's island and the warm conference room to complete the days deliberation. Yoram wrapped up the day with a summation of the opportunity, the needs of each partner and expressed a conviction about making a mutually persistent effort at finding  our way.  Specific methods and waypoints along the path to a full industrial scale partnership.
What a day of hope and inspiration! I pray that God's hand will be on us all as we seek ways to forward this work in spite of obstacles of time, money and forces of chaos arrayed against us in this world.



Can I tell you a little story?

March 2019

So, ok, since you didn't say no...

In 2009 I found myself in the hinterlands of Zambia at a large mission hospital. Barbara Latenser, MD (may she rest in peace) asked me to sub for another surgeon on an eduational exchange mission under the flag of the American Burn Association International Outreach Committee. I hope to meet her again some day in another dimension; she is one of my life's heros.

Electricity at St. Francis Hospital was somewhat unreliable; if the lights went out during surgery, someone switched on a flash light. The hospital has a great big generator out in back, big GM 6-71 diesel unit on rails, sucked down 20 liters/hour; at about $10/liter, so it wasn't used all that often.

The kitchen is a primitive place;  A great big darkened room from soot, down to your knees;  huge pots perched over primitive clay stoves; just a big mud/ceramic combustion chambers with an open top and front, primitive flu out the back. Wood goes in as cord-wood, all day long. It takes some hours to heat the stove itself, so it makes sense to just keep feeding it, rather than start from scratch with a cold stove each meal. 360 patients, 200 nursing students, various and asundry other staff boarding over on the compound during their rotating assignments, all need to eat.  One eats nshima (grits) as a staple, with one or another "relish" to garnish it, whether greens, fish, meat, tomato sauce.

Wood, truckloads of it, arrive to keep the fires burning. Tons of wood is delivered every other week or so. Medical sterilizing utilizes electric autoclaves, so one runs the autoclaves when the power was on, or used the generator if it fails.

At that facility I observed the sources of burn injury. Guys do what guys do the world over; lit things on fire. They get burned when the wind shifts as they burn off the chaff from their corn-fields to exterminate the rodents and snakes, when the petrol they use as an accelerant explodes, when they are drunk, working on their motorbikes/cars/trucks and not paying attention; you know, guy stuff.

Women and children, on the other hand,  are injured almost exclusively around the cooking fire. Half the world cooks in open pots over open fires, pots perched precariously on 3 stones on the ground,  big roaring fires, huge cauldons of simmering water with root vegetables, corn meal, whatever. Women of all ages cook in their long, flowing skirts (Chitengas in Zambia, Saris in India), generally the same dress with a different name, down to the ankle. infants are strapped to the hip, toddlers run un-checked through the cooking zone. So, clothes catch on fire, embers brand the skin, little curious hands tip over pots, wild young playmates trip and land in fires. These burns can be small, large, in between. They are almost always disfiguring, disabling or deadly due to lack of access to basic and expert care. I came home with observations; unreconciled, but I began to think and read about burns in poor countries, open fires, cooking, public health data and energy poverty.

In 2011, I returned to the same place, this time with a more mature view on which to build new observations. I had discovered an Oregon invention, the Rocket Stove. I bought a personal/family stove, checked it with my luggage. it arrived damaged, but still useable as a demo unit. Over 3 weeks of service, I observed more, thought more, read what I could with my rickety internet connection.

In late 2012, I made contact with Aprovecho Research Institute and Institutional Stove Solutions, co-located in Cottage Grove. January 2013, I attended Stove Camp. My life changed in a moment. I met amazing people, doing amazing things. Some became very important in my life. Fred, Lise, Tom, Jim, Nick and others. I also met Kirk, with Seeds of Hope International Partnerships, a NGO with US and Zambian divisions. 6 months later, I was on the ISS board of directors.  I visited SoHIP in September 2013, while on a trip looking for a better location to establish a burn center of excellence.

Kirk had established a demonstration site for clean cookstoves at the SoHIP compound. I used my week in Ndola to cold-call multiple mission hospitals over the internet. God had His hand on this venture. The strongest lead came from Chitokolaki Mission Hospital in far NW Zambia. Gordon Hanna, the administrator, a Canadian missionary, responded. We shipped 4 stoves, 2 sterilizers through SoHIP, arriving in mid 2014.

We waited impatiently until January 2016 for feedback. It was stunning. The stoves, sterilizers performed fully to expectations, changed their energy usage dramatically while improving the users experience in cooking, sterilizing medical equipment.  I committed to donating 10 stoves to the mission health organization, CHAZ on that basis. ISS found donors for sterilizers, we ended up shipping 16 stove/sterilizer combinations.  They finally arrived in July 2017 and were distributed throughout Zambia over the following 6 months. I committed to $10,000 in stoves to CHAZ for 2018. ISS found donors for several autoclaves and the shipment went out in September.

It has taken forever, but it is about to arrive in Lusaka as I write. The challenge for CHAZ is to use this inventory to test a market model for distribution, using an existing microcredit program available to their 180-some-odd member organizations, mostly rural hospitals, health centers and clinics.

In the meantime, Institutional Stove Solutions has undergone a death/resurrection experience. The founder retired, the 501c3 closed and I purchased the factory contents to retire accounts payable. Nick Moses, the young engineer, opened Institutional Energy Solutions, and has inked a deal to build institutional stoves for Burn Manufacturing in Kenya. The next generation of ISS is alive and well.

I have a burden, placed on my heart, for the mission sector in Zambia. There is a similar sector in every country in Africa, many other parts of the world where the poorest countries on earth struggle to escape the bonds of poverty.  Mission hospitals are ambassadors for everything good in rural parts of poor countries;  education, literacy, wage-earning jobs in skilled occupations. The world uses biomass in large quantities to cook and heat dwellings. Problem is, they use it in highly inefficient ways that lead to deforestation, desertification, personal illness and injury, energy poverty.  I see a pathway for introduction of high efficiency, affordable technology through the leadership of mission hospitals. Not only can the facilities and their workers directly benefit from clean, more efficient means to cook and sterilize, but they can become ambassadors in the communities they serve.  This is my burden, my dream. It started with a career in burn surgery. It has morphed into a public health, environmental stewardship dream, and a fulfillment of a lifelong question about how someone like me, with no talent for preaching, could fulfill a missionary's dream.

God laid this vision out for me starting at age 49.  He saw fit to allow my busy self-absorbed career as a burn surgeon slowly crumble before my eyes. He opened doors that I literally fell into, blind and backwards. He pried my eyes open and propped them open until I finally began to recognize what it was I was seeing.

I am approaching 59, and I see this as a part of my work to the end of the days He has in store for me. At the rate I can afford to do so, I will continue to sponsor stoves to Zambia, to mission health organizations, to feeding programs, to international disaster relief organizations, any pathway I can find to deliver appropriate technology to the most impoverished places on earth. I will continue connecting dots between technology, health care, people and places who can use one another.

It is a huge blessing to have a dream that is much bigger than what I can accomplish, what I can acquire and possess. One eventually learns that contentment in life revolves around what one can give, rather than what one can get and possess. Whether I impact a few or many others, the work will be a blessing to others and a blessing to me as well. What a gift!...do you have a dream that will carry you to the last day of your life?

Yes? then you are truly blessed.  No? Walk with me a while, share this dream and see where the road takes you. Maybe you'll come to a fork in the road that takes you down a different path. Maybe we'll walk along together for a long time. I have known amazing fulfillment along this path and have been blessed to share it with others. There's more than enough to go around. You can drink from a deep well of satisfaction, knowing very deeply that real people are experiencing real transformation in their lives, health and work directly as a result of the work you do; we do; together.  It starts with a conversation;  Talk to me. Dream with me.  nkemalyan@me.com    503-929-5219 cell/text

peace;

Nathan A. Kemalyan, MD

Thursday, December 21, 2017

flickering back to life

Long pause....
in posting, not in working in the improved cookstove space. I'll be setting down many more thoughts in the near term future.
Life happened, and as it happened, I steadily moved closer to this issue. Here's a piece of that story

Just over 4 years ago, I was riding in the co-pilot seat of a small commercial plane, heading to Chipata in the eastern province of Zambia. We ascended to perhaps 4000 meters out of Lusaka and then descended gently down over perhaps 30 minutes to our destination. Definition of features on the ground became clearer as we descended. Across at least 150 km and 30-45  minutes, I could increasingly make out details of the landscape;  A dry semi-wooded, hilly landscape, an occasional dirt road, more frequent dirt tracks, little villages, large villages, watercourses, etc.  Higher up, I was puzzled by random "target lesions " on the landscape. Concentric rings with a central large white spot, each well larger than a thatched roof of a hut, smaller than a large building.

As we descended,  I had an "Aha" moment when I realized these plaques were broadly associated with either villages or dirt tracks.  I was seeing aerial evidence of the charcoal industry. It made a huge impression on me; kilometer after kilometer, as far to one side and the other as the eye could see, these circular zones were clearings in the scrub forest with a big ash-pile in the center.  I quickly connected this with the many prior observations of piles of burlap bags packed to overflowing with charcoal along the roads, the old diesel exhaust belching trucks hopelessly overloaded with these bags, the men on bicyles perilously balancing 3 or more of these bags on a bicycle, pedaling laboriously towards Lusaka.

The concepts of deforestation, desertification, massive amounts of wood burning on a global scale began real in the image of those "lesions" on the landscape. It is said that 70% of the combustible energy in wood used to produce charcoal goes "up the smoke-stack" so to speak, only there is no smoke stack, just a hole in the top of the great big pile of wood heaped up, covered with dirt and carefully lit on fire. The objective is pyrolysis, driving wood-gas off of the fuel until only pure carbon remains. Controlling this transformation in the traditional fashion is very imprecise, as indicated by the huge ash piles littering the rural landscape.

Now; I am not opposed to using biomass as a fuel source. After all, we're dredging up carbon stores that have been buried for eons and stacking them on top of the more available carbon cycling through the biosphere on a continual basis.  A very long term, stable form of carbon storage which simultaneously enriches our soils is biochar, far more durable than mulch and capable of absorbing water, providing excellent habitat for microbes of every sort that convert biomass into compost, recycling minerals and carbon back into the soil.

Even ash recycles some nutrients, largely minerals, back into the earth, but bio-char is even better as a soil builder. It is a far more durable amendment than mulch or compost. If we had an intentional and productive means to harvest the first 70 percent of the heat value of wood and use the last 30% as a soil amendment or many other secondary uses we would transform our global carbon footprint on a similar scale as would the elimination of the use of hydrocarbons to power our cars, trucks, ships and planes. Biochar can be used as fuel; after all, it is simply a form of charcoal, but far better to make it a byproduct of the primary extraction of energy from wood for gainful purposes, than the primary product for heating and cooking in the slums of large cities.

Were we to convert maximally to the pyrolysis of biomass as a source of energy, we'd divert 1/3 of the actively circulating CO2 in the atmosphere that is converted to biomass by plants and trees and sequester it in soil, while harvesting 2/3 as energy, leaving all that historically sequestered carbon in the form of oil and natural gas where it lies. The amount of petrochemical derived fertilizer required to produce our food can be reduced as soil fertility is improved. 

Rather than the gas pump, the propane filling station, the electric charging station,  one could pull up to the pellet elevator, pick up a load of  pellets,  gasify the first 70% for motive power and return the 30% as biochar to be used as a soil amendment. I wonder how far your Prius, your Honda Fit, your energy sipping compact,  your fuel-guzzling SUV could travel on 100 kg of wood pellets?

This all seems a bit romantic until you examine what is now occurring in industries that create biomass waste as they install co-generation power plants, reducing their energy inputs by extracting energy from biomass byproducts of their industrial processes. We may get there incrementally, converting from fossil fuels to "fresh" biomass,  but every journey starts with a single step. We need to begin to take those first steps to begin to reverse the balance of carbon entering active circulation in our biosphere.  One massive source of biomass waste is the production of meat from feedlot enterprises, with massive biomass inputs and similarly massive biomass outputs in the form of urea, methane and incompletely metabolized cellulose. Digesters produce bio-gas,  usable for combustion-based applications in lieu of fossil fuel gas sources.  Landfills produce bio-gas. Burping cows produce bio-gas. Every colon in every living creature produces bio-gas. Harvesting this bio-gas is impractical if not impossible, but it is possible to harvest those bi-products of animal metabolism that are in non-volatile forms.

Saturday, July 6, 2013

"clean", "safe" cookstove

What constitutes a clean cookstove? What about a safe cookstove? And what about efficiency?

Unless you can improve on the 3-stone fire, you may as well not get started.  Your stove needs to be more efficient than an open fire, for a host of reasons. Ideally, it'll be as efficient as is humanly possible, while preserving adequate simplicity and utility and ease of use.


Clean means; no smoke, and low emissions.  Safe means; fire separated from skin, and pots are stable, not prone to tipping

People cook in very different styles, with different staples,  throughout the world. They have different traditions, different mythology and different motivations where it comes to cooking and fuel energy.
One size definitely will not fit all.  Where one can gain a foothold, regardless of local customs, is in institutional cooking.  The requirements associated with institutional cooking are similar the world over.

Efficiency is determine by testing; both lab and field testing. safety hasn't been fully defined, but a simple rule is "can you touch it without being burned'. Tip-ability doesn't have a definition that everyone agrees on yet. Safety is also about emissions. Safety means low exposure to particulate smoke and less non-infectious respiratory disease.

Wednesday, July 3, 2013

How can you save the world through cooking????

why this?

I need to get a message out to all my friends, acquaintances and business contacts.  I am putting my efforts behind a growing movement to bring basic technology and better health to half the world that doesn't have it. Why would I feel compelled to take on such a hopelessly romantic and gargantuan task? Well, first of all, I'm not alone. Secondly, I visited a very rural, 3rd world environment to teach burn care in a mission hospital. I saw how people suffer burns and what it does to them there. I realized they can never afford what we first-world professionals have to offer with respect to fixing big burns. The only reasonable response to that misery is prevention. The targets for prevention are the common mechanisms by which people get burned. For women and children, it's about cooking at home.

Think about your relationship to food. You're ready to prepare a meal. You walk into the kitchen, put a pot on the stove. You open the refrigerator and get out the ingredients, pre-packaged and trimmed for preparation. You turn on the gas or electricity and proceed to fry, broil, bake, boil, steam, saute, roast your food.  You turn on the flu fan, set the timer,  attend to other tasks and return in time to stir, turn, toss the food, turn it down to a simmer, etc.

 Transport yourself half-way across the world, to a small village in Thirdworldia.  You have picked greens from your garden, hauled water- 1/2 mile in a bucket, pounded corn into corn-meal, butchered a chicken (if you're lucky).  You spent several hours this week walking into the hinterland to gather wood. You carried 25 kg. home in a bundle on your head. Your baby (another 5 kg) rode on your hip in a shawl. You broke the wood up with an axe.  It's the wet season, so you can't cook outside. Your stove is three stones on the dirt floor. With a bit of care, you can balance a pot between them, in the corner of your kitchen/living room/bedroom. You stoke the fire, start feeding wood in from all angles. 25 minutes pass and your water is boiling; in goes the meat, the greens, the cornmeal. 40 minutes and 5 kg more wood later, you have stew.

80% of the heat from that wood heated the ground, the stones, the air, but not the pot. Smoke followed you around the room, gathers in the room down to your waist. The place reeks of smoke.  Your child coughs repeatly. That wood represented an hour's work of gathering. You'll do it again next week, and again and again. Sometimes you have to scavange wood further out; a 4 mile walk out, and back.  There's only time to prepare one major meal a day, and no means to preserve the leftovers.

 This is your life as a woman in Thirdworldia.  And it gets worse...while you were tending your crop, your 3 year old stumbled into the embers of the fire;  He has a nasty burn on his foot. With no local health care, it's a disabling, even life threatening injury.

Your mother in law caught her dress on fire once; she has horrible scars on her legs and thighs, but she survived after 3 months of misery. She limps badly, because one knee won't extend fully due to the scar contracture.  There's a child in your neighborhood who can't use her hands. They are horribly deformed after she tipped over a pot of scalding water and burned both hands badly. She'll be worthless as a wife because she can't work.

Kids in your village have a 20% chance of dying before age 5. They all cough chronically in the rainy season when you have to cook inside. Along with malaria, TB and HIV, they often get pneumonia and die.
Your older women have emphysema. They never smoked a cigarette in their lives. But they cooked for 40 years over open fires, inside and outside. They die at around age 55, looking like they are 75.

You don't have to look far to find this scenario. It's everywhere, in half of the world. And there are solutions within our grasp.

There are words that describe this situation;

energy poverty
food insecurity
indoor particulate smoke pollution
air pollution
deforestation
global warming

These words attempt to describe the consequences of a very basic activity serving  the most primal human needs; burning wood to heat a home and cook food. They completely fail to describe the experience of 3.5 billion people on earth, and the mothers, sisters and daughters who cook for them.
How can we remain ignorant of their circumstance and the very basic and accessible means to make their work cleaner, safer and more efficient? 

stay tuned and I'll share with you what I am learning about how to change that sad reality.