[ Fall 2012 ]
Raphael Arku should have been on top of the world. There he was, in his early 20s, a geologist for a gold mining company, a job with prestige and money—neither of which he’d ever had before.
The second of seven siblings, Arku had been raised by his single mother in a rural village in Ghana. At school, with his fellow students, he would forage for firewood and carry water in from a nearby stream. He always had a candle in his pocket. “The lights can go off anytime, and we don’t have generators,” Arku recalls. “But you have to study because you’re competing with other students for the same national exams to enter the university. So the best you can do is have candles, and you light them up to study. That was my high school.”
Arku won a slot at the University of Ghana and then secured his lucrative job. To everyone who knew him, it made sense that after those years of grinding work, Arku should be happy.
But he wasn’t.
Exploring for gold in Ghana came with ugly surprises. “We caused a lot of damage to villagers’ water resources, to their farm fields,” Arku says. One day, working in a remote village, the team dynamited a huge boulder. “It was right on top of the water head,” Arku says. “Everything fell into the water and it became muddy. We were washing the alluvial gold right into the river.”
Villagers soon came to fetch drinking water. Before using it, they simply let the toxic sediment settle to the bottom. But the water was now fouled with contaminants from the blasting, including arsenic and other toxic heavy metals, and with gas and diesel from the miners’ leaky equipment. “They didn’t even know they could boil it,” Arku says. After only a year on the job, he quit. “I had a conflict between my personal beliefs and what was happening in the field.”
Arku replaced his high-paying career with something far more valuable: a commitment to improving the environment for his fellow Ghanaians. Once again poor, the quiet, slender student began a long, difficult journey toward a public health career—one that had him earning two master’s degrees before starting his doctorate at Harvard School of Public Health in 2010.
Now 31, Arku has traded his interest in water for a passion to clean up Ghanaians’ foul air. The need, he implies, is obvious. “Have you ever been to Accra?” he asks, eyebrows raised. With some 4 million residents, Accra is the country’s largest city and one of the fastest-growing urban areas in the world. A stew of ingredients in the air—exhaust from the city’s fleet of old imported cars, dust from unpaved roads, and especially toxic emissions from the coal and firewood most people use as cooking fuel—makes it one of the globe’s most polluted. “If you go out in the morning,” says Arku, “over the course of the day, you can actually see the color of your shirt darken.”
He had begun his quest to understand how the tainted environment affects the health of Accra’s residents, especially the poor, as an undergraduate at the University of Ghana in 2003. There, he worked for Allan Hill, today HSPH’s Andelot Professor of Demography. Hill was on leave, setting up the Women’s Health Survey of Accra with the University of Ghana. He needed skilled interviewers—and people capable of persuading female participants to provide blood samples and submit to medical exams. “Raphael quickly distinguished himself as by far the most able of my new recruits,” Hill says.
One big problem: mistaken identities could easily foul up the research sample. “In Ghana, people have family names, ‘days’ names, nicknames, and so on,” Hill says. “Raphael would doggedly approach the women in turn and, by systematic inquiry and cajoling, ensure the right women were recruited for the study.”
Arku’s day started at dawn, when he would hop a minibus or ride a motorbike to the neighborhood they had targeted. Often, he made several trips to catch the women at home. “The work continued to late in the evening,” Hill recalls. “But Raphael’s work rate was relentless.”
When he pursued his first master’s degree in 2006, Arku helped another HSPH professor, Majid Ezzati (now an adjunct professor at HSPH and chair in Global Environmental Health at Imperial College London), who was equally impressed. Their work, also with the University of Ghana, was groundbreaking. With pockets of wealth, a sizable middle class, and millions living in poverty, Accra is notable for its striking economic inequality—inequality that, Ezzati theorized, reaches all the way down into the air and water.
With the help of Arku and other students, Ezzati pinpointed the sources of air pollution in four neighborhoods, from high-income areas to slums. “You’re trying to do really good science in a place where everything from the electricity supply to the social conditions are unstable,” Ezzati says. Trudging from place to place, the researchers learned that in the densely populated slums, almost everyone uses firewood; cheap, dirty coal; and dung for cooking, typically in makeshift kitchens set up in bedrooms or on front porches. In contrast, Arku says, about 80 percent of people living in high-income neighborhoods use liquid propane gas (LPG), with biomass fuels as a backup due to an unstable LPG delivery system. Not surprisingly, “The lowest-income neighborhoods had the highest air pollution,” Ezzati reports.
Poor residents cook with these low-quality fuels because it’s all they can afford. From previous studies elsewhere—including HSPH’s Six Cities study—it’s clear that high levels of particulate matter produced by fossil fuels cause health problems ranging from low birth weights to asthma, bronchitis, lung cancer, cardiovascular disease, and premature death.
Intending to learn more about the link between Accra’s dirty air and the health of its residents, Arku applied to HSPH to do his doctorate. “My dream was to be at Harvard,” he says. Although he hasn’t yet settled on a dissertation, he is deeply interested in analyzing urban energy use and infrastructure—and exploring technology and policy innovations (further electrifying the city, for example, or introducing clean-burning, affordable stoves) that could help reduce both household and neighborhood air pollution exposures.
Wrestling with Bureaucrats
Last summer, Arku returned to Ghana to collect more data—this time trying to link illness to air pollution sources. In the smoggy heat, he walked from one doctor’s office and clinic to another, trying to find administrators willing to share information. “It takes several hours or days to find the right person,” Arku says. “Think of this as ‘wrestling with bureaucrats’ to get the data you need.”
Arku wants to return home, Ph.D. in hand (expected in 2015), to set up a world-class research program at the University of Ghana. “If you ever lived in Accra and you have a passion for the environment, I think you would be mad enough so that you would like to do something,” he says.
But given his experience of growing up without a stable source of energy, Arku has an extremely practical side. “There is an urgent need for regular, community-level access to cleaner fuel,” he says. The recent discovery of crude oil off Ghana’s shores, along with the expectation of new production of natural gas, could help alter the future for Accra’s people, depending upon how new resources are expended. According to Arku, “We need a relevant policy debate that would focus on whether a portion of the proceeds and supply from these projects should be used to develop energy infrastructure in low- and middle-income Accra neighborhoods.”
Such fundamental changes could vastly improve residents’ health. Arku’s research will be central to building the case for such changes, not just in Accra, but also in scores of cities across Africa.
Elaine Appleton Grant is assistant director of development communications and marketing at HSPH and a former public radio reporter.