Springtime in Mongolia and the miasma theory of disease

It finally really seems like spring here in Ulaabaatar. After a crazy dust/mud/windstorm last Sunday that brought some real rain in its wake, we started to notice tiny new leaves on a couple of trees on our walk through the neighborhood. The evergreens are green again, after a winter of being encrusted in black soot from the pollution. People have been raking up the brown grass to make way for new green growth. And coming back from the supermarket the other evening, we saw cherry blossoms on three tiny trees in front of an apartment building. Some larches in front of an office building were starting to turn green as well. And, best of all, there’s a lot more bird activity. We still mainly see sparrows, crows, and pigeons in our neighborhood, but they are way more active, and we can hear starlings from our apartment as well. Spring has arrived.

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In my last post, I wrote about the dust storms that characterize spring here. The rain seems to have helped with that a bit. It’s still quite windy, but the air blew in clear yesterday, and a cold, cloudy morning with clouds that whitened the mountain tops of the Bogd Khan Uul (the national park we see from our apartment) ended in a gorgeous, blue-skied, sunny afternoon. Unfortunately, it was also MIU’s Open Day, a big event to recruit undergraduates, and I was teaching demonstration classes in the morning, and then we attended the International Food Festival in the afternoon. The food festival is part of the Open Day, to showcase MIU’s international community, with food from not only Mongolia but China, Korea, the USA, Russia, and Afghanistan/Central Asia. Good food, but so many people. We got back to the apartment and collapsed. As Emma said, too much human contact for one day.

We are also both recovering from bad colds. Emma started it, and is further along in her recovery than I am. She even missed a day of school (her third this year), which means she felt really sick. She is hoarding her sick days to take the month of June off, as she says. Her school allows them to miss 18 days, and she calculated early on that if she wasn’t sick, she could take off the last three weeks of school. (She’s missed three days of school, so she has 15 left.) But she also has really good friends there, and I have been suspecting that she wouldn’t want to do that. The other day, she asked me, “Would you really let me take June off completely?” I said I would, if that was what she really wanted to do. Then she said, “I’m still thinking about it. I might just go, anyway.” I suspect in the end she will go because of her friends. But we were laughing the other night because she really dislikes her current school, and she’s only missed three days this year. In California, she was sick A LOT (it took longer than it should have for me to realize she’s allergic to our dogs), and even though she loved her school, she would miss 18-20 days a year.

This past week I was so sick I also ended up cancelling classes for the first time. I didn’t want to, because unlike at UCSD, here you have to file a lot of paperwork and hold make-up classes, which I knew would be difficult to do with my already full teaching load. But when my voice was shot and I couldn’t stop coughing, and I also had trouble standing up straight, I thought it might be a good idea not to teach for a day. And it was. I was still exhausted for the rest of the week, but I was able to teach my other classes, and I’m definitely feeling much better. Coming from a culture where you’re supposed to just power through being sick and keep working no matter what, I don’t easily take time off, but whenever I do, I realize how stupid it is not to, because if you actually let yourself recover, you feel better faster. Americans need to figure this out.

At work, I was talking to Gerelee, and she said that everyone here gets sick in the spring. Part of it is all the energy it takes to make it through the winter just taps people out. But also, in the winter, everything is frozen, solid, for months. When the temperatures warm and the ground starts to thaw, and the winds whip up the dust, a lot of bad stuff is carried through the air, and people get sick from allergies and respiratory ailments. Having experienced it, this makes total sense to me, even though it does sound a bit like the miasma theory of disease. Or maybe because it does.

Emma was just learning about the miasma theory in school, the notion that preceded the germ theory of disease, that illnesses were caused by noxious “bad air” that arose from rotting organic matter. The word “miasma” comes from the ancient Greek for “pollution.” Miasma was held responsible for epidemics of cholera, bubonic plague, and other diseases throughout European history, and similar theories have been held in India and China as well. It was replaced in the 1880s by the germ theory of disease, in which specific diseases are known to be caused by specific germs, which need individualized treatment. The miasma theory was rendered obsolete and thrown in the dustbins of medical history.

But perhaps the miasma theory was thrown out too soon. Not because the germ theory of disease is inaccurate, but because it is incomplete. I am sure a lot of people have had the experience of “bad air,” and in some places, it has gotten exponentially worse over time. Here in Ulaanbaatar, as the earth and water have thawed, all of the garbage that has lain frozen around the city has also thawed, leading to some pretty interesting smells. The acrid smell of burning coal has been replaced by the pungent smell of rotting garbage. It may not cause lung cancer, but it can’t be considered healthy. Going out and getting “fresh air” means staying away from the thawing ditches that crisscross our neighborhood, now choked with trash as the water is starting to flow. All of this could be cleaned up, and not allowed to accumulate to begin with, if people decided a clean environment was something that they valued. But for now, it all sits until there is enough water to wash it out into the river and then away towards the ocean, where surely some of it will eventually end up.

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“Bad air” can also refer to the pollution that people here breathe on a daily basis. In the winter, the air quality is extremely poor, frequently going off the Air Quality Index scale. Even though it is warmer now, and people aren’t having to heat their homes as much, the pollution levels in the city remain high for people who like to exercise outdoors, as well as for the very young and old. My air pollution apps tell me to limit outdoor activity. Despite that, we go walking every day. And we are over wearing our air pollution masks, even though the air still isn’t the healthiest. Especially if we walk along the larger city streets where the exhaust from trucks and busses more than compensates for the high percentage of Priuses among the passenger cars. The verges of Peace Avenue, one of the main drags through town, have been planted with trees and shrubs, but until they leaf out, their air cleaning function just isn’t happening.

Industrialized, urbanized societies abound with “bad air.” Dismissing this as a source of ill health is foolish. We have made our environment toxic, and we need to start recognizing the public health effects of that. Of course, we now know that “bad air” doesn’t cause cholera; Vibrio cholerae does, and it’s carried in food and water. And the Bubonic plague is from Yersinia pestis, carried by small mammals and transmitted by fleas (in Mongolia it’s called “marmot plague” after the main carrier here). But “bad air” causes all sorts of serious illnesses, from asthma to heart disease to lung cancer. The American Lung Association releases an annual State of the Air report; the 2019 edition reported that 40% of Americans live in places where the air pollution is “too dangerous to breathe.”  The World Health Organization has concluded that 91% of the world’s population breathes air that is too polluted, and that around 8 million people die each year from either outdoor or indoor air pollution.

The form of individualized medicine that developed out of the germ theory of disease, where individual patients are treated for individual manifestations of disease, proves inadequate to quell the environmental illnesses we are subject to. Cleaning up the “bad air” needs to become a priority again. It’s something that requires a collective effort, as the American experience has shown. Our air was getting cleaner, even in major urban centers notorious for their “bad air,” as cities and states enforced legislation designed to supplement the federal Clean Air Act, initially passed in 1963. Now, the US government is walking back on this, seeking to destroy the progress we made in cleaning up our air and prevent further progress. The notion of environmental health, not just the health of our environment but our own health as well, needs a revival.

Here in Mongolia, international organizations churn out report after report on the dangers of air pollution and the need to address it, offering solutions ranging from better air pollution monitoring to wearing pollution masks to cleaned up coal to fuel-efficient stoves for domestic heating. Many of the solutions to air pollution get stuck in the pilot program stage, or remain in the pages of reports, as the city government fails to make headway in tacking the problem. One very practical alternative, which would clean both the indoor and outdoor air, is to convert and/or build houses that are highly insulated and don’t require coal stoves for heating. It would be relatively inexpensive and would greatly reduce the ambient air pollution of Ulaanbaatar’s winters. But this option gets passed by, at least in part because of how entrenched coal has become here. Coal mining is a major source of revenue, in part because of demand from nearby China, and the mining sector here has been growing steadily. Other sources of energy such as wind and solar remain stunted by government policy and lack of development.

As the world is starting to get more serious about addressing our growing climate crisis, some relief from “bad air” surely is in sight. The turn to renewable energy will alleviate some of the problem, though it won’t clean up all air pollution. Clearly, an environmental health framework will go a long way towards creating healthier people as well. Our environment’s health is our health, and if our environment is sick, so are we. My cold and Emma’s may have been caused by viruses, but we both can feel how our overall health has been affected by where we live.