In June 2007, after completing our first year of medical school, we all had people telling us: "This is the last summer break of your life." The more pressing follow-up question was: "So how are you going to spend it?"

For the five of us, our desire to make a positive impact on people's lives and to broaden our understanding of health and illness drove us to spend our summer doing a public health project in Chiapas, Mexico.

Half of the world's population uses an open fire for cooking and heating. The indoor air pollution that results from the combustion of solid fuels is responsible for more than 1.5 million deaths a year and tremendous disability related to chronic lung disease and acute respiratory infections. Typically, the women and children of the community experience the majority of the exposure to indoor air pollution, and the subsequent disease burden.

The use of a fuel-efficient chimney stove can greatly reduce exposure and the money spent on biomass fuel. Plus, if implemented on a large enough scale, it can help mitigate deforestation in regions where fuel wood is scarce. The combined economic, environmental and health benefits of a stove are what drew us to this work.

We developed a project to address this problem in Quexalhukum, Chiapas, a rural community in the highlands of the southern-most state in Mexico. The 450 inhabitants are descendents of the Maya and speak Tzotzil, an ancient indigenous language. Only some are fluent in Spanish. Most earn a living from day labor and subsistence farming. The people of Quexalhukum are strong and their community is well organized, but the daily challenges they face are daunting. Upon our arrival, every family in the community used an open fire and spent up to 30 percent of their income on fuel wood.

To carry out the project, we partnered with Las Abejas, a grassroots organization born out of the indigenous highland communities to fight for human rights and improve health in the region; Helps International, a nonprofit stove manufacturer that provided us with 48 Onil stoves; and Rufus Edwards, MD, a professor in the Department of Epidemiology at the UC Irvine School of Medicine.

Along with Dr. Edwards, we developed a method to evaluate how well the stoves reduced indoor air pollution, and we measured the subsequent improvement of health indicators. We performed a before-and-after comparison of four factors: 24-hour mean kitchen carbon monoxide (CO) levels; 24-hour personal exposure to CO; exhaled CO levels; and blood pressure. CO is a direct correlate of indoor air pollution that is causally linked to certain respiratory pathologies.

Using a stove requires families to drastically adjust their daily lives. This is where the local health promoters from Las Abejas were integral. These men and women are members of the community trained as healthcare providers and advocates in areas where doctors and infrastructure are in short supply. Their active participation in the installation  and adoption of stoves, as well as their assistance in conducting the study, were critical elements in establishing our relationship with the community. This dynamic created an environment of collaboration and solidarity, rather than a paternalistic intrusion by foreign medical students.

Final results of the indoor air pollution study are pending, as data collection and analysis are ongoing. Preliminary data analysis indicates reductions in indoor air pollution of about tenfold. We hope to publish our results by summer 2008.

Our work in Chiapas gave 48 families a means to carry out their daily lives in a healthier, more efficient manner. Taking into account the oppressive poverty, hardship and discrimination that they and millions like them endure, this is a drop in the bucket. But as a component of our medical education, this act of solidarity with the powerless gives us a prism through which we will view the rest of our training-the rigors of which will not deter us from continuing our work toward health and social justice for the people of Chiapas.

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Authors Greg Sacks, Scott Kendall, Janet Ho, Andrew Eads and John Rose are medical students at UC Irvine School of Medicine.