For the cost of two cups of tea, lives can be saved. That simple equation has kept Sri Lankan surgeon Dr Wijaya Godakumbura welded to the cause of safe kerosene bottle lamps for nearly 18 years.
Around the world, nearly 1.6 billion people - a fourth of humanity - have no access to electricity. Almost all live in developing countries, largely in Africa and South and East Asia.
Faced with the reality of limited economic prospects and infrastructure, these men, women and children clamour for the most rudimentary forms of energy to power their households.
Kerosene lamps, cobbled together from old bottles, cotton wicks and either loose-fitting or no caps, are a one-size-fits-all solution: adults cook, clean and work, children study and families live by their light. But the same affordable fuel that makes kerosene lamps a staple of rural communities also makes them life-threatening.
Many developing nations subsidise oil products, including kerosene, to ensure the poor have access to fuel and to achieve other domestic policy goals. In India, for example, the price of kerosene is the lowest in South Asia.
But without the right safeguards, kerosene can also cause unimaginable damage and horrific death, as Dr Godakumbura discovered. Returning to his native Sri Lanka to practice medicine in the 1970s, the young surgeon encountered case after case of young men, women and children left severely disfigured, blinded or suffering agonising and ultimately fatal burns caused by unsafe kerosene lamps at home.
"Of all disabilities and injuries, burns are the worst," Dr Godakumbura said in a recent interview. "They are the most painful and devastating injuries that one can live with."
Nearly 30 years later, the retired general surgeon still remembers patients at Colombo's National Hospital who could not close their mouths because their lips had been burnt off; others who lost their fingers and thumbs; young women and wives rejected by society following severe disfiguration; and still others for whom death seemed preferable to immense and prolonged suffering.
At the time, nearly 1.5 million homes across Sri Lanka did not have electricity. The nation, Dr Godakumbura estimates, faced an average of three deaths from lamp burns every week, in addition to the hundreds whose lives were deeply and forever scarred by preventable injuries.
"For several years, I saw so much suffering and so many deaths that made me want to act, but I felt a surgeon could not make a difference, could not contribute the time and energy to undertake a big job like this," he said. One particular tragedy proved to be a turning point. In 1992, a young woman in excruciating pain was brought in with severe burns to nearly 75 per cent of her body. Despite the best efforts of Dr Godakumbura and the hospital's casualty staff, she died on the following day, along with her unborn child. "There was so much suffering and so many deaths that made me consider an action plan [I had created] long before 1992, but [the tragedy] made me take the plunge, finally," he said.
Follow-ups revealed that a homemade lamp had overturned at the young woman's home, spilling kerosene on to her clothing. The flashpoint of kerosene, Dr Godakumbura says, is lower than widely believed and kerosene-soaked fabric acts like a wick, turning victims into human torches. Additionally, few if any people had any knowledge of how to respond to burns or deliver emergency first aid.
From 1992 to 1998, Dr Godakumbura worked alone, devoting every moment of his spare time to find a solution to these entirely preventable and devastating incidents. His first step was research: he asked burn victims, inevitably rural residents with low levels of education, engaged in menial work and responsible for large families, to bring in their lamps.
What he saw opened his eyes: the lamps were repurposed bottles, previously used to hold medicine, vitamins or other household staples. Tiny tin circles, pierced by a small metal housing for the wick, rested on top. The slightest jolt could tip the bottle and spill its highly flammable contents, starting a fire. Dr Godakumbura realised the key to extinguishing these tragedies lay in a better, safer lamp.
The second step was discovery. With his family and junior assistants helping, he tested a variety of options.
"We first tried safe oils to be used in the existing lamps to minimise costs, but safe vegetable oils like coconut oil do not ascend in the metal tube carrying the wick," he said.
Repurposing existing bottles, using a wick through the original lid, also proved unsafe. They also tried collecting old squat bottles that would not tip easily, and manufacturing only screw-top lids to cut costs (bottles cost 22 cents, lids 6 cents each). But collecting and cleaning the bottles proved difficult, and sometimes the lids did not fit properly.
"If it wouldn't work the way we wanted, it would still lead to burns, so we had to keep going back to the drawing board," Dr Godakumbura said. The only realistic option was to design a lamp that would be safe even with kerosene.
He launched a public campaign, inviting everyone to design a safe, cheap lamp. The contest yielded several responses, but most proved too complex or too expensive for the rural poor.
Step three was innovation. After a nearly ten-month process, Dr Godakumbura sketched a lamp built along the lines of a Marmite bottle: small and squat, with two flat sides and equipped with a metal screw cap to hold the wick. Not only was the bottle more stable, it meant no kerosene spills even if the bottle overturned. The two flat sides meant the bottle could not roll, and it was tough enough not to break. "We didn't even require any changes or trial versions of that design."
The next step was to produce the safe lamps in large quantities and distribute them to those who needed them most. "Initially, I wrote to 70 pharmaceutical firms requesting funds, sending them gruesome photos of patients, but the response was poor," Dr Godakumbura said.
He identified a factory willing to produce the lamps from recycled glass at low cost, launched publicity and awareness campaigns about burn aid, and attempted to build a distribution network across the island nation. Along the way, he secured the support of the Sri Lanka Medical Association, the College of Surgeons and the National Society for Prevention of Injuries. Still, concrete help remained distant.
"Finally, in 1993, Sir Arthur C Clarke, on reading one of my articles, sent $1,000 unsolicited. The Canadian Embassy gave $20,000. From there, it was a steady march forward though at times things were not so good." In 1998, the tide really began to turn when Dr Godakumbura won a Rolex Award and $50,000 in prize money. Using those funds and capitalising on the global publicity the award created, the surgeon was finally able to establish an NGO and hire two people to run the operation. Today, over a decade later, the team remains that size.
Today, one of the foundation's safe bottle lamps, approved by the World Health Organisation and the International Society for Burn Injuries, costs 43 cents to produce - the price of two cups of tea.
The Sri Lankan Health Ministry gives the Safe Bottle Lamp Foundation $4,400 per year, $4,600 short of the foundation's annual expenditure. An additional 13 cents per lamp makes up the shortfall.
The foundation is currently producing and distributing 3,000 to 4,000 safe lamps a month but, Dr Godakumbura says, capacity can increase to more than 30,000 lamps a month if funds were available.
There is no doubt the need exists. In Sri Lanka an estimated 900,000 homes are without electricity, and Dr Godakumbura estimates that less than half of those - 400,000 - have received the foundation's lamps, two per household. On the plus side, with an average of four members in each household, this means the foundation has helped keep more than a million Sri Lankans safe from burns.
The remaining half-million households need one million safe lamps, from the foundation or elsewhere. Operating at full capacity, the foundation can manufacture and distribute or sell 300,000 lamps annually - which would ensure that every household has two safe bottle lamps by 2013.
"About 20 per cent of our nation's 4.5 million households have no light," the surgeon said. "In addition, we have an unknown number of households that have electricity but use bottle lamps during power outages, which are quite frequent in many areas, or when cooking with firewood at home."
External factors have also had an impact on the foundation. In 2003, the foundation distributed 65,000 lamps; in 2004, nearly 100,000. In the wake of the December 2004 tsunami, demand for the lamps skyrocketed, with aid agencies clamouring for more lamps for devastated areas.
"Until five years ago, we could not send lamps to the north and east provinces (due to the political situation there)," Dr Godakumbura said. "In 2005, we sent 46,000 lamps there. Last month, we sent 6,000 lamps to the northern provinces. We hope to be able to cover the whole island."
In the last few months, that goal has come closer. In December 2009, the Safe Bottle Lamp Foundation was named global winner of the 5th World Challenge awards held by the BBC World Service, Newsweek and Shell. The prize added $20,000 to the foundation's purse.
Medical reporting from Malawi to Bangladesh and India to Indonesia show that death, injury and destruction from unsafe kerosene lamps is not limited to the island nation. In India alone, a reported 2.5 million people suffer severe burns every year, primarily due to overturned kerosene lamps - in addition to homes and even entire communities burnt to the ground by toppled lamps. Dr Godakumbura, a speaker at burns conferences around the world, is also frequently asked to supply the foundation's lamps to other nations.
"We cannot undertake exports, but we are willing to share our design specifications with others around the world," he said.
Saving hundreds of lives a year and preventing thousands of horrific burn injuries is only part of the solution, however, Dr Godakumbura continues to invest his time in teaching fire safety.
"There must be a million unsafe lamps still in use in Sri Lanka," the retired surgeon said. "Even those using safe lamps need to exercise caution. Everyone needs to know how to extinguish flames when clothes catch fire, using the stop, drop and roll procedure. Burnt skin must be cooled immediately by pouring running water for 30 minutes, otherwise the heat retained harms the deeper tissues," he said.
Dr Godakumbura agrees with the criticisms of fuel-based lighting. "Kerosene pollutes and kills, it's true; but 1.5 billion people are compelled to use it," he said.
"Mine is a quick solution, a short-term one to prevent suffering and save lives until a permanent one comes along," he added.
Of all the disabilities and injuries you saw in your line of work, what moved you to act on kerosene burns? Why not, for example, corrective surgery for children with cleft palates, just as an example?
Kerosene burns affect the poorest of the poor. People don't use kerosene lamps because they want to, but because they have no other choice. Also, cleft palate surgeries and operating on burn victims are forms of treatment, not prevention. All surgeons perform surgery, but how many in the world do a massive amount of preventive work? Maybe 100, maybe less? I wanted to be one such surgeon.
Can anyone make a difference, or do you need special skills, talents or resources? Those with a kind heart and a desire to help others get motivated, but that's not enough. The desire and the motivation can unmask a hidden talent like innovativeness and if support from others comes at this point, well and good. Sometimes, while there is support from some, there can be opposition from a few for personal reasons like jealousy, and one has to have courage, dedication and resolve to face them. Commitment is the icing on the cake.
What holds people back from solving their own and other people's problems?
Failure to learn from one's own and others' mistakes, lack of foresight, and reluctance to get advice when needed and fear of being blamed even after doing everything possible holds people back from solving their own and other people's problems.
Did you have any experience of working with design or glass, or even fuels, before this?
Is there anything in your educational background or life history that would have prepared you for this?
Yes: a kind heart.