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Purely, Water

Purely, Water

Purely, Water (continued)

By Jackie Powder

The 17-member multidisciplinary team with the Johns Hopkins chapter of Engineers Without Borders (EWB), which includes two students from the Bloomberg School, traveled to the villages in June 2006 to launch the project. They recruited agricultural engineer David Alcock as the project liaison. As a South African of English descent who grew up in the area speaking Zulu as a first language, Alcock first worked with the villagers to identify their most pressing water-related needs.

"Because of his prior relationships with the Zulu people, we didn't come into their community and say, 'This is what you need,'" says project participant Sharon Nappier, a PhD candidate in Environmental Health Engineering at the Bloomberg School.

The EWB group spent three weeks building "ram pumps" in the two villages. With Alcock's design updates to the basic technology, the student engineers were able to construct the pumps with locally available materials like car tire rubber and lead weights at a cost of less than $100 each. The system runs on the hydraulic energy of a stream and delivers water through pipes to storage tanks in the gardens.

The student volunteers spent long days digging ditches and laying the pipes. And the grandmother gardeners, who sometimes worked alongside them, served up daily lunches of phutu, a dish similar to grits, made with corn, beans, pumpkin, cabbage and sometimes meat.

In addition to helping with construction, Nappier and fellow Bloomberg student Maura Dwyer conducted a baseline health assessment, testing water from taps and in storage containers—trashcans, in some cases—and gathering data on diets and water usage.

Among the findings: Eighty percent of the survey participants in Inchanga and 40 percent in Maphaphateni said they do not have enough water to meet basic needs. In Inchanga, 46 percent of the respondents reported injuries from retrieving water.

When the Hopkins group returned to KwaZulu-Natal this past summer to follow up and install two more garden irrigation systems in other communities, the changes were dramatic. The communal gardens with the new systems were substantially larger and crop yields had increased to the point of surplus, enabling a number of new families to join as garden members.

Though health data hasn't yet been analyzed, the researchers expect to reduce exposure to schistosomiasis, a waterborne disease endemic to the area and caused by skin contact with parasitic worms. Now, instead of wading into an infected stream to collect water, the gardeners simply turn a spigot at the garden site.

And the more bountiful harvest should bring more nutritious diets in general, essential for AIDS patients to receive the full benefits of antiretroviral therapy, Nappier notes, adding, "It's another way we can help public health."

HOME-TECH

For most mothers in low-income Indonesian communities, the day starts by lighting a kerosene stove to boil water.

It's a daily practice that's been promoted by the government for decades as the best way to purify water in a country where 100 million people lack access to safe drinking water—and where waterborne diarrheal disease causes 20 percent of all deaths among children under 5.

"They have been receiving the message about boiling for so many decades that it's very entrenched in the culture," says Maria Elena Figueroa, PhD, director of the School's Global Program on Water and Hygiene.

Despite the consistent use of boiling, however, studies have found that in many Indonesian households the water contains fecal bacteria. Although boiling purifies the water, it doesn't provide protection from recontamination, which frequently occurs from improper storage.

That's where Air RahMat comes in. For 40 cents a bottle, the chlorine-based solution treats a month's worth of water, and unlike boiling, it leaves behind residual chlorine, which continues to protect the water from recontamination. The product is currently being introduced by the School's Global Program to middle- and low-income Indonesian communities through the USAID-funded Aman Tirta (Safe Water) Partnership. (The partnership is also being aided by the Centers for Disease Control and Prevention, the private sector and local nongovernmental groups.)

Despite Indonesia's obvious need for improvements in water quality, introducing a new water treatment method doesn't guarantee that it will be widely adopted. That's why the Global Program, a division of the School's Center for Communication Programs, works to understand behavior change in connection with safe water use and supports related awareness campaigns—within the context of government policies and services, and a community's cultural and social beliefs.

"Most of us working in public health know that the greatest benefit of safe drinking water for people in developing countries is to prevent diarrhea in young children," Figueroa says. But mothers in many communities around the world associate diarrhea in young children as part of normal development, teething, or even "sorcery."

"Sometimes the health connection with water is not a strong one," she says. "Seldom do you hear, 'Oh, he must have drunk unclean water, or he did not use soap to wash his hands after using the toilet or before eating.'"

When it came to "selling" Indonesians on the benefit of Air RahMat, the researchers took a pragmatic approach, emphasizing its money- and time-saving benefits: lower kerosene costs and no more waiting for boiled water to cool.

After a year of promotions on television and radio and through community-based activities, residents of some North Sumatra districts are getting the message.

Ibu Yuyun, a mother of six, grandmother of one and a respected kader, or health educator, in her community in Petojo Utara, uses Air RahMat consistently. "Clean and safe water is a must," Yuyun said, when interviewed as part of an ongoing program assessment. "We, especially the baby, could get a disease if we don't use safe water."

Ibu Siti, who runs an orphanage for 25 children, said that Air RahMat is her "secret in stretching her budget."

The Aman Tirta Partnership Program will soon roll out the next stage of the project, which includes a national media campaign and expanded access to the product in 80,000 outlets. In addition, Robert Ainslie, the Global Program's representative in Indonesia, is working with the country's health officials to craft a national policy endorsing chlorine-based and other water treatment products as alternatives to boiling. "People need to receive a technology to fit their needs in their context," Figueroa says.

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