Although I am rather far away from my goal of becoming a Zambian and have quite a lot of work to do in the time left here, I look forward to learning more about the Zambian culture. I love being able to experience another culture from a first hand perspective. It has been an amazing experience so far and I enjoy every day of it.

June 29, 2010

by John Sauer

Huffington Post

Sauer WASH in schools

I've been traveling the past three weeks in Bangladesh and West Bengal visiting water, sanitation and hygiene (WASH) organizations and their field programs. I've covered a fair amount of ground and have seen the work of local governments, the UN and international and local NGOs.

Five to ten years ago many villagers did not have safe drinking water or a sanitary latrine -- the situation on the ground has improved. In Bangladesh, deaths caused by diarrhea have decreased significantly in the past several years.

Many folks I spoke with attribute the substantial drop in death rates to the increase in the amount of safe drinking water. In most villages I visited families had their own tube well, though some did share a well with a few other families. Before this rapid expansion of a water source close to the home, many families collected water from the ubiquitous unprotected ponds of Bangladesh and West Bengal. According to Water For People country coordinator Rajashi Mukherjee, "The ponds are absolute death traps; hygiene is the last thing you can associate with them." Fortunately, with the proliferation of tube wells, most people can now avoid collecting water from unsanitary ponds.

This progress underscores the solvability of the problem when there is a convergence of partners -- communities, local government, local NGOs and international donors and NGOs. The tube well example is interesting because it shows how scale can happen when an idea catches on and the private sector (mostly small businesses) gets involved. Nearly 8 million tube wells were sunk in recent years. Roughly 1 million were paid for and installed by the UN, government and other NGOs and 7 million by families/communities themselves by hiring private contractors. The scale of this push for clean water shows how progress was made when stakeholders perceived the need for clean water and took action into their own hands.

However the reality is that each year as many as 70,000 people still die of diarrhea in Bangladesh. In India the figures are astronomically higher, exceeding 450,000. In fact a few days ago there was an all-too-familiar report in the local Bangladesh paper that five people had died of diarrhea. This story demonstrates the significant challenge the people of Bangladesh still face.

One of the unfortunate and unforeseen side effects of the installation of the millions of tube wells is that a fair proportion of the wells are infected with naturally-occurring arsenic. Many programs have emerged to test and mark the wells, but large-scale solutions to rectify the problem are not yet in place. I did see several arsenic removal technologies of varying cost, but the very expensive options would be hard to bring to scale without large donor support. There were also other less expensive arsenic removal technologies that are still being tested that might hold promise in the future.

Overall the successful programs that I did see dealing with arsenic removal came about through contributions from the community level, local government and outside donor support.
Besides the arsenic problem, greatly improving sanitation and hygiene will be essential to further reduce WASH-related disease and sickness and improve the quality of life for the people of Bangladesh and West Bengal. The governments in both countries have made promoting sanitation a priority. Unfortunately, many challenges exist on the ground related to education about sanitary toilets and appropriate hygiene. There was limited use of "infotainment," (using entertainment, such as television shows to pass key health and hygiene messages), even though some "infotainment" pilot projects appeared effective. Also there were an insufficient number of community health and hygiene promoters. The result is that people are not constructing or maintaining toilets or practicing good hygiene (such as washing their hands with soap). I did visit several communities that had achieved 100% WASH coverage. The trend in those communities was strong local leadership, active community health and hygiene workers and effective leadership from so-called "child brigades" to pressure the community into action. One idea being floated is to employ these local leaders as a cadre of "barefoot consultants" hired by other villages and local NGOs to greatly scale up these successes.


Some of the most exciting work I saw in the field was improvements to the quality of WASH in schools facilities. In one of the schools I visited, the children had been involved in the design of their own toilets. The girls demanded a separate changing room where they could have privacy and an adjacent incinerator for safe disposal of sanitary pads during menstruation. Before these programs were in place many of the children missed school, walking home to use the toilet. Girls in particular would often miss three to four days a month of school, sometimes even missing exams.

I feel that it is possible for communities in Bangladesh and West Bengal to continue to improve their WASH conditions if they can enhance community leadership and capacity for WASH. There is a great opportunity to share success stories and best practices. Let's not forget the power of increasing the role of children and adolescents. It's equally important to recognize sanitation and hygiene as a matter of status and use it as a tactic to motivate people towards behavior change. There is a need to embed messages related to status into communities, so people will prioritize sanitation and hygiene.

Overall, I've been amazed at how much is happening on the ground. Despite the multitude of WASH problems, the issue seems entirely solvable here. Sanitary products are available everywhere, at reasonable prices and are accessible to almost everyone, except for the extremely poor and vulnerable. (I actually saw some very good examples of how motivated communities found ways to help out the poorest members of their communities). Communities transform with access to WASH--health improves, new job opportunities arise and more children finish school. I hope that donors take notice of this transformation and work with the people of Bangladesh and West Bengal to put this issue to rest once and for all.

Follow John Sauer on Twitter: www.twitter.com/wateradvocates

 

As time goes on I am getting more responsibilities in the clinic. As of late, I have been working with a Zambian dentist named Ba Ian (Ba means Mr. or Mrs.). He is a wonderfully kind and patient man that is very good at explaining his work. A small skinny man in stature but hold tremendous respect with his patients; always keeping a smile on his facem, he whistles and tells his patients jokes to keep them at ease. There is much you can take from his patient-provider interaction.
Two Lipscomb College of Pharmacy Students Send Their First Impressions of Namwalia, Zambia

Global Health Leaders Brittany Latimer and John Deason arrived in Zambia last week. This is Brittany's first time in Africa, and this is John's first time outside the United States. Though both are dealing with a touch of culture shock in Namwianga, Zambia, they report a warm welcome at the local church, a fun time with kids over food and dancing, and a challenge with the local clinic to understand how best they can translate their knowledge of clinical care given the limited resources available for the patients.

We invite you to read their blogs and see their photos!
This past week I was involved with the coordination and follow through of community health fairs on the island. These health fairs are vital for the public in that they enable us to reach out to those living on the island and perform various health screenings for people who do not understand the importance of and/or do not have the funds to get these health screenings on their own.
Our show at Darien Lake - located between Buffalo and Rochester - had us a little concerned about being able to recruit volunteers, since it is a bit of a drive from either city. We were excited to have a great crew of volunteers come out and join us: a mother, daughter & aunt team of Susan, Carol and Melissa, as well as Corey, Chelsea, Cary and Lyndsey, who are a combination of friends, sisters and fiances that all drove into from Rochester! Our team did great, helping us sign up lots of new supporters and raising lots of money for our well building projects, working all night to talk to Brad fans about the importance of clean water.
Health education has been quite a success at the local high school. The Senior 3 class was very interested in and had many questions about the previous HIV/AIDS education. I based the next class on their questions. The following week I chose malaria as the topic because of its prevalence in the area. The students were misinformed about transmission of malaria. They thought that it was transmitted through unsafe drinking water, as so many of the other common diseases. I think that this may have been a communication error in previous education about removing stagnant water which breeds mosquitoes. I continued health education in the general paper (essay) classes which I mentioned in my last update. Students have turned in the required information on their selected health topics. The topics they could choose from were as follows: malaria, food contamination, safe water, community safety, and HIV/AIDS . The students’ personal experience stories are educational for me and very eye-opening to the severity of these community health problems. The quality of their work varies widely. Ensuring that each student learns has involved individual study sessions after school hours. The students know where I am staying and come to visit me for help, sometimes voluntarily, sometimes by my request. I am in the process of grading the papers and discussing the topics with them. It has been helpful to the students to spend so much time discussing major health concerns in their community. This education has served a total of 112 students. Teachers also learn and ask questions.
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