Sunday, December 9, 2007

Untold Stories

Even in the under-reported water and sanitation sector, we are constantly bombarded by stories and reports about what doesn’t work, what hasn’t worked, how we are failing as a planet to meet the water and sanitation MDGs. So in a belated Happy Thanksgiving post, I offer a couple of stories and snaps that show the progress the sector is making in small but meaningful ways:

There is a child in school in Niger because she doesn’t have diarrhea thanks to an extraordinarily simple bucket half full of clean water and a little sliver of soap that she and her family use to wash their hands every day.

A woman’s hands in Guatemala are no longer calloused because her village recently acquired a borehole with a handpump. The story – more of a human dignity story than a water story - involves her coming up with gratitude to the project leader and insisting that he feel how soft her hands were. (Thanks to Gil Garcetti for the great photo.)

There is a village in Tibet that is 100% free of open defecation because of some bold little kids running around sticking ‘poo flags’ in each pile, with the names of their shamed depositors written on those flags.

There is a woman in Senegal who no longer has to wait until nightfall for cultural reasons to defecate, because her family invested $4 in a household pit latrine. I couldn’t find a picture of ‘less severe constipation’ or ‘fewer liver problems’ to post, but you get the point.


Sunday, December 2, 2007

Vaccinations vs. safe drinking water and sanitation

An interesting article in The Lancet late last year didn’t receive the attention that it – or at least one sentence in it – merits.

I’d like to change that with the help of my now six readers:In Vol. 368, Issue 9543 (Oct 7 – 13, 2006) The Lancet published an editorial to coincide approximately with the release of the UNDP 2006 Human Development Report “Beyond scarcity: Power, poverty and the global water crisis”.

The Lancet piece dealt with the primacy of water and sanitation in global development, and drew attention to the likelihood that the world will fail to meet the MDG on sanitation. It also highlighted the regional disparities which are masked by global progress on the water MDG (viz. progress in India and China masking a lack of such progress in subSaharan Africa). Also of note in the one page editorial was the continued/continuing lack of prioritization of water and sanitation in budgets throughout the developing world.

The sentence at the heart of the argument I want to make on this blog is:
"It is dangerously short sighted to pour immense time and resources into vaccinating children only for them to die a few years later from diarrhoeal illnesses."
I don’t care if the solution to the global safe drinking water and sanitation problem is not a “traditional” health intervention like passing out antiretrovirals or vaccinations. There is clearly not a silver bullet, or even a silver shotgun solution to the water challenge – each situation (unfortunately) requires its own unique solution. Those solutions involve fewer traditional health interventions, and more engineering and infrastructure projects, more behavioral change and education programs (think massive handwashing campaigns for women and kids like this one).

Public health officials in any country, state, province or elsewhere should support and lobby for these non-health initiatives to provide safe water and sanitation, as should the international donor community:

a) they save lives and livelihoods, and

b) less water-related mortality and morbidity frees up hospital beds, staff and other health care resources for those more traditional health interventions. A person sick from preventable waterborne diarrheal disease is occupying a hospital bed whose purpose would be better served by hosting an HIV or TB or malaria patient (plus that girl suffering from diarrhea would be better off in school thank you very much).

Health systems are burdened beyond capacity in many areas already – advocates for public health, water and sanitation throughout the developing and developed world should focus more cogently on preventing preventable illness.