The Trouble with Water

Well, right now it is sexy to be worked up about malaria. It is a problem that the developed world has beaten and the developing world still struggles with it everyday. The solution to malaria seems to be so simple, when in fact it is fairly complex. All this talk about malaria and malaria nets got me to thinking about the less sexy, more practical and simple problem of water and sanitation… That’s right there is nothing less sexy than poo. Who would the celebrity spokesperson be? Johhny Knoxville?

Water, the most abundant natural resource on the planet and one which more than 1.1 billion people cannot count on accessing safely. Not only that but 2.6 billion people lack access to basic sanitation.

What does having reliable access to safe water mean?
How near is the water source to your home
How protected from pollution and human (or animal) excreta is it?
How private is it?

When water does not come flowing out of all the faucets in your house what are the consequences?
Well, for the 1.1 billion I mentioned above it means, huge portions of the day spent traveling back and forth from the communal well/borehole/stream/waterhole what have you to their homes so they can drink, cook, bath, water their gardens or crops, and animals. Often carrying a bucket on their head that weighs the equivalent of a checked bag at the airport or about 44lbs (20kg). Ever tried to carry your suitcase on your head? In Africa the amount of time spent transporting water is estimated to be 40 billion hours. That’s billion with a “b” per person about 26% of people’s time is spent carrying water… and those people are mostly female. If the time spent going back to get water exceeds 30 minutes, studies have shown that the amount of water transported is not adequate to their needs. Which means that using water for washing often is sacrificed as the lowest priority need behind drinking and cooking. Additionally, the more time is spent transporting water, the less time there is available for other critical tasks. Girls are also affected in other unexpected ways. Many girls do not have access to schooling because the schools lack adequate toilet facilities. Often dropping out of school after puberty when privacy becomes a critical issue.

Time and dignity is the least of the concerns associated with unimproved water and sanitation. When water comes from an unprotected source it becomes a health-risk. Not just any health-risk mind you. Water related diseases are the leading cause of death in the world, with 2 billion people affected per year. Ahead of HIV (35 million affected) and Malaria (251 million affected)… not only that, unsafe water is a leading contributor to the spread of malaria and is a factor in decreasing life expectancy in people living with HIV/AIDs.

Water borne disease include:
Diarrhea: About 4 billion cases of diarrhea per year cause 1.8 million deaths, over 90 per cent of them (1.6 million) among children under five.

Arsenicosis: Long-term exposure to low concentrations of arsenic in drinking-water causes painful skin lesions and can result in cancers of the skin, lungs, bladder and kidney. There is no reliable estimate of the extent of the problem worldwide. WHO is presently collecting information in order to make such an estimate.

Cholera: In 2002, over 120,000 cholera cases were reported worldwide. It is estimated that 450,000 children per year die from Cholera and it accounts for 30 – 50% of hospitalizations in children under 2 years.

Fluorosis: Essentially fouride poisoning which effects the bones caused by high concentrations of fluoride found in groundwater. The total number of people affected is not known, but a conservative estimate would number in the tens of millions.

Guinea worm disease: These parasites cause debilitating ulcers when the mature larve leave the body. In 2002 there were 50,000 cases reported 13 African countries.

Intestinal worms: This infestation leads to malnutrition, anaemia or retarded growth. About 400 million school-age children are infected by roundworm, whipworm and/or hookworm. In fact, roundworm and whipworm alone are estimated to affect one-quarter of the world’s population

Malaria: There are 300-500 million annual cases of malaria throughout the world and about 1 million child deaths. Improving drainage and eliminating uncovered water tanks is an important factor in reducing malaria cases.

Schistosomiasis: Parasitic worms penetrate the skin of people swimming, bathing or washing in contaminated water, These worms lead to the Schistisomiasis infection which can damage the liver, intestines, lungs and bladder. About 200 million people are infected with schistosomiasis, 20 million of whom suffer severe consequences

Trachoma: An eye infection that can lead to blindness; currently approximately 6 million people are blind due to trachoma infections.

Typhoid: Characterized by headaches, nausea and loss of appetite. About 12 million people suffer from typhoid every year

So what are the solutions?
Here is where the lack of sexiness of the issue really shows. I don’t see many people getting excited about drilling a borehole, covering a well, soap, hand washing, latrines, water pipes and faucets. Which is a shame, because this is a problem we know how to solve, no fancy technology needs to be developed. We don’t need to tap the Bill and Melinda Gates Foundation for research money to cure all the diseases listed. We know how to fix it… the will needs to be there to do it.

What is the cost?
In Uganda a new borehole costs between $7500 and $10,000 US dollars (source: Uganda Water Board). One borehole can serve the water needs of over 4000 people. That is $2.50 per person! Cheaper than a malaria net, and a multi-tasker… What a deal!

Hygiene education is inexpensive and does not require tremendous skill or technology to provide. Letting people to know what carries germs and how to avoiding contaminating the water they worked so hard to transport home goes a long way toward reducing the incidence of disease.

Relative costs of Sanitation projects

Granted its not as easy to sell sewer pipes as it is malaria nets. It’s not as easy to spin or hang a viral campaign on. Nobody’s bragging about how many toilets or feet or water pipe they are buying in Africa… Never mind a latrine. So yeah a full on construction project that includes water treatment, recirculation, pipes, adding toilets to homes, bringing in water to a village center is complicated… but here is the thing. This complicated project creates jobs, a skilled labor force, opens up time for children and adults to get an education, take on additional income generating projects and more… along with the health and wellness benefits. PLUS, if it is built, run and maintained by local labor the project does not require on-going external support. Unlike a malaria net that at best needs to be replaced in 5 years. Let’s work at getting to the root of a problem rather than slapping a band-aid on it. So if all this attention on malaria and malaria nets protects a large portion of the population for 5 years, why not take that time to address some of the fundamental issues that lead to malaria infestations including water and sanitation?

Statistics and Charts Courtesy of The World Health Organization

Tagged as: Africa, Cholera, diarrhea, Malaria, Sanitation, Typhoid, Water, water projects