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Safe Water Access for Rural Communities in Ecuador REPORT Nยบ1 March, 01-2012


Safe Water Access for rural communities in Ecuador. March 1, 2012

1. BACKGROUND

COAST

MAP (Medical Assistance Program) International is a Faith based non-profit non-government organization whose vision is to have a world in which individuals, families and communities have the hope and capacity to build conditions that promote Total Health. The mission of MAP International is to promote Total Health of people living in the world’s poorest communities by partnering to provide essential medicines, prevent and mitigate disease, disaster and other health threats, and to promote community health development (known within MAP as the 3P strategy). MAP’s definition of Total Health is ‘Communities taking ongoing, comprehensive action to improve their health and wellbeing’.

Nearly 40 % of the 14 million inhabitants of Ecuador live under the level of poverty. Within these populations there is an immediate risk of diseases related to poverty. Improving water delivery, sanitation, and hygiene (WSSH) are critical to health, development and survival (CDC, 2011). If the water is filtered and purified, it can make a significant difference in reducing the disease burden that could be as high as 75 % of the disease load that the community encounters. This has a clear impact on reducing mother and child mortality rates. This project proposes the introduction and use of a special water filter that has proven capabilities and a long life. The project will be launched in twenty-two needy communities in rural regions where MAP International is working in Ecuador.

ANDES

2. OBJECTIVES

2.1 Improving Health and Accomplishing Positive Changes with regard to the use of safe water, improved hygiene and sanitation in 22 rural communities in Ecuador through the installation of 350 Sawyer filters. Also, the use of training, monitoring and continued guidance and education by MAPEC and local health care promoters will be a major objective. 2.2 Researching, Testing and Documenting the Performance of the Filter in rural communities of Ecuador.

AMAZON Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


Safe Water Access for rural communities in Ecuador. March 1, 2012

3. ACTIVITIES CARRIED OUT NOVEMBER TO FEBRUARY - 2012

Through this project, the lives of 2,1001 people (CENSUS, 2010) will be dramatically changed. They will experience better health and education about sanitation, both of which will have resounding positive effects that touch on almost every other aspect of their lives. The 6 communities from the Pilot Project of 2010 plus another 16 new communities will make up this project. Of these 22 communities, 10 are located in the Amazon Region, 6 in the Andes Region, and 6 in the Coastal Region of Ecuador. The activities carried out during these three months are related to the following:

“…I never imagined that it was so simple to use the filter and have safe water so fast.” -Rosa, 47 yrs. Ébano Community (costal region)

Above: Introduction of the filters in Ebano Community in the coastal area

Introduction and Placement of Filters: The introduction of the filters in the selected communities is continuing in the order that was established. The first meeting was held with the directors of the community to understand the water situation and the problems it causes in families. Then, the benefits of using filters and the potential availability for selected families were explained. Each community discussed with their families the possible delivery of selected filters, and the responsibilities and commitments they would have upon receiving the filter. Some of the commitments were to participate in training sessions, allow a visit to monitor the use of the filter and be part of gathering information and measuring their impact on health. Map International competed this phase during December and January and met with the selected families to explain the operation and benefits of using the filter. The role of the health promoter is key for the coordination and organization in every community and in the explanation, clarification and guidance in local language communities such as the Quechua communities. As part of the co-responsibility, each family had to buy a bucket or container for the filter installation. It is important to note that one person was named in charge of making the hole in the containers because it was considered dangerous for children to drill the bucket at home. With one person in charge, we were sure that an adult

1

*The average size of Ecuadorian families per National Census is 5.2 and higher in rural areas where it is approximately 6.0, multiplied by 450 filters, equalling a total of 2,700 people. Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


Safe Water Access for rural communities in Ecuador. March 1, 2012

monitored the assembly. It was preferred to assemble all filters in each family meeting with either the person in charge or a health promoter to also provide solutions in cases of malfunction of the filters.

Training Needs: Since the subject of education is an important component in this phase, we identified priority issues for health education. Six major issues were identified in most communities on the coast, in the mountains and in the Amazon areas. The families expressed great interest in learning about the issues presented in the accompanying graph.

Currently, 1,552 people are benefiting from safe water through the Sawyer filters.

Defining the issues with the benefiting families allows the timely organization of educational methods. For tracking and monitoring, depending on the number of filters implemented, some communities chose a group coordinator, other communities a local health worker, and still other communities used water committees to fulfill the task of identifying these issues. In relation to the delivery of the 350 filters that Map - Ecuador received, 300 filters have been delivered. An estimated 1,552 people are benefiting from the safe water access through the use of the Sawyer filters. It is expected that 100% of the filters be implemented and in use this month. Communities, regions and filters currently using the Sawyer filters: Region

Community

Filters

People

Coast

2

100

520

Andes

1

190

980

Amazon

1

10

52

According to reports from the families, it appears that the majority of the filters are used by one family permanently. This occurs mostly in the communities where the majority of the families possess a filter. In communities where only a few families have a filter, the neighboring families have expressed interest in the filters, its benefits and the availability to share the water is high. When questioned, the families that have the filter say they are in agreement with sharing the filter and sharing the water that comes from the filter. Their explanation is that everybody needs Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


Safe Water Access for rural communities in Ecuador. March 1, 2012

clean water and “…if my neighbor does not have a filter, I must share my filtered water…”

Baseline Application

“…everyone needs clean water, if my neighbor does not have a filter, I must share my filtered water…” Carlos, 52 yrs, Tambayacu Community (Amazon)

In order to understand how safe water access is improving health and wellbeing, it was necessary to create and apply a baseline. The results widen our understanding of the reality of the families in relation to water and in taking effective actions in order to change the situation . Two application instruments were created, a checklist to understand the level of family vulnerability in relation to safe water access and environmental sanitation. The second instrument was a survey to understand the illness incident rate, level of medical expenses and types of treatments used. In continuation, this report shows the principle results of the baseline that was applied during the month of January. INCIDENTS OF ILLNESS A total of 45% of the benefiting families, a total of 150 families, shared information with us through the survey. The best representation of the incidents of illness is presented in these results from the Amazon region. The main illnesses of the families in the last three months were stomach pain, illness related to the cold (cough, sore throat, cold symptoms), diarrhea, fevers and skin problems. According to the accompanying graph the children suffer the most from diarrhea, stomach problems and fever. Poor diet, poor sanitary conditions and consumption of contaminated water were directly related to these illnesses whose consequences are most felt by the children. For example, the analysis of the diarrhea and stomach problems incidences that occurred at least twice monthly were more linked to the consumption of unsafe water. In teenagers the incidence of illness was less. In adults stomach problems and body aches were the most common, probably due to poor diet and excessive work factors that deteriorate health. The analysis also indicated Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


Safe Water Access for rural communities in Ecuador. March 1, 2012

that the problems with diarrhea were presented mostly in the men. In the women skin problems and cold symptoms were the most frequent. The rest of the illnesses appeared in a similar pattern. TREATMENTS USED In relation to the most commonly used treatments, the results of the Apatug community in the Andes region are presented here. Natural medicines along with modern are the most commonly used treatments. Among the reasons for choosing these methods are the understanding of the plants and home remedies to treat stomach problems, such as diarrhea, parasites and infections. The families use three methods: natural medicine, purchased medicine and, for children under five years old, a medical center. The distance and lack of money are the factors that explain the low use of local health services. Self-medication is the preferred method for the illnesses related to the cold weather, probably due to the easy access to local stores and city pharmacies that have been used for a long time and recommended by other people. A smaller percentage of people indicated that they have not had any illnesses in the family and because of this have not used any treatments. MEDICAL EXPENSES PER ILLNESS The presence of family illness does not only cause worry, pain and suffering, but it also affects the family’s economy. The results of the analysis show that 45% of the interviewed families spend more than $40 per month for medical treatments. This expense represents approximately 20% of the family’s monthly salary. Earlier studies have demonstrated that the average salary of a rural Amazonian family is $200 dollars.

Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


Safe Water Access for rural communities in Ecuador. March 1, 2012

The results related to the monthly expenses for water treatment are presented here from Apatug. An opposite effect can be seen that indicates that the monthly expenses for health increase at the same rate that the water treatment rate decreases. The effect is similar in the coastal and Amazonian regions. This is evidence that demonstrates the direct relation between the presents of illness with the quality of available water. Furthermore, it prioritizes the educational component for the care of the water on a family level and the importance of preserving the water sources on a community level. Finally, the analysis shows a direct relation between the understanding of health and the impact it has on the level of monthly health expenses. The graph shows that the families that have not received health education spend more monthly on health related expenses. However, the relation is not significant for the families that have received health education and show high levels of monthly expenses. The explanation was given to us by a local health promoter who explained that many families receive health education from institutions and public and private organizations but only a few actually put into practice what they have learned, they forget what they have learned and continue causing themselves to become ill. The effect is similar in the coast and amazon regions. These results demonstrate the poor effects of seeking change only through sporadic educational chats. There has to be a progressive, permanent, analytical process about the factors that affect the health and build relationships with the families to initiate change.

Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


Safe Water Access for rural communities in Ecuador. March 1, 2012

Level of Family Vulnerability For this analysis a check-list was applied to families in order to better understand the level of vulnerability in relation to the access to safe water, hygiene and sanitation. The results presented are a summary of what appears in Toachi Valley (coastal area), whose conditions reflect those of the rest of the Amazon and Andes regions. Five parameters were considered to study the vulnerability in relation to access and quality of the water. Each parameter is calculated based on a scale that goes from 1 being the most negative to 5 being the most positive. For example, for the category “Amount of Water for Family Use� the criteria were 1- without their own water, 2- very small amount, 3- insufficient, 4sufficient and 5- more than enough. Based on this scale, the health promoter chose a number based on the reality of each family. The rest of the information is shown as concentrated data that was taken from 30 families and from direct observation of the health promoter or the person responsible for completing the checklist. With the graph, the communities of Toachi Valley can be observed. It shows the highest vulnerability in three areas. The lowest is the system of eliminating the grey waters. 90% of the families indicated that they dispose of the grey water in front of the house, in plants or in the street. The storage of drinking water is also low. 80% of the families said that they stored their water outside of the house with little protection, putting it at high risk for contamination. The community does not have a septic system and grey waters are always accumulating in the streets (see photo). The main source of water comes from wells constructed inside the houses. The quality of this water is very poor and not fit for human consumption. Another category analyzed the cleanliness of the water storage containers. The majority of the families cleans these containers very sporadically, which creates a high risk of water contamination.

Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


Safe Water Access for rural communities in Ecuador. March 1, 2012

The situation in relation to hygiene was also studied using the same criteria as the previous graph. Each category has a scale from 1 to 5, with 5 being the desired situation, or very positive. The highest vulnerability is seen in the children not using protection on their feet. It is very common to see them playing in the streets or rural countryside without any shoes. This is a risk factor for parasites and other illnesses. The cleanliness of the faces of the children is also low and can be observed even more in the families where the parents spend all day working and leave the children with older siblings or a neighboring family. The same occurs in the Amazon and coastal regions. The vulnerability for not having household odors or a place for a family bathroom was low. In the coastal region the hot and humid conditions promote a higher cleaning rate and there were similar findings in the Amazon region. This is not the case, however, in the Andes region where the level of vulnerability was high (in the 5’s) in all categories.

Finally, the sanitation in the home was a risk factor for the appearance of illnesses. Five parameters were selected (see graph). The cleanliness of the bathroom was the lowest rated. Many of the bathrooms are outside, falling apart and not maintained. On house visits the strong smell was noticed coming from the poorly kept bathrooms. The disposal of the garbage is also insufficient. Many families burn their garbage; others leave it in the street. The order and cleanliness in the kitchens appears very positive. Constant and thorough cleaning assures that flies and insects cannot continue their lifecycle there which is a positive sign towards the prevention of illness. This same result was found in the Amazon region. However, Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


Safe Water Access for rural communities in Ecuador. March 1, 2012

this was not the case in the Andean (high mountain area) community of Apatug. The reality there is the opposite. The presents of flies and disorder in the kitchen are quite common and generalized. Currently, MAP is putting lot of emphasis on the importance of order and cleanliness of the kitchen in this area.

Parasites Another important aspect of this project is the level of parasites in the families and the impact that safe water via the filter could have on that number. The following presents the results of tests done on 80 people from two communities in the coastal area. There were three types of parasites that were identified in the tests in the city hospital: Ameba histolytica, Ascaris lumbriciodes and Trichurus trichiura.

The graphs show the level of parasites from zero to low, medium and high counts. Ascaris is the most common parasite in the tested families, effecting more than 90% of the people. This is directly related to the poor hygiene conditions, poor water quality and, as mentioned earlier, the poor quality of the bathrooms. The parasites are a result of these real problems. When analyzed by age groups, it appears that the children under five years old are affected only by the Arcaris, while people of all ages suffer from Ameba and Trichurus. In the next report the results from the people from the Amazon and the Andes regions will be presented.

Currently, government programs are working through the health offices to create parasite camps in rural communities, giving priority the children between 9 and 13 years of age. Also, the government suggests that the mothers bring their children to regular medical screenings and part of that program is frequent anti-parasitic medication. These efforts add up to support the community through organizations, however, the problem of the contaminated water continues.

Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


Safe Water Access for rural communities in Ecuador. March 1, 2012

In the next report we will present and explain how the educational process is going with the families who have the filters as well as reports of the visits and more testimonies about how the filter is impacting the health of the families in these three regions of Ecuador.

Conclusion With this first report we wanted to share the advances that have been made with the implementation of the filter for access to safe water. As MAP, we are strengthening this strategy and incorporating actions for prevention of illness and promotion of better health with an integral focus. The use of the filter alone is not sufficient to generate great changes in the health of the community; other actions are required such as production, food, education, infrastructure, environment, etc. However, with the use of the filter we are being very strategic in confronting one of the major factors for general illness: the consumption of unsafe water. This project is allowing for a strengthening in the relationships of the communities and families, which in turn creates conditions for reflection. Through this approach, the people in these rural communities can analyze their situation and take action to better other important health factors such as sanitation and hygiene. The next report we´ll show you how the impact continues into the families and community and the analyze others technical aspects that is part of this project also. Finally many thanks to Stephanie Peterson (Map´s volunteers) by your support in this report and research.

Geovanny Santamaria. gsantamaria@map.org El Universo E-756 y Shyris – Quito-Ecuador


sawyer report