Joseph B. Treaster: Water and The World

A Continuing Discussion on Water and People on A Warming Planet

Dec 22 2010

A Problem Worse Than Cholera

Published by Knight Center under OneWater.org

MIAMI—Cholera is working its way through Haiti. It is killing people and terrifying everyone.  Medical help and money has been pouring in – not enough money, the United Nations says, but a lot of money, a lot more money than has been flowing for a much worse health problem.

In the first six weeks of the cholera outbreak in Haiti, more than 2,000 people died. During the same time, many more people in poor countries around the world died from the other health problem, an estimated 210,000.  But hardly anyone noticed.

“This is a silent killer,” said David Winder, an international aid executive in Washington who has been dealing with public health for decades.

Cholera and the bigger problem are cousins. Both are forms of diarrhea. But the more common, forms of diarrhea are far more widespread and far more deadly. Cholera kills about 120,000 people a year; the more common forms of diarrhea kill 15 times more people, about 1.8 million a year, 5,000 a day.  Hard to believe when you live in the United States or Europe; but in poor countries diarrhea is a persistent killer.

Cholera gets the headlines for good reason. It can kill in hours rather than days as with other kinds of diarrhea. “It’s very dramatic,” said Dr. Gordon M. Dickinson, a University of Miami specialist on infectious diseases at the Veterans Hospital in Miami.  People become dehydrated, go into shock and die. The other forms of diarrhea kill the same way.  But there is more time to react.

Children are the main victims. More of them die of severe diarrhea than from HIV/AIDS, malaria and measles all together.   Yet the problem has not captured the imagination.

“People think of diarrhea as a temporary illness associated with something like bad food,” said Brenda McIlwraith, a spokeswoman for WaterAid, a non-profit organization in London, working to reduce diarrhea around the world.

Very little progress is being made.  In Haiti, “diarrhea is here all the time,” said Christian Lindmeier, a spokesman for the World Health Organization in Port-au-Prince. In the first wave of cholera deaths, he said by telephone, people thought “it was just another diarrhea” and they did not seek treatment.

Cholera and the other forms of diarrhea are preventable. “We know how to deal with these diseases,” said Dr. Claire-Lise Chaignat, the head of the World Health Organization’s Global Task Force on Cholera Control in Geneva. The bacteria, parasites and viruses that cause the diseases travel in drinking water. They get into the water and, sometimes, food, along with human waste, as sewage and on dirty hands. All that needs to be done to fix the problem is to provide clean drinking water, basic toilets and some tips on hygiene.

But the scale of the problem is staggering. About 1 billion people do not have clean drinking water, the United Nations estimates, and 2.6 billion, nearly 40 percent of the world’s 7 billion people, don’t have toilets.

It could take $50 billion dollars to put a big dent in the problem. No one is sure. But right now, Mr. Winder, the head of WaterAid in America, says spending “is far below what’s needed.”

The United Nations anticipates spending $164 million to tamp down a cholera epidemic that may sicken as many as 400,000 Haitians. Only about 20 percent of the money had been raised as the epidemic settled in. But it is a real spending target. And that is a lot of money in proportion to total spending in Haiti on public health.

Spending that kind of money in advance in Haiti on clean water and toilets would have saved lives. It would have made it harder for cholera to get going. It would have been the right thing to do economically, too. Half the hospital beds in the poor countries are filled with patients with severe diarrhea. That is a daily recurring cost. Improving sanitation would reduce those costs. It would also reduce days lost at work and from school.

Doctors and engineers may know how to solve the diarrhea problem, but every day there is evidence that it is not easy. Hundreds of aid agencies are working on it, but the work is piecemeal and sometimes counter-productive. In some places, Dr. Chaignat said, the people responsible for health and water “rarely talk to each other. The health sector doesn’t understand the water sector and vice versa.”

So the plague of diarrheal diseases grinds on. The people suffering most have no political clout. They are poor and they die quietly. Sometimes they make it to hospitals. But often they die in huts and shacks and out-of-the way places. One at a time. You don’t hear about it. #

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Jan 29 2010

A Drinking Water Crisis In Haiti Long Before Earthquake Destruction

Published by Joseph B. Treaster under OneWater.org

MIAMI—Long before the earthquake, Haiti was mired in a crisis that only a few experts noticed – a severe lack of clean drinking water.

The country’s 10 million people had drinking water from springs and rivers and wells and a broken-down municipal water system in the capital, Port-Au-Prince. But a great deal of the water was loaded with bacteria and parasites and, in some cases, chemicals and other pollutants.

The foul water undermined everything in Haiti. It caused chronic diarrhea, dysentery, hepatitis and even typhoid and cholera. The diseases filled hospital beds, kept children out of school and grown ups from work. And the water-borne diseases caused death. The Pan American Health Organization estimates that half of all the deaths in Haiti in recent years — apart from those in calamities like floods and hurricanes — have been the result of water-borne diseases. In most cases, severe diarrhea took hold. People became
dehydrated and very quickly were gone.

Many countries share Haiti’s plight. According to the World Health Organization, at least 1 billion people around the world do not have clean drinking water. Even more do not have toilets. The lack of clean water and toilets is a disaster. Each year, about two million people die from water-borne diseases. That is eight times the deaths in the Asian tsunami in 2004, and it happens every year. It is not on the radar of most Americans.

Most of the victims are young children. They die quietly, at home and in little clinics in slums and out-of-the way places in the countryside in India and Nepal, in Bolivia and Honduras. Hardly anyone notices that, according to United Nations data, more children die from simply drinking unhealthy water than from HIV/AIDS, malaria and measles combined.

These people do not have to die. All the technology for providing clean drinking water exists. It is not very complicated and it is not incredibly expensive. But almost nowhere in the developing world does clean water get high priority. Drilling wells and running pipelines and building water purification plants have never really captured the imagination of political leaders. The people who suffer most are the poorest, the hungriest, the least influential.

It is not that nothing is being done about providing clean water. Even in Haiti, many water projects were underway before the earthquake. Some had budgets in the millions of dollars. Some involved small private groups that were able to put in a few wells or a few dozen water treatment devices. One group, International Action, says it has installed 110 neighborhood water tank chlorinators in Port-au-Prince. But in Haiti and elsewhere, the efforts have scarcely made a dent.

Nowhere in the developing world is there a plan that coordinates national or region water projects, small and large. Inevitably, some of the good work overlaps. Some of it never gets finished. Quite often maintenance is overlooked and systems collapse. For example, in Kampala, the capital of Uganda, drinking water is fine at the treatment plant. But the water mains are corroded and punctured. They lie in the same trenches as the sewer lines and filthy waste sloshes into the drinking water.

As the rebuilding of Haiti gets underway, billions of dollars are going to be spent. Some of those dollars, perhaps a billion or more, should be dedicated to cleaning up the country’s drinking water and to making sure it stays clean. It would help put Haiti on a sound footing for the future perhaps more than any other single thing. A well-orchestrated plan for providing clean drinking water to the people of Haiti could be a model for the world. #

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Sep 24 2009

A Fixable Problem Remains Unresolved And Kids Keep Dying

Published by Joseph B. Treaster under Uncategorized

WASHINGTON—Dirty water is killing kids–lots of kids. The magnitude of the deaths is staggering, perhaps 5,000 a day, 1.8 million a year – more deaths annually than the combined total from malaria, measles and HIV/AIDS.

And who’s talking about it? Who is outraged? Practically no one. It is a problem that is virtually unknown in the United States and Europe. The victims are poor children in poor families throughout most of Africa and in remote parts of Asia.

Specialists in water and health are working on the problem and spending lots of money. But some experts say that progress has been meager and that the situation could be getting even worse.

The deaths come quickly and simply. Kids drink the only water they can get. It is loaded with bacteria. They get diarrhea, which is a manifestation of many diseases, including cholera. They get dehydrated and before their parents realize how bad things have gotten the kids are gone. Some grownups die, too. But mostly the 1.8 million victims annually are children, five years old and younger. Millions of kids don’t die from diarrhea. But their illnesses strain already strained hospitals and clinics. By some estimates kids sick with diarrhea miss nearly 300 million school days a year.

This has been going on for decades, almost unbelievable rates of death and sickness among millions of kids. They and their families cannot solve the problem on their own. And they are not getting enough help to break the pattern. They are stuck in a vast pool of nearly 1 billion people around the world who do not have dependable access to clean water every day. Most of them are also among the 2.5 billion people who do not have even the most basic toilets. Without a good supply of clean water and without toilets, disease, sickness and death are almost guaranteed.

The International Federation of Red Cross and Red Crescent Societies, which works in the most awful places and is not given to hysteria, said earlier this year that it had been seeing an increase in cases of water-related diseases that cause diarrhea, including cholera. Uli Jaspers, the head of water and sanitation for the federation at its headquarters in Geneva, said in a statement that “data suggests we may be losing the battle.”

Hundreds if not thousands of people in government and private agencies are devoting their energies to stopping the silent epidemic. Often times the work is one person, one-village, one school at a time. Paul Faeth, the president of Global Water Challenge, a group of organizations here in Washington committed to working against water-related diseases, is getting soap and water to schools in Africa. Sally Cowal, a water expert at Population Services International, also in Washington, provides several low-cost ways of purifying water. They are both having successes, they said at a conference here presented by UPI.com, the Internet incarnation of a former news agency that competed with the Associated Press and Reuters. But they also acknowledge that what they are doing is not enough.

Katherine Bliss, a deputy director at the Center for Strategic and International Studies in Washington, said at the UPI conference that about $18 billion a year is needed to meet the United Nations’ goal of deeply reducing the problem of water and disease or about three times more than is now being spent worldwide.

But the barrier to a solution is not just money. Often people with the best intentions are working at cross purposes. According to a recent report by several environmental groups, including units of the United Nations and the Nature Conservancy, efforts around the world to provide clean water and sanitation are “plagued by institutional fragmentation that may result in governmental agencies working against each other” in pursuit of their own strategic objectives.

There is no coordinating body or global clearing house for work related to water, Ms. Bliss said, no one seeing that the work of governments and non-governmental organizations complement each other, don’t duplicate, don’t cancel out some other effort. For HIV/AIDS there is the United Nations organization, UNAIDS. Tuberculosis, malaria and HIV/AIDS come under the aegis of the Global Fund to Fight Aids. Water has no similar counterpart.

“Within the United Nations,” Ms. Bliss said, “water and sanitation activities are managed across 26 different technical agencies.” And no one is in charge. The work of the agencies is officially coordinated by the United Nations Water Office. But it does not have enough clout to have much impact.

For now, this is a problem that looks like it can be fixed. But it is a problem that is not getting the attention, the money and the coordination it needs. #

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