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. #

No responses yet

Jun 03 2010

In The War On Malaria Some Hopeful Signs, But A Long Way to Go

Published by Joseph B. Treaster under OneWater.org

KISUMU, Kenya—The rainy season in East Africa is also the malaria season.

Rain water collects in puddles and old tires and gutters. It also accumulates in discarded tin cans and in the folds of plastic shopping bags in garbage heaps. Malarial mosquitoes lay their eggs in the stagnant water and pretty soon you have killer mosquitoes hatching.

Around the world more than 800,000 people die every year from malaria, mostly young children. More than 90 percent of the deaths are in Africa, and Kenya is among a handful of African countries where the disease is at its worst.

The red clay flatlands and hills here in western Kenya, around Lake Victoria and the hard-scrabble city of Kisumu, lie in the worst part of a bad malaria zone - ground zero in Kenya. “There’s a very high chance of getting malaria here,” said Tom Guda, a Kenyan researcher at the International Center of Insect Physiology and Ecology in the nearby lake shore town of Mbita.

Western Kenya is an ideal place to study malaria and American and Kenyan researchers have been working together here for years at a joint laboratory of the Centers for Disease Control and Prevention and the Kenya Medical Research Institute. The Centers for Disease Control and Prevention, one of the main research institutes in the United States for malaria and other infectious diseases, began nearly 70 years ago as an important player in the ultimate elimination of malaria in the United States.

In the last few years malaria has caught the imagination of Hollywood entertainers, government leaders around the world, gazillionaires and ordinary people. Lots of money has been raised. The World Health Organization estimates that $1.7 billion was available for malaria in 2009, double the amount just three years earlier. The American Idol television show, alone, raised $9 million for the organization Malaria No More during a single charity broadcast, and the Bill and Melinda Gates Foundation has put more than $168 million into overcoming the disease.

This may be a time of great progress against malaria. But it is hard to be sure. The latest data compiled by the World Health Organization shows little change in recent years: 863,000 deaths and 243 million cases of malaria reported in 2008 compared with 881,000 deaths and 247 million infections two years earlier. But experts say that record-keeping on malaria is poor and that the numbers don’t tell the whole story.

Much of the malaria money is going into buying and handing out mosquito nets saturated with insect repellant–at $10 each–

and to spraying insecticide on the inside walls of houses. And it may be paying off.

“We know that sleeping under insect nets is effective and we know that the number of people sleeping under nets is increasing rapidly,” said Dr. Matthew Lynch, the director of the Global Program on Malaria at the Johns Hopkins Bloomberg School of Public Health in Baltimore in an interview.

Richard Tren, the director of Africa Fighting Malaria, a small organization with offices in Durban, South Africa and in Washington, told me that “progress in some places is phenomenal.” But, he added, “there are a lot of other places where things are not working.”

The World Health Organization says it believes there have been big gains against malaria in some small countries, including Rwanda and Zambia and on the island of Zanzibar off East Africa. But it is urging that anti-malaria efforts be concentrated more on bigger countries like the Democratic Republic of Congo and Nigeria, where malaria is rampant and where the situation has either gotten worse or not changed much.

At the Center for Insect Physiology and Ecology on Lake Victoria, Mr. Guda said that malaria infections and deaths are increasing in western Kenya.

“People are getting bed nets but it is still rising,” Mr. Guda told me one sweltering afternoon at his center. One reason, he said, is that “people are not using the nets properly.”

In the one-room huts that are home to many people here, Mr. Guda said, there is one bed. “The big people sleep in the bed,” with the net, he said. “The children sleep on the floor.”

Dr. Laurence Slutsker is the chief of the malaria branch at the Centers for Disease Control and Prevention in Atlanta, Ga. Dr. Slutsker, who worked at the Centers for Disease Control and Prevention laboratories in western Kenya for five years and still watches the area closely, said that after dropping sharply over the last 15 years, infections in children around here have begun to rise. Two years ago, 30 percent of those under five had malaria parasites in their blood. The latest samplings, he said, showed 40 percent were infected. Not a good sign.

The big picture on malaria around the world? “I think it’s getting better in some places,” Dr. Slutsker said in an interview. “I think it’s basically the same in other places. We talk about our success, which is good. But there’s a lot of work that needs to be done.” #

No responses yet

Mar 18 2010

Drinking Water Filthy But Big Money Goes To Build New Stadium

Published by Joseph B. Treaster under OneWater.org

MIAMI—The news was from South Africa. It was about an expensive new soccer stadium that had been built in a city where the drinking water is often dirty and many people have neither electric lights nor toilets.


It was an outsized example of what keeps happening with government spending in so much of the world and how it can be that decade after decade more than one billion people around the world struggle along without a reliable supply of clean drinking water. They are routinely sick and, each year, about two million die – mostly children.


They shouldn’t be dying. We know how to provide clean water and the cost is not overwhelming. But we’re not making much progress.


The barriers seem to involve human nature, politics and, often, good intentions: Instead of putting in wells and pumps and pipelines to get clean water to everyone, government officials put up hospitals and schools and sport facilities. Or they put their money into joint projects with businesses that promise to help the economy, and often do. Or they just squander the money, sometimes on themselves.


Compared with building hospitals and schools and even soccer stadiums, water projects are not that interesting. But clean drinking water underpins everything. More than half the people in hospitals in developing countries are there because they drank foul water. School attendance is much lower than it might be because children get sick from the only water available to them and can’t go to classes.


The United Nations, in its latest global report on water, said that work in this area “has been plagued by lack of political support, poor governance, under-resourcing and under-investment.” The U.N. estimated that $148 billion was needed for water projects over the next 20 years, but that somewhere between $33 billion and $81.5 billion might be available.


The story from South Africa involved much more money than is often in play. The soccer stadium cost $137 million. It was built as part of South Africa’s hosting of the World Cup games in the summer of 2010.  The stadium was put up in the city of Nelspruit, population 600,000, in northeastern South Africa.


The story in The New York Times got me thinking about water and injustice. The spending on the stadium was bad enough. But some of the money apparently went into people’s pockets and investigators are now recommending criminal charges. The corruption seems to have led to at least two murders.


It is hard to argue against any kind of development in countries that need almost everything. It is especially hard to oppose building hospitals. But using the money to fix the dirty water problem would cut back on the number of people who need hospital treatment. More kids would make it through school. Both would be good for economies.


The impact on the economy of spending to clean up drinking water might be more gradual than an investment in a factory or a high-tech center that could handle overseas business. But not long ago, a panel of experts on finance and water, led by Michel Camdessus, a former chairman of the International Monetary Fund, said that solving the drinking water problem would do more for reducing poverty and advancing other social goals “than almost any other conceivable actions.”


In Nelspruit in South Africa, Simon Magagula lives in a mud house on a dirt road near the new stadium. He talked with Barry Bearak of The New York Times and seemed to be saying that he thought the stadium was part of a plan to make things better in Nelspruit. But he said work on the stadium had provided fewer jobs than expected and that not much had changed. The drinking water is still a model of neglect.


“We’ve been promised a better life,” Mr. Magagula told the Times reporter, “but look how we live. If you pour water into a glass, you can see things moving inside.”


The soccer stadium in Nelspruitone of five built in South Africa for the World Cup games – is just one more example of the exciting things you can do with money, and how hard it is to get anyone to focus on the mundane work of making sure that people like Simon Magagula get clean drinking water. #


One response so far

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. #

One response so far

Dec 31 2009

Why Jessica Biel Is Climbing Kilimanjaro Without Timberlake

Published by Joseph B. Treaster under OneWater.org

MIAMI—When Wold Zemedkun was in high school in Ethiopia he decided to take a sample of the water his family drank every day to his biology class. The water came from a nearby river. It was sparkling clear and tasted fine.

“We put it under a microscope and that clear water was completely full of moving creatures, billions of them,” Mr. Zemedkun told me in an interview.  Maybe it wasn’t actually billions of creatures, but he remembers the water as shockingly unhealthy.

It was stories like that, said Mr. Zemedkun’s son, the singer-song writer Kenna, that inspired him to organize an expedition of Hollywood entertainers and others to climb the highest mountain in Africa, Mt. Kilimanjaro, to attract attention to the problem of unsafe drinking water in developing countries.

Among those who have signed up for the expedition early in 2010 are actors Jessica Biel and Isabel Lucas, hip-hoppers Lupe Fiasco and Santigold and Alexandra Cousteau, the granddaughter of the underwater explorer, Jacques Cousteau. She is the founder of an organization called “Blue Legacy” that focuses on water problems.

Kenna says that on a snowboarding outing he told his friend and actor Justin Timberlake about the climb and that Justin was “super excited about it.”

But by the time the expedition was scheduled, Justin had already committed to making a new movie, “Social  Network.” Justin and Jessica were together at a party in Los Angeles to publicize the climb. But Justin won’t be climbing.

Around the world, experts say, at least 1 billion people routinely drink unsafe water. They are regularly sick. They miss work and they miss days at school. A ghastly number of them die each year—nearly 2 million, according to the World Health Organization, mostly children under the age of five.

Kenna was born in Ethiopia in East Africa and came to the United States with his parents when he was three. Africa is the part of the world where the most people are struggling with unhealthy drinking water. It is bad also in parts of Asia and Latin America.

As I spoke with Kenna’s father, the older man recalled the reaction of his high school biology teacher to the river water under the microscope.

“The professor says, ‘Is this what you drink? That’s what your whole family drinks?’ And I said, ‘yes.’ And he said, ‘And nobody gets sick?’ And I said, ‘We’re sick all the time.’”

The professor told Mr. Zemedkun the family should be boiling their drinking water. They took his advice. But no one ever come around to try to clean up the river or to offer the family and their neighbors disinfectants for the water. That is the way it goes for most people whose only drinking water is unhealthy. Almost no one is on the case.

The celebrity climb is being sponsored by Hewlett Packard, Procter & Gamble and Eddie Bauer.  The climbers will be using Hewlett Packard gear to blog and Twitter as they work their way up the mountain.

For a decade or so, Procter & Gamble, has been making a powder that people dissolve in their water to get rid of bacteria and other unwanted things. The company does not make money on the powder. It is sold mostly at cost. But it has gotten the company a lot of good publicity and it has made a tiny dent in the problem in developing countries.

Greg Allgood runs the program on clean drinking water at Procter & Gamble and he is going up the mountain with Kenna and the others.  At 50, he is the oldest of the climbers. He’s athletic and in good shape and he’s been training hard. Even so, he says he’s not sure he’ll make it to the top of Mt. Kilimanjaro. “I’m gong to do my very best,” Mr. Allgood said. “I have fantastic motivation—to help save kids by providing safe drinking water.”

Kenna told me he tried to climb Kilimanjaro a few years back as a quiet test of himself. He did not make it. And that’s another reason he organized the celebrity climb. #

For More on the Worldwide Water Crisis See: http://1h2o.org

2 responses so far

Jul 30 2009

A Promising Solution To Clean Water Problem Fails To Win Support

Published by Joseph B. Treaster under Uncategorized

ZURICH — When Martin Wegelin worked in Tanzania his three-year-old daughter’s playmate fell ill one morning. By afternoon the playmate, a boy who lived next door, was dead.

The boy routinely had been drinking water loaded with bacteria. He was stricken with diarrhea, became dehydrated and was gone before his parents realized how sick he was.

In Africa and other developing countries, diarrhea is at the top of the list of child-killers. Around the world, the World Health Organization says, 5,000 children die as a result of diarrhea every day; 1.8 million a year. Most of the children die because of drinking water that often looks clean but contains all kinds of bugs.

The boy’s death put Mr. Wegelin, a Swiss engineer who specializes in water and sanitation, on a mission. He determined that he would find a simple, low-cost way to purify drinking water. He developed a method that, in most cases, costs absolutely nothing. But 30 years later, only a few million of the nearly 1 billion people around the world who lack clean drinking water – and are often sick - are using his process called SODIS or Solar Water Disinfection.

Mr. Wegelin says the problem has to do with perception. “It is too simple,” he said in an interview in his government laboratory in the Zurich suburb of Duebendorf. “People think it can’t work.”

The only ingredients in Mr. Wegelin’s process are water, a discarded plastic bottle – the kind used everywhere for soft drinks and commercially packaged water – and sunlight. After six hours in bright sunlight the water is healthy to drink.

“It’s magical,” said Sally G. Cowal, a vice president and water specialist at PSI or Population Services International, a non-profit aid organization in Washington.

But water experts say there are several reasons that the process has never taken off, all fairly frustrating. For one thing, no one has been able to figure out how to make money with it. No big companies have gotten involved, as they have in producing chlorine tablets, liquid and powder that cost about a penny a day to purify water for a family of six. Not big money, but money.

Then there is the matter of the plastic bottle. Environmental groups hate the bottles. They are made from petroleum, their manufacture adds to global warming and they never go away: garbage dumps are filled with them and they are all over the oceans and the waterways. No one has a good word for them and at a time when some cities are banning plastic bottles from municipal vending machines, no government wants to back a program that depends on them.

Ten years ago, Ms. Cowal started a project on household treatment of water in developing countries and decided to go with the chlorine process. The water did not taste as good as sunshine cleaned water. But by using a product that could be sold, Population Services International could do good and continue to do good. They sell the chlorine at a shade above cost, Ms. Cowal said, and put their sliver of profit “into promotion and advertising.” A perpetual motion machine. The sunshine machine gets a nod of approval from the United Nations, but no big allocation of money.

The sunshine method is not without its problems. For one thing, if it’s cloudy the process takes longer, and it is often hard for families to gauge how long. More importantly, making the process work requires a change of behavior for people who have routinely just been drinking water as it has come to them. “We come along,” Mr. Wegelin said, “and tell people, ‘You have another activity. You have to treat the water.’ That requires a change of habit. And changing habits takes time.”

Educating people about water treatment and disease requires aid organizations to invest time and energy and the lessons don’t always stick. It is less complicated to just pump in clean water. But the worldwide problem is so great, that billions of dollars are needed. And, so far, that money has not been forthcoming.

The big government aid agencies and big private aid organizations have strategic problems with the sunshine purification system, the chlorine process and low-cost filters, all designed to be used by individuals and families. They want high impact. They don’t want to do their work one family at a time. They prefer to install networks of standpipes and dig new wells that serve lots of people. Their way provides water to people who might have previously had to walk long distances to get water. It doesn’t always provide clean water. Or water that stays clean. But it works on a large scale. A lot of people get some improvement and aid managers get credit for the accomplishment. If the water quality is not perfect, people can boil it when they get home – or not. The water providers and the health service agencies are not always on the same page, which is one of the many reasons that deaths from water-borne diseases have declined very little in the last decade. #

No responses yet