Can you drink this?

I arrived in South Africa at the end of August to start a 4 month Public Health seminar based out of Durban. The program is run through an American university called the School for International Training. The school is based on experiential learning with an international experience. I am currently in my last year of undergraduate work at the University of Puget Sound (near Seattle Washington) studying Biology on a pre-health track.

After 2 months of lectures, homestays and field experience in Durban, we were able to design a study project to conduct over a month long period. Several of the lectures were focused on rural medicine and the public health sector. We were also taught about the consequences of sanitation, hygiene and water quality and their importance in the community. One of the Millennium Development goals, set by UNICEF, was to decrease child mortality by 2/3 by the year 2015. One of the major contributors to child mortality is poor water quality combined with sanitation as well as hygiene. About 1.7 million children under the age of five, die annually due to complications caused by diarrhoeal diseases. Of that number, 88% are attributed to unsafe water supply, inadequate sanitation and hygiene. South Africa has pledged to provide safe water to all by 2008 and adequate sanitation by 2010.

I had done a water quality study in Tanzania in 2006 and wanted to continue with the theme but I wanted to conduct the study in a rural environment where these issues are known to be a major problem. A study done recently at Zithulele Hospital found that only 20% of the population had access to piped water sources. The region is one of the poorest in the country. The unemployment rate is 77% and only 9% of the population has access to electricity. A non-profit Foundation, the Jabulani Rural Health Foundation, has recently been established to assist with development work in the community. Their emphasis is on health related interventions.

The first part of my project involved interviewing the mothers who came into Zithulele. I focused on the women in the Paediatric ward with their children, but also interviewed several from the outpatients department (OPD). With the help of a translator I asked them several questions about their water collection, feeding habits and sanitation issues. Based on the interviews, I was able to gain a greater knowledge of the issues at hand in the community. I found that out of the 80 women I interviewed, only 29% of them had access to a toilet facility and 71% were forced to use the forests. In the past, using the forest as a toilet, was not a major issue because the pigs would clean up the human faeces. However, because of a swine fever outbreak in 2005/6, the forests are left contaminated and the rain sweeps everything into the rivers and streams which is where 81% of the women interviewed go to collect their water.

Almost two thirds of the women said that the water that was collected was not clean and therefore unsafe to drink. Nevertheless, seventy-two percent of mothers do not boil their water or use any filtration methods. It seems that education would play a key role in decreasing child mortality in this area. It is possible that the mothers are not aware of the consequences that correlate to feeding their children water contaminated with bacteria. Another contributing factor may be the economic cost of fuel or time collecting wood.

I was also able to test the water of 17 different sites around Zithulele. I tested the two major rivers, several different tributaries, communal taps put in by the government, rain barrels, a pond, and two different sources in the hospital. Only two sources were fit for human consumption according to WHO standards. Both were treated by the hospital. The rivers were both contaminated with possible E.coli and total coliform levels that made the water unfit to drink. Both of the rain barrels tested had high levels of coliforms but only one of them had suspected E.coli. Of the five different communal taps, 3 of them had evidence of E.coli. The only tap that proved to be safe for human consumption was on the grounds of the church near the hospital. The church founded the hospital, thus this tap is supplied by treated water from the hospital. The Paediatric ward in the hospital is also okay to drink in terms of the microbiological aspects.

The Foundation hopes to develop an intervention to help the community access safe water. A cornerstone of this will be education; the community can learn about the dangers of contaminated water as well as the importance of basic sanitation. The simple process of washing your hands with soap has been shown to decrease diarrhoeal diseases in children, by 45%!

By Emily Clasen