sawyer report

Safe Water Access for

Rural Communities in

Ecuador

REPORT Nº1

March, 01-2012

Safe Water Access for rural communities in Ecuador.

March 1, 2012

Geovanny Santamaria. [email protected]

El Universo E-756 y Shyris – Quito-Ecuador

1. BACKGROUND

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.

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.

COAST

ANDES

AMAZON


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:

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.

Above: Introduction of the

filters in Ebano Community

in the coastal area

“…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)


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.

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.

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:

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

Region Community Filters People

Coast 2 100 520

Andes 1 190 980

Amazon 1 10 52

Currently, 1,552

people are

benefiting from

safe water

through the

Sawyer filters.

Training Needs:


March 1, 2012



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

filtered water…”

Baseline Application

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

“…everyone needs

clean water, if my

neighbor does not

have a filter, I

must share my

filtered water…”

Carlos, 52 yrs,

Tambayacu

Community (Amazon)


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.


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.


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, 4-

sufficient 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.


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,


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.


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.

Documents

sawyer report