Estimable lives in a very small earth-walled home near a drainage channel running along a dirt road. The land around her is almost all mud and the road is under a foot of water in places. Floods plague her village, called Lameau, in the community of Grande-Saline in Haiti’s Artibonite River valley.
This is one of Haiti’s most productive agricultural areas, and over the years, the government and international donors have built a network of canals and channels, to divert water to dry areas, and drain out the wet ones. Small villages line these channels. Just after the harvest, many are drying their rice crop on tarps on the side of the road, near their small homes, some of which are quaint wooden houses that resemble gingerbread cottages. Others are more modest earth-walled dwellings. Children play and swim in the channels, laughing and splashing in the sun.
It looks idyllic but the Artibonite River valley can be a tough place to live, Estimable says. “When there’s too much water in our houses, in our fields, we get upset stomachs. It’s very hard to live here with so much water.” The lack of clean water in 2010 after one particularly rainy period coincided with a cholera outbreak which killed 300 people in this area, according to local officials.
Grande-Saline’s mayor, Erole Romeus, drew up a plan to clear out the mud and vegetation choking six kilometers (3.75 miles) of the secondary channels like the one near Estimable’s house. He’s also hired heavy equipment to widen them to handle more water flow. The project is employing two 132-member work teams in a cash-for-work program that provides much needed wages of about five dollars a day for 12 days. The project prioritizes hiring people living near the channels. About 2,000 people in 400 households live in this area and will benefit from better flood control.
Sansion Morisette is one of the workers; she has just spent the morning raking weeds out of the narrow channel running along the road next to Estimable’s house. “It’s about time we started this work,” she says. “I’m out on the street now because water destroyed my house in Rossignol. Take a look around you, we’re lucky if we can get two bags of rice out of our harvest sometimes, the water just eats everything we grow.”
Mayor Romeus says the project in Grande-Saline should take the community a long way towards reducing flooding, especially during the annual hurricane season. “Every time it rains, we can have 200 to 300 small houses destroyed,” he says standing on a flooded road next to the drainage channel, where scores of workers in white t-shirts are clearing away plants and other debris.
“We started talking about rehabilitating these channels as a means to deliver a durable solution to the people here,” Romeus says. “We came to Oxfam America because it is an organization that is interested in helping vulnerable people reduce the risks of disasters.
“Since we cleared all this out, people will probably have an opportunity to harvest. But if we did not, in another week we would have been in danger: the people, crops, and animals.”
Oxfam is devoting $20,000 for this project, which is covering about half the costs and supports the cash-for-work component, wages for heavy equipment operators, and fuel. It’s part of a larger program to reduce vulnerability to disasters in the countryside, and make it easier for people to make a living in farming, an alternative to the overcrowded conditions in Port-au-Prince.
Sancion Morisette is optimistic that the newly rehabilitated channels will help them. “Now I know that when it rains, the water will flow in the channel and go directly to the sea.”
]]>That was 15 years ago. Today, clean water in the small communities of El Recuerdo and Agua Zarca is as precious as ever—and still hard to get. There's no turning on the tap over a kitchen sink and letting the gallons gush. Here, many people trudge to a communal source, fill their jugs, and lug the heavy load home again. But seasonal flooding—sometimes hugely destructive and, with climate change, possibly becoming more severe—contaminates many of the area's hand-dug wells, exposing people to waterborne illnesses.
But now, with the help of Oxfam America and its local partner, PROVIDA, the well that Cruz worked so hard to dig on the school grounds in El Recuerdo is pumping enough clean water to satisfy the drinking needs not only of the students but of about 80 families in the surrounding area. The well is one of five "healthy wells" in southern Zacatecoluca province PROVIDA lined, surrounded with a filter, capped to ensure its cleanliness, and outfitted with a pump that sends water to a large tank for chlorination and storage.
"The families in this area are living in extreme poverty, living as subsistence farmers or low paid day laborers in the nearby sugar cane plantations," says Karina Copen, an Oxfam humanitarian program officer. "They face numerous challenges in having to adapt to the increased frequency and intensity of the flooding in their area. With access to a healthy well, they can at least know that in the next flood, they will have a safe source of water for their families and the good health that comes along with it."
Adaptations, such as these healthy wells, are essential for Salvadoran families living in the department of La Paz in the lower region of the Lempa River where seasonal rains, tropical depressions, and hurricanes, make it one of the country's most flood-prone areas.
Coupled with those natural hazards is the fact that communities in the region have significantly less access to improved water sources and sanitation than other parts of the country. The "healthy wells" along with 27 new composting latrines have been a boon to families in the area.
"Kids are getting sick less; families are healthier," says Santos Efrain Coto, one of the local leaders in El Recuerdo. "When they drank contaminated water they got diarrhea and parasites."
The improved wells are based on a model that's new to El Salvador and designed by an organization called Swiss Labour Assistance. Besides having their tops sealed with cement to prevent polluted flood waters from slopping in, the wells are lined with a type of plastic pipe, known as polyvinyl chloride, or PVC, that extends down into the aquifer. Packed around the outside of the lining is a filter of volcanic rock that prevents contamination from seeping through underground.
At the El Recuerdo school one day recently, teacher Ana Elsa Cubias describes how students used to bring their own water from home to drink during the school day. Now, the refurbished well guarantees them a clean supply right on the spot.
"They're drinking water from a protected source and the kids have water right in the classroom," says Cubias.
A short distance from the classrooms sits a large plastic tank, sky blue and able to hold 1,100 liters of water pumped fresh from the well. Chlorinated, the water from the tank flows to two taps standing just outside the gates to the school. They're accessible to whoever is driving or walking by. And to ensure the stored water stays safe for drinking, the water committee arranges to have the tank cleaned every couple of weeks—a task that falls to a child small enough to wiggle inside and scrub the interior walls with a brush and bleach.
"We make sure he bathes before he gets in the tank," adds Coto, the local leader.
In Agua Zarca, a few communities over, Jose Luis Funes Cruze says that before PROVIDA and Oxfam installed the new well, most of the local residents depended on their own backyard wells for drinking water—and that was a problem.
"The household wells take on a lot of rain water and a lot of filthy water when there's flooding," says Cruz, pointing in the direction of the polluted San Antonio River, which spills its banks during big storms. "The things people throw in—there are pigs up river. And the cheese factory is up river."
In the past, when their drinking supply has been contaminated, families in Agua Zarca have had to rely on the government or aid groups to truck in drinking water for them.
But now, with a new communal well their supply of drinking water is much improved.
"We're very grateful—the whole community is—to have that water," says Blanca Lidia Jiménez, who lives close to the well makes about six trips a day to fetch enough water for the seven people in her house. "We don't get sick so much when we drink the water from this well. The little kids would get swollen bellies, but with the new well that problem has been solved."
Still, the situation in Agua Zarca points to the challenges of providing clean water in this area. The community's new well was built on the only land available: next to a cow pasture—an arrangement that could be problematic during the wet season when rain sloshes manure about and allows it to seep into the groundwater.
The deep plastic lining on the well and its volcanic-rock filter help, though, says Guillermo Morán, a professor and researcher at the University of El Salvador's Earth Sciences Institute. He worked with Oxfam America and another of its partners, the Harvard Humanitarian Initiative (HHI), to evaluate the effectiveness of the wells while studying the health practices of families who use them.
The study is an important component of Oxfam's public health work: It promotes accountability and offers a different model for aid groups by linking their work with that of universities.
"We have the field experience and they have the technical expertise," says Miriam Aschkenasy, Oxfam America's public health specialist. "Together we're able to evaluate programs at a higher standard and at one that increases accountability."
In its draft report, HHI said that individuals who live in communities with "healthy wells" were less likely to have diarrhea and reported fewer cases of the illness during the time of the study. But the draft report also revealed that in two of those communities, some people were still using hand-dug wells for their drinking water while other people from places without "healthy wells" were making the trek to a community that had one to fetch their water.
"The study gives us insight in a way we couldn't have anticipated," says Aschkenasy. "It gives us an idea of where to focus in the future. We now know we need to find a way to encourage people who are still relying on the hand-dug wells to use the healthy ones instead. And it gives us great incentive to build more of them."
]]>Tacked to the outside wall of a government office building in Zimbabwe, the warning served notice to all who could read English that Mudzi district is in the throes of a major public health crisis.
Like wildfire, hot spots of cholera—a waterborne diarrheal disease that can kill quickly if not treated properly-- continued to erupt in late January in this rural northeast region on the border with Mozambique. I heard about the spikes—and the challenge of stopping their spread—at the morning meetings at Kotwa hospital, where aid groups and government health officials gather to coordinate each day’s attack on the disease. Oxfam and its local partner, Single Parents Widow(er)s Support Network, or SPWSnet, are among those responding to the crisis.
Fanning out from the hospital grounds, a small team of nurses, water engineers, and public health promoters hit the road each day, traveling up to two hours to reach the more remote areas where people need everything from clean water to basic information about cholera prevention. And they return each night—sometimes long after dark—to prepare their reports for the next morning.
The news they deliver, along with their statistics, is often unsettling: Reports of people drinking from a stream in which others are washing dirty clothes and dishes; shortages of oral rehydration salts and disinfectant; an ox cart toting a patient who died before reaching a clinic. All of it paints a picture of a country crippled by hyperinflation and failing water and sanitation systems. In Mudzi, less than a third of the households have access to proper latrines, according to one estimate.
Already cholera has sickened close to 85,000 people across Zimbabwe, killing more than 3,900 of them as of Feb. 6. The World Health Organization has called it one of the largest outbreaks ever recorded. And Mudzi, poor and far from central areas of commerce and government activity, has been one of the hardest-hit districts.
Here, in Mudzi, fear of the disease is palpable. Fist bumps have replaced handshakes as people worry that palm-to-palm contact could transmit cholera. Some people are even afraid to eat, though of course they must, one man tells me.
“We are not settled,” says the man, Wonderful Nyatsuto, as he helps a SPWSnet engineer repair a deep well, known as a bore hole, about a mile and a half from his home. About 15 people in his village have contracted the disease, he says, and a third of those have died. Cases of cholera started to erupt when people began fetching their water from a nearby river after the bore hole stopped functioning. Across Mudzi, many of the region’s 600-plus boreholes no longer work and communities are too poor to repair them. But without a supply of clean water, residents face a growing danger from the disease.
“We are trying to maintain the rules they tell us,” Nyatsuto adds. “Boil water. Clean hands before you eat. Clean the toilet.”
Still, in a region where many locals supplement their meager incomes by panning for gold in a network of streams and drink the contaminated water as they labor, people are continuing to get sick.
But getting to a clinic is no easy matter. Functioning ones are few and far between. Some have no medicines. Others have no medical equipment. And so sick people trudge great distances to get the care they need. Roads are rough, sometimes barely more than tracks through the bush, cars are scarce, and fuel is both dear and hard to find—even for aid workers who have access to outside resources to buy what they need. Sometimes, aid groups have to send vehicles all the way back to Harare, the capital, a two-and-a-half hour drive from the Kotwa hospital, to scrounge for a small supply of fuel that they can port back to keep their trucks in Mudzi running.
One day in late January, 49 patients packed a clinic in Makaha, a ward in Mudzi where cases of cholera were suddenly spiking. A series of tents and one dimly lit concrete room served as wards for people stretched out, limp and mostly silent, on cholera cots—beds with large holes cut in the middle beneath which buckets are placed.
Snaking between the tents and the out buildings was a narrow path of mud bricks powdered, here and there, with flecks of white—the remnants of the dried lime-chloride used to disinfect contaminated surfaces. Mixed with water, a jug of it sat at the exit of the clinic, a reminder to all visitors to give their hands a thorough dousing.
As she finished hosing down an empty cot with the chloride solution, a nurse, her face flat with exhaustion, described some of the misery she had witnessed in the last few days. A mother, six months pregnant and very sick with cholera had managed to get herself to the clinic only to lose her baby. The next day, her husband arrived with their five-year-old son whom he had carried more than 16 kilometers from their home in search of help. Weak with cholera, the boy had died en route. And now the husband was gravely ill, too. The nurse was uncertain whether he would survive.
Behind her, on a shelf, stood a plastic barrel—a mini storage tank for the mixture of oral rehydration salts that were helping to keep the clinic’s patients alive. But the barrel had barely two inches of liquid left in it—nowhere near enough to sustain all those who desperately needed the sugar-and-salt mixture. And there was no more solution anywhere else in the clinic. Fortunately, we had a small supply of rehydration packets in our Oxfam truck and immediately gave them to the nurse. But that’s not all she needed. The clinic had just two doses left of ciprofloxacin, an antibiotic used to treat a variety of bacterial infections including severe cases of diarrhea.
Beyond the tents, was the observation area—a patch of dirt in the shade of a large tree. Here, patients waiting to be admitted slumped on the ground and those who had improved continued to rest before making the journey home. Outside the gate to the clinic, family members huddled around small cooking fires, the smoke curling around them. They were preparing food for the patients inside—a kindness that was also a cause of concern to nurses who feared cholera could soon sweep through the family support network.
Compounding the challenge of treating cholera is the widespread hunger many people in Zimbabwe are now confronting in the months leading up to the next harvest. Hunger has left people weak and more vulnerable to the disease.
The World Food Program plans to feed more than five million people in February, the greatest number in a single month since 2002. But because more people need food, the program is reducing ration size so that it can stretch its stocks far enough to accommodate everyone.
For some families, even coming up with the basics to fight cholera—such as sugar for a rehydration solution—can be daunting. Dutchman Matika tells of having to borrow sugar from a neighbor to make his wife the solution when she came down with cholera. As he speaks, two of his young sons listen intently, their hair tinged with orange—a sign of malnutrition. With 11 children and three wives in his household, Matika says mealie meal—a local staple—is in short supply.
“When you walk around, you see it,” says an aid worker about the malnutrition that has followed on the heels of several poor harvests and that’s affecting people most acutely in the interior of the country. “Poppy tummies. That’s one of the very clear indications. It’s mainly in kids. And you get wasting away in adults.”
But this year, in Mudzi, there are signs the next harvest may be better. While there is never enough fertilizer to guarantee robust crops, the rains during the current wet season have been unusually plentiful. Where corn and sorghum, millet and ground nuts have been planted, green shoots abound—slivers of hope for the future.
]]>There, on the shore behind what's left of a half-constructed mansion, the chug-chug-chug of a diesel pump holds the promise of clean water for 11,042 people at Buhimba camp. They are just some of more than one million villagers forced to flee their homes as conflict has swept across the eastern provinces of that vast country. A short distance away, a second pump, submerged deep in the lake, provides water for an additional 18,016 people in two other camps known as Mugunga I and II.
Without clean water, without decent sanitation, and without the public health outreach that helps people understand the link between the two, waterborne diseases could ripple through theses camps with devastating consequences. That's what Oxfam, together with its local partner, Action Santé Femme, or ASAF, was determined to prevent when it helped establish the water systems for these three camps—and a fourth, Bulengo—outside Goma, the capital of North Kivu province. Through a network of rigid plastic pipes, storage tanks, and outdoor faucets, water from Lake Kivu now gushes into the jerry cans of thousands of families with the turn of a tap.
At the top of a short but steep hill at Buhimba, where two massive water storage tanks frame the sprawling camp below, Helene Kanyere Ndakas stands ready with a notebook in hand. She is the manager of this storage station—and knows better than almost anybody the importance of making sure the system runs smoothly.
What gives her that special knowledge?
Ndakas herself relies on the water that flows from it. She and her family are among the thousands of people who are now making their homes temporarily at Buhimba.
Flipping her notebook open, Ndakas points to the careful records she keeps each time she opens the valves to refill the tanks with lake water. And she notes the amount of chlorine that goes in to guarantee its cleanliness. Hired by Oxfam, Ndakas is on water duty from 6am to 4pm each day—a job she takes very seriously.
"People are depending on her," says Charles Mampasu, an Oxfam program manager in Goma. "And they're happy with her job."
In a place where there was little or no infrastructure to support a water system, supplying tens of thousands of people with clean water on an emergency basis has been no small feat. And making sure they continue to have access to it when Oxfam moves on to its next project is one of the organization's central concerns. That's why Oxfam is working hand-in-hand with ASAF to help it build its ability to handle the water system on its own, particularly in Mugunga camps.
A tour through Mugunga I shows how important a steady supply of clean water can be—especially when people are struggling with such harsh living conditions. Built on fields of sharp volcanic rocks, the shelters many people now call home are not even tall enough in which to stand. Made from grasses and dried banana leaves flung over a frame of saplings and topped with a plastic sheet, the huts offer only minimal protection from the elements. To keep warm—and to drive the bugs out—many people cook on small wood fires inside their huts, the smoke curling into their lungs and out through the cracks in the shelter walls.
At the health clinic, the nurse on duty reports that respiratory infections are among the most common medical problems he sees. About 150 people a day flock to the clinic with a host of ailments that also include malaria, tuberculosis, and diarrhea. The latter is what the clean water—and scores of latrines that Oxfam has also installed—help to fight.
Snaking across the rocks, over roots, and through the mud, a network of wide black plastic pipes carries the water from Lake Kivu. It's replacing a temporary supply that another agency had been trucking in daily and storing in two plump water bladders—they look like giant egg yokes when full—at a cost of $3,500 a week. Nearby, the water blasts from faucets when kids turn on the taps to fill plastic jugs before lugging them home.
The water jug of choice for many kids has a familiar look: it's the container that once carried their family's allotment of cooking oil, doled out during the regular food distributions that displaced people have no choice but to depend on. Here at Mugunga, nothing goes to waste—not the jugs, and not the precious water they carry.
]]>Amid cheers from a throng of enthusiastic supporters and international media, Make Trade Fair won the day.
Oxfam's trade campaign was launched.
Within hours of the Hong Kong debut, events were held in 25 cities including Brussels, Dublin, Geneva, Mexico City, San Salvador, and Washington, D.C. These events ranged from press conferences and symposiums to a rock concert in London’s Trafalgar Square.
Oxfam's trade campaign seeks to unite concerned citizens around the world in calling for fair trade policies that will help move millions of people out of poverty.
Nobel Prize Professor Amartya Sen, UN Secretary-General Kofi Annan, and musician and social activist Bono were among those who endorsed the campaign. "Oxfam has got it right," said Bono. "It wouldn't cost much to change the rules of trade so that poor countries can work their way out of poverty. But the world's leaders won't act unless they hear enough people telling them."
Also in this issue of EXCHANGE, writers Frances and Anna Lappé discuss their book Hope's Edge: The Next Diet for a Small Planet, and we bring you updates on Oxfam's work with water and sanitation, drought in Ethiopia, and indigenous women in the highlands of Peru who are speaking out after decades of violence.
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