Chances are that when it comes to clean drinking water, you are quite literally swimming in it. Most of us have such easy access to clean, healthy water that we can fill swimming pools with it, water our houseplants, take a bath whenever we want, leave the tap running while brushing our teeth, wash our clothes in it, heat our homes with it, use it for ice, entertain ourselves with it, play sports with it, relax to the sound of it running over decorative fountains, cook with as much of it as we like, and dump it down the drain if it doesn't taste fresh enough or cold enough for our liking.
What if you couldn't do this? What if you had no plumbing, or you did but couldn't trust the healthfulness of the water coming through the pipes? What if your choices were to drink unhealthy water, or buy expensive clean water?
Some of the homes in 28, 6, and Altos have running water, but if my observations at the school are any indication, plumbing works only intermittently. During our clinic week at the school, the water was turned off. We flushed toilets using buckets of water brought up from a rainwater cistern. We drank what we brought in bottles or purchased at a colmado, and refilled when necessary from a cooler holding clean water. Cleaning hands was done with hand sanitizer or by sacrificing a few precious drops of drinking water. I did this on occasion when my hands had gotten too grimy for sanitizer alone. It felt wasteful, because water was limited and clean hands seemed less important than hydration. When options are limited, your priorities become much more clear.
I previously mentioned the drainage ditches that flow from 28, 6, and Altos and curve around the West side of Esfuerzo.
These are full of runoff from the other neighborhoods - soap, garbage, silt, remnants of whatever has been scrubbed from floors, water that has seeped through burned trash, and potentially human waste as well.
Near Esfuerzo, runoff from the community joins the ditch. Keep in mind that there is no plumbing in any home in Esfuerzo. While some homes have pit toilets, others use containers, which must be emptied. Where are they being emptied? Your guess is as good as mine.
There is animal waste to be considered, as well. Pigs, horses, cattle, chickens, dogs, and cats roam this area.
The water in this ditch either sits stagnant (providing an ideal breeding place for mosquitoes carrying dengue or malaria), or flows into the river, where children play:
After Abel (on the right) showed me his flipping and diving skills, he refreshed himself with a drink from the river. I cringed and looked down at the bank next to me:
The adults - and, most likely, most of the kids - understand that drinking the water in the river is unhealthy. And in this particular situation, most kids would drink from the river (have you ever tried to prevent a kid from playing in or drinking from a river or lake?). The alternative, however, is to purchase water. Several homes in Esfuerzo run mini-colmados (corner stores). This one advertises "bags of water for sale."
I often saw empty baggies in the streets. I would estimate that each fundita holds about 8 ounces of water when full. You tear a corner to drink.
Imagine that your funds are already short, and if you want a drink of safe water, you have to pay for it, and then you receive it in a container which can easily be torn and cannot be re-capped, allowing you to save some for later? Consider that many of the households in Esfuerzo have a single, female head of household, and that she may be doing domestic work, for which she gets paid $100-125 USD per month, before she considers expenses such as travel to and from her job (which might include riding a gua-gua, or hiring a motoconcho, then taking the Metro, then a taxi). Clean water, which is considered by the UN to be a human right, may not be affordable and accessible enough to support good health.
Also imagine: if you didn't have plumbing and clean water were expensive, how would you bathe? Would you be likely to wash your hands before eating? A 2010 thesis shows that 60.2% of Dominican households do not treat their drinking water, and 59.8% of adults report diarrheal illness consistent with soil- and water-borne parasitic infections. SOMOS research indicates an overall parasitic infection rate of 48% of all people living in the developing world, with 10% infection by two or more organisms. In the Dominican Republic, approximately 20% of individuals are infected with roundworms; ~34% have amoebiasis, ~59% carry whipworm, and ~59% have hookworm infections. If one were to examine only members of communities without running water, I imagine the rates would be even higher.
The lack of clean water is related to infection with both water-borne and soil-borne parasites. The water is neither safe to drink, clean enough for bathing, nor available enough for the frequent washing required to defend against parasites in soil or fecal-oral contamination.
For a person who wishes to get medical treatment, there are many barriers. Finding time away from a job, paying for transportation to medical facilities, and arranging for time/transportation to a farmacia all reduce access to medical care. For a person who manages to get to a clinic, wait times may be prohibitively long. Once at a pharmacy, drugs might not be available, or if they are, they might be too expensive.
One of the most frequently-prescribed medications in the clinic is Albendazole. Every child who comes to the clinic receives it. Albendazole is easily obtained by an American physician and is inexpensive, approximately $0.02-0.03 (2-3 cents) per dose. It is effective against hookworms (soil), roundworms (fecal-oral), whipworms (soil), pinworms (fecal-oral), and giardia (water). It is also effective against a liver fluke that is common in the Caribbean islands.
Is a single dose of Albendazole, received once or twice a year, really helpful? Yes and no. Frequent treatment and/or easy, affordable access to clean water for drinking, cooking, and bathing would be best for eradicating parasitic infections. But in the absence of programs that can provide clean water or regular, easier, and more affordable access to medical care, a single dose once or twice a year can help to lower the parasite load in a person's body, thereby reducing the cumulative effects of the infection and improving the person's overall health. Not ideal, but better than no treatment.
It's important to point out that Esfuerzo is not a rural community. It is situated on the margins of the largest urban center in the Dominican Republic, Santo Domingo. This isn't something that affects only least-developed countries or those experiencing natural disasters. It isn't limited to quaint "native villages" where women in colorful costumes carry buckets on their heads. You don't have to be a refugee in a war-torn country to lack water. You don't have to be experiencing drought. It's an urgent need here in Santo Domingo, a large, vibrant, modern city in a lush environment. If you have regular access to waste removal and to potable water, you are in the minority in the world.
Yesterday was World Water Day 2011, and this year's theme is "Water for Cities." Some locales are celebrating World Water Week, but really, every day is water day. We can't live without it. I hope you'll think about how you use water, what lack of access to clean water might mean to you, and how the global community can work together to meet this need.
UN Water Day: World Water Day 2011
Water.org information
UNICEF Tap Project
CDC: Healthy Water
UN human rights - access to clean water
What would you do without clean water?
