Toxic water
February 2012
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Brunson says many water projects in developing countries fail for obvious reasons - money runs out, or machinery breaks down."
Access to safe drinking water is a global problem for nearly a billion people.
For about 200 million, many in Africa, high levels of naturally occurring fluoride in the water causes disfiguring dental and skeletal disease.
“Dental fluorosis is a darkening or mottling of the teeth,” says Laura Brunson, an environmental scientist at the University of Oklahoma in the United States. “There is a sort of social stigma attached to it, maybe a poverty stigma. Skeletal fluorosis is much more physically debilitating.”
But Brunson is on the case. She's developing fluoride-filtering devices that use cheap materials that are readily available in the villages. A resident with a kiln, for example, could create the char from eucalyptus wood, or bones.
The low-cost filter would treat the water, which can then be sold for a minimal cost. That would both provide fluoride-treated water to the community and give the person who's running that business a job.
During recent field work in Ethiopia, Brunson and her team set up a lab in a local guest house - and started experimenting.
“Are there things we can add,” asks Brunson, “or ways we can alter the bone char either through some sort of oxidation process, or through adding something like aluminum to the material, that would make it even more effective?”
Brunson says many water projects in developing countries fail for obvious reasons - money runs out, or machinery breaks down.
“Of the seven or eight communities we visited, there only were maybe two that were actually functioning as far as treatment systems.”
But equally important, she says, are cultural factors. Figuring out how to get the community behind a water filtering project.
The team spoke to a lot of people, and asked a lot of questions.
“How do you use water, where do you get it from, what do you think about the current treatment system, is there something you would prefer to have?”
Brunson, who also teaches in the college of business, says getting communities committed to water treatment could also be a money-making opportunity for local people.
“If you can set up a business so that the char you are selling that is helping people get treated water is making enough money so you can be self sustaining, then you can keep going,” says Brunson.
Science and social entrepreneurship coming together to make affordable, safe water available to millions.
Cooking, not killing
January 2012
Dar es Salaam, Tanzania
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The World Health Organization says this type of pollution causes nearly two million premature deaths each year."
An estimated three billion people - nearly half the world’s population - still use an open fire as the primary source of energy for cooking and heating.
But there’s a problem: the smoke.
“You have respiratory issues, lung disease, you’ve got pneumonia and you’ve got longer-term issues like cancer and heart disease as well that can result from exposure to indoor air pollution,” says Radha Muthiah, Executive Director of the
Global Alliance for Clean Cookstoves.
The World Health Organization says this type of pollution causes nearly two million premature deaths each year. That’s more than tuberculosis and three times as many as malaria.
Everline Kihulla is one of the people trying to do something about it. She works for TaTedo, which manufactures and sells so-called ‘clean cookstoves’ in Tanzania.
TaTedo’s stoves are made with clay liners, which along with other simple design features, emit far less smoke and pollutants. And they use a fraction of the fuel.
Kihulla crouches beside one of them: “This one we have improved it and it currently uses almost 50 percent compared to the traditional one,” she says. “So the charcoal consumption here is less compared to the traditional one.”
Another benefit is that these stoves are made locally.
A nearby workshop employs 21 people and churns out 400 to 500 stoves each month.
Each person follows a cookstove through every stage of production, from pottery to painting. This teaches each worker a variety of skills.
Producing locally also boosts the economy and keeps the costs down, but the price-point is still an issue.
Cookstoves start at about $6 (U.S.). That’s a lot of money for many families in developing countries.
But subsidizing the price, or even giving stoves away free with the help of aid agencies, doesn’t necessarily work.
“There’s something about, you know, having to allocate a portion of even your small wallet to something that ensures that you value that and use that, and so that’s what we’ve seen in some of the other models that are out there,” says Muthiah.
“The fact that yes, people don’t have that much money at all, but if they spend even a few cents a day, you know, towards that stove, that they actually value and use it much more.”
Sitting alone on the steps of her home in Dar es Salaam, Lillian Njuu stirs a large pot of stew, which rests on a clean stove that she has used for two years.
She feels the expense is worth it for the health of her family, and plans to buy another.
In addition, while the upfront cost to buy a clean cookstove is higher, the fuel costs are lower because it burns less.
That in turn has an environmental impact. Burning less charcoal or wood means there’s less deforestation, which has caused major problems like flooding in many countries.
“It’s one relatively simple intervention that has a multitude of impacts that can really address the development agenda within a particular country as well,” says Muthiah.
Now the challenge is to get clean stoves into enough homes to really make a difference.
Return to Burundi
December 2011
Kigutu, Burundi
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Nothing good was going on in the country for more than a decade but trauma and infection and no treatment and no prevention."
Deogratias Niyizonkiza is an extraordinary young man.
Known to his friends as just “Deo”, he barely escaped Burundi’s ethnic conflict in 1993, when rebels attacked the hospital that he worked in.
He made his way to the United States, where through the kindness of strangers he was given shelter and later, a top education.
Now he’s back in his homeland, helping to restore a shattered health system.
"Nothing good was going on in the country for more than a decade but trauma and infection and no treatment and no prevention," says Niyizonkiza.
On his return to Burundi, Niyizonkiza founded a non-profit called Village Health Works and opened a health clinic, which has served more than 60,000 people since 2007.
One thing he learned when studying similar programs was the value of free health care and the use of local volunteers.
The clinic has now deployed more than 100 community health workers across this rugged, mountainous region, where constant surveillance is needed.
Cecile Sijeniyo is one of the workers. She’s visiting an HIV-positive woman to make sure that she’s taking her medication.
HIV carries a great deal of stigma, and it can be difficult for people to open up to members of their community like this.
The interpreter explains why this patient allows Cecile to visit: "She chose Cecile because first of all she is a neighbor and second of all she is somebody who can be discreet and also who can be willing to be following her on a daily basis."
Niyizonkiza says two elements that are crucial to the success of the program are, first, that the community workers are paid a small stipend, and second, that they get a bonus for each new patient.
That acts as an incentive to spot potential cases of HIV, tuberculosis and other infectious diseases.
Catching and treating those cases early, they say, is crucial for the health of the entire community.
Dead women walking
December 2011
Dar es Salaam, Tanzania
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After surgery they go back home with their dignity restored as new ladies and mothers who can go back out there and have a wonderful life ahead of them."
After years, sometimes decades, of living as pariahs in their communities, a group of Tanzanian women finally have something to be cheerful about.
They all suffered from an obstetric fistula, which can occur during prolonged, traumatic complications while giving birth.
The child usually dies, and the mother is left with a fistula, or tear, between the birth passage and the bladder or rectum.
Without corrective surgery, the woman suffers incontinence for the rest of her life, often, ruining her life.
But at a disability hospital called Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), women can get corrective surgery for free, and with it, a new lease on life.
“One World Bank report called them ‘Dead women walking’”, explains Tom Vanneste, the hospital’s Deputy Director. “That’s how horrible their condition is, how they’re completely socially excluded and embarrassed. So they come here very much depressed, very scared, unsure of what their future is.”
Later, says Vanneste, they feel liberated: “After surgery they go back home with their dignity restored as new ladies and mothers who can go back out there and have a wonderful life ahead of them.”
Rukia Shabiby is one woman who’s long journey led here.
26 years ago, at the age of 13, she was married and became pregnant.
At such a young age, with her body still under-developed, the birth was traumatic, and ended in tragedy.
Her baby was still-born, and Rukia herself would soon discover that something else was very wrong.
During the birth she had suffered a fistula, though she had no idea what it was.
Rukia tells us that in the ensuing weeks, months and years, the odor and perception of uncleanliness led to her being shunned by the community.
And the great tragedy is that like so many other women and girls with this condition, Rukia thought she was the only one.
In reality, the United Nations estimates there are more than two million living with the condition.
In Rukia’s case, after years of suffering, she heard about CCBRT and traveled to Dar es Salaam for a successful operation.
She’s now ready for a fresh start.
“When she goes back,” says Eric Ndambiri, a nurse at CCBRT who helped Rukia through surgery and recovery, “she’s thinking that she’s going to be a good ambassador, to tell others that even you, who feels the condition is incurable, that somewhere there is a solution for your problem.”
As with other developing countries, many women who get fistulas are from poor, rural areas.
Even if they hear that they can be cured, they often don’t have the resources to even pay the bus fare to Dar es Salaam.
To solve that problem, CCBRT employs what it calls “ambassadors” to look out for ostracized women with fistulas.
When they find a possible case, they contact CCBRT for advice, and bus fare.
“When we are sure it’s a fistula patient,” says Tom Vanneste, “we actually use mobile phone money transfer system technology to transfer the money for transport to the ambassador, who basically gets an SMS that says ‘Look, you’ve received $20 from CCBRT hospital.’ He converts the e-money into cash, collects the cash, buys the bus ticket for the patient, helps the patient get on the bus, and basically we pick up the patient here at the bus station and operate on her the next week.”
After surgery, the women stay for at least two weeks to recover.
During that time they learn new skills, like crocheting.
In addition, 18 women are selected each year to stay in Dar es Salaam to be trained in sewing, printing and jewelry-making.
The Mabinti Training Center also teaches them how to speak English and run a small business.
“When I came here I said ‘Wow this is my new beginning. And I have to stick on this so that I can rebuild my life again,’” says Jane Rugalabamu, one of the trainees.
That new life won’t be alone. Jane plans to join with several of the women here to start a business.
Her other job, she says, will be to spread the word and make sure that women and girls don’t spend years in isolation for a condition that can be cured with an operation in less than two hours.
Teens fight for child brides
July 2011
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Let’s ask the mother: ‘How old were you when you got married?’ The chances are she’ll say ‘I was 21.’ So why are you sending your daughter away at 12?”
The disturbing prospect of 100 million child brides in the next decade has galvanized teenage girls in the United States, who are demanding action on behalf of their young counterparts around the world.
The United Nations Foundation’s Girl Up campaign says it has mobilized 150,000 American teens. They say they want the practice of child marriage stopped and have delivered a petition to the White House signed by girls across the U.S.
“It’s a human rights issue,” says Erica Lamberson, who’s one of the teen leaders. “I think it’s a problem when anyone is forced to do anything that they don’t want to do or are not clear about or are not prepared for. Child marriage is huge because once you get married at such a young age, you know, your life’s not over but your life has drastically changed its path.”
Child bride expert Jennifer Redner says the practice of marrying girls off early has profound negative impacts. “When a young girl may come home from school one day and find her bags packed or may find out the next day there may be some sort of ceremony where she’ll be wed – sometimes as young as eight, nine, ten – the consequences can be absolutely detrimental.”
Redner, who serves as U.S. Policy Consultant to the International Women's Health Coalition, says that child brides are also more likely to marry much older men. “Therefore the power dynamics will be even more difficult in terms of her being able to negotiate safe sex, be able to stay in school, to be able to not get pregnant as early as 10, 11 years old, so the consequences are quite, quite strong.”
Elizabeth Gore, Vice President of Global Partnerships at the UN Foundation, says that for the victims of this practice, the stakes are high: “One girl who I met in Ethiopia who is scared and has run away is sitting in a bus depot and is either going to be brokered into sex work or not educated or into domestic labor and she never gets a shot.”
But old habits die hard. Sheila Siwela, Zambia’s Ambassador to the U.S., says education is key in changing deep-seated cultural traditions. “Lets go back to the girl child themselves, let’s go back to the parents and the mothers. Lets ask the mother ‘how old were you when you got married?’ the chances are she’ll say ‘I was 21.’ So why are you sending your daughter away at 12?”
But Siwela believes the practice can be eliminated. “I think it’s nearer than we think. As long as we step up the efforts of encouraging the girl childs to go back to school and finish school, and again as long as we go back to the communities themselves to make their own decisions.”
And at the end of the day, if the Girl Up campaign is to succeed, it must be the adults in the communities who change their thinking, and let the children be children.
