Monday, November 10, 2014

Sanitation Mission to Bangladesh Teaches Pittsburgh “Super Volunteer” Greg Smith About Health Challenges Facing Developing Countries

By Greg Smith

Inadequate safe water, sanitation, and good hygiene practice is endemic in rural communities throughout the developing world. Today 2.5 billion people do not have access to proper sanitation and 900 million have no source of safe drinking water.

Bangladesh is good example of a country with these problems. Bangladesh is located between India and Myanmar, half way around the world from the United States, at a latitude similar to Cuba. It is considered the most densely populated country in the world, and two-thirds of the country is river delta with elevations less than 12 feet. Tropical cyclones, spring flooding from the Himalayas, and the monsoon season make Bangladesh a difficult place to maintain clean, safe sources of water and appropriate areas for sanitation. The temperatures are high and the humidity is oppressive.

In Bangladesh, 46 percent of the population has access to improved sanitation; however only half of those that have access to improved sanitation also have convenient access to clean water and soap. The most recent statistics for Bangladesh indicate that there are 51,000 deaths from diarrhea in children under 5 years of age. Sadly, washing hands with soap and water can prevent more than 50 percent of these deaths. Awareness of proper sanitation and hygiene practices is low in most rural areas.

In late September, I joined three other trainers and spent two weeks in Bangladesh teaching WaSH (Water, Sanitation and Hygiene) and Community Development principles to 19 Bangladesh Nazarene Mission development workers. These students would then travel to rural villages to teach these practices.

We worked through Lifewater International, a non-profit, Christian water development organization based in California that works around the world to eliminate water-borne disease and inadequate access to water. The training provided is a hands on “train the trainers” program that emphasizes participation and interactive learning.

Bangladesh Nazarene Mission (BNM) is a Christian development organization that has worked in Bangladesh among the “poorest of the poor” for more than 20 years. It is a well-established organization and works in many development areas, including WaSH, emergency relief and food security.

Between flight time and the 10 hour time change, it took almost two days to arrive at the training center. Transportation was interesting as always and included flying in a plane, walking, sitting in a rickshaw, standing in a flat topped boat to cross the river, lounging on a steam driven boat, and finally taking a two-hour trip in an ambulance.

Why an ambulance? The out-of-power political party had called for a transportation strike on the day we arrived and the only motorized ground transportation allowed was an ambulance. Any other transport risked being stoned or having its tires slashed or even being burned. Our hosts somehow found an ambulance and we raced off to the training center, horn blaring and siren screaming!

The training center was quite modern. We had rooms with hot water, flush toilets and air conditioning. However trekking up the 80 non air-conditioned steps and down the long hot hallways to our rooms when the temperatures were consistently over 100 was a constant reminder about what conditions were for most of the country.

The students were primarily project managers in their early to mid thirties and consisted of 13 men, six women, one Muslim, one Hindu, and the rest Christian. This group had a broad background in community development and came from various development sectors, such as disaster relief, training, WaSH, etc.

The native language of this group is Bengali. Even though many of the students knew or understood a fair amount of English we worked through several translators, The translators were energetic and quite interested in the subjects we were discussing, which unfortunately led to many ‘off topic’ conversations between the students and the translators. Ultimately the outcomes were good but the discussions were often tedious and confusing.

The students were excited about both the material and how it was presented. As in many places they were accustomed to sitting for hours and hours through boring lectures. The idea of interactive instruction, role-playing, and somebody actually asking them their opinion on a subject was exciting to them. They loved developing and acting out short plays, which they called dramas, and creating a posters and poems about the training material.

This group loved to sing and dance. Our training sessions were regularly filled with singing, dancing, and even jokes, none of which I understood because jokes don’t make it through translation very well.

This photo is an example of the “hands on instruction” we were conducting. Here we were discussing the disease transmission route from "poop" to mouth and the ways that this transmission can be blocked.

The “poop” is on the left with a “mouth” on the right. The pictures between them represented conditions when germs can be spread, such as through dirty water, on flies, through animal droppings, etc. The strings represent germ transmission routes and the pictures over the strings represent ways to block these routes, such as boiling water or fencing animals in or hand washing.

Typically I laid the posters on the ground and showed them one route and one blocker. I would then ask volunteers to find other routes and to come up with ways to block the routes. This created a lot of discussion about the subject. This is a very simple way to teach the subject and can be done in the most basic of situations.

Other subjects such as hand washing, making and keeping safe water, the sanitation ladder, transformational change, and cleaning latrines were presented in the same way. The group developed numerous plays and songs about each subject, including my favorite –the latrine cleaning dance!

At the conclusion of the training we had a “Cultural Night.” Primarily the students wanted us to dress in indigenous clothing and dance to traditional music. We laughed a lot and even learned a step or two.

We spent one day in the field visiting a BNM site called JoyMoni. A typical day in JoyMoni at this time of year is balmy with a heat index near 100. The day of this site visit it was very hot and humid with heat index at 115 in the shade. Of course we had to be there at noon. Even the locals were complaining about the high temperature, and I was surprised to see both men and women using umbrellas to shade themselves from the sun.

This site is located on the Bay of Bengal and has no local source of fresh water as the wells, even those 250 feet deep, are contaminated with salt, arsenic, and iron. Since the village is encircled by ever changing water levels due to tidal changes, spring floods from snow melt in the Himalayas, and monsoons, healthy sanitation practices are uncommon. One way the people of JoyMoni they have learned to cope with water level variability is to build floating toilets.

While floating toilets are a good solution to “where to go,” this same water often is source of drinking water and has become contaminated. This is a good example of the difficult choices that many rural communities face. 

Lifewater and BNM have partnered with this community to develop alternate strategies for situations like this, while at the same time teaching good hygiene and safe water practices. The BNM employees will work through local safe water and sanitation committees to teach WaSH principles to the entire JoyMoni community.

Lifewater follows the progress on a weekly basis and will be studying the effects of the training and making recommendations for improvement. The goal in communities like JoyMoni is to improve awareness of good hygiene and sanitation practices which can result in a 50 percent reduction in diarrheal disease.

As we said goodbye to our new Bangladeshi friends, I was inspired to see the enthusiasm and dedication they bring to solving some of the more difficult health issues facing their fellow countrymen. It reminded me of this quote from Mother Teresa:

“We think sometimes that poverty is only being hungry, naked and homeless. The poverty of being unwanted, unloved and uncared for is the greatest poverty. We must start in our own homes to remedy this kind of poverty.”
(Greg Smith lives in Pittsburgh. He is a member of The Global Switchboard.)

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