Mozambique: A few drops of understanding to improve water supply

18 Mar 2015
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Water and sanitation improvement is an essential step in stopping cholera, a waterborne disease. A current outbreak in Mozambique has resulted in 46 deaths and affected over 5,000 people. Médecins Sans Frontières/Doctors Without Borders (MSF) teams are working to improve the situation, but it will take more than a quick, technical fix.

Raising awareness 

“What is it that you want? To build a water treatment station, or have people use it?”, asks Eveline Cleynen, an MSF health promotion officer.

The rough rubber boots and the dusty MSF vests may not be screaming ‘diplomatic mission’, but it's more or less what this morning is about: understanding, talking, explaining, and convincing local leaders on how to defeat cholera.

In the Tete cholera treatment centre (CTC) there has been an influx of patients from Chimadzi, a large ‘bairro’ that resembles something between an urban slum and big village.

Providing clean drinking water

A cholera outbreak is caused by contaminated water and poor hygiene and sanitation, so water and sanitation specialists like Mihail Papageorgiou play a key role in the response.

He immediately knows what needs to be implemented: a water treatment unit that will soak up the water from the nearby river, clean it, and source it to the 3,000 families.

“This centralised water treatment system is designed for rapid response. We could go in with 20 guys, and within three hours we would be done; bang, bang; in and out.”

This hardware component of the response, setting up the most appropriate water treatment system, is mainly technical and can be quick. The real challenge lies in trying to improve understanding and correct use of this system, or the ‘software’ component.

“You might be producing the cleanest water in the world, but if the community you do it for doesn’t trust it or use it properly, the net health impact of your response is small. There, the health promotion teams play a key role.

“We want to leave information and education behind us, not a mess, so we have to take our time,” he says.

Breaking habits

While Mihail and logistician Iain Watermeyer examine the area's water pump – a possible source of contaminated water -  Eveline talks to the local leaders, with a neighbourhood toddler stuck on her hip.

Manuel Faquero, the local leader, agrees to hold a meeting to discuss the new system with the community. “I'll try to convince them, but it's difficult to change habits,” he says.

Cholera is a waterborne disease; a person who has cholera has been drinking dirty water, or disregarding personal hygiene measures such as hand washing. Avoiding contracting it seems simple: stop drinking dirty water, and wash your hands regularly.

However,  there are many factors at play. Habits. Practicality. Lack of information. Distrust of the messenger – be it NGO people or government people. There is a huge difference between telling people what to do, and showing them that you're willing to try and understand the situation.

It’s important to taste and drink the water when setting up a point-of-collection water treatment system. This clearly demonstrates that the chlorine that we’re adding is not unhealthy or even causing cholera, as is sometimes believed.

Working with local leaders to promote change

We climb down towards Chimadzi river that runs about 10 metres away from the pump. It is large and low: a few hundred metres wide, and barely a foot deep. Women are cleaning their laundry; kids jump in stark naked; a donkey cart passes by. The river bed is poked with holes where people take their water from.

The sand acts as a natural filter and the water is crystal clear, but it is open to all kinds of contamination from run-off water and dust.

Mikhaelis finishes his sample collection, and asks which water the people in the community prefer to drink. Now it starts to make sense: the water from the pump is slightly salty, and the sample from the hole in the river tastes like... water. It’s no wonder people prefer it. Something to keep in mind when the water treatment centre is finished.

Once the first litres of treated water start coming out of the system, the responsibility lies with the health promotion team and the local leaders. There will be meetings and there will be questions. Hopefully there will also be change, at least until the outbreak is over.

Find out more about MSF's work in Mozambique

Find out more about MSF's Cholera response