Global health: improving access to clean water, sanitation, and sustainable farming

By Michael

As a research scientist in Oncology, I was passionate about this project because unlike cancer, where disease onset and treatment success can vary unpredictably, ailments such as diarrhea that afflict this population may be preventable with the measures provided.

COVID-19 has gripped the world with intense fear and anxiety due to our lack of understanding of the disease and inability to contain the spread. The disease is stealthy with most carriers unaware they have the illness since the signs and symptoms are often delayed and highly variable. What does a person with mild disease experience? Why would they not participate in social functions if their mild symptoms feel like a bad case of the Mondays. With WHO declaring COVID-19 a global pandemic, the world economy might be in crisis as more cities and countries quarantine their citizens. Armed with only hygienic guidelines to keep us safe, I am also not immune to this fear of harming my own health and potentially putting others at risk, yet I found that what has calmed my worries were my learnings about the people we are helping with our client’s Healthy Homes program.

Our client, a foundation, started the Healthy Homes initiative to along the Carajás railway in Maranhão with access to clean water (cistern building, cistern care/water treatment trainings), improved sanitation (dry toilet installation, maintenance/disposal trainings), and sustainable farming practices (permaculture supplies/training). Underlying this effort is the foundation’s commitment to enable sustainable living practices in their communities while ensuring that public health is preserved since the majority of Maranhão cities are beyond the reach of basic municipal services.

Our team was asked to evaluate the overall effectiveness of these initiatives and improve survey metrics in order to monitor continued progress. As a research scientist in Oncology, I was passionate about this project because unlike cancer, where disease onset and treatment success can vary unpredictably, ailments such as diarrhea that afflict this population may be preventable with the measures provided. However, as one of the poorest states in Brazil, prevention is not easy to enforce in Maranhão when action depends on the community’s commitment to public health.

With little demographic data publicly available, not much is known about the people living in the cities of Maranhão. Even more difficult is finding information on those rural villages whom our client is supporting. Fortunately, the organization made available to us the results of their survey used to gauge the level of family need, determine which families qualify for aid, and monitor the progress of their program (quarterly basis). The completed surveys were extensive and full of yes/no and free-range responses to a host of questions that inquired about families’ health and financial status in addition to their water storage/use, farming, and sanitation habits. Not many have access to this dataset that provides a glimpse of what life is like in these communities. I felt compelled by this information to be able to help these people with our recommendations so that they can live their healthiest lives given their meager circumstances.

In the Buriticupu municipality of Maranhão where the most surveys were taken (419 total) among eight of its cities, families (average four per household) subsist on $102.03 US dollars every month, which includes additional support from the Bolsa Familia program (71% of families). As for education, only 7% of the heads of households completed high school while only 6% completed elementary school.  Although majority of families (~70%) are supported by the presence of a community health professional/agent monthly, the threat to population health brought by multiple forms of infectious disease may leave families vulnerable with limited access to acute care and potentially high out-of-pocket costs. To better understand the impact of Healthy Homes’ clean water initiatives, I focused on diarrhea, where prevention can directly correlate with compliance of Healthy Homes guidelines for filtering and decontaminating water. 36 of the 419 surveyed suffered (8.6%) from diarrhea without any comorbidities. 31 of these 36 families (86.1%) were non-compliant with safe water practices. Based on this data, the solution to find out how our client can better implement these measures depends on citizens’ regard to why these actions are necessary. Ensuring that families realize the importance to routinely employ measures that prevent disease with community-led initiatives may be the way forward to improve public health with the Healthy Homes program.

Diarrhea is only one of the many conditions that afflict the Buriticupu municipality. 83% of families cited one or more of the following diseases in the past year each survey was conducted: Hepatitis A, Dengue, Yellow Fever, Zika, Chikungunya, Leishmaniasis, Malaria, Cholera, Conjunctivitis, Skin Diseases, Mycoses, Leptospirosis, Schistosomiasis, Amebiasis, and Footworm. When you consider the numerous threats to public health for people living in Buriticupu, I am imbued with a sense of gratitude to have been provided with the infrastructure – education, public policy, access to affordable healthcare, and financial means – that can properly support my overall well-being, yet I am also disappointed with how very few of us take personal accountability of our own health as the Buriticupu people must do.

As I pause and reflect on the growing concerns with COVID-19, I take a step back and remember those in Buriticupu who persevere despite the weight of their circumstance and appreciate the gift of each new day by making the most with what little they have. It may feel like the world is ending tomorrow with news of the global COVID-19 pandemic, but to the people of Buruticupu, it is another day to be lived to the fullest.

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