FUTURE BOOKS

Water Proposal

September 2008

The Problem

The gravity of water deficiency, sanitation, and poor hygiene is weakening the world daily. Hundreds of people are dying every hour from preventable diseases caused by the lack of availability and knowledge in regards to safe drinking water, sanitation, and hygiene.

The International Red Cross has stated that 88% of diarrhoeal disease is attributed to these three factors which kill about 5,000 children every day. The Director General of the WHO says, “Water and sanitation are among the most important determinants of public health. Whenever people achieve reliable access to safe drinking-water and adequate sanitation they have won a major battle against a wide-range of diseases.” Unfortunately, this has yet to happen and the water dilemma is ever growing.

The impact of illiteracy
The problem and need for improved sanitation, safe drinking water, and hygienic practice is obvious and is accompanied by the aggravating factor of illiteracy. With every provision made there is a gap between accessibility and utilization. Unicef and similar organizations constantly report that it is not the access to a facility or clean water tap that leads to a decrease in disease, but the understanding and correct use of these items.

USAID furthers this saying “too often, the impact of environmental health interventions has been limited by the failure to understand and influence human behavior.” There are a plethora of cases where people receive needed facilities like “latrines, improved water systems or water treatment options”, but they do not use them as intended.

The scarcity of teaching manuals on sanitation and hygiene for schools and communities means that sanitation and hygiene are still inadequately taught. In addition to a lack of materials the areas in which waterborne illnesses are most prevalent are also areas in which illiteracy is highest. Parallel to the problem of misuse of given facilities, there is no point disseminating written pamphlets or brochures to people needing the information if they are unable to use them.

Low literacy is a major problem. It has seriously impacted the effectiveness of any literature distributed to the many thousands in need of health care education. Combining the latest sound chip technology, Books of Hope has successfully created an effective means to present complex health care issues, producing hard backed books featuring a sound track read by well-known local personalities in any language, to take the reader on a step by step guide to wellness whilst encouraging them to build self confidence with a simple action plan.

Each Speaking Book in the Books of Hope series consists of 16 pages of colorful illustrations supported by straightforward and easy to understand text. For each page there is a corresponding push button that triggers a sound track of the text, so no matter what the level of comprehension, the information will be seen, read and heard, to result in a powerful combination. Clearly printed on the back cover of each book is a list of agencies, with addresses and phone numbers. Thus the Speaking Book serves as a referral mechanism, creating demand for services available and accessible in the local community. The Books are then distributed by community workers, often volunteers, to the community members who are most at risk for the health care issue covered by the book.

In a study done on one of the first Speaking Books researchers found that 94.8% of the sample found the book to have useful information and that 93.8% of the sample reported that the books made it easier to talk to patients. Researchers following the Home Based Care Workers who visited households with HIV found that an average of 27 users saw the book and heard the full set of messages (“Living with HIV doesn’t mean Living with Depression”).

An additional study revealed a 58% increase in understanding among those who had only received a Speaking Book, compared to the group who received counseling at a full community event who showed a 65% improvement in the ability to identify a peer at risk of suicide and what to do about it (“Teen Suicide shouldn’t be a Secret”).

Three Main Issues

Safe Drinking Water
The water and sanitation crisis claims more lives than any war. With close to half of all people in the developing world suffering at any given time from health problems caused by the water and sanitation deficit, it is clear that no intervention has greater overall impact upon national development and public health than the provision of safe drinking water and the proper disposal of human waste.

Water is essential for life. Plants, animals, and especially humans cannot survive without it. An individual can withstand weeks without food, but only a few days without water. Unfortunately, many communities around the world do not have accessible, potable water. This scarcity leads to dangerous and unhealthy means of collecting and consuming water. Sadly, what looks like a refreshing drink for a thirsty child may actually be a parasite-filled death sentence.

Every year 2.2 million people die from unsafe drinking water. For children under the age of five, water-related diseases are the leading cause of death, with more than 5,000 children dying every day as a result of them (Unicef). People with waterborne illnesses occupy half of the world’s hospital beds. Although these numbers appear inconceivably high, they are very real and most of these deaths come from diarrhoeal diseases like cholera and dysentery.

The impact of unsafe drinking water reaches far beyond the borders of physical ailment and disease. The costs of water-related diseases are not only “enormous in terms of the number of people killed and affected, but also in terms of the large, but poorly quantified adverse impacts on economic productivity in many developing countries” (IFRC). Education, work productivity, and household income can all suffer from the effects of unsafe drinking water.

Safe Drinking Water Speaking Book:
The creation of a Speaking Book that discusses the importance of safe drinking water could reveal the dangers of unsafe drinking water, diarrhea- cholera and dysentery. It could also talk about how the child loses school days and how the head of the family loses workdays. After the Speaking Book could discuss the seriousness of filtering and purifying water no matter how clean it might appear. The book can go into detail about certain filters (whether cloth, sand, or three fold) and/or purifiers. The book could also teach about well maintenance, using the same bucket to get the water, having a clean rope, not letting cows graze/defecate around the well, and keeping the well covered.

Sanitation
This year, 2008, is named the International Year of Sanitation. Sanitation is ‘clean living,’ free from contact with excreta and other disease-carrying agents. It is “environmental cleanliness; hand-washing; garbage removal and waste water disposal” (UN). Sanitation has been regarded as the most important medical advance in the last 140 years and the value of its improvement is almost unmatched.

At the start of this year, the chair of UN-water, Dr. Pasquale Steduto called for more resources and strong commitments to be made in order to fulfill the Millenium Development Goals which promise to halve those without access to basic sanitation by 2015. Steduto explains, “Sanitation is vital for health, enhances social development; is a good economic investment; improves the environment and most importantly it is achievable.”
About two-fifths of the world’s population does not have access to adequate sanitation and in the next 20 years those numbers could reach 4.5 billion. Facilities such as toilets, piped in water for laundry and bathing are rare. Moreover, trash pickups or storm water drainage are unheard of, leaving puddles and filthy ponds which create new breeding ground for disease. Eventually 90 per cent of human excreta in such places end up in untreated in local rivers.

The 2.6 billion people living without sanitation are mainly in the rural lands, where outside defecation is normal. In many of these places tradition requires women to wait until dark to defecate leaving them vulnerable to animal attacks and rape. While most people lacking sanitation live in rural areas it is necessary to note that that the urban communities are growing rapidly with over a million newborns and migrants added each week. Most of these people are living in illegal areas, located on the outskirts of towns and cities, many times actually on the waste ground, where even the most basic services are not provided.

The need for sanitation education is constantly growing. Diarrhoeal infections like cholera are killing thousands every day, both rural and urban. At the same time, poor sanitation also leads to problems with intestinal parasites like roundworm, hookworm, and whipworm which affect more than 130 million people a year. Although less life-threatening, these worms seriously hinder children’s health, causing malnutrition, listlessness, sleepiness, and the inability to concentrate in school. Substantial evidence show that increased sanitation education could greatly drop infection rates (UN).

In addition to saving lives, the improvement of sanitation would limit the burden on family income and the economy as a whole. The WHO estimates that reaching the Sanitation Goal (refer to Box1) “would save $66 billion US dollars in time, productivity, averted illness, and expenditures on medicines, health care, and funerals.”

Sanitation Speaking Book:
A Speaking Book on Sanitation has the capability to focus in many directions. The book could be created as a precursor to the development of a latrine (Why a latrine is important, what it prevents, how to use it, how to dispose of waste, etc.). A book that teaches about the importance of allowing women to defecate before darkness, explaining the strain on bowels, the danger of animal attacks and rape. In addition the book could focus on why sanitation as whole is important, to avoid illness associated with diarrhoeal illnesses. It will also include important facts related to sanitation, like where worms come from and that babies faeces carry more disease than adult faeces.

Hygiene
Access to safe drinking water and improved sanitation does not necessarily lead to improved health. Although the two are vitally important, illnesses may still exist if hygienic practices are not acquired too.

The Global Health Council writes, “Unwashed hands can transmit the bacteria, viruses and parasites found in human faeces directly to foods and mouths,” which leads to preventable illnesses, such as diarrhoea or intestinal worms. About 1.8 million people die each year from diarrhoea and over 90 per cent of them are children under five. In addition, illnesses associated with lack of hygiene cost developing countries around five billion working days a year (IFRC).

Research has shown that the simple act of washing hands with soap and clean water after defecation and before eating or preparing food can significantly reduce the prevalence of diarrhea by almost 50 percent. In addition to diarrhea reduction, hand-washing has been noted for reducing other diseases, “notably pneumonia, trachoma, scabies, skin and eye infections and diarrhoea-related diseases like cholera and dysentery.” Unfortunately, “Around the world, the observed rate for handwashing with soap at critical moments ranges from zero to 34 percent” (USAID).

If effortlessly washing your hands with soap can reduce disease in half then the adherence and other hygienic practices like bathing, boiling water for food, and discarding bath water can only yield greater benefits.

Hygiene Speaking Book:
We can create a Speaking Book on importance of hygiene, washing hands, bathing, boiling food, etc. Inside could be facts on the life-threatening results of poor hygiene. It would be an educational tool to teach the importance of soap as it breaks down the grease and dirt that are many times invisible to the human eye, but which carry most germs. The soap dislodges these germs and leaves the hand clean with a pleasant smell. Furthermore, the book would emphasize the critical moments for hand-washing with soap: after using the toilet, cleaning a child’s bottom, before handling food, and before eating. On the back of the book could be numbers of places to get soap, or clinics to get help for illnesses.