Winter 2000 Issue
Safe Water, Simply Made
A CDC Foundation program brings a CDC project to thousands of people
Every year, more than 2 million people around the world die of diseases they contracted from contaminated water. They may know that there’s something wrong with the water they drink from leaky pipes, a shallow lagoon or an overused river, but they have no choice. That is their only source.
Giving everyone in the world safe drinking water would cost hundreds of billions of dollars in treatment plants, pipes and taps. But with a simple, narrow-mouthed plastic container and a bottle of chlorine bleach, safe water could be a reality for even the poorest families in the most remote parts of the globe.
That revelation became a mission for a team of scientists at CDC. They tested such a simple apparatus, dubbed CDC’s Safe Water System, in Bolivia, Zambia, and other countries plagued by epidemics of water-borne diseases and found it reduced diarrheal diseases by at least 50 percent.
With backing from the CDC Foundation’s CARE-CDC Collaborative Health Initiative, funded by the Robert W. Woodruff Foundation, these scientists have now expanded the program to Kenya and Madagascar, bringing the disinfecting system within reach of thousands, perhaps millions of people.
Unclean water can carry a variety of parasites and infectious diseases. Cholera is one of the most dreaded. It sweeps into communities, beginning with just a case or two. “By the afternoon, there are a hundred. The next day, there are a thousand,” says Eric Mintz, chief of the diarrheal diseases epidemiology section at CDC.
Cholera brings on debilitating cramps, vomiting and diarrhea, draining the body of fluids, salts and electrolytes. In severe cases, cholera victims can lose up to one liter of fluid per hour. “It can cause death in 12 hours,” says Mintz. “People can change from being perfectly healthy to being so dehydrated that they go into shock.”
That is the situation that Mintz and his colleagues witnessed when they traveled to Latin America in 1991 to investigate a severe epidemic of cholera. Hospitals overflowed with patients, and special oral rehydration tents were constructed in remote regions to try to save people who were too far from hospitals. Eventually, more than 10,000 people died.
In the midst of analyzing the epidemic, the CDC team asked simple questions. Who was staying healthy? Those who boiled water and stored clean water in containers with lids or small openings. What kept the CDC workers from getting sick? Simple water treatment. “We take a little plastic container and an iodine tablet. We treat our own water,” says Robert Tauxe, chief of CDC’s Foodborne and Diarrheal Diseases Branch. “We can go anywhere and we’re fearless.”
Suddenly, Tauxe and Mintz realized that a similar technique could work anywhere in the world. Instead of using iodine, people could generate chlorine (as sodium hypochlorite) by passing an electric current through salt water. Narrow-mouthed containers would prevent family members from dipping cups or hands directly into the water and would keep animals and pests out.
The first tests took place in Bolivia, where some families already filtered their water with cloth to remove bugs or pieces of dirt. The CDC scientists explained that they also needed to remove bugs that were too tiny to see.
“‘It may taste different,’” Tauxe would tell the families who drew their water from contaminated wells, “‘but that taste is the taste of health.’ Because they were afraid of cholera, they were willing to try the Safe Water System.”
Among the most challenging tasks for the CDC team have been marketing and distributing the plastic molds and the solar-powered chlorine generators, and communicating the clean water message. For this, they have received the backing of non-profit organizations such as Rotary Club of Estes Park, Colo.; other agencies, such as the Pan American Health Organization; and companies such as Proctor & Gamble.
In Bolivia, Population Services International helped create a logo and a mascot, using a water drop-shaped fellow named “Clarito” and a brand name of “Claro,” the Spanish word for “clear” and “of course.” In Zambia, volunteers went door-to-door to educate people about “Clorin.”
Marketing and distributing the Safe Water System through the CDC Foundation’s CARE-CDC Collaborative Health Initiative (CCHI), funded with a $500,000 CCHI grant, adds a strong community orientation to the disease prevention efforts. For example, CARE workers will organize villages in rural Kenya to improve the safety of their water and will help people in urban Madagascar adopt new habits of disinfecting and storing water. Such behavior change is as important to the Safe Water System as the chlorine itself, notes medical epidemiologist Rob Quick, a member of the CDC team.
The challenge, says Quick, is to help the target populations understand the benefits of chlorination - and to make clean water accessible and affordable. A bottle with enough chlorine to last a month costs 25 cents, including a five-cent commission to the person who sells it. But even those cents are precious to people who struggle just to afford food. “The people we target are the world’s poorest because that’s where the need is greatest,” Quick says.
The best promotion, of course, is the effect of chlorination itself.
Its use is often seasonal, peaking during the rainy season when cholera is more prevalent. The CCHI seeks to make chlorination a self-sustaining, year-round enterprise. Along with safer water, the disinfecting system creates a sense of empowerment in small villages and communities, Quick says. “They realize they can do something to improve their lives,” he says. “That can be a magical, transforming realization.”
- Michele Cohen Marill