In The Third World, Filthy Water Means death - All Too Often

By Nicholas D. Kristof - The New York Times

The Bhagwani boys scamper barefoot along the narrow muddy 
paths that wind through the labyrinth of a slum, squatting 
and relieving themselves as the need arises. The boys are as 
casual about the filth as the bedraggled rats that nose 
around in the raw sewage trickling beside the paths.
Usha Bhagwani, a rail-thin 28-year-old housemaid, points out 
her children and frets. Should she buy good food so the 
children will get stronger? Or should she buy shoes so they 
will not get hookworms? Or should she send them to school? Or 
should she buy kerosene to boil the water? Because there 
isnıt enough money for all those needs, parents such as 
Bhagwani always must choose.
It was to save money, as well as time, that Bhagwani was 
serving unboiled water the other day to her 5- and 7-year-old 
boys in her one-room hovel. Her bony face and sharp eyes 
softened as she watched them take the white plastic cup and 
gulp the deadly drink. The water has killed two of her 
children, Santosh, a 15- monthold boy who died two years ago, 
and Sheetal, a frail 7-month-old girl who died a few months 
ago. But everyone in the slum drinks the water, usually 
without boiling it.
Water seems so natural and nurturing that Bhagwani does not 
understand the menace that it contains. ³I try to boil the 
water,² Bhagwani said. ³But the boys sometimes insist on 
drinking right away because theyıre thirsty.² Then there is 
the cost, she said. To boil water consistently would cost 
about $4 a month in kerosene, almost one-third of Bhagwaniıs 
earnings. She could afford that, but then there would be less 
money for food.
The water comes from a pipe that runs into the slum where the 
Bhagwanis live, in the city of Thane, near Bombay. The pipes 
are cracked and run in a ditch that is filled with sewage. 
But health workers say that even if the water is treated 
properly at its source, sewage seeps in. That produces one of 
the most deadly ailments in the world today: diarrhea. 
Diarrheal disease kills about 3.1 million people annually, 
almost all of them children. The larger issue is that the 
most fundamental health challenge in the world at the end of 
the 20th century might be the same as it apparently was four 
millennia ago: sanitation.
To families such as Bhagwaniıs, perhaps nothing would make 
more difference than clean water and a toilet. All in all, 
human wastes may be more menacing than nuclear wastes. Feces 
kill far more people than radioactive substances. A wide 
range of diseases and parasites infect people by the fecal-
oral route, transmitted from one personıs waste by food, 
water or poor hygiene into the mouth of someone else. Some of 
those ailments are fatal; others weaken people and entire 
nations.
The burden of poor water and sanitation was evident in the 
frown on Sok Khengıs face as she sat in a hammock on the 
porch of her wooden hut beside a dirt trail in southwestern 
Cambodia. Sok Kheng, 36, a farm wife with a round face and 
hair tied back in a ponytail, held onto her son, Thouch, 2, 
who is physically and mentally retarded. ³He still canıt 
walk, and he canıt even sit on his own,² Sok Kheng said. ³He 
isnıt talking at all either.² Thouch probably will not 
recover.
In November, his mother took him to a doctor, who said the 
boy was severely malnourished, apparently because of worms or 
chronic diarrhea. The drinking water Sok Kheng gets from a 
pond 50 feet from her house probably caused it. The villagers 
bathe in the pond, and cattle use it, too. Because there is 
no toilet, the water probably is contaminated with human 
waste.
The doctor recommended giving Thouch cowıs milk to supplement 
his diet, so the family scrounged to buy a can of milk. At 85 
cents a can, it cost more than twice what the boyıs father 
earns for a dayıs work. A neighbor felt sorry for the child 
and gave them a few cans. But because the family has no 
concept of hygiene, the milk could do more harm than good. 
The milk is so precious that Sok Kheng makes each can last as 
long as possible, even though she has no refrigerator to keep 
it cool in tropical temperatures.
Sok Kheng is in many ways representative of those living in 
the Third World. About 2.9 billion people‹66 percent of the 
Third World population‹have no access to a toilet, not even a 
decent pit latrine. The vast majority simply uses a bush or a 
quiet piece of ground. For them, toilet paper is an 
unimaginable luxury. Most rely on leaves or a splash of 
water. Afterward, few have the means and training to wash 
their hands thoroughly with soap and water. Conditions 
improve 	
In some respects, sanitation in poor countries has worsened 
in the past few years. World Health Organization statistics 
show that in the first half of the 1990s the proportion of 
people in the Third World with access to a toilet actually 
fell, from 36 percent to 34 percent. But overall, sanitation 
conditions and water supplies have improved noticeably in the 
past few decades, and child death rates have fallen sharply. 
In particular, most countries are registering great progress 
in supplying potable water. In the first half of the 1990s, 
the proportion of people in the Third World with access to 
safe drinking water rose from 61 percent to 75 percent.
³When you look at the last century, the greatest advance was 
not antibiotics,² said Dr Graham Ogle, an Australian with 
long experience as a physician in Papua New Guinea. ³It was 
sanitation and the provision of clean water.² 
However grim conditions sometimes seem to be today, the 
progress of the past few decades is striking. The record in a 
variety of countries also is important because it suggests 
that although no single magic bullet is available, many 
approaches that help control sanitation-related diseases are 
available. 
One of the most persistent reasons for poor hygiene is simply 
that there is almost no water to wash with in many parts of 
Africa, India and China. Hand washing after defecation can 
seem like a luxury when the water must be lugged from a creek 
two hours away. 
(Copyright (c) The Oregonian 1997)