Monday, October 20, 2008

Operation Sphincter Plug

If you read any literature from the United Nations, World Health Organization, etc. the most widely-used statistic to measure the development of water sanitation infrastructure is the “percentage of the population with access to clean water.” My village of Sanadougou has one water pump which filters out particulate matter, guinea worm larvae, amoebas and giardia cysts – so according to UN/WHO criteria, 100 percent of Sanadougou’s 4,426 inhabitants have access to clean water. And so now everyone is parasite-free and perfectly healthy and there is nothing left for me to do here.

… Just kidding. The Japanese foreign aid agency which funded the construction of the primary school in town was certainly benevolent and forward-thinking in their construction of a water pump and filter next door. So when elementary school kids are thirsty they can drink clean water, and so can I and the few people whose houses are right next to the filtered water pump. But water is surprisingly heavy, and to draw a bucket of water every time you have to take a drink, cook a meal, clean the dishes, do laundry or water the garden, and carrying 50 pounds of water on your head for any distance is an onerous, tedious task. Asides from the cluster of families whose houses are in the direct vicinity of the school, very few people in Sanadougou ever bother to walk all the way to the pump and back.

I would say that 95 percent of the people in town drink well water. And when I say a well, I don’t mean a raised cement-brick structure with a cover and a pulley. When I talk about a well in Mali, I usually mean a hole dug in the ground with water in the bottom – slightly discolored water which looks like the pond you swam in at summer camp. Most people have their own well in the family compound, which means that it is situated on the dirt floor probably equidistant from the kitchen, the chicken coop and the donkey stable. So when your typical Malian is thirsty, the nearest woman drops a bucket into the hole in the ground, pulls it up and drinks whatever is inside. Sometimes people just crouch down in the nearest mud puddle, cup their hands and slurp up the contents.

Hence even though everyone in Sanadougou technically has “access to clean water” provided by the most state-of-the-art Japanese-built pump, if people prefer to drink from their neighborhood mud puddle, the concept of water sanitation here is really little more than a figment of the imagination of some bureaucrat sitting in an air-conditioned office in Geneva. And likewise, it is not very difficult to understand why diarrhea is after malaria the most lethal cause of infant mortality in this country. Some nights when I can smell the telltale sulfur wafting in the air, if I can gauge the direction from which the wind is blowing I can tell precisely which of my neighbors has giardia – my olfactory hypothesis at this point is approximately 70 percent of the good people of Sanadougou.

Some old, dead white guy once said that “Politics is the art of the possible.” My mission over the next two years is to design and implement an affordable and feasible plan to reduce the number of people in this village suffering from water-borne diseases, and methinks that the most doable stratagem within my reach for reducing the number of children who die from dehydration before their parents carry their tiny bodies to the clinic next door in vain is to concentrate on combating diarrhea. The threat of HIV/AIDS, cancer, tuberculosis, African river blindness, and even Al-Qaeda in the Islamic Maghreb pales in comparison to the threat to Malian well-being posed by diarrhea, and so it is this doer of evil towards which I am for now concentrating my labor. And so I call my current campaign Operation Sphincter Plug.

I am absolutely anal retentive (pun intended) about what I drink, so any drop of water which gets anywhere near my mouth – unless it was previously in a boiling teapot – comes first from the Japanese water pump, then I filter it again with my own personal two-tiered charcoal filter to be doubly protected against undesirable water-borne organisms, and then I treat it with an ample dose of chlorine bleach. If the Republic of Mali could purchase one of these babies at maybe 50 bucks a pop for each and every one of its 11 million concitoyens, then cholera, dysentery, amoebas, giardia and every single malady which leads to juvenile diarrhea and infant mortality would plummet. However, the World Bank’s inflation-paranoid lending policy has commanded that Mali keep government spending to an absolute minimum – thus no such program could conceivably exist so long as their development policy is restricted to the free market orthodoxy of the Washington Consensus.

I could also organize the farmers of Sanadougou to put aside all of the profits from their peanut and cotton harvests from now on, spend none of it on food and medicine and instead put those profits away in one of the local banks which does not give out interest, and pray that maybe 80 years from now there will be enough accumulated enough capital to construct a new water pump in the center of the village. If this plan works, then the World Bank would be very pleased as the invisible hand of capitalism develops without government interference.

Accepting the fact that people are going to drink from their wells until a more convenient source of water appears in their family courtyard, and acknowledging the cruel realities of my financial constraints, the first forward offensive of Operation Sphincter Plug to eradicate juvenile diarrhea in the village of Sanadougou has been rather modest. Since I can't buy everyone their own personal two-tier charcoal water filter, I am endeavoring to replicate the chemical reactions which occur in the bottom tier of my charcoal water filter: chlorine bleach treatment, a method which works against microscopic pathogens but not larger parasites like guinea worm. I am spending most of my time now going door to door and talking to housewives about how they can treat their well water with chlorine bleach available at any every butigi (the Malian equivalent of a bodega).

Though the concept of microscopic pathogens is not widely understood – many people believe in witches and warlocks – there is a Bambara term banakise which means “bad seeds”. Nobody seems to know what these “bad seeds” are or where they come from, but they are undoubtedly very, very bad. Every Malian I talk to accepts that banakise - whether created by nature or by black magic - can cause sickness. I am never going to be able to get people to stop believing in sorcery, but I’m not a missionary and I don’t care if people believe in ghosts or goblins or the Easter Bunny so I’m not even going to try. Without challenging people’s beliefs or skimping on the science, I explain that chlorine bleach kills the banakise. So far people seem to be receptive to the idea, and they are much more receptive to my suggestions in regards to treating water with chlorine bleach than they are to washing their hands with soap.

I am also trying to teach people how to treat their wells each month with a larger amount of bleach, and this is tremendously more difficult as it involves math. In order to treat well water with the appropriate amount of bleach, one must first ascertain the volume of water in the well. As anyone who has ever taken a junior high school geometry class could probably figure out, this entails measuring the diameter of surface, measuring the depth of the water with a rope tied to a rock, and calculating the volume of a cylinder. Using the Bambara words for “depth” – dunya - and “diameter” - fie, one calculates the volume of well water with the formula
V = d x [π ( f2 / 4)].

Some people in town can understand this concept very well; i.e. people who use math on an everyday basis such as the math teacher, the doctor, carpenters. But the majority of people in Mali are illiterate. I don’t mean illiterate as in people who get their news from the graphs in USA Today – I mean illiterate illiterate, as in people who sign their name with an “X” - if they even know how to hold a pencil. Though the schools in Sanadougou are free of charge, many people simply don’t go because their family needs them to herd cattle and till the peanut fields, and therefore illiteracy is simply a fact of life. In a society where the ability to read and do math beyond simple arithmetic is quite rare, to many people the expression: V = d x [π ( f2 / 4)] is absolute gobbledygook. And so I am engaged in the tedious process of doing the calculations for every family's well and writing a table so all that they have to do is measure the depth of the well water.

That's not all. If you think that it might only be difficult to explain the concept of measuring volume in cubic meters, try explaining the concept of what a meter is. Few people besides carpenters even have any means to make a precise measurement - a peanut farmer who makes the equivalent of 400 dollars a year has little reason to invest in a meter stick. So for many families, I have actually made them meter sticks by simply taking a flat board or pole and copying the hashmarks on my own.

At this rate, I will have explained the treatment of well water with chlorine bleach to every household in Sanadougou in one year; if everyone to whom I teach this practical water sanitation method actually employs it, maybe - just maybe - the number of kids in this village who die from diarrhea-induced dehydration will decrease. Now if only I could convince everyone to wash their hands with soap...

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