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“Bacteria, I’ve heard of it” Zaina says; “It comes from vegetables. It’s a sickness in your eyes” Rosi Yakobo suggests; “A skin disease,” according to Ijumaa Mfinanga. Speaking about amoebas Majuma Damezia says, “All I know is that my sister had one.” Hilda Ndokusi added “Amoebas live in your stomach, they say.” Those who have heard of virusi, all relate it to AIDS or blood. They clearly grasp the macroscopic, visible import of the virus. “It destroys people,” Rafael Amhudi says. 82 year-old Meraji Abdallah summarizes: “It’s bad.” More alarmingly, the villagers do not translate their words into behavior. While 63% of Uchirans reported boiling their drinking water, observation and discussion with village leaders suggest that the percentage of those who actually boil is closer to 5%. Fully 63% of villagers have heard the public health ads on the radio, seen posters at bus stops, or listened to well-intentioned missionaries, village leaders, and aid workers. Yet only 5% took home anything more than words. As the village secretary Bariliel Mgalah says, “We have given them education, but they don’t know the importance of the education.”
When challenged about drinking unboiled water, some teenagers just roll their eyes. Older villagers cite habit, a long day in the fields, and most often, lack of money as reasons for not boiling. Dr. Lyimo scathingly commented on their excuses, saying, “they are poor in understanding, not in money.” This lack of understanding crops up in soap use, mosquito net use, hand washing, plate washing, and latrine maintenance. With each failure of education the water gets dirtier and the people get sicker.
Studies all over the world find that water and sanitation are linked; they also find that effective hygiene education, though diffi- cult, is the key to truly improving public health. For example, a large UN water and sanitation project in India (1964-2000) found that it had to shift focus from “pipes and pumps” to “behavioral change” to see real improvements in health.
Although the UN’s Millennium Development Goals (MDG) underline “improved access to drinking water” as a major target, the metric they employ only measures the quantity of water designated “improved for drinking.” Quality receives no mention. All the officially designated “drinking water” in the world won’t relieve anyone’s thirst if it’s undrinkable. While the world remains on track for the UN “improved drinking water” target, the world will miss the “improved sanitation” target by half a billion people. Zaina says, over the next cup of tea, “some of these poor people, they don’t know how to use our water.”
Some attitudes may be changing. In the ground breaking “New Water Strategy” promulgated in 2005, Tanzania’s Ministry of Water and Livestock Development remarked that, historically, more consideration has been given to water services than to sanitary services in Tanzania. Government officials and NGOs have accorded little priority to hygiene education, but their priorities need to change. Fittingly, GTZ also pledged money for a progressive health education project in Uchira designed to avoid the pitfalls that have sunk similar efforts in the past. Combining the chlorination project with savvy education efforts would seem to make drastic health improvements inevitable. But statistics on what kills Tanzanians show that even perfect sanitary conditions and hygiene education could just be another small step in the long march towards public health.
Un-development
When the chlorination technicians and public health educators arrive in Uchira, they will encounter a stark reminder of Tanzania’s third greatest killer, the fading roadside bloodstain of a 12-year old boy. A bus driving from Dar-es-Salaam to Arusha crushed him as he walked home on the narrow shoulder on July 17th. The situation in Uchira has confirmed the need for the new multidisciplinary approach to public health currently being built by the United Nations and enacted by groups like GTZ. But roadside deaths confirm that the new approach to battling disease is no panacea. Technological development and education do not automatically improve health. It confirms that in a developing country, the issue of public health develops too.