It wasn't that I had never heard of corruption or the political and social factors that hamper work by international aid organizations; I just had never thought that these problems would affect me. I was, after all, an undergraduate doing a relatively miniscule project in a remote part of Ecuador. I had come prepared for the technical, scientific difficulties I would encounter in the project, but I was completely unaware of the complex political-social factors that are involved in any public health project, however small.

It all started as I was sitting in my customary chair in Muisne Hospital’s emergency room in July 2006. I spent every day that summer in the emergency room, observing and assisting the doctors and nurses in the small hospital that gave the only in-patient care for a rural region of Ecuador. Muisne is an island with a population of about 5000, located on the northwestern coast of Ecuador, one side facing out into the Pacific Ocean, the other side looking across a narrow estuary that separates the island from the continent of South America.

In the emergency room, I saw nearly every patient that walked through the hospital’s doors. Some of the patients came in with machete wounds that gushed blood, others endured surgeries without anesthesia, and several had malaria, dengue fever, and other dramatic medical problems that I would have been unlikely to see in a hospital in the United States. But by far the most noteworthy of what I saw was the sheer number of people stricken with gastrointestinal illnesses. Countless children and adults came into the hospital daily, severely dehydrated by diarrhea and vomiting. While these illnesses were not as exciting as some of the other afflictions I saw in the hospital, I recognized that the quantity of patients with these problems represented a major health problem for the citizens of Muisne.

I hadn’t heard of John Snow’s famous identification of a contaminated water source as the cause of a cholera epidemic in London; nor had I known that diarrhea from dirty water killed 2.2 million people last year, according to the World Health Organization. However, I did know that water was often the cause of gastrointestinal disease. In Muisne, I conjectured, water was probably a major reason for the tremendous number of people suffering from such illnesses.

I left the island at the end of the summer to return to New Haven and the grind of classes, but during my junior year I began to plan a project to evaluate the contamination of Muisne’s drinking water. I received a Bates Summer Travel Fellowship and a Yale Fellowship for International Research in the Sciences and Global Health to return to Ecuador, and so, one year later, I found myself once again on that small, sandy island extending tentatively into the Pacific.

The first thing to surprise me when I began to investigate the drinking water in Muisne was the variety of water sources that people used. The public wells were only used by a small fraction of the population. Rain water (I was in Muisne during the rainy season) was far more popular, and so was water purchased in 12 liter jugs in stores. The jugs cost 60 cents, a princely sum for a Muisnian, since an average family of five gets by on five to eight dollars per day and almost no one has their basic needs satisfied, but people’s trepidation about well and rain water made this more expensive water the most popular for drinking. In addition, some people used private wells, and a few people drank water from the municipal treatment plant.