By: Christopher Wahlfeld
It is well recognized that diarrheal diseases have a profound impact on the health and wellbeing of a community. The World Health Organization states that diarrheal diseases are the 2nd leading cause of death among children under the age of five. 1 The principal contributors to the spread of these diseases are poor hygiene, a lack of safe drinking water, and poor sanitation. Thankfully, diarrheal diseases are quite preventable. Indeed, preventing the spread of diarrheal diseases is the primary objective of water, sanitation, and hygiene (WASH) programs.
WASH trainings focus on three important practices aimed at reducing the transmission of diarrheal causing agents: proper hand washing techniques (including use of soap), the treatment and storage of safe drinking water, and the safe disposal of feces. Each of these practices has been shown to reduce the risk of acquiring a diarrheal disease by 30% or more.
Though I had read up on WASH programs prior to coming to Kenya, I remained interested in seeing how WASH programs are implemented on the ground. Luckily, Lwala Community Alliance holds regular WASH events, many of which I had the chance to experience over the past few months.
Each month, staff from Lwala’s Community Health Office team up two or three community health workers to lead at least one WASH training session. These sessions take place either at Lwala, or in one of the communities in North Kamagambo. Though open to everyone in the community, WASH trainings often focus on high-risk audiences, including mothers with children under-five, and/or people living with HIV (PLHIV). Primary school teachers are also important targets of WASH training, as they have the opportunity to pass what they have learned onto their young students. In the end, Lwala’s goal is to have at least one member of every household trained in WASH.
WASH trainings are highly participatory and last between three and five days. These trainings cover a wide spectrum of practical topics, including disease pathways, the construction of different types of latrines, and various ways to effectively treat available water supplies prior to use. During their training, participants are taught how to make liquid soap, and a 6-step handwashing technique is emphasized. In addition, participants are taught how to build “tippy taps.” As piped water is not common in the region, these devices, often modified plastic jerry cans, are a common component of handwashing stations found at schools and near latrines throughout North Kamagambo. Tippy taps provide a simple way to supply running water for wetting and rinsing soapy hands.
I have had the pleasure of attending two WASH graduations in recent weeks and have spoken with several participants following their training. It has been enlightening listening to participants enthusiastically describe all that they learned in the previous days, and how they plan to implement WASH at their homes, and within their communities.
WASH training is of particular import for people living with HIV. Due in great part to their compromised immune systems, PLHIV have a greater susceptibility to opportunistic infections. Diarrhea is common symptom of opportunistic infections and affects approximately 90% of PLHIV. 3 The World Health Organization (WHO) states that “diarrhea rates are 2-6 times higher in PLHIV than in those who are not infected, and rates of acute and persistent diarrhea are twice as high in populations of PLHIV as in uninfected populations.” 3 To reach PLHIV, and larger segments of the general community, Lwala promotes WASH practices at its HAWI outreaches. HAWI is Lwala’s HIV/AIDS and WASH Integrated program. The acronym HAWI could not be more appropriate as it translates into “luck” in the local Dholuo language. Spearheaded by the Lwala’s Community Health Office, HAWI outreaches take place approximately once a month in one, or more, of the ten areas which Lwala serves in North Kamagambo. Lasting one day, HAWI outreaches are open to the community, regardless of HIV status.
HAWI outreaches can be quite lively. With loud music blaring in the background, community members have the opportunity to compete in several fun events throughout the day, including a dance contest, a sack race, and/or an egg race. Participants in these events compete to win WASH related prizes, including liquid soap, water treatment tablets, wash tubs, and plastic pitchers.
HAWI outreaches are also educational events consisting of both HIV and WASH components. Community members attending the outreach have the opportunity to learn about the different types of latrines, and the importance of building a handwashing station. Stigma reduction is also a prominent goal of HAWI outreaches. Throughout the day, individuals, and couples, living with HIV are encouraged to provide testimonials to the community, describing their experiences living with HIV and how proper adherence to antiretroviral therapy has
improved their health and overall wellbeing.
After attending several WASH related events, I decided it was time for me to go through an in-depth WASH training. Luckily, Lwala offered a 3-day WASH training for teachers last week, and I was able to attend. I am happy to report that, just like many of my friends in North Kamagambo, I too am now WASH trained.