Providing water for life

Prof Kevin McGuigan, Director of the RCSI Solar Disinfection Research Group, has a simple formula for saving lives — sunlight and plastic bottles. He has been using both for water disinfection in the developing world for decades and is now spearheading a major expansion of the initiative in Ethiopia, Uganda, Malawi and South Africa.

“With water treatment in low-income countries, it’s very easy to see the beneficial effects among children in particular because they are the ones most at risk. Our research has demonstrated lower disease rates. We’ve also seen faster child development and improved attendance in schools,” Prof McGuigan told the Medical Independent (MI). “The solution is so simple. It’s about putting water into a transparent bottle and leaving it in the sunlight.”

But, like all simple ideas, its success depends on implementing it carefully and ensuring a buy-in by the communities it seeks to help. So when MI spoke with Prof McGuigan, he was preparing to head off to Ethiopia and Uganda to consult with local community leaders and get their input to make sure the project meets their needs.

But he probably shouldn’t be overly concerned, because Prof McGuigan has been getting it right for decades now since he first became involved in bringing water disinfection to millions of people in the developing world and educating communities to implement the solution themselves. He is quick to credit others, but he is the main driver of this project funded by the EU to the tune of €3.6 million.

Over the next four years, as Coordinator of WATERSPOUTT (Sustainable Point- of-Use Treatment Technologies), he will lead 18 international partners, including researchers from Dublin City University and Maynooth University, under the auspices of the 3U Partnership’s Global Health group, to develop, field-test and pilot large-volume solar treatment technologies. This essentially means the project is moving on from disinfection in bottles to using larger containers.

WATERSPOUTT is aimed at people who have no hope of being attached to a municipal water supply and are relying on surface water ponds or hand-pumps or bore holes. “We’ve done a couple of projects in Uganda and one is still going on there, also in Kenya, Zimbabwe, parts of South Africa, Cambodia and Ethiopia. So the last 20-to-25 years have been about introducing it on a household level using freely-available bottles. Now we’re increasing the volume to make it easier for the families.

“Up to now, we’ve been telling people to get their hands on a plastic or glass transparent bottle and use that for solar disinfection and that will reduce the amount of illness within the family. That’s been very successful and what we want to do now is to introduce containers with large volumes. So, rather than one family having 10-to-12 bottles out every day, they just have to manage one single 20-litre container.”

The four-year project started in June and in July, the RCSI hosted a kick-off meeting where all the principal investigators from the 18 institutions discussed the plan of action and agreed what needs to happen over the following four years. “It was a wonderful way of making sure that anything unforeseen came to the fore and we could plan for those eventualities,” Prof McGuigan explained. “So it was really successful in that regard.”

The preparation is paying off and the project is going well. “We’ve made all our deliverables so far and the EU is also happy with our progress. You never know what’s around the corner but everything seems to be proceeding as planned and working as we hoped.”

Between now and Christmas, Prof McGuigan is going to be back and forth to Ethiopia and Uganda to meet with local community leaders about the project.

His first stop will be Ethiopia on 23 October and then Uganda on 6 November. “In Ethiopia, where we are piloting transparent jerry cans for the project that could be in households rather than schools, we’ll be talking to community leaders to let them know this is going to be happening in the next year and get their feedback on what they think should be included in the design. There’s no point going there with a fully-formed prototype that might not be suitable, so we get their input right from the start.

“In Uganda, we’re installing a large-volume solar disinfection reactor that will disinfect harvested water. So we will look at places that have harvested rainwater tanks, specifically schools and households in southern Uganda, and we’re going to select which ones would be ideal for solar disinfection.”

<h3 class=”p4″>SODIS</h3> WATERSPOUTT will use solar water disinfection (SODIS), which provides safe water on a daily basis for up to five million people in 55 developing countries and has been in existence for about 30 years, thanks largely to the efforts of Prof McGuigan.

The technique consists of placing water into two-litre transparent plastic or glass containers, which are then exposed to the sun. Exposure times vary from six-to-48 hours, depending on the intensity of sunlight and sensitivity of the pathogens. Its germicidal effect is based on the combined effect of thermal heating of solar light and UV radiation and it is recommended by the World Health Organisation (WHO) as a method for household water treatment and safe storage. According to the WHO, some two million people each year die of preventable water-borne diseases and about one billion lack access to a source of safe drinking water.

Prof McGuigan first encountered SODIS in his early days as a young physics lecturer at the RCSI. He recalls the life-changing moment like this: “The door of my office burst open one morning and a very distinguished looking elderly gentleman tapped his stick on my desk and asked me to help to save lives with sunlight.”

<blockquote> ‘There are many ways you can treat water. What we’re looking at in my group at the RCSI is using solar energy to make the water safe to drink’

</blockquote> For the young lecturer, it was an irresistible pitch. “The man was Dr Joseph Barnes, lecturer in tropical medicine, who has since retired. He wanted some experiments done using solar energy. We just formed a very effective collaboration and we took it from there.”

Their collaboration and research caught the imagination of others and became pivotal in establishing beyond doubt the effectiveness of water disinfection using plastic bottles and sunlight and the method has now been in use for over two decades across the developing world.

“There are many ways you can treat water. What we’re looking at in my group at the RCSI is using solar energy to make the water safe to drink. We’ve been doing this work for about 25 years and we’ve been able to show how effective it is in trials we’ve done throughout Africa and Asia.

“Our current project, which kicked-off in June, is looking at new technologies that will treat larger amounts of water in the household and in primary schools and clinics in the developing world.

“We’re relying on the cheapest source of energy, which is the freely-available sunlight; we’re using larger, low-cost, sustainable containers to store the available water and it gets treated within those.

“We’ve already got programmes running in Uganda so it will be a continuation of that, looking specifically at three new technologies — the 20-litre transparent jerry cans and rainwater tanks, with the intention of using those in primary schools in Uganda and in private dwellings in South Africa. And the last one is a type of combined technology of solar disinfection — which is actually more effective than ceramic filtration — by adding a ceramic filter so people get the enhanced disinfection and treatment by combining a more effective solar disinfection aspect, as well as the existing ceramic filtration.”

<h3 class=”p4″>Partnership</h3> The project brings together 18 international partner institutions from countries such as Austria, Italy, the Netherlands, Spain, Switzerland, Turkey and the UK, along with four African partners from Ethiopia, Uganda, Malawi and South Africa.

“We have a design school in the University of Buckinghamshire in the UK, we have small private companies and we have research institutions in Europe and in Africa. We have a broad mix of basic scientists, designers and manufacturing experts and over all of that, we’ve got a team of social scientists who will help us to talk to the target population to make sure that what we develop is actually meeting their needs, rather than us coming up with something that looks great in the laboratory but wouldn’t actually be suitable in the field.”

3U Global Health researcher Prof Honor Fagan, Professor of Sociology at the Department of Sociology in Maynooth University, is work-package leader for the social science component of the project and Dr Brid Quilty, Senior Lecturer at the School of Biotechnology at DCU, is looking after aspects of the enhancement technologies.

“I’ve been ploughing the solar disinfection furrow for over 25 years,” Prof McGuigan commented. “We’ve co-ordinated the trials in developing countries and collected the data and then did the analysis. So we’re in the project management area now. Over 20 years ago, we pioneered the microbiological testing to make sure it was safe and now we’re looking at pilot trials for the various innovations.”

An important aspect of the project is that researchers are recruited from within the developing countries to encourage capacity-building. Whenever they do a study in a particular country, they link-up with a local partner, which could be an aid agency or a government agency or a university. In the case of the WATERSPOUTT project, the African partners are third-level universities in the four countries involving scientists who are doing similar research in this area.

“For the current African project, our PhD students will be African, so once the project is finished they will still have experts in these technologies who are working within Africa and promoting the technology beyond the lifetime of the project.”

<h3 class=”p4″>Context</h3> Prof McGuigan stresses that such work with communities in the developing world has to be sensitive to the cultural and community contexts. “The big challenge I’ve always found is not the science; it’s the social science aspect. That’s why over the last 10 years we found ourselves relying more and more on our social science colleagues. Science will only get you so far. It might get you onto the bench in the laboratory but it might not get you onto the kitchen table in the household, unless you can convince the care-givers in the house that what you’re doing is worthwhile and will benefit their families. It’s helping people realise that something as simple as a transparent bottle can improve the health and education of their children.

“Usually at the start of a project, you go over and have meetings with community leaders and you explain what you’re hoping to do and then you ask them for their feedback and address any concerns that they raise, and once you do that, you can get buy-in from the communities. If the community leaders are happy that your motives are coming from the right direction, it becomes much easier to introduce the technique in an area.”

That’s where Prof Fagan comes in. Vulnerable communities without access to safe drinking water require more than just technological evidence of disinfection efficiency, she points out. “If the solar-based technologies are to be successfully adopted, strategies must be tailored, such that the advantages of collection and treatment at the household are immediately apparent to those who stand to benefit most from their introduction.”

Prof Fagan has visited the water disinfection project in Uganda and has been involved in this type of work for about 15 years. She is also preparing to travel with Prof McGuigan to Ethiopia this month.

“Prof McGuigan works at the health and technological end. I work at the social science end. The social science dimension is about making sure the people are on board and understand and work with the technologies and in fact influence what technologies are designed for their community, which are often poor and vulnerable,” Prof Fagan told MI.

“We’re beginning this new project but we’ve just come out of a five-year project in a rural community in Uganda and we worked with the University of Makerere there to train eight new Ugandan-based scientists and social scientists to deal with their country’s water problems. We worked with those eight people to help them get PhDs in areas like engineering and biology. In that way, we built the research capacity of a country’s people. We trained them in a community context and we trained the locals in the community as well.

“In Uganda, for example, we took a case study area and worked with the community and the research trainees. So the social scientists moved in and set the ball rolling. We had a gender anthropologist, a local Ugandan, to see how women manage the water because the fact of the matter is that at community level, and particularly household level, women are responsible for water. For example, the anthropologist lived in one of the women’s houses and went to the well and sat by it and talked to the women and kids and became part of that community.

“Meanwhile, the project itself is proceeding. We do a baseline survey of about 500 families to determine their water needs, their difficulties in relation to water and the level of water poverty. The geography expert, meantime, is walking with the cow-herders and working with them in relation to their challenges and how they are managing, while an engineer goes around checking the pumps to see what’s broken and what needs to be fixed. So we move a whole social science team into the community and work with them for four years in Uganda.”

<h3 class=”p4″>The role of women</h3> Invariably, in developing countries, women do all the work with water but have very little power and very little income. This means that women very often have to travel unaccompanied for long distances on foot and wait for long periods at the water source, increasing their risk of injury, ill-health and economic hardship. The Ugandan government has strong policies on female representation and quotas on water resource management teams. But, in reality, as Prof Fagan discovered, it doesn’t always work out that way.

“We found after studying 15 water resource management teams with the quotas that three did have women managing the committee. These teams, we found, were doing so much better than the other ones — their pumps were working, the fee for the water was being collected and when there were repairs to be done, they were efficiently organised.

“They have a public-private partnership and the arrangement is that people do have to pay some money and they do have an element of fees for water, which seems incredibly crazy in the context of the poverty. To get around this they go to water resources, probably an open water resource, where they don’t have to pay fees so you will find many people not using the improved water resources, but instead drinking poorly-sanitised water.”

Prof Fagan co-ordinates the social science dimension of all the universities involved in the project in the four African countries. “We look at the relations of gender and class in the communities and the social conflict that might be there. So we’re looking at the social, political and economic context of communities — what kind of resources they have, how much money they have, how they organise themselves, and so on.

“Then we look at the governance context for water — how is water governed in Ethiopia, Uganda, Malawi and South Africa? What are their water policies, where are they in terms of reaching the sustainable water goals in the millennium development plan in terms of delivering water to households?

“Then we do an economic survey of all the households to see what are the needs of those households, what are their incomes and so on. That’s all going on in the background and at the same time, we begin to work with the water committees and introduce them to the idea of new technologies around water and solar disinfection.

“We know already that women do the water work for the domestic households and we know that they in turn farm-out a good bit of that work to the children, so maybe two hours of carrying water is done before school in the morning and if it’s not done, the children don’t get to school. So if we come with the solar technology and a, say, five-litre jerry can for a school and leave those there for the children to drink water while they’re at school and it’s getting disinfected while it sits there, so that’s a good use for that particular container. So we watch sustainability issues carefully and talk to the community, because there is a history of people going in and giving tractors, for example, but people in these communities not having the money for the petrol.

<h3 class=”p4″>Rewards</h3> “When we meet people, they are desperate for help with their water. They know that water quality is related to health because there are education programmes on water in all of these countries. What they don’t have is easy, safe access and are usually desperate for any help in relation to that.”

And when the project is over, the local community is trained-up to continue it. “We resolve the water needs in the local communities in a way that can be scaled-up to national level. That’s why we have educational packages so they’re available to go out to other communities to further this work.”

Prof Fagan said the work is extremely rewarding. “It’s hugely rewarding. At the scientific level, at the theoretical level and then at the social level, you are making a difference. You’re putting change into action. You’re having an impact.”

Prof McGuigan sees it similarly: “That’s why we do it. It’s to see the children having less illness, developing in a more healthy fashion and having a better education.” It is about saving lives, too, he noted, especially when cholera hits a community. “The thing that stood out for me most over the last 25 years concerns Kenya. We were doing a water project there and at the end of it, there was an outbreak of cholera in that region.

“We were able to go back and do an analysis on how the people using solar disinfection fared in the epidemic and we were able to show that those who were using solar disinfection were seven times less likely to contract cholera, a disease that can kill a child within 24-to-36 hours. So something as simple as a plastic bottle was able to protect children from such a fatal disease.

“I get great solace from that. If I did nothing else, I can point to that and say ‘we saved lives on that occasion in Kenya’. You take your victories where you can find them and that was a huge one for us.”

See www.WATERSPOUTT.eu for more information.

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