Waters of death

That almost eight in 10 Malawians have access to clean water is not good enough until the unreached two are no longer excluded. JAMES CHAVULA writes.

Getting sick is scary in remote parts of the country. In the sprawling district of Mzimba, health centres are few and far apart-though thousands of Malawians are at high risk of dying of diseases caused by unsafe water, poor sanitation and hygiene.

“Water problems keep haunting us. We often fall sick instead of farming,” says Pastor Owen Mwafulirwa of Thimalala Village, Traditional Authority (T/A) Mtwalo in Mzimba North.

In the countryside, many households draw drinking water from a swamp where livestock drink.

The villagers speak of rampant stomachaches, diarrhea, bilharzia and roundworms, saying children are the worst hit. When we met, the Assemblies of God cleric was battling with the worms which leaves one in 10 Malawians in danger of anaemia, malnutrition and retarded growth.

“Children fall sick frequently,” he says. “However, I have spent months and money seeking for drugs for de-worming, but the stomachaches continue.”

The people, who walk over five kilometres to reach Engucwini or Kaweche health centres, assert of being sick and tired of dying of the parasitic water-related diseases which retard growth and mental development.

In the bastion of crop diversification and livestock, it is clear why most children are often bed-ridden and stunted due to bilharzia, malaria, roundworms and other preventable waterborne diseases.

Bushy slopes and crop fields border a swampy ‘oxbow lake’ on the banks of Kasito River. The water is stagnant, murky and overgrown, a breeding ground for mosquitoes which transmit malaria. The motionless water, with reeds and grass all over the place, is also favourable for snails in which bilharzia parasites lay eggs.

When it rains, the human excreta infesting the surrounding bushes-where some of 1.4 million Malawians with no latrines at all mostly defecate-washes into the muddy pool. Continued open defecation is a risk factor for diarrhoeal infections as well as the spread of roundworms, hookworms and tapeworms.

Sadly, the villagers, especially women and children, are constantly in contact with the contaminated waters through swimming, washing as well as drinking it and eating food that has been washed in it.

During the visit, we saw a group of women drawing the muddy water.

“We often use it for bathing and washing clothes, kitchen utensils and beddings. Some drink it because they cannot withstand walking long distances to boreholes,” says Esnes Simwaka of Yobe Village.

Standing in the water exposes them to eggs of bilharzia worms, schistosomiasis-which prick the skin as they tunnel into the bloodstream.

Children-as seen at play in the brownish waters-are mainly vulnerable to the disease which causes blood in urine, World Health Organisation (WHO) warns.

Swimming in contaminated fresh-water waterways in areas where schistosomiasis is endemic worsens the risk, the United Nations health agency reports.

It is not peculiar the villagers sound familiar with bilharzia symptoms-including itches, skin rashes, fatigue, unstable body temperature, weight loss and blood in urine.

“On radio, we hear many people saying water is life, but we are struggling with terrible infections, especially bilharzia, because boreholes are beyond reach,” she laments.

Nearly 200 million people globally are infected by bilharzia at a time 20 in 100 citizens have no access to safe water.

The search for improved well-being has united Thimalala residents to construct a clinic complete with two houses for health surveillance assistants. The locals envisage the milestone trimming of the long journeys to existing health facilities and being gradually upgraded into a health centre.

When asked, the health surveillance assistant Alliston Kasisi, while thanking the community for saving him from awful conditions associated with leaky huts with dusty floors, describes the water situation as pathetic.

“I work with almost 1 650 people scattered in 15 villages, but only four villages have boreholes,” he says.

Unsafe water accounted for about 20 bilharzia patients in 2014, 16 diarrhea patients in November 2015 and up to eight malaria cases daily during this rainy season, he recounted.

“The clinic project demonstrates the locals’ willingness to improve their wellbeing, but they are being let down by lack of safe water,” Kasisi states.

To him, the disease burden could be symptomatic of how rural localities are sidelined as both government and non-governmental organisations (NGOs) scramble for urban zones.

Foundation for Children’s Rights (FCR) is one of the few agents of change working in the remote spot. The locals actually approached St Andrews-Liverpool to support the construction of the clinic after FCR trained community leaders in how to lobby for decent health services.

Environmental health practitioner Kondwani Botha, who managed the FCR community empowerment project, says the water-related illnesses mirror “how public health gaps often taken for granted tend to have costly implications on healthcare delivery”.

“There are fewer health centres in rural areas where many Malawians in poverty live, but most of the facilities struggle with a huge disease burden and drug shortages because basics, such as provision of water, sanitation and hygiene facilities, don’t seem to receive the priority they deserve,” Botha explains.

The World Bank estimates that the country loses K8.8 billion ($57m) due to poor access to water, sanitation and hygiene services. Each year, almost K6.6 billion ($43m) is lost due to premature death as approximately 8 800 Malawians, including 4500 children under five, die each year from diarrhea-nearly 90 percent of which is directly attributed to poor water, sanitation and hygiene.

The disease is a leading killer of children countrywide-accounting for 11 in every 100 deaths among under-fives.

Not investing in equitable access to safe water, especially for unreached areas, is neglecting the world’s second largest killer, a study by Water Aid implores.

At Engucwini Health Centre, in-charge Esther Kajadu-Zulu pointed at health workforce overwhelmed by an avoidable workload, saying: “We work day and night treating preventable diseases as many communities in our catchment area still have access to safe water.” Yobe village development committee chairperson Jimmy Kamoza Gondwe wants concrete action to eliminate the unmet demand for safe water, especially in rural settings.

He says: “We have been suffering for decades. If we had money, we would have drilled enough boreholes to make waterborne diseases history-as we are expanding the clinic.” n