"A healthcare facility without WASH is not a health-care facility."
- Dr. Maria Neira, director of Public Health and Environment, World Health Organization
- Dr. Maria Neira, director of Public Health and Environment, World Health Organization
Women wait to give birth in facilities without adequate water and sanitation.
Photo: Haik Kocharian for Village Health Partnership (VHP)
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Healthcare facilities are centers of infections and upwards of 50% of them are operated by faith-based organizations in some countries. Nowhere could we have a greater impact on human health than here.
Well into the 21st century, hospitals and healthcare facilities around the world look like something from the 1800s. During the middle Ages, life-expectancy was measured in the teens, not decades. Much of the world lived in filth with poor hygiene, practically no sanitation and unsafe water. Epidemics and diseases like bubonic plague, typhus, smallpox and tuberculosis (“consumption”) were the result, taking a massive toll on humanity. Little improvement was made until the mid- to late- nineteenth century when the Industrial Revolution, germ theory of disease, and a nurse named Florence Nightingale became the driving force for hospital reform. She convinced the world that improving hygiene and sanitation, as well as having trained professional nurses tend to the sick, were necessities. |
 This ward is not from the 1800s. Photo: Oxfam International
As medicine travels across bionics and gene therapy into string theory and nanotechnology, the most important discovery that can save millions of lives is left behind: In 2018, the University of North Carolina Water Institute crunched data from 129,000 healthcare facilities in 78 low- to middle- income countries, revealing tremendous gaps:
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Newborns in intensive care share incubators that cannot be properly cleaned.
PHOTO: Haik Kocharian for VHP
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Midwives do the best they can.
PHOTO: Haik Kocharian for VHP
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Newborns and new mothers are the most vulnerable:
WASH and safe births:
“Encouraging women to give birth in healthcare facilities is one of the key strategies for reducing maternal mortality. Yet even in the very facilities that are set up to serve their communities with healthcare and welcome new life into the world, there is often no constant clean water supply, functioning toilets or handwashing facilities.” click here to read more...
“Bring your own” birthing kit:
“In some cases, women giving birth must buy their own ‘clean birth kit’, which includes a plastic sheet and gloves to compensate for the lack of adequate hygiene provision in maternity units.” click here to read more...
Newborns and sepsis:
“8% of maternal mortality is caused by sepsis. A failure to make sure that a woman has a clean place to give birth, that a midwife, birth attendant or doctor has clean hands when helping her deliver, and that the blade which separates the child from his mother by cutting the umbilical cord is clean puts a baby at risk. The absence of sufficient infection prevention and control measures in healthcare facilities should be of particular concern to those attempting to redress the slow progress to reduce maternal mortality globally.” click here to read more...
50 % of the health burden of malnutrition is attributable to WASH:
“Diarrhea is deadly. 1.5 million people die every year from diarrheal diseases (including cholera); 90% are children under 14, mostly in developing countries. 88% of diarrhea is attributed to unsafe water supply, inadequate sanitation and hygiene. As diarrhea causes undernutrition, it creates a vicious cycle by also reducing a child’s resistance to subsequent infections; repeated bouts of diarrhea can negatively impact children’s physical and cognitive development.” click here to read more...
Up to 1:2 surgical patients can leave a hospital with an infection they did not have upon arrival:
“In some developing countries up to one in every two patients (45.6%) left hospital with an infection they had not had on arrival.”
click here to read more...
For more information:
WASH and safe births:
“Encouraging women to give birth in healthcare facilities is one of the key strategies for reducing maternal mortality. Yet even in the very facilities that are set up to serve their communities with healthcare and welcome new life into the world, there is often no constant clean water supply, functioning toilets or handwashing facilities.” click here to read more...
“Bring your own” birthing kit:
“In some cases, women giving birth must buy their own ‘clean birth kit’, which includes a plastic sheet and gloves to compensate for the lack of adequate hygiene provision in maternity units.” click here to read more...
Newborns and sepsis:
“8% of maternal mortality is caused by sepsis. A failure to make sure that a woman has a clean place to give birth, that a midwife, birth attendant or doctor has clean hands when helping her deliver, and that the blade which separates the child from his mother by cutting the umbilical cord is clean puts a baby at risk. The absence of sufficient infection prevention and control measures in healthcare facilities should be of particular concern to those attempting to redress the slow progress to reduce maternal mortality globally.” click here to read more...
50 % of the health burden of malnutrition is attributable to WASH:
“Diarrhea is deadly. 1.5 million people die every year from diarrheal diseases (including cholera); 90% are children under 14, mostly in developing countries. 88% of diarrhea is attributed to unsafe water supply, inadequate sanitation and hygiene. As diarrhea causes undernutrition, it creates a vicious cycle by also reducing a child’s resistance to subsequent infections; repeated bouts of diarrhea can negatively impact children’s physical and cognitive development.” click here to read more...
Up to 1:2 surgical patients can leave a hospital with an infection they did not have upon arrival:
“In some developing countries up to one in every two patients (45.6%) left hospital with an infection they had not had on arrival.”
click here to read more...
For more information:
CASE STUDY:
VILLAGE HEALTH PARTNERSHIP
"I recently found myself in a packed labor and delivery ward. When an unexpected twin was born not breathing, we had no choice. With almost no protective gear, two nurses I’d brought with me jumped in and saved the baby. Covered with blood, we just had to hope no mother or child we came in contact with that day was infected with HIV, hepatitis... We had no way to clean up because this massive, overcrowded hospital that serves 2.5 million people, had had no water in six weeks.”
- Margaret “Migs” Muldrow, MD Internal Medicine and Dermatology, Founder, Village Health Partnership
VILLAGE HEALTH PARTNERSHIP
"I recently found myself in a packed labor and delivery ward. When an unexpected twin was born not breathing, we had no choice. With almost no protective gear, two nurses I’d brought with me jumped in and saved the baby. Covered with blood, we just had to hope no mother or child we came in contact with that day was infected with HIV, hepatitis... We had no way to clean up because this massive, overcrowded hospital that serves 2.5 million people, had had no water in six weeks.”
- Margaret “Migs” Muldrow, MD Internal Medicine and Dermatology, Founder, Village Health Partnership
Village Health Partnership seeks to improve health systems in rural Ethiopia. A recent visit to 16 rural healthcare facilities found, without exception, every hospital and clinic with periods of limited or no water and not one had the basic combination of clean water, access to hand-washing facilities with soap in exam rooms (including labor and delivery), and sanitation. Ethiopia is in no way alone. It's a problem common throughout the world.
Photos by Haik Kocharian for Village Health Partnership (VHP)
Photos by Haik Kocharian for Village Health Partnership (VHP)
At this main referral facility mothers give birth, side-by-side, sometimes three at a time. With no working water tap, when very busy, the mothers clean up their blood and bodily fluids with their own clothes and rags to make way for the next women about to give birth. Mothers are afraid to deliver here but they are also afraid to die in labor at home. |
At one health center serving some 53,000 people, there is just one latrine, no shower and two donkeys make 20 trips a day to transport water from a nearby, dirty river. It’s clear the donkeys cannot meet the facility’s needs, but the staff does much with little. The place is clean and organized. |
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“Ethiopians work very hard to solve their issues. They are also deeply ashamed of the level of poverty and won’t talk about sanitation for fear outsiders will react with judgment. I have anything but judgment. I have hope. Though one of the most desperate places in terms of maternal and child health, mortality rates are dropping in areas where international assistance and the Ethiopian government have reach. And we’re learning that local commitment is vital to creating sustainable health systems. But it seems to me that we shouldn’t have to learn that water is, too.” - Dr. Margaret “Migs” Muldrow |
This labor and delivery ward has no working sink, a common problem in healthcare centers around the world.
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"A darling, petite young woman with a beautiful smile on the outside, Mecca’s reality is a daily onslaught of pain and shame due to a completely preventable injury of pregnancy, afflicting a million women and resulting in untold stillbirths. I was in Ethiopia with a project focused on the appalling absence of Water/Sanitation/Hygiene (WASH) in health-care facilities. It’s a global health scandal impacting hundreds of thousands of clinics and hospitals around the world. But I hadn’t anticipated Meeting Mecca..." |
VHP founder, Dr. Migs Muldrow (far left) and Susan Barnett (far right), founder, Faiths for Safe Water, interview Mecca outside her home in rural Ethiopia. Read her story.
If we don’t take global action to prevent infections, and keep relying on antibiotics to cure infections, we will return to the days before we had any antibiotics.
"Our modern medical system is built on effective antibiotics. If our antibiotics stop working, if bacteria become resistant to most of them, medicine will be in trouble.”
- Eili Klein, Center for Disease Dynamics, Economics and Policy
Already, many of the common antibiotics we’ve all come to rely on are no longer effective making drug resistance is a rapidly growing global threat. Drug-resistant diseases can cause longer and more complicated illnesses, more doctor visits, the need for stronger and more expensive drugs, and more deaths. The CDC recently uncovered new "nightmare bacteria" — resistant to almost every drug, and particularly deadly to the elderly and people with chronic illnesses. Up to half of these infections are fatal.
Yet, 2000 to 2015 saw a 65% rise in worldwide consumption of the drugs; on average, especially among wealthier nations. "Unrestrained antibiotics use is the key reason drug-resistant infections now kill more than half a million people a year worldwide," according to a recent study co-authored by Eli Klein of the Center for Disease Dynamics, Economics and Policy in Washington. About 2 million Americans are sickened by antibiotic-resistant bacteria each year and 23,000 die, according to the CDC.
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But what about the antibiotics of tomorrow? you're probably asking. Pharmaceutical companies have continually withdrawn from developing new antibiotics. In 1990, there were at least 18 large pharmaceutical companies actively developing antibiotics. Today, there are four. Concern has led England’s chief medical officer to recently add antimicrobial resistance to the UK’s national risk register of civil emergencies. Five years ago, Dame Sally Davies warned of an “apocalyptic scenario” where people die of common infections and simple operations because antibiotics no longer work. Davies recently told The Guardian, “The importance of clean water, sanitation and vaccination must not be forgotten to avoid infections occurring in the first place.” More in The Guardian. Resistance can also spread between microorganisms. Using antimicrobials in any one sector (human health, aquaculture, agriculture or on crops) can result in unintended exposure in other sectors. AMR can undermine not only human health, but also animal health, crop health and ecosystem health. |
Every infection prevented is one that needs no treatment. We must prevent infections and better manage antibiotics: 
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FAITH COMMUNITY CALL-TO-ACTION: Because faith-based communities run up to 50% of healthcare facilities in some countries, no community is better positioned to lead. If we are truly committed to preventing illness and disease, and improving health outcomes, then we must direct greater focus to sustainable WASH in healthcare facilities.
This problem is not one that we can solve on our own, all the more reason to show leadership. Our faith-based organizations can help to prioritize and coordinate the multi-sector cooperation needed for progress: water, health, development and finance partners from government and the private sector. We must work together. And because water pumps, pipes, and faucets do break, let's make sure there’s also a commitment to often-overlooked maintenance.
This problem is not one that we can solve on our own, all the more reason to show leadership. Our faith-based organizations can help to prioritize and coordinate the multi-sector cooperation needed for progress: water, health, development and finance partners from government and the private sector. We must work together. And because water pumps, pipes, and faucets do break, let's make sure there’s also a commitment to often-overlooked maintenance.
WATER IS LIFE:
Photo: Save the Children
BUT TOO OFTEN IT IS NOT:
Maternity Waiting Area
Photo: Haik Kocharian for VHP
PREVENTION:
IT'S AS CLEAR AS CLEAN WATER.
- Improved water supply reduces diarrhea morbidity by 21%.
- Improved sanitation reduces diarrhea morbidity by 37.5%.
- Simply handwashing with soap can reduce diarrheal episodes by about 45%.
- When children wash their hands, healthy global development indicators like height, weight, and social skills increase as do child well‐being and social productivity.
Faiths for Safe Water's Faith-based Resources offer lots of ways for families, students and congregations to make our shared religious symbol a source of health and life for all.
LET'S MAKE EVERY DAY
WORLD WATER DAY
Photo: UNICEF