Figure 1. Sticker
Colonias in the border city of Ciudad Juárez are populated by several hundred thousand individuals who lack direct access to potable water and sewerage services. However, this problem is not limited to the Mexican side of the border. In the state of Texas alone, it is estimated that 376,026 individuals live in 1,526 colonias. Some 45,000 to 60,000 El Paso County residents do not have drinking water services and 74,000 individuals live in colonias in the county. The problem of inadequate infrastruc-ture for so many is further compounded by the enormous population growth in the El Paso-Ciudad Juárez area. City planners have been unable thus far to keep up with the growth of these marginalized areas and the problems will only get worse with continued rapid population growth.
Many families in the colonias have unsanitary water storage practices. Common water sources for colonia inhabitants on the U.S. side of the border include community water distribution points, shallow wells, and outside water spigots. In Ciudad Juárez, water is generally delivered to residents of low-income areas by tanker trucks. The water from most of these sources is generally of adequate quality, but the most important health concern arises from the unsanitary storage of water in the home. The fact that lack of sewerage services forces families to dispose of their own fecal wastes further increases the odds of contamination and disease in these homes.
The implications of having no access to potable water and sewage services are quite serious in relation to disease. Diarrhea, caused by water con-taminated with fecal matter (often due to inadequate disposal of human wastes), is still a significant cause of illness in both El Paso and Ciudad Juárez. In Ciudad Juárez, the disease is the seventh cause of death in children under age five, and the second cause of death in infants under one year of age.
Other diseases related to untreated water, such as Hepatitis A, Salmonella, and Shigella Dysentery, are also leading causes of illness among young children on both sides of the border. A recent study of Hepatitis A in San Elizario, an El Paso colonia of about 3,000 inhabitants, revealed that 281 of the residents (one-third of children under nine and 90% of adults between the ages of 30 and 34) had, or had contracted in the past, Hepatitis A. The rates of Shigella Dysentery and Hepatitis A infection in El Paso are four times the national average.
Providing potable drinking water infrastructure and adequate sewerage systems would drastically reduce these numbers. Unfortunately, however, such a solution would require not only an enormous financial investment, but also the commitment of local, state, and federal politicians. While city officials on both sides of the border are working toward this long-term goal, resolution of the infrastructure deficit will not be achieved soon. Meanwhile, many suffer serious illness and death due to inadequate drinking water and lack of education about hygiene. Other, more short-term solutions, such as teaching the inhabitants of these colonias proper sanitation and hygiene, would more quickly help to reduce the appalling numbers of deaths due to these diseases.
The researchers called their education model the Hygiene Education and Appropriate Technologies Model (HEAT) because the education component was supplemented by the provision of simple tools for participants to purify their water. The educational outreach portion of the model was implemented by 51 volunteers from within the communities who completed a 15-hour training course that took place over five days. Volunteers completing the course received diplomas after spending an additional 25 hours to teach families about water sanitation and hygiene. Each volunteer taught approximately ten families, resulting in the participation of 525 families in the project. Participants also received various simple technologies to help them keep their water pure.
Data on actual practices and uses of water were gathered via surveys. Questions explored how families stored their water, the origin of water used, the amount of water available, disposal of fecal wastes, and other hygiene practices. Finally, researchers tested the quality of drinking water in each home through the evaluation of chlorine levels and presence of fecal coliform bacteria.
With this baseline data, researchers were able to design the training course for the volunteers. Existing educational materials from government and private organizations were also used to develop a training booklet in comic book format. With the instruction program established, two paid staff members began training the 51 volunteers. These volunteers then worked with families from their own communities so that a total of 525 households, 275 from Mexico and 250 from the United States participated in the pilot project.
Technical Intervention. Water storage practices are commonly unsanitary and often even dangerous in the poor neighborhoods along the U.S.-Mexican border. Colonia inhabitants commonly store their water in industrial 55-gallon drums that constitute a risk because their previous contents are unknown. The drums are usually located at the front of the house or lot where they are accessible to the trucks that deliver water to the colonias. Typically, the drums have been used by industry to store chemicals and other materials utilized by local factories in manufacturing processes, and in many cases may have contained hazardous or toxic chemicals. Storing water in these drums without a liner puts inhabitants at risk of unknowingly poisoning themselves with the toxic residue. Contamination of drinking water results from unsanitary storage practices in the home. Often, drinking water containers are left uncovered or water is retrieved by dipping utensils or unwashed hands directly into the container rather than pouring it.
As a result of these problems, researchers recognized that education alone would not be sufficient to improve the quality of drinking water. Inhabitants would also need appropriate technologies. The investigators identified two technologies to be distributed to the participating families:
Educational Intervention. Volunteers made a total of five visits over five weeks to participating families. After completing the instruction course, they trained members of households how to disinfect their water through demonstrations of chlorine use or boiling. They also emphasized proper water storage and possible health repercussions of unsanitary storage practices. Finally, household members were taught the basics of safe hygiene and sanitation practices. The instruction from the volunteers was reinforced via the illustrative labels on both water containers, as well as by coloring books called Agua Para Beber, which contain all the information covered by the volunteers (Figure 1).
Figure 1. Sticker
The project's volunteer trainers visited each participating family five times to complete the program. On the first visit, the volunteers evaluated the knowledge, attitudes, and practices of the families. Also, the family's drinking water was tested for the presence of chlorine or fecal coliform bacteria. For the next three visits, the volunteers discussed health practices and provided the technologies previously described. On the fifth visit, the volunteers evaluated changes in attitudes via interviews and observation, and again checked the quality of the drinking water.
Figure 2. Home Disinfection of Drinking Water
Samples taken from the families' drinking water indicated that there were adequate chlorine levels at the beginning of the study for 27% of households; by the final visit adequate levels were at 80%. Not surprisingly, participant knowledge of disease transmission and how water contamination occurs increased significantly. The presence of fecal material in or around the house also decreased as families' knowledge about basic sanitary practices improved. Incidence of fecal material observed decreased from 21% to 10% over the five weeks. Not only did knowledge increase and sanitation practices improve, but researchers were able to document a decrease in the incidence of disease as well. Diarrhea was present in 22% of homes at the first visit, and only 6% of homes by the fifth visit.
The project introduced use of liners for the 55-gallon water storage drums. The distribution of the liners was primarily in Ciudad Juárez where the use of industrial drums is more prevalent. Although the project did not test for inorganic water contaminants, the long-term health benefits of use of this simple technology are obvious.
The dramatic improvements in sanitation practices and water quality are clear indications of the success that this low-cost, short-term project brought to the problem of water contamination in border colonias. The model is extremely cost-effective, as the small costs of training volunteers and providing the technologies are offset by reduction of the large costs of illness and deaths from diseases related to water contamination. While the best solution is the establishment of water supply and wastewater treatment infrastructure, the HEAT model is an important intermediate solution that saves lives and improves the quality of life of many residents along the U.S.-Mexican border.
Agua Para Beber is currently being transferred to community-based organizations. This allows the program to achieve a greater multiplier effect, reaching the largest number of families possible, and to enhance program sustainability. As a result of partnering with eight local organizations, the program will reach an additional 1,000 families (approximately 5,000 individuals) in the Ciudad Juárez and El Paso area during the summer of 1996. The research team at UTEP's Center for Environ-mental Resource Management will continue to expand the program in the transborder region and beyond to meet the needs of the disenfranchised border residents who lack services.
The success of this SCERP-funded program has been widely recognized in the border region and it is growing to include more communities. In Chihuahua, the state level social service agency, the System for the Integral Development of the Family (DIF), is going to implement the Agua Para Beber program in a number of areas. In addition, the Levi Strauss Company recently awarded a grant to Agua Para Beber to support expansion and continuation of the project.
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Last updated 5/6/99