Nothing good was going on in the country for more than a decade but trauma and infection and no treatment and no prevention."
Deogratias Niyizonkiza is an extraordinary young man.
Known to his friends as just “Deo”, he barely escaped Burundi’s ethnic conflict in 1993, when rebels attacked the hospital that he worked in.
He made his way to the United States, where through the kindness of strangers he was given shelter and later, a top education.
Now he’s back in his homeland, helping to restore a shattered health system.
"Nothing good was going on in the country for more than a decade but trauma and infection and no treatment and no prevention," says Niyizonkiza.
On his return to Burundi, Niyizonkiza founded a non-profit called Village Health Works and opened a health clinic, which has served more than 60,000 people since 2007.
One thing he learned when studying similar programs was the value of free health care and the use of local volunteers.
The clinic has now deployed more than 100 community health workers across this rugged, mountainous region, where constant surveillance is needed.
Cecile Sijeniyo is one of the workers. She’s visiting an HIV-positive woman to make sure that she’s taking her medication.
HIV carries a great deal of stigma, and it can be difficult for people to open up to members of their community like this.
The interpreter explains why this patient allows Cecile to visit: "She chose Cecile because first of all she is a neighbor and second of all she is somebody who can be discreet and also who can be willing to be following her on a daily basis."
Niyizonkiza says two elements that are crucial to the success of the program are, first, that the community workers are paid a small stipend, and second, that they get a bonus for each new patient.
That acts as an incentive to spot potential cases of HIV, tuberculosis and other infectious diseases.
Catching and treating those cases early, they say, is crucial for the health of the entire community.
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Nothing good was going on in the country for more than a decade but trauma and infection and no treatment and no prevention."
Deogratias Niyizonkiza is an extraordinary young man.
Known to his friends as just “Deo”, he barely escaped Burundi’s ethnic conflict in 1993, when rebels attacked the hospital that he worked in.
He made his way to the United States, where through the kindness of strangers he was given shelter and later, a top education.
Now he’s back in his homeland, helping to restore a shattered health system.
"Nothing good was going on in the country for more than a decade but trauma and infection and no treatment and no prevention," says Niyizonkiza.
On his return to Burundi, Niyizonkiza founded a non-profit called Village Health Works and opened a health clinic, which has served more than 60,000 people since 2007.
One thing he learned when studying similar programs was the value of free health care and the use of local volunteers.
The clinic has now deployed more than 100 community health workers across this rugged, mountainous region, where constant surveillance is needed.
Cecile Sijeniyo is one of the workers. She’s visiting an HIV-positive woman to make sure that she’s taking her medication.
HIV carries a great deal of stigma, and it can be difficult for people to open up to members of their community like this.
The interpreter explains why this patient allows Cecile to visit: "She chose Cecile because first of all she is a neighbor and second of all she is somebody who can be discreet and also who can be willing to be following her on a daily basis."
Niyizonkiza says two elements that are crucial to the success of the program are, first, that the community workers are paid a small stipend, and second, that they get a bonus for each new patient.
That acts as an incentive to spot potential cases of HIV, tuberculosis and other infectious diseases.
Catching and treating those cases early, they say, is crucial for the health of the entire community.
He is no longer a burden on his family, nor a source of sadness for them. This is my happiness as a promoter, to see him well.”
Many patients with chronic health conditions become overwhelmed with the complex demands of their daily care. Which medications have to be taken at what time of day? How many times each day for this pill or that syrup? Which to take with food, and which to take on an empty stomach? Which medicines can be combined and which must be taken alone?
Complex treatment plans can be especially overwhelming for people who are battling multiple chronic conditions, say heart disease and diabetes, or tuberculosis and HIV infection.
Patients who suffer from chronic problems worldwide could benefit from a program in Lima, Peru. The program shows that patients can improve when a kind of “health coach” visits them at home.
Not long ago, a young mother was emaciated and weak. For fear of discrimination, she asked us to call her “Carmen.”
Carmen discovered she was pregnant, and she went to seek ordinary prenatal care. A blood test showed she was HIV-positive. She was shocked and distraught over the news. She was terrified that her baby would be born with HIV, and both of them would die.
Carmen took medicines to reduce her daughter’s chance of infection. Her daughter was born premature. Doctors couldn’t tell for sure right away whether the baby was infected with HIV or not.
Additional medicines to fight her own HIV infection were available to Carmen. But like a lot of women, she was too busy taking care of others to properly care for herself.
“Because of my own lack of care, I abandoned treatment for six months. They gave me a new regimen. Sometimes I would take the pills, sometimes I would not take them. I was very irregular. And they didn’t really help me much, because I lost a lot of weight. I think one of them gave me anemia. I would only take them when I would remember, or only when I wanted to. I went to the doctor and they did some tests. The doctor told me that my viral load was way too high and my tests results were poor.”
Carmen’s brother developed tuberculosis. “I took care of him because there was nobody else to do it,” Carmen says. “I would go to the hospital and my mother would stay here with my baby. And I got TB. For me, that was a very heavy load, because I had to take the tuberculosis pills,” in addition to her HIV medications.
Carmen didn’t think she could make it on her own. “Because at that point in time, I didn’t have anybody who would come to me and talk with me,” Carmen says. “I didn’t have anybody who would help me manage the medicines.”
That’s when a trained volunteer called a “health promoter” stepped in. Now she visits Carmen at home almost every day.
“She comes here, she talks with me, she gives me my pills, she gives me advice,” says Carmen. “She plays with my daughter. She spends time with me. She’s worried about me when I’m sick. She takes me to a doctor. She’s concerned with my health and that gives me joy, knowing that somebody who is not my family is with me and is supporting me. That’s something that gives me a lot of comfort.”
The volunteers are trained by “Partners in Health,” an international medical group that serves low-income people, working with Peru’s Ministry of Health.
Carmen’s health coach is Maria Soledad Pobisas Carate. She herself suffered from tuberculosis long ago. She says it was a very isolating illness. “Discrimination still exists and we have to work against that, little by little, providing patients with our support and our affection,” she says. “I think the level of confidence and the strength of the relationship you manage to build with your patients, that’s what makes them want to follow your advice.”
Maria helped Carmen complete her tuberculosis treatment with success. In the meantime, news came through that Carmen’s daughter did not have HIV.
Maribel Muñoz Valle is a Project Coordinator for “Socios en Salud,” the local partner for the program. She says visiting coaches can prevent severe health crises, by catching dangerous problems early. “If there’s a fever, or nausea, or headaches, home visits allow us to avoid a rapid decline,” she says. “Because once an infection takes hold, if you don’t respond quickly, it can turn deadly very fast.”
Clemente’s family was terrified he would die from complications brought on by infections with HIV and tuberculosis. Clemente himself was convinced there was no hope for him. “I was like an empty bag,” he says. “I was dead. Because of my health, I didn’t have energy to do anything.”
Now Clemente is strong enough to carry passengers and their burdens with his transport business. He drives a small motor cart around Lima. Clemente credits his health promoter for his dramatic recovery. Explaining the role of health coaches, he says, “They keep track of our medication, they’re with us, they give us moral support, they talk with us, they tell us about the experience of other people, they motivate us to be able to do well. And not to abandon treatment.”
Sticking with treatment benefits patients, their families and communities – lessening the burden of infectious disease.
Clemente’s health promoter is Nelly Palomino. She says, “He’s 100% better. He was sad and stuck in bed. He was a man who weighed 48 kilos (105 lbs), and now he weighs 73 kilos (160 lbs). He’s alive and he’s working and he’s being useful to his family. He has a small child who he feeds and who he supports. He is no longer a burden on his family, nor a source of sadness for them. This is my happiness as a promoter, to see him well.”
Program sponsors say they’re having success with health promoters in other locations, including Haiti and the United States. They say health coaches could also be effective for patients with non-infectious diseases, like diabetes, hypertension and heart disease, worldwide.
We’re here to help support the government implement their roadmap and do it effectively and they gave us the space to try new things and to innovate.”
A baby boy, just 10 minutes old, lies on a small bed gasping for air. Despite his strained breathing, he’s alive and well.
That may not have been the case if his mother had not been brought to the new Butaro Hospital in one of Rwanda’s most remote districts. In fact he’s the very first baby born here.
While his mother was in labor, her unborn child had shown signs of respiratory distress: a major problem if the delivery had taken place at home or in a rural health center.
Instead, mother and unborn baby were brought to the hospital, where trained staff and quality equipment ensured their safety.
Dr. Agnes Binagwaho, Rwanda’s Permanent Secretary of Health, is passionate about improving maternal health in her country. But Rwanda still has a long way to go. “There are too many deaths that we could prevent by increasing access to care in a geographic way,” she says, “and also increasing the expertise of health professionals that deliver services, but also the number of health professionals.”
This is what the Butaro Hospital was built for: to provide quality health care that has been lacking in Burera District, which just a few years ago only had one doctor for its 340,000 people.
The spotless facility stands on top of a hill with views of Rwanda’s lush valleys. It’s a beacon of hope in a country with many scars. But the government couldn’t have done it without the help of others.
The U.S.-based nonprofit Partners in Health, which has built hospitals and clinics throughout the developing world, provided expertise and paid more than $4 million for the construction.
The Clinton Foundation also provided support, while the Rwandan government covered the cost of the hospital equipment.
Dr. Peter Drobac, the Country Director for Partners in Health here, says the alliance has worked extremely well. “I think it really represents the way partnerships, public-private partnerships for development, should work. We’re here to help support the government implement their roadmap and do it effectively and they gave us the space to try new things and to innovate.”
The innovation includes effective but inexpensive design features that can be replicated across the developing world.
People gather in the open air instead of confined corridors where diseases like tuberculosis can spread.
In the wards, every detail from the smooth resin on the floor that is easily sterilized, to the type of ceiling, has been carefully considered.
“The ceilings are high and vaulted and at the upper level there are these non-operable louvered windows and that allows air to pass up and out. It’s something called stack-effect ventilation,” says Drobac. “Heat rises naturally so air rises up and it’s continually passing out.”
Floating above Drobac is a large fan that spins slowly and silently while circulating air up and out of the windows. There are also ultraviolet lights that kill TB bacteria and other microbes in the air.
“Those things,” says Drobac, “collectively can actually achieve the same degree of ventilation and infection control as we do in United States hospitals at a fraction of the cost.”
And cost is key in a country like Rwanda, which is still recovering from the 1994 genocide that left an estimated 800,000 people dead.
In order to heal, and develop a better health system, the government is implementing a pyramid-based structure with the district hospital at the top.
At the base level, every village has at least two community health workers. They’re the first link in a chain that connects the villages with the health centers, and the centers with the hospital.
They’re trusted members of the community with rudimentary training to monitor those on medication and spot possible cases of common conditions like HIV, TB, malaria and malnutrition.
If there’s a serious case that cannot be treated at the community level, the patient is referred to the hospital.
For maternal health, the strategy is having a major impact. Until recently most women in Rwanda gave birth at home with no trained health providers on hand. In too many cases a complication resulted in the death of the baby and sometimes the mother as well.
Now, the community workers encourage women to give birth in the nearest health center, which has trained staff who can handle routine deliveries. If there’s a problem, they send the patient to the hospital.
This strategy has drastically reduced maternal mortality in a country with one of the worst records in the world.
“A couple of years ago we had eight deaths a day in Rwanda, and now we are at less than one death a day,” says Agnes Binagwaho, the Permanent Secretary of Health. “Even it’s too much, but that means there’s progress, but we should reach the point where we have zero deaths that we can prevent.”
Had it not been for the new procedures in Burera, a remarkable birth of quadruplets 16 months ago would probably have ended in tragedy.
When Angelique Mukazigama was in labor she thought she was just carrying twins.
Fearing complications, she was taken to the temporary Butaro Hospital, which handled difficult cases while the new hospital was being built. Converted from an old health center, the facility was basic, but it had doctors and trained staff.
After delivering the first two babies, they discovered there was a third. And then, another surprise, not just for the mother, but the doctor as well.
“When I did the last examination in order to deliver the placenta,” explains Dr. Juvenal Musavuli, “I realized that there were two feet – two other feet. Then it was very exciting. We called all the authorities for the hospital and finally the last one came – the fourth baby. It was very exciting and I think it’s one of my best days.”
The days for the doctors and patients should get better still.
Many jobs have been created and new skills learned in a community that built Butaro Hospital on a firm foundation.
The outer walls are made of local volcanic rock, signifying renewal from a tempestuous past.
Inside those walls, preparations are underway for the first Caesarean section. All while the first baby born here lies peacefully nearby, oblivious to the people and machines that are keeping him warm and helping him breath.
But as he grows, his aspirations will be much like the Butaro Hospital itself: to breathe, walk and run independently.
Even though the two countries share an island and a border, at times it seems as if they have little in common. Except disease."
Haiti has had more than its share of misery. Its sole neighbor on the island of Hispaniola, the Dominican Republic, hasn’t had an easy ride either.
Even though the two countries share an island and a border, at times it seems as if they have little in common. Except disease.
Mosquito-borne conditions like malaria and lymphatic filariasis are among them. The latter, which is also known as ‘elephantiasis,’ causes severe swelling in the limbs.
To encourage greater cooperation, former U.S. President Jimmy Carter and his wife Rosalynn led a delegation from the Atlanta-based Carter Center to promote a unique joint venture.
The goal is to stamp out malaria and lymphatic filariasis by 2020.
President Carter says the project is a breakthrough. “Never in the past have we seen an adequate element of cooperation between the two countries to have a common commitment to eradicate or eliminate a disease.”
The pilot project encompasses two border towns - Dajabon in the Dominican Republic and Ouanaminthe on the Haitian side.
Health centers now use the same protocol and procedures, including free diagnosis and identical medication for malaria.
The Carter Center has also provided lab equipment, bednets and training for outreach workers who travel throughout the communities to test and treat new cases.
On the Dominican Republic side, conditions are less severe, but there’s still a great deal of work to do. A single outbreak of malaria in 2004 cost the country $200 million in lost tourism alone.
It’s better now, says Carter, especially in the Dominican Republic. “Just 10 months ago in this same area out of every 100 people that you visited 30 of them would have malaria, and they already made great progress just in the short time available with proper medicine to treat people, but also with the bed nets and with the cooperation across the river.”
That’s a message Carter took to the capitals as well, meeting with both presidents and top health officials.
He stressed that the pilot project would end soon. After that it will be up to their governments and private agencies to take the lessons learned and use them to finally rid the island of these crippling diseases.
Global Health Frontline News (GHFN) is a special reporting unit of Cielo Productions, Inc., a nonprofit video production company based in the United States.
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That’s a radical change for the population. They finally have access to modern medicine.”
The tiny island of Haiti is one of the most densely populated and poorest countries in the world. Its latest report says that at least half the population lives in the countryside, with no access to safe drinking water and health care. There are just three doctors for every 10,000 Haitians.
But there’s one thing they have plenty of. Sunshine is free and finally someone is tapping into it.
Getting to Boucan Carre is no easy feat. It’s only 45 miles, or 70 kilometers, from the capital of Port-au-Prince, but it takes an arduous three hour drive to get there.
Located in the Central Plateau, Boucan Carre and its mountainous remote communities have been cut-off from the rest of the country for years. Most of its 58,000 inhabitants have never been to Port-au-Prince. There are virtually no roads, and in the rainy season, the smallest path is flooded. Until two years ago, it had a tiny health center that functioned mostly in the dark, even in daylight hours.
Cate Oswald is the program director for the U.S.-based non-profit Partners in Health. She arrived in here five years ago.
“What we found was a small two room clinic, no doctors,” she said. “Not only did we go without electricity because we couldn’t get gas out, but we also had women in labor trying to cross the river and not able to. We ended up losing a number of patients because of that.”
But tucked away in the mountains is its hope for the future: the St. Michel Hospital. Built and run with Partners in Health funding, it’s powered by an abundant resource: the sun.
Driving the jeep on the rocky road to the town, Jean Baptiste Certain of the Solar Electric Light Fund (SELF) told us:“To bring solar panels and fragile electronic equipment and very large batteries on a dirt road for hours is not the easiest thing to do.”
But all 66 solar panels did make it, thanks to the efforts of SELF. Today Boucan Carre has a fully-equipped hospital with power 24 hours, seven days a week.
Certain told us, “That’s a radical change for the population. They finally have access to modern medicine.”
Now young and old patients benefit from a laboratory complete with electron microscope, radiology equipment and a state of the art surgery room.
In the hospital’s crowded waiting area, an ultra-violet light is on to kill the bacteria of coughing tuberculosis patients. The fan circulates the air preventing the infection of other patients and staff.
Dr. Moise Compere told us, “Its a tremendous difference, whether it’s the laboratory where the machines can’t run without the solar panels, radiology, and especially our surgery room.”
Inside the women’s ward, Dr. Compere talks to Narcisse Dieudonne, who brought her daughter to St. Michel Hospital.
Narcisse told us, “Thank the Lord we came here. My little one got to see a doctor right away.”
A bank of solar batteries are the lifeline. They require skilled maintenance and recharging.
Andre Poteau Geles is one of the technicians trained by SELF. He’s been here for 10 years, and as the logistics manager has seen a vast change.
“When we started here with our little health clinic, we didn’t have power. It wasn’t until 2003 that we finally got a generator. Very often we couldn’t get the fuel up here and we had to work in the dark.”
Ironically, it’s thanks to the dirt road built to transport the solar panels to Boucan Carre, that the Haitian government finally started installing the first electric poles ever here… just two months ago. But with Haiti’s weak and unreliable grid, they might at best come in handy to recharge the solar batteries, says Certain.
“It’s highly unreliable, at best a couple of hours per day.”
Meanwhile, St. Michel is already well on the path to improving and guaranteeing the long-term well-being of these remote communities.
As we left, ominous skies foretold the start of the rainy season. The river of hell, as it’s called, will overflow. Only now Boucan Carre won’t be left in the dark.
That is our fight, to make the victim understand that you don't have to be ashamed."
Violence against women is an issue that people in Haiti are all too familiar with.
Two years after the country’s devastating earthquake, the UNHCR reports an alarming upsurge in rape cases against women and children of all ages in the squalid refugee camps. But there are some who have had the courage to take on the system and become crusaders for women's rights.
Jocie Philistin has been fighting to criminalize rape and stop violence against women in Haiti for 15 years. A first victory was making rape a crime in 2005.
"Violence against women and young girls in Haiti has always been taken for granted,” says Jocie. “It's been a huge victory in Haiti, that now it is considered a crime under Haitian law."
Jocie runs Kofaviv, one of the first women's rights organizations in Haiti founded by rape victims. She says it took time to effect change, but becoming a victim of violence herself galvanized her efforts.
In 1994, as a law student, Jocie was on a routine student committee meeting with the military government.
"One of the officials called me into his office. The door slammed shut. It was one of those doors that could only open when pressing a button. He took my clothes off and I fought him off. Thank God the penetration was not all the way, but the atrocity of his violence was hard to fight. He finally let me go."
Jocie says she kept he assault a secret, even while working as an advocate for other rape victims. “I had reconciled myself to the fact that my virginity had not been completely violated. And thought it could be forgotten."
Still, she filed a complaint, never expecting to see him again. "I was working in prisons… preaching. When I saw him in jail, I relived all the atrocities of that day. That's when I realized the post-traumatic conditions were still very much alive."
It proved a turning point for Jocie. Today she coordinates Kofaviv, providing one of the few “safe houses” in a dilapidated capital that remains dangerous territory for unprotected women and children living in appalling conditions in the refugee camps.
Despite the change in the law, few rape cases have been brought to justice, especially in a country where human rights groups say poverty and weak state institutions foster a climate of impunity. Jocie told us, “There's always a problem applying the law when you have a dysfunctional justice system that instills fear among the population, especially the victims who are the most vulnerable and live in marginalized conditions."
But while she will never forget, she still has hope.
“One can, over time, maybe heal a little, self-channel. But it's an act you can never forget. Because you don't want a rape to diminish you, to marginalize you in society. And that is our fight, to make the victim understand that you don't have to be ashamed."
It was around seven at night. The man came up from behind and put a gun to my head."
Getting food, clean water and medical treatment in Haiti's refugee camps is challenging enough for families displaced by the earthquake.
But now, the U.N. High Commissioner for Refugees is reporting an alarming increase in rapes and violence against young girls and adult women in these camps.
One refugee told GHFN, “It was around seven at night. This man came up from behind and put a gun to my head.”
Another rape victim told us, “You can try to resign yourself, but you can never forget. An act like that, one can never forget.”
Still another said, “I felt my life was finished. That I would never again be able to function in society again.”
They are all victims of one of the worst forms of violence against women. Yet in Haiti, rape wasn’t even a crime until seven years ago.
Jocie Philistin, a coordinator of an organization running one of the few camp “safe houses” told us, "Violence against women and young girls in Haiti has always been taken for granted. It's been a huge victory in Haiti, that now it is considered a crime under Haitian law."
Jocie Philistin is one of the pioneers of the 2005 law that finally made rape a crime.
A former rape victim, today she is the coordinator of Kofaviv, a Haitian women’s rights organization formed by rape victims. She says the law has helped educate women on their rights, but few cases have been brought to justice, especially in a country where human rights groups say poverty and weak state institutions foster a climate of impunity.
“There's always a problem applying the law when you have a dysfunctional justice system that instills fear among the population, especially the victims who are the most vulnerable and live in marginalized conditions."
In January 2010, a devastating earthquake struck Port-au-Prince, Haiti's densely populated capital, killing more than 200,000 people. With 2.8 million inhabitants mostly living in overcrowded poor neighborhoods, its long-term impact is catastrophic.
A million and a half Haitians were left homeless, finding shelter in tent-cities that mushroomed overnight throughout the capital. Thousands of children, adolescents and adult women were thrust into a no-man's land, with no protection.
Jocie told us, "These are people who lived in low income neighborhoods. Even if they lived in slums, they lived in a community where everyone knew each other.”
Within seconds, that social safety net of communities was leveled and transformed overnight into a chaotic landscape of survivors.
"You find yourself in a camp where you don't know your neighbor. You look around, up, down, to the side, and you don't know a soul. People are living in inhumane, degrading conditions and everyone is exposed. There is no security."
More than two years later, half a million-plus refugees still remain in the decaying camps.
With international emergency aid exhausted, they are among the most vulnerable, no longer receiving basic needs like drinking water, sanitation services or security.
The UNHCR says one of the most notorious camps, where an upsurge in rape attacks has been taking place, is Champs de Mars camp, right in front of the collapsed presidential palace.
In its narrow alleys we found Yuseline Marcellus, a 16-year old girl who says she was gang-raped in the camp last November.
She became pregnant. Without family and nowhere to turn, she says, she turned to prostitution to feed her 4-month old child.
With her head in her hands, she told us, "There were ten of them. It's hard. It hurts a lot, it's always in my mind. I can't forget."
We were led to Yuseline's tent by two young men, Carlos and Ludner, who volunteer to protect her and other young women here.
Carolos told us, "Since I've been living in the camp for two years, I see many little girls been raped, nine-year old girls, young people, old people, they don't care.”
“We try to stop that right now. We made a group, fifty guys, to try to stop the rape, but you know we can't, we just can't."
Philistin says there's been notable progress and help from the Haitian police, pointing to 450 officially registered complaints so far this year. But with a judicial system still in limbo, many of those cases may never see their day in court.
On the other side of town, at Camp Nicaragua, Delna Charlotin is both refugee and president of the camp's women watchdog group, one of sixteen "frontline" volunteer associations working day and night throughout the camps.
Delna and her committee check regularly through the camp to make sure everyone’s flashlight has working batteries, and especially that every female has a whistle.
"We give all the women a whistle so that if any of them feel threatened, they can just blow it and everyone will be on alert and come to her rescue."
When they locate a victim in a camp, they refer her to a place like Kofaviv, which has one of the few safehouses in the capital.
Kofaviv's community workers are for the most part victims of rape or other violence themselves.
Philistin explained, “In a first phase we relocate the victim and her family. The mother and children are placed in a secure setting. During that time, the victim is sensitized to issues of reproductive health, gender-based violence, family planning and community support."
"The second phase is the reintegration of these victims. Once they leave the safehouse, they don't return to the camp."
In the final stages, Kofaviv will ensure up to a year's rent for the woman and her family, and pay for the children's schooling and health.
"We want the assistance to help them get back on their feet," Philistin says.
But for most of these women, it's hard to forget.
Rosamirlande, one of the camp inhabitants, told us she still has hope.
Smiling, she said, “Yes, I think I can have a second life.”
Brunson says many water projects in developing countries fail for obvious reasons - money runs out, or machinery breaks down."
Access to safe drinking water is a global problem for nearly a billion people.
For about 200 million, many in Africa, high levels of naturally occurring fluoride in the water causes disfiguring dental and skeletal disease.
“Dental fluorosis is a darkening or mottling of the teeth,” says Laura Brunson, an environmental scientist at the University of Oklahoma in the United States. “There is a sort of social stigma attached to it, maybe a poverty stigma. Skeletal fluorosis is much more physically debilitating.”
But Brunson is on the case. She's developing fluoride-filtering devices that use cheap materials that are readily available in the villages. A resident with a kiln, for example, could create the char from eucalyptus wood, or bones.
The low-cost filter would treat the water, which can then be sold for a minimal cost. That would both provide fluoride-treated water to the community and give the person who's running that business a job.
During recent field work in Ethiopia, Brunson and her team set up a lab in a local guest house - and started experimenting.
“Are there things we can add,” asks Brunson, “or ways we can alter the bone char either through some sort of oxidation process, or through adding something like aluminum to the material, that would make it even more effective?”
Brunson says many water projects in developing countries fail for obvious reasons - money runs out, or machinery breaks down.
“Of the seven or eight communities we visited, there only were maybe two that were actually functioning as far as treatment systems.”
But equally important, she says, are cultural factors. Figuring out how to get the community behind a water filtering project.
The team spoke to a lot of people, and asked a lot of questions.
“How do you use water, where do you get it from, what do you think about the current treatment system, is there something you would prefer to have?”
Brunson, who also teaches in the college of business, says getting communities committed to water treatment could also be a money-making opportunity for local people.
“If you can set up a business so that the char you are selling that is helping people get treated water is making enough money so you can be self sustaining, then you can keep going,” says Brunson.
Science and social entrepreneurship coming together to make affordable, safe water available to millions.
The World Health Organization says this type of pollution causes nearly two million premature deaths each year."
An estimated three billion people - nearly half the world’s population - still use an open fire as the primary source of energy for cooking and heating.
But there’s a problem: the smoke.
“You have respiratory issues, lung disease, you’ve got pneumonia and you’ve got longer-term issues like cancer and heart disease as well that can result from exposure to indoor air pollution,” says Radha Muthiah, Executive Director of the Global Alliance for Clean Cookstoves.
The World Health Organization says this type of pollution causes nearly two million premature deaths each year. That’s more than tuberculosis and three times as many as malaria.
Everline Kihulla is one of the people trying to do something about it. She works for TaTedo, which manufactures and sells so-called ‘clean cookstoves’ in Tanzania.
TaTedo’s stoves are made with clay liners, which along with other simple design features, emit far less smoke and pollutants. And they use a fraction of the fuel.
Kihulla crouches beside one of them: “This one we have improved it and it currently uses almost 50 percent compared to the traditional one,” she says. “So the charcoal consumption here is less compared to the traditional one.”
Another benefit is that these stoves are made locally.
A nearby workshop employs 21 people and churns out 400 to 500 stoves each month.
Each person follows a cookstove through every stage of production, from pottery to painting. This teaches each worker a variety of skills.
Producing locally also boosts the economy and keeps the costs down, but the price-point is still an issue.
Cookstoves start at about $6 (U.S.). That’s a lot of money for many families in developing countries.
But subsidizing the price, or even giving stoves away free with the help of aid agencies, doesn’t necessarily work.
“There’s something about, you know, having to allocate a portion of even your small wallet to something that ensures that you value that and use that, and so that’s what we’ve seen in some of the other models that are out there,” says Muthiah.
“The fact that yes, people don’t have that much money at all, but if they spend even a few cents a day, you know, towards that stove, that they actually value and use it much more.”
Sitting alone on the steps of her home in Dar es Salaam, Lillian Njuu stirs a large pot of stew, which rests on a clean stove that she has used for two years.
She feels the expense is worth it for the health of her family, and plans to buy another.
In addition, while the upfront cost to buy a clean cookstove is higher, the fuel costs are lower because it burns less.
That in turn has an environmental impact. Burning less charcoal or wood means there’s less deforestation, which has caused major problems like flooding in many countries.
“It’s one relatively simple intervention that has a multitude of impacts that can really address the development agenda within a particular country as well,” says Muthiah.
Now the challenge is to get clean stoves into enough homes to really make a difference.
