Tippy Taps: Handwashing Made Easy

by Ce Zhang

When I volunteered with UVP in the summer of 2009, our team visited two primary-level schools in our village that were interested in forming health clubs. Surprisingly, we noticed that in both schools, there was a lack of a hand-washing facilities for children to wash their hands immediately after using the latrine or after playing outside. For many of us growing up in industrialized nations such as America, we are accustomed to having bathrooms with piped water supplies, drinking water from faucets after exercise, or even portable hand sanitizers to use after having a single thought of uncleanliness. Yet, in many countries where water technologies are scarce, preventable bacterial diseases surface and cause substantial mortality that can otherwise be prevented. Moreover, it can be difficult and costly to inhibit epidemics such as malaria and AIDS, but simple and cheap hygienic interventions such as handwashing can help prevent the spread of bacterial and diarrheal diseases, which are the 4th leading cause of death for all ages in Uganda according to the WHO.

In many destitute rural areas, the lack of access to both water technologies such as a piped water supply becomes an imposing barrier to handwashing. Everyday in Uganda, the youngest are hit the hardest: 17% of all deaths in children under the age of 5 are caused by diarrheal diseases. The Center for Disease Control (CDC) has acknowledged that the simple act of washing hands with soap and water could potentially cut this figure by almost half. So without any piped water systems, how does one wash his/her hands? One idea could be washing your hands in a bowl of water, but then another person could be washing their hands in the dirty bowl you left behind. You could also try walking to the nearest water pump and ask somebody else to pump water while you wash your hands- probably not the most efficient idea because that requires two people and wastes a lot of water. So how can we do better? Enter the Tippy Tap.

The tippy tap is a simple and highly economical technology to encourage handwashing in the village. The tippy tap primarily consists of a jerrycan or jug which releases a small amount of water each time it is tipped. When the “tap” is released, it swings back to its starting upright position. The tippy-tap is easily made with commonly available materials and not dependent on a piped water supply. Also, it is very hygienic in that it is foot-operated, you only touch the soap. Lastly, it conserves 10 times the average amount of water used for handwashing in regular faucets. In our village, we provided materials for primary-level students to build tippy-taps near latrines at their schools. It was a success in that the students were very involved in constructing and eventually using the finished tippy-taps. Students at one school even erected a large sign near their latrine stating: “Wash your hands after using the latrine.”


So, reader, I bet you are now itching to make a tippy-tap as well? If so, I will now outline the steps on how to make a Tippy Tap using simple materials found almost anywhere. I highly encourage anybody to spread the idea of Tippy-Taps in areas where there is a lack of access to handwashing during critical moments (for example, after using the latrine, before handling food, while cleaning a child). It is a simple, low cost, and fun idea that could potentially make a tremendous impact in preventing the spread of bacterial diseases.

Materials needed for 1 Tippy Tap

2 long fork-shaped (Y) branches

1 long stick (holds jerry can)

1 short stick (acts as lever)

Shovel

Durable string

5 liter jerrycan or jug

Knife or scissors (to cut string)

Bar of soap



Steps:

1. Poke three medium sized holes on the front side (side closest to cap) of the jerry can and fill with water
2. Dig two holes in the ground that are spaced and put the two fork-shaped branches in the holes.
3. Cover up the holes firmly so forked shaped branches are steady
4. Slide 1 long stick through the handle of the jerrycan/jug and place long stick on the two fork shaped branches.
5. Tie string firmly to jerrycan/jug cap or handle and connect string to short stick on the ground. (Note: short stick on the ground functions as the foot lever that tips the jerrycan down).
6. Poke hole through center of soap and tie with string to dangle off the long stick on the Y-shaped branches
7. Step on short stick lever and adjust angle of lever accordingly so that the jug tips over and back to original position in a smooth motion.
8. Wash your hands!

Birth Control in the Healthy Villages

This month, we are again providing free birth control to women in our villages, their third ‘cycle’ since the launch of Healthy Villages over the summer. 

We launched the birth control program last summer by bringing an outside NGO, SoftPower, into the villages.  SoftPower nurses held outreaches with nutrition and family planning information (these two topics are interlinked in Uganda, where poor child spacing or too many children can lead to malnutrition), and then gave out birth control and condoms.  (All women who wish to go on birth control must first take a pregnancy test.)

Three months ago, we worked with both local Health Centers and SoftPower.  They held joint outreaches where the SoftPower nurses trained Health Center staff to conduct the nutrition and family planning education presentations, and Health Center staff met the women who were taking birth control, and helped give pregnancy tests, injections, etc.  This was a sort of ‘transition’ phase of our birth control program.

Now, we are working with Health Center nurses only.  They are still doing both nutrition and family planning education sessions, handing out condoms, and giving out birth control after the necessary pregnancy test.  Sometimes the Health Centers don’t have all the equipment or contraceptives necessary, and then they’ll either borrow from other Health Centers, or UVP will buy certain items.  So far, we’ve managed to scrape together all that we need to do the outreaches successfully.  Our hope is that, over time, the Health Centers will begin to place more importance on regularly ordering all items necessary to birth control provision.  If the district is consistently failing to deliver certain items, even when the Health Centers place orders correctly, we’ll speak with district officials about the situation.

After a year or two, we may begin helping women to go to their local Health Centers for birth control, as opposed to bringing the local Health Centers to them.  At the moment, many women fear to go to Health Centers for birth control because of the mild stigma attached to family planning, or because their husbands will not allow them.  Many women are also afraid to take birth control in general, even if they do wish to have fewer children, because they have heard myths about the dangers of birth control.  It is our hope that, through a year or two of bringing birth control and family planning education into the village, and by making sure to educate men as well as women, we will help to cultivate an acceptance and understanding of birth control, eventually empowering women to go to the health centers themselves, without the help of UVP.  

Water As a Political Right

Contributed by
Hae Jin Kang

Water. No resource is more important to our health than this liquid. Many countries, however, lack this fundamental need. For instance, only 64% of Uganda has access to clean drinking water and globally, 1.1 billion people do not have this access, with 1.6 million people dying every year from water-induced diseases. But why are countries lacking something as basic as water in the era of globalization and progress? Rarely is it because of an absence of water, but rather because of how governments treat the provision of water in national policies and laws.

Current policies in many countries often do not treat water as a political right or even a basic need that should be provided by the government. As a result, families, especially in rural areas, go without clean water. However, despite this lack of government services in many developing countries, water is clearly defined in several international principles as a political right that must be guaranteed and secured for all. For instance, the Convention on the Rights of Children specifically states the right of children to have water to ensure their best possible health and well being. The right to water is also guaranteed in the Humanitarian Law, which ensures that armed forces do not contaminate enemy’s waters or civilian water sources, such as wells or rivers. While it is clear that international laws deem water as a political right, this view if often not extended to national policies. However, when national policies are amended to address water, access to water is increased all throughout the country, and subsequently, health is improved.

Take South Africa for example. Not until recently was water acknowledged as a political right in South Africa, where the 2010 FIFA World Cup will be held. Following the end of apartheid, the new constitution endorsed a constitutional right to water. But how does this shift in the status of water impact health? Statistics from the 2009 World Health Organization report show that 94% of South Africa now has access to an improved, clean source of water. This is directly influenced by the series of national policies and laws that endeavored to improve access to clean water: the Free Basic Water Policy (2001), Water Services Act (1997), and the National Water Act (1994) to name a few.

Despite this breakthrough, however, South Africa initially faced several challenges in implementing this political right. One instance was when local policies conflicted with the goals of the national laws, which occurred in the Eastern Cape Province when the local government was unable to keep up with the demands of South Africa’s new Free Basic Water Policy. Another challenge was when over half of the people considered “poor” initially were not even aware of their constitutional right to water, thereby hindering the effectiveness of the policy. In addition to the challenges of implementing new policies, privatization of water added to existing complications. Private water companies in South Africa began to impose high rates and began to eliminate access to water to those who could not afford to pay their water bills. As a result, locals in many communities were forced to obtain water from unhealthy and unsanitary alternatives for water, such as lakes and rivers, resulting in the cholera outbreak of 2008. Yet, despite all of these difficulties, South Africa has improved access to clean water for many of its citizen by defining water as a political right and addressing the provision of such in their national policies and agenda.

In Uganda, water policies have also changed to reflect responsibilities of national governments to provide water. For instance, water is a key issue that is recognized in the Poverty Eradication Action Planand since 1997, several reforms have been initiated in the water sector: The National Water Policy (1999), The Water Statute (1995), The National Water and Sewerage Corporation Statute (1995), and the Local Government Act (1997) to name a few. Most importantly, the National Water Policy is based on the principle, “some for all, rather than all for some” adopted from the 1990 “New Delhi Statement” to guarantee access to water for all Ugandans (UNESCO Report)

Yet, only 64% of Uganda has improved access to water, with rural areas even worse off. Why is this so? Although most of the aforementioned policies have been initiated more than ten years ago, many of its provisions are not “fully operational, especially at the local government and local community levels.” Especially in rural areas, the provision of water is harder to locally manage and subsequently, new water policies are harder to implement. As a result, many NGOs and non-profit organizations have taken their own initiative to work directly with rural villages so that communities can have safe water for drinking and sanitation. Currently, Uganda Village Project, among its many health initiatives, works to improve access to safe, clean water in villages in rural Uganda.

Despite the emergence of international initiatives, such as Uganda Village Project, the root of the problem seems to be in how nations define water in their policies and also in how local and national governments cooperate to improve access. Thus, it is crucial to understand water as a political right and understand how volunteers and non-profit organizations “fit in” into the scope of the political structure.

Are clay pots safe for household use?

contributed by Sonali Palchaudhuri

Understanding the intricacies of the drinking water supply chain in rural Uganda has been an ongoing effort for Uganda Village Project. No matter how pristine the water may be when it comes from the source (and most rural sources are more like muddy puddles than pristine fountains), there are numerous opportunities for the water to be contaminated with bacteria that can kill the most vulnerable community members in villages - the children, the sick, and the elderly. Early on, we realized that frequently, safe water is contaminated through the common practice of dipping into the clay storage pots. For years now, we have been using innovative technologies to try to make the safe water chain 'humanproof' - to make it so that safe water automaticallystays safe, without requiring much behavior change or financial investment on the part of community members.

UVP has been working with local potters to produce new clay pots modified with spigots to access water safely. The pots have a small neck designed to keep even children's hands from reaching inside. These new clay pots have been going through testing to make sure we have a high quality product to provide for the local villagers, as well as to set up a strong social business with local entrepreneurs and potters. Of course, the first priority for these pots is to make sure that they improve the health of users. Thus, we wanted to make sure the clay being used did not contain any harmful contaminants that could leach into the drinking water. Samples of clay were collected from a variety of potters and tested in University of Michigan laboratories with an Environmental Scanning Electron Microscope (ESEM), to see what materials the clays were composed of. Fortunately, preliminary observations of the 11 samples suggest that they are all free of dangerous compounds, like mercury and lead. They are mostly composed of the normal materials found in clay – aluminum, oxygen, silicon, carbon – with trace amounts of titanium, iron and copper that we will continue to evaluate. We continue to look at these clay samples and determine if we should exclude any particular clay source, or be aware of any properties that would make the clay more susceptible to bacterial contamination.

Reflections of a Summer Intern

Early mornings on the train tracks: children going to school

It’s been five months since I lived in Walukuba Village as an intern for UVP. One of the questions most often asked of me is: “What is it like to live in an African village?” I usually say, “It is unforgettable.” I had no idea what of kind of impact it would have on me but I know now that the effects of living in a rural village in Africa have greatly enriched my life in many ways. To many, voluntarily living in an environment without access to running water or electricity with three initial strangers (my amazing team) sounds a little unworldly. However the experience helped me gain a deeper understanding of what I believe life is all about. In addition to the health programs we implemented and building a well with the villagers, what has stayed with me the most was appreciating the beauty in the simplicity of their lives. Residents in the village have very little materially, yet spiritually they are overflowing.

My mornings would start off with the sound of the rooster - usually around 5:30am. I would look through my mosquito net and my open window and see the night sky still dark so I'd lie there until it was light enough to go outside, or I would roll back asleep. The mornings involved me greeting Oliver and Betty, our host family’s two cows, then going to the train tracks; either to talk on my small phone to friends and family back home or to watch the sunrise. Sometimes it included both. But really the best part was seeing the primary school kids scamper along, balancing themselves on the tracks, saying "bonga!" to me as they passed by, then burst into giggles and run off to school. These kids are absolutely beautiful. I have never seen so many glowing, bright, shiny, perfect little faces with smiles full of white teeth.

Nights in the village were equally as beautiful as watching the sunrise. The best nights were when the moon lit the entire sky and I could enjoy being out on the expansive red dirt landscape that we called our front yard, on my wooden folding chair and just sit, listen and watch. The sense of community was palpable as I watched neighbors chatting and children walking with jerry cans on their way to retrieve water. I'd listen to the village continue to bustle along, little kerosene lamps dotting the main road which allowed me to see the shadows that moved in the dark. Of course for me, I couldn't see anything, but Ugandan night vision is strong and most people move around at night since they work in the gardens most of the day.

It was the small connections I made with others and simple moments during my summer in Walukuba that had the biggest impact on me. There were so many sweet moments with the children. You can't go to Africa and not like children. It's almost sacrilege! I'll remember Mpata - a little man with a big belly and the gentlest round face. He would walk around with one hand rubbing his fat little belly, the other behind his head with such a serene look on his face and I would think: he'll be doing that exact same pose when he's 80. His sister Doreen, we called Doreeny, had a similar face, beautiful with distinct features and the longest eyelashes. Then there was Shebala, the little girl who ruled the roost and probably the most photogenic of them all. I also can’t forget Esther, the absolutely, certifiably crazy four year old who lived across the way from us. She always had her tongue hanging out, wide-eyes smiling, carrying a knife around in her filthy hands. I made sure to never cross her! After getting all clean from taking a bucket bath I'd be out with the kids and a half naked Esther would come marching up, tongue wagging, and her head covered with dust and she would flail herself around on my lap. She'd then place her unwashed hands all over my face and in my mouth, and I'd think: well I'm no longer Africa clean, I'm now Esther clean. And of course Kamuya, the sweet seven year old who took to me right away at the soccer fields at the beginning of the summer. Never failing to greet me, I would always say to her “Maku matifua” (give me a hug) and she was frequent visitor in our house.

The children were everywhere…Children of the Maize! I swear I'd think I was alone and out of nowhere I'd hear a tiny voice say my name, or at times scream my name, and I'd have to search the horizon before I'd spot four little ones lost in the maize standing there frantically waving their little arms until they were about to fall off only to stop when I shouted back to them "Jambo!" Sometimes they would just stand there with their arm straight out, like we were being saluted. Katie, one of my teammates, said we should start our own little child army that worshipped us….we would have had quite a following. I would look at them, their smooth and flawless dark skin, black eyes, and naturally curled eyelashes and wonder what their futures have in store for them. Will they stay in the village and live the slow, predictable village life, bear a lot of children and perpetuate the cycle of poverty? Or will they push the envelope, challenge themselves, and attempt to expand their world outside the boundary lines of their village? What opportunities will present themselves to better their lives? Will they have the luxury of Choice to improve their lives? I don't know but I do know that all of the children in the village are bright and smart and have a glowing presence about them that is much bigger than any small village can handle. These kids helped me feel so at home by always, without a doubt greeting me with the same enthusiasm and zest that they greeted me with the day before, hour before, or even minutes before. "JAMBO MZUNGU! MZUNGU BYEEEEEE!" But by the end of the summer the word 'mzungu' was replaced with 'Sarah'. Now I can't say that they all really knew my name because there were only three mzungu women in the area and two of us were named Sarah, so it is entirely possible that they thought every female mzungu's name was Sarah!

My absolute favorite memory is the very last night we all stayed in the village. What started out as a simple dance party turned into a rager! With about twenty children singing upbeat Ugandan songs and another child pounding on an empty jerry can with a wooden stick, we filled the night air with the sounds of a true party. The kids' voices were harmonic and fast as if to preserve the atmosphere of a popular nightclub, they sang songs at the top of their lungs in Lusoga, clapping their hands and waving them everywhere, synchronizing to the beat of the jerry can, and all under the disco ball of the bright half moon. I wouldn't be surprised if villages miles away could hear our party. They put fabric around our hips, which is a tradition for them. I don’t know the exact meaning behind this but I think it's to accentuate the hips since they are involved in so many movements. I felt little hands behind me grasp my hips guiding them to move from side to side as fast as I possibly could; sometimes eventually falling over from losing my balance. We did conga lines. We hit the dirt ground on our knees, to do the infamous Twin Dance. We just danced. Sweaty and hot, it was the most fun I have had in a long time and better than any dance club I've ever been to in my life. I just remember reminding myself that evenings like this is what life is all about. Making cross-cultural connections with people you might never have otherwise met in life really leads to such an enriching and fulfilled life. After almost two hours of dancing, the mzungus had to call it quits because we were so tired and we all had to get up early the next day to leave - the children had outlasted us. They were so sad. But us going into the house didn't stop them. About 10 of them remained and stood in front of our house, sang goodbye songs to us in Lusoga, then songs about America. They didn't want to leave!

Since I’ve left and had more time to reflect on my stay in the village - I realize that it really is the smaller things in life that make the biggest impacts. The simple connections with others and the mini-moments are now what help me define balance in life. At the beginning of this experience I set out to make a lasting impact and bring change to a small village. Yet what I learned is that I have received more than I could ever give and the biggest impression is not what I left on the village but what the villagers have left on me.