Agua potable en guatemala Mary Anne Kucera

Patanatic, Guatemala Sololá Panajachel Lago de Atitlan

objectives Be familiar with the community we were in and a glimpse at the background data and information Explain the barriers to clean drinking water in Patanatic and a glimpse at the background data and information related to our community Discuss the implementation of water filters in the sectors Spread awareness of the lack of knowledge and education around the topic and importance of clean drinking water Share our accomplishments during our trip and time spent in Patanatic

Background information Patanatic, Guatemala is a unique community that is geographically divided into four sectors. While the location and makeup of each sector varies significantly, the health problems noted were evidently similar among all sectors. One of the major problems is a lack of clean drinking water. This issue manifests in a variety of gastrointestinal illnesses among the population, particularly in children. These issues were identified through our assessments both in the clinic and during home visits throughout the community.

The clinic in Patanatic Woodland’s Charity Private clinic Two nurses currently at the clinic Community doctor completing 3/5 year of medical school Few resources but more than the government ran clinics Distributes water filters throughout the 4 sectors within the community

Drinking water Access to clean water has been inadequate and posed many health risk factors to community members. The clinic implemented a water filtration system to many community members in order to provide a source of clean water. Families lack proper teaching to monitor filter status and are not fully competent in maintenance of filters. Inadequate knowledge and awareness in regards to water hygiene also persists. Overall description of topic/issues covered in specific learning objectives

Las estadisticas sobre La programa de los filtros de agua Goal is to keep water supply for the residents of Patanatic by protecting water springs and incorporating them into the system Water filters clean 7 liters of water in 45 minutes, their use cuts down on plastic bottle waste Water filter costs about 400 q each. Community members pay about 75 q based on how much the family can pay and this is decided by a community meeting Families must understand the value of the filter and sign contract stating they will use the filter, not sell filter, and let volunteers supervise use of filter Outside foreign groups are welcomed into homes to complete filter assessments Filters started in schools, then families with school-aged kids, then families without kids who requested them The Pan American bank does invest in water projects (about 4-6 million q) in the area but local leaders need to take lead of projects Need to replace underground pipes, still in assessment stage of determining extent of the problem Lesniewski, C. (2016). Interpersonal communication [COCODE meeting].

Highlights There were many health issues seen throughout our clinical assessments and well- checks that were related to unsafe drinking water and lack of awareness of the health effects. The community’s ability to maintain healthy lifestyles is jeopardized by the lack of infrastructure and resources The local government, particularly in the region of Sololá, finds itself in a continuous struggle to allocate adequate funds in rural communities that would help facilitate their implementation of water safety resources. This would further enhance positive health outcomes and decrease gastrointestinal health disparities across the region. Unsafe water, sanitation, and handwashing were listed as top risk factors driving death and disability in Guatemala (Institute for Health Metrics and Evaluation, 2017). We utilized the World Health Organization’s (WHO) “Golden Rules” for safe food preparation. “Las Reglas de Oro” indicate for use of clean drinking water to prevent GI illnes A highlight of the primary information you learned specific to the health issue identified in learning objectives Include strategies or interventions at individual, community, and system level 5 slides max

Interventions After identifying the needs of our population, we met with the community leaders to discuss how we could improve water sanitation knowledge to increase awareness about the importance of clean drinking water. We mainly targeted school-aged children Were seeing them in the clinic for well-checks Presentation to school Mukamana and Johri (2016) share the framework of “health promoting schools” as an evidence based practice to increase knowledge, health literacy, and result in sustainable behavioral changes Children in Guatemala also tend to have higher literacy levels than their parents and can more effectively communicate the knowledge Informational posters, flyers, and visually appealing handouts were created to disperse communication and educate the community members.

Conclusion/suggestions The village of Patanatic has faced many challenges regarding gastrointestinal illnesses. Water and food- borne illnesses account for 17.2% of all illnesses.. Diarrheal disease is among top 3 causes of premature death (58.6% of premature death). The main cause of these illnesses is due to the lack of access to clean drinking water, and deficient knowledge regarding food safety. There is a lack of access to clean drinking water throughout the community of Patanatic due to contaminated water sources, lack of infrastructure, and lack of proper resources to implement new strategies. The clinic has come up with a water filtration system for the families within the 4 sectors of the community, but education and training is still needed to stay on top of maintenance requirements. Implementation of water filters began in the school. This is an EBP approach as children have higher literacy levels and will pass the information on They are also the future generation and can make more of a lasting impact Train the trainer methodology Assures standardization of teaching Allows for a greater population to be impacted The community of Patanatic will benefit from cleaner water sources and education on hygiene and sanitation Some water sanitation and food safety techniques, as advertised by the World Health Organization’s “Golden Rules” for safe food preparation, were emphasized in key teaching points. We hope that by encouraging the children to continue these teachings at home, in return we will see a decrease in gastrointestinal illnesses. Summary points regarding identified topics covered in specific learning objectives Include issues or problems raised and how the issue may be better addressed or improved

Recommendations for future trips Engage in process of reflection at the end of each day Make small changes along the way, noting what worked well and what could improve Standardize the communication you give and allow for follow-up teaching if patient or client still lacks knowledge after completion of teaching Frequently reassess data at various points of implementation and data collection Pass on baseline knowledge to assist future groups traveling to Patanatic to ensure future interventions are effective and lead to sustainable change Provide tips on successful and/or unsuccessful interventions Pass on educational pieces

Most profound Experience – clinically or academically There were so many valuable experiences throughout the entire trip Assessment practice Such a unique and valuable learning experience to have before heading into the profession Language practice Valuable experience to be on opposite side and unable to explicitly communicate Rewarding to have the communication practice so I can better serve my Spanish-speaking patient’s in the hospital

Most profound experience – culturally There was so much to take in and learn about the culture and community in Patanatic Powerful sense of community Happy with the little they had Nothing else mattered Felt care-free and did not have to worry about the daily worries of life here in the United States Social media, what clothes you were wearing, if you got dirty, etc. Could live in the present moment and appreciate the small things

references Ariscain, V. H. (n.d.). WHO "Golden Rules" for Safe Food Preparation. Institute for Health Metrics and Evaluation. (2017). Guatemala. Retrieved from: http://www.healthdata.org/guatemala Coromac, J. (2017). Interpersonal Communication. Lesniewski, C. (2016). Interpersonal communication [COCODE meeting]. Lesniewski, C. & Coromac, J. (2016). Interpersonal communication. Lesniewski, C. (2017). 2017 Patanatic clinic data [Microsoft Excel spreadsheet]. Mukamana, O., & Johri, M. (2016). What is known about school-based interventions for health promotion and their impact in developing countries? A scoping review of the literature. Health Education Research, 31(5), 587-602. Pan American Health Organization, & World Health Organization. (2002). Health in the Americas (Vol. 1). Pan American Health Org.