Five Villages – Five Chiefs – One Flood & Empowering people to help themselves with what they already have...

Many thanks to the generous people of PLAN-Cambodia and WTO offering guidance, transportation, translation, housing and friendship &

Where were the wells? Angkor Chum District, Siem Reap Province Five villages, an NGO office and PP restaurant 12 wells tested Tested in July &

Inexpensive water testing $2 per test - plus shipping No incubator required but it will take 48 instead of 24 hours &

How much is too much? A CFU is a colony forming unit Almost all health standards in the world say E-coli, fecal coliforms and Salmonella should be 0 CFU per 100 ml The WHO recognizes that is difficult to attain in developing countries & WHO Guidelines for drinking-water quality – Second Edition Volume 3, Surveillance and control of community supplies

Whats an E-coli Almost all health standards in the world say E-coli, fecal coliforms and Salmonella should be 0 CFU per 100 ml E-coli (from Theodor Escherich, 1885) is important as an indicator bacteria Infectious dose is 20 to 10 8 depending on type Most common cause of pediatric Urinary Tract Infections Remember – e-coli is an indicator of probability that other infectious bacteria are present & to 3 micros long and 0.5 wide

Whats Salmonella? Health standards in the world = 0 CFU/100ml One form causes typhoid Diarrhea, fever, vomiting, stomach cramps Headache Infectious dose is 15 to 20 cells US Food and Drug Administration Infectious dose is lower for children & to 5 micros long and 1 wide

Whats Aeromonas? Most water standards do not include Aeromonas Most cases of aeromonas related pneumonia are found in the 16,000 to 160,000 near drownings in the USA each year Respiratory illness, skin and soft tissue infections, fever, vomiting, stomach cramps, headache, eye infections, (not so much diarrhea) Infectious dose ? Infectious dose is lower for children & to 3 micros long and 0.7 wide

Non-sealed, hand-dug or bore-hole wells less than 25m deep offer a convenient water supply – not safety. Contaminated water is always present Hand Dug Wells (HDW) are shallow, 3m -5m We all know to put a latrine 20m from a drinking water well. The same holds true to put it 20m from a paddy or other puddle of water &

Chief Lek Hat of Svay Chhum 130 Families Village wells were not tested After the flood, villagers bailed out the wells and started using the water There was little increase in diarrhea Many people in the village, including the Chief, got a sickness after the flood that included high temperature, vomiting, dizziness, headache, and sleepiness. The illness lasted about two weeks &

Chief Huon Oeum of Tumroab 133 Families All wells tested were contaminated in July Water levels in HDW = paddy water level The village wells did not flood & m deep bore hole 40 e-coli/ 100ml 20 salmonella 120 aeromonas Hand-dug well # e-coli/100ml 20 salmonella 10,000+ aeromonas Hand-dug well # e-coli/100ml 20 salmonella 10,000+ aeromonas

Chief Rein Satuon of Koak Kroul 136 Families All wells tested were contaminated in July All village wells were flooded After the flood, villagers bailed out the wells and started using the water The Chiefs brother got typhoid fever after the flood The chiefs ceramic filter removed all bacteria we tested for & no photo Chiefs ceramic filter 0 e-coli/100ml 0 salmonella 0 aeromonas Hand-dug well in paddy field e-coli/100ml 2,000+ salmonella 2,000+ aeromonas Hand-dug well used by Chief e-coli/100ml 2,000+ salmonella 2,000+ aeromonas

Chief Khat Khoan of Romiet 74 Families All wells tested were contaminated in July 14 village wells flooded After the flood they started using the well water without emptying or decontaminating There were outbreaks of fever and diarrhea for two- weeks after the flood & Hand-dug well # e-coli/100ml 640 salmonella 1,200 aeromonas Hand-dug well # e-coli/100ml 800 salmonella 10,000+ aeromonas

Chief Mao Mang of Chumpung 101 Families All wells tested were contaminated in July Not much flood damage or health problems No wells were flooded & Hand-dug well # e-coli/100ml 600 salmonella 2,000 aeromonas Hand-dug well # e-coli/100ml 1,000 salmonella 3,000+ aeromonas

Along the road and an NGO Both wells tested were contaminated in July Water levels in HDW = paddy water level & no photo Bore-hole well 40 m w Rope pump 20 e-coli/100ml 0 salmonella 0 aeromonas Hand-dug well NGO office 100 e-coli/100ml 100 salmonella 10,000+ aeromonas Phnom Penh Restaurant 120 e-coli/100ml 40 salmonella 40+? aeromonas

The Take Away on health effects Ask health Department to present bi-annual WASH related illness data during WATSAN meetings. This information would be powerful for targeting, monitoring and independent evaluation. By District every six months starting next year By Commune, every six months, starting in 2017 Ask Health Department to investigate whether aeromonas is a major cause of respiratory disease in Cambodian children less than 5. Might explain high incidents of acute respiratory illness (5 to 10 times more prevalent than diarrhea). Might shift WASH sector to putting more resources toward HWT &

The Take-Away on wells All hand-dug wells should be considered contaminated unless proven otherwise. Wells should be tested in August, September, or October (wettest season) New well installation programs should include household water treating training and efforts to make HWT devices available. Alert the villagers to the hazards of thinking the well water is clean Coordinate with NGOs to offer HWT products Tell villagers to boil or use SODIS or pasteurization if they can not afford a HWT device We all know to put a latrine 20m from a drinking water well. The same holds true to put a drinking water well 20m from a paddy or other puddle of water – especially if it leaks! Continue to dig HDWs in Cambodia, but synergistically concentrate on HWT until we can afford deep-well (minimum 20m deep) sealed bore holes everywhere or centralized water distribution systems that work &

Thank you and good luck &

Five Villages – Five Chiefs – One Flood Houston, Texas Empowering people to help themselves with what they already have...