As I sit in the boat looking out at the vast ocean, I have two thoughts in my mind. One is how to control my sea sickness and the other is if used properly, how much this water could be utilized for electricity and good health outcomes.
The Earth comprises of approximately 70% water and 30% land. Why is it then water is considered a scare and economic good? I answer the question myself; It is because the quality of the water is not up to par to use for drinking. We had outlined earlier how Achham is considered a dry region with low access to water.
As a hospital, the MD had told me, without water and basic hygiene, infection control was close to non-existent. Water a basic yet economic good is required to sustain a human body. Why is it that people have to pay to get quality drinking water? Again I answer this question myself; if there was no minimum cost for it, I would be seeing more people drinking 2 sips of water from bottled water and then pouring it in the garbage because they don’t want to carry the bottle around. In a perfect market, supply and demand cross to create equilibrium. However, the market of water is inelastic. Irrespective of the price of water, people will still buy it to replenish their body. The people who can’t afford it will drink black water or cholera infected water from the river or ocean. We again go back to the issue of what is the line between a basic right and a commodity?
I have been privileged to work in two developing country settings (Nepal and Tanzania). As a Tanzanian, I have worked in Dar-Es-Salaam, Dodoma and Mtwara. One particular event I remember vividly was on the way to the Clinical Officers Training College, Mtwara: I witnessed 2 children collecting water from pot holes in a bucket. This water was probably used to clean themselves, use in the toilet and drink. I experienced a similar incident when in Achham. I had visited CHW areas and saw a water source from a rock being used for washing, drinking and cleaning. As part of my MPH, I was taught that most of the water based diseases’ were due to lack of basic water supply. I come back to the present and look at a never ending ocean which could be used to alleviate health outcomes, yet the water continues to flow with people in the regions of Achham and Mtwara not getting water for days. Where is the equality in that?
I always argue, as a public health specialist, although we are meant to focus on one determinant of health to make our intervention specific, measurable, achievable, and relevant and time bound; Individuals often forget there are many other determinants that are inbuilt. Many a times, the Clinical Officers I was teaching asked me how they could teach school students about pubertal changes when the school had a single bathroom for 300 students. I was also asked, how they could teach about STI control when there was no water available to wash blood during their menstruation.
As I prepare to apply for my PhD, I think back on all of these points and wonder which specialization I want to focus on. However, in the end I know it is a cycle. Everything is interconnected. The ocean, the people, the environment and their associated health outcomes.
Astha Ramaiya is the Blog Manager for Nyaya Health and a student pursuing her MSc Public Health at the London School of Hygiene and Tropical Medicine