for improving health in rural Cambodia, writes John Macgregor. A shift
in thinking away from rigidly rational development models to a more
random, spirited approach may also help, he argues.
The most visually striking thing about rural Cambodia might be the
abysmal state of people's health. If you were someone who liked
log-frame diagrams, you might have arrows emanating from poverty,
dirty water, outdoor defecation and poor nutrition to pictures of
listless adults, kids infested with parasites, and just about everyone
some inches shorter than their optimal height. In villages far from a
main road, that's certainly the visual which hits you in the face.
In some places, nearly everyone is sick. Work is slow, and learning
largely absent. Ratanakkiri province, for example, has worse child
stunting, and child mortality, than Sierra Leone.
Battambang province has more of a mixture of pluses and minuses. Knach
Romeas commune on the Thai border, for example, has high rice
production – but no clean water. A recent study there by the NGO I
work with, Lom Orng, found that residents spend 18 per cent of their
disposable income on expensive, untreated, trucked-in water. This
water (and sanitation in general) is so bad that villagers spend
another 27 per cent on medical bills. At a guess, bad water might
steal away a third of local income.
But every aid practitioner knows that single issues are a bit of an
illusion. How do you tease water apart from sanitation, or sanitation
from education, or education from income? And what if you overlay
factors like high birth rate and global warming? Or the downstream
effects of the latter, such as the flooding of the Mekong Delta and
the millions this will displace on Cambodia's doorstep? At this point
your log-framer might start to go mad (assuming log-framers aren't
this way already).
Given the infinity of problems, and the finitude of money, the best
anyone can do is to arm themselves to the teeth with a love of the
poor (incidentally, a solution par excellence to Western neuroses),
and to pick the high-yield targets.
The US$1.4m After the Flood project – being run across three
northwestern provinces by four local NGOs – is providing seeds and
training for a quick short-term rice crop, re-stocking chicken coops
and vegetable gardens, and building food-dense Permaculture "safe
grounds" above the flood line. It is also repairing schools, education
being the specialty of one consortium member, PKO.
The psychological software is being addressed as well: here we judged
that poor hygiene and sanitation habits are the most compelling
target, given that they poison both water sources and food. In lieu of
crowding people into rooms with whiteboards, the hygiene trainers have
opted for a little drama. Perhaps 40 villagers are brought together to
draw a map of the village in the dirt. Various coloured sands are
provided to represent walkways, homes, streams, and so on. They are
then asked to mark areas where they shit. (I'll use that word rather
than "defecate", as our Khmer teams are rather taken with its
naughtiness, which chimes well with colloquial Khmer. They now
laughingly refer to themselves as "shit experts".)
Drawing a village map can take all morning. Trainers might step in
sometimes and ask, for example, what people make of the fact that they
are shitting within a few feet of their water source. But mostly they
allow villagers to draw their own map and reach their own conclusions.
Then walks are done to outside toilet areas, and shit collected. Flies
are observed gathering on it, and then on people. It's mixed with
drinking water in a plastic bottle, and offered round as a drink, to
general guffaws. Basic facts about the fecal-oral route of water and
food contamination are introduced – but 95 per cent of it is letting
villagers describe their own patterns of behaviour, see them in a
slightly new light, and make their own connections.
We haven't gauged results yet, but this Community-Led Total Sanitation
training is certainly confronting enough to grab villagers' attention.
And as they are driving the process; they feel free to have noisy
debates. Getting a birds' eye view of things seems to be another
clincher: seeing the relationships in graphical form.
After the Flood has no consultants, no SUVs, and one meeting a month,
which no one enjoys. It is succeeding partly because it is lean, but
mostly because my Cambodian colleagues are so good at what they do.
While they possess the Khmer impatience with theory and detail – and
so tend to jump straight in – this is because they know their communes
like the backs of their hands. These are the men and women who jumped
into boats with supplies last October, and saved 6,000 inundated
people from malnutrition, disease and death – on two days' notice.
The project to date has been characterised by cross-fertilisation. The
CLTS training was taught to the other NGOs by Ockenden, which has
experience in it. Lom Orng has shared its knowledge of short-term rice
cropping and horticulture; while DCO – more of a nuts-and-bolts
operation – racked up large tallies of ponds, safe grounds, chicken
coops and vegetable gardens in the first month, spurring everyone else
to get moving. Several times staff from the various NGOs have pooled
their salaries to build houses for flood survivors they found living
on the dirt.
The project is having some effects beyond its bounds. Its Permaculture
demonstration farm, begun by Ockenden in Battambang's Rukha Kiri
district, will long outlive the project, and will hopefully become a
permanent feature of the country's agricultural landscape. For Lom
Orng, After the Flood has strengthened our grasp of the link between
water and health, and we have drafted a plan to bring cheap,
reticulated water to scores of communes – using the profit from one
commune to seed a venture in a neighbour: a kind of
commune-leapfrogging revolving fund.
Seeing a village boy with tuberculosis last week – the disease that
killed my grandmother back in 1931, a decade before antibiotics –
reminded me of the distance left to travel. Much of that distance will
be covered in a motley rather than a rational way. But leaving certain
things to the gods of randomness is the heart of Asian psychology, and
if we mean what we say about allowing local communities to design and
lead their own development, allowing for some happy accidents would be
in the spirit of things.
John Macgregor is communications director at the Lom Orng Organisation
(formerly the Cambodian War Amputees Rehabilitation Society). Lom Orng
is part of a consortium of NGOs running After the Flood in Bantheay
Meanchey, Battambang and Pursat. The others are Ockenden Cambodia,
Disadvantaged Cambodians Organisation and Puthi Komar Organisation.
Start with sanitation
Tuesday, 10 April 2012
http://www.phnompenhpost.com/index.php/2012041055536/Special-Reports/start-with-sanitation.html
