A Case S tu d y F ro m P an ama

Review of a Peace Corps Supported Water Intervention

& Community Health Status

K e v i n R . B i n g l e y

M P H C a p s t o n e P r o j e c t

D e c e m b e r 2 0 11

A d v i s o r : K e l l o g g J . S c h w a b

Presentation Outline

Preamble

Part 1: Capstone Objectives

Part 2: Background

Part 3: Intervention

Part 4: Discussion

Part 5: Conclusion

Sources

Preamble

Capstone represents a comprehensive analysis of a community-level water intervention undertaken with the support of the Author who served as a Peace Corps Volunteer in Panama from 2002 through 2005

Community-level data obtained through direct observations, project reports, site and health surveys, and personal communications

Johns Hopkins Institutional Review Board Exempt status approval to use data collected in Panamá and to conduct an interview with Christian Medical Missions, Inc. staff was received on August 30, 2011

Part 1: Capstone Objectives

Objective No. 1: Address the global water & sanitation burden while focusing on how access deficiencies impact a specific population

Objective No. 2: Review the Peace Corps development approach used in assisting the Panamanian community of Majé in achieving their goal of decreasing the prevalence of diarrhea through an improved community-level water supply

Rationale: Knowledge gained from individual case studies adds to the collective capacity of international development in an effort to shift public health interventions towards more sustainable and effective approaches

Part 2: Background

Panama Water & Sanitation 90% of population with access to improved

water1

73% of population with access to improved sanitation1

Rural vs. Urban disparities2

Rural native populated Darien Province has 9% improved water coverage 3% improved sanitation coverage

Part 2: Background (Cont.)

Peace Corps Development Approach3

Long-term capacity building of people

‘Problem’ as an end point to be solved by a peoples own ability to improve their livelihoods

Insertion of volunteers into host nation two years after training in language, culture, and capacity building

Part 2: Background (Cont.)

The Community of Maje 835 people

Remote Wounaan Village Traditional & subsistence-

based livelihoods

Active tribal council

Past community Projects

Part 2: Background (Cont.)

MAJE

Map Source: http://www.panamarailroad.org/maps.html

Part 3: Intervention

Pre-1986 No community water or sanitation systems Water: Two community streams and tidal river Sanitation: Open defecation in forests No health history data

Part 3: Intervention (Cont.)

1986 and Cholera Population ~500 Cholera killed ~50 Community partnered with

Catholic Church for construction of gravity water system

Used surface water source Elimination of cholera

Part 3: Intervention (Cont.)

1987 to 2001 Population growth to 835 Water system capacity limited Households return to streams and

river No change in sanitation conditions

Christian Medical Missions, Inc. (CMMI) first visits in 1997 CMMI states common ailments include

“parasites, diarrhea, upper respiratory infections, malaria, fungal infections of the skin, general neck and back pain and severe tooth decay.”4

Part 3: Intervention (Cont.)

2002 to 2005 CMMI funding to improve water systems in 4 communities CMMI and Maje requested technical support from Peace

Corps No volunteer stationed in or near the community Project-based visits to Maje by Peace Corps Water Assessment:

No water treatment and shortages in supply Use of streams and river for consumptive water

2 years project with capacity building

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Phase II: Existing Tank Repair, Filter Bed Preparation, Field Training, and System Startup

Phase I: Construction. Cleanout Points, Drip

Chlorinator, Water Tank, Upflow Sand Filter, &

Classroom O&M Training

Community Design and Coordination Meeting

Water Assessment

Phase II: Distribution System Upgrade & Field

O&M Training

Phase II: Field O&M Training

Followup Hands-on Trainging Session

and System Inspection

2003 2004 2005

Part 3: Intervention (Cont.)

Peace Corps Involvement

Part 3: Intervention (Cont.)

2002 to 2005 (Cont.) February 2005 visit:

In May-July 2003, 13 patients visited Health Post with diarrhea

Health Aide noted typical annual pattern After startup, no water system related

disease until January 2005 In January, Water Committee membership

change with no continuity O&M training In January, 4 patients seen at health post

with severe diarrhea In February, training led by old water

committee for new

Part 3: Intervention (Cont.)

2005 to Today CMMI discontinued medical trips to Maje

“The rate of diarrhea dropped dramatically in 2004 and 2005” and they sought out more needy communities to receive their services4

After May 2005, No Peace Corps or CMMI follow-up No information to support an analysis of the long-term

sustainability and effectiveness of the intervention

Part 4: Discussion

Modified Peace Corps approach in MajéSuitable as community regularly identified needs and mobilized

to solve them Technical approach resulted in decline in diarrhea cases

Part 4: Discussion (Cont.)

Community dynamics’ & project-focused visits by Peace Corps

A Peace Corps Volunteer stationed in Majé could have identify risks associated with community practices and infrastructure associated with water, sanitation, and hygiene; and, incorporated capacity building around a collective intervention that supported a more successful short- and long-term health outcome

Part 5: Conclusion

Maje’s residents proved to be motivated, organized, and capable of tackling their public health concerns

The Peace Corps development approach in Majé was appropriate for community organizational level in supporting their short-term goals of decreasing the incidence of diarrhea throughout the community.

However, community dynamics and project-focused visits caused gaps in system operation that resulted in water quality to return to pre-project levels and may have hindered the long-term sustainability and success of the community water intervention.

Sources

1. World Health Organizations (WHO) and United Nations Children’s Fund (UNICEF). (2006). Meeting the MDG Drinking Water and Sanitation Target, The Urban And Rural Challenge of the Decade. Geneva: WHO Library. Web. 3 Oct. 2011. www.who.int/water_sanitation_health/ monitoring/jmp2006/en/index.html

2. Hernandez Mazariegos, Juan E. (2006). Human Development Report 2006, Water and Basic Sanitation in Latin American and the Caribbean. United Nations Development Programme. 2006/25. Web. 5 Oct. 2011. http://hdr.undp.org/fr/rapports/mondial/rdh2006/documents/ Hernandez%20Mazariegos.pdf

3. Peace Corps. (2002). Roles of the Volunteer in Development, Toolkits for Building Capacity. Peace Corps Information Collection and Exchange. July. Web. 14 Oct. 2011.  www.peacecorps.gov/multimedia/pdf/library/ T0005_rvidcomplete.pdf

4. Diane Gelé, Christian Medical Missions, Inc. Interview. 2011

Questions