1. A Case Study From Panama Review of a Peace Corps Supported Water Intervention & Community Health Status Kevin R. Bingley MPH Capstone Project December 2011 Advisor: Kellogg J. Schwab

2. Presentation Outline Preamble Part 1: Capstone Objectives Part 2: Background Part 3: Intervention Part 4: Discussion Part 5: Conclusion Sources

3. 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

4. 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

5. Part 2: Background Panama Water & Sanitation  90% of population with access to improved water 1  73% of population with access to improved sanitation 1  Rural vs. Urban disparities 2  Rural native populated Darien Province has 9% improved water coverage 3% improved sanitation coverage

6. Part 2: Background (Cont.) Peace Corps Development Approach 3  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

7. Part 2: Background (Cont.) The Community of Maje  835 people  Remote Wounaan Village  Traditional & subsistence- based livelihoods  Active tribal council  Past community Projects

8. Part 2: Background (Cont.) MAJE Map Source: http://www.panamarailroad.org/maps.html

9. 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

10. 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

11. 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

12. 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

13. Part 3: Intervention (Cont.) Peace Corps Involvement

14. 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

15. 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 services 4  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

16. Part 4: Discussion Modified Peace Corps approach in Majé Suitable as community regularly identified needs and mobilized to solve them Technical approach resulted in decline in diarrhea cases

17. 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

18. 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.

19. 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

20. Questions