Five Villages – Five Chiefs – One 2011 Flood & Empowering people to help themselves with what they already have...

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

Where were the wells? Angkor Chum District, Siem Reap Province Five villages, an NGO office and a Phnom Penh restaurant 12 wells tested were tested in these villages in July of We revisited the villages after the October floods to ask how their wells and health were effected by the floods &

Inexpensive water testing We used $2 per test We tested for E-coli, Salmonella, and Aeromonas No incubator is required but good results may take 36 hours instead of 24 if the air temp. is less than 27C & All samples were tested within 2 hours of being drawn

How much bacteria 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 It is the 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

What is Salmonella? Health standards in the world = 0 CFU/100ml One form causes typhoid Causes diarrhea, fever, vomiting, stomach cramps headache Infectious dose is only 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 Causes respiratory illness, skin and soft tissue infections, fever, vomiting, stomach cramps, headache, eye infections, (not so much diarrhea) Infectious dose is not established, but may be >10 8 ( Morgan et al., 1985) Infectious dose will be lower for children & to 3 micros long and 0.7 wide We at NHN are curious if Aeromonas might contribute to child respiratory disease during the rainy season when children are swimming in ditches and breathing water aerosols.

Non-sealed, hand-dug or bore-hole wells less than 25m deep offer a convenient water supply, BUT NOT a safe drinking water supply. Contaminated surface water is always present We know to build a latrine 20m from a drinking water well, but the same holds true to put it 20m from a rice paddy or other contaminated puddle of water & Diagrams indicate how external contaminated water gets into wells (They are also contaminated via using dirty ropes and buckets)

Chief Lek Hat of Svay Chhum 130 families live in his village Village wells were not tested in July of 2011 After the October floods, the villagers simply bailed out the wells and started using the water He says 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, but little diarrhea. The illness lasted about two weeks &

Chief Huon Oeum of Tumroab 133 families live in his village All wells tested in July of 2011 were contaminated Though the village wells did not flood, the water level in their hand-dug-wells was equal to the adjacent rice paddy water level indicating almost certain contamination & 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 live in his village All wells tested in July 2011 were contaminated All village wells were flooded in October 2011 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 of the 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 live in his village All wells tested in July 2011 were contaminated 14 village wells flooded in October 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 live in his village All wells tested in July 2011 were contaminated Not much flood damage or health problems No wells were flooded in October & 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 in July were contaminated Water levels in the hand dug wells (HDW) was equal to the level of water in the adjacent rice paddies less than 2 meters form the wells. This is a near certain indicator of cross contamination & 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 of illness cusing agents. 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 Household Water Treatment (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 new-well water is clean Coordinate with NGOs to make HWT products accessible 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 he same holds true to put a drinking water well 20m from a paddy or other puddle of water. Continue to dig HDWs in Cambodia, but synergistically concentrate on Household Water Treatment 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 &

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