Making Water a Reality in Rural Health Centers

The room was bare - a green-sheeted examination table pushed up against the far wall and a large desk, cluttered with papers, bisecting the room’s length. A lone poster fluttered on the wall, moving every time the door swung open or shut. The lack of other adornment so typical of Western medical offices was not uncommon here at the Ruhunda Health Center. More striking, however, was the absence of a sink or even a bucket in which health center staff and patents could briefly wash their hands.

The general consultation room at Ruhunda routinely sees an average of 60 patients each day. This is where Juvenal Niyomugaba, the Vice Titulaire at Ruhunda, practices. Beginning at 8:00 each morning and working until 4:00 or 5:00 each evening, Juvenal consults with patients, treating them for a wide assortment of illnesses and conditions including respiratory illnesses, malaria, pre and postnatal consultations, and general wounds and skin infections. As they enter the room, he congenially greets them with a handshake and then proceeds to investigate their aches and pains or dress their wounds. Despite the otherwise professional nature of the visit, the health center’s lack of running water made it difficult for Juvenal to wash his hands between consultations except for the few moments when he was able to take a quick break.

“I am busy every minute of the day - in consultations with new patients, meeting with past patients, and performing administrative tasks,” said Juvenal. “I am a professional, so I know the importance of hand washing between patients, but how can I do it when there is no sink and no bucket to wash my hands with and I have to go outside to fetch water? It’s not possible.”

Unfortunately, this unsanitary and poor clinical practice was not singular to Juvenal’s service. Rather, it was an intolerable condition shared among all rooms and health professionals at the health center. Most notably, neither the delivery room nor the pediatric and adult consultation rooms at Ruhunda had access to running water. That any doctor would be forced to deliver a child without immediately washing his or her hands before and after performing procedures is unfortunate and reveals the sometimes perilous risks inherent to both practitioners and patients when water is not available.

Ready and reliable access to water is critical in determining the quality of care offered at health centers in Rwanda. Rwandans face a daily onslaught of pathogens and parasites which threaten their health in both small and large ways. Soil transmitted helminths, amoebas, and general bacteria and viruses exploit the country’s poor hygiene, resulting in increased morbidity and lowered productivity among both working adults and students.

Water is an easy remedy to these problems, especially in health centers where people are most vulnerable. Not only does water enable equipment sterilization equipment and hygienic care, but its presence in health centers also allows health professionals to role model good hygiene and hand washing.

Unfortunately, many health centers must operate without this basic service. According to the 2008-2009 Ministry of Health Annual Statistical Booklet, only 59% of health centers nationwide are connected to either the local or national water grid. The rest must rely on a combination of rainwater harvesting, surface water from nearby lakes or rivers, and wells and boreholes. Even those health centers already connected to a water grid must struggle to bring water inside their health centers; they are often forced to carry water in buckets from an outside tap on to the grounds of the health center. Before local Access Project Peace Corps Volunteers applied for and received water grants from Appropriate Projects, both Ruhunda and Musha Health Centers were among Rwanda’s many health centers without internal running water.

The villages of Ruhunda and Musha are both located in the Rwamgana District in the Eastern Province of Rwanda. Ensconced in the folds of gently rolling hills in rural Rwanda, they both host small communities of small scale and subsistence farmers. While both Ruhunda and Musha are relatively close to the nearest regional capital, Rwamagana – a mere 20 and 30 kilometers, respectively - the cities remain largely untouched by modernity. Although electricity and cell phone coverage are available, few in these largely agricultural cities use these resources.

But in March and April of 2010, the Ruhunda and Musha Health Centers took a critical step in their path towards modernization and improving the care they provide. With assistance from Access and its Peace Corps Volunteers, funding from Appropriate Projects, and the initiative and leadership of the health center titulaires, sinks were finally installed and connected to running water at both health centers, thereby eliminating previous practices of hauling water by bucket and sporadic hand washing.

The projects were organized and executed by Peace Corps Volunteers Colleen Laurence and Kara Rogers in coordination with the Rwamagana District Health Advisor, Charles Ngirabatware. The volunteers worked with Appropriate Projects, an initiative of Water Charity, to coordinate the funding of each project. According to the description on their Website, Water Charity aims to complete small but critically important water and sanitation projects working exclusively with Peace Corps Volunteers serving throughout the world. They mandate that each project present a complete solution to a problem, use appropriate technology, finish quickly, and cost no more than $500.

At Ruhunda, the project outfitted both the general and pediatric consultation rooms as well as the delivery room with sinks. Similarly at Musha, the consultation, pharmacy, surgery, and pediatric rooms received sinks and were connected to the local water source. From start to finish, the projects took on average two months to finish, and the positive results were visible immediately. A combined population of 22,167 people from the cities of Gishari, Munyiginya, and Ruhunda (all served by the Ruhunda Health Center) and 15,432 people within the Musha Health Center catchment area now receive a higher standard of care when they visit the local health center. In follow-up visits after the conclusion of construction, nurses and technicians applauded the improvements and noted an unexpected benefit from the water project – namely, their health had improved as well!

During the application process, Gerard Kaberuka, Titulaire of the Ruhunda Health Center, said, “Everyone knows that water is the source of life. If we receive water, then we receive life. Water will decrease disease prevalence and improve the quality of services offered at the center.” Now, thanks to Water Charity, water flows freely and life blooms in a healthy environment at Ruhunda and Musha.

Since first writing, several other projects to install internal running water in health centers have been organized and completed by Peace Corps Volunteers in conjunction with Water Charity. Jessica McGhie facilitated projects at three separate health centers in the northern Musanze District to install running water in the hospitalization, consultation, and pharmacy services at two centers and pipe in and treat the water at another. Similarly, Colleen Laurence has just completed her second project at the Murehe Health Post in Rwamagana District which installed sinks in the maternity, consultation, and laboratory services and connected them to the on-grounds water source. Her colleague in Rwamagana, Jenny Boyd, is currently working with the staff at Rubona Health Center to install water in their maternity, consultation, and laboratory services. The combined impact of these projects will affect the over 125,000 people who seek care at these health centers.