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This photo is not from the 19th century:
Photo: Oxfam International
The Bible names water 722 times. Perhaps that helps explain why water is the single symbol shared by every world religion. Used throughout rituals to cleanse, purify and sanctify, water is the foundation for all life. But that turns out to not be true in a most unexpected place:
Hospitals and healthcare facilities around the world today.
As medicine travels across bionics and gene therapy into string theory and nanotechnology, one the most important discoveries that can still save millions of lives is being left behind:
During the middle Ages, life-expectancy measured in the teens not decades because much of the world lived in filth with poor hygiene and practically no sanitation. Epidemics and diseases like bubonic plague, typhus, smallpox and tuberculosis (“consumption”) thrived and took a massive toll on humanity.
Little improvement was made until the mid- to late- nineteenth century when the Industrial Revolution and the discovery of the germ theory of disease brought to light good hygiene and sanitation as a necessity for public health. A nurse named Florence Nightingale became the driving force for hospital reform. She convinced the world that improving hygiene and sanitation, as well as having trained professional nurses tend to the sick, were necessities.
We're now well into the 21st century, and hospitals and healthcare facilities around the world still look like something from the 1800s.
For anyone who believes U.S. foreign assistance can be more effective and efficient, including Water, Sanitation, and Hygiene (WASH) is key:
Hospitals and healthcare facilities around the world today.
As medicine travels across bionics and gene therapy into string theory and nanotechnology, one the most important discoveries that can still save millions of lives is being left behind:
- Improved water supply reduces diarrhea morbidity by 21%.
- Improved sanitation reduces diarrhea morbidity by 37.5%.
- Simply handwashing with soap can reduce diarrheal episodes by about 45%.
- When children wash their hands, healthy global development indicators like height, weight, and social skills increase as do child well‐being and social productivity.
During the middle Ages, life-expectancy measured in the teens not decades because much of the world lived in filth with poor hygiene and practically no sanitation. Epidemics and diseases like bubonic plague, typhus, smallpox and tuberculosis (“consumption”) thrived and took a massive toll on humanity.
Little improvement was made until the mid- to late- nineteenth century when the Industrial Revolution and the discovery of the germ theory of disease brought to light good hygiene and sanitation as a necessity for public health. A nurse named Florence Nightingale became the driving force for hospital reform. She convinced the world that improving hygiene and sanitation, as well as having trained professional nurses tend to the sick, were necessities.
We're now well into the 21st century, and hospitals and healthcare facilities around the world still look like something from the 1800s.
For anyone who believes U.S. foreign assistance can be more effective and efficient, including Water, Sanitation, and Hygiene (WASH) is key:
2014: Ebola causes global panic and exposes deadly healthcare
Doctors Without Borders says a key reason the Ebola virus spread was due to limited access to safe running water. With the vaccine more than two years away, family members and healthcare workers were on their own when it came to not contracting the disease. But many who came in contact with an infected person or the deceased could not effectively wash their hands.
Dr. Jamie Bartram runs the prestigious Water Institute at the University of North Carolina and focuses on the links between water science, policy and practice. The World Health Organization, WHO, asked him to survey healthcare facilities in 54 low- and middle- income countries. Here's what he found:
Dr. Jamie Bartram runs the prestigious Water Institute at the University of North Carolina and focuses on the links between water science, policy and practice. The World Health Organization, WHO, asked him to survey healthcare facilities in 54 low- and middle- income countries. Here's what he found:
- 40% of healthcare facilities do not have access to safe water
- 35% do not have soap and water for handwashing
- 20% do not have basic sanitation
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Upwards of 40% of hospitals and healthcare facilities are run by faith-based organizations; yet our shared symbol and foundation for life, is an instrument of disease and death:
1:2 patients leave the hospital with an infection they did not have upon arrival: “In some developing countries up to one in every two patients (45.6%) left hospital with an infection they had not had on arrival.” click here to read more... The lack of WASH in Health Care Facilities is devastating: “The lack of WASH contributes to millions of infection-related deaths each year. When these infections do not result in death, they can cause prolonged hospital stays, long-term disability, increased antibiotic resistance and economic burden on health-care systems.” click here to read more... |
Overcrowded clinic in Uganda. Photo: GlobalJews.org
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Sink but no water, health center in Ethiopia. Photo: Village Health Partnership
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WASH and safe births:
“Encouraging women to give birth in healthcare facilities is one of the key strategies for reducing maternal mortality. Yet even in the very facilities that are set up to serve their communities with healthcare and welcome new life into the world, there is often no constant clean water supply, functioning toilets or handwashing facilities.” click here to read more... “Bring your own” birthing kit: “In some cases, women giving birth must buy their own ‘clean birth kit’, which includes a plastic sheet and gloves to compensate for the lack of adequate hygiene provision in maternity units.” click here to read more... Newborns and sepsis: “8% of maternal mortality is caused by sepsis. A failure to make sure that a woman has a clean place to give birth, that a midwife, birth attendant or doctor has clean hands when helping her deliver, and that the blade which separates the child from his mother by cutting the umbilical cord is clean puts a baby at risk. The absence of sufficient infection prevention and control measures in healthcare facilities should be of particular concern to those attempting to redress the slow progress to reduce maternal mortality globally.” click here to read more... |
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50 % of the health burden of malnutrition is attributable to WASH:
“Diarrhea is deadly. 1.5 million people die every year from diarrheal diseases (including cholera); 90% are children under 14, mostly in developing countries. 88% of diarrhea is attributed to unsafe water supply, inadequate sanitation and hygiene. As diarrhea causes undernutrition, it creates a vicious cycle by also reducing a child’s resistance to subsequent infections; repeated bouts of diarrhea can negatively impact children’s physical and cognitive development.” click here to read more... WASH and HIV/AIDS: “HIV-positive people cannot be treated without clean water, in the hospital and at home. Anti-Retroviral drugs (ARVs) are essential to enable people living with HIV/AIDS to lead healthy and productive lives. Their consumption requires approximately 1.5 litres of safe water every day.” click here to read more... For more information: |
Overcrowded clinic in Malawi. Photo: Oxfam International
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CASE STUDY: VILLAGE HEALTH PARTNERSHIP
“I recently found myself in a packed labor and delivery ward. When an unexpected twin was born not breathing, we had no choice. With almost no protective gear, two nurses I’d brought with me jumped in and saved the baby. Covered with blood, we just had to hope no mother or child we came in contact with that day was infected with HIV, hepatitis... We had no way to clean up because this massive, overcrowded hospital that serves 2.5 million people, had had no water in six weeks.”
- Margaret “Migs” Muldrow, MD Internal Medicine and Dermatology, Founder, Village Health Partnership
Asked to review WASH in 13 rural health care facilities in Ethiopia this past year, Dr. Muldrow shared her findings with FIA. Without exception, every hospital and clinic went through periods of having no water. Here's some of what her team saw:
- Margaret “Migs” Muldrow, MD Internal Medicine and Dermatology, Founder, Village Health Partnership
Asked to review WASH in 13 rural health care facilities in Ethiopia this past year, Dr. Muldrow shared her findings with FIA. Without exception, every hospital and clinic went through periods of having no water. Here's some of what her team saw:
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At one health center serving some 53,000 people, there is just one latrine, no shower and two donkeys make 20 trips a day to transport water from a river 1.5 miles away. It’s clear the donkeys cannot meet the facility’s needs, but the staff does much with little. The place is clean and organized. |
Photo: Village Health Partnership
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Photo: Village Health Partnership
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At this main referral facility mothers give birth, side-by-side, sometimes three at a time. When very busy, the mothers clean up their blood and bodily fluids with their own clothes and rags to make way for the next women about to give birth. Blood covers the walls and exam tables. Mothers are afraid to deliver here but they are also afraid to die in labor at home. |
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This pit latrine is impossible to keep clean and will often overflow during rainy season, sending sewage into the healthcare compound. “Ethiopians work very hard to solve their issues. They are also deeply ashamed of the level of poverty and won’t talk about sanitation for fear outsiders will react with judgment. I have anything but judgment. I have hope. Though one of the most desperate places in terms of maternal and child health, mortality rates are dropping in areas where international assistance and the Ethiopian government have reach. And we’re learning that local commitment is vital to creating sustainable health systems. But it seems to me that we shouldn’t have to learn that water is, too.” - Margaret “Migs” Muldrow, MD Internal Medicine and Dermatology, Founder, Village Health Partnership |
Photo: Village Health Partnership
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It's Worse Than You Think:
If we don’t take global action to prevent infections, and instead keep relying on antibiotics to cure infections, we will return to the days before we had any antibiotics. Drug resistance is a rapidly growing global threat. Drug-resistant diseases can cause longer and more complicated illnesses, more doctor visits, the need for stronger and more expensive drugs, and more deaths. Already, many of the common antibiotics we’ve all come to rely on are no longer effective.
And that’s really scary.
But wait! What about the antibiotics of tomorrow? you're probably asking. Over the last several decades, there has been a continual withdrawal of pharmaceutical companies engaged in developing new antibiotics. In 1990, there were at least 18 large pharmaceutical companies actively developing antibiotics.
Today, there are four.
The supply of new medicines is insufficient to keep up with the increase in drug resistance, as older medicines are used more widely and microbes evolve to resist them. Combating the emergence and spread of AMR, and ensuring the efficacy of antimicrobials, requires each of us to take responsibility for how we use medication.
And that’s really scary.
But wait! What about the antibiotics of tomorrow? you're probably asking. Over the last several decades, there has been a continual withdrawal of pharmaceutical companies engaged in developing new antibiotics. In 1990, there were at least 18 large pharmaceutical companies actively developing antibiotics.
Today, there are four.
The supply of new medicines is insufficient to keep up with the increase in drug resistance, as older medicines are used more widely and microbes evolve to resist them. Combating the emergence and spread of AMR, and ensuring the efficacy of antimicrobials, requires each of us to take responsibility for how we use medication.
Antibiotic resistance is a subset of Antimicrobial resistance, AMR, which includes antifungals, antivirals and anti-malarials. Bacteria resistant to antibiotics is the acquired ability by microbes to survive and grow in the presence of drugs meant to treat the infections they cause. The development of resistance is a natural phenomenon, however human actions promote avoidable emergence and spread of AMR.
To reduce the emergence and spread of AMRs, we must 1) prevent infections and 2) better manage how we use antibiotics:
Every infection prevented is one that needs no treatment.
Get the right drug to the right patient at the right time.
- Tuberculosis: In 2015, the WHO reported that TB surpassed HIV as the leading cause of death from a single infectious disease. Two types of tuberculosis are resistant to anti-biotics -- multidrug-resistant tuberculosis called MDR-TB, and extensively drug-resistant TB called XDR-TB.TB disproportionately affects the poor. TB is also a danger to people with compromised immune systems due to HIV, diabetes and other conditions. The impact of this disease on individuals and families is also economically devastating. An average TB patient can lose up to four months of work and 30% of their annual income.
- MRSA: Commonly called MRSA, methicillin resistant staphylococcus aureus is a type of staph bacteria that is resistant to many antibiotics. In a healthcare setting it can cause bloodstream infections, pneumonia and surgical site infections. If not treated quickly, MRSA infections can cause sepsis and death.
- Other dangerous AMRs include: Carbapenem resistant enterobacteriaceae known as CRE, ceftriaxone resistant neisseria gonorrhoeae, and clostridium difficile.
To reduce the emergence and spread of AMRs, we must 1) prevent infections and 2) better manage how we use antibiotics:
Every infection prevented is one that needs no treatment.
- Prevention can be cost-effective and implemented even where resources are limited. Good sanitation, hygiene (including access to reliable energy), and other measures such as vaccinations, can slow the development and restrict the spread of drug-resistant infections.
Get the right drug to the right patient at the right time.
- Large quantities of antibiotics are wasted on patients who do not need them. Doctors or pharmacists excessively prescribe them; self-medicating patients might use leftover medicine or buy antibiotics over-the-counter or at village markets. Meanwhile others who need antibiotics do not have access. Using antibiotics at a dosage less than the amount required for a therapeutic effect -- from a biological perspective – also promotes drug-resistance. Sub-therapeutic doses come from counterfeit, substandard or expired drugs; self-medication; access without prescription; cost and lack of reliable access to drugs; lack of education or information about the importance of taking the full dose.
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AMR is a “One Health” Issue:
For more information, see WHO's global report on AMR |
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How a Medical Miracle Turned
into the Biggest Public Health Danger
of our Time
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By Lecia Bushak
The success of antibiotics may be completely cancelled out by their combative counterparts: resistant bacteria. The discovery of penicillin marked the advent of the age of antibiotics, an era where previously deadly infectious diseases could be cured in days. Read more... |
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Alexander Fleming, who discovered penicillin, was also one of the first scientists to warn about the perils of antibiotic resistance.
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Which Came First, The Antibiotic Or The Resistance?
The antibiotic era, as it’s called, may not have begun until the 21st century, but antibiotics were still in use in ancient folk medicine. Click here to read a fascinating timeline starting in 350 CE. |
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The Superbugs Arrive
1955. As Fleming had predicted, resistance to penicillin gradually built up due to the accessibility of the drug. By 1955, many countries had attempted to slow this resistance by limiting penicillin use to prescription only, but it was too little too late: many bacterial strains had already defeated the antibiotic, including staphylococci. Read more... |
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Now for the eye-popping conclusion:
From farms to hospitals to everyday workplaces, animals and humans are likely teeming with different forms of resistant bacteria. In 2013, a Consumer Reports investigation showed that over half of ground turkey meat sold in the U.S. contained strains of drug-resistant bacteria. According to the CDC, some 2 million people in the U.S. are infected with drug-resistant bugs every year, and 23,000 of them die from these infections. Those numbers are likely to get worse in the coming decades, according to recent reports.
The danger of the situation is mainly in its complexity, Rustav Aminov wrote in a 2010 report on antibiotic resistance: “It is not a single grand challenge; it is rather a complex problem requiring concerted efforts of microbiologists, ecologists, health care specialists, educationalists, policy makers, legislative bodies, agricultural and pharmaceutical industry workers, and the public to deal with. In fact, this should be of everyone's concern, because, in the end, there is always a probability for any of us at some stage to get infected with a pathogen that is resistant to antibiotic treatment.
From farms to hospitals to everyday workplaces, animals and humans are likely teeming with different forms of resistant bacteria. In 2013, a Consumer Reports investigation showed that over half of ground turkey meat sold in the U.S. contained strains of drug-resistant bacteria. According to the CDC, some 2 million people in the U.S. are infected with drug-resistant bugs every year, and 23,000 of them die from these infections. Those numbers are likely to get worse in the coming decades, according to recent reports.
The danger of the situation is mainly in its complexity, Rustav Aminov wrote in a 2010 report on antibiotic resistance: “It is not a single grand challenge; it is rather a complex problem requiring concerted efforts of microbiologists, ecologists, health care specialists, educationalists, policy makers, legislative bodies, agricultural and pharmaceutical industry workers, and the public to deal with. In fact, this should be of everyone's concern, because, in the end, there is always a probability for any of us at some stage to get infected with a pathogen that is resistant to antibiotic treatment.
MARCH 22 is WORLD WATER DAY
One the most important discoveries that can still save millions of lives is being left behind: access to safe water and sanitation.
No doubt, science has made remarkable progress in curing diseases. Recent work has yielded vaccines for cholera and Ebola; polio is nearly eradicated polio. More people are surviving malaria and living with HIV. But absent access to clean water and basic sanitation, the threat of every one of these diseases remains and increases the opportunity for drug resistance – AMR – to take hold.
HIV/AIDS is just one of many examples: AIDS has gone from a death sentence to a chronic condition thanks to life-saving anti-retroviral drugs, ARVs. But millions of patients must take ARVs with contaminated water that makes their immuno-suppressed bodies sick, unable to properly absorb the medications and increasing the opportunity for resistance.
No doubt, science has made remarkable progress in curing diseases. Recent work has yielded vaccines for cholera and Ebola; polio is nearly eradicated polio. More people are surviving malaria and living with HIV. But absent access to clean water and basic sanitation, the threat of every one of these diseases remains and increases the opportunity for drug resistance – AMR – to take hold.
HIV/AIDS is just one of many examples: AIDS has gone from a death sentence to a chronic condition thanks to life-saving anti-retroviral drugs, ARVs. But millions of patients must take ARVs with contaminated water that makes their immuno-suppressed bodies sick, unable to properly absorb the medications and increasing the opportunity for resistance.
Photo: USAID
It’s as clear as clean water: illness, disease, resistant bacteria and death are not what our shared religious symbol is meant to be. Check out FIA's Clergy Resources for lots of ways you, your children, students and faith community can take simple actions for real change!
Let’s make every day World Water Day.
Let’s make every day World Water Day.