Hi, my name is Ryan Rowe. It’s a great honour to be here and thank you for giving me thisopportunity to share with you my Fellowship experience. I am going to talk about my studies at theUniversity of North Carolina in the United States where I recently completed a Master of PublicHealth and my research and activities on the topic of water quality and point‐of‐use or household‐based water treatment and safe storage.

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This slide aims to describe what the Peace Fellowship means to me personally: Investing in Peaceand Taking Action.

Rotary and Rotarians invests in leaders from communities around the world, and give them theopportunity to accumulate knowledge, skills and tools around specific topics related todevelopment and conflict resolution.

As Peace Fellows, our mission is then to take those new skills and collaborate with the communitiesthat Rotary serves.

Today I am going to tell you about some of what I’ve learned during the Fellowship and from theorganizations I’ve had the opportunity to work with. I am also going to tell you what I plan to dogoing forward from here.

Over 600 Peace Fellows are working around the world now, many of them working on developmentand peace isssues with organizations such as the United Nations and other multilateral institutions,NGOs small and large, and in universities, for example. Each Peace Fellow will have their ownpersonal story to tell you about their Fellowship experience and if you’d like to learn more you cancontact Mike Pfriem at the Rotary Foundation who manages the alumni network of Rotary PeaceFellows.

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My story starts with the poorest of the poor.

All Rotary Peace Fellows are required to undertake a summer of work overseas, applying the skills we learn during our graduate studies.

During my summer of work from May to August 2012 I was in Kenya and became involved with a school located in Kibera, one of thelargest slums in East Africa.

These pictures were taken at the school. They make me smile because each photo triggers a memory that is special to me. For example,on the left you can see a photo of the children sleeping very closely together. It seems to me that they feel safer when they are bunchedup close together. It is also a safe and peaceful moment away from the turmoil of their home environment.

These kids come from the most broken and impoverished families in the slum. These are the poorest of the poor – folks who earn abouta dollar a day. Many of them don’t know their father or mother, and are being taken care of by “guardians” or members of theirextended family. They live in 10 feet by 10 feet square shacks where as many as 10 people might spend the night.

For example, this boy, with his cute little smirk and tucked under the arm of the school principal lives in a shack which sits next to a garbage dump.

And this boy, Daniel, has HIV and so does his brother Rufus. They come from a family of nine kids, who have to take care of each otherbecause the mother is often not around. About half a dozen of the kids out of the 75 attending this school have HIV.

Most of these kids have what’s known as persistent diarrhea, day after day, as a result of being exposed to pathogens transmittedthrough the water supply and the environment, which ends up on their hands, in their food, in their water, and in their stomachsbecause it’s simply unavoidable. Dirty water can be fatal for kids like this living with HIV/AIDS, as it reduces the absorption of much‐needed anti‐retroviral medication.

The school owners make sure kids take their HIV medication daily. They also get two meals and two snacks a day, and have access toclean water, a clean toilet, and a handwashing station – all of which help to reduce the incidence of that diarrhoea. This is what is knownas an integrated approach to health and development. Seeing the positive impact of clean water on these kids has really reinforced theimportance of working in this area. Today I’m going to talk to you about one of the solutions that exists: household water treatment.

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During the summer of 2011, I travelled to Kenya to research water issues. It was my first time working “in the field” so to speak and it was an extraordinary opportunity to learn more about howto improve access to clean water – an experience I would not have had without Rotary’s help.

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I spent the bulk of my time in the capital city of Nairobi, in a very well known slum named Kiberawhich you can see in this satellite shot. As many as half a million people live there. I was hosted by a local NGO, Carolina for Kibera, which has its roots at the University of North Carolina and has beenstrongly supported by a local Rotarian over the years.

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There is no water and sanitation infrastructure in the slum – at least not the kind that we are usedto in North America. Sewage and waste flow through ditches between homes and you need to keepa careful eye on where you step. When we talk about the poorest of the poor, we are referring tocommunities like Kibera.

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Without an adequate supply and good quality of water, people are locked into a vicious cycle of poverty. As a result of the dirty water and environments they are exposed to, women and young girls often travel as far as 6 kilometres each day just to collect water for their homes and families, spending in aggregate some 200 million hours fetching water.

Sometimes that water is not even clean, and the resulting illnesses force them to miss education and income opportunities, as well as incurring the need for treatment and medication from local clinics, if they can afford them. Approximately 1.5 million people a year die as a result of preventable diarrheal diseases, most of them children.

The result is a vicious cycle of poverty, which also contributes to insecurity, economic instability, and the potential for conflict.

But there’s some good news ‐ global access may be improving. WHO and UNICEF released theirlatest update on the global water and sanitation picture two weeks ago. According to the report, the United Nations Millennium Development Goals, a set of targets for eradicating poverty and improving global health, announced that the drinking water target had been met, one of the firsttargets to have been achieved

For those who are not familiar with the goal, the aim was to halve the proportion of people living without access to an improved source of water at baseline (1990) by 2015.  So we wanted to movefrom 24% to about 12% of the world’s population, and according to this latest report we achievedthat target at the end of 2010. While this is good news, we can see from this gap here, thathundreds of million will still not have “access to clean water” even if the goal is met.

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Furthermore, the numbers at the global level hide the reality at regional and country levels.

For example, the coverage in Sub‐Saharan Africa is only 61% compared to 94% in Latin America. In six of these African countries, the coverage rate is below 50% (Congo, Mozambique, Ethiopia, Somalia, Madagascar, Niger). And in Kenya, the coverage rate is only 59%.

Within countries, there is further inequality. Urban areas usually have more access than rural areas. And rich people tend to have greater access than poor people because they can afford to pay for it. So those who need it most are least able to access it and afford it.

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The Millennium Development Goals as they relate to water and sanitation use what’s known as a water/sanitation “ladder” that goes from unimproved sources to improved sources to piped source.

In this picture, there are unimproved sources which include water sources such as an unprotected dug well, an unprotected spring, a cart with small tank or drum, a tanker truck, surface water sources (e.g river, dam, lake, pond, stream, canal, irrigation channel) [and even bottled water if the source is unknown]. As of the 2010 JMP update, 41% of Kenyans were drinking water from unimproved sources, and this figure would include the kids shown in the picture on the previous slide. This number breaks out to about 17% of the urban population and 48% of the rural population. The water quality of an unimproved source cannot be counted upon – as animal and human waste often runs into the water during rainstorms or as a result of people using the stream to wash.

At the second level, we have “improved” sources which include a public tap or standpipe, tubewellor borehole, a protected dug well, a protected spring, and rainwater collection. An improved drinking water source is one that by the nature of its construction adequately protects the source from outside contamination, in particular with faecal matter. But quality is often not assured because protection is inadequate or in disrepair. We hear stats coming from Africa that as many as 50% to 60% of water projects are not in functioning order.

Finally, we have piped water into dwelling, yard or plot. But even the water quality of piped sources is not guaranteed. Utilities often underinvest in their water networks, which leads to leaks, or contamination. 

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If you lived in Kibera, your water situation would look something like this.

First of all, you’d have to deal with Cartels:Many water enterprises are operated by entrepreneurs or CBOs but locals widely report “cartels” often steal or vandalize water connections to set up their own water kiosks. This destructive activity can cause water shortages or service outages, increase prices, decrease water quality, and affect the cost of doing business.

Secondly, issues of cost:Most residents do not have household supply and buy water on an as‐needed basis from local water vendors at rates much higher than Nairobians connected to the grid. And the poorer you are, the less likely you are to be able to pay the connection fee to the municipal water network, have a bank account to pay your bill.

Thirdly, Water access for your daily needs:Water use among Kibera residents is often below the minimum daily requirements for basic human activities such as bathing, washing clothes, cooking and drinking. Frequent shortages / rationing are also an issue in Nairobi and this can disrupt water supply. If you were living on one dollar a day and had to spend 4 cents for every 20 litres of water, how would you choose to spend it?

Fourthly, Water quality will be suspect: Kibera water is generally clear in color, but may be contaminated with pathogens invisible to the eye. Deep inside Kibera, water quality may worsen even further due to conveyance through damaged / leaky pipes. One of the toughest issues of all is convincing people that they should pay to treat their water even when it looks safe to drink. Residents may believe it is safe to drink but a recent study showed that approximately 8% of water samples tested from water vendors in Gatwekera were contaminated. [Based on informal conversation with director of local NGO. Sample size approx. 200 water points in Gatwekera village of Kibera. Unpublished.]

Finally, there are Environmental and Behavioral risks: And finally, if that weren’t enough, if your water wasn’t contamined to begin with, it’s likely to be so once you bring it home because of the conditions in which you live and because it’s so difficult to keep things free of germs, especially your water supply. As individuals transport, store and use their water, contamination levels are likely to increase due to unsanitary environmental and household conditions, and poor hygiene practices.

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This is a picture of a local water vendor, the type of kiosk where the vast majority of people living in Kibera will purchase their water. The container you see here holds about 5 gallons of water and willcost about 4 cents during the wet season. In the dry season, that price will rise to about 20 shillings(25 cents). 5 gallons is about the same amount of water you would use during 60 seconds in theshower.

Inside his shack, this vendor may have a meter monitoring his connection to the network. If he doesnot, he is likely illegally connected.

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This is an example of the piped network through Kibera. It runs right through the sewage trenchesthat go through the community. These pipes are usually made of plastic instead of metal as metal pipes are more subject to theft. The problem is that plastic pipes break more easily and are oftenvandlized by competing water vendors. So as you go deeper into Kibera, the more likely that waterrunning through such pipes has become contaminated due to leaks or breakage. Once thosepathogens get into the water supply, you’ll spread disease very very quickly.

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Household water treatment is a possible solution. It can be used to improve the quality of water consumed in the home. A series of meta‐analyses by Fewtrell (2005), Clasen (2006), and Waddington (2010) showed that HWTS could reduce the incidence of diarrheal disease by between 35% and 47%. But while it’s shown to work it can be very tricky to implement because it is so inherently behavioral.

Use of an effective, appropriate HWTS option is really important – it needs to work in the local context. For example, if you’re trying to use solar disinfection at a certain latitude, it won’t work as effectively. Correct use is making sure that the method or technology is used in the right way and improves the quality of the water. Consistent use means it is done every time the user is consuming water so that clean water is always being used. It only takes one exposure to a pathogen to trigger diarrhea. Long‐term and sustainable use is about long‐term behavior change. Children are especially important – to inculcate a culture of appreciate for good water, good sanitation, and good hygiene. 

Reaching a vulnerable population is about reaching those who need the intervention the most and about improving equitable access to clean water. HWTS can help improve access to clean water for the most vulnerable groups of people. Public health programs need to be vigorously focused on their primary beneficiaries, instead of a blanket approach that reaches all kinds of secondary audiences. Finally, HWTS needs to be integrated with other WASH and health programmes so as to realize the financial and health synergies from a multi‐pronged development intervention.

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Here are five examples of accepted and proven HWTS methods. Each has its advantages and disadvantages and the choice of which one to use depends on the local context. Some methodsprotect against re‐contamination such as through a chlorine residual or a safe storage mechanism (i.e. solar disinfection in a plastic bottle). Boiling is not ideal due to a range of factors: sub‐optimal performance, no protective factor against recontamination risk, creates smoke in the household,heightens the risk of burn injuries, environmental issues.

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Since the fellowship has ended, I have been involved in a number of activities to support the increased use of household water treatment.

During my studies I worked part‐time with the WHO and UNICEF and over 100 members globally, including Rotary, as the communications lead for the International Network on Household Water Treatment and Safe Storage. My role was to facilitate the sharing of the latest news from the sector, such as upcoming events, recent publications, and jobs and funding opportunities. I also link our organizational members with some of the latest literature on household water treatment and also help organize and implement our webinars, capacity‐building workshops, and open working groups which anyone can join.

Now that my studies have ended, I remain involved with the Network and will be taking on more of a technical role that will utilise my new public health skills and water sector knowledge to work with communities, organisations and governments and build up their capacity to lead and implement their own water and sanitation projects.

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The Water and Sanitation Rotarian Action Group is a technical advisory group for Rotarians byRotarians. They provide advice, access to informational resources and help marshal funding. As a Rotary Peace Fellow, I was asked to work with this group in various areas, such as the developmentof a learning module on safe water. Rotarians can join WASRAG and access resources for theirprojects for 25 dollars a year. To learn more about WASRAG, please visithttp://www.startwithwater.org.

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An exciting project I have been working on recently is for the Government of Malawi, advising the Ministry of Health and the Ministry of Water Development & Irrigation on a strategy to increase access to safe water through the use of household water treatment. The first major component of the strategy is to create an enabling environment to faciliate broad access by the entire population to household water treatment technologies as and when needed, on a commercial basis and involving the private sector. The second is to focus on specific vulnerable groups to reduce the risk of diarrhea and make an impact on the burden of disease.

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Another project I am involved in is to incorporate water, sanitation, hygiene training into thecurriculum of the pre‐school in Kibera. The model involved adding daily instruction on varioustopics, and assessing the extent of knowledge in the children before and after. We are alsointerested in seeing if these skills can be transferred from the children to the parents.

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The key point of this slide is that improving the quality and supply of water can help break the cycle of poverty by freeing up resources and time that would otherwise be spent on health care or buying water that is available only at long distances from home.

The work I am doing today is possible because of the opportunity of the Rotary Peace Fellowship program. I urge you and your fellow Rotarians to continue supporting this program. There is a great quote from the book The Alchemist by Paulo Coelho. It goes: “If you follow your dreams, the entire universe will conspire to help you achieve them”. For me, Rotary represents that universe.