well water in angkor chum health and practicality

Five Villages – Five Chiefs – One 2011 Flood

www.naturehealingnature.org [email protected] www.thecenterforrainwaterharvesting.org 016-685-915 & +1 832-423-8425

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Many thanks to the generous people ofPLAN-Cambodia and the World Toilet

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and friendship


Where were the wells?Angkor Chum District, Siem Reap ProvinceFive villages, an NGO office and a Phnom Penh restaurant

12 wells tested were tested in thesevillages in July of 2011. We revisitedthe villages after the October floodsto ask how their wells and healthwere effected by the floods.


Inexpensive water testingWe used Easy-Gel @ $2 per test We tested for E-coli, Salmonella, and AeromonasNo incubator is required but good results may take

36 hours instead of 24 if the air temp. is less than 27C


All samples were testedwithin 2 hours of being drawn

How much bacteria is too much?A CFU is a colony forming unitAlmost all health standards in the world say E-coli, fecal coliforms

and Salmonella should be 0 CFU per 100 mlThe WHO recognizes that is difficult to attain in developing countries


WHO Guidelines for drinking-water quality – Second EditionVolume 3, Surveillance and control of community supplies

What’s an E-coliAlmost all health standards in the world say

E-coli, fecal coliforms and Salmonella shouldbe 0 CFU per 100 ml

E-coli (from Theodor Escherich, 1885) is important as an indicator bacteria

Infectious dose is 20 to 108 depending on type It is the most common cause of pediatric Urinary Tract Infections

http://emedicine.medscape.com/article/969643-overview

Remember – E-coli is an indicator of probability that other infectious bacteria are present


2 to 3 micros long and 0.5 wide

What is Salmonella?Health standards in the world = 0 CFU/100ml One form causes typhoidCauses 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


2 to 5 micros long and 1 wide

What’s Aeromonas?Most water standards do not

include AeromonasMost cases of aeromonas related pneumonia

are found in the 16,000 to 160,000 neardrownings 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 >108 (Morgan et al., 1985)

Infectious dose will be lower for children


1 to 3 micros long and 0.7 wide

We at NHN are curious if Aeromonas might contribute to childrespiratory 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 presentWe 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 othercontaminated 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 Chhum130 families live in his villageVillage wells were not tested in July of 2011After the October floods, the villagers simply bailed

out the wells and started using the waterHe 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 Tumroab133 families live in his villageAll wells tested in July of 2011 were contaminatedThough the village wells did not flood, the water level in

their hand-dug-wells was equal to the adjacent rice paddywater level indicating almost certain contamination


21m deep bore hole

40 e-coli/100ml20 salmonella120 aeromonas

Hand-dug well #1

2.000 e-coli/100ml20 salmonella10,000+ aeromonas

Hand-dug well #1

5.000+ e-coli/100ml20 salmonella10,000+ aeromonas

Chief Rein Satuon of Koak Kroul 136 families live in his village All wells tested in July 2011 were contaminatedAll village wells were flooded in October 2011After the flood, villagers bailed out the

wells and started using the waterThe Chief’s brother got

typhoid fever after theflood

The chief’s ceramic filterremoved all of the bacteriawe tested for


nophoto

nophoto

nophoto

Chief’s ceramic filter

0 e-coli/100ml0 salmonella0 aeromonas

Hand-dug well in paddy field

2.000+ e-coli/100ml2,000+ salmonella2,000+ aeromonas

Hand-dug well used by Chief

2.000+ e-coli/100ml2,000+ salmonella2,000+ aeromonas

Chief Khat Khoan of Romiet 74 families live in his villageAll wells tested in July 2011 were contaminated14 village wells flooded in OctoberAfter the flood they started using the well water

without emptying or decontaminatingThere were outbreaks of

fever and diarrhea for two-weeks after the flood


Hand-dug well #1 800 e-coli/100ml640 salmonella1,200 aeromonas

Hand-dug well #2 220 e-coli/100ml800 salmonella10,000+ aeromonas

Chief Mao Mang of Chumpung 101 families live in his villageAll wells tested in July 2011 were contaminatedNot much flood damage or health problemsNo wells were flooded in October


0

Hand-dug well #1 4.000+ e-coli/100ml600 salmonella2,000 aeromonas

Hand-dug well #2 300 e-coli/100ml1,000 salmonella3,000+ aeromonas

Along the road and an NGO Both wells tested in July were contaminatedWater levels in the hand dug wells (HDW) was

equal to the level of water inthe adjacent rice paddiesless than 2 meters form thewells. This is a near certainindicator of crosscontamination.


nophoto

Bore-hole well 40m w Rope pump 20 e-coli/100ml0 salmonella0 aeromonas

Hand-dug well NGO office 100 e-coli/100ml100 salmonella10,000+ aeromonas

Phnom PenhRestaurant

120 e-coli/100ml40 salmonella40+? aeromonas

The “Take Away” on health effectsAsk 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.


Five Villages – Five Chiefs – One Floodwww.naturehealingnature.org www.thecenterforrainwaterharvesting.org

[email protected]

016-685-915+1 832-423-8425Houston, Texas

Empowering people to help themselves with what they already have . . .

well water in angkor chum health and practicality

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