EHJ November 2004, pages 343-345
Natasha and Barrie Whitehead, trustees of Water for Kids, together with Dr Chris Harris, a member of the environmental health charity who returned to Zambia after 30 years, reports for EHJ on a recent visit to the central African state

Zambia is at the heart of Africa. This landlocked central African state has been overlooked by tourists and was forgotten by the rest of the world as it struggled to build its economy after independence in 1964.

Thwarted by a lack of coastline, an unstable global copper market, sanctions against then neighbouring Rhodesia and drought, Zambia became gripped by a poverty that brings with it high rates of mortality from preventable disease and endemic corruption. A corruption that prevents the larger aid agencies from operating effectively. So when the CIEH centres were challenged, three years ago, to grasp the nettle and help colleagues in Africa move forward the public health cause, the North Western Centre saw an opportunity to help.

The charity Water for Kids had already shown how it could be done in neighbouring Tanzania. In Dar es Salaam's Muhimbili University the country's only environmental health course had been elevated from diploma to degree status, giving the country's EHOs a much needed fillip to champion the public health message that prevention is better than cure. A sustainable model-project would also have to be set up showing that providing safe water and sanitation along with education, would save thousands of lives.

Initially, the Zambian Institute of Environment Health (ZIEH) pointed the North Western Centre, now working on behalf of Water for Kids, towards the sprawling village of Kapuka, one-hour drive north of the capital Lusaka, down six miles of dirt tracks. Here 1,500 villagers, surviving off subsistence farming and living mostly in traditionally built homes, had been drawing their water from four shallow and contaminated wells. This sort of village fails to attract the larger aid agencies, yet it is somewhere where results can quickly be achieved. The ZIEH, realising the potential, adopted the village itself and having found funds, managed to install two water pumps just six weeks before our visit, this September. This was one of the first villages we visited on our weeklong trip to Zambia, during which we aimed to progress the ZIEH twinning arrangement and discuss providing safe water for a model project, which could then be replicated across Zambia. The gratitude and pleasure expressed by these villagers at being given access to safe water was overwhelming.

But it was to the south of Lusaka, in Kamaila, a village born out of the charcoal trade in the early sixties that our work lay. This, the ZIEH felt, was a more suitable starting point as it more closely resembled the Dar es Salaam project, with the Kamaila middle basic school providing a focal point for our work. Six hundred children are taught here in three classrooms, 80 to 100 at a time, with little furniture, no electric lights and only 10 teachers.

Yet, as in other parts of Africa, the thirst for knowledge and the desire to learn is unquenchable. It is all too easy to be swamped by the tragedy of HIV/ Aids and early mortality in Zambia, until you see the energy and enthusiasm of the people. This is a country capable of solving its own problems, and education is key.

Charcoal burners established Kamaila village in 1963. Over the years its population rose to around 4,000, spread over a wide area, eventually linking with a neighbouring community. There are no refuse pits, houses are made from baked mud bricks with grass roofs. Ventilation is through open eaves and lighting is by candle, or for the wealthier, paraffin lanterns.

The village is around 38km from Lusaka and 11km into the bush from the main road. The nearest health clinic is 18km away. Here, diarrhoea ranks number three among the top ten causes of morbidity, admissions and mortality. Eight unprotected wells supply the villagers with their water needs along with one borehole, whose owner charges users 20 US cents a month to use, for some an impossible amount when trade is often only done by barter. Pit latrines are only 10 meters from these water supplies, which have queues of women with buckets waiting to draw water. Wells are covered with a few logs which women use to stand on when hauling up water by rope.

The school and its surrounding community is served by an additional well, with a broken hand pump providing a trickle of safe water. Over 1,000 people rely on this poor supply. By simply fixing this pump, the relentless onset of disease in this community could start to be stemmed. Here diarrhoea, malaria, upper respiratory tract infections, skin diseases and eye infections are common. There have also been recent outbreaks of cholera and dysentery.

The only two pit latrines available to the 600 boys and girls in the school had become structurally unsafe, two makeshift toilets separated by grass fencing for modesty have replaced them. There are no taps for washing hands. Teachers use improvised pit latrines in their homes.

On our visit to the school we noticed groups of boys, as you would anywhere in the world, playing football. But here what once had been a football was no more than a piece of leather. Other children played with rags bundled together. So the joy when we donated eight footballs, six basketballs, tennis balls and hundreds of pens overwhelmed us. This helps illustrate what few resources are available to the school. The hire of a pneumatic drill to break through rocky ground to build more latrines is far beyond their means.

Water for Kids is determined to help provide Kamaila with two boreholes with solar pumps, water towers, tanks, distribution pipes and taps. But clean water alone is not enough, so we are going to work with the ZIEH and the Kamaila village water committee to ensure that this water project meets all the conditions of a Water, Sanitation and Health Education (Washe) project. Demonstration ventilated improved pit (Vip) latrines will be built. Local EHOs and environmental health students will deliver a rolling programme of health education.

Unfortunately, while construction is taking place, villagers will have to use water with high levels of suspended solids. For this reason a simple sand filter is being proposed. Water will be fed into the base of a sand and gravel filled drum and allowed to percolate upwards to provide a clear flow from the top outlet. The cost is minimal and the benefits immediate. Water for Kids also hopes to raise enough funds to renovate or replace the school pump, and provide a toilet block of Vips for the school with a bank of taps for hand washing.

But aid projects are never simple. In 1947, the Forestry Commission dug boreholes in the region for forestry workers. They were exploiting the forests of what was then northern Rhodesia to meet demand for large supplies of wood at the end of the Second World War. Wood was treated on site with chemicals with no thought of the environmental impact. The legacy from those colonial times could still lurk deep in the soil around Kamaila so the ZIEH will test the water for complex organo chlorines from deep boreholes to ensure that one public health crisis is not being swapped for another.

But Kamaila was only part of the reason we were in Zambia. Helping to establish an environmental health degree course would provide a foundation on which sustainable public health policies can be built. There is no shortage of young and talented people to provide this public health workforce and EHOs trained to diploma level are already doing great work. But a catch 22 exists. Lusaka University, in common with many African universities, has a policy that all tutors must have two degrees. Students with a diploma in environmental health saw no point in gaining a degree, and so moved on to get a masters in public health, not enough to qualify as a lecturer.

The answer to this impasse may come in a twinning between Salford and Lusaka universities. Students with a diploma and masters in environmental health in Zambia will be invited to do the last year of a UK degree course, so enabling them to teach. A target date of April 2005 has been set to start Zambia's first environmental health degree.

But, as in Kamaila, it is not straightforward. Where to accommodate the students is a problem. An existing prefabricated building needs renovating and extending to include two extra classrooms and an office. But these obstacles are not insurmountable. Zambia's growing belief in public health is reflected in a comment made by the dean of Lusaka University, Professor Munkonge. He told us that if the university had first launched an environmental health degree rather than a degree in medicine, more lives may have been saved. The time for change has arrived in Zambia and so has the time come for us to show we are amicus humanis generis.

To make a donation towards this project you can contact Water for Kids treasurer Jason Cox at Tan-Y-Bryn, Hanley Court, Welland Road, Hanley Swan, Worcestershire, WR8 0DA quoting "Kamaila project Zambia". Phone 01684 310717 or e-mail jasoncox@tinyonline.co.uk