Bottled or filtered?
However, I don't really like the taste of boiled and filtered water that much so, being a spoilt mzungu, I always make sure we have a few bottles of mineral water in the cupboard. It's Ugandan mineral water, of course, from the Rwenzori Mountains or thereabouts, but, still, it's a luxury.
Most of Kampala has reasonable access to water. By 'reasonable', I mean there's a standpipe within a couple of kilometres of most people's homes and most middle class people pay to have one in their compound. A few people, like us, even have piped water which, strangely, at Shs 32 for 20 litres is cheaper than the Shs 100 paid at pay taps by the majority of the urban poor. During the dry season, the supply dries up in some parts of the city, but now we're into the rainy season it's flooded drains we have to worry about, not water shortage. Wherever we drive, whether towards the university on our way to the office or along Ntinda Road on our way to town, we see lines of women and children, jerry cans carefully balanced on their heads, on the way to the standpipe, or back from it. Pity the pregnant, and the women with small children.
Fetching water takes precedence over school, so at half past eight, when most schools should have already started, there will still be children trekking back and forth, for large Ugandan families need a lot of water. And that picture is one that is repeated all over the country. All car journeys whatever the time of year, are along roads lined with youngsters of all ages with their jerry cans.
The water sources in urban areas may look pretty basic by western standards, but they bring water closer to the people. In the photo below taken on the main Kampala to Entebbe road, the women on the left are waiting for the boy down by the standpipe to get his water first. To us, it looks like a gutter, but it is a water supply.
The further you go into the country, the further people have to walk. It is not uncommon to see lines of women and children stretching three of four miles as they walk from one settlement to another to get water.
The size of the jerry cans is usually adjusted to the size of the child, but not always.
And do men ever carry water?
Very rarely. If they do, it's a business operation, and they don't use their heads, they use bicycles or carts. They then sell the water, usually at around Shs200 for a large can, though it can rise to two or three times this at times of water shortage. Once, shortly after we arrived, Stuart and I needed to buy water because our radiator was about to explode. We were charged Shs 2000 for a part-can, and paid because we thought it was the going rate. No, it was the mzungu rate.
The standpipes are operated by hand pumps, good exercise but pretty tough on children.
The jerry cans are usually recycled cooking oil containers - the Roki brand are the favourite as they're solid. If you lose the screwtop, you just replace it with a banana or a bundle of leaves. Recycling and reselling cooking oil containers is big business.
So that's water for you. Pretty straightforward ... except it isn't.
Why? Because only about 75% of the population (Ugandan National Household Survey 09/10) has 'access' to national water (and these figures are contested - see below). People often have to wait in line for four or five hours when water is scarce, with significant impact on the safety of women and girls and on children's schooling. And even if you're within a couple of kilometres of a standpipe, that doesn't mean you use it. Even in Kampala, we often see young children squatting in the gutter to fill their jerry cans with filthy yellow water, because the standpipe is just too far.
And the quarter to a third of the population without 'access' to a standpipe or a borehole?
Wakiso town and local area (around Kampala) had as good as no water for months. We know because one of our friends lived there. According to the Monitor, people have been forced to collect water from contaminated springs, roadside trenches and swamps. Water went up to between Shs600 and 1000 per jerry can.
The photo below is of water collection at a crater lake in Queen Elizabeth National Park. Looks nice, from a distance. Looks green close up.
In Masaka (about a couple of hours drive west from Kampala), two girls recently drowned trying to draw water from the river and two women were gang raped at night. The NWSC manager said 'the situation might not change soon'.
In the Rakai area close to Lake Victoria and an hour or so from Kampala, the UN Habitat funded water and sanitation project has collapsed because of corruption. People now have to trek across the border to Tanzania to collect water. The children below are collecting water from Lake Victoria at Jinja, further north, but equally contaminated.
And it is far far worse the further from Kampala you go. Moroto one of the two main towns in Karamoja, only has one tap in the whole municipality. In northern Uganda, at least 500 households have been drinking contaminated water from a single borehole, the Agata restaurant borehole in the centre of Adjumani town. (Note to self: remember not to go to the Agata restaurant when next in Adjumani.) UNHCR and the local water and health departments are providing water treatment tablets. The district was supposed to inspect the water quality every three months but 'lacked the funds'. Unsurprisingly, the area has a high prevalence of water-borne diseases such as diarrhoea and dysentery. Water sources in at least 10 sub-counties are being tested, particularly 'those downhill near pit latrines, those with cracked platforms and the ones that are prone to flooding,' said the Assistant District Health Officer.
Ah, pit latrines... now that's another - but related - story. In Uganda, and many other countries, pit latrines represent modern improved sanitation. According to the UNHS survey, across Uganda 85% of households have pit latrines, 4% have VIP pit latrines (with a pipe to lead the smell away), 2% have flush toilets and ... 9% have no toilet at all and use the bush or similar. An important thing to remember is that if you don't have piped water for drinking, you are hardly likely to have a flush toilet and anyway, there are virtually no sewage systems.
What's a pit latrine?
A pit latrine is a large hole dug in the ground and covered with a concrete base with a hole in it. Using a pit latrine has a knack to it - aiming accurately. Really good pit latrines have foot shaped blocks to help you position yourself properly. My advice? Don't look down and don't breathe in for the duration. The poster below should give you the idea, though this does seem to be a particularly posh pit latrine, with a removable cover.
Every family is legally required to have their own pit latrine or similar. Most people dig their own. This is the row of individual family pit latrines lining a road near us.
They have been built out of bricks shaped out of the mud by the side of the road. You can see some spare bricks drying. (Just don't think what's in the mud....)
One of my worst inspection memories - having sworn never ever to use a school pit latrine - is being too cowardly to explain to a colleague that I wasn't too keen on the lukewarm rice and beans served in his chosen eating place and ending up lurching from one school pit latrine to another as we made our 'visitations'. (Inspectors are like angels...) Actually, the latrines were not as bad as they could have been. A favourite punishment for errant pupils is scrubbing the pit latrines (favourite for the teachers, that is).
A word of caution. 85% pit latrines across the country is an average and more positive than figures quoted elsewhere. The World Bank report below found between two and three people out of every 10 had no 'proper' latrine. In Budaka, 40% of the population don't have pit latrines. In Kotido in Karamoja, it's worse: 90% use the bush. Persuading the local population to dig latrines is the responsibility of local leaders. However, 75% of leaders in Kotido district in Karamoja themselves do not have latrines. In fact, only 5% of leaders have any sort of sanitation at all. New Vision claims that even those latrines which exist are often not used because they are considered taboo.
Lack of latrines in schools has a serious effect on school attendance. Drop-out rates in Masindi are reported to be increasing because of inadequate sanitary facilities, lack of water and sinking latrines (a common and quite dangerous hazard). In Napak, many schools have no latrines, with both staff and pupils using nearby ground which then becomes littered with human waste. WaterAid states that across the country the pupil to latrine stance ratio in primary schools has declined from 54:1 to 66:1.
'Parents starve children to avoid spending on toilets' (Daily Monitor)
And it is not just country areas which lack sanitation. A recent research report called 'Living in Kampala' and produced by John Paul II Justice and Peace Centre states that the city's 10 major slum areas have only 322 pit latrines between them for 22,391 people (an impressive 'one' at the end of that total) and these are often 'dilapidated, filthy and inadequate'. That means that 99.7% of households do not have latrines, contrary to the Public Health Act. Many have open drains and the biggest, Katwe, is said to have no sanitation at all. The prevalence of 'flying toilets' - defecating in a plastic bag which is then thrown away - means I always check carefully where I place my feet when walking. The report states that as it costs between Shs100-200 to use the few public toilets, some parents avoid feeding their children to reduce the frequency of toilet visits. Sanitation is not just a health and safety issue: it is also a matter of human dignity.
And the impact of poor sanitation?
In Uganda, over 75% of the disease burden is preventable. According to a new World Bank report Economic Impacts of Poor Sanitation in Africa, Uganda loses $177 million each year due to poor sanitation. The findings show that 84% of these costs come from premature death. About 90% of the deaths are as a result of poor water, sanitation, and hygiene. Premature death, health care costs, lack of productivity and time lost, are all a result of inadequate sanitation.
The report indicates that each person without access to a toilet can spend up to 2.5 days per year finding a private location to defecate in. Women are particularly affected because of their role in looking after children, the sick and the elderly. Lack of access is also a significant safety issue for women and girls.
The Ministry of Health has just reported that in Kampala 46 cases of dysentery and 38 cases of typhoid have been recorded in one week alone since the rainy season started. The same is true in other regions of Uganda: Kamwenge, Hoima and Kisoro in the west and Adjumani and Yumbe in the north. When it rains, water sources become contaminated with faeces from poorly built and maintained pit latrines and from human and animal waste scattered across the land and deposited in drainage channels. Children suffer most because they are the ones sent to collect water. They are also more likely to play in it and if they catch any of the water-borne bugs, they are more vulnerable to the diseases they cause.
The Ministry has also reported 280 registered cholera cases in Mbale, Kasese, Buliisa, Sironko and Bududa (from the far west to the far east). About 30 people have died. In Mbale, the cause was 'interrupted water supply' which resulted in people using contaminated river water. The number of cholera cases in Nebbi has risen to 700. Newspapers are showing pictures of patients being treated in tents and on drips under trees as the health facilities struggle to cope. Authorities are blaming the outbreak on the fact that only a quarter of households have pit latrines and humans and animals share the same water sources.
According to WaterAid, the government target is for 77% of the rural population and 100% of the urban population to have safe water within easy reach and hygienic sanitation facilities by 2015. Unfortunately, the figures for safe water have stagnated at 65% in rural areas, and reduced from 67% to 66% in urban areas. The good news is that access to improved sanitation has increased to 70% in the countryside and 81% in urban areas.
WaterAid and its partner NGOs are doing an invaluable job in Uganda, particularly in ex-conflict areas, sinking boreholes, establishing rainwater harvesting, constructing dams and building latrines. It has calculated that if Uganda managed to achieve the relevant millennium development goal, the lives of 9,000 children could be saved by 2015. However, if current levels of investment continue only 2,000 will be saved. As usual, NGOs and international donors are filling the gaps.
I know all these stories about horrible water-borne diseases sound very off-putting to the average westerner. However, as with most unpleasant things in Uganda, they don't affect everyone. Average figures are misleading. The gap between rich and poor is enormous, and almost all westerners, even volunteers like us, are unimaginably rich by the standards of most Ugandans. People like us boil and filter our water: we have the time and resources to do so. We wash our fruit and vegetables without begrudging every drop. We think nothing of buying weekly supplies of bottled water just because it tastes better. Even when we travel about the country, we don't see the worst of the conditions nor do we come in contact with the poorest of the poor. When we are working, we stay in relatively nice hotels and, on the whole, eat in decent restaurants. The same is true of most middle-class Ugandans as well. When we are on holiday, we stay in the kind of accommodation that local people couldn't even dream of because it would be beyond their imagination.
For all these reasons, I really do not have a deep understanding of what it is like to be poor in a country like Uganda. However, I do believe I'll think rather differently about water once I return to the UK.
You may also be interested in the following slideshow:
Uganda: the problem of unsafe water and poor sanitation in pictures (The Guardian)