A thirst for safe water and sanitation
By Kay Torrance
Years ago, while working as a merger and acquisition lawyer in Latin America, Thomas Clasen came across a novel water filtration that he thought was ripe for development into a point-of-use water treatment system housed inside a water bottle. "I was intrigued by the idea of point-of-use water treatment as a way of jumping over poor infrastructure in low-income countries, much like the mobile phone networks. I thought if I made this great product, people would buy it, essentially ‘build it and people will come,’" he says. "I learned all of my assumptions were wrong."
The water bottle system proved too costly for use in developing countries, but he sold the rights to it, ditched his 20-year law career, and headed off to the London School of Hygiene and Tropical Medicine to earn his master’s and doctorate in waterborne diseases. He joined the faculty in 2004 and in August 2013 came to Rollins and its Center for Global Safe Water (CGSW) as the Rose Salamone Gangarosa Chair of Sanitation and Safe Water.
Since his early days in London, he’s been a prolific researcher and writer. He’s published more than 70 articles—evaluating household filtration in more than a dozen countries, assessing the effects of India’s largest-ever sanitation campaign, and challenging the United Nations on its declaration that it had met its Millennium Development Goal of increasing safe drinking water when it did not use a sound metric to measure water quality. But what really irks him is the fact that more people around the world have cell phones than toilets, according to a United Nations study, and that the poorest 40% of people in southern Asia have barely benefited from improvements in sanitation.
"This is not about spending decades testing a vaccine," he says. "We know how to build latrines that safely contain feces and how to remove pathogens from drinking water. The challenge here is getting those solutions to the most vulnerable. The investment in water and sanitation overseas or by developing countries themselves in rural areas or urban slums has been flat or falling.
|
|
"So much of my work could seem frustrating since I often find there is no evidence of impact, even from interventions that are being widely promoted. I’d like to find interventions that work, but I take most of my satisfaction in designing and running a rigorous evaluation that says whether or not it’s effective."
The opportunity to catalyze research opportunities through the endowed Gangarosa chair is the main reason why Clasen chose the RSPH. "Rollins is one of the few schools of public health that has made a genuine commitment in the area of water and sanitation," he says. "It has strong microbiologists and epidemiologists—I know them, and I know their work. Atlanta is pretty much ground zero for this area of work with CARE, the CDC, the Carter Center, and Rollins all here."
For the past few years, Clasen’s ground zero has been Odisha, India (formerly known as Orissa). His Gates Foundation-funded studies are looking at how India’s sanitation campaign is playing out in this northeastern coastal state of 42 million. One piece of research so far has yielded some interesting results that may change some long-held beliefs in the field.
Clasen has shown that giving water disinfectant tablets to households with children under age 5 provided them with no protection against diarrhea. This result may have finally settled the debate over the intervention; previous studies were split on the issue. Clasen’s study had a larger sample size and a longer follow-up period, and it included both urban and rural areas.
Odisha also has not seen a positive impact on effective disposal of child feces, considered a significant source of exposure to fecal pathogens. In the 20 villages Clasen and his colleagues studied, the sanitation campaign had been running for at least three years, and most households had a latrine. But neither were children under the age of 5 using the latrine nor were their parents properly disposing of feces in it.
The Indian government built many latrines around the country but did not ensure their functionality or use advertising to break the long-held norm of open defecation.
"They built a lot of latrines, but the campaign lacks incentives to ensure or even encourage latrine use," Clasen says. "We not only have to come up with effective solutions, but we have to change the norm, and I don’t know where the tipping point is where people will think I have to use a latrine to defecate. And a change in behavior may lead to health gains.
"By contrast, open defecation is not the norm in Africa," he adds. "The question is whether or not there is improved sanitation. Latrine pits in Africa are deep so that they can be used longer. They have a lower population density so rural dwellers can dig new pits when the old ones fill up. In India they have to empty pits; there is no room for new pits. I think the challenges in Africa are more manageable."
In Africa, the task is to update its water supply system. Through his studies in Zambia, Congo, and Rwanda, Clasen has shown that household filters can work. People will use them, and they can store water and keep it free from contamination. But as positive as those studies were, Clasen doesn’t believe the water and sanitation community should ignore what he sees as the end goal—a safe and uninterrupted water supply.
"I think point-of-use filtration has a role," he says. "For people who are not going to be reached by a regulated, piped-in water system anytime soon, household filters give people a way to address deficiencies in water quality. In some countries the water suppliers are so focused on improving access that they’ve abandoned their role in improving quality. So point-of-use filtration has a role, but it shouldn’t displace the real goal, which is a safe, continuous, regulated supply of water delivered to household taps. Ensuring optimal outcomes requires not only water quality but water quantity."
