Keeping patients safe from infection without clean water - an impossible task.
Amongst the beautiful hills of Jabi Tehnan in rural Ethiopia, lies a weathered health centre.
In many ways, it's not that dissimilar from the GP surgeries and healthcare centres that we have here. It has doctors, nurses, cleaners, medical equipment and medicine. But there's something vital missing: water, and more specifically, clean water.
The hard-working staff at Yiraber Health Centre want what is best for their patients, but there are daily struggles that come with coping without water. They have to make difficult decisions every day, knowing they could be spreading infections to new patients.
The lack of water also means that there's something else different about Yiraber – they have a member of staff whose job it is just to collect water.
This is Tirunesh. She is paid a modest fee to collect 40 litres of water every day. She makes the back-breaking journey to the nearest water source, a spring half an hour's walk away, twice a day. On Thursdays and bank holidays she makes extra trips to make up for the following days she won’t be collecting. And it’s still not enough.
It's hard to imagine relying on this as the only way to get desperately needed water for staff to be able to keep patients safe, when so many of us can simply turn on a tap. But that is the reality for staff at Yiraber.
Half of the 40 litres of water Tirunesh collects is used for hand washing. The other half is for cleaning the entire health centre.
"We have all the cleaning equipment – we have a broom, a mop, detergents, soaps, gloves, boots – we have everything! But, ironically, we don't have water."
Yehasab is a cleaner at the Yiraber Health Centre, and has the almost-impossible job of keeping patients safe by keeping it clean.
Ideally, every room should be mopped. But Yehasab has to choose which rooms to mop and which to just sweep, even though sweeping won't remove any infections remaining on the surfaces.
Despite there being a lot of blood-contact in the dressing and the injection rooms, she doesn't have enough water to mop them, and instead has to make the difficult decision about which rooms to prioritise.
Without clean water, patients are exposed to infectious diseases like scabies or diarrhoea. And trachoma (a contagious infection of the eye, which can lead to blindness) is common, because people can't use clean water to wash their faces.
Even though Yehasab has had training in infection-prevention, she can't apply it here. One of the most important ways to prevent infection is by regular and thorough hand washing, but she, like the other staff members just don't have enough water to wash her hands every time she needs to.
I really want to clean the health centre well, but I can’t because of the lack of water. And that affects the patients, because people can easily get infections, when the health centre is not clean.
Yaye works at the health centre as a clinical nurse.
As a professional, he struggles to work with the daily situations he's faced with, like reusing water for patients – even during deliveries – and for cleaning equipment.
"A year back, I was hired here with two of my friends. But they couldn't handle it. They said 'How can we work on children's health without water in the health centre?' and they left soon after. But I believe that it is my duty to work in every difficult situation as a health practitioner, and to serve the community."
Sometimes Yaye wipes his hands with rubbing alcohol, but often has to wait until he goes home to wash them.
Staff at Yiraber try to teach the community about good hygiene, but without water, they're not able to practice good hygiene themselves.
It is hard to express it – it is a sorrowful experience working here.
I feel sad that, instead of healing patients, I might expose them to other diseases. Though we work in health, we are in a highly infectious environment.
Clean water and good health go hand in hand. The health centre delivers a baby at least once a day. Without water staff struggle to keep their patients free from infection, and this is particularly dangerous for mothers and newborns, like Tiru and her baby.
Thankfully, Tiru had a safe birth, but it wasn't easy.
I am delighted to have a son! The joy is beyond words. But I wish I could have washed after delivery. I came back home with blood stained clothes. It feels bad to come back home with bloodstains all over me.