Keeping patients safe from infection without clean water - an impossible task.

WaterAid/ Genaye Eshetu

Among the beautiful hills of Jabi Tehnan in rural Ethiopia, lies a weathered health center.

In many ways, it's not that dissimilar from the clinics and hospital 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 Center 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. 

Tirunesh Alemu, employed by Yiraber Health Centre to fetch 40 litres of water per day, in Jabi Tehnan, West Gojjam, Ethiopia, December 2018.
WaterAid/ Genaye Eshetu

This is Tirunesh. She is paid a modest fee to collect 40 liters 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 holidays she makes extra trips to make up for the days she won’t be collecting. And still, it's not enough. 

Tirunesh Alemu, employed by Yiraber Health Centre to fetch 40 litres of water per day, collecting water from the nearest water source 15-minutes walk away, Jabi Tehnan, West Gojjam, Ethiopia, December 2018.
WaterAid/ Genaye Eshetu
Tirunesh collecting water from the spring to take to the health center.

It's hard to imagine this is 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 liters of water Tirunesh collects is used for handwashing. The other half is for cleaning the health center. 

Yehasab Ayenew, 24, a cleaner at Yiraber Health Centre, Jabi Tehnan, West Gojjam, Ethiopia, December 2018.
WaterAid/ Genaye Eshetu

"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 nearly 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 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 prioritize.

Yehasab Ayenew, 24, a cleaner, washing her hands using the 20 litres of water set aside for hand washing at Yiraber Health Centre, Jabi Tehnan, West Gojjam, Ethiopia, December 2018.
WaterAid/ Genaye Eshetu
Yehasab Ayenew, 24, a cleaner, washing her hands using the 20 liters of water set aside for hand washing at Yiraber Health Centre, Ethiopia.

Without clean water, patients are exposed to infectious diseases like scabies or diarrhea. 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 handwashing, 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 center 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 center is not clean.

Yaye Wale, 25, a clinical nurse, standing with a cup of water and Oral Rehydration Theraphy (ORS) he uses to demonstrate for parents whose children have diarrhea, Yiraber Health Centre, Jabi Tehnan, West Gojjam, Ethiopia, December 2018.
WaterAid/ Genaye Eshetu

Yaye works at the health center as a clinical nurse.

As a professional, he struggles daily to reuse water for patients – even during deliveries – and for cleaning equipment.

"A year ago, 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 center?' 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 center 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.

Tiru Tefera, 18, with her recently-delivered her first son born at Yiraber Health Centre, Jabi Tehnan, West Gojjam, Ethiopia, December 2018.
WaterAid/ Genaye Eshetu

 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.