Fighting Diarrhea in Samrong Cambodia: Part 1

Monday, June 3, 2013

Diarrheal disease is the second leading cause of death in children under five years old, and is responsible for killing around 760,000 children (worldwide) every year (WHO Fact sheet N°330 April 2013). Yet, diarrhea is treatable and preventable. Most people who die from diarrhea actually die from severe dehydration and fluid loss.

Patients, mostly children being treated for diarrhea at the inpatient ward room of the Roh Minh health Center, Roh Minh, Ko Andet District, Takeo Provence, Cambodia
14.2% of Children in Cambodia have diarrhea, and only 3 in 5 children are taken to a health provider for treatment (Cambodian Demographic and Health Survey, 2010). The lack of access to clean drinking water, and simple basic sanitation practices like hand washing with soap and latrine facilities, are habitually at the foundation of the problem. Only about 17% of rural poor Cambodian households have access to improved sanitation facilities – latrines which effectively separate human excreta from human contact.

For several months now, I have been working on a diarrhea prevention project here in my community. The project is designed to run through October 2013. Today, I begin a series of posts leading you through this project as it unfolds.

A Little Background

In January, I did a little number crunching. I discovered that the village of Samrong, one of 17 villages served by my health center, has the highest incidence of diarrhea in children 5 years of age and under.

Samrong Village, Koh Andet, Takeo Province Cambodia

Samrong village is a poor, rural, Muslim community composed primarily of rice farmers and fisherman. It has a population of 970 residents, 147 of who are children 5 years old and under. Last year, my health center treated 3% of Samrong’s total population, and 16% of its children 5 and under for diarrhea. The incidence of diarrhea is undoubtedly higher in this village as the above numbers represent only patients that sought professional treatment, and who could afford, or were able, to travel to the health center only 6 kilometers away. Remember, only 3 in 5 Cambodian children are taken to a health provider. These numbers therefore do not account for unreported and untreated cases.

Samrong Village, Koh Andet District, Takeo Provence, Cambodia

In February, I teamed up with Ashley Pfister, a second year Peace Corps Volunteer living about 35 Kilometers away from me, to develop and implement a diarrhea prevention project. The project is built on the back of another project I am working on to develop a series of community health education lesson plans that can be used by all the Cambodian Health Education Peace Corps Volunteers. This project will pilot the lessons relating to Water and Sanitation Hygiene, or as we call it WASH.

Our first step is to firmly establish the need for the project, and get important support. The numbers seem to indicate a need, and my health center chief Dr. Sera agrees. However, we also, most importantly, need the buy-in of the community. Therefore, we go to Samrong and met with the Village Chief.

Peace Corps Heath Education Volunteer Ashley Phister speaking with the Samrong Village Chief about a diarrhea prevention training project, Koh Andet District, Takeo Provence, Cambodia

No one speaks English in Samrong. Ashley’s great Khmer language skills allow us to interview the Village Chief and some of the women that were hanging out at his house. The Chief confirms that diarrhea is a widespread problem within his village. He welcomes our idea to help.

The Project

I will say it again, diarrhea is both preventable and treatable. Most diarrheal diseases are caused by bacteria, viruses, or parasites, and are transmitted through contaminated food, water, or from person to person. Hand washing, proper water treatment, and safe disposal of feces are the three key hygiene behaviors that can be improved to reduce diarrheal disease. Treatment with commercially prepared oral rehydration salts (ORS), and easy to make home mixtures help replenish the fluid loss to those affected by diarrhea.

This project will educate community members and promote proper water, sanitation, and hygiene (WASH) practices in order to decrease the incidence of diarrhea, especially for children 5 and under, and improve the general health in Samrong village.

We will build capacity by training and coordinating with 4 volunteers from the village. These volunteers will train as trainers for WASH behaviors giving them the necessary skills to implement improvements on their own, within their own community, and into the future. The volunteers will also monitor and evaluate results.

This Project Has 4 Components:

  • First, Ashley and I will train the 4 volunteers in WASH skills and practices over a three-day Training of Trainers workshop. They will learn skills such as the treatment and prevention of diarrhea, proper hand washing, the importance of using latrines, and water treatment techniques.
  • Second, we will assist the volunteers in collecting data on the current, or lack of current, WASH practices in the community. This information will be used as a baseline to establish a list of families most in need of training, and to create a community billboard tracking and publicly displaying the project’s progress.
  • Third, we will assist the volunteers in conducting community meetings and private home visits to the families most in need. At these meetings, the volunteers will demonstrate and educate, encouraging people to adopt WASH practices.
  • Fourth, I will assist the volunteers in periodically collecting community WASH statistics from now through October to update the display board for the community to see their own progress, helping them to maintain motivation.

We projected a budget for this project of $511.63.  A Small Project Assistance Grant (SPA) that I applied for and received will provide $292.13 to the project. SPA grants are one of the funding sources available to Peace Corps Cambodia and comes from USAID for projects exactly like this one. One of the requirements of this grant is that at least a 25 percent of the project comes from community contribution. This again serves to assure the commitment of the community to the project. The remainder, therefore, comes from in-kind contributions in the form of donations of time and resources from the community.

Our next step will be to do a Community Needs Assessment in Part 2.

3 responses to “Fighting Diarrhea in Samrong Cambodia: Part 1”

  1. Marianne says:

    Hey Richaaaahd,
    How about using those fabulous photo skills of yours to tale pictures of local people doing what they should (like washing hands and using latrines), and then posting them at latrines and washbasins? Everyone loves a little notoriety, and they might just do it (wash etc) to get their picture taken. Also, a picture is worth a thousand words. Do you have access to a color printer? You are doing some great deeds! Keep up the fight 🙂
    love, Marianne

    • rich says:

      That is an interesting idea. I might try that. I do not have easy access to a color printer, but I could have prints made in Phnom Penh and bring them back to the village. That would make a very personalized reminder of good practices.

  2. andy says:

    maybe photos of the village chief and other notables doing the right thing? It must feel great to be making a difference.

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