Report from the Field: the test and treat program in Monte Cristo and San Antonio, Department of Rivas, Nicaragua

CTripleS is grateful to the Daniele Agostino Foundation for partial support of the work described here

    This is a report of the activities of the Center for Scientific and Social Studies ( in  this case, Jon Soderberg, Andrea Schuman and Rafael Ruiz, special assistant) between February 13 And March 12, 2001, in the San Juan del Sur region of Nicaragua. As planned, activities focused on the development of a test and treat program for drinking water in the settlements of Monte Cristo and San Antonio. Other major objectives included followup and expansion of the system in El Pochote, initiated in November 2000, and discussion of possible multiregional diffusion of project techniques with personnel from the university in Managua.

El Pochote Followup and Expansion

            Events in El Pochote since our initial work there had significant impact on the scope of the project when we returned.  An elaborate water supply system developed by the East Germans twenty years ago and long fallen into disuse had been at least partially revived (we believe our work in November, which became widely talked about throughout the region, spurred the regional governmental authorities to action. This system involved pumping water from a well 2 kilometers distant from the community to storage tanks on a hilltop, where it could be gravity fed to water points located within the housing area of the town. While this represented a major decrease in the work related to water in the sense that people no longer had to carry five gallon buckets from the wells by the river, the system has many disadvantages. For one, the water is as contaminated as that of the other wells, making this a system that makes it easier for people to consume polluted water. For another, the required cost per family for operation, at thirty cordobas per month, is expensive. Thirdly, the system is not reliable, has many leaks in its buried piping, (forcing residents to attempt repairs without the financial or knowledge resources to effect them), and could only supply water a couple of hours a day. Although unexpected, we had to offer assistance and advice on the engineering aspects of the water supply system. This included specification and procurement of valves and fittings from project funds and instruction on how to isolate sections of the underground piping to determine where there might be breaks. Finally, the source well appeared likely to run dry soon (and has as of April, 2001, according to news received from participants); its location at close to sea level appears to preclude digging it deeper, as it is susceptible to salt water intrusion.

            On our return to Pochote, the barrel masters explained the changes in the water situation, and how they had modified the test and treat system as a result. As the individual in charge of the piped water had told them he was chlorinating the tanks, they had discontinued chlorinating the barrels, although they continued filtration in order to remove  parasites. Two of the three barrel masters had taken this tack, while the third told us privately that she " didn't think this was right," that she didnt want to give her family dirty water, and so she continued to maintain her barrel according to treatment protocols.

            Discussion with concerned participants led to a testing round of the filtered water: only the barrel maintained by the woman who continued the full protocol had a good outcome. This was a powerful lesson for the others, who resumed chlorinating immediately. We discussed in detail the reasons why chlorination of the storage tanks was unlikely to be effective, which provided the opportunity to review the basic concepts presented in November. To try to modify the common perception by many in the community that water drawn from a "modern" faucet was potable, the barrel masters sampled and tested the 11 water points of the system, and demonstrated that all were heavily contaminated.

            Expansion: A group of residents on the edge of town who were relatively distant from a filter barrel asked that they might have the next barrel. A very committed man volunteered to come with us to the new project communities and learn all aspects of the system, becoming the barrel master for this group of families. This he did  successfully.  The Pochote group fabricated, filled, and stabilized this fourth community barrel independently, which will serve eight to ten additional families.

            The situation in regard to water supply in El Pochote is somewhat unstable now with the partial functioning of the piped water system, at least seasonally. Understandably, some residents feel their problems with water have been solved.  A sensitive approach will be needed to expand the numbers of people who recognize the desirability of treatment to minimize threats to health.  A final disappointing outcome resulted from our assessment of an alternative water source upstream and upgradient from pollution sources near the town. Participants had told us of an "ojo de agua" (mountain spring), several kilometers into the hills which they believed to be clean, and which had never gone dry in the memory of the community. They envisioned a system of overland piping which they would provide the labor to install, which would bring this reliable water directly to the town through gravity feed. They took us to this physically remote site with enthusiasm, asking us to test the water quality.  Unfortunately, it also proved to be highly polluted. While this finding was a tremendous disappointment to the villagers, it was not totally unexpected, being concordant with the published literature in tropical microbiology  referencing the long term viability of released fecal bacteria in tropical watersheds. There are numerous ranches and the shore of the highly polluted Lake Nicaragua 10 to 15 kilometers beyond the ojo de agua.

Monte Cristo and San Antonio

            Background: These two communities comprise an almost continuous settlement extending approximately 8 kilometers that stretches along an ox cart road that is sometimes passable by motor vehicles. The road is continually crossed by meandering rivers, which flood the whole region during the rainy season, during which time some families are literally encircled by water.

            Each community has a primary school. Monte Cristo’s (MC) one room school is staffed by a teacher who is also the community's health promoter and adult literacy teacher. After our initial introduction by personnel from Servicios Medicos Communales, who had prepared the way for our arrival, Carmen served as our primary contact person for both settlements. San Antonio (SA) has a two room school. Students from both communities who continue on to secondary school either walk or ride horseback to Ostionale, a larger community about 6 kilometers from the near boundary of MC, or attend school in San Juan del Sur or Rivas, living apart from their families. During the rains and river flooding, the students follow tortuous footpaths over the high hills to circumvent the unfordable rivers.

            MC and SA are very isolated, poor communities. During the month of this project, our daily comings and goings in the four wheel drive truck provided the means for several people to travel to San Juan for medical treatment (one urgent) or to make purchases of basic foods in quantities larger than they could carry.  Being back in the "bush" limits opportunities for community members even more than residents of Pochote, who carry on  trading, familial and social relationships across the border with Costa Rica. Aside from the three teachers, a small storekeeper in San Antonio, a woman who makes pottery to order (infrequently), scant cash is earned within the community. No telephone or radio contact is available for emergencies, and while there is electricity, outages of periods of up to a month are common.

     Project Activities: Previous experience in El Pochote provided the basic outline for the sequence of events in MC/SA, with the addition of  the Pochote team as a teaching and demonstration resource.  Our intent from the beginning of the work with El Pochote was for the water quality project to be sustainable on the community level, in terms of affordability, time demand on participants, and technical "know how," and sustainable at the regional/ inter regional level, enabling transfer of acquired knowledge and skills to new communities with minimal professional oversight. Initiation of the project in MC offered the first opportunity to test the feasibility of this community-to-community teaching strategy.

            After an initial meeting in MC to introduce the project and confirm community interest, we suggested that participants might want to visit Pochote to see how people there had developed the system and talk with them about its utility. This was met with enthusiasm. The next day, we arrived to pick them up, and twenty-two people crammed in the truck and endured a hard hours drive for what was obviously a rare social occasion as well as an opportunity to learn about the water system. During the explanation of the barrel treatment and testing process, three small groups developed, each led by one of the Pochote barrel masters. We were extremely impressed with the depth of understanding they had developed about the issues surrounding waterborne disease and the mechanisms at work in this test/treat regimen to lower their risk. Their responses to questions made it clear that their understanding went considerably beyond rote retention of procedures. 

            A few days later, Pochote residents came with us to MC for the construction and filling of the first community barrel. (Our initial testing had confirmed that all currently used sources of water in MC showed considerable contamination with fecal bacteria. Referee methods performed at our base in San Juan del Sur employed Colilert and membrane filtration to validate results from field H2S testing.) Again, their retention of the important aspects of the process was impressive, as were their innovations in completing required tasks and their ability to communicate their knowledge to new participants. Over the next week, barrels were started at the school site in MC, at the teacher's house in MC, and at the house next to the major community well in MC.

            Given project time limitations, we had been advised by Servicios Medicos to limit project activities to MC, particularly in light of the unanticipated time required to assist with the water system in Pochote. This proved impossible. The two communities blurred into a long continuous line of isolated roadside houses, with the ox cart road terminating into the bush beyond San Antonio. While working on the filtration barrels at MC, people from SA came on foot and horseback asking their wells be tested. An elderly woman walked 5 kilometers to us with a cup of water for testing. A number of men from SA showed up and sat in on the activities in MC. In response, we tested 9 wells in SA, 8 of which were heavily contaminated with only a newly constructed well showing lower levels. We agreed to discuss the issue of contaminated water with interested community participants at the SA school. To our great surprise 27 people attended , and we felt we had no option but to concurrently run the project in MC and SA, and accept the logistical difficulties of procuring more materials and supplies in Managua and Rivas.

            The expansion of the project into SA was undertaken while filtration units in MC were being stabilized and prepared for use. Barrels and materials were procured for siting near community wells and were placed in the SA school, in the pulperia (small store), and in the patio of a centrally located house in the interior residential section. One day of intense intercommunity outreach to SA for instruction in filter construction and testing was conducted by the barrel masters and other volunteers from Pochote and MC. As the filter units were constructed and being prepared for use, the distinction between community members blurred as volunteers from MC assisted daily in the washing, sieving, and cycling of SA filter bed material, while volunteers from SA assisted in filling and unloading barrels of transported water for cycling the MC filters.  

            As we came to know these two communities better, and listened to residents' concerns, it became clear that reliance on communal barrels alone would not adequately meet specific local needs. Many individual homesteads had their own wells, some were at considerable distance from the communal wells, and seasonal flooding would make the barrels inaccessible to some families. After responding to many individual requests to test home wells, we decided that a response tailored to local conditions had to include individual homesite systems. Two men volunteered to construct, maintain and help others develop such systems, with materials we provided. They then built a system for a family on the outskirts of town with a household that sometimes includes twenty people, including small children, where the father was absent due to labor migration. Subsequently, they constructed 3 more 15 gallon units for other isolated families. With this model in place and local expertise in construction, at least some residents told us they could afford to purchase the necessary materials to construct homebased filters (at approximately 75-90 Cordoba, depending on materials used). 

            In addition to barrel construction, rope pumps at a community well and a school well were repaired, concrete tops were constructed for two open community wells, and arrangements were made to pump clean the wells at the two schools. We were careful to explain that this was a totally inadequate step for assuring disinfection, but that any improvement in the quality of the source water from these neglected and very dirty wells would support the disinfection protocol.

Problems Encountered

            The effects of seasonal changes in water levels and variations in the geology of local pebbles and sands were evident during this return visit. During November in Pochote, water ran in the river, making the washing of the barrel fill materials fairly easy. February/March is encompassed by the dry season, and materials in MC/SA had to be washed in many buckets with water drawn from the wells. This less effective washing technique, in combination with the fact that the fill material was considerably dirtier, made stabilization of the barrels a more lengthy and difficult process. An additional potential problem arises from the nature of the stone in the region. What is available locally is predominantly limestone interbedded with a large percentage of clays, the clays having been largely washed off the stone in the running river at Pochote. In the dried river bottom strata at MC and SA, dispersed clay had hardened into  pebble and sand sized grains intermixed with stone. In combination with the chlorine used for disinfection, residual clay gives the water a distinctive taste, which was pleasant to some but offensive to others. Whether this will affect residents' desire to continue consumption of treated water remains to be seen.

            On arrival, it became apparent to us that the idea of sharing the incubator between Pochote and MC/SA was completely impractical. Although the distance is not that great, the challenges of the geography make travel between the two areas difficult and infrequent. Jon fabricated an interim incubator for MC/SA using an insulated cooler and other materials, which works well enough for the testing to be completed in this already hot region; a more technically adequate incubator remains for Jon to make and send to MC/SA, with a design similar to that used in Pochote. We are still puzzling over why none of our Nicaraguan colleagues pointed out to us in advance the impracticality of our original plan.

            Geographical factors affected our efficiency as well. During the stabilization period for the barrels, we had to travel from one end of MC/SA to the other repeatedly in one day, given the spread out nature of the communities and the siting of the barrels, in addition to driving an hour or more each way to transport the Pochote volunteers to MC/SA. This also meant repeating the same teaching of techniques and concepts multiple times with the subsets of people clustered around  each barrel. Nevertheless, we remain committed to the community-to-community teaching strategy incorporated in the project, and which proved highly successful. Combined with the need to accommodate interested parties and community leaders in MC/SA who worked in the mornings, our direct workday in the new communities was somewhat compressed. The work was at times quite stressful because of these issues: on many occasions, we could not return to our San Juan del Sur base until after 9PM.

            The most challenging problem encountered, as well as opportunity seized, resulted from the totally inexplicable initiative on the part of the municipal government to retrofit and activate the defunct war era water supply system at Pochote. We initially encountered textbook attitudinal changes attendant when piped water is first made available. For many, their deep concern over contamination simply vanished when water came out of a faucet, and even our barrel masters largely accepted the claim that the system water was being adequately disinfected, forgoing their resources to test it. We observed women who in November had been very conservative in their use of water now left faucets run open as they washed clothes. For our part, we could not offend the community and the political leadership in San Juan by stating that, simply by inspection, it was evident that the retrofit system was an engineering disaster. Even if there had been funding allocated to purchase disinfectant, there was no provision to mix it into the supply water. A swimming pool filter pump had been installed to replace the two originally specified large industrial pumps, with the consequence that it required 5 hours to fill the storage tanks which were emptied by use and leakage within two hours. After years of disuse, the supply piping was full of leaks and blockage. Most importantly, the Naranjo well was going dry, and that soon there would again be no water supply system available to the town.

            But the situation also brought the opportunity, not only to reinforce water quality requirements to the barrel masters and other previous participants, but to introduce these concepts to the three men on the water system committee, none of whom had participated in November. Two of the three became very supportive, with one becoming a dedicated volunteer in the work at MC/SA. The third considered himself an engineer/operator with the fixed view that pumped groundwater, being colder than river water or Pochote well water, meant that it was potable. But after cooperating with him on engineering aspects of the system, he at least was not publicly antagonistic toward the project.

            The ancillary project goal of discussing dissemination of  project techniques with university personnel was only very minimally addressed. We were able to meet with the doctors only once, for a general discussion of Nicaraguan health systems and the problems and opportunities they present. Because of the doctors' involvement in a World Health Organization sponsored campaign of cancer detection in underserved women, their time was severely limited during our stay. This campaign and the arrival of a brigade of volunteer dentists also took the energy of personnel from Servicios Medicos Communales, who could not be as involved in this water project as they had been in the Pochote effort.

Addition of Special Assistant

             We were fortunate to have the full time assistance of Raphael Ruiz, a San Juan del Sur resident who has been active in community development efforts in the past. Rafael participated in the Pochote effort on a volunteer basis, and so was familiar with project goals and techniques. Without his participation, the logistical challenges of the MC/SA project might well have overwhelmed us. Trained as an electrician, Rafael is adept at working with his hands as well as being an insightful and hard working team member. He was paid a salary of fifty dollars a week (six days) from project funds, and will also be available to do minimal follow-up, paid by funds left deposited with Carlos Guzman, who serves as treasurer for several international organizations active in the area. Rafael is our main communication conduit with the communities, through e-mail.

APPENDIX I

El Pochote Water Supply System

            During the war, Pochote was founded as a planned community with strategic military importance on the frontera with Costa Rica, populated by locals from the original destroyed settlement and by immigrants mobilized from surrounding areas.  Little present day consequence of this history remains, beyond the unique configuration of identical houses laid out in rectangular grids. When we first visited Pochote in November 2000, we were mystified by water points- piped water faucets with washing sinks centrally located within a rectangular perimeter of houses. As they were not being used, we confined our attention the Pochote wells from which water was hand carried in buckets back to the residential area. Occasional questions about the water points prompted answers such as "there are big underground pipes for water all through the town" and "the water supply was built by a German who acted like a hacienda patron."  Further questioning yielded "there was water for a little while, then it stopped and the German went away;" "the well is not here, it is over by the Naranjo River" (2 kilometers away); "there were two wells at Naranjo, one was contaminated by salt water, then they built the second;" "the German said the water at Pochote was too contaminated to use but that the water from Naranjo was good."

            The probable history of the water points and supply system is that there was East German economic and technical aid to provide a water supply for the isolated but planned community of Pochote. Engineering problems and/or local sustainability issues quickly led to the failure of the system. Although the original pumps have disappeared, the remaining control panels on the walls of the pump house indicate that the system had been designed to meet industrial engineering standards and practices. It is doubtful if replacement parts for the European pumps could have been obtained in Nicaragua.

            Although we found high contaminant levels and insufficient water in the supply well, it is quite possible that watershed contamination has increased since construction of the system, and from our own explorations of the region, we know that the groundwater table has declined precipitously in the past 15 years.

            It was also troubling to hear that an engineering firm in Managua was paid $70,000 US to perform the present retrofit work. It is hard to imagine work actually performed costing more than $10,000 US. The engineers left without even testing to ensure that water actually reached the water points, and the Pochote community was left to its own devices. Hopefully the skills learned in our water project will be of assistance in "bandaiding" the system when feasible, and in better surviving their condition when its not feasible to operate the system.