24 Jan, 13 | by BMJ
“Water is another matter,
has no direction but its own bright grace”
[from “Water” by Pablo Neruda, Chilean poet].
I turn on the kitchen tap but no water flows. Surprised, and a little confused, I go to the bathroom—nothing. The shower—dry. Then I recall the notice seen earlier in the hotel lift. Something in Spanish about a water shortage. Some vague emails circulated this morning about Santiago’s water supplies being cut off for the day. Must be that, I think to myself. Oh well, only a few hours. Can’t be that bad. At least I have electricity.
A few minutes later, I want to wash my hands. It is nearly 30 degrees and I have been out and about all morning. I also want to take a shower, maybe fill the kettle, brush my teeth, flush the loo, rinse vegetables to cook for lunch. But all those things require a precious commodity that, for the next 10 hours, I will not possess. I decide to venture out to equip myself with bottled water.
Remarkably, the fountain outside my hotel is in full flow. A homeless man washes himself in it with abandon, relinquishing his few belongings to the street, whilst I clutch my handbag fiercely, warnings of pickpockets ringing in my head. I feel slightly ashamed. It dawns on me that, today, we are all the “great unwashed.” Rich, poor, cuicos, hobos, gringos, all equal in our filth, sweat, and humanness. I may attempt to deny or buy my way out of it, with perfume and bottled water, but the evidence speaks against me.
The street dogs of Santiago are smart, I think. They’ve sniffed out the territory and know where the supplies are at. It’s only people like us who go to the supermarket and feel surprised when the shelves are empty. People who have lived in relative comfort all their lives. I thought this when I watched a scene from the film “Machuca,” showing people queuing for food at hyperinflated prices under Salvador Allende’s presidency in the early 70s. I also thought this as I stood in the Museo de la Memoria y los Derechos Humanos (Museum of Memory and Human Rights) the other day, a museum commemorating those who were imprisoned, tortured, and eliminated during the Pinochet dictatorship. As my (very wise) grandmother said to me before I left for one of my travels, encountering difficulty can make you resilient.
Many shops and businesses were closed today (Tuesday 22 January 2013) and a third of the city’s population, around 600,000 families, in 21 districts, are without water. According to the BBC, the supply has been cut off because the Maipo (the main river that flows through the Santiago metropolitan region) was contaminated through landslides from the Andes. It seemed we were given little warning. Yet, people were still out on the streets in my district this afternoon, going about their usual business, chatting, smoking, eating ice cream, or drinking a pisco sour. They seemed unfazed. Resilient.
I was supposed to write about family medicine in Chile. I have come here to learn about health reform and community medicine. Instead, today’s events compel me to write about the most basic of public health needs, and a human right—access to clean water.
According to the World Health Organization and UNICEF, 783 million people in the world—approximately 1 in 10 of the world’s population—do not have access to safe water, and 2.5 billion have no access to adequate sanitation. It is a stark and timely reminder that much needs to be done to address these problems, which pose a disproportionate burden on the poor.
Rapid urbanisation is a key factor hampering progress in improving access to clean water. Additionally, climate change and pollution are likely to diminish future usable supplies. Chile, like any developing country in transition, has felt the impact of urbanisation almost as palpably as it feels its natural disasters, such as earthquakes and landslides. Today, over 90% of Chile’s population, mostly in the urban areas, have access to clean water and sanitation. In 1991 Chile suffered an epidemic of cholera that originated in Peru, largely due to the use of contaminated wastewater to irrigate crops. At that time, only 5% of the country had access to safe potable water. To contain the outbreak, swift and multi-pronged public health, policy, and preventive strategies were implemented. One legacy of this manifests itself today in restaurants and households alike, where you will rarely be served an unpeeled raw vegetable. Plans are afoot to increase safe water coverage to 100% in the urban areas over the next five years and Chilean entrepreneurs are coming up with their own cheap and efficient water treatment innovations, yet information on rural safe water remains elusive.
It is past midnight and still there is no water. I contemplate washing with agua gasificada: will I come out sparkling? I realise, now, that it is not local health centres that will get to the root of this problem, even if people become ill as a consequence. It is the water companies. Solutions to public health problems may not necessarily be found within health systems. Infrastructure, housing, sanitation, cross-sectoral collaboration, sensible policies, accountability, and good governance—all those things easily found in rhetoric, but less so in practice—really are essential in this particular battle. I hope that with tomorrow’s rising sun the bright grace of water will return to Santiago.
Suchita Shah is a general practitioner in Oxford, UK. She is currently living in Boston and is a student at the Harvard School of Public Health, Boston. She is in Chile for January looking at primary healthcare reform.