Reports from Honduras

Running water doesn’t exist here. Or, rather, it does, but only very sporadically. Because of this, people store water in large basins called pilas. The idea is to leave your tap on and, when the water does come, it will fill the pila and you’ll have enough water for the day. This water is used for hand washing, bathing, flushing toilets, pretty much everything but drinking. Most pilas are next to outhouses, which means they’re outside. Which means there is standing water. In a malarial and dengue zone. From a public health perspective it’s a frightening, frightening sight. But there’s really not much to be done and, for some reason no one has yet been able to explain to me, pilas are never covered.

So, how do you wash your hands? You go outside, scoop some water up from the pila with a plastic bowl, soap up and pour water over your hands. There are a number of issues here. First, you have to go outside to wash your hands, which makes it very difficult for medical professionals to wash hands between patients due to high patient volume. Second, you’re washing your hands with mosquito larve and other bugs that may have fallen in the pila. Third, there’s an issue of re-contamination of the hands because you must hold the plastic container with the first hand to clean the second and, onc the second is clean, with the second to clean the first. The last problem has to do with the flushing of toilets. Because there is no running water here, to flush toilets you must fill a bucket from the pila and pour it into the toilet. You fill the buckets with the same plastic container you use to wash your hands and the bucket used to flush is kept inside the stall. This means that there is ample chance for fecal contamination of the entire pila. Because of all these constraints to effective hand washing, so far the response to the hand washing system has been highly positive.