Water, sanitation, and hygiene must be the first lines of defence against antimicrobial resistance. The Lancet Global Health Blog, Sept 21, 2016 |
Author : Yael Velleman. Yael Velleman is a WaterAid senior policy analyst on health and hygiene
As world leaders meet at the UN General Assembly to discuss the rise of drug-resistant micro-organisms globally, they would do well to consider the experience of the midwives at Kiomboi hospital, in the Iramba district of Tanzania.
Before a WaterAid intervention earlier this year, Kiomboi’s taps were dry for 23 hours per day, leaving medical professionals faced with a difficult choice: risk the transmission of infection during childbirth because the delivery room and instruments could not be properly cleaned, or prescribe precious antibiotics as a preventive measure, possibly contributing to the emerging problem of drug-resistant infections.
It is difficult to describe what it is like for medical professionals like these, delivering babies and caring for patients in a hospital without adequate access to clean water or proper sanitation. The water supply to the wards runs for just 1 hour per day, medical equipment is washed in the same sink that waste from the maternity ward is disposed into, and expectant mothers wash their babies’ clothes in the dirty water of a nearby river. The only toilet is fetid and dank and the shower is next to an open sewer. Dirty hands and dirty water mean that pathogens spread quickly and babies and their mothers risk infections like sepsis.
In March, when Kiomboi was without water for 3 consecutive weeks, staff told WaterAid they had to turn first to unpredictable collection of rainwater, and then had to send a car to collect water from a river. Without readily available clean water, midwives were not able to do their jobs safely. At least 12 babies developed sepsis during this period, and two of them died. Midwives were then faced with the torturous question of whether those babies’ deaths were their fault: were those infections transmitted in the delivery process?