March 22, 2013 | The Editors

The truth about diarrhea

Today is World Water Day, a time to recognize that an estimated 780 million people lack access to safe water, and to acknowledge just what that means in human terms. If everyone had access to safe water, for example, almost 90 percent of deaths from diarrheal disease could be prevented. To commemorate the day, we bring you the story of Jane Wamalwa, who knows just how devastating diarrheal disease can be to a family, and how best to avoid diarrhea’s sad consequences.

Portrait of Jane Wamalwa.
Jane Wamalwa lost three children to diarrhea. Photo: PATH/Gabe Bienczycki.

The first to die was her little boy, just five years old when he got sick. The following year, Jane Wamalwa lost a second child, this time her 18-month-old son. When her baby daughter fell ill two years later, Jane knew what was going to happen next and felt powerless to stop it.

She watched in despair as her third child succumbed to an illness that is both deadly and easily preventable: diarrheal disease.

Strategies that beat diarrhea

In western Kenya, where Jane lives, diarrhea is one of the top causes of death for children under five years old. The tools to prevent these deaths are surprisingly simple, affordable, and effective. But how do you reach parents with information and strategies to avert such tragic and needless losses?

That’s where Jane comes in. Selected by village leaders and trained by PATH, Jane is now a community health worker taking the fight against diarrhea door to door in her community. Her deeply personal understanding of the disease’s consequences makes her a powerful ambassador for the tools and techniques that can save children’s lives.

A curse, then death

Three small mounds in a cornfield near Jane’s house mark her children’s graves.

Looking back, Jane, 48, knows she was sadly misinformed about the causes of diarrhea and the best ways to treat it. She didn’t know that after working on her farm, she should wash her hands before breastfeeding her children. She’d never heard about oral rehydration solution (ORS) or zinc tablets, both used to treat dehydration caused by diarrhea.

What she knew came from other women in her community: diarrhea meant a child had been cursed. And the only way to cure it was to pay a witch doctor to administer special herbs. When the child vomited, Jane was told it was a good sign—the curse was leaving the child’s body. In fact, the vomiting hastened death.

Jane’s in-laws blamed her when the children died from dehydration, and her husband beat her for giving birth to sickly children.

The truth about diarrhea

Then Jane began hearing about new ways to manage diarrhea. She learned about ORS at a meeting of village elders, and she heard about the importance of treating the family’s drinking water on radio programs sponsored by PATH. She met a community health worker, who taught her ways to improve the family’s hygiene and sanitation practices.

By the time she gave birth again, Jane knew exactly what to do to protect her newborn daughter.

Reaching out with lifesaving tools

Today, Jane’s daughter is a healthy 11-year-old. Jane’s health training and her standing and connections in the community have made her a trusted information source for her neighbors.

“I go to my neighbors,” Jane says, “and I say: ‘You know me. I lost my kids because of this. Now I am informed.’”

PATH has trained thousands of community health workers across western Kenya in strategies for preventing and treating diarrhea—volunteers who are at the heart of our work to reduce deaths from diarrhea.

Our goal is to bring prevention and treatment strategies to more than 10 million people in Nyanza and Western provinces, mainly mothers, caregivers, and young children. People in this region are among the poorest in Kenya. Only about one in four has safe water and fewer than one in ten has access to improved latrines or flush toilets.

Promising signs of progress

In Jane’s village, PATH provided technical support and guidance that helped the community work together to improve its water source. Some families have also built upgraded latrines and incorporated better household sanitation practices, like creating dedicated bathing and food preparation areas.

In Nyanza and Western provinces, we helped reestablish oral rehydration therapy corners in 170 health facilities. Now, families can quickly get treatment for dangerously dehydrated children.

At the national level, our comprehensive approach includes expanding access to new treatment options and improving case management. We helped the government develop and launch an integrated policy for diarrhea management and successfully argued to make zinc an over-the-counter diarrhea treatment so parents can get it to their children in the first hours of sickness.

Fewer deaths, less disease

Health officials say they’re seeing significant progress in the fight against diarrheal disease, with more children getting earlier treatment and fewer needing hospitalization due to severe dehydration.

Global deaths from diarrheal disease have fallen by nearly half over the past two decades. But there’s more to be done, and Jane considers this her calling: to reach people with the facts and the tools that can make the difference between a healthy child and a life cut short by diarrhea.

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