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Day 4: May 19, 2016

Community Health Worker Workshops and Building Water Filters: Featuring Lathan & Akshay

This morning, Akshay and I (Lathan) left a little bit earlier in order to go shopping for bowls to build our water filtration system. We went to IC Norte, which is huge supermarket, kind of like a Target. Akshay also wanted to get some beans for dinner. When paying, there was a little misunderstanding with what NIP meant, but I realized that it was a PIN number in Spanish, número de identificación personal. I also asked the cashier the difference between sin nombre and con nombre. Basically, if you say con nombre, you include your name and you have to pay some sort of tax. I’m not really too clear on it to be honest, so I have to clarify more.

On our way to the printing shop in order to print out the evaluation questions and the activities, we chatted with our taxi driver. We basically told him about what Refresh does. At the printing shop, we printed and stapled our evaluations together. In total, we paid 76 Bs for all the printed materials. The printing shop is actually an Internet cafe, so there are some games loaded on the computers. Unfortunately, Akshay realized we left our bags at IC Norte, so he went back to get them while I waited there at the printing shop for all the materials to print. He also went back to Simhouse to get all the materials we needed for today’s workshop - markers, bowls, and plastic wrap.

After we got all our materials, we headed to Maria Eugenia’s house to teach the workshop. When I got there, we were greeted enthusiastically by all the women. We started immediately. While Akshay had the women complete the first evaluation forms, I prepared the materials by cutting out the activity cards and organizing them. Then, Akshay went through the evaluation forms. This is what we talked about:

Water Supply System

All the women knew that it was important to cover their water barrels. We went over the types of water tanks and water barrels in terms of size. The water tanks are found above the houses and bathrooms, and they come in various sizes (350, 600, 900, 1200L). Also, what was really impressive was that one of the women knew that tanks made out of aluminum wasn’t good because aluminum oxidizes into rust, which can contaminate the water. In addition, we talked about the cement tanks in the ground. There is a cistern to draw water. However, these tanks are painted on the interior, which is not good because the paint can chip and go into the water supply. We also asked who provides the water, and the women replied that nameless independent contractors come into the communities to fill the water tanks. The women clean their water tanks every time they use up all the water, which is good because the suggested frequency is at least once a month. Akshay also explained why covers on the water barrels are so important in order to prevent contamination by insects and other things. He also explained why dirty water coming in contact with open wounds are dangerous. It’s because the bacteria within the dirty water can infect the wound.

Next, we decided to talk about some topics of discussion that came up on Monday that we wanted to clarify.


First, we talked about Juana’s pharmacy. So we learned that they have medicines, but do not know how to sell the major medicines. In other words, the medicines that were treatments. They only knew how to use the small medicines, such as the ones to manage fever and pain. Juana’s pharmacy is free. She usually gets about 1-2 people a day. If people have more serious illnesses, they usually go the doctor, and then to another pharmacy with the prescription.


The garbage collectors come to the barrios every Wednesday and Saturday. However, they do not leave the garbage out because they don’t have garbage cans, only garbage bags. Thus, the dogs oftentimes go through the garbage. The garbage man oftentimes go through the main street, but they do not go to the upper parts of the barrio. As a result, the people who live in places not visited by the garbage men either bury biodegradable waste, burn nonbiodegradable waste, or drive 30 min by car to dispose of the waste in a central garbage bin. That last fact totally blew my mind. They travel 30 minutes every two weeks just to throw out their trash. We definitely take throwing away trash for granted.

Health Facilities

Most of the women go to the nearest hospital, Villa Pagador. Some women also go to a hospital run by the Cuban government. Everything is free there. However, it takes about 40 minutes by car to get there. No one has health insurance, so they all have to pay out of pocket. Medical expenses can be really expensive. 10-20 Bs are for a consultation, and prescriptions can go up to 100 Bs. One of the women had an appendectomy, which cost 14,000 Bs. She couldn’t afford it at the time, so she had to pay in increments afterwards in order to pay off the operation.


We decided to do a breakdown of each women’s expenses. First we had them confidentially write their source of annual income on a piece of paper and hand them in to us. After calculating all their expenses and earnings, we roughly calculated that they made 30,000 Bs and spent at least 26,000 Bs a year. With other expenses, including medical ones, bank deposits, and gas money, their remaining 4000 Bs quickly evaporates. They do not have any money to spend for luxury.


We also talked about pozos. We had them describe what their pozo looked like. It’s essentially a hole in the ground where they go to the bathroom. The hole is surrounded by four wooden walls and covered with makeshift curtains. Companies charge 200Bs to build a small one, 400 Bs for a large one, and 200 Bs to dig the hole. We also conducted a mini-survey as to what type of bathroom the women had. 55% had constructed bathrooms, 9% had these pozos, and the other 45% had no constructed bathrooms, so they would go outside. Clearly, this wasn’t representative of the larger community because many are without constructed bathrooms, and they go the bathroom in torrenteras, which are basically cliffsides.


After a lunch break (Maria Eugenia got us all boxed lunches), I (Lathan) led the activity, which basically required the women to categorize a bunch of cards depicting certain activities as good for your health, bad for your health, and neutral for your health. I think that went pretty well. Almost all the women understood the importance of treating water such as by filtration, boiling, or prevention of contamination, and hand-washing.

Water Filters

Next, Akshay described the water filter we are building. Basically it takes advantage of evaporation that makes the water condense on the plastic wrap that we cover the bowls of water with. In theory, the water will evaporate, leaving the contaminants behind, condense on the plastic film cover, and then drip into a small bowl within the large bowl. We put weight in the center of the film in order to create a dip where water can drip off from into the smaller bowl.

We guided the women to building their own water filters. We got water and dirtied it by adding dirt and gravel. We will see how they turn out on Monday.

We ended the day by conducting evaluations. I led these evaluations, and they went pretty well. The wording of certain questions could have been better possibly, since many of the women kept on asking me what certain questions meant. However, they all seemed to understand how to treat water and adopt good hygiene habits. The hope is that they will return to their communities with this knowledge and educate their fellow community members.

One woman in particular, Monica, is extremely bright. She understands almost instinctively good sanitation practices and soaks up all the knowledge that we provide. In addition, she is extremely driven; even coming to us personally afterwards to ask if she could take some materials home with her. Personally, it makes me appreciate education so much more because I can’t imagine the things people like Monica could achieve given the right opportunities and education.

Bathrooms: Featuring Claudia & Harsh

So this morning Harsh arrived at 8:30am from Miami -- he took a night flight so he was essentially dead the entire day on the inside even though he had to work in the sun literally from 10am - 6pm building the bathroom. But let’s start from the beginning. The ride back from the airport was pretty entertaining because Rodrigo - my 20 year old friend who is high up in the Ministry of Justice of Bolivia --offered to come with me to pick up Harsh in his pretty awesome truck. Rodrigo is very much work hard play hard, so on the way back from the airport even though it was 9am he was blasting party tunes. We then went to have a typical Bolivian breakfast of Api con Pastel. Api is a drink made o

ut of purple and yellow corn and a pastel is essentially a fried cheese pastry with powdered sugar on top. Harsh thought it was good so mission accomplished. Rodrigo then dropped us off at SIM house and we took a taxi to the bathroom site.

The woman, Sandra, whose receiving the bathroom was chosen because we thought she understood that this was a pilot bathroom. We’ve never built these microflush toilets before, however, we truly believe that based off of Dr. Stephen Mecca’s plans they are the most cost efficient and high quality bathrooms that exist for rural areas. We have had meetings with Sandra in the past to explain that this is an experimental bathroom, however, it was clear today that she did not understand. She made it very clear that she did not want our bathroom design and that she wanted only a dry bathroom. Last January we attempted to build the microflush toilets however, we definitely failed and that was our fault. And the communities heard of our failure --from far and wide it appears that women have traveled to see our January bathrooms and they all share one opinion on them: they are terrible. It’s a fair opinion because they just don’t work and they don’t look nice because we didn’t finish them. That’s why this week’s work is so important. We only have 5 days to finish the bathrooms completely…. But we can do it! Hopefully.

Anyways, so today we dug the hole for the bathrooms --which is super hard work and Harsh did essentially by himself-- and made a wooden frame for the bathroom. We attempted to get started on making a metal rebar grid on the frame to support the concrete but Harsh was understandably tired, and it was already 6pm. Thankfully, Rodrigo came and picked us up! We explained that we needed to get a different type of rebar (the one we bought was too thin) and that we needed to make the grid. He told us he would take us a tool shop to buy the rebar --we drove around the city for 1 hour looking for a tool shop but they were all closed. Also, the traffic from 6-7pm in Cochabamba is brutal. For a city so small it’s astonishing how many cars can fit in its streets.

After giving up on finding a tool shop we stopped to get Greek Yogurt as a snack. I know it’s common in America but it is literally the new “thing” in Cochabamba right now since they just got this yogurt stand last month. The best flavor was beet jam topping with normal yogurt --sounds weird but is amazing Harsh and Rodrigo got it, and I regret not getting it. Then we picked up Rodrigo’s sister --Carolina-- and her Brazilian boyfriend --Mattheus-- and went to eat at a Mexican restaurant called “La Chingada” not a super nice phrase in spanish but oh well. Throughout the meal everyone tried to talk to Harsh because his spanish is not the best. They are all super nice and open people and dinner was definitely not dull. Then we came back to SIM house and fell into a pretty dead sleep, due to the high amounts of activity during the day.

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