Agua Para La Vida believes in an integrated approach to making a difference in a community. So they don't just drop a potable water system and disappear. They try to set up a program that will be self-sustaining and which can make a long-term difference in the health and welfare of the community. For that reason they always provide an outhouse (actually constructed by the family), and have a health team in charge of evaluating the community's needs, training them in appropriate health practices, and monitoring the water quality of the installed system.
Lilian Bando and Gregoria Espinoza have been working for APLV in their role as health promoters for a dozen years, and they still find that their educational role is the most important thing they do.
When they arrive at a new project, it's quite common to find that there are few or no outhouses (of course there are no sewage or water systems, so outhouses, where they exist, are the workhouses of sanitation in rural Central America). And it's also common to find that the entire community is ignorant of basic concepts like handwashing after going to the bathroom, proper management of drinking water, appropriate disposal of trash, and the like. There are an awful lot of villages where defecating out back and letting the pigs and chickens clean up is normal, and that's not good on the health front.
Lilian and Gregoria have an entire health evaluation routine that they do at the beginning and at delivery of a project, and they they spend the bulk of their efforts doing group and family-by-family training on the critical aspects of health practices. By the end of their routine the practices and the health of the community can be much improved.
I was working with these two helping with a spreadsheet that analyzed the before and after health practices and statistics. According to these numbers, the instance of childhood diarrhea in the village we were analyzing dropped by 50-70%, which is a pretty amazingly good number. It's no surprise that the basic answers to "do you wash your hands after going to the bathroom and before eating" had improved amazingly as well.
Once again, it's a treat to see two women who have been working together on the same mission for more than a dozen years sticking to it with an impressive intensity and compassion. They only thing that really gets them down is when they work with a community that has so little to eat that it seems they need that before working on sanitation issues. Sometimes, they say, they just wish they could give out nail clippers to the families that can't even afford one.