Water and Sanitation: Probably the Greatest Possible Benefit to Health that Exists

Great to read an article in the New England Journal of Medicine (NEJM) making it quite clear, if it wasn't clear enough already, that the cure for cholera is improving access to safe water and sanitation. The recent massive cholera epidemic in Haiti means that several years and billions of dollars of aid money have not resulted in the provision of safe water and sanitation. The epidemic in Zimbabwe means that provision of water and sanitation, which may have been adequate at one time, collapsed. (It is estimated that about half a million people were infected with some kind of diarrhea in Zimbabwe alone in 2012.)

The good news is that lots of diseases can be wrapped up along with cholera and eradicated; most water-borne diseases. The bad news is that no country has ever eradicated cholera or any other water-borne disease without providing clean water and sanitation. The mere development of a vaccine for cholera or any other single disease misses the point and misses a wonderful opportunity. Half a million cholera infections and thousands of deaths are reported every year, all for want of clean water and sanitation. But the true number of infections is likely to be several million and the number of deaths likely to be 100-200,000.

Institutions such as the Gates Foundation like to boast about how many billions they are putting into vaccines for individual diseases, such as rotavirus. That's admirable in its own way, but why line up a few diseases to be addressed and ignore the conditions that ensure these diseases will remain endemic for the foreseeable future? Especially considering how long lack of access to clean water and sanitation has been one of the most serious issues facing developing countries. If, as the NEJM article claims, the problem is related to rapid urbanization, we're a long time getting around to it; urbanization in many African countries began decades ago.

Access to clean water and sanitation for all may seem like a very long term goal. However, in conjunction with improved health services and education, better water and sanitation will also lead to better health and educational attainment indicators. Even maternal and child health, which are often said to be priorities, would be greatly improved. Rather than targeting various diseases and sectors of developing country populations, improved water and sanitation for all would result in benefits for all sectors. Indeed, progress in health and education provision will be a lot slower without improvements in water and sanitation provision.

In relation to the challenges of such an intervention, NEJM mentions expanded access to antiretroviral treatment to poor people in developing countries. But improved water and sanitation is not at all like antiretroviral treatment; everyone needs access to water and sanitation, not just pockets of people in certain parts of certain countries. Improved antiretroviral treatment does not aim to prevent HIV transmission, though big claims are now made about preventive benefits. Antiretroviral treatment is not like provision of water and sanitation because the former targets one disease, almost entirely ignoring other diseases, and even health, education and other development areas.

Indeed, the parallel is even weaker than that. Lack of access to water and sanitation affects all poor people, especially those living in rural areas and, arguably, affects women and children more, perhaps more directly, than adults and men. HIV is often more common among wealthier people with better education, and certainly among those who live in more urbanized areas. The article concludes that "the current state of development leaves more than a billion of the poorest and most marginalized people at risk of ingesting feces with their food and water". So let's not approach lack of water and sanitation as we did HIV and access to antiretroviral drugs. Access to clean water and sanitation is a basic human right, so why not approach it that way?

Maker Faire Africa; an Exhibition of Brilliant Ideas

I was in Nairobi yesterday to visit Maker Faire Africa, a trade exhibition for people who make things, invent things, develop things and use things to achieve worthwhile ends. The exhibition divided roughly into crafts and technologies. The crafts ranged from highly original to original variations on a theme. And the technologies ranged from pretty low tech, through intermediate and right up to high tech exhibits.

Many of the exhibits were familiar to me in some way, largely through the blog Afrigadget.com. This blog searches for and covers any really good ideas and they are often just the kinds of ideas I've been searching for, in one way or another.

For example, I work in a place where sisal is grown but no high value goods are made from it here and no local people make anything more than a pittance as a result of working with the crop. But I came across a set of jewellery made from sisal, made in Rwanda, something that people here could easily make (I include links where possible but the majority of them didn't work for me). There was also a man who had developed a small machine that one or two people could use to make sisal string and rope. At present, the industry is dominated by a handful of foreign owned factories that date back to the 1950s.

I have also been trying to persuade people that they could use a lot of their organic waste to produce fertilizer or to compress into briquettes that can be used instead of charcoal, wood or other expensive fuels. There was a company exhibiting that makes presses that can be used for producing oil (from seeds), produce low cost and highly resilient bricks and compress fuel briquettes. There was also a group of people producing low cost fertilizer from organic waste. There's a shortage of affordable fertilizer here and far too much dangerous waste, so there's nothing like a product that has a whole range of benefits.

The issue of water hyacinth infestation in Lake Victoria and other inland waterways has long been an environmental challenge. Yet, there was already plenty of technologies and knowledge about how to use the hyacinths as biomass to make into fodder, fuel, fertilizer, furniture, household goods and anything else people can make, depending on their ingenuity. After all, the infestation is relatively new in East Africa but not in Asia. I saw an example of the many possible products, yesterday, made from water hyacinth grown in Nairobi Dam.

Bicycles are a very familiar and useful technology here and there were demonstrations of how to use them to charge mobile phones and other devices. Also, there was a young man demonstrating a bicycle powered maize shucker. People beat maize cobs in sacks at the moment to get the grain off the cob. The bicycle shucker is far quicker and more efficient. This young American man working in Tanzania also had an excellent command of Kiswahili, I was envious. A similar technology can be used to grind the maize, which could save people a lot of money and time as well.

While there was some medium to high technology being exhibited, much of it seemed of little interest to the places where I work, where most people don't have electricity, let alone TV or computers. Even internet cafes are expensive and slow and few people would even know how to use them, or have any inclination to do so. Technophiles forget that basic education is a prerequisite to many things, technology is just one of them.

Anyhow, there was a man from South Africa demonstrating a small (but scalable) telecommunication system which would be ideal for villages, especially where they have also looked into some locally available source of power, such as wind or solar (or a combination). It was unsurprising to find that this man had worked in development for many years and understood some of the hurdles that people face, instead of producing something that has no application in the sorts of places it was intended for.

Spanning design and craft, there were some young women who were making solar powered LED torches, which use local wood and are shaped to have a large surface available for the solar panel. The panels come from Switzerland, which probably explains the high cost of the torches. I also met a man from Malawi who had built a device that cooks ugali (maize porridge, the Kenyan staple, revered but ultimately tasteless, nutrition free and responsible for high rates of diabetes here. He was very enterprising and well informed and it's not his fault that the staple food is not ideal!). He also worked with windmills and other technologies. I'd love to see people building and using windmills in Kenya.

On the craft side of the exhibition there was some amazing ceramic work by a small company called 'Beauty for Ashes Pottery'. Most of the ceramic work I've seen here is just copies of copies churned out for tourists and it's refreshing to see genuine art mixed with this practical and indigenous skill. There was also a young design student who had pushed the boundaries of jewellery and accessory design using recycled materials and I regret not having any contact details for her. But I think the word will get around.

A man who used recycled materials to produce the most bizarre looking novelty glasses got a lot of well deserved attention. An example can be seen on the Maker Faire site at the moment, but you'll have trouble visualizing the length he has gone to in using highly unlikely materials. Other designers used well-known recycled materials to make commonly made products, but some had modified processes in interesting ways. There were the predictable accessories made from the caps of beer bottles but one woman was creating a nice effect by covering each cap with cloth so the bags, wallets, etc, looked a bit like armour plating. Very eye-catching.

On both the design and the technology fronts, there was a very noticeable presence of Kibera, people from Kibera, organizations with Kibera in their name; it's almost a brand. Perhaps in NGO-speak it really is a recognised brand. Journalists seem unable to mention poverty in Nairobi without mentioning Kibera and a handful of factoids about it. But journalists seem unable to mention anything that isn't also mentioned, frequently, by other journalists. And they don't seem able to mention things that haven't been hyped, that's just the way journalism works, it seems. They rub our faces in what we know already, perhaps in the hope that we won't notice that there is anything else.

You'd think there were no other slums in Nairobi, when in fact the majority of Nairobeans live in a slum that is not Kibera. The majority of Kenyans live in a slum that is not in Nairobi. But then, those slums haven't had films, computer games, pop videos and documentaries in them. They are not home to hundreds of NGOs and thousands of development projects. It's hard to believe that there is anyone poor left in Kibera but if there are (and I think there are many), what the hell are all these organizations and their millions of dollars doing?

I didn't get to talk to all the exhibitors, that's just a list of the ones I did get to talk to. Most were very fired up by what they were doing and they all had a spark of originality, also the desire to produce and do things that are needed, rather than copying what millions of others are doing. There was a real spirit of adventure in most of the people I met, I think anyone who meets them and sees what they are doing will want them to succeed, will want to think that they will hear more about these and other great ideas.

I suspect there are many 'makers' of all descriptions around Kenya and other African countries but they can be very hard to find. I've found that myself, other people working in community development have said the same thing. Almost all the people I talked to had some, probably good, access to the internet and other technologies, even where their work is not technological. But some of the people who organized the event have put a lot of effort into finding the best exhibitors and I think the next fair will be even bigger.

I warmly congratulate the people who organized the Maker Faire Africa exhibition and those who exhibited. I was very impressed, both with those who demonstrated things I had heard of but not seen and those who demonstrated things I had not heard of, despite searching high and low for good ideas. I hope people who can benefit from these ideas get to hear about them so that those who develop the ideas can prosper and produce more good ideas. Some people say that development must come from Africans themselves, and I agree. And there is some evidence that this is already happening.

The Ups and Downs of April for Ribbon of Hope

It's nice to get to the end of another month and find that, despite all the problems and minor disasters, there are also things that are going well. Ribbon of Hope Self Help Group has quite a number of projects that are steady, and should produce good results soon. And there are other projects that are going just as we would like them to go. One project that didn't go so well was our acre of watermelons. Due to a combination of problems, we didn't sell a single one. Torrential rains and humid weather meant that they rotted and split just when we should have been harvesting them.

But on to the good projects. Some of the people we work with recently started a rabbit project and the rabbits have been doing what they are well known for. These same people have a chicken project which was a slow burner for some time but now is producing very good results. Near the watermelon field, on the Equator near Mogotio, we have an acre and a half of maize and beans and they are doing well, despite continuing heavy rains. And all is not lost in the watermelon field. We're only a third of the way into the one year lease, we'll grow more things there. And this is only a few of the projects that Ribbon of Hope is involved in. You can read the monthly report on their Facebook page.

I have been working with several community based organisations for some time now and I always worried about how they would keep managing to implement income generation activities that would really generate income. Sooner or later, if you keep starting chicken, goat and cow projects, there will be too many eggs and hens and new projects will undermine existing ones. Yet, chicken projects and growing maize and the like are good projects for several reasons. They are relatively cheap to start, the products sell well and they can be used by the producer or sold locally.

I started to look for other income generation activities and, although I compiled quite a list, I realized that there was another way to help achieve poverty reduction. There are various ways of cutting down on day to day household expenses and I have discussed them many times on this blog. The best examples are solar cookers and cooking baskets. These and other intermediate technologies can help people to reduce the amount of money they spend on cooking fuel considerably and use the money for something else.

These techniques have many advantages, including the fact that they cost little or nothing but can save quite a lot of money over a year, especially in a big family. Ribbon of Hope doesn't have a huge amount of funding and they would like to use what they have for projects that generate money. So projects that don't generate money, that save people money, are all the more welcome if they don't cost much. And income generation activities are well complemented by techniques for cutting everyday expenditure.

I have mentioned that two support groups we work with benefit greatly from having a very active and dedicated leader. But another support group had the opposite kind of leader, one who really undermined members of the group and, as a result, all their projects flatlined or failed. Recently, the members gave him the boot and elected a new and somewhat reluctant leader. But since then, the group has gone from strength to strength. I was ready to dismiss this group at one time. But luckily my colleague persevered and helped to turn everything around.

As for some groups, we never really had to worry about their leadership. In Mogotio, we have very fine group leaders who are constantly busy with community affairs. They are trained health volunteers and they spend so much time doing voluntary work, I still haven't figured out how they ever find time to make enough money to care for their own families. Yet they do care for their families and they each care for a local orphan as well. I'd really like to know how they do it.

It's a bit of a struggle for people sometimes because, even when things go well, they can end up with other problems. If you get a good maize crop, it's probably because the whole area is producing a surplus. But if conditions are bad, you are as likely to fail as everyone else. I'd like to see people diversify away from producing maize to the exclusion of almost everything else. Also, I'd like to see people concentrating on food crops until they have enough food and spare land to start growing cash crops. Too many lose everything because a cash crop gave good yields but had to be dumped because or a lack of market or something like that.

For me, the ideal crops are food, food that is eaten locally, food the grower can use themselves, food that can be stored, food that has a good, local market, and crops that are indigenous and therefore resilient when it comes to drought, flooding and all the other common adverse conditions you get here. Crops that require expensive inputs should be left to those who can afford them. Growing a crop that is secured against hazards is far better, to my mind, than one that could make you a very good profit, if it works. Sadly, watermelons fall into the latter category.

Visiting With SAIPEH

Although I am only in Mumias on a short visit, I brought a couple of solar cookers with me, along with some black pots. I was hoping I would be asked to demonstrate the impressive, but very simple, trick of cooking food without any costly fuel. Sure enough, I was taken to SAIPEH's feeding centre, where volunteers feed 100 or more children who are orphans, in some way vulnerable or disabled. They get through a lot of fuel every day and the cost over the course of a year is in the region of $1000. This is a very sizable sum to an organisation like SAIPEH. Any way of reducing it or eliminating it would be very welcome.

There were only a few people when I got there as it was far too early for lunch. But we set up the cookers to prepare some rice, just to demonstrate. We also set up a cooker to demonstrate how you can pasteurize milk or water to make them safe to drink. Solar cookers heat things up to 80 or 85 degrees, which is hot enough to cook and to kill all bacteria. In order to show that the water had reached the required temperature, we used a WAPI (Water Purification Indicator). This is a plastic cylinder with a lump of wax inside which melts at a little over 80 degrees. The wax is at the top of the cylinder when you start, but as it melts, it slides to the bottom.

Both the demonstrations worked well, despite a lot of thin cloud. The sun was hot even though the cloud didn't shift the whole morning. The rice cooked faster than I expected, in about one and a half hours and the water was ready in about 45 minutes. People were appropriately impressed. Every time I demonstrate, I keep thinking, what if it doesn't work. But it always does, as long as it doesn't cloud over. But in addition to being impressed, I would like to think that people would adopt the technology. They always say they will, but people who have been demonstrating for a long time say most people never adopt it. So we have to wait. Given that SAIPEH pay for the fuel, perhaps they will make sure that the fuel bill is cut, substantially.

We also had the opportunity today to demonstrate cooking baskets, at least, to some extent. There were lots of banana trees growing nearby and there were deep, round baskets available. We weren't organised enough to cook anything in one, they were too small, but I think the point got across. These can really save a lot of fuel and you can use them whether it's night or day, sunny or raining. They can be made of easy to find materials, such as straw, hay, newspaper, leaves, old clothes, etc, along with a bit of sacking material if you don't have baskets of the right size.

A technology we didn't have the opportunity to demonstrate yet, we just described it, is that of fuel briquettes made from organic waste, such as kitchen waste. They are made of various kinds of waste, finely chopped and mixed so they bind into a cohesive lump. These can be dried or compressed with a simple press made of wood or metal. We haven't got a press yet but we are still hoping to get one made as a template. Then they can easily be produced by 'jua khali' workers (jua khali meaning 'hot sun', they work outside).

If you combine these three technologies and put the required amount of work in, and that's not a lot of work, you can reduce your fuel bills to almost zero. Perhaps you can eliminate them but I suspect there will always be unforeseen occasions when you will need wood and charcoal. But even a few hundred dollars a year could mean better food for existing children or more food for more children. Now that the idea is there, hopefully there will be those who want to use these intermediate technologies. I'll be checking up on them now.

SAIPEH support several hundred children and teenagers and this brings up many problems that children have when they are orphaned, disabled or in some way vulnerable. A meeting revealed that some girls are still unable to go to school when they are having their monthly periods. I felt so bad when I heard that there was even a girl who reported using leaves because she didn't have access to any alternative. But it is unthinkable that even some of them are unable to go to school because of something like this.

Some community development workers in Kenya and other African countries teach girls to make re-usable sanitary pads out of flannel or other appropriate materials that can be recovered from old clothes. They are easy to make, especially for SAIPEH, as they have a training and resource centre that teaches tailoring. Making sanitary pads would be a great thing for prospective tailors to start off with. You can start and finish several of them in a few hours. A perfect lesson plan! Again, I hope there are people willing to adopt this simple alternative to commercial disposable sanitary pads. They are very expensive and ultimately unsustainable, both economically and environmentally.

No matter how good these intermediate technologies are and no matter how appropriate they are, the main challenge is getting people to adopt them. Just being impressed is not enough. You may think that anything would be better than using leaves instead of proper sanitary pads, but these technologies have been promoted elsewhere and they haven't always taken off. For me, it's all very well doing the research and giving people the plans and diagrams, but I'd really like to crack the nut of why people seem unwilling to adopt things that seem so obviously good and how I can meet this challenge. If and when the scales drop from my eyes, I'll report back.

High Technology and Appropriate Technology

Nakuru is not far from the equator and today we travelled to Mogotio, even closer to the equator. We were there to irrigate onions, peppers and other vegetables. The irrigation process for a small shamba (smallholding) is fiddly and time consuming. The field is beside a river. The pump is petrol operated. But the process of attaching bits of pipe so that the water reaches the farthest parts of the shamba takes several people and a lot of time.

In fact, it's a process of attaching, detaching and re-attaching bits of pipe until the whole job is done. While two people add and remove pipes, two others use hoes to make furrows for the water to flow through and block furrows where adequate water has entered. Why do people not use good lengths of flexible pipe or drip irrigation?

This is a one acre shamba, the kind and size that many Kenyans own. It's for growing small amounts of produce. It's labour intensive but labour is cheap, flexible pipe and other pieces of equipment are expensive. If the shamba was bigger and more productive, we could afford drip irrigation or some other form of irrigation, but this sort of technology is beyond the means of most people here.

So I was pretty annoyed to come across an article about some 'clever' people who have developed a device which allows a farmer to SMS or call a number to turn on their irrigation system. Great, but people who can afford an irrigation system that can be switched on and off don't have to do much work on the shamba themselves. They employ people to do it. It's not the first time I have seen articles about how brilliant mobile phones are. They have their uses but most of the problems poor people suffer don't go away just because they have a mobile phone.

I also came across an article about how Uganda is using mobile phones to spread the 'message' about HIV. Do they really think their unsuccessful and very expensive programmes over the last 20 years failed because of the medium that was used? How much evidence do they need that the problem was not just with the medium?. Many people there and in other countries know all sorts of things about HIV, not all of them true. But they still engage in the sort of behaviour that is thought to spread HIV. So why should spreading the 'message' by mobile phone change anything?

Anyhow, as well as hoeing and irrigating the shamba, we were in Mogotio to demonstrate the process of solar cooking to some people there. We cooked rice, ugali (boiled maize meal) and sukuma wiki (a popular collard green). Sounds a bit starchy but Kenyans like a fair bit of starch. The result was excellent. The area is so hot that things cooked quickly. So the workers in the field were impressed at the large amount of food they were provided with and even more impressed that no charcoal or wood had been used in the cooking process.

I had my worries about the ugali. It is almost worshiped here and getting it wrong could be fatal. But it turned out pretty solid and sticky. I have tried a few other things, stew, various vegetables, even soda bread. They are very good, as long as the sun lasts. So it's time to be more adventurous and do a bit of experimenting. I have no doubt that some 'genius' will be able to invent a device that pulls a screen across the solar cooker when the food is cooked. Until then, I'll just use the time honoured process of looking at the food.

Low Emissions Cooking

The Science and Development Network had a couple of interesting articles on cookers, cookers that only require freely available, renewable fuels and cookers that produce less pollution. Environmental degradation and air pollution are serious threats in all countries but especially in developing countries.

Solar cookers have been mentioned on this blog in the past. Now a solar cooker made mainly of cardboard boxes and other cheap, accessible materials has won a prize that will fund the manufacture of the product for developing countries. It's called the Kyoto Box, after the Kyoto Protocol. It's very simple and the fact that it can be made from easy to obtain materials is important where people earn little or no money.

The inventor emphasizes the Kyoto Box's simplicity. We hear a lot of hot air about high technology solutions, such as diagnosing TB using satellite technology or supporting people on antiretroviral therapy using mobile phones. Not that there is anything wrong with these, but they are usually not accessible to people in developing countries and not appropriate to countries with poor infrastructure.

I have heard from several sources that solar cookers are a hard sell, partly because their use can disrupt a daily pattern that people are reluctant to change. For example, women (who usually do the cooking) go to the market in the morning and spend a good while there. They don't just buy and sell things, going to the market is an opportunity to gather with friends and neighbours and keep informed. Yet this is the time when you need to be cooking the midday meal, so cooking by sun may not appeal to everyone.

However, the solar cooker can be used for other things, drying fruit and vegetables. You can produce, for example, sun dried tomatoes, bananas, mangoes, dried mushrooms, fish, etc. Many products need to be sold or preserved and solar cookers can help speed up drying and preservation without requiring much labour. They can also be used for pasteurising water in areas where contaminated water causes much sickness and many deaths.

The Kyoto Box is estimated to save up to two tonnes of carbon emissions per family per year and may be eligible for carbon credits. I hate the thought that people in developing countries will be forced to subsidise the wasteful habits of people in rich countries, as they do that enough already. But I hope the availability of cheap solar cookers will help some people to reduce their daily costs and reap the benefits of a very clean and completely renewable source of fuel.

The other article was about a stove that produces less soot than conventional cooking methods. Soot is the second biggest contributor to climate change, so reducing soot production could have quite an impact on efforts to slow down climate change. Soot and other emissions from traditional cookers also give rise to health problems in the households that use them. Acute respiratory infections are responsible for around 20% of deaths in young children (another 20% being caused by water borne conditions).

This cooker is a problem because of its cost. They cost $20 to make, which is way beyond the means of most poor people, many of whom earn $2 a day or less. It remains to be seen whether rich countries are willing to pay for an intermediate technology that may help us out of the mess that we have created and continue to create.

Whether rich countries are willing to participate in reducing global warming or not, it is good to see intermediate technologies promoted in developing countries. Especially intermediate technologies that can be developed and produced in those countries without expensive materials and expertise that are virtually unavailable there. Far too much aid money is spent on advanced technologies, such as pharmaceutical products, genetically modified organisms and military projects. Spending aid money on these technologies only benefits the rich multinationals who produce them. Aid money should be spent on poor people, not rich people.

Sun Worship and Self Reliance

A couple of months ago I had the pleasure of visiting a company in Nairobi that makes, demonstrates and sells solar cooking devices of various kinds; Solar Cookers International (SCI), based in Kileleshwa. These cookers can be used for more than just cooking. They are also great for pasteurising water for consumption, heating water for cleaning, drying foods to preserve them and various other things.

This has numerous advantages: it saves money spent on fuel, prevents destruction of trees and forests, reduces people's exposure to smoke and fumes, cooks food without denaturing nutrients, cooks without dangerous levels of heat, has a very low capital outlay, employs easy to find materials, and even recycled materials, to construct.

I also had the pleasure a couple of months ago of visiting a small community based organisation called Shining Hope for Community (SHOFCO), based in Kibera. They are involved in several projects that support community members. For instance, HIV positive women come to the headquarters several times a week and make bead jewellery which SHOFCO sells on their behalf. Young girls and boys do theatre and other performances to highlight issues that people in Kibera currently face, such as violence, HIV, water and sanitation problems and the like. They also distribute sanitary towels to girls and food to families, when possible.

On Friday, Solar Cookers International visited SHOFCO and spent the best part of the day setting up and demonstrating the process of cooking by sunlight. As a matter of fact, setting up a simple cooker takes seconds, but a number of different styles of cooker were demonstrated. The food was bought and prepared and after around three hours (there was a fair bit of passing cloud to interrupt the vital process!), ten or twelve of us sat down to copious amounts of rice, vegetable, sweet potato, ugali, meat and tea. There was even lots of hot water to do the washing up afterwards.

Before the preparation started there were some sceptical faces, but everyone was fired up by the prospect of seeing this process in action and the added treat of a hearty meal. Faustine and her colleagues from SCI made sure that everyone had a hand in peeling, scraping, chopping and preparing the food. This gave her the chance to insist on rigorous handwashing and care when preparing food. By the time people had got down to the work, they had forgotten their doubts and it wasn't long before the smell of food cooking reassured the doubters.

There was then time for us to go inside and shelter from the blazing sun and discuss what we were involved in. Faustine got people to volunteer answers to questions arising about why anyone would want to use solar cookers. Indeed, people came up with most of the reasons themselves, with little prompting. There were also some welcome questions about some of the drawbacks of these cookers. For instance, what if you are in a hurry, what if it is dark or cloudy or raining?

The answer is that you can't use them under such conditions. The answer is in the question, really. You then need wood, charcoal, kerosene, gas, whatever else you can use for cooking. But even in Nairobi, where there is not all year round sunshine, you could still save yourself a lot of expensive fuel. It's just one technique. Not far from SHOFCO there are people experimenting with biogas. Others use photovoltaic panels, which allow you to charge up batteries to be used later.

When I originally visited SHOFCO I asked them what income generation schemes they had. They mentioned that they made bead jewellery, and that is the main one, at present. Just as solar cookers can't be used when it's raining, bead jewellery can't be sold when there is little or no market. Women make the jewellery but there are few tourists this year because of the post election violence last year. While it is sometimes possible to sell things abroad, markets are difficult to access and not too reliable.

It's still too early to say, but hopefully solar cookers will provide income generating opportunities for organisations like SHOFCO. They could sell, demonstrate or perhaps even make solar cookers. The market is on their doorstep. They will be selling to other Kenyans and benefiting the broader community, not just themselves. There are many other community based organisations that may also be interested in solar cooking.

But there are other technologies that save people money and can even make people money. It's just a matter of people getting together, sharing their ideas and putting them into action. After the solar cookery demonstration, the drama group went to rehearse for a performance. This performance will involve people walking through a market and stumbling upon a solar cookery demonstration. They start off sceptical but gradually see that there is something very interesting to be learned.

Before SCI left SHOFCO, members of each organisation had discussed projects that could be mutually beneficial. I hope those projects are realised. As I said, it's early, but I'll keep in touch and look forward to hearing what happens.

On a similar theme, yesterday I travelled to a village near Thika to visit an orphanage called Watoto wa Barakai (Blessed Children). There are 25 children there but a far larger number of orphans are supported while living with relatives. The place is more like a big family living on a small farm, a beautiful farm. They have cattle, pigs, rabbits and various food crops and they are expanding fast. The people running the orphanage have been very enterprising and have raised a lot of money for the expansion and development.

More importantly, they are interested in sustainability, in particular, in the area of cooking. Trees in the area are being cut down and not replaced. Fuel is expensive and the children (and adults) suffer from respiratory problems. Respiratory problems underlie a huge number of deaths in Kenya, especially among infants and children under the age of five. People running Watoto wa Baraka had already started researching potential technologies, they already have a solar shower and a photovoltaic panel to light one of their buildings. They harvest rain and consider the sustainability of all their projects.

Many people are inspired by intermediate technologies but only some adopt them, ultimately. I think Kenya will only develop if Kenya do the developing and that in many cases, the less Western countries do, the better. Perhaps intermediate technology will be one way that developing countries can become more self reliant.

Empty Pocket Finances

Firstly, the Dr X, and colleagues that I mentioned earlier were not able to come up with an estimate of how many voluntary testing and counselling facilities would be required for a country the size, population and population distribution of Kenya. In a one liner, Dr X thanked me for the question but said he didn't know. I'll keep an eye on this particular issue and hope that there are people who are able to help in this matter.

I need suggestions for ways of making money or saving money in places where there is very little money or resources. For example, I have mentioned Solar Cookers, which have numerous advantages and can be made cheaply or for free. Solar Cookers and other sources of renewable energy are sometimes referred to as 'intermediate technology'.

Another example of a way of making or saving money is the production of reusable sanitary towels using recycled materials. However, I am thinking of these for areas where there is little or electricity, such as Kibera. What would the hygiene implications be? At present, a community based organisation I am in touch with in Kibera are using donations to buy and distribute sanitary towels but they are made in China. They also distribute antiseptic wipes, but these are made in the USA.

Surely it is possible for a country the size of Kenya to produce certain products that use indigenous and perhaps even recycled materials? I know there are people who produce all sorts of things and I really need advice from them. I believe you can make soap using meat fat, ash and probably some other things. Can you use other oils, that could perhaps be produced cheaply here?

I have heard of oil producing trees in parts of India being used to make lamp oil. Here, many people spend a lot of money on kerosene. Is this necessary? Ok, if you are thinking I could just research this myself, you're right, and I will do that when I have the opportunity. But getting time online can have complications.

There's is a range of attitudes among people working in community based organisations towards secrecy and openness. Some want to talk to other people and share ideas. Others keep their ideas to themselves. Some people I have spoken to have lots of experience and they will happily share it with others. Some feel that they should be careful about what they tell other organisations who may be 'competitors'.

If there is a lot of emphasis on funding, which organisations must get from somewhere, then 'commercial' principles may be at stake and each organisation may be competing. But a major difference between non-profits and commercials is that the former aim to reduce the market, whereas the latter aim to expand it. The commercial wants to maximise sales, the non-profit, hopefully, wants to reduce suffering.

Well, maybe I'm misrepresenting things a bit, but let's look at two small community based organisations applying for 5000 pounds which is available to help 50 commercial sex workers to give up or reduce their dependence on sex. Are the two in competition? The donor could give it all to one or half to each. But would the funder suggest that the two organisations join together and share the 5000?

I suggest that the 5000 pounds could go a lot further if it's administrated by twice as many brains, but perhaps I'm hopelessly idealistic. As a matter of fact, I would like it to go on record as being idealistic, whatever about being hopelessly so.

I came to what may seem like an absurd conclusion about how a country like Kenya is going to dig itself out of the hole it is in at present. Firstly, Kenyans are going to have to do most of the digging. Secondly, they will have to do it on virtually no funding. Therefore, they need to discover something that is of very high value but costs absolutely nothing.

So the challenge is to find things that are accessible to Kenyans, have a high value and cost little or nothing. While I can see the absurdity, I think there are such things. After all, some things may seem intrinsically valuable, but other things have value because people value them. Some people value being able to convert their waste to biogas and fertilizer, some value being able to pump water using the wind, others enjoy the benefits of cooking by solar energy.

The working title for my quest is Mfuko Mtupo, the empty pocket. It can stay empty, of course, that's the point, really.

I need more suggestions, I need suggestions till they come out my ears, I need help, only free, non-monetary help, and only help that costs little or nothing to implement.

Aid is for the poor? Really?

One of the most interesting people I met last week works for Solar Cookers International. I have long been interested in solar cookers because they appear to have numerous advantages. In the field of international development this is very significant. Some people see development as being just one thing, population control, globalisation, political circumstances, corruption or whatever. I don't wish to define development but rather to say that, if the problem is malnutrition, food security is an issue, if the problem is a health risk factor such as acute respiratory infections, health is an issue, etc. They all relate to development; development is not just one thing.

Solar Cookers International make cheap solar cookers and other 'intermediate' technologies. More importantly, they give demonstrations and courses on using these technologies. This could play a part in development because it addresses nutrition, health, the environment and many other things. Using a solar oven, then, is not just a matter of cooking; it has implications for the nutritional value of the food, the environment, the economic circumstances of the user, the health of the user, the amount of time spent on domestic tasks, water and sanitation, using recycled materials and a whole lot more. Here's a partial list:

1) They don't require expensive fuel (that means time saved and less environmental degradation)
2) Reduced levels of smoke inhalation, experienced by women cooking and other occupants of kitchen
3) They preserve nutrients in the food because the food cooks more slowly
4) They can be used to pasteurise water and other utensils in areas where water may be contaminated
5) They can be used to heat water for cleaning and washing
6) Training in their use gives people knowledge about many other practical health and social issues
7) Recycled and cheap materials can be used to construct solar ovens, creating employment
8) They are light, portable and take up very little space when stored, compared to other cookers
9) They contribute to increased self reliance and self sufficiency

Another organisation I visited was called SHOFCO, based in Kibera, Nairobi. They carry out a number of activities relating to HIV, education and poverty reduction. I found their details when I was researching the use of income generation schemes as a way of allowing women to reduce and even eliminate their need to resort to commercial sex work.

Kibera is not an ideal place for solar cookers. There is not much space and Nairobi has less sun than many areas. However, there are communal areas in Kibera and there is enough sun to cook on many days of the year. Given the costs and advantages, the cost of a solar cooker would be recouped in a couple of months, perhaps less.

In addition to reducing household costs, it is possible that solar cookers could be produced by people in Kibera as a way of raising income. That's what I'm hoping, anyway. The problem is that many people adopting income generation schemes are undercutting each other's market. In Kibera, some women make and sell bead jewellery. However, there are so many people making and selling bead jewellery that it's getting harder and harder to make any money from it.

If you can't make enough money from your job, whatever it happens to be, you still need to resort to commercial sex work. If times get hard, and they are getting harder in Kibera, each woman needs to have more clients and to engage in more dangerous kinds of sexual intercourse, for example, agreeing not to use a condom. Bad economic conditions increase the vulnerability of people who are already poor, exposing them to HIV and other risks.

I look forward to meeting and hearing from others who have tried out income generation schemes of various kinds, and those who have successfully adopted intermediate technologies.
Renewable energy, of course, is not the only type of intermediate technology. Solar Cookers International also sell cheap and easy to use water testing kits. Many diseases in a country like Kenya are water borne, eg. cholera, E Coli and the many diseases caused by various intestinal parasites. Water and sanitation also play a part in the spread of malaria as mosquitoes breed in stagnant water.

If I seem to hop from one subject to another, I apologise, but these matters are all connected, really!

Cholera and Malaria relate to one of the largest sources of funding for the search to eliminate these problems; I'm referring to the Bill and Melinda Gates Foundation. Far from wishing to criticize an organisation that contributes so much to good causes, I'd like to look at disease a different way. The Gates Foundation is putting a lot of money into finding a vaccine for cholera. Yet cholera only exists where there is little or no water and sanitation infrastructure, where people don't have access to clean water.

The cure for cholera is clean water. Dying from cholera means dying of dehydration, perhaps after repeatedly drinking contaminated water. Countries who once had a problem with cholera no longer have that problem because they have addressed water and sanitation issues. A vaccine would be brilliant, except that it would not solve all the other water borne diseases, and there are many. What is the point in surviving cholera only to die of E Coli or hepetitis E?

Malaria is not so simple but again, countries that now have good water and sanitation no longer have malaria. The Gates Foundation has, quite rightly IMHO, been criticized for taking human resources from other projects, overlapping with existing health projects and distorting health funding. The Foundation has prioritised a few diseases when it's not the diseases that are the main problem. It's the risk factors, such as water and sanitation or acute respiratory infections that we should be concentrating on.

There are two other concerns that receive a lot of the Foundation's money: HIV and genetically modified crops (GM). The foundation is interested in finding a cure for HIV or treating HIV positive people and 'feeding the starving', allegedly. But only if these solutions involve intellectual property, it seems, intellectual property being something very close to the Gates heart.

Anti retroviral drugs (ARVs) and GM technologies are pieces of intellectual property. There are very cheaply produced drugs that do the same thing, but US money goes into expensive ARVs, produced by Americans in America. Does this make you think of the free condoms distributed in Mumias?

GM corn is a modified version of the corn that you see hundreds of hectares of between Mumias and Eldoret. But it costs a lot of money and it belongs to the company that produces it, not the person who grows it. A farmer can grow one crop with GM corn before buying more seed, from the GM producer, of course. Using the non GM version, they can save seed and grow corn every year.

Where was I? Oh yes, intermediate technology, such as renewable sources of energy. This technology is owned by whoever uses it. This can be contrasted with high technology, which belongs to very rich multinationals. So, would you choose a cheap technology that eradicates cholera and most other water borne diseases and has many other advantages, or would you choose a very expensive one that only eradicates cholera for those who can afford it? It only works for as long resistance to it is not developed. But then, a new version can be found, at a cost.

Finally, for those working with HIV and AIDS, I hope you have a productive World Aids Day! I'll post the news from Mumias later today or tomorrow.