water from a microbiologist's perspective

Dr. Abhilasha Karkey

These are a collection of sample water from various sources. The dirties water is from the main stone spout next to Durbar Square (Mangaa Hiti). The two next to it are also from stone spouts, the next three are from wells and the last one on the right is municipal supply water. I showed this to people but still they think it's ok to drink from the stone spout. People say "Oh yea, we let the sediment sink and it's fine." Well, I don't think so.

These are EPI strips and we use them to identify bacteria. All of them are different chemicals. You interpret them according to the change in color. I put sample water from a well in them and it identified salmonella.

nce I started doing microbiology I stopped eating with my hands. The first experiment we did was put our palms on the media and see what grows. After seeing what grows from there I stopped eating with my hands. I have hand gel everywhere.

I used to joke and call this 'my line of frustration'. We used to go to the well to get sample water for our research. Initially people were very helpful but since the study went on for a year, towards the end it was difficult. There was this long line of gagris, and in the dry season it's a lot to ask for a liter of water when there's barely any. 

financial independence

LAXMI SHRESTHA

I do not have an education. I used to sew clothes and earn some money. Even if you are not educated but if you have a skill then you can earn a living. So to represent that I sculpted a sewing machine.

SANU MAIYA MAHARJAN

It is important for women to be independent. 

Exhibition

caste discrimination around water sources

Sometimes people's drawings illustrate the stories they were thinking of, sometimes the act of drawing brought out stories of their past. 

Chan Maya Maharjan

"When I was 12 years old, I got married. My mother-in-law made me fetch water from the community well. One day when returning home, my mother-in-law threw away all the water I'd carried home from the well. The reason was, there were people from the so-called lower caste fetching water from the well at the same time, so my mother-in-law thought that one of the lower caste people might have touched the water and made it impure. As a young girl, I did not understand why my mother-in-law did that."

Badri Laxmi Shrestha

"When I was a child I went to my maternal uncle's home in Chyasal. One day my uncle asked me to fetch water from the community well. Coincidentally, one of the village girls who belonged to the so-called lower caste looked very similar to me. So the villagers thought that I was the girl from the lower caste trying to fetch water, so they scolded me very badly. I ran crying towards my uncle and threw away the pitcher and from that day never went to that well again. I experienced how unjust and terrifying it was to live as a lower caste person. These days, such acts don't occur, at least not in the city areas."

first workshop post earthquake

Just as things seemed to be calming down and resuming some form of normality, right after our morning meeting on Tuesday May 12 another big earthquake struck again. People ran into the streets and stayed in the roads long after the aftershocks have died down. Tents that had been taken down were once again resurrected, people who had moved back home once again moved into common tents in larger open spaces such as school grounds or parks. The overall mood was depressing but as we had cancelled and moved so many workshops, we decided to continue as planned and have the workshop on friday. 

Four of five members of the Nawapratiba group bravely came as planned but as there were some cracks in the building and our workshop space was on the second floor, most of us were not comfortable with sitting in the room. So we moved the workshop to the patch of cement yard downstairs and worked on the ground. As the workshop progressed it got increasingly hot and we had to share umbrellas. The situation was both funny and sad, because it was, too, one of our last workshops and time together. 

Everyone painted the sculptures they had made in the previous workshop about things in their lives they wish they'd been able to do, or about events in their lives that made a big impact on them. The dominating conversation these days revolve around earthquakes and the atmosphere is generally tense so it was a good distraction for everyone to play with colors and think about something different. 

facilitation workshop

On a cold day in the first weeks of 2015 research scientists, community medical advisors, artists and teachers all came together at Sattya’s workshop space for one of the first workshops linked to the Sacred Water project. All were interested in learning how to design and facilitate participatory workshops, a skill (or set of skills) that done well can look so easy as to go unnoticed but are valuable in ensuring participatory sessions achieve what they set out to be. The workshop was designed to introduce both a little bit of theory and some practical tools to help us in our work to bring together groups of people, draw on their knowledge and arrive a new thinking and understandings and with new found skills. 

We kicked off by scribbling our hopes and fears for the workshop onto sticky notes and sharing these as a group. Everyone came to learn more, some came with different ideas of what they wanted to do and the contexts they wanted to use their facilitation skills within. This ranged from running arts workshops, to focus groups as part of research to health education. We were an eclectic bunch. 
And why did such a range of people show up on this chilly morning? Answers from those in the room were:

•    To develop confidence in standing in front of groups
•    To think of new ways to teach
•    To translate scientific research results into practice (rather than in a lecture format) in a more effective way. 

The fears were more practical in nature, to do with our temperature, concentration spans, level of English and access to hot beverages all things that a facilitator can think through in advance or address early on. Luckily there was electricity and hot tea was on hand.

Participatory? 

The first main session delved a little into the term ‘participatory’, where it has come from and some of the values heralded to underpin participatory approaches. The word participatory is used so often nowadays that in many cases it has become divorced from the political roots, which drove its rise into our vocabulary. It is often used by people working in international development, education, communication and community based arts. The ethos of this training was to depart from the top down lecture style of interaction between an expert and a subject to something more equal which recognizes that everyone in the room has their own knowledge and experiences to share and agendas motivating them. Lena and I were facilitators for the day, aiming to draw on the diverse experiences and ideas already in the room and for everyone to have a part in the content discussed. 
In a quick ‘pair buzz’ exercise (where people speak with a partner on a topic for two minutes to get thoughts flowing) we got thinking about what words come to our minds when we think of running a participatory workshop? These were: 

Active
Focused on goals
Use of visual methods
Empowerment
Safe environment
Creativity
Non judgmental
Inclusive
Enabling people from different backgrounds
To have an open mind
Honesty
Simple language

Facilitation?

We went on to interrogate the idea of facilitation. We thought through some of the styles of facilitation, some more visible than others on a spectrum from the parent, to the role model, to the chameleon. Things got fun when we moved into an exercise designed to think through what good facilitation look like. How did we do this? By thinking up the worst kind of facilitator and their characteristics (sometimes its easier recall bad experiences than good ones). Our list was extensive:

The Worst Kind of Facilitator is…

Dominating
Speaks too much 
Doesn’t listen to other’s ideas
Short temper
Sense of superiority
Know it all
Goes off topic
Ill prepared
Discriminatory within participants
Unaware of their own behavior
Don’t know about their participant’s and their experiences and interests
Don’t provide food
Badly organized, has no structure
Bad at time management
They lie about what they know 

Turning these around we came up with our list of qualities for a good facilitator (one helpful participant suggested that we just stick not or don’t at the beginning of each term or phrase).

Participants both devised their own ground rules, got to know one another by drawing one another’s personal history timelines and also got immersed in a rich picture exercise to depict all the things that are flowing in and out of a workshop and influencing the direction it could take. The participatory environment cannot be considered a vacuum. Outside issues could have a strong influence on the process from the amount of sleep participants managed to have the night before to whether or not they are caught up with a personal outside of the workshop space or if they have enough sugar in their blood. Some of these things are within a facilitator’s control and some aren’t, some are easy to gauge and others less so. 

We focused in on group dynamics as something a facilitator might be able to handle. We did this through a problem tree exercise (where a group explores the root causes of a problem and the possible actions, solutions). One participant facilitated and the others played various roles and personality types. People picked their roles from the proverbial hat and ended up with: the observer, the quiet person, the dominant person, the person that needs support, the facilitator. The teams picked their own problems to generate problem trees from and came up with one about bandhs (strikes) in Nepal and another about religious intolerance.  

It was only towards the end where we got onto thinking about the sort of tools that are useful to have in the facilitator’s toolkit and when and how these might be useful. Too often the tool is the first thing we like to think about, however, tools are only as effective as the skills (and the attitude) of the craftsman and a good craftsman wouldn’t pick up a spanner when she needs a paint brush. 

Small groups read through a few examples and came up with some of their favourite activities from the discussion handouts. These were:

1-Graffiti wall 
A tool which, allows individuals to write or draw their comments and suggestions when inspiration takes them on a designated wall or paper. What is written can then be used to generate group discussion.

2-Water walks 
This idea came from a project designed to work with teenage girls in Nigeria, which saw a suite of activities held around water sources. Since walking to the well or pump and collecting water is an activity which takes up much of a girls day and where girls are able to walk peacefully with a friend and discuss their lives in private this is a space and activity where girls feel safe and have the time and space to discuss new things. The project set up mats for the girls to sit on near the water source itself and discussion sessions, drama events and role model meet and greats were run. http://www.girleffect.org/media?id=3213 

3-Future Visioning. ‘A perfect day’
This again comes from the Girl Effect toolkit (http://www.girleffect.org/media?id=2986) and enables the facilitator to understand the lives of the participants and what matters to them. Participants are asked to use their imaginations, close their eyes, and let the facilitator guide them through the task of envisaging their perfect day, a day where they are happy and everything goes right – it can be anywhere they can imagine (encourage to think of a different place to encourage context shift) 
What would happen at each point in the day? 
What would the city/place look like? 
What would a perfect day be like when they first woke up 
How would they feel?
What would they be doing? 
Who would they be with? 
I think we all liked the positive spin and the use of creative imagination, which this tool encourages.

4-Transect community walks
This is a tool used a lot in rural participatory project interested in the use of land and the environment of the participants. The idea is to describe farm characteristics and changes by touring someone’s environment. This can be a piece of farming land or the local streets. Management issues such as variations in cropping patterns, issues with drainage, cracks in the pavement can be documented in detail along with the participants observations and comments. At the end of the exercise the findings are relayed back to the participants and discussed or diagramed. The process of walking and talking again is thought to be useful in jogging thoughts as well as developing an appreciation for the environment in which participants live. 
We were nearly finished but we needed to ask one more thing of our flagging brains. Lena and I needed to know how this day packed with exercises and thinking had been for trainees. We took themes from the hopes and fears from the first exercise of the day and posted these on the wall. Then everyone took sticky dots and together ranked how the workshop had addressed these from incredibly happy to outright upset (depicted by smiley or not so smiley faces down the x axis). Everyone seemed to be walking away with something they thought they could use in their everyday work and some were inspired to do things in new ways. The ranking exercise gave us mostly smiles as did people’s faces as we waved goodbye and started clearing up the pens, sticky notes, dots and other paraphernalia, all things participatory facilitators know and love but would rather not have to clear up!

your body, my body, our bodies

One of the first few activities that we did with all participants was the body mapping activity. Participants were asked to draw a body part that they love, a body part they think is particularly important to them, and a body part they have health issues with. 

We warmed up with a few quizzes about the body before starting on making the body outlines. 

The results varied from quite general to very personal. Identifying specific body parts allowed people to be more comfortable with talking about their own bodies and health, as well as tell stories about themselves and their loved ones. 

The boy parts people like either symbolizes activities that they're able to do such as think (head), see (eyes), express (mouth), make (hands). Sometimes, people like a body part simply because of the way it looks, such as their beautiful hands or nose. 

Some health issues people have are very personal, but many are common such as backaches resulting from childbirth, bending down to wash clothes or having to carry heavy buckets of water up and down the stairs. Because the body and parts are not made to be in proportion the resulting combined figure were sometimes comical, and in that way helped everyone relax and talk freely about their relationship with and perception of their body. In a small group, we were comfortable to share.  

Sun, New Talent, Friendly, Friend's Groups

Of the 24 people who showed interest at the introduction session at the municipal 23 people ended up actually coming to the workshops.

We divided everyone into 4 different groups of 5 to 6 people. In response to people's requests we placed those who were in the same women's group together so that they could walk together to the workshops. For the women, it was important for them to be able to take part with their friends. Most people were active in their women's group but came from varying backgrounds, some were grade school teachers; others married at a young age and never had a chance to go to school; some had shops that they take care of; others were housewives. All were Newari ethnics but of varying casts. There were some younger participants but many already have grandchildren.

The women named their own groups: Saathi Samuha (Friend's group), Milansaar Samuha (Friendly group), Nawapratiba Samuha (New Talent group), and Surya Samuha (Sun group).

The workshops took place on Fridays and Saturdays and each group met twice a month on alternating weeks. Bidhata facilitated 2 groups and Mahima the other two. 
Here are some photos from each group's first workshop in January.

Friends group (Saathi samuha) 

Members of the New Talent group (Nawapratiba samuha) making family maps

Friendly group (Milansaar samuha) introduction activity

Sun group (Suriya samuha) cutting and pasting

Setting up (part 3) - Creating a space

After looking at a number of locations for workshop space, I was happy to learn a room in the Sattya Media Arts Collective building opened up at the end of December. Sattya is a resource center for creatives and activists. They have had many projects such as Kolor Kathmandu and recently the Bato ko Cinema that works towards making media and arts more accessible to people; bringing awareness as well as encouraging people to express and shape their communities. As 'Sacred Water' more or less has similar wishes, naturally, it made sense to chose this place as the base for the project. The workshop room itself is small but we have the rooftop space and Sattya has also been very generous to offer to lent us their bigger workshop room if it was available when we needed it. 

Here're a few photos of the entrance to Sattya and our workshop space, and the surrounding neighborhood. We are right behind the Zoo. 

Because of the cold we had the floor carpeted and got a few tables and cushions. 

And voila, workshop space, ready to go!

Setting up (part 2) - Finding participants

The info session happened according to plan. The Lalitpur Office helped us invite 40 women from amongst the thousands of women volunteers in the area that worked with them, and Aneeva from OUCRU-NP helped me order some snacks for all participants. 

Saturday is a day off but Mr. Ashok and a technician from the Municipal office came to help us set up. They were extremely helpful and let us use a spacious meeting room on the roof, equipped with projector and screen. 

The day was overcast and it was drizzling slightly. By 2pm, the announced starting time, only two women showed up. We were a slight bit nervous but started joking about how 'Nepali time' was different from official time. We got tea delivered to keep everyone warm. By the time tea arrived more women showed up, so we ordered more tea. Then more women came, so we had more tea. The room was starting to look cozier as people filled in. 

Finally at 2:30 I started my presentation. There were 24 women representatives in the room, several staffs from the Municipal, and Sian, Amit, Niva and Aishana from OUCRU-NP, and Mahima, one of the artists who will be leading the workshops. 

At one point I mentioned the fact that lots of people drink straight from the hitis and never get sick and asked everyone "Why do you think?" The immediate outpour of opinions took me by surprise. These women were very active and eager to express their thoughts. Some people mentioned that there were filters in the spouts, others said it was because they had grown up drinking the water and thus was immune to it. 

Thanks to Niva's fantastic translation I could see nods as I went through the slides and gave examples, drawn from 'Dekha Undekha' and JWDC, of how they could express themselves and tell their stories through arts. 

By the end of the talk we had to pick participants for the 12 spots in the workshop and drew a lottery for those interested. By the time the selection process was over every woman in the room was interested in participating and asked if they could take turn going to the workshops so that everyone would have a chance. Mahima proposed alternating schedules and everyone agreed. So in the end, instead of having 12 participants attending the workshop once a week, we now have 24 participants, each attending twice a month. 

As people were leaving, two women came up to me and said "We liked the presentation. We also want to express ourselves."

View from the to top of the Lalitpur City Office where the meeting room was.

Setting up (part 1) - Acquiring permission

In order to get official permission for the project we had to submit a proposal to the Lalitpur Sub-Metropolitan City Office. 

I had gone to their office with Amit and Sian in October and submitted a project outline as requested to the person who had agreed to support us at the beginning of November. Unfortunately, this person left her post within the month, so we returned to the City Office last Monday to re-introduce the project to the Chief of the Social Welfare Division, Mr. Ashok Shrestha. Our project seemed well-received and we were asked to submit a letter of intent on top of the project outline which I did the following day. 

If all goes well, we will organize an information session to introduce the overall project to all involved parties including science researchers, workshop artists and potential women participants on Saturday, January 3rd, 2015. The office will help us invite interested women volunteers from Chyasal, Sundhara, Bagalamukhi and Mangalbazar, which researches from OUCRU-Nepal have identified as neighborhoods most at risk of enteric disease due to contaminated water, and we will invite interested science researchers from Patan hospital, and the two workshop lead artists, Mahima and Bidhata. 

Lalitpur Sub-Metropolitan City Office

Areas identified by OUCRU-NP as at high risk of typhoid infection.

The components of a Gaa hiti

HITI - hi means running, and ti (from tila) means conduit. Hiti actually refers to the conduit made from burnt clay and sometimes wood in this complex water system, but overtime people generally use simply hiti to refer to these spaces as a whole.  

GAA HITI - are hiti that are built below road level, so that the spouts can align with natural or manmade underground water conduits leading water from tanks or reservoirs. They comprise of 1 or more spouts built against the wall, set about a meter above ground. 

HITIMANGAA - are intricately carved stone spouts often depicting creatures and gods relating to water. They are highly artistic as well as carry religious functions. 

DWHON - is the outlet drain that takes the excess water downstream or to places where they can be used for irrigation. The drainage system is a very important and their being able to function is key to the survival of the hiti as a clogged hiti can collapse. 

ATHAH - meaning washer bowl, and acts as a distribution bowl. Some conduits have filtration systems engineered into them, where filtered water are then distributed through the bowl. I'm still not entirely clear how the bowl functions, and it seems the athah at the Mangaa Hiti is a recent replacement and is no longer in use. 

All of the terms above are from the Newari language, and their functions are mostly based off of descriptions in the UN-HABITAT publication "Water Movement in Patan" 2008. It's a recommended read if you're interested in knowing more about water situations in Patan, as well as the hiti. 

Mangaa Hiti, built around 570 AD, at the Patan Durbar Square on Mangal Bazaar

What is enteric fever?

A study published by the Oxford Clinical Research Unit Nepal in 2008 mentioned that Kathmandu was considered the enteric fever capital of the world. By the time I arrived in Kathmandu in October 2014, I am told the number of infected cases have decreased significantly this year.

It is worth mentioning that precisely because of Dr. Abhilasha's studies on the presence of Salmonella Typhi and Salmonella Paratyphi A in water sources around Patan, including those collected from the hiti that sparked this project. There is substantial effort in studying illnesses caused by poor sanitation and contaminated water, but not enough is known about the complex relationship people have with the hiti, which aside from providing water has many other religious and social functions. 

So what is enteric fever? 

After some research for my own understanding, the following is a breakdown of the sickness in layman terms. 

Enteric fever, or typhoid, is a bacteria infection that can spread to other organs. It can be critical if not treated, particularly in children and young adults. It is caused by Salmonella enterica and its subdivisions Paratyphi A, B, and C. In Nepal S typhi and Paratyphi A are mainly responsible for outbreaks. 

'Bacilli of typhoid fever from a culture' Photo from the Wellcome Library, London. CC By 4.0

Typhoid spread when people ingest food or water contaminated by feces of an infected person. This happens when the infected person serve food or water without washing their hands after defecation, or when insects and house flies spread the bacteria in places with poor sanitation and open sewers by landing on waste material and then on food or drinks. The disease also spread quickly when water sources for consumption are contaminated by sewage or waste water. Below is a fantastic illustration from 1939 showing water in a well become contaminated from the Wikipedia page for typhoid fever.

'An illustration showing various ways that a water well (center) may become infected by typhoid fever bacteria' 1939. Illustration from the Vore Sygdome; Bind II, side 116. PD

Typhoid outbreaks mostly occur in poor areas with low sanitation. Because it only spreads from human to human, it can be prevented by improving sanitation and hygiene. The simple act of washing our hands after using the bathroom can help prevent infection.

In the case of Nepal, the influx in rural people moving into the city in recent years created overcrowded unhygienic living conditions and water shortage. Rural people also lack resistance to bacteria present in the valley and are more susceptible to getting ill. The religious function of the hiti as well as old habits also make the act of drinking straight from the spouts very common and accepted. In the case when water from these hiti are badly contaminated, a large number of people, consequently, become ill. 

Mangaa Hiti, built around 570 AD, at the Patan Durbar Square on Mangal Bazaar

Hiti - The names

Hiti is the traditional water supply system in the Kathmandu valley with an attached tap (mostly carved from stone) channeling water from underground sources or other water reservoirs to public spaces, often built under street level, where people come to collect water. The system is at least  1500 years old but are still in use today providing daily water supply to a substantial part of the population, particularly the urban poor.

Hiti have undergone many name changes. In the Lichhavi period (400 - 750) it was called Kirti, meaning merit, referring to the merit received in the act of building something essential to life. In the late Lichhavi period it was called Pranali. From the Malla period (13th - 18th century) it is popularly referred to as Gaahiti, Hitigaa, Lonhiti, Ihohiti, or simply Hiti, in the Newari language, and Gairidhara, Makaradhara or Dhunge Dhara in Nepali, literally meaning stone stream. 

Because this elaborate system was built by the Newar people, natives of the Kathmandu Valley, I will hereby refer to this system as hiti. Hi meaning moving, and ti is an abbreviation of tila, meaning conduit.

Mangaa hiti, built around 570 AD, at the Patan Durbar Square on Mangal Bazaar