Improving the Sanitation and Hygiene of the Kara-Koo Family Group Practice

Below you will find a much more detailed explanation of the project we will be undertaking at the hospital (Family Group Practice) in my village. Please read below and check out the pictures, budget, and the other information. If you can help out financially please follow the link to the indiegogo life page to donate. If you do not have the means to assist financially you can share this blog post and the indiegogo life link within your network and encourage other to donate or share. My counter part, Jangyl Niazieleva and I thank you very much for your help. It means so much to her, as her place of work and career and to me, finishing up my time here in Kyrgyzstan.

The Family Group Practice (FGP)

The Family Group Practice (FGP) is located in Kara-Koo village, Tong Rayon, Issyk-Kul Oblast, Kyrgyzstan. The FGP is the primary health care provider and hospital for the Ak-Terek village region, consisting of six villages with an estimated population of eight-thousand. The FGP consists of three sectors: a maternity ward, a general care facility, and a dentist. The FGP has thirty-eight staff members and sees about ninety to one-hundred patients a day between all three sectors.

The Need

The FGP lacks the necessary facilities for it to run in a hygienic manner. This is a result of the lack of running hot and cold water, the lack of proper cleaning facilities, and the lack of sanitary toilets. The FGP has plumbing throughout, however the piping has rusted through and is no longer usable. Only two of the existing sinks in the FGP are in a usable condition, but they only have running water when the village has running water. The village has a water station that provides the village with water, but there is only water for three to four hours a day. The two sinks that do work at the FGP therefore only operate during those three to four hours a day. The FGP must have water to function. Currently, each of the three sectors has a cleaning woman who is responsible for carrying in buckets of water from the nearest working water source every morning. Depending on the season the nearest source may be in the yard of the FGP; however, in the winter that source freezes so these women must walk two to five minutes away to a street pump. They are only able to carry two buckets at a time so these women end up making several labor intensive trips a day to haul water to the FGP. During this time they are unable to focus their time on keeping the FGP clean and sanitary. Since there is not running water, most of the FGP’s rooms have portable sinks that store water in the top, and, using your hands, you push on a lever that disperses the water while you are washing your hands. These work, however in the winter the water is ice cold making basic hand washing a chore. There are also no working sinks in public areas for patients to use after they have used the outhouse. Some of the rooms even lack a portable sink so the staff uses recycled bottles to store water in for hand washing. This system is inadequate since one hand must be used to pour the water from the bottle over the other and proper hand washing is impossible. The gynecologist at the FGP uses this system, but she will sometimes go to her home so she can properly wash her hands. The FGP also lacks proper cleaning facilities. All dirty bed sheets and other linens must be brought home and hand washed since the FGP does not have the facilities for doing so. There is also no way for patients to bathe if they are having an extended stay. All women remain at the hospital for three days after giving birth in Kyrgyzstan, but aside from the cleaning the nurses do mothers are unable to bathe properly until after leaving the FGP. Lastly, there are no sanitary toilets at the FGP. Outside of the FGP there are several simple pit latrines. These are not sanitary, can be difficult to use if you are sick, and act as breeding grounds for flies. The lack of running hot and cold water compounded with inadequate cleaning facilities and the absence of sanitary toilets creates an environment that is susceptible to spreading many diarrheal and other preventable diseases.

Recycled plastic bottle used for hand washing

A portable sink used for hand washing

The Solution

In order to improve the sanitation and hygiene of the FGP, the existing plumbing will need to be replaced. All of the existing piping will be removed and replaced with modern piping. Thirteen new sinks and small water heaters will be installed in thirteen of the FGP’s rooms. One existing shower in the maternity ward will be restored to operating condition and one new shower and water heater will be installed in the general care facility. A new automatic washing machine will be installed in the maternity ward that can be used for washing bedding, the staff’s uniforms, towels, and other linens. The FGP already has the plumbing connections necessary for toilets, and they will be repaired so that they will work properly when there is running water. The FGP has an existing septic system that is in working condition, but the pipes leading to the outside of the FGP will all be replaced since they are rusted through in numerous places. The solution to the village only having running water three to four hours a day is to install two large reservoirs on the second floor of the FGP. A pump will pump water from the village water source into the reservoirs, and from the reservoirs, water will flow to the rest of the FGP. The reservoirs will be accessible for routine cleaning and have emergency shut off valves between the pump and the piping leading to the rest of the FGP. The installation will be done in a way that will allow for an easy transition to the village water source in the event that the village water source will one day provide constant running water. The reservoirs will be large enough not only to provide the FGP with water during the working hours when the village water is not running, but also provide water for the FGP for several days in the event that the village water system is not working, which happens occasionally. This solution will greatly improve the sanitation and hygiene of the FGP. It will also reduce manual labor and the amount of time the staff spends fetching water. Having hot water to use for hand washing, bathing, and the washing machine will allow for more thorough cleaning to be done in order to reduce the spread of germs and improve sanitation and hygiene. The sinks in the bathroom will be available for anyone in the FGP to wash their hands properly after using the indoor or outdoor toilets.

Implementation

The FGP and the local government will pay for all increased electric costs due to the water heaters and pump. The FGP will not have any increased fees for using more water since they do not charge for water used in the village. The FGP will provide soap, cleaning materials, detergent, toilet paper, and all other disposable resources used in the everyday operation of the new facilities. In the event of a pipe break or other unexpected plumbing problem the FGP has a man on its staff with the knowledge and tools to fix it. Three people will be responsible for the labor involved in the project. They are all knowledgeable in plumbing and building. Once funds are secured the first step will be to purchase materials from Bishkek, the capital. A truck will be rented to bring the materials to the village. From the time construction begins, it is estimated that it will take the three men twenty working days to complete the project. 

Plan of hospital showing sinks, hot water heaters, showers, and toilets that will be installed

Detailed Budget

Over the next month we will be adding video, photo, and other updates. Please if you are able to donate to this project follow this link and if you cannot donate please share this information within your network.  

Thank you very much for your support and helping to make a major difference in my community here in Kyrgyzstan!