Saving Lives by Making Water Safe to Drink

Environmental engineer Amy Pickering is leading a test to see if a simple way to bring clean water to low-resource communities improves health outcomes
A woman leans over a blue chlorine dispenser in a village while small children look on. Environmental engineer Amy Pickering is leading a test to see if a simple solution to bringing clean water to low-resource communities works
Amy Pickering checks to make sure there is liquid chlorine in one of the chlorine dispensers in the study area. Photo: Courtesy of Amy Pickering
February 5, 2020

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In poor countries around the world, more than 800,000 children under five die each year from diarrheal diseases—more than AIDS, malaria, and measles combined. “Diarrheal disease is the second leading cause of under-five child mortality globally,” said Amy Pickering, Tiampo Family Assistant Professor of Civil and Environmental Engineering at Tufts. “And it’s completely preventable.”

Diarrheal diseases are caused by pathogens, including rotavirus and typhoid, in drinking water. Now Pickering is co-leading a study to test if community chlorine dispensers could eliminate those pathogens and greatly improve child mortality.

“It’s depressing to think that the simple act of providing safe water can still save so many lives, but it really can,” Pickering said. “If you can find interventions to reduce diarrhea and deliver them at scale, you could potentially have big impacts on child survival.”

Pickering studied biological engineering as an undergrad at Cornell, and received a master’s in civil and environmental engineering at Berkeley in 2004. Her first experience with developing water treatment for low-resource communities was in Sri Lanka after the 2005 tsunami, when she joined an effort to restore clean water to refugee villages.

“I fell in love with this kind of work, including interacting with people and tinkering around with a technology to figure out how best to make it work for a particular setting,” she said. She later earned a doctorate in Stanford’s interdisciplinary Ph.D. program, combining engineering with global health.

Engineers have an important role to play in public health, she said. “Improving global health is about big societal problems, and engineers are well trained to solve problems.” She came to Tufts last year for a position specifically focused on environmental health in low-income and vulnerable populations. “It was perfect for me,” she said.

When it comes to water safety in poorer countries, many engineering projects have just focused on the lowest-cost solutions without taking ease of use into account, even though that factor could lead to widespread adoption of a particular solution by the community.

One program, for example, encouraged households to treat water by putting plastic bottles on the roof to be disinfected in the sun—a process taking up to eight hours. “So you have a very long delay and a lot of effort for water that’s not that pleasant to drink,” Pickering said.

By contrast, her lab focuses on projects that balance cost and ease of use. “The idea is to make water safe coming out of the tap by default, which I think everyone deserves to have,” she said.

She first began working with chlorine water dispensers six years ago, collaborating with an NGO called Evidence Action, which has installed more than 27,000 dispensers in villages in Kenya, Malawi, and Uganda, where they now provide access to clean water for more than four million people, at the cost of about $1.25 per person per year.

The bright blue dispensers are placed at community water sources such as springs or wells, and automatically combine the proper amount of chlorine for a twenty-liter jerry can, the most common container for water in the area.

When the dispensers were first installed, Pickering and other researchers created a controlled experiment to investigate if children in villages with the dispensers and handwashing stations had better health outcomes after two years. This year, one of the NGO’s founders, Nobel Prize–winning Harvard economist Michael Kremer, contacted Pickering to help measure the dispensers’ effect on child survival.

“Amy is an enormously creative researcher who has done very exciting work in the field that I expect will make a tremendous difference for global health,” Kremer said. “She brings deep knowledge of water and health in the developing world, the ability to understand local context, and the ability to work in an interdisciplinary way.”

The ambitious study, funded with a $580,000 grant from the Sint Antonius Foundation in the Netherlands, has been sending trained Kenyan volunteers to more than 700 villages in rural Kenya to conduct interviews at tens of thousands of households.

The first goal is to find all mothers who have given birth in the past five years. Once these mothers are identified, they’re asked if their children survived, and if not, how they died. The volunteers also test to see if the households used chlorine-treated water. Julie Powers, a Tufts Ph.D. student working with Pickering on the project, has spent five out of the past seven months living in Kenya and working closely with REMIT, the local organization conducting the field work.

Originally, Kremer and Pickering predicted they would find 20,000 mothers in the study area; they’ve since updated that figure to more than 40,000, and they’ve received an additional $270,000 from the foundation to complete their work. “It’s a huge study,” said Pickering. “It’s the largest data collection effort I’ve ever been involved in.”

Right now, the study is blinded, so the researchers don’t know the results; if it shows that the dispensers have no effect on child mortality, then it could help save thousands of dollars from being wasted on ineffectual treatments. Pickering is hopeful, however, that the dispensers will prove effective.

She pointed to non-experimental studies that suggest chlorine does cut down on childhood death from waterborne diseases. If the study she and Kremer have undertaken shows similar results, it could help influence future government and nonprofit efforts to improve health in rural areas, not only in Kenya but beyond.

“It’ll be exciting to have rigorous evidence that chlorination at the point of collection could have this benefit for child survival,” Pickering said. “It could potentially mobilize resources to save a lot of lives around the world.”

Michael Blanding is a Boston-based freelance writer.