The Weight of Water

Women in the developing world carry the global water crisis on their shoulders. Two Emory experts—one in microfinance, the other in public health—are determined to lighten the load.

Think about waking up tomorrow morning in a house with no running water. No hot shower for you to step into, no toilet to flush, no tap to fill the coffeepot, no sink to fill the dog's water bowl. The only water you ever have is what you collect from a community spigot, which sometimes works and sometimes does not. Or from a water truck, which often runs out before you reach the front of the line with your jerrycan. Or from a small lake nine miles away that serves as both water source and sewage dump. Every drop you use, you carry. You are well accustomed to the weight of water.

"There's no shortage of water in the world, only safe water," says April Rinne 96C of, who returned to her alma mater in early March to speak about women, water, and microfinance.

She flashes a photo on the wall from a recent trip to Cambodia. A young girl is kneeling on the porch of a ramshackle waterfront stilt house in Siam Reap, a northern village. Two wooden rowboats moored with rope float beside her in a marshy, narrow river snaking by her home.

"Where do you think this girl and her family go to the bathroom?" Rinne asks, addressing a packed auditorium in White Hall. "I'm not sure, but I have a guess."

An astounding one billion people lack access to safe drinking water, says Rinne.

In developing areas, it is routine for human or animal waste to contaminate an entire village's water supply: One child with dysentery. One well that's too shallow. One latrine that floods.

Women bear the brunt of the world's safe water and sanitation crisis, but they also have the will and the social networks to create workable solutions, says Rinne, flashing to another photo of women in Bangladesh mapping out a water system for their village.

All they need is a little capital.

As global director of's WaterCredit initiative, Rinne oversees programs with microfinance institutions in India, Bangladesh, Kenya, and Uganda, and is exploring water and sanitation needs in Cambodia, Indonesia, Peru, Bolivia, and Colombia to see where expansion could have the most impact.

"Microfinance is just one tool in the tool box, not a panacea or a silver bullet, but it absolutely works," she says. "More than 85 percent of microfinance clients globally are women. Banks consider women better bets."

WaterCredit loans (nearly fifty-two thousand so far, totaling $6.1 million) are currently offered for household water and sewerage connections, toilets, sinks, tube wells, and rainwater harvesting equipment. The average WaterCredit loan? $120. The global repayment rate is 97 percent.

Rinne, who lives in San Francisco, is a textbook overachiever with a Zen streak. She's a Fulbright Scholar with a degree in international studies and Italian studies from Emory, an MA from the Fletcher School at Tufts University, and a JD from Harvard Law School. She has been a director of venture development and an associate in a law firm, and guided hiking and bike tours all over the world. She likes to do handstands in exotic locales—on the top of mountains and beside temples. She also moves in some pretty heady circles: Matt Damon cofounded and is actively involved in publicizing the organization's efforts; she was named a Young Global Leader by the World Economic Forum (honorees this year include Salman Khan, the founder of Khan Academy, and Grammy-winning singer John Legend, founder of the Show Me campaign). And she's a member of the board of directors of the World Wide Web Foundation, which is exactly as cool as it sounds—its mission is "to advance one Web that is free and open and to extend the Web's benefit to all."

Rinne considers herself a finance expert, not a water activist. But she has learned a good bit about water and sanitation—or "watsan," as it's known in the sector. And these things she knows: water's a problem, it's a problem that affects women and the poor disproportionately, and it's going to get worse. Water stress or scarcity is predicted in forty-eight nations by 2025.

Higher cost for the poor

If you are collecting water for your family, Rinne says, you are, almost always, a woman. In most of the world, men do not concern themselves with collecting the family's water; that is still women's work: a wife's duty, a mother's responsibility, a girl's chore. Men do other things, but women collect the water. The vessels they fill and transport provide cooking water, drinking water, washing water.

In many parts of the world, water is the most valuable commodity and costs accordingly, with the highest prices being reserved for vended water. "The world's poor pay on average five to fifteen times more for water than their middle-class neighbors," Rinne says.

Developed countries are not immune. Right now, most Americans pay less than $3.75 for every thousand gallons of water delivered to their taps. But the infrastructure of the US water supply is outdated and crumbling, and will cost approximately $1 trillion to replace or repair during the next twenty-five years. Water bills will triple in some areas. Regions will become possessive of their fresh water sources. Water will not be the sure commodity it once was for anyone.

In an op-ed piece Rinne wrote for the Washington Post that ran in February, titled "Women, Water, and the Ugly Global Crisis We're Not Talking About," she said, "Water wars, impending water conflicts, water stress (not enough water in many places, too much water in others) is daily news. . . . But women and girls bear the overwhelming majority of the global water and sanitation burden. They are the ones pulled and kept out of school, rendered unable to take on productive work, and trapped by the gender and financial dynamics of this crisis."

Rinne is driven to help by a pressing feeling that life is fleeting. She learned the value of each day, and the immutable nature of time, in a brutal way: both her parents were killed in a car accident when she was an Emory student. She received the call while in England on an exchange program and flew home immediately. When she returned to Emory, her Italian professor, Judy Raggi Moore, informally adopted her and made her part of her family. They remain close, and Rinne stays with her during visits to Atlanta.

"Emory was so fundamentally important to my survival as a person," she said, during a Skype interview from Phnom Penh. "At the age of twenty, I developed this whole sense of, if I died tomorrow, have I done the things I wanted to do?"

Her father, a cultural geographer, had raised her with "a map of the world in my back pocket," so traveling became both his legacy and her continuing education plan: "To constantly go and explore and gain a deep appreciation of how other people live."

Sometimes Rinne sees girls like the one in Siam Reap, about the age of her nieces, and she thinks how much better their lives could be with such small improvements: a faucet, a private latrine. "Water is so basic, it's appalling that humanity as a whole hasn't been able to see it for what it is and allocate it in an equitable way," she says. There are more cell phones in the world than toilets, a statistic Rinne finds both ironic and alarming. "Sanitation can be summed up in one word: dignity," she says.

Flying toilets and grimy latrines

Fewer than one in three people around the world has a toilet, says Christine Moe, director of Emory's Center for Global Safe Water and the Eugene J. Gangarosa Professor of Safe Water and Sanitation in the Rollins School of Public Health. Where public latrines are available, they are often dirty, germ-ridden places without hand-washing options. When Moe visited Accra, the rapidly growing capital of Ghana, she spoke with groups of women outside the city's latrines.

"Some of the public toilets we visited were really awful, and we were agreeing that it's not proper for women to have these kinds of conditions. Even though they are poor, they understand they deserve privacy and dignity," Moe says. "Disgusting public latrines, what type of solution is that?"

Destined to become known as the "water woman," Moe started her graduate training in environmental microbiology and later added a minor in infectious disease epidemiology.

After graduating from college, she spent time as a VISTA volunteer in an Appalachian coal mining town. Moe remembers seeing toilet paper draping the bushes beside a narrow creek that ran between the houses and the railroad tracks. That was the beginning of her fight to bring safe water and sanitation to those who can least afford it yet most need it.

Moe first came to Atlanta as a postdoctoral fellow in the Division of Viral Disease at the Centers for Disease Control and Prevention (CDC). As a scientist, she focuses on the environmental transmission of infectious agents, specifically waterborne, and oversees a microbiology lab at Rollins, studying noroviruses, the pathogens that cause the "stomach flu."

After coming to Emory in 2000 to teach and conduct research, Moe took over the Center for Global Safe Water, a landmark partnership among Emory, CARE USA, Georgia Institute of Technology, The Carter Center, and the CDC. The center's international team is engaged in finding solutions for problems at the intersection of water, sanitation, and hygiene.

The lack of latrines or toilets in developing countries, she says, affects women more than men because it's easier for men to go to the bathroom. In many countries, it isn't acceptable for women to relieve themselves in the daylight, so they must wait, going outside either very early in the morning or late in evening to find a private location.

About half of all girls worldwide attend schools that don't have toilets. "This is why a lot of girls drop out when they are adolescents and start their menstruation," Moe says. "They don't go to school on the days they menstruate. They stay home for privacy and to avoid embarrassment."

A dearth of safe water and sanitation also leads to rampant diarrheal disease, which strikes mainly children under five. "It's almost always the mother or grandmother or older sisters who take care of that child," says Moe. "The consequences fall on women disproportionately from many different angles."

Moe, along with Emeritus Professor of Global Health Eugene Gangarosa, taught a short course during Emory's last winter break on water and sanitation.

"There has been huge growth in the number of students interested in these issues," she says. "Some students tell us that the reason they came to Rollins was because of the Center for Global Safe Water."

The center has consulted with the city of Atlanta, which has the smallest watershed in the nation for a metropolitan area of its size, and loses an estimated 17 million gallons of water a day due to leaks. Working with officials in Gwinnett County, Moe has tested a wastewater plant for its capacity to remove viral pathogens from Lake Lanier.

Globally, the center's funded projects total more than $13 million, with field research in Kenya, Ghana, Rwanda, Honduras, and Mexico.

Several new projects have been funded this past year. The largest, supported by a $2.5 million grant from the Bill and Melinda Gates Foundation, studies ways in which individuals are exposed to human waste in cities of the developing world. In summer 2011, the Gates Foundation officially made sanitation its top priority, given that many groups already are working on water.

Poor sanitation practices can expose large numbers of people to fecal contamination through the environment, drinking water, and food. In urban areas, small plots of land with crops are often irrigated with raw sewage water.

Tanker trucks pump out septic tanks and public latrines and take the waste to the coast to dump. "They are discharging the excreta they suck up from public latrines directly into the ocean," Moe says. "The beaches downstream have heavy contamination."

In cities that are exploding with population growth, millions of residents might have no sewage system at all, just open drains, and a large proportion of the population uses dirty public latrines or "flying toilets" (plastic bags).

In field visits, Moe has discovered brand-new latrines being used to store grain and wastewater treatment plants left idle because of a broken pump.

Simple composting toilets could solve many of these sanitation issues, says Moe. She is particularly proud of a partnership with Georgia Tech students, who are helping to design new latrines with solar panels for improved composting.

Several prototypes were constructed and built to reach higher temperatures for complete pathogen inactivation, and the start-up company Sanivation was formed, based on research done at Emory and Georgia Tech. This year, Sanivation sold its services to the largest NGO in Chile, Un Techo Para Chile.

One common problem with latrines is what to do once they get full, but these solar latrines could make the waste into harmless compost.

Social webs offer solutions

Whether in the city or the countryside, the most sustainable water and waste solutions tend to be homegrown, taking into consideration the culture and the specific needs of the population.

"One of our alumni in Haiti, who is now with Deep Springs International, told us about a local woman, Madame Evelyn, who through sheer force of personality gets everyone in her community to use chlorine to treat their drinking water," Moe says. "That's the flip side of women being most affected—women also have the knowledge, influence, and motivation to be the movers and the shakers behind these solutions."

It's never as simple as "buying a toilet or digging a well," says Rinne, since the community needs to be vested in maintenance and upkeep. Microfinance can create sustainable systems that become self-perpetuating.

"Money you put into the hands of women tends to find its way to children, education, nutrition, and health," Rinne says. "Women are embedded in the social web. They are the family managers and community mobilizers. Women are a good investment."

Water is draining women's ambitions.

If you feel this is overdramatization, try an experiment. Turn off your taps. Go collect water from the nearest natural source you know. Carry it home. Clean and cook and bathe with it. Figure out how to make it safe enough for your children to drink. Dispose of your family's waste without contaminating any water supply. Now do this every day.

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