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We walk another ten minutes upstream, and Binayo claims a perch next to a good pool, one fed not only by a dirty puddle just above but also a cleaner stream to the side. Children are jumping on the banks, squishing mud through their feet and stirring up the water. "Please don't jump," Binayo admonishes them. "It makes the water dirtier." A donkey steps in to drink from the puddle feeding Binayo's pool. When the donkey leaves, the women at the puddle scoop out some water to clear it, sending the dirty water down to Binayo, who scolds them.

After half an hour it is her turn. She takes her first jerry can and her yellow plastic scoop. Just as she puts her scoop in the water, she looks up to see another donkey plunk its hoof into the pool feeding hers. She grimaces. But she cannot wait any longer. She does not have the luxury of time.

An hour after we arrive at the river, she has filled two jerry cans—one for her to carry back up, one for me to carry for her. She ties a leather strap around my can and puts it on my back. I am grateful for the smooth leather—Binayo herself uses a coarse rope. Still, the straps cut into my shoulders. The plastic can is full to the top, and the 50-pound load bounces off my spine as I walk. With difficulty, I make it halfway up. But where the trail turns steepest I can go no farther. Sheepishly, I trade cans with a girl who looks to be about eight, carrying a jerry can half the size of mine. She struggles with the heavier can, and about ten minutes from the top it is too much for her. Binayo takes the heavy jerry can from the girl and puts it on her own back, on top of the one she is carrying. She shoots us both a look of disgust and continues up the mountain, now with nearly 12 gallons of water—a hundred pounds—on her back.

"When we are born, we know that we will have a hard life," Binayo says, sitting outside a hut in her compound, in front of the cassava she is drying on a goatskin, holding Kumacho, who wears no pants. "It is the culture of Konso from a long time before us." She has never questioned this life, never expected anything different. But soon, for the first time, things are going to change.

When you spend hours hauling water long distances, you measure every drop. The average American uses a hundred gallons of water just at home every day; Aylito Binayo makes do with two and a half gallons. Persuading people to use their water for washing is far more difficult when that water is carried up a mountain. And yet sanitation and hygiene matter—proper hand washing alone can cut diarrheal diseases by some 45 percent. Binayo washes her hands with water "maybe once a day," she says. She washes clothes once a year. "We don't even have enough water for drinking—how can we wash our clothes?" she says. She washes her own body only occasionally. A 2007 survey found that not a single Konso household had water with soap or ash (a decent cleanser) near their latrines to wash their hands. Binayo's family recently dug a latrine but cannot afford to buy soap.

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