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Much of the cash they do have goes for four- to eight-dollar visits to the village health clinic to cure the boys of diarrhea caused by bacteria and parasites they regularly get from the lack of proper hygiene and sanitation and from drinking untreated river water. At the clinic, nurse Israel Estiphanos said that in normal times 70 percent of his patients suffer waterborne diseases—and now the area was in the midst of a particularly severe outbreak. Next to the clinic a white tent had arisen for these patients. By my next visit, Estiphanos was attending to his patients wearing high rubber boots.

Sixteen miles away at the district health center in Konso's capital, almost half the 500 patients treated daily were sick with waterborne diseases. Yet the health center itself lacked clean water. On the walls of the staff rooms were posters listing the principles of infection control. But for four months a year, the water feeding their taps would run out, said Birhane Borale, the head nurse, so the government would truck in river water. "We use water then only to give to patients to drink or swallow medicine," he said. "We have HIV patients and hepatitis B patients. They are bleeding, and these diseases are easily transmittable—we need water to disinfect. But we can clean rooms only once a month."

Even medical personnel weren't in the habit of washing hands between patients, as working taps existed at only a few points in the building—most of the examining rooms had taps, but they were not connected. Tsega Hagos, a nurse, said she had gotten spattered with blood taking out a patient's IV. But even though there was water that day, she had not washed her hands afterward. "I just put on a different glove," she said. "I wash my hands when I get home after work."

Bringing clean water close to people's homes is key to reversing the cycle of misery. Communities where clean water becomes accessible and plentiful are transformed. All the hours previously spent hauling water can be used to grow more food, raise more animals, or even start income-producing businesses. Families no longer drink microbe soup, so they spend less time sick or caring for loved ones stricken with waterborne diseases. Most important, freedom from water slavery means girls can go to school and choose a better life. The need to fetch water for the family, or to take care of younger siblings while their mother goes, is the main reason very few women in Konso have attended school. Binayo is one of only a handful of women I met who even know how old they are.

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