Tim Cunningham, BA, MSN Candidate Rebeccca Dillingham, MD, MPH Nisha Botchwey, PhD

Water Scarcity in Limpopo Province According to the National Water Resource Agency in South Africa, the water management area that includes the province is 36 million m 3 of water in deficit as of 2000.

According to the National Water Resource Agency in South Africa, the water management area that includes the province is 36 million m 3 of water in deficit as of 2000.

Water Collection and Quality in Limpopo Province Quantitative testing for fecal coliforms and diarrheagenic pathogens reveals unacceptable levels in surface water, stored water, and in prepared weaning foods . Similar pathogens found in patients with diarrhea both in the community and in the hospital. Obi et al. Water Sci Tech 2003 Potgieter et al. J Health Pop Nut 2005 Samie et al. JASTMH.2006

Quantitative testing for fecal coliforms and diarrheagenic pathogens reveals unacceptable levels in surface water, stored water, and in prepared weaning foods . Similar pathogens found in patients with diarrhea both in the community and in the hospital.

Obi et al. Water Sci Tech 2003

Potgieter et al. J Health Pop Nut 2005

Samie et al. JASTMH.2006

The Challenge To engage students, faculty, and other partners at UVa and UNIVEN to create innovative solutions to ensure access to water and sanitation & to improve water-related health outcomes in Limpopo Province.

To engage students, faculty, and other partners at UVa and UNIVEN to create innovative solutions to ensure access to water and sanitation & to improve water-related health outcomes in Limpopo Province.

UVA Center for Global Health Microbiology Nursing Hydrology Planning UVa student projects Univen J-term participants Univen research fellows UVa faculty mentors and researchers Univen Institute for Global Health Community clinics and hospitals Engineering Nursing Medicine Environmental Science Sustainable Infrastructure Systems Environmental Planning UVa summer study abroad BI-DIRECTIONAL EXCHANGE Local non-governmental organizations Engineering Students without Borders SAVANA

“ Learning through Photos” A Photovoice Assessment of Water Perceptions Limpopo, South Africa

Community Statistics Population: 1855 Households: 265 Households w/o sanitation: 189 Governance: Chiefdom/Consensus Oral traditions: Few written records High Unemployment: Reliance on Municipality support

Population: 1855

Households: 265

Households w/o sanitation: 189

Governance: Chiefdom/Consensus

Oral traditions: Few written records

High Unemployment: Reliance on Municipality support

Targeted Populations Members of Selected Community Members of the Vhembe Region of Limpopo South Africa Model for a Qualitative Approach in Other International Settings

Members of Selected Community

Members of the Vhembe Region of Limpopo South Africa

Model for a Qualitative Approach in Other International Settings

Methods: Photovoice

Background “ Photovoice blends a grassroots approach to photography and social action. It provides cameras not to health specialists, policy makers, or professionals, but to people with least access to those who make decisions affecting their lives.” Caroline Wang (2005). http://photovoice.com/background/index.html Retrieved June 15, 2008. Developed in 1992 by Caroline Wang, working with Dr. Mary Ann Burris at UC Berkeley. Implemented throughout the USA and in China with various populations. Focused on a topic, but open for individual interpretation of the topic at hand  Empowerment.

“ Photovoice blends a grassroots approach to photography and social action. It provides cameras not to health specialists, policy makers, or professionals, but to people with least access to those who make decisions affecting their lives.”

Caroline Wang (2005). http://photovoice.com/background/index.html Retrieved June 15, 2008.

Developed in 1992 by Caroline Wang, working with Dr. Mary Ann Burris at UC Berkeley.

Implemented throughout the USA and in China with various populations.

Focused on a topic, but open for individual interpretation of the topic at hand  Empowerment.

Methods: Grounded Theory Developed by Glasser and Straus, 1967. Awareness of Dying. Deductive Qualitative Method Codify, Conceptualize, Categorize, Theorize Borgatti, 2008. http://www.analytictech.com/mb870/introtoGT.htm Use of Grounded Theory in data assessment Individual and Group Interviews to Codify Incorporation of Photos to Conceptualize and Categorize Final Report will Suggest Theory of Water Perceptions in Community

Developed by Glasser and Straus, 1967. Awareness of Dying.

Deductive Qualitative Method

Codify, Conceptualize, Categorize, Theorize

Borgatti, 2008. http://www.analytictech.com/mb870/introtoGT.htm

Use of Grounded Theory in data assessment

Individual and Group Interviews to Codify

Incorporation of Photos to Conceptualize and Categorize

Final Report will Suggest Theory of Water Perceptions in Community

Process: Project Length: 21 Days on-site

Project Length:

21 Days on-site

Process: Buy - In IRB Approval Community Meetings “ No Promises” Privacy, Confidentiality

IRB Approval

Community Meetings

“ No Promises”

Privacy, Confidentiality

Process: Photo Training

Process: Shooting Photos

Process: Individual Interviews Individual Interviews Voice Recordings Transcription Validation Grounded Theory Analysis

Individual Interviews

Voice Recordings

Transcription

Validation

Grounded Theory Analysis

Process: Group Interviews/Debrief

Process: Group Presentation Empowerment Voice Photo Gallery

Empowerment

Voice

Photo Gallery

Results

Results: Quantitative Participants: 13 Photos Taken: 317 Avg. amount of photos taken per person: 24 Selected photos: 22 Enlarged photos: 13 Number of initial interviews: 13 Avg. length of initial interviews: 18 minutes 4 second Number present at group presentation/debrief: 10 Avg. length of group photo/storytelling: 3 minutes 21 seconds Length of project in country: 19 days Length of project in village: 14 days Age Range: 51 years (26-77) Median Age: 38 Average Age: 43.5 Gender: 7 M, 6 F

Participants: 13

Photos Taken: 317

Avg. amount of photos taken per person: 24

Selected photos: 22

Enlarged photos: 13

Number of initial interviews: 13

Avg. length of initial interviews: 18 minutes 4 second

Number present at group presentation/debrief: 10

Avg. length of group photo/storytelling: 3 minutes 21 seconds

Length of project in country: 19 days

Length of project in village: 14 days

Age Range: 51 years (26-77)

Median Age: 38

Average Age: 43.5

Gender: 7 M, 6 F

Results: Qualitative (Coded Groups) Infrastructure/Storage 80% Community 61% Money 53% Food 40% Health/Hygiene 38% Pain 23%

Infrastructure/Storage 80%

Community 61%

Money 53%

Food 40%

Health/Hygiene 38%

Pain 23%

Infrastructure/Storage

Community

Money and Nourishment

Health/Hygiene

Pain Other themes: Naming Gender differences Deferral to Elders Pride Public Speaking

Other themes:

Naming

Gender differences

Deferral to Elders

Pride

Public Speaking

Barriers/Biases Interpretation Time Cameras without Flashes Volunteer Selection Age

Interpretation

Time

Cameras without Flashes

Volunteer Selection

Age

Discussion Certificates given to Particpants WHIL project Next Steps Value of Photovoice in a Quantitative Context Value of Qualitative before Quantitative

Certificates given to Particpants

WHIL project Next Steps

Value of Photovoice in a Quantitative Context

Value of Qualitative before Quantitative

Sustainability

“ Such approaches to managing the water supply must be evidence-based, sustainable, affordable, equitable, and acceptable to the local community.” Barry, M & Hughes, J.M. (2008). Talking dirty – the politics of clean water and sanitation. New England Journal of Medicine. 359:8, 784.

“ Such approaches to managing the water supply must be evidence-based, sustainable, affordable, equitable, and acceptable to the local community.”

Barry, M & Hughes, J.M. (2008). Talking dirty – the politics of clean water and

sanitation. New England Journal of Medicine. 359:8, 784.

“ Cross-disciplinary efforts…are promising ways to recast the conventional disciplinary lines so that the expertise of the university can be harnessed on complex interdisciplinary challenges.” -Jeffrey Sachs, Common Wealth “… we need to encourage a certain attitude among our young scientists: that while some of them stay with their own specialty or discipline, some others among them should work in an integrated way across disciplines. Their voice would be the one most likely to be heard, with the least confusion, to the policy makers in government.” -Nobel laureate, Norman Borlaug

“ Cross-disciplinary efforts…are promising ways to recast the conventional disciplinary lines so that the expertise of the university can be harnessed on complex interdisciplinary challenges.”

-Jeffrey Sachs, Common Wealth

“… we need to encourage a certain attitude among our young scientists: that while some of them stay with their own specialty or discipline, some others among them should work in an integrated way across disciplines. Their voice would be the one most likely to be heard, with the least confusion, to the policy makers in government.”

-Nobel laureate, Norman Borlaug

Ro Livhuwa, Thank You Special Thanks to: Rebecca Dillingham, MD, MPH Nisha Botchwey, PhD Vhonani Netshandama, RN, PhD Doris Greiner, PhD, RN The UVA Center For Global Health The UVA Schools of Nursing, Medicine, Architecture and Engineering