DESEA Peru provides comprehensive community health solutions to rural communities near the Sacred Valley, Cusco, Peru. DESEA has a three-pronged approach which includes:
Community Health Workers
Community Health Programs
This integrated approach is significantly reducing mortality and morbidity rates in project areas, particularly for mothers and young children.
DESEA constructs biosand water filters in its Lamay workshop, which are installed in homes and schools with the assistance of community residents. We educate residents in the importance of clean drinking water and safe hygiene and sanitation practices and in the use and maintenance of their biosand water filter. Through on-going filter monitoring and education carried out by DESEA’s community health workers (qhalis) and nurses DESEA achieves a correct filter usage rate greater than 90%, measured one year after installation.
The CAWST Biosand Filter
Concrete biosand water filters, designed in the 1990’s by Dr. David Manz of the University of Calgary, have been refined and promoted since 2001 by the Centre for Affordable Water and Sanitation Technology Through its comprehensive extension and training programs, CAWST has fostered adoption of this technology at locations throughout Africa, Asia, and the Latin American-Caribbean region.
In 2008 and 2009 DESEA constructed and installed 150 of the CAWST–design concrete filters, but found them too heavy to move to the less accessible homes, those which were most in need of improved drinking water.
DESEA’s Biosand Filter
In 2011, DESEA director Sandy Hart, with assistance from volunteers Matt Hastie and Pat Teti, designed a biosand water filter using 315 mm (12”) PVC pipe, which adheres to the geometry and efficacy of CAWST’s widely-tested concrete filter, but weighs only 10 kg. The PVC model has been tested in-house by DESEA, by NGO Soluciones Prácticas (Sicuani, Peru), and by the Peruvian Ministry of Health. These filters have now been installed in over 250 households and schools in DESEA’s project communities, many of which would have been too inaccessible for concrete filter installations.
How does a biosand filter work?
The biosand water filter involves slow percolation of water within a 90-cm, free-standing concrete or plastic container of fine sand (with a biologically-active layer at the sand surface) and lower, drainage layers of gravel. Based on in-house and independent studies, CAWST reports that biosand filters are able to remove 95-99% of bacteria; 90% of viruses; and 99.99% of parasites (including Giardia, Cryptosporidium, other protozoa, and helminths). DESEA’s PVC filter provides up to 15 litres/hour of treated drinking water.
Filter Installations and Training
DESEA constructs the PVC filters in its Lamay workshop and transports them to the communities. Filter recipients then assist with transporting the materials to their homes, washing of the sand and gravel media, and installation of their filter. Residents also participate in a mandatory training course relating to water filter maintenance and safe hygiene and sanitation practices. Monitoring of the filters is carried out initially by the DESEA nurses in the company of qhalis, and later, by the qhalis independently. Continuous family and community contact is a vital element of DESEA’s approach. Fully acquainting community residents with the link of drinking water quality to human health and with the importance of safe hygiene and sanitation can be a very gradual process. Through the long term, DESEA’s qhalis will provide this on-going support, while maintaining contact with DESEA staff and other government and non-government medical services.
DESEA’s PVC Biosand Water Filter Manual
A manual describing construction and installation of DESEA’s PVC water filter is available on our Downloads page (scroll down).
As a grassroots NGO, individual donations are vital to our activities – if you are able, please help support our water filter work and the translation and publication of materials.
Health Conditions in the Project Areas
Indigenous (or campesino) people of the Andes have some of the poorest health outcomes in Latin America. Overall, Peru has the second highest maternal and infant mortality rates in South America, and the remote Andean communities have rates significantly higher than the national average. In DESEA’s project areas, living standards are very low, particularly at the higher elevations where the climate is harshest and agricultural production is poorest. Families typically live in crowded adobe buildings with rustic furnishings, poor smoke ventilation, no access to potable water, no telephone service, frequent access to homes by domestic animals, and, in many cases, no functional latrines. Drinking water sources at streams, springs, or shallow wells are frequently contaminated by fecal coliform bacteria, parasites, and other pathogens.These adverse living conditions, together with limited access to health care services, have produced very high rates of illness and mortality, especially for under-five children, mothers, and the elderly. To address these issues DESEA Peru has implemented a comprehensive water treatment and community health program in the project communities.
DESEA Peru nurses provide a comprehensive, community-based health program strongly rooted in health promotion and illness prevention that is significantly improving health outcomes. In project communities, since the initiation of DESEA’s healthcare model, there have been no maternal or under-five child deaths from preventable illnesses. As well, there has been a significant decrease in diarrheal disease and pneumonia and a significant improvement in nutrition in children and pregnant and lactating women.
DESEA nurses provide bi-weekly clinics in each community, seeing patients, wherever they are encountered, thereby providing a realistic and respectful approach to community members who live long distances from the nearest Ministry of Health clinics. With the direct involvement of qhalis (community health workers), DESEA Peru nursing staff provide on-going instruction to families, schools, and community groups in water filter use, hygiene and sanitation, nutrition, and healthcare practices. DESEA nurses and qhalis also work in conjunction with the Ministry of Health medical health clinics and assist with Ministry of Health programs such as their monthly health days and dental campaigns.
The term qhali is derived from the Quechua expression qhali’kaypac llank’sun meaning working for health. Qhalis are women who are elected by their community, in collaboration with DESEA, to train and practice as community health workers. A primary goal of this program is to train the qhalis to provide sustainable family health education and support. The qhalis serve as the sole health providers who are permanently and immediately available to their communities.
DESEA has developed an innovative program for the training and activities of qhalis which does not require literacy or numeracy, challenges which face most local women. During their first year the qhalis receive more than 200 hrs of healthcare training, using theater, hands-on practice, art, and interactive learning, all presented in their maternal tongue of Quechua. In following years they participate in continued workshops together with newly-selected qhalis and they provide family education both by themselves and in the course of community visits with DESEA nurses.
Qhalis are trained in a wide range of health issues affecting their communities, including: advanced first aid; reproductive health; prenatal health; postnatal/neonatal health; care for sick children; chronic health conditions; care for the elderly; traditional medicine; occidental medicine; water filter installation, monitoring and maintenance; hygiene and sanitation; nutrition; mother and child stimulation; tuberculosis; alcoholism; domestic violence; and leadership and social change.
At the end of the first year of training each qhali will be able to:
- teach hygiene and sanitation practices to families, groups, and school classes;
- instruct families and schools in biosand water filter operation and maintenance;
- monitor and maintain all community biosand filters
- provide emergency first aid;
- measure and interpret basic vital signs and assess basic health conditions;
- know when to seek medical assistance;
- supervise use of basic medications, including tuberculosis medications;
- dispense basic medications such as acetaminophen, ibuprofen and antibiotic creams;
- clean and dress wounds;
- support community members who need hospital services;
- advocate for improved community health services.
DESEA’s Qhali Training Materials
DESEA has developed a series of modules for the health educator to train illiterate community health workers. These modules and accompanying teaching aids, currently in draft form, will be available for download here. As a grassroots NGO, individual donations are vital to our activities – if you are able, please help support our qhali training work and publication of materials.
Community Health Programs
When community members are empowered through respectful and effective educational programs, positive health changes can be realized. DESEA community health programs are managed by the DESEA nurses and qhalis (community health workers) and include:
Maternal and Child Health Program
The maternal and child health program, operated by DESEA nurses and qhalis, consists of the following:
- Prenatal health – The qhalis visit all prenatal patients on a monthly basis to provide reproductive and maternal health education and birth preparation and they arrange for all prenatal patients to be visited by DESEA nurses. Basic health monitoring of prenatal patients can be done directly in the patient’s home including Doppler fetal heart monitoring and urine testing. DESEA qhalis and nurses also work in coordination with the Ministry of Health to ensure that patients are given the support they need to birth in licensed birthing centres. All prenatal patients are supplied with maternal multivitamin/mineral supplements.
- Postnatal/neonatal health – Qhalis monitor all postnatal/neonatal patients in the community, visiting new mothers and babies on days 1, 3, 7, 14, 21, 28, and 40. Concentrating of frequent visits during the first 40 days postpartum had helped to decrease mortality and morbidity rates in these populations. In addition to monitoring the patients, qhalis provide education regarding newborn care, and help to support new mothers with household chores should they be without help (a common problem in the communities as the father is often out of community for work-related reasons). Qhalis arrange visits by the visiting DESEA nurse, and encourage new mothers to obtain medical checkups in the Ministry of Health postnatal program. All postnatal women are maintained on a multivitamin/micronutrient supplement while lactating, until their child is one year of age.
- Reproductive health – Qhalis support women in making healthy choices about birth control and child spacing through educational materials that do not require literacy, and in helping women to monitor their monthly cycle using DESEA’s innovative bead-monitoring method. DESEA nurses provide Ministry of Health contraceptives in patients’ homes. This approach has greatly improved patient compliance and child spacing. Qhalis also identify newly pregnant women helping to make sure that they are started immediately on prenatal vitamins, if they were not previously using these supplements. Women who want to become pregnant are started on a multivitamin/micronutrient prior to pregnancy if at all possible.
- Ministry of Health height and weight program – DESEA staff supports the Ministry of Health monthly child height and weight monitoring program with translation services and nursing assistance in their monthly campaigns, and twice yearly Ministry hemoglobin campaigns which screen children for anemia. Additionally, the qhalis help with patient registration and organization for the monthly Ministry of Health campaigns.
- Educational sessions and workshops – DESEA nurses provide education sessions to mothers during monthly Ministry Health clinics on a wide range of health topics. As well, DESEA nurses provide day-long workshops to groups on topics such as child stimulation and traditional medicines. DESEA also distributes graphic materials for families (which do not require literacy) covering a wide range of health topics pertinent to health conditions in the Andes.
- Medical campaigns – DESEA organizes and facilitates visiting medical specialists from Canada and the United States, offering health services directly in the project communities. Ministry of Health staff participate in these campaigns, often learning new and different techniques and treatment possibilities. Maternal and child health, as well as elderly patients are key areas of focus during our medical campaigns.
School Health Program
The school health program is managed by DESEA nurses and involves students, teachers, and qhalis.
- Filters – Each school receives a PVC biosand filter, ensuring that clean water is available to students, particularly during their school lunch program. Students learn the importance of filters and clean water at school, and thus can help to support filter use in their homes.
- Hygiene and sanitation – Yearly handwashing programs are offered in each classroom and help to emphasize the importance of safe hygiene and sanitation practices. DESEA provides each classroom with an interactive training program plus soap and towels. Qhalis continue to monitor school handwashing throughout the school year.
- Dental Health – DESEA’s dental health program includes dental health education and distribution of toothbrushes and toothpaste. When possible, DESEA works in conjunction with the Peruvian Ministry of Health dentist, assisting with fluoride treatments, and patient support during dental extractions and cavity repairs.
- Acute Health Care – DESEA nurses are in each community biweekly and watch for viral outbreaks and monitor health within the school. Children with acute health concerns are attended by the visiting DESEA nurse.
- Vitamin supplements – children under six are maintained on a children’s multi-vitamin which is dispensed daily by their teacher.
- Educational programs – DESEA nurses provide educational programs on a number of health issues including first aid and reproductive health.
The Vitamin Program
Through a donation by US-based NGO Vitamin Angels, DESEA maintains all women of childbearing age, and those that are pregnant or lactating (with a child under one-year-of-age) with a daily multivitamin/micronutrient supplement. When breastfed children reach one year of age, the mother is discontinued from a lactating vitamin and the child is started on a multivitamin and continued on this supplement until six years of age.