KIBERA , Kenya -- The government clinic gets a shipment of water purification tablets every three or four months. In a week or two the tablets are gone. And then the people here in this rambling slum on the edge of Nairobi are on their own.
So how bad is that? This is one of those places around the world where the water can make you very sick. But, just like a lot of other places, it doesn't always make you sick. Many people are convinced that the water is fine, or almost fine. People take the purification tablets because they are free. They don't routinely use them, just like they don't routinely boil their water. Most people in Kibera don't have toilets and that adds to health problems.
The worn, reddish clay hills of Kibera are packed with tin-roofed shanties. The stench of sewage is strong in the air . Little clouds of smoke from charcoal cooking fires and burning garbage sting the eyes. The slum is a microcosm of horrible conditions in much of the developing world. The United Nations estimates that more than a billion people in places like Kibera -- and places that are not nearly so extreme -- don't have consistently safe drinking water piped into their homes or within easy walking distance. Perhaps 2.5 billion people don't have toilets. This adds up to a lot of sickness and about two million deaths every year. Over the last decade or so the situation has improved only slightly and it may very well get worse as the world population relentlessly rises.
Governments in many developing countries pay very little attention to clean drinking water and toilets and I could see from conversations in Kibera that there is little or no demand for improvement from many people living with iffy-water and unspeakable sanitary conditions. They don't see a problem with their water. Some non-governmental organizations put a lot of energy into water and sanitation. But the going is tough.
In Kibera I sat on a railroad bridge with two men in their 30s who said they work from time to time as laborers in Nairobi. They said they were never sick because of the water. Just about everyone I spoke with said the same thing. Dolith Okello has set up a sports bar with four television screens in a three-room shack that she calls the Miami Inn Café. Ms. Okello, who roots for a British soccer team and speaks colloquial English, said the water never made her sick either.
"We don't boil our water and we don't get sick," she told me. "There are diarrhea outbreaks, but they're not related to the water. It's because we don't have proper latrines and we don't have proper garbage disposal. "
She thought a little more about water having nothing to do with diarrhea in Kibera and added: "That's 75 percent no and 25 percent maybe. "
At the hot, dusty government clinic, Joyce Omune, a registered nurse who is in charge, said most of the patients are very young children. "Number one on the list" of problems," she said, "is diarrheal diseases." There are five other nurses, two of them registered nurses, and no doctors. There is no electricity. The paint is peeling. Each morning about 60 children are brought in with diarrhea, Ms. Omune said. One day like that would be a crisis in the United States and Europe.
Dr. Onesmo K. Ole-MoiYoi, a Kenya n graduate of Harvard University and an expert on disease in East Africa, said the problem in Kibera was almost certainly a result of "drinking contaminated water." Malnutrition, he said, makes children more susceptible. In turn, frequent diarrhea contributes to malnutrition, said Dr. Linda K. Ethangatta, a former United Nations nutritionist .
Some treated municipal water lines flow into Kibera, but the pipes are corroded and sewage seeps in. Middlemen routinely intercept the water and sell it. People end up with just enough to get by. They don't wash their hands often enough. There are garbage and filth everywhere. Flies dip into open sewers, then dance on fish and chunks of meat sizzling in open pots.
During surges of diarrhea, Ms. Omune said, people ask for purification tablets. "But when things settle down," she said, "they go back to their old routine of just using the water the way it is."
Ms. Omune said several non-governmental organizations had conducted campaigns to help people understand the bad things that can happen with drinking water. But there is still a lot of work to do here and around the world. And most of it is not getting done.