This is a jackfruit tree

Aren't they interesting? This was taken outside of a beautiful hotel in downtown Thanjavur where I took a break to go swimming and eat a grilled cheese sandwich this weekend. So good on the sweet bread that's standard around here. Sort of like Hawaiian bread back home.

Oh yes, and we are doing work too. Visual proof of a session with ICTPH staff above.

Mostly lots of writing for our intervention plan. We seemed to have narrowed down our options to a few different intervention ideas:

-point of access purification plus an educational component about the purification device...so some device to put at the water taps where people get their water. Ideally this would be a device that is produced and maintained locally so that the intervention also contributes to local economic growth.

-point of use purification and storage techniques plus an education component about the device and/or techniques ...so some device or storage techniques to keep water clean once it's in the home.

-an education campaign about proper use of oral rehydration solution for children with diarrhea. we learned that while ORS is readily available, there is a gap in the way in which parents are instructed to use it.

Each idea has significant pros and cons. Ideally we would want to focus as high on the delivery system as possible (i.e. at the point of access versus at the point of use). This means less work for people and is more of a structural change. However, it does not guarantee that water will be kept clean once it's in the home. It also relies on an outside actor maintaining the intervention.

Point of use interventions require small, but significant behavior changes. I keep thinking of it in terms of obesity in the US-- people know that they should eat healthier to avoid all kinds of disease, but they don't. I wonder if it's similar with water treatment. People know they should (people report giving sick kids boiled water), but it's an inconvenience, or treated water tastes bad, so they don't do it.

Education campaigns about treatment would seem to be pretty effective, but they are focusing on kids who are already sick. Would be nice to break the cycle to being with.

While this is just a 40,000 foot outline of what we've been talking about, it does illustrate some of the tensions and questions that keep arising. How do you focus limited resources--on an intervention that would most likely be successful but not break the cycle of the problem, or on an intervention that might break the cycle of the problem, but might fail? Is it effective to continue to design and implement piecemeal projects and interventions--would a greater impact be had if we pooled all our resources to fix the cracked pipes that are likely causing contamination (assuming they are)? Then how do we ensure this is sustained when some water also gets contaminated in the home?

And what role do cultural practices play? We've already seen that just building toilets doesn't mean that people will feel comfortable using them (or that the resources are available to keep them nice so that people will want to use them)...so how do you, in a sensitive and effective way, tell people that their behavior is contributing to the occurrence of disease? And how do you build a sustainable way to ensure the benefits of changed behavior become obvious?

We keep coming back to these basic questions, but can't seem to find any ground breaking answers...maybe those questions are outside the scope of building a concrete, simple(ish) intervention that can easily be implemented and measured...