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the AVON ladies of Kenya, but their wares are far from beauty products. Instead they sell lifesaving interventions: a chlorine solution to disinfect water, mosquito nets, condoms. They go door-to-door or sometimes set up simple shops. They are drawn from the Society for Women and AIDS in Kenya (SWAK), and these women give emotional support and home care to those with AIDS and the widows and orphans left in its wake.
     When CDC went looking for a way to market a safe water intervention in Kenya, it found an untapped resource in SWAK. The Safe Water System (SWS) combines treatment of contaminated water with a chlorine solution, safe storage, and follow-up education. (See related story, Safer Water) CDC wanted to get the SWS intervention to the peri-urban communities and remote villages that needed it the most. How to reach the poorest of the poor in one of the poorest countries in the world? How to reach those with the worst health outcomes, the worst sanitation practices, collecting the most polluted water from the farthest distance?
     CDC staff conceived of engaging local women to sell the purifying chlorine solution. CARE provided the initial training and products, and the SWAK marketers were in business. With access to start-up capital from a Kenyan micro-credit organization, they bought the products wholesale and sold them retail. They started small, selling the chlorine solution to neighbors, then slowly expanded their product line to include protein-fortified flour, mosquito repellent, ointments for HIV sores, condoms, and other health items.
     “Empowering women may be the way to go,” says CDC scientist Rob Quick, who helped developed the SWS. “We want to make them the most effective Avon ladies they can be.”
      That’s where the Center for Global Safe Water (CGSW) and the Global Environmental Health (GEH) program at the Rollins School of Public Health (RSPH) come in. Faculty and students at the school have helped in the evaluation of the Safe Water System implementation in Kenya. For example, in the summer of 2003, RSPH student Shelly Bratton traveled to the shores of Lake Victoria to compare different strategies in changing water treatment and storage behaviors. Of various community groups and nongovernmental organizations promoting the initiative, the highest adoption of the SWS resulted from the efforts of the SWAK marketer, according to the evaluation.
This summer, fellow GEH students Matthew Freeman and Dan Abbott followed Bratton’s path to Kenya to do further studies on water behaviors there. Freeman, working in the western Nyanza area, found SWAK’s influence was leading to high adoption rates (up to 40% in some cases) of the chlorine solution in communities they targeted. “These groups are targeting areas that wouldn’t otherwise be reached by large-scale social marketing, due to their distance from commercial centers and low economic status,” Freeman says. “Through SWAK, the community members take the initiative and become involved in raising awareness, as opposed to outsiders who may not fully understand local issues and perceptions.”
     Abbott carried out his research further south in five communities near Homa Bay. During the three months he lived there, he coordinated a survey, administered in the Luo language by native interviewers, of 540 households in these five communities.
      Abbott found the distribution system for the chlorine solution around Homa Bay varied, including two communities where CARE had trained groups of marketers, one community where volunteers from a local organization distributed the product, and two areas where there were commercial advertisements but no distributors. For Abbott, one surprising finding was that areas with advertising through radio and wallboards showed a higher recognition and uptake of the water products than the areas where an active distribution system was under way. Although Abbott and Freeman had not completed final analysis of their data at the time of publication, their preliminary analysis showed that rates of adoption of the chlorine solution were lower in Abbott’s study group than in the communities covered by SWAK.
     As Abbott’s and Freeman’s research projects demonstrate, the GEH program teaches skills to strengthen public health interventions through applied research, says Richard Rheingans, GEH director and acting director of the CGSW. “We want to raise the bar in scientific research, and field experience is so important for that.”
     The GEH masters degree is a new offering at the RSPH. It began in 2002 and graduated its first full class in the spring of 2004. In fact, it is one of only a few programs in the country that formally links the environment with international studies in a degree program. In addition to solid practicum and field experience, the program offers a grounding of classroom instruction in international health studies and the environment.
     “The GEH program is a wonderful educational opportunity, combining the vital subject matter of environmental health—safe water, clean air, toxin reductions, healthy urban design—with the global orientation and the on-the-ground program skills of inter-national health,” says Howard Frumkin, chair of the Department of Environmental and Occupational Health (EOH).
     GEH faculty are drawn from the departments of International Health and EOH and include guest lecturers from public health partners. Neither department could have offered such a program alone, says International Health Chair Reynaldo Martorell, but “by pooling our resources and working with our partners at CDC and CARE, we are able to offer quality MPH training and incredible opportunities for summer field research.” Reflecting the growing program, EOH has added four new faculty this year.
     The program arose from a natural intersection of international and environmental health. “Increasingly the world’s most serious environmental problems are found in developing nations, and projected trends in population growth and industrialization suggest that this will remain true for many years,” Frumkin says. “GEH graduates are well positioned to help protect public health around the world by recognizing, assessing, and controlling environmental hazards.”
     For Dan Abbott, the program is setting the stage for a future career. With ready access to expert faculty at RSPH and CDC, a field experience under his belt, and work experiences at The Carter Center and the Center for Global Safe Water this fall, he has plans to continue in international and environmental health work after graduation—“much along the lines of what I’ve done this summer,” he says.
     Freeman is interning at CARE USA this fall. “The program’s ties to CDC got me to Kenya and now to CARE in Atlanta,” says Freeman. “Nowhere else could I have this opportunity.”

For more about the GEH program, visit


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