It's Not Easy Running A Hospital Without Running Water

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In the United States, if a hospital didn't have running water even for one day, it'd be a crisis.

But in some parts of the world, that's business as usual.

Researchers at the Johns Hopkins Bloomberg School of Public Health looked at studies on 430 hospitals in 19 low- and middle-income countries. In an article published online in the Journal of Surgical Research, they reported that a third of the hospitals surveyed — a total of 147 — did not have continuous running water.

The most startling statistics come from Liberia, where 80 percent of the hospitals did not have running water all the time, and Sierra Leone, where the figure was 81 percent. By contrast, 100 percent of the hospitals surveyed in Bangladesh and 94 percent in Ghana did have continuous running water.

For more details, we talked to Dr. Adam Kushner, a co-author of the report. An associate with the Johns Hopkins Bloomberg School of Public Health, he's a general surgeon with a master's degree in public health who has worked in developing countries — in hospitals without running water.

First of all, I can't imagine how a hospital can function without running water.

It's kind of crazy.

I'd assume you need water if you're going to do surgery.

Exactly. You need water to clean instruments, the gowns and the [surgical] drapes, to clean the wounds, to wash the floors of the patients' rooms. All this requires water. If you don't have that, people would be hard-pressed to actually do surgery.

So I guess these hospitals can't do surgery, then?

The hospitals we surveyed were doing surgery. Not every hospital was doing every procedure, but these hospitals were providing surgical care.

How?

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They use workarounds. They collect rainwater, they truck in the water [from reservoirs, for example].

In hospitals that rely on rainwater, what happens during the dry season?

Maybe in the middle of the dry season they have to stop [doing surgery].

So if a patient comes in during the dry season and needs surgery, what happens?

You potentially refer her to another hospital. Or potentially she dies.

Obviously, running water is the long-term goal. But in the short term, what's helpful for these hospitals?

I'm cofounder of Surgeons Overseas. We sent a container of supplies to Sierra Leone including disposable sterile operating gowns and drapes. I thought, I don't know why we're sending that because in most of these places they have linen gowns and drapes that they wash and re-use. I asked the chief of surgery of this hospital in Sierra Leone, "Are these disposable gowns and drapes useful?" And he said, absolutely — because in the dry season when they wash the linen gowns and drapes they can hang them outside to dry, but in the rainy season the gowns and drapes don't dry.

Washing medical instruments with rainwater, that can't be sterile?

For washing the instruments, water is used mainly to clear away the larger debris and then the instruments are sterilized. There's a difference between having something cleaned and making something sterile.

Just curious, how are instruments sterilized in these hospitals?

It depends on the facility. It can be through an autoclave [a heated container]. Some places have autoclaves that they put on a charcoal fire.

What should happen to fix this situation?

Nonprofit groups and policy makers and health administrators need to say: This is a priority. Let's get continuous running water in all of our hospitals. If they said that, it would probably attract some donor attention.

But they're not saying that?

For some reason that's not happening.

Meanwhile, water isn't the only thing in short supply.

I worked at a hospital in Malawi. One time I was making rounds and a patient had a very dirty dressing. I said to the nurse, "Let's change that." And she turned to me and said, "We have no gauze."

