Onsite Testing of Water: A Field Trial

by Jessica Ryan

The Onsite Testing Pilot Project

Conclusions

Acknowledgements

BACKGROUND

Western Australia has about 260 discrete Aboriginal Communities recorded by the Western Australian government.

Fig 1: Kalumburu Community in the Western Australia's far North

Many of these have satellite communities, which are often called outstations. In 1997 The Aboriginal and Torres Straight Islander Commission recorded 367 communities, including seasonal camps and outstations. A community is often either a large mission, or a government run settlement, town or fringedweller camp as well a self determined stations or homeland centres (Anda 1998). Of all of these communities, 56 have regular bacteriological testing carried out at least once a month by the service provider. There are three such service providers in Western Australia, (Cowell Electric in the Pilbara, Kimberley Regional Service Provider in the Kimberley, Ngaanyatjarra Services in the Ngaanyatjarra Lands and Goldfieds). These companies are contracted to do such testing however they can employ a person based at the community to provide the services. Due to the vastness and differences between the areas in Western Australia (WA) three different service providers are needed. WA covers 2,500,000 sq km and had an estimated population of 1,805,400 in 1997. Of these 42,000 were Indigenous people (Daube 1994).

On-site testing of water in remote areas offers the communities a quick, accurate and low cost method of testing their water for contamination at any time. This project implemented a test for presence/absence of total coliforms and thermo-tolerant coliforms. The methods however do not test for the number of indicator organisms present. The presence and absence is displayed by a colour change, due to the enzymes produced by the coliform bacteria. The test has also been verified by laboratories and was found to be a good indicator of coliforms

The ability of the community to conduct on site water testing is not affected by geographical or demographical or monetary circumstances. However there are some restrictions to completing on site testing such as the need for a 24hr supply of electricity and the need for the consumables to conduct the test. The success of the program depends on the implementation of the kit and the training that occurs.

The samples are tested for coliforms and E.Coli, which are indicators of faecal contamination of drinking water supplies. However coliforms are not harmful themselves, but if they are present in drinking water supplies, the water may have been contaminated with faeces of a warm blooded animal. Often there are also germs that can cause disease present. Some diseases that can be present are Campylobacter spp., Salmonella spp., Shigella spp., Vibrio spp., Cryptosporidium parvum, Giardia intestinalis, as well as Adenvirus, Enterovirus, Hepatitis and Rotavirus.

INTRODUCTION

Microbial contamination of water in remote Aboriginal communities is a frequent cause of ill health and is the primary health risk associated with drinking water. Often this low quality of drinking water is continually consumed. The low quality is only detected and acted upon when an outbreak of disease occurs. Isolation and severe unpredictable weather patterns as well as distance from laboratories effects the frequency of which tests are conducted. The routine testing of water is a public health requirement and it is recommended that water be tested for it’s microbial constituents as least once a month, preferably fortnightly as recommended by The National Health and Medical Research Council. Unfortunately this is not the case for communities who do not have the levels of infrastructure, population and co-ordination, which is required before testing will be funded.

On-site methods also allow communities access to information, which effects their livelihood and quality of life. Epidemics of diseases can occur due to contamination of water supplies, these can include all types of gastro-intestinal diseases present in the communities

Prevention of these diseases is of great importance because they can spread among a community rapidly and have the potential to effect the entire community. On a world wide scale diarrhoea was estimated to have killed 2 million children and to have caused 900 million episodes of illness annually (World Development Report 1992), and in Western Australia it has been reported that Aboriginal children who are under five years of age are hospitalised for gastroenteritis at a rate seven times higher than that of non Aboriginal children (EHNCC 1997). As well, diarrhoeal and respiratory diseases are the major causes of morbidity in Aboriginal children in their first three years of life (Healthabitat 1999).

WHY TEST WATER?

Safe and clean water is vital for healthy living practises as well as for consumption and is one of the primary requisites for healthy human life (World Development Report 1992). The Uwankara Palyanylu Kanintjaku (UPK) environmental review in 1987 identified nine healthy living practises which were aimed at changing the specific health problems that faced in remote and rural Aboriginal communities (Pholeros 1993). These nine healthy practises, in order of priority were:

Washing people
Washing clothes
Removing waste
Improve nutrition
Reducing crowding
Separating dogs and children
Controlling dust
Controlling temperature
Reducing trauma

The three practises with the highest priority all involve water (Pholeros 1993). Therefore having a water supply that is not contaminated is of great importance for healthy living practises as well as for consumption.

As well as this water is often the media for infectious diseases. Epidemics that arise from waterborne diseases are seen all over the globe and 80% of the infectious diseases throughout the world are water related (World Development Report 1992). The routine testing of water is a public health requirement and it is recommended that water be tested for it’s microbial constituents as least once a month, or preferably fortnightly as recommended by The National Health and Medical Research Council (NHMRC 1998) and according to the World Health Organisation water should be routinely monitored for the presence of coliforms, with the frequency of the testing depending on the size of the water source and the water uses, treatment and the distribution system (WHO 1993).

Recently the presence/absence test has also been accepted as a standard method of testing. The test that was used was the Colisure or Colilert test. The reasons for this were it's easy identification of a positive result when a sample turned red and also that the chemical already came in the bottle, which the sample is poured. Each community was supplied with all the consumables to conduct the test for one year. The maintenance of these articles of hardware that were supplied were the responsibility of Murdoch University and the communities were instructed to report any failure of the incubator or if the supplies of the chemicals were low if had run out.

Fig 2 : Stanley Till, The Environmental Health Worker at Noonkanbah Community putting a sample in an incubator.

PRESENT SITUATION

In response to the need for water testing the Remote Area Developments Group produced a kit which could be used on site at Aboriginal Communities and would give them a result of the bacteriological content of the water within 24 hours.

The kit contained

1. Soap

2. Clean cloth or rag:

3. Gas Blower/ Lighter or Matches

4. Test Bottles with the chemicals in them:

5. Incubator :

6. Disinfecting liquid:

7. Video

8. Booklet

The incubators were produced at Murdoch University. They were designed to heat up to 35 degrees Celsius to reproduce the conditions that are found in the human gut. The test needs to be incubated for 24 hours and then checked for a colour change in the water. The coliform bacteria by-products react with the chemicals in the reagent, causing the colour change.

As well as this Murdoch University produced the booklet which contains all the information needed to conduct a test and dispose of a test properly. The booklet explains what coliforms are, what equipment is needed, how to conduct the test and interpret the results as well as disposing of the test and examples of the fax sheets. These booklets are left at the community for the people on the communities' reference. There is an accompanying video, which clearly explains how to conduct a test without contaminating the sample.

Procedure of presence/absence the test

The following are the steps to conduct a water test as described in the video and booklet:

Turn the incubator on and wash hands thoroughly

Clean the tap with a cloth and then sterilise the tap with a gas blower or by heating it until the water in the tap boils

Fig 3: Wayne Green, trainee EHW at Cosmo Newberry Community near Laverton, sterilising the tap

Fill the sample bottle to the line marked on the side, being careful not to contaminate the sample by touching the inside of the bottle or the inside of the lid.

Fig 4: Willie Cherabun at Muludja taking a sample

Make sure that the lid is sealed tightly and shake the bottle until all the chemical powder is dissolved

Fig 5: Kenny Brolga At Looma opening the chemicals.

Label the bottle with the date, time and place from where that sample has been taken from

Fig 6: Brendan Walters the Essential Services Officer at Noonkanbah, labelling the bottle

Incubate the sample for 24 hours at 35^degreeC

Check the results 24 hours later

Write the results on the test result fax sheet and fax to the number on the sheet

Dispose of the test safely

The off site testing at the communities is done in the standard method adopted for water testing. This requires the sample to be tested within 24 hours of collection. It involves either Membrane filtration or the Most Probable Number method. These methods are time consuming, expensive and require laboratory and technical support. Often these facilities are only located in Perth and are not readily available to people in remote areas. Often road and then plane transport the sample. This restraint is a reason why so few communities receive the current testing.

THE ON SITE TESTING PILOT PROJECT

Between 1996 and 1999, 20 remote communities were visited by members of the Remote Area Developments Group, Institute for Environmental Science, Murdoch University. As each community differs in location, community dynamics and infrastructure, a set guidelines to conduct the visits and to provide the testing facilities were was developed allowing for differences between communities.

In general the community would be contacted 2 months before visiting, to let the community members and management know of the program and to see if they wanted to be included in the testing program. A follow up phone call was made to see if the community wanted to be a part of the program.

Once the participating communities had been established and divided into geographical areas, the field trips and workshops began.

The specific aims of the field trips were to

introduce the project of on site testing to the community

train the local Aboriginal people with the skills to conduct the test

Establish a structure for the support of the water testing program

Establish and activate a support mechanism within the community to ensure the provision of safe drinking water

Provide the community with the booklet and video with contacts and instructions for the test procedure

Improve the communities perceptions of the hazards of drinking contaminated water.

Generally the Environmental Health Worker, the nurse or the schoolteacher were all trained to be able to conduct the water testing.

Figure 7: L-R John Jubbadah, Lawford Smith and Bobby Wade at Bayulu near Fitzroy Crossing, preparing to take a test.

Results of the trial

The RADG visited 20 communities from July 1996 to June 1998. After the responsibility of the water testing was given to the local people, some communities some communities tested their water occasionally and less than 10 reports were obtained over a trial period, of which 4 communities responded just once. Only one community responded very well with 22 reports. Even after repeated follow up no test results were obtained from 6 communities.

Fig 8: Bruce Wells, Billie Cox, Paul Cox, Keith Andrew , Jessica Ryan and Clayton Bell, at Yiyill Community, all community water samplers.

Of the communities that had sent testing results, 4 communities were found to get non-compliant results very frequently and some occasionally. In 5 communities the water was found to be compliant during all testing. When results non-compliant were received the party responsible for the water supply in the area was contacted.

There is a new trial currently taking place including 20 Western Australian communities and 25 in other states.

It can be seen by the studies that the RADG has conducted, the drinking water in many communities was contaminated and the coliform bacteria were often encountered. Many communities seemed to have stopped testing when they obtained consecutive results. Four communities, which sent more than five results, obtained positive results, which may have encouraged them to do more testing. However after some months, the testing ceased, which may indicate that more personal visits from the support providers would be necessary to encourage and continue testing. The low frequency of testing conducted by the communities and the number of reports sent indicated that the importance of the testing had not been emphasised enough during the training. It was noted that the community who completed 22 tests had an Environmental Health Worker who is fully aware of the consequences of drinking contaminated water. The frequent analysis of the drinking water especially in remote areas is possible only if the local people conduct the tests.

One solution to increase the frequency of testing is to introduce the fortnightly testing into the training and duties of the community workers on the community, so that the completing the tests are paid jobs. The workers whom this would fit into their job description are Environmental Health Workers, or Essential Service Officers. As well as this if the responsibility of the test is be given to more than one person i.e. Water Testing Team or group structures of people responsible for the quality of the water that the people are testing, there will be a likely increase in test numbers, as people can leave the community and move around for extended periods of time.

Ownership of the program is very important for the program if the frequency is to be improved. The materials that are given to the community are theirs if the testing continues, if testing does not continue the funding body can remove the facilities and place them in another community. This has not happened yet. If ownership is given to the community, and the community are completing tests for their own benefit, not for an agency who can use the data only for a study or exploitation or against the community, it is almost certain that the frequency will increase. This is ownership idea is supported by a quote from Fred Hollows

"Unless Aboriginal people develop ideologies and build group structures that will enable them to work together to change their lifestyle, health and hygiene, they are destined to die out" (Hollows 1986)

CONCLUSIONS

This project is one of the ways that Aboriginal people can work together to improve health on the communities. Such testing can change and save people's lives. The future of this program is implementation into every appropriate community in Australia.

The success of the program in the future is dependant on the training that is given at the time of the implementation visit to the community as well as the support given to the community testers after leaving the site. The success also dependant on the awareness of the community to the dangers of drinking contaminated water. Increasing the training for community workers on this importance will greatly increase the success and the levels at which the community take up the testing.

ACKNOWLEDGMENTS

Funding provided by the National Health and Medical Research Council and the supplementary funding by the Aboriginal and Torres Strait Islander commission is gratefully acknowledged. The Department of Commerce and Trade is acknowledged also for its financial support for the Environmental Technology Centre.