“The availability of clean water has been one of the greatest achievements of mankind in the late 19^th and early 20^th century — responsible for preventing the demise of untold numbers from waterborne diseases. And according to World Health Organization, while vaccination has greatly reduced the burden of infectious diseases, only clean water has performed better.” 

Speaking on the topic of strengthening partnerships to strengthen public health during the two-day Bilateral Health Summit that took place in the territory this past Wednesday and Thursday, ASPA CEO Utu Able Male explained how there is a natural affinity between the American Samoa Power Authority and the Dept. of Health. “The Sanitary Engineering services of Water, Waste Water and Solid Waste, if properly provided to the community, will greatly improve the public’s health,” he said.

Adding to the equation, Utu pointed out that the conveyance of sewage and its treatment, proper discharge into the environment has done as much for public health as clean drinking water.  “When the density of the population of a settlement reaches a critical point, then septic tank systems are no longer capable of properly treating sewage. A centralized sewer treatment system must be financed and built or you risk the outbreak of diseases from direct contact with sewer or the contamination of aquifers, streams and the harbor littoral,” he explained.

Municipal Solid Waste collection and disposal is not a convenience but a necessity for a healthy society.  Allowing garbage to collect too long, attracting vermin and vectors will result in the spread of diseases. “There — obviously you can see the natural link between utility services and public health,” he said.

Utu said that the natural link between utility services and public health needs more than just recognition, it requires mutual respect of each other’s leaders because without that respect and trust, there will be areas where information goes unshared, ignored, or worse, data are not collected at all. “Data must be religiously collected, converted to useful information to be used by those who can do something to help the public. Defensiveness must be eradicated through trust and respect.”

The ASPA CEO spoke plainly and forcefully about the need for political appointees in key departments to have the qualifications, technical skills and appreciation for the need to protect the public’s health

And he also spoke about the public’s responsibilities; everyone has a stake in public health. “Growing up in American Samoa, I do not recall ever hearing about dengue fever, zika or chikungunya ---but they are here now in the Pacific islands,” Utu said.

Utu said getting the enforcers to enforce is a challenge and that litter that accumulates and is undisturbed for long periods is not only unsightly but it collects stagnant water, a breeding ground for mosquitoes. Plastic floating out to sea is killing marine wildlife and young seabirds.

Governor Lolo has urged us to “change our mindset,” he said and the governor led the way with the formation of the Island Wide Clean Up Committee as an example of partnership during an outbreak.  “We have been trying halfheartedly for decades to solve the serious litter problem in the islands; so far, we have managed to poke a stick at it and move it around; kick the can down the road so to speak.”

Utu pointed out that with the outbreak of diarrheal diseases—amoebiasis and shigellosis early this year ASEPA stepped in and sampled drinking water at the homes where the disease occurred.  The government water system was declared safe; but there was a positive test for fecal coliforms at a home served by untreated village water. DOH and LBJ worked with CDC (Center for Disease Control) and a laboratory in Hawaii to definitively identify the pathogens. DOH performed their spot-mapping and targeted households affected and they inspected affected homes and partnered with ASPA to initiate the Healthy Homes program, which continues to this day.

He said 25 homes were targeted for bathroom improvements and that lavatories were installed; materials and labor was provided under the condition that the family CLEANED and disinfected the bathrooms first. The bathrooms were correctly plumbed following public health and plumbing standards.  New connections to the sewer line in the area were made and even brand new septic tank systems were installed thanks to USEPA.  Utu said that a local hardware store donated all the fixtures; twenty-two more homes are on the list for a total of 47 homes for this program.

Utu also noted that the initial announcement of the unhygienic condition of the bathrooms where the outbreak of dysentery occurred was not met with open arms from some families, especially those who were not even affected.  They were in disbelief or denial. “You see, sometimes we in the islands are ashamed to admit that we are found wanting. Although we have no problem going after grants from the Federal government or donors, we are loathe to admit that we have poor people in our midst suffering from basic material want when we are supposed to be a society that shares and takes care of one another.”

“Dysentery is a result of unhygienic conditions whether in the home or from eating spoiled food sold on store counters or from social gatherings in the hot tropical sun. To have this happen in a US territory is shameful,” Utu said.

Paraphrasing former PM of Singapore, Lee Kwan Yew, Utu said, “If we have a swine flu outbreak at home, we inform the world and then we fix the problem.  We don’t pretend it’s not there and hide it from ourselves and the world.”

He explained how we live in the tropical zone – or island paradise — where many things grow, some bad or unsightly such as the mold and mildew that sticks to the walls of our homes.  High humidity and salt spray conspire to return iron to its more natural oxidized state of RUST.  “Our conditions are attractive to invasive species including pathogens that are introduced by ships and planes, arriving as stowaways.”

 “DOH, ASEPA, ASPA, DMWR, ASVB and others are taking a multipronged approach requiring the resources and smarts of many individuals,” Utu pointed out and ended with a call to action. “There is one overarching conclusion from my talk to this audience of public health professionals: SEEK out the support of your respective utilities. Health and Utilities is a partnership that works,” he said.