CALANG, Indonesia, Jan. 20 -- Sometimes preventing disease requires breaking rocks in 90-degree heat.
Bob Brox, his relief worker colleagues and a team of seven Indonesian laborers learned that this week as they spent three days turning a hillside spring and rivulet into a "protected" source of drinking water for some of this town's 2,500 tsunami survivors.
Aid workers Neil Hitchen, left, from England, and Akbarjan, of Afghanistan, construct a waterway in Calang, Indonesia.
(David Brown -- The Washington Post)
They widened and deepened a stretch of the stream in the jungle above Calang. They lined the impoundment with rocks and filled it with gravel to filter the water. They built a dam of local stone and mortar, with a spillway to relieve pressure on the structure during prolonged downpours. They pierced the dam with a 1 1/4-inch galvanized pipe and ran it 400 feet downhill to four huge plastic tanks fitted with spigots.
"We have limited time and we have limited materials. Normally, it would take about three months to do a water project," Brox said as he looked at the muddy construction site. A Washingtonian on a two-month contract with the International Rescue Committee, a humanitarian organization, Brox has training in both engineering and public health.
Across the tsunami-stripped coast of northwestern Indonesia, disaster relief has moved into the reconstruction and utility phase. Water and sanitation, rather than medical care and food delivery, are the increasing preoccupation of humanitarian groups such as the IRC and the Irish organization GOAL, which together built the first piece of Calang's emergency waterworks.
So far, Indonesia hasn't suffered major medical consequences from the Dec. 26 tsunami beyond the injuries caused by the event itself. There have been dozens of cases of tetanus, many fatal, caused by infected wounds, and high rates of mild diarrhea, the result of drinking water contaminated with feces. But diseases of epidemic potential -- notably cholera, dysentery, measles and malaria -- have not occurred in large numbers.
The Measles Initiative, a cooperative effort of many international health groups, plans to provide every child in Aceh province under age 15 with measles vaccine, vitamin A, the anti-worm drug mebendazole and an insecticide-treated mosquito net to sleep under.
The Indonesian government is boosting its mosquito control program in Banda Aceh, the provincial capital, which has hundreds of acres of standing water that didn't exist a month ago. And people are building latrines and water systems to lower the risk of cholera and dysentery, perhaps the two most feared waterborne diseases.
Disease outbreaks are not inevitable among refugees. Nor are they unavoidable after natural disasters.
Cholera, caused by a bacterium, is endemic in southern Asia. The disease tends to occur in distinct, slow-moving, worldwide epidemics. The seventh pandemic, now underway, began in Indonesia in 1961 and arrived in South America in 1991, where it caused a million cases of illness in three years.
The other waterborne microbes -- shigella, the bacterium that causes dysentery, and the viruses hepatitis A and E are present at low rates in most populations. Crowding and water contaminated with human waste can establish and amplify chains of transmission, which is why refugee populations are especially vulnerable.
Research has suggested that improving sanitation -- building latrines, providing soap and buckets, and teaching personal hygiene -- may be more important than improving water in the days and weeks after an emergency. Increasing the quantity of water, in turn, is a higher priority than improving water purity.
The spring project symbolized the fraternity of emergency water and sanitation engineers, most of whom are single men, many working on short-term contracts with humanitarian groups.
Brox works for Cardi, a consortium that includes the IRC and several Scandinavian aid groups. He does carpentry in Washington and supervises woodworkers in the sculpture program at the Corcoran College of Art and Design.
Neil Hitchen, who was working with Brox, is a Yorkshireman who lived in Kenya for many years. He works for an Irish charity. Desmond McCall, another Cardi contractor, is a native of Belfast who divides his time between consulting jobs in Brighton, England, and disaster zones.
Akbarjan, an Afghan engineer who uses one name, is the exception. He is married and a father who has worked for the IRC in his native country for 14 years.
Although there was a sizable local labor crew working for about $5.50 a day, the aid staff did more than supervise. Hitchen shaped rocks for the masonry dam with a broken claw hammer. Brox wrestled a wheelbarrow full of bags of cement down a rutted trail and across a downed tree. The construction work was accompanied by the songs and squawks of rain forest birds.
As the third day's work proceeded on Thursday, 10 women sat on low plastic chairs under the shade of a large blue plastic tarpaulin. Most appeared to be in their twenties. All but two wore Muslim head coverings and one had a child on her lap.
They were the soap-and-water shock troops for their fellow survivors living in hand-built shelters on Calang's hillsides.
This was the third day they had come down the hill to the IRC's growing compound of camping tents, shaded meeting spaces and tarpaulin warehouses full of cement, shovels, pipe, hose, buckets, chlorine tablets, food and other supplies.
"Good morning. Thank you for coming again. Sorry I'm late," McCall said, turning to Khalid, 28, an interpreter and university graduate who once studied linguistics.
McCall had three messages he wanted the women to disseminate: Use the latrines; wash hands after the toilet; use water from protected sources.
The women wanted to know when the buckets and soap would arrive. The answer was that afternoon.
Would there be enough soap for everyone? Each latrine would have its own soap, tethered to the bucket with plastic twine looped through a hole in the bar.
McCall took the women on a field trip to the IRC wash station 50 feet away. He handed out twine.
Before they left, with instructions to teach in areas they hadn't yet reached, the teacher asked if there was anything more they wanted.
"They are asking about the flies. They want something to control the flies," Khalid said.
McCall agreed that the flies were a problem. He said, as an aside, that it was because garbage was being tossed next to houses. But three messages about water and sanitation were enough for now, he said. He would get to flies and garbage later.