By Mike Paddock

I rounded a curve in the road and my heart nearly stopped. There was a potable water truck filling its 10,000-liter tank from the river. I nearly threw myself through the windshield applying the brakes and ran over to the startled driver. He explained that a nearby community was without drinking water due to the dry season. But I knew that water was dangerous, as I had just discovered the unimaginable source of its contamination. 

I’ve traveled the world as a volunteer engineer to some of the world’s most challenging environments with Engineers Without Borders. I have seen far too many places where the lack of water and sanitation has left behind dismal conditions. But the most shocking sight of all has to be in and around health care facilities, turning centers of healing into centers of infection.

It’s a deadly gender issue that puts mothers and newborns at tremendous risk, when every year, 17 million women give birth in health care facilities without adequate water, soap, and toilets. In some places, newborns aren’t even named because death is so common when infections are easily transmitted by unwashed hands, contaminated beds, unsafe water, and dirty instruments used to cut umbilical cords. Most of these deaths are preventable.

This crisis is global and affects hundreds of thousands of health care facilities in low- and middle- income countries where some 2 billion people have to use health care facilities without basic water services.

It also affects us in the Global North. These facilities and the health care workers who put themselves on the line everyday, are our front line of defense against pandemic diseases, and antibiotic resistance. In the US, at least 2 million cases of drug resistance each year result in some 23,000 deaths (CDC).

This problem has remained hidden in plain sight. Finally, there is recent good news to report. Some 80 North American philanthropists, non-governmental organizations, universities, financial institutions, and corporations announced historic commitments in funding, technical assistance, training, research, and advocacy totaling well over $120 million to help tackle this global crisis. It's a historic step forward and will be followed by a meeting in Zambia to begin to develop government plans. The UN and the World Health Organization (WHO) have called for action. WHO Director-General Dr. Tedros Adhanom Ghebreyesus recently put it straight when it comes to the absence of water, sanitation, and hygiene (WASH) in health care: "If you can't do the basics forget the rest. Prevention, prevention, prevention."

I couldn’t agree more, but I offer a word of caution.

Untreated wastewater flowing from hospital to river.
Untreated wastewater flowing from hospital to river.
Image: Courtesy of Mike Paddock

I was recently assessing a Guatemalan regional hospital that serves more than 250,000 people. Over the years, projects have dramatically reduced waterborne disease and parasites in the hospital and surrounding pueblo. In a country like Guatemala, where nearly half of the country’s population is weakened from chronic malnutrition, access to safe health care is vital and I was proud of these projects. 

Yet something jumped out at me on this recent visit. I saw that the box “Improved Sanitation” was checked on an assessment report, indicating that the hospital’s wastewater, filled with all forms of medical and human waste, was connected to the municipal sewer system. But I did not know where the wastewater pipe went after it left the hospital grounds. When I asked, the hospital administrator assumed it joined other sewage and was treated. But after looking into way too many manholes, it was clear to me that the sewer pipe led directly to the river, a short distance from the hospital. 

I had seen this situation before. I will never forget the day I had to inform a hospital director that his wastewater system was the cause of the typhoid outbreak he was desperately fighting. You can’t imagine the agony on his face. So when this regional hospital staff accompanied me on the short walk, they saw exactly what I feared: putrid water from the hospital dumping into the river. The staff thought about all the pathogens they worked so hard to remove from their patients, potentially creating new patients who used that water downstream. 

Which is why a few hours later, I found myself slamming on my brakes when I saw the tanker truck about to fill up with river water just downstream from the hospital. I explained to the truck driver what was in this untreated runoff from the hospital, just upstream. Once again I saw that shocked look as he realized that he had unknowingly become an efficient conveyor of potential disease. He will now fill his truck using clean water from a treated source. And now that the hospital staff is aware, they are committed to getting the wastewater treated.

The author's great-grandfather and great-grandmother.
The author's great-grandfather and great-grandmother.
Image: Courtesy of Mike Paddock

One hundred years ago, the Spanish flu pandemic infected one-third of the planet's population and killed at least 50 million people, including my great-grandfather. It was fueled by health care facilities with inadequate WASH. Today, our best defense against a pandemic just might be that health care facility in Africa, Asia, or Latin America with adequate WASH to contain infectious disease. For those of us who travel, anyone of us could wind up needing those health services during our professional and personal travels.

Most importantly, these health workers and the patients they serve deserve the dignity and safety of better facility conditions. We all need to push local and global leaders to get safe and sustainable water, toilets, and hygiene into health care facilities everywhere. And we need to make sure that what comes out of those facilities has a safe place to go, too. 

This story was published in partnership with Global Water 2020.

Mike Paddock is Chief Engineer at Engineers Without Borders-USA, overseeing engineering projects serving the world’s most vulnerable communities. Learn more about volunteer opportunities at


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