Sarah Cunningham, in Ghana

Sarah Lynn Cunningham works for the Louisville and Jefferson County Metropolitan Sewer District in Kentucky, implementing the principles of the Coalition for Environmentally Responsible Economies (CERES). This week, she's doing reconnaissance in Tamale, Ghana, to assess ways to improve water and waste management.

We began our day by travelling to Tugu, a rural village 11 miles from urban Tamale (yet still on the outside edge of Tamale's formal boundary). The residents of Tugu participated in a recent survey related to the Millennium Development Goals program, the same program that brought my colleague Steve Hubbs and I here. The results showed that clean drinking water and environmental protection are their top priorities. Our chief wanted to pay her respects to the Tugu chief, specifically to express her appreciation to the Tugu community for their participation.

The landscape along the way was typical savannah, yet noticeably greener in some places, perhaps because the water table is closer to the surface. We even saw some places where rice is grown during the rainy season. A huge Baobob marked the entrance to the village.

Each "compound" within the village is a necklace of mainly circular, though sometimes rectangular, one-room "houses" connected by walls. Most of the houses and walls are made of mud; roofs can be corrugated metal, which is hotter, but a status symbol, or cooler, traditional thatch. Most of a compound's houses open onto its courtyard -- not to the outside.

A chief's compound is referred to as a palace. Its south-facing house has exterior and interior doors, the exterior of which opens toward the chief's pavilion.

Meetings of chiefs are highly scripted by protocol. We drove to near the chief's pavilion and stayed in our vehicle, while our chief's assistant, Haroon, communicated to the Tugu chief's elders, who then informed him of our arrival. When they returned, we were escorted to our proper places in the pavilion. When the delay appeared lengthy, Steve, Haroon, and I explored the village a bit. As we did, I noticed chewed-up D-cell batteries lying on the ground. I mentioned to Haroon that we needed to try to teach folks not to leave old batteries lying around; they contain dangerous chemicals that could harm goats and children.

When we returned to the pavilion, we found that various villagers had taken their places. (Unlike the previous two chiefs we visited, this village allowed some of the children to sit in the pavilion too; they were impressively well-behaved.) A fellow with a beautifully melodic voice began singing about the virtues of his chief. When he finished, the elders escorted the chief to his chair on an elevated platform.

With Haroon serving as translator, the chiefs greeted each other and exchanged gifts. We gave money (per protocol), and were given cola nuts and a live chicken. (I decided to sample my cola nut, found the first little bit too bitter, disposed of it without getting caught ... and got no buzz.) When Steve and I were formally introduced to the chief, Haroon added what I'd said about the batteries lying around. Everyone seemed to earnestly listen.

When it became clear that we wanted to take pictures, their chief returned to his compound via procession with his elders, to change clothes. He returned, having added sunglasses (with the UV-protection sticker still on one lens) and his six wives to pose.

Lastly, the chief spoke about the importance of clean water and cooperation, quoting an African proverb: "If someone helps you by washing your back, you should wash your own front."

Health Clinic

Health Clinic Our next stop was the well-respected Wamale Health Clinic, also in rural Tamale, operated by Dr. David Abdulai. The clinic uses a bank of photovoltaic cells to power a pump for drawing groundwater into storage tanks, which are disinfected before use. We also saw the clinic's catchment basin, which is used to collect water during the rainy season and to raise fish year-round. Water had eroded the basin's overflow during the last rainy season. Villagers who'd been treated at the clinic, but couldn't pay, were working to rebuild it. We liked the vibes we got from them as we spoke, and took their pictures in front of a nearby tree with cheerful yellow blooms.

Peri-Urban Pit Toilets

After dropping our chief and her husband off at her palace, a fellow with the sanitation department took Steve and I to a "peri-urban village" to see the new pit toilets the municipality is constructing. One compound had a nearly-finished pair. At other compounds, we saw an unfinished cylindrical pit, made of curved masonry block, and the slab lids that would sit atop the pits. The plan is for a compound's family (often numbering 15-20 people due to polygamy) to use one privy until it's full and then switch to the other, while the contents of the first one break down. We did not hear how many iterations of this back-and-forth cycle a pair is expected to last or how the municipality decides where to build them.

West Hospital

Years ago, I read about a very clever installation in an Indonesian village: It consisted of two buildings of toilets and showers, an anaerobic digester between them, and two buildings of stoves to burn the gas generated by the digester. The villagers were able to get clean water and improved public health, and were also able to quit cutting down their trees for cooking fuel. I wondered if this model might work in Tamale, and was eager to see what we'd heard were somewhat similar installations.

When we arrived at this small hospital, there were lots of obviously sick people waiting on benches under a big tree outside the hospital, which sounded quite busy inside. I didn't want to interrupt the doctor and instead asked to speak to the maintenance staff. When that fellow appeared, he took us to see their facilities.

A building with toilets and showers for men and women drained to a septic tank. The tank's vent pipe was capped. I asked to open it, but was discouraged. Insisting I'm used to stinky smells, I asked again and was obliged, but had to put my nose an inch from it to smell anything. The pipe that looked to us like the one the gas would need to travel through to get to the kitchen for cooking was disconnected. Given the continued presence of a sign detailing construction information, we concluded that it wasn't quite finished.

I was staying with Tamale's mayor and his family, which made this trip especially rewarding. The household includes his wife, six children, two nephews, and staff -- a fascinating beehive of activity, to say nothing of the goats, sheep, cow, chickens, dog, rabbits, and guinea pigs also inhabiting the compound.

That evening, the mayor attended a dinner at our chief's palace and heard an update on our field visits. On our way home, he detoured to the hospital, found the doctor working in his office, and told me to tell him what I'd seen and concluded. The doctor insisted everything was working well and scolded me for not interrupting him so he could have shown us that nothing was wrong. I wanted to believe him and was willing to assume another pipe existed to carry the gas to the kitchen, but wondered how the odor could be so faint. It was too dark to try to reinvestigate.

Teaching Hospital

This large hospital also had a septic-digestion-and-methane-utilization system. We found administrative staff, who directed us to other staff, who took us to the septic system with convincingly stinky vent-pipe gas. Next, we visited one of two refrigerators they said were running on the methane gas; the contents were not as cold as we keep things (few refrigerators here are), but we could confirm that it was running on gas.

Still, we got conflicting answers as to whether the kitchen stoves were also cooking with this gas. Since the septic tankage we'd seen looked too small for several large buildings, I asked how many patients they housed and was told they didn't know. Their body language said I was probing into uncomfortable space, so I dropped the matter temporarily. We later learned that various problems keep the patient population low, so perhaps the gas-generation rate was on target for a society that conserves water and creates so little wastewater per person.

More worrisome was the fact that the overflow discharge from the septic system goes to an off-site stormwater drainage system, increasing the chances that downstream residents are being exposed to sick folks' pathogens.