HOOPER BAY -- Residents without running water who want to take a shower or a steam bath see the warnings at the community washeteria.
"Public Health concern," signs inside the building say. "DO NOT shower or sauna if you have sores, boils, rash, etc. This goes for everyone young and old alike!! (this includes your kids) Stop the spread of germs to the public!!!"
The issue is underscored at the community's big health clinic, which stays busy with patients coming in for skin infections, including impetigo and drug-resistant staph, as well as respiratory tract illnesses
Patients are asked not only what brought them in but also about their water source, the number of people living in their home and whether they have adequate heat. Illnesses spread quickly in crowded homes.
"It's very common for us to treat three, four, five, six members of the same family in the same day for pretty much the same illness," said Steve Bertrand, a physician assistant in Hooper Bay.
With serious skin infections, the clinic isn't able to scientifically backtrack to the source, but patients often say how they think they got it, and it's a common transmission route for communities without running water, he said. "People tell me that we went to a steam bath, or we sat in certain places that other people sit that haven't been cleaned or sanitized since."
Three Alaska studies in the last decade found that a lack of running water in rural Alaska is connected to high rates of serious skin and respiratory infections. Now a new study that followed more than 1,000 people from four Western Alaska villages over six years confirms that illness drops once people get water piped into their homes.
Village residents aren't drinking dirty water or suffering from high rates of serious diarrhea or gastrointestinal diseases such as cholera that weaken and kill people in developing countries. In almost every village, residents can fill buckets from spigots with well water or treated surface water at community watering points, sometimes for coins or tokens. But that clean water then must be hauled home, often one 5-gallon jug at a time.
Village residents without piped water end up using just 2 to 5 gallons per person a day, not enough water to wash away germs and stay healthy, studies have found. That compares to an average of 88 gallons per person a day across the country, counting water used for car washing, lawns and gardens, according to the U.S. Geological Survey.
"The analogy is sort of like when you go camping," said Tom Hennessy, a doctor, epidemiologist and director of the U.S. Centers for Disease Control's Anchorage-based Arctic Investigations Program. He's temporarily on assignment in Sierra Leone, working to track and stop the Ebola outbreak in West Africa. "You only have a couple of gallons of water. You use it for drinking, cooking, washing dishes. And handwashing, body cleaning and dental hygiene falls a little lower on the priority list."
Rationing water leads to high rates of what public health officials call "water washed" infection rather than water-borne illness. Pathogens multiply and move from one person to the next. The illnesses can be serious and include meningitis, pneumonia and drug-resistant skin infections, he said.
Hennessy was lead medical researcher on a 2008 study that found significantly higher rates of hospitalizations for respiratory and skin infections in Alaska communities in which 10 percent or fewer of the homes had running water.
That was part of a trio of studies that for the first time in Alaska and the circumpolar north established a connection between illness and a steady supply of water to individual homes. Hospitalization rates for respiratory and skin infections were found to be five to 11 times higher for people without running water. Those studies simply looked back to compare disease rates in places that did and didn't have water service.
The new study led by medical researchers with the Alaska Native Tribal Health Consortium and contributed to by the CDC followed 1,032 people from three Yukon-Kuskowim Delta villages and a fourth from the Bristol Bay region for the three years before and the three years after their communities received piped water services.
Researchers found significant declines in clinic visits and hospitalizations for skin, respiratory and gastrointestinal infections after piped water service and a big increase in water usage, from about 1.5 gallons per person per day to just over 25 gallons a day. That's still just half the amount that state officials overseeing village water construction factor into new systems. New consumers tend to be careful with their water.
The study is still being reviewed for publication in a medical journal but was presented last year at the World Congress of Epidemiology.
Only systems with piped water or home delivery of large amounts of treated water are believed to improve public health, Hennessy said.
A 2013 public health survey identified important health measures to monitor in Alaska. The No. 1 issue was the rate of suicide. No. 2: the percentage of rural homes with running water.