In rural Alaska, access to water is preventive medicine

Presented by Alaska Native Tribal Health Consortium

The advice is omnipresent and seemingly simple: Wash your hands frequently and keep your home clean to stave off risks of contracting COVID-19.

But for thousands of rural Alaskans who lack access to clean water, such seemingly simple advice is more complicated.

Across the state, roughly 31 Alaska Native communities -- 1,700 homes -- have no running water or sewer, said Mark Landon, manager with the Alaska Native Tribal Health Consortium, which has been helping connect rural Alaskans with water for 15 years.

These Alaskans can’t just turn on the tap. Instead, they often haul water from rivers, store it in 55-gallon drums, and use outhouses or honey buckets for sewage needs. They also face a much higher risk of contracting serious diseases compared to Alaskans with running water in their homes.

“It’s night and day,” Landon said of the difference.

Access to clean water is an increasingly critical health care consideration for Alaska Native people, and the people who work on rural water projects say their mission of providing access to water has never been more important -- or more challenging -- as we face a global pandemic.

Read on to learn how rural water projects are changing lives, from Lower Kalskag on the Southwest tundra, all the way to Klawock, on Prince of Wales Island.

Painful memories and heightened health risks

For some, the global pandemic is a painful reminder of the 1918 Spanish flu, which devastated many Alaska villages. In Wales, half the population is estimated to have died, according to Alaska Public Media.

“We never recovered to this day,” Wales Mayor Frank Oxeorok Jr. told the news site.

But for communities that lack access to water or sewer, like Wales, residents must navigate the current crisis in the face of an already heightened risk of illness.

Alaska homes without running water have significantly higher infant hospitalization rates for pneumonia, and higher rates of skin infection and respiratory illness. Rates of invasive pneumococcal disease in Southwest Alaska are among the highest in the world.

Conversely, access to water boosts the health of an entire community. One study found that when four rural Alaska villages received piped water, clinic visits declined for respiratory, skin, and gastrointestinal infection, with the largest decline seen in younger age groups.

Access to clean water is preventative medicine, Landon said.

“It’s sort of unusual,” Landon said. “ANTHC is a health organization that owns a construction company.”

When ANTHC helped install a new water plant Savoonga, the changes were crystal clear.

“Definitely made it a lot easier for people to stay clean, do their laundry,” the lead water plant operator in Savoonga, Scott Kingeekuk, said in November.

“Hygiene went up. I can tell kids have less cavities, they’re brushing their teeth more, washing up more,” Kingeekuk said.

‘Equivalent to living in a desert’

Landon’s program usually brings wells and septic systems to about 55 homes each year, in addition to the homes that are served through community-wide construction projects. The pandemic has slowed things down, but Landon hopes to get close to that target in 2020.

“We serve homes where Alaska Native Elders have never had service their entire life,” Landon said. “Those types of projects are very rewarding for us, and more so when there are children in the home.”

In Lower Kalskag, a community-wide construction project spanning 12 years has resulted in major upgrades for the community of roughly 300 people.

“People are getting clean, potable, good tasting water,” said ANTHC Engineering Department Project Manager Brent Hove.

The villages' old water treatment plant was decommissioned and a new one was built, Hove said. The sewage lagoon has been upgraded, and once the project is complete, 84 homes will also be connected to water and sewer.

One reason these projects are so important is because Alaskans who lack running water invest far more time in dealing with their water needs, said Hove. Then they use as little water as possible.

“They’re typically conservative because they have to put all this effort into acquiring and hauling it,” Hove said.

One study discovered extreme water conservation in four Alaskan communities that lacked running water. These residents used just 1.5 gallons of water per person, per day, equivalent to water usage in the country of Mali, in Saharan Africa.

By contrast, the average person in the U.S. uses 156 gallons of water a day, the study said.

These Alaska communities were “at the extreme end of the water use spectrum, equivalent to living in a desert,” a 2016 ANTHC paper said.

Now that health guidelines are directly related to having a clean source of running water, such low usage is even more troubling, Hove said, and access to water even more important.

‘A hazard waiting to happen’

Roughly 1,000 miles away from Lower Kalskag, ANTHC is nearing completion on a wastewater treatment plant rehabilitation in the Southeast Alaska community of Klawock, a Tlingit village of roughly 800 people.

Potable water is an important need, but safe disposal of sewage is just as necessary, said ANTHC Engineering Project Manager Kevin Ulrich.

Rural Alaskans without running water often use honey buckets as toilets - generally 5-gallon buckets lined with plastic bags and dumped in a sewage lagoon or other container, Ulrich said.

“Any time you’re having direct exposure to handling sewage, that is going to increase your health risk a lot,” Ulrich said. “It’s a hazard waiting to happen.”

In Klawock, mechanical issues and corrosion were causing serious issues with the wastewater treatment plant, to the point where operators were handling sewage directly.

Not only was this a major risk for the employees, but also for the environment, Ulrich said. Without the ability to process the waste effectively, the community was opened up to the potential of untreated sewage escaping into the ocean.

Critical construction had just begun when the pandemic hit, Ulrich said, forcing them to rethink their plans on the fly. Despite the delays, Ulrich’s team successfully navigated ANTHC’s enhanced safety and travel restrictions in response to the pandemic. Construction is now in the finishing stages.

Only-in-Alaska challenges

There’s still a long way to go. The state of Alaska’s Village Safe Water program has identified nearly $1.4 billion in needed funding to address rural Alaska’s sanitation needs.

Funding comes from the Indian Health Service, the Environmental Protection Agency, the U.S. Department of Agriculture, and matching State of Alaska funds. Lining all that funding up can be difficult, Hove said.

Then there are unique challenges that come with living off the road system. In the Yukon-Kuskokwim region, villages rely on barges to bring in supplies, including construction materials. The barges stop running once the rivers freeze over. Construction projects must be timed around these seasonal patterns.

“Stuff like that, you don’t typically have to deal with in the Lower 48,” Hove said.

The global pandemic threw another wrench in the gears, with long quarantines and supply causing delays slowing construction this spring and summer, Hove said.

But for all the hurdles, the benefits of bringing water to rural communities are worth it, both for the Alaskans who gain access to safe, clean water and sewage and for the engineers who see the changes in the everyday lives of the villages they serve.

“It really does have a very big impact on health and quality of life,” Ulrich said.

This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the creative services department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.