Brighton Sewer circa 1874

The single most important contribution to improving aspects of public health in most cities of the southern hemisphere is to install proper sewage and sanitation systems. With sewers human waste is removed and stagnant water is drained. And with that go the diarrhoea, malaria and all of the other bacterial and parasitic diseases that compromise human lives.

We are not talking of science big or little here, for there are no science problems to be solved in these instances. We are not even talking about high-level engineering issues either, for these too pose no to little difficulty. We are talking about tried and tested pedestrian engineering that simply has to be tweaked to work in local circumstances.

For the historians, the earliest covered sewers – ones that conveyed liquid human waste – were uncovered by archaeologists in cities of the Indus Valley, fascinating, as it is ancient. The Cloaca Maxima of ancient Rome ran into the Tiber. Medieval Europe used existing water canals and then covered them.

Of course, Paris’ brick-water sewer system is so famous the city offers organised tours for which there indeed are takers, strange but true! The French put their sewer system – unevenly mind you – into place in their colonial territories, when they had them. One of the most impressive is Vietnam’s. The technology was not lost on the Vietcong.

It is of course a matter of health, convenience and dignity to have proper sanitation, sewage and water supply systems. It is also, in South Africa, a constitutional right to have access to these assets and resources. Government has been working hard to provide these services, but not hard enough, that much is apparent.

It is also such plain common sense to introduce measures that prevent disease rather than spend much more money to cure the disease once it has taken hold. Not true in all instances, when it comes to infectious disease it also often cheaper and more efficient to prevent than to cure.

Provide proper drainage of rainwater in Nairobi and you – with new netting systems – will do more to check malaria than all the pills and vaccines in the world. It is cheaper too. Vaccines are expensive to produce and, apparently, there is no ready-made market to recoup the research and development costs.

Provide proper waste removals systems in the teeming squatter camps of South Africa and you will do more to eliminate diarrhoea and reduce infant mortality in a single stroke. That we have been unable to do so – and rapidly – is not only a national disgrace, it is bizarre, for there is no excuse.

So what then is our problem? Is it money? Finance Minister Trevor Manuel says that there is enough money. In fact, many service-delivery departments return unspent funds at the end of the financial year. There are, apparently, more than enough public funds available to take care of basic service delivery.

Is it the lacks of brains? The scientific community involved here are engineers, likely many more technicians, public health experts and project managers. In South Africa we have been doing this sort of thing for decades and it is hardly rocket science to repeat the exercise in emerging communities.

There is talk in certain quarters that the manner in which affirmative action has been applied compromises service delivery. Simply put, to appoint a qualified engineer or technician who happens to be white takes over 6 months to get through the bureaucracy, by which time the candidate has understandably found another job!

Is it a question of political will? Everyone involved in politics including the President has been going on about this. Budgets have been set aside. Perhaps the tone of the will has been schoolmaster-ish and intellectual. Some people think that by talking a lot about a problem it actually gets done!

It does not mean we should stop thinking. It does mean that simply thinking does not do something. I was struck by how the great biologist J.D. Bernal used his mighty brain to put together a practical plan for post 2nd World War housing construction in Britain (Andrew Brown, J.D.Bernal – The Sage of Science, Oxford, 2005).

He and his team had available well organised (and unionised) teams of trained artisans, technicians and engineers who were shielded from the machinations of politics and who simply got on with it, day in and day out, until it was done.

We need that order of deliberate persistence of well-organised expertise in our country.