One of our initiatives is to set up hand washing stations. Without running water, it takes some amount of innovation to have a place to wash your hands. Our design is basic: a holey cup with a hook, soap tied by twine (covered by the top of a water bottle) and a small pot or bucket for holding water. You dip the cup in the pot, and then use the drizzling water to wash your hands.

The great thing about this is that people before don’t have much way to wash their hands. And in a place where toilet paper is not yet widely used, it’s especially, especially important for people to wash their hands.

Last month, we’ve been running a competition to see who could build the most stations. Last week, Nelly and I went around checking those who people said they had built. There were mixed results. Some of the stations were not in use. Some had been destroyed by children (by doing such things as using the twine-attached cup to swing from). There were also problems we had not anticipated. Who would have guessed that livestock love eating soap? The core problem in these places, in my opinion at least, was that people did not value the stations. Sure they liked washing their hands, but not enough to keep water in the basin or to replace the soap. Maybe this is because diarrhea is less of a problem (we’ll have the data on that soon). Maybe it has to do with different ways our health reps and field officers explained it. Behavior change is a tough thing, particularly teaching grown-ups a new and strange habit.

But not all the homes were like that. One of the families we visited had even innovated on our original design: they attached it to their dish rack (a box with chicken wire for drying dishes). This was a pre-existing, sturdy structure already valued by the family. Children could not destroy it without consequence. They used it regularly and were satisfied.

Another family told us with joy about their station. The mother showed it off, proudly telling about how her children actually helped maintain it and kept the water full. They would wash their hands even without being told. She told us that the months before, her family had really been affected by diarrhea. But since she had been washing her hands last month, her family hasn’t had any diarrhea. She was beaming!

It is certainly amazing how cheap improved health can be in Kenya. In the US, to improve health is extremely expensive. To reduce diarrhea in the US, we have to spend millions of dollars to make sure we screen every last spinach leaf, or do surgery on rare bowel disorders. But in Kenya, it only costs a foot of wire, a re-used water bottle and a few minutes of education. When you including the cost for me to be here, Nelly to administer the program, and the Field Officers to build the stations and teach (adjusting for the portion of our time here dedicated to the stations) the cost per station is just $5.

In the US we talk and talk about how we shouldn’t put a price on a human life; we debate forever about how this health plan or that insurance company is putting a dollar sign on a life. But the reality is that we already do that. For every dollar we, as a society, spend on US healthcare instead of on Kenyan healthcare, we are putting a dollar sign on Kenyan life. In the US, we spend more than 15% of our GDP on our own health and far less than 1% on all development (health projects being one small part of that). When we, as a society, pay for a $50,000 surgery we’re saying that’s more important to us than 1,000 families in the developing world having a place to wash their hands. We certainly shouldn’t dump money on the developing world stupidly (like we have been doing…I’ve seen it all over Kenya and healthcare especially) and I’m not suggesting we stop caring for our own sick. But we should spend more of our resources caring for the sick outside out own borders, and we should do it intelligently.