Case Analysis

Water-Boiling in a Peruvian Village

A Case of Innovation that failed*

The public health service in Peru attempts to introduce innovations to villagers to improve their health
and lengthen their lives. The change agency enjoys a reputation throughout Latin America as efficient. It
encourages people to install pit latrines, burn garbage daily, control house flies, report suspected cases of
communicable disease, and boil drinking water. These innovations involve major changes in thinking and
behavior for Peruvian villagers, who have little knowledge of the relationship between sanitation and

Water-boiling is a necessary method of preventive medicine for these people. Unless they boil drinking
water, patients who are “cured” of infectious diseases in village medical clinics often return within the
month to be treated for the same disease.

A two-year water-boiling campaign conducted in Los Molinos, a peasant village of 200 families in the
coastal region of Peru, persuaded only eleven housewives, who are the key decision makers in the family,
to boil water. From the viewpoint of the health agency, the local hygiene worker, Nelida, had a simple
task: To persuade the housewives of Los Molinos to add water-boiling to their pattern of existing
hebaviour. Even with the aid of a medical doctor, who gave public talks on water-boiling, and fifteen
village housewives who were already boiling water before the campaign, Nelida’s program of directed
change failed. To understand why, we need to take a closer look at the culture, the local environment, and
the individuals.

The Village
Most residents of Los Molinos are peasants who work as field hands on local plantations. Water is carried
directly from stream or well by can, pail, gourd, or cask. Children are the usual water carriers; it is not
considered appropriate for teenagers of courtship age or for adult men to carry water, and they seldom so.
The three sources of water in Los Molinos include a seasonal irrigation ditch close by the village, a spring
more than a mile from the village, and a public well whose water the villagers dislike. All three are
subjected to pollution at all times and show contamination whenever tested. Of the three sources, the
irrigation ditch is most commonly used. It is closer to most homes and children can be sent to fetch the
water; it has the advantage of being running water, rather than stagnant, and the villagers like its taste.

Although it is not feasible for the village to install a sanitary water system, the incidence of typhoid and
other water-borne diseases could be reduced by boiling the water before consumption. During her two-
year residence in Los Molinos, Nelida paid several visits to every home in the village but devoted
especially intensive efforts to twenty-one families. She visited each of these selected families between
fifteen and twenty-five times, eleven of these families now boil their water regularly.

What kinds of persons do these numbers represent? By describing three village housewives-one who boils
water to obey custom, one who was persuaded to boil water by the health worker, and one of the many
who rejected the innovation—we may add further insight into the process of planned diffusion.

Mrs. A: Custom-Oriented
Mrs. A is about forty and suffers from sinus infection. She is labeled by the Los Molinos villagers as a
“sickly one.” Each morning, Mrs. A boils a potful of water and uses it throughout the day. She has no
understanding of germ theory, as explained by Nelida; her motivation for water-boiling is a complex local
custom of hot and cold distinctions. The basic principle of this belief system is that all foods, liquids,


How. a lowland peril. In essence hot-cold distinctions serve as a series of avoidances and approaches in such behavior as pregnancy and child rearing. A likes a dash of cinnamon in her drinking water. she is ill. Mrs. and the entire health-illness system. leaving them less time to boil water for their families. Mrs. B who imparts knowledge and brings protection. hear. Boiled water and illness are closely linked in the folk-ways of Los Molinos. At no point in the village belief system is the notion of bacteriological contamination of water involved. boiling is aimed at eliminating the innate “cold” quality of unboiled water. quite apart from their actual temperature. Mrs. how can they hurt a grown person? There are enough real threats in the worlds to worry about-poverty and hunger-without bothering with tiny animals one cannot see. These women lack time to gather firewood and to boil water. it is unthinkable for him to eat pork (very cold) or to drink brandy (very hot). particularly those of the lower social class. only the ill use cooked. Mrs. Villagers learn from childhood to dislike boiled water. or herbs. She will never achieve more than marginal social acceptance in the village. B not only boils water but also has installed a latrine and has sent her youngest child to the health center for an inspection. A firm believer in the hot-cold superstition. Extremes of hot and cold must be avoided by the sick. B’s practice of boiling water has no effect on her marginal status. C: Rejector This housewife represents the majority of Los Molinos families who were not persuaded by the efforts of the change agent during the two-year health campaign. or smell. C’s allegiance to traditional customs are at odds with the boiling of water. Nelida. located among the peaks of the high Andes. cinnamon. are rejecters because they have neither the time nor the means to boil water. B is marked as an outsider in the community by her highland hairdo and stumbling Spanish. Having nothing to lose socially. such as sugar. she feels that only the sick must drink boiled water. The poor cannot afford the cost of fuel for water-boiling and the wives often work as field labourers besides their husbands. B worries about lowland diseases which she feels infest the village. is added. Mrs. By tradition. which is perceived to be very cold. not the harmful bacteria. It is partly because of this anxiety that the change agent. by custom. food habits. but they are still strongly oriented toward their birthplace. must be boiled to overcome the extreme temperature. Once an individual becomes ill. B: Persuaded The B family came to Los Molinos a generation ago. and other objects are inherently hot or cold. Because the community is not an important reference group to her. Most can tolerate cooked water only if flavoring. in spite of Nelida’s repeated explanations. she argues. Nelida is a friendly authority to Mrs. touch. or “hot” water. She is grateful to Nelida for teaching her how to neutralize the danger of contaminated water. Mrs. Mrs. B gains in personal security by heeding Nelda’s friendly advice. therefore. B deviates from group norms on innovation. even if they were convinced of its value. Mrs. C does not understand germ theory. 2 . Several housewives. A drinks boiled water in obedience to local custom. Mrs.medicines. B to boil water. Mrs. was able to convince Mrs. raw water. Mrs. lemon. can microbes survive in water which would drown people? Are they fish? If germs are so small that they cannot be seen or felt. Mrs.

eleven families to say specifically. change agents in other Peruvian Villages were able to convince 15 to 20 per cent of the housewives. to adopt the innovation. was largely unsuccessful. Was it proper on the part of Nelida to be friendly with Mrs. B was marked as an outsider by the local community? b. can you visualize how the relationship has hampered Nelida’s campaign? c. a. Do you agree that Nelida should not have worried about such people? If you agree/do not agree. If you feel it was not proper. aimed at persuading housewives to boil drinking water. C was a rejecter.Questions for discussion This intensive two-year campaign by a public health worker in a Peruvian Village of 200 families. 1. Nelida was able to encourage only about 5 per cent of the population. Can you suggest some ideas to make the Nelida’s campaign successful? 3 . can you suggest how Nelida could have used the relationship to make her campaign successful? d. 3. give reasons. Can you suggest reasons for failure of Nelida’s Campaign? 2. if you feel it was proper. In contrast. You know Mrs.

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