Come Over Into Macedonia, H. Allen

Helping the Peasant to Help Himself


APOSTOLIS KOSKINIDES immediately appropriated to himself a significant phrase. He intended, he said, to confine his efforts to helping the peasant to help himself. This was merely a concise restatement for his own purposes of the underlying philosophy of our whole reconstruction program. Only by this means did Koskinides, or any of the rest of us for that matter, see any hope of improving gradually the unsanitary conditions of those Macedonian villages.

In January, 1933 we conducted our usual mid-winter training conference for the agricultural leaders. Always devoting some time at these semi-annual meetings to questions of rural health and sanitation, we expanded that part of the program this year into a series of practical seminars. The reconnaissance survey Just completed was made the basis for much of this discussion. Actual conditions in the villages from which these men came were carefully pointed out. Attention was called to specific projects that might well be undertaken in connection with their regular programs.

The part that each rural worker would henceforth play as a representative of the Sanitation Department was fully explained. We emphasized again that every progressive and intelligent leader, working in these communities of limited resources, should concern himself not alone with his particular specialty, but to a certain extent with all phases of community betterment. It was decided that each agriculturist would be expected to undertake during the ensuing period at least one simple project in general sanitation. Everyone was to be on the lockout for important improvements that might well be directed by Koskinides himself. All were to serve as zealous missionaries in converting the peasant to the gospel of cleanliness.

With the conference out of the way and the men back in their communities, Koskinides lost no time in swinging into action. The first urgent call to be answered came from the village of Kokkinoghia near the city of Drama. Koskinides had spotted this opportunity while making his earlier survey. It was a question of water; and the villagers, especially the women, needed little encouragement to offer all kinds of cooperation to anyone who would help them. The problem involved was quite simple, too simple in fact to have been permitted to remain for long without proper attention.

Several years before water had been piped to this settlement from a spring some distance away. In the village the water was pumped into a reservoir from which it flowed to the public fountain by gravity. The pump was out of order. No one had the initiative or felt the responsibility to repair it. The pipeline itself had rusted out in several places from disuse. As a result the women of the village, who are always the water carriers, were forced to make a round trip of five miles each day in order to bring to their homes this vital necessity. To make matters worse, the water which they now secured came from an open stream and was undoubtedly the source of much of the dysentery and typhoid that was prevalent in that area.

Encouraged by Koskinides, the village elders applied to the head of the district for an appropriation to make the necessary repairs. The required amount was soon granted. With this money, supplemented by volunteer labor, the big pump and the long water line were repaired. Within a few weeks, Kokkinoghia had once more a supply of pure water and the women no longer had to add long daily treks to their already overburdened lives.

Hardly was this job out of the way, before Horopani put in a bid for assistance. Here was another little project which, if immediately undertaken, might result in averting serious trouble for the community. A small stream meandered through the village. In the spring it was a raging torrent; in summer it was usually dry. A year or two previous, a sudden landslide had blocked the stream, backed up the water, and developed a sizeable swamp. Our district agriculturist called attention to the fact that mosquitoes had already begun to breed here; and the summer before, malaria had taken a big jump.

Koskinides looked the situation over with his, as yet, unpracticed eye. Satisfied that there were no complicating factors and that the job could readily be accomplished, he offered his services with the usual proviso—full local cooperation. Not only willing, the villagers were all eager to help. It was not merely a question of labor, but a need for someone to organize and to guide them. Quickly forming a labor battalion from among the numerous volunteers, Koskinides planned out a schedule of work. In a few weeks, the course of the stream was reopened and the menace of the Horopani swamp no longer existed.

And then came a request from Lazohori. In this case, it was as elemental a need as a school toilet. In an earlier visit to this place, Koskinides had pointed out to the schoolmaster the serious danger that lurked in the absence of such an important facility. The instructor agreed that he should add to his new school this piece of modern equipment. But what could he do? The state made no provision for such a luxury and the village fathers considered it quite unimportant. They did not bother about such a convenience in their own homes; so why, therefore, should they be concerned about their children at school ?

But this particular schoolmaster was young and ambitious and he persisted in his efforts. One day he wrote for Koskinides to come out. He reported, when Apostolis arrived, that he had aroused the interest of some of his more progressive committee-men. They had agreed to supply necessary labor and such building materials as could be found in the village. Koskinides gave them a plan for the structure, explained how the work should be done and stated that he himself would be on hand to supervise the construction. He agreed to loan to the school one of his several latrine borers with which to drill the holes, and he promised also to supply from his own budget the "Turkish-type" floor. In a few weeks this little school had an inexpensive but sanitary latrine; one section for boys and one for the girls. The Lazohori toilet was more than just another development in an individual community. It proved to be an important first milestone in a long campaign.

The construction of latrines for peasant homes as well as for schools quickly attained the status of a major activity. In this development more than in any other single improvement, perhaps, was reflected an increasing consciousness of health on the part of the peasants. With Koskinides the vital importance of this elemental necessity became almost an obsession. He talked about it with government officials, village leaders and friends, and on occasions when somewhat lighter subjects might have been a bit more appropriate. His emphasis upon this problem in season and out of season afforded the basis for considerable good-natured joking among his fellow workers. Their friendly jesting found appropriate expression one Christmas in a perfectly built miniature of one of his pet structures.

Not without good reason did Koskinides stress this seemingly commonplace matter. Surveys covering our whole demonstration area brought out the fact that latrines for private homes were practically non-existent. Privies evidently were considered to be an unnecessary luxury. As for public schools, studies showed that only five per cent had latrines that might be considered useable, even if not at all sanitary. Seventy-seven per cent had old, dilapidated structures that were long since abandoned or, if used at times, were more dangerous than none at all. Eighteen per cent lacked even a semblance of a latrine.

In his efforts to demonstrate the solution of this problem, Koskinides had the benefit of an effective device which had been brought out by the Rockefeller Foundation several years before. Facing a similar situation in another part of the world quite as primitive as Macedonia, Rockefeller engineers had perfected the so-called bored-hole latrine.

With nothing more than a specially constructed post-hole auger of enlarged proportions, a hole of about eighteen inches in diameter is drilled in the earth to a depth of eighteen or twenty feet. As the boring proceeds, additional sections can be added to the upright shaft in order to arrive at the desired depth. Four men operating the cross arms at the top have little difficulty in handling the machine in ordinary soil. Sometimes a light charge of dynamite is dropped in at the last to enlarge the opening at the bottom. A tin or iron sleeve is inserted at the top to prevent the soil from caving in. Over this is placed a stone or cement slab with the required opening. The rest of the floor may be of the same material or simply hard earth. An appropriate enclosure to insure the necessary privacy can then be erected. At the depth indicated above, anaerobic bacteria work on the feccs with the result that it is gradually decomposed without odor. For the ordinary family one of these structures will last almost indefinitely.

With his usual energy, Koskinides made a thorough study of the whole problem of latrine construction from the simple bored-hole device to various forms of the pit type. He included in his equipment a large number of the special borers, complete with extra lengths of shaft and cross arms and heavy wrenches for assembling the various parts. He prepared sets of drawings with specifications covering single units for homes and multiple units for schools. Gradually he added numerous little refinements of his own invention to improve the sanitation. For the peasant home he was able to point out that practically any type of superstructure of any available materials was quite satisfactory. He soon discovered that for most schools it was necessary to recommend the pit latrine as the bored-hole type was not adequate to the numbers of children.

It might be well to add that in Macedonia and throughout the Near East the so-called "Turkish-type" toilet is generally used. In fact, this is considered by experienced persons to be by far the most sanitary kind. It is merely a flat piece of cement or stone with the necessary opening placed on a level with the surrounding floor. This type of toilet is found in hotels and railway coaches throughout the Near East. It can be equipped with modern plumbing connections including suitable arrangements for flushing. Sometimes the raised seat toilet is also provided as a special concession to the visitor from the west; but the wise traveler soon learns the advantages in that part of the world of going native and following the Turkish procedure.

One or two other projects of a fairly simple but, withal, important nature may be of interest to mention before we take up several of the more ambitious ventures that soon occupied most of the time of our sanitation leader. There was, for instance, the problem of Skydra at the western extremity of our demonstration area. Here was a school of around two hundred pupils with no adequate supply of drinking water close at hand. The fact that this was not an unusual situation did not lessen the importance of attempting a solution. The public fountain was some distance away, and this was already quite inadequate for the constant line of women who were always waiting their turn for water. Then there was the matter of the school grounds. The yard was unusually spacious and our agriculturist wanted to develop with the teachers and pupils a good garden. Why not attempt a combined solution for these two related problems?

Koskinides was called in to consider the matter. He found that water could he brought to the place without too much expense. Parents agreed to contribute certain materials and a few pennies, or rather drachmas, each. The older boys and some of the village fathers would provide the labor. It was not long, therefore, before water was piped to a newly constructed reservoir in the school yard. A series of drinking fountains were arranged along one side of the tank to take care of the needs of thirsty children. Irrigation ditches were dug, connected with the reservoir and a fine garden with trees, shrubs, flowers, and vegetables was eventually developed.

On the outskirts of the little village of Megali Vrysi in Central Macedonia, a swamp of several acres in area had developed. A careful study of the situation indicated that the place could be drained with the labor of a few good workers. In this rural settlement there was an active club of energetic young men directed by the Foundation's agricultural leader of that area under the general supervision of our recreational specialist, Theodore Pays. It was suggested by Koskinides that the draining of this swamp might be a good proj ect in community improvement for the members of this club. Pays was intrigued with the idea. It was just the type of thing he desired to promote in the community programs of his organized groups. He took up the matter with the agriculturist and his Megali Vrysi boys and succeeded in arousing their interest. As a result these ambitious and public-spirited young men dug a ditch a quarter of a mile long and drained the swamp. The mosquitoes died in the drying mud. Eventually, this spot became the site of a village garden, also promoted by the youthful members of this same group.

These few introductory projects which we have here briefly reviewed were not the only activities of the Sanitation Department even during the first season of organized effort. Our agricultural leaders were making also their own important, even if modest, contributions to this special phase of rural improvement. During the first eight months following the impetus of the January conference these men, with the advice and assistance of Koskinides, had distributed thousands of Gambusia fish to three malarial districts; repaired, disinfected, or dug forty-one wells; and brought about the construction of twenty-seven latrines for peasant homes. In addition to all of this, Koskinides had succeeded in getting himself thoroughly involved in a really difficult task.

The first warm days of spring had forced a serious problem upon the attention of all of us. Should we or should we not attempt a thoroughgoing demonstration in malaria control in at least one of the villages of our area? Here was a wide-spread menace to health which could not be overlooked. As has already been pointed out, malaria was practically epidemic throughout much of Macedonia. Some sections were worse than others of course. There were villages that were reported to have as high as one hundred per cent infection. And yet in spite of such a tragic situation, we felt inclined to approach this problem with considerable caution, for the more one became acquainted with all of the complexities of this disease, the more he was forced to admit that malaria was a challenge for the best of the experts.

True, no small percentage of this common ailment could be traced to certain unsanitary practices of these people in their homes and in their communities. And this aspect of the difficulty might, with proper education and adequate supervision, be corrected and thus lessen in a measure the intensity of this affliction.

In general, however, this scourge of the land was the end-product of centuries of erosion. The numerous meandering streams, silted rivers, and extensive swamps to be found all over the countryside represented not simply so many mosquito-breeding areas, but deep-seated topographical mal-adjustments which required more than mere leadership and the volunteer labor of illiterate villagers to correct. We fully recognized, or thought we did, the danger of rushing in as so many others had done to attempt the impossible; but even our feeble efforts should be directed, it seemed, toward contributing what we could to alleviate a situation which was so obviously a limiting factor not only in the health, but also in the economic life of all Macedonia.

Under the circumstances there could be but one conclusion to our somewhat amateurish deliberations; we would attempt the complete control of malaria-bearing mosquitoes in one village of our area. After an extensive study of several possibilities, Makriyalos was chosen. This typically rural settlement of plain country folk was situated on the southern shore of Salonika Bay about twenty-five or thirty miles from the Macedonia capital. The people urgently needed our help, and the problem of control appeared to us not entirely an impossible task. The inhabitants of this place had their full share of malaria, but there were no bad swamps in the vicinity of the settlement, no conditions that required extensive and expensive engineering undertakings to correct. Several small streams carrying shed waters from the slopes of high Olympus some thirty miles inland ran through the village and emptied into the adjacent bay, but these streams were so situated that they could be conveniently controlled and properly sprayed from both sides. The job appeared to us to be fairly simple. With all of our caution we were vet to learn how complicated and how extremely difficult a problem even the simplest of malaria control can turn out to be.

Preliminary to the inauguration of a systematic program of mosquito eradication, several important steps had to be taken. A village survey involving much more detail than any previously attempted was required. The whole area was carefully mapped, and on this map was indicated the dwellings, all of the streams, and every possible source of mosquito larvae. Certain homes and barns were designated as catching stations to serve as barometers which would indicate the effectiveness of all control measures.

In order to record accurately any progress that eventually might be made it was necessary also to make a careful study of the existing health conditions of every individual family with particular reference to malaria. The local doctor who resided in a neighboring village volunteered to make such a study. It was found that eighty-nine per cent of the total population had enlarged spleens, which are the result of chronic malaria; forty-four per cent showed blood parasites. In this one village of only two hundred and fifty families a total of 9,177 adult working-days had been lost the previous year as a result of illness from malaria. Obviously this represented a tragic sacrifice of time and money, to say nothing of the suffering involved. In the hope of alleviating somewhat their periodic fevers these poor people had purchased quinine during the preceding twelve months to the amount of 22,484 drachmas (approximately $225), in addition to the large rations of this drug distributed free of charge by the government service.

The inhabitants of Makriyalos were only too glad to secure assistance in solving a problem which was entirely beyond their means of control, and they promised to cooperate in every possible way within their limited resources. The small community  budget was already too seriously strained to include any extra expenditures at the moment, but the village council expressed  the hope of adding a special item for malaria control the following year. Two young men were assigned to help in the spraying : operations, learn something of the measures generally used in I such work, and perhaps serve eventually as mosquito experts  for their own home community.

By mid-April when the first of the larvae began to appear in the warming waters, Koskinides was ready for the season's campaign. Regularly every ten days with the aid of his two young helpers, he sprayed the three streams that ran through his control zone. Fortunately, mosquitoes could not breed in the salty waters of Salonika Bay which lapped the edge of the village along its northern side. But in every other direction Koskinides reached out with his spray guns to a distance of three or four kilometers. Still his catchings at the stations were too large. He extended his operations to include a fourth stream, and still later a fifth. He soon found himself covering twenty-eight kilometers of meandering streams, to say nothing of numberless pools and little side rivulets.

Gradually his catchings came down. Elatedly he decided he must be killing off the pests at their source. Koskinides felt better once more and his optimism returned to its normal high level. But the mosquitoes were soon back in numbers much greater than ever. The catchings in his four stations showed a sudden increase. He added a fifth station to arrive at a more accurate check. Here also the insects were found in increasing numbers. Perhaps strong winds were bringing them in or possibly, as some thought, they came in the bodies of farm animals. Whatever the cause of the difficulty, it was evident that more stringent measures had to be adopted.

And so our leader sent out a desperate call for help from his former instructors in Athens. Obligingly they came to his rescue. After studying carefully every step that had been taken, these experts decided that our control area must be extended still further. The creeks and little rivers were winding and the distances as a mosquito flies were not as great as they seemed to Koskinides and his boys when they tramped those long stream beds with a spray outfit strapped to their back. It was pointed out that special attention must be given to moist grass at the edge of streams and stagnant water collected in the hollows of dead stumps. It was found necessary also to increase the periodic sprayings to once a week during the hot weather. More frequent inspections had to be made of home yards to see that untutored peasants kept barrels and pots and pans properly emptied of water. Our Rockefeller friends emphasized that Koskinides must devote more attention to the education of the whole population by giving appropriate talks in the coffee houses, the church, and the school. All of these recommendations and many others of a similar nature were carried out. The almost immediate drop in the number of mosquitoes was sufficient proof that the measures adopted were effective.

Somehow Apostolis Koskinides managed to get through that first season of malarial control; and, as a result of his natural persistence, he seemed to have won the battle—at least as far as such a battle could be won in any single season. The doctor who was brought in to make examinations late that fall found a substantial improvement in the spleen index and a very considerable reduction of blood parasites. Moreover, no infants under one year of age had contracted the disease. In a near by village used as a check, fifty-four per cent of a similar group examined had become infected during the first year of their existence. One definite indication of the beneficial effect of this program on the adult life of the village was the fact that this year only 1,459 work days had been lost as a direct result of illness from malaria.

Perhaps the chief beneficiary of this particular program, from one standpoint at least, was the leader himself. Here was a problem which simply would not be solved by that bubbling optimism which had won Koskinides so many battles before. He still needed his abundant enthusiasm and his cheerful outlook in the face of discouraging obstacles. But somehow mosquitoes refused to respond to such fine human traits. Just when Koskinides felt sure that his efforts were bringing definite results, his several barometers (the catching stations) would show a sudden and unexpected rise. He found that to win this battle he had to give the most scrupulous attention to the minutest of details. A few pot-holes made by the footsteps of wandering cattle, one unsprayed spot around the bend of a stream, a little slide from the bank of a brook—all of these simple items and many others just as seemingly minor could seriously affect all of his calculations. Makriyalos undoubtedly represented as simple a problem in malaria control as could have been found in any village of Macedonia. But Makriyalos turned out to be like a frosty iron—once taken in hand it could not easily be dropped. Nevertheless, two or three years of administering such a program served to complete, or at least considerably perfect, the scientific education of our man Koskinides. This was soon to be noted-in his more careful approach to every sanitation project of whatever nature.

Each year during the mosquito breeding season, Makriyalos became one of the busiest centers of our rapidly developing sanitation department. For a few months other important projects. had to take second place as far as the personal attention of Koskinides himself was concerned. Each year Koskinides brought to this program a constantly increasing experience, a growing-knowledge of mosquitoes, an ever improving technique and finally a more thorough approach to the whole question of mosquito-control. The peasants themselves showed increasing interest each year. Gradually, in addition to providing labor for this important work, they came to the point of including a small sum of money in their annual budget. This was something entirely new in the annals of village financing.

The improvement in the health of the people continued, not with the same sudden jump as the first year, but with a gradual and steady upward climb. In certain years, when malaria was particularly serious throughout the whole countryside, the various indices at Makriyalos would barely hold their own. The following season Koskinides would redouble his efforts and another improvement in the general health of the whole population would be his reward.

Nearly every spring there were landslides to be removed and stream beds to be straightened out in order to make more effective the spray operations of the summer. Little by little it was found necessary to extend the boundaries of the control zone far beyond these accepted distances mentioned in many of the textbooks on this subject. During the first two seasons Paris green was used as the killing agent instead of oil because of its greater economy. But by the third season it seemed wise to modify this-practice. Paris green will kill the larvae of anopheles, the malaria-bearing species, but it is not effective against culex, the bothersome but innocuous kind. Oil sprayed on the surface of water will exterminate both. It was finally found highly advisable to get rid of the two types even at the risk of some added expense. The buzzing and biting of culex mosquitoes, harmless though they may be, will not make a favorable impression on a visitor to an area that is supposed to be demonstrating the control of these insects.

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