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An Inside Look at Cuba’s Constant Struggle for Clean Water

The World Through a Lens
An Inside Look at Cuba’s Constant Struggle for Clean Water
Across the country, battling water scarcity requires a vast array of workers, from inspectors and fumigators to truck drivers and pipe layers.
Bottled water is distributed among the shops in Central Havana.Credit…
Supported by
- Feb. 15, 2021, 5:00 a.m. ET
In one hand Manuel Reyes Estrada carried a form and a pencil, in the other a bucket filled with small fish and a plastic Bucanero beer cup. “It is like this,” he said. “We, the health brigade employees, are only allowed to write with pencils.” His superiors, he explained, use pens. In the afternoon, the superiors visit the houses where the health brigade employees have worked earlier in the day — “to check if we have done our work well.”
Manuel stopped for a second on the unpaved road in the Cuban city of Holguín to fill in the house numbers on his otherwise empty form. He swept the sweat away from his face.

Every day in towns across Cuba, a vast array of workers — from inspectors and fumigators to truck drivers and pipe layers — takes to the streets in a coordinated effort to provide clean water to their fellow citizens.
Among other responsibilities, the health workers conduct exhaustive inspections of rooftop water tanks, ensuring that the water is clean and free of mosquito larvae, thereby helping to prevent the transmission of tropical diseases such as dengue, chikungunya and Zika.
The efforts are part of an analog, labor-intensive solution in a largely nondigital society.
A significant portion of Cuba’s available drinking water is lost through its leaky and antiquated pipelines — more than 50 percent, by some estimates.
In recent years, infrastructure problems have been compounded by droughts and rising temperatures. For much of the population, running water is available only sporadically — in some cases, for one or two hours a day, every few days. While it flows, residents store the available water in cisterns or tanks, which then serve as potential breeding environments for mosquitoes.
Manuel ignored the barking dog as he entered the house. A woman wearing curlers in her hair showed him the spiral staircase that leads to the roof. After locating the building’s water tank, he used a small mirror to illuminate its shadowy interior.
Using the plastic beer cup, Manuel scooped five little fish from his bucket into the water tank. “Normally we use Abate,” he said, referring to a larvicide, also known as temefos, used to treat water. But the chemical wasn’t available, he explained, and so the fish, which eat the larvae, are employed as a natural — if complicated — alternative.
With a background in anthropology, I have long been interested in how people live and manage their everyday challenges.
During previous visits to Cuba, I noticed the daily struggles for fresh water: people hassling with water pumps, the streets soaked because of faulty pipelines, water trucks continuously plying the roads. Born and raised in the rainy Netherlands, where clean drinking water is taken for granted, I hadn’t expected water to be a scarcity on a tropical island.
In February 2019, Cubans voted to approve a new constitution, which, among many other provisions, established the right to clean water. I decided to make this constitutional right a starting point for a project on Cuba’s underreported water crisis.
I traveled to Cuba for six weeks in April and May 2019, and for four more weeks in January 2020. On the first trip I learned how different areas experience different problems — and find solutions. I also discovered how many professions were involved in providing water to residents.
By shadowing different workers who were involved in guaranteeing water access on various parts of the island, I began to see a cross-section of contemporary Cuba.
In the town of Trinidad, for example, I met Alexis Alonso Mendoza, who described himself as “the most popular man in town.”
Trinidad is divided into several districts, each of which usually has running water for two hours every five days. As the “water-key man,” Alexis is responsible for turning the underground sluices that change the direction of the water within the town.
Using an off-line map, I located the small clinics, called policlínicas, where, at 8 a.m., the inspectors and fumigators of the health brigade gather before dispersing into the streets.
I climbed aboard several water trucks, called pipas, which supply water in the event of a broken pipeline or insufficient pressure — or when functioning plumbing simply doesn’t exist.
Many of the drivers were kind enough to let me observe how they fill their trucks and distribute the water. I witnessed firsthand the bureaucracy involved — and the seemingly endless amounts of time the drivers spent waiting to fill their tanks.
I also hopped on the horse-drawn carriages that carry the water throughout the city, and observed how Cubans — with an ingeniousness and thoroughness — tried to fix their water hoses and pumps with whatever materials were available to them.
It’s difficult to know the full effects of the pandemic on Cuba’s water crisis. For much of 2020, the country largely controlled the virus, but a dearth of tourists led to one of the worst food shortages in nearly 25 years. Infections increased dramatically after lockdowns were lifted and the country’s borders were opened in November. Since then, additional stresses to the public health system may have exacerbated inspection, fumigation and delivery.
While walking back to the policlínica at the end of one of his shifts, Manuel, who has worked for the health brigade for 13 years, reflected on his work. He was pleased, he said, to be “contributing to the health of my compatriots.” But he also enjoys the interactions — visiting people, having a chat. “Often they invite me for coffee,” he said.
A man on a bicycle greeted him as he rode past. “Manuel, can you bring me some fish tomorrow? I will get you some cigars in return.”
Later, Manuel passed his supervisor. “You know the green house at the corner, where the older lady lives alone?” he said. “I found mosquito larvae in the lower tank on the patio.”
“OK,” his supervisor responded. “I’ll send the fumigators to smoke them out. See you tomorrow, mi vida.”
Sanne Derks is a Dutch freelance photojournalist and anthropologist. You can follow her work on Instagram.
Her project on Cuba’s struggles with water accessibility was funded in part by the Dutch Fund for In-depth Journalism and the Anna Cornelis Fund for Documentary Photographers.
Follow New York Times Travel on Instagram, Twitter and Facebook. And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation.
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An Inside Look at Cuba’s Constant Struggle for Clean Water

The World Through a Lens
An Inside Look at Cuba’s Constant Struggle for Clean Water
Across the country, battling water scarcity requires a vast array of workers, from inspectors and fumigators to truck drivers and pipe layers.
Bottled water is distributed among the shops in Central Havana.Credit…
Supported by
- Feb. 15, 2021, 5:00 a.m. ET
In one hand Manuel Reyes Estrada carried a form and a pencil, in the other a bucket filled with small fish and a plastic Bucanero beer cup. “It is like this,” he said. “We, the health brigade employees, are only allowed to write with pencils.” His superiors, he explained, use pens. In the afternoon, the superiors visit the houses where the health brigade employees have worked earlier in the day — “to check if we have done our work well.”
Manuel stopped for a second on the unpaved road in the Cuban city of Holguín to fill in the house numbers on his otherwise empty form. He swept the sweat away from his face.

Every day in towns across Cuba, a vast array of workers — from inspectors and fumigators to truck drivers and pipe layers — takes to the streets in a coordinated effort to provide clean water to their fellow citizens.
Among other responsibilities, the health workers conduct exhaustive inspections of rooftop water tanks, ensuring that the water is clean and free of mosquito larvae, thereby helping to prevent the transmission of tropical diseases such as dengue, chikungunya and Zika.
The efforts are part of an analog, labor-intensive solution in a largely nondigital society.
A significant portion of Cuba’s available drinking water is lost through its leaky and antiquated pipelines — more than 50 percent, by some estimates.
In recent years, infrastructure problems have been compounded by droughts and rising temperatures. For much of the population, running water is available only sporadically — in some cases, for one or two hours a day, every few days. While it flows, residents store the available water in cisterns or tanks, which then serve as potential breeding environments for mosquitoes.
Manuel ignored the barking dog as he entered the house. A woman wearing curlers in her hair showed him the spiral staircase that leads to the roof. After locating the building’s water tank, he used a small mirror to illuminate its shadowy interior.
Using the plastic beer cup, Manuel scooped five little fish from his bucket into the water tank. “Normally we use Abate,” he said, referring to a larvicide, also known as temefos, used to treat water. But the chemical wasn’t available, he explained, and so the fish, which eat the larvae, are employed as a natural — if complicated — alternative.
With a background in anthropology, I have long been interested in how people live and manage their everyday challenges.
During previous visits to Cuba, I noticed the daily struggles for fresh water: people hassling with water pumps, the streets soaked because of faulty pipelines, water trucks continuously plying the roads. Born and raised in the rainy Netherlands, where clean drinking water is taken for granted, I hadn’t expected water to be a scarcity on a tropical island.
In February 2019, Cubans voted to approve a new constitution, which, among many other provisions, established the right to clean water. I decided to make this constitutional right a starting point for a project on Cuba’s underreported water crisis.
I traveled to Cuba for six weeks in April and May 2019, and for four more weeks in January 2020. On the first trip I learned how different areas experience different problems — and find solutions. I also discovered how many professions were involved in providing water to residents.
By shadowing different workers who were involved in guaranteeing water access on various parts of the island, I began to see a cross-section of contemporary Cuba.
In the town of Trinidad, for example, I met Alexis Alonso Mendoza, who described himself as “the most popular man in town.”
Trinidad is divided into several districts, each of which usually has running water for two hours every five days. As the “water-key man,” Alexis is responsible for turning the underground sluices that change the direction of the water within the town.
Using an off-line map, I located the small clinics, called policlínicas, where, at 8 a.m., the inspectors and fumigators of the health brigade gather before dispersing into the streets.
I climbed aboard several water trucks, called pipas, which supply water in the event of a broken pipeline or insufficient pressure — or when functioning plumbing simply doesn’t exist.
Many of the drivers were kind enough to let me observe how they fill their trucks and distribute the water. I witnessed firsthand the bureaucracy involved — and the seemingly endless amounts of time the drivers spent waiting to fill their tanks.
I also hopped on the horse-drawn carriages that carry the water throughout the city, and observed how Cubans — with an ingeniousness and thoroughness — tried to fix their water hoses and pumps with whatever materials were available to them.
It’s difficult to know the full effects of the pandemic on Cuba’s water crisis. For much of 2020, the country largely controlled the virus, but a dearth of tourists led to one of the worst food shortages in nearly 25 years. Infections increased dramatically after lockdowns were lifted and the country’s borders were opened in November. Since then, additional stresses to the public health system may have exacerbated inspection, fumigation and delivery.
While walking back to the policlínica at the end of one of his shifts, Manuel, who has worked for the health brigade for 13 years, reflected on his work. He was pleased, he said, to be “contributing to the health of my compatriots.” But he also enjoys the interactions — visiting people, having a chat. “Often they invite me for coffee,” he said.
A man on a bicycle greeted him as he rode past. “Manuel, can you bring me some fish tomorrow? I will get you some cigars in return.”
Later, Manuel passed his supervisor. “You know the green house at the corner, where the older lady lives alone?” he said. “I found mosquito larvae in the lower tank on the patio.”
“OK,” his supervisor responded. “I’ll send the fumigators to smoke them out. See you tomorrow, mi vida.”
Sanne Derks is a Dutch freelance photojournalist and anthropologist. You can follow her work on Instagram.
Her project on Cuba’s struggles with water accessibility was funded in part by the Dutch Fund for In-depth Journalism and the Anna Cornelis Fund for Documentary Photographers.
Follow New York Times Travel on Instagram, Twitter and Facebook. And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation.
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Sunscreen and Bug Spray: Children’s Summer Skin Care

Credit Getty Images
Summer is here, and we know we’re supposed to shield children from the sun. There’s strong evidence that early sun exposure can increase children’s risk of later skin cancer, and that’s true also for darker-skinned children who are less likely to burn. Boston and Miami Beach are providing free sunscreen in public places, and now New York is talking about it, too.
Parents have certainly gotten much more aware about sun protection, though they sometimes feel a little overwhelmed by the variety of products and by the job of keeping up with the imperatives for proper use.
And with old worries about ticks and new worries about mosquito-borne viruses, parents wonder if they should also be coating a child’s exposed skin with bug repellent.
But babies’ delicate skin is more permeable than adults’, so any chemicals we apply may be more likely to be absorbed, and their immature organs may be less able to handle those chemicals. What stays on the skin may be absorbed; but what doesn’t stay on the skin doesn’t shield. Dermatological toxicology involves considering the balance between “wash in,” the risk of absorbing potentially toxic substances through the skin, and “wash out,” the loss of protection as substances are lost by sweating or water exposure or rubbing. Both are highly complex processes, with many variables, and not necessarily well studied in young children.
With little babies, the advice is always to rely on reducing exposure, on shade and clothing for sun, and on adding screens and netting to keep the bugs off. Both the Food and Drug Administration and the American Academy of Pediatrics emphasize that babies under 6 months should be kept out of direct sunlight, protected with shade, shielded with sunhats and protective clothing when they do have to be out, rather than relying on sunscreen.
Babies’ skin surface is large in proportion to their body volume and their internal fluids, putting them at high risk for heat and dehydration. So make sure they are drinking and wetting their diapers regularly.
Adults and children alike are advised to avoid the hours of maximum exposure — to stay out of the sun between 10 and 2, and to avoid going outside at dusk in areas with lots of mosquitoes. But of course, that isn’t necessarily easy.
Sun hats and protective clothing are important for older babies and toddlers, and so is avoiding those peak hours. For children under 2, “the rule of thumb in this age group is clothing first,” said Jacqueline Thomas, an assistant professor of dermatology and surgery at Nova Southeastern University in Fort Lauderdale, who is the senior author on a commentary reviewing pediatric sunscreen and sun safety guidelines published last year in the journal Clinical Pediatrics. Dark colors and more tightly woven fabrics are more effective.
As to sunscreen, experts say not to choose by what is marketed for children or babies, and to read the label carefully. In 2011, the F.D.A. required much more information to be standardized on sunscreen labels; parents should look for products with an SPF of 30 or higher, advises the American Academy of Dermatology, and make sure they are labeled as “water resistant” (lasts 40 minutes in the water) or “very water resistant” (80 minutes), and as “broad spectrum,” meaning that they block both UVA and UVB rays, both of which do damage. There is no such thing as waterproof sunscreen.
The active agents in sunscreen can be either chemical blockers or physical blockers, and the physical blockers are safer for children because they are much less likely to be absorbed. For children ages 2 to 12, look for products with titanium or zinc as their active ingredients, rather than chemical agents, which really haven’t been studied in children.
The recommended amount for an adult-size body is variously described as a shot glass and a golf ball for the trunk and extremities; for under 12, some authorities suggest using the amount that would fill a child’s cupped hand as a rough guide. It needs to be reapplied after two hours, because the efficacy is gone, even if you can still feel the lotion on your skin, and sunscreens with higher SPFs don’t last any longer than those with lower SPFs (in fact, there is no evidence that SPFs over 50 are more protective).
Although spray-on sunscreens are popular, their efficacy has not been studied,, and there’s concern about children inhaling them. The F.D.A. has asked for more data.
What about insects? Mosquito repellents generally contain either DEET, picaridin or one of several essential plant oils, most commonly oil of lemon eucalyptus, as an active ingredient; permethrin, which is meant to be applied to clothing (or sometimes already applied by manufacturers) works to repel ticks.
There has been concern in the past about DEET toxicity, and the recommendation is to avoid DEET and picaridin for babies younger than 2 months, and to avoid oil of lemon eucalyptus for children under 3. But most pediatricians would recommend being very sparing with all of these substances on babies and young children, applying them only to exposed skin, right before going outside, and washing them off when you come back in. Don’t let young children apply the stuff themselves, and keep it away from their eyes and their mouths, and their hands if they tend to put those in their mouths. If possible, put the repellent on the clothing, or on the tent; there are also clip-on devices that can be attached to strollers.
Dr. Adelaide A. Hebert, a professor of dermatology and pediatrics at McGovern Medical School at the University of Texas Health Science Center at Houston, said she tends to recommend picaridin-based insect repellents such as Cutter Advanced and Off Clean Feel for children over those that contain DEET. “I like picaridin. I feel there’s less concern for parents using it with regard to toxicity,” she said. The strength of these insect repellents can vary as well, so again, it’s important to read the label. “We don’t recommend DEET strength above 20 percent because of concern about toxicity,” Dr. Hebert said.
Combination products are another problem, though the idea of a single lotion that protects against both sun and insects is very appealing. “I never recommend combination products,” said Dr. Hebert. “We don’t want to reapply the insect repellent as often as we may need to reapply the sunscreen.” Further, there’s evidence that the mixture may make the sunscreen less effective, and the chemicals more likely to be absorbed.
So keep babies out of the sun, be scrupulous about sun hats and protective clothing, about screens and mosquito netting. As children grow, don’t forget about protecting the eyes; think about broad-brimmed hats and sunglasses. If you need protection against insects, apply insect repellent over sunscreen, and reapply the sunscreen after two hours, on top of the insect repellent, which does not have to be reapplied so frequently.
The skin is the largest organ of the body, proportionally larger in the smallest children, and protecting it properly needs our care and attention.
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- A Reconsideration of Children and Screen Time
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Ask Well: Why Do Mosquito Bites Itch?

Credit iStock
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