Grant Proposal Example, Arnold P Gold Purified Drinking Water Technology, Public Health

1. ARNOLD P GOLD GRANT PROPOSAL __ 2016 __ WRITTEN BY RICHARD ALAN RUSSELL
Abstract: 2025 Lima, Perú is projected over the cusp into crisis leading to severe water scarcity; this desert
metropolis Limeño is comprised of nearly 10 million people that need and deserve daily water (McGrath,
2014). Global climate changes, cultural-political tangles, inadequate infrastructure, and imbalanced water
usage between city districts are some factors leading to such water sparsity (“Water crisis in Lima,” 2011;
Mervin, 2015; Ioris, 2012; World Bank, 2015). This research project will investigate anthropology, economics,
public health, technology, culture and language, and education in the context of drinking water over 1.5 years
abroad on leave from the University of Arizona College of Medicine (UACOM) while enrolled at la
Universidad Nacional Mayor de San Marcos (UNMSM), Facultad de Medicina de San Fernando, as part of
Thesis 1 (Proyecto de Tesis I), Research Methods (Proyectos de Investigación), and Thesis II (Proyecto de
Tesis II) coursework. A written report with supplementary tables and visuals, in addition to a compelling oral
story for professional presentation about the health needs for purified drinking water technology (PDWT), will
both be completed in two phases. Phase I will focus on determining, identifying, assessing, and analyzing the
need for PDWT in communities that are vulnerable to clean drinking water unavailability or contamination
due to large-scale industrial processes, such as pipe corrosion, discharge from mines, pollution and trash, and
byproducts of chemical disinfection of water. In phase II, members of a case study group in Lima, Perú, will
receive a PDWT system, referred to here as a Conditional Public Asset Transfer (CPAT), with the intent of
identifying potential public health benefits in a particular urban district(s) in Lima. The case study CPAT will
be modeled on previously successful public health programs common to 18 countries in Latin America called
Conditional Cash Transfers (CCTs). The case study will be approximately 10-weeks; it will involve
continuous patient interaction funded by humanism to improve clean drinking water access for two families.
Hypothesis: CCTs enable financial independence within underserved populations by providing money to
participating households, thus CPATs enable Lima residents autonomous access to clean drinking water and
opportunity for long-term financial independence via PDWT provision.
Objectives and Significance: Phase I will determine at least one PDWT to improve water security and
optimal health of Lima residents; identify domestic and international groups involved in similar public health
PDWT activities; assess the social-cultural and economic environment in a generalizable fashion to
understand key social institutions, customs, traditions, and beliefs regarding PDWT and CPATs; and analyze
the political-legal environment to understand the influence of government and regulations on any case study
activities. Phase II will complete a case study of a group defined by a city district of urban Lima by donating a
PDWT to a participant with conditions based upon phase I findings. Participation requires learning about
water from a multi-perspective approach and sharing details of the experience with their new PDWT. This
grant funds phase II materials during semester-I 2017 at UNMSM, covering cost of flights, water jugs, cost of
legal inscription translations, and RO/AWG systems.
Background
A commodity fundamental to public health and survival is water, and in 2013, Peruvians’ universal access to
clean drinking water was codified in the Sanitation Services Modernization Law (N⁰ 30045/2013). The
Peruvian water supply, including that of metropolitan Lima, is a natural resource currently derived from
Chillón, Rimac and Lurin river basins with future water sources planned to draw from wells, lakes, reservoirs
and desalination or water treatment plants (Kalra et al., 2015). Rural small-scale providers supply water and
sanitation services (SSPs). Both private and communal SSPs service communities’ basic operations and
function, while in urban Lima, water and sanitation services are mostly provided by utilities e.g. SEDAPAL
(with some SSPs working mostly in peripheral urban districts). Many of the SSPs both rural and urban are
efficient, more so than large utility providers in their respective communities who benefit from economies of
scale. The Water and Sanitation Program concludes large scale utilities and SSPs should “cooperate with one
another rather than segment the markets by working separately” (Ringskog, 2007). More recently, in the non-
peripheral urban zones of Lima there is daily access to potable water (The World Bank, 2011). Furthermore,
as of 2015, public water utilities provided potable water to approximately 9 million of 9.75 million urban
residents of Lima (Bozzo, 2015). This potable water varies in quantity and quality, depending on large-scale
infrastructure projects and holistic water resource allocation strategies (“Decade, Water for Life, 2015,” 2014).
Presently, there is sufficient quantity in most parts of Lima despite long-term forecasts of climate change
shortages. Hence the quality of this water is more immediately in public health consideration.

2. ARNOLD P GOLD GRANT PROPOSAL __ 2016 __ WRITTEN BY RICHARD ALAN RUSSELL
Defining the maximum contaminant levels (MCLs) of microorganisms, disinfectants, disinfection byproducts,
inorganic chemicals, organic chemicals, and radionuclides is one way to determine drinking water quality
(“NRDS,” 2003). Monitoring of MCLs varies by nation and geography, but not incomparably. MCL goals and
monitoring can include over 90 individual contaminants in some industrial nations (based upon the regulations
set by the Environmental Protection Agency of the United States). Of the 90 contaminants often regulated,
less than 1/9th
are biological or naturally occurring (e.g. cryptosporidium, legionella, turbidity, viruses, etc).
The majority of monitored contaminants are from modern industrial processes such as farming runoff, mining
discharge, herbicides, chemical factories, corrosion of piping, residue of banned termiticides and insecticides
(“Table of Regulated Drinking Water Contaminants,” n.d.). As for common tap water, there is public concern
over contaminants in the water (Bojorquez, 2016; “Conoce por qué no debes beber agua del caño,” 2015). In
2009 a study by the Environmental Working Group found a total of 316 contaminants in tap water, and 202 of
these had no safety standards of MCL (“National Drinking Water Database,” 2009). Other studies have looked
at the minerals or total dissolved solid (TDS) levels in drinking water. In Europe bottled water has higher
Ca2+, Mg2+ and Na+ than US tap water which translates to bottled water from Europe having higher TDS
(Azoulay et al., 2001) than US tap water. The World Health Organization (WHO) has published findings that,
low TDS, demineralized water is associated with increased risk of cardiovascular changes (on
electrocardiography), higher blood pressure, somatoform autonomic dysfunctions, headache, dizziness, and
osteoporosis over long-term consumption (Kozisek, 2003; Ong, 2009). Ultimately, the WHO offers a
comprehensive basis for determining the quality of drinking water in the Guidelines for Drinking-water
Quality 4th
Ed, and the highest quality drinking water has low contaminant levels (Ashmed, 2011).
In Lima, Perú there are many different cultural, institutional, environmental and quality complexities
concerning the state of general water access, distribution, and purification (e.g. sanitation, disinfection, etc.).
A growing and direct public health concern for urban areas with adequate quantity of water is the quality of
water. The question remains of how to introduce a PDWT effectively in Lima and whether the PDWT should
be a reverse osmosis (RO) system, an atmospheric water generator (AWG), simple carbon filter or some other
system. With new PDWT (e.g. water desalination treatment plants, RO, AWG) new public health factors
should be considered with TDS being one of these new factors recognized by the WHO. Since access to clean
drinking water is a basis of public health and a medical necessity, in a sense directly related to poverty, a
successful development program aimed at reducing poverty and its associated public health problems can
model CCTs (Rawlings, 2005). In the context of a CCT, a program condition could be to require children of
an enrolled household receive vaccinations. Other conditions, like participation in a multi-perspective
approach (e.g. scientific, historical, geographic, or gender and human rights) to learn about drinking water and
health, should be tested especially in CPATs of PDWT (“Learning about Water - Multiple-Perspective
Approaches,” 2012; Simon, n.d.). With CPATs it is possible that communities learn about the value of
purified drinking water for health, while also receiving a PDWT to serve their community and generate
income. In this sense CPATs can achieve similar ends of CCTs, while also meeting public health needs.
Methodology: The proposed fieldwork methodologies are qualitative and quantitative. (1) Free-listing and
pile sorting – participants asked to organize words or physical representations – are methods to define the
lexicon specific to a topic within a culture, and these methods determine language and terms for use in surveys,
as well as, culturally semantical aspects allowing effective structured interviews. These methods can elucidate
what CPATs mean to a Lima district population because these methods will help give meaning to aspects of
purified drinking water, public health and community economics that are valued or even understood within
each population. By limiting sampling by district, any hidden sample population factors (mainly of social-
economic nature) and water service provision factors can be controlled for with increased focus and
specificity of investigation; thus results are particular to each district’s demographic and needs. (2) Direct
observations plus structured interviews (with the same questions, in the same order, on a single rating scale)
will underpin the oral story, which will focus on the case study and the processes and challenges of
investigating phase I. The oral story will be supplemented by quantitative data and analysis of these data,
photographs and video-clips as well as schematics and diagrams. (3) The data from questionnaires and
additional survey techniques will be quantitative in nature to help understand the resources participants and
district communities have for PDWT, and price-points can serve as an estimator or proxy of personal value as
well as real financial capacity for obtaining purified drinking water. For example, a game will be played with

3. ARNOLD P GOLD GRANT PROPOSAL __ 2016 __ WRITTEN BY RICHARD ALAN RUSSELL
coins to be placed on each of the household expenses that were free listed, (including that of water if included)
to calculate the percent income spent on water. With the survey participant numbers will be as large as
possible to better represent the given district, and all participants sampled will be legal adults not from a
vulnerable population (i.e. pregnant, minors, prisoners, or as determined by the IRB of UACOM). UNMSM
students and the UACOM transfer student will collaborate in constructing the questionnaires and collecting
responses. All project collaborators interacting with human participants will comply with IRB standards. All
participants will sign a photo release for any oral story documentation. IRB approval is with receipt of award.
After the first year abroad the transfer student will be required to renew their leave status with UACOM
(approximately July 27th
, 2018) by sharing updates on enrollment status, experiences and findings with the
Student Progress Committee, a panel consisting of over 20 professionals.
Direct Patient Interaction: Extensive time will be spent in the classroom and in direct clinical settings such
as hospitals and rural clinics. During this 1.5 year-long project the UACOM transfer student will participate in
UNMSM, San Fernando course numbers 26, 27, 9, 17, 5, 19, 32, 33, 11, 35, 37, 42, 43, and 44 at UNMSM
(syllabuses available in Spanish). These courses have both didactic and clinical aspects, and the respective
titles are: un capítulo de medicina tradicional, proyecto de tesis I, sociología antropología aplicada a la
medicina (estudio independente), proyectos de investigación, historia de la medicina, ética, introduction a la
clinica, proyecto de tesis II, atencion de la salud en N1 y N2 (1) and atencion de la salud en N1 y N2 (2),
Cirujía, Medicina Legal Violencía y Certificado de Defunción, Geritatría, and the beginning portion of
Externado.
Future Research: (1) Phase I (by itself) is the first part (of three) of a proposed international public water
project. (2) The UACOM transfer student will aim to apply for dual Peruvian citizenship after the 1.5 years
abroad as well as certification of Médico Cirujano (MC), which is similar to the MD title. This experience in
whole can pave the way for additional doctors to earn international dual-degrees and invaluable experiences in
medicine, public health and research projects. It could also train future doctors in Spanish-English
bilingualism which cultivates cultural competency for a life-time. This international culture will ultimately
incubate healthcare leaders better equipped to advocate for the Pan American people’s health. (3) This grant
increases the mobility of future graduates, doctors and participants, and this will make interdisciplinary career
options around the world available. The research funded by this grant offers a profound opportunity for many
vested interests within the real work world of academia and public health medicine because it multiplies the
opportunities of those engaged in the exchange between Peru and North American.
Discussion
I have always had many interests. I earned a BS/BA triple major in mathematics with life sciences emphasis,
economics of social and behavior sciences, and molecular cellular biology, with a minor in business
administration from the University of Arizona. My undergraduate research in Oaxaca, Mexico focused on
trying to understand how education and income level relate to preference for traditional medicine versus
allopathy. This work consisted of administering questionnaires/surveys and conducting structured interviews
with doctors in numerous hospitals and clinics who generously donated their time. My experience in Oaxaca
led me to the conclusion that the exchange of information during doctor-patient interviews, along with
teaching within the pluralistic framework, would influence the long-term cultural faith in traditional and/or
allopathic medicine. And after living in Lima for the month of July 2015, I know this is how I want to spend
my time.
This entire research opportunity is based on UNESCO’s vision for higher education. If successful, I will learn
the Latin American culture in depth and be in a position to bridge relations between UACOM and UNMSM.
This will increase my mobility in life while opening my worldview to include Peruvian and North American
cultures. Since first going to Mexico, I have made Spanish fluency a major life goal. Accomplishing this goal
will both increase my confidence and allow me to enjoy the arts of both languages - arts that connect human
to human, doctor to patient. This research opportunity defines a lifetime of passion, exploration, and learning
for me. I want to inspire my future patients to face each day knowing that there are limitless opportunities for
learning and growth between our shared cultures. From Lima to Tucson, I want to live a life that inspires
others to be healthy with preventative measures like drinking clean water.

4. ARNOLD P GOLD GRANT PROPOSAL __ 2016 __ WRITTEN BY RICHARD ALAN RUSSELL
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5. ARNOLD P GOLD GRANT PROPOSAL __ 2016 __ WRITTEN BY RICHARD ALAN RUSSELL
Contact Email: wsplac@worldbank.org.
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