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The pandemic helped spur a national response. The just-signed Infrastructure Investment and Jobs Act includes $3.5 billion in Indian Health Service sanitation facilities construction program, with work to be phased in over five years, plus $230 million for the Environmental Protection Agency’s grant program for village water and wastewater projects.
It was a compelling case among her colleagues, said Senator Lisa Murkowski, the Alaska Republican who helped craft the legislation. “When I tell them and I show them pictures about what happens in some of our communities where we’re dumping, children are hauling buckets of human waste and dumping it into a lagoon, they’re shocked,” she said at a Nov. 10 news conference.
The most critical needs in Alaska are in communities such as Teller, one of 31 villages in the state that are totally lacking in-home water and sewer connections and considered “unserved.”
But water and sanitation problems extend more broadly than those unpiped communities.
Several Alaska communities are classified as “underserved” because no more than half of the homes have piped-water service. Elsewhere, running water and sewer service might be available, but it is substandard and vulnerable to disruptions. And even in larger hub communities, some residents can’t afford the monthly utility fees or necessary home upgrades to escape the honey-bucket system.
Poor water and sanitation service means more disease
The connection between poor water and sanitation service and poor health is well-established in Alaska and elsewhere in the North. There is a long list of related illnesses and maladies in rural Alaska and the Arctic that have been chronic problems for decades. They range from respiratory diseases to skin infections to tooth decay. One of the most pressing problems has been infections of respiratory syncytial virus, or RSV, which plague babies and young children in rural Alaska and similarly situated areas of Arctic Canada.
In the far-flung villages of southwestern Alaska’s Yukon-Kuskokwim River Delta, the state’s poorest region, the RSV outbreaks and other respiratory problems are especially severe for babies and young children, a top Alaska health official told U.S. senators earlier in the year.
“We expect that one out of every three of our infants every year in one of those communities will be hospitalized simply because they don’t have running water,” Valerie Davidson, president of the Alaska Native Tribal Health Consortium, said in testimony at a U.S. Senate hearing in March.
Davidson, who is Yup’ik, had her own experience with RSV: Her daughter was hospitalized as a baby for nine days with RSV. Her daughter developed lingering problems. “She has asthma and was hospitalized eight additional times for pneumonia by the time she was 7 years old, which is unacceptable in our country,” Davidson told the committee.
Those respiratory infections can have tragic outcomes.
In 2016, Okbaok-Garnie lost her youngest child, a baby boy, to pneumonia. She and her son had both been sick when things took a turn for the worse. She loaded him onto her snow machine and headed for the hospital in Nome 70 miles away. “He stopped breathing that night on my back,” she said. He was named Hunter; he was just 5 and a half months old.
  Teller Mayor Blanche Okbaok-Garnie in her home. Her son, Hunter, died from pneumonia before he reached 6 months. (Yereth Rosen)
Okbaok-Garnie chose a small inland cemetery site for Hunter because the same permafrost thaw that is underlies the honey-bucket dumpsite is causing Teller’s main cemetery, located on a coastal bluff, to erode and sink.
“I put my son here because he died in winter and I wasn’t sure what all that erosion looked like under the snow, and I didn’t want to pick the wrong spot,” she said as she drove past Hunter’s gravesite.
Through the COVID-19 pandemic, the rural Alaska death toll has also mounted, especially in the early months before vaccines arrived. Much of the blame is put squarely on poor water and sanitation services.
Those rural Alaska services are better than they used to be. In the early 1980s, only about a quarter of rural Alaska homes had running water and indoor plumbing, but three decades later, that had increased to about 75 percent, according to the Alaska Department of Environmental Conservation.
Some communities are still waiting for service
Still left are the last unserved communities, encompassing about 3,300 homes. They are the most challenging cases.
Teller is typical of those communities.
There is a primary source for household water where residents fill up containers to haul home: a weather-beaten storage tank that rises above the city offices and “washeteria” in the village center that that offers limited piped-water services, including a laundromat and showers. The tank holds hold 1 million gallons and is filled with creek water sent by a community pipeline; it also feeds into the school, which has its own internal water system that extends to teacher housing but no further.
There is a standard way for getting rid of wastes, too. Urine and feces are deposited into trash bags within honey buckets. When filled, the bags are tied and the buckets and their contents placed outside homes for pickup on Monday, Wednesday and Friday by the city workers who truck the waste to the disposal site. Honey bucket pickup services cost $35 a month per household.
The routine of collecting water and getting rid of wastes, repeated throughout villages in rural Alaska and the wider Arctic, can be taxing. Clean water and dirty waste are hard to carry and easy to spill, especially when conditions are snowy, icy and slippery.
The difficulties translate to very limited daily water use, well below World Health Organization recommendations of 13.2 gallons per day, as many studies have documented. A survey of 21 households in one northwestern Alaska village revealed per-capita daily water use of 2.4 gallons, according to a 2016 ANTHC study; another study found that single-mother households in the region had even lower daily use. By comparison, the average daily per capita water use in the United States is 156 gallons per day, according to the ANTHC experts.
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