4 June - Asian Geographic: The taboo of poo - why are we so reluctant to talk about one of the biggest threats to human health?
Check out the introduction to the article by Sean Mooney on the Asian Geographic website, or read the whole article below:
ENVIRONMENT
"The Taboo of Poo"
Why are we so reluctant to talk about one of the greatest threats to human health?
Text by SEAN MOONEY
Picture this: The setting sun is spreading a warm glow over your small rural village, but you are inside your house doubled over with intestinal pain. All you want is for darkness to fall so you can stagger out into the night, find a relatively secluded spot in the fields and void your bowels. You have been resisting the urge to defecate for most of the day as it is considered disgraceful in your community for a woman to be seen heeding nature’s call. You sometimes suffer from urinary tract infections and constipation, and you have almost been bitten by scorpions and snakes while squatting in the open. You have even suffered sexual violence at the hands of unknown men under the cover of night. You fear for your own health and safety, and for that of your young daughter and disabled mother. Your life is tormented by the taboo of poo.
This sad tale is repeated every day in poverty-stricken regions across Asia. It is estimated that about 1.7 billion people in southern and eastern Asia don’t have the proper means of dealing with their human waste. Many are forced to practise what is known as ‘open defecation’, which involves the use of buckets, plastic bags or simply nothing at all. They might use fields, rivers, railway lines or squalid, foul-smelling unsanitary latrines. This is not only embarrassing and undignified, it is also extremely dangerous, as the majority of the world’s illness is a result of the dispersal of human faeces. Contamination of food and water with faecal matter causes the transmission of deadly diseases such as typhoid and cholera. Every year, 1.5 million children under the age of five die from diarrhoeal diseases. It’s a human tragedy, whichever way you look at it.
So why is it so difficult to get people to talk about defecation and urination? Maggie Black, co-author of The Last Taboo: Opening the door on the global sanitation crisis, says it is primarily a social issue. “From the smallest age, Indian women have had to learn to hold themselves in, in such a way that they often do themselves internal damage,” she says. “If a respectable Indian woman disgraces herself by being in any way identified with having to use a toilet, how can she ever express the misery and indignity she experiences by not having one in the home? Is it surprising that customer demand for toilets is not vocal? I think this kind of social attitude – an extreme form of ‘out of sight, out of mind’ – is the main problem. There needs to be strong social endorsement for things to change.”
Thérèse Mahon runs WaterAid’s country programs in Bangladesh, India, Nepal and Pakistan. She thinks that the absence of discussion about women’s personal matters means that the provision of private toilets is given very low priority. “This paradox results in women living in a constant state of anxiety as they strive to meet their sanitation needs without losing their dignity,” she says. “While men and boys are found squatting by roadsides in broad daylight, similar behaviour for women and girls is unthinkable. If there are no separate latrines for girls at schools this can also prevent girls from attending school particularly once they reach puberty.”
But this is not just a South Asian problem. Sanitation disaster areas exist in that other extremely populous Asian nation, China, as well as many other countries across south and south-east Asia. World Bank Senior Water and Sanitation Economist Guy Hutton estimates that the cost of not investing in sanitation is US$9 billion per year in Cambodia, Indonesia, the Philippines and Vietnam alone. Nor is it simply a rural issue. The Indian co-ordinator for the Swiss-based Water Supply and Sanitation Collaborative Council (WSSCC), Depinder Kapur, believes sanitation is a health time bomb for Asia’s urban areas, where more than 50 per cent of the population lives in shanty towns and slums. “The governments have no accountability to provide for basic services as the people living there are seen as illegal tenants,” he says. “Expensive infrastructure projects for sanitation are being brought in that bypass the slums.” Mr Kapur cites the example of the city of Trichi in south India, where the non-government organisation (NGO) Gramalya, along with other NGOs, has built community-owned and managed toilets for nearly all of the city’s urban slums. “The challenge that they faced was not technology but working with the municipality in slum areas to erect and maintain community sanitation and bathing and washing complexes,” he explains. “To provide for not just sanitation but also all other hygiene facilities for poor slum dwellers.”
In an effort to encourage large-scale action to tackle this problem, the United Nations General Assembly declared 2008 the International Year of Sanitation (IYS), with a stated aim of ‘breaking the taboo’. Thérèse Mahon feels that the IYS “helped to galvanise governments, civil society, communities and other stakeholders around the most neglected Millennium Development Goal”. This goal, declared by the United Nations in 2002, aims to reduce by half by 2015 the numbers of people without access to sanitation in 1990. But judging by current progress, it will take until mid-century to get anywhere near this target.
So what can be done? Ms Mahon suggests that all the goals and declarations that have been made by governments need to translate into urgent action “to ensure lasting results and to realise citizens’ rights to sanitation”. Depinder Kapur says sanitation issues are best addressed by making adolescent girls and women leaders in creating sanitation, drainage and waste-disposal systems. However, Mr Kapur admits that many challenges lie ahead, and that they might require a rethink of current practices. “Making a loo in the rural setting of Asia means creating additional space and finding water to clean the toilets,” he says. “In terms of behaviour, rural people find it easy to go out and defecate and this needs to be addressed by bringing in issues of dignity and behaviour change and not the health imperatives as is being done currently by many agencies. It is difficult for rural people to understand health impacts of safe sanitation.”
This focus on dignity and behaviour change is already being employed in many parts of Asia, and is commonly referred to as community-led total sanitation (CLTS). It was pioneered in the Rajshahi district of Bangladesh in 2000 by Indian development consultant Kamal Kar, together with the Village Education Resource Centre (VERC), a partner of WaterAid Bangladesh. To put it bluntly, this strategy explains to community members that they are eating each others’ faeces. Mr Kar explains it this way: “The method used encourages local communities to visit the dirtiest and filthiest areas in the neighbourhood, appraising and analysing their practices; it shocks, disgusts and shames people. This style is provocative and fun, and is hands-off in leaving decisions and action to the community.” Thérèse Mahon says that these shock tactics create a powerful realisation within the community that collective action is necessary because if any individuals continue to practise open defecation then they will all be at risk. “This process begins to break down the notion that sanitation is not a purely private/individual matter, but is a significant issue for public health,” she says. “Support is then given to show communities how they can build low-cost, hygienic latrines using locally available materials, and technical support is provided.” Guy Hutton adds a note of caution, based on the World Bank’s experiences in Cambodia: “Sometimes [CLTS] works great, where all the preconditions are there. But we are finding that CLTS in Cambodia has many challenges due to weather (after rainy season most of the self-made latrines have broken down), traditional attitudes (preferences for doing your business in nature), and also supply constraints (non-availability of good and cheap materials for constructing a long-lasting but simple latrine). It needs a sustained effort, and close collaboration of all the national and local actors.”
Once a community is aware that it has a sanitation problem, it needs to work out how to fix it. Mr Hutton says that there are as many different solutions as there are types of communities. “Asia varies from poverty-stricken rural areas and slums to first-world mega-cities, so the technology required varies from a cheap basic [but hygienic] pit latrine in rural areas, to public toilets for slum areas, to costly water-based sewerage (with treatment) in cities.” Maggie Black states that the main alternative technology is the pour-flush pit toilet. “This is used in many countries, including India, Bangladesh and Thailand, and has many, many different variations,” she says. The World Health Organization’s A Guide to the Development of on-Site Sanitation outlines a selection of sanitation systems, with indications of their suitability for particular situations, the constraints on their use, and their disadvantages. There’s everything from simple pit, pour-flush and composting latrines, to septic tanks and aqua-privies. Factors to be considered include cost, cultural acceptability, simplicity of design and construction, operation and maintenance, and local availability of materials and skills. The Compendium of Sanitation Systems and Technologies, published by WSSCC and the Swiss Federal Institute of Aquatic Science, sheds even more light on the diversity of sanitary systems and technologies available. It offers a mind-boggling selection of sanitation systems, such as waterless systems with urine diversion, double ventilation pits, aquaculture ponds and dehydration vaults, as well as so-called ecological sanitation systems.
Maggie Black sees an important role for ecological sanitation, which usually separates urine and faeces. The faecal matter can then be treated to make safe fertiliser pellets rich in nitrogen, phosphorus and potassium. Considering that an IYS study estimated that 90 per cent of human excreta in China is used in agriculture, a system that ensures that raw sewage is not put on the fields is extremely useful. One of the great characters of the sanitation movement is Jack Sim, head of the World Toilet Organization. He says that if we recycle our nutrients back to the farms, we can reduce our reliance on energy-intensive chemical fertilisers. “We will also help conserve the depletion of phosphorous mines,” he says. “I think we really need to know that our phosphorous rock mines are depleting at a rapid pace and chemical fertiliser supply will soon face a similar crisis to the oil-depletion problem. Therefore, the sustainable way is to recycle our excreta into fertiliser and soil conditioner.”
This year’s Stockholm Water Prize Laureate Dr Bindeshwar Pathak is the founder of the Sulabh International Social Services Organisation, a non-government group that since 1970 has installed low cost and ecologically sustainable toilets in more than 1.2 million houses across India. Dr Pathak has also designed biogas technology that allows for the complete recycling and reuse of human excreta from public toilets. Biogas is produced by anaerobic digestion of human excreta in a biogas digester, and is used for cooking, lighting and electricity generation. In addition, biogas plant effluent is treated by a simple method to make it colourless, odourless and pathogen-free, rendering it quite safe for irrigation or discharge into any water body. These facilities are used by 10.5 million people in India and have made a marked difference to the environment, both in urban and rural areas.
Despite the immense challenges facing the fight for better sanitation, with the right technology, implementation and funding, progress has already been made. Now it’s time to tackle the reluctance of many societies even to talk about human-waste management. Jack Sim says that the taboo of poo can be overcome with a concerted effort to be open about the issue. “The problem is people refuse to talk about toilets, and what we do not discuss, we cannot improve,” he says. “If you ask a person how many times he eats a day, he’ll know. If you ask him how many times he visits the toilet a day, that’ll be the first time in his life he starts counting. Just like other taboos such as sex, leprosy, AIDS, women’s liberation and so on, after we are able to speak about it, we will wonder why we were so coy about it before. When public toilets are finally accepted as a lifestyle product, life will be wonderful inside the toilet – it will be a room full of inspiration!”
Sean Mooney is a writer and editor based in Sydney, Australia. He has lived and worked in Europe, North America, the Middle East and Asia. When he isn’t writing about travel and cultural issues, he is editing a group of free magazines for parents that encourage a better understanding of our children.
Did You Know?
Resources available for communities seeking sanitation solutions:
* The Compendium of Sanitation Systems and Technologies can be downloaded free of charge at www.sandec.ch and www.wsscc.org.
* A handbook on Community-led Total Sanitation is available for free download at www.communityledtotalsanitation.org/resources
* Go to www.wateraid.org/splash_out/fun_and_games/7195.asp for The Adventures of Super Toilet, a fun reminder for children of the importance of clean toilets.
* A collection of songs, photos, posters, games, artworks and other advocacy materials promoting sanitation can be found at www.worldtoilet.org/resources.asp?no=2
* The World Health Organization’s catalogue of water, sanitation and hygiene information products is online at www.who.int/water_sanitation_health/en/
* The General Assembly of the United Nations’ International Year of Sanitation website is http://esa.un.org/iys/