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Saturday, Jul 11, 2009
Our frank interview about human waste may horrify you about how the world cleans itself down there.
By Katharine Mieszkowski
Read more: Books, Health, Interviews, Authors, Katharine Mieszkowski, Books Interviews, Salon Conversations, Environment & Science
Oct. 16, 2008 | If you're one of those Americans who does not leave the house without showering and applying deodorant, you may be surprised to learn that hundreds of millions of people around the world likely think that you're unclean, if not downright disgusting.
It's all about how you clean your butt.
In cultures that use water to clean down there after defecating, dry toilet paper as a substitute is something of an ass abomination. Yet to those of us raised on Charmin, using a bidet, even though it's more hygienic, is just as foreign.
Bathroom hygiene is just one of the foul and frankly fascinating aspects of what's euphemistically known as "sanitation," which British journalist Rose George explores in her new book, "The Big Necessity: The Unmentionable World of Human Waste and Why It Matters."
For her reporting, George ventured into the bowels of London's sewer system with an emergency breathing apparatus strapped on her waist. She squatted in a doorless public toilet in China. And she visited slum dwellers in Mumbai who live in areas with 100 public toilets for 45,000 residents.
Here in the industrialized world, where we happily flush it and forget it, it's hard to imagine that literally billions of people elsewhere have no access to a toilet. It may also be difficult to believe that 90 percent of the world's sewage ends up untreated in oceans, rivers and lakes, some of that filth burbling out of our supposedly sophisticated sewage systems. While the humble toilet has added decades to the lives of those of us lucky enough to have one, George reports, it's also created a whole host of environmental problems.
Salon talked toilet, latrine and bidet with George by phone from London.
Some 2.6 billion people have no access to a toilet whatsoever, and that includes a latrine, a bucket or a box. They literally have nowhere to go. Can you talk about what that means?
Anyone who has traveled to India and taken an early morning train will know exactly what that means because all you have to do is look out of the window. What you'll see is people just simply squatting there, doing their business where they can.
What it means in terms of public health is catastrophic. Human waste can be extremely toxic. It can carry millions of bacteria, viruses and worms. And you don't want that kind of stuff lying around. But these 2.6 billion people, who have absolutely no sanitation, have no choice but to use the nearest bush or roadside. That means it's being tramped around in the human environment. It's getting into people's food, it's getting into their water, and it's making them extremely sick.
The death toll from diarrhea, which is largely caused by poor sanitation, is astronomical. It's the second biggest killer of children in the world after respiratory diseases.
Why isn't this more of an international health issue?
It's quite simply that we don't want to talk about it. There is a linguistic problem. We don't have the language for it anymore because we've resorted to euphemism. In the West, we've been able to resort to euphemism because we have the wonderful flush toilet and waterborne sewage system, which gives us the luxury of being able to flush something away and assume it will be treated elsewhere.
We literally flush it out of our mind as well, and it's not in public discourse anymore. This wasn't always the case. Three hundred years ago it was considered an honor to attend kings when they were seated on their toilets. People in the West have this great system and I think they just assume that it's the same for everybody in the world.
Is there a celebrity out there who wants to be the Angelina Jolie of toilets, making this a popular issue?
Matt Damon has started to talk about school latrines, which is great news. It's inevitable because he does a lot of great work on clean water. For example, if you go to a school in a village in Africa, you've got a nice clear water supply, and you've got the nice tap, but you've got no latrines. So obviously the kids are going to be contaminating the water supply because they simply have no sanitation. You've got to make the connection. You can't have clean water without decent sanitation.
You found in your research there's no single solution. Why not?
The answer is not that everybody should have a sewer or everyone should have a toilet. That is simply impractical, and most countries can't afford it. Culturally, in sanitation, we're very different around the world. People have different attitudes to hygiene and toilets. Some countries are fecal-phobic and some countries are not. China is quite at home with excrement, and uses it as fertilizer, whereas Indians are not. They're quite averse to any use of human waste.
In Benin, Africa, some very interesting research was done into what would make people buy a latrine. Mothers, who didn't have a latrine, could see that their kids were getting sick every week with diarrhea. They were spending money on medicine, and their kids weren't going to school, but they still wouldn't buy a latrine.
An academic named Mimi Jenkins discovered that the biggest incentive for someone to buy a latrine in Benin was to feel royal, because the royal family had one. It was a question of pride and status, it wasn't about health. Health messages never work, because nobody wants to be nagged, even when they've got the evidence in front of them.
So telling people, "This is where the cholera is coming from," doesn't have as much impact as appealing to their pride?
Exactly. It's what I call the "doctors who smoke" understanding of people. Doctors who smoke know it's bad for them, yet they still do it. What a lot of sanitation activists are saying is that we have to make people want toilets. It has to be something they aspire to and desire.
Isn't part of that incentive making defecating in the outdoors unappealing?
Yeah, and there's a very interesting movement going on in many developing countries, including India, Cambodia and Bangladesh, called Community Led Total Sanitation. It appeals to people's sense of disgust.
A few visitors will go to a village, and the villagers will want to show off their village to the guests. They'll take them around the village, and then at the end of the tour, the visitors will say, "Well, yes, that's nice, but can we see your open defecation grounds?"
Because they're polite, the villagers will take them there. The technique is to make people stand there and confront it, to not be able to turn away from the fact that they're shitting in the open, and that their kids are tramping it back into the village, and that they're all eating it. Someone calculated that people in villages who are doing open defecation are probably ingesting 10 grams of shit a day. That's pretty disgusting.
People will run off and dig latrines. Once the whole village is cleaned up, nobody will want to be the dirty person in the village. And once the village is cleaned up, the clean village will be in competition with the next village, and that village will want to clean up. It's a chain reaction.
Don't some governments pay for latrines, and the people don't always use them?
Yes. For 20 or 30 years, India has been pouring money into sanitation, and has been building, or subsidizing, lots of extremely nice latrines all over the country. But because they're nicer than people's houses, they get turned into a temple, or an extra room, or a goat shed, or simply used for storage. Because people have this engrained habit of going out into the bush, they don't see anything wrong with it.
Well, if you're used to going outside, maybe it's kind of gross to go inside, in a bathroom, or even near your home.
That is a problem, and that's what makes sanitation very tricky. In India, it is considered unclean to have a latrine close to the home. The answer is to make sure that it is a decent latrine, and it doesn't smell. It has to be an adequate latrine, it has to have some kind of fly-proofing, and some kind of vent pipe so there is no odor. If it's a decent enough place, then people get used to it.
Let's talk about some of the slums you visited where there are 100 toilets for 45,000 people. What happens then? People don't end up using the toilet, right?
They use it if they can. But if it takes half an hour to get from one side of the slum to the other, or you're waiting in line and the doors are falling off, and it's unpleasant, then people won't use it. They just go in the street, or on the roadside, or they find the nearest beach. There are beaches in Mumbai that are absolutely filthy.
What are flying toilets or helicopter toilets?
A flying toilet is a plastic bag. You defecate into the plastic bag, you wrap the plastic back up, and you throw it. Hence it's a helicopter or flying toilet. This is the only form of sanitation available to a lot of slum residents in Africa, particularly in Kenya and Tanzania. At least it's potentially containing the toxic human excrement, but obviously it's not ideal, and they're all over the place in the slums. It's quite a nice phrase for an extremely unpleasant practice.
Isn't it true that your own shit isn't a danger to you, it's other people's?
If you wanted to, you could probably ingest your own shit, but it wouldn't necessarily be toxic. But the problem is that shit is such a good vehicle for disease transmission. That's why we in the West have such good sewer systems and waterborne waste treatment. In about 1850 or so in London, a doctor called John Snow realized that cholera was being carried in drinking water, and it was being carried in human shit.
By some accounts, the toilet has added 20 years to the modern lifespan, so this thing that we won't even discuss is actually responsible for perhaps decades of all of our lives.
Yes, exactly. Last year, the readers of the British Medical Journal voted sanitation the biggest medical advance in the past 200 years. It is an amazing thing -- the toilet. We do live longer because of the toilet. Before sewers and toilets became popular in the 19th century, one in two children in London died before their 5th birthday. There was an enormous mortality rate, and that dropped dramatically, especially when soap and hand washing also became popular. We should be on our knees before the toilet.
We should worship at it.
We should worship the toilet. It's been an enormous medical advance. It's been fantastic, so I think that we should give it its due.
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