We had broken for lunch under a shady tree, in the far reaches of Liberia, in a village four hours from the nearest town.
It was hot, of course, and we were tired. A villager wandered over to talk. He was one of the local pastors, and he chatted amiably about this and that.
Amongst the “this and that,” the man mentioned—with seemingly chilling casualness—that his daughter, 9-month-old Marie, had died in November from diarrhea. She got sick, stayed sick for three days, and then she died.
His casual tone was not to be condemned. It was not evidence of a lack of emotion but of the endemic, remorseless, awful death toll of diarrhea in a country where 70 percent of people have no sanitation whatsoever. Ask a Liberian how many children they have and they will answer carefully. “Six, living.”
In this village, the creek was everything. It carried away dead bodies in times of war. It brought animal carcasses. Its flow channeled the upstream villages’ excrement, human and animal.
The creek was drinking water, and washing water, and water that brought death. It was the water in which hopeful mothers, who had trekked four hours to the clinic for the free ORS salts, mixed the medicine.
They knew the creek water was dirty, and they still drank it. They had countless visitors tell them about hygiene and disease, and didn’t lack skills to build pits when they built their own houses. Still they used the bush for defecation. Still they tramped fecal particles back into their cooking and living areas, to be ingested and turned into diarrhea.
Sanitation, you see, is not easy.
It is not easy because humans can be difficult. And it is not easy because despite more and more voices speaking out about its benefits—financial, health, and environmental—and despite increasing momentum, it is still not enough.
How can it be easy when Marie remains only one amongst 1.5 million children who die of something that for most Westerners is a one-day stomach bug? How can it be easy, when sanitation remains an uncomfortable topic of discussion for many policy-makers and a hugely underfunded priority?
Sanitation is an inordinately powerful health prevention tool. Good sanitation can save money (India alone loses $58 billion a year in healthcare cost and lost labour), place girls back in school, increase income, and save lives. It is the most cost-effective health prevention tool in existence. It baffles me why politicians are still failing to exploit it.
So I am pleased to learn that the Bill & Melinda Gates Foundation is scaling up its efforts to fund sanitation. I am pleased for everyone labouring away at this most unfashionable of causes who will benefit, such as the staff of UNICEF's WaSH team in Mozambique, and the people of Maparanhanga, Venceremos, and other previously sanitation-deprived villages that I visited, with the Foundation, last year.
But most of all I am pleased because what sanitation needs, still, is credibility. Momentum has certainly increased over the last few years, but sanitation still needs to be shouted about. The authority of the foundation, and its willingness to acknowledge this “taboo” of sanitation, this vital human need, is more than welcome. Marie, and millions like her, needs it.