Bill & Melinda Gates Foundation

A Nigerian in India: When Sanitation Issues Collide

March 25, 2013

Jennifer Igwe traveled to India in 2013 with the International Reporting Project. She is a principal reporter, newscaster presenter, and producer with the Nigerian Television Authority (NTA).

A little boy of about six years old stormed out of a ramshackle structure in Holumbi Kalan Phase two, New Delhi, to answer an inevitable call. The urgency with which he ran was a reflection of how powerful the call by nature can be. Under normal conditions this child ought to have done this important life function in the privacy and comfort of a toilet, probably supervised by an adult. Openly and rather oblivious of the many activities happening around him, he publicly defecated. This scenario is rather the norm in India, especially among slum settlements like Holumbi Kalan 2.

Nearly 60 per cent of those practising open defecation worldwide, according to a report by UNICEF, live in India. Only one-third of households have access to sanitation, while about 626 million people (five times the size of Nigeria and about twice the size of the US) still defecate in the open. The situation is quite a challenge because in spite of 20 million toilets being constructed every year by the government, demand for their use is minimal.

 Toilets are luxuries many cannot afford.

Experts say it's because of lack of availability in some areas and a complex case of behavior, habit, and attitude in others. This is because most people, especially those in the rural areas and slums, would prefer to openly defecate rather than use a toilet. Largely built toilets by the government on the other hand aimagettracts some fees. In Holumbi Kalan 2 one rupee is charged for urinating, while stooling cost two rupees.

Dr. Anita Harish is a medical doctor with the Child Survival India (CSI), a non profit initiative that provides free healthcare through mobile clinics in slums like Holumbi khurd, Holumbi Kalan phase 2 and some other states.

According to Harish, “Due to bad sanitary condition in these communities we get a lot of diarrhea in children even in the elderly. Many of the patients have skin problems as a result of poor hygiene. 70 percent of the patients we treated initially had ailments related to them. Today, although there is remarkable improvement, we still have many of such cases." The mobile clinic (patients wait their turn below) attends to about 120- 140 patients daily.

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Dr. Beeps Bajaj, the chief executive of CSI, noted that lack of and use of toilets in addition to limited access to portable water supply and poor hygiene are contributory factors responsible for many sicknesses in the areas they cover.

Dr Bajaj said, "Previously before we came there were lots of deaths from diarrhea, cholera and malaria including air and vector borne diseases."

Management of these health challenge, she says, is also crucial for maternal care and child survival. According to her, many of the women they treat say they opt for open defecation because if for instance they or their children or other members of their households need to stool more than once a day, that would mean additional expenses. Each visit to the rest room would be definitely be accompanied by rupees from the sick pockets of many of the families. The case is even worse if any of them has diarrhea, rather inevitably doing their thing any where in the open becomes a welcome option.

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Nigeria, as it is the case in India

The Indian case is not too far from the "short put” system in some slums and rural communities in Nigeria. Named after the popular age long sports, short put, this type of open defecation is done in polythene bags or papers and flung into the nearest bush, waste dump or drainage. In some worst case scenarios, it could become an unwanted parcel and sight at your gate or road side.

Kayode, a resident of Pedro Village, a shanty slum Makoko, under the Mainland Local Governimagement Area of Lagos State (a community which has been declared illegal by the state government) says the “short put” system is for them a necessary evil. Toilets, he says, are luxuries many cannot afford and for a community with thousands of households this important facility he says is virtually non existent:

"I don’t know any house that get toilet for this place o”, he lamented in broken English. “Na inside water we dey shit and water go carry am go. You fit shit for nylon throw way am for where dem dey throw dirty." According to him they would prefer to use toilet facilities but have no access to them.

Tunji Bello is the Lagos State Commissioner for Environment. He says the state has so far provided over 100 public toilets, noting, “We discovered that it’s not about building toilets but changing the bad habits of people defecating openly. We are already creating awareness on this and encouraging the private sectors to invest in public toilets as government can not do this alone.”

Although many Lagosians agree that the fifty to hundred naira charged for the use of public lavatories are tokens, some in very low-income areas disagree.

A report by UNICEF and World Health Organization, WHO, in 2012 shows that more than 1.1 billion people in the world practise open defecation. The largest numbers of these people are in India (626 million), followed by Indonesia (63 million), Pakistan (40 million), Ethiopia (38 million), and Nigeria (34 million).

Lack of sanitation and hygiene, according to medical experts in Nigeria, are the major causes of some contagious diseases including diarrhea, cholera and typhoid.

 
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