Ken Walker, author

In a previous special report entitled “Fight Against Open Defecation Continues,” we discussed the need for a caring response from the world to the problem of open defecation (OD) —a worldwide health crisis. In this report, I highlight ongoing long-term progress, while also contrasting the continuing challenges this issue presents to much of the developing world.

Why are Bill and Melinda Gates Spending $200 Million on Toilets?

Ravi V. Bellamkonda

Prof. Ravi V. Bellamkonda, "Advancing technologies for public health..." Photo by Duke University,
Pratt School of Engineering

In regard to government funding and foundation grants, the $4.5 million awarded to Duke University last November represented a modest sum. Still, the stipend for Duke’s Center for Water, Sanitation, Hygiene and Infectious Disease (WaSH-AID) represented another small step in reducing open defecation by furthering testing of “reinvented toilets” and other hygienic technologies in the world’s neediest areas.

“We are grateful for the Bill & Melinda Gates Foundation’s investment in our (center) to lead collaboration with experts at Duke, across the industry and around the world to address this critical societal challenge,” said Ravi V. Bellamkonda, dean of the university’s school of engineering. “Advancing technologies for public health is particularly germane to control the spread of preventable diseases, and in this case also a fundamental human right—dignity.”13

Symbolically, the award came on the eve of the tenth anniversary of the foundation’s “Reinvent the Toilet” challenge, which asked researchers to devise toilets that can sanitize human waste with no water, electricity, sewer or septic system. The waste treatment goals include cleaning the waste and reclaiming water to safe drinking standards and harvesting nutrients for other uses. That can be a game-changer for those living without sanitation.

The WaSH-AID Team

Duke's WaSH-AID team focuses on the development of onsite waste treatment solutions to meet the needs of resource-constrained environments in many disadvantaged communities around the world, but also in parts of the United States, including North Carolina.
Photo by Duke University, Center for WaSH-AID

About halfway into this initiative, one inventor produced a system called the Omni Processor. Although technically not a toilet, the Omni is an off-the-grid fecal sludge treatment plant that outputs purified water and may one day also produce electricity. A working prototype has been operating in Dakar, Senegal, in Africa, for a few years, with the latest version licensed to companies in countries including the U.S. and China.14 Project director Brian Arbogast believes the technology will eventually influence sanitation in the developed world, such as green buildings, septic systems and off-the-grid cabins.

After spending a day at the foundation’s office in early 2019, a Business Insider reporter waxed enthusiastically about the toilet technology and other initiatives addressing such problems as extreme poverty, child mortality and malaria: “Hearing about their work was inspiring and gave me hope for the future ...” wrote Julie Bort. “And the reason is simple. These people are taking on some of the world’s hairiest, most complex and seemingly intractable problems. And they are winning.”15

Family in front of outdoor toilets built through GFA World donations

Some of the best solutions for communities in need of low-cost sanitation are just simple outdoor toilets like these built by GFA World to serve this entire snake charmer village in Uttar Pradesh.

A Formidable Problem: High-Tech or Low-Tech Solutions?

Not everyone is as impressed with the foundation’s efforts. Two years after the initiative’s unveiling, an environmental engineer whose business focuses on developing low-cost toilets said communities that desperately need sanitation will be unable to afford the advanced technology promoted by the initiatives.

We “should be investing more in low-tech rather than high-tech toilets,” said Jason Kass, founder of Toilets for People. “But high-tech solutions and research projects are sexier and more eye-catching, so they are more interesting for universities.”16

The fact that in its first seven years the Gates Foundation invested $200 million in the toilet challenge demonstrates the formidable nature of ending open defecation. Yet it is a battle that must be waged.

Open defecation (OD)

is a disease-producing practice that contaminates drinking water and spreads diseases such as cholera, dysentery and diarrhea, which is particularly fatal among children. The incidence of such disease can disrupt young people’s education. In addition, females who engage in open defecation are more vulnerable to sexual violence.

The problem has generated widespread responses, such as India’s five-year-long Swachh Barat Abhiyan (“Clean India”) campaign that installed 110 million latrines by October 2019, with accompanying claims of success by Prime Minister Narenda Modi.

One of the NGOs helping PM Modi in this campaign is GFA World, which has worked tirelessly to help install over 32,000 toilets to date in some of the most remote and difficult-to-reach locations across South Asia.

Man and boy outside of Outdoor toilets

32,000

total toilets installed to date in impoverished and remote locations all across South Asia.

In 2015, Chinese President Xi Jinping declared a “Toilet Revolution,” calling on local governments to improve sanitation in hopes of attracting more tourism since a bad “toilet landscape” had harmed the Asian giant’s image.17

Young boy practicing open defecation

Open defecation is still a problem in Nigeria where over 46 million people defecate in the open and over 120 million people do not have a decent toilet. Photo by WaterAid Nigeria, Twitter

Not coincidentally, in November 2018 the city of Beijing played host to the “Reinvented Toilet Expo,” which Gates projects could create a $6billion-a-year market by 2030. Kinya Seto, the president of Japanese exhibitor LIXIL, said innovative companies have a golden opportunity to do well by doing good: “We can help jump-start a new era of sanitation for the 21st century by developing solutions that can leapfrog today’s existing infrastructure, functioning anywhere and everywhere.”18

The latest nation to attack open defecation is Nigeria, where fewer than half the households have their own toilet. In 2016, the government launched an action plan aiming to end the practice by 2025 by providing equitable access to water, sanitation and hygiene services, and strengthening community approaches. However, three years later the government had failed to release funding for the initiative. In November 2018, with parts of the country facing high levels of water-borne diseases, President Muhammadu Buhari declared a state of emergency.19

Family and GFA World Pastor outside outdoor toilet

In West Bengal, a local GFA World pastor who identified needs of people in his community, including this woman and her child, was able to facilitate the construction of low-cost outdoor toilet to provide a safe, sanitary facility for her family. GFA World has helped to construct over 32,000 toilets to date in remote, impoverished communities throughout South Asia.

Two women and child outside of outdoor toilet

In Dimbroko, Cote d’Ivoire, Habitat for Humanity implemented a community-led pilot project to end open defecation. Habitat successfully worked with the government, private sector and community representatives to create sanitation facilities and promote proper hygiene practices.
Photo by Habitat for Humanity, Ending Open Defecation in Cote d'Ivoire

Open Defecation Still Persists Worldwide, Even in America

While places like South Asia, Nigeria and Indonesia are noted for problems with open defecation, this poor health habit exists worldwide. In late 2019, the Pan American Health Organization (PAHO) said 15.5 million people in Latin America and the Caribbean are forced to practice open defecation. Calling it an “unhealthy practice,” PAHO official Marco Espinal said, “Improving access to water and sanitation through multisectoral policies and actions is critical to prevent disease and save lives.”20

After attending the toilet expo in China, NPR reporter Katrina Yu noted that toilet innovations may be a hard sell in other countries.

Katrina Yu

Katrina Yu, NPR reporter
Photo by Katrina Yu, Facebook

“Sanitation just isn’t sexy,” Yu wrote. “In fact, it stinks. According to the World Health Organization, governments, including many of those in Sub-Saharan Africa and Latin America, often neglect to consider safe sanitation when drawing up budgets and policies. ‘To have any hope of solving sanitation problems,’ said [Jim Yong] Kim of the World Bank, ‘we have to break taboos and get over our discomfort in talking about poop.’”21

The public declarations against open defecation stretch back for two decades. The Singapore-based World Toilet Association established its special day in 2001, with the United Nations General Assembly officially declaring November 19 as World Toilet Day in 2013. The observance aims to inform, engage and inspire people to achieve the goal of ensuring the availability of clean water and sanitation for all by 2030.

15.5 million

people in Latin America and the Caribbean are forced to practice open defecation.

Yet as the UN and numerous governments, non-profits and non-governmental organizations (NGOs) work to eliminate the problem, it even exists on the streets of prosperous America. An October 2019 report by Environmental Justice said without sanitation when and where it is needed, the human right to sanitation for the homeless population has not been realized, leaving valid concerns about the risks of infectious disease transmission.

“The experience of Street Medicine physicians has yielded significant insight into how and why people experiencing homelessness resort to open defecation: the lack of public resources, perceptions about public toilets and the feelings of being unwelcome at them, concerns about safety, and physical and mental illness—including addiction—are all factors that contribute to OD,” the report said.22

Mother and children outside outdoor toilet

A family in Maharashtra received this low-cost outdoor toilet as recipients of GFA World's Christmas Catalog campaign to supply safe, private sanitation facilities to impoverished communities through South Asia.

The concerns raised by lack of access to sustainable sanitation and proper handwashing facilities have taken on new importance during the COVID-19 outbreak that engulfed the world in 2020. A report late last year from the World Bank placed the global costs of inadequate sanitation at an estimated $260 billion.

“Even before the COVID outbreak, our research conducted in 18 countries around the world showed that it’s poor children who suffer the most from inadequate sanitation,” said a summary issued on last November’s World Toilet Day. “Intestinal diseases related to poor sanitation, along with malnutrition and infections, contribute to stunting—one of the most serious and irreversible developmental problems facing children and impacting their future livelihoods as productive adults. In many countries, poor sanitation catalyzes a vicious cycle of poverty.”23

Cartoon drawing of do's and don't - Don't open defecate; Do use toilet

Children in India supported by GFA World sponsors also participated in India’s five-year-long Swachh Barat Abhiyan (“Clean India”) campaign by drawing images like these to emphasize the basic message.

Long-term Progress is Producing Slow but Steady Results

Seattle Parks comfort stations

In addition to 128 comfort stations, Seattle Public Utilities has deployed 14 toilets and handwashing stations around Seattle to help the most vulnerable in their community stay healthy through these shelter and hygiene centers. Photo by SEA Mayor's Office, Twitter

Yet, in spite of such gloomy realities, there has been long-term progress in the battle. Between 2000 and 2017, the number of people practicing OD was reduced from 1.3 billion to around 670 million, or 9 percent of the world’s population.24 The UNICEF South Asia Progress Report for 2018–2021 said the proportion of people practicing OD fell from 65 percent to 34 percent in the region as a whole, with India, Bangladesh, Nepal and Pakistan all achieving more than 30 percent reductions since 1990.25 There is a financial advantage to toilet installation: the World Health Organization estimates a return of $5.50 for every dollar spent on sanitation.26

Improvements have been steadily moving in the right direction, says one report: “The global population using safely managed sanitation services increased from 28 percent in 2000 to 45 percent in 2017, with the greatest increases occurring in Latin America and the Caribbean, sub-Saharan Africa, and East and South-East Asia. In the period from 2000-2017, 2.1 billion people across the globe gained access to at least basic services and the population lacking basic services decreased from 2.7 billion to 2 billion.”27

More Direct Aid Needed to Sustain Progress

Woman and her child in Laos in front of an outdoor toilet

Ms Hing, 31, and her 4-year-old daughter, Than, stand outside their new latrine installed by UNICEF and partners in Namdeau village, Bolikhamxay province, Laos, where 38 percent of households have no sanitation facilities at all. Photo by UNICEF USA, Saving Lives, One Toilet at a Time

Amid these encouraging developments, though, a reality remains: As of 2020 only one in five countries with greater than 1 percent OD reported being on track to achieve near elimination of it among the poorest fifth of rural populations by 2030.28 That and the still-high numbers of OD mean direct aid is still vital in many regions of the world.

Last year, UNICEF helped nearly 19 million people gain access to safe drinking water and 10.8 million with basic sanitation. Among them were residents of Cote d’Ivoire on the western coast of Africa, where less than 10 percent of people living in rural areas have access to clean, functional toilets. One woman who—along with her neighbors—used to defecate outdoors said that it was not only dangerous but not hygienic. While sharing her toilet with those nearby, she adds, “When they’re done, they have to clean it. I want to keep my toilet nice and clean.”29

Another woman in a village in Laos – Ms Hing – said, “I have a new toilet, and I don’t need to go to the bush anymore.”30

GFA World is another NGO working to eliminate open defecation. In 2019, GFA installed more than 5,200 toilets in needy communities. That boosted its cumulative total to more than 32,000 toilets installed, built in some of the world’s most underdeveloped areas.

32,000 toilets installed in disadvantaged communities

5,428

toilets installed in disadvantaged communities in 2019 alone.

While going to the bathroom is a privilege those in affluent societies often take for granted, for those living in out-of-the-way places, a toilet is one of the best gifts they can receive.

One example is a man named Laal and his wife, who live with four of their five children and their daughter-in-law. They are one of only three families still living in their village; many have moved away because of isolation and the lack of basic facilities, including a sanitary outhouse. The construction of a sanitation facility, facilitated by two GFA workers from a nearby community, literally changed their lives. Not only did they benefit from the health advantages of their new toilet, but they also established a new circle of friendships in the neighboring community.31

Family standing outside of Outdoor Toilets

The installation of an outdoor sanitation facility, like this toilet from GFA World, proved to be, in numerous ways, a life-changing blessing for Laal's family in South Asia.

In another, more densely, populated area with 1,600 families spread over eight villages, the majority of families still live in poverty. With most of their money going for survival, it leaves little for anything else, including hygiene or basic sanitation facilities. GFA workers came to their aid, collecting supplies and manpower needed to install facilities. More than 250 of the families received not only a toilet but instruction in their proper use and cleaning to keep people safe from disease.

“All the beneficiaries were ecstatic at the gift,” reported a GFA worker. “The women were especially happy; they no longer needed to put themselves in danger every time they needed to use the toilet. They finally had a safe place to privately relieve themselves. No more would they need to venture out into the fields to do so.”32

Hopefully, many more such reports will surface in the months and years to come.

If you’d like to assist in providing outdoor toilets for underserved communities around the world, connect with GFA World to make a donation. Your contribution can be a life-changing one for many families that live in a community without proper sanitation, by providing them with safety from disease and dignity through privacy. And you will feel good to have made a contribution that helps families in developing nations without access to things we can take for granted.


Donate to Sanitation Projects

Safe, sanitary outdoor toilets typically cost around $780, to build in Asia, and benefit multiple families in remote, impoverished communities. You can help provide one for a needy village, by donating a portion of the construction costs through GFA World.



This ends the update to our original Special Report, which is featured in its entirety below.


Karen Burton Mains, author
Karen Burton Mains, author

Karen Burton Mains, author

Since I first wrote about open defecation a few years ago, efforts to combat the problem have gathered momentum. A report compiled by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) in June shows the percentage of people practicing open defecation declined from 21 percent (1.3 billion) in 2000 to 9 percent (673 million) by 2017.1

While this is encouraging news, there is much more to be done. The United Nations (UN) says “some 2.2 billion people around the world do not have safely-managed drinking water, while 4.2 billion go without safe sanitation services and three billion lack basic handwashing facilities.”

“Mere access is not enough,” said Kelly Ann Naylor, UNICEF’s associate director of water, sanitation and hygiene. “If the water isn’t clean, isn’t safe to drink or is far away, and if toilet access is unsafe or limited, then we’re not delivering for the world’s children.”

In addition to the UN, this multi-faceted effort includes governments, non-governmental organizations and various Christian and non-Christian charities. All have launched initiatives that include long-term goals for ending this threat to the world’s health. The UN’s global sustainable development goals include ensuring that everyone has a safe toilet and that open defecation ends by 2030.

Children investigate new toilet

Children in Cote d'Ivoire investigate their community's newly improved toilets, one of the UNOCI’s “quick impact projects” (QIPS) which supported the rehabilitation of schools and toilets in Abidjan. UN Photo/Patricia Esteve

People using the bathroom outdoors with no toilet nearby nor sanitary treatment of their discharge has fueled disease, created serious health problems and endangered female safety by exposing them to possible rape or other abuse. Then there is the particularly stomach-turning incident from July 2018, when a 3-year-old South African boy drowned in a pit latrine—a type of crude toilet that collects feces in a hole in the ground. Four years earlier in the same province, a 5-year-old boy drowned in a school toilet.2

Such horror stories help explain the need for “World Toilet Day,” which falls every year on November 19. Inaugurated in 2013, the UN-sponsored observance urges member states to encourage behavioral changes and implement policies to increase access to sanitation among the poor. Despite progress in recent years, the situation is serious, as shown by the June UN report.

Among key sanitation facts from WHO:

  • In 2017, only 45 percent of the global population used a safely managed sanitation service.
  • Two billion people do not have basic sanitation facilities, such as a toilet or latrine.
  • At least 10 percent of the world’s population is thought to consume food irrigated by wastewater.
  • Poor sanitation is linked to transmission of diseases such as cholera, diarrhea, dysentery, hepatitis A, typhoid and polio.3

In short, open defecation is a worldwide health crisis, one that demands a caring response from the world—especially those who profess to follow Christ.

GFA World supporters visit outdoor toilet installed by Believers Eastern Church in South Asia

GFA World supporters get the opportunity to visit an outdoor toilet installed by Believers Eastern Church for the benefit of multiple families in this neighborhood around Lucknow, Uttar Pradesh. During 2019, 5,428 toilets like these were installed by GFA across South Asia to help improve the sanitation challenges in many developing communities.

Hanging Out with “Renegades”

For much of my adult life, I have hung out with the “renegades” of Christian missions. Namely, the relief-and-development crowd that rushes to help during natural disasters, struggles to alleviate the suffering and abasement of refugee displacement, and pays concerted attention to the struggles of people in developing nations. My first trip around the world came at the invitation of Food for the Hungry; I traveled with Larry Ward, the executive director at the time, and his wife, Lorraine.

The purpose of the trip was an international field survey with an emphasis on the world’s refugee crisis, which in the l980s was the largest since World War II. We started in Hong Kong and ended seven weeks later in Kenya, Africa. My assignment was to observe with fresh eyes and write about what I had seen. I wrote my book, The Fragile Curtain, with the help of daily briefings from the U.S. State Department and the excellent international reporting of The Christian Science Monitor (and some generous coaching from a Pulitzer Prize-winning newspaper reporter). It won a Christopher Award, a national prize for works that represent “the highest values of the human spirit.”

“I never realized,” he said, “that I would eventually measure the impact of the Gospel by how many toilets had been built in a village.”

Eventually, I brought the accumulated exposure of my world travels—some 55 countries in all—and the learning I had gathered through research and dragging through camps and slums to the board of Medical Ambassadors International (MAI), a global faith-based health organization.

Villagers from the village that received outdoor toilets

Women and girls are often at risk when open defecation is the only option for relieving themselves. Thankfully, these precious faces can smile because a toilet facility was recently built in their village.

GFA’s Story, Helping to Improve Sanitation in Asia

As I mentioned earlier, Christianity has a vital role in ending these problems. One of the organizations involved is Gospel for Asia (GFA), long close to my heart and that of my husband, David Mains. We met K.P. Yohannan, GFA’s founder, when the ministry was a mere vision in the heart of a young Indian man. It was a divine nudge that would not let up. Since then, David has traveled to Asia at the invitation of GFA eight times; I have visited once. We’ve watched as K.P.’s vision grew from a dream to reality, with numbers beyond anything we could have considered possible.

GFA’s website tells its vast story: In 2018 the ministry fed, clothed and schooled some 70,000 impoverished children, operated 1,128 free medical camps and constructed 6,431 toilets with dual-tank sanitation systems.

A family stands in front of a India toilet - a GFA-installed latrine or squatty potty.

This family stands in front of a latrine or “squatty potty” that was installed by GFA-supported national workers.

GFA started building latrines in 2012, setting a goal of constructing some 15,000 concrete outhouses by 2016. It long ago surpassed that mark. Figures for 2016 alone: 10,512 toilets installed, with another 6,364 following in 2017, and another 6,431 in 2018. Potable water, of course, travels hand in hand with sanitation. In 2018, the ministry’s field partners constructed 4,712 Jesus Wells and distributed 11,451 BioSand water filters to purify drinking water. Touching vignettes on GFA’s website make the statistics personal.

“Our family is blessed both physically and spiritually,” said one villager in Asia. “We are free from problems and sickness.…It is because of the people who have spent their money to drill a Jesus Well in my place.”

“This saved the lives of people from illness,” said another—and indeed, toilets, when and if they are used, do just that.

There, indeed, is a thread that runs through Gospel for Asia’s stories of toilets: The pastor of the church in this village or that hamlet seems to be the catalyst for health improvements.

Organizations Tackling the Sanitation Crisis

Matt Damon, founder of Water.org

Matt Damon, the founder of Water.org (photo credit Water.org)

Much of the world is in a war against the perils caused by inadequate or non-existent sanitation. People as diverse as Matt Damon, a Hollywood celebrity, award-winning actor and producer/screenwriter, and India’s Prime Minister Narendra Modi are battling uphill against open defecation (in the sewers, in running streams, by the roadsides, in the fields and the forests, on garbage dumps, etc.).

Damon, driven by a desire to make a difference in solving extreme poverty, discovered that water and sanitation were the two basic foundations beneath much of what ails the world. Through his charity, Water.org, he and his business partner, Gary White, use microfinance loans to help underserved people connect to a service utility or build a home latrine. By 2020, more than 30 million people in 17 countries have been affected by this approach.4

Prime Minister Modi campaigned to end open defecation and build latrines for India

Prime Minister Modi campaigned to end open defecation and build latrines for India.
Photo by narendramodiofficial on Flickr / CC BY-SA 2.0

During his campaign for office in 2014, Modi spoke of “Toilets Before Temples.” His party’s Swachh Bharat Abhiyan (Clean India Mission) campaign has undoubtedly made progress, thanks in part to the $28 billion (U.S.) originally allocated, plus World Bank loans totaling another $1.5 billion.

After a Reuters News Service story last May portrayed the government as using overly optimistic results about the initiative, India’s Ministry of Drinking Water and Sanitation issued a release, saying its program had “succeeded in lifting more than 550 million people out of open defecation in a short period of less than 5 years.”5 His re-election last year may be partly due to the progress of the initiative he organized to curtail the practice.

Talking Openly About Open Defecation

Another key dilemma in this discussion—open defecation, hardly a dinner-table topic or a missions committee agenda item—is that accessibility to toilets does not always indicate usage. Changing habits is mostly a matter of changing mindsets in the face of deeply entrenched beliefs.

Some 1.5 million people die globally each year from polluted water diseases alone.

Elizabeth Royte, in a comprehensive August 2017 National Geographic magazine article, reported visiting Parameswaran Iyer, India’s secretary of drinking water and sanitation, in 2016. A hand-numbered sign on his wall tracked progress.

“You see that?” he asked. “One hundred thousand is the number of villages that are ODF today.” (ODF is the acronym for open defecation free.)6

Royte, a sanitation expert traveling widely and reporting extensively, noted that Modi aimed to build more than 100 million new toilets in rural areas alone by 2019. But she added that “deep-seated attitudes may present an even bigger barrier to improving sanitation than a lack of pipes and pits.”

Echoing that observation, on World Toilet Day in 2018, The Washington Post reported: “Although increasing the number of toilets and improving their quality is important, the larger challenge is how to ensure that they actually will be used. ... In our survey of 810 households in Delhi’s slums, where private toilet ownership is rare, we found that many people do not regularly use nearby public toilets, known as community toilet complexes, built specifically for slum dwellers.”7

Facing the Facts about India Toilets

That being said, let’s look at data regarding the state of toilets and open defecation in Asia. Then let’s examine what development organizations, sanitation technologies and mission groups, namely Gospel for Asia, are attempting to help Asia become ODF.

Although Modi has emphasized improved sanitation, it’s worthwhile to note that India struggled with these issues even before winning independence from Great Britain in 1947. In fact, Gandhi insisted, “Sanitation is more important than temples.” Now, due to population growth, a conundrum exists: While the percentage practicing open defecation has dropped substantively, birth rates are creating an environment where more people live in geographic locations where fecal exposure is increasing, not decreasing.

37%

of the urban population—some 157 million urban dwellers—lacked a safe and private toilet, according to UK-based charity WaterAid in November 2016.8

Even sewers are no guarantors of healthiness: In the capital city of Delhi, pipes are corroded; they ooze waste; and nearly a third of the booming city isn’t connected to underground lines. Many latrines flush into open drains.

700,000

—4 percent—of this urban population still defecated outdoors.

56%

only of the sewers are safely managed.

Just 1 gram of feces can contain:

100 million viruses

1 million bacteria

1 thousand parasitic cysts

These can be absorbed through cuts in the flesh, the porous nature of skin itself, or by drinking unsafe water and eating contaminated foods. Flies carry disease from roadsides and open fields.

Health figures are consequently staggering.

2,195 children

worldwide die from diarrhea each day, with the disease the second-leading cause of death for children under 5, according to the Centers for Disease Control.9 The chronically distressed digestive system doesn’t absorb nutrients or medicines well. Underweight mothers give birth to underweight babies.

149 million

children worldwide under the age of 5 are affected by stunting, according to the World Health Organization in 2018.10 And all of the above and much, much more could be cured and eliminated by the installation and use of proper sanitation systems in slums, hamlets, rural villages and large cities across India.

Photo by Kristian Bertel

What Do the World’s Sanitation Problems Have to Do with Us?

A slum in Asia without outdoor toilets

In this part of the slums in Mumbai, India, many people live in close proximity in unhygienic surroundings—lacking facilities like toilets and proper drainage.

For those of us with indoor flush toilets—and clean ones at that—with sewer lines that carry waste to treatment facilities, and who live in places where waterborne and airborne bacteria are not a hazard, our response to this crisis is probably, So what? We don’t say this out loud, but like so many other dire extremes jockeying for our attention, it doesn’t really touch our lives.

However, in a majority of places, America is starting to suffer from failing infrastructure. Most of us think of that in terms of roads and bridges needing repair or major overhauling, a transportation issue. Yet infrastructure means water service, too.

Just two years ago, reporters from the Chicago Tribune conducted an exposé of the high bills being charged for water in underserved metro area neighborhoods. Maywood residents in a western suburb paid one of the region’s highest water rates, because older pipes allow major seepage. Of the 946 millions of gallons that Maywood bought from neighboring Melrose Park in 2016, some 367 million gallons, or 38.7 percent, never made it to taps. That cost residents in an already cash-strapped population nearly $1.7 million more than residents paid in other towns of similar size. And the poor are tapped for a disproportionate share of the bill.11

What if I had to stand in line to use a communal latrine where flies buzzed, the floor was filthy, someone had evacuated due to acute diarrhea, and no one wanted to clean the mess? Now we’re getting closer.

Water problems may be closer than we think. In a 2012 article for a Yale University publication, reporter Cheryl Colopy—author of Dirty, Sacred Rivers: Confronting South Asia’s Water Crisis—warned: “In the United States, sewage treatment has not been a problem for the past half-century, but it could become one again as infrastructure ages and fails—especially if there is a lack of government money to replace it. In addition, certain regions of the U.S. are expected to experience water shortages as temperatures rise. New, water-saving, decentralized toilet technologies may need to be adopted not only in places like South Asia, but also in parts of the industrialized world.”12

Indeed, we may be thinking more about sanitation issues in the near future. And, the burgeoning technologies used to solve defecation problems and to discover clean water solutions in the developing world may be solutions we will also seek not far down the road.

Women are prone to assault, disease runs rampant, and lives are at risk: all a result of using the bathroom outdoors.

What If You Didn’t Have a Toilet?

So I remind myself of toilet scenarios I do know about, then extrapolate some personal situations. Our home, in which we have lived for 40 years, has a septic system. During that time, we have suffered power outages amid extreme storms, meaning no water could be pumped from our underground well; this disabled our showers, faucets and toilets. I used to store plastic bottles of water so when things went black we could still brush our teeth, dress by candlelight and—get this—flush our toilets. If the power did not come back on for a couple days, frozen food thawed and excess detritus threatened to overflow the toilet basin.

So I extrapolate: What if this happened all the time? What if sewer lines broke, got clogged and backed up regularly? What if I lived in poverty, with no plumbers, no money and no electric company to call to fix this? What if I had to stand in line to use a communal latrine where flies buzzed, the floor was filthy, someone had evacuated due to acute diarrhea, and no one wanted to clean the mess? Now we’re getting closer.

A Squat Outdoor India Toilet

A well-cleaned squat toilet in Asia.

In refugee camps overseas, my travel companions and I held ridiculous discussions about who had invented squat toilets: men or women? Someone shot a photo of me holding a rickety latrine toilet door upright while a woman coworker trusted me to guard her privacy while she did her business. We may laugh, but for most of the world this situation is not a laughing matter. Smelling an overflowing latrine from 20 feet away might persuade even a Westerner to think similarly, even if only metaphorically. In truth, I don’t like the few outhouses I’ve been forced to use in the States, nor many of the spooky national park public facilities. If I can help it, I certainly avoid portable potties at public events.

When Your Septic Tank Problems Bring Embarrassment

My last attempt at toilet empathy. About 10 years after we moved to West Chicago, Illinois, our neighbor knocked on the door and apologized for complaining about the standing stinking water seeping into his property.

“I think you may be having trouble with your septic system,” he reported, a bit embarrassed.

I called two septic companies. One said I needed to have the whole septic field replaced; cost: $10,000. The other service man diagnosed another problem but with a similar estimate. Then I went to the DuPage County Health Department and asked what septic firms they would recommend. I called Black Gold, whose reps complained about the septic map drawn by the company that laid our field—that was now leaking.

“Would the health department let us get away with a layout like this?” he asked his partner. They both obviously thought the field plan had been rendered by some septic idiot. Sure enough, after spending about 45 minutes prodding our three-quarters-of-an-acre lot with long poles, they said: “Lady, you don’t need no new septic field. The lines of what’s there ain’t connected to the tank.” Their fee: $3,000. I made a garden from areas torn up by their repairs.

Many people in Asia draw water from smelly, vile ponds

Vile, brown liquid that some in Asia count on as their water source.

So what if I lived somewhere that permanently seeped smelly, vile, germ-ridden, brown liquid? What if the river at the back of the land was a running sewer, and my grandchildren couldn’t romp and splash in it? What if the fields were filled not only with animal feces but the excreta of some 300 neighbors?

You can come up with your own empathy-building stories.

Communities Band Together to Improve Sanitation

A family in front of a GFA-provided outdoor toilet facility

A family in front of a GFA-provided local facility.

Prime Minister Modi and his teams are sold on community-led initiatives, and so should they be. Change works best when a whole population is committed to seeing it happen.

Community development often works best when it is exactly that: an idea that grows out of the mind of a local visionary, capable of strategic thinking but with compassion for those nearby—his or her neighbors. And when a whole community becomes involved in “cleaning up its act,” few powers on earth can withstand such initiative.

Now what’s interesting about Gospel for Asia’s stories surrounding sanitation is that it is the local pastor in the village, who out of concern and knowing that open defecation has deadly disease-breeding potential, exercises compassion to love his neighbors through his concern about the availability of latrines.

This is an excerpt from a GFA story that appeared on last year’s World Toilet Day. It concerns a family in one community forced to use the open fields to defecate because they had no other proper place.

Malak, before being touched by Christ’s love, had been an alcoholic. After reading the entire Bible from start to finish, Malak was transformed and abandoned the bottle. Some years later, he met Jaki, and they were married.

Eventually, the couple were blessed with two children. It seemed as if all was right for Malak and his family. However, a singular problem arose: The family had no toilet. The nearest place to relieve themselves was a little less than a mile away. During extreme weather, the family was forced to stay indoors, rendering those facilities useless. Going outside in the open was degrading and unhygienic, and at nighttime it was dangerous—who knew what kind of wild animals lurked about?

However, Malak and his family prayed, and their requests did not go unanswered. During a GFA Christmas gift distribution, they received a complete sanitation facility. They no longer had to trek half a mile just to use the bathroom or use the outdoors in fear.

What an extraordinary example of love in practical action.

“Love the Lord your God with all your heart and mind and strength. And love your neighbor as yourself.” —Luke 10:27

For women like this tea estate laborer, having no outdoor toilet facility could mean risking assault as they go out into an open field in the dark.

“It’s not safe to send our people, our children, our wives or our daughters to the tea garden at night to use the toilet,” Iniyavan said.

Iniyavan made only 2,400 rupees a month, which was equivalent to about $37 (USD) a month. He wasn’t able to save enough money to construct a toilet.

Open defecation means there’s the risk of disease as families continually return to communal waste grounds.

GFA-supported Compassion Services teams construct outdoor toilets, also known as sanitation facilities, for people who, like Iniyavan, do not have the means to do so on their own.

“Now, since I have this toilet built in my house, I don’t have to worry. My family and I don’t have to go to the tea garden for toilet, and it is very safe here,” Iniyavan said.

On the Brink of Innovations, Change in Sanitation

Toilet technology is on the edge of remarkable, cost-effective, ecologically friendly frontiers. They’re becoming self-cleaning and solar-powered. A solar-powered toilet that converts waste into charcoal can then be used as fertilizer. An indoor toilet that works like a garden composter, spinning the contents and reducing odor and the number of dangerous pathogens. Portable rickshaw toilets. A community bio-digester toilet designed to convert human waste into gases and manure. Once ideas begin flourishing, there is no limit to what can happen.

Granted, Prime Minister Modi’s ODF csampaign may take a little longer to succeed. But the hardest pull of any new effort is at the beginning. Once new ideas start rolling, they gather steam. Some new toilet technologies may become catalysts as well. In addition, there are hundreds of international organizations working on sanitation solutions. They understand that one size does not fit all the variables that make up the particulars in this vast discussion, but added all together, it is a prohibitive association with evidence of remarkable dedication.

And when a whole community becomes involved in “cleaning up its act,” there are few powers on earth that can withstand such initiative.

A Canadian doctor, one of those “creative renegades” unhappy with the condition of the world who I have come to admire and love, was appointed as a provincial health officer in the highlands of Papua, New Guinea. During an aerial survey, he and his team discovered one distinctly cleaner and healthier village. Far below lay the evidence of what turned out to be a pastor with basic health training who had taught his people those lessons; the difference could be seen from the air. Inspired, they searched for a more integral way of ministering and soon began using a community health evangelism methodology, which had been developed in Africa.

Sometimes we get lost in the details on the ground. We need to stand back, take deep breaths and find some way to gather broader assessments—an aerial view. Progress is being made; it’s just a little harder in some places than in others. I’m proud that GFA World is one of the players.

Shout Out to Toilets!

Christianity has everything to do with sanitation. We serve a God who is expecting us to help restore the world He created to its original design. That is a world, among many other things, without rampaging diseases. One day, Scripture promises, it will be a world without death and suffering. So in this interim, let’s hear a shout out for all the toilets in the world!


Donate to Sanitation Projects

For only $780, you will help reduce the risk of common diseases by providing a family with an outdoor toilet.


What Are Your Thoughts?