In a fit of exasperation an Indian Minister for Rural Development uttered the lines that shocked the saffron fundies of India.
India Needs More Toilets Than Temples.
When I am asked what I think the greatest invention in the history of healthcare is, I say that the biggest invention of public medicine is Sanitation.
Clean Drinking Water, Refuse Disposal and Sewage.
Taps, Bins and Toilets.
India’s toilets are legendary among travellers to India. The squat toilet does have a slightly bad reputation but one that I will dispel for you.
They are better for your health. That’s right. The porcelain throne is not the better toilet. The squat position is more natural and helps produce a higher level of abdominal pressure to aid with defaecation. But all is not lost. You too can gain such an advantage by a simple and elegant solution that combines the best of both.
Take a foot stool with you, pop your feet up on it and get the same benefit of changing your position and aiding.
But back to the problem. To many travellers using the squat toilet is not just an achievement but a rite of passage. It’s something as mundane as having a shit taken to such a new and terrifying place.
Terrifying because most Indian toilets are terrifying holes in the ground. To us in the west and indeed in the more richer parts of India, the toilet is an expression of the house. We spend money on porcelain fittings and take care to keep them clean. Public toilets in India are fetid urine and shit soaked terror hole.
I am tough as nails and one of the first things I did to my clinic was fork out my own money for a PROPER bathroom. Unlike my fellow Brits, I am a gigantic wuss when it comes down to that. I rationalised it as me drawing a line at sacrifices. I also say that my toilet is more hygiene friendly since it’s “cost” makes others treat it with respect.
And this was something I realised a little too late for one of my early projects.
The construction of a clean, hygienic toilet for a rural village. Within 3 months it had gone from brand new to terrifying pit of hell.
Why? Because I “gave” it to them. When I came back I was harassed by angry locals who didn’t understand that it was a gift. They claimed no one had come to clean it and what was I going to do about it.
The next one I built I had an idea. I sourced tiles and made it look good.
Then I charged a very very undercut fee for it. Enough money to make it seem like the people “bought” the facility from me. To this day this keeps working and functioning because the people who paid Rs. 1000 (10 quid) a home (Don’t smirk for many that’s a week’s earning and a lot of savings) think they bought it lock stock and barrel rather than at a much much reduced cost. They are invested in it and so wish to see it succeed.
Toilets save lives. That Rs. 1000 is probably what they would spend if they got a major diarrhoeal disease that year. Amoebic Dysentery, Cholera, Rotavirus, Typhoid… the list of diseases that cause major distress from diarrhoea is large.
In many villages, there are no such facilities. But there is usually a temple. And I agree. India could do with more toilets and fewer temples. With 1.2 billion people, India’s sanitation and toilet stats are frankly down the drain.
One in Three Houses has a toilet or access to one. Urban Areas have more toilets but they are plagued with poor cleanliness and insanitary disposal methods. And this leads to a horrific rate of water-borne disease.
In addition India’s traditional toilets is home to one of the most horrific and oppressive practices. Euphemistically called Manual Scavenging, the practice involves the Untouchables (dalits) who manually (AKA by hand) clean out human faeces from open pit lavatories. In the 1960s the practice was so widespread that there were 4 million dalits living in this condition. Today? The numbers seem to be a lot better with around 100,000 people still involved in this. This Must Stop.
It is inhumane, dehumanising and leads to the social ostracisation and rampant illness that often targets the rural dalit community and with the control of water by the upper castes in many villages and the lack of healthcare aimed at the dalits, the toll of disease is often higher.
In this way the old toilet is a method of oppression.
Out of 24.6 million houses in India the majority still don’t have toilets. Above 50% of houses don’t have an indoor toilet. 50% of people defaecate in the open. This leads to a massive disease burden of around 40 Million Dollars a year (2.5 trillion rupees) in healthcare costs that is preventable. This is 5% of the GDP.
In some states such as Jharkhand and Odisha upto 80% of houses lack a toilet.
The problem is we need to see that the access to a hygienic and clean toilet is part of the right to live a life of dignity and equality. But the scale is enormous. 1.2 billion people is roughly 1/6 people on the planet. They need these facilities and that is a lot of toilets that need to be built and a lot of infrastructure to make it all work. It is an immense undertaking.
There also needs to be a culture of toilet usage. People don’t understand why outdoor defaecation is harmful. We go back to my little game about how shoes save lives by cutting down on hookworm infestations which are a major cause of anaemia which complicates simple diseases. If you don’t understand you cannot see the benefit.
India lacks a culture of sanitation. It is in the same stage that Europe was in a hundred years ago with regards to that. What must occur is a change in attitudes and a willingness to discuss this. Discussing toilets is not bad or dirty but vital to saving lives.
And this is again a place where women are affected more than men. Many public facilities are not aimed at women or are nearly impossible to use for them. In many places the female bathroom has become a place of fear due to attacks on users. Women and girls often have no other option but open air defaecation. In many places there are simply no facilities for women.
This has led to one comical part of Indian culture. India still utilises the arranged marriage method of finding a partner and men have taken to posing with their toilets to PROVE to future brides to be that if they select him, she too will be the proud owner of an indoor toilet.
For many a man and woman in India they have to utilise toilets that are not clean, not functional and with no privacy. Many a tourist has been horrified by a public toilet with no door and the urgent pressure that comes from the lack of hygiene in India (Diarrhoea). Many a tourist rates that moment as the lowest moment in India.
That’s a bigger shame to my culture than discussing hygiene.
The sad fact of the matter is if we tried to encourage politicians and the public to build these hygienic life savers there would be less interest than if we were to want to build a new temple. I agree that India does need less temples and more toilets. The lives improved and saved would be enormous and it’s an investment in the future.
Today is World Toilet Day. (Well yesterday. It shares it’s day with Men’s Day)