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Tuesday, 27 August 2013

Latrines, lifelines and links: the view from Ethiopia

‘I was persistently sick. One time, the sickness lasted three months and I came near to death.  Our lives are very greatly changed because we have a toilet.  We still struggle to grow enough to eat and life is hard, but the toilet has made such a difference.’  

These are the words of Ethiopian Tirame Ayago (55 years old), and they illustrate the enormous benefits of gaining access to a latrine.   

Tirame outside her latrine [photo: Richard Hanson/Toilet Twinning]
Toilet Twinning wanted to take a peep behind the scenes to find out about the thinking that goes into bringing about changes like these.  So we asked Tadesse Dadi, Tearfund’s programme support advisor based in Ethiopia, to write this blog:

Tadesse Dadi [photo: Louise Thomas/Tearfund]
My daughter has just completed her high school in Addis Ababa with very good exam results. This was a great joy for the whole family and we praised God for it.  
I still remember the first day my wife and I took her to nursery school. She was very happy and was looking forward to playing with the other children and finding new toys. A week or so later, though, we had to keep her at home for a few days until she recovered from a bout of diarrhoea. It was clear that poor hygiene and sanitation at the school were the cause of this.
Those of us who have had the privilege of bringing up babies and infants know how vulnerable they are to infection in their early years. Poor nutrition and unhealthy environments associated with poverty take a huge toll on young lives. The statistics are alarming: pneumonia and diarrhoea are leading killers of the world’s youngest children, accounting for 18 and 11 per cent of deaths respectively. This equates to more than two million lives lost each year.  
Unsafe water, inadequate sanitation and poor hygiene are all contributory factors. Together they account for nearly 90 per cent of deaths due to diarrhoea worldwide.  
I recently learnt about the ‘F’ diagram, which shows the route taken by disease-causing pathogens, from faeces to our food and water. These pathogens are helped along their way by fingers, fluids, flies, fields and floors. The first line of defence is to block the path of the pathogens through safe disposal of faeces - in other words, using latrines.  
This is not a new idea!  In the Bible, God instructed the Israelites: “Designate a place outside the camp where you can go to relieve yourself. As part of your equipment have something to dig with, and when you relieve yourself, dig a hole and cover up your excrement.” (Deuteronomy 23:12-14, NIV). This is clear instruction to us to erect ‘primary’ barriers to prevent disease transmission.  
We also know that handwashing with soap, particularly after using the toilet or changing nappies, is an essential habit for all of us.  
So creating an understanding of the link between the way we dispose of faeces on the one hand, and killer diseases such as diarrhoea on the other, is the first step in tackling the problem. Once that understanding is created, then sustainable solutions to problems - such as taboos surrounding the use of pit latrines - usually come from within the communities we are working with.
On a recent visit to the Turkana area of Northern Kenya, I found awareness of the problems among the villagers, but a lack of action. Most of the 50 or so households in the village did not have pit latrines. So while the risk of open defecation was well understood, the cost of constructing a pit latrine was prohibitive.
As development practitioners we need to bring people to the point where they understand that investing in pit latrines saves lives, so that the solution is owned by the community, not imposed from outside.
In Turkana a lady in the group I was talking to proposed a local way to reduce the latrine cost. She drew a diagram on the sandy ground to show us that the top of the pit could be covered by locally available poles, with twigs and earth on top of them.  
I left the area on a positive note, knowing that it is possible to save lives – by looking for local solutions. Enabling people to solve their own problems truly empowers them to be creative.  
Thank you Tadesse!
Water Supply and Sanitation Collaborative Council and World Health Organisation. 2005. Sanitation and Hygiene: programming guidance.  WHO Press, Geneva.
UNICEF. 2012.  Pneumonia and diarrhoea: Tackling the deadliest diseases for the world’s poorest children. New York.  www.childinfo.org/publications
Water Supply and Sanitation Collaborative Council. 2010 . Hygiene and sanitation software: an overview of approaches.   Geneva