Getting Real about Sanitation: The Dirty Secret


Hand washing is an important part of World Vision's sanitation education programs. Read about Dr. Greg Allgood's recent visit to Zambia, where hygiene and sanitation are transforming the health and well-being of communities!

Hand washing is an important part of World Vision's sanitation education programs.

When World Vision provides a community with clean water, the impact of that water reaches much farther than the water the people drink. Latrines (sanitation) and proper hygiene (hand washing) are also crucial components of our holistic approach to community development.

Read about Dr. Greg Allgood's recent visit to Zambia, where hygiene and sanitation are transforming the health and well-being of communities!

It’s tragic that 1,600 children die every day from diarrhea caused by unsafe water and the lack of adequate hygiene and sanitation. That’s more than die from AIDS and malaria combined. Our water team at World Vision not only provides clean water to address this public health tragedy, but also works with communities to improve sanitation and hygiene.

The reason that children die from diarrhea is typically because human waste gets into water or on food and is shared on dirty hands. So providing clean water is great, but to have the greatest reduction in diarrhea, clean water needs to be paired with preventing the spread of human waste by building latrines and teaching proper hand-washing practice. This is an area in which World Vision’s water team excels.

Right now, our best approach is being done in Zambia. We have a regional learning center in Zambia for all of our southern Africa water efforts led by Dr. Emmanuel Opong. Dr. Opong and his team know that communities will quickly ask for our help in providing clean water, but latrines and hand-washing education is a much lower priority: the transmission of disease through poor sanitation isn’t as widely known.

Once we’ve lived and worked in communities long enough to build trust, we start with sanitation education. Our approach is called Community Led Total Sanitation (CLTS), and I recently took part in a session in a rural village in Zambia. It’s clear that the community trusted our local water leader, Nachula Bwalya. Along with a local community volunteer, Nachula had the community prepare a map of the layout of the community. It identified all of the houses, water sources, and existing latrines.

We then walked through the community on what is called the “walk of shame.” This is because we’re literally hunting for human feces on the ground. When there are few or no latrines, people defecate in the bushes, which can lead to contaminated water. It’s not hard for us to find feces during our walk. The lack of latrines results in a loss of dignity by having to defecate in the bushes. It’s part of the dirty secret of the lack of sanitation.

This part of changing the community’s behavior is very blunt. In fact, trainers don’t use the word “feces” but vernacular words like “poop.” It helps make the experience real. And it gets very real and allows for the type of open dialogue needed to change behaviors.

We collect human waste with a shovel and bring it back to where we’re sitting for our discussion. The volunteer has some bread, which she shares with the community members. She then places a piece of the bread next to the feces that we’ve collected, and flies quickly move between them. She then offers this bread to members of the community who, of course, refuse to eat it.

We then discuss the amount of waste being deposited in the village. This is a very specific exercise based on the size of the feces, the number of defecation times per day, and the number of people in the village. We then determine how much will be deposited per week and work it up to the total amount per year. The calculation is made easy to understand by using the size of items that people know. The local soap happens to be the size of an average defecation. The name of the soap is “Big Boom” (you can’t make this stuff up!).

When we go through the total calculation, the village is shocked to learn that they’re depositing the equivalent of 1,440 large bags of rice (7 tons of waste) each year on the ground of their village. It’s no wonder that the nearby water sources are contaminated.

Through these and other powerful examples, including understanding the financial impact of clinic visits from sick family members, the community begins to understand the need to build latrines. It’s a process that takes more than one day, but this first session has made an impact and many of the households are eager to learn. We start with some early adopters, and soon entire villages are ready to build latrines.

In fact, the community can be certified as “Open Defecation Free,” and this is one of the measures we use to determine if a community is ready for a new water source.

Proper hand-washing behaviors are also a critical part of the education process. Not only do community members learn about proper hand washing and the critical times for hand washing, we also show them how to construct hand-washing stations that conserve water and are easy to use. A popular technique is called a “tippy tap,” which is an efficient way to wash your hands effectively in villages that do not have running water. 

Through our work, the community begins to understand that improved sanitation and hygiene practices can play a critical role in ensuring the health of the community. Along with the provision of clean water, we’re providing the foundation for transformation in health and the basis for lifting communities out of poverty. That’s worth a toast with clean drinking water. Cheers!

By Dr. Greg Allgood
(Photo: 2014 Dr. Greg Allgood/World Vision)

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