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| This picture has nothing to do with poo. I just like it. |
For the last two weeks, my colleagues and I
have been travelling Haiti, talking to people about poop. We ask them where
they poop, how they wipe, if they wash their hands, and if they have toilet
paper, water or soap.
What we are learning is that a lot of
people, particularly the rural poor, don’t have latrines, and even less people have soap and water. This is outrageous for a country that is 2.5
years into the worst cholera epidemic in recent history.
Cholera is transmitted by fecal oral route,
meaning literally when feces enter the mouth.
This sounds gross – and it is – but it’s really much easier for this to
happen then one would think. If you don’t
have a latrine and you need to go to the bathroom outside, often the poop can
then be blown or carried with rain into a source of water, which people then
drink from (no they are not literally drinking poo – but they are drinking
water that has touched poo, and that carries the bacteria).
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| Cholera can also be spread when feces touch fruits and vegetables which are then eaten. |
Having a place to poop is a really
important part of stopping the spread of cholera and everyone that we speak to
knows this. The people who don’t have
their own toilet express great shame in not having one. The problem is that for many they are just
too expensive. When we ask people about
their priorities, they are clear: send my kids to school, fix the house, maybe
buy a motorcycle so that they can get into the city to find work. A latrine is understandably not high up on the
list, especially when they have survived just fine without one until now.
Giving people latrines sounds like a
no-brainer, and in some respects it is.
Everyone should have one. But
nothing is that straightforward in Haiti.
There is no piped water system in much of the country, so the kinds of
toilets that we have in our houses are pretty much out of the question. Dry pit latrines (just like outhouses) are
the simplest solution but they can smell, and eventually they fill up and a new
hole needs to be dug. An intermediate model uses water to flush, but doesn’t
need to be hooked up to plumbing. All of these types will require emptying or
re-digging within a few years, and that kind of service is not readily
available. Then you have to make sure
that whatever style of latrine you chose can withstand all of the hurricanes
and tropical storms that Haiti gets annually.
Many of the latrines that we saw completely collapsed during hurricane
Sandy.
After you have chosen your environmentally
friendly, hurricane-proof latrine (please share if you succeed!), you need to
make sure that there is water nearby so that people can wash their hands. This is a whole other feat in and of itself,
especially way up in the mountains. Then
you need to make sure that people have a steady supply of soap to wash their
hands, and Clorox to clean their latrines.
Now that you have all of the hardware set
up, you need to work on the software: making sure that people use their latrine,
that they clean it, and wash their hands. Laugh if you will, but if this was so simple
you wouldn't find “employees must wash hands before returning to work” in every
restaurant bathroom.
Behavior is hard to change. It takes a long time. If all people needed to
change their behavior was knowledge, no one would smoke, we would have stopped
the spread of AIDS, and obesity might not exist. People need repeated, ongoing reminders of
what to do, and they need all the systems to be in place to facilitate them
making the right decisions. We asked one of the project staff how long it takes to create sustained behavior change and he responded, 'It takes a long time. Very long. Until death.'
In Haiti, many people don’t have
latrines. They can’t afford soap. They have to walk long distances for water.
The systems just are not in place to stop the spread of cholera.
My job, as an evaluator, is to help
organizations navigate complex situations like these. I am part of a team that helps organizations to learn from their past experiences and to apply that knowledge to best meet the needs of their beneficiaries,
in this case Haitians.
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| The team, crammed into the back of a land cruiser. |
