Talkin’ about poop.

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).

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. 

The team, crammed into the back of a land cruiser.