For most of us privileged enough to have easy access to flush toilets, squatting to defecate, exposed to others' view, is something we have only ever experienced in our nightmares. The closest we've come to it is going in the bush on a safe hiking trail.
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Having no choice in the matter is what holocaust survivor Primo Levi called “a deep wound inflicted on human dignity,” on a par with the debasements of being stripped naked and beaten. He describes lack of basic sanitation as one of the worst aspects of the train journey to Auschwitz:
In my car there were quite a few old people...for everybody, but especially for them, evacuating in public was painful or even impossible...It was our paradoxical luck (but I hesitate to use the word in this context), that in our car there were also two young mothers and their infants of a few months and one of them had brought along a chamber pot: one only, and it had to serve about fifty people...With a piece of string and a blanket we improvised a screen, which was substantially symbollic: we are not yet animals...
It might seem a bit extreme to evoke the most notorious human rights violation in history here. Then again: this indignity is not one consigned to the past.
On the contrary. On World Toilet Day, 19 November, and every day, the 1.1 billion people in the developing world who live without toilets will have to endure this form of debasement. About 2.6 billion have toilets of some description, but ones woefully inadequate in basic sanitation terms, and ones you or I would no doubt go to great lengths to avoid using.
1g of faeces, millions of pathogens
Open defecation, in addition to the damage it does to psychology and spirit, of course also spreads disease. Disgusting as it sounds, most illness in the world is caused by swallowing faecal matter – from the ground, it gets onto food and into water, and is carried to the mouth on unwashed hands.
It only takes a tiny amount, invisible to the naked eye, to make you sick. In 1 gram of faeces can contain 10 million viruses, 1 million bacteria, 1000 parasite cysts and 100 parasite eggs.
1.8 million people die from faecally-transmitted diseases every year. Most deaths are among children, whose small bodies put them at high risk for fatal dehydration from diarrhoea. About 5000 children die every day from these diseases – more than either HIV/AIDS or malaria.
Diarrhoeal diseases also hit poor families and countries economically by keeping children out of school and breadwinners away from work for weeks on end.
Women hurt most deeply
Women and girls are rendered particularly vulnerable by being forced to defaecate outdoors. In many areas, modesty forces women to seek out-of-the-way areas during the hours of darkness, making them easy targets for sexual assault and physical violence.
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Got an interesting toilet anecdote? Feel free to share it in the comment box below. And yes, you may choose to remain anonymous...
Levi, Primo. The Drowned and the Saved. 1986.
World Toilet Organisation. 2014
Olivia Rose-Innes is Health24’s EnviroHealth Editor. Read more of her columns and articles or post a question to her expert forum.