Why does your drain smell so bad?

So, you have finished using the toilet. And, have flushed it down. But seriously, where does it all go?

When you ask this question, the answers you get will range from septic tanks to pits to the underground sewerage systems etc. But, is that the whole story? Now that is the difficult question, which begs a real hard look at the ground reality.

Let’s travel some years back in history. It is a well-known fact that ancient India had a fine network of storm water drains, which acted both as groundwater recharge systems, as well as flood control devices. In cities like Chennai, the network of storm water drains led to ponds (kulams) which acted as natural flood control devices. Thanks to unbridled ‘development’ and growth of unplanned settlements both these ‘kulams’ and the storm water drains are polluted and choked.

How have things come to this state? One of the major contributors of pollution in storm water drains (SWDs) are the people themselves. This happens in three ways:  Many of the households, which have no containment structures attached to their toilets, connect the toilets to the storm water drains.  Sometimes, even households, which have containment structures, connect the outlets the storm water drains. Thirdly, it is not unusual to see that the grey water from the kitchen and bathroom being connected to the storm water drain directly.

A study conducted by Tamil Nadu Urban Sanitation Support Programme (TNUSSP) on the state of the storm water drains showed that this kind of pollution was not only common in small towns but also in mega cities. When asked why toilets and containment structures were connected to storm water drains, most of the residents said that they used the storm water drains as an easy option because it was the “common practice in the area.” Some of them also mentioned the “lack of other options” as one of the reasons.

Letting grey water from the kitchen and bathroom into the open or closed drains is a very common practice all over the country. This is also because many of the people believe that storm water drains are meant to carry the grey water. It comes as a surprise to many people when they learn that storm water drains are meant only to carry storm water and urban runoff (surface runoff of rainwater) to the natural water bodies.  However, in reality, the storm water drains end up carrying all the wastewater from the cities (and towns) to the natural water bodies resulting in the grand scale pollution of the water bodies and leading to a colossal public health hazard.

How does dumping of solid waste affect drains?
Dumping of solid waste in the drains is another huge problem that affects the functioning of the drain itself. The drains are designed based on certain set of criteria like the amount of rainfall in the area, natural slope and type of soil etc., which helps to estimates the amount of storm water that will get collected in a particular area. Dumping of solid waste and wastewater into the drains affect their functioning, resulting in improper flow, siltation and stagnation of water which further leads to a whole range of problems like bad odour and serving as a breeding ground for diseases like malaria, dengue, etc.

Where does it end up?
The final destination for the wastewater, which is carried by the drains are the natural water bodies such as streams, rivers, canals etc. A research into how these waterbodies have transformed over a period of time into gutters carrying dirty water will help us understand how we are killing them slowly.  Not very long ago, people used to stop to look down bridges to enjoy the scenic beauty of clean, flowing water. Today, they cover their noses and try to get away as soon as possible.

To understand this problem better, the TNUSSP team conducted catchment level assessment of drains in selected locations. Watch this space for further insights into the study.

For Further Reference:

1. (http://www.downtoearth.org.in/news/what-drains-mean-to-cities-44069, 2014)

 

 

 

 

Olassayil Sancy Sebastian
Junior Specialist, TNUSSP

 

 

 

 

Suneethi Sundar
Specialist, TNUSSP

Menstrual Hygiene Management – Let us talk louder

Menstruation is concomitant with womanhood. Nevertheless, in my adolescence, I was taught to deal with this as a taboo subject. But, that was a while ago. What is the situation now? How does the modern adolescent girl, in this age, deal with this inevitable body function? Has the silence around ‘those five days’ been broken? It was with these thoughts that I embarked upon a study to explore what adolescent girls in small towns think of menstruation, and how to deal with it.

Recently, I happened to chat with a bunch of 12-14- year old girls about menstruation, and what they thought about it. The girls were shy and uncomfortable in the beginning. Gradually, they began to open up and what followed was a very engrossing discussion. Every single girl in the group had something to say from her own personal experience. While many of the stories sounded similar, a few were rather unusual.

When I was growing up, despite the silence and the taboo, my mother had taken care to introduce the concept of menstruation to me. When I attained menarche, I was mentally prepared to handle it. Contrary to what I had experienced, most of the girls I spoke to practically had no information about menstruation from their mothers. On the other hand, many of them had been told that they had to inform an aunt or an elderly woman in the neighbourhood at the onset of their first period. It was a popular belief that informing the mother or the grandmother would bring bad luck to the girl for her entire life. The girls also said that during the course of their first period they were made to sit on a wooden plank in a secluded area of the house for a period of 7 to 10 days. Some of them were also made to remain there for as long as two weeks. Once the period of seclusion was over, some families celebrated the occasion with a grand ceremony to which neighbours and relatives were invited.

However, once this celebration was over, the girls were not expected to speak about their periods openly even with their own mothers. Their monthly cycle was to be ‘suffered’ in silence, because of which girls got the basic information from their peers, who were as ill-informed as themselves. This had resulted in a variety of misconceptions around menstruation and menstrual hygiene.

The girls also reported that several restrictions were imposed on them during their monthly menstrual cycle. They were prohibited from attending any religious festivals, going to the temple, prevented from entering the kitchen or hanging out with their friends and family members. Some of them were even prevented from eating certain kinds of foods.

“During my periods, my family behaves like I have got a contagious disease. I am not even allowed to touch anyone else,” said one girl, while some others reported that they had to refrain from eating some kinds of foods. Anything sweet was forbidden because it was popularly believed that eating sweets would result in increased blood flow, which would be detrimental to the health of the girl.

Attending school during the menstrual cycle continued to be a nightmare, with problems being faced at every stage from travelling to school to concentrating in the classroom to changing sanitary pads. “Taking a sanitary pad out of my bag, carrying it discreetly to the toilet and safely disposing of the used pad, is not at all easy,” said one girl. Her story reminded me of my school days.

While government schools have made a small attempt to make girls comfortable during their monthly cycle by offering them six packets of free sanitary napkins each month, the girls were not comfortable using them. “These pads are not very absorbent,” they said, adding that most of them took the packets and gave them to their mothers, who used them along with the usual cloth. The girls, on the other hand, preferred to use branded sanitary pads, which they got from the local pharmacy.

Home remedies were still the most popular form of treatment to deal with problems and discomfort associated with menstruation. Most of the girls said that they had never thought of consulting a physician for any period-related discomfort like stomach aches or cramps. Coconut oil, turmeric powder, fenugreek seeds, castor oil etc., continued to be the sought-after remedies during those five days. Superstitious beliefs continued to thrive around everything related to menstruation, some of them even leading to unintended good. “My grandmother says if I don’t dispose of the used napkin properly I will get Naga Dosha,” said one girl to my amusement. At least proper disposal was being taken care of, I thought.

As the discussion came to a close, I realised that taboos and irrational fear continued to abound around everything related to menstruation. It is very important that girls are not only educated about menstruation and menstrual hygiene but also to be given lessons that would trigger a positive perception about their monthly period, thereby boosting their self-esteem. Parents, especially mothers, had to be brought into the ambit of discussion and talking about menstruation and menstrual management had to be encouraged.

 

 

 

S. Elizabeth Prasanna,                                Social Worker,
Keystone Foundation

A day out with the honeysuckers

Working in sanitation throws up many interesting possibilities and questions. One such question was about the ‘hidden taskforce’ of septage management – the desluding workers – who work behind the scene, who are hardly acknowledged, but who are the prime players in septage management. Theoretically, we know that unless the collected septage is carefully desludged and safely transported from the containment structures to the treatment plant, no amount of securing the rest of the links in the sanitation chain would ensure safe sanitation. However, we barely interact with the desludging operators and know far less about their work on a day-to-day basis.

With dry toilets being declared illegal, and more and more houses moving towards toilets with septic tanks, a set of budding entrepreneurs are appearing in the market with their vacuum trucks known as honeysuckers to empty the septic tanks for a small fee.  We also read regular articles in the media about illegal dumping of septage into water sources and open grounds, which creates a huge health as well as environmental hazard.

Given all this myriad information, we decided to find out more.  So one fine morning, my colleague Suresh and I decided to get on to a desludging truck and find out what one day in the life of a desluding operator looked like. We got on to a desludging truck….
***

Before he turns in the ignition key, let me introduce you to Kumar, our lorry driver. A resident of Sathyamangalam, Kumar travels around 70 kms each day to reach his workplace in Coimbatore. Around 8:30 am, each morning, Kumar teams up with another one or two people and sets out on that day’s business. Today, he has one assistant, Muthu with him, but since the two of us are also around, he has asked Muthu to go and sit on top of the vacuum tank, while the two of us take our place next to the driver.  Once we are comfortable, Kumar informs us that we are going to a poultry farm near Kaattampatti for the first desludging operation of the day.

Two hours along the Pollachi Highway brings us to Kaattampatti. We make our way to one of the largest poultry farms in the district. As soon as we enter the premises, a couple of workers come our way with cans of phenyl, which they pour on the lorry to disinfect it.  The ease with which the entire exercise is carried out makes us realise that the farm is among Kumar’s regular clients.  After the ‘disinfecting’, the lorry proceeds to the place where the septic tanks are situated.

Once the ignition is switched off, we watch in amazement at Kumar’s metamorphosis. He is no longer the chatty person who was sitting beside us behind the wheel. He jumps down from the driver’s cabin, reaches the septic tank and breaks open the sealed manhole with a crowbar. In an equally well-coordinated move, Muthu pulls down the extension hose from the top of the truck, connects it to the valve embedded on the tanker, and pushes the other end into the septic tank. Thanks to the vacuum suction technology, the vacuum tank is filled with 5000 litres of septage in a few minutes.  Throughout the entire process, Kumar has kept a careful watch on the volume gauge mounted on the tanker.

***

While this entire exercise is taking place, Suresh and I introduce ourselves to the staff of the poultry farm.   After some initial hesitation, some of the workers began speaking to us. We get to know that close to 90 workers work and live on the poultry farm. They share common sanitary facilities, which are spread around the farm, and on an average around 15 lorry loads of septage was being generated by the farm every month. Our jaws drop on hearing this number. “Where do they take so much septage? What is the disposal mechanism,” was the question on our minds. We keep a straight face and ask Kumar where the nearest dumping location was. “Oh, I have an arrangement with the nearby farmland,’’ he says confidently. “We will go there in a while,” he adds.

Surely enough, half an hour later we are at a large coconut grove. With the farmer’s wife supervising the unloading, Kumar and Muthu empty the entire tanker into the groove. We take the opportunity to speak to the farmer’s wife. She tells us that her farm receives around 20 loads of septage every couple of months. “It is not only from the poultry farm, we have an arrangement with a couple of other places for regular supply of septage,” she says with a smile. Her husband who had joined her tells us that the septage is very important during dry spells when the farm faces acute water scarcity.

Soon it is time for lunch. The owners of the farm invite Suresh and me to join them for lunch. Kumar and Muthu have brought their lunch along with them. They go to a nearby tap and begin washing up.  I watch as Muthu fumbles around in the driver’s cabin and pulls out a used detergent soap wrapped in a newspaper, which he and Kumar use to clean their hands and feet. The sight is a kind of relief for us, as we had observed the two carry the hosepipe from one septic tank to another on their shoulder, wiping the spillage with their bare hands!

Once lunch is done, the work continues. Kumar and Muthu take turns building mud bunds around the coconut trees, with their bare hands, to prevent spillage and overflow. The farm owners’ small children continued to play in the vicinity. One toddler keeps coming to Kumar and Muthu and the duo keep embracing him, carrying him, playing with him throughout the time they are working.

It is late in the evening, when the work is done. It is time to head home. On our way back, we find out that both Kumar and Muthu had dropped out of school and taken up this profession. Kumar earns close to Rs 17,000/- per month, while Muthu earns Rs 12,000/- .
As we near Coimbatore, we stop at a roadside teashop. “Take that smelly truck away,” someone shouts from inside.  We look at Kumar. He has a defiant look on his face, but his voice trembles as he says, “There is no point in getting into a brawl. This is our profession and we are proud of it.

Vinitha Murukesan

Environment and Sanitation Analyst, TNUSSP

Suresh Kumar

Community Coordinator, TNUSSP

What does your gut instinct tell you?

In this post truth era, where objective facts are misrepresented and made more appealing to emotions, and personal beliefs shape one’s opinion, I know I belong to the feeble voiced, when I am stressing on the importance of health education. I know the odds stacked against this task, but I will endeavour to raise it to the point where we could tip the scale and overcome this challenge.

In this final part of the Helminth-related series, let me try to bring in a sense of closure to this “Helminths and its infections” discussion. I will attempt to clear the fog in our minds and fight back the untruths and exaggerations about Helminths-related illnesses.

From the earlier blogs (Everything you need to know about Helminths – Well, almost everything,  Helminths-related infections and Open Defecation – It is obvious!) I believe that we have to come to understand the transmission dynamics of the Helminth worms and eggs in our environment, and the various kinds of infections (gut, skin etc.) that it causes. The burden, due to poor sanitation and open defecation, on children is manifested as soil or water transmitted infections. In order to prevent recurring illnesses and develop mitigation measures, serious discussion is pertinent about the need for a sound health education programme catering to all sections of society.

One of the key strategy for controlling Helminth-related infections is carrying out periodic deworming among pre-schoolers, toddlers and children. The WHO recommended that medicines such as albendazole (400 mg) and mebendazole (500 mg) are reported to be effective, inexpensive and easy to administer by non-medical personnel (Eg: teachers). These antihelminthic medications are administered by the National Ministries of Health in many countries, for treatment of all children in the school-going age group. Though, this regular treatment for high-risk groups (i.e. children) is based on epidemiological surveillance and will yield benefits in the long run, let us also keep in mind the potential threat of drug resistance. Anyway, there is an urgent need to develop a multi-disease fighting approach that goes beyond just deworming, and health educators must ensure that it works towards controlling Helminths transmission and preventing recurrent illnesses.

Source: http://www.istockphoto.com/in/vector/child-and-parasite-gm672465844-123289505

Proper guidance on safe and hygienic handling of human faeces, wearing shoes in areas that have been designated for defecation and also while accessing public/community toilets, personal hygiene and sanitation behaviours, especially whilst using community swimming pools, safe sanitation practices including hand washing with soap, consumption of boiled water and properly cooked food etc. are some of the measures that would be effective in controlling Helminths transmission.

Long-term solutions like improving the quality of water supply, promoting safe sanitation and sustainable hygiene strategies and practices are key to the elimination of helminth infections. It is important to remember that children can be treated for helminths, but unless their living environments are secured from infection, there is a high chance of them being infected again and again. Improvements to WASH resulting in better quality of life, complemented by appropriate health education, is essential for achieving sustained control of helminths in the medium and long term.

Positive correlation between sound health education and supportive healthcare resulting in improved quality of life is evident. But to get this message through and make it a reality is indeed a difficult challenge. So are you up for the challenge or do you need more convincing? What does your gut feeling tell you? !!

For further reference

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125032/ (accessed on Sep 7, 2017)
2. http://www.who.int/mediacentre/factsheets/fs366/en/ (accessed on Sep 7, 2017)
3. http://www.sciencedirect.com/science/article/pii/S0001706X10001828 (accessed on Sep 7, 2017)
4. https://www.ncbi.nlm.nih.gov/pubmed/12592987 (accessed on Sep 8, 2017)
5. https://www.ncbi.nlm.nih.gov/pubmed/15081942 (accessed on Sep 8, 2017)

 

 

 

Suneethi Sundar
Specialist, TNUSSP

Helminths-related infections and Open Defecation – It is obvious!

When somebody says something really obvious, we usually tend to ignore it and not pay enough attention. Why is it we don’t feel the need to know about things that might one day prove to be valuable to us and others? I was in the park the other day, sitting on a bench trying to read my book. That is when I heard this very interesting conversation between two friends:

He says: I thought I should tell you this. I think it is important.

She says: Ummm ok. Is everything alright?

He says: Yes. You remember my little niece who fell ill recently. She was so sick that we were all really scared of losing her.

She says:  Yes, I remember. Isn’t she the one who eats mud?

He says: Hey! She is only 3 years old. And yeah, she eats mud. So did all of us at her age. My grandmother even thinks it is due to some deficiency and she will outgrow it, as she grows older.

Image Source: https://www.scientificamerican.com/article/would-you-like-side-dirt-eating-soil/ (accessed on Aug 17, 2017)

At this point, I am intrigued and embarrassed. Embarrassed because as a child I also used to eat mud.  Intrigued because I want to know more.

He says:   The funny thing is that her geophagia- the practice of eating soil intentionally was the reason for her getting so sick. (Geophagia – that thing even has a scientific name?) The soil that she had consumed was infested with these ‘worm eggs’ that had made her fall so sick with severe diarrhoea.

She says:  No kidding. Are you talking about ‘Helminth eggs’? Everything you need to know about Helminths – Well, almost everything

He says: Oh! So you know about Helminth eggs?

She says: Of course. Helminths are worms that are widely present in areas, which are known for poor sanitary conditions and where open defecation is widely practised. The larvae of these worms, when consumed cause a variety of infections in people. But, where did your niece find soil that was contaminated with Helminth eggs?  Is there any open defecation spot near her school?

He says: Oh my God!  The school uses an open ground nearby as a makeshift playground. A part of that ground is also being used by the local communities as an open defecation spot.  You know what? When I went to pick her up from school the other day, her class teacher told me that there were atleast a dozen other children with gastro-intestinal infections.

The two friends did not realise that they now had a keen listener. I recalled the numerous occasions when I had been taken to the doctor as a child because of tummy and intestinal infections. The two friends continued their discussion on sanitation and hygiene practices of pre-schoolers.

She says: I recently read a report by Water Research Commission, which stated that, pre-schoolers are at a greater risk for getting exposed to these ‘Helminths infections’. They are infected by not just ingesting soil, but also because of inadequate hand washing, consumption of fruits and vegetables that are not properly cleaned, and consumption of food and drink on which flies sit.

He says: Is that all or is there something else you are going to frighten me with?

She says: Oh, there is a lot more. For instance, one type of Helminths – hookworm, are transmitted when the skin is in direct contact with the contaminated soil, like walking barefoot.

He says: That means I should take care to see that my niece doesn’t go out to play barefoot. But is there any other way that children get infected?

She says:  Children can catch infections from other children and adults who are already infected. The Helminth eggs live under fingernails and can be easily passed on from one person to another. Extra care has to be taken with kids frequently using public swimming pools.

He says: How do I know if a child or adult is infected? Are there any signs of Helminths-related infection?

She says: For hookworm, itching and localised rash are the initial signs, since the Helminths larva penetrate the skin.  More severe infections can cause a sore tummy, abdominal pain, diarrhoea, loss of appetite, weight loss, fatigue and anaemia. On the other hand, roundworm and whipworm display no initial signs of infection, since they get into the body through dirt, soil, food and water.  Severe roundworm infections can cause intestinal blockage and even growth impairment, which affects cognitive development in children.

He says: This is really frightening. How does one protect children from Helminths-related infections? Is it enough to give deworming medications and iron supplements?

She says: Deworming medications and iron supplements, though essential are not enough. For a long term solution, education on proper hygiene and inculcating safe sanitation practices is very important. Children should be taught to avoid food that is not carefully cooked. Fruits and vegetables should be washed thoroughly and one should make a practice of drinking boiled water. But more than everything else, I cannot emphasise enough on the importance of washing hands before handling food.

He says: I think that the importance of adequate sanitation and hygiene should be taught at school and home.

She says: I know. Besides children, parents and caretakers should be made aware of the fact that Helminths-based infections are a major source of concern. So, the next time when you play with your niece in the open grounds, you’ll know what to watch out for.

He says: Yes ofcourse. Thanks for all this information.

Soon after, the two friends bid goodbye. After being a silent (and secret) witness to this entire conversation on Helminths-related infection and its connection to open defecation, I was dumbstruck. How is it possible that something is so obvious and we are still not aware of it?  I was left wondering, how many ‘It’s so obvious’ life lessons that I could have have missed so far. Probably more than I can imagine. 
And then came the obvious question, how do we make our soil and water safe from Helminth eggs.  I decided to do some research on the subject. And what I found out was some amazing information. But more of that in the concluding part of this series on Helminths.

For further reference:

1. WRC (2014). Investigating the practice of open defecation post sanitation provision and the practice and implications of ingesting soil which may be contaminated – Review of literature and anecdotal accounts (draft). Partners in Development, Bashomi Consulting and Projects, Amanz’abantu for Water Research Commission project K5/2379, Pretoria, South Africa
2. Clasen, T. et al. (2015). Assessing the effectiveness of improved sanitation on diarrhoea and Helminth infection: A cluster-randomized, controlled field trial in Orissa, India – Various documents on results from research grant. London School of Hygiene and Tropical Medicine
3. Guidelines for deworming of young children, NRHM, Assam (http://www.nrhmassam.in/pdf/guidelines_for_de-worming.pdf) accessed on July 15, 2017.

 

 

Suneethi Sundar
Specialist, TNUSSP

Everything you need to know about Helminths – Well, almost everything

It had been such a warm day in Chennai and like everyone else I was also looking at the clear skies wondering how much hotter it could get. As I was thirsty and hungry, I went to a nearby street vendor selling some fruits which he had cut and laid out on display. Just as I was making my decision on what to buy, I overheard a conversation from other buyers who were talking about some kind of ‘worms’ that causes serious ‘illness’ in people. Being the curious type, I went ahead and joined in the conversation, while I continued to gulp down the pieces of mangoes which the vendor had wrapped in the previous day’s newspaper.

Here is the gist of the conversation from the alleged ‘worm expert’.

It turns out the worms the person was talking about are called Helminths. So what are Helminths? And how do they make people fall ill? Well, Helminths are basically worms that are widely present in areas which plagued by poor sanitation and where open defecation is widely practised. The Helminth worms are usually tape worm (Taenia solium), hook worm (Anclostoma duodenale and Necator americanus), round worm (Ascaris lumbricoides), whip worm (Trichuris trichiura) etc., I realised that the Helminths eggs and larvae are the agents that cause infection, and are usually discharged into the environment via faeces. The ‘Worm expert’ told me that the viable eggs will be infective when it develops as a larva and gets attached to a suitable host such as humans.

But, “Why is it important to know about Helminths?” I wanted to know. “Because it causes various kinds of illnesses in human beings,” he said, adding that these illnesses are commonly known as Helminthiases. Helminths are transmitted mainly through water and soil through the oral – faecal transmission pathway (popularly referred as the F-diagram). “Synergy between WASH and nutrition” – It’s complicated The worms are widely present in faeces, sewage, sludge and fecal sludge and crops. Consuming infected water or food, physical contact when handling infected soil and water, or even walking barefoot on contaminated soil, can lead to one getting infected. Wow! who would have thought of that, right?

Relative sizes of Helminth eggs.                                                                             Source: http://ogimed.blogspot.in/2013/06/relative-sizes-of-helminth-eggs.html (dated Aug 4, 2017)

The worm expert told me, that worms come in sizes varying from 1 mm to several metres in length. The eggs range from 20 to 80 microns’ size, which means they cannot be seen by the naked eye. Interestingly, the eggs are also sticky in nature, and can stick to vessels, furniture, cash, food, water, door handles, stair cases rails, fingers and nails etc., thereby escalating the risk of infection without people even realising it.

The situation is so alarming that the World Health Organisation in 2015 called Helminthiases a major health concern. Helminths infections in human beings affect the nutritional status by causing poor absorption of nutrients, loss of appetite, bowel obstruction and increased blood loss. Long term and heavy infections can cause abdominal pain, diarrhoea, blood and protein loss, and slow down the physical and cognitive growth. Heavy infections with whipworm and roundworm can even impair growth in children. Hookworm infections are a major cause of anaemia in pregnant women and children.

Wow, not only had I learnt something about these ‘dangerous worms’ that makes people sick, but thanks to my newly established camaraderie with the ‘Worm expert’, I went on to ask him more questions:  How do we ensure that Helminths are eliminated from our surroundings? There are various ways, he said. But the most important one is to make sure that all those materials which consists of Helminths are treated before being released into the environment. In that way, we can minimise the risk of infection, if not completely eliminate it.

I realised that we have reached the end of our intense conversation. But there was one more question to which I needed an answer. How do we reduce the incidence of Helminths -related infections in our day-to-day activities, I wanted to know? “Well, the obvious yet often overlooked practice of hand washing, is one of the most effective ways to beat the infection cycle. In addition to that, thorough washing of vegetables and fruits before consumption should be compulsorily followed,” the worm-expert said. I thought of the delicious mangoes that I had just gulped down. I had not bothered to find out if the fruit had been washed properly, and how long ago it had been cut.

I thanked the worm-expert profusely for answering all my questions and bade him goodbye. As I left, he said: “Don’t underestimate the power of what you can’t see or smell.” I was strangely intrigued. So I decided to find out more. And what I found out included a wealth of information on the universe of microbial pathogens and their implication on public health, and how the very act of defecating in the open can lead to Helminth infection and what can be done to keep ourselves safe.
But more of that in the next part, where we will talk about Helminths infection and its very obvious relationship to open defecation.

For further reference

https://www.unicef.org/media/files/IntegratingWASHandNut_WHO_UNICEF_USAID_Nov2015.pdf (accessed on April 24, 2017)

http://atm.eisai.co.jp/english/ntd/helminthiasis.html (accessed on April 25, 2017)

B.E. Jimenez-Cisneros and C. Maya-Rendon (2007) “Helminths and Sanitation”, Communicating Current Research and Educational Topics and Trends in Applied Microbiology

 

 

 

Suneethi Sundar
Specialist, TNUSSP

A loo that is usable too!

In the winter of 1999, when I was a post graduate student of social work in Mumbai, we were taken to a remote village in Banaskantha District, Gujarat. The objective of this visit was to understand the rural way of life, their customs and practices, the formal and informal institutions at work and so on. As young 20 somethings, we all were very excited about the trip but for one aspect. There were no toilets!! We were all told that we would have to use the open fields just like all the other women in the village did. At some point or the other in our growing up years, we would have definitely relieved ourselves in public; either while travelling by bus, or while visiting our native village or sometimes even within the city while going from point A to point B where public conveniences were either absent or open defecation (OD) was better than using these toilets.

Photo Courtesy: Nitin Kumar Gupta/NavShrishti NGO

However, in our early twenties, defecating in the open seemed quite an uncomfortable task to do especially when you had to choose between early morning or late night. During the course of those ten days, while some of us got adjusted to the open toilets, few others had severe gastrointestinal problems on our return back to Mumbai. Of course there were a fair share of humorous incidents such as the one where after an “evening visit” to the anointed spot, as we were collecting the “lotas” to leave, we suddenly saw a huge black thing move right next to us. To our utter alarm, we realized we had been blissfully unaware of the camel sitting right next to us while we defecated under the star-lit sky!

Our experience with inadequate toilets didn’t quite end in the village. As we waited in Ahmedabad for our train to Mumbai, we were forced to use the toilets in a movie hall which repulsed us to the core.   Badly maintained, with no running water, poor electricity and broken doors, it made us want to run back to the open fields in the villages. When I look back at this episode in light of the recent attention to sanitation and OD, I am able to relate to all the reasons people gave for not cultivating the toilet-using habit. Despite having built toilets, poor maintenance, lack of water and hygiene were the main reasons which made several women in the villages to prefer open fields to toilets, risking their safety, privacy and convenience.

So, why is that though there are several schemes and programmes for toilet construction, OD is still a major concern in India? The answer, I believe, lies in the usability of the toilets constructed. By usability, I don’t mean only the cleanliness and maintenance of the facility. Usability comprises of several other factors: availability of the toilet, followed by the distance to the facility, accessibility i.e is there sufficient lighting, are there ramps for the disabled and senior citizens, are the toilet pans appropriate for different age groups such as children? Is there privacy and safety for adolescent girls, and so on. The sanitation infrastructure in India lacks the human life-cycle thinking. The recognition that different people have different sanitation requirements at different stages in their life which affects the way they use toilets is neglected in toilet design and construction. Although a handful of organisations working at the grassroots have incorporated some aspects of this life-cycle thinking by making smaller pans for children, open dwarf-walled cubicles where children can see their mothers or defecate under the mothers’ supervision and so on, these modifications in design are exceptions and not the norm.

With rampant construction of toilets under the SBM and attention to behavior change where people are encouraged to use toilets, it might be worthwhile to conduct rapid assessments of the different needs of toilet users in order to reorient the current toilet designs. With several players getting involved in sanitation construction and campaigns targeting behavior change, we need to mainstream studies on usability to bring about a shift in the guidelines on toilet specifications. For our multi-crore schemes to be effective and reach the target audience, it is time to pause and pay attention to the needs of the end user. Achieving universal access to sanitation is a good thing, but let us ensure people can use it too.

Sriharini Narayanan

Senior Specialist, TNUSSP

The Curious Case of Mr Muthusamy

The Millennium Development Goals, which were launched with much fanfare in the beginning of the millennium, were meant to be reached by the end of 2015.  Even a cursory glance at the report card will show that India’s performance has been far from satisfactory. Interestingly, just before the MDG time frame came to an end, the Government of India lunched the Swachh Bharat Mission in 2014 aimed at making the country Open Defecation Free by 2019. While this programme has gained immense momentum in the last few years and continues to do so, it is important to note that the agenda has not gone beyond building toilets.
Just as in the case of many low and middle income countries, onsite sanitation systems are predominant in India. Toilets need containment structures such as septic tanks and twin pits that are scientifically constructed. Moreover, these containment structures need to be desludged regularly and the sludge has to be treated before being disposed. While an emerging market has made way for private operators to desludge the septic tanks and twin pits for a price, the story does not end there.
Have you ever wondered where the septage from the septic tank and twin pits is dumped ? More often than not, this septage is disposed of into water bodies or in open grounds thereby polluting the environment. Another convenient option is farm land, thanks to the popular perception that septage has high nutrient value and is beneficial to crops. Moreover, the water content in the septage also compensates for the increasing water shortage.
Recently, my colleagues and I went to a nearby town panchayat to interact with farmers who use raw septage as manure, and to understand the rationale behind this practice. Though it was a hot summer day, the cool breeze from the farms around made our expedition rather pleasant. The whole area was lush green, covered with a variety of crops. There was a strong aroma of fresh milk from the dairy nearby. Brushing aside the nostalgia that I felt for my hometown, I began my work by talking to the farmers who were working in their farms. “What are the crops you grow? How do you deal with the increasing water shortage? Has climate change impacted productivity,” we wanted to know. The farmers were very vocal in their responses and we hurriedly wrote down everything they were saying.
It was then that I saw Mr Muthusamy. He looked somewhere about 50 years old. He had a tired look about him. He was either exhausted from working in the fields or was just unwell. He, however, was eager to talk to us, and we made our way to where he was lying down on his rope cot. Mr Muthusamy began talking to us about the good old days when farming was easy, climate more predictable and water was plenty.  He said that though his borewell had enough water even to this day, he just like the other farmers had begun applying raw septage to his fields to save water. “But, we have stopped that practice in the last couple of years,” he said.
This naturally aroused our curiosity. We wanted to know the reason why Mr Muthusamy, unlike others, had suddenly stopped using readily available raw septage. “It smells a lot,” he said. “We cannot work on the land for at least three to four days after applying septage.”  This reply did not satisfy us. There was nothing new about the stench. So why had Mr Muthusamy stopped using raw septage in his farm?
A bit of prodding brought out the answer. “Using raw septage has led to the proliferation of visha poondu,” he said. “This plant is hindering the growth of crops and has led to decreasing yield.”  “Can you show us some visha poondu?,” we asked him. We wanted to know what this plant looked like. An half-hour’s walk into the field revealed that visha poondu was nothing but the parthenium weed.
“When there were a few plants around, we used to remove them manually, but now there seems to be an infestation of the weed. We are scared because people seem to be falling ill with different kinds of allergies,” he said.
Parthenium, (Parthenium hysterophorus) is a noxious invasive species, which is considered to be one of the worst weeds currently known. This is a weed of global significance responsible for severe human and animal health issues, such as dermatitis, asthma and bronchitis, and agricultural losses besides creating a great problem for biodiversity (Holm et al., 1997).
Mr Muthusamy was now in a talkative mood. “We have other issues too,” he said. “Whenever we work in the fields where septage has been freshly applied, we end up getting skin infections on our feet. As farmers, we consider our crops to be auspicious and we don’t wear footwear when we are in our fields. So each time we go to a field where raw septage has been freshly applied, a few of us end up with skin allergies,” he explained.
After a long conversation with Mr Muthusamy, we turned to leave.
As we were leaving, his wife, who was listening to the entire conversation quietly, asked us. “Can you do something about the septage? Add some chemicals to it, so that it becomes safe for us to use it?”
It looked like the importance of treatment had reached Muthusamy’s farm.

Reference:

1. Holm, J. Doll, E. Holm, J. V. Pancho, and J. P. Herberger, World Weeds: Natural Histories and Distribution, John Wiley & Sons, New York, NY, USA, 1997.

Vinitha Murukesan

Environment and Sanitation Analyst, TNUSSP

Laws are good, implementation not so much

As a child back in the village, I had always cherished the sight of clear water running below bridges. But moving to the city, the car windows are always drawn up and the car zooms across bridges in a bid to avoid the stench emanating from the river. This begs the question, why are we in urban India so deprived of a clean environment?

We live in an age where adequate importance is being given to toilets. However, what happens after one uses the toilet? Where does it all go? Ideally the toilets are either connected to the underground sewer (off-site sanitation system) or a pit latrines or septic tanks (on-site sanitation system) from which the waste is taken to the sewage/septage treatment plants. Does this really happen?

Urban India with a whopping population of 377 million sends out only 30% of the sewage/sepatge from its toilets to the treatment plants. An analysis by Indiaspend says that the remaining three-fourths of the sewage/septage is illegally dumped into our lakes, rivers and seas polluting our water bodies.  So why is this rampant pollution of our environment being ignored? Is it the lack of legal instruments and monitoring mechanisms to control the pollution, or is it the poor implementation of existing laws?

To start with, let us look at the laws which are in place for safe containment, collection and transportation of fecal sludge.

1. Tamil Nadu District Municipalities Act, 1920 (applies to the 124 Municipalities and 528 Town Panchayats in the state)
2. 12 Municipal Corporation Acts enacted for the 12 Municipal Corporations in the State.
3. Tamil Nadu Public Health Act, 1939.
4. Various bye-laws at the State and Urban Local Body level.

The TN District Municipalities Act, 1920 and 12 Municipal Corporation Acts has rules and bye-laws in place for construction, operation and maintenance of toilets, sewer systems and septic tanks. The Tamil Nadu Public Health Act, 1939, is a significant Act which exercises rules for prevention of sewage/septage from containment systems or insanitary toilets to be let out into open spaces or water bodies, prohibits practices of open defecation, and further issues directions for closure of unfit containment systems/insanitary toilets violating the laws.  With respect to Toilets and On-site systems, there are Acts which enforce safe regulation. In any case, despite existence these legal instruments a deeper question arises with respect to implementation of these laws.

The enforcement of many of these rules do not hold good at the field-level due to practical difficulties involved in identifying insanitary toilets and retrofitting them. The minimal fines starting from Rs. 30 to be imposed for violation of laws are seldom put into practice. In terms of collection/desludging, the CPHEEO Manual on Sewerage and Treatment, 2013 advises regular de-sludging of septic tanks. The Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013 recommends the usage of mechanical devices and safety gears for deslugding.

A further look at the transport and emptying of fecal sludge component denotes neglect with respect to legal structures. Although the Act says that only authorised vehicles/carts with adequate covers and licenses are allowed to collect fecal sludge from households; regulatory practices for checking on their safe disposal seem to be absent. Particularly, there is an absence of any designated monitoring authority to prevent disposal of fecal sludge into the water bodies/open lands. As a result of these gaps there is a rise in the unregulated private sector operating under unsatisfactory conditions causing harm to the environment and public health.

While there are gaps existing in the current legal instruments which need to be plugged, the bigger issue, however, is the poor implementation mechanisms. These can be attributed to fragmented laws, lack of awareness on the negative impacts of improper sanitation and inadequate number of existing sanitary personnel solely dedicated to implementing sanitary works.

Therefore, it is necessary that the Central government and Tamil Nadu State government which are now in the process of seriously implementing the National Policy on Fecal Sludge Management and Operative Guidelines for Septage Management for Urban and Rural local bodies in Tamil Nadu, 2014 respectively, should work towards creating awareness among all stakeholders which will go a long way in the implementation of these policies/guidelines.

References:

Tamil Nadu District Municipalities Act. 1920. “Tamil Nadu District Municipalities Act.” Tamil Nadu: Government of Tamil Nadu.

Public Health Act. 1939. “Tamil Nadu Public Health Act.” Tamil Nadu: Government of Tamil Nadu.

https://thewire.in/20320/70-of-urban-indias-sewage-is-untreated/

 

Srinithi Sudhakar
Senior Associate, TNUSSP

 

Bladder Woes: Bridging the sanitation gap along the highways

As I was mentally getting prepared for an almost 12-hour journey from Delhi to Shimla, my thoughts were fixed on one crucial thing, to get through the journey without having to use any of the public toilets on the way. The highways do not have any specific public toilet structures and by public toilets, I refer to those available in hotels or restaurants situated on the highway. I am not ashamed to confess that I suffer from toilet anxiety or toilet phobia particularly at the thought of using public toilets. The fear of having to use an unhygienic and a reeking toilet compels me to consciously hold the urge to urinate, no matter how bumpy the ride is. Though it may sound anomalous, it is a fact that many women silently endure this inescapable dilemma while traveling. This pernicious tendency to procrastinate the urge to pee not only increases one’s likelihood of developing urinary tract infections (UTIs) but also intensifies the anxiety level. This then leads us to an important question, why is there a vacuity in sanitation amenities between urban set ups?

 

The answer is rather direct – sanitation along state and national highways has not received adequate attention within the WASH sector or policy in India. In the context of urban sanitation, which in recent years has received concerted attention among policy-makers and practitioners in India, the provision of toilets along National or State Highways is a missing component. The vision of the National Sanitation Policy 2008 by the Ministry of Urban Development, Government of India clearly states that, “All Indian cities and towns become totally sanitized, healthy and livable and ensure and sustain good public health and environmental outcomes for all their citizens with a special focus on hygienic and affordable sanitation facilities for the urban poor and women” (NUSP, 2008 www.moud.gov.in). Providing sanitation related amenities along State or National Highways certainly does not come under its purview and this gap has been filled to some extent by other Government departments and agencies like the Ministry of Road Transport and Highways and the National Highway Authority of India (NHAI).

The Ministry of Road Transport and Highways has dove-tailed the sanitation component into their broader sector guidelines and in 2013, issued a set of guidelines/norms for access permission to fuel stations, private properties, rest area complexes and such other facilities along National Highways. The rest areas will have to provide a variety of amenities to road users including free access to toilets 24/7.  Further, in 2016, NHAI announced that, in line with the Prime Minister’s Swachch Bharat Mission, processes are in place to upgrade toilets in petrol pumps along the National Highway. The petroleum companies were also given a basic design to conform to and renovate. Further, proposals were called for setting up wayside amenities along National Highways across India using Public Private Partnership (PPP) (www.nhai.org) . These initiatives are commendable and definitely provides some amount of solace to the existing problem. However, it does not cater to all kinds of road users especially those who travel by public or private tourist buses that operate on their own terms and makes pit stops in stipulated motels/restaurants. So, what can be the solution to this cohort?

The most viable opportunity is to target motels and restaurants that dot all along the State and National Highways. These rest points offer to the tourists or travellers an opportunity to replenish and relieve themselves. Nevertheless, the toilets offered by these establishments are often dirty and insufficient with just one toilet for a busload of people. By identifying and mapping the existing motels or restaurants amenity-wise, the State or Urban Local Government can include them under the broader umbrella of a Sanitation Mission. This can include orientation and training of motel or restaurant owners on the need to provide and regularly maintain hygienic toilets. In order to motivate them to ensure a standard, the toilets in the establishments can be given a five-star ranking based on the level of cleanliness and usability of the toilet. The toilet star ranking can be then exhibited outside the establishment for visibility. In addition, the tourist logistic companies can also be roped in to educate them on ensuring that tourists are given a fair opportunity to use clean toilets. In doing so, they should be encouraged to choose motels or restaurants that have a toilet star ranking that is four or five.

Access to a clean and a safe toilet is a right for all and the responsibility to ensure accessibility rests predominantly with the National and State Governments. By re-defining urban spaces within the existing National Sanitation Policy, these oblivion toilets will serve its purpose to anxious travellers like me.

 

 

 

Reeba Devaraj
Senior Specialist, TNUSSP