
India Is Winning Its War on Human Waste - gauMah
https://www.gatesnotes.com/Development/Indias-War-on-Human-Waste
======
avar

        > Unfortunately, in many places, it’s not
        > feasible to lay down sewer pipes or build
        > treatment facilities. [...] But giving
        > people access to toilets isn’t enough. You
        > also have to persuade them to use the
        > toilets.
    

I can't find it now, but there was a news video making the rounds a year or
two ago that showed that this problem is much more fundamental than that.

It showed a Indians in a tiny village who were falling ill because they were
literally taking a shit in the same river that they were getting their
drinking water from, just a few meters away.

These people all knew each other, and even if they didn't have any toilets or
basic infrastructure I would have thought that something as basic as "if you
shit where you drink, you get cholera" would be common knowledge anywhere in
the world by now.

Of course it would have been nice for those people to have sewer pipes,
toilets etc. But in that case the problem could have been solved with a few
shovels, and a marked area indicating where you should be going to do your
business, preferable in some open field far from the drinking water.

For those people toilets would be nice, but unnecessary. They clearly all have
a shared interest in not drinking each other's shit. If by some magic they
aren't aware that mixing shit with water leads to bad consequences that seemed
to be solvable by some one-time government presentation on the consequences of
them keeping doing what they were doing.

But somehow the problem persists, it's unbelievable.

~~~
staticassertion
The first or second chapter of Diffusion of Innovation covers a case where a
health organization official tried to convince people to boil their water. No
one did it. The concept of "germs" was so foreign to them, and their beliefs
about water were already so ingrained. It was a complete failure.

It seems obvious to say "if you drink dirty water you will get sick" but
you're assuming that people can make so many connections - what makes it
dirty? What makes you sick? What is illness?

In many places there is no connection between 'germs' and illness because
germs are not a concrete concept to them.

~~~
sidlls
People understand just fine what "illness" is. Every culture has a long
tradition of medical practice since long before anyone knew what a germ was,
and people in many civilizations (this isn't some eurocentric western-world
thing) have known for hundreds or thousands of years to keep feces away from
their food and water.

It seems obvious because it is obvious and has been, in India and practically
everywhere else, for centuries.

What the parent described is probably due to other external factors (e.g. lack
of choice, land restrictions or other things) that constrain behavior.

Edit for further clarity: it's unlikely these people are all "too stupid" to
realize what they're doing is not healthy, but that there are other factors
making it a (perceived) better choice than others (which may be perceived as
worse).

~~~
gumby
>> In many places there is no connection between 'germs' and illness because
germs are not a concrete concept to them.

> People understand just fine what "illness" is. Every culture has a long
> tradition of medical practice since long before anyone knew what a germ was,
> and people in many civilizations (this isn't some eurocentric western-world
> thing) have known for hundreds or thousands of years to keep feces away from
> their food and water.

The germ theory is relatively recent and was not readily accepted in Europe.
And for that matter _Europe_ was very late to adopt a theory of keeping faeces
away from their food and water.

Traditional Brahmanism in India is extremely fastidious. Sadly by connecting
the practices to caste they did not become widespread among others.

Your sense of obviousness is inconsistent with the investigations of history
or sociology.

~~~
thevardanian
You have Indians invent small-pox vaccination techniques which clearly shows,
at least to some level, an understanding and acceptance of the idea of "germs"
albeit something more basic.

Furthermore trying to tie everything to caste related issues will cause more
harm than good, as it is popular and easy to blame a simple demon the truth is
often more nuanced.

~~~
gumby
> Furthermore trying to tie everything to caste related issues will cause more
> harm than good, as it is popular and easy to blame a simple demon the truth
> is often more nuanced.

How true that is, and I agonized over how to word the end of my comment to
avoid overstating/ misstating / offending / hitting peoples' hot buttons (pro
or con). However I think there's an essential truth somewhere in there, and I
chose the word "fastidious" because it is more clear than incorrect (and
emotionally laden) words like "better" / "cleaner" etc. In fact "fastidious"
can even have some slightly negative implications.

But to be realistic: my Brahmin grandparents and great grandparents (born in
1800s!) & family all lived well into their 90s as long as they survived
childhood. My anglo grandparents and great grandparents (also born in 1800s)
were lucky to survive childhood and make it to their 50s, much less past that.

The note I was responding to claimed that Europeans had the germ theory and
anyone who did something bad for their health was willfully ignorant and
stupid.

~~~
sidlls
That wasn't my note you were responding to, in that case. In fact it was the
exact opposite in meaning to what you suggest.

------
nojvek
Two of the most forward thinking folks I believe are Bill Gates and Elon Musk.
While Elon wants to carve way into science fiction, Bill wants to ensure no
one gets left behind. Exciting time to be alive.

In this case big kudos goes to Narendra Modi and the Indian govt to ensure
this happens. I believe such fundamental things are the most effective when
govt pushes for it rather than individuals.

~~~
lern_too_spel
You can't carve away at science fiction without the human capital to do the
science. Lifting huge populations out of disease and poverty is going to have
a larger effect on scientific progress than spending money on directing the
few who can do science right now.

~~~
oblio
I think you were a bit too negative but I don't agree with your downvotes.

Back to the topic: I agree with you. I think people underestimate, especially
in the current Trumpist/Brexitist/etc. climate, the long term impact that
lifting ~4 billion people out of poverty will have. By 4 billion people I mean
China, India, Africa.

China's probably 20 years away from having 30% of the world's middle class in
their country. India will probably follow the same trajectory, only with a 40
year delay. Africa is lagging but even there things seem to be moving and my
money's on things accelerating as soon as they get some strong regional poles.
Nigeria, Kenya, Ethiopia seem strong contenders.

~~~
lern_too_spel
I don't see my comment as negative. Both are good, but one is going to have an
order of magnitude larger effect on scientific progress than the other.

To say that the effect of Gates's work will be to merely bring more people
along for the ride instead of getting left behind as the original commenter
stated is not understanding the full effect of his work. Gates is accelerating
the ride.

------
blhack
It's outlined in the article, but I think it's worth saying again: the most
difficult part of what they're doing seems to be getting people to change
their habits.

It's the same psychology involved in pollution and climate change. Because
people don't see an _immediate_ reaction to for instance plastic-pollution,
it's harder to get them to understand the serious effects that it is having.

~~~
johnnydoe9
Yeah they're doing great work but I've actually met people who told us they
didn't want to use the toilets because they couldn't "build up the pressure"
in the cramped space since they are used to the open fields since decades.

This is going to take a long time but they're actually doing a pretty good job
at installing toilets that's for sure.

~~~
blhack
I wonder: has anybody tried building a squat toilet that is out in the open
without any walls around it?

That might help with some of the habit changes required. Just give people
exactly what they are asking for.

------
sytelus
The reason toilets don't get used even when available in India is that Indian
version of toilets are not very maintainable. First every one needs to get
water from somewhere and carry it all the way with them to toilet. If water
turns out not to be enough then toilet retains the waste, start becoming
smelly and unhygienic. Also because of extensive water use, its unpleasant
place to walk around. Toilets with flushing system uses 1950s mechanical
system and often breaks down easily or gets plugged easily with no way to
unplug it unless maintainer comes around (who often doesn't exist).

So the basic problem is Indian toilet tech and the whole process has not been
evolved. In Western world and especially places like Japan, there are lots of
people working on innovations in this area and things keep improving. In
India, this area is considered to be assigned to lowest members of social cast
system and thinking about it or working on it by intellectuals is considered
taboo.

~~~
aianus
Why can't they use outhouses? They're just holes in the ground (very little
maintenance, no requirement for plumbing) and far better than shitting out in
the open or in a potable water source.

~~~
CydeWeys
Outhouses fill up very quickly with lots of people using them. You need
regular service with someone picking up the shit. Exactly like Port-a-Johns,
really.

------
linux_devil
This village in India is the cleanest village in asia, sharing one article:
[http://www.bbc.com/travel/story/20160606-the-cleanest-
villag...](http://www.bbc.com/travel/story/20160606-the-cleanest-village-in-
asia)

~~~
prawn
The article talks about various people contributing to the regular cleaning. I
think one solution to the developing job/motivation crisis is some sort of
Civilian Conservation Corps providing a base wage to people in exchange for a
few hours each week of easy, non-essential work contributing to the general
decency of a locale. Pruning, sweeping an area, weeding a verge, removing
litter from a roadside. The sort of work you see gardeners doing at dawn
throughout Asia, especially in resorts.

There could be many older men for example keen to have a sense of purpose,
doing a task they're capable of and staying active, rather than putting in 40+
hours/week at a desk.

------
walrus01
I recall seeing a video of a property owner who has a piece of land with a
long, approx 2.5 meter height wall facing a street in a suburb of Delhi. He
had a significant problem with the wall becoming an unofficial "designated
pissing wall" and the whole place reeked of urine. Problem was solved by first
power washing the wall and then hiring a few local mural painters to paint
images of various Hindu gods (Hanuman, Ganesh, etc) on the wall. No more
pissing problem.

------
arcticbull
Based on my walk to work along Mission street, I'd say we've got something to
learn X_x

~~~
perfectstorm
seriously, i exit at Powell station and the amount of shit and piss i smell
every day is unimaginable.

------
vthallam
Glad this initiative is working. The Indian govt emphasizes on this very
frequently and I am surprised to see this dashboard:
[http://sbm.gov.in/sbmdashboard/Default.aspx](http://sbm.gov.in/sbmdashboard/Default.aspx)

~~~
cholantesh
Hah; my workplace has a firewall rule for connections to India. Seems bizarre.

------
agustamir
I hope that all these toilets being built are actually being used, serviced
and maintained by the people of the community. I have seen TV reports where
these toilets were being built to achieve targets and end up being either
filthy because no one maintained them, or used as storage(?). This, along with
a massive awareness drive(the govt has some ads running on tv) to push people
towards using these toilets. Many challenges ahead, and I can only hope for
the best for the motherland.

~~~
indogooner
Unfortunately your fears are not unfounded. I have been to a village which is
supposed to be model village for the constituency (adopted by the ruling party
legislator). Open defecation has not reduced significantly. The toilets built
are in a deplorable state and if people are not using them it is
understandable. I think the public is also to be blamed for this but if the
legislator can't introduce/inculcate mindset change in just one model village
in their constituency it is not encouraging.

------
thowbit9
This has nothing to do with building toilets. Its with education. The northern
parts of India has very low literacy rate. High literacy + HDI states like
Kerala and Meghalaya was already clean. The dashboard of 2014 data proves
that.

~~~
burkaman
If you don't have a toilet, how does learning how to read help you not poop in
the open?

~~~
thowbit9
Because learning makes people less stupid in our part of the world.

~~~
burkaman
They literally don't have a toilet. Are they going to conjure one if they
become smart enough? I understand there's an issue of people not using them
once they have one, but step one is getting a toilet, and step two is
educating people enough to want to use them.

~~~
sirclueless
I'm not so sure. Step 1 is making sure people want a toilet. If you give
someone a toilet without their understanding its purpose, it is going to be
neglected and considered pointless.

If people want toilets, they can spend some free time to dig a big pit in a
nearby yard, and it will be more sanitary than their current situation.
Ultimately the two go hand in hand (toilets and education) but education
without toilets is a problem that solves itself, while toilets without
education is doomed to fail.

~~~
burkaman
Well, that's not the goal they're talking about: "There are two keys to
achieving the targets of Clean India. One involves giving everyone access to a
well-managed toilet, which means all the waste is treated (either on-site or
in a treatment facility) to remove the pathogens that make people sick. It’s
crucial to get the entire process right, from containing the waste in a toilet
to collecting it, transporting it if necessary, and treating it. If one link
in the chain fails, people still get sick."

Anyway, the original comment here, "this has nothing to do with toilets",
still doesn't make sense. High literacy states aren't clean because of
education, they are clean and educated because they aren't poor. And we all
agree that education and toilets go hand in hand, the article addresses this.
All I was responding to was the idea that toilets are irrelevant, which is
ridiculous.

------
thowbit9
Wow very proud of my state Kerala which looks the cleanest. Kerala always
stands out from rest of the India in all positive aspects.

------
blobbers
India is Winning Its War on Human Waste!!!

... unfortunately San Francisco is losing that same war.

~~~
adventured
Or you could be intentionally exaggerating the problem by about 100 fold.

Perhaps you'd like to show me the stats that indicate a million people (or
even how about 2.5% - ~100k people) in the San Francisco metro area have begun
shitting in the streets, in their drinking water, etc.

~~~
adamkittelson
Or we could explore the possibility that the acceptable amount of human feces
on the streets of a major city in a first world country is none.

~~~
droopyEyelids
You can't reliably tell the difference between human and other omnivore feces,
and there are always going to be coyotes pooping wherever they please.

Gotta accept a bit of poop in your life.

~~~
GeneralMayhem
There's not a lot of coyotes in downtown SF...

~~~
droopyEyelids
[http://www.sfgate.com/bayarea/article/San-Francisco-
coyote-f...](http://www.sfgate.com/bayarea/article/San-Francisco-coyote-
filmed-playing-with-ball-9132048.php)

> Record numbers of coyotes have moved into the city in recent years.

------
jwilk
Archived copy, which can be read without JS enabled:

[https://archive.fo/V1Vtq](https://archive.fo/V1Vtq)

------
criddell
I love UNICEF's approach:

[https://www.youtube.com/watch?v=_peUxE_BKcU](https://www.youtube.com/watch?v=_peUxE_BKcU)

------
Taylor_OD
Only 1.7 million people die from unsafe water? That's a lot less than I
thought. It's still a awful and fixable issue but not as bad as I thought.

~~~
danans
I'm sure a much larger number get seriously ill, but don't die, so the
potential for quality of life improvement is even bigger.

------
theprop
This is probably the single best way to reduce rape in India as well. I
remember in one Indian tv serial episode, the plot was a woman who refused to
marry a man (in a village) until he got indoor plumbing in the house so she
didn't have to go to a field at night to use the bathroom.

India was one of the first countries in the world to emphasize regular bathing
-- this was thousands of years ago, even the kings among the Europeans started
bathing daily fewer than 300 years ago. We need to get hygiene country-wide to
the world standards it created.

------
pm90
Heh, I think Gates might have inadvertently DDoS'd the dashboard detailing
toilet coverage in Rural India. I won't post the link here but its at the end
of the article.

------
jsudhams
I have had and have two issues in my village especially for poor.

1\. Keeping the toilet in home, this is no issue(99% of my village is fine
with it)but having exhaust and running it is still an issue 2\. Running water
with pipe , if you ask a must if you need good toilet. A big issue for 6
months in our village so able people built storage tank , pump up water when
water comes in pipe from village tank but for the ones who keep in vessels ,
it is big issue 3\. Space for septic tank, in many plots house is built on
full land available to them so no more space for septic tank 4\. Last but not
least, if you have issue septic there is not a possibility to clean like in
city using that special lorry that come with pump and tank

If govt can do something about 2/3/4 then it is possible to have more toilets.

------
rajitdasgupta
I'd say take this data with a healthy pinch of salt. I have friends currently
working in conjunction with the Health and Sanitation department who say that
the ground reality is very different.

As someone else noted in another thread, toilet maintenance and water
availability continue to remain a very real problem.

The dashboard data reflects only the number of new toilets being built (and
their corresponding 'expected' coverage). This doesn't take into account how
many of them are actually being used as toilets.

In some districts in Uttar Pradesh and Haryana, less than 1 out of 15
households actually use the newly built toilets. Elsewhere, they have already
been converted into mini-grocery stores and storage facilities. All these
instances are being conveniently ignored.

------
danellis
I guess I'm confused as to why this is only a problem for women and girls. Are
there toilets that the men use that they don't let the women use? Or is it
that Indian men don't have a problem with themselves defecating anywhere?

~~~
skbohra123
Mostly because open defacting creates other issues for women, like sexual
harrasment, rape etc.

------
Abishek_Muthian
It's worth to note that to fund the Swachh Bharat mission business in India
are contributing 0.5% towards it via service tax on every bill. It's a
collective effort of public-govt-private partnership.

------
Myrmornis
The Ethiopian countryside along main roads (Oromia and south of there) seems
to also have acquired a lot of public toilets in the last 5 years.

------
dafrankenstein2
then finally its happening? once we heard that India has more phone users than
toilet users.

------
baron816
Wait, did Bill Gates really go out to the train tracks in India and film
people pooping?

------
Pica_soO
The thing that strikes me as the most odd - is that until ww1 (thats right the
recent Battlefieldified one)- soldiers would carry talismans into the battle,
that where supposed to make them bulletproof and immortal. Thats right,
something that sounds oh, so exotic, right in the midst of the west.

Also, it helps if you look at the Congo and Europe during WW2. The same chaos,
the same refugee rows, the same anarchy and murdering. Noting is written in
stone.

~~~
toomanybeersies
If someone's shooting at you, you're going to make damn sure you take every
measure possible to not get shot.

There are no atheists in foxholes.

~~~
vacri
However being in a foxhole is an entirely artificial situation, and people in
foxholes aren't known for their long-range planning and forethought. If you're
being shelled, you're not going to be thinking about whether you can service a
new mortgage and whether you should refinance, for example.

~~~
Pica_soO
I wonder, if you put a mathematician specializing in statistics into a
foxhole, what are the odds he becomes a believer?

------
zerop
Narendra Modi, a person who can change things in India.. Because he knows
Sankhya.

~~~
nindalf
That's not a very helpful comment considering that most people on this forum
wouldn't be familiar with that concept. For those trying to decipher this,
he's referring to a school of philosophy.

It's quite silly to say that anyway, because a person's thoughts on philosophy
rarely predict how good they would be at passing legislation and working with
bureaucracy.

> Ruling is hard. This was maybe my answer to Tolkien, whom, as much as I
> admire him, I do quibble with. Lord of the Rings had a very medieval
> philosophy: that if the king was a good man, the land would prosper. We look
> at real history and it’s not that simple. Tolkien can say that Aragorn
> became king and reigned for a hundred years, and he was wise and good. But
> Tolkien doesn’t ask the question: What was Aragorn’s tax policy? Did he
> maintain a standing army? What did he do in times of flood and famine? And
> what about all these orcs? By the end of the war, Sauron is gone but all of
> the orcs aren’t gone – they’re in the mountains. Did Aragorn pursue a policy
> of systematic genocide and kill them? Even the little baby orcs, in their
> little orc cradles?

> George R R Martin

------
thowbit9
What I see and hear from the people on the field is that Narendra Modi is a
show man with no stuff. Dashboard looks cool, but those toilets built are not
maintained and is in the verge of wreck.

~~~
intended
A long my time ago, a steel company installed toilets in Orissa (I hope I'm
recalling the conversation exactly). They've just fallen into disrepair.

People didn't use them.

This is a habit change that has to be completed, once that happens, a lot will
change on its own.

~~~
thowbit9
There was an initiative in the state of Kerala for bio portable toilets with
solar powered light. I saw one or two in the Cochin city which uses a 1 rupee
coin to open the door.

The problem with these initiatives is that they are all politically motivated.
Once the ruling parties get the necessary PR around it, the funding is
stopped. Modi is no different. There is no reason to laud Modi for this. The
previous governments have also done this though with a less "catchy" names
with no PR.

~~~
vthallam
> The problem with these initiatives is that they are all politically
> motivated.

So what's your plan? Stop trying?

>The previous governments have also done this though with a less "catchy"
names with no PR.

Come on man. Hate Modi all you want and there are few reasons, but this is not
one. He is trying to get people accountable, at least talking about the issue.
You don't even understand the buzz a topic creates if PM of 1 billion people
repeatedly reminds us about the importance of sanitation.

I don't want to start any objective discussion with a throw away account, so,
I'd say keep an open mind.

------
jarmitage
Read the comments of this article.

I think the 'poor' of India should be telling Bill Gates where to shit and not
the other way around.

------
noiv
Request to de-weaponize the title.

War should denote humans fighting humans only - not humans fighting physics.

~~~
function_seven
It sounds like you’re waging a war on metaphor. And losing.

~~~
noiv
Well, nothing against metaphors, but 'war' is really not a pleasing one and it
isn't useful either since truth is its first victim. Why using a title forcing
the reader to assume bullshit follows.

