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Africa: Health begins in the toilet and 2 billion people lack it | Future Planet

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When Mussa Sanha arrives in a rural community in the interior of Guinea-Bissau, he places a plate with feces and another with food in front of the congregated neighbors, almost always under the shade of a tree. It doesn’t take many seconds before the flies start to hover, going from one container to another. He then offers the food to be tasted by those present. “None wants. Because it contains poop ”. On the other hand, when he invites those who have not seen the previous scene, they accept. It does the same with water. Open a bottle and drink. Then he sticks a stick in the droppings and then dips it into the water. One wiggle and no one wants to consume it anymore.

DVD1050. Bafatá. Guinea Bissau. 19/04/2021

Photogallery | This is how a country is freed from open defecation

With this exercise, the director of the Association of Basic Sanitation, Water Protection and Environment (ASPAAB, for its acronym in Portuguese) shows the population the importance of defecating in a properly constructed latrine. So that the flies do not contaminate their food or the feces seep into the wells of the water they drink. Convincing them is not easy and usually requires several views, talks, exercises. This is what they call the awakening phase and then take action: having the neighbors build the toilets.

This process is what they have followed in Cansantin, a village that does not appear on the maps, 45 minutes by car on dirt roads from the city of Bafatá, where the NGO is based. In this remote place 11 families live in houses made of wood, adobe, cement, sheet metal and straw. Since the association’s first visit in March 2020, progress has been made: now they all have a toilet built by the residents with their own resources, without financial support, but following certain technical specifications. With local materials and labor, it costs them about 35 euros (22,500 francs), a fortune in a country where the minimum wage is about 145 euros (95,500 francs) and almost 70% live below the poverty line.

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“They have to be more than 30 meters from the nearest water source, to avoid contamination, and they cannot excavate more than two meters,” says Sanha while touring the already built toilets, checking if they meet the standards. “You have to put a lid on it,” he says to one of the neighbors and reminds him that the flies that enter there will be able to walk through their food later.

In the world, 2 billion people lack a toilet and 673 million people defecate in the open, of which 91% live in rural areas. A figure that going down, but that must be left to zero in 2030, as established in the sixth of the Sustainable Development Goals. In Guinea-Bissau (1.9 million inhabitants), 10.6% of the population relieves themselves on the street, in the forest, among bushes. The percentage rises to 16.2% in rural areas. Added to the lack of sanitation is the lack of safe water: 33% do not have access; rate that rises to 44.6% in non-urban areas of the country. These are the most recent data from the 2020 National Multiple Indicator Survey (MICS-6). Sanha and the other workers of the local NGO ASPAAB are fighting against these statistics. With the support of the European Union, and in collaboration with other international organizations such as ADPP (Humana) and the Portuguese TESE, they have nine million euros for a water, sanitation and energy project.

In the world, 673 million people defecate in the open, of which 91% live in rural areas

The normal thing is that in three or four visits the plan is completed from that first contact to the last follow-up to ensure that the built toilets are used regularly. A change in habits that is achieved with the support of neighbors who are involved in the task. They are local animators, in terms of the NGO. Ramatuldi Balde, 29, has five children and is one of the members of the village sanitation group. Your role is to chat with your family and friends about the importance of having and using the toilets. “I am proud that now everyone here has a toilet. For women, defecating in the open is dangerous. It is safer in a latrine and also when we have menstruation and we have to take off our cloths, ”he says. Now, says the young mother, the children have less diarrhea.

In Guinea-Bissau, 36.4% of children are stunted; after five years, the physical and cognitive consequences are irreversible

According to data from the latest Multiple Indicator Survey (MICS6) of the country, 8% of children under five years of age suffered from diarrhea in the two weeks prior to the survey, more than half did not receive any treatment or professional medical attention. Contaminated food and water, due to lack of sanitation, drinking water and hygiene, are the cause of this disease that can lead to a situation of chronic malnutrition or growth retardation. In Guinea-Bissau, 36.4% of children have a height less than the minimum for their age. After five, the physical and cognitive consequences are irreversible.

At worst, acute episodes of diarrhea can lead to death. It is not uncommon. This disease, which in the developed world is hardly an inconvenience and is easily treated with rehydration, is the second cause of infant mortality in the world. In 2019 alone, it killed 370,000 children. In the villages of Guinea-Bissau, in the capital’s medical centers and main hospital, it is not difficult to observe unwell babies, wrapped in cloths that their parents change when they get dirty.

Therefore, having a latrine is a question of health and survival, as well as security for women. So is having safe water. For the management of the fountains and wells in the villages, water committees are created, also composed mainly of women. Their task is to clean the enclosure, inform on how to transport the water, without putting branches or other objects that could contaminate it, and that they regularly wash the only glass that they usually have in the houses. “We are three with the same function, we clean; and a man who is the mechanic for the repairs ”, explains Taibu Balde, 58 years old. She and her companions were the ones who asked the men of the community to build a wall around the fountain so that the cows would not sneak in. One less source of dirt and germs. “Before the pumps, we had a well and a lake where today we wash and get water for bathing,” he recalls.

It is a tradition in some rural communities in Guinea-Bissau to offer water, stored in containers on the street, to travelers.  A practice that NGOs try to eradicate because it is a source of disease transmission.
It is a tradition in some rural communities in Guinea-Bissau to offer water, stored in containers on the street, to travelers. A practice that NGOs try to eradicate because it is a source of disease transmission.Alvaro Garcia

One of the pending tasks in Cansantin, indicates Sanha, is the promotion of hygiene habits, such as hand washing. Another of the practices that he wants to eradicate is the tradition of offering water, stored in vessels on the street and with a glass for consumption, to travelers. This is a custom of hospitality rooted in the peoples of the country and it will not be easy to convince them to abandon it, but neither is it impossible. Sanha will have to come up with a strategy together with the rest of the ASPAAB team.

Other towns of the 350 in which ADPP and ASPAAB intervene to promote sanitation and eradication of open defecation have not experienced favorable progress like Cansantin. “Some communities resist because they believe that defecating in the open is better. Sometimes after 15 visits we are unable to convince them to build the latrines, ”laments Sanha. This is the case of Bindur Dugál, half an hour from the city of Mansoa, in the Oio region. According to the NGO registry, 56 families live here in 71 houses (almost 600 people, of which 80 are children). The neighbors are from the Balanta tribe, who do not have chiefs, which makes dialogue with the community difficult. Animal pens are attached to houses and hygiene is poor. The houses in this group are usually very dispersed, in addition, with up to three kilometers between houses. A difficult intervention.

In one of their visits, Sunlite, one of the ASPAAB workers, explains to those gathered under the branches of a bissilon that the construction of latrines has health advantages, children will have less diarrhea and diseases related to food. Doing them will also qualify them as a village free of open defecation, an essential requirement to access other aid and development projects.

Julia Trapa, 22 and mother of two children, two and four years old, is part of the sanitation group. “Because the community is not organized; it has no cleaning and we need latrines. The water is not clean either. We have health problems ”, he justifies. After her husband died in March 2021 – “something big came out in his throat, then his body hurt and he died in the hospital”, sums up the widow, without regret – Trapa went back to studying. Every day, after preparing food and working on the cashew picking or selling things that she buys in the city, she travels five miles to school. “I am in 11th grade; It’s tiring, sometimes I go without eating, but I like it. I want to continue and be a nurse to work in the hospital ”, she details. Despite her health concerns, she has not yet built a latrine in her home. The concern is not enough and the young woman lacks time, support and resources.

Aulé Quandi, 25, a mother of two, has dug her toilet and has another one running “for visits.” She is doing it herself because her husband is very old and cannot. “I no longer study,” he laments. “But I feel good about being part of the sanitation group and talking to the community. It is good that important visitors come and it helps us to convince them that latrines are necessary ”, he says as he walks through his house showing the holes, cemented and with the gas outlet pipe perfectly installed.

“This is a non-subsidiary project; in previous editions we gave the materials, but it didn’t work. So we copied a model from Bangladesh: let them make it themselves with local materials, at little cost, and take responsibility. If they don’t support you to build a house or eat, why do they have to do it to build a toilet? ”, Asks Sayo Camarra, project manager for ADPP for the Oio region. Despite the adversities, with this model, “162 communities in Bafatá have abandoned open defecation due to the intervention of ASPAAB. It is a pride; We are recognized by the Government, Unicef, other international organizations. It is a pride ”, adds Sanha. The director of ASPAAB, who in his previous life was a mathematics teacher who one day decided that he could not look the other way, is proud of the progress of the program. And it does not shrink from the challenge posed by the opposition of some populations, where it returns again and again. Neither did Camarra: “In the face of resistance, we must persist and speak out.”

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