We do deserve better; I for one don’t particularly enjoy squatting in the bushes. The World Toilet Organization agrees, and sponsors World Toilet Summits and World Toilet Expos, “wherein all toilet and sanitation organizations can learn from one another and leverage on media and global support that in turn can influence governments to promote sound sanitation and public health policies.” They also started the first World Toilet College, providing training in toilet design, maintenance, school sanitation, disaster sanitation, and implementation of sustainable sanitation systems.

Okay, you can snicker now. I know I am.

This would be even funnier if it wasn’t actually serious — human waste is a major disease carrier if not handled correctly, and an awful lot of people are still just pooping on the ground or in the river. But let’s not dwell on negatives; in the carefree spirit of World Toilet Day, I thought I’d briefly discuss, and show some pictures, of the types of toilets I’ve encountered in various parts of the world. Travel yields many surprises, and, astonishingly, there were places where I had to learn to wipe my ass all over again. (“Don’t you know how to use the three seashells?” indeed.)

France
France uses mostly Western-style flush toilets, though they used to have many more squat toilets, and you’ll still encounter them in public washrooms outside of Paris. The Morlaix train station in Brittany– I remember it well. I was 19, naive, and on another continent for the first time in my life. I walked into the stall and might have actually said “what the fuck?” out loud when I saw only a porcelain basin set into the floor. That was a day of firsts: the first time I ever rode a high speed train, and the first time I ever experienced a toilet from another culture. The next day was no less revolutionary: I discovered a bidet in my cheap Paris hotel.

Thailand
Squat toilets, as is usual in Asia. However, no toilet paper. This was my first “three seashells” moment. The answer is that rubber hose connected to the faucet. Which is also why the floor is always wet, ewww. The squat toilet may  flush automatically with a lever or button; otherwise, you just run more water down the hole. Western toilets are nonetheless common in the cites and becoming more so, Public washrooms in, e.g. malls will have a combination of both western and squat toilets in different stalls, while fancier places such as nice hotels might have Western toilets only.

India
Not a good country for toilets. Almost universally squats, of course, and almost universally not the kind that flush. This a country all about buckets. The bathroom is a nasty little humid, smelly room where the floor is always wet. If there’s plumbing, there’s a faucet to fill the buckets, which are these days invariably cheap made-in-China plastic, typically red or green. In the really rural areas, there often isn’t plumbing. This means that someone has actually hand-carried the water into the bathroom for you, filling up the buckets at the river or the well. You better not use it all before tomorrow, lest you have nothing to flush with in the middle of the night. This precious water is also used for washing your ass and your wiping hand (the left) and also for bathing, which is performed by squatting on the floor and pouring water over your head.

Of course if you’re very poor (like several hundred million people in India) you just bathe in the river. Here are some people without toilets:

Indian Trains
I truly love the Indian train system. I do not love indian train toilets. Pee +  moving train = nasty. Also, the toilets are just holes onto the tracks. Between every pair of rails in India there are two stripes of old dried shit, one for the bathroom on either side of the car. Lest ye judge, European trains used to be engineered exactly the same way.

United Kingdom
No real surprises here, in the country that invented the water closet. However, you’ll still a lot of the classic elevated cistern design — works the same, but the tank is overhead. Cheerio.

Indonesia
In Indonesia we have the Mandi. The Mandi is a room, and it is also a cistern. The Indonesian bathroom is a small room with a concrete or tiled floor (fancy!) with a squat toilet set into it, and a big tiled cistern along one wall. This cistern, usually rectangular, is the Mandi proper. You extract water from it with a scoop, using only your clean right hand, and pour it over your backside and your wiping left hand. The geometry of this manuever confused me for weeks. Fortunately, I eventually found signs in a friendly tourist restuarant named “Bedudal” (click to enlarge and read the very helpful text)

Nonetheless, Western-style toilets are slowly appearing in Indonesia, and the locals are every bit as confused by this as a Kansas housewife facing her first bidet. The problem is the squatting habit: squatting on the seat of a Western toilet just leads to nasty. Also, the squat fixture is set into the ground and is a drain, so you just throw water at it to clean it, but this doesn’t work so well with a western toilet. The result is a mess, a stinking wet toilet seat that no one wants to sit on. It’s somehow reassuring to know that they’re just as confused by our bathrooms as we are by theirs.

Russia
Regular old Western-style toilets, and they use toilet paper. The only real hazard here is getting scowled at as you exit. There’s an inevitable old babushka who was waiting forever for that stupid foreigner to finish up. The Russians are not a happy people.

West Africa
There are squat toilets and western toilets and even the occasionally working flush toilet in the cities; outside of that, it’s buckets again. In the spring of 2007 I lived for a month in a little town in Northern Mali. The house was made out of dirt; let’s just start there. The bathroom had a little square stall in it, and once each day the woman of the house hand-carried water in buckets from the nearby well (only a few blocks). Like India, you squatted and poured water over yourself, and the “shower” drained through a hole in the wall directly onto the dirt street outside. The toilet proper was a latrine just outside the house; that is, a deep pit with a wooden lid over it, with a hole for pooping through.

Latrines are a relatively good arrangement, in that they are really quite sanitary. In many places, even in medium-sized towns, people just go in the river, like this man.

This sounds terrible, and it is– but even the sewage systems usually just dumped waste directly into the river. This would be bad in an industrial country, but it’s even worse when many people also bathe in the river. It spells D-I-S-E-A-S-E.

That Boat on the Niger River
I have to say that my favorite toilet ever was on a wooden cargo boat heading up the niger river. It was just a hole in the rear of the boat, by the tiller, but the view was marvelous, and there were two very friendly goats to keep you company.

Ethiopia
Ethiopia is not actually a desert, except for the eastern parts. Nevertheless, there’s not a lot of water. Per-capita daily water consumption is 20 litres, compared to over 200 for the United States. This means there’s not nearly as much flushing and washing going on as one would like. In the capital and the larger cities, water comes out of the tap. In smaller places, it’s typically stored in big cisterns filled every few days by the water truck. Everyone else carries it on their backs from the well. This, of course, is women’s work.

Anyway, toilets are squat type, where available. But rural Ethiopia is one of the poorest places in the world, and many, many villagers don’t have any toilets at all. Not even latrines. There are major development projects in this country just to dig latrines. This improves health by limiting the spread of disease, both by directly containing waste material and by reducing the number of flies, which are vectors for several unpleasant things (for example it’s suspected that they spread trachoma, which eventually makes you blind.) The required technology is not fancy by any means; a latrine is just a hole in the ground and a couple of  planks to squat over. Still, occasionally someone does get ambitious, dries clay in the sun, and constructs a genuine brick shithouse.

Oman
The usual developing world pattern: squat toilets, no toilet paper, wipe with your left. Then eat with your right! Like many ancient cultures, the traditional Middle East lacked both a) soap and b) utensils. This makes it very important not to confuse these two hands. And no, no one is left-handed.

Annapurna Base Camp, Nepal
Inside each stall was a pretty standard squat-with-bucket. But I have no idea where the water came from or where the poo went or how it was disposed of, because — here’s the thing — this at 4000 meters elevation, and the local temperature is well below freezing for most of the year. Ah, the mysteries of Nepal.

Japan
I’ve never been to Japan. My friend Nicole tells me that the toilets there break down into basically three types.

1. Squat toilet with flush
2. Western toilet with flush
3. Robot washlet

That’s right: ROBO-TOILET. I have no idea how this really works, but apparently it’s the height of comfort, sanitation, and good taste. Actually, it’s much more than style: toilet flushing is a major water consumer. Not only are low-volume toilets far more common in Japan, but some washrooms recycle the waste water from the sinks into the toilets. This is sustainability genius. It makes me absolutely certain that I live in a primitive culture, and so do you.

In conclusion
Toilets are important. Not only are they a critical piece of sanitation infrastructure, but many of the world’s toilets are exceedingly nasty. I’ve never bothered to photograph my least favorite toilets of all time, but that’s probably because I couldn’t wait to get out of there. We in the west with our flush toilets and toilet paper and sparkling shower stalls are the exception; the rest of the world thinks a bathroom is a wet, smelly place, when they have a bathroom at all. A good toilet means you probably have a very good quality of life, so enjoy yours. Happy World Toilet Day!

Apparently this was distributed to all J&J employees, perhaps in the hope that no one would sue for slipping on the immaculately maintained non-slip flooring. Let’s peruse, shall we? (click on any image for a bigger version)

Step 1: Watch your step! Humans are not naturally adept at level changes, because we evolved in the savanna, where it’s flat. Also, there are no stray power cords there.

Step 2: Height can hurt. As any mountain biker, knows, “going down is more dangerous than going up.” This is why there are non-slip treads on mountains.

Step 3: Health Helps! This man is exercising his arms so that he may walk safer. Also, you should not walk when you are stressed — after a bad day at work, it’s best to call a friend to come pick you up in a wheelchair.

Step 4: Don’t Do It! This one is really very reasonable, I think. There really could be a crocodile hiding in the grass. You know, in the savanna.

Step 4 again: Yes, there really are multiple pages on each one of these topics. Likewise, the authors felt it was important to discuss jumping down versus across. Sesame Street couldn’t have said it better.

Step 5: Wear the right shoes. In particular, wearing shoes at all is recommended. But I disagree — here’s to all our barefoot heroes!

Step 6: Hold on. Don’t ever carry something with more than one hand. That’s why we evolved with two: one to drag the zebra carcass, the other for the handrail.

Step 7: Fix it. It has long been known that the restroom needs to be closed with a “Caution: Wet Floor” sign until evaporation has made it safe to enter. Further, OSHA has now taken an interest in hazards in other phases, and is recommending labels on all objects in the workplace, with the standardized wording of “Caution: Solid Matter.”

The booklet concludes with the discussion “How Likely Are You To Fall?” on pages 38 and 39. Yes, that was 40 pages on how to walk. Whenever I’m feeling that the fall of Communism has the left the world with a shortage of absurdity, I like to imagine the production meetings for this book.

As an antidote, I present to you here a typical Southeast-Asian sidewalk, this one from Penang, Malaysia:

Note the many objects in the way of the sidewalk, which is bordered by huge gaping open sewers. Huge gaping open unsigned sewers! Nary a strip of caution tape in sight! Further, I assure you that just offscreen there are cars and pedestrians dancing senselessly, and a lack of good footwear. How do these people survive?

Actually, I find walking down the street in developing countries somewhat difficult, so don’t think I’m advocating for the open sewers approach. It’s just that– well, there’s got to be a balance here somewhere.

]]> http://jonathanstray.com/too-safe-too-funny/feed 3 http://jonathanstray.com/medicine-is-the-killer-app-for-technology http://jonathanstray.com/medicine-is-the-killer-app-for-technology#comments Fri, 08 Aug 2008 22:09:16 +0000 Jonathan Stray http://jonathanstray.com/?p=47 I’ve met quite a few people who feel that civilization was a mistake. Technology in particular, they say, is bad in some way. If they’re an anarcho-primitivist theorist, they’ll tell you it’s alienating: it creates hierarchies, produces psychological illusions of scarcity, and turns us into little more than specialized insects. If they’re less geeky and more hippie, they’ll just expound on how happy they were living in that rural Indian village, how spiritual that life was, how much more natural a world without technology would be.

In the bright Nepali sunshine, sipping chai in a tourist cafe overlooking the lake, I found I could not agree, no matter how cute the dreadlocked girl sitting across from me. I see a lot of idealism and projection in her arguments. I also see an iPod in her bag. But neither could I come up with a concrete reason to insist that technology is fundamentally good, that the human race should invest as heavily in technology as it has. I admit that I really enjoy both the intellectual playground of technology and the fruits it brings, but that’s no way to form a moral imperative.

Until Ethiopia. I was working on a trachoma epidemiology study. This is an ancient, simple disease, and so fragile that the merest hint of civilization will destroy it — we’re not quite sure why yet. It could be antibiotics used for other things wipes it out, it could be that just washing your hands daily in clean water prevents its spread. But if left untreated long enough, this feeble disease will make you blind.

I had the cliché moment. I hiked out across the roadless wilderness to that idealized little village, that tiny traditional portion of the way we used to live. The simple folk gathered round us, gazing strangely at our white skin and synthetic fabrics. In turn we stared at their traditional cotton garments and coarse shiny jewelry, artifacts of a society that makes everything with its own hands. We stood a moment in that field, contemplating one another across vast distances of education and context. Then I looked into the scarred corneas of a blind young man and felt suddenly: this sucks. This man cannot see, for no reason at all. Extremely simple medicine could have prevented that.

It’s one of those moments when you realize that you’re not okay with the world as it is.

Medicine is good because health is good. I see no other way to draw this conclusion. And medicine is technological. Antibiotics are in no sense natural, x-rays and heart transplants less so. Medicine is the moral justification for continued technological development and dissemenation. It’s the killer app for technology, because it’s not just medical technology that must be known: modern medicine requires an entire technological infrastructure to design and manufacture its many, many inputs. Computers. Polymers. Superconducting magnets. Refrigerators to make the ice to keep cold our collected samples, and enzymes to do the PCR to detect the trachoma DNA, mathematics to do the statistical analysis to determine if our mass antibiotic distribution is actually denting the epidemic. It takes a world to raise a hospital.

That’s the moral reason for continued technological development. That blind man. Go tell his mother that we’d all be happier as hunter-gatherers.

Of course, that’s not why we actually will continue to develop our technology.

In the late afternoon sunlight I lounged against a tree, waiting for the last few villagers to show up so we could test them. They had fed us some (traditional, natural, idealized) beer, and I was sleepy and idle. I extracted my MP3 key from my kit and put the headphones in, leaned back to something relaxed. A kid came up to me, looking expectantly. He must have been about twelve.

“MP3 player?” he said.

“Yeah,” I replied.

“How many gigabytes?” he asked. Then: “I want one.”

I find it hard to disagree with him.

No big surprise here — the the citizens of richer countries do eat more food. The interesting thing is to ask what the actual numbers mean, in terms of health. Simply put, people living in the developed world eat way too much. Oddly, this might mean that the current poor will one day be healthier than the formerly rich.

On this map, white means 3400-3700 calories per person per day. The US Health and Human Services Dietary Guidelines 2005 includes a rather sophisticated chart recommending average daily caloric intake for men and women of different ages and levels of activity, but the maximum value on it is 2800-3200 calories/day for a teenage male who walks more than three miles per day. By comparison, the average sedentary 35 year old woman needs just 1800 calories per day. This means that many people in America must actually be eating twice as much as they need.

There are epidemic health problems with this, obesity and its consequences (heart disease, diabetes) being the most obvious. But there is a less well-known advantage to eating less: it might make you live longer. In 1935 it was discovered that rats kept on a very restricted diet lived 30% longer, four years instead of the usual three. Since then it has been established that that “calorie restricted” diets increase lifespan in mice, dogs, and, in the last few years monkeys. There is still no direct evidence that eating less will make a human live longer — that will take decades — but the early results of small, short term studies are highly suggestive that it will.

And yet all those underfed people in Africa are dying sooner than well-fed whites, as this map of global lifespan shows.

Contrary to research, you can see that global lifespan is more or less highly correlated with caloric intake. Why is this? One longevity researcher notes that “In experiments of nature, humans have been subjected to periods of nonvolitional partial starvation. However, the diets in almost all of these cases have been of poor quality.” In other words, there is a difference between eating less and starving; besides which, we rich people have access to all the wonders not only of modern medicine but of simple public health infrastructure, such as clean water.

Still, it’s not hard to imagine that one day, Africans etc. will be able to eat “high quality” diets and drink clean water. What then? Perhaps the formerly poor of the world will follow us into gluttony just because they can. Or, perhaps their frugal eating habits will persist, raising the strange possibility that the citizens of the developing world will actually begin to outlive us.

But I doubt it. While data from India over the last several decades actually show slight decline in overall per-capita caloric intake, the richest 30% of the population is definitely eating more. Like people, nations usually have to make all their own mistakes before they learn.

By comparison, a recent French campaign talks about sex as if it were a good thing, with their “Explore — just protect yourself” series:

This poster is really quite an exceptional piece of art, and well worth examining at full size (just click.) Additional information can be found here.

(Image and data from theglobaleducationproject.org.)

Drinking or bathing in biologically contaminated water — say, from a river that the villagers upstream defecate into every morning — causes serious disease epidemics. It seems ridiculous that large numbers of people will die this year from diarrhea, but they will. All the travel guides tell us not to drink the local water, but the locals have no choice.

So a village-scale UV water disinfection system seems like a great idea. Such a system kills pathogens by exposing water to strong ultra-violet light from a special bulb. It’s cheap, simple, reliable technology. One can imagine building the device out of rugged materials, and just for good measure powering the whole device with solar cells. Hand it off to the grateful villagers, count yourself lucky to have been able to help, and go home smiling. But it wouldn’t work.

What happens when the bulb needs to be changed? Where do you get a new one? From whom? Who pays for it? What about maintenance generally? Who is trained to repair such a thing? With what materials? Why would they bother repairing it at all? Does the designated repair person actually appreciate the link between dirty water and disease? Does the community? Is the machine going to be cannibalized for useful parts such as batteries? Who is responsible for running it? Will it rust in the monsoon rains/corrode in the the desert dust/rot in the the jungle damp?

We in the developed world may see that water purifier as a simple machine, but in reality it is a machine that is supported by a vast network of infrastructure and institutions. Any developed country can easily manufacture the needed parts — light bulbs and pumps, basically — and further, has a vast educated workforce of persons who already know how to use a screwdriver. In rural Africa, the population may be mostly illiterate and is certainly mostly uneducated, and probably has very little in the way of tools — as a reference point, I noticed that the typical rural household kitchen in Mali contains exactly one big bowl, one wooden spoon, and one rusty knife. Even more crucially, a water purification machine relies completely on the idea that clean water is important. A village of very poor people who were never taught the germ theory of disease in elementary school probably do not see water disinfection as a priority.

There can be even more fundamental misunderstandings of world-view on the part of those who wish to help. In order to actively participate in a water purification project, the target population must first believe that change is possible through their own efforts. In our hyper-entrepreneurial society, it can be difficult to understand how dis-empowered the members of certain societies, cultures, or social groups feel. Sometimes this is even justified through religious fatalism: we will have clean water, if Allah wills it.

I do not have many ideas about how to deal with such dis-empowerment. What I can do is point to a few developing world technology projects that seem to be successful at the village level. For example, a foot-powered water pump sold throughout sub-Saharan Africa, as advertised in this signboard from Mopti, Mali:

The “Moneymaker” pump is a product of KickStart, a non-profit dedicated to the “tools to end poverty.” It is simple, robust, and specifically designed to be manufactured in Africa; KickStart even trains the manufacturers. The pump also appeals to a need that needs no explanation in the local culture: the opportunity to make money by growing and selling vegetables. Public health will be harder to promote; it will require far more than good technology.