In many rural parts of Pakistan, modern systems of sanitation are not available. Photo Credit: Cassandra Nelson/Mercy Corps

Until recently, Mohammad Nafees was like most children in his village when it came to relieving himself.

"I used to poop outside. Just over there," the nine-year-old giggled, pointing to the green field near his family's home in the mountain village of Kamra, about 70km east of Islamabad.

"We didn't have a latrine in our house. I thought everyone did that," he quipped.

His assumption about basic toilet protocol amongst Kamra's 1,871 residents is largely correct.

"You can't imagine how difficult it is for women," Zarqa Saeed, told IRIN.

Recently arrived from the urban sprawl of Rawalpindi to live with her in-laws, it took some time for her to get used to residents' ways.

"I had never gone outside in the open air," the 25-year-old teacher laughed.

No laughing matter

But in rural Pakistan open defecation is hardly a laughing matter.

Although modern toilets are plentiful across urban parts of Pakistan, basic latrines are less common in rural areas where about 65 percent of the country's 165 million inhabitants live.

"We didn't have a latrine in our house. I thought everyone did that," he quipped. His assumption about basic toilet protocol amongst Kamra's 1,871 residents is largely correct.

This in turn will impede the country's UN Millennium Development Goal of reducing by half the proportion of people without access to basic sanitation by 2015.

Close to 80 percent of households in Battian Union Council - where Kamra is located - have no access to functioning latrines, which means adults and children alike have no option but to defecate in the open.

Of Battian's nearly 10,000 inhabitants, only one in four has access to a toilet that works: Ending defecation in the open will need more than just building toilets - building awareness will also be key.

One local non-governmental organisation (NGO) spearheading that campaign is Pakistan's Rural Support Programmes Network (RSPN), based in Islamabad.

Since June 2007, the UK-funded RSPN programme has been working in three rural union councils in Pakistan, including Battian in Punjab Province, Samaro in Sindh, as well as Danyore in Pakistan's Federally Administered Northern Areas.

"The object of this programme is to declare a village open defecation-free by bringing about behaviourial change through mobilisation," Enayat Ur Rehman, RSPN's programme officer - health, told IRIN.

Old Habits Die Hard

But changing habits does not come easy.

Earlier efforts by groups to build latrines in the area failed largely because they did not include local residents in the building process, but also because they failed to point out to people the many health and financial benefits latrines can bring.

As a result, residents could not maintain the latrines or simply did not really understand their value - a fact RSPN was quick to pick up on.

Shame, Shock and Disgust

Part of RSPN's campaign to raise awareness is to develop a sense of shame, shock and disgust among local residents regarding their current toilet practices - in an effort to get communities themselves to understand the latrines' true importance and the solution.

Earlier efforts by groups to build latrines in the area failed largely because they did not include local residents in the building process...

Facilitated by social mobilisers from the community, residents visit those areas commonly used for defecation purposes in their village.

Once there, they are then asked to calculate approximately how much human excrement they might produce on a daily basis - an embarrassing, but revealing moment for all.

Assuming World Health Organization estimates that the average person can produce as much as 1.5 kilos of faeces and urine per day, Kamra's residents produce close to 3,000 kilos of waste daily or upwards of 20,000 kilos a week - all out in the open.

"Many of them had no idea how big a problem it really was - or the health implications," Ur Rehman said.

But with piles of excrement in Kamra's surrounding fields, the risk that germs could be brought back into their homes and find their way into their food, either on their shoes, or through other sources, including livestock or local springs from which residents drink, was soon understood.

Health Benefits

The residents were then asked for possible links with common diseases including diarrhoea, typhoid and malaria - and the resulting increased health costs.

"We simply weren't aware that these unhygienic practices led to diseases or that we could prevent them." -- Mohammad Arbi

"We simply weren't aware that these unhygienic practices led to diseases or that we could prevent them," said 58-year-old resident Mohammad Arbi, noting the importance of the moment and why he himself had decided to finally build a latrine.

But with permanent latrines costing nearly US$100 to build, many residents still complain they do not have the means to do so. RSPN provides technical advice as to how they can use cheaper local materials. A simple pit with a privacy wall and seat can cost as little as $5.

Impact

The campaign to stamp out open defecation - one community at a time - appears to be having an impact, despite some initial hesitancy.

It is also being replicated by the government in two other parts of the country. The community-led total sanitation approach, including open defecation-free and solid waste-free communities, is already part of Pakistan's national sanitation policy approved in 2006.

Since June most Kamra residents have dug temporary latrines, while others have made theirs more permanent.

"It's really accelerating now. It's as though we have an election campaign under way," said an enthusiastic Wajid Ali, one of the NGO's social mobilisers.

"I was able to dig the latrine myself," said daily wage earner Asad Mehmood. "Now I'm glad I did," the 26-year-old said, recalling how just a few months back he used to defecate in the open.

"It sure is easier now," he smiled.






Contributed by IRIN. Reprinted with permission from IRIN.

To read another Global Envision article about sanitation, see The Silent Sanitation Scandal.



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