Book review: The Last Taboo

14 04 2009

Most people want in the world somewhere safe, clean and private to relieve themselves of their body’s waste. Diseases relating to faeces (shit) contribute towards the deaths of an estimated 1.5 million children under the age of 5 every year. Many more suffer from cognitive and growth impairments due to worms and other parasites conveyed by shit, to use the clearest word available, and lost productivity due to faecal related illness costs the developing world 10s of millions of dollars every year. An estimated 2.6 billion people don’t have access to proper sanitation facilities (far more than don’t have access to clean water). And yet, according to “The Last Taboo” by Maggie Black and Ben Fawcett, sanitation is the poor relation in the development world, tagging along behind it’s more glamorous partner “clean water”, despite the fact that proper sanitation cuts off more of the routes of infection than clean water (demonstrated in the diagram below), and an easy way to clean up what water supply their already is to prevent human effluent from reaching the rivers etc used for washing and the water table the bore holes and wells draw from. The authors claim that this neglect stems from the embarrassment of officials and charities to talk about the issue.

F-diagram: Primary routes of faecal-oral diseasesThe thick black lines show which routes each intervention blocks

The issue is definitely worth discussing and learning about. My colleague Richard in Bolga discusses in this blog post what it’s like to teach in a residential school with 1,000 pupils and almost no toilet facilities at all. It is quite normal here to see people squatting by the side of the road to relieve themselves and the smell in some parts of town is dreadful. As a result I’ve become a lot more interested in the provision of sanitation to the poor.

As well as the obvious health issue of diarrhoea there are less obvious problems surrounding the issue of sanitation. One aspect I hadn’t considered before coming to Ghana is that the lack of clean, private and enclosed facilities is a major reason for the non attendance of girls in school, always important as boys and girls are becoming more self conscious but especially important for girls during their periods. Yet this topic seems to be rarely discussed when girl child education is discussed. Another educational impact is the effect that intestinal worms have; apparently one study in Indonesia showed that anaemia stemming from hookworm infestation reduced children’s working memory and could cause difficulties in reasoning and reading comprehension. It is estimated that 400 million school age children suffer from intestinal parasites every year.
“The Last Taboo” starts by describing the history of sanitation, describing toilets through history and then discusses the impact of industrialisation and urbanisation Britain (primarily London), including with Dr Snow’s linking water supply to Cholera in Soho, Bazalgette’s great engineering triumphs. They point out that it was the domestic demand for home improvement in the form of flush toilets that led to the increased pollution of the water supply as there was no infrastructure to take the effluent being created, the traditional night soil men were side tracked as the shit was flushed into streams or storm drains leading straight to the Thames. In 1858 the stench was enough to force parliament to pay for the sewer system, creating the assumption that water based systems with their associated (expensive) infrastructure was the only acceptable way of dealing with human effluent.
The book goes into a fair amount of detail describing the different types of systems that have been tried out, from community developed and maintained small bore sewers in South America via various “improved” latrines (including the “water flush goose neck” and the VIP ventilation improved latrine) to “dry”, “urine diversion” systems that convert faeces to fertiliser. It discusses the advantages and disadvantages of each step on the “sanitation ladder”, from the cat method (taking a small shovel with you into the field and burying it) up to western style industrialised systems with flush toilets, sewers and treatment plants. The authors acknowledge that different systems are appropriate for different communities, with the cat method (burial) probably best for poor, low density rural communities.
What comes out strongly throughout the book are the need for community involvement and ownership of projects, the creation of “demand” rather than the imposition of supply, the role of the local private sector in meeting the demand and providing other necessary services (such as the emptying of pits or the maintenance of other systems), the need to ensure the solution fits the culture and geography of the community and the need for facilities that are clean, safe and well maintained. The authors talk about the importance of removing the smell and unpleasant aspects of toilets before it is reasonable to expect people to choose to use them over the relative privacy and cleanliness of fields or beaches.
The Last Taboo is not a light read, full of diagrams, figures and references it is a bit more like a reference or text book at times but it is about an incredibly important subject, and is worth the effort needed to read if you’re at all interested in development issues.




2 responses

14 04 2009

excellent post, Tim. A complex issue and one we take for granted.

15 04 2009
Tim Little

Thanks Rick

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