Wednesday, March 25, 2015

Triggering disgust to save lives

By Anne-Sophie Galli
“Do you want to eat your neighbour’s poo?” Children participating in a ‘triggering session’ are disgusted to hear how their food and drink can be contaminated as a result of open-defecation.
© Ministry of Rural Development/2010   
KAMPONG THOM, Cambodia, 25 March 2015 – “Do you want to eat your neighbour’s poo?” asks UNICEF WASH Specialist and facilitator, Heng Santepheap to a group of community members. Everyone looks at him in stunned silence as he puts a plate of rice on the floor next to a pile of human faeces. Soon flies are swarming around the food and faeces, flitting between the two. Nearby, a chicken steps into another pile of poo and then steps into a house. “This is what happens every day”, says Santepheap. “And it won’t stop unless everyone works together.” The villagers then find their voices and start chattering all at once, commenting on what they have seen.

Santepheap, as a group facilitator, is leading a ‘triggering session’, a core activity in the implementation of community-led total sanitation (CLTS) which mobilises communities to eliminate open defecation. (OD). ‘Triggering’ aims to ignite a collective sense of disgust and shame among community members as they understand the negative impacts of open defecation. The session prompts them into building their own toilets, maintaining, using and sharing them with families who cannot afford to build their own. This has proved the most efficient way to stop diarrhoea.

According to a recent census, 61.5 per cent of Cambodians living in rural areas practice open-defecation: one of the highest rates in Southeast Asia. Open-defecation encourages bad hygiene and spreads bacterial diseases like diarrhoea, which is the second biggest killer of children under 5 in Cambodia. Every day, an estimated 50 children under 5 die mainly from preventable diseases like diarrhoea and pneumonia. Furthermore, when a child falls ill, their body cannot absorb nutrients adequately which leads to poorer brain development. They are also more likely to drop out of school because they miss too many classes when they are ill.

Villagers map their community indicating with leaves all the places where they defecate.
© UNICEF Cambodia/2010/Heng Santepheap
Open defecation due to lack of access and awareness 

The main reasons why many Cambodians defecate outside is that they have no access to latrines and they are unaware of the impact their habits on their health, their families and the community. CLTS recognizes that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. However by facilitating communities to conduct an appraisal and analysis of the situation, they initiate their own actions to become open defecation-free.

UNICEF and the Cambodian government, with funding from the German National Committee for UNICEF, are supporting the training of more and new facilitators like Santepheap to organise information sessions in other villages throughout the country to educate both adults and children about the dangerous impacts of open defecation.

After the triggering session with a well-trained facilitator, most people are motivated to stop open defecation by building a toilet or sharing one. Children develop posters citing reasons why they want a toilet which they present to their parents. After the session, many children also plead with their parents to build a toilet. Some have been known to spontaneously kneel before them begging not to be put at risk of eating other people’s faeces: an appeal which has been known to make some mothers cry.

After the information session, children create posters to say why they want a toilet. Among the messages: ‘Mother, father, please build a toilet for us,’ ‘Mother, father, please stop open defecation,’ ‘Have a toilet, have dignity,’ Have a toilet, have good health.’
© UNICEF Cambodia/2012/Heng Santepheap
“We want to stop open defecation,” say villagers who have decided to build a toilet after an information session.
© UNICEF Cambodia/2010/Heng Santepheap
Lives transformed

One family in Svay Kal village, Kampong Thom says their lives were transformed following a triggering session in 2007.  As Mr. Sok Chin (46) explained, “Finally I found the reason why my children had diarrhoea all the time, missed at least one week of school per month and had bad grades,” said the father of three. Although he only earned US$5 a day as a farm labourer, he decided to invest a day’s wage to buy corrugated iron to build a latrine that he completed using found materials - palm tree branches, wood and cloth - using instructions provided during the information session.

The latrine has served the family and 12 neighbours for seven years. Sok Chin’s three children are rarely ill, two of them have finished school, one has found a job in a hotel in Phnom Penh and his youngest is getting good grades in primary school.

Sok Chin (left), his daughter and some neighbours look to see if their latrine is clean before a toilet control volunteer comes for a monthly check.
© UNICEF Cambodia/2014/Anne-Sophie Galli
Sok Chin makes sure that his three children always wash their hands with soap after using the toilet.
© UNICEF Cambodia/2014/Anne-Sophie Galli
To ensure that the toilets are used properly, UNICEF-supported CLTS training encourages each village to establish a team of five volunteers who check all toilets every month and help to repair the broken ones. "Sometimes I need to remind people to cover their poo with enough ash [that way] the latrines don't stink," said Yong Heang, village chief from Svay Kal village and a toilet control volunteer. Heang himself has a more advanced flush toilet, which cost around US$200 to build and which he shares with 16 people. "I'm proud to say that none of my community poos outside anymore, and if I see a guest do it, I tell them that this is not allowed in my village," said Heang.
After using latrines for several months, many villagers aspire to own a flush toilet which is more sustainable than their initial pit latrine. Sok Chin's latrine was destroyed five times after being flooded in the rainy season. "I hope I can afford a flush toilet one day," said Sok Chin. "But for now, always rebuilding my latrine when it's destroyed is cheaper than buying medicine for my sick children."

From triggering ‘disgust’ CLTS training with good quality facilitators and follow-up has led to ‘delight’ in Svay Kal village as the healthy community can now enjoy the scent of palm tree fruit instead of the smell of human faeces.

Village chief and toilet control volunteer Yong Heang in front of his US$200 flush toilet.
© UNICEF Cambodia/2014/Anne-Sophie Galli

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