The Big Necessity

by Rose George

  THE BIG NECESSITY

  THE BIG

  NECESSITY

  THE UNMENTIONABLE WORLD

  OF HUMAN WASTE

  AND WHY IT MATTERS

  ROSE GEORGE

  METROPOLITAN BOOKS Henry Holt and Company New York

  Metropolitan Books

  Henry Holt and Company, LLC

  Publishers since 1866

  175 Fifth Avenue

  New York, New York 10010

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  Metropolitan Books® and ® are registered trademarks of

  Henry Holt and Company, LLC.

  Copyright © 2008 by Rose George

  All rights reserved.

  Distributed in Canada by H. B. Fenn and Company Ltd.

  Library of Congress Cataloging-in-Publication Data

  George, Rose, 1969–

  The big necessity : the unmentionable world of human waste and why it matters / Rose George.—1st ed.

  p. cm.

  Includes bibliographical references and index.

  ISBN-13: 978-0-8050-8271-5

  ISBN-10: 0-8050-8271-9

  1. Sanitation—Health aspects I. Title.

  [DNLM: 1. Feces. 2. Sewage 3. Cross-Cultural Comparison. 4. Hygiene.

  5. Socioeconomic Factors. 6. Toilet Facilities. WA 785 G348b 2008]

  RA567.G46 2008

  363.72—dc22 2008029999

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  premiums. For details contact: Director, Special Markets.

  First Edition 2008

  Designed by Kelly S. Too

  Printed in the United States of America

  1 3 5 7 9 10 8 6 4 2

  For T.D.W. George, for the introduction

  Like an apartment where there’s a kitchen, bedroom, bathroom. People see that and they want the same for themselves, a bigger house with different rooms for everything. They can’t have all that so they get the big necessity, a toilet.

  —SHEIKH RAZAK,

  slum toilet builder, Mumbai

  _______________

  CONTENTS

  _______________

  Introduction: Examining the Unmentionables

  1. In the Sewers

  2. The Robo-Toilet Revolution

  3. 2.6 Billion

  4. Going to the Sulabh

  5. China’s Biogas Boom

  6. A Public Necessity

  7. The Battle of Biosolids

  8. Open Defecation–Free India

  9. In the Cities

  10. The End

  Notes

  Further Reading

  Filmography

  Acknowledgments

  Index

  THE BIG NECESSITY

  _________________

  Chengdu, China

  (Author)

  _______________

  INTRODUCTION

  EXAMINING THE UNMENTIONABLES

  _______________

  I need the bathroom. I assume there is one, though I’m at a spartan restaurant in the Ivory Coast, in a small town filled with refugees from next-door Liberia, where water comes in buckets and you can buy towels secondhand. The waiter, a young Liberian man, only nods when I ask. He takes me off into the darkness to a one-room building, switches on the light, and leaves. There’s a white tiled floor, white tiled walls and that’s it. No toilet, no hole, no clue. I go outside to find him again and ask if he’s sent me to the right place. He smiles with sarcasm. Refugees don’t have much fun but he’s having some now. “Do it on the floor. What do you expect? This isn’t America!” I feel foolish. I say I’m happy to use the bushes, it’s not that I’m fussy. But he’s already gone, laughing into the darkness.

  I need the bathroom. I leave the reading room of the British Library in central London and find a “ladies” a few yards away. If I prefer, there’s another one on the far side of the same floor, and more on the other five floors. By 6 P.M., after thousands of people have entered and exited the library and the toilets, the stalls are still clean. The doors still lock. There is warm water in the clean sinks. I do what I have to do, then flush the toilet and forget it, immediately, because I can, and because all my life I have done no differently.

  This is why the Liberian waiter laughed at me. He thought that I thought a toilet was my right, when he knew it was a privilege.

  It must be, when 2.6 billion people don’t have sanitation. I don’t mean that they have no toilet in their house and must use a public one with queues and fees. Or that they have an outhouse, or a rickety shack that empties into a filthy drain or pigsty. All that counts as sanitation, though not a safe variety. The people who have those are the fortunate ones. Four in ten people have no access to any latrine, toilet, bucket, or box. Nothing. Instead, they defecate by train tracks and in forests. They do it in plastic bags and fling them through the air in narrow slum alleyways. If they are women, they get up at 4 A.M. to be able to do their business under cover of darkness for reasons of modesty, risking rape and snakebites. Four in ten people live in situations where they are surrounded by human excrement because it is in the bushes outside the village or in their city yards, left by children outside the backdoor. It is tramped back in on their feet, carried on fingers onto clothes, food, and drinking water.

  The disease toll of this is stunning. A gram of feces can contain 10 million viruses, 1 million bacteria, 1,000 parasite cysts, and 100 worm eggs. Bacteria can be beneficial: the human body needs bacteria to function, and only 10 percent of cells in our body are actually human. But plenty are malign. Small fecal particles can contaminate water, food, cutlery, and shoes, and be ingested, drunk, or unwittingly eaten. One sanitation specialist has estimated that people who live in areas with inadequate sanitation ingest 10 grams of fecal matter every day. Poor sanitation, bad hygiene, and unsafe water—usually unsafe because it has fecal particles in it—cause one in ten of the world’s illnesses. Children suffer most. Diarrhea—nearly 90 percent of which is caused by fecally contaminated food or water—kills a child every fifteen seconds. The number of children who have died from diarrhea in the last decade exceeds the total number of people killed by armed conflict since the Second World War. Diarrhea, says the UN children’s agency UNICEF, is the largest hurdle a small child in a developing country has to overcome. Larger than AIDS, or TB, or malaria. 2.2 million people—mostly children—die from an affliction that to most Westerners is the result of bad take-out food. Public health professionals talk about water-related diseases, but that is a euphemism for the truth. These are shit-related diseases.

  In 2007, readers of the British Medical Journal were asked to vote for the biggest medical milestone of the last two hundred years. Their choice was wide: antibiotics, penicillin, anesthesia, the Pill. They chose sanitation. In poorly sewered nineteenth-century London, one child out of two died early. After toilets, sewers, and hand-washing with soap became normal, child mortality dropped by a fifth. It was the largest reduction in child mortality in British history. In the poor world, proper disposal of human excreta—the process which is given the modern euphemism of “sanitation”—can reduce diarrhea by nearly 40 percent. (Though 90 percent of most sanitation-related budgets go on water supply, providing more or cleaner water only reduces diarrhea by 16 to 20 percent.) Harvard University geneticist Gary Ruvkun believes the toilet is the single biggest variable in increasing human life span. Modern sanitation has added twenty years to the average human life. Good sanitation is also economically sensible. A government that provides adequate sanitation saves money on hospital visits avoided, and does not lose labor days to dysentery or workers to cholera. Where good sanitation exists, people are wealthier, healthier, and cleaner.

  When sanitarians talk about history, their time line usual
ly begins on a Friday morning in 1854, when Dr. John Snow, a doctor in London’s Soho, removed the handle from a water pump in Broad Street because he was the first to understand that cholera was traveling in excrement that got into the water supply and the awful consequences of this fact (in 1849, cholera killed over 50,000 people nationwide). Sewers followed; flush toilets flourished. By now, modern living provides nearly everyone with one or several magic disposal units that make excrement disappear and that act as a barrier between humans and their potentially toxic waste. Every city has sewers that take it away to who knows where, where a bigger disposal unit does with it whatever it does, out of sight and one hopes without smell. Sanitation is what modern cities are built on and how they can function with so many people living so closely together without the consequences that the plastic-bag defecators know too well because it cripples their guts and kills their children.

  Rich toileted people; poor toiletless masses. Life, luxury, and health for the privileged. Disease and death and business as usual for the poor. This is the assumption the Liberian waiter relied on to make me feel embarrassed. He was entitled to it, because he was a refugee, and diarrhea probably kills more refugees—in camps, on the run—than soldiers or guerillas. But he was mistaken.

  In the spring of 2007, the city of Galway, on the west coast of Ireland, held its annual arts parade. Galway has a reputation as a cultural center. It has a good university. It has nice benches in pleasant parks, including one on which I once sat and watched, dumbly, as a hand snaked over and stole my backpack, then listened as a crowd of shouting men immediately spilled out of a nearby pub and set off in pursuit of the thief out of the goodness of their Guinness-filled hearts. I have good memories of Galway, but I’m glad I wasn’t there that year, because the newest addition to the Galway Arts Parade was a man in a green fuzzy costume with many arms and one eye. He had been given the name Crypto, and anyone who had been in Galway for the previous five months would have needed no further introduction, because Crypto was the reason that a world-class cultural city was living with the conditions familiar to any inhabitant of the world’s worst slums. Crypto was a big cuddly version of a parasite called cryptosporidium, a disease-causing protozoa—a single-celled, amoeba-like organism—that can travel in feces. For five months and counting, Crypto and his billions of cousins had been the reason that a rich and developed city in a rich and developed country had no drinking water. A cultural center of Europe, in a land wealthy enough to be nicknamed the Celtic Tiger, was forced to issue boil-water notices more familiar in places of poverty and dust where children die young.

  It had begun in early March, with reports of persistent stomachaches and diarrhea. There were hospitalizations, of the vulnerable (the old, the young, the immuno-suppressed) and there was bewilderment as to the cause. Something had polluted the drinking-water supply of Lough Corrib. First the cows were blamed. They must have been defecating nearby. Then it was the farmers: runoff from their pesticide-treated fields could have polluted the water. Then someone began to suspect sewage. Initial tests found that most infections were caused by Cryptosporidium hominis, which passes from human to human. An investigative program on Ireland’s national radio station found that levels of cryptosporidium in effluent discharged into the lough from Oughterard sewage works were 600 times over the levels permitted in neighboring Northern Ireland.

  Two facts about Galway’s cryptosporidium crisis held my attention. First, that the scandal didn’t reverberate beyond Ireland’s borders, though an advanced society that had supposedly known how to dispose of its sewage for nearly 150 years was suddenly unable to provide its citizens with water uncontaminated by excrement. Second, that it was not unexpected. After the outbreak was publicized, the people of Ennis, the seat of County Clare, did some crypto one-upmanship. You may have had no drinking water for five months, they said, but we haven’t had any for two years (and they won’t have any until 2009, when a water treatment plant should be completed). A fifth of Ireland’s towns are at high risk of cryptosporidium infection, according to the national environmental protection authority. Nearly half the country treats its sewage only to primary levels, which involves nothing more taxing than screening out the lumps and discharging the rest. And Ireland is not the only rich country with an infrastructure more suited to a poor one.

  Milan, Italy’s cultural capital, has a world-class opera house, La Scala, and is an international fashion capital, but until shamefully recently, it couldn’t manage to do anything with its sewage but discharge it, raw and dangerous, into the suffering river Lambro. The city finally built its first treatment plant three years ago, possibly spurred by a threat from the European Union of being fined $15 million a day for contravening a waste disposal directive. This is ironic, considering that Brussels, the wealthy and powerful city that serves as the EU’s administrative seat, only began to build a treatment plant for its own sewage in 2003. Before that, it sent the waste of all those diplomats, bureaucrats, and clever, competent people into a river, and those clever, competent people didn’t question it. In the United States—where, by the way, 1.7 million people have no sanitation—cryptosporidium in Milwaukee’s drinking water made 400,000 people sick and killed more than 100. It was the biggest water-contamination disease outbreak in U.S. history, and it happened in 1993, over a century after the fathers of America’s cities installed pipes to bring clean water to their citizens, and sewers and treatment plants to take the foul water away. But to where? Milwaukee discharges treated sewage effluent—treated to remove some things, but not pharmaceuticals or all pathogens—into Lake Michigan, which also supplies its drinking water. Sometimes it discharges raw sewage, too. Since 1994, 935 million gallons of “full-strength, untreated sewage” have been poured into the lake’s waters. This is not illegal. In fact, it’s what the system is designed to do, if too much storm water overloads storage capacity at treatment works.

  Ninety percent of the world’s sewage ends up untreated in oceans, rivers, and lakes, and a fair share comes from the sanitary cities supplied with sewers and treatment plants. Sanitation in the Western world is built from pipes and on presumption. Despite the technology, the engineers and the ingenuity of modern sanitary systems, despite the shine of progress and flush toilets, even the richest, best-equipped humans still don’t know what to do with sewage except move it somewhere else and hope no one notices when it’s poured untreated into drinking water sources. And they don’t.

  In 2006, I wrote a series on sewage for the online magazine Slate. Later, I found a comment that a reader left on the discussion page: “Someone at Slate a scat freak? Is this all some giant experiment to see if we have no sense of class or dignity?” It made me smile, but it wasn’t surprising. I’ve spent many months now answering the question of why I’m writing a book like this. The interrogation happens so often that my responses have become routine.

  First I establish that I am no scatologist, fetishist, or coprophagist. I don’t much like toilet humor (and by now I’ve heard a lot of it). I don’t think 2.6 billion people without a toilet is funny. Then I tailor my answers and language to the social situation—still managing to spoil many lunches—by explaining the obvious. Everyone does it. It’s as natural as breathing. The average human being spends three years of life going to the toilet, though the average human being with no physical toilet to go to probably does his or her best to spend less. It is a human behavior as revealing as any other about human nature, but only if it can be released from the social straitjacket of denial. Rules governing defecation, hygiene, and pollution exist in every culture at every period in history.

  It may in fact be the foundation of civilization: What is toilet training if not the first attempt to turn a child into an acceptable member of society? Appropriateness and propriety begin with a potty. From this comes the common claim, usually from sanitation activists, that the toilet is the barometer of civilization. How a society disposes of its human excrement is an indication of how it treats its hum
ans, too. Unlike other body-related functions like dance, drama, and songs, the Indian sanitarian Dr. Bindeshwar Pathak wrote, “defecation is very lowly.” Yet when discussing it, he continued, “one ends up discussing the whole spectrum of human behavior, national economy, politics, role of media, cultural preference, and so forth.” And that’s a partial list. It is missing biology, psychology, chemistry, language. It is missing everything that touches upon understanding what the American development academic William Cummings called “the lonely bewilderment of bodily functions.”

  If my questioner is religious, I say that all the world’s great faiths instruct their followers how best to manage their excrement, because hygiene is holy. I explain that taking an interest in the culture of sanitation puts them in good company. Mohandas K. Gandhi, though he spent his life trying to rid India of its colonial rulers, nonetheless declared that sanitation was more important than independence. The great architect Le Corbusier considered the toilet to be “one of the most beautiful objects industry has ever invented”; and Rudyard Kipling found sewers more compelling than literature. Drains are “a great and glorious thing,” he wrote in 1886, “and I study ’em and write about ’em when I can.” A decent primer on sanitary engineering, he wrote, “is worth more than all the tomes of sacred smut ever produced.” Anton Chekhov was moved to write about the dreadful sanitation in the far-eastern Russian isle of Sakhalin. And Sigmund Freud thought the study of excretion essential and its neglect a stupidity. In the foreword to Scatologic Rites of All Nations, an impressive ethnography of excrement by the amateur anthropologist—and U.S. army captain—John Bourke, Freud wrote that “to make [the role of excretions in human life] more accessible . . . is not only a courageous but also a meritorious undertaking.”