The Big Necessity

by Rose George

  The other fashionable concept is sustainability. This has penetrated even the rich world of engineering certainties and infrastructurally invasive sewers and wastewater treatment plants. At the wastewater treatment conference I attended in London, the biggest draw by far was a presentation by Duncan Mara about waste stabilization ponds. Afterward, I asked Mara why he was so popular. He wasn’t certain but thought that it was probably due to panic. Wastewater treatment plants now have to conform to strict EU energy limits, and ponds don’t require electricity. Governments have finally noticed that wastewater treatment is not green. A sewage works uses up to 11.5 watts of energy per head, or a quarter of the output of the UK’s largest coal-fired power station. The UK’s environment minister made this point in a new national water strategy, when he wrote that “there’s a carbon impact here that simply has to be tackled.”

  Other things will also have to be tackled. Pharmaceuticals in wastewater will be the next headache. A recent investigation discovered that the city of Philadelphia utility found 90 percent of the drugs it tested for, including evidence of medicines used for heart disease, mental illness, epilepsy, and asthma. These are tiny, trace elements, admittedly. Studies have shown that pharmaceutical residues have made male frogs produce eggs and deformed some fish. As for the effects on humans, no one yet knows. But being exposed to other people’s excreted drugs in drinking water, said one environmental health professor, “can’t be good.” A senior EPA official admitted that “there needs to be more searching, more analysis.”

  David Stuckey, an engineering professor at London’s Imperial College, was recently awarded nearly a million dollars to develop an innovative anaerobic process that reduces sludge volumes by 90 percent. This will save enormous amounts of money and considerable carbon dioxide. He thinks change must come, and it will be through economics. “People are looking to invest in wastewater treatment,” he tells me. “You don’t have to be a genius—just look at the price of resources and the cost of nitrogen and phosphorous. Once costs go up, people change.”

  Petter Jenssen sits on the other side of the waterborne sewerage and ecological sanitation divide, but he agrees. “We’ve invested so much in conventional sewerage. There are many economic interests tangled up in it. It depends on what politicians dare to do. Maybe it will take another fifty years to reach a sustainable system. But things can happen. Fifteen years ago I was considered a romantic scientist. Now I’m chairman of the national Water Association.”

  _____

  In the toiletless world, there is cautious hope. The Prince of Orange, chair of the UN Secretary General’s sanitation advisory panel, is a significant man, says Eddy Perez of the World Bank, and he represents an increasingly significant cause. “Not only is he royalty,” says Perez, over coffee in the World Bank’s gleaming lobby, “but he knows what he’s talking about. He comes to the Bank and has meetings with vice presidents to say, ‘What are you doing about sanitation?’ Two years ago that would have been completely unbelievable.” An outsider might think that he gets such access because he’s the figurehead of the International Year of Sanitation 2008. This must be a big deal. In fact, the International Year of Sanitation nearly lost out to the International Year of the Potato when potato-growing New Zealanders objected. Now there are two dirt-related years on offer. Toilets or tubers.

  UN years are notoriously meaningless. This one may seem remarkably empty when the sanitation Millennium Development Goal is currently the farthest off target. To meet its goal, 95,000 toilets must be installed every day. One toilet per second, every twenty-four hours until 2015. Nonetheless, Pete Kolsky, who describes himself as a glass-half-empty man, thinks something has shifted. “This sector has finally got its act together. I don’t think it’s widespread among politicians yet but it’s getting there. They’re getting a clear and coherent message that, goddammit, it’s time to talk about crap.”

  People who work in sanitation sometimes have visions. Eco-san people see a future where instead of controlling pollution after it happens, we prevent it in the first place by some kind of source separation. Water separated from excreta; urine separated from feces. The discarded products of the human body given treatment appropriate to one name (shit, meaning to separate), not another (waste, from the Latin vastus meaning unoccupied or uncultivated). I read about a cleaner new world where people put out their trash cans full of fecal compost to be collected on a Monday, like they do with garbage.

  Why not? Recycling is relatively new yet pervasive (though not necessarily much use and rarely lucrative). Three thousand Swedes have NoMix urine separation toilets. Large-scale eco-san projects in Linz, Austria, and Dongsheng, Inner Mongolia, are working, more or less, though the Austrians are hampered by legislation forbidding them to reuse urine, and the Inner Mongolians have a bad habit of cleaning their urine diversion toilets by flushing water down them, defeating their source-separating purpose. These visions are seductive from an environmental perspective, but I wonder if they are realistic. The flush toilet is ubiquitous because it is useful. It removes excreta from the living environment; it doesn’t take up space; it can be situated inside a house; it can be used in multi-story housing, and it doesn’t smell. It seems unassailable as the default option of how to dispose of human excreta in sophisticated, wealthy places.

  But it can evolve. In a small French village near the house where I wrote this book, there is a tiny public toilet on a bridge. It has been replaced by newer toilets that do not, as this one did, dispense with sewage by means of a big hole and the river below, and is locked and unused. On the wall outside the toilet, someone has fixed copies of the original designs and documents that were drawn up to build the toilet a hundred years earlier. The documents are a sign of pride, and rightly. I like engineers. They build things that are useful and sometimes beautiful—a brick sewer, a suspension bridge—and take little credit. They do not wear black and designer glasses like architects. They do not crow. Many of the world’s waterborne sewage systems are engineering marvels. The public health benefits are undeniably stunning and still persisting two centuries on. There are plenty of reasons to support waterborne sewerage, to be a fan of flushing. On the riverside path running alongside Crossness, there is a poster celebrating the work of Joseph Bazalgette. The title reads, “Great Stink—Great Solution.” But it’s the assumption that the sewer is the solution that has prevented evolution.

  Since I started researching this book, I’ve noticed I do some things differently. I always put the toilet seat lid down before I flush because I’ve learned that urine sprays fine mists. I use less toilet paper and more soap and water. I wash my hands more, and mostly follow the five-step handwashing guidelines provided by the Centers for Disease Control, which at some point I plan to pin up in most pub urinals and the student bathrooms at the London School of Hygiene. Because I wash my hands more I use more hand cream, and when I wash my hands again, I think of organic chemicals and pharmaceutical residues going down the drain. Yet I still use the hand cream and the shampoo and the facial wash and all the other products helping to top up my body burden.

  What else? I notice manholes. I scowl at paved-over front gardens. I pour used cooking oil on a flowerbed, in memory of those fat-blocked sewers. If it’s not urgent, I don’t flush the toilet immediately and I don’t feel bad about it. This is what hygiene specialists would call behavior change. The sociologist Harvey Molotch prefers to call it “the moral rectitude of pee.” He explains: during a five-year drought in California, people stopped flushing urinals to save water. “I was in the restroom one day with a colleague from overseas who said, that’s disgusting. It hit me that it’s not disgusting. In a drought context, darker yellow pee in urinals signified moral rectitude.” Petter Jenssen tells me about the children of a friend. “He had put in a composting toilet and when his children started kindergarten they didn’t want to go to the toilet because they could see shit floating in the water and they were used to a black hole. You can get used to anything.
”

  It’s no use dismissing sanitation as a problem of the poor. It’s true that hardly anyone in the developed world now dies from dirty water. But the diseases of the poor now travel thanks to international airlines. In the World Health Report of 2007, WHO director Dr. Margaret Chan wrote of a disease situation that was “anything but stable.” New diseases are increasing at the historically unprecedented rate of one per year. “Airlines,” Chan wrote, “now carry more than two billion passengers annually, vastly increasing opportunities for the rapid international spread of infectious agents and their vectors.”

  To understand what this has to do with modern plumbing, go to Amoy Gardens, a large apartment block in Hong Kong. In 2003, a seventh-floor bathroom in Amoy Gardens became an epicenter of an outbreak of SARS, when a man who had caught the infection in hospital came to stay with his brother. He had diarrhea, and because his brother’s bathroom wasn’t working properly—the air vent was sucking out sewage droplets trapped in faulty U-bends—his infectious diarrheal droplets were spread up and down the floors. Because SARS spread from person to person, required no vector, and incubated unnoticed for a week, it spread on several international flights between mainland China, Singapore, and Canada. By the end of the four-month outbreak, 8,422 cases had been reported and 11 percent of those people died. And some of it happened because of faulty sanitation in the developed, sophisticated environs of Hong Kong. No country is protected, the WHO report stated bluntly, “by virtue of its wealth or its high levels of education, standards of living and health care or equipment and personnel at border crossings.” In fact, SARS was “a disease of prosperous urban centers.” And of those centers’ apparently sophisticated but actually flawed and disregarded sanitation infrastructure. The slums of Mumbai and Lagos may seem far removed from modern cities built on sturdy sewers and sanitary confidence. They look like a seething, desperate Dickensian past. But what if they’re the future?

  The economist William Easterly, in White Man’s Burden, recently divided the aid world into Planners and Searchers. Planners are the top-down bureaucrats; they are the ones who put toilets on people’s heads while not thinking of making the nearby bush seem an unattractive option instead. They are the engineers and wastewater managers, the workshop attendees and the gray suits who don’t want to do it differently. They are the stagnant status quo of sanitation. This book has been about Searchers. Joe Madiath, Kamal Kar, Wang Ming Ying. Jessie, the Plan volunteer in Gan Quan Fang, who took her leave by saying, “I just want to change my surroundings. I know I am only small energy. But I want to try my best.”

  What is the best? Someone once asked me for a systems theory about sanitation. He wanted something that could solve everything. I had to disappoint him. But I think the first step is an easy one. In 1940, Harold Farnsworth Gray concluded that “urban man today still unnecessarily pollutes streams, bathing beaches, bays and estuaries, without benefit of the excuse of ignorance which was available to his ancestors.” We have less ignorance and less excuse. The first thing sanitation needs is a spotlight shining on it. It needs to be unshackled from shame. It needs some scrutiny.

  We can do better, I’m certain, than the young man in London, who came around the hours of midnight to where I was standing with the flushers around an open manhole. The pubs had just closed, but he was the only person among several passing crowds to amble over to what I thought was an arresting scene of several burly men and one woman, in crotch-harnesses, paper overalls, and thigh-high waders, standing around a black hole in the street. The young man asked what we were doing. It was a good start. I waited for him to ask more, such as where the sewers went and what happened when they got there. Or why we refuse to notice that we still don’t know how to properly deal with something that we all produce, up to several times a day, many million years after we first started producing it.

  But a flusher answered his only question, quick as a rat, with, “We’re opening a nightclub, mate.” And the young man nodded and moved away, with no further questions.

  __________

  NOTES

  __________

  INTRODUCTION: EXAMINING THE UNMENTIONABLES

  2.6 billion don’t have sanitation United Nations Development Programme (UNDP), Human Development Report 2006, “Beyond Scarcity: Power, Poverty and the Global Water Crisis” (New York: Palgrave Macmillan, 2006), p. v.

  10 million viruses, 1 million bacteria Water Supply and Sanitation Collaborative Council (WSSCC), “A Guide to Investigating One of the Biggest Scandals of the Last 50 Years” (Geneva: WSSCC, n.d.), p. 3.

  One in ten illnesses Bad sanitation is linked to, for example, respiratory infections (which can be spread by unwashed hands); malnutrition; malaria; and worm infections. A. Prüss-Üstün et al., Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health (Geneva: WHO Press, 2008), p. 8.

  Nearly 90 percent World Health Organization, “Water, Sanitation and Hygiene Links to Health, Facts and Figures, updated November 2004,” available from http://www.who.int/water_sanitation_health/publications/facts2004/en/.

  Ten percent of cells are human Gary Hamilton, “Insider Trading,” New Scientist, June 26, 1999.

  Since the Second World War “Responding to the Sanitation Scandal: WSSCC Launches the Global Sanitation Fund,” WSSCC news release, March 7, 2008.

  The biggest medical milestone “Medical Milestones,” British Medical Journal, http://www.bmj.com/cgi/content/full/334/suppl_1/DC3.

  One child out of two Stephen Halliday, The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Capital (Stroud, U.K.: Sutton Publishing, 1999, repr. 2007), p. vii.

  Mortality dropped by a fifth Johan Mackenbach, “Sanitation: Pragmatism Works,” British Medical Journal 334 (January 6, 2007): s17, supp. 2.

  Reduce diarrhea by nearly 40 percent Val Curtis and Sandy Cairncross, “Water, Sanitation and Hygiene at Kyoto,” British Medical Journal 327 (July 5, 2003): 3–4.

  Modern sanitation has added twenty years Personal communication with Gary Ruvkun, March 2003.

  50,000 people nationwide Steven Johnson, The Ghost Map: A Street, an Epidemic and the Two Men Who Battled to Save Victorian London (London: Allen Lane, 2006), p. 70.

  Forced to issue boil-water notices “We’ll be boiling water until the summer—HSE,” Galway Advertiser, March 29, 2007.

  600 times levels permitted RTE, “Dirty Water: Galway,” May 24, 2007, http://www.rte.ie/radio1/investigate/1134569.html.

  We haven’t had any for two years Clare County Council, Ennis Public Water Supply Reminder, December 14, 2007, http://www.clarecoco.ie/news/news.html.

  Nearly half the country Working data table provided by Peter Kristensen, European Environment Agency, based on data from Eurostat and national sources.

  Fined $15 million a day Personal communication with European Commission press office, February 2008.

  1.7 million “The U.S. 2000 Census reveals that more than 1.7 million people in the United States, 670,986 households, still lack the basic plumbing facilities that most of us have come to take for granted.” Rural Community Assistance Partnership, “Still Living Without the Basics in the 21st Century: Analyzing the Availability of Water and Sanitation Services in the United States,” 2004, p. 3.

  Milwaukee’s drinking water Natural Resources Defense Council (NRDC), “Swimming in Sewage” (Washington, D.C.: NRDC, February 2004), p. 50; see also Robert D. Morris, The Blue Death: Disease, Disaster and the Water We Drink (New York: HarperCollins, 2007).

  Full-strength, untreated sewage NRDC, “Swimming in Sewage,” p. 51.

  Ninety percent of the world’s sewage Reuters, “World Sanitation Goals Slip, Nature Can Help,” March 16, 2008.

  Defecation is very lowly Bindeshwar Pathak, “History of Toilets,” paper presented at International Symposium on Public Toilets, Hong Kong, May 25–27, 1995.

  The lonely bewilderment of bodily functions William Cummings, “Squat Toilets a
nd Cultural Commensurability,” Journal of Mundane Behavior 1/3 (October 2000): 268.

  Drains are a great and glorious thing Rudyard Kipling,Letters of Rudyard Kipling, ed. Thomas Pinney (Basingstoke, U.K.: Macmillan, 1990–2004), 1: 121.

  A meritorious undertaking Sigmund Freud, “Preface to Bourke’s Scatologic Rites of All Nations,” in Standard Edition of the Complete Psychological Works of Sigmund Freud, trans. from the German by James Strachey, (London: Hogarth Press, 1995), p. 337.

  Slowly through a pond filled with reeds http://www.princeofwales.gov.uk/personalprofiles/residences/highgrove/.

  The only patent-holding monarch in the world The patent for the Chaipattana Aerator was granted to King Bhumibol on February 2, 1993. The Chaipattana Foundation, http://www.chaipat.or.th/chaipat_old/journal/aug03/aerator_e.html.

  My baby doesn’t smell Trevor I. Case, Betty M. Repacholi, and Richard J. Stevenson, “My Baby Doesn’t Smell as Bad as Yours: The Plasticity of Disgust,” Evolution and Human Behavior 27 (2006): 357–65.

  Scatological burglars Albert B. Friedman, “The Scatological Rites of Burglars,” Western Folklore 27 (1968): 171–79.

  Sniffed like snuff Martin Monestier, Histoire et Bizarreries Sociales des Excréments: Des Origines à Nos Jours (Paris: Le Cherche-Midi, 1997), p. 93.

  Ninety percent of patients recover Thomas Borody, a pioneer of the technique, has written that “there are few medical therapies that reduce illness so dramatically.” Thomas J. Borody, “Flora Power: Fecal Bacteria Cure Chronic C. difficile Diarrhea,” American Journal of Gastroenterology 11 (August 1995): 3028–29.